Impact of intraoperative use of vasopressors in lower extremity reconstruction: Single centre analysis of 437 free gracilis muscle and fasciocutaneous anterolateral thigh flaps

Clin Hemorheol Microcirc. 2019;71(2):193-201. doi: 10.3233/CH-189411.

Abstract

Background: While complication rates in free tissue transfers have continuously decreased over time due to improved techniques, the intraoperative use of vasopressors and their negative effects on flap microcirculation and patency of the anastomoses remains controversial. To further elucidate this matter, this retrospective study examines the effect of intraoperative vasopressors on free gracilis muscle and free fasciocutaneous anterolateral thigh (ALT) flaps for lower extremity reconstruction.

Methods: A total of 425 patients underwent 437 free flaps for lower limb reconstruction. The series was divided into two groups: use of intraoperative vasopressors (V, n = 318) or no use (NV, n = 119). The data were retrospectively screened for patients' demographics, perioperative details, and surgical complications.

Results: The two groups were comparable regarding patient comorbidities. Independently of flap type, there were no significant difference between the groups regarding major complications, i.e. total flap loss (V: 5.35% versus NV: 5.04%, p = 0.899) or revision rate (V: 18.87% versus NV: 12.61%; p = 0.122), or minor complications, i.e. partial flap loss (V: 6.29% versus NV: 5.88%, p = 0.875).

Conclusion: This study confirms that the usage of intraoperative vasopressors has no influence on free flap survival rate in lower extremity reconstruction. It seems to be no difference between free muscle or fasciocutaneous flaps.

Keywords: Vasopressors; free flaps; lower extremity reconstruction; microsurgery; norepinephrine.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Free Tissue Flaps / surgery*
  • Gracilis Muscle / surgery*
  • Humans
  • Lower Extremity / surgery*
  • Male
  • Middle Aged
  • Plastic Surgery Procedures / methods
  • Retrospective Studies
  • Thigh / surgery*
  • Treatment Outcome
  • Vasoconstrictor Agents / pharmacology
  • Vasoconstrictor Agents / therapeutic use*
  • Young Adult

Substances

  • Vasoconstrictor Agents