Impact of Intraoperative Vasopressor Use in Free Tissue Transfer for Head, Neck, and Extremity Reconstruction

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General anesthesia induces hypotension and this is commonly treated intraoperatively with administering vasopressors. Microsurgeons are hesitant to use vasopressors due to the potential risk of inducing vasoconstriction and flap necrosis. The aim of this study was to determine the frequency of intraoperative vasopressor utilization in patients undergoing free tissue transfer reconstruction and to determine its impact on patient outcomes.

An IRB-approved retrospective review was performed for 47 consecutive patients undergoing free tissue transfer for head, neck, and extremity reconstruction at Wake Forest Baptist Health over a 3-year period.

Free flap survival was 97%, with 3% of patients having total flap necrosis and 17% with partial flap necrosis. The frequency of intraoperative vasopressor use was 53.2%. There was no significant difference in the frequency of total or partial flap necrosis between patients who received intraoperative vasopressors and those who did not. Similarly, there was no statistical significance 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 significantly increase postoperative complications. The timing of vasopressor administration did not affect outcomes.

Intraoperative vasopressors are used more frequently than previously realized during free tissue transfer for reconstructive surgery. The use of intraoperative vasopressors does not appear to adversely affect outcomes of free tissue transfer. Further investigation and larger study size are needed to analyze the timing of drug administration, dose, and type of vasopressor to better understand the impact of intraoperative vasopressor use in free tissue transfer outcomes.

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