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36 [0.18, 0.73]; p = 0.005, I2 67% and subgroup analysis repeated application had an OR of 0.05 [0.01, 0.21]; p less then 0.001, I2 14%. CONCLUSION Nitroglycerin seemed to be an ideal agent to increase the chance of flap survival in mastectomy flaps. It has an excellent safety profile, hence, is suitable for empiric use. More randomized controlled trials comparing different regiments and other preparations are needed to conclude whether repeated application at a low dose is most effective, and whether the success is reproducible on other types of flaps. The