Journal of reconstructive microsurgery最新文献

Diabetic foot ulcer (DFU) care represents a significant challenge in plastic and reconstructive surgery. Oftentimes, patients encounter complex articles and websites to answer questions about their surgeries, including anterolateral thigh (ALT) flaps. Artificial intelligence (AI) represents a new and simplified resource for DFU patients seeking information regarding their care. To assess ChatGPT's utility as a patient resource, we evaluated the accuracy, comprehensiveness, and safety of AI-generated responses to frequently asked questions (FAQs) related to ALT flap surgery for DFU.Ten DFU and ALT flap care FAQs were posed to ChatGPT Model 3.5 in June 2024. Four plastic surgeons evaluated responses using a 10-point Likert scale for accuracy, comprehensiveness, and danger of ChatGPT's answers. Surgeons also provided qualitative feedback. Response readability was assessed using 10 readability indexes, averaged to produce a reading grade level for each response.Overall, ChatGPT answered patient questions with a mean accuracy of 9.1 ± 1.2, comprehensiveness of 8.2 ± 1.5, and danger of 2.0 ± 1.0. ChatGPT answered at a mean grade level of 19.8 ± 20.1. Qualitatively, physician reviewers complimented the organizational clarity of the responses (n = 4/10) and the AI's ability to provide information on possible surgical complications (n = 4/10). While one response was noted to present explicitly incorrect information about preoperative preparation protocols and when they should be initiated, the majority of responses (n = 6/10) left out key postoperative information, notably dangle protocols and compression.ChatGPT provides accurate and comprehensive responses to FAQs related to patients undergoing ALT flap surgery for the treatment of DFUs. The AI-generated responses were praised for organizational clarity and informative content regarding surgical complications, but lacked essential postoperative care details. Therefore, while ChatGPT is a valuable informational tool, further refinement is necessary to ensure that fully comprehensive information is provided to DFU patients.

Muscle flaps were historically considered superior to fasciocutaneous (FC) flaps for coverage of open fractures and exposed hardware. However, both flap types are now commonly used in modern lower extremity (LE) reconstruction, and it remains unclear whether postoperative infections rates differ. This study compares postoperative infection rates between muscle and FC flaps in free flap reconstruction following open LE fractures.A retrospective review was conducted on patients aged ≥18 years treated from 2011 to 2021 for open LE fractures requiring flap reconstruction after internal fixation. Demographics, injury characteristics, and perioperative factors were collected. The primary outcome was postoperative infection that could not be treated with antibiotics alone and required an unplanned return to the operating room for washout within 9 months of reconstruction. Univariate and multivariate analyses compared outcomes between muscle and FC flaps in free flap reconstruction.Of 164 patients, 86 (52.4%) had muscle flaps and 78 (47.6%) had FC flaps. Muscle flaps were more commonly used in patients with higher injury severity scores and injuries involving the knee/lower leg. The overall postoperative infection rate was 23.2%, with no significant difference between muscle or FC flaps (25.6 vs. 20.5%, p = 0.56). On multivariate analysis, muscle and FC flap types were not predictors postoperative infection. Other outcomes, including reoperation, length of hospital stay postreconstruction, time to ambulation, and secondary amputation rates, were similar between flap types.In reconstruction of open LE fractures, muscle and FC flaps yield comparable infection rates and complication profiles. Therefore, flap selection should be guided by injury characteristics, patient factors, and reconstructive goals.

Blood loss is a critical component of all surgical procedures. Excess blood loss may require a blood transfusion and increase the risk of complications after autologous breast reconstruction.Retrospective cohort of 264 consecutive autologous breast reconstruction patients between July 2017 and June 2022. Patients were stratified by reconstruction timing and bilateral versus unilateral reconstruction. Postoperative hemoglobin reduction and transfusion incidence were the primary outcomes of interest.Average preoperative hemoglobin (12.6 g/dL) was equivalent among all groups. Comparing bilateral immediate (n = 77) and delayed (n = 50) patients, immediate reconstructions had greater postoperative hemoglobin losses (-3.26 g/dL vs. -1.98 g/dL, p < 0.01) and higher transfusion rates (14% vs. 2.0%, p = 0.02). Comparing unilateral immediate (n = 99) and delayed (n = 38) patients, immediate reconstructions had greater hemoglobin losses (-2.60 g/dL vs. -1.41 g/dL, p < 0.0001) and higher transfusion rates (12.1% vs. 0.0%, p = 0.03). Using regression analysis, controlling for confounding variables and intraoperative resuscitation risk factors for blood transfusion requirement, were postmastectomy radiation therapy requirement (odds ratio [OR]: 10.3, p < 0.01) and vascular disease (OR: 14.5, p = 0.02). Unilateral reconstruction was protective from requiring transfusion (OR: 0.20, p = 0.03). Increasing BMI was protective, and with each increasing unit of BMI, transfusion requirement incidence decreased by 12.3% (p = 0.04). Transfusion was not associated with flap thrombosis or flap loss.Compared to immediate autologous breast reconstruction, a staged approach to both unilateral and bilateral patients can help minimize the risk of transfusion requirement. These factors, as well as additional modifiable and nonmodifiable risk factors, should be considered when determining the timing of autologous breast reconstruction for a patient.

The intersaphenous veins are inconstant veins interconnecting the great and the small saphenous veins. Due to the inclination of the superficial venous system to be rather inconsistent, this topic has never been described thoroughly and adequately before. The aim of our research was to observe intersaphenous veins and give a profound description of their variable anatomy.Sixty-three body donor limbs of Central European origin embalmed in formaldehyde were dissected. The tips of the medial and lateral malleoli were selected as suitable points of reference for measurements on the vertical axis of the leg. Additionally, each fibula was measured and related to the average length of the fibula in our examined sample. Consequently, each measurement was recalculated by this coefficient.Five types of arrangement were described: no connection (22.22%), one connection (46.03%), two connections (19.05%), three connections (11.11%), and four connections (1.59%). The average point of communication between the great saphenous vein and the intersaphenous vein was located 21.50 ± 9.64 cm proximal to the medial malleolus and between the small saphenous vein and the intersaphenous vein, 18.45 ± 6.05 cm proximal to the lateral malleolus. Multiple heatmaps were created for an easier comprehension of the topic.This research provides a detailed anatomy of intersaphenous veins of the leg. Yet variable in their arrangement, intersaphenous veins were found in the majority of investigated limbs. Thanks to their favorable anatomy, intersaphenous veins offer new alternatives to the traditional venous grafts from the saphenous veins, not only for heart bypasses.

Surgical reconstruction of pelvic defects aims to restore pelvic floor anatomy and function after oncological resection, infection, or trauma. The functional demands of the pelvis and proximity to anogenital flora can complicate wound healing, often necessitating locoregional flap reconstruction. While enhanced recovery after surgery (ERAS) protocols have shown benefits in other surgeries, they lack standardization for pedicled flap-based pelvic and perineal reconstructions.PubMed and Embase were queried for articles from January 2000 to January 2025 reporting pedicled flap-based pelvic and perineal reconstruction. Single case reports were excluded. Data regarding postoperative mobility protocols, including bed rest, mobilization, sitting, drain management, discharge timing, and complication rates, were extracted and categorized by the flap donor site region.Out of 536 articles identified, 42 met inclusion criteria. Remobilization protocols varied across different flap types. The median out-of-bed remobilization times for vertical rectus abdominis myocutaneous, inferior gluteal artery perforator, internal pudendal artery perforator, anterolateral thigh, and gracilis flaps were 5, 2, 5, 2, and 1 days postoperatively, respectively, with an overall range of 0 to 36 days. Sitting was allowed at 15, 6, 14, 14, and 2 days postoperatively for these flaps.The findings advocate for standardized ERAS protocols with early mobilization and graded sitting, challenging traditional prolonged bed rest practices. We propose specific guidelines for pedicled flap reconstruction of the pelvic and perineal areas, including 1 to 2 days of strict bed rest followed by short-distance ambulation. Gradual sitting protocols should start in the second week with attention to cushioning and offloading. For more vulnerable perineal-based flaps, 4 to 5 days of bed rest and sitting beginning in the third week are recommended. Continuing recovery at a rehabilitation center is also advised. Future studies are needed to examine and modify these protocols, taking into consideration patient factors, disease severity, such as radiation exposure, and the type of reconstruction performed.

Although arterial inflow considerations dominate microsurgical planning, venous outflow is equally vital for flap survival. Patients requiring free tissue transfer (FTT) for lower extremity (LE) reconstruction frequently present with occult preoperative venous thrombosis (VT), yet there are little data guiding perioperative management in this setting. This study examines the prevalence and clinical characteristics of patients with preoperative venous thrombosis (VT) undergoing LE FTT, as well as postoperative outcomes, to evaluate the feasibility of successful microsurgery in this high-risk cohort.A retrospective review of patients with preoperative VT undergoing LE FTT at a single institution was conducted.Among 279 patients, 43 (15.4%) were positive for VT. The overall deep VT (DVT) incidence in this population was 5.7% (n = 16/279) and the superficial VT (SVT) incidence was 10.0% (n = 28/279). Most thromboses were chronic (67.8%). There were two cases of takeback (4.7%) due to thrombosis (one arterial and one venous), of which one flap was salvaged. By a median follow-up duration of 9.7 months, a limb salvage rate of 88.4% was achieved.Preoperative VT is common in microsurgical candidates for limb salvage; however, it is not a contraindication to FTT if proper adjustments are made perioperatively. Considerations include (1) routine use of venous ultrasound to identify VT; (2) perioperative anticoagulation management, including IVC filter placement when indicated; (3) selection of recipient veins that are unaffected by VT; (4) prioritizing the use of two deep veins for anastomosis when feasible; and (5) incorporating implantable devices to monitor venous outflow.

Polyethylene glycol (PEG) hydrogel is capable of fusing transected axons and restoring axonal continuity. The technique requires precise nerve coaptation alignment and stability, which is difficult to achieve utilizing conventional microsuture neurorrhaphy. Nerve Tape (NT) is a microhook-based nerve coaptation device engineered to facilitate stable and accurate nerve end alignment. The primary objective was to modify and validate NT-assisted PEG fusion using a rabbit proximal tibial nerve repair model at an intermediate time point.Three groups of rabbits underwent mid-thigh tibial nerve transection and immediate repair with NT + PEG (n = 6), Suture + PEG (n = 6), or Suture only (n = 6). PEG-induced axonal fusion was acutely confirmed via demonstration of compound motor action potential (CMAP) restoration. Final outcome testing at 16 weeks included electrodiagnostic testing, nerve histomorphology, and muscle morphology.All 18 animals demonstrated immediate restoration of CMAPs. At 16 weeks, there were no statistical differences in nerve conduction velocity or amplitude, no statistical differences between groups in axon counts or g-ratios either near the nerve coaptations or at the ankle, and no differences in normalized gastrocnemius weight or girth.PEG fusion did not improve nerve regeneration or functional recovery in a rabbit tibial nerve repair model at 16 weeks. Modified NT did not improve the reliability or efficacy of the PEG fusion process compared with microsuture neurorrhaphy.

The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for revision, advantages well-suited to pediatric patients. Despite documented success in adults, the safety and utility of SCIP and SCIA-f are underexplored in pediatric populations.A systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases identified 93 articles reporting SCIP/SCIA-f outcomes in patients ≤ 17 years of age. Patient demographics, clinical characteristics, and postoperative outcomes were collected. Cohorts were stratified by SCIP/SCIA and age group. Mann-Whitney U tests compared cohort outcomes.Thirty-one studies were included, constituting 107 SCIA-f and 57 SCIP-f, with ages 10 weeks to 17 years. Most cases were congenital or traumatic defects in upper/lower extremities. Compared with SCIA-f, SCIP-f demonstrated significantly lower rates of all-cause complications, total flap loss, major and minor complications, and debulking (p < 0.05). All-cause complication rates were also significantly lower across age groups (p < 0.001).This meta-analysis demonstrates favorable efficacy and safety of SCIP-f in children with congenital and traumatic defects, especially of the extremities. SCIP-f may be considered a reliable option for pediatric reconstruction. Additionally, fewer subsequent procedures for contouring may be required.

Assessing the long-term implications of combining cross-facial nerve graft (CFNG) and masseteric-to-facial nerve transfer on long-term outcomes in patients with subacute facial paralysis.Patients with subacute facial palsy who underwent a masseteric-to-facial nerve transfer with CFNG from 2013 to 2020 were reviewed. A minimum of 2-year follow-up was required with 18 patients meeting inclusion criteria. Midface and periorbital measurements on standardized photos of patients in repose, closed, and open smile were analyzed preoperatively, 3 months, 1 year, and 3 years postoperatively as available. Emotrics software (Massachusetts Eye and Ear Infirmary, Boston, MA) and ImageJ (Rasband, W.S., U.S, National Institutes of Health, Bethesda, MD) were used for measurements. Longitudinal comparisons at each timepoint were analyzed using Wilcoxon two-sample testing.In repose, 1-year measurements including Commissure-Position, Smile-Angle, and Upper-Lip-Height-Deviation, were nonsignificant, whereas significance was noted at 3 years postoperatively (p = 0.042, 0.031, 0.042, respectively). Midface dynamic smile measurements on the palsy side and with symmetry showed significant differences from preoperative measurements at 1 and 3 years postoperatively. Periorbital measurements, including Marginal-Reflex-Distance-1, Marginal-Reflex-Distance-2, and Palpebral-Fissure-Height in repose, showed no significant changes at 1 year but were significant at 3 years (p = 0.004, 0.011, and 0.002, respectively), while during animation were significant at 1 and 3 years postoperatively.Combining CFNG with nerve transfer demonstrated progressive long-term improvement in resting tone and symmetry around the midface and periorbital region. Expected improvements were observed during animation over time.

Data supporting use of prophylactic venous augmentation in the deep inferior epigastric perforator flap (DIEP) is limited. This study aims to assess the outcomes of single vein DIEP flaps compared with those with venous augmentation and present an intraoperative decision pathway.A retrospective chart review was performed on patients who underwent DIEP flap reconstruction at a single institution from 2009 to 2023. Statistical analysis was performed and p-values less than 0.05 were considered statistically significant.A total of 1,099 patients had DIEP flap breast reconstruction resulting in 1,745 flaps. Two or more veins were utilized in 32.4%, whereas 67.6% had a single venous anastomosis. Prophylactic augmentation was documented for 24.5% of flaps. The rate of return to operating room was 5.8% with no significant difference found in the rate of return for all causes (p = 0.14) and suspected venous compromise (p = 0.95). Suspected venous compromise was documented in 41flaps (2.3%), with no significant difference between the single vein and prophylactic vein group (p = 0.95). There was no difference in rates of early (p = 0.10) or late flap loss (p = 0.15). Difference in operative duration was increased for flaps with prophylactic venous anastomoses (559.4 ± 127.8 vs. 505.6 ± 130.8 minutes; p < 0.001).This study demonstrates no significant difference in postoperative complications as well as demonstrating prophylactic multivein anastomosis was associated with significantly longer operative times. With the use of an intraoperative decision pathway, one can determine which flaps will benefit from additional venous outflow and avoid unnecessary routine augmentation without benefit.