2.1. Pre-, Intra-, and Postoperative Treatment

All free TFL flap operations were performed in a two-team approach for the donor- and recipient-sites. Intraoperatively, 500 IU to 1500 IU (international units) of unfractionated heparin were applied prior to releasing the flap anastomosis or 2000 IU to 3000 IU in case of an arteriovenous loop (AVL). Intraoperative flap perfusion measurements were not performed regularly. However, since January 2017, indocyanine green angiography (ICG) has been performed occasionally, depending on the individual intraoperative decision of the senior surgeon. Primary closure of the TFL donor-site was performed in two layers. Closed suction drains were left in situ in all cases. No additional reconstruction of the fascia was performed. Postoperatively, all patients received 30 mg enoxaparin twice a day over a five-day period, followed by daily 40 mg doses for at least two weeks. Subsequently, the therapy was continued until adequate mobilization of the patient was achieved All free flaps were examined hourly by analyzing the capillary refill, skin temperature, and skin color for five days in order to detect any perfusion alterations.