Summary
Background
Vasopressor use in patients undergoing autologous free tissue transfer is generally
discouraged by surgeons perioperatively. This stems from concerns about the increased
risk of flap failure with their use. The aim of this systematic review was to investigate
the evidence and quantify any harm or benefits associated with vasopressor use.
Methods
A systematic review of the literature was undertaken using OVID Medline to search
13 databases. The search strategy used Boolean operators, text word searches, truncation
symbols, and adjacency searching. Terms such as “free flap,” “free tissue graft,”
and “free tissue transfer” were used along with a list of appropriate vasopressors.
The primary outcome was free flap failure, on which a meta-analysis was performed.
Result
The search initially identified 1029 unique articles, which after title and abstract
screening was reduced to 112, of which 15 remained after full-text screening for inclusion
in the review and analysis. We analyzed data from 8427 flaps, with 6695 having received
a vasopressor. Meta-analysis demonstrated that vasopressor use reduced the relative
risk (RR) of free flap failure (RR: 0.70; 95% CI: 0.50–0.97; p = 0.03) but did not affect rates of other adverse events (RR: 0.81; 95% CI: 0.63–1.05;
p = 0.11).
Conclusion
Vasopressor use appears beneficial for autologous free tissue transfer, with evidence
that it reduced the risk of flap failure without impacting the rates of other adverse
events. The use of vasopressors should, therefore, be encouraged on a case-by-case
basis, depending upon the general physiological needs of the patient.
Keywords
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Article info
Publication history
Published online: August 28, 2022
Accepted:
August 18,
2022
Received:
March 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
