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Background and Objectives Flaps are commonly employed for reconstruction, and manystudies have sought to improve flap survival. In this study, we determined whether sildenafiland epinephrine synergistically improve the survival rate of transverse rectus abdominis mus-culocutaneous (TRAM) flaps. Materials and Method Twenty-four Sprague-Dawley rats were divided into four groups ofsix rats each: a control group, an epinephrine group, a sildenafil group, and an epinephrine-plus-sildenafil group. TRAM flaps were elevated on the upper abdomen. Results The average flap survival area and number of blood vessels differed significantlybetween the control and experimental groups; however, the various experimental groups didnot differ significantly. The level of vascular epithelial growth factor was higher in the experi-mental groups than in the control group. Conclusion Both epinephrine and sildenafil citrate significantly improve TRAM flap sur-vival in rats. However, whether effects are better when the drugs are combined rather thanwhen used alone remains unclear. Further research is required.