Journal of reconstructive microsurgery最新文献

{"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><p>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.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.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%).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":"623-630"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","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><p>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.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.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).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":"614-622"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","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":"Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population.","authors":"Jakob B W Weiss, Branislav Kollár, Steffen U Eisenhardt","doi":"10.1055/a-2460-4761","DOIUrl":"10.1055/a-2460-4761","url":null,"abstract":"<p><p>Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear.We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study.Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (<i>p</i> > 0.05). There were no major bleeding complications or deep vein thrombosis.The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"606-613"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576347","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 Insurance Status on Postoperative Recovery after Microsurgical Breast Reconstruction.","authors":"Yi-Hsueh Lu, Evan Rothchild, Yufan Yan, Lakshmi Mahajan, Michelle Park, Joseph A Ricci","doi":"10.1055/a-2460-4900","DOIUrl":"10.1055/a-2460-4900","url":null,"abstract":"<p><p>Persistent disparities in breast reconstruction access have been widely documented, yet a significant research gap remains in understanding the impact of social determinants of health (SDOH) on postoperative outcomes and complications.A retrospective chart review was performed on all patients who underwent abdominal-based free-flap breast reconstruction between August 2018 and December 2022 at a racially, ethnically, and socioeconomically diverse urban academic institute with a historically underserved patient population. Patients were stratified by the public (Medicare and Medicaid) versus private insurance as a proxy for SDOH. Patient demographics, length of stay (LOS), timing in progression through postoperative recovery milestones, and complications were compared.A total of 162 patients were included, and 57% of patients had public insurance, with this group more likely to be Hispanic (odds ratio [OR] 2.7; <i>p</i> = 0.003) and Spanish-speaking (OR 3.4; <i>p</i> = 0.003). Privately insured patients were more likely to be non-Hispanic Black (OR 2.7; <i>p</i> = 0.006). Patients with public insurance had a higher rate of unplanned return to the operating room within 90 days and a higher incidence of complications, though not statistically significant. They also experienced a significantly longer LOS than privately insured patients (3.6 ± 1.0 vs. 3.0 ± 0.7 days; <i>p</i> < 0.0001). Logistic regression identified an LOS exceeding 3 days as independently associated with public insurance status (OR 3.0; <i>p</i> = 0.03), bilateral procedure (OR 5.6; <i>p</i> = 0.0007), preoperative functional-dependent status (OR 7.0; <i>p</i> = 0.04), and higher body mass index (BMI; OR 1.1; <i>p</i> = 0.03). Patients with public insurance were more likely to encounter delays in achieving recovery milestones.Public insurance status, serving as a proxy for a disadvantage in SDOH, is predictive of extended LOS and postoperative recovery delays following microsurgical breast reconstruction. This underscores the need for future quality improvement efforts to address and mitigate these disparities.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"586-594"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576368","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":"Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and Vein.","authors":"Jeongmok Cho, Donggeon Kim, Taehyun Kim, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong","doi":"10.1055/a-2460-4940","DOIUrl":"10.1055/a-2460-4940","url":null,"abstract":"<p><p>This research aims to validate the proficiency and accuracy of the robotic microsurgery platform using rat femoral vessel model.A total of 256 rat femoral vessels were performed, half using robotic and the other by manual microanastomosis by eight microsurgeons with less than 5 years of experience given eight trials (rats) each. Vessel demographics, proficiency (duration of suture and Structured Assessment of Robotic Microsurgical Skills [SARMS]), and accuracy (patency and scanning electron microscopic [SEM]) were analyzed between the two groups.Using the robot, an average of four trials was needed to reach a plateau in total anastomosis time and patency. Significant more time was required for each vessel anastomosis (34.33 vs. 21.63 minutes on the eighth trial, <i>p</i> < 0.001) one factor being a higher number of sutures compared with the handsewn group (artery: 7.86 ± 0.51 vs. 5.86 ± 0.67, <i>p</i> = 0.035, vein: 12.63 ± 0.49 vs. 9.57 ± 0.99, <i>p</i> = 0.055). The SARMS scores became nonsignificant between the two groups on the fourth trial. The SEM showed a higher tendency of unevenly spaced sutures, infolding, and tears in the vessel wall for the handsewn group.Using the robot, similar patency, accuracy, and proficiency can be reached through a fast but steep learning process within four trials (anastomosis of eight vessels) as the handsewn group. The robotic anastomosis may take longer time, but this is due to the increased number of sutures reflecting higher precision and accuracy. Further insight of precision and accuracy was found through the SEM demonstrating the possibility of the robot to prevent unexpected and unwanted complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"595-605"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576364","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":"Unplanned 180-day Readmissions and Health Care Utilization after Immediate Breast Reconstruction for Breast Cancer.","authors":"Arturo J Rios-Diaz, Theodore E Habarth-Morales, Emily L Isch, Chris Amro, Harrison D Davis, Robyn B Broach, Matthew Jenkins, John P Fischer, Joseph M Serletti","doi":"10.1055/a-2460-4821","DOIUrl":"10.1055/a-2460-4821","url":null,"abstract":"<p><p>To assess the burden of postdischarge health care utilization given by readmissions beyond 30 days following immediate breast reconstruction (IBR) nationwide.Women with breast cancer who underwent mastectomy and concurrent IBR (autologous and implant-based) were identified within the 2010 to 2019 Nationwide Readmission Database. Cox proportional hazards and generalized linear regression controlling for patient- and hospital-level confounders were used to determine factors associated with 180-day unplanned readmissions and incremental hospital costs, respectively.Within 180 days, 10.7% of 100,942 women were readmitted following IBR. Readmissions tended to be publicly insured (30.8 vs. 21.7%, <i>p</i> < 0.001) and multimorbid (Elixhauser Comorbidity Index > 2 31.6 vs. 19.6%, <i>p</i> < 0.001) compared with nonreadmitted patients. There were no differences in readmission rates among types of IBR (tissue expander 11.2%, implant 10.7%, autologous 10.8%; <i>p</i> > 0.69). Of all readmissions, 40% occurred within 30 days and 21.7% in a different hospital and 40% required a major procedure in the operating room. Infection was the leading cause of readmissions (29.8%). In risk-adjusted analyses, patients with carcinoma in situ, publicly insured, low socioeconomic status, and higher comorbidity burden were associated with increased readmissions (all <i>p</i> < 0.05). Readmissions resulted in additional $8,971.78 (95% confidence interval: $8,537.72-9,405.84, <i>p</i> < 0.001) in hospital costs, which accounted for 15% of the total cost of IBR nationwide.The majority of inpatient health care utilization given by readmissions following mastectomy and IBR occurs beyond the 30-day benchmark. There is evidence of fragmentation of care as a quarter of readmissions occur in a different hospital and over one-third require major procedures. Mitigating postoperative infectious complications could result in the highest reduction of readmissions.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"575-585"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576373","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":"One Size Does Not Fit All: Prediction of Nerve Length in Implant-based Nipple-Areola Complex Neurotization.","authors":"Casey Zhang, Elizabeth A Moroni, Andrea A Moreira","doi":"10.1055/a-2460-4589","DOIUrl":"10.1055/a-2460-4589","url":null,"abstract":"<p><p>Breast reconstruction with sensory restoration is gaining recognition as an important goal. Successful reinnervation has been shown in autologous reconstruction but not widely studied in implant-based reconstruction (IBR). This article describes our technique for nipple-areola complex (NAC) neurotization to predict maximal nerve length. We also propose a novel equation that can be utilized preoperatively to estimate the total nerve length required for NAC neurotization.This is a retrospective study of patients who underwent nerve reconstruction with IBR between April 2021 and May 2022. An equation based on the arc length of a circle was utilized to predict the total nerve length required. Postoperative assessment of sensation was performed at 3, 6, and 12 months using Semmes-Weinstein monofilament testing in all four breast quadrants and the NAC. Patients completed the Breast-Q Sensation Module preoperatively and at 3, 6, and 12 months.NAC neurotization was performed in 58 patients undergoing IBR. The average length of intercostal nerve (ICN) harvested was 5.3 cm for staged reconstructions and 5.6 cm for direct-to-implant reconstruction. The average total nerve length (allograft + mobilized ICN) was 12.3 cm. On average, 6.9 cm of nerve allograft was used. The mean difference between total nerve length and predicted nerve length was 0.47 cm (range -3.5 to 4.6 cm). There was a significant improvement in sensory monofilament values measured in all four breast quadrants and the NAC between 3 to 6 and 6 to 12 months postoperatively.A thorough understanding of sensory anatomy and precise surgical techniques are essential to perform NAC neurotization successfully. Our early results suggest the positive impact of breast sensation on patient quality of life.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"566-574"},"PeriodicalIF":2.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755272","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":"Evaluating Dynamic Smile Outcomes of Free Gracilis Muscle Transfer in Pediatric Facial Palsy Using Image-Based Analysis.","authors":"Melanie Bakovic, Asli Pekcan, Raina Patel, Valeria Mejia, Sally Danto, Maya Lazar, William P Magee Iii, Jessica Lee, Mark A Urata, Jeffrey Hammoudeh","doi":"10.1055/a-2671-9586","DOIUrl":"10.1055/a-2671-9586","url":null,"abstract":"<p><p>Facial nerve palsy in children leads to significant functional impairment and facial asymmetry. While free gracilis muscle transfer (FGMT) is a cornerstone technique for smile reanimation in both pediatric and adult patients, its evaluation has mainly focused on the single metric of commissure excursion. This study seeks to evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy using image analysis.A retrospective review was conducted in children who underwent FGMT for facial palsy at a major children's hospital between 2007 and 2020. Data collection included pre- and postoperative chart reviews and image analysis. Anthropometric measurements were obtained using a machine learning-based smile analysis software. Primary outcomes included commissure excursion, commissure angle, dental show, and smile symmetry. Statistical analysis was performed using the Wilcoxon signed-rank test.A total of 31 patients with an average age of 10 years underwent FGMT for smile reanimation during the study period. The most common diagnosis was Moebius syndrome (48%). Donor nerves for gracilis neurotization included 18 ipsilateral trigeminal nerves (58.1%) and 12 contralateral facial nerves via cross-face sural nerve grafts (38.7%). Overall, 84% of patients demonstrated active gracilis contraction within a mean of 2.5 years postoperative follow-up. Commissure excursion increased by 9.7 mm at 1 year (<i>p</i> < 0.05), and symmetry significantly improved for commissure height, commissure excursion, upper lip height, and smile angle. There were no significant improvements in dental show, commissure angle, symmetry of dental show, and lower lip height. Furthermore, only 16% of patients demonstrated clinically symmetric smiles within the follow-up period.While FGMT effectively restores commissure excursion in pediatric patients with facial palsy, achieving multidimensional smile reanimation remains a challenge. New techniques in multi-vector free tissue transfer may help optimize FGMT outcomes in pediatric patients.</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":"144753674","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":"Robotic-Assisted DIEP Flap Harvest: A Call for Balanced Discussion of Surgical Risk.","authors":"Raymund E Horch, Andreas Arkudas","doi":"10.1055/a-2690-9728","DOIUrl":"https://doi.org/10.1055/a-2690-9728","url":null,"abstract":"<p><p>We commend Choe et al. for their technically detailed report on robotic-assisted deep inferior epigastric perforator (DIEP) flap harvest. While recognizing the promise of robotic surgery in microsurgical applications, we believe a more critical evaluation of the intraabdominal approach is warranted. The technique's emphasis on reduced fascial incision length must be weighed against underexplored risks, including potential intraabdominal complications, peritoneal entry, adhesions, increased hernia risk from multiple port sites, and the physiologic effects of gas insufflation. Additionally, longer ischemia times and total operative duration should be considered when assessing overall surgical benefit. This letter highlights key concerns and encourages a balanced discussion on the true trade-offs of robotic-assisted DIEP flap harvest within the evolving field of reconstructive microsurgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-27","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":"Optimizing Donor Site Morbidity in DIEP Flap Reconstruction: Advancements in Minimizing Anterior Fascial Defects: A Systematic Review.","authors":"Diwakar Phuyal, Isaac Mordukhovich, James Gaston, Arturo J Rios-Diaz, Osama Darras, Rommy Obeid, Risal Djohan, Graham Schwarz, Raffi Gurunian, Sarah N Bishop","doi":"10.1055/a-2659-6939","DOIUrl":"10.1055/a-2659-6939","url":null,"abstract":"<p><p>Numerous minimally invasive deep inferior epigastric perforator flap (MI-DIEP) techniques have been described in the literature to reduce donor site morbidities. This systematic review aimed to summarize existing MI-DIEP techniques and postoperative outcomes relative to conventional harvest (cDIEP).A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to include articles with novel DIEP harvesting techniques. Studies without perioperative information were excluded. Chi-square and Fisher's exact test were used to compare complication rates (partial flap loss, total flap loss, hernia or bulge, and fat necrosis) in MI-DIEP with cDIEP. Joanna Briggs Institute critical appraisal tool was used for bias assessment.A total of 978 patients underwent 1,272 MI-DIEP flap harvests across 17 studies. Techniques included robotic DIEP (rDIEP; <i>n</i> = 97), abdominal perforator exchange (APEX; <i>n</i> = 158), laparoscopic (<i>n</i> = 39), endoscopic (<i>n</i> = 94), two-staged delayed DIEP (<i>n</i> = 135), short fasciotomy (<i>n</i> = 124), short pedicle (<i>n</i> = 26), vascular pedicle measuring (<i>n</i> = 209), and microfascial incision (<i>n</i> = 81). No significant differences were found between endoscopic, laparoscopic, and robotic approaches compared with cDIEP. However, the short pedicle technique had higher partial flap loss (8.82% vs. 1.98%, <i>p</i> = 0.04), while APEX and vascular pedicle measuring techniques had lower fat necrosis rates (1.99% and 0.48% vs. 5.81%, <i>p</i> = 0.04 and 0.004 respectively). Short fasciotomy was associated with higher fat necrosis (12.9% vs. 5.8%, <i>p</i> = 0.004) and longer hospital stay (<i>p</i> = 0.005). Robotic, laparoscopic, endoscopic, two-staged, and APEX techniques were associated with shorter hospital stays, and rDIEP was linked to reduced postoperative day 1 pain (<i>p</i> < 0.001).MI-DIEP techniques demonstrate comparable complication rates to cDIEP, with certain methods offering benefits such as reduced fat necrosis, shorter hospital stays, and less postoperative pain.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667895","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}