Journal of reconstructive microsurgery最新文献

{"title":"Evaluating the Merit and Applications of the Caprini Risk Score as a Complication Predictor.","authors":"Kristina Khaw, India Jones, Alec H Fisher, Krystal Hunter, Steven Bonawitz","doi":"10.1055/a-2555-2118","DOIUrl":"https://doi.org/10.1055/a-2555-2118","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) is considered a complication of free flap surgery. Prior studies investigating the use of Caprini Risk Score (CRS) to estimate risk of complications in free flap reconstruction are confounded by small sample sizes, varying surgical sites, and disparate classification of risk. This study evaluates the predictive merit of CRS for complications in free flap reconstructions.</p><p><strong>Methods: </strong>A retrospective review of patients (n=502) who underwent free flap reconstruction from January 2015 to April 2022 collected patient medical history, type and location of free tissue transfer, CRS, and prior and perioperative anticoagulation (AC). Reconstructive outcomes and complications were analyzed in low (CRS<8) and high (CRS≥8) cohorts using chi-squared tests. Complications were also analyzed by flap sites in sufficient cohort populations (n>10).</p><p><strong>Results: </strong>Of 502 patients, the high CRS cohort (n=71) were associated with upper (p<0.005) and lower (p<0.001) extremity reconstructions while the low CRS (n=431) cohort were associated with breast reconstructions (p<0.001). The high CRS cohort demonstrated an increased need for intraoperative blood transfusions (p<0.001). Other intra-operative or post-operative complications such as flap loss, intraoperative AC, return to OR, or VTE had no significant correlations. High CRS patients were more likely to be discharged on AC (p<0.001) and have a longer length of stay (LOS) (p<0.001). By flap site, there was a significant association between CRS and LOS >14 days in breast and head and neck flaps (p<0.05) and discharge on AC in head and neck flaps only (p<0.001).</p><p><strong>Conclusion: </strong>CRS may have utility in predicting the need for blood transfusion and AC requirements in free flap reconstruction but does not seem to predict incidence of flap complications. A larger, higher-powered study may be used to assess the validity of CRS in risk of VTE and anticoagulant prophylaxis.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605267","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":"Optimizing Postoperative Anticoagulation Regimen To Improve Lower Extremity Free Flap Outcomes.","authors":"Kylie Swiekatowski, Delani Woods, Ellen Wang, Edwin Acevedo, David Hopkins, Mohin A Bhadkamkar, Yuewei Wu-Fienberg","doi":"10.1055/a-2555-2252","DOIUrl":"https://doi.org/10.1055/a-2555-2252","url":null,"abstract":"<p><strong>Purpose: </strong>Free flap reconstruction for lower extremity (LE) trauma has a higher failure rate than free flaps in other anatomic regions. Post-operative anticoagulation and antiplatelet therapy may influence LE free flap outcomes, but an optimal regimen has not been established. This study aims to evaluate complication rates associated with different anticoagulation and antiplatelet protocols in LE free flap reconstruction.</p><p><strong>Methods: </strong>Adult patients (≥18 years of age) with LE trauma requiring free flap reconstruction at our level 1 trauma center from 2016-2021 were included for retrospective chart review. Complications requiring reoperation were grouped into a composite variable named major complications (i.e. hematoma, flap thrombosis, flap necrosis >10%, infection requiring reoperation). Non-randomized patients were categorized into three groups based on postoperative anticoagulation or antiplatelet regimen (aspirin only, heparin only, and aspirin + heparin), with heparin being a subtherapeutic fixed-dose heparin infusion at 500-800 units/hour. Complication rates were compared across groups, and both univariate and multivariate analyses were conducted to identify associations with major complications. P-values were set at p < 0.05.</p><p><strong>Results: </strong>Of 191 patients, 37 (19.4%) received aspirin only, 76 (39.8%) received heparin only, and 78 (40.8%) received aspirin + heparin. Demographics were similar between the groups. On univariate analysis, the heparin group had a significantly lower rate of major complications (5.26%) compared to aspirin only (18.92%) and aspirin + heparin (20.51%) (p = 0.016); however, on multivariate analysis, when accounting for additional perioperative factors, no association between anticoagulation group and major complications was found.</p><p><strong>Conclusions: </strong>Our study found that neither aspirin alone, heparin alone, or aspirin + heparin demonstrated a more favorable association with LE free flap outcomes. To reduce bias from the study's retrospective design and the surgeon's discretion in choosing anticoagulation protocols, future research should randomize patients to standardized postoperative regimens to assess differences in complications.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605269","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":"Surgical Treatment of Lymphedema at LE&RN Comprehensive Centers of Excellence.","authors":"James E Fanning, Rosie Friedman, Kathleen Shillue, Aaron Fleishman, William Repicci, Kevin Donohoe, Dhruv Singhal","doi":"10.1055/a-2540-0648","DOIUrl":"https://doi.org/10.1055/a-2540-0648","url":null,"abstract":"<p><p>Despite major advancements in lymphatic care, there remains a lack of consensus across institutions regarding the evaluation and surgical management of lymphedema. The aim of this study is to describe the practices for diagnosis and surgical treatment of lymphedema across accredited Lymphatic Education & Research Network (LE&RN) comprehensive Centers of Excellence (COEs).A survey was distributed to directors of the 16 LE&RN comprehensive COEs in January 2023. Directors were queried on lymphatic surgeon training, evaluation of potential surgical patients, description of surgical operations offered at their center, surgical algorithms, and operative techniques for various procedures.Nine COEs completed the survey (56% response rate). Eight of nine centers reported having an interdisciplinary surgical evaluation program, including lymphatic surgery (100%, 8/8), certified lymphedema therapy (100%, 8/8), and lymphatic medicine (75%, 6/8). COEs use a variety of lymphatic imaging modalities, with indocyanine green lymphography (89%, 8/9) and lymphoscintigraphy (78%, 7/9) being the most common. While all COEs offered debulking procedures, 67% (6/9) offered physiologic procedures (lymphovenous bypass and vascularized lymph node transplant), and 56% (5/9) offered immediate lymphatic reconstruction. There was no consensus on surgical algorithms or operative approaches.LE&RN comprehensive COEs consistently use multidisciplinary care teams for medical and surgical evaluations, but there is significant variability in lymphatic imaging modalities used and lymphatic surgery types and techniques. These findings underscore the need for continued research and standardization of lymphatic surgery outcomes to develop consensus.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586100","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 M Ritschl, Alex Grabenhorst, Constantin Wolff, Katharina Pippich, Dorothea Dick, Pascal O Berberat, Klaus-Dietrich Wolff, Andreas M Fichter","doi":"10.1055/a-2540-0917","DOIUrl":"10.1055/a-2540-0917","url":null,"abstract":"<p><p>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 nonbiological and biological models.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 10 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.A total of 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. In the survey, 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.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":"2025-03-07","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":"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":"10.1055/a-2540-0737","url":null,"abstract":"<p><p>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: .The study was performed on a total of 292 primary oral cancer patients who underwent FFF reconstruction between 2015 and 2019. A variety of clinicopathological, surgical, and postoperative parameters were identified and assessed. The data were statistically analyzed with univariate and multivariate logistic regression, and the probability of plate exposure-free rate was plotted as Kaplan-Meier survival curve.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%, <i>p</i> < 0.05). The 3-year probability of plate exposure-free rates in patients with (<i>n = 216</i>) and without (<i>n = 76</i>) postoperative radiotherapy were 65.9 and 92.5%, and in patients with (<i>n = 141</i>) and without (<i>n = 151)</i> postoperative wound infection were 55.3 and 91.2%, respectively. The multivariate logistic regression showed postoperative 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], <i>p</i> = 0.01 and <i>p</i> <0.001, respectively). More patients required surgical intervention to manage the exposure of hardware.Our study has highlighted that postoperative radiotherapy and postoperative wound infection are independent risk factors for plate exposure.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-07","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":"Effects of 4-aminopyridine as an Adjuvant Therapy Following Peripheral Nerve Repair in an Animal Model of Nerve Transection Injury.","authors":"Jung Il Lee, Dong Whan Kim, Jong Woong Park, Duk Hee Lee","doi":"10.1055/a-2540-0786","DOIUrl":"https://doi.org/10.1055/a-2540-0786","url":null,"abstract":"<p><p>Peripheral nerve repair is considered the gold standard treatment for complete nerve transection injuries, yet achieving satisfactory functional recovery remains challenging due to muscle atrophy during the time required for axonal regeneration. This study investigated the beneficial effects of 4-aminopyridine (4-AP), a potassium channel blocker, on neural and muscular recovery.Following complete transection of the right sciatic nerve, 40 mice underwent end-to-end nerve repair using microscopic epineural sutures and were randomly assigned to either the control or 4-AP groups immediately after surgery (<i>n</i> = 20 per group). The experimental animals were administered intraperitoneal injections of 200 μL normal saline or soluble 4-AP at a dose of 10 μg daily. The sciatic functional index (SFI) and nerve conduction studies were measured until 12 weeks postoperatively. Morphological analyses of nerve and muscle, and Western blotting for proteins associated with muscle atrophy were performed at 3 and 12 weeks after surgery.There were no significant differences in the SFI between the two groups. Nerve conduction study showed that 4-AP treatment increased the compound muscle action potential and decreased latency. A histomorphometric study showed that 4-AP treatment increased myelin thickness, G-ratio (axonal diameter/axoglial diameter on cross-sectioned nerve), cross-sectional area of myofibrils, and minimal Feret diameter of myofibrils. Additionally, expression levels of FoxO3 and mTORC1 were lower in the 4-AP treated mice, while myogenin expression levels showed no significant difference between the groups.4-AP treatment promotes myelination and prevents denervation-induced muscle atrophy after neurorrhaphy. These findings suggest that 4-AP may be a promising candidate for clinical consideration as an adjuvant therapy following nerve repair for transection injuries.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586097","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 DIEP Dive into Patient Risk Factors for Hernia and Bulge Development: A Meta-regression.","authors":"Nikki Rezania, Kelly A Harmon, Reilly Frauchiger-Ankers, Okensama La-Anyane, Keid Idrizi, Jocelyn To, Ethan M Ritz, David E Kurlander, Deana Shenaq, George Kokosis","doi":"10.1055/s-0044-1788564","DOIUrl":"10.1055/s-0044-1788564","url":null,"abstract":"<p><strong>Background: </strong> This meta-regression aims to investigate risk factors for abdominal hernia and bulge in patients undergoing deep inferior epigastric perforator (DIEP) flaps and the effect of prophylactic mesh placement on postoperative complications.</p><p><strong>Methods: </strong> A systematic search was conducted in July of 2022 in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Seventy-four studies published between 2000 and 2022 met the inclusion criteria. Sixty-four studies were included in the analysis for bulge and 71 studies were included in the analysis for hernia. Meta-regressions were run on the proportion of patients experiencing hernia or bulge to assess for patient risk factors and the role of prophylactic mesh placement. Proportions were transformed using the Freeman-Tukey double arcsine method.</p><p><strong>Results: </strong> The average rates of hernia and bulge after DIEP flaps were found to be 0.18% and 1.26%, respectively. Increased age (β = 0.0059, <i>p</i> = 0.0117), prior abdominal surgery (β = 0.0008, <i>p</i> = 0.046), and pregnancy history (β = -0.0015, <i>p</i> = 0<i>.</i>0001) were significantly associated with hernia. Active smoking (β = 0.0032, <i>p</i> = 0<i>.</i>0262) and pregnancy history (β = 0.0019, <i>p <</i> 0.0001) were significantly associated with bulge. Neither the perforator vessel laterality nor the number of perforator vessels harvested had any association with hernia or bulge. Prophylactic mesh placement was not associated with hernia or bulge.</p><p><strong>Conclusion: </strong> Understanding the comorbidities associated with hernia or bulge following DIEP flap breast reconstruction, such as advanced age, prior abdominal surgery, pregnancy history, and active smoking status, allows surgeons to proactively identify and educate high-risk patients. Future studies may further explore whether prophylactic mesh placement offers patients any benefit.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"237-247"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633785","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":"Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review.","authors":"Ryan P Cauley, Benjamin Rahmani, Oluwaseun D Adebagbo, John Park, Shannon R Garvey, Amy Chen, Sasha Nickman, Micaela Tobin, Lauren Valentine, Allan A Weidman, Dhruv Singhal, Arriyan Dowlatshahi, Samuel J Lin, Bernard T Lee","doi":"10.1055/a-2331-7885","DOIUrl":"10.1055/a-2331-7885","url":null,"abstract":"<p><strong>Background: </strong> Plastic and reconstructive surgeons are often presented with reconstructive challenges as a sequela of complications in high-risk surgical patients, ranging from exposure of hardware, lymphedema, and chronic pain after amputation. These complications can result in significant morbidity, recovery time, resource utilization, and cost. Given the prevalence of surgical complications managed by plastic and reconstructive surgeons, developing novel preventative techniques to mitigate surgical risk is paramount.</p><p><strong>Methods: </strong> Herein we aim to understand efforts supporting the nascent field of preventive surgery, including (1) enhanced risk stratification, (2) medical optimization and prehabilitation, (3) surgical mitigation techniques, and (4) advancements in postoperative care. Through an emphasis on four surgical cohorts who may benefit from preventive surgery, two of which are at high risk of morbidity from wound-related complications (patients undergoing sternotomy and spine procedures) and two at high risk of other morbidities, including lymphedema and neuropathic pain, we aim to provide a comprehensive and improved understanding of preventive surgery. Additionally, the role of risk analysis for these procedures and the relationship between microsurgery and prophylaxis is emphasized.</p><p><strong>Results: </strong> Although multiple risk mitigation methods have demonstrated clear benefits, including prophylactic surgical procedures and earlier involvement of plastic surgery, their use is widely variable across institutions. Many current risk assessment tools are suboptimal for supporting more algorithmic approaches to reduce surgical risk.</p><p><strong>Conclusion: </strong> Reconstructive surgeons are ideally placed to lead efforts in the creation and validation of accurate risk assessment tools and to support algorithmic approaches to surgical risk mitigation. Through a paradigm shift, including universal promotion of the concept of \"Preventive Surgery,\" major improvements in surgical outcomes may be achieved.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"248-260"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087299","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":"The \"Flapbot\": A Global Perspective on the Validity and Usability of a Flap Monitoring Chatbot.","authors":"Hamza Ejaz, Stephen R Ali, Juan E Berner, Thomas D Dobbs, Iain S Whitaker","doi":"10.1055/a-2355-3970","DOIUrl":"10.1055/a-2355-3970","url":null,"abstract":"<p><strong>Background: </strong> The Flapbot chatbot assists in free-flap monitoring, emphasizing accessibility, user-friendliness, and global reliability. This study assesses Flapbot's worldwide validity and usability and uses qualitative analysis to identify areas for future enhancement.</p><p><strong>Methods: </strong> Flapbot, built on Google's DialogFlow, was evaluated by international plastic surgeons. Invitations were sent to the International Lower Limb Reconstruction Collaborative (INTELLECT), International Confederation of Plastic Surgery Societies (ICOPLAST), and the International Microsurgery Club. Out of the 42 surgeons who agreed to participate, 21 tested the Flapbot and completed an online survey on its validity and usability. The survey had 13 validity items and 10 usability items. Data analysis involved computing the individual content validity index (I-CVI) and scale-wide content validity index (S-CVI) for validity, and the system usability score (SUS) for usability. Thematic analysis distilled free-text responses to identify key themes.</p><p><strong>Results: </strong> Nine of 13 items had an I-CVI over 0.78, denoting significant relevance. The S-CVI score stood at 0.82, indicating high relevance. The SUS score was 68, representing average usability. Themes highlighted issues with the current model, development suggestions, and surgeons' concerns regarding growing reliance on digital tools in health care.</p><p><strong>Conclusion: </strong> Flapbot is a promising digital aid for free-flap monitoring. While it showcases notable validity and usability, improvements in functionality, usability, and accessibility are needed for broader global use.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"227-236"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468998","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":"Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function.","authors":"Jason S Kofoed, Fatma B Tuncer, Alvin C Kwok, Jayant P Agarwal, Bradley A Ruple, Marta Borrelli, J David Symons, Russell S Richardson, Ryan M Broxterman","doi":"10.1055/s-0044-1788326","DOIUrl":"10.1055/s-0044-1788326","url":null,"abstract":"<p><strong>Background: </strong> Surgeons routinely apply papaverine, lidocaine, or verapamil to produce acute vasodilation and prevent vasospasms during microvascular surgeries. There is evidence that topical vasodilators may induce postoperative endothelial and smooth muscle dysfunction, which would present after the acute vasodilatory effects of the topical drugs wear off. Therefore, the purpose of the current study was to evaluate the lasting effects of papaverine, lidocaine, and verapamil on human deep inferior epigastric perforator artery vasodilatory function after the acute effects of the topical drugs had worn off.</p><p><strong>Methods: </strong> Deep inferior epigastric arterial samples were obtained from 12 patients during surgery. Each artery was dissected into four rings which where incubated for 1 minute in either physiological saline solution (control), papaverine (30 mg/mL), lidocaine (20 mg/mL), or verapamil (2.5 mg/mL), followed by a 2-hour washout. Endothelial-dependent and -independent vasorelaxation were then assessed by the isometric tension responses to acetylcholine or sodium nitroprusside, respectively.</p><p><strong>Results: </strong> Peak acetylcholine-evoked vasorelaxation (mean ± standard deviation) was not different between control (62 ± 23%) and lidocaine (57 ± 18%, <i>p</i> = 0.881), but was reduced (all <i>p</i> < 0.002) in papaverine (22 ± 27%) and verapamil (22 ± 20%). Peak sodium nitroprusside-evoked vasorelaxation was not different (all <i>p</i> > 0.692) among control (132 ± 35%), lidocaine (121 ± 22%), and verapamil (127 ± 22%), but was less in papaverine (104 ± 41%; <i>p</i> = 0.045) than control.</p><p><strong>Conclusion: </strong> Surgically used doses of papaverine and verapamil, but not lidocaine, have lasting negative effects on arterial vasodilatory function despite the acute effects of the drugs having worn off. These findings, in conjunction with the spasmolytic properties of each drug, may help guide the selection of an optimal topical vasodilator for use during microvascular surgeries.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"219-226"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748479","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}