Microsurgery最新文献

{"title":"Comments on “the Heart-Lung Machine in Major Limb Replantation: Report of Two Cases”","authors":"Rocco De Vitis, 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}

{"title":"The Impact of Depression and Anxiety Comorbidities on Acute Postoperative Pain After DIEP Flap Breast Reconstruction","authors":"Carol Wang,&nbsp;Megan Tang,&nbsp;Reanna Shah,&nbsp;Jamie Frost,&nbsp;Esther Kim,&nbsp;Peter E. Shamamian,&nbsp;Olachi Oleru,&nbsp;Nargiz Seyidova,&nbsp;Peter W. Henderson,&nbsp;Peter J. Taub","doi":"10.1002/micr.31260","DOIUrl":"10.1002/micr.31260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Depression and anxiety have a complex association with opioid dependence, though their impact on acute postoperative pain is unclear. The present study investigated the impact of depression and anxiety on acute postoperative pain and opioid requirements following deep inferior epigastric perforator (DIEP) flap breast reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients receiving DIEP flap breast reconstruction were retrospectively identified from 2019 to 2023. Patients were classified into the psychiatric comorbidity (PC) group based on a history of depression or anxiety diagnoses, or the control group. Pain (0–10 Numerical Rating Scale [NRS]) scores and cumulative inpatient opioid requirements (in morphine milli-equivalents [MMEs]) were compared between groups. Linear regression analysis assessed the association of psychiatric comorbidities with pain outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 557 patients were included, of which 11.4% reported a psychiatric history. The PC group was younger (50.0 vs. 52.7 years, <i>p</i> = 0.032) and more frequently reported current marijuana use (15.6% vs. 4.3%, <i>p</i> = 0.001) and former smoking (51.6% vs. 24.5%, <i>p</i> &lt; 0.001). The PC group had higher mean (2.5 vs. 2.0, <i>p</i> &lt; 0.001) and maximum pain scores (8.6 vs. 7.8, <i>p</i> = 0.003) than the control group, which corresponded to higher opioid requirements (256 vs. 223 MMEs, <i>p</i> = 0.041). Psychiatric comorbidities were associated with higher average and maximum pain scores (<i>p</i> &lt; 0.01) while current marijuana use was associated with higher opioid requirements (<i>p</i> = 0.033).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with depression or anxiety comorbidities tended to have greater acute postoperative pain and opioid consumption. Marijuana use was also more prevalent, potentially exacerbating pain outcomes, and risk of opioid dependence. These findings will inform patient discussions and targeted interventions to mitigate opioid misuse.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623864","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":"L-Shaped Scapular and Parascapular Combined Flap for Reconstruction of a Large Surface Defect After Sarcoma Resection Using ICG Angiography: A Case Series of 6 Patients","authors":"Ryo Karakawa,&nbsp;Hidehiko Yoshimatsu,&nbsp;Hirofumi Imai,&nbsp;Tomoyuki Yano","doi":"10.1002/micr.31259","DOIUrl":"10.1002/micr.31259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Soft tissue sarcomas (STS) pose challenges in management due to large defects following wide resection. Reconstructive options are often limited, especially in patients with large circular defects below the gluteal region. This article addresses the question of how to effectively reconstruct such defects while minimizing donor-site morbidity. We present our experience with using an L-shaped combined scapular and parascapular flap after STS resection, highlighting the novelty of employing indocyanine green (ICG) angiography to ensure optimal blood flow and surgical safety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients who underwent STS resection and immediate reconstruction using an L-shaped scapular and parascapular combined flap between October 2022 and April 2024. The feasibility of the procedure was assessed by analyzing the patient demographics, tumor characteristics, defect and flap sizes, operative time, and postoperative outcomes, including donor-site complications and shoulder function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six patients underwent reconstruction using an L-shaped combined flap with no donor-site complications or significant shoulder dysfunction. The average sizes were 15.7 × 13.7 cm for the defect, 20 × 7 cm for the scapular flap, and 23 × 7.3 cm for the parascapular flap. The average operative time was 7 h and 9 min. The average follow-up period was 10.2 months. Except for one case of partial flap necrosis, all flaps survived completely, highlighting the reliability of the procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>L-shaped combined scapular and parascapular flaps are promising reconstructive techniques for large surface defects after STS resection with low donor-site morbidity and preservation of shoulder function. The novel application of these flaps for large circular defects below the gluteal region, combined with the use of ICG angiography to ensure flap viability and enhance surgical safety, are key contributions of this study.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623614","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}