Three episodes of gracilis free muscle transfer under epidural anaesthesia.

The use of regional anaesthesia in major surgery is associated with a lower risk of complications. However, recent evidence suggests that a vascular steal phenomenon may result in a reduction of free flap blood flow in such patients. We report three cases of free gracilis transfer under epidural anaesthesia in patients who were considered high risk for general anaesthesia. Our experience suggests that there remains an important role for epidural anaesthesia in the management of patients undergoing lower limb free flap reconstruction. The inability to undergo general anaesthesia does not preclude free flap surgery in carefully selected patients.