Tadalafil to improve cutaneous flap perfusion in smokers: A case series and literature review

Use of Phosphodiesterase Inhibitors in the Postoperative Period of Skin Flaps: A Systematic Review

Ischemia-reperfusion injury can occur in several clinical conditions, and it has been widely studied in the context of skin flaps. Vascular distress results in an imbalance between the supply and demand of oxygen to living tissues, and the result of this process is tissue necrosis. Several drugs have been studied to reduce vascular distress of skin flaps and tissue loss.

Methods

The present study performed a systematic review of literature in the main databases (PubMed, Web of Science, LILACS, SciELO, and Cochrane), including articles published in the last 10 years.

Results

It was observed that phosphodiesterase inhibitors, mainly types III and V, have shown promising results in terms of vascularization of the postoperative skin flap, especially when started on the first postoperative day and maintained for 7 days.

Conclusion

New studies with different posology, duration of use, and new drugs are needed to better elucidate the use of this substance to optimize the circulation of skin flaps.

The Treatment Algorithm in Diabetic Foot: An Alternative Against Amputation?

This clinical treatment modality was applied to 62 diabetic ulcers on lower extremities for which surgeons had been advised amputation. Total healing was achieved in 53 of them and was achieved through this treatment in a 3-month period. The remaining nine cases also showed improvement in healing at different levels, but they were not accepted as a ‘satisfactory result’. This treatment modality contains a synthetic prostacyclin analogue, two different phosphodiesterase inhibitors, a peripheral revascularisation agent, another agent increasing peripheral resistance to ischaemia, and a polysaccharide with positive rheologic properties on capillary circulation. Therefore, this treatment was found to be effective on circulation of the extremities, with radiologically-proven insufficient blood supply. The treatment also had a positive effect on recirculation and effects on collateral revascularisation through mechanical vacuum application, modified from standard vacuum treatments. With this combination, this technique was found extremely effective by application, according to the algorithm explained below, and should be an alternative to the current therapy applications in diabetic ulcers.