Microsurgery最新文献

{"title":"Staged Flap Reconstruction of Massive Abdominal Loss of Domain and Sacral Pressure Injury to Restore Quality of Life: A Case Report","authors":"Kate Jensen,&nbsp;Diwakar Phuyal,&nbsp;Julia Ting,&nbsp;Raffi Gurunian,&nbsp;Sarah N. Bishop","doi":"10.1002/micr.70256","DOIUrl":"10.1002/micr.70256","url":null,"abstract":"<p>Simultaneous massive abdominal wall loss of domain (LOD) and chronic sacral pressure injury presents an exceptional reconstructive challenge. Optimal sequencing of reconstruction in patients with multifocal defects and impaired mobility remains poorly defined. In this case report, we describe a strategically staged approach prioritizing restoration of trunk stability to enable definitive pressure ulcer reconstruction in a complex patient. A 34-year-old male developed a 32 × 25 cm ventral abdominal wall defect with LOD and a persistent stage IV sacral ulcer following catastrophic complications of a gastric bypass. Severe abdominal LOD resulted in truncal flexion deformity and wheelchair dependence. Reconstruction was staged to prioritize abdominal wall restoration to improve mobility and allow effective pressure offloading before sacral reconstruction. AWR was performed using transversus abdominis release (TAR) with retromuscular mesh placement, partial fascial bridging, and a free anterolateral thigh (ALT) musculocutaneous flap to provide durable fascial reinforcement and soft-tissue coverage. Restoration of abdominal domain significantly improved trunk stability and ambulation. Eight months later, the 14 × 10 cm sacral ulcer was definitively reconstructed using bilateral keystone perforator flaps. Both reconstructions healed without complication, resulting in marked functional recovery and elimination of wheelchair dependence. This case shows the effectiveness of a staged, multidisciplinary strategy for a patient with severe, multifocal soft-tissue defects and supports the notion that a carefully staged and individualized reconstructive approach may provide durable restoration, substantially improving mobility, functional independence, and overall quality of life.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252258","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":"Recipient Vessel Selection in Free Flap Phalloplasty: A Systematic Review and Single-Arm Meta-Analysis","authors":"James Gaston,&nbsp;R'ay Fodor,&nbsp;Antonio Rampazzo,&nbsp;Michele Fascelli,&nbsp;Bahar Bassiri Gharb","doi":"10.1002/micr.70251","DOIUrl":"10.1002/micr.70251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Selection of recipient vessels in phalloplasty is challenging due to the absence of adequate vessels in the immediate proximity. There is no consensus on the appropriate vessel selection. We hypothesized that recipient vessel selection in phalloplasty is associated with differences in complications and flap survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A literature search following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across Ovid MEDLINE/PubMed, Embase, and CENTRAL databases identified 46 articles. Collected data included demographics, surgical details, donor and recipient vessels, use of interpositional grafts, number of venous anastomoses, and outcomes. Statistical analysis followed the random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand nine hundred and seventy six phalloplasty cases were identified. The deep inferior epigastric artery (DIEA) was used in 1413 cases (71.5%) and the femoral artery (FA) was used in 563 cases (28.5%). Pooled proportions of arterial and venous thrombosis were 2.0% and 2.2%, respectively. The use of an interpositional vein graft or arteriovenous loop with the FA was associated with a significantly higher arterial thrombosis rate (16.0%) compared to direct anastomosis to the FA (0.1%, <i>p</i> &lt; 0.001) and to the DIEA (1.2%, <i>p</i> &lt; 0.001). In the absence of vascular thrombosis, partial flap necrosis occurred significantly less often with direct anastomosis to the FA (0.6%) than with the DIEA (6.2%, <i>p</i> = 0.016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The choice of recipient vessels is an important consideration in phalloplasty flap survival. The DIEA is associated with a low thrombosis rate. However, the significantly higher proportion of thrombosis observed with the FA may be attributable to the use of an interpositional vein graft or arteriovenous loop. Despite lower thrombosis rates, the use of the DIEA was associated with a higher proportion of partial flap necrosis when vessels were patent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258895","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":"Tunneled Peroneal Perforator Propeller Flap With De-Epithelialized Bridge for Coverage of Anterior Mid-Tibial Defect After Skin Cancer Resection: A Case Report","authors":"Matteo Meroni,&nbsp;Federica Martini,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.70259","DOIUrl":"10.1002/micr.70259","url":null,"abstract":"<div>\u0000 \u0000 <p>Anterior mid-tibial defects are difficult to cover because the tibial crest lacks soft tissue and excess bulk impairs function and contour. Different procedures can be used in these cases, including split thickness skin graft (STSG), local random pattern flaps, or pedicled muscular flaps. STSG represents the most common and simple procedure; however, the aesthetic results are often poor and it cannot be performed if bone tissue is directly exposed. Local flaps are suboptimal in this region due to high skin tension, whereas muscle flaps yield poor aesthetic outcomes and are associated with increased morbidity and prolonged healing time. In this setting, there is still not a definitive solution able to provide the right amount of tissue, with a safe donor site morbidity. Here, we report a case of anterior tibial reconstruction after wide local excision of basal cell carcinoma in a 71 years old man using a peroneal artery perforator propeller flap. Color Doppler localized a reliable distal-lateral perforator, enabling a single-perforator skin island flap measuring 19 × 6 cm, with careful pedicle skeletonization; indocyanine-green angiography confirmed perfusion before inset. A generous subcutaneous tunnel minimized kinking, and a de-epithelialized central bridge created two paddles, one for the defect and one to assist tension-free donor closure. Recovery was uncomplicated; at 6 months the flap was stable, with good contour, color match, and no need for refinements. Key reliability enhancers were judicious perforator selection, gravity-assisted design, liberal tunneling, and the protective bridge. Compared with skin grafting, this approach improves durability and integration; compared to free flaps, it preserves major vessels while reducing operative complexity and morbidity.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218346","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":"Magnesium-Doped Artificial Bone Combined With Pedicled Peri-Acetabular Bone Flap for ARCO Stage II Osteonecrosis of the Femoral Head: A Comparative Study","authors":"Feng Wang,&nbsp;Liangliang Cheng,&nbsp;Tianwei Zhang,&nbsp;Jiawei Ying,&nbsp;Xu Feng,&nbsp;Hao Su,&nbsp;Dewei Zhao","doi":"10.1002/micr.70250","DOIUrl":"10.1002/micr.70250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Magnesium (Mg) ions promote bone regeneration. Combined with a vascularized periosteal flap providing blood supply and mechanical support, this approach may improve outcomes for osteonecrosis of the femoral head (ONFH), but its clinical efficacy is unclear. This study compared this approach with conventional core decompression (CD) for Association Research Circulation Osseous (ARCO) Stage II ONFH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 76 patients (82 hips) with ARCO Stage II ONFH. The observation group (OG) (39 patients, 44 hips) received Mg-doped artificial bone combined with pedicled peri-acetabular bone flap (MAB-PPBF), while the control group (CG) (37 patients, 38 hips) underwent CD. Operative time, intraoperative blood loss, Harris Hip Score (HHS), Visual Analog Scale (VAS), ARCO stage, Kerboul angle, and hip-preserving success rate were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline characteristics were comparable between groups. The OG had longer operative time (47.9 ± 7.2 vs. 44.2 ± 3.5 min) and greater blood loss (36.2 ± 8.1 vs. 27.3 ± 7.1 mL) than the CG (<i>p</i> &lt; 0.05). At final follow-up, the OG showed significantly higher HHS (84.12 ± 3.14 vs. 81.94 ± 2.09) and lower VAS (2.97 ± 0.43 vs. 3.32 ± 0.76) compared with controls (<i>p</i> &lt; 0.05). The OG also had a higher proportion of ARCO Stage II (47.6% vs. 30.0%) and lower proportion of Stage IV (4.8% vs. 16.7%, <i>p</i> &lt; 0.05). The Kerboul angle was significantly smaller in the OG (203.54° ± 32.84° vs. 221.39° ± 31.82°, <i>p</i> &lt; 0.05). The hip-preserving success rate was significantly higher in the OG (90.9%, 40/44) than in the CG (65.8%, 25/38, <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For ARCO Stage II ONFH, MAB-PPBF achieves more thorough necrotic bone removal, adequate grafting, accelerated bone regeneration, effective hip pain relief, improved hip function, and delayed disease progression compared with CD, showing superior clinical outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148218359","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 Tongue Tip Reconstruction on Articulatory Performance After Major Tongue Resections: Evidence From a Multicentric Study","authors":"Arianna Caselli,&nbsp;Luca Gazzini,&nbsp;Sara Bassani,&nbsp;Giulia Togo,&nbsp;Carlotta Borghini,&nbsp;Alessia Rubini,&nbsp;Maria Rosini,&nbsp;Carlotta Liberale,&nbsp;Claudia Montenegro,&nbsp;Iara Comicini,&nbsp;Jacopo Di Domenico,&nbsp;Valentina Camesasca,&nbsp;Alice Cremasco,&nbsp;Andrea Calabrese,&nbsp;Dario Gregori,&nbsp;Daniele Marchioni,&nbsp;Alberto Giulio Dragonetti,&nbsp;Cesare Piazza,&nbsp;Remo Accorona,&nbsp;Alberto Grammatica,&nbsp;Francesco Mattioli,&nbsp;Luca Calabrese","doi":"10.1002/micr.70258","DOIUrl":"10.1002/micr.70258","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The anterior tongue is crucial in speech articulation; however, the functional implications of tongue tip resection and reconstruction following glossectomy remain inadequately elucidated. This multicentric study aimed to evaluate the impact of lingual tip reconstruction on postoperative articulatory performance and self-perceived speech outcomes in patients undergoing major tongue resections for oral squamous cell carcinoma (OSCC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was performed on 57 patients who underwent hemiglossectomy or extended glossectomy across four tertiary referral centers between 2007 and 2023. Articulatory performance was assessed utilizing selected tests from the Fussi-Cantagallo test and the Speech Handicap Index (SHI). Patients were stratified into two groups based on tongue tip management: Group A, ipsilateral tip resection without reconstruction (contralateral tip preserved); Group B, ipsilateral tip resection with partial tip reconstruction. Comparative analyses and multivariate models examined the associations between reconstructive patterns, articulatory performance, and SHI scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In tests 1 and 2, the difference between Groups A and B showed a clear trend towards significance in favor of Group A (<i>p</i> = 0.061). No significant difference was found between the two groups in the other tests. Younger age was independently associated with improved articulatory performance (<i>p</i> &lt; 0.02). No differences were observed in outcomes associated with flap type or adjuvant therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Omitting apical reconstruction when the contralateral apex remains functional may be associated with superior speech outcomes by preserving residual mobility. A function-oriented reconstruction approach, emphasizing motility rather than morphological symmetry, should be prioritized to enhance postoperative communication quality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148199411","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 “Arterialized Saphenous Vein Transfer for Microvascular Free Flap Reconstruction of Complex Posterior Defects”","authors":"Haris Akbar,&nbsp;Syed Hatim Hussain,&nbsp;Syed Muhammad Momin","doi":"10.1002/micr.70257","DOIUrl":"https://doi.org/10.1002/micr.70257","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148174340","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":"Temporary Vascular Shunting to Prevent Excessive Ischemia Time for a Fillet-of-Leg Free Flap During External Hemipelvectomy: A Case Report","authors":"Michael Edgar,&nbsp;Homa Pourriyahi,&nbsp;Naji Bou Zeid,&nbsp;Willem Wisselink,&nbsp;Lee Alkureishi","doi":"10.1002/micr.70254","DOIUrl":"https://doi.org/10.1002/micr.70254","url":null,"abstract":"<div>\u0000 \u0000 <p>The free fillet flap is a well-established reconstructive option following external hemipelvectomy. However, mitigating prolonged warm ischemia during the extensive tumor resection poses a significant challenge to flap viability. Presented herein is a case illustrating the novel use of temporary intraoperative vascular shunting to overcome this limitation. During hemipelvectomy for a 17.7 × 16.9 × 19.3 cm osteosarcoma of the proximal left femur in a 74-year-old man, unplanned early ischemia of the lower extremity was addressed by placing carotid shunts between the external iliac and popliteal vessels. The technique maintained continuous perfusion to the future flap for 4 h during the concurrent pelvic resection and fillet flap harvest. Definitive microvascular anastomosis was performed subsequently and the 37 × 31 cm flap remained viable postoperatively for the 3 months of follow-up. This case report reintroduces temporary shunting as a simple, effective, and readily available technique to preserve flap perfusion in complex microsurgical reconstructions, mirroring damage-control principles from trauma surgery.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148174339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free Composite Osteotomized Serratus Anterior Chondroosteomusculocutaneous Flap for Dynamic Reconstruction of a Pediatric Combined Maxillectomy and Hemimandibulectomy Defect: A Case Report","authors":"Semih Baghaki,&nbsp;Yetkin Zeki Yilmaz,&nbsp;Batu Özlüşen","doi":"10.1002/micr.70249","DOIUrl":"10.1002/micr.70249","url":null,"abstract":"<div>\u0000 \u0000 <p>Pediatric mandibular reconstruction is challenging due to the need to restore mandibular continuity, temporomandibular joint (TMJ) function, and long-term craniofacial growth. Conventional osseous free flaps may not adequately reproduce the ramus–condyle unit or provide a growth-capable cartilaginous component. The serratus anterior-rib composite flap offers vascularized bone and costochondral tissue but remains rarely used in children. We presented a 12-year-old pediatric patient with rhabdomyosarcoma who underwent en bloc resection including hemimandibulectomy and maxillectomy. Reconstruction was achieved using a free composite multi-segment osteotomized serratus anterior chondroosteomusculocutaneous flap incorporating the vascularized 6th rib, its costochondral junction, serratus anterior muscle, and a skin paddle. The rib was osteotomized to recreate mandibular contour, and the costochondral junction was shaped to form a neocondyle. The flap tolerated adjuvant radiotherapy and chemotherapy without complications over a 19-month follow-up period. No mandibular asymmetry was observed. Although larger series with longer follow-up periods are needed, this technique may offer a single-flap, growth-preserving solution for complex defects involving the ramus–condyle unit in pediatric patients.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163787","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":"Subunit-Based Intraflap Debulking Technique for Secondary Contouring After Free Flap Reconstruction","authors":"Kyung-Eun Yoo,&nbsp;Kyeong-Tae Lee","doi":"10.1002/micr.70253","DOIUrl":"10.1002/micr.70253","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite advances in surgical technique for flap thinning, secondary debulking is often needed in areas with thin soft tissue coverage. Flaps spanning multiple anatomical subunits pose a particular challenge, as central bulkiness, often located near subunit junctions, is difficult to address with traditional margin-based approaches and may obscure natural contours. We introduced a subunit-based intraflap debulking technique, placing incisions across the flap along anatomical subunit borders and evaluated its safety and effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients who underwent free flap reconstruction between 2021 and 2025 and later received secondary debulking using this technique. The procedure involved placing intraflap incisions along internal subunit borders, excising central redundant skin and adjacent fatty tissue in a cone-shaped fashion, and reapproximating the flap to restore natural subunit boundaries. Their postoperative outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 22 cases were treated using the subunit-based intraflap approach, most commonly for lower extremity reconstructions, particularly of the foot, with the superficial circumflex iliac artery perforator flap being the most frequently used in the initial surgery. Debulking was performed at a median of 10 months following the initial reconstruction. No postoperative complications, including wound dehiscence, delayed wound healing, seroma, hematoma, or infection, were observed. The median time to complete healing was 14 days. All patients reported satisfaction with the aesthetic outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The subunit-based intraflap debulking technique appears to be a safe approach for secondary contouring after free flap reconstruction in selected cases, allowing effective central debulking and restoration of natural subunit borders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149049","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":"Correction of Lateralization of the Perioral Insertion of Gracilis Muscle in Facial Reanimation in Children: A Report of Two Cases","authors":"A. Haumer,&nbsp;O. Engström,&nbsp;R. Dong,&nbsp;A. Rodriguez-Lorenzo","doi":"10.1002/micr.70255","DOIUrl":"10.1002/micr.70255","url":null,"abstract":"<p>Facial palsy in pediatric patients can lead to severe functional impairments and psychosocial challenges. Free gracilis muscle transfer (FGMT) is to date the gold standard for dynamic facial reanimation, but suboptimal aesthetic outcomes (SAO), due to malpositioning of the nasolabial fold, still represent a challenge to the surgeons. Especially, craniolateral displacement of the medial insertion of the gracilis muscle at the nasolabial fold represents a true challenge. The purpose of these two case reports is to propose a novel technique for the medialization of the perioral insertion of the gracilis muscle using fascia lata slings in pediatric patients, which might be useful to the reconstructive surgeon in dealing with this challenging complication. We present the cases of two male pediatric patients with complete unilateral facial palsy; a 7-year-old affected by congenital, complete, right-sided and an 11-year-old post-oncological complete right-sided facial palsy. Both patients underwent FGMT and suffered from craniolateral displacement of the nasolabial fold postoperatively after different time spans. (3- and 5-years post FGMT). To correct this SAO, we performed our herein proposed technique for secondary repositioning of the gracilis muscle to correct the malpositioned nasolabial fold. Pre- and postoperative outcomes were evaluated using photography, videography, and the Terzis Functional and Aesthetic Grading System by seven independent investigators. These independent investigators found that the overall Terzis score increased from poor to moderate through FGMT and sustained another relevant increase from moderate to good through our proposed medialization technique. Moreover, within our follow-up period of 17 months, we observed no major or minor complications. The take home message of this report is that our technique of medialization of the gracilis muscle insertion using fascia lata slings represents an effective and low-risk approach for correcting a lateralized nasolabial fold. In these challenging cases, this novel technique can offer a surgical alternative which can improve both functional and aesthetic outcomes in pediatric facial reanimation. However, further investigation with larger cohorts is necessary to validate our surgical approach.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148150572","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}