Microbiome–host interactions in plastic and reconstructive surgery: clinical relevance, translational evidence, and research priorities—a scoping review

Vaca B.; Escandón J.M.; Díaz Z.J.; Ciudad P. · European Journal of Plastic Surgery (2026) · DOI: 10.1007/s00238-026-02562-z

Resumen

Background: The microbiome has emerged as a potential contributor to wound healing, infection, pathological scarring, implant-related complications, burn recovery, and reconstructive tissue viability. However, its relevance to plastic and reconstructive surgery has not been comprehensively characterized. This scoping review mapped the available evidence and identified priorities for future research. Methods: PubMed/MEDLINE, Scopus, and ClinicalTrials.gov were searched for studies published between January 2021 and July 2026 following the Joanna Briggs Institute population–concept–context framework and PRISMA-ScR guidance. EBSCOhost served as a supplementary retrieval and verification source. Included studies were charted according to reconstructive domain, microbiome compartment, analytical approach, and reported outcomes, followed by descriptive evidence-maturity classification. Results: Nineteen studies met the eligibility criteria. Evidence spanned six reconstructive domains: burn injury, burn scar microbiome, pathological scarring, implant-based breast reconstruction and biofilm, wound healing and infection, and flap viability. Burn injury provided the most clinically proximal evidence, whereas pathological scarring showed the greatest mechanistic development. Implant-based reconstruction relied primarily on indirect evidence related to antimicrobial exposure, microbial colonization, and biofilm biology, with little direct perioperative microbiome profiling. Evidence for wound healing remained largely translational, and flap viability was limited to preclinical investigation. Conclusions: Current evidence suggests that microbiome–host interactions may influence multiple reconstructive processes, but the literature remains heterogeneous and predominantly mechanistic, indirect, or preclinical. Prospective studies integrating multi-compartment microbiome assessment with standardized reconstructive outcomes are needed to determine whether microbiome-informed strategies provide clinically meaningful value beyond established surgical risk factors before they can be adopted in routine perioperative practice. Level of Evidence: Not gradable © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.

Instituciones: Universidad Peruana Cayetano Heredia; Universidad de Piura; Universidad Nacional Federico Villarreal