Application study of febuxostat combined with hypothermic preservation technology in reducing ischemia-reperfusion injury in free flap transplantation

To investigate the application effect of febuxostat combined with modified hypothermic preservation technology in reducing ischemia-reperfusion injury in free flap transplantation. A retrospective analysis was conducted on 60 patients who underwent free flap transplantation from February 2021 to February 2025, divided into control group and intervention group according to treatment received with 30 cases each. The control group received standard surgical procedure with flaps preserved in 4°C normal saline; the intervention group received febuxostat (40mg 12 hours preoperatively, 40mg/day for 14 consecutive days postoperatively) and modified University of Wisconsin preservation solution in addition to the control group protocol. Flap survival rate, ischemia-reperfusion injury biomarkers (malondialdehyde, superoxide dismutase, lactate dehydrogenase, creatine kinase), blood perfusion indicators, inflammatory response indicators, and complications were compared between the two groups. The complete flap survival rates in the intervention group at 7, 14, and 30 days postoperatively were 86.7%, 93.3%, and 96.7%, respectively, all significantly higher than those in the control group (63.3%, 70.0%, and 73.3%) (P<0.05). At all postoperative time points, serum malondialdehyde, lactate dehydrogenase, and creatine kinase levels in the intervention group were significantly lower than those in the control group, while superoxide dismutase activity was significantly higher (P<0.001). The intervention group showed higher flap blood flow velocity, shorter capillary refill time, and significantly lower levels of inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α) and D-dimer compared to the control group (P<0.001). The complication rate in the intervention group was 6.7%, lower than the 13.3% in the control group. Febuxostat combined with modified hypothermic preservation technology can significantly improve free flap transplantation survival rates, effectively reduce ischemia-reperfusion injury, improve blood perfusion, control inflammatory response, and has good safety profile, providing an effective organ protection strategy for clinical practice.