Tadalafil to improve cutaneous flap perfusion in smokers: A case series and literature review
Abstract
PDE5: phosphodiesterase-5 POD: postoperative day INTRODUCTION The viability of cutaneous flaps and grafts is dependent on adequate circulation and perfusion. Smoking, excessive tension or pressure, arterial insufficiency, and venous congestion are factors that can contribute to flap failure due to poor perfusion. Early identification of tissue ischemia and its intervention can improve flap survival. Tadalafil is a phosphodiesterase-5 (PDE5) inhibitor that increases blood flow by vasodilation of the peripheral vasculature as well as inhibition of platelet aggregation. Although current indications for tadalafil by the US Food and Drug Administration are for erectile dysfunction and pulmonary hypertension, its mechanism of action is theoretically beneficial in increasing blood perfusion in patients who are at risk of flap or graft ischemia due to poor circulation. The following case series presents the successful off-label use of tadalafil in preventing tissue ischemia in high-risk patients and treating patients with early signs of tissue necrosis.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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