Journal of reconstructive microsurgery最新文献

{"title":"Revisiting Heparin-Induced Thrombocytopenia among Patients Undergoing Free Tissue Transfer: A Systematic Review.","authors":"Mohammed Yamin, Micaela Tobin, Tricia Raquepo, John B Park, Daniela Lee, Maria J Escobar-Domingo, Jose Foppiani, James E Fanning, Eric Zhu, Agustin N Posso, Haobo Ma, Samuel J Lin, Bernard T Lee, Ryan P Cauley","doi":"10.1055/a-2687-0443","DOIUrl":"10.1055/a-2687-0443","url":null,"abstract":"<p><p>Heparin is frequently used to mitigate the risk of thrombosis in microsurgical free tissue transfer. Although rare, heparin-induced thrombocytopenia (HIT) is a severe, life-threatening complication that can arise in patients exposed to heparin products. This systematic review aims to examine patterns in demographics, flap characteristics, diagnostic approaches, and treatment protocols for HIT following free flap reconstruction.A systematic search was conducted across PubMed, MEDLINE, and Web of Science, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included \"heparin-induced thrombocytopenia,\" \"HIT syndrome,\" \"free flaps,\" \"microsurgery,\" \"plastic surgery,\" and \"reconstructive surgery.\" Case reports or series written in English that presented patients developing HIT following free flap procedures were included. Eligibility criteria are accessible on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42025650125).A total of 15 articles were included, encompassing a total of 23 free flap reconstruction cases. The median patient age was 52 years, with male predominance (69.6). Lower extremity reconstruction was most common (47.8%), primarily using anterolateral thigh flaps (39.1%). Median 4T score was 6, median time to HIT diagnosis was 6 days, and median nadir platelet count was 72 × 10³/μL. Thrombotic complications were common, with venous thrombosis (34.8%) predominating. Argatroban (26.1%) was the most frequently used alternative anticoagulant, while warfarin (30.4%) was the most common discharge medication. Overall flap survival was 43.5%. Meta-analysis revealed no significant difference in flap survival between anticoagulation strategies (95% CI: 0.38-2.63, <i>p</i> = 1.000).HIT represents a rare but devastating complication in free flap reconstruction, with approximately half of the affected flaps failing despite intervention. Although no single anticoagulation strategy demonstrated superior outcomes, expeditious diagnosis and treatment may improve flap salvage rates. This review provides a foundation for developing standardized protocols for HIT management in microsurgical patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958298","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":"Ex Vivo Rabbit: A Novel High-Fidelity Training Model for Microsurgical and Supermicrosurgical Training.","authors":"Belén Andresen-Lorca, Iván Heredia-Alcalde, Pedro Alvedro-Ruiz, María García-García, Alberto Ruiz-Cases, María Dolores Pérez-Del-Caz","doi":"10.1055/a-2687-0380","DOIUrl":"10.1055/a-2687-0380","url":null,"abstract":"<p><p>The development of appropriate microsurgical and supermicrosurgical skills is essential for reconstructive surgeons. Training courses frequently employ in vivo models, which have various drawbacks: Limited availability, high cost, and/or ethical conflicts. To overcome these limitations, we looked for an inert model that was analogous to the gold standard in vivo, surpassing the classic ex vivo models at the same time.We studied the ex vivo rabbit as an animal training model by means of 10 specimen dissections, microscopically analyzing the mean caliber and length of its main vascular pedicles and comparing them to those of the most common flaps and recipient vessels employed in reconstructive surgery. We designed a routine with increasingly difficult exercises, which we propose as a training plan.The rabbit's main vascular pedicles have a mean caliber of 0.4 mm (internal mammary), 0.8 mm (iliolumbar), 0.9 mm (brachial), 1.2 mm (femoral), 1.5 mm (renal), 1.9 mm (common carotid), and 2.8 mm (aorta). They allow for a progressive increase in the level of complexity, as well as the practice of a wide variety of techniques (end-to-end anastomosis between vessels of different sizes, end-to-side anastomosis, neurorrhaphies, nerve transfers, ortho- and heterotopic replants, and free flaps).The ex vivo rabbit serves as a valid alternative to other recognized high-fidelity microsurgical models, overcoming the limitations of in vivo-it is easily accessible, inexpensive, and inert-as well as ex vivo-it offers a wide range of calibers and the possibility of practicing advanced techniques-models which have been used in the past.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958274","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":"Intraoperative Vasopressor Use Does Not Adversely Impact Free Flap Outcomes in Lower Extremity Limb Salvage Procedures in a Highly Comorbid Atraumatic Wound Population.","authors":"Rachel N Rohrich, Nicole C Episalla, Ryan P Lin, Sami Ferdousian, Julie Suh, Maeesha Noshin, Luke J Llaurado, Richard C Youn, Christopher E Attinger, Cameron M Akbari, Russell T Wall, Karen K Evans","doi":"10.1055/a-2687-0254","DOIUrl":"https://doi.org/10.1055/a-2687-0254","url":null,"abstract":"<p><p>The use of vasopressors during microsurgical reconstruction is debated. Their effect on the comorbid lower extremity (LE) wound population is unstudied. This study characterizes the impact of intraoperative vasopressor use in LE free tissue transfer (FTT) for limb salvage.A review of LE FTT from February 2017 to June 2024 was conducted. Flap outcomes within 7 and 42 days were evaluated, as well as long-term limb salvage.Of 258 LE FTT performed, vasopressors were used in 177 cases (68.6%). Most vasopressors were administered via intermittent bolus only (75.7%) or combined with continuous infusion (23.7%). American Society of Anesthesiologists Class was significantly higher in the vasopressor group compared with controls (<i>p</i> = 0.001). The vasopressor group trended to have higher median Charlson Comorbidity Indices (4, interquartile range [IQR]: 3 vs. 3, IQR: 3; <i>p</i> = 0.055), and rates of diabetes (65.0% vs. 54.3%, <i>p</i> = 0.103), peripheral vascular disease (63.8% vs. 51.9%, <i>p</i> = 0.068), and chronic kidney disease (14.7% vs. 6.2%, <i>p</i> = 0.063). The rate of reoperation, microvascular thrombosis, or flap success at 7 and 42 days did not differ between groups. By a median long-term follow-up of 24.5 (IQR: 39.2) months, rates of major limb amputation (vasopressor: 10.7% vs. control: 7.4%, <i>p</i> = 0.402) and mortality (6.8% vs. 2.5%, <i>p</i> = 0.237) were similar between groups.In this complex population, intraoperative use of vasopressors does not appear to negatively impact flap viability or limb salvage.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006232","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 Novel Lymphosome-Based Long-Lasting Rat Tail Model of Lymphedema.","authors":"Junzhe Chen, Yun Wang, Shilin Tu, Yan Zhou, Haokun Qin, Zeyao Tang, Yuezhong Chen, Shune Xiao, Chengliang Deng","doi":"10.1055/a-2687-0506","DOIUrl":"10.1055/a-2687-0506","url":null,"abstract":"<p><p>Secondary extremity lymphedema is a chronic and progressive condition caused by obstructed lymphatic drainage, commonly following lymphadenectomy, infection, or trauma. Rodent models are preferred for experimental lymphedema research due to cost-effectiveness and reproducibility. Currently, rat tail models encounter limitations due to transient swelling and their inability to fully replicate the comprehensive pathophysiology of lymphedema, particularly concerning the effects of lymph node removal.We developed a series of rat tail lymphedema models incorporating skin resection, deep lymphatic vessel disruption, and gluteal lymph node (GLN) excision to assess effects on lymphatic architecture, inflammation, and fibrosis. Indocyanine green (ICG) lymphography was used to visualize lymphatic function. Tail volume and circumference were measured weekly, and histological assessments quantified fibrosis and fibroadipose thickening. Bulk RNA sequencing was performed to characterize the inflammatory processes triggered by GLN removal.The combined model (skin removal, deep lymphatic disruption, and GLN excision) resulted in severe and persistent lymphedema marked by progressive swelling and pronounced fibrosis. ICG lymphography confirmed disruption of superficial lymphatic flow with partial recanalization of deep channels. Notably, lymphangiogenesis was observed at the GLN excision site, forming compensatory pathways connecting the tail to the popliteal lymph nodes. Histology revealed extensive collagen deposition and fibroadipose thickening in groups with lymph node removal, with the combined model showing the most pronounced changes. Bulk RNA-sequencing confirmed the removal of GLN involving the inflammatory and fibrosis process in the tail model.This lymphosome-based rat tail model successfully replicates key features of lymphedema, including sustained swelling, lymphatic disruption, inflammation, and fibrosis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958244","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":"Functional Rehabilitation and Quality of Life After Fibula Free Flap Reconstruction in Mandibular Defects.","authors":"Mathias Fiedler, Christoph Brunnhuber, Jonas Eichberger, Maximilian Gottsauner, Johannes G Schuderer, Michael Maurer, Jürgen Taxis, Johannes K Meier, Michael Gerken, Torsten E Reichert, Tobias Ettl","doi":"10.1055/a-2687-0316","DOIUrl":"10.1055/a-2687-0316","url":null,"abstract":"<p><p>Patients undergoing mandibular reconstruction often experience long-term functional and aesthetic challenges, impacting their quality of life (QOL). The objective of this study was to identify factors that most powerfully impact the long-term QOL and functional outcome of patients following mandibular reconstruction with free fibula flaps. This investigation was undertaken to enhance the treatment of this patient population.QOL was assessed between March 2022 and May 2023 in 47 consecutive patients undergoing mandibular reconstruction with fibula free flaps (FFFs) using the University of Washington QOL Questionnaire. Evaluation of functional outcome was based on mouth opening, jaw deviation, tissue atrophy, tongue mobility, lip competence, and speech intelligibility.The study found that loss of chewing was the strongest impairment of QOL (score: 63.83). The most important negative predictors for QOL were female gender (<i>p</i> = 0.047), radiotherapy (QOL subcategory <i>p</i>-values: <i>p</i> = 0.007 to <i>p</i> = 0.034), anterior segment resection (QOL subcategory <i>p</i>-values: <i>p</i> = 0.038 to <i>p</i> = 0.045), advanced defect size (QOL subcategory <i>p</i>-values: <i>p</i> = 0.008 to <i>p</i> = 0.035), and free-hand fibula reconstruction (QOL subcategory <i>p</i>-values: <i>p</i> = 0.003 to <i>p</i> = 0.041). Long-term outcomes revealed that reduced tissue atrophy (QOL subcategory <i>p</i>-values: <i>p</i> < 0.001 to <i>p</i> = 0.025) and preserved tongue mobility (QOL subcategory <i>p</i>-values: <i>p</i> = 0.002 to <i>p</i> = 0.043) were associated with better QOL scores. Functional limitations such as reduced mouth opening (QOL subcategory <i>p</i>-values: <i>p</i> = 0.008 to <i>p</i> = 0.049) and impaired speech intelligibility (QOL subcategory <i>p</i>-values: <i>p</i> < 0.001 to <i>p</i> = 0.015) were significantly correlated with lower QOL in several domains.Mandibular reconstruction with FFFs provides a favorable long-term QOL and functional outcomes, though certain clinical factors, including radiotherapy, anterior segment resection, and defect size, significantly reduce patient-reported QOL.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958369","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":"Surgeon Experience and Outcomes in Microsurgical Breast Reconstruction: A 10-Year Single Surgeon Analysis.","authors":"Evan Rothchild, Isabelle T Smith, Stephen O Popoola, Joseph A Ricci, Neil Tanna","doi":"10.1055/a-2687-0207","DOIUrl":"10.1055/a-2687-0207","url":null,"abstract":"<p><p>Microsurgical breast reconstruction with deep inferior epigastric perforator (DIEP) flaps has become increasingly popular. While surgeons undergo rigorous training, it is believed that plastic surgeons continue to refine and enhance their performance through independent practice. This study evaluates the effect of surgeon experience on clinical outcomes in DIEP flap breast reconstruction.A retrospective review was conducted on consecutive DIEP flap procedures performed by a single surgeon from fellowship completion in 2013 to 10 years of independent professional practice in 2023. Patients were categorized into \"early\" and \"late\" groups, separated by a midpoint surgery date (July 30, 2018). Statistical analyses included student's <i>t</i>-tests, chi-squared analysis with Fisher's exact test, and multivariable regressions controlling for comorbidities.The study included a total of 1,182 DIEP flaps in 632 patients, with 238 in the early group and 394 in the late group. The late group had a lower mean body mass index (28.83 vs. 29.98, <i>p</i> = 0.004), prevalence of hypertension (26.6% vs. 35.3%, <i>p</i> = 0.021), and prevalence of diabetes (7.9% vs. 14.3%, <i>p</i> = 0.010) than the early group. After controlling for potential confounders, the late group was independently associated with decreased length of stay (incidence rate ratio [IRR] = 0.611, <i>p</i> < 0.001) and fewer revision surgeries (IRR = 0.689, <i>p</i> < 0.001).This large, single-surgeon series demonstrates that even with extensive initial training, plastic surgeons continue to evolve their surgical outcomes through accumulated experience. These findings emphasize the importance of consistent volume over time in achieving optimal results in microsurgical breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958326","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":"Effects of Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft Tissue Sarcoma Defects.","authors":"Rebecca L Farmer, Justin Easton, Ruston Sanchez, Elisa Emanuelli, Eldon Mah","doi":"10.1055/a-2460-4649","DOIUrl":"10.1055/a-2460-4649","url":null,"abstract":"<p><p>The treatment approach for soft tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data have demonstrated a potentially increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for the reconstruction of STS defects influenced rates of microvascular complications in our patients.A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009 to 2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications were compared across groups.A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, <i>p</i> = 0.52). The use of perforating branches as recipient vessels did not confer an increased risk of microvascular complications (OR = 0.87, <i>p</i> = 0.75).The reconstruction of irradiated lower-extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without a significantly increased risk of microvascular complications. Furthermore, unnamed perforating branches can be successfully used for reconstruction in anatomically challenging areas of the lower extremity.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"547-556"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576353","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":"Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures.","authors":"Anshumi Desai, Angela Luo, Peter A Borowsky, Valeria P Bustos, Natalia Fullerton, Kyle Y Xu, Kashyap K Tadisina","doi":"10.1055/a-2460-4706","DOIUrl":"10.1055/a-2460-4706","url":null,"abstract":"<p><p>Upper extremity (UE) replantation and revascularization are challenging surgical procedures, with survival rates being 50 to 90%. Preoperative risk stratification is challenging yet crucial as patients with comorbid conditions face increased complications. This study assesses the predictive value of the modified 5-item frailty index (5-mFI) for postoperative complications in these procedures.A retrospective study was done using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2021) for UE replantation/revascularization. The 5-mFI score assigned points for comorbidities including pulmonary disease, heart failure, diabetes, hypertension, and functional status (0-5 scale; 1 point to each). 5-mFI scores stratified patients into <2 (low-risk) or ≥2 (high-risk) categories.Of 2,305 patients, the mean age and body mass index (BMI) were 53.13 years and 28.53 kg/m², respectively. The 5-mFI ≥2 cohort experienced higher rates of all-cause complications, systemic complications, unplanned readmissions, and return to the operating room on univariate analysis. There was no significant difference in wound complication rates. Multivariable logistic regression showed that a higher 5-mFI was significantly associated with increased risks of all-cause mild and severe systemic complications. Wound complications, length of stay over 30 days, unplanned readmission, and return to the operating room were higher in high-risk patients, however not statistically significant.5-mFI is an effective tool for evaluating risk in UE replantation and revascularization, correlating high scores with significantly increased postoperative complications. High-risk patients with 5-mFI ≥2 also had more reoperations and readmissions. The use of 5-mFI in preoperative assessments can help personalize management, enhancing patient selection and care quality in these complex reconstructions.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"557-565"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cephalic Vein Transposition for Head and Neck Reconstruction: An Anatomical Study.","authors":"Daniel 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":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","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":"Deep Inferior Epigastric Perforator Flap with Implant Placement has a Favorable Complication Profile Compared with Implant-Only or Flap-Only Reconstruction.","authors":"Carol Wang, Nikita Roy, Keisha E Montalmant, Peter Shamamian, Nargiz Seyidova, Olachi Oleru, Francis Graziano, Jordan M S Jacobs, Hani Sbitany, Peter W Henderson","doi":"10.1055/a-2483-5472","DOIUrl":"10.1055/a-2483-5472","url":null,"abstract":"<p><p>Hybrid deep inferior epigastric perforator (DIEP) flap and simultaneous silicone implant breast reconstruction procedures (\"DIEP + I\") have many conceptual advantages compared with either reconstruction method alone, but the outcomes of DIEP + I reconstruction have not yet been well studied. Therefore, the purpose of this study was to compare the outcomes of DIEP + I with implant-only and DIEP-only reconstruction.A retrospective review was conducted of patients undergoing DIEP + I, implant-only, and DIEP-only breast reconstruction from 2019 to 2023 at a single institution. Demographics and complication rates were compared between groups.A total of 145 patients were included in the DIEP + I (<i>N</i> = 26), implant-only (<i>N</i> = 59), and DIEP-only (<i>N</i> = 60) groups. The DIEP + I group had a lower overall complication rate than implant-only reconstruction (18.4 vs. 41.1%, <i>p</i> = 0.014), which was primarily due to the lower incidence of infections in the DIEP + I group (2.6 vs. 22.2%, <i>p</i> = 0.006). Accordingly, DIEP + I reconstruction decreased the odds of infection by 90% (OR = 0.095, <i>p</i> = 0.024) compared with implant-only reconstruction. The DIEP + I group had similar rates of wound healing and implant-related complications compared with the implant-only and DIEP-only groups, and no patients in the DIEP + I group experienced flap loss.DIEP + I breast reconstruction had a lower rate of infectious complications than implant-only reconstruction, and no higher rate of flap compromise or wound healing complications. This technique could be considered as a means of minimizing infection risk in patients with other risk factors who are seeking implant-based reconstruction, and of enhancing breast projection in patients who are seeking DIEP flap reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"631-640"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715823","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}