Journal of reconstructive microsurgery最新文献

{"title":"Comment: Effect of Enhanced Recovery After Surgery on Racial Inequalities in Prescribing Practices for Autologous Breast Reconstruction.","authors":"Benedetto Longo, Martina Giacalone, Lisa Vannucchi, Valerio Cervelli","doi":"10.1055/a-2920-4111","DOIUrl":"10.1055/a-2920-4111","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584543","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":"Have Outcomes Improved in Microsurgical Breast Reconstruction? An 8-Year Prospective Longitudinal Study of 5,671 Flaps Across 22 Centers.","authors":"Uwe von Fritschen, Sonja Fertsch, Andreas Arkudas, Maike Keck, Emre Gazyakan, Daniel Schiltz","doi":"10.1055/a-2920-4042","DOIUrl":"10.1055/a-2920-4042","url":null,"abstract":"<p><strong>Background: </strong>Prospective national registry data provide a unique opportunity to evaluate whether increasing experience and structured certification translate into improved microsurgical breast reconstruction outcomes over time.</p><p><strong>Methods: </strong>All microsurgical free-flap breast reconstructions recorded in the prospective quality assessment database of the German Society of Plastic, Reconstructive, and Aesthetic Surgeons between 2011 and 2018 were analyzed. Data from 22 certified centers were included. Temporal trends in flap selection, operative parameters, and clinical outcomes were assessed at national, center, and surgeon levels.</p><p><strong>Results: </strong>A total of 5,671 microsurgical flaps in 4,909 patients were evaluated. Overall flap-loss rates remained stable throughout the study period (2.6-4.2%, <i>p</i> = 0.894) despite increasing center participation and surgeon experience. Additional flap techniques were gradually introduced; however, diversification remained limited with heterogeneous uptake across centers, and deep inferior epigastric perforator (DIEP) remained the predominant reconstructive option. Operative duration decreased significantly in high-volume centers (mean difference: -38 minutes, 95% CI: -69 to -7; <i>p</i> = 0.020) and among more experienced surgeons (mean difference: -30 minutes, 95% CI: -49 to -11; <i>p</i> = 0.003), but no overall reduction in operative duration was observed over time. In contrast, ischemia time showed an overall trend toward prolongation.</p><p><strong>Conclusion: </strong>Microsurgical breast reconstruction within a nationwide network of certified centers achieved consistently high and internationally comparable outcomes. Despite increasing institutional experience and the introduction of additional flap techniques, flap-loss rates remained stable, and DIEP remained the predominant reconstructive option. Although learning-curve effects were identifiable at both the institutional and surgeon level, they did not translate into further reduction in complications. Further quality improvement is therefore more likely to benefit from structured benchmarking and regular feedback of operative and outcome metrics than from technical refinements alone.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562351","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":"When Coverage Isn't Enough: The Sociodemographic Impact on Weight-Bearing Progression After Flap Reconstruction for Lower Extremity Open Fractures.","authors":"Kate B Liao, Tien Do, Kylie Swiekatowski, Stephen Parlamas, Chris Williams, Ellen Wang, Anthony Basta, Dylan Bezzini, Jeffrey G Trost, Justin McCarty, Mohin A Bhadkamkar","doi":"10.1055/a-2920-3909","DOIUrl":"10.1055/a-2920-3909","url":null,"abstract":"<p><strong>Background: </strong>Lower extremity (LE) open fractures are difficult wounds to manage, oftentimes requiring flap reconstruction. These procedures involve complex recoveries that impact daily function and quality of life, with early weight-bearing progression as a key milestone in recovery. Few studies have examined how factors influence weight-bearing progression in patients undergoing flap reconstruction after traumatic LE open fractures.</p><p><strong>Methods: </strong>All patients > 18 years old between 2012 and 2024 who presented with a Gustilo III or higher LE open fracture and underwent flap reconstruction at our level 1 trauma center were analyzed. Individual-level sociodemographic factors assessed included race/ethnicity, age, sex, primary language, and insurance status. Neighborhood-level factors, including median income, employment rate, and distance from trauma center, were derived from Zip Code Tabulation Areas. Primary outcome was time to weight bearing as tolerated (WBAT). Secondary outcomes included minor complications (not requiring reoperation) and major complications (requiring reoperation). Multivariate analyses were performed.</p><p><strong>Results: </strong>A total of 324 patients were included. Of these, 298 patients (92%) had documented clearance for weight bearing and were included in the WBAT analysis. The median time to WBAT was 88 days (interquartile range: 55-137). Non-English-speaking patients had significantly shorter times to WBAT (<i>exp</i> (β) = 0.66, 95% CI: 0.47-0.92, <i>p</i> = 0.01). No neighborhood-level SES variables were associated with time to WBAT, and no individual- or neighborhood-level sociodemographic factors were significantly associated with complication rates.</p><p><strong>Conclusion: </strong>Non-English-speaking patients achieved WBAT clearance sooner than English-speaking patients. This counterintuitive finding, in the absence of other individual- or neighborhood-level associations, may reflect unmeasured social and financial pressures influencing postoperative recovery milestones.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562383","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":"Influence of Body Mass Index on Perioperative Outcomes of Oncologic Head and Neck Free Flaps: Comprehensive Analysis Using a Prospective Institutional Database.","authors":"Honghao Xu, Elizabeth D Dominguez, Vanessa Mroueh, Adriana M Duncan, Matthew T Bottegal, Seungwon Kim, Mario G Solari","doi":"10.1055/a-2903-1493","DOIUrl":"10.1055/a-2903-1493","url":null,"abstract":"<p><strong>Background: </strong>The impact of body mass index (BMI) extremes on the outcomes after head and neck cancer (HNC) reconstruction remains uncertain. Herein, we investigate the influence of low and high BMI on the intraoperative and postoperative outcomes of oncologic head and neck microvascular reconstruction.</p><p><strong>Methods: </strong>We analyzed a prospective institutional database (September 2019-December 2024). Patients were stratified into underweight, normal weight, overweight, and obesity I, II, and III. Flaps were categorized by donor site (thigh, back, fibula, or forearm). Demographics, intraoperative events, and donor, recipient, and systemic postoperative complications were assessed.</p><p><strong>Results: </strong>Among 542 patients, BMI distribution was: 9.6% underweight (<18.5 kg/m²), 34.7% normal weight (≥18.5 and <25 kg/m²), 29.5% overweight (≥25 and <30 kg/m²), and 15.5, 7.0, and 3.7% within obesity I (≥30 and <35 kg/m²), II (≥35 and <40 kg/m²), and III (≥40 kg/m²), respectively. Flaps employed significantly differed between low and high BMI groups (<i>p</i> < 0.001). Underweight patients demonstrated increased odds of donor-site (odds ratio [OR]: 4.60; <i>p</i> = 0.011) and recipient-site (OR: 2.49; <i>p</i> = 0.007) complications, notably salivary leaks (24.0% vs. ≤11.2%; <i>p</i> = 0.0322). In subgroup analyses, obesity II patients undergoing thigh-based reconstructions saw increased flap loss (16.7% vs. ≤2.4%, <i>p</i> = 0.0002); obesity II and III patients trended toward increased recipient-site hematoma (16.7% vs. ≤3.6%, <i>p</i> = 0.1376) and dehiscence (20.0% vs. ≤7.1%, <i>p</i> = 0.0824), respectively.</p><p><strong>Conclusion: </strong>BMI extremes relate to perioperative risk in HNC microvascular reconstruction. Underweight status is associated with higher perioperative complications across flaps, while obesity-related risk concentrates in class II/III patients undergoing thigh-based flaps. Findings support BMI-informed preoperative optimization and flap selection strategies.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352288","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":"Interest in Robotics Outpaces Access: Results from a Survey of Practicing Plastic Surgeons.","authors":"Jacquelyn Roth, Bernice Z Yu, Casey Zhang, Andrea Moreira, Aparna Vijayasekaran, Alice Yao","doi":"10.1055/a-2905-7010","DOIUrl":"10.1055/a-2905-7010","url":null,"abstract":"<p><strong>Background: </strong>While the launch of the da Vinci Surgical System catalyzed the expansion of robotic surgery across disciplines, adoption in plastic surgery remains modest. To explore this disconnect, this study surveys plastic surgeons to gauge interest, utilization, and perceived barriers to robotic surgery adoption.</p><p><strong>Methods: </strong>A 15-question survey on training, access, interest, and barriers to robotic procedures was developed on Qualtrics and distributed via email to members of the American Society of Plastic Surgeons (ASPS) in May 2024. Descriptive statistics were used to summarize responses.</p><p><strong>Results: </strong>About 123 responses were collected among 3,512 survey recipients. Among respondents, 84.6% reported having access to a surgical robot; however, only 13.8% had training on robotic systems during residency, and only 12.2% utilized the technology for plastic surgery procedures. Interest in robotics was noted among 47.9% of respondents, particularly for deep inferior epigastric perforator (DIEP) flap procedures (65.5%), rectus/Vertical Rectus Abdominis Myocutaneous (VRAM) flap (58.2%), and hernia repairs (27.3%). Key barriers to adoption included training requirements (63.9%), lack of demand (60.2%), increased operative time (54.6%), and financial concerns (26.9%). Additional obstacles cited were credentialing difficulties and skepticism about the necessity of robotics in plastic surgery.</p><p><strong>Conclusions: </strong>The present survey identified inadequate training, high costs, and limited demand as key barriers to the adoption of robotics in plastic surgery, reflecting the current lack of robotic integration into residency curricula, as well as the substantial investment and maintenance costs associated with robotic systems. Nevertheless, the strong interest in robotics highlights the need for expanded training programs, promotion of clinical benefits, and research quantifying potential downstream savings to overcome these barriers.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396817","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":"Enhancing Microvascular Anastomosis Using an Axial-View Microscope.","authors":"Sotatsu Fukuyama, Ryohei Ishihara, Masayuki Okochi, Kyoko Dogo, Michiko Fukuba, Masahiro Nakagawa, Yuzo Komuro","doi":"10.1055/a-2905-6935","DOIUrl":"10.1055/a-2905-6935","url":null,"abstract":"<p><strong>Background: </strong>Under a conventional digital microscope, the cross-section of a vessel is visualized as a long oval because it is observed from a bird's-eye perspective (bird's-eye-view microscope, bMS). This limited perspective can hinder accurate identification of the vascular lumen and tunica intima during microvascular anastomosis. To overcome this limitation, we developed a novel microscope system that provides an axial view of the vascular stump (axial-view microscope, aMS).</p><p><strong>Methods: </strong>In this experimental study, we used our proprietary digital microscope, which integrates a low-resolution digital camera with the aMS system, and defined this system as the bMS. Ten chicken femoral arteries were used, and two arterial anastomoses were created for each artery. One anastomosis was performed using both the bMS and aMS (aMS-assisted group), whereas the other was performed using the bMS alone (bMS-only group). Anastomosis creation was divided into two stages. Stage 1 consisted of identifying the tunica intima and inserting the surgical needle through the vascular wall. Stage 2 included all remaining procedures, excluding rotation of the vascular clamp, intraluminal irrigation, and adjustment of vessel position. Operative times were recorded and compared between groups.</p><p><strong>Results: </strong>The ratio of the average duration of Stage 1 (front and back sides combined) in the aMS-assisted group relative to the bMS-only group was 0.58 ± 0.19, indicating a significantly shorter Stage 1 duration with aMS use (<i>p</i> < 0.001). The ratio of the average total anastomosis time was 0.88 ± 0.08, demonstrating a significant reduction in overall anastomosis time in the aMS-assisted group (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>The aMS provides direct visualization of the vascular cross-section and facilitates rapid identification of the tunica intima without prolonging other steps of microvascular anastomosis. These findings indicate that this system may enhance the operative view and reduce anastomosis time in microsurgical procedures.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367993","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":"Beyond Body Mass Index: Using Abdominal Wall Thickness to Guide Patient Selection for Deep Inferior Epigastric Perforator Flap Breast Reconstruction.","authors":"Joyce Xiaoran Cui, Eric Zeng, Mary Lee Duet, Marion Tapp, Attila K Dos Santos, John Michael Robinson, Thomas N Steele, Bennett Calder","doi":"10.1055/a-2905-6837","DOIUrl":"10.1055/a-2905-6837","url":null,"abstract":"<p><strong>Introduction: </strong>Body mass index (BMI) limits of 30.0 to 32.7 kg/m² have been recommended to reduce postoperative complications in autologous breast reconstruction. However, BMI does not accurately represent body composition for all individuals. This study evaluates the relationship between abdominal wall thickness (AWT) and postoperative complication rates using a novel, accessible measuring method.</p><p><strong>Methods: </strong>A retrospective chart review of 793 patients (1,310 flaps) who underwent deep inferior epigastric perforator (DIEP) flap reconstruction from November 2017 to May 2024 at two medical sites was conducted. Demographics, medical history, operative course, and postoperative complications were reviewed. Subcutaneous AWT was measured on preoperative computed tomography angiogram at four standardized anatomical landmarks. Patients were stratified by BMI (<25, 25-30, 30-35, and >35) and AWT (<20, 20-40, and >40 mm). Statistical analysis was conducted in R.</p><p><strong>Results: </strong>The mean patient age was 50.5 years, and mean BMI was 30.3 kg/m². BMI was strongly correlated with AWT (<i>r</i> = 0.68, <i>p</i> < 0.001), and both variables were strong predictors for complication rates (<i>p</i> < 0.001, <i>p</i><0.001). Stepwise increases in wound dehiscence, infection, and fat necrosis were observed across AWT groups. Receiver operating characteristic analysis identified AWT threshold of 26.3 mm for overall complications. AWT and BMI models demonstrated comparable predictive ability for complication rates. Patients with mismatched BMI and AWT highlighted cases where BMI alone underestimated risk.</p><p><strong>Conclusion: </strong>AWT may serve as a valuable adjunct tool in determining DIEP flap eligibility, particularly for patients with a high BMI and thin abdominal wall, or vice versa.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368877","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":"Insights into Cervical Phrenic Nerve Variations Based on Cadaveric Dissection and Intraoperative Electromyography.","authors":"Xingyi Ma, Zirui Yu, Chenglong Zhao, Haipeng Wang, Wendong Xu, Yanqun Qiu","doi":"10.1055/a-2905-7065","DOIUrl":"https://doi.org/10.1055/a-2905-7065","url":null,"abstract":"<p><strong>Background: </strong>In complex cervical nerve surgeries, ensuring the integrity of the phrenic nerve (PN) adjacent to the anterior scalene muscle is critical. However, we have encountered a clinical paradox: Postoperative diaphragmatic dysfunction occurred even when the main PN trunk was preserved intraoperatively. This suggests the potential involvement of PN variations (PNVs), such as the accessory PN, which merges with the main trunk, and separate branches that maintain an independent course.</p><p><strong>Methods: </strong>Using contralateral C7 nerve transfer (CC7) as a surgical model, this study aimed to characterize the prevalence and electrophysiology of the cervical PNV by combining cadaveric dissection with intraoperative electromyography (EMG) monitoring.</p><p><strong>Results: </strong>Anatomical dissection revealed a PNV prevalence of 31.8% (7/22 sides), whereas intraoperative EMG identified PNVs in 63.3% of cases (19/30 sides). Intraoperatively, the PNV was typically observed coursing lateral to the main PN (47.4%, 9/19), overlying the anterior scalene muscle. Electrophysiological analysis demonstrated a moderate correlation between PNV- and PN-evoked responses (latency ρ = 0.661; amplitude ρ = 0.673; <i>p</i> < 0.05). The PN generally exhibited larger amplitudes (<i>p</i> < 0.001), confirming its role as the primary motor supply to the diaphragm. Notably, in 44.4% of cases with recordable signals, the PNV amplitude reached ≥50% of the ipsilateral PN amplitude, suggesting that these PNVs may contribute to diaphragmatic innervation. All identified branches were successfully preserved, with no severe postoperative complications observed.</p><p><strong>Conclusion: </strong>Conventional anatomical studies may underestimate the prevalence of the PNV relative to intraoperative electrophysiological assessment. Intraoperative EMG monitoring is not required for all cervical nerve procedures; however, when feasible, particularly in procedures that may involve bilateral PNs, it can help identify and preserve functionally important branches, thereby reducing the risk of iatrogenic injury.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148447653","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":"Homocysteine Levels as a Potential Contributor to Impaired Wound Healing in Plastic and Reconstructive Surgery.","authors":"Lauren R Kiel, Katie G Egan, Murilo Secanho, David Woodbridge Mathes, Christodoulos Kaoutzanis","doi":"10.1055/a-2903-1562","DOIUrl":"10.1055/a-2903-1562","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352292","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":"Revisiting Heparin-Induced Thrombocytopenia among Patients Undergoing Free Tissue Transfer: A Systematic Review.","authors":"Mohammed Yamin, Micaela Tobin, Tricia Raquepo, John B Park, Daniela Lee, Maria J Escobar-Domingo, Jose Foppiani, James E Fanning, Eric Zhu, Agustin N Posso, Haobo Ma, Samuel J Lin, Bernard T Lee, Ryan P Cauley","doi":"10.1055/a-2687-0443","DOIUrl":"10.1055/a-2687-0443","url":null,"abstract":"<p><strong>Background: </strong>Heparin is frequently used to mitigate the risk of thrombosis in microsurgical free tissue transfer. Although rare, heparin-induced thrombocytopenia (HIT) is a severe, life-threatening complication that can arise in patients exposed to heparin products. This systematic review aims to examine patterns in demographics, flap characteristics, diagnostic approaches, and treatment protocols for HIT following free flap reconstruction.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed, MEDLINE, and Web of Science, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included \"heparin-induced thrombocytopenia,\" \"HIT syndrome,\" \"free flaps,\" \"microsurgery,\" \"plastic surgery,\" and \"reconstructive surgery.\" Case reports or series written in English that presented patients developing HIT following free flap procedures were included. Eligibility criteria are accessible on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42025650125).</p><p><strong>Results: </strong>A total of 15 articles were included, encompassing a total of 23 free flap reconstruction cases. The median patient age was 52 years, with male predominance (69.6). Lower extremity reconstruction was most common (47.8%), primarily using anterolateral thigh flaps (39.1%). Median 4T score was 6, median time to HIT diagnosis was 6 days, and median nadir platelet count was 72 × 10³/μL. Thrombotic complications were common, with venous thrombosis (34.8%) predominating. Argatroban (26.1%) was the most frequently used alternative anticoagulant, while warfarin (30.4%) was the most common discharge medication. Overall flap survival was 43.5%. Meta-analysis revealed no significant difference in flap survival between anticoagulation strategies (95% CI: 0.38-2.63, <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong>HIT represents a rare but devastating complication in free flap reconstruction, with approximately half of the affected flaps failing despite intervention. Although no single anticoagulation strategy demonstrated superior outcomes, expeditious diagnosis and treatment may improve flap salvage rates. This review provides a foundation for developing standardized protocols for HIT management in microsurgical patients.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"473-481"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958298","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}