protective effect of vitamin c against ischemia reperfusion injury in rat epigastric free skin flaps: a double-blind experimental study

Ischemia–reperfusion (i/r) injury is a major cause of flap ne- crosis in reconstructive surgery. oxygen free radicals and neu- trophil-mediated inflammation are central contributors to tis- sue damage. vitamin c is a potent antioxidant that scavenges free radicals and may reduce i/r-related tissue necrosis. this study evaluated the protective effect of vitamin c on flap sur- vival and oxidative tissue damage in a rat epigastric skin flap model. sixteen male wistar albino rats (250–300 g) were ran- domized into two groups: control (n=8) and vitamin c (n=8). in the vitamin c group, epigastric flaps were raised and sub- jected to 8 hours of ischemia by clamping the inferior epigas- tric pedicle. fifteen minutes before reperfusion, vitamin c was administered intravenously (2.5 ml/kg diluted in 0.9% sa- line). after 48 hours of reperfusion, flap survival percentage was measured by paper template method. tissue specimens were collected for neutrophil count and biochemical analysis including mda and sod enzyme activity. vitamin c signifi- cantly improved mean flap viability (71%) compared to the control in the original model (9%). necrosis was largely con- fined to the distal portion. neutrophil infiltration was mark- edly lower (mean distal 201/hpf, central 64.49/hpf) than untreated i/r groups. mda levels were significantly reduced and sod activity increased compared with saline controls. in- travenous vitamin c administered before reperfusion signifi- cantly improved flap survival, reduced neutrophil-mediated inflammation, and enhances antioxidant defense in i/r-in- jured flaps. vitamin c is a simple, low-cost intervention that could improve outcomes in reconstructive surgery.