Microsurgery最新文献

{"title":"Outcomes of Parascapular Free Flap in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis","authors":"Agustin N. Posso,&nbsp;Audrey Mustoe,&nbsp;Maria J. Escobar-Domingo,&nbsp;Charlotte Thomas,&nbsp;Jade E. Smith,&nbsp;Jose Foppiani,&nbsp;Dorien I. Schonebaum,&nbsp;Noelle Garbaccio,&nbsp;Samuel J. Lin,&nbsp;Bernard T. Lee","doi":"10.1002/micr.70099","DOIUrl":"https://doi.org/10.1002/micr.70099","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The parascapular free flap (PFF), primarily harvested as a fasciocutaneous flap, is perfused by the parascapular branch of the circumflex scapular artery. Its anatomy enables modification and combination with other flaps. However, its use in reconstructive microsurgery has not been comprehensively characterized. This systematic review and meta-analysis aim to assess the key features and outcomes of the PFF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study protocol followed the PRISMA guidelines. Multiple online databases were used to identify articles published through 2024. Studies including patients who underwent PFF procedures were eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome (failure rate), secondary outcomes (other complications), and additional information. An analysis of pooled data was performed to evaluate rates of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-four articles were included in this review. A total of 647 patients and 664 PFFs were identified; among these, 57.38% were harvested solely as PFFs, while 42.62% involved combinations with other free flaps. The predominant recipient site was the head and neck, accounting for 72.52% of cases. The leading indications were malignancy (28.64%), post-burn scarring (17.35%), and trauma (13.26%). Meta-analysis of the primary outcome revealed no heterogeneity across the studies (<i>I</i>² = 0.00%; <i>Q</i> statistic 17.50, <i>p</i> = 0.56), with a pooled failure rate of 0.99% (95% CI: 0%–2.63%). Other complication rates included partial necrosis (2.09%, 95% CI: 0%–5.45%), hematoma (5.18%, 95% CI: 1.34%–10.63%), wound dehiscence (5.98%, 95% CI: 0.38%–15.47%), infection (0.86%, 95% CI: 0.00%–3.97%), and venous thrombosis (1.57%, 95% CI: 0.00%–4.95%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The PFF is a versatile and reliable option in reconstructive microsurgery, offering low failure rates and minimal complications. Its applicability across various anatomical regions and indications makes it an invaluable option for microsurgeons.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695817","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 Bilateral Paranasal Skin and Soft Tissue Defects Using a Free Bilobed Thoracoacromial Artery Perforator Flap Following Multiple Cutaneous Squamous Cell Carcinomas Resection: A Case Report and Literature Review","authors":"Shu-qing Huang,&nbsp;Xin Zhou,&nbsp;Tong-chun Mao,&nbsp;Rong-shuai Yan,&nbsp;Xiang Li,&nbsp;Zhi-bin Yang,&nbsp;Ze-yuan Lei","doi":"10.1002/micr.70094","DOIUrl":"https://doi.org/10.1002/micr.70094","url":null,"abstract":"<div>\u0000 \u0000 <p>In recent years, the thoracoacromial artery perforator (TAAP) flap has emerged as a promising option for the reconstruction of facial defects, typically utilized in the form of a pedicled flap. However, there remains relatively limited experience in using a free TAAP to repair facial defects. This case describes the first application of a free bilobed TAAP for one-stage reconstruction of multiple facial defects after resecting cutaneous squamous cell carcinomas (cSCC). The patient was a 76-year-old man who noticed progressive enlargement of two black neoplasms around the left and right nose for over 1 year and 3 months, respectively. A preoperative biopsy confirmed both lesions as cSCC. During surgery, two skin and soft tissue defects, measuring approximately 6.5 cm × 3.0 cm and 3.5 cm × 2.0 cm, were left in the bilateral paranasal regions after the removal of tumors. A free bilobed TAAP flap of the appropriate size was designed and harvested to repair these defects. The postoperative course was uneventful, and the patient recovered without complications. Good esthetic and functional outcomes were achieved during a 14-month follow-up period. This report suggests that a free bilobed TAAP flap may be an option for reconstructing multiple facial defects caused by trauma, tumor resection, or other lesions.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695818","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":"Tactile Sensory Recovery in Neurotized Versus Non-Neurotized Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis","authors":"Alejandra Aristizábal,&nbsp;Harrison Herrera,&nbsp;Joseph M. Escandón,&nbsp;Pedro Ciudad,&nbsp;Gabriel del Corral,&nbsp;Rahim Nazerali,&nbsp;Andres Mascaro,&nbsp;Oscar J. Manrique","doi":"10.1002/micr.70096","DOIUrl":"https://doi.org/10.1002/micr.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non-neurotized outcomes are still controversial due to methodological heterogeneity. This review uses consistent and objective outcomes to evaluate the current evidence's qualitative characteristics and quantitative tactile sensory recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a systematic electronic literature search from database inception through 10 February 2024, of the following databases: PubMed, Ovid MEDLINE, Embase, SCOPUS, and CINAHL to identify all studies reporting outcomes of tactile sensory recovery using the Semmes-Weinstein Measuring scale in free-flap ABR comparing neurotization versus non-neurotization. The SWM scale score, demographic characteristics, and surgical features were extracted from each study. Due to the data heterogeneity within the studies, we transformed the data into means and pooled the qualitative information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 264 articles. After thorough screening, 12 fulfilled the inclusion criteria and were included in the qualitative synthesis. Finally, 7 were quantitatively analyzed with a total of 251 breasts that underwent ABR with free flap neurotization and 244 breasts without neurotization. This revealed a mean SWM score difference of −0.67 and a significant <i>p</i>-value &lt; 0.05. A subgroup DIEP flap analysis performed for 177 neurotized compared to 175 non-eurotized flaps yielded a significant mean difference of −0.86 <i>p</i> &lt; 0.05. There were no significant differences between groups in age (48.8 vs. 49.8, <i>p</i> = 0.5), history of chemotherapy (72 vs. 74, <i>p</i> = 0.91), radiotherapy (61 vs. 56, <i>p</i> = 0.84), or follow-up time (21.85 vs. 25.09 months, <i>p</i> = &lt; 0.05) that could have influenced tactile sensory recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neurotization in free-flap ABR could allow better tactile sensory recovery than the spontaneous sensation gained without it. The additional surgical time required for coaptation is short, and no studies have reported associated complications, making it a safe procedure that can potentially improve patients´ quality of life. Nonetheless, higher-quality studies, such as randomized control trials with standardized sensation testing and more rigorous methodologies, are needed before making final clinical recommendations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657681","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":"Impact of Vasopressors on Microvascular Free Flap Perfusion in Head and Neck Reconstruction","authors":"Mark Ooms,&nbsp;Philipp Winnand,&nbsp;Marius Heitzer,&nbsp;Nils Vohl,&nbsp;Marie Katz,&nbsp;Johannes Bickenbach,&nbsp;Frank Hölzle,&nbsp;Ali Modabber","doi":"10.1002/micr.70095","DOIUrl":"https://doi.org/10.1002/micr.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The use of vasopressors in microvascular head and neck reconstruction is still controversial in view of its potentially negative influence on microvascular flap perfusion, which is crucial for flap viability and commonly used as a parameter in flap monitoring. The aim of this study was to investigate the influence of vasopressors on microvascular free flap perfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Perfusion measurement data recorded intraoperatively and postoperatively using the Oxygen-2-see (O2C) analysis system in 274 patients undergoing microvascular head and neck reconstruction with fasciocutaneous free flaps (FFFs) or perforator free flaps (PFFs) between 2011 and 2020 were analyzed retrospectively. Vasopressor dose and perfusion parameters, such as flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation, as well as flap flow conductance (calculated as the ratio of flap blood flow and mean arterial blood pressure), were tested for associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Intraoperative hemoglobin oxygen saturation and postoperative flap blood flow were negatively associated with vasopressor dose in PFFs (<i>r</i> = −0.307, <i>p</i> &lt; 0.001; <i>r</i> = −0.211, <i>p</i> = 0.012, respectively). Both associations remained in multivariable analysis (<i>p</i> = 0.002; <i>p</i> = 0.022, respectively). Postoperative flap flow conductance was negatively associated with vasopressor dose in PFFs (<i>r</i> = −0.232, <i>p</i> = 0.008). This association remained in multivariable analysis (<i>p</i> = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The use of vasopressors influences microvascular free flap perfusion in PFFs in terms of intraoperative hemoglobin oxygen saturation, postoperative flap blood flow, and postoperative flap flow conductance. This suggests that the use of vasopressors in PFFs may be an adjustable variable for controlling flap perfusion and should be considered a confounding variable during flap monitoring based on flap perfusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615461","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":"Lower Extremity Nerve Decompression to Treat Complex Regional Pain Syndrome: A Case Report in Pediatric Age Group","authors":"Mark A. Poisler,&nbsp;A. Lee Dellon,&nbsp;Eric H. Williams","doi":"10.1002/micr.70091","DOIUrl":"https://doi.org/10.1002/micr.70091","url":null,"abstract":"<div>\u0000 \u0000 <p>While much has been written about the persistence and symptoms of Complex Regional Pain syndrome, the role of peripheral nerve surgery as a treatment remains overlooked, especially in the lower extremity of the pediatric population. The purpose of this report is to describe the application of lower extremity peripheral nerve decompression to address specific injuries and entrapments, to provide meaningful relief and functional recovery in a pediatric patient with CRPS. A 14-year-old male presented with severe CRPS after several traumatic events involving the left lower extremity. After seeing 11 different physicians, failing physical therapy, and dropping out of high school, the patient was referred to a Peripheral Nerve Surgeon. On physical examination, multiple peripheral nerve entrapments were identified. The surgical approach included neurolysis of the tibial nerve at the soleal sling, a release of the four medial ankle tunnels, a neurolysis of the common peroneal nerve and lateral sural nerve at the fibular head, and a decompression of the saphenous nerve at the medial knee with the goal of treating multiple previously unrecognized peripheral nerve entrapments that had developed from the time of his injuries to his first consultation. At 1 year post-op, the patient reported full use of the extremity, a decrease in pain from 8 to 1. He had returned to physical activities and work, graduated from high school, and returned to the sport of fencing. He was off opiates. This report gives insight into how pain relief and functional restoration of lower extremity CRPS of a pediatric patient may be achieved by the same peripheral nerve approach to CRPS as in an adult patient.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582233","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":"Forearm Synostosis Using A Vascularized Pedicled Ulnar Periosteal Graft for Supination Deformity in Brachial Plexus Birth Injury","authors":"Francisco Soldado,&nbsp;Paula Díaz-Gallardo,&nbsp;Juliana Rojas-Neira,&nbsp;Ismaray De Avila-Diaz,&nbsp;Dashiell Cañizares-Betancourt,&nbsp;Sandra Villafranca-Solano","doi":"10.1002/micr.70088","DOIUrl":"https://doi.org/10.1002/micr.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Forearm supination posture is a common secondary deformity in brachial plexus birth injury (BPBI), leading to functional impairment of the upper limb, as pronation is required for most activities of daily living. The purpose of this report is to analyze a series of children with forearm supination deformity secondary to severe BPBI and complete pronation palsy, who were treated with forearm fusion in slight pronation through the creation of a radioulnar synostosis using a novel distal pedicled vascularized ulnar periosteal flap (VUPF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analysis. Inclusion criteria included complete pronation paralysis with active wrist extension present 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 (1-very unsatisfied, 2-unsatisfied, 3-satisfied, and 4-extremely satisfied) were analyzed. A retrograde distally pedicled vascularized ulnar periosteal flap covering approximately one third of the ulnar length and based on the posterior interosseous vessels—was transferred to the dorsal aspect of the radius and fixed for 4 weeks using Kirschner wires.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty children with a mean age of 53.6 months (range 20 to 115 months) and a mean passive forearm pronation of 9° (range 60° to 60°) with a mean follow-up of 13.7 months (range 8 to 18 months) were included in this report. All except one had complete residual BPBI. A partially ossified radioulnar synostosis was radiographically observed at 4 weeks in all cases. Mean immediate postoperative and final follow-up rotational values were similar, measuring 15° of pronation (range 0° to 30°). All parents reported extreme satisfaction with both functional and cosmetic outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Forearm fusion in slight pronation by creating a radioulnar synostosis using a distal pedicled vascularized ulnar periosteal flap is an effective and fast technique to correct supination deformity and might be considered among other reported strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573495","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":"Arterializing the Venous System in a SCIP Flap—Insights Into Tissue Perfusion Biomechanics: A Case Report","authors":"Edward A. Stanley,&nbsp;Vlad Illie","doi":"10.1002/micr.70090","DOIUrl":"https://doi.org/10.1002/micr.70090","url":null,"abstract":"<div>\u0000 \u0000 <p>This case report presents a novel observation on tissue perfusion biomechanics achieved through arterializing the deep venous system in a superficial circumflex iliac artery perforator (SCIP) flap. An 89-year-old male with a cutaneous squamous cell carcinoma overlying the mandible underwent SCIP flap reconstruction. The flap was 5 mm thick and measured 8 cm × 7 cm. Due to pedicle damage, the venae comitantes served as the inflow system, anastomosed to a facial artery branch, while the superficial circumflex iliac vein served as the outflow system. The flap initially showed venous congestion but resolved without intervention, healing with an acceptable color match and contour over a six-month follow-up. This novel technique suggests that venous systems can be repurposed to support tissue perfusion effectively, offering new insights into tissue perfusion biomechanics. The broader implications of this approach include expanding our understanding of tissue perfusion mechanisms, which could lead to broader applications in reconstructive surgery. Ultimately, this method may enable the use of donor sites that do not rely on intrinsic arterial systems, potentially increasing the versatility of flap reconstruction techniques.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573496","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":"Unconventional Combination of Thigh Flaps for Large Knee Defect Reconstruction After Sarcoma Resection: A Case Report","authors":"Matteo Meroni,&nbsp;Federica Martini,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.70089","DOIUrl":"https://doi.org/10.1002/micr.70089","url":null,"abstract":"<div>\u0000 \u0000 <p>Reconstructing large knee defects after sarcoma resection poses a significant surgical challenge, particularly when vascular anatomy variations or intraoperative vessel damage limit conventional reconstructive options. Achieving stable, tension-free coverage while preserving mobility is essential for optimal functional outcomes. We report the case of a 45-year-old male patient who underwent radical resection of a distal thigh myxofibrosarcoma, resulting in a large defect (24 × 18 cm) over the anterior knee region. A distally based anterolateral thigh (ALT) flap with two skin paddles was initially planned in order to achieve a “kissing” flap inset. However, intraoperative findings revealed that the distal part of the descending branch of the lateral circumflex femoral artery (DB-LCFA) had been compromised, necessitating modifications to the reconstruction strategy. The distal ALT skin paddle was utilized as a pedicled propeller flap, while the proximal ALT skin paddle, which had a separate vascular supply, was harvested as a free flap and anastomosed to a distal perforator from the DB-LCFA in a perforator-to-perforator fashion. Despite this approach, a significant residual defect remained. To achieve complete coverage, we performed an additional free flap using a vertical posterior medial thigh (vPMT) flap from the contralateral thigh, anastomosed to perforator vessels from the genicular artery. This case highlights the necessity of intraoperative adaptability when managing large oncologic defects, especially in the presence of vascular compromise. The combination of pedicled and free flaps, including an unconventional ALT flap configuration and a secondary vPMT flap, provided a stable, functional, and esthetically satisfactory outcome. Strategic integration of perforator-based techniques and intraoperative imaging optimized flap viability, demonstrating a reliable approach for complex lower limb reconstructions.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Efficacy and Morbidity of Heparin Infusion in Salvaging Autologous Breast Reconstruction Free Flaps”","authors":"Saraswati Sah,&nbsp;Renu Sah","doi":"10.1002/micr.70087","DOIUrl":"https://doi.org/10.1002/micr.70087","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537197","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":"Assessment of Aesthetic Outcomes in Autologous Breast Reconstruction Using Profunda Femoris Artery Perforator Flap","authors":"Chika Gon,&nbsp;Ryo Karakawa,&nbsp;Hidehiko Yoshimatsu,&nbsp;Yuma Fuse,&nbsp;Rei Ogawa,&nbsp;Tomoyuki Yano","doi":"10.1002/micr.70085","DOIUrl":"https://doi.org/10.1002/micr.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While autologous breast reconstruction using the profunda femoris artery perforator (PAP) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate the reconstructed breast using the PAP flap quantitatively and to clarify which factors contribute to the aesthetically favorable results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We identified 127 patients who underwent breast reconstructions using the vertically designed PAP flap for unilateral breast cancer between April 2018 and December 2021. The PAP flap was elevated vertically to avoid disrupting lymphatic pathways and was inserted between the pectoralis major muscle and the subcutaneous fat after the anastomoses. We classified cases into two groups: the “Favorable cosmesis group” and the “Unfavorable cosmesis group” based on aesthetic evaluations using the vectra three-dimensional (3D) imaging system. Patient characteristics and outcomes between two groups were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 127 patients, 15 were excluded: three with stacked PAP flaps, two with flap necrosis, and 10 with missing aesthetic outcome data. Among the remaining 112 patients, 18 were classified in the “Favorable cosmesis group” and 94 in the “Unfavorable cosmesis group.” Comparative analysis revealed that the “Favorable cosmesis group” showed significantly higher ratio with small volume in the upper pole of the unaffected side (21% vs. 72%, <i>p</i> &lt; 0.01) and had a smaller final inset flap weight (147 vs. 190 g, <i>p</i> = 0.028) compared to the “Unfavorable cosmesis group.” All 112 patients were evaluated using vectra 3D system at 12 months postoperatively, and their postoperative flap courses were uneventful.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In our study, inherent small volume of the upper pole and smaller flap inset weight contribute to more favorable outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367323","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}