{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:58:14Z","timestamp":1790600294515,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Random-pattern skin flaps are prone to distal necrosis, a major challenge in reconstructive surgery. Tranexamic acid (TXA) reduces perioperative bleeding, but its impact on flap viability remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to investigate the concentration-dependent effects of local TXA application on random-pattern flap survival, with and without surgical delay, in the McFarlane dorsal rat flap model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty-four female Wistar albino rats were randomized into 8 groups (n = 8): control, TXA 10, 30, and 100\u2005mg\/mL, delayed control, and delayed TXA at the same concentrations. A 3 \u00d7 9\u2005cm caudal-based dorsal flap was elevated, and 1\u2005mL of saline or TXA was administered locally before closure. Flap necrosis was quantified using ImageJ software. Two-way analysis of variance (ANOVA) assessed the independent effects of delay and TXA concentration; subgroup analyses used 1-way ANOVA with Tukey honestly significant difference (HSD) (nondelayed) and Kruskal\u2013Wallis with Dunn's test (delayed).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>High-concentration TXA (100\u2005mg\/mL) significantly increased necrosis in nondelayed flaps (40.39% \u00b1 7.41%, P = .016 vs control). Delayed flaps showed markedly reduced necrosis across all groups (delayed control: 1.00% \u00b1 1.45%, P &amp;lt; .001). No significant differences were observed among delayed subgroups regardless of TXA concentration. Two-way ANOVA identified the delay procedure as the dominant main effect (F(1,56) = 665.97, P &amp;lt; .001, partial \u03b72 = 0.922).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High-concentration local TXA impairs random-pattern flap survival, whereas low-concentration TXA (10\u2005mg\/mL) appears well tolerated. The surgical delay procedure markedly reduces TXA-associated necrosis risk across all concentrations. Careful concentration selection is recommended when TXA is used in cutaneous flap surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjag183","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T19:59:10Z","timestamp":1788465550000},"source":"Crossref","is-referenced-by-count":0,"title":["Tranexamic Acid Concentration and Flap Survival in Rats"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1705-9781","authenticated-orcid":false,"given":"Ertu\u011frul","family":"Karanfil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9077-2976","authenticated-orcid":false,"given":"Metin","family":"G\u00f6rg\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9161-324X","authenticated-orcid":false,"given":"Berkalp","family":"Berker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dcmit Ozan","family":"\u00d6zlen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00fcleyman Mert","family":"K\u0131l\u0131\u00e7","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasin Burak","family":"Bozdemir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026092808021629700_sjag183-B1","doi-asserted-by":"publisher","first-page":"5234","DOI":"10.3390\/ijms23095234","article-title":"Current status of experimental animal skin flap models: ischemic preconditioning and molecular factors","volume":"23","author":"Lee","year":"2022","journal-title":"Int J Mol Sci"},{"key":"2026092808021629700_sjag183-B2","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/00006534-196502000-00007","article-title":"The design of a pedicle flap in the rat to study necrosis and its prevention","volume":"35","author":"McFarlane","year":"1965","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B3","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/00006534-196503000-00001","article-title":"A study of the delay phenomenon in experimental pedicle flaps","volume":"35","author":"McFarlane","year":"1965","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B4","doi-asserted-by":"publisher","first-page":"e145","DOI":"10.1097\/SAP.0000000000002919","article-title":"Standardization of the rat dorsal random pattern (McFarlane) flap model and evaluation of the pharmacological agents aiming to salvage partial flap necrosis: a systematic review and a meta-analysis","volume":"87","author":"\u00dcst\u00fcn","year":"2021","journal-title":"Ann Plast Surg"},{"key":"2026092808021629700_sjag183-B5","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1055\/s-2008-1080530","article-title":"Prevention and treatment of thrombosis in microvascular surgery","volume":"24","author":"Hanasono","year":"2008","journal-title":"J Reconstr Microsurg"},{"key":"2026092808021629700_sjag183-B6","doi-asserted-by":"publisher","first-page":"585","DOI":"10.2165\/11209070-000000000-00000","article-title":"Tranexamic acid: a review of its use in the treatment of hyperfibrinolysis","volume":"72","author":"McCormack","year":"2012","journal-title":"Drugs"},{"key":"2026092808021629700_sjag183-B7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD010562.pub2","article-title":"Topical application of tranexamic acid for the reduction of bleeding","volume":"7","author":"Ker","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2026092808021629700_sjag183-B8","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1056\/NEJMoa1606424","article-title":"Tranexamic acid in patients undergoing coronary-artery surgery","volume":"376","author":"Myles","year":"2017","journal-title":"N Engl J Med"},{"key":"2026092808021629700_sjag183-B9","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1097\/PRS.0000000000008884","article-title":"Safety and efficacy of local tranexamic acid for the prevention of surgical bleeding in soft-tissue surgery: a review of the literature and recommendations for plastic surgery","volume":"149","author":"Ausen","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B10","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.burns.2024.01.024","article-title":"Tranexamic acid reduces inflammation, edema and burn wound conversion in a rodent model","volume":"50","author":"Prudovsky","year":"2024","journal-title":"Burns"},{"key":"2026092808021629700_sjag183-B11","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1097\/MOO.0000000000000886","article-title":"Modern use of tranexamic acid in facial plastic surgery","volume":"31","author":"Luetzenberg","year":"2023","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"2026092808021629700_sjag183-B12","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1093\/asj\/sjad177","article-title":"Wound healing complications with tranexamic acid: not the silver bullet after all","volume":"43","author":"Yalamanchili","year":"2023","journal-title":"Aesthet Surg J"},{"key":"2026092808021629700_sjag183-B13","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1186\/s13018-022-03167-5","article-title":"Cytotoxicity of tranexamic acid to tendon and bone in vitro: is there a safe dosage?","volume":"17","author":"Bolam","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"2026092808021629700_sjag183-B14","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1302\/0301-620X.100B3.BJJ-2017-1135.R1","article-title":"Is tranexamic acid toxic to articular cartilage when administered topically? What is the safe dose?","volume":"100-B","author":"Parker","year":"2018","journal-title":"Bone Joint J"},{"key":"2026092808021629700_sjag183-B15","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1089\/fpsam.2023.0245","article-title":"Complications associated with tranexamic acid use with cutaneous flap surgery","volume":"26","author":"Abraham","year":"2024","journal-title":"Facial Plast Surg Aesthet Med"},{"key":"2026092808021629700_sjag183-B16","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.bja.2020.05.054","article-title":"High-dose versus low-dose tranexamic acid for paediatric craniosynostosis surgery: a double-blind randomised controlled non-inferiority trial","volume":"125","author":"Goobie","year":"2020","journal-title":"Br J Anaesth"},{"key":"2026092808021629700_sjag183-B17","doi-asserted-by":"publisher","first-page":"85","DOI":"10.52312\/jdrs.2023.1044","article-title":"Topical or intravenous administration of tranexamic acid accelerates wound healing","volume":"35","author":"Sa\u011flam","year":"2024","journal-title":"Jt Dis Relat Surg"},{"key":"2026092808021629700_sjag183-B18","doi-asserted-by":"publisher","first-page":"517e","DOI":"10.1097\/PRS.0000000000007190","article-title":"Tranexamic acid in microvascular free flap reconstruction","volume":"146","author":"Klifto","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B19","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1093\/asj\/sjaf130","article-title":"Local tranexamic acid in facelift surgery is not associated with wound healing complications: a matched, single-surgeon cohort study","volume":"45","author":"Darras","year":"2025","journal-title":"Aesthet Surg J"},{"key":"2026092808021629700_sjag183-B20","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s00238-020-01735-8","article-title":"Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty","volume":"44","author":"Serrano Reyes","year":"2021","journal-title":"Eur J Plast Surg"},{"key":"2026092808021629700_sjag183-B21","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1093\/asj\/sjaa198","article-title":"Prospective study assessing the effect of local infiltration of tranexamic acid on facelift bleeding","volume":"41","author":"Kochuba","year":"2021","journal-title":"Aesthet Surg J"},{"key":"2026092808021629700_sjag183-B22","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1038\/nmeth.2089","article-title":"NIH Image to ImageJ: 25 years of image analysis","volume":"9","author":"Schneider","year":"2012","journal-title":"Nat Methods"},{"key":"2026092808021629700_sjag183-B23","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00238-021-01794-5","article-title":"Tranexamic acid in plastic surgery: routes of administration and dosage considerations","volume":"44","author":"AlGhanim","year":"2021","journal-title":"Eur J Plast Surg"},{"key":"2026092808021629700_sjag183-B24","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/PRS.0000000000003926","article-title":"The role of tranexamic acid in plastic surgery: review and technical considerations","volume":"141","author":"Rohrich","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jpra.2026.03.031","article-title":"International survey on the use of tranexamic acid in plastic surgery\u2014current practices and perspectives","volume":"50","author":"Aranda","year":"2026","journal-title":"JPRAS Open"},{"key":"2026092808021629700_sjag183-B26","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1002\/bjs5.50192","article-title":"Cytotoxicity and effect on wound re-epithelialization after topical administration of tranexamic acid","volume":"3","author":"Eikebrokk","year":"2019","journal-title":"BJS Open"},{"key":"2026092808021629700_sjag183-B27","doi-asserted-by":"publisher","first-page":"127","DOI":"10.26650\/iuitfd.2019.0058","article-title":"Effects of tranexamic acid on coagulation and flap survival in rats","volume":"83","author":"Aydin","year":"2020","journal-title":"J Istanbul Fac Med"},{"key":"2026092808021629700_sjag183-B28","doi-asserted-by":"publisher","first-page":"24","DOI":"10.7205\/MILMED-D-14-00479","article-title":"TXA in combat casualty care\u2014does it adversely affect extremity reconstruction and flap thrombosis rates?","volume":"180","author":"Valerio","year":"2015","journal-title":"Mil Med"},{"key":"2026092808021629700_sjag183-B29","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1097\/00006534-199912000-00021","article-title":"The delay phenomenon: the story unfolds","volume":"104","author":"Dhar","year":"1999","journal-title":"Plast Reconstr Surg"},{"key":"2026092808021629700_sjag183-B30","doi-asserted-by":"publisher","first-page":"3063","DOI":"10.1007\/s00266-022-03032-0","article-title":"Effect of topical tranexamic acid on seroma formation in a rat mastectomy model","volume":"46","author":"Lee","year":"2022","journal-title":"Aesthetic Plast Surg"},{"key":"2026092808021629700_sjag183-B31","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1186\/s40001-025-02634-z","article-title":"Topical tranexamic acid prevents scar tissue formation following craniectomy in a rat model","volume":"30","author":"\u015eahin","year":"2025","journal-title":"Eur J Med Res"},{"key":"2026092808021629700_sjag183-B32","doi-asserted-by":"publisher","first-page":"207","DOI":"10.5152\/j.aott.2020.02.44","article-title":"The effect of topical and systemic tranexamic acid on fracture healing in rats","volume":"54","author":"\u00c7evik","year":"2020","journal-title":"Acta Orthop Traumatol Turc"},{"key":"2026092808021629700_sjag183-B33","doi-asserted-by":"publisher","first-page":"688","DOI":"10.52312\/jdrs.2021.42","article-title":"The histological effect of tranexamic acid on tendon-to-bone healing in rats","volume":"32","author":"Bozkurt","year":"2021","journal-title":"Jt Dis Relat Surg"},{"key":"2026092808021629700_sjag183-B34","doi-asserted-by":"publisher","first-page":"S59","DOI":"10.21037\/gs.2018.03.10","article-title":"The use of tranexamic acid in microsurgery\u2014is it safe?","volume":"7","author":"Lardi","year":"2018","journal-title":"Gland Surg"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag183\/70948619\/sjag183.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjag183\/70948619\/sjag183.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:02:22Z","timestamp":1790596942000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/advance-article\/doi\/10.1093\/asj\/sjag183\/8785120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":34,"URL":"https:\/\/doi.org\/10.1093\/asj\/sjag183","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"sjag183"}}