Background and objective.

Microsurgical free flaps have become an indispensable tool in Reconstructive Surgery. Vasospasm is an entity that can cause flap failure.

Our objective is to evaluate the different therapies for vasospasm prevention and treatment and to propose a management algorithm for this complication.

Methods.

Bibliographic review of studies of experimental or quasi-experimental design that assesed the effect of interventions for the prevention and treatment of vasospasm.

Results.

Thirty one experimental studies were included, of which 5 analyzed non-pharmacological interventions and 26 pharmacological interventions. All experimental studies were performed in animal models. Among the non-pharmacological interventions studied, adventicetomy and adequate control of hemostasis proved to be effective measures for the prevention of vasospasm. Within topical pharmacological interventions, lidocaine, papaverine, 10% magnesium sulfate, and verapamil consistently demonstrated their effectiveness in the prevention and treatment of vasospasm. Within the systemic pharmacological interventions, pentoxifylline and prostaglandin E1 were the most effective interventions for the management of vasospasm. Other drugs showed controversial evidence: nifedipine, nicardipine and prostaglandin E1 (topicallys); nicardipine, nifedipine and verapamil (systemics).

Conclusions.

The current evidence regarding the effectiveness of measu-res aimed at managing vasospasm in microsurgery is based mainly on animal studies. The vasospasm management algorithm presented is based on accumulated clinical experience and the best currently available evidence. Having this therapeutic strategy makes it possible to standardize management in clinical practice for rapid decision-making.

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