Page 43 - Read Online

Garoosi et al. Plast Aesthet Res 2024;11:42 https://dx.doi.org/10.20517/2347-9264.2024.57 Page 11 of 17

Example 5. Patient A’s bipedicled DIEP free flap. Independent pedicle anastomoses to the internal mammary vessels in an antegrade
and retrograde fashion. DIE: Deep inferior epigastric; IMA: internal mammary artery; IMV: internal mammary vein; DIEP: deep inferior
epigastric perforator.

7. Postoperative Monitoring
● Monitoring of the flap is essential in the immediate postoperative period to detect vascular compromise
early. Techniques include clinical observation, use of a handheld Doppler, tissue oxygen saturation
monitoring and, in some cases, implantable Doppler probes and venous couplers. Implantable Doppler
probes and venous couplers are useful if one of the flaps must be fully buried and external skin monitoring
is not possible .
[39]

POSTOPERATIVE CONSIDERATIONS
1. Monitoring Flap Viability: Postoperative monitoring is crucial for any free flap reconstruction to ensure
flap viability. Frequent monitoring of flap perfusion is highly recommended for the first 48 h to detect
vascular compromise early and allow prompt intervention if needed to salvage the flap. Monitoring can be
done through clinical assessment, the use of a handheld Doppler, tissue oxygen saturation monitoring and,
in some cases, implantable Doppler probes and venous couplers .
[39]

2. Pain Management: Effective pain management is critical in the immediate postoperative period. A
multimodal approach is recommended, typically as part of an Enhanced Recovery After Surgery (ERAS)
pathway, including the use of several different classes of drugs such as acetaminophen, non-steroidal anti-
inflammatory drugs (NSAIDs), pregabalin, and opioids [40,41] . Such an approach allows not only satisfactory
pain control, but can also facilitate early mobilization.