Effects of a Vitamin Pool (Vitamins A, E, and C) on the Tissue Necrosis Process: Experimental Study on Rats Roge ´rio Porto da Rocha, M.D., Daniela Pettinato Lucio, Thiago de Lima Souza, Se ´rgio Tavolaro Pereira, M.D., and Geraldo Jose ´ Medeiros Fernandes, M.D. Sa ˜o Paulo, Brazil Abstract. During surgical procedures on the epidermis, either aesthetic or reconstructive, the medical literature shows that certain technical standards and skin flap proportions should be followed, unless the risk of necrosis increases, in different de- grees, directly related to the trauma. This study evaluates the evolution of skin flaps on the dorsum of rats treated with a vitamin pool (VP) (vitamins A, E, and C). Twenty-six rats, divided into two groups, were used: (A) the treated group (13 specimens), in which we performed a dorsal skin flap and applied the VP, and (B) the control group (13 specimens), in which we performed a flap on the dorsum without application of the VP. Our results demonstrate that, at the macroscopic level, the group treated with the VP had more tissue sufferance, whereas at the microscopic level, small statistical differences were observed between the groups and also between the vertex and the middle of the flap. Despite these small differences, better results were obtained in group A, showing that in this study the clinical aspect did not correspond to the histological features. Key words: Necrosis — Skin — Vitamin A — Vitamin C — Vitamin E Necrosis is the death of a circumscribed portion of an organ or tissue, due to a cellular lesion caused by isch- emia, physical or chemical agents, drugs, infection, or immunological reactions, to name a few [1]. A cell that suffers degeneration due to ischemia has a low pH, gly- cogen and lipid deposits, and swelling and loss of mi- crovillosity, among other alterations [1]. The lesion be- comes irreversible, mainly after leakage of the cell mem- brane and intracellular liberation of lysosomal enzymes [1]. In the past few years, with the rise of new techniques and the development of substances related to tissue repa- ration (vitamins A, E, and C), many authors began to administer these substances in necrotic flaps, aiming to regress the process. Recent studies have revealed this regression [2]. However, some authors, through the ob- servation of clinical cases, have noticed results that dis- agree with the literature. The association of vitamin A in the form of 0.1% retinoic acid vitamin C in the form of 0.05% ascorbic acid, and vitamin E in the form of 0.05% tocopherol acetate and 0.01% EDTA is described in the literature as being a complex able to revert cutaneous suffering. In this way, the present study evaluated the evolution of skin flaps on the dorsum of rats treated with such a vitamin pool (VP). Materials and Methods The study was carried out at the Laboratory of Surgical Technique of the UNILUS, College of Medical Sciences at Santos. The Veterinary Anatomical Terminology (1983) and the principles of ethics on animal experimen- tation elaborated by the National Council of Animal Ex- perimentation Control (COCEA) were followed. Twenty-six male rats (Rattus norvegicus, Rodentia mammalia) of the Wistar–UNILUS lineage were used. They weighed from 210 to 350 g and were provided by the vivarium of the College of Medical Sciences at San- tos. The animals were observed during 4 days, in relation to health conditions, receiving specific rat rations and water ad libitum. During the experiment, the rats were kept in individual cages in acoustically isolated rooms, at 25°C, with artificial illumination (white light, 100 W) for 12 h daily alternating with 12 h of darkness. The study Correspondence to Roge ´rio Porto da Rocha, Avenida Ana Costa 118, Vila Mathias, Santos, Sa ˜o Paulo, Brazil 11064-032 Aesth. Plast. Surg. 26:197–202, 2002 DOI: 10.1007/s00266-002-1359-5 © 2002 Springer-Verlag New York Inc.