Abstract
Background Postoperative microvascular arterial vasospasm is a rare clinical entity. There are
no published management algorithms and also the pathophysiology of this phenomenon
has not been elucidated.
Methods An email survey of American Society for Reconstructive Microsurgery (ASRM) and World
Society for Reconstructive Microsurgery (WSRM) members regarding their experiences
with postoperative arterial vasospasm was conducted, returning 116 responses. A comprehensive
literature search was conducted regarding the current body of knowledge on this entity.
Results Sixty-five percent of respondents encountered cases where postoperative arterial
vasospasm was clearly the cause of flap ischemia. The majority (62%) of surgeons believed
a damaged segment of the artery was responsible for the spasm, with technical issues
cited as the most likely cause. Sixty-two percent and 50% of surgeons used segmental
resection of the recipient and donor vessels, respectively.
Rated for proclivity to vasospasm, superficial inferior epigastric artery (SIEA) was
the flap, superior thyroid artery (STA) the recipient vessel, and the lower limb the
anatomic region most frequently mentioned.
Most widely used management strategies were: topical vasodilators (91%), adventitial
stripping (82%), and dilation of recipient and donor vessels (76%). Over 50% of surgeons
used some type of vessel resection technique.
Conclusions When flap ischemia is encountered without mechanical issues or thrombus, vasospasm
can be the root cause. Certain vessels (SIEA, STA) and anatomic regions (lower limb)
pose a higher risk for this phenomenon. When a vessel is affected, it is common practice
to excise the questionable segment and use a graft as needed. Vessel resection as
part of a multimodal approach can result in a reasonable salvage rate.
Keywords
vasospasm - microsurgery - arterial spasm - postoperative - vasodilator
