Pure Alpha Versus Mixed Adrenergic Vasopressors Perioperative Outcomes in Autologous Free Flap Surgery: A Systematic Review and Meta-Analysis

In contemporary free-flap surgery, vasopressors are not uniformly harmful - but choice may matter. Phenylephrine and ephedrine were associated with fewer surgical revisions and thrombotic events compared to norepinephrine. While absolute differences in flap failure were small, the higher complication rates with norepinephrine warrant caution, and agent selection should be individualised. Further randomised trials are needed to refine hemodynamic management strategies in microvascular reconstruction.