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INNOSC Theranostics and
Pharmacological Sciences Dapsone enhance skin flap survival

levels in our treatment groups. Although the precise impact Acknowledgments
of dapsone on angiogenesis remains poorly understood,
our results suggest a dual effect: inhibition of excess The first author expresses deep gratitude to Lawrence B.
inflammation and neutrophil infiltration on the one side, Cohen (Yale School of Medicine) for his assistance in editing
the English language in this article.
and enhancement of angiogenesis on the other. There is solid
evidence supporting the role of dapsone in the inhibition Funding
of progressive inflammation and cytokine production. 59-61
Numerous studies have sought to explore the underlying None.
mechanisms of wound healing and the formation of scar Conflict of interest
tissue and fibrosis as undesirable outcomes of impaired
healing. Various factors contribute to regulating the process The authors declare no conflicts of interest.
of appropriate healing and minimizing scar formation. The
previous research has indicated that a balanced interplay Author contributions
between inflammation and angiogenesis plays a critical Conceptualization: Abolfazl Badripour, Ahmadreza
role in preventing impaired wound healing. For instance, Dehpour
persistent neutrophil infiltration and overexpression of Formal analysis: Abolfazl Badripour, Armaghan
TNF-α not only impede angiogenesis and downregulate Ahangarishizary
VEGF expression but also decrease the viability and Investigation: Seyed Mohsen Ahmadi-Tafti, Mohammad
survival of keratinocytes. 24,62,63 Similarly, our results also Ashouri
suggest a correlation between prolonged inflammation and Methodology: Abolfazl Badripour, Zahra Ebrahim Soltani,
the status of angiogenesis. Armaghan Ahangarishizary
Writing – Original draft: Abolfazl Badripour, Anahita
Before drawing a conclusion, several factors should
be taken into consideration. First, dapsone is associated Najafi, Alireza Hasanzadeh, Alireza Rahbar, Mohamad
Behzadi
with adverse side effects, including hematologic Writing – Review & editing: Abolfazl Badripour, Anahita
(methemoglobinemia and hemolysis), dermatologic Najafi, Alireza Hasanzadeh, Alireza Rahbar, Mohamad
(exfoliative dermatitis and erythema multiform), Behzadi
neurologic (peripheral neuropathy), and gastrointestinal
45
(anorexia and nausea/vomiting) effects. Second, patients Ethics approval and consent to participate
with peripheral vascular disease (e.g., Buerger’s disease)
are known to possess a higher risk of flap surgery failure. It The study protocol was executed in agreement with
has been suggested that diabetic or atherosclerotic patients the National Institutes of Health (NIH) Guide for the
may benefit from preconditioning to mitigate their risk of Care and Use of Laboratory Animals (NIH publication
flap failure. Pharmacologic or ischemic preconditioning, No. 86-23, Eighth Ed.) and institutional and governmental
alone or in combination, could serve as a therapeutic concerns for animal care and use (Approval ID: IR.TUMS.
approach for patients with compromised perfusion and, MEDICINE.REC.1398.922).
consequently, an increased risk of flap failure. 64-66 However, Consent for publication
to translate pharmacologic agent studies into clinical
practice, large-scale animal studies involving various flap Not applicable.
types and sizes are required. Availability of data

5. Conclusion The datasets used during this study are available on
In this study, we explored the effects of dapsone on skin reasonable request from the corresponding author.
flap survival, focusing on its anti-inflammatory properties. References
Our results revealed that systemic administration of
dapsone effectively prevented skin flap necrosis and 1. Basu G, Downey H, Guo S, et al. Prevention of distal flap
ulceration. Subsequent assessments demonstrated that necrosis in a rat random skin flap model by gene electro
dapsone decreased neutrophil infiltration, IL-8 levels, transfer delivering VEGF(165) plasmid. J Gene Med.
2014;16(3-4):55-65.
and TNF-α expression, as well as enhanced the VEGF
expression. However, future investigations are warranted doi: 10.1002/jgm.2759
to fully elucidate the promising anti-inflammatory effects 2. Pavletic MM. Skin flaps in reconstructive surgery. Vet Clin
of dapsone. North Am Small Anim Pract. 1990;20(1):81-103.

Volume 7 Issue 2 (2024) 9 doi: 10.36922/itps.2241