Microsurgery最新文献_第4页

The Impact of Increased Body Mass Index on Patient Outcomes and Complications in Microsurgical Lower Extremity Reconstruction 体质指数增加对显微外科下肢重建术患者疗效和并发症的影响。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-05 DOI: 10.1002/micr.31231

Eloise W. Stanton, Artur Manasyan, Elizabeth Boudiab, Joseph N. Carey, David A. Daar

Background

Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction.

Methods

A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories.

Results

A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10–15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years.

Conclusions

BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.

背景：体重指数（BMI）升高是伤口延迟愈合和感染等并发症的已知围手术期风险因素。然而，人们对体重指数升高如何影响创伤后下肢（LE）微血管重建后的预后还缺乏了解：方法：2007 年至 2022 年期间，一家一级创伤中心对接受创伤后下肢微血管重建术的患者进行了回顾性研究。记录了人口统计学、皮瓣/伤口细节、并发症和结果。患者按疾病控制中心的体重指数分层：结果：共纳入 398 名患者，平均 BMI 为 28.2 ± 5.8。近一半（45%）的LE缺损位于腿的远端三分之一处，27.5%位于中间三分之一处，34.4%位于近端三分之一处。与筋膜皮瓣（16.8%）相比，大多数重建手术使用含肌肉的皮瓣（74.4%）。手术方法包括游离皮瓣（47.6%）和局部皮瓣（52.5%）。III级肥胖患者不行动的可能性明显高于非肥胖患者（OR：4.10，95% CI 1.10-15.2，P = 0.035）。在最后的随访中，30.1% 的 III 级肥胖患者可以行走，但需要轮椅（42.3%）或辅助设备（26.9%）。并发症发生率与肥胖程度无明显差异（0.704）。整个组群的平均随访时间为 5.8 年：结论：在 LE 重建中，BMI 对患者护理和手术决策至关重要。结论：BMI 对 LE 重建中的患者护理和手术决策至关重要，有必要开展进一步研究，以优化 BMI 较高患者的治疗效果，从而减轻术后并发症的负担，促进患者的整体康复。

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引用次数: 0

Free Superficial Circumflex Iliac Artery Perforator Flap for Reconstruction of Traumatic Thumb Soft Tissue Defect in an 18-Year-Old Male Patient 游离浅表环状髂动脉穿孔器皮瓣用于重建一名 18 岁男性患者的外伤性拇指软组织缺损。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-05 DOI: 10.1002/micr.31225

Hsu-Tang Cheng

引用次数: 0

Use of Free Internal Mammary Artery Perforator Flap Harvested With Minimally Invasive Approach for Facial Reconstruction: Report of Two Cases 使用微创方法采集的游离乳内动脉穿孔器皮瓣进行面部重建：两个病例的报告。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-03 DOI: 10.1002/micr.31233

Yun Choi, Kyeong-Tae Lee

The internal mammary artery perforator (IMAP) flap has been widely used for chest wall and neck reconstruction. The color of its skin paddle closely resembles that of facial skin, making it attractive for facial reconstruction. However, there has been insufficient investigations reporting the use of free IMAP flap. Furthermore, even in such studies, somewhat invasive procedures, including rib cartilage resection, were employed to ensure sufficient pedicle length, potentially increasing donor morbidity. Our report presents two cases of successful facial defect reconstruction using a free IMAP flap harvested with minimal donor site damage, showing its feasibility. In the first case, a 48-year-old male underwent wide excision for a malignant melanoma on his right cheek, resulting in a 4 × 4.5 cm full-thickness defect. A free IMAP flap with a 2.5 cm pedicle, was harvested without rib cartilage resection, preserving IMA main trunk, and transferred with anastomosed to the angular vessels within the defect. The second patient presented with a 4.5 × 3.5 cm basal cell carcinoma on the left cheek, necessitating wide excision and leaving a 6 × 5 cm defect. A free IMAP flap was harvested with the same approach and successfully reconstructed the defect with connected to the superficial temporal vessels using vascular bridge. Both patients were discharged complication-free, with no recurrence during 24 and 15 months of follow-up, respectively. They were highly satisfied with the final skin color and texture outcomes. Harvesting a free IMAP flap while minimizing donor morbidity may offer an attractive option for facial reconstruction.

乳内动脉穿孔器（IMAP）皮瓣已被广泛用于胸壁和颈部重建。它的皮瓣颜色与面部皮肤非常相似，因此在面部重建中很有吸引力。然而，关于游离 IMAP 皮瓣使用情况的调查报告并不充分。此外，即使在这些研究中，也采用了一些侵入性程序，包括肋软骨切除，以确保足够的蒂长度，这可能会增加供体的发病率。我们的报告介绍了两例成功使用游离IMAP皮瓣进行面部缺损重建的病例，对供体部位的损伤极小，显示了其可行性。在第一个病例中，一名 48 岁的男性因右颊恶性黑色素瘤接受了广泛切除术，导致 4 × 4.5 厘米的全厚缺损。在不切除肋软骨、保留 IMA 主干的情况下，移植了一个带有 2.5 厘米蒂的游离 IMAP 皮瓣，并与缺损处的角血管吻合。第二位患者的左脸颊上有一个 4.5 × 3.5 厘米的基底细胞癌，需要进行广泛切除，并留下一个 6 × 5 厘米的缺损。患者采用同样的方法采集了一个游离的 IMAP 皮瓣，并利用血管桥成功地重建了与颞浅血管相连的缺损。两名患者出院时均无并发症，分别在 24 个月和 15 个月的随访中未见复发。他们对最终的皮肤颜色和质地效果非常满意。在最大程度降低供体发病率的同时，采集游离 IMAP 皮瓣可为面部重建提供一个极具吸引力的选择。

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引用次数: 0

Management of a Complex, Recurrent Case of Medial Thigh Sarcoma With Pedicled Deep Inferior Epigastric Artery Perforator (DIEP) Lymphatic Flow-Through (LyFT) Flap and Secondary Anterolateral Thigh (ALT) Free Flap With Innervated Vastus Lateralis Anastomosed to Synthetic Artery Graft: A Case Report 使用带蒂深腹外动脉穿孔器 (DIEP) 淋巴管穿行 (LyFT) 皮瓣和带有与合成动脉移植物吻合的神经支配的大腿前外侧 (ALT) 游离皮瓣治疗复杂的大腿内侧肉瘤复发病例：病例报告。

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-09-02 DOI: 10.1002/micr.31224

Federica Martini, Matteo Meroni, Mario F. Scaglioni

Soft-tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin and account for only 1% of adult malignancies. They tend to occur most commonly in the lower extremities. Reconstruction after sarcoma resection can be challenging, especially when important structures are involved and recurrences occur. Additionally, more attention is now being paid to reconstructing the lymphatic system to prevent lymphatic complications. In this case report, we presented the management of recurrent medial thigh sarcoma that necessitated multiple challenging reconstructions to provide valuable insights for lectures on similar cases. A 50-year-old male patient was diagnosed with an undifferentiated pleomorphic cell sarcoma (UPS) of the anteromedial thigh. After preoperative radiotherapy, a mass of 23 × 15 cm was removed, and reconstruction with a pedicled deep inferior epigastric artery perforator (p-DIEP) flap-based lymphatic flow through (LyFT) was performed. Six months later, the patient developed the first local recurrence with the presence of a distant metastasis. Following the tumor resection, the medial part of the DIEP flap was de-epithelized and buried in the defect for dead space obliteration. Another local recurrence arose 7 months after the second surgery. Therefore, a major debulking surgery involving the femoral neurovascular bundle was performed. The femoral artery was reconstructed with a synthetic graft, and the femoral vein with the great saphenous vein harvested from the contralateral thigh. A composite myocutaneous neurotized anterolateral thigh (ALT) flap from the contralateral thigh was used to obliterate the defect and restore the loss of function of the quadriceps femoris. Two lymphaticovenular anastomoses (LVAs) were performed at the ankle to reduce the risk of lymphatic sequelae. This case report highlights the importance of integrating various techniques to create a tailored approach that effectively addresses complex surgical requirements to avoid limb amputation and maintain functionality.

软组织肉瘤（STS）是一种罕见的间质细胞来源实体瘤，仅占成人恶性肿瘤的 1%。它们最常发生在下肢。肉瘤切除术后的重建具有挑战性，尤其是在涉及重要结构和复发的情况下。此外，现在人们更加关注淋巴系统的重建，以防止淋巴并发症的发生。在本病例报告中，我们介绍了复发性大腿内侧肉瘤的治疗方法，该病例需要进行多次具有挑战性的重建，为类似病例的讲座提供了宝贵的见解。一名 50 岁的男性患者被诊断为大腿前内侧未分化多形性细胞肉瘤（UPS）。术前放疗后，切除了一个 23 × 15 厘米的肿块，并用带蒂的下腹深动脉穿孔（p-DIEP）皮瓣进行了基于淋巴流过（LyFT）的重建。六个月后，患者首次出现局部复发，并伴有远处转移。肿瘤切除后，DIEP皮瓣的内侧部分被去表皮并埋入缺损处，以消除死腔。第二次手术后 7 个月，再次出现局部复发。因此，又进行了一次涉及股神经血管束的大切除手术。用人工合成移植物重建了股动脉，用从对侧大腿采集的大隐静脉重建了股静脉。使用对侧大腿的复合肌皮神经化大腿前外侧（ALT）皮瓣来消除缺损，恢复股四头肌的功能。在脚踝处进行了两处淋巴管-静脉吻合术（LVA），以降低淋巴管后遗症的风险。本病例报告强调了整合各种技术的重要性，以创建一种量身定制的方法，有效解决复杂的手术要求，避免截肢并保持功能。

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引用次数: 0

Using Your Hands as a Visual Aide to Teach and Remember the Order of Suture Placement in Arterial Micro-Anastomosis 在动脉显微吻合术中用手作为视觉辅助工具来教授和记忆缝合顺序

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-08-31 DOI: 10.1002/micr.31223

Elena Kakouri, Anna A. K. Khoo, Guido Köhler, Richard M. Haywood

引用次数: 0

Interposition of Free Vascularized Fascia Into the Trapezial Resection Cavity for the Surgical Treatment of Trapeziometacarpal Osteoarthritis 将游离血管化筋膜植入斜方肌切除腔，用于斜方肌骨性关节炎的手术治疗

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-08-30 DOI: 10.1002/micr.31221

Simo Mattila, Ville Haapamäki, Eero Waris

Backround

Trapeziometacarpal osteoarthritis has been treated with interposition of autologous fascia into the trapezial resection cavity to prevent scaphometacarpal impingement with suboptimal results. Autologous fascia may undergo necrosis and gradual shrinkage due to avascularity. We propose vascularization of the interposed fascia using microvascular techniques as a new alternative to achieve a durable graft with sufficient soft tissue volume.

Patients and Methods

In this retrospective study, 11 surgeries for 8 patients (6 women, 2 men) (5 primary and 6 revision cases) were performed using vascularized fascial grafts from the anterolateral thigh for interposition in the trapezial resection cavity with microvascular anastomosis for revascularization. Subjective assessment included the short version of the Quick Disabilities of the Hand, Shoulder and Arm and patient related hand wrist evaluation scores. Objective assessment included strength and range of motion measurements. Radiographs were obtained preoperatively and at each follow-up visit. An MRI was done at a mean of 19 months postoperatively.

Results

The size of the harvested fascial grafts was 2 × 2–3 cm with a thickness of 1.5–2 cm. There were no postoperative complications apart from one seroma in the graft harvest site. The mean clinical and radiologic follow-up was 2 years and 8 months. The procedure provided pain relief PRWHE pain 32 (SD 13)—9 (SD 12), p < 0.0001, increased tip pinch strength 4 kg (SD3)—6 kg (SD2), p < 0.05, and improved overall function PRWHE 60 (SD28)—16 (SD21), p < 0.0001 and QuickDash 50 (SD21)—13 (SD17), p < 0.0001. Radiographs demonstrated maintenance of the scaphometacarpal space, while MRI scans showed the presence of mildly edematous interposed tissue within the resection cavity.

Conclusions

Although technically demanding, vascularized fascia presents an attractive alternative for the treatment of trapeziometacarpal osteoarthritis. It may be particularly advantageous in complex cases requiring revision surgery and in young patients with high functional demands.

背景在治疗梯形掌骨性关节炎时，曾将自体筋膜植入梯形切除腔，以防止肩胛掌骨撞击，但效果并不理想。自体筋膜可能因无血管而坏死并逐渐萎缩。我们建议使用微血管技术对插入的筋膜进行血管化处理，作为一种新的替代方法，以获得具有足够软组织容量的耐用移植物。患者和方法在这项回顾性研究中，我们对 8 名患者（6 名女性，2 名男性）的 11 例手术（5 例初次手术和 6 例翻修手术）进行了研究，这些手术使用了大腿前外侧的血管化筋膜移植物，将其植入斜方肌切除腔，并用微血管吻合进行血管再造。主观评估包括手部、肩部和手臂快速残疾简易版以及患者相关的手部腕部评估评分。客观评估包括力量和活动范围测量。术前和每次随访时都要进行X光检查。术后平均 19 个月时进行核磁共振成像检查。结果取下的筋膜移植物大小为 2 × 2-3 厘米，厚度为 1.5-2 厘米。除了移植物采集部位出现一个血清肿之外，术后没有其他并发症。平均临床和放射学随访时间分别为 2 年和 8 个月。手术缓解了疼痛，PRWHE 疼痛 32（SD 13）-9（SD 12），p < 0.0001，增加了顶端夹持力量 4 公斤（SD3）-6 公斤（SD2），p < 0.05，改善了整体功能，PRWHE 60（SD28）-16（SD21），p < 0.0001，QuickDash 50（SD21）-13（SD17），p < 0.0001。X光片显示肩掌间隙得以保持，而核磁共振成像扫描显示切除腔内存在轻度水肿的间隙组织。结论血管化筋膜虽然在技术上要求较高，但却是治疗掌骨骨关节炎的一种有吸引力的替代方法。对于需要进行翻修手术的复杂病例和对功能要求较高的年轻患者来说，它可能更具优势。

{"title":"Interposition of Free Vascularized Fascia Into the Trapezial Resection Cavity for the Surgical Treatment of Trapeziometacarpal Osteoarthritis","authors":"Simo Mattila, Ville Haapamäki, Eero Waris","doi":"10.1002/micr.31221","DOIUrl":"https://doi.org/10.1002/micr.31221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backround</h3>\u0000 \u0000 <p>Trapeziometacarpal osteoarthritis has been treated with interposition of autologous fascia into the trapezial resection cavity to prevent scaphometacarpal impingement with suboptimal results. Autologous fascia may undergo necrosis and gradual shrinkage due to avascularity. We propose vascularization of the interposed fascia using microvascular techniques as a new alternative to achieve a durable graft with sufficient soft tissue volume.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In this retrospective study, 11 surgeries for 8 patients (6 women, 2 men) (5 primary and 6 revision cases) were performed using vascularized fascial grafts from the anterolateral thigh for interposition in the trapezial resection cavity with microvascular anastomosis for revascularization. Subjective assessment included the short version of the Quick Disabilities of the Hand, Shoulder and Arm and patient related hand wrist evaluation scores. Objective assessment included strength and range of motion measurements. Radiographs were obtained preoperatively and at each follow-up visit. An MRI was done at a mean of 19 months postoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The size of the harvested fascial grafts was 2 × 2–3 cm with a thickness of 1.5–2 cm. There were no postoperative complications apart from one seroma in the graft harvest site. The mean clinical and radiologic follow-up was 2 years and 8 months. The procedure provided pain relief PRWHE pain 32 (SD 13)—9 (SD 12), <i>p</i> < 0.0001, increased tip pinch strength 4 kg (SD3)—6 kg (SD2), <i>p</i> < 0.05, and improved overall function PRWHE 60 (SD28)—16 (SD21), <i>p</i> < 0.0001 and QuickDash 50 (SD21)—13 (SD17), <i>p</i> < 0.0001. Radiographs demonstrated maintenance of the scaphometacarpal space, while MRI scans showed the presence of mildly edematous interposed tissue within the resection cavity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although technically demanding, vascularized fascia presents an attractive alternative for the treatment of trapeziometacarpal osteoarthritis. It may be particularly advantageous in complex cases requiring revision surgery and in young patients with high functional demands.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.31221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100280","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

Thrombotic Consequences of COVID-19 Infection on Microsurgical Reconstruction COVID-19 感染对显微外科重建造成的血栓形成后果

IF 1.5 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2024-08-29 DOI: 10.1002/micr.31219

Sabrina H. Han, Kyle Ockerman, Matthew Kirchmier, Markos Mardourian, Jaimie Bryan, Elizabeth Cox, Harvey Chim, Lisa Spiguel, Arash Momeni, Sarah Sorice-Virk

Background

Evidence has shown increased morbidity and mortality for patients with COVID-19 infection within 7 weeks of surgery. However, no studies have specifically investigated the effects of COVID-19 in microsurgical outcomes. This study evaluated thrombotic and overall complications after free tissue transfer for a variety of indications in patients with and without previous COVID-19 infection.

Methods

A retrospective cohort study was performed in adult patients with or without a history of COVID-19 infection who underwent microsurgical reconstruction between 2017 and 2022. Patients with a history of COVID-19 infection were matched to controls based on age, gender, race, body mass index, history of diabetes, coronary artery disease, hypertension, Caprini score, tobacco use, and flap indication.

Results

From 2017 to 2022, 35 patients had a documented history of COVID-19. Matched case analysis determined a 4.8 times increased odds ratio of postoperative complications in the COVID-19 group compared with controls (p = 0.002). Significantly, more patients with COVID-19 experienced total or partial flap loss and anastomotic issues (COVID-19: 7/35, Control: 0/35; p < 0.001). There was no significant difference in incidence of VTE (COVID-19: 1/35, Control: 0/35; p = 0.493). Of note, 62.9% of the COVID-19 group were discharged on anticoagulants (versus 14.3% in the control group [p < 0.001]).

Conclusion

COVID-19 has dire, long-lasting effects on virtually every organ system, chief among them, the microcirculation. Further studies are needed to fully determine the extent and influence of COVID-19 on complex procedures such as free tissue transfer and how to optimize the screening, workup, and postoperative care to guard against the associated thrombotic consequences.

背景有证据表明，手术后 7 周内感染 COVID-19 的患者发病率和死亡率会增加。然而，还没有研究专门调查过 COVID-19 对显微手术结果的影响。本研究评估了曾感染或未感染 COVID-19 的患者因各种适应症进行游离组织转移后的血栓形成和整体并发症。方法对 2017 年至 2022 年期间接受显微外科重建手术的有或无 COVID-19 感染史的成年患者进行了一项回顾性队列研究。根据年龄、性别、种族、体重指数、糖尿病史、冠心病史、高血压史、Caprini评分、吸烟史和皮瓣适应症，将有COVID-19感染史的患者与对照组进行配对。结果从2017年到2022年，35名患者有COVID-19病史记录。配对病例分析表明，与对照组相比，COVID-19 组术后并发症的几率增加了 4.8 倍（P = 0.002）。值得注意的是，更多的 COVID-19 患者出现了皮瓣全部或部分脱落以及吻合问题（COVID-19：7/35，对照组：0/35；p <0.001）。VTE 发生率无明显差异（COVID-19：1/35，对照组：0/35；P = 0.493）。值得注意的是，COVID-19 组 62.9% 的患者出院时服用了抗凝药物（对照组为 14.3% [p<0.001]）。结论 COVID-19 几乎对每个器官系统都有可怕而持久的影响，其中最主要的是微循环。要全面确定 COVID-19 对游离组织移植等复杂手术的影响程度，以及如何优化筛查、检查和术后护理以预防相关血栓后果，还需要进一步的研究。

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引用次数: 0

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。

{"title":"Analysis of the microsurgery fellowship match: 2019–2022 update","authors":"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","doi":"10.1002/micr.31217","DOIUrl":"10.1002/micr.31217","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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 <i>t</i>-tests.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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], <i>p</i> = .45). There was a significant increase in the match rate between groups (67.8% vs. 80.2%, <i>p</i> = .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 (<i>p</i> = .35) and 95.6% (43 of 45) in 2019 (<i>p</i> = .006). Mean in-service examination percentiles for successfully matched applicants did not differ between (2016–2018) and (2019–2022) applicants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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