Reconstruction of skin, muscle and bone loss due to previous traumatic injuries or congenital defects by transferring free vascularized tissue (free flaps) has been made possible by recent and continuous improvements of microsurgical techniques and is the background on which hand transplant surgery stands. Surgical skill is a well-recognized factor of success in free flap surgery, but hypoperfusion and subsequent necrosis of transferred tissues are important problems  which challenge both surgeon and anaesthesiologist. Anaesthesia influences central haemodynamics and regional blood flow and therefore may affect blood flow in the flap  or in the transplanted limb. Changes in blood volume and use of vasoactive drugs during anaesthesia may influence free flap perfusion as well .
KeywordsBlood Viscosity Free Flap Anaesthetic Management Driving Pressure Brachial Plexus Block
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