Microsurgery最新文献

{"title":"Clinical, Preclinical, and Educational Applications of Robotic-Assisted Flap Reconstruction and Microsurgery: A Systematic Review","authors":"Laura Awad,&nbsp;Edward Bollen,&nbsp;Benedict Reed,&nbsp;Benjamin J. Langridge,&nbsp;Sara Jasionowska,&nbsp;Dariush Nikkhah,&nbsp;Peter E. M. Butler,&nbsp;Allan Ponniah","doi":"10.1002/micr.31246","DOIUrl":"10.1002/micr.31246","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Microsurgery and super-microsurgery allow for highly technical reconstructive surgeries to be performed, with repairs of anatomical areas of less than 1 mm. Robotic-assisted surgery might allow for further advances within microsurgery, providing higher precision, accuracy, and scope to operate in previously inaccessible anatomical areas. However, robotics is not well-established within this field.</p>\u0000 \u0000 <p>We provide a summary of the clinical and preclinical uses of robotics within flap reconstruction and microsurgery, educational models, and the barriers to widespread implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted of PubMed, Medline, and Embase. Preclinical, educational, and clinical articles were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One thousand five hundred and forty-two articles were screened; 87 articles met the inclusion criteria across flap harvest, flap/vessel pedicle dissection, vascular anastomosis, and nerve repair. The literature presents several potential benefits to the surgeon and patient such as high cosmetic satisfaction, minimally invasive access with reduced scarring (flap harvest), and low complication rates. Lack of haptic feedback was reported by authors to not impede the ability to perform vessel anastomosis; however, this required further investigation. A steep learning curve was identified, particularly for microsurgeons embarking upon robotic-assisted surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robotic-assisted surgery can potentially enhance microsurgery and flap reconstruction, with feasibility demonstrated within this review, up to anastomosis of 0.4 mm in diameter. However, there is a lack of sufficiently powered comparative studies, required to strengthen this statement. To increase accessibility to robotic surgery for plastic and reconstructive surgeons, educational opportunities must be developed with standardized assessment of skill acquisition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31246","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469817","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":"Unfractionated Heparin Administered Every 8 h Outperforms 12 Hourly Administration for Venous Thromboembolism Prophylaxis in Reconstructive Head and Neck Tumor Patients: A 12 Year Retrospective Cohort Study","authors":"Jevan Cevik,&nbsp;David P. Newland,&nbsp;Edward Cheong,&nbsp;Omar Shadid,&nbsp;Siyuan Pang,&nbsp;Sakshar Nagpal,&nbsp;Miguel Cabalag,&nbsp;Anand Ramakrishnan","doi":"10.1002/micr.31248","DOIUrl":"10.1002/micr.31248","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant risk of morbidity and mortality in surgical patients, especially those undergoing head and neck cancer surgery with microvascular free flap reconstruction. These patients are at a heightened risk of VTE due to numerous patient and surgical risk factors. VTE chemoprophylaxis guidelines in these patients are limited due to a distinct paucity of research. This study aims to contribute to this scarcity of information, providing guidance for surgeons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study evaluated the efficacy and safety of subcutaneous unfractionated heparin administered every 8 h versus every 12 h for postoperative VTE prophylaxis in patients undergoing head and neck resections with immediate free flap reconstruction. Data was collected from hospital medical records between January 2010 to December 2021. Patient demographics, operative details, and outcomes, including incidence of VTE and bleeding complications, were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 622 patients, those receiving heparin every 8 h (<i>n</i> = 393) demonstrated a significantly lower rate of VTE (0.8%) compared to 12-hourly group (<i>n</i> = 229; 3.9%) (<i>p</i> = 0.006). Additionally, there were no significant differences in the rates of postoperative hematoma between the two groups (9.4% versus 7.9% respectively, <i>p</i> = 0.510).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study suggests that an increased daily dose of unfractionated heparin every 8 h for VTE chemoprophylaxis is superior to a 12-hourly regimen with comparable bleeding profiles. Further multicentre, prospective studies are needed to validate these results and compare the efficacy and safety of unfractionated heparin with other agents such as low-molecular-weight heparin in this patient group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 8","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469819","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 the Outcomes of Osteocutaneous Radial Forearm and Fibula Free Flaps in the Reconstruction of Mandibular Osteoradionecrosis","authors":"Ayham Al Afif,&nbsp;Alex Peña-Garcia,&nbsp;Carissa M. Thomas,&nbsp;Joshua J. Kain,&nbsp;Jessica W. Grayson,&nbsp;Kiranya E. Tipirneni,&nbsp;Lindsay S. Moore,&nbsp;Hari Jeyarajan,&nbsp;Larissa Sweeny,&nbsp;Lisa Clemons,&nbsp;Eben L. Rosenthal,&nbsp;Benjamin J. Greene","doi":"10.1002/micr.31243","DOIUrl":"https://doi.org/10.1002/micr.31243","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study compares the outcomes of osteocutaneous radial forearm free flap (OC-RFFF) and fibula free flap (FFF) reconstruction of mandibular osteoradionecrosis (ORN).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective review of patients undergoing OC-RFFF/FFF reconstruction for mandible ORN between 2005 and 2020 at a tertiary center. Patient characteristics, postoperative complications, and functional outcomes were evaluated using chi-squared and logistic regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-six patients were included (OC-RFFF: 38; FFF: 18). Significantly more OC-RFFF patients had lateral mandible defects (94% vs. 61%, <i>p</i> = 0.0014). There were significantly more patients with exposed intraoral bone in the OC-RFFF group (23% vs. 0% <i>p</i> = 0.02), but no significant differences in hardware complications or flap failure. Donor site partial skin graft loss was more common in the FFF group (22% vs. 2.6%, <i>p</i> = 0.016), but no other significant differences in donor site morbidity were seen. Bivariable analysis showed no impact of flap type, tobacco/alcohol use, diabetes, or hypothyroidism on postoperative complications. Sixty percent of OC-RFFF, and 67% of FFF, patients resumed an oral diet after surgery. Oral diet was not impacted by flap type (OR = 0.769, 95% CI = 0.201–2.706, <i>p</i> = 0.688).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The OC-RFFF is an acceptable option in the reconstruction of ORN involving the lateral mandible, though there is increased risk of bone exposure. These findings can help guide surgeon selection of microvascular free flap donor sites and appropriate patient counseling.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447701","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":"Perforator-to-Perforator SCIP-Based Vascularized Lymphnode Transfer to Reduce Morbidity and Increase Efficacy in Lymphedema Surgery: Preliminary Results With 12 Cases","authors":"Matteo Meroni,&nbsp;Mario F. Scaglioni","doi":"10.1002/micr.31249","DOIUrl":"https://doi.org/10.1002/micr.31249","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vascularized lymphnode transfer (VLNT) is one of the most common surgical treatments for moderate and severe lymphedema. Various techniques have been described for harvesting lymph nodes from different donor sites. However, a standardized harvest procedure is still lacking. The transplantation of inguinal lymph nodes using the perforator-to-perforator technique may represent a significant advancement in this context. This approach relies always on the same vascular pedicle, offers a lower morbidity, and allows for a more superficial inset at the recipient site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>Between 2019 and 2022, 12 patients received a perforator-to-perforator VLNT for the treatment of late stage (Late II) lymphedema, both primary and secondary. In all cases, the lymphnodes were harvested from the groin supplied by the superficial circumflex iliac artery perforator (SCIP) vessels. The average age was 62.2 years old (range 47–73 years old); nine patients were females and three were males. In 11 cases, the lower limb was affected, and in one case, the upper limb was affected. Eight patients received additional lymphovenous anastomosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All the patients reported an improvement of the symptoms after surgery in terms of tissue quality (tenderness, lymphangiectasia, and pain), and no cases of recurrent cellulitis were reported. Postoperative lymphoscintigraphy was performed at 6 months, and in all cases, the function of transplanted lymphnodes was confirmed. No complications were encountered, neither at donor nor at recipient site. The follow-up was at least 12 months in all patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite being more technically demanding, the systematic implementation of the perforator-to-perforator technique for the transfer of SCIP-based inguinal lymphnodes can be a valuable evolution of VLNT. The aim of this study is to present how this technical approach may become a standardized procedure for inguinal-based VLNT, offering a reduced donor and recipient site morbidity and potentially enhancing the lymph draining effects due to a more superficial inset.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447702","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":"Video-Capillaroscopic Observation of Lymph Flow Following Lymphaticovenular Anastomosis","authors":"Chihiro Matsui,&nbsp;Hatan Mortada,&nbsp;Reiko Tsukuura,&nbsp;Toko Miyazaki,&nbsp;Maya Kanasaki","doi":"10.1002/micr.31245","DOIUrl":"https://doi.org/10.1002/micr.31245","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435498","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":"Development of a Training Model for Microvascular Tongue Reconstruction","authors":"Takeaki Hidaka,&nbsp;Yutaka Fukunaga,&nbsp;Shimpei Miyamoto,&nbsp;Takuya Higashino","doi":"10.1002/micr.31247","DOIUrl":"10.1002/micr.31247","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391788","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":"Full Thickness, Near-Total to Total Lower Lip Reconstruction Using Superficial Circumflex Iliac Artery Perforator Free Flap: A Case Report","authors":"Edward A. Stanley,&nbsp;Vlad Illie","doi":"10.1002/micr.31242","DOIUrl":"10.1002/micr.31242","url":null,"abstract":"<div>\u0000 \u0000 <p>Near-total to total lower lip defects present significant challenges for reconstructive surgeons, requiring restoration of oral competency, maximization of oral aperture, and cosmetic appearance. This report explores a novel reconstructive option addressing all three needs. Traditionally, local flap options restore cosmesis and oral competency by recruiting local tissue of similar thickness, pliability, and appearance, but often result in microstomia. Conversely, free flaps prevent microstomia but can lead to bulky and cosmetically unacceptable reconstructions. We present the first case of using a super-thin superficial circumflex iliac artery perforator (SCIP) free flap for near-total, full-thickness lower lip reconstruction. The patient was a 66-year-old female with recurrent squamous cell carcinoma of the lower lip, requiring wide local excision and resulting in an 80% full-thickness defect with unilateral oral commissure loss. An 8 cm × 5 cm × 5 mm SCIP flap was raised with a 4.5-cm pedicle length and anastomosed to the facial artery and vein. Clear fluids were commenced 7 days postoperatively, wounds healed 2 weeks postoperatively, and a normal diet was resumed at this time. The SCIP flap offers an excellent additional option for managing full-thickness near-total to total lower lip defects. Its thin, pliable nature and minimal donor site morbidity help restore oral competency, maximize oral aperture, and achieve a pleasing cosmetic result.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365817","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 Venous Augmentation on Complication Rates in Deep Inferior Epigastric Perforator Breast Reconstruction","authors":"Alexander Germann,&nbsp;Patrick Palines,&nbsp;Hannah Doran,&nbsp;Devin M. Melancon,&nbsp;Hugo St. Hilaire,&nbsp;Robert J. Allen,&nbsp;Mark Stalder","doi":"10.1002/micr.31220","DOIUrl":"10.1002/micr.31220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>With the rising popularity of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction, use of the superficial inferior epigastric vein (SIEV) to augment venous outflow has been proposed as a strategy to prevent venous congestion, a complication positively associated with flap volume. This study evaluated the impact of routine SIEV venous augmentation on the risk of vascular complications or operative fat necrosis in the context of flap size and operating time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study compared complication rates of patients with SIEV-augmented DIEP flaps to controls over a 3-year period. Outcomes assessed included vascular complications, defined as venous congestion or compromise requiring take-back, partial flap necrosis, total flap loss, as well as operative fat necrosis. Relative risk was modeled by Cox proportional hazard regression analysis. Sensitivity analysis was performed to assess for an interaction effect by flap mass.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study sample included 197 patients with 316 flaps. The mean mass of the SIEV-augmented flaps was significantly greater than in the control group (832.9 vs. 653.9 g; <i>p</i> = 0.0007). After adjustment for flap characteristics, patient demographic factors, and comorbidities, pooled risk of vascular complication and operative fat necrosis was found to be significantly lower in the SIEV-augmented group compared to controls (hazard ratio = 0.33, 95% CI [0.11–1.00]; <i>p</i> = 0.0489). Sensitivity analysis demonstrated no effect interaction by flap weight (<i>p</i> = 0.5139).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Routine venous outflow augmentation via anastomosis of SIEV to the internal mammary vein perforator at the second intercostal space significantly reduced the risk of vascular complications and operative fat necrosis, regardless of flap weight. No significant increase in operative time was observed among cases in which augmentation was performed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365819","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":"Microsurgery Training Using AR Glasses","authors":"Satoru Tamura,&nbsp;Ko Yoshizumi,&nbsp;Toshio Netsu,&nbsp;Ryuichi Azuma","doi":"10.1002/micr.31244","DOIUrl":"10.1002/micr.31244","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365818","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":"Reevaluation of Recipient Vessel Selection in Breast Free Flap Reconstruction","authors":"Mehdi S. Lemdani,&nbsp;Dustin T. Crystal,&nbsp;Jane N. Ewing,&nbsp;Zachary Gala,&nbsp;Chris Amro,&nbsp;Said C. Azoury,&nbsp;Robyn B. Broach,&nbsp;Irfan A. Rhemtulla,&nbsp;Joseph M. Serletti","doi":"10.1002/micr.31222","DOIUrl":"10.1002/micr.31222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current consensus has established the internal mammary vessels (IMV) over the thoracodorsal vessels (TDV) as the preferred recipients for microvascular breast reconstruction due to their superior flow rates and long-established outcomes. Yet, there are occurrences where the IMVs are not reliable and may subsequently prompt intraoperative decision-making. Several options exist, including the contralateral IMVs, thoracoacromial vessels, and TDVs. The appropriate sequence for vessel choice is not universally agreed upon. This study reevaluates the TDVs to highlight their viability as a second-line intraoperative alternative to the IMV and provide reference to the straightforward dissection required for harvest.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective, single-institution, breast-level analysis examining 4754 breast free flaps from 2978 patients undergoing bilateral free flap reconstruction was conducted. Postoperative complications within 180 days were evaluated, and cohorts based on anatomic anastomosis (IMV vs. TDV) were created to compare outcomes. Subanalysis was conducted based on flap laterality as well as whether a flap was planned or converted intraoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4754 breast free flaps, 4269 (89.8%) used the IMV while 485 (10.2%) used the TDV. Most complication rates between the TVD and IMV were not significantly different. Rates of flap loss were 1.0% and 1.2% for the IMV and TDV anastomosis (<i>p</i> = 0.59). IMV and TDV anastomosed flaps experienced similar rates of fat necrosis (6.3% vs. 6.2%, <i>p</i> = 0.915). However, multivariable analysis of all breasts regardless of laterality showed that skin necrosis was significantly less likely in TDV breasts (OR 0.45, 95% CI 0.29–0.71, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Given the relative similarity in cohort outcomes, TDV anastomosis can be considered a viable alternative to the IMV when the IMV is unavailable or technically disadvantageous. The TDV artery remains a robust and reliable option in the present-day plastic surgeon's repertoire for breast reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"44 7","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350001","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}