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Related Experiment Video

Updated: Dec 15, 2025

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Vasodilation by Verapamil-Nitroglycerin Solution in Microvascular Surgery.

Rahul Seth1, Karam W Badran1,2, Elizabeth Cedars1

  • 1Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|July 8, 2020
PubMed
Summary

A verapamil and nitroglycerin (VG) solution effectively dilated blood vessels during microvascular surgery, showing a 48% increase in artery diameter. This safe and effective vasodilator is a viable alternative to papaverine for free tissue transfers.

Keywords:
anastomosisantispasmodicfree flaphead and neck reconstructionmicrovascular surgerynitroglycerinpapaverinevasodilatorvasospasmverapamil

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Area of Science:

  • Vascular Surgery
  • Pharmacology
  • Microsurgery

Background:

  • Papaverine is a common topical vasodilator in microvascular surgery.
  • A national shortage of papaverine necessitated exploring alternative vasodilators.
  • Verapamil and nitroglycerin (VG) solution is evaluated as a potential papaverine alternative.

Purpose of the Study:

  • To assess the efficacy and safety of a verapamil and nitroglycerin (VG) solution as a pharmacologic vasodilator in microvascular free tissue transfer.
  • To evaluate the impact of VG solution on recipient artery diameter and compare its complication profile to papaverine.

Main Methods:

  • Retrospective case series at two academic medical centers.
  • Analysis of 306 free tissue transfers using VG solution for head and neck reconstruction (2014-2017).
  • Measurement of cervical recipient artery diameter before and after VG solution application in 44 flaps.

Main Results:

  • The VG solution increased mean recipient artery diameter by 48% (2.1 mm to 3.1 mm, P < .01).
  • Only 0.98% of flaps failed due to reasons unrelated to the VG solution.
  • No intraoperative cardiac events or complications were attributed to the VG solution.

Conclusions:

  • The VG solution demonstrated safe and effective pharmacologic vasodilation in microvascular free tissue transfer.
  • The observed vasodilation was apparent and sustained.
  • VG solution is a safe and efficacious alternative to papaverine in microvascular surgery.