Microsurgery最新文献_第4页

Current Perceptions Toward the Use of Superficial Temporal Vessels in Head and Neck Reconstruction 目前对使用颞浅血管进行头颈部重建的看法。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-29 DOI: 10.1002/micr.70164

Belén Andresen-Lorca, Alberto Pérez-García, Arantxa Blasco-Serra, Eva M. González-Soler, María D. Pérez-del-Caz, Alfonso A. Valverde-Navarro

引用次数: 0

Urethral Reconstruction for Hypospadias Repair Using an Ulnar Forearm Flap: A Report of Long-Term Outcomes of 3 Cases 应用前臂尺侧皮瓣重建尿道修复尿道下裂3例远期疗效分析。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-22 DOI: 10.1002/micr.70161

Goki Ohashi, Takashi Nuri, Koichi Ueda

Hypospadias is a congenital anomaly affecting 1 in 300 male infants. When urethral stricture develops after the initial surgery, it tends to become intractable, often necessitating multiple corrective surgeries. We previously reported favorable outcomes using an ulnar forearm flap for urethral reconstruction in such refractory cases. Here, we describe the long-term outcomes of three cases treated by this method. All had undergone surgery for hypospadias during childhood and repeated urethral stricture surgeries before undergoing urethral reconstruction using our method. Case 1 was a 40-year-old man who underwent this surgery at age 21. The flap size was 3.0 × 12.5 cm. Postoperatively, the patient had favorable outcomes for 12 years. Subsequently, urethral stricture recurred, requiring corrective surgery using a skin graft. Case 2 was a 58-year-old man who underwent this surgery at age 40 years. The flap size was 3.5 × 10.0 cm. Postoperatively, the patient had favorable outcomes for 11 years. Subsequently, urethral stricture recurred, but symptoms were improved by balloon dilation alone. Case 3 was a 48-year-old man who underwent this surgery at age 45 years. The flap size was 3.2 × 10.0 cm. Postoperatively, urethral stricture recurred at 6 months, necessitating correction using a penile skin flap. The donor site exhibited prominent hypertrophy, suggesting a predisposition for hypertrophic scar development. The follow-up periods were 19 years for Case 1, 18 years for Case 2, and 4 years for Case 3, without stricture recurrence. Compared with long-term outcomes for urethral reconstruction using skin or buccal mucosa grafts, our method showed the potential for more favorable outcomes. This method may be a good treatment option, but may lead to early stricture recurrence depending on the patient's constitution, requiring careful follow-up.

尿道下裂是一种先天性畸形，每300名男婴中就有1人患有。当初次手术后出现尿道狭窄时，它往往变得难以治疗，往往需要多次矫正手术。我们以前报道过在这种难治性病例中使用前臂尺皮瓣重建尿道的良好结果。在这里，我们描述了用这种方法治疗的三个病例的长期结果。所有患者均在儿童期接受过尿道下裂手术和多次尿道狭窄手术，然后采用我们的方法进行尿道重建。病例1是一名40岁的男性，他在21岁时接受了这项手术。皮瓣大小为3.0 × 12.5 cm。术后12年，患者预后良好。随后，尿道狭窄复发，需要进行植皮矫正手术。病例2是一名58岁的男性，他在40岁时接受了这项手术。皮瓣大小为3.5 × 10.0 cm。术后11年，患者预后良好。随后，尿道狭窄复发，但仅经球囊扩张后症状得到改善。病例3是一名48岁的男性，他在45岁时接受了这项手术。皮瓣大小为3.2 × 10.0 cm。术后6个月尿道狭窄复发，需要阴茎皮瓣矫正。供体部位表现出明显的肥厚，提示增生性瘢痕发展的易感性。病例1随访19年，病例2随访18年，病例3随访4年，无狭窄复发。与使用皮肤或颊粘膜移植重建尿道的长期结果相比，我们的方法显示出更有利的结果。这种方法可能是一个很好的治疗选择，但根据患者的体质，可能导致早期狭窄复发，需要仔细随访。

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引用次数: 0

Thigh-Based Flap Reconstruction for Complex Abdominal Wall Loss of Domain: A 10-Year Retrospective Cohort Study 基于大腿的皮瓣重建复杂腹壁区域丧失：10年回顾性队列研究。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-21 DOI: 10.1002/micr.70156

Diwakar Phuyal, Filippo A. G. Perozzo, Fuad Abbas, Christopher Jou, Anshumi Desai, Kashyap Tadisina, Juan Rodolfo Mella Catinchi, Risal Djohan, Raffi Gurunian, Sarah N. Bishop

Background

Complex abdominal wall reconstruction (AWR) is a technically demanding procedure often required in patients with large fascial defects and significant comorbidities. When primary closure is not feasible, thigh-based flaps can provide durable soft tissue coverage and structural support. However, literature on flap-based AWR remains limited.

Methods

A retrospective cohort study of patients who underwent thigh-based AWR between 2014 and 2024 at a single tertiary center was conducted. All patients had significant loss of domain and underwent reconstruction with pedicled or free flaps, with or without mesh. Data on demographics, defect characteristics, comorbidities, surgical techniques, and postoperative outcomes were analyzed.

Results

Fifteen patients (9 males, 6 females; mean age 53.7 ± 7 years; BMI 30.8 ± 5.9 kg/m²) underwent reconstruction. Comorbidities were common: 53% had a smoking history, 40% had diabetes, 67% had hypertension, and 93% of patients had a median of 8 previous abdominal surgeries. Defects averaged 840 cm² (fascial) and 504 cm² (skin). Mesh was used in all cases, and 67% of patients required free flaps. Flap types included anterolateral thigh (ALT), chimeric, and vastus lateralis myocutaneous configurations. The median hospital stay was 15 days. Any complications occurred in 80% of patients, with 20% experiencing Clavien-Dindo (CD) grade III events. Long-term outcomes included low rates of abdominal bulge (6.7%) and fistula recurrence (7%).

Conclusions

Our 10-year experience demonstrates consistent achievement of definitive fascial closure, reliable flap survival, and manageable complication rates, even in the presence of significant comorbidities and prior surgical complexity.

背景：复杂腹壁重建（AWR）是一项技术要求很高的手术，通常需要在患者有大的筋膜缺损和显著的合并症。当初次闭合不可行时，基于大腿的皮瓣可以提供持久的软组织覆盖和结构支持。然而，关于皮瓣AWR的文献仍然有限。方法：回顾性队列研究2014年至2024年在单一三级中心进行的基于大腿的AWR患者。所有患者都有明显的区域丧失，并接受带蒂或自由皮瓣重建，有或没有补片。分析了人口统计学、缺陷特征、合并症、手术技术和术后结果的数据。结果：15例患者行重建术，男9例，女6例，平均年龄53.7±7岁，BMI 30.8±5.9 kg/m2。合并症很常见：53%有吸烟史，40%有糖尿病，67%有高血压，93%的患者既往腹部手术中位数为8次。缺损平均840平方厘米（筋膜）和504平方厘米（皮肤）。所有病例均使用补片，67%的患者需要游离皮瓣。皮瓣类型包括股前外侧肌（ALT）、嵌合肌和股外侧肌。平均住院时间为15天。80%的患者出现并发症，20%的患者出现Clavien-Dindo (CD) III级事件。长期结果包括低腹胀率（6.7%）和瘘复发率（7%）。结论：我们10年的经验表明，即使在存在明显的合并症和既往手术复杂性的情况下，也能始终如一地实现最终的筋膜闭合，可靠的皮瓣存活率和可控的并发症发生率。

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引用次数: 0

Comparing Transabdominal and Totally Extraperitoneal Approaches for Minimally Invasive DIEP Flap Harvest: A Systematic Review 经腹和全腹膜外入路在微创DIEP皮瓣切除术中的比较：系统综述。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-20 DOI: 10.1002/micr.70160

Diwakar Phuyal, James Gaston, Natalie Hoffner, Osama Darras, Risal Djohan, Graham Schwarz, Raffi Gurunian, Sarah N. Bishop

Introduction

Minimally invasive techniques for DIEP flap harvest, including transabdominal (TAPP) and totally extraperitoneal (TEP) approaches, have been reported to be beneficial in reducing morbidity; however, direct comparative synthesis between these methods remains scarce, limiting consensus on the optimal approach.

Method

Following PRISMA guidelines, we searched MEDLINE, Embase, and Cochrane Central for prospective and retrospective studies on robotic or laparoscopic DIEP harvest in breast reconstruction. Cadaveric studies and non-DIEP procedures were excluded. Primary operative outcomes included harvest time, type of robot, fascial incision length, intramuscular length, and intraoperative complications, while secondary clinical outcomes were postoperative complications, length of stay, and pain. A structured narrative synthesis was conducted using pooled descriptive data, without inferential statistical analysis.

Results

Ten studies were included, including six describing TAPP harvest, two robotic TEP, and two laparoscopic TEP. Reported unilateral reconstruction times averaged 442.6 ± 63.4 min for TAPP and 460.3 ± 90.4 min for TEP, while bilateral procedures averaged 682.6 ± 115.1 min for TAPP compared with 453.0 ± 81.5 min for TEP. Fascial incisions were longer with TAPP (3.75 ± 1.34 cm) compared to TEP (2.59 ± 0.49 cm), and intramuscular pedicle dissection length was greater in TAPP (4.1 ± 0.7 vs. 2.25 ± 0.27 cm). No study reported bowel injury or postoperative ileus, and overall complication rates—including vessel avulsion, flap loss, infection, and seroma—were similar. Postoperative pain scores were 1.9 ± 0.9 in TAPP versus 2.3 ± 0.9 in TEP, while hospital stay averaged 3.9 ± 1.3 days for TAPP and 4.5 ± 0.9 days for TEP.

Conclusion

Both TAPP and TEP appear safe and effective for minimally invasive DIEP flap harvest. Trends suggest bilateral TAPP requires longer operative times, while TEP results in shorter fascial incisions and had shorter intramuscular pedicle lengths. Pain and complication rates were comparable, although study heterogeneity and small sample sizes limit generalizability. Larger, prospective comparative studies are essential to better define technique selection.

导读：微创技术的DIEP皮瓣收获，包括经腹（TAPP）和完全腹膜外（TEP）入路，已报道有利于降低发病率；然而，这些方法之间的直接比较综合仍然很少，限制了对最佳方法的共识。方法：根据PRISMA指南，我们检索MEDLINE、Embase和Cochrane Central，检索机器人或腹腔镜DIEP采集在乳房重建中的前瞻性和回顾性研究。排除了尸体研究和非diep程序。主要手术结局包括收获时间、机器人类型、筋膜切口长度、肌内长度和术中并发症，次要临床结局包括术后并发症、住院时间和疼痛。使用汇总的描述性数据进行结构化叙事综合，不进行推论统计分析。结果：纳入10项研究，其中6项描述TAPP收获，2项机器人TEP和2项腹腔镜TEP。报道的单侧重建时间TAPP平均为442.6±63.4 min， TEP为460.3±90.4 min，双侧重建时间TAPP平均为682.6±115.1 min， TEP为453.0±81.5 min。TAPP组筋膜切口较TEP组（2.59±0.49 cm）长（3.75±1.34 cm），肌内蒂剥离长度较大（4.1±0.7 cm比2.25±0.27 cm）。没有研究报告肠损伤或术后肠梗阻，总体并发症发生率（包括血管撕脱，皮瓣丢失，感染和血清）相似。TAPP组术后疼痛评分为1.9±0.9，TEP组为2.3±0.9，TAPP组平均住院时间为3.9±1.3天，TEP组平均住院时间为4.5±0.9天。结论：TAPP和TEP在微创DIEP皮瓣切除术中均安全有效。趋势表明，双侧TAPP需要更长的手术时间，而TEP导致更短的筋膜切口和更短的肌内蒂长度。尽管研究的异质性和小样本量限制了普遍性，但疼痛和并发症发生率具有可比性。更大规模的前瞻性比较研究对于更好地定义技术选择至关重要。

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引用次数: 0

Outcome Analysis of Modified End-to-Side Bony Strut Placement for Osteo-Cutaneous Fibular Free Flap Reconstruction of Segmental Mandibular Defects 改良端侧骨支撑置入术修复下颌骨节段性缺损的效果分析。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-16 DOI: 10.1002/micr.70157

Sam El Abbadi, Rushil R. Dang, Ellen M. Lee, Lukas Pindur, Chung-Kan Tsao

Background

Segmental mandibular reconstruction with osteocutaneous fibular free flaps commonly employs end-to-end (E-T-E) wedge osteotomies. However, excessive osteotomies or limited fibular length can compromise vascularity, bony union, available pedicle length. This study evaluates the outcomes of a modified end-to-side (E-T-S) fibular strut configuration in mandibular reconstruction.

Methods

A retrospective analysis was conducted on 11 patients who underwent mandibular reconstruction using fibular free flaps with at least one E-T-S osteotomy between 2017 and 2021. Bony union was assessed radiographically ≥ 12 months postoperatively and categorized as complete (CBU) or incomplete bony union (IBU). Complication rates were also analyzed.

Results

Among 33 junctions, 11 were reconstructed using the modified E-T-S approach. Of these, 7 achieved complete bony union. In the remaining 22 junctions reconstructed with E-T-E osteotomies, 15 achieved complete bony union.

Conclusion

Descriptively, the union rates observed in modified E-T-S osteotomies were similar to those seen in conventional E-T-E reconstructions. It offers a viable alternative in complex reconstructions where pedicle length, anatomy, or perfusion constraints preclude standard approaches.

背景：骨皮腓骨游离皮瓣的下颌骨重建通常采用端到端楔形截骨术。然而，过度截骨或腓骨长度有限会损害血管、骨愈合和可用椎弓根长度。本研究评估改良端侧（E-T-S）腓骨支撑结构在下颌骨重建中的效果。方法：回顾性分析2017年至2021年间11例使用游离腓骨瓣进行下颌骨重建并至少一次E-T-S截骨的患者。术后≥12个月影像学评估骨愈合，并分类为完全骨愈合（CBU）或不完全骨愈合（IBU）。同时分析并发症发生率。结果：采用改良E-T-S入路重建33个神经连接，其中11个重建成功。其中7例实现骨完全愈合。其余22例采用E-T-E截骨术重建接点，15例实现骨完全愈合。结论：改良E-T-S截骨术的愈合率与传统E-T-E重建术相似。它提供了一个可行的选择，在复杂的重建椎弓根长度，解剖结构或灌注限制排除标准方法。

{"title":"Outcome Analysis of Modified End-to-Side Bony Strut Placement for Osteo-Cutaneous Fibular Free Flap Reconstruction of Segmental Mandibular Defects","authors":"Sam El Abbadi, Rushil R. Dang, Ellen M. Lee, Lukas Pindur, Chung-Kan Tsao","doi":"10.1002/micr.70157","DOIUrl":"10.1002/micr.70157","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Segmental mandibular reconstruction with osteocutaneous fibular free flaps commonly employs end-to-end (E-T-E) wedge osteotomies. However, excessive osteotomies or limited fibular length can compromise vascularity, bony union, available pedicle length. This study evaluates the outcomes of a modified end-to-side (E-T-S) fibular strut configuration in mandibular reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted on 11 patients who underwent mandibular reconstruction using fibular free flaps with at least one E-T-S osteotomy between 2017 and 2021. Bony union was assessed radiographically ≥ 12 months postoperatively and categorized as complete (CBU) or incomplete bony union (IBU). Complication rates were also analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 33 junctions, 11 were reconstructed using the modified E-T-S approach. Of these, 7 achieved complete bony union. In the remaining 22 junctions reconstructed with E-T-E osteotomies, 15 achieved complete bony union.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Descriptively, the union rates observed in modified E-T-S osteotomies were similar to those seen in conventional E-T-E reconstructions. It offers a viable alternative in complex reconstructions where pedicle length, anatomy, or perfusion constraints preclude standard approaches.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145763425","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

A Systematic Review and Meta-Analysis of Functional Tongue Reconstruction Using Dynamic Free Flap Designs 动态自由皮瓣重建舌功能的系统回顾与meta分析。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-16 DOI: 10.1002/micr.70155

O. V. Hovav, D. S. Sparks, G. Velli, M. David, D. Rowe, T. Read

Background

The treatment of tongue malignancies frequently produces deficits in feeding, swallowing, and speech intelligibility. These have a significant impact on patients' quality-of-life. Free tissue transfer is the preferred method for reconstructing larger, complex defects, and aims to restore both mechanical and sensory function while protecting the airway. The role of dynamic free flap designs incorporating motor reinnervation remains unclear, particularly in cases with more extensive glossectomy defects. The objective of this systematic review is to evaluate the speech and swallow outcomes of patients undergoing dynamic free flap reconstruction following ablative tongue surgery.

Methods

A systematic review was performed to determine the role of dynamic free flap surgery for functional tongue reconstruction. Searches were conducted in MEDLINE (PubMed), EMBASE, the Cochrane Library, Google Scholar, and included English-language studies from 1980 onward. Search terms included: glossectomy in combination with functional reconstruction and related outcomes. Primary outcome measures were flap compromise, competent swallow, and intelligible speech. A meta-analysis was performed using pooled data from comparative studies. Key data analysis was undertaken to calculate weighted effect sizes using random–effects models.

Results

Thirteen studies reported on the use of dynamic free flaps for tongue reconstruction. A total of 168 innervated flaps were available for comparison after pooling data. The non-weighted flap failure rate was 1.2% within this cohort. Competent swallow varied from 43% to 100% with a mean value of 80.2%. Rates of satisfactory speech were between 73% and 100% with a mean value of 91.7%. The mean follow-up duration was 21.8 months and ranged between 9.5 and 47.6 months. With further analyses of comparative sub-groups, there was a marked improvement in swallow competency with dynamic flap types over static designs (OR = 4.09, 95% CI: 1.75, 9.58, p = < 0.01).

Conclusion

Current evidence indicates that dynamic free flap designs enhance functional recovery and may benefit both swallow and speech outcomes postoperatively.

背景：舌恶性肿瘤的治疗经常导致进食、吞咽和言语清晰度的缺陷。这些对患者的生活质量有重大影响。游离组织移植是修复较大、复杂缺损的首选方法，旨在恢复机械和感觉功能，同时保护气道。结合运动神经支配的动态自由皮瓣设计的作用尚不清楚，特别是在更广泛的舌骨切除缺陷的情况下。本系统综述的目的是评估在舌骨消融手术后进行动态自由皮瓣重建的患者的言语和吞咽结果。方法：系统回顾动态游离皮瓣在舌功能重建中的作用。检索在MEDLINE （PubMed）、EMBASE、Cochrane图书馆、谷歌Scholar中进行，包括1980年以来的英语研究。搜索词包括：舌骨切除术合并功能重建及相关结果。主要观察指标为皮瓣收缩、吞咽能力和言语可听得清。使用来自比较研究的汇总数据进行荟萃分析。采用随机效应模型对关键数据进行分析，计算加权效应值。结果：13项研究报道了动态自由皮瓣在舌部重建中的应用。汇总数据后，共有168个神经支配皮瓣可供比较。在该队列中，非加权皮瓣失败率为1.2%。吞咽能力从43%到100%不等，平均值为80.2%。言语满意率在73% ~ 100%之间，平均值为91.7%。平均随访时间为21.8个月，9.5 ~ 47.6个月不等。通过进一步的比较亚组分析，动态皮瓣比静态皮瓣在吞咽能力方面有明显的改善（OR = 4.09, 95% CI: 1.75, 9.58, p =）。结论：目前的证据表明，动态自由皮瓣设计可以增强功能恢复，并可能有利于术后吞咽和言语预后。

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引用次数: 0

Reconstruction of Anterior and Posterior Tibial Arteries as Recipient Vessels for Free Flap Transfer in Gustilo–Anderson Classification Type IIIB Severe Open Tibial Fractures 重建胫骨前、后动脉受体血管用于Gustilo-Anderson分类IIIB型严重胫骨开放性骨折游离皮瓣移植。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-15 DOI: 10.1002/micr.70159

Yuta Izawa, Kentaro Futamura, Masahiro Nishida, Yoshihiko Tsuchida

Background

In severe lower leg trauma requiring soft tissue transfer, a limited number of run-off vessels is a risk factor for reoperation and flap necrosis. We hypothesized that early reconstruction of injured major arteries (the anterior tibial artery (ATA) or posterior tibial artery (PTA)) to prepare two recipient arterial systems could reduce anastomotic complications. This study aimed to evaluate the effectiveness of arterial reconstruction in patients with severe lower extremity trauma.

Methods

This study included patients with Gustilo–Anderson type IIIB open lower leg fractures and arterial injuries who underwent free flap surgery. The patients were divided into two groups: group 1 comprised patients with ATA or PTA run-off at free-flap surgery, and group 2 comprised patients with both ATA and PTA run-off after early revascularization. Patient demographics, injury characteristics, and treatment details were recorded. Primary outcome was occurrence of flap necrosis, and secondary outcomes were occurrence of intraoperative anastomosis revision and unplanned return to operating room. Outcomes were statistically compared between the two groups.

Results

Groups 1 and 2 comprised 12 patients. Group 1 had a mean age of 38.7 years (nine males and three females), including nine ATA injuries and three PTA injuries: 11 latissimus dorsi (LD) and one anterolateral thigh (ALT) flaps were used. Group 2 had a mean age of 50.8 years (all males), with 2 ATA and 10 PTA injuries; 10 LD and 2 ALT flaps were used. Intraoperative revision and unplanned return were significantly more frequent in group 1 than in group 2 (both p = 0.029). Complete flap loss occurred in two patients in group 1 and none in group 2 (p = 0.333).

Conclusions

Early reconstruction of injured arteries to prepare two recipient systems significantly reduced vascular complications and may improve free-flap outcomes in patients with severe open lower leg fractures.

背景：在需要软组织转移的严重下肢创伤中，有限数量的流出血管是再次手术和皮瓣坏死的危险因素。我们假设早期重建受损的大动脉（胫前动脉（ATA）或胫后动脉（PTA））以准备两个受体动脉系统可以减少吻合并发症。本研究旨在评估动脉重建在严重下肢外伤患者中的有效性。方法：本研究纳入Gustilo-Anderson IIIB型下肢开放性骨折及动脉损伤患者，行游离皮瓣手术。患者分为两组：1组为游离皮瓣手术中ATA或PTA流出的患者，2组为早期血运重建术后ATA和PTA同时流出的患者。记录患者人口统计、损伤特征和治疗细节。主要结局是皮瓣坏死的发生，次要结局是术中吻合口翻修和意外返回手术室的发生。对两组结果进行统计学比较。结果：1、2组共12例患者。组1平均年龄38.7岁（男9例，女3例），其中ATA损伤9例，PTA损伤3例，使用背阔肌（LD）皮瓣11个，大腿前外侧（ALT）皮瓣1个。2组平均年龄50.8岁（均为男性），ATA 2例，PTA 10例；使用10个LD皮瓣和2个ALT皮瓣。组1术中翻修和意外复发的发生率明显高于组2 （p = 0.029）。1组有2例皮瓣完全丢失，2组无皮瓣完全丢失（p = 0.333）。结论：早期重建损伤动脉以准备两个受体系统可显著减少血管并发症，并可改善严重下肢开放性骨折患者的自由皮瓣预后。

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引用次数: 0

Vascularized Radial Periosteal Pedicled Flap for Recalcitrant Ulnar Nonunion in Children: Anatomical Study and Case Report 带血管的桡骨骨膜带蒂皮瓣治疗儿童顽固性尺骨不连的解剖学研究及病例报告。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-15 DOI: 10.1002/micr.70158

Francisco Soldado, Javier Buendía-Pérez, Vivian Sinclair, Carla Carbonell-Rosell, Pablo Romero-Larrauri, Amr Fouad, Duc Minh Nguyen, Paula Diáz-Gallardo

Background

Pediatric cases of bone nonunion are rare and often a result of complex local vascular limitations. The periosteum plays a key role in bone healing through its regenerative properties. Vascularized periosteal grafts have previously been effective in treating complex cases. This study explores the vascular anatomy of the radial periosteum supplied by the anterior interosseous vessels and introduces the vascularized radial periosteal graft (VRPG), successfully implemented in a case of ulnar nonunion.

Material and Methods

Cadaveric studies of ten upper limbs were conducted under ×2.5 loupe magnification following injection of colored natural latex through the brachial artery. Anterior interosseous vessels (AIOV) branches supplying the radial shaft periosteum were studied with regards to AIOV length, number of periosteal branches, and their respective distances from the distal radioulnar joint (DRUJ). As part of our case report, two pediatric cases of complex ulnar shaft nonunion underwent treatment with a VRPG: one a 15-year-old with a multioperated ulnar nonunion and the other a 5-year-old with congenital pseudoarthrosis.

Results

The mean AIOV length was 15.9 cm (range 14.2–17.8). They were found to have an average of 9.6 (range 8–13) periosteal branches with a mean distance to the DRUJ of 16 mm (range 11–23 mm) from the most distal branch and 111 mm (98–136) from the most proximal periosteal branch. Case report follow-up of both cases showed a very early initially ossified prominent callus and early bone union and callus remodeling with excellent function.

Conclusions

The AIOV reliably supplies the radial periosteal shaft, allowing for successful harvest of a pedicled periosteal flap. This flap has proven effective in treating 2 cases of pediatric ulnar nonunion and warrants further evaluation and consideration in similar cases in the future.

背景：小儿骨不愈合的病例是罕见的，往往是复杂的局部血管限制的结果。骨膜通过其再生特性在骨愈合中起关键作用。带血管的骨膜移植以前在治疗复杂病例中是有效的。本研究探讨了由前骨间血管供应的桡骨骨膜的血管解剖，并介绍了血管化桡骨骨膜移植物（VRPG），成功应用于一例尺骨不愈合。材料和方法：通过肱动脉注射彩色天然乳胶，在×2.5放大镜下对10例上肢进行尸体研究。我们研究了供应桡骨轴骨膜的前骨间血管（AIOV）分支的AIOV长度、骨膜分支的数量及其与远端尺桡关节（DRUJ）的距离。作为我们病例报告的一部分，两例复杂尺干不连的儿童病例接受了VRPG治疗：一名15岁的多手术尺干不连，另一名5岁的先天性假关节。结果：AIOV平均长度为15.9 cm（14.2 ~ 17.8）。他们平均有9.6（范围8-13）个骨膜分支，与DRUJ的平均距离为16毫米（范围11-23毫米），距离最近骨膜分支111毫米（范围98-136）。病例报告随访显示，两例患者均出现早期初始骨化的突出骨痂，早期骨愈合和骨痂重塑功能良好。结论：AIOV可靠地供应桡骨骨膜轴，允许成功收获带蒂骨膜瓣。该皮瓣已被证明有效治疗2例儿童尺骨不连，值得在未来类似病例中进一步评估和考虑。

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引用次数: 0

Defining BMI Thresholds for Free Flap Reconstruction Following Nipple-Sparing Mastectomy 确定保留乳头乳房切除术后自由皮瓣重建的BMI阈值。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-12-13 DOI: 10.1002/micr.70153

Salman Khan, Mehdi S. Lemdani, Dustin Crystal, Chris Amro, Robyn B. Broach, Joseph M. Serletti, Saïd C. Azoury

Background

Autologous breast reconstruction (ABR) following nipple-sparing mastectomy (NSM) is recognized for superior aesthetic outcomes. However, body mass index (BMI)-based recommendations for free flap reconstruction remain debated due to the risk of perioperative complications. This study assesses outcomes concerning BMI, defining optimal BMI cutoffs for patients undergoing ABR after NSM.

Methods

A retrospective review of free flap breast reconstruction following NSM from 2005 to 2024 was performed. Patient BMI was utilized as a predictor of complications post-NSM with ABR. Considering demographic and comorbidity factors, risk-adjusted logistic regression models evaluated the BMI-outcome relationship. Receiver operating characteristic (ROC) curves defined BMI cutoffs. Youden's Index identified optimal BMI cutoffs.

Results

A total of 301 patients (466 breasts) underwent free flap breast reconstruction following NSM. The median BMI was 27.8 kg/m² ± 5.3. Nipple areolar complex (NAC) necrosis was observed in 4.8% of the cases, with an AUC of 0.7195 and a BMI threshold of 37.6. The rates, AUC values, and BMI cutoffs for other complications included: 1.7% seroma rate (AUC: 0.8352, BMI: 41.1), 3.4% hematoma rate (AUC: 0.700, BMI: 39.2), and 11.8% skin necrosis rate (AUC: 0.6878, BMI: 34). Flap loss due to vascular complications was observed in 0.9% of patients, with an AUC of 0.7308 and a BMI cutoff of 43.2.

Conclusion

This study quantifies the significance of BMI in determining postoperative complications after NSM with free flap breast reconstruction. ABR after NSM is broadly safe across most BMI values, with progressively higher risk primarily at very high BMI. Prudent consideration of BMI cutoffs can reduce postoperative morbidity. This data offers surgeons BMI thresholds for improved patient counseling, surgical planning, and outcome optimization.

背景：保留乳头乳房切除术（NSM）后自体乳房重建（ABR）被认为具有良好的美学效果。然而，由于围手术期并发症的风险，基于身体质量指数（BMI）的游离皮瓣重建建议仍存在争议。本研究评估了与BMI相关的结果，为NSM后接受ABR的患者定义了最佳BMI临界值。方法：回顾性分析2005年至2024年NSM术后游离皮瓣乳房重建情况。患者BMI被用作nsm合并ABR后并发症的预测指标。考虑人口统计学和合并症因素，采用风险调整logistic回归模型评估bmi与预后的关系。受试者工作特征（ROC）曲线定义BMI截止点。约登指数确定了最佳BMI临界值。结果：301例患者（466个乳房）在NSM术后行游离皮瓣乳房重建。中位BMI为27.8 kg/m2±5.3。乳头乳晕复合体（NAC）坏死发生率为4.8%，AUC为0.7195，BMI阈值为37.6。其他并发症的发生率、AUC值和BMI临界值为：血肿率1.7% (AUC: 0.8352, BMI: 41.1)，血肿率3.4% (AUC: 0.700, BMI: 39.2)，皮肤坏死率11.8% （AUC: 0.6878, BMI: 34）。0.9%的患者出现血管并发症导致皮瓣丢失，AUC为0.7308，BMI截止值为43.2。结论：本研究量化了BMI对NSM游离皮瓣乳房再造术术后并发症的判断意义。在大多数BMI值范围内，NSM后ABR大体上是安全的，主要在非常高的BMI时，风险逐渐增加。谨慎考虑BMI临界值可降低术后发病率。该数据为外科医生提供BMI阈值，以改善患者咨询，手术计划和结果优化。

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Comments on “Free Flap Reconstruction in Burns: A Systematic Review of Current Practices and Evidence” “烧伤游离皮瓣重建：当前实践和证据的系统回顾”评论

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-11-27 DOI: 10.1002/micr.70140

Mare G. Kaulakis, Christopher J. Fedor, Sarah M. Tepe, Francesco M. Egro

引用次数: 0