Frontiers in Surgery最新文献

{"title":"Ewing sarcoma of the first metacarpal: a rare case report with thumb-sparing resection and fibular graft reconstruction.","authors":"Aouinti Mohamed Nizar, Sahar Ben Ammar, Walid Saied, Hajer Ben Mansour, Ahmed Hamdi, Henda Rais, Sami Bouchoucha, Rim Boussetta","doi":"10.3389/fsurg.2026.1833919","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1833919","url":null,"abstract":"<p><strong>Background: </strong>Ewing sarcoma is a malignant primary bone tumor that predominantly affects the long bones and pelvis of children and adolescents. Involvement of the hand is exceptionally rare, particularly at the level of the first metacarpal. When the dominant thumb is affected, treatment becomes especially challenging due to the critical functional role of this structure.</p><p><strong>Case presentation: </strong>We report the case of an 11-year-old right-handed boy who presented with a painful swelling of the right thumb. Imaging revealed an aggressive osteolytic lesion of the first metacarpal with soft tissue extension. Histology confirmed Ewing sarcoma. After neoadjuvant chemotherapy according to the EuroEWing 2012 protocol, Thumb-sparing resection was performed, including the trapeziometacarpal and metacarpophalangeal joints. Reconstruction was achieved using a non-vascularized fibular autograft. Despite a poor histological response, surgical margins were tumor-free. Adjuvant chemotherapy and radiotherapy were administered. At one-year follow-up, there was no local recurrence, with satisfactory functional outcome of the dominant hand.</p><p><strong>Conclusion: </strong>Ewing sarcoma of the first metacarpal is exceedingly rare. Limb-sparing surgery with fibular graft reconstruction may represent a valid alternative to amputation in carefully selected pediatric patients, even in cases of limited histological response, provided that oncological principles are respected.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1833919"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral biportal endoscopic decompression compared with tubular or uniportal endoscopic decompression for lumbar spinal stenosis: a systematic review and meta-analysis.","authors":"Jie Song, Jun Li, Xiu-Lei Xu, Quan Sun","doi":"10.3389/fsurg.2026.1805531","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1805531","url":null,"abstract":"<p><strong>Background: </strong>Comparative evidence regarding unilateral biportal endoscopic decompression vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis remains limited and inconsistent.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of comparative clinical studies that evaluated UBE vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis. Pooled analyses were performed for predefined outcomes, and comparator-specific analyses were additionally performed to improve interpretability.</p><p><strong>Results: </strong>A total of 1,395 patients from 10 studies were included in this meta-analysis. Overall complications and dural tear or cerebrospinal fluid leak events were lower in the unilateral biportal endoscopic decompression group than in the pooled control group. The unilateral biportal endoscopic decompression group also showed modestly lower ODI and pain scores at the final follow-up, although the magnitude of benefit varied across outcomes. In addition, the changes in the dural sac cross-sectional area after surgery also favored unilateral biportal endoscopic decompression, with low to moderate heterogeneity.</p><p><strong>Conclusions: </strong>For lumbar spinal stenosis, UBE may provide comparable overall safety and modest advantages in selected perioperative, clinical, and radiological outcomes compared with tubular or uniportal endoscopic decompression. However, the clinical relevance of some statistically significant differences remains uncertain, and further high-quality comparative studies are required.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1805531"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of inferior pulmonary ligament dissection versus preservation during thoracoscopic upper lobectomy: a retrospective comparative analysis.","authors":"Xinhe Huang, Zheng Zhu, Baisheng Xie, Kaifei Chen, Yue Xie, Yi Zhu","doi":"10.3389/fsurg.2026.1812714","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1812714","url":null,"abstract":"<p><strong>Background: </strong>The clinical benefit of dividing the inferior pulmonary ligament (IPL) during video-assisted thoracoscopic upper lobectomy (TUL) for early-stage lung cancer remains controversial. This study aimed to evaluate the association between IPL division during TUL and postoperative clinical outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 95 patients who underwent TUL between December 2020 and June 2025. Patients were assigned to an IPL-preservation group (Group P) or an IPL-division group (Group D). Group P included 50 patients (31 right-sided and 19 left-sided procedures), and Group D included 45 (29 right-sided and 16 left-sided procedures). Postoperative outcomes-including operative time, intraoperative blood loss, duration of postoperative air leak, chest tube duration, length of postoperative hospital stay, and changes in bronchial angle, lung volume, pulmonary function, and cough severity-were compared between groups. Bronchial angle and lung volume were measured using three-dimensional (3D) reconstructed chest computed tomography (CT) images. Cough severity and cough-related quality of life before and after surgery were assessed using the Mandarin Chinese version of the Leicester Cough Questionnaire (LCQ-MC).</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups, with no statistically significant differences (all <i>P</i> > 0.05). IPL division was associated with a greater degree of postoperative bronchial angle change after left-sided surgery, reaching borderline significance at 3 months (68.1 ± 7.2° vs. 78.1 ± 7.8°, <i>P</i> = 0.046) and poorer 6-month outcomes, including smaller lung volume (3615 ± 475 mL vs. 3392 ± 489 mL, <i>P</i> = 0.027), a trend towards lower FEV1% (73.04 ± 9.36 vs. 69.06 ± 10.11, <i>P</i> = 0.049), lower DLCO (80.82 ± 10.35 vs. 76.06 ± 11.08, <i>P</i> = 0.033), and lower total LCQ-MC score (17.70 ± 1.72 vs. 16.98 ± 1.69, <i>P</i> = 0.042). No significant between-group differences were observed for other endpoints.</p><p><strong>Conclusions: </strong>IPL division did not demonstrate a clear benefit over IPL preservation. The findings suggest that IPL division may be associated with reduced postoperative lung volume, impaired recovery of diffusing capacity, greater displacement of the residual bronchus, and more severe chronic cough. However, particularly for outcomes with marginally significant P values, these results should be interpreted with caution due to multiple comparisons. These conclusions are hypothesis-generating and require confirmation in larger, prospective studies.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1812714"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior uniportal endoscopic laminotomy for cervical ossification of posterior longitudinal ligament: a case report and technical summary.","authors":"Baoliang Li, Zhigang Shi, Jianxin Zhang, Nianhu Li, Changjiao Ji","doi":"10.3389/fsurg.2026.1786576","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1786576","url":null,"abstract":"<p><strong>Background: </strong>The management of cervical ossification of posterior longitudinal ligament (OPLL) with unilateral radiculopathy poses significant challenges. Posterior uniportal endoscopic laminotomy offers a minimally invasive alternative, yet its application in OPLL-related stenosis remains technically demanding and underreported.</p><p><strong>Case summary: </strong>A 49-year-old female presented with progressive left upper limb radiculopathy, numbness, weakness, and cervicobrachial pain due to OPLL-induced severe neuroforaminal and lateral recess stenosis at C6-C7 and C7-T1. Through a single 1-cm incision, posterior endoscopic decompression was performed via unilateral laminotomy at both target levels. The procedure was completed in 1.5 h with minimal blood loss. Postoperatively, the patient showed rapid symptomatic improvement, with significant reduction in pain and recovery of grip strength by 6-month follow-up. Integrating contemporary evidence with technical experience, we outline key procedural insights to support the adoption of this technique in selected OPLL cases.</p><p><strong>Conclusion: </strong>Posterior uniportal endoscopic laminotomy is a feasible and effective minimally invasive option for selected OPLL patients with unilateral radiculopathy. It achieves clinical improvement while preserving spinal motion and avoiding fusion-related complications, provided patient selection and surgical technique are optimized.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1786576"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer-related lymphedema of the upper limb: integrating early surveillance and functional surgery into a synergistic management paradigm.","authors":"Tao Wu, Baixin Li, Bingyang Ma, Fuxing Zhao, Yan Li, Zhen Liu","doi":"10.3389/fsurg.2026.1810682","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1810682","url":null,"abstract":"<p><p>Breast cancer-related lymphedema (BCRL) of the upper limb is a chronic complication of breast cancer treatment that significantly impairs patient quality of life. Conventional management typically begins only after overt swelling occurs. This reactive approach delays diagnosis, relies on subjective assessment, and prioritizes volume reduction over functional recovery. Consequently, it often misses the optimal window for intervention. Recent advances in objective early-monitoring technologies, such as hyperspectral imaging and bioelectrical impedance analysis, alongside the development of precision functional lymphatic surgery, are now transforming BCRL care. This article details a novel \"Precision Collaborative Management\" paradigm, which integrates these diagnostic and surgical advances into a synergistic cycle where monitoring informs clinical decisions and surgical outcomes refine subsequent strategies. This paradigm establishes a continuous management pathway encompassing risk screening, early warning, precise intervention, and long-term follow-up across the entire disease continuum. Through sustained exploration in the aforementioned directions, we aim to transform BCRL management from a reactive symptom treatment to a proactive health safeguard, ultimately empowering breast cancer survivors to achieve a comprehensive and high-quality life. The paradigm facilitates a fundamental shift in BCRL clinical practice from delayed symptomatic treatment to early, function-preserving care.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1810682"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic-assisted uni-portal spine surgery via modified interlaminar approach combined with annular suturing for L5/S1 disc herniation: a case report and technical note.","authors":"Zhijun Chen, Wenrong Yang, Jincai Liu, Zhigang Zhao, Nan Zhou, Guangmin Pu, En Song","doi":"10.3389/fsurg.2026.1807236","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1807236","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lumbar disc herniation (LDH) is a common clinical spinal disorder, with the L5/S1 segment being a frequently affected site due to its unique anatomical and biomechanical characteristics. Conventional minimally invasive spinal endoscopic techniques, such as percutaneous transforaminal endoscopic discectomy (PTED), percutaneous endoscopic interlaminar discectomy (PEID), and unilateral biportal endoscopy (UBE), have inherent limitations in treating L5/S1 LDH. These include difficulty bypassing the high iliac crest (for PTED), a steep learning curve (for PEID), and potential impairment of spinal stability (for UBE). To address these challenges, this study applied Arthroscopic-assisted uni-portal spine surgery (AUSS) via a modified interlaminar approach combined with 4-0 absorbable suture annular repair for L5/S1 LDH, reporting its short-term clinical outcomes and detailing key technical points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A 45-year-old male patient presented with a 1-year history of low back pain, which worsened over 1 month with persistent right lower limb radicular pain, unresponsive to conservative treatment. Preoperative lumbar MRI and CT confirmed L5/S1 disc herniation, with T2-weighted MRI showing low signal intensity of the herniated disc and axial CT demonstrating direct compression of the right S1 nerve root by the herniated nucleus pulposus. The patient underwent the modified procedure: during surgery, a portion of the ligamentum flavum was excised to expose the herniated nucleus pulposus, while the remainder was retracted and preserved. After complete removal of the herniated nucleus pulposus, full-thickness annular suturing was performed using 4-0 absorbable sutures, with knot tying performed extracanalicularly and pushed into place using a dedicated knot pusher. At 1, 3, and 12 months postoperatively, the incision healed well without complications such as infection, nerve injury, or cerebrospinal fluid leakage. Imaging re-evaluation showed no recurrence of L5/S1 disc herniation and a smooth posterior annular margin. The patient experienced significant relief of low back and leg pain, resuming normal daily activities within 1 month postoperatively. The visual analogue scale (VAS) score decreased from 7 preoperatively to 1, the Japanese Orthopaedic Association (JOA) score reached 25, and the Oswestry Disability Index (ODI) decreased from 68% preoperatively to 12%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Arthroscopic-assisted uni-portal spine surgery via the modified interlaminar approach combined with annular suturing is a safe, feasible, and effective treatment for L5/S1 LDH. Its core advantages include bypassing anatomical barriers such as the high iliac crest, maximizing the preservation of spinal osseous and ligamentous structures, ease of operation, high surgical efficiency, and a low short-term recurrence rate. This procedure is a targeted optimization of the traditional interlaminar approach,","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1807236"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult intracranial pial arteriovenous fistulas: a case report and literature review.","authors":"Hong Chen, Ying Xu, Zhongyue Liu, Yugang Jiang, Ming Wang","doi":"10.3389/fsurg.2026.1759994","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1759994","url":null,"abstract":"<p><p>Intracranial pial arteriovenous fistula (PAVF) is a rare high-flow cerebrovascular lesion defined by a direct shunt between pial/cortical arteries and a single draining vein or venous pouch without a nidus, adult cases are particularly uncommon. A 56-year-old woman presented with sudden severe headache after yoga. CT/MRI revealed a right frontal intracerebral hemorrhage associated with a giant venous pouch, and angiography demonstrated a single-channel PAVF fed by an MCA M2 branch with venous drainage to the superior sagittal and sphenoparietal sinuses. The patient underwent craniotomy for hematoma evacuation, microsurgical fistula disconnection, and venous pouch resection under indocyanine green angiography and FLOW800 guidance. Postoperative CT confirmed complete hematoma removal, and follow-up DSA on day 4 showed total obliteration of the fistula with no residual abnormal drainage. Pathology revealed a vascular malformation with focal calcification. She was discharged neurologically intact and remained symptom-free without recurrence on CTA at 3 months. Adult PAVF is extremely rare but carries a high risk of hemorrhage; early angiographic diagnosis and definitive flow disconnection yield excellent outcomes.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1759994"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion via bilateral channel for lumbar degenerative disease.","authors":"Ji-Hui Zhang, Liang Yu, Jing-Fei Xu, Jin-Ming Han, Xu-Yu Liao, Bo Chai, Liu-Jun Zhao","doi":"10.3389/fsurg.2026.1787824","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1787824","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of bilateral channel minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the management of lumbar degenerative diseases.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of 68 patients diagnosed with lumbar degenerative diseases who underwent surgical intervention at Ningbo No.6 Hospital between April 2021 and February 2022. The patients were categorized into a traditional TLIF group (38 cases) and a bilateral channel MIS-TLIF group (30 cases). Comparative assessments were performed between the two groups in terms of surgical outcomes.</p><p><strong>Results: </strong>All surgical procedures were successfully performed and postoperative follow-up was maintained for (12.7 ± 1.7 months). Statistically significant differences were observed in operation time, intraoperative fluoroscopy frequency, intraoperative blood loss, postoperative drainage volume, and length of hospital stay between two groups. The VAS scores and ODI of the two groups measured at 7 days postoperatively and at the final follow-up were significantly lower than the preoperative values, with statistically significant differences. The fusion rates were 89.5% in the traditional group and 93.3% in the bilateral channel MIS-TLIF group, with no statistically significant differences.</p><p><strong>Conclusion: </strong>Bilateral channel MIS-TLIF is a feasible surgical procedure and it can reduce the surgical duration and radiation exposure associated with intraoperative fluoroscopy.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1787824"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choledochoduodenal fistula paradoxically prevents biliary obstruction: a case report.","authors":"Chengzhen Lyu, Ziqi Guo, Kun He, Xiyi An, Wenyi Deng, Huadan Xue, Gechong Ruan, Qingwei Jiang","doi":"10.3389/fsurg.2026.1752034","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1752034","url":null,"abstract":"<p><strong>Background: </strong>A 38-year-old woman with a 32-year history of recurrent biliary stones (cholecystectomy at age 6 and open choledochotomy with 6-month T-tube indwelling at age 16) presented with 2 h of postprandial right upper quadrant pain. Laboratory tests showed mild hyperbilirubinemia (total bilirubin 24.4 μmol/L, direct bilirubin 8.4 μmol/L) and elevated alanine transaminase of 287 U/L. Abdominal CT scan revealed common bile duct (CBD) stones without pneumobilia. Her symptoms resolved spontaneously before scheduled endoscopic retrograde cholangiopancreatography (ERCP). ERCP showed compensated dilatation of the CBD without residual stones, inadvertent contrast overflowing into the duodenum, a 5-mm choledochoduodenal fistula in the proximal descending duodenum, and a slender distal CBD segment confirmed by intraductal ultrasound. The fistula, further confirmed by enhanced CT, acted as a benign physiological drainage pathway. The slender distal CBD formed a specific pressure gradient, and spontaneous stone passage was achieved via this fistula, which was the core mechanism for the patient's long-term symptom-free survival.</p><p><strong>Conclusion: </strong>Choledochoduodenal fistula can, in rare circumstances, exert a protective rather than deleterious effect in patients with cholelithiasis. This case with a benign clinical course complements the clinical scenario beyond the conventional clinical paradigm that choledochoduodenal fistulas commonly require active intervention.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1752034"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A translational mechanistic synthesis of ischemia-reperfusion injury in experimental flap models toward free flap salvage.","authors":"Ovunc Akdemir","doi":"10.3389/fsurg.2026.1824889","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1824889","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ischemia-reperfusion (I/R) injury remains a principal biological determinant of partial or total flap failure in reconstructive microsurgery. Reperfusion paradoxically initiates a coordinated cascade involving reactive oxygen species generation, lipid peroxidation, neutrophil activation, endothelial dysfunction, and microvascular obstruction, ultimately propagating progressive tissue necrosis. Despite extensive experimental investigation, effective translation into perioperative free flap salvage strategies remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A structured translational synthesis was conducted integrating institutional experimental flap I/R studies performed over two decades with systematically mapped external literature published between 2000 and February 2026. Study identification followed PRISMA-informed search principles to ensure methodological transparency. Data extraction adhered to ARRIVE 2.0 domains to standardize experimental quality assessment. Given predefined biological heterogeneity in flap type, ischemia duration, intervention timing, and outcome definitions, quantitative meta-analysis was not pursued. Instead, biologically stratified comparative analyses were performed, and biologically contextualized viability changes were descriptively evaluated within comparable severe ischemia subgroups to preserve mechanistic interpretability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across experimental platforms, effective interventions demonstrated a reproducible biological signature characterized by attenuation of lipid peroxidation, suppression of neutrophil-mediated inflammation, restoration of endogenous antioxidant defenses, and preservation of nitric oxide bioavailability. In a comparable severe ischemia epigastric island flap paradigm, trimetazidine, propionyl-L-carnitine, and lutein each demonstrated improved survival area relative to ischemic controls within their respective experimental contexts. Surgical conditioning strategies exhibited robust protection, with venous flap pre-arterialization and delay procedures achieving survival rates approaching near-complete viability in the respective model. However, these conditioning strategies are not directly transferable to acute free flap salvage scenarios and are primarily applicable to planned or staged reconstructive settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Flap I/R injury follows a reproducible oxidative stress-inflammation-microvascular dysfunction axis. Interventions targeting multiple components of this cascade appear to demonstrate a more reproducible protective pattern across severe ischemia conditions within their respective experimental contexts. These findings establish a translational mechanistic framework to guide rational adjunctive strategies in high-risk free flap protocols and support prospective clinical integration in microsurgical salvage scenarios. This synthesis is intended to guide mechanistic prioritization rather than im","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1824889"},"PeriodicalIF":1.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}