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Does Intraoperative Use of Vasopressors Increase the Risk of Flap Thrombosis
Lin Fang, MD, PhD, Matthew Hanasono, MD, Jun Liu, PhD, Gang Zheng, MD, Peirong Yu, M.D., M.S..
University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.

PURPOSE: Most microsurgeons anecdotally avoid the use of vasopressors during free flap surgery. The purpose of this study was to examine their effects on free flap outcomes.
METHODS: All free flap reconstructions from 2004 to 2014 were reviewed. Vasopressors were given intraoperatively when blood pressure dropped more than 20% from the pre-operative baseline. The timing of intraoperative vasopressor administration was divided into three phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); End of P1 to 30 minutes after the end of ischemia (P2); end of P2 to end of surgery (P3). Three types of vasopressors were used: phenylephrine, ephedrine, and calcium chloride.
RESULTS: A total of 5129 free flap cases for head and neck, breast, trunk, and extremity reconstructions were identified. The incidences of intraoperative and postoperative pedicle thrombosis (including both arterial and venous) were 0.4% and 3.4%, respectively. Total flap loss was 1.8%. Vasopressor use during P1, P2, and P3 were 72%, 37%, and 28%, respectively. Use of any vasopressors during P1, P2, and P3 had no effect on intraoperative or postoperative pedicle thrombosis or flap loss (OR=0.96, p=0.79). Further analysis of different types of vasopressors used during surgery also showed no significant effect on intraoperative or postoperative pedicle thrombosis or flap loss (p=0.162).
CONCLUSION: Intraoperative use of vasopressors was common during free flap reconstruction. Use of phenylephrine, ephedrine, or calcium during any time of surgery did not increase the incidence of intraoperative or postoperative flap thrombosis or flap loss.


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