Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction – a randomized controlled trial

Anker, Alexandra; Prantl, Lukas; Strauss, Catharina; Brébant, Vanessa; Heine, Norbert; Lamby, Philipp; Geis, Sebastian; Schenkhoff, Felix; Pawlik, Michael; Klein, S.

doi:10.3233/ch-189129

Cited by 26 publications

(23 citation statements)

References 31 publications

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“…A variety of defects were reconstructed, most commonly of the head and neck 13,15,16,[19][20][21][22][23][24]26 and breast. 14,16,18,23,25,27 Most studies reported no significant association between vasopressor use and the outcome measures of this study. Isolated studies found increased pedicle thrombosis with postoperative vasopressor use (OR: 3.40, p < 0.05) 22 and increased flap-related complications with intraoperative vasopressor use (OR: 1.67, p < 0.01).…”

Section: Resultsmentioning

confidence: 57%

“…Alpha-1 and β2 receptors found on vascular smooth muscle mediate peripheral vasoconstriction and vasodilatation, respectively. 37 Alpha-2 receptor activation 18 Chen et al 2010 14 Fang et al 2018 16 Nelson et al 2017 25 41/2527 (1. 18 Fang et al 2018 16 Nelson 19 Fang et al 2018 16 Farquhar et al 2018 20 Harris et al 2012 15 Monroe et al 2010 13 Monroe et al 2011 24 Rose Chan et al 2013 19 Fang et al 2018 16 Monroe et al 2010 13 Monroe et al 2011 24 98/2947 (3.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies involving 1,337 cases reported their overall flap complication rates. [13][14][15]18,20,21,23,26 Comparing 842 cases who received vasopressors with 495 cases who did not, there was no significant difference in flap complication rates (OR: 0.92, 95% CI: 0.67-1.26, p ¼ 0.61) among these statistically homogenous studies (I 2 ¼ 0%). Overall flap complication rates were deduced in four other studies by totaling the numbers for each flap-related complication that was reported.…”

Section: Meta-analysis Of Flap Outcomesmentioning

confidence: 97%

“…Twelve studies with a total of 7,969 cases (6,304 vasopressor, 1,665 non-vasopressor) provided extractable data to perform meta-analysis of free flap outcomes. [13][14][15][16][18][19][20][21][23][24][25][26] Two studies could not be included as outcomes were reported in percentages and OR only. 22,27 We found that total flap failure was significantly less likely in the vasopressor group (OR: 0.71, 95% CI: 0.50-0.99, p ¼ 0.05) with low heterogeneity in the results (I 2 ¼ 17%; ►Fig.…”

Section: Meta-analysis Of Flap Outcomesmentioning

confidence: 99%

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Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Goh

Song

et al. 2019

J reconstr Microsurg

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Background The use of vasopressors in free flap surgery has traditionally been avoided due to the presumed risk of pedicle vasospasm leading to flap failure. However, there is a lack of strong clinical evidence to suggest that their administration during microvascular surgery is absolutely contraindicated. The aim of this study is to clarify the impact of perioperative vasopressor use on free flap outcomes. Methods A systematic review was performed of all English-language articles that have compared free flap outcomes between patients who received vasopressors and those who did not. The outcome measures were total flap failure, pedicle thrombosis, and overall flap complications. Meta-analysis was performed using Mantel–Haenszel fixed-effects and DerSimonian and Laird random-effects models. Results From a total of 130 citations, 14 studies representing 8,653 cases were analyzed. Majority of these did not find any negative effects of vasopressor use irrespective of dose, timing of administration, and method of delivery. Meta-analysis demonstrated that vasopressors were associated with less total flap failure overall (odds ratio, [OR]: 0.71, p = 0.05) and less pedicle thrombosis in head and neck reconstruction specifically (OR: 0.58, p = 0.02). Flap complication rates were similar across all defect types (OR: 0.97, p = 0.81) but appeared to be increased in breast reconstruction (OR: 1.46, p = 0.01). Conclusion Perioperative vasopressor administration does not appear to be as detrimental to free flap survival as has been previously feared. Their role in optimizing hemodynamic stability may have a more beneficial effect on overall flap perfusion and in minimizing the complications of iatrogenic fluid overload.

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Section: Resultsmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Meta-analysis Of Flap Outcomesmentioning

confidence: 97%

Section: Meta-analysis Of Flap Outcomesmentioning

confidence: 99%

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Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Goh

Song

et al. 2019

J reconstr Microsurg

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“…Ein kürzerer Krankenhausaufenthalt steigert das subjektive Wohlbefinden, senkt das Risiko für nosokomiale Infektionen (e. g. Wundinfektion, Harnwegsinfekte) sowie die Behandlungskosten [15,16]. Im Sinne des Fast-Track-Konzeptes begünstigt eine Senkung der stationären Verweildauer die postoperative Rehabilitation und Morbidität nachweislich [17][18][19].…”

Section: Diskussionunclassified

Verzicht auf Drainagen bei der Abdominoplastik – eine randomisiert-kontrollierte Studie

Anker

Prantl

Baringer

et al. 2020

Handchir Mikrochir Plast Chir.

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ZUSAMMENFASSUNG Einleitung Es gibt keine wissenschaftliche Evidenz aus randomisiert-kontrollierten Studien, die für eine routinemäßige Anlage von subkutanen Drainagen bei körperformenden Eingriffen in der Plastischen Chirurgie spricht. Die vorliegende Studie untersucht, inwiefern sich ein Verzicht auf Wunddrainagen bei Abdominoplastik auf das Seromvolumen, die stationäre Verweildauer und postoperative Komplikationen auswirkt. Material und Methoden Die Studienteilnehmer wurden prospektiv in zwei Gruppen mit Anlage von Drainagen (MD) und ohne Anlage von Drainagen (OD) bei Abdominoplastik randomisiert. Einschlusskriterien waren eine Abdominoplastik mit horizontaler oder kombiniert horizontal/vertikaler Schnittführung unter Schonung der Scarpa-Faszie und ein BMI ≤ 30 kg/m2. Ausschlusskriterien beinhalteten eine simultane Liposuction des Operationsgebietes, bekannte Gerinnungsstörungen sowie ein ASA-Score ≥ 3. Das kumulative Seromvolumen über einen Beobachtungszeitraum von 4 Wochen wurde als primärer Endpunkt definiert. Die stationäre Verweildauer und revisionspflichtige Komplikationen stellten sekundäre Endpunkte dar. Resultate Bei 53 Studienteilnehmern wies das kumulative Seromvolumen keinen statistisch signifikanten Unterschied zwischen den beiden Studienpopulationen MD (30/53) und OD (23/53) auf (MMD 493 ± SD 407 ml; MOD 459 ± SD 624 ml; p = 0,812). Verglichen mit dem MD-Patientenkollektiv, konnte durch den Verzicht auf Wunddrainagen in der OD-Kohorte eine signifikant kürzere mittlere stationäre Verweildauer erzielt werden (MMD 5,1 ± SD 1,4 d; MOD 4,2 ± SD 1,5 d; p = 0,023). Beide Studiengruppen hatten identische Komplikationsraten (nMD = 1; nOD = 1). Schlussfolgerung Bezugnehmend auf die Ergebnisse der vorliegenden Erhebung, kann bei präadipösen Patienten (BMI ≤ 30 kg/m2) ein routinemäßiger Verzicht auf Drainagen bei Abdominoplastik (horizontale, kombiniert horizontale/vertikale Schnittführung) in Erwägung gezogen werden. Die Anlage von Drainagen sollte lediglich auf patientenindividueller Basis erfolgen.

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Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery

et al. 2023

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Blood pressure regulation is critical in patients undergoing microsurgical free tissue transfer; however, guidelines for addressing and preventing perioperative hypotension remain highly debated, with two current thought paradigms: (1) intravenous fluid administration with a balanced salt solution (e.g., lactate ringer and normal saline) and/or colloid (e.g., albumin) and (2) vasoactive pharmacological support with vasopressors (e.g., dobutamine, norepinephrine, epinephrine), with fluid administration being the preferred conventional approach. Here, we review the most up to date available literature and summarize currents perspectives and practices for fluid resuscitation and vasopressor use, while offering evidence‐based guidelines to each.

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Vasopressor support vs. liberal fluid administration in deep inferior epigastric perforator (DIEP) free flap breast reconstruction – a randomized controlled trial

Cited by 26 publications

References 31 publications

Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Perioperative Vasopressor Use in Free Flap Surgery: A Systematic Review and Meta-Analysis

Verzicht auf Drainagen bei der Abdominoplastik – eine randomisiert-kontrollierte Studie

Evidence based recommendations for perioperative vasopressor use and fluid resuscitation in microsurgery

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