Journal of reconstructive microsurgery最新文献

{"title":"The Efficacy of Transversus Abdominis Plane (TAP) Blocks in Abdominal Tissue Free Flap Breast Reconstruction.","authors":"Rachel Park, Ugochukwu K Odega, Robert G DeVito, Jesse Chou, Chris A Campbell, John T Stranix","doi":"10.1055/a-2671-7296","DOIUrl":"https://doi.org/10.1055/a-2671-7296","url":null,"abstract":"<p><strong>Background: </strong>Regional blocks are effective adjuncts in autologous breast reconstruction. Data on specific regional blocks and agents remain unclear.</p><p><strong>Methods: </strong>We performed a retrospective review of patients that underwent abdominal free flap breast reconstruction between July 2017 and June 2022. A total of 256 patients were included with 181 that received Exparel TAP blocks, 54 with non-Exparel TAP blocks, and 21 without TAP block. Length of stay, ICU length of stay, average daily MME, and average total MME were collected.</p><p><strong>Results: </strong>Comparing the Exparel TAP Block cohort and Non-Exparel TAP Block cohort, there was no difference in LOS (2.71 vs. 2.72 days, p = 0.96), ICU LOS (0.35 vs. 0.56 days, p = 0.18), Daily MME (29.08 vs. 29.71 MME, p = 0.85), and Total MME (113.69 vs. 113.92 MME, p = 0.99). Comparing the Exparel TAP Block Cohort and Non-TAP Block cohort there were significant differences in LOS (2.71 vs. 3.62 days, p = 0.003), ICU LOS (0.35 vs. 1.1 days, p = 0.001), Daily MME (29.08 vs. 39.56, p = 0.04), and total MME (113.69 vs. 195.55, p = 0.001). When comparing the Non-Exparel TAP Block cohort and the Non-TAP Block cohort there were differences in LOS (2.72 vs. 3.62 days, p = 0.004), ICU LOS (0.56 vs. 1.1 days, p = 0.04), and total MME (113.92 vs. 195.55 MME, p = 0.006).</p><p><strong>Conclusion: </strong>TAP block can effectively reduce length of stay and post-operative narcotic use in patients undergoing autologous breast reconstruction regardless of the choice of local anesthetic.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving Textbook Outcomes in Bilateral DIEP Flap Breast Reconstruction: Does a Co-Surgeon Matter?","authors":"Robert G DeVito, Colby Newson, Benjamin G Ke, Hanzhi Yang, Jessica M Pawly, Scott T Hollenbeck, Chris A Campbell, John T Stranix","doi":"10.1055/a-2671-8578","DOIUrl":"https://doi.org/10.1055/a-2671-8578","url":null,"abstract":"<p><strong>Background: </strong>It is essential to examine predictors of ideal outcomes in surgery. \"Textbook outcomes\" are optimal surgical results based on multiple quality measures. It is important that patients have access to trusted centers that consistently produce high quality surgical outcomes.</p><p><strong>Methods: </strong>A retrospective review of all bilateral DIEP flap breast reconstructions at our institution from 2017 to 2022 was performed. Criteria for \"textbook outcome\" were OR time within one standard deviation of institutional average or less, length of stay </= 4 days, no intraoperative complications, no operative complications, no readmission within 30 days, no infection requiring IV antibiotics, no systemic complications, and no mortality. Propensity score matching was used to control for common comorbidities, reconstruction timing, and oncologic factors. This resulted in 47 matched pairs of bilateral DIEP flap reconstructions for comparison between a single-surgeon cohort and a co-surgeon cohort.</p><p><strong>Results: </strong>Textbook outcomes occurred at a significantly higher rate in the co-surgeon cohort compared to the single surgeon cohort (79% vs. 57%, p = 0.025). The average OR time was significantly shorter in the co-surgeon cohort compared to the single surgeon cohort (403 minutes vs. 572 minutes, p <0.0001), and elevated OR time was the most common reason for not achieving a textbook outcome. There were no differences in the other criteria for a \"textbook outcome\".</p><p><strong>Conclusion: </strong>Textbook outcomes in bilateral DIEP flap breast reconstruction are achieved at significantly higher rates with a co-surgeon. This is primarily due significantly shorter OR times. Further research into factors affecting textbook outcomes is needed.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Microsurgical Education: A Systematic Review of its Role in Training Surgeons.","authors":"Tricia Mae Raquepo, Micaela J Tobin, Shreyas Puducheri, Mohammed Yamin, Jannat Dhillon, Matthew Bridgeman, Ryan P Cauley","doi":"10.1055/a-2672-0260","DOIUrl":"https://doi.org/10.1055/a-2672-0260","url":null,"abstract":"<p><p>Background Microsurgery is associated with a steep learning curve that requires extensive training through supervised surgeries, cadaver practice, and simulations. The emergence of artificial intelligence (AI) in medical education offers a new potential avenue for microsurgery training by providing real-time feedback, performance analytics, and advanced simulation. This study aims to evaluate the scope, implementation, and outcomes of AI in microsurgical education for trainees across all levels. Methods A systematic review was performed in October 2024 following Preferred Reporting Items for Systematic Reviews and Meta-Analysis with extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases, including Embase, PubMed, Scopus, and Web of Science, returned 3,323 citations. Inclusion criteria were studies investigating the use of AI in the medical education of microsurgical trainees. Abstracts, commentaries, editorials, systematic reviews, and non-English studies were excluded. After two-stage screening, a total of 16 studies were included in this review. Results The assessed AI interventions appeared in the following number of studies: Computer Vision (n=13), Sensor-Driven Models (n=2), Classical/Statistical Machine Learning (n=4), Task-Specific Neural Networks (n=4), Transfer Learning of Neural Networks (n=3), Zero-Shot Inference of Pretrained Models (n=5), Augmented/Virtual Reality (n=5), and Anatomical Landmark Tracking (n=5). Upon full data extraction, three overarching themes were identified among studies 1) Objective Assessment of Microsurgical Skills, 2) Innovations in Microsurgical Education Materials, and 3) Improvement of Surgeon Workload and Performance. AI improved skill assessment (accuracy: 0.74-0.99), training, and workload optimization. AI-enhanced microsurgical training reduced training time (p=0.015), improved ergonomics, and minimized cognitive load, accelerating learning (β=0.86 vs. β=0.25). Conclusion Artificial intelligence has transformative potential in microsurgical education and practice, as emphasized by its capacity to enhance skill assessment, educational tools, and ergonomic support. Despite these enhancements, additional work is needed to address challenges such as data bias, standardization, and real-world implementation.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose-Derived Stem Cell Sheets Prepared with Ascorbate 2-Phosphate Enhance Nerve Regeneration in Rat Sciatic Nerve Autografts.","authors":"Arsuro Murai, Kaoru Tada, Mika Akahane, Yuta Nakamura, Soichiro Honda, Masashi Matsuta, Akari Mori, Satoru Demura, Roboon Jureepon, Tsuyoshi Hattori, Osamu Hori, Hiroyuki Tsuchiya","doi":"10.1055/a-2671-7768","DOIUrl":"https://doi.org/10.1055/a-2671-7768","url":null,"abstract":"<p><strong>Background: </strong>Autologous nerve grafts remain the gold standard for peripheral nerve repair but have limited regenerative potential. Adipose-derived stem cells (ADSCs) have been investigated for their potential in nerve regeneration, and ascorbate 2-phosphate (A2P) enables the formation of ADSC sheets. This study examined whether ADSC sheets applied around autologous nerve grafts enhance functional and histological recovery in a rat sciatic nerve model.</p><p><strong>Methods: </strong>A 15 mm sciatic nerve segment was excised, inverted, and sutured for autologous grafting in rats. Three groups were compared: phosphate-buffered saline (PBS, control), ADSC suspension, and ADSC sheets. Functional recovery was assessed at 12 weeks (n = 10 per group) using the sciatic functional index (SFI), nerve conduction studies (latency, amplitude), and tibialis anterior muscle wet weight. Histological analyses, including toluidine blue staining, evaluated axonal changes at 1, 2, 4, 8, and 12 weeks (n = 3 per group per time point). DiI-labeled ADSCs were tracked at 1 week to assess cell retention (n = 3 per group).</p><p><strong>Results: </strong>At 12 weeks, the ADSC sheet group showed significantly improved SFI and muscle wet weight compared to controls and ADSC suspension groups. Nerve conduction studies revealed shorter distal latency in the ADSC sheet group versus controls, with no significant differences in the suspension group. While histological analysis did not demonstrate statistically significant differences among the groups, qualitative observations suggested that the ADSC sheet group tended to exhibit a greater number of myelinated axons at 12 weeks and fewer degenerative changes at earlier time points (1 and 2 weeks). DiI-labeled ADSCs were more frequently observed around the graft in the sheet group compared to the suspension group.</p><p><strong>Conclusion: </strong>Application of ADSC sheets to autologous nerve grafts may promote functional recovery. Forming ADSC sheets with A2P may represent a favorable approach for improving outcomes in peripheral nerve repair.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Dynamic Smile Outcomes of Free Gracilis Muscle Transfer in Pediatric Facial Palsy Using Image-Based Analysis.","authors":"Melanie Bakovic, Asli Pekcan, Raina K Patel, Valeria Mejia, Maya Lazar, Sally Danto, William Magee, Jessica A Lee, Mark M Urata, Jeffrey A Hammoudeh","doi":"10.1055/a-2671-9586","DOIUrl":"https://doi.org/10.1055/a-2671-9586","url":null,"abstract":"<p><strong>Background: </strong>Facial nerve palsy in children leads to significant functional impairment and facial asymmetry. While free gracilis muscle transfer (FGMT) is a cornerstone technique for smile reanimation in both pediatric and adult patients, its evaluation has mainly focused on the single metric of commissure excursion. This study seeks to evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy using image analysis.</p><p><strong>Methods: </strong>A retrospective review was conducted in children who underwent FGMT for facial palsy at a major children's hospital between 2007 and 2020. Data collection included pre- and post-operative chart reviews and image analysis. Anthropometric measurements were obtained using a machine learning-based smile analysis software. Primary outcomes included commissure excursion, commissure angle, dental show, and smile symmetry. Statistical analysis was performed using Wilcoxon sign-rank test.</p><p><strong>Results: </strong>A total of 31 patients with an average age of 10 years underwent FGMT for smile reanimation during the study period. The most common diagnosis was Moebius Syndrome (48%). Donor nerves for gracilis neurotization included 18 ipsilateral trigeminal nerves (58.1%) and 12 contralateral facial nerves via cross-face sural nerve grafts (38.7%). Overall, 84% of patients demonstrated active gracilis contraction within a mean of 2.5 years postoperative follow up. Commissure excursion increased by 9.7 mm at one year (p<0.05) and symmetry significantly improved for commissure height, commissure excursion, upper lip height and smile angle. There were no significant improvements in dental show, commissure angle, and symmetry of dental show and lower lip height. Furthermore, only 16% of patients demonstrated clinically symmetric smiles within the follow up period.</p><p><strong>Conclusion: </strong>While FGMT effectively restores commissure excursion in pediatric patients with facial palsy, achieving multidimensional smile reanimation remains a challenge. New techniques in multi-vector free tissue transfer may help optimize FGMT outcomes in pediatric patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Color Doppler Allen's Test before Harvesting a Radial Forearm Free Flap-To Do or Not to Do?","authors":"Dominik A Walczak, Ewa Migacz, Jakub Opyrchał, Daniel Bula","doi":"10.1055/a-2632-2720","DOIUrl":"10.1055/a-2632-2720","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cephalic vein transposition for head and neck reconstruction: An Anatomical Study.","authors":"Daniel Jay Paul Bahat, R'ay Fodor, Dylan Suriadinata, Kelly Hoerger, Robert Siska, Dwayne Jackson, Andrea Di Sebastiano, William Albabish, Risal Djohan","doi":"10.1055/a-2659-6863","DOIUrl":"https://doi.org/10.1055/a-2659-6863","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the anatomical feasibility and utility of cephalic vein transposition for venous outflow in head and neck reconstruction, particularly in vessel-depleted necks.</p><p><strong>Methods: </strong>Bilateral dissections were performed on 11 fresh cadavers to assess the cephalic vein's length, course, and suitability for transposition. The vein was freed, transected at the antecubital fossa, and transposed via a subcutaneous tunnel to the neck. Measurements were taken of the in-situ vein length and the remaining length after transposition.</p><p><strong>Results: </strong>Nineteen cephalic veins were suitable for transposition. The average in situ length was 31.40 ± 2.30 cm, and 29.59 ± 2.20 cm after division. Post-transposition, the residual length beyond the superior helix was 8.47 ± 2.53 cm. The average vein diameter was 3.12 ± 0.75 cm.</p><p><strong>Conclusion: </strong>Cephalic vein transposition is a viable option for venous anastomosis in vessel-depleted necks, providing a long, stable venous conduit with favorable anatomical characteristics for complex head and neck reconstructions.  .</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Donor Site Morbidity in DIEP Flap Reconstruction: Advancements in Minimizing Anterior Fascial Defects- A Systematic Review.","authors":"Diwakar Phuyal, Isaac Mordukhovich, James Gaston, Arturo J Rios-Diaz, Osama Darras, Rommy Obeid, Graham Schwarz, Risal Djohan, Raffi Gurunian, Sarah N Bishop","doi":"10.1055/a-2659-6939","DOIUrl":"https://doi.org/10.1055/a-2659-6939","url":null,"abstract":"<p><strong>Introduction: </strong>Numerous minimally invasive deep inferior epigastric perforator flap (MI-DIEP) techniques have been described in literature to reduce donor site morbidities. This systematic review aimed to summarize existing MI-DIEP techniques and postoperative outcomes relative to conventional harvest (cDIEP). Methods A systematic review was conducted following PRISMA guidelines to include articles with novel DIEP harvesting techniques. Studies without perioperative information were excluded. Chi square and Fischer exact test was used to compare complication rates (partial flap loss, total flap loss, hernia or bulge, and fat necrosis) in MI-DIEP with cDIEP. Joanna Briggs Institute (JBI) critical appraisal tool was used for bias assessment. Results A total of 978 patients underwent 1,272 MI-DIEP flap harvests across 17 studies. Techniques included robotic DIEP (rDIEP) (n=97), abdominal perforator exchange (APEX) (n=158), laparoscopic (n=39), endoscopic (n=94), two-staged delayed DIEP (n=135), short fasciotomy (n=124), short pedicle (n=26), vascular pedicle measuring (n=209), and microfascial incision (n=81). No significant differences were found between endoscopic, laparoscopic, and robotic approaches compared to cDIEP. However, the short pedicle technique had higher partial flap loss (8.82% vs 1.98%, p=0.04), while APEX and vascular pedicle measuring techniques had lower fat necrosis rates (1.99% and 0.48% vs 5.81%, p=0.04 and 0.004). Short fasciotomy was associated with higher fat necrosis (12.9% vs 5.8%, p=0.004) and longer hospital stay (p=0.005). Robotic, laparoscopic, endoscopic, two-staged, and APEX techniques were associated with shorter hospital stays, and robotic DIEP was linked to reduced postoperative day 1 pain (p<0.001). Conclusion/ Discussion: Minimally invasive DIEP techniques demonstrate comparable complication rates to conventional DIEP, with certain methods offering benefits such as reduced fat necrosis, shorter hospital stays, and less postoperative pain.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes Following Immediate Dental Implant Placement (IDIP) in Free Fibula Flaps for Oncologic Mandibular Reconstruction.","authors":"Robert Jr J Allen, Kevin Zhang, Zack Cohen, Annu Singh, Kenneth Kronstadt, Ian Ganly, Farooq Shahzad, Evan Rosen, Jonas A Nelson, Evan Matros","doi":"10.1055/a-2659-6993","DOIUrl":"https://doi.org/10.1055/a-2659-6993","url":null,"abstract":"<p><p>Background 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. Methods A retrospective, non-inferiority 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 (CAD/CAM) technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or non-implant-supported resection prosthesis. Results 148 patients were included in the study. IDIP patients (n=86) were significantly older (p=0.017) and had a higher BMI (p<0.0001) than non-IDIP patients (n=62). Median follow-up time was 2.4 years and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups (p>0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting (p<0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation [IDIP: 69.8%, non-IDIP: 25.8%; p<0.0001] and at an earlier timepoint [median (interquartile range): 120 (45, 297) days vs. 355 (243, 595) days; p=0.0002] after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients (p=0.818). Conclusion 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.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications and Hardware Failure Following Synthetic Cranioplasty Implants and Free Flap Coverage.","authors":"Nicholas Oleck, Kevin K Zhang, Ronnie L Shammas, Jonas A Nelson, Robert Jr J Allen, Evan Matros, Yisong Geng, Amanda R Sergesketter, Hani I Naga, Detlev Erdmann, Brett T Phillips","doi":"10.1055/a-2659-7072","DOIUrl":"https://doi.org/10.1055/a-2659-7072","url":null,"abstract":"<p><strong>Background: </strong>Composite scalp and calvarial reconstruction is complex, often requiring synthetic cranioplasty implants for bony reconstruction and robust soft tissue coverage. When the native scalp is compromised, free tissue transfer becomes necessary. This study presents a multi-institutional review of composite calvarial reconstruction with free flap coverage of synthetic cranioplasty implants, focusing on flap selection, long- term outcomes, and rates of hardware extrusion and explantation.</p><p><strong>Methods: </strong>A retrospective review was conducted at Duke University Medical Center and Memorial Sloan Kettering Cancer Center for patients who underwent cranioplasty and free tissue transfer between 2001 and 2022. Data collected included patient demographics, comorbidities, reconstructive indications, cranioplasty materials, flap types, and 90-day surgical complications. Long-term implant exposure and explantation data were also analyzed.</p><p><strong>Results: </strong>Forty-two patients (average age 59) were identified, with 54.7% having prior scalp radiation. Cranioplasty was primarily performed following tumor extirpation (88%) using titanium mesh (64.3%). The most common free flaps were latissimus (45.2%), anterolateral thigh (16.7%), and radial forearm (16.7%). Surgical complications occurred in 60% of cases, with wound complications (33.3%) and surgical site infections (28.6%) being most frequent. Implant extrusion occurred in 31% of patients at an average of 7.9 months, and explantation was required in 42.9% at an average of 12.8 months. The average follow-up duration was 27.1 months.</p><p><strong>Conclusion: </strong>Composite cranial reconstruction with free flap coverage is associated with high surgical complication rates and significant hardware extrusion and explantation. Flap composition and reconstruction timing may impact hardware retention and should be carefully considered in preoperative planning.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}