{"title":"A Case of Severe Necrotizing Soft-tissue Infection With Reconstruction of the Mid-lower Leg Using a Distally Based Pedicled Gracilis Muscle Flap.","authors":"Kenta Tanakura, Rie Hayasaka, Yukiko Kuramoto, Tomohiro Imai","doi":"10.1097/GOX.0000000000008096","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008096","url":null,"abstract":"<p><p>Here, we report the management of a severe necrotizing soft-tissue infection involving the entire lower limb of a man in his 70s. The infection originated from a lower leg hematoma that developed during anticoagulant therapy for deep vein thrombosis. Necrosis extended from the deep thigh to the lower leg, involving areas surrounding critical structures such as the femoral artery, sciatic nerve, and tibia. Limb salvage was achieved through multiple debridement procedures and skin grafts performed in collaboration with orthopedic and cardiovascular surgery teams. The exposed cortical bone on the anterior midtibia was covered using a distally pedicled gracilis muscle flap in combination with negative-pressure wound therapy to avoid the need for a distal flap. The flap survived sufficiently to avoid a distal flap, and the patient was able to ambulate without a cane 6 months postoperatively.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8096"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuan Chen, Ronghao Ouyang, Hang Zhang, Jiaqi Yao, Yingzi Li, Hongli Chai, Jintian Hu
{"title":"Lower-extremity Deep Vein Thrombosis after Plastic Surgery: Clinical Characteristics and Outcomes in a Retrospective Case Series.","authors":"Yuan Chen, Ronghao Ouyang, Hang Zhang, Jiaqi Yao, Yingzi Li, Hongli Chai, Jintian Hu","doi":"10.1097/GOX.0000000000008131","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008131","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT) is a significant complication in plastic surgery, particularly affecting the lower extremities. Understanding the associated characteristics can aid in developing effective prevention strategies.</p><p><strong>Methods: </strong>We conducted a retrospective, quality improvement-oriented case series of 5 ultrasound-confirmed symptomatic postoperative lower-extremity DVT events after plastic surgery under general anesthesia at a single institution (January 2020-May 2024). Among 39,055 general anesthesia procedures during the study period, de-identified records were reviewed for patient and procedural characteristics, prophylaxis and mobility pathways, duplex ultrasonography confirmation, management, and short-term outcomes. No non-DVT comparator cohort was extracted; analyses were descriptive and not intended for risk-factor inference. One patient with postoperative chest/back pain and transfer for suspected pulmonary embolism without in-hospital lower-extremity DVT confirmation was excluded from the final case series.</p><p><strong>Results: </strong>The 5 included cases were clinically heterogeneous and involved complex perioperative settings, including post-massive weight loss body contouring, craniofacial reconstruction with implant use, neurosurgical-related reconstruction, extensive head and neck lesion surgery, and posttraumatic facial reconstruction. All DVTs were confirmed by duplex Doppler ultrasonography, with thrombi involving the posterior tibial, peroneal, or calf muscular veins. Several cases involved prolonged procedures, reoperation for postoperative hematoma, or delayed mobilization. Postoperative anticoagulation was administered in most cases, whereas postoperative mechanical prophylaxis was not consistently documented.</p><p><strong>Conclusions: </strong>In a very low-frequency setting, this series highlights potentially actionable prevention gaps-especially postoperative mechanical prophylaxis and mobility disruptions-rather than establishing causal risk factors.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8131"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rare Subungual Fibroepithelial Polyp With Keratosis: Differential Diagnosis.","authors":"Faris Aldaghri, Amal A Alghtani, Hisham Alkhalidi","doi":"10.1097/GOX.0000000000008192","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008192","url":null,"abstract":"<p><p>Fibroepithelial polyps (FEPs), commonly known as acrochordons or skin tags, are benign cutaneous lesions typically found in intertriginous areas, such as the neck, axilla, and groin. Occurrence within the nail unit is exceptionally rare, presenting a diagnostic challenge as it mimics more common ungual tumors. We report a rare case of a 23-year-old woman who presented with a 4-year history of a painful, slow-growing lesion emerging from the proximal nail fold of the right fifth toe, causing nail plate deformity. Clinical differentials included acquired ungual fibrokeratoma and Koenen tumors. The lesion was completely excised, and the base was ablated. Histopathological examination revealed a FEP with keratosis, characterized by a loose collagenous core, distinguishing it from the dense vertical collagen typical of fibrokeratomas. Although FEPs are common skin lesions, their presentation in the nail unit is unusual. This case highlights the importance of considering FEP in the differential diagnosis of subungual and periungual tumors. Complete excision with ablation of the base was curative and prevented recurrence.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8192"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Digital Replant Failure Following Δ<sup>9</sup>-tetrahydrocannabinol Vaping: A Case Report and Literature Review.","authors":"Jianjun Ma, Hannah Miller","doi":"10.1097/GOX.0000000000008158","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008158","url":null,"abstract":"<p><p>Digital replantation outcomes critically rely on microvascular integrity. Although cigarette smoking is well-known to impair replant survival, the vascular impact of Δ<sup>9</sup>-tetrahydrocannabinol (THC) vaping remains poorly defined. We report the case of a 29-year-old man with a 6-year history of daily THC vaping who sustained an avulsion injury to the right thumb. The patient initially underwent successful thumb replantation and was instructed to abstain from postoperative vaping. Ninety-six hours after surgery, he vaporized 5 puffs of THC; within 48 hours, vascular compromise developed, culminating in total replant failure. A toe-to-thumb transfer with the second digit was subsequently performed successfully, although it required re-exploration for a vascular crisis. This case underscores the potential for catastrophic microvascular failure associated with postoperative THC vaping and highlights the necessity of early, explicit patient counseling on cannabis abstinence after replantation. THC activates CB<sub>1</sub> and CB<sub>2</sub> receptors in vascular endothelial cells, triggering vasoconstriction, platelet aggregation, and prothrombotic cascades. Even a brief postoperative exposure may precipitate thrombosis during the critical period of microvascular adaptation. The increasing legalization and prevalence of THC vaping, especially among young adults, makes perioperative cannabis exposure an important risk factor in replantation surgery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8158"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joyce X Cui, Eric Zeng, Mary L Duet, Courtney Stone, Marion Tapp, John Michael Robinson, Thomas N Steele, Bennett Calder
{"title":"Associations of Deep Inferior Epigastric Perforator Flap Weight with Postoperative Complications and Revisions.","authors":"Joyce X Cui, Eric Zeng, Mary L Duet, Courtney Stone, Marion Tapp, John Michael Robinson, Thomas N Steele, Bennett Calder","doi":"10.1097/GOX.0000000000008162","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008162","url":null,"abstract":"<p><strong>Background: </strong>The deep inferior epigastric perforator (DIEP) flap has emerged as the preferred method for autologous breast reconstruction. There is growing interest in identifying factors associated with complications. This study investigates the relationship between DIEP flap weight and postoperative outcomes using a large, DIEP-specific database.</p><p><strong>Methods: </strong>We performed a retrospective review of 757 patients (757 oncologic flaps) with a history of breast cancer who underwent DIEP flap reconstruction from 2017 to 2024 at 2 medical sites. Demographics, medical history, operative course, and complications were analyzed.</p><p><strong>Results: </strong>Body mass index (BMI) strongly correlated with flap weight (<i>r</i> = 0.79), and both correlated with complication rates (<i>P</i> < 0.001, <i>P</i> < 0.001). Patients were grouped by BMI (<25, 25-30, 30-35, and >35 kg/m<sup>2</sup>) and subsequently by those with and without complications within a mean of 9.6 months from reconstruction. Adjusted logistic regression revealed that flap weight was associated with higher odds of overall complications [odds ratio (OR) 1.17], minor complications (OR 1.18), fat necrosis (OR 1.27), and wound dehiscence (OR 1.29) in BMI 30-35 group. Heavier flaps were also associated with skin necrosis in the BMI less than 25 group (OR 2.31) and hematoma in the BMI 25-30 group (OR 1.37). Further stratification by flap weight showed trends toward higher rates of minor complications, skin necrosis, and wound dehiscence, although associations were inconsistent across strata.</p><p><strong>Conclusions: </strong>Flap weight correlated with complications in select BMI subgroups, most notably BMI 30-35, although findings were inconsistent across groups. Further study is needed to better understand the multifactorial relationship between flap weight and postoperative outcomes.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8162"},"PeriodicalIF":1.9,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yao Li, Yi-Long Guo, Yu-Hao Zhou, Cheng-En Luo, Wei-Jin Hong
{"title":"Radiofrequency for the Treatment of Facial Ligament Laxity: A Split-face Controlled Exploratory Study.","authors":"Yao Li, Yi-Long Guo, Yu-Hao Zhou, Cheng-En Luo, Wei-Jin Hong","doi":"10.1097/GOX.0000000000008127","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008127","url":null,"abstract":"<p><strong>Background: </strong>Facial aging is a complex and multilayered process. Facial retaining ligaments play a critical role in maintaining soft-tissue position and resisting gravitational descent. Although radiofrequency (RF) therapy is widely used for noninvasive facial rejuvenation, ligament-targeted RF strategies remain insufficiently investigated.</p><p><strong>Methods: </strong>This prospective, evaluator-blind, split-face controlled study enrolled patients with mild-to-moderate facial laxity. A 1.7-MHz bipolar RF device was used for 3 treatment sessions at 4-week intervals. The left side received conventional full-face RF treatment, whereas the right side underwent ligament-targeted RF treatment. The primary outcome was the change in 3-dimensional facial volume measured using the Vectra M3 imaging system. Secondary outcomes included physician- and subject-rated Global Aesthetic Improvement Scale scores at 1 month and 6 months post final treatment. Safety outcomes were also recorded.</p><p><strong>Results: </strong>A total of 12 patients completed the study (N = 12 per side). One month after the final treatment, no statistically detectable difference was observed between the treatment and control sides in the mean change in 3-dimensional facial volume. Improvements in facial laxity were observed on both sides after treatment. Both physician- and subject-rated Global Aesthetic Improvement Scale scores improved at 1 month and 6 months posttreatment, with no statistically detectable differences between sides. All treatment-related adverse events were mild and transient.</p><p><strong>Conclusions: </strong>No statistically detectable differences in contour outcomes were observed between the 2 treatment approaches in this preliminary study. These findings suggest that an anatomically guided approach may offer a feasible option for noninvasive structural facial rejuvenation and warrant further investigation in larger studies.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8127"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
John S Mayo, Michelle Frees, Allison J Kehren, Omar Cespedes-Gomez, Nicole D Garrett, Warren Schubert, Minh-Doan T Nguyen
{"title":"Body Mass Index: Does It Really Matter for Breast Reductions?","authors":"John S Mayo, Michelle Frees, Allison J Kehren, Omar Cespedes-Gomez, Nicole D Garrett, Warren Schubert, Minh-Doan T Nguyen","doi":"10.1097/GOX.0000000000008170","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008170","url":null,"abstract":"<p><strong>Background: </strong>Multiple studies have demonstrated higher complication rates for patients undergoing reduction mammoplasty who have high body mass index (BMI). As a result, some insurance companies and providers have used a BMI limit to deny coverage of this procedure to patients seeking surgery. Still, few studies have examined whether higher complication rates affect patient satisfaction. This study further explores the relationship between BMI, complications, and patient satisfaction in reduction mammoplasty.</p><p><strong>Methods: </strong>A total of 899 consecutive patients at a single institution underwent reduction mammoplasty by 8 surgeons for symptomatic macromastia from 2016 to 2021. This cohort was queried using the BREAST-Q survey postoperatively. Kruskal-Wallis H-test was used to evaluate patient satisfaction and complication rates for 4 BMI groups, that is, normal (18.5-24.9 kg/m<sup>2</sup>), overweight (25-29.9 kg/m<sup>2</sup>), obese (30-39.9 kg/m<sup>2</sup>), and morbidly obese (>40 kg/m<sup>2</sup>).</p><p><strong>Results: </strong>Two hundred fifty patients completed surveys. The mean BMI was 32.4 kg/m<sup>2</sup> (range 20.3-50.5 kg/m<sup>2</sup>). Mean survey responses were highly favorable in all BMI categories, including 90% stating they \"definitely agree\" they \"would do it again.\" There was no statistical difference between the 4 BMI categories for patient satisfaction or complications.</p><p><strong>Conclusions: </strong>Patients with high BMI may have similar postoperative BREAST-Q satisfaction scores when compared to those with lower BMI.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8170"},"PeriodicalIF":1.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cesarean Delivery after Abdominal Wall Reconstruction Using an Anterolateral Thigh Flap with Vascularized Fascia Lata.","authors":"Shiori Taniguchi, Kaori Yoriki, Toshiaki Numajiri","doi":"10.1097/GOX.0000000000008148","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008148","url":null,"abstract":"<p><p>Techniques for abdominal wall reconstruction include the use of prosthetic materials (synthetic or biological meshes), component separation, autologous tissue reconstruction, or a combination thereof. Reconstruction using prosthetic materials avoids additional trauma to healthy tissues but carries risks such as infection, adhesion to surrounding structures, and bowel obstruction caused by intestinal adhesions. Therefore, abdominal wall reconstruction using autologous tissue may be considered as an option suitable for women of childbearing potential. Only a few cases of successful childbirth following abdominal wall reconstruction have been reported, and opportunities to reincise and directly observe the reconstructed wall are rare. No previous reports have described intraoperative findings during reincision of a previously reconstructed abdominal wall. We report the case of a 23-year-old woman who underwent abdominal wall resection for a rectus abdominis tumor secondary to an immature ovarian teratoma. We reconstructed the abdominal wall using an anterolateral thigh flap with vascularized fascia lata, including the perifascial areolar tissue. The defect was reinforced with a well-vascularized flap sutured in an inlay manner, partially in 2 layers. The patient conceived naturally after reconstruction. The reconstructed abdominal wall remained strong and flexible, accommodating expansion of the abdominal circumference during pregnancy without herniation. We reincised the reconstructed abdominal wall during cesarean section and found no adhesions to the surrounding tissues. Therefore, an anterolateral thigh flap with vascularized fascia lata and perifascial areolar tissue may represent a promising option for abdominal wall reconstruction in young women with childbearing potential.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8148"},"PeriodicalIF":1.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sajni Parikh, Wayne Bauerle, Olivia Hoy, Lisa Jacob, Christopher Sanders
{"title":"Repurposing the Pedicled Posterior Arm Flap for Autologous Breast Reconstruction.","authors":"Sajni Parikh, Wayne Bauerle, Olivia Hoy, Lisa Jacob, Christopher Sanders","doi":"10.1097/GOX.0000000000008173","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008173","url":null,"abstract":"<p><p>The posterior arm flap (PAF) is a fasciocutaneous flap that has been used in axillary reconstruction; however, there is a paucity of literature to support its use in postmastectomy reconstruction in patients who no longer have more traditional autologous breast reconstruction options available. Herein, we present an alternative approach for autologous breast reconstruction using a modified pedicled PAF. Our patient presented to the clinic requesting implant removal and autologous reconstruction due to persistent pain and discomfort. Her history of a right-sided transverse rectus abdominis myocutaneous flap, extended axillary scar violating latissimus dorsi muscle, and liposuction to bilateral thighs precluded use of the deep inferior epigastric perforator, latissimus dorsi, or profunda artery perforator flaps. She was noted to have excess tissue in the upper extremities and, thus, the decision was made to perform a pedicled PAF for reconstruction. An adipocutaneous flap was raised from the bilateral posteromedial arms based on perforators from the brachial artery. The implant and capsule were excised using the previous mastectomy incisions. The PAF was tunneled through the axilla and inset to fill the breast mound. The patient tolerated the procedure well and was discharged home on postoperative day three. At her 1-year follow-up, the patient remains pleased with her results and has had no postoperative complications. The PAF is a viable option in patients who desire small-to-moderate sized breasts and in those unable to undergo prolonged free flap reconstruction due to comorbidities or inadequate donor sites.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8173"},"PeriodicalIF":1.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noam Yanay, Eduardo Williams-Medina, Diwakar Phuyal, Eve Michel-Gabriel, Mihnea Stanciulescu, Ahmad Matalkah, Mario Cherubino, Sarah N Bishop, Raffi Gurunian
{"title":"Robot-assisted Deep Inferior Epigastric Perforator Flap Breast Reconstruction: First Reported Case in the Middle East Gulf Region.","authors":"Noam Yanay, Eduardo Williams-Medina, Diwakar Phuyal, Eve Michel-Gabriel, Mihnea Stanciulescu, Ahmad Matalkah, Mario Cherubino, Sarah N Bishop, Raffi Gurunian","doi":"10.1097/GOX.0000000000008153","DOIUrl":"https://doi.org/10.1097/GOX.0000000000008153","url":null,"abstract":"<p><p>Despite encouraging early outcomes, robot-assisted deep inferior epigastric perforator (DIEP) reconstruction has yet to be widely adopted because of its technical complexity, cost considerations, and limited institutional experience. We report the first robot-assisted DIEP flap breast reconstruction performed in the Middle East Gulf region. A 53-year-old woman with a history of breast cancer, prior irradiation, implant-based reconstruction, and severe capsular contracture underwent robot-assisted DIEP flap reconstruction using a transabdominal preperitoneal approach. Preoperative computed tomography angiography demonstrated a short intramuscular perforator course and nontortuous pedicle anatomy. Robotic pedicle harvest was completed through a 2-cm fascial incision and three 8-mm robotic ports, with a console time of 77 minutes. The flap was successfully transferred without intraoperative complications. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 3. At 5-month follow-up, there was no evidence of flap compromise, abdominal bulge, or hernia. This case demonstrates the technical feasibility of robot-assisted DIEP flap reconstruction in a carefully selected patient and highlights the successful implementation of robotic microsurgical breast reconstruction within a developing regional program. As the first reported robot-assisted DIEP flap reconstruction in the Middle East Gulf region, this report contributes to the growing but still limited global experience with robotic autologous breast reconstruction.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"14 10","pages":"e8153"},"PeriodicalIF":1.9,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}