Plastic Surgery Weekly

Intraoperative vasopressors during free flap reconstruction carry a modest penalty rather than a catastrophic one: a multicentre propensity-matched analysis in Microsurgery reports infection at RR 1.10 (95% CI 1.05–1.15) and dehiscence at RR 1.09, no consistent increase in flap failure or reoperation, and phenylephrine as the one agent with a broad adverse signal, including anastomotic revision at RR 1.29. The largest effect of the week comes from nerve surgery: in J Plast Reconstr Aesthet Surg, medial triceps motor branch transfer to the anterior division of the axillary nerve achieved BMRC M3 or better in 86.2% of patients versus 50.7% after interposition grafting (RR 1.70; risk difference +35.5%), with M4 in 70.1% of transfers against 6.0% after grafts. Two comparisons return null results. An Ann Surg randomised trial found negative pressure therapy after major lower extremity amputation did not significantly reduce 30-day wound complications, 19.4% versus 24% (RR 0.80, P=0.339), with benefit confined to post hoc subgroups such as patients without diabetes (9.8% versus 27.6%). Radiotherapy history made no difference to corrective surgery after DIEP reconstruction, 2.83 versus 2.84 procedures per flap. Pooled data in Aesthet Surg J set fat grafting for breast augmentation at 25.9% complications, 61.3% retention at twelve months and 93.1% satisfaction.