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J Reconstr Microsurg
DOI: 10.1055/a-2687-0254
Original Article

Intraoperative Vasopressor Use Does Not Adversely Impact Free Flap Outcomes in Lower Extremity Limb Salvage Procedures in a Highly Comorbid Atraumatic Wound Population

Authors

  • Rachel N. Rohrich 

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Nicole C. Episalla

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Ryan P. Lin

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Sami Ferdousian 

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
    2   Georgetown University School of Medicine, Washington, District of Columbia, United States

  • Julie Suh

    2   Georgetown University School of Medicine, Washington, District of Columbia, United States

  • Maeesha Noshin

    2   Georgetown University School of Medicine, Washington, District of Columbia, United States

  • Luke J. Llaurado

    2   Georgetown University School of Medicine, Washington, District of Columbia, United States

  • Richard C. Youn

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Christopher E. Attinger

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Cameron M. Akbari

    3   Department of Vascular Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Russell T. Wall

    4   Department of Anesthesiology, MedStar Georgetown University Hospital, Washington, District of Columbia, United States

  • Karen K. Evans

    1   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
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Abstract

Background

The use of vasopressors during microsurgical reconstruction is debated. Their effect on the comorbid lower extremity (LE) wound population is unstudied. This study characterizes the impact of intraoperative vasopressor use in LE free tissue transfer (FTT) for limb salvage.

Methods

A review of LE FTT from February 2017 to June 2024 was conducted. Flap outcomes within 7 and 42 days were evaluated, as well as long-term limb salvage.

Results

Of 258 LE FTT performed, vasopressors were used in 177 cases (68.6%). Most vasopressors were administered via intermittent bolus only (75.7%) or combined with continuous infusion (23.7%). American Society of Anesthesiologists Class was significantly higher in the vasopressor group compared with controls (p = 0.001). The vasopressor group trended to have higher median Charlson Comorbidity Indices (4, interquartile range [IQR]: 3 vs. 3, IQR: 3; p = 0.055), and rates of diabetes (65.0% vs. 54.3%, p = 0.103), peripheral vascular disease (63.8% vs. 51.9%, p = 0.068), and chronic kidney disease (14.7% vs. 6.2%, p = 0.063). The rate of reoperation, microvascular thrombosis, or flap success at 7 and 42 days did not differ between groups. By a median long-term follow-up of 24.5 (IQR: 39.2) months, rates of major limb amputation (vasopressor: 10.7% vs. control: 7.4%, p = 0.402) and mortality (6.8% vs. 2.5%, p = 0.237) were similar between groups.

Conclusion

In this complex population, intraoperative use of vasopressors does not appear to negatively impact flap viability or limb salvage.

Keywords

free flap - vasopressor - microsurgery - chronic wounds - lower extremity

Supplementary Material



Publication History

Received: 14 February 2025

Accepted: 18 August 2025

Article published online:
05 September 2025

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