The Use of Vasopressors in Pedicled Flaps for Chest Wall Reconstruction

• Published in: Annals of plastic surgery Vol. 79; no. 3; pp. e11 - e14
• Main Authors: Kite, Amy C, Nigro, Lauren C, Feldman, Michael J, Pozez, Andrea L
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-09-2017
• Subjects: Adult; Female; Follow-Up Studies; Graft Survival; Humans; Male; Mammaplasty - statistics & numerical data; Middle Aged; Muscle, Skeletal - surgery; Postoperative Complications - epidemiology; Retrospective Studies; Surgical Flaps - statistics & numerical data; Thoracic Neoplasms - surgery; Thoracic Wall - surgery
• ISSN: 0148-7043; 1536-3708
• DOI: 10.1097/SAP.0000000000001108

INTRODUCTIONThe effect of vasopressors on flaps remains controversial in the literature. Often, surgeons avoid vasopressors with the thought that vasoconstriction reduces flap perfusion resulting in flap loss.
METHODSA retrospective review was performed on patients who required chest wall reconstruction from 1998 to 2013. Patients were identified through the use of Current Procedural Terminology codes. The data collected included demographics, indications for surgery, prior debridement, preoperative albumin levels, and perioperative vasopressor use. Outcomes measures included flap survival, flap complications, reoperation rates, intensive care unit length of stay, and mortality.
RESULTSOf the 1220 patient records reviewed, 88 had chest reconstruction by a plastic surgeon. Twenty-one patient records were excluded due to incomplete data. One patient experienced complete flap loss; these data were excluded from statistical analysis. Fifty patients received perioperative vasopressors whereas 15 did not. There was no significant difference in flap survival or loss between groups who received perioperative vasopressors and those who did not receive vasopressors. Age, intensive care unit length of stay, flap complications, and reoperation rates were significantly higher in those with partial flap survival.
CONCLUSIONSPerioperative vasopressor use does not adversely affect the outcome of pedicled flaps for chest wall reconstruction. Further research is warranted to review the effects of vasopressor dose and type on pedicled flaps.