Journal of reconstructive microsurgery最新文献

{"title":"Twelve Commandments of Reconstructive Microsurgery.","authors":"Dominik A Walczak, Daniel Bula, Tommy Nai-Jen Chang, Jakub Opyrchał","doi":"10.1055/a-2564-6762","DOIUrl":"10.1055/a-2564-6762","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700687","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":"Prevalence of Popliteal Artery Variants in Free Tissue Transfer for Limb Salvage: A 12-Year Vasculoplastic Experience.","authors":"Rachel N Rohrich, Karen R Li, John W Rutland, Ryan P Lin, Sami Ferdousian, Christopher E Attinger, Richard C Youn, Cameron M Akbari, Karen K Evans","doi":"10.1055/a-2555-2292","DOIUrl":"10.1055/a-2555-2292","url":null,"abstract":"<p><p>Popliteal artery variants (PAVs) are anatomical deviations of the popliteal artery's branching pattern and should be considered in microsurgical planning for patients undergoing lower extremity (LE) free tissue transfer (FTT). However, there is a significant lack of FTT literature in this patient population. Thus, this study presents our 12-year experience with LE FTT in patients with PAV.Patients receiving LE FTT reconstruction from July 2011 to March 2024 were reviewed. Preoperative angiograms were reviewed by a single vascular surgeon, and the presence of PAV was identified and classified as IIIA, IIIB, or IIIC. Primary outcomes were flap success and limb salvage.A total of 339 LE FTT were performed in 331 patients. A total of 32 patients (9.4%) had PAV, accounting for a total of 34 LE FTT. Class IIIA was the most common category (<i>n</i> = 20, 58.8%) followed by IIIB (<i>n</i> = 8, 23.5%) and IIIC (<i>n</i> = 6, 11.7%). Median age and body mass index were 63.5 (interquartile range [IQR]: 22.5) years and 27.4 (IQR: 10.3) kg/m². The median Charlson Comorbidity Index was 5 (IQR: 2.5), with prevalent rates of diabetes (<i>n</i> = 18/32, 56.3%) and peripheral artery disease (<i>n</i> = 16/32, 50.0%). Median wound area was 71.0 (IQR: 80.0) cm². Flap success rate was 100% (<i>n</i> = 34/34). At a median follow-up of 12.8 (IQR: 22.6) months, limb salvage was 97.1% (<i>n</i> = 33/34) and mortality was 6.3% (<i>n</i> = 2/32).In this large population of LE FTT, PAV occurs in almost 1 out of 10 patients. Essential to flap success and limb salvage is appropriate preoperative vascular imaging with arteriography, as the presence of PAV changes microsurgical intraoperative planning and technical considerations.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605270","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":"Microsurgery Education among U.S. Plastic Surgery Residency Programs.","authors":"Emily R Finkelstein, Yasmina Samaha, Alex Harris, Meaghan Clark, Devinder Singh, Kyle Y Xu, Juan Mella-Catinchi","doi":"10.1055/a-2555-2055","DOIUrl":"10.1055/a-2555-2055","url":null,"abstract":"<p><p>Microsurgery is a core component of U.S. plastic surgery residency curriculum. This study compares publicly available information on microsurgery curricula and training among U.S. plastic surgery residency programs, while evaluating the background and experience of microsurgeon faculty at these institutions.The authors performed a cross-sectional web search on 103 accredited U.S. plastic surgery residency programs in March 2023. Publicly available information evaluated for each program included nonclinical microsurgery education, clinical microsurgical exposure, and the number of microsurgeon faculty. The perceived gender and race, professorship title, previous training, academic productivity, and scope of practice were determined for each individual faculty member.While approximately one-half of programs had evidence of microsurgical skill labs with anastomosis models (<i>n</i> = 56; 54%), fewer had a formal microsurgery curriculum (<i>n</i> = 36; 35%), or benchmark examinations (<i>n</i> = 25; 24%). Significantly more home institutions provided clinical exposure to breast, trauma or cancer, head and neck, and hand-related microsurgery than gender (<i>p</i> < 0.001) and lymphedema microsurgery (<i>p</i> < 0.001). Of the 724 faculty microsurgeons, most were male (<i>n</i> = 543), Caucasian (<i>n</i> = 488), and assistant professors (<i>n</i> = 316). Faculty underrepresented in plastic surgery were most often assistant professors with significantly fewer years of experience than their male (<i>p</i> < 0.001) and Caucasian counterparts (<i>p</i> < 0.023).Great variability exists in clinical and nonclinical microsurgery training among U.S. plastic surgery residency programs. As the demand for microsurgery continues to rise, we can expect microsurgery education to become more uniform. Most microsurgeon faculty underrepresented in plastic surgery were earlier in their career, suggesting a potential shift in diversity as these individuals ascend the academic ladder.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605268","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 the Merit and Applications of the Caprini Risk Score as a Complications Predictor.","authors":"Kristina L Khaw, India Jones, Alec H Fisher, Krystal Hunter, Steven C Bonawitz","doi":"10.1055/a-2555-2118","DOIUrl":"10.1055/a-2555-2118","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is considered a complication of free flap surgery. Prior studies investigating the use of the Caprini Risk Score (CRS) to estimate the risk of complications in free flap reconstruction are confounded by small sample sizes, varying surgical sites, and disparate classification of risk. This study evaluates the predictive merit of CRS for complications in free flap reconstructions.A retrospective review of patients (<i>n</i> = 502) who underwent free flap reconstruction from January 2015 to April 2022 collected patient medical history, type and location of free tissue transfer, CRS, and prior and perioperative anticoagulation (AC). Reconstructive outcomes and complications were analyzed in low (CRS <8) and high (CRS ≥8) cohorts using chi-square tests. Complications were also analyzed by flap sites in sufficient cohort populations (<i>n</i> > 10).Of 502 patients, the high CRS cohort (<i>n</i> = 71) was associated with upper (<i>p</i> < 0.005) and lower (<i>p</i> < 0.001) extremity reconstructions while the low CRS (<i>n</i> = 431) cohort was associated with breast reconstructions (<i>p</i> < 0.001). The high CRS cohort demonstrated an increased need for intraoperative blood transfusions (<i>p</i> < 0.001). Other intraoperative or postoperative complications such as flap loss, intraoperative AC, return to operating room (OR), or VTE had no significant correlations. High CRS patients were more likely to be discharged on AC (<i>p</i> < 0.001) and have a longer length of stay (LOS; <i>p</i> < 0.001). By flap site, there was a significant association between CRS and LOS >14 days in breast and head and neck flaps (<i>p</i> < 0.05) and discharge on AC in head and neck flaps only (<i>p</i> < 0.001).CRS may have utility in predicting the need for blood transfusion and AC requirements in free flap reconstruction but does not seem to predict the incidence of flap complications. A larger, higher-powered study may be used to assess the validity of CRS in risk of VTE and anticoagulant prophylaxis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605267","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 Wall Reinforcement Using OviTex after Deep Inferior Epigastric Perforator Flap.","authors":"Alec S McCranie, Caitlin Blades, Steven Dawson, Jose A Foppiani, Taylor Allenby, Julian Winocour, Justin Cohen, David Mathes, Christodoulos Kaoutzanis","doi":"10.1055/a-2555-2348","DOIUrl":"10.1055/a-2555-2348","url":null,"abstract":"<p><p>Abdominal wall bulges and hernias are not uncommon complications following deep inferior epigastric perforator (DIEP) flap harvest. Abdominal wall reinforcement using synthetic meshes has been found to decrease bulges by up to 70%; however, such meshes can be associated with other issues such as seromas and infections. Reinforced tissue matrix (RTM) mesh can be used for abdominal wall reinforcement due to its ability to recruit fibroblasts and provide a scaffold for cellular proliferation. There is no literature on the use of OviTex mesh for abdominal wall reinforcement following DIEP flap harvest. Therefore, this study aimed to evaluate the efficacy and safety of its use in this setting.A retrospective review was performed on patients undergoing DIEP flap harvest between January 2020 and June 2023. Patients who had completed at least 12 months of follow-up visits were included. Descriptive, univariate, and multiple logistic regression analyses were completed.A total of 199 patients were included. The mean age at the time of surgery was 51.1 ± 10.0 years and the mean body mass index (BMI) was 30.2 ± 5.9 kg/m². Abdominal wall reinforcement was completed in 85 (42.7%) patients. Patients who had OviTex placed developed fewer bulges compared to the non-mesh cohort (0% vs. 5.3%, <i>p</i> = 0.04). Furthermore, OviTex mesh did not increase adverse events and was not significantly different in seroma/hematoma rates when compared to the non-mesh cohort (10.6% vs. 5.3%, <i>p</i> = 0.26).This study demonstrates that OviTex mesh is safe and efficacious in reducing the rate of bulges following DIEP flap harvest without increasing other complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605156","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":"Risk Factors for Flap Loss in Midface Reconstruction with Vascularized Fibular Flap.","authors":"Katsuhiro Ishida, Yohjiro Makino, Keita Kishi, Hiroki Kodama, Haruyuki Hirayama, Doruk Orgun, Masaki Nukami, Taisuke Akutsu, Takeshi Miyawaki","doi":"10.1055/a-2555-2169","DOIUrl":"10.1055/a-2555-2169","url":null,"abstract":"<p><p>Midface reconstruction should address both functional and cosmetic aspects. The vascularized fibular osteomyocutaneous flap (VFOF) is a promising first choice because of its numerous advantages in this type of reconstruction.This study aimed to investigate the causes of VFOF failure during midface reconstruction. We retrospectively reviewed patients who underwent midface defect reconstruction using VFOF from August 2011 to May 2022 at a single center. The primary outcome variable was VFOF loss within 30 days, and secondary outcomes included late complications related to VFOF occurring at least 6 months postoperatively.A total of 62 patients underwent VFOF reconstruction for midface defects. The VFOF technique was primarily used in 56 (90.3%) patients for initial reconstruction. according to the Brown and Shaw classification, most reconstructions were performed for Class III (77.4%) and Class b (83.6%) defects. Skin paddles of the VFOF were used in 51 (82.3%) patients, and a double flap technique utilizing the fibular was employed in 24 (38.7%) patients. VFOF failure occurred in 10 (16.1%) patients. Prognostic factors associated with VFOF failure included sex (<i>p</i> = 0.01) and maxillary Brown and Shaw classification (horizontal; <i>p</i> = 0.01). Long-term follow-up of 47 patients revealed late complications in 11 (23.4%) patients, and diabetes mellitus was identified as a significant risk factor (<i>p</i> < 0.01).The VFOF is suitable for midface defect reconstruction; however, proper placement of the fibular bone, avoiding pedicle vessel kinking, ensuring tension-free vascular anastomosis during surgery, considering the use of an additional flap in addition to the fibula flap for large defects, and diligent postoperative nasal care are essential.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605271","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 Co-Surgeon Model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.","authors":"Emmanuel Giannas, Brandon Alba, Kelly Harmon, Annie Fritsch, David Kurlander, Deana Shenaq, Christodoulos Kaoutzanis, Christopher Reid, Evan Matros, Babak Mehrara, George Kokosis","doi":"10.1055/a-2540-0835","DOIUrl":"10.1055/a-2540-0835","url":null,"abstract":"<p><p>Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeon perspectives on the utility of the co-surgeon model.A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (± 9.7) years. Most of the microsurgeons were male (71%) practicing in the United States (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with immediate lymphatic reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4 and 36.4%, respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves \"very much\" or \"quite a bit\" operative efficiency and duration, as well as surgeon well-being and career longevity.This study provides new insight into the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon well-being, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting well-being among microsurgeons.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492529","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":"Effect on Timing of Free Flap Breast Reconstruction on Mastectomy Skin Necrosis.","authors":"Shahnur Ahmed, Jordan Crabtree, Kasra N Fallah, Ethan J Rinne, Luci Hulsman, Carla S Fisher, Kandice K Ludwig, Rachel M Danforth, Mary E Lester, Aladdin H Hassanein","doi":"10.1055/a-2540-1154","DOIUrl":"https://doi.org/10.1055/a-2540-1154","url":null,"abstract":"<p><strong>Background: </strong> Deep inferior epigastric perforator (DIEP) flap is a common autologous breast reconstruction option. DIEP flap may be performed immediately on the day of mastectomy (immediate DIEP) or at a later date typically following placement of a tissue expander during mastectomy (delayed-immediate DIEP). Preparing internal mammary vessels during microsurgical anastomoses involves prolonged retraction of the breast skin flaps, which can increase tension on acutely ischemic mastectomy skin. The purpose of this study is to investigate whether DIEP flap timing has an effect on mastectomy skin necrosis.</p><p><strong>Methods: </strong> A single-center study was performed of patients who underwent immediate or delayed DIEP flap reconstruction over a 3-year period. Patients were divided into two groups: Group I (immediate DIEP flap) and Group II (delayed-immediate DIEP with flap staged separately from mastectomy). The outcomes assessed were breast skin flap necrosis and management of skin flap necrosis.</p><p><strong>Results: </strong> The study included 106 patients (173 flaps) in Group I (49 patients, 80 flaps) and Group II (57 patients, 93 flaps). Mastectomy skin flap necrosis rates were 11.3% (9/80) for Group I compared to 2.2% (2/93) of Group II patients (<i>p</i> = 0.025). Skin necrosis necessitating operative debridement was 7.5% (6/80) in Group I and 1.1% (1/93) in Group II (<i>p</i> = 0.0499).</p><p><strong>Conclusion: </strong> Immediate DIEP flaps performed on the day of mastectomy have a significantly higher risk of mastectomy skin necrosis. Patients may be counseled that another advantage of performing a DIEP flap on a different day than a mastectomy is to decrease the risk of mastectomy skin necrosis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605159","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":"Thoracodorsal Artery Perforator Diameter and Flow Velocity Correlate with Muscle Thickness.","authors":"Claudius Illg, Katarzyna Rachunek-Medved, Henrik Lauer, Johannes Tobias Thiel, Adrien Daigeler, Sabrina Krauss","doi":"10.1055/a-2540-1100","DOIUrl":"https://doi.org/10.1055/a-2540-1100","url":null,"abstract":"<p><strong>Background: </strong> The thoracodorsal artery perforator (TDAP) flap is a versatile pedicled and free flap with low donor site morbidity and a relatively thin skin paddle. Physical patient characteristics may influence interindividual differences in perforator characteristics and, therefore, help to estimate the safety of the TDAP flap.</p><p><strong>Methods: </strong> Dynamic infrared thermography and color duplex ultrasound were applied to assess the TDAP diameter, peak systolic velocity (PSV), end-diastolic velocity, resistance index, and thickness of the latissimus dorsi muscle and the subcutaneous tissue bilaterally in 25 subjects. The effect of handedness on the symmetry of perforator characteristics was investigated.</p><p><strong>Results: </strong> Perforator properties were not significantly altered by sex or body mass index. The mean latissimus dorsi muscle thickness correlated positively with both the perforator diameter (Pearson's <i>r</i> = 0.25, <i>p</i> = 0.0048, <i>n</i> = 124) and the PSV (<i>r</i> = 0.29, <i>p</i> = 0.0012, <i>n</i> = 124). In contrast, a negative correlation was observed between subcutaneous tissue thickness and PSV (<i>r</i> = -0.31, <i>p</i> = 0.0003, <i>n</i> = 124). A comparison of the perforator diameter and the PSV in the dominant and nondominant sides showed no statistically significant difference.</p><p><strong>Conclusion: </strong> The findings of the study indicate that perfusion of the thoracodorsal artery flap is enhanced by the presence of a thicker latissimus dorsi muscle, a thinner subcutaneous tissue, and a reduced quantity of TDAPs.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605272","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 Review of Minimally Invasive Techniques for Perfusion Optimization of Flaps.","authors":"Micaela Tobin, Charlotte Thomas, Tricia Raquepo, Mohammed Yamin, Audrey Mustoe, Agustin Posso, Jose Foppiani, Ryan P Cauley","doi":"10.1055/a-2540-1044","DOIUrl":"10.1055/a-2540-1044","url":null,"abstract":"<p><strong>Background: </strong> There is a growing emphasis on minimally invasive techniques as an alternative to surgical delay to promote vessel reorganization and prevent partial and total flap loss. This systematic review evaluates existing literature on these minimally invasive techniques, focusing on their potential applications in preventing ischemia-related complications.</p><p><strong>Methods: </strong> A systematic review was conducted in July 2024 using PubMed, MEDLINE, and Web of Science following preferred reporting items for systematic reviews and meta-analysis guidelines. Inclusion criteria were studies that included patients undergoing any flap-based reconstruction treated with minimally invasive delay. Exclusion criteria were non-English papers, other systematic reviews, nonhuman patients, and pediatric patients.</p><p><strong>Results: </strong> Six studies were included (angiographic delay <i>n</i> = 143, heat preconditioning <i>n</i> = 191, ischemic preconditioning <i>n</i> = 60) which examined minimally invasive methods for perfusion optimization. Aggregated data from the three studies on angiographic delay demonstrated a 13% (18/143) combined skin or fat flap necrosis rate, which was lower than that of non-delayed flaps and comparable to more invasive traditional surgical ligation. Ischemic preconditioning showed no significant differences (<i>p</i> = 1.0) g compared with controls, whereas heat preconditioning led to reductions (26% vs. 35%) in flap necrosis and necrosis requiring surgical intervention (11% vs. 17%).</p><p><strong>Conclusion: </strong> Angiographic embolization presents a promising alternative to invasive surgical delay, effectively reducing flap necrosis risk. Heat and ischemic preconditioning also show potential for increasing flap survival, although current studies are limited by small sample sizes. Further research is essential to explore preoperative conditioning interventions to improve surgical outcomes for patients who require less invasive delay techniques.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441198","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}