Journal of reconstructive microsurgery最新文献

{"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}

{"title":"Bridging the Gap between Microsurgery and Supermicrosurgery: A Rat Study for 0.3 mm Vascular Anastomosis Comparing Robotic-assisted vs. Conventional Approach.","authors":"Tae Hyung Kim, Seohee Chae, Donggeon Kim, Taehyun Kim, Jin Geun Kwon, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong","doi":"10.1055/a-2824-6437","DOIUrl":"10.1055/a-2824-6437","url":null,"abstract":"<p><strong>Background: </strong>Supermicrosurgery involving vessels ≤0.3 mm remains among the most technically demanding procedures in reconstructive surgery. Robotic platforms have shown potential to enhance precision, but their feasibility at this extreme scale requires further validation.</p><p><strong>Methods: </strong>Apprentice surgeons (≤5 years' experience) performed rat femoral vessel (approximately 0.26-0.30 mm) anastomoses using both hand-sewn and robotic-assisted techniques across eight consecutive trials. Outcome measures included Structured Assessment of Robotic Microsurgical Skills (SARMS) scores, operative time, stitch count, and patency rate. Learning curves were assessed with cumulative summation (CUSUM) analysis, and anastomotic quality was evaluated using scanning electron microscopy (SEM).</p><p><strong>Results: </strong>Robotic-assisted anastomosis reached proficiency earlier than hand-sewn repair (4th versus 6th trial). Although initial operative time was longer for robotic cases (1,772 ± 120 seconds versus 1,355 ± 187 seconds, <i>p</i> = 0.013), times equalized by the 5th trial and decreased by 42% by the 8th (1,026 ± 58 seconds versus 1,023 ± 73 seconds, <i>p</i> = 0.959). Stitch counts were higher in later robotic trials (4.2 ± 0.6 versus 3.5 ± 0.5, <i>p</i> = 0.015). Both groups achieved 100% patency by the 4th trial. CUSUM and SEM analyses confirmed a steeper learning curve and superior anastomotic precision with robotic assistance.</p><p><strong>Conclusion: </strong>Robotic-assisted supermicrosurgery enables earlier proficiency, enhanced precision, and reproducible anastomotic quality compared with hand-sewn techniques. Despite longer initial times, robotic performance rapidly improved, achieving equivalent efficiency with greater technical control. These findings confirm the technical feasibility of robotic supermicrosurgery at the 0.3 mm scale and support its potential role in microsurgical and lymphatic reconstruction training and clinical practice.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"533-540"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13271816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Lymphosome-Based Long-Lasting Rat Tail Model of Lymphedema.","authors":"Junzhe Chen, Yun Wang, Shilin Tu, Yan Zhou, Haokun Qin, Zeyao Tang, Yuezhong Chen, Shune Xiao, Chengliang Deng","doi":"10.1055/a-2687-0506","DOIUrl":"10.1055/a-2687-0506","url":null,"abstract":"<p><strong>Background: </strong>Secondary extremity lymphedema is a chronic and progressive condition caused by obstructed lymphatic drainage, commonly following lymphadenectomy, infection, or trauma. Rodent models are preferred for experimental lymphedema research due to cost-effectiveness and reproducibility. Currently, rat tail models encounter limitations due to transient swelling and their inability to fully replicate the comprehensive pathophysiology of lymphedema, particularly concerning the effects of lymph node removal.</p><p><strong>Methods: </strong>We developed a series of rat tail lymphedema models incorporating skin resection, deep lymphatic vessel disruption, and gluteal lymph node (GLN) excision to assess effects on lymphatic architecture, inflammation, and fibrosis. Indocyanine green (ICG) lymphography was used to visualize lymphatic function. Tail volume and circumference were measured weekly, and histological assessments quantified fibrosis and fibroadipose thickening. Bulk RNA sequencing was performed to characterize the inflammatory processes triggered by GLN removal.</p><p><strong>Results: </strong>The combined model (skin removal, deep lymphatic disruption, and GLN excision) resulted in severe and persistent lymphedema marked by progressive swelling and pronounced fibrosis. ICG lymphography confirmed disruption of superficial lymphatic flow with partial recanalization of deep channels. Notably, lymphangiogenesis was observed at the GLN excision site, forming compensatory pathways connecting the tail to the popliteal lymph nodes. Histology revealed extensive collagen deposition and fibroadipose thickening in groups with lymph node removal, with the combined model showing the most pronounced changes. Bulk RNA-sequencing confirmed the removal of GLN involving the inflammatory and fibrosis process in the tail model.</p><p><strong>Conclusion: </strong>This lymphosome-based rat tail model successfully replicates key features of lymphedema, including sustained swelling, lymphatic disruption, inflammation, and fibrosis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"466-472"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13286090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Technique for Anterolateral Thigh Flap Harvesting: A Questionnaire Study From 263 International Microsurgeons.","authors":"Joachim N Meuli, Shiuan Shyu, Kevin Yu-Ting Chen, Elzat Elham, Lisa Wen-Yu Chen, Johnny Chuieng-Yi Lu, Jung-Ju Huang, Tommy Nai-Jen Chang","doi":"10.1055/a-2702-4225","DOIUrl":"10.1055/a-2702-4225","url":null,"abstract":"<p><strong>Background: </strong>The anterolateral thigh (ALT) flap is a very popular perforator flap, but variations in design and in harvest techniques result in a broad spectrum of approaches that considerably differ from literature descriptions. We therefore designed this study to assess the differences in surgical techniques and practice preferences toward this flap across world regions.</p><p><strong>Methods: </strong>The study was conducted via an online questionnaire covering demographic data, surgical techniques, and preferences in 21 questions. The participants were divided into six geographical regions that were compared. Two questions that are the subject of debate amongst microsurgeons (limitation of vasopressor use and anticoagulation before flap division) were further analyzed using a logistic regression to identify predicting variables.</p><p><strong>Results: </strong>There were 263 respondents worldwide with notable differences in demographics, experience, level, and technique across different world regions. The main differences were noted in intraoperative evaluation of perforators, in the primary instrument for dissection, and in the use of loupe magnification. Microsurgeons in North America with limited experience were more likely to limit vasopressor use during flap harvest. There were also discrepancies regarding the use of systemic anticoagulation prior to flap division, but not of the same magnitude.</p><p><strong>Conclusion: </strong>This study is the first attempt to offer a clinical reference to apprehend differences in surgical preferences regarding ALT flap harvest techniques. Vasopressor use is notably limited by microsurgeons in North America, as well as by less experienced microsurgeons, despite available clinical evidence.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"499-505"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Flap Reconstruction Following Mohs Surgery: Our Approach to Complex Skin Cancer on the Scalp.","authors":"Ayaka N Deguchi, Niv Milbar, Andrew Pregnall, Malia Voytik, Margaret M Hornick, Salman Khan, Stephanie Wang, Hisashi Motomura, Christopher Miller, Stephen J Kovach, Robyn B Broach, Jason D Wink","doi":"10.1055/a-2702-4427","DOIUrl":"10.1055/a-2702-4427","url":null,"abstract":"<p><strong>Background: </strong>Scalp reconstruction following Mohs micrographic surgery (MMS) presents significant challenges when defects are complicated by radiation, extensive defect size and depth, and the use of implants. As a result, free flap reconstruction may provide optimal coverage for these complex cases. This study aims to highlight free flap reconstruction as an effective approach for treating complicated scalp defects after MMS and to identify risk factors associated with complications.</p><p><strong>Methods: </strong>A single-center retrospective chart review of patients who underwent MMS and subsequent free flap reconstruction of the scalp between March 2010 and June 2024 was conducted. Demographics, comorbidities, and perioperative details were collected and analyzed. Scalp defect complexity was categorized based on factors such as radiation exposure, defect size, and depth, and implant use. Outcomes were compared between patients with complex and noncomplex defects. Multivariate regression analysis and comparative analysis were performed.</p><p><strong>Results: </strong>Sixty free flaps in 56 patients were included in our study. Most skin cancers were basal cell carcinoma (BCC; 64%) and squamous cell carcinoma (SCC; 23%), located predominantly on the vertex or multi-focally throughout scalp. The median defect size was 112 cm² (IQR: 65.3-169). The anterolateral thigh (58.3%) and latissimus dorsi flaps (38.3%) were commonly used for reconstruction. Age and body mass index were associated with higher overall complication rates, while comorbidities, cancer diagnosis, lesion locations, and flap types were not. Highly complex defects were associated with significantly higher incidences of delayed wound healing (OR: 26.2, <i>p</i> = 0.0182) and dehiscence (OR: 9.94, <i>p</i> = 0.0242).</p><p><strong>Conclusion: </strong>This study demonstrates a comprehensive exploration of free flap reconstruction as a standard treatment for complicated scalp defects following MMS, highlighting its efficacy and identifying risk factors for complications. Our findings underscore the importance of a collaborative approach between microsurgeons and Mohs surgeons to optimize patient outcomes in the treatment of challenging scalp defects.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"525-532"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080916","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":"Ex Vivo Rabbit: A Novel High-Fidelity Training Model for Microsurgical and Supermicrosurgical Training.","authors":"Belén Andresen-Lorca, Iván Heredia-Alcalde, Pedro Alvedro-Ruiz, María García-García, Alberto Ruiz-Cases, María Dolores Pérez-Del-Caz","doi":"10.1055/a-2687-0380","DOIUrl":"10.1055/a-2687-0380","url":null,"abstract":"<p><strong>Background: </strong>The development of appropriate microsurgical and supermicrosurgical skills is essential for reconstructive surgeons. Training courses frequently employ in vivo models, which have various drawbacks: Limited availability, high cost, and/or ethical conflicts. To overcome these limitations, we looked for an inert model that was analogous to the gold standard in vivo, surpassing the classic ex vivo models at the same time.</p><p><strong>Methods: </strong>We studied the ex vivo rabbit as an animal training model by means of 10 specimen dissections, microscopically analyzing the mean caliber and length of its main vascular pedicles and comparing them to those of the most common flaps and recipient vessels employed in reconstructive surgery. We designed a routine with increasingly difficult exercises, which we propose as a training plan.</p><p><strong>Results: </strong>The rabbit's main vascular pedicles have a mean caliber of 0.4 mm (internal mammary), 0.8 mm (iliolumbar), 0.9 mm (brachial), 1.2 mm (femoral), 1.5 mm (renal), 1.9 mm (common carotid), and 2.8 mm (aorta). They allow for a progressive increase in the level of complexity, as well as the practice of a wide variety of techniques (end-to-end anastomosis between vessels of different sizes, end-to-side anastomosis, neurorrhaphies, nerve transfers, ortho- and heterotopic replants, and free flaps).</p><p><strong>Conclusion: </strong>The ex vivo rabbit serves as a valid alternative to other recognized high-fidelity microsurgical models, overcoming the limitations of in vivo-it is easily accessible, inexpensive, and inert-as well as ex vivo-it offers a wide range of calibers and the possibility of practicing advanced techniques-models which have been used in the past.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"443-448"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Rehabilitation and Quality of Life After Fibula Free Flap Reconstruction in Mandibular Defects.","authors":"Mathias Fiedler, Christoph Brunnhuber, Jonas Eichberger, Maximilian Gottsauner, Johannes G Schuderer, Michael Maurer, Jürgen Taxis, Johannes K Meier, Michael Gerken, Torsten E Reichert, Tobias Ettl","doi":"10.1055/a-2687-0316","DOIUrl":"10.1055/a-2687-0316","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing mandibular reconstruction often experience long-term functional and aesthetic challenges, impacting their quality of life (QOL). The objective of this study was to identify factors that most powerfully impact the long-term QOL and functional outcome of patients following mandibular reconstruction with free fibula flaps. This investigation was undertaken to enhance the treatment of this patient population.</p><p><strong>Methods: </strong>QOL was assessed between March 2022 and May 2023 in 47 consecutive patients undergoing mandibular reconstruction with fibula free flaps (FFFs) using the University of Washington QOL Questionnaire. Evaluation of functional outcome was based on mouth opening, jaw deviation, tissue atrophy, tongue mobility, lip competence, and speech intelligibility.</p><p><strong>Results: </strong>The study found that loss of chewing was the strongest impairment of QOL (score: 63.83). The most important negative predictors for QOL were female gender (<i>p</i> = 0.047), radiotherapy (QOL subcategory <i>p</i>-values: <i>p</i> = 0.007 to <i>p</i> = 0.034), anterior segment resection (QOL subcategory <i>p</i>-values: <i>p</i> = 0.038 to <i>p</i> = 0.045), advanced defect size (QOL subcategory <i>p</i>-values: <i>p</i> = 0.008 to <i>p</i> = 0.035), and free-hand fibula reconstruction (QOL subcategory <i>p</i>-values: <i>p</i> = 0.003 to <i>p</i> = 0.041). Long-term outcomes revealed that reduced tissue atrophy (QOL subcategory <i>p</i>-values: <i>p</i> < 0.001 to <i>p</i> = 0.025) and preserved tongue mobility (QOL subcategory <i>p</i>-values: <i>p</i> = 0.002 to <i>p</i> = 0.043) were associated with better QOL scores. Functional limitations such as reduced mouth opening (QOL subcategory <i>p</i>-values: <i>p</i> = 0.008 to <i>p</i> = 0.049) and impaired speech intelligibility (QOL subcategory <i>p</i>-values: <i>p</i> < 0.001 to <i>p</i> = 0.015) were significantly correlated with lower QOL in several domains.</p><p><strong>Conclusion: </strong>Mandibular reconstruction with FFFs provides a favorable long-term QOL and functional outcomes, though certain clinical factors, including radiotherapy, anterior segment resection, and defect size, significantly reduce patient-reported QOL.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"482-490"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958369","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":"Basic versus Complex Arteriovenous Loop Positions in Reconstructive Free Flap Surgery: An Outcome Analysis Focusing on the Antithrombotic Treatment Regimen.","authors":"Alexander Geierlehner, Julia Hirtreiter, Werner Lang, Ulrich Rother, Armin Ströbel, Raymund E Horch, Andreas Arkudas","doi":"10.1055/a-2702-3957","DOIUrl":"10.1055/a-2702-3957","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous (AV) loop followed by free flap reconstruction remains a challenging and high-risk intervention and is therefore reserved for a selective patient population. It is unclear to what extent factors such as defect localization, choice of free flap, positioning of the AV loop, and especially the antithrombotic regimen have an influence on complications such as thromboembolic events or flap failure.</p><p><strong>Methods: </strong>Medical records from 123 patients between 2003 and 2023 were reviewed. Postoperative outcomes were compared between the complexity of AV loop positioning, one- and two-stage reconstruction, defect locations, free flap type, and antithrombotic regimen.</p><p><strong>Results: </strong>After AV loop creation and before free flap transfer (first-stage), loop thrombosis (<i>p</i> = 0.025) and loop failure (<i>p</i> = 0.003) rates differed significantly between defect sites. The flap failure rate after free flap transfer (second-stage), which was performed on average 8 days after AV loop creation, differed significantly between defect sites with basic (3%) and complex (17%) AV loop positioning and routing (<i>p</i> = 0.028). Low-dose heparin was applied significantly more frequently in cases with basic loop positioning, while high-dose heparin was applied significantly more frequently in complex loop cases (<i>p</i> = 0.002). The combined use of low-dose heparin with acetylsalicylic acid in complex loops is associated with a significantly higher thrombosis rate than in basic loops (<i>p</i> = 0.046).</p><p><strong>Conclusion: </strong>Defect localization and the complexity of the AV loop position have an influence on the occurrence of vascular thrombosis and flap failure. For this reason, consideration of defect localization and AV loop position is crucial for the choice of the appropriate antithrombotic regimen.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"514-524"},"PeriodicalIF":2.3,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251523","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}