Journal of reconstructive microsurgery最新文献

{"title":"Microsurgery in Motion: An Objective Assessment of Microsurgical Skill and Efficiency.","authors":"Sarah M Lyon, Weifeng Zeng, Su Yang, Brett J Wise, Hossein Mohamadipanah, Carla M Pugh, Samuel O Poore","doi":"10.1055/a-2491-3249","DOIUrl":"10.1055/a-2491-3249","url":null,"abstract":"<p><p>High levels of precision, as well as controlled, efficient motions, are important components of microsurgical technique and success. An accurate and objective means of skill assessment is lacking in resident microsurgical education. Here we employ three-dimensional, real-time motion-tracking technology to analyze hand and instrument motion during microsurgical anastomoses. We hypothesize that motion metrics can objectively quantify microsurgical skill and predict the overall level of expertise.Seventeen participants including medical students, plastic surgery residents, and attendings performed two end-to-end arterial microsurgical anastomoses in a laboratory setting. Motion tracking sensors were applied to standardized positions on participants' hands and microsurgical instruments. Motion and time parameters were abstracted using sensor-derived position data.A total of 32 anastomoses were completed and analyzed. There were significant differences in time for task completion and idle time between attendings and junior residents (post-graduate year (PGY)1-3). Path length and working volume consistently differentiated between students and attendings for all phases of an anastomosis. Motion and time data were less able to consistently distinguish attendings from residents stratified by laboratory anastomosis experience.Quantifiable motion parameters provide objective data regarding the efficiency of microsurgical techniques in surgical trainees. These data provide a basis for microsurgical competency assessments and may inform future structured feedback through instruction, instruments, and technological interfaces.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"684-692"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007241","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":"TMR/RPNI Awareness and Pain Outcomes: A Nationwide Survey of Amputees.","authors":"Aidan S Weitzner, Zachary H Zamore, Arushi Biswas, Jeffrey Khong, Keith T Kuo, Erica B Lee, William Padovano, Sami H Tuffaha","doi":"10.1055/a-2702-4167","DOIUrl":"10.1055/a-2702-4167","url":null,"abstract":"<p><p>Amputation leads to a symptomatic neuroma in 5 to 25% of amputees, causing debilitating pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) are novel peripheral nerve interventions used to prevent/treat neuromas. Our objective was to assess whether amputees who underwent TMR or RPNI at primary amputation reported less pain and greater ability to use prosthetics than those receiving a delayed (secondary) TMR/RPNI or no TMR/RPNI.A REDCap survey was administered to 1,377 amputees and 294 responded. Participants were recruited via social media and the Amputee Coalition Web site. Amputees were queried on demographics, amputation, and quality-of-life characteristics. Knowledge of TMR/RPNI procedures was also assessed.About 13 and 7% of patients had a primary and secondary TMR/RPNI, respectively. Outcomes were adjusted for amputation physician and clinical setting. Patients receiving primary TMR/RPNI had significantly lower pain severity score (<i>p</i> = 0.019) and pain interference score (<i>p</i> = 0.046) compared with no intervention. Pain with prosthetic use and proportion experiencing severe pain were not significantly lower among those receiving prophylactic TMR or RPNI.Compared with no or secondary peripheral nerve intervention, primary TMR/RPNI led to a significant reduction in pain interference and pain severity. Although not significant, preliminary trends also show reduction in pain with prosthetic use, proportion experiencing severe pain, and sustained opioid use with primary TMR/RPNI. As utilization of TMR/RPNI as a primary procedure yields better pain outcomes in a nationwide cohort, we must identify and address barriers to performance.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085898","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":"Reliability and Efficacy of Microvascular Coupler Devices for End-to-Side Venous Anastomosis in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Jisu Kim, Kyeong-Tae Lee","doi":"10.1055/a-2702-4335","DOIUrl":"10.1055/a-2702-4335","url":null,"abstract":"<p><p>While the efficacy of coupling devices in venous anastomosis has been well-studied, most evidence focuses on end-to-end techniques. In head and neck reconstruction, end-to-side (ETS) venous anastomoses involving the internal/external jugular vessels are common, yet evidence for using couplers in this context is limited. This study systematically evaluates the reliability and efficacy of couplers versus the hand-sewn method for ETS venous anastomosis in head and neck reconstruction.A literature search was conducted for articles reporting outcomes of ETS anastomosis in head and neck reconstruction. Studies were divided into two groups based on the anastomosis method: Hand-sewn and couplers. Pooled analysis was performed to compare the outcomes between the two groups. Using double-arm studies reporting outcomes for both methods, meta-analysis was conducted.Forty studies representing 2,664 cases were included, with 663 using couplers and 2,001 using hand-sewn methods. Most studies were retrospective cohorts. In the pooled analysis, the venous thrombosis rate was 1.8% for hand-sewn anastomoses and 2.5% for couplers, while the flap failure rate was 2.5% for hand-sewn and 1.9% for couplers, with no significant differences in either outcome. Meta-analysis based on four studies showed comparable venous thrombosis rates between the two groups. Anastomosis time was significantly shorter with couplers (standardized mean difference -3.93, <i>p</i> < 0.0001).ETS venous anastomosis using a coupler device in head and neck reconstruction seems to be as safe as the hand-sewn method and may offer time-saving benefits. However, additional well-designed studies are needed to confirm these findings.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080991","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 Combined \"Vasculoplastic\" Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer.","authors":"Karen R Li, Rachel N Rohrich, Christian X Lava, Nisha J Gupta, Cecelia M Hidalgo, Nicole C Episalla, Cameron M Akbari, Karen K Evans","doi":"10.1055/a-2491-3381","DOIUrl":"10.1055/a-2491-3381","url":null,"abstract":"<p><p>Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on performing targeted direct endovascular reperfusion on a vessel that will be used as the flap recipient. Our study compares outcomes of patients who received targeted revascularization (TR) to the recipient vessel for LEFF anastomosis versus nontargeted revascularization (NR) of arterial recipients prior to LEFF.LEFF patients who underwent preoperative endovascular revascularization (ER) from July 2011 to January 2023 were reviewed. Location of ER, demographics, perioperative details, and outcomes were collected. TR was performed on the same vessel as the flap recipient and NR was located on a different vessel than the flap recipient.A total of 55 LEFF patients were identified. Overall, 50.91% (<i>n</i> = 28) received TR and 49.1% (<i>n</i> = 27) received NR. Average age was 60.3 ± 10.9 years and average Charlson Comorbidity Index was 5.3 ± 1.9. On preoperative angiogram, the TR group had significantly lower rates of ER above the knee (3.6 vs. 33.3%, <i>p</i> < 0.001). Immediate flap success rate was 98.2%, with no differences between groups (<i>p</i> = 1.000). No significant differences were found in rates of any postoperative flap complications (<i>p</i> = 0.898), takeback (<i>p</i> = 0.352), partial flap necrosis (<i>p</i> = 0.648), or dehiscence (<i>p</i> = 0.729). Both TR and NR groups had similar rates of a postoperative angiogram (42.9 vs. 48.2%, <i>p</i> = 0.694) and reintervention (35.7 vs. 40.7% <i>p</i> = 0.701). Amputation rates were similar between TR and NR (17.9 vs. 14.8%, <i>p</i> = 1.000).Close follow-up with vascular and plastic surgery is required for patients who undergo ER prior to LEFF, as nearly half of our cohort required additional endovascular procedures. Overall, we observed no significant differences in complication rates for the TR and NR groups, informing revascularization strategies for free tissue transfer in a highly comorbid chronic wound population.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"693-702"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895579","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":"Using Transcranial Magnetic Nerve Stimulation to Differentiate Motor and Sensory Fascicles in a Mixed Nerve: Experimental Rat Study.","authors":"Kota Hayashi, Tsung-Hsun Hsieh, Yen-Lin Huang, David Chwei-Chin Chuang","doi":"10.1055/a-2483-5556","DOIUrl":"10.1055/a-2483-5556","url":null,"abstract":"<p><p>Accurately matching the correct fascicles in a ruptured mixed nerve is critical for functional recovery. This study investigates the use of transcranial magnetic stimulation (TMS) to differentiate motor and sensory fascicles in a mixed nerve.In all 40 rats, the median nerve in the left upper arm was evenly split into three segments. The rats were separated into two groups. In Group A (20 rats), the segment with the highest amplitude during TMS was selected as the motor neurotizer and transferred to the musculocutaneous nerve. In Group B (20 rats), only the medial one-third segment was selected and transferred without using TMS. The results were compared using grooming tests, nerve electrophysiological studies, muscle tetanus contraction force measurements, muscle weight, and axon counts at 16 weeks.The grooming test showed that Group A performed significantly better than Group B at 12 and 16 weeks postoperatively. Tetanic muscle contraction force measurements also revealed that Group A had significantly better outcomes than Group B. However, electrophysiological testing, muscle weight, and axon counts showed no significant differences between the two groups.This study suggests that TMS can be used to distinguish motor fascicles from sensory fascicles in a mixed nerve. It is desirable to apply this technique intraoperatively to differentiate motor and sensory fascicles for appropriate nerve matching and to select the motor fascicles as a motor neurotizer for functioning free muscle innervation in human mixed nerve injury.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"649-659"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950579","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":"Population Assessment of Anatomic Eligibility for Robotic-Assisted DIEP Flap.","authors":"Jacquelyn M Roth, Maxwell Godek, Ethan Fung, Reanna Shah, Bernice Yu, Areeg A E Hawa, Keisha E Montalmant, Alex Kagen, Alice Yao, Peter W Henderson","doi":"10.1055/a-2702-4021","DOIUrl":"10.1055/a-2702-4021","url":null,"abstract":"<p><p>Compared with traditional deep inferior epigastric perforator (DIEP) flap breast reconstruction procedures, robotic-assisted DIEP (R-DIEP) minimizes abdominal wall morbidity by reducing fascial incision length. Optimal R-DIEP candidates have large perforators with short intramuscular courses, but no large-scale studies have quantified their prevalence. This study aims to identify the proportion of patients who are anatomically eligible for R-DIEP.A retrospective review of patients who underwent magnetic resonance angiography perforator mapping prior to DIEP flap breast reconstruction between 2019 and 2023 was conducted. Patient demographics were collected. \"Dominant perforator\" was defined as the largest perforator at or below the level of the umbilicus. The intramuscular course of each perforator was calculated as the hypotenuse of a theoretical prism connecting its entry and exit points with respect to the rectus abdominis muscle. Perforator diameter was measured at the anterior rectus sheath. \"Conservative\" (intramuscular course ≤ 2.5 cm) and \"liberal\" (intramuscular course ≤ 5 cm) eligibility criteria were applied. Perforator diameter > 2 mm was used as a secondary criterion.A total of 574 dominant perforators were identified in 287 patients. The average intramuscular length of each perforator was 3.8 ± 1.9 cm (range: 0-11.0 cm). Twenty-nine percent of dominant perforators (<i>n</i> = 165) had an intramuscular course length ≤ 2.5 cm, 77% (<i>n</i> = 441) had an intramuscular course length ≤ 5 cm, and 2.3% (<i>n</i> = 13) were paramuscular (no intramuscular course). Forty-six percent of patients (<i>n</i> = 132) had at least one dominant perforator (i.e., left- or right-sided) with an intramuscular course ≤ 2.5 cm, and 93% of patients (<i>n</i> = 268) had at least one dominant perforator with an intramuscular course ≤ 5 cm. Thirty-one percent of dominant perforators (<i>n</i> = 185) had a diameter > 2 mm and an intramuscular course ≤ 2.5 cm, and 49% of dominant perforators (<i>n</i> = 281) had a diameter > 2 mm and an intramuscular course ≤ 5 cm.A substantial portion of the population is anatomically eligible for R-DIEP breast reconstruction, especially when liberal criteria are applied.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080954","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 Technique for Anterolateral Thigh Flap Harvesting-A Questionnaire Study from 263 International Microsurgeons.","authors":"Joachim N Meuli, Shiuan Shyu, Yu-Ting Chen, Elzat Elham, Lisa Wen-Yu Chen, Johnny Chuieng-Yi Lu, Jung-Ju Huang, Tommy Nai-Jen Chang","doi":"10.1055/a-2702-4225","DOIUrl":"https://doi.org/10.1055/a-2702-4225","url":null,"abstract":"<p><strong>Background: </strong>The anterolateral thigh (ALT) flap is a very popular perforator flap but variations in design and in harvest techniques result in a broad spectrum of approaches that considerably differ from literature descriptions. We therefore designed this study to assess the differences in surgical techniques and practice preferences toward this flap across world regions.</p><p><strong>Methods: </strong>The study was conducted via an online questionnaire covering demographic data, surgical techniques and preferences in 21 questions. The participants were divided in 6 geographical regions that were compared. Two questions that are the subject of debate amongst microsurgeons (limitation of vasopressor use and anticoagulation before flap division) were further analyzed using a logistic regression in order to identify predicting variables.</p><p><strong>Results: </strong>There were 263 respondents worldwide with notable differences in demographics, experience, level and technique across different world regions. The main differences were noted in intraoperative evaluation of perforators, in the primary instrument for dissection, and in the use of loupe magnification. Microsurgeons in North-America and with limited experience were more likely to limit vasopressor use during flap harvest. There were also discrepancies regarding the use of systemic anticoagulation prior to flap division but not of the same magnitude.</p><p><strong>Conclusion: </strong>This study is the first attempt to offer a clinical reference to apprehend differences in surgical preferences regarding ALT flap harvest techniques. Vasopressor use is notably limited by microsurgeons in North-America as well as by less experienced microsurgeons against available clinical evidence.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080976","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":"Free Flap Reconstruction following Mohs Surgery: Our Approach to Complex Skin Cancer on the Scalp.","authors":"Ayaka Nochi Deguchi, Niv Milbar, Andrew Pregnall, Stephanie Wang, Salman Khan, Malia Voytik, Margaret M Hornick, Hisashi Motomura, Stephen J Kovach, Christopher J Miller, Robyn Broach, Jason D Wink","doi":"10.1055/a-2702-4427","DOIUrl":"https://doi.org/10.1055/a-2702-4427","url":null,"abstract":"<p><p>Background Scalp reconstruction following Mohs Micrographic Surgery (MMS) presents significant challenges when defects are complicated by radiation, extensive defect size and depth, and the use of implants. As a result, free flap reconstruction may provide optimal coverage for these complex cases. This study aims to highlight free flap reconstruction as an effective approach for treating complicated scalp defects after MMS and to identify risk factors associated with complications. Methods A single-center retrospective chart review of patients who underwent MMS and subsequent free flap reconstruction of the scalp between March 2010 to June 2024 was conducted. Demographics, comorbidities, and perioperative details were collected and analyzed. Scalp defect complexity was categorized based on factors such as radiation exposure, defect size and depth, and implant use. Outcomes were compared between patients with complex and non-complex defects. Multivariate regression analysis and comparative analysis were performed. Results Sixty free flaps in 56 patients were included in our study. Most skin cancers were basal cell carcinoma (BCC; 64%) and squamous cell carcinoma (SCC; 23%), located predominantly on the vertex or multi-focally throughout scalp. The median defect size was 112 cm2 (IQR 65.3-169). The anterolateral thigh (58.3%) and latissimus dorsi flaps (38.3%) were commonly used for reconstruction. Age and BMI were associated with higher overall complication rates, while comorbidities, cancer diagnosis, lesion locations, and flap types were not. Highly complex defects were associated with significantly higher incidences of delayed wound healing (OR 26.2, p=0.0182) and dehiscence (OR 9.94, p=0.0242). Conclusion This study demonstrates a comprehensive exploration of free flap reconstruction as a standard treatment for complicated scalp defects following MMS, highlighting its efficacy and identifying risk factors for complications. Our findings underscore the importance of collaborative approach between microsurgeons and Mohs surgeons to optimize patient outcomes in the treatment of challenging scalp defects.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080916","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":"Differential Perfusion Patterns of Perforator and Random Flaps Assessed by Indocyanine Green Imaging.","authors":"Abdullh AlQhtani, Nara Lee, Hyung Bae Kim, Jin Sup Eom, Hyun Ho Han","doi":"10.1055/a-2702-4290","DOIUrl":"https://doi.org/10.1055/a-2702-4290","url":null,"abstract":"<p><strong>Background: </strong>Indocyanine green angiography (ICGA) is widely used to evaluate flap perfusion in reconstructive surgery, but the optimal timing for assessment may differ by flap type. This study compared perfusion dynamics of perforator and random pattern flaps in a rat model using ICGA.</p><p><strong>Methods: </strong>ICGA dynamics were compared between perforator and random flaps in a rat model. Sixteen Sprague-Dawley rats (275-300 g) were randomly assigned to either a perforator or a random flap group. A 0.25 mg dose of indocyanine green(ICG) was administered via the femoral vein, and fluorescence images were acquired at predefined intervals over 4 minutes. Hypoperfusion was defined as fluorescence intensity below 30% of the peak value. Necrosis was assessed on postoperative day 7. Statistical analyses included the Mann-Whitney U and log-rank tests with EMICM modeling.</p><p><strong>Results: </strong>In the perforator flap group, the final area of necrosis corresponded to the ICGA-defined perfusion boundary observed between 10 and 50 seconds post-injection. In contrast, necrosis in the random flap group aligned with the ICGA-defined perfusion boundary captured between 30 and 150 seconds. The most accurate time points for necrosis prediction were 50 seconds for perforator flaps and 150 seconds for random flaps, both demonstrating statistical significance (p = 0.0028).</p><p><strong>Conclusion: </strong>ICGA timing requirements differ between flap types. Implementing flap-specific assessment windows may enhance intraoperative interpretation and reduce false-positive findings. These findings support the development of flap-specific ICGA protocols to improve intraoperative decision-making in reconstructive surgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080890","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":"Evaluation of surgical techniques for end-to-side neurorrhaphy in a rat model: A quantitative and qualitative analysis of postoperative neural repair and recovered nerve function.","authors":"Daniel Staribacher, Dzmitry Kuzmin, Tomaz Velnar, Gavin Britz, Guenther C Feigl","doi":"10.1055/a-2702-4380","DOIUrl":"https://doi.org/10.1055/a-2702-4380","url":null,"abstract":"<p><strong>Introduction: </strong>There are two basic techniques to surgically reconstruct peripheral nerves for recovery of function after traumatic nerve injuries. The end-to-end-neurorrhaphy (EtE) and in case of loss of the proximal stump the end-to-side-neurorrhaphy(EtS) where the distal end of the acceptor nerve is connected to the side of a donor nerve. The current study was designed to further contribute to finding the best surgical technique for an EtS neurorrhaphy comparing the functional outcome in a rat model.</p><p><strong>Methods: </strong>Using a rat sciatic nerve model qualitative and quantitative analyses were performed to evaluate peripheral nerve regeneration after EtS. A total of 22 female Lewis rats (Charles River Wiga, 190g, 8 weeks old) were used for this study. In one test group (E1 / n=6) an EtS was conducted without and in the other(E2 / n=8) with performing a partial neurotomy (PN) through the EPF (epineurial partial flap).</p><p><strong>Results: </strong>In the test groups (E1 / E2) animals with EtS neurorrhaphy without PN reached the best mean functional score of 1.8 points according to our grading scale. Animals with EtS and PN scored in the mean with 2.2 points. These rats with EtS neurorrhaphy and partial neurotomy had the poorest outcome. The control group C1 with EtE neuroraphies showed the best functional outcome with an average score of 1.</p><p><strong>Conclusions: </strong>The EtE represents the best surgical option for reconstruction of a nerve's anatomical continuity after transection if both ends are preserved. The EtS on the other hand represent a good alternative with almost equally good functional outcome in cases where the proximal nerve stump was lost. Results also indicate that an EPF should be created for optimal collateral axonal sprouting and best possible results when performing an EtS. However, all other additional injuries of the donor nerve such as a PN should be avoide.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080904","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}