Microsurgery最新文献

{"title":"A Case of Ala Reconstruction With an Extended Pedicle Helical Rim Flap.","authors":"Filipa Poleri, Jorge Correia-Pinto, Larissa Lanzaro, Rui Casimiro, Carolina Chaves, Horácio Zenha, Horácio Costa","doi":"10.1002/micr.70027","DOIUrl":"https://doi.org/10.1002/micr.70027","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":"e70027"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059791","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":"Arterial End-To-Side Anastomosis as a Salvage Maneuver in DIEP-Flap Breast Reconstruction.","authors":"E Schouppe, Dariush Nikkhah","doi":"10.1002/micr.70028","DOIUrl":"https://doi.org/10.1002/micr.70028","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":"e70028"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059697","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":"Microsurgical Reconstruction of Complex Scalp Defects With Vastus Lateralis Free Flap.","authors":"Giovanni Zabbia, Emanuele Cammarata, Mara Franza, Francesca Toia, Greta Tondini, Francesca Graziano, Domenico Gerardo Iacopino, Adriana Cordova","doi":"10.1002/micr.70025","DOIUrl":"10.1002/micr.70025","url":null,"abstract":"<p><strong>Background: </strong>Scalp reconstruction is a challenging field for plastic surgeons. In case of large or complex defects, microsurgical-free flaps are usually required. Reconstructive failure can result in high morbidity and in some cases be life-threatening. In this article, we present our experience in the reconstruction of complex scalp defects with the use of a vastus lateralis (VL) free flap.</p><p><strong>Patients and methods: </strong>From July 2013 to July 2023, we retrospectively analyzed patients who underwent soft tissue reconstruction of the scalp with a VL-free flap at the authors' institution. The patient's demographic, clinical and surgical characteristics, and postoperative complications were recorded and analyzed.</p><p><strong>Results: </strong>Thirty patients were included. The mean age was 67.3 years. Seventeen patients were male, while 13 were female. In 56.7% of patients, defects resulted from cancer resection. In four patients, the defect was limited to the soft tissues while a multi-layer defect with bone and/or dura involvement was present in 26 patients. Soft tissue reconstruction was always achieved with a VL-free flap (n = 30). In 28 cases, a skin-grafted muscular flap was used. The most used recipient vessels were the superior thyroid vessels (n = 18). Complications occurred in six patients (20%): two cases of total flap loss and two cases of infection of the cranioplasty materials requiring their removal. In two cases patients died within 48 h. All patients were satisfied with the aesthetic and functional results at 6 months.</p><p><strong>Conclusions: </strong>In the case of complex scalp defects, the gold standard is reconstruction through microsurgical flaps that provide well-vascularized tissue and allow to cover large defects, reducing the incidence of infections and ensuring good brain protection even without cranioplasty. In our experience, VL-free flap represents a valid option, providing a low donor site morbidity, the possibility of a two-team approach, and a low complication rate.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":"e70025"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11776040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Factors of a Dominant Superficial Venous Drainage System in DIEP Flap Surgery With Preoperative Computed Tomography Angiography.","authors":"Victor Pozzo, Marion Goutard, Yohann Dabi, Golda Romano, Marc-David Benjoar, Mikhael Benjoar, Ilyes Hadji, Zhi Yang Ng, Alexandre G Lellouch, Laurent A Lantieri","doi":"10.1002/micr.70008","DOIUrl":"https://doi.org/10.1002/micr.70008","url":null,"abstract":"<p><strong>Background: </strong>Venous congestion due to superficial venous system dominance (SVD) in deep inferior epigastric perforator (DIEP) flap surgery occurs in approximately 2% of cases, with attendant sequelae and increased cost to healthcare systems. This study aimed to describe the predictive factors for SVD in DIEP flap breast reconstruction based on preoperative computed tomography angiography (CTA) findings.</p><p><strong>Methods: </strong>All women who required takebacks for additional venous anastomosis to the cephalic vein because of SVD after DIEP flap breast reconstruction between 2015 and 2022 were included. Complication-free DIEP breast reconstruction patients were then randomly selected based on a 1:2 enrollment ratio to form a control group. A retrospective analysis of pre-operative CTAs was performed for both groups to compare the size and location of the perforators, diameter of the superficial inferior epigastric vein (SIEV), diameter of the deep inferior epigastric vein (DIEV), and flap thickness.</p><p><strong>Results: </strong>Twenty-four women were identified in the SVD group; however, only 18 were included in the final analysis. CTA analysis suggested that the ratio between SIEV and DIEV (SIEV/DIEV) diameters was significantly higher in the SVD group than in the controls (0.98 vs. 0.83; p = 0.043). The mean flap thickness was also significantly lower in the SVD group than in the controls (29.4 vs. 36.3 mm; p < 0.001). Perforator characteristics and the SIEV diameter did not differ between the two groups.</p><p><strong>Conclusions: </strong>The SIEV/DIEV diameter ratio on preoperative CTA can be used to predict whether the DIEP flap has SVD. This may then be used to anticipate whether additional venous anastomosis is required to reduce postoperative complications.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70008"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007937","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":"Vascularized Periosteal Grafts for Bone Union in Children: A Systematic Review.","authors":"Francisco Soldado, Diego Gonzalez-Morgado, Pablo Romero-Larrauri, Trong-Quynh Nguyen, Antonio Carlos da Costa, Jorge Knorr","doi":"10.1002/micr.70021","DOIUrl":"https://doi.org/10.1002/micr.70021","url":null,"abstract":"<p><strong>Background: </strong>The periosteum is the main organ responsible for bone regeneration. Vascularized Periosteal Grafts (VPG) have demonstrated exceptional efficacy and speed in facilitating bone union among children with challenging bone healing conditions. Despite their promising results, the overall impact of these interventions has yet to be comprehensively evaluated through systematic review. This systematic review aimed to provide comprehensive insights into bone union outcomes and complications related to the use of VPG in children.</p><p><strong>Materials and methods: </strong>MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to September 2023 and screened for relevant studies. Data were collected regarding patient demographics, disease, treatment, anatomical location, graft used, donor and receptor vessels, skin paddle monitoring, follow-up duration, time to union, consolidation, and complications. The correlation between age and bone union was assessed using Pearson and Spearman correlation coefficients, as appropriate. Study quality was assessed using the Methodological Index for Non-randomized Studies Criteria.</p><p><strong>Results: </strong>A total of 15 studies involving 135 patients were included. All the studies were classified as Level 4 evidence. The mean MINORS score was 5.1 ± 1. The aim of the VPG was nonunion treatment in 90 patients (67%), nonunion prevention in 35 patients (26%), and bone union acceleration in 10 patients (7%). The origin of the bone union problem was traumatic in 59 cases (44%), congenital pseudoarthrosis of the tibia or fibula in 48 patients (35%), oncologic in 23 patients (17%), and infectious in 5 patients (4%). Nine different sources of periosteal flaps were used to enhance bone union. Bone union rate was 96% with a mean time of 4.2 months (range 1-18 months). Spearman test showed a non-statistically significant negative correlation between age and bone union time (r = -0.3, p = 0.759).</p><p><strong>Conclusions: </strong>VPGs are a safe and reliable treatment for promoting bone union, especially in the context of complex pediatric bone-healing challenges.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70021"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984229","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":"Radial to Median Sensory Nerve Transfers to Restore Sensate Key Pinch: A Cadaveric Assessment of Size Match and Implications for Transfer.","authors":"Christine V Schaeffer, Ambika Menon, Spencer Chambers, Alexander Graf, Nina Suh, Paul Ghareeb","doi":"10.1002/micr.70017","DOIUrl":"https://doi.org/10.1002/micr.70017","url":null,"abstract":"<p><strong>Background: </strong>Loss of key-pinch sensation after median nerve injury poses significant functional detriment. Nerve transfers are utilized to improve function after nerve injury and size matching of donor and recipient nerves is important to optimize success. This anthropometric study investigates the anatomy of the superficial branch of the radial nerve (SBRN) to the thumb and index finger and explores radial to median sensory nerve transfers, a necessary but not heavily discussed facet of nerve transfers for the hand.</p><p><strong>Methods: </strong>Anatomic dissection of SBRN in 15 cadaver hands was performed to assess variability in diameter and branching patterns based on nerve location. Dissection of the index radial and thumb ulnar digital nerves was performed to assess diameter based on location and calculate ideal size match for nerve transfer.</p><p><strong>Results: </strong>All specimen thumbs had 2 SBRN branches at the level of the metacarpal shaft and proximal phalanx; 87% had 2 index SBRN branches extending to the proximal phalanx. Index radial and ulnar SBRN branches were similar in diameter at all levels (p > 0.0167). There was a significant size mismatch between the individual SBRN branches and index digital at all measured levels (p < 0.0167). The thumb radial SBRN was significantly larger than ulnar SBRN (p = 0.006).</p><p><strong>Conclusions: </strong>Optimal size match for transfer involved transection of radial index SBRN 1 cm distal to the MCP joint and ulnar thumb SBRN 1 cm distal to the MCP joint. Consideration should be made for transfer of both index SBRN branches at the level of the MCP joint to improve size match. Corresponding digital nerves were transected 1 cm proximal to the level of SBRN harvest.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70017"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971624","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":"Long-Term Follow-Up After the Charles Procedure: Possibilities for Minimally Invasive Reconstructive Lymphedema Surgery With Lymphaticovenous Anastomosis: A Report of Four Cases.","authors":"Natalia Ewa Krzesniak, Marzanna Zaleska, Balazs Mohos, Manon Czedik-Eysenberg, Michaela Krammel, Chieh-Han John Tzou","doi":"10.1002/micr.70015","DOIUrl":"10.1002/micr.70015","url":null,"abstract":"<p><p>The Charles procedure (CP) is a potentially devastating treatment; however, in cases of an end stage of untreated or improperly treated lymphedema, it is the ultimate surgical therapy. As a life-saving solution, it quickly relieves patients with giant, hypertrophic extremities, mostly in ambulation and hygiene maintenance. Nevertheless, long-term results may disappoint both doctors and patients, who struggle with social stigma, the need for lifelong compression, massive lymphoedema in the distal parts of the feet, badly fitting shoes, excessive skin fibrosis, severe keratinization of skin-grafted surfaces, periodic lymphorrhea from the resected areas, or acute and chronic inflammation. For these reasons, patients may seek further surgical help, even many years after treatment. This article describes findings in fluorescent lymphography with indocyanine green (ICG-L) in four patients (49, 56, 56 years old females and 35 years old males) after CP and outcomes of treatment with lymphaticovenous anastomosis (LVA). In all patients, nonresected areas of the dorsum of the feet showed massive lymphedema stage II to III with dermal backflow (DB). In two patients, resected and skin-grafted areas showed deep subfascial lymphatics with lazy flow and no DB. In the remaining two cases, resected areas showed massive DB. Patients were reluctant to undergo further extensive surgical treatment with lymph node transfers due to the trauma experienced after CP. Since they still struggle with residual lower extremity lymphedema in unresected areas of the lower limbs, we performed minimally invasive, physiologic LVA surgeries in their feet, and in one patient in proximal thighs. In all cases, the postoperative course was uneventful. The treatment brought relief, reducing the circumference of the feet by ~2 cm, and allowed the return to previously used shoes in a follow-up of 18-36 months. This is the first report of ICG-L findings in CP patients, who benefit from minimal invasive LVA surgery. This information might help improve the life quality of patients after CP.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70015"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circumflex Scapular Artery Perforator Flap and Its Surgical Refinements in Soft Tissue Reconstruction for Various Regions of the Foot and Ankle in Pediatric Patients.","authors":"Xinlei Sui, Liming Qing, Fang Yu, Panfeng Wu, Juyu Tang","doi":"10.1002/micr.70010","DOIUrl":"10.1002/micr.70010","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction for various regions of the foot and ankle in pediatric patients remains a challenging topic. This study presents the circumflex scapular artery perforator (CSAP) flap and its surgical refinements for addressing soft tissue defects in various regions of the foot and ankle in pediatrics.</p><p><strong>Patients and methods: </strong>Forty-seven patients underwent CSAP flap and its surgical refinements for the reconstruction of foot and ankle defects from 2010 to 2022. Mean age was 6.9 (range 2-14). Defects were observed in the ankle, dorsal foot, heel, and sole. The classic CSAP flap was used in 23 patients, and the CSAP flap with refined techniques was utilized in 24 patients, including double skin paddle, debulking, flow-through, and chimeric CSAP flaps.</p><p><strong>Results: </strong>The size of the CSAP flaps ranged between 4.5 × 4 and 18 × 6.5 cm². All flaps survived except for one case. The patient suffered total flap necrosis and was treated with a secondary reconstructive surgery. Primary closure of the donor site was achieved in all cases. The average follow-up period was 15.6 months. At the final follow-up, the mean AOFAS score was 93.6 (range 77-100). Mean VAS flap appearance score was 8.1 (range 6-10). Most patients showed satisfactory results.</p><p><strong>Conclusion: </strong>The CSAP flap and its surgical refinements are alternative options for repairing pediatric foot and ankle defects, especially in cases involving large defects around the ankle joint, dorsal foot, and non-weight-bearing regions of the heel and sole.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70010"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective Management Strategies for Primary Lymphedema of the Lower Extremities: Integrating Conservative and Surgical Therapies in Early and Late Stages.","authors":"Yasser Farid, Mirco Pozzi, Alberto Bolletta, Emanuele Cigna, Luigi Losco, Vanessa Marron Mendes, Giuseppe Diluiso, Thierry Cleve, Michela Schettino, Hung-Chi Chen","doi":"10.1002/micr.70014","DOIUrl":"10.1002/micr.70014","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Lymphedema, a debilitating characterized by localized fluid retention and tissue swelling, results from abnormalities in the lymphatic system. In the case of primary lymphedema, this condition is attributed to malformations in lymphatic vessels or nodes, and it is marked by a relentless progression leading to irreversible tissue fibrosis after repetitive inflammation. Many questions regarding its treatment, such as the choice of the type of intervention and the timing, still remain unanswered. This study aims to present our comprehensive approach to treat this challenging condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To elucidate our approach, we conducted a retrospective chart review of 42 patients treated for primary lymphedema at 3 hospitals between July 2010 and December 2022. The study included two patient groups, those with early-stage disease (20) and those in the advanced stages (22). We outline our algorithm, based on our clinical experience in Taiwan. Patients were followed for at least 12 months post-treatment, and assessments were made, including photographic evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 42 patients participated in our study: 20 in the early stage and 22 in the late stage. Our approach yielded significant functional improvements and symptom regression in both groups. In the early-stage cohort, all 20 patients underwent VLNT procedures and SAL, with 15 (75%) undergoing unilateral procedures and 5 (25%) bilateral. Among the advanced-stage patients, 12 (54.5%) were treated with the modified Charles' procedure, and 10 (45.5%) with RRPP. The outcomes showed an average circumference reduction of 4.1 cm (2.9-5.3) after VLNT and liposuction. Reductions were noted at various levels: 5.7 cm (4.6-6.8) at mid-thigh, 4.3 cm (2.5-6.1) at mid-calf, 3.5 cm (2.7-4.3) at the ankle, and 1.4 cm (0.7-2.1) at mid-foot. Tonicity decreased by 5.9% (5.2-6.6), indicating significant tissue softening. Tissue removal averaged 3.7 kg (2.9-4.5) after the modified Charles' procedure and 2.6 kg (2.3-2.9) after RRPP. Patients experienced a mean of 3 (2-4) episodes of cellulitis per year, with no cellulitis in early-stage treated limbs during the follow-up period. Complications were minimal, including 4 partial skin graft losses that healed with conservative treatment and 3 postoperative infections after the modified Charles' procedure, treated successfully with antibiotics. No major complications were reported at the lymph node flap donor site.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Primary lymphedema poses a considerable challenge, primarily due to its relentless progression if left untreated. The existing literature offers limited guidance on its management. Our algorithm, developed over years of experience, aims to fill this gap. By integrating surgical and conservative interventions, as well as individualized patient follow-up, we provide a comprehensive framework for managing both early and late- stage cases.&lt;/p","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70014"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951497","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 Functional Muscle Transfer in Brachial Plexus Injury Patients With Subclavian Artery Injury Using Arteriovenous Loop Grafts.","authors":"Roongsak Limthongthang, Saichol Wongtrakul, Panai Laohaprasitiporn, Yuwarat Monteerarat, Torpon Vathana","doi":"10.1002/micr.70020","DOIUrl":"10.1002/micr.70020","url":null,"abstract":"<p><strong>Background: </strong>Free functional muscle transfer (FFMT) for brachial plexus injury (BPI) requires adequate donor arterial flow for successful anastomosis. However, concomitant BPI and subclavian artery injury are not uncommon. Arteriovenous (AV) loop graft is one of the methods used to extend vessels to areas with vascular depletion. This case series aims to report the feasibility and outcomes of AV loop grafts for FFMT in BPI patients with subclavian artery injury.</p><p><strong>Patients and methods: </strong>This longitudinal descriptive report included adult patients with BPI and concomitant subclavian artery injury. Patients with adequate intra-operative thoracoacromial and/or thoracodorsal arterial flow, sufficient for FFMT without the need for an AV loop graft, were excluded.</p><p><strong>Results: </strong>Of the 10 initially enrolled patients, three were excluded: two for adequate intra-operative arterial flow, and one for extensive adhesions around the external jugular vein, precluding the index surgery. Seven patients, with a median age of 37 years, mostly male and injured in motorcycle accidents, were included. Four patients underwent a single-stage operation (AV loop graft and FFMT simultaneously), while three patients underwent a two-stage operation. Success rates were 100% for the single-stage operation and 33% for the two-stage operation. The two-stage operation led to increased operative time, extended hospital stays, and anastomosis mismatch challenges. Successful cases regained gracilis muscle motor power for elbow flexion, achieving grade III-IV within 13-29 months.</p><p><strong>Conclusion: </strong>FFMT with AV loop graft for BPI patients with subclavian artery injury is feasible and effective. Despite complex microsurgical requirements, these procedures significantly restore limb functionality when standard FFMT operations are insufficient.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06437990.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":"e70020"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}