Zebolsky AL, Harrison D, Clarke T
… +2 more, Naylor T, Eid A
Microsurgery
· 2025 Dec · PMID 41159660
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BACKGROUND: Traditional intraoperative flap assessments like capillary refill and distal bleeding can provide insight on flap viability and circulation; however, it is difficult to assess the cause of the vascular compro...BACKGROUND: Traditional intraoperative flap assessments like capillary refill and distal bleeding can provide insight on flap viability and circulation; however, it is difficult to assess the cause of the vascular compromise or detect early "subclinical" thrombosis. This study was designed to determine the sensitivity and specificity of indocyanine green angiography (ICGA) in detecting subclinical intraoperative thrombosis during HN-MFTT. METHODS: A retrospective cohort study was performed on HN-MFTT cases at a single institution. Flaps where ICGA was employed after completing the anastomosis were reviewed. The frequency of subclinical intraoperative thrombosis was compared between cases with normal and abnormal ICGA prompting vessel exploration. RESULTS: A total of 67 patients who had intraoperative ICGA were included (male, 55 [82.1%]; median age, 64 [interquartile range, 56-72]). Most underwent anterolateral thigh (n = 56, 83.6%), fibula (n = 13, 19.4%), or radial forearm (n = 12, 17.9%) reconstruction. Of the flaps included, 11 (16.5%) had abnormal ICGA and 9 (13.4%) had subclinical thrombosis. For predicting subclinical thrombosis, abnormal ICGA had a sensitivity of 100% (95% CI: 66.4-100), specificity of 96.6% (95% CI: 88.1-99.6), positive predictive value of 81.8% (95% CI: 48.2-97.7), and negative predictive value of 100% (95% CI: 93.6-100). There was no significant difference in takebacks, flap loss, and complications between those with normal and abnormal ICGA (p > 0.05 for all tests). CONCLUSION: ICGA is a sensitive and specific technique for detecting intraoperative, subclinical thrombosis during HN-MFTT in properly selected patients. This warrants future research to define indications for ICGA use and evaluate how this technology affects clinical outcomes.
Microsurgery
· 2025 Dec · PMID 41159634
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INTRODUCTION: Peroneal artery-based free flaps, including fibula and peroneal flaps, are commonly used in reconstructive surgeries. Despite their clinical utility, donor site morbidity remains a concern. Elastography is...INTRODUCTION: Peroneal artery-based free flaps, including fibula and peroneal flaps, are commonly used in reconstructive surgeries. Despite their clinical utility, donor site morbidity remains a concern. Elastography is a non-invasive imaging technique that quantifies the elasticity or stiffness of soft tissues. This study aimed to utilize elastography to assess muscle stiffness changes at donor sites following peroneal artery-based flap harvest. PATIENTS AND METHODS: Between 2020 and 2022, nine patients underwent peroneal artery-based flap reconstruction for head and neck defects. Donor site morbidity was evaluated using elastography and American Orthopedic Foot and Ankle Society (AOFAS) scores at multiple time points: preoperatively, and at 1 month, 3 months, and 6 months postoperatively. Paired t-tests were used to compare preoperative and postoperative measurements at the flap donor site. RESULTS: Six of the nine patients completed all postoperative evaluations. Analysis revealed that only the soleus muscle demonstrated a statistically significant increase in stiffness on elastography at the 6-month postoperative assessment (medial soleus: axial measurements increased from 51.5 ± 41.4 kPa preoperatively to 107.9 ± 75.4 kPa postoperatively, p = 0.04; lateral soleus: axial measurements increased from 65.5 ± 42.2 kPa preoperatively to 76.7 ± 43.1 kPa postoperatively, p = 0.04). However, no statistically significant differences were observed between the preoperative and 6-month postoperative AOFAS functional scores. CONCLUSION: Peroneal artery-based flap harvest did not result in clinically significant functional impairment at the donor site six months postoperatively, despite objective increases in soleus muscle stiffness detected by elastography.
Microsurgery
· 2025 Oct · PMID 41121968
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Peri-orbital lymphedema is a difficult problem to treat, but fortunately, due to the rich lymphatic networks of the face, conservative management with manual lymphatic drainage in some cases suffices. However, in extreme...Peri-orbital lymphedema is a difficult problem to treat, but fortunately, due to the rich lymphatic networks of the face, conservative management with manual lymphatic drainage in some cases suffices. However, in extreme situations, such as described here, surgical restoration is warranted. We describe a case wherein the entire orbicularis oculi muscle was avulsed off the underlying bone and, in the process, damaged the overlying skin, muscle, nerves, bone, and lymphatics. At secondary reconstruction, 16 months later, the 0.3 mm deep lymphatic collector of the lateral cheek pathway in the sub-orbicularis oculi plane was identified distally and anastomosed to its proximal avulsed segment, along with the repair of the intra-orbicularis oculi motor branches. The importance of restoring the synergy of both the intrinsic contractility of lymphatic smooth muscles and the extrinsic muscular compression of the facial muscles is highlighted. This approach hinges on attention to detail using super microsurgery techniques.
Xie T, Li Y, Cao L
… +5 more, Du W, Liu H, Hou R, Ju J, Tang L
Microsurgery
· 2025 Oct · PMID 41102138
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PURPOSE: For patients with small-area emergency finger injuries and short venous defects, using the traditional second toe tibial free flap with dorsal toe veins would increase donor site damage and compromise the esthet...PURPOSE: For patients with small-area emergency finger injuries and short venous defects, using the traditional second toe tibial free flap with dorsal toe veins would increase donor site damage and compromise the esthetic outcomes of both hands and feet. This study presents an innovative harvesting technique for the second toe tibial free flap, specifically designed for fingertip or volar pulp defect reconstruction. METHODS: From March 2020 to June 2023, our institution managed 15 cases of finger pulp or fingertip defects using second toe tibial flaps with plantar vein grafts, involving 16 digits. The cohort comprised 10 males and 5 females aged 20-60 years mean 38 years. All patients underwent immediate reconstruction with free second toe tibial flaps. Surgical procedures included: anastomosis of the plantar artery to the digital proper artery, plantar vein to palmar vein, and plantar nerve to digital proper nerve. RESULTS: Postoperative outcomes were assessed using two-point discrimination (2-PD), modified Vancouver Scar Scale (mVSS), Michigan Hand Outcome Questionnaire (MHOQ), and total active joint mobility (TAM). All 16 flaps survived without postoperative complications. The mean follow-up period was 11 months (range 6-18). Quantitative outcomes: Mean 2-PD: 9 mm (range 7-12). Donor site mVSS: 5 (range 4-7). Recipient site mVSS: 5 (range 4-7). MHOQ score: 8 (range 5-11). Thirteen patients reported complete satisfaction with reconstructed digit function and esthetics, while two expressed partial satisfaction. No prominent scarring was observed at foot donor sites. No secondary complications occurred during follow-up. CONCLUSIONS: The modified free second toe tibial flap technique demonstrates favorable clinical outcomes for digital pulp/tip reconstruction, achieving functional restoration with minimal donor site morbidity. This approach represents a valuable technique for widespread clinical adoption.
Microsurgery
· 2025 Oct · PMID 41102134
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Fournier's gangrene often leads to extensive perineogenital soft tissue loss, necessitating complex reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is known for its thin pliable skin and lo...Fournier's gangrene often leads to extensive perineogenital soft tissue loss, necessitating complex reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is known for its thin pliable skin and low donor site morbidity. We present a case of a 65-year-old male with Fournier's gangrene affecting both the mons pubis and scrotum. After multiple debridements, a double-paddle SCIP flap based solely on the superficial branch of the SCIA was designed with two independent skin paddles to reconstruct these adjacent but anatomically distinct areas. Preoperative CT angiography and intraoperative SPY imaging enabled flap design and ensured vascular reliability. A double-paddle SCIP flap was elevated with two skin paddles, each inset to separate regions. Through proximal-to-distal dissection, the superficial circumflex iliac artery and its superficial branch were identified and dissected. Upon confirming the origin of the arterial branching of the superficial branch, two flaps were designed-one superiorly and one inferiorly positioned-measuring 14 × 7 cm and 8 × 5 cm, respectively, with an approximate thickness of 10 mm and a pedicle length of 8 cm. The total operative time was approximately 55 min. Postoperative recovery was uneventful, with satisfactory healing and aesthetic outcome at 6 months. This case illustrates a novel use of a double-paddle SCIP flap based exclusively on the superficial branch of the SCIA to simultaneously reconstruct two separate anatomic regions affected by Fournier's gangrene. This approach provides a single-donor, dual-target solution that is both reliable and aesthetically favorable.
Microsurgery
· 2025 Oct · PMID 41082276
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BACKGROUND AND OBJECTIVES: The tongue is the most common site of oral malignancy, and surgical treatment may result in impaired feeding, swallowing, and speech. Free tissue transfer is the preferred method for reconstruc...BACKGROUND AND OBJECTIVES: The tongue is the most common site of oral malignancy, and surgical treatment may result in impaired feeding, swallowing, and speech. Free tissue transfer is the preferred method for reconstructing complex defects. Evidence remains unclear on whether sensory reinnervation improves function. The objective of this review is to evaluate the outcome of patients undergoing innervated versus noninnervated free flap reconstruction following tongue cancer surgery. METHODS: A systematic review was performed to determine the role of sensory neurotization in lingual reconstruction. Only studies with comparative designs were eligible for inclusion. Primary outcome measures included static two-point discrimination (S2PD), pinprick sensation, swallowing, and speech. A meta-analysis was performed using key data analysis to calculate weighted effect sizes for reconstruction with or without neurotization using random-effects models. The statistical heterogeneity was determined using the Higgins' method. RESULTS: Nine studies were included which produced 107 reinnervated flaps and 117 non-innervated flaps for pooled analysis. Objective measures of sensation were significant, favoring the reinnervation group for pinprick sensation and S2PD (p < 0.05), with the pooled difference in proportions being 0.25 and -13.88 (0.06-0.45, 95% CI, -26.66 mm to -1.11, 95% CI), respectively. Functional outcome measures revealed significantly improved speech in the reinnervated group (p < 0.05, non-weighted means 74.8 vs. 62.5%). CONCLUSIONS: This study found a strong association favoring the sensory neurotization for tongue reconstruction. Higher quality studies are required to further define the role of reinnervation for the restoration of swallow, relative differences between type of free flap selected, and measure changes in patients' quality of life.
Tsukuura R, Engmann T, Miyazaki T
… +1 more, Yamamoto T
Microsurgery
· 2025 Oct · PMID 41054917
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Penile skin reconstruction is traditionally performed using a skin graft and/or local pedicled flap. The scrotal flap is one of the options. However, previous techniques sacrifice the bilateral external pudendal arteries...Penile skin reconstruction is traditionally performed using a skin graft and/or local pedicled flap. The scrotal flap is one of the options. However, previous techniques sacrifice the bilateral external pudendal arteries which put the skin pedicle at risk of dyspareunia and stretching. To overcome this limitation, we used the external pudendal artery perforator (EPAP) hemi-scrotal flap with isolation of the pedicle perforator to elevate the perforator flap with a wider rotation arc, easier and safer inset without tension, and sufficient coverage of the defect. A 40 years old male with schizophrenia had circumferential penile skin defect after penile replantation. The sensate EPAP hemi-scrotal flap measuring 9 × 14 cm was designed using doppler ultrasound preoperatively and harvested above the deep fascia. The external pudendal artery perforator and the anterior scrotal nerve were isolated. The shaft skin defect was covered with the sensate EPAP flap and the donor site was closed primarily. Postoperative course was uneventful without any short-term complications. Seven months after the reconstructive surgery, the transferred flap showed good color match and sensation, and the donor site was inconspicuous. Its function recovered without the sensation of pain and stretching. According to current literature the scrotal flap is a suitable donor site because of its thin, pliable, pigmented, and sensate characteristics. Beyond this current approach, we believe that harvesting the scrotal flap specifically as a perforator flap may be a superior flap for penile skin coverage. A higher rotation arc and inconspicuous donor site scar are further beneficial features of this approach.
Almeida VFA, Donato G, de Carvalho AA
… +6 more, de Carvalho WA, Lakda A, Dias Y, Dantas M, Danielian P, Duraes EFR
Microsurgery
· 2025 Oct · PMID 41042058
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BACKGROUND: Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regio...BACKGROUND: Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated. OBJECTIVE: This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay. METHODS: A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (I ≥ 25%) or fixed-effects model (I < 25%). RESULTS: Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = -4.99 mg; 95% CI: [-8.42; -1.56], p < 0.01, I = 0%) and POD 2 (MD = -3.35 mg; 95% CI: [-5.74; -0.96], p < 0.01, I = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = -0.17; 95% CI: [-0.52; 0.18], p = 0.34, I = 83.1%). CONCLUSION: LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.
Kumar N, Bustos SS, Odorico SK
… +1 more, Vijayasekaran A
Microsurgery
· 2025 Oct · PMID 41042018
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The deep inferior epigastric perforator (DIEP) flap remains the preferred flap option for autologous breast reconstruction following mastectomy. This case report presents the novel use of the cephalic vein (CV) as an int...The deep inferior epigastric perforator (DIEP) flap remains the preferred flap option for autologous breast reconstruction following mastectomy. This case report presents the novel use of the cephalic vein (CV) as an interposition graft to alleviate venous congestion in a patient undergoing DIEP flap reconstruction. A 42-year-old woman experienced venous congestion following her initial autologous reconstruction, attributed to thrombus formation from kinking of the vascular pedicle. Despite initial attempts to resolve the congestion, the condition persisted. Since the flap was based on a single perforator, we decided to attempt a CV turndown. The CV was noted to be attenuated and not feasible for use in turndown; therefore, venous salvage was completed by using the CV as an interposition graft to bypass the affected flap vena comitans. The procedure successfully restored venous flow, allowing for flap salvage and subsequent healing. This case underscores the potential of CV as an interposition graft in autologous breast reconstruction, particularly when traditional CV turndown is not possible due to vessel attenuation.
Sakamoto D, Ikeguchi R, Aoyama T
… +7 more, Ando M, Yoshimoto K, Iwai T, Fujita K, Miyamoto T, Noguchi T, Matsuda S
Microsurgery
· 2025 Oct · PMID 41020453
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BACKGROUND: Recently, the immunomodulatory effects of mesenchymal stem cells have been reported in several studies. The purpose of this study was to evaluate the effect of the administration of human amnion-derived mesen...BACKGROUND: Recently, the immunomodulatory effects of mesenchymal stem cells have been reported in several studies. The purpose of this study was to evaluate the effect of the administration of human amnion-derived mesenchymal stem cells (hAm-MSCs) in a rat vascularized composite allotransplantation model. MATERIALS AND METHODS: A total of 18 Lewis (LEW) rats and 6 Brown-Norway (BN) rats were used. Sixteen LEW rats as recipients were divided randomly into four groups: Isograft (Iso), Untreated (UT), FK, and MSC groups (n = 4, each group). Hind limb transplantation was performed. In the Iso group, 2 LEW rats were used as donors. In the other groups, 6 BN rats were used as donors. In the UT group, no immunosuppressant was used. In the FK group, 0.2 mg/kg/day of FK506 (tacrolimus) was administered from day 0 to day 6. In the MSC group, 2 × 10 hAm-MSCs were administered on day 7 after tacrolimus administration (day 0-6). Graft survival was assessed by daily inspection, histology, and immunohistology with the TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) assay. Cytokine mRNA expression analysis using real-time, reverse transcription PCR (RT-PCR) of the grafts was analyzed. RESULTS: Graft survival in the MSC group (14.8 days) was significantly prolonged compared with that of the FK group (13 days; p < 0.05). Histology and immunohistology with the TUNEL assay showed a significant reduction of mononuclear cell infiltration and apoptotic cells in the MSC group compared with the FK group (p < 0.05). RT-PCR analysis of cytokine mRNA expression showed a significant decrease of IL-2 and an increase of TGFβ in graft muscle (p < 0.05). CONCLUSIONS: hAm-MSCs prolonged graft survival in the rat vascularized composite allotransplantation model. hAm-MSCs could be an alternative immunomodulatory agent to avoid the side effects of conventional immunosuppressant.
BACKGROUND: Connective tissue diseases (CTDs) are associated with impaired wound healing and hypercoagulability. There is currently a paucity of research examining postoperative outcomes in these patients following micro...BACKGROUND: Connective tissue diseases (CTDs) are associated with impaired wound healing and hypercoagulability. There is currently a paucity of research examining postoperative outcomes in these patients following microsurgical procedures. We aimed to analyze postoperative outcomes in patients with CTDs following breast reconstruction with the deep inferior epigastric perforator (DIEP) flap. METHODS: A single-institution retrospective study was conducted consisting of all patients that underwent breast reconstruction with DIEP flaps between 2015 and 2023. Outcomes were assessed in the 90-day postoperative period, and Fisher's exact test was used to compare results between patients diagnosed with a CTD and patients who do not have CTDs. RESULTS: Five hundred ten DIEP flaps were performed on 286 patients. Eight of these patients, who underwent 13 DIEP flaps, were diagnosed with CTDs. The patients with and without CTDs were similar with respect to patient demographics. Patients with CTDs were not at increased risk of experiencing any major complication. However, patients with CTDs were at increased risk of experiencing fat necrosis, particularly of the breast (p < 0.05). CONCLUSION: Our data suggests that breast reconstruction using DIEP flaps is a safe procedure for patients who have CTDs; however, they may be at increased risk for fat necrosis of the breast, which does not require significant intervention.
Microvascular free-flap transfer is a widely used technique for reconstructing complex tissue defects. While early postoperative flap survival depends on intact vascular anastomoses, neovascularization may contribute to...Microvascular free-flap transfer is a widely used technique for reconstructing complex tissue defects. While early postoperative flap survival depends on intact vascular anastomoses, neovascularization may contribute to long-term viability. However, direct intraoperative human evidence of early neovascularization in free flaps remains limited. This case report aims to provide direct intraoperative evidence of early neovascularization in a free SCIP flap. We present a case of an 88-year-old female who underwent wide resection of a soft tissue sarcoma and reconstruction with a free superficial circumflex iliac artery perforator (SCIP) flap. The flap survived uneventfully, but on postoperative Day 19, the patient sustained a fall, resulting in a tibial fracture requiring a secondary operation. During this procedure, multiple neovascular perforators were observed between the recipient bed and the previously transplanted SCIP flap. Specifically, at least two neovascular perforators measuring 0.3 mm and 0.5 mm were identified, confirming active neovascularization. This case provides rare intraoperative human evidence of neovascularization in a free flap. While previous studies have questioned the extent of neovascularization, our findings suggest that new vascular connections may form under favorable conditions, such as a well-vascularized recipient site. Neovascularization may offer an additional layer of vascular support in free flaps, particularly in cases of partial vascular compromise. Further research is needed to determine its clinical significance and potential implications for reconstructive surgery.
BACKGROUND: Lymphedema is a chronic condition that can occur in patients following axillary lymph node dissection (ALND). Breast reconstruction has been reported to reduce lymphedema risk. When immediate lymphatic recons...BACKGROUND: Lymphedema is a chronic condition that can occur in patients following axillary lymph node dissection (ALND). Breast reconstruction has been reported to reduce lymphedema risk. When immediate lymphatic reconstruction (ILR) is combined with implant-based breast reconstruction (IBR), it offers the potential for both functional and esthetic benefits in one surgery. However, its impact on postoperative complications, such as infection and wound dehiscence, among others, remains underexplored. METHODS: An IRB-approved retrospective review was conducted on patients who underwent ALND and immediate implant reconstruction (IBR). Data collected included patient demographics, treatment characteristics, and complication rates. Assessed complications included major infection requiring intravenous antibiotic or reoperation, minor infection requiring oral antibiotic, hematoma, seroma, wound issues, deep vein thrombosis, mastectomy flap necrosis, reoperation, implant explantation, and rehospitalization. The primary outcome was a comparison of complication rates between patients who received ILR and those who did not. RESULTS: The study included 178 patients (68 with ILR and 110 without ILR), accounting for implant reconstruction in 266 breasts. Mean operative time was significantly longer in the ILR group (326 min vs. 245, p < 0.001). Despite this, overall complication rates were comparable (38% vs. 34%, p = 0.63). No significant differences were observed in infection rates, seroma formation, reoperations, or implant explantations over a three-year follow-up period. Age and BMI were identified as independent predictors of complications. CONCLUSIONS: Despite longer operative times, ILR demonstrates a comparable safety profile to implant-based breast reconstruction when performed concurrently following ALND.
BACKGROUND: The aim of this study is to compare the traditional triple innervation technique with a new version, designed to reduce eye-mouth synkinesis. To reduce unpleasant synkinesis, the authors proposed changing the...BACKGROUND: The aim of this study is to compare the traditional triple innervation technique with a new version, designed to reduce eye-mouth synkinesis. To reduce unpleasant synkinesis, the authors proposed changing the connection between the masseteric nerve and the injured facial nerve, analyzing the outcome in terms of reduction of synkinesis and power of contraction of the mimic muscle. The traditional technique conveys the quantitative stimuli from the masseteric nerve to the temporofacial branch and from the hypoglossal nerve (30%) to the cervicofacial branch. Traditionally, the stimulus coming from the masseteric nerve is directed in that way to both the orbicularis oculi and the great zygomatic muscle, leading to eye-mouth synkinesis. The evolved technique connects the masseteric nerve more distally on the branch directed to the great zygomatic muscle and the hypoglossal nerve (30%) to the main trunk of the injured facial nerve. Long-term follow-up could be interesting to check what happens to the eye without the stimulus coming from the masseteric nerve. METHODS: Exactly 32 patients were included, subdivided into two groups based on the type of surgical technique. Static symmetry, voluntary movements, and synkinesis were evaluated with eFACE software. RESULTS: Both techniques allowed to obtain excellent outcomes: pre- and post-operative parameters showed a statistically significant improvement in both groups and no differences between the two groups, except in palpebral fissure width forced eye closure, in oculo and midfacial synkinesis: a significant reduction of synkinesis was evident in the evolved version group. CONCLUSIONS: The new triple innervation offers significant improvements in reducing synkinesis, ocular and mid-facial muscle spasm, leading to a more relaxed tone at rest.
BACKGROUND: Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissect...BACKGROUND: Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissection and/or radiotherapy. We analyzed outcomes with regard to recipient vessel selection and flap failure, referring to patients' histories of radiotherapy and/or neck dissection. METHODS: Records of 671 patients who had undergone head and neck reconstruction in our institution from April 2018 to March 2024 were retrospectively reviewed. We divided patients into four groups based on their treatment history: radiotherapy alone (RT, n = 82), neck dissection alone (ND, n = 43), both radiotherapy and neck dissection (NDRT, n = 39), and intact neck with no history of radiotherapy or neck dissection (IN, n = 488). We collected data on flap types, defect areas, selected recipient vessels, and the occurrence of flap failure. We also assessed the risk factors for flap failure. RESULTS: In Group RT, 66 of 84 (79%) recipient vessels were located within irradiated areas. In contrast, in Group ND, 37 of 45 (82%) recipient vessels were outside the dissected areas. No significant association was observed between overall flap failure and variables we assessed. However, our additional flap failure analysis by arterial or venous factors showed an association with the patients' history of radiation treatment (p < 0.05) and in cases where anastomosed vessels were actually located within irradiated areas (p < 0.05). CONCLUSION: In patients with previous radiotherapy history, recipient vessels even within irradiated areas can often be successfully used as recipient vessels. However, after undergoing irradiation treatment, the risk of venous-related flap failure may be higher compared with the non-irradiated area; thus, it necessitates careful consideration during reconstruction.