Ooms Mark, Winnand Philipp, Heitzer Marius, Vohl Nils, Katz Marie, Bickenbach Johannes, Hölzle Frank, Modabber Ali
Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.
Microsurgery. 2025 Jul;45(5):e70095. doi: 10.1002/micr.70095.
The use of vasopressors in microvascular head and neck reconstruction is still controversial in view of its potentially negative influence on microvascular flap perfusion, which is crucial for flap viability and commonly used as a parameter in flap monitoring. The aim of this study was to investigate the influence of vasopressors on microvascular free flap perfusion.
Perfusion measurement data recorded intraoperatively and postoperatively using the Oxygen-2-see (O2C) analysis system in 274 patients undergoing microvascular head and neck reconstruction with fasciocutaneous free flaps (FFFs) or perforator free flaps (PFFs) between 2011 and 2020 were analyzed retrospectively. Vasopressor dose and perfusion parameters, such as flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation, as well as flap flow conductance (calculated as the ratio of flap blood flow and mean arterial blood pressure), were tested for associations.
Intraoperative hemoglobin oxygen saturation and postoperative flap blood flow were negatively associated with vasopressor dose in PFFs (r = -0.307, p < 0.001; r = -0.211, p = 0.012, respectively). Both associations remained in multivariable analysis (p = 0.002; p = 0.022, respectively). Postoperative flap flow conductance was negatively associated with vasopressor dose in PFFs (r = -0.232, p = 0.008). This association remained in multivariable analysis (p = 0.023).
The use of vasopressors influences microvascular free flap perfusion in PFFs in terms of intraoperative hemoglobin oxygen saturation, postoperative flap blood flow, and postoperative flap flow conductance. This suggests that the use of vasopressors in PFFs may be an adjustable variable for controlling flap perfusion and should be considered a confounding variable during flap monitoring based on flap perfusion.
鉴于血管升压药对微血管皮瓣灌注可能产生负面影响，而微血管皮瓣灌注对皮瓣存活至关重要，且通常作为皮瓣监测的一个参数，因此在微血管头颈部重建中使用血管升压药仍存在争议。本研究的目的是探讨血管升压药对游离微血管皮瓣灌注的影响。
回顾性分析2011年至2020年间274例行微血管头颈部重建术并采用游离筋膜皮瓣（FFFs）或穿支游离皮瓣（PFFs）的患者术中及术后使用Oxygen-2-see（O2C）分析系统记录的灌注测量数据。对血管升压药剂量与灌注参数，如皮瓣血流量、血红蛋白浓度和血红蛋白氧饱和度，以及皮瓣血流传导率（计算为皮瓣血流量与平均动脉血压之比）进行相关性测试。
在PFFs中，术中血红蛋白氧饱和度和术后皮瓣血流量与血管升压药剂量呈负相关（r分别为-0.307，p<0.001；r为-0.．211，p = 0.012）。在多变量分析中，这两种相关性均仍然存在（p分别为0.002；p = 0.022）。术后皮瓣血流传导率与PFFs中的血管升压药剂量呈负相关（r = -0.232，p = 0.008）。在多变量分析中，这种相关性仍然存在（p = 0.023）。
血管升压药的使用在术中血红蛋白氧饱和度、术后皮瓣血流量和术后皮瓣血流传导率方面影响PFFs的游离微血管皮瓣灌注。这表明在PFFs中使用血管升压药可能是控制皮瓣灌注的一个可调节变量，并且在基于皮瓣灌注的皮瓣监测期间应被视为一个混杂变量。
