Microsurgery最新文献

{"title":"Human Amnion-Derived Mesenchymal Stem Cells Prolong Graft Survival in a Rat Hind Limb Allotransplantation Model","authors":"Daichi Sakamoto,&nbsp;Ryosuke Ikeguchi,&nbsp;Tomoki Aoyama,&nbsp;Maki Ando,&nbsp;Koichi Yoshimoto,&nbsp;Terunobu Iwai,&nbsp;Kazuaki Fujita,&nbsp;Tetsuya Miyamoto,&nbsp;Takashi Noguchi,&nbsp;Shuichi Matsuda","doi":"10.1002/micr.70125","DOIUrl":"10.1002/micr.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Recently, the immunomodulatory effects of mesenchymal stem cells have been reported in several studies. The purpose of this study was to evaluate the effect of the administration of human amnion–derived mesenchymal stem cells (hAm-MSCs) in a rat vascularized composite allotransplantation model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 18 Lewis (LEW) rats and 6 Brown-Norway (BN) rats were used. Sixteen LEW rats as recipients were divided randomly into four groups: Isograft (Iso), Untreated (UT), FK, and MSC groups (<i>n</i> = 4, each group). Hind limb transplantation was performed. In the Iso group, 2 LEW rats were used as donors. In the other groups, 6 BN rats were used as donors. In the UT group, no immunosuppressant was used. In the FK group, 0.2 mg/kg/day of FK506 (tacrolimus) was administered from day 0 to day 6. In the MSC group, 2 × 10⁶ hAm-MSCs were administered on day 7 after tacrolimus administration (day 0–6). Graft survival was assessed by daily inspection, histology, and immunohistology with the TUNEL (terminal deoxynucleotidyl transferase dUTP nick-end labeling) assay. Cytokine mRNA expression analysis using real-time, reverse transcription PCR (RT-PCR) of the grafts was analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Graft survival in the MSC group (14.8 days) was significantly prolonged compared with that of the FK group (13 days; <i>p</i> &lt; 0.05). Histology and immunohistology with the TUNEL assay showed a significant reduction of mononuclear cell infiltration and apoptotic cells in the MSC group compared with the FK group (<i>p</i> &lt; 0.05). RT-PCR analysis of cytokine mRNA expression showed a significant decrease of IL-2 and an increase of TGFβ in graft muscle (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>hAm-MSCs prolonged graft survival in the rat vascularized composite allotransplantation model. hAm-MSCs could be an alternative immunomodulatory agent to avoid the side effects of conventional immunosuppressant.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186267","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":"Investigating the Safety of Breast Reconstruction With the Deep Inferior Epigastric Flap in Patients With Connective Tissue Diseases","authors":"Sophia Arbuiso,&nbsp;Makayla Kochheiser,&nbsp;Albert Truong,&nbsp;Samuel J. Medina,&nbsp;Matthew W. Liao,&nbsp;Sarah Diaddigo,&nbsp;Gianni Thomas,&nbsp;Leslie Cohen,&nbsp;Jason A. Spector,&nbsp;David M. Otterburn","doi":"10.1002/micr.70092","DOIUrl":"10.1002/micr.70092","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Connective tissue diseases (CTDs) are associated with impaired wound healing and hypercoagulability. There is currently a paucity of research examining postoperative outcomes in these patients following microsurgical procedures. We aimed to analyze postoperative outcomes in patients with CTDs following breast reconstruction with the deep inferior epigastric perforator (DIEP) flap.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-institution retrospective study was conducted consisting of all patients that underwent breast reconstruction with DIEP flaps between 2015 and 2023. Outcomes were assessed in the 90-day postoperative period, and Fisher's exact test was used to compare results between patients diagnosed with a CTD and patients who do not have CTDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five hundred ten DIEP flaps were performed on 286 patients. Eight of these patients, who underwent 13 DIEP flaps, were diagnosed with CTDs. The patients with and without CTDs were similar with respect to patient demographics. Patients with CTDs were not at increased risk of experiencing any major complication. However, patients with CTDs were at increased risk of experiencing fat necrosis, particularly of the breast (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data suggests that breast reconstruction using DIEP flaps is a safe procedure for patients who have CTDs; however, they may be at increased risk for fat necrosis of the breast, which does not require significant intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137905","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":"Evaluating the Safety of Immediate Lymphatic Reconstruction With Implant-Based Breast Reconstruction: Eight-Year Institutional Review","authors":"Diwakar Phuyal,&nbsp;Fuad Abbas,&nbsp;Osama Darras,&nbsp;Zoe E. Belardo,&nbsp;Jack Sims,&nbsp;Risal Djohan,&nbsp;Steven L. Bernard,&nbsp;Graham Schwarz,&nbsp;Raffi Gurunian,&nbsp;Sarah N. Bishop","doi":"10.1002/micr.70119","DOIUrl":"10.1002/micr.70119","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Lymphedema is a chronic condition that can occur in patients following axillary lymph node dissection (ALND). Breast reconstruction has been reported to reduce lymphedema risk. When immediate lymphatic reconstruction (ILR) is combined with implant-based breast reconstruction (IBR), it offers the potential for both functional and esthetic benefits in one surgery. However, its impact on postoperative complications, such as infection and wound dehiscence, among others, remains underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An IRB-approved retrospective review was conducted on patients who underwent ALND and immediate implant reconstruction (IBR). Data collected included patient demographics, treatment characteristics, and complication rates. Assessed complications included major infection requiring intravenous antibiotic or reoperation, minor infection requiring oral antibiotic, hematoma, seroma, wound issues, deep vein thrombosis, mastectomy flap necrosis, reoperation, implant explantation, and rehospitalization. The primary outcome was a comparison of complication rates between patients who received ILR and those who did not.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 178 patients (68 with ILR and 110 without ILR), accounting for implant reconstruction in 266 breasts. Mean operative time was significantly longer in the ILR group (326 min vs. 245, <i>p</i> &lt; 0.001). Despite this, overall complication rates were comparable (38% vs. 34%, <i>p</i> = 0.63). No significant differences were observed in infection rates, seroma formation, reoperations, or implant explantations over a three-year follow-up period. Age and BMI were identified as independent predictors of complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite longer operative times, ILR demonstrates a comparable safety profile to implant-based breast reconstruction when performed concurrently following ALND.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069894","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":"Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report","authors":"Lorena Ballerini,&nbsp;Ryo Karakawa,&nbsp;Tomoyuki Yano","doi":"10.1002/micr.70121","DOIUrl":"10.1002/micr.70121","url":null,"abstract":"<div>\u0000 \u0000 <p>Microvascular free-flap transfer is a widely used technique for reconstructing complex tissue defects. While early postoperative flap survival depends on intact vascular anastomoses, neovascularization may contribute to long-term viability. However, direct intraoperative human evidence of early neovascularization in free flaps remains limited. This case report aims to provide direct intraoperative evidence of early neovascularization in a free SCIP flap. We present a case of an 88-year-old female who underwent wide resection of a soft tissue sarcoma and reconstruction with a free superficial circumflex iliac artery perforator (SCIP) flap. The flap survived uneventfully, but on postoperative Day 19, the patient sustained a fall, resulting in a tibial fracture requiring a secondary operation. During this procedure, multiple neovascular perforators were observed between the recipient bed and the previously transplanted SCIP flap. Specifically, at least two neovascular perforators measuring 0.3 mm and 0.5 mm were identified, confirming active neovascularization. This case provides rare intraoperative human evidence of neovascularization in a free flap. While previous studies have questioned the extent of neovascularization, our findings suggest that new vascular connections may form under favorable conditions, such as a well-vascularized recipient site. Neovascularization may offer an additional layer of vascular support in free flaps, particularly in cases of partial vascular compromise. Further research is needed to determine its clinical significance and potential implications for reconstructive surgery.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075788","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":"Evolution of Triple Innervation Technique in the Treatment of Facial Paralysis","authors":"Fabiana Allevi,&nbsp;Amelia Beretta,&nbsp;Federico Bolognesi,&nbsp;Filippo Tarabbia,&nbsp;Valeria Battista,&nbsp;Federico Biglioli","doi":"10.1002/micr.70111","DOIUrl":"https://doi.org/10.1002/micr.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The aim of this study is to compare the traditional triple innervation technique with a new version, designed to reduce eye-mouth synkinesis. To reduce unpleasant synkinesis, the authors proposed changing the connection between the masseteric nerve and the injured facial nerve, analyzing the outcome in terms of reduction of synkinesis and power of contraction of the mimic muscle. The traditional technique conveys the quantitative stimuli from the masseteric nerve to the temporofacial branch and from the hypoglossal nerve (30%) to the cervicofacial branch. Traditionally, the stimulus coming from the masseteric nerve is directed in that way to both the orbicularis oculi and the great zygomatic muscle, leading to eye-mouth synkinesis. The evolved technique connects the masseteric nerve more distally on the branch directed to the great zygomatic muscle and the hypoglossal nerve (30%) to the main trunk of the injured facial nerve. Long-term follow-up could be interesting to check what happens to the eye without the stimulus coming from the masseteric nerve.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Exactly 32 patients were included, subdivided into two groups based on the type of surgical technique. Static symmetry, voluntary movements, and synkinesis were evaluated with eFACE software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both techniques allowed to obtain excellent outcomes: pre- and post-operative parameters showed a statistically significant improvement in both groups and no differences between the two groups, except in palpebral fissure width forced eye closure, in oculo and midfacial synkinesis: a significant reduction of synkinesis was evident in the evolved version group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The new triple innervation offers significant improvements in reducing synkinesis, ocular and mid-facial muscle spasm, leading to a more relaxed tone at rest.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145057819","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":"A Simple and Novel Microsurgery Instrument for Atraumatic Vessel and Perforator Dissection","authors":"Muhammad Umair Javed","doi":"10.1002/micr.70117","DOIUrl":"https://doi.org/10.1002/micr.70117","url":null,"abstract":"","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012541","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":"Vessel Selection in Head and Neck Reconstruction After Neck Dissection or Radiotherapy","authors":"Yasufumi Makiuchi,&nbsp;Daisuke Kageyama,&nbsp;Masaki Arikawa,&nbsp;Satoshi Akazawa","doi":"10.1002/micr.70116","DOIUrl":"https://doi.org/10.1002/micr.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissection and/or radiotherapy. We analyzed outcomes with regard to recipient vessel selection and flap failure, referring to patients' histories of radiotherapy and/or neck dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Records of 671 patients who had undergone head and neck reconstruction in our institution from April 2018 to March 2024 were retrospectively reviewed. We divided patients into four groups based on their treatment history: radiotherapy alone (<i>RT</i>, <i>n</i> = 82), neck dissection alone (<i>ND</i>, <i>n</i> = 43), both radiotherapy and neck dissection (<i>NDRT</i>, <i>n</i> = 39), and intact neck with no history of radiotherapy or neck dissection (<i>IN</i>, <i>n</i> = 488). We collected data on flap types, defect areas, selected recipient vessels, and the occurrence of flap failure. We also assessed the risk factors for flap failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In <i>Group RT</i>, 66 of 84 (79%) recipient vessels were located within irradiated areas. In contrast, in <i>Group ND</i>, 37 of 45 (82%) recipient vessels were outside the dissected areas. No significant association was observed between overall flap failure and variables we assessed. However, our additional flap failure analysis by arterial or venous factors showed an association with the patients' history of radiation treatment (<i>p</i> &lt; 0.05) and in cases where anastomosed vessels were actually located within irradiated areas (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients with previous radiotherapy history, recipient vessels even within irradiated areas can often be successfully used as recipient vessels. However, after undergoing irradiation treatment, the risk of venous-related flap failure may be higher compared with the non-irradiated area; thus, it necessitates careful consideration during reconstruction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007988","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":"Does the Timing, Type, and Method of Flap Coverage After Open Tibia Fracture Fixation Influence the Rate of Deep Infection?","authors":"Umar Khan,&nbsp;Kennedy Gray,&nbsp;Senay Ghidei,&nbsp;Caitlin Quigley,&nbsp;Vineet Mehan,&nbsp;Earl Johnson,&nbsp;Abraham Goch,&nbsp;Greg Gaski","doi":"10.1002/micr.70110","DOIUrl":"https://doi.org/10.1002/micr.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate whether the timing of flap coverage following definitive fixation influences deep infection and nonunion in patients with Gustilo-Anderson (GA) Type 3B and 3C open tibia fractures, accounting for flap method (local vs. free) and tissue type (muscle vs. fasciocutaneous).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective cohort study of patients with GA 3B and 3C tibia fractures treated at a Level I trauma center (2013–2022) with fracture fixation and soft-tissue reconstruction. Primary outcomes were deep surgical site infection and nonunion, assessed by timing of flap coverage (≤ 72 vs. &gt; 72 h), tissue type, and flap method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-one patients (52 extremities) met inclusion criteria. Deep infection was significantly higher after free (13/30, 43%) versus local flaps (0/22; <i>p</i> &lt; 0.001). There was a trend toward increased infection rates when coverage occurred &gt;72 h post-fixation (9/30, 30%) versus ≤ 72 h (4/22, 18%; <i>p</i> = 0.33). Among free flaps, coverage ≤ 72 h had fewer infections (4/13, 31%) than coverage &gt; 72 h (9/17, 53%; <i>p</i> = 0.22). Tissue type and timing had no significant effect: muscle ≤ 72 h (4/20, 20%) vs. &gt; 72 h (8/23, 35%; <i>p</i> = 0.28); fasciocutaneous ≤ 72 h (0/2) vs. &gt; 72 h (1/7, 14%; <i>p</i> &gt; 0.99). Nonunion was more common with free flaps (13/30) than local flaps (2/22; <i>p</i> = 0.007). Free flaps placed ≤ 72 h had fewer nonunions (4/13, 31%) than those placed &gt; 72 h (9/17, 53%; <i>p</i> = 0.22).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Free flaps were associated with higher rates of deep infection and nonunion. Although not statistically significant, there was a trend toward increased complications with coverage &gt; 72 h, especially for free and muscle flaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935144","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":"Use of Contrast-Enhanced Ultrasound in Genital Lymphedema: A Report of Three Cases","authors":"Maria V. Rios-Sanchez,&nbsp;Samyd S. Bustos,&nbsp;Alejandra Aristizábal,&nbsp;Carlos Bruces-Molina,&nbsp;Christine U. Lee,&nbsp;Nho V. Tran,&nbsp;Vahe Fahradyan","doi":"10.1002/micr.70114","DOIUrl":"https://doi.org/10.1002/micr.70114","url":null,"abstract":"<div>\u0000 \u0000 <p>Genital lymphedema presents significant challenges in surgical management, with limited effective interventions. This case report explores the use of contrast-enhanced ultrasound (CEUS) with microbubble injection as an alternative adjunct technique for lymphatic mapping in lymphaticovenous anastomosis (LVA) surgery for genital lymphedema. A retrospective chart review approved by our institutional review board was performed for patients with genital lymphedema undergoing LVA surgery between 2020 and 2024. Intraoperative CEUS for lymphatic mapping was used with intradermal injection of microbubble suspension Lumason (Bracco Suisse, Monroe Township, NJ, USA). Data regarding demographics, comorbidities, clinical and operative characteristics, complications, and surgical outcomes were retrieved. Three patients with genital lymphedema who underwent LVA were identified. The first patient was a 34-year-old female with recurrent lymphangioma circumscriptum and vesicular drainage. She successfully underwent CEUS-guided LVA followed by two debulking procedures. The second patient was a 16-year-old male with congenital scrotal and lower extremity lymphedema. He had two CEUS-guided LVAs and subsequent debulking for anterior scrotal swelling, with long-term reduction in edema. The third patient was a 31-year-old female with primary lymphedema of the right lower extremity and genital region. She underwent seven CEUS and indocyanine green lymphography (ICG) guided anastomoses targeting the mons and lower abdomen, resulting in substantial symptomatic and volumetric improvement. CEUS detected target lymphatic vessels in all cases, including cases where ICG imaging failed to identify candidate lymphatic vessels. CEUS with intradermal microbubble injection successfully identified target lymphatic vessels in the preoperative planning for LVA surgery in patients with genital lymphedema.</p>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935145","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 Use of Peripheral Nerve Surgery and Peripheral Nerve Stimulation in Patients With Refractory Neuropathic Pain","authors":"Floris V. Raasveld,&nbsp;Benjamin R. Johnston,&nbsp;David Hao,&nbsp;Ian L. Valerio,&nbsp;Kyle R. Eberlin","doi":"10.1002/micr.70112","DOIUrl":"https://doi.org/10.1002/micr.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Peripheral nerve injury (PNI) can lead to chronic neuropathic pain, significantly impacting quality of life. While surgical intervention may offer relief in some cases, outcomes are variable. Peripheral nerve stimulation (PNS) offers an alternative treatment approach for managing neuropathic pain in these patients. This study aims to describe the outcomes of a combined surgical and PNS approach for severe, refractory neuropathic pain following PNI or amputation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted on seven patients who underwent combined peripheral nerve surgery and PNS at a specialized multidisciplinary nerve clinic. Patient-reported outcome measures, including pain scores, Patient's Global Impression of Change (PGIC), and quality of life metrics, were collected. Patient data were retrospectively reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The cohort included five males and two females (mean age 58.3 ± 8.9 years), with four amputees and three non-amputees. The average follow-up duration was 2.4 ± 0.8 years. Six out of seven patients reported reduced pain when the stimulator was activated, with an average pain score reduction of 4.4 ± 1.5 points. All seven patients reported improvement on the PGIC scale. Mean pain intensity and pain interference scores averaged 54.7 ± 5.5 and 66.3 ± 6.5, respectively. One patient underwent device removal due to irritation from the topical adhesive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This proof-of-concept study suggests that combined peripheral nerve surgery and PNS may be a viable option for carefully selected patients with severe, refractory neuropathic pain. While pain reduction and functional improvement were observed in most patients, outcomes varied considerably. Future prospective studies with larger cohorts are needed to refine patient selection criteria and optimize this combined approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929912","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}