Microsurgery最新文献

{"title":"Vascularized Periosteal Grafts for Bone Union in Children: A Systematic Review","authors":"Francisco Soldado,&nbsp;Diego Gonzalez-Morgado,&nbsp;Pablo Romero-Larrauri,&nbsp;Trong-Quynh Nguyen,&nbsp;Antonio Carlos da Costa,&nbsp;Jorge Knorr","doi":"10.1002/micr.70021","DOIUrl":"10.1002/micr.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The periosteum is the main organ responsible for bone regeneration. Vascularized Periosteal Grafts (VPG) have demonstrated exceptional efficacy and speed in facilitating bone union among children with challenging bone healing conditions. Despite their promising results, the overall impact of these interventions has yet to be comprehensively evaluated through systematic review. This systematic review aimed to provide comprehensive insights into bone union outcomes and complications related to the use of VPG in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to September 2023 and screened for relevant studies. Data were collected regarding patient demographics, disease, treatment, anatomical location, graft used, donor and receptor vessels, skin paddle monitoring, follow-up duration, time to union, consolidation, and complications. The correlation between age and bone union was assessed using Pearson and Spearman correlation coefficients, as appropriate. Study quality was assessed using the Methodological Index for Non-randomized Studies Criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 15 studies involving 135 patients were included. All the studies were classified as Level 4 evidence. The mean MINORS score was 5.1 ± 1. The aim of the VPG was nonunion treatment in 90 patients (67%), nonunion prevention in 35 patients (26%), and bone union acceleration in 10 patients (7%). The origin of the bone union problem was traumatic in 59 cases (44%), congenital pseudoarthrosis of the tibia or fibula in 48 patients (35%), oncologic in 23 patients (17%), and infectious in 5 patients (4%). Nine different sources of periosteal flaps were used to enhance bone union. Bone union rate was 96% with a mean time of 4.2 months (range 1–18 months). Spearman test showed a non-statistically significant negative correlation between age and bone union time (<i>r</i> = −0.3, <i>p</i> = 0.759).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VPGs are a safe and reliable treatment for promoting bone union, especially in the context of complex pediatric bone-healing challenges.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984229","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 to Median Sensory Nerve Transfers to Restore Sensate Key Pinch: A Cadaveric Assessment of Size Match and Implications for Transfer","authors":"Christine V. Schaeffer,&nbsp;Ambika Menon,&nbsp;Spencer Chambers,&nbsp;Alexander Graf,&nbsp;Nina Suh,&nbsp;Paul Ghareeb","doi":"10.1002/micr.70017","DOIUrl":"10.1002/micr.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Loss of key-pinch sensation after median nerve injury poses significant functional detriment. Nerve transfers are utilized to improve function after nerve injury and size matching of donor and recipient nerves is important to optimize success. This anthropometric study investigates the anatomy of the superficial branch of the radial nerve (SBRN) to the thumb and index finger and explores radial to median sensory nerve transfers, a necessary but not heavily discussed facet of nerve transfers for the hand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Anatomic dissection of SBRN in 15 cadaver hands was performed to assess variability in diameter and branching patterns based on nerve location. Dissection of the index radial and thumb ulnar digital nerves was performed to assess diameter based on location and calculate ideal size match for nerve transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All specimen thumbs had 2 SBRN branches at the level of the metacarpal shaft and proximal phalanx; 87% had 2 index SBRN branches extending to the proximal phalanx. Index radial and ulnar SBRN branches were similar in diameter at all levels (<i>p</i> &gt; 0.0167). There was a significant size mismatch between the individual SBRN branches and index digital at all measured levels (<i>p</i> &lt; 0.0167). The thumb radial SBRN was significantly larger than ulnar SBRN (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimal size match for transfer involved transection of radial index SBRN 1 cm distal to the MCP joint and ulnar thumb SBRN 1 cm distal to the MCP joint. Consideration should be made for transfer of both index SBRN branches at the level of the MCP joint to improve size match. Corresponding digital nerves were transected 1 cm proximal to the level of SBRN harvest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971624","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":"Effective Management Strategies for Primary Lymphedema of the Lower Extremities: Integrating Conservative and Surgical Therapies in Early and Late Stages","authors":"Yasser Farid,&nbsp;Mirco Pozzi,&nbsp;Alberto Bolletta,&nbsp;Emanuele Cigna,&nbsp;Luigi Losco,&nbsp;Vanessa Marron Mendes,&nbsp;Giuseppe Diluiso,&nbsp;Thierry Cleve,&nbsp;Michela Schettino,&nbsp;Hung-Chi Chen","doi":"10.1002/micr.70014","DOIUrl":"10.1002/micr.70014","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Lymphedema, a debilitating characterized by localized fluid retention and tissue swelling, results from abnormalities in the lymphatic system. In the case of primary lymphedema, this condition is attributed to malformations in lymphatic vessels or nodes, and it is marked by a relentless progression leading to irreversible tissue fibrosis after repetitive inflammation. Many questions regarding its treatment, such as the choice of the type of intervention and the timing, still remain unanswered. This study aims to present our comprehensive approach to treat this challenging condition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To elucidate our approach, we conducted a retrospective chart review of 42 patients treated for primary lymphedema at 3 hospitals between July 2010 and December 2022. The study included two patient groups, those with early-stage disease (20) and those in the advanced stages (22). We outline our algorithm, based on our clinical experience in Taiwan. Patients were followed for at least 12 months post-treatment, and assessments were made, including photographic evidence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A total of 42 patients participated in our study: 20 in the early stage and 22 in the late stage. Our approach yielded significant functional improvements and symptom regression in both groups. In the early-stage cohort, all 20 patients underwent VLNT procedures and SAL, with 15 (75%) undergoing unilateral procedures and 5 (25%) bilateral. Among the advanced-stage patients, 12 (54.5%) were treated with the modified Charles' procedure, and 10 (45.5%) with RRPP.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;The outcomes showed an average circumference reduction of 4.1 cm (2.9–5.3) after VLNT and liposuction. Reductions were noted at various levels: 5.7 cm (4.6–6.8) at mid-thigh, 4.3 cm (2.5–6.1) at mid-calf, 3.5 cm (2.7–4.3) at the ankle, and 1.4 cm (0.7–2.1) at mid-foot. Tonicity decreased by 5.9% (5.2–6.6), indicating significant tissue softening. Tissue removal averaged 3.7 kg (2.9–4.5) after the modified Charles' procedure and 2.6 kg (2.3–2.9) after RRPP.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;Patients experienced a mean of 3 (2–4) episodes of cellulitis per year, with no cellulitis in early-stage treated limbs during the follow-up period. Complications were minimal, including 4 partial skin graft losses that healed with conservative treatment and 3 postoperative infections after the modified Charles' procedure, treated successfully with antibiotics. No major complications were reported at the lymph node flap donor site.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Primar","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951497","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 Functional Muscle Transfer in Brachial Plexus Injury Patients With Subclavian Artery Injury Using Arteriovenous Loop Grafts","authors":"Roongsak Limthongthang,&nbsp;Saichol Wongtrakul,&nbsp;Panai Laohaprasitiporn,&nbsp;Yuwarat Monteerarat,&nbsp;Torpon Vathana","doi":"10.1002/micr.70020","DOIUrl":"10.1002/micr.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free functional muscle transfer (FFMT) for brachial plexus injury (BPI) requires adequate donor arterial flow for successful anastomosis. However, concomitant BPI and subclavian artery injury are not uncommon. Arteriovenous (AV) loop graft is one of the methods used to extend vessels to areas with vascular depletion. This case series aims to report the feasibility and outcomes of AV loop grafts for FFMT in BPI patients with subclavian artery injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>This longitudinal descriptive report included adult patients with BPI and concomitant subclavian artery injury. Patients with adequate intra-operative thoracoacromial and/or thoracodorsal arterial flow, sufficient for FFMT without the need for an AV loop graft, were excluded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 10 initially enrolled patients, three were excluded: two for adequate intra-operative arterial flow, and one for extensive adhesions around the external jugular vein, precluding the index surgery. Seven patients, with a median age of 37 years, mostly male and injured in motorcycle accidents, were included. Four patients underwent a single-stage operation (AV loop graft and FFMT simultaneously), while three patients underwent a two-stage operation. Success rates were 100% for the single-stage operation and 33% for the two-stage operation. The two-stage operation led to increased operative time, extended hospital stays, and anastomosis mismatch challenges. Successful cases regained gracilis muscle motor power for elbow flexion, achieving grade III-IV within 13–29 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>FFMT with AV loop graft for BPI patients with subclavian artery injury is feasible and effective. Despite complex microsurgical requirements, these procedures significantly restore limb functionality when standard FFMT operations are insufficient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ClinicalTrials.gov identifier: NCT06437990</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11707729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951499","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":"First Palmar Intermetacarpal Flap for Congenital First Web Contracture: A Case Series","authors":"Diego Gonzalez-Morgado,&nbsp;Vivian Sinclair,&nbsp;Xiao F. Shen,&nbsp;Javier Buendía-Pérez,&nbsp;Juliana Rojas-Neira,&nbsp;Francisco Soldado","doi":"10.1002/micr.70022","DOIUrl":"10.1002/micr.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pediatric first web space contractures of the hand can lead to disability in hand function. Several techniques have been proposed for treating this condition. Recently, a new technique involving the first palmar cutaneous flap was described in a cadaveric study. This report aimed to elucidate the clinical outcomes of the first palmar intermetacarpal flap in patients with congenital first web space contractures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Case series of patients with moderate-to-severe first web contracture underwent surgery with the first palmar intermetacarpal flap. The variables included age, sex, diagnosis, preoperative and postoperative first intermetacarpal angle (IMCA), associated surgical procedures, postoperative complications, and follow-up time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten patients with a median age of 4 years and 8 months (range: 1 year and 5 months–16 years and 6 months) underwent surgery on a total of 12 hands. The median follow-up was 25 months (range: 12–49 months). IMCA increased in all patients following surgery, from a preoperative median of 20° (range: 0°–20°) to a postoperative median 40° (range: 30°–40°). Associated surgical procedures were performed in eight cases. Five simple complications occurred, including four cases of full-thickness skin graft pigmentation and one case of distal flap tip dehiscence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The first palmar intermetacarpal flap is an effective option in the surgical management of moderate-to-severe first web contractures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142951498","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":"Reconstruction of Abdominal Defects After Open Abdomen Treatment Using Propeller Flaps of the Superior and Deep Inferior Epigastric Artery System: Report of Two Cases","authors":"Martin C. Lam,&nbsp;Andreas Henkel,&nbsp;Lisa Greber,&nbsp;Martin W. von Websky,&nbsp;Jörg C. Kalff,&nbsp;Klaus J. Walgenbach","doi":"10.1002/micr.70016","DOIUrl":"10.1002/micr.70016","url":null,"abstract":"<p>Open abdomen treatment (OAT) is associated with significant morbidity and mortality. In cases where primary or delayed fascial closure cannot be achieved, vacuum-assisted wound closure and mesh-mediated fascial traction are indicated, which often result in a planned ventral hernia. If secondary skin closure is not feasible, common treatment of granulated abdominal defects involves split-thickness skin-grafting or healing by secondary intention leading to significant scarring and sometimes mutilating defects. Late enteroatmospheric fistulae may develop as a result of instable scar tissue or insufficient soft tissue coverage. Perforator propeller flaps have been described for reconstruction of soft tissue defects of the abdomen; however, not for OAT-induced abdominal defects. We report two complex cases of OAT-induced abdominal wall defects of 20 × 8 and 22 × 10 cm, which were reconstructed with a propeller flap based on the superior epigastric artery perforator in the first case and the deep inferior epigastric artery perforator in the second case. The flaps were rotated into each of the abdominal defects following the propeller flap concept with primary closure of the donor sites and successful reconstruction of both defects. At 1-year follow-up, both patients developed asymptomatic incisional ventral hernias. Secondary-stage abdominal wall reconstruction was not considered due to satisfaction with the reconstructive result and feared complications. Pedicled perforator flaps designed based on either the superior or deep inferior epigastric artery system are useful reconstructive options for midline abdominal defects without necessity for pedicle lengthening, microsurgical anastomosis, or another donor site beyond the abdomen. In conclusion, soft tissue coverage of OAT-induced abdominal defects in critically ill patients can be achieved with the presented propeller flaps avoiding poor results of skin grafting or secondary intention healing.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927570","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":"Real-Time Subcutaneous Arterial Navigation for Thinning of an Anterolateral Thigh Flap Using Photoacoustic Imaging and Projection Mapping: A Case Report","authors":"Itaru Tsuge,&nbsp;Susumu Saito,&nbsp;Maria Chiara Munisso,&nbsp;Tomoko Kosaka,&nbsp;Ayako Takaya,&nbsp;Chang Liu,&nbsp;Goshiro Yamamoto,&nbsp;Naoki Morimoto","doi":"10.1002/micr.70013","DOIUrl":"10.1002/micr.70013","url":null,"abstract":"<p>Thinning of anterolateral thigh flap is challenging. Anatomical studies have shown variations in arterial branching patterns in the subcutaneous layer, which were suspected to be the reason for the high frequency of thinning failures. We attempted to visualize subcutaneous arterial courses preoperatively and perform thinning of perforator flaps using this information appropriately. We accumulated evidence on the accuracy of noninvasive vascular visualization using photoacoustic tomography (PAT). In the present case, we applied a medical imaging projection system (MIPS), which enabled real-time surgical navigation using indocyanine green (ICG) emission signals, to use photoacoustic information intraoperatively during the flap thinning procedure. A 69-year-old woman underwent half-tongue resection using the pull-through method for right-sided tongue cancer. Preoperative PAT was performed 5 days before surgery. The 12 × 6-cm area took ~8 min to scan. We used an ICG test card containing ICG-positive control material cut into strips to show tentative artery lines by projection mapping. The transparent vascular map was laminated and sterilized. MIPS captured ICG fluorescence signals that penetrated the anterolateral thigh flap and continuously projected the purple area on the reverse side of the flap, guiding the position of the tentative arteries. A 20 × 6.5-cm anterolateral thigh flap was elevated with the distal part of the reconstructed tongue and proximal de-epithelialized part to fill the pull-thorough tunnel in the submandibular region. Active bleeding was observed when cutting marginal fat tissue near the purple line of the distal ALT flap projected by MIPS. The study protocol did not include a highly invasive trial for MIPS-guided thinning; therefore, we removed minimal marginal fat tissue. The ALT flap showed no postoperative complications while maintaining conversation and swallowing functions. We present the concept of subcutaneous arterial real-time navigation surgery using PAT and MIPS for safe, easy, and fast flap thinning procedures in the future.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927551","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":"Technical Pearls for Breast Reconstruction in Low BMI Asian Women With the Profunda Artery Perforator Flap","authors":"Allen Wei-Jiat Wong,&nbsp;David Chon-Fok Cheong,&nbsp;Wen-Ling Kuo,&nbsp;Chia-Fang Chen,&nbsp;Jung-Ju Huang","doi":"10.1002/micr.70009","DOIUrl":"10.1002/micr.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The deep inferior epigastric perforator (DIEP) flap is currently the gold standard for autologous breast reconstruction. In cases where the DIEP is contraindicated, the profunda artery perforator (PAP) flap is now the preferred second-line option in our institution. The PAP flap poses unique challenges to the reconstructive surgeon, especially in Asian women with low body mass index (BMI). Herein, we share the unique technical pearls when performing breast reconstruction in this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort studies, where data were collected on all consecutive patients who underwent breast reconstruction by the senior author, from June 2015 to February 2023. Only patients who underwent the PAP free flap reconstructions were included in this study. The PAP flap design was based on the transverse pattern in the upper medial third of the thigh. The flap is inset in the transverse fashion in the mastectomy pocket, utilizing either the internal mammary pedicle, lateral thoracic pedicle, or the thoracodorsal pedicle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 32 free PAP flaps were performed for 31 Asian patients. The average age was 39.5 years old (range 25–60), and the average BMI was 21.3 (range 18.5–27.4). An average of 5.0 of myocutaneous perforators (range 1–7) can be identified in each donor site. The average flap was 7.8 cm wide (range 6–10), 21.3 cm long (range 15–30), weighing 259.6 g (range 145–555), with an average of 1.3 perforators (range 1–3) and a pedicle length 5.9 cm (range 4–10). The critical steps to a successful reconstruction with the PAP flap lie with the appropriate patient selection, pre-operative imaging, flap design, inset, and donor site management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>East Asian women tend to have lower BMI and smaller breasts and are good candidates for the PAP flap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927571","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":"Facial Lymphedema Following Head and Neck Tumor Resection: Preliminary Experience of Supermicrosurgical Treatment With LVA—Report of Three Cases","authors":"Juste Kaciulyte,&nbsp;Giorgio Giacomini,&nbsp;Leonardo Garutti,&nbsp;Davide Spadoni,&nbsp;Jonathan Velazquez-Mujica,&nbsp;Federico Lo Torto,&nbsp;Pedro Ciudad,&nbsp;Chad Chang,&nbsp;Marco Marcasciano,&nbsp;Hung Chi Chen","doi":"10.1002/micr.70012","DOIUrl":"10.1002/micr.70012","url":null,"abstract":"<div>\u0000 \u0000 <p>Facial lymphedema (FL) is a potential complication following head-and-neck tumor (HNT) therapy. Conservative management is often difficult, and there is limited literature on surgical treatments for FL. This report presents three cases of FL treated with lymphaticovenular anastomosis (LVA). All three patients were male with ISL stage 2 FL following treatment for oral squamous cell carcinoma, aged 59, 45, and 55 years. In each case, double end-to-end LVAs were performed in the preauricular region (right side in cases 1 and 3, left side in case 2). Follow-up was 12 months for cases 1 and 2 and 9 months in case 3, with no post-operative complications. Case 1 showed a 4% reduction in two of three anthropometric parameters, case 2 demonstrated an 8% reduction in all the parameters along with quality-of-life improvement, and case 3 had a 6% reduction in all parameters with improvement in both pinch test and quality-of-life. LVA supermicrosurgery appears to be an effective treatment for FL, improving quality of life with minimal complications and no need for further surgical interventions.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927545","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 “Partial Second-Toe Pulp Free Flap for Fingertip Reconstruction: Experience and Surgical Tips to Minimize Complications”","authors":"Deok Hyeon Ryu","doi":"10.1002/micr.70011","DOIUrl":"10.1002/micr.70011","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910042","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}