Journal of reconstructive microsurgery最新文献

{"title":"Robotic DIEP Flap Surgery: The Need for a Balanced Discussion of Intra-Abdominal Risks and Outcomes.","authors":"Raymund E Horch, Andreas Arkudas","doi":"10.1055/a-2690-9728","DOIUrl":"10.1055/a-2690-9728","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"e1-e2"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958328","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":"Keep Your Friends Close and Your Teammates Closer: The Impact of Staffing with Familiar Personnel in Microsurgical Breast Reconstruction.","authors":"Pranav N Haravu, Jenny A Foster, Brett T Phillips","doi":"10.1055/a-2717-4665","DOIUrl":"10.1055/a-2717-4665","url":null,"abstract":"<p><strong>Background: </strong>Microsurgical breast reconstruction is intraoperatively complex. Evidence of standardized workflows improving outcomes exists, but the impact of staffing cases with familiar personnel is not documented.</p><p><strong>Methods: </strong>All microsurgical breast reconstructions (July 2021-June 2024) at our institution were analyzed for staff familiarity at granular time intervals (T₀: setup to incision, T₁-T₃: each third of procedure). Staff were deemed \"unfamiliar\" if they staffed <2 microsurgical breast reconstructions with the attending in past 4 months. Intraoperative setbacks included anastomotic revisions, vessel damage, switching recipient vessels, or mastectomy flap defect. Major complications included operative takeback or flap loss.</p><p><strong>Results: </strong>Among 291 surgeries (5 attendings, 2 hospitals), 35.1% were immediate, 77.3% used standard hemiabdominal DIEP flaps, 58.4% were bilateral, and 49.5% had prior radiation. Intraoperative setbacks occurred in 19.7%, major complications in 7.4%, average duration was 631.6 minutes, and supply costs averaged $5,216. Unfamiliar scrub-techs correlated with increased intraoperative setbacks (OR: 2.11, <i>p</i> < 0.05), particularly in early time intervals (T₁: 1.91, <i>p</i> = 0.06; T₂: 2.09, <i>p</i> < 0.05). Unfamiliar circulators correlated with increased supply costs (+12.2%, <i>p</i> < 0.05), especially in later time intervals (T₂: +12.2%, <i>p</i> < 0.05; T₃: +16.0%, <i>p</i> < 0.05). In addition to staff familiarity, at univariate level, intraoperative setbacks also correlated with prior radiation (<i>p</i> < 0.05), duration correlated with laterality, immediate reconstructions, mastectomy type, and anastomoses (<i>p</i> < 0.05), and costs correlated with anastomoses (<i>p</i> < 0.05). Multivariate analysis confirmed unfamiliar scrub-techs and circulators were significantly correlated with increased intraoperative setbacks and higher costs (<i>p</i> < 0.05), with a trend toward longer duration (<i>p</i> = 0.06).</p><p><strong>Conclusion: </strong>In microsurgical breast reconstruction, unfamiliar teams correlated with increased intraoperative setbacks, costs, and durations. Adjusting staffing models to prioritize familiarity may provide medical, financial, and logistical benefits.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"602-611"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275020","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":"An Algorithmic Approach to Arterial Coupler Use in Microsurgical Breast Reconstruction: Comparison with Hand-Sewn Sutures.","authors":"Hyung Bae Kim, Hyun Il Kang, Hyun Ho Han, Jin Sup Eom","doi":"10.1055/a-2751-8780","DOIUrl":"10.1055/a-2751-8780","url":null,"abstract":"<p><strong>Background: </strong>Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures.</p><p><strong>Methods: </strong>A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (<i>n</i> = 62) and a hand-sewn suture group (<i>n</i> = 43). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed.</p><p><strong>Results: </strong>Patients in the coupler group were younger (47.6 ± 8.6 vs. 53.0 ± 7.9 years, <i>p</i> = 0.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, <i>p</i> = 0.025). Microanastomosis time was significantly shorter with couplers (19.6 ± 8.9 vs. 26.1 ± 6.5 minutes, <i>p</i> < 0.01). Flap survival was comparable between groups (96.8% vs. 100%, <i>p</i> = 0.512). Complication rates, including arterial/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure.</p><p><strong>Conclusion: </strong>Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"541-547"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596790","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":"Patient Demographics Associated with Latissimus Dorsi Muscle Dimension for Flap Coverage Planning.","authors":"Sophia Jacobi, Omer Sadeh, Emily Davidovic-Katz, Samara Moll, Janos Barrera, Jacques H Hacquebord","doi":"10.1055/a-2717-4556","DOIUrl":"10.1055/a-2717-4556","url":null,"abstract":"<p><strong>Background: </strong>The latissimus dorsi (LD) is a common workhorse flap used in reconstructive surgery to cover large wound defects. Estimating the area of possible coverage is necessary for preoperative planning and surgical success. The aim of this study is to investigate the relationship between patient factors and the measurable dimensions of the LD flap in order to inform more personalized preoperative planning and evidence-based flap selection.</p><p><strong>Methods: </strong>This is a retrospective study of individuals who underwent computed tomography (CT) angiography of the chest and abdomen. Patient demographics - height, age, sex, and body mass index (BMI) were collected. The primary outcome was the dimensions of the LD muscle edges and length of the thoracodorsal pedicle measured on CT. Multivariable linear regression was performed to determine the independent effects of patient demographics on the dimensions of the LD muscle.</p><p><strong>Results: </strong>A total of 50 patients were included in this study. Patient demographics were significantly associated with all LD muscle dimensions. The length of the vascular pedicle was 9.502 ± 1.281 cm and was significantly associated with height (<i>p</i> < 0.001). Patient demographics had a strong correlation (<i>r</i> = 0.957) with this length. The average wound defect area the LD can cover was 209.99 cm² (range: 114.24-312.40 cm²). This area increases or decreases by 1.498 cm² per centimeter change in a patient's height (<i>p</i> = 0.011).</p><p><strong>Conclusion: </strong>An understanding of how patient factors are associated with LD muscle dimensions is critical for preoperative planning and surgical success. Our study found that height, BMI, age, and sex all have associations with the dimensions of the LD muscle. As well, height is strongly correlated with the length of the thoracodorsal vascular pedicle, influencing the possible rotation arc of the flap.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"612-618"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275010","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":"Clinical Scenarios Using Thoracodorsal and Lateral Thoracic Vessels Versus Internal Mammary Vessels in Bipedicled Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Comparative Study.","authors":"Chia-Fang Chen, David Chon-Fok Cheong, Wen-Ling Kuo, Chi-Chang Yu, Hsu-Huan Chou, Shin-Cheh Chen, Jung-Ju Huang","doi":"10.1055/a-2717-4996","DOIUrl":"10.1055/a-2717-4996","url":null,"abstract":"<p><strong>Background: </strong>Autologous breast reconstruction using the bipedicled deep inferior epigastric perforator (DIEP) flap poses unique challenges in Asian patients with a low BMI and limited donor volume. While internal mammary vessels (IMA/Vs) remain the standard recipient site, the rise of minimally invasive mastectomy has limited access to IMA/Vs. This study compared the results of thoracodorsal and lateral thoracic vessels (lateral-based) versus IMA/Vs (medial-based) in bipedicled DIEP flap breast reconstruction.</p><p><strong>Methods: </strong>A retrospective review was conducted on 62 patients who underwent bipedicled DIEP flap reconstruction between 2018 and 2023 by a single senior surgeon. Patients were stratified by incision placement and recipient vessel choice into medial- and lateral-based groups. Clinical outcomes, complication rates, and long-term aesthetic results were analyzed.</p><p><strong>Results: </strong>Despite a higher re-exploration rate in the lateral-based group (12.5% versus 4.5%; <i>p</i> = 0.298), flap survival was comparable between the groups. Fat necrosis rates were lower in flaps without re-exploration (5.4%) and increased significantly following compromised perfusion (33.3%). The lateral-based group achieved superior aesthetic outcomes in breast shape (<i>p</i> = 0.043) and scar visibility (<i>p</i> < 0.001), with a reduced need for secondary fat grafting. Dual vascular sources provided more reliable perfusion and improved long-term fat survival, although further validation with perfusion imaging is warranted.</p><p><strong>Conclusion: </strong>The lateral-based approach, despite technical challenges, is a viable alternative to the medial-based method in certain patients, offering reliable perfusion and superior aesthetic outcomes with fewer revisions. An algorithmic approach to recipient vessel selection can optimize outcomes of bipedicled DIEP flap reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"566-574"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390622","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":"Local Capacity Building, Constraints, and Microsurgical Reconstruction in a Low-Resource Country: A Cross-sectional Study of Surgeons.","authors":"Olayinka A Olawoye, Fernando Mijares-Diaz, Samuel A Ademola, Ayodele O Iyun, Afieharo I Michael, Rotimi O Aderibigbe, Odunayo M Oluwatosin, Adeyemi A Ogunleye","doi":"10.1055/a-2717-3772","DOIUrl":"10.1055/a-2717-3772","url":null,"abstract":"<p><strong>Background: </strong>While the need for reconstructive microsurgical procedures has increased across the developing world, several constraints in low- and middle-income settings prevent its consistent performance. Our study aimed to understand the impact of microsurgery training on local capacity in a low-income setting, and to understand limitations that may affect long-term build-up of microsurgical capacity.</p><p><strong>Methods: </strong>Cross-sectional study evaluating survey responses of trainees and surgeons who participated in a Flap Transfer and Microsurgery course held in Ibadan, Nigeria. The survey consisted of a pre- and postcourse questionnaire, and a 2-year posttraining survey. The questionnaire sought to assess training impact on microsurgical capacity and limitations at each participants institution. Fourteen surgeons completed all questionnaires and were included in the study.</p><p><strong>Results: </strong>Thirteen (92.3%) participants had encountered at least one defect requiring microvascular surgery within 2 years of the training, and 9 (69.2%) reported having performed at least one surgery. Most surgeons indicated having performed less procedures than needed across all defect anatomical site/etiology. The most common limitation reported by participants consisted of man-power shortage (78.6%), followed by expense of each procedure, difficulty procuring materials, and trainers with limited experience.</p><p><strong>Conclusion: </strong>There is a significant need for microsurgical reconstruction in sub-Saharan Africa, with varied local challenges preventing consistent delivery of microsurgical care. The analysis complements previous literature on microsurgical care in developing countries and highlights significant constraints preventing widespread adoption and the role of local training opportunities that help in building long-term local capacity.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"625-630"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377562","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":"Single Port Robotic Vascularized Omental Lymph Node Transfer for Lymphedema: A Novel Comparison to Open Technique.","authors":"Jonathan L Jeger, Lyndsay Kandi, Johnny Yi, W Nicholas Jungbauer, Chad M Teven, William J Casey, Alanna Rebecca","doi":"10.1055/a-2717-4610","DOIUrl":"10.1055/a-2717-4610","url":null,"abstract":"<p><strong>Background: </strong>The da Vinci Single-Port (SP) system is a robotic surgery platform that allows access into the abdominal cavity through a single short surgical incision. The omentum is an attractive donor site for vascularized omental lymph node transfer (VOLT) in the treatment of lymphedema. We hypothesize that SP robotic VOLT will allow for improvement in perioperative outcomes as compared to open laparotomy for omental flap harvest.</p><p><strong>Methods: </strong>A retrospective cohort study was performed, comprised of a study sample of patients with a diagnosis of lymphedema who presented to our institution for VOLT using either an open or SP robotic technique between May 2020 and February 2023. The primary outcome was length of hospital stay. The secondary outcomes included intraoperative complication rate, postoperative complication rate, and length of surgery.</p><p><strong>Results: </strong>Fifteen patients underwent da Vinci SP omental flap harvest, and 14 patients underwent open harvest. There was no significant difference in average age, BMI, sex, or lymphedema etiology between the two groups. Average length of stay was 2.2 ± 1.7 days in the SP group and 2.3 ± 2.1 days in the open group (<i>p</i> = 0.91). There were no significant differences in terms of intraoperative or postoperative complications between the two groups. Ninety-three percent of SP robotic and 86% of open patients reported at least partial subjective improvement following VOLT (<i>p</i> = 0.50).</p><p><strong>Conclusion: </strong>Our findings suggest that SP robotic omental harvest for VOLT is feasible. Perioperative outcomes show comparable results in terms of length of hospital stay, complications, and subjective postoperative improvement when comparing the open to the SP approach.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"589-595"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275034","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":"Relative Donor Site Morbidity and Complication Rates of Gracilis Myocutaneous and Muscle Flaps in Reconstructive Surgery.","authors":"Walter D Sobba, Sydney Thai, Janos A Barrera, Samuel R Montgomery, Nikhil A Agrawal, Jamie P Levine, Jacques H Hacquebord","doi":"10.1055/a-2717-3666","DOIUrl":"10.1055/a-2717-3666","url":null,"abstract":"<p><strong>Background: </strong>The gracilis flap is a versatile muscle flap that can be utilized as a muscle-only or myocutaneous flap for soft tissue coverage, as well as for reconstruction of facial animation or extremity function. Few studies have compared donor site complications of free and pedicled gracilis flaps, including the effect of skin paddle harvest on donor site morbidity.</p><p><strong>Methods: </strong>We performed a retrospective review of patients who underwent a free or pedicled gracilis flap at our institution from 2013 to 2023. Gracilis flaps were categorized as: pedicled gracilis muscle flaps, free gracilis muscle flaps, and free gracilis myocutaneous flaps. Outcome variables were duration of drain placement and complications, including seroma, hematoma, infection, dehiscence, and persistent numbness.</p><p><strong>Results: </strong>We identified 128 gracilis flaps, including 19 free myocutaneous flaps, 35 free muscle flaps, and 74 pedicled muscle flaps. Free myocutaneous flaps required longer drain placement as compared to free muscle flaps or pedicled flaps (13.6 days vs. 8.4 days vs. 7.4 days, respectively, <i>p</i> = 0.002). Free myocutaneous flaps displayed a higher complication rate (36.8%) as compared to pedicled muscle flaps (10.8%) or free muscle flaps (11.4%, <i>p</i> = 0.020). After adjusting for age, BMI, and ASA status, free myocutaneous flaps demonstrated higher odds of major donor site complications as compared to pedicled muscle flaps (OR: 1.23, <i>p</i> < 0.001), while free muscle flaps were not associated with increased odds of major complications (OR: 1.08, <i>p</i> = 0.117). Of the documented complications, the most common were surgical site infection (36.8%), hematoma (21.1%), and seroma (21.1%).</p><p><strong>Conclusion: </strong>The inclusion of a skin paddle during gracilis flap harvest is associated with increased duration of drain placement and donor site complications, including surgical site infection, hematoma, and seroma. These factors should be carefully considered in the context of patients' reconstructive needs and other risk factors.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"596-601"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275026","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":"Quantitative Preoperative Peroneal Vessel Assessment in Fibula Free Flap Surgery.","authors":"Evan Rothchild, Neginder Saini, Isabelle T Smith, Jina Yom, Joseph A Ricci","doi":"10.1055/a-2717-4909","DOIUrl":"10.1055/a-2717-4909","url":null,"abstract":"<p><strong>Background: </strong>Fibula free flap (FFF) surgery complications can arise from vascular disease within the donor peroneal artery. Computed tomography angiography (CTA) has become standard for preoperative evaluation. However, current methods rely on qualitative assessments to determine surgical eligibility. This study aims to improve preoperative risk evaluation by implementing two quantitative scoring systems, the Bollinger score and the lower limb arterial calcification score (LLACS), assessing distinct vascular health components. The Bollinger score quantifies intraluminal stenosis caused by atherosclerotic plaques, while the LLACS quantifies arteriosclerosis by evaluating calcification within the arterial walls.</p><p><strong>Methods: </strong>A retrospective review was conducted on all head and neck microvascular FFF procedures performed at a university-affiliated tertiary care center between August 2021 and March 2023. Data collected included patient demographics, medical history, operative details, and postoperative complications (infection, hematoma, seroma, fistula, dehiscence, or flap failure) within 90 days. Peroneal artery Bollinger scores and crural segment LLACSs from the donor lower extremity were calculated from preoperative CTAs.</p><p><strong>Results: </strong>A total of 117 patients were included. Increasing Bollinger scores were significantly associated with an increased risk of complications and longer hospital stays, even after controlling for potential confounders. Combining both scores improved risk stratification, with high-risk patients experiencing an 8.36-fold higher risk of complications.</p><p><strong>Conclusion: </strong>Our findings suggest that quantitative preoperative peroneal vessel assessment improves risk stratification for patients undergoing FFF surgery. These scoring systems may enhance patient selection and guide strategies to minimize postoperative complications. Integrating multiple scoring systems is key to the comprehensive assessment of vascular health.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"582-588"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275076","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":"Simultaneous Microsurgery During Bilateral Autologous Breast Reconstruction Reduces Ischemia Time Without Increasing Complications.","authors":"Jacquelyn M Roth, Maxwell Godek, Jamie Frost, Bernice Yu, Ethan Fung, Hani Sbitany, Jordan M S Jacobs, Steven M Sultan, Rebecca Suydam, Peter W Henderson","doi":"10.1055/a-2702-4108","DOIUrl":"10.1055/a-2702-4108","url":null,"abstract":"<p><strong>Background: </strong>In bilateral deep inferior epigastric perforator (DIEP) flap reconstruction procedures, the microsurgical anastomoses are usually performed consecutively, where one side is completed before the other side is started. However, when a co-surgeon model and loupe magnification are used, it is possible to perform both sides simultaneously. This study assesses the implications of simultaneous versus consecutive microsurgery on ischemia time and postoperative outcomes in bilateral DIEP flap reconstruction.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on bilateral DIEP flap breast reconstruction patients between 2017 and 2023. Ischemia time was used to categorize the microsurgical anastomosis, with an overlap of 10 or more minutes between sides classified as \"simultaneous microsurgery,\" and an overlap of less than 10 minutes classified as \"consecutive microsurgery.\" Data were collected on patient demographics, total ischemia time (total time when one or both sides of the abdomen were undergoing microsurgical anastomoses), total operating time, postoperative complications, 90-day postoperative events, hospital length of stay (LOS), and morphine milligram equivalents (MME) required for pain management. Regression analyses assessed the impact of simultaneous versus consecutive microsurgery on key outcomes. Statistical significance was set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Seventy-four patients met the inclusion criteria for this study. Thirty-one (42%) had undergone simultaneous microsurgery, and 43 (58%) had undergone consecutive microsurgery. There were no significant differences between the two groups in age, body mass index (BMI), race, ethnicity, or baseline comorbidities. Univariate analysis revealed a statistically significant reduction in total ischemia time associated with simultaneous microsurgery (111 minutes vs. 147 minutes; <i>p</i> < 0.001), and no differences in total operating time, complications, 90-day postoperative events, LOS, or MME. These findings were unchanged on multivariate regression controlling for age, BMI, comorbidities, and flap weight.</p><p><strong>Conclusion: </strong>Simultaneous microsurgery during bilateral DIEP flap reconstruction significantly reduces total ischemia time without increasing complications, hospital LOS, or pain management requirements.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"559-565"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081025","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}