Introduction and objective:
The deep inferior epigastric perforator (DIEP) flap is widely used in breast reconstruction and offers advantages such as muscle preservation and a sufficient tissue volume for coverage. However, complications such as thrombosis and flap failure remain a concern in postoperative care. Thromboelastography (TEG)/Thromboelastometry (ROTEM) is a valuable tool for monitoring coagulation in the perioperative period, providing real-time data on clot formation, stability, and fibrinolysis.

Material and methods:
The study included 26 patients undergoing DIEP flap reconstruction, with ROTEM performed preoperatively, intraoperatively, and postoperatively. Clinical data and laboratory results were analyzed, with a particular focus on thromboelastometric parameters. Anticoagulation strategies were individually adjusted based on ROTEM findings.

Results:
ROTEM detected abnormal clotting profiles in a substantial proportion of patients. The use of ROTEM facilitated targeted intra-operative management, resulting in reduced thrombotic events and improved blood product utilization compared to conventional coagulation tests (CCTs). Flap-related complications were limited to one total flap loss (4%) and three instances of marginal necrosis (11%). These findings align with current evidence supporting the increasing role of visco-elastic testing in optimizing outcomes in microsurgical procedures.

Conclusions:
TEG/ROTEM provided more accurate and timely coagulation information than routine laboratory tests, leading to improved management of anticoagulation and reduced thrombotic complications in DIEP flap breast reconstruction. Proper perioperative management guided by ROTEM can minimize complications, such as thrombosis, while optimizing blood transfusion requirements and flap survival.