Journal of Reconstructive Microsurgery

BACKGROUND:  Lower extremity trauma often necessitates reconstruction with flap transfer. One of the reconstructive goals is a thin soft tissue coverage with appropriate contour. Therefore, a secondary debulking of the flap is usually performed. METHODS:  Debulking through conventional lipectomy is compared with liposuction followed by excision of the defatted flap excess. Demographic data, surgical details, and postoperative outcomes are compared and analyzed...

INTRODUCTION:  The use of perforator flaps has become more popular with improvement of surgical technique, technology, as well as understanding of microvascular anatomy. The selection of well-perfused angiosomes is critical to the successful outcome of patients undergoing free tissue transfer. The number of perforators that are needed is dependent upon the surface area of the flap being harvested; however, there have been no studies to assess the optimal surface area supplied by each perforator...

BACKGROUND: There has been a greater focus in recent literature proposing air to be a superior medium to saline in tissue expanders. This study aims to review the literature and assess the quality of data on the efficacy and safety of air as an alternative medium to saline in tissue expanders, in the setting of post-mastectomy two-stage reconstruction. METHODS: A systematic review regarding air inflation of tissue expanders were conducted using PubMed, Embase, Cochrane Library, and Web of Science...

BACKGROUND: With greater acceptance of post-mastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing...

BACKGROUND:  Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery. METHODS:  Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats...

BACKGROUND: This study aimed to quantify the blood flow of free flaps and compare the blood flow of small-vessel (<0.8 mm) and larger-vessel (>0.8 mm) anastomosed free flaps. METHODS: A retrospective study included the patients treated with a perforator free flap which was successful in the lower extremity were included between June 2015 and March 2017. A color duplex ultrasound system measured flow volume through the pedicle by analyzing the mean flow peak velocity, flow volume, and flow volume per 100g of the flap...

BACKGROUND: The most common method for autologous breast reconstruction is the deep inferior epigastric perforator (DIEP) flap. The umbilicus can be managed in various ways, including re-inset, neo-umbilicus, and umbilectomy without reconstruction. This study evaluated the aesthetic differences in umbilicus reconstruction choice and variation in patients' post-operative satisfaction with their abdomen. METHODS: A retrospective review of 1019 patients treated with DIEP flap breast reconstruction between August 2009 and January 2022 was conducted...

BACKGROUND:  Recent advancements in supermicrosurgery and promising preliminary outcomes have led to a surge in physiologic lymphedema surgery. This study is the first to evaluate lymphedema surgical education among U.S. plastic surgery residency programs, along with the background and experience of plastic surgeons subspecializing in the field. METHODS:  Cross-sectional evaluation of 103 accredited U.S. plastic surgery residency programs was performed in January 2023...

BACKGROUND: Augmented reality (AR) and virtual reality (VR)-termed mixed reality-has shown promise in the care of operative patients. Currently, AR and VR has well-known applications for craniofacial surgery, specifically in preoperative planning. However, the application of AR/VR technology to other reconstructive challenges has not been widely adopted. Thus, the purpose of this investigation is to outline the current applications of AR and VR in the operative setting. METHODS: Literature pertaining to the use of AR/VR technology in the operative setting was examined...

BACKGROUND: Abdominal wall morbidity occurs with increased frequency following flap harvest in the obese abdomen. Its impact on patient-reported outcomes in breast reconstruction has been poorly characterized. METHODS: A retrospective review of obese patients undergoing abdominal-based free autologous breast reconstruction (ABFABR) was conducted over fifteen years. Patient and operative characteristics were recorded and outcomes analyzed. Patient-reported outcomes (PRO) were assessed using the BREAST-Q™ abdominal survey...

BACKGROUND: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. METHODS: Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory...

BACKGROUND: Within the last 20-years, Medicare reimbursements for microsurgery have been declining, while physician expenses continue to increase. As a result, hospitals may increase charges to offset revenue losses, which may impose a financial barrier to care. This study aimed to characterize the billing trends in microsurgery and their implications on patient care. METHODS: The 2013-2020 Provider Utilization and Payment Data Physician and Other Practitioners Dataset was queried for 16 CPT codes...

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BACKGROUND: Breast cancer-related lymphedema is the most common cause of lymphedema in the United States and occurs in up to 50% of individuals receiving axillary lymph node dissection (ALND). Lymphovenous bypass (LVB) at the time of ALND may prevent lymphedema, but long-term results and anastomotic patency are unclear. This study evaluates the feasibility and outcomes of performing immediate lymphatic reconstruction via coupler-assisted bypass (CAB). METHODS: This is a retrospective review of all patients undergoing prophylactic LVB following ALND at two tertiary care centers between 2018-2022...

BACKGROUND: Cryoanalgesia is a tool being used by interventional radiology to treat chronic pain. Within a certain cold temperature range, peripheral nerve function is interrupted, and recovers, without neuroma formation. Cryoanalgesia has most often been applied to the intercostal nerve. Cryoanalgesia has applications to peripheral nerve surgery, yet is poorly understood by reconstructive microsurgeons. METHODS: Histopathology of nerve injury was reviewed to understand cold applied to peripheral nerve...

BACKGROUND: Gender bias in graduate medical evaluations remains a challenging issue. This study evaluates implicit gender bias in video-based evaluations of microsurgical technique, which has not previously been described in the literature. METHODS: Two videos were recorded of microsurgical anastomosis; the first was performed by a hand/microsurgery fellow and the second by an expert microsurgeon. 150 surgeons with microsurgical experience were recruited to evaluate the videos; they were told these videos depicted a surgical trainee 1-month into fellowship followed by the same trainee 10 months later...

BACKGROUND: The ideal time to perform reconstruction after the completion of post-mastectomy radiation therapy (PMRT) in patients with locally advanced breast cancer is currently unknown. We evaluate the association between the timing of delayed autologous breast reconstruction following PMRT and postoperative complications. METHODS: Patients who underwent mastectomy, PMRT, and then delayed autologous breast reconstruction from 2009-2016 were identified from the Truven Health MarketScan Research Databases...

BACKGROUND: Patients with complex lower extremity (LE) wounds and single-vessel LE runoff (1-VRO) are often considered for amputation. While more challenging, free tissue transfer (FTT) is a means for limb salvage. This study aims to demonstrate the feasibility of limb salvage with FTT in patients with 1-VRO. METHODS: Patients undergoing FTT by a single surgeon between 2011 and 2021 were retrospectively reviewed. Data collected included demographics, wound characteristics, vascular status, and operative details...

BACKGROUND: Prophylactic lymphatic bypass or LYMPHA (Lymphatic Microsurgical Preventive Healing Approach) is increasingly offered to prevent lymphedema following breast cancer treatment, which develops in up to 47% of patients. Previous studies focused on intraoperative and postoperative lymphedema risk factors, which are often unknown preoperatively when the decision to perform LYMPHA is made. This study aims to identify preoperative lymphedema risk factors in the high-risk inflammatory breast cancer (IBC) population...

BACKGROUND: Autologous tissue has become the gold standard in breast reconstruction. The use of a DIEP flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared to the transverse rectus abdominis myocutaneous (TRAM) flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival...