Anaesthesia for plastic and reconstructive surgery

Plastic and reconstructive surgery aims to restore normal and functional anatomy following tissue destruction or impaired wound healing. The techniques required depend on the complexity of the wound, from simple closure to flap reconstruction. More complicated wounds with large skin defects may need free flap transfer for optimal functional and cosmetic results. Flap failure is a major potential complication and perioperative anaesthetic management plays an important role in successful surgery. Factors which may lead to vasoconstriction must be avoided, including pain, hypothermia and hypovolaemia. Blood flow is also improved by maintaining an adequate blood pressure, moderate haemodilution and normocarbia. Free flap failure occurs mainly during the first three postoperative days. Venous thrombosis secondary to congestion is more common than arterial obstruction. Prompt surgical re-exploration is the key to flap salvage.