Anker, Alexandra M. and Prantl, Lukas and Strauss, Catharina and Brebant, Vanessa and Schenkhoff, Felix and Pawlik, Michael and Vykoukal, Jody and Klein, Silvan M. (2020) Assessment of DIEP Flap Perfusion with Intraoperative Indocyanine Green Fluorescence Imaging in Vasopressor-Dominated Hemodynamic Support Versus Liberal Fluid Administration: A Randomized Controlled Trial With Breast Cancer Patients. ANNALS OF SURGICAL ONCOLOGY, 27 (2). pp. 399-406. ISSN 1068-9265, 1534-4681
Full text not available from this repository. (Request a copy)Abstract
Background. Dogmatic denial of vasopressor agents for blood pressure regulation during free-flap surgery is associated with concomitant large-volume intraoperative fluid administration. Yet, the doctrinal banning of vasopressors during microvascular breast reconstruction still is a subject of controversy. Several retrospective observations have recently drawn attention to serious iatrogenic consequences of intravenous crystalloid overload in microsurgery such as thrombus formation and increased flap failure rates. Methods. This prospective randomized controlled trial investigated the potential effects of fluid-restrictive vasopressor-dominated hemodynamic support (FRV) compared with vaso-pressor-restrictive liberal fluid administration (LFA) on clinically relevant perfusion of the deep inferior epigastric perforator (DIEP) flap via intraoperative indocyanine green (ICG) fluorescence imaging. The primary end point of the study was quantitative assessment of the percentage of insufficiently perfused tissue (NP) on the overall flap. Major complications were assessed as secondary end points. Results. In 44 DIEP flap breast reconstructions after mastectomy, FRV circulatory support resulted in no statistically significant difference in total flap perfusion as detected via ICG fluorescence imaging in direct comparison with a traditional LFA strategy (NPFRV, 31.8% +/- 12.2% vs NPLFA, 29.5% +/- 13.3%; p = 0.559). One flap failure was registered with LFA, whereas no major complication occurred in the FRV cohort. Conclusions. According to the results of this study, neither a norepinephrine concentration of 0.065 +/- 0.020 mu g/kg/min (FRV) nor fluid administration of 5.1 +/- 2.2 ml/kg/h (LFA) has a clinically significant impact on microperfusion in a standard DIEP flap procedure for breast reconstruction. Consistent with the current literature reporting a rise in complications with intraoperative fluid over-resuscitation, one flap failure occurred in the LFA cohort.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FREE TISSUE TRANSFER; OF-THE-LITERATURE; MANAGEMENT STRATEGIES; ENHANCED RECOVERY; MAJOR SURGERY; RECONSTRUCTION; HEAD; COMPLICATIONS; NECK; EPINEPHRINE; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Plastische-, Hand- und Wiederherstellungschirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 31 Mar 2021 09:02 |
| Last Modified: | 31 Mar 2021 09:02 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45283 |
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