Comparing the Effect of Eutectic Mixture of Lidocaine and Prilocaine and Capsaicin on Improving Ischemic Random Skin Flaps: An Animal Model

Abstract

Background: Ischemia of skin flaps is an important complication in reconstructive surgery. This study evaluated the effectiveness of eutectic mixture of lidocaine and prilocaine (EMLA) and capsaicin on improving flap survival.
Methods: A number of 39 white-albino male rats were divided randomly into three groups: EMLA, capsaicin, and control groups. A standard rectangular, distally based dorsal random pattern skin flap was elevated on each rat. Intraperitoneal cefazolin was administered to prevent infection. No pharmaceutical agent was administered for the control group except for pure Vaseline cream. In EMLA group, EMLA cream was administrated daily after surgery for 10 days. In capsaicin group, capsaicin cream was rubbed on the flap surface daily. The rats were evaluated 10 days after the operation for viable and necrotic portions of flaps.
Results: The mean values of necrosis in the flaps were 603.33 ± 116.00 mm², 665.00 ± 220.26 mm², and 920.00 ± 247.31 mm² in the EMLA, capsaicin and control groups, respectively. Both EMLA and capsaicin were effective on flap survival significantly (P = 0.002 and P = 0.011, respectively). Despite advantages, EMLA was not significantly better than capsaicin (P = 0.739).
Conclusions: EMLA and capsaicin are effective pharmaceutical agents that significantly increase the viability of random skin flaps in rats. They can be added to other vasoactive topical agents to reach better results and be used as a medical workhorse in reconstructive wards.