Reconstructive Surgery Research Articles

The tensile strength of different methods of anterior cruciate ligament graft end stitches in an animal model.

There are several methods for stitching graft ends in anterior cruciate ligament reconstructive surgery. The tendon-suture construct should be able to withstand tensioning until the graft is stabilized with an implant. In this biomechanical study, 40 porcine lower extremity tendons ends were stitched with No. 2 suture, secured to the grips of the Zwick-Roell testing machine and tested for load at failure and type of failure (tendon v/s suture thread). The applied force was linear, the results are given in Newtons (N) as a mean. The Mann-Whitney U test was used for statistical analysis. The following constructs were compared: a whipstitch of each tendon end individually with 3, 4, and 5 passes through the tendon, a whipstitch of both tendon ends folded together and a tendon end knot without stitching. All specimens survived the minimum tensile load of 80N. The load at failure for whipstitch with 3,4 and 5 passes were 175N, 211N and 254N respectively. The load at failure was greater for individual whipstitch than for both ends folded together (261N v/s 152N). The mean load at failure for braided graft was 209N. The braided graft slips off the tendon before failure leading to uneven strength distribution during tensioning. Increasing number of suture passes resulted in higher load at failure. Individual tendon ends whipstitched with 5 passes was the strongest construct. All of the investigated techniques are sufficient to withstand the suggested optimal graft tension of 80N.

Decellularized Adipose Matrix for Soft Tissue Regeneration: Enhancing Angiogenesis and Adipogenesis.

Human decellularized adipose matrix (hDAM) has emerged as a promising, off-the-shelf option for soft tissue augmentation, providing a biocompatible scaffold that supports angiogenesis, adipogenesis, and volume retention with minimal immunogenicity. This systematic review synthesizes preclinical and clinical evidence on hDAM's regenerative potential, focusing on its capacity to integrate with host tissue and enhance volume retention. A comprehensive literature search was performed across multiple databases yielding 21 studies (14 preclinical, 6 clinical, and 1 combined) that met eligibility criteria. Risk of bias (RoB) was evaluated for animal and human studies using the Collaboration for the Assessment of Risks and Benefits of Anticancer Therapies (CAMARADES) and RoB In Nonrandomized Studies of Interventions (ROBINS-I) tools, respectively. Key preclinical findings indicate that hDAM supports progressive angiogenesis and adipogenesis, with significant weekly increases in vessel formation and adipocyte development. Linear mixed models were used to quantify these rates, showing an increase of 0.366% per week (p < 0.001) in the percentage of CD31+ positive area, and a 3.88% rise in perilipin-positive area per week (p < 0.001), representing angiogenesis and adipogenesis, respectively. Variability in regeneration rates underscores the influence of different hDAM preparation methods, such as enzyme-free decellularization and ultrasonication, which have been shown to improve cell compatibility and volume retention. Clinical studies demonstrate that hDAM achieves notable volume retention and patient satisfaction, particularly in facial and body contouring applications, while also improving skin texture, tone, and functionality. Compared with traditional autologous fat transfer and synthetic fillers, hDAM offers advantages in integration, resorption rates, and low complication risks, without donor site morbidity. Limitations of current studies include variability in hDAM preparation techniques, inconsistent outcome measures, and a paucity of long-term follow-up data. This review establishes hDAM as a safe and effective scaffold for soft tissue regeneration and provides a quantitative analysis of its regenerative timeline. Standardizing preparation methods and outcome measures, coupled with more randomized clinical trials, will be essential for optimizing treatment protocols. Future directions include exploring patient-specific factors and combination therapies to enhance hDAM's applicability in reconstructive and aesthetic surgery.

Sagittal Parameters and Clinical Outcomes in Cervical Spondylitis: The Cohort Analysis

Background. Cervical spondylitis is accompanied by segmental instability and sagittal imbalance. The purpose of this work is to conduct a search of correlation between sagittal parameters and clinical outcomes in cervical spondylitis. Materials and Methods. The monocentric cohort study encompassed the clinical and radiological data of 59 patients who underwent reconstructive surgeries on the suboccipital, subaxial, and cervicothoracic spine. We evaluated local cervical sagittal parameters: cervical sagittal vertical axis (CSVA), T1 slope (T1S), Health-Related Quality of Life—HRQOL (Oswestry Disability Index—ODI)—and others pre- and postoperatively. Results. The duration of the therapeutic pause and T1S correlated with HRQOL. It revealed the direct relationship between the age of the patient and the value of CSVA. A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more on the Charlson scale. Conclusions. The factors influencing HRQOL in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of spondylitis yields a correction of the sagittal balance parameters. The leading predictors of complications from the surgical treatment of cervical spondylitis are the Charlson comorbidity index and the variant of anterior reconstruction.

Skin, scalpel and the silicon chip: a systematic review on the accuracy, bias and data governance of artificial intelligence in dermatology, minimally invasive aesthetics, aesthetic, plastic and reconstructive surgery

Skin, scalpel and the silicon chip: a systematic review on the accuracy, bias and data governance of artificial intelligence in dermatology, minimally invasive aesthetics, aesthetic, plastic and reconstructive surgery

DIGITAL BLOCK APPLICATIONS; A DETAILED SURVEY BETWEEN SURGICAL BRANCH SPECIALIST AND SPECIALIST STUDENTS

Purpose: The purpose of this study was to investigate the digital block application methods of specialists and assistants working in the Departments of Orthopedics and Traumatology, Emergency Medicine, Anesthesia and Reanimation, and Plastic and Reconstructive Surgery in Turkey and the accuracy of the information on which these methods are based, through a survey, and to interpret the survey results.Study plan: In the survey consisting of a total of eighteen questions, the personal information of the physicians, their preferred digital block application methods, local anesthetic agent selection and application doses, and the source of the information on which these preferences are based were questioned in a digital environment. The responses were interpreted and analyzed.Findings: A total of 110 physicians, 16 specialists and 94 assistants, participated in our survey. In the responses given to the multiple-choice question asked to the participants about the cases you encounter most frequently in your clinic, we saw that the most common ones were fractures at the finger and toe level, skin and subcutaneous lacerations at the finger level, and tendon injuries. In the responses we received to the question of the most preferred type of anesthesia in such injuries, we saw that 51.9% preferred digital block and 42.6% preferred regional anesthesia. In the responses we received to other questions regarding the application method, dosage and different usage patterns in our survey, it was seen that traditional and personal experiences were effective in digital block applications.Conclusion: It was determined that the digital nerve block applications preferred by specialists and specialist students were not compatible with the literature. The results of the study are warning signs for the revision of digital block applications. Experience-based applications and personal teachings should be replaced by evidence-based applications in digital block applications.

Reconstruction after Nasal Skin Cancer Resection: Nasal Obstruction and Associated Factors.

Background: Equal attention must be given to nasal aesthetics and function when reconstructing nasal defects after skin cancer resection. Little data exist on functional nasal outcomes following nasal reconstruction. Learning/Study Objective: Describe and analyze factors contributing to functional outcomes following nasal skin cancer defect reconstruction. Design Type: Retrospective review. Methods: Patients who underwent reconstruction of Mohs nasal defects were included. Reconstruction methods included primary closure, skin grafts, and local and interpolated flaps. Both subjective reports and physician-noted exam findings suggestive of nasal obstruction were noted. The obstructive domain of the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS-O) was administered preoperatively and at follow-up intervals. Results: In total, 193 patients met the inclusion criteria. Female sex, medial or lateral ala primary defect subunit, and auricular cartilage use were associated with increased risk of postoperative nasal obstruction within the first year on multivariate analysis, while reconstruction with a skin/composite graft was associated with lower risk of obstruction. Average time from reconstructive surgery to first report of obstruction was 116 days, and time to reported resolution was 235 days. Conclusion: The incidence of nasal obstruction following nasal defect reconstruction is low. Female sex, ala involvement, and auricular cartilage may increase the risk of nasal obstruction postoperatively.

Maxillary reconstruction using the “Autoplan” software

The aim of the study: to improve the functional and aesthetic results of surgical treatment of maxillary defects using additive technologies and the “Autoplan” software. Materials and methods. The study included 110 patients (60 - main group and 50 - control group) with maxillary defects. In patients of the main group with maxillary defects, a 3-stage algorithm was used using the “Autoplan” software. The postoperative results were assessed 6 months after the operation and included the following parameters: functional, aesthetic result, and surgery time. Results. In the main group, a good aesthetic result was achieved in 29 (48.33%) cases, in the control group - in 17 (34%) (p0.05). Main group, good speech quality was achieved in 31 (86.11%) cases, control group - 22 (78.57%) (p0.05). Main, an unrestricted diet was noted in 26 cases (72.22%), control - 18 (64.29%) (p0.05). The mean time of the reconstructive stage using scapular flap: main - 210±35 minutes, control - 300±35 min (time reduction by 30±13.4%); fibular flap: main - 180±16 min, control - 260±36 min (time reduction by 30, 77 ± 11.2%); ALT flap: main - 175±17 min, control - 220±33 min (time reduction by 20.45±13.3%); radial flap: group — 130±12 min, control — 170±12 min (time reduction by 23.53±8.1%). Conclusion. We can assume that the use of additive technologies, individualized fixation systems and preoperative planning is an integral part of modern reconstructive surgery, which in practice allows to reduce the time of surgery, as well as to obtain good functional and aesthetic results.

Exosomes in Skin Flap Survival: Unlocking Their Role in Angiogenesis and Tissue Regeneration

This review explores the critical role of exosomes in promoting angiogenesis, a key factor in skin flap survival. Skin flaps are widely used in reconstructive surgery, and their survival depends heavily on the formation of new blood vessels. Exosomes, small extracellular vesicles secreted by various cells, have emerged as important mediators of intercellular communication and play a crucial role in biological processes such as angiogenesis. Compared to traditional methods of promoting angiogenesis, exosomes show more selective and targeted therapeutic potential as they naturally carry angiogenic factors and can precisely regulate the angiogenesis process. The review will delve into the molecular mechanisms by which exosomes facilitate angiogenesis, discuss their potential therapeutic applications in enhancing skin flap survival, and explore future research directions, particularly the challenges and prospects of exosomes in clinical translation. By highlighting the unique advantages of exosomes in skin flap survival, this review provides a new perspective in this field and opens up new research directions for future therapeutic strategies.

Indications for Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

The anterior cruciate ligament (ACL) is a major sagittal plane stabilizer of the knee joint. Even if anterior laxity can be brought under control by utilizing modern surgical techniques, internal rotational instability may not always be controlled adequately. Various surgical techniques are used to prevent this coronal or rotational instability, such as lateral extra-articular tenodesis (LET). Despite an abundance of articles in recent decades discussing LET in ACL reconstruction, no definitive indicators for extra-articular tenodesis have been described in the literature. Given the scarcity of literature assessing the indications in LET, the purpose of this study was to conduct a systematic review of the described indications for this operation in the context of concurrent ACL reconstruction. Systematic review; Level of evidence, 4. We searched PubMed, Cochrane Central, ScienceDirect, Web of Science, and Embase using the following key terms with no limits regarding the year of publication: (extraarticular OR extraarticular) AND (tenodesis OR plasty OR augmentation OR procedure or reconstruction OR reconstructive OR surgical OR surgery OR technique) AND (ACL OR anterior cruciate ligament). We included clinical human studies based on levels of evidence 1 to 4 that were written in English. We excluded studies not written in English, case studies, reviews, letters to editors, conference abstracts, or studies containing incomplete or irrelevant data. The analysis evaluated 29 articles published between 1999 and 2023. We evaluated mostly level 3 (n = 13) and level 4 (n = 12) evidence; however, there were 4 articles with level 1 evidence. The majority of the studies were retrospective (n = 21), although there were prospective studies (n = 8). The mean age of the participants was 24.4 years. The most prevalent indications for LET were high-risk sports (16 articles), medial meniscal repair/excision (11 articles), and pivot-shift test grades 2 and 3 (11 articles). The reviewed articles showed reduced pivoting and laxity, improved clinical outcomes, and decreased revision rates after primary ACL reconstruction. The main frequent and repeated indications for using LET in ACL reconstruction are meniscal surgery, sports activity, and grade 2 and 3 pivoting.

Successful rescue of a patient with cardiogenic shock following traumatic cardiac arrest using VA-ECMO after air medical transport: a case report

BackgroundTraumatic cardiac arrest (TCA) poses significant challenges in resuscitation, with extremely high mortality rates, making it a critical issue in emergency and critical care medicine. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as a crucial rescue technology for patients with cardiac arrest, providing short-term support for cardiopulmonary failure. However, the successful application and related clinical experience of VA-ECMO in TCA remain limited and require further investigation.Case presentationA male patient sustained a stab wound to the left lower limb, resulting in femoral artery and vein injuries, massive hemorrhage, and subsequent hemorrhagic shock. The patient experienced cardiac arrest upon admission to a local hospital. Following cardiopulmonary resuscitation (CPR) and emergency femoral vascular reconstruction surgery, spontaneous circulation was temporarily restored, but the patient remained hemodynamically unstable postoperatively. Initial treatment at the local hospital was ineffective. On the second morning, the patient was transferred to our hospital via air medical transport, with a transport time of 35 min. Upon arrival, the patient was promptly evaluated, and VA-ECMO support was initiated within 17 min. After 3 days of VA-ECMO support and 5 days of mechanical ventilation, the patient was successfully weaned from life support and discharged in good condition.ConclusionVA-ECMO can significantly improve the survival outcomes of patients with cardiogenic shock following traumatic cardiac arrest. The use of interhospital air medical transport effectively reduces rescue time, providing critical opportunities for the timely management of severely ill patients.

Expert consensus for full course management of plexiform neurofibroma (2025 edition)

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder caused by mutations in the NF1 gene, affecting approximately 1 in 3 000 newborns worldwide. Plexiform neurofibroma (PNF) is one of the common clinical manifestations of NF1. PNF can lead to a range of clinical symptoms, with a high rate of disability and teratogenesis; furthermore, there is a risk for malignant transformation that poses significant threats to the life and health of patients. Currently, there is no unified standard regarding the definition, diagnosis, evaluation, monitoring, or treatment strategies for PNF. In order to further standardize the clinical diagnosis and treatment of PNF, initiated by the Group of Neurofibromatosis, Plastic and Reconstructive Surgery Society of Chinese Medical Association, the experts and scholars from various disciplines within the NF1 field across China were organized. Finally, based on existing evidence-based medicine evidence, a total of 18 recommendations have been proposed for the diagnosis, screening, surgical treatment, pharmacological treatment, disease monitoring, as well as patient education and psychological support related to PNF, aiming to serve as a reference for the standardized clinical diagnosis and treatment of PNF.

The Interplay Between Chronic Pelvic Pain and Pelvic Organ Prolapse.

Chronic pelvic pain (CPP) affects approximately 26% of the world's female population and has various proposed etiologies. This manuscript aims to review concepts related to pelvic organ prolapse (POP) and CPP, encompassing its etiology, risk factors, clinical findings, and pain management. A narrative review was performed using MeSH terms and text words on PubMed, and the Cochrane Database of Systematic Reviews through May 2024. A total of 33 references were used to address the questions posed in this review. Specific risk factors for CPP associated with POP include pain antedating POP onset, POP surgery duration, and extent of soft tissue trauma. Studies indicate that uterosacral ligament repair performed during surgical interventions for POP correction has alleviated CPP symptoms whether performed vaginally or laparoscopically. Women with preexisting CPP or central sensitization syndrome (CSS) undergoing pelvic reconstructive surgery for POP may experience less favorable postoperative outcomes compared to those without preexisting pain conditions. These outcomes include lower patient satisfaction, less resolution of discomfort, and poorer improvement in urinary symptoms. On the basis of current evidence, surgeries for POP correction, especially those involving the uterosacral ligament, have shown a positive impact on reducing pelvic pain. However, untreated CPP is associated with lower satisfaction and less improvement in outcomes after POP surgery regarding pelvic symptoms and quality of life. Screening for and treating CPP conditions prior to POP surgery should be prioritized.Pain management of CPP should be addressed preoperatively, perioperatively, and postoperatively.

Here's to a Future Beyond Reconstructive Surgery for Pelvic Osteomyelitis.

Here's to a Future Beyond Reconstructive Surgery for Pelvic Osteomyelitis.

Anterior Cruciate Ligament Reconstruction: Common Intraoperative Mistakes and Techniques for Error Recovery.

Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure among general orthopedists, and is a logged procedure required for graduation from accredited orthopaedic residency programs. ACL reconstruction surgery has a number of critical steps, and intraoperative errors can significantly impact the success rate and morbidity of this operation. Technical errors are frequently cited as some of the most common reasons for ACL reconstruction failure. This narrative review provides low-volume surgeons and trainees with an overview of the common errors that can be made during the critical steps of an ACL reconstruction procedure. We suggest technical points for avoiding commonly-encountered errors and provide a description of evidence-supported error recovery techniques to address these errors if they occur intraoperatively. These key steps include femoral tunnel creation, tibial tunnel creation, graft harvest and preparation, and graft fixation within the tunnels. We discuss a number of primary and backup fixation strategies as well as all commonly used autografts (bone-patellar tendon-bone, hamstring, and quadriceps tendon). Additionally, we provide a brief overview on address intra-operative graft contamination citing currently available evidence.

Diverse Applications of Saphenous Vein Graft in Oral and Maxillofacial Reconstruction.

The greater saphenous vein (GSV) is widely used as an autologous graft in reconstructive surgeries, particularly in coronary artery bypass grafting and peripheral vascular interventions. This study explores the applicability of the GSV as a valuable graft option in oral and maxillofacial reconstructions, focusing on complex head and neck cases. Given the unique anatomic challenges of these areas, including proximity to vital structures and the need for extensive tissue resection, the GSV serves as an effective conduit in reconstructive strategies. This article provides a detailed overview of the typical GSV harvesting technique and presents case studies demonstrating the diverse applications of GSV grafts, including mandibular defect reconstruction, replacement of the internal jugular vein after radical neck dissection, and maxillary reconstruction after oncologic resection. The discussion addresses common anatomic and technical considerations, such as variable GSV diameters, vessel size mismatches, and donor site morbidity. A number of advanced anastomotic techniques is evaluated to address graft-recipient vessel discrepancies, ensuring optimal outcomes. Emphasizing careful patient evaluation and precise surgical techniques, this study concludes that the GSV is a reliable autogenous graft option, extending its versatility to challenging head and neck reconstructions. Preoperative anatomic assessment through Doppler analysis, patient consultation, and meticulous graft handling are essential to optimize graft function and minimize complications.

Beneath the Perforators: Unravelling Fascia Lata Intrinsic Vascular Architecture using microfocus X-ray computed tomography.

The fascia lata (FL), a dense connective tissue enveloping the deep structures of the thigh, has served as an avascular scaffold for decades in reconstructive surgeries, but never as a standalone vascularized flap, because its vasculature is only described by perforating vessels coming from the lateral circumflex femoral artery without specific intrinsic vasculature. However, the demand for vascularized tissue replacements requires a thorough understanding of this inherent vascularization. Based on the anterolateral thigh (ALT) flap knowledge, this study explores the detailed quantitative vascular architecture of the FL, from the perspective of using it as a standalone vascularized flap. High-resolution microfocus X-ray computed tomography (microCT) of Angiofil-latex injected flaps allowed us to study the specific fascial distribution of perforators. Dissections of 11 fresh-frozen lower limbs identified the main perforating arterioles. The intrinsic vascular network within the FL tissue was then analyzed using microCT. The study confirmed an average of 2.5±0.5 main perforating trunks giving rise to 5.6±2.9 perforating arterioles per thigh. Notably, microCT revealed a distinct intrinsic vascular network within the FL tissue, with tiny arterioles of 55.39±28.47µm radius and a volumetric density of 33,347,960±23,243,879µm³/mm². This intrinsic vasculature exhibited a high density of bifurcations (branching nodes=1.36±2.26/mm²), demonstrating its potential use as a vascularized flap. This study unveils the intrinsic vascularization of the FL, supporting its utility as a mega-thin vascularized flap in reconstructive surgery. Based on this vascular carrier, these findings also open new applications for tissue engineering and personalized medicine, toward an improvement of surgical outcomes and patient recovery.

Adults With Head and Neck Burns Experience Worse Long-Term Outcomes and Require More Reconstructive Surgeries: A Burn Model System Study.

Adults living with head and neck burn injuries experience psychosocial consequences due to scarring as well as functional disabilities. However, the impact of head and neck burns on long-term self-reported psychosocial outcomes, return to work, and need for reconstructive surgery has not been well described. This study investigates the unique longitudinal problems in psychosocial and functional recovery faced by adults with head and neck burn injuries. Utilizing the multicenter Burn Model System (BMS) National Database, long-term psychosocial and functional outcomes as well as postdischarge reconstructive surgery rates between adult participants with and without head and neck burns injured after 2014 were compared. Of 1247 participants, 579 had head and neck burns and 668 had non-head and neck burns. Head and neck burn was a significant predictor of worse anxiety (β = 1.63, P = 0.049) and body image (β = -0.30, P = 0.011) at 6 months post burn; worse anxiety (β = 2.68, P = 0.004), depression (β = 2.14, P = 0.021), and body image (β = -0.41, P = 0.001) at 12 months post burn; and worse life satisfaction (β = -1.64, P = 0.036) at 24 months post burn. Head and neck burn participants reported significantly worse anxiety ( P = 0.001), depression ( P = 0.0026), and life satisfaction ( P < 0.001) at 12 months post burn and worse body image at 6 ( P < 0.001), 12 ( P < 0.001), and 24 ( P < 0.001) months post burn. The head-and-neck group had a significantly greater proportion of participants who had undergone contracture surgery at 12 months post burn ( P < 0.001) and a smaller proportion who had returned to work by 6 ( P < 0.001) and 12 ( P < 0.001) months post burn. This study suggests that adults with head and neck burns might strongly benefit from additional counseling, psychotherapy, and greater aftercare.

Expanded Approaches for Mastopexy in Aesthetic and Reconstructive Breast Surgery.

After studying this article, the participant should be able to: (1) Understand the unique differences between mastopexy in aesthetic and reconstructive breast surgery. (2) Describe the approach to performing mastopexy with autoaugmentation or after explantation. (3) Have insight into the approach and decision-making process for performing mastopexy with nipple-sparing mastectomy. (4) Apply the mastopexy skin reduction techniques to ptotic women undergoing postmastectomy breast reconstruction. Techniques and indications for mastopexy are expanding. In aesthetic surgery, access to supportive meshes and higher rates of breast implant explantation without replacement contribute to this. In breast reconstruction, higher rates of nipple-sparing mastectomy and higher expectations for cosmetically favorable outcomes with ptotic breasts are key drivers. A keen understanding of the available blood supply and how it may change over time with a staged approach, thoughtful use of otherwise-discarded tissues, and judicious application of mesh support are important new considerations for plastic surgeons to apply to traditional mastopexy. This evidence-based article focuses on specific aesthetic and reconstructive mastopexy techniques associated with autoaugmentation, explantation, and nipple-sparing mastectomy.

Enhancing fat graft survival: thymosin beta-4 facilitates mitochondrial transfer from ADSCs via tunneling nanotubes by upregulating the Rac/F-actin pathway.

Autologous fat grafting is a widely used technique in plastic and reconstructive surgery, but its efficacy is often limited by the poor survival rate of transplanted adipose tissue. This study aims to enhance the survival of fat grafts by investigating the role of thymosin beta-4 (Tβ4) in facilitating mitochondrial transfer from adipose-derived stem cells (ADSCs) to adipocytes and newly formed blood vessels within the grafts via tunneling nanotubes (TNTs). We demonstrate that Tβ4 upregulates the Rac/F-actin pathway, leading to an increased formation of TNTs and subsequent transfer of mitochondria from ADSCs. This process mitigates oxidative stress, reduces apoptosis, and promotes revascularization, thereby improving the quality and volume retention of fat grafts. Our findings provide a novel mechanistic insight into the enhancement of fat graft survival and suggest that mitochondrial transplantation and Tβ4 are potential therapeutic strategies to improve clinical outcomes in autologous fat transfer procedures.

Jejunal Artery and Vein Positioning in Free Jejunal Transfer: Surgical Considerations and Clinical Implications

Previous computed tomography studies have reported that the superior mesenteric artery is often located ventrally to the superior mesenteric vein; however, the precise location of the peripheral jejunal arteriovenous system is unknown. This study investigated the arteriovenous positioning of the free jejunal flaps during reconstructive surgery. This retrospective cohort study included 78 patients who underwent free jejunal flap reconstruction between June 2021 and May 2023. The positions of the jejunal artery and vein were classified into 6 patterns (A-F) based on the photographs taken during the flap harvest. Statistical analysis was performed to examine the location of the artery (ventral vs. dorsal) and its orientation along the oral-anal axis in relation to the vein. The jejunal arteries were most commonly located on the oral and ventral sides of the vein (type A, 48.6%) when the mesentery of the jejunal flap is positioned toward the front, with the left and right sides corresponding to the oral and anorectal sides, respectively. Notably, 62.1% of the arteries were located on the oral side and 71.6% on the ventral side. The recipient arteries used for vascular anastomosis were predominantly the superior thyroid artery (44.6%) and transverse cervical artery (50.0%), while the internal jugular vein (85.1%) was the most commonly used vein. The position of the jejunal arteriovenous system is important for optimizing anastomotic techniques and ensuring safe surgical outcomes. Understanding vascular anatomy patterns can help prevent vessel misplacement and allow for more reliable and accurate anastomosis procedures.