Microsurgery最新文献

{"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}

{"title":"A Simple and Novel Microsurgery Instrument for Atraumatic Vessel and Perforator Dissection","authors":"Muhammad Umair Javed","doi":"10.1002/micr.70117","DOIUrl":"https://doi.org/10.1002/micr.70117","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012541","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":"Vessel Selection in Head and Neck Reconstruction After Neck Dissection or Radiotherapy","authors":"Yasufumi Makiuchi,&nbsp;Daisuke Kageyama,&nbsp;Masaki Arikawa,&nbsp;Satoshi Akazawa","doi":"10.1002/micr.70116","DOIUrl":"https://doi.org/10.1002/micr.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissection and/or radiotherapy. We analyzed outcomes with regard to recipient vessel selection and flap failure, referring to patients' histories of radiotherapy and/or neck dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Records of 671 patients who had undergone head and neck reconstruction in our institution from April 2018 to March 2024 were retrospectively reviewed. We divided patients into four groups based on their treatment history: radiotherapy alone (<i>RT</i>, <i>n</i> = 82), neck dissection alone (<i>ND</i>, <i>n</i> = 43), both radiotherapy and neck dissection (<i>NDRT</i>, <i>n</i> = 39), and intact neck with no history of radiotherapy or neck dissection (<i>IN</i>, <i>n</i> = 488). We collected data on flap types, defect areas, selected recipient vessels, and the occurrence of flap failure. We also assessed the risk factors for flap failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In <i>Group RT</i>, 66 of 84 (79%) recipient vessels were located within irradiated areas. In contrast, in <i>Group ND</i>, 37 of 45 (82%) recipient vessels were outside the dissected areas. No significant association was observed between overall flap failure and variables we assessed. However, our additional flap failure analysis by arterial or venous factors showed an association with the patients' history of radiation treatment (<i>p</i> &lt; 0.05) and in cases where anastomosed vessels were actually located within irradiated areas (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with previous radiotherapy history, recipient vessels even within irradiated areas can often be successfully used as recipient vessels. However, after undergoing irradiation treatment, the risk of venous-related flap failure may be higher compared with the non-irradiated area; thus, it necessitates careful consideration during reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007988","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":"Does the Timing, Type, and Method of Flap Coverage After Open Tibia Fracture Fixation Influence the Rate of Deep Infection?","authors":"Umar Khan,&nbsp;Kennedy Gray,&nbsp;Senay Ghidei,&nbsp;Caitlin Quigley,&nbsp;Vineet Mehan,&nbsp;Earl Johnson,&nbsp;Abraham Goch,&nbsp;Greg Gaski","doi":"10.1002/micr.70110","DOIUrl":"https://doi.org/10.1002/micr.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate whether the timing of flap coverage following definitive fixation influences deep infection and nonunion in patients with Gustilo-Anderson (GA) Type 3B and 3C open tibia fractures, accounting for flap method (local vs. free) and tissue type (muscle vs. fasciocutaneous).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of patients with GA 3B and 3C tibia fractures treated at a Level I trauma center (2013–2022) with fracture fixation and soft-tissue reconstruction. Primary outcomes were deep surgical site infection and nonunion, assessed by timing of flap coverage (≤ 72 vs. &gt; 72 h), tissue type, and flap method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one patients (52 extremities) met inclusion criteria. Deep infection was significantly higher after free (13/30, 43%) versus local flaps (0/22; <i>p</i> &lt; 0.001). There was a trend toward increased infection rates when coverage occurred &gt;72 h post-fixation (9/30, 30%) versus ≤ 72 h (4/22, 18%; <i>p</i> = 0.33). Among free flaps, coverage ≤ 72 h had fewer infections (4/13, 31%) than coverage &gt; 72 h (9/17, 53%; <i>p</i> = 0.22). Tissue type and timing had no significant effect: muscle ≤ 72 h (4/20, 20%) vs. &gt; 72 h (8/23, 35%; <i>p</i> = 0.28); fasciocutaneous ≤ 72 h (0/2) vs. &gt; 72 h (1/7, 14%; <i>p</i> &gt; 0.99). Nonunion was more common with free flaps (13/30) than local flaps (2/22; <i>p</i> = 0.007). Free flaps placed ≤ 72 h had fewer nonunions (4/13, 31%) than those placed &gt; 72 h (9/17, 53%; <i>p</i> = 0.22).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Free flaps were associated with higher rates of deep infection and nonunion. Although not statistically significant, there was a trend toward increased complications with coverage &gt; 72 h, especially for free and muscle flaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935144","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":"Use of Contrast-Enhanced Ultrasound in Genital Lymphedema: A Report of Three Cases","authors":"Maria V. Rios-Sanchez,&nbsp;Samyd S. Bustos,&nbsp;Alejandra Aristizábal,&nbsp;Carlos Bruces-Molina,&nbsp;Christine U. Lee,&nbsp;Nho V. Tran,&nbsp;Vahe Fahradyan","doi":"10.1002/micr.70114","DOIUrl":"https://doi.org/10.1002/micr.70114","url":null,"abstract":"<div>\u0000 \u0000 <p>Genital lymphedema presents significant challenges in surgical management, with limited effective interventions. This case report explores the use of contrast-enhanced ultrasound (CEUS) with microbubble injection as an alternative adjunct technique for lymphatic mapping in lymphaticovenous anastomosis (LVA) surgery for genital lymphedema. A retrospective chart review approved by our institutional review board was performed for patients with genital lymphedema undergoing LVA surgery between 2020 and 2024. Intraoperative CEUS for lymphatic mapping was used with intradermal injection of microbubble suspension Lumason (Bracco Suisse, Monroe Township, NJ, USA). Data regarding demographics, comorbidities, clinical and operative characteristics, complications, and surgical outcomes were retrieved. Three patients with genital lymphedema who underwent LVA were identified. The first patient was a 34-year-old female with recurrent lymphangioma circumscriptum and vesicular drainage. She successfully underwent CEUS-guided LVA followed by two debulking procedures. The second patient was a 16-year-old male with congenital scrotal and lower extremity lymphedema. He had two CEUS-guided LVAs and subsequent debulking for anterior scrotal swelling, with long-term reduction in edema. The third patient was a 31-year-old female with primary lymphedema of the right lower extremity and genital region. She underwent seven CEUS and indocyanine green lymphography (ICG) guided anastomoses targeting the mons and lower abdomen, resulting in substantial symptomatic and volumetric improvement. CEUS detected target lymphatic vessels in all cases, including cases where ICG imaging failed to identify candidate lymphatic vessels. CEUS with intradermal microbubble injection successfully identified target lymphatic vessels in the preoperative planning for LVA surgery in patients with genital lymphedema.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935145","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":"Combined Use of Peripheral Nerve Surgery and Peripheral Nerve Stimulation in Patients With Refractory Neuropathic Pain","authors":"Floris V. Raasveld,&nbsp;Benjamin R. Johnston,&nbsp;David Hao,&nbsp;Ian L. Valerio,&nbsp;Kyle R. Eberlin","doi":"10.1002/micr.70112","DOIUrl":"https://doi.org/10.1002/micr.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Peripheral nerve injury (PNI) can lead to chronic neuropathic pain, significantly impacting quality of life. While surgical intervention may offer relief in some cases, outcomes are variable. Peripheral nerve stimulation (PNS) offers an alternative treatment approach for managing neuropathic pain in these patients. This study aims to describe the outcomes of a combined surgical and PNS approach for severe, refractory neuropathic pain following PNI or amputation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted on seven patients who underwent combined peripheral nerve surgery and PNS at a specialized multidisciplinary nerve clinic. Patient-reported outcome measures, including pain scores, Patient's Global Impression of Change (PGIC), and quality of life metrics, were collected. Patient data were retrospectively reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included five males and two females (mean age 58.3 ± 8.9 years), with four amputees and three non-amputees. The average follow-up duration was 2.4 ± 0.8 years. Six out of seven patients reported reduced pain when the stimulator was activated, with an average pain score reduction of 4.4 ± 1.5 points. All seven patients reported improvement on the PGIC scale. Mean pain intensity and pain interference scores averaged 54.7 ± 5.5 and 66.3 ± 6.5, respectively. One patient underwent device removal due to irritation from the topical adhesive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This proof-of-concept study suggests that combined peripheral nerve surgery and PNS may be a viable option for carefully selected patients with severe, refractory neuropathic pain. While pain reduction and functional improvement were observed in most patients, outcomes varied considerably. Future prospective studies with larger cohorts are needed to refine patient selection criteria and optimize this combined approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929912","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":"Augmented Reality for Lymphovenous Anastomosis Planning Based on ICG Lymphography Anatomy of the Healthy Limb","authors":"Nicolás Pereira,&nbsp;María Antonella López,&nbsp;Vanessa Oñate,&nbsp;Ricardo Roa","doi":"10.1002/micr.70115","DOIUrl":"https://doi.org/10.1002/micr.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>When indocyanine green lymphography (ICG-L) fails to display a linear pattern, preoperative planning for lymphovenous anastomosis (LVA) becomes challenging. Given the anatomical symmetry of lymphatics in extremities, the healthy limb can serve as a template for the affected one. This study introduces an accessible technique that uses augmented reality (AR) to mirror the lymphatic anatomy of the unaffected limb onto the affected side to assist in surgical planning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twelve patients with unilateral secondary lymphedema of the upper or lower extremity (Stage II or less) were included. After standard ICG-L mapping, the unaffected limb was photographed when it showed a linear lymphatic pattern. The image was mirrored and superimposed onto the affected limb using an AR smartphone app to guide incision planning for LVA. Volume reduction and clinical outcomes were measured postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 39 LVAs were successfully performed at the planned locations, with 100% intraoperative accuracy. No modifications or extensions of incisions were needed. Patients experienced an average operative time of 142.5 min. Volume excess was reduced by 47% over a follow-up period of 3–24 months, with a notable reduction in episodes of cellulitis and improvements in symptoms and quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>“Mirror the lymph” is a reliable, low-cost AR-based planning method for identifying lymphatic vessels in patients with unilateral lymphedema when ICG-L mapping shows early dermal backflow. This technique improves surgical precision and efficiency and offers an innovative tool for resource-limited settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935320","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":"Larynx Preservation Surgery Revisited: A Case Series of Free-Flap Reconstructions for Various Laryngeal Compartments","authors":"Jonas Werner,&nbsp;Mario F. Scaglioni,&nbsp;Alexios Martin,&nbsp;Jana Ciritsis,&nbsp;Anja von Muralt,&nbsp;Grégoire B. Morand,&nbsp;Gunesh P. Rajan","doi":"10.1002/micr.70113","DOIUrl":"https://doi.org/10.1002/micr.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Reconstruction after partial laryngectomy poses challenges in preserving voice, swallowing, and airway patency. Tailored laryngeal free-flap reconstructions using multiple chimeric perforator flaps aim to maximize functional preservation of the larynx and facilitate swallowing rehabilitation by enhancing larynx mobility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Various compartmental laryngeal reconstructions using chimeric free flaps were performed on seven male patients (aged 40–82) with laryngeal malignancies following open partial laryngectomy. Chimeric anterolateral thigh (ALT) flaps and triple chimeric superficial circumflex iliac artery perforator (SCIP) flaps were each used in two patients, while three patients received chimeric medial femoral condyle perforator (MFCP) flaps. Patients were regularly monitored for tumor recurrence, airway patency, and voice and swallowing functions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Postoperative courses were uneventful in all patients. Over a median follow-up of 30 months (range 9–41), five of seven patients were tracheostomy-independent, and four were on a full oral diet without a gastrostomy tube. Four patients had undergone prior radiotherapy, of whom two developed a second local recurrence, requiring total laryngectomy. One patient died from distant disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Following partial laryngectomy, compartment reconstruction with chimeric perforator flaps enhances larynx mobility, potentially improving functional outcomes. In the salvage setting, laryngeal preservation procedures may compromise oncological control. Further studies comparing the presented techniques with conventional reconstruction methods are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144927226","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":"Comments on “Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction”","authors":"Carla Herman,&nbsp;Nathalie Auger","doi":"10.1002/micr.70103","DOIUrl":"https://doi.org/10.1002/micr.70103","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915124","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 of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis","authors":"May X. Li,&nbsp;Jason Zhang,&nbsp;Michael A. Howard,&nbsp;Chad M. Teven","doi":"10.1002/micr.70109","DOIUrl":"https://doi.org/10.1002/micr.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer-related lymphedema (BCRL). This meta-analysis estimates the benefit of ILR in preventing lymphedema by incorporating double- and single-arm studies and stratifying by length of follow-up time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Three databases were queried for studies with primary data on ILR. Both double- and single-armed studies were included, and papers with small sample sizes, overlapping samples, and unreported data were excluded. Treatment effects were calculated with risk ratios and converted to a logarithmic scale. A meta-analysis was performed using the inverse variance method and a random-effects model, with further analysis done by study design and length of follow-up time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 17 studies were included (9 double-arm and 8 single-arm; <i>n</i> = 2607). The pooled treatment effect of ILR, expressed as log risk ratio (95% CI), was −0.89 (−1.18, −0.60; <i>p</i> &lt; 0.0001). This corresponds to a relative risk of 0.41 (0.31, 0.55) and a number needed to treat of 9. Double- and single-arm studies showed no significant differences in effect sizes. Studies with &lt; 1-year follow-up demonstrated a larger effect size than those with longer follow-up, and the benefits of ILR were no longer significant past 3 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients receiving ILR were significantly less likely to develop BCRL than those receiving ALND alone. Further work is needed to examine whether benefits can truly be sustained long-term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905582","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}