Vasoactive Agents Do Not Adversely Influence the Success of Maxillo-Facial Microvascular Free-flap Surgery: A Retrospective Analysis

Introduction: Microvascular free-flap surgery has become the gold standard in Head and Neck oncology reconstruction with published success rates of ≥95%. Evidence suggests that poor blood flow to the flap remains the primary cause of failure and this might be linked to the type of vasoconstrictor used during anaesthesia. Aims: The objectives of this analysis were (1) an assessment of the success rate of microsurgical free-flaps placed by the Oral and Maxillo-Facial surgeons at the Royal Derby Hospital, (2) whether the intraoperative administration of vasoactive agents had a negative effect on this success, (3) to investigate whether type and/or method of administration of vasoactive agents influences flap success rates. Methods: A sample of 123 consecutive patients undergoing surgery in an eight-year period were analysed retrospectively. Data collected included the type of free-flap used, the success of the procedure, the type of vasoconstrictor used and the drug administration method. Results: There were 119 successful flaps and 4 failures giving a success rate of 97% in the study period. Two vasoconstrictors (noradrenaline and metaraminol) were used intraoperatively, either alone or in combination. These agents were administered by differing methods depending on anaesthetic choice. No association was found between the use of vasoconstrictors and flap failure. Nor was there an association between the method of vasoconstrictor administration and flap failure. Conclusions: This analysis of a limited number of patients indicates that administration of a vasoconstrictor appears to have no detrimental effect on the success rate of microvascular free-flap surgery. Further, the type of vasoconstrictor and mode of administration does not appear to influence these success rates.