Pharmacologic optimization of microsurgery in the new millennium

Microsurgical anastomoses are largely technically dependent; however, there exists a finite rate of failure, with often devastating consequences. Pharmacologic prophylaxis and intervention are used extensively in microsurgical cases, yet a unified algorithm does not exist among the various basic science and clinical studies in the literature. This results in a confusing and nonstandardized practice based on anecdotal experiences. The purpose of this article is to review the literature on this topic and synthesize a practical clinical management algorithm for pharmacologic therapy in microsurgery.