{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:43Z","timestamp":1790585923068,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Timely re\u2010exploration is critical when free flaps show vascular compromise. However, the relative contribution of modifiable pre\u2010incision delays after surgery registration and opportunities to shorten time to re\u2010exploration within the recognition\u2010to\u2010incision pathway after flap ischaemia recognition remain uncertain. This study aimed to evaluate whether pre\u2010incision delays are associated with free\u2010flap salvage failure and to identify potential workflow targets for quality improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective, single\u2010center analysis of 113 free\u2010flap revision surgeries performed over the past 6\u2009years. Time from registration to incision was partitioned into arrival latency (ward to operating room (OR)), anesthesia lead time, operating\u2010room preparation, and surgery lead time. Operative duration was assessed separately. The primary outcome was salvage versus failure (total loss).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Total flap loss occurred in 14.2% of re\u2010explorations. Median registration\u2010to\u2010incision time was similar between salvage and failure (78\u2009min vs. 77\u2009min, \u00b130\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.89). Arrival latency (19\u2009min vs. 20\u2009min, \u00b117\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.89), operating\u2010room preparation (25\u2009min vs. 22\u2009min, \u00b112\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.66) and door to incision (52\u2009min vs. 53\u2009min, \u00b123.5 min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.5) showed no difference. Failures trended toward longer anesthesia lead time (28 vs. 38\u2009min, \u00b116.7\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.48) and operative duration (83 vs. 109\u2009min, \u00b175\u2009min,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12). Night\u2010time operations were not associated with failure, but weekend cases showed a higher proportion of failure (25% vs. 12%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06, trend only).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort, pre\u2010incision delays (arrival and OR preparation (prep)) were not associated with failure. Signals instead pointed toward patient and anesthetic complexity and technically challenging salvage procedures. Thus, quality improvement attempts should prioritize rapid recognition\/decision pathways and anesthesia\u2010surgery coordination rather than focusing solely on logistics between ward and incision.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70292","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T11:21:38Z","timestamp":1789125698000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pre\u2010Incision Time Intervals and Outcomes of Free Flap re\u2010Exploration: A Retrospective Single\u2010Center Study"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1356-6433","authenticated-orcid":false,"given":"Alexander","family":"Fiedler","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0073-3411","authenticated-orcid":false,"given":"Nesrin","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4977-2398","authenticated-orcid":false,"given":"Maria","family":"F\u00fcth","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7582-7488","authenticated-orcid":false,"given":"Tatjana Katharina","family":"Fricke","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3841-9067","authenticated-orcid":false,"given":"Sonja Verena","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2265-725X","authenticated-orcid":false,"given":"Felix","family":"Reinkemeier","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3599-9243","authenticated-orcid":false,"given":"Flemming","family":"Puscz","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Ruhr University Bochum, BG University Hospital Bergmannsheil  Bochum 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