Microsurgery最新文献

{"title":"Oncologic Considerations for Primary Facial Reanimation Following Parotid Adenoid Cystic Carcinoma Resection","authors":"Abraham Zavala, Christian Loayza, Cristian Apéstegui, Giancarlo Lucho, Ricardo Delgado","doi":"10.1002/micr.31264","DOIUrl":"10.1002/micr.31264","url":null,"abstract":"","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":"142623719","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":"Reducing the Distance Between Anode and Cathode to Make Handheld Nerve Stimulators More Selective in Nerve Fascicle Selection: Report of Two Cases","authors":"Lucas Marina,&nbsp;Elisa Sanz,&nbsp;Lara Cristobal,&nbsp;Andres A. Maldonado","doi":"10.1002/micr.31263","DOIUrl":"10.1002/micr.31263","url":null,"abstract":"<div>\u0000 \u0000 <p>Precise nerve fascicle identification is important in certain peripheral nerve procedures. Although we believe bipolar nerve stimulation with intraoperative neuromonitoring is a superior method, many rely on clinical response evoked by handheld monopolar nerve stimulators. We present a modification in the use of the latter for a more precise fascicle stimulation. A 55-year-old man with a right high brachial plexus injury and a 47-year-old woman with a left median nerve schwannoma were scheduled for exploration and ulnar-to-musculocutaneous nerve transfer, and for surgical excision respectively. Intraoperatively, we used a disposable handheld monopolar nerve stimulator in an unorthodox way, placing the anode right next to the cathode (both touching the same nerve fascicle). In the first case, a fascicle that showed flexor carpi ulnaris (FCU) and intrinsic hand muscle contraction with standard stimulation (anode placed on patient's skin), showed only FCU activation with our modified method, and was chosen as donor. A BMC grade M4 elbow flexion was achieved 9 months after surgery. In the second case, safe schwannoma excision was performed after our modified stimulation technique caused thenar muscle activation in a single, unaffected fascicle, while standard monopolar stimulation showed activation in several fascicles. No unexpected motor/sensory deficits were noted during follow-up. This report shows an easy modification in the use of handheld nerve stimulators that improves selectiveness when looking for nerve fascicles.</p>\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":"142623726","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":"Comparing Safety Profiles of Skin-Sparing and Nipple-Sparing Mastectomy With Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Retrospective Analysis","authors":"Madeleine M. Blazel,&nbsp;Joseph D. Quick,&nbsp;Rachel E. Schafer,&nbsp;Priya Shukla,&nbsp;Shannon S. Wu,&nbsp;Steven Bernard,&nbsp;Graham Schwarz,&nbsp;Risal Djohan,&nbsp;Raffi Gurunian,&nbsp;Sarah N. Bishop","doi":"10.1002/micr.31256","DOIUrl":"10.1002/micr.31256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mastectomy is performed prior to or concurrently with deep inferior epigastric perforator (DIEP) flap breast reconstruction. However, the complication rates of nipple-sparing mastectomy (NSM) versus skin-sparing mastectomy (SSM) with DIEP are not well-characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included patients who underwent SSM or NSM with DIEP reconstruction between January 2019 and July 2022 at an academic institution. The primary outcome was 30-day postoperative complication rate. Variables were compared using Student's <i>t</i>-tests/Wilcoxon rank-sum and Chi-square/Fisher's exact tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 535 patients, 195 (36%) underwent NSM and 340 (64%) underwent SSM. The 30-day postoperative complication rates did not differ between cohorts (16.4% in NSM vs. 16.8% in SSM, <i>p</i> &gt; 0.9). The NSM cohort had a higher rate of any flap necrosis (9.2% vs. 3.5%, <i>p</i> = 0.01) compared to the SSM cohort, though rates of total DIEP flap loss rate did not differ (4.1% vs. 1.5% respectively). Site-wide total DIEP flap loss was 2.4%. The NSM cohort had smaller preoperative sternal notch-to-nipple distances (25.0 vs. 26.5 cm, <i>p</i> &lt; 0.001) and had lower rates of preoperative radiation therapy (28.2% vs. 42.9%, <i>p</i> &lt; 0.002) compared to the SSM cohort. The cohorts did not differ in demographic or operative variables including reconstruction timing (delayed vs. immediate interval), readmission, and reoperation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals who received an NSM prior to DIEP reconstruction had more flap complications compared to the SSM cohort. Both cohorts had comparable overall 30-day postoperative complication rates and demographic variables, and rate of total DIEP flap loss was 2.4%. Patient preference can further guide surgical decision-making.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623588","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":"Linked Flaps of the Thoracodorsal Vascular Tree for Correcting Extensive Post-Burn Deformities and Achieving Optimal Reconstruction Outcomes","authors":"Hyun Jung Ryoo,&nbsp;Ji Hwan Park,&nbsp;Ji Ah. Park,&nbsp;Youn Hwan Kim,&nbsp;Hyung-Sup Shim","doi":"10.1002/micr.31254","DOIUrl":"10.1002/micr.31254","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autologous skin grafting has been the popular method for reconstructing post-burn defects. However, this technique has limitations such as high contracture rates and inadequate volume coverage. This report aims to propose the principles and advantages of utilizing microsurgically linked perforator flaps for the reconstruction of extensive burn defects and associated post-burn scar contracture in the lower and upper extremities and trunk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Patients who underwent free tissue transfer for primary and secondary burn wound reconstruction at a single institution between 2016 and 2023 were included in the study. Patients received thoracodorsal vascular tree-linked flaps for the correction of post-burn deformities. Postoperative results were evaluated, including flap survival, complications, and the DASH self-report questionnaire for upper extremity reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>Among the 20 patients, 12 required primary reconstruction, while 8 underwent secondary reconstruction using anastomotic chimeric free tissue transfer. The majority of burn injuries resulted from thermal contact (<i>n</i> = 8), followed by flames (<i>n</i> = 5), scalds (<i>n</i> = 4), electrical contact (<i>n</i> = 2), and friction (<i>n</i> = 1). The most frequently utilized combinations were the thoracodorsal artery perforator (TDAp) and anterolateral thigh (ALT) flap (11 cases). Additionally, four cases involved the pedicled TDAp flap in conjunction with the deep inferior epigastric artery perforator (DIEP) flap. The average DASH score for upper extremity burn patients was 10.58.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Three-dimensional tissue coverage achieved through the linkage of two or even three independent free flaps is increasingly utilized in post-burn reconstruction. This approach offers multiple advantages and represents a viable option for burn reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583713","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 Use of Pedicular Arteriovenous Fistula (PAVF) in Microvascular Reconstruction to Enhance Flow Across the Microvascular Anastomoses","authors":"Andrei Odobescu,&nbsp;Berkay Basagaoglu,&nbsp;Anca Dogaroiu,&nbsp;Rudolph F Buntic,&nbsp;Andrew Y Zhang,&nbsp;Bauback Safa","doi":"10.1002/micr.31252","DOIUrl":"10.1002/micr.31252","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free flap success rates have improved dramatically over the past three decades, setting a high standard for microvascular reconstruction. However, rates of arterial or venous thrombosis, and subsequent failure, remain high in burn and trauma reconstruction when compared to autologous breast reconstruction and other elective flaps. To address the higher failure rate, we use a novel vascular approach. We create a pedicular arteriovenous fistula (PAVF), allowing the flow to be enhanced across the microvascular anastomoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective review of 13 consecutive patients with 14 free flaps who underwent PAVF creation by the first author, AO. All patients who required free tissue transfer for trauma and burn reconstruction were indicated for PAVF during this study period. The flaps in this study included ALT, fibula, parascapular, and partial latissimus. The perforator and pedicle for the flaps were dissected in the usual manner. Distal to the takeoff of the perforator to the flap, the pedicular artery and the larger of the accompanying veins were anastomosed to create the PAVF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients were followed for a mean of 171 days Thrombosis was a rare complication in the group with one venous thrombosis (<i>n</i> = 1, 7.14%) and no arterial thrombosis. The most common complication was return to the operating room <i>n</i> = 4 (28.57%), two of which secondary to hematomas (14.29%), one wound dehiscence and one venous thrombosis. This latter patient eventually had partial flap loss.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We did not observe flap ischemia due to vascular steal, nor any venous congestion from pressurizing the venous outflow. As opposed to anticoagulation, flow enhancement aims to decrease the risk of thrombosis by reducing stasis. While further data is needed to compare the outcomes of venous enhanced flaps when compared to flaps treated prophylactically with anticoagulation, our initial data suggests that PAVF is a safe procedure and does not result in vascular steal or flap congestion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569080","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":"Postoperative Morbidity Outcomes Associated With Superficial Temporal Versus Cervical Vessels as Recipient Vessels in Head and Neck Reconstruction: A Systematic Review and Meta-Analysis","authors":"Woo Shik Jeong,&nbsp;Woonhyeok Jeong","doi":"10.1002/micr.31255","DOIUrl":"10.1002/micr.31255","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The purpose of this meta-analysis was to compare the surgical outcomes of head and neck reconstruction via free flap surgery, with neck vessels versus superficial temporal vessels as recipient vessels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PubMed, Embase, and Scopus databases were systematically searched via the following keywords: (“superficial temporal” OR “temporal”) AND (“free flap” OR “free tissue transfer”) AND (“head and neck” OR “face”). The following data were extracted: first author, publication year, flap type, reconstruction region, concordant vein graft, recipient vessel, and postoperative complications, including thrombosis, partial necrosis, and flap failure. The recipient vessels were divided into two groups: the superficial temporal artery (STA)/V group and the neck group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six hundred and thirty-five studies that met the inclusion criteria were included and reviewed systematically for a meta-analysis. Compared with the neck vessel group, the STA/V vessel group had a significantly greater risk of flap failure (odds ratio: 2.18; 95% CI: 1.32–3.60; <i>p</i> = 0.002), with low heterogeneity (<i>p</i> = 0.84; <i>I</i>² = 0%). However, there were no significant differences in the rates of thrombosis or partial necrosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with the use of neck vessels, the use of STA/V vessels as recipient vessels for head and neck reconstruction could increase the risk of total flap necrosis. Considering these findings, surgeons should exercise caution when selecting the STV as the recipient site, and as some authors have suggested, proximal dissection may be necessary during surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558213","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":"Simultaneous Reconstruction of the Esophagus and Posterior Tracheal Wall Using a Combination of Free Jejunal and Mesenteric Flaps: A Case Report","authors":"Keiichi Goishi,&nbsp;Yoshiro Abe,&nbsp;Hiroshi Harada,&nbsp;Kenta Ikushima,&nbsp;Mai Nakagawa,&nbsp;Shunsuke Mima,&nbsp;Ichiro Hashimoto","doi":"10.1002/micr.31257","DOIUrl":"10.1002/micr.31257","url":null,"abstract":"<div>\u0000 \u0000 <p>Free jejunal transfer is one of the most useful procedures for reconstructing circumferential defects following total pharyngolaryngoesophagectomy (TPLE). When an extended resection of the surrounding soft tissue is performed in addition to the TPLE, the defect may require another flap in addition to the jejunal flap to reconstruct the soft tissue defect. In such multiple defects, the choice of reconstruction method remains unanswered and unsolved. Herein, our objective was to clarify the utility of our newly developed technique of simultaneous reconstruction of two defects in the neck using a combination of free jejunal and mesenteric flaps. An 81-year-old man had defects in the upper esophagus, total larynx/pharynx, and posterior tracheal wall caused by the resection of invasive upper esophagus cancer anterior to the membranous part of the trachea. A chimera flap composed of a 15 cm free jejunal and mesenteric flap along with 15 cm of surplus mesentery was harvested; the jejunum was inserted into the esophageal defect and the mesentery was placed on the tracheal defect. The patient exhibited a favorable postoperative course at 8 months with no recurrence or stenosis in the reconstructed respiratory or gastrointestinal tract. This method offers a straightforward vessel anastomosis, making it a good and reasonable option for reconstructing partial tracheal defects along with TPLE.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558214","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":"Lymph-Interpositional-Flap Transfer Using Anterolateral Thigh Flap for Severe Limb Trauma Complicated by Lymphorrhea and Dermal Backflow: Indocyanine Green Lymphography-Assisted Approach","authors":"Takashi Kageyama,&nbsp;Hokuto Morii,&nbsp;Koichi Inokuchi","doi":"10.1002/micr.31253","DOIUrl":"10.1002/micr.31253","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504014","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 and Cost-Effectiveness of Intraoperative Flap Perfusion Assessment With Indocyanine Green Fluorescence Angiography in Breast and Head and Neck Reconstructions: A Systematic Review and Meta-Analysis","authors":"Ashokkumar Singaravelu,&nbsp;Cathleen McCarrick,&nbsp;Shirley Potter,&nbsp;Ronan A. Cahill","doi":"10.1002/micr.31250","DOIUrl":"10.1002/micr.31250","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Indocyanine green fluorescence angiography (ICGFA) is gaining popularity for the assessment of reconstructive flap perfusion intraoperatively. This study analyses the literature with a focus on its clinical efficacy and cost-effectiveness across various plastic and reconstructive surgery procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was conducted in accordance with PRISMA guidelines on published studies in English comparing ICGFA with standard clinical assessment for flap perfusion. Meta-analysis concerned perfusion-related complications and cost data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five studies met the inclusion criteria, of which two were randomized controlled trials (RCTs) and four were prospective cohort studies. Twenty-one studies were AHRQ Standard ‘Good’; however, the overall level of evidence remains low. ICGFA was predominantly performed in breast surgeries (<i>n</i> = 3310) and head and neck reconstruction (<i>n</i> = 701) albeit with inconsistency in protocols and predominantly subjective interpretations (only five studies utilized objective thresholds). In breast surgery, meta-analysis demonstrated significant reductions in mastectomy skin flap necrosis (odds ratio (OR) 0.58, <i>p</i> &lt; 0.0001), fat necrosis (OR 0.31, <i>p</i> &lt; 0.001), infection (OR 0.66, <i>p</i> = 0.02), and re-operation (OR 0.40, <i>p</i> &lt; 0.0001), but no significant decrease in total or partial flap loss (OR 0.78, <i>p</i> = 0.57/OR 0.87, <i>p</i> = 0.56, respectively) or increase in dehiscence (OR 1.55, <i>p</i> = 0.11). In head and neck surgery, ICGFA significantly decreased total flap loss (OR 0.47, <i>p</i> = 0.04), although not partial flap loss (OR 0.37, <i>p</i> = 0.13) and reoperation (OR 0.92, <i>p</i> = 0.73). Lower limb (<i>n</i> = 104) and abdominal wall (<i>n</i> = 95) reconstructive surgeries were much less studied with no significant ICGFA impact. Seven studies reported cost savings with flap surgeries and breast reconstructions, although study heterogeneity precluded meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ICGFA appears to be a useful, cost-effective tool to identify otherwise unsuspected hypoperfusion in breast and head and neck reconstruction. There is a clear need for standardization, however, to avoid bias. Further RCTs are necessary to solidify these promising clinical findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504013","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 Effect of Leg Dominance in Patients on Perforator-Based Flaps Elevated From the Lower Extremities","authors":"Dicle Aksöyler,&nbsp;Yiğit Yalçin,&nbsp;Görkem Durak,&nbsp;Mehmet Semih Çakir,&nbsp;Luigi Losco,&nbsp;Erol Kozanoğlu","doi":"10.1002/micr.31251","DOIUrl":"10.1002/micr.31251","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The lower extremities are the largest donor sites in the body for perforator flap reconstruction. Multislice row computed tomography angiography allows for a multiplanar assessment of perforators using a large number of three-dimensional images with high resolution. In this study, the effect of leg dominance on perforator flap donor site preference was investigated radiologically to increase preoperative perforator mapping precision and surgical success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The study included 40 patients. Superior <i>g</i>luteal artery perforator (SGAP) flap, inferior gluteal artery perforator (IGAP) flap, superficial circumflex iliac artery perforator flap, anterolateral thigh (ALT) flap, profunda artery perforator (PAP) flap, medial sural artery perforator (MSAP) flap, peroneal artery perforator (PP) flap, and posterior tibial artery perforator (PTAP) flap were analyzed according to their number of perforators (&gt; 0.8-mm perforators counted, number of larger perforators [nLP]), dominant perforator diameter (DPD), related muscle thickness (RMT), and related subcutaneous tissue thickness (RSTT) in each leg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of these 40 patients, 35 (87.5%) were right-leg dominant and 5 (12.5%) were left-leg dominant. The dominant leg had higher DPD for MSAP, PTAP, and PP than the nondominant leg (<i>p</i> = 0.08, <i>p</i> = 0.06, and <i>p</i> = 0.06, respectively). The dominant leg had a significantly higher nLP (&gt; 0.8 mm) in MSAP, PTAP, and PP flaps than the nondominant leg (<i>p</i> &lt; 0.05). Except for the PAP flap (adductor magnus muscle; <i>p</i> &gt; 0.05), RMT of all other perforator flaps (SGAP, IGAP, ALT, MSAP, PTAP, and PP) was statistically higher in the dominant leg (<i>p</i> &lt; 0.05). There was no statistically significant difference in RSTT between any of the two groups (<i>p</i> &gt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>According to findings, the dominant leg could be considered a donor site preference to improve surgical outcomes and reduce microsurgical complications due to an increased nLP, perforator diameter, and RMT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469818","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}