Journal of reconstructive microsurgery最新文献

The fat-augmented latissimus dorsi (FALD) flap is an autologous flap that combines the latissimus dorsi (LD) flap with intraoperative autologous fat transfer (AFT) to improve the volume of the reconstructed breast. In recent years, our team has described the ergonomic FALD flap, a modification of this technique that helps to achieve a complete reconstruction in a single surgical step. In this case-control study, we analyze the long-term morphological changes of the breast after ergonomic FALD flap reconstruction compared with the traditional FALD flap technique.Between December 2020 and April 2023, we prospectively enrolled patients undergoing BR using FALD flap into two groups: group A included ergonomic FALD flap, while group B included traditional FALD flap. The primary endpoint was to compare the two groups in terms of breast projection, breast width, and breast height, while the second endpoint concerned the analysis of the aesthetic outcomes.Forty-two FALD flaps (31 patients) were performed for group A and 37 FALD flaps (29 patients) for group B. The two groups were homogeneous regarding demographic variables. Using a propensity score weighting analysis, group A showed a significantly higher breast projection compared with group B (6.78 vs. 5.75; p < 0.0001), after 18 months of follow-up. Final aesthetic analyses showed to be superior in group A concerning breast shape (p = 0.003) and global score evaluation (p = 0.023).The ergonomic FALD flap showed better long-term aesthetic outcome compared with the traditional transverse FALD flap, with higher breast projection and fewer additional delayed AFT sessions. The study provides level II evidence.

The descending genicular artery (DGA) axis can provide a versatile reconstruction that includes several tissue components, including bone, skin, muscle, tendon, and nerve. We present a novel CT angiography study to define the branches of the DGA axis as they relate to flap design for composite bone and soft tissue defect reconstruction.Lower limb CT angiography studies performed at a major microsurgery unit between 2019 and 2021 were evaluated by two independent clinicians. Vascular anatomy of the DGA, saphenous artery (SA), and branches to regional structures were evaluated and measured.An initial 98 studies were identified, with 64 studies included for final analysis. The DGA was seen in 56 (87.5%) cases. Cutaneous supply via the DGA axis was possible in 40 cases (70%). Cutaneous supply was seen via direct perforators in 18 (32.1%) cases and the SA in 34 (53.1%) cases. Branches to the vastus medialis were frequent (51.6%). A novel four-tier classification system of the cutaneous supply was developed to assist in chimeric flap design based on these findings. Based on this classification, cutaneous paddle design was possible via the SA in 60% of cases and a further 10% of cases via a direct DGA perforator (skin perforator arising from the DGA proper).The DGA axis provides separate and consistent soft tissue and bone pedicles, enabling reliable chimeric flap design. Preoperative CT angiographic imaging ensures a simple, versatile flap with a long pedicle and minimal donor morbidity.

At our breast reconstruction center, we have, over time, developed a focused program to increase access to care for low-resource patients. This program includes outreach clinics, physician extenders, care coordinators, and telehealth utilization.A retrospective review of all free flap breast reconstruction patients between 2017 and 2022 at our center was performed. Specific criteria, including insurance carrier, educational attainment, and zip code median household income, language barriers, and distance to hospital, were used to create favorably-resourced (FR) and unfavorably-resourced (UR) cohorts. Propensity score matching was then used to control for clinical factors and comorbidities.A total of 49 and 52 patients met the inclusion criteria for FR and UR cohorts, respectively, producing 33 matched pairs. FR was associated with a greater average number of donor site revisions (0.73 vs. 0.45, p = 0.05). Other statistically significant differences included average zip code household income ($109,477 FR vs. $71,996 UR, p < 0.01), bachelor's degree education level (26% FR vs. 16% UR, p < 0.01), and average distance to hospital (25 miles FR vs. 82 miles UR, p < 0.01). No significant differences were detected between groups regarding mastectomy skin flap necrosis, recipient site infection, recipient site wound, breast revisions, donor site infection, donor site wound, seroma, fat necrosis, hernia/bulge, length of follow-up, or drain removal time.This study shows that within a health system utilizing dedicated access to care programs, equivalent results were observed in autologous breast reconstruction among favorably and unfavorably resourced patients.

Microsurgical reconstruction is often first-line treatment in trauma cases, yet its role in burn reconstruction remains inconsistent, despite comparable injury complexity and resuscitation demands. While literature suggests mixed outcomes for free flap use in burns, no study has directly compared microsurgical outcomes between trauma and burn reconstructions. This study aimed to evaluate complication rates and outcomes of free flap reconstruction in trauma versus burn patients.We conducted an institutional review board-approved retrospective cohort study of patients who underwent microsurgical reconstruction following traumatic or burn injuries between October 2016 and September 2024 at a single Level 1 trauma and major burn referral center. Outcomes assessed included flap survival, flap failure, hematoma, infection, flap debridement, and hospital length of stay (LOS). Subgroup analysis compared acute versus delayed reconstructions.Ninety-six patients met inclusion criteria: 67 in the trauma group and 29 in the burn group. Flap success was 96.6% in the burn group versus 92.5% in the trauma group. Median LOS was significantly longer in burn patients (34 days [interquartile range, IQR: 1-67]) compared with trauma patients (20 days [IQR: 10-30]; p = 0.046). Complication rates did not significantly differ between groups (p = 0.356). In acute cases, flap success was 100% for burns versus 92% for trauma.Microsurgical reconstruction in burn patients demonstrates similar success and complication rates to trauma patients. Given these comparable outcomes, microsurgeons should actively collaborate with burn teams to ensure optimal care and expand reconstructive options for burn patients.

Organ-on-a-chip (OoC) platforms are microfluidic systems that replicate key aspects of human tissue physiology in controlled environments. Originally developed for drug testing and disease modeling, they provide a more human-specific and reproducible alternative to traditional preclinical models, which often fail to capture the complexity of tissues relevant to plastic and reconstructive surgery.This review synthesizes current OoC technologies with direct application to plastic and reconstructive surgery, focusing on skin-, vessel-, adipose-, and nerve-on-a-chip systems. The analysis emphasizes how these platforms model tissue structure, function, and interactions and evaluates their ability to simulate clinically relevant processes.Skin-on-a-chip platforms enable dynamic modeling of wound healing, graft integration, and barrier function. Vessel-on-a-chip systems replicate microcirculatory flow, endothelial function, and vascular wall behaviors, supporting studies of flap viability and ischemia-reperfusion injury. Adipose-on-a-chip preserves lipid metabolism and inflammatory signaling, informing research into fat graft retention and remodeling. Nerve-on-a-chip platforms allow real-time monitoring of nerve injury and regeneration, aiding evaluation of nerve repair and graft performance. Across these systems, OoC models provide more clinically relevant insights than animal or static in vitro approaches, though limitations persist, including restricted physiological complexity, lack of platform standardization, short-term viability, and scalability challenges.OoC platforms offer significant promise for advancing plastic and reconstructive surgery research by bridging translational gaps and aligning in vitro modeling with surgical outcomes such as graft take and nerve function. Future directions include incorporating immune elements, developing multitissue systems, expanding commercial accessibility, and improving long-term functionality. As these technologies mature, they have the potential to accelerate innovation and improve patient outcomes in reconstructive surgery.

Abdominally based free flap breast reconstruction offers excellent long-term outcomes, but donor-site morbidity remains a concern. Lower back pain is a prevalent musculoskeletal condition that may impair core stability and abdominal donor-site recovery after surgery. This study evaluated the association between a preexisting diagnosis of lower back pain and long-term physical well-being of the abdomen after surgery.We conducted a retrospective study of patients who underwent abdominally based free flap breast reconstruction between 2017 and 2024. Patients were categorized by the presence or absence of a preexisting diagnosis of lower back pain. The primary outcome was physical well-being of the abdomen, assessed using the BREAST-Q. Multivariable linear mixed-effects models evaluated the association between lower back pain and abdominal well-being.A total of 2,594 patients were included. Donor-site complications occurred in 15% of patients, including wound dehiscence (9.1%), surgical site infection (4.3%), palpable bulge (2.4%), seroma (2.2%), and hematoma (0.5%). Patients with preexisting lower back pain (n = 298, 11.5%) had significantly lower abdominal well-being scores compared with those without at 1 year (62 vs. 69; p < 0.001) and 5 years (65 vs. 76; p = 0.014). On multivariable analysis, lower back pain was independently associated with worse abdominal well-being (β = -5, 95% confidence interval [CI]: -8.9 to -0.97; p = 0.015), exceeding the minimal clinically important difference of ≥4.Preexisting lower back pain is associated with significantly worse long-term abdominal well-being after breast reconstruction. Future studies should investigate targeted interventions such as pre- and postoperative core rehabilitation protocols to improve outcomes in these high-risk patients.

Scalp reconstruction following oncologic resection can be challenging due to the presence of complicating factors such as extensive defects, cranioplasty, and radiotherapy, frequently requiring the need for free tissue transfer. While musculocutaneous flaps have traditionally been used, fasciocutaneous flaps are increasingly favored. However, their safety in these high-risk conditions remains unclear. This study examines whether flap type influences outcomes in oncologic scalp reconstruction.A retrospective review was performed of patients who underwent microsurgical scalp reconstruction for oncologic defects between 2018 and 2024 at two tertiary centers. Patients were grouped into musculocutaneous and fasciocutaneous flap cohorts. Postoperative complication rates were compared between the groups across various clinical settings.A total of 109 patients were included: 35 (32.1%) underwent musculocutaneous flap reconstruction, and 74 (67.9%) received fasciocutaneous flaps. The most commonly used flaps were the latissimus dorsi and anterolateral thigh flaps, respectively. The musculocutaneous group had more comorbidities, more frequent irradiation history, and larger defects. Postoperative complications occurred in 37 patients (33.9%), most commonly delayed wound healing. Overall and specific complication rates were similar between groups, except for late complications (occurring or persisting beyond 3 months), which were more frequent in the musculocutaneous group. This pattern held across subgroups defined by cranioplasty, radiotherapy, and defect size. Flap type did not independently predict complications on multivariable analysis.Our results suggest that both musculocutaneous and fasciocutaneous flaps are effective for oncologic scalp reconstruction. Fasciocutaneous flaps appear to be a reliable alternative, even in complex cases involving radiotherapy, cranioplasty, or extensive defects.

Postoperative hematoma is a common yet unfavorable complication following head and neck free flap reconstruction (HNFFR). This study aims to clarify how perioperative blood pressures influence postoperative neck hematoma development and its effect on outcomes in patients undergoing HNFFR.A retrospective chart review was conducted for all patients who underwent HNFFR at a single academic institution between January 2020 and December 2023. Data included demographics, radiation history, comorbidities, flap type, complications, and blood pressures at preoperative, intraoperative, early (<24 hours), and late (days 1-7) postoperative periods.A total of 317 patients with 329 flaps were included in our analysis. Twenty-seven patients developed a neck hematoma, and flap failure was significantly higher in these patients (11.1% vs. 2.4%, p = 0.044). After adjusting for potential confounding variables, hematoma formation was significantly associated with higher preoperative systolic and pulse pressures; peak early postoperative systolic pressures; and peak late postoperative systolic, diastolic, and mean arterial pressures (MAP). In a multivariate model including preoperative, early, and late postoperative MAP, only late postoperative MAP remained an independent predictor of hematoma. Each 1 mm Hg rise in late MAP raised hematoma odds by 4% (OR: 1.04, p = 0.004), and receiver operator curve analysis identified late MAP ≥ 117.8 carried a fivefold higher risk of hematoma (OR: 5.24, p < 0.001).Our findings suggest that postoperative blood pressure control is critical in reducing hematoma risk following HNFFR. Strict postoperative blood pressure management, particularly maintaining a MAP goal of < 110 mm Hg, may reduce hematoma risk and associated flap failure.

Timely surgical intervention for head and neck cancer (HNC) is critical to improving survival, particularly in advanced-stage disease requiring free-flap reconstruction. In medically underserved states, structural barriers such as rurality, socioeconomic disadvantage, and limited specialty availability can delay care. This study evaluates how race, insurance status, Social Vulnerability Index (SVI), and geographic distance affect delays in HNC surgical treatment in a state with the poorest national health outcomes and only one tertiary referral center.A retrospective cohort study was conducted at the University of Mississippi Medical Center, including all patients undergoing oncologic resection by oral and maxillofacial surgery and free-flap reconstruction by plastic surgery from January 2016 to July 2024. Demographics, tumor stage, insurance status, SVI, and driving distance were recorded. Care intervals were defined as the time from symptom onset to initial tertiary appointment (PreUMMC) and from initial appointment to surgery (PostUMMC).Of 180 patients (62.2% male, 70.6% White, 23.9% Black), 60% had government insurance and 22.5% resided in SVI quartile 4. Median PreUMMC delay was 115 days (interquartile range [IQR]: 61-225), which was over three times longer than the PostUMMC median of 28 days (IQR: 20-39; p < 0.001). PreUMMC delays were longest for SVI 4 patients (203.5 days, p = 0.029) and correlated with driving distance (ρ = 0.213, p = 0.004). Black patients were more likely to reside in high-SVI areas and present with advanced-stage tumors (pT4, 46.5 vs. 24.8%, p = 0.029). No significant sociodemographic differences were observed in PostUMMC timing.In Mississippi, disparities in HNC surgical timing occur predominantly before tertiary care access, reflecting the influence of geographic distance and social vulnerability. Once within the academic system, treatment timelines are equitable across groups. Addressing upstream barriers through targeted referral pathways, transportation solutions, and outreach to high-SVI communities is essential to improving timely surgical access.

Lymphatic surgery has gained increasing attention over the years due to significant advancements and successful outcomes in treating lymphedema and other lymphatic complications. Cornerstone treatments remain lymphovenous anastomosis and vascularized lymph node transfer. However, the transfer of lymphatic-rich tissues, known as vascularized lymphatic vessels transfer (VLVT), represents a technically simpler alternative. Once largely overlooked, this has recently gained attention as studies have shown its promising potential.A systematic review of PubMed, Google Scholar, and Scopus was performed using relevant keywords. Only human studies in English were included, excluding case reports. References cited in selected articles were also reviewed. The study aimed to evaluate the effectiveness of VLVT for immediate lymphatic reconstruction (ILR) to prevent lymphatic sequelae and for lymphedema treatment (LT) based on both objective and subjective symptom improvement. Complication rates at donor sites were also assessed. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.After removing duplicates, the literature search identified 213 articles, of which 12 studies, including 182 patients, were deemed eligible. VLVT was used for LT in 59 patients and for ILR in 123 patients. Among patients treated for lymphedema, most showed subjective and objective improvement, statistically significant reductions in circumference, decreased cellulitis incidence, and symptom relief, as reported in questionnaires. However, the evaluation of results varied significantly across studies. No cases of condition worsening were reported. For the ILR cases, when lymph axiality was maintained, the treatment succeeded in all cases.VLVT represents a promising addition to the surgical armamentarium for the surgical treatment and prevention of lymphedema, offering significant potential for physiological lymphatic restoration and improved patient outcomes.