Microsurgery最新文献

{"title":"Functional Reconstruction of a Huge Lateral Thoraco-Abdominal Defect With Combined Innervated Pedicled Latissimus Dorsi Flap and Vastus Lateralis Free Functional Muscle Transfer: A Case Report","authors":"Beniamino Brunetti,&nbsp;Marco Morelli Coppola,&nbsp;Fiorella Oliveri,&nbsp;Valeria Petrucci,&nbsp;Omar Al-Hilli,&nbsp;Sergio Valeri,&nbsp;Rossana Alloni,&nbsp;Irene Giovanna Aprile,&nbsp;Stefania Tenna,&nbsp;Paolo Persichetti","doi":"10.1002/micr.70038","DOIUrl":"https://doi.org/10.1002/micr.70038","url":null,"abstract":"<p>Full thickness thoraco-abdominal defects are traditionally challenging to reconstruct, exposing the patient to a significant risk of wound complications and functional impairment. The authors present an extremely challenging and unique case where a huge lateral thoraco-abdominal defect was reconstructed with a combination of innervated flaps allowing to completely restore contour and function of the operated region. A 77-year-old male patient presented with a leiomyosarcoma arising in the right lateral thoraco-abdominal region. Full-thickness resection involved the anterior part of the latissimus dorsi (LD) and serratus anterior muscles along with IX to XII ribs, a cuff of diaphragm muscle and the entire lateral abdominal wall, creating a 30 × 25 cm defect with exposure of right lung, liver, and ascending and transverse colon. After the placement of a synthetic mesh, a 28 × 16 cm pedicled innervated LD flap was advanced in V-Y fashion to cover the thoracic part of the defect. Then the patient was turned supine and a vastus lateralis free functional muscle transfer (FFMT) from the contralateral thigh was used to reconstruct the abdominal part of the defect. The recipient vessels were provided transposing the ipsilateral deep inferior epigastric pedicle according to the extra-anatomical pedicle rerouting technique. Motor branch for the VL was coapted to a sizeable intercostal nerve. The muscle was covered with split-thickness skin grafts. Both flaps healed uneventfully, allowing to obtain a complete restoration of form and function with M5 score according to the MRC Scale for muscle strength 8 months after surgery. Functional reconstruction of the lateral abdominal wall with FFMT has never been reported. Our successful case shows the importance of functional reconstruction of lateral thoraco-abdominal defects to prevent abdominal weakness or herniation, trunk instability, postural deficiencies and core strength loss.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438878","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":"Early Feeding After Free Flap Reconstruction for Oral Cavity Cancer: A Single Institution Retrospective Review","authors":"Joshua Barlow,&nbsp;Christine Little,&nbsp;Susmita Chennareddy,&nbsp;Rocco Ferrandino,&nbsp;Catharine Kappauf,&nbsp;Tamar Kotz,&nbsp;Michael Berger,&nbsp;Diana N. Kirke,&nbsp;Marita S. Teng,&nbsp;Eric M. Genden,&nbsp;Mohemmed N. Khan,&nbsp;Scott A. Roof","doi":"10.1002/micr.70035","DOIUrl":"https://doi.org/10.1002/micr.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Patients undergoing free flap reconstruction of the oral cavity have traditionally received nothing by mouth for 6–14 days postoperatively to limit the risk of wound complications. Growing evidence suggests that initiation of oral intake may not increase the morbidity. This study further investigates the utility of “early feeding.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study conducted at a large, urban tertiary healthcare system. Patients who underwent free flap reconstruction for oral cavity cancer between June 1, 2020, and October 31, 2022, were grouped as early feeding (oral intake on or before Postoperative Day 5) or late feeding (LF) (oral intake after Postoperative Day 5). Outcomes included rate of orocutaneous fistula, development of other local or systemic complications, and hospital length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty six patients were studied, with 26 belonging to the LF group and 40 to the early feeding (EF) group. The LF group was significantly older (median age 64.5 vs. 80 years, <i>p</i> = 0.027) and more likely to have a defect extending beyond the oral cavity (25.0% vs. 50.0%, <i>p</i> = 0.037). No significant differences were found in orocutaneous fistula formation between the LF and EF groups (7.7% vs. 0%, <i>p</i> = 0.152), but the rate of total complications was significantly higher in the LF group (38.5% vs. 12.5%, <i>p</i> = 0.014). LOS was significantly longer in the LF group (12.5 vs. 6 days, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that in the correctly suggested patient population, early postoperative oral intake may facilitate earlier hospital discharge without increasing the risk of postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423617","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":"Coherences of Cesarean Sectioning Scars and Other Abdominal Scars and Venous Augmentation Using SIEV in Free DIEP Flaps for Breast Reconstruction","authors":"Ines E. Tinhofer,&nbsp;Tzong-Yun Tsai,&nbsp;David Chon-Fok Cheong,&nbsp;Tzu-En Lin,&nbsp;Wen-Ling Kuo,&nbsp;Jung-Ju Huang","doi":"10.1002/micr.70039","DOIUrl":"https://doi.org/10.1002/micr.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With a global trend towards cesarean deliveries and abdominal surgeries for gastrointestinal disease treatment, more and more candidates for breast reconstruction using free deep inferior epigastric artery (DIEP) flap presented with abdominal scars. The purpose of the study was to investigate the risk of scar-related perfusion complications in DIEP flaps in patients with different abdominal scars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted in patients receiving DIEP flaps for breast reconstruction between October 2008 and April 2022. Demographics and the existing abdominal scars were collected. Acute and late complications were reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>273 breasts in 267 patients were included. Abdominal scars presented in 96 (36.0%) patients, including transverse cesarean sectioning in 69, midline scars in eight, laparoscopic scars in 23, appendectomy scars in five, abdominal total hysterectomy in one, and umbilicus scar in one patient. They did not increase the conversion rate from DIEP to ms-TRAM flap. The flap sizes were significantly bigger in the scar (SG) than in the control group (CG) (flap length SG: 29.8 ± 3.0 cm, CG: 28.9 ± 3.0 cm, <i>p</i> = 0.021 and flap width SG: 11.9 ± 1.1 cm, CG: 11.6 ± 0.9 cm, <i>p</i> = 0.002, respectively). However, the flap used percentage was similar (SG: 72.9% ± 13.1% and CG: 75.7% ± 12.2%, respectively, <i>p</i> = 0.086). The SIEV could be identified bilaterally significantly more often in the CG than in the SG (SG: 80.2% and CG: 91.8%, <i>p</i> = 0.006). The availability of SIEV was significantly less when a transverse scar was present. The need for venous superdrainage with SIEV was not statistically different in both groups (SG: 8.3% and CG: 12.3%, <i>p</i> = 0.320). The overall re-exploration rate was 6.2%. Acute re-explorations (SG: 5.1% vs. CG: 6.9%) or late revisions for aesthetics (SG: 17.7% vs. CG: 21.8%) were equally distributed. Flap-related complications like partial necrosis or fat necrosis showed similar rates, regardless of SIEV use for superdrainage (<i>p</i> = 0.287). Lastly, acute donor site complications, especially poor wound healing, occurred similarly in both groups (<i>p</i> = 0.234).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pre-existing abdominal scars do not compromise DIEP flap transfer, nor increase the incidence of late fat necrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423974","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":"The Roles of Fasciotomy and Peripheral Nerve Decompression in Electric Burn Patients: A Systematic Review and Meta-Analysis","authors":"E. E. Blears,&nbsp;J. Ballou,&nbsp;A. Weitzner,&nbsp;Julie Caffrey,&nbsp;A. L. Dellon","doi":"10.1002/micr.70036","DOIUrl":"https://doi.org/10.1002/micr.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Peripheral nerves preferentially conduct electricity due to their low resistance as compared with other tissues, predisposing them to injury from electrical burns. The purpose of this study was to investigate the efficacy of fasciotomy and peripheral nerve decompression on peripheral nerves after electric injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review of patients who had sustained electric burn injuries was performed according to PRISMA Guidelines. Incidence, demographic and injury characteristics, and patterns of symptoms were analyzed. Meta-analysis was performed to examine changes from baseline from nerve conduction studies. Outcomes for fasciotomy and various nerve decompressions were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 119 articles included in for systematic review, 16,773 patients were included. Most available studies the case reports or case series that yielded moderate- to poor-quality evidence. The median follow-up of the included patients was 44 weeks (IQR 15–97 weeks). Patients who underwent fasciotomy had significantly lower rates of peripheral neuropathy than those who did not by the last recorded follow-up (45% vs. 92%, <i>p</i> &lt; 0.0001). Patients who underwent peripheral nerve decompression after 30 days of injury had lower rates of peripheral neuropathy at the last follow-up compared with those who underwent decompression within 30 days (21% vs. 53%, <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A paucity of high-quality evidence exists to standardize management recommendations for peripheral nerve injury; however, of what literature does exist, it seems that fasciotomy and nerve decompressions are associated with improved peripheral nerve function in the long-term, but nerve decompression likely provides more benefit when performed if symptoms persist one-year post-injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423973","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":"Breast Reconstruction With Low-Design Bilateral Conjoined Superficial Inferior Epigastric Artery Flap due to Abdominal Mercedes-Benz Incision Scar: A Case Report","authors":"Hakuba Takeishi,&nbsp;Shimpei Miyamoto,&nbsp;Daichi Kurita,&nbsp;Masahiko Tanabe,&nbsp;Mutsumi Okazaki","doi":"10.1002/micr.70037","DOIUrl":"https://doi.org/10.1002/micr.70037","url":null,"abstract":"<p>Breast reconstruction using an abdominal flap in patients with scarring on the upper abdomen is challenging. We present herein a new approach to two-stage breast reconstruction using a low-design bilateral conjoined superficial inferior epigastric artery (SIEA) flap in a 48-year-old woman with breast cancer and a Mercedes-Benz abdominal scar. The 30 × 8 cm² abdominal flap was designed more inferior than the conventional deep inferior epigastric artery perforator (DIEP) flap, excluding the umbilicus and widening the width between the transverse scar of the Mercedes-Benz incision and the cephalad incision line of the flap. This modification preserved the paraumbilical DIEPs within the upper abdominal skin of the donor site while the abdominal flap was harvested with the bilateral superficial inferior epigastric arteries as the main vascular pedicles. The left and right vascular pedicles were then anastomosed to the proximal and distal ends of the internal mammary vessels, respectively. The flap survived completely after surgery and the donor site healed without any major complications. 6 months after surgery, the reconstructed breast was slightly smaller than its counterpart, although it maintained good shape. The low-flap design in this case contributed to the prevention of donor-site complications, and the use of a bilateral conjoined SIEA flap allowed for the transfer of the entire abdominal pannus without compromising the strength of the abdominal wall. The case reported herein shows that this technique can be a viable reconstructive option for patients with a history of scarring on the upper abdomen.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396840","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":"Usefulness of Pulsed Wave Doppler Ultrasonography for Evaluating Recipient Vessels of Free Flap Reconstruction in Patients With Severe Extremity Trauma: A Preliminary Report","authors":"Shunsuke Sato,&nbsp;Satoshi Hatashita,&nbsp;Takuya Nikaido,&nbsp;Michiyuki Hakozaki,&nbsp;Takuya Kameda,&nbsp;Yoichi Kaneuchi,&nbsp;Yoshifumi Kawamae,&nbsp;Masayuki Ito,&nbsp;Yoshihiro Matsumoto","doi":"10.1002/micr.70030","DOIUrl":"https://doi.org/10.1002/micr.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In cases of severe extremity trauma treated with the ‘internal fixation for fractures and flap’ technique, successful soft tissue reconstruction requires selecting recipient vessels that avoid the zone of injury. Pulsed wave Doppler ultrasonography has been proposed as a useful tool for the preoperative evaluation of recipient vessels in plastic surgeries. This report aimed to present the preliminary experience of pulsed wave Doppler ultrasonography in traumatic disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This report included 14 free flaps from 13 patients with severe extremity trauma. The flaps included nine free latissimus dorsi flaps (two combined with serratus anterior flaps) and five free anterolateral thigh flaps. The recipient vessels included the posterior tibial artery (<i>n</i> = 8), anterior tibial artery (<i>n</i> = 2), perforator of the hypoplastic posterior tibial artery (<i>n</i> = 1), brachial artery (<i>n</i> = 1), radial artery (<i>n</i> = 1), and the ulnar artery (<i>n</i> = 1). Preoperative pulsed Doppler ultrasonography was used to evaluate the recipient vessels and the vascular anastomosis site was determined based on the modified waveform classification and maximum flow velocity (<i>V</i>_max), as described by Ogino et al. The following variables were analyzed: modified vascular waveform classification at the anastomosis site, <i>V</i>_max, presence of posttraumatic vessel disease, and flap survival rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The modified vascular waveform classification at the anastomotic site was D-1a in seven cases, D-1b in four cases, and D-2 in three cases, with an average <i>V</i>_max of 27.4 cm/s (range: 16.2–40.0 cm/s). Post-traumatic vessel disease was not observed in any of the cases. The flap survival rate was 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pulsed wave Doppler ultrasonography is a valuable tool for the preoperative evaluation of recipient vessels in free flap reconstruction for severe extremity trauma. Its use can help ensure the optimal selection of recipient vessels, contributing to high flap survival rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388917","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 “Effects of Preoperative Hemoglobin on Microsurgical Reconstruction and Perioperative Blood Transfusion Requirement: A Meta-Analysis and Systematic Review of the Literature”","authors":"Mehrab Neyazi,&nbsp;Rachana Mehta,&nbsp;Shubham Kumar,&nbsp;Ranjana Sah","doi":"10.1002/micr.70032","DOIUrl":"https://doi.org/10.1002/micr.70032","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388918","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":"Factors Associated With Claw Toe Deformity Following Vascularized Fibula Flap Harvesting: A Retrospective Analysis of Potential Risk Factors and Preventive Strategies","authors":"Shigeki Ishibashi,&nbsp;Rikuo Shinomiya,&nbsp;Yuta Hayashi,&nbsp;Tsubasa Tashiro,&nbsp;Shogo Nagamatsu,&nbsp;Tomoaki Hamana,&nbsp;Toru Sunagawa,&nbsp;Nobuo Adachi","doi":"10.1002/micr.70031","DOIUrl":"https://doi.org/10.1002/micr.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Claw toe deformity at the donor site is a complication following vascularized fibula flap surgery. Despite its potential to necessitate further surgery, the factors contributing to this complication are not well understood. Therefore, this study aimed to identify factors associated with this complication and propose potential preventive strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 40 cases of vascularized fibula flap harvesting conducted between 2010 and 2022. The presence of claw toe deformity was evaluated, and various patient and surgical factors were analyzed. Postoperative magnetic resonance imaging (MRI) and intraoperative indocyanine green angiography images were also assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Claw toe deformity was observed in 25% of patients, with a significantly higher incidence among those undergoing primary wound closure (<i>p</i> = 0.018). Age (<i>p</i> = 0.595), body mass index (<i>p</i> = 0.482), smoking status (<i>p</i> = 0.157), diabetes (<i>p</i> = 0.556), peripheral arterial disease (<i>p</i> &gt; 0.999), preoperative chemotherapy (<i>p</i> = 0.715), operative time (<i>p</i> = 0.080), harvested fibula length (<i>p</i> = 0.981), skin paddle size (<i>p</i> = 0.695), and horizontal width of skin flap (<i>p</i> = 0.906) were not significantly associated with claw toe deformity. The cutoff values for primary wound closure were identified as a skin flap horizontal width of 3.5 cm and a horizontal width-to-circumference ratio of 10.4%. MRI revealed signal changes in the flexor hallucis longus on T2-weighted images in all six cases with claw toe deformity and in 6 of the 12 cases without deformity. Indocyanine green angiography revealed ischemia in the flexor hallucis longus in all six examined cases; however, four of these cases did not develop claw toe deformity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study emphasizes the importance of the wound closure method and skin flap size in primary closure for preventing claw toe deformity after vascularized fibula flap procedures. These findings may contribute to improved postoperative outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380796","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":"Risk Factors of Free Flap Outcomes After Head and Neck Cancer Surgery: A Multivariable Analysis From a Single Center Experience","authors":"Chia-Hsuan Tsai,&nbsp;Cristhiam Yang,&nbsp;Yao-Chang Liu,&nbsp;Chi-Ling Chen,&nbsp;Huang-Kai Kao","doi":"10.1002/micr.70023","DOIUrl":"https://doi.org/10.1002/micr.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Risk factors for unfavorable outcomes, such as surgical site infection (SSI) and flap loss, following free flap reconstruction in patients with head and neck cancer are repeatedly reported without a definitive conclusion. Institutional reviews and meta-analyses each have their advantages and limitations. Although this study is without a definitive answer to these questions, it contributes to the literature by identifying potential influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center cohort study included 596 patients who underwent head and neck reconstruction between 2015 and 2017. Patients were initially divided into two groups based on the presence or absence of SSI, and a similar comparison was made for flap loss. Data were further analyzed using univariate and multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The overall SSI rate was 18.29%, with the age of patients (65–74 years, adjusted OR 2.41, <i>p</i> &lt; 0.001; &gt; 74 years, adjusted OR 3.53, <i>p</i> &lt; 0.001) and segmental mandibulectomy (adjusted OR 1.81, <i>p</i> = 0.035) as independent risk factors. The overall flap failure rate was 4.4%, with medial sural flap (adjusted OR 6.89; <i>p</i> = 0.025) and prolonged operative time per hour (adjusted OR 1.38; <i>p</i> &lt; 0.001) identified as significant influencing factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Age should not be the sole determinant for excluding patients for free tissue transfer, though it may elevate the SSI rate. Special attention is potentially needed during postoperative care for patients who received segmental mandibulectomy, medial sural flap, or experienced prolonged operative time. Identifying these risk factors can assist surgeons in optimizing flap outcomes before head and neck reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362730","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":"Usefulness of Dorsal Scapular Artery Perforator Flap for Donor Site Closure After Harvesting Latissimus Dorsi Flap/Thoracodorsal Artery Perforator Flap: A Report of Three Cases","authors":"Se Yeon Park,&nbsp;Kyeong-Tae Lee","doi":"10.1002/micr.70033","DOIUrl":"https://doi.org/10.1002/micr.70033","url":null,"abstract":"<div>\u0000 \u0000 <p>Reducing donor-site morbidity is crucial in free-flap reconstruction, with the primary goals of achieving dermis-to-dermis closure and avoiding skin grafts. Although latissimus dorsi (LD) myocutaneous and thoracodorsal artery perforator (TDAP) flaps usually allow primary closure, larger flap harvests may require skin grafts, potentially leading to undesirable outcomes. In such situations, local flap transfer can be considered for donor-site closure, yet there are few reports on this. This report aims to present cases where a dorsal scapular artery perforator (DSAP) rotational flap was used to close donor defects following large TDAP/LD flap harvests. The first case involved a 16-year-old girl who required a below-knee amputation due to an acute thrombotic event, leaving a 20 × 20 cm²-sized stump defect. Bilateral LD myocutaneous flaps were harvested, with the right donor site closed primarily, while a 20 × 9 cm²-sized defect remained on the left. A 22 × 9 cm²-sized DSAP flap, based on three perforators, was rotated to close the defect, showing excellent outcomes at 12 months. In the second and third cases, 75- and 78-year-old male patients with scalp angiosarcoma underwent wide excision and reconstruction with TDAP flaps, leaving 14 × 6 cm² and 14 × 7 cm²-sized donor defects. DSAP flaps, 15 × 7 cm² and 15 × 8 cm² in size, were rotated based on nearby perforators to close these areas. Both patients showed no morbidities at postoperative 8 and 2 months, respectively. When primary closure of the donor site is challenging after harvesting large TDAP /LD flaps, a DSAP rotational flap can provide a valuable option for minimizing donor-site morbidity.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143248729","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}