The Top 100 Most Cited Articles in Reconstructive Microsurgery: Identifying Evidence Gaps and Research Trends for Future Investigation: A Bibliometric and Visualization Analysis.

Abstract

Reconstructive microsurgery restores form and function after trauma, oncological resection, or congenital deformities. This study provides a bibliometric analysis of the most cited articles, identifies evidence gaps, and proposes future research priorities. The top 100 most cited articles were retrieved from Scopus on January 1, 2025, and analyzed for publication trends, authorship, themes, and impact metrics using VOSviewer and R Bibliometrix. From 57,925 articles, the top 100 were selected (mean citations: 251.99 ± 207.78), predominantly in Q1 journals. Head and neck reconstruction dominated (49.5%). Hidalgo D.A. was the most frequent author, and the United States contributed nearly half of all articles. Most provided Level III-IV evidence (38.14% each); none met Level I criteria. Annual citation rates increased from 6.87 (1970s) to 16.32 (2010s). Four evolutionary phases were identified: Technical feasibility, clinical refinement, evidence-based optimization, and emerging interdisciplinary standardization. Three critical findings emerged: (1) No Level I studies and only 7.22% Level II evidence; (2) geographic concentration, with nearly half of contributions from the United States; and (3) a thematic shift from anatomical descriptions toward outcomes research. These findings provide a roadmap for advancing the field.