Journal Of Reconstructive Microsurgery[JOURNAL]
Sun
200 papers
Long-Term Outcomes Following Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction.
Allen RJ, Zhang KK, Cohen Z … +7 more , Singh A, Kronstadt K, Ganly I, Shahzad F, Rosen E, Nelson JA, Matros E
J Reconstr Microsurg · 2026 May · PMID 40681154 · Publisher ↗
Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosth...
Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosthodontic outcomes of IDIP in oncologic mandible reconstruction.A retrospective, noninferiority cohort study was performed comparing IDIP and non-IDIP in patients undergoing FFF reconstruction of oncologic mandibulectomy defects using computer-aided design and computer-aided manufacturing technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or nonimplant-supported resection prosthesis.One hundred forty-eight patients were included in the study. IDIP patients ( = 86) were significantly older ( = 0.017) and had a higher BMI ( < 0.0001) than non-IDIP patients ( = 62). Median follow-up time was 2.4 and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups ( > 0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting ( < 0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation (IDIP: 69.8%, non-IDIP: 25.8%; < 0.0001) and at an earlier time point (median [interquartile range]: 120 [45, 297] days vs. 355 [243, 595] days; = 0.0002) after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients ( = 0.818).IDIP safely achieves dental restoration in less time and at a higher rate than non-IDIP in oncologic patients. Measurement of patient-reported outcomes is needed to bolster support for IDIP as the standard of care in oncologic patients.
Effect of Enhanced Recovery After Surgery on Racial Inequalities in Prescribing Practices for Autologous Breast Reconstruction.
Baek A, Smith R, Coots LB … +5 more , Andersen ES, Song C, Juan HY, Lele S, Mountziaris PM
J Reconstr Microsurg · 2026 May · PMID 40609547 · Publisher ↗
Enhanced recovery after surgery (ERAS) pathways have improved surgical outcomes and reduced narcotic needs. This study evaluated racial differences in our institution's opioid prescribing practices in autologous breast r...
Enhanced recovery after surgery (ERAS) pathways have improved surgical outcomes and reduced narcotic needs. This study evaluated racial differences in our institution's opioid prescribing practices in autologous breast reconstruction before and after ERAS implementation.This was a retrospective review of consecutive patients undergoing autologous breast reconstruction from 2013 to 2021, pre-ERAS and after ERAS implementation. Primary outcomes were morphine milligram equivalents (MME) for intravenous (IV) and oral (PO) narcotics peri- and postoperatively. Secondary outcomes included infection, delayed wound healing, and need for reoperation.Of 163 patients, 150 met inclusion criteria. The pre-ERAS group comprised 65 patients (35% Black, 65% White), and the ERAS group included 85 patients (44% Black, 54% White). Pre-ERAS, Black patients received more IV narcotics than White patients, 814 versus 505 MME ( < 0.05). There was no difference between inpatient and outpatient PO MME ( 0.05). ERAS decreased IV MME 10-fold ( < 0.05) and decreased inpatient PO MME approximately 3-fold ( < 0.05). Nevertheless, racial differences existed in IV narcotics (80 vs. 58 MME; 0.05) and inpatient PO narcotics (93 vs. 59 MME; < 0.05). Black race was a significant positive predictor in univariate and multivariate analyses for IV MME in both pre-ERAS and ERAS.Black patients unexpectedly received more IV narcotics pre-ERAS. Although ERAS decreased inpatient opioid administration, racial differences persisted; Black patients also received more PO narcotics, contrary to literature findings of systemic pain undertreatment. Standardized protocols alone may be inadequate to address complexities of postoperative pain.
How Invasive is the Free Gracilis Muscle Flap? A Prospective Study on Donor Site Morbidity.
Wachtel N, Giunta RE, Hirschmann M … +4 more , Hellweg M, Nuernberger T, Moellhoff N, Ehrl D
J Reconstr Microsurg · 2026 May · PMID 40588227 · Publisher ↗
Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbid...
Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of free GM flaps.A control group ( = 100) without surgery was recruited to assess interindividual differences in strength and range of motion (ROM) in the hip and knee joint (dominant vs. nondominant side). Additionally, for 50 patients with free GM flap surgery, these parameters were assessed in an identical manner.The control group showed significant interindividual differences in strength for abduction and adduction in the hip joint when comparing the dominant to the nondominant side, but no significant differences in the ROM. GM flap harvest led to no significant differences in maximum force 20.3 (± 13.8) months after surgery in all parameters/movements that were assessed. However, the ROM for abduction in the ipsilateral hip joint was significantly reduced after surgery.The GM flap has a low donor site morbidity and should therefore be considered as a first-line option for microsurgical reconstructive procedures. Moreover, the low morbidity is not affected by preexisting differences in strength when comparing the dominant to the nondominant side.
Extensive Primary Thinning of the Free Functional Gracilis Flap is Safe and Does Not Compromise Functional Outcomes in Dynamic Smile Reconstruction.
Chi D, Ha AY, Keane G … +3 more , Tawaklna K, Skolnick GB, Snyder-Warwick AK
J Reconstr Microsurg · 2026 May · PMID 40523396 · Publisher ↗
Facial reanimation surgery using a free functional gracilis muscle transfer is the standard of care in long-standing facial paralysis. Surgical revision rates are high, with most directed toward flap debulking and improv...
Facial reanimation surgery using a free functional gracilis muscle transfer is the standard of care in long-standing facial paralysis. Surgical revision rates are high, with most directed toward flap debulking and improving contour. During the index surgery, the muscle can be thinned extensively to potentially avoid revisions, but there is concern for injuring the neurovascular pedicle or weakening contractility. The authors hypothesize that primary flap thinning is safe without compromising smile contractility.Patients undergoing dynamic smile reconstruction with free functional gracilis muscle transfer were retrospectively reviewed over an 8-year period. Functional morphometric outcomes were evaluated with the Emotrics facial expression recognition software. Time to innervation, secondary procedures, and complications were also recorded.In total, 34 facial reanimation procedures met the inclusion criteria. The average muscle flap weight after primary thinning was 17.0 ± 9.3 g (range 5-46 g). Smile excursion improved by 7.7 ± 5.5 mm in the unilateral and 5.7 ± 3.4 mm in the bilateral paralysis groups, with significant improvement from preoperative commissure ( = 0.001) and smile angle ( = 0.003) measurements. One patient required a secondary debulking procedure. Secondary outcomes of improved reinnervation time and smile excursion weakly trended with decreased gracilis weight but did not achieve statistical significance. Complications included one flap loss, one donor site hematoma, one facial abscess, and one facial hematoma.Flap thinning at the time of primary free functional gracilis transfer did not result in increased complications or compromise its ability to produce symmetric smiles of adequate excursion. Compared to published cohorts, this technique may reduce the need for secondary revisions.
Characterization of Soft Tissue Reconstruction Following Chordoma Resection.
Rajagopalan SP, Sim D, Rodriguez-Silva WA … +8 more , Dewan A, Rezwan S, Papali P, Al-Mistarehi AH, Hersh A, Lubelski D, Cooney CM, Colakoglu S
J Reconstr Microsurg · 2026 Mar · PMID 40505696 · Publisher ↗
Chordomas are rare, malignant bone tumors of the axial skeleton. Soft tissue reconstruction is often needed postextirpation to reduce the risk of peritoneal content herniation. The purpose of this study is to describe pr...
Chordomas are rare, malignant bone tumors of the axial skeleton. Soft tissue reconstruction is often needed postextirpation to reduce the risk of peritoneal content herniation. The purpose of this study is to describe presurgical factors associated with postchordoma resection reconstruction and evaluate postoperative outcomes.We retrospectively reviewed patients who underwent reconstruction postexcision of chordomas derived from the lumbar or sacral regions at a single institution between 2012 and 2023. Wilcoxon rank sum test, chi-square test, Fisher's exact test, and Kruskal-Wallis test were used to compare outcomes based on reconstruction method.Among 68 patients who met the inclusion criteria, 67 underwent sacrectomy. Patients primarily received gluteus muscle (GM) flaps ( = 36, 53%). Vertical rectus abdominus myocutaneous (VRAM) and paraspinous muscle (PSM) flaps were the second most common, each used in 12 patients (18%). Eight patients (12%) underwent reconstruction with fasciocutaneous local flaps only. GM and VRAM flaps were primarily used to reconstruct defects at the level of the sacrum ( = 47, 98%) while PSM flaps were used for lumbar ( = 7 [58%]) and sacral ( = 5 [42%]) reconstruction, respectively. The median tumor volumes were 468 cm (271-1,592) for VRAM flaps, 92 cm (12-246) for GM flaps, 77 cm (34-239) for PSM flaps, and 25 cm (16-86) for non-muscle reconstruction; tumor volume was significantly greater in patients who underwent VRAM flap reconstruction. Median defect diameter managed by VRAM flaps was significantly longer compared with GM flaps (33 [30-46] cm vs. 22 [15-30] cm, respectively; = 0.001). VRAM and PSM flap reconstruction were more often associated with hardware placement ( < 0.01). Median follow-up was 34 months. Neither reconstruction type nor hardware placement was associated with the incidence of postoperative complications.We found that surgical reconstruction following chordoma resection varied depending on the chordoma spinal level, tumor volume, and defect diameter. Complication rates were similar among the included reconstructive options.
Insurance Coverage for Hyperbaric Oxygen Therapy in Acutely Compromised Tissues.
Heron MJ, Zhu KJ, McVeigh AB … +3 more , Rezwan SK, Cooney CM, Broderick KP
J Reconstr Microsurg · 2026 Mar · PMID 40505695 · Publisher ↗
Beyond its indication for chronic wounds, hyperbaric oxygen therapy (HBOT) is an adjunct to managing acutely compromised grafts and flaps. Because physicians have reported challenges obtaining insurance coverage for HBOT...
Beyond its indication for chronic wounds, hyperbaric oxygen therapy (HBOT) is an adjunct to managing acutely compromised grafts and flaps. Because physicians have reported challenges obtaining insurance coverage for HBOT, this cross-sectional analysis reviews policy requirements and presents an algorithm to enhance the odds of successful reimbursement.We identified the 60 largest health insurers by market share and enrollment and collected their policies on HBOT. We then conducted a dual, blind extraction of policy details (e.g., continuing and prior authorization, documentation, treatment guidelines) and compiled these data into an insurance reimbursement algorithm to assist prescribing physicians.Fifty-three health insurers (88.3%) had policies on HBOT; 47.2% ( = 25) required prior authorization, and 61.9% ( = 13) required continuing authorization after a set number of HBOT sessions (median: 20 sessions, interquartile range [IQR]: 12-30 sessions). Thirty-eight (71.7%) permitted clinical judgment when defining flap or graft "compromise," and 35.7% ( = 15) considered any pressure greater than 1 atmosphere absolute to be "hyperbaric." Twenty-two insurers (41.5%) outlined documentation requirements for HBOT reimbursement; the most often requested documentation were medical records ( = 19, 86.4%), signs of healing ( = 12, 54.5%), images ( = 10, 45.5%), treatment goals ( = 8, 36.4%), and dive parameters ( = 5, 22.7%).Most insured Americans are eligible for 12 sessions of HBOT; however, medical necessity must be established early and reconfirmed often to increase the likelihood of reimbursement. Additionally, prescribing physicians should be aware that insurers differ in their documentation, prior authorization, and continuing authorization requirements.
Tranexamic Acid in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis.
Rothchild E, Smith IT, Ricci JA
J Reconstr Microsurg · 2026 May · PMID 40499913 · Publisher ↗
Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase...
Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase the risk of thromboembolic events and compromise flap viability. Therefore, the aim of this study was to determine the impact of TXA in microsurgical reconstructive procedures.A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases was conducted from their inception to September 21, 2024. Inclusion criteria were retrospective or prospective cohort studies and randomized controlled trials that administered TXA in the context of microsurgical reconstruction. Data on postoperative outcomes were extracted and pooled for meta-analysis.Five retrospective cohort studies were included, with a total of 718 patients (TXA group: 343 patients; control group: 375 patients). All studies were low-level evidence and retrospective in design, with only one including a matched control group. There was considerable variation across studies in both the microsurgical procedures performed and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate an increased risk of thromboembolic events, showed a significantly decreased mean blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared to the control group.Our findings provide low-level evidence that TXA use in microsurgical reconstruction does not increase the risk of thromboembolic events and may help reduce perioperative blood loss, hematoma formation, and transfusion rates. These results offer preliminary support for the safety of TXA in microsurgical reconstruction procedures and highlight its potential benefits for patients at risk of bleeding complications. However, given the limited number, heterogeneity, and low quality of available studies, these findings should be interpreted with caution. Higher-quality research is needed to support the routine use of TXA in microsurgery.
Color Doppler Allen's Test before Harvesting a Radial Forearm Free Flap-To Do or Not to Do?
Walczak DA, Migacz E, Opyrchał J … +1 more , Bula D
J Reconstr Microsurg · 2026 Jun · PMID 40499912 · Publisher ↗
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Versatility of the Latissimus Dorsi Flap in Head and Neck Surgery: Supporting Evidence from a Tertiary Oncology Center.
Khan S, Saini V, Pawde SA
J Reconstr Microsurg · 2026 Jul · PMID 40499911 · Publisher ↗
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Impact of Postoperative Hyperglycemia on Adverse Outcomes in Microvascular Free Tissue Transfer for Limb Salvage.
Lewcun JA, Kelly B, McCaughey M … +5 more , Melki G, Vanderkwaak B, Nichols D, Wong A, Mountziaris PM
J Reconstr Microsurg · 2026 Mar · PMID 40480264 · Publisher ↗
Postoperative hyperglycemia has been associated with higher rates of complications and prolonged hospitalization. This study aimed to evaluate the effect of postoperative hyperglycemia on outcomes after microvascular fre...
Postoperative hyperglycemia has been associated with higher rates of complications and prolonged hospitalization. This study aimed to evaluate the effect of postoperative hyperglycemia on outcomes after microvascular free tissue transfer for upper and lower limb salvage.This was a retrospective review of all patients undergoing free tissue transfer for limb salvage at our institution from 2014 to 2024. Rates of surgical site infection (SSI), wound healing complications, flap loss, length of stay, and readmission were compared between patients with postoperative hyperglycemia (≥140 mg/dL within 48 hours of surgery) and normoglycemic patients.One hundred forty-one patients had perioperative glucose values measured and thus were included. Fifty-nine point five seven percent ( = 84) were normoglycemic, while 40.43% ( = 57) had postoperative hyperglycemia. Hyperglycemic patients had higher rates of SSI (33.33% vs. 9.52%, < 0.01) and wound healing complications (35.09% vs. 21.43%, = 0.07) compared to normoglycemic patients. The mean length of stay was longer (41.00 vs. 32.83 days, = 0.04) for hyperglycemic compared to normoglycemic patients. On multivariate analysis, postoperative hyperglycemia was a significant predictor of SSI. Notably, the diagnosis of diabetes mellitus was not a significant predictor of complications ( > 0.05).Postoperative hyperglycemia following free tissue transfer for limb salvage is associated with increased length of stay, and with higher rates of SSI and wound healing complications. Maintenance of perioperative normoglycemia after free tissue transfer is important to optimize patient outcomes.
Fortuitous Forty-Year Follow-Up of a Family's Free Flaps-a Fable.
Hallock GG
J Reconstr Microsurg · 2026 Mar · PMID 40480263 · Publisher ↗
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The Influence of the Level of Injury on the Selection of Recipient Vessels in Severe Open Fractures of the Tibia and Foot.
Hayashi K, Futamura K, Tsuchida Y … +6 more , Nishida M, Hasegawa M, Suzuki T, Tsuihiji K, Ogawa T, Sato R
J Reconstr Microsurg · 2026 Feb · PMID 40446834 · Publisher ↗
The selection of recipient vessels is critical for the success of free flap transfer in lower extremity reconstruction following trauma. We hypothesized that variations in soft tissue, vascular, and bone injuries across...
The selection of recipient vessels is critical for the success of free flap transfer in lower extremity reconstruction following trauma. We hypothesized that variations in soft tissue, vascular, and bone injuries across different injury levels influence recipient vessel selection. This study aimed to investigate the injury patterns and recipient vessel selection at different injury levels.A retrospective analysis was performed on patients with acute open tibial fractures (Gustilo IIIB/C) and mangled foot injuries treated at a single trauma center between 2013 and 2022. Injury levels were classified as proximal tibia (P/3), middle tibia (M/3), distal tibia (D/3), and foot injuries. We analyzed injury patterns by level and defined recipient vessel selection as the primary outcome.A total of 91 limbs from 88 patients were analyzed (P/3: 10, M/3: 39, D/3: 18, foot: 24). M/3 injuries were the most severe, with extensive compartment involvement ( < 0.01) and bone loss in 49% of cases, whereas P/3 injuries were the least severe. The distal posterior tibial artery was predominantly used in P/3 injuries, the proximal posterior tibial artery was most frequently used in M/3 and D/3 injuries, and the anterior tibial artery was used primarily for foot injuries ( < 0.01). Vein grafts were required exclusively in M/3 cases, with intraoperative vascular disturbances occurring in 33%. Postoperative vascular complications ranged from 6 to 20%, with an overall flap survival and limb salvage rate of 95%.Among the findings of this study, key findings were that M/3 injuries were the most severe, and P/3 injuries had favorable outcomes with distal posterior tibial artery anastomosis. Injury patterns and recipient vessel selection show distinct, level-specific differences in severe open fractures of the tibia and foot.
Ultrasonographic Quantification of Blood Flow in Microsurgical Breast Reconstruction: Correlation with Indocyanine Green Angiography.
Kim HB, Oh SM, Han HH … +1 more , Eom JS
J Reconstr Microsurg · 2026 Mar · PMID 40404140 · Publisher ↗
Although autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap is a standard procedure, flap perfusion-associated complications remain a concern. This study aimed to investigat...
Although autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap is a standard procedure, flap perfusion-associated complications remain a concern. This study aimed to investigate the correlation between blood flow information obtained through color Doppler ultrasonography (CDU) and flap perfusion assessed by indocyanine green (ICG) angiography.This prospective study included 30 female patients who underwent DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative flow parameters, including arterial peak velocity, arterial volume flow, and venous peak velocity, were measured using CDU. Flap perfusion was evaluated using ICG angiography.The study demonstrated a positive correlation between venous flow and overall flap blood flow. Arterial peak velocity ( = 0.368, = 0.046), arterial volume flow ( = 0.455, = 0.011), and venous peak velocity ( = 0.399, = 0.029) all showed significant associations with ICG-stained area percentages. These findings suggest that venous flow data can provide valuable information for predicting flap viability.This study demonstrates a significant correlation between flow information obtained through CDU and flap perfusion assessed via ICG angiography in patients undergoing DIEP flap breast reconstruction. Both arterial and venous flow data were shown to be crucial for predicting flap viability, with venous flow exhibiting a notable positive correlation with flap blood flow.
Chronological Changes in Breast and Nipple Position After Autologous Reconstruction in an Asian Population.
Lohasammakul S, Yoon J, Suppasilp C … +2 more , Eom JS, Han HH
J Reconstr Microsurg · 2026 May · PMID 40398861 · Publisher ↗
The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple po...
The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared with the contralateral breast in the Asian population.Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral nipple-sparing mastectomy at our institution between June 2017 and December 2019. Univariate and multivariate analyses were performed to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year postsurgery.Among the 170 patients (mean age, 48.04 ± 7.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap and 8 (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0-2) and exposure to radiotherapy were associated with an increased degree of retraction.Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.
Validating a Scalable Approach to Microsurgery Education in Resource-Limited Countries.
Darrach H, Kneib C, Friedrich J … +3 more , Inchauste S, Mamo HL, Chang J
J Reconstr Microsurg · 2026 Mar · PMID 40398860 · Publisher ↗
Microsurgery remains largely nonexistent in sub-Saharan Africa due to a lack of access to specialized training and microsurgical instruments. However, smartphones with magnification capabilities are globally widespread,...
Microsurgery remains largely nonexistent in sub-Saharan Africa due to a lack of access to specialized training and microsurgical instruments. However, smartphones with magnification capabilities are globally widespread, even in low-resource nations. The use of smartphones as simulators for microsurgery training has been previously reported, but little is known with respect to skills acquisition over time.A cohort of Ethiopian plastic surgery attendees and residents participated in a microsurgery training workshop. Before and after the workshop, as well as 6 months afterward, participants were recorded performing a synthetic vessel repair using a smartphone for magnification. Video recordings were graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skills.A total of 13 participants were surveyed and recorded. Overall microsurgical performance SMaRT scores significantly improved (2.05 vs. 2.72 on a five-point scale; = 0.001) upon completion of the workshop, and continued to increase (3.05), but not significantly so ( = 0.201) 6 months afterward. However, improvements were maintained at 6 months. Significant improvement was noted in all SMaRT scale domains postworkshop and further significant improvement in instrument handling was noted at 6 months.Our findings suggest that smartphones can serve as valuable tools for microsurgery training in low-resource settings. Further research is warranted to evaluate the long-term impact of smartphone-based simulation training on skill acquisition and clinical outcomes in low-resource settings, but even in the short-term participants were able to demonstrate significant improvement, as well as maintenance to improvement of skill at 6 months follow-up.
Feedback and Assessment Methods in Microsurgery Education: A Scoping Review.
Abbas MY, Haas J, Huang E … +4 more , Gormley J, McKinnon V, Coroneos C, Acai A
J Reconstr Microsurg · 2026 May · PMID 40398859 · Publisher ↗
With distinctive instrumentation, challenges, and training, the unique nature of microsurgery necessitates the provision of feedback and assessment for trainees. The uncertain applicability of feedback or assessment meth...
With distinctive instrumentation, challenges, and training, the unique nature of microsurgery necessitates the provision of feedback and assessment for trainees. The uncertain applicability of feedback or assessment methods may lead to poor trainee satisfaction and operative outcomes. We conducted a scoping review of the feedback and assessment methods in microsurgery.The Medline, EMBASE, ERIC, and Web of Science databases were searched for studies discussing feedback and/or assessment of microsurgery trainees. Study characteristics, feedback methods, assessment methods, and all other relevant data were extracted. The Medical Education Research Study Quality Instrument (MERSQI) was used to critically appraise the quantitative studies.From 2,440 articles, 99 were included. Sixty-five percent of articles were published since 2015. Plastic surgery, neurosurgery, and ophthalmology were the most common surgical specialties. Ninety percent of articles discussed exclusively assessment methods, with only 10% discussing both feedback and assessment. Microvascular anastomosis was the most common task (55%), with ex vivo synthetic, (20%) chicken (16%), and rat models (11%) being widely used. Global rating scales (GRSs) providing holistic evaluation based on multiple competency domains were the most common assessment methods (73%), followed by checklists (23%), and device-derived metrics (21%). Parameters included suture placement (53.5%), dexterity (50.5%), and tissue handling (48.5%). Real-time verbal, one-to-one feedback was the most common method among relevant studies (80%), while delayed written video review (20%) was also used. No structured feedback methods were used.This review identified a variety of feedback and assessment methods specific to microsurgery. GRSs continue to be popular; however, with increasing accessibility, device-derived metrics continue to increase in prevalence. A juxtaposition between named, structured, and validated assessment methods and informal feedback methods was evident. Particularly, the lack of standardized feedback methods may act as a barrier to the implementation of feedback across microsurgical education.
Career Paths After Microsurgery Fellowship: A 10-Year Analysis.
Lin E, Pillai T, Yi VN … +5 more , Flusche AM, Chopra S, Tran M, Patel A, Rezak KM
J Reconstr Microsurg · 2026 Mar · PMID 40393686 · Publisher ↗
Over the past 10 years, microsurgery fellowship programs and positions have increased by 50%, underscoring the need to understand graduate career paths and provide trainees context about future practice. This study analy...
Over the past 10 years, microsurgery fellowship programs and positions have increased by 50%, underscoring the need to understand graduate career paths and provide trainees context about future practice. This study analyzed who pursues microsurgery fellowships and factors associated with academic careers.This cross-sectional analysis examined graduates from the past 10 years from fellowships recognized by the American Society of Reconstructive Microsurgery or graduates of international fellowships who completed residency in the United States. Demographic variables included gender, race, residency location, and integrated versus independent plastic surgery residency. bibliometric indices at the time of graduation and October 2024 were measured. Initial and current practice settings were categorized as academic (full-time faculty), "private affiliated" (involved in teaching but not full-time faculty), or private practice.Overall, 423 graduates were identified. The majority were male (62.9%) and White (63.4%). Most completed Integrated residency (72.6%). Five fellowships accounted for 48.0% of graduates: MD Anderson (80), Memorial Sloan Kettering (46), University of Pennsylvania (38), Stanford University (23), and The Buncke Clinic (16). After fellowship, 68.0% of graduates entered academia, and 63.2% of graduates are in academia currently out of 419 analyzed. Fellowship location was associated with initial academic practice ( = 0.01), many graduates from International (80.0%), and Southern (78.4%) fellowships entering academia. Graduates in initial academic practice had higher median initial -index (13 vs. 10, = 0.03) and median initial publications (15 vs. 11, = 0.02). Multiple logistic regression found initial publications and fellowship location to be the best predictors of initial academic practice.While most graduates pursue academia, a significant number enter private practice, indicating it is a viable option. Southern or International fellowships send more graduates into academia, but this is likely influenced by popular fellowships. Nuanced factors like personal preference, financial considerations, and networking likely play a significant role in career choices.
Effects of the Medicaid Continuous Enrollment Requirement on Access to Reconstructive Breast Surgery.
Liang J, Lin E, Shammas RL … +2 more , Patel A, Phillips BT
J Reconstr Microsurg · 2026 Mar · PMID 40393685 · Publisher ↗
The "continuous enrollment provision" of the Families First Coronavirus Response Act of 2020 (FFCRA) maintained states' Medicaid enrollments throughout the COVID-19 public health emergency. This study evaluated the impac...
The "continuous enrollment provision" of the Families First Coronavirus Response Act of 2020 (FFCRA) maintained states' Medicaid enrollments throughout the COVID-19 public health emergency. This study evaluated the impact of the continuous enrollment requirement on Medicaid patients' access to reconstructive breast surgery.A retrospective cohort study was conducted on all patients who received reconstructive breast surgery procedures at a large academic institution between July 1, 2013, and July 1, 2023. The Medicaid continuous enrollment period was defined as March 18, 2020, to July 1, 2023. Univariate analysis, multivariable logistic regression, and difference-in-difference analysis were performed.Three thousand five hundred sixty-four patients were included, of whom 252 patients were insured by Medicaid. Patients' odds of Medicaid insurance before and during the continuous enrollment period did not differ ( = 0.096). The distribution of Medicaid and non-Medicaid insurance among autologous breast reconstruction patients similarly did not differ during the continuous enrollment period ( = 0.86). Difference-in-difference analysis confirmed that Medicaid prevalence among autologous breast reconstruction patients did not change with the continuous enrollment requirement ( = 0.07). Increased age was predictive of Medicaid insurance (odds ratio [OR]: 1.043; < 0.001); however, age-dependent differences decreased during the continuous enrollment period. Patients with non-English language preferences had lower odds of Medicaid insurance (OR: 0.38; = 0.035); this difference remained unchanged with the continuous enrollment requirement ( = 0.59).The continuous enrollment requirement alleviated certain age-dependent barriers for Medicaid patients but may not have addressed other patient-level, system-level, and procedure-specific barriers to reconstructive breast surgery.
Impact of Judicious Fluid Administration in the Setting of Abdominally Based Free Flaps.
Kandi LA, Spronsen NV, Jungbauer WN … +6 more , Sexton J, Movtchan N, Chang YH, Reece E, Rebecca AM, Casey WJ
J Reconstr Microsurg · 2026 Mar · PMID 40393684 · Publisher ↗
Abdominally based free flaps are commonly utilized in the context of breast reconstruction. Historically, postoperative care of these patients involved liberal amounts of intravenous fluid administration; however, overad...
Abdominally based free flaps are commonly utilized in the context of breast reconstruction. Historically, postoperative care of these patients involved liberal amounts of intravenous fluid administration; however, overadministration of fluids puts patients at risk of developing flap edema via fluid shifts, electrolyte imbalances, wound dehiscence, and other sequelae. The purpose of this study is to assess fluid administration trends in this cohort at the authors' institution and assess its impact on patient outcomes.A retrospective review was performed on patients who underwent free-flap breast reconstruction. Patient demographics and hospitalization data were collected, and type of abdominal flap and reconstruction timing was noted. Perioperative fluid administration volumes were tracked, and primary outcomes included complication rate and type (e.g., acute blood loss anemia [ABLA], partial/total flap loss, etc.). Multivariable logistic regression was performed to assess the impact of fluid volume on patient outcomes.A total of 115 patients (mean age of 51.3 ± 10.5 years) underwent 188 abdominally based free flaps. Deep inferior epigastric artery perforator flaps were performed most often ( = 91), followed by muscle-sparing transverse rectus abdominis flaps ( = 88). Multivariable logistic regression demonstrated that high perioperative fluid administration (≥9,000 mL) was associated with increased odds of medical complications (odds ratio [OR] = 21.7; confidence interval [CI]: 5.54-84.5; < 0.001). Patients with high fluid administration volumes experienced an increased (but nonstatistically significant) flap complication rate (OR = 2.96; CI: 0.89-9.88; = 0.08) and developed ABLA at a higher rate (OR = 15.86; CI: 5.30-46.4; < 0.001).High-volume resuscitation (≥9,000 mL) was associated with increased odds of ABLA as well as a greater likelihood of medical and flap complications in patients undergoing abdominally based free flaps for breast reconstruction. These data should be used to guide the development of protocols within institutions, which perform free flaps for breast reconstruction.
Physiological Restoration of Lymphatic Flow in Posttraumatic Extremity Lymphedema Using Lymphatic Flaps.
Abdelfattah U, Elsawy GA, Nafea SA … +3 more , Omarah M, Elfateh SM, Elbanoby T
J Reconstr Microsurg · 2026 Mar · PMID 40393683 · Publisher ↗
Posttraumatic lymphedema is poorly discussed in literature. Flap reconstruction considering its lymphatic-axiality has been reported in preventing lymphedema development following trauma or sarcoma excision. In this stud...
Posttraumatic lymphedema is poorly discussed in literature. Flap reconstruction considering its lymphatic-axiality has been reported in preventing lymphedema development following trauma or sarcoma excision. In this study, we report the results of utilizing lymphatic flaps in treatment of established posttraumatic lymphedema.This was a retrospective study of 74 patients (60 lower limbs and 14 upper limbs) with posttraumatic lymphedema that underwent simultaneous soft tissue and lymphatic reconstruction using lymphatic skin flaps. The primary endpoint was providing stable soft tissue coverage and change in limb volume. Secondary endpoints were changes in lymph flow using both lymphoscintigraphy and indocyanine green (ICG) lymphography.Superficial circumflex iliac artery perforator (SCIP) flap was used in 46 cases (62.2%), anterolateral thigh flap in 14 cases (18.9), superficial inferior epigastric artery flap in 9 cases (12.2%), and deep inferior epigastric artery perforator (DIEAP) flap in 5 cases (6.8%). End (vein)-to-side (lymphatic) lymphaticovenous anastomosis was successfully performed in 21 cases (28.4%). During follow-up, significant change in volume was noted in all patients. Using ICG lymphography, lymphatic flow through the flaps was revealed in 59.5% of patients. No lymphatic flow within the flap was observed in 30 cases (40.5%). While qualitative lymphoscintigraphy showed significant changes in the parameters including improved symmetry in the uptake of Technitium nanocolloids (89.2%), visualizing the proximal draining lymph nodes and major lymphatic ducts, and improvement in the dermal backflow.Lymphatic skin flaps allow simultaneous soft tissue and lymphatic reconstruction. Scar excision at the affected limb, flap selection, and insetting based on ICG navigation at both the recipients and donor sites is important for successful flap integration and spontaneous lymphatic communications.
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