Should epidural analgesia be used in free flap transfer?

Abstract

Afree flap is a composite block of tissue transferred from a donor site to a distant recipient site, where its circulation is restored by microvascular anastomosis of the artery and vein in the vascular pedicle to vessels at the recipient site. Indications for free flap transfer are trauma with soft tissue loss, e.g. lower third tibulo-fibular compound fractures, and reconstruction of complex defects following oncological surgery and burns. Free flaps allow better matching of resected tissue and provide more even cover of the defect with superior aesthetic and functional results, making them the preferred option for reconstruction. Adequate microvascular perfusion is vital for flap survival and decreased blood flow with consequent ischaemia is one of the main causes of flap failure.