ReviewPlastic and reconstructive surgery. Global open2026
Mythbusters in Microsurgery: Evaluating Evidence and Debunking Dogma-A Practical Review: Part II.
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
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The first part of this 2-part practical review critically appraised 8 common perioperative practices in reconstructive microsurgery, revealing that several were unsupported by evidence. This second part evaluated the remaining 9 frequently cited dogmas in microsurgical reconstruction. Methods: A comprehensive review of all major databases was performed to identify studies addressing vein grafts, number and sequence of anastomoses, vasodilator selection, flap choice for osteomyelitis, vessel selection in trauma, caffeine use, postoperative mobilization, and showering with drains after surgery. Evidence was synthesized and graded using the GRADE system. Results: Vein-grafted free flaps demonstrated modestly higher failure rates, but overall high success, particularly when used in complex cases. Dual venous anastomoses provided benefit in high-risk or large flaps, whereas a single vein is sufficient in most limb reconstructions. No clear superiority exists for artery- versus vein-first anastomosis; both are effective if performed correctly. Papaverine is not indispensable, as other agents achieve comparable vasodilation. Muscle flaps are not inherently superior to fasciocutaneous flaps for osteomyelitis. Avoiding "zone of injury" vessels is unnecessary if intraoperative assessment shows good quality, and the use of tranexamic acid is safe as an adjunct to reduce bleeding. Moderate caffeine intake does not compromise flap outcomes, and early mobilization (including discharge) does not increase complications and supports enhanced recovery. Showering under running water 48 hours or more after surgery, with/without drains, does not increase the risk of surgical site infection. Conclusions: Several dogmas in reconstructive microsurgery lack robust evidence. Adoption of flexible, evidence-based strategies can improve patient outcomes and streamline perioperative protocols.
Identifiers
What OpenQuestion holds
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.