Is the knowledge on tissue microcirculation important for microsurgeon?

This review article outlines the importance of knowledge on the hemodynamics of microcirculatory responses during free tissue transfer procedures. Anatomy and pathophysiology of peripheral microcirculation are outlined in the context of its responses during microsurgical procedures submitted to ischemia and reperfusion injury. The factors influencing the patient's outcome such as neural, humoral, and muscular regulations and prostoglandins, kinins, nitric oxide actions, and so on are outlined. In addition, other important factors influencing microcirculatory responses are discussed. The goal of this review article is to introduce nonsurgical factors independent of the microsurgeon's control which, via changes in microcirculatory hemodynamics, may contribute to free flap survival and final patient's outcomes. Thus, we hope that this overview of the pathophysiology of tissue microcirculation will help microsurgeons to monitor factors beyond control of vessel patency and technical aspects of microvascular anastomosis.