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This procedure is commonly performed under general anaesthesia to minimize soft tissue distortion and vasoconstriction associated with local anaesthesia injection.

Smaller defect can be repaired under local anesthesia with or without sedation or general anesthesia.

The fluid volume of local anaesthetic alters the dimension, thickness, and position of both the donor tissues and recipient site. The blanching caused by epinephrine will make evaluation of tissue vascularity difficult intraoperatively.