Microsurgery最新文献_第9页

Augmented Reality for Lymphovenous Anastomosis Planning Based on ICG Lymphography Anatomy of the Healthy Limb 基于ICG淋巴造影的增强现实在健康肢体淋巴静脉吻合规划中的应用

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-09-03 DOI: 10.1002/micr.70115

Nicolás Pereira, María Antonella López, Vanessa Oñate, Ricardo Roa

Background

When indocyanine green lymphography (ICG-L) fails to display a linear pattern, preoperative planning for lymphovenous anastomosis (LVA) becomes challenging. Given the anatomical symmetry of lymphatics in extremities, the healthy limb can serve as a template for the affected one. This study introduces an accessible technique that uses augmented reality (AR) to mirror the lymphatic anatomy of the unaffected limb onto the affected side to assist in surgical planning.

Methods

Twelve patients with unilateral secondary lymphedema of the upper or lower extremity (Stage II or less) were included. After standard ICG-L mapping, the unaffected limb was photographed when it showed a linear lymphatic pattern. The image was mirrored and superimposed onto the affected limb using an AR smartphone app to guide incision planning for LVA. Volume reduction and clinical outcomes were measured postoperatively.

Results

A total of 39 LVAs were successfully performed at the planned locations, with 100% intraoperative accuracy. No modifications or extensions of incisions were needed. Patients experienced an average operative time of 142.5 min. Volume excess was reduced by 47% over a follow-up period of 3–24 months, with a notable reduction in episodes of cellulitis and improvements in symptoms and quality of life.

Conclusions

“Mirror the lymph” is a reliable, low-cost AR-based planning method for identifying lymphatic vessels in patients with unilateral lymphedema when ICG-L mapping shows early dermal backflow. This technique improves surgical precision and efficiency and offers an innovative tool for resource-limited settings.

当吲哚菁绿淋巴造影（ICG-L）不能显示线性模式时，术前规划淋巴静脉吻合（LVA）变得具有挑战性。鉴于四肢淋巴的解剖对称性，健康肢体可以作为患病肢体的模板。本研究介绍了一种使用增强现实（AR）将未受影响肢体的淋巴解剖镜像到受影响侧的可访问技术，以协助手术计划。方法选取单侧继发性上肢或下肢淋巴水肿（II期及以下）患者12例。在标准的ICG-L制图后，当未受影响的肢体显示线性淋巴模式时拍照。使用AR智能手机应用程序将图像镜像并叠加到患肢上，以指导LVA的切口规划。术后测量体积缩小和临床结果。结果39例LVAs在计划位置成功完成，术中准确率100%。不需要修改或延长切口。患者平均手术时间为142.5 min。在3-24个月的随访期间，体积过剩减少了47%，蜂窝织炎发作显著减少，症状和生活质量得到改善。结论“镜像淋巴”是一种可靠的、低成本的基于ar的规划方法，当ICG-L制图显示早期真皮回流时，可以识别单侧淋巴水肿患者的淋巴管。这项技术提高了手术的精度和效率，为资源有限的环境提供了一种创新的工具。

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引用次数: 0

Larynx Preservation Surgery Revisited: A Case Series of Free-Flap Reconstructions for Various Laryngeal Compartments 喉保留手术重访：一系列喉间室的自由皮瓣重建病例

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-09-02 DOI: 10.1002/micr.70113

Jonas Werner, Mario F. Scaglioni, Alexios Martin, Jana Ciritsis, Anja von Muralt, Grégoire B. Morand, Gunesh P. Rajan

Objective

Reconstruction after partial laryngectomy poses challenges in preserving voice, swallowing, and airway patency. Tailored laryngeal free-flap reconstructions using multiple chimeric perforator flaps aim to maximize functional preservation of the larynx and facilitate swallowing rehabilitation by enhancing larynx mobility.

Methods

Various compartmental laryngeal reconstructions using chimeric free flaps were performed on seven male patients (aged 40–82) with laryngeal malignancies following open partial laryngectomy. Chimeric anterolateral thigh (ALT) flaps and triple chimeric superficial circumflex iliac artery perforator (SCIP) flaps were each used in two patients, while three patients received chimeric medial femoral condyle perforator (MFCP) flaps. Patients were regularly monitored for tumor recurrence, airway patency, and voice and swallowing functions.

Results

Postoperative courses were uneventful in all patients. Over a median follow-up of 30 months (range 9–41), five of seven patients were tracheostomy-independent, and four were on a full oral diet without a gastrostomy tube. Four patients had undergone prior radiotherapy, of whom two developed a second local recurrence, requiring total laryngectomy. One patient died from distant disease.

Conclusion

Following partial laryngectomy, compartment reconstruction with chimeric perforator flaps enhances larynx mobility, potentially improving functional outcomes. In the salvage setting, laryngeal preservation procedures may compromise oncological control. Further studies comparing the presented techniques with conventional reconstruction methods are warranted.

目的喉部分切除术后的喉重建在保留声带、吞咽和气道通畅方面提出了新的挑战。使用多个嵌合穿支皮瓣进行喉自由瓣重建，旨在通过增强喉的活动能力来最大限度地保留喉的功能并促进吞咽康复。方法对7例40 ~ 82岁男性喉部分切除术后喉恶性肿瘤患者进行不同类型的喉间室重建。2例患者采用大腿前外侧嵌合皮瓣（ALT）和三嵌合旋髂浅动脉穿支（SCIP）皮瓣，3例患者采用股骨内侧髁穿支（MFCP）皮瓣。定期监测患者的肿瘤复发、气道通畅、声音和吞咽功能。结果所有患者术后疗程均顺利。在中位随访30个月（范围9-41个月）中，7名患者中有5名气管造口独立，4名患者完全口服饮食而不使用胃造口管。4例患者先前接受过放疗，其中2例发生第二次局部复发，需要全喉切除术。一名患者死于远处疾病。结论喉部分切除术后，嵌合穿支皮瓣重建喉间室可提高喉活动能力，改善喉功能。在抢救情况下，喉保留手术可能危及肿瘤的控制。进一步的研究将所提出的技术与传统的重建方法进行比较是必要的。

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引用次数: 0

Free Tissue Transfer for the Management of Diabetic Lower Limb Ulcers: A Systematic Review and Meta-Analysis. 游离组织移植治疗糖尿病下肢溃疡：系统回顾和荟萃分析。

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-09-01 DOI: 10.1002/micr.70093

Quillan Young Sing, Tiffanie-Marie Borg, Yousif F Yousif, Kai Jian Chin, Konstantinos Devetzis, Sara Sousi

Background: Diabetic foot ulcers are a major complication of diabetes, with resulting soft tissue defects increasing the risk of limb amputation and mortality. Reconstruction of defects may be in the form of local, pedicled, or free tissue transfer. This systematic review aims to confirm the role and benefit of free tissue transfer in this patient cohort.

Method: This review is registered on PROSPERO (ID: 617657). A literature search was performed using the online databases EMBASE, MEDLINE, and Web of Science to identify literature reporting use of free flaps in the management of diabetic lower limb ulcers. Mesh terms used included "diabetes," "lower limb," "ulcer," and "free tissue transfer." A random-effect meta-analysis was implemented to assess the efficacy of free flaps as a treatment based on complication and limb salvage rates.

Results: Twenty-five studies were included in this systematic review, amounting to 547 free flaps. The total complication rate was 26% (95% CI = 21%-32%, I² = 27%, p = 0.11). Partial flap loss was noted in 6% of cases (95% CI = 3%-11%, I² = 0%, p = 0.96) while complete loss occurred in 4% of cases (95% CI = 2%-7%, I² = 0%, p = 1.0). The most performed flap was the anterolateral thigh (ALT) flap. Revascularization was performed prior to free flap reconstruction in 15% of cases. The amputation-free rate was 95% at the latest follow-up point of each study.

Conclusion: Free tissue transfer is a viable treatment option for patients with diabetic foot ulcers. The low complication including amputation rate supports its implementation in practice provided a myriad of factors and careful patient selection is maintained.

背景：糖尿病足溃疡是糖尿病的主要并发症，其导致的软组织缺损增加了截肢和死亡的风险。缺损的重建可以采用局部、带蒂或游离组织移植的形式。本系统综述旨在确认游离组织移植在该患者队列中的作用和益处。方法：本综述在PROSPERO （ID: 617657）上注册。使用在线数据库EMBASE、MEDLINE和Web of Science进行文献检索，以确定报道使用游离皮瓣治疗糖尿病下肢溃疡的文献。使用的网状术语包括“糖尿病”、“下肢”、“溃疡”和“自由组织移植”。采用随机效应荟萃分析评估游离皮瓣作为一种基于并发症和肢体保留率的治疗效果。结果：本系统综述纳入了25项研究，共计547个游离皮瓣。总并发症发生率为26% （95% CI = 21% ~ 32%, I2 = 27%, p = 0.11）。6%的病例皮瓣部分丧失（95% CI = 3%-11%, I2 = 0%, p = 0.96）， 4%的病例皮瓣完全丧失（95% CI = 2%-7%, I2 = 0%, p = 1.0）。应用最多的是大腿前外侧皮瓣。15%的病例在自由皮瓣重建之前进行了血运重建。在每次研究的最新随访点，无截肢率为95%。结论：游离组织移植是治疗糖尿病足溃疡的可行方法。低并发症包括截肢率支持其在实践中实施，提供了无数的因素和谨慎的病人选择。

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引用次数: 0

Comments on “Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction” 关于“氨甲环酸在头颈部游离皮瓣重建中的应用”的评论

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-29 DOI: 10.1002/micr.70103

Carla Herman, Nathalie Auger

引用次数: 0

Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis 立即淋巴重建预防乳腺癌相关淋巴水肿的疗效：系统回顾和荟萃分析

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-27 DOI: 10.1002/micr.70109

May X. Li, Jason Zhang, Michael A. Howard, Chad M. Teven

Background

Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer-related lymphedema (BCRL). This meta-analysis estimates the benefit of ILR in preventing lymphedema by incorporating double- and single-arm studies and stratifying by length of follow-up time.

Methods

Three databases were queried for studies with primary data on ILR. Both double- and single-armed studies were included, and papers with small sample sizes, overlapping samples, and unreported data were excluded. Treatment effects were calculated with risk ratios and converted to a logarithmic scale. A meta-analysis was performed using the inverse variance method and a random-effects model, with further analysis done by study design and length of follow-up time.

Results

A total of 17 studies were included (9 double-arm and 8 single-arm; n = 2607). The pooled treatment effect of ILR, expressed as log risk ratio (95% CI), was −0.89 (−1.18, −0.60; p < 0.0001). This corresponds to a relative risk of 0.41 (0.31, 0.55) and a number needed to treat of 9. Double- and single-arm studies showed no significant differences in effect sizes. Studies with < 1-year follow-up demonstrated a larger effect size than those with longer follow-up, and the benefits of ILR were no longer significant past 3 years.

Conclusion

Patients receiving ILR were significantly less likely to develop BCRL than those receiving ALND alone. Further work is needed to examine whether benefits can truly be sustained long-term.

背景：即时淋巴重建（ILR）是一种在腋窝淋巴结清扫（ALND）时进行淋巴显像和淋巴静脉旁路的技术，以预防乳腺癌相关淋巴水肿（BCRL）。本荟萃分析通过纳入双臂和单臂研究并按随访时间分级，估计ILR在预防淋巴水肿方面的益处。方法对3个数据库进行查询，获得有关ILR的主要资料。纳入了双臂和单臂研究，排除了小样本量、重叠样本和未报告数据的论文。用风险比计算治疗效果，并转换为对数量表。采用反方差法和随机效应模型进行meta分析，并根据研究设计和随访时间长短进行进一步分析。结果共纳入17项研究（9项双臂研究，8项单臂研究，n = 2607）。ILR的综合治疗效果，用对数风险比（95% CI）表示，为- 0.89 （- 1.18,- 0.60;p < 0.0001）。相对危险度为0.41(0.31,0.55)，治疗所需危险度为9。双臂和单臂研究显示在效应量上没有显著差异。随访1年的研究比随访时间较长的研究显示出更大的效应量，并且ILR的益处在3年后不再显著。结论接受ILR的患者发生BCRL的可能性明显低于单独接受ALND的患者。需要进一步的工作来检验这些益处是否能够真正长期持续。

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引用次数: 0

Hip Stiffness Fifteen Years After Reconstruction of Femoral Tumor With Vascularized Fibular Epiphyseal Transfer 带血管的腓骨骨骺移植重建股骨肿瘤后15年的髋关节僵硬

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-26 DOI: 10.1002/micr.70107

Carla Carbonell-Rosell, Jorge Knorr, Francisco Soldado

引用次数: 0

Lower Extremity Free Tissue Transfer in Peronea Arteria Magna: An Observational Retrospective Cohort Study of Anatomic and Microsurgical Considerations 腓大动脉下肢游离组织移植：解剖学和显微外科观察回顾性队列研究

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-26 DOI: 10.1002/micr.70079

John W. Rutland, Rachel N. Rohrich, Karen R. Li, Paul F. Martinez, Richard C. Youn, Christopher E. Attinger, Cameron M. Akbari, Karen K. Evans

Background

Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT). The present study aims to leverage a high volume lower extremity reconstruction center to determine the incidence and microsurgical considerations in PAM.

Methods

A retrospective cohort study was conducted at a single tertiary limb salvage center, reviewing all patients who underwent lower LE FTT from July 2011 to January 2024. Patients were included if they had preoperative arteriography and underwent LE FTT for atraumatic wounds. Patient demographics, vascular anatomy, microsurgical technique, and postoperative outcomes were analyzed.

Results

Arteriograms for a total of 334 patients who underwent lower extremity FTT were reviewed, of which 34 patients (10.2%) had Kim–Lippert Class III variant patterns, and six patients (1.8%) had Class IIIc (PAM). Of these, all six anastomoses were performed in an end-to-side fashion. There were no instances of postoperative lower extremity devascularization or ischemia. There were no flap losses. One of the six patients required immediate return to the operating room for venous thrombosis with successful flap salvage after clot evacuation and a second venous anastomosis.

Conclusion

PAM is a rare yet important anatomic variant that is occasionally observed in the lower extremity FTT population. The following features are important in managing patients with PAM undergoing FTT: the routine use of preoperative arteriography, an understanding of venous anatomic variability, the use of a smaller target window for microsurgery given the majority of vessels residing in the deep posterior compartment, the preservation of all peroneal side branches, and the use of ETS anastomosis when possible.

背景：只有腓骨动脉供血到足部的患者，称为腓骨大动脉（PAM），是一个罕见的队列，也是复杂的下肢游离（LE）组织移植（FTT）的一个独特挑战。本研究旨在利用一个大容量的下肢重建中心来确定PAM的发生率和显微外科注意事项。方法回顾性队列研究在单一三级肢体保留中心进行，回顾2011年7月至2024年1月期间接受下肢FTT的所有患者。如果患者术前进行了动脉造影，并接受了非创伤性LE FTT，则纳入该研究。分析患者人口统计学、血管解剖、显微外科技术和术后结果。结果共回顾334例下肢FTT患者的动脉造影，其中34例（10.2%）为Kim-Lippert III类变异模式，6例（1.8%）为IIIc类（PAM）。其中，所有6例吻合均采用端侧吻合。术后无下肢断流或缺血。没有襟翼损失。6例患者中有1例因静脉血栓形成需要立即返回手术室，并在血栓清除和第二次静脉吻合后成功挽救皮瓣。结论PAM是一种罕见但重要的解剖变异，在下肢FTT人群中偶见。以下特点对于管理接受FTT的PAM患者很重要：常规术前动脉造影，了解静脉解剖变异性，考虑到大多数血管位于后腔室深部，使用较小的显微手术靶窗，保留所有腓侧分支，并在可能的情况下使用ETS吻合术。

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引用次数: 0

Lymphovenous Anastomosis Using Pedicled Deep Inferior Epigastric Perforator Flap Vein for Ulcer With Lymphorrhea: A Case Report 带蒂胃下深穿支皮瓣静脉吻合溃疡伴淋巴漏1例

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-25 DOI: 10.1002/micr.70108

Yuko Yamagiwa, Naoya Otani, Takaki Oue, Yusuke Shikano, Michiko Nomori, Tateki Kubo

Lymphovenous anastomosis (LVA) is an effective surgical treatment for inguinal lymphorrhea, a complication that can occur after surgery involving vessels. LVA, however, requires a suitable vein for anastomosis near the leaking lymphatic vessel, which is sometimes difficult to secure. Here we report the successful treatment of a refractory ulcer with lymphorrhea by anastomosis of a flap vein to the lymphatic vessel concerned, along with flap closure. The patient was a 26-year-old male who developed a lymphatic leak in the right inguinal region following cannula removal after mechanical circulatory support for fulminant cardiomyopathy. He received conservative therapy but developed an infected femoral artery aneurysm, leading to replacement with the femoral vein. However, because of the persistent, intractable ulcer with exposed graft vessels and continued lymphatic leakage, pedicled flap reconstruction and LVA were planned. A 14 × 6.5 cm spindle-shaped pedicled deep inferior epigastric perforator flap was elevated from the right lower abdomen with branches reserved for use in LVA, rotated 180° through the subcutaneous tunnel, and migrated to the ulcer site. The source of lymphorrhea in the ulcer was identified by indocyanine green (ICG) lymphangiography, and the lymphatic vessels were anastomosed to a branch of the flap pedicle vein. ICG lymphangiography confirmed unimpeded venous flow without the stagnation of lymphatic fluid. At 6 months postoperatively, there was no evidence of ulceration or recurrence of lymphorrhea or lymphedema. In cases of lymphorrhea with refractory ulceration, there often are no suitable veins for LVA in the wound area due to scarring or adhesions. The present case demonstrates the use of a flap pedicle vein to solve this problem, potentially offering a new treatment option for lymphorrhea with extensive ulceration.

淋巴静脉吻合术（LVA）是一种有效的手术治疗腹股沟淋巴漏，一种并发症可能发生在手术后涉及血管。然而，LVA需要在泄漏的淋巴管附近有合适的静脉进行吻合，这有时很难确定。在这里，我们报告成功的治疗难治性溃疡伴淋巴漏通过吻合皮瓣静脉到有关的淋巴管，以及皮瓣关闭。患者为26岁男性，因暴发性心肌病在机械循环支持下拔管后右侧腹股沟区出现淋巴渗漏。他接受了保守治疗，但出现了感染的股动脉动脉瘤，导致用股静脉置换。然而，由于顽固性溃疡持续存在，移植物血管暴露，淋巴持续渗漏，我们计划带蒂皮瓣重建和LVA。从右下腹提起一个14 × 6.5 cm的梭形带蒂腹下深穿支皮瓣，保留分支用于LVA，通过皮下隧道旋转180°，并迁移到溃疡部位。采用吲哚菁绿（ICG）淋巴管造影确定溃疡内淋巴管的来源，淋巴管与皮瓣蒂静脉的一个分支吻合。ICG淋巴管造影证实静脉流动通畅，无淋巴液淤滞。术后6个月，无溃疡或淋巴漏或淋巴水肿复发的迹象。在难治性溃疡的淋巴漏病例中，由于疤痕或粘连，伤口区域通常没有合适的静脉进行LVA。本病例展示了皮瓣蒂静脉的使用来解决这个问题，潜在地为广泛溃疡的淋巴漏提供了一个新的治疗选择。

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引用次数: 0

Comprehensive Analysis on the Use of Superficial Temporal Vessels as Free Flap Recipients in Head and Neck Reconstruction: Systematic Review on Anatomic Characteristics and Surgical Outcomes 颞浅血管作为游离皮瓣在头颈部重建中的综合分析：解剖学特点和手术结果的系统回顾

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-19 DOI: 10.1002/micr.70106

Belén Andresen-Lorca, Alberto Pérez-García, Iván Heredia-Alcalde, Pedro Alvedro-Ruiz, María García-García, María D. Pérez-del-Caz

Background

Head and neck reconstruction often involves complex defects requiring microvascular free flaps. While cervical vessels are commonly used as recipients, anatomical variations and prior interventions may necessitate alternative options. The superficial temporal vessels (STV) offer advantages such as accessibility, suitable caliber, and proximity to craniofacial defects. This study systematically evaluates the anatomical and surgical outcomes of STV in head and neck reconstruction.

Methods

A systematic review following PRISMA guidelines was conducted across PubMed and Scopus to identify studies on the anatomical characteristics and surgical outcomes of STV. Inclusion criteria focused on studies involving adult patients, reporting surgical outcomes with STV as recipient vessels, and presenting anatomical measurements. Statistical analysis of flap survival, complications, and vessel caliber was performed using IBM SPSS 30.0.

Results

Twenty-two studies on surgical outcomes (506 flaps) and 23 anatomical studies (976 specimens) were analyzed. STV exhibited a mean arterial caliber of 2.30 mm at the origin, 1.88 mm at the zygomatic arch, and 1.51 mm at the bifurcation, with vein diameters averaging 2.58 mm. The flap survival rate was 96.72%, with major complications in 15.4% of cases and anastomosis revision in 5.14%. The anterolateral thigh flap was the most common donor site (177 cases). STV use was most frequent in middle-third facial defects (33%).

Conclusion

The STV are reliable alternatives for microvascular reconstruction in head and neck surgery, particularly for defects in the upper and middle thirds of the face. Their favorable anatomical characteristics and high flap survival rates underscore their potential as primary or secondary recipient vessels, especially in vessel-depleted necks.

背景头颈部重建通常涉及复杂的缺陷，需要微血管游离皮瓣。虽然通常使用颈血管作为受体，但解剖结构的变化和先前的干预可能需要其他选择。颞浅血管（STV）具有可及性、合适的口径和接近颅面缺损等优点。本研究系统评估STV在头颈部重建中的解剖和手术效果。方法根据PRISMA指南对PubMed和Scopus进行系统综述，以确定STV的解剖特征和手术结果。纳入标准侧重于涉及成年患者的研究，报告以STV为受体血管的手术结果，并提供解剖测量结果。采用IBM SPSS 30.0对皮瓣存活率、并发症及血管口径进行统计分析。结果分析了22项手术结果（506个皮瓣）和23项解剖结果（976个标本）。STV起始处动脉直径平均2.30 mm，颧弓处动脉直径平均1.88 mm，分叉处动脉直径平均1.51 mm，静脉直径平均2.58 mm。皮瓣成活率96.72%，主要并发症15.4%，吻合口修复5.14%。以股前外侧皮瓣为最常见的供体部位（177例）。STV的使用在三分之一的面部缺损中最为常见（33%）。结论STV是头颈外科微血管重建的可靠选择，尤其适用于面部上、中三分之一的缺损。其良好的解剖特征和高皮瓣存活率强调了其作为主要或次要受体血管的潜力，特别是在血管衰竭的颈部。

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引用次数: 0

Outcomes of Microsurgical Reconstruction of Post-Burn Joint Contracture—Systematic Review and Meta-Analysis 烧伤后关节挛缩显微外科重建的疗效：系统回顾和荟萃分析

IF 1.7 3区医学 Q3 SURGERY

Microsurgery

Pub Date : 2025-08-15 DOI: 10.1002/micr.70104

Abdulaziz Elemosho, Layne N. Raborn Macdonald, Derek E. Bell, Jeffrey E. Janis

Background

Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction.

Methods

A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model.

Results

Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (I² = 0% [95% CI: 97.7–99.6]) of pedicled and 90.1% (I² = 82.8% [95% CI: 62.7–100]) of free flap reconstructions, recurring in 1.8% (I² = 0% [95% CI: 0.7–3.3]) at sites reconstructed with pedicled flaps and 0.6% (I² = 0% [95% CI: 0.1–1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (I² = 0% [95% CI: 0.6–2.7]) and 2.9% (I² = 37.9% [95% CI: 0.9–5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (I² = 65.1% [95% CI: 3.4–11.5]) and 5.2% (I² = 65% [95% CI: 1.7–10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (p = 0.50), contracture recurrence (p = 0.15), total flap loss (p = 0.18) or partial flap loss (p = 0.31) regardless of the flap type used.

Conclusions

Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.

背景：挛缩复发是烧伤重建常见的挫折，特别是对于严重或大面积挛缩。以皮瓣为基础的烧伤重建已显示出较低的挛缩复发率。本研究旨在总结和评估基于皮瓣的技术用于烧伤后关节挛缩重建的结果。方法按照PRISMA指南进行系统评价。检索的数据库包括PUBMED、EMBASE、Scopus和Web of Science。文章描述了使用具有已知血液供应的皮瓣重建烧伤后关节挛缩。排除资料不完整、涉及多个解剖部位挛缩、病例报告和非英文文章的研究。提取患者人口统计学、皮瓣类型、并发症和挛缩消退的数据。采用DerSimonian和Laird随机效应模型进行比例荟萃分析。结果在850项研究中，27项符合纳入标准。报告830例关节挛缩重建。带蒂皮瓣重建的挛缩消退率为98.9% (I2 = 0% [95% CI: 97.7-99.6])，自由皮瓣重建的挛缩消退率为90.1% (I2 = 82.8% [95% CI: 62.7-100])，带蒂皮瓣重建的部位复发率为1.8% (I2 = 0% [95% CI: 0.7-3.3])，自由皮瓣重建的部位复发率为0.6% （I2 = 0% [95% CI: 0.1-1.7]）。皮瓣并发症发生率较低，有蒂皮瓣和自由皮瓣的总皮瓣损失分别为1.5% （I2 = 0% [95% CI: 0.6-2.7]）和2.9% （I2 = 37.9% [95% CI: 0.9-5.8]）。带蒂皮瓣和自由皮瓣的部分皮瓣损失分别为6.9% （I2 = 65.1% [95% CI: 3.4-11.5]）和5.2% （I2 = 65% [95% CI: 1.7-10.4]）。无论使用何种皮瓣，在挛缩消退率（p = 0.50）、挛缩复发率（p = 0.15）、皮瓣全损率（p = 0.18）或部分皮瓣损率（p = 0.31）方面均无显著差异。结论皮瓣重建烧伤挛缩并发症少，挛缩复发率低。带蒂和自由皮瓣重建烧伤挛缩部位产生相似的结果。

{"title":"Outcomes of Microsurgical Reconstruction of Post-Burn Joint Contracture—Systematic Review and Meta-Analysis","authors":"Abdulaziz Elemosho, Layne N. Raborn Macdonald, Derek E. Bell, Jeffrey E. Janis","doi":"10.1002/micr.70104","DOIUrl":"https://doi.org/10.1002/micr.70104","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (<i>I</i><sup>2</sup> = 0% [95% CI: 97.7–99.6]) of pedicled and 90.1% (<i>I</i><sup>2</sup> = 82.8% [95% CI: 62.7–100]) of free flap reconstructions, recurring in 1.8% (<i>I</i><sup>2</sup> = 0% [95% CI: 0.7–3.3]) at sites reconstructed with pedicled flaps and 0.6% (<i>I</i><sup>2</sup> = 0% [95% CI: 0.1–1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (<i>I</i><sup>2</sup> = 0% [95% CI: 0.6–2.7]) and 2.9% (<i>I</i><sup>2</sup> = 37.9% [95% CI: 0.9–5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (<i>I</i><sup>2</sup> = 65.1% [95% CI: 3.4–11.5]) and 5.2% (<i>I</i><sup>2</sup> = 65% [95% CI: 1.7–10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (<i>p</i> = 0.50), contracture recurrence (<i>p</i> = 0.15), total flap loss (<i>p</i> = 0.18) or partial flap loss (<i>p</i> = 0.31) regardless of the flap type used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18600,"journal":{"name":"Microsurgery","volume":"45 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144853659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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