Journal of reconstructive microsurgery最新文献

{"title":"Long-Term Implications of Combined Cross-Facial Nerve Graft and Nerve Transfer in Facial Paralysis.","authors":"Roshni Thachil, Yuan Edward Wen, Cristina V Sanchez, Adolfo Zamaro Madrazo, Joan S Reisch, Shai M Rozen","doi":"10.1055/a-2726-4717","DOIUrl":"10.1055/a-2726-4717","url":null,"abstract":"<p><strong>Background: </strong>Assessing the long-term implications of combining cross-facial nerve graft (CFNG) and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute facial paralysis.</p><p><strong>Methods: </strong>Patients with subacute facial palsy who underwent a masseteric-to-facial nerve transfer with CFNG from 2013 to 2020 were reviewed. A minimum of 2-year follow-up was required with 18 patients meeting inclusion criteria. Midface and periorbital measurements on standardized photos of patients in repose, closed, and open smile were analyzed preoperatively, 3 months, 1 year, and 3 years postoperatively as available. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Longitudinal comparisons at each timepoint were analyzed using Wilcoxon two-sample testing.</p><p><strong>Results: </strong>In repose, 1-year measurements including Commissure-Position, Smile-Angle, and Upper-Lip-Height-Deviation, were nonsignificant, whereas significance was noted at 3 years postoperatively (<i>p</i> = 0.042, 0.031, 0.042, respectively). Midface dynamic smile measurements on the palsy side and with symmetry showed significant differences from preoperative measurements at 1 and 3 years postoperatively. Periorbital measurements, including Marginal-Reflex-Distance-1, Marginal-Reflex-Distance-2, and Palpebral-Fissure-Height in repose, showed no significant changes at 1 year but were significant at 3 years (<i>p</i> = 0.004, 0.011, and 0.002, respectively), while during animation were significant at 1 and 3 years postoperatively.</p><p><strong>Conclusion: </strong>Combining CFNG with nerve transfer demonstrated progressive long-term improvement in resting tone and symmetry around the midface and periorbital region. Expected improvements were observed during animation over time.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"767-779"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370385","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":"Efferent Lymphaticovenular Anastomosis for Pelvic and Lower Extremity Lymphedema after Gynecologic Cancer Treatment: Indication and Timing Criteria Based on Nodal Function.","authors":"Yukio Seki, Hitoshi Nemoto, Teruhito Okino, Rintarou Asai, Mayo Tomochika, Akiyoshi Kajikawa","doi":"10.1055/a-2717-4946","DOIUrl":"10.1055/a-2717-4946","url":null,"abstract":"<p><strong>Background: </strong>Efferent lymphaticovenular anastomosis (ELVA) uses efferent lymphatic vessels from inguinal lymph nodes, which receive multiple afferent inputs from the lower extremity, to drain substantial lymphatic fluid. However, nodal degeneration during disease progression may impair function and affect ELVA efficacy. This study evaluated ELVA outcomes for lower extremity and pelvic lymphedema based on the presence or absence of nodal degeneration.</p><p><strong>Methods: </strong>This retrospective study included 30 patients who underwent LVA using the ELVA technique for pelvic and lower extremity lymphedema (LEL) following gynecological cancer treatment. Preoperative ultrasonography was performed to assess the vascularity of the inguinal lymph nodes. Patients with preserved nodal vascularity were classified into the primary ELVA group and underwent ELVA as the initial treatment. Those without detectable vascular flow were initially treated with leg LVA; ELVA was subsequently performed once the vascularity of the inguinal nodes improved. Treatment efficacy was evaluated based on changes in pelvic and leg volume indices.</p><p><strong>Results: </strong>Based on preoperative ultrasonography, seven patients were classified into the primary ELVA group and 23 into the secondary ELVA group. Preoperative ICG lymphography revealed significantly lower severity in the primary group (<i>p</i> < 0.01). The mean postoperative follow-up period was 31.5 months. Significant volume reductions were observed in leg and pelvic regions, with LEL index reduced from 275.1 ± 33.8 to 247.8 ± 28.2 (<i>p</i> < 0.01), and pelvic lymphedema index from 1,053.2 ± 81.2 to 972.7 ± 76.5 (<i>p</i> < 0.01). No significant differences in volume reduction were found between the two groups.</p><p><strong>Conclusion: </strong>ELVA may be effective for both pelvic and LEL, even in advanced cases when performed after nodal function recovery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"741-749"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258276","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":"Complication Burden and Demographic Trends in Autologous Breast Reconstruction Outcomes: Insights from the NIH All of Us Program.","authors":"Hiren N Parekh, Salih Colakoglu, Sashank K Reddy","doi":"10.1055/a-2737-6539","DOIUrl":"10.1055/a-2737-6539","url":null,"abstract":"<p><strong>Background: </strong>While the risks and benefits of autologous breast reconstruction have been widely examined, nationally representative, longitudinal data on complication burden, flap utilization trends, and patient-level risk factors remain limited. The NIH All of Us Research Program provides an opportunity to address these gaps using a diverse, population-scale cohort.</p><p><strong>Methods: </strong>We identified 260 patients who underwent autologous breast reconstruction using current procedural terminology codes within the All of Us Registered Tier Dataset (1995-2025). Complications were tracked at 30 days and 1 year postoperatively. Logistic, multivariate regressions, and Kaplan-Meier analyses evaluated predictors and timing of complications. Unsupervised machine learning via k-means clustering was utilized to uncover phenotypic subgroups by age and body mass index (BMI).</p><p><strong>Results: </strong>Deep inferior epigastric perforator flap utilization increased over time, particularly among younger patients. Complication rates did not significantly differ across flap types. BMI > 32.7 kg/m² was associated with increased 30-day complications, while age and race were not independent predictors. Chronic pain and persistent postoperative pain were the most common 1-year complications. Flap failure occurred in fewer than 2% of cases. Clustering revealed three patient subgroups with distinct complication profiles; older patients and those with higher BMI experienced greater morbidity but maintained high flap success rates.</p><p><strong>Conclusion: </strong>Autologous breast reconstruction is broadly effective across diverse patient populations. Complication risk is more strongly influenced by BMI than by age or race. Chronic pain emerged as a common long-term morbidity, underscoring the need for improved detection and management efforts. The diversity, depth, and follow-up available through All of Us enable nuanced insights into reconstructive outcomes not possible with traditional datasets.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"831-842"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459017","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":"Predictors of Aesthetic Outcomes in Bilateral DIEP Flap Breast Reconstruction: A Preliminary Analysis of Aesthetic Grading Tool Scores.","authors":"Jennifer Wang, Ronnie L Shammas, Elizabeth Smith-Montes, Lillian A Boe, Robert Jr J Allen, Carrie S Stern, Jonas A Nelson","doi":"10.1055/a-2968-4594","DOIUrl":"10.1055/a-2968-4594","url":null,"abstract":"<p><strong>Background: </strong>Objective assessment of aesthetic outcomes following post-mastectomy breast reconstruction remains challenging. The Aesthetic Grading Tool (AGT) was developed as a standardized tool to evaluate aesthetic outcomes independent of patient-reported satisfaction. This study aimed to identify factors associated with aesthetic outcomes using the AGT.</p><p><strong>Methods: </strong>A total of 35 de-identified photographs of patients who underwent bilateral autologous reconstruction were included in the AGT. Respondents including attending physicians, advanced practice providers, nurses, trainees, and patients rated aesthetic outcomes on a 5-point Likert scale. Associations between aesthetic scores and clinical variables, including receipt of radiation, 90-day readmission, and mastectomy type, were assessed. Differences in scores by respondent training level were also analyzed.</p><p><strong>Results: </strong>Ninety-one respondents completed the AGT. Of the 35 patients whose photographs are included in the AGT, 26% received radiation, and 91% underwent a skin-sparing mastectomy. Receipt of preoperative radiation was associated with lower scores (β = -0.68, 95% CI: - 1.3 to - 0.04, <i>p</i> = 0.039). Patients with 90-day readmission (1.98 vs. 3.15, <i>p</i> = 0.11) and those who underwent conventional as opposed to skin-sparing or nipple-sparing mastectomy (2.25 vs. 3.09 vs. 3.21, <i>p</i> = 0.5) trended toward lower AGT scores. Attending physicians consistently assigned higher scores across all variables, whereas patient respondents provided among the lowest scores.</p><p><strong>Conclusion: </strong>Receipt of radiation is associated with worse aesthetic outcomes following bilateral autologous reconstruction. Patients with 90-day readmission and conventional mastectomy trend toward worse aesthetic outcomes. Providers should counsel patients who are undergoing bilateral deep inferior epigastric perforator (DIEP) flap reconstruction on expected aesthetic outcomes based on their treatment course.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075084","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":"Establishing a Comprehensive Lymphedema Program in a Rural Region.","authors":"Devin John Clegg, Catherine Lock, Andrew J Ward, Payton Grande, Ashton J Brooks, Patricia N E Roberson, Jillian M Lloyd, Stefanos Boukovalas","doi":"10.1055/a-2972-6145","DOIUrl":"10.1055/a-2972-6145","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive lymphedema programs (CLPs) have recently been established at several large academic medical centers. However, little has been published regarding implementation of multidisciplinary lymphedema programs serving predominantly rural and medically underserved populations. We describe our early experience developing a CLP and highlight lessons that may facilitate implementation in similar settings.</p><p><strong>Methods: </strong>We performed a retrospective review of all patients referred to our CLP from November 2021 to April 2024. Patients without complete electronic medical record information were excluded. Financial analyses were limited to patients who underwent operative intervention and completed all insurance preauthorization and appeal processes.</p><p><strong>Results: </strong>A total of 321 patients were referred to our CLP, of whom 190 underwent complete evaluation. Seventy-three patients (38.4%) underwent operative intervention, including 43 (58.9%) who underwent immediate lymphatic reconstruction (ILR). Among patients undergoing delayed lymphatic reconstruction (DLR), 60% underwent physiologic and 26.7% underwent debulking procedures. The program demonstrated sustained growth throughout the study period with expansion into a multistate referral network. Insurance reimbursement remained limited, with insurers covering 29.7% of surgeon fees and total reimbursement averaging 35.7% of billed surgeon charges.</p><p><strong>Conclusion: </strong>Development of a CLP serving a predominantly rural and medically underserved population region is feasible through multidisciplinary collaboration, strategic resource allocation, and adaptation to local resources. The principles described may provide a practical framework for developing sustainable CLPs and expanding access to specialized lymphedema care in similar settings.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110768","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":"Facing Allograft Failure: A Systematic Review of Explantation and Retransplantation in Vascularized Composite Allotransplantation.","authors":"Alexis K Gursky, Y Edward Wen, Anandhini D Narayanan, Shaina M Staffenberg, Hailey P Wyatt, Sergio A Segrera, Bruce E Gelb, Daniel J Ceradini, Eduardo D Rodriguez","doi":"10.1055/a-2972-6379","DOIUrl":"10.1055/a-2972-6379","url":null,"abstract":"<p><strong>Background: </strong>Vascularized composite allotransplantation: (VCA) can restore form and function beyond conventional reconstruction, but acute (AR) and chronic rejection (CR) limit long-term allograft survival. When allograft failure becomes irreversible, explantation or retransplantation may be necessary. This review evaluates the indications, management, and operative considerations associated with explantation and retransplantation in VCA.</p><p><strong>Methods: </strong>A systematic review of PubMed, PubMed Central, MEDLINE, Scopus, and Web of Science was conducted to identify studies reporting patient-level data on VCA recipients who underwent allograft explantation or retransplantation. Extracted data included recipient demographics, immunologic characteristics, rejection history, and explantation or retransplantation outcomes.</p><p><strong>Results: </strong>Nineteen studies reporting 25 VCA recipients were included, comprising 22 explants and three retransplants (two face, one abdominal wall). The most common VCA types were uterus (32%), face (24%), and hand (16%). The leading indications for graft removal were CR (44%), perfusion-related complications (32.0%), medication noncompliance (24.0%), and patient request (12.0%). The median time to explant was 12.5 months and to retransplant was 7.3 years. Management of CR included pulse steroids, increased immunosuppression, plasmapheresis, and biologic agents. Retransplantation was more technically challenging than the primary transplant due to scarring, distorted anatomy, and vessels affected by CR, requiring more proximal vascular anastomoses and nerve coaptations.</p><p><strong>Conclusion: </strong>Explantation and retransplantation in VCA are feasible but last-line interventions. The leading cause of graft loss was CR, though perfusion-related and patient-related factors also contributed. Earlier recognition and management of AR, clearer definitions of CR, and overall improved strategies to prevent progression to irreversible graft failure are needed.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110990","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":"Innovations in Microsurgery: A Qualitative Appraisal of a Novel 3D-Printed Microscope.","authors":"Emily E Zona, Sahand C Eftekari, Elizabeth P Wu, Myiah P Quach, M Kristine Carbullido, Ellen C Via, Weifeng Zeng, Aaron M Dingle, Samuel O Poore","doi":"10.1055/a-2972-6217","DOIUrl":"10.1055/a-2972-6217","url":null,"abstract":"<p><strong>Background: </strong>Microsurgery is a critical component of plastic and reconstructive surgery. However, the high cost of training and equipment poses significant barriers, particularly in resource-limited settings. To address this challenge, the Microsurgery and Regenerative Medicine Laboratory within the Division of Plastic Surgery at the University of Wisconsin developed a low-cost, three-dimensionally (3D)-printed surgical microscope. This study qualitatively appraised the use of this novel microscope for microsurgery training by surveying surgeons about their experiences using this tool relative to traditional magnification methods.</p><p><strong>Methods: </strong>In this prospective, multi-institutional appraisal study, surgical residents, fellows, and attending surgeons with varying microsurgical experience performed a single end-to-end microsurgical anastomosis on chicken thigh femoral arteries using the 3D-printed microscope. Participants then completed a survey assessing ease of use, adequacy for microsurgical training, educational value, and perceived impact on teaching capacity in local and global settings.</p><p><strong>Results: </strong>Over 80% of participants (Survey 1: <i>n</i> = 36; Survey 2: <i>n</i> = 24) reported that performing an end-to-end anastomosis was easier or equivalent using the 3D-printed microscope compared with surgical loupes. All respondents expressed willingness to use the device for microsurgery teaching and practice. Additionally, 91.7% (33/36) believed access to the microscope would enhance microsurgical teaching at their home institutions, and 97.1% (34/35) felt it would improve teaching capacity globally. Qualitative feedback was overwhelmingly positive, with suggestions primarily related to ergonomics and lighting.</p><p><strong>Conclusion: </strong>This study supports that this low-cost, 3D-printed microscope is an effective microsurgical training tool. Ongoing design refinements informed by user feedback may further optimize its role in expanding access to microsurgery education worldwide.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111214","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":"BMI Changes Associated with DIEP Flap Breast Reconstruction.","authors":"Denisse Cristina Porras Fimbres, Chanel Rachel Varney, Meredith Cox, Tara Pillai, Brett T Phillips","doi":"10.1055/a-2972-6100","DOIUrl":"https://doi.org/10.1055/a-2972-6100","url":null,"abstract":"<p><strong>Background: </strong>As patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction frequently anticipate improved abdominal contour, they may also expect a degree of meaningful weight loss. This study aims to clarify whether patients undergoing mastectomy with DIEP flap breast reconstruction experience a significant and durable change in body mass index (BMI).</p><p><strong>Methods: </strong>A single-institution, retrospective cohort study was performed on patients who underwent DIEP flap breast reconstruction between 2020 and 2021. Patients were included if they had BMI data available from ≤ 3 months before mastectomy until ≥ 2 years after reconstruction. Every BMI data point within this timeframe was captured. Longitudinal BMI trends were analyzed using a mixed-effects model for the overall cohort and for subgroups of patients with immediate or delayed breast reconstruction.</p><p><strong>Results: </strong>A total of 143 patients (median age at reconstruction, 51.6 years) were included. Most patients (55.5%) underwent unilateral mastectomy and reconstruction. The mean mastectomy tissue masses were 640.8 g (SD 260.9) and 1,363.5 g (SD 713.9) for unilateral and bilateral cases, respectively. In the overall cohort and delayed reconstruction subgroup, there were no significant changes in BMI between pre-mastectomy and post-reconstruction periods. In contrast, patients with immediate reconstruction experienced a BMI decrease of 0.445 kg/m² between pre-procedure and post-procedure periods (<i>p</i> = 0.023), corresponding to a weight loss of 2.70 lbs.</p><p><strong>Conclusion: </strong>In a cohort of 143 patients, we did not find evidence of clinically significant BMI change associated with mastectomy and DIEP flap breast reconstruction. These results may improve the comprehensiveness and clarity of perioperative counseling, ensuring patients formulate evidence-based reconstructive preferences.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194622","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":"A Propensity Score-Matched Analysis of Geographic Distance in Immediate Free Flap and Implant-Based Breast Reconstruction.","authors":"Benjamin G Ke, Robert G DeVito, Aqiyl Mills, Naomi N Ghahrai, Virginia Bailey, Hibo M Wehelie, Eileen Wen, Scott T Hollenbeck, John T Stranix, Chris A Campbell","doi":"10.1055/a-2972-6028","DOIUrl":"10.1055/a-2972-6028","url":null,"abstract":"<p><strong>Background: </strong>Patient proximity to a surgical center is an important consideration in the coordination and delivery of high-quality postoperative care. Implant-based and autologous breast reconstruction require different perioperative resources and may be impacted in a varying manner by distance from the health care center. This study evaluated the impact of geographic distance on clinical and financial outcomes in free flap and implant-based breast reconstruction.</p><p><strong>Methods: </strong>A retrospective review was conducted of 176 free flap and 239 implant-based immediate breast reconstructions performed from 2017 to 2023 at a single academic center. Patients were classified by great-circle distance to the medical center as far (≥ 30 miles) or near (< 30 miles). Propensity score-matched cohorts were created for free flap (<i>n</i> = 70 pairs) and implant-based (<i>n</i> = 79 pairs) reconstruction, controlling for demographics, comorbidities, treatment variables, and laterality. Clinical outcomes, wound complications, revision procedures, opioid use, hospital resource utilization, and financial measures between near and far patients for each reconstruction type were compared using paired <i>t</i>-tests, McNemar's tests, and exact binomial testing for sparse outcomes.</p><p><strong>Results: </strong>In the flap cohort, near- and far-distance groups did not differ significantly in operative time, length of stay, intensive care use, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes. Total flap loss and thromboembolic events were rare and did not differ significantly between groups. In the implant-based cohort, there were no significant differences in operative time, length of stay, postoperative communication, emergency department visits, opioid requirements, complication rates, revision procedures, or financial outcomes between groups.</p><p><strong>Conclusion: </strong>Geographic distance was not associated with worse clinical or financial outcomes after immediate breast reconstruction. These findings suggest that high-volume academic centers can deliver consistent reconstructive outcomes across a range of patient proximities.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110752","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":"Impact of Intraoperative Vasopressors on Deep Inferior Epigastric Perforator Flap Reconstruction After Radiation Therapy.","authors":"Renee Gao, Michael K Turgeon, Yibin B Zhang, Goutam K Gadiraju, Yizhuo Shen, Madeline E Duncan, Allison Pellegrino, Adara Bochanis, Justin M Broyles","doi":"10.1055/a-2943-3619","DOIUrl":"10.1055/a-2943-3619","url":null,"abstract":"<p><strong>Background: </strong>The deep inferior epigastric perforator (DIEP) flap is widely used for autologous breast reconstruction, given its minimal donor site morbidity. However, debate exists regarding intraoperative vasopressor use, particularly in patients who received radiation therapy. This study aims to determine the impact of intraoperative vasopressors on postoperative outcomes in patients undergoing DIEP flap reconstruction, focusing on the irradiated high-risk population.</p><p><strong>Methods: </strong>A retrospective review of patients with stage I to III breast cancer who underwent DIEP flap breast reconstruction from 2023 to 2024 at a single quaternary-referral center was performed. The primary outcome was postoperative complications. Secondary outcome was flap loss (partial or total). Subgroup analysis was performed for patients who received adjuvant radiation therapy.</p><p><strong>Results: </strong>Of 217 patients, 340 DIEP flaps were analyzed. Mean age was 50 years (interquartile range: 43-56) and body mass index 28.5 ± 3.8. Half of the cohort received radiation therapy (50.3%, <i>n</i> = 171). Vasopressors were administered intraoperatively in 16% (<i>n</i> = 55) of cases. The overall complication rate was 19%. Breast wound dehiscence rates were 6%, fat necrosis 8%, partial flap loss 5%, and complete flap loss < 1%. Postoperative transfusion was an independent predictor of flap loss (odds ratio [OR]: 4.00, 95% confidence interval [CI]: 1.06-15.1, <i>p</i> = 0.04). For patients who received radiation therapy, revision of venous anastomosis (OR: 8.25, CI: 1.19-57.0, <i>p</i> = 0.03), revision of arterial anastomosis (OR: 6.25, CI: 1.16-7.45, <i>p</i> = 0.04), and prior hormone therapy (OR: 6.54, CI: 1.46-29.3, <i>p</i> = 0.01) was associated with flap loss. When accounting for relevant clinicopathologic factors, intraoperative vasopressor use was not associated with increased postoperative complications in either the overall cohort or radiation therapy subgroup (all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>Intraoperative vasopressors appear safe in DIEP flap reconstruction, even in patients who receive radiation therapy. In this higher-risk population who received radiation therapy, adverse outcomes were driven by technical microvascular factors, particularly anastomotic revision, rather than by vasopressor use. These findings underscore the importance of patient selection and anticipatory surgical planning, enabling more effective counseling and operative strategies for challenging cases.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955987","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}