Journal of reconstructive microsurgery最新文献

{"title":"Differential Perfusion Patterns of Perforator and Random Flaps Assessed by Indocyanine Green Imaging.","authors":"Abdullh Z AlQhtani, Nara Lee, Hyungbae Kim, Jin Sup Eom, Hyun Ho Han","doi":"10.1055/a-2702-4290","DOIUrl":"10.1055/a-2702-4290","url":null,"abstract":"<p><strong>Background: </strong>Indocyanine green angiography (ICGA) is widely used to evaluate flap perfusion in reconstructive surgery, but the optimal timing for assessment may differ by flap type. This study compared the perfusion dynamics of perforator and random pattern flaps in a rat model using ICGA.</p><p><strong>Methods: </strong>ICGA dynamics were compared between perforator and random flaps in a rat model. Sixteen Sprague-Dawley rats (275-300 g) were randomly assigned to either a perforator or a random flap group. A 0.25-mg dose of indocyanine green (ICG) was administered via the femoral vein, and fluorescence images were acquired at predefined intervals over 4 minutes. Hypoperfusion was defined as fluorescence intensity below 30% of the peak value. Necrosis was assessed on postoperative day 7. Statistical analyses included the Mann-Whitney U and log-rank tests with Expectation-Maximization Iterative Convex Minorant (EMICM) modeling.</p><p><strong>Results: </strong>In the perforator flap group, the final area of necrosis corresponded to the ICGA-defined perfusion boundary observed between 10 and 50 seconds postinjection. In contrast, necrosis in the random flap group aligned with the ICGA-defined perfusion boundary captured between 30 and 150 seconds. The most accurate time points for necrosis prediction were 50 seconds for perforator flaps and 150 seconds for random flaps, both demonstrating statistical significance (<i>p</i> = 0.0028).</p><p><strong>Conclusion: </strong>ICGA timing requirements differ between flap types. Implementing flap-specific assessment windows may enhance intraoperative interpretation and reduce false-positive findings. These findings support the development of flap-specific ICGA protocols to improve intraoperative decision-making in reconstructive surgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"548-553"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080890","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":"Indications and Outcomes of Autologous Conversion from Implant-Based Breast Reconstruction.","authors":"Lauren J Kim, Langfeier Liu, Sumeet S Teotia, Nicholas T Haddock","doi":"10.1055/a-2717-4207","DOIUrl":"10.1055/a-2717-4207","url":null,"abstract":"<p><strong>Background: </strong>In this study, we explored the transition from implant-based to autologous breast reconstruction, focusing on the factors prompting conversion, patient outcomes, and the role of emerging flap types such as profunda artery perforator (PAP) and lumbar artery perforator (LAP) in reconstruction choices. Historically, implant-based methods dominated breast reconstruction, but limitations and complications have led a subset of patients to prefer autologous reconstruction, especially after radiation therapy. This research aimed to elucidate the decision-making process behind switching to autologous methods, examining a broad range of patient demographics and conversion factors.</p><p><strong>Methods: </strong>A retrospective review was conducted using REDCap database information from January 2012 to August 2023, including 119 patients who converted from implant-based to autologous reconstruction and 1,329 who underwent primary autologous reconstruction. Data analysis covered demographics, comorbidities, reasons for conversion, types of surgeries performed, and BREAST-Q responses to assess satisfaction and quality of life.</p><p><strong>Results: </strong>Indications for conversion included capsular contracture, dissatisfaction, and complications from previous treatments. Patients undergoing autologous conversion typically experienced more revision surgeries compared with those with primary autologous reconstruction. Notably, emerging flap options like PAP and LAP were more frequently utilized in conversions. BREAST-Q scores showed no significant preoperative differences, but postoperative satisfaction varied, highlighting the nuanced outcomes of reconstruction choices.</p><p><strong>Conclusion: </strong>In conclusion, converting to autologous breast reconstruction offers a patient-centered alternative for those facing implant-based reconstruction failures, underscoring the need for individualized surgical approaches. This study contributes valuable insights into optimizing reconstructive outcomes by understanding patient preferences and advancements in flap techniques.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"619-624"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275084","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":"Combination of Smartphone Thermography with Color-Doppler Ultrasonography-an Easy Method for Preoperative Planning of ALT Flaps for Novice Microsurgeons.","authors":"Dominik A Walczak, Agnieszka Piotrowska-Seweryn, Agata Żółtaszek, Łukasz Krakowczyk, Adam Maciejewski, Maciej Grajek, Marcin Zeman, Cezary Szymczyk, Ewa Migacz, Jakub Opyrchał, Daniel Bula","doi":"10.1055/a-2717-4243","DOIUrl":"10.1055/a-2717-4243","url":null,"abstract":"<p><strong>Background: </strong>The design and preoperative planning of microsurgical free flaps are crucial for successful outcomes. Studies have shown that preoperative vascular mapping significantly shortens operative time, reduces complication rates, and lowers overall costs. Various methods of perforator detection have been introduced; however, none is ideal. Some surgeons propose that combining two or even three different methods could better meet clinical expectations. Therefore, this study sought to determine the effect of augmenting color Doppler ultrasound (CDUS) preoperative perforator detection with smartphone-based dynamic infrared thermography (DIRT) on concordance with intraoperative findings.</p><p><strong>Methods: </strong>The study included 46 patients scheduled for anterolateral thigh flap (ALTF) reconstruction. Patients were divided into two groups according to the method of perforator mapping: Group 1 underwent CDUS alone, while Group 2 underwent DIRT followed by CDUS. Assessments were performed by novice surgeons with limited ultrasound experience.</p><p><strong>Results: </strong>The time required for perforator mapping was significantly shorter in Group 2 (9 min vs. 16 min, <i>p</i> < 0.0001). The mean number of detected perforators in the evaluated area was 2.5 in Group 1 and 2.96 in Group 2 (<i>p</i> = 0.046). Combining CDUS with DIRT significantly reduced the number of overlooked vessels (<i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>DIRT plays an important role in perforator flap planning by identifying likely perforator locations before CDUS. In turn, CDUS provides detailed information on the perforator's course and hemodynamic properties. The combination of these two techniques offers a rapid, easily interpretable method for preoperative flap planning that can be used by any microsurgeon.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"575-581"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275093","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":"Population Assessment of Anatomic Eligibility for Robotic-Assisted DIEP Flap.","authors":"Jacquelyn M Roth, Maxwell Godek, Ethan Fung, Reanna Shah, Bernice Yu, Areeg A E Hawa, Keisha E Montalmant, Alex Kagen, Alice Yao, Peter W Henderson","doi":"10.1055/a-2702-4021","DOIUrl":"10.1055/a-2702-4021","url":null,"abstract":"<p><strong>Background: </strong>Compared with traditional deep inferior epigastric perforator (DIEP) flap breast reconstruction procedures, robotic-assisted DIEP (R-DIEP) minimizes abdominal wall morbidity by reducing fascial incision length. Optimal R-DIEP candidates have large perforators with short intramuscular courses, but no large-scale studies have quantified their prevalence. This study aims to identify the proportion of patients who are anatomically eligible for R-DIEP.</p><p><strong>Methods: </strong>A retrospective review of patients who underwent magnetic resonance angiography perforator mapping prior to DIEP flap breast reconstruction between 2019 and 2023 was conducted. Patient demographics were collected. \"Dominant perforator\" was defined as the largest perforator at or below the level of the umbilicus. The intramuscular course of each perforator was calculated as the hypotenuse of a theoretical prism connecting its entry and exit points with respect to the rectus abdominis muscle. Perforator diameter was measured at the anterior rectus sheath. \"Conservative\" (intramuscular course ≤ 2.5 cm) and \"liberal\" (intramuscular course ≤ 5 cm) eligibility criteria were applied. Perforator diameter > 2 mm was used as a secondary criterion.</p><p><strong>Results: </strong>A total of 574 dominant perforators were identified in 287 patients. The average intramuscular length of each perforator was 3.8 ± 1.9 cm (range: 0-11.0 cm). Twenty-nine percent of dominant perforators (<i>n</i> = 165) had an intramuscular course length ≤ 2.5 cm, 77% (<i>n</i> = 441) had an intramuscular course length ≤ 5 cm, and 2.3% (<i>n</i> = 13) were paramuscular (no intramuscular course). Forty-six percent of patients (<i>n</i> = 132) had at least one dominant perforator (i.e., left- or right-sided) with an intramuscular course ≤ 2.5 cm, and 93% of patients (<i>n</i> = 268) had at least one dominant perforator with an intramuscular course ≤ 5 cm. Thirty-one percent of dominant perforators (<i>n</i> = 185) had a diameter > 2 mm and an intramuscular course ≤ 2.5 cm, and 49% of dominant perforators (<i>n</i> = 281) had a diameter > 2 mm and an intramuscular course ≤ 5 cm.</p><p><strong>Conclusion: </strong>A substantial portion of the population is anatomically eligible for R-DIEP breast reconstruction, especially when liberal criteria are applied.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"554-558"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080954","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":"Cutaneous Nerve Anatomy Relevant to Lateral Arm Flap Surgery.","authors":"Buse Naz Çandır Gürses, Özge Irmak Doğancı, Ahmet Ertaş, İlke Ali Gürses","doi":"10.1055/a-2943-3807","DOIUrl":"10.1055/a-2943-3807","url":null,"abstract":"<p><strong>Background: </strong>The inferior lateral brachial cutaneous nerve (ILBCN) and posterior antebrachial cutaneous nerve (PACN) are clinically relevant during lateral arm flap elevation and procedures involving the distal arm and lateral elbow. However, their anatomy remains inconsistently described. This study aims to clarify the origins, courses, and anatomical relationships of the ILBCN and PACN to reproducible surgical landmarks.</p><p><strong>Methods: </strong>Twenty-one upper extremities from 12 embalmed adult body donors were dissected. The ILBCN and PACN were traced from their origin at the radial nerve to their superficial distribution. Relationships to the lateral head of the triceps brachii, lateral intermuscular septum (LIMS), brachial fascia, distal deltoid attachment, and lateral epicondyle were documented.</p><p><strong>Results: </strong>The ILBCN and PACN arose from a common trunk in 52.4% of specimens and separately in 47.6%. The ILBCN most commonly pierced the LIMS and became superficial in the anterior compartment (57.1%). The PACN most frequently became superficial posterior to the LIMS after piercing the distal attachment of the lateral head of the triceps brachii (61.9%). At the interepicondylar line, the PACN lay 15.6 ± 5.7 mm anterior to the lateral epicondyle. An overlapping cutaneous pathway supplying both ILBCN and PACN territories was identified in five specimens (23.8%).</p><p><strong>Conclusion: </strong>The ILBCN and PACN demonstrate reproducible anatomical relationships relevant to lateral arm flap elevation, sensory reconstruction, and preservation of donor-site sensibility. The overlapping cutaneous pathway identified in this study may contribute to variability in postoperative sensory outcomes involving the lateral arm and posterior forearm.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794637","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":"Gaps in Breast Reconstruction Patient Educational Resources: Comparing Patient and Surgeon Perspectives.","authors":"Erica Lee, Lily Zhu, Helen Xun, Chao L Azad, Pooja Yesantharao, Faraah Bekheet, Justin M Sacks, Lily R Mundy, Jennifer Sheng, Kristen P Broderick","doi":"10.1055/a-2920-3851","DOIUrl":"https://doi.org/10.1055/a-2920-3851","url":null,"abstract":"<p><strong>Background: </strong>Breast reconstruction is an important component of cancer care following mastectomy, improving psychosocial well-being and quality of life. However, not all patients are satisfied with their outcomes. Patient satisfaction with preoperative information is a strong predictor of postoperative satisfaction, but it remains unclear how patient and surgeon perspectives differ regarding the quality and availability of educational resources and which areas of education most need improvement.</p><p><strong>Materials and methods: </strong>A cross-sectional survey evaluated patient and plastic surgeon preferences and assessments of breast reconstruction educational resources. Eligible patients were aged 18 years or older and had undergone breast reconstruction. Plastic surgeons were members of the American Council of Educators in Plastic Surgery. Surveys assessed demographics, use of educational resources, and perceived gaps in existing education.</p><p><strong>Results: </strong>The survey was completed by 82 patients and 38 plastic surgeons. Patients most frequently used internet searches (82%), peer support groups (54%), and family and friends (49%) for education outside of clinic visits. Surgeons overestimated patients' use of social media as an educational resource (estimated 50-75%, actual 19%). Both groups identified the feel of the reconstructed breast and the impact on body image as difficult to anticipate preoperatively. Patients reported significantly more difficulty visualizing reconstructive stages (<i>p</i> < 0.01) and skin rippling (<i>p</i> < 0.01), and desired more body image-related education (<i>p</i> < 0.05), realistic images, and reconstruction timelines. Both groups highlighted the need for improved education on breast feel, reconstruction duration and stages, complications, and realistic images. Racial and ethnic minority patients were significantly more likely to desire images reflecting their own skin tone and body type (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Patient and surgeon perceptions of breast reconstruction educational resources are largely concordant but differ in several key areas. Surgeons can enhance patient understanding and satisfaction with reconstruction outcomes by improving visual and representative content and aligning with patient preferences.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840600","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":"High-Frequency Ultrasound Mapping of Facial Nerve Branches: Validation of a Systematic Technique and Clinical Application.","authors":"Marc Blasi, Àngels Ribera, Xavier Sala-Blanch, Javier de la Fuente, Tomas Ayté, Jan Xarrié, Ramon Balius, María Del Rio, Cristian Carrasco López, Carmen Higueras Suñé","doi":"10.1055/a-2936-1711","DOIUrl":"10.1055/a-2936-1711","url":null,"abstract":"<p><strong>Background: </strong>Several surface anatomy landmarks have been described to aid in the surgical dissection of facial nerve donor branches for neurotization purposes yet are limited by considerable anatomical variability. High-frequency ultrasound has shown promise for facial nerve imaging and could be a more precise complementary tool to intraoperative neurostimulation. We aimed to validate a systematic ultrasound examination technique to determine the exact location for each main extratemporal branch and to assess its preliminary clinical feasibility and safety profile for preoperative mapping.</p><p><strong>Methods: </strong>Ten cadaveric hemifaces with a total of 56 facial nerve extratemporal branches were examined to validate a branch-by-branch ultrasound-based mapping technique. The accuracy of skin markings and ultrasound-guided methylene blue injections for each branch was confirmed by subsequent dissection. Additionally, a retrospective clinical series, comprising five cross-face nerve grafts and one facial nerve-to-muscle neurotization, was analyzed to assess reproducibility in the clinical setting.</p><p><strong>Results: </strong>In the cadaveric series, branch-by-branch analysis demonstrated a sensitivity of 92.9% (95% confidence interval [CI]: 84.2-97.7), a positive predictive value of 92.9% (95% CI: 84.2-97.7), and an overall agreement between ultrasound findings and dissection of 86.7% (95% CI: 75.4-93.3). In the clinical series, the targeted facial nerve branches were successfully identified without complications.</p><p><strong>Conclusion: </strong>The proposed systematic ultrasound-based mapping technique, readily performed by surgeons trained in ultrasonography, shows promising accuracy in the identification of facial nerve arborization and a good preliminary feasibility and safety profile in the clinical setting.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148723842","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":"Machine Learning-Based Prediction of Fibular Artery Septocutaneous Perforators.","authors":"Jannik Ketschau, Jonathan Mohr, Yannik Leonhardt, Nils Krautkremer, Johannes Brandt, Andreas Fichter, Lucas M Ritschl","doi":"10.1055/a-2936-1847","DOIUrl":"https://doi.org/10.1055/a-2936-1847","url":null,"abstract":"<p><strong>Background: </strong>Reliable identification of septocutaneous fibular artery perforators is important for free fibula flap harvest involving a skin paddle. While imaging modalities such as computed tomography angiography (CTA) provide high diagnostic accuracy for direct perforator visualization, they do not quantify segment-level probability of perforator presence based on global anatomical characteristics.</p><p><strong>Methods: </strong>In this retrospective CTA-based study, 246 patients (490 limbs) were analyzed. Each fibula was divided into 10 equal segments, yielding 4,900 limb-zone observations. Using limb-level anatomical and vascular parameters, machine learning models were developed to predict the presence of at least one perforator per segment. Data were split at the patient level (80% training, 20% testing). Model performance was evaluated using area under the receiver operating characteristic curve (ROC-AUC), area under the precision-recall curve (PR-AUC), and Brier score.</p><p><strong>Results: </strong>Overall segment-level perforator prevalence was 15.4%, and 20.6% of limbs exhibited no septocutaneous perforator. Ridge-regularized logistic regression (primary model) achieved a ROC-AUC of 0.684, PR-AUC of 0.243, and Brier score of 0.1214. Random forest achieved a ROC-AUC of 0.705, PR-AUC of 0.239, and Brier score of 0.1216. XGBoost achieved a ROC-AUC of 0.710, PR-AUC of 0.245, and Brier score of 0.1213. The generalized additive model yielded a ROC-AUC of 0.683, PR-AUC of 0.231, and Brier score of 0.1223. All approaches reproduced the characteristic midfibular peak in perforator probability.</p><p><strong>Conclusion: </strong>Machine learning enables moderate segment-level discrimination of perforator presence based on global anatomical features. While not comparable to imaging for direct vessel localization, probabilistic modeling may complement imaging by providing structured, patient-specific estimation of regional perforator likelihood.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818728","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":"Psychological Sequelae and Support for Microsurgeons After Free Flap Failure.","authors":"Skyler K Palmer, Malka Korenblit, Zain Aryanpour, Timothy J Irwin, Mark A Greyson, Christodoulos Kaoutzanis, David W Mathes, Amanda K Silva, Katie G Egan","doi":"10.1055/a-2936-1793","DOIUrl":"10.1055/a-2936-1793","url":null,"abstract":"<p><strong>Background: </strong>Free tissue transfer is the standard for complex reconstruction, yet flap failure remains an inevitable reality of microsurgical practice. Beyond patient impact, these events can profoundly affect surgeons through psychological, physical, and professional sequelae. Comprehensive data on prevalence, risk factors, and support systems specific to microsurgeons remain limited.</p><p><strong>Methods: </strong>Following IRB approval, a 15-item REDCap survey was distributed to American Society for Reconstructive Microsurgery members. The survey assessed demographics, flap experience, psychological and physical symptoms following flap loss, symptom duration and impact, coping strategies, available institutional support, and desired support. Statistical analyses included descriptive statistics, Fisher's exact test, Spearman correlation, and logistic regression. Free-text responses underwent thematic content analysis.</p><p><strong>Results: </strong>Eighty-two microsurgeons completed the survey (63.4 male and 36.6% female; mean: 12.2 years in practice). Sixty-seven point one percent experienced guilt, 61.0% fear of future poor outcomes, 58.5% difficulty sleeping, and 56.1% anxiety and questioning of surgical ability. While most experienced short-term symptoms, 17.1% reported prolonged duration (several months or longer). Female-identifying surgeons experienced prolonged symptoms significantly more often than male-identifying surgeons (30.0% vs. 9.6%, <i>p</i> = 0.031). Having ≤ 5 microsurgical colleagues was associated with prolonged symptoms (27.3% vs. 5.3%, <i>p</i> = 0.009). Years in practice were modestly associated with shorter symptom duration and lower perceived impact. The most common coping strategy was discussing events with colleagues (72.8%). A substantial gap existed between available and desired support: only 25.9% had access to counseling services, while 51.9% desired peer support programs.</p><p><strong>Conclusion: </strong>Psychological sequelae after flap loss are nearly universal among microsurgeons, with female-identifying surgeons and those in smaller practices particularly vulnerable. Institutions and microsurgical societies should develop structured, psychologically safe support systems to improve surgeon well-being, promote professional sustainability, and strengthen a culture of reflection and learning.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148722001","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":"Anterolateral Thigh Versus Parascapular Fasciocutaneous Free Flap Donor Site Morbidity: A Systematic Review.","authors":"Malia Voytik, Salman Khan, William Piwnica-Worms, Rachel Greenblatt, Jovial Joseph, Jamie Lee, Kristina McShea, Robyn Broach, Ines C Lin","doi":"10.1055/a-2920-3973","DOIUrl":"10.1055/a-2920-3973","url":null,"abstract":"<p><strong>Background: </strong>The anterolateral thigh (ALT) and parascapular (PS) flaps are commonly used fasciocutaneous free flaps for extremity reconstruction, offering large reliable soft tissue coverage with low donor site morbidity. However, comparative data on donor site functional outcomes remain limited. This review evaluates and compares reported donor site morbidity associated with ALT and PS flaps.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, Scopus, and the Cochrane Library was conducted through October 6, 2025. Studies reporting binary outcomes for donor site complications after ALT or PS flap harvest were included. Data on hematoma, seroma, delayed healing, dehiscence, weakness, functional deficit, and numbness were pooled and analyzed using Fisher's exact or Chi-square tests.</p><p><strong>Results: </strong>Of 1,167 studies screened, 46 met inclusion criteria: 43 reported on ALT flaps, 2 on PS flaps, and 1 on both, totaling 3,380 ALT and 50 PS flaps. For ALT flaps, pooled complication rates were: numbness 51.7%, dehiscence 9.6%, delayed healing 7.5%, weakness 5.0%, seroma 4.5%, functional deficit 1.5%, and hematoma 1.3%. For PS flaps, complication rates were: numbness 26.3%, dehiscence 16.7%, delayed healing 10.0%, weakness 10.0%, functional deficit 10.0%, seroma 8.0%, and hematoma 0%. ALT flaps were associated with significantly greater numbness (<i>p</i> = 0.01), while PS flaps showed higher functional deficits (<i>p</i> = 0.04). No other outcomes differed significantly.</p><p><strong>Conclusion: </strong>ALT and PS flaps both offer effective reconstruction with low overall morbidity. ALT flaps are more often associated with numbness, while PS flaps may pose a higher risk of functional impairment; however, this latter finding should be interpreted cautiously given the limited number of PS flap studies and small sample size. These differences may guide flap selection when clinical factors are otherwise equivalent.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648659","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}