{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T23:13:26Z","timestamp":1778022806878,"version":"3.51.4"},"reference-count":12,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Intraoperative microvascular complications in autologous breast reconstruction may increase the risk of immediate postoperative flap complications, such as congestion, thrombosis, and flap loss. The impact of specific intraoperative complications on patient outcomes remains unclear.<\/jats:p>\n                  <jats:p>A retrospective chart review of microsurgical breast reconstruction cases from 2017 to 2023 was performed to determine intraoperative and postoperative complications, as well as patient outcomes. Statistical analysis was conducted to determine associations between intraoperative complications and outcomes.<\/jats:p>\n                  <jats:p>A total of 1,005 flaps were performed in 620 patients, with intraoperative complications experienced in 15.1% (152\/1,005) flaps. Pedicle\/perforator injury was the most common (5.3%). Difficult flap pedicle dissection was a predictor of the need for a blood transfusion (17.7% vs. 8.3%, OR: 2.4 [95% CI: 1.1\u20135.0], p\u2009=\u20090.04). Hematoma was not associated with any intraoperative complications. In comparison, postoperative flap ischemia was associated only with intraoperative arterial thrombosis (8.3% vs. 0.7%, OR: 2.8 [95% CI: 1.5\u2013113.0], p\u2009=\u20090.003). Postoperative flap congestion was associated with both intraoperative complications of alternate venous outflow (40% vs. 1.9%, OR: 34.4 [95% CI: 5.4\u2013218], p\u2009=\u20090.004) and pedicle\/perforator injury (10.5% vs. 1.9%, OR: 6.0 [95% CI: 1.3\u201327.7], p\u2009=\u20090.01). Prolonged length of stay greater than the expected 3 days was associated with difficult flap pedicle vessel dissection (52.9% vs. 31.5%, OR: 2.4 [95% CI: 1.4\u20134.3], p\u2009=\u20090.001) and intraoperative arterial thrombosis (63.6% vs. 32.3%, OR: 3.7 [95% CI: 1.1\u201312.7], p\u2009=\u20090.04). Length of stay greater than 4 days was solely associated with intraoperative thrombosis (36.4% vs. 9.9%, OR: 5.4 [1.6\u201318.7], p\u2009=\u20090.019). The intraoperative complications of venous anastomosis revision and difficult internal mammary vessel dissection had no significant association with the postoperative course.<\/jats:p>\n                  <jats:p>Specific intraoperative complications are associated with higher rates of postoperative complications. Awareness of the tendency for a complex postoperative recovery is warranted.<\/jats:p>","DOI":"10.1055\/a-2858-3537","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T22:55:53Z","timestamp":1776812153000},"source":"Crossref","is-referenced-by-count":0,"title":["Predicting Postoperative Recovery Following Intraoperative Microvascular Complications in Autologous Breast Reconstruction"],"prefix":"10.1055","author":[{"given":"Kerilyn N.","family":"Godbe","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin E.","family":"Rauber","sequence":"additional","affiliation":[{"name":"School of Medicine, The University of Kansas School of Medicine, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niaman","family":"Nazir","sequence":"additional","affiliation":[{"name":"Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Farmer","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-2127","authenticated-orcid":false,"given":"Katie G.","family":"Egan","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Holding","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Butterworth","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kansas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"e4180","DOI":"10.1097\/GOX.0000000000004180","article-title":"Implant-based versus autologous reconstruction after mastectomy for breast cancer: a systematic review and meta-analysis","volume":"10","author":"J M Broyles","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1097\/SLA.0000000000002033","article-title":"Complications in postmastectomy breast reconstruction: one-year outcomes of the mastectomy reconstruction outcomes consortium (MROC) study","volume":"267","author":"E G Wilkins","year":"2018","journal-title":"Ann Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0042-1748978","article-title":"Quantifying complications: an analysis of operative time and intraoperative factors in microsurgical breast reconstruction","volume":"39","author":"K G Egan","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1097\/PRS.0b013e318218fc95","article-title":"Closer to an understanding of fate: the role of vascular complications in free flap breast reconstruction","volume":"128","author":"J Fosnot","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref5","first-page":"489","article-title":"Intraoperative complications as predictors of flap failure in autologous breast reconstruction","volume":"41","author":"K N Godbe","year":"2024","journal-title":"J Reconstr Microsurg"},{"issue":"07","key":"ref6","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1055\/s-0035-1554939","article-title":"The impact of intraoperative microvascular compromise on outcomes in microsurgical breast reconstruction","volume":"31","author":"A H Chao","year":"2015","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"566e","DOI":"10.1097\/PRS.0000000000010343","article-title":"Predictors of complications in autologous breast reconstruction using DIEP flaps: implications for management","volume":"152","author":"S S Wu","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1097\/PRS.0b013e318244222d","article-title":"Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction","volume":"129","author":"H Sbitany","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref9","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/j.bjps.2016.07.006","article-title":"Predictors and consequences of intraoperative microvascular problems in autologous breast reconstruction","volume":"69","author":"A C O'Neill","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1055\/a-2003-7890","article-title":"Predictors and consequences of intraoperative anastomotic failure in DIEP flaps","volume":"39","author":"J Chen","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"162e","DOI":"10.1097\/PRS.0000000000011951","article-title":"Moving towards the outpatient DIEP flap: factors influencing early discharge","volume":"156","author":"F D Graziano","year":"2024","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref12","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/j.spinee.2017.04.028","article-title":"Effect of liberal blood transfusion on clinical outcomes and cost in spine surgery patients","volume":"17","author":"T E Purvis","year":"2017","journal-title":"Spine J"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2858-3537.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T23:00:45Z","timestamp":1778022045000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2858-3537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":12,"URL":"https:\/\/doi.org\/10.1055\/a-2858-3537","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4,21]]},"published":{"date-parts":[[2026,4,21]]}}}