Botulinum Toxin A Versus Myricetin for Enhancing Random-Pattern Flap Survival: A Comparative Experimental Study.

INTRODUCTION: Ischemia-related complications remain a significant challenge, leading to increased morbidity and additional procedures after flap surgeries. Myricetin, a flavonoid with antioxidant and anti-inflammatory properties, has not been previously studied for flap survival. This study compares the effects of botulinum toxin A (BTX-A) and myricetin on flap survival in a rat model. METHODS: A total of 40 Wistar albino rats were randomly divided into 5 groups. A modified McFarlane flap was elevated on the dorsum of each rat. Indocyanine green angiography was performed immediately after flap surgery. Flap survival rates were assessed, and tissue samples were collected for histopathologic, immunohistochemical, and biochemical analyses. RESULTS: Mean flap necrosis rates were 37.95±7.01% in the flap control group, 20.91±13.58% in the BTX-A group, 26.21±11.12% in the myricetin group, and 13.56±9.15% in the combination group (P=0.001). Both the BTX-A and myricetin groups showed significantly higher flap survival rates compared with the control group (P<0.001). Histopathologic examination revealed increased vascular density and reduced inflammation in both treatment groups. Biochemical analysis demonstrated improved total antioxidant status (TAS) and decreased total oxidant status (TOS) in the treatment groups. CONCLUSIONS: Both BTX-A and myricetin significantly improved flap survival, with combination therapy showing the best results. These agents enhanced tissue oxygenation, modulated inflammatory response, and promoted angiogenesis. Myricetin especially decreased oxidative stress and improved antioxidant capacity. Both agents have been shown to increase tissue oxygenation. These 2 agents and their combinations may be preferred to reduce complications and necrosis and to increase flap survival.