MicrosurgeryPub Date : 2026-05-29DOI: 10.1002/micr.70234
Geoffrey G. Hallock
{"title":"What Is the Posteromedial Thigh Flap?","authors":"Geoffrey G. Hallock","doi":"10.1002/micr.70234","DOIUrl":"10.1002/micr.70234","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055578","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}
MicrosurgeryPub Date : 2026-05-19DOI: 10.1002/micr.70241
Cemal B. Sirkeci, Can E. Yalcin, Servet Y. Aydın, Melih S. Sağır, Çağlar Yılmaz, Şima Kılıç, Anıl Demiröz
{"title":"Timing of Antioxidant Pretreatment With Melatonin, Vitamin C, and Vitamin E in Ischemia–Reperfusion Injury: A Rat Inferior Epigastric Island Flap Model","authors":"Cemal B. Sirkeci, Can E. Yalcin, Servet Y. Aydın, Melih S. Sağır, Çağlar Yılmaz, Şima Kılıç, Anıl Demiröz","doi":"10.1002/micr.70241","DOIUrl":"10.1002/micr.70241","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free flap surgeries represent significant advancements in reconstructive surgery. Despite surgical progress, ischemia–reperfusion injury (IRI) due to vascular complications remains a challenge, potentially leading to flap loss. Various strategies, including surgical methods and pharmacological treatments, have been explored to mitigate IRI. Among these, antioxidant treatments have garnered interest, but research on the optimal timing of antioxidant administration is lacking. This study addresses this gap by investigating the timing of antioxidant pretreatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this experimental study, a 6 × 3 cm<sup>2</sup> inferior epigastric island flap was elevated in 40 male Wistar Albino rats and subjected to 8 h of ischemia followed by reperfusion. The animals were divided into five groups: a control group without ischemia–reperfusion (IR), an IR group receiving saline, and three treatment groups pretreated with melatonin (10 mg/kg), vitamin C (200 mg/kg), and vitamin E (40 mg/kg), administered 7 days preoperatively, 30 min before ischemia, or 30 min before reperfusion. Blood samples were obtained on postoperative days 1 and 7 to assess total antioxidant capacity. Flap photographs were taken and tissue biopsies were collected on postoperative day 7 for histopathological, immunohistochemical, and biochemical analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean necrosis rate was 33.5% in the IR group compared to 6.3% in the 7-day pretreatment group (I7) (<i>p</i> < 0.001). Histopathological evaluation showed significant improvement in inflammatory and vascular parameters in antioxidant-treated groups compared to IR (<i>p</i> < 0.05), while collagen organization was significantly better only in the I7 group (<i>p</i> = 0.0014). Immunohistochemical analysis revealed reduced eNOS, caspase-3, and IL-1β expression in antioxidant-treated groups and higher VEGF expression in the I7 group (<i>p</i> < 0.05). No significant differences were observed between groups in biochemical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Initiating antioxidant pretreatment 7 days prior to surgery significantly enhances flap viability, highlighting the importance of timing for optimal outcomes in elective free flap procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973731","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":"Clinical Performance of Digital Microscopes in Microsurgery: A Retrospective Analysis of Operative Time and Intraoperative/Postoperative Thrombosis Rates","authors":"Tomoyuki Ito, Yuichi Ichikawa, Yukio Seki, Miho Tobita, Meisei Takeishi, Hiroshi Mizuno","doi":"10.1002/micr.70240","DOIUrl":"10.1002/micr.70240","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Digital microscopes (DMs) have been increasingly adopted in microsurgery; however, clinical evidence regarding their operative efficiency, safety, and learning curve compared with conventional optical microscopes (OMs) remains limited. In particular, anastomosis-specific operative time and intraoperative thrombosis—an indicator closely related to technical precision—have not been sufficiently evaluated in clinical settings. Therefore, this study aimed to evaluate the learning curve associated with digital microscope adoption in microsurgical reconstruction using operative time metrics and to assess thrombotic events as exploratory safety outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 123 consecutive free-flap reconstructions performed by three experienced plastic surgeons between June 2022 and March 2025. The cases were categorized into three groups: OM, early-phase DM (DM-T1), and late-phase DM (DM-T2). The choice of visualization system was determined by operating room availability rather than surgeon preference. Microscope usage time, arterial and venous anastomosis times, and intraoperative and postoperative arterial or venous thromboses were analyzed. Intraoperative arterial patency was assessed by palpation and pinprick tests, and venous patency was assessed by the patency test. Learning curve effects were evaluated by comparing DM-T1 and DM-T2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of cases in each group was 37, 34, and 52 in the DM-T1, DM-T2, and OM groups, respectively. Mean microscope usage time was longer in DM-T1 than in DM-T2 and OM (71.9 ± 15.0 vs. 57.6 ± 13.4 vs. 58.5 ± 19.8 min; <i>p</i> = 0.0055 and <i>p</i> = 0.0021). Mean arterial anastomosis time was also longer in DM-T1 compared with DM-T2 and OM (22.5 ± 7.2 vs. 19.0 ± 5.1 vs. 17.4 ± 4.9 min; <i>p</i> = 0.048 and <i>p</i> = 0.0028). Venous anastomosis time showed a decreasing trend from DM-T1 to DM-T2 but did not reach statistical significance. The incidence of intraoperative and postoperative thrombosis did not differ among groups (intraoperative arterial thrombosis: 18.9%, 14.7%, and 15.4% in the DM-T1, DM-T2, and OM groups, respectively; <i>p</i> ≥ 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>DM demonstrates a measurable learning curve, with operative efficiency improving to levels comparable to those of OM, while maintaining similar thrombotic safety. DMs are a reliable visualization platform for microsurgical reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973764","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":"Strategic Muscle Coverage in Free Fibular Mandibular Reconstruction: An Osteotomy Approach to Minimize Plate Exposure, A Retrospective Analysis of 580 Consecutive Patients","authors":"Rajan Arora, Kripa Shanker Mishra, Anchit Kumar, Nikhil Prasad, Abisshek Raj Alagarasan, Samarth Gupta","doi":"10.1002/micr.70237","DOIUrl":"10.1002/micr.70237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free fibula flap reconstruction represents the gold standard for mandibular reconstruction following oncologic resection. However, plate exposure remains a significant complication, particularly in patients receiving postoperative radiotherapy. Traditional reconstructive approaches emphasize precise hardware contouring and basic soft tissue coverage but frequently fail to provide adequate muscle protection over hardware, especially in irradiated tissues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted of 580 consecutive free fibula flap reconstructions performed between 2018 and 2024. Patients were stratified into two cohorts based on plate exposure occurrence. The modified surgical technique involved strategic fibular segment rotation to position the flexor hallucis longus muscle directly over critical hardware fixation points. Statistical analyses included Mann–Whitney U tests, Fisher's exact tests, and logistic regression modeling to identify significant risk factors for plate exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adequate muscle coverage was present in 33.33% of patients with plate exposure compared with 97.02% of those without exposure (<i>p</i> < 0.0001). Among patients receiving postoperative radiotherapy, adequate muscle coverage was achieved in 96.34% of cases without exposure compared to 50% in the exposure group (<i>p</i> = 0.001). Multivariate analysis confirmed inadequate muscle coverage as an independent predictor of plate exposure (OR: 22.669, 95% CI: 3.79–135.596).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The described osteotomy modification was associated with consistent muscle coverage over reconstructive hardware and was associated with lower plate exposure rates, particularly in patients undergoing postoperative radiotherapy. Prospective studies are required for long-term assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948902","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}
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