Microsurgery最新文献_第3页

The “Petals Arteriotomy”: A Technique for Upsizing Microvascular Anastomotic Coupler Device 花瓣动脉切开术"：放大微血管吻合器装置的技术

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-08-29 DOI: 10.1002/micr.31226

Michalis Hadjiandreou, Youn Hwan Kim, Georgios Pafitanis

引用次数: 0

Fully Telemetric Robotic Microsurgery: Clinical Experience With 23 Cases 全遥控机器人显微手术：23 例临床经验

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-08-29 DOI: 10.1002/micr.31227

Shaghayegh Gorji, Kai Wessel, Alexander Dermietzel, Matthias Aitzetmueller, Isa Wendenburg, Charalampos Varnava, Marie-Luise Klietz, Philipp Wiebringhaus, Tobias Hirsch, Maximilian Kueckelhaus

Background

Recently, there is an ongoing trend in plastic surgery with robotic-assisted microsurgery and supermicrosurgery devices being developed. Combining a telemetrically controlled robotic microscope with an also telemetrically controlled microsurgery robot unlocks synergistic effects with complete disconnection of the operating surgeon from the operating field. Here, we report the first clinical free flap reconstructions using this setup.

Methods

Twenty-three surgeries were performed with the combined remote approach using the Symani Surgical System and the RoboticScope in open microsurgery procedures. Anastomosis time and ischemia time were recorded. The surgical performance for anastomoses was assessed using the modified Structured Assessment of Microsurgical Skills (SAMS) score. Subjective satisfaction was evaluated by the surgeons in comparison with conventional microsurgery. To evaluate the learning curve, the senior authors first four (first group) and last four (last group) procedures were compared.

Results

Overall, flap survival was 95.7%. The average arterial anastomosis time was 36.7 ± 10.9 min. Total time of surgery was 277.7 ± 63.8 min, and ischemia time was 100.6 ± 24.9 min. Most SAMS score parameters were significantly higher in the last group of surgical procedures compared with the first operations. Subjective satisfaction was equal or better with the combined robotic-assisted approach in most categories.

Conclusions

Our data demonstrates safety and feasibility of the use of a combined remote approach. Robotic systems for microsurgical procedures may hold promising potential for improvement of surgical quality and open up new frontiers in microsurgery.

背景最近，整形外科领域出现了机器人辅助显微手术和超级显微手术设备的发展趋势。将遥测控制的机器人显微镜与同样由遥测控制的显微手术机器人结合使用，可以产生协同效应，使手术外科医生完全脱离手术现场。在此，我们报告了使用这种装置进行的首例临床游离皮瓣重建手术。方法在开放式显微外科手术中使用 Symani 手术系统和 RoboticScope 联合远程方法进行了 23 例手术。记录了吻合时间和缺血时间。吻合的手术表现采用改良的显微外科技能结构评估（SAMS）评分进行评估。与传统显微外科手术相比，外科医生对主观满意度进行了评估。为了评估学习曲线，资深作者对前四次（第一组）和后四次（最后一组）手术进行了比较。结果总体而言，皮瓣存活率为 95.7%。平均动脉吻合时间为（36.7 ± 10.9）分钟。手术总时间为（277.7 ± 63.8）分钟，缺血时间为（100.6 ± 24.9）分钟。与第一组手术相比，最后一组手术的大多数 SAMS 评分参数明显更高。在大多数类别中，机器人辅助联合方法的主观满意度相同或更高。结论我们的数据证明了使用联合远程方法的安全性和可行性。用于显微外科手术的机器人系统有望提高手术质量，开辟显微外科的新领域。

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引用次数: 0

Analysis of the microsurgery fellowship match: 2019–2022 update 显微外科奖学金匹配分析：2019-2022 年更新。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-24 DOI: 10.1002/micr.31217

J. Reed McGraw MD, Reena S. Sulkar MBA, Chris Amro MD, Zachary Gala MD, Babak J. Mehrara MD, Alex K. Wong MD, Stephen J. Kovach III. MD, FACS, Evan Matros MD, MPH, MMSc, Saïd C. Azoury MD

Background

A recent analysis of microsurgery fellowship match data published in 2019 demonstrated increased competition for available positions. With growing opportunities in the field, the authors hypothesize that the landscape for both applicants and programs has become more competitive. The aim of this study is to compare two periods of match data to inform residents and programs in microsurgery.

Methods

Microsurgery fellowship match data was obtained from the San Francisco Match with approval by the American Society for Reconstructive Microsurgery for the years 2014–2022. Data were stratified into the categories of 2016–2018 and 2019–2022. Parameters assessed included: program and position fill rates, match rates, and in-service examination percentiles. Data were analyzed using Pearson's Chi-square tests and unpaired t-tests.

Results

The median number of participating programs and positions increased to 29 and 47 in 2019–2022, compared with 23 and 40 in 2016–2018. This coincided with a decrease in the number of applicants per position (1.3 [52–40] vs. 1.1 [50–47], p = .45). There was a significant increase in the match rate between groups (67.8% vs. 80.2%, p = .007). Recently, 2022 saw the lowest position fill rate on record, at 75.4% (40 of 53 positions filled), down from 85.3% (35 of 41) in 2018 (p = .35) and 95.6% (43 of 45) in 2019 (p = .006). Mean in-service examination percentiles for successfully matched applicants did not differ between (2016–2018) and (2019–2022) applicants.

Conclusion

Recent years have seen a rise in the number of microsurgery fellowship training programs with a decline in the number of applicants. Accordingly, there has been an increased match rate for prospective applicants. Despite this, a pool of unmatched applicants and unfilled positions with training opportunities still remain. The reasons for which are likely multifactorial.

背景：最近发布的 2019 年显微外科奖学金匹配数据分析显示，现有职位的竞争日益激烈。作者推测，随着该领域机会的增加，申请者和项目的竞争也变得更加激烈。本研究旨在比较两个时期的匹配数据，为显微外科住院医师和项目提供参考：方法：经美国显微外科重建学会批准，从旧金山匹配项目中获得了2014-2022年显微外科研究员匹配数据。数据分为 2016-2018 年和 2019-2022 年两类。评估参数包括：计划和职位填补率、匹配率和在职考试百分比。数据采用皮尔逊卡方检验和非配对 t 检验进行分析：与 2016-2018 年的 23 个和 40 个相比，2019-2022 年参与计划和职位的中位数分别增至 29 个和 47 个。与此同时，每个职位的申请人数也有所减少（1.3 [52-40] vs. 1.1 [50-47]，p = .45）。各组之间的匹配率大幅上升（67.8% vs. 80.2%，p = .007）。最近，2022 年的职位填补率是有记录以来最低的，为 75.4%（53 个职位填补了 40 个），低于 2018 年的 85.3%（41 个职位填补了 35 个）（p = .35）和 2019 年的 95.6%（45 个职位填补了 43 个）（p = .006）。成功配对的申请人的在职考试平均百分位数在（2016-2018 年）和（2019-2022 年）申请人之间没有差异：近年来，显微外科研究员培训项目的数量有所增加，但申请人数却有所下降。因此，潜在申请人的匹配率有所提高。尽管如此，仍有大量未匹配的申请人和未填补的培训机会职位。其原因可能是多方面的。

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引用次数: 0

Immediate foot reconstruction and revascularization of toes using an interposition superficial circumflex iliac artery perforator flow-through flap: A case report 使用髂浅周动脉穿孔带穿刺皮瓣立即进行足部重建和脚趾血管再造：病例报告。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-24 DOI: 10.1002/micr.31216

Kohei Mitsui MD, Chihena H. Banda MD, Kanako Danno MD, Kento Hosomi MD, Megumi Furuya MD, Mitsunaga Narushima MD, Ryohei Ishiura MD

Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28-year-old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6–7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2-year follow-up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow-through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow-through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization.

足部损伤，尤其是脱臼损伤，可导致趾部神经血管结构的节段性缺失，使得同时重建足部和趾部具有挑战性。本病例报告介绍了一种使用髂浅周动脉穿孔器（SCIP）皮瓣立即重建足背并重建多个足趾血管的技术。一名 28 岁的男子脚背脱臼受伤，造成 9 × 6 厘米的皮肤缺损、开放性骨折脱位、肌腱外露和神经血管损伤，其中包括供应第一、第二和第三趾的血管出现 6-7.5 厘米的节段性缺损，导致所有三个趾缺血。通过采集一个 12.5 × 5 厘米的 SCIP 皮瓣，包括浅支和深支，并结合上腹部浅静脉（SIEV），立即进行了重建。SCIP 深支用于重建第三和第二脚趾，SIEV 静脉移植用于重建第一脚趾。患者恢复良好，两年随访时未发现并发症，保留了所有三个脚趾并恢复了活动能力。使用 SCIP 皮瓣作为穿流皮瓣，皮瓣覆盖层薄，血管口径大小与数字血管匹配，减少了从远处进行静脉移植的需要，提高了手术效率。这些特性使穿流插植 SCIP 皮瓣成为重建足部缺损和血管再通脚趾的绝佳选择。我们报告的这个病例证明了 SCIP 皮瓣在即时软组织覆盖和指骨血管再造中的实用性。

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引用次数: 0

The free vastus lateralis—And conjoined vastus lateralis anterolateral thigh/tensor fascia lata flap for oncological chest wall reconstruction 用于肿瘤胸壁重建的游离大腿前外侧阔筋膜瓣和连体大腿前外侧阔筋膜瓣/张肌筋膜瓣。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-24 DOI: 10.1002/micr.31212

Florian Falkner MD, Benjamin Thomas MD, MSc, Simon A. Mayer MD, Oliver Didzun MD, Leonard Knoedler MD, Adriana C. Panayi MD, Gabriel Hundeshagen MD, Felix H. Vollbach MD, Emre Gazyakan MD, Ulrich Kneser MD, Amir K. Bigdeli MD

Introduction

A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options.

Methods

Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared.

Results

A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9).

Conclusion

The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.

简介：游离肌皮阔筋膜（VL）皮瓣是广泛胸壁重建的一种选择，它可以单独使用，也可以与大腿前外侧筋膜（cVLALT）和/或肌筋膜张力筋膜（cVLTFL）皮瓣一起使用。我们旨在直接比较这些重建方案的效果：这项回顾性研究纳入了 2010 年 2 月至 2022 年期间使用游离 VL、cVLALT 或 cVLTFL 皮瓣进行肿瘤胸壁重建的患者。研究评估了患者的人口统计学特征、手术特征以及医疗和重建结果。比较了肌皮VL、cVLALT和cVLTFL皮瓣重建的手术效果：结果：共有 41 名患者接受了游离肌皮 VL（n = 25；61%）、cVLALT（n = 14；34%）或 cVLTFL 的胸壁重建术。整个队列中有 3 例急性皮瓣血栓形成（3/41，7%），其中 1 例肌皮 VL 皮瓣因在挽救手术中复发静脉血栓而失败。两例皮瓣完全坏死（5%；VL皮瓣：n = 1；cVLALT皮瓣：n = 1），一例VL皮瓣部分坏死（1/25，4%），三例cVLALT皮瓣远端ALT部分坏死（3/14，21%）。孤立VL皮瓣和连体VL皮瓣的部分坏死率（p = .28）或全部皮瓣坏死率（p = .9）无明显差异：结论：游离（连体）VL皮瓣能可靠地消除死腔，实现复杂胸壁缺损的持久重建。

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引用次数: 0

Propeller flap's assisted recipient site closure after free SCIP flap coverage of medial ankle defect: A case report 游离 SCIP 皮瓣覆盖内踝缺损后，螺旋桨皮瓣辅助受区闭合：病例报告。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-19 DOI: 10.1002/micr.31215

Matteo Meroni MD, Mario F. Scaglioni MD

Defects in the distal lower limbs are common in the field of orthoplastic reconstruction. The ankle area presents little subcutaneous tissue and is often affected by high-energy traumas and bone fractures. Wounds in this region are frequently associated with severe edema that might prevent primary closure. Due to its thinness and tension, the skin overlying both the medial and lateral malleoli is prone to necrosis, which can further lead to large soft tissue defects. Vessels, nerves, and tendons can easily become exposed. The reconstructive approach should aim to provide high-quality tissue that is durable enough to withstand the weight-bearing pressures and the friction from shoes, while remaining sufficiently elastic to conform to the shape of the ankle and to permit the foot movement. In this study, we describe the use of an additional propeller flap to reduce skin tension at the recipient site. A superficial circumflex iliac artery perforator (SCIP) flap was utilized to cover a defect below the medial malleolus. However, after flap inset, achieving a primary closure of the proximal wound without tension was not possible. During the dissection of the posterior tibial artery, perforator vessels were identified and preserved. The larger of these vessels was then used to vascularize a propeller flap, which was then rotated toward the defect to aid a tension-free closure. The postoperative course was uneventful. This case may provide a valuable insight into the challenges often faced during wound closure, even after flap inset. Since the flap itself may increase the width of the dissection area, the present case shows the importance of preserving perforator vessels during the proximal dissection since they can allow the harvest of an additional flap to achieve primary closure and further alleviate tension.

下肢远端缺损在整形重建领域很常见。脚踝部位皮下组织较少，经常受到高能量创伤和骨折的影响。该区域的伤口经常伴有严重水肿，可能会妨碍伤口的初次闭合。由于内侧和外侧踝关节周围的皮肤较薄且张力较大，很容易发生坏死，进而导致大面积软组织缺损。血管、神经和肌腱很容易外露。重建方法应旨在提供高质量的组织，这些组织应足够耐用，能够承受负重压力和鞋子的摩擦，同时保持足够的弹性，以符合踝关节的形状并允许足部活动。在本研究中，我们介绍了使用额外的螺旋桨皮瓣来减少受术部位皮肤张力的方法。我们使用了髂浅周动脉穿孔器（SCIP）皮瓣来覆盖内侧踝骨下方的缺损。然而，皮瓣嵌入后，无法在无张力的情况下实现近端伤口的初次闭合。在解剖胫后动脉时，确定并保留了穿孔血管。然后用其中较大的血管为螺旋桨皮瓣充血，再将其向缺损处旋转，以帮助实现无张力闭合。术后恢复顺利。这个病例为我们提供了一个宝贵的视角，让我们了解到即使在皮瓣嵌入后，伤口闭合过程中也会经常面临的挑战。由于皮瓣本身可能会增加剥离区域的宽度，因此本病例显示了在近端剥离时保留穿孔血管的重要性，因为这些血管可以用来采集额外的皮瓣以实现初次闭合并进一步减轻张力。

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引用次数: 0

A clinical application for arterial coupling and histomorphometric comparison of internal mammary and thoracodorsal arteries for safe use 动脉耦合的临床应用以及乳内动脉和胸背动脉的组织形态学比较，以确保安全使用。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-19 DOI: 10.1002/micr.31214

Suphalerk Lohasammakul MD, Seok Joon Lee MD, Chaiyawat Suppasilp MD, Natawan Sirivongs MD, Kasem Koedpuech BSc, Terasut Numwong MD, Rosarin Ratanalekha MD, MSc, Hyun Ho Han MD, PhD

Background

In breast reconstruction, arterial coupling has been reported to be more favorable in the thoracodorsal artery (TDA) than the internal mammary artery (IMA). This technique may help overcome anastomosis in a small, deep space. Understanding the arteries' mechanical properties is crucial for breast reconstruction's safety and success.

Methods

Abdominal-based free flap breast reconstructions performed by a single surgeon between 2020 and 2022 were retrospectively analyzed. The patients were classified by microanastomosis technique (handsewn and coupler device) to compare the rate of vascular revision. Histomorphometric analysis of arterial coupling in TDA and IMA was performed in 10 fresh cadavers for comparing wall thickness and composition, including densities of elastic fiber, smooth muscle, and collagen.

Results

A total of 309 patients (339 reconstructed breasts) were included. There were 29 patients in the TDA handsewn group (A), 38 patients in the TDA coupler group (B), and 242 patients in the IMA handsewn group (C). The rates of arterial revision in groups A, B, and C were 0.00% (95%CI: 0.00%–11.03%), 2.5% (95%CI: 0.44%–12.88%), and 1.49% (95%CI: 0.58%–3.77%), respectively, with no statistically significant differences (p-value = .694). Histologically, the thickness of the tunica media and adventitia between IMA and TDA showed no significant difference. The density of elastic fiber was significantly higher in IMA (16.70%) than in TDA (0.79%) (p-value <.001).

Conclusion

The histologic characteristics of TDA are more favorable for arterial coupling than those of IMA. Arterial coupling is a safe option in situations where TDA anastomosis must be performed through a narrow and deep incision.

背景：据报道，在乳房重建中，胸背动脉（TDA）的动脉耦合比乳腺内动脉（IMA）更有利。这种技术有助于克服在狭小、较深空间内的吻合问题。了解动脉的机械特性对乳房重建的安全和成功至关重要：回顾性分析了 2020 年至 2022 年期间由一名外科医生实施的腹部游离皮瓣乳房重建术。根据微吻合技术（手缝和耦合器装置）对患者进行分类，以比较血管翻修率。在10具新鲜尸体上对TDA和IMA的动脉耦合进行了组织形态学分析，以比较管壁厚度和成分，包括弹性纤维、平滑肌和胶原蛋白的密度：共纳入 309 例患者（339 例重建乳房）。TDA 手缝组（A）有 29 名患者，TDA 耦合器组（B）有 38 名患者，IMA 手缝组（C）有 242 名患者。A 组、B 组和 C 组的动脉翻修率分别为 0.00%（95%CI：0.00%-11.03%）、2.5%（95%CI：0.44%-12.88%）和 1.49%（95%CI：0.58%-3.77%），差异无统计学意义（P 值 = .694）。组织学上，IMA 和 TDA 的中膜和外膜厚度无明显差异。IMA 的弹性纤维密度（16.70%）明显高于 TDA（0.79%）（P 值结论：与 IMA 相比，TDA 的组织学特征更有利于动脉耦合。在必须通过窄而深的切口进行 TDA 吻合的情况下，动脉耦合是一种安全的选择。

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引用次数: 0

Long-term outcome of fibula flaps in complex limb reconstruction compared to alternative procedures, a median follow up of 41 months 腓骨瓣在复杂肢体重建中的长期效果与其他手术相比，中位随访时间为 41 个月。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-16 DOI: 10.1002/micr.31213

Raymond Challita MD,MPH, Alexandra Forli MD, Jean-Philippe Giot MD,PhD, Denis Corcella MD

Introduction

Complex open long bone fractures present a multidisciplinary surgical challenge. Various treatment options are discussed with no consensus. Fibula flaps (FF) are frequently used in maxillofacial surgery, however their use in limb injuries is less common. With the tremendous improvement in microsurgery, orthoplastic surgery gained importance. Our retrospective study aims to assess the long-term results and the quality of life of the patients operated by FF for complex traumatic limb reconstruction.

Patients and Methods

We conducted an observational mono centric retrospective study from the year 2011 to the year 2021. Patients operated for complicated traumatic limb fractures using FF were included in the study. Not only long-term clinical results were evaluated, but also Patient-reported outcome measures (PROM). These included the Lower Extremity Functional Scale (LEFS), Quick Disabilities of the Arm, shoulder and hand (Qdash), and the Visual Analogue Scale (VAS). The statistical analysis was done using the R Software.

Results

Twenty patients were included in our study. 80% achieved complete union with no re fracture rate at a median follow-up of 41 months. All of the patients (n = 4) who underwent amputation were smokers (p = .09), were operated for lower limb fractures (p = .54), and were males (p = 1). The length of hospital stay was associated with an increased duration to complete bony union (p = .01, coefficient = 2.88). At the end of follow-up, the LEFS median score was 67 for the total population and 63.5 for the lower limb reconstructed sub group.

Conclusion

VFF is an important tool in the armamentarium of orthoplastic surgeons. Encouraging long term functional and clinical outcomes were obtained in patients with complex traumatic limb fractures.

简介复杂的开放性长骨骨折是一项多学科手术挑战。人们对各种治疗方案进行了讨论，但尚未达成共识。腓骨瓣（FF）常用于颌面外科，但在四肢损伤中的应用却不常见。随着显微外科技术的巨大进步，整形外科也变得越来越重要。我们的回顾性研究旨在评估复杂创伤肢体重建中使用 FF 手术的患者的长期效果和生活质量：我们开展了一项观察性单中心回顾性研究，研究时间为 2011 年至 2021 年。研究对象包括使用 FF 进行复杂创伤性肢体骨折手术的患者。研究不仅评估了长期临床结果，还评估了患者报告结果指标（PROM）。这些指标包括下肢功能量表（LEFS）、手臂、肩部和手部快速残疾量表（Qdash）以及视觉模拟量表（VAS）。统计分析使用 R 软件进行：研究共纳入 20 名患者。中位随访时间为 41 个月，80% 的患者达到完全愈合，无再次骨折。所有接受截肢手术的患者（n = 4）均为吸烟者（p = .09）、下肢骨折手术者（p = .54）和男性（p = 1）。住院时间的长短与完全骨结合时间的延长有关（p = .01，系数 = 2.88）。随访结束时，总人数的 LEFS 中位数为 67 分，下肢重建亚组的 LEFS 中位数为 63.5 分：结论：VFF是整形外科医生的重要工具。结论：VFF是整形外科医生的重要工具，在复杂创伤性四肢骨折患者中取得了令人鼓舞的长期功能和临床效果。

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引用次数: 0

Positive effect of ulnar nerve fascicle transfer to musculocutaneous nerve seeded with allogeneic adipose tissue derived stem cells on nerve regeneration for repairing upper brachial plexus injury in a rat model: A preliminary study 用异体脂肪组织衍生干细胞播种尺神经束转移到肌皮神经对修复大鼠模型上臂丛神经损伤的神经再生有积极作用：初步研究。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-16 DOI: 10.1002/micr.31208

Muhammed Nebil Selimoglu MD, Metin Kocacan MD, Seçkin Tuncer PhD, Zekeriya Tosun MD, Ender Erdogan MD

Background

Traumatic peripheral nerve injury, with an annual incidence reported to be approximately 13–23 per 100,000 people, is a serious clinical condition that can often lead to significant functional impairment and permanent disability. Although nerve transfer has become increasingly popular in the treatment of brachial plexus injuries, satisfactory results cannot be obtained even with total nerve root transfer, especially after serious injuries. To overcome this problem, we hypothesize that the application of stem cells in conjunction with nerve transfer procedures may be a viable alternative to more aggressive treatments that do not result in adequate improvement. Similarly, some preliminary studies have shown that adipose stem cells combined with acellular nerve allograft provide promising results in the repair of brachial plexus injury. The purpose of this study was to assess the efficacy of combining adipose-derived stem cells with nerve transfer procedure in a rat brachial plexus injury model.

Methods

Twenty female Wistar rats weighing 300–350 g and aged 8–10 weeks were randomly divided into two groups: a nerve transfer group (NT group) and a nerve transfer combined adipose stem cell group (NT and ASC group). The upper brachial plexus injury model was established by gently avulsing the C5–C6 roots from the spinal cord with microforceps. A nerve transfer from the ulnar nerve to the musculocutaneous nerve (Oberlin procedure) was performed with or without seeded allogeneic adipose tissue-derived stem cells. Adipose tissue-derived stem cells at a rate of 2 × 10⁶ cells were injected locally to the surface of the nerve transfer area with a 23-gauge needle. Immunohistochemistry (S100 and PGP 9.5 antibodies) and electrophysiological data were used to evaluate the effect of nerve repair 12 weeks after surgery.

Results

The mean latency was significantly longer in the NT group (2.0 ± 0.0 ms, 95% CI: 1.96–2.06) than in the NT and ASC group (1.7 ± 0.0 ms, 95% CI: 1.7–1.7) (p < .001). The mean peak value was higher in the NT group (1.7 ± 0.0 mV, 95% CI: 1.7–1.7) than in the NT and ASC group (1.7 ± 0.3 mV, 95% CI: 1.6–1.9) with no significant difference (p = .61). Although S100 and PGP 9.5 positive areas were observed in higher amounts in the NT and ASC group compared to the NT group, the differences were not statistically significant (p = .26 and .08, respectively).

Conclusions

This study conducted on rats provides preliminary evidence that adipose-derived ste

背景：据报道，外伤性周围神经损伤的年发病率约为十万分之十三至二十三，是一种严重的临床症状，通常会导致严重的功能障碍和永久性残疾。虽然神经转移在臂丛神经损伤的治疗中越来越受欢迎，但即使是全神经根转移也无法获得令人满意的效果，尤其是在严重损伤后。为了克服这一问题，我们假设，干细胞与神经转移手术的结合应用，可能是一种可行的替代方法，以取代无法充分改善病情的更激进的治疗方法。同样，一些初步研究表明，脂肪干细胞与无细胞神经异体移植相结合，在修复臂丛神经损伤方面具有良好效果。本研究的目的是在大鼠臂丛神经损伤模型中评估脂肪干细胞与神经移植手术相结合的疗效：方法：20只体重300-350克、年龄8-10周的雌性Wistar大鼠被随机分为两组：神经转移组（NT组）和神经转移联合脂肪干细胞组（NT和ASC组）。上臂丛神经损伤模型是用微型钳子将C5-C6神经根从脊髓中轻轻剥离而建立的。从尺骨神经到肌皮神经的神经转移（奥伯林手术）在播种或不播种异体脂肪组织衍生干细胞的情况下进行。用23号针头将2×106个脂肪组织衍生干细胞局部注射到神经转移区域的表面。免疫组化（S100和PGP 9.5抗体）和电生理数据用于评估术后12周的神经修复效果：结果：NT 组的平均潜伏期（2.0 ± 0.0 ms，95% CI：1.96-2.06）明显长于 NT 和 ASC 组（1.7 ± 0.0 ms，95% CI：1.7-1.7）（p 结论：该研究对大鼠的神经修复效果进行了初步评估：这项在大鼠身上进行的研究提供了初步证据，证明脂肪源性干细胞可能对治疗臂丛神经损伤的神经转移有积极作用。要证实这些发现，还需要样本量更大、随访时间更长的进一步研究。

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引用次数: 0

A comparison of postoperative outcomes based on recipient vessels in scalp free flap reconstruction: A systematic review and meta-analysis 根据头皮游离皮瓣重建中的受体血管比较术后效果：系统回顾和荟萃分析。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-07-12 DOI: 10.1002/micr.31211

Asli Pekcan BS, Idean Roohani BS, Eloise Stanton BA, Deborah Choe BA, Micaela Tomaro BS, Ishani D. Premaratne MD, Langley G. Wallace BA, Joseph N. Carey MD, David A. Daar MD, MBA

Purpose

The superficial temporal artery (STA) and facial artery (FA) are two commonly used recipient vessels when performing free tissue transfer to the head and neck. This meta-analysis compares the impact of recipient vessel location on free flap outcomes in scalp reconstruction.

Methods

A systematic review was conducted following PRISMA-P guidelines using six databases. Studies reporting free tissue transfer using the STA or FA as a recipient vessel for reconstructing scalp defects were included. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality evaluation was performed using ASPS criteria and the ROBINS-I tool.

Results

Of 3270 identified articles, 12 were included for final analysis. In total, 125 free flaps were identified (75 STA, 50 FA). Pooled analysis demonstrated an overall flap survival rate of 98.4% (STA 98.7% vs. FA 98.0%; p = .782). The mean defect size was significantly greater for flaps using the STA compared with the FA (223.7 ± 119.4 cm² vs. 157.1 ± 96.5 cm², p = .001). The FA group had a higher incidence of wound dehiscence than the STA group (14.0% vs. 1.3%, p = .005). However, meta-analysis demonstrated no significant difference in rates of wound dehiscence, flap loss, partial flap necrosis, venous congestion, or postoperative infection between groups.

Conclusion

This is the first systematic review and meta-analysis to assess recipient vessel selection in scalp reconstruction. Our results do not support a single vessel as the superior choice in scalp reconstruction. Rather, these findings suggest that the decision between using the STA or FA is multifaceted, requiring a flexible approach that considers the individual characteristics of each case. Further research is needed to explore additional factors influencing recipient vessel selection, including defect location, radiation therapy, and prior head and neck surgery.

目的：颞浅动脉（STA）和面动脉（FA）是头颈部进行游离组织转移时常用的两种受体血管。这项荟萃分析比较了受体血管位置对头皮重建游离皮瓣结果的影响：方法：根据 PRISMA-P 指南，使用六个数据库进行了系统性综述。方法：根据 PRISMA-P 指南，使用 6 个数据库进行了系统性回顾，纳入了报告使用 STA 或 FA 作为受体血管进行游离组织转移以重建头皮缺损的研究。相关结果包括皮瓣脱落、部分皮瓣坏死、伤口裂开、静脉血栓和感染率。采用ASPS标准和ROBINS-I工具进行质量评估：结果：在3270篇鉴定文章中，有12篇被纳入最终分析。总共确定了 125 个游离皮瓣（75 个 STA，50 个 FA）。汇总分析显示，皮瓣总存活率为 98.4%（STA 98.7% vs. FA 98.0%；P = .782）。使用 STA 的皮瓣的平均缺损面积明显大于使用 FA 的皮瓣（223.7 ± 119.4 平方厘米 vs. 157.1 ± 96.5 平方厘米，p = .001）。FA 组的伤口开裂发生率高于 STA 组（14.0% 对 1.3%，P = .005）。然而，荟萃分析表明，不同组间的伤口开裂、皮瓣脱落、部分皮瓣坏死、静脉充血或术后感染率无明显差异：这是首次对头皮重建中受体血管选择进行评估的系统回顾和荟萃分析。我们的研究结果并不支持单一血管作为头皮重建的最佳选择。相反，这些研究结果表明，决定使用 STA 还是 FA 是多方面的，需要考虑每个病例的个体特征，采取灵活的方法。还需要进一步研究探讨影响受体血管选择的其他因素，包括缺损位置、放射治疗和之前的头颈部手术。

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引用次数: 0

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