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The Sensate External Pudendal Artery Perforator (EPAP) Hemi-Scrotal Flap for the Circumferential Skin Defect of the Penile Shaft: A Case Report and Literature Review 感觉阴部外动脉穿支(EPAP)半阴囊皮瓣修复阴茎干周围皮肤缺损1例并文献复习。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-10-07 DOI: 10.1002/micr.70123
Reiko Tsukuura, Toni Engmann, Toko Miyazaki, Takumi Yamamoto
{"title":"The Sensate External Pudendal Artery Perforator (EPAP) Hemi-Scrotal Flap for the Circumferential Skin Defect of the Penile Shaft: A Case Report and Literature Review","authors":"Reiko Tsukuura,&nbsp;Toni Engmann,&nbsp;Toko Miyazaki,&nbsp;Takumi Yamamoto","doi":"10.1002/micr.70123","DOIUrl":"10.1002/micr.70123","url":null,"abstract":"<div>\u0000 \u0000 <p>Penile skin reconstruction is traditionally performed using a skin graft and/or local pedicled flap. The scrotal flap is one of the options. However, previous techniques sacrifice the bilateral external pudendal arteries which put the skin pedicle at risk of dyspareunia and stretching. To overcome this limitation, we used the external pudendal artery perforator (EPAP) hemi-scrotal flap with isolation of the pedicle perforator to elevate the perforator flap with a wider rotation arc, easier and safer inset without tension, and sufficient coverage of the defect. A 40 years old male with schizophrenia had circumferential penile skin defect after penile replantation. The sensate EPAP hemi-scrotal flap measuring 9 × 14 cm was designed using doppler ultrasound preoperatively and harvested above the deep fascia. The external pudendal artery perforator and the anterior scrotal nerve were isolated. The shaft skin defect was covered with the sensate EPAP flap and the donor site was closed primarily. Postoperative course was uneventful without any short-term complications. Seven months after the reconstructive surgery, the transferred flap showed good color match and sensation, and the donor site was inconspicuous. Its function recovered without the sensation of pain and stretching. According to current literature the scrotal flap is a suitable donor site because of its thin, pliable, pigmented, and sensate characteristics. Beyond this current approach, we believe that harvesting the scrotal flap specifically as a perforator flap may be a superior flap for penile skin coverage. A higher rotation arc and inconspicuous donor site scar are further beneficial features of this approach.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239173","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}
引用次数: 0
Cephalic Vein Interposition Graft for Salvage of Compromised DIEP Flap in Breast Reconstruction 头静脉间置移植术在乳房再造术中修复受损DIEP皮瓣。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-10-03 DOI: 10.1002/micr.70124
Nishant Kumar, Samyd S. Bustos, Scott K. Odorico, Aparna Vijayasekaran
{"title":"Cephalic Vein Interposition Graft for Salvage of Compromised DIEP Flap in Breast Reconstruction","authors":"Nishant Kumar,&nbsp;Samyd S. Bustos,&nbsp;Scott K. Odorico,&nbsp;Aparna Vijayasekaran","doi":"10.1002/micr.70124","DOIUrl":"10.1002/micr.70124","url":null,"abstract":"<div>\u0000 \u0000 <p>The deep inferior epigastric perforator (DIEP) flap remains the preferred flap option for autologous breast reconstruction following mastectomy. This case report presents the novel use of the cephalic vein (CV) as an interposition graft to alleviate venous congestion in a patient undergoing DIEP flap reconstruction. A 42-year-old woman experienced venous congestion following her initial autologous reconstruction, attributed to thrombus formation from kinking of the vascular pedicle. Despite initial attempts to resolve the congestion, the condition persisted. Since the flap was based on a single perforator, we decided to attempt a CV turndown. The CV was noted to be attenuated and not feasible for use in turndown; therefore, venous salvage was completed by using the CV as an interposition graft to bypass the affected flap vena comitans. The procedure successfully restored venous flow, allowing for flap salvage and subsequent healing. This case underscores the potential of CV as an interposition graft in autologous breast reconstruction, particularly when traditional CV turndown is not possible due to vessel attenuation.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213085","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}
引用次数: 0
Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis 布比卡因脂质体在经腹平面阻滞中用于自体乳房重建术后疼痛控制:一项系统综述和荟萃分析。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-10-03 DOI: 10.1002/micr.70126
Victor F. A. Almeida, Glaudir Donato, Andressa Alves de Carvalho, Wanessa Alves de Carvalho, Ammar Lakda, Yara Dias, Manoela Dantas, Pedro Danielian, Eliana F. R. Duraes
{"title":"Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis","authors":"Victor F. A. Almeida,&nbsp;Glaudir Donato,&nbsp;Andressa Alves de Carvalho,&nbsp;Wanessa Alves de Carvalho,&nbsp;Ammar Lakda,&nbsp;Yara Dias,&nbsp;Manoela Dantas,&nbsp;Pedro Danielian,&nbsp;Eliana F. R. Duraes","doi":"10.1002/micr.70126","DOIUrl":"10.1002/micr.70126","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autologous breast reconstruction using abdominally based flaps is common post-mastectomy, but donor-site pain often leads to prolonged opioid use. The transversus abdominis plane (TAP) block is a common regional anesthesia technique, with bupivacaine as the standard anesthetic. Liposomal bupivacaine (LB), a prolonged-release formulation, aims to extend pain relief and reduce opioid consumption, though its efficacy remains debated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This systematic review and meta-analysis compared LB versus plain bupivacaine (PB) in TAP blocks for autologous breast reconstruction, focusing on opioid consumption, pain scores, and hospital stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search identified randomized controlled trials and observational studies comparing LB (with or without PB) to PB in TAP blocks. Data were pooled using a random-effects model (<i>I</i><sup>2</sup> ≥ 25%) or fixed-effects model (<i>I</i><sup>2</sup> &lt; 25%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six studies (429 patients) met inclusion criteria. LB was associated with significant reduction in opioid consumption on postoperative days (POD) 1 (MD = −4.99 mg; 95% CI: [−8.42; −1.56], <i>p</i> &lt; 0.01, <i>I</i><sup>2</sup> = 0%) and POD 2 (MD = −3.35 mg; 95% CI: [−5.74; −0.96], <i>p</i> &lt; 0.01, <i>I</i><sup>2</sup> = 0%). Pain scores were significantly lower on POD 2 and POD 3. No difference in hospital stay was found (MD = −0.17; 95% CI: [−0.52; 0.18], <i>p</i> = 0.34, <i>I</i><sup>2</sup> = 83.1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>LB reduced opioid consumption during the first 48 h postoperatively and modestly improved pain control on POD 2 and POD 3, but did not shorten hospital stay. Further large-scale RCTs are needed to validate its benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213137","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}
引用次数: 0
DeBakey Forceps: The Quintessential Tool for Perforator Surgery? DeBakey钳:穿支手术的必备工具?
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-10-02 DOI: 10.1002/micr.70122
James Macgregor, Miles Banwell, Richard Haywood
{"title":"DeBakey Forceps: The Quintessential Tool for Perforator Surgery?","authors":"James Macgregor,&nbsp;Miles Banwell,&nbsp;Richard Haywood","doi":"10.1002/micr.70122","DOIUrl":"10.1002/micr.70122","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206836","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}
引用次数: 0
Human Amnion-Derived Mesenchymal Stem Cells Prolong Graft Survival in a Rat Hind Limb Allotransplantation Model 人羊膜间充质干细胞在大鼠后肢同种异体移植模型中延长移植物存活。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-29 DOI: 10.1002/micr.70125
Daichi Sakamoto, Ryosuke Ikeguchi, Tomoki Aoyama, Maki Ando, Koichi Yoshimoto, Terunobu Iwai, Kazuaki Fujita, Tetsuya Miyamoto, Takashi Noguchi, Shuichi Matsuda
{"title":"Human Amnion-Derived Mesenchymal Stem Cells Prolong Graft Survival in a Rat Hind Limb Allotransplantation Model","authors":"Daichi Sakamoto,&nbsp;Ryosuke Ikeguchi,&nbsp;Tomoki Aoyama,&nbsp;Maki Ando,&nbsp;Koichi Yoshimoto,&nbsp;Terunobu Iwai,&nbsp;Kazuaki Fujita,&nbsp;Tetsuya Miyamoto,&nbsp;Takashi Noguchi,&nbsp;Shuichi Matsuda","doi":"10.1002/micr.70125","DOIUrl":"10.1002/micr.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recently, the immunomodulatory effects of mesenchymal stem cells have been reported in several studies. The purpose of this study was to evaluate the effect of the administration of human amnion–derived mesenchymal stem cells (hAm-MSCs) in a rat vascularized composite allotransplantation model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 18 Lewis (LEW) rats and 6 Brown-Norway (BN) rats were used. Sixteen LEW rats as recipients were divided randomly into four groups: Isograft (Iso), Untreated (UT), FK, and MSC groups (<i>n</i> = 4, each group). Hind limb transplantation was performed. In the Iso group, 2 LEW rats were used as donors. In the other groups, 6 BN rats were used as donors. In the UT group, no immunosuppressant was used. In the FK group, 0.2 mg/kg/day of FK506 (tacrolimus) was administered from day 0 to day 6. In the MSC group, 2 × 10<sup>6</sup> hAm-MSCs were administered on day 7 after tacrolimus administration (day 0–6). Graft survival was assessed by daily inspection, histology, and immunohistology with the TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) assay. Cytokine mRNA expression analysis using real-time, reverse transcription PCR (RT-PCR) of the grafts was analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Graft survival in the MSC group (14.8 days) was significantly prolonged compared with that of the FK group (13 days; <i>p</i> &lt; 0.05). Histology and immunohistology with the TUNEL assay showed a significant reduction of mononuclear cell infiltration and apoptotic cells in the MSC group compared with the FK group (<i>p</i> &lt; 0.05). RT-PCR analysis of cytokine mRNA expression showed a significant decrease of IL-2 and an increase of TGFβ in graft muscle (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>hAm-MSCs prolonged graft survival in the rat vascularized composite allotransplantation model. hAm-MSCs could be an alternative immunomodulatory agent to avoid the side effects of conventional immunosuppressant.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186267","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}
引用次数: 0
Investigating the Safety of Breast Reconstruction With the Deep Inferior Epigastric Flap in Patients With Connective Tissue Diseases 探讨结缔组织疾病患者应用腹下深层皮瓣重建乳房的安全性。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-24 DOI: 10.1002/micr.70092
Sophia Arbuiso, Makayla Kochheiser, Albert Truong, Samuel J. Medina, Matthew W. Liao, Sarah Diaddigo, Gianni Thomas, Leslie Cohen, Jason A. Spector, David M. Otterburn
{"title":"Investigating the Safety of Breast Reconstruction With the Deep Inferior Epigastric Flap in Patients With Connective Tissue Diseases","authors":"Sophia Arbuiso,&nbsp;Makayla Kochheiser,&nbsp;Albert Truong,&nbsp;Samuel J. Medina,&nbsp;Matthew W. Liao,&nbsp;Sarah Diaddigo,&nbsp;Gianni Thomas,&nbsp;Leslie Cohen,&nbsp;Jason A. Spector,&nbsp;David M. Otterburn","doi":"10.1002/micr.70092","DOIUrl":"10.1002/micr.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Connective tissue diseases (CTDs) are associated with impaired wound healing and hypercoagulability. There is currently a paucity of research examining postoperative outcomes in these patients following microsurgical procedures. We aimed to analyze postoperative outcomes in patients with CTDs following breast reconstruction with the deep inferior epigastric perforator (DIEP) flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-institution retrospective study was conducted consisting of all patients that underwent breast reconstruction with DIEP flaps between 2015 and 2023. Outcomes were assessed in the 90-day postoperative period, and Fisher's exact test was used to compare results between patients diagnosed with a CTD and patients who do not have CTDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five hundred ten DIEP flaps were performed on 286 patients. Eight of these patients, who underwent 13 DIEP flaps, were diagnosed with CTDs. The patients with and without CTDs were similar with respect to patient demographics. Patients with CTDs were not at increased risk of experiencing any major complication. However, patients with CTDs were at increased risk of experiencing fat necrosis, particularly of the breast (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data suggests that breast reconstruction using DIEP flaps is a safe procedure for patients who have CTDs; however, they may be at increased risk for fat necrosis of the breast, which does not require significant intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137905","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}
引用次数: 0
Evaluating the Safety of Immediate Lymphatic Reconstruction With Implant-Based Breast Reconstruction: Eight-Year Institutional Review 评估以假体为基础的乳房重建的即时淋巴重建的安全性:八年的机构回顾。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-16 DOI: 10.1002/micr.70119
Diwakar Phuyal, Fuad Abbas, Osama Darras, Zoe E. Belardo, Jack Sims, Risal Djohan, Steven L. Bernard, Graham Schwarz, Raffi Gurunian, Sarah N. Bishop
{"title":"Evaluating the Safety of Immediate Lymphatic Reconstruction With Implant-Based Breast Reconstruction: Eight-Year Institutional Review","authors":"Diwakar Phuyal,&nbsp;Fuad Abbas,&nbsp;Osama Darras,&nbsp;Zoe E. Belardo,&nbsp;Jack Sims,&nbsp;Risal Djohan,&nbsp;Steven L. Bernard,&nbsp;Graham Schwarz,&nbsp;Raffi Gurunian,&nbsp;Sarah N. Bishop","doi":"10.1002/micr.70119","DOIUrl":"10.1002/micr.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lymphedema is a chronic condition that can occur in patients following axillary lymph node dissection (ALND). Breast reconstruction has been reported to reduce lymphedema risk. When immediate lymphatic reconstruction (ILR) is combined with implant-based breast reconstruction (IBR), it offers the potential for both functional and esthetic benefits in one surgery. However, its impact on postoperative complications, such as infection and wound dehiscence, among others, remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An IRB-approved retrospective review was conducted on patients who underwent ALND and immediate implant reconstruction (IBR). Data collected included patient demographics, treatment characteristics, and complication rates. Assessed complications included major infection requiring intravenous antibiotic or reoperation, minor infection requiring oral antibiotic, hematoma, seroma, wound issues, deep vein thrombosis, mastectomy flap necrosis, reoperation, implant explantation, and rehospitalization. The primary outcome was a comparison of complication rates between patients who received ILR and those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 178 patients (68 with ILR and 110 without ILR), accounting for implant reconstruction in 266 breasts. Mean operative time was significantly longer in the ILR group (326 min vs. 245, <i>p</i> &lt; 0.001). Despite this, overall complication rates were comparable (38% vs. 34%, <i>p</i> = 0.63). No significant differences were observed in infection rates, seroma formation, reoperations, or implant explantations over a three-year follow-up period. Age and BMI were identified as independent predictors of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite longer operative times, ILR demonstrates a comparable safety profile to implant-based breast reconstruction when performed concurrently following ALND.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069894","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}
引用次数: 0
Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report 术中证据早期新生血管在SCIP皮瓣术后创伤:1例报告。
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-16 DOI: 10.1002/micr.70121
Lorena Ballerini, Ryo Karakawa, Tomoyuki Yano
{"title":"Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report","authors":"Lorena Ballerini,&nbsp;Ryo Karakawa,&nbsp;Tomoyuki Yano","doi":"10.1002/micr.70121","DOIUrl":"10.1002/micr.70121","url":null,"abstract":"<div>\u0000 \u0000 <p>Microvascular free-flap transfer is a widely used technique for reconstructing complex tissue defects. While early postoperative flap survival depends on intact vascular anastomoses, neovascularization may contribute to long-term viability. However, direct intraoperative human evidence of early neovascularization in free flaps remains limited. This case report aims to provide direct intraoperative evidence of early neovascularization in a free SCIP flap. We present a case of an 88-year-old female who underwent wide resection of a soft tissue sarcoma and reconstruction with a free superficial circumflex iliac artery perforator (SCIP) flap. The flap survived uneventfully, but on postoperative Day 19, the patient sustained a fall, resulting in a tibial fracture requiring a secondary operation. During this procedure, multiple neovascular perforators were observed between the recipient bed and the previously transplanted SCIP flap. Specifically, at least two neovascular perforators measuring 0.3 mm and 0.5 mm were identified, confirming active neovascularization. This case provides rare intraoperative human evidence of neovascularization in a free flap. While previous studies have questioned the extent of neovascularization, our findings suggest that new vascular connections may form under favorable conditions, such as a well-vascularized recipient site. Neovascularization may offer an additional layer of vascular support in free flaps, particularly in cases of partial vascular compromise. Further research is needed to determine its clinical significance and potential implications for reconstructive surgery.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075788","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}
引用次数: 0
Evolution of Triple Innervation Technique in the Treatment of Facial Paralysis 三联神经支配技术治疗面瘫的进展
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-15 DOI: 10.1002/micr.70111
Fabiana Allevi, Amelia Beretta, Federico Bolognesi, Filippo Tarabbia, Valeria Battista, Federico Biglioli
{"title":"Evolution of Triple Innervation Technique in the Treatment of Facial Paralysis","authors":"Fabiana Allevi,&nbsp;Amelia Beretta,&nbsp;Federico Bolognesi,&nbsp;Filippo Tarabbia,&nbsp;Valeria Battista,&nbsp;Federico Biglioli","doi":"10.1002/micr.70111","DOIUrl":"https://doi.org/10.1002/micr.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of this study is to compare the traditional triple innervation technique with a new version, designed to reduce eye-mouth synkinesis. To reduce unpleasant synkinesis, the authors proposed changing the connection between the masseteric nerve and the injured facial nerve, analyzing the outcome in terms of reduction of synkinesis and power of contraction of the mimic muscle. The traditional technique conveys the quantitative stimuli from the masseteric nerve to the temporofacial branch and from the hypoglossal nerve (30%) to the cervicofacial branch. Traditionally, the stimulus coming from the masseteric nerve is directed in that way to both the orbicularis oculi and the great zygomatic muscle, leading to eye-mouth synkinesis. The evolved technique connects the masseteric nerve more distally on the branch directed to the great zygomatic muscle and the hypoglossal nerve (30%) to the main trunk of the injured facial nerve. Long-term follow-up could be interesting to check what happens to the eye without the stimulus coming from the masseteric nerve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Exactly 32 patients were included, subdivided into two groups based on the type of surgical technique. Static symmetry, voluntary movements, and synkinesis were evaluated with eFACE software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both techniques allowed to obtain excellent outcomes: pre- and post-operative parameters showed a statistically significant improvement in both groups and no differences between the two groups, except in palpebral fissure width forced eye closure, in oculo and midfacial synkinesis: a significant reduction of synkinesis was evident in the evolved version group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The new triple innervation offers significant improvements in reducing synkinesis, ocular and mid-facial muscle spasm, leading to a more relaxed tone at rest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057819","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}
引用次数: 0
A Simple and Novel Microsurgery Instrument for Atraumatic Vessel and Perforator Dissection 一种简单新型的非创伤性血管及穿支解剖显微手术器械
IF 1.7 3区 医学
Microsurgery Pub Date : 2025-09-08 DOI: 10.1002/micr.70117
Muhammad Umair Javed
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