Anaesthesia for reconstructive surgery

Skin or tissue defects that cannot be closed primarily with simple suturing require skin grafts or flaps to maintain skin integrity and prevent infection. Tissue defects may be covered using skin grafts, tissue-expanded skin, local skin flaps, pedicled flaps or free flaps. This article describes the different methods. The causes of flap failure are discussed. In general they are the result of poor blood flow or oedema. Flap tissue has no lymphatic drainage and is therefore susceptible to oedema, which reduces flow to the flap. The practical conduct of anaesthesia for reconstructive surgery is also explained.