{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:51:12Z","timestamp":1791931872127,"version":"4.3.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Head and neck free-flap microvascular surgery is a type of surgery where multiple anaesthetic factors play a very important role in the outcome of the surgery while the conduct of anaesthesia itself may be quite challenging for the anaesthesiologist. In microvascular reconstruction of head and neck malignancies, flaps are used to reconstruct a primary defect formed by wide local excision. A free flap is raised after removing the neurovascular pedicle from the donor site and transplanting it by microvascular anastomosis to the new location. This gives rise to a secondary defect which is then repaired by direct suture or skin graft. The anaesthesiologist\u2019s role includes optimizing the physiological conditions for the survival of the flap while decreasing morbidity at the same time. Failure of the free flap is attributed to numerous causes. This is an attempt to highlight them along with discussion of the anaesthesia-related issues that are faced during this type of surgery. The various pre-, intra- and postoperative factors affecting flap survival and overall postoperative outcome in the patient are discussed here.<\/jats:p>","DOI":"10.4103\/joacp.joacp_22_20","type":"journal-article","created":{"date-parts":[[2022,1,19]],"date-time":"2022-01-19T06:03:51Z","timestamp":1642572231000},"page":"499-504","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":16,"title":["Anaesthetic implications of free-flap microvascular surgery for head and neck malignancies \u2013 A relook"],"prefix":"10.4103","volume":"37","author":[{"given":"Upasana","family":"Goswami","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Deen Dayal Upadhyay Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anurag","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Deen Dayal Upadhyay Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"key":"B1-20240828","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/S0034-7094(12)70156-3","article-title":"Anesthesia and surgical microvascular flaps","volume":"62","author":"Pereira","year":"2012","journal-title":"Rev Bras Anestesiol"},{"key":"B2-20240828","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1067\/mhn.2001.116788","article-title":"Free flap reconstruction of the head and neck:Analysis of 241 cases","volume":"125","author":"Haughey","year":"2001","journal-title":"Otolaryngol Head Neck Surg"},{"key":"B3-20240828","first-page":"33","article-title":"Anesthesia for microvascular free tissue transfer","volume":"3","author":"Adams","year":"2003","journal-title":"Br J Anaesth"},{"key":"B4-20240828","first-page":"356","article-title":"Factors affecting the risk of free flap failure in microvascular surgery","volume":"70","author":"Stepanovs","year":"2016","journal-title":"Proc Latvian Acad Sci"},{"key":"B5-20240828","first-page":"327","article-title":"Vasoactive agents do not adversely influence the success of maxillo-facial microvascular free-flap surgery:A retrospective analysis","volume":"4","author":"Rose","year":"2016","journal-title":"Int J Anesth Res"},{"key":"B6-20240828","first-page":"177","article-title":"The role of anaesthetic management in enhancing peripheral blood flow in patients undergoing free flap transfer","volume":"67","author":"Aps","year":"1985","journal-title":"Ann R Coll Surg Engl"},{"key":"B7-20240828","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/micr.22387","article-title":"Impact of increasing operative time on the incidence of early failure and complications following free tissue transfer? 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