Microsurgery最新文献

{"title":"Comments on “the Effect of Venous Augmentation on Complication Rates in Deep Inferior Epigastric Perforator Breast Reconstruction”","authors":"Chiara Camilloni, Beniamino Brunetti, Dario Melita, Paolo Persichetti, Mario Cherubino, 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}

{"title":"Enhancing Breast Reshaping in Massive Weight Loss Patients: The Post-Bariatric DIEP Approach","authors":"Isidoro Musmarra,&nbsp;Giuseppe A. G. Lombardo,&nbsp;Federico Barbera,&nbsp;Monica Vappiani,&nbsp;David Ragonez,&nbsp;Paola Aguilar,&nbsp;Corentin Taveau,&nbsp;Julien Quilichini","doi":"10.1002/micr.70042","DOIUrl":"https://doi.org/10.1002/micr.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Massive weight loss (MWL) patients often experience breast sequelae characterized by difficult-to-treat emptying and ptosis due to altered skin quality. Silicone prosthesis use is associated with a high rate of ptosis recurrence. The use of DIEP flap allows simultaneous treatment of breast and abdominal deformities. This study aims to present our experience using the DIEP-free flap as an autologous breast prosthesis for volumetric breast augmentation in the postbariatric population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study involved all postbariatric patients who underwent breast reshaping using a double DIEP-free flap. Patient demographics, operative details, and postoperative outcomes were evaluated. Patients filled out BREAST-Q and BODY-Q surveys both preoperatively and after 6 months to study the rate of satisfaction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients underwent breast reshaping with double DIEP-free flap between September 2020 and October 2023. The average age was 30 years, with an average weight loss of 52.2 kg. Sleeve gastrectomy was the most common bariatric surgery procedure (75%). The average duration of surgeries was 461.38 min. The average length of stay was 6.5 days.</p>\u0000 \u0000 <p>Two flaps required surgical revision, with one flap loss. Two complications have been registered for the donor site, one liponecrosis with wound dehiscence and one abdominal bulging. Statistically significant improvements were observed in satisfaction with breast appearance and psychological, physical, and sexual well-being.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the postbariatric population, the DIEP flap represents a safe and reproducible surgical technique for addressing breast deformities. Autologous volumetric augmentation offers harmonious and stable long-term outcomes without secondary sequelae at the donor site.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530429","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 Comparative Study of Platysmal Myoneurectomy With Variations of Selective Neurectomies in Post-Facial Palsy Synkinesis","authors":"Maria Paranhos Barbot,&nbsp;Catriona Neville,&nbsp;Tamsin Gwynn,&nbsp;Karen Young,&nbsp;Crystal Selley-West,&nbsp;Raman Malhotra,&nbsp;Charles Nduka,&nbsp;Ruben Yap Kannan","doi":"10.1002/micr.70040","DOIUrl":"https://doi.org/10.1002/micr.70040","url":null,"abstract":"<p>Synkinesis is a distressing sequela of facial palsy. The main treatment for this condition has been Botulinum toxin injections. However, more recently, selective neurolysis/neurectomies have shown promise, with some variations in practice evolving over time. A clinical review of practice was performed on sixty-eight patients (<i>n</i> = 68) with Bell's palsy over five years (2018–2023) who underwent synkinesis surgery, following facial palsy. Comparisons were made between platysmal myoneurectomy only (Group I), platysmal myoneurectomy and zygomaticus major/levator labii superior direct neurotization (Group II), platysmal myoneurectomy and depressor anguli oris (DAO) selective neurectomy (Group III) and platysmal myoneurectomy + DAO and buccinator selective neurectomies (Group IV). The following outcome measures were used: Sunnybrook Facial Grading Scale (FGS), Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Statistical analyses were performed using the student's <i>t</i>-test and ANOVA. There was an overall improvement for patients pre- and post-operatively (42.34 ± 16.37 vs. 65.12 ± 14.34; Student's <i>t</i>-test, <i>p</i> &lt; 0.0001). All FGS scores showed statistically significant (<i>p</i> &lt; 0.05) improvement. FDI-physical, SAQ, and FaCE showed statistically significant improvements, apart from the FDI-social (<i>p</i> = 0.08). Qualitatively, all procedures showed significant improvement compared with their pre-op state, with Group IV showing the best results among platysmal myoneurectomy variants in terms of repose, volitional movements, and synkinesis reduction compared with its contemporaries.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497070","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":"Vascularized Deep Femoral Periosteal Flap: Anatomical Study and Clinical Application in Congenital Pseudarthrosis of the Tibia in Two Cases","authors":"Antonio Carlos da Costa,&nbsp;Pablo Romero-Larrauri,&nbsp;Juliana Rojas-Neira,&nbsp;Diego Gonzalez-Morgado,&nbsp;Amr Fouad,&nbsp;Cristina Alves,&nbsp;Francisco Soldado","doi":"10.1002/micr.70043","DOIUrl":"https://doi.org/10.1002/micr.70043","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vascularized periosteal transplants have proven to be highly effective and rapid in promoting bone healing in biologically complex nonunions in children, with several reported donor sites. This study aimed to assess the feasibility of harvesting a vascularized diaphyseal femoral periosteal flap (VDFPF) from cadavers and evaluate its clinical application in two cases of bilateral congenital pseudarthrosis of the tibia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study investigated the periosteal branches of the deep femoral vessels (DFV) supplying the femoral diaphysis in 19 previously latex-injected cadavers. The femur was divided into four segments. The distance from the midpoint of the inguinal ligament to the origin of the DFV and the number of periosteal branches were recorded. The vascularized diaphyseal femoral periosteal flap (VDFPF) was used to treat one side in two patients with bilateral congenital pseudarthrosis of the tibia (aged 14 and 2 years).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The DFV's origin was located at a mean of 4.2 cm (range 2.8–8.5 cm) distal to the midpoint of the inguinal ligament. In 15 cases, the DFV coursed adjacent to the second and third quarters of the femoral shaft, providing a mean number of 5 (range 4–8) periosteal branches, allowing for the harvesting of a new pure vascularized periosteal flap. Healing of congenital pseudarthrosis of the tibia occurred within 3 months in both patients, with no donor or recipient site complications at the final follow-up of 13 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The VDFPF may be an effective periosteal transplant and a viable alternative to other large free periosteal transplants used in children for treating complex non-unions, especially when tibial and fibular donors are not available. Bone union was fast compared to other techniques used to treat these challenging cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475560","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":"Conventional High-Frequency Ultrasound for Preoperative Planning of Superficial Circumflex Iliac Artery Perforator (SCIP) Pure Skin Perforator (PSP) Flaps","authors":"Paloma Malagón,&nbsp;Reiko Tsukuura,&nbsp;Nana Yamamoto,&nbsp;Takumi Yamamoto","doi":"10.1002/micr.70041","DOIUrl":"https://doi.org/10.1002/micr.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pure skin perforator (PSP) flaps had shown their reliability and usefulness for the reconstruction of thin soft-tissue defects. However, accurate localization of PSP is required for safe and fast flap elevation. This study aimed to evaluate the usefulness of conventional high-frequency ultrasound (US) for PSP flap elevation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent reconstruction using PSP flap based on the superficial branch of the superficial circumflex iliac artery (SCIA) were retrospectively included and divided into two groups according to the use of preoperative US mapping of SCIA PSPs; a portable US device with an 18 MHz probe was used to localize the PSP in a US group, whereas US was not used in a control group. Intraoperative findings and postoperative results were compared between the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-seven patients were included: 12 in the US group and 15 in the control group. There were no statistically significant differences in patient characteristics and postoperative results between the groups; both groups showed flap survival without major complications in all cases. Flap thickness ranged from 1.0 to 2.5 mm (average, 1.87 mm). Time for flap harvest was significantly shorter in the US group than in the control group (18.9 ± 4.5 vs. 50.5 ± 20.8 min, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative mapping of PSP using high-frequency US allowed reducing the surgical time for harvesting PSP flaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143475561","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":"Indocyanine Green Fluorescence Angiography as a Predictor of Distal Flap Necrosis in Latissimus Dorsi Free Flaps","authors":"Oliver Didzun,&nbsp;Benjamin Thomas,&nbsp;Adriana C. Panayi,&nbsp;Sonja Broichhausen,&nbsp;Sophie Osenegg,&nbsp;Florian Falkner,&nbsp;Gabriel Hundeshagen,&nbsp;Samuel Knoedler,&nbsp;Leonard Knoedler,&nbsp;Felix Vollbach,&nbsp;Ulrich Kneser,&nbsp;Emre Gazyakan,&nbsp;Amir K. Bigdeli","doi":"10.1002/micr.70019","DOIUrl":"https://doi.org/10.1002/micr.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vascularization of the distal latissimus dorsi (LD) muscle flap determines the success of the procedure, particularly in large defects. Failure due to distal flap necrosis can necessitate reoperation and increase mortality. Indocyanine green fluorescence angiography (ICGFA), as a modality that allows for intraoperative imaging of <i>fasciocutaneous</i> flap perfusion, has revolutionized free flap surgery. Evidence of use in muscle flap perfusion assessment is lacking. We investigate the efficacy of ICGFA in predicting distal flap necrosis in large LD free flaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We prospectively recorded all cases of large LD free flap reconstruction (surface area &gt; 250 cm²) at our institution (01/2018–12/2022). Patients were grouped according to the intraoperative perfusion assessment: ICGFA or clinical judgment. The primary outcome was distal flap necrosis &gt; 5% of the total flap. Secondary outcomes included reoperation and total operation time. Multivariable analyses were applied to identify independent risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 107 patients with mean age of 57 ± 18 years and BMI of 29 ± 6 kg/m² were included. Thirty-six patients (34%) underwent ICGFA. ICGFA was associated with a significant reduction in distal flap necrosis (18.3% vs. 2.8%, OR: −0.15, 95% CI: −0.29 to −0.02; <i>p</i> = 0.03) and reoperation (40.8% vs. 19.4%, OR: −0.21, CI: −0.41 to −0.02; <i>p</i> = 0.03), with no prolongation of the operation time (158 ± 63 vs. 191 ± 91 min, <i>p</i> = 0.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ICGFA is associated with increased success of large LD free flap reconstruction, allowing a more accurate and reliable assessment of perfusion. This highlights the immense potential of ICGFA as a clinical standard, surpassing its application solely in fasciocutaneous free flap surgery and, showcasing its efficacy in free muscle flap procedures.</p>\u0000 \u0000 <p><b>Registration:</b> This study has been registered at https://www.researchregistry.com (identification number: researchregistry9496).</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431326","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":"Functional Reconstruction of a Huge Lateral Thoraco-Abdominal Defect With Combined Innervated Pedicled Latissimus Dorsi Flap and Vastus Lateralis Free Functional Muscle Transfer: A Case Report","authors":"Beniamino Brunetti,&nbsp;Marco Morelli Coppola,&nbsp;Fiorella Oliveri,&nbsp;Valeria Petrucci,&nbsp;Omar Al-Hilli,&nbsp;Sergio Valeri,&nbsp;Rossana Alloni,&nbsp;Irene Giovanna Aprile,&nbsp;Stefania Tenna,&nbsp;Paolo Persichetti","doi":"10.1002/micr.70038","DOIUrl":"https://doi.org/10.1002/micr.70038","url":null,"abstract":"<p>Full thickness thoraco-abdominal defects are traditionally challenging to reconstruct, exposing the patient to a significant risk of wound complications and functional impairment. The authors present an extremely challenging and unique case where a huge lateral thoraco-abdominal defect was reconstructed with a combination of innervated flaps allowing to completely restore contour and function of the operated region. A 77-year-old male patient presented with a leiomyosarcoma arising in the right lateral thoraco-abdominal region. Full-thickness resection involved the anterior part of the latissimus dorsi (LD) and serratus anterior muscles along with IX to XII ribs, a cuff of diaphragm muscle and the entire lateral abdominal wall, creating a 30 × 25 cm defect with exposure of right lung, liver, and ascending and transverse colon. After the placement of a synthetic mesh, a 28 × 16 cm pedicled innervated LD flap was advanced in V-Y fashion to cover the thoracic part of the defect. Then the patient was turned supine and a vastus lateralis free functional muscle transfer (FFMT) from the contralateral thigh was used to reconstruct the abdominal part of the defect. The recipient vessels were provided transposing the ipsilateral deep inferior epigastric pedicle according to the extra-anatomical pedicle rerouting technique. Motor branch for the VL was coapted to a sizeable intercostal nerve. The muscle was covered with split-thickness skin grafts. Both flaps healed uneventfully, allowing to obtain a complete restoration of form and function with M5 score according to the MRC Scale for muscle strength 8 months after surgery. Functional reconstruction of the lateral abdominal wall with FFMT has never been reported. Our successful case shows the importance of functional reconstruction of lateral thoraco-abdominal defects to prevent abdominal weakness or herniation, trunk instability, postural deficiencies and core strength loss.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438878","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":"Early Feeding After Free Flap Reconstruction for Oral Cavity Cancer: A Single Institution Retrospective Review","authors":"Joshua Barlow,&nbsp;Christine Little,&nbsp;Susmita Chennareddy,&nbsp;Rocco Ferrandino,&nbsp;Catharine Kappauf,&nbsp;Tamar Kotz,&nbsp;Michael Berger,&nbsp;Diana N. Kirke,&nbsp;Marita S. Teng,&nbsp;Eric M. Genden,&nbsp;Mohemmed N. Khan,&nbsp;Scott A. Roof","doi":"10.1002/micr.70035","DOIUrl":"https://doi.org/10.1002/micr.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Patients undergoing free flap reconstruction of the oral cavity have traditionally received nothing by mouth for 6–14 days postoperatively to limit the risk of wound complications. Growing evidence suggests that initiation of oral intake may not increase the morbidity. This study further investigates the utility of “early feeding.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study conducted at a large, urban tertiary healthcare system. Patients who underwent free flap reconstruction for oral cavity cancer between June 1, 2020, and October 31, 2022, were grouped as early feeding (oral intake on or before Postoperative Day 5) or late feeding (LF) (oral intake after Postoperative Day 5). Outcomes included rate of orocutaneous fistula, development of other local or systemic complications, and hospital length of stay (LOS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty six patients were studied, with 26 belonging to the LF group and 40 to the early feeding (EF) group. The LF group was significantly older (median age 64.5 vs. 80 years, <i>p</i> = 0.027) and more likely to have a defect extending beyond the oral cavity (25.0% vs. 50.0%, <i>p</i> = 0.037). No significant differences were found in orocutaneous fistula formation between the LF and EF groups (7.7% vs. 0%, <i>p</i> = 0.152), but the rate of total complications was significantly higher in the LF group (38.5% vs. 12.5%, <i>p</i> = 0.014). LOS was significantly longer in the LF group (12.5 vs. 6 days, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that in the correctly suggested patient population, early postoperative oral intake may facilitate earlier hospital discharge without increasing the risk of postoperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423617","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":"Coherences of Cesarean Sectioning Scars and Other Abdominal Scars and Venous Augmentation Using SIEV in Free DIEP Flaps for Breast Reconstruction","authors":"Ines E. Tinhofer,&nbsp;Tzong-Yun Tsai,&nbsp;David Chon-Fok Cheong,&nbsp;Tzu-En Lin,&nbsp;Wen-Ling Kuo,&nbsp;Jung-Ju Huang","doi":"10.1002/micr.70039","DOIUrl":"https://doi.org/10.1002/micr.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With a global trend towards cesarean deliveries and abdominal surgeries for gastrointestinal disease treatment, more and more candidates for breast reconstruction using free deep inferior epigastric artery (DIEP) flap presented with abdominal scars. The purpose of the study was to investigate the risk of scar-related perfusion complications in DIEP flaps in patients with different abdominal scars.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted in patients receiving DIEP flaps for breast reconstruction between October 2008 and April 2022. Demographics and the existing abdominal scars were collected. Acute and late complications were reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>273 breasts in 267 patients were included. Abdominal scars presented in 96 (36.0%) patients, including transverse cesarean sectioning in 69, midline scars in eight, laparoscopic scars in 23, appendectomy scars in five, abdominal total hysterectomy in one, and umbilicus scar in one patient. They did not increase the conversion rate from DIEP to ms-TRAM flap. The flap sizes were significantly bigger in the scar (SG) than in the control group (CG) (flap length SG: 29.8 ± 3.0 cm, CG: 28.9 ± 3.0 cm, <i>p</i> = 0.021 and flap width SG: 11.9 ± 1.1 cm, CG: 11.6 ± 0.9 cm, <i>p</i> = 0.002, respectively). However, the flap used percentage was similar (SG: 72.9% ± 13.1% and CG: 75.7% ± 12.2%, respectively, <i>p</i> = 0.086). The SIEV could be identified bilaterally significantly more often in the CG than in the SG (SG: 80.2% and CG: 91.8%, <i>p</i> = 0.006). The availability of SIEV was significantly less when a transverse scar was present. The need for venous superdrainage with SIEV was not statistically different in both groups (SG: 8.3% and CG: 12.3%, <i>p</i> = 0.320). The overall re-exploration rate was 6.2%. Acute re-explorations (SG: 5.1% vs. CG: 6.9%) or late revisions for aesthetics (SG: 17.7% vs. CG: 21.8%) were equally distributed. Flap-related complications like partial necrosis or fat necrosis showed similar rates, regardless of SIEV use for superdrainage (<i>p</i> = 0.287). Lastly, acute donor site complications, especially poor wound healing, occurred similarly in both groups (<i>p</i> = 0.234).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pre-existing abdominal scars do not compromise DIEP flap transfer, nor increase the incidence of late fat necrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423974","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}