title: A postoperative analysis of perfusion dynamics in deep inferior epigastric perforator flap breast reconstruction: a noninvasive quantitative measurement of flap oxygen saturation and blood flow.
abstract: BACKGROUND
  The blood supply of microvascular free flaps is rated as very critical, particularly in the first postoperative days. Only a timely recognition of a complication and its treatment can ensure the survival of the flap. To quantify the postoperative perfusion dynamics, we measured the oxygen supply and blood flow of the deep inferior epigastric perforator (DIEP) flaps.
  
  
  METHODS
  A total of 23 patients undergoing DIEP flap breast reconstruction were involved in this study. Noninvasive measurements were performed with the O2C-device, which combines the determination of hemoglobin oxygenation and blood flow using white light and laser light. The first measurement was performed immediately after the flap anastomosis. Further measurements were carried out on the first, third, fifth, and seventh postoperative days.
  
  
  RESULTS
  The preoperative value represents our baseline. With the exception of the third day, all postoperative measurements were above the baseline. On the third postoperative day, there was a decrease in the cutaneous oxygen saturation of 22% and a decrease in blood flow of 18% on average, regardless of the individual fluctuations of patient's blood pressure.
  
  
  CONCLUSIONS
  The postoperative perfusion characteristics of the DIEP flap showed a critical drop in the cutaneous oxygen supply and blood flow on the third postoperative day. This represents a potential risk and should be considered in the postoperative management of the DIEP flap.
authors.affiliation: Department of Plastic, Reconstructive, Hand, and Burn Surgery, BG-Trauma Center, Eberhard Karls University, Tuebingen, Germany. arahmanian@bgu-tuebingen.de
authors.forename: Afshin
authors.initials: A
authors.lastname: Rahmanian-Schwarz
authors.forename: Jens
authors.initials: J
authors.lastname: Rothenberger
authors.forename: Amro
authors.initials: A
authors.lastname: Amr
authors.forename: Patrick
authors.initials: P
authors.lastname: Jaminet
authors.forename: Hans-Eberhard
authors.initials: HE
authors.lastname: Schaller
mesh_terms: D000328:Adult; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis* / Q000378:metabolism*; D061525:Perforator Flap / Q000098:blood supply* / Q000592:standards*; D011182:Postoperative Care / Q000379:methods; D012039:Regional Blood Flow
chemical_list: D010100:Oxygen