Comparison of the efficacy of multiple antioxidant and hyperbaric oxygen treatments in the prevention of ischemia and necrosis of local random McFarlane skin flap

J Tissue Viability. 2021 May;30(2):196-206. doi: 10.1016/j.jtv.2021.02.008. Epub 2021 Feb 26.


Objective: The aim of this study was to compare the efficacy of multiple antioxidant (Proxeed Plus (PP) with Carnitine, Selenium, Zinc, Coenzyme Q10, Vitamin C, Folic Acid, Vitamin B12) on local random skin flap healing with the hyperbaric oxygen (HBO) therapy.

Methods: Fourty rats were equally divided into five groups (Control, PP, HBO, HBO + PP, PP + HBO + PP). Local random McFarlane skin flap was applied to all rats. Following the applications, evaluations were made biochemical (TAS, TOS, OSI, IL-1β, IL-6, TNF-α, TGF-β, VEGF) and histopathological parameters.

Results: Necrosis percentage was found to be lower in the PP + HBO + PP group than all other groups whereas the necrosis percentages of PP and HBO groups were similar. Oxidative stress rates were significantly higher in the control group compared to the other groups whereas it was lower in the PP + HBO + PP group than all other groups. The inflammation parameters were the highest in the control group and the lowest in the PP + HBO + PP group. Growth factors were higher in the PP + HBO + PP group than all other groups. Epithelialization and wound healing were better in the HBO and PP groups than in the control group. The greatest healing, epithelialization and vascularization was seen in the PP + HBO + PP group. The histopathological findings in the PP + HBO + PP group were better in each inner region than in the other groups.

Conclusion: Biochemical and histopathological parameters have shown that PP reduces ischemia and necrosis and increases oxygenation in flap healing by providing significant improvement thanks to the multiple molecular structures in its content.

Keywords: Ischemia; Multiple antioxidant; Rat; Skin flap; Survival.

MeSH terms

  • Animals
  • Antioxidants / pharmacology
  • Antioxidants / standards*
  • Disease Models, Animal
  • Hyperbaric Oxygenation / methods
  • Hyperbaric Oxygenation / standards*
  • Hyperbaric Oxygenation / statistics & numerical data
  • Ischemia / physiopathology
  • Ischemia / therapy*
  • Oxygen / pharmacology
  • Oxygen / therapeutic use
  • Rats
  • Rats, Sprague-Dawley
  • Surgical Flaps / blood supply*
  • Wound Healing / drug effects
  • Wound Healing / physiology


  • Antioxidants
  • Oxygen