Journal of reconstructive microsurgery最新文献

{"title":"Optimal Vasodilators in Microsurgery and Their Effects on Blood Vessels.","authors":"Misato Ueda, Tadashi Nomura, Hiroto Terashi, Shunsuke Sakakibara","doi":"10.1055/a-2483-5634","DOIUrl":"https://doi.org/10.1055/a-2483-5634","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846906","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":"Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population.","authors":"Jakob B W Weiss, Branislav Kollár, Steffen U Eisenhardt","doi":"10.1055/a-2460-4761","DOIUrl":"10.1055/a-2460-4761","url":null,"abstract":"<p><strong>Background: </strong> Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear.</p><p><strong>Methods: </strong> We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study.</p><p><strong>Results: </strong> Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (<i>p</i> > 0.05). There were no major bleeding complications or deep vein thrombosis.</p><p><strong>Conclusion: </strong> The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576347","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":"One Size Does Not Fit All: Prediction of Nerve Length in Implant-based Nipple-Areola Complex Neurotization.","authors":"Casey Zhang, Elizabeth A Moroni, Andrea A Moreira","doi":"10.1055/a-2460-4589","DOIUrl":"https://doi.org/10.1055/a-2460-4589","url":null,"abstract":"<p><strong>Background: </strong> Breast reconstruction with sensory restoration is gaining recognition as an important goal. Successful reinnervation has been shown in autologous reconstruction but not widely studied in implant-based reconstruction (IBR). This article describes our technique for nipple-areola complex (NAC) neurotization to predict maximal nerve length. We also propose a novel equation that can be utilized preoperatively to estimate the total nerve length required for NAC neurotization.</p><p><strong>Methods: </strong> This is a retrospective study of patients who underwent nerve reconstruction with IBR between April 2021 and May 2022. An equation based on the arc length of a circle was utilized to predict the total nerve length required. Postoperative assessment of sensation was performed at 3, 6, and 12 months using Semmes-Weinstein monofilament testing in all four breast quadrants and the NAC. Patients completed the Breast-Q Sensation Module preoperatively and at 3, 6, and 12 months.</p><p><strong>Results: </strong> NAC neurotization was performed in 58 patients undergoing IBR. The average length of intercostal nerve (ICN) harvested was 5.3 cm for staged reconstructions and 5.6 cm for direct-to-implant reconstruction. The average total nerve length (allograft + mobilized ICN) was 12.3 cm. On average, 6.9 cm of nerve allograft was used. The mean difference between total nerve length and predicted nerve length was 0.47 cm (range -3.5 to 4.6 cm). There was a significant improvement in sensory monofilament values measured in all four breast quadrants and the NAC between 3 to 6 and 6 to 12 months postoperatively.</p><p><strong>Conclusion: </strong> A thorough understanding of sensory anatomy and precise surgical techniques are essential to perform NAC neurotization successfully. Our early results suggest the positive impact of breast sensation on patient quality of life.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755272","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":"Evaluation of Modified Frailty Index for Predicting Postoperative Outcomes after Upper Extremity Replantation and Revascularization Procedures.","authors":"Anshumi Desai, Angela Luo, Peter A Borowsky, Valeria B Hemer, Natalia Fullerton, Kyle Y Xu, Kashyap K Tadisina","doi":"10.1055/a-2460-4706","DOIUrl":"10.1055/a-2460-4706","url":null,"abstract":"<p><strong>Background: </strong> Upper extremity (UE) replantation and revascularization are challenging surgical procedures, with survival rates being 50 to 90%. Preoperative risk stratification is challenging yet crucial as patients with comorbid conditions face increased complications. This study assesses the predictive value of the modified 5-item frailty index (5-mFI) for postoperative complications in these procedures.</p><p><strong>Methods: </strong> A retrospective study was done using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2011-2021) for UE replantation/revascularization. The 5-mFI score assigned points for comorbidities including pulmonary disease, heart failure, diabetes, hypertension, and functional status (0-5 scale; 1 point to each). 5-mFI scores stratified patients into <2 (low-risk) or ≥2 (high-risk) categories.</p><p><strong>Results: </strong> Of 2,305 patients, the mean age and body mass index (BMI) were 53.13 years and 28.53 kg/m², respectively. The 5-mFI ≥2 cohort experienced higher rates of all-cause complications, systemic complications, unplanned readmissions, and return to the operating room on univariate analysis. There was no significant difference in wound complication rates. Multivariable logistic regression showed that a higher 5-mFI was significantly associated with increased risks of all-cause mild and severe systemic complications. Wound complications, length of stay over 30 days, unplanned readmission, and return to the operating room were higher in high-risk patients, however not statistically significant.</p><p><strong>Conclusion: </strong> 5-mFI is an effective tool for evaluating risk in UE replantation and revascularization, correlating high scores with significantly increased postoperative complications. High-risk patients with 5-mFI ≥2 also had more reoperations and readmissions. The use of 5-mFI in preoperative assessments can help personalize management, enhancing patient selection and care quality in these complex reconstructions.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576358","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 Neoadjuvant Radiation and Recipient Vessel Characteristics on Microvascular Complication Rates in Reconstruction of Lower Extremity Soft Tissue Sarcoma Defects.","authors":"Rebecca L Farmer, Justin Easton, Ruston Sanchez, Elisa Emanuelli, Eldon Mah","doi":"10.1055/a-2460-4649","DOIUrl":"10.1055/a-2460-4649","url":null,"abstract":"<p><strong>Background: </strong> The treatment approach for soft tissue sarcomas (STS) of the lower extremity has shifted toward the use of neoadjuvant radiation combined with limb-sparing surgery (LSS). The resulting defects often require reconstruction with free tissue transfer for adequate outcomes. Data have demonstrated a potentially increased risk of microvascular complications for free flaps performed using irradiated recipient vessels. Similarly, certain anatomic areas of the lower extremity have a high proportion of unnamed perforators that are available as recipient vessels, increasing the technical difficulty. We aimed to determine if the characteristics of recipient vessels that were used for the reconstruction of STS defects influenced rates of microvascular complications in our patients.</p><p><strong>Methods: </strong> A retrospective chart review of all patients who underwent reconstruction of lower extremity STS defects with free tissue transfer from 2009 to 2020 was conducted. Data regarding recipient vessel type (axial vessel vs. unnamed perforator), radiation status of the recipient vessels (irradiated vs. non-irradiated), and microvascular complications were compared across groups.</p><p><strong>Results: </strong> A total of 204 free flaps were included. The overall microvascular complication rate was 13.7% (28 cases). Most microvascular complications were detected postoperatively (82.1%) rather than intraoperatively, with the majority involving venous congestion/thrombosis (20 cases, 71.4%). While there was a trend toward increased microvascular complications with the use of irradiated recipient vessels (27 cases, 96.4%), this did not reach statistical significance (OR = 1.98, <i>p</i> = 0.52). The use of perforating branches as recipient vessels did not confer an increased risk of microvascular complications (OR = 0.87, <i>p</i> = 0.75).</p><p><strong>Conclusion: </strong> The reconstruction of irradiated lower-extremity STS defects represents a particularly challenging issue. This analysis demonstrates that free tissue transfer can be safely performed using irradiated vessels without a significantly increased risk of microvascular complications. Furthermore, unnamed perforating branches can be successfully used for reconstruction in anatomically challenging areas of the lower extremity.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576353","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":"Impact of Insurance Status on Postoperative Recovery after Microsurgical Breast Reconstruction.","authors":"Yi-Hsueh Lu, Evan Rothchild, Yufan Yan, Lakshmi Mahajan, Michelle Park, Joseph A Ricci","doi":"10.1055/a-2460-4900","DOIUrl":"10.1055/a-2460-4900","url":null,"abstract":"<p><strong>Background: </strong> Persistent disparities in breast reconstruction access have been widely documented, yet a significant research gap remains in understanding the impact of social determinants of health (SDOH) on postoperative outcomes and complications.</p><p><strong>Methods: </strong> A retrospective chart review was performed on all patients who underwent abdominal-based free-flap breast reconstruction between August 2018 and December 2022 at a racially, ethnically, and socioeconomically diverse urban academic institute with a historically underserved patient population. Patients were stratified by the public (Medicare and Medicaid) versus private insurance as a proxy for SDOH. Patient demographics, length of stay (LOS), timing in progression through postoperative recovery milestones, and complications were compared.</p><p><strong>Results: </strong> A total of 162 patients were included, and 57% of patients had public insurance, with this group more likely to be Hispanic (odds ratio [OR] 2.7; <i>p</i> = 0.003) and Spanish-speaking (OR 3.4; <i>p</i> = 0.003). Privately insured patients were more likely to be non-Hispanic Black (OR 2.7; <i>p</i> = 0.006). Patients with public insurance had a higher rate of unplanned return to the operating room within 90 days and a higher incidence of complications, though not statistically significant. They also experienced a significantly longer LOS than privately insured patients (3.6 ± 1.0 vs. 3.0 ± 0.7 days; <i>p</i> < 0.0001). Logistic regression identified an LOS exceeding 3 days as independently associated with public insurance status (OR 3.0; <i>p</i> = 0.03), bilateral procedure (OR 5.6; <i>p</i> = 0.0007), preoperative functional-dependent status (OR 7.0; <i>p</i> = 0.04), and higher body mass index (BMI; OR 1.1; <i>p</i> = 0.03). Patients with public insurance were more likely to encounter delays in achieving recovery milestones.</p><p><strong>Conclusion: </strong> Public insurance status, serving as a proxy for a disadvantage in SDOH, is predictive of extended LOS and postoperative recovery delays following microsurgical breast reconstruction. This underscores the need for future quality improvement efforts to address and mitigate these disparities.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576368","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":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-21","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":"On a Hunt for the \"True\" Septocutaneous Perforator: A Histology Cross-Section Study.","authors":"Martin Kubat, Zdenek Dvorak, Dusan Zoufaly, Marketa Hermanova, Marek Joukal, Geoffrey G Hallock","doi":"10.1055/a-2435-7531","DOIUrl":"10.1055/a-2435-7531","url":null,"abstract":"<p><strong>Background: </strong> Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself.</p><p><strong>Methods: </strong> Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue.</p><p><strong>Results: </strong> Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap).</p><p><strong>Conclusion: </strong> Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are \"true\" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391385","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 Bell's Palsy Is Cancer: Avoiding Misdiagnosis and Its Implications.","authors":"Y Edward Wen, Benjamin Rail, Cristina V Sanchez, April R Gorman, Shai M Rozen","doi":"10.1055/a-2434-4737","DOIUrl":"10.1055/a-2434-4737","url":null,"abstract":"<p><strong>Background: </strong> Facial paralysis due to cancer can be misdiagnosed as Bell's palsy. This study aims to clearly identify and quantify diagnostic differentiators and further evaluate the prognostic implications of misdiagnosis.</p><p><strong>Methods: </strong> Adult patients older than 18 years with facial palsy of unknown or cancerous etiology presenting between 2009 and 2023 were reviewed. Patient characteristics, examination findings, and clinical course were compared between facial paralysis patients with cancer misdiagnosed as Bell's palsy (Cancer-Bell's-Palsy group) and patients correctly diagnosed with Bell's palsy (Bell's-Palsy group). Additionally, morbidity and mortality were compared between facial paralysis patients with cancer initially misdiagnosed with Bell's palsy and facial paralysis patients initially correctly diagnosed with cancer (Cancer-Palsy group).</p><p><strong>Results: </strong> Two-hundred and forty-three patients participated including 43 Cancer-Palsy, 18 Cancer-Bell's-Palsy, and 182 Bell's-Palsy patients. Cancer-Bell's-Palsy patients were significantly less likely than Bell's-Palsy patients to develop synkinesis (odds ratio [OR] = 0.0042; 95% confidence interval [CI]: [0.0005-0.0339]; <i>p</i> < 0.0001), significantly more likely to experience gradual onset facial paralysis (OR = 1,004.69; 95% CI: [54.40-18,555.77]; <i>p</i> < 0.0001), and significantly more likely to have additional nonfacial cranial nerve neuropathies (OR = 49.98; 95% CI: [14.61-170.98]; <i>p</i> < 0.0001). Cancer-Bell's-Palsy patients were more likely than Cancer-Palsy patients to have a greater than 6-month period from initial cancer-attributable symptom onset to cancer diagnosis (OR = 47.62; 95% CI: [9.26-250.00]; <i>p</i> < 0.001), stage IV cancer (OR: 12.36; 95% CI: 1.49-102.71; <i>p</i> = 0.006), and decreased duration of life after cancer diagnosis (median [interquartile range], 40.0 [87.0] vs. 12 [56.3] months, respectively; <i>p</i> = 0.025).</p><p><strong>Conclusion: </strong> Facial paralysis related to cancer must be differentiated from Bell's palsy, as misdiagnosis leads to delayed intervention and poorer prognosis. Gradual onset facial palsy, multiple cranial nerve neuropathies, lack of synkinesis, and lack of improvement were nearly definitive differentiators for underlying cancer.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372137","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 Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction.","authors":"Yi-Hsueh Lu, Lakshmi Mahajan, Hayeem Rudy, Yufan Yan, Joseph A Ricci","doi":"10.1055/a-2277-0117","DOIUrl":"10.1055/a-2277-0117","url":null,"abstract":"<p><strong>Background: </strong> There is an increasing prevalence of marijuana use in the general population yet clinical studies on marijuana's effect on surgical outcomes remain limited. Marijuana's effect on wound healing, venous thromboembolism (VTE) due to endothelial inflammation, and bleeding due to inhibited platelet function have been cited based on animal models but have not been evaluated clinically in patients undergoing microsurgical reconstruction.</p><p><strong>Methods: </strong> Retrospective chart review was performed on all patients who underwent abdominal-based free flap breast reconstruction in a single institute from August 2018 to December 2022. Patient self-reported marijuana use, demographics, total narcotic use during hospitalization converted to oral morphine milligram equivalent (MME), and 90-day complications were collected and compared.</p><p><strong>Results: </strong> A total of 162 patients were included and 13 patients (8.5%) had reported marijuana use on presurgical history. Marijuana users are more likely to be younger and report concurrent nicotine smoking. Marijuana users were also at a significantly elevated risk of developing symptomatic VTE (15 vs. 1%; odds ratio (OR) 13.4 [95% confidence interval (CI) 1.71-104.2]; <i>p</i> = 0.01) and marijuana use remained a significant risk factor with multivariate analysis. On postoperative 90-day complications, there was no increased risk of flap loss, reoperation, postoperative transfusion, or hematoma associated with marijuana use, and no significantly increased risk for overall donor or recipient site complications. Marijuana users required significantly more narcotics for pain control during hospitalization (100 ± 77 vs. 49 ± 45 MME; <i>p</i> = 0.0003), although they had similar lengths of stay, achievement of mobilization on post operative day (POD)1, and maximal pain scores.</p><p><strong>Conclusion: </strong> Marijuana use increases the risks of postoperative VTE and increased postoperative narcotic requirements in patients who underwent abdominal-based free flap breast reconstruction. Future prospective cohort study is required to further understand marijuana-associated risks in microsurgical procedures.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"680-687"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139983144","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}