Microsurgery最新文献_第6页

One versus two vein anastomoses in breast reconstruction with a profunda artery perforator flap—does it make a difference 使用深动脉穿孔器皮瓣进行乳房再造时，采用一条静脉吻合还是两条静脉吻合--是否有区别

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-27 DOI: 10.1002/micr.31179

Charalampos Varnava M.D, Maximilian Kueckelhaus M.D MBA, Sascha Wellenbrock M.D, Tobias Hirsch M.D, Philipp Wiebringhaus M.D., MHBA

Background

The profunda artery perforator (PAP) flap has gained popularity as a reliable alternative in breast reconstruction. Extensive research has focused on its vascular supply, dissection techniques, and broader applications beyond breast reconstruction. This study aims to investigate the correlation between the number of veins anastomosed for the PAP flap and postoperative complications.

Methods

A retrospective study was conducted to evaluate the outcomes of breast reconstructions with PAP flaps at our institution between 2018 and 2022. A total of 103 PAP flaps in 88 patients were included. Statistical analysis was performed to compare outcomes between flaps with one vein anastomosis and those with two vein anastomoses. Patient characteristics, intra and postoperative parameters were analysed.

Results

One vein anastomosis was used in 36 flaps (35.0%), whereas two vein anastomoses were used in 67 flaps (65.0%). No significant differences were found in patient characteristics between the one vein and two vein groups. The comparison of ischemia times between flaps with one versus two veins revealed no statistically significant difference, with mean ischemia times of 56.2 ± 36.8 min and 58.7 ± 33.0 min, respectively. Regarding outcomes, there were no statistically significant differences in secondary lipofilling, revision of vein anastomosis, or total flap loss between the two groups. Fat necrosis was observed in 5 (13.9%) one vein flaps and 5 (7.5%) two vein flaps, indicating no statistically significant difference between the two groups (p = .313). In the one vein group, the most frequently employed coupler ring had a diameter of 2.5 mm. In the two vein group, the most prevalent combination consisted of a 2.0 mm diameter with a 2.5 mm diameter.

Conclusion

Based on our study results, both one vein anastomosis and two vein anastomoses are viable options for breast reconstruction with PAP flap. The utilization of either one or two veins did not significantly affect ischemia time or flap loss. Fat necrosis exhibited a higher incidence in the single-vein group; however, this difference was also not statistically significant. These findings underscore the effectiveness of both approaches, providing surgeons with flexibility in tailoring their surgical techniques based on patient-specific considerations and anatomical factors.

背景深动脉穿孔器（PAP）瓣作为乳房重建中的一种可靠替代方法，已受到广泛欢迎。大量研究集中于其血管供应、解剖技术以及乳房重建以外的更广泛应用。本研究旨在探讨 PAP 皮瓣吻合的静脉数量与术后并发症之间的相关性。方法对我院 2018 年至 2022 年期间使用 PAP 皮瓣进行乳房重建的结果进行回顾性研究。共纳入了 88 名患者的 103 个 PAP 皮瓣。通过统计分析，比较了单静脉吻合皮瓣和双静脉吻合皮瓣的疗效。对患者特征、术中和术后参数进行了分析。结果 36 个皮瓣（35.0%）采用了一条静脉吻合，而 67 个皮瓣（65.0%）采用了两条静脉吻合。单静脉组和双静脉组的患者特征无明显差异。单静脉与双静脉皮瓣缺血时间的比较结果显示，两者的差异无统计学意义，平均缺血时间分别为（56.2±36.8）分钟和（58.7±33.0）分钟。在结果方面，两组之间在二次脂肪填充、静脉吻合术翻修或皮瓣总损失方面没有统计学意义上的显著差异。在 5 个（13.9%）单静脉皮瓣和 5 个（7.5%）双静脉皮瓣中观察到脂肪坏死，这表明两组之间的差异无统计学意义（P = .313）。在单静脉组中，最常用的耦合环直径为 2.5 毫米。在双静脉组中，最常用的组合是直径 2.0 毫米和直径 2.5 毫米的组合。结论根据我们的研究结果，单静脉吻合和双静脉吻合都是使用 PAP 皮瓣进行乳房重建的可行方案。使用一根或两根静脉对缺血时间或皮瓣损失没有明显影响。单静脉组的脂肪坏死发生率较高，但这一差异也没有统计学意义。这些发现强调了两种方法的有效性，为外科医生提供了根据患者的具体情况和解剖因素灵活调整手术技术的机会。

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引用次数: 0

Optimizing donor fascicle selection in Oberlin's procedure: A retrospective review of anatomical variability using intraoperative neuromonitoring 优化奥伯林手术中的供体筋膜选择：利用术中神经监测对解剖变异进行回顾性审查

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-25 DOI: 10.1002/micr.31178

Lucas Marina MD, Elisa Sanz MD, M. Carmen Morillo Balsera PhD, Lara Cristobal MD, PhD, Andres A. Maldonado MD, PhD

Background

Transfer of the fascicle carrying the flexor carpi ulnaris (FCU) branch of the ulnar nerve (UN) to the biceps/brachialis muscle branch of the musculocutaneous nerve (Oberlin's procedure), is a mainstay technique for elbow flexion restoration in patients with upper brachial plexus injury. Despite its widespread use, there are few studies regarding the anatomic location of the donor fascicle for Oberlin's procedure. Our report aims to analyze the anatomical variability of this fascicle within the UN, while obtaining quantifiable, objective data with intraoperative neuromonitoring (IONM) for donor fascicle selection.

Methods

We performed a retrospective review of patients at our institution who underwent an Oberlin's procedure from September 2019 to July 2023. We used IONM for donor fascicle selection (greatest FCU muscle and least intrinsic hand muscle activation). We prospectively obtained demographic and electrophysiological data, as well as anatomical location of donor fascicles and post-surgical morbidities. Surgeon's perception of FCU/intrinsic muscle contraction was compared to objective muscle amplitude during IONM.

Results

Eight patients were included, with a mean age of 30.5 years and an injury-to-surgery interval of 4 months. Donor fascicle was located anterior in two cases, posterior in two, radial in two and ulnar in two patients. Correlation between surgeon's perception and IONM findings were consistent in six (75%) cases. No long term motor or sensory deficits were registered.

Conclusions

Fascicle anatomy within the UN at the proximal arm is highly variable. The use of IONM can aid in optimizing donor fascicle selection for Oberlin's procedure.

背景将携带尺神经（UN）尺侧屈肌（FCU）分支的筋膜转移到肌皮神经的肱二头肌/肱肌分支（Oberlin 手术），是上臂丛神经损伤患者恢复肘关节屈曲的主要技术。尽管该方法被广泛使用，但有关奥伯林手术供体筋膜解剖位置的研究却很少。我们的报告旨在分析联合国内该筋膜的解剖变异性，同时通过术中神经监测（IONM）获得可量化的客观数据，用于供体筋膜的选择。方法我们对本机构在 2019 年 9 月至 2023 年 7 月期间接受奥伯林手术的患者进行了回顾性审查。我们使用 IONM 进行供体筋膜选择（最大的 FCU 肌肉和最小的手部固有肌肉激活）。我们前瞻性地获取了人口统计学和电生理学数据，以及供体筋膜的解剖位置和术后发病情况。将外科医生对 FCU/内在肌肉收缩的感知与 IONM 期间的客观肌肉振幅进行比较。结果共纳入八名患者，平均年龄为 30.5 岁，受伤到手术的间隔时间为 4 个月。两例患者的供肌筋膜位于前方，两例位于后方，两例位于桡侧，两例位于尺侧。在六例（75%）病例中，外科医生的感觉与 IONM 检查结果之间的相关性是一致的。没有发现长期的运动或感觉障碍。结论联合国臂近端筋膜解剖结构变化很大。使用 IONM 可以帮助优化奥伯林手术的供体筋膜选择。

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引用次数: 0

Application of extended ulnar parametacarpal perforator free flap for the reconstruction of total pulp defect of the thumb: A case report 应用扩展尺侧掌旁穿孔器游离皮瓣重建拇指全髓缺损：病例报告

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-24 DOI: 10.1002/micr.31180

Satoshi Usami MD, PhD, Kentaro Sonoki MD, Kohei Inami MD, Kyoichi Murakami MD

Many procedures are available for the coverage of thumb pulp defects; however, to gain thumb function and esthetics, a similar tissue is desirable. If the length of the longitudinal defect is <2 cm, a volar advancement flap is appropriate; however, if the flap is >2 cm long or wider, retrograde or free flaps are required. Here, we present a case of thumb pulp reconstruction using an extended ulnar parametacarpal perforator (UPM) flap, which achieved excellent functional and esthetic outcomes. A 46-year-old man underwent reconstruction surgery of his thumb, which was a degloved total pulp. A sensate 5.2 × 3.2 cm UPM flap was designed on the ulnar side of the right palm and transferred to his thumb. The flap donor site was covered with a V-Y advancement flap on the dorsal side of the right hand. At 12 months postoperatively, the patient achieved a functional and natural thumb appearance with high satisfaction. The UPM flap can offer soft tissue similar to the pulp region in the digit without a palm scar at the donor site. This extended application is suitable for the reconstruction of a total pulp defect of the digit and is an alternative option for a hemi-pulp flap from the toe area.

有许多方法可用于覆盖拇指牙髓缺损；但是，为了获得拇指的功能和美观，最好使用类似的组织。如果纵向缺损的长度为2厘米，则适合使用侧方推进皮瓣；但如果皮瓣长度为2厘米或更宽，则需要逆行或游离皮瓣。在此，我们介绍了一例使用加长尺侧掌侧穿孔器（UPM）皮瓣进行拇指牙髓重建的病例，该手术取得了极佳的功能和美学效果。一名 46 岁的男子接受了拇指重建手术，他的拇指全髓脱落。在右手掌尺侧设计了一个5.2 × 3.2厘米的感性UPM皮瓣，并转移到他的拇指上。皮瓣供区用右手背侧的 V-Y 推进皮瓣覆盖。术后 12 个月，患者的拇指外观功能自然，满意度很高。UPM 皮瓣可以提供类似于手指髓区的软组织，而不会在供区留下手掌疤痕。这种扩展应用适用于指骨全髓缺损的重建，也是脚趾部位半髓皮瓣的替代选择。

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引用次数: 0

Syndactylized glabrous flaps for multiple finger palmar defects 用于多指掌侧缺损的综合无毛皮瓣

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-24 DOI: 10.1002/micr.31161

Özgün Barış Güntürk MD, Kubilay Erol MD, Yusuf Gürbüz MD, Murat Kayalar MD

Background

Palmar finger or pulp defects require coverage with glabrous tissue to achieve a good match with the lost tissue. The management of multiple finger palmar or pulp defects is challenging because these defects may not always be suitable for local or pedicled flaps. In such situations, syndactylizing free or pedicled flaps can be used.

Patients and methods

We evaluated the results of free glabrous flaps syndactylizing across multiple finger defects. The two flaps used were the superficial branch of the radial artery (SUPBRA) flap and hypothenar free flap. Seven syndactylized glabrous free flaps were used to cover the defects in 16 fingers. The functional results and complaints were also assessed.

Results

Mean flap size was 14.35 cm². Six flaps survived. Postoperative evaluation data were obtained for the 13 fingers. All the patients returned to their previous work. All patients had a diminished protective sensation of at least 4.31 according to the SWM test. The mean two-point discrimination score of the patients was 9.9 mm (7–14). One finger had a PIP joint flexion contracture of 30°, no donor-site complaints were observed.

Conclusion

The advantages of these flaps include single operation site, strong glabrous tissue coverage, low risk of flexion contracture, and adequate tissue size for large defects. Disadvantages include two-stage and complex microsurgical operations, prolonged treatment, and hospital stay.

背景手指掌面或髓质缺损需要用无毛组织覆盖，以达到与缺损组织的良好匹配。处理多指掌侧或髓质缺损具有挑战性，因为这些缺损可能并不总是适合使用局部皮瓣或带蒂皮瓣。在这种情况下，可以使用联合游离皮瓣或带蒂皮瓣。患者和方法我们评估了游离无毛皮瓣联合多指缺损的效果。使用的两种皮瓣分别是桡动脉浅支（SUPBRA）皮瓣和下臂游离皮瓣。七块联合无毛游离皮瓣用于覆盖 16 根手指的缺损。同时还对功能效果和主诉进行了评估。结果平均皮瓣大小为 14.35 平方厘米。六个皮瓣存活。获得了 13 个手指的术后评估数据。所有患者都恢复了以前的工作。根据 SWM 测试，所有患者的保护性感觉至少减弱了 4.31。患者的平均两点辨别力为 9.9 毫米（7-14）。一个手指的 PIP 关节屈曲挛缩为 30°，但未观察到供体部位的不适。结论这类皮瓣的优点是手术部位单一、无毛组织覆盖力强、屈曲挛缩风险低、组织面积足够用于大面积缺损。缺点是需要两阶段和复杂的显微外科手术，治疗时间长，住院时间长。

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引用次数: 0

The use of vascularized fibula flap with allograft in post-oncologic microsurgical bone reconstruction of lower limbs in pediatric patients 血管化腓骨瓣与同种异体移植在小儿肿瘤术后下肢骨重建中的应用

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-23 DOI: 10.1002/micr.31172

Delcroix Luca MD, Tamburello Sara MD, Innocenti Marco MD, Campanacci Domenico Andrea MD

Background

Post-oncologic surgical reconstruction of lower limbs in pediatrics remains a challenging topic. Microsurgical techniques allow reconstructions of large bony defects. The use of vascularized fibular flap with allograft has proven to be an ideal biologic construct. We aim to assess the success rate of this operation, including flap survival, bony union, weight-bearing ambulation, and complications in a long-term follow-up in our case series compared to the literature.

Patients and methods

Our case-series includes 18 femoral resections (9 osteosarcomas, 8 Ewing sarcoma, and 1 desmoid tumor) and 15 tibial resections (10 osteosarcoma, 4 Ewing sarcoma, and 1 Malignant Fibrous Histiocytoma). We collected patients' demographics, type of tumor, type of resection, defect size, fibula-flap length, method of fixation, anastomosis site, follow-up data, complications, and their management. All survivals were examined by X-ray and CT-scan to evaluate the morphological changes of the vascularized fibula and follow-up. The functional evaluation was performed by the 30-point Musculoskeletal Tumor Society Rating Score (MSTS) for the lower limb (Enneking et al., Clinical Orthopaedics and Related Research 1993(286):241–246).

Results

The mean age of the femur resection patients' group was 11.2 years with a mean defect size of 14 cm and a mean length of the fibular flap of 18 cm; for the tibia the mean age was 12 years with a mean defect size of 14 cm and a mean length of the fibular flap of 16.6 cm. The overall survival of the reconstructions at 5 years follow-up was 17 out 18 cases for the femur and 13 out of 15 cases for the tibia. MSTS score was 28.2 for the femur and 23.7 for the tibia. The average time of union of the fibula was seen after 5 months, while allograft consolidation was observed around 19.7 months. The mean time of follow-up was 144.5 months for the femur and 139.2 months for the tibia. The complication rate observed was 7 out of 18 for the femur and 7 out of 15 for the tibia reconstructions.

Conclusions

The viability of the fibula is a cornerstone in the success of reconstruction as well as the successful management of complications in intercalary defects after tumor resection in pediatrics to restore good functionality. Our results are in line with those reported in the literature in terms of overall complication rates. The high primary union of allograft, the high MSTS score obtained, and the low rate of severe complications reflect the mechanical role of this recon

背景儿科肿瘤术后下肢重建仍是一个具有挑战性的课题。显微外科技术可以重建巨大的骨缺损。使用血管化纤维皮瓣和同种异体移植已被证明是一种理想的生物构造。我们旨在评估该手术的成功率，包括皮瓣存活、骨结合、负重行走以及与文献相比的长期随访并发症。患者和方法我们的病例系列包括 18 例股骨切除术（9 例骨肉瘤、8 例尤文肉瘤和 1 例类脂膜瘤）和 15 例胫骨切除术（10 例骨肉瘤、4 例尤文肉瘤和 1 例恶性纤维组织细胞瘤）。我们收集了患者的人口统计学资料、肿瘤类型、切除类型、缺损大小、腓骨瓣长度、固定方法、吻合部位、随访数据、并发症及其处理方法。所有存活者均接受了X光和CT扫描检查，以评估血管化腓骨的形态变化和随访情况。功能评估采用下肢肌肉骨骼肿瘤协会 30 分评分法（MSTS）（Enneking 等人，《临床骨科及相关研究》，1993(286):241-246）。结果股骨切除患者组的平均年龄为 11.2 岁，平均缺损面积为 14 厘米，腓骨瓣的平均长度为 18 厘米；胫骨切除患者组的平均年龄为 12 岁，平均缺损面积为 14 厘米，腓骨瓣的平均长度为 16.6 厘米。在 5 年的随访中，股骨重建的总存活率为 18 例中的 17 例，胫骨重建的总存活率为 15 例中的 13 例。股骨的 MSTS 评分为 28.2 分，胫骨为 23.7 分。腓骨的平均结合时间为 5 个月，而异体移植物的巩固时间约为 19.7 个月。股骨和胫骨的平均随访时间分别为144.5个月和139.2个月。股骨和胫骨的并发症发生率分别为：股骨重建 18 例中 7 例，胫骨重建 15 例中 7 例。结论腓骨的存活能力是重建成功的基石，也是成功处理儿科肿瘤切除术后闰骨缺损并发症以恢复良好功能的基石。就总体并发症发生率而言，我们的结果与文献报道一致。异体移植的初次结合率高、获得的 MSTS 评分高、严重并发症发生率低，反映出这种重建技术在长期随访中的机械作用。

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引用次数: 0

The use of superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis to treat inguinal lymphatic fistula: A case report 使用髂浅周穿孔静脉（SCIP）椎弓根静脉进行淋巴管吻合术治疗腹股沟淋巴瘘：病例报告

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-23 DOI: 10.1002/micr.31181

Matteo Meroni MD, Mario F. Scaglioni MD

The management of lymphatic fistulas following surgical procedures, in particular after inguinal lymphadenectomy, represents a significant clinical challenge. The current case report shows the novel use of the superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis (LVA) to treat a chronic inguinal lymphatic fistula in a 58-year-old male patient. This patient had developed a persistent lymphorrhea and wound dehiscence after a right inguinal lymph node biopsy performed for oncological reasons 1.5 months before. Pre-operative assessment with indocyanine green (ICG) lymphography confirmed a substantial lymphatic contribution to the wound discharge, thus guiding the surgical strategy. During the procedure, a pedicled tissue segment containing the SCIV was dissected and utilized to fill the wound's dead space and facilitate LVA with the leaking lymphatic vessel. Notably, a coupler device was employed for the anastomosis due to the large caliber of the lymphatic vessel involved, a technique not commonly reported in lymphatic surgeries. The result of the procedure was successful, with intra-operative ICG imaging confirming the patency of the anastomosis. After surgery the wound healed without complications. This case illustrates the potential of SCIV employment in lymphatic fistula repair in the inguinal region. While further research is needed to validate these findings, this report provides an unconventional approach to a relatively common problem in clinical practice.

外科手术后淋巴瘘的治疗，尤其是腹股沟淋巴结切除术后淋巴瘘的治疗，是一项重大的临床挑战。本病例报告展示了利用髂浅周穿孔静脉（SCIP）椎弓根静脉进行淋巴管吻合术（LVA）治疗一名 58 岁男性腹股沟慢性淋巴瘘的新方法。该患者在 1 个半月前因肿瘤原因进行右腹股沟淋巴结活检后，出现了持续性淋巴结肿大和伤口裂开。术前通过吲哚菁绿（ICG）淋巴造影术进行了评估，证实淋巴对伤口分泌物有很大影响，从而指导了手术策略。在手术过程中，医生解剖了含有 SCIV 的带蒂组织，并利用其填补伤口的死腔，促进漏出淋巴管的 LVA。值得注意的是，由于涉及的淋巴管口径较大，因此采用了耦合器进行吻合，这种技术在淋巴手术中并不常见。手术很成功，术中 ICG 成像证实吻合处通畅。术后伤口愈合，未出现并发症。该病例说明了 SCIV 在腹股沟区淋巴瘘修复中的应用潜力。虽然还需要进一步的研究来验证这些发现，但本报告为临床实践中一个相对常见的问题提供了一种非常规的方法。

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引用次数: 0

Analysis of flap thickness to breast projection ratio correlating to body mass index and age in east Asian women: Considerations in flap selection in breast reconstruction 东亚女性皮瓣厚度与乳房投影比与体重指数和年龄的相关性分析：乳房重建中皮瓣选择的考虑因素

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-04-09 DOI: 10.1002/micr.31177

Hyung Bae Kim M.D., Young Song Kim M.D., Jin Sup Eom M.D., Ph.D., Hyun Ho Han M.D., Ph.D.

Background

Several alternative flaps have been introduced and used for autologous breast reconstruction. However, as body fat distribution is different among patients, the donor of choice for sufficient breast projection varies between patients.

Methods

Patients who underwent autologous breast reconstruction from Jan 2018 to Sep 2022 were included. Age, body mass index (BMI), smoking history and hypertension, and diabetes occurrence were collected as baseline demographic data. Breast projection with five types of flap thickness was measured based on computed tomography angiography. Analysis was performed for five major autologous flaps for breast reconstruction.

Results

A total of 563 patients were included in the study. The mean age of the patients was 47.4 ± 7.9 (standard deviation; SD) years. The mean BMI of the patients was 24.0 ± 3.4 kg/m². Only the correlation between flap thickness to breast projection ratio and age in the PAP flap illustrated statistical significance (p = .039), but the correlation coefficient was quite low (r = −0.087). Slim patients who had lower BMIs (under 25 kg/m²) had significantly higher sufficient flap thickness for breast reconstruction than patients with higher BMIs over 25 kg/m² in the profunda artery perforator (PAP) flap (p < .001), the lumbar artery perforator (LAP) flap (p < .001), and the superior gluteal artery perforator (SGAP) flap (p < .001).

Conclusions

The deep inferior epigastric perforator flap provided sufficient thickness and was not usually affected by age and BMI. The PAP, LAP, and SGAP flaps tended to maintain the thickness of the flap even when BMI decreased, so they are advantageous for reconstruction in slim patients. This study contributes evidence in consideration of flap selection in autologous breast reconstruction.

背景目前，已有多种替代性皮瓣被引入并用于自体乳房重建。然而，由于不同患者的身体脂肪分布不同，因此不同患者为获得足够的乳房投影而选择的供体也不尽相同。方法纳入 2018 年 1 月至 2022 年 9 月期间接受自体乳房重建的患者。收集年龄、体重指数（BMI）、吸烟史和高血压以及糖尿病发生率作为基线人口统计学数据。根据计算机断层扫描血管造影测量了五种皮瓣厚度的乳房投影。对用于乳房重建的五种主要自体皮瓣进行了分析。结果共有 563 名患者参与了研究。患者的平均年龄为 47.4 ± 7.9（标准差；SD）岁。患者的平均体重指数为 24.0 ± 3.4 kg/m2。只有 PAP 皮瓣厚度与乳房投影比和年龄之间的相关性具有统计学意义（p = .039），但相关系数很低（r = -0.087）。体重指数（BMI）较低（低于 25 kg/m2）的苗条患者的乳房重建所需的足够皮瓣厚度明显高于体重指数超过 25 kg/m2 的患者，在深部动脉穿孔器（PAP）皮瓣（p < .001）、腰动脉穿孔器（LAP）皮瓣（p < .001）和臀上动脉穿孔器（SGAP）皮瓣（p < .001）中均是如此。结论下腹深部穿孔器皮瓣具有足够的厚度，通常不受年龄和体重指数的影响。即使体重指数下降，PAP、LAP 和 SGAP 皮瓣也能保持皮瓣的厚度，因此它们在瘦弱患者的重建中具有优势。这项研究为考虑自体乳房重建中皮瓣的选择提供了证据。

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引用次数: 0

Direct neurotization of free nipple grafts with cadaveric nerve grafts following mastectomy for gender affirming surgery 在乳房切除术后用尸体神经移植物直接神经化游离乳头移植物，以进行性别平权手术。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-29 DOI: 10.1002/micr.31174

Atlee M. Loughran MD, Jennifer M. Hopkins BS, Elizabeth Kidney-Hilt BS, Kathryn Doshi PA-C, Jonathan Keith MD, FACS

Background

Free nipple grafting makes sensory recovery challenging. Permanent decreased sensation to touch and temperature in skin-grafted skin is common. Direct neurotization of the nipple-areolar complex (NAC) graft has been described. However, quantitative data regarding degree of nipple reinnervation possible is unknown. This study aims to quantify and qualify sensation recovery following nerve coaptation to reinnervate the NAC.

Methods

Patients undergoing mastectomy for gender dysphoria from 2020 to 2022 were offered nerve allograft to restore nipple sensation. A lateral intercostal nerve was selected and coapted to allograft which was embedded beneath the nipple graft. Semmes Weinstein testing was used to assess nipple sensation. Assessments were made at visits <1 year and >1 year from surgery. Filaments used represented normal sensation, minor diminished sensation, diminished sensation, loss of protective sensation, and deep pressure sensation only.

Results

A total of 115 patients elected for direct neurotization. Semmes Weinstein testing was limited to 46 patients representing 46 encounters and 92 nipples in the <1 year group and 24 encounters and 48 nipples in the >1 year group. Of the 92 nipples in the <1 year group, 17 (18.5%) noted return of normal sensation and 37 (40.2%) noted minor diminished or diminished sensation, indicating nerve reinnervation. There were 38 (41%) nipples with loss of protective sensation or deep sensation only. There were 48 nipples included in the >1 year group. Of the 48 nipples, 4 (8.3%) noted normal sensation and 30 (62.5%) noted minor diminished or diminished sensation, indicating nerve reinnervation. For the remaining 14 nipples, 14 (29%) noted loss of protective sensation or deep sensation only.

Conclusion

Sensory outcomes in NAC grafts used for reconstruction in patients undergoing double incision mastectomy remain poor. Sensation restoration beyond that expected from full thickness skin grafts can be achieved in the majority of patients with nerve allograft via direct neurotization.

背景：游离乳头移植术给感觉恢复带来了挑战。植皮后的皮肤对触觉和温度的永久性感觉减退很常见。乳头乳晕复合体（NAC）移植物的直接神经化已被描述过。然而，有关乳头神经再支配程度的定量数据尚不清楚。本研究旨在量化和鉴定神经接合以重新支配 NAC 后的感觉恢复情况：方法：2020 年至 2022 年期间，因性别障碍接受乳房切除术的患者接受神经异体移植，以恢复乳头感觉。选择了一侧肋间神经，并与异体神经吻合，将其嵌入乳头移植物下方。Semmes Weinstein 测试用于评估乳头感觉。评估在手术后 1 年进行。使用的丝线代表正常感觉、轻微感觉减弱、感觉减弱、失去保护性感觉和仅深压感觉：共有 115 名患者选择了直接神经化。塞姆斯-韦恩斯坦测试仅限于 46 名患者，分别代表 46 次和 1 年组的 92 个乳头。在 1 年组的 92 个乳头中在 48 个乳头中，4 个（8.3%）感觉正常，30 个（62.5%）感觉轻微减弱或减弱，这表明有神经再支配。其余 14 个乳头中，有 14 个（29%）失去了保护性感觉或仅有深层感觉：结论：接受双切口乳房切除术的患者使用 NAC 移植物重建乳房的感觉效果仍然不佳。大多数患者可以通过神经异体移植的直接神经化来实现超出全厚皮肤移植预期的感觉恢复。

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引用次数: 0

Technical refinements of the scapular tip-free flap for mandibular reconstruction 用于下颌骨重建的无肩胛尖皮瓣的技术改进。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-29 DOI: 10.1002/micr.31176

Andrea Ferri MD, Giuseppe Perlangeli MD, Francesca Zito MD, Silvano Ferrari MD, Bernardo Bianchi MD, Francesco Arcuri MD, Tito Poli MD

Background

The use of scapular tip chimeric free flaps (STFFs) for reconstructing mandibular defects has recently become popular, but its utility relative to other bone-containing free flaps remains debatable. The aim of the report is to describe how technical modification of STFF impacted in its use for mandibular reconstruction also commenting results obtained in a unicentric series of patients.

Patients and Methods

Patients undergoing mandibular reconstruction using an STFF from January 1, 2014 to June 1, 2022 were retrospectively enrolled in this report. We collected data on chimeric flap type, bone management, vascular pedicles, and the final outcomes. In total, 31 patients (13 men and 18 women) with a mean age of 68 years were enrolled. According to the classification system of Urken, 15 patients had body defects, while 7 had ramus defects, another 7 had symphysis defects, and 2 had both ramus and bodily defects. STFF was always harvested working in two equips simultaneously, in supine position. Dissection included preparation of chimeric components of the flap as latissimus dorsi, serratus and scapular tip. After pedicle dissection scapular bone was cut basing on reconstructive needing with a rectangular (stick) shape including the border of the scapula. In cases of longer bone harvesting, circumflex pedicle was also included to perfuse the upper portion of the scapular border. In five cases, the STFF was harvested with only the scapular angle component, and was thus a composite osteomuscular flap; for the remaining 26 cases, a chimeric STFF was used. Circumflex pedicle was included for eight patients. Six of the seven patients with symphyseal defects underwent a single osteotomy.

Results

The average length of the harvested was 69.92 mm (maximum length = 104 mm). The average height of transplanted bone was 26.78 mm (maximum height = 44.2 mm). Mouth-opening was normal in 25 patients, limited in 6 patients, and severely impaired in no patients. The cosmetic results were rated as excellent by 20 patients, good by 8 patients, and poor by 3 patients.

Conclusion

The STFF is an excellent option for mandibular reconstruction when other flaps are not available and for patients in poor general condition. Technical innovations here presented made possible to harvest long bone segments with accurate shape thanks to osteotomies if needed and with adequate soft tissues components of the chimeric flap, ensuring satisfactory functional and cosmetic results.

背景：使用肩胛尖嵌合游离瓣（STFF）重建下颌骨缺损最近很流行，但与其他含骨游离瓣相比，STFF的效用仍有待商榷。本报告旨在描述STFF的技术改造如何影响其在下颌骨重建中的应用，并对单中心系列患者获得的结果进行评论：本报告回顾性地纳入了2014年1月1日至2022年6月1日期间使用STFF进行下颌骨重建的患者。我们收集了有关嵌合瓣类型、骨管理、血管蒂和最终结果的数据。共有 31 名患者（13 男 18 女）入选，平均年龄为 68 岁。根据Urken的分类系统，15名患者有身体缺损，7名患者有臼齿缺损，另外7名患者有干骺端缺损，2名患者同时有臼齿和身体缺损。STFF 总是以仰卧位在两台设备上同时采集。解剖包括皮瓣嵌合部分的准备，如背阔肌、锯肌和肩胛尖。在解剖骨蒂后，根据重建需要切割肩胛骨，切割成包括肩胛骨边界在内的矩形（棒状）。在截取较长骨头的病例中，还包括环行骨蒂，以灌注肩胛骨边缘的上半部分。在5例病例中，STFF只采集了肩胛角部分，因此是一种复合骨肌皮瓣；在其余26例病例中，使用的是嵌合STFF。8例患者使用了环状蒂。七名有骨骺缺损的患者中有六名接受了单次截骨术：移植骨的平均长度为 69.92 毫米（最大长度 = 104 毫米）。移植骨的平均高度为 26.78 毫米（最大高度 = 44.2 毫米）。25 名患者的张口功能正常，6 名患者的张口功能受限，没有患者的张口功能严重受损。20名患者的美容效果被评为 "优"，8名患者的美容效果被评为 "良"，3名患者的美容效果被评为 "差"：结论：当没有其他皮瓣可用时，STFF 是下颌骨重建的绝佳选择，也适用于全身状况不佳的患者。本文所介绍的技术创新使得在必要时通过截骨术获得形状准确的长骨段成为可能，而且嵌合瓣中有足够的软组织成分，确保了令人满意的功能和美容效果。

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引用次数: 0

Responses to comments on “Revolutionizing patient education: ChatGPT outperforms Google in answering patient queries on free flap reconstruction” 对 "患者教育的革命性变革：ChatGPT 在回答患者关于游离皮瓣重建的询问方面优于谷歌"。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-29 DOI: 10.1002/micr.31173

Tiffany Jeong BA, Hilary Liu BS, Mario Alessandri Bonetti MD, Sumaarg Pandya BS, Vu T. Nguyen MD, Francesco M. Egro MD

引用次数: 0

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