The use of topical vasodilators in microvascular surgery

Topical vasodilators are widely used in reconstructive microsurgery in order to ameliorate intraoperative vascular spasm (vasospasm) and facilitate microvascular anastomoses. There is, however, a paucity of literature to support or discredit this practice. A survey of current practice in UK Plastic Surgery Departments was therefore undertaken. Email questionnaires were sent to all 281 consultant plastic surgeons in the UK and we received responses from 91 representing 35 out of the 49 'main' Plastic Surgery Units (71%). Of the 84 consultants who completed the questionnaire, the majority (94%) utilised vasodilators during microsurgery. The commonest preparations used were papaverine (52%), calcium channel blockers (47%) and local anaesthetics (27%). The most frequent reasons cited for topical vasodilator use were empirical (42%), habit (21%) and 'that it works' (16%). The agents were almost always applied topically (99%) compared to intraluminally in 19%. It is concluded that multiple vasodilators are employed routinely in UK microvascular surgical practice, but there is little scientific basis for their use.