Microsurgery最新文献_第9页

Plantar intermetatarsal perforator flap for first web skin-graftless syndactyly release: Anatomical study and clinical application 用于第一蹼无植皮联合畸形松解术的跖间穿孔器皮瓣：解剖学研究与临床应用

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-16 DOI: 10.1002/micr.31151

Francisco Soldado MD, PhD, Jose Antonio Prieto-Mere MD, Abdelmounim Cherqaoui MD, Paula Diaz Gallardo MD, Jorge Knorr MD, Pablo Corona MD

Introduction

Foot-syndactyly has long been managed through conventional surgical procedures, each having its own distinct advantages and drawbacks. While these methods, which do not require skin grafts, exhibit a lower incidence of long-term complications, they lead to undesirable scarring on the dorsal side of the foot and reduced patient satisfaction. In this study, we introduce an innovative technique involving an intermetatarsal plantar flap, supported by an anatomical investigation and clinical application.

Methods

Eight freshly preserved lower limbs were injected with colored latex to examine the cutaneous vessels on the plantar surface, a skin-flap was designed in an elliptical shape to address first web conjoined toes. The flap was extended from the center of each affected ray measuring ~30% of the sole's length. Using the mentioned novel approach, a flap was created and dorsally extended with a straight incision to release bilateral simple foot-syndactyly in an 8-year-old child presented with Apert's Syndrome.

Results

We identified cutaneous branches originating either from the medial plantar vessels or the lateral proper artery of the hallux. On average, the mean number of cutaneous branches found over the first intermetatarsal web spaces was 5.8 (ranging from 5 to 8) most of them originating from medial plantar vessels with a mean of 5.1 branches (range 4–6) while proper lateral great-toe digital artery provided a mean of 0.6 branches (range 0–2). Intra-operatively, in our patient, advancing the plantar flap ensured complete coverage of the commissure, obviating the necessity for skin grafts. Incisions healed uneventfully and a wide first web was obtained. Over a 15 months follow-up, no complications were observed.

Conclusions

Our findings suggest that the skin-graftless first web release of syndactyly using a plantar intermetatarsal flap is a reliable and straightforward procedure with good cosmetic results, offering a promising alternative to conventional techniques.

Level of evidence

Therapeutic IV.

简介长期以来，人们一直通过传统的外科手术方法来治疗足拇趾发育不良，每种方法都有其独特的优点和缺点。这些方法无需植皮，长期并发症发生率较低，但会在足背侧留下不良瘢痕，降低患者满意度。在本研究中，我们介绍了一种涉及跖间皮瓣的创新技术，并辅以解剖学研究和临床应用：方法：在八只新鲜保存的下肢上注射彩色乳胶，以检查足底表面的皮肤血管。皮瓣从每条受影响射线的中心延伸，长度约为脚底长度的 30%。我们采用上述新方法制作了一个皮瓣，并通过直切口向背侧延伸，为一名患有阿博特综合征的 8 岁儿童解除了双侧单纯趾挛缩症：结果：我们确定了源自足底内侧血管或拇指外侧正中动脉的皮支。在第一跖蹼间隙发现的皮肤分支平均为 5.8 个（5 至 8 个不等），其中大部分源自内侧足底血管，平均为 5.1 个分支（4 至 6 个不等），而大趾外侧数字动脉提供的分支平均为 0.6 个（0 至 2 个不等）。术中，在我们的患者中，推进足底皮瓣可确保完全覆盖关节窝，从而避免了植皮的必要性。切口愈合顺利，第一蹼较宽。随访 15 个月，未发现并发症：我们的研究结果表明，使用跖间皮瓣进行无植皮第一蹼松解术治疗腓骨联合畸形是一种可靠而简单的手术，具有良好的美容效果，是传统技术的一种很有前途的替代方法：证据级别：IV 级治疗。

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引用次数: 0

Radial forearm free flap reconstruction in a 3-month-old patient with undifferentiated pharyngeal sarcoma 一名 3 个月大的未分化咽肉瘤患者的前臂桡侧游离皮瓣重建术。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-16 DOI: 10.1002/micr.31149

Theodore Lam MBBS, Eric Levi FRACS, MBBS, BSc, PGDipSurgAnat, MPH&TM, Jacson Shen MD, Daniel Wilks MBChB, BSc, FRCS (Plast), FRACS (Plast), Dip Hand Surg, William Alexander MBBS, FRACS (Plastic)

There is minimal information regarding free tissue transfers in very young infants, especially those less than a year old. It is often thought that that age remains a limit to free tissue transfers, with younger patients having smaller vessels, making the operation technically challenging. In this case report, we discuss the youngest and smallest recorded case of a free flap reconstruction. A 3-month-old patient with a malignant parapharyngeal undifferentiated round cell sarcoma underwent a resection and reconstruction with a radial forearm free flap (RFFF). The defect was 35 by 20 by 15 mm, and required a pharyngeal “patch,” as opposed to a “tube,” reconstruction. The defect was templated, and the RFFF then raised in a standard subfascial fashion, and inset with resorbable sutures. The patient was observed in the ICU postoperatively. The patient was subsequently diagnosed with Stage IV primary undifferentiated sarcoma with regional metastasis and received adjuvant chemotherapy. Fifteen-month follow up revealed no signs of recurrence, full oral intake, a well-reconstructed pharynx on nasoendoscopic examination, and minimal donor site morbidity. This report illustrates several unique adaptations of free flap transfer in infants and adds to the emerging body of evidence that age is not a contraindication for head and neck reconstruction.

有关年幼婴儿，尤其是一岁以内婴儿的游离组织移植的资料很少。人们通常认为，年龄仍然是游离组织转移的一个限制，因为年龄较小的患者血管较小，使得手术在技术上具有挑战性。在本病例报告中，我们讨论了有记录以来年龄最小的一例游离皮瓣重建手术。一名 3 个月大的恶性咽旁未分化圆形细胞肉瘤患者接受了切除手术，并用前臂桡侧游离皮瓣（RFFF）进行了重建。缺损面积为 35 x 20 x 15 毫米，需要进行咽部 "补片 "重建，而不是 "管状 "重建。对缺损进行了模板化处理，然后以标准的筋膜下方式隆起 RFFF，并用可吸收缝合线缝合。患者术后在重症监护室接受观察。患者随后被诊断为原发性未分化肉瘤 IV 期，并伴有区域转移，接受了辅助化疗。15 个月的随访显示，患者没有复发迹象，可以完全进食，鼻内镜检查显示咽部重建良好，供体部位发病率极低。该报告说明了游离皮瓣移植在婴儿身上的几种独特适应症，并为年龄并非头颈部重建禁忌症这一新兴证据增添了新的内容。

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引用次数: 0

Systematic review of pathologic markers in skin ischemia with and without reperfusion injury in microsurgical reconstruction: Biomarker alterations precede histological structure changes 对显微外科重建中伴有或不伴有再灌注损伤的皮肤缺血病理标志物进行系统回顾：生物标志物的变化先于组织学结构的变化。

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-15 DOI: 10.1002/micr.31141

Ryan Khalaf BS, Daniela Duarte Bateman MD, Jose Reyes BS, Daniel Najafali BS, Antonio Rampazzo MD, PhD, Bahar Bassiri Gharb MD, PhD

Background

Ischemia and ischemia–reperfusion injury contribute to partial or complete flap necrosis. Traditionally, skin histology has been used to evaluate morphological and structural changes, however histology does not detect early changes. We hypothesize that morphological and structural skin changes in response to ischemia and IRI occur late, and modification of gene and protein expression are the earliest changes in ischemia and IRI.

Methods

A systematic review was performed in accordance with PRISMA guidelines. Studies reporting skin histology or gene/protein expression changes following ischemia with or without reperfusion injury published between 2002 and 2022 were included. The primary outcomes were descriptive and semi-quantitative histological structural changes, leukocyte infiltration, edema, vessel density; secondary outcomes were quantitative gene and protein expression intensity (PCR and western blot). Model type, experimental intervention, ischemia method and duration, reperfusion duration, biopsy location and time point were collected.

Results

One hundred and one articles were included. Hematoxylin and eosin (H&E) showed inflammatory infiltration in early responses (12–24 h), with structural modifications (3–14 days) and neovascularization (5–14 days) as delayed responses. Immunohistochemistry (IHC) identified angiogenesis (CD31, CD34), apoptosis (TUNEL, caspase-3, Bax/Bcl-2), and protein localization (NF-κB). Gene (PCR) and protein expression (western blot) detected inflammation and apoptosis; endoplasmic reticulum stress/oxidative stress and hypoxia; and neovascularization. The most common markers were TNF-α, IL-6 and IL-1β (inflammation), caspase-3 (apoptosis), VEGF (neovascularization), and HIF-1α (hypoxia).

Conclusion

There is no consensus or standard for reporting skin injury during ischemia and IRI. H&E histology is most frequently performed but is primarily descriptive and lacks sensitivity for early skin injury. Immunohistochemistry and gene/protein expression reveal immediate and quantitative cellular responses to skin ischemia and IRI. Future research is needed towards a universally-accepted skin injury scoring system.

背景：缺血和缺血再灌注损伤会导致皮瓣部分或完全坏死。传统上，皮肤组织学被用来评估形态和结构变化，但组织学并不能检测到早期变化。我们假设，缺血和IRI引起的皮肤形态和结构变化发生较晚，而基因和蛋白质表达的改变是缺血和IRI最早发生的变化：方法：根据 PRISMA 指南进行了系统回顾。方法：根据 PRISMA 指南进行了系统综述，纳入了 2002 年至 2022 年间发表的报告缺血后皮肤组织学或基因/蛋白质表达变化的研究，无论是否存在再灌注损伤。主要结果为描述性和半定量组织学结构变化、白细胞浸润、水肿、血管密度；次要结果为定量基因和蛋白质表达强度（PCR 和 Western 印迹）。收集了模型类型、实验干预、缺血方法和持续时间、再灌注持续时间、活检位置和时间点：结果：共纳入 1001 篇文章。血栓素和伊红（H&E）显示炎症浸润为早期反应（12-24 小时），结构改变（3-14 天）和新生血管形成（5-14 天）为延迟反应。免疫组化（IHC）确定了血管生成（CD31、CD34）、凋亡（TUNEL、caspase-3、Bax/Bcl-2）和蛋白定位（NF-κB）。基因（PCR）和蛋白表达（western blot）检测炎症和细胞凋亡；内质网应激/氧化应激和缺氧；以及新生血管。最常见的标记物是 TNF-α、IL-6 和 IL-1β（炎症）、caspase-3（细胞凋亡）、VEGF（新生血管）和 HIF-1α（缺氧）：结论：对于缺血和内部损伤期间皮肤损伤的报告，目前尚无共识或标准。H&E组织学是最常用的方法，但主要是描述性的，对早期皮肤损伤缺乏敏感性。免疫组化和基因/蛋白表达揭示了皮肤缺血和IRI的即时和定量细胞反应。未来的研究需要建立一个普遍接受的皮肤损伤评分系统。

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引用次数: 0

Anatomical features of a crossing vein connecting left and right internal mammary veins: A preliminary study with computerized tomography or magnetic resonance imaging 连接左右乳内静脉的交叉静脉的解剖学特征：计算机断层扫描或磁共振成像初步研究

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-11 DOI: 10.1002/micr.31148

Mayu Ueno MD, Hiroki Mori MD, PhD, Noriko Uemura MD, PhD, Sayuri Kato MD, Kentaro Tanaka MD, PhD

Background

In breast reconstruction with free flaps, retrograde venous anastomosis into the internal mammary vein (IMV) is often unavoidable. Utility of a crossing vein between the right and left IMV, one of the anatomical foundations which make retrograde flow possible, has been reported but only with a few detailed features. This study evaluated the presence, actual location, and diameter of the crossing veins using preoperative imaging such as contrast-enhanced computed tomography (CECT), or contrast-enhanced magnetic resonance imaging (CEMRI). Moreover, this is a preliminary non-invasive study to clarify these processes on a larger scale.

Methods

We included 29 cases of unilateral breast reconstruction performed between July 2018 and September 2023 at our institution using unipedicled or bipedicled free deep inferior epigastric artery perforator (DIEP) flaps with retrograde venous anastomosis to only one IMV at the level of anastomosis. No congestion or necrosis was observed. In the final 24 cases with sufficient imaging coverage of preoperative contrast-enhanced images (15 CECT and 9 CEMRI), the crossing veins of IMVs were detected and the number, localization, and diameter were measured.

Results

In 20 cases of 24 images, the crossing veins between IMVs were completely identified (83%). In 18 of the cases, only one crossing vein was established immediately ventral to the xiphoid process, averaging 19.3 ± 7.18 mm caudal to the fibrous junction between the sternal body and xiphoid process. The average diameter of the veins was 1.57 ± 0.42 mm. In two other cases, the second crossing vein originated on the dorsal surface of the sternum, but it was a very thin vein of about 0.4 mm. Three images indicated incomplete identification of the crossing vein at the xiphoid process, and in one case, no crossing vein was observed between bilateral IMVs.

Conclusion

The contrast-enhanced imaging study revealed an anatomic feature that the crossing veins (about 1.5 mm in diameter) connecting the right and left IMVs are located just ventral to the xiphoid process. Furthermore, the crossing veins can be identified on contrast-enhanced images, and refinement of this method is expected to lead to future non-invasive anatomical investigations in an even larger number of cases.

背景在使用游离皮瓣进行乳房重建时，逆行静脉吻合到乳腺内静脉（IMV）往往是不可避免的。左右乳内静脉之间的交叉静脉是使逆行血流成为可能的解剖学基础之一，其效用已有报道，但只有少数详细特征。本研究使用对比增强计算机断层扫描（CECT）或对比增强磁共振成像（CEMRI）等术前成像技术评估了交叉静脉的存在、实际位置和直径。此外，这是一项初步的非侵入性研究，目的是在更大范围内明确这些过程。方法我们纳入了 2018 年 7 月至 2023 年 9 月期间在我院进行的 29 例单侧乳房重建病例，这些病例使用单髁或双髁游离深下上腹部动脉穿孔器（DIEP）皮瓣，在吻合口水平仅与一个 IMV 进行逆行静脉吻合。未观察到充血或坏死。在最后 24 例术前造影剂增强图像（15 例 CECT 和 9 例 CEMRI）有足够成像覆盖的病例中，检测了 IMV 的交叉静脉，并测量了其数量、位置和直径。结果在 24 张图像中，有 20 例完全确定了 IMV 之间的交叉静脉（83%）。在其中的 18 个病例中，只有一条交叉静脉紧靠剑突腹侧，平均距离胸骨体和剑突之间的纤维交界处尾部 19.3 ± 7.18 mm。静脉的平均直径为 1.57 ± 0.42 毫米。在另外两个病例中，第二条交叉静脉起源于胸骨背侧，但它是一条非常细的静脉，约 0.4 毫米。有三幅图像显示剑突处的交叉静脉未完全识别，有一例病例在双侧 IMV 之间未观察到交叉静脉。结论对比增强成像研究揭示了一个解剖学特征，即连接左右IMV的交叉静脉（直径约1.5毫米）位于剑突腹侧。此外，交叉静脉可在对比增强图像上识别，这种方法的改进有望在未来对更多病例进行无创解剖学研究。

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引用次数: 0

Assessment of x-ray efficacy for intraoperative microneedle retrieval using a cadaveric model 利用尸体模型评估术中微针取出的 X 射线疗效

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31143

Sara C. Chaker BS, Ya-Ching Hung M.D. MPH, Ariel A. Vinson MS, Mariam Saad MD, Galen Perdikis MD, Panambur Laxminarayan Bhandari MD

Introduction

Institutional protocols often mandate the use of x-rays when a microneedle is lost intraoperatively. Although x-rays can reliably show a macroneedle, the benefit of x-rays in detecting microneedles in human tissues has not been established as available data on this topic are investigated in anthropometric models. The current study aims to evaluate whether x-rays can reliably detect retained microneedles in a human cadaveric model. We hypothesize that microneedles would be detected at a significantly lower rate than macroneedles by x-ray in human tissues.

Materials and Methods

Needles ranging from 4-0 to 10-0 were placed randomly throughout a cadaveric hand and foot. Each tissue sample was x-rayed using a Fexitron X-Ray machine, taking both anteroposterior and lateral views. A total of six x-ray images were then evaluated by 11 radiologists, independently. The radiologists circled over the area where they visualized a needle. The accuracy of detecting macroneedles (size 4-0 to 7-0) was compared with that of microneedles (size 8-0 to 10-0) using a chi-square test.

Results

The overall detection rate for the microneedles was significantly lower than the detection rate for macroneedles (13.5% vs 88.8%, p < .01). When subcategorized between the hand and the foot, the detection rate for microneedles was also significantly lower than the rate for macroneedles (hand: 7.6% for microneedles, 93.2% for macroneedles, p < .01; foot: 19.5% for microneedles, 84.4% for macroneedles, p < .01). The detection rate, in general, significantly decreased as the sizes of needles became smaller (7-0:70.5%, 8-0:18.2%, 9-0:16.7%, 10-0:2.3%, p < .01).

Conclusion

X-rays, while useful in detecting macroneedles, had a significantly lower rate of detecting microneedles in a cadaveric model. The routine use of x-rays for a lost microneedle may not be beneficial. Further investigation with fresh tissue and similar intraoperative x-ray systems is warranted to corroborate and support these findings.

当术中丢失微针时，机构协议通常会要求使用 X 光。虽然X射线可以可靠地显示微针，但X射线在人体组织中检测微针的益处尚未确定，因为现有的相关数据都是在人体测量模型中进行研究的。本研究旨在评估 X 射线是否能可靠地检测人体尸体模型中残留的微针。我们假设在人体组织中通过 X 射线检测到微针的比率将明显低于大针。

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引用次数: 0

Microsurgical breast reconstruction and primary hypercoagulable disorders 显微外科乳房再造与原发性高凝血症

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31146

Rakel M. Zarb MD, Charles Lamberton BS, Aishwarya Ramamurthi MD, Vince Berry BS, Karri A. Adamson MD, Erin L. Doren MD, MPH, Patrick C. Hettinger MD, John B. Hijjawi MD, John A. LoGiudice MD

Background

Primary hypercoagulable disorders pose a significant challenge to microsurgeons and have traditionally been regarded as a relative contraindication to free tissue transfer. Since free flaps offer numerous advantages in breast reconstruction, there is an effort to expand the population to whom these operations can be safely offered. The purpose of this study is to describe our chemoprophylaxis regimen in cases of primary hypercoagulability, as well as to compare flap outcomes and complications between women with and without hypercoagulability.

Patients and Methods

A single institution retrospective review identified 15 patients (25 flaps) with known primary hypercoagulability who underwent microsurgical breast reconstruction from 2010 through 2020. There were 785 patients (1268 flaps) without primary hypercoagulability who underwent microsurgical breast reconstruction, including 40 patients (73 flaps) with a history of venous thromboembolism (VTE), evaluated for comparison. Patient characteristics, thromboprophylaxis regimen, and surgical outcomes were collected. In carrying out this cohort study, we have adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results

Fifteen patients with primary hypercoagulability were identified, including heterozygous factor V Leiden mutation (n = 12), protein S deficiency (n = 1), prothrombin mutation (n = 1), and primary antiphospholipid syndrome (n = 1). Thirteen of these (87%) were discharged with an extended LMWH course. There was no postoperative VTE or mortality in this cohort, and no significant difference in hematoma or transfusion compared with the control group (p = .31, p = .87, respectively). The flap loss rate was 4% in the hypercoagulable group compared with 0.92% in the control group (p = .15). The salvage for arterial or venous compromise in the hypercoagulable group was poor (0% vs. 52%, p = .3).

Conclusion

Microsurgical breast reconstruction in women with primary hypercoagulability disorders is feasible with acceptable risk of flap loss but poor salvage potential. Postoperative thromboprophylaxis with extended prophylactic LMWH in this population appears to be a safe regimen.

背景原发性高凝血症给显微外科医生带来了巨大的挑战，传统上被认为是游离组织转移的相对禁忌症。由于游离组织瓣在乳房重建中具有诸多优势，因此人们正在努力扩大可安全进行此类手术的人群。本研究的目的是描述我们对原发性高凝状态病例的化学预防方案，并比较有和没有高凝状态的女性的皮瓣效果和并发症。患者和方法通过单个机构的回顾性审查，确定了 15 名已知患有原发性高凝状态的患者（25 个皮瓣），这些患者在 2010 年至 2020 年期间接受了显微外科乳房再造手术。接受显微外科乳房再造手术的 785 名患者（1268 个皮瓣）不存在原发性高凝状态，其中包括 40 名有静脉血栓栓塞症（VTE）病史的患者（73 个皮瓣）。研究收集了患者特征、血栓预防方案和手术结果。在进行这项队列研究时，我们遵守了加强流行病学观察性研究报告（STROBE）指南。结果共发现 15 例原发性高凝状态患者，包括杂合子因子 V Leiden 突变（12 例）、蛋白 S 缺乏（1 例）、凝血酶原突变（1 例）和原发性抗磷脂综合征（1 例）。其中 13 人（87%）出院时延长了 LMWH 疗程。该组患者术后无 VTE 或死亡，血肿或输血与对照组相比无显著差异（分别为 p = .31 和 p = .87）。高凝组的皮瓣脱落率为 4%，而对照组为 0.92%（p = .15）。高凝血症组的动脉或静脉损伤抢救效果不佳（0% 对 52%，P = .3）。结论对患有原发性高凝状态疾病的女性进行显微外科乳房重建是可行的，但皮瓣脱落的风险可以接受，但挽救的可能性较低。在这类人群中，术后延长预防性 LMWH 的血栓预防似乎是一种安全的方案。

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引用次数: 0

Pedicled chimeric superficial circumflex iliac artery perforator (SCIP) flap with external oblique fascia for vesicocutaneous bladder fistula repair: A case report and literature review on the utility of pedicled chimeric SCIP 髂周浅动脉穿孔器（SCIP）瓣与外斜筋膜嵌合用于膀胱经皮膀胱瘘修补术：关于带蒂嵌合 SCIP 实用性的病例报告和文献综述

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31138

Nicholas Jan Lichtenberg BSc (Hons), MD, Sandeep B MBBS, FRACS (Plas), D. M. Taylor MBChB, FRACS (Plas)

Following its initial description by Koshima in 2004, the superficial circumflex iliac artery perforator (SCIP) flap has become a ubiquitous and extremely useful flap in coverage of defects whereby bulkiness must be avoided. It also allows direct closure and concealment of the donor site. Its use as a free tissue transfer has been demonstrated by various surgeons globally. Nevertheless, there are few cases illustrating the utility of the pedicled SCIP flap in the reconstruction of lower abdominal defects. We present a case of a pedicled SCIP flap utilized as a chimeric flap incorporating external oblique muscle fascia on a deep branch along with the typical fasciocutaneous component based on the superficial branch to cover the suprapubic defect after vesicocutaneous fistula repair. We thereafter report on the literature of pedicled chimeric SCIP flap for locoregional reconstruction. A 26-year-old female was referred to the Plastic and Reconstructive Surgery unit after suffering a functional bladder outlet obstruction necessitating the creation of a urinary stoma. Subsequently, stoma obstruction occurred, and a suprapubic catheter was performed that was complicated by infection and resulted in the development of a vesicocutaneous fistula. Accordingly, the urological surgeons were planning surgical closure of the suprapubic vesicocutaneous defect, measuring 5 × 4 cm. A pedicled SCIP flap was designed to match the defect size; and raised as a chimeric flap with external oblique muscle fascia based on the deep branch, along with the fasciocutaneous component based on the superficial branch. The external oblique fascial component was used to secure the suture line of fistula repair, over which the fasciocutaneous component was inset, effectively double breasting the fistula repair and full thickness lower abdominal defect. The patient had an unremarkable postoperative recovery and has since been followed up in the outpatient setting without complication for the past 24 months. Robust coverage of the suprapubic defect was reliably achieved and no further fistulation has occurred. This case illustrates that a pedicled SCIP flap can be harvested as a chimeric flap and used to reliably cover defects in the infra-umbilical region.

继 2004 年小岛（Koshima）对髂周浅动脉穿孔器（SCIP）皮瓣的首次描述之后，该皮瓣已成为一种无处不在且非常有用的皮瓣，可用于覆盖必须避免肥大的缺损。它还可以直接关闭和隐藏供体部位。全球许多外科医生都证明了它作为游离组织转移的用途。然而，很少有病例能说明有蒂 SCIP 皮瓣在重建下腹部缺损中的作用。我们介绍了一个病例，在膀胱阴道瘘修补术后，利用带蒂SCIP皮瓣作为嵌合皮瓣，将深层分支上的外斜肌筋膜和浅层分支上的典型筋膜皮成分结合在一起，覆盖耻骨上缺损。此后，我们报告了迂曲嵌合 SCIP 皮瓣用于局部重建的文献。一名 26 岁的女性因功能性膀胱出口梗阻而需要建立尿路造口，随后被转诊至整形外科。随后，造口发生梗阻，并进行了耻骨上导尿，但因感染并发症而导致膀胱皮肤瘘。因此，泌尿外科医生计划对 5 × 4 厘米的耻骨上膀胱皮肤缺损进行手术缝合。根据缺损大小设计了一个有蒂的 SCIP 皮瓣，并以深层分支的外斜肌筋膜和浅层分支的筋膜成分作为嵌合皮瓣。外斜肌筋膜部分用于固定瘘管修复的缝合线，筋膜部分则嵌入其上，从而有效地对瘘管修复和全厚下腹部缺损进行双重缝合。患者术后恢复良好，24 个月来一直在门诊随访，未出现并发症。该手术可靠地覆盖了耻骨上缺损，没有再出现瘘管。该病例说明，可以将有蒂的SCIP皮瓣作为嵌合皮瓣采集，并用于可靠地覆盖脐下区域的缺损。

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引用次数: 0

Comment on: Conjoined thoracodorsal perforator-supercharged dorsal intercostal artery perforator propeller flap for reconstruction of a complex upper back defect: Case report and review of the literature on supercharged pedicled perforator flaps 评论胸背侧穿孔器-背肋间动脉穿孔器螺旋桨瓣联合用于重建复杂的上背部缺损：病例报告及关于增压带蒂穿孔器皮瓣的文献综述

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31145

Mario F. Scaglioni MD, Matteo Meroni MD

引用次数: 0

The cross-leg free flap: A systematic review of the literature 跨腿游离皮瓣：文献系统回顾

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31144

Karel-Bart Celie MD, Sarah Guo MD, Jessica Raya BS, Artur Fahradyan MD, Joseph Carey MD, Ara A. Salibian MD

Background

Free tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross-leg flap cannot provide enough coverage, a cross-leg free flap (CLFF) is a limb-saving alternative. The aim of this study is to conduct a systematic review of the literature published on the CLFF.

Methods

We conducted a systematic review of articles describing the CLFF, according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Inclusion criteria included articles with primary data on the CLFF. Exclusion criteria included those describing pedicled cross-leg flaps or lacking complete data. Data analysis was performed using SPSS 29.0.

Results

Our review included 28 articles encompassing 130 patients who underwent free tissue transfer. Most were male (63.8%) with a mean age of 32.4 years. Latissimus dorsi was the most common flap type (30.0%), followed by vertical rectus myocutaneous (20.0%). Average flap size was 301.8 cm², with trauma in the lower third of the leg being the most common indication (73.1%). The contralateral posterior tibialis was the most common recipient artery (84.1%) followed by the anterior tibialis (9.5%). Complications included amputation (1.4%), partial graft loss, thrombosis, hematoma, prolonged pain, nonunion, and seroma; a forest plot was used to illustrate the low overall adverse events rate. Although bivariate analysis identified age, flap size, type, location, and donor site as variables significantly impacting the incidence of complications (p < .05), this was not sustained in a multivariate logistic regression model.

Conclusion

The CLFF remains an excellent option for limb salvage when a suitable recipient vessel is unavailable. Our review demonstrates 1.4% flap failure and an acceptable complication rate. While most cases in our review describe muscle flaps, we report a complex case of limb salvage using an unusually large anterolateral thigh flap.

游离组织转移是治疗下肢软组织损伤的主要方法。当传统的交叉腿皮瓣无法提供足够的覆盖范围时，交叉腿游离皮瓣（CLFF）是一种挽救肢体的替代方法。本研究旨在对有关跨腿游离皮瓣的文献进行系统回顾。

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引用次数: 0

Sciatic nerve reconstruction with cables of vascularized pedicled sural nerve graft 利用带血管的腓肠神经移植电缆重建坐骨神经

IF 2.1 3区医学 Q2 Medicine

Microsurgery

Pub Date : 2024-02-01 DOI: 10.1002/micr.31150

Mariana Jarnalo MD, Pedro Machado MD, Margarida Mendes MD, Inês Ínsua MD, Joana Costa MD

引用次数: 0