Journal of reconstructive microsurgery最新文献

{"title":"Color Doppler Allen's Test before Harvesting a Radial Forearm Free Flap-To Do or Not to Do?","authors":"Dominik A Walczak, Ewa Migacz, Jakub Opyrchał, Daniel Bula","doi":"10.1055/a-2632-2720","DOIUrl":"10.1055/a-2632-2720","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275186","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":"Versatility of the Latissimus Dorsi Flap in Head and Neck Surgery: Supporting Evidence from a Tertiary Oncology Center.","authors":"Subhendu Khan, Varun Saini, Sanujit Apurv Pawde","doi":"10.1055/a-2632-2767","DOIUrl":"10.1055/a-2632-2767","url":null,"abstract":"","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275188","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":"Effect of Enhanced Recovery After Surgery on Racial Inequalities in Prescribing Practices for Autologous Breast Reconstruction.","authors":"Annabel Baek, Rachel Smith, Lesley B Coots, Emily S Andersen, Cindy Song, Hui Yu Juan, Sonia Lele, Paschalia M Mountziaris","doi":"10.1055/a-2632-2565","DOIUrl":"https://doi.org/10.1055/a-2632-2565","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) pathways have improved surgical outcomes and reduced narcotic needs. This study evaluated racial differences in our institution's opioid prescribing practices in autologous breast reconstruction before and after ERAS implementation.This was a retrospective review of consecutive patients undergoing autologous breast reconstruction from 2013 to 2021, pre-ERAS and after ERAS implementation. Primary outcomes were morphine milligram equivalents (MME) for intravenous (IV) and oral (PO) narcotics peri- and postoperatively. Secondary outcomes included infection, delayed wound healing, and need for reoperation.Of 163 patients, 150 met inclusion criteria. The pre-ERAS group comprised 65 patients (35% Black, 65% White), and the ERAS group included 85 patients (44% Black, 54% White). Pre-ERAS, Black patients received more IV narcotics than White patients, 814 versus 505 MME (<i>p</i> < 0.05). There was no difference between inpatient and outpatient PO MME (<i>p ></i> 0.05). ERAS decreased IV MME 10-fold (<i>p</i> < 0.05) and decreased inpatient PO MME approximately 3-fold (<i>p</i> < 0.05). Nevertheless, racial differences existed in IV narcotics (80 vs. 58 MME; <i>p</i> <i><</i>0.05) and inpatient PO narcotics (93 vs. 59 MME; <i>p</i> < 0.05). Black race was a significant positive predictor in univariate and multivariate analyses for IV MME in both pre-ERAS and ERAS.Black patients unexpectedly received more IV narcotics pre-ERAS. Although ERAS decreased inpatient opioid administration, racial differences persisted; Black patients also received more PO narcotics, contrary to literature findings of systemic pain undertreatment. Standardized protocols alone may be inadequate to address complexities of postoperative pain.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560429","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":"Tranexamic Acid in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis.","authors":"Evan Rothchild, Isabelle T Smith, Joseph A Ricci","doi":"10.1055/a-2632-2621","DOIUrl":"10.1055/a-2632-2621","url":null,"abstract":"<p><p>Tranexamic acid (TXA) has gained popularity across various surgical specialties for reducing perioperative blood loss. However, its role in microsurgery remains underexplored, likely due to concerns that TXA may increase the risk of thromboembolic events and compromise flap viability. Therefore, the aim of this study was to determine the impact of TXA in microsurgical reconstructive procedures.A systematic search of the PubMed, EMBASE, Ovid MEDLINE, and Web of Science databases was conducted from their inception to September 21, 2024. Inclusion criteria were retrospective or prospective cohort studies and randomized controlled trials that administered TXA in the context of microsurgical reconstruction. Data on postoperative outcomes were extracted and pooled for meta-analysis.Five retrospective cohort studies were included, with a total of 718 patients (TXA group: 343 patients; control group: 375 patients). All studies were low-level evidence and retrospective in design, with only one including a matched control group. There was considerable variation across studies in both the microsurgical procedures performed and the timing, dosage, and route of TXA administration. The TXA group did not demonstrate an increased risk of thromboembolic events, showed a significantly decreased mean blood loss, and exhibited a trend toward reduced transfusion and hematoma rates compared to the control group.Our findings provide low-level evidence that TXA use in microsurgical reconstruction does not increase the risk of thromboembolic events and may help reduce perioperative blood loss, hematoma formation, and transfusion rates. These results offer preliminary support for the safety of TXA in microsurgical reconstruction procedures and highlight its potential benefits for patients at risk of bleeding complications. However, given the limited number, heterogeneity, and low quality of available studies, these findings should be interpreted with caution. Higher-quality research is needed to support the routine use of TXA in microsurgery.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275187","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 Godina Principle in the 21st Century: Free Flap Timing after Isolated Lower Extremity Trauma in a Retrospective National Cohort.","authors":"Theodore E Habarth-Morales, Harrison D Davis, Arturo J Rios-Diaz, Robyn B Broach, Joseph M Serletti, Saïd C Azoury, L Scott Levin, Stephen J Kovach, Irfan A Rhemtulla","doi":"10.1055/a-2404-7634","DOIUrl":"10.1055/a-2404-7634","url":null,"abstract":"<p><strong>Background: </strong> The timing of free flap reconstruction after lower extremity trauma has been a controversial debate since Marko Godina's original 72-hour recommendation. Recent advances in microsurgery warrant an evaluation of the optimal time to reconstruction.</p><p><strong>Methods: </strong> The Nationwide Readmission Database (2014-2019) was used to identify patients undergoing free flap reconstruction after lower extremity trauma. Risk-adjusted statistical methods were used to identify optimal time where risk of infectious and microsurgical complications increase and to quantify the risk associated with time delays.</p><p><strong>Results: </strong> A total of 1,030 patients undergoing reconstruction were identified. The mean time to flap coverage was 24.3 days. Thirty-three percent were performed within 72 hours, 24% from 72 hours to 10 days, 18% from 10 to 30 days, and 24% after 30 days. Flaps performed after 10 days were associated with increased risk of surgical site infection, osteomyelitis, and other wound complications, compared with those performed within 72 hours. There was no increased risk in the period of 72 hours to 10 days. Revision amputation and microsurgical complications were not increased after 10 days. The predicted optimal cutoff was 9.5 days for microsurgical complications and 14.5 days for infectious complications.</p><p><strong>Conclusion: </strong> Advances in microsurgery may be responsible for extending the time in which definitive soft tissue coverage is required for wounds resulting from lower extremity trauma. Although it appears the original 72-hour time window can be safely extended, efforts should be made to refer patients to specialty limb salvage centers in a timely fashion.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"469-477"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080681","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":"When Bell's Palsy Is Cancer: Avoiding Misdiagnosis and Its Implications.","authors":"Y Edward Wen, Benjamin Rail, Cristina V Sanchez, April R Gorman, Shai M Rozen","doi":"10.1055/a-2434-4737","DOIUrl":"10.1055/a-2434-4737","url":null,"abstract":"<p><strong>Background: </strong> Facial paralysis due to cancer can be misdiagnosed as Bell's palsy. This study aims to clearly identify and quantify diagnostic differentiators and further evaluate the prognostic implications of misdiagnosis.</p><p><strong>Methods: </strong> Adult patients older than 18 years with facial palsy of unknown or cancerous etiology presenting between 2009 and 2023 were reviewed. Patient characteristics, examination findings, and clinical course were compared between facial paralysis patients with cancer misdiagnosed as Bell's palsy (Cancer-Bell's-Palsy group) and patients correctly diagnosed with Bell's palsy (Bell's-Palsy group). Additionally, morbidity and mortality were compared between facial paralysis patients with cancer initially misdiagnosed with Bell's palsy and facial paralysis patients initially correctly diagnosed with cancer (Cancer-Palsy group).</p><p><strong>Results: </strong> Two-hundred and forty-three patients participated including 43 Cancer-Palsy, 18 Cancer-Bell's-Palsy, and 182 Bell's-Palsy patients. Cancer-Bell's-Palsy patients were significantly less likely than Bell's-Palsy patients to develop synkinesis (odds ratio [OR] = 0.0042; 95% confidence interval [CI]: [0.0005-0.0339]; <i>p</i> < 0.0001), significantly more likely to experience gradual onset facial paralysis (OR = 1,004.69; 95% CI: [54.40-18,555.77]; <i>p</i> < 0.0001), and significantly more likely to have additional nonfacial cranial nerve neuropathies (OR = 49.98; 95% CI: [14.61-170.98]; <i>p</i> < 0.0001). Cancer-Bell's-Palsy patients were more likely than Cancer-Palsy patients to have a greater than 6-month period from initial cancer-attributable symptom onset to cancer diagnosis (OR = 47.62; 95% CI: [9.26-250.00]; <i>p</i> < 0.001), stage IV cancer (OR: 12.36; 95% CI: 1.49-102.71; <i>p</i> = 0.006), and decreased duration of life after cancer diagnosis (median [interquartile range], 40.0 [87.0] vs. 12 [56.3] months, respectively; <i>p</i> = 0.025).</p><p><strong>Conclusion: </strong> Facial paralysis related to cancer must be differentiated from Bell's palsy, as misdiagnosis leads to delayed intervention and poorer prognosis. Gradual onset facial palsy, multiple cranial nerve neuropathies, lack of synkinesis, and lack of improvement were nearly definitive differentiators for underlying cancer.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"495-507"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372137","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 Association between Preflap Negative-Pressure Wound Therapy and Surgical Outcomes in Extremity Free Flap Reconstruction: A Systematic Review.","authors":"Madeline C Rocks, Meagan Wu, Victoria Comunale, Nikhil Agrawal, Rebecca S Nicholas, Ali Azad, Jacques H Hacquebord","doi":"10.1055/a-2434-5798","DOIUrl":"10.1055/a-2434-5798","url":null,"abstract":"<p><strong>Background: </strong> While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction.</p><p><strong>Methods: </strong> A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups.</p><p><strong>Results: </strong> A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%).</p><p><strong>Conclusion: </strong> Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"515-520"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372135","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":"Early Postoperative Pain Course following Primary and Secondary Targeted Muscle Reinnervation: A Temporal Description of Pain Outcomes.","authors":"Floris V Raasveld, Yannick Albert J Hoftiezer, Barbara Gomez-Eslava, Justin McCarty, Ian L Valerio, Marilyn Heng, Kyle R Eberlin","doi":"10.1055/a-2404-7732","DOIUrl":"10.1055/a-2404-7732","url":null,"abstract":"<p><strong>Background: </strong> Targeted muscle reinnervation (TMR) is an effective surgical treatment of neuropathic pain for amputees. However, limited data exist regarding the early postoperative pain course for patients who undergo either primary (<14 days since amputation) or secondary (≥14 days) TMR. This study aims to outline the postoperative pain course for primary and secondary TMR during the first 6 postoperative months to aid in patient education and expectation management.</p><p><strong>Methods: </strong> Patients were eligible if they underwent TMR surgery between 2017 and 2023. Prospectively collected patient-reported outcome measures of pain scores, Pain Interference, and Pain Intensity were analyzed. Multilevel mixed-effects models were utilized to visualize and compare pain courses between primary and secondary TMR patients.</p><p><strong>Results: </strong> A total of 203 amputees were included, with 40.9% being primary and 59.1% being secondary TMR patients. Primary TMR patients reported significantly lower pain scores over the full 6-month postoperative trajectory (<i>p</i> < 0.001) compared with secondary TMR patients, with a difference of Δ -1.0 at the day of TMR (primary = 4.5, secondary = 5.5), and a difference of Δ -1.4 at the 6-month mark (primary = 3.6, secondary = 5.0). Primary TMR patients also reported significantly lower Pain Interference (<i>p</i> < 0.001) and Pain Intensity scores (<i>p</i> < 0.001) over the complete trajectory of their care.</p><p><strong>Conclusion: </strong> Primary TMR patients report lower pain during the first 6 months postoperatively compared with secondary TMR patients. This may reflect how pre-existing neuropathic pain is more challenging to mitigate through peripheral nerve surgery. The current trends may assist in both understanding the postoperative pain course and managing patient expectations following TMR.</p><p><strong>Level of evidence: </strong> Therapeutic - IV.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"459-468"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080677","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":"On a Hunt for the \"True\" Septocutaneous Perforator: A Histology Cross-Section Study.","authors":"Martin Kubat, Zdenek Dvorak, Dusan Zoufaly, Marketa Hermanova, Marek Joukal, Geoffrey G Hallock","doi":"10.1055/a-2435-7531","DOIUrl":"10.1055/a-2435-7531","url":null,"abstract":"<p><strong>Background: </strong> Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself.</p><p><strong>Methods: </strong> Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue.</p><p><strong>Results: </strong> Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap).</p><p><strong>Conclusion: </strong> Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are \"true\" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"540-546"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391385","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":"Electrophysiological Signal Validation of Regenerative Peripheral Nerve Interface at Nerve Ending: A Preliminary Rat Model Experiment.","authors":"Jeongmok Cho, Hyunsuk Peter Suh, Changsik Pak, Joon Pio Hong","doi":"10.1055/a-2434-4605","DOIUrl":"10.1055/a-2434-4605","url":null,"abstract":"<p><strong>Background: </strong> As the number of extremity amputations continues to rise, so does the demand for prosthetics. Emphasizing the importance of a nerve interface that effectively amplifies and transmits physiological signals through peripheral nerve surgery is crucial for achieving intuitive control. The regenerative peripheral nerve interface (RPNI) is recognized for its potential to provide this technical support. Through animal experiment, we aimed to confirm the actual occurrence of signal amplification.</p><p><strong>Methods: </strong> Rats were divided into three experimental groups: control, common peroneal nerve transection, and RPNI. Nerve surgeries were performed for each group, and electromyography (EMG) and nerve conduction studies (NCS) were conducted at the initial surgery, as well as at 2, 4, and 8 weeks postoperatively.</p><p><strong>Results: </strong> All implemented RPNIs exhibited viability and displayed adequate vascularity with the proper color. Clear differences in latency and amplitude were observed before and after 8 weeks of surgery in all groups (<i>p</i> < 0.05). Notably, the RPNI group demonstrated a significantly increased amplitude compared with the control group after 8 weeks (<i>p</i> = 0.031). Latency increased in all groups 8 weeks after surgery. The RPNI group exhibited relatively clear signs of denervation with abnormal spontaneous activities (ASAs) during EMG.</p><p><strong>Conclusion: </strong> This study is one of few preclinical studies that demonstrate the electrophysiological effects of RPNI and validate the neural signals. It serves as a foundational step for future research in human-machine interaction and nerve interfaces.</p>","PeriodicalId":16949,"journal":{"name":"Journal of reconstructive microsurgery","volume":" ","pages":"478-488"},"PeriodicalIF":2.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372133","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}