Microsurgery最新文献

{"title":"The Gastroepiploic Vascularized Lymph Node Transfer in the Treatment of Male Genital Lymphedema: A Report of Three Cases","authors":"Marco Morelli Coppola,&nbsp;Wladyslaw Gawel,&nbsp;Rossella Elia,&nbsp;Emilie Uldry,&nbsp;Marie Nicod Lalonde,&nbsp;Michele Maruccia,&nbsp;Pietro Giovanni di Summa","doi":"10.1002/micr.70072","DOIUrl":"https://doi.org/10.1002/micr.70072","url":null,"abstract":"<div>\u0000 \u0000 <p>Male genital lymphedema (MGL) is a debilitating condition that may require surgical intervention. Lymphaticovenous anastomosis (LVA) can be ineffective in primary and advanced cases because of lymphatic disruption, whereas vascularized lymph node transfer (VLNT) can overcome this limitation by promoting neolymphangiogenesis but traditionally carries some risk of donor site complications. Gastroepiploic vascularized lymph node transfer (GEVLNT) has recently emerged as an effective treatment option for upper and lower limb lymphedema, with negligible complications. However, its role in genital lymphedema remains unexplored. This is the first short series reporting the use of GEVLNT in MGL. Three male patients (44, 61, and 52 years old) with GL underwent GEVLNT. The first patient had idiopathic disease, which relapsed after previous treatment with LVA; the other two had secondary lymphedema due to cancer treatment and hydrocele surgery, respectively. In all patients, the right gastroepiploic lymphosome was harvested laparoscopically, with flap sizes of 14 × 5 cm, 15 × 4 cm, and 12 × 4 cm, respectively. The recipient vessels were the deep inferior epigastric artery and vein in the first case, and the superficial external pudendal vessels in the other two. Post-operative courses were uneventful for all patients, with no complications reported. Follow-up periods were 36, 23, and 12 months, respectively. In all cases, GEVLNT resulted in significant clinical improvements and reductions in genital lymphedema severity (GLS) scores (7–1, 9–4, and 8–4). Our preliminary experience suggests that GEVLNT could be a viable and effective option for treating male genital lymphedema with minimal donor site morbidity and stable results over time. However, further research with larger patient cohorts, comparative studies, and long-term follow-up is needed to fully establish its efficacy.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171503","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":"Robotic Harvest of the Free Ileocolon Flap for Esophageal Reconstruction: A Case Report","authors":"Gökhan Sert,&nbsp;Nezih Akkapulu","doi":"10.1002/micr.70076","DOIUrl":"https://doi.org/10.1002/micr.70076","url":null,"abstract":"<div>\u0000 \u0000 <p>The ileocolon flap is a fully autologous, single-stage option in the reconstruction of challenging laryngoesophageal defects, restoring voice and swallowing in patients. This procedure represents one of the most sophisticated cases in the field of reconstructive microsurgery. However, the traditional approach to harvesting the ileocolon flap requires a midline laparotomy, which is associated with several donor site complications. In the literature, a minimally invasive approach for the harvest of this flap, which is complex, associated with numerous morbidities related to laparotomy, and has many modifications to perfect its outcomes, has not yet been defined. The purpose of this report is to describe the technique of robotic harvest of the free ileocolon flap to avoid the risks associated with laparotomy. A 53-year-old patient who underwent laryngectomy and cervical esophagectomy (15-cm defect) for treatment of laryngeal squamous cell carcinoma has been admitted to our department for restoration of voice and swallowing. The robotic surgery system (Da Vinci Xi, Intuitive Surgical) enables precise dissection of the ileum, colon, and ileocolic artery and vein by providing optimized high-definition visualization of the surgical field and enhanced control through robotic arms, which offer a much greater range of motion than the surgeon's hand or laparoscopic systems. The flap included 15 cm of ascending colon, ileocecal valve, 10 cm ileum (voice tube), and 5 cm of chimeric ileal segment (seromuscular patch flap). The flap insetted in the neck in an isoperistaltic fashion; ascending colon end-to-end to the esophageal stumps and voice tube anastomosed to tracheal stump in end-to-side fashion. The microvascular anastomoses were performed to the facial artery and external jugular vein. During a 4-month follow-up period, no complications were observed. The patient can eat solid food and speak with his own voice postoperatively. We believe that robotic harvesting of the free ileocolon flap is a safe, feasible, and effective technique that significantly reduces the risk of morbidity related to the invasiveness of the traditional flap harvesting technique.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140425","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":"Advancing Temporomandibular Joint Reconstruction: A Cadaveric Study on the Design of the Fourth Chondrocostal Joint Flap","authors":"Servet Elçin Alpat,&nbsp;Mehmet Aydın,&nbsp;Burak Kaya,&nbsp;Halil İbrahim Açar","doi":"10.1002/micr.70070","DOIUrl":"https://doi.org/10.1002/micr.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The free fibula flap is the gold standard for reconstructing mandibular defects caused by trauma, tumors, dysplastic diseases, osteoradionecrosis, and atrophy. However, it has not yet been shown to be the ideal method for condylar reconstruction. This anatomical study proposes a surgically pragmatic approach to temporomandibular joint and condylar reconstruction by defining the vascularity of the chondrocostal joint.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One fresh frozen and six fixed cadavers were dissected to assess the suitability of the 4th rib for the planned procedure. Bilateral internal thoracic vessels and branches surrounding chondrocostal joints were identified. The 4th chondrocostal joint flap was dissected with care to preserve the joint surface and perichondral vascularity. Digital calipers were used for precise measurements of maximal flap and pedicle length. The vascular anatomy was further explored in a fresh frozen cadaver through fluoroscopic imaging by radiopaque latex injection. The flap's suitability for temporomandibular joint reconstruction was tested by surgically removing the original temporomandibular joint from the cadaveric skull and positioning the chondrocostal joint flap in the resultant defect.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The dominant pedicle to the fourth chondrocostal joint was shown to be the perforators of the internal thoracic vessels. The mean pedicle length was 4.7 cm, which was sufficient to reach recipient vessels in the neck. The compatibility between the fourth chondrocostal joint and the glenoid fossa was confirmed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that the fourth chondrocostal joint flap is a promising free flap for temporomandibular joint and condylar reconstruction. It offers ideal pedicle positioning, length, and vascular size match at the anastomosis, making it a suitable technique for reconstructing the challenging temporomandibular region. This approach adds a new option to the reconstructive surgeon's armamentarium, addressing previous limitations in condylar reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108799","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":"Photoacoustic Imaging of Midline-Crossing Vessels and Implications for Surgical Strategy in Patients With Midline Abdominal Scars","authors":"Ayako Takaya,&nbsp;Itaru Tsuge,&nbsp;Aiko Makino,&nbsp;Maria Chiara Munisso,&nbsp;Tomoko Kosaka,&nbsp;Hiroki Yamanaka,&nbsp;Susumu Saito,&nbsp;Naoki Morimoto","doi":"10.1002/micr.70069","DOIUrl":"https://doi.org/10.1002/micr.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Blood vessels are severed in patients with midline vertical abdominal scars, but detailed reports on the status of vessels penetrating the scar or vertical location from the umbilicus of the midline-crossing vessels in vivo are lacking. We revealed the effects of the scar and anatomical features of midline-crossing vessels using photoacoustic imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Women in the outpatient follow-up period of the gynecology and gastrointestinal surgery department of our institution were included. Ultrasonography and photoacoustic imaging were performed. The region of interest (ROI) was set 3–12 cm below the umbilicus. Patients were categorized into three groups: Group 1, no surgical scars within the ROI; Group 2, surgical scars along the entire length of the ROI; Group 3, a mixture of areas with and without scars. The numbers of midline-crossing arteries (MCA) and veins (MCV) were compared between Groups 1 and 2. The vertical position of the MCA and MCV from the umbilicus was investigated in Group 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MCA and MCV were observed in all patients in Group 1 (<i>n</i> = 14), and the median number of MCA was 2, while the median number of MCV was 5. Three patients in Group 2 (<i>n</i> = 17) had MCV, although none of the patients had MCA. In Group 3 (<i>n</i> = 6), residual MCA was found apart from the scar. In half of Group 1, the MCA was not visualized within 4 cm caudal to the umbilicus, but MCV was visualized in all cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although MCA was not depicted within the scar, MCV was visualized penetrating the scar in some patients. The results of Group 1 showed that there are individual differences in the location of the MCA. Detecting residual MCA and MCV in Group 3 implies the ability of photoacoustic tomography to assess a surgical application for a single-pedicle transverse abdominal flap in breast reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085213","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":"Reconstruction of Wagner Grade 4 Diabetic Foot Ulcers With the Superficial Circumflex Iliac Artery Perforator Free Flap","authors":"Nuh Evin","doi":"10.1002/micr.70068","DOIUrl":"https://doi.org/10.1002/micr.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microsurgical free tissue transfers are inevitable for Wagner grade 4 diabetic foot ulcers that cannot be treated conservatively and have a high risk of amputation. In this study, the results of the multidisciplinary management of Wagner grade 4 diabetic foot ulcers and their reconstruction using the SCIP free flap are presented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-one patients with Wagner grade 4 diabetic foot ulcers who underwent reconstruction with the SCIP free flap were retrospectively reviewed. The pain, disability, and activity limitations were evaluated using the foot function index. The foot contour and esthetic satisfaction were evaluated using a 5-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen patients were male and 6 were female. Reconstruction was performed with chimeric SCIP flaps in five patients and with single-skin-island SCIP flaps in 16 patients. Thirteen flaps were suprafascial and eight were fasciocutaneous. All flaps survived; however, venous congestion (<i>n</i> = 2) and flap dehiscence (<i>n</i> = 2) were observed, which resolved spontaneously within 24 h and were treated conservatively. Seroma (<i>n</i> = 3) and dehiscence (<i>n</i> = 2) were observed in the donor area of fasciocutaneous flaps and treated conservatively with primary suturing. The mean pain, disability, and activity limitation scores were 9 ± 0.7, 8.5 ± 0.5, and 7.9 ± 0.4 preoperatively and 2.3 ± 0.7, 2.2 ± 0.5, and 1.9 ± 0.6 12 months postoperatively, respectively, showing statistically significant improvements (<i>p</i> &lt; 0.001). The foot contour and esthetic satisfaction were excellent (mean Likert score = 5) in patients with suprafascial flaps and good to excellent (mean Likert score = 4.5 ± 0.5) in those with fasciocutaneous flaps, with a statistically significant difference (<i>p</i> = 0.0012). All flaps adapted well to the recipient areas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Wagner grade 4 diabetic foot ulcers can be salvaged from amputation through multidisciplinary management and advanced microsurgical techniques, and that suprafascial SCIP flaps provide significant advantages in restoring the form and function of diabetic feet owing to their thin structure and the ability to create chimeric designs for multiple defects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938948","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":"Analysis of the Effects of Arterial Anastomosis Techniques and Vein Selection in Free Flap Surgery After Extremity Trauma","authors":"Kubilay Erol,&nbsp;Özgün Barış Güntürk","doi":"10.1002/micr.70067","DOIUrl":"https://doi.org/10.1002/micr.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Decision making about the selection of artery and vein anastomosis techniques is a challenging dilemma in free flap surgery, especially in trauma cases in which it is difficult to distinguish the zone of injury. This study aimed to analyze the effects of the selection of end to end (ETE) or end to side (ETS) artery anastomosis, one or two venous anastomoses, and the deep or superficial venous anastomoses on the flap survival and re-exploration rates. We further aimed to investigate whether there were any differences between lower and upper extremity free flaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A total of 447 patients were included in the study. Upper and lower extremity reconstructions were performed in 281 and 166 patients, respectively. The most commonly used flap was the anterolateral thigh (ALT) flap (42%). Flap survival and re-exploration status, number of recipient veins, deep/concomitant or superficial/subcutaneous venous anastomosis, and type of arterial anastomosis were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall flap survival rate was 94.9%. Flap re-exploration and flap failure rates were higher in the ETE group, although the difference was not statistically significant. Single venous anastomosis was performed in 56.8% of flaps. Most flaps were anastomosed with the deep/concomitant venous system (45.6%). There were no statistically significant differences regarding these venous anastomosis data. There was not any statistically significant difference between upper and lower extremities, either.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ETS or ETE arterial anastomosis, number of the veins or the selection of the deep/concomitant or superficial/subcutaneous system do not affect the flap survival and re-exploration rates, so the decision should be made according to the flap strategy or the condition of the vessels regarding the zone of injury. All techniques provide similar outcomes when performed properly.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938816","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":"Efficacy and Morbidity of Heparin Infusion in Salvaging Autologous Breast Reconstruction Free Flaps","authors":"Scott K. Odorico,&nbsp;Muhammad Sabry Mazroua,&nbsp;Leda Wang,&nbsp;Andrew Awadallah,&nbsp;Serena Day,&nbsp;Christin Harless,&nbsp;Jorys Martinez-Jorge,&nbsp;Aparna Vijayasekaran","doi":"10.1002/micr.70065","DOIUrl":"https://doi.org/10.1002/micr.70065","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Abdominal-based free flaps are the mainstay in autologous breast reconstruction. Their safety and consistency in outcomes are well-documented. When flap compromise occurs, operative salvage is the gold standard. However, when—and if—to place these patients on heparin infusions is unclear. The goal of this study was to investigate abdominal-based free flap compromise and compare outcomes with and without heparin infusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This was a single-institution, multiple-surgeon, retrospective chart review of patients undergoing autologous, abdominal-based free flap breast reconstruction who experienced anastomotic compromise within a 6-year period. Treatment and outcomes data collected include flap salvage, hematoma, seroma, surgical site infection (SSI), transfusion requirement, and length of hospital stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one flaps had evidence of compromise. A total of 31 (60.8%) patients were placed on heparin infusions after experiencing anastomotic compromise, compared to 20 who did not receive heparin infusion. Thirty-five patients (68.6%) underwent deep inferior epigastric perforator flaps. Twenty-six patients (51%) experienced venous congestion, 22 patients (43.1%) experienced arterial compromise, and three (5.9%) experienced both. Twenty-eight patients (54.9%) received tissue plasminogen activator; in the heparin infusion group, 21 patients (67.7%) received tissue plasminogen activator. The total salvage rate of compromised flaps was 94.1% (48/51). There was no significant difference between heparin infusion and standard cares in length of hospital stay, length of drains in-place, successful salvage (93.5% vs. 95%), hematoma (19.4% vs. 15%), fat necrosis, SSI, hospital readmission (19.4% vs. 15%), and return rates to the operating room (48.4% vs. 50%). However, there was a significantly higher transfusion rate in patients receiving heparin infusion (38.7% vs. 10%). Of the 25 flaps with evidence of thrombosis, 72% were placed on heparin infusions while 28% were not; there was no significant difference in salvage rate in this sub-group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This review of autologous breast reconstruction free flap compromise provides evidence of similar safety profiles, with similar salvage rates, when comparing salvage with and without heparin infusion; there is a higher transfusion requirement when treating with heparin infusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919657","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":"Drain Fluid Amylase as an Early Negative Predictor of Salivary Fistula Following Free Flap Reconstruction","authors":"Micah K. Harris,&nbsp;Mark Kubik,&nbsp;Mario G. Solari,&nbsp;Kevin J. Contrera,&nbsp;Ore Odeniyi,&nbsp;Zoey Morton,&nbsp;Lauren Gardiner,&nbsp;Matthew E. Spector,&nbsp;Shaum S. Sridharan","doi":"10.1002/micr.70066","DOIUrl":"https://doi.org/10.1002/micr.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Salivary fistula is a known complication following head and neck free flap reconstruction involving the aerodigestive tract. We sought to examine the association between surgical drain fluid amylase and salivary fistula formation during postoperative hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty patients who underwent head and neck reconstruction involving the aerodigestive tract at our institution between 2019 and 2023 were included. Amylase concentration (IU/L) was measured from a Jackson-Pratt drain located along the mucosal closure line on postoperative days 1–5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve patients (15%) developed salivary fistulas. The change in drain amylase concentration between postoperative day 1 and day 2 was found to be significantly higher in those who developed a fistula during postoperative hospitalization. A receiver operating characteristic curve found that a threshold of 15% provided a sensitivity of 58.3% and specificity of 80.6% (area under the curve 0.767) to predict salivary fistula. This threshold remained significant on multivariate analysis (odds ratio 5.35, 95% confidence interval 1.79–24.3) when controlling for prior radiation, perioperative transfusion, and total laryngectomy. When retrospectively applied to our cohort, a cutoff of 15% resulted in a positive predictive value of 35% and a negative predictive value of 91.5%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Change in surgical drain fluid amylase from postoperative day 1 to 2 was associated with fistula formation following free flap reconstruction of the aerodigestive tract. Importantly, a change in amylase of &lt; 15% from postoperative day 1 to 2 was best at identifying patients who are at low risk of developing salivary fistula during postoperative hospitalization, with a negative predictive value of 91.5%.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70066","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914131","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":"Evaluating the Role of Digital Subtraction Angiography in Traumatic Lower Extremity Flap Reconstruction: A Comparative Analysis With CT Angiography","authors":"Artur Manasyan,&nbsp;Eloise W. Stanton,&nbsp;Erin Wolfe,&nbsp;Idean Roohani,&nbsp;Joseph N. Carey,&nbsp;David A. Daar","doi":"10.1002/micr.70063","DOIUrl":"https://doi.org/10.1002/micr.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite its high sensitivity and specificity, CTA can yield inconclusive or inaccurate results due to technical limitations such as metallic streak artifacts or inadequate opacification of arteries. On the other hand, digital subtraction angiography (DSA), a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels, stands as a gold standard for the assessment of arterial injuries, offering high-resolution and dynamic imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing lower extremity reconstruction with a free flap at a Level 1 trauma center between 2015 and 2022 were retrospectively queried. Demographic data, details of arterial injuries assessed by CTA/DSA, flap and wound details, complications, and ambulatory outcomes were recorded. The study data were assessed and presented qualitatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 175 patients underwent microsurgical lower extremity reconstruction from 2015 to 2023, 98 (56.0%) of whom had CTA, and 14 (8.0%) underwent DSA preoperatively. The mean patient age was 47.1 ± 15.6 years, ranging from 21 to 68 years, with 10 (71.4%) males and four (28.6%) females. The most common indications for DSA were inconclusive CTA results of vessel runoff status (<i>n</i> = 6), evaluation of clinically suspected vascular injury not clearly delineated by CTA (<i>n</i> = 3), and artifact/streak due to orthopedic hardware (<i>n</i> = 2). DSA in six of the 14 cases revealed discrepancies with initial CTA findings, providing clarification on the location and extent of vascular injury preoperatively. Four of these patients experienced a change in surgical plan following formal angiography. There was no significant difference in postoperative flap complications (<i>p</i> = 0.189) or ambulation status (<i>p</i> = 0.074) between the DSA and CTA cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DSA effectively overcomes limitations encountered with CTA, such as issues related to hardware interference. In select patients where CTA limitations are significant, DSA might offer improved outcomes, highlighting the need for further research to validate these preliminary findings and better define the contexts in which DSA could be more beneficial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892822","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":"Pedicled Vascularized Common Peroneal Nerve Graft in Sciatic Nerve Reconstruction With Involvement of Inner Pelvic Lumbar and Sacral Nerve Roots: A Case Report and Literature Review","authors":"Rou Wan,&nbsp;Aida K. Sarcon,&nbsp;Alejandra Aristizabal,&nbsp;Mehmet Furkan Tunaboylu,&nbsp;Mattew T. Houdek,&nbsp;Steven L. Moran","doi":"10.1002/micr.70064","DOIUrl":"https://doi.org/10.1002/micr.70064","url":null,"abstract":"<div>\u0000 \u0000 <p>Long segment losses exceeding 10 cm in the sciatic nerve are challenging in both the reconstructive techniques and optimizing sensory and motor function recovery. This case report and literature review describes our experience of using a pedicled vascularized common peroneal nerve graft to repair a 14-cm sciatic nerve defect, involving L4, L5, and S1 nerve roots. Additionally, we conducted a literature review of various types of nerve autografts for large sciatic nerve defects, summarizing their characteristics and outcomes to aid clinicians in decision-making and expected results in different scenarios. The patient, a 23-year-old female diagnosed with neurofibromatosis type I, underwent R0 tumor resection of the proximal left sciatic nerve due to a malignant peripheral nerve sheath tumor. She received an ipsilateral pedicled vascularized common peroneal nerve graft. The reconstruction included the L4, L5, and S1 nerve roots beyond the greater sciatic foramen into the inner pelvis. The patient's postoperative course was uneventful. At the 26-month follow-up, she showed MRC grade 4/5 strength in hamstrings with 90°knee flexion and a steady gait pattern. At the 32-month follow-up, she could ambulate very well with an ankle-foot orthosis. The outcomes support the use of a pedicled vascularized common peroneal nerve graft in a single-staged surgery to restore motor function for large sciatic nerve defects. Our literature review revealed that in cases where sural nerves are insufficient or injured for sciatic nerve reconstruction, the common peroneal nerve is a viable alternative to help patients regain functional independence.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875630","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}