{"title":"Usefulness of Pulsed Wave Doppler Ultrasonography for Evaluating Recipient Vessels of Free Flap Reconstruction in Patients With Severe Extremity Trauma: A Preliminary Report","authors":"Shunsuke Sato, Satoshi Hatashita, Takuya Nikaido, Michiyuki Hakozaki, Takuya Kameda, Yoichi Kaneuchi, Yoshifumi Kawamae, Masayuki Ito, Yoshihiro Matsumoto","doi":"10.1002/micr.70030","DOIUrl":"https://doi.org/10.1002/micr.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In cases of severe extremity trauma treated with the ‘internal fixation for fractures and flap’ technique, successful soft tissue reconstruction requires selecting recipient vessels that avoid the zone of injury. Pulsed wave Doppler ultrasonography has been proposed as a useful tool for the preoperative evaluation of recipient vessels in plastic surgeries. This report aimed to present the preliminary experience of pulsed wave Doppler ultrasonography in traumatic disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This report included 14 free flaps from 13 patients with severe extremity trauma. The flaps included nine free latissimus dorsi flaps (two combined with serratus anterior flaps) and five free anterolateral thigh flaps. The recipient vessels included the posterior tibial artery (<i>n</i> = 8), anterior tibial artery (<i>n</i> = 2), perforator of the hypoplastic posterior tibial artery (<i>n</i> = 1), brachial artery (<i>n</i> = 1), radial artery (<i>n</i> = 1), and the ulnar artery (<i>n</i> = 1). Preoperative pulsed Doppler ultrasonography was used to evaluate the recipient vessels and the vascular anastomosis site was determined based on the modified waveform classification and maximum flow velocity (<i>V</i><sub>max</sub>), as described by Ogino et al. The following variables were analyzed: modified vascular waveform classification at the anastomosis site, <i>V</i><sub>max</sub>, presence of posttraumatic vessel disease, and flap survival rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The modified vascular waveform classification at the anastomotic site was D-1a in seven cases, D-1b in four cases, and D-2 in three cases, with an average <i>V</i><sub>max</sub> of 27.4 cm/s (range: 16.2–40.0 cm/s). Post-traumatic vessel disease was not observed in any of the cases. The flap survival rate was 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pulsed wave Doppler ultrasonography is a valuable tool for the preoperative evaluation of recipient vessels in free flap reconstruction for severe extremity trauma. Its use can help ensure the optimal selection of recipient vessels, contributing to high flap survival rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388917","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":"Comment on “Effects of Preoperative Hemoglobin on Microsurgical Reconstruction and Perioperative Blood Transfusion Requirement: A Meta-Analysis and Systematic Review of the Literature”","authors":"Mehrab Neyazi, Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.1002/micr.70032","DOIUrl":"https://doi.org/10.1002/micr.70032","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388918","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":"Factors Associated With Claw Toe Deformity Following Vascularized Fibula Flap Harvesting: A Retrospective Analysis of Potential Risk Factors and Preventive Strategies","authors":"Shigeki Ishibashi, Rikuo Shinomiya, Yuta Hayashi, Tsubasa Tashiro, Shogo Nagamatsu, Tomoaki Hamana, Toru Sunagawa, Nobuo Adachi","doi":"10.1002/micr.70031","DOIUrl":"https://doi.org/10.1002/micr.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Claw toe deformity at the donor site is a complication following vascularized fibula flap surgery. Despite its potential to necessitate further surgery, the factors contributing to this complication are not well understood. Therefore, this study aimed to identify factors associated with this complication and propose potential preventive strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 40 cases of vascularized fibula flap harvesting conducted between 2010 and 2022. The presence of claw toe deformity was evaluated, and various patient and surgical factors were analyzed. Postoperative magnetic resonance imaging (MRI) and intraoperative indocyanine green angiography images were also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Claw toe deformity was observed in 25% of patients, with a significantly higher incidence among those undergoing primary wound closure (<i>p</i> = 0.018). Age (<i>p</i> = 0.595), body mass index (<i>p</i> = 0.482), smoking status (<i>p</i> = 0.157), diabetes (<i>p</i> = 0.556), peripheral arterial disease (<i>p</i> > 0.999), preoperative chemotherapy (<i>p</i> = 0.715), operative time (<i>p</i> = 0.080), harvested fibula length (<i>p</i> = 0.981), skin paddle size (<i>p</i> = 0.695), and horizontal width of skin flap (<i>p</i> = 0.906) were not significantly associated with claw toe deformity. The cutoff values for primary wound closure were identified as a skin flap horizontal width of 3.5 cm and a horizontal width-to-circumference ratio of 10.4%. MRI revealed signal changes in the flexor hallucis longus on T2-weighted images in all six cases with claw toe deformity and in 6 of the 12 cases without deformity. Indocyanine green angiography revealed ischemia in the flexor hallucis longus in all six examined cases; however, four of these cases did not develop claw toe deformity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study emphasizes the importance of the wound closure method and skin flap size in primary closure for preventing claw toe deformity after vascularized fibula flap procedures. These findings may contribute to improved postoperative outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380796","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}
MicrosurgeryPub Date : 2025-02-08DOI: 10.1002/micr.70023
Chia-Hsuan Tsai, Cristhiam Yang, Yao-Chang Liu, Chi-Ling Chen, Huang-Kai Kao
{"title":"Risk Factors of Free Flap Outcomes After Head and Neck Cancer Surgery: A Multivariable Analysis From a Single Center Experience","authors":"Chia-Hsuan Tsai, Cristhiam Yang, Yao-Chang Liu, Chi-Ling Chen, Huang-Kai Kao","doi":"10.1002/micr.70023","DOIUrl":"https://doi.org/10.1002/micr.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Risk factors for unfavorable outcomes, such as surgical site infection (SSI) and flap loss, following free flap reconstruction in patients with head and neck cancer are repeatedly reported without a definitive conclusion. Institutional reviews and meta-analyses each have their advantages and limitations. Although this study is without a definitive answer to these questions, it contributes to the literature by identifying potential influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center cohort study included 596 patients who underwent head and neck reconstruction between 2015 and 2017. Patients were initially divided into two groups based on the presence or absence of SSI, and a similar comparison was made for flap loss. Data were further analyzed using univariate and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall SSI rate was 18.29%, with the age of patients (65–74 years, adjusted OR 2.41, <i>p</i> < 0.001; > 74 years, adjusted OR 3.53, <i>p</i> < 0.001) and segmental mandibulectomy (adjusted OR 1.81, <i>p</i> = 0.035) as independent risk factors. The overall flap failure rate was 4.4%, with medial sural flap (adjusted OR 6.89; <i>p</i> = 0.025) and prolonged operative time per hour (adjusted OR 1.38; <i>p</i> < 0.001) identified as significant influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age should not be the sole determinant for excluding patients for free tissue transfer, though it may elevate the SSI rate. Special attention is potentially needed during postoperative care for patients who received segmental mandibulectomy, medial sural flap, or experienced prolonged operative time. Identifying these risk factors can assist surgeons in optimizing flap outcomes before head and neck reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362730","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}
MicrosurgeryPub Date : 2025-02-06DOI: 10.1002/micr.70033
Se Yeon Park, Kyeong-Tae Lee
{"title":"Usefulness of Dorsal Scapular Artery Perforator Flap for Donor Site Closure After Harvesting Latissimus Dorsi Flap/Thoracodorsal Artery Perforator Flap: A Report of Three Cases","authors":"Se Yeon Park, Kyeong-Tae Lee","doi":"10.1002/micr.70033","DOIUrl":"https://doi.org/10.1002/micr.70033","url":null,"abstract":"<div>\u0000 \u0000 <p>Reducing donor-site morbidity is crucial in free-flap reconstruction, with the primary goals of achieving dermis-to-dermis closure and avoiding skin grafts. Although latissimus dorsi (LD) myocutaneous and thoracodorsal artery perforator (TDAP) flaps usually allow primary closure, larger flap harvests may require skin grafts, potentially leading to undesirable outcomes. In such situations, local flap transfer can be considered for donor-site closure, yet there are few reports on this. This report aims to present cases where a dorsal scapular artery perforator (DSAP) rotational flap was used to close donor defects following large TDAP/LD flap harvests. The first case involved a 16-year-old girl who required a below-knee amputation due to an acute thrombotic event, leaving a 20 × 20 cm<sup>2</sup>-sized stump defect. Bilateral LD myocutaneous flaps were harvested, with the right donor site closed primarily, while a 20 × 9 cm<sup>2</sup>-sized defect remained on the left. A 22 × 9 cm<sup>2</sup>-sized DSAP flap, based on three perforators, was rotated to close the defect, showing excellent outcomes at 12 months. In the second and third cases, 75- and 78-year-old male patients with scalp angiosarcoma underwent wide excision and reconstruction with TDAP flaps, leaving 14 × 6 cm<sup>2</sup> and 14 × 7 cm<sup>2</sup>-sized donor defects. DSAP flaps, 15 × 7 cm<sup>2</sup> and 15 × 8 cm<sup>2</sup> in size, were rotated based on nearby perforators to close these areas. Both patients showed no morbidities at postoperative 8 and 2 months, respectively. When primary closure of the donor site is challenging after harvesting large TDAP /LD flaps, a DSAP rotational flap can provide a valuable option for minimizing donor-site morbidity.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248729","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 Case of Ala Reconstruction With an Extended Pedicle Helical Rim Flap","authors":"Filipa Poleri, Jorge Correia-Pinto, Larissa Lanzaro, Rui Casimiro, Carolina Chaves, Horácio Zenha, Horácio Costa","doi":"10.1002/micr.70027","DOIUrl":"10.1002/micr.70027","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059791","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}
MicrosurgeryPub Date : 2025-01-29DOI: 10.1002/micr.70028
E. Schouppe, Dariush Nikkhah
{"title":"Arterial End-To-Side Anastomosis as a Salvage Maneuver in DIEP-Flap Breast Reconstruction","authors":"E. Schouppe, Dariush Nikkhah","doi":"10.1002/micr.70028","DOIUrl":"10.1002/micr.70028","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059697","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}
MicrosurgeryPub Date : 2025-01-29DOI: 10.1002/micr.70025
Giovanni Zabbia, Emanuele Cammarata, Mara Franza, Francesca Toia, Greta Tondini, Francesca Graziano, Domenico Gerardo Iacopino, Adriana Cordova
{"title":"Microsurgical Reconstruction of Complex Scalp Defects With Vastus Lateralis Free Flap","authors":"Giovanni Zabbia, Emanuele Cammarata, Mara Franza, Francesca Toia, Greta Tondini, Francesca Graziano, Domenico Gerardo Iacopino, Adriana Cordova","doi":"10.1002/micr.70025","DOIUrl":"10.1002/micr.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening.</p>\u0000 \u0000 <p>In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (<i>n</i> = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (<i>n</i> = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059703","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}
MicrosurgeryPub Date : 2025-01-27DOI: 10.1002/micr.70024
François Thuau, Antoine Hamel, Franck Duteille
{"title":"Double-Barreled Vascularized Fibula Free Flap in Pediatric Tibial Bone Defect Reconstruction: A 20-Year Monocentric Experience","authors":"François Thuau, Antoine Hamel, Franck Duteille","doi":"10.1002/micr.70024","DOIUrl":"10.1002/micr.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reconstructing large bone defects for lower limb salvage in the pediatric population remains challenging due to complex oncological or septic issues, limited surgical options, and lengthy procedures prone to complications. The vascularized double-barreled fibula free flap is pivotal for reconstructing large bones. In this article, we report our experience with this technique in the surgical management of pediatric tibial bone defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of patients under 18 years of age who underwent tibial reconstruction using a double-barreled fibula free flap at our center between 2004 and 2023. Collected data included demographic information, operative details, time to bone consolidation and full weight-bearing, and functional outcomes using the Musculoskeletal Tumor Society (MSTS) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight patients (5 females, 3 males) with a mean age of 12.5 years (range 5–17) were included. The average tibial defect length was 11.2 cm (range 7–14 cm), affecting the proximal tibia in 4 cases (50%), the middle third in 3 cases (37.5%), and the distal third in 1 case (12.5%). Reconstruction followed oncologic resection in 7 patients (87.5%) and addressed congenital pseudarthrosis in 1 patient (12.5%).</p>\u0000 \u0000 <p>One patient died of sarcoma. Six patients (75%) achieved full weight-bearing within a median of 7 months (range 6–16) and a bone consolidation at 9 months in median (range 6–18). One reconstruction (12.5%) failed due to septic pseudarthrosis leading to a below-knee amputation. The mean MSTS score was 81.65 (range 63.3–100).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to focus on pediatric tibial reconstructions using the double-barreled vascularized fibula free flap. It highlights the technique's reliability for reconstructing tibial defects, particularly in intermediate-sized cases (7–14 cm). This single-stage procedure minimizes stress fracture risk, enables earlier weight-bearing, and is an alternative to the Capanna technique without requiring an allograft.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052967","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}
MicrosurgeryPub Date : 2025-01-27DOI: 10.1002/micr.70029
Faraaz Azam, Cyril Awaida, Anca Dogaroiu, Andrei Odobescu
{"title":"Current Practices and Evidence of Aspirin Usage in Microvascular Surgery: A Systematic Review and Meta-Analysis","authors":"Faraaz Azam, Cyril Awaida, Anca Dogaroiu, Andrei Odobescu","doi":"10.1002/micr.70029","DOIUrl":"10.1002/micr.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acetylsalicylic acid (ASA) has been used in reconstructive microsurgery since the inception of the field. However, when compared to placebo groups, its efficacy is not confirmed. In our study, we hypothesize that the utility of ASA postoperatively in microvascular surgery is not associated with improved outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of the literature was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines. Documentation of antiplatelet regimens and postoperative complications were the primary endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four articles met inclusion criteria including a total of 1196 patients. There were 637 patients who received aspirin and 559 patients who did not. The average age was not found to be significantly different between the two groups (<i>p</i> > 0.05). In terms of flap type, patients undergoing DIEP had a significantly higher likelihood of receiving aspirin, whereas patients undergoing fibula flaps had a lower rate of aspirin usage (<i>p</i> < 0.05). TRAM, anterolateral thigh flaps, SIEA, and radial forearm flaps were equally distributed between the two groups (<i>p</i> > 0.05). A total of 317 complications were noted across both groups. Total complication rate, complete flap loss, and venous/arterial thrombosis rate were not found to be significantly different between the two groups (<i>p</i> > 0.05). Hematoma rate was found to be significantly higher in the group receiving aspirin when compared to the control (RR = 1.70, 95% CI 1.19–2.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aspirin usage did not confer significant advantage in preventing postoperative complication rates and increased rates of hematoma formation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052963","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}