Mythbusters in Microsurgery: Evaluating Evidence and Debunking Dogma-A Practical Review: Part I.

Area of Science:

• Microsurgery
• Evidence-based medicine
• Surgical outcomes

Background:

• Reconstructive microsurgery is vital for complex defects.
• Many perioperative practices lack robust evidence.
• Complications and variable protocols necessitate re-evaluation.

Purpose of the Study:

• Critically appraise common perioperative myths in reconstructive microsurgery.
• Identify evidence-based practices to improve patient outcomes.
• Guide best practices in microsurgical care.

Main Methods:

• Comprehensive literature review of major databases.
• Studies assessed and graded using the GRADE system.
• Prioritized meta-analyses and systematic reviews.

Main Results:

• Intraoperative vasopressor use is safe.
• NSAIDs do not increase hematoma or thrombosis risk.
• Routine anticoagulation/dextran offers no benefit and increases bleeding.
• High-dose steroids increase complications.
• Extended antibiotics beyond 24 hours do not reduce infections.
• Negative-pressure wound therapy is safe for free flaps.
• Vascular compromises typically occur within 48-72 hours.
• Advanced age and comorbidities do not preclude reconstruction.

Conclusions:

• Many perioperative microsurgery practices lack current evidence.
• Adopting updated, evidence-based protocols minimizes complications.
• Standardizing care improves reconstructive microsurgery outcomes.