Induction of anesthesia and intubation through the tracheostoma by the anesthesia colleague. Then opening of the right side of the neck. Irrigation. Diffuse bleeding can be seen in the area of the dissected skin flap under the platysma, then in all muscular areas. Inspection of the anastomosis under the microscope. Dry conditions in both the arterial and venous areas. The blood supply to the flap is good. Careful hemostasis in the area of the musculature and insertion of a new Redon drainage. A breakthrough to the left side was made intraoperatively in the 1st operation, from which blood is also continuously drained, therefore the left side must also be opened again and here too the same picture of diffuse bleeding. Hemostasis using bipolar coagulation and hydrogen. Then insertion of a Redon drainage and two-layer wound closure on both sides. The coagulation diagnostics are unremarkable, but it is striking that the previously over 300,000 thrombocysts have decreased to 17,000,000, possibly due to heparin. The patient received 0.4 m Clexane preoperatively and the graft was flushed with heparin in the usual manner. The patient did not receive systemic intravenous heparin. Tranexamic acid was administered intraoperatively during hemostasis. Please check the platelets, if necessary administer platelets or FFP, Hb controls and blood reserves if necessary.