Fluid overload & anastomosis failure In this study, a high volume of fluid therapy during surgery was retrospectively associated with a significant higher incidence of return to the operating theatre for revision of the anastomosis. The majority of these patients developed further complications such TFL or ma‐FC leading to return to the operating theatre for debridement. A possible pathogenic explanation is that fluid overload precipitates edema in the flap and therefore impairs the microcirculation. This in turn leads to venous stasis and, subsequently, thrombosis. Finally, arterial perfusion is impaired in a retrograde manner. In addition, the free flaps may be especially susceptible to edema formation due to the loss of lymphatic drainage. Based on the results of this study, a goal‐directed or more restricted intravenous fluid therapy in addition with safe use of inotropes may be recommended. Invasive monitoring such as central venous pressure and invasive arterial monitoring may guide this. Fluid loss should be replaced, but fluid overload should be avoided in breast reconstruction with free‐tissue transfer. 35
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