Abstract
Anesthesia for free flap reconstruction surgery is challenging due to its length and invasive nature. Although maintaining the blood flow of the skin flap is vital to flap survival, circulatory disturbance of the flap may occur due to postoperative hypotension (PH). We hypothesized that PH can be a risk factor for flap complications. In this report, the predictors of PH and the incidence rate of flap complications are discussed.
We retrospectively investigated the causes of PH and the incidence of flap complications. Patients diagnosed with head and neck cancer who underwent cancer resection and immediate free flap reconstruction were enrolled in the study. Subjects were divided in two groups -the PH group (n = 46), and the non-PH group (n = 36) - according to the occurrence of PH after surgery. The PH group included patients who received additional fluid therapy and vasopressor support when systolic arterial pressure was below 90 mmHg. We evaluated the condition of the flaps from medical records.
There was no significant difference in the incidence of flap failure between the two groups. However, the incidence of poor flap circulation, total fluid balance during surgery, and systemic inflammatory response syndrome was significantly higher in the PH group. We must be aware of the risk of PH is order to prevent poor flap circulation.
