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First, Do No Harm: Effect of TXA in a Rodent Random-Pattern Flap Model
Samuel Medina
*, Abby Chopoorian, Matthew W. Liao, Olivia H. Carrafiell, Terrence C. Green, David Dugue, Malini Chinta, Elias Khayat, Jaime L. Bernstein, Xue Dong, Jason A. Spector
Weill Cornell, New York, NY
Background: Tranexamic acid (TXA) is an antifibrinolytic agent that is routinely used to reduce intraoperative bleeding. Despite its ubiquity, there remains a theoretical risk that TXA may compromise tissue perfusion, particularly in thin random pattern flaps (e.g. rhytidectomy), which are prone to ischemic injury. We assessed the effect of perioperative TXA administration on tissue viability, microvascular perfusion, and wound healing of thin random-pattern skin flaps in a rodent model.
Methods: Twenty-two Sprague-Dawley rats underwent elevation of a 9cm x 3cm cranially based dorsal McFarlane flap. Each animal received TXA or PBS subcutaneously (SQ) or intravenously (IV). Flap viability and perfusion were assessed with planimetry and fluorescent imaging on postoperative day (POD) 7 and 14. On POD 14, samples were harvested for histological evaluation. Biomechanical testing was performed across flap suture lines to assess wound tensile strength.
Results: No significant difference in flap necrosis was observed across individual groups on POD 7 (p=0.25; POD 14). On POD 14, flaps treated with IV TXA demonstrated significantly less percent area necrosis compared to those treated with IV PBS (12.1% vs. 37.5%, p=0.03). Similarly, pooled analyses (PBS vs. TXA irrespective of route of delivery) demonstrated significantly reduced flap necrosis in the TXA treated group on both POD 7 (15.2 % vs 32.9 %, p = 0.04) and POD 14 (14.0 % vs 34.8 %, p = 0.01). Fluorescent imaging studies corroborated these results with more robust and diffuse perfusion patterns observed in TXA-treated flaps compared to PBS controls. No significant differences in inflammation (p = 0.94), tissue injury (p = 0.20), or fibrosis (p = 0.42) were observed during pooled analyses POD 14. No significant differences were observed during biomechanical testing (all p>.05).
Conclusions: These findings suggest TXA is safe to use during operations which make use of thin random cutaneous flaps and add to a growing body of evidence surrounding its favorable saftey profile.
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