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

Area of Science:

• Reconstructive Microsurgery
• Perioperative Care
• Evidence-Based Medicine

Background:

• This is the second part of a review evaluating 9 frequently cited dogmas in reconstructive microsurgery.
• The first part appraised 8 perioperative practices, finding limited evidence for several.

Purpose of the Study:

• To critically evaluate the evidence supporting common dogmas in reconstructive microsurgery.
• To identify areas where practice may not align with current scientific evidence.

Main Methods:

• A comprehensive literature review of major databases was conducted.
• Studies on vein grafts, anastomoses, vasodilators, flap choice, vessel selection, caffeine, mobilization, and showering were analyzed.
• Evidence was synthesized and graded using the GRADE system.

Main Results:

• Vein-grafted free flaps show high success, especially in complex cases.
• Dual venous anastomoses benefit high-risk flaps; single veins suffice for most limb reconstructions.
• No superiority of artery-first vs. vein-first anastomosis; papaverine is not essential; muscle flaps are not superior for osteomyelitis; "zone of injury" vessel avoidance is unnecessary; tranexamic acid is safe.
• Moderate caffeine intake and early mobilization do not harm flap outcomes or increase complications.
• Showering after 48 hours post-surgery, with or without drains, does not increase surgical site infection risk.

Conclusions:

• Many commonly held beliefs in reconstructive microsurgery lack strong evidence.
• Implementing flexible, evidence-based strategies can enhance patient outcomes and optimize perioperative protocols.