Exploring personalized postoperative non-invasive tissue oximetry in DIEP flap breast reconstruction

A.A.M.A. Lindelauf*, N.P.A. Vranken, R.M. Schols, E.A.C. Bouman, P.W. Weerwind, R.R.W.J. van der Hulst

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Early detection of vascular compromise after autologous breast reconstruction is crucial to enable timely re-exploration for flap salvage. Several studies proposed non-invasive tissue oximetry for early identification of ischemia of deep inferior epigastric perforator (DIEP) flaps. The present study aimed to explore the utility of non-invasive tissue oximetry following DIEP flap surgery using a personalized oxygenation threshold. Methods Patients undergoing immediate/delayed DIEP flap surgery were included in this prospective observational study. DIEP flap tissue oxygenation (StO(2)) was monitored continuously using near-infrared spectroscopy. A baseline measurement was performed by positioning one sensor at the marked position of the major inferior epigastric perforator on the abdomen. A new sensor was positioned postoperatively on the transplanted tissue. In unilateral procedures, postoperative StO(2) values of the native breast were also obtained. Measurements were continued for 24 h. Results Thirty patients (42 flaps) were included. Fourteen patients (46.7%) had an uncomplicated postoperative course. A minor complication was observed in thirteen patients; in five patients, at least one major complication occurred, requiring re-exploration. Median StO(2) readings were significantly lower in patients with major complications compared to uncomplicated cases. In fourteen unilateral DIEP flap procedures, StO(2) values of the native breast were similar to the preoperative baseline measurement (92%; p = 0.452). Conclusions Non-invasive tissue oximetry following DIEP flap surgery could aid in early detection of vascular compromise. StO(2) values of the native breast and abdominal wall preoperatively can be used interchangeably and can serve as personalized reference value. Level of evidence: Level IV, diagnostic / prognostic study.
Original languageEnglish
Pages (from-to)267-275
Number of pages9
JournalEuropean Journal of Plastic Surgery
Issue number2
Early online date23 Aug 2021
Publication statusPublished - Apr 2022


  • DIEP flap
  • Autologous breast reconstruction
  • Tissue oximetry
  • NIRS
  • Non-invasive tissue monitoring
  • Personalized threshold

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