Journal of reconstructive microsurgery最新文献

{"title":"Assessment and Management of Extremity Lymphedema: Position Paper of WSRM.","authors":"Peter Neligan, Dimitrios Dionyssiou, David Woosuk Chang, Jaume Masia Ayala, Akitatsu Hayashi, Johnson Chia-Shen Yang, Dhruv Singhal, Joon Pio Hong","doi":"10.1055/a-2968-4476","DOIUrl":"10.1055/a-2968-4476","url":null,"abstract":"<p><strong>Abstract: </strong>This position paper was developed by the World Society for Reconstructive Microsurgery Task Force on Lymphedema to establish consensus-based recommendations for the management of extremity lymphedema. The document addresses key domains of care, including assessment, treatment strategies, surgical interventions, and postoperative management, with the goal of providing practical and adaptable guidance applicable across diverse clinical settings.</p><p><strong>Abstract: </strong>Effective management of extremity lymphedema requires a structured and standardized approach encompassing comprehensive evaluation, individualized treatment, and long-term follow-up. Initial assessment should include a detailed history and physical examination, supplemented by standardized limb circumference measurements and clinical photography to ensure objective and reproducible documentation. Imaging modalities, such as lymphoscintigraphy and indocyanine green (ICG) fluorescent lymphography, are essential for accurate disease characterization and surgical planning. Preoperative optimization with conservative therapy and compression remains a critical step prior to intervention. Surgical management should be tailored to disease severity and patient-specific factors, incorporating physiologic procedures-including lymphaticovenous anastomosis (LVA), vascularized lymph node transfer (VLNT), and lymphaticovenular anastomosis (LNVA)-as well as excisional techniques such as liposuction and direct excision when indicated. Postoperative care should include regular noninvasive assessments at 3-month intervals and annual imaging to monitor outcomes. Long-term follow-up, extending up to 5 years, is recommended to ensure sustained clinical improvement and to guide ongoing management.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075072","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":"Learning Curve in Robotic-Assisted Microsurgery: A Systematic Review of Skill Acquisition.","authors":"Josip Plascevic, Joey Liang, Tara Pillai, Ash Patel","doi":"10.1055/a-2972-6306","DOIUrl":"https://doi.org/10.1055/a-2972-6306","url":null,"abstract":"<p><p>Background Robotic-assisted microsurgery offers enhanced precision, tremor filtration, and improved ergonomics, but adoption is limited by undefined learning curves. This systematic review evaluates the learning curve of microvascular anastomosis performed on dedicated robotic platforms. Methods A systematic review was conducted across MEDLINE, EMBASE, Web of Science, and Cochrane databases (inception to June 2025). Evaluated outcomes included time metrics (anastomosis time, time per stitch), microsurgical skills and anastomosis quality for the robot-assisted (RA) and hand-sewn (HS) techniques. Results After screening 6,743 records, 19 studies were included. In preclinical studies (n=11), mean RA anastomosis time decreased by 18.54 [4.01-47.00] minutes versus 8.43 [0.31-30.00] minutes for HS, although mean final RA time remained longer at the final attempt (20.94 [8.99-36.00] vs 14.78 [4.58-30.00]). RA time per stitch decreased by a mean of 2.96 [0.83-5.62] minutes compared to 1.58 [-0.31-4.84] minutes in the HS group. Preclinical microsurgical skill scores improved by 0.99 [0.50-1.63] in the RA group and by 0.76 [-0.10-1.30] in the HS group. In clinical studies (n=8), RA anastomosis time was reduced by 18.03 [6.30-37.27] minutes over anastomosis attempts. Preclinical Anastomosis Lapse Index scores were comparable between techniques. Reported immediate patency in clinical settings ranged from 95.66% to 100%. Conclusion Performance on dedicated robotic platforms improved with practice, but the current evidence did not demonstrate overall superiority over HS technique. In preclinical studies, final RA anastomosis and per-stitch times remained longer, while early anastomosis quality and patency were broadly comparable. Considering added time and platform-associated costs, the clinical settings in which robotic assistance may provide a meaningful benefit remain to be defined. Heterogeneity in models, operators, platforms, and outcome reporting limits definitive characterization of the learning curve. Future studies should standardize learning curve methodology, report complete sequential trajectories, and define clinically relevant proficiency thresholds before integration into credentialing frameworks.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111277","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":"Anatomical Study of Venous Valves and Valve-Like Structures in the Superficial Temporal Veins: Implications for Reconstructive Surgery.","authors":"Yunzhang Wang, Zilong Cao, Qiang Yue, Shu Rui, Tiran Zhang, Liqiang Liu","doi":"10.1055/a-2717-4031","DOIUrl":"10.1055/a-2717-4031","url":null,"abstract":"<p><strong>Background: </strong>Detailed knowledge of venous valves and valve-like structures is essential in reconstructive surgery, as these structures may contribute to postoperative venous congestion following flap transfer. However, their presence in the superficial temporal veins (STVs), which are frequently utilized in craniofacial reconstruction, remains unclear. The authors performed morphological and morphometrical examinations of venous valves and valve-like structures in the STVs through cadaver dissection.</p><p><strong>Methods: </strong>This study involved the longitudinal dissection of 24 STVs from 12 cadavers. The veins were then examined under a stereomicroscope to determine the presence of venous valves or valve-like structures, and their quantity and location were recorded.</p><p><strong>Results: </strong>The STVs contain both venous valves and valve-like structures known as venous cristae. All observed venous valves were bicuspid, whereas venous cristae were characterized by ridge-like protrusions of venous wall into the lumen. A total of 5 venous valves and 69 cristae were identified across 24 STVs. Venous valves were exclusively located in the main trunks of the STVs, whereas venous cristae were classified into five types based on their locations, with venous bifurcations being the most common sites. Most main trunks (22/24)contained either one venous valve or one crista, and the average distances from these structures to the superior margin of the zygomatic arch were 8.42 ± 0.80 and 9.03 ± 0.86 mm, respectively.</p><p><strong>Conclusion: </strong>A comprehensive understanding of the characteristics, quantity, and distribution of venous valves and cristae in the STVs could provide valuable insights for surgeons in preventing postoperative venous congestion.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"725-731"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258209","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 Efficacy of Chimeric Superficial Circumflex Iliac Artery Perforator (SCIP) Flap in Treatment of Posttraumatic Chronic Osteomyelitis.","authors":"Usama Abdelfattah, Nourhan Abdelwahab, Yahya O Emara, Tarek Elbanoby","doi":"10.1055/a-2717-4713","DOIUrl":"10.1055/a-2717-4713","url":null,"abstract":"<p><strong>Background: </strong>Management of chronic osteomyelitis (COM) remains a challenge for plastic and orthopedic surgeons. Among many perforator flaps utilized in COM, chimeric flaps reported superior successful outcomes. The objective of this study is to evaluate the efficacy of chimeric superficial circumflex iliac artery perforator (SCIP) in treatment of various forms of COM.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all patients with posttraumatic COM who underwent reconstruction using chimeric SCIP flaps between September 2019 and November 2023. Patients with insufficient data or follow-up less than 1 year were excluded from the study. The preoperative basic data and the operative details and postoperative follow-up data were collected and statistically analyzed. Correlation between recurrence and the following factors was analyzed: comorbidities, type of trauma, duration of COM, and limb vascularity condition.</p><p><strong>Results: </strong>A total of 59 patients were analyzed, with a mean age 35.31 years. A total of 29 patients underwent chimeric SCIP skin-iliac bone flap reconstruction, 16 received chimeric skin-iliac periosteal flaps, and 4 had chimeric flaps combining skin, periosteum, and bone. There were two cases of total flap loss and two cases of partial flap loss. Additionally, three patients (5.08%) experienced a recurrence of COM. The significant predictor of COM recurrence was major vascular injury. Although not statistically significant, COM recurrence was more prevalent among patients with comorbidities, smoking, and diabetes.</p><p><strong>Conclusion: </strong>Chimeric SCIP flaps can be effectively used to treat COM with composite tissue defects, eliminate inflammation of the affected limbs, allow composite tissue reconstruction, and promote wound healing.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"690-699"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390672","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":"Investigation of Routine Venous Augmentation in Deep Inferior Epigastric Artery Perforator Flap and Intraoperative Decision Pathway.","authors":"Anne M Meyer, Cole Bird, Niaman Nazir, Meredith Collins, Rebecca Farmer, Eric Lai, James Butterworth, Julie Holding","doi":"10.1055/a-2717-4388","DOIUrl":"10.1055/a-2717-4388","url":null,"abstract":"<p><strong>Background: </strong>Data supporting use of prophylactic venous augmentation in the deep inferior epigastric perforator flap (DIEP) is limited. This study aims to assess the outcomes of single vein DIEP flaps compared with those with venous augmentation and present an intraoperative decision pathway.</p><p><strong>Methods: </strong>A retrospective chart review was performed on patients who underwent DIEP flap reconstruction at a single institution from 2009 to 2023. Statistical analysis was performed and <i>p</i>-values less than 0.05 were considered statistically significant.</p><p><strong>Results: </strong>A total of 1,099 patients had DIEP flap breast reconstruction resulting in 1,745 flaps. Two or more veins were utilized in 32.4%, whereas 67.6% had a single venous anastomosis. Prophylactic augmentation was documented for 24.5% of flaps. The rate of return to operating room was 5.8% with no significant difference found in the rate of return for all causes (<i>p</i> = 0.14) and suspected venous compromise (<i>p</i> = 0.95). Suspected venous compromise was documented in 41flaps (2.3%), with no significant difference between the single vein and prophylactic vein group (<i>p</i> = 0.95). There was no difference in rates of early (<i>p</i> = 0.10) or late flap loss (<i>p</i> = 0.15). Difference in operative duration was increased for flaps with prophylactic venous anastomoses (559.4 ± 127.8 vs. 505.6 ± 130.8 minutes; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This study demonstrates no significant difference in postoperative complications as well as demonstrating prophylactic multivein anastomosis was associated with significantly longer operative times. With the use of an intraoperative decision pathway, one can determine which flaps will benefit from additional venous outflow and avoid unnecessary routine augmentation without benefit.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"674-680"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258190","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":"Go Deep or Go Home: Evaluating Venous Drainage Systems in Microvascular Lower Extremity Reconstruction.","authors":"Imran Rizvi, Bora Kahramangil, Ellen Wang, Kylie Swiekatowski, Jessica R Nye, Jeffrey G Trost, Mohin A Bhadkamkar","doi":"10.1055/a-2717-3721","DOIUrl":"10.1055/a-2717-3721","url":null,"abstract":"<p><strong>Background: </strong>No consensus exists regarding the utilization of the lower extremity superficial venous system compared with the deep veins in free flap procedures for limb salvage. This study analyzed the risks of venous complications associated with superficial and deep venous anastomoses for lower extremity reconstruction.</p><p><strong>Methods: </strong>A retrospective review was performed on patients who required free flap reconstruction of the lower extremity between 2016 and 2024. The recipient veins were characterized as deep (venae comitantes) or superficial (saphenous veins). Flaps with two venous anastomoses were further classified as deep, superficial, or combined venous drainage. The primary study outcome was composite venous complications, which included venous congestion, flap hematoma, and partial and total flap necrosis during index hospitalization.</p><p><strong>Results: </strong>A total of 333 patients underwent free flap reconstruction of the lower extremity. Of these patients, 31 (9.3%) experienced the primary outcome. Free flaps with superficial-only drainage had a significantly higher rate of venous complications (27.8%) than those with deep (8.6%) or combined (4.3%) drainage systems. Multivariate analysis showed that flaps anastomosed to superficial veins had significantly higher odds of venous complications (OR = 4.11, CI: 1.24-11.9, <i>p</i> = 0.049) than those utilizing a deep drainage system.</p><p><strong>Conclusion: </strong>This study showed higher rates of venous complications with the use of superficial venous drainage in lower-extremity free flaps. Although efforts should be made to incorporate a deep venous recipient, superficial veins may be used as an adjunct in certain situations with good reconstructive outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"719-724"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258267","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":"Does Academic Quarter or Operative Day of the Week Affect Free Flap Success?","authors":"Walter D Sobba, Sophia Jacobi, Janos Barrera, Alexis K Gursky, Hailey P Wyatt, Jamie P Levine, Nikhil A Agrawal, Jacques H Hacquebord","doi":"10.1055/a-2717-4789","DOIUrl":"10.1055/a-2717-4789","url":null,"abstract":"<p><strong>Background: </strong>The \"July Effect\" refers to the potential increase in adverse outcomes associated with the annual turnover of medical trainees, although its impact on surgical fields remains uncertain. Additionally, few studies have examined whether the operative day of the week and subsequent flap monitoring during the weekend affect time to reoperation or flap salvage. This study investigated whether academic quarter and operative day influence reoperation rates, flap salvage, or flap failure in microvascular free flap procedures.</p><p><strong>Methods: </strong>A retrospective review was conducted between June 2011 and November 2023. Multivariate analyses adjusted for patient demographics, comorbidities, flap type, and recipient region. Flaps were categorized by academic quarter and operative day, excluding weekends due to limited sample size. Primary outcomes included reoperation rates for vascular compromise, time to reoperation, and flap salvage.</p><p><strong>Results: </strong>A total of 769 free flaps met inclusion criteria for analysis. No significant differences in reoperation rates for vascular compromise were observed across academic quarters. While procedure duration trended longer in the first three quarters compared with the fourth, these differences were not statistically significant. Additionally, operative day did not impact reoperation rates, flap salvage, or time to reoperation. Flaps were predominantly indicated for head and neck reconstruction (74.4%) and had an overall flap loss rate of 3.0%.</p><p><strong>Conclusion: </strong>We found no evidence of a \"July Effect\" in microvascular surgery or that operative day affects free flap outcomes. Institutional factors, such as structured flap monitoring, attending oversight, and advanced practice provider support, likely mitigate risks associated with trainee turnover and shift-based staffing fluctuations.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"681-689"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258273","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":"Largest Investigation of Branching Patterns of the Popliteal Artery.","authors":"Cen-Hung Lin, Jui-Po Yeh, Yun-Ting Chen, Meng-Hsiang Chen","doi":"10.1055/a-2717-4092","DOIUrl":"10.1055/a-2717-4092","url":null,"abstract":"<p><strong>Background: </strong>Head and neck squamous cell carcinoma accounts for 4.5% of all new cancers diagnosed. A fibula free flap is often performed after tumor resection. Preoperative acknowledgment of the branching patterns of the popliteal artery is important to avoid flap failure or leg ischemia after flap harvest. We performed this extensive study using a modified classification to help thoroughly recognize variations.</p><p><strong>Methods: </strong>The subjects were Taiwanese patients who received radiologic examinations of their lower limbs at a single medical center from May 2006 to December 2022. Only digital subtraction angiography, computed tomography angiography, and magnetic resonance angiography, which reveal the vasculature of the lower limbs, were included. All images were viewed by the same plastic surgeon on the same computer screen. Statistical analysis was subsequently performed on the data.</p><p><strong>Results: </strong>In total, 1,244 right legs and 1,198 left legs (2,442 legs in total) from 1,485 Taiwanese patients were included in this study. In addition to normal branching, type IA, other branching patterns as variations occurred in 4.1% (<i>n</i> = 100) of the included legs. The second and third common patterns were type IIIA (1.06%, <i>n</i> = 26) and IB (0.98%, <i>n</i> = 24), respectively. Forty-seven patients presented with variation and had both legs evaluated, and 29.8% of them presented with bilateral variations.</p><p><strong>Conclusion: </strong>A preoperative vascular examination is strongly recommended before harvesting a free fibular flap because some patients might have a blood supply to the foot and lower leg, mainly from the planned-to-be-harvested peroneal artery (PR), or might not have a workable PR. Using fibular vessels as a flap pedicle might not be able to be performed in up to 1.84% of legs.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"667-673"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258257","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":"Postoperative Prophylactic Anticoagulation in Flap Surgery: A Review of the Evidence and Challenging Common Beliefs.","authors":"Hamid Malekzadeh, Jude Kluemper, Abdulaziz Elemosho, Jeffrey E Janis","doi":"10.1055/a-2717-4751","DOIUrl":"10.1055/a-2717-4751","url":null,"abstract":"<p><strong>Background: </strong>Postoperative anticoagulation is widely used in microsurgical flap reconstruction to reduce the risk of thrombosis and flap complications. However, their effectiveness and safety in relation to flap outcomes remain uncertain. This systematic review and meta-analysis evaluate the existing evidence on postoperative anticoagulant use in microsurgical flap reconstruction.</p><p><strong>Methods: </strong>A literature search was performed in the PubMed database for studies published from 1995 until January 2025 that compared flap outcomes with postoperative prophylactic anticoagulation regimens in microsurgical flap procedures. Outcomes of interest included hematoma, complete flap failure, and reoperation. Relevant data were extracted and analyzed using meta-analytic techniques.</p><p><strong>Results: </strong>In total, 11 studies were included in the final review and meta-analysis. Seven studies comparing patients who received postoperative anticoagulation with those who did not demonstrated a significantly higher rate of hematoma in the anticoagulated group (5.0% vs. 3.0%; <i>p</i> = 0.03). However, there were no significant differences in flap failure or reoperation rates. In subgroup analyses, only studies using unfractionated heparin showed increased hematoma risk, whereas low-molecular-weight heparin (LMWH) showed no significant effect. Four studies compared patients receiving postoperative anticoagulation plus aspirin with those receiving anticoagulation alone and found a higher reoperation rate when aspirin was added (17.5% vs. 10.0%; <i>p</i> < 0.01), with no significant differences in flap failure rates.</p><p><strong>Conclusion: </strong>Postoperative heparin increases the risk of hematoma without improving flap survival. Additionally, combining aspirin with LMWH may increase reoperation rates. These results suggest that routine anticoagulation may not benefit all patients and support a risk-based approach to postoperative management in microsurgical reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"660-666"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275029","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 Donor Site Morbidity in Harvesting the Intercostal Main Nerve as a Graft for Breast Neurotization in Microsurgical Breast Reconstruction.","authors":"Ying-Hsuan Lee, Jung-Ju Huang, Johnny Chuieng-Yi Lu, David Chon-Fok Cheong, Chai-Fang Chen, Tommy Nai-Jen Chang","doi":"10.1055/a-2717-4502","DOIUrl":"10.1055/a-2717-4502","url":null,"abstract":"<p><strong>Background: </strong>Breast neurotization using autologous grafts has been indicated to be effective. Previous studies focused mainly on restoring sensation and optimizing the operative techniques of neurotization in microsurgical breast reconstruction. There are few studies on the adverse effects and potential risks associated with simultaneous microsurgical breast reconstruction and neurotization procedures. The rates of overall and pulmonary complications in patients receiving neurotization during autologous breast reconstruction were examined in this study.</p><p><strong>Methods: </strong>A retrospective comparative study was conducted between two groups of patients: 100 consecutive patients (reinnervation group) underwent neurotization procedures during deep inferior epigastric perforator (DIEP) breast reconstruction, while the other 100 patients (control group) underwent DIEP breast reconstruction alone. The patients' demographic data, reconstructive methods, postoperative complications, specific pulmonary complications, and length of hospital stay were reviewed.</p><p><strong>Results: </strong>The overall complication rates were 23% in the reinnervation group and 20% in the control group (<i>p</i> = 0.731), and this difference was not statistically significant. The incidence rates of vascular insufficiency (7% vs. 9%), pneumothorax (5% vs. 3%), hematoma/seroma (2% vs. 3%), and wound infection (1% vs. 2%) were similar between the reinnervation group and the control group. A greater percentage of patients in the reinnervation group developed pleural effusion than did those in the control group (12% vs. 4%, <i>p</i> = 0.037), whereas the majority of the patients in the reinnervation group were asymptomatic and managed conservatively.</p><p><strong>Conclusion: </strong>Although harvesting the main intercostal nerve for breast neurotization may irritate the pleura, the effect was minimal and manageable. This procedure is safe and feasible and can be widely applied in breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"640-647"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390617","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}