(1) Background: Microsurgical reconstruction of foot defects with free flaps is rare as it is a challenging task for a surgeon. For extensive defects, advanced surgical procedures, such as free flap transfer with microsurgical anastomosis, may be the last chance to avoid major amputation. The aim of the study was to examine the opportunities and risks posed by free flap reconstruction of foot defects and to illustrate in which situations reconstruction is useful on the basis of case characteristics. (2) Methods: In this study, we retrospectively analyzed data of cases with free flap reconstruction of the foot from 2007 to 2022. Therefore, demographic data, comorbidities, information about the defect situation, data on the operational procedure, and complications were evaluated. (3) Results: A total of 27 cases with free flap coverage of foot defects could be included. In 24 of these cases (89%), defect coverage was successful. In 18 patients, some form of complication occurred in the postoperative stage. The most frequently used flap was the latissimus dorsi flap, with 13 procedures. (4) Conclusions: Foot reconstruction using free flaps is a proven procedure for the treatment of larger foot defects and can offer a predominantly good functional outcome. The lengthy process and possible complications should be thoroughly discussed in advance so as to provide criteria, suitably adjusted to the individual prerequisites of the patients, for deciding whether limb salvage using advanced surgical procedures should be attempted.

Background: Microvascular thrombosis following free tissue transfer presents a complex challenge for surgeons and carries the potential risk of flap failure. The application of fibrinolytic agents represents a robust therapeutic option. The aim of this systematic review is to provide a comprehensive overview of the clinical use of fibrinolytic drugs in the rescue of compromised free flaps. Methods: A systematic literature search for clinical studies detailing the utilization of fibrinolytic agents for salvaging free flaps was conducted using the PubMed and Web of Science databases. The inclusion criteria encompassed English-language publications that specifically addressed the clinical application of fibrinolytic agents for free-flap salvage. Results: A total of 331 articles were screened after excluding duplicates, with 56 meeting the inclusion criteria. Among these, 21 were clinical trials (evidence level III), and 35 were case studies (evidence level IV/V). In total, 459 flaps underwent treatment with fibrinolytic agents. Conclusion: The application of fibrinolytic agents appears to be a valuable intervention for rescuing compromised free flaps attributable to microvascular compromise. Notably, no prospective randomized trials have been published on this subject, and the evidence within the existing literature is characterized by its limited and heterogeneous nature. Further research is imperative to gather data on the efficacy, dosage, and safety profile of fibrinolytic agents.

The vascularized fibula transfer is a well-established technique for extremity reconstruction, but operative planning and patient selection remains crucial. Although recently developed techniques for bone reconstruction, such as bone segment transfer, are becoming increasingly popular, bone defects may still require vascularized bone grafts under certain circumstances. In this study, 41 cases, 28 (68%) men and 13 (32%) women (median age: 40 years), were retrospectively analyzed. Therapy-specific data (flap vascularity [free vs. pedicled] size in cm and configuration [single- vs. double-barrel], mode of fixation [internal/external]) and potential risk factors were ascertained. Indications for reconstruction were osteomyelitis at host site (n = 23, 55%), pseudarthrosis (n = 8, 20%), congenital deformity (n = 6, 15%), traumatic defect, and giant cell tumor of the bone (n = 2, 5% each). Complete healing occurred in 34 (83%) patients after a median time of 6 months. Confounders for prolonged healing were female gender (p = 0.002), reconstruction in the lower limb (p = 0.011), smoking (p = 0.049), and the use of an external fixator (p = 0.009). Six (15%) patients required secondary limb amputation due to reconstruction failure, and one patient had persistent pseudarthrosis at last follow-up. The only risk factor for amputation assessed via logistic regression analysis was preexisting PAOD (peripheral artery occlusive disease; p = 0.008) The free fibula is a reliable tool for extremity reconstruction in various cases, but time to full osseous integration may exceed six months. Patients should be encouraged to cease smoking as it is a modifiable risk factor.

Abdominoplasty removes redundant skin and subcutaneous tissue but poses perioperative challenges. Although higher resection weight has been linked to complications, variation in resection burden and its relationship to post-operative complications remain incompletely defined. This exploratory study assessed patient- and procedure-related factors associated with resection weight and evaluated whether resection weight was associated with post-operative complications. This retrospective cohort included 217 adults undergoing abdominoplasty after massive weight loss (MWL; excess weight loss ≥ 50%) at the Medical University of Graz (2012-2023). Pregnancy-related and oncologic procedures, isolated revisions, and incomplete records were excluded. Variables included weight history, resection weight, post-operative complications (Clavien-Dindo), demographics, and procedure-related factors. Correlation, group comparison, multivariable linear and logistic regression analyses were applied. Mean age was 45 years (SD 12); 76% were female. Mean pre-operative BMI was 26.3 kg/m² (SD 3.5) and mean resection weight was 1,727 g (SD 1,132). Pre-operative BMI showed the strongest bivariate association with resection weight (Spearman r = 0.620, p < 0.001). In multivariable linear regression, pre-operative BMI (B = 209.9 g per kg/m², p < 0.001), female sex (+363.5 g, p = 0.004), metabolic disease (+346.0 g, p = 0.006), and concomitant belt lipectomy (+365.6 g, p < 0.001) were associated with higher resection weight, explaining 56% of variance. Post-operative complications occurred in 76 patients (35.0%). In adjusted logistic regression, younger age (OR 0.969 per year, p = 0.016) and pre-operative anemia (OR 2.153, p = 0.043) were associated with the composite complication endpoint; resection weight was not (OR 1.015 per 100 g, p = 0.245). Pre-operative BMI was the strongest factor associated with resection weight, with female sex, metabolic disease, and procedural extent adding explanatory value. Resection weight was not significantly associated with composite, major, or wound-specific complications; however, smaller effects could not be excluded.

Verbrennungsverletzungen entstehen in der Regel durch unterschiedliche äußere Einflüsse. Hierbei zu nennen sind neben Hitze auch extreme Kälte, chemische oder elektrische Quellen sowie durch Reibung erzeugte Hitze [1]. Allen gemein ist die Destruktion oder Degeneration, wobei die Art der Nekrose durch die Quelle bestimmt wird. In der Regel präsentieren sich Verbrennungen durch Sonneneinstrahlung oberflächlich, da es im Rahmen der Autoregulation, durch Schweiß und Durchfluss von erwärmtem Blut, zur Verteilung der Hitze sowie zu einem protektivem Rückzug von der Hitzequelle kommt [2]. In der vorliegenden Arbeit stellen wir zwei Fälle vor, bei denen es auf Grund fehlender Autoregulation in Kombination mit schwarzer Kleidung zu Koagultionsnekrosen kam. Die vorgestellten Patienten gaben Ihr Einverständnis zur Publikation der Kasuistiken. Article published online: 24 May 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background and Objectives: The growing global burden of surgical disease—including trauma, burns, congenital anomalies, and oncological defects—disproportionately affects populations in low- and middle-income countries (LMICs), where advanced reconstructive surgical resources remain scarce. Jugaad, a Sanskrit-derived Hindi concept denoting principle-driven, frugal problem-solving, offers a potentially coherent framework for advancing reconstructive plastic surgery in these settings. This narrative review aims to: (1) examine the theoretical alignment between the six jugaad principles and established reconstructive surgical innovation; (2) synthesize published evidence from LMIC case examples demonstrating frugal reconstructive approaches; and (3) propose a multi-level, evidence-informed integration framework for jugaad-driven reconstructive practice. Search Strategy: A narrative literature search, following the SANRA (Scale for the Assessment of Narrative Review Articles) reporting framework, was conducted using PubMed, Scopus, and Web of Science. Search terms included combinations of “jugaad,” “frugal innovation,” “reconstructive surgery,” “plastic surgery,” “resource-limited settings,” “low- and middle-income countries,” “limb salvage,” “wound management,” and “surgical equity.” Peer-reviewed publications, book chapters, and authoritative reports in English published up to 2025 were included. Articles were selected for relevance to the jugaad conceptual framework, evidence-based reconstructive practice in LMICs, or frugal innovation in healthcare more broadly. Key Findings: The six jugaad principles (seek opportunity in adversity, do more with less, think and act flexibly, keep it simple, include the margin, and follow your heart) align conceptually with reconstructive innovations described across Nepal, Bangladesh, Ethiopia, Rwanda, and India. This evidence base, however, derives almost entirely from case reports, case series, cross-sectional surveys, and narrative programme accounts rather than comparative or controlled studies. Modified vacuum-assisted closure (VAC) systems, simplified flap approaches, locally derived antimicrobial dressings, and community-based rehabilitation protocols exemplify jugaad-driven innovations. Individual sources report high technical success and flap survival in specific single-centre cohorts, and several report substantially lower direct costs than typical high-resource benchmarks; however, outcome definitions, comparators, and cost-accounting methods vary widely, and reported figures—including limb-salvage rates of 85–90% and cost reductions from >US$10,000 to US$1000–3000 per patient—could not consistently be traced to comparable, verifiable cohorts within the sources reviewed. These figures should therefore be read as illustrative of the wider frugal-surgery literature rather than as validated, generalizable outcomes. A multi-level integration framework is proposed operationalizing jugaad at individual surgical decision-making, departmental innovation culture, and health-systems design levels. Conclusions: Jugaad philosophy provides a coherent and actionable framework for advancing reconstructive plastic surgery in resource-limited environments without compromising evidence-based standards or patient safety. Responsible integration requires systematic innovation validation, transparent patient communication, sustained investment in surgical training, and explicit attention to ethical standards. LMIC-derived reconstructive innovations represent a valuable bidirectional knowledge source for global surgical practice. Prospective, comparative, and health-economic research is needed before broader clinical claims can be substantiated.