Long-term pretreatment with pentoxifylline increases random skin flap survival.

Optimizing survival of random skin flaps is essential to ensure successful rehabilitation of patients in whom flap reconstruction is necessary. This study tested the hypothesis that pentoxifylline improves random skin flap survival in porcine dorsal flank flaps when administered for at least 2 weeks preoperatively. Specific aims included establishing the mechanisms by which pentoxifylline enhanced survival. Treatment with pentoxifylline (25 mg/kg per day) for 14 days before surgery and for 7 days thereafter significantly increased mean flap survival to 73.2% +/- 4.5% compared with mean flap survival of 49.6% +/- 2.2% in untreated pigs. Increased flap survival was associated with a parallel increase in red blood cell flexibility. Plasma concentration of pentoxifylline ranged from 92.9 to 122.7 ng/mL but did not correlate directly with the improved flap survival. Likewise, pentoxifylline decreased platelet aggregation; there was a trend toward increased flap survival in those pigs with the least amount of aggregation. Thus, pentoxifylline improves random flap survival but only after a sufficient pretreatment period of at least 14 days.