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Published on: December 5, 2025
Evolution of Reconstructive Microsurgery: 5,113 Free Flaps, One Surgeon, Four Decades.
Steven J Lo1,2, Fu Chan Wei3,4
1Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom.
Plastic and Reconstructive Surgery
|May 19, 2026
Summary
Microsurgical techniques evolve with innovations like the anterolateral thigh (ALT) flap and external factors such as legislation. These changes impact reconstructive surgery trends and planning.
Area of Science:
- Microsurgery
- Reconstructive Surgery
- Surgical Innovation
Background:
- Analysis of 5,113 free flaps performed between 1981 and 2023.
- Focus on reconstructive surgery trends and influencing factors.
Purpose of the Study:
- To analyze time-trends in free flap usage.
- To understand the impact of innovations and external forces on microsurgical practice.
Main Methods:
- Utilized time-trend analysis with segmented regression and joinpoint modeling.
- Examined data from a single surgeon at Chang Gung Memorial Hospital.
Main Results:
- Anterolateral thigh (ALT) flap introduction led to rapid growth and substitution of other flaps.
- Fibula flap usage showed slower growth, later repurposed for mandible reconstruction, correlating with oral cancer incidence.
- Toe transfers declined significantly following national safety legislation.
Conclusions:
- Microsurgical practice is shaped by technical advancements and external factors like health policy.
- Innovations and legislation differentially impact reconstructive surgery trends.
- Long-range surgical planning requires consideration of epidemiological shifts and health policy.
