Journal of reconstructive microsurgery最新文献

{"title":"The Co-Surgeon model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.","authors":"Emmanuel Giannas, Brandon Alba, Kelly A Harmon, Annie Fritsch, David Kurlander, Deana Shenaq, Christodoulos Kaoutzanis, Chris Reid, Evan Matros, Babak Mehrara, George Kokosis","doi":"10.1055/a-2540-0835","DOIUrl":"https://doi.org/10.1055/a-2540-0835","url":null,"abstract":"<p><strong>Background: </strong>Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.</p><p><strong>Methods: </strong>An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeons perspectives on the utility of the co-surgeon model.</p><p><strong>Results: </strong>A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (±9.7) years. Most of the microsurgeons were male (71%) practicing in the US (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with Immediate Lymphatic Reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4% and 36.4% respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves \"very much\" or \"quite a bit\" operative efficiency and duration, as well as surgeon wellbeing and career longevity.</p><p><strong>Conclusion: </strong>This study provides new insight on the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon wellbeing, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting wellbeing among microsurgeons.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492529","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":"Influence and longevity of a microsurgery course for medical students on their future careers: A retrospective report of up to 10 years.","authors":"Lucas Maximilian Ritschl, Alex Grabenhorst, Constantin Tibor Wolff, Katharina Pippich, Dorothea Dick, Pascal Oliver Berberat, Klaus-Dietrich Wolff, Andreas Maximilian Fichter","doi":"10.1055/a-2540-0917","DOIUrl":"https://doi.org/10.1055/a-2540-0917","url":null,"abstract":"<p><p>Background This study evaluates the influence and longevity of a microsurgery course on the future careers of medical students over a period of up to 10 years. The course, which has been well-established for over 15 years, aimed to impart fundamental microsurgical skills through practical exercises using non-biological and biological models. Material and methods This study was conducted as an anonymous online cross-sectional survey. Only students who have completed a microsurgical training course at our department within a ten years period between 2013 and 2023 were eligible for this online survey. This survey aimed to analyze the subjective microsurgical skills at the time of the survey and the influence of the course on further career decisions and development. Results 300 former participants were eligible and 120 answered the survey. Key findings showed that 99.2% of participants rated the course content and the balance of practice to theory as appropriate, with 100% feeling confident in their microsurgical suturing abilities post-course. A significant 87.5% felt competent to perform vascular anastomoses, though only 63.9% felt confident about nerve coaptation. Statistical analysis indicated no significant gender differences in course evaluations, though some differences were noted between semester-accompanying and block course participants. 54.2% of respondents reported using their microsurgical skills in their subsequent medical careers, and 50.4% indicated that the course influenced their medical specialization choices. Conclusions The study concludes that early exposure to microsurgical training can significantly impact students' skills and career trajectories, supporting the integration of such courses into medical education curricula to enhance surgical training and professional development.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441216","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 Review of Minimally Invasive Techniques for Perfusion Optimization of Flaps.","authors":"Micaela J Tobin, Charlotte Thomas, Tricia Mae Raquepo, Mohammed Yamin, Audrey K Mustoe, Agustin N Posso, Jose Foppiani, Ryan P Cauley","doi":"10.1055/a-2540-1044","DOIUrl":"https://doi.org/10.1055/a-2540-1044","url":null,"abstract":"<p><p>Background There is a growing emphasis on minimally invasive techniques as an alternative to surgical delay to promote vessel reorganization and prevent partial and total flap loss. This systematic review evaluates existing literature on these minimally invasive techniques, focusing on their potential applications in preventing ischemia-related complications. Methods A systematic review was conducted in July 2024 using PubMed, MEDLINE, and Web of Science following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria were studies that included patients undergoing any flap-based reconstruction treated with minimally invasive delay. Exclusion criteria were non-English papers, other systematic reviews, nonhuman patients, and pediatric patients. Results Six studies were included (angiographic delay n=143, heat preconditioning n=191, ischemic preconditioning n=60) which examined minimally invasive methods for perfusion optimization. Aggregated data from the three studies on angiographic delay demonstrated a 13% (18/143) combined skin or fat flap necrosis rate, which was lower than that of non-delayed flaps and comparable to more invasive traditional surgical ligation. Ischemic preconditioning showed no significant differences (p=1.0) g compared to controls, whereas heat preconditioning led to reductions (26% vs. 35%) in flap necrosis and necrosis requiring surgical intervention (11% vs. 17%). Conclusion Angiographic embolization presents a promising alternative to invasive surgical delay, effectively reducing flap necrosis risk. Heat and ischemic preconditioning also show potential for increasing flap survival, although current studies are limited by small sample sizes. Further research is essential to explore preoperative conditioning interventions to improve surgical outcomes for patients who require less invasive delay techniques.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441198","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 SIEA/SCIA and DIEP Flaps for Autologous Breast Reconstruction.","authors":"Sydney Somers, Brittany Foley, Aaron Dadzie, Chase Hart, Joanna Chen, Catie Bautista, Kaylee Scott, Devin Eddington, Jayant P Agarwal, Alvin C Kwok","doi":"10.1055/a-2540-0987","DOIUrl":"https://doi.org/10.1055/a-2540-0987","url":null,"abstract":"<p><p>Background The deep inferior epigastric perforator (DIEP) flap is considered the gold standard for autologous breast reconstruction. Less commonly used abdominal flaps include the superficial inferior epigastric artery (SIEA) and the superficial circumflex iliac artery (SCIA) flaps which are based on the superficial vasculature of the abdominal wall. We sought to compare complication rates between DIEP and superficial system flaps and their associated risk factors. Methods A retrospective chart review of 400 breast cancer patients undergoing abdominally-based free flap breast reconstruction with either a DIEP or superficial flap from January 2017 to December 2023 was performed at a single institution. The primary outcome was breast and abdominal site complications. Results A total of 638 flaps, 571 (89.4%) DIEP and 67 (10.5%) superficial, were performed with flap complication rates of 27.3% and 22.4% respectively. At the recipient site, there was a significant difference in the rate of postoperative thrombosis (0.7% vs. 4.5%, p=0.015); however, there were no differences for flap failure (0.4% vs. 1.5%, p=0.28) or other flap complications. Donor site outcomes were similar between groups. Although not statistically significant, abdominal bulging was seen in 18 DIEP flap patients compared to none observed in the superficial flap patients (p=0.24). When controlling for age, BMI, and radiation history, the overall rate of superficial flap and abdominal complications was not statistically significant from the rate of DIEP flap complications (p=0.576). Conclusion Compared to DIEP flaps, superficial flaps had significantly higher rates of immediate perioperative thrombosis. However, there were no significant differences in rates of flap failure or other flap complications with superficial flaps compared to DIEP flaps. There was a clinically significant trend toward increased abdominal bulging with the use of DIEP flaps. Our results will help surgeons better understand the risks and benefits associated with superficial flaps for autologous breast reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441194","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":"Risk of Plate Exposure in Vascularized Fibula Flap for Mandibular Reconstruction in Primary Oral Cancers.","authors":"Ashwin Alke Pai, Angela Chien-Yu Chen, Charles Yuen Yung Loh, Shao-Yu Hung, Chung-Kan Tsao, Huang-Kai Kao","doi":"10.1055/a-2540-0737","DOIUrl":"https://doi.org/10.1055/a-2540-0737","url":null,"abstract":"<p><strong>Background: </strong>To investigate the risk factors for plate exposure in primary oral cancer patients with mandibular defects undergoing tumor ablation followed by vascularized free fibular flap (FFF) transfer, we conducted a retrospective observational study in a single institution in Taiwan.</p><p><strong>Methods: </strong>Between 2015 and 2019, a total of 292 primary oral cancer patients who underwent FFF reconstruction was performed. A variety of clinicopathological, surgical together with post-operative parameters were identified and assessed. The data was statistically analyzed with univariate and multivariate logistic regression and the probability of plate exposure-free rate was plotted as Kaplan-Meier survival curve.</p><p><strong>Results: </strong>The overall plate exposure rate was 28.76 %. The re-exploration group had a higher rate of plate exposure than patients without re-exploration (12.2% vs. 5%, p <0.05). The 3-year probability of plate exposure-free rate in patients with (n =216) and without (n =76) post-operative radiotherapy were 65.9% and 92.5%, and in patients with (n =141) and without (n= 151) post-operative wound infection were 55.3% and 91.2%, respectively. The multivariate logistic regression showed post-operative radiotherapy and wound infection were independent risk factors for developing plate exposure (adjusted odds ratio [95% CI]: 3.73 [1.37-10.68] and 10.71 [5.15-22.26], p = 0.01 and p <0.001, respectively). More patients required surgical intervention to manage the exposure of hardware. <b>Conclusions: </b>Our study has highlighted that post-operative radiotherapy and post-operative wound infection are independent risk factors for plate exposure.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441240","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":"Optimal Strategies for the Management of Macromastia and Breast Ptosis for Patients Undergoing Nipple-sparing Mastectomy.","authors":"Andrea A Moreira, Erica Kozorosky, Suzanne B Coopey","doi":"10.1055/a-2508-6495","DOIUrl":"https://doi.org/10.1055/a-2508-6495","url":null,"abstract":"<p><p>High-volume breasts pose challenges for nipple-sparing mastectomy (NSM) due to their large size, indistinct tissue boundaries, and high degree of ptosis. Historically, NSM was not considered feasible for such cases, but advancements in surgical techniques have expanded eligibility criteria.We developed a surgical algorithm for patients with macromastia and ptosis undergoing NSM. We also outline techniques for preserving the nipple-areolar complex (NAC) based on the severity of macromastia and breast ptosis, especially when immediate mastopexy/reduction is required during mastectomy. The proposed algorithm provides a practical guide for surgeons managing these complex cases.By employing carefully selected approaches, it is possible to successfully preserve the NAC in high-volume breasts undergoing NSM. This broader eligibility criteria not only accommodates a more diverse patient population but also enhances their quality of life and improves aesthetic outcomes.Advancements in surgical techniques have made NSM a viable option for breast reconstruction in high-volume breasts. By addressing challenges and preserving the NAC through carefully selected approaches, surgeons can improve outcomes and quality of life for patients undergoing NSM.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414463","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":"Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction Is Cost-Effective.","authors":"K Lynn Zhao, Alexander J Kammien, Elena Graetz, Miranda S Moore, Brogan G Evans, Eric B Schneider, Haripriya S Ayyala","doi":"10.1055/a-2517-0803","DOIUrl":"10.1055/a-2517-0803","url":null,"abstract":"<p><strong>Background: </strong> Simultaneous symmetrizing surgery (SSS) at the time of unilateral free flap reconstruction has been described as a method to facilitate single-stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described.</p><p><strong>Methods: </strong> Patients with unilateral free flap reconstruction were identified in national administrative data from 2017 to 2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with and without SSS. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma, and thromboembolism. The costs of initial hospitalization and subsequent surgeries were determined. Deferred symmetrizing surgeries within one year were identified. Chi-squared and Fisher exact tests and Wilcoxon tests were used for statistical analysis.</p><p><strong>Results: </strong> A total of 1,136 patients were identified, out of which 638 were delayed reconstructions: 75 with SSS and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with SSS underwent revision surgery (29% vs. 51%, [<i>p</i> = 0.001]) or at least one additional procedure (36% vs. 57%, <i>p</i> < 0.001). Patients with SSS had lower total costs ($35,897 vs. $50,521, <i>p</i> = 0.005). There were 498 immediate reconstructions: 63 with SSS and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries, or total costs.</p><p><strong>Conclusion: </strong> Symmetrizing procedures at the time of unilateral reconstruction may decrease the cost and number of subsequent surgeries without increasing complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007249","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":"Experimental Cranial Nerve Models in the Rat.","authors":"Huseyin Karagoz, Feng Zhang, Sara C Chaker, William C Lineaweaver","doi":"10.1055/s-0044-1787729","DOIUrl":"10.1055/s-0044-1787729","url":null,"abstract":"<p><strong>Background: </strong> The intricacies of nerve regeneration following injury have prompted increased research efforts in recent years, with a primary focus on elucidating regeneration mechanisms and exploring various surgical techniques. While many experimental animals have been used for these investigations, the rat continues to remain the most widely used model due to its cost-effectiveness, accessibility, and resilience against diseases and surgical/anesthetic complications. A comprehensive evaluation of all the experimental rat models available in this context is currently lacking.</p><p><strong>Methods: </strong> We summarize rat models of cranial nerves while furnishing descriptions of the intricacies of achieving optimal exposure.</p><p><strong>Results: </strong> This review article provides an examination of the technical exposure, potential applications, and the advantages and disadvantages inherent to each cranial nerve model.</p><p><strong>Conclusion: </strong> Specifically in the context of cranial nerve injury, numerous studies have utilized different surgical techniques to expose and investigate the cranial nerves in the rat.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"133-143"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419559","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":"Blunt Trauma Induced Closed Femoral Bone Fracture in a Rat Model: Are Vessels Safe to Use for Microsurgery? Further Insight into the Zone of Injury Concept.","authors":"Karaca Basaran, Asli Datli, Mehmet Sagir, Mehmet Sar, Esra Bilgi","doi":"10.1055/a-2332-0263","DOIUrl":"10.1055/a-2332-0263","url":null,"abstract":"<p><strong>Background: </strong> The study aims to investigate the zone of injury for major vessels after high-velocity traumas, as it is unclear whether avoiding vascular structures is necessary during microvascular anastomosis or how long it takes for them to be used again.</p><p><strong>Methods: </strong> This study uses Doppler ultrasonography and a rat model to evaluate the histopathological changes and flow velocity of major vessels in the zone of injury after high-velocity trauma with closed femoral bone fracture. Osteosynthesis was performed using an intramedullary wire. Samples were collected from day 3 and week 3. The unaffected contralateral side is used as control.</p><p><strong>Results: </strong> Results from arterial and venous flow assessments showed no evidence of ischemia in the extremities. Both arteries and veins were patent in both intervals and on the control side. The evaluation of the vessels showed arterial injury with a slightly reduced arterial flow on day 3 and week 3. The venous flow was slightly reduced on day 3 but not on week 3. Statistically, arterial endothelial injury was higher on day 3 than on week 3 (<i>p</i> = 0.006). Media inflammation was also higher on day 3 (<i>p</i> = 0.06). Arterial endothelization distribution was higher in week 3 (<i>p</i> = 0.006). No significant differences were found in arterial media irregularity, necrosis, platelet aggregation, bleeding, and wall rupture. Venous samples showed no significant differences in any parameter (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong> High-velocity trauma increases the risk of thrombosis in vessels. Intravascular repair can start on day 2 and continue till week 3 with significant endothelization. Although physiologic findings do not alter arterial or venous flow, histologic findings support vessel injuries leading to potential complications. Microsurgery should be considered out of the injury zone until adequate vessel healing is achieved.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"149-155"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087333","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":"Investigating the Thickness of the Deltoid Free Flap Using Ultrasonography and Clinical Application in Foot and Hand Soft-Tissue Defect Reconstruction.","authors":"Nguyen Ngoc-Huyen, Nguyen The-Hoang, Nguyen Quang-Vinh, Rainer Staudenmaier","doi":"10.1055/s-0044-1791255","DOIUrl":"10.1055/s-0044-1791255","url":null,"abstract":"<p><strong>Background: </strong> Although the deltoid flap is widely described as a thin flap, no studies have reported on the measurement of its thickness. Thus, this study aimed to measure deltoid flap thickness at different points using brightness-mode ultrasonography and report our initial clinical experience.</p><p><strong>Methods: </strong> This study included 36 adults (26 males and 10 females; mean age: 34 years) with 72 healthy deltoid regions. Ultrasonography was employed to measure flap thickness at eight designated positions. The ultrasonography results were also applied clinically in 30 patients to evaluate its compatibility.</p><p><strong>Results: </strong> The mean deltoid flap thickness was 5.14 ± 0.81 mm, with the thickest point being the emerging point of the flap pedicle. The subcutaneous fat gradually thinned toward the shoulder. No significant differences in the subcutaneous fat layer thickness were observed between the right and left sides, different ages, or the two sexes. Body mass index was the most critical factor related to flap thickness (<i>p</i> < 0.001). All deltoid free flaps were successfully transferred, resulting in good or excellent final clinical outcomes.</p><p><strong>Conclusion: </strong> The ultrasonography results suggest harvesting the deltoid flap upward toward the shoulder area and across the acromion from the emerging position of the flap pedicle to optimize flap thinness. The results showed that besides the flaps that have been clinically well established, the deltoid flap should be considered a valuable alternative for reconstructing limb soft-tissue defects, particularly where thin flaps are required and favorable aesthetic results are crucial.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"123-132"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348960","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}