Journal of reconstructive microsurgery最新文献

{"title":"Efficacy of Microsurgical Venous Couplers in Lymphovenous Anastomosis of the Thoracic Duct: An Examination of Outcomes and Patency at Follow-Up.","authors":"Dustin T Crystal, Zachary Gala, Selma Brkic, Robyn Broach, Said C Azoury, Maxim Itkin, Stephen J Kovach","doi":"10.1055/a-2596-5270","DOIUrl":"10.1055/a-2596-5270","url":null,"abstract":"<p><p>Central lymphatic disruption can result in devastating lymphedema, chylothorax, chylous ascites, metabolic deficiencies, and death. Literature from our institution has previously demonstrated the technical feasibility of lymphovenous anastomosis (LVA) for thoracic duct (TD) bypass. Here, we present our complete patient series with expanded follow-up utilizing a microsurgical venous coupler to facilitate LVA.A single-institution, retrospective review was conducted for adult patients who underwent LVA for TD bypass between 2019 and 2024. Demographic, etiological, and perioperative information was collected. Symptomatic resolution with or without radiographically confirmed patency was considered a successful bypass at follow-up.A total of 23 patients underwent LVA of the TD. The mean age was 49.7 years. Median postoperative follow-up was 395 days (interquartile range [IQR]: 150.5-554.5). Anastomotic targets included the EJV (<i>n</i> = 15), IJV (<i>n</i> = 4), AJV (<i>n</i> = 2), or another regional vein (<i>n</i> = 3). The technical success of the venous coupler was 100%. Three patients experienced a surgical site complication (13.0%). At follow-up, 13 patients (56.5%) had a patent TD anastomosis with symptomatic resolution. One patient (4.3%) had a patent anastomosis confirmed on imaging but experienced mild symptomatic recrudescence. The remaining patients (39.1%) had nonpatent anastomoses. The median venous coupler size was 3.0 mm for both the patent cohort and the nonpatent cohort.LVA for TD bypass with an anastomotic coupler is well tolerated and provided durable relief of symptoms in over half of our cohort. This data supports venous coupler utilization in LVA for thoracic TD occlusion. Patient accrual is ongoing to further evaluate and optimize outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988559","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 Postoperative Anticoagulation Regimen to Improve Lower Extremity Free Flap Outcomes.","authors":"Kylie R Swiekatowski, Delani E Woods, Ellen B Wang, Edwin Acevedo, David C Hopkins, Mohin A Bhadkamkar, Yuewei Wu-Fienberg","doi":"10.1055/a-2555-2252","DOIUrl":"10.1055/a-2555-2252","url":null,"abstract":"<p><p>Free flap reconstruction for lower extremity (LE) trauma has a higher failure rate than free flaps in other anatomic regions. Postoperative anticoagulation and antiplatelet therapy may influence LE free flap outcomes, but an optimal regimen has not been established. This study aims to evaluate complication rates associated with different anticoagulation and antiplatelet protocols in LE free flap reconstruction.Adult patients (≥18 years of age) with LE trauma requiring free flap reconstruction at our level 1 trauma center from 2016 to 2021 were included for retrospective chart review. Complications requiring reoperation were grouped into a composite variable named major complications (i.e., hematoma, flap thrombosis, flap necrosis >10%, infection requiring reoperation). Nonrandomized patients were categorized into three groups based on postoperative anticoagulation or antiplatelet regimen (aspirin only, heparin only, and aspirin + heparin), with heparin being a subtherapeutic fixed-dose heparin infusion at 500 to 800 units/hour. Complication rates were compared across groups, and both univariate and multivariate analyses were conducted to identify associations with major complications. <i>p</i>-Values were set at <i>p</i> < 0.05.Of 191 patients, 37 (19.4%) received aspirin only, 76 (39.8%) received heparin only, and 78 (40.8%) received aspirin + heparin. Demographics were similar between the groups. On univariate analysis, the heparin group had a significantly lower rate of major complications (5.26%) compared with aspirin only (18.92%) and aspirin + heparin (20.51%; <i>p</i> = 0.016); however, on multivariate analysis, when accounting for additional perioperative factors, no association between anticoagulation group and major complications was found.Our study found that neither aspirin alone, heparin alone, or aspirin + heparin demonstrated a more favorable association with LE free flap outcomes. To reduce bias from the study's retrospective design and the surgeon's discretion in choosing anticoagulation protocols, future research should randomize patients to standardized postoperative regimens to assess differences in complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Salvage of Ischemic Myopathy at the Neuromuscular Junction Level: A Mouse Model Study on Prolonged Muscle Ischemia in the Upper Limb.","authors":"Angela Chien-Yu Chen, Yu-Han Huang, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.1055/a-2596-5380","DOIUrl":"https://doi.org/10.1055/a-2596-5380","url":null,"abstract":"<p><p>Ischemic myopathy in the upper limb may develop progressively in cases of peripheral arterial disease or acutely following traumatic vascular injuries. Prolonged ischemia can lead to catastrophic damage to distal muscles, with a significant risk of irreversible motor function loss. It is hypothesized that the neuromuscular junction (NMJ) sustains substantial damage beyond a critical threshold of arterial ischemia. Furthermore, concomitant upstream nerve injuries may exacerbate NMJ degeneration, potentially resulting in permanent dysfunction. This study aims to evaluate the NMJ-level changes in target muscles and investigate the impact of nerve injury and repair, with a particular focus on the potential benefits of the supercharge end-to-side (SETS) nerve transfer technique.A mouse forelimb ischemia model was created by clamping the brachial artery and ablating collateral vessels. The first aim assessed NMJ changes with increasing ischemia time. The second investigated the impact of ischemia on muscle reinnervation after transection and repair of the median nerve. Lastly, the ulnar nerve was used for SETS to the distal median nerve following nerve repair to evaluate its effect on muscle recovery. Functional grip tests, electrophysiological assessments, and immunohistochemical analyses were performed.Prolonged ischemia significantly decreased CMAP and grip strength, with markedly declined after 8 hours of prolonged arterial ischemia. When the upstream median nerve was cut and repaired, NMJ innervation of the target muscle dropped significantly at 12 hours, with fully innervated NMJs reduced to 27 to 39% compared with 67 to 72% at 4 to 8 hours (control = 81%). SETS transfers significantly improved CMAP, grip strength, and NMJ innervation, particularly in the 12-hour ischemia group.Prolonged ischemia leads to severe NMJ degeneration within the target muscle, with 8 hours being the critical time point at limb ischemia, and 12 hours being the time point after ischemia and nerve injury. As an alternative to limb amputation or muscle loss, SETS nerve transfer to augment the innervating median nerve can initiate partial NMJ innervation within the remaining target muscles to attempt to restore functional capacity.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110807","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":"Comparison of Biomechanical and Histopathological Properties of Robot-Assisted Anastomoses Using the Symani Surgical System® versus Conventional Anastomoses in a Preclinical Microsurgical Model.","authors":"Vincent G J Guillaume, Tekoshin Ammo, Sophie Leypold, Maximilian Praster, Danny Jonigk, Justus P Beier, Tim Leypold","doi":"10.1055/a-2596-5437","DOIUrl":"https://doi.org/10.1055/a-2596-5437","url":null,"abstract":"<p><p>The Symani surgical system (Symani) is the first robotic system specifically designed for microsurgical purposes and attracted substantial interest in recent times. Despite some initial investigations, no independent analysis of the histopathological/biomechanical properties and anastomoses quality of Symani-sutured anastomoses have been conducted so far. This study aims to compare in-depth robotic-assisted microsurgical anastomoses using the Symani versus conventional anastomoses regarding anastomosis quality, biomechanical, and histopathological properties.We compared 12 microsurgical end-to-end anastomoses sewn by the Symani versus 12 by the conventional technique in a preclinical artery chicken-thigh-model regarding time until completion of the anastomosis, anastomosis quality (modified MARS10-rating and anastamosis lapse index (ALI)) and diameter. Additionally, histopathological analysis of the thread hole diameter, and knot firmness as well as biomechanical tests for intraluminal resistance and tensile strength of the anastomoses were conducted.Anastomosis quality was comparable between both techniques. The Symani-assisted anastomosis took a significantly longer time to perform than conventional anastomosis. Histopathological analysis revealed similar vessel wall damage while showing greater variability in knot spacing and bite width in the robotic anastomoses. No significant differences were observed in the tensile strength test or intraluminal resistance. However, the knot firmness of Symani-assisted anastomosis was significantly less than conventionally performed knots.This study demonstrates that the Symani performs on par with conventional anastomosis techniques regarding anastomosis quality, vessel wall damage, intraluminal resistance, and tensile strength. Long-term continuous training and/or further innovations of the Symani system may lower the time required to perform the anastomosis and improve knot firmness.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101959","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":"Should Caffeine Be Avoided Following Free Flaps: Fact or Fiction?","authors":"Nina Dharmarajah, Jeewon Chon, Bianca DiChiaro, Eleanor Bucholz","doi":"10.1055/a-2596-5333","DOIUrl":"https://doi.org/10.1055/a-2596-5333","url":null,"abstract":"<p><p>Many microsurgeons recommend that their patients avoid all compounds containing caffeine after free tissue transfer, however, there is little in the literature to implicate caffeine as a contributor to flap loss. While caffeine has historically been viewed as a vasoconstrictor that could theoretically impair flap perfusion, its physiological effects are complex, involving both vasoconstrictive and vasodilatory mechanisms. This review aims to determine whether caffeine consumption may increase flap-related complications including ultimate failure.A narrative review was conducted through PubMed and Google Scholar to evaluate the mechanism of action of caffeine. Articles were included if they provided insights into caffeine's mechanisms of action in the central nervous system, cardiovascular system, endothelium, and microcirculation.Caffeine causes the release of neurotransmitters in the CNS promoting wakefulness through the antagonism of adenosine receptors. In both smooth muscle and vascular endothelium, caffeine promotes vasodilation through the activation or inhibition of different types of receptors including adenosine, inositol triphosphate, and nitrous oxide. Studies in both human and animal models suggest that caffeine does not significantly affect microvascular perfusion or anastomotic patency. Data suggest that habitual caffeine consumers show blunted vascular responses, further mitigating concerns in flap outcomes.Despite current recommendations for caffeine restriction following free tissue transfer, the existing evidence does not support caffeine as a major risk factor for flap failure. Postoperative caffeine avoidance may be unnecessary, particularly for habitual users. Larger prospective studies are needed to further elucidate caffeine's role in microsurgical outcomes and to explore the effects of other stimulants, such as ADHD medications, on microvascular circulation.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078655","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 Efficacy of Upper Extremity Neuroma Surgery in Reducing Long-Term Opioid Use in Patients with Preoperative Opioid Use.","authors":"Emmanuel O Emovon Iii, Hannah Langdell, Elliott Rebello, J Alex Albright, Ethan Ong, Daniel Y Joh, Suhail K Mithani, Neill Y Li","doi":"10.1055/a-2576-0128","DOIUrl":"10.1055/a-2576-0128","url":null,"abstract":"<p><p>Neuromas can cause severe neuropathic pain, leading to functional decline and psychosocial distress. For pain relief, patients refractory to medications for neuropathic pain may be prescribed opioids; however, such use has been shown to have unfortunate adverse effects. With increasing awareness and diagnostic capabilities for neuroma formation, this study evaluates whether upper extremity neuroma excision may reduce opioid use and if adjunctive nerve procedures further reduce opioid use.The PearlDiver database was queried for patients undergoing upper extremity neuroma excision surgery from 2010 to 2020. Patients with opioid prescription fill records preoperatively were extracted and stratified by an operative technique involving either (1) excision alone, (2) nerve implantation into bone or muscle, or (3) nerve reconstruction. Records were then assessed at 1, 3, and 6 months postoperatively to assess for opioid use. Prescription fill rates at 1, 3, and 6 months postoperatively were then assessed across techniques.Of the 14,330 patients that underwent upper extremity neuroma excision, 4,156 filled opioids preoperatively. Excision led to significant reductions in opioid prescription fill rates postoperatively, decreasing to 67.4% at 1 month and to 57.5% by 6 months (<i>p</i> < 0.001). Excision alone resulted in lower opioid use compared with excision with implantation at all postoperative time points (<i>p</i> < 0.05). At 6 months, opioid use was also significantly less following excision with nerve reconstruction compared with implantation (56.4% vs. 65.6%, <i>p</i> = 0.0096). There were no differences between excision alone and excision with nerve reconstruction.Neuroma excision significantly reduces opioid use in patients with preoperative opioid use while adjunctive operative techniques did not potentiate opioid reduction. This highlights the importance of understanding patient complaints, neuroma localization, and candidacy for excision as an effective measure for addressing opioid use in patients with preoperative opioid dependence.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803643","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":"Free Flap Reconstruction of the Lower Lip: A Systematic Review and Meta-Analysis.","authors":"Alexander Murray-Douglass, Pascalino Romeo, Carly Fox","doi":"10.1055/s-0044-1788543","DOIUrl":"10.1055/s-0044-1788543","url":null,"abstract":"<p><strong>Background: </strong> Large defects of the lower lip often require free tissue coverage. Fasciocutaneous free flaps have been traditionally used, but innervated muscular free flaps may fundamentally address orbicularis oris deficiency and improve dynamic competence. This review aimed to determine if innervated muscular free flaps provided benefit over fasciocutaneous free flaps for reconstruction of defects of more than 50% of the lower lip. Outcomes of interest included functional oral outcomes including oral competence, aesthetic outcomes, and patient-reported outcome measures.</p><p><strong>Methods: </strong> Five databases (PubMed, Embase, Web of Science, CINAHL, and CENTRAL) were searched for variations of \"lip\" and \"free flap.\" Two authors screened articles and included primary research of free flap reconstruction of more than 50% of the lower lip from any etiology in living humans with an English full-text available. Composite bony flaps were excluded. Oral competence and aesthetic satisfaction, reconstruction details, and complications were extracted. Proportional meta-analyses were used to synthesize results for fasciocutaneous free flaps, which were compared with those for muscular free flaps.</p><p><strong>Results: </strong> Fifty-nine articles describing 242 patients were included. Muscular free flaps reported significantly higher proportional oral competence than fasciocutaneous free flaps (98 vs. 83%, <i>p</i> = 0.01). Aesthetic outcomes (98 vs. 97%, <i>p</i> = 0.22) and complications (17 vs. 18%, <i>p</i> = 0.79) were equivalent between fasciocutaneous and muscular free flaps.</p><p><strong>Conclusion: </strong> Muscular free flaps may address the fundamental orbicularis oris defect that causes oral incompetence and seem to provide better functional results. Aesthetic outcomes and complications seem to be equivalent.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"302-311"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759410","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":"Dynamic Eye Closure Restoration in Facial Palsy with Neurotized Platysma Muscle Graft in Rats.","authors":"Tsz Yin Voravitvet, Yenlin Huang, Sawarin Voravitvet, Juan Larsson, Po-Hao Lien, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu, Tommy Nai-Jen Chang","doi":"10.1055/s-0044-1788565","DOIUrl":"10.1055/s-0044-1788565","url":null,"abstract":"<p><strong>Background: </strong> One of the most devastating deficits of facial paralysis is eyelid dysfunction, which is controlled by the orbicularis oculi muscle (OOM), as it leads to loss of the protective mechanism of the eye. This study used a rat model to assess the functional outcomes of neurotized platysma muscle grafts (PMGs) for OOM replacement.</p><p><strong>Methods: </strong> Forty male Sprague-Dawley rats with iatrogenic right eyelid dysfunction were divided into five groups: one control group and four groups utilizing PMG with different sources of nerve innervation. Eyelid function recovery was assessed at 2, 4, 6, and 8 weeks. The PMGs were harvested for pathological examination at the end of the study.</p><p><strong>Results: </strong> All rats except those in the control group and one from the group using ipsilateral frontal and upper zygomatic frontal nerve branches directly neurotized to the PMG (nerve-to-muscle) recovered eyelid closure function within 8 weeks of the study period. The mean recovery time was 3.87 ± 1.28 weeks. A total of 87.5% of rats that had the contralateral zygomatic branch as the donor nerve regained the consensual corneal reflex (<i>p</i>-value < 0.001).</p><p><strong>Conclusion: </strong> Replacement of neurotized PMG for OOM function is successful in a rat model. Using the upper zygomatic branch as the donor nerve, it was possible to restore the consensual corneal reflex. This method shows promise for further human studies.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"330-338"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748405","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":"Corrigendum: Dynamic Eye Closure Restoration in Facial Palsy with Neurotized Platysma Muscle Graft in Rats.","authors":"Tsz Yin Voravitvet, Yenlin Huang, Sawarin Voravitvet, Juan Larsson, Po-Hao Lien, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu, Tommy Nai-Jen Chang","doi":"10.1055/s-0044-1788992","DOIUrl":"https://doi.org/10.1055/s-0044-1788992","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":"41 4","pages":"e1"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989164","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 New Era in Perforator Flap Surgery for Breast Reconstruction: A Comparative Study of Robotic versus Standard Harvest of Bilateral Deep Inferior Epigastric Artery Perforator Flaps.","authors":"Andrea Moreira, Elizabeth A Bailey, Brian Chen, William Nelson, Jenna Li, Richard Fortunato, Stanislav Nosik, Daniel Murariu","doi":"10.1055/s-0044-1788642","DOIUrl":"10.1055/s-0044-1788642","url":null,"abstract":"<p><strong>Background: </strong> Traditional deep inferior epigastric artery perforator (DIEP) flap harvest splits the anterior sheath, weakening the abdominal wall and predisposing patients to bulge or hernia. Abdominal wall morbidity may be decreased using minimally invasive techniques. We refined a transabdominal approach to the robotic harvest of bilateral DIEP flaps.</p><p><strong>Methods: </strong> A retrospective medical record study involving all patients who underwent bilateral or bipedicled robotic DIEP (rDIEP) or standard DIEP (sDIEP) flap harvest between July 2021 and September 2022. Outcomes included abdominal wall morbidity, total operative time, length of stay (LOS), and complications.</p><p><strong>Results: </strong> Forty-seven patients were included (48 sDIEP flaps, 46 rDIEP flaps) with no significant difference in patient characteristics. Fascial incision length in the rDIEP group was shorter (4.1 vs. 11.7 cm, <i>p</i> < 0.001). Mesh reinforcement of the abdominal wall was used in 13/24 sDIEP and none in rDIEP patients (<i>p</i> < 0.001). Operative time was longer in the rDIEP cohort (739 vs. 630 minutes, <i>p</i> = 0.013), although subanalysis showed no difference in the second half of the cohort. The average robotic dissection time was 135 minutes, which decreased significantly with the surgeon's experience. There were no intraoperative complications from using the robot. LOS was shorter with rDIEP but not statistically significant (3.9 vs. 4.3 days, <i>p</i> = 0.157).</p><p><strong>Conclusion: </strong> This study represents the most extensive cohort analysis of bilateral rDIEP flap harvest, offering a comprehensive comparison to traditional sDIEP. The initial results underscore the viability of robotic techniques for flap harvesting, highlighting potential advantages including reduced fascial incision length and decreased abdominal disruption. Furthermore, using robotics may obviate the necessity for fascial reinforcement with mesh.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"277-286"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893701","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}