Journal Of Reconstructive Microsurgery[JOURNAL]
Sun
200 papers
Safety and Utility of Superficial Circumflex Iliac Perforator versus Superficial Circumflex Iliac Artery Flaps in Pediatric Reconstructive Surgery.
Garbaccio N, Schonebaum DI, Smith JE … +5 more , Cordero JJ, Foster L, Mehdizadeh M, Dowlatshahi AS, Lin SJ
J Reconstr Microsurg · 2025 Nov · PMID 41248677 · Publisher ↗
The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for...
The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for revision, advantages well-suited to pediatric patients. Despite documented success in adults, the safety and utility of SCIP and SCIA-f are underexplored in pediatric populations.A systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases identified 93 articles reporting SCIP/SCIA-f outcomes in patients ≤ 17 years of age. Patient demographics, clinical characteristics, and postoperative outcomes were collected. Cohorts were stratified by SCIP/SCIA and age group. Mann-Whitney U tests compared cohort outcomes.Thirty-one studies were included, constituting 107 SCIA-f and 57 SCIP-f, with ages 10 weeks to 17 years. Most cases were congenital or traumatic defects in upper/lower extremities. Compared with SCIA-f, SCIP-f demonstrated significantly lower rates of all-cause complications, total flap loss, major and minor complications, and debulking ( < 0.05). All-cause complication rates were also significantly lower across age groups ( < 0.001).This meta-analysis demonstrates favorable efficacy and safety of SCIP-f in children with congenital and traumatic defects, especially of the extremities. SCIP-f may be considered a reliable option for pediatric reconstruction. Additionally, fewer subsequent procedures for contouring may be required.
Complication Burden and Demographic Trends in Autologous Breast Reconstruction Outcomes: Insights from the NIH All of Us Program.
Parekh HN, Colakoglu S, Reddy SK
J Reconstr Microsurg · 2025 Dec · PMID 41197982 · Publisher ↗
While the risks and benefits of autologous breast reconstruction have been widely examined, nationally representative, longitudinal data on complication burden, flap utilization trends, and patient-level risk factors rem...
While the risks and benefits of autologous breast reconstruction have been widely examined, nationally representative, longitudinal data on complication burden, flap utilization trends, and patient-level risk factors remain limited. The NIH All of Us Research Program provides an opportunity to address these gaps using a diverse, population-scale cohort.We identified 260 patients who underwent autologous breast reconstruction using current procedural terminology codes within the All of Us Registered Tier Dataset (1995-2025). Complications were tracked at 30 days and 1 year postoperatively. Logistic, multivariate regressions, and Kaplan-Meier analyses evaluated predictors and timing of complications. Unsupervised machine learning via k-means clustering was utilized to uncover phenotypic subgroups by age and body mass index (BMI).Deep inferior epigastric perforator flap utilization increased over time, particularly among younger patients. Complication rates did not significantly differ across flap types. BMI > 32.7 kg/m was associated with increased 30-day complications, while age and race were not independent predictors. Chronic pain and persistent postoperative pain were the most common 1-year complications. Flap failure occurred in fewer than 2% of cases. Clustering revealed three patient subgroups with distinct complication profiles; older patients and those with higher BMI experienced greater morbidity but maintained high flap success rates.Autologous breast reconstruction is broadly effective across diverse patient populations. Complication risk is more strongly influenced by BMI than by age or race. Chronic pain emerged as a common long-term morbidity, underscoring the need for improved detection and management efforts. The diversity, depth, and follow-up available through All of Us enable nuanced insights into reconstructive outcomes not possible with traditional datasets.
Comparing Blood Loss in Immediate and Delayed Autologous Breast Reconstruction.
DeVito RG, Harlan D, Ke BG … +5 more , Isaula DM, Park RH, Hollenbeck ST, Campbell CA, Stranix JT
J Reconstr Microsurg · 2025 Nov · PMID 41197981 · Publisher ↗
Blood loss is a critical component of all surgical procedures. Excess blood loss may require a blood transfusion and increase the risk of complications after autologous breast reconstruction.Retrospective cohort of 264 c...
Blood loss is a critical component of all surgical procedures. Excess blood loss may require a blood transfusion and increase the risk of complications after autologous breast reconstruction.Retrospective cohort of 264 consecutive autologous breast reconstruction patients between July 2017 and June 2022. Patients were stratified by reconstruction timing and bilateral versus unilateral reconstruction. Postoperative hemoglobin reduction and transfusion incidence were the primary outcomes of interest.Average preoperative hemoglobin (12.6 g/dL) was equivalent among all groups. Comparing bilateral immediate ( = 77) and delayed ( = 50) patients, immediate reconstructions had greater postoperative hemoglobin losses (-3.26 g/dL vs. -1.98 g/dL, < 0.01) and higher transfusion rates (14% vs. 2.0%, = 0.02). Comparing unilateral immediate ( = 99) and delayed ( = 38) patients, immediate reconstructions had greater hemoglobin losses (-2.60 g/dL vs. -1.41 g/dL, < 0.0001) and higher transfusion rates (12.1% vs. 0.0%, = 0.03). Using regression analysis, controlling for confounding variables and intraoperative resuscitation risk factors for blood transfusion requirement, were postmastectomy radiation therapy requirement (odds ratio [OR]: 10.3, < 0.01) and vascular disease (OR: 14.5, = 0.02). Unilateral reconstruction was protective from requiring transfusion (OR: 0.20, = 0.03). Increasing BMI was protective, and with each increasing unit of BMI, transfusion requirement incidence decreased by 12.3% ( = 0.04). Transfusion was not associated with flap thrombosis or flap loss.Compared to immediate autologous breast reconstruction, a staged approach to both unilateral and bilateral patients can help minimize the risk of transfusion requirement. These factors, as well as additional modifiable and nonmodifiable risk factors, should be considered when determining the timing of autologous breast reconstruction for a patient.
Optimizing Postoperative Mobility: A Review of Enhanced Recovery after Surgery Protocols for Pedicled Flap-Based Pelvic Reconstructions.
Chryssofos SZ, Jeong D, Sacks JM … +2 more , Tung TH, Badran S
J Reconstr Microsurg · 2025 Nov · PMID 41197980 · Publisher ↗
Surgical reconstruction of pelvic defects aims to restore pelvic floor anatomy and function after oncological resection, infection, or trauma. The functional demands of the pelvis and proximity to anogenital flora can co...
Surgical reconstruction of pelvic defects aims to restore pelvic floor anatomy and function after oncological resection, infection, or trauma. The functional demands of the pelvis and proximity to anogenital flora can complicate wound healing, often necessitating locoregional flap reconstruction. While enhanced recovery after surgery (ERAS) protocols have shown benefits in other surgeries, they lack standardization for pedicled flap-based pelvic and perineal reconstructions.PubMed and Embase were queried for articles from January 2000 to January 2025 reporting pedicled flap-based pelvic and perineal reconstruction. Single case reports were excluded. Data regarding postoperative mobility protocols, including bed rest, mobilization, sitting, drain management, discharge timing, and complication rates, were extracted and categorized by the flap donor site region.Out of 536 articles identified, 42 met inclusion criteria. Remobilization protocols varied across different flap types. The median out-of-bed remobilization times for vertical rectus abdominis myocutaneous, inferior gluteal artery perforator, internal pudendal artery perforator, anterolateral thigh, and gracilis flaps were 5, 2, 5, 2, and 1 days postoperatively, respectively, with an overall range of 0 to 36 days. Sitting was allowed at 15, 6, 14, 14, and 2 days postoperatively for these flaps.The findings advocate for standardized ERAS protocols with early mobilization and graded sitting, challenging traditional prolonged bed rest practices. We propose specific guidelines for pedicled flap reconstruction of the pelvic and perineal areas, including 1 to 2 days of strict bed rest followed by short-distance ambulation. Gradual sitting protocols should start in the second week with attention to cushioning and offloading. For more vulnerable perineal-based flaps, 4 to 5 days of bed rest and sitting beginning in the third week are recommended. Continuing recovery at a rehabilitation center is also advised. Future studies are needed to examine and modify these protocols, taking into consideration patient factors, disease severity, such as radiation exposure, and the type of reconstruction performed.
Exploring the Connection between Flap Type and Infection in Lower Extremity Fractures.
Swiekatowski KR, Parlamas SF, Wang EB … +4 more , Kahramangil B, Rizvi I, Trost JG, Bhadkamkar MA
J Reconstr Microsurg · 2025 Nov · PMID 41192455 · Publisher ↗
Muscle flaps were historically considered superior to fasciocutaneous (FC) flaps for coverage of open fractures and exposed hardware. However, both flap types are now commonly used in modern lower extremity (LE) reconstr...
Muscle flaps were historically considered superior to fasciocutaneous (FC) flaps for coverage of open fractures and exposed hardware. However, both flap types are now commonly used in modern lower extremity (LE) reconstruction, and it remains unclear whether postoperative infections rates differ. This study compares postoperative infection rates between muscle and FC flaps in free flap reconstruction following open LE fractures.A retrospective review was conducted on patients aged ≥18 years treated from 2011 to 2021 for open LE fractures requiring flap reconstruction after internal fixation. Demographics, injury characteristics, and perioperative factors were collected. The primary outcome was postoperative infection that could not be treated with antibiotics alone and required an unplanned return to the operating room for washout within 9 months of reconstruction. Univariate and multivariate analyses compared outcomes between muscle and FC flaps in free flap reconstruction.Of 164 patients, 86 (52.4%) had muscle flaps and 78 (47.6%) had FC flaps. Muscle flaps were more commonly used in patients with higher injury severity scores and injuries involving the knee/lower leg. The overall postoperative infection rate was 23.2%, with no significant difference between muscle or FC flaps (25.6 vs. 20.5%, = 0.56). On multivariate analysis, muscle and FC flap types were not predictors postoperative infection. Other outcomes, including reoperation, length of hospital stay postreconstruction, time to ambulation, and secondary amputation rates, were similar between flap types.In reconstruction of open LE fractures, muscle and FC flaps yield comparable infection rates and complication profiles. Therefore, flap selection should be guided by injury characteristics, patient factors, and reconstructive goals.
The Use of Artificial Intelligence in Responding to Patient Questions About Anterolateral Thigh Flap Surgery for Diabetic Foot Ulcers.
Llaurado LJ, Shah KS, Snee IA … +5 more , Rohrich RN, Bender RJ, Episalla NC, Youn RC, Evans KK
J Reconstr Microsurg · 2025 Nov · PMID 41192454 · Publisher ↗
Diabetic foot ulcer (DFU) care represents a significant challenge in plastic and reconstructive surgery. Oftentimes, patients encounter complex articles and websites to answer questions about their surgeries, including a...
Diabetic foot ulcer (DFU) care represents a significant challenge in plastic and reconstructive surgery. Oftentimes, patients encounter complex articles and websites to answer questions about their surgeries, including anterolateral thigh (ALT) flaps. Artificial intelligence (AI) represents a new and simplified resource for DFU patients seeking information regarding their care. To assess ChatGPT's utility as a patient resource, we evaluated the accuracy, comprehensiveness, and safety of AI-generated responses to frequently asked questions (FAQs) related to ALT flap surgery for DFU.Ten DFU and ALT flap care FAQs were posed to ChatGPT Model 3.5 in June 2024. Four plastic surgeons evaluated responses using a 10-point Likert scale for accuracy, comprehensiveness, and danger of ChatGPT's answers. Surgeons also provided qualitative feedback. Response readability was assessed using 10 readability indexes, averaged to produce a reading grade level for each response.Overall, ChatGPT answered patient questions with a mean accuracy of 9.1 ± 1.2, comprehensiveness of 8.2 ± 1.5, and danger of 2.0 ± 1.0. ChatGPT answered at a mean grade level of 19.8 ± 20.1. Qualitatively, physician reviewers complimented the organizational clarity of the responses ( = 4/10) and the AI's ability to provide information on possible surgical complications ( = 4/10). While one response was noted to present explicitly incorrect information about preoperative preparation protocols and when they should be initiated, the majority of responses ( = 6/10) left out key postoperative information, notably dangle protocols and compression.ChatGPT provides accurate and comprehensive responses to FAQs related to patients undergoing ALT flap surgery for the treatment of DFUs. The AI-generated responses were praised for organizational clarity and informative content regarding surgical complications, but lacked essential postoperative care details. Therefore, while ChatGPT is a valuable informational tool, further refinement is necessary to ensure that fully comprehensive information is provided to DFU patients.
Rethinking Dangling: Omission of Inpatient Dangle Protocols Shortens Hospital Stay Without Adverse Effects on Lower Extremity Flap Outcomes.
Kim MI, Shen KA, Olivas C … +6 more , Stanton EW, Yoon J, Jin J, Carey JN, Daar DA, Koesters EC
J Reconstr Microsurg · 2025 Nov · PMID 41192453 · Publisher ↗
Formal dangling protocols are often used after lower extremity free flap reconstruction to acclimate flaps to gravitational stress. However, their clinical benefit remains uncertain. This study evaluates how the inclusio...
Formal dangling protocols are often used after lower extremity free flap reconstruction to acclimate flaps to gravitational stress. However, their clinical benefit remains uncertain. This study evaluates how the inclusion or omission of structured inpatient dangling affects flap outcomes.A retrospective review was conducted of 82 patients who underwent lower extremity free flap reconstruction at a single institution (2015-2024). Patients were grouped based on use of a formal dangling protocol (≥3 consecutive supervised sessions beginning after postoperative day 5) versus no protocol (ad libitum dangling beginning day 3). Outcomes included flap survival, complications, 30-day unplanned reoperation, time to ambulation, and length of stay. Statistical analysis included chi-squared, -tests, and multivariable regression models.Fifty-three patients adhered to a dangle protocol; 29 did not follow a protocol. Demographics, comorbidities, flap type, and defect characteristics were similar between groups. Flap survival (96.2% vs. 96.6%, = 0.94), partial necrosis (9.4% vs. 10.3%, = 0.89), and reoperation rates (3.4% vs. 7.5%, = 0.46) were comparable. On multivariable analysis, dangle protocol use was not associated with reduced complication risk (OR = 0.95, = 0.93) but was associated with a 3.0-day longer median hospital stay ( < 0.01).The application of a formal dangling protocol did not affect flap survival but was independently associated with prolonged hospitalization. These findings challenge the necessity of structured regimens and support more patient-tailored postoperative strategies that may accelerate recovery without compromising surgical outcomes.
Efficacy of Nerve Tape-Assisted PEG Fusion in a Rabbit Tibial Nerve Repair Model.
Isaacs J, Bendale G, Reiter C … +3 more , Savsani K, Gomatam A, Phan K
J Reconstr Microsurg · 2025 Nov · PMID 41192452 · Publisher ↗
Polyethylene glycol (PEG) hydrogel is capable of fusing transected axons and restoring axonal continuity. The technique requires precise nerve coaptation alignment and stability, which is difficult to achieve utilizing c...
Polyethylene glycol (PEG) hydrogel is capable of fusing transected axons and restoring axonal continuity. The technique requires precise nerve coaptation alignment and stability, which is difficult to achieve utilizing conventional microsuture neurorrhaphy. Nerve Tape (NT) is a microhook-based nerve coaptation device engineered to facilitate stable and accurate nerve end alignment. The primary objective was to modify and validate NT-assisted PEG fusion using a rabbit proximal tibial nerve repair model at an intermediate time point.Three groups of rabbits underwent mid-thigh tibial nerve transection and immediate repair with NT + PEG ( = 6), Suture + PEG ( = 6), or Suture only ( = 6). PEG-induced axonal fusion was acutely confirmed via demonstration of compound motor action potential (CMAP) restoration. Final outcome testing at 16 weeks included electrodiagnostic testing, nerve histomorphology, and muscle morphology.All 18 animals demonstrated immediate restoration of CMAPs. At 16 weeks, there were no statistical differences in nerve conduction velocity or amplitude, no statistical differences between groups in axon counts or g-ratios either near the nerve coaptations or at the ankle, and no differences in normalized gastrocnemius weight or girth.PEG fusion did not improve nerve regeneration or functional recovery in a rabbit tibial nerve repair model at 16 weeks. Modified NT did not improve the reliability or efficacy of the PEG fusion process compared with microsuture neurorrhaphy.
Stacked vs. Single Free Flaps in Autologous Breast Reconstruction: A National Analysis of Clinical and Financial Outcomes.
Gupta N, Ibrahim Y, Elkins E … +5 more , Valenzuela AR, Chervu NL, Mallick S, Benharash P, DeLong MR
J Reconstr Microsurg · 2025 Nov · PMID 41192451 · Publisher ↗
Autologous breast reconstruction (ABR) is a reliable option for reconstruction after mastectomy. In cases where single donor sites do not offer adequate tissue, the use of "stacked" flaps, or multiple free flaps, can be...
Autologous breast reconstruction (ABR) is a reliable option for reconstruction after mastectomy. In cases where single donor sites do not offer adequate tissue, the use of "stacked" flaps, or multiple free flaps, can be brought together to provide optimal breast volume. This large-scale study aims to compare clinical outcomes, resource utilization, and readmission rates between single and stacked flaps.The National Readmission Database was used to retrospectively identify adult female patients who underwent ABR with free flaps between 2016 and 2020. In this study, free flaps were restricted to nonpedicled types, with latissimus dorsi (LD) and pedicled transverse rectus abdominis myocutaneous flaps (TRAM) excluded. Patients were categorized based on flap type (single vs. stacked) using relevant International Classification of Diseases, Tenth Edition (ICD-10) procedure codes. Patient demographics, hospital factors, complication rates, and readmission data were analyzed. The primary outcome was the difference in postoperative flap complication rates between single and stacked flaps.A total of 52,180 adult females were included for analysis. Of these, 51,140 ( = 98.5%) had single flaps and 783 patients ( = 1.5%) had stacked flaps. Use of stacked flaps was not statistically associated with higher odds of any flap complication (adjusted odds ratios: 1.16, = 0.46) compared to single flaps. Stacked flaps were associated with longer length of stay and higher hospitalization costs, but there was no significant difference in 30-day readmission compared to the single flap cohort.Our study found similar rates of overall flap complications between the cohorts. Thus, in cases where more tissue is needed or desired, the use of stacked flaps appears to be a safe and feasible option to ABR.
Deltoid Fasciocutaneous Free Flap: Cadaveric Study and Clinical Outcomes of Treating Open Infected Limb Fracture with Soft Tissue Defect.
Ngoc-Huyen N, The-Hoang N, Quang-Vinh N … +3 more , Nuwayhid R, Kurow O, Bomhard AV
J Reconstr Microsurg · 2025 Oct · PMID 41151751 · Publisher ↗
The deltoid fasciocutaneous free flap is a valuable reconstructive option for tissue defects following injury or tumor resection. However, limited studies have provided objective data on the anatomical characteristics of...
The deltoid fasciocutaneous free flap is a valuable reconstructive option for tissue defects following injury or tumor resection. However, limited studies have provided objective data on the anatomical characteristics of this flap. This study aimed to investigate the cadaveric anatomical characteristics of this flap and report our initial results for treating open infected fracture-related infection (FRI) with skin defects in the extremities.This prospective cross-sectional study involved the dissection of 27 adult cadavers (13 male and 14 female), including 16 formalin-fixed (32 deltoid regions) and 11 fresh cadavers (22 deltoid regions). Anatomical characteristics, including the blood supply area and neurovascular pedicle, were examined. The findings from the cadaveric investigation were then applied and analyzed in a clinical setting with 50 patients.The mean angiosome area was 20.41 × 12.36 cm. The main vascular pedicle supplying blood to the flap is the posterior circumflex humeral artery (PCHA), which originates from the axillary and subscapular arteries and was observed in 94.44% of cases. The cutaneous perforator branch is the posterior subcutaneous deltoid artery (PSDA), which was separate from the PCHA in 100% of cases. The mean PCHA length was 38.98 ± 3.88 mm, and mean diameter was 3.17 ± 0.7 mm. The mean PSDA length was 45.5 ± 3.65 mm, and mean diameter was 1.38 ± 0.13 mm. All deltoid free flaps were successfully transferred, and all open FRI demonstrated fracture consolidation in the postoperative course.In addition to clinically well-established free flaps, the deltoid fasciocutaneous free flap represents a valuable reconstructive option for treating open FRI with skin and soft tissue defects in the extremities, particularly when other well-established free flaps are not feasible or have previously been used.
Complications and Donor Site Morbidity in Harvesting the Intercostal Main Nerve as a Graft for Breast Neurotization in Microsurgical Breast Reconstruction.
Lee YH, Huang JJ, Lu JC … +3 more , Cheong DC, Chen CF, Chang TN
J Reconstr Microsurg · 2025 Oct · PMID 41151750 · Publisher ↗
Breast neurotization using autologous grafts has been indicated to be effective. Previous studies focused mainly on restoring sensation and optimizing the operative techniques of neurotization in microsurgical breast rec...
Breast neurotization using autologous grafts has been indicated to be effective. Previous studies focused mainly on restoring sensation and optimizing the operative techniques of neurotization in microsurgical breast reconstruction. There are few studies on the adverse effects and potential risks associated with simultaneous microsurgical breast reconstruction and neurotization procedures. The rates of overall and pulmonary complications in patients receiving neurotization during autologous breast reconstruction were examined in this study.A retrospective comparative study was conducted between two groups of patients: 100 consecutive patients (reinnervation group) underwent neurotization procedures during deep inferior epigastric perforator (DIEP) breast reconstruction, while the other 100 patients (control group) underwent DIEP breast reconstruction alone. The patients' demographic data, reconstructive methods, postoperative complications, specific pulmonary complications, and length of hospital stay were reviewed.The overall complication rates were 23% in the reinnervation group and 20% in the control group ( = 0.731), and this difference was not statistically significant. The incidence rates of vascular insufficiency (7% vs. 9%), pneumothorax (5% vs. 3%), hematoma/seroma (2% vs. 3%), and wound infection (1% vs. 2%) were similar between the reinnervation group and the control group. A greater percentage of patients in the reinnervation group developed pleural effusion than did those in the control group (12% vs. 4%, = 0.037), whereas the majority of the patients in the reinnervation group were asymptomatic and managed conservatively.Although harvesting the main intercostal nerve for breast neurotization may irritate the pleura, the effect was minimal and manageable. This procedure is safe and feasible and can be widely applied in breast reconstruction.
Clinical Scenarios Using Thoracodorsal and Lateral Thoracic Vessels Versus Internal Mammary Vessels in Bipedicled Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparative Study.
Chen CF, Cheong DC, Kuo WL … +4 more , Yu CC, Chou HH, Chen SC, Huang JJ
J Reconstr Microsurg · 2025 Oct · PMID 41151749 · Publisher ↗
Autologous breast reconstruction using the bipedicled deep inferior epigastric perforator (DIEP) flap poses unique challenges in Asian patients with a low BMI and limited donor volume. While internal mammary vessels (IMA...
Autologous breast reconstruction using the bipedicled deep inferior epigastric perforator (DIEP) flap poses unique challenges in Asian patients with a low BMI and limited donor volume. While internal mammary vessels (IMA/Vs) remain the standard recipient site, the rise of minimally invasive mastectomy has limited access to IMA/Vs. This study compared the results of thoracodorsal and lateral thoracic vessels (lateral-based) versus IMA/Vs (medial-based) in bipedicled DIEP flap breast reconstruction.A retrospective review was conducted on 62 patients who underwent bipedicled DIEP flap reconstruction between 2018 and 2023 by a single senior surgeon. Patients were stratified by incision placement and recipient vessel choice into medial- and lateral-based groups. Clinical outcomes, complication rates, and long-term aesthetic results were analyzed.Despite a higher re-exploration rate in the lateral-based group (12.5% versus 4.5%; = 0.298), flap survival was comparable between the groups. Fat necrosis rates were lower in flaps without re-exploration (5.4%) and increased significantly following compromised perfusion (33.3%). The lateral-based group achieved superior aesthetic outcomes in breast shape ( = 0.043) and scar visibility ( < 0.001), with a reduced need for secondary fat grafting. Dual vascular sources provided more reliable perfusion and improved long-term fat survival, although further validation with perfusion imaging is warranted.The lateral-based approach, despite technical challenges, is a viable alternative to the medial-based method in certain patients, offering reliable perfusion and superior aesthetic outcomes with fewer revisions. An algorithmic approach to recipient vessel selection can optimize outcomes of bipedicled DIEP flap reconstruction.
The Efficacy of Chimeric Superficial Circumflex Iliac Artery Perforator (SCIP) Flap in Treatment of Posttraumatic Chronic Osteomyelitis.
Abdelfattah U, Abdelwahab N, Emara YO … +1 more , Elbanoby T
J Reconstr Microsurg · 2025 Oct · PMID 41151748 · Publisher ↗
Management of chronic osteomyelitis (COM) remains a challenge for plastic and orthopedic surgeons. Among many perforator flaps utilized in COM, chimeric flaps reported superior successful outcomes. The objective of this...
Management of chronic osteomyelitis (COM) remains a challenge for plastic and orthopedic surgeons. Among many perforator flaps utilized in COM, chimeric flaps reported superior successful outcomes. The objective of this study is to evaluate the efficacy of chimeric superficial circumflex iliac artery perforator (SCIP) in treatment of various forms of COM.A retrospective analysis was performed of all patients with posttraumatic COM who underwent reconstruction using chimeric SCIP flaps between September 2019 and November 2023. Patients with insufficient data or follow-up less than 1 year were excluded from the study. The preoperative basic data and the operative details and postoperative follow-up data were collected and statistically analyzed. Correlation between recurrence and the following factors was analyzed: comorbidities, type of trauma, duration of COM, and limb vascularity condition.A total of 59 patients were analyzed, with a mean age 35.31 years. A total of 29 patients underwent chimeric SCIP skin-iliac bone flap reconstruction, 16 received chimeric skin-iliac periosteal flaps, and 4 had chimeric flaps combining skin, periosteum, and bone. There were two cases of total flap loss and two cases of partial flap loss. Additionally, three patients (5.08%) experienced a recurrence of COM. The significant predictor of COM recurrence was major vascular injury. Although not statistically significant, COM recurrence was more prevalent among patients with comorbidities, smoking, and diabetes.Chimeric SCIP flaps can be effectively used to treat COM with composite tissue defects, eliminate inflammation of the affected limbs, allow composite tissue reconstruction, and promote wound healing.
Local Capacity Building, Constraints, and Microsurgical Reconstruction in a Low-Resource Country: A Cross-sectional Study of Surgeons.
Olawoye OA, Mijares-Diaz F, Ademola SA … +5 more , Iyun AO, Michael AI, Aderibigbe RO, Oluwatosin OM, Ogunleye AA
J Reconstr Microsurg · 2025 Oct · PMID 41145120 · Publisher ↗
While the need for reconstructive microsurgical procedures has increased across the developing world, several constraints in low- and middle-income settings prevent its consistent performance. Our study aimed to understa...
While the need for reconstructive microsurgical procedures has increased across the developing world, several constraints in low- and middle-income settings prevent its consistent performance. Our study aimed to understand the impact of microsurgery training on local capacity in a low-income setting, and to understand limitations that may affect long-term build-up of microsurgical capacity.Cross-sectional study evaluating survey responses of trainees and surgeons who participated in a Flap Transfer and Microsurgery course held in Ibadan, Nigeria. The survey consisted of a pre- and postcourse questionnaire, and a 2-year posttraining survey. The questionnaire sought to assess training impact on microsurgical capacity and limitations at each participants institution. Fourteen surgeons completed all questionnaires and were included in the study.Thirteen (92.3%) participants had encountered at least one defect requiring microvascular surgery within 2 years of the training, and 9 (69.2%) reported having performed at least one surgery. Most surgeons indicated having performed less procedures than needed across all defect anatomical site/etiology. The most common limitation reported by participants consisted of man-power shortage (78.6%), followed by expense of each procedure, difficulty procuring materials, and trainers with limited experience.There is a significant need for microsurgical reconstruction in sub-Saharan Africa, with varied local challenges preventing consistent delivery of microsurgical care. The analysis complements previous literature on microsurgical care in developing countries and highlights significant constraints preventing widespread adoption and the role of local training opportunities that help in building long-term local capacity.
Long-Term Implications of Combined Cross-Facial Nerve Graft and Nerve Transfer in Facial Paralysis.
Thachil R, Wen YE, Sanchez CV … +3 more , Madrazo AZ, Reisch JS, Rozen SM
J Reconstr Microsurg · 2025 Nov · PMID 41138718 · Publisher ↗
Assessing the long-term implications of combining cross-facial nerve graft (CFNG) and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute facial paralysis.Patients with subacute facial pal...
Assessing the long-term implications of combining cross-facial nerve graft (CFNG) and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute facial paralysis.Patients with subacute facial palsy who underwent a masseteric-to-facial nerve transfer with CFNG from 2013 to 2020 were reviewed. A minimum of 2-year follow-up was required with 18 patients meeting inclusion criteria. Midface and periorbital measurements on standardized photos of patients in repose, closed, and open smile were analyzed preoperatively, 3 months, 1 year, and 3 years postoperatively as available. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Longitudinal comparisons at each timepoint were analyzed using Wilcoxon two-sample testing.In repose, 1-year measurements including Commissure-Position, Smile-Angle, and Upper-Lip-Height-Deviation, were nonsignificant, whereas significance was noted at 3 years postoperatively ( = 0.042, 0.031, 0.042, respectively). Midface dynamic smile measurements on the palsy side and with symmetry showed significant differences from preoperative measurements at 1 and 3 years postoperatively. Periorbital measurements, including Marginal-Reflex-Distance-1, Marginal-Reflex-Distance-2, and Palpebral-Fissure-Height in repose, showed no significant changes at 1 year but were significant at 3 years ( = 0.004, 0.011, and 0.002, respectively), while during animation were significant at 1 and 3 years postoperatively.Combining CFNG with nerve transfer demonstrated progressive long-term improvement in resting tone and symmetry around the midface and periorbital region. Expected improvements were observed during animation over time.
Combination of Smartphone Thermography with Color-Doppler Ultrasonography-an Easy Method for Preoperative Planning of ALT Flaps for Novice Microsurgeons.
Walczak DA, Piotrowska-Seweryn A, Żółtaszek A … +8 more , Krakowczyk Ł, Maciejewski A, Grajek M, Zeman M, Szymczyk C, Migacz E, Opyrchał J, Bula D
J Reconstr Microsurg · 2025 Nov · PMID 41072486 · Publisher ↗
The design and preoperative planning of microsurgical free flaps are crucial for successful outcomes. Studies have shown that preoperative vascular mapping significantly shortens operative time, reduces complication rate...
The design and preoperative planning of microsurgical free flaps are crucial for successful outcomes. Studies have shown that preoperative vascular mapping significantly shortens operative time, reduces complication rates, and lowers overall costs. Various methods of perforator detection have been introduced; however, none is ideal. Some surgeons propose that combining two or even three different methods could better meet clinical expectations. Therefore, this study sought to determine the effect of augmenting color Doppler ultrasound (CDUS) preoperative perforator detection with smartphone-based dynamic infrared thermography (DIRT) on concordance with intraoperative findings.The study included 46 patients scheduled for anterolateral thigh flap (ALTF) reconstruction. Patients were divided into two groups according to the method of perforator mapping: Group 1 underwent CDUS alone, while Group 2 underwent DIRT followed by CDUS. Assessments were performed by novice surgeons with limited ultrasound experience.The time required for perforator mapping was significantly shorter in Group 2 (9 min vs. 16 min, < 0.0001). The mean number of detected perforators in the evaluated area was 2.5 in Group 1 and 2.96 in Group 2 ( = 0.046). Combining CDUS with DIRT significantly reduced the number of overlooked vessels ( < 0.01).DIRT plays an important role in perforator flap planning by identifying likely perforator locations before CDUS. In turn, CDUS provides detailed information on the perforator's course and hemodynamic properties. The combination of these two techniques offers a rapid, easily interpretable method for preoperative flap planning that can be used by any microsurgeon.
Relative Donor Site Morbidity and Complication Rates of Gracilis Myocutaneous and Muscle Flaps in Reconstructive Surgery.
Sobba WD, Thai S, Barrera JA … +4 more , Montgomery SR, Agrawal NA, Levine JP, Hacquebord JH
J Reconstr Microsurg · 2025 Oct · PMID 41072485 · Publisher ↗
The gracilis flap is a versatile muscle flap that can be utilized as a muscle-only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have...
The gracilis flap is a versatile muscle flap that can be utilized as a muscle-only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have compared donor site complications of free and pedicled gracilis flaps, including the effect of skin paddle harvest on donor site morbidity.We performed a retrospective review of patients who underwent a free or pedicled gracilis flap at our institution from 2013 to 2023. Gracilis flaps were categorized as: pedicled gracilis muscle flaps, free gracilis muscle flaps, and free gracilis myocutaneous flaps. Outcome variables were duration of drain placement and complications, including seroma, hematoma, infection, dehiscence, and persistent numbness.We identified 128 gracilis flaps, including 19 free myocutaneous flaps, 35 free muscle flaps, and 74 pedicled muscle flaps. Free myocutaneous flaps required longer drain placement as compared to free muscle flaps or pedicled flaps (13.6 days vs. 8.4 days vs. 7.4 days, respectively, = 0.002). Free myocutaneous flaps displayed a higher complication rate (36.8%) as compared to pedicled muscle flaps (10.8%) or free muscle flaps (11.4%, = 0.020). After adjusting for age, BMI, and ASA status, free myocutaneous flaps demonstrated higher odds of major donor site complications as compared to pedicled muscle flaps (OR: 1.23, < 0.001), while free muscle flaps were not associated with increased odds of major complications (OR: 1.08, = 0.117). Of the documented complications, the most common were surgical site infection (36.8%), hematoma (21.1%), and seroma (21.1%).The inclusion of a skin paddle during gracilis flap harvest is associated with increased duration of drain placement and donor site complications, including surgical site infection, hematoma, and seroma. These factors should be carefully considered in the context of patients' reconstructive needs and other risk factors.
Quantitative Preoperative Peroneal Vessel Assessment in Fibula Free Flap Surgery.
Rothchild E, Saini N, Smith IT … +2 more , Yom J, Ricci JA
J Reconstr Microsurg · 2025 Oct · PMID 41072484 · Publisher ↗
Fibula free flap (FFF) surgery complications can arise from vascular disease within the donor peroneal artery. Computed tomography angiography (CTA) has become standard for preoperative evaluation. However, current metho...
Fibula free flap (FFF) surgery complications can arise from vascular disease within the donor peroneal artery. Computed tomography angiography (CTA) has become standard for preoperative evaluation. However, current methods rely on qualitative assessments to determine surgical eligibility. This study aims to improve preoperative risk evaluation by implementing two quantitative scoring systems, the Bollinger score and the lower limb arterial calcification score (LLACS), assessing distinct vascular health components. The Bollinger score quantifies intraluminal stenosis caused by atherosclerotic plaques, while the LLACS quantifies arteriosclerosis by evaluating calcification within the arterial walls.A retrospective review was conducted on all head and neck microvascular FFF procedures performed at a university-affiliated tertiary care center between August 2021 and March 2023. Data collected included patient demographics, medical history, operative details, and postoperative complications (infection, hematoma, seroma, fistula, dehiscence, or flap failure) within 90 days. Peroneal artery Bollinger scores and crural segment LLACSs from the donor lower extremity were calculated from preoperative CTAs.A total of 117 patients were included. Increasing Bollinger scores were significantly associated with an increased risk of complications and longer hospital stays, even after controlling for potential confounders. Combining both scores improved risk stratification, with high-risk patients experiencing an 8.36-fold higher risk of complications.Our findings suggest that quantitative preoperative peroneal vessel assessment improves risk stratification for patients undergoing FFF surgery. These scoring systems may enhance patient selection and guide strategies to minimize postoperative complications. Integrating multiple scoring systems is key to the comprehensive assessment of vascular health.
Postoperative Prophylactic Anticoagulation in Flap Surgery: A Review of the Evidence and Challenging Common Beliefs.
Malekzadeh H, Kluemper J, Elemosho A … +1 more , Janis JE
J Reconstr Microsurg · 2025 Oct · PMID 41072483 · Publisher ↗
Postoperative anticoagulation is widely used in microsurgical flap reconstruction to reduce the risk of thrombosis and flap complications. However, their effectiveness and safety in relation to flap outcomes remain uncer...
Postoperative anticoagulation is widely used in microsurgical flap reconstruction to reduce the risk of thrombosis and flap complications. However, their effectiveness and safety in relation to flap outcomes remain uncertain. This systematic review and meta-analysis evaluate the existing evidence on postoperative anticoagulant use in microsurgical flap reconstruction.A literature search was performed in the PubMed database for studies published from 1995 until January 2025 that compared flap outcomes with postoperative prophylactic anticoagulation regimens in microsurgical flap procedures. Outcomes of interest included hematoma, complete flap failure, and reoperation. Relevant data were extracted and analyzed using meta-analytic techniques.In total, 11 studies were included in the final review and meta-analysis. Seven studies comparing patients who received postoperative anticoagulation with those who did not demonstrated a significantly higher rate of hematoma in the anticoagulated group (5.0% vs. 3.0%; = 0.03). However, there were no significant differences in flap failure or reoperation rates. In subgroup analyses, only studies using unfractionated heparin showed increased hematoma risk, whereas low-molecular-weight heparin (LMWH) showed no significant effect. Four studies compared patients receiving postoperative anticoagulation plus aspirin with those receiving anticoagulation alone and found a higher reoperation rate when aspirin was added (17.5% vs. 10.0%; < 0.01), with no significant differences in flap failure rates.Postoperative heparin increases the risk of hematoma without improving flap survival. Additionally, combining aspirin with LMWH may increase reoperation rates. These results suggest that routine anticoagulation may not benefit all patients and support a risk-based approach to postoperative management in microsurgical reconstruction.
Indications and Outcomes of Autologous Conversion from Implant-Based Breast Reconstruction.
Kim LJ, Liu L, Teotia SS … +1 more , Haddock NT
J Reconstr Microsurg · 2025 Oct · PMID 41072482 · Publisher ↗
In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as profunda arter...
In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as profunda artery perforator (PAP) and lumbar artery perforator (LAP) in reconstruction choices. Historically, implant-based methods dominated breast reconstruction, but limitations and complications have led a subset of patients to prefer autologous reconstruction, especially after radiation therapy. This research aimed to elucidate the decision-making process behind switching to autologous methods, examining a broad range of patient demographics and conversion factors.A retrospective review was conducted using REDCap database information from January 2012 to August 2023, including 119 patients who converted from implant-based to autologous reconstruction and 1,329 who underwent primary autologous reconstruction. Data analysis covered demographics, comorbidities, reasons for conversion, types of surgeries performed, and BREAST-Q responses to assess satisfaction and quality of life.Indications for conversion included capsular contracture, dissatisfaction, and complications from previous treatments. Patients undergoing autologous conversion typically experienced more revision surgeries compared with those with primary autologous reconstruction. Notably, emerging flap options like PAP and LAP were more frequently utilized in conversions. BREAST-Q scores showed no significant preoperative differences, but postoperative satisfaction varied, highlighting the nuanced outcomes of reconstruction choices.In conclusion, converting to autologous breast reconstruction offers a patient-centered alternative for those facing implant-based reconstruction failures, underscoring the need for individualized surgical approaches. This study contributes valuable insights into optimizing reconstructive outcomes by understanding patient preferences and advancements in flap techniques.
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