Journal Of Reconstructive Microsurgery[JOURNAL]
Sun
200 papers
The Co-Surgeon Model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.
Giannas E, Alba B, Harmon K … +8 more , Fritsch A, Kurlander D, Shenaq D, Kaoutzanis C, Reid C, Matros E, Mehrara B, Kokosis G
J Reconstr Microsurg · 2025 Nov · PMID 39993427 · Publisher ↗
Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been dev...
Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeon perspectives on the utility of the co-surgeon model.A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (± 9.7) years. Most of the microsurgeons were male (71%) practicing in the United States (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with immediate lymphatic reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4 and 36.4%, respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves "very much" or "quite a bit" operative efficiency and duration, as well as surgeon well-being and career longevity.This study provides new insight into the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon well-being, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting well-being among microsurgeons.
A Review of Minimally Invasive Techniques for Perfusion Optimization of Flaps.
Tobin M, Thomas C, Raquepo T … +5 more , Yamin M, Mustoe A, Posso A, Foppiani J, Cauley RP
J Reconstr Microsurg · 2025 Nov · PMID 39961363 · Publisher ↗
There is a growing emphasis on minimally invasive techniques as an alternative to surgical delay to promote vessel reorganization and prevent partial and total flap loss. This systematic review evaluates existing literat...
There is a growing emphasis on minimally invasive techniques as an alternative to surgical delay to promote vessel reorganization and prevent partial and total flap loss. This systematic review evaluates existing literature on these minimally invasive techniques, focusing on their potential applications in preventing ischemia-related complications.A systematic review was conducted in July 2024 using PubMed, MEDLINE, and Web of Science following preferred reporting items for systematic reviews and meta-analysis guidelines. Inclusion criteria were studies that included patients undergoing any flap-based reconstruction treated with minimally invasive delay. Exclusion criteria were non-English papers, other systematic reviews, nonhuman patients, and pediatric patients.Six studies were included (angiographic delay = 143, heat preconditioning = 191, ischemic preconditioning = 60) which examined minimally invasive methods for perfusion optimization. Aggregated data from the three studies on angiographic delay demonstrated a 13% (18/143) combined skin or fat flap necrosis rate, which was lower than that of non-delayed flaps and comparable to more invasive traditional surgical ligation. Ischemic preconditioning showed no significant differences ( = 1.0) g compared with controls, whereas heat preconditioning led to reductions (26% vs. 35%) in flap necrosis and necrosis requiring surgical intervention (11% vs. 17%).Angiographic embolization presents a promising alternative to invasive surgical delay, effectively reducing flap necrosis risk. Heat and ischemic preconditioning also show potential for increasing flap survival, although current studies are limited by small sample sizes. Further research is essential to explore preoperative conditioning interventions to improve surgical outcomes for patients who require less invasive delay techniques.
A Comparison of SIEA/SCIA and DIEP Flaps for Autologous Breast Reconstruction.
Somers S, Foley B, Dadzie A … +7 more , Hart C, Chen J, Bautista CH, Scott K, Eddington D, Agarwal JP, Kwok AC
J Reconstr Microsurg · 2026 Jan · PMID 39961362 · Publisher ↗
The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction (ABR). Less commonly used abdominal flaps include the superficial inferior epigastric artery (SIEA)...
The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction (ABR). Less commonly used abdominal flaps include the superficial inferior epigastric artery (SIEA) and the superficial circumflex iliac artery (SCIA) flaps which are based on the superficial vasculature of the abdominal wall. We sought to compare complication rates between DIEP and superficial system flaps and their associated risk factors.A retrospective chart review of 400 breast cancer patients undergoing abdominally-based free flap breast reconstruction with either a DIEP or superficial flap from January 2017 to December 2023 was performed at a single institution. The primary outcome was breast and abdominal site complications.A total of 638 flaps, 571 (89.4%) DIEP and 67 (10.5%) superficial, were performed with flap complication rates of 27.3 and 22.4%, respectively. At the recipient site, there was a significant difference in the rate of postoperative thrombosis (0.7% vs. 4.5%, = 0.015); however, there were no differences for flap failure (0.4% vs. 1.5%, = 0.28) or other flap complications. Donor site outcomes were similar between groups. Although not statistically significant, abdominal bulging was seen in 18 DIEP flap patients compared with none observed in the superficial flap patients ( = 0.24). When controlling for age, BMI, and radiation history, the overall rate of superficial flap and abdominal complications was not statistically significant from the rate of DIEP flap complications ( = 0.576).Compared with DIEP flaps, superficial flaps had significantly higher rates of immediate perioperative thrombosis. However, there were no significant differences in rates of flap failure or other flap complications with superficial flaps compared with DIEP flaps. There was a clinically significant trend toward increased abdominal bulging with the use of DIEP flaps. Our results will help surgeons better understand the risks and benefits associated with superficial flaps for ABR.
Influence and Longevity of a Microsurgery Course for Medical Students on Their Future Careers: A Retrospective Report of Up to 10 Years.
Ritschl LM, Grabenhorst A, Wolff C … +5 more , Pippich K, Dick D, Berberat PO, Wolff KD, Fichter AM
J Reconstr Microsurg · 2026 Jan · PMID 39961361 · Full text
This study evaluates the influence and longevity of a microsurgery course on the future careers of medical students over a period of up to 10 years. The course, which has been well-established for over 15 years, aimed to...
This study evaluates the influence and longevity of a microsurgery course on the future careers of medical students over a period of up to 10 years. The course, which has been well-established for over 15 years, aimed to impart fundamental microsurgical skills through practical exercises using nonbiological and biological models.This study was conducted as an anonymous online cross-sectional survey. Only students who have completed a microsurgical training course at our department within a 10 years period between 2013 and 2023 were eligible for this online survey. This survey aimed to analyze the subjective microsurgical skills at the time of the survey and the influence of the course on further career decisions and development.A total of 300 former participants were eligible and 120 answered the survey. Key findings showed that 99.2% of participants rated the course content and the balance of practice to theory as appropriate, with 100% feeling confident in their microsurgical suturing abilities post-course. A significant 87.5% felt competent to perform vascular anastomoses, though only 63.9% felt confident about nerve coaptation. Statistical analysis indicated no significant gender differences in course evaluations, though some differences were noted between semester-accompanying and block course participants. In the survey, 54.2% of respondents reported using their microsurgical skills in their subsequent medical careers, and 50.4% indicated that the course influenced their medical specialization choices.The study concludes that early exposure to microsurgical training can significantly impact students' skills and career trajectories, supporting the integration of such courses into medical education curricula to enhance surgical training and professional development.
Risk of Plate Exposure in Vascularized Fibula Flap for Mandibular Reconstruction in Primary Oral Cancers.
Pai AA, Chen AC, Loh CYY … +3 more , Hung SY, Tsao CK, Kao HK
J Reconstr Microsurg · 2025 Nov · PMID 39961360 · Publisher ↗
To investigate the risk factors for plate exposure in primary oral cancer patients with mandibular defects undergoing tumor ablation followed by vascularized free fibular flap (FFF) transfer, we conducted a retrospective...
To investigate the risk factors for plate exposure in primary oral cancer patients with mandibular defects undergoing tumor ablation followed by vascularized free fibular flap (FFF) transfer, we conducted a retrospective observational STUDY IN A SINGLE INSTITUTION IN TAIWAN: .The study was performed on a total of 292 primary oral cancer patients who underwent FFF reconstruction between 2015 and 2019. A variety of clinicopathological, surgical, and postoperative parameters were identified and assessed. The data were statistically analyzed with univariate and multivariate logistic regression, and the probability of plate exposure-free rate was plotted as Kaplan-Meier survival curve.The overall plate exposure rate was 28.76%. The re-exploration group had a higher rate of plate exposure than patients without re-exploration (12.2% vs. 5%, < 0.05). The 3-year probability of plate exposure-free rates in patients with () and without () postoperative radiotherapy were 65.9 and 92.5%, and in patients with () and without ( postoperative wound infection were 55.3 and 91.2%, respectively. The multivariate logistic regression showed postoperative radiotherapy and wound infection were independent risk factors for developing plate exposure (adjusted odds ratio [95% CI]: 3.73 [1.37-10.68] and 10.71 [5.15-22.26], = 0.01 and <0.001, respectively). More patients required surgical intervention to manage the exposure of hardware.Our study has highlighted that postoperative radiotherapy and postoperative wound infection are independent risk factors for plate exposure.
Optimal Strategies for the Management of Macromastia and Breast Ptosis for Patients Undergoing Nipple-sparing Mastectomy.
Moreira AA, Kozorosky E, Coopey SB
J Reconstr Microsurg · 2026 Jan · PMID 39947639 · Publisher ↗
High-volume breasts pose challenges for nipple-sparing mastectomy (NSM) due to their large size, indistinct tissue boundaries, and high degree of ptosis. Historically, NSM was not considered feasible for such cases, but...
High-volume breasts pose challenges for nipple-sparing mastectomy (NSM) due to their large size, indistinct tissue boundaries, and high degree of ptosis. Historically, NSM was not considered feasible for such cases, but advancements in surgical techniques have expanded eligibility criteria.We developed a surgical algorithm for patients with macromastia and ptosis undergoing NSM. We also outline techniques for preserving the nipple-areolar complex (NAC) based on the severity of macromastia and breast ptosis, especially when immediate mastopexy/reduction is required during mastectomy. The proposed algorithm provides a practical guide for surgeons managing these complex cases.By employing carefully selected approaches, it is possible to successfully preserve the NAC in high-volume breasts undergoing NSM. This broader eligibility criteria not only accommodates a more diverse patient population but also enhances their quality of life and improves aesthetic outcomes.Advancements in surgical techniques have made NSM a viable option for breast reconstruction in high-volume breasts. By addressing challenges and preserving the NAC through carefully selected approaches, surgeons can improve outcomes and quality of life for patients undergoing NSM.
Corrigendum: Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline.
Lohasammakul S, Tonaree W, Suppasilp C … +3 more , Numwong T, Ratanalekha R, Han HH
J Reconstr Microsurg · 2024 Jul · PMID 39909394 · Publisher ↗
Abstract loading — click title to view on PubMed.
Applying the Modified Five-Item Frailty Index to Predict Complications following Lower Extremity Free Flap Reconstruction in Trauma Patients.
Gonzalez M, Zietowski M, Patel R … +3 more , Chattha A, Cripps CN, Beederman M
J Reconstr Microsurg · 2025 Nov · PMID 39875120 · Publisher ↗
Free flap reconstruction in the setting of lower extremity trauma continues to be a challenging clinical problem fraught with a high risk of complications including flap compromise. Although studies have described certai...
Free flap reconstruction in the setting of lower extremity trauma continues to be a challenging clinical problem fraught with a high risk of complications including flap compromise. Although studies have described certain risk factors that predispose these patients to poor outcomes, there remains a paucity of literature detailing frailty as a risk factor. As such, the aim of our study was to examine the application of the 5-item modified frailty index (mFI-5) in trauma patients undergoing lower extremity free flap reconstruction.The 2012 to 2020 American College of Surgeons-National Surgical Quality Improvement Program database was queried for lower extremity free flap reconstructive procedures. After excluding nontrauma etiologies, patients were stratified into three cohorts by their respective mFI-5 score (0, 1, and ≥2). Univariate and multivariate logistic regressions were performed to assess the effect of mFI-5 scores on postoperative complications.A total of 219 patients were included (64.8% male) with an average age of 47.6 ± 16 years. A total of 22.4% ( = 49) of patients had at least one complication. An increased mFI-5 score was associated with an increase in any complication ( < 0.001), hematological complication ( = 0.023), and reoperation ( = 0.004) rates. A high mFI-5 score was found to be an isolated risk factor for having at least one complication (mFI-5 ≥ 2: odds ratio [OR]: 3.829; < 0.007; 95% confidence interval [CI]: 1.445-10.145) and reoperation (mFI-5 ≥ 2: OR: 5.385; < 0.002; 95% CI: 1.826-15.877).Our results indicate that the mFI-5 can be a helpful assessment tool for lower extremity trauma patients undergoing free flap reconstruction to predict the risk of surgical complications and reoperation rates. Patients with an mFI-5 score > 2 should be counseled preoperatively of their increased risk of complications.
Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction Is Cost-Effective.
Zhao KL, Kammien AJ, Graetz E … +4 more , Moore MS, Evans BG, Schneider EB, Ayyala HS
J Reconstr Microsurg · 2025 Nov · PMID 39821138 · Publisher ↗
Simultaneous symmetrizing surgery (SSS) at the time of unilateral free flap reconstruction has been described as a method to facilitate single-stage breast reconstruction. However, the impact on cost and number of additi...
Simultaneous symmetrizing surgery (SSS) at the time of unilateral free flap reconstruction has been described as a method to facilitate single-stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described.Patients with unilateral free flap reconstruction were identified in national administrative data from 2017 to 2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with and without SSS. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma, and thromboembolism. The costs of initial hospitalization and subsequent surgeries were determined. Deferred symmetrizing surgeries within one year were identified. Chi-squared and Fisher exact tests and Wilcoxon tests were used for statistical analysis.A total of 1,136 patients were identified, out of which 638 were delayed reconstructions: 75 with SSS and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with SSS underwent revision surgery (29% vs. 51%, [ = 0.001]) or at least one additional procedure (36% vs. 57%, < 0.001). Patients with SSS had lower total costs ($35,897 vs. $50,521, = 0.005). There were 498 immediate reconstructions: 63 with SSS and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries, or total costs.Symmetrizing procedures at the time of unilateral reconstruction may decrease the cost and number of subsequent surgeries without increasing complications.
Microsurgery in Motion: An Objective Assessment of Microsurgical Skill and Efficiency.
Lyon SM, Zeng W, Yang S … +4 more , Wise BJ, Mohamadipanah H, Pugh CM, Poore SO
J Reconstr Microsurg · 2025 Oct · PMID 39814035 · Publisher ↗
High levels of precision, as well as controlled, efficient motions, are important components of microsurgical technique and success. An accurate and objective means of skill assessment is lacking in resident microsurgica...
High levels of precision, as well as controlled, efficient motions, are important components of microsurgical technique and success. An accurate and objective means of skill assessment is lacking in resident microsurgical education. Here we employ three-dimensional, real-time motion-tracking technology to analyze hand and instrument motion during microsurgical anastomoses. We hypothesize that motion metrics can objectively quantify microsurgical skill and predict the overall level of expertise.Seventeen participants including medical students, plastic surgery residents, and attendings performed two end-to-end arterial microsurgical anastomoses in a laboratory setting. Motion tracking sensors were applied to standardized positions on participants' hands and microsurgical instruments. Motion and time parameters were abstracted using sensor-derived position data.A total of 32 anastomoses were completed and analyzed. There were significant differences in time for task completion and idle time between attendings and junior residents (post-graduate year (PGY)1-3). Path length and working volume consistently differentiated between students and attendings for all phases of an anastomosis. Motion and time data were less able to consistently distinguish attendings from residents stratified by laboratory anastomosis experience.Quantifiable motion parameters provide objective data regarding the efficiency of microsurgical techniques in surgical trainees. These data provide a basis for microsurgical competency assessments and may inform future structured feedback through instruction, instruments, and technological interfaces.
Using Transcranial Magnetic Nerve Stimulation to Differentiate Motor and Sensory Fascicles in a Mixed Nerve: Experimental Rat Study.
Hayashi K, Hsieh TH, Huang YL … +1 more , Chuang DC
J Reconstr Microsurg · 2025 Oct · PMID 39775443 · Publisher ↗
Accurately matching the correct fascicles in a ruptured mixed nerve is critical for functional recovery. This study investigates the use of transcranial magnetic stimulation (TMS) to differentiate motor and sensory fasci...
Accurately matching the correct fascicles in a ruptured mixed nerve is critical for functional recovery. This study investigates the use of transcranial magnetic stimulation (TMS) to differentiate motor and sensory fascicles in a mixed nerve.In all 40 rats, the median nerve in the left upper arm was evenly split into three segments. The rats were separated into two groups. In Group A (20 rats), the segment with the highest amplitude during TMS was selected as the motor neurotizer and transferred to the musculocutaneous nerve. In Group B (20 rats), only the medial one-third segment was selected and transferred without using TMS. The results were compared using grooming tests, nerve electrophysiological studies, muscle tetanus contraction force measurements, muscle weight, and axon counts at 16 weeks.The grooming test showed that Group A performed significantly better than Group B at 12 and 16 weeks postoperatively. Tetanic muscle contraction force measurements also revealed that Group A had significantly better outcomes than Group B. However, electrophysiological testing, muscle weight, and axon counts showed no significant differences between the two groups.This study suggests that TMS can be used to distinguish motor fascicles from sensory fascicles in a mixed nerve. It is desirable to apply this technique intraoperatively to differentiate motor and sensory fascicles for appropriate nerve matching and to select the motor fascicles as a motor neurotizer for functioning free muscle innervation in human mixed nerve injury.
Utilizing Lateral Sprouting Axons to Reinnervate a Transferred Free Muscle to Enhance Distal Muscle Recovery When Performing High-Level Nerve Repair: Experimental Rat Study.
Tsao CK, Jung SM, Chuang DC
J Reconstr Microsurg · 2025 Nov · PMID 39750584 · Publisher ↗
High-level median or ulnar nerve injuries and repairs typically result in suboptimal reinnervation of distal muscles. Functioning free muscle transplantation (FFMT) is increasingly recognized as an effective method to re...
High-level median or ulnar nerve injuries and repairs typically result in suboptimal reinnervation of distal muscles. Functioning free muscle transplantation (FFMT) is increasingly recognized as an effective method to restore function in chronic muscle denervation cases. This study investigates the efficacy of using an additional FFMT, neurotized by lateral sprouting axons from a repaired high-level mixed nerve in the upper limb, to enhance distal hand function.Thirty-five Sprague-Dawley rats were divided into four groups to evaluate the proposed FFMT technique. The infraclavicular median nerve (MN) was transected and repaired in each animal. The nearby musculocutaneous nerve (MCN) was transected, and the terminal nerve after the biceps muscle was divided and embedded into the biceps muscle, creating an FFMT model. The distal stump of the MCN was anchored to the MN, 1.5 mm distal to the MN repair site. Assessments of nerve and muscle function were conducted 4 months postoperatively.Behavioral analysis, along with measurements of biceps muscle weight and tetanic contraction force, indicated significant recovery in the biceps muscle. Histological staining confirmed reinnervation of the MCN from the repaired MN. Additionally, functional examination of the flexor digitorum superficialis muscle revealed no deterioration associated with the repaired MN.The study demonstrates the potentiality of utilizing lateral sprouting axons from a repaired high-level MN to reinnervate an additional FFMT to enhance flexor digitorum superficialis function. The surgical strategy promises recovery of distal muscle function and implies for diverse clinical applications.
Early Initiation of Dangle Protocol in Lower Extremity Free Flap Microsurgery.
Su S, Menon A, Taillon C … +3 more , Saad O, Merceron T, Ghareeb P
J Reconstr Microsurg · 2025 Nov · PMID 39750583 · Publisher ↗
Defects of the lower extremity often require free tissue transfer to provide adequate soft tissue reconstruction. Patients typically undergo a postoperative dangle protocol to condition the flap to withstand the increase...
Defects of the lower extremity often require free tissue transfer to provide adequate soft tissue reconstruction. Patients typically undergo a postoperative dangle protocol to condition the flap to withstand the increase in venous pressure. The purpose of this study was to evaluate the safety and postoperative length of stay after early initiation of dangle.A retrospective review of patients undergoing lower extremity free tissue transfer reconstruction at the Grady Memorial Hospital from 2012 to 2022 was conducted. Patient demographics, surgical characteristics, and outcomes were analyzed. Patients were categorized into two groups: early (within 5 days after surgery) and late dangle (day 6 or greater). Univariate and multivariate statistical analyses were performed, with significance determined to be < 0.05.A total of 83 of 99 available patients met inclusion criteria; 22 patients underwent early and 61 late dangle. Free flap survival was 90.9% in the early and 90.2% in the late group. The mean postoperative length of stay in the early and late groups were 12.3 and 18.8 days, respectively ( = 0.0018). There was no difference in the number of patients who had wound healing complications, flap failure, and a need for amputation in each group.Our results demonstrate that initiation of an early dangle protocol does not affect surgical outcome and leads to a reduction in postoperative length of stay. These results can be used to inform evidence-based recommendations for flap management in lower extremity reconstruction.
Clinical Variables Associated with Lymphedema Surgery: Physiologic versus Excisional.
Lenders J, Best CSW, Eisner ZJ … +1 more , Kung TA
J Reconstr Microsurg · 2025 Nov · PMID 39750582 · Publisher ↗
As surgical interventions for lymphedema become increasingly available, it is important to understand characteristics of patients that undergo lymphedema surgery. The goal of this study was to define clinical variables o...
As surgical interventions for lymphedema become increasingly available, it is important to understand characteristics of patients that undergo lymphedema surgery. The goal of this study was to define clinical variables of patients evaluated at a medical center who underwent lymphedema surgery to better inform which referred patients are surgical candidates.A cross-sectional observational study was performed on patients referred to plastic surgery for lymphedema between January 2016 and June 2023. The operative group included patients who underwent lymphedema surgery, including physiologic surgery (PS) and excisional surgery (ES). The nonoperative group consisted of patients referred for lymphedema who did not undergo lymphatic surgery. Patient records were collected, and between-group comparisons were performed.A total of 285 total patients were identified ( = 66 operative, = 219 nonoperative). The operative cohort had higher body mass index (BMI) than the nonoperative (33.5 vs. 31.2 kg/m, < 0.035) and was more likely to have undergone physical therapy/occupational therapy (68.2 vs. 53.4%, = 0.005). Within the operative cohort (PS = 37, ES = 29), PS patients were more likely to be White (91.9 vs. 69.0%, = 0.043) and have lower BMI (32 vs. 42.7 kg/m, = 0.007). PS patients were diagnosed for a longer period (8 vs. 3 years, = 0.03) before seeing a plastic surgeon, more commonly had upper extremity lymphedema (43.2 vs. 13.8%, = 0.016) and presented at an earlier lymphedema stage (stage 1 64.9 vs. 27.6%, = 0.002). PS patients were more likely to have prior radiation (56.8 vs. 20.7%, = 0.005), previous surgery (75.5 vs. 48.3%, = 0.038), and prior lymphatic intervention (67.6 vs. 17.2%, < 0.001) near the affected area.Defining patient characteristics associated with surgical intervention for lymphedema can aid surgeons to increase the proportion of patients seen in clinic who are surgical candidates. Factors relating to oncological and surgical history in the affected area may suggest a patient is more likely to undergo PS.
Impact of Technological Advancements on Short-term Outcomes in Flap Reconstruction after Soft Tissue Sarcoma Resection: A Retrospective Comparative Analysis.
Karakawa R, Yoshimatsu H, Fuse Y … +7 more , Kurosawa N, Saito M, Hayakawa K, Tanizawa T, Ae K, Matsumoto S, Yano T
J Reconstr Microsurg · 2025 Nov · PMID 39750581 · Publisher ↗
Soft tissue sarcomas (STS) are rare malignancies requiring extensive surgical resection, often leading to significant soft tissue defects. Flap reconstruction is crucial for restoring function and appearance. Recent reco...
Soft tissue sarcomas (STS) are rare malignancies requiring extensive surgical resection, often leading to significant soft tissue defects. Flap reconstruction is crucial for restoring function and appearance. Recent reconstructive microsurgery advancements, including high-resolution indocyanine green (ICG) imaging and ultra-high frequency ultrasonography (UHFU), have revolutionized preoperative planning and intraoperative guidance. We aimed to compare the surgical procedures and short-term outcomes of patients undergoing immediate flap reconstruction before and after our department's adoption of these technologies.We retrospectively analyzed 276 patients who underwent immediate flap reconstruction post-sarcoma resection between May 2014 and December 2023. They were categorized into pre- and post-technology groups based on the introduction of ICG angiography and UHFU in July 2019. We collected demographic, surgical, and postoperative data and compared outcomes using Fisher's exact and -tests.The muscle preservation rate at the donor site was significantly higher in the post-Tech than in the pre-Tech group (no muscle damage: 65% vs. 37%, incision muscle damage: 25% vs. 26%, and muscle resection: 10% vs. 37%; < 0.01). The proportions of complications (21% vs. 36%, = 0.01), flap complications (17% vs. 30%, = 0.01), partial flap loss (5% vs. 17%, < 0.01), and flap dehiscence (9% vs. 25%, < 0.01) were low in the post-Tech group. In the stratified analysis of free-flap reconstruction, the post-Tech group had a shorter operative time (7:01 vs. 8:13, = 0.03) and fewer takebacks due to compromised flap perfusion (4% vs. 15%, = 0.03) compared with the pre-Tech group.The introduction of ICG angiography and UHFU has improved surgical outcomes in STS flap reconstructions. These technologies facilitate precise preoperative planning and intraoperative decision-making, resulting in reduced operative times, low complication rates, and enhanced muscle preservation at the donor site.
Career Paths of Young Fellowship-Trained Microsurgeons.
Howell CR, Tierney MG, Westerfield A … +1 more , Silva AK
J Reconstr Microsurg · 2025 Nov · PMID 39740774 · Publisher ↗
Microsurgery is a highly specialized field requiring years of dedicated training and proper support to sustain a practice. We sought to describe the career paths of young microsurgeons and investigate factors associated...
Microsurgery is a highly specialized field requiring years of dedicated training and proper support to sustain a practice. We sought to describe the career paths of young microsurgeons and investigate factors associated with switching jobs.Public data on surgeons who completed a microsurgery fellowship between 2016 and 2020 were collected. Analysis of job switching was determined using the Kaplan-Meier method.One hundred and sixty-seven graduates were analyzed. Most initially practiced microsurgery (92.2%) and 61.7% went into academics. Fifty-two (31.4%) have switched jobs and Kaplan-Meier estimates that 36.0% will switch by 5 years into practice. Over half (58%) changed practice setting type, 19% left academics, and 12% stopped performing microsurgery.Gender, residency training type, taking a job where they trained, and the presence of a microsurgery fellowship had no effect on job switching ( = 0.74, 0.95, 0.71, 0.26). Surgeons in academics were significantly more likely to change jobs ( = 0.04).Gender, residency training type, or taking a job where they trained had no effect on leaving academics ( = 0.89, 0.42, 0.37). Taking a first job where a microsurgery fellowship was present was significantly associated with staying in academics ( = 0.04)Most microsurgery fellows take jobs performing microsurgery. Thirty-six percent will switch jobs in 5 years, more than half will change practice setting type, and about 20% will leave academics. A minority will stop performing microsurgery. Surgeons in academics are more likely to switch jobs. Taking a job where there is a microsurgery fellowship is significantly associated with staying in academics during the switch.
A Combined "Vasculoplastic" Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer.
Li KR, Rohrich RN, Lava CX … +5 more , Gupta NJ, Hidalgo CM, Episalla NC, Akbari CM, Evans KK
J Reconstr Microsurg · 2025 Oct · PMID 39730119 · Publisher ↗
Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of...
Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on performing targeted direct endovascular reperfusion on a vessel that will be used as the flap recipient. Our study compares outcomes of patients who received targeted revascularization (TR) to the recipient vessel for LEFF anastomosis versus nontargeted revascularization (NR) of arterial recipients prior to LEFF.LEFF patients who underwent preoperative endovascular revascularization (ER) from July 2011 to January 2023 were reviewed. Location of ER, demographics, perioperative details, and outcomes were collected. TR was performed on the same vessel as the flap recipient and NR was located on a different vessel than the flap recipient.A total of 55 LEFF patients were identified. Overall, 50.91% ( = 28) received TR and 49.1% ( = 27) received NR. Average age was 60.3 ± 10.9 years and average Charlson Comorbidity Index was 5.3 ± 1.9. On preoperative angiogram, the TR group had significantly lower rates of ER above the knee (3.6 vs. 33.3%, < 0.001). Immediate flap success rate was 98.2%, with no differences between groups ( = 1.000). No significant differences were found in rates of any postoperative flap complications ( = 0.898), takeback ( = 0.352), partial flap necrosis ( = 0.648), or dehiscence ( = 0.729). Both TR and NR groups had similar rates of a postoperative angiogram (42.9 vs. 48.2%, = 0.694) and reintervention (35.7 vs. 40.7% = 0.701). Amputation rates were similar between TR and NR (17.9 vs. 14.8%, = 1.000).Close follow-up with vascular and plastic surgery is required for patients who undergo ER prior to LEFF, as nearly half of our cohort required additional endovascular procedures. Overall, we observed no significant differences in complication rates for the TR and NR groups, informing revascularization strategies for free tissue transfer in a highly comorbid chronic wound population.
A New Concept in Peripheral Nerve Repair: Incorporating the Tunica Adventitia.
Zuhour M, İnce B, Oltulu P … +2 more , Gök O, Tekecik Z
J Reconstr Microsurg · 2025 Oct · PMID 39706220 · Publisher ↗
Pedicled, prefabricated, and free nerve flaps have several drawbacks, such as requiring microsurgical anastomosis, the need for secondary operations and the risk of developing thrombosis. In this study, we aimed to vascu...
Pedicled, prefabricated, and free nerve flaps have several drawbacks, such as requiring microsurgical anastomosis, the need for secondary operations and the risk of developing thrombosis. In this study, we aimed to vascularize the repaired nerve in a single session by establishing a connection between the epineurium of the repaired median nerve and the tunica adventitia of the brachial artery.The technique was performed on the median nerves of a total of 42 rats over 13 weeks. While group 1 didn't receive any intervention, the following three groups (2, 3, and 4) received classic treatments (coaptation, graft, and vein conduit). In addition to classic treatments, the other three groups (5, 6, and 7) were vascularized by attaching the adventitia of the brachial artery to the repaired nerves. Nerve regeneration was evaluated using functional tests, immunohistochemical analysis, and electron microscope.The vascularized groups (5, 6, and 7) showed earlier functional recovery ( < 0.05). Vascularization reduced inflammation in the coaptation group, reduced fibrosis and degeneration in the nerve graft group, and reduced fibrosis, degeneration and disorganization while increased the number of passing fibers and myelination in the vein conduit group ( < 0.05). Vascularization provided superior ultrastructural findings. Microscopic analysis revealed a novel finding of "zone of neurovascular interaction" between the adventitia and the regenerating nerve.Vascularizing the repaired nerves with this new technique provided faster functional and better histological healing. Unlike classic vascularization techniques, this method does not require microsurgical anastomosis, does not carry the risk of thrombosis, and does not necessitate secondary operations. The "zone of neurovascular interaction" identified in this study revealed regenerating axon clusters alongside newly developed blood vessels. This important finding highlights a potential role of the tunica adventitia in nerve regeneration.
Effect of Enhanced Recovery after Surgery in Morbidly Obese Patients Undergoing Free Flap Breast Reconstruction.
Stephens KL, DeVito RG, Hollenbeck ST … +2 more , Campbell CA, Stranix JT
J Reconstr Microsurg · 2025 Nov · PMID 39701166 · Publisher ↗
Enhanced recovery after surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have...
Enhanced recovery after surgery (ERAS) pathways have been widely implemented across many surgical practices, including autologous breast reconstruction. However, the benefits of ERAS in the morbidly obese population have yet to be defined.A retrospective chart review of patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our institution from 2017 to 2022 was performed. Length of stay (LOS), intensive care unit (ICU) utilization, opioid usage, cost, and flap outcomes were analyzed in patients with body mass index greater than 35 before and after ERAS implementation.Thirty-five morbidly obese patients receiving DIEP flap breast reconstruction were identified before ERAS and 18 after ERAS. There were no differences in unilateral versus bilateral or immediate versus delayed reconstruction. LOS decreased with ERAS (3.43 vs. 2.06 days, < 0.0000001). ICU utilization decreased with ERAS (0.94 vs. 0.0 days, < 0.0001). Daily and total opioid usage decreased with ERAS (41.8 vs. 17.9 morphine milligram equivalent [MME], < 0.0001; 190.5 vs. 54.7 MME, < 0.0001). Financial metrics improved with ERAS, including decreased total cost ($33,454 vs. $25,079, = 0.0002) and increased cost margin ($4,458 vs. -$8,306, = 0.004). There were no differences in donor or recipient site outcomes including flap loss, deep venous thrombosis/pulmonary embolism, hernia/bulge, delayed wound healing, revisions, and blood loss.ERAS pathways maintain benefits in the morbidly obese population undergoing abdominally based autologous breast reconstruction, including decreased LOS, ICU utilization, opioid use, and cost while maintaining successful reconstruction outcomes.
Optimal Vasodilators in Microsurgery and Their Effects on Blood Vessels.
Ueda M, Nomura T, Terashi H … +1 more , Sakakibara S
J Reconstr Microsurg · 2026 May · PMID 39689873 · Publisher ↗
Abstract loading — click title to view on PubMed.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe