Journal of reconstructive microsurgery最新文献

{"title":"Deltoid Fasciocutaneous Free Flap: Cadaveric Study and Clinical Outcomes of Treating Open Infected Limb Fracture with Soft Tissue Defect.","authors":"Nguyen Ngoc-Huyen, Nguyen The-Hoang, Nguyen Quang-Vinh, Rima Nuwayhid, Olga Kurow, Achim von Bomhard","doi":"10.1055/a-2717-4839","DOIUrl":"10.1055/a-2717-4839","url":null,"abstract":"<p><strong>Background: </strong>The deltoid fasciocutaneous free flap is a valuable reconstructive option for tissue defects following injury or tumor resection. However, limited studies have provided objective data on the anatomical characteristics of this flap. This study aimed to investigate the cadaveric anatomical characteristics of this flap and report our initial results for treating open infected fracture-related infection (FRI) with skin defects in the extremities.</p><p><strong>Methods: </strong>This prospective cross-sectional study involved the dissection of 27 adult cadavers (13 male and 14 female), including 16 formalin-fixed (32 deltoid regions) and 11 fresh cadavers (22 deltoid regions). Anatomical characteristics, including the blood supply area and neurovascular pedicle, were examined. The findings from the cadaveric investigation were then applied and analyzed in a clinical setting with 50 patients.</p><p><strong>Results: </strong>The mean angiosome area was 20.41 × 12.36 cm². The main vascular pedicle supplying blood to the flap is the posterior circumflex humeral artery (PCHA), which originates from the axillary and subscapular arteries and was observed in 94.44% of cases. The cutaneous perforator branch is the posterior subcutaneous deltoid artery (PSDA), which was separate from the PCHA in 100% of cases. The mean PCHA length was 38.98 ± 3.88 mm, and mean diameter was 3.17 ± 0.7 mm. The mean PSDA length was 45.5 ± 3.65 mm, and mean diameter was 1.38 ± 0.13 mm. All deltoid free flaps were successfully transferred, and all open FRI demonstrated fracture consolidation in the postoperative course.</p><p><strong>Conclusion: </strong>In addition to clinically well-established free flaps, the deltoid fasciocutaneous free flap represents a valuable reconstructive option for treating open FRI with skin and soft tissue defects in the extremities, particularly when other well-established free flaps are not feasible or have previously been used.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"648-659"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390687","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":"Mix and Match: Enhancing Microsurgical Breast Reconstruction Outcomes with Hybrid Techniques.","authors":"Anna E Daytz, Jina Yom, Christopher Aiello, Darren L Sultan, Raquel A Minasian, Isabelle T Smith, Ashley M Howell, Mark L Smith, Neil Tanna","doi":"10.1055/a-2717-4314","DOIUrl":"10.1055/a-2717-4314","url":null,"abstract":"<p><strong>Background: </strong>Hybrid breast reconstruction can alleviate the discordance between donor flap and desired breast volume in patients previously excluded from flap-based modalities. The authors review their consecutive experiences with two novel hybrid microsurgical breast reconstruction techniques.</p><p><strong>Methods: </strong>A review of all consecutive patients who received microsurgical flap reconstruction was performed over a 5-year period, both with and without hybrid techniques. The HyPAD® technique combines flap reconstruction with stacked prepectoral acellular dermal matrix (ADM), while the HyFIL® technique combines a flap, prepectoral implant, and fat transfer (lipofilling). Demographic, health-related, surgical, and outcome indicators were measured for comprehensive qualitative and quantitative analysis.</p><p><strong>Results: </strong>During the study period (2018-2023), 101 patients with hybrid breast reconstruction (HyPAD® <i>n</i> = 40, HyFIL® <i>n</i> = 61) were compared with 208 patients who received DIEP flap reconstruction alone. Hybrid patients were significantly younger (47.3 versus 52.9 years, <i>p</i> < 0.01), had lower BMIs (24.9 versus 30.3 kg/cm², <i>p</i> < 0.01), and had reduced mastectomy weights (452.1 versus 652.0 g, <i>p</i> < 0.01) and flap weights (348.7 versus 683.5 g, <i>p</i> < 0.01). Hybrid patients had fewer clinically significant readmissions after discharge (1 versus 15, <i>p</i> = 0.02). No significant differences were found for length of stay of index admission (<i>p</i> = 0.56) or returns to the operating room upon index admission (<i>p</i> = 0.64). No implant or ADM extrusions occurred in the hybrid cohort.</p><p><strong>Conclusion: </strong>Hybrid microsurgical breast reconstruction is a safe and reliable method to enhance core projection and volume.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"732-740"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258341","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":"Reliability and Efficacy of Microvascular Coupler Devices for End-to-Side Venous Anastomosis in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Jisu Kim, Kyeong-Tae Lee","doi":"10.1055/a-2702-4335","DOIUrl":"10.1055/a-2702-4335","url":null,"abstract":"<p><strong>Background: </strong>While the efficacy of coupling devices in venous anastomosis has been well-studied, most evidence focuses on end-to-end techniques. In head and neck reconstruction, end-to-side (ETS) venous anastomoses involving the internal/external jugular vessels are common, yet evidence for using couplers in this context is limited. This study systematically evaluates the reliability and efficacy of couplers versus the hand-sewn method for ETS venous anastomosis in head and neck reconstruction.</p><p><strong>Methods: </strong>A literature search was conducted for articles reporting outcomes of ETS anastomosis in head and neck reconstruction. Studies were divided into two groups based on the anastomosis method: Hand-sewn and couplers. Pooled analysis was performed to compare the outcomes between the two groups. Using double-arm studies reporting outcomes for both methods, meta-analysis was conducted.</p><p><strong>Results: </strong>Forty studies representing 2,664 cases were included, with 663 using couplers and 2,001 using hand-sewn methods. Most studies were retrospective cohorts. In the pooled analysis, the venous thrombosis rate was 1.8% for hand-sewn anastomoses and 2.5% for couplers, while the flap failure rate was 2.5% for hand-sewn and 1.9% for couplers, with no significant differences in either outcome. Meta-analysis based on four studies showed comparable venous thrombosis rates between the two groups. Anastomosis time was significantly shorter with couplers (standardized mean difference -3.93, <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>ETS venous anastomosis using a coupler device in head and neck reconstruction seems to be as safe as the hand-sewn method and may offer time-saving benefits. However, additional well-designed studies are needed to confirm these findings.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"631-639"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080991","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 Obesity on Surgical and Patient-Reported Outcomes Following Immediate Lymphatic Reconstruction.","authors":"Abbas M Hassan, John P Hajj, John P Lewis, Carla S Fisher, Folasade O Imeokparia, Kandice K Ludwig, Rachel M Danforth, R Jason VonDerHaar, Ravinder Bamba, Mary E Lester, Aladdin H Hassanein","doi":"10.1055/a-2717-5063","DOIUrl":"10.1055/a-2717-5063","url":null,"abstract":"<p><strong>Background: </strong>While obesity is a known risk factor for developing breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND), its impact on outcomes of immediate lymphatic reconstruction (ILR) is yet to be elucidated. The purpose of this study is to assess the influence of obesity on BCRL incidence and patient-reported outcomes following ILR.</p><p><strong>Methods: </strong>We retrospectively studied consecutive patients who underwent ILR following ALND between 2017 and 2024 across a university hospital system. BCRL prevalence and condition-specific (LYMPH-Q) quality-of-life performance were compared and correlated via multivariable regression.</p><p><strong>Results: </strong>We identified 172 patients (mean body mass index [BMI]: 29.5 ± 6.9 kg/m²) with 72 patients (41.9%) categorized as obese (BMI ≥ 30). BCRL incidence was 7.0% with no significant difference between groups (obese, 8.3% vs. nonobese, 6.0%; <i>p</i> = 0.553). In adjusted models, obesity was not associated with higher risk of BCRL (OR, 0.90; 95% CI, 0.23-3.47; <i>p</i> = 0.875), surgical complications (OR, 1.18; 95% CI, 0.50-2.74, <i>p</i> = 0.708) or unplanned reoperation (OR, 0.72; 95% CI, 0.29-1.80, <i>p</i> = 0.479). However, obese patients showed significantly lower mean scores in the LYMPH-Q symptom scale (66.7 ± 27.7 vs. 84.7 ± 16.8, <i>p</i> = 0.004) when compared with nonobese patients. In adjusted models, obesity was associated with independently lower LYMPH-Q symptom scores (-13.8; 95% CI, -26.7 to -0.81; <i>p</i> = 0.038).</p><p><strong>Conclusion: </strong>ILR mitigated the risk of BCRL associated with obesity following ALND. However, obesity remained associated with significantly worse patient-reported lymphedema symptom burden following ILR. These findings highlight a dissociation between objective risk reduction and subjective symptom burden, underscoring the need for integrated assessment and targeted symptom management protocols.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"711-718"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13022778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Utility of Superficial Circumflex Iliac Perforator versus Superficial Circumflex Iliac Artery Flaps in Pediatric Reconstructive Surgery.","authors":"Noelle Garbaccio, Dorien I Schonebaum, Jade E Smith, Justin J Cordero, Lacey Foster, Morvarid Mehdizadeh, Arriyan S Dowlatshahi, Samuel J Lin","doi":"10.1055/a-2717-4139","DOIUrl":"10.1055/a-2717-4139","url":null,"abstract":"<p><strong>Background: </strong>The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for revision, advantages well-suited to pediatric patients. Despite documented success in adults, the safety and utility of SCIP and SCIA-f are underexplored in pediatric populations.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases identified 93 articles reporting SCIP/SCIA-f outcomes in patients ≤ 17 years of age. Patient demographics, clinical characteristics, and postoperative outcomes were collected. Cohorts were stratified by SCIP/SCIA and age group. Mann-Whitney U tests compared cohort outcomes.</p><p><strong>Results: </strong>Thirty-one studies were included, constituting 107 SCIA-f and 57 SCIP-f, with ages 10 weeks to 17 years. Most cases were congenital or traumatic defects in upper/lower extremities. Compared with SCIA-f, SCIP-f demonstrated significantly lower rates of all-cause complications, total flap loss, major and minor complications, and debulking (<i>p</i> < 0.05). All-cause complication rates were also significantly lower across age groups (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates favorable efficacy and safety of SCIP-f in children with congenital and traumatic defects, especially of the extremities. SCIP-f may be considered a reliable option for pediatric reconstruction. Additionally, fewer subsequent procedures for contouring may be required.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"700-710"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541227","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 Effect of BMI on the Image Quality of CTA Scans for DIEP Flap Breast Reconstruction.","authors":"Noah C O Terng, Tessa M Kos, Marc A M Mureau, Daniel Bos, Eveline M L Corten","doi":"10.1055/a-2943-3564","DOIUrl":"10.1055/a-2943-3564","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography angiography (CTA) imaging is currently the gold standard for the preoperative planning of deep inferior epigastric perforator (DIEP) flap breast reconstruction. Limited research has been performed on the effect of body mass index (BMI) on CTA image quality. Hence, we evaluated the association between BMI and CTA image quality.</p><p><strong>Methods: </strong>To investigate the association between BMI and image quality, the image quality of 100 CTA scans was scored on a 5-point Likert scale for five different perforator aspects: caliber, location of fascia penetration, intramuscular course, intramuscular branching, and subcutaneous branching. Ordinal regression was performed to determine the effect of BMI on the image quality of the scans.</p><p><strong>Results: </strong>Image quality was scored highest for the subcutaneous branching with a mean score of 3.99 (standard deviation [SD]: 0.64), while the intramuscular branching showed the lowest scores with a mean of 3.35 (SD: 0.82). A higher BMI was associated with a statistically significant lower image quality regarding the assessment of the intramuscular course and intramuscular branching of the perforator, with a regression coefficient of - 0.648 and - 0.801, respectively.</p><p><strong>Conclusion: </strong>A higher BMI was associated with lower image quality with respect to the assessment of the intramuscular course and intramuscular branching in CTA scans for the preoperative planning of DIEP flap breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969407","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 Versatile ORAM Flap: A Microsurgeon's Pedicled Flap for Perineal Reconstruction Compared with the Reported VRAM Outcomes.","authors":"Amir Dehdashtian, Geoffrey E Hespe, Theodore A Kung","doi":"10.1055/a-2968-4536","DOIUrl":"https://doi.org/10.1055/a-2968-4536","url":null,"abstract":"<p><strong>Background: </strong>Abdominoperineal resection (APR) and pelvic exenteration create large, frequently irradiated three-dimensional defects with expectedly high complication rates. The oblique rectus abdominis myocutaneous (ORAM) flap offers an articulated skin paddle with variable thickness with the potential for muscle-sparing harvest. We report our experience using ORAM flaps for pelvic, perineal, and vaginal reconstruction following oncologic resection.</p><p><strong>Methods: </strong>We conducted a retrospective review of consecutive patients undergoing ORAM flap reconstruction after APR or pelvic exenteration (July 2016-September 2025). Demographics, oncologic treatments, operative details, and outcomes were abstracted. Primary outcomes were flap survival, recipient and donor site complications, and reoperation. Subgroup analysis examined risk factors for complications and whether vaginal reconstruction was performed.</p><p><strong>Results: </strong>A total of 26 patients underwent ORAM reconstruction. The cohort was predominantly female (73%) with a mean age of 58.2 years and BMI 27.5 kg/m². Ninety-two percent of patients received neoadjuvant radiation. Most reconstructions used pedicled ORAM flaps (96%) whereas in one case a free ORAM flap was used. Median follow-up was 3.2 months. Complete flap loss occurred in 1 patient (4%) and partial necrosis in 2 patients (8%). Recipient site delayed healing occurred in 35% and donor site delayed healing in 31%. Risk stratification showed higher complication rates among current smokers (recipient site 67%; donor site 83%) and patients with BMI >30 kg/m² (recipient site 71%; donor site 57%). In 18 patients requiring vaginal reconstruction, the thinner distal skin paddle enabled creation of a neovaginal vault with favorable early functionality.</p><p><strong>Conclusions: </strong>The ORAM flap provides reliable and versatile flap for reconstruction of large pelvic defects after cancer extirpation. The articulated design with proximal soft tissue bulk for filling dead space and thinner distal skin for lining, facilitates simultaneous pelvic, perineal, and vaginal reconstruction. Careful attention to perforator number and preoperative risk modification may further optimize outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062106","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 Immediate Lymphatic Reconstruction after Breast Cancer Surgery: A Systematic Review and Time-course Dynamics Meta-analysis.","authors":"Hong-Jie Chang, Kuan-Yu Chen, Wen-Kuan Chiu, Khanh Dinh Hoang, Tun-Wen Pai, Chin-Yu Sun, Chiehfeng Chen","doi":"10.1055/a-2943-3724","DOIUrl":"10.1055/a-2943-3724","url":null,"abstract":"<p><strong>Background: </strong>Immediate lymphatic reconstruction (ILR) is a prophylactic approach for breast cancer-related lymphedema (BCRL) following axillary lymph node dissection (ALND). This study assessed the preventive effect of ILR by evaluating data from prior studies, with a focus on time-course dynamics.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed of 17 studies comparing ALND plus ILR with ALND alone. The primary outcome was BCRL incidence. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were stratified by follow-up duration (1-48 months).</p><p><strong>Results: </strong>ILR significantly reduced BCRL incidence (RR: 0.37; 95% CI: 0.28-0.49). Time-stratified analysis indicated that the prophylactic effect was robust within the first 2 years postoperatively, peaking at 12 months (RR: 0.13; 95% CI: 0.04-0.46). Limited data beyond 2 years necessitates further studies to clarify long-term results.</p><p><strong>Conclusion: </strong>ILR reduces BCRL risk, remaining a valuable preventive strategy for breast cancer patients. This benefit remains unclear in the long term, highlighting the need for further high-quality trials with extended surveillance.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812190","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":"Operative-Time Gradients Reveal Miscalibration in Microsurgical Risk Prediction.","authors":"Shaan Sekhon, Miracle Uzoekwe, Casey Tompkins-Rhoades, Angelica McDaniel, Hiteshi Patel, Minh Trinh, Scott L Hansen","doi":"10.1055/a-2943-3902","DOIUrl":"10.1055/a-2943-3902","url":null,"abstract":"<p><strong>Background: </strong>General surgical risk models support perioperative counselling, but acceptable overall calibration may conceal clinically important error. We evaluated generalized American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) predictions after microsurgical reconstruction and tested whether morbidity calibration varied across operative time.</p><p><strong>Methods: </strong>Adult ACS NSQIP cases from 2014 to 2023 were analyzed. Plastic-surgery-service cases meeting exact principal Current Procedural Terminology (CPT) or principal-procedure-text criteria formed the primary cohort. Performance was assessed using observed-to-expected (O:E) ratios, discrimination, and calibration measures. Operative-time calibration was examined by quartiles, deciles, and continuous spline models. Sensitivity analyses used exact principal CPT codes alone and excluded cases with a known morbidity component or reoperation on postoperative day 0 or 1.</p><p><strong>Results: </strong>Among 20,604 microsurgery cases, observed and predicted morbidity were similar overall (12.52 vs. 12.79%; O:E, 0.98; 95% confidence interval [CI], 0.94-1.02), although discrimination was modest (area under the receiver operating characteristic curve, 0.639; 95% CI, 0.627-0.651). Mortality was uncommon (21 deaths; O:E, 0.81; 95% CI, 0.50-1.24). Aggregate calibration concealed a graded reversal across operative time. Morbidity was overpredicted in the shortest quartile (8.66% observed vs. 12.87% predicted; O:E, 0.67; 95% CI, 0.61-0.74) and underpredicted in the longest quartile (16.94 vs. 12.96%; O:E, 1.31; 95% CI, 1.22-1.40). The prespecified linear interaction was nonsignificant (<i>p</i> = 0.183), whereas flexible continuous analyses demonstrated calibration variation before and after global recalibration (both <i>p</i> < 0.001). Findings persisted in both sensitivity analyses.</p><p><strong>Conclusion: </strong>Generalized ACS NSQIP morbidity prediction was accurate in aggregate but systematically miscalibrated across the operative-time gradient, overestimating risk in shorter operations and underestimating it in longer operations. Realized operative time should be interpreted as a postoperative marker of incompletely captured procedural complexity and intraoperative course, not as a causal exposure or preoperative predictor.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794675","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":"International Perspectives on Contralateral C7 Transfer for Brachial Plexus Injuries.","authors":"R Llewellyn Thomas, Chaia Geltser, Tommy Nai-Jen Chang, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.1055/a-2943-3677","DOIUrl":"10.1055/a-2943-3677","url":null,"abstract":"<p><strong>Background: </strong>The use of contralateral C7 (CC7) transfer for brachial plexus injury (BPI) varies considerably across geographic regions and surgical specialties. This study aimed to investigate international variation in the adoption of CC7 transfer and identify factors associated with differences in clinical practice.</p><p><strong>Methods: </strong>A questionnaire was distributed to an international cohort of brachial plexus surgeons to evaluate current use of CC7 transfer, training background, practice characteristics, and factors influencing clinical decision-making. Responses were analyzed according to geographic region and surgical specialty.</p><p><strong>Results: </strong>A total of 160 attending surgeons completed the survey, of whom 45.6% performed CC7 transfer. Adoption was highest in Asia and lower in Europe and the Americas. Reasons for non-use varied by region, with lack of prior exposure reported most frequently in North and South America, whereas lack of peer acceptance was more common in Europe. Adoption also varied by specialty, with use reported by 56% of orthopedic surgeons, 53% of hand surgeons, 40% of plastic surgeons, and 30% of neurosurgeons. Prior exposure to CC7 was strongly associated with its use, although 28% of surgeons with previous exposure did not perform the procedure.</p><p><strong>Conclusion: </strong>Substantial geographic and specialty-specific variation exists in the adoption of CC7 transfer. Practice patterns appear to be influenced by multiple factors, including prior exposure, perceived efficacy, peer culture, and local practice patterns. These findings provide insight into the international variation in CC7 adoption and support further investigation into the factors underlying both its use and non-use.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794698","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}