Journal of reconstructive microsurgery最新文献

{"title":"Does Side Matter? The Impact of Free Flap Harvest Laterality on Ambulatory Function in Lower Extremity Traumatic Reconstruction.","authors":"Tayla Moshal, Idean Roohani, Eloise W Stanton, Paige K Zachary, Elizabeth Boudiab, Jessica Lo, Emily Markarian, Joseph N Carey, David A Daar","doi":"10.1055/s-0044-1787181","DOIUrl":"10.1055/s-0044-1787181","url":null,"abstract":"<p><strong>Background: </strong> Free flaps are essential for limb salvage in patients with lower extremity (LE) trauma; however, significant donor-site morbidity could impact functional outcomes. This study compares postoperative ambulatory function between contralateral and ipsilateral free flap harvest in LE traumatic reconstruction.</p><p><strong>Methods: </strong> A retrospective review was performed on patients who underwent LE reconstruction at a level 1 trauma center from 2009 to 2022. Flap characteristics, injury history, and ambulatory function were collected. Flap harvest laterality was determined in relation to the injured leg. The flaps were categorized as either fasciocutaneous or those that included a muscle component (muscle/myocutaneous). Chi-squared and Mann-Whitney tests were used for statistical analysis.</p><p><strong>Results: </strong> Upon review, 173 LE free flaps were performed, of which 70 (65.4%) were harvested from the ipsilateral leg and 37 (34.6%) were from the contralateral leg. Among all LE free flaps, the limb salvage rate was 97.2%, and the flap survival rate was 94.4%. Full ambulation was achieved in 37 (52.9%) patients in the ipsilateral cohort and 18 (48.6%) in the contralateral cohort (<i>p</i> = 0.679). The average time to full ambulation did not vary between these cohorts (<i>p</i> = 0.071). However, upon subanalysis of the 61 muscle/myocutaneous flaps, the ipsilateral cohort had prolonged time to full ambulation (6.4 months, interquartile range [IQR]: 4.8-13.5) compared with the contralateral one (2.3 months, IQR: 2.3 [1.0-3.9]) <i>p</i> = 0.007. There was no significant difference in time to full ambulation between flap harvest laterality cohorts among the fasciocutaneous flaps (<i>p</i> = 0.733).</p><p><strong>Conclusion: </strong> Among free flaps harvested from the ipsilateral leg, fasciocutaneous flaps were associated with faster recovery to full ambulation relative to muscle/myocutaneous flaps. Since harvesting muscle or myocutaneous flaps from the ipsilateral leg may be associated with a slower recovery of ambulation, surgeons may consider harvesting from a donor site on the contralateral leg if reconstruction requires a muscle component.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"53-62"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183831","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 and Technical Considerations in Fascicular Nerve Transfers for Foot Drop.","authors":"Mitchel Seruya","doi":"10.1055/a-2287-6446","DOIUrl":"10.1055/a-2287-6446","url":null,"abstract":"<p><strong>Background: </strong> Foot drop is the common endpoint for a diverse set of nerve injuries, affecting over 128,000 in the United States each year. The level of injury, finite pace of regeneration, and/ exponential decay in the percentage of motor end-plates reinnervated over time may explain the limited success with natural recovery. Past nerve techniques have also been met with limited success.</p><p><strong>Methods: </strong> This narrative review explores why past nerve techniques have failed to correct foot drop.</p><p><strong>Results: </strong> Previously described nerve transfer techniques suffer from incompletely balancing the foot and ankle, poor donor-target nerve synergy, and/or not effectively bypassing the wide and oftentimes underappreciated zone of injury. For maximal stability, one should look to balance the foot in both dorsiflexion and eversion. Detailed descriptions and illustrations of the branching anatomy for the peroneal and tibial nerves are provided, with specific application to nerve transfer reconstruction.</p><p><strong>Conclusion: </strong> Based on an understanding of why past nerve techniques have failed to correct foot drop, a set of surgical principles can be codified to optimize functional outcomes. A surgical technique should be versatile enough to address foot drop from any of the three common pathways of injury (lumbar spine, sciatic nerve, and common peroneal nerve). With increasing familiarity using this once poorly understood anatomical region, limitations with past nerve transfer techniques may be overcome.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"19-27"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131704","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":"Volumetric Analysis of a Novel Chimeric Gracilis and Profunda Artery Perforator Flap.","authors":"Nicole R Van Spronsen, Jacob B Hammond, Alexander T Plonkowski, Clint E Jokerst, Jonathan A Flug, Max A Shrout, Edward M Reece, William J Casey, Alanna M Rebecca","doi":"10.1055/a-2320-5489","DOIUrl":"10.1055/a-2320-5489","url":null,"abstract":"<p><strong>Background: </strong> The presence of a chimeric gracilis and profunda artery perforator (PAP) flap with a common arterial pedicle has been demonstrated on computed tomography angiography in up to 59% of patients and confirmed in a cadaveric model. Already utilized for head and neck reconstruction by Heredero et al, this novel flap could provide more volume than either flap alone which is advantageous, particularly in patients with sizable defects. The purpose of this study was to determine the average tissue volume that can be utilized from this chimeric flap.</p><p><strong>Methods: </strong> CT Angiogram imaging studies exhibiting chimeric flap anatomy were reviewed over a 7-year period at a single institution utilizing Visage Version 7.1, a radiology picture archiving and communication system. This software was used to trace the flap pedicles and to capture estimated soft tissue volumes of each respective flap.</p><p><strong>Results: </strong> A total of 31 patients, consisting of 52 lower extremity gracilis and PAP chimeric flaps, underwent tissue volume analysis. The average total volume of soft tissue supplied by the gracilis flap was found to be 70.21 cm³ (standard deviation [SD] = 26.99). The average volume of the PAP flap was 31.73 cm³ (SD = 26.12). The average total volume captured by the chimeric gracilis and PAP flap was 101.94 cm³ (SD = 62.40).</p><p><strong>Conclusion: </strong> The potential soft tissue volume that can be harvested from a chimeric gracilis and PAP flap is significantly greater than solitary gracilis or PAP flaps. This chimeric flap may serve as a viable and advantageous reconstructive option for patients requiring large volume soft tissue coverage, particularly if other sizable options are not available.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"63-67"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855702","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 Use of Unlisted Billing Codes for Microsurgical Breast Reconstruction and Implications for Code Consolidation.","authors":"Alan Z Yang, Colby J Hyland, Matthew J Carty, Jessica Erdmann-Sager, Andrea L Pusic, Justin M Broyles","doi":"10.1055/s-0044-1785218","DOIUrl":"10.1055/s-0044-1785218","url":null,"abstract":"<p><strong>Background: </strong> Private insurers have considered consolidating the billing codes presently available for microvascular breast reconstruction. There is a need to understand how these different codes are currently distributed and used to help inform how coding consolidation may impact patients and providers.</p><p><strong>Methods: </strong> Using the Massachusetts All-Payer Claims Database between 2016 and 2020, patients who underwent microsurgical breast reconstruction following mastectomy for cancer-related indications were identified. Multivariable logistic regression was used to test whether an S2068 claim was associated with insurance type and median household income by patient ZIP code. The ratio of S2068 to CPT19364 claims for privately insured patients was calculated for providers practicing in each county. Total payments for professional fees were compared between billing codes.</p><p><strong>Results: </strong> There were 272 claims for S2068 and 209 claims for CPT19364. An S2068 claim was associated with age < 45 years (OR: 1.89, 95% CI: 1.11-3.20, <i>p</i> = 0.019), more affluent ZIP codes (OR: 1.11, 95% CI: 1.03-1.19, <i>p</i> = 0.004), and private insurance (OR: 16.13, 95% CI: 7.81-33.33, <i>p</i> < 0.001). Median total payments from private insurers were 101% higher for S2068 than for CPT19364. In all but two counties (Worcester and Hampshire), the S-code was used more frequently than CPT19364 for their privately insured patients.</p><p><strong>Conclusion: </strong> Coding practices for microsurgical breast reconstruction lacked uniformity in Massachusetts, and payments differed greatly between S2068 and CPT19364. Patients from more affluent towns were more likely to have S-code claims. Coding consolidation could impact access, as the majority of providers in Massachusetts might need to adapt their practices if the S-code were discontinued.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318457","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 Arterial System of the Fasciocutaneous Deltoid Flap Pedicle on 320-Detector Row Computed Tomography and Clinical Application in the Foot and Hand.","authors":"Nguyen Ngoc-Huyen, Nguyen The-Hoang, Khanh Lam, Nguyen Quang-Vinh, Rainer Staudenmaier","doi":"10.1055/s-0044-1787774","DOIUrl":"10.1055/s-0044-1787774","url":null,"abstract":"<p><strong>Background: </strong> Fasciocutaneous free deltoid flaps are used to reconstruct hand, foot, and maxillofacial defects. Although anatomical studies of this flap pedicle have been performed on cadavers, there are no reports on the use of 320-detector row computed tomography angiography (CTA-320) to investigate the deltoid flap pedicle in living humans. This study aimed to investigate the arterial characteristics of the deltoid flap pedicle using the CTA-320 system in living humans.</p><p><strong>Methods: </strong> Twenty-seven adult Vietnamese patients with 54 healthy deltoid regions underwent CTA-320 to investigate arterial blood supply before clinical free-flap transfer. Two- and three-dimensional reconstruction images of the arterial pedicle were visualized, and clinical reconstruction results were evaluated.</p><p><strong>Results: </strong> The cutaneous vessel branches of the deltoid flap were separated from the posterior circumflex humeral artery (PCHA) and originated from the axillary (77.78%), subscapular (12.96%), and brachial (9.26%) arteries. The PCHA penetrated the quadrangular space in 90.74% of patients. The cutaneous arterial branch was present in the deltoid-triceps groove in 100% of patients. The average diameter and length of the PCHA were 3.38 ± 0.58 and 43.08 ± 6.60 mm, respectively. The average diameter and length of the flap cutaneous branch were 1.49 ± 0.28 and 44.57 ± 4.83 mm, respectively. The findings of CTA-320 were aligned with the intraoperative clinical findings well. All deltoid flaps were successfully free-transferred with good outcomes.</p><p><strong>Conclusion: </strong> The CTA-320 is a practical and effective method for investigating deltoid flap pedicles. It enables accurate flap design and harvesting of flaps, thereby enhancing the clinical success of free-flap transfer.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"77-84"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446452","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 Combined \"Vasculoplastic\" Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer.","authors":"Karen R Li, Rachel N Rohrich, Christian X Lava, Nisha J Gupta, Cecelia M Hidalgo, Nicole C Episalla, Cameron M Akbari, Karen K Evans","doi":"10.1055/a-2491-3381","DOIUrl":"https://doi.org/10.1055/a-2491-3381","url":null,"abstract":"<p><strong>Background: </strong> Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on performing targeted direct endovascular reperfusion on a vessel that will be used as the flap recipient. Our study compares outcomes of patients who received targeted revascularization (TR) to the recipient vessel for LEFF anastomosis versus nontargeted revascularization (NR) of arterial recipients prior to LEFF.</p><p><strong>Methods: </strong> LEFF patients who underwent preoperative endovascular revascularization (ER) from July 2011 to January 2023 were reviewed. Location of ER, demographics, perioperative details, and outcomes were collected. TR was performed on the same vessel as the flap recipient and NR was located on a different vessel than the flap recipient.</p><p><strong>Results: </strong> A total of 55 LEFF patients were identified. Overall, 50.91% (<i>n</i> = 28) received TR and 49.1% (<i>n</i> = 27) received NR. Average age was 60.3 ± 10.9 years and average Charlson Comorbidity Index was 5.3 ± 1.9. On preoperative angiogram, the TR group had significantly lower rates of ER above the knee (3.6 vs. 33.3%, <i>p</i> < 0.001). Immediate flap success rate was 98.2%, with no differences between groups (<i>p</i> = 1.000). No significant differences were found in rates of any postoperative flap complications (<i>p</i> = 0.898), takeback (<i>p</i> = 0.352), partial flap necrosis (<i>p</i> = 0.648), or dehiscence (<i>p</i> = 0.729). Both TR and NR groups had similar rates of a postoperative angiogram (42.9 vs. 48.2%, <i>p</i> = 0.694) and reintervention (35.7 vs. 40.7% <i>p</i> = 0.701). Amputation rates were similar between TR and NR (17.9 vs. 14.8%, <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong> Close follow-up with vascular and plastic surgery is required for patients who undergo ER prior to LEFF, as nearly half of our cohort required additional endovascular procedures. Overall, we observed no significant differences in complication rates for the TR and NR groups, informing revascularization strategies for free tissue transfer in a highly comorbid chronic wound population.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895579","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":"Sociodemographic Status Impacts Ambulatory Outcomes in Lower Extremity Flap Reconstruction.","authors":"Eloise W Stanton, Artur Manasyan, Idean Roohani, Erin Wolfe, David A Daar, Joseph N Carey","doi":"10.1055/a-2491-3564","DOIUrl":"10.1055/a-2491-3564","url":null,"abstract":"<p><strong>Background: </strong> There is a lack of literature regarding the effects of language barriers, socioeconomic status, racial disparities, and travel distance to the hospital on the outcomes of lower extremity (LE) flap reconstruction. Consequently, this study assesses the potential influence of these factors on ambulation within this specific patient demographic.</p><p><strong>Methods: </strong> A retrospective review was performed between 2007 and 2022 of patients who underwent LE reconstruction with tissue flap placement at a single institution. The primary outcome was ambulation status, with cohorts compared between those who were ambulatory versus nonambulatory. Covariates included race, age, gender, primary language, distance from patient home to hospital, socioeconomic status (determined using area deprivation index [ADI]), and flap characteristics. Outcomes were assessed with multivariable logistic regression.</p><p><strong>Results: </strong> A total of 242 patients who underwent LE flap reconstruction during the study period. The average time to final ambulatory status was 7.0 months (standard deviation: 11.0), with 51.7% requiring either a wheelchair or assistance device and 48.4% being fully ambulatory at final follow-up. The average state ADI for the cohort was 5.8, with Hispanic patients having significantly higher deprivation indexes (6.3 vs. 5.6, <i>p</i> < 0.001). Multiple logistic regression demonstrated that when controlling for numerous covariates, patients in the highest 15th percentile of deprivation were significantly less likely to be fully ambulatory at final follow-up (odds ratio: 0.22, 95% confidence interval: 0.061-0.806, <i>p</i> = 0.022).</p><p><strong>Conclusion: </strong> The current study emphasizes the substantial impact of socioeconomic disparities on postoperative outcomes in LE flap reconstruction. The finding that patients in the highest 15th percentile of deprivation were less likely to achieve full ambulation underscores the need to prioritize socioeconomic factors in clinical consideration and highlights a crucial avenue for future research.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751064","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 and Safety of Subcutaneous Unfractionated Heparin Administered Every 8 hours for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A Systematic Review and 6-Year Institutional Case Series.","authors":"Jevan Cevik, David P Newland, Edward Cheong, Miguel Cabalag, Anand Ramakrishnan","doi":"10.1055/a-2483-5277","DOIUrl":"10.1055/a-2483-5277","url":null,"abstract":"<p><strong>Background: </strong> Patients with head and neck tumors undergoing free flap reconstructions are at high risk of postoperative venous thromboembolism (VTE). To date, no specific guidelines are available regarding VTE prophylaxis in this patient group. This study aims to contribute to this scarcity of information by reviewing the literature regarding anticoagulation regimens in this patient group and evaluating the efficacy and safety of postoperative subcutaneous heparin dosed at 5,000 units every 8 hours routinely utilized at our institution.</p><p><strong>Methods: </strong> PubMed and Embase databases were searched from inception until November 2023. Data were collected and levels of evidence were evaluated according to the Oxford Centre for Evidence Based Medicine guidelines. Additionally, a retrospective review of all patients with head and neck tumors undergoing free tissue transfer at our institution between 2015 and 2021 was performed. Patients were restricted to those receiving 5,000 units of subcutaneous heparin every 8 hours postoperatively. Key outcomes included rates of VTE and surgical site hematoma.</p><p><strong>Results: </strong> This systematic review found 15 studies eligible for inclusion ranging from 1998 to 2023. Anticoagulation regimens were markedly heterogenous. Among the literature, VTE rates reported ranged from 0 to 9.6% and bleeding rates ranged between 3.5 and 29%. Our 6-year institutional analysis revealed 393 total patients. Overall, three episodes of VTE were identified (0.76%) consisting of one deep vein thrombosis and two pulmonary emboli. The overall rate of hematoma was 9.4% with a higher rate of hematoma at the recipient site (8.1%) than the donor site (1.3%).</p><p><strong>Conclusion: </strong> When compared with the existing literature this study found a low rate of VTE and a comparable incidence postoperative hematoma. This suggests that 5,000 units of subcutaneous heparin given every 8 hours may be a safe and effective postoperative anticoagulation regimen for these patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715937","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 Impact of Perioperative Blood Transfusion on Flap Survival: A Single-Center Review of Limb Salvage in the Trauma Setting.","authors":"Devon O'Brien, Asli Pekcan, Eloise Stanton, Idean Roohani, Paige Zachary, Neil Parikh, David A Daar, Joseph N Carey","doi":"10.1055/a-2483-5207","DOIUrl":"10.1055/a-2483-5207","url":null,"abstract":"<p><strong>Background: </strong> Limb salvage following traumatic lower extremity (LE) injury often necessitates blood transfusion for adequate tissue perfusion. Appropriate transfusion decision-making via a risk-benefit analysis could maximize the opportunity for flap survival. This study aims to examine the impact of perioperative blood transfusion on postoperative complications in traumatic LE reconstruction.</p><p><strong>Methods: </strong> A retrospective review was conducted at a level 1 trauma center on patients who underwent LE reconstruction between January 2007 and October 2023. Patient demographics, comorbidities, perioperative blood transfusions, flap characteristics, and postoperative complications were recorded. Outcomes investigated included postoperative amputation rates, infection, partial flap necrosis, and flap loss. Univariate analysis and multivariable logistic regression were performed to examine the impact of patient factors on flap necrosis.</p><p><strong>Results: </strong> In total, 234 flaps met inclusion criteria. Of these, 149 cases (63.7%) received no transfusion during their hospital stay (Tf - ) and 85 cases (36.3%) received at least one unit of packed red blood cells intraoperatively through 48 hours following flap placement (Tf + ). Overall flap survival rates were similar across both cohorts (Tf + : 92.9 vs. Tf - : 96.6%, <i>p</i> = 0.198). The Tf+ cohort had significantly higher rates of partial flap necrosis (12.9 vs. 2.0.%, <i>p</i> < 0.001), amputation (6.0 vs. 0.7%, <i>p</i> = 0.015), and postoperative hardware infection (10.6 vs. 2.7%, <i>p</i> = 0.011) relative to the Tf- cohort. Multivariable logistic regression demonstrated that transfusion status was independently associated with a 5.1 fold increased risk of flap necrosis (<i>p</i> = 0.033).</p><p><strong>Conclusion: </strong> Transfusions administered intraoperatively through the acute postoperative period were associated with a significantly increased likelihood of flap necrosis. Surgeons should consider a conservative transfusion protocol to optimize flap viability in patients with traumatic LE injuries.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716337","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":"Microsurgeon Development, Attrition, and Hope for the Future: A Qualitative Analysis.","authors":"Jaclyn T Mauch, Yasmeen M Byrnes, Alesha A Kotian, Hannah Z Catzen, Mary E Byrnes, Paige L Myers","doi":"10.1055/a-2483-5337","DOIUrl":"10.1055/a-2483-5337","url":null,"abstract":"<p><strong>Background: </strong> The field of microsurgery continues to grow, yet barriers to practice still exist. This qualitative study aims to elucidate factors both strengthening and threatening this subspecialty through structured interviews with fellowship-trained microsurgeons.</p><p><strong>Methods: </strong> An interview guide was designed, and structured interviews were conducted with practicing fellowship-trained microsurgeon members of the American Society of Reconstructive Microsurgeons between August 2021 and May 2022. Three independent reviewers transcribed, content-coded, and thematically analyzed the interviews. Themes and subthemes were discussed and finalized.</p><p><strong>Results: </strong> Twenty-one practicing microsurgeons were interviewed, hailing from all four Census geographical regions of the United States. The most common practice model was academic (43%, <i>n</i> = 9). Five overarching themes emerged: a passion for microsurgery, training and mentorship, practical considerations, team support, and hope for the future. Microsurgeons reported early exposure to microsurgery as catalyzing their passion, whereas a strong training foundation and lifelong mentors sustained it. Practical challenges arose when establishing and maintaining a microsurgery practice, such as poor reimbursement and unfavorable referral patterns. Team support from staff and other microsurgeons (e.g., a co-surgeon model) was crucial to success. Finally, microsurgeons hoped that future advances would expand access to microsurgical reconstruction for patients and plastic surgeons.</p><p><strong>Conclusion: </strong> This unique, qualitative description of the current landscape of microsurgery revealed that though practical barriers exist, team-based models can alleviate some difficulties. Future advances that increase accessibility may further strengthen this unique and versatile field.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716229","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}