Improved skin flap survival with nicotinic acid and nicotinamide in rats.

The effects of some components of the coenzyme nicotinamide adenine dinucleotide (NAD) on tissue viability were investigated in acute island skin flaps which were constructed to exceed the blood supply provided by a unilateral pedicle of inferior epigastric vessels. Control flaps undergo significant necrosis. Treatment with nicotinamide or nicotinic acid, precursors of NAD, prior to flap elevation significantly improved the area of viability in the random portion of the flap from 44 +/- 9% (mean +/- SD) to 67 +/- 12 and 65 +/- 5%, respectively. Similarly, NAD improved viability to 68 +/- 10% (P less than 0.001). Treatment with other components, adenosine diphosphoribose or quinolinic acid, had no effect on flap survival. The results suggest that nicotinic acid and nicotinamide deserve therapeutic consideration with regard to the treatment of ischemia/reperfusion injury in skin.