Improving flap survival by sustaining cell metabolism within ischemic cells: a study using rabbits.

Allopurinol, acting as a metabolic depressant, significantly increases flap survival in high doses, but not at doses that might be acceptable clinically. Prednisolone is highly effective in improving flap survival when the afferent blood supply is provided by small arteries such as are found in the panniculus carnosus of rabbits and in axial pattern flaps. I feel that the study should encourage plastic surgeons to experiment with drugs that sustain metabolism during ischemic periods, as a means of improving flap survival. In situations in which ischemia can be anticipated, its effects may be minimized by using such drugs before the insult.