Journal of reconstructive microsurgery最新文献

{"title":"Intraoperative Complications as Predictors of Flap Failure in Autologous Breast Reconstruction.","authors":"Kerilyn N Godbe, Erin Rauber, Niaman Nazir, Julie Holding, James A Butterworth, Eric C Lai, Katie G Egan","doi":"10.1055/a-2434-4661","DOIUrl":"10.1055/a-2434-4661","url":null,"abstract":"<p><strong>Background: </strong> Intraoperative microvascular complications in autologous breast reconstruction significantly increase the risk of postoperative complications. No study has identified which specific intraoperative complications contribute to partial or total flap loss.</p><p><strong>Methods: </strong> A retrospective chart review of microsurgical breast reconstructions by five surgeons between 2009 and 2020 analyzed operative variables and patient outcomes, with complications determined from the operative report. Flap loss rates were compared between cases with and without intraoperative complications. Statistical analysis was performed using Fisher's exact and <i>t</i>-tests for discrete and continuous variables, respectively.</p><p><strong>Results: </strong> Intraoperative complications were analyzed for 1,465 autologous breast flaps performed in 916 patients. Early partial flap loss was predicted by arterial anastomosis revision (2.90 vs. 0.44%, <i>p</i> = 0.03) and alternate venous outflow (14.29 vs. 0.41%, <i>p</i> = 0.002), with no association with intraoperative thrombosis, venous revision, or difficult recipient or flap dissection. In comparison, early total flap loss was predicted by intraoperative arterial revision (5.80 vs. 0.51%, <i>p</i> = 0.001), venous revision (5.45 vs. 0.57%, <i>p</i> = 0.007), intraoperative thrombosis (12.12 vs. 0.49%, <i>p</i> < 0.001), and difficult flap dissection (2.91 vs. 0.59%, <i>p</i> = 0.04). Difficult flap dissection was the only intraoperative variable associated with late partial flap loss (6.80 vs. 1.69%, <i>p</i> = 0.004). Late total flap loss only occurred in 6/1,465 flaps, the sole association being difficult recipient vessel dissection (2.78 vs. 0.29%, <i>p</i> = 0.03). Postoperative arterial and venous compromise occurred in 1.10% (13/1,187) and 2.53% (30/1,187) of cases with no intraoperative complications, respectively, compared with 3.2% (9/278, <i>p</i> = 0.02) and 6.12% (17/278, <i>p</i> = 0.002) in cases with an intraoperative complication.</p><p><strong>Conclusion: </strong> Alternate venous outflow predicts early partial flap loss, while intraoperative thrombosis and arterial and venous revision predict early total loss. Difficult flap dissection was associated with early total and late partial flap loss, while difficult recipient vessel dissection was associated with late total flap loss.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"489-494"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372134","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 Lumbar Artery Perforator Free Flap as an Alternative Option for Breast Reconstruction in Low BMI Patients: Analysis of CT Angiography of Donor Sites Across BMI.","authors":"Máire-Caitlin Casey, Anna R Hurley, Minas Chrysopoulo, Aadil Ali Khan, Kieran Power, Theodore Nanidis","doi":"10.1055/a-2434-5722","DOIUrl":"10.1055/a-2434-5722","url":null,"abstract":"<p><strong>Background: </strong> In patients with a low body mass index (BMI), the options for autologous breast reconstruction are limited. With the hypothesis that adipose tissue deposition favors the lumbar region over the abdominal wall, this study sought to investigate the lumbar artery perforator (LAP) flap as an alternative reconstructive option in patients with deficient autologous donor sites consequent to a low BMI.</p><p><strong>Methods: </strong> A retrospective cohort analysis was performed, from a prospectively maintained database, of all consecutive deep inferior epigastric artery perforator flap breast reconstructions performed in our unit. A randomized selection of 100 patients with low BMI < 22, normal BMI 22 to 24, and high BMI > 30 was performed. Patient computerized tomography scans were analyzed to measure abdominal wall and lumbar tissue thickness and to define anatomical landmark relations of the LAP.</p><p><strong>Results: </strong> A statistically significant difference was identified between the ratio of lumbar-to-abdominal wall thickness between BMI groups, highlighting preservation of the lumbar thickness in patients with low BMI. The mean distance at which the fourth lumbar perforator entered the subcutaneous tissues was 7.7 cm lateral to the spinous process (range 6.4-9.5 cm), with no significant difference between BMI groups, highlighting this consistent anatomical position.</p><p><strong>Conclusion: </strong> This study confirms a greater lumbar-to-abdominal wall thickness, therefore volume, in low BMI patients, with consistent lumbar perforator anatomy of 6.4 to 9.5 cm lateral to the spinous process. The LAP flap should therefore be strongly considered for autologous breast reconstruction in this patient cohort.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"508-514"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372136","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 Systematic Review of the Complications Associated with Free Fibular Flaps in Adult and Pediatric Spinal Reconstruction.","authors":"Katherine J Zhu, Annie M Cho, Joel S Beckett, Luke Macyszyn, David Mathes, Phuong Nguyen, Timothy Irwin, Christodoulos Kaouzanis, Jason W Yu","doi":"10.1055/a-2434-5882","DOIUrl":"10.1055/a-2434-5882","url":null,"abstract":"<p><strong>Background: </strong> Free fibular flaps have been suggested as a modality of reconstruction for complex spinal deformities. However, there is limited data that describes associated postoperative outcomes. The purpose of this systematic review was to characterize outcomes after spinal reconstruction using the free fibular flap for both adults and children.</p><p><strong>Methods: </strong> Thirty-nine articles among four databases were identified as having met inclusion criteria. Patient demographics, indications for spinal reconstruction as well as location and anastomosis, history of chemotherapy and radiation therapy, and postoperative outcomes including complications were identified. Major complications were defined as complications requiring reoperation, while minor complications were those that did not require reoperation. Systemic complications were defined as complications affecting sites or organ systems beyond the local donor and recipient sites. Statistical analysis was performed using Fischer's exact, chi-squared, and <i>t</i>-tests.</p><p><strong>Results: </strong> We identified 218 adult patients (mean age 47.7 years, 56.4% male) and 27 pediatric patients (mean age 12.7 years, 55.6% male). While there was no significant difference in the rates of bony union between the two groups (adults: 90.8%, children: 90%, <i>p</i> > 0.9), adults had significantly higher rates of major (27% vs. 7.4%, <i>p</i> = 0.026), minor (26.1% vs. 7.4%, <i>p</i> = 0.032), and systemic (14.2% vs. 0%, <i>p</i> = 0.047) complications.</p><p><strong>Conclusion: </strong> Free fibular flaps are effective for spinal reconstruction for both adults and children, as evidenced by the high rates of bony union. However, adults exhibited significantly higher complication rates. Further research is required to better understand the patient and clinical risk factors associated with increased rate of complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"521-530"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372132","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":"Surgical Complications after Targeted Muscle Reinnervation at a Safety-Net Hospital.","authors":"Chioma G Obinero, Jackson C Green, Kylie R Swiekatowski, Chimdindu V Obinero, Arvind Manisundaram, Matthew R Greives, Mohin Bhadkamkar, Yuewei Wu-Fienberg, Erik Marques","doi":"10.1055/a-2435-7410","DOIUrl":"10.1055/a-2435-7410","url":null,"abstract":"<p><strong>Background: </strong> Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) can reduce neuroma formation and phantom limb pain (PLP) after lower extremity (LE) amputation. These techniques have not been studied in safety-net hospitals. This study aims to examine the surgical complication rates after TMR and/or RPNI at an academic safety-net hospital in an urban setting.</p><p><strong>Methods: </strong> This was a retrospective review of patients older than 18 years who had prior above-knee guillotine amputation (AKA) or below-knee guillotine amputation (BKA) and underwent stump formalization with TMR and/or RPNI from 2020 to 2022. Demographics, medical history, and operative and postoperative characteristics were collected. The primary outcome was any surgical complication, defined as infection, dehiscence, hematoma, neuroma, or reoperation. Univariate analysis was conducted to identify variables associated with surgical complications and PLP.</p><p><strong>Results: </strong> Thirty-two patients met the inclusion criteria. The median age was 52 years, and 75% were males. Indications for amputation included diabetic foot infection (71.9%), necrotizing soft tissue infection (25.0%), and malignancy (3.1%). BKA was the most common indication for formalization (93.8%). Most patients (56.3%) had formalization with TMR and RPNI, 34.4% patients had TMR only, and 9.4% had RPNI alone. The incidence of postoperative complications was 46.9%, with infection being the most common (31.3%). The median follow-up time was 107.5 days. There was no significant difference in demographics, medical history, or operative characteristics between patients who did and did not have surgical complications. However, there was a trend toward higher rates of PLP in patients who had a postoperative wound infection (<i>p</i> = 0.06).</p><p><strong>Conclusion: </strong> Overall complication rates after LE formalization with TMR and/or RPNI at our academic safety-net hospital were consistent with reported literature. Given the benefits, including reduced chronic pain and lower health care costs, we advocate for the wider adoption of these techniques at other safety-net hospitals.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"531-539"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391386","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":"How Invasive is the Free Gracilis Muscle Flap? A Prospective Study on Donor Site Morbidity.","authors":"Nikolaus Wachtel, Riccardo E Giunta, Maximilian Hirschmann, Marc Hellweg, Tim Nuernberger, Nicholas Moellhoff, Denis Ehrl","doi":"10.1055/a-2632-2663","DOIUrl":"https://doi.org/10.1055/a-2632-2663","url":null,"abstract":"<p><p>Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of free GM flaps.A control group (<i>n</i> = 100) without surgery was recruited to assess interindividual differences in strength and range of motion (ROM) in the hip and knee joint (dominant vs. nondominant side). Additionally, for 50 patients with free GM flap surgery, these parameters were assessed in an identical manner.The control group showed significant interindividual differences in strength for abduction and adduction in the hip joint when comparing the dominant to the nondominant side, but no significant differences in the ROM. GM flap harvest led to no significant differences in maximum force 20.3 (± 13.8) months after surgery in all parameters/movements that were assessed. However, the ROM for abduction in the ipsilateral hip joint was significantly reduced after surgery.The GM flap has a low donor site morbidity and should therefore be considered as a first-line option for microsurgical reconstructive procedures. Moreover, the low morbidity is not affected by preexisting differences in strength when comparing the dominant to the nondominant side.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528505","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":"Effects of the Medicaid Continuous Enrollment Requirement on Access to Reconstructive Breast Surgery.","authors":"Joey Liang, Elaine Lin, Ronnie L Shammas, Ash Patel, Brett T Phillips","doi":"10.1055/a-2616-4775","DOIUrl":"10.1055/a-2616-4775","url":null,"abstract":"<p><p>The \"continuous enrollment provision\" of the Families First Coronavirus Response Act of 2020 (FFCRA) maintained states' Medicaid enrollments throughout the COVID-19 public health emergency. This study evaluated the impact of the continuous enrollment requirement on Medicaid patients' access to reconstructive breast surgery.A retrospective cohort study was conducted on all patients who received reconstructive breast surgery procedures at a large academic institution between July 1, 2013, and July 1, 2023. The Medicaid continuous enrollment period was defined as March 18, 2020, to July 1, 2023. Univariate analysis, multivariable logistic regression, and difference-in-difference analysis were performed.Three thousand five hundred sixty-four patients were included, of whom 252 patients were insured by Medicaid. Patients' odds of Medicaid insurance before and during the continuous enrollment period did not differ (<i>p</i> = 0.096). The distribution of Medicaid and non-Medicaid insurance among autologous breast reconstruction patients similarly did not differ during the continuous enrollment period (<i>p</i> = 0.86). Difference-in-difference analysis confirmed that Medicaid prevalence among autologous breast reconstruction patients did not change with the continuous enrollment requirement (<i>p</i> = 0.07). Increased age was predictive of Medicaid insurance (odds ratio [OR]: 1.043; <i>p</i> < 0.001); however, age-dependent differences decreased during the continuous enrollment period. Patients with non-English language preferences had lower odds of Medicaid insurance (OR: 0.38; <i>p</i> = 0.035); this difference remained unchanged with the continuous enrollment requirement (<i>p</i> = 0.59).The continuous enrollment requirement alleviated certain age-dependent barriers for Medicaid patients but may not have addressed other patient-level, system-level, and procedure-specific barriers to reconstructive breast surgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110634","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":"Chronological Changes in Breast and Nipple Position After Autologous Reconstruction in an Asian Population.","authors":"Suphalerk Lohasammakul, Johyun Yoon, Chaiyawat Suppasilp, Jin Sup Eom, Hyun Ho Han","doi":"10.1055/a-2616-4258","DOIUrl":"10.1055/a-2616-4258","url":null,"abstract":"<p><p>The breast shape changes between reconstructed and native breasts in autologous reconstruction, which is important to achieve symmetry. This study was conducted to clarify chronological changes in the shape and nipple position of the reconstructed breast compared with the contralateral breast in the Asian population.Photographic assessments were conducted at baseline and during annual visits of patients who underwent immediate free flap breast reconstruction following unilateral nipple-sparing mastectomy at our institution between June 2017 and December 2019. Univariate and multivariate analyses were performed to identify factors associated with the change in shape and nipple position. This observation was most marked at 1-year postsurgery.Among the 170 patients (mean age, 48.04 ± 7.55 years), 164 (96.47%) had a deep inferior epigastric perforator flap and 8 (4.71%) required further surgery on the contralateral breast for correction of asymmetry. The chronological changes in the breast shape and nipple position significantly differed between the native and the reconstructed breast, with the latter showing a higher degree of retraction. Grading of breast ptosis (grades 0-2) and exposure to radiotherapy were associated with an increased degree of retraction.Retraction may occur after free flap breast reconstruction, particularly in patients with ptosis or those receiving radiotherapy. These findings support careful planning, including volume adjustment and contralateral procedures. While based on an Asian population, the results may inform surgical decisions in similar patient groups.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119953","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":"Complex Open Fractures of the Lower Extremity: What is the Optimal Time from Bone Fixation to Flap Coverage?","authors":"Stephen F Parlamas, Kylie R Swiekatowski, Bora Kahramangil, Imran Rizvi, Mohin A Bhadkamkar, Yuewei Wu-Fienberg","doi":"10.1055/a-2596-5211","DOIUrl":"10.1055/a-2596-5211","url":null,"abstract":"<p><p>Shorter delays from presentation to soft tissue coverage in patients with lower extremity open fractures are associated with fewer infections. Orthoplastic teams should know how long flaps can be safely delayed after internal fixation (IF), rather than presentation, because concurrent life-threatening injuries delay limb salvation. We compared infection rates (IRs) of flap coverage delays within 24, 24 to 72, and over 72 hours of IF.This is a retrospective cohort study of adult patients in a Level I trauma center from 2011 to 2021. Patients sustained Gustilo III lower extremity fractures and received flap coverage after fixation. IRs between various delays of flap coverage were compared. A multivariate logistic regression model (including patient demographics, flap composition, bone fixation technique, perioperative antibiotics, three aforementioned time intervals, time from presentation to flap coverage, and time from fixation to flap coverage) was used to determine significant predictors of infections.Of 274 patients, 76 (27.7%) developed an infection. The average time between fixation and flap coverage was 84.9 hours and 106.6 hours in non-infected and infected patients (<i>p</i> = 0.074). IRs among the time intervals were 23.2%, 25.0%, and 31.5% (<i>p</i> = 0.40). Time from fixation to flap coverage was the only significant predictor of infection (<i>p</i> = 0.04).Time from fixation to flap placement is an effective predictor of wound infection. Although the IRs of the >72-hour group did not reach significance, we believe larger cohorts would yield statistical significance. We recommend soft tissue coverage within 72 hours of IF to mitigate infections.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024984","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":"Physiological Restoration of Lymphatic Flow in Posttraumatic Extremity Lymphedema Using Lymphatic Flaps.","authors":"Usama Abdelfattah, Gamal A Elsawy, Saber A Nafea, Mona Omarah, Sherif M Elfateh, Tarek Elbanoby","doi":"10.1055/a-2616-4311","DOIUrl":"10.1055/a-2616-4311","url":null,"abstract":"<p><p>Posttraumatic lymphedema is poorly discussed in literature. Flap reconstruction considering its lymphatic-axiality has been reported in preventing lymphedema development following trauma or sarcoma excision. In this study, we report the results of utilizing lymphatic flaps in treatment of established posttraumatic lymphedema.This was a retrospective study of 74 patients (60 lower limbs and 14 upper limbs) with posttraumatic lymphedema that underwent simultaneous soft tissue and lymphatic reconstruction using lymphatic skin flaps. The primary endpoint was providing stable soft tissue coverage and change in limb volume. Secondary endpoints were changes in lymph flow using both lymphoscintigraphy and indocyanine green (ICG) lymphography.Superficial circumflex iliac artery perforator (SCIP) flap was used in 46 cases (62.2%), anterolateral thigh flap in 14 cases (18.9), superficial inferior epigastric artery flap in 9 cases (12.2%), and deep inferior epigastric artery perforator (DIEAP) flap in 5 cases (6.8%). End (vein)-to-side (lymphatic) lymphaticovenous anastomosis was successfully performed in 21 cases (28.4%). During follow-up, significant change in volume was noted in all patients. Using ICG lymphography, lymphatic flow through the flaps was revealed in 59.5% of patients. No lymphatic flow within the flap was observed in 30 cases (40.5%). While qualitative lymphoscintigraphy showed significant changes in the parameters including improved symmetry in the uptake of Technitium⁹⁹ nanocolloids (89.2%), visualizing the proximal draining lymph nodes and major lymphatic ducts, and improvement in the dermal backflow.Lymphatic skin flaps allow simultaneous soft tissue and lymphatic reconstruction. Scar excision at the affected limb, flap selection, and insetting based on ICG navigation at both the recipients and donor sites is important for successful flap integration and spontaneous lymphatic communications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110981","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":"Feedback and Assessment Methods in Microsurgery Education: A Scoping Review.","authors":"Muhammad Yaseen Abbas, Justin Haas, Elena Huang, Jessica Gormley, Victoria McKinnon, Christopher Coroneos, Anita Acai","doi":"10.1055/a-2616-4370","DOIUrl":"10.1055/a-2616-4370","url":null,"abstract":"<p><p>With distinctive instrumentation, challenges, and training, the unique nature of microsurgery necessitates the provision of feedback and assessment for trainees. The uncertain applicability of feedback or assessment methods may lead to poor trainee satisfaction and operative outcomes. We conducted a scoping review of the feedback and assessment methods in microsurgery.The Medline, EMBASE, ERIC, and Web of Science databases were searched for studies discussing feedback and/or assessment of microsurgery trainees. Study characteristics, feedback methods, assessment methods, and all other relevant data were extracted. The Medical Education Research Study Quality Instrument (MERSQI) was used to critically appraise the quantitative studies.From 2,440 articles, 99 were included. Sixty-five percent of articles were published since 2015. Plastic surgery, neurosurgery, and ophthalmology were the most common surgical specialties. Ninety percent of articles discussed exclusively assessment methods, with only 10% discussing both feedback and assessment. Microvascular anastomosis was the most common task (55%), with ex vivo synthetic, (20%) chicken (16%), and rat models (11%) being widely used. Global rating scales (GRSs) providing holistic evaluation based on multiple competency domains were the most common assessment methods (73%), followed by checklists (23%), and device-derived metrics (21%). Parameters included suture placement (53.5%), dexterity (50.5%), and tissue handling (48.5%). Real-time verbal, one-to-one feedback was the most common method among relevant studies (80%), while delayed written video review (20%) was also used. No structured feedback methods were used.This review identified a variety of feedback and assessment methods specific to microsurgery. GRSs continue to be popular; however, with increasing accessibility, device-derived metrics continue to increase in prevalence. A juxtaposition between named, structured, and validated assessment methods and informal feedback methods was evident. Particularly, the lack of standardized feedback methods may act as a barrier to the implementation of feedback across microsurgical education.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119957","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}