Microsurgery最新文献

{"title":"Re-Evaluation of the Ideal Injury to Flap Time Frame for Lower Extremity Free Flap Reconstruction: Is 72 h Still the Gold Standard?","authors":"Alexa Clark, Calvin Abdallah, Makenna Ash, William Knaus, Ciara Brown, Paul Ghareeb","doi":"10.1002/micr.70228","DOIUrl":"https://doi.org/10.1002/micr.70228","url":null,"abstract":"<p><strong>Background: </strong>Traumatic lower extremity injuries often require free tissue transfer (FTT) for limb salvage when local tissue is insufficient. Traditionally, reconstruction within 72 h has been considered optimal; however, advancements in wound management and perioperative care have challenged this paradigm.</p><p><strong>Objective: </strong>To evaluate outcomes of lower extremity FTT based on time from injury to reconstruction.</p><p><strong>Methods: </strong>A retrospective review was performed on patients undergoing lower extremity FTT after trauma at a single Level 1 trauma center (2014-2022). Patients were grouped by time from injury to flap: (< 3 days, 4-21 days, 22-90 days, and > 90 days). Ninety nine percent of patients were managed with negative-pressure wound therapy (NPWT) prior to definitive reconstruction. Outcomes included flap loss, complications, infection, osteomyelitis, nonunion, and amputation. Associations with comorbidities, surgical techniques, and fracture characteristics were assessed.</p><p><strong>Results: </strong>Among 102 patients, timing of reconstruction showed no significant differences in flap loss (p = 0.56), complications (p = 0.42), nonunion (p = 0.54), osteomyelitis (p = 0.19), or amputation (p = 0.58). No independent predictors of flap loss or complications were identified. Nonunion was associated with middle/proximal fracture levels (p = 0.0092), Masquelet technique (p = 0.0004), and higher Modified Frailty Index (p = 0.05). Osteomyelitis correlated with male gender (p = 0.01), proximal fracture level (p = 0.0098), and Masquelet technique (p = 0.0095). Amputation was associated with latissimus and radial forearm flaps (p = 0.0081), ipsilateral femur fracture (p = 0.0063), hypertension (p = 0.011), and higher ASA score (p = 0.0021).</p><p><strong>Conclusion: </strong>In this series, delayed FTT beyond 72 h was not associated with increased flap loss or limb-threatening complications. Delayed reconstruction may optimize patient and wound factors, though aggressive wound management is essential. Given the retrospective design, uneven group sizes, and small early reconstruction cohort, these findings should be interpreted cautiously. Further research with larger cohorts and long-term outcomes is warranted.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70228"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775979","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":"Application of the SCIA-Pure Skin Perforator Flap in Bilateral Upper Eyelid Reconstruction: A Case Report and Review of the Literature.","authors":"Carlos Pueyo Morillo, Zhan Q Lin Wu, Jordi Serracanta Domènech, Antonio Bulla, Juan P Barret, Danilo A Rivas Nicolls","doi":"10.1002/micr.70232","DOIUrl":"https://doi.org/10.1002/micr.70232","url":null,"abstract":"<p><p>Facial burns often result in cicatricial eyelid retraction, causing corneal exposure, ulceration, and vision loss. Traditional reconstructive methods, such as full-thickness skin grafts or local flaps, frequently fail in extensive burns due to limited healthy tissue and a high risk of recurrent contracture. Achieving durable functional and aesthetic outcomes in such cases remains a major challenge. We report the use of bilateral free superficial circumflex iliac artery pure skin perforator (SCIA-PSP) flaps for upper eyelid reconstruction in a 50-year-old man with severe facial burns and recurrent bilateral upper eyelid retraction, leading to persistent lagophthalmos despite prior skin grafting. Preoperative color Doppler ultrasound was used to map SCIA perforators. Bilateral PSP flaps were elevated from the groin in the subdermal plane and transferred as free flaps to the eyelids, with microvascular end-to-end anastomoses to the supraorbital vessels. The postoperative course was uneventful, with no flap-related complications. At 52 months follow-up for the left eyelid and 31 months for the right, the patient achieved stable bilateral eyelid closure, resolution of lagophthalmos, excellent tissue pliability, and satisfactory aesthetic integration. The SCIA-PSP flap offers ultra-thin, vascularized tissue, effectively preventing recurrent contracture, and represents a reliable alternative in complex burn-related eyelid reconstruction.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70232"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147776004","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":"3D Printing of a Patient-Specific Biomodel and Cutting Guide for Metatarsal Reconstruction With an Osteocutaneous SCIP Flap Using Open-Source Software: A Case Report.","authors":"Miguel L Obaíd, Antonio Núñez, Leonardo Parada, Vanessa Oñate, Cristina Almeida, Ricardo Roa, Nicolás Pereira","doi":"10.1002/micr.70236","DOIUrl":"https://doi.org/10.1002/micr.70236","url":null,"abstract":"<p><p>Technology-assisted planning is increasingly integrated into reconstructive plastic surgery, including virtual reality, augmented reality, and three-dimensional (3D) printing. 3D printing has been especially useful in maxillofacial surgery, both for patient-specific cutting guides for osteotomies and for biomodels to customize osteosynthesis plates. However, to our knowledge, there have been no reports of a 3D-printed cutting guide to harvest a custom iliac crest bone flap based on the deep branch of the superficial circumflex iliac artery perforator (SCIP) flap, together with a biomodel of the foot skeleton with the bone defect for intraoperative use. We report a 36-year-old man with a 45-mm bone defect of the first metatarsal and a 9 × 8 cm skin defect on the dorsum of the right foot after firearm trauma. Computer-aided design and computer-aided manufacturing (CAD/CAM) using open-source software were used to prepare a cutting guide that allowed harvesting a bone flap of precise dimensions and a biomodel that enabled intraoperative adjustment of the flap without pedicle division. Reconstruction was achieved with a 45-mm bone flap based on the deep branch of the SCIP and a 9 × 8 cm skin flap based on the superficial branch of the SCIP. Both flaps survived without complications; bone consolidation was observed at 4 months, and at 10 months, the patient had an adequate, pain-free gait. This case illustrates that an open-source, low-cost 3D-printing workflow may be a useful adjunct for planning and execution of metatarsal reconstruction with osteocutaneous free flaps.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70236"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840045","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":"Cervical Spine Reconstruction With Vascularized Osteoadipofascial Fibular Flap and Periosteum Extension After Chordoma Resection and Adjuvant Proton Therapy: A Case Report.","authors":"Javier Buendía Pérez, Santiago Sanz Medrano, Ángela Carrascosa Granada, Sergio Asensio Ramos, Beatriz Iniesta Lima, Cristina Gomez-Martinez de Lecea, Francisco Soldado","doi":"10.1002/micr.70230","DOIUrl":"10.1002/micr.70230","url":null,"abstract":"<p><p>Cervical spine reconstruction is essential following en bloc tumor resections, particularly in defects exceeding four centimeters. Traditional mechanical solutions or non-vascularized grafts are often suboptimal, with complications such as non-union, infections, and instability. The vascularized osteoadipofascial fibular flap offers a durable alternative with structural and biological benefits. We present the case of a 55-year-old woman with an 8-month history of cervicobrachialgia and left upper limb paresis. Imaging revealed a 7-cm lesion spanning C4-T1 with foraminal infiltration, and histopathology confirmed a chordoma. A two-stage surgery was performed: posterior stabilization and partial tumor resection, followed by anterior corpectomies (C5, C6, C7) and reconstruction with a vascularized fibular flap. The flap was anastomosed to the superior thyroid vessels, and its adipofascial component isolated the esophagus from the anterior cervical plate. Postoperative proton therapy was administered. Postoperative recovery was uneventful, with a 10-day hospital stay. At 24 months, the patient showed no recurrence, complete symptom resolution, and stable osteosynthesis with evidence of bone callus formation at graft-vertebra junctions. This case suggests that vascularized fibular reconstruction may provide reliable structural support and biological integration in complex cervical oncologic defects.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70230"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723244","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 Effect of Ulnar Nerve Motor Branch Transfer in Cubital Tunnel Syndrome Surgery: A Comparison With In Situ Decompression Alone.","authors":"Mustafa Kemal Yenidünya, İbrahim Faruk Adıgüzel, Esra Sena Orbak Yenidünya","doi":"10.1002/micr.70233","DOIUrl":"https://doi.org/10.1002/micr.70233","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Advanced cubital tunnel syndrome causes progressive sensory and motor dysfunction, leading to hand weakness, intrinsic muscle atrophy, and functional impairment. Although surgical decompression relieves mechanical compression, functional recovery in McGowan Stage 3 patients is often limited due to irreversible axonal degeneration and delayed reinnervation of distal muscles. Distal end-to-side anterior interosseous nerve transfer has therefore been proposed as an adjunct to decompression to enhance reinnervation. The aim of this study was to evaluate the effects of this distal nerve transfer on intrinsic muscle recovery, clinical function, and electrophysiological outcomes in patients with advanced cubital tunnel syndrome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;This retrospective study included 23 adult patients with McGowan Stage 3 ulnar neuropathy treated between February 2022 and June 2024. Patients were assigned to decompression alone (Group 1, n = 13) or decompression combined with distal end-to-side anterior interosseous nerve to ulnar motor branch transfer (Group 2, n = 10). Functional outcomes were evaluated using QuickDASH, British Medical Research Council (BMRC) grading, lateral pinch, and grip strength. Electrophysiological assessments included compound muscle action potential (CMAP) amplitude and motor conduction velocity (MCV) measured preoperatively and at 6 and 12 months postoperatively, with subgroup analyses based on preoperative fibrillation status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 12 months, QuickDASH improved significantly in both groups (Group 1: 52.4 ± 5.6 to 36.5 ± 10.0, p = 0.001; Group 2: 55.1 ± 8.8 to 34.2 ± 9.8, p = 0.005). British Medical Research Council grades also increased in both groups (Group 1: 2.6 ± 0.8 to 2.9 ± 0.6, p = 0.005; Group 2: 2.1 ± 0.7 to 3.1 ± 0.7, p = 0.047). Lateral pinch improved significantly only in Group 2 (7.8 ± 1.8 kg to 9.4 ± 2.0 kg, p = 0.011), while grip strength showed no significant change (Group 1: 33.6 ± 6.9 kg to 36.1 ± 5.2 kg, p = 0.057; Group 2: 31.9 ± 5.7 kg to 35.0 ± 7.9 kg, p = 0.078). CMAP increased significantly at 12 months in both groups (Group 1: 5.28 ± 1.93 mV to 5.9 ± 1.7 mV, p = 0.017; Group 2: 6.4 ± 1.7 mV to 7.6 ± 2.4 mV, p = 0.036), and MCV also improved (Group 1: 37.9 ± 10.4 m/s to 43.6 ± 9.1 m/s, p = 0.039; Group 2: 42.0 ± 8.5 m/s to 58.1 ± 8.5 m/s, p = 0.008). Among patients with preoperative fibrillation, Group 2 demonstrated better postoperative lateral pinch (10.7 ± 1.2 vs. 8.0 ± 1.0 kg, p = 0.013), QuickDASH (27.5 ± 5.5 vs. 42.3 ± 6.8, p = 0.011), and BMRC grades (3.5 ± 0.6 vs. 3.1 ± 0.4, p = 0.037) compared with Group 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Distal end-to-side anterior interosseous nerve to ulnar motor branch transfer combined with decompression is associated with improved intrinsic muscle recovery and functional outcomes compared with decompression alone in patients with advanced cubital tunnel syndrome, pa","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70233"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775999","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":"Innervated Dorsal Digital Artery Propeller Perforator Flaps in One-Stage Reconstruction of Fingertip Defects: Experience With 45 Cases","authors":"Hui Liu,&nbsp;Yuan Cheng,&nbsp;Yachao Jia,&nbsp;Dongdong Cheng,&nbsp;Yaling Yu,&nbsp;Zhengbing Zhou","doi":"10.1002/micr.70223","DOIUrl":"10.1002/micr.70223","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We describe a technique to reconstruct fingertip defects with dorsal digital artery perforator flaps innervated with terminal branches of the proper digital nerve in a propeller manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To reconstruct fingertip defects, a dorsal digital artery perforator flap innervated with terminal branches of the proper digital nerve was performed. This retrospective study includes 44 fingers and 4 thumbs in 45 cases. Thirty-seven males and eight females with a mean age of 43.7 years were enrolled. The sizes of large paddles ranged from 2.0 cm × 1.3 cm to 6.0 cm × 1.6 cm, and the sizes of little paddles ranged from 0.4 cm × 0.6 cm to 2.1 cm × 0.4 cm. All flaps were harvested from the injured fingers. Donor sites were primarily closed in all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All flaps survived without major complications, except two cases with partial epidermis necrosis that healed after dressing changes. The mean follow-up period was 14.9 months. Postoperative appearance and texture of the flaps were close to normal, and no deficiency was observed in the sensory functions, although partial recovery of nociceptive and tactile sensation was detected in three patients. Postoperative extension and flexion functions of the fingers were assessed using active range of motion, with all patients demonstrating values within standard parameters and showing no signs of tendon adhesions or scar contractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The dorsal digital artery propeller perforator flap innervated with terminal branches of the proper digital nerve is a reliable and relatively simple flap for the one-stage reconstruction of fingertip defects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674968","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":"From Palliation After Angiosarcoma Resection to Totally Autologous Aesthetic Breast Reconstruction Combining Kiss Latissimus Dorsi Flap and Contralateral Breast Sharing Internal Mammary Artery Perforator Flap: A Case Report","authors":"Beniamino Brunetti,&nbsp;Valeria Petrucci,&nbsp;Martina Ponzo,&nbsp;Fiorella Oliveri,&nbsp;Matteo Pazzaglia,&nbsp;Marco Morelli Coppola,&nbsp;Mauro Barone,&nbsp;Stefania Tenna,&nbsp;Paolo Persichetti","doi":"10.1002/micr.70198","DOIUrl":"10.1002/micr.70198","url":null,"abstract":"<div>\u0000 \u0000 <p>Angiosarcoma of the breast is a rare but aggressive disease that often requires wide-margin resection resulting in massive thoracic defects. In this report we present the unique case of a patient who underwent primary chest wall reconstruction with palliative intent using Kiss Latissimus Dorsi (LD) Flap after resection of a huge angiosarcoma of the right breast, followed 3 years later by a secondary shift to totally autologous aesthetic breast reconstruction which was achieved by combining the first flap with breast-sharing internal mammary artery perforator (IMAP) flap and simultaneous contralateral breast reduction. The defect after extended mastectomy, measuring 24 × 18 cm, was resurfaced with a Kiss LD flap designed with two skin paddles of 24 × 13 and 14 × 5 cm, respectively. Three years after the initial reconstruction, the patient was tumor-free and required breast symmetrization. Therefore, a left reduction mammaplasty with simultaneous breast sharing Internal Mammary Artery Perforator (IMAP) flap was performed, augmenting the hypoplastic right breast with the entire lower pole of the contralateral side, transferring an 18 × 9 cm flap based on the fifth IMAP. Vascular safety of the procedure was guaranteed by intra-operative indocyanine green angiography evaluation. Recovery was uneventful and the 6 months post-operative follow-up confirmed flap integration, volume symmetry and high aesthetic satisfaction. This report underlines the versatility of this innovative combination of flaps in complex reconstructive scenarios where complex microsurgical transfers are contraindicated.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639336","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":"Anterior Interosseous Artery as a Recipient Vessel in Superficial Circumflex Iliac Artery Perforator Flap Transplantation to the Forearm","authors":"Satoshi Kodaira,&nbsp;Keizo Fukumoto,&nbsp;Tomoyuki Koike,&nbsp;Yasuaki Okada","doi":"10.1002/micr.70221","DOIUrl":"10.1002/micr.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When transplanting a superficial circumflex iliac artery perforator (SCIP) flap to the forearm, the small diameter of the superficial circumflex iliac artery (SCIA) complicates end-to-end anastomosis with the radial or ulnar artery. The small diameter of the anterior interosseous artery (AIA) may make it suitable for end-to-end anastomosis with the SCIA; however, no such cases have been reported to date. We assessed AIA diameter using computed tomography angiography (CTA) and analyzed six cases of SCIP flap transfer to the forearm using the AIA as the recipient vessel.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 22 patients with traumatic hand or finger skin defects, we measured the diameters of the AIA and radial and ulnar arteries at the forearm center (point A) and distal quarter (point B) using CTA. Six cases of SCIP flap transfer to the forearm using the AIA as the recipient vessel were also analyzed. Defects were located in the distal part of the forearm in four cases, the middle part in one case, and the proximal part in one case, ranging from 5 × 10 to 12 × 16 mm².</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The AIA diameter (1.59 ± 0.05 mm at point A; 1.30 ± 0.07 mm at point B) was significantly smaller than that of the radial (2.64 ± 0.12 mm; 2.53 ± 0.10 mm) and ulnar arteries (2.25 ± 0.10 mm; 2.25 ± 0.09 mm) on CTA (<i>p</i> &lt; 0.01). In the six surgical cases, the flap size ranged from 4.5 × 14.5 to 14 × 19 mm², and mean diameters of the anastomosed SCIA and AIA were 1.28 mm and 1.37 mm, respectively. The superficial circumflex iliac vein or SCIA accompanying vein was anastomosed to the cephalic vein. All flaps survived without postoperative circulatory complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest that the AIA is suitable for end-to-end anastomosis with the SCIA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639288","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 Use of Serratus Anterior Artery as the Pedicle for Complex Humerus Reconstruction With a Vascularized Fibular Graft: Anatomical Study and Clinical Application in a Case Series","authors":"Aleksandar Lovic,&nbsp;Javier Pérez-Rodríguez","doi":"10.1002/micr.70219","DOIUrl":"10.1002/micr.70219","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Free vascularized fibular graft is an optimal option for the reconstruction of long, complex bone defects in the humerus. Previous surgeries, infection, and trauma, particularly with brachial artery revascularization, may limit the use of conventional recipient vessels. In this study, we review the use of the serratus anterior artery as a recipient vessel, the anatomical validation of its feasibility and its clinical application in a series of cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The anatomical study consisted of 14 dissections on 7 Thiel-embalmed cadavers. The distance from the origin of the serratus anterior pedicle to the most distal point where the artery had at least 1.2 mm of external diameter was measured, as well as to the surgical neck of the humerus. A retrospective review (2008–2024) included patients undergoing humeral reconstruction with a free vascularized fibular graft using the serratus anterior artery. Etiology, previous procedures, bone healing, complications, pain (Visual Analogue Scale, VAS), and function (quick Disabilities of the Arm, Shoulder and Hand score, quickDASH) were recorded. This study adheres to STROBE guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The anatomical study showed that the mean pedicle length was 13.5 cm (range 11.8–15.5 cm), and in all dissections, the transposed pedicle reached distal to the humeral surgical neck. 5 patients (mean age 43 years, range 24–58 years) were included in the study. There were two posttraumatic and three post-oncologic reconstructions, with a mean of six previous surgeries. The mean follow-up was 9.7 years (range 1–17 years). All cases achieved bone union within the first postoperative year. There were two cases of postoperative complications: one case of fibular graft fracture that healed conservatively and one case of delayed healing of the fibular graft donor area. Mean VAS at last follow-up was 1.5 (range 0–4); mean quickDASH was 15.4 (range 0–32).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The serratus anterior artery provides a reliable length and caliber for use as a recipient vessel for humeral reconstruction with a free vascularized fibular graft when conventional recipient vessels are not available.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608962","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":"Flap Use for Wound Coverage After Spinal Hardware Infection: A Systematic Review of the Literature","authors":"Marah I. Jolibois,&nbsp;Artur Manasyan,&nbsp;Idean Roohani,&nbsp;Eva Williams,&nbsp;Joseph N. Carey,&nbsp;David A. Daar","doi":"10.1002/micr.70216","DOIUrl":"10.1002/micr.70216","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reconstructing spinal defects complicated by surgical site infection (SSI) is challenging, with SSIs occurring in 1%–4% of spine surgeries, often involving hardware exposure. These infections increase hospital stays, costs, and risks of poor outcomes. Effective management strategies are crucial for addressing infected spinal wounds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic review following PRISMA-P guidelines across six databases. Included studies reported flap coverage for spinal reconstructions with or without hardware. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality was evaluated using ASPS criteria and the ROBINS-I tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 4436 articles, 32 studies were included, comprising 969 patients, with 496 undergoing reconstructions for infected chronic wounds. The mean patient age was 52.1 years. Infection contributors included spinal instrumentation, radiotherapy, smoking, and diabetes, with <i>Staphylococcus aureus</i> being the most common organism (52.7%). Paraspinal muscle flaps and latissimus dorsi flaps were most frequently used. Out of the 27 studies that investigated the need for hardware removal, eight reported patients required it in the postoperative period. The pooled flap survival rate was 89%, with muscle flaps showing higher effectiveness compared to fasciocutaneous flaps (92% vs. 85%). Other complications included wound dehiscence (12%), flap necrosis (8%), and reinfection (10%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provides evidence-based insights into managing complex spinal defects. Flap reconstruction remains a viable solution for soft-tissue coverage, highlighting the importance of tailored surgical planning based on defect characteristics and patient factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513361","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}