Microsurgery最新文献

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","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":"148085047","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,&nbsp;Yuichi Ichikawa,&nbsp;Yukio Seki,&nbsp;Miho Tobita,&nbsp;Meisei Takeishi,&nbsp;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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","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":"148079742","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,&nbsp;Kripa Shanker Mishra,&nbsp;Anchit Kumar,&nbsp;Nikhil Prasad,&nbsp;Abisshek Raj Alagarasan,&nbsp;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> &lt; 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}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148074479","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":"Arteriovenous Loop-Assisted Free Functional Gracilis Transfer in Vessel-Compromised Patients: A Salvage Strategy for Facial Reanimation","authors":"Justus Osterloh,&nbsp;Jakob B. W. Weiss,&nbsp;Mark Fricke,&nbsp;Cam Tu Nguyen,&nbsp;Branislav Kollár,&nbsp;Steffen U. Eisenhardt","doi":"10.1002/micr.70238","DOIUrl":"10.1002/micr.70238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free functional gracilis transfer (FFGT) is the gold standard for dynamic facial reanimation in long-standing facial paralysis and its success depends on the availability of reliable recipient vessels. In patients with compromised vessels due to prior surgery, radiation, or trauma, arteriovenous (AV) loops are a well-established reconstructive strategy. However, their role in facial reanimation remains scarcely reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed all patients with facial paralysis receiving facial reanimation with FFGT at our center between January 2010 and March 2025. All patients with absent or compromised standard recipient vessels, who underwent facial reanimation using FFGT in combination with an AV loop, were included. A sequential approach with preoperative Doppler examination, intraoperative flow assessment, AV loop construction, and continuous Cook-Schwartz Doppler monitoring was used before gracilis harvest. Each case was compared with an age-matched cohort of patients who underwent conventional FFGT without AV loops to contextualize operative and ischemia times. Primary outcomes were technical success and perioperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 196 patients who underwent facial reanimation, four patients (4/196, 2.0%) with compromised recipient vessels who received AV loop-assisted FFGT were identified (mean age 57 years (range: 40–65) years). The mean follow-up time was 19.3 months (13–30 months). No AV-loop thrombosis, flap loss, hematoma, wound complications, or donor-site morbidity occurred. Compared with age-matched controls, operative times were prolonged, whereas ischemia times remained comparable. Functional smile restoration was achieved in two of four patients within 12 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>AV loop-assisted FFGT is a technically feasible salvage approach for facial reanimation in patients with compromised recipient vessels, enabling restoration of vascular access and expanding reconstructive options.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>FRKS (Freiburger Reister Klinischer Studien), No. FRK005908</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868841","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":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148067281","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":"3D Printing of a Patient-Specific Biomodel and Cutting Guide for Metatarsal Reconstruction With an Osteocutaneous SCIP Flap Using Open-Source Software: A Case Report","authors":"Miguel L. Obaíd,&nbsp;Antonio Núñez,&nbsp;Leonardo Parada,&nbsp;Vanessa Oñate,&nbsp;Cristina Almeida,&nbsp;Ricardo Roa,&nbsp;Nicolás Pereira","doi":"10.1002/micr.70236","DOIUrl":"10.1002/micr.70236","url":null,"abstract":"<div>\u0000 \u0000 <p>Technology-assisted planning is increasingly integrated into reconstructive plastic surgery, including virtual reality, augmented reality, and three-dimensional (3D) printing. 3D printing has been especially useful in maxillofacial surgery, both for patient-specific cutting guides for osteotomies and for biomodels to customize osteosynthesis plates. However, to our knowledge, there have been no reports of a 3D-printed cutting guide to harvest a custom iliac crest bone flap based on the deep branch of the superficial circumflex iliac artery perforator (SCIP) flap, together with a biomodel of the foot skeleton with the bone defect for intraoperative use. We report a 36-year-old man with a 45-mm bone defect of the first metatarsal and a 9 × 8 cm skin defect on the dorsum of the right foot after firearm trauma. Computer-aided design and computer-aided manufacturing (CAD/CAM) using open-source software were used to prepare a cutting guide that allowed harvesting a bone flap of precise dimensions and a biomodel that enabled intraoperative adjustment of the flap without pedicle division. Reconstruction was achieved with a 45-mm bone flap based on the deep branch of the SCIP and a 9 × 8 cm skin flap based on the superficial branch of the SCIP. Both flaps survived without complications; bone consolidation was observed at 4 months, and at 10 months, the patient had an adequate, pain-free gait. This case illustrates that an open-source, low-cost 3D-printing workflow may be a useful adjunct for planning and execution of metatarsal reconstruction with osteocutaneous free flaps.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840045","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":"Modified Open Guide Suture for Both Vessel Walls in Microvascular Anastomosis.","authors":"Ryo Kitai, Riku Katayama, Shinya Suzuki, Yoshichika Yasunaga","doi":"10.1002/micr.70247","DOIUrl":"https://doi.org/10.1002/micr.70247","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70247"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982225","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":"Feasibility of Flexor Hallucis Muscle-Based Fibula Bone Segment for Ramus Reconstruction in Head and Neck Cancers.","authors":"Meghna Reddy, Mayur Mantri, Vineet Kumar, Ameya Bindu, Kunal Mokhale, Dushyant Jaiswal, Saumya Mathews, Vinay Kant Shankhdhar","doi":"10.1002/micr.70245","DOIUrl":"10.1002/micr.70245","url":null,"abstract":"<p><strong>Introduction: </strong>In mandibular reconstruction with a free fibula flap, ramus reconstruction is very important to match the ramus height, which eventually helps in good mouth opening and mastication. The fibula bone segment attached to the pedicle is used for ramus reconstruction. But when the bone requirement is large and the pedicle is short, we propose an alternate method in which the bone segment is separated from the pedicle but is attached to the flexor hallucis longus (FHL) muscle from which it receives its vascularity indirectly. Through this article, we aim to examine the non-inferiority of the FHL-based ramus in such cases.</p><p><strong>Patients and methods: </strong>This is a retrospective observational report carried out in a tertiary care cancer institute and includes the segmental mandibular defects reconstructed with free fibula flaps (FHL-based vs. vascularized ramus) between January 2019 and December 2021, with a follow-up of a minimum of 1 year. The primary objective is to assess the complication rates for FHL-based ramus for osteoradionecrosis (ORN), hardware exposure, bone union rates, chronic sinus/discharge, and the need for secondary procedures in cases of free fibula flaps.</p><p><strong>Results: </strong>In 100 patients included in this report, the plate/hardware exposure rate (14% vs. 12%) (p = 1), nonunion rate (5.3% vs. 4%) (p = 1), sinus rate (4% vs. 0%) (p = 0.57), ORN (5.3% vs. 4%) (p = 1), and secondary procedures (16% vs. 16%) (p = 1) in FHL-based ramus versus vascularized ramus fibula flaps. p value is one suggesting the proportion of complications is the same in both groups.</p><p><strong>Conclusion: </strong>An FHL-based ramus provides an additional tool in the armamentarium when the bone requirement is huge and is not inferior to a vascularized ramus in terms of complication rate related to hardware exposure and bone necrosis.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70245"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982129","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}