Expression patterns and functional evaluation of RGMa during the early phase of peripheral nerve regeneration using the mouse median nerve model.

BACKGROUND: In this study, we evaluate the role of RGMa (Repulsive Guidance Molecule a) during peripheral nerve regeneration using the mouse median nerve model. METHODS: By real-time PCR and Western Blot analysis, we examined expression changes of RGMa mRNA and RGMa protein in neural tissue after transection and microsurgical repair of the mouse median nerve distal to the transection site. We evaluated histomorphometrical changes in neural tissue distal to the injury site and functional recovery of the grasping force after median nerve transection and repair in wild-type mice and RGMa+/- heterozygous mice. RESULTS: RT-PCR revealed a 1,8 fold increase of RGMa mRNA two weeks and a 4,4 fold increase of RGMa mRNA 3 weeks after nerve transection and repair in the nerve segment distal to the injury site. In Western blot analysis, we could show a high increase of RGMa in the nerve segment distal to the injury site at day 14. Histomorphometrical analysis showed significant differences between wild-type animals and heterozygous animals. The absolute number of myelinated fibres was significantly higher in operated heterozygous RGMa+/- animals compared to operated wildtye animals. Using the functional grasping test, we could demonstrate that peripheral nerve regeneration is significantly diminished in heterozygous RGMa+/- mice. CONCLUSIONS: Employing the mouse median nerve model in transgenic animals, we demonstrate that RGMa plays an important role during peripheral nerve regeneration.

Treatment of Scaphoid Nonunion: Radiologic Outcome of 286 Patients in 10 Years.

Background: We analyzed the radiologic outcome of different treatment options for scaphoid nonunion. The results were compared with literature, and a treatment algorithm was proposed. Methods: On the basis of a retrospective case-control study, 286 patients suffering from scaphoid nonunion were treated over a 10-year period. Patients were grouped depending on the location of the nonunion: proximal (n = 126), middle (n = 130), or distal (n = 30) third. In the presence of an avascular proximal fragment or after prior unsuccessful operation, interposition of a vascularized pedicled bone graft from the distal radius was performed (n = 82). Scaphoid healing was detected by conventional radiography and computed tomography. Results: Excellent healing rates of 96.3% were obtained for middle and distal third scaphoid nonunions by conventional iliac crest bone grafting (n = 137). Furthermore, we achieved healing rates of 91.3% for persistent nonunions using a palmar vascularized bone graft from the distal radius after prior unsuccessful operation (n = 23). When using a dorsal vascularized bone graft from the distal radius, scaphoid consolidation was reached in 81.1% for avascular proximal fragments (n = 59). Conclusions: Applying a sophisticated treatment algorithm, the prognosis of scaphoid nonunion is very good.

Platelet-targeted dual pathway antithrombotic inhibits thrombosis with preserved hemostasis.

Despite advances in antithrombotic therapy, the risk of recurrent coronary/cerebrovascular ischemia or venous thromboembolism remains high. Dual pathway antithrombotic blockade, using both antiplatelet and anticoagulant therapy, offers the promise of improved thrombotic protection; however, widespread adoption remains tempered by substantial risk of major bleeding. Here, we report a dual pathway therapeutic capable of site-specific targeting to activated platelets and therapeutic enrichment at the site of thrombus growth to allow reduced dosing without compromised antithrombotic efficacy. We engineered a recombinant fusion protein, SCE5-TAP, which consists of a single-chain antibody (SCE5) that targets and blocks the activated GPIIb/IIIa complex, and tick anticoagulant peptide (TAP), a potent direct inhibitor of activated factor X (FXa). SCE5-TAP demonstrated selective platelet targeting and inhibition of thrombosis in murine models of both carotid artery and inferior vena cava thrombosis, without a significant impact on hemostasis. Selective targeting to activated platelets provides an attractive strategy to achieve high antithrombotic efficacy with reduced risk of bleeding complications.

[Diagnosis Related Groups in reconstructive plastic surgery of malignant head and neck skin tumours]. / Fallpauschalenabbildung plastischer Rekonstruktionen bei malignen Hauttumoren im Kopf-Hals-Bereich.

BACKGROUND: Diagnosis Related Groups (DRGs) were introduced in Germany as a medico-economic classification system 13 years ago. In this analysis, we looked into the compensation for reconstructive plastic surgery after the excision of malignant head and neck skin tumours by DRGs. MATERIAL AND METHODS: Four main diagnoses (malignant melanoma, basal cell carcinoma, squamous cell carcinoma, carcinoma in situ) at a maximum of 6 different locations in the head and neck were combined with the following procedures: excision and primary wound closure, excision with temporary soft tissue coverage, split-thickness or full-thickness skin grafting, local, free or regional pedicle flaps, distant flaps as well as combined procedures for coverage. RESULTS: We defined 10 different DRGs based on 5750 combinations of diagnoses and procedures. DRG J22Z (revenue: EUR 2817) predominated for large temporary soft tissue coverage and skin grafting techniques. In 2017, local flaps were devaluated and now lead to DRG J11D (revenue: EUR 1903) in most cases. In this context, an aggregation of cases by a two-stage approach (stage 1: excision, stage 2: reconstruction) is particularly important. Malignant tumours of the lips are inconsistently represented by DRGs with a lack of definite rules. The highly rated main group DRG J08 (including DRGs J08A, J08B and J08C) can be achieved almost invariably by addition of specific single procedures. CONCLUSION: The current representation of reconstructive surgery for malignant skin tumours by DRGs is associated with potential disincentive effects, which may have an impact on patient care. In search of a diversified portfolio, the main group DRG J08 should be considered in addition to the common practice of coding. The authors of this study think that this may be a possibility to compensate for the actual devaluation and to achieve resource-related reimbursement in high-cost cases. However, incorrect and inflationary use should be avoided due to the lack of long-term orientation caused by dilution of the DRGs.

The PAVE (peeling-assisted volume-enhancing) lift: A retrospective 6-year clinical analysis of a combined approach for facial rejuvenation.

The peeling-assisted volume-enhancing (PAVE) lift is a single-stage approach that combines superficial musculoaponeurotic system (SMAS) plication techniques with fat grafting and different peeling agents. To evaluate the safety of this approach, we analyzed the records of 159 patients who underwent surgery between 2008 and 2014. The percentage of complications observed was not higher than values reported in the literature for each treatment entity: surgical facelift: n=3 haematomas (1.89 %), n=2; temporary apraxia of the mandibular branch (1.26%); fat transfer: minor asymmetry in n = 5 cases (3.14%); peeling: temporary hyperpigmentation in trichloroacetic acid (n = 5; 3.8%) and phenol peels (n = 4; 3.1%), permanent hypopigmentation (n = 6; 5.6%), formation of skin miliae persisting longer than 2 to 3 months (n = 5; 4.6%) and prolonged erythema (n = 3; 0.28%) in phenol peels. The single-stage use of chemical peels, autologous fat transfer, and surgical rhytidectomy was safe.

Assessment of sural flap microcirculation: Which position maintains the optimal perfusion?

BACKGROUND: Limb elevation is a commonly used approach for reducing edema and increasing venous drainage. Considering the anatomy of the sural flap with retrograde perfusion and hence potentially difficult blood outflow, the best angle for positioning the leg following operation is not yet known. METHODS: A total of 14 patients undergoing sural flap lower limb reconstruction were enrolled in the study. We assessed the perfusion dynamics of the flaps using the oxygen-to-see (O2C) device that combines laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin and oxygen saturation. Three different positions were evaluated: 45° angle downward, the horizontal position, and 45° angle upward. RESULTS: The blood flow was significantly higher in the 45° upward position compared to the 45° downward position. The relative amount of hemoglobin was significantly lower in the 45° upward position compared to the 45° downward position. No significant differences with regard to oxygen saturation were observed. CONCLUSION: The results of this study show a more precise pattern of perfusion due to different positioning. The 45° upward position of the leg generally maintains the best blood flow and venous drainage. However, compared to horizontal positioning, these differences were not statistically significant. As an elevation of 45° can be uncomfortable for patients, we recommend an elevation of the leg which approximates the 45° upward position but is still comfortable.

Utilization of laser Doppler flowmetry and tissue spectrophotometry for burn depth assessment using a miniature swine model.

Currently, the diagnosis of burn depth is primarily based on a visual assessment and can be dependent on the surgeons' experience. The goal of this study was to determine the ability of laser Doppler flowmeter combined with a tissue spectrophotometer to discriminate burn depth in a miniature swine burn model. Burn injuries of varying depth, including superficial-partial, deep-partial, and full thickness, were created in seven Göttingen minipigs using an aluminium bar (100 °C), which was applied to the abdominal skin for periods of 1, 3, 6, 12, 30, and 60 seconds with gravity alone. The depth of injury was evaluated histologically using hematoxylin and eosin staining. All burns were assessed 3 hours after injury using a device that combines a laser light and a white light to determine blood flow, hemoglobin oxygenation, and relative amount of hemoglobin. The blood flow (41 vs. 124 arbitrary units [AU]) and relative amount of hemoglobin (32 vs. 52 AU) were significantly lower in full thickness compared with superficial-partial thickness burns. However, no significant differences in hemoglobin oxygenation were observed between these depths of burns (61 vs. 60%). These results show the ability of laser Doppler flowmeter and tissue spectrophotometer in combination to discriminate between various depths of injury in the minipig model, suggesting that this device may offer a valuable tool for burn depth assessment influencing burn management.

Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius.

OBJECTIVE: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. METHODS: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients' data, healing rates, and factors influencing scaphoid healing were analyzed. RESULTS: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation. CONCLUSIONS: In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole.

Evaluation of sensory recovery after reconstruction of digital nerves of the hand using muscle-in-vein conduits in comparison to nerve suture or nerve autografting.

BACKGROUND: Muscle-in-vein conduits are a good alternative solution to nerve autografts for bridging peripheral nerve defects since enough graft material is available and no loss of sensation at the harvesting area is expected. The purpose of this study was to compare regeneration results after digital nerve reconstruction with muscle-in-vein conduits, nerve autografts, or direct suture. PATIENTS AND METHODS: 46 patients with 53 digital nerve injuries of the hand subjected to direct suture (n = 22) or reconstruction of 1-6 cm long defects with either nerve autografts (n = 14) or muscle-in-vein conduits (n = 17) between 2008 and 2012, were examined using the two-point discrimination and Semmes-Weinstein Monofilaments. RESULTS: The follow-up examinations took place 12 to 58 months after surgery. A median reduction of sensibility of 2 Semmes-Weinstein monofilaments compared with intact digits was observed after direct suture (DS) and of 2.5 and 2 Semmes-Weinstein monofilaments after reconstruction with autologous nerve grafts (ANG) and muscle-in-vein conduits (MVC), respectively. No statistically significant differences between all three groups could be found with a significance level set by a P < 0.006 (PDS-ANG = 0.24, PDS-MVC = 0.03, PANG-MVC = 0.52). After harvesting a nerve graft, reduction of sensibility at the donor site occurred in 10 of 14 cases but only in one case after harvesting a muscle-in-vein conduit. CONCLUSIONS: Muscle-in-vein conduits may be a good alternative solution to autografts for the reconstruction of digital nerves, since no significant differences could be demonstrated between the two methods.

Correlation analysis of histomorphometry and motor neurography in the median nerve rat model.

OBJECTIVE: Standard methods to evaluate the functional regeneration after injury of the rat median nerve are insufficient to identify any further differences of axonal nerve regeneration after restitution of motor recovery is completed. An important complementary method for assessing such differences is a histomorphometric analysis of the distal to lesion nerve fibers. Recently, an electrophysiological method has been proposed as a sensitive method to examine the quality of axonal nerve regeneration. METHODS: A linear regression analysis has been performed to correlate histomorphometric and neurographic data originating from 31 rats subjected to neurotmesis and immediate reconstruction of their right median nerve. RESULTS: A significant linear correlation between the velocity of neuromuscular conduction and the total number of nerve fibers (P = .037) as well as between the amplitude of compound muscle action potential and the total number of nerve fibers (P = .026) has been identified. Interestingly, a significant correlation between the velocity of neuromuscular conduction and the square root of the cross-sectional area of the nerve could be found (P = .008). This corresponds to a linear correlation between the velocity of neuromuscular conduction and the radius of the nerve. CONCLUSION: These results contribute in a better interpretation of morphological predictors of nerve regeneration and verify the previously described electrophysiological assessment in the median nerve rat model as a valid method.

A quantitative analysis of microcirculation in sore-prone pressure areas on conventional and pressure relief hospital mattresses using laser Doppler flowmetry and tissue spectrophotometry.

BACKGROUND: Pressure ulcers are associated with severe impairment for the patients and high economic load. With this study we wanted to gain more insight to the skin perfusion dynamics due to external loading. Furthermore, we evaluated the effect of different types of pressure relief mattresses. METHODS: A total of 25 healthy volunteers were enrolled in the study. Perfusion dynamics of the sacral and the heel area were assessed using the O2C-device, which combines a laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin. Three mattresses were evaluated compared to a hard surface: a standard hospital foam mattress bed, a visco-elastic foam mattress, and an air-fluidized bed. RESULTS: In the heel area, only the air-fluidized bed was able to maintain the blood circulation (mean blood flow of 13.6 ± 6 versus 3.9 ± 3 AU and mean relative amount of hemoglobin of 44.0 ± 14 versus 32.7 ± 12 AU.) In the sacral area, all used mattresses revealed an improvement of blood circulation compared to the hard surface. CONCLUSION: The results of this study form a more precise pattern of perfusion changes due to external loading on various pressure relief mattresses. This knowledge may reduce the incidence of pressure ulcers and may be an influencing factor in pressure relief mattress selection.

Development of an animal frostbite injury model using the Goettingen-Minipig.

BACKGROUND: A standardized reproducible animal model is desirable to gain a better understanding in the pathophysiology of frostbite injury and to develop novel therapies. Little has been studied about frostbite injury models. The depth and extent were not always being controllable and consistent. Therefore, we developed a frostbite injury model using the Göttingen Minipigs. METHODS: 42 frostbite injuries were inflicted on the abdomen of seven minipigs using an aluminium bar (300g, circular with a radius of 1cm) frozen with liquid nitrogen to -196°C. The bar was applied for 1, 3, 6, 12, 30 and 60s. Five hours after injury biopsies were performed and evaluated by the presence of denatured collagen, blood vessels, follicular epithelial cells and mesenchymal cells. RESULTS: A large spectrum of frostbite injuries was obtained ranging from superficial, superficial partial, deep partial to full thickness. The depth of injury in the sets of frostbites was highly consistent (Pearson correlation ranged from r=0.89 to 0.94). CONCLUSION: We described a simple, inexpensive and safe swine frostbite model. The accurate reproducibility of the depth of the frostbite injuries allows researchers to accurately plan frostbite studies.

Assessment of microcirculatory changes of cold contact injuries in a swine model using laser Doppler flowmetry and tissue spectrophotometry.

BACKGROUND: Until now, the exact pathophysiology of frostbite injuries is poorly understood. The aim of the study is to evaluate the perfusion changes of frostbite injuries to get a better understanding of the exact mechanism underlying the resulting tissue damage. Particular attention has been given to the differentiation of changes between the various injury depths. METHODS: Cold contact injury ranging from superficial, superficial-partial, deep-partial to full thickness were generated using seven goettingen minipigs. The perfusion dynamics were assessed before and 3 h after the injuries were inflicted using the O2C-device, which combines a laser light, to determine blood flow, and white light to determine hemoglobin oxygenation and relative amount of hemoglobin. A total of 42 cold contact injuries were inflicted and 84 measurements were carried out. RESULTS: In superficial and superficial partial injuries there was an increase in the blood flow (mean, 20 ± 2.4%, 15 ± 5.1%, respectively) and in the relative amount of hemoglobin (mean, 29 ± 9.1%, 28 ± 7.2%, respectively), whereas the hemoglobin oxygenation did not alter (mean, -0.15 ± 2.4%, -0.8 ± 3.1%, respectively). In deep partial injuries there was a decrease in the blood flow (mean range, -4 ± 2.1 to -17 ± 4.7%) and an increase in the relative amount of hemoglobin (mean range, 79 ± 17.2 to 93 ± 17.7%), whereas the hemoglobin oxygenation did not alter (mean range, -0.7 ± 3.1 to -2.9 ± 3.3%). In full thickness injuries there was a drop in the blood flow (mean range, -24 ± 7.6 to -27 ± 11.8%) and in the hemoglobin oxygenation (mean range, -16 ± 3.5 to -19 ± 2.5%) and an increase in the relative amount of hemoglobin (mean range, +126 ± 19.8 to 145 ± 10.9%). CONCLUSION: The results of this study form a more precise pattern of cold contact injury perfusion changes, which can be a valuable tool to assess the degree of cold contact injury and furthermore the efficacy of novel diagnostic aids, therapeutics and treatment modalities.

Evaluating the role of Netrin-1 during the early phase of peripheral nerve regeneration using the mouse median nerve model.

BACKGROUND: Less is known about the role of Netrin-1 in the peripheral nervous system. In this study, we evaluated the role of Netrin-1 using the mouse median nerve model for assessment of peripheral nerve regeneration. METHODS: Using real-time PCR and western blot analysis, we examined expression changes of netrin-1 mRNA and Netrin-1 protein after transection and repair of the mouse median nerve in Wild-type animals. We further evaluated histomorphometrical changes as well as the functional recovery of the grasping force after median nerve transection and repair in WT mice and Netrin-1(+/-) heterozygous mice. RESULTS: RT-PCR revealed a 1, 9 fold increase of Netrin-1 mRNA two weeks after nerve transection and repair in the nerve segment distal to the injury site. In Western blot analysis, we could show a high increase of Netrin-1 in the nerve segment distal to the injury site at day 14. Histomorphometrical analysis showed significantly higher cross sectional area and a lower fibre density in heterozygous Netrin-1(+/-) mice. Using the functional grasping test, we could show that peripheral nerve regeneration is significantly diminished in heterozygous Netrin-1(+/-) mice. CONCLUSIONS: Employing the mouse median nerve model in transgenic animals, we demonstrate that Netrin-1 plays an important role during peripheral nerve regeneration.

Expression patterns and functional evaluation of the UNC5b receptor during the early phase of peripheral nerve regeneration using the mouse median nerve model.

INTRODUCTION: In this study, we evaluated the role of the Netrin-1 receptor UNC5b (Uncoordinated), a neuronal guidance molecule, during peripheral nerve regeneration using the mouse median nerve model. MATERIALS AND METHODS: Using Western blot analysis, we examined the expression changes of UNC5b after transection and microsurgical repair of the mouse median nerve distal to the transection site. We evaluated the histomorphometrical changes and functional recovery of the grasping force after median nerve transection and repair in wild-type (WT) mice and UNC5b(+/-) heterozygous mice. RESULTS: In Western blot analysis, we could show a high increase of UNC5b in the nerve segment distal to the injury site at day 14. Histomorphometrical analysis did not show any significant differences between WT animals and heterozygous animals. Using the functional grasping test, we could demonstrate that peripheral nerve regeneration is significantly diminished in heterozygous UNC5b(+/-) mice. CONCLUSION: By using the mouse median nerve model in transgenic animals, we demonstrate that the Netrin-1 receptor UNC5b plays an important role during peripheral nerve regeneration.

Whole-body vibration improves functional recovery in spinal cord injured rats.

Whole-body vibration (WBV) is a relatively novel form of exercise used to improve neuromuscular performance in healthy individuals. Its usefulness as a therapy for patients with neurological disorders, in particular spinal cord injury (SCI), has received little attention in clinical settings and, surprisingly, even less in animal SCI models. We performed severe compression SCI at a low-thoracic level in Wistar rats followed by daily WBV starting 7 (10 rats) or 14 (10 rats) days after injury (WBV7 and WBV14, respectively) and continued over a 12-week post-injury period. Rats with SCI but no WBV training (sham, 10 rats) and intact animals (10 rats) served as controls. Compared to sham-treated rats, WBV did not improve BBB score, plantar stepping, or ladder stepping during the 12-week period. Accordingly, WBV did not significantly alter plantar H-reflex, lesion volume, serotonergic input to the lumbar spinal cord, nor cholinergic or glutamatergic inputs to lumbar motoneurons at 12 weeks after SCI. However, compared to sham, WBV14, but not WBV7, significantly improved body weight support (rump-height index) during overground locomotion and overall recovery between 6-12 weeks and also restored the density of synaptic terminals in the lumbar spinal cord at 12 weeks. Most remarkably, WBV14 led to a significant improvement of bladder function at 6-12 weeks after injury. These findings provide the first evidence for functional benefits of WBV in an animal SCI model and warrant further preclinical investigations to determine mechanisms underpinning this noninvasive, inexpensive, and easily delivered potential rehabilitation therapy for SCI.

The effect of repetitive intraperitoneal anesthesia by application of fentanyl-medetomidine and midazolam in laboratory rats.

BACKGROUND: Literature reviews show numerous options for anesthesia in the small laboratory animals. Many methods are associated with complications, such as high technical effort, difficult monitoring, respiratory and cardiovascular depression, and prolonged sedation. In the present study, we report first time results after repeated use of an intraperitoneal combined anesthesia with a high tolerability. METHODS: Three hundred and seventy-four anesthesias were performed on 38 adult male Lewis rats (280-460 g). Each animal was anesthetized repeatedly over a period of three months, using an intraperitoneal combination of Fentanyl-Medetomidine and Midazolam (FMM). The time required for the animals to lose ear pinch response and the ability to perform a righting and pedal withdrawal reflex was measured. For evaluation of the clinical state, a four-point vitality scale was developed. The anesthesia was antagonized with Naloxone, Flumazenil, and Atipamezole (s.c.). RESULTS: The animals lost all three reflex responses within 5 (± 2.4) min of injection. Without antagonism of anesthesia, the ear pinch response returned on average within 125 (± 21.5) min. After antagonism of anesthesia, the rats needed 5 (± 2.9) min to regain all three reflex responses. No significant differences of vitality-index were measured after repeated use of FMM during the investigation period. CONCLUSIONS: A repeatable and secure anesthesia is indispensable for any experimental studies that require multiple anesthesia of a single animal. Intraperitoneal combination of FMM provides an adequate procedure to induce a well tolerable, repeatable state of anesthesia, which conforms to all the necessary requirements for laboratory rats.

Fibulo-scapho-lunate arthrodesis after resection of the distal radius for giant-cell tumor of the bone.

BACKGROUND: Giant-cell tumors of the distal radius are rare. They have a high-risk of local recurrence and a risk of pulmonary metastasis. Curettage alone or combined with adjunctive agents is often associated with local recurrence. METHODS: Three patients with giant-cell tumor of the distal radius are presented. All patients showed Campanacci grade 3 lesions. All patients underwent complete distal radius resection and reconstruction with a vascularized fibular graft distally fused with the scaphoid and the lunate, allowing midcarpal motion. RESULTS: The follow-up period ranged from 6 to 60 months. For all three patients, emotional acceptance was excellent. The postoperative motion of the wrist was good, with a range of motion of 30-0-30°, 40-0-0°, and 30-0-10° (extension-flexion). There was neither tumor recurrence nor pulmonary metastasis. CONCLUSION: Fibulo-scapho-lunate fusion is an elegant method of distal radius reconstruction with good functional outcome and low risk of pulmonary metastasis.

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.

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. METHOD: 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.