Arginine Improves Microcirculation in the Free Transverse Rectus Abdominis Myocutaneous Flap after Breast Reconstruction: A Randomized, Double-Blind Clinical Trial

Background: Partial flap loss is caused by the incapability of the vascular pedicle to provide sufficient microvascular perfusion in distal segments of the flap in addition to the reperfusion injury that occurs in the whole flap after free tissue transfer. In experimental studies, the amino acid arginine reduces reperfusion injury and improves microvascular perfusion. The purpose of this clinical study was to explore the effect of arginine in free flap surgery. Methods: In this randomized, double blind, placebo-controlled trial, 20 patients with unilateral breast reconstruction using the free transverse rectus abdominis myocutaneous flap were included. Patient and flap data were recorded. Patients received a continuous intravenous infusion of arginine or the control amino acid alanine for 5 days. Microcirculation was recorded in the flap in a standardized fashion using laser Doppler flowmetry (Perimed). Results: Zone IV microcirculatory blood flow postoperatively was higher in the arginine group than in the alanine control group (p = 0.04). Conclusion: The authors' study shows beneficial effects of intravenous therapy with arginine to improve microcirculation in the free transverse rectus abdominis myocutaneous flap. (Plast. Reconstr. Surg. 127: 2216, 2011.)