Microsurgery最新文献

{"title":"Free Innervated Gracilis Muscular Flap for Functional Abdominal Wall Reconstruction Following Desmoid Tumor Resection: A Case Report and Literature Review","authors":"Efstathios G. Lykoudis,&nbsp;Marios Papadakis,&nbsp;Ilias Stylianos K. Iliadis,&nbsp;George E. Lykoudis,&nbsp;Dimitra V. Peristeri,&nbsp;Ioannis Dalianoudis","doi":"10.1002/micr.70306","DOIUrl":"10.1002/micr.70306","url":null,"abstract":"<p>Desmoid tumors (DTs) are rare, benign, locally aggressive myofibroblastic neoplasms. Complete resection with negative margins remains the standard treatment despite their lack of metastatic potential. As DT commonly involve the anterior abdominal wall, their excision may result in complex defects requiring advanced reconstruction. We herein present the first functional single-stage reconstruction of an abdominal wall defect with the use of a free innervated gracilis muscle flap transfer. A 29-year-old woman, presented with a palpable tumor on the left-side of her abdominal wall. She underwent surgery and on biopsy, the tumor was diagnosed as a DT. The patient underwent wide resection through an abdominoplasty approach, which resulted in a rectus abdominis defect involving the anterior rectus abdominis sheath. The 8 × 7cm-sized defect was reconstructed with free transfer of a neurotized gracilis muscle flap, anastomosed to the deep inferior epigastric vessels, whereas, the anterior branch of the obturator nerve was coapted to the ninth intercostal nerve. Finally, a monofilament polypropylene mesh was used for reconstruction of the missing anterior rectus sheath. Ever since and during a follow-up of 5 years, electromyographic examinations have demonstrated excellent re-innervation of the gracilis muscle flap. The patient underwent regular follow-up examinations, including CT imaging at 1, 2, and 5 years postoperatively, with no evidence of abdominal wall protrusion or tumor recurrence. This case demonstrates that the free innervated gracilis flap can provide a safe and reliable reconstructive option for complex abdominal wall defects following oncologic resection.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195465","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":"Predictors of Complications and the Role of Early Revision in Reverse-Flow Posterior Interosseous Artery Flaps: A Multivariable Analysis of 110 Cases","authors":"Kubilay Erol,&nbsp;Can Yener,&nbsp;Bakıt Kerekulov,&nbsp;Erdem Er,&nbsp;Özgün Barış Güntürk","doi":"10.1002/micr.70307","DOIUrl":"10.1002/micr.70307","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The pedicled reverse-flow posterior interosseous artery (PIA) flap is a reliable option for soft-tissue reconstruction of the hand and wrist. However, the predictors of complications and the impact of early revision surgery have not been adequately evaluated using multivariable analysis. This study aimed to investigate the factors affecting flap survival, complication rates, and outcomes of salvage surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 110 patients who underwent reconstruction with a pedicled reverse PIA flap between 2010 and 2025. Univariable and multivariable logistic regression analyses were performed to identify predictors of venous congestion, flap loss, and donor site grafting. Receiver operating characteristic (ROC) analysis was used to determine the dimensional thresholds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean patient age was 34.2 years, and the majority of defects were traumatic in etiology (80.9%). Venous congestion occurred in 30 patients (27.3%), whereas total and partial flap loss occurred in five (4.5%) and 15 (13.6%) patients, respectively. On multivariable analysis, flap length was independently associated with venous congestion (OR = 1.45, 95% CI 1.17–1.79; <i>p</i> &lt; 0.001) and flap loss (OR = 1.47, 95% CI 1.17–1.85; <i>p</i> &lt; 0.001). ROC analysis identified a flap length of 9 cm as a practical reference threshold (high specificity, modest sensitivity) for these complications. In a separate donor-site grafting model, flap width &gt; 4 cm was associated with grafting on univariable analysis but became only borderline significant after multivariable adjustment (OR 1.60, 95% CI 0.98–2.60; <i>p</i> = 0.059), while traumatic etiology was independently associated with donor site grafting (OR = 8.00, 95% CI 2.20–29.03). Among patients with venous congestion, early revision was associated with a lower flap loss rate than conservative management (43.75% vs. 92.86%, <i>p</i> = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In reverse-flow PIA flap reconstruction, greater flap length was independently associated with venous congestion and flap loss. Traumatic etiology emerged as an independent predictor of donor-site grafting, an association that has received little prior attention. In patients with venous compromise, early revision was associated with a lower overall flap loss rate, although this observational finding requires confirmation in prospective studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194569","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":"Scratch Collapse Test and Patient-Reported Outcomes After Lower Extremity Nerve Decompression Surgery","authors":"Syeda Hoorulain Ahmed,&nbsp;Ramin Shekouhi,&nbsp;Syed Ali Haider,&nbsp;Harvey Chim","doi":"10.1002/micr.70305","DOIUrl":"10.1002/micr.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Entrapment neuropathies of the lower extremity are uncommon, frequently misdiagnosed or diagnosed late, and have no well-established diagnostic protocol. The scratch collapse test (SCT) has been described for carpal and cubital tunnel syndrome and, in the lower extremity, has been evaluated only for common peroneal nerve compression; whether it can localize uncommon or multiple sites of lower extremity nerve compression, and how it compares with Tinel's sign at those sites, is unknown. This study evaluates the feasibility of the SCT for localizing the site of nerve compression and describes functional and patient-reported outcomes (PROMs) in a cohort undergoing lower extremity nerve decompression (LEND).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-five consecutive patients who underwent LEND surgery were reviewed. Patients were assessed using standardized PROMs, including Visual Analog Scale (VAS), Patient Satisfaction Scale (PSS), Norfolk QOL-DN questionnaire, Lower Extremity Functional Scale (LEFS), and Michigan Neuropathy Screening Instrument (MNSI). Data were analyzed using t-tests and linear regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten compression sites were identified across 45 patients, most commonly the common peroneal (19, 42.2%), superficial peroneal (17, 37.8%), and tibial (13, 28.9%) nerves. The SCT was positive in all 45 patients and Tinel's sign in 38 (84.4%). Postoperatively, sensory deficits improved in 73.3% of patients and muscle weakness in 35.6%. Among the 10 patients with paired clinical pain scores, pain improved from 8.9 ± 1.8 to 4.3 ± 3.5 (<i>p</i> = 0.003). Postoperative PROMs, available for 18 patients (40.0%), showed a mean VAS of 4.8 ± 2.8, PSS 3.6 ± 1.6, Norfolk QOL-DN 38.1 ± 29.5, LEFS 47.5 ± 24.5, and MNSI 5.2 ± 3.2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SCT is a feasible bedside adjunct for localizing common and uncommon sites of lower extremity nerve compression. In the absence of a control group or independent reference standard, these findings reflect feasibility and clinical utility rather than diagnostic accuracy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165159","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":"Frailty as a Predictor of Outcomes After Fibula Free Flap for Head and Neck Reconstruction: A Multi-Institutional Analysis Using the mFI-5","authors":"Jia Wei Tee,&nbsp;Dany Matar,&nbsp;Lorenzo Puppi,&nbsp;Thomas Schaschinger,&nbsp;Tobias Niederegger,&nbsp;Iman Ghanad,&nbsp;Leonard Knoedler,&nbsp;Samuel Knoedler,&nbsp;Dennis P. Orgill,&nbsp;Henri Kreiker,&nbsp;Carsten Rendenbach,&nbsp;Max Heiland,&nbsp;Gabriel Hundeshagen,&nbsp;Adriana C. Panayi","doi":"10.1002/micr.70301","DOIUrl":"https://doi.org/10.1002/micr.70301","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chronological age inadequately reflects physiologic vulnerability in older adults undergoing complex reconstruction. Frailty, quantified by the 5-item Modified Frailty Index (mFI-5), may better stratify perioperative risk in fibula free flap (FFF) reconstruction for head and neck defects, but its impact remains underdefined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of 406 adults undergoing FFF reconstruction (ACS-NSQIP, 2009–2023) evaluated the association between mFI-5 and 30-day postoperative outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher mFI-5 scores were associated with increased medical complications (14.1% mFI-5 = 0 vs. 34.3% mFI-5 = 2; <i>p</i> = 0.02), including pneumonia and myocardial infarction. mFI-5 = 1 (aOR 1.84; 95% CI, 1.01–3.47) and mFI-5 = 2 (aOR 3.45; 95% CI, 1.38–8.57) independently predicted medical complications; mFI-5 = 2 also predicted surgical complications (aOR 2.27; 95% CI, 1.00–5.43).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Frailty is a stronger predictor of postoperative morbidity than chronological age. Incorporating frailty assessment may enhance risk stratification and perioperative decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149146367","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":"Patient and Disease Factors Linked to Intraoperative Findings in Lymphaticovenous Anastomosis Surgery for Lymphedema: An International Multicenter Study.","authors":"Tinna H Arnardottir, Alieske Kleeven, Yasmine M J Jonis, Villiam V Kildal, Susanna Kauhanen, Hanneke J P Tielemans, Shan Shan Qiu, Maria Mani","doi":"10.1002/micr.70296","DOIUrl":"https://doi.org/10.1002/micr.70296","url":null,"abstract":"<p><strong>Background: </strong>Lymphaticovenous anastomosis (LVA) is an established microsurgical treatment for lymphedema, but predictors of intraoperative vessel characteristics and immediate anastomosis patency remain unclear. This study investigated associations between preoperative patient and disease factors and intraoperative findings during LVA surgery.</p><p><strong>Methods: </strong>In this prospective international multicenter study, 183 patients undergoing 426 LVAs were included. Preoperative patient and disease characteristics were recorded. Surgeons documented intraoperative findings using a standardized semiquantitative grading form, assessing lymphatic vessel function and fibrosis, and venous backflow and patency of the immediate anastomosis using intraoperative indocyanine green lymphography (ICG-L). Accuracy of preoperative ICG-L markings was also assessed. Associations between preoperative variables and intraoperative findings were analyzed using cumulative link mixed models and negative binomial regression.</p><p><strong>Results: </strong>The upper extremity had markedly less lymphatic vessel fibrosis (OR: 10.23, 95% CI: 2.27-45.99, p = 0.002) and greater venous backflow (OR: 0.46 for reduced backflow, 95% CI: 0.22-0.97, p = 0.041). Increased age correlated with more accurate ICG-L markings (OR: 1.04 per year, 95% CI: 1.00-1.08, p = 0.048) and greater surgeon confidence in immediate LVA patency (OR: 1.02 per year, 95% CI: 1.00-1.05, p = 0.028). Prior radical lymph node dissection reduced surgeon confidence in LVA patency (OR: 0.40, 95% CI: 0.16-0.97, p = 0.042). Body mass index (BMI) > 30 showed a trend toward more venous backflow. Increased patient age (IRR: 1.03 per year, 95% CI: 1.00-1.07, p = 0.026) and lower extremity location (upper- vs. lower-extremity IRR: 0.33, 95% CI: 0.11-0.87, p = 0.020) were associated with more preoperative erysipelas infections. Lymphedema stage (0-2b), etiology and duration, gender, and adjuvant therapy had no significant association with intraoperative findings.</p><p><strong>Conclusion: </strong>This multicenter study identified patient age and lymphedema location as factors associated with intraoperative findings in LVA surgery, including infection frequency, lymphatic vessel fibrosis, venous backflow, and surgeon-reported patency. Lymphedema stage (0-2b), etiology, and duration showed no significant associations.</p><p><strong>Trial registration: </strong>ISRCTN registry number: 72662721.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":"e70296"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228280","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":"Activated Clotting Time-Guided Systemic Heparinization as One Component of a Stepwise Salvage Algorithm for Inadequate Internal Mammary Artery Flow in Microsurgical Breast Reconstruction.","authors":"Kazuhiro Tsunekawa, Daisuke Yanagisawa, Shunsuke Yuzuriha","doi":"10.1002/micr.70310","DOIUrl":"https://doi.org/10.1002/micr.70310","url":null,"abstract":"<p><strong>Background: </strong>The internal mammary vessels are commonly used as recipient vessels for free flap breast reconstruction. However, inadequate arterial flow may be encountered intraoperatively. This hypothesis-generating study evaluated the safety and feasibility of activated clotting time (ACT)-guided systemic heparinization as one component of a salvage strategy in such situations.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive autologous breast reconstructions using the internal mammary artery (IMA) between 2019 and 2025. Based on intraoperative jet bleeding status and intimal findings, IMA vessels were categorized into three groups: normal flow, inadequate flow managed by conventional measures, and inadequate flow subsequently managed by ACT-guided systemic heparinization. ACT-guided systemic heparinization targeted an ACT of 200 s. An initial heparin bolus infusion of 36-60 IU/kg was given, followed by ACT measurement 15-30 min later and every 30-60 min thereafter, with additional heparin administered for ACT ≤ 200 s. Clinical outcomes were evaluated and compared.</p><p><strong>Results: </strong>A total of 103 IMA vessels (101 patients) were analyzed: 80 (77.7%) in the normal flow group, 17 (16.5%) in the inadequate flow group, and 6 (5.8%) in the ACT-guided heparinization group. Patient characteristics, aortic calcification, IMA diameter, and blood loss did not differ among groups (all p > 0.05). Postoperative hematoma rate was 2/80 for normal flow, 0/17 for inadequate flow, and 0/6 for ACT-guided heparinization (p > 0.05). Median peak ACT was 238 s, and median intraoperative heparin dose was 4758 IU. Despite the significantly longer intraoperative flap ischemia time in the ACT-guided heparinization group (normal flow: 98.5 min, inadequate flow: 127 min, ACT-guided heparinization: 208 min; p < 0.01), all six flaps survived.</p><p><strong>Conclusions: </strong>As part of intraoperative rescue, ACT-guided systemic heparinization was employed successfully in 5.8% of IMA vessels in this series. ACT monitoring provides rapid and objective assessment and may represent an additional intraoperative option for suboptimal arterial flow.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":"e70310"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228356","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":"Prophylactic Immediate Lymphatic Reconstruction for the Prevention of Secondary Lymphedema: A Systematic Review and Meta-Analysis of Comparative Studies","authors":"T. Read,&nbsp;R. Arora,&nbsp;G. Velli,&nbsp;A. Ho,&nbsp;M. Cheng,&nbsp;L. Watson","doi":"10.1002/micr.70295","DOIUrl":"https://doi.org/10.1002/micr.70295","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Secondary lymphedema remains a frequent and debilitating complication of axillary and inguinal lymph node dissection within oncological settings. Prophylactic lymphovenous shunting (LVS) delivered as immediate lymphatic reconstruction (ILR) has emerged as a strategy to preserve lymphatic continuity and reduce postoperative lymphedema. This systematic review and meta-analysis evaluated the effectiveness of prophylactic LVS across oncologic indications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive search of Medline (PubMed), Embase (Elsivier) and Cochrane Central databases identified comparative studies reporting lymphedema outcomes following prophylactic LVS performed at the time of nodal dissection. Seventeen studies met inclusion criteria, encompassing both upper- and lower-limb procedures. Primary outcome was incidence of clinically diagnosed lymphedema. A random-effects model was used to derive pooled effect estimates. Heterogeneity, subgroup analyses, and publication bias (including trim-and-fill adjustment) were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across 2261 patients, prophylactic ILR was associated with a significant reduction in postoperative lymphedema (100/800 [12.5%] vs. 353/1461 [24.2%]); (pooled OR 0.27; 95% CI 0.17–0.42; <i>p</i> &lt; 0.01). Between-study heterogeneity was moderate (<i>I</i>² = 52.8%; <i>Q</i> = 35.47 <i>p</i> &lt; 0.01). Subgroup analysis demonstrated no significant difference in treatment effect between upper- and lower-limb procedures (<i>Q</i>_m = 0.47; <i>p</i> = 0.49). Trim-and-fill adjustment suggested potential small-study effects; however, the protective association persisted following imputation (adjusted OR 0.37; <i>p</i> &lt; 0.0001). Overall, the direction of effect across studies was consistent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prophylactic LVS was associated with a lower incidence of lymphedema following axillary and inguinal lymph node dissection. However, confidence in the estimated treatment effect is limited by the predominance of observational evidence, methodological heterogeneity, and possible publication bias, highlighting the need for adequately powered multicenter randomized trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068168","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":"Evaluating the Impact of Therapeutic Anticoagulation Management in Head and Neck Free Tissue Transfer: A Retrospective Study of 126 Cases","authors":"Austin J. Lee,&nbsp;Derek J. Vos,&nbsp;Conrad K. Blunck,&nbsp;Michael A. Fritz,&nbsp;Eric D. Lamarre,&nbsp;Brandon L. Prendes,&nbsp;Peter J. Ciolek","doi":"10.1002/micr.70298","DOIUrl":"https://doi.org/10.1002/micr.70298","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Existing literature on anticoagulation in head and neck free flap reconstruction largely focuses on postoperative thromboprophylaxis. Less is known about preoperative therapeutic anticoagulation, including how perioperative anticoagulation holds, timing of resumption, and anticoagulant class relate to hemorrhagic, thromboembolic, and flap-related complications. This study evaluates these outcomes in anticoagulated patients undergoing head and neck free flap reconstruction and compares complication rates with matched non-anticoagulated controls.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective chart review was performed on patients who underwent free flap reconstruction between 2009 and 2023 and had been on therapeutic anticoagulation for over 1 month preoperatively. A matched control group of non-anticoagulated patients was included for comparison.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>126 anticoagulated patients (mean age 71.8 years, 75.4% male) were included. The most common indications for anticoagulation were atrial fibrillation (62.7%) and venous thromboembolism (30.2%). Anticoagulation medications included warfarin (49.2%), apixaban (36.5%), rivaroxaban (12.7%), and dabigatran (1.6%). Anticoagulation was stopped an average of 4.4 days preoperatively and resumed 7.8 days postoperatively. Hemorrhagic complications occurred in 14 patients (11.1%), including hematomas and unrelated bleeding. Thromboembolic complications occurred in 9 patients (7.1%), 6 of which resulted in flap failure. On matched cohort analysis, controls had lower odds of any complication (OR 0.41, 95% CI 0.21–0.81, <i>p</i> = 0.010), hemorrhagic or thromboembolic complications (OR 0.27, 95% CI 0.11–0.63, <i>p</i> = 0.003), and hemorrhagic complications specifically (OR 0.26, 95% CI 0.09–0.81, <i>p</i> = 0.020), while thromboembolic complication odds were not significantly different between groups (OR 0.47, 95% CI 0.15–1.44, <i>p</i> = 0.19).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study highlights the challenges of managing therapeutic anticoagulation in head and neck free flap surgery, where thromboembolic risk during interruption and hemorrhagic complications upon resumption point to the need for clearer guidelines. Evidence-based protocols are needed to replace discretionary practices and improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068310","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":"Triceps Motor Branch Transfers to the Infraspinatus and Teres Minor Motor Branches for Restoration of Shoulder External Rotation: A Cadaver Study","authors":"Bruno Azevedo Veronesi,&nbsp;Ângelo Santana Guerra,&nbsp;Renata Gregorio Paulos,&nbsp;Hugo Alberto Nakamoto,&nbsp;Teng Hsiang Wei,&nbsp;Marcelo Rosa de Rezende","doi":"10.1002/micr.70289","DOIUrl":"10.1002/micr.70289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recovery of shoulder external rotation after upper brachial plexus injury remains limited. This study investigated the anatomical feasibility of selective neurotizations using radial nerve branches to the triceps brachii as donors for the motor branches to the infraspinatus (bIS) and teres minor (bTm) muscles, aiming to enhance external rotation outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty fresh adult cadavers underwent posterior dissections to expose the suprascapular, axillary, and radial nerves. Radial nerve branches to the triceps were identified, measured, and mobilized to simulate transfers to bIS and bTm. Donor–recipient lengths, diameters, and feasibility of coaptation were analyzed. In 10 cadavers, histomorphometric evaluation quantified myelinated axons to assess compatibility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The most frequent branching pattern of the radial nerve included one branch to the long head of the triceps (bLoHT), two branches to the medial head (bMHT1 and bMHT2), and one or two branches to the lateral head (bLaHT1 and bLaHT2). bMHT2 was the longest branch (93.0 ± 8.0 mm, <i>p</i> &lt; 0.05), showed the highest axon count (3646 ± 2333 axons, <i>p</i> &lt; 0.05), and had the best reach to bIS. bLoHT and bMHT2 were the thickest branches (1.99 ± 0.49 mm and 2.07 ± 0.58 mm, respectively; <i>p</i> &lt; 0.05). The most feasible transfers were bMHT2 to bIS and bMHT1 to bTm, both demonstrating 100% feasibility, with diameter and axon count measurements also supporting these neurotizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Selective transfers from triceps branches to bIS and bTm are anatomically feasible. Medial head branches combine favorable length, diameter, and axon load, supporting their use as preferred donors to restore external rotation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13572804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963684","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":"Pre-Incision Time Intervals and Outcomes of Free Flap re-Exploration: A Retrospective Single-Center Study","authors":"Alexander Fiedler,&nbsp;Nesrin Ibrahim,&nbsp;Maria Füth,&nbsp;Tatjana Katharina Fricke,&nbsp;Sonja Verena Schmidt,&nbsp;Felix Reinkemeier,&nbsp;Flemming Puscz,&nbsp;Yonca Steubing,&nbsp;Marcus Lehnhardt,&nbsp;Christoph Wallner,&nbsp;Marius Drysch","doi":"10.1002/micr.70292","DOIUrl":"https://doi.org/10.1002/micr.70292","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Timely re-exploration is critical when free flaps show vascular compromise. However, the relative contribution of modifiable pre-incision delays after surgery registration and opportunities to shorten time to re-exploration within the recognition-to-incision pathway after flap ischaemia recognition remain uncertain. This study aimed to evaluate whether pre-incision delays are associated with free-flap salvage failure and to identify potential workflow targets for quality improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective, single-center analysis of 113 free-flap revision surgeries performed over the past 6 years. Time from registration to incision was partitioned into arrival latency (ward to operating room (OR)), anesthesia lead time, operating-room preparation, and surgery lead time. Operative duration was assessed separately. The primary outcome was salvage versus failure (total loss).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total flap loss occurred in 14.2% of re-explorations. Median registration-to-incision time was similar between salvage and failure (78 min vs. 77 min, ±30 min, <i>p</i> = 0.89). Arrival latency (19 min vs. 20 min, ±17 min, <i>p</i> = 0.89), operating-room preparation (25 min vs. 22 min, ±12 min, <i>p</i> = 0.66) and door to incision (52 min vs. 53 min, ±23.5 min, <i>p</i> = 0.5) showed no difference. Failures trended toward longer anesthesia lead time (28 vs. 38 min, ±16.7 min, <i>p</i> = 0.48) and operative duration (83 vs. 109 min, ±75 min, <i>p</i> = 0.12). Night-time operations were not associated with failure, but weekend cases showed a higher proportion of failure (25% vs. 12%, <i>p</i> = 0.06, trend only).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort, pre-incision delays (arrival and OR preparation (prep)) were not associated with failure. Signals instead pointed toward patient and anesthetic complexity and technically challenging salvage procedures. Thus, quality improvement attempts should prioritize rapid recognition/decision pathways and anesthesia-surgery coordination rather than focusing solely on logistics between ward and incision.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943024","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}