Do vasoactive agents negatively influence the success of Maxillo-Facial microvascular free-flap surgery: A retrospective audit
Introduction: Microvascular free-flap surgery has become the gold standard in Head and Neck oncology reconstruction. Current literature states free-flap success rates of 95%. Evidence suggests that adverse effect on blood flow to the flap remains the primary cause of failure, which may be linked to the type of vasoconstrictor used during anaesthesia. The premise of this audit is to assess the success rate of microsurgical free-flaps in the Oral and Maxillo-facial Surgery department at Royal Derby Hospital (RDH) and review whether the administration of vasoactive agents has an effect on this.Aims: To determine the success rate of Maxillo-Facial free-flap surgery at RDH. To determine whether the use of vasoactive agents has any effect on the success rates.Methods: A retrospective sample of 123 consecutive patients was analysed. Data collected included the type of free-flap used, the success of the flap, the type of vasoconstrictor used and the administration method. Results: There were 4 flap failures giving a success rate of 97%. Two vasoconstrictors were used intraoperatively; Noradrenaline, Metaraminol or a combination of the two. These were administered via different methods; infusion, single or multiple boluses. No association was found between the use of vasoconstrictors and flap failure. No association was found between the method of vasoconstrictor administration and flap failure.Conclusions: This audit suggests that administration of vasoconstrictors appears to have no detrimental effect on the success rate of microvascular free-flap surgery. In addition, the mode and type of vasoconstrictor administered does not appear to influence these success rates.