Journal of reconstructive microsurgery最新文献

Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures.A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (n = 62) and a hand-sewn suture group (n = 43). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed.Patients in the coupler group were younger (47.6 ± 8.6 vs. 53.0 ± 7.9 years, p = 0.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, p = 0.025). Microanastomosis time was significantly shorter with couplers (19.6 ± 8.9 vs. 26.1 ± 6.5 minutes, p < 0.01). Flap survival was comparable between groups (96.8% vs. 100%, p = 0.512). Complication rates, including arterial/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure.Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.

Anatomy has long served as the foundation of surgical education and innovation. From the anatomical plates of the Renaissance to dissection theaters of the 18th century and currently modern cadaveric simulation labs and courses, the understanding of the human body has facilitated the evolution of microsurgery. This manuscript traces the historical connections between anatomical study and surgical advancement, focusing on anatomy's foundational role in the development of modern microsurgery.A narrative historical review was undertaken, examining primary and secondary sources describing the progression of anatomical study, its integration into surgical education, and its influence on the emergence and refinement of microsurgical techniques. Key contributions by early anatomists, the rise of microsurgery, and the construction of dedicated cadaver labs and respective flap courses are described and examined here.This review demonstrates that anatomical investigation has continuously informed and shaped microsurgical practice. Early anatomists established the groundwork for understanding vascular and soft-tissue relationships, while later innovations-including detailed mapping of cutaneous and perforator vessels, refinement of vascular anastomosis techniques, and the introduction of specialized microsurgical tools-emerged from anatomical inquiry. The establishment of dedicated cadaver labs and flap courses further strengthened this link, providing structured environments where anatomical knowledge and operative technique could be integrated, rehearsed, and advanced. Across centuries, these developments collectively illustrate the central role of anatomical dissection in enabling the precision and innovation that define modern microsurgery.As microsurgery advances alongside emerging technologies, the cadaver lab remains an irreplaceable cornerstone across all levels of surgical training-linking centuries of anatomical knowledge to the evolving demands of modern microsurgical practice.

This study investigates the impact of preoperative ultrasound mapping using color Doppler ultrasound (CDU) on surgical outcomes for anterolateral thigh (ALT) free flap reconstructions.A retrospective review was conducted on patients who were diagnosed with cancer and underwent ALT free flap reconstruction. Patients were grouped based on the use of either computed tomography angiography (CTA) with a handheld Doppler (HHD) or CDU for preoperative planning. Patient demographics, operation times, flap elevation durations, and postoperative outcomes were evaluated.A total of 63 patients were included in this study (23 in the CTA + HHD group and 40 in the CDU group). Preoperative CDU planning was associated with a significantly shorter total operation time (214 vs. 252 minutes, p = 0.05) compared with conventional imaging. The CDU group also demonstrated significantly lower rates of revision surgery (p = 0.006), total flap loss (p = 0.05), and partial flap loss (p = 0.05). In multivariate linear regression analysis, CDU use was the only factor independently associated with shorter flap elevation time (p = 0.04) among the evaluated surgical variables.The findings suggest that incorporating preoperative ultrasound mapping enhances surgical outcomes by optimizing flap elevation and reducing complications. The use of CDU proves valuable in achieving better preoperative planning, leading to improved efficiency and overall success in reconstructive surgeries using ALT free flaps.

While the risks and benefits of autologous breast reconstruction have been widely examined, nationally representative, longitudinal data on complication burden, flap utilization trends, and patient-level risk factors remain limited. The NIH All of Us Research Program provides an opportunity to address these gaps using a diverse, population-scale cohort.We identified 260 patients who underwent autologous breast reconstruction using current procedural terminology codes within the All of Us Registered Tier Dataset (1995-2025). Complications were tracked at 30 days and 1 year postoperatively. Logistic, multivariate regressions, and Kaplan-Meier analyses evaluated predictors and timing of complications. Unsupervised machine learning via k-means clustering was utilized to uncover phenotypic subgroups by age and body mass index (BMI).Deep inferior epigastric perforator flap utilization increased over time, particularly among younger patients. Complication rates did not significantly differ across flap types. BMI > 32.7 kg/m² was associated with increased 30-day complications, while age and race were not independent predictors. Chronic pain and persistent postoperative pain were the most common 1-year complications. Flap failure occurred in fewer than 2% of cases. Clustering revealed three patient subgroups with distinct complication profiles; older patients and those with higher BMI experienced greater morbidity but maintained high flap success rates.Autologous breast reconstruction is broadly effective across diverse patient populations. Complication risk is more strongly influenced by BMI than by age or race. Chronic pain emerged as a common long-term morbidity, underscoring the need for improved detection and management efforts. The diversity, depth, and follow-up available through All of Us enable nuanced insights into reconstructive outcomes not possible with traditional datasets.

Surgical needles have evolved to optimize tissue approximation while minimizing tissue damage. Needle point geometry is a critical operative factor that impacts surgical dexterity. This study aims to compare the effects of taper point (TP) and reverse cutting (RC) needles on tissue damage and anastomotic bleeding risk across different tissue types and needle diameters.Two experimental models were employed. The Tissue Damage Model pierced 10 abdominal and 10 cheek skin samples using TP and RC needles. Histologic impact on skin layers was analyzed. The Anastomosis Leakage Model measured fluid leakage after 30 porcine aortas were punctured by TP and RC needles of varying diameters in an ex vivo pulsatile flow system. Both experiments ensured controlled variables and consistent methodologies.In the Tissue Damage Model, RC needles caused twice as much dermal disruption in both abdominal and cheek skin as TP needles (p < 0.01). Abdominal skin exhibited twice the histological damage compared to facial skin, irrespective of needle geometry (p < 0.05).In the Anastomosis Leakage Model, RC needles caused 5.6-, 4.0-, and 8.7-fold more leakage than TP needles at small, medium, and large needle diameters, respectively (p < 0.002). Leakage from RC needles increased with needle diameter (p < 0.001). TP needles did not exhibit this effect.RC needles caused significantly more dermal disruption compared to TP needles. Greater tissue damage was observed in abdominal skin than in facial skin. Additionally, RC needles led to progressively higher fluid leakage as needle diameter increased, while TP needles did not.

Following open thoracoabdominal surgery, patients are at risk of chronic pain due to unintentional peripheral nerve injury (PNI), such as nerve transection, compression, or stretching of peripheral nerves. While laparoscopic surgery is minimally invasive, the incidence of subsequent PNI from laparoscopic surgery remains unknown.PubMed, Embase, Web of Science, and Scopus databases were searched for peer-reviewed literature discussing nerve injuries following open or laparoscopic thoracoabdominal surgeries.From 1,580 unique citations, 28 articles (n = 871 patients) qualified for inclusion. There were 555 (63.7%) males and 316 (36.3%) females. The mean age was 54.5 ± 9.6 years, ranging from 18 to 92. Following 451 open thoracoabdominal surgeries, there were 214 nerve injuries (47.5%). Following 420 laparoscopic thoracoabdominal surgeries, there were 22 nerve injuries (5.2%). Laparoscopic surgery had statistically significantly lower PNI (p < 0.0001) than open procedures. These procedures caused 236 reported cases of PNI, which included neuromas (50.4%), nerve enlargement (37.3%), nerve transection (8.5%), nerve entrapment (2.5%), perineural inflammation (2.2%), and nerve crush injury (0.4%). Of patients with PNI, surgery was performed on 170 (72.0%) patients, and nonsurgical treatments were given in 64 (27.1%) patients. The surgical interventions for PNI included neurectomy (78.8%), neuroma excision (19.4%), and scar excision (1.8%).A laparoscopic approach, versus a surgical open approach to treat thoracoabdominal surgical problems, has decreased the risk of inadvertent nerve injuries. The wide variation in the description of the types of injuries is indicative of the generally poorly understood nature of PNI, indicating an opportunity for greater emphasis on the diagnosis and treatment of this problem.

Formal dangling protocols are often used after lower extremity free flap reconstruction to acclimate flaps to gravitational stress. However, their clinical benefit remains uncertain. This study evaluates how the inclusion or omission of structured inpatient dangling affects flap outcomes.A retrospective review was conducted of 82 patients who underwent lower extremity free flap reconstruction at a single institution (2015-2024). Patients were grouped based on use of a formal dangling protocol (≥3 consecutive supervised sessions beginning after postoperative day 5) versus no protocol (ad libitum dangling beginning day 3). Outcomes included flap survival, complications, 30-day unplanned reoperation, time to ambulation, and length of stay. Statistical analysis included chi-squared, t-tests, and multivariable regression models.Fifty-three patients adhered to a dangle protocol; 29 did not follow a protocol. Demographics, comorbidities, flap type, and defect characteristics were similar between groups. Flap survival (96.2% vs. 96.6%, p = 0.94), partial necrosis (9.4% vs. 10.3%, p = 0.89), and reoperation rates (3.4% vs. 7.5%, p = 0.46) were comparable. On multivariable analysis, dangle protocol use was not associated with reduced complication risk (OR = 0.95, p = 0.93) but was associated with a 3.0-day longer median hospital stay (p < 0.01).The application of a formal dangling protocol did not affect flap survival but was independently associated with prolonged hospitalization. These findings challenge the necessity of structured regimens and support more patient-tailored postoperative strategies that may accelerate recovery without compromising surgical outcomes.

In total brachial plexus injury (BPI), there are inadequate donor nerves to adequately reinnervate the limb to regain full upper limb function. Free vascularized ulnar nerve grafts have been used to connect root stumps to the distal median nerve (MN) for hand neurotization. Axonal regeneration arrives by presenting with a sensate hand, but unpredictable motor reinnervation of the target muscles renders a paralyzed hand without extrinsic finger flexion. Thus, we describe the strategy of recycling the motor branches from the MN and replacing the forearm muscles with free functioning muscle transplantations (FFMTs).Between 1998 and 2017, a total of 34 patients received gracilis-FFMT for finger flexion, using previously reinnervated MN motor branches as the motor neurotizer. The muscle power of finger flexion [Medical Research Council (MRC)] and the satisfactory rate (≥M2) were recorded. The patient-reported outcomes, including the shortened version of the Disability of Arm, Shoulder and Hand (QuickDASH) and the Michigan Hand Outcomes Questionnaire (MHQ), were obtained.About 67.7% of the patients achieved finger flexion of M2 or greater after FFMT. The average postoperative QuickDASH score significantly decreased from 76.3 ± 13.8 to 65 ± 15.8 (p = 0.042). The overall MHQ score showed significant improvement in the domains of overall hand function and work.FFMT neurotized by previously reinnervated MN branches can serve as a salvage or adjunctive strategy to augment finger flexion. The surgical strategy of recycling previously innervated MN to an FFMT helps with efficient planning of donor nerves in reconstruction for total BPI.

Autologous breast reconstruction (ABR) is a reliable option for reconstruction after mastectomy. In cases where single donor sites do not offer adequate tissue, the use of "stacked" flaps, or multiple free flaps, can be brought together to provide optimal breast volume. This large-scale study aims to compare clinical outcomes, resource utilization, and readmission rates between single and stacked flaps.The National Readmission Database was used to retrospectively identify adult female patients who underwent ABR with free flaps between 2016 and 2020. In this study, free flaps were restricted to nonpedicled types, with latissimus dorsi (LD) and pedicled transverse rectus abdominis myocutaneous flaps (TRAM) excluded. Patients were categorized based on flap type (single vs. stacked) using relevant International Classification of Diseases, Tenth Edition (ICD-10) procedure codes. Patient demographics, hospital factors, complication rates, and readmission data were analyzed. The primary outcome was the difference in postoperative flap complication rates between single and stacked flaps.A total of 52,180 adult females were included for analysis. Of these, 51,140 (n = 98.5%) had single flaps and 783 patients (n = 1.5%) had stacked flaps. Use of stacked flaps was not statistically associated with higher odds of any flap complication (adjusted odds ratios: 1.16, p = 0.46) compared to single flaps. Stacked flaps were associated with longer length of stay and higher hospitalization costs, but there was no significant difference in 30-day readmission compared to the single flap cohort.Our study found similar rates of overall flap complications between the cohorts. Thus, in cases where more tissue is needed or desired, the use of stacked flaps appears to be a safe and feasible option to ABR.