Anesthesia in Free Flap Surgery

Free tissue transfer is an important technique for closure of larger soft tissue defects that may not be amenable to pedicled or local advancement flaps. The muscle or fascia is harvested, with or without the overlying skin, along its vascular pedicle and transferred with vascular anastomosis. Flap failure is a major potential complication for this type of surgery and perioperative anaesthetic management plays an important role in successful surgery. The guiding principle of anaesthesia for free flap surgery is the maintenance of optimum blood flow. In addition, the goals of anaesthesia for free flap surgery are vasodilatation, good perfusion pressure and low viscosity. Thus, factors which may lead to vasoconstriction must be avoided, including pain, hypothermia and hypovolaemia