Objective: Dexamethasone (DXM) can regulate the balance of neutrophil and cytokine and enhance the ischemia-reperfusion tolerance of the skin flap; amlodipine besylate (AB) can selectively expand the peripheral blood vessels and relieve the vascular smooth muscle spasm. To investigate the percutaneous penetration ability of DXM/AB compound gel and evaluate its effect on survival of ischemic skin flap.
Methods: Sodium carboxymethylcellulose was used to make blank gel, which was mixed in DXM, AB, azone (AZ), and propylene glycol (PG) respectively to make the compound gel containing 0.3%DXM/0.5%AB only (group D), the compound gel containing 3%AZ/2%PG, 3%AZ, and 2%PG (groups A, B, and C), the 0.3%DXM gel containing 3%AZ/2%PG (group E), the 0.5%AB gel containing 3%AZ/2%PG (group F). The accumulative penetration of DXM and AB in compound gel, 0.3%DXM gel, 0.5%AB gel through excised rat skin and its penetration within flap tissue were investigated by ultraviolet spectrophotometry. Fifty SD rats were selected to make 100 mm x 10 mm random flap at the back, and were randomly divided into 5 groups according to different gels which were used to treat flaps (n = 10): compound gel group (group A1), 0.3%DXM gel group (group B1), 0.5%AB gel group (group C1), blank gel group (group D1), and peritoneal injection of DXM (5 mg/kg) and AB (2 mg/kg) (group E1). The survival area of ischemic random skin flap was measured on the 7th day by planimetry. Twenty-four SD rats were selected to make 100 mm x 10 mm random flap at the back, and were randomly divided into 2 groups (n = 12). The accumulative penetration of DXM and AB within skin flap were also detected at 2 and 6 hours after application of 2 g of compound gel containing 3%AZ/2%PG (group A2) and peritoneal injection AB (2 mg/kg) / DXM (5 mg/kg) (group B2).
Results: The accumulative penetration of DXM and AB in compound gel were increased in time-dependent manner (P < 0.05), and it was the highest in group A, and was significantly higher than that in group B and group C (P < 0.01), but there was no significant difference when compared with group E or group F (P > 0.05). The accumulative penetration of DXM and AB in groups A, B, and C were significant higher than that in group D (P < 0.05). After 7 days, the survival area of flaps in groups A1, B1, C1, D1, and E1 were (695.0 +/- 4.6), (439.3 +/- 7.1), (477.5 +/- 14.5), (215.2 +/- 3.8), and (569.4 +/- 9.7) mm2, respectively; group A1 was significantly higher than other groups (P < 0.05). After 2 and 6 hours, the quantities of DXM and AB in skin flap of group A2 were significantly higher than that of group B2 (P < 0.05).
Conclusion: In 0.3%DXM/0.5%AB compound gel, DXM and AB might penetrate into skin tissue, which could significantly increase the survival area of ischemic skin flap.