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J Surg Res. 2018 Aug;228:253-262. doi: 10.1016/j.jss.2018.03.014. Epub 2018 Apr 12.

Effects of açaí and cilostazol on skin microcirculation and viability of TRAM flaps in hamsters.

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Division of Plastic and Reconstructive Surgery, Pedro Ernesto University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Electronic address:
Laboratory of Clinical and Experimental Research in Vascular Biology, Department of Physiological Sciences, Institute of Biology, UERJ, Rio de Janeiro, Brazil.
Department of Pharmacology, Institute of Biology, UERJ, Rio de Janeiro, Brazil.



Tissue necrosis caused by insufficient perfusion is a major complication in flap transfer. This study evaluated whether treatment with cilostazol or hydroalcoholic extract of seeds of Euterpe oleracea Mart. (açaí) protects the transverse rectus abdominis myocutaneous (TRAM) flap against ischemic damage in hamsters.


Fifty-four hamsters were divided into three oral treatment groups: placebo, açaí, or cilostazol. Caudally based, unipedicled TRAM flaps were raised, sutured back, classified into four vascular zones (I-IV), and evaluated for tissue viability, capillary blood flow (CBF), perfused vessel density (PVD), and microvascular flow index (MFI) by orthogonal polarization spectral imaging at three time points: immediately postoperatively (IPO), 24 h postoperatively (24hPO), and 7 d postoperatively (7POD).


Comparing to placebo, açaí increased PVD at IPO and açaí and cilostazol increased CBF and PVD at 24hPO in zone I; cilostazol increased CBF, PVD, and MFI at IPO, and CBF at 24hPO in zone II; açaí and cilostazol increased CBF at all time points and PVD and MFI at IPO and 24hPO in zone III; cilostazol increased CBF at IPO and 7POD, açaí increased CBF at 7POD, and both increased PVD and MFI at all time points in zone IV; and açaí and cilostazol increased the percentage of viable area in zones III and IV.


Açaí and cilostazol treatments had a protective effect against ischemic damage to TRAM flaps in hamsters, improving microvascular blood flow and increasing the survival of flap zones contralateral to the vascular pedicle (zones III and IV).


Açaí berries; Cilostazol; Microcirculation; Myocutaneous flap; Necrosis; Tissue survival

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