Background: Reconstruction of wound defects with associated dead space requires adequate obliteration using well-vascularized tissue to reduce fluid accumulation and support infection control. Conventional musculocutaneous flaps are commonly used for this purpose, but may have limited flexibility in positioning the muscle component. This study evaluated the clinical utility of a chimeric pattern anterolateral thigh (ALT) flap with independently mobile skin and muscle components. Patients and Methods: Between May 2016 and January 2024, 49 patients underwent reconstruction of wound defects with dead space using free or pedicled ALT flaps. Of these, 26 cases were reconstructed with the conventional musculocutaneous flap, employing the classic en bloc technique. The remaining 23 cases utilized a chimeric pattern perforator flap, consisting of separate skin and muscle components. The skin flap served to resurface the skin defect, while the independently mobile muscle flap was tailored to fill the dead space. Results: Postoperative infection occurred in 3 of 26 patients in the conventional flap group and in none of the chimeric flap group, although the difference was not statistically significant. Both techniques achieved stable wound coverage. The chimeric flap allowed independent positioning of the muscle component according to the location and configuration of the dead space. Conclusion: The chimeric pattern ALT flap offers greater technical flexibility by allowing independent positioning of the skin and muscle components. This technique may facilitate reconstruction of wound defects with eccentrically located or deep dead spaces. Despite the limitations of this study, these findings suggest a potential technical advantage rather than superiority over conventional musculocutaneous ALT flaps.
Background: Postoperative monitoring of free vascularized flaps (FVFs) is critical for early detection of ischemia and timely salvage. Although traditional monitoring relies heavily on clinical examination and adjunctive devices, these approaches are labor‑intensive, subjective, and resource‑dependent. Recent advances in artificial intelligence (AI), particularly machine learning and deep learning, have enabled automated, data‑driven approaches to postoperative free‑flap monitoring. However, the clinical readiness, methodological robustness, and translational challenges of these AI‑based systems remain incompletely understood. Objective: This review examines recent studies on AI‑assisted postoperative free‑flap monitoring, focusing on technical methodologies, clinical applications, translational relevance, current limitations, and future research directions. Methods: A systematic-narrative hybrid review was conducted by searching PubMed, Embase, Web of Science, and Google Scholar from January 2000 to February 2, 2026. Eligible studies reported clinically relevant outcomes, including flap viability, ischemia detection, venous congestion, thrombosis prevention, and salvage rates. Studies focused on preoperative prediction models, non‑AI monitoring techniques, editorials, and opinion articles were excluded. Two independent reviewers performed study selection and data extraction, with disagreements resolved by consensus. Results: Nine studies met the inclusion criteria. Most studies used supervised machine‑learning models, primarily using visible‑light images, infrared imaging, photoplethysmography, hyperspectral imaging, or multimodal sensor data for flap surveillance. All but 1 study were retrospective, and no prospective human clinical trials were identified. AI‑based systems demonstrated promising performance in detecting arterial ischemia and venous congestion, often achieving diagnostic accuracies comparable to or exceeding those of traditional monitoring methods. Diagnostic accuracy across studies ranged from 82% to 98.4%. Key challenges included limited data sets, lack of external validation, heterogeneous methodologies, absence of standardized outcome metrics, and concerns about generalizability across diverse skin tones and clinical settings. Conclusions: AI‑assisted postoperative free‑flap monitoring is a rapidly evolving and promising adjunct to conventional surveillance. Although current evidence suggests benefits for early ischemia detection and workload reduction, significant barriers—particularly methodological heterogeneity, data scarcity, and limited prospective validation—must be addressed before widespread clinical implementation. Future progress will depend on standardized data sets, transparent model development, multicenter prospective studies, and ethically sound, interoperable AI frameworks that enable equitable and scalable precision microsurgical care.
Background: Accurate distinction between viable and necrotic tissue is essential during wound debridement, but visual assessment may be affected by blood coverage, uneven illumination, blurred tissue transitions, and instrument occlusion. This study developed and evaluated a deep learning-assisted image segmentation method for wound tissue assessment. Methods: A retrospective data set of clinical wound debridement images was annotated at the pixel level as background, viable or preservable tissue, and necrotic or nonviable tissue. Tissue-aware copy-paste augmentation was used to improve necrotic tissue representation. A SegFormer-based semantic segmentation model with boundary-aware output was trained and evaluated using pixel accuracy, intersection over union (IoU), Dice coefficient, precision, recall, and boundary F1 score. Results: The augmented data set contained 356 image-mask pairs, including 156 original and 200 synthesized pairs. Training, validation, and test sets included 249, 53, and 54 samples, respectively. On the test set, pixel accuracy was 98.01%. For viable and necrotic tissue, mean IoU and mean Dice were 85.97% and 92.45%, respectively. Dice scores were 92.24% for viable tissue and 92.67% for necrotic tissue. Necrotic tissue recall was 94.09%, and mean boundary F1 was 61.83%. Conclusions: The proposed method showed strong region-level agreement with expert annotations and high sensitivity for necrotic tissue. Color-coded prediction maps and overlay visualizations may support wound tissue assessment, although exact boundary localization remained less accurate. Larger independent clinical data sets are needed for further validation.
Background: Randomized controlled trials are the gold standard for investigating the safety and efficacy of a new intervention. In particular, clinical trials in aesthetic and reconstructive breast surgery are critical for the advancement of treatment modalities and device development. This study evaluates the factors associated with early discontinuation of breast reconstruction and aesthetic breast surgery-related studies. Methods: A cross-sectional analysis of all breast surgery-related clinical trials on the ClinicalTrials.gov registry was performed. Trials were categorized as aesthetic, reconstructive, or both. Clinical trials related to breast cancer surgery only, without reconstruction, were excluded. Trials listed as “suspended,” “terminated,” or “withdrawn” were defined as discontinued trials. Trials were then further subdivided into 7 study topics, which included: (1) anesthesia/pain management, (2) infection control/wound healing, (3) breast implant/tissue expanders, (4) general breast reconstruction, (5) fat grafting, (6) microsurgery, and (7) patient/surgical education. Additional factors examined included intervention type, funding source, enrollment size, subject gender, subject age, trial start date, and location. Results: A total of 3658 clinical trials were identified with start dates between January 1994 and July 2024. Of these, 565 trials were included in the final analysis. Seventy-eight percent of studies were reconstructive, 8% were aesthetic, and 14% were both. A total of 76 trials were prematurely discontinued, most commonly secondary to low patient accrual (24%), institutional/principal investigator decision (17%), and inadequate staffing (12%). Thirty-nine percent of discontinued trials were device-related, followed by drug/pharmaceutical (33%) and surgical technique (21%). Study category, topic, and study location were not associated with early discontinuation. Observational studies had a significantly lower likelihood of early discontinuation compared with randomized controlled trials [OR=0.23 (0.10-0.48), P <0.001]. Industry-funded studies had a higher likelihood of early discontinuation compared with nonindustry funded studies [OR=2.07 (1.17-3.59), P <0.001]. Conclusion: Successful completion of clinical trials in aesthetic and reconstructive breast surgery is essential for improving patient outcomes. Our study demonstrates that 13.5% of clinical trials did not reach fruition, largely secondary to poor patient recruitment and staffing issues. Targeted efforts to help support trial completion are necessary to help improve evidence-based practice within breast surgery.
Objective: Short-term surgical missions (STMs) have been used by various organizations to address gaps in the surgical workforce in low- and middle-income countries (LMICs). However, the literature is inadequate in documenting host communities' perceptions of STMs. We aimed to understand surgeons' perceptions in Vietnam as a proxy for LMICs’ experiences working with international STM volunteers. Methods: An anonymous online survey questionnaire was administered to attendees at the Vietnamese Society of Aesthetic Plastic Surgery’s annual conference in Hanoi, Vietnam, in April 2025. Questions focused on attendees’ previous experience and perspectives working with international doctors or medical workers. Results: Four hundred three out of 807 conference surgeon attendees completed the survey in its entirety, yielding a response rate of 49.9%. Most responses were positive, with reports that international volunteers provided training beneficial to their own clinical practice and institutions. In addition, most respondents believed that international surgeons were knowledgeable, professional, and culturally competent, and that they made patients feel comfortable. Reported perceived values of the international medical workers included improving staff knowledge and skills and improving the quality of patient care. Concerns reported included volunteer length of stay, lack of patient follow-up, cultural and language barriers, lack of volunteer awareness of available resources or the institution’s needs, and lack of necessary clinical skills among volunteers. Conclusions: Overall, hosts perceive STMs as positive experiences that benefit their clinical practice and their institution. However, the concerns survey respondents raised highlight the need for STMs to prioritize collaboration with the host community to prepare STM volunteers culturally, alignment of goals and expectations with host community needs, orientation of volunteers to the available local resources, plans for follow-up care and complication management, and improvement of the experience of hosts and volunteers. In addition, continued efforts to elicit and incorporate the perspectives and experiences of LMIC host communities and to implement changes to STM programs are essential to maximize the benefits of STMs for host communities.
