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European Journal of Plastic Surgery
Published in: European Journal of Plastic Surgery 6/2016

01-12-2016 | Original Paper

Influence of postoperative vasoactive agent administration on free flap outcomes

Authors: Dimitra Kotsougiani, Cornelia M. Banz, Caroline A. Hundepool, Thomas Kremer, Ulrich Kneser, Marcus Lehnhardt, Leila Harhaus

Published in: European Journal of Plastic Surgery | Issue 6/2016

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Abstract

Background

The use of vasoactive agents (VAs) in free flap reconstruction remains controversial due to the potential risk of free flap failure. Most of the existing literature has focussed on intraoperatively administered VAs in free flap procedures. However, hypotension frequently requires VA support, both intraoperatively and in the first postoperative days. The objective of this study was to analyse the influence of postoperatively administered VAs on thromboembolic complications.

Methods

A retrospective study was performed including all patients undergoing free flap reconstruction between February 2010 and June 2012. Logistic regression analysis identified predictors for postoperative VA administration and whether its use was a prognostic risk factor for the outcome parameters of revision surgery or free flap loss due to vascular compromise of the venous or arterial anastomosis.

Results

A total of 209 free flap procedures were performed, with an overall survival rate of 94.3 %. In 19.7 % of the free flap procedures performed, postoperative VA administration was noted. Predictors for postoperative VA administration were intraoperative VAs, age ≥50, ASA ≥3, hypertension and peripheral vascular disease. Postoperative VA administration was found to be a significant risk factor for the outcome parameter of revision surgery, particularly in the perforator free flaps used for lower extremity reconstruction. However, there was no significant correlation between the postoperative use of VAs and free flap loss.

Conclusions

We have demonstrated an association between postoperative VA administration and an increased revision rate in free flaps. Appropriate flap selection, close free flap monitoring and optimally adjusted anticoagulation therapy are recommended in patients receiving VA support during the early postoperative free flap period.
Level of Evidence: Level III, risk/prognostic study.
Literature
1.
Serletti JM, Higgins JP, Moran S, et al. (2000) Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 106:66–70
2.
Ozkan O, Ozgentas HE, Islamoglu K, et al. (2005) Experiences with microsurgical tissue transfers in elderly patients. Microsurgery 25:390–395
3.
Goldberg JA, Alpert BS, Lineaweaver WC, et al. (1991) Microvascular reconstruction of the lower extremity in the elderly. Clin Plast Surg 18:459–465
4.
Scholz A, Pugh S, Fardy M, et al. (2009) The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*. Anaesthesia 64:1089–1093
5.
Kanter J, DeBlieux P (2014) Pressors and inotropes. Emerg Med Clin North Am 32:823–834
6.
Bangash MN, Kong ML, Pearse RM (2012) Use of inotropes and vasopressor agents in critically ill patients. Br J Pharmacol 165:2015–2033
7.
Belletti A, Musu M, Silvetti S, et al. (2015) Non-adrenergic vasopressors in patients with or at risk for vasodilatory shock. A systematic review and meta-analysis of randomized trials. PLoS One 10:e0142605
8.
Heller AR, Heger J, Gama de Abreu M, et al. (2015) Cafedrine/theodrenaline in anaesthesia: influencing factors in restoring arterial blood pressure. Anaesthesist 64:190–196
9.
Zhang J, Lipa JE, Black CE, et al. (2000) Pharmacological characterization of vasomotor activity of human musculocutaneous perforator artery and vein. J Appl Physiol 89:2268–2275
10.
Banbury J, Siemionow M, Porvasnik S, et al. (1999) Muscle flaps triphasic microcirculatory response to sympathectomy and denervation. Plast Reconstr Surg 104:730–737
11.
Suominen S, Svartling N, Silvasti M, et al. (2004) The effect of intravenous dopamine and dobutamine on blood circulation during a microvascular TRAM flap operation. Ann Plast Surg 53:425–431
12.
Godden DR, Little R, Weston A, et al. (2000) Catecholamine sensitivity in the rat femoral artery after microvascular anastomosis. Microsurgery 20:217–220
13.
Harris L, Goldstein D, Hofer S, et al. (2012) Impact of vasopressors on outcomes in head and neck free tissue transfer. Microsurgery 32:15–19
14.
Lohman RF, Langevin CJ, Bozkurt M, et al. (2013) A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry. J Reconstr Microsurg 29:51–56
15.
Liu YF, Vuong C, Walker PC, et al. (2016) Noninvasive free flap monitoring using Eulerian video magnification. Case Rep Otolaryngol 2016:9471696
16.
Vyas K, Wong L (2014) Intraoperative management of free flaps: current practice. Ann Plast Surg 72(6):S220–S223
17.
Cordeiro PG, Santamaria E, Hu QY, et al. (1997) Effects of vasoactive medications on the blood flow of island musculocutaneous flaps in swine. Ann Plast Surg 39:524–531
18.
Eley KA, Young JD, Watt-Smith SR (2012) Epinephrine, norepinephrine, dobutamine, and dopexamine effects on free flap skin blood flow. Plast Reconstr Surg 130:564–570
19.
Eley KA, Young JD, Watt-Smith SR (2013) Power spectral analysis of the effects of epinephrine, norepinephrine, dobutamine and dopexamine on microcirculation following free tissue transfer. Microsurgery 33:275–281
20.
Fischer JP, Wink JD, Nelson JA, et al. (2013) A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction. J Reconstr Microsurg 29:407–416
21.
Rizzoni D, Perlini S, Mircoli L, et al. (2000) Enhanced vascular reactivity in the sympathectomized rat: studies in vivo and in small isolated resistance arteries. J Hypertens 18:1041–1049
22.
Khouri RK, Cooley BC, Kunselman AR, et al. (1998) A prospective study of microvascular free-flap surgery and outcome. Plast Reconstr Surg 102:711–721
23.
Kelly DA, Reynolds M, Crantford C, et al. (2014) Impact of intraoperative vasopressor use in free tissue transfer for head, neck, and extremity reconstruction. Ann Plast Surg 72(6):S135–S138
24.
Chen C, Nguyen MD, Bar-Meir E, et al. (2010) Effects of vasopressor administration on the outcomes of microsurgical breast reconstruction. Ann Plast Surg 65:28–31
25.
Chang EI, Carlsen BT, Festekjian JH, et al. (2013) Salvage rates of compromised free flap breast reconstruction after recurrent thrombosis. Ann Plast Surg 71:68–71
26.
Dubova MN (1981) Correction of cardiovascular hypodynamics in the early postoperative period with the adrenergic beta receptor agonist acrinor. Anesteziol Reanimatol:21–24
27.
Heller A, Grosser KD (1974) Hemodynamics in patients with myocardial infarct following intravenous administration of Akrinor. Die Medizinische Welt 25:1890–1892
28.
Sternitzke N, Schieffer H, Rettig G, et al. (1984) Mechanism of action of oxyfedrine as a partial beta receptor agonist. Z Kardiol 73:586–593
29.
Sakai K, Sugano S, Shiraki Y, et al. (1972) Studies on noradrenalinetheophylline and norephedrinetheophylline as peroral pressor agents in unanesthetized animals. Arzneimittelforschung 22:702–706
30.
Sakai K, Shioya A, Hashimoto K (1972) Effect of combining noradrenalinetheophylline and norephedrinetheophylline in various ratios on renal circulation. Arzneimittelforschung 22:698–701
31.
Usichenko TI, Foellner S, Gruendling M, et al. (2006) Akrinor-induced relaxation of pig coronary artery in vitro is transformed into alpha1-adrenoreceptor-mediated contraction by pretreatment with propranolol. J Cardiovasc Pharmacol 47:450–455
32.
London MJ, Zaugg M, Schaub MC, et al. (2004) Perioperative beta-adrenergic receptor blockade: physiologic foundations and clinical controversies. Anesthesiology 100:170–175
33.
London MJ, Itani KM, Perrino AC Jr, et al. (2004) Perioperative beta-blockade: a survey of physician attitudes in the Department of Veterans Affairs. J Cardiothorac Vasc Anesth 18:14–24
34.
Lindenauer PK, Pekow P, Wang K, et al. (2005) Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med 353:349–361
35.
Boerma EC, Ince C (2010) The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients. Intensive Care Med 36:2004–2018
36.
Pereira CM, Figueiredo ME, Carvalho R, et al. (2012) Anesthesia and surgical microvascular flaps. Rev Bras Anestesiol 62:563–579
37.
Rubino C, Coscia V, Cavazzuti AM, et al. (2006) Haemodynamic enhancement in perforator flaps: the inversion phenomenon and its clinical significance. A study of the relation of blood velocity and flow between pedicle and perforator vessels in perforator flaps. J Plast Reconstr Aesthet Surg 59:636–643
38.
Schirmer S, Ritter RG, Rice A, et al. (2011) Preventing lower limb amputations in patients suffering from diabetic foot syndrome and peripheral vascular disease—opportunities and limitations. Handchir Mikrochir Plast Chir 43:338–344
Metadata
Title
Influence of postoperative vasoactive agent administration on free flap outcomes
Authors
Dimitra Kotsougiani
Cornelia M. Banz
Caroline A. Hundepool
Thomas Kremer
Ulrich Kneser
Marcus Lehnhardt
Leila Harhaus
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Plastic Surgery / Issue 6/2016
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI
https://doi.org/10.1007/s00238-016-1223-5

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