Abstract
Tobacco cigarette smoking remains a serious risk factor for necrosis of local facial
skin flaps. To date, no pharmacological therapies exist for cigarette smoke-induced
impairment of skin flap tissue survival. Accumulating evidence suggest that phosphodiesterase-5
(PDE-5) inhibitor therapy may counteract the negative effects of cigarette smoke on
flap survival. Here, we evaluate skin flap survival in a series of consecutive tobacco
cigarette users treated with the PDE-5 inhibitor, sildenafil, who underwent local
flap facial reconstruction. We included 11 patients (5 females; median age: 64) with
a significant smoking history. Seventeen facial flaps were performed for 14 defects.
All patients received sildenafil in the postoperative setting. One complication of
necrosis of the flap distal margin was encountered. Follow-up was available for all
patients. Our results demonstrate that facial reconstruction in tobacco cigarette
smokers can be performed with improved success and that sildenafil therapy may mitigate
the deleterious effects of smoking on flap survival.
Keywords
phosphodiesterase-5 inhibitor - PDE-5 inhibitor - facial flap - local flap - flap
necrosis - flap failure - tobacco - smoking - sildenafil
