Journal of reconstructive microsurgery最新文献

{"title":"Embracing Robotics in Microsurgery: Robotic-Assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction.","authors":"Joshua Choe, Christopher Aiello, Jina Yom, Raquel A Minasian, Gainosuke Sugiyama, Mark L Smith, Jesse C Selber, Neil Tanna","doi":"10.1055/a-2404-2445","DOIUrl":"10.1055/a-2404-2445","url":null,"abstract":"<p><p>The integration of robotic-assisted surgery (RAS) has transformed various surgical disciplines, including more recently plastic surgery. While RAS has gained acceptance in multiple specialties, its integration in plastic surgery has been gradual, challenging traditional open methods. Robotic-assisted deep inferior epigastric perforator (DIEP) flap breast reconstruction is a technique aimed at overcoming drawbacks associated with the traditional open DIEP flap approach. These limitations include a relatively large fascial incision length, potentially increasing rates of postoperative pain, abdominal bulge, hernia rates, and core weakening. The robotic-assisted DIEP flap technique emerges as an innovative and advantageous approach in fascial-sparing abdominal autologous breast reconstruction. While acknowledging certain challenges such as increased operative time, ongoing refinements are expected to further improve the overall surgical experience, optimize results, and solidify the role of robotics in advancing reconstructive microsurgical procedures in plastic surgery. Herein, the authors provide an overview of robotic surgery in the context of plastic surgery and its role in the DIEP flap harvest for breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"450-458"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080679","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":"The Influence of the Level of Injury on the Selection of Recipient Vessels in Severe Open Fractures of the Tibia and Foot.","authors":"Kota Hayashi, Kentaro Futamura, Yoshihiko Tsuchida, Masahiro Nishida, Masayuki Hasegawa, Takafumi Suzuki, Kanako Tsuihiji, Takashi Ogawa, Ryo Sato","doi":"10.1055/a-2576-0389","DOIUrl":"https://doi.org/10.1055/a-2576-0389","url":null,"abstract":"<p><p>The selection of recipient vessels is critical for the success of free flap transfer in lower extremity reconstruction following trauma. We hypothesized that variations in soft tissue, vascular, and bone injuries across different injury levels influence recipient vessel selection. This study aimed to investigate the injury patterns and recipient vessel selection at different injury levels.A retrospective analysis was performed on patients with acute open tibial fractures (Gustilo IIIB/C) and mangled foot injuries treated at a single trauma center between 2013 and 2022. Injury levels were classified as proximal tibia (P/3), middle tibia (M/3), distal tibia (D/3), and foot injuries. We analyzed injury patterns by level and defined recipient vessel selection as the primary outcome.A total of 91 limbs from 88 patients were analyzed (P/3: 10, M/3: 39, D/3: 18, foot: 24). M/3 injuries were the most severe, with extensive compartment involvement (<i>p</i> < 0.01) and bone loss in 49% of cases, whereas P/3 injuries were the least severe. The distal posterior tibial artery was predominantly used in P/3 injuries, the proximal posterior tibial artery was most frequently used in M/3 and D/3 injuries, and the anterior tibial artery was used primarily for foot injuries (<i>p</i> < 0.01). Vein grafts were required exclusively in M/3 cases, with intraoperative vascular disturbances occurring in 33%. Postoperative vascular complications ranged from 6 to 20%, with an overall flap survival and limb salvage rate of 95%.Among the findings of this study, key findings were that M/3 injuries were the most severe, and P/3 injuries had favorable outcomes with distal posterior tibial artery anastomosis. Injury patterns and recipient vessel selection show distinct, level-specific differences in severe open fractures of the tibia and foot.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187249","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":"Efficacy of Microsurgical Venous Couplers in Lymphovenous Anastomosis of the Thoracic Duct: An Examination of Outcomes and Patency at Follow-Up.","authors":"Dustin T Crystal, Zachary Gala, Selma Brkic, Robyn Broach, Said C Azoury, Maxim Itkin, Stephen J Kovach","doi":"10.1055/a-2596-5270","DOIUrl":"10.1055/a-2596-5270","url":null,"abstract":"<p><p>Central lymphatic disruption can result in devastating lymphedema, chylothorax, chylous ascites, metabolic deficiencies, and death. Literature from our institution has previously demonstrated the technical feasibility of lymphovenous anastomosis (LVA) for thoracic duct (TD) bypass. Here, we present our complete patient series with expanded follow-up utilizing a microsurgical venous coupler to facilitate LVA.A single-institution, retrospective review was conducted for adult patients who underwent LVA for TD bypass between 2019 and 2024. Demographic, etiological, and perioperative information was collected. Symptomatic resolution with or without radiographically confirmed patency was considered a successful bypass at follow-up.A total of 23 patients underwent LVA of the TD. The mean age was 49.7 years. Median postoperative follow-up was 395 days (interquartile range [IQR]: 150.5-554.5). Anastomotic targets included the EJV (<i>n</i> = 15), IJV (<i>n</i> = 4), AJV (<i>n</i> = 2), or another regional vein (<i>n</i> = 3). The technical success of the venous coupler was 100%. Three patients experienced a surgical site complication (13.0%). At follow-up, 13 patients (56.5%) had a patent TD anastomosis with symptomatic resolution. One patient (4.3%) had a patent anastomosis confirmed on imaging but experienced mild symptomatic recrudescence. The remaining patients (39.1%) had nonpatent anastomoses. The median venous coupler size was 3.0 mm for both the patent cohort and the nonpatent cohort.LVA for TD bypass with an anastomotic coupler is well tolerated and provided durable relief of symptoms in over half of our cohort. This data supports venous coupler utilization in LVA for thoracic TD occlusion. Patient accrual is ongoing to further evaluate and optimize outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988559","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":"Ultrasonographic Quantification of Blood Flow in Microsurgical Breast Reconstruction: Correlation with Indocyanine Green Angiography.","authors":"Hyung Bae Kim, So Min Oh, Hyun Ho Han, Jin Sup Eom","doi":"10.1055/a-2616-4817","DOIUrl":"https://doi.org/10.1055/a-2616-4817","url":null,"abstract":"<p><strong>Background: </strong>Although autologous breast reconstruction using the deep inferior epigastric artery perforator (DIEP) flap is a standard procedure, flap perfusion-associated complications remain a concern. This study aimed to investigate the correlation between blood flow information obtained through color Doppler ultrasonography (CDU) and flap perfusion assessed by indocyanine green (ICG) angiography.</p><p><strong>Methods: </strong>This prospective study included 30 female patients who underwent DIEP flap breast reconstruction between August 2023 and June 2024. Preoperative flow parameters, including arterial peak velocity, arterial volume flow, and venous peak velocity, were measured using CDU. Flap perfusion was evaluated using ICG angiography.</p><p><strong>Results: </strong>The study demonstrated a positive correlation between venous flow and overall flap blood flow. Arterial peak velocity (r = 0.368, p = 0.046), arterial volume flow (r = 0.455, p = 0.011), and venous peak velocity (r = 0.399, p = 0.029) all showed significant associations with ICG-stained area percentages. These findings suggest that venous flow data can provide valuable information for predicting flap viability.</p><p><strong>Conclusion: </strong>This study demonstrates a significant correlation between flow information obtained through CDU and flap perfusion assessed via ICG angiography in patients undergoing DIEP flap breast reconstruction. Both arterial and venous flow data were shown to be crucial for predicting flap viability, with venous flow exhibiting a notable positive correlation with flap blood flow.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127897","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 Postoperative Anticoagulation Regimen to Improve Lower Extremity Free Flap Outcomes.","authors":"Kylie R Swiekatowski, Delani E Woods, Ellen B Wang, Edwin Acevedo, David C Hopkins, Mohin A Bhadkamkar, Yuewei Wu-Fienberg","doi":"10.1055/a-2555-2252","DOIUrl":"10.1055/a-2555-2252","url":null,"abstract":"<p><p>Free flap reconstruction for lower extremity (LE) trauma has a higher failure rate than free flaps in other anatomic regions. Postoperative anticoagulation and antiplatelet therapy may influence LE free flap outcomes, but an optimal regimen has not been established. This study aims to evaluate complication rates associated with different anticoagulation and antiplatelet protocols in LE free flap reconstruction.Adult patients (≥18 years of age) with LE trauma requiring free flap reconstruction at our level 1 trauma center from 2016 to 2021 were included for retrospective chart review. Complications requiring reoperation were grouped into a composite variable named major complications (i.e., hematoma, flap thrombosis, flap necrosis >10%, infection requiring reoperation). Nonrandomized patients were categorized into three groups based on postoperative anticoagulation or antiplatelet regimen (aspirin only, heparin only, and aspirin + heparin), with heparin being a subtherapeutic fixed-dose heparin infusion at 500 to 800 units/hour. Complication rates were compared across groups, and both univariate and multivariate analyses were conducted to identify associations with major complications. <i>p</i>-Values were set at <i>p</i> < 0.05.Of 191 patients, 37 (19.4%) received aspirin only, 76 (39.8%) received heparin only, and 78 (40.8%) received aspirin + heparin. Demographics were similar between the groups. On univariate analysis, the heparin group had a significantly lower rate of major complications (5.26%) compared with aspirin only (18.92%) and aspirin + heparin (20.51%; <i>p</i> = 0.016); however, on multivariate analysis, when accounting for additional perioperative factors, no association between anticoagulation group and major complications was found.Our study found that neither aspirin alone, heparin alone, or aspirin + heparin demonstrated a more favorable association with LE free flap outcomes. To reduce bias from the study's retrospective design and the surgeon's discretion in choosing anticoagulation protocols, future research should randomize patients to standardized postoperative regimens to assess differences in complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605269","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":"Validating a Scalable Approach to Microsurgery Education in Resource-Limited Countries.","authors":"Halley Darrach, Cameron Kneib, Jeffrey Friedrich, Suzanne Inchauste, Hellina Legesse Mamo, James Chang","doi":"10.1055/a-2616-4028","DOIUrl":"https://doi.org/10.1055/a-2616-4028","url":null,"abstract":"<p><strong>Introduction: </strong>Microsurgery remains largely nonexistent in sub-Saharan Africa due to lack of access to specialized training and microsurgical instruments. However, smartphones with magnification capabilities are globally widespread, even in low-resource nations. The use of smartphones as simulators for microsurgery training has been previously reported, but little is known with respect to skills acquisition over time.</p><p><strong>Methods: </strong>A cohort of Ethiopian plastic surgery attendings and residents participated in a microsurgery training workshop. Before and after the workshop, as well as six months afterwards, participants were recorded performing a synthetic vessel repair using a smartphone for magnification. Video recordings were and graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skill.</p><p><strong>Results: </strong>13 participants were surveyed and recorded. Overall microsurgical performance SMaRT scores significantly improved (2.05 vs 2.72 on a 5-point scale; p = 0.001) upon completion of the workshop, and continued to increase (3.05), but not significantly so (p = 0.201) six months afterwards. However, improvements were maintained at six months. Significant improvement was noted in all SMaRT scale domains post workshop and further significant improvement in instrument handling was noted at six months.</p><p><strong>Conclusion: </strong>Our findings suggest that smartphones can serve as valuable tools for microsurgery training in low-resource settings. Further research is warranted to evaluate the long-term impact of smartphone-based simulation training on skill acquisition and clinical outcomes in low-resource settings, but even in the short-term participants were able to demonstrate significant improvement, as well as maintenance to improvement of skill at six months follow-up.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119916","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":"Chronological Changes in Breast and Nipple Position After Autologous Reconstruction in an Asian Population.","authors":"Suphalerk Lohasammakul, Johyun Yoon, Chaiyawat Suppasilp, Jin Sup Eom, Hyun Ho Han","doi":"10.1055/a-2616-4258","DOIUrl":"https://doi.org/10.1055/a-2616-4258","url":null,"abstract":"<p><strong>Background: </strong>The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared to the contralateral breast in the Asian population.</p><p><strong>Methods: </strong>Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral NSM at our institution between June 2017 and December 2019. Univariate and multivariate analyses were carried out to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year post-surgery.</p><p><strong>Results: </strong>Among the 170 patients (mean age, 48.047.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap, and eight (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0-2) and exposure to radiotherapy were associated with an increased degree of retraction.</p><p><strong>Conclusions: </strong>Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119953","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, Victoria McKinnon, Christopher Coroneos, Anita Acai","doi":"10.1055/a-2616-4370","DOIUrl":"https://doi.org/10.1055/a-2616-4370","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>From 2,440 articles, 99 were included. 65% of articles were published since 2015. Plastic surgery, neurosurgery, and ophthalmology were the most common surgical specialties. 90% 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 reviewed (20%) was also used. No structured feedback methods were used.</p><p><strong>Conclusion: </strong>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":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","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":"Physiological restoration of lymphatic flow in Posttraumatic extremity lymphedema using lymphatic flaps.","authors":"Usama Ahmed Abdelfattah, Tarek Elbanoby, Saber Nafea, Gamal Elsawy, Mona Omarah, Sherif Mohamed Elfateh","doi":"10.1055/a-2616-4311","DOIUrl":"https://doi.org/10.1055/a-2616-4311","url":null,"abstract":"<p><strong>Background: </strong>Posttraumatic lymphedema is poorly discussed in literature. Flap reconstruction considering its lymphatic- axiality has been reported in preventing lymphedema development following trauma or sarcoma excision. In this study we report the results of utilizing lymphatic flaps in treatment of established posttraumatic lymphedema.</p><p><strong>Methods: </strong>This was a retrospective study of 74 patients (60 lower limbs and 14 upper limbs) with posttraumatic lymphedema that underwent simultaneous soft tissue and lymphatic reconstruction using lymphatic skin flaps. The primary endpoint was providing stable soft tissue coverage and change in limb volume. Secondary endpoints were changes in lymph flow using both lymphoscintigraphy and ICG lymphography.</p><p><strong>Results: </strong>SCIP flap was used in 46 cases (62.2%), anterolateral thigh (ALT) flap in 14 cases (18.9), superficial inferior epigastric artery (SIEA) flap in 9 cases (12.2%), and deep inferior epigastric artery perforator (DIEAP) flap in 5 cases (6.8%). End (vein)- to- side (lymphatic) LVA was successfully performed in 21 cases (28.4%). During follow-up, significant change in volume was noted in all patients. Using ICG lymphography, lymphatic flow through the flaps was revealed in 59.5% of patients. No lymphatic flow within the flap was observed in 30 cases (40.5%). While qualitative lymphoscintigraphy showed significant changes in the parameters including improved symmetry in the uptake of Technitium99 nanocolloids (89.2%), visualizing the proximal draining lymph nodes and major lymphatic ducts, and improvement in the dermal backflow.</p><p><strong>Conclusion: </strong>Lymphatic skin flaps allow simultaneous soft tissue and lymphatic reconstruction. Scar excision at the affected limb, flap selection and insetting based on ICG navigation at both the recipients and donor sites is important for successful flap integration and spontaneous lymphatic communications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110981","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":"Career Paths After Microsurgery Fellowship: A 10-Year Analysis.","authors":"Elaine Lin, Tara Pillai, Victoria N Yi, Ann Marie Flusche, Sakshi Chopra, Melissa Tran, Ash Patel, Kristen Rezak","doi":"10.1055/a-2616-4716","DOIUrl":"https://doi.org/10.1055/a-2616-4716","url":null,"abstract":"<p><p>Background Over the past 10 years, microsurgery fellowship programs and positions have increased by 50%, underscoring the need to understand graduate career paths and provide trainees context about future practice. This study analyzed who pursues microsurgery fellowships and factors associated with academic careers. Methods This cross-sectional analysis examined graduates from the past 10 years from fellowships recognized by the American Society of Reconstructive Microsurgery or graduates of international fellowships who completed residency in the United States. Demographic variables included gender, race, residency location, and Integrated vs. Independent plastic surgery residency. Bibliometric indices at the time of graduation and October 2024 were measured. Initial and current practice setting were categorized as academic (full-time faculty), \"private affiliated\" (involved in teaching but not full-time faculty), or private practice. Results Overall, 423 graduates were identified. The majority were male (62.9%) and White (63.4%). Most completed Integrated residency (72.6%). Five fellowships accounted for 48.0% of graduates: MD Anderson (80), Memorial Sloan Kettering (46), University of Pennsylvania (38), Stanford University (23), and The Buncke Clinic (16). After fellowship, 68.0% of graduates entered academia, and 63.2% of graduates are in academia currently out of 419 analyzed. Fellowship location was associated with initial academic practice (p=0.01), many graduates from International (80.0%), and Southern (78.4%) fellowships entering academia. Graduates in initial academic practice had higher median initial g-index (13 vs. 10, p=0.03) and median initial publications (15 vs. 11, p=0.02). Multiple logistic regression found initial publications and fellowship location to be best predictors of initial academic practice. Conclusion While most graduates pursue academia, a significant number enter private practice, indicating it is a viable option. Southern or International fellowships send more graduates into academia, but this is likely influenced by popular fellowships. Nuanced factors like personal preference, financial considerations, and networking likely play a significant role in career choices.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110631","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}