Vasopressor use in free tissue transfer surgery

Objective: To document the frequency of vasopressor use in free tissue transfer surgery and to compare the incidence of flap complications and flap survival in patients receiving or not receiving intraoperative vasopressors. Study Design and Setting: Case series with chart review of free tissue transfers performed between 2004 and 2006 at a large-volume tertiary academic hospital. Results: Of 241 free flaps, 169 had data available for analysis. Flap survival was 96.5 percent. The rate of other flap complications was 29 percent. A total of 139 (82%) patients received vasopressors intraoperatively. Of these, four (2.9%) flap failures and 40 (29%) complications occurred. In the 30 (18%) patients who did not receive vasopressors, two (6.7%) flap failures and nine (30%) complications occurred. The most common reasons for flap failure were arterial thrombus (n = 3) and thrombosis of the venous pedicle (n = 3). Conclusion: Intraoperative vasopressors are used more frequently than previously realized but do not appear to increase overall flap failure and the incidence of complications. Intraoperative vasopressor use in free flap surgery may not be as harmful as previously feared.