Microsurgery最新文献

{"title":"Long-Term Follow-Up of Single-Step Free Vascularized Lymph Node Transfer for the Management of Combined Genital and Lower Extremity Lymphedema: A Case Report","authors":"Ramu Janarthanan,&nbsp;Shravan Rai,&nbsp;G. Srilekha Reddy,&nbsp;Subramania Iyer","doi":"10.1002/micr.70007","DOIUrl":"10.1002/micr.70007","url":null,"abstract":"<div>\u0000 \u0000 <p>The occurrence of genital lymphedema with lower extremity involvement is rare. There is no standard approach in the management of combined genital and lower extremity lymphedema (CGLL). The limited literature available on the management of CGLL reveals the use of multiple procedures, including vascularized lymph node transfer (VLNT), lymphovenous anastomosis (LVA), and debulking. These approaches individually target the lower extremity or genital region. There is no single-step procedure for managing the CGLL, which involves two different anatomical regions. In this case report, we describe a single-step surgical approach for managing CGLL using a single free VLNT. A fifty-four-year-old male presented with CGLL due to filariasis, affecting the quality of life (QOL) predominantly due to genital involvement. He underwent supraclavicular lymph node transfer with an elliptical skin flap of size 5 × 3 cm, placed onto the inguinal region to target the primary lymphatic drainage of both genital and lower extremities. Venous congestion during the initial postoperative period was managed by anastomosing additional veins. The patient developed donor-site lymphorrhea, which was managed conservatively. At 5 years follow-up, the patient showed clinical improvement of both genital and lower extremity lymphedema with enhanced QOL. The functional status of the VLNT was confirmed by lower extremity lymphoscintigraphy with single-photon emission computed tomography (SPECT) and scrotal lymphangiogram with indocyanine green (ICG). This case report shows the placement of a single VLNT in the inguinal region as a useful single-step approach to improve functional outcomes in the management of CGLL.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837794","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":"Angle-Adjusted Transverse Thoracodorsal Artery Perforator Flap in Lower Extremity Reconstruction: A Case Series of 63 Patients","authors":"Jin-Woo Park,&nbsp;Bo Young Park","doi":"10.1002/micr.70001","DOIUrl":"10.1002/micr.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The thoracodorsal artery perforator (TDAP) flap is a viable option for reconstructing various soft tissue defects. Despite its numerous benefits, including reduced donor site morbidity, the TDAP flap has not gained popularity because of its anatomical variations and technical challenges. Herein, we aimed to introduce the application of the angle-adjusted transverse TDAP flap in lower extremity reconstruction and provide novel perspectives, with emphasis of outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed data from patients who underwent lower extremity reconstruction using a novel, modified transverse-TDAP flap at a single center between 2015 and 2019. This modification introduced a more transverse pattern with an innovative angle adjustment of approximately 30°–60°, specifically designed to optimize coverage and adaptability to various defects and aimed to prevent irritation at the posterior aspect of the scar, which could otherwise lead to pain during rehabilitation—addressing a common challenge in traditional TDAP flap designs. We conducted a comprehensive assessment of the TDAP flap, including patient characteristics, surgical details, long-term outcomes, functional evaluation of donor site using the American Shoulder and Elbow Surgeons (ASES) Score, and postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-three consecutive patients who underwent TDAP free flap reconstruction were included. Mean follow-up duration was 54.3 months; most common etiology was trauma (25 cases; 39.7%), followed by diabetes (16 cases; 28.6%). Twenty-six cases (41.3%) involved lesions in the foot, and 11 (17.5%) involved lesions in the distal tibia. Complications included total flap loss in five patients and donor site complications in one patient. As assessed using the ASES, the average functional score of the donor site was 97.8 points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The modified transverse-TDAP flap provides favorable outcomes with minimal donor site morbidity, making it a viable alternative in clinical practice. Its design ensures effective coverage with reduced complications, establishing it as a reliable choice for lower extremity reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on “the Heart-Lung Machine in Major Limb Replantation: Report of Two Cases”","authors":"Rocco De Vitis,&nbsp;Genitiempo Maurizio","doi":"10.1002/micr.70006","DOIUrl":"https://doi.org/10.1002/micr.70006","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762193","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":"Bilateral Pedicled Superior Gluteal Artery Perforator (SGAP) Flap for Double-Layer Closure and Reconstruction of Sacrococcygeal Defect After Chordoma Resection: A Case Report","authors":"Federica Martini,&nbsp;Matteo Meroni,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.70000","DOIUrl":"https://doi.org/10.1002/micr.70000","url":null,"abstract":"<div>\u0000 \u0000 <p>Chordomas are rare, slow-growing, locally aggressive malignant tumors arising from notochord remnants that commonly affect the sacrococcygeal area. Surgical resection with negative margins is crucial but often results in extended defects with exposed critical structures, necessitating complex reconstructions. The reconstruction techniques commonly employed and described in the literature often utilize musculocutaneous flaps, which are associated with higher donor site morbidity. Thus, the challenge remains to minimize donor site morbidity while ensuring effective reconstruction and long-term stability. This case report presents a novel technique for sacrococcygeal defect reconstruction after chordoma resection. This approach aims to help reconstructive surgeons to improve patient outcomes and broaden the range of available surgical strategies in this area while minimizing donor site morbidity. An 87-year-old male patient presented a sacrococcygeal chordoma measuring 51 × 41 × 58 mm, which caused the destruction of the coccygeal vertebrae and infiltrated the levator ani muscle. After a multi-disciplinary discussion, the patient underwent en-bloc tumor resection. The mass measured 11 × 8 cm and included the coccyx, the gluteus maximus insertion to the coccyx, and a portion of the levator ani muscle, leaving part of the rectum ampulla exposed. For the reconstruction, to create a strong barrier to minimize the risk of rectal herniation, obliterate the dead space, and cover the defect, we performed a bilateral advancement of the gluteus maximus and harvested two pedicled superior gluteal artery perforator (SGAP) flaps measuring 15 × 10 cm and centered on the perforator. The flaps were consequently tunneled below the gluteal skin, rotated 90°, and placed in the defect; one was de-epithelialized and buried into the defect, and the other was placed above it for surface coverage. The postoperative recovery was uneventful, and at a 1-year follow-up, the patient reported no motor dysfunction or problems during sitting, and no signs of rectal herniation were shown at the CT. The reconstruction with bilateral pedicled SGAP flaps arranged in a double-layer fashion could effectively address the key points of reconstruction of the sacrococcygeal area after chordoma resection, with several advantages since it causes minimal donor site morbidity and maintains the contour of the gluteal area with excellent functional outcomes. However, further studies are warranted to validate and refine this approach.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762352","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":"Iatrogenic Brachial Plexus Lower Trunk Posterior Division Injury During C7 Harvest for Contralateral Transfer in a Child With Hemiplegic Cerebral Palsy","authors":"Francisco Soldado,&nbsp;Diego Gonzalez-Morgado,&nbsp;Juliana Rojas-Neira","doi":"10.1002/micr.70005","DOIUrl":"https://doi.org/10.1002/micr.70005","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762232","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":"Induction of Acute T-Cell Mediated Rejection in Hand Allotransplant by COVID-19 Infection","authors":"Lee-Moay Lim,&nbsp;Yue-Chiu Su,&nbsp;Ho-Yin Huang,&nbsp;Hung-Tien Kuo,&nbsp;Po-Liang Lu,&nbsp;Yur-Ren Kuo","doi":"10.1002/micr.70002","DOIUrl":"https://doi.org/10.1002/micr.70002","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762353","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":"Evaluating Donor Morbidity in ALT and TDAP Flaps With Drainless Closure Compared to Conventional Drain Placement","authors":"Dianne Dong Un Lee,&nbsp;Kyeong-Tae Lee","doi":"10.1002/micr.70003","DOIUrl":"https://doi.org/10.1002/micr.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Recent trends in reconstructive surgery focus on rapid recovery, questioning the necessity of postoperative drains. Although harvesting perforator flaps causes minimal injury to anatomical structures at donor sites, attempts to omit drains have been limited. This study aimed to assess the safety of not using drains after harvesting the anterolateral thigh (ALT) perforators and the thoracodorsal artery perforator (TDAP) flaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All consecutive patients who underwent free ALT or TDAP flap-based reconstruction between 2020 and 2022 did not have drains placed at the donor site. Their donor morbidities were evaluated, and compared with those who underwent the same operation between 2016 and 2019 with donor drains placed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The drainless cohort consisting of 202 cases (159 ALT and 43 TDAP flaps) and the control cohort comprising 119 (52 ALT and 67 TDAP flaps) were analyzed. In ALT flap cases, the drainless cohort, apart from a larger flap dimension, exhibited comparable baseline characteristics to the control. The rates of overall donor complications were comparable between the two cohorts (10.1% vs. 11.5%, <i>p</i> = 0.795), as were rates for specific complications including wound dehiscence (<i>p</i> = 0.751) and seroma (<i>p</i> = 0.999). Multivariable analysis revealed no significant association between omitting drains and increased donor complications. Consistent results were obtained in the analysis for cases using TDAP flaps, with no significant difference between drainless and drain-using groups (<i>p</i> = 0.297).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Omitting drains in the donor site of ALT and TDAP flaps might be safe, not escalading the risks of donor morbidity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762169","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":"Anatomical Landmarks of the Facial Artery and Vein for Intraoral Anastomosis: A Cadaveric Study","authors":"Kengo Nakatsuka,&nbsp;Tomoyuki Yano,&nbsp;Takuya Omotehara,&nbsp;Shinichi Kawata,&nbsp;Masahiro Itoh","doi":"10.1002/micr.70004","DOIUrl":"https://doi.org/10.1002/micr.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intraoral anastomosis is a widely used technique for microvascular alveolar ridge augmentation and midface reconstruction. However, the predictable anatomical positioning of facial structures, such as the vessels, parotid duct, and facial nerve in the buccal region, has remained unclear. Therefore, we aimed to obtain the anatomical characteristics of these locations to establish surgical landmarks for the intraoral anastomosis of facial vessels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 26 sides from 13 formaldehyde-fixed cadavers approximately a month after fixation with a mean age at death of 86.6 ± 11.2 years (range: 55–104 years) were anatomically examined. Facial vessels, nerves, and the parotid duct were dissected intraorally. From the oral cavity side, the X-axis was defined as the line from the labial commissure to the lowest point of the intertragic notch.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the oral cavity side, all branches of the facial nerve were found under the facial artery and vein. The positioning order along the X-axis was the facial artery, vein, and parotid duct exit. The facial artery was 21.3 ± 2.2 mm and the facial vein was 39.2 ± 2.7 mm from the labial commissure. Ninety-two percent of facial veins were found within 15–20 mm of the facial artery on the X-axis. The parotid duct exit was 46.8 ± 2.0 mm from the labial commissure. In the buccal region, the vessel calibers of the facial artery and vein were 1.8 ± 0.2 and 2.1 ± 0.2 mm, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Knowledge of the anatomical relations among the facial artery, vein, parotid duct, and facial nerve from the oral cavity side can enhance the safety and efficacy of midface reconstruction surgeries involving intraoral anastomosis procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749359","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":"Effects of Preoperative Hemoglobin on Microsurgical Reconstruction and Perioperative Blood Transfusion Requirement: A Meta-Analysis and Systematic Review of the Literature","authors":"Artur Manasyan,&nbsp;Eloise W. Stanton,&nbsp;Idean Roohani,&nbsp;Elizabeth Boudiab,&nbsp;Emma Koesters,&nbsp;David A. Daar","doi":"10.1002/micr.31261","DOIUrl":"10.1002/micr.31261","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Purpose&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Although blood loss in microsurgical reconstruction is rarely large enough to be life-threatening, preoperative anemia can be a particular issue in terms of postoperative morbidity, impaired wound healing, and compromised tissue viability. We seek to review the effect of preoperative hemoglobin (Hgb) levels on perioperative blood transfusion (PBT) requirements and complications to guide management of patients with preexisting anemia undergoing reconstruction.&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;PubMed, Embase, and Scopus were queried for relevant articles. Inclusion criteria were as follows: original studies investigating outcomes and PBT requirements in flap-based reconstruction based on preoperative Hgb levels. Patient and study characteristics were analyzed using descriptive statistics. A meta-analysis was conducted to assess transfusion requirements across the included studies using Stata (version 18.0 Stata Corp, College Station, Texas, USA). The Fisher method was used to aggregate individual study &lt;i&gt;p&lt;/i&gt; values into a single combined value to statistically assess the combined findings, where a &lt;i&gt;p&lt;/i&gt; value of &lt; 0.05 was set as statistically significant.&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;One thousand three hundred and eighty-nine studies were screened for title and abstract relevance, 14 of which met the inclusion criteria, including a total of 61,116 patients. Meta-analysis of the studies revealed a PBT requirement of 36.2% for anemic individuals, significantly higher than the 20.0% for those with normal preoperative Hgb levels (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), with an average 4.9 versus 2.4 units of packed red blood cells being transfused (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The majority of studies concluded that preoperative anemia was associated with medical complications, such as myocardial infarction, stroke, and infection (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). While six studies reported a significant relationship between low preoperative Hgb and flap morbidity (flap loss and partial flap necrosis), two studies found no correlation. The overall postoperative complication rate across the studies was 42.2% among patients with low preoperative Hgb levels, whereas the nonanemic group demonstrated a markedly lower rate of 13.9% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001).&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;The existing evidence is strongly suggestive of increased PBT requirement in patients with anemia, highlighting the necessity for preoperative optimization of Hgb levels and intraoperative monitoring. While preliminary evidence demonstrates a relationship between anemia and medical complications, more rese","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647508","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":"Pain Remission Following Delayed Targeted Muscle Reinnervation in Amputees","authors":"Floris V. Raasveld,&nbsp;Maximilian Mayrhofer-Schmid,&nbsp;Benjamin R. Johnston,&nbsp;Charles D. Hwang,&nbsp;Ian L. Valerio,&nbsp;Kyle R. Eberlin","doi":"10.1002/micr.31258","DOIUrl":"10.1002/micr.31258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Targeted muscle reinnervation (TMR) has demonstrated efficacy for treatment of neuropathic pain. This study aims to identify patients for whom delayed TMR may be most effective and to identify associated factors for favorable pain outcomes in this patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An analysis was conducted on prospectively enrolled amputee patients who underwent delayed TMR at a tertiary care center from 2017 to 2024. Data on demographics, comorbidities, surgical details, and pain outcomes were collected. Patient reported pain severity on a 0–10 scale was prospectively collected. The main pain outcome was pain remission (achieving the minimally clinically important difference (MCID)). Additionally, sustained mild pain (pain score ≤ 3/10 for ≥ 3 months), and pain disappearance (pain score 0/10 for ≥ 3 months) were assessed. Multivariable regression analyses identified factors influencing pain outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 101 patients included in this study, 64 patients (63.4%) achieved pain remission within a two-year post-operative period, and 37 patients (36.6%) did not. Sustained mild pain, which could be achieved in addition to pain remission, was achieved by 45.8% of patients, with 17.8% of these achieving complete pain disappearance. Patients achieving pain remission demonstrated lower pain over the entire post-operative trajectory (<i>p</i> &lt; 0.001). Lower pre-operative pain scores, absence of depression, no pre-operative opioid use, lower Elixhauser Comorbidity Index, and distal amputation levels were correlated with favorable outcomes following delayed TMR (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Pre-operative pain severity, psychiatric comorbidities, and opioid use significantly influenced pain outcomes, emphasizing the need for comprehensive patient assessment. These findings will help with patient stratification and pre-operative counseling to support patients who are best suitable for delayed TMR surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639120","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}