Microsurgery最新文献

{"title":"Intra-Oral Vascularized Cross-Facial Nerve Grafts in Early Flaccid Facial Palsy: A Five-Year Review of Clinical Practice","authors":"R. Y. Kannan,&nbsp;C. Neville,&nbsp;T. Gwynn,&nbsp;K. Young,&nbsp;C. Selley-West,&nbsp;R. Malhotra,&nbsp;C. Nduka","doi":"10.1002/micr.70151","DOIUrl":"10.1002/micr.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>An unanswered question in facial reanimation surgery is how to improve the results of conventional primary cross-facial nerve grafts. In this study, we designed a study to determine whether vascularizing cross-facial nerve grafts with shorter lengths following intra-oral insets, provides sufficient neural input to the targeted smile-mimetic muscles without the need for a concomitant “babysitter” procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In a retrospective review of practice over 5 years on facial palsy patients with smile asymmetry, we performed a combination of the intra-oral vascularized nerve graft (VNG) which connects the buccal branches of the facial nerve, that supply the smile-mimetic muscles, on either side of the face; the “Koshima-type” procedure. This VNG is performed in combination with a forked fascicular transfer of the masseteric nerve, which is coapted to the zygomatic branches of the facial nerve (Group I). In Group II, only the “Koshima-type” procedure was performed without a “babysitter” procedure, which only connected the buccal branches of the facial nerve on either side (Group II). Both approaches were statistically compared in cases of acute facial palsy (within 24 months of onset), in those with no pre-existing synkinesis. Statistical analysis was performed using the Mann–Whitney test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of a total of 13 patients in the overall cohort; seven in Group I and six in Group II, there was a significant improvement in both groups in terms of an open mouth smile following surgery (<i>p</i> &lt; 0.001), with no statistically significant difference between them (<i>p</i> = ns); but in terms of snarl movement, only patients in Group II showed significant improvement in upper lip elevation (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The “Koshima-type” procedure alone is sufficient in providing optimal and spontaneous smile reanimation, without the need for a “babysitter” procedure, provided it is performed within 24 months in facial palsy patients with no clinical or neurophysiological evidence of reinnervation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596637","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}

{"title":"End-To-Side Venous Anastomosis in Head and Neck Free Flap Reconstruction: A Systematic Review and Meta-Analysis","authors":"Andrea Costantino,&nbsp;Daniel Uralov,&nbsp;Bianca Maria Festa,&nbsp;Uthman Alamoudi,&nbsp;Mario Alessandri-Bonetti,&nbsp;Claudio Sampieri,&nbsp;Gabriele Molteni,&nbsp;Raul Pellini,&nbsp;J. Scott Magnuson,&nbsp;Armando De Virgilio","doi":"10.1002/micr.70148","DOIUrl":"https://doi.org/10.1002/micr.70148","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>We performed a systematic review and meta-analysis to evaluate the outcomes of end-to-side (ETS) anastomosis to the internal jugular vein (IJV) in head and neck free flap reconstruction. Postoperative outcomes of ETS were compared to the conventional end-to-end (ETE) technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive electronic search was performed on PubMed/MEDLINE, Scopus, and Google Scholar databases. Odds ratios (ORs) were calculated with their 95% confidence intervals (CIs) for each study comparing the two groups (ETS vs. ETE).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 9645 patients undergoing 9663 head and neck free flap reconstructions (ETS, <i>N</i> = 2618; ETE, <i>N</i> = 7045) were included from 45 studies. The ETS technique showed an overall free flap failure rate of 2.5% (95% CI: 1.9–3.2). The pooled venous thrombosis rate was 3.8% (95% CI: 2.5–5.8), while the reoperation rate was 5.6% (95% CI: 2.7–11.5). No significant difference was found for the free flap failure rate (OR = 1.35, 95% CI: 0.77–2.36), venous thrombosis rate (OR = 0.93, 95% CI: 0.48–1.82) and reoperation rate (OR = 0.83, 95% CI: 0.42–1.63) when comparing the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that ETS venous anastomoses offer excellent outcomes, with safety and efficacy comparable to ETE anastomoses. Both techniques can be successfully employed depending on individual patient anatomy and surgeon experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145572560","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}

{"title":"Negative Pressure Wound Therapy in Free Flap Reconstruction: A Systematic Review and Meta-Analysis","authors":"Kazuho Kawashima,&nbsp;Ali Esmaeili","doi":"10.1002/micr.70144","DOIUrl":"10.1002/micr.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite extensive research on negative pressure wound therapy (NPWT), its impact on immediate post-operative application in free flap reconstruction remains underexplored. The objective of this systematic review and meta-analysis is to evaluate the efficacy of NPWT compared with conventional wound therapy (CWT) in post-operative management of free flap, focusing on flap survival, complication rates, and flap size.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Searches were carried out in CENTRAL, Medline, and Embase. All prospective or retrospective clinical studies examining the effect of immediate post-operative application of NPWT after free flap reconstruction were considered for the review. No restrictions were placed on the date of publication but only papers written in English were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>13 studies were included in the review, with 6 studies eligible for the meta-analysis. A total of 321 free flaps were included in the pooled analysis. NPWT reduced overall complication rates compared with CWT (OR 0.34, 95% CI 0.13 to 0.88, <i>p</i> = 0.03, <i>n</i> = 240) and also resulted in a statistically significant reduction in flap size (SMD −1.54, 95% CI ‒2.48 to −0.54, <i>p</i> = 0.002, <i>n</i> = 43). However, there was no significant difference in flap survival rates (OR 2.34, 95% CI 0.77 to 7.09, <i>p</i> = 0.13, <i>n</i> = 252).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NPWT appears to offer benefits over CWT in reducing complications and flap size, but precautions should be taken in interpreting these results. Further high-quality randomized controlled trials are required to validate these findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549317","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}

{"title":"Hybrid Total Achilles Tendon Reconstruction Combining Acellular Dermal Matrix Placement and Free Latissimus Dorsi Flap Coverage: A Report of Two Cases","authors":"Beniamino Brunetti,&nbsp;Chiara Camilloni,&nbsp;Matteo Pazzaglia,&nbsp;Valeria Petrucci,&nbsp;Marco Morelli Coppola,&nbsp;Rosa Salzillo,&nbsp;Stefania Tenna,&nbsp;Irene Giovanna Aprile,&nbsp;Marco Germanotta,&nbsp;Sergio Valeri,&nbsp;Mauro Barone,&nbsp;Paolo Persichetti","doi":"10.1002/micr.70146","DOIUrl":"10.1002/micr.70146","url":null,"abstract":"<p>Reconstruction of complex Achilles tendon defects involving both the tendon and the overlying soft tissues represents a challenging scenario for plastic surgeons. In this report, we present an innovative technique of hybrid total Achilles tendon reconstruction combining acellular dermal matrix placement to restore the full-thickness continuity of the tendon and free latissimus dorsi (LD) flap coverage to allow graft integration and simultaneously resurface the soft tissue defect, ultimately leading to lower limb salvage. Between August 2023 and February 2024 two patients received microsurgical hybrid reconstruction of complex defects, measuring 10 × 10 cm and 17 × 14 cm, respectively, involving the lower third of the leg and the Achilles tendon region, due to trauma with multiple previous failed surgeries and sarcoma resection. The full-thickness continuity of the tendon was reconstructed by use of an XCM BIOLOGIC Tissue Matrix (DePuy Synthes, Johnson &amp; Johnson), measuring 6 and 10 cm long, respectively, folded in a three-layered tridimensional structure to recreate the shape and function of a new tendon. Subsequently, a free myo-cutaneous LD flap, was used to wrap and revascularize the neo-tendon and resurface the soft tissue defect. In both patients the flaps healed uneventfully, and neo-tendon integration was documented by MRI examination. The follow-up was uneventful. Long-term functional evaluation showed almost normal tendon excursion with both patients walking without assistance. The proposed hybrid approach may be a good alternative and innovative solution for the reconstruction of complex Achilles tendon defects consequent to trauma or oncological resection. Such results are more than promising for future studies on large series of patients.</p>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145550101","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}

{"title":"MicroRAG: Development of a Novel Artificial Intelligence Retrieval-Augmented Generation Model for Microsurgery Clinical Decision Support","authors":"Berk B. Ozmen,&nbsp;Nishant Singh,&nbsp;Kavach Shah,&nbsp;Ibrahim Berber,&nbsp;Damanjit Singh,&nbsp;Eugene Pinsky,&nbsp;Steven A. Schulz,&nbsp;Sarah N. Bishop,&nbsp;Steven Bernard,&nbsp;Risal S. Djohan,&nbsp;Graham S. Schwarz","doi":"10.1002/micr.70138","DOIUrl":"10.1002/micr.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Microsurgical decision-making requires integration of diverse patient-specific factors, advanced surgical techniques, and dynamic intraoperative insights. While artificial intelligence (AI), large language models (LLMs), and retrieval-augmented generation (RAG) models have advanced significantly in various fields, no AI-driven clinical decision support systems currently exist for microsurgery. We developed MicroRAG, the first AI-powered clinical decision support system specifically designed for microsurgery, capable of instantly providing evidence-based recommendations by searching and synthesizing the entire microsurgical literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed an AI clinical decision support system integrating 4876 peer-reviewed microsurgical publications (2000–2024) using advanced retrieval-augmented generation (RAG) technology. The system processes clinical queries through hierarchical document clustering and provides real-time, evidence-based recommendations with direct literature citations. We evaluated system performance using 10 standardized clinical scenarios covering common microsurgical decisions, measuring answer relevancy, faithfulness to source literature, and clinical accuracy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>MicroRAG demonstrated exceptional performance with an average answer relevancy score of 0.953 (range: 0.857–1.000) and faithfulness score of 0.907 (range: 0.676–1.000). G-Eval correctness averaged 0.88 with Semantic Evaluation Metrics showing an average similarity score of 0.75 and confidence score of 0.80. The system successfully provided comprehensive, immediately actionable guidance for complex scenarios including free flap monitoring protocols, vascular complication management, and surgical technique selection. All responses were grounded in peer-reviewed literature with direct citations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>MicroRAG represents a technological innovation in microsurgical practice, providing instant access to evidence-based recommendations that typically require hours of literature review. By delivering comprehensive, literature-grounded guidance in real-time, this system has the potential to standardize best practices, reduce decision-making uncertainty, and ultimately improve patient outcomes across all levels of surgical experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513362","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}

{"title":"Combined Nerve Grafting and Myoelectric Orthosis Bionic Approach (MOBA) for Functional Restoration After Pan-Plexus Injury","authors":"Y. Jost,&nbsp;S. Benner,&nbsp;B. Benecken,&nbsp;B. Zimmerlein,&nbsp;C. Hirche,&nbsp;A. A. Maldonado","doi":"10.1002/micr.70145","DOIUrl":"10.1002/micr.70145","url":null,"abstract":"<div>\u0000 \u0000 <p>A variety of approaches have been described to obtain a rudimentary grasp following traumatic pan-plexus injury in the adult. The aim of this report is to present a novel reconstructive algorithm based on the combination of reconstructive surgery and the fitting of a myoelectric orthosis (Myoelectric Orthosis Bionic Approach [MOBA]), to gain grasp function after a pan-plexus injury. A 44-year-old patient presented with a pan-plexus injury after a heavy branch fell on his right shoulder during forestry operations. After 5 months without spontaneous recovery, the patient underwent a brachial plexus exploration with intraoperative neuromonitoring, neurolysis of the C5 root and the upper trunk, and spinal accessory nerve transfer to the musculocutaneous nerve using a sural nerve graft. The myoelectric orthosis was initially employed for rehabilitation purposes, with a cutaneous electromyography (EMG) sensor positioned over the trapezius muscle to activate elbow flexion. Six months after the surgery, the patient presented Grade M1 pectoral muscle contraction, strong enough to be detected by cutaneous EMG. A second separate EMG sensor was placed over the pectoralis muscle to activate the finger flexion. As soon as the patient achieved Grade M2 active elbow bending (biceps muscle) with reinnervation signs at EMG, the sensor over the trapezius muscle was transferred to the biceps muscle to augment elbow bending. One year after surgery, the patient presented with active elbow bending (biceps muscle Grade M4), and finger flexion and extension using the myoelectric orthosis through the pectoral electrical signal, being able to hold and open. In addition, the patient presented Grade S2 proprioception and sensation in all fingers. This new treatment algorithm for pan-plexus injuries is further discussed. We believe the MOBA should be considered as an alternative treatment protocol after a pan-plexus injury.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513324","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}

{"title":"Diagnostic Accuracy of Artificial Intelligence Models for Predicting Postoperative Complications Following Free Flap Reconstruction: A Systematic Review and Meta-Analysis","authors":"Ramin Shekouhi,&nbsp;Hassan Darabi,&nbsp;Harvey Chim","doi":"10.1002/micr.70143","DOIUrl":"10.1002/micr.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To systematically evaluate the diagnostic performance of artificial intelligence (AI) models in predicting postoperative complications following flap surgery, and to compare the efficacy of different input modalities used in model training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Web of Science to identify studies utilizing AI for flap monitoring and postoperative complication prediction. A total of 12 studies comprising 18,520 patients and 32,148 input data points were included. Pooled sensitivity, specificity, likelihood ratios, and SROC curves were calculated using a bivariate random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis revealed a pooled sensitivity of 78.0% [95% CI: 0.54–0.91] and a pooled specificity of 88.0% [95% CI: 0.76–0.94]. The positive and negative likelihood ratios were 6.36 [95% CI: 2.54–15.91] and 0.25 [95% CI: 0.10–0.64], respectively. The area under the SROC curve was 0.91 [95% CI: 0.88–0.93], indicating excellent overall diagnostic performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AI models, particularly those incorporating photographic data and deep learning models, demonstrate high diagnostic accuracy and hold promise as adjunct tools for postoperative flap monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505765","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}

{"title":"The Proximal Fibula Bone Flap for Complex Maxillary Reconstruction: Anatomic Evaluation and a Case Report","authors":"Farooq Shahzad,&nbsp;Evan Matros","doi":"10.1002/micr.70149","DOIUrl":"10.1002/micr.70149","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Total maxillectomy defects that involve both the supra- and infra-structure pose a reconstructive challenge. Accurate reconstruction of the orbital rim and alveolus is needed for orbital floor reconstruction and dental implant placement. The fibula is the workhorse flap for osseous craniofacial reconstruction. The distal fibula is harvested as vascularized bone while the proximal fibula is typically discarded after separating it from the pedicle. We evaluated the vascular anatomy of the proximal fibular segment for potential use as a separate bone flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The anatomy of the peroneal vessels was studied in clinical cases and with computed tomographic angiograms. The branches of the proximal peroneal artery and vein were dissected during routine fibula flap harvest in 25 patients. Lower extremity computed tomographic angiograms of 100 limbs were also studied. We reconstructed a hemi-maxillectomy defect resulting from resection of salivary gland adenocarcinoma in a 69-year-old female, with a vascularized bone flap supplied by this proximal peroneal branch. The conventional fibula bone flap based on the peroneal vessels was used for alveolar reconstruction and the proximal fibula based on the proximal peroneal branch was used for inferior orbital rim reconstruction as a flow-through flap anastomosed to the distal end of the peroneal vessels. A polytetrafluoroethylene-titanium implant was used to recreate the orbital floor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In all fibula flap dissections and radiographic studies, a perforating branch of the peroneal vessels was seen supplying the proximal part of the fibula. The patient's postoperative course was uneventful, and adjuvant radiation was administered. At a follow-up of 1 year 3 months, the patient had excellent globe position, normal vision, and a moderate contour depression of the right cheek.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The proximal fibula bone is consistently supplied by a branch of the peroneal vessels and can thus be harvested as a vascularized perforator bone flap.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505725","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}

{"title":"Associations Between Fracture Characteristics and Surgical Outcomes in Distal Digit Replantation of Tamai Zones 1–2","authors":"Takashi Kageyama,&nbsp;Yuki Shiko,&nbsp;Maiko Osawa,&nbsp;Yohei Kawasaki,&nbsp;Toko Miyazaki,&nbsp;Hayahito Sakai,&nbsp;Reiko Tsukuura,&nbsp;Takumi Yamamoto","doi":"10.1002/micr.70142","DOIUrl":"10.1002/micr.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although numerous risk factors were reported for the failure of digit replantation, there was a lack of studies investigating the association between replantation outcomes and fracture characteristics. The purpose of this study was to evaluate the survival rate and functional outcomes of distal digit replantation based on the fracture patterns.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed patients with Tamai zones I–II amputated digits who underwent replantation between 2018 and 2022. The fracture characteristics of the distal phalanx were compared to outcomes, including the survival rate, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and range of motion (ROM) of the distal interphalangeal (DIP) joint. Additionally, we compared the diagnostic performance of our proposed FIVE criteria with the mechanism of injury (MOI) and other prognostic factors in predicting replantation failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>51 digits from 48 patients, including 38 males, met the inclusion criteria. The overall survival rate was 29/51 digits (56.9%), consisting of 18/39 digits (46.2%) in crush-degloving injuries and 11/12 digits (91.7%) in sharp-cut injuries. Comminution of fractures significantly worsened the survival rate (10% vs. 69.7%; <i>p</i> = 0.002), while tuft fractures also significantly deteriorated the survival rate (34.8% vs. 75.0%; <i>p</i> = 0.005). Crush-degloving injuries significantly decreased the survival rate (<i>p</i> = 0.007). The FIVE criteria demonstrated relatively overall superior diagnostic performance for replantation failure, showing the highest accuracy (83.7%), specificity (89.7%), and positive predictive value (83.3%) compared to other indicators. The ROM of the DIP joint significantly worsened in high-energy fractures (<i>p</i> = 0.027) and subzone 4 digits (<i>p</i> = 0.012). DASH scores significantly deteriorated in high-energy fractures (<i>p</i> = 0.003), subzone 4 digits (<i>p</i> = 0.013), and base fractures (<i>p</i> = 0.036).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In Tamai zones 1–2, comprehensive evaluations of high-risk fracture patterns, MOI, and venous anastomosis can be a useful tool for more reliable prediction of replantation failure and functional outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495792","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}

{"title":"Bloodletting Therapy Using Subcutaneous Heparin and Controlled Scarification for Venous Insufficiency in Free Flap Reconstruction","authors":"Can Ege Yalcin,&nbsp;Berrak Karatan,&nbsp;Anil Demiroz","doi":"10.1002/micr.70147","DOIUrl":"10.1002/micr.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Venous congestion is a significant complication in microsurgical reconstruction and may persist despite surgical revision attempts, as demonstrated in our clinical experience. In cases where repeated surgical interventions are either not feasible or unsuccessful, alternative methods like bloodletting therapy using subcutaneous heparin injection may be beneficial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive, retrospective report evaluated six patients who underwent microsurgical tissue transfers between 2019 and 2025 and developed refractory venous congestion. Patients were managed with a standardized protocol involving a single subcutaneous injection of 10 IU heparin administered into the congested flap zone at initiation. Dermal windows measuring approximately 2 × 5 mm were created and during follow-up, heparin-soaked gauze pads (1000 IU heparin in sterile saline) were applied over the dermal windows to sustain bleeding. If bleeding diminished, windows were gently enlarged or new sites were created.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the six patients was 30.8 years (range 12–63). Total flap survival was achieved in three patients (50%), partial loss in two patients (33%), and marginal loss in one patient (17%). Treatment duration ranged from 3 to 10 days, with a mean transfusion requirement of 1.8 units per patient (Range 0–6 units).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Subcutaneous heparin combined with controlled scarification represents a safe, practical, and potentially effective method to manage persistent venous congestion when surgical revision is unsuccessful or contraindicated. Future prospective studies are warranted to better define its role and optimize outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 8","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495806","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}