Abstract
Learning Objectives After reading this article, the participant should be able to (1) outline the rationale
for different perioperative types of fluid therapy in free flap surgery and identify
the methods considered best for flap survival; (2) understand the current views on
the use of vasoactive agents and consider its possible safe use; (3) compare the most
commonly used intraoperative and postoperative anticoagulant therapies and identify
the risks and benefits associated with each.
Background Free flap surgery has become a reliable and efficient method for reconstruction of
complex soft tissue and bony defects. Despite high success rates, free flap failure
remains an important concern. A review of the literature was conducted on nonsurgical
factors that may contribute to flap failure or success. Various anesthesiological
and anticoagulant methods are applied in free flap surgery, but for the ideal approach
there is no consensus. This article provides clinical recommendations on perioperative
fluid management and the use of vasoactive and antithrombotic agents and offers a
balanced view on the risks and benefits.
Keywords
microsurgery - reconstructive surgery - anesthetic management - fluid therapy - vasoactive
agents - antithrombotic agents - flap failure
