Journal of reconstructive microsurgery最新文献

{"title":"Tensile Strength of Nerve Bridging Models Using Collagen Nerve Conduits.","authors":"Yusuke Hattori, Shinsuke Takeda, Takuya Usami, Ryutaro Shibata, Hiroshi Takahashi, Yuji Joyo, Yohei Kawaguchi, Hideki Okamoto, Hideki Murakami, Permsak Paholpak, Hideyuki Ota","doi":"10.1055/a-2387-3282","DOIUrl":"10.1055/a-2387-3282","url":null,"abstract":"<p><strong>Background: </strong> In the treatment of peripheral nerve injuries with nerve defects, second-generation collagen-based conduits, such as Renerve® (Nipro, Osaka, Japan), have shown the potential for promoting nerve regeneration. However, there is concern related to the weak material properties. No previous studies have addressed the strength of the bridging model using collagen conduits. This study aimed to investigate the tensile strength and failure patterns in nerve defect models bridged with Renerve® conduits through biomechanical research.</p><p><strong>Methods: </strong> Using fresh chicken sciatic nerves, we examined the maximum failure load of four groups: bridging models using Renerve® with one suture (group A), with two sutures (group B), with three sutures (group C), and end-to-end neurorrhaphy models with two sutures (group N). Each group had eight specimens. We also evaluated failure patterns of the specimens.</p><p><strong>Results: </strong> Group N showed a significantly higher maximum failure load (0.96 ± 0.13 N) compared to groups A (0.23 ± 0.06 N, <i>p</i> < 0.0001), B (0.29 ± 0.05 N, <i>p</i> < 0.0001), and C (0.40 ± 0.10 N, <i>p</i> < 0.0001). Regarding failure patterns, all specimens in group A showed nerve-end dislocation from the conduit. Two specimens in group B and three specimens in group C failed due to circumferential cracks in the conduit. Six specimens in group B and five specimens in group C exhibited cutting out of sutures from the conduit.</p><p><strong>Conclusion: </strong> This study suggests that the number of sutures in synthetic collagen nerve conduits has little effect on the maximum failure load. To take advantage of its biomaterial benefits, a period of postoperative range of motion restriction may be required.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"383-389"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141982555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Postoperative Outcomes Based on Muscle versus Fasciocutaneous Flaps in Scalp Reconstruction: A Systematic Review and Meta-analysis.","authors":"Eloise W Stanton, Asli Pekcan, Idean Roohani, Deborah Choe, Joseph N Carey, David A Daar","doi":"10.1055/a-2404-2539","DOIUrl":"10.1055/a-2404-2539","url":null,"abstract":"<p><strong>Background: </strong> Scalp reconstruction in plastic and reconstructive surgery often necessitates the transfer of soft-tissue flaps to restore form and function. The critical decision lies in choosing between muscle-containing (MC) and fasciocutaneous (FC) flaps for scalp reconstruction, and while both variants have their merits, flap composition remains a subject of ongoing debate. This scientific discussion aims to explore this contentious issue through a comprehensive meta-analysis, shedding light on the rationale behind the choice of these flaps and the potential impact on clinical outcomes.</p><p><strong>Methods: </strong> A comprehensive systematic review was conducted following PRISMA-P guidelines, encompassing six prominent databases up to the year 2023. Data were collected from studies assessing outcomes of MC and FC flaps for scalp reconstruction. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool. Statistical analysis included descriptive statistics, meta-analysis, sensitivity analysis, and assessment of bias using STATA software.</p><p><strong>Results: </strong> The meta-analysis included 28 nonrandomized studies, totaling 594 flaps (MC: 380, FC: 214). MC flaps were significantly larger than FC flaps. There were no significant differences in flap loss, flap necrosis, or wound dehiscence between the two flap types. However, the incidence of venous congestion was significantly higher in FC flaps. Sensitivity analysis confirmed the robustness of results, and publication bias assessment showed no significant evidence of bias.</p><p><strong>Conclusion: </strong> While both MC and FC flaps offer viable options for scalp reconstruction, the choice should be tailored to individual patient characteristics and defect size. FC flaps may provide advantages such as shorter operative times and reduced morbidity, whereas MC flaps could be preferred for addressing larger defects. Future research should focus on prospective studies and strategies to mitigate venous congestion in FC flaps, enhancing their safety and efficacy in scalp reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"424-431"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiosome-Guided Perfusion Decellularization of Fasciocutaneous Flaps.","authors":"Liya Yang, Xueshan Bai, Yuanbo Liu, Shan Zhu, Shanshan Li, Zixiang Chen, Tinglu Han, Shengyang Jin, Mengqing Zang","doi":"10.1055/a-2404-2608","DOIUrl":"10.1055/a-2404-2608","url":null,"abstract":"<p><strong>Background: </strong> Tissue engineering based on whole-organ perfusion decellularization has successfully generated small-animal organs, including the heart and limbs. Herein, we aimed to use angiosome-guided perfusion decellularization to develop an acellular fasciocutaneous flap matrix with an intact vascular network.</p><p><strong>Methods: </strong> Abdominal flaps of rats were harvested, and the vascular pedicle (iliac artery and vein) was dissected and injected with methylene blue to identify the angiosome region and determine the flap dimension for harvesting. To decellularize flaps, the iliac artery was perfused sequentially with 1% sodium dodecyl sulfate (SDS), deionized water, and 1% Triton-X100. Gross morphology, histology, and DNA quantity of flaps were then obtained. Flaps were also subjected to glycosaminoglycan (GAG) and hydroxyproline content assays and computed tomography angiography.</p><p><strong>Results: </strong> Histological assessment indicated that cellular content was completely removed in all flap layers following a 10-hour perfusion in SDS. DNA quantification confirmed 81% DNA removal. Based on biochemical assays, decellularized flaps had hydroxyproline content comparable with that of native flaps, although significantly fewer GAGs (<i>p</i> = 0.0019). Histology and computed tomography angiography illustrated the integrity and perfusability of the vascular system.</p><p><strong>Conclusion: </strong> The proposed angiosome-guided perfusion decellularization protocol could effectively remove cellular content from rat fasciocutaneous flaps and preserve the integrity of innate vascular networks.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"405-414"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flap-Based Reconstruction in Patients with Autoimmune Disease: An Institutional Experience with the Deep Inferior Epigastric Perforator Flap and Review of the Literature.","authors":"Artur Manasyan, Eloise W Stanton, Tayla Moshal, David A Daar, Joseph N Carey, Emma Koesters","doi":"10.1055/a-2383-4617","DOIUrl":"10.1055/a-2383-4617","url":null,"abstract":"<p><strong>Background: </strong> Autoimmune diseases are associated with characteristic chronic inflammation, aberrations in tissue perfusion, and hypercoagulability, and thus have considerable implications for local and free-flap reconstruction. We seek to summarize the current evidence on outcomes of flap-based reconstruction in patients with pre-existing autoimmune disease and present our experience with autologous breast reconstruction in this population.</p><p><strong>Methods: </strong> PubMed, Embase, Scopus, Cochrane, and Web of Science were searched for relevant articles, and pertinent data were presented qualitatively. Institutional data were queried for patients who underwent autologous breast reconstruction with deep inferior epigastric perforator (DIEP) flaps between 2015 and 2024. A retrospective review was conducted to identify DIEP patients with a history of autoimmune disease. Data on patient demographics, medication history, flap outcomes, and perioperative complications were collected.</p><p><strong>Results: </strong> The majority of existing studies found no increased independent risk of flap complications. However, other complications, predominantly wound dehiscence, were independently associated with autoimmune disease. Regarding immunosuppressant therapy, the literature demonstrated that perioperative glucocorticoid use was consistently associated with all complications, including seroma, infection, wound disruption, and partial flap loss.Our 13-patient institutional experience identified no cases of total flap loss or microvascular thrombotic complications. There was one case of partial flap necrosis further complicated by abdominal site cellulitis, and one case of recipient-site dehiscence managed with local wound care. No patients required re-operation for flap or donor-site complications.</p><p><strong>Conclusion: </strong> The literature suggests that flap reconstruction can be performed safely in patients with autoimmune conditions, which was also supported by our institutional experience. While there is likely minimal risk of microsurgical complications in the context of free tissue transfer, donor-site morbidity and wound dehiscence remain major concerns for patients with a history of autoimmune disease. Limiting the use of immunosuppressive agents, especially corticosteroids, may potentially improve outcomes of flap reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"390-397"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevating Lower Extremity Reconstruction: An Algorithmic Approach to Free Flap Re-elevation.","authors":"Jessica R Nye, David T Mitchell, Michael T Talanker, David C Hopkins, Ellen Wang, Chioma G Obinero, Jose E Barrera, Matthew R Greives, Yuewei Wu-Fienberg, Mohin A Bhadkamkar","doi":"10.1055/a-2404-2759","DOIUrl":"10.1055/a-2404-2759","url":null,"abstract":"<p><strong>Background: </strong> Free flap (FF) reconstruction is frequently required for soft-tissue coverage after significant orthopaedic trauma of the lower extremity (LE). While usually the final step in limb salvage, re-elevation of the previously inset FF may be necessary to restore a functional limb. In this study, we present our algorithm for LE FF re-elevation and review our experience to identify factors associated with successful limb salvage and return to ambulation.</p><p><strong>Methods: </strong> A retrospective, single-institution review was conducted of adult patients with LE wounds who required FF reconstruction from 2016 to 2021. From this cohort, patients who required re-elevation of their LE FF were identified. Successful FF re-elevation was defined by limb salvage and return to ambulation.</p><p><strong>Results: </strong> During the study period, 412 patients with LE wounds required flap reconstruction. Of these patients, 205 (49.8%) underwent free tissue transfer, and 39 (9.5%) met our inclusion criteria. From this cohort, 34 had successful FF re-elevation, while 1 was non-weight bearing and 4 were elected for amputation due to chronic complications unrelated to their FF. Univariate analysis revealed the total number of FF re-elevations (<i>p</i> < 0.001), the frequency of re-elevation indicated for orthopaedic access (<i>p</i> < 0.001), and infections necessitating return to the operating room (<i>p</i> = 0.001) were each negatively associated with limb salvage and return to ambulation.</p><p><strong>Conclusion: </strong> The described algorithm highlights the preoperative planning and meticulous flap preservation necessary for the successful coverage of critical structures following FF re-elevation. Our data demonstrate that LE FFs can be safely re-elevated for hardware access or flap revision. In these complex cases of LE trauma, management by a multidisciplinary team is essential for successful limb salvage.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"415-423"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications.","authors":"Brooke E Porter, Thalia C Anderson, Angela S Ash, Sarah E Langsdon, Leanna M Zelle, Thomas D Willson","doi":"10.1055/a-2404-7899","DOIUrl":"10.1055/a-2404-7899","url":null,"abstract":"<p><strong>Background: </strong> Microsurgical free tissue transfer has become an essential method for reconstruction of complex surgical defects, making the level of training an important factor to consider. There is little published regarding the impact of training level on microsurgical outcomes. This study investigates microsurgical free tissue transfer ischemia time and postoperative complications based on resident and attending surgeon experience level.</p><p><strong>Methods: </strong> A retrospective review of all free flaps at a single institution from January 1, 2013, to December 31, 2021 was performed. Linear regression was performed analyzing ischemia time of 497 free flaps and attending surgeon experience defined by years in practice and resident level defined as postgraduate year (PGY). Logistic regression model was used to analyze complications based on attending experience and resident level.</p><p><strong>Results: </strong> The average resident PGY was 3.5 ± 0.8; the average attending has been practicing for 6.4 ± 5.1 years. There was no statistically significant difference in ischemia time or complication rates based on resident PGY or attending surgeon experience level.</p><p><strong>Conclusion: </strong> Lower PGY residents were not found to increase ischemia time or increase complication rates. Lower attending surgeon year was not found to increase ischemia time or increase complication rates compared with surgeons who had been practicing for longer. Microsurgical free tissue transfer is considered a safe procedure in residency training and trainee involvement should be encouraged to improve resident education and enhance technical skills.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"443-449"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accessibility of Neurotization in Deep Inferior Epigastric Perforator Flap Reconstruction: Inequities and Implications for Preauthorization.","authors":"Rachel E Schafer, Joseph D Quick, Madeleine M Blazel, Priya Shukla, Shannon S Wu, Raffi Gurunian, Steven Bernard, Sarah N Bishop, Graham Schwarz, Risal Djohan","doi":"10.1055/a-2404-1924","DOIUrl":"10.1055/a-2404-1924","url":null,"abstract":"<p><strong>Background: </strong> Breast anesthesia and hypoesthesia occur commonly after mastectomy and negatively impact quality of life. Neurotization during deep inferior epigastric perforator (DIEP) breast reconstruction offers enhanced sensory recovery. However, access to neurotization for DIEP reconstruction patients has not been evaluated.</p><p><strong>Methods: </strong> This retrospective study included patients who underwent DIEP breast reconstruction between January 2021 and July 2022 at a tertiary-care, academic institution. Demographics, outcomes, insurance type, and Area Deprivation Index (ADI) were compared using two-sample <i>t</i>-test or chi-square analysis.</p><p><strong>Results: </strong> Of the 124 patients who met criteria, 41% had neurotization of their DIEP flaps. There was no difference in history of tobacco use (29% vs 33%), diabetes (14% vs 9.6%), operative time (9.43 vs 9.73 h), length of hospital stay (3 d vs 3 d), hospital readmission (9.8% vs 6.8%), or reoperation (12% vs 12%) between patients with and without neurotization. However, access to neurotization differed significantly by patient health insurance type. Patients who received neurotization had a lower median ADI percentile of 40.0, indicating higher socioeconomic advantage compared with patients who did not receive neurotization at 59.0 (<i>p</i> = 0.01).</p><p><strong>Conclusion: </strong> Access to neurotization differed significantly by patient health insurance and by ADI percentile. Expanding insurance coverage to cover neurotization is needed to increase equitable access and enhance quality of life for patients who come from disadvantaged communities. Our institution's process for preauthorization is outlined to enhance likelihood of insurance approval for neurotization.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"398-404"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computer-Aided Design and Manufacturing to Facilitate Microvascular Free Tissue Transfer in Extremity, Pelvic, and Spinal Reconstructions.","authors":"Alec D Simoni, Justin E Bird, Patrick P Lin, Laurence D Rhines, Alexander F Mericli","doi":"10.1055/a-2404-7819","DOIUrl":"10.1055/a-2404-7819","url":null,"abstract":"<p><strong>Background: </strong> Numerous surgical fields have embraced computer-aided design and computer-aided manufacturing (CAD/CAM), including plastic and reconstructive surgery. However, most of the literature and clinical use pertains to reconstruction of the head and neck. Herein, we provide a case series and systematic review of the literature, documenting the use of CAD/CAM in facilitating complex microvascular free tissue transfer for reconstructions involving the extremities, pelvis, and spine (EPS).</p><p><strong>Methods: </strong> This study consisted of two components: a case series and a systematic review of the literature. For the case series, the senior author's cases that included CAD/CAM to assist microvascular free tissue transfer reconstructions of the EPS were included. For the systematic review, all PubMed-, Scopus-, and Google Scholar-indexed studies describing the use of CAD/CAM to facilitate free tissue transfer in the EPS were identified and included using PRSMA guidelines.</p><p><strong>Results: </strong> The case series identified 10 patients who received CAD/CAM-assisted microvascular reconstruction. Our systematic review identified 15 articles, representing 124 patients and 133 CAD/CAM-assisted free tissue transfers. Most authors believed that CAD/CAM facilitated a more efficient operation by shifting much of the intraoperative planning to the preoperative phase, ultimately translating to a shorter and more accurate surgery with improved function and cosmesis.</p><p><strong>Conclusion: </strong> CAD/CAM can be used to facilitate microvascular reconstruction of the EPS. Our cases series and systematic review suggest that CAD/CAM for EPS surgery may improve outcomes.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"432-442"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Risk Analysis Index Frailty Scores as a Predictor of Adverse Outcomes in Lower Extremity Reconstruction.","authors":"Kylie R Swiekatowski, Jose E Barrera, David Hopkins, Arvind D Manisundaram, Mohin A Bhadkamkar, Yuewei Wu-Fienberg","doi":"10.1055/a-2383-6916","DOIUrl":"10.1055/a-2383-6916","url":null,"abstract":"<p><strong>Background: </strong> The rising clinical importance of assessing frailty is driven by its predictive capability for postoperative outcomes. This study assesses the effectiveness of RAI-rev (Revised Risk Analysis Index) in predicting adverse outcomes in lower extremity (LE) flap reconstruction.</p><p><strong>Methods: </strong> Analyzing NSQIP (National Surgical Quality Improvement Program) data from 2015 to 2020, we compared demographics, perioperative factors, and 30-day outcomes in all locoregional and free-flap cases. Frailty scores, calculated using RAI-rev, were categorized with <15 as nonfrail and >35 as the most frail. Adjusted odds ratios (aORs) for specific complications were calculated using nonfrail as the reference group. Frailty scores in locoregional flaps were compared with those in free flaps.</p><p><strong>Results: </strong> We identified 270 locoregional and 107 free-flap cases. Higher RAI-rev scores in locoregional flaps correlated with increased complications, such as deep surgical site infection (1% nonfrail vs. 20% RAI 31-35), stroke (0% nonfrail vs. 17% most frail), and mortality (0% nonfrail vs. 17% most frail). Locoregional flap cases with RAI-rev scores in the most frail group had a significantly elevated aOR for stroke (51.0, 95% confidence interval [CI]: 1.8-1402.5, <i>p</i> = 0.02), mortality (43.1, 95% CI: 1.6-1167.6, <i>p</i> = 0.03), and any complication (6.8, 95% CI: 1.2-37.4, <i>p</i> = 0.03). In free-flap cases, higher RAI-rev scores were associated with increased complications, with only sepsis showing a statistically significant difference (6% nonfrail vs. 100% most frail; aOR: 42.3, CI: 1.45-1245.3, <i>p</i> = 0.03). Free-flap cases had a significantly lower RAI-rev score compared with locoregional flap cases (14.91 vs. 17.64, <i>p</i> = 0.01).</p><p><strong>Conclusion: </strong> Elevated RAI-rev scores (>35) correlated with more complications in locoregional flaps, while free-flap reconstruction patients had generally low RAI-rev scores. This suggests that free flaps are less commonly recommended for presumed higher risk patients. The study demonstrates that RAI-rev may be able to serve as a risk calculator in LE reconstruction, aiding in the assessment of candidates for limb salvage versus amputation.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"376-382"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transabdominal Robotic Harvest of Bilateral DIEP Pedicles in Breast Reconstruction: Technique and Interdisciplinary Approach.","authors":"Daniel Murariu, Brian Chen, Elizabeth Bailey, William Nelson, Richard Fortunato, Stanislav Nosik, Andrea Moreira","doi":"10.1055/s-0044-1788930","DOIUrl":"10.1055/s-0044-1788930","url":null,"abstract":"<p><strong>Background: </strong> The deep inferior epigastric artery perforator (DIEP) flap is the gold standard for autologous breast reconstruction. However, the conventional procedure's anterior sheath division, from perforating vessels to the pedicle origin, risks weakening the abdominal wall's primary strength layer. Employing the da Vinci Xi Surgical System with indocyanine green dye and near-infrared fluorescence imaging, we refined a robotic technique for bilateral DIEP flap harvest. This approach enhances safety during vessel dissection, utilizing smaller fascial incisions. This study will present this technique in detail to microsurgeons interested in robotic DIEP flaps.</p><p><strong>Methods: </strong> In a retrospective cohort study spanning July 2021 to September 2022, female patients undergoing robotic bilateral DIEP flap reconstruction were analyzed. Following suprafascial flap dissection, the surgical robot was docked to target the pelvis, identifying and exposing deep inferior epigastric vessels intracorporeally. Mobilization and division occurred at their bases, with retrieval through a minimal anterior fascial incision, minimizing disruption to the abdominal wall and its motor innervation.</p><p><strong>Results: </strong> The study comprised 23 patients (46 flaps), with a mean fascial length of 4.1 cm and mean pedicle length of 12.82 cm. Mesh usage was absent. Robotic time averaged 139 minutes, overall case length was 739 minutes, and the average length of stay was 3.9 days. Notably, no pedicle or intra-abdominal injuries were reported.</p><p><strong>Conclusion: </strong> This technique ensures safe and efficient pedicle dissection in robotic DIEP flap harvests. Given the limited number of plastic surgeons adept in minimally invasive abdominal surgeries, we recommend collaborative efforts, with general surgeons initially assisting microsurgeons in adopting the robotic approach. This strategy facilitates a smooth transition until plastic surgeons attain confidence and competence in independent robotic dissection.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"369-375"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}