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RESULTS: A total of 780 autologous breast free flaps were reviewed, with 16 (2.0%), 369 (46.8%) and 291 (36.9%) receiving intraoperative epinephrine, phenylephrine, and ephedrine, respectively. Flap failure was observed in 15 (1.9%), venous thrombosis in 13 (1.6%) and flap congestion in 37 (4.7%) free flaps. Vasopressor use was not associated with flap failure (p = 0.345) or other complications, but was significantly associated with a decreased risk of postoperative flap congestion (p = 0.001). However, in a multivariate analysis, vasopressor use was associated with an increased risk of postoperative acute blood loss anemia (p = 0.012).

Abstract: Venous Coupler Versus Hand-Sewn Anastomoses in Autologous Breast Reconstruction: A Systematic Review and Pooled Analysis