Jose A Foppiani, Dani C Leung, Aneesh Syal, Roan N Anderson, Pedram Zargari, Neej Patel, Nolan Schwarz, Thomas Suszynski, Umar Choudry, Samuel J Lin
Background: Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasing limb dependency, to enhance venous adaptation. However, wide variability exists in their design, and the impact of dangling duration and frequency on complication rates remains unclear.
Methods: A systematic meta-analysis was performed to evaluate pooled complication rates associated with dangling protocols and to assess whether protocol duration (minutes per session) or frequency (number of sessions) was associated with adverse outcomes. Following PRISMA 2020 guidelines, we searched Medline, Embase, Web of Science, and Cochrane for relevant studies published through 2024. Then, a random-effects model was used to estimate pooled rates of partial flap loss, total flap loss, venous congestion, arterial compromise, hematoma, infection, wound dehiscence, return to the operating room, and donor site complications. Meta-regression was performed to examine associations with dangling protocol characteristics.
Results: Across pooled studies, overall complication rates were low, including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). No statistically significant associations were found between dangling duration and any complication type. While increased frequency of dangling was significantly associated with higher return-to-OR rates in the full model (slope = 0.0224; p = 0.0002), this relationship was entirely driven by a single study reporting 24 sessions/day. When this outlier was excluded, the association became non-significant.
Conclusion: Dangling protocols appear safe and well tolerated, with low rates of major complications. While the duration of dangling sessions does not affect complication risk, higher frequency may increase the likelihood of surgical re-intervention. These findings support the need for standardized, evidence-based protocols and further research into the physiologic and clinical thresholds guiding postoperative flap care. A meta-analysis of lower extremity free flap studies demonstrated low complication rates across common endpoints including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%).
Level of evidence: 3:
背景：悬垂方案被广泛应用于下肢游离皮瓣的术后处理，以促进微血管的适应。为了优化结果，外科医生使用悬垂方案，逐渐增加肢体依赖性，以增强静脉适应。然而，它们的设计存在很大的可变性，悬垂时间和频率对并发症发生率的影响尚不清楚。方法：进行了系统的荟萃分析，以评估与悬垂治疗方案相关的合并并发症发生率，并评估治疗方案持续时间（每次治疗分钟）或频率（每次治疗次数）是否与不良结果相关。根据PRISMA 2020指南，我们检索了Medline、Embase、Web of Science和Cochrane，检索了截至2024年发表的相关研究。然后，使用随机效应模型来估计部分皮瓣丢失、全部皮瓣丢失、静脉充血、动脉损伤、血肿、感染、伤口裂开、返回手术室和供区并发症的总发生率。进行meta回归以检查与悬垂协议特征的关联。结果：在汇总研究中，总体并发症发生率较低，包括皮瓣总丢失（0.30%）、动脉损害（0.30%）和静脉充血（0.73%）。悬垂时间与并发症类型之间无统计学意义的关联。虽然在整个模型中，悬挂频率的增加与更高的or回报率显著相关（斜率= 0.0224;p = 0.0002），但这种关系完全是由一项报告24次/天的研究驱动的。当这个异常值被排除后，这种关联就变得不显著了。结论：悬垂治疗方案安全且耐受性良好，主要并发症发生率低。虽然悬挂手术的持续时间不会影响并发症的风险，但更高的频率可能会增加手术再干预的可能性。这些发现支持了标准化、循证方案的必要性，并进一步研究指导术后皮瓣护理的生理和临床阈值。下肢游离皮瓣研究的荟萃分析显示，常见终点的并发症发生率较低，包括皮瓣总丢失（0.30%）、动脉损伤（0.30%）和静脉充血（0.73%）。证据等级：3；
{"title":"The Art and Science of Dangling: A Systematic Review of Free Flap Protocols.","authors":"Jose A Foppiani, Dani C Leung, Aneesh Syal, Roan N Anderson, Pedram Zargari, Neej Patel, Nolan Schwarz, Thomas Suszynski, Umar Choudry, Samuel J Lin","doi":"10.1002/micr.70190","DOIUrl":"https://doi.org/10.1002/micr.70190","url":null,"abstract":"<p><strong>Background: </strong>Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasing limb dependency, to enhance venous adaptation. However, wide variability exists in their design, and the impact of dangling duration and frequency on complication rates remains unclear.</p><p><strong>Methods: </strong>A systematic meta-analysis was performed to evaluate pooled complication rates associated with dangling protocols and to assess whether protocol duration (minutes per session) or frequency (number of sessions) was associated with adverse outcomes. Following PRISMA 2020 guidelines, we searched Medline, Embase, Web of Science, and Cochrane for relevant studies published through 2024. Then, a random-effects model was used to estimate pooled rates of partial flap loss, total flap loss, venous congestion, arterial compromise, hematoma, infection, wound dehiscence, return to the operating room, and donor site complications. Meta-regression was performed to examine associations with dangling protocol characteristics.</p><p><strong>Results: </strong>Across pooled studies, overall complication rates were low, including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). No statistically significant associations were found between dangling duration and any complication type. While increased frequency of dangling was significantly associated with higher return-to-OR rates in the full model (slope = 0.0224; p = 0.0002), this relationship was entirely driven by a single study reporting 24 sessions/day. When this outlier was excluded, the association became non-significant.</p><p><strong>Conclusion: </strong>Dangling protocols appear safe and well tolerated, with low rates of major complications. While the duration of dangling sessions does not affect complication risk, higher frequency may increase the likelihood of surgical re-intervention. These findings support the need for standardized, evidence-based protocols and further research into the physiologic and clinical thresholds guiding postoperative flap care. A meta-analysis of lower extremity free flap studies demonstrated low complication rates across common endpoints including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%).</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 2","pages":"e70190"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142888","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}
Jonas Wüster, Leonard Knoedler, Tobias Niederegger, Leonard Simon Brandenburg, Gabriel Hundeshagen, Max Heiland, Steffen Koerdt
Background
Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions.
Methods
A narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability.
Results
Flap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions—such as thin fasciocutaneous or muscle flaps on well-perfused beds—were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap “training,” showed potential to promote vascular remodeling, but clinical evidence remains limited.
Conclusion
Flap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.
{"title":"Autonomization of Microvascular Free Flaps in Reconstructive Surgery: A Narrative Review","authors":"Jonas Wüster, Leonard Knoedler, Tobias Niederegger, Leonard Simon Brandenburg, Gabriel Hundeshagen, Max Heiland, Steffen Koerdt","doi":"10.1002/micr.70186","DOIUrl":"10.1002/micr.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Flap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions—such as thin fasciocutaneous or muscle flaps on well-perfused beds—were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap “training,” showed potential to promote vascular remodeling, but clinical evidence remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Flap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086227","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}
Anna Paganini, Jonas Löfstrand, Nushin Mirzaei, Emma Hansson
Background
As bariatric surgery becomes increasingly common, reconstructive surgeons are encountering more massive weight loss (MWL) patients requiring breast reconstruction. MWL alters breast anatomy, tissue characteristics, and healing capacity, potentially impacting reconstructive outcomes.
Objective
To update and evaluate the evidence on how MWL affects complication and revision rates, flap-relevant anatomy, and patient-reported outcomes (PROMs) following postmastectomy breast reconstruction. In addition, research gaps were identified.
Methods
This systematic review updated a previous review and followed PRISMA guidelines. Eligible studies included cohort studies and case series of postmastectomy breast reconstruction after MWL. Data extraction and appraisal were performed independently by two reviewers, with evidence quality rated using the GRADE system.
Results
Fifteen studies met the inclusion criteria, including three case–control studies and twelve case series, reporting outcomes for 102 patients after massive weight loss (MWL). Most reconstructions used abdominally based free flaps, with few MWL-specific modifications. MWL patients experienced significantly higher rates of delayed wound healing, surgical-site infection, fat necrosis, and need for revision compared with controls, while total flap loss rates were similar. Evidence on implant-based reconstruction, vascular anatomy, and PROMs was scarce. The overall certainty of evidence was very low (GRADE ⊕⊝⊝⊝).
Conclusion
Breast reconstruction after MWL is associated with increased wound-healing complications and revision rates, though patient satisfaction appears acceptable. Evidence remains limited by small, heterogeneous studies and a lack of controlled or prospective data. Future research should address optimal reconstructive techniques, timing, and patient selection, including the identification of modifiable risk factors and the use of PROMs to guide evidence-based care.
{"title":"Postmastectomy Breast Reconstruction Following Massive Weight Loss: An Updated Systematic Review and Identification of Research Gaps","authors":"Anna Paganini, Jonas Löfstrand, Nushin Mirzaei, Emma Hansson","doi":"10.1002/micr.70185","DOIUrl":"10.1002/micr.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As bariatric surgery becomes increasingly common, reconstructive surgeons are encountering more massive weight loss (MWL) patients requiring breast reconstruction. MWL alters breast anatomy, tissue characteristics, and healing capacity, potentially impacting reconstructive outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To update and evaluate the evidence on how MWL affects complication and revision rates, flap-relevant anatomy, and patient-reported outcomes (PROMs) following postmastectomy breast reconstruction. In addition, research gaps were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This systematic review updated a previous review and followed PRISMA guidelines. Eligible studies included cohort studies and case series of postmastectomy breast reconstruction after MWL. Data extraction and appraisal were performed independently by two reviewers, with evidence quality rated using the GRADE system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifteen studies met the inclusion criteria, including three case–control studies and twelve case series, reporting outcomes for 102 patients after massive weight loss (MWL). Most reconstructions used abdominally based free flaps, with few MWL-specific modifications. MWL patients experienced significantly higher rates of delayed wound healing, surgical-site infection, fat necrosis, and need for revision compared with controls, while total flap loss rates were similar. Evidence on implant-based reconstruction, vascular anatomy, and PROMs was scarce. The overall certainty of evidence was very low (GRADE ⊕⊝⊝⊝).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Breast reconstruction after MWL is associated with increased wound-healing complications and revision rates, though patient satisfaction appears acceptable. Evidence remains limited by small, heterogeneous studies and a lack of controlled or prospective data. Future research should address optimal reconstructive techniques, timing, and patient selection, including the identification of modifiable risk factors and the use of PROMs to guide evidence-based care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086254","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}
The risk of internal jugular vein thrombosis is a concern when using the internal jugular vein as a recipient vein in microvascular head and neck reconstruction. This study aimed to investigate the incidence of internal jugular vein thrombosis within 2 weeks of microvascular head and neck reconstruction using computed tomographic angiography.
Methods
This retrospective study included 103 patients who underwent postoperative contrast-enhanced computed tomography within 2 weeks of microvascular head and neck reconstruction. The incidence, characteristics, treatment course, outcomes, and risk factors of internal jugular vein thrombosis were investigated.
Results
Internal jugular vein thrombosis was found in five cases (4.7%). In three of these cases (2.8%), internal jugular vein thrombosis occurred on the side of the microvascular anastomosis, and all of them were completely obstructed; however, the flaps survived without vascular compromise. No variables were considered risk factors for internal jugular vein thrombosis.
Conclusions
The incidence of internal jugular vein thrombosis after microvascular head and neck reconstruction was lower than previously reported. Most cases of internal jugular vein thrombosis are assumed to be subclinical and do not lead to anastomotic failure. It remains unclear whether asymptomatic internal jugular vein thrombosis on the anastomotic side should be treated.
{"title":"Prevalence of Subclinical Internal Jugular Vein Thrombosis After Microvascular Head and Neck Reconstruction","authors":"Daichi Kurita, Shimpei Miyamoto, Yuki Saito, Kenya Kobayashi, Kou Fujisawa, Mutsumi Okazaki","doi":"10.1002/micr.70183","DOIUrl":"10.1002/micr.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The risk of internal jugular vein thrombosis is a concern when using the internal jugular vein as a recipient vein in microvascular head and neck reconstruction. This study aimed to investigate the incidence of internal jugular vein thrombosis within 2 weeks of microvascular head and neck reconstruction using computed tomographic angiography.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 103 patients who underwent postoperative contrast-enhanced computed tomography within 2 weeks of microvascular head and neck reconstruction. The incidence, characteristics, treatment course, outcomes, and risk factors of internal jugular vein thrombosis were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Internal jugular vein thrombosis was found in five cases (4.7%). In three of these cases (2.8%), internal jugular vein thrombosis occurred on the side of the microvascular anastomosis, and all of them were completely obstructed; however, the flaps survived without vascular compromise. No variables were considered risk factors for internal jugular vein thrombosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of internal jugular vein thrombosis after microvascular head and neck reconstruction was lower than previously reported. Most cases of internal jugular vein thrombosis are assumed to be subclinical and do not lead to anastomotic failure. It remains unclear whether asymptomatic internal jugular vein thrombosis on the anastomotic side should be treated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Level of Evidence</h3>\u0000 \u0000 <p>3.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146030260","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}
Ethan Blum, Ashley Brantingham, Jennifer Goodlin, Nathaniel P. Olafsen, Christopher J. Dy
Severe carpal tunnel syndrome (CTS) with advanced thenar denervation has limited reconstructive options, and reliable reinnervation remains challenging. Reverse end-to-side (RETS) nerve transfers have been described in other contexts but to our knowledge, have not been applied clinically to compressive median neuropathy at the wrist. Here, we present three patients, ages 59, 68, and 72 years, with severe CTS, visible thenar atrophy, and electrodiagnostic evidence of profound median motor axon loss who underwent carpal tunnel release with abductor digiti minimi (ADM)-to-recurrent motor branch (RMB) RETS transfer. All procedures were performed using a standardized microsurgical technique. Follow-up was 10 months (Case 1), 24 months (Case 2), and 8 months (Case 3). Postoperatively, each patient demonstrated early return of visible thenar contraction between 6 weeks and 4 months, with final abductor pollicis brevis (APB) strength of 4 to 4+. Sensory recovery improved across all cases, with two-point discrimination normalizing to 5–8 mm. Follow-up electrodiagnostic studies in two patients showed markedly greater APB compound muscle action potential (CMAP) amplitudes when stimulating through the ulnar nerve than through the median nerve, consistent with donor-derived reinnervation through the transfer. Patient-reported outcome measurement information system (PROMIS) upper extremity (UE) and physical function (PF) scores improved by 9–22 points. Although these early results suggest the potential for donor-derived reinnervation in severe CTS, the findings are preliminary and should be interpreted with caution. Larger prospective studies will be necessary to determine the true functional benefit, appropriate patient selection criteria, and comparative effectiveness of this technique.
{"title":"Reverse End-to-Side Abductor Digiti Minimi-to-Recurrent Motor Branch Nerve Transfer for Severe Carpal Tunnel Syndrome: Report of Three Cases","authors":"Ethan Blum, Ashley Brantingham, Jennifer Goodlin, Nathaniel P. Olafsen, Christopher J. Dy","doi":"10.1002/micr.70184","DOIUrl":"10.1002/micr.70184","url":null,"abstract":"<div>\u0000 \u0000 <p>Severe carpal tunnel syndrome (CTS) with advanced thenar denervation has limited reconstructive options, and reliable reinnervation remains challenging. Reverse end-to-side (RETS) nerve transfers have been described in other contexts but to our knowledge, have not been applied clinically to compressive median neuropathy at the wrist. Here, we present three patients, ages 59, 68, and 72 years, with severe CTS, visible thenar atrophy, and electrodiagnostic evidence of profound median motor axon loss who underwent carpal tunnel release with abductor digiti minimi (ADM)-to-recurrent motor branch (RMB) RETS transfer. All procedures were performed using a standardized microsurgical technique. Follow-up was 10 months (Case 1), 24 months (Case 2), and 8 months (Case 3). Postoperatively, each patient demonstrated early return of visible thenar contraction between 6 weeks and 4 months, with final abductor pollicis brevis (APB) strength of 4 to 4+. Sensory recovery improved across all cases, with two-point discrimination normalizing to 5–8 mm. Follow-up electrodiagnostic studies in two patients showed markedly greater APB compound muscle action potential (CMAP) amplitudes when stimulating through the ulnar nerve than through the median nerve, consistent with donor-derived reinnervation through the transfer. Patient-reported outcome measurement information system (PROMIS) upper extremity (UE) and physical function (PF) scores improved by 9–22 points. Although these early results suggest the potential for donor-derived reinnervation in severe CTS, the findings are preliminary and should be interpreted with caution. Larger prospective studies will be necessary to determine the true functional benefit, appropriate patient selection criteria, and comparative effectiveness of this technique.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018765","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}
Ahmed M. Omran, Atef A. Hassan, Sherif Hamdeno, Mahmoud Abdelhamid Elhendawy, Mohamed M. Elghor, Rania Fouad Khattab, Mohamed Gaafar, Hany Mahmoud Ismail, Mohamed Hamouda Elkasaby, Amr A. Hassan, Saber M. Abdelmaksoud
Background
Peripheral nerve injuries (PNI), particularly digital nerve injuries, can lead to significant loss of function, pain, and sensory deficits. Autologous nerve grafting (ANG) has been the gold standard for nerve gap reconstruction, but it is associated with donor site morbidity and other complications. Nerve conduits, including collagen-based, chitosan-based, and muscle-in-vein conduits, have emerged as potential alternatives with the advantage of avoiding donor site morbidity. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of nerve conduits versus autologous nerve grafts for digital nerve repair, with a particular focus on sensory recovery.
Methods
A systematic review and meta-analysis were performed following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies comparing nerve conduits to ANG for the treatment of digital nerve injuries were identified through comprehensive database searches up to July 2025 on PubMed, Scopus, Embase, and Web of Science. Primary outcomes included static and moving two-point discrimination (S2PD and M2PD). Secondary outcomes included the safety profile. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model.
Results
A total of five studies with a total number of 214 patients were included in the analysis. Nerve conduits showed comparable sensory recovery to ANG for both S2PD (MD = −0.21; 95% CI −2.25 to 1.83; p = 0.84) and M2PD (MD = −0.67; 95% CI −2.00 to 0.66; p = 0.84). Subgroup analysis indicated that chitosan-based conduits demonstrated significantly better outcomes than ANG for S2PD (MD = −2.57; 95% CI −3.40 to −1.74; p < 0.0001); however, overall pooled results across all conduit types showed comparable sensory recovery to ANG. Complication rates were comparable between the two treatments (RR = 2.36; 95% CI 0.90 to 6.22; p = 0.08), with low heterogeneity across studies (I2 = 0%). Pooled results from RCTs showed a lower rate of complications with the conduit compared to ANG, RR = 3.32 (95% CI: 1.15 to 9.64; p = 0.03), with no heterogeneity (I2 = 0%).
Conclusions
Nerve conduits, particularly chitosan-based, collagen-based, and muscle-in-vein conduits, provide comparable sensory recovery to ANG without donor site morbidity, representing a viable alternative for digital nerve repair.
背景：周围神经损伤（PNI），特别是指神经损伤，可导致严重的功能丧失、疼痛和感觉缺陷。自体神经移植（ANG）一直是神经间隙重建的金标准，但它与供体部位发病率和其他并发症有关。神经导管，包括胶原基、壳聚糖基和肌肉静脉导管，已成为潜在的替代方案，具有避免供体部位发病的优势。本系统综述和荟萃分析的目的是比较神经导管与自体神经移植物修复指神经的疗效和安全性，特别关注感觉恢复。方法：根据PRISMA指南进行系统回顾和荟萃分析。通过截至2025年7月的PubMed、Scopus、Embase和Web of Science的综合数据库检索，确定了比较神经导管与ANG治疗数字神经损伤的随机对照试验（rct）和观察性研究。主要结局包括静态和移动两点辨别（S2PD和M2PD）。次要结局包括安全性。使用随机效应模型合并95%置信区间（CI）的平均差异（MD）和风险比（RR）。结果：共纳入5项研究，214例患者。S2PD （MD = -0.21; 95% CI -2.25至1.83;p = 0.84）和M2PD （MD = -0.67; 95% CI -2.00至0.66;p = 0.84）的神经导管显示与ANG相当的感觉恢复。亚组分析表明，壳聚糖导管治疗S2PD的效果明显优于ANG （MD = -2.57; 95% CI -3.40至-1.74;p 2 = 0%）。随机对照试验的汇总结果显示，与ANG相比，导管并发症发生率较低，RR = 3.32 (95% CI: 1.15至9.64;p = 0.03)，无异质性（I2 = 0%）。结论：神经导管，特别是壳聚糖基、胶原基和静脉肌导管，提供与ANG相当的感觉恢复，且无供体部位病变，是指神经修复的可行选择。
{"title":"Sensory Recovery Following Digital Nerve Repair Using Conduits Versus Autologous Nerve Grafts: A Systematic Review and Meta-Analysis","authors":"Ahmed M. Omran, Atef A. Hassan, Sherif Hamdeno, Mahmoud Abdelhamid Elhendawy, Mohamed M. Elghor, Rania Fouad Khattab, Mohamed Gaafar, Hany Mahmoud Ismail, Mohamed Hamouda Elkasaby, Amr A. Hassan, Saber M. Abdelmaksoud","doi":"10.1002/micr.70182","DOIUrl":"10.1002/micr.70182","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Peripheral nerve injuries (PNI), particularly digital nerve injuries, can lead to significant loss of function, pain, and sensory deficits. Autologous nerve grafting (ANG) has been the gold standard for nerve gap reconstruction, but it is associated with donor site morbidity and other complications. Nerve conduits, including collagen-based, chitosan-based, and muscle-in-vein conduits, have emerged as potential alternatives with the advantage of avoiding donor site morbidity. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of nerve conduits versus autologous nerve grafts for digital nerve repair, with a particular focus on sensory recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis were performed following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies comparing nerve conduits to ANG for the treatment of digital nerve injuries were identified through comprehensive database searches up to July 2025 on PubMed, Scopus, Embase, and Web of Science. Primary outcomes included static and moving two-point discrimination (S2PD and M2PD). Secondary outcomes included the safety profile. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of five studies with a total number of 214 patients were included in the analysis. Nerve conduits showed comparable sensory recovery to ANG for both S2PD (MD = −0.21; 95% CI −2.25 to 1.83; <i>p</i> = 0.84) and M2PD (MD = −0.67; 95% CI −2.00 to 0.66; <i>p</i> = 0.84). Subgroup analysis indicated that chitosan-based conduits demonstrated significantly better outcomes than ANG for S2PD (MD = −2.57; 95% CI −3.40 to −1.74; <i>p</i> < 0.0001); however, overall pooled results across all conduit types showed comparable sensory recovery to ANG. Complication rates were comparable between the two treatments (RR = 2.36; 95% CI 0.90 to 6.22; <i>p</i> = 0.08), with low heterogeneity across studies (I<sup>2</sup> = 0%). Pooled results from RCTs showed a lower rate of complications with the conduit compared to ANG, RR = 3.32 (95% CI: 1.15 to 9.64; <i>p</i> = 0.03), with no heterogeneity (I<sup>2</sup> = 0%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Nerve conduits, particularly chitosan-based, collagen-based, and muscle-in-vein <b>conduits</b>, provide comparable sensory recovery to ANG without donor site morbidity, representing a viable alternative for digital nerve repair.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018888","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}
Francesco Laganà, Alice Marzi Manfroni, Francesco Arcuri, Andrea Ferri, Bernardo Bianchi
<div> <section> <h3> Background</h3> <p>Reconstruction of maxillary and mandibular defects following oncologic resection remains challenging due to their three-dimensional complexity and critical role in function and aesthetics. The scapular tip free flap (STFF) provides reliable vascularity, substantial bone stock, and chimeric versatility. Computer-Aided Design and Manufacturing (CAD/CAM) has been widely applied in reconstructive surgery to optimize resection accuracy and flap insetting, but its role in STFF supine harvest and inset has never been reported. This report aims to describe the advantages of application of CAD/CAM technology to guide resection and reconstruction in complex maxillary and mandibular oncological defects.</p> </section> <section> <h3> Patients and Methods</h3> <p>We retrospectively analyzed nine patients who underwent maxillary (<i>n</i> = 5) or mandibular (<i>n</i> = 4) reconstruction with STFF between January 2023 and December 2024 at IRCCS Policlinico San Martino, Genoa, Italy. Nine patients of mean age 67.4 years with malignant neoplasms of the mandible (<i>n</i> = 4) or maxilla (<i>n</i> = 5), including squamous cell carcinoma (<i>n</i> = 7) and carcinoma ex inverted papilloma (<i>n</i> = 2), were included in the study. Preoperative virtual surgical planning was performed in collaboration with biomedical engineers to design patient-specific cutting guides and titanium plates. Functional outcomes were assessed using the EORTC QLQ-HN35 questionnaire; morphological accuracy was evaluated by overlay analysis of pre- and postoperative 3D imaging. Operative and ischemia times, complications, and patient-reported satisfaction were recorded.</p> </section> <section> <h3> Results</h3> <p>All procedures were successfully completed without major intraoperative complications. CAD/CAM-assisted planning enabled precise osteotomies and facilitated flap contouring prior to pedicle division, resulting in reduced ischemia duration and streamlined operative workflow, particularly in mandibular reconstructions. Functional assessments showed preserved swallowing and speech with only mild limitations in social eating and social interaction. Morphological analysis demonstrated high concordance between pre- and postoperative reconstructions, with minimal surface differential in maxillary (range 198–258 mm<sup>2</sup>) and mandibular (range 156–204 mm<sup>2</sup>) bounding boxes, demonstrating satisfactory restoration of facial contour. Patient-reported satisfaction was high across the cohort, ranging from acceptable to excellent.</p> </section> <section> <h3> Conclusion</h3> <p>CAD/CAM-assisted STFF reconstruction allows a
{"title":"Computer Aided Design/Computer Aided Manufacturing-Guided Scapular Tip Free Flap Reconstruction for Complex Maxillofacial Defects","authors":"Francesco Laganà, Alice Marzi Manfroni, Francesco Arcuri, Andrea Ferri, Bernardo Bianchi","doi":"10.1002/micr.70176","DOIUrl":"10.1002/micr.70176","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reconstruction of maxillary and mandibular defects following oncologic resection remains challenging due to their three-dimensional complexity and critical role in function and aesthetics. The scapular tip free flap (STFF) provides reliable vascularity, substantial bone stock, and chimeric versatility. Computer-Aided Design and Manufacturing (CAD/CAM) has been widely applied in reconstructive surgery to optimize resection accuracy and flap insetting, but its role in STFF supine harvest and inset has never been reported. This report aims to describe the advantages of application of CAD/CAM technology to guide resection and reconstruction in complex maxillary and mandibular oncological defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed nine patients who underwent maxillary (<i>n</i> = 5) or mandibular (<i>n</i> = 4) reconstruction with STFF between January 2023 and December 2024 at IRCCS Policlinico San Martino, Genoa, Italy. Nine patients of mean age 67.4 years with malignant neoplasms of the mandible (<i>n</i> = 4) or maxilla (<i>n</i> = 5), including squamous cell carcinoma (<i>n</i> = 7) and carcinoma ex inverted papilloma (<i>n</i> = 2), were included in the study. Preoperative virtual surgical planning was performed in collaboration with biomedical engineers to design patient-specific cutting guides and titanium plates. Functional outcomes were assessed using the EORTC QLQ-HN35 questionnaire; morphological accuracy was evaluated by overlay analysis of pre- and postoperative 3D imaging. Operative and ischemia times, complications, and patient-reported satisfaction were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All procedures were successfully completed without major intraoperative complications. CAD/CAM-assisted planning enabled precise osteotomies and facilitated flap contouring prior to pedicle division, resulting in reduced ischemia duration and streamlined operative workflow, particularly in mandibular reconstructions. Functional assessments showed preserved swallowing and speech with only mild limitations in social eating and social interaction. Morphological analysis demonstrated high concordance between pre- and postoperative reconstructions, with minimal surface differential in maxillary (range 198–258 mm<sup>2</sup>) and mandibular (range 156–204 mm<sup>2</sup>) bounding boxes, demonstrating satisfactory restoration of facial contour. Patient-reported satisfaction was high across the cohort, ranging from acceptable to excellent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAD/CAM-assisted STFF reconstruction allows a","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949062","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}
Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report two toddler cases of vascular malformations reconstructed with free anterolateral thigh (ALT) flaps. Case 1 was a 2-year-old boy with a submandibular venous malformation complicated by coagulopathy. After lesion resection with overlying skin (5 × 10 cm), an ALT flap (5.5 × 12 cm) was transferred. The flap artery was interposed with the transected facial artery, and the veins were anastomosed end-to-side to the internal and external jugular veins. The flap survived completely, and coagulation parameters normalized. Case 2 was a 3-year-old boy with a painful forearm ulcer caused by a capillary lymphatic venous malformation. After ulcer debridement (5.5 × 13 cm), the defect was reconstructed with an ALT flap (6 × 14 cm). The flap vessels were anastomosed to the radial artery and its concomitant veins in a flow-through manner. Partial flap necrosis required secondary wound closure, but the ulcer did not recur, and the pain resolved completely. No anastomotic failure or donor-site complications occurred in either case. Extensive resection followed by ALT flap reconstruction is a reliable option for pediatric vascular malformations. Meticulous microvascular techniques and multiple anastomoses may reduce microvascular complications in young patients.
{"title":"Free Anterolateral Thigh Flap Reconstruction After Excision of Extensive Vascular Malformations in Toddlers: Report of Two Cases","authors":"Kou Fujisawa, Shimpei Miyamoto, Mutsumi Okazaki","doi":"10.1002/micr.70173","DOIUrl":"10.1002/micr.70173","url":null,"abstract":"<p>Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report two toddler cases of vascular malformations reconstructed with free anterolateral thigh (ALT) flaps. Case 1 was a 2-year-old boy with a submandibular venous malformation complicated by coagulopathy. After lesion resection with overlying skin (5 × 10 cm), an ALT flap (5.5 × 12 cm) was transferred. The flap artery was interposed with the transected <i>facial artery</i>, and the veins were anastomosed end-to-side to the <i>internal</i> and <i>external jugular veins</i>. The flap survived completely, and coagulation parameters normalized. Case 2 was a 3-year-old boy with a painful forearm ulcer caused by a capillary lymphatic venous malformation. After ulcer debridement (5.5 × 13 cm), the defect was reconstructed with an ALT flap (6 × 14 cm). The flap vessels were anastomosed to the <i>radial artery</i> and its concomitant veins in a flow-through manner. Partial flap necrosis required secondary wound closure, but the ulcer did not recur, and the pain resolved completely. No anastomotic failure or donor-site complications occurred in either case. Extensive resection followed by ALT flap reconstruction is a reliable option for pediatric vascular malformations. Meticulous microvascular techniques and multiple anastomoses may reduce microvascular complications in young patients.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12784239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934030","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}
Reconstruction of the columella, one of the smallest facial subunits, presents significant aesthetic and functional challenges due to its complex anatomy, limited local tissue for repair, and restricted vascularisation. Although many methods are described, literature on microsurgical solutions for complex secondary reconstructions, especially after conventional methods have failed, remains limited. This report introduces a tailored, single-stage approach that combines a first web space free flap from the foot with an iliac bone graft to provide both soft tissue coverage and structural support, while also reviewing other microsurgical techniques. A 24-year-old patient presented with a severe deformity, including a shortened columella, depressed nasal tip, and a scar extending to the right upper lip, causing alopecia in the mustache area due to a shrapnel injury during the Palestine War. After excising scar tissue and a necrotic L-strut from a previous failed surgery, a 2 × 3 cm columellar and septal defect was created. A fasciocutaneous free flap from the first web space of the foot was planned as a 2.5 × 4 cm rectangle, positioned transversely over the first web space and microsurgically transferred for end-to-end anastomosis to the angular artery and vein, then folded over an iliac bone graft to provide both external skin coverage and internal lining. The postoperative course was uneventful, and the patient was discharged on the fifth day. At the one-year follow-up, the reconstructed columella remained stable, and the patient expressed high satisfaction with the final aesthetic and functional results. This report shows that the first web space free flap, combined with a structural bone graft, offers a single-stage solution for complex columellar defects, providing a tailored approach when conventional methods have failed or are insufficient. The novelty of this approach lies in using an iliac bone graft, which offers strong and durable support capable of resisting scar contracture and maintaining long-term nasal tip projection despite heavily scarred tissue. Compared with other reviewed techniques, this single-stage approach avoids the multiple procedures required for prefabricated flaps and reduces donor site morbidity or bulkiness. Furthermore, its long vascular pedicle is an advantage over shorter-pedicled auricular or hand flaps, while the robust bone graft supplies a more durable framework against the contractile forces of compromised local tissue than cartilage-based reconstructions.
{"title":"Microsurgical Reconstruction of the Columella With a First Web Space Free Flap: A Case Report and Review of Techniques","authors":"Sinem Cilingir, Polat Bicici, Alper Aksoy","doi":"10.1002/micr.70177","DOIUrl":"10.1002/micr.70177","url":null,"abstract":"<div>\u0000 \u0000 <p>Reconstruction of the columella, one of the smallest facial subunits, presents significant aesthetic and functional challenges due to its complex anatomy, limited local tissue for repair, and restricted vascularisation. Although many methods are described, literature on microsurgical solutions for complex secondary reconstructions, especially after conventional methods have failed, remains limited. This report introduces a tailored, single-stage approach that combines a first web space free flap from the foot with an iliac bone graft to provide both soft tissue coverage and structural support, while also reviewing other microsurgical techniques. A 24-year-old patient presented with a severe deformity, including a shortened columella, depressed nasal tip, and a scar extending to the right upper lip, causing alopecia in the mustache area due to a shrapnel injury during the Palestine War. After excising scar tissue and a necrotic L-strut from a previous failed surgery, a 2 × 3 cm columellar and septal defect was created. A fasciocutaneous free flap from the first web space of the foot was planned as a 2.5 × 4 cm rectangle, positioned transversely over the first web space and microsurgically transferred for end-to-end anastomosis to the angular artery and vein, then folded over an iliac bone graft to provide both external skin coverage and internal lining. The postoperative course was uneventful, and the patient was discharged on the fifth day. At the one-year follow-up, the reconstructed columella remained stable, and the patient expressed high satisfaction with the final aesthetic and functional results. This report shows that the first web space free flap, combined with a structural bone graft, offers a single-stage solution for complex columellar defects, providing a tailored approach when conventional methods have failed or are insufficient. The novelty of this approach lies in using an iliac bone graft, which offers strong and durable support capable of resisting scar contracture and maintaining long-term nasal tip projection despite heavily scarred tissue. Compared with other reviewed techniques, this single-stage approach avoids the multiple procedures required for prefabricated flaps and reduces donor site morbidity or bulkiness. Furthermore, its long vascular pedicle is an advantage over shorter-pedicled auricular or hand flaps, while the robust bone graft supplies a more durable framework against the contractile forces of compromised local tissue than cartilage-based reconstructions.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145934040","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}
Ishith Seth, Akshay Soni, Yi Mon, Omar Shadid, Warren M. Rozen
{"title":"From Microscope to Metaverse: Reimagining Supermicrosurgery Training in the Age of AI and AR","authors":"Ishith Seth, Akshay Soni, Yi Mon, Omar Shadid, Warren M. Rozen","doi":"10.1002/micr.70175","DOIUrl":"10.1002/micr.70175","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933968","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}
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