Journal of reconstructive microsurgery最新文献

{"title":"The Efficacy of Transversus Abdominis Plane Blocks in Abdominal Tissue Free Flap Breast Reconstruction.","authors":"Rachel H Park, Ugochukwu K Odega, Robert G DeVito, Jesse Chou, Chris A Campbell, John T Stranix","doi":"10.1055/a-2671-7296","DOIUrl":"10.1055/a-2671-7296","url":null,"abstract":"<p><p>Regional blocks are effective adjuncts in autologous breast reconstruction. Data on specific regional blocks and agents remain unclear.We performed a retrospective review of patients who underwent abdominal free flap breast reconstruction between July 2017 and June 2022. A total of 256 patients were included with 181 who received Exparel transversus abdominis plane (TAP) blocks, 54 with non-Exparel TAP blocks, and 21 without a TAP block. Length of stay (LOS), intensive care unit length of stay (ICU LOS), average daily morphine milligram equivalents (MME), and average total MME were collected.Comparing the Exparel TAP block cohort and non-Exparel TAP block cohort, there was no difference in LOS (2.71 vs. 2.72 days, <i>p</i> = 0.96), ICU LOS (0.35 vs. 0.56 days, <i>p</i> = 0.18), daily MME (29.08 vs. 29.71 MME, <i>p</i> = 0.85), and total MME (113.69 vs. 113.92 MME, <i>p</i> = 0.99). Comparing the Exparel TAP block cohort and non-TAP block cohort, there were significant differences in LOS (2.71 vs. 3.62 days, <i>p</i> = 0.003), ICU LOS (0.35 vs. 1.1 days, <i>p</i> = 0.001), daily MME (29.08 vs. 39.56, <i>p</i> = 0.04), and total MME (113.69 vs. 195.55, <i>p</i> = 0.001). When comparing the non-Exparel TAP block cohort and the non-TAP block cohort, there were differences in LOS (2.72 vs. 3.62 days, <i>p</i> = 0.004), ICU LOS (0.56 vs. 1.1 days, <i>p</i> = 0.04), and total MME (113.92 vs. 195.55 MME, <i>p</i> = 0.006).TAP block can effectively reduce the LOS and postoperative narcotic use in patients undergoing autologous breast reconstruction regardless of the choice of local anesthetic.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760433","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":"Achieving Textbook Outcomes in Bilateral DIEP Flap Breast Reconstruction: Does a Co-Surgeon Matter?","authors":"Robert G DeVito, Colby Newson, Benjamin G Ke, Hanzhi Yang, Jessica Pawly, Scott T Hollenbeck, Christopher A Campbell, John T Stranix","doi":"10.1055/a-2671-8578","DOIUrl":"10.1055/a-2671-8578","url":null,"abstract":"<p><p>It is essential to examine predictors of ideal outcomes in surgery. \"Textbook outcomes\" are optimal surgical results based on multiple quality measures. It is important that patients have access to trusted centers that consistently produce high-quality surgical outcomes.A retrospective review of all bilateral Deep Inferior Epigastric Perforator (DIEP) flap breast reconstructions at our institution from 2017 to 2022 was performed. Criteria for \"textbook outcome\" were operating room (OR) time within one standard deviation of institutional average or less, length of stay ≤ 4 days, no intraoperative complications, no operative complications, no readmission within 30 days, no infection requiring IV antibiotics, no systemic complications, and no mortality. Propensity score matching was used to control for common comorbidities, reconstruction timing, and oncologic factors. This resulted in 47 matched pairs of bilateral DIEP flap reconstructions for comparison between a single-surgeon cohort and a co-surgeon cohort.Textbook outcomes occurred at a significantly higher rate in the co-surgeon cohort compared with the single surgeon cohort (79% vs. 57%, <i>p</i> = 0.025). The average OR time was significantly shorter in the co-surgeon cohort compared with the single surgeon cohort (403 minutes vs. 572 minutes, <i>p</i> < 0.0001), and elevated OR time was the most common reason for not achieving a textbook outcome. There were no differences in the other criteria for a \"textbook outcome.\"Textbook outcomes in bilateral DIEP flap breast reconstruction are achieved at significantly higher rates with a co-surgeon. This is primarily due to significantly shorter OR times. Further research into factors affecting textbook outcomes is needed.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760419","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":"Adipose-Derived Stem Cell Sheets Prepared with Ascorbate 2-Phosphate Enhance Nerve Regeneration in Rat Sciatic Nerve Autografts.","authors":"Atsuro Murai, Kaoru Tada, Mika Akahane, Yuta Nakamura, Soichiro Honda, Masashi Matsuta, Akari Mori, Satoru Demura, Jureepon Roboon, Tsuyoshi Hattori, Osamu Hori, Hiroyuki Tsuchiya","doi":"10.1055/a-2671-7768","DOIUrl":"10.1055/a-2671-7768","url":null,"abstract":"<p><p>Autologous nerve grafts remain the gold standard for peripheral nerve repair, but have limited regenerative potential. Adipose-derived stem cells (ADSCs) have been investigated for their potential in nerve regeneration, and ascorbate 2-phosphate (A2P) enables the formation of ADSC sheets. This study examined whether ADSC sheets applied around autologous nerve grafts enhance functional and histological recovery in a rat sciatic nerve model.A 15 mm sciatic nerve segment was excised, inverted, and sutured for autologous grafting in rats. Three groups were compared: phosphate-buffered saline (control), ADSC suspension, and ADSC sheets. Functional recovery was assessed at 12 weeks (<i>n</i> = 10 per group) using the sciatic functional index (SFI), nerve conduction studies (NCS; latency and amplitude), and tibialis anterior muscle wet weight. Histological analyses, including toluidine blue staining, evaluated axonal changes at 1, 2, 4, 8, and 12 weeks (<i>n</i> = 3 per group per time point). DiI-labeled ADSCs were tracked at 1 week to assess cell retention (<i>n</i> = 3 per group).At 12 weeks, the ADSC sheet group showed significantly improved SFI and muscle wet weight compared with controls and ADSC suspension groups. NCS revealed shorter distal latency in the ADSC sheet group versus controls, with no significant differences in the suspension group. While histological analysis did not demonstrate statistically significant differences among the groups, qualitative observations suggested that the ADSC sheet group tended to exhibit a greater number of myelinated axons at 12 weeks and fewer degenerative changes at earlier time points (1 and 2 weeks). DiI-labeled ADSCs were more frequently observed around the graft in the sheet group compared with the suspension group.Application of ADSC sheets to autologous nerve grafts may promote functional recovery. Forming ADSC sheets with A2P may represent a favorable approach for improving outcomes in peripheral nerve repair.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760431","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":"Reconstruction of the Acute Isolated Common Peroneal Nerve Palsy Using Primarily Nerve Repair and/or Nerve Graft: A Single-Center 28-Year Experience.","authors":"Arash Izadpanah, Y Alper Aytac, Ahmet H Sakarya, Che-Hsiung Lee, Bassem Daniel, Lisa Wen-Yu Chen, Johnny Chuieng-Yi Lu, David Chwei-Chin Chuang, Tommy Nai-Jen Chang","doi":"10.1055/a-2671-8660","DOIUrl":"https://doi.org/10.1055/a-2671-8660","url":null,"abstract":"<p><p>Drop foot is a devastating problem in patients with common peroneal nerve palsy (CPN). The standard surgical treatments are categorized into three main categories: nerve-related procedures, tendon transfers, and functioning free muscle reconstruction. The outcomes of nerve surgeries such as neurolysis, nerve repair, transfer, or graft remain controversial. In this study, we present our experience in acute CPN palsy, employing neurolysis, nerve repair, and nerve grafting in a single institution.Between 1980 and 2016, 50 patients with CPN injury underwent either primary nerve repair, neurolysis, or nerve graft. Thirty-eight patients met our final inclusion criteria. The functional outcomes of CPN injury were reviewed, categorizing surgical outcomes into three groups based on total ankle ROM and muscle strength. Those with total ROM less than 20 or < M2 muscle strength, 20 to 30 or ≥M2, and ≥30 degrees or ≥M3 were believed to have poor, good, and excellent outcomes, respectively.Nerve grafts shorter than 6 cm are associated with better functional outcome in CPN. Seventy-one percent of patients with nerve grafts shorter than 6 cm achieved good-excellent functional results. Furthermore, 100% of patients in the neurolysis and primary nerve repair groups achieved excellent functional outcomes.CPN surgery is often associated with underwhelming outcomes. With appropriate patient selection and meticulous surgical techniques, one could expect acceptable outcomes in such a patient population. The correct diagnosis and early intervention, along with postoperative immobilization and aggressive rehabilitation, are crucial for improving the outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958292","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 Clinical Pearls and Pitfalls of Using the Symani System in Microsurgery.","authors":"Anshul Ratnaparkhi, Emily Finkelstein, Aneeq S Chaudhry, Kyle Xu, Kashyap Tadisina, Miguel Medina, Sara Danker, Devinder Singh, Juan Rodolfo Mella-Catinchi","doi":"10.1055/a-2659-7126","DOIUrl":"https://doi.org/10.1055/a-2659-7126","url":null,"abstract":"<p><p>The improved stability and controllability of robotics has the potential to expand the spectrum of reconstructive surgery. Until recently, however, no robot was designed specifically for microsurgery. The present study aims to summarize the clinical pearls and pitfalls of utilizing the Symani Surgical System in microsurgical practice.The PubMed Database was queried using the search term \"Symani Robot System\" from inception until January 2025. Data regarding demographics, study design, technique, and surgical outcomes were extracted from the full text by two independent reviewers.In the present analysis, 21 publications encompassing the results of 397 patients (range: 1-100) and 642 robotic anastomoses were included. Of the 335 patients included in the studies that reported complication rates, pooled analysis yielded an overall complication rate of 14.03% (<i>n</i> = 47) and a partial or complete flap loss rate of 2.09% (<i>n</i> = 7). Of 642 robotic total anastomoses, only 1.24% (<i>n</i> = 8) required a transition to a manual approach. A total of 19 groups (90.47%) reported high precision of Symani, 15 (71.43%) highlighted improved surgical access to deeper anatomical fields, and 12 (57.15%) reported enhanced microsurgical ergonomics. Regarding limitations, 13 (61.90%) cited the expense of the system, 5 (23.81%) reported a lack of haptic feedback, 5 (23.81%) identified instrument \"stickiness\" as a factor slowing operations, and 3 (14.29%) highlighted the need for improved grip. The learning curve associated with Symani was discussed in 15 studies (71.43%).The results of the present literature review demonstrate that the Symani robot offers numerous benefits that will help advance the field of microsurgery. It provides complete tremor elimination, motion scaling, and improved operative ergonomics, leading to patent anastomosis and complication rates comparable to a traditional manual approach. However, more data are needed before widespread clinical implementation to determine whether the increased precision and controllability outweigh the cost and learning curve.The present study highlights the use of the Symani Surgical System, a novel robotic system designed specifically for microsurgery. Symani offers increased precision, dexterity, controllability, and numerous benefits that will help advance the field.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855658","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":"Long-Term Outcomes Following Immediate Dental Implant Placement in Free Fibula Flaps for Oncologic Mandibular Reconstruction.","authors":"Robert J Allen, Kevin K Zhang, Zack Cohen, Annu Singh, Kenneth Kronstadt, Ian Ganly, Farooq Shahzad, Evan Rosen, Jonas A Nelson, Evan Matros","doi":"10.1055/a-2659-6993","DOIUrl":"10.1055/a-2659-6993","url":null,"abstract":"<p><p>Immediate dental implant placement (IDIP) in free fibula flap (FFF) reconstruction of the mandible is an important treatment paradigm for head and neck cancer patients. This study examines the long-term safety and prosthodontic outcomes of IDIP in oncologic mandible reconstruction.A retrospective, noninferiority cohort study was performed comparing IDIP and non-IDIP in patients undergoing FFF reconstruction of oncologic mandibulectomy defects using computer-aided design and computer-aided manufacturing technology. Outcomes of interest included long-term complications and rates of dental rehabilitation with either an implant or nonimplant-supported resection prosthesis.One hundred forty-eight patients were included in the study. IDIP patients (<i>n</i> = 86) were significantly older (<i>p</i> = 0.017) and had a higher BMI (<i>p</i> < 0.0001) than non-IDIP patients (<i>n</i> = 62). Median follow-up time was 2.4 and 4.9 years in the IDIP and non-IDIP groups, respectively. Complication rates were comparable between groups (<i>p</i> > 0.05). The IDIP cohort received 219 dental implants, whereas four patients in the non-IDIP cohort received 10 implants in a delayed setting (<i>p</i> < 0.0001). IDIP patients were more likely to achieve long-term dental rehabilitation (IDIP: 69.8%, non-IDIP: 25.8%; <i>p</i> < 0.0001) and at an earlier time point (median [interquartile range]: 120 [45, 297] days vs. 355 [243, 595] days; <i>p</i> = 0.0002) after reconstruction. Adjuvant radiation did not affect the likelihood of completing dental rehabilitation in IDIP patients (<i>p</i> = 0.818).IDIP safely achieves dental restoration in less time and at a higher rate than non-IDIP in oncologic patients. Measurement of patient-reported outcomes is needed to bolster support for IDIP as the standard of care in oncologic patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667894","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":"Abdominal Peripheral Nerve Blocks Do Not Impact Postoperative Pain in Free Flap Breast Reconstruction.","authors":"Zain Aryanpour, Ansley Wallace, Julian Winocour, David W Mathes, Christodoulos Kaoutzanis, Katie G Egan","doi":"10.1055/a-2671-4007","DOIUrl":"https://doi.org/10.1055/a-2671-4007","url":null,"abstract":"<p><p>Transverse abdominis plane (TAP) and rectus sheath (RS) blocks are utilized in enhanced recovery after surgery protocols, but with highly variable methodologies and outcomes in reported literature. The purpose of this study was to evaluate the efficacy of abdominal peripheral nerve blocks in free flap breast reconstruction as they pertain to postoperative pain medication requirements and hospital length of stay (LOS).Retrospective review was conducted on patients undergoing breast reconstruction with deep inferior epigastric artery perforator free flaps at a large academic institution. Target variables included history of chronic pain diagnosis, laterality, and nerve block type (TAP or RS). Outcomes included daily and total opioid oral morphine milligram equivalents on postoperative days one to three. Patient cohorts were analyzed by TAP block, RS block, or no block. Blocks were performed intraoperatively by the surgical team.Between 2021 and 2023, 225 patients met the inclusion criteria; 87 received TAP blocks, 72 received RS blocks, and 66 received no block. Patients with chronic pain diagnoses who underwent bilateral reconstruction had higher total postoperative opioid requirements. There were no significant differences in hospital LOS or postoperative pain medication requirements between the three groups before or after controlling for multiple co-variables.In this large cohort of abdominal-based free flap breast reconstruction patients, there was no impact of peripheral nerve block or nerve block type on postoperative pain medication requirement or hospital LOS. Bilateral flap reconstruction and a history of chronic pain diagnoses were the only factors found to affect perioperative opioid utilization in patients undergoing abdominally based breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855657","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":"Artificial Intelligence in Microsurgical Education: A Systematic Review of Its Role in Training Surgeons.","authors":"Tricia M Raquepo, Micaela Tobin, Shreyas Puducheri, Mohammed Yamin, Jannat Dhillon, Matthew Bridgeman, Ryan P Cauley","doi":"10.1055/a-2672-0260","DOIUrl":"10.1055/a-2672-0260","url":null,"abstract":"<p><p>Microsurgery is associated with a steep learning curve that requires extensive training through supervised surgeries, cadaver practice, and simulations. The emergence of artificial intelligence (AI) in medical education offers a new potential avenue for microsurgery training by providing real-time feedback, performance analytics, and advanced simulation. This study aims to evaluate the scope, implementation, and outcomes of AI in microsurgical education for trainees across all levels.A systematic review was performed in October 2024 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis with extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases, including Embase, PubMed, Scopus, and Web of Science, returned 3,323 citations. Inclusion criteria were studies investigating the use of AI in the medical education of microsurgical trainees. Abstracts, commentaries, editorials, systematic reviews, and non-English studies were excluded. After two-stage screening, a total of 16 studies were included in this review.The assessed AI interventions appeared in the following number of studies: Computer Vision (<i>n</i> = 13), Sensor-Driven Models (<i>n</i> = 2), Classical/Statistical Machine Learning (<i>n</i> = 4), Task-Specific Neural Networks (<i>n</i> = 4), Transfer Learning of Neural Networks (<i>n</i> = 3), Zero-Shot Inference of Pretrained Models (<i>n</i> = 5), Augmented/Virtual Reality (<i>n</i> = 5), and Anatomical Landmark Tracking (<i>n</i> = 5). Upon full data extraction, three overarching themes were identified among studies: (1) Objective Assessment of Microsurgical Skills, (2) Innovations in Microsurgical Education Materials, and (3) Improvement of Surgeon Workload and Performance. AI improved skill assessment (accuracy: 0.74-0.99), training, and workload optimization. AI-enhanced microsurgical training reduced training time (<i>p</i> = 0.015), improved ergonomics, and minimized cognitive load, accelerating learning (β = 0.86 vs. β = 0.25).AI has transformative potential in microsurgical education and practice, as emphasized by its capacity to enhance skill assessment, educational tools, and ergonomic support. Despite these enhancements, additional work is needed to address challenges such as data bias, standardization, and real-world implementation.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760432","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":"Do We Need a Negative Culture? Examining the Role of Final Debridement Cultures in Microsurgical Limb Salvage: Recommendations from Our 13-Year Experience.","authors":"Rachel N Rohrich, Joshua P Carreras, Sahil Sharma, Ryan P Lin, Sami Ferdousian, Meghan E Currin, Richard C Youn, Christopher E Attinger, Karen K Evans","doi":"10.1055/a-2659-7184","DOIUrl":"https://doi.org/10.1055/a-2659-7184","url":null,"abstract":"<p><p>Lower extremity free tissue transfer (LE FTT) expands limb salvage options for patients with chronic wounds. Infected wounds require serial debridement to optimize the wound bed before reconstruction, but the role of qualitative microbiological cultures in guiding surgical wound closure timing remains unclear. This study evaluates the impact of final preoperative culture results on postoperative outcomes, including flap success, infection rates, and limb salvage.A retrospective review of 344 patients undergoing LE FTT at a single institution was conducted. All patients underwent serial debridement, with final cultures obtained from the final debridement prior to flap reconstruction. Patients were stratified into positive and negative final culture groups. Subgroup analyses assessed the impact of polymicrobial colonization and comorbidity burden (Charlson Comorbidity Index [CCI] >6) on outcomes. Primary outcome was flap infection, defined as any documented clinical concern for infection, including cellulitis, purulent drainage, abscess formation, or initiation of targeted antibiotic therapy.Polymicrobial final cultures were associated with increased infection (<i>p</i> = 0.003) and flap complications (<i>p</i> = 0.041). Among patients with CCI >6, positive final culture was associated with significantly higher infection rates (<i>p</i> = 0.032), but not among those with CCI ≤6. In the total cohort, comparing positive final culture to negative final culture, flap outcomes were similar between groups.Final culture positivity alone does not predict poor outcomes, but polymicrobial cultures and host factors may increase flap infection risk. A risk-stratified approach should guide surgical decision-making, with additional debridement and/or wound bed optimization considered for polymicrobial wounds and polymorbid patients (CCI >6).</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835470","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":"Complications and Hardware Failure Following Synthetic Cranioplasty Implants and Free Flap Coverage.","authors":"Nicholas C Oleck, Kevin K Zhang, Ronnie L Shammas, Jonas A Nelson, Robert J Allen, Evan Matros, Yisong Geng, Amanda R Sergesketter, Hani I Naga, Detlev Erdmann, Brett T Phillips","doi":"10.1055/a-2659-7072","DOIUrl":"10.1055/a-2659-7072","url":null,"abstract":"<p><p>Composite defects of the scalp and calvarium are complex reconstructive problems. Bony reconstruction is often achieved with synthetic implants, demanding robust soft tissue coverage. In cases where the native scalp has been compromised, free tissue transfer may be indicated. The existing literature on this topic lacks a robust analysis of long-term outcomes and hardware retention rates. The current study is a multi-institutional review of composite calvarial reconstruction with free flap coverage of synthetic cranioplasty implants, focusing specifically on flap selection, long-term outcomes, hardware extrusion, and explantation rates.A retrospective review was conducted at two high-volume institutions for patients who had undergone cranioplasty and free tissue transfer between 2001 and 2022. Patient demographics and comorbidities, reconstructive indications, cranioplasty material, flap type, and complications within a 90-day period were collected. Implant exposure and explantation data were collected through follow-up.A total of 42 patients were identified with an average age of 59 years (SD 14.9). Prior scalp radiation was present in 54.7% of cases. Cranioplasty was most commonly indicated after tumor extirpation (88.0%), with titanium mesh as the most common material utilized (64.3%). The most commonly used free flaps were latissimus (45.2%), anterolateral thigh (ALT) (16.7%), and radial forearm (16.7%). The most common recipient vessels were the superficial temporal (64.2%), facial (21.4%), and superior thyroid (9.5%). Flap compromise requiring return to the operating room occurred in two patients (4.8%) and partial flap loss occurred in three patients (7.14%). Surgical complications occurred in 60% of cases with wound complications (33.3%) and surgical site infection (28.6%) being the most common. Implant extrusion occurred in 31% of cases at an average of 7.9 months (SD 30.1) after definitive reconstruction, and explantation was required in 42.9% of cases at an average of 12.8 months (SD 33.6). The average total length of follow-up was 27.1 months.This multi-institutional analysis found that patients who undergo composite cranial vault reconstruction and free flap coverage experience high rates of surgical complications, and over one-third of these patients experience implant extrusion or explantation. Although no individual patient-related risk factor was independently associated with increased complication rates, our findings suggest that flap composition and timing of reconstruction may influence hardware retention and should be carefully considered during preoperative planning.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667893","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}