In free flap surgery, patency of the arterial and venous microvascular anastomoses is a major contributor to flap survival. Extended periods of vascular compromise may lead to ischaemic necrosis, which can only be minimized by tissue reperfusion. However, restoration of blood flow evokes ischaemia reperfusion injury. In this manuscript, a case is presented of a patient who demonstrated a normal oxygenation pattern of a deep inferior epigastric perforator (DIEP) flap. As an ischaemic response can be seen as a sign of temporal vascular compromise, we hypothesize that a short ischaemia time is feasible for tissue viability by eliminating ischaemia reperfusion injury.
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