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Intraoperative management of free flaps: current practice
1From the *University of Kentucky College of Medicine; and †Division of Plastic Surgery, Department of Surgery, University of Kentucky, Lexington, KY.
Annals of Plastic Surgery
|April 3, 2014
Summary
Microsurgeons often avoid vasopressors for intraoperative hypotension during free tissue transfer, preferring fluids. This national survey reveals current practices, highlighting the need for evidence-based guidelines in microsurgery management.
Area of Science:
- Plastic Surgery
- Microsurgery
- Anesthesiology
Background:
- Management of hemodynamic instability during microvascular flap reconstruction relies heavily on anecdotal evidence.
- High success rates in microsurgery make randomized controlled trials challenging.
- Current practices for intraoperative hypotension during microsurgical free tissue transfer are not well-defined.
Purpose of the Study:
- To determine current practices for managing intraoperative hypotension during microsurgical free tissue transfer.
- To identify surgeon preferences and experiences regarding hemodynamic management in microsurgery.
Main Methods:
- An anonymous online survey with 17 questions was distributed to university-affiliated plastic and reconstructive microsurgeons.
- Survey data collected included surgeon experience, flap volume, blood pressure limits, hypotension treatment preferences, and monitoring methods.
- Responses were analyzed based on individual experience and volume of procedures performed annually.
Main Results:
- A 26.7% response rate was achieved, with 88.3% of respondents actively performing microsurgery.
- The preferred treatment for hypotension was fluid administration (94.5%); vasopressors were used less frequently, particularly by high-volume surgeons.
- A significant portion of respondents (23.2%) reported flap loss associated with vasopressor use, though no significant difference was found between high- and low-volume surgeons.
Conclusions:
- A national survey indicates that many microsurgeons are hesitant to use vasopressors for intraoperative hypotension, irrespective of experience.
- Current practices in managing hypotension during free tissue transfer are outlined, acknowledging potential responder bias.
- There is a clear need to establish a scientific foundation for intraoperative hemodynamic management in microsurgery.
