Chapter 1 peri‐operative risk factors for flap failure. We hypothesized that nonsurgeon factors are associated with flap complications. In addition, the incidence of flap complications in our study population is analyzed. The role of intravenous fluid and perioperative hemodynamics and the use of vasoactive medication are analyzed in relation to the development of in‐hospital complications in patients undergoing microsurgical breast reconstruction. In chapter 3, we review the literature to obtain possible ways to reduce IR injury. The current role of NO and NO‐based intervention in surgical flaps is summarized. Chapter 4 presents study of the perioperative microcirculation in the distal parts of the flap following IR in muscle‐sparing TRAM breast reconstruction. In chapter 5, the influence of risk factors on microcirculatory blood flow after IR and clinical outcome is described. Whetherflap survival after IR injury is improved with arginine suppletion, a precursor of NO, is the subject of chapter 6. In chapter 7, the partial flap loss in the DIEP/TRAM flap model is investigated in relation to IR injury. The aim of this experimental study is to investigate whether IR injury has any effect on the extent of (distal) partial flap loss. The previous chapters ar summarized and discussed in chapter 8 20
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