Comparative analysis of the effect of antihypertensive drugs on the survival of perforator flaps in a rat model

Background: First-line antihypertensive drugs include calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics. In this study, we compared the effects of antihypertensive drugs on the survival of perforator flaps in a rat model. Materials and methods: Fifty normotensive rats were randomly divided into five groups, with 10 rats in each group. Four different antihypertensive drugs were given via oral gavage for 7 days: group I: 1.5 mg/kg amlodipine; group II: 15 mg/kg captopril; group III: 15 mg/kg losartan; group IV: 7 mg/kg dichlozid; and group V: saline. An 8 × 10-cm-sized extended dorsal island skin flap based on the unilateral deep circumflex iliac artery perforator was elevated and fixed in place. At postoperative day 7, evaluation of viable flap area, edema measurement, and histological analysis were conducted. Results: No significant difference in systolic blood pressure was observed preoperatively between any of the groups. The mean flap survival area was 81.54 ± 6.71, 55.76 ± 21.01, 48.45 ± 13.72, 58.14 ± 16.96, and 67.99 ± 10.68% in groups I, II, III, IV, and V, respectively. It was significantly increased in group I (P =.007) and decreased in group III (P =.011) compared with the control group. The mean full-thickness necrosis area was significantly increased in group III (P =.024) compared to the control group. Conclusions: Angiotensin receptor blockers adversely affected the survival of perforator flaps, while calcium channel blockers increased it. These results suggest that the regimen of antihypertensive drugs may need to be carefully selected for patients undergoing perforator flap reconstruction.