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Intraoperative vasopressor use in free flap breast reconstruction is safe and reduces postoperative flap congestion
Danielle C. Marshall, BA, Jessica Asirwatham, BS, Jessica Oh, BA, Anooj Patel, BS, Brian Gastman, MD
Cleveland Clinic Foundation
2018-02-14
Presenter: Danielle Marshall
Affidavit:
Danielle C. Marshall
Director Name: Brian Gastman
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
BACKGROUND: Many microsurgeons still avoid the use of vasopressors during free flap reconstruction. Experimental evidence suggests vasopressors have a negative impact on flap survival due to peripheral vasoconstriction, but these findings have not been borne out in clinical research. The aim of this study was to evaluate the relationship between vasopressor use and free flap complications.
METHODS: A retrospective review was conducted of all patients who underwent autologous free flap breast reconstruction between 2000-2017. Postoperative complications including flap failure, hematoma, and flap congestion were recorded.
RESULTS: A total of 780 autologous breast free flaps were reviewed, with 369 (46.8%) and 291 (36.9%) receiving intraoperative phenylephrine and ephedrine, respectively. Flap failure was observed in 1.9%, venous thrombosis in 1.6% and congestion in 4.7% of flaps. Vasopressor use was not associated with flap failure (p = 0.345), but was significantly associated with a decreased risk of postoperative flap congestion (p = 0.001). However, in a multivariate analysis, vasopressor use was associated with an increased risk of postoperative acute blood loss anemia (p = 0.012).
CONCLUSION: Consistent with previous studies, there was no statistical difference in free flap failure between patients who did or did not receive vasopressors intraoperatively. In contrast to previous concerns that vasopressor use compromises flap viability, our study demonstrated intraoperative vasopressors use was significantly associated with a decreased risk of flap congestion. These benefits must be balanced with the potential increased risk of postoperative anemia. Further research is necessary to elucidate the optimal dosing and schedule of vasopressor administration.
