Taylor Robert J, Patel Rusha, Wolf Bethany J, Stoll William D, Hornig Joshua D, Skoner Judith M, Hand William R, Day Terry A
Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Department of Otolaryngology-Head & Neck Surgery, West Virginia University, Morgantown, West Virginia, USA.
Microsurgery. 2021 Jan;41(1):5-13. doi: 10.1002/micr.30677. Epub 2020 Nov 10.
Historically, there were concerns vasopressors impair free flap outcomes, but recent studies suggest vasopressors are safe. Here we investigate this controversy by (1) evaluating vasopressors' effect on head and neck free-flap survival and surgical complications, and (2) performing soft tissue and bony subset analysis.
Post hoc analysis was performed of a single-blinded, prospective, randomized clinical trial at a tertiary care academic medical center involving patients ≥18 years old undergoing head and neck free flap reconstruction over a 16-month period. Patients were excluded if factors prevented accurate FloTrac™ use. Patients were randomized to traditional volume-based support, or goal-directed support including vasopressor use. Primary data was obtained by study personnel through intraoperative data recording and postoperative medical record review.
Forty-one and 38 patients were randomized to traditional and pressor-based algorithms, respectively. Flap survival was 95% (75/79). There was no significant difference between the pressor-based and traditional protocols' flap failure (1/38 [3%] vs. 3/41 [7%], RR 0.36, 95% CI of RR 0.04-3.31, p = .63) or flap-related complications (12/38 [32%] vs. 18/41 [44%], RR 0.72, 95% CI 0.40-1.29, p = .36) Soft tissue flaps had surgical complication rates of 12/30 (40%) and 9/27 (33%) for traditional and pressor-based protocols, respectively. Bony flaps had surgical complication rates of 6/11 (55%), and 3/11 (27%) for traditional and pressor-based protocols, respectively.
Intraoperative goal-directed vasopressor administration during head and neck free flap reconstruction does not appear to increase the rate of flap complications or failures.
从历史上看，人们担心血管升压药会影响游离皮瓣的效果，但最近的研究表明血管升压药是安全的。在此，我们通过以下方式来研究这一争议：（1）评估血管升压药对头颈部游离皮瓣存活和手术并发症的影响；（2）进行软组织和骨组织亚组分析。
在一家三级医疗学术中心，对一项单盲、前瞻性、随机临床试验进行事后分析，该试验涉及16个月内接受头颈部游离皮瓣重建的18岁及以上患者。如果存在妨碍准确使用FloTrac™的因素，则将患者排除。患者被随机分为传统的基于容量的支持组或包括使用血管升压药的目标导向支持组。主要数据由研究人员通过术中数据记录和术后病历审查获得。
分别有41例和38例患者被随机分配到传统算法组和基于血管升压药的算法组。皮瓣存活率为95%（75/79）。基于血管升压药的方案与传统方案在皮瓣失败率（1/38 [3%] 对 3/41 [7%]，RR 0.36，RR的95% CI为0.04 - 3.31，p = 0.63）或皮瓣相关并发症发生率（12/38 [32%] 对 18/41 [44%]，RR 0.72，95% CI 0.40 - 1.29，p = 0.36）方面无显著差异。传统方案和基于血管升压药的方案中，软组织皮瓣的手术并发症发生率分别为12/30（40%）和9/27（33%）。骨组织皮瓣的手术并发症发生率，传统方案为6/11（55%），基于血管升压药的方案为3/11（27%）。
头颈部游离皮瓣重建术中进行目标导向的血管升压药给药似乎不会增加皮瓣并发症或失败的发生率。
