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. 2025 Jul;45(5):e70095.
doi: 10.1002/micr.70095.

Impact of Vasopressors on Microvascular Free Flap Perfusion in Head and Neck Reconstruction

Mark Ooms  1 , Philipp Winnand  1 , Marius Heitzer  1 , Nils Vohl  1 , Marie Katz  1 , Johannes Bickenbach  2 , Frank Hölzle  1 , Ali Modabber  1
Affiliations

Impact of Vasopressors on Microvascular Free Flap Perfusion in Head and Neck Reconstruction

Mark Ooms et al. Microsurgery. 2025 Jul.

Abstract

Introduction: 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.

Materials and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: flap perfusion; free flap; head and neck reconstruction; microsurgery; vasopressors.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Postoperative flap blood flow and vasopressor dose in PFFs. Scatter plot for postoperative flap blood flow (AU) and vasopressor dose (μg/min per kg) in PFFs; r and p value corresponding to Spearman correlation coefficient (*p = 0.022 upon adjustment for mean arterial blood pressure (mmHg), flap ischemia duration (min), flap size (cm2), and flap type (anterolateral thigh flap vs. fibula free flap) in multiple regression analysis); abbreviations: AU, arbitrary units.
FIGURE 2
FIGURE 2
Postoperative flap flow conductance and vasopressor dose in PFFs. Scatter plot for postoperative flap flow conductance (AU/mmHg) and vasopressor dose (μg/min per kg) in PFFs; r and p value corresponding to Spearman correlation coefficient (*p = 0.023 upon adjustment for flap ischemia duration (min), flap size (cm2), and flap type (anterolateral thigh flap vs. fibula free flap) in multiple regression analysis); abbreviations: AU, arbitrary units.
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