Related Experiment Video
Updated: Jun 17, 2025
A Modified Vessel-Sparing Microsurgical Vasoepididymostomy
Published on: June 8, 2022
Microsurgery and vasospasms: Spasms' predictive factors during harvesting
Germain Pomares1, Amandine Ledoux1, Thomas Jager1
1Institut Européen de la Main, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, L2540 Luxembourg, Luxembourg.
Background:
Vasospasm (VS) in microsurgery is a source of surgical complications, repeat operations, stress for the patient and the surgical team, as well as increased length of stay. Various risk factors have been identified but knowledge regarding the implicated mechanism remains limited.
Hypothesis:
Our objective was to determine if the harvesting conditions for microsurgical toe transfers could increase the risk of VS. Our secondary objective was to determine the correlation between VS occurrence before flap division, and the occurrence of vascular complications after completion of vascular anastomoses.
Patients And Methods:
Primary endpoints were the existence of locoregional anaesthesia of the lower limb, the Gilbert classification, the nature of the graft taken from the foot, the characteristics of the patients and smoking status. Our secondary endpoints were the presence of secondary VS or microsurgical failure. This series consists of 14 toe transfers over a 30-month period. Primary VS was defined as occurring prior to flap division, while secondary VS occurred after transfer.
Results:
In this series, we identified 4 cases of primary VS. The average age of the operated population was 30.6 ± 11.2 years (16-58). The patients who presented with primary VS had a mean age of 35.3 ± 16.2 years (21-58), with no statistical difference with the other group (p = 0.54). There was a statistically significant difference between the absence of locoregional anaesthesia and the occurrence of primary VS in toe transfer (p = 0.0008). Microsurgical failure occurred in 1 case. This failure was linked to the presence of a primary VS. Gilbert's classification and type of graft were not predictive of VS (p = 0.15 and p = 0.08, respectively). The occurrence of secondary VS was statistically linked to the occurrence of primary VS (p = 0.009).
Discussion:
The occurrence of VS remains unpredictable and the effectiveness of available treatments is debated in the literature. Faced with the failure of curative treatments, this study aimed to determine predictive factors for VS. The existence of secondary VS, when prolonged and non-responsive to conventional measures, can lead to anastomotic revision. Performing locoregional anaesthesia on the lower limb makes it possible to effectively combat the occurrence of VS. The absence of primary VS was correlated with an absence of secondary VS and an absence of microsurgical failure. In addition to controlling vasospasm, regional anaesthesia provides effective analgesia at the harvesting site.
Level Of Evidence:
IV.
Insights
Locoregional anesthesia in toe transfers significantly reduces vasospasm (VS) risk, preventing complications and microsurgical failure. Absence of primary VS correlates with better outcomes, highlighting anesthesia
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.
