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Risk of Radiation-Induced Capsular Contracture following Subpectoral or Prepectoral Implant-Based Breast Reconstruction.
[BACKGROUND] Radiation therapy (RT) significantly increases the risk of capsular contracture after implant-based breast reconstruction. However, the relationship between anatomic plane placement (eg, submuscular or prepectoral) and the deve…
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Latest Research in Microsurgery.
Microsurgery continues to evolve, integrating advanced imaging, robotic techniques, perfusion assessment, artificial intelligence, anastomotic devices, and enhanced recovery after surgery pathways. High-resolution ultrasound and augmented r…
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The Impact of BMI on Donor and Recipient Site Morbidity in Mandibular Reconstruction with Fibula Free Flap.
[BACKGROUND] Obesity is a known risk factor for surgical complications, but its impact on mandibular reconstruction with fibula free flap (FFF) remains unclear. This study examines the association between body mass index (BMI) and postopera…
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The Fibula Free Flap for Salvage of Complications After Orthopedic Extremity Bony Fixation in Oncologic Patients.
[BACKGROUND] Advances in orthopedic oncology have significantly improved outcomes following extremity tumor resections; however, complications like nonunion, hardware failure, and radiation-induced fractures can occur after orthopedic fixat…
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Management of the Condyle in Posterior Mandibular Reconstruction: Major Clinical and Patient-Reported Outcomes.
[BACKGROUND AND OBJECTIVES] Tumor involvement of the posterior mandible often requires resection of the mandibular condyle and associated soft tissue. This study explores clinical and patient-reported outcomes (PROs) associated with condyle…
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Preoperative Lower Back Pain is a Risk Factor for Worse Physical Well-Being of the Abdomen After Breast Reconstruction.
Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability and abdominal donor-s…
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Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy.
[BACKGROUND] Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported…
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Perioperative Venous Thromboembolism Chemoprophylaxis Does Not Increase Risk of Complications in Free Flap Breast Reconstruction.
[BACKGROUND] Patients undergoing abdominal-based free flap breast reconstruction are at risk for perioperative venous thromboembolism (VTE), but the optimal anticoagulation protocol remains unknown. We hypothesized that a standardized chemo…
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Evaluating the Accuracy of Relative Value Unit and Operative Time Changes in Breast Reconstruction.
[BACKGROUND] As part of the 2021 changes to breast reconstruction CPT codes, the Relative Value Scale Update Committee (RUC) recommended adjustments to work RVUs (wRVUs) based on newly surveyed intraoperative times. The authors' objective w…
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Moving Toward the Outpatient DIEP Flap: Factors Influencing Early Discharge.
[BACKGROUND] Enhanced recovery after surgery (ERAS) protocols can reduce the length of stay (LOS) for surgical patients, including those undergoing unilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, all…
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Complications and Hardware Failure Following Synthetic Cranioplasty Implants and Free Flap Coverage.
Composite defects of the scalp and calvarium are complex reconstructive problems. Bony reconstruction is often achieved with synthetic implants, demanding robust soft tissue coverage. In cases where the native scalp has been compromised, fr…
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Reconstructing Segmental Mandibular Defects: A Single-Center, 21-Year Experience with 413 Fibula Free Flaps.
[BACKGROUND] The fibula free flap (FFF) is a common choice for mandibular reconstruction after post-oncologic resection. Advances in technology and surgical technique have changed the workflow of FFF-based mandible reconstruction. This stud…
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Optimizing venous thromboembolism chemoprophylaxis in abdominal-based breast reconstruction: a narrative review of evidence and practice.
[BACKGROUND AND OBJECTIVE] Venous thromboembolism (VTE) remains a leading cause of preventable morbidity and mortality in surgical patients, with individuals undergoing abdominal-based free flap breast reconstruction representing a particul…
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The Co-Surgeon Model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.
Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate t…
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Textured versus Smooth Tissue Expanders: A Comparison of Complications in 3526 Breast Reconstructions.
[BACKGROUND] Increased understanding of breast implant-associated anaplastic large-cell lymphoma has led to a shift away from textured breast devices. A few small studies have compared the complication rates of textured and smooth tissue ex…
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Surgical Management of Textured Breast Implants: Assessing Risk and Analyzing Patient-Reported Outcomes.
[BACKGROUND] Textured implants have been linked to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Patients who undergo explantation have options for reconstruction, but data on safety and patient-reported outcomes (PRO…
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Early Complications in Prepectoral Breast Reconstructions with and without Acellular Dermal Matrix: A Preliminary Analysis of Outcomes.
[BACKGROUND] Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other ear…
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A preliminary analysis of patient reported outcomes following posterolateral mandible reconstruction: The role of flap type.
[BACKGROUND] The choice of tissue type for free flap reconstruction of posterolateral mandible resections is dependent on patient and defect characteristics. We compared clinical and patient-reported outcomes following reconstruction of the…
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Clinical, functional, and patient-reported outcomes of radial forearm versus anterolateral thigh free tissue transfer for reconstruction of glossectomy defects.
[BACKGROUND] There is a lack of literature of health-related quality of life endpoints for radial forearm (RF) versus anterolateral thigh (ALT) free flap reconstruction for glossectomy defects. Our goal was to perform a comprehensive evalua…
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Free Flap Reconstruction in the Era of Commercial Price Transparency: What Are We Paying For?
[BACKGROUND] Commercial rates for free flap reconstruction were not known publicly before the 2021 Hospital Price Transparency Final Rule. The purpose of this study was to examine commercial facility payments to characterize nationwide vari…
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Analysis of the microsurgery fellowship match: 2019-2022 update.
[BACKGROUND] A recent analysis of microsurgery fellowship match data published in 2019 demonstrated increased competition for available positions. With growing opportunities in the field, the authors hypothesize that the landscape for both …
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Quality of Life Outcomes after Free Fibula Flap Reconstruction of Mandibular Defects: A Longitudinal Examination.
[BACKGROUND] A comprehensive understanding of changes in health-related quality of life after head and neck cancer surgery is necessary for effective preoperative counseling. The goal of this study was to perform a longitudinal analysis of…
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Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus.
[BACKGROUND] Surgical treatment of lymphedema has outpaced coding paradigms. In the setting of ambiguity regarding coding for physiologic procedures [lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT)], we hypothesized …
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Top 25 Medications the Plastic and Reconstructive Surgery Trainee Should Know for an Emergency Medicine Department Consult.
Plastic surgery trainees are often called to render care in the emergency department (eg, for established patients, trauma, burns). Broad-based knowledge in pharmacotherapeutics during these encounters is critical. This includes an understa…
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Air versus Saline in Initial Prepectoral Tissue Expansion: A Comparison of Complications and Perioperative Patient-Reported Outcomes.
[BACKGROUND] One option to optimize prepectoral tissue expander fill volume while minimizing stress on mastectomy skin flaps is to use air as an initial fill medium, with subsequent exchange to saline during postoperative expansion. The aut…
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Textbook outcomes in DIEP flap breast reconstruction: a Delphi study to establish consensus.
[PURPOSE] Composite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and quality of care. This study utilized a Delphi process to define a textbook outcome in DIEP flap breast recon…
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Modern Approaches to Alternative Flap-Based Breast Reconstruction: Profunda Artery Perforator Flap.
Autologous free flap breast reconstruction allows for natural-appearing breasts, while avoiding the risks associated with implants, including exposure, rupture, and capsular contracture. However, this is offset by a much higher technical ch…
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Outcomes and Perioperative Risk Factors after Oncologic Free-Flap Scalp Reconstruction.
[BACKGROUND] Little is known about the risk factors associated with complications after free flap scalp reconstruction. The purpose of this study was to identify patient, scalp defect, and flap characteristics associated with increased ris…
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The contribution of microvascular free flaps and pedicled flaps to successful chest wall surgery.
[OBJECTIVE] Pedicled flaps (PFs) have historically served as the preferred option for reconstruction of large chest wall defects. More recently, the indications for microvascular-free flaps (MVFFs) have increased, particularly for defects i…
- Superselective Free Flap Artery Branch Embolization of an Uncontrolled Postoperative Hemorrhage.