Microsurgery最新文献

{"title":"When Fewer Complications Cost More: A Value-Based Reanalysis of Donor-Site Reconstruction.","authors":"Georgios Karamitros, Gregory A Lamaris, William C Lineaweaver","doi":"10.1002/micr.70235","DOIUrl":"10.1002/micr.70235","url":null,"abstract":"<p><strong>Background: </strong>Reconstructive strategies are commonly evaluated according to complication rates and technical success at the individual patient level. However, interventions that reduce complications may simultaneously increase cumulative procedural exposure, operative utilization, and healthcare resource consumption across patient populations. This distinction reflects a broader epidemiologic trade-off between universal prophylactic intervention and selective escalation following clinically significant failure.</p><p><strong>Methods: </strong>We performed a value-based reinterpretation of the donor-site reconstruction study by Angela Alnemri et al., comparing staged reconstruction of radial forearm free flap donor sites using Integra followed by delayed split-thickness skin grafting (STSG) with primary STSG closure. Using published cohort data, we conducted a composite procedural burden analysis evaluating cumulative donor-site closure procedures under observed treatment patterns and under a procedural-economy counterfactual in which all patients underwent primary STSG with selective operative salvage only when clinically necessary.</p><p><strong>Results: </strong>The original study demonstrated lower rates of skin graft breakdown and tendon exposure with staged reconstruction. However, staged reconstruction required a second operative episode for nearly all patients by design, resulting in substantially greater cumulative procedural exposure. Across 179 patients, the observed treatment strategy resulted in 313 donor-site closure procedures. In contrast, the modeled procedural-economy strategy resulted in 179 + r procedures, where r represented patients requiring operative salvage following donor-site complications. Under the base-case assumption (r = 0), this corresponded to 134 fewer operative procedures. Even under conservative sensitivity assumptions permitting selective reoperation, substantial procedural reduction persisted before parity with universal staging was reached.</p><p><strong>Conclusions: </strong>Lower complication rates do not necessarily translate into lower healthcare utilization or greater value at the population level. In donor-site reconstruction, staged strategies reduce individual-level morbidity but do so through universal escalation of procedural intensity. Reconstructive decision-making should therefore incorporate procedural economy, operative exposure, and health-system resource utilization alongside conventional complication-based endpoints. Integrating epidemiologic and health-economic principles into reconstructive algorithms may better align technical outcomes with value-based surgical care.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70235"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982331","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":"Effect of Ultrasonic Dissection on Donor-Site Morbidity and Drainage in Latissimus Dorsi Free Flaps.","authors":"Bo Young Park","doi":"10.1002/micr.70246","DOIUrl":"10.1002/micr.70246","url":null,"abstract":"<p><strong>Background: </strong>Donor-site morbidity, particularly prolonged drainage and seroma formation, remains a persistent challenge in latissimus dorsi myocutaneous (LDMC) flap surgery. Although the Harmonic scalpel allows simultaneous cutting and coagulation and has demonstrated advantages in other surgical settings, its potential to mitigate drainage-related morbidity during full-muscle LDMC flap harvest has not been fully characterized. This study evaluated its impact on donor-site outcomes in free LDMC flap reconstruction.</p><p><strong>Methods: </strong>A retrospective review was performed of patients who underwent free LDMC flap reconstruction for lower extremity defects (from 2015 to 2025). Patients were grouped by dissection method: Harmonic versus conventional electrocautery. Outcomes included total drain volume, mean daily drainage, drainage duration, and seroma. Group comparisons and multivariable regression were used to assess predictors.</p><p><strong>Results: </strong>Forty-nine patients were analyzed (Harmonic, n = 21; Conventional, n = 28). Flap elevation time was significantly shorter in the Harmonic group (74.8 ± 14.7 vs. 120.2 ± 32.8 min, p < 0.001). Seroma occurred in six patients (21.4%) in the Conventional group but in none in the Harmonic group (p = 0.075). Mean total drainage volume was lower with Harmonic dissection (437.3 ± 242.0 vs. 610.7 ± 379.7 mL, p = 0.020), whereas mean daily drainage was similar (57.2 ± 21.5 vs. 54.8 ± 29.1 mL/day, p = 0.167). Drainage duration was significantly shorter in the Harmonic group (7.5 ± 2.4 vs. 10.9 ± 3.4 days, p = 0.004). On multivariable analysis, flap size independently predicted total drainage volume (β = 0.77, 95% CI 0.23-1.30, p = 0.006), and Harmonic use independently reduced drainage duration by 3.3 days (β = -3.32, 95% CI -5.54 to -1.09, p = 0.004).</p><p><strong>Conclusion: </strong>Harmonic dissection in free LDMC flap harvest shortened elevation time, reduced drainage duration, and eliminated seroma. These findings support its role in minimizing donor-site morbidity and improving efficiency.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":"e70246"},"PeriodicalIF":1.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005899","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":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148093736","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":"Re-Evaluation of the Ideal Injury to Flap Time Frame for Lower Extremity Free Flap Reconstruction: Is 72 h Still the Gold Standard?","authors":"Alexa Clark,&nbsp;Calvin Abdallah,&nbsp;Makenna Ash,&nbsp;William Knaus,&nbsp;Ciara Brown,&nbsp;Paul Ghareeb","doi":"10.1002/micr.70228","DOIUrl":"10.1002/micr.70228","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traumatic lower extremity injuries often require free tissue transfer (FTT) for limb salvage when local tissue is insufficient. Traditionally, reconstruction within 72 h has been considered optimal; however, advancements in wound management and perioperative care have challenged this paradigm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate outcomes of lower extremity FTT based on time from injury to reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was performed on patients undergoing lower extremity FTT after trauma at a single Level 1 trauma center (2014–2022). Patients were grouped by time from injury to flap: (&lt; 3 days, 4–21 days, 22–90 days, and &gt; 90 days). Ninety nine percent of patients were managed with negative-pressure wound therapy (NPWT) prior to definitive reconstruction. Outcomes included flap loss, complications, infection, osteomyelitis, nonunion, and amputation. Associations with comorbidities, surgical techniques, and fracture characteristics were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 102 patients, timing of reconstruction showed no significant differences in flap loss (<i>p</i> = 0.56), complications (<i>p</i> = 0.42), nonunion (<i>p</i> = 0.54), osteomyelitis (<i>p</i> = 0.19), or amputation (<i>p</i> = 0.58). No independent predictors of flap loss or complications were identified. Nonunion was associated with middle/proximal fracture levels (<i>p</i> = 0.0092), Masquelet technique (<i>p</i> = 0.0004), and higher Modified Frailty Index (<i>p</i> = 0.05). Osteomyelitis correlated with male gender (<i>p</i> = 0.01), proximal fracture level (<i>p</i> = 0.0098), and Masquelet technique (<i>p</i> = 0.0095). Amputation was associated with latissimus and radial forearm flaps (<i>p</i> = 0.0081), ipsilateral femur fracture (<i>p</i> = 0.0063), hypertension (<i>p</i> = 0.011), and higher ASA score (<i>p</i> = 0.0021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this series, delayed FTT beyond 72 h was not associated with increased flap loss or limb-threatening complications. Delayed reconstruction may optimize patient and wound factors, though aggressive wound management is essential. Given the retrospective design, uneven group sizes, and small early reconstruction cohort, these findings should be interpreted cautiously. Further research with larger cohorts and long-term outcomes is warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775979","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":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148093513","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 Effect of Ulnar Nerve Motor Branch Transfer in Cubital Tunnel Syndrome Surgery: A Comparison With In Situ Decompression Alone","authors":"Mustafa Kemal Yenidünya,&nbsp;İbrahim Faruk Adıgüzel,&nbsp;Esra Sena Orbak Yenidünya","doi":"10.1002/micr.70233","DOIUrl":"10.1002/micr.70233","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Advanced cubital tunnel syndrome causes progressive sensory and motor dysfunction, leading to hand weakness, intrinsic muscle atrophy, and functional impairment. Although surgical decompression relieves mechanical compression, functional recovery in McGowan Stage 3 patients is often limited due to irreversible axonal degeneration and delayed reinnervation of distal muscles. Distal end-to-side anterior interosseous nerve transfer has therefore been proposed as an adjunct to decompression to enhance reinnervation. The aim of this study was to evaluate the effects of this distal nerve transfer on intrinsic muscle recovery, clinical function, and electrophysiological outcomes in patients with advanced cubital tunnel syndrome.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Patients and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This retrospective study included 23 adult patients with McGowan Stage 3 ulnar neuropathy treated between February 2022 and June 2024. Patients were assigned to decompression alone (Group 1, &lt;i&gt;n&lt;/i&gt; = 13) or decompression combined with distal end-to-side anterior interosseous nerve to ulnar motor branch transfer (Group 2, &lt;i&gt;n&lt;/i&gt; = 10). Functional outcomes were evaluated using QuickDASH, British Medical Research Council (BMRC) grading, lateral pinch, and grip strength. Electrophysiological assessments included compound muscle action potential (CMAP) amplitude and motor conduction velocity (MCV) measured preoperatively and at 6 and 12 months postoperatively, with subgroup analyses based on preoperative fibrillation status.&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;At 12 months, QuickDASH improved significantly in both groups (Group 1: 52.4 ± 5.6 to 36.5 ± 10.0, &lt;i&gt;p&lt;/i&gt; = 0.001; Group 2: 55.1 ± 8.8 to 34.2 ± 9.8, &lt;i&gt;p&lt;/i&gt; = 0.005). British Medical Research Council grades also increased in both groups (Group 1: 2.6 ± 0.8 to 2.9 ± 0.6, &lt;i&gt;p&lt;/i&gt; = 0.005; Group 2: 2.1 ± 0.7 to 3.1 ± 0.7, &lt;i&gt;p&lt;/i&gt; = 0.047). Lateral pinch improved significantly only in Group 2 (7.8 ± 1.8 kg to 9.4 ± 2.0 kg, &lt;i&gt;p&lt;/i&gt; = 0.011), while grip strength showed no significant change (Group 1: 33.6 ± 6.9 kg to 36.1 ± 5.2 kg, &lt;i&gt;p&lt;/i&gt; = 0.057; Group 2: 31.9 ± 5.7 kg to 35.0 ± 7.9 kg, &lt;i&gt;p&lt;/i&gt; = 0.078). CMAP increased significantly at 12 months in both groups (Group 1: 5.28 ± 1.93 mV to 5.9 ± 1.7 mV, &lt;i&gt;p&lt;/i&gt; = 0.017; Group 2: 6.4 ± 1.7 mV to 7.6 ± 2.4 mV, &lt;i&gt;p&lt;/i&gt; = 0.036), and MCV also improved (Group 1: 37.9 ± 10.4 m/s to 43.6 ± 9.1 m/s, &lt;i&gt;p&lt;/i&gt; = 0.039; Group 2: 42.0 ± 8.5 m/s to 58.1 ± 8.5 m/s, &lt;i&gt;p&lt;/i&gt; = 0.008). Among patients with preoperative fibrillation, Group 2 demonstrated better postoperative lateral pinch (10.7 ± 1.2 vs. 8.0 ± 1.0 kg, &lt;i&gt;p&lt;/i&gt; = 0.013), QuickDASH (27.5 ± 5.5 vs. 42.3 ± 6.8, &lt;i&gt;p&lt;/i&gt; = 0.011), ","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775999","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":"Application of the SCIA-Pure Skin Perforator Flap in Bilateral Upper Eyelid Reconstruction: A Case Report and Review of the Literature","authors":"Carlos Pueyo Morillo,&nbsp;Zhan Q. Lin Wu,&nbsp;Jordi Serracanta Domènech,&nbsp;Antonio Bulla,&nbsp;Juan P. Barret,&nbsp;Danilo A. Rivas Nicolls","doi":"10.1002/micr.70232","DOIUrl":"10.1002/micr.70232","url":null,"abstract":"<div>\u0000 \u0000 <p>Facial burns often result in cicatricial eyelid retraction, causing corneal exposure, ulceration, and vision loss. Traditional reconstructive methods, such as full-thickness skin grafts or local flaps, frequently fail in extensive burns due to limited healthy tissue and a high risk of recurrent contracture. Achieving durable functional and aesthetic outcomes in such cases remains a major challenge. We report the use of bilateral free superficial circumflex iliac artery pure skin perforator (SCIA-PSP) flaps for upper eyelid reconstruction in a 50-year-old man with severe facial burns and recurrent bilateral upper eyelid retraction, leading to persistent lagophthalmos despite prior skin grafting. Preoperative color Doppler ultrasound was used to map SCIA perforators. Bilateral PSP flaps were elevated from the groin in the subdermal plane and transferred as free flaps to the eyelids, with microvascular end-to-end anastomoses to the supraorbital vessels. The postoperative course was uneventful, with no flap-related complications. At 52 months follow-up for the left eyelid and 31 months for the right, the patient achieved stable bilateral eyelid closure, resolution of lagophthalmos, excellent tissue pliability, and satisfactory aesthetic integration. The SCIA-PSP flap offers ultra-thin, vascularized tissue, effectively preventing recurrent contracture, and represents a reliable alternative in complex burn-related eyelid reconstruction.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147776004","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":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148092465","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":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148086424","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":"Cervical Spine Reconstruction With Vascularized Osteoadipofascial Fibular Flap and Periosteum Extension After Chordoma Resection and Adjuvant Proton Therapy: A Case Report","authors":"Javier Buendía Pérez,&nbsp;Santiago Sanz Medrano,&nbsp;Ángela Carrascosa Granada,&nbsp;Sergio Asensio Ramos,&nbsp;Beatriz Iniesta Lima,&nbsp;Cristina Gomez-Martinez de Lecea,&nbsp;Francisco Soldado","doi":"10.1002/micr.70230","DOIUrl":"10.1002/micr.70230","url":null,"abstract":"<div>\u0000 \u0000 <p>Cervical spine reconstruction is essential following en bloc tumor resections, particularly in defects exceeding four centimeters. Traditional mechanical solutions or non-vascularized grafts are often suboptimal, with complications such as non-union, infections, and instability. The vascularized osteoadipofascial fibular flap offers a durable alternative with structural and biological benefits. We present the case of a 55-year-old woman with an 8-month history of cervicobrachialgia and left upper limb paresis. Imaging revealed a 7-cm lesion spanning C4–T1 with foraminal infiltration, and histopathology confirmed a chordoma. A two-stage surgery was performed: posterior stabilization and partial tumor resection, followed by anterior corpectomies (C5, C6, C7) and reconstruction with a vascularized fibular flap. The flap was anastomosed to the superior thyroid vessels, and its adipofascial component isolated the esophagus from the anterior cervical plate. Postoperative proton therapy was administered. Postoperative recovery was uneventful, with a 10-day hospital stay. At 24 months, the patient showed no recurrence, complete symptom resolution, and stable osteosynthesis with evidence of bone callus formation at graft-vertebra junctions. This case suggests that vascularized fibular reconstruction may provide reliable structural support and biological integration in complex cervical oncologic defects.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723244","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}