Journal of reconstructive microsurgery最新文献

{"title":"Cephalic Vein Transposition for Head and Neck Reconstruction: An Anatomical Study.","authors":"Daniel 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":"10.1055/a-2659-6863","url":null,"abstract":"<p><p>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.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.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. Posttransposition, the residual length beyond the superior helix was 8.47 ± 2.53 cm. The average vein diameter was 3.12 ± 0.75 cm.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":"334-338"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","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":"Long-Term Outcomes Following Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction.","authors":"Robert J Allen, Kevin K 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":"10.1055/a-2659-6993","url":null,"abstract":"<p><p>Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosthodontic outcomes of IDIP in oncologic mandible reconstruction.A retrospective, noninferiority cohort study was performed comparing IDIP and non-IDIP in patients undergoing FFF reconstruction of oncologic mandibulectomy defects using computer-aided design and computer-aided manufacturing technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or nonimplant-supported resection prosthesis.One hundred forty-eight patients were included in the study. IDIP patients (<i>n</i> = 86) were significantly older (<i>p</i> = 0.017) and had a higher BMI (<i>p</i> < 0.0001) than non-IDIP patients (<i>n</i> = 62). Median follow-up time was 2.4 and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups (<i>p</i> > 0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting (<i>p</i> < 0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation (IDIP: 69.8%, non-IDIP: 25.8%; <i>p</i> < 0.0001) and at an earlier time point (median [interquartile range]: 120 [45, 297] days vs. 355 [243, 595] days; <i>p</i> = 0.0002) after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients (<i>p</i> = 0.818).IDIP safely achieves dental restoration in less time and at a higher rate than non-IDIP in oncologic patients. Measurement of patient-reported outcomes is needed to bolster support for IDIP as the standard of care in oncologic patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"324-333"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","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":"Tranexamic Acid in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis.","authors":"Evan Rothchild, Isabelle T Smith, Joseph A Ricci","doi":"10.1055/a-2632-2621","DOIUrl":"10.1055/a-2632-2621","url":null,"abstract":"<p><p>Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase the risk of thromboembolic events and compromise flap viability. Therefore, the aim of this study was to determine the impact of TXA in microsurgical reconstructive procedures.A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases was conducted from their inception to September 21, 2024. Inclusion criteria were retrospective or prospective cohort studies and randomized controlled trials that administered TXA in the context of microsurgical reconstruction. Data on postoperative outcomes were extracted and pooled for meta-analysis.Five retrospective cohort studies were included, with a total of 718 patients (TXA group: 343 patients; control group: 375 patients). All studies were low-level evidence and retrospective in design, with only one including a matched control group. There was considerable variation across studies in both the microsurgical procedures performed and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate an increased risk of thromboembolic events, showed a significantly decreased mean blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared to the control group.Our findings provide low-level evidence that TXA use in microsurgical reconstruction does not increase the risk of thromboembolic events and may help reduce perioperative blood loss, hematoma formation, and transfusion rates. These results offer preliminary support for the safety of TXA in microsurgical reconstruction procedures and highlight its potential benefits for patients at risk of bleeding complications. However, given the limited number, heterogeneity, and low quality of available studies, these findings should be interpreted with caution. Higher-quality research is needed to support the routine use of TXA in microsurgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"314-323"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275187","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":"Feedback and Assessment Methods in Microsurgery Education: A Scoping Review.","authors":"Muhammad Yaseen Abbas, Justin Haas, Elena Huang, Jessica Gormley, Victoria McKinnon, Christopher Coroneos, Anita Acai","doi":"10.1055/a-2616-4370","DOIUrl":"10.1055/a-2616-4370","url":null,"abstract":"<p><p>With distinctive instrumentation, challenges, and training, the unique nature of microsurgery necessitates the provision of feedback and assessment for trainees. The uncertain applicability of feedback or assessment methods may lead to poor trainee satisfaction and operative outcomes. We conducted a scoping review of the feedback and assessment methods in microsurgery.The Medline, EMBASE, ERIC, and Web of Science databases were searched for studies discussing feedback and/or assessment of microsurgery trainees. Study characteristics, feedback methods, assessment methods, and all other relevant data were extracted. The Medical Education Research Study Quality Instrument (MERSQI) was used to critically appraise the quantitative studies.From 2,440 articles, 99 were included. Sixty-five percent of articles were published since 2015. Plastic surgery, neurosurgery, and ophthalmology were the most common surgical specialties. Ninety percent of articles discussed exclusively assessment methods, with only 10% discussing both feedback and assessment. Microvascular anastomosis was the most common task (55%), with ex vivo synthetic, (20%) chicken (16%), and rat models (11%) being widely used. Global rating scales (GRSs) providing holistic evaluation based on multiple competency domains were the most common assessment methods (73%), followed by checklists (23%), and device-derived metrics (21%). Parameters included suture placement (53.5%), dexterity (50.5%), and tissue handling (48.5%). Real-time verbal, one-to-one feedback was the most common method among relevant studies (80%), while delayed written video review (20%) was also used. No structured feedback methods were used.This review identified a variety of feedback and assessment methods specific to microsurgery. GRSs continue to be popular; however, with increasing accessibility, device-derived metrics continue to increase in prevalence. A juxtaposition between named, structured, and validated assessment methods and informal feedback methods was evident. Particularly, the lack of standardized feedback methods may act as a barrier to the implementation of feedback across microsurgical education.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"263-277"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119957","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":"Do We Need a Negative Culture? Examining the Role of Final Debridement Cultures in Microsurgical Limb Salvage: Recommendations from Our 13-Year Experience.","authors":"Rachel N Rohrich, Joshua P Carreras, Sahil Sharma, Ryan P Lin, Sami Ferdousian, Meghan E Currin, Richard C Youn, Christopher E Attinger, Karen K Evans","doi":"10.1055/a-2659-7184","DOIUrl":"10.1055/a-2659-7184","url":null,"abstract":"<p><p>Lower extremity free tissue transfer (LE FTT) expands limb salvage options for patients with chronic wounds. Infected wounds require serial debridement to optimize the wound bed before reconstruction, but the role of qualitative microbiological cultures in guiding surgical wound closure timing remains unclear. This study evaluates the impact of final preoperative culture results on postoperative outcomes, including flap success, infection rates, and limb salvage.A retrospective review of 344 patients undergoing LE FTT at a single institution was conducted. All patients underwent serial debridement, with final cultures obtained from the final debridement prior to flap reconstruction. Patients were stratified into positive and negative final culture groups. Subgroup analyses assessed the impact of polymicrobial colonization and comorbidity burden (Charlson Comorbidity Index [CCI] >6) on outcomes. Primary outcome was flap infection, defined as any documented clinical concern for infection, including cellulitis, purulent drainage, abscess formation, or initiation of targeted antibiotic therapy.Polymicrobial final cultures were associated with increased infection (<i>p</i> = 0.003) and flap complications (<i>p</i> = 0.041). Among patients with CCI >6, positive final culture was associated with significantly higher infection rates (<i>p</i> = 0.032), but not among those with CCI ≤6. In the total cohort, comparing positive final culture to negative final culture, flap outcomes were similar between groups.Final culture positivity alone does not predict poor outcomes, but polymicrobial cultures and host factors may increase flap infection risk. A risk-stratified approach should guide surgical decision-making, with additional debridement and/or wound bed optimization considered for polymicrobial wounds and polymorbid patients (CCI >6).</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"339-350"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835470","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":"Quantification of Retained Donor Nuclei in ECM-Based Nerve Wraps: A Histological Assessment of Decellularization and Biocompatibility.","authors":"Andrew Rader, Logan Orr, Zoe Becher","doi":"10.1055/a-2856-1085","DOIUrl":"10.1055/a-2856-1085","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve injuries present a significant clinical challenge, often resulting in chronic pain, sensory loss, and motor dysfunction. Biologically derived nerve wraps are frequently used in surgical nerve repair to reduce adhesion, promote regeneration, and minimize fibrosis. These extracellular matrix (ECM)-based biomaterials vary widely in composition and processing, including the extent of donor decellularization. Retained donor nuclei and cellular remnants have been implicated in triggering adverse immune responses, including chronic inflammation and fibrotic encapsulation. This study investigates the extent of retained nuclear material in commercially available nerve wraps to establish histological metrics for decellularization efficiency and potential biocompatibility.</p><p><strong>Methods: </strong>Samples of multiple commercially available nerve wraps were collected and prepared according to manufacturer specifications. Histological assessment was performed using hematoxylin and eosin (H&E) staining. Slides were analyzed at 20× magnification using a standardized fluorescence imaging system. Two primary endpoints were quantified: (1) the number of visible nuclei per three representative microscopic fields and (2) the percentage of cell-free fields per sample.</p><p><strong>Results: </strong>Substantial variability was observed among products. One reconstituted xenograft and a porcine placental product demonstrated complete decellularization with >90% cell free fields and <10 nuclei per field. In contrast, both a native porcine small intestinal submucosa and a human amnion/chorion membrane exhibited high nuclear retention with >50 nuclei per field and 0% cell free fields. These findings suggest inconsistent decellularization practices across manufacturers.</p><p><strong>Conclusion: </strong>This study identifies significant differences in residual donor nuclear content among commercially available ECM nerve wraps. Histological quantification using H&E staining may serve as a reproducible method for assessing decellularization quality. These metrics may help predict immunologic compatibility and guide future biomaterial selection in peripheral nerve repair.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774833","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":"Microvascular Anastomosis Devices: A Scoping Review.","authors":"Myiah P Quach, Emily E Zona, Doruk Orgun, Piayeng Thao, Sakar Gupta, Natalie J Furtado, Jasmine N Craig, Leslie A Christensen, Weifeng Zeng, Aaron M Dingle, Samuel O Poore","doi":"10.1055/a-2824-6184","DOIUrl":"https://doi.org/10.1055/a-2824-6184","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Performing a hand-sewn microvascular anastomosis is a technically challenging and potentially time-consuming task, the results of which can dramatically impact prolonged ischemia time and clinical outcomes. This scoping review aims to examine and synthesize the landscape of microvascular anastomotic devices with the ultimate goal of evaluating their practical utility in comparison to traditional suture-only methods. Emphasis was placed on efficiency, outcomes, and potential limitations as a means of identifying areas for innovation.A scoping review of the PubMed, Scopus, Cochrane Library, and Web of Science databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Search terms related to microsurgery, anastomoses, and devices (e.g., couplers, staplers, clips, stents, glue, laser). Eligible studies included primary research, excluding meeting abstracts, reviews, commentaries, non-English studies, and research on robotic technology or venous couplers for end-to-end anastomoses. Data were extracted on study design, anastomosis completion outcomes (e.g., patency rates, time to completion), and complication rates (e.g., flap loss, anastomotic thrombosis).4875 unique studies underwent title/abstract screening and full-text review. Seventy-three English-language articles met the inclusion criteria. Device distribution included: couplers (36.1%), clip appliers (25.0%), lasers (8.0%), glue (6.2%), and intravascular stents (2.6%). Most included studies were prospective cohorts (43.1%), followed by preclinical studies (23.6%), retrospective review studies (22.2%), case series (5.6%), prospective comparative studies (2.8%), and randomized controlled trials (2.8%). The majority of studies evaluating devices replacing traditional hand-sewn suture, such as clips, staplers, and couplers, reported significantly reduced anastomotic times with comparable or improved vessel patency and/or flap survival, with one study reporting an average anastomotic time of less than 5 minutes. Adjunctive anastomosis devices such as laser, stents, and glue were also shown to be useful in a majority of studies. Intravascular stents were reported to have similar results to the conventional technique; however, some studies noted concerns about long-term vessel patency and compromised perfusion. Glue was shown to reduce the number of required sutures, though few studies noted reactive inflammation and significantly increased thrombosis.This scoping review demonstrates that these microvascular anastomotic devices, either as a replacement for conventional suture or as an adjunct, demonstrate favorable efficiency and safety profiles. Certain limitations were identified, such as vessel characteristics (diameter, thickness, friability), increased risk of thrombosis, or reactive inflammation. These devices also exist in a greater context of practicality, such as cost feasibility, ease of us","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147654135","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":"Bridging the Gap between Microsurgery and Supermicrosurgy: A Rat Study for 0.3 mm Vascular Anastomosis Comparing a Robotic-assisted vs. Conventional Approach.","authors":"Tae Hyung Kim, Seohee Chae, Donggeon Kim, Taehyun Kim, Jin Geun Kwon, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong","doi":"10.1055/a-2824-6437","DOIUrl":"https://doi.org/10.1055/a-2824-6437","url":null,"abstract":"<p><p>Supermicrosurgery involving vessels ≤0.3 mm remains among the most technically demanding procedures in reconstructive surgery. Robotic platforms have shown potential to enhance precision, but their feasibility at this extreme scale requires further validation.Apprentice surgeons (≤5 years' experience) performed rat femoral vessel (approximately 0.26-0.30 mm) anastomoses using both hand-sewn and robotic-assisted techniques across eight consecutive trials. Outcome measures included Structured Assessment of Robotic Microsurgical Skills (SARMS) scores, operative time, stitch count, and patency rate. Learning curves were assessed with cumulative summation (CUSUM) analysis, and anastomotic quality was evaluated using scanning electron microscopy (SEM).Robotic-assisted anastomosis reached proficiency earlier than hand-sewn repair (4th versus 6th trial). Although initial operative time was longer for robotic cases (1,772 ± 120 seconds versus 1,355 ± 187 seconds, <i>p</i> = 0.013), times equalized by the 5th trial and decreased by 42% by the 8th (1,026 ± 58 seconds versus 1,023 ± 73 seconds, <i>p</i> = 0.959). Stitch counts were higher in later robotic trials (4.2 ± 0.6 versus 3.5 ± 0.5, <i>p</i> = 0.015). Both groups achieved 100% patency by the 4th trial. CUSUM and SEM analyses confirmed a steeper learning curve and superior anastomotic precision with robotic assistance.Robotic-assisted supermicrosurgery enables earlier proficiency, enhanced precision, and reproducible anastomotic quality compared with hand-sewn techniques. Despite longer initial times, robotic performance rapidly improved, achieving equivalent efficiency with greater technical control. These findings confirm the technical feasibility of robotic supermicrosurgery at the 0.3 mm scale and support its potential role in microsurgical and lymphatic reconstruction training and clinical practice.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645669","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":"Assessing Health Literacy as a Predictor of Outcomes in Autologous Breast Reconstruction across Comorbidity Burdens.","authors":"Hibo M Wehelie, Robert G DeVito, Jessica Pawly, Margaret Mercante, Chris A Campbell, John T Stranix, Scott Hollenbeck","doi":"10.1055/a-2824-6312","DOIUrl":"10.1055/a-2824-6312","url":null,"abstract":"<p><p>Health literacy is closely linked to health outcomes, underscoring the importance of accessible patient education, particularly for patients undergoing complex surgical procedures. Despite this, there is limited research examining the influence of health literacy on outcomes in autologous breast reconstruction.We performed a retrospective review of autologous breast reconstruction patients between 2017 and 2022 at our institution. Baseline demographic and clinical data were collected. Health literacy scores were assessed using the validated Set of Brief Screening Questions (SBSQ), with increasing value equating lower health literacy. Patients were categorized by the Charlson Comorbidity Index (CCI) into groups representing mild, moderate, and severe comorbidity burden. Logistic and linear regression analyses were performed.The study included 264 patients, of whom 175 had mild, 49 moderate, and 40 severe comorbidity burden. Within the severe CCI group, worse HL was associated with increased odds of recipient site wound (OR 1.85, <i>p</i> = 0.0472), postoperative emergency department visits within 30 days (OR 2.56, <i>p</i> = 0.0489), and increased postoperative phone utilization (β = 0.52, <i>p</i> = 0.0461). No significant association was found between health literacy scores and the rate of surgical site infections, donor site wounds, or postoperative hernia.In this study, lower health literacy was significantly associated with increased health system utilization and wound complications in patients with severe comorbidity burden. This highlights the complex relationship between health literacy and outcomes, and the importance of patient education and shared decision-making in autologous breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433862","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 Breast Morphological Analysis After Ergonomic FALD Flap Reconstruction: A Case-Control Study.","authors":"Gennaro D'Orsi, Benedetto Longo, Alessio Farcomeni, Martina Giacalone, Elettra Gagliano, Lisa Vannucchi, Gianluca Vanni, Oreste C Buonomo, Valerio Cervelli","doi":"10.1055/a-2824-5638","DOIUrl":"10.1055/a-2824-5638","url":null,"abstract":"<p><p>The fat-augmented latissimus dorsi (FALD) flap is an autologous flap that combines the latissimus dorsi (LD) flap with intraoperative autologous fat transfer (AFT) to improve the volume of the reconstructed breast. In recent years, our team has described the ergonomic FALD flap, a modification of this technique that helps to achieve a complete reconstruction in a single surgical step. In this case-control study, we analyze the long-term morphological changes of the breast after ergonomic FALD flap reconstruction compared with the traditional FALD flap technique.Between December 2020 and April 2023, we prospectively enrolled patients undergoing BR using FALD flap into two groups: group A included ergonomic FALD flap, while group B included traditional FALD flap. The primary endpoint was to compare the two groups in terms of breast projection, breast width, and breast height, while the second endpoint concerned the analysis of the aesthetic outcomes.Forty-two FALD flaps (31 patients) were performed for group A and 37 FALD flaps (29 patients) for group B. The two groups were homogeneous regarding demographic variables. Using a propensity score weighting analysis, group A showed a significantly higher breast projection compared with group B (6.78 vs. 5.75; <i>p</i> < 0.0001), after 18 months of follow-up. Final aesthetic analyses showed to be superior in group A concerning breast shape (<i>p</i> = 0.003) and global score evaluation (<i>p</i> = 0.023).The ergonomic FALD flap showed better long-term aesthetic outcome compared with the traditional transverse FALD flap, with higher breast projection and fewer additional delayed AFT sessions. The study provides level II evidence.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369601","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}