ReviewPlastic and reconstructive surgery. Global open2026
Mythbusters in Microsurgery: Evaluating Evidence and Debunking Dogma-A Practical Review: Part I.
Review in Plastic and reconstructive surgery. Global open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Reconstructive microsurgery has become a cornerstone in the management of complex tissue defects, yet many perioperative practices remain rooted in tradition rather than robust evidence. Persistent complications and variable protocols necessitate systematic evaluation of these dogmas to guide best practices. Methods: We conducted a comprehensive literature review of all major databases to identify all studies addressing techniques, perioperative care, monitoring, patient selection, and recovery in reconstructive microsurgery. Relevant studies were assessed and graded using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. When available, meta-analyses and updated systematic reviews were prioritized; individual studies within such analyses were not separately reported to avoid redundancy. Results: Eight commonly held perioperative myths were critically appraised. Evidence demonstrates that judicious intraoperative vasopressor use does not increase flap compromise or loss. Perioperative nonsteroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, do not raise the risk of hematoma or thrombosis. Routine therapeutic anticoagulation or dextran use provides no benefit in flap survival and increases bleeding risk. High-dose perioperative steroids are associated with greater flap and wound complications. Extended antibiotic prophylaxis beyond 24 hours postoperatively does not reduce surgical site infections. Negative-pressure wound therapy is safe for free flaps. Most vascular compromises occur within 48-72 hours, supporting step-down monitoring thereafter. Finally, advanced age, diabetes, obesity, or immunosuppression due to solid organ transplantation or other reasons should not preclude patients from getting microsurgical reconstruction. Conclusions: Many entrenched perioperative practices in microsurgery lack contemporary evidence. Evidence-based adoption of updated protocols can minimize complications, standardize care, and improve outcomes in reconstructive microsurgery.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.