Topical Vasodilators in Microsurgery: What Is the Evidence?

Area of Science:

• Microsurgery
• Vascular Surgery
• Pharmacology

Background:

• Topical vasodilators are crucial for managing vasospasm and thrombosis in free tissue transfer.
• Current selection of vasodilators often relies on anecdotal evidence rather than robust data.
• A need exists for evidence-based guidance on topical vasodilator selection for microsurgeons.

Purpose of the Study:

• To systematically review the literature on topical vasodilators used in microsurgery.
• To provide microsurgeons with data-driven insights for selecting effective vasodilating agents.

Main Methods:

• Conducted a systematic literature review using PubMed, EMBASE, and Google Scholar.
• Included studies with comparative quantitative assessments of topical vasodilators.
• Analyzed in vitro, in vivo, and clinical studies.

Main Results:

• Fifteen studies were included in the analysis.
• Calcium channel blockers (CCBs), papaverine, and lidocaine were the most common classes studied.
• CCBs (nifedipine, verapamil) demonstrated the highest efficacy, followed by papaverine and lidocaine.

Conclusions:

• Calcium channel blockers (nifedipine, nicardipine, verapamil) are the most effective topical vasodilators.
• CCBs show superior efficacy compared to commonly used papaverine and lidocaine.
• Further research is needed to compare individual CCBs and study their effects on specific microsurgical vessels.