Role of Topical Nitroglycerin in Prevention and Management of Post-mastectomy Skin Flap Necrosis: A Prospective Randomized Controlled Study

Introduction: Mastectomy skin flap necrosis is a common postoperative complication following breast cancer surgery and is associated with delayed wound healing, increased morbidity, prolonged hospital stay, additional surgical procedures, and delayed initiation of adjuvant therapy.Impaired flap perfusion is considered the primary underlying mechanism.Topical nitroglycerin, through nitric oxide-mediated vasodilation, has been proposed as a simple and cost-effective method to improve flap vascularity and reduce ischemic complications.This study aimed to evaluate the efficacy and safety of topical nitroglycerin in preventing and reducing post-mastectomy skin flap necrosis.Materials and methods: A prospective, randomized, assessor-blinded, controlled study was conducted on 60 patients undergoing modified radical mastectomy (MRM).Patients were randomly allocated into two groups of 30 each.The intervention group received topical 2% nitroglycerin ointment, while the control group received topical povidone-iodine ointment.The primary outcome was the incidence of skin flap necrosis.Secondary outcomes included wound healing time, delayed wound healing, surgical site infection, debridement requirement, hospital stay, severity of flap necrosis, and treatment-related adverse events.Results: Skin flap necrosis occurred in two (6.7%) patients in the nitroglycerin group compared with 10 (33.3%) patients in the control group.Patients receiving nitroglycerin demonstrated significantly faster wound healing, lower rates of delayed wound healing, and reduced requirement for surgical debridement.Full-thickness flap necrosis occurred only in the control group, and the mean necrotic area was significantly smaller among patients treated with nitroglycerin.Although surgical site infection and hospital stay were lower in the nitroglycerin group, these differences were not statistically significant.Adverse events were mild and self-limiting, with no treatment discontinuations.Conclusion: Topical nitroglycerin is a safe and effective adjunct for reducing post-mastectomy skin flap necrosis and improving wound healing outcomes.Its routine use may improve postoperative recovery and reduce flap-related complications following MRM.