Influence of postoperative vasoactive agent administration on free flap outcomes

Abstract

The use of vasoactive agents (VAs) in free flap reconstruction remains controversial due to the potential risk of free flap failure. Most of the existing literature has focussed on intraoperatively administered VAs in free flap procedures. However, hypotension frequently requires VA support, both intraoperatively and in the first postoperative days. The objective of this study was to analyse the influence of postoperatively administered VAs on thromboembolic complications. A retrospective study was performed including all patients undergoing free flap reconstruction between February 2010 and June 2012. Logistic regression analysis identified predictors for postoperative VA administration and whether its use was a prognostic risk factor for the outcome parameters of revision surgery or free flap loss due to vascular compromise of the venous or arterial anastomosis. A total of 209 free flap procedures were performed, with an overall survival rate of 94.3 %. In 19.7 % of the free flap procedures performed, postoperative VA administration was noted. Predictors for postoperative VA administration were intraoperative VAs, age ≥50, ASA ≥3, hypertension and peripheral vascular disease. Postoperative VA administration was found to be a significant risk factor for the outcome parameter of revision surgery, particularly in the perforator free flaps used for lower extremity reconstruction. However, there was no significant correlation between the postoperative use of VAs and free flap loss. We have demonstrated an association between postoperative VA administration and an increased revision rate in free flaps. Appropriate flap selection, close free flap monitoring and optimally adjusted anticoagulation therapy are recommended in patients receiving VA support during the early postoperative free flap period. Level of Evidence: Level III, risk/prognostic study.