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The BAHNO Journal Club continues a long tradition of an active online critical appraisal of new research in head and neck surgery.  Senior clinicians will assess the scientific merit of new articles in the published literature and present best new evidence in the regularly updated forum.  If you have any suggested papers or would like to be a contributor to this club please contact


Intraoperative hypotension and flap loss in free tissue transfer surgery of the head and neck

Authors: NJason L. Kass MD | Sameer Lakha MD | Matthew A. Levin MD | Thomas Joseph MD, PhD | Hung-Mo Lin ScD | Eric M. Genden MD| Marita S. Teng MD | Brett A. Miles DDS, MD | Samuel DeMaria Jr MD

Journal: Head and Neck 2018;1–6.

Journal Impact factor: 2.471

By: Mr. James Wokes 


Single centre, multi-surgeon study from the USA of 445 patients undergoing head and neck surgery involving free tissue transfer over 7 years (2009-15).

Retrospective analysis with the hypothesis being that prolonged periods of intraoperative hypotension lead to a higher incidence of flap failure.

The primary outcome measure was flap loss or flap complication within first 72 hours

Secondary outcome measures were the association with major medical complications, fluid administration, and mortality were also assessed. The authors also investigated whether blood pressure lability or hypertension affected perioperative outcomes.

Multivariable logistic regression analysis seems sound and group comparisons were assessed using Wilcoxon rank sum tests.

The only hemodynamic variable significantly associated to flap loss was MAP<60 mm Hg. This had a clear relationship between increasing cumulative duration and subsequent flap loss rate. No other outcome measures were significant.

Interestingly there was no observed association of flap loss or flap-related complications to either boluses or infusions of vasopressor, contrary to popular anecdotally held beliefs

Summary – hypotension = bad, vasopressors to maintain normal BP = ok.