Key result
Intraoperative vasopressors show no association with increased flap failure during head and neck reconstruction.
Why the study?
There is controversy and concern regarding the safety of perioperative intravenous vasopressor use during microvascular free tissue transfer for head and neck reconstruction due to potential risks of flap thrombosis and failure.
Does the use of intraoperative vasopressor agents affect free flap survival and complication rates in patients undergoing head and neck reconstruction?
Does the use of intraoperative vasopressor agents affect free flap survival and complication rates in patients undergoing head and neck reconstruction?
The use of intraoperative vasopressors during head and neck free tissue transfer appears safe and is not associated with increased flap failure or thrombosis.
Supports vasopressor use without flap compromise in head and neck reconstruction; hypothesis-generating from Level 5 data and requires prospective confirmation.
BACKGROUND/OBJECTIVES: Microvascular free tissue transfer has become essential to head and neck reconstruction and recent advancements in microvascular surgery have led to excellent surgical outcomes. However, there continues to be controversy and a stigma associated with the use of perioperative intravenous vasopressor agents among both surgeons and anesthesiologists. Due to concern for vasoconstriction of peripheral vasculature flowing to the denervated tissue flap, there remains concerns about potential thrombosis, decreased tissue perfusion and ultimately flap failure. This topic becomes even more important as vasopressors play an essential role in new Extended Recovery After Surgery (ERAS) protocols being put in place to optimize postoperative recovery for patients. The purpose of this study was to comprehensively review the role and safety as well as discuss current trends with intraoperative vasopressor agents in free tissue transfer for head and neck reconstruction. METHODS: A scoping literature review was conducted of all studies that examined the use of vasopressor agents during head and neck free flap tissue transfer. Primary and secondary outcomes included free flap survival, arterial thrombosis, venous congestion, need for revision surgery, and other postoperative complications. RESULTS: One prospective and nine retrospective studies were identified. Phenylephrine and ephedrine were the most common vasopressors reported; the rate of vasopressor use ranged from 53% to 85% and administration methods included both bolus and infusion. The included studies did not show any significant association between the use of vasopressors and free flap failure, pedicle thrombosis, or other flap complications. CONCLUSION: The administration of vasopressors during microvascular free tissue transfer for head and neck reconstruction does not seem to be associated with increased flap failure rates or other postoperative morbidities. Moreover, vasopressors may provide overall improved hemodynamic stability and help to limit overall fluid administration and subsequent postoperative complications. Additional prospective investigation is warranted to further elucidate and establish evidence-based recommendations regarding the type, timing, and dose of vasopressors to further enhance free flap survival and patient outcomes.
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Naik et al. (2020) conducted a review in Head and neck reconstruction with microvascular free tissue transfer. Intraoperative vasopressor agents vs. No intraoperative vasopressor use was evaluated on Free flap failure. Intraoperative administration of vasopressors during microvascular free tissue transfer for head and neck reconstruction is not associated with increased flap failure rates or other postoperative morbidities.
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