Microsurgery最新文献

{"title":"Double-Barreled Vascularized Fibula Free Flap in Pediatric Tibial Bone Defect Reconstruction: A 20-Year Monocentric Experience","authors":"François Thuau,&nbsp;Antoine Hamel,&nbsp;Franck Duteille","doi":"10.1002/micr.70024","DOIUrl":"10.1002/micr.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reconstructing large bone defects for lower limb salvage in the pediatric population remains challenging due to complex oncological or septic issues, limited surgical options, and lengthy procedures prone to complications. The vascularized double-barreled fibula free flap is pivotal for reconstructing large bones. In this article, we report our experience with this technique in the surgical management of pediatric tibial bone defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of patients under 18 years of age who underwent tibial reconstruction using a double-barreled fibula free flap at our center between 2004 and 2023. Collected data included demographic information, operative details, time to bone consolidation and full weight-bearing, and functional outcomes using the Musculoskeletal Tumor Society (MSTS) score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight patients (5 females, 3 males) with a mean age of 12.5 years (range 5–17) were included. The average tibial defect length was 11.2 cm (range 7–14 cm), affecting the proximal tibia in 4 cases (50%), the middle third in 3 cases (37.5%), and the distal third in 1 case (12.5%). Reconstruction followed oncologic resection in 7 patients (87.5%) and addressed congenital pseudarthrosis in 1 patient (12.5%).</p>\u0000 \u0000 <p>One patient died of sarcoma. Six patients (75%) achieved full weight-bearing within a median of 7 months (range 6–16) and a bone consolidation at 9 months in median (range 6–18). One reconstruction (12.5%) failed due to septic pseudarthrosis leading to a below-knee amputation. The mean MSTS score was 81.65 (range 63.3–100).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study is the first to focus on pediatric tibial reconstructions using the double-barreled vascularized fibula free flap. It highlights the technique's reliability for reconstructing tibial defects, particularly in intermediate-sized cases (7–14 cm). This single-stage procedure minimizes stress fracture risk, enables earlier weight-bearing, and is an alternative to the Capanna technique without requiring an allograft.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052967","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":"Current Practices and Evidence of Aspirin Usage in Microvascular Surgery: A Systematic Review and Meta-Analysis","authors":"Faraaz Azam,&nbsp;Cyril Awaida,&nbsp;Anca Dogaroiu,&nbsp;Andrei Odobescu","doi":"10.1002/micr.70029","DOIUrl":"10.1002/micr.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acetylsalicylic acid (ASA) has been used in reconstructive microsurgery since the inception of the field. However, when compared to placebo groups, its efficacy is not confirmed. In our study, we hypothesize that the utility of ASA postoperatively in microvascular surgery is not associated with improved outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of the literature was conducted using PubMed, Google Scholar, and SCOPUS according to PRISMA guidelines. Documentation of antiplatelet regimens and postoperative complications were the primary endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four articles met inclusion criteria including a total of 1196 patients. There were 637 patients who received aspirin and 559 patients who did not. The average age was not found to be significantly different between the two groups (<i>p</i> &gt; 0.05). In terms of flap type, patients undergoing DIEP had a significantly higher likelihood of receiving aspirin, whereas patients undergoing fibula flaps had a lower rate of aspirin usage (<i>p</i> &lt; 0.05). TRAM, anterolateral thigh flaps, SIEA, and radial forearm flaps were equally distributed between the two groups (<i>p</i> &gt; 0.05). A total of 317 complications were noted across both groups. Total complication rate, complete flap loss, and venous/arterial thrombosis rate were not found to be significantly different between the two groups (<i>p</i> &gt; 0.05). Hematoma rate was found to be significantly higher in the group receiving aspirin when compared to the control (RR = 1.70, 95% CI 1.19–2.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Aspirin usage did not confer significant advantage in preventing postoperative complication rates and increased rates of hematoma formation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052963","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":"Impact of Norepinephrine Use on Free Flap Survival in Breast Reconstructive Microsurgery","authors":"Quentin Larcher,&nbsp;Thibaud Mernier,&nbsp;Marie Feigna,&nbsp;Victor Pozzo,&nbsp;Laurent Lantieri","doi":"10.1002/micr.70026","DOIUrl":"10.1002/micr.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The optimal method for maintaining intraoperative blood pressure during microsurgical procedures remains controversial. While intravenous fluid administration is essential, overfilling can lead to complications. Vasopressor agents are used cautiously due to their vasoconstrictive effects, which could potentially lead to flap failure. Numerous studies have explored the possible link between amine administration and free flap failure, yielding inconsistent results. This study aims to determine whether intraoperative norepinephrine administration increases the flap failure rate in microsurgical breast reconstructions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All women (<i>n</i> = 335) who underwent breast reconstruction using DIEP or PAP flaps (<i>n</i> = 400) in 2018 and 2022 in the Plastic Surgery Department of Georges-Pompidou European Hospital (Paris, France) were included in the study. These patients were classified into two groups based on the intraoperative administration of norepinephrine: the <i>N</i>+ group (50 patients) and the <i>N</i>− group (285 patients). Norepinephrine was administered when systolic blood pressure fell below 90 mmHg or mean arterial pressure (MAP) dropped below 65 mmHg, following fluid resuscitation in 2018, or without prior fluid loading in 2022. The primary endpoint was total flap loss. Secondary endpoints included arterial and venous thrombosis and the need for revision surgeries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Norepinephrine administration significantly increased the risk of total flap loss in DIEP and PAP flap surgeries (<i>p</i> &lt; 0.001). It also heightened the risk of arterial thrombosis (<i>p</i> = 0.002) and venous thrombosis (<i>p</i> = 0.04), and led to a greater number of revision surgeries (<i>p</i> &lt; 0.001). Subgroup analysis indicated that PAP flaps are more sensitive to norepinephrine compared to DIEP flaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study suggests that the intraoperative administration of any dose of norepinephrine is associated with an increased risk of flap failure in breast reconstructive microsurgery using DIEP and PAP flaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047293","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":"Perforator-Based Propeller Flap Application in Pressure Ulcer Reconstruction: A Comparative Analysis With Advancement Flaps","authors":"Jong-Ho Kim,&nbsp;Man Wong Han,&nbsp;Joseph Kyu-hyung Park,&nbsp;Kyoung Min Lee,&nbsp;Baek-Kyu Kim","doi":"10.1002/micr.70018","DOIUrl":"10.1002/micr.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pressure ulcers are a prevalent and debilitating condition, often necessitating surgical reconstruction. Various flap techniques, such as Advancement Flaps (AF) and Perforator-based Propeller Flaps (PBPF), are commonly used for pressure sore reconstruction. While both techniques have proven effective, there is limited research comparing their outcomes in different clinical scenarios. In recent years, PBPF has demonstrated favorable outcomes in various reconstruction fields. However, there remains a need to establish the optimal technique for specific clinical conditions and patient populations. Therefore, this study aims to compare the outcomes of PBPF and AF in patients undergoing pressure ulcer reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on patients who underwent pressure sore reconstruction utilizing either AF or PBPF techniques between January 2020 and December 2023. Data on demographics, pressure ulcer details, operative time, hospital stay, recurrence rate, and complications were collected and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study of 56 patients, 30 underwent AF, and 26 underwent PBPF. Demographic and clinical characteristics showed no significant differences. Clinical and surgical outcomes indicated no significant differences in defect size (<i>p</i> = 0.517), hospitalization period (<i>p</i> = 0.786), follow-up duration (<i>p</i> = 0.746), number of preoperative debridements (<i>p</i> = 0.781), time to recurrence (<i>p</i> = 0.224), or postoperative complications (<i>p</i> = 0.757). However, PBPF resulted in a smaller flap size (93.7 ± 29.5 cm² for AF vs. 70.5 ± 19.7 cm² for PBPF, <i>p</i> &lt; 0.001), a longer operation time compared to AF (94.6 ± 39.1 min for AF vs. 161.0 ± 38.9 min for PBPF, <i>p</i> &lt; 0.001), and lower recurrence rate in long-term follow-up (<i>p</i> = 0.036).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PBPF may have the drawback of prolonged surgical time due to the complexity of the surgical procedure. However, when applied appropriately, it can be a meaningful surgical approach for reducing the recurrence rate of pressure ulcers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007932","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":"Predictive Factors of a Dominant Superficial Venous Drainage System in DIEP Flap Surgery With Preoperative Computed Tomography Angiography","authors":"Victor Pozzo,&nbsp;Marion Goutard,&nbsp;Yohann Dabi,&nbsp;Golda Romano,&nbsp;Marc-David Benjoar,&nbsp;Mikhael Benjoar,&nbsp;Ilyes Hadji,&nbsp;Zhi Yang Ng,&nbsp;Alexandre G. Lellouch,&nbsp;Laurent A. Lantieri","doi":"10.1002/micr.70008","DOIUrl":"10.1002/micr.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous congestion due to superficial venous system dominance (SVD) in deep inferior epigastric perforator (DIEP) flap surgery occurs in approximately 2% of cases, with attendant sequelae and increased cost to healthcare systems. This study aimed to describe the predictive factors for SVD in DIEP flap breast reconstruction based on preoperative computed tomography angiography (CTA) findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All women who required takebacks for additional venous anastomosis to the cephalic vein because of SVD after DIEP flap breast reconstruction between 2015 and 2022 were included. Complication-free DIEP breast reconstruction patients were then randomly selected based on a 1:2 enrollment ratio to form a control group. A retrospective analysis of pre-operative CTAs was performed for both groups to compare the size and location of the perforators, diameter of the superficial inferior epigastric vein (SIEV), diameter of the deep inferior epigastric vein (DIEV), and flap thickness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four women were identified in the SVD group; however, only 18 were included in the final analysis. CTA analysis suggested that the ratio between SIEV and DIEV (SIEV/DIEV) diameters was significantly higher in the SVD group than in the controls (0.98 vs. 0.83; <i>p</i> = 0.043). The mean flap thickness was also significantly lower in the SVD group than in the controls (29.4 vs. 36.3 mm; <i>p</i> &lt; 0.001). Perforator characteristics and the SIEV diameter did not differ between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The SIEV/DIEV diameter ratio on preoperative CTA can be used to predict whether the DIEP flap has SVD. This may then be used to anticipate whether additional venous anastomosis is required to reduce postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007937","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":"Long-Term Follow-Up After the Charles Procedure: Possibilities for Minimally Invasive Reconstructive Lymphedema Surgery With Lymphaticovenous Anastomosis: A Report of Four Cases","authors":"Natalia Ewa Krzesniak,&nbsp;Marzanna Zaleska,&nbsp;Balazs Mohos,&nbsp;Manon Czedik-Eysenberg,&nbsp;Michaela Krammel,&nbsp;Chieh-Han John Tzou","doi":"10.1002/micr.70015","DOIUrl":"10.1002/micr.70015","url":null,"abstract":"<p>The Charles procedure (CP) is a potentially devastating treatment; however, in cases of an end stage of untreated or improperly treated lymphedema, it is the ultimate surgical therapy. As a life-saving solution, it quickly relieves patients with giant, hypertrophic extremities, mostly in ambulation and hygiene maintenance. Nevertheless, long-term results may disappoint both doctors and patients, who struggle with social stigma, the need for lifelong compression, massive lymphoedema in the distal parts of the feet, badly fitting shoes, excessive skin fibrosis, severe keratinization of skin-grafted surfaces, periodic lymphorrhea from the resected areas, or acute and chronic inflammation. For these reasons, patients may seek further surgical help, even many years after treatment. This article describes findings in fluorescent lymphography with indocyanine green (ICG-L) in four patients (49, 56, 56 years old females and 35 years old males) after CP and outcomes of treatment with lymphaticovenous anastomosis (LVA). In all patients, nonresected areas of the dorsum of the feet showed massive lymphedema stage II to III with dermal backflow (DB). In two patients, resected and skin-grafted areas showed deep subfascial lymphatics with lazy flow and no DB. In the remaining two cases, resected areas showed massive DB. Patients were reluctant to undergo further extensive surgical treatment with lymph node transfers due to the trauma experienced after CP. Since they still struggle with residual lower extremity lymphedema in unresected areas of the lower limbs, we performed minimally invasive, physiologic LVA surgeries in their feet, and in one patient in proximal thighs. In all cases, the postoperative course was uneventful. The treatment brought relief, reducing the circumference of the feet by ~2 cm, and allowed the return to previously used shoes in a follow-up of 18–36 months. This is the first report of ICG-L findings in CP patients, who benefit from minimal invasive LVA surgery. This information might help improve the life quality of patients after CP.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007931","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":"Circumflex Scapular Artery Perforator Flap and Its Surgical Refinements in Soft Tissue Reconstruction for Various Regions of the Foot and Ankle in Pediatric Patients","authors":"Xinlei Sui,&nbsp;Liming Qing,&nbsp;Fang Yu,&nbsp;Panfeng Wu,&nbsp;Juyu Tang","doi":"10.1002/micr.70010","DOIUrl":"10.1002/micr.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Reconstruction for various regions of the foot and ankle in pediatric patients remains a challenging topic. This study presents the circumflex scapular artery perforator (CSAP) flap and its surgical refinements for addressing soft tissue defects in various regions of the foot and ankle in pediatrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Forty-seven patients underwent CSAP flap and its surgical refinements for the reconstruction of foot and ankle defects from 2010 to 2022. Mean age was 6.9 (range 2–14). Defects were observed in the ankle, dorsal foot, heel, and sole. The classic CSAP flap was used in 23 patients, and the CSAP flap with refined techniques was utilized in 24 patients, including double skin paddle, debulking, flow-through, and chimeric CSAP flaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The size of the CSAP flaps ranged between 4.5 × 4 and 18 × 6.5 cm². All flaps survived except for one case. The patient suffered total flap necrosis and was treated with a secondary reconstructive surgery. Primary closure of the donor site was achieved in all cases. The average follow-up period was 15.6 months. At the final follow-up, the mean AOFAS score was 93.6 (range 77–100). Mean VAS flap appearance score was 8.1 (range 6–10). Most patients showed satisfactory results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CSAP flap and its surgical refinements are alternative options for repairing pediatric foot and ankle defects, especially in cases involving large defects around the ankle joint, dorsal foot, and non-weight-bearing regions of the heel and sole.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11736338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007819","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":"Vascularized Periosteal Grafts for Bone Union in Children: A Systematic Review","authors":"Francisco Soldado,&nbsp;Diego Gonzalez-Morgado,&nbsp;Pablo Romero-Larrauri,&nbsp;Trong-Quynh Nguyen,&nbsp;Antonio Carlos da Costa,&nbsp;Jorge Knorr","doi":"10.1002/micr.70021","DOIUrl":"10.1002/micr.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The periosteum is the main organ responsible for bone regeneration. Vascularized Periosteal Grafts (VPG) have demonstrated exceptional efficacy and speed in facilitating bone union among children with challenging bone healing conditions. Despite their promising results, the overall impact of these interventions has yet to be comprehensively evaluated through systematic review. This systematic review aimed to provide comprehensive insights into bone union outcomes and complications related to the use of VPG in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to September 2023 and screened for relevant studies. Data were collected regarding patient demographics, disease, treatment, anatomical location, graft used, donor and receptor vessels, skin paddle monitoring, follow-up duration, time to union, consolidation, and complications. The correlation between age and bone union was assessed using Pearson and Spearman correlation coefficients, as appropriate. Study quality was assessed using the Methodological Index for Non-randomized Studies Criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15 studies involving 135 patients were included. All the studies were classified as Level 4 evidence. The mean MINORS score was 5.1 ± 1. The aim of the VPG was nonunion treatment in 90 patients (67%), nonunion prevention in 35 patients (26%), and bone union acceleration in 10 patients (7%). The origin of the bone union problem was traumatic in 59 cases (44%), congenital pseudoarthrosis of the tibia or fibula in 48 patients (35%), oncologic in 23 patients (17%), and infectious in 5 patients (4%). Nine different sources of periosteal flaps were used to enhance bone union. Bone union rate was 96% with a mean time of 4.2 months (range 1–18 months). Spearman test showed a non-statistically significant negative correlation between age and bone union time (<i>r</i> = −0.3, <i>p</i> = 0.759).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VPGs are a safe and reliable treatment for promoting bone union, especially in the context of complex pediatric bone-healing challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984229","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":"Radial to Median Sensory Nerve Transfers to Restore Sensate Key Pinch: A Cadaveric Assessment of Size Match and Implications for Transfer","authors":"Christine V. Schaeffer,&nbsp;Ambika Menon,&nbsp;Spencer Chambers,&nbsp;Alexander Graf,&nbsp;Nina Suh,&nbsp;Paul Ghareeb","doi":"10.1002/micr.70017","DOIUrl":"10.1002/micr.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Loss of key-pinch sensation after median nerve injury poses significant functional detriment. Nerve transfers are utilized to improve function after nerve injury and size matching of donor and recipient nerves is important to optimize success. This anthropometric study investigates the anatomy of the superficial branch of the radial nerve (SBRN) to the thumb and index finger and explores radial to median sensory nerve transfers, a necessary but not heavily discussed facet of nerve transfers for the hand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Anatomic dissection of SBRN in 15 cadaver hands was performed to assess variability in diameter and branching patterns based on nerve location. Dissection of the index radial and thumb ulnar digital nerves was performed to assess diameter based on location and calculate ideal size match for nerve transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All specimen thumbs had 2 SBRN branches at the level of the metacarpal shaft and proximal phalanx; 87% had 2 index SBRN branches extending to the proximal phalanx. Index radial and ulnar SBRN branches were similar in diameter at all levels (<i>p</i> &gt; 0.0167). There was a significant size mismatch between the individual SBRN branches and index digital at all measured levels (<i>p</i> &lt; 0.0167). The thumb radial SBRN was significantly larger than ulnar SBRN (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimal size match for transfer involved transection of radial index SBRN 1 cm distal to the MCP joint and ulnar thumb SBRN 1 cm distal to the MCP joint. Consideration should be made for transfer of both index SBRN branches at the level of the MCP joint to improve size match. Corresponding digital nerves were transected 1 cm proximal to the level of SBRN harvest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971624","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":"Effective Management Strategies for Primary Lymphedema of the Lower Extremities: Integrating Conservative and Surgical Therapies in Early and Late Stages","authors":"Yasser Farid,&nbsp;Mirco Pozzi,&nbsp;Alberto Bolletta,&nbsp;Emanuele Cigna,&nbsp;Luigi Losco,&nbsp;Vanessa Marron Mendes,&nbsp;Giuseppe Diluiso,&nbsp;Thierry Cleve,&nbsp;Michela Schettino,&nbsp;Hung-Chi Chen","doi":"10.1002/micr.70014","DOIUrl":"10.1002/micr.70014","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Lymphedema, a debilitating characterized by localized fluid retention and tissue swelling, results from abnormalities in the lymphatic system. In the case of primary lymphedema, this condition is attributed to malformations in lymphatic vessels or nodes, and it is marked by a relentless progression leading to irreversible tissue fibrosis after repetitive inflammation. Many questions regarding its treatment, such as the choice of the type of intervention and the timing, still remain unanswered. This study aims to present our comprehensive approach to treat this challenging condition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To elucidate our approach, we conducted a retrospective chart review of 42 patients treated for primary lymphedema at 3 hospitals between July 2010 and December 2022. The study included two patient groups, those with early-stage disease (20) and those in the advanced stages (22). We outline our algorithm, based on our clinical experience in Taiwan. Patients were followed for at least 12 months post-treatment, and assessments were made, including photographic evidence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 42 patients participated in our study: 20 in the early stage and 22 in the late stage. Our approach yielded significant functional improvements and symptom regression in both groups. In the early-stage cohort, all 20 patients underwent VLNT procedures and SAL, with 15 (75%) undergoing unilateral procedures and 5 (25%) bilateral. Among the advanced-stage patients, 12 (54.5%) were treated with the modified Charles' procedure, and 10 (45.5%) with RRPP.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;The outcomes showed an average circumference reduction of 4.1 cm (2.9–5.3) after VLNT and liposuction. Reductions were noted at various levels: 5.7 cm (4.6–6.8) at mid-thigh, 4.3 cm (2.5–6.1) at mid-calf, 3.5 cm (2.7–4.3) at the ankle, and 1.4 cm (0.7–2.1) at mid-foot. Tonicity decreased by 5.9% (5.2–6.6), indicating significant tissue softening. Tissue removal averaged 3.7 kg (2.9–4.5) after the modified Charles' procedure and 2.6 kg (2.3–2.9) after RRPP.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Patients experienced a mean of 3 (2–4) episodes of cellulitis per year, with no cellulitis in early-stage treated limbs during the follow-up period. Complications were minimal, including 4 partial skin graft losses that healed with conservative treatment and 3 postoperative infections after the modified Charles' procedure, treated successfully with antibiotics. No major complications were reported at the lymph node flap donor site.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Primar","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951497","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}