Previous research has implicated arachidonic acid metabolites in the failure of the distal dying flap. The progressive ischemic necrosis has been postulated to be secondary to excessive thromboxane A2 production, which upsets the normal balance between prostacyclin and thromboxane. We have examined the effect of continuous intraarterial prostacyclin infusion on axial skin flap survival in the pig, in an effort to reestablish homeostatsis. We found prostacyclin to have a biphasic effect upon the flap survival. Low-dose locally administered prostacyclin was of benefit in flap salvage; however, the complicated pharmacological effect of the agent is emphasized.
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