Although the level of evidence is an important parameter during critical appraisal, the quality of reporting is similarly relevant. It is surprising that no objective analysis of the quality of reporting of the most common group of studies (ie, evidence level 4) has been performed to date.A hand search was conducted including all issues of Plastic and Reconstructive Surgery, British Journal of Plastic Surgery, Journal of Plastic Reconstructive and Aesthetic Surgery, Annals of Plastic Surgery, and Microsurgery for the years 1992, 2002, and 2012. All evidence level 4 studies with a focus on microsurgical reconstruction were included in the study. To assess the quality of reporting, a modification of an established quality assessment scale for retrospective clinical studies was used. This instrument generates a total possible score of 32, with a score of lower than 11, 12 to 21, and 22 to 32 representing poor, fair, and good quality of reporting, respectively.A total of 223 studies were included in the final analysis. An increase in the number of published case series was noted (46, 73, and 104 in 1992, 2002, and 2012, respectively). Similarly, an increase in the median number of patients was seen over time (8 [range, 2-165], 11 [range, 2-660], and 16 [range, 2-819] patients in 1992, 2002, and 2012, respectively) (P = 0.03). Most of the studies were conducted in Asia (38.1%) and North America (30.5%) and predominantly focused on head and neck (30.5%) as well as lower extremity reconstruction (21.5%). Although the quality of reporting was poor in 1992 and 2002 (median score, 10 [range, 3-19] in both years), an improvement to a fair quality of reporting was noted in 2012 (median score, 13 [range, 4-24]) (P = 0.0001).The trend to publish an increasing number of case series with a focus on microsurgical reconstruction is paralleled by an improvement in the quality of reporting. Although a favorable trend is seen, increased efforts are indicated to further improve the quality of case series in microsurgery.
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