Microsurgery最新文献

Flap-Based Lower Extremity Reconstruction in the Elderly—Is It Safe and Does Age Impact Ambulation? 基于皮瓣的老年人下肢重建术--是否安全，年龄是否会影响行走？

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-20 DOI: 10.1002/micr.31239

Artur Manasyan, Eloise W. Stanton, Erin Wolfe, Joseph N. Carey, David A. Daar

Introduction

Lower extremity (LE) reconstruction in the elderly population presents a multifaceted challenge, primarily due to age-related degenerative changes, comorbidities, and functional decline. Elderly individuals often encounter conditions such as osteoarthritis, osteoporosis, and cardiovascular and peripheral artery disease (PAD), which can severely compromise the structural integrity and function of the lower limbs. As such, we aim to assess postoperative complications and functional recovery following LE reconstruction in elderly patients.

Methods

Patients ≥ 18 years who underwent post-traumatic LE reconstruction with flap reconstruction at a Level 1 trauma center between 2007 and 2022 were included. Patient demographics, flap/wound characteristics, complications, and ambulation for the elderly (≥ 60 years old) and the control (< 60 years old) cohorts were recorded. The primary outcome was final ambulation status, modeled with logistic regression. Secondary outcomes included postoperative complications.

Results

The mean ages of the control (n = 374) and elderly (n = 49) groups were 37.4 ± 12.6 and 65.8 ± 5.1 years, respectively. Elderly patients more frequently required amputation after flap surgery (p = 0.002). There was no significant difference between the two cohorts in preoperative ambulation status (p = 0.053). Postoperatively, 22.4% of elderly patients were independently ambulatory at final follow-up, compared to 49.5% of patients < 60. Of the elderly, 14.3% could ambulate with an assistance device (cane, walker, etc.), compared to 26.5% in the control group. A wheelchair was required for 46.9% of elderly patients, significantly higher than the 22.7% of those < 60 years of age (p < 0.001). Multivariate regression confirmed an association between older age and nonambulatory final status (p = 0.033).

Conclusion

LE reconstruction can likely be performed safely in patients 60 years of age or older. However, older age is independently associated with significantly worse postoperative ambulation. Preoperative assessment, including gait and muscle strength, and early initiation of postoperative rehabilitation can potentially improve ambulation in elderly individuals undergoing LE reconstruction.

引言老年人群的下肢（LE）重建面临着多方面的挑战，主要原因是与年龄相关的退行性变化、合并症和功能衰退。老年人经常会遇到骨关节炎、骨质疏松症、心血管疾病和外周动脉疾病（PAD）等疾病，这些疾病会严重损害下肢结构的完整性和功能。因此，我们旨在评估老年患者 LE 重建后的术后并发症和功能恢复情况。方法纳入2007年至2022年期间在一级创伤中心接受创伤后皮瓣重建术的年龄≥18岁的左下肢重建患者。记录老年组（≥ 60 岁）和对照组（60 岁）患者的人口统计学特征、皮瓣/伤口特征、并发症和行走情况。主要结果是最终的行走状况，采用逻辑回归建模。次要结果包括术后并发症。结果对照组（n = 374）和老年组（n = 49）的平均年龄分别为 37.4 ± 12.6 岁和 65.8 ± 5.1 岁。老年患者在皮瓣手术后更常需要截肢（P = 0.002）。两组患者的术前行走状况无明显差异（p = 0.053）。术后，22.4%的老年患者在最终随访时可以独立行走，而 60 岁患者的这一比例为 49.5%。在老年患者中，14.3% 的患者可以借助辅助设备（手杖、助行器等）行走，而对照组的这一比例为 26.5%。46.9%的老年患者需要使用轮椅，明显高于22.7%的60岁患者（p< 0.001）。多变量回归证实了老年与最终不行动状态之间的关联（p = 0.033）。结论 60 岁或以上的患者可以安全地进行 LE 重建。但是，年龄越大，术后行走能力越差。包括步态和肌肉力量在内的术前评估以及术后康复的早期启动有可能改善接受左侧肢体重建术的老年人的行走能力。

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引用次数: 0

Preoperative Vascular Imaging in Lower Extremity Free Flap Reconstruction: Comparison Between Imaging Modalities 下肢游离皮瓣重建术前血管成像：不同成像模式的比较

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-20 DOI: 10.1002/micr.31241

Leah Ahn, Joani M. Christensen, Seth Fruge, Mara Z. Meulendijks, Yannick Albert J. Hoftiezer, Frankie K. Wong, Krystle R. Tuano, Ian L. Valerio, Kyle R. Eberlin

Background

Adequate vascular anatomy and perfusion status are essential for successful lower extremity free tissue transfer. Computed tomography angiography (CTA) is widely available, minimally invasive, and enables visualization of soft tissues and bones. Angiography permits temporal evaluation of flow, identifies potential needs for concurrent endovascular interventions, and enhances visibility in the setting of hardware. Despite widespread availability of these imaging modalities, no standardized algorithm for preoperative imaging prior to lower extremity free flap reconstruction exists.

Methods

Current Procedural Terminology (CPT) codes identified patients undergoing free flap reconstruction of the lower extremity over an 18-year period (2002–2020). Electronic medical records were reviewed for patient, treatment, and imaging characteristics, and pre- and post-imaging laboratory values. Outcomes included imaging findings and related complications and surgical outcomes.

Results

In total, 405 patients were identified, with 59% (n = 238) undergoing preoperative imaging with angiography, 10% (n = 42) with CTA, 7.2% (n = 29) with both imaging modalities, and 24% (n = 96) with neither performed. Forty percent (122 of 309) of patients who underwent preoperative imaging had less than 3-vessel runoff. Four patients developed contrast-induced nephropathy (CIN) after angiography only and one after having both CTA and angiography. Vessel runoff on CTA and angiography demonstrated moderate correlation.

Conclusion

Most patients undergoing lower extremity free tissue transfer underwent preoperative imaging with angiography and/or CTA, 40% of which had less than 3-vessel runoff. Both angiography and CTA had low complication rates, with no statistically significant risk factors identified. Specifically, the incidence of CIN was not found to be significant using either modality. We discuss our institutional algorithm to aid in decision-making for preoperative imaging prior to lower extremity free flap reconstruction. Specifically, we recommend angiography for patients with peripheral vascular disease, internal hardware, or distal defects secondary to trauma.

背景充分的血管解剖和灌注状态对成功进行下肢游离组织转移至关重要。计算机断层扫描血管造影术（CTA）应用广泛，创伤小，可观察软组织和骨骼。血管造影可对血流进行时间评估，确定同时进行血管内介入治疗的潜在需求，并提高硬件设置的可视性。尽管这些成像模式已广泛应用，但目前还没有下肢游离皮瓣重建术前成像的标准化算法。方法对 18 年内（2002-2020 年）接受下肢游离皮瓣重建术的患者进行当前程序术语（CPT）代码识别。对电子病历进行了审查，以了解患者、治疗和成像特征以及成像前后的实验室值。结果包括成像结果、相关并发症和手术结果。结果共确定了 405 名患者，其中 59%（n = 238）的患者在术前接受了血管造影成像，10%（n = 42）的患者接受了 CTA，7.2%（n = 29）的患者同时接受了两种成像方式，24%（n = 96）的患者两种成像方式都没有进行。在接受术前成像的患者中，40%（309 例中的 122 例）的血管径流少于 3 条。四名患者仅在血管造影后出现造影剂诱发肾病 (CIN)，一名患者在同时进行 CTA 和血管造影后出现造影剂诱发肾病 (CIN)。CTA 和血管造影的血管径流显示出中等相关性。结论大多数接受下肢游离组织转移的患者在术前都接受了血管造影和/或 CTA 检查，其中 40% 的患者血管径流少于 3 条。血管造影和 CTA 的并发症发生率都很低，没有发现有统计学意义的风险因素。具体而言，两种方式的CIN发生率都不高。我们讨论了本机构在下肢游离皮瓣重建术前成像的辅助决策算法。具体来说，我们建议患有外周血管疾病、内部硬件或因外伤继发远端缺损的患者进行血管造影。

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引用次数: 0

Free Vascularized Scapula tip Flap to L5—S1 Vertebral Defect After Chronic Infection Related to Interbody Fusion Cage: A Case Report 椎间融合支架引发慢性感染后游离血管化肩胛尖瓣治疗 L5-S1 椎体缺损：病例报告

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-19 DOI: 10.1002/micr.31236

Frank O. F. Reilly, Ioannis Georgopoulos, Håkan Jonsson, Kevin Mani, Andrés Rodriguez-Lorenzo, Nikos Schizas

Septic nonunion after vertebral fusion can lead to significant patient disability. The management of septic nonunions usually involves surgical debridement, bone fixation, and antibiotic therapy. Particularly challenging is lumbosacral vertebral nonunions, which necessitate a difficult surgical approach. We present a novel approach using a scapula tip free flap through an intra-abdominal approach to reconstruct a L5–S1 vertebral defect after a septic nonunion. Our patient, 31-year-old man, with no medical conditions, had a fusion of L5–S1 due to severe lower back pain secondary to isthmic spondylolysis and spondylolisthesis. Despite multiple attempts of surgical fusion, postoperatively the patient developed a septic nonunion. Following a modified DAIR, the nonunion was reconstructed with a scapula tip bone flap 4 × 3 × 2 cm. The subscapular vessels were anastomosed to the deep inferior epigastric vessels after an intra-abdominal inset. The patient was discharged at 15 days postoperatively without any complications. At 1-year follow-up the patient is pain-free, off opiate analgesia with radiological evidence of fusion between the scapula tip, L5 and the S1 vertebral body. This case report describes the use, for the first time, of a free scapula tip, to a lumbosacral spinal defect. The use of the free scapula tip flap may be considered for reconstruction of osseous spinal defects due to its long pedicle and the unique bone shape.

脊椎融合术后化脓性骨不连可导致患者严重残疾。化脓性骨不连的治疗通常包括手术清创、骨固定和抗生素治疗。腰骶部椎体骨不连尤其具有挑战性，必须采用困难的手术方法。我们介绍了一种通过腹腔内入路使用肩胛尖游离皮瓣重建化脓性椎体骨不连后 L5-S1 椎体缺损的新方法。我们的患者是一名 31 岁的男性，无任何疾病，因峡部性脊柱溶解症和脊柱滑脱症引起的剧烈下背痛而接受了 L5-S1 椎体融合术。尽管多次尝试了手术融合，但术后患者出现了化脓性不愈合。经过改良的DAIR手术后，用4×3×2厘米的肩胛骨尖骨瓣重建了骨不连。肩胛下血管在腹腔内嵌顿后与下腹深血管吻合。患者术后 15 天出院，未出现任何并发症。随访 1 年后，患者已无痛苦，不再使用阿片类镇痛药，放射学证据显示肩胛骨尖、L5 和 S1 椎体之间已融合。本病例报告描述了首次将游离肩胛骨尖用于腰骶部脊柱缺损。游离肩胛尖皮瓣具有长蒂和独特的骨形状，因此可考虑用于骨性脊柱缺损的重建。

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引用次数: 0

Deep Branch-Based SCIP Flap After Inguinal-Genital Debridement 腹股沟-生殖器切除术后的深支 SCIP 皮瓣

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-17 DOI: 10.1002/micr.31240

Reo Karakama, Toko Miyazaki

引用次数: 0

Facial Artery Perforator Flap for Perioral and Perinasal Oncologic Defect Reconstruction: Surgical Technique and Postoperative Outcomes 用于口周和鼻周肿瘤缺损重建的面动脉穿孔器皮瓣：手术技术和术后效果

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-17 DOI: 10.1002/micr.31238

Pierre-Louis Chiche, François Avry, Julien Drouet, Pierre Weill, Hervé Bénateau, Quentin Qassemyar, Rachid Garmi

Introduction

Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management.

Methods

We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (n = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups.

Results

The mean histological tumor defect area was 331 mm². During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, p = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, p = 0.04).

Conclusion

Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.

引言面部动脉穿孔器（FAP）皮瓣是一种多功能、可靠的一步式面部重建技术。然而，由于缺乏明确的指导原则和严格的技术要求，其潜力仍未得到充分发挥。本研究报告了本中心使用 FAP 皮瓣治疗口周和鼻部肿瘤缺损的情况，重点介绍了手术技巧和术后管理。方法我们对 4 年内所有在肿瘤切除后仅使用口周或鼻周 FAP 皮瓣进行重建的患者（29 人）进行了回顾性研究。测量参数包括皮瓣存活率、并发症发生率、手术技巧以及是否需要进行修补手术。根据患者的年龄、缺损大小和部位进行分组，并对各组的结果进行比较。结果组织学肿瘤缺损的平均面积为 331 平方毫米。在至少 6 个月的随访期间，未发现局部复发。27个（93.1%）皮瓣完全存活。7例（23.8%）患者出现了主要的术后并发症，包括皮瓣完全坏死（1例）、皮瓣部分坏死（1例）、皮瓣塌陷（1例）、静脉充血（1例）、伤口裂开（1例）和局部感染（2例）。鼻尖缺损的并发症发生率更高（80.0% 对 12.5%，P = 0.007）。涉及鼻侧壁和鼻背的重建更经常需要修整手术（53.8% 对 13.3%，P = 0.04）。结论根据我们的经验，FAP 皮瓣对重建上唇、鼻唇沟和某些肿瘤性鼻缺损非常有效。然而，鼻尖等特定的缺损位置可能与较高的并发症发生率有关，因此需要谨慎选择患者和制定手术计划。

{"title":"Facial Artery Perforator Flap for Perioral and Perinasal Oncologic Defect Reconstruction: Surgical Technique and Postoperative Outcomes","authors":"Pierre-Louis Chiche, François Avry, Julien Drouet, Pierre Weill, Hervé Bénateau, Quentin Qassemyar, Rachid Garmi","doi":"10.1002/micr.31238","DOIUrl":"https://doi.org/10.1002/micr.31238","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (<i>n</i> = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean histological tumor defect area was 331 mm<sup>2</sup>. During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, <i>p</i> = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, <i>p</i> = 0.04).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142244999","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}

引用次数: 0

Potential of the Thoracoepigastric Vein as a Drainage Vein in Breast Reconstruction With a Free Flap: An Anatomical Study Using Computed Tomography 游离皮瓣乳房再造术中胸腹静脉作为引流静脉的潜力：使用计算机断层扫描的解剖学研究

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-13 DOI: 10.1002/micr.31230

Hitoshi Nemoto, Kengo Nakatsuka, Daiki Morita, Yukio Seki, Kotaro Imagawa, Yotaro Tsunoda, Chieko Komaba, Ushio Hanai

Background

The recipient vessel choice is very important when performing free-flap breast reconstructions. Usually, the concomitant vein of the recipient artery is anastomosed, and mismatches in the diameter are occasionally observed. We consider the thoracoepigastric vein (TEV) as a potential useful recipient vein. The use of the TEV is not a novel technique. It has been used by surgeons for free-flap anastomoses in the axillary region, but usually as an anastomotic site for the second vein. However, anatomical findings such as TEV diameter, its deficiency rate, and influence on mastectomy are not clear. In this study, computed tomography (CT) was performed to evaluate the use of the TEV as a recipient vein for breast reconstruction.

Methods

The medical records of patients who underwent breast reconstruction with free-flap transfer were retrospectively evaluated. In most cases, CT was performed using a tissue expander inserted after mastectomy. The TEV was considered suitable if its diameter on the mastectomy side was >1 mm and the vertical distance from the most distal slice level where the TEV could be seen at the third costal cartilage height of the parasternal region was <50 mm.

Results

Sixty-six sides of 33 patients were evaluated. The mean age of the patients was 49.3 ± 5.1 years. The TEV was used in five flaps. TEV diameters were not significantly different between the left and right sides (1.85 ± 0.53 vs. 1.82 ± 0.6, respectively, p = 0.836). On the mastectomy side, eight (25%) TEVs were injured, but only three (8.6%) were considered unavailable. On the healthy side, 96.4% TEVs were available.

Conclusions

TEVs may be a good choice as vein anastomosis targets for breast reconstruction with a free flap because of their relatively large vessel diameter.

Trial Registration

UMIN-CTR: R000061573

背景在进行游离瓣乳房重建时，受体血管的选择非常重要。通常情况下，受体动脉的伴行静脉会被吻合，偶尔也会出现直径不匹配的情况。我们认为胸腹静脉（TEV）是一种潜在的有用受体静脉。使用胸腹静脉并不是一项新技术。外科医生已将其用于腋窝区域的游离瓣吻合，但通常是作为第二静脉的吻合部位。然而，TEV 的直径、缺损率以及对乳房切除术的影响等解剖学发现尚不清楚。本研究通过计算机断层扫描（CT）来评估将 TEV 用作乳房重建受体静脉的情况。方法回顾性评估了接受游离瓣转移乳房重建术患者的病历。在大多数病例中，CT 是在乳房切除术后插入组织扩张器进行的。如果乳房切除侧的 TEV 直径为 1 毫米，且胸骨旁区域第三肋软骨高度处可看到 TEV 的最远切片水平的垂直距离为 50 毫米，则认为 TEV 合适。结果对 33 名患者的 66 个侧面进行了评估。患者的平均年龄为 49.3 ± 5.1 岁。五个皮瓣使用了 TEV。左侧和右侧的 TEV 直径无明显差异（分别为 1.85 ± 0.53 vs. 1.82 ± 0.6，p = 0.836）。在乳房切除侧，8 个 TEV（25%）受伤，但只有 3 个（8.6%）被认为不可用。在健康一侧，96.4%的 TEV 可用。结论 TEV 因其血管直径相对较大，可能是游离皮瓣乳房重建的静脉吻合目标的良好选择。试验注册 UMIN-CTR: R000061573

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引用次数: 0

One-Stage Bilateral Severe Trismus Reconstruction: Simultaneous Utilization of Free Anterolateral Thigh and Tensor Fascia Latae Flaps From a Single Donor Thigh: Report of Three Cases 一期双侧重度三体功能障碍重建术：同时使用来自单个供体的游离大腿前外侧皮瓣和张肌筋膜瓣：三个病例的报告

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-13 DOI: 10.1002/micr.31235

Jia-Siang Ye, Ng Kwan Lok Benjamin, Savitha Ramachandran, Yu-Chi Wang, Chao-Wei Chang, Yur-Ren Kuo

Bilateral trismus associated with oral cancer was commonly occurred in those who had received surgical intervention and radiotherapy. Complete release of bilateral fibrotic tissues followed by free flaps reconstruction was the main current surgical intervention. However, reconstructions of both defects mostly needed to harvest two flaps from different donor sites were time-consuming and increasing morbidities. Herein, we presented three cases who undergone modified reconstructive method by harvesting the anterolateral thigh (ALT) flap and tensor fascia latae (TFL) flap simultaneously from the same donor site. Trismus release was performed including resection of the buccal part and fibrotic tissue, myotomy of the masticatory and medial pterygoid muscles, and bilateral coronoidectomy. Case 1, a 52 years-old man, with severe trismus as the interincisal distance (IID) was about 0 mm. He undergone a combined 12 × 7.5 cm ALT and 11 × 6 cm TFL flap reconstruction from a single-donor thigh. The IID apparently increased to 37 mm after 1-year follow-up. Case 2, a 64 years-old man, went through a combination of 6 × 7 cm ALT and 6 × 6 cm TFL flap reconstruction from unilateral thigh for severe trismus. The IID significantly improved from 10 mm to 30 mm after one and a half-year follow-up. Case 3, a 53 years-old woman, with IID was around 0 mm before the surgery. A combined 9 × 3 cm ALT and 9 × 3 cm TFL flap reconstruction was performed as the IID enhanced to 20 mm after 6 months follow-up. This reconstruction method using ALT and TFL flaps harvested from a single-donor thigh simultaneously could be suitable for patients with bilateral severe trismus.

在接受过手术治疗和放射治疗的患者中，与口腔癌相关的双侧三叉畸形很常见。完全松解双侧纤维组织，然后进行游离皮瓣重建是目前主要的手术治疗方法。然而，两个缺损的重建大多需要从不同的供体部位获取两个皮瓣，耗时长且增加了发病率。在此，我们介绍了三例同时从同一供体部位获取大腿前外侧（ALT）皮瓣和张肌筋膜（TFL）皮瓣的改良重建方法。进行了包括颊部和纤维组织切除、咀嚼肌和翼状内侧肌切开术以及双侧冠状突切除术在内的三叉神经松解术。病例 1 是一名 52 岁的男性，因咬合间距（IID）约为 0 毫米而患有严重的三趾畸形。他接受了 12 × 7.5 厘米 ALT 和 11 × 6 厘米 TFL 联合皮瓣重建术，皮瓣取自单供体大腿。随访 1 年后，IID 明显增加到 37 毫米。病例 2 是一名 64 岁的男性，因重度三股肌挛缩而接受了 6 × 7 厘米 ALT 和 6 × 6 厘米 TFL 联合皮瓣重建术。经过一年半的随访，IID 从 10 毫米明显改善到 30 毫米。病例 3：53 岁女性，术前 IID 约为 0 毫米。由于 IID 在 6 个月的随访后增加到 20 毫米，因此进行了 9 × 3 厘米 ALT 和 9 × 3 厘米 TFL 联合皮瓣重建。这种同时从单供体大腿上获取ALT和TFL皮瓣的重建方法适用于双侧重度三叉畸形患者。

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引用次数: 0

Artery Grafting for Arterial Anastomoses in Head and Neck Free Tissue Transfer Reconstruction 头颈部游离组织转移重建中的动脉吻合移植术

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-13 DOI: 10.1002/micr.31232

Eric V. Mastrolonardo, Pablo Llerena, Dev R. Amin, Emma De Ravin, Kathryn Nunes, Kelly M. Bridgham, Daniel J. Campbell, Ramez Philips, Shaum Sridharan, Andrés Bur, Ryan Heffelfinger, Mark K. Wax, Joseph M. Curry

Background

Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects.

Methods

A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported.

Results

Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (n = 3) and facial artery (n = 3) were the most commonly harvested arteries. The scalp (n = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (n = 4) or similarities in wall thickness (n = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses.

Conclusions

When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.

背景血管移植是头颈部游离组织转移（FTT）重建中的一项重要技术，否则无法进行无张力吻合。据我们所知，有关头颈部重建中动脉吻合的间位动脉移植的数据非常有限。在此，我们介绍了一个多机构的头颈部缺损 FTT 重建动脉插管移植物队列。方法在四家三级医疗机构对接受头颈部缺损 FTT 重建术的患者进行了回顾性审查，这些患者在动脉吻合时使用了插位动脉移植物。对病历进行了审查，内容包括所采集动脉移植物的类型和长度、手术指征、动脉移植物的指征、所采集皮瓣的类型以及各种术前特征（包括放射史或既往接受过 FTT 重建手术）。对术后 30 天内的术后并发症进行了测量和报告。结果九名患者符合纳入标准。最常采集的动脉是股外侧环动脉（横支或降支）（3 例）和面动脉（3 例）。头皮（5 例）是最常见的主要缺损部位。七例移植物是按计划初次采集的，两例是作为抢救技术（皮瓣抢救或静脉移植物失败）采集的。在有计划的移植物中，动脉是首选的插管移植物方法，原因是移植物和受体动脉的尺寸匹配（4 例）或壁厚相似（3 例）。据报道，没有出现意外再入院、术后血肿、瘘管形成、伤口感染或供体部位发病的病例。有两名患者因皮瓣受损而需要意外返回手术室，这两名患者最终都因动脉和静脉吻合处血块形成而导致皮瓣失败。结论当动脉蒂长度不足时，对于某些高度复杂的头颈部游离组织重建病例，间位动脉移植是一种可行的无张力动脉吻合技术。

{"title":"Artery Grafting for Arterial Anastomoses in Head and Neck Free Tissue Transfer Reconstruction","authors":"Eric V. Mastrolonardo, Pablo Llerena, Dev R. Amin, Emma De Ravin, Kathryn Nunes, Kelly M. Bridgham, Daniel J. Campbell, Ramez Philips, Shaum Sridharan, Andrés Bur, Ryan Heffelfinger, Mark K. Wax, Joseph M. Curry","doi":"10.1002/micr.31232","DOIUrl":"https://doi.org/10.1002/micr.31232","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Vessel grafting is an important technique in head and neck free tissue transfer (FTT) reconstruction when a tension-free anastomosis is not otherwise feasible. To our knowledge, there are limited data regarding interposition artery grafts for arterial anastomoses in head and neck reconstruction. Here, we present a multi-institutional cohort of arterial interposition grafts for FTT reconstruction for head and neck defects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was conducted at four tertiary care institutions for patients who underwent FTT reconstruction for head and neck defects which utilized an interposition artery graft for the arterial anastomosis. Charts were reviewed for type and length of artery grafts harvested, surgical indication, indication for artery graft, types of flaps harvested, and various preoperative characteristics (including history of radiation or previous FTT reconstruction surgery). Postoperative complications within postoperative day 30 were measured and reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine patients met inclusion criteria. The lateral circumflex femoral artery (either transverse or descending branches) (<i>n</i> = 3) and facial artery (<i>n</i> = 3) were the most commonly harvested arteries. The scalp (<i>n</i> = 5) was the most common primary defect site. Seven grafts were harvested initially and in a planned fashion, while two were harvested as salvage techniques (either for flap salvage or vein graft failure). In planned grafts, arteries were the preferred interposition grafting method due to either size match preferences (<i>n</i> = 4) or similarities in wall thickness (<i>n</i> = 3) between graft and recipient artery. There were no reported cases of unplanned readmission, postoperative hematoma, fistula formation, wound infection, or donor site morbidities. Two patients required unplanned return to the operating room for flap compromise, both of which ultimately resulted in flap failure secondary to clot formation at both arterial and venous anastomoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>When arterial pedicle length is insufficient, interposition artery grafting is both a feasible and viable technique to achieve tension-free arterial anastomoses for select cases of highly complex head and neck free tissue reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230943","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}

引用次数: 0

Evaluation of Ischemic Time and Complications in Free Jejunum Transfer 评估游离空肠移植的缺血时间和并发症

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-11 DOI: 10.1002/micr.31237

Mayu Suzuki, Jun Arata, Shuko Kaito

Background

In free jejunum transfer, knowing the ischemic tolerance time of the jejunum is crucial. It helps determine the need for reharvesting if an unexpected situation prolongs the ischemic time. The current ischemic tolerance time in humans is unknown. We investigated the relationship between ischemic time and postoperative complications in head and neck cancer patients who underwent free jejunum transfer.

Methods

The study included 76 patients with available medical records out of 103 patients who underwent free jejunum transfer between 2009 and 2023. The association between the surgical procedure, including ischemic time, and patient's background, and flap engraftment, stenosis of the intestinal anastomosis, the swallowing function, and other complications was investigated.

Results

The ischemic time for jejunal flaps ranged from 1 h 24 min to 6 h, with a mean of 197 ± 55.5 min. In 72 patients, the jejunum was successfully engrafted, but vascular occlusion occurred in another four patients. In three of these patients, jejunal necrosis occurred, and there was no specific trend in ischemic time. Stenosis of the intestinal anastomosis occurred in 17 cases (22%), with ischemic time (≥3 h) and age (≥75 years) being significant factors for stenosis (ischemic time: 30% vs. 10%, p = 0.048, age: 50% vs. 15%, p < 0.01). No significant correlations were observed with other complications or the swallowing function.

Conclusion

There was no specific trend between ischemic time and jejunal survival rate, indicating that an ischemic time within 6 h may not have affected engraftment. Although we have recently performed intestinal anastomosis prior to vascular anastomosis, the choice of surgical technique should be adapted to the patient's age and background.

背景在游离空肠移植中，了解空肠的缺血耐受时间至关重要。如果出现意外情况导致缺血时间延长，它有助于确定是否需要重新采集。目前人类的缺血耐受时间尚不清楚。我们研究了接受游离空肠转移的头颈部癌症患者缺血时间与术后并发症之间的关系。方法研究纳入了 2009 年至 2023 年期间接受游离空肠转移术的 103 例患者中 76 例有病历记录的患者。研究了手术过程（包括缺血时间）、患者背景、皮瓣移植、肠吻合口狭窄、吞咽功能和其他并发症之间的关系。结果空肠皮瓣的缺血时间从 1 h 24 min 到 6 h 不等，平均为 197 ± 55.5 min。72 例患者成功移植了空肠，但有 4 例患者发生了血管闭塞。其中三名患者出现空肠坏死，缺血时间没有特定趋势。17例（22%）发生肠吻合口狭窄，缺血时间（≥3小时）和年龄（≥75岁）是导致狭窄的重要因素（缺血时间：30%对10%，P = 0.048；年龄：50%对15%，P < 0.01）。与其他并发症或吞咽功能无明显相关性。结论缺血时间与空肠存活率之间没有特定的趋势，表明缺血时间在6小时以内可能不会影响移植。虽然我们最近在血管吻合前进行了肠吻合术，但手术技术的选择应根据患者的年龄和背景而定。

{"title":"Evaluation of Ischemic Time and Complications in Free Jejunum Transfer","authors":"Mayu Suzuki, Jun Arata, Shuko Kaito","doi":"10.1002/micr.31237","DOIUrl":"https://doi.org/10.1002/micr.31237","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In free jejunum transfer, knowing the ischemic tolerance time of the jejunum is crucial. It helps determine the need for reharvesting if an unexpected situation prolongs the ischemic time. The current ischemic tolerance time in humans is unknown. We investigated the relationship between ischemic time and postoperative complications in head and neck cancer patients who underwent free jejunum transfer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study included 76 patients with available medical records out of 103 patients who underwent free jejunum transfer between 2009 and 2023. The association between the surgical procedure, including ischemic time, and patient's background, and flap engraftment, stenosis of the intestinal anastomosis, the swallowing function, and other complications was investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ischemic time for jejunal flaps ranged from 1 h 24 min to 6 h, with a mean of 197 ± 55.5 min. In 72 patients, the jejunum was successfully engrafted, but vascular occlusion occurred in another four patients. In three of these patients, jejunal necrosis occurred, and there was no specific trend in ischemic time. Stenosis of the intestinal anastomosis occurred in 17 cases (22%), with ischemic time (≥3 h) and age (≥75 years) being significant factors for stenosis (ischemic time: 30% vs. 10%, <i>p</i> = 0.048, age: 50% vs. 15%, <i>p</i> < 0.01). No significant correlations were observed with other complications or the swallowing function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There was no specific trend between ischemic time and jejunal survival rate, indicating that an ischemic time within 6 h may not have affected engraftment. Although we have recently performed intestinal anastomosis prior to vascular anastomosis, the choice of surgical technique should be adapted to the patient's age and background.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169871","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}

引用次数: 0

From Angiosomal to Bi-Angiosomal and Extra-Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction 从血管瓣到双血管瓣和血管瓣以外的带蒂穿孔器皮瓣：在腹壁重建中优化使用当地组织

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-11 DOI: 10.1002/micr.31229

Beniamino Brunetti, Marco Morelli Coppola, Valeria Petrucci, Matteo Pazzaglia, Chiara Camilloni, Alessandra Putti, Rosa Salzillo, Stefania Tenna, Barbara Cagli, Paolo Persichetti

<div> <section> <h3> Introduction</h3> <p>The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from <i>angiosomal</i> to <i>bi-angiosomal</i> and <i>extra-angiosomal</i> perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios.</p> </section> <section> <h3> Patients and Methods</h3> <p>A total of 15 patients underwent abdominal wall reconstruction with <i>angiosomal</i>, <i>bi-angiosomal</i>, and <i>extra-angiosomal</i> pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale.</p> </section> <section> <h3> Results</h3> <p>Ten <i>angiosomal</i> perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 <i>bi-angiosomal</i> and <i>extra-angiosomal</i> conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm<sup>2</sup> (mean size was 194.7 cm<sup>2</sup>). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm<sup>2</sup> (mean surface was 209.3 cm<sup>2</sup>). No major complications were registered. One <i>bi-angiosomal</i> bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87.</p> </section> <section> <h3> Conclusio

引言自由式和螺旋桨式穿孔器皮瓣已被广泛用于躯干和四肢中等大小缺损的重建，但在腹部重建领域的应用却鲜有报道。本报告旨在介绍作者在腹壁重建中使用带蒂穿孔器皮瓣的经验，提出从血管腔内穿孔器皮瓣向双血管腔内穿孔器皮瓣和血管腔外穿孔器皮瓣过渡的创新理念，并根据多种临床情况展示不同皮瓣设计的应用。患者和方法共有15名患者接受了腹壁重建手术，使用从周围腹腔亚单位采集的血管瘤、双血管瘤和血管外带蒂穿孔器皮瓣，治疗中等和较大尺寸的腹壁浅表或全厚缺损。分别有11例和4例患者因软组织肉瘤（STS）和非黑色素瘤皮肤癌（NMSC）切除术而导致腹壁缺损。手术数据、术后过程和并发症均有记录。此外，在 12 个月的随访中，患者还被要求对重建手术的美学和功能效果进行 5 分 Likert 评分。结果 15 位患者成功转移了 10 个血管腔穿孔器皮瓣（4 个 DIEP、4 个 SCIP、1 个 SEAP 和 1 个 LICAP 皮瓣）和 5 个双血管腔和血管腔外连体穿孔器皮瓣，包括不同的血管区域（3 个双侧 DIEP、1 个双侧 SEAP 和 1 个同侧 DIEP-SEAP 皮瓣）。有两名患者进行了显微外科吻合术，以确保额外皮肤区域的血管正常化。患者平均年龄为 59.3 岁。缺损面积从98到408平方厘米不等（平均面积为194.7平方厘米）。平均手术时间为 280 分钟。皮瓣面积从108到336平方厘米不等（平均面积为209.3平方厘米）。无重大并发症发生。一名双腔双侧DIEP皮瓣出现部分坏死，需要进行额外的皮瓣重建。所有患者都接受了为期12个月的随访，只有一名患者没有接受临床随访，但在9个月的临床随访中对Likert量表做出了反应。患者的总体满意度很高，美观度和功能度的平均评分分别为 4.27 分和 3.87 分。结论在腹壁重建领域，使用局部组织是一种未得到充分利用的解决方案。事实证明，血管腔、双血管腔和血管腔外穿孔器皮瓣是一种可靠的选择，可以转移大量组织，提供同类重建，同时最大限度地提高皮瓣存活率。

{"title":"From Angiosomal to Bi-Angiosomal and Extra-Angiosomal Pedicled Perforator Flaps: Optimizing the Use of Local Tissues in Abdominal Wall Reconstruction","authors":"Beniamino Brunetti, Marco Morelli Coppola, Valeria Petrucci, Matteo Pazzaglia, Chiara Camilloni, Alessandra Putti, Rosa Salzillo, Stefania Tenna, Barbara Cagli, Paolo Persichetti","doi":"10.1002/micr.31229","DOIUrl":"https://doi.org/10.1002/micr.31229","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from <i>angiosomal</i> to <i>bi-angiosomal</i> and <i>extra-angiosomal</i> perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A total of 15 patients underwent abdominal wall reconstruction with <i>angiosomal</i>, <i>bi-angiosomal</i>, and <i>extra-angiosomal</i> pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten <i>angiosomal</i> perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 <i>bi-angiosomal</i> and <i>extra-angiosomal</i> conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm<sup>2</sup> (mean size was 194.7 cm<sup>2</sup>). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm<sup>2</sup> (mean surface was 209.3 cm<sup>2</sup>). No major complications were registered. One <i>bi-angiosomal</i> bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusio","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169872","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}

引用次数: 0