Microsurgery最新文献

{"title":"Comments on “Innervated Dorsal Digital Artery Propeller Perforator Flaps in One-Stage Reconstruction of Fingertip Defects: Experience With 45 Cases”","authors":"Luigi Losco, Marco Marcasciano, Dicle Aksoyler","doi":"10.1002/micr.70291","DOIUrl":"10.1002/micr.70291","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920113","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":"Bilateral Lumbar Artery Perforator (LAP) Flaps for Extensive Lumbosacral Defects: A Report of Two Cases","authors":"Serdar Dönmez,&nbsp;Furkan Altar Deniz,&nbsp;Muhammed Karakaya,&nbsp;Menekşe Kastamoni Başkan,&nbsp;Süleyman Çeçen,&nbsp;Güzin Yeşim Özgenel,&nbsp;Selçuk Akın","doi":"10.1002/micr.70293","DOIUrl":"10.1002/micr.70293","url":null,"abstract":"<div>\u0000 \u0000 <p>Extensive lumbosacral defects remain a major reconstructive challenge because of limited regional tissue mobility, contamination risk, proximity to neural structures, and frequent association with prior surgery or spinal instrumentation. Although lumbar artery perforator (LAP) flaps are recognized as muscle-sparing options for posterior trunk reconstruction, their capacity to safely reconstruct very large midline lumbosacral defects and their applicability in rare adult presentations of lumbosacral myelomeningocele remain insufficiently defined. We report two adult female patients who underwent reconstruction of extensive midline lumbosacral defects using bilateral pedicled LAP flaps to illustrate the applicability of this approach in exceptionally large post-instrumentation and adult dysraphic defects. The first patient, a 19-year-old woman, presented with a 36 × 28 cm post-instrumentation defect with exposed L4–S1 hardware following multi-trauma and repeated soft-tissue necrosis. After serial debridements and prolonged culture-directed intravenous antibiotic therapy, bilateral LAP flaps measuring 22 × 12 cm were elevated based on bilateral L4 perforators identified by computed tomography angiography and Doppler ultrasonography. The second patient, a 28-year-old paraplegic woman with spina bifida, presented with recurrent cerebrospinal fluid leakage associated with a 22 × 16 cm lumbosacral myelomeningocele defect. Following neurosurgical dural repair, bilateral LAP flaps measuring 18 × 10 cm were harvested based on medially displaced L4 perforators. In both cases, the flaps were designed according to defect geometry and perforator location, then rotated approximately 90° medially to achieve tension-reduced midline closure while facilitating primary donor-site closure. Complete flap survival was achieved in both patients without venous congestion or total flap loss. In the first case, limited wound dehiscence related to hardware prominence was successfully revised with a local V–Y advancement flap, and a small donor-site tension area was managed with split-thickness skin grafting. In the second case, a limited lateral donor defect also required split-thickness skin graft coverage. At 13 months, spinal instrumentation was electively removed in the first patient after adequate osseous stabilization, while flap stability was preserved. At 15 and 9 months of follow-up, respectively, both patients demonstrated durable soft-tissue coverage without recurrent breakdown or cerebrospinal fluid leakage. These cases suggest that bilateral pedicled LAP flaps may facilitate stable, muscle-sparing reconstruction in selected extensive lumbosacral defects, including exceptionally large post-instrumentation wounds and rare adult presentations of lumbosacral myelomeningocele.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920093","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":"Post-Traumatic Lymphatic Vessel Thrombosis Treated With Thrombus Removal and Lymphaticovenous Anastomosis: A Case Report","authors":"Matteo Meroni,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.70290","DOIUrl":"10.1002/micr.70290","url":null,"abstract":"<div>\u0000 \u0000 <p>Lymphatic vessel thrombosis is a rare finding, and its role in the development of lymphedema remains unclear. Secondary lymphedema is usually related to oncologic lymph node dissection, radiotherapy, infection, or major tissue trauma. In contrast, focal lymphatic obstruction after minor limb trauma has rarely been described. We report the case of a 71-year-old woman who developed progressive Stage II lymphedema of the left lower limb after a minor trauma without fracture. Preoperative examination showed persistent lower-limb swelling with a focal medial proximal lower-leg nodule, and conservative treatment with manual lymphatic drainage and compression produced only partial improvement. Venous duplex ultrasound and magnetic resonance imaging excluded venous obstruction, tumor, or muscular injury. Ultrasound suggested a lymphatic rather than venous origin of the focal lesion, while lymphoscintigraphy with SPECT/CT demonstrated an interruption of lymphatic drainage at the medial proximal lower leg, associated with a 17-mm subcutaneous fluid collection consistent with a lymphocele. Intraoperatively, the lymphocele was excised and an intact but dilated collecting lymphatic vessel distal to the obstruction was identified. After opening the vessel, intraluminal thrombotic material was removed, resulting in restoration of spontaneous lymphatic flow. Lymphaticovenous anastomosis was then performed using the recovered lymphatic vessel, with intraoperative confirmation of patency and lymphatic washout. The postoperative course was uneventful, with significant clinical improvement confirmed at 6 months follow-up. This case supports the hypothesis that lymphatic thrombosis may occur after minor trauma and may directly contribute to secondary lymphedema, although longer follow-up and objective outcome assessment are required.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906609","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 Postoperative Outcomes of Rib-Sparing Versus Rib-Sacrificing in Free Flap Breast Reconstruction Using the US Collaborative Network in TriNetX","authors":"Chloe J. Cottone,&nbsp;Katherine A. Kozlowski,&nbsp;Alyssa D. Reese,&nbsp;Erinn E. Mangona,&nbsp;Joshua C. Hwang,&nbsp;Jordan D. Frey","doi":"10.1002/micr.70270","DOIUrl":"10.1002/micr.70270","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The “rib-sparing” method of autologous breast reconstruction has gained popularity alongside the historically used “rib-sacrificing” technique. Literature has endorsed benefits of the “rib-sparing” technique, including reduced contour irregularities, postoperative morphine use, and operative time. However, higher rates of fat necrosis and thromboembolic complications have been reported with this method. This study aims to compare postoperative complications in those undergoing rib-sparing and rib-sacrificing free flap breast reconstruction using a large-scale database.&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;A retrospective cohort study was conducted using the US Collaborative Network in TriNetX. Two cohorts were identified: those who underwent a free flap breast reconstruction (CPT 16634) and those who underwent a free flap breast reconstruction and a partial rib excision (CPT 21600). Propensity score matching for age and type of previous mastectomy was performed. Complications tabulated within 3 months of reconstruction were fat necrosis, hematoma/seroma, infection, dehiscence/necrosis, and venous thromboembolism. Mastodynia and deformity/disproportion within 8–18 months and reconstruction within 6–10 years of reconstruction were also tabulated.&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;Propensity score matching yielded 992 subjects with a mean age of 50 ± 9.7 in each group. No difference was found between the rib-sparing and rib-sacrificing cohorts within the perioperative window for the included complications: hematoma/seroma (8.1% vs. 8.1%; &lt;i&gt;p&lt;/i&gt; = 1.00), infection (&lt;i&gt;p&lt;/i&gt; = 14.4% vs. 12.3%; 0.166), dehiscence/necrosis (9.2% vs. 7.6%; &lt;i&gt;p&lt;/i&gt; = 0.195), and VTE (5.1% vs. 5.3%; &lt;i&gt;p&lt;/i&gt; = 0.857). The rib sacrificing cohort were at 1.28 times increase risk for experiencing fat necrosis (12.9% vs. 10.1%; 95% CI: 1.00–1.64; &lt;i&gt;p&lt;/i&gt; = 0.049). No difference was found in incidence of mastodynia (4.8% vs. 3.5%; &lt;i&gt;p&lt;/i&gt; = 0.145) or dehiscence/necrosis (24.8% vs. 26.8%; &lt;i&gt;p&lt;/i&gt; = 0.305) within 8–18 months. Subjects in the rib-sacrificing cohort were found to be at 1.21 (35.9% vs. 32.2%; 95% CI: 1.08–1.35;&lt;i&gt;p&lt;/i&gt; &lt; 0.001) times increased risk to undergo a revision within 6–10 years following initial reconstruction.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Those who underwent rib-sacrificing reconstruction have a mild increased risk of experiencing fat necrosis and a revision in the 3 months and 6–10 years following initial reconstruction, respectively. Surgeons should consider the nuanced risks and benefits of both techniques and prioritize patient-centered decision-","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881053","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":"Lymphovenous Anastomosis in a Patient With Chronic Venous Insufficiency After Femoral Vein Ligation.","authors":"Karina Andrea Tacconi, Mahdi Malekpour, C Anton Fries","doi":"10.1002/micr.70300","DOIUrl":"https://doi.org/10.1002/micr.70300","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70300"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017332","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":"Comment on \"Liposomal Bupivacaine in Transversus Abdominis Plane Block for Postoperative Pain Control After Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis\".","authors":"Malka Korenblit, David W Mathes, Katie G Egan, Christodoulos Kaoutzanis","doi":"10.1002/micr.70302","DOIUrl":"https://doi.org/10.1002/micr.70302","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70302"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039810","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 Criteria for Totally Extraperitoneal Robotic DIEP Flap Harvest: A Case Report and Review of the Literature.","authors":"Julia Ting, Diwakar Phuyal, Clayton Petro, Victor F A Almeida, Lucas Beffa, Raffi Gurunian, Risal Djohan, Graham Schwarz, Sarah N Bishop","doi":"10.1002/micr.70288","DOIUrl":"10.1002/micr.70288","url":null,"abstract":"<p><p>Robotic-assisted deep inferior epigastric perforator (DIEP) flap harvest minimizes donor-site morbidity by reducing fascial disruption and preserving rectus muscle integrity. Traditional criteria for robotic DIEP have limited use to short intramuscular perforators, but this case demonstrates the feasibility of a totally extraperitoneal (TEP) approach in a patient with a long (91.6 mm) intramuscular perforator. Using a multi-port robotic system and a 3 cm anterior fascial incision, we successfully dissected a 17 cm pedicle without muscle sacrifice or mesh reinforcement. A literature review highlights the rarity of TEP techniques, especially for long perforators. This case supports expanding robotic DIEP criteria based on perforator anatomy rather than strict length cutoffs and illustrates the potential of TEP dissection to avoid intra-abdominal entry while preserving abdominal wall integrity.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70288"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017353","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":"Pedicled Radial Forearm Flap for Partial Glossectomy Reconstruction: Rescue From Aberrant Vascular Anatomy.","authors":"David Strum, Ghayoour Mir, Jamie Levine, Adam Jacobson","doi":"10.1002/micr.70303","DOIUrl":"https://doi.org/10.1002/micr.70303","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70303"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069850","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 Supercharged Pedicled PTAP-Saphenous Flap for Distal Lower-Limb Reconstruction.","authors":"Stefano Bacchini, Anna Scarabosio, Alessandro Mastroiacovo, Shih-Heng Chen, Alberto Bolletta, Emanuele Cigna, Hung-Chi Chen","doi":"10.1002/micr.70299","DOIUrl":"https://doi.org/10.1002/micr.70299","url":null,"abstract":"<p><strong>Background: </strong>In distal lower-limb reconstruction, reverse-flow pedicled flaps remain vulnerable to venous congestion and partial flap loss, particularly after crush injury or major trauma, in elderly or comorbid patients and when longer flaps are required. We evaluated a standardized distally-based pedicled posterior tibial artery perforator (PTAP)-plus saphenous flap with planned supercharging and a temporary cutaneous bridge to reinforce venous outflow in that high-risk subset.</p><p><strong>Methods: </strong>A retrospective study of 26 consecutive reconstructions (2010-2025) performed under a uniform protocol by the senior author was conducted. Inclusion criteria comprised patients at high risk for flap loss, defined by crush injury or major trauma; elderly or patients with relevant comorbidities; and longer flaps targeting distal reach. Preoperative Doppler identified the most distal reliable perforator as pivot. Supercharging was performed end-to-end between the saphenous system and a superficial vein near the defect.</p><p><strong>Results: </strong>Twenty-six patients (21 men, 5 women; mean age, 34 years; range, 18-61 years) underwent reconstruction. Trauma accounted for 21 cases. Defects were located in the lower leg (n = 15), ankle (n = 9), and foot (n = 2). Tibia or ankle joint was exposed in 18 cases and tendons in 8. Venous supercharging was performed using a GSV branch in 23 flaps and the LSV in 3. Mean flap size was 5 × 16 cm (width range, 4-7 cm; length range, 7-20 cm); mean distal perforator distance from the medial malleolus was 9 cm (range, 5-12 cm). The estimated mean arc of rotation was 100° (range, 90°-150°). Complete survival occurred in 24/26 flaps (92.3%).</p><p><strong>Conclusions: </strong>A \"tripedicled,\" routinely supercharged PTA perforator plus saphenous flap, combined with a skin pedicle, provided reliable coverage of distal-leg, ankle, and foot defects with a low rate of flap loss. Based on our data and experience, this configuration is feasible and safe for crush injuries, elderly/comorbid patients, and longer flaps.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70299"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017235","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":"Evaluation of the Feasibility, Safety, and Effectiveness of a Tailored Enhanced Recovery After Surgery Protocol for Gastroepiploic Vascularized Lymph Node Transfer in Breast Cancer-Related Upper Extremity Lymphedema: A Preliminary Retrospective Comparative Study.","authors":"Federico Lo Torto, Bilel Dribine, Alessia Pagnotta, Andrea Loreti, Giuseppe Cavallaro","doi":"10.1002/micr.70294","DOIUrl":"10.1002/micr.70294","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative pathways designed to reduce surgical stress, accelerate recovery, and improve resource utilization. Although ERAS principles have been increasingly adopted in microsurgery, their application in vascularized lymph node transfer (VLNT), particularly using gastroepiploic flaps, remains poorly defined. The aim of this study was to evaluate the feasibility, safety, and effectiveness of a tailored ERAS protocol in patients undergoing gastroepiploic VLNT for breast cancer-related upper extremity lymphedema.</p><p><strong>Patients and methods: </strong>A retrospective comparative study was conducted in patients with unilateral breast cancer-related upper extremity lymphedema (ISL Stage II-III) undergoing gastroepiploic vascularized lymph node transfer after failure of at least 6 months of conservative treatment. Patients were managed either with a conventional perioperative protocol, including nasogastric tube placement, delayed oral intake, delayed mobilization, opioid-based analgesia, and delayed initiation of complete decongestive therapy (CDT), or with a tailored ERAS-VLNT protocol incorporating early oral intake, early mobilization, opioid-sparing analgesia, avoidance of nasogastric decompression, and CDT initiation from postoperative Day 7. Outcomes included circumferential reduction rate, LYMQOL score, infection rate, flap-related complications, length of hospital stay, and hospitalization costs.</p><p><strong>Results: </strong>A total of 45 patients were included, with 29 in the ERAS group and 16 in the conventional group. Baseline demographic and clinical characteristics were comparable between groups. The ERAS group demonstrated a significantly shorter hospital stay (2.34 ± 0.48 vs. 5.56 ± 0.51 days, p < 0.001) and lower estimated hospitalization costs (€1400 vs. €3300, p < 0.001). Flap survival was 100% in both groups, with no flap-related complications. Circumferential reduction rate was comparable between groups (44.39% ± 10.20% vs. 47.53% ± 8.26%, p = 0.278), as were LYMQOL scores at 12 months (8.21 ± 0.73 vs. 7.93 ± 0.70, p = 0.236) and infection rates (2.62 ± 0.90 vs. 2.73 ± 0.96 episodes/year, p = 0.71).</p><p><strong>Conclusion: </strong>An ERAS-based protocol tailored to VLNT is feasible and safe, and is associated with improved perioperative recovery and reduced healthcare costs without evidence of compromised surgical or functional outcomes. These findings support the integration of ERAS principles into lymphatic microsurgery and warrant further prospective validation.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70294"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012723","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}