Microsurgery最新文献

{"title":"Use of Silicone Drains to Prevent Pedicle Compression in Edematous Crush Trauma","authors":"Burak Özkan, Mehmet Ali Şahin, Eray Işık","doi":"10.1002/micr.70217","DOIUrl":"10.1002/micr.70217","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486677","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":"Optimizing Flap Selection for Urosymphyseal Fistula Repair: A Comparative Analysis of Surgical Outcomes","authors":"Joseph M. Escandón,&nbsp;Lucas Kreutz-Rodrigues,&nbsp;Anthony E. Fadel,&nbsp;Jayson P. Kemble,&nbsp;Matthew T. Houdek,&nbsp;Boyd Viers,&nbsp;Karim Bakri","doi":"10.1002/micr.70197","DOIUrl":"10.1002/micr.70197","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is limited data regarding the surgical outcomes of urosymphyseal fistula (USF) repair with primary repair or autologous tissue transfer. We performed a study to compare outcomes of USF repair with primary repair, VRAM flap, and omental flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively identified patients with a diagnosis of USF who underwent fistula decompression and urinary tract reconstruction. The minimal follow-up was 3 months. Patients with distal urethral obstruction, radiation cystitis, or a non-viable sphincter underwent anterior exenteration and flap transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six patients were included. Eleven patients underwent surgical management for USF using primary repair (19.6%), 34 had omental flap-based reconstruction (60.8%), and a VRAM flap was used in 11 patients (19.6%). The 90-day rate of sepsis was lower with omentum flap transposition (3%) compared with VRAM flap (27%) or primary repair (18%, <i>p</i> = 0.041). The rate of fistula recurrence was lower in the omentum flap group compared with USF primary repair (30%) or VRAM flap repair group (27.3%, <i>p</i> = 0.04). On multivariable analysis, USF repair with the omentum flap decreased the odds of fistula recurrence 90 days after surgery compared with primary repair (OR 0.012, <i>p</i> = 0.011) but not when compared with VRAM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The omentum flap may offer a better safety profile in terms of decreasing the rate of early sepsis and rate of fistula recurrence for USF repair in comparison to primary repair. There is limited evidence regarding the superiority of the omentum flap to decrease the rate of late fistula recurrence when compared with the VRAM flap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147474394","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":"Baxter's Nerve Exists but Is Usually NOT the First Branch of the Lateral Plantar Nerve","authors":"Nathaniel H. Williams,&nbsp;John R. Senatore,&nbsp;A. Lee Dellon,&nbsp;Eric H. Williams","doi":"10.1002/micr.70215","DOIUrl":"10.1002/micr.70215","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463248","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":"Monitoring of Venous and Arterial Occlusion With Remote Interstitial Tissue Glucose Measurement Systems in a Rabbit Free Flap Model","authors":"Canberk M. Gurbuz,&nbsp;Ceyhun Uzun,&nbsp;Oguzhan Eroglu,&nbsp;Emrah K. Yasar,&nbsp;Murat S. Alagoz","doi":"10.1002/micr.70214","DOIUrl":"10.1002/micr.70214","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free tissue transfer requires meticulous postoperative monitoring to detect vascular occlusion. Although experimental studies have explored the relationship between interstitial glucose levels and tissue perfusion, long-term evaluation of glucose levels during and after occlusion-reperfusion has not been thoroughly investigated. The study objective was to investigate the correlation between controlled venous and arterial occlusion and changes in interstitial tissue glucose, using a remote interstitial glucose monitoring device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This experimental study was conducted on eight New Zealand White rabbits, each weighing between 3.2 and 3.8 kg, under general anesthesia, utilizing a 4 × 8 cm perforator flap supplied by skin perforators originating from the thoracodorsal artery. Interstitial glucose levels within the flaps were continuously monitored using FreeStyle Libre flash glucose monitoring system. Baseline glucose levels were recorded 1 day prior to vascular occlusion, followed by monitoring between 15 min intervals during experimental clamping of both venous ischemia (75 min), venous decongestion (75 min), and arterial occlusion (45 min). Criteria for detecting vessel occlusion were established based on changes in interstitial glucose concentration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Venous occlusion was associated with a significant increase in interstitial glucose levels. At 15 min post-occlusion, interstitial glucose increased by 47.8%, which was significantly higher than baseline (<i>p = 0.018</i>). However, at 30 min post-unclamping, interstitial glucose declined by 18.3% (<i>p</i> = 0.028) and by 57.4% over 75 min. In contrast, arterial occlusion was associated with a rapid decline in glucose levels. At 15 min post-occlusion, interstitial glucose decreased by 56% (<i>p = 0.018</i>). Total necrosis was observed in all flaps followed by arterial occlusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Interstitial glucose monitoring appears to be a reliable method for detecting vascular occlusion in free tissue transfers within this experimental model. This technique may offer a rapid, minimally invasive, and cost-effective approach for postoperative vascular monitoring of free flaps. Further investigation in human trials is warranted to confirm these findings and assess clinical utility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12989637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463403","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":"Renaming the Profunda Femoris Artery Perforator Flap as the Posteromedial Thigh Flap: Clarifying Nomenclature Through Anatomical Precision","authors":"Janet Ngai Man Hung,&nbsp;Chia-Chun Lee,&nbsp;Yur-Ren Kuo","doi":"10.1002/micr.70213","DOIUrl":"10.1002/micr.70213","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434174","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 Internal Mammary Artery Branch for Small-Caliber Arterial Anastomosis in Autologous Breast Reconstruction","authors":"Matteo Meroni,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.70212","DOIUrl":"10.1002/micr.70212","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390235","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":"Super-Thin ALT Flap for Composite Nasal Reconstruction in an Elderly Kidney Transplant Patient","authors":"Benedetto Longo,&nbsp;Jennifer Okoroafor,&nbsp;Lisa Vannucchi,&nbsp;Ruggiero Marrano,&nbsp;Gennaro D’Orsi,&nbsp;Irene Nunziata,&nbsp;Martina Giacalone,&nbsp;Valerio Cervelli","doi":"10.1002/micr.70210","DOIUrl":"10.1002/micr.70210","url":null,"abstract":"<div>\u0000 \u0000 <p>Nasal reconstruction is one of the most challenging procedures in plastic surgery, requiring restoration of the three-dimensional structure, precise contour, internal lining, and airway function. These challenges are further amplified when traditional donor sites are unavailable, particularly in elderly patients or those undergoing concomitant treatments. We report the case of a 78-year-old man on immunosuppressive therapy following kidney transplantation, presenting with recurrent basal cell carcinoma affecting the middle and lower thirds of the nose. After tumor excision resulting in a 7 × 5 cm defect, and given the patient's characteristics and limitations of conventional options, a customized super-thin anterolateral thigh (ALT) flap (7 × 16 × 0.8 cm) combined with nasal septal and auricular cartilage grafts was chosen for reconstruction. Postoperative recovery was uneventful, and at 6 months, the patient demonstrated normal nasal contour, an open airway, and no signs of recurrence. Despite inherent limitations related to skin and subcutaneous tissue quality and thickness, a super-thin ALT flap may represent a reliable single-stage alternative for total nasal reconstruction in selected high-risk patients.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390240","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":"Arterialized Saphenous Vein Transfer for Microvascular Free Flap Reconstruction of Complex Posterior Defects","authors":"Thomas J. Sorenson,&nbsp;David Tran,&nbsp;Carter J. Boyd,&nbsp;Jenn J. Park,&nbsp;Jonathan Bekisz,&nbsp;Angela Volk,&nbsp;Oriana Cohen,&nbsp;Jamie P. Levine","doi":"10.1002/micr.70202","DOIUrl":"10.1002/micr.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Complex posterior defects often present significant reconstructive challenges, particularly due to the scarcity of suitable recipient vessels. In these cases, an arterialized saphenous vein transfer can facilitate flap perfusion when direct anastomosis is not feasible. This study presents our institutional experience using an arterialized saphenous vein transfer for microvascular free flap (MVFF) reconstruction of posterior defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed consecutive patients who underwent posterior MVFF reconstruction using an arterialized saphenous vein transfer. Patient demographics, comorbidities, defect etiologies (including trauma, silicone injection, malignancy, and congenital abnormalities), flap types, and perioperative outcomes were collected through manual chart review.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six patients with eight MVFFs were included. Five were adults and one was a child; four were females and two were males. All defects were located on the posterior trunk/buttocks. Flap types included four standard latissimus dorsi (LD), three anterolateral thigh (ALT), and one extended conjoined LD flap. Average skin paddle size was 232 cm² (±73). Arterialized saphenous vein transfer arterial inflow sources included the descending branch of the lateral femoral circumflex artery (<i>n</i> = 6), deep inferior epigastric artery (<i>n</i> = 1), and transverse branch of the superficial femoral artery (<i>n</i> = 1). Average operative time was 11:00 h (±2:50); median hospital stay was 12 days (range: 6–76). There were no flap losses. One patient required two flap explorations; two patients required postoperative blood transfusions. At a mean follow-up of 1247 days (±393), all flaps had healed, including persistent minor wounds in the two silicone injection cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Arterialized saphenous vein transfers enabled durable, successful MVFF reconstruction in complex posterior defects and represent a reliable option in anatomically challenging scenarios.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378178","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":"Comparison of Hand-Held Doppler, Infra-Red Thermography and Indocyanine Green Angiography for Identification of Perforator in Antero-Lateral Thigh Flap: A Randomized Controlled Trial","authors":"Almas Fatma,&nbsp;Pawan Kumar Dixit,&nbsp;Deepti Katrolia,&nbsp;Shilpi Karmakar,&nbsp;Prakash Chandra Kala","doi":"10.1002/micr.70205","DOIUrl":"10.1002/micr.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate preoperative localization of perforators is crucial for the success of perforator-based flaps. While handheld Doppler (HHD) is commonly used, newer modalities like infra-red (IR) thermography and indocyanine green (ICG) angiography may offer greater accuracy and precision. We aimed to compare the diagnostic accuracy of HHD, IR thermography, and ICG angiography in identifying perforators in the anterolateral thigh (ALT) flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-centre, three-arm parallel randomized controlled trial conducted from May 2023 to April 2025 in the Department of Burns and Plastic Surgery at a tertiary care center. Sixty patients undergoing ALT flap reconstruction were randomized (1:1:1) to HHD, IR thermography, or ICG angiography groups. The primary outcome was the diagnostic accuracy of each modality in perforator localization (defined as spatial concordance with intra-operative location). Secondary outcomes included flap complications and duration of flap harvest. Data were analyzed using ANOVA and chi-square tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Oncological resection was the most common indication for flap surgery (53.3%), and the head and neck region was the commonest site of reconstruction. ICG angiography demonstrated the highest diagnostic accuracy (85%), sensitivity (94.4%), and positive predictive value (89.47%) compared to IR thermography (50%, 100%, and 50%) and HHD (15%, 75%, and 15.79%) (<i>p</i> &lt; 0.0001). There was no significant difference in flap complication rates or hospital stay between groups. Diagnostic accuracy was lower in obese patients across all modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The accuracy of ICG was better than IR Thermography and HHD in detecting perforators pre-operatively in patients undergoing ALT flap surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>CTRI/2023/05/053290</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147378181","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":"Expanding Flap Territory With Intraflap Anastomosis in Thoracodorsal Artery Perforator and Anterolateral Thigh Flaps: Feasibility and Strategic Considerations","authors":"Jina Kim,&nbsp;Chanwoo Park,&nbsp;Kyeong-Tae Lee","doi":"10.1002/micr.70211","DOIUrl":"10.1002/micr.70211","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>When reconstructing extensive defects with large perforator flaps, incorporating multiple perforators from different perforasomes may improve perfusion reliability, for which intraflap anastomosis can be an effective strategy. Although well described in breast reconstruction, its application in other perforator flaps remains limited. This report reviews its application in thoracodorsal artery perforator (TDAP) and anterolateral thigh (ALT) flaps to explore feasible strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent reconstruction with bipedicled ALT or TDAP flaps using intraflap anastomosis between 2019 and 2023 were reviewed. This technique was reserved for cases requiring large flaps without a single dominant perforator, necessitating multiple perforators from different source vessels. Operative details and postoperative outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve cases (six TDAP and six ALT flaps) were analyzed. Median defect and flap sizes were 224 and 238.5 cm², respectively. In the TDAP group, the descending branch of the thoracodorsal artery was most commonly used as the primary pedicle, and its serratus branch served as the recipient for intraflap anastomosis with the dorsal intercostal or scapular artery perforator. In the ALT group, the descending branch of the lateral circumflex femoral artery was the primary pedicle, with the oblique or ascending branch as the secondary; the distal runoff of the descending branch served as the recipient. Except for one case of tip necrosis, no perfusion-related complications occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This small retrospective report suggests that the intraflap anastomosis technique appears to be a feasible approach for expanding vascular territories in TDAP and ALT flaps, offering a valuable option for extensive defect reconstruction when indicated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372619","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}