Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Mortada et al. (Tue,) studied this question.