Microsurgery最新文献

{"title":"Portable-Type Laser Doppler Flowmetry Monitoring for Free Tissue Transfers: Factors That Affects Free Flap Blood Flow.","authors":"Shuchi Azuma, Aya Onodera, Nobuyuki Mitsuhashi, Takayuki Honda, Minoru Sakuraba","doi":"10.1002/micr.70268","DOIUrl":"10.1002/micr.70268","url":null,"abstract":"<p><strong>Backgroud: </strong>Laser Doppler flowmetry (LDF) is an established tool for monitoring free flaps, yet traditional devices are often bulky and difficult to interpret the value. We utilized portable LDF (pLDF), which is lightweight and allows for easier mobilization compared to conventional LDF systems. This study aimed to identify systemic factors affecting pLDF values to enable more objective clinical interpretation.</p><p><strong>Methods: </strong>We retrospectively reviewed 65 free flaps in 64 patients over a 3-year period. All flaps were monitored using pLDF. A mixed-effects model was employed to explore factors influencing pLDF values.</p><p><strong>Results: </strong>Two flaps (2.9%) developed vascular compromise, one of which was successfully salvaged after emergency reoperation. Statistical analysis revealed that pLDF values were significantly influenced by mean blood pressure (mBP) and hemoglobin concentration (Hb). Specifically, every 1 mmHg increase in mBP resulted in a 0.098 mL/min increase in the pLDF value (p < 0.001), and every 1 g/dL decrease in Hb resulted in a -0.883 mL/min increase in the pLDF value (p < 0.001). Other factors, including age, sex, recipient site, and history of smoking or hypertension, diabetes, demonstrated no significant differences.</p><p><strong>Conclusions: </strong>This study defined the quantitative relationship between systemic parameters and flap blood flow; specifically, 1 g/dL change in Hb is equivalent to 9 mmHg change in mBP in its effect on pLDF values. These findings provide a novel, objective formula for interpreting LDF data, allowing clinicians to distinguish systemic physiological changes from local vascular complications without relying solely on subjective experience.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70268"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437134","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":"Computed Tomography Angiography-Based Mapping of Septocutaneous Fibular Artery Perforators: An Anatomical Analysis.","authors":"Jannik Ketschau, Jonathan Mohr, Yannik Leonhardt, Alex Grabenhorst, Hannes Singer, Helena Kram, Nils Krautkremer, Sina Heimüller, Katharina Pippich, Herbert Stimmer, Klaus-Dietrich Wolff, Lucas M Ritschl","doi":"10.1002/micr.70266","DOIUrl":"10.1002/micr.70266","url":null,"abstract":"<p><strong>Background: </strong>Reliable localization of septocutaneous fibular artery perforators is essential for fibula free flap planning. However, the influence of lower-leg vascular anatomy on perforator number and spatial distribution remains unclear. This study aimed to analyze perforator number and spatial distribution using computed tomography angiography (CTA) with both fibula- and artery-based reference systems.</p><p><strong>Methods: </strong>In this retrospective study, patients undergoing lower-extremity CTA before mandibular continuity resection were screened. Parameters included run-off status, Kim classification, vascular anomalies, atherosclerotic plaque, and morphometric characteristics of the fibula and fibular artery. Perforator number per limb and relative perforator position were assessed using fibula- and artery-based reference systems. Associations were evaluated using nonparametric tests and multivariable regression models.</p><p><strong>Results: </strong>A total of 491 limbs from 247 patients were included, yielding 812 septocutaneous perforators. Limbs with fibular artery stenosis showed fewer perforators compared with limbs without stenosis (median 0.5 [0-2] vs. 2 [1-2], p < 0.001). Perforator distribution was nonuniform in both reference systems, with clustering in mid-segments (p < 0.001). Notably, spatial distribution patterns differed depending on the reference system used. In multivariable analyses, non-1A Kim run-off classification was associated with a more proximal perforator position along the fibula (β = -10.0 percentage points, p < 0.001), whereas no limb-level factor was associated with artery-referenced perforator position, indicating greater stability of artery-based mapping.</p><p><strong>Conclusion: </strong>Septocutaneous fibular artery perforators show reference-dependent spatial variability. Fibular artery stenosis is associated with fewer perforators, whereas only Kim run-off classification affects fibula-referenced location. These findings support artery-based mapping for fibula flap planning.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70266"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13370060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448036","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":"Outcomes From Radial Fascicular Nerve Transfers Including Extensor Carpi Radialis Longus to Triceps for Elbow Extension.","authors":"Nayan Bhindi, Scott Ferris","doi":"10.1002/micr.70272","DOIUrl":"10.1002/micr.70272","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of elbow extension is an important aim after brachial plexus injury. In extended partial brachial plexus injuries affecting elbow extension, a variety of nerve transfer techniques have been described to neurotize triceps. Spinal accessory, ulnar fascicles, axillary branches, intercostal and phrenic nerves have all been reported. These donors have mostly been transferred to triceps brachii nerves; however, more proximal transfers have also been reported. Results with these techniques have been inconsistent. In extensive partial brachial plexus palsy, radial fascicular transfers, primarily aiming for the extensor carpi radialis longus (ECRL) fibers as donors, warranted further investigation for their efficacy in the restoration of elbow extension.</p><p><strong>Patients and methods: </strong>Single-surgeon case series of four consecutive patients (mean age: 32 years, range 22-46 years) over a 5-year period with traumatic brachial plexus palsies, including complete triceps weakness, underwent radial fascicular transfers incorporating ECRL donor fibers direct to triceps nerves. All had previously undergone nerve transfers for restoration of elbow flexion and shoulder function. Expendable radial fascicles (primary to ECRL with possible inclusion of other extensors including ECRB) were coapted to motor branches of triceps (medial or lateral head) using standard microsurgical techniques. All patients were followed clinically (mean: 19 months) and assessed for elbow extension strength (Medical Research Council grade), range of motion and any donor-site deficits.</p><p><strong>Results: </strong>All patients regained functional elbow extension. Mean follow-up was 19 months (range 10-24 months). At final follow-up, elbow extension strength was MRC ≥ 4/5 in all cases (three patients achieved MRC grade 4/5, one achieved MRC grade 5/5). Elbow active range of motion reached was excellent. There were no wrist or finger extensor weakness/donor site deficits or postoperative surgical complications.</p><p><strong>Conclusion: </strong>Radial fascicular transfers using ECRL donor fibers direct to triceps nerves represent a safe and effective surgical technique for the restoration of elbow extension. As demonstrated in these 4 consecutive successful cases, patients with brachial plexus palsy including triceps palsy with preserved function in wrist extensors warrant consideration for this technique.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70272"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13391035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562146","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":"The Super Thin External Pudendal Artery Free Flap for Buccal Reconstruction: A Case Report.","authors":"Olivier Mathieu, Leo Ouhayoun, Nicolas Walhin, Jean-François Honart, Stéphane Temam, Nicolas Leymarie","doi":"10.1002/micr.70261","DOIUrl":"10.1002/micr.70261","url":null,"abstract":"<p><p>Reconstruction of buccal mucosal defects requires thin, pliable, and well-vascularized tissue to preserve oral function and cheek mobility. While the radial forearm free flap remains widely used, alternative ultra-thin options are needed, particularly in obese patients where conventional perforator flaps may be excessively thick. We report the case of a 59-year-old obese man (BMI 32 kg/m²) undergoing resection of a superficial squamous cell carcinoma of the left buccal mucosa, resulting in a wide 6 × 6 cm defect. Reconstruction was performed using a super-thin external pudendal artery (STEPA) free flap harvested from the hemiscrotum. The fasciocutaneous flap, measuring 6 × 6 cm, demonstrated uniform near-millimetric thickness (2-3 mm), allowing direct intraoral inset without the need for thinning. Microvascular anastomoses were performed to the facial vessels, and donor-site closure was achieved primarily. The postoperative course was uneventful, with early enteral feeding, progressive oral intake from day 10, and no complications. At 3 months of follow-up, the flap showed complete integration with preserved cheek mobility and satisfactory mouth opening. This case highlights that the STEPA free flap may represent a useful ultra-thin reconstructive option for buccal mucosal defects in selected patients, particularly when minimal flap thickness is required.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70261"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579384","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":"Management of Slowly Progressive Facial Weakness in Patients With Benign Tumors of the Facial Nerve.","authors":"Christine F Johansen, Benjamin Rail, Natalie A Gault, Shai M Rozen","doi":"10.1002/micr.70271","DOIUrl":"10.1002/micr.70271","url":null,"abstract":"<p><strong>Background: </strong>Benign facial nerve tumors have unique presentations granting distinct diagnostic and management implications. Unlike acute-onset facial paralysis, the gradual, intermittent course complicates diagnosis, treatment strategy, and timing, especially when considering potential reanimation. This study presents our institutional experience and proposes approaches to management and evaluation of patients with slowly progressive facial weakness due to benign tumors.</p><p><strong>Methods: </strong>A retrospective review included patients between August 2009 and April 2026 with slowly progressive facial weakness or hemifacial spasm due to a benign facial nerve tumor. Demographics, facial palsy history, tumor characteristics, treatment strategies, reanimation procedures, and outcomes were analyzed.</p><p><strong>Results: </strong>Fifteen patients met inclusion criteria with a mean age of onset of 45 years. Sixty-seven percent were initially misdiagnosed. Forty-seven percent presented with synkinesis. The most common tumor type was facial nerve schwannoma (60%). Forty percent underwent complete resection, 27% received radiation, and 27% are under observation. Six patients underwent dynamic facial reanimation: proactively (before tumor extirpation) in three cases, with one undergoing both proactive and concomitant reanimation during extirpation, concomitantly with extirpation in one, and following radiation in one. All achieved recovery of motion on average 3.7 months (range 2-7) later. Two patients are currently planned for reanimation.</p><p><strong>Conclusions: </strong>Benign facial nerve tumors require individualized management based on functional trajectory, tumor characteristics, and patient preference. Treatment options range from observation and radiation to surgical extirpation, but due to the slowly progressive and partial nature of the facial paralysis, the reanimation strategy is guided not only by mimetic musculature viability but also by patient preference on timing. In patients with progressive weakness and anticipated nerve sacrifice during extirpation, proactive reanimation using nerve transfers, cross facial nerve grafts, and free functional muscle transfer should be considered early to establish reinnervation pathways before the denervation window closes, avoiding irreversible facial paralysis.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70271"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497761","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":"Emergency Free Flap Reconstruction in Traumatic Extremity Injuries: Clinical Indications and Framework.","authors":"Omar Moussa, Jatupoom Chansomboon, Floris V Raasveld, Ian L Valerio, Krystle R Tuaño, L Scott Levin, Kyle R Eberlin","doi":"10.1002/micr.70263","DOIUrl":"10.1002/micr.70263","url":null,"abstract":"<p><strong>Background: </strong>Emergency free flap reconstruction (EFFR) involves flap coverage performed during initial operative intervention or within 24 h after traumatic injury. Although EFFR offers notable advantages, standardized criteria for its application are not well established. This manuscript proposes a treatment framework outlining three primary indications for EFFR, including the use of viable tissue from spare parts.</p><p><strong>Methods: </strong>We retrospectively analyzed 14 patients (15 flaps) with traumatic limb-threatening injuries treated with EFFR across two academic centers from 2016 to 2024. Data collected included patient demographics, injury patterns, operative details, and clinical outcomes, with results compared to existing literature. Functional recovery was defined as independent ambulation for lower extremity injuries and restoration of range of motion for upper extremity or digital injuries.</p><p><strong>Results: </strong>The cohort (mean age 35 years; 79% male) presented three key indications for 15 EFFR flaps: spare part utilization (47%, n = 7), immediate coverage of exposed critical structures (20%, n = 3), and distal revascularization using flow-through flaps (33%, n = 5). Flap success rate was 87%, with an overall complication rate of 47%. In multiple cases, spare part flaps preserved functional levels of amputation, such as the below-elbow or below-knee level. Functional recovery averaged 5 months (range, 2-11), and mean hospital stay was 15 days (range, 8-39).</p><p><strong>Conclusions: </strong>EFFR is effective for traumatic limb salvage when tailored to specific indications. Our experience-based framework offers structured guidance based on spare part use, timely soft-tissue coverage, and distal revascularization, supporting this acute orthoplastic approach for care of traumatic injuries.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70263"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13342472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405122","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":"The Composite Radial Forearm Free Flap for Tibialis Anterior Tendon Reconstruction: A Case Report.","authors":"Stephanie E Shin, Megan R Newsom, Annabel E Baek, Brooks Kelly, Rendell Bernabe, Jatin P Vemuri, Paschalia Mountziaris, Ramon DeJesus","doi":"10.1002/micr.70227","DOIUrl":"10.1002/micr.70227","url":null,"abstract":"<p><p>Distal leg reconstruction is particularly challenging due to limited local options. This challenge is accentuated when there is a concurrent tendon rupture and threatened hardware, making soft tissue coverage crucial for preserving limb function. This report describes a 37-year-old male with a 5 × 8 cm wound on the distal leg, including a 7.5 cm loss of tibialis anterior tendon (TAT) with underlying tibial hardware. A 5 × 9 cm composite left radial forearm free flap (FF), including flexor carpi radialis and palmaris longus tendons, was used to reconstruct the TAT and cover the tibial hardware. The patient's postoperative course was smooth, and he was able to walk without assistance after 6 weeks. At 10 months, the patient continued to show strong ankle dorsiflexion and ambulated independently. This case demonstrates that a composite radial forearm FF may be an effective autologous option for simultaneous soft tissue coverage and tendon reconstruction in the lower extremity.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":"e70227"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042954","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":"Closure of Tracheoesophageal Fistula Employing the Superficial Circumflex Iliac Artery Perforator (SCIP) Flap: Report of Three Cases","authors":"Evelin Kovacs-Sipos,&nbsp;Mario F. Scaglioni,&nbsp;Matteo Meroni,&nbsp;Gunesh P. Rajan","doi":"10.1002/micr.70260","DOIUrl":"10.1002/micr.70260","url":null,"abstract":"<div>\u0000 \u0000 <p>The tracheoesophageal fistula (TOF) is defined as a pathological connection between the trachea and esophagus, both congenital and acquired. The latter is often associated with malignancies or their treatments. Reconstruction in this context is particularly challenging due to the defect's location, size, and compromised tissue quality. Here, we present for the first time the surgical treatment of TOF using a free superficial circumflex iliac artery perforator (SCIP) flap. Three patients were included in the present report (84-year-old female, 74-year-old male, 62-year-old male). Two patients developed a TOF following total laryngectomy combined with partial pharyngectomy, and one patient, following total laryngectomy without partial pharyngectomy. All the patients received a surgical treatment for a head and neck malignancy. The TOFs were successfully closed in three patients using a SCIP-Flap. The elevated SCIP-Flap measured on average 15 × 8 cm. In two cases, the return to a normal, oral diet was established within 1–3 months with successful vocal rehabilitation. The third case did not return to a complete oral diet because of a dehiscence and ongoing palliative chemotherapy. The other two patient underwent 1-year follow-up without complications. This report suggests that the SCIP flap could be a feasible low morbidity and relatively straightforward reconstructive option, yielding favorable postoperative outcomes for TOF even in cases of multiple prior surgeries and adjuvant radiochemotherapy treatment.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308382","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":"Umbilical Inset Incision Type Influences Abdominal Donor Site Healing in Autologous Breast Reconstruction","authors":"Kshipra Hemal,&nbsp;Thomas Sorenson,&nbsp;Rebecca Lisk,&nbsp;Malory Alexis,&nbsp;Sachin Chinta,&nbsp;Alay Shah,&nbsp;Rebecca Vernon,&nbsp;Carter Boyd,&nbsp;John Muller,&nbsp;Angela Volk,&nbsp;Jamie P. Levine,&nbsp;Vishal Thanik,&nbsp;Nolan Karp,&nbsp;Mihye Choi,&nbsp;Oriana Cohen","doi":"10.1002/micr.70248","DOIUrl":"https://doi.org/10.1002/micr.70248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Delayed abdominal wound healing remains a common complication following abdominally based autologous breast reconstruction. We hypothesized that the type of umbilical inset incision impacts the incidence of delayed wound healing due to differential disruption of abdominal wall vascularity, particularly in the infraumbilical region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted of all patients undergoing abdominally based autologous breast reconstruction at a single center between 2014 and 2021. The primary outcome was delayed abdominal wound healing, classified as major (requiring readmission or reoperation), minor (managed with outpatient care, antibiotics, or debridement), or both. Umbilical inset incision type was evaluated as a predictor using univariate and multivariate analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred and eighty-eight patients and 791 flaps were included. Patients were on average 51 ± 9 years old and had a median body mass index of 28 (IQR 7) kg/m². The most used umbilical incision was an elliptical incision (193, 40%) followed by vertical (141, 29%), inverted-U (30, 6%), other (39, 8%), and unknown (81, 17%). Abdominal wound healing complications occurred in 63 (13%) patients. The incidence of abdominal wound healing complications was lowest with elliptical incisions (<i>p</i> &lt; 0.001). In a multivariate regression model controlling for age, BMI, diabetes, smoking history, and flap weight, umbilical incision predicted abdominal wound healing complications, with inverted-U and vertical incisions conferring higher odds of abdominal wound healing complications (OR 5.9, 95% CI [1.6, 20.8] and OR 4.6, 95% CI [2.0, 11.4], <i>p</i> &lt; 0.05) as compared to elliptical incisions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Abdominal wall vascularity likely plays a critical role in donor site healing following autologous reconstruction. In this large cohort, inverted-U and vertical umbilical inset incisions were associated with the highest rates of wound healing complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148282563","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 the Efficacy and Utility of Preoperative Computed Tomography Angiography in Perforator Flap Surgeries: A Systematic Review and Meta-Analysis","authors":"Athena Brooks,&nbsp;Jessica Lemke,&nbsp;Anna Hornbach,&nbsp;Nathan Keller,&nbsp;Jose Foppiani,&nbsp;Maria J. Escobar-Domingo,&nbsp;Noelle C. Garbaccio,&nbsp;Jade E. Smith,&nbsp;Theodore C. Lee,&nbsp;Cayci Cenk,&nbsp;Umar Choudry,&nbsp;Samuel Lin","doi":"10.1002/micr.70252","DOIUrl":"10.1002/micr.70252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Deep inferior epigastric artery perforator (DIEP) flaps are widely used in autologous breast reconstruction and increasingly favored due to superior patient-reported outcomes. Preoperative imaging is central to efficient and safe DIEP flap planning, yet the optimal modality remains debated. While computed tomography angiography (CTA) is recommended by ERAS protocols, concerns over radiation exposure and cost have prompted interest in alternatives such as ultrasound (US) and magnetic resonance angiography (MRA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review following PRISMA guidelines was conducted across five major databases, including clinical trials and observational studies published through 2025. Studies included patients undergoing DIEP flap reconstruction with preoperative imaging using CTA, US, MRA, or other modalities. Data extracted included imaging-to-surgical perforator correlation, operative time, complication rates, and flap outcomes. Meta-analyses and heterogeneity assessments were performed using STATA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-two studies encompassing 3238 patients were included. CTA was used in nearly all studies; US, MRA, SPY/ICG, and DIRT were evaluated in a subset. Pooled perforator utilization was highest with MRA (92%), followed by CTA (87%) and US (85%). Among 2967 patients with complication data, 410 (13.8%) experienced adverse outcomes. Complication rates differed significantly across strategies. Patients utilizing US alone experienced the highest complication rates (17.3%), compared to CTA alone (13.9%) and CTA and US (10.8%). The complication rate difference between US alone patients and CTA and US alone patients was statistically greater (RR = 0.63, <i>p</i> = 0.0123). The complication rates between CTA alone and US alone or CTA and US were not statistically different (US alone: RR = 0.81, <i>p</i> = 0.1040; CTA and US: RR = 0.78, <i>p</i> = 0.11). Complete flap loss occurred in 8.0% of complications, partial flap loss in 14%, and fat necrosis in 19%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CTA remains the most studied imaging modality for DIEP flap surgical planning, demonstrating high perforator utilization and low complication rates. Combining CTA with US may further improve outcomes by integrating anatomical precision with dynamic feedback. As newer, lower-risk imaging technologies emerge, comparative studies are needed to determine whether they can match or exceed the performance of CTA in DIEP reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265518","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}