Impact of intraoperative vasopressors use in free tissue transfer for head, neck and extremity reconstruction

Abstract

Abstract: Generalanesthesiainduceshypotensionandthisiscommonlytreatedintraoperatively with administering vasopressors. Microsurgeons are hesitantto use vasopressors due to the potential risk of inducing vasoconstriction andflap necrosis. The aim of this study was to determine the frequency of intraope-rative vasopressor utilization in patients undergoing free tissue transfer recon-struction and to determine its impact on patient outcomes.An IRB-approved retrospective review was performed for 47 consec-utive patients undergoing free tissue transfer for head, neck, and extremityreconstruction at Wake Forest Baptist Health over a 3-year period.Free flap survival was 97%, with 3% of patients having total flapnecrosis and 17% with partial flap necrosis. The frequency of intraoperativevasopressor use was 53.2%. There was no significant difference in the fre-quency of total or partial flap necrosis between patients who received intra-operative vasopressors and those who did not. Similarly, there was no statisticalsignificance in the rate of arterial or venous thrombosis between the 2 groups(P = 0.095 and P = 0.095, respectively). The use of vasopressors did not sig-nificantly increase postoperative complications. The timing of vasopressor ad-ministration did not affect outcomes.Intraoperative vasopressors are used more frequently than previouslyrealized during free tissue transfer for reconstructive surgery. The use of in-traoperative vasopressors does not appear to adversely affect outcomes offree tissue transfer. Further investigation and larger study size are needed toanalyze the timing of drug administration, dose, and type of vasopressor tobetter understand the impact of intraoperative vasopressor use in free tissuetransfer outcomes.Key Words: vasopressors, free tissue transfer, microsurgery(Ann Plast Surg 2014;72: S135YS138)