ABSTRACT
Over the past four decades, free tissue transfer has evolved into a reliable tool for immediate reconstruction following ablative surgery for head and neck tumours. The success of free flap depends on continuous arterial inflow and venous outflow through the patent microvascular anastomoses until neovascularisation is established at the recipient wound bed. This chapter focuses on general initial care of the patient and the latter half will focus on contemporary specific techniques in free-flap monitoring. To optimise both body systems support and monitoring, patients typically have the following lines established perioperatively and arrive in intensive care unit or high dependency unit with a nasogastric or gastrostomy feeding tube, large gauge peripheral access, arterial line, urinary catheter, and often a tracheostomy tube and central line. Urine output greater than 0.5 mL/kg/hour should be maintained with appropriate fluid management. Clinical assessment is regarded as the most reliable monitoring tool.
