Vasopressors improve outcomes in autologous free tissue transfer: A systematic review and meta-analysis

  • Omar Noori
    School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
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  • Jose L Pereira
    School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
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  • Despoina Stamou
    Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
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  • Sydney Ch'ng
    School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia

    Melanoma Institute Australia, North Sydney, NSW, Australia

    Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Royal Prince Alfred Hospital Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
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  • Alexander HR Varey
    Corresponding author at: Department of Plastic Surgery, Westmead Hospital, Sydney, NSW, Australia.
    School of Medicine, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia

    Melanoma Institute Australia, North Sydney, NSW, Australia

    Department of Plastic Surgery, Westmead Hospital, Sydney, NSW, Australia
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Published:August 28, 2022DOI:



      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.


      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.


      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).


      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.


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