Terazosin blockade of nicotine-induced skin flap necrosis in the rat.

OBJECTIVE: To examine the ability of terazosin hydrochloride to block the decrease in skin flap survival induced by nicotine. DESIGN: A randomized controlled animal trial. SUBJECTS: Ninety-two male Sprague-Dawley rats were randomized to 1 of 5 groups: double-placebo control (n = 15), nicotine opposed by oral placebo (n = 26), nicotine opposed by subcutaneous placebo (n = 16), nicotine opposed by oral terazosin (n = 21), and nicotine opposed by subcutaneous terazosin (n = 14). INTERVENTION: All rats received 1 mg of nicotine twice daily via subcutaneous injection except for those in the double-placebo control group, which received saline injections twice daily, for the 6-week study. The terazosin treatment groups received 1.5 mg of terazosin hydrochloride twice daily either orally or subcutaneously while the rest received a saline solution placebo either orally or subcutaneously for the last 4 weeks of the study. At the end of the fifth week, a 4 x 10-cm, caudally based, dorsal random-pattern flap was elevated and repositioned. The outcome was measured in percentage area of flap survival. RESULTS: The mean (+/-SEM) area of flap survival for the double-placebo control group was 79% +/- 2%. Nicotine opposed by oral placebo or subcutaneous placebo produced a significant decrease in survival areas (mean [+/-SEM] area, 73% +/- 2% and 74% +/- 2%, respectively). Nicotine opposed by oral terazosin produced a mean (+/-SEM) survival area of 81% +/- 2%, which was significantly better than the nicotine opposed by placebo group and similar to the control group (P = .02). CONCLUSION: Use of oral terazosin elevated flap survival rates to control levels in nicotine-treated rats.