Journal Of Reconstructive Microsurgery[JOURNAL]
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200 papers
Quantification of Retained Donor Nuclei in ECM-Based Nerve Wraps: A Histological Assessment of Decellularization and Biocompatibility.
Rader A, Orr L, Becher Z
J Reconstr Microsurg · 2026 May · PMID 42013899 · Publisher ↗
BACKGROUND: Peripheral nerve injuries present a significant clinical challenge, often resulting in chronic pain, sensory loss, and motor dysfunction. Biologically derived nerve wraps are frequently used in surgical nerve...
BACKGROUND: Peripheral nerve injuries present a significant clinical challenge, often resulting in chronic pain, sensory loss, and motor dysfunction. Biologically derived nerve wraps are frequently used in surgical nerve repair to reduce adhesion, promote regeneration, and minimize fibrosis. These extracellular matrix (ECM)-based biomaterials vary widely in composition and processing, including the extent of donor decellularization. Retained donor nuclei and cellular remnants have been implicated in triggering adverse immune responses, including chronic inflammation and fibrotic encapsulation. This study investigates the extent of retained nuclear material in commercially available nerve wraps to establish histological metrics for decellularization efficiency and potential biocompatibility. METHODS: Samples of multiple commercially available nerve wraps were collected and prepared according to manufacturer specifications. Histological assessment was performed using hematoxylin and eosin (H&E) staining. Slides were analyzed at 20× magnification using a standardized fluorescence imaging system. Two primary endpoints were quantified: (1) the number of visible nuclei per three representative microscopic fields and (2) the percentage of cell-free fields per sample. RESULTS: Substantial variability was observed among products. One reconstituted xenograft and a porcine placental product demonstrated complete decellularization with >90% cell free fields and <10 nuclei per field. In contrast, both a native porcine small intestinal submucosa and a human amnion/chorion membrane exhibited high nuclear retention with >50 nuclei per field and 0% cell free fields. These findings suggest inconsistent decellularization practices across manufacturers. CONCLUSION: This study identifies significant differences in residual donor nuclear content among commercially available ECM nerve wraps. Histological quantification using H&E staining may serve as a reproducible method for assessing decellularization quality. These metrics may help predict immunologic compatibility and guide future biomaterial selection in peripheral nerve repair.
GLP-1 Receptor Agonist Use and Wound Outcomes After Free Flap Breast Reconstruction.
Ha J, Lester ER, De May H … +4 more , Somers S, Eddington D, Agarwal JP, Kwok AC
J Reconstr Microsurg · 2026 May · PMID 42013898 · Publisher ↗
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1s) are increasingly used for glycemic control and weight loss, but their impact on surgical wound complications remains unclear. Some studies suggest GLP-1s red...
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1s) are increasingly used for glycemic control and weight loss, but their impact on surgical wound complications remains unclear. Some studies suggest GLP-1s reduce complications such as infection and dehiscence, while others report increased risk in certain procedures. This study evaluates whether preoperative GLP-1 use is associated with postoperative wound complications in free flap breast reconstruction. METHODS: We conducted a retrospective cohort study using the TriNetX Research Network, a global database of de-identified health records. Adults (≥18 years) undergoing free flap breast reconstruction (2012-2025) were identified with CPT codes. Patients were stratified into cohorts by GLP-1 use within 1 year before surgery. Prescriptions for semaglutide, liraglutide, dulaglutide, exenatide, or tirzepatide defined GLP-1 users. Cohorts underwent 1:1 propensity score matching, and matched groups were analyzed for wound outcomes. Subgroup analyses were performed by diabetes status. RESULTS: In the pooled cohort, GLP-1 users had significantly lower composite wound complication rates compared with non-users (9.0% versus 17.1%, = 0.002), including reduced surgical site infections (4.1% versus 8.1%, = 0.026) and wound dehiscence (3.8% versus 7.8%, = 0.023). No differences were observed in debridement, seroma, or hematoma rates. In subgroup analyses, GLP-1 use was associated with significantly lower composite wound complications in the non-diabetic subgroup (7.9 versus 18.6%, = 0.007), while overall complication rates in the diabetic subgroup were comparable between users and non-users. CONCLUSION: Preoperative GLP-1 use was not linked to increased wound complications and may confer benefit, supporting safety when used perioperatively.
Predicting Postoperative Recovery Following Intraoperative Microvascular Complications in Autologous Breast Reconstruction.
Godbe KN, Rauber EE, Nazir N … +5 more , Farmer R, Egan KG, Holding J, Butterworth J, Lai E
J Reconstr Microsurg · 2026 May · PMID 42013897 · Publisher ↗
BACKGROUND: Intraoperative microvascular complications in autologous breast reconstruction may increase the risk of immediate postoperative flap complications, such as congestion, thrombosis, and flap loss. The impact of...
BACKGROUND: Intraoperative microvascular complications in autologous breast reconstruction may increase the risk of immediate postoperative flap complications, such as congestion, thrombosis, and flap loss. The impact of specific intraoperative complications on patient outcomes remains unclear. METHODS: A retrospective chart review of microsurgical breast reconstruction cases from 2017 to 2023 was performed to determine intraoperative and postoperative complications, as well as patient outcomes. Statistical analysis was conducted to determine associations between intraoperative complications and outcomes. RESULTS: A total of 1,005 flaps were performed in 620 patients, with intraoperative complications experienced in 15.1% (152/1,005) flaps. Pedicle/perforator injury was the most common (5.3%). Difficult flap pedicle dissection was a predictor of the need for a blood transfusion (17.7% vs. 8.3%, OR: 2.4 [95% CI: 1.1-5.0], = 0.04). Hematoma was not associated with any intraoperative complications. In comparison, postoperative flap ischemia was associated only with intraoperative arterial thrombosis (8.3% vs. 0.7%, OR: 2.8 [95% CI: 1.5-113.0], = 0.003). Postoperative flap congestion was associated with both intraoperative complications of alternate venous outflow (40% vs. 1.9%, OR: 34.4 [95% CI: 5.4-218], = 0.004) and pedicle/perforator injury (10.5% vs. 1.9%, OR: 6.0 [95% CI: 1.3-27.7], = 0.01). Prolonged length of stay greater than the expected 3 days was associated with difficult flap pedicle vessel dissection (52.9% vs. 31.5%, OR: 2.4 [95% CI: 1.4-4.3], = 0.001) and intraoperative arterial thrombosis (63.6% vs. 32.3%, OR: 3.7 [95% CI: 1.1-12.7], = 0.04). Length of stay greater than 4 days was solely associated with intraoperative thrombosis (36.4% vs. 9.9%, OR: 5.4 [1.6-18.7], = 0.019). The intraoperative complications of venous anastomosis revision and difficult internal mammary vessel dissection had no significant association with the postoperative course. CONCLUSION: Specific intraoperative complications are associated with higher rates of postoperative complications. Awareness of the tendency for a complex postoperative recovery is warranted.
Microvascular Anastomosis Devices: A Scoping Review.
Quach MP, Zona EE, Orgun D … +8 more , Thao P, Gupta S, Furtado NJ, Craig JN, Christensen LA, Zeng W, Dingle AM, Poore SO
J Reconstr Microsurg · 2026 Apr · PMID 41962556 · Publisher ↗
Performing a hand-sewn microvascular anastomosis is a technically challenging and potentially time-consuming task, the results of which can dramatically impact prolonged ischemia time and clinical outcomes. This scoping...
Performing a hand-sewn microvascular anastomosis is a technically challenging and potentially time-consuming task, the results of which can dramatically impact prolonged ischemia time and clinical outcomes. This scoping review aims to examine and synthesize the landscape of microvascular anastomotic devices with the ultimate goal of evaluating their practical utility in comparison to traditional suture-only methods. Emphasis was placed on efficiency, outcomes, and potential limitations as a means of identifying areas for innovation.A scoping review of the PubMed, Scopus, Cochrane Library, and Web of Science databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Search terms related to microsurgery, anastomoses, and devices (e.g., couplers, staplers, clips, stents, glue, laser). Eligible studies included primary research, excluding meeting abstracts, reviews, commentaries, non-English studies, and research on robotic technology or venous couplers for end-to-end anastomoses. Data were extracted on study design, anastomosis completion outcomes (e.g., patency rates, time to completion), and complication rates (e.g., flap loss, anastomotic thrombosis).4875 unique studies underwent title/abstract screening and full-text review. Seventy-three English-language articles met the inclusion criteria. Device distribution included: couplers (36.1%), clip appliers (25.0%), lasers (8.0%), glue (6.2%), and intravascular stents (2.6%). Most included studies were prospective cohorts (43.1%), followed by preclinical studies (23.6%), retrospective review studies (22.2%), case series (5.6%), prospective comparative studies (2.8%), and randomized controlled trials (2.8%). The majority of studies evaluating devices replacing traditional hand-sewn suture, such as clips, staplers, and couplers, reported significantly reduced anastomotic times with comparable or improved vessel patency and/or flap survival, with one study reporting an average anastomotic time of less than 5 minutes. Adjunctive anastomosis devices such as laser, stents, and glue were also shown to be useful in a majority of studies. Intravascular stents were reported to have similar results to the conventional technique; however, some studies noted concerns about long-term vessel patency and compromised perfusion. Glue was shown to reduce the number of required sutures, though few studies noted reactive inflammation and significantly increased thrombosis.This scoping review demonstrates that these microvascular anastomotic devices, either as a replacement for conventional suture or as an adjunct, demonstrate favorable efficiency and safety profiles. Certain limitations were identified, such as vessel characteristics (diameter, thickness, friability), increased risk of thrombosis, or reactive inflammation. These devices also exist in a greater context of practicality, such as cost feasibility, ease of use, and initial learning curve. Further high-quality, large-scale trials are required to confirm these findings in both human and preclinical settings.
Bridging the Gap between Microsurgery and Supermicrosurgery: A Rat Study for 0.3 mm Vascular Anastomosis Comparing Robotic-assisted vs. Conventional Approach.
Kim TH, Chae S, Kim D … +5 more , Kim T, Kwon JG, Pak CJ, Suh HP, Hong JP
J Reconstr Microsurg · 2026 Jul · PMID 41956127 · Full text
BACKGROUND: Supermicrosurgery involving vessels ≤0.3 mm remains among the most technically demanding procedures in reconstructive surgery. Robotic platforms have shown potential to enhance precision, but their feasibilit...
BACKGROUND: Supermicrosurgery involving vessels ≤0.3 mm remains among the most technically demanding procedures in reconstructive surgery. Robotic platforms have shown potential to enhance precision, but their feasibility at this extreme scale requires further validation. METHODS: Apprentice surgeons (≤5 years' experience) performed rat femoral vessel (approximately 0.26-0.30 mm) anastomoses using both hand-sewn and robotic-assisted techniques across eight consecutive trials. Outcome measures included Structured Assessment of Robotic Microsurgical Skills (SARMS) scores, operative time, stitch count, and patency rate. Learning curves were assessed with cumulative summation (CUSUM) analysis, and anastomotic quality was evaluated using scanning electron microscopy (SEM). RESULTS: Robotic-assisted anastomosis reached proficiency earlier than hand-sewn repair (4th versus 6th trial). Although initial operative time was longer for robotic cases (1,772 ± 120 seconds versus 1,355 ± 187 seconds, = 0.013), times equalized by the 5th trial and decreased by 42% by the 8th (1,026 ± 58 seconds versus 1,023 ± 73 seconds, = 0.959). Stitch counts were higher in later robotic trials (4.2 ± 0.6 versus 3.5 ± 0.5, = 0.015). Both groups achieved 100% patency by the 4th trial. CUSUM and SEM analyses confirmed a steeper learning curve and superior anastomotic precision with robotic assistance. CONCLUSION: Robotic-assisted supermicrosurgery enables earlier proficiency, enhanced precision, and reproducible anastomotic quality compared with hand-sewn techniques. Despite longer initial times, robotic performance rapidly improved, achieving equivalent efficiency with greater technical control. These findings confirm the technical feasibility of robotic supermicrosurgery at the 0.3 mm scale and support its potential role in microsurgical and lymphatic reconstruction training and clinical practice.
Women's Microsurgery Group Mentorship Program: Are We Fostering Connection and Meeting Mentees Needs?
Palmer SK, Anderson MJ, Wen E … +2 more , Caterson SA, Silva AK
J Reconstr Microsurg · 2026 Mar · PMID 41819137 · Publisher ↗
Access to female mentorship in microsurgery is limited. The American Society for Reconstructive Microsurgery Women's Microsurgery Group (WMG) established a mentorship program in 2014. This study evaluates recent particip...
Access to female mentorship in microsurgery is limited. The American Society for Reconstructive Microsurgery Women's Microsurgery Group (WMG) established a mentorship program in 2014. This study evaluates recent participant demographics and mentee priorities.Data from the 2023 to 25 WMG mentorship cohorts were analyzed to assess demographics, mentor practice patterns, and mentee priorities using standard statistical methods.The recent cohort includes 51 mentors and 55 mentees. Mentees were primarily medical students. Mentors were primarily junior attendings. Mentees represented 48 institutions; 12.5% lacked female plastic surgery faculty and 39.6% lacked a female microsurgeon. Among medical student mentees, 32.1% were from schools without an integrated residency and 25% had no home plastic surgery program. Mentee priorities varied significantly by training level ( = 0.006), with earlier trainees valuing career advancement and later trainees prioritizing transition to practice. Significant discordance existed between mentee preferences and mentor backgrounds in both practice type ( < 0.001) and setting ( = 0.006). While 55.8% of mentees expressed interest in blended practices and 36.5% favored hospital-based or private practice settings, most mentors had purely reconstructive (86.3%) academic practices (86.3%).The WMG mentorship program effectively connects mentees-many from institutions lacking female microsurgeons or plastic surgery programs-with female mentors. The majority of mentors are junior faculty and a substantial number of mentees are "orphan applicant" medical students, underscoring the need for broader mentorship initiatives and efforts to reduce mentor fatigue. Findings also highlight the importance of expanding mentor recruitment to better reflect the evolving interests and goals of mentees.
Assessing Health Literacy as a Predictor of Outcomes in Autologous Breast Reconstruction across Comorbidity Burdens.
Wehelie HM, DeVito RG, Pawly J … +4 more , Mercante M, Campbell CA, Stranix JT, Hollenbeck S
J Reconstr Microsurg · 2026 Apr · PMID 41812998 · Publisher ↗
Health literacy is closely linked to health outcomes, underscoring the importance of accessible patient education, particularly for patients undergoing complex surgical procedures. Despite this, there is limited research...
Health literacy is closely linked to health outcomes, underscoring the importance of accessible patient education, particularly for patients undergoing complex surgical procedures. Despite this, there is limited research examining the influence of health literacy on outcomes in autologous breast reconstruction.We performed a retrospective review of autologous breast reconstruction patients between 2017 and 2022 at our institution. Baseline demographic and clinical data were collected. Health literacy scores were assessed using the validated Set of Brief Screening Questions (SBSQ), with increasing value equating lower health literacy. Patients were categorized by the Charlson Comorbidity Index (CCI) into groups representing mild, moderate, and severe comorbidity burden. Logistic and linear regression analyses were performed.The study included 264 patients, of whom 175 had mild, 49 moderate, and 40 severe comorbidity burden. Within the severe CCI group, worse HL was associated with increased odds of recipient site wound (OR 1.85, = 0.0472), postoperative emergency department visits within 30 days (OR 2.56, = 0.0489), and increased postoperative phone utilization (β = 0.52, = 0.0461). No significant association was found between health literacy scores and the rate of surgical site infections, donor site wounds, or postoperative hernia.In this study, lower health literacy was significantly associated with increased health system utilization and wound complications in patients with severe comorbidity burden. This highlights the complex relationship between health literacy and outcomes, and the importance of patient education and shared decision-making in autologous breast reconstruction.
Randomized Control Trial of Smartphones as Microscope Simulators in Early Microsurgical Education.
Guo CR, Khunte M, Sobti N … +2 more , Maselli A, Kwan D
J Reconstr Microsurg · 2026 Mar · PMID 41812687 · Publisher ↗
Microsurgery is an important discipline with a steep learning curve. The gold standard for training is on traditional operative-level microscopes (TM), although they are expensive, large, and immobile. Smartphones as mic...
Microsurgery is an important discipline with a steep learning curve. The gold standard for training is on traditional operative-level microscopes (TM), although they are expensive, large, and immobile. Smartphones as microscope simulators (SMS) pose a promising alternative due to their ubiquity, affordability, and portability, yet existing studies are limited.Students and surgical residents were recruited and randomized to three groups: Test-Only (no interval training), SMS (remote training on smartphone), or TM (training on hospital TM). Participants completed identical initial and final suture tests 1-week apart on the TM that were filmed, then blindly evaluated by two microsurgery fellowship-trained plastic surgeons. During the week in between, SMS and TM participants had four training sessions. One and five suture completion, suture quality (using the Stanford Microsurgery and Resident Training [SMART] Score), speed, self-confidence, and training completion rate were evaluated. Paired -tests and multivariate analysis of variance were performed in R Studio.A total of 58 participants completed the study. Compared with no training, SMS ( = 20) significantly improved single suture and five suture completion ( = 0.004), SMART Score ( = 0.0002), and self-confidence ( = 0.001). Test-Only ( = 20) had significant improvement for self-confidence ( = 0.039) but not suturing. TM ( = 18) had higher SMART Scores ( = 0.006) and training completion rate compared with SMS (89 vs. 45%, respectively [ = 0.012]). Between SMS and TM, there was no difference in five suture completion ( = 0.178), speed ( = 0.289), or self-confidence ( = 0.632). Students after SMS training had similar SMART Scores as residents at baseline ( = 0.260).SMS is an effective training modality for achieving basic suture competency, speed, and self-confidence, whereas TM remains superior for suturing quality. SMS may be particularly well suited for acquisition of basic microsurgical skills in training situations with limited TM access, or as an adjunct to TM in early training to establish basic skills, instrument familiarity, and increase repetitions.
The Effect of Patient Resources on Outcomes in Autologous Breast Reconstruction: A Single Center Matched Cohort Study.
Johnson AK, English SB, Ke BG … +6 more , Wehelie HM, Glenney A, DeVito RG, Campbell CA, Stranix JT, Hollenbeck ST
J Reconstr Microsurg · 2026 Mar · PMID 41802759 · Publisher ↗
At our breast reconstruction center, we have, over time, developed a focused program to increase access to care for low-resource patients. This program includes outreach clinics, physician extenders, care coordinators, a...
At our breast reconstruction center, we have, over time, developed a focused program to increase access to care for low-resource patients. This program includes outreach clinics, physician extenders, care coordinators, and telehealth utilization.A retrospective review of all free flap breast reconstruction patients between 2017 and 2022 at our center was performed. Specific criteria, including insurance carrier, educational attainment, and zip code median household income, language barriers, and distance to hospital, were used to create favorably-resourced (FR) and unfavorably-resourced (UR) cohorts. Propensity score matching was then used to control for clinical factors and comorbidities.A total of 49 and 52 patients met the inclusion criteria for FR and UR cohorts, respectively, producing 33 matched pairs. FR was associated with a greater average number of donor site revisions (0.73 vs. 0.45, = 0.05). Other statistically significant differences included average zip code household income ($109,477 FR vs. $71,996 UR, < 0.01), bachelor's degree education level (26% FR vs. 16% UR, < 0.01), and average distance to hospital (25 miles FR vs. 82 miles UR, < 0.01). No significant differences were detected between groups regarding mastectomy skin flap necrosis, recipient site infection, recipient site wound, breast revisions, donor site infection, donor site wound, seroma, fat necrosis, hernia/bulge, length of follow-up, or drain removal time.This study shows that within a health system utilizing dedicated access to care programs, equivalent results were observed in autologous breast reconstruction among favorably and unfavorably resourced patients.
Impact of a Microsurgical Curriculum on Intraoperative Efficiency and Technical Skills in Free Flap Breast Reconstruction.
Towfighi P, Konig DJ, Konig LE … +3 more , Hassanein AH, Danforth RM, Lester ME
J Reconstr Microsurg · 2026 Mar · PMID 41794021 · Publisher ↗
Microsurgery is an essential component of plastic surgery, yet its technical demands and steep learning curve pose challenges for trainees. The Fundamentals of Microsurgery (FMS) curriculum is a structured, competency-ba...
Microsurgery is an essential component of plastic surgery, yet its technical demands and steep learning curve pose challenges for trainees. The Fundamentals of Microsurgery (FMS) curriculum is a structured, competency-based simulation training program with five increasingly difficult noncadaveric tasks testing microsurgical dexterity outside the operating room (OR). This study evaluates the impact of FMS simulation on microsurgical efficiency and technical skills in plastic surgery trainees, translated into outcomes in the OR.A retrospective review of 28 total integrated and independent plastic surgery residents who participated in the FMS curriculum from 2019 to 2024 at a single-institution was conducted, analyzing 168 individual arterial anastomoses amongst 104 unique free flap breast reconstructions in the OR. Patient predictive variables, including body mass index (BMI) and prior radiation where analyzed. Outcomes included arterial anastomosis times, intraoperative technical imperfections, and total operative times. Statistical analyses were performed to assess independent predictors of surgical efficiency, with < 0.05.Completion of the FMS curriculum was significantly associated with shorter intraoperative arterial anastomosis times (22.45 minutes vs. 33.65 minutes; < 0.001) and fewer intraoperative technical imperfections, even in more difficult cases such as patients with higher BMI and those with prior radiation.The FMS curriculum enhances microsurgical technical skills and operative efficiency in plastic surgery trainees, even in difficult cases. These findings underline the necessity for standardized microsurgical training curricula to improve operative efficiency and technical precision. FMS or similar models should be integrated into all plastic surgery training programs to optimize patient outcomes and trainee competency.
Perioperative Blood Pressure Kinetics and Hematoma Rates in Head and Neck Free Flaps.
Park YJ, Rothchild E, Smith IT … +5 more , O'Connor P, Coyle L, Yom J, Bins G, Ricci JA
J Reconstr Microsurg · 2026 Mar · PMID 41791425 · Publisher ↗
Postoperative hematoma is a common yet unfavorable complication following head and neck free flap reconstruction (HNFFR). This study aims to clarify how perioperative blood pressures influence postoperative neck hematoma...
Postoperative hematoma is a common yet unfavorable complication following head and neck free flap reconstruction (HNFFR). This study aims to clarify how perioperative blood pressures influence postoperative neck hematoma development and its effect on outcomes in patients undergoing HNFFR.A retrospective chart review was conducted for all patients who underwent HNFFR at a single academic institution between January 2020 and December 2023. Data included demographics, radiation history, comorbidities, flap type, complications, and blood pressures at preoperative, intraoperative, early (<24 hours), and late (days 1-7) postoperative periods.A total of 317 patients with 329 flaps were included in our analysis. Twenty-seven patients developed a neck hematoma, and flap failure was significantly higher in these patients (11.1% vs. 2.4%, = 0.044). After adjusting for potential confounding variables, hematoma formation was significantly associated with higher preoperative systolic and pulse pressures; peak early postoperative systolic pressures; and peak late postoperative systolic, diastolic, and mean arterial pressures (MAP). In a multivariate model including preoperative, early, and late postoperative MAP, only late postoperative MAP remained an independent predictor of hematoma. Each 1 mm Hg rise in late MAP raised hematoma odds by 4% (OR: 1.04, = 0.004), and receiver operator curve analysis identified late MAP ≥ 117.8 carried a fivefold higher risk of hematoma (OR: 5.24, < 0.001).Our findings suggest that postoperative blood pressure control is critical in reducing hematoma risk following HNFFR. Strict postoperative blood pressure management, particularly maintaining a MAP goal of < 110 mm Hg, may reduce hematoma risk and associated flap failure.
Long-Term Breast Morphological Analysis After Ergonomic FALD Flap Reconstruction: A Case-Control Study.
D'Orsi G, Longo B, Farcomeni A … +6 more , Giacalone M, Gagliano E, Vannucchi L, Vanni G, Buonomo OC, Cervelli V
J Reconstr Microsurg · 2026 Mar · PMID 41791424 · Publisher ↗
The fat-augmented latissimus dorsi (FALD) flap is an autologous flap that combines the latissimus dorsi (LD) flap with intraoperative autologous fat transfer (AFT) to improve the volume of the reconstructed breast. In re...
The fat-augmented latissimus dorsi (FALD) flap is an autologous flap that combines the latissimus dorsi (LD) flap with intraoperative autologous fat transfer (AFT) to improve the volume of the reconstructed breast. In recent years, our team has described the ergonomic FALD flap, a modification of this technique that helps to achieve a complete reconstruction in a single surgical step. In this case-control study, we analyze the long-term morphological changes of the breast after ergonomic FALD flap reconstruction compared with the traditional FALD flap technique.Between December 2020 and April 2023, we prospectively enrolled patients undergoing BR using FALD flap into two groups: group A included ergonomic FALD flap, while group B included traditional FALD flap. The primary endpoint was to compare the two groups in terms of breast projection, breast width, and breast height, while the second endpoint concerned the analysis of the aesthetic outcomes.Forty-two FALD flaps (31 patients) were performed for group A and 37 FALD flaps (29 patients) for group B. The two groups were homogeneous regarding demographic variables. Using a propensity score weighting analysis, group A showed a significantly higher breast projection compared with group B (6.78 vs. 5.75; < 0.0001), after 18 months of follow-up. Final aesthetic analyses showed to be superior in group A concerning breast shape ( = 0.003) and global score evaluation ( = 0.023).The ergonomic FALD flap showed better long-term aesthetic outcome compared with the traditional transverse FALD flap, with higher breast projection and fewer additional delayed AFT sessions. The study provides level II evidence.
Negative Pressure Wound Therapy and Donor Site Morbidity in DIEP and Tram Flap Reconstruction: A Single-Center Longitudinal Review.
Thomas JR, Crystal DT, Patel SD … +5 more , Kim J, Habarth-Morales TE, Broach RB, Kanchwala SK, Azoury SC
J Reconstr Microsurg · 2026 Mar · PMID 41776943 · Publisher ↗
Abdominally based breast free flap reconstruction exposes patients to potential significant donor site morbidity. Utilization of postoperative Incisional Negative Pressure Wound Therapy (iNPWT) has been proposed to minim...
Abdominally based breast free flap reconstruction exposes patients to potential significant donor site morbidity. Utilization of postoperative Incisional Negative Pressure Wound Therapy (iNPWT) has been proposed to minimize incision site complications. This study aims to assess if iNPWT reduces rates of donor site complications after DIEP and TRAM flap harvest.This single-center, retrospective study included patients who underwent Deep Inferior Epigastric Artery (DIEP) or Transverse Rectus Abdominis Muscle (TRAM) flap reconstruction from 2022 to 2024. Patients' abdominal donor sites received either standard wound care or iNPWT at the time of reconstruction.A total of 362 patients were identified with a median age of 51.3 (IQR: 43.3-59.6) years. Rates of delayed healing at the donor site were lower in the iNPWT cohort compared to standard of care (13.4% vs. 35.3%, < 0.001). Controlling for tobacco exposure, diabetes, hypertension, and laterality, there was a lower likelihood of delayed healing in the iNPWT cohort (OR: 0.249 [0.14-0.43], < 0.001). This finding persisted in current and former smokers (OR: 0.269 [0.16-0.46], < 0.001) and patients with comorbid hypertension (OR: 0.257 [0.15-0.44], < 0.001).These results suggest iNPWT usage is associated with lower rates of donor site delayed healing after DIEP and TRAM procedures in the general patient population and should be considered in those with two or more vascular risk factors. Further investigation is required to stratify the risk of delayed healing for patients with concomitant hypertension, tobacco exposure, diabetes, and/or obesity.
Comparing Outcomes in Microsurgical Reconstruction of Trauma and Burn Patients.
Sanchez CV, Hinson C, Dogaroiu A … +2 more , Sink M, Odobescu A
J Reconstr Microsurg · 2026 Mar · PMID 41776942 · Publisher ↗
Microsurgical reconstruction is often first-line treatment in trauma cases, yet its role in burn reconstruction remains inconsistent, despite comparable injury complexity and resuscitation demands. While literature sugge...
Microsurgical reconstruction is often first-line treatment in trauma cases, yet its role in burn reconstruction remains inconsistent, despite comparable injury complexity and resuscitation demands. While literature suggests mixed outcomes for free flap use in burns, no study has directly compared microsurgical outcomes between trauma and burn reconstructions. This study aimed to evaluate complication rates and outcomes of free flap reconstruction in trauma versus burn patients.We conducted an institutional review board-approved retrospective cohort study of patients who underwent microsurgical reconstruction following traumatic or burn injuries between October 2016 and September 2024 at a single Level 1 trauma and major burn referral center. Outcomes assessed included flap survival, flap failure, hematoma, infection, flap debridement, and hospital length of stay (LOS). Subgroup analysis compared acute versus delayed reconstructions.Ninety-six patients met inclusion criteria: 67 in the trauma group and 29 in the burn group. Flap success was 96.6% in the burn group versus 92.5% in the trauma group. Median LOS was significantly longer in burn patients (34 days [interquartile range, IQR: 1-67]) compared with trauma patients (20 days [IQR: 10-30]; = 0.046). Complication rates did not significantly differ between groups ( = 0.356). In acute cases, flap success was 100% for burns versus 92% for trauma.Microsurgical reconstruction in burn patients demonstrates similar success and complication rates to trauma patients. Given these comparable outcomes, microsurgeons should actively collaborate with burn teams to ensure optimal care and expand reconstructive options for burn patients.
Sociodemographic Factors and Delays in Care for Patients Undergoing Treatment for Head and Neck Cancer in a Medically Underserved State.
Pitre K, McCall R, Nodurft M … +11 more , Islam S, Elver A, Taylor H, Facundus E, Fleming A, Phillips J, Austin J, Velasco Martinez I, Vahdani S, McIntyre B, Humphries L
J Reconstr Microsurg · 2026 Mar · PMID 41776941 · Publisher ↗
Timely surgical intervention for head and neck cancer (HNC) is critical to improving survival, particularly in advanced-stage disease requiring free-flap reconstruction. In medically underserved states, structural barrie...
Timely surgical intervention for head and neck cancer (HNC) is critical to improving survival, particularly in advanced-stage disease requiring free-flap reconstruction. In medically underserved states, structural barriers such as rurality, socioeconomic disadvantage, and limited specialty availability can delay care. This study evaluates how race, insurance status, Social Vulnerability Index (SVI), and geographic distance affect delays in HNC surgical treatment in a state with the poorest national health outcomes and only one tertiary referral center.A retrospective cohort study was conducted at the University of Mississippi Medical Center, including all patients undergoing oncologic resection by oral and maxillofacial surgery and free-flap reconstruction by plastic surgery from January 2016 to July 2024. Demographics, tumor stage, insurance status, SVI, and driving distance were recorded. Care intervals were defined as the time from symptom onset to initial tertiary appointment (PreUMMC) and from initial appointment to surgery (PostUMMC).Of 180 patients (62.2% male, 70.6% White, 23.9% Black), 60% had government insurance and 22.5% resided in SVI quartile 4. Median PreUMMC delay was 115 days (interquartile range [IQR]: 61-225), which was over three times longer than the PostUMMC median of 28 days (IQR: 20-39; < 0.001). PreUMMC delays were longest for SVI 4 patients (203.5 days, = 0.029) and correlated with driving distance (ρ = 0.213, = 0.004). Black patients were more likely to reside in high-SVI areas and present with advanced-stage tumors (pT4, 46.5 vs. 24.8%, = 0.029). No significant sociodemographic differences were observed in PostUMMC timing.In Mississippi, disparities in HNC surgical timing occur predominantly before tertiary care access, reflecting the influence of geographic distance and social vulnerability. Once within the academic system, treatment timelines are equitable across groups. Addressing upstream barriers through targeted referral pathways, transportation solutions, and outreach to high-SVI communities is essential to improving timely surgical access.
The Chimeric Descending Genicular Artery Flap: Expanding the Applications of the Medial Femoral Condyle Pedicle to Composite Free Flap Reconstruction.
Kim YD, Langbart M, Kernohan M … +2 more , Ngo Q, Harish V
J Reconstr Microsurg · 2026 Mar · PMID 41776940 · Publisher ↗
The descending genicular artery (DGA) axis can provide a versatile reconstruction that includes several tissue components, including bone, skin, muscle, tendon, and nerve. We present a novel CT angiography study to defin...
The descending genicular artery (DGA) axis can provide a versatile reconstruction that includes several tissue components, including bone, skin, muscle, tendon, and nerve. We present a novel CT angiography study to define the branches of the DGA axis as they relate to flap design for composite bone and soft tissue defect reconstruction.Lower limb CT angiography studies performed at a major microsurgery unit between 2019 and 2021 were evaluated by two independent clinicians. Vascular anatomy of the DGA, saphenous artery (SA), and branches to regional structures were evaluated and measured.An initial 98 studies were identified, with 64 studies included for final analysis. The DGA was seen in 56 (87.5%) cases. Cutaneous supply via the DGA axis was possible in 40 cases (70%). Cutaneous supply was seen via direct perforators in 18 (32.1%) cases and the SA in 34 (53.1%) cases. Branches to the vastus medialis were frequent (51.6%). A novel four-tier classification system of the cutaneous supply was developed to assist in chimeric flap design based on these findings. Based on this classification, cutaneous paddle design was possible via the SA in 60% of cases and a further 10% of cases via a direct DGA perforator (skin perforator arising from the DGA proper).The DGA axis provides separate and consistent soft tissue and bone pedicles, enabling reliable chimeric flap design. Preoperative CT angiographic imaging ensures a simple, versatile flap with a long pedicle and minimal donor morbidity.
Regional Nodal Irradiation Impact on Lymphedema, Surgical Outcomes, and Quality-of-Life Following Mastectomy, Axillary Dissection, and Immediate Lymphatic Reconstruction.
Hassan AM, Hajj JP, Lewis JP … +5 more , Fisher CS, Danforth RM, Lester ME, Zellars RC, Hassanein AH
J Reconstr Microsurg · 2026 Mar · PMID 41776939 · Full text
Radiation therapy following axillary lymph node dissection (ALND) is a key risk factor for lymphedema, with regional nodal irradiation (RNI) posing a higher risk. Immediate lymphatic reconstruction (ILR) with microsurgic...
Radiation therapy following axillary lymph node dissection (ALND) is a key risk factor for lymphedema, with regional nodal irradiation (RNI) posing a higher risk. Immediate lymphatic reconstruction (ILR) with microsurgical lymphovenous anastomosis performed concurrently with ALND aims to prevent lymphedema, but its efficacy in the setting of RNI is unclear. This study compares lymphedema incidence, complications, and LYMPH-Q patient-reported outcomes (PROs) after ILR based on receipt of RNI.We retrospectively studied consecutive patients who underwent mastectomy and ALND with ILR between 2017 and 2024 at our institution. Patients receiving radiotherapy were categorized based on receipt of RNI, and outcomes were compared using multivariable regression, adjusting for patient and treatment factors.We identified 119 patients with a mean follow-up time of 25.0 ± 15.5 months, of whom 68.9% ( = 82) received RNI. Radiotherapy characteristics were comparable between the RNI and non-RNI cohorts, including 3D Conformal Radiotherapy use (95.1% vs. 88.2%, = 0.945), mean chest wall radiation dose (5,006 ± 238 cGy vs. 5,054 ± 593 cGy, = 0.656), and receipt of chest wall scar boosts (32.9% vs. 27.0%; = 0.520). In adjusted analyses, RNI was not associated with higher odds of lymphedema (OR, 0.30; = 0.429), surgical complications (OR: 1.94; = 0.540), reoperation (OR: 1.11; = 0.844) or worse LYMPH-Q symptoms ( = 0.823), function ( = 0.353), appearance ( = 0.362), or psychological well-being ( = 0.174) scales.RNI in the setting of ILR was not associated with increased surgical morbidity, lymphedema rates, or adverse patient-reported outcomes. While ILR may mitigate the expected morbidity of RNI, prospective studies are needed to establish its definitive value in this high-risk population.
Plastic Surgery-on-a-Chip: Organ-on-a-Chip Applications in Plastic and Reconstructive Surgery.
Gupta A, Zhang YS, Mokashi S
J Reconstr Microsurg · 2026 Mar · PMID 41776938 · Publisher ↗
Organ-on-a-chip (OoC) platforms are microfluidic systems that replicate key aspects of human tissue physiology in controlled environments. Originally developed for drug testing and disease modeling, they provide a more h...
Organ-on-a-chip (OoC) platforms are microfluidic systems that replicate key aspects of human tissue physiology in controlled environments. Originally developed for drug testing and disease modeling, they provide a more human-specific and reproducible alternative to traditional preclinical models, which often fail to capture the complexity of tissues relevant to plastic and reconstructive surgery.This review synthesizes current OoC technologies with direct application to plastic and reconstructive surgery, focusing on skin-, vessel-, adipose-, and nerve-on-a-chip systems. The analysis emphasizes how these platforms model tissue structure, function, and interactions and evaluates their ability to simulate clinically relevant processes.Skin-on-a-chip platforms enable dynamic modeling of wound healing, graft integration, and barrier function. Vessel-on-a-chip systems replicate microcirculatory flow, endothelial function, and vascular wall behaviors, supporting studies of flap viability and ischemia-reperfusion injury. Adipose-on-a-chip preserves lipid metabolism and inflammatory signaling, informing research into fat graft retention and remodeling. Nerve-on-a-chip platforms allow real-time monitoring of nerve injury and regeneration, aiding evaluation of nerve repair and graft performance. Across these systems, OoC models provide more clinically relevant insights than animal or static in vitro approaches, though limitations persist, including restricted physiological complexity, lack of platform standardization, short-term viability, and scalability challenges.OoC platforms offer significant promise for advancing plastic and reconstructive surgery research by bridging translational gaps and aligning in vitro modeling with surgical outcomes such as graft take and nerve function. Future directions include incorporating immune elements, developing multitissue systems, expanding commercial accessibility, and improving long-term functionality. As these technologies mature, they have the potential to accelerate innovation and improve patient outcomes in reconstructive surgery.
Reliable Outcomes of Free Fasciocutaneous Flaps for Complex Oncologic Scalp Reconstruction: A Multicenter Comparative Analysis.
Chen J, Cole-Price A, Hespe GE … +5 more , Shahzad F, Nelson J, Matros E, Allen RJ, Lee KT
J Reconstr Microsurg · 2026 Mar · PMID 41776937 · Publisher ↗
Scalp reconstruction following oncologic resection can be challenging due to the presence of complicating factors such as extensive defects, cranioplasty, and radiotherapy, frequently requiring the need for free tissue t...
Scalp reconstruction following oncologic resection can be challenging due to the presence of complicating factors such as extensive defects, cranioplasty, and radiotherapy, frequently requiring the need for free tissue transfer. While musculocutaneous flaps have traditionally been used, fasciocutaneous flaps are increasingly favored. However, their safety in these high-risk conditions remains unclear. This study examines whether flap type influences outcomes in oncologic scalp reconstruction.A retrospective review was performed of patients who underwent microsurgical scalp reconstruction for oncologic defects between 2018 and 2024 at two tertiary centers. Patients were grouped into musculocutaneous and fasciocutaneous flap cohorts. Postoperative complication rates were compared between the groups across various clinical settings.A total of 109 patients were included: 35 (32.1%) underwent musculocutaneous flap reconstruction, and 74 (67.9%) received fasciocutaneous flaps. The most commonly used flaps were the latissimus dorsi and anterolateral thigh flaps, respectively. The musculocutaneous group had more comorbidities, more frequent irradiation history, and larger defects. Postoperative complications occurred in 37 patients (33.9%), most commonly delayed wound healing. Overall and specific complication rates were similar between groups, except for late complications (occurring or persisting beyond 3 months), which were more frequent in the musculocutaneous group. This pattern held across subgroups defined by cranioplasty, radiotherapy, and defect size. Flap type did not independently predict complications on multivariable analysis.Our results suggest that both musculocutaneous and fasciocutaneous flaps are effective for oncologic scalp reconstruction. Fasciocutaneous flaps appear to be a reliable alternative, even in complex cases involving radiotherapy, cranioplasty, or extensive defects.
Preoperative Lower Back Pain is a Risk Factor for Worse Physical Well-Being of the Abdomen After Breast Reconstruction.
Shammas RL, Boe LA, Wang J … +7 more , Graziano FD, Hespe GE, Allen RJ, Stern CS, Matros E, Nelson JA, Mehrara BJ
J Reconstr Microsurg · 2026 Mar · PMID 41771493 · Publisher ↗
Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability a...
Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability and abdominal donor-site recovery after surgery. This study evaluated the association between a preexisting diagnosis of lower back pain and long-term physical well-being of the abdomen after surgery.We conducted a retrospective study of patients who underwent abdominally based free flap breast reconstruction between 2017 and 2024. Patients were categorized by the presence or absence of a preexisting diagnosis of lower back pain. The primary outcome was physical well-being of the abdomen, assessed using the BREAST-Q. Multivariable linear mixed-effects models evaluated the association between lower back pain and abdominal well-being.A total of 2,594 patients were included. Donor-site complications occurred in 15% of patients, including wound dehiscence (9.1%), surgical site infection (4.3%), palpable bulge (2.4%), seroma (2.2%), and hematoma (0.5%). Patients with preexisting lower back pain ( = 298, 11.5%) had significantly lower abdominal well-being scores compared with those without at 1 year (62 vs. 69; < 0.001) and 5 years (65 vs. 76; = 0.014). On multivariable analysis, lower back pain was independently associated with worse abdominal well-being (β = -5, 95% confidence interval [CI]: -8.9 to -0.97; = 0.015), exceeding the minimal clinically important difference of ≥4.Preexisting lower back pain is associated with significantly worse long-term abdominal well-being after breast reconstruction. Future studies should investigate targeted interventions such as pre- and postoperative core rehabilitation protocols to improve outcomes in these high-risk patients.
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