Microsurgery and vasospasms: Spasms' predictive factors during harvesting.

Area of Science:

• Microsurgery
• Vascular Surgery
• Anesthesiology

Background:

• Vasospasm (VS) is a significant complication in microsurgery, leading to repeat operations and increased hospital stays.
• Limited knowledge exists regarding the mechanisms and predictive factors of VS in microsurgical procedures.

Purpose of the Study:

• To investigate if microsurgical toe transfer harvesting conditions increase VS risk.
• To determine the correlation between VS occurrence before flap division and subsequent vascular complications.

Main Methods:

• Retrospective analysis of 14 toe transfers over 30 months.
• Primary endpoints included locoregional anesthesia, Gilbert classification, graft type, patient demographics, and smoking status.
• Secondary endpoints assessed were primary VS (before flap division) and secondary VS (after transfer), and microsurgical failure.

Main Results:

• Four cases of primary VS were identified; no significant age difference was noted.
• Absence of locoregional anesthesia was statistically linked to primary VS (p=0.0008).
• Primary VS was associated with microsurgical failure (1 case) and secondary VS (p=0.009).

Conclusions:

• Vasospasm remains unpredictable, but locoregional anesthesia effectively combats its occurrence in toe transfers.
• Absence of primary VS correlates with absence of secondary VS and microsurgical failure.
• Regional anesthesia offers effective analgesia and vasospasm control at the harvesting site.