Microsurgery最新文献

英文中文

Use of the pedicle of previously harvested pectoral myocutaneous flap as a recipient for free flaps in head and neck reconstruction 在头颈部重建手术中使用之前采集的胸肌皮瓣作为游离皮瓣的受体。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-29 DOI: 10.1002/micr.31175

Ersin Gur MD, Yigit Ozer Tiftikcioglu MD, Turgut Furkan Kuybulu MD, Kutay Durukan MD, Hamit Hakan Bekir MD, Kerem Ozturk MD

Introduction

The pectoral myocutaneous flap (PMF) is a workhorse regional reconstructive option for head and neck defects. It is commonly used for primary reconstructions due to its advantages or as a life-boat flap in the salvage of failed reconstructions of free flaps. However, it also has intrinsic drawbacks, such as perfusion problems and partial or complete flap loss. Although there are many studies about the advantages and use of PMF in the literature, the number of studies about salvage of this workhorse flap is inadequate. We aimed to present the use of the pedicle of previously performed PMF as a recipient for free flaps in head and neck reconstruction.

Methods

Between January 2022 and August 2023, 10 free flaps were used in nine patients (three females and six males) who had previously undergone head and neck reconstruction with PMF. The age of the patients ranged from 54 to 74 years. Seven out of the nine PMFs were previously performed by different surgical teams. Squamous cell carcinoma (SCC) was the reason for primary surgeries in all patients and the PMFs were used for right lower lip and right submandibular defect, left lower lip and mentum defect, lower lip defect, right lower lip and right submandibular defect, right retromolar trigone defect, right buccal defect, left anterolateral esophageal defect, right retromolar trigone defect and left anterolateral pharyngoesophageal defect reconstructions. The problems were partial skin island necrosis and wound dehiscence in six patients and total skin necrosis in three patients. The partial skin island necroses already showed that the pedicles were unproblematic. For patients with total skin island necrosis the muscle stalks so the pedicles were also unproblematic which were confirmed by physical examination and Doppler device. After complications, the finally defects were located in the lower lip, left lower lip and mentum, right lower lip and right submandibular area, left anterolateral esophageal area and left neck, right buccal area, right retromolar trigon, left anterolateral pharyngoesophageal fistula and left neck. The sizes of the defects were between 3 × 4 cm and 11 × 17 cm. For all patients, the pedicle of the previously harvested PMF was used as a recipient for free flaps. Since the PMF was flipped over the clavicula for the reconstruction previously, the pedicle was so close to skin or skin graft which was used for coverage of the muscle stalk. The Doppler device was used first over the clavicle where the PMF was flipped for vessel identification. After marking the vessels, a vertical zigzag incision was made on the skin or skin graft. The perivascular fatty tissue and the pedicle were encountered with minimal dissection by the guidance of Doppler. Aft

简介：胸肌皮瓣（PMF）是头颈部缺损区域重建的主要选择。由于其优势，它常用于初次重建，或作为救生艇皮瓣用于挽救游离皮瓣失败的重建。然而，它也有其固有的缺点，如灌注问题和皮瓣部分或完全脱落。尽管文献中有很多关于PMF优点和使用的研究，但关于抢救这种主力皮瓣的研究数量不足。我们的目的是介绍在头颈部重建中如何使用之前做过的 PMF 的蒂作为游离皮瓣的受体：方法：2022 年 1 月至 2023 年 8 月间，我们在 9 名曾接受 PMF 头颈部重建术的患者（3 名女性和 6 名男性）身上使用了 10 个游离皮瓣。患者的年龄从54岁到74岁不等。九名患者中有七名曾由不同的手术团队进行过PMF手术。所有患者的原发手术都是鳞状细胞癌（SCC），PMF用于右下唇和右下颌下缺损、左下唇和颏下缺损、下唇缺损、右下唇和右下颌下缺损、右后齿三叉缺损、右颊部缺损、左食管前外侧缺损、右后齿三叉缺损和左咽喉食管前外侧缺损的重建。其中，6 名患者出现部分皮肤岛坏死和伤口裂开的问题，3 名患者出现皮肤全部坏死的问题。部分皮肤岛坏死的患者已经表明，基底没有问题。对于皮肤全岛坏死的患者，肌肉茎干也没有问题，这一点通过体格检查和多普勒设备得到了证实。并发症发生后，最终缺损位于下唇、左下唇和咽鼓管、右下唇和右颌下腺区域、左食管前外侧区域和左颈部、右颊部、右后三叉神经、左咽食管瘘前外侧和左颈部。缺损的大小介于 3 × 4 厘米和 11 × 17 厘米之间。所有患者的游离皮瓣都是以之前采集的PMF蒂为受体。由于之前是将PMF翻转到锁骨上进行重建，因此肌蒂非常靠近皮肤或用于覆盖肌柄的植皮。多普勒设备首先用于翻转 PMF 的锁骨处，以识别血管。标记血管后，在皮肤或植皮上做垂直之字形切口。在多普勒的引导下，以最小的剥离量接触到血管周围的脂肪组织和血管蒂。在显微镜下进行细致的剥离后，像往常一样准备吻合 PMF 的蒂。九名患者的头颈部重建共使用了六个前臂桡侧游离皮瓣（RFFF）和四个大腿前外侧皮瓣（ALT）：皮瓣的大小在 4 × 5 厘米和 12 × 17 厘米之间。受体动脉的直径在 0.9 至 1.2 毫米之间。受体静脉的直径与动脉大致相同。有一名患者使用了两根静脉移植物来延长动脉和静脉以到达受体血管。其余患者在没有静脉移植的情况下进行了端对端吻合。术后第一天出现的动脉血栓被成功挽救。两名患者出现血肿，三名患者出现伤口裂开。没有出现皮瓣部分或全部坏死的情况，所有皮瓣都存活了下来。随访时间从 2 个月到 12 个月不等。尽管重建手术取得了成功，但仍有两名患者在随访期间死于与此无关的疾病。其余患者的功能效果均可接受：结论：以前使用过的胸肌皮瓣的蒂部可能是头颈部重建中游离皮瓣受体的一个有用替代选择。

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引用次数: 0

Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections 足踝矫形手术：肿瘤切除后软组织缺损重建概述。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31168

Andrea Angelini MD, PhD, Cesare Tiengo MD, Maria Chiara Cerchiaro MD, Fernando Soto MD, Carlo Biz MD, Francesco Messana MD, Franco Bassetto MD, Pietro Ruggieri MD, PhD

Introduction

Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of “orthoplasty.” The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery.

Methods

We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique.

Results

The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap.

Conclusions

The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.

简介：足部恶性肿瘤非常罕见，考虑到该部位复杂的解剖结构，治疗策略极具挑战性。近年来，技术的巨大进步和不同专科（如骨科、肿瘤科、放射科、整形外科和血管外科）之间的合作极大地改变了在不切除肢体的情况下治疗复杂恶性肿瘤的方法。矫形外科和整形外科的优势相结合，构成了现代 "矫形术 "的定义。这篇综述文章旨在提供肿瘤切除后肢体挽救手术中重建足踝的治疗策略，特别关注整形外科的显微外科技术：我们在 PubMed、Scopus、Embase 和 Web of Science 上对相关论文进行了全面检索。我们纳入了以患者为基础的研究，这些研究报告了软组织重建手术中的小型和大型软组织缺损。我们讨论了每种重建技术的适应症、利弊和技巧提示：搜索使用了过去 30 年（1990 年至今）的文献，结果发现约有 725 篇文章描述了 2000 多个病例。皮瓣包括外侧肩胛上皮瓣、内侧足底皮瓣、反向鞍神经皮岛皮瓣、内侧腿皮瓣和外侧腿皮瓣。游离皮瓣包括大腿前外侧皮瓣、前臂桡侧皮瓣、背阔肌皮瓣、擒拿肌皮瓣、臂外侧皮瓣和腹直肌皮瓣：结论：肌肉骨骼肿瘤学中的整形方法是骨科医生和整形外科医生共同合作的模式，可提高有截肢风险的患者的肢体挽救成功率。在过去的几十年中，治疗方案、生物替代品和手术技术都有了很大的改进，增加了功能重建的可能性。显微外科手术策略代表了这些高难度重建手术的新前沿。

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引用次数: 0

Transverse division of the rectus abdominis muscle in deep inferior epigastric perforator flap elevation: A rescue technique to include more than one perforator 腹直肌横向分割下腹穿孔器皮瓣提升术：包括一条以上穿孔器的拯救技术。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31169

Jong Yun Choi MD, Jun Nyeon Kim MD, Chae Rim Lee MD, PhD, Jangyoun Choi MD, PhD, Suk-Ho Moon MD, PhD, Young Joon Jun MD, PhD, Deuk Young Oh MD, PhD

Background

It is important to include as many perforators as possible in order to enhance the vascularity of a deep inferior epigastric perforator (DIEP) flap. However, the rectus muscle must be transected transversely, which prevents suturing and can cause a defect along the same line as the muscle-sparing procedure. When harvesting the DIEP flap, no specific method was suggested to solve these muscle defects. We found that by transecting the rectus muscle transversely, the muscle could be sutured in the tendinous area more easily while maintaining muscle function. The purpose of this study is to confirm the long-term recovery of the rectus abdominis muscle through the volume change after DIEP flap using this tendinous transection and suture method.

Patients and Methods

A retrospective review of 28 patients who underwent unilateral breast reconstruction using a DIEP flap and the tendinous transection method for multiple perforators between May 2018 and April 2020 was conducted. The preoperative and postoperative volumes of the rectus abdominis muscle were estimated both the harvest and opposite sides.

Results

The preoperative and postoperative muscle volumes from the harvest side were 50.08 ± 8.71 cm³ and 48.56 ± 8.61 cm³, respectively. The volume difference was 1.522 cm³ decrease, which was not statistically significant (p = .070). The preoperative and postoperative muscle volumes from the opposite side were 50.50 ± 8.15 cm³ and 50.08 ± 8.18 cm³, respectively. The volume difference was 0.434 cm³ increase and was not statistically significant (p = .064). Postoperative volume changes in the rectus muscle were not statistically significant on either side.

Conclusion

The tendinous transection method in the DIEP flap procedure did not significantly affect postoperative rectus muscle volume. Therefore, we expect this harvest method to allow DIEP flap reconstruction that includes multiple perforators and complete donor muscle recovery.

背景：为了增强下腹穿孔器（DIEP）皮瓣的血管功能，尽可能多地包含穿孔器非常重要。然而，必须横向横切直肌，这样就无法进行缝合，而且会造成与肌肉切除术相同的缺损。在采集 DIEP 皮瓣时，没有提出解决这些肌肉缺损的具体方法。我们发现，通过横向横切直肌，可以更容易地将肌肉缝合在肌腱区域，同时保持肌肉功能。本研究的目的是通过使用这种腱性横断和缝合方法进行 DIEP 皮瓣术后腹直肌的体积变化来证实腹直肌的长期恢复情况：对2018年5月至2020年4月期间使用DIEP皮瓣和多穿孔肌腱膜横切法进行单侧乳房重建的28例患者进行回顾性回顾。对收割侧和对侧的腹直肌的术前和术后体积进行了估算：收肌侧的术前和术后肌肉体积分别为（50.08±8.71）立方厘米和（48.56±8.61）立方厘米。体积差异为减少 1.522 立方厘米，无统计学意义（P = 0.070）。术前和术后对侧肌肉体积分别为 50.50 ± 8.15 立方厘米和 50.08 ± 8.18 立方厘米。体积差异为增加 0.434 立方厘米，无统计学意义（p = 0.064）。两侧直肌术后体积变化均无统计学意义：结论：DIEP 皮瓣手术中的肌腱横断法对术后直肌体积没有明显影响。因此，我们希望这种切取方法可用于包括多穿孔器和供体肌肉完全恢复的 DIEP 皮瓣重建。

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引用次数: 0

Clinical effectiveness of postoperative prostaglandin E1 administration in reducing flap necrosis following microsurgical reconstruction 术后服用前列腺素 E1 对减少显微外科重建术后皮瓣坏死的临床效果。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31166

Se Yeon Park MD, Kyeong-Tae Lee MD, PhD

Background

Extensive experimental evidence has suggested the potential efficacy of prostaglandin E1 (PGE1) in enhancing flap survival, leading to its widespread empirical use following free flap operation. However, the translation of these experimental findings into clinical benefits remains uncertain. This study aimed to assess the clinical effectiveness of postoperative PGE1 administration on the outcomes of microsurgical reconstruction.

Methods

A retrospective review was conducted for patients who underwent free flap-based reconstruction between September 2020 and November 2022, dividing into two cohorts. For all consecutive cases conducted during the formal half, PGE1 was administered for postoperative 7 days (PGE1 cohort), and for those during the latter, PGE1 was not given (non-PGE1 cohort). The profiles of perfusion-related complications (PRC) were compared between the two cohorts. Further analyses after propensity-score matching were performed.

Results

In total, 274 cases were analyzed, consisting of 142 in PGE1 and 132 in non-PGE1 cohort. Baseline characteristics were similar between the two cohorts, except for higher rates of comorbidities and chronic wound-related defects in the PGE1 cohort. Overall PRC developed in 37 cases (13.5%), including 6 (2.1%) total loss and 38 (10.2%) partial necrosis. Compared to the control, the PGE1 cohort exhibited significantly lower rates of overall PRC and partial flap necrosis. This difference remained significant on multivariable analyses. The rate of total flap loss did not differ between the cohorts. Consistent associations were observed in the propensity-score matching analysis.

Conclusion

Postoperative administration of PGE1 appears to be associated with reduced risks for the development of partial flap necrosis.

背景：大量实验证据表明，前列腺素 E1（PGE1）具有提高皮瓣存活率的潜在功效，因此在游离皮瓣手术后被广泛应用。然而，这些实验结果能否转化为临床疗效仍不确定。本研究旨在评估术后使用 PGE1 对显微外科重建的临床效果：方法：对 2020 年 9 月至 2022 年 11 月期间接受游离皮瓣重建术的患者进行回顾性研究，分为两个队列。在前半期进行的所有连续病例中，术后 7 天均使用 PGE1（PGE1 组），而在后半期进行的病例中，则不使用 PGE1（非 PGE1 组）。两组患者的灌注相关并发症（PRC）情况进行了比较。结果：共分析了 274 个病例：共分析了 274 例病例，其中 PGE1 组 142 例，非 PGE1 组 132 例。两个队列的基线特征相似，只是 PGE1 队列中合并症和慢性伤口相关缺陷的比例较高。共有 37 例（13.5%）发生了 PRC，其中 6 例（2.1%）完全坏死，38 例（10.2%）部分坏死。与对照组相比，PGE1 组的总体 PRC 和皮瓣部分坏死率明显较低。在多变量分析中，这一差异仍然明显。两组患者的皮瓣全损率没有差异。在倾向分数匹配分析中观察到了一致的关联：结论：术后使用 PGE1 似乎与部分皮瓣坏死的发生风险降低有关。

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引用次数: 0

Perforator-to-perforator SCIP-based vascularized lymphnode and lymphatic vessels transfer: A first report 基于穿孔器到穿孔器 SCIP 的血管化淋巴结和淋巴管转移：首次报告

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31167

Matteo Meroni MD, Mario F. Scaglioni MD

引用次数: 0

Comments on “Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review” 关于 "在桡侧前臂游离皮瓣供体部位的闭合中，分层厚度植皮与厚度植皮的效果比较：系统综述"。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31170

Sumaarg Pandya BS, Mario Alessandri-Bonetti MD, Casey Zhang BS, Ana Reis BS, Andrea Costantino MD, Francesco M. Egro MD, MSc, MRCS

引用次数: 0

High-frequency ultrasound-assisted perforator mapping enhances efficiency in microsurgical reconstruction using thin ALT and SCIP flaps 高频超声辅助穿孔器绘图提高了使用薄型 ALT 和 SCIP 皮瓣进行显微外科重建的效率。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31171

Sang-Hun Lee MD, Kyeong-Tae Lee MD, PhD

Background

With the growing demand for the use of thin perforator flaps, obtaining knowledge on the superficial anatomy of perforators is imperative for stable flap elevation. Conventional modalities for perforator mapping fall short in providing such information. High-frequency ultrasound (HFUS), known for visualizing the superficially located anatomic structures, may potentially fill this void. This study aimed to evaluate the effectiveness of HFUS in the outcome of anterolateral thigh (ALT) and superficial circumflex iliac artery perforator (SCIP) flap-based reconstructions.

Methods

Consecutive patients who underwent free ALT or SCIP flap-based reconstruction from January 2021 to November 2022 were retrospectively reviewed. Perforator mapping was conducted using a handheld Doppler during the first year, while HFUS was used in the latter part. The two techniques were compared in terms of flap harvesting time and perfusion-related complication rates while considering the flap elevation plane.

Results

In total, 123 cases were analyzed, including 82 ALT flaps (41 in each group) and 41 SCIP flaps (16 in the Doppler and 25 in the HFUS group). The time required for flap elevation exhibited a tendency to decrease in the HFUS group, with a significant difference observed in cases involving thin flap elevation (super-thin ALT flaps and pure-skin-perforator SCIP flaps). Compared with the Doppler group, the HFUS group demonstrated significantly lower rates of PRCs, particularly partial flap necrosis. This difference remained significant in multivariable analyses.

Conclusion

Our results suggest that HFUS might be an appealing modality for perforator mapping in cases requiring thin ALT and SCIP flap.

背景：随着使用薄穿孔器皮瓣的需求日益增长，获得穿孔器表层解剖知识对于稳定皮瓣隆起至关重要。传统的穿孔器绘图方法无法提供此类信息。高频超声（HFUS）以可视化浅表解剖结构而著称，有可能填补这一空白。本研究旨在评估高频超声在基于大腿前外侧（ALT）和髂浅环动脉穿孔器（SCIP）皮瓣重建中的效果：回顾性分析2021年1月至2022年11月期间接受游离ALT或SCIP皮瓣重建术的连续患者。第一年使用手持多普勒进行穿孔器测绘，后一年使用高频超声。比较了两种技术的皮瓣采集时间和灌注相关并发症发生率，同时考虑了皮瓣隆起平面：共分析了123个病例，包括82个ALT皮瓣（两组各41个）和41个SCIP皮瓣（多普勒组16个，HFUS组25个）。在 HFUS 组中，皮瓣提升所需的时间呈减少趋势，在涉及薄皮瓣提升的病例（超薄 ALT 皮瓣和纯皮肤穿孔器 SCIP 皮瓣）中观察到显著差异。与多普勒组相比，HFUS 组的 PRC 发生率明显较低，尤其是部分皮瓣坏死。这一差异在多变量分析中仍有意义：我们的研究结果表明，在需要薄型 ALT 和 SCIP 皮瓣的病例中，HFUS 可能是一种有吸引力的穿孔器测绘方式。

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引用次数: 0

The combined risk predictive power of frailty and hypoalbuminemia in free tissue flap reconstruction: A cohort study of 34,571 patients from the NSQIP database 虚弱和低白蛋白血症在游离组织瓣重建中的综合风险预测能力：来自 NSQIP 数据库的 34,571 例患者的队列研究。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31156

Adriana C. Panayi MD, PhD, Leonard Knoedler, Dany Y. Matar BA, Jasmin Rühl BS, Sarah Friedrich PhD, Valentin Haug MD, Alen Palackic MD, Benjamin Thomas MD, Ulrich Kneser MD, PhD, Dennis P. Orgill MD, PhD, Gabriel Hundeshagen MD, MMS

Introduction

Significant morbidity and mortality are hallmarks of the functional decline seen in physically frail patients. The modified frailty index 5 (mFI-5) represents a risk predictor score that has been validated as a comorbidity-based scale in surgery. Serum albumin levels of <3.5 g/dL (hypoalbuminemia) have also been implicated with poor postoperative outcomes. However, the association between these two parameters remains to be investigated. We aimed to elucidate the interdependence of preoperative albumin levels and frailty, as evaluated by the mFI-5 score, and its reliability to prognosticate postoperative results in free flap reconstruction (FFR).

Methods

We conducted a multicenter, retrospective cohort study and accessed the ACS National Surgical Quality Improvement Program (ACS-NSQIP) from 2008 to 2021. We identified all adult patients (≥18 years of age) who underwent a FFR. We extracted perioperative data and lab values including albumin. Multivariable linear and logistic regression analyses were performed to identify independent risk predictors. Main outcomes involved mortality, length of hospital stay, reoperation, medical and surgical complications, and discharge destination within the 30-day postoperative period.

Results

A total of 34,571 patients were included in the study, with an average age of 53.9 years (standard deviation [SD] 12.2) and an average body mass index (BMI) of 28.8 (SD 6.1). Of these patients, 7484 were male (21.6%), whereas 22,363 (64.7%) had no frailty (mFI = 0). Additionally, 9466 patients had a frailty score of 1 (27.4%), 2505 had a score of 2 (7.2%), 226 had a score of 3 (0.7%), and 11 had a score of 4 or higher (0.0%). Albumin levels were available for 16,250 patients (47.0%), and among them, 1334 (8.2%) had hypoalbuminemia. Regression analyses showed that higher mFI scores were independent predictors of any, surgical, and medical complications, as well as increased rates of reoperations, unplanned readmissions, and prolonged hospital stays. Hypoalbuminemia independently predicted any, surgical, and medical complications, and higher mortality, reoperation, and longer hospital stay. When both frailty and albumin levels (mFI-5 and albumin) were considered together, this combined assessment was found to be a more accurate predictor of all major outcomes (any, medical and surgical complications, mortality, and reoperation). Further, our analysis identified a weak negative correlation between serum albumin levels and mFI scores (Spearman R: −.1; p < .0001).

Conclusio

导言：身体虚弱的病人功能衰退会导致严重的发病率和死亡率。改良虚弱指数 5（mFI-5）是一种风险预测评分，已作为外科手术中基于合并症的量表得到验证。方法：我们开展了一项多中心、回顾性队列研究，并访问了 2008 年至 2021 年的 ACS 国家外科质量改进计划 (ACS-NSQIP)。我们确定了所有接受 FFR 的成年患者（≥18 岁）。我们提取了围手术期数据和实验室值，包括白蛋白。我们进行了多变量线性和逻辑回归分析，以确定独立的风险预测因素。主要结果包括死亡率、住院时间、再次手术、内外科并发症以及术后30天内的出院去向：研究共纳入了 34571 名患者，平均年龄为 53.9 岁（标准差 [SD] 12.2），平均体重指数 (BMI) 为 28.8（标准差 6.1）。这些患者中有 7484 名男性（21.6%），22363 名患者（64.7%）没有虚弱症状（mFI = 0）。此外，9466 名患者的虚弱评分为 1 分（占 27.4%），2505 名患者的评分为 2 分（占 7.2%），226 名患者的评分为 3 分（占 0.7%），11 名患者的评分为 4 分或以上（占 0.0%）。有 16250 名患者（47.0%）的白蛋白水平可用，其中 1334 人（8.2%）患有低白蛋白血症。回归分析表明，较高的 mFI 分数是任何并发症、手术并发症和内科并发症的独立预测因素，也是再次手术率、非计划再入院率和住院时间延长率增加的独立预测因素。低白蛋白血症可独立预测任何并发症、手术并发症和内科并发症，以及更高的死亡率、再次手术率和更长的住院时间。当同时考虑虚弱和白蛋白水平（mFI-5 和白蛋白）时，我们发现这种综合评估能更准确地预测所有主要结果（任何并发症、内科和外科并发症、死亡率和再次手术）。此外，我们的分析还发现血清白蛋白水平与 mFI 评分之间存在微弱的负相关（Spearman R：-.1；P总之，这项队列研究强调了低白蛋白血症与不良术后结果之间的关系，包括那些与虚弱并无直接关系的不良后果。同时，较高的 mFI 分数可独立预测与低白蛋白血症无关的结果。基于这些发现，我们建议对接受 FFR 的患者同时考虑血清白蛋白水平和虚弱程度。这种围手术期算法有助于提供更加个性化的规划，包括多学科护理和术前、术后康复。

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引用次数: 0

Anterior intramuscular approach to profunda artery perforator flap harvest 前部肌肉内方法摘取深动脉穿孔器皮瓣。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-28 DOI: 10.1002/micr.31165

Shimpei Miyamoto MD, Daichi Kurita MD, Kou Fujisawa MD, Mutsumi Okazaki MD

引用次数: 0

Free flap reconstruction of elbow soft tissue defects: Lessons learned from 15 years of experience 肘部软组织缺损的游离皮瓣重建：从 15 年的经验中汲取教训。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-03-26 DOI: 10.1002/micr.31163

J. Reed McGraw BS, Reena S. Sulkar MBA, Corey M. Bascone MD, MBA, Sammy Othman MD, Jaclyn T. Mauch MD, MBE, Hani I. Naga MD, L. Scott Levin MD, Stephen J. Kovach III MD

Background

The elbow is a complex joint that is vital for proper function of the upper extremity. Reconstruction of soft tissue defects over the joint space remains challenging, and outcomes following free tissue transfer remain underreported in the literature. The purpose of this analysis was to evaluate the rate of limb salvage, joint function, and clinical complications following microvascular free flap coverage of the elbow.

Methods

This retrospective case series utilized surgical logs of the senior authors (Stephen J Kovach and L Scott Levin) to identify patients who underwent microvascular free flap elbow reconstruction between January 2007 and December 2021. Patient demographics and medical history were collected from the medical chart. Operative notes were reviewed to determine the type of flap procedure performed. The achievement of definitive soft tissue coverage, joint function, and limb salvage status at 1 year was determined from postoperative visit notes.

Results

Twenty-one patients (14 male, 7 female, median age 43) underwent free tissue transfer for coverage of soft tissue defects of the elbow. The most common indication for free tissue transfer was traumatic elbow fracture with soft tissue loss (n = 12, [57%]). Among the 21 free flaps performed, 71% (n = 15) were anterolateral thigh flaps, 14% (n = 3) were latissimus dorsi flaps, and 5% (n = 1) were transverse rectus abdominis flaps. The mean flap size was 107.5 cm². Flap success was 100% (n = 21). The following postoperative wound complications were reported: surgical site infection (n = 1, [5%]); partial dehiscence (n = 5, [24%]); seroma (n = 2, [10%]); donor-site hematoma (n = 1, [5%]); and delayed wound healing (n = 5, [24%]). At 1 year, all 21 patients achieved limb salvage and definitive soft tissue coverage. Of the 17 patients with functional data available, 47% (n = 8) had regained at least 120 degrees of elbow flexion/extension. All patients had greater than 1 year of follow-up.

Conclusion

Microvascular free flap reconstruction is a safe and effective method of providing definitive soft tissue coverage of elbow defects, as evidenced by high rates of limb salvage and functional recovery following reconstruction.

背景：肘部是一个复杂的关节，对上肢的正常功能至关重要。关节间隙软组织缺损的重建仍具有挑战性，文献中对游离组织转移后的结果报道不足。本分析旨在评估肘部微血管游离皮瓣覆盖后的肢体挽救率、关节功能和临床并发症：这项回顾性病例系列研究利用资深作者（Stephen J Kovach 和 L Scott Levin）的手术日志确定了在 2007 年 1 月至 2021 年 12 月期间接受微血管游离皮瓣肘关节重建术的患者。从病历中收集了患者的人口统计学特征和病史。审查手术记录以确定所实施的皮瓣手术类型。根据术后访视记录确定1年后软组织覆盖、关节功能和肢体挽回情况：21名患者（14名男性，7名女性，中位年龄43岁）接受了游离组织转移术，以覆盖肘部软组织缺损。最常见的游离组织转移适应症是外伤性肘部骨折伴软组织缺损（12 例，[57%]）。在21个游离皮瓣中，71%（15个）为大腿前外侧皮瓣，14%（3个）为背阔肌皮瓣，5%（1个）为腹横肌皮瓣。皮瓣的平均大小为 107.5 平方厘米。皮瓣成功率为 100%（n = 21）。术后伤口并发症如下：手术部位感染（1例，[5%]）；部分开裂（5例，[24%]）；血清肿（2例，[10%]）；供体部位血肿（1例，[5%]）；伤口延迟愈合（5例，[24%]）。1 年后，所有 21 名患者都实现了肢体挽救和明确的软组织覆盖。在17名有功能数据的患者中，47%（8人）的肘关节屈伸功能恢复了至少120度。所有患者的随访时间均超过1年：微血管游离皮瓣重建是一种安全有效的方法，可为肘部缺损提供明确的软组织覆盖，重建后的肢体挽救率和功能恢复率都很高。

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