# The application of robot-assisted microsurgery in orthoplastic surgery

## TL;DR

This study explores the use of robot-assisted microsurgery in complex limb reconstructions, showing it is feasible with promising initial results.

## Contribution

The paper presents the first institutional experience of robot-assisted free flap reconstruction in orthoplastic surgery.

## Key findings

- Robot-assisted microsurgery was successfully used in 18 patients with complex limb injuries.
- One major complication occurred, but no complete flap loss was observed.
- The study demonstrates the feasibility of RAMS in orthoplastic reconstructions.

## Abstract

The orthoplastic approach has emerged as the gold standard in the reconstruction of complex extremity injuries. While robot-assisted microsurgery (RAMS) enhances precision and ergonomics, its role in the challenging orthoplastic setting remains largely unexplored. This study aimed to evaluate our initial institutional experience with robot-assisted free flap reconstruction for complex limb injuries within an orthoplastic approach.

From February 2023 to February 2025, we prospectively collected data on patients with combined traumatic bone and soft tissue injuries undergoing robot-assisted free flap transfer to the extremities. Data included patient demographics, surgical details (e.g., operating times, anastomosis/coaptation duration), and complications. Ethical approval was obtained.

Our cohort of 18 patients (78 % male, mean age 50.3 years) received free flaps for traumatic soft tissue defects (78 % lower extremity). The ALT flap was most commonly used (67 %). Mean operating time was 353.0 min. 19 anastomoses and coaptations were performed, with no conversions to conventional techniques. A major complication (arterial thrombosis) occurred in one case, successfully salvaged with conventional re-anastomosis, resulting in no complete flap losses. There was one partial flap loss. Three minor complications (delayed wound healing, 17 %) were observed.

Our experience shows the feasibility of RAMS in orthoplastic limb reconstruction. Further studies are needed to validate these findings and define the optimal role and benefits of RAMS in orthoplastic surgery.