Microsurgery最新文献

{"title":"Lower Extremity Free Tissue Transfer in Peronea Arteria Magna: An Observational Retrospective Cohort Study of Anatomic and Microsurgical Considerations","authors":"John W. Rutland,&nbsp;Rachel N. Rohrich,&nbsp;Karen R. Li,&nbsp;Paul F. Martinez,&nbsp;Richard C. Youn,&nbsp;Christopher E. Attinger,&nbsp;Cameron M. Akbari,&nbsp;Karen K. Evans","doi":"10.1002/micr.70079","DOIUrl":"https://doi.org/10.1002/micr.70079","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT). The present study aims to leverage a high volume lower extremity reconstruction center to determine the incidence and microsurgical considerations in PAM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted at a single tertiary limb salvage center, reviewing all patients who underwent lower LE FTT from July 2011 to January 2024. Patients were included if they had preoperative arteriography and underwent LE FTT for atraumatic wounds. Patient demographics, vascular anatomy, microsurgical technique, and postoperative outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Arteriograms for a total of 334 patients who underwent lower extremity FTT were reviewed, of which 34 patients (10.2%) had Kim–Lippert Class III variant patterns, and six patients (1.8%) had Class IIIc (PAM). Of these, all six anastomoses were performed in an end-to-side fashion. There were no instances of postoperative lower extremity devascularization or ischemia. There were no flap losses. One of the six patients required immediate return to the operating room for venous thrombosis with successful flap salvage after clot evacuation and a second venous anastomosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>PAM is a rare yet important anatomic variant that is occasionally observed in the lower extremity FTT population. The following features are important in managing patients with PAM undergoing FTT: the routine use of preoperative arteriography, an understanding of venous anatomic variability, the use of a smaller target window for microsurgery given the majority of vessels residing in the deep posterior compartment, the preservation of all peroneal side branches, and the use of ETS anastomosis when possible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144897368","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 Using Pedicled Deep Inferior Epigastric Perforator Flap Vein for Ulcer With Lymphorrhea: A Case Report","authors":"Yuko Yamagiwa,&nbsp;Naoya Otani,&nbsp;Takaki Oue,&nbsp;Yusuke Shikano,&nbsp;Michiko Nomori,&nbsp;Tateki Kubo","doi":"10.1002/micr.70108","DOIUrl":"https://doi.org/10.1002/micr.70108","url":null,"abstract":"<div>\u0000 \u0000 <p>Lymphovenous anastomosis (LVA) is an effective surgical treatment for inguinal lymphorrhea, a complication that can occur after surgery involving vessels. LVA, however, requires a suitable vein for anastomosis near the leaking lymphatic vessel, which is sometimes difficult to secure. Here we report the successful treatment of a refractory ulcer with lymphorrhea by anastomosis of a flap vein to the lymphatic vessel concerned, along with flap closure. The patient was a 26-year-old male who developed a lymphatic leak in the right inguinal region following cannula removal after mechanical circulatory support for fulminant cardiomyopathy. He received conservative therapy but developed an infected femoral artery aneurysm, leading to replacement with the femoral vein. However, because of the persistent, intractable ulcer with exposed graft vessels and continued lymphatic leakage, pedicled flap reconstruction and LVA were planned. A 14 × 6.5 cm spindle-shaped pedicled deep inferior epigastric perforator flap was elevated from the right lower abdomen with branches reserved for use in LVA, rotated 180° through the subcutaneous tunnel, and migrated to the ulcer site. The source of lymphorrhea in the ulcer was identified by indocyanine green (ICG) lymphangiography, and the lymphatic vessels were anastomosed to a branch of the flap pedicle vein. ICG lymphangiography confirmed unimpeded venous flow without the stagnation of lymphatic fluid. At 6 months postoperatively, there was no evidence of ulceration or recurrence of lymphorrhea or lymphedema. In cases of lymphorrhea with refractory ulceration, there often are no suitable veins for LVA in the wound area due to scarring or adhesions. The present case demonstrates the use of a flap pedicle vein to solve this problem, potentially offering a new treatment option for lymphorrhea with extensive ulceration.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144894445","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":"Comprehensive Analysis on the Use of Superficial Temporal Vessels as Free Flap Recipients in Head and Neck Reconstruction: Systematic Review on Anatomic Characteristics and Surgical Outcomes","authors":"Belén Andresen-Lorca,&nbsp;Alberto Pérez-García,&nbsp;Iván Heredia-Alcalde,&nbsp;Pedro Alvedro-Ruiz,&nbsp;María García-García,&nbsp;María D. Pérez-del-Caz","doi":"10.1002/micr.70106","DOIUrl":"https://doi.org/10.1002/micr.70106","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Head and neck reconstruction often involves complex defects requiring microvascular free flaps. While cervical vessels are commonly used as recipients, anatomical variations and prior interventions may necessitate alternative options. The superficial temporal vessels (STV) offer advantages such as accessibility, suitable caliber, and proximity to craniofacial defects. This study systematically evaluates the anatomical and surgical outcomes of STV in head and neck reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review following PRISMA guidelines was conducted across PubMed and Scopus to identify studies on the anatomical characteristics and surgical outcomes of STV. Inclusion criteria focused on studies involving adult patients, reporting surgical outcomes with STV as recipient vessels, and presenting anatomical measurements. Statistical analysis of flap survival, complications, and vessel caliber was performed using IBM SPSS 30.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two studies on surgical outcomes (506 flaps) and 23 anatomical studies (976 specimens) were analyzed. STV exhibited a mean arterial caliber of 2.30 mm at the origin, 1.88 mm at the zygomatic arch, and 1.51 mm at the bifurcation, with vein diameters averaging 2.58 mm. The flap survival rate was 96.72%, with major complications in 15.4% of cases and anastomosis revision in 5.14%. The anterolateral thigh flap was the most common donor site (177 cases). STV use was most frequent in middle-third facial defects (33%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The STV are reliable alternatives for microvascular reconstruction in head and neck surgery, particularly for defects in the upper and middle thirds of the face. Their favorable anatomical characteristics and high flap survival rates underscore their potential as primary or secondary recipient vessels, especially in vessel-depleted necks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869705","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":"Outcomes of Microsurgical Reconstruction of Post-Burn Joint Contracture—Systematic Review and Meta-Analysis","authors":"Abdulaziz Elemosho,&nbsp;Layne N. Raborn Macdonald,&nbsp;Derek E. Bell,&nbsp;Jeffrey E. Janis","doi":"10.1002/micr.70104","DOIUrl":"https://doi.org/10.1002/micr.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (<i>I</i>² = 0% [95% CI: 97.7–99.6]) of pedicled and 90.1% (<i>I</i>² = 82.8% [95% CI: 62.7–100]) of free flap reconstructions, recurring in 1.8% (<i>I</i>² = 0% [95% CI: 0.7–3.3]) at sites reconstructed with pedicled flaps and 0.6% (<i>I</i>² = 0% [95% CI: 0.1–1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (<i>I</i>² = 0% [95% CI: 0.6–2.7]) and 2.9% (<i>I</i>² = 37.9% [95% CI: 0.9–5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (<i>I</i>² = 65.1% [95% CI: 3.4–11.5]) and 5.2% (<i>I</i>² = 65% [95% CI: 1.7–10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (<i>p</i> = 0.50), contracture recurrence (<i>p</i> = 0.15), total flap loss (<i>p</i> = 0.18) or partial flap loss (<i>p</i> = 0.31) regardless of the flap type used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144853659","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":"Immediate Versus Delayed Grafting: Re-Evaluating Graft Timing in Microsurgical Reconstruction","authors":"Georgios Karamitros,&nbsp;William C. Lineaweaver","doi":"10.1002/micr.70105","DOIUrl":"https://doi.org/10.1002/micr.70105","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144814722","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 Fingertip Reconstruction: A Comparative Analysis of Reverse Homodigital Island and Digital Artery Perforator Flaps","authors":"Yusuke Miyashima,&nbsp;Hiroyuki Gotani,&nbsp;Mitsuhiro Okada,&nbsp;Yoshitaka Tanaka,&nbsp;Hirohisa Yagi,&nbsp;Kosuke Saito,&nbsp;Kotaro Okamoto,&nbsp;Hidetomi Terai","doi":"10.1002/micr.70101","DOIUrl":"https://doi.org/10.1002/micr.70101","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fingertip amputations are a common form of hand trauma and often require soft tissue reconstruction when replantation is not feasible. The reverse homodigital island flap (RHI) and the digital artery perforator flap (DAP) are two widely used techniques for fingertip reconstruction; however, direct comparisons of their clinical outcomes remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study analyzed 39 patients who underwent either RHI (<i>n</i> = 20) or DAP (<i>n</i> = 19) procedures for fingertip injuries. Patients with thumb injuries, multiple finger injuries, or insufficient follow-up data were excluded. Postoperative management included flap monitoring, limb elevation, and early rehabilitation. Outcomes assessed included flap survival, operative time, hospital stay, functional recovery, and complications such as flap congestion, necrosis, and nail deformities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were found in baseline characteristics or affected digits. The RHI group mainly involved Ishikawa subzone II injuries with avulsion patterns, while the DAP group had predominantly subzone I crush injuries. Distal phalanx bone defect length was comparable between groups. Both RHI and DAP demonstrated high flap survival rates, with no cases of major necrosis. The mean operative time was significantly shorter in the DAP group (68 min) compared to the RHI group (101 min, <i>p</i> &lt; 0.001). Similarly, the hospital stay was shorter in the DAP group (13 days) than in the RHI group (18 days, <i>p</i> &lt; 0.05). While both flaps achieved good functional and sensory recovery, the DAP group exhibited a lower secondary procedure rate (21.1%) compared to the RHI group (70%, <i>p</i> &lt; 0.002). However, nail deformities, particularly claw deformities, were more frequently observed in the DAP group (47.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The DAP flap offers a shorter operative time, faster recovery, and a lower secondary procedure rate, making it a preferable option for functional reconstruction. In contrast, although the RHI flap requires a longer treatment period, it may provide superior esthetic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144751445","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":"Machine Learning-Based Flap Takeback Prediction Modeling: Theory for a Real-Time, Patient-Specific Postoperative Flap Monitoring and Alert System","authors":"Olachi O. Oleru,&nbsp;Kim-Anh-Nhi Nguyen,&nbsp;Peter Taub,&nbsp;Arash Kia","doi":"10.1002/micr.70100","DOIUrl":"https://doi.org/10.1002/micr.70100","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative free flap monitoring is crucial yet taxing, requiring frequent and often subjective assessments to detect early signs of compromise. The present study aims to develop a machine learning model to predict the risk of flap take-back reoperation due to arterial and/or venous compromise, as a basis for real-time risk monitoring and alerts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study utilized patient data from a New York City hospital system from 2019 to 2024. Adult patients undergoing free flap reconstruction were included. Data from electronic medical records (EMRs) included demographic and clinical variables. The primary outcome was flap takeback, defined as urgent or emergent microvascular exploration or revision surgery during the same admission. A random forest model was developed and trained on the data with oversampling to balance the training set. Model performance was evaluated using AUROC, sensitivity, specificity, accuracy, and precision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 458 patient encounters, with a flap takeback rate of 6.1%. The final model achieved a train AUROC of 0.99 and a test AUROC of 0.86. Sensitivity and specificity on the test set were 75% and 78%, respectively, with 78% accuracy. Key predictors included skin integrity, pulse, and diastolic blood pressure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The machine learning model accurately predicts free flap takeback, offering a proactive approach to postoperative monitoring. Integrating this model into EMR platforms can provide real-time early warning systems (EWS), enhancing early detection and intervention for flap compromise. Future research should validate the model across diverse settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740530","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":"Free Chain-Linked Fillet Flaps From a Contralateral Chopart Amputation for Reconstruction of an Extensive Lower Extremity Defect: A Case Report and Literature Review","authors":"Keisuke Shimbo,&nbsp;Yuki Aoki,&nbsp;Tatsuhiko Saiki","doi":"10.1002/micr.70102","DOIUrl":"https://doi.org/10.1002/micr.70102","url":null,"abstract":"<div>\u0000 \u0000 <p>Free fillet flap reconstruction transfers composite tissue from an unsalvageable limb to repair a separate defect. We report a case of free fillet flaps based on the posterior tibial artery (PTA) and anterior tibial artery (ATA). A 41-year-old man was crushed under a truck; his right leg suffered an open tibia and fibula fracture (Gustilo IIIB) with extensive soft tissue loss, while his left foot was amputated at the tarsal level. He initially underwent Chopart-level amputation of the left limb, which was subsequently revised to a below-knee amputation. Two free fillet flaps were harvested from the amputated limb: one based on the PTA (15 × 13 cm) and the other based on the ATA (20 × 8 cm). Two chain-linked fillet flaps via flow-through anastomosis were used to cover the soft tissue defect exposing the right tibia. Postoperatively, partial necrosis occurred in the ATA-based fillet flap, which healed after reoperation. The patient regained mobility with a prosthesis. Free chain-linked fillet flaps harvested from a limited amputation segment are a feasible and useful option for reconstructing complex soft tissue defects without additional donor site morbidity.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740528","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":"Fasciocutaneous Vascularized Lymph Node Transfer for Head and Neck Lymphedema: A Case Report","authors":"Hamzah Almadani,&nbsp;Hosung Rhyu,&nbsp;Andrew Cantor,&nbsp;Philip S. Brazio","doi":"10.1002/micr.70098","DOIUrl":"https://doi.org/10.1002/micr.70098","url":null,"abstract":"<div>\u0000 \u0000 <p>Head and neck lymphedema is a common complication of head and neck cancer treatment. Lymphovenous bypass is a promising surgical treatment but may not be an option for all patients after radiotherapy due to the obliteration of local lymphatic targets for bypass. We aim to present vascularized lymph node transfer (VLNT) as a solution to this problem. We report the case of a 38-year-old patient with Stage 2 face and neck lymphedema after treatment for T4aN1oral squamous cell carcinoma, who had no targets for lymphovenous bypass. The patient was treated with a 6 by 14 cm fasciocutaneous VLNT based on the left superficial circumflex iliac artery and vein, to the right facial vein and facial artery. The patient was given a low-dose heparin infusion, placed in a head bolster to prevent neck rotation, and discharged with low-dose aspirin. 4.5 months after free flap reconstruction, the patient underwent revision of the flap including indocyanine green lymphatic mapping, thinning with lymph-sparing liposuction, and re-advancement with Z-plasty for contour. At 11 months, the patient experienced a reduction of swelling, improvement of symptoms, and no further need for compression and manual lymphatic drainage. The area of greatest mobility impairment was resurfaced with flap skin, improving subjective tightness. Indocyanine green imaging at 4 months and 11 months revealed linear lymphatics traversing from the facial skin into the flap. Facial dermal thickness on ultrasound decreased from 1.43 to 1.09 mm between 4 and 11 months postoperatively. Fasciocutaneous VLNT has the potential to restore lymphatic drainage, improving swelling and tightness for patients with head and neck lymphedema who do not have lymphatic targets for bypass. Future studies on head and neck lymphedema should routinely employ ultrasound measurement of dermal thickness as an objective measure.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725481","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":"Segmental Cylindrical Gracilis Free Flap for Dead Space Obliteration in Chronic Midfoot Osteomyelitis Secondary to Ballistic Injury: A Case Report","authors":"Erkan Sabri Ertaş","doi":"10.1002/micr.70097","DOIUrl":"https://doi.org/10.1002/micr.70097","url":null,"abstract":"<div>\u0000 \u0000 <p>Chronic osteomyelitis of the midfoot, particularly following high-energy trauma such as a landmine injury, presents a formidable challenge due to the region's limited soft tissue envelope, complex anatomy, and the critical need for effective and durable dead space obliteration. While various flap options have been described, there remains no consensus on the optimal approach for managing deep defects in the midfoot, especially in cases complicated by prior surgical procedures. We present the case of a 23-year-old male who developed chronic midfoot osteomyelitis following a landmine explosion. Despite multiple debridements, targeted antibiotic therapy, and initial soft tissue coverage with an anterolateral thigh (ALT) flap, a persistent 6 × 5 cm (30 cm³) dead space remained, consistent with a Cierny–Mader type III-A classification. A segmentally harvested gracilis muscle flap was designed and sculpted to conform to the dimensions of the cavity, then inset into the defect. Microvascular end-to-side anastomosis was performed to the anterior tibial artery and two accompanying veins, and the flap was covered with a split-thickness skin graft. The postoperative course was uneventful at the recipient site. Mild serous drainage from the donor site, attributed to fat necrosis, resolved completely with conservative elastic compression therapy. At 12-month follow-up, the patient remained infection-free, was fully ambulatory without assistance, and imaging confirmed complete obliteration of the dead space. This case suggests that a segmentally harvested gracilis muscle flap may offer a viable, anatomically conforming single-stage option for managing complex midfoot osteomyelitis in selected patients. In individuals with prior treatment failure, this approach may help reduce surgical burden, enhance infection control, and support not only physical but also psychological recovery through resolution of a prolonged disease course.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714862","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}