Microsurgery最新文献

{"title":"Fate of the Flexor Hallucis Longus Muscle at the Donor Site After Fibula Flap Harvest: Assessing Muscle Viability Using Novel MRI Techniques – A Cohort Study","authors":"Yu-Ching Lin,&nbsp;Yu-Hsiang Juan,&nbsp;Nidal F. AL Deek,&nbsp;B. S. Tsun-Ching Chang,&nbsp;B. S. Yu-Jr Lin,&nbsp;Chee-Jen Chang,&nbsp;Fu-Chan Wei","doi":"10.1002/micr.70047","DOIUrl":"https://doi.org/10.1002/micr.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fibula flap dissection sacrifices the blood vessels to the flexor hallucis longus (FHL) and other calf muscles. This novel MRI study investigates perfusion and fibrosis of the FHL muscle after fibula flap harvest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A cohort study from September 2018 to January 2021, we prospectively recruited head and neck cancer patients who were planned to receive fibula flap transfer for jaw reconstruction. All participants received MRI before and one year after the operation. Muscle fibrosis was quantified via extracellular volume matrix fraction (ECV); muscle perfusion via time to peak (TTP), T2* change, and T2* slope by BOLD sequence. Muscle fibrosis and perfusion were compared before and after the operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total of 18 patients completed the study (mean age: 48.83 years). Significantly increased fibrosis was seen in the postoperative FHL muscle via elevated ECV (11.23%–32.54%, <i>p</i> &lt; 0.001). Despite prolonged TTP in postoperative FHL (38.17–51.83 s, <i>p</i> = 0.343), increased T2* change (8.43%–9.53%, <i>p</i> = 0.369), and increased T2* slope (0.22%–0.23%/s, <i>p</i> = 0.766), these muscle perfusion changes were not statistically significant. Postoperative complications, such as great toe clawing and donor site infection, were not observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite severe fibrosis within the FHL muscle after extensive dissection during fibula harvest and peroneal arterial ligation, the FHL muscle perfusion could be retained from an MRI perspective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689944","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":"Micro-Inset: Three-Dimensional Fibrin Glue Fixation of Microvascular Anastomosis and Pedicle in Free Tissue Transfer","authors":"Michalis Hadjiandreou,&nbsp;Youn Hwan Kim,&nbsp;Bilal Rafique,&nbsp;Samim Ghorbanian,&nbsp;Georgios Pafitanis","doi":"10.1002/micr.70051","DOIUrl":"https://doi.org/10.1002/micr.70051","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639261","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 Systematic Review of Functional Donor-Site Morbidity in Scapular Bone Transfer","authors":"Estephania Candelo,&nbsp;John E. Richter Jr.,&nbsp;Oriana Arias-Valderrama,&nbsp;Phillip Pirgousis,&nbsp;Samip Patel","doi":"10.1002/micr.70044","DOIUrl":"https://doi.org/10.1002/micr.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the general perception of minimal donor-site morbidity associated with scapular free flaps, the surgical harvest of scapular bone and subsequent reattachment of parascapular muscle have the potential to compromise postoperative shoulder function. A comprehensive assessment of functional impairment remains undocumented in the literature. Therefore, this systematic review was conducted to thoroughly explore both subjective and objective donor-site morbidity following free flap surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Searches were conducted on PubMed, Embase, and CENTRAL to locate articles addressing functional donor-site morbidity after the transfer of scapular bone. Qualifying articles reported scapular free flaps which utilized bone, including lateral border, medial border, and scapular tip. Each measured donor-site morbidity using at least one of these measures: Constant-Murley score (CM), Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), shoulder range of motion (ROM), and shoulder strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search culminated in 16 eligible studies, incorporating data from 316 cases. The CM was employed in five studies, yielding mean values from 60.6 to 95, while the DASH was utilized in nine studies, with means ranging from 10.44 to 46.7. Compared to normative values, these CM and DASH scores reflected negligible to mild impairment in shoulder function. Additional evaluations of shoulder ROM, conducted in four studies, revealed modest yet statistically significant reductions in flexion, abduction, and external rotation. Three studies measuring shoulder strength reported associated mild weakening of these motions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This systematic review enables healthcare providers to characterize the probable scope of shoulder dysfunction following scapular bone harvest. Patient-reported outcomes imply a high tolerance for the procedure, while objective measures denote the potential for substantial restoration of shoulder function approaching preoperative levels. To augment the understanding of functional recovery, future research should incorporate a comparative analysis of preoperative and postoperative functional metrics for each subject.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639260","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":"Comments on the Delphi Study, “Consensus Recommendations for Neurogenic Thoracic Outlet Syndrome From the INTOS Workgroup”","authors":"A. Lee Dellon","doi":"10.1002/micr.70053","DOIUrl":"https://doi.org/10.1002/micr.70053","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632918","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":"Twenty Years of the International Fellowship at China Medical University Hospital—A Legacy of Mentorship and Innovation","authors":"Marco Marcasciano,&nbsp;Jacopo Nanni,&nbsp;Alex Sorkin,&nbsp;Michele Maruccia,&nbsp;Yasser Farid,&nbsp;Chad Chang,&nbsp;“Alumni Association of Professor Hung-Chi Chen” Collaborative Group","doi":"10.1002/micr.70052","DOIUrl":"https://doi.org/10.1002/micr.70052","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143632917","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":"Objectifying Clinical Outcomes After Lymphaticovenous Anastomosis and Vascularized Lymph Node Transfer in the Treatment of Extremity Lymphedema: A Systematic Review and Meta-Analysis","authors":"Brett A. Hahn,&nbsp;Alieske Kleeven,&nbsp;Milan C. Richir,&nbsp;Arjen J. Witkamp,&nbsp;Anke M. J. Kuijpers,&nbsp;Tim de Jong,&nbsp;Shan Qiu,&nbsp;J. Henk Coert,&nbsp;David D. Krijgh","doi":"10.1002/micr.70050","DOIUrl":"https://doi.org/10.1002/micr.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Upper extremity lymphedema (UEL) and lower extremity lymphedema (LEL) can develop as a result of lymph node dissection in the treatment of various malignancies. While emerging microsurgical interventions using lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) show promising outcomes for patients with lymphedema, the best approach to implementing the two procedures remains to be defined. This systematic review and meta-analysis provide a comprehensive overview of published literature on the clinical improvement of extremity lymphedema in patients who undergo either LVA, VLNT, or a combined microsurgical procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From Embase, PubMed, and Web of Science databases, 52 studies were identified that met inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The risk of bias was assessed using the Risk Of Bias In Nonrandomized Studies-of Interventions (ROBINS-I) tool and the Cochrane tool for randomized trials (RoB 2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Random-effects meta-analyses of means estimated a pooled clinical improvement of 36.46% (95% CI: 29.44–43.48) for UEL and 34.16% (95% CI: 23.93–44.40) for LEL. Subgroup analyses revealed differences in clinical improvement according to the microsurgical approach. Clinical improvement of UEL was 29.44% (95% CI: 15.58–43.29) for LVA, 41.66% (95% CI: 34.13–49.20) for VLNT, and 32.80% (95% CI: 21.96–43.64) for combined VLNT + LVA, while the improvement of LEL was 31.87% (95% CI: 18.60–45.14) for LVA and 39.53% (95% CI: 19.37–59.69) for VLNT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings from this study elucidate the clinical improvement in extremity lymphedema from various microsurgical approaches. This knowledge could aid physicians in the shared decision-making process with UEL and LEL patients and better facilitate proper patient selection for microsurgical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595195","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":"Cadaver-Based Training in Lymphaticovenular Anastomosis: A Realistic and Effective Model for Skill Development","authors":"Yushi Suzuki,&nbsp;Yusuke Shimizu,&nbsp;Yoshifumi Takatsume,&nbsp;Nobuaki Imanishi,&nbsp;Kazuo Kishi","doi":"10.1002/micr.70048","DOIUrl":"https://doi.org/10.1002/micr.70048","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594885","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 Tranexamic Acid in Head and Neck Free Flap Reconstruction","authors":"Fuat B. Bengur,&nbsp;Micah K. Harris,&nbsp;Michael S. Hu,&nbsp;Rula Mualla,&nbsp;Arash Samadi,&nbsp;Olivier Bourguillon,&nbsp;Joshua Smith,&nbsp;Vu T. Nguyen,&nbsp;Michael L. Gimbel,&nbsp;Kevin Contrera,&nbsp;Matthew Spector,&nbsp;Mario G. Solari,&nbsp;Mark W. Kubik,&nbsp;Shaum S. Sridharan","doi":"10.1002/micr.70046","DOIUrl":"https://doi.org/10.1002/micr.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tranexamic acid (TXA) is commonly used in surgical settings to reduce blood loss. Due to its antifibrinolytic properties, TXA theoretically increases the risk of thrombosis. In this study, the use of TXA was assessed in patients undergoing head and neck free flap reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of patients from February 2021 to September 2023 received TXA. Patients received 3 g of intravenous TXA intraoperatively, in addition to topical TXA to the donor, recipient, and neck dissection sites. Patients were compared to a retrospective cohort from August 2019 to January 2021. All patients, including those in the retrospective control cohort, met the criteria for TXA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 397 patients underwent free flap reconstruction (53.6% thigh, 25.6% fibula), of which 185 received TXA and 212 did not. Patients receiving the TXA protocol had a lower perioperative transfusion rate (12.9% vs. 20.7%, <i>p</i> = 0.042) and intraoperative estimated blood loss (196.4 ± 102.9 cc vs. 263.7 ± 247.8 cc, <i>p</i> &lt; 0.001). There was no difference in postoperative flap vascular compromise in the TXA (7.6%) versus control (10.4%) groups (<i>p</i> = 0.33). Postoperative complications, including hematoma and thromboembolic events, were not statistically different between the groups. On multivariate analysis, the use of TXA remained predictive of reduced perioperative transfusion when controlling for BMI &gt; 25, osseous flap, and hypertension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients who received TXA demonstrated decreased perioperative transfusion after head and neck free flap reconstruction with no increase in flap vascular compromise or major thromboembolic events. Implementation of our protocol to larger cohorts and randomized controlled trials could help identify an optimal dosing regimen and demonstrate long-term efficacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143581602","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":"Comments on “the Effect of Venous Augmentation on Complication Rates in Deep Inferior Epigastric Perforator Breast Reconstruction”","authors":"Chiara Camilloni,&nbsp;Beniamino Brunetti,&nbsp;Dario Melita,&nbsp;Paolo Persichetti,&nbsp;Mario Cherubino,&nbsp;Giuseppe A. G. Lombardo","doi":"10.1002/micr.70049","DOIUrl":"https://doi.org/10.1002/micr.70049","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143564869","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":"“INVOS” WE TRUST. Tissue Oximetry for Free Flap Monitoring in Lower Limb Reconstruction","authors":"Manuel Fernández Garrido,&nbsp;Laura Torrano,&nbsp;Jordi Riba,&nbsp;Andree Ibarra,&nbsp;Ania Smialkowski,&nbsp;Paúl Zamora Alarcón","doi":"10.1002/micr.70045","DOIUrl":"https://doi.org/10.1002/micr.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Free flaps on the lower limb could make the difference between salvage and amputation. Regional tissue oximetry (rSO₂) measured by near-infrared light is a tool that is not yet widely described or recognized, as most published studies focus on its use in breast flap monitoring. However, in the context of lower limb reconstruction, it offers an objective and real-time evaluation of flap tissue perfusion, enabling faster responses for salvage compared to traditional clinical monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study comparing lower limb free flap monitoring using two techniques. Group A (June 2016–January 2020) used local real-time rSO₂ monitoring with the INVOS-TM 5100C Somatic Oximeter (Medtronic Inc., Minneapolis, MN); each patient had two sensors, one over the flap, another (control) over a nearby non-flap area. Group B (February 2013–May 2016) relied on traditional clinical examination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 148 free flaps were included (74 in each group). There was a small, non-significant difference in overall flap survival (Group A: 94.6% vs. Group B: 90.5%, <i>p</i> = 0.344). The flap salvage rate, when reoperated within the first 72 h, was higher but not significantly so (66% vs. 43%, <i>p</i> = 0.483) and significantly faster (121 vs. 181 min, <i>p</i> = &lt; 0.001) in Group A. According to our study, INVOS demonstrated 100% sensitivity and negative predictive value (NPV), with 90% specificity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Regional tissue oximetry monitoring of lower limb free flaps is a real-time, objective, non-invasive, and reliable method for early detection of complications. This study allows us to affirm that the revisions of the flaps are statistically significantly faster. It also provides valuable information about anastomotic failure, clearly differentiating between arterial and venous issues, as well as identifying local or systemic issues.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535772","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}