Microsurgery最新文献

{"title":"Nasal Septum Reconstruction With Medial Femoral Condyle Free Flap: A Case Report and Literature Review.","authors":"İlker Uyar, Ersin Aksam","doi":"10.1002/micr.70297","DOIUrl":"10.1002/micr.70297","url":null,"abstract":"<p><p>Nasal septum defects cause significant functional and aesthetic morbidity. In large septal defects requiring reconstruction, the goal is to achieve appropriate tissue matching, obtain well-vascularized tissue, and minimize donor site morbidity. Repair alternatives are quite limited in large defects. The medial femoral condyle (MFC) free flap is a preferred option in craniofacial reconstructions due to its vascularized, cortical bone with periostal architecture. In this article, we present a patient who underwent successful reconstruction of a severely advanced nasal septum defect using a medial femoral condyle free flap. A 63-year-old male patient underwent repair with a free MFC flap for an anterior septal defect approximately 2 × 2 cm in size. The cause of the septal defect was previous tumor surgery. A free flap from the medial femoral condyle was designed for repair; the flap bone size was approximately 2 × 2 cm, and the periosteum size was approximately 2 × 4 cm. The patient was followed up for 18 months, and no problems were detected during follow-up. The MFC free flap may be a suitable option for the reconstruction of large septal defects, providing structural support without the need for additional tissue transfer for mucosal covering. It may be kept in mind for the repair of large septal defects.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":"e70297"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012655","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":"Vasopressor Use in Free Flap Reconstruction: A Multicenter Propensity-Matched Analysis of Outcomes","authors":"Diwakar Phuyal,&nbsp;Emanuella M. Brito,&nbsp;Malena Albright,&nbsp;Georgia Babb,&nbsp;Chinenye Ogbonnah,&nbsp;Harvey Chim","doi":"10.1002/micr.70287","DOIUrl":"10.1002/micr.70287","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The use of intraoperative vasopressors during microvascular free flap reconstruction remains controversial due to concerns regarding vasoconstriction and impaired flap perfusion. This study evaluates the association between vasopressor use and postoperative outcomes across a large, multicenter cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was performed using the TriNetX Collaborative Network. Adult patients undergoing free flap reconstruction were identified and stratified by intraoperative vasopressor exposure. Propensity score matching (1:1) was used to balance baseline characteristics. Outcomes within 90 days included flap-related complications, wound complications, reoperation, and mortality. Subgroup analyses were conducted by flap type and vasopressor agent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 43,157 patients were identified, with 17,970 matched pairs included. Overall vasopressor use was associated with increased risks of infection (RR 1.10, 95% CI 1.05–1.15; <i>p</i> &lt; 0.01) and wound dehiscence (RR 1.09, 95% CI 1.02–1.15; <i>p</i> = 0.01), and decreased rates of debridement (RR 0.84, 95% CI 0.78–0.90; <i>p</i> &lt; 0.01). Phenylephrine demonstrated the most consistent association with adverse wound outcomes, including infection (RR 1.17, 95% CI 1.10–1.24; <i>p</i> &lt; 0.01), dehiscence (RR 1.15, 95% CI 1.06–1.24; <i>p</i> &lt; 0.01), skin graft failure (RR 1.17, 95% CI 1.03–1.33; <i>p</i> = 0.02), and anastomotic revision (RR 1.29, 95% CI 1.02–1.65; <i>p</i> = 0.04). Breast reconstructions showed higher complication rates with vasopressor exposure, extremity reconstructions demonstrated minimal differences, and head and neck reconstructions showed increased infection, skin graft failure, and mortality. No consistent increase in flap failure or reoperation rates was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative vasopressor use is associated with modest increases in select postoperative complications, with variability by agent and flap type. Phenylephrine may carry higher risk, while other agents demonstrate more neutral effects. These findings support a selective, context-dependent approach to vasopressor use during free flap reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865714","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":"Radial Reconstruction With Fibular Free Flap Using CAD-CAM and Virtual Surgical Planning in Pediatric Pseudoarthrosis due to Neurofibromatosis Type 1: A Case Report and Literature Review","authors":"Alicia Dean,&nbsp;Manuel Román Torres,&nbsp;Concepción Centella Gutiérrez,&nbsp;Guillermo Rodríguez Martínez,&nbsp;Genoveva Molina Pérez,&nbsp;Francisco Alamillos Granados","doi":"10.1002/micr.70285","DOIUrl":"10.1002/micr.70285","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that causes skeletal dysplasia and congenital pseudoarthrosis of the forearm, which is very difficult to repair. The vascularized free fibular flap (FFF) is the standard treatment. CAD-CAM technologies and virtual surgical planning (VSP) offer greater precision and their full integration into primary pediatric reconstruction for NF1 is described. The objective of this case report is to present the simultaneous integration of all these tools in the primary reconstruction of a child with forearm pseudarthrosis due to NF1. We present the case of a 7-year-old boy with NF1 and radial pseudoarthrosis reconstructed using FFF, patient-specific CAD-CAM guides, and an interactive 3D VSP environment. A 3-cm defect was reconstructed using an FFF and a premolded LCP plate. Bone union was achieved at 7–8 months, with full range of motion in the wrist and nearly complete pronation-supination. No morbidity was reported in the donor site. This case reports the complete integration of FFF, CAD-CAM, and VSP in the primary reconstruction of a forearm pseudarthrosis in a child with NF1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>V Expert Opinion/Case Report.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830161","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":"Dedicated Robotic-Assisted Microsurgery Platforms in Plastic and Reconstructive Surgery: A Systematic Review","authors":"Simon M. Kratzer,&nbsp;Mehmet Ergisi,&nbsp;Laura Awad,&nbsp;Deepak M. Kalaskar,&nbsp;Peter Butler,&nbsp;Dariush Nikkhah","doi":"10.1002/micr.70286","DOIUrl":"10.1002/micr.70286","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dedicated robotic-assisted microsurgical systems (RAMS), including the Symani Surgical System and MUSA, were developed to overcome physiological tremor, surgeon fatigue, and restricted maneuverability in deep surgical fields. Existing reviews of robotic plastic surgery largely span heterogeneous applications beyond microsurgery or lack structured risk-of-bias appraisal specific to dedicated microsurgical platforms. This review systematically synthesizes clinical outcomes, learning-curve dynamics, and technological features of dedicated RAMS platforms in microsurgery, incorporating structured risk-of-bias appraisal to clarify the evidence base and inform clinical adoption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies published 2015–2025 were identified through PubMed, Embase, Scopus, and Web of Science (PROSPERO CRD420261320086). Following independent screening, 21 studies were included, assessing free flap survival, anastomotic patency, complications, operative times, and learning-curve metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Free flap reconstruction showed high survival (96%–100%); supermicrosurgical anastomosis patency was 96.6%–100%. Robotic anastomosis times fell 51%–66% with experience (largest reduction 66.1%, for deep-plane arterial anastomosis), though times remained longer than manual benchmarks even after the learning phase (e.g., 25.3 ± 12.3 vs. 14.1 ± 4.3 min for mixed procedures). Conversion/failure was infrequent (0%–4.3%). Motion scaling (up to 20×) and tremor filtration were consistent advantages; haptic feedback remained universally absent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Dedicated RAMS platforms are safe and effective for micro- and supermicrosurgical reconstruction, non-inferior to manual techniques. Initial time penalties resolve with experience. Future research should prioritize randomized controlled trials, standardized outcome measures, and cost-effectiveness analyses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840073","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":"Animal Models of Lymphaticovenous Anastomosis: A Systematic Review of Current Evidence and Future Directions in Translational Research","authors":"Juan I. Isaac,&nbsp;Prabh G. Singh,&nbsp;Christine U. Lee,&nbsp;James T. Paget,&nbsp;Vahe Fahradyan","doi":"10.1002/micr.70283","DOIUrl":"10.1002/micr.70283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lymphovenous bypass (LVB) or lymphaticovenous anastomosis (LVA) is increasingly applied, including experimental use for Alzheimer's disease via cervical lymphatic pathways. However, literature on long-term patency and failure mechanisms is scarce, and no gold standard exists for evaluating durability. Robust, reproducible LVA models are essential to advance translational research. This review maps current animal models and proposes strategies for improving reliability and mechanistic insight.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A PRISMA-guided search of PubMed, Scopus, and Google Scholar identified original animal studies reporting intra- or postoperative patency using functional or structural methods. Extracted data included species, anastomosis type, assessment tools, follow-up intervals, patency rates, and histology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 107 records screened, 11 met criteria: rats (<i>n</i> = 7), rabbits (<i>n</i> = 1), piglets (<i>n</i> = 1), and canines (<i>n</i> = 2). Techniques were mainly end-to-end (<i>n</i> = 9) and end-to-side (<i>n</i> = 2), targeting femoral, iliolumbar, popliteal, mesenteric, cervical, and thoracic-duct outflows. Intraoperative patency was uniformly high (≥ 90%). Postoperative patency was reported in six studies, ranging from 80% to 100% at ≤ 7 days (ICG lymphography) to 67% at 1 month (canines). Histology (three studies) distinguished patent sites (smooth endothelium) from failed ones (irregular endothelium, thrombus, fibrosis). Follow-up was categorized as short-term (0–7 days), mid-term (2–4 weeks), and long-term (≥ 1 month), but standardized long-term outcomes were absent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future models should integrate noninvasive imaging, serial long-term follow-up, and detailed histologic and molecular analysis to clarify success and failure mechanisms. Standardized methodologies will enhance translational relevance, refine surgical techniques, and inform therapies to improve LVA durability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830159","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":"Comparative Outcomes of Super Thin Anterolateral Thigh Flaps Versus Radial Forearm Free Flaps in Head and Neck Reconstruction","authors":"Kyung Jun Heo,&nbsp;Woo Yeol Baek,&nbsp;Won Jai Lee,&nbsp;Young Chul Suh","doi":"10.1002/micr.70278","DOIUrl":"10.1002/micr.70278","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The anterolateral thigh (ALT) flap is a versatile reconstructive option for head and neck defects but may be excessively bulky in contour-sensitive regions. Super thin ALT flaps (≤ 10 mm) have been introduced to improve pliability and contour; however, their comparative clinical advantages over established fasciocutaneous flaps remain unclear. This study aimed to evaluate the clinical outcomes of super thin ALT flaps and to compare them with radial forearm free flaps (RFFF) in head and neck reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted on patients who underwent head and neck reconstruction with super thin ALT flaps between 2021 and 2023 at a single tertiary center. A comparative cohort of patients reconstructed with RFFF during the same period was also included. Super thin ALT flaps were elevated within the superficial fascial layer with a target thickness of ≤ 10 mm. Outcomes assessed included complication rates, fistula formation, reoperation, flap failure, and operative time. Postoperative drain amylase levels were analyzed as a surrogate marker for salivary leakage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 28 patients in the super thin ALT group and 44 in the RFFF group were included in the analysis. All ALT flaps survived without partial necrosis. There were no statistically significant differences between the groups in total complication rate (7.1% vs. 11.3%, <i>p</i> = 0.692), fistula formation (3.5% vs. 6.8%, <i>p</i> = 1.000), reoperation (7.1% vs. 11.3%, <i>p</i> = 0.692), or operative time (145 ± 34 min vs. 159 ± 42 min, <i>p</i> = 0.125). No flap failure occurred in the super thin ALT group, whereas three cases (6.8%) were observed in the RFFF group. The super thin ALT group demonstrated lower postoperative amylase levels, although the difference was not statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Super thin ALT flaps provide clinical outcomes comparable to those of RFFF while offering enhanced pliability and improved conformity to complex defects. These characteristics make them a reliable and versatile alternative for head and neck reconstruction, particularly in contour-sensitive regions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813511","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":"Complex Posterior Chest Wall Reconstruction Using Bilateral Deep Inferior Epigastric Perforator Flaps After Failed Latissimus Dorsi Free Flap: A Case Report","authors":"Léa Dibiase,&nbsp;Laetitia Ruffenach,&nbsp;Pierre Emmanuel Falcoz,&nbsp;Yann-Philippe Charles,&nbsp;Pierre Kara,&nbsp;Frédéric Bodin","doi":"10.1002/micr.70284","DOIUrl":"https://doi.org/10.1002/micr.70284","url":null,"abstract":"<p>Radical resection of posterior chest wall sarcomas may result in extensive composite defects exposing lung parenchyma, prosthetic material, and spinal instrumentation, while simultaneously exhausting standard pedicled reconstructive options. Salvage reconstruction after free-flap failure in this setting remains particularly challenging and poorly described. We report the case of a 58-year-old patient who underwent en bloc resection of a large posterior chondrosarcoma involving ribs 6–11 and adjacent hemivertebrae, resulting in a massive full-thickness posterior thoracic defect reconstructed with PTFE mesh and spinal instrumentation. Initial soft-tissue coverage using a contralateral free latissimus dorsi and serratus anterior flap failed because of early arterial and venous thrombosis. Salvage reconstruction was subsequently performed using bilateral deep inferior epigastric perforator (DIEP) flaps supplied through a Y-configured saphenous vein graft anastomosed to the thoracodorsal system. The bilateral DIEP flaps provided sufficient surface area and pedicle length extension to achieve tension-free coverage of the near-total posterior hemithorax defect. The salvage procedure lasted 10 h in total. Both flaps survived completely without further vascular complications, allowing timely adjuvant radiotherapy. At one-year follow-up, the patient demonstrated durable soft-tissue coverage without reconstruction failure or local recurrence (Figure 3B,C). This case highlights bilateral DIEP flaps combined with Y-configured vein-graft extension as a feasible salvage strategy for extensive posterior chest wall defects when conventional latissimus-based reconstructive options are unavailable or have failed.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148784007","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 “Re-Evaluation of the Ideal Injury to Flap Time Frame for Lower Extremity Free Flap Reconstruction: Is 72 h Still the Gold Standard?”","authors":"Muhammed Said Aydin,&nbsp;Gökay Özler,&nbsp;Şükrü Kasap,&nbsp;Mustafa Nişancı,&nbsp;Onur Özvurmaz","doi":"10.1002/micr.70282","DOIUrl":"10.1002/micr.70282","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761891","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 Complications According to the Number of Venous Anastomoses in Lower Extremity Reconstruction","authors":"Buğra Mert Aytekin,&nbsp;Kerem Dokuzluoğlu,&nbsp;Dağhan Dağdelen,&nbsp;Ahmet Hamdi Sakarya,&nbsp;Bülent Saçak,&nbsp;Zeynep D. Akdeniz-Dogan","doi":"10.1002/micr.70281","DOIUrl":"https://doi.org/10.1002/micr.70281","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous congestion remains a leading cause of early free flap failure in lower extremity reconstruction. Although double venous anastomosis has been proposed to enhance venous outflow, its benefit over single venous anastomosis remains controversial. This study aimed to compare complication rates between single and double venous anastomoses in lower extremity free flap reconstruction across different etiologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted of 134 patients who underwent lower extremity soft tissue reconstruction with free flaps between 2015 and 2023. Patients were divided into single venous anastomosis (Group 1, <i>n</i> = 81) and double venous anastomosis (Group 2, <i>n</i> = 53) groups. Group 2 was further subdivided according to venous drainage configuration (double superficial, double deep, and dual-system). Demographics, comorbidities, flap characteristics, and complication rates were analyzed. Major complications included total flap loss and return to the operating room (OR); minor complications included wound-related problems not requiring additional flap coverage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 26 major complications and 9 total flap losses occurred. Group 1 demonstrated significantly higher overall, major, and minor complication rates compared with Group 2 (<i>p</i> &lt; 0.05). Total flap loss rates were comparable between groups. No significant differences were found among double venous anastomosis subgroups with respect to complication rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Double venous anastomosis in lower extremity free flap reconstruction is associated with a significant reduction in overall and perioperative complications, although total flap survival remains similar. These findings support consideration of dual venous outflow, particularly in high-risk lower extremity reconstructions, while emphasizing the importance of individualized recipient vein selection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148754008","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":"Radioulnar Synostosis Using a Vascularized Pedicled Radial Periosteal Flap for Supination Deformity in Residual Brachial Plexus Birth Injury","authors":"Francisco Soldado,&nbsp;Paula Díaz-Gallardo,&nbsp;Vivian Sinclair,&nbsp;Ismaray De Avila-Diaz,&nbsp;Sandra Villafranca-Solano,&nbsp;Jayme Bertelli","doi":"10.1002/micr.70280","DOIUrl":"10.1002/micr.70280","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Supination posture is a common secondary deformity in brachial plexus birth injury (BPBI) that results in functional upper limb impairment. Radioulnar synostosis using a vascularized ulnar periosteal flap has recently been reported, with dorsal forearm scarring as the main reported disadvantage. This report evaluates outcomes in a series of children with forearm supination deformity and complete pronation palsy secondary to severe BPBI undergoing radioulnar synostosis in slight pronation using a novel proximal pedicled vascularized radial periosteal flap (VRPF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We completed a retrospective analysis of patients with residual BPBI who underwent radioulnar synostosis with an antegrade proximally pedicled VRPF transfer to the volar ulna. The interosseous membrane was released when necessary, and the forearm was fixed in 10°<i>–</i>20° of pronation for 4 weeks, using a Kirschner wire. Inclusion criteria included complete pronation paralysis, presence of active wrist extension, and a minimum of 6 months follow-up. Demographic information, preoperative passive pronation, postoperative forearm rotational position, radiographic union, and parental satisfaction using a 4-point Likert-type ordinal scale were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-one children with a mean age of 59 months (range 24–132 months) were included in this report. Mean preoperative passive forearm pronation was −9° (range −60° to 45°) and mean follow-up was 17.1 months (range 9–32 months). A partially ossified radioulnar synostosis was radiographically observed at 4 weeks in all cases. Mean postoperative rotational position measured 20° of pronation (range 0°<i>–</i>30°). All parents expressed satisfaction with both functional and cosmetic outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Forearm fusion achieved by radioulnar synostosis using a proximally pedicled VRPF appears promising as an effective and rapid technique for correction of BPBI-associated supination deformity and should be further explored in the management of residual supination deformity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 6","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689711","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}