Lin Fang1, Jun Liu1, Cuicui Yu2, Matthew M Hanasono1, Gang Zheng2, Peirong Yu1. 1. Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX. 2. Department of Anesthesiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX.
Abstract
OBJECTIVE: To examine the effects of vasopressors on free flap outcomes. BACKGROUND: Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions. METHODS: All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively. Vasopressors were given intraoperatively as an intravenous bolus when blood pressure dropped >20% from baseline. The timing of intraoperative vasopressor administration was divided into 3 phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); end of P1 to 30 minutes after revascularization (P2); end of P2 to end of surgery (P3). Agents included phenylephrine, ephedrine and calcium chloride. RESULTS: A total of 5671 free flap cases in 4888 patients undergoing head and neck, breast, trunk, or extremity reconstruction were identified. Vasopressors were used intraoperatively in 85% of cases. The overall incidence of pedicle compromise was 3.6%, with a flap loss rate of 1.7%. A propensity score matching analysis showed that intraoperative use of any agents at any time of surgery was not associated with increased overall pedicle compromise [51/1584 (3.2%) vs 37/792 (4.7%); P = 0.074] or flap failure rates [26/1584 (1.6%) vs 19/792 (2.4%); P = 0.209]. Rather, there was less risk of venous congestion [33/1584 (2.1%) vs 31/792 (3.9%); P = 0.010]. CONCLUSIONS: Intraoperative use of phenylephrine, ephedrine, or calcium chloride as an intravenous bolus does not increase flap compromise and failure rates in cancer patients.
OBJECTIVE: To examine the effects of vasopressors on free flap outcomes. BACKGROUND: Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions. METHODS: All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively. Vasopressors were given intraoperatively as an intravenous bolus when blood pressure dropped >20% from baseline. The timing of intraoperative vasopressor administration was divided into 3 phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); end of P1 to 30 minutes after revascularization (P2); end of P2 to end of surgery (P3). Agents included phenylephrine, ephedrine and calcium chloride. RESULTS: A total of 5671 free flap cases in 4888 patients undergoing head and neck, breast, trunk, or extremity reconstruction were identified. Vasopressors were used intraoperatively in 85% of cases. The overall incidence of pedicle compromise was 3.6%, with a flap loss rate of 1.7%. A propensity score matching analysis showed that intraoperative use of any agents at any time of surgery was not associated with increased overall pedicle compromise [51/1584 (3.2%) vs 37/792 (4.7%); P = 0.074] or flap failure rates [26/1584 (1.6%) vs 19/792 (2.4%); P = 0.209]. Rather, there was less risk of venous congestion [33/1584 (2.1%) vs 31/792 (3.9%); P = 0.010]. CONCLUSIONS: Intraoperative use of phenylephrine, ephedrine, or calcium chloride as an intravenous bolus does not increase flap compromise and failure rates in cancerpatients.
Authors: Bryan J Dooley; Daniella Karassawa Zanoni; Marlena R Mcgill; Mahmoud I Awad; Jatin P Shah; Richard J Wong; Clara Broad; Babak J Mehrara; Ian Ganly; Snehal G Patel Journal: Head Neck Date: 2019-10-08 Impact factor: 3.147
Authors: Akash N Naik; Taylor Freeman; Michael M Li; Scarlett Marshall; Akina Tamaki; Enver Ozer; Amit Agrawal; Stephen Y Kang; Matthew O Old; Nolan B Seim Journal: Front Pharmacol Date: 2020-08-28 Impact factor: 5.810
Authors: Thais O Polanco; Meghana G Shamsunder; Madeleine E V Hicks; Kenneth P Seier; Kay See Tan; Sabine Oskar; Joseph H Dayan; Joseph J Disa; Babak J Mehrara; Robert J Allen; Jonas A Nelson; Anoushka M Afonso Journal: J Plast Reconstr Aesthet Surg Date: 2021-02-04 Impact factor: 3.022
Authors: Robert J Taylor; Rusha Patel; Bethany J Wolf; William D Stoll; Joshua D Hornig; Judith M Skoner; William R Hand; Terry A Day Journal: Microsurgery Date: 2020-11-10 Impact factor: 2.425
Authors: John-Patrik Burkhard; Jelena Pfister; Roland Giger; Markus Huber; Claudia Lädrach; Manuel Waser; Radu Olariu; Dominique Engel; Lukas M Löffel; Benoît Schaller; Patrick Y Wuethrich Journal: Clin Oral Investig Date: 2021-03-08 Impact factor: 3.573