Tranexamic Acid: Is It As Safe As We Think?

Background: The purpose of this work is to evaluate the effects of tranexamic acid (TXA) on skin flap perfusion, as well as wound healing. TXA has gained widespread popularity for its hemostatic properties and has been shown to be safe in terms of overall patient outcomes and not increase the risk of deep venous thrombosis. However, there are little to no data regarding the effect of TXA at the microvascular level, particularly how it affects skin flap perfusion and wound healing. This knowledge gap is of particular concern among surgeons, especially in (but not limited to) procedures like facelifts, where thin skin flaps are elevated and rely on random pattern blood flow. We hypothesize that the use of TXA in skin flap surgeries does not negatively affect skin flap perfusion or wound healing. We plan to evaluate the effect of different administration routes of TXA at a therapeutic in vivo dose on skin flap in a modified rodent Macfarlane flap model, an excellent pre-clinical homologue of thin skin flap elevation, to provide objective evidence regarding the safety of TXA in (aesthetic) plastic surgical procedures, especially those involving the elevation of thin random flaps.