Dual Synergistic Effect: The Effect of Dexamethasone Plus Carnitine on Skin Flap Survival

In Brief Dexamethasone has well-known useful effects in dealing with the progression of necrosis. Carnitine is an endogenous cofactor, for having a regulatory action on the energy flow from different oxidative sources. The aim of this study was to determine whether combined local dexamethasone and systemic carnitine administration would result in an additive enhancement of skin flap survival in the rat model. A rectangular (3 cm × 11 cm) dorsal random skin flap was elevated on the rats and then sutured back into its original site with separate sutures. Overall, 40 rats were allocated randomly into 4 groups: Group 1 (control group, n = 10), group 2 (Dexamethasone group, n = 10, 2.5 mg/kg), group 3 (carnitine group, n = 10, 100 mg/kg), group 4 (dexamethasone plus carnitine group, n = 10). The mean flap survival area was 57.50 ± 5.2% (mean survival area ± SD) in control group (group 1), 71.5 ± 4.8% in the dexamethasone group (group 2), 73.0 ± 5.5% in the carnitine group (group 3), 85.30 ± 6.1% in the dexamethasone plus carnitine group (group 4). In conclusion, based on the findings of this experimental study, the synergistic effect of carnitine and dexamethasone on skin flap viability is determined. In a rat dorsal random flap model, intraflap injection of dexamethasone and intraperitoneal administration of carnitine independently increased flap surviving area. Use of both agents together resulted in a synergistic effect on surviving area.