ABSTRACT
Within the head and neck, microsurgical reconstruction is employed when other options such as local and distant flap transfers are deemed inappropriate. Having planned the flap based on the size and type of tissue required, an alternative reconstruction should always be considered as a 'lifeboat'. Recipient vessel location should be planned out with potential zones of injury. Potential donor sites should be devoid of vascular access. During the operation and in the immediate post-operative period, prolonged use of vasoconstrictors should be avoided. The patient should be adequately hydrated with a good central venous pressure. Likewise, the patient's core temperature should be maintained to avoid vasospasm. If hypotensive anaesthesia is adopted at any stage, then this should be reversed prior to microsurgery. The main enemy of the microvascular surgeon is fatigue. Physical exertion, alcohol and caffeine should be avoided for at least 24 hours in individuals prone to a tremor.
