Effect of intraoperative dopamine on free flap survival in a rat model: a double-blind, randomized, controlled trial.

BACKGROUND The classic teaching is that free flaps have unique postsurgical transfer physiology that renders them highly sensitive to vasoactive drugs owing to the complete denervation of the tissue. There are no basic or animal studies on this phenomenon, and expert opinion is against the use of vasoactive substances in free flap surgeries. It has been our general impression that judicial use of ionotropes to support perfusion does not affect free flap survival. OBJECTIVE The purpose of this study was to determine the effect on free flap survival of the intraoperative use of dopamine in a free flap rat model. METHODS A microvascular free flap model was used by raising a fasciocutaneous flap based on the epigastric artery and vein in the adult Sprague-Dawley rat. Fifty-six rats were randomized to receive two intraoperative boluses of either saline or high-dose dopamine. Each free flap was assessed for skin necrosis, capillary refill, and vessel thrombosis at 48 hours postprocedure. Data for each group were collected in a double-blinded fashion. RESULTS There was no difference (p = .2) in free flap survival when comparing the saline group (38%) to the dopamine group (50%). CONCLUSIONS This study shows that high-dose intraoperative boluses of dopamine had no effect on early free flap survival in a rat model. This is the first study to examine the use of intraoperative vasoactive medications in a free flap model.

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