Microsurgery[JOURNAL]
Sun
200 papers
Superficial Palmar Branch of the Radial Artery, Medial Plantar Artery Perforator, and Medial Sural Artery Perforator Free Flaps in Digital Soft Tissue Reconstruction: Comparisons of Clinical Outcomes From a Retrospective Institutional Series.
Yalçın C, Keçeci N, Manav S … +2 more , Kaplan A, Karamürsel S
Microsurgery · 2026 Jul · PMID 42403034 · Publisher ↗
INTRODUCTION: Digital defects requiring soft tissue reconstruction are still challenging. There is no first-choice free flap for digital reconstruction, although various free flaps were used to reconstruct the defects to...
INTRODUCTION: Digital defects requiring soft tissue reconstruction are still challenging. There is no first-choice free flap for digital reconstruction, although various free flaps were used to reconstruct the defects to provide functional and aesthetically acceptable results. The aim of this study is to evaluate the functional, aesthetic, and sensory results of medial sural artery perforator, medial plantar artery perforator, and superficial palmar branch radial artery free flap techniques in digital tissue defects. PATIENTS AND METHODS: This retrospective institutional study was conducted in accordance with the STROBE guidelines. Between 2022 and 2023, 28 patients underwent free tissue transfer for their digital soft tissue defects, which were reconstructed with MSAP, MPAP, and SPBRA flaps. The age, sex, etiology of the trauma, and the defect size were noted. The flaps' sizes, recipient vessels, donor site complications, and follow-up durations were also documented. Patient and observer scar assessment scale (POSAS) was used to assess aesthetic satisfaction. To evaluate the functional results, Sollerman hand function test (SHFT) was used. To determine the sensorial improvements, static-2PD test and Cold intolerance scoring scale (CISS) were applied. RESULTS: The average ages of the patients were 42.3 ± 13.1, 44.4 ± 14, and 42.5 ± 13.9, respectively. The tests were administered to the patients at an average of 25.3 ± 2.3 months. According to the POSAS scores, patients reported the SPBRA flap to be more comfortable and aesthetically acceptable, and the MSAP flap was associated with drawbacks such as increased thickness and surface irregularity. SHFT scores were comparable among groups (MSAP: 70.56 ± 7.60, MPAP: 70.22 ± 6.61, SPBRA: 71.40 ± 4.67; p > 0.05). The 2PD test showed significantly better results in SPBRA (8.10 ± 1.20) compared to MPAP (11.78 ± 1.39) and MSAP (15.00 ± 2.18) (p < 0.05). CISS scores were significantly higher in SPBRA (48 ± 10.97) than in MPAP (19.56 ± 13.07) and MSAP (15.00 ± 12.58) (p < 0.05). As a result of the correlation analysis, a statistically significant and moderately negative relationship was found between the 2PD and CISS scores (r = -0.536, p = 0.003). CONCLUSION: The flaps showed relative strengths depending on the parameters evaluated. Therefore, it is not possible to identify a single flap as the definitive first-choice option.
Lymphovenous Anastomosis for Treatment of Breast Lymphedema Following Delayed Autologous Reconstruction: A Case Report.
Peet BM, Wagner BD, Sidoti A … +3 more , Nelson JA, Mehrara BJ, Yoshimatsu H
Microsurgery · 2026 Jul · PMID 42402979 · Publisher ↗
Breast lymphedema (BLE) is an underrecognized sequela of breast cancer treatment that can lead to chronic swelling, pain, and recurrent infections. While lymphovenous anastomosis (LVA) is well established for the managem...
Breast lymphedema (BLE) is an underrecognized sequela of breast cancer treatment that can lead to chronic swelling, pain, and recurrent infections. While lymphovenous anastomosis (LVA) is well established for the management of extremity lymphedema, its application to BLE has rarely been described. Here, we discuss a case of LVA for refractory BLE following delayed autologous reconstruction. A 49-year-old woman developed severe left-sided BLE after deep inferior epigastric artery perforator flap reconstruction. The clinical course was complicated by nine episodes of cellulitis requiring hospital admission for intravenous treatment despite compliance with prophylactic antibiotics and compression therapy. The patient underwent indocyanine green (ICG)-guided supermicrosurgical LVA within the reconstructed breast. Immediate postoperative decongestion was observed, and substantial reductions in breast pain and improvements in symmetry were reported 1 month postoperatively. At 10 months postoperatively, the patient maintained durable reductions in swelling and infection frequency. Our experience showed that LVA may be safely and effectively performed in the reconstructed breast and may represent a viable physiologic option for patients with refractory BLE unresponsive to conservative therapy.
Symani-Assisted Microsurgery in Head and Neck Reconstruction: A Systematic Review of Indications, Techniques, and Pooled Analysis of Clinical Outcomes.
Sorenson TJ, Chopoorian A, Tran D … +4 more , Al Shammari A, Prince AC, Jacobson A, Levine JP
Microsurgery · 2026 Jul · PMID 42394295 · Publisher ↗
BACKGROUND: Robot-assisted microsurgery with the Symani surgical system has emerged as a potential adjunct in complex reconstructive procedures. Its application in head and neck reconstruction remains early and incomplet...
BACKGROUND: Robot-assisted microsurgery with the Symani surgical system has emerged as a potential adjunct in complex reconstructive procedures. Its application in head and neck reconstruction remains early and incompletely characterized. We performed a systematic review to evaluate indications, technical utilization, and reported clinical outcomes of Symani-assisted microsurgery in head and neck reconstruction. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. PubMed (MEDLINE), Embase, Scopus, and the Cochrane Library were searched for studies reporting Symani-assisted microsurgery in head and neck reconstruction. Primary outcomes were flap success and anastomotic complications. Secondary outcomes included operative time, conversion to conventional technique, ischemia time, reported learning curve metrics, and risk of bias. RESULTS: A total of eight studies encompassing 157 patients with 157 flaps were included. Study designs consisted primarily of case reports and retrospective case series. The Symani was used for arterial and/or venous anastomosis in free flap reconstruction, most commonly in radial forearm flaps and most commonly to the facial vessels. Flap success rates were high (> 95%) with only five requiring return to operating room and two flap losses; random-effects meta-analysis demonstrated a pooled flap loss rate of 3.3% (95% CI, 1.1%-9.1%; I = 0%). Anastomotic complication rates were reported to be low with conversion to conventional technique occurring in one case due to technical malfunction. Anastomosis times were poorly reported across studies. CONCLUSIONS: Early clinical experience suggests that robot-assisted microsurgery with the Symani surgical system in head and neck reconstruction is technically feasible with acceptable short-term outcomes in selected cases. However, evidence remains limited to small, heterogeneous series. Prospective comparative studies are required to determine whether robotic assistance confers meaningful clinical or efficiency advantages over conventional microsurgery and determine optimal operative indications.
Proposing Objective 3D Facial Surface Scanning to Evaluate Surgical Outcomes in Facial Lymphedema.
Benedetti S, Frosolini A, Gabriele G … +1 more , Gennaro P
Microsurgery · 2026 Jul · PMID 42394264 · Publisher ↗
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Closure of Tracheoesophageal Fistula Employing the Superficial Circumflex Iliac Artery Perforator (SCIP) Flap: Report of Three Cases.
Kovacs-Sipos E, Scaglioni MF, Meroni M … +1 more , Rajan GP
Microsurgery · 2026 Jul · PMID 42338127 · Publisher ↗
The tracheoesophageal fistula (TOF) is defined as a pathological connection between the trachea and esophagus, both congenital and acquired. The latter is often associated with malignancies or their treatments. Reconstru...
The tracheoesophageal fistula (TOF) is defined as a pathological connection between the trachea and esophagus, both congenital and acquired. The latter is often associated with malignancies or their treatments. Reconstruction in this context is particularly challenging due to the defect's location, size, and compromised tissue quality. Here, we present for the first time the surgical treatment of TOF using a free superficial circumflex iliac artery perforator (SCIP) flap. Three patients were included in the present report (84-year-old female, 74-year-old male, 62-year-old male). Two patients developed a TOF following total laryngectomy combined with partial pharyngectomy, and one patient, following total laryngectomy without partial pharyngectomy. All the patients received a surgical treatment for a head and neck malignancy. The TOFs were successfully closed in three patients using a SCIP-Flap. The elevated SCIP-Flap measured on average 15 × 8 cm. In two cases, the return to a normal, oral diet was established within 1-3 months with successful vocal rehabilitation. The third case did not return to a complete oral diet because of a dehiscence and ongoing palliative chemotherapy. The other two patient underwent 1-year follow-up without complications. This report suggests that the SCIP flap could be a feasible low morbidity and relatively straightforward reconstructive option, yielding favorable postoperative outcomes for TOF even in cases of multiple prior surgeries and adjuvant radiochemotherapy treatment.
Umbilical Inset Incision Type Influences Abdominal Donor Site Healing in Autologous Breast Reconstruction.
Hemal K, Sorenson T, Lisk R … +12 more , Alexis M, Chinta S, Shah A, Vernon R, Boyd C, Muller J, Volk A, Levine JP, Thanik V, Karp N, Choi M, Cohen O
Microsurgery · 2026 Jul · PMID 42322253 · Full text
BACKGROUND: Delayed abdominal wound healing remains a common complication following abdominally based autologous breast reconstruction. We hypothesized that the type of umbilical inset incision impacts the incidence of d...
BACKGROUND: Delayed abdominal wound healing remains a common complication following abdominally based autologous breast reconstruction. We hypothesized that the type of umbilical inset incision impacts the incidence of delayed wound healing due to differential disruption of abdominal wall vascularity, particularly in the infraumbilical region. METHODS: A retrospective review was conducted of all patients undergoing abdominally based autologous breast reconstruction at a single center between 2014 and 2021. The primary outcome was delayed abdominal wound healing, classified as major (requiring readmission or reoperation), minor (managed with outpatient care, antibiotics, or debridement), or both. Umbilical inset incision type was evaluated as a predictor using univariate and multivariate analysis. RESULTS: Four hundred and eighty-eight patients and 791 flaps were included. Patients were on average 51 ± 9 years old and had a median body mass index of 28 (IQR 7) kg/m. The most used umbilical incision was an elliptical incision (193, 40%) followed by vertical (141, 29%), inverted-U (30, 6%), other (39, 8%), and unknown (81, 17%). Abdominal wound healing complications occurred in 63 (13%) patients. The incidence of abdominal wound healing complications was lowest with elliptical incisions (p < 0.001). In a multivariate regression model controlling for age, BMI, diabetes, smoking history, and flap weight, umbilical incision predicted abdominal wound healing complications, with inverted-U and vertical incisions conferring higher odds of abdominal wound healing complications (OR 5.9, 95% CI [1.6, 20.8] and OR 4.6, 95% CI [2.0, 11.4], p < 0.05) as compared to elliptical incisions. CONCLUSION: Abdominal wall vascularity likely plays a critical role in donor site healing following autologous reconstruction. In this large cohort, inverted-U and vertical umbilical inset incisions were associated with the highest rates of wound healing complications.
Evaluating the Efficacy and Utility of Preoperative Computed Tomography Angiography in Perforator Flap Surgeries: A Systematic Review and Meta-Analysis.
Brooks A, Lemke J, Hornbach A … +9 more , Keller N, Foppiani J, Escobar-Domingo MJ, Garbaccio NC, Smith JE, Lee TC, Cenk C, Choudry U, Lin S
Microsurgery · 2026 Jul · PMID 42304573 · Publisher ↗
BACKGROUND: Deep inferior epigastric artery perforator (DIEP) flaps are widely used in autologous breast reconstruction and increasingly favored due to superior patient-reported outcomes. Preoperative imaging is central...
BACKGROUND: Deep inferior epigastric artery perforator (DIEP) flaps are widely used in autologous breast reconstruction and increasingly favored due to superior patient-reported outcomes. Preoperative imaging is central to efficient and safe DIEP flap planning, yet the optimal modality remains debated. While computed tomography angiography (CTA) is recommended by ERAS protocols, concerns over radiation exposure and cost have prompted interest in alternatives such as ultrasound (US) and magnetic resonance angiography (MRA). METHODS: A systematic review following PRISMA guidelines was conducted across five major databases, including clinical trials and observational studies published through 2025. Studies included patients undergoing DIEP flap reconstruction with preoperative imaging using CTA, US, MRA, or other modalities. Data extracted included imaging-to-surgical perforator correlation, operative time, complication rates, and flap outcomes. Meta-analyses and heterogeneity assessments were performed using STATA. RESULTS: Thirty-two studies encompassing 3238 patients were included. CTA was used in nearly all studies; US, MRA, SPY/ICG, and DIRT were evaluated in a subset. Pooled perforator utilization was highest with MRA (92%), followed by CTA (87%) and US (85%). Among 2967 patients with complication data, 410 (13.8%) experienced adverse outcomes. Complication rates differed significantly across strategies. Patients utilizing US alone experienced the highest complication rates (17.3%), compared to CTA alone (13.9%) and CTA and US (10.8%). The complication rate difference between US alone patients and CTA and US alone patients was statistically greater (RR = 0.63, p = 0.0123). The complication rates between CTA alone and US alone or CTA and US were not statistically different (US alone: RR = 0.81, p = 0.1040; CTA and US: RR = 0.78, p = 0.11). Complete flap loss occurred in 8.0% of complications, partial flap loss in 14%, and fat necrosis in 19%. CONCLUSION: CTA remains the most studied imaging modality for DIEP flap surgical planning, demonstrating high perforator utilization and low complication rates. Combining CTA with US may further improve outcomes by integrating anatomical precision with dynamic feedback. As newer, lower-risk imaging technologies emerge, comparative studies are needed to determine whether they can match or exceed the performance of CTA in DIEP reconstruction.
Recipient Vessel Selection in Free Flap Phalloplasty: A Systematic Review and Single-Arm Meta-Analysis.
Gaston J, Fodor R, Rampazzo A … +2 more , Fascelli M, Gharb BB
Microsurgery · 2026 Jul · PMID 42298783 · Full text
BACKGROUND: Selection of recipient vessels in phalloplasty is challenging due to the absence of adequate vessels in the immediate proximity. There is no consensus on the appropriate vessel selection. We hypothesized that...
BACKGROUND: Selection of recipient vessels in phalloplasty is challenging due to the absence of adequate vessels in the immediate proximity. There is no consensus on the appropriate vessel selection. We hypothesized that recipient vessel selection in phalloplasty is associated with differences in complications and flap survival. METHODS: A literature search following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across Ovid MEDLINE/PubMed, Embase, and CENTRAL databases identified 46 articles. Collected data included demographics, surgical details, donor and recipient vessels, use of interpositional grafts, number of venous anastomoses, and outcomes. Statistical analysis followed the random-effects model. RESULTS: One thousand nine hundred and seventy six phalloplasty cases were identified. The deep inferior epigastric artery (DIEA) was used in 1413 cases (71.5%) and the femoral artery (FA) was used in 563 cases (28.5%). Pooled proportions of arterial and venous thrombosis were 2.0% and 2.2%, respectively. The use of an interpositional vein graft or arteriovenous loop with the FA was associated with a significantly higher arterial thrombosis rate (16.0%) compared to direct anastomosis to the FA (0.1%, p < 0.001) and to the DIEA (1.2%, p < 0.001). In the absence of vascular thrombosis, partial flap necrosis occurred significantly less often with direct anastomosis to the FA (0.6%) than with the DIEA (6.2%, p = 0.016). CONCLUSIONS: The choice of recipient vessels is an important consideration in phalloplasty flap survival. The DIEA is associated with a low thrombosis rate. However, the significantly higher proportion of thrombosis observed with the FA may be attributable to the use of an interpositional vein graft or arteriovenous loop. Despite lower thrombosis rates, the use of the DIEA was associated with a higher proportion of partial flap necrosis when vessels were patent.
Staged Flap Reconstruction of Massive Abdominal Loss of Domain and Sacral Pressure Injury to Restore Quality of Life: A Case Report.
Jensen K, Phuyal D, Ting J … +2 more , Gurunian R, Bishop SN
Microsurgery · 2026 Jul · PMID 42290211 · Full text
Simultaneous massive abdominal wall loss of domain (LOD) and chronic sacral pressure injury presents an exceptional reconstructive challenge. Optimal sequencing of reconstruction in patients with multifocal defects and i...
Simultaneous massive abdominal wall loss of domain (LOD) and chronic sacral pressure injury presents an exceptional reconstructive challenge. Optimal sequencing of reconstruction in patients with multifocal defects and impaired mobility remains poorly defined. In this case report, we describe a strategically staged approach prioritizing restoration of trunk stability to enable definitive pressure ulcer reconstruction in a complex patient. A 34-year-old male developed a 32 × 25 cm ventral abdominal wall defect with LOD and a persistent stage IV sacral ulcer following catastrophic complications of a gastric bypass. Severe abdominal LOD resulted in truncal flexion deformity and wheelchair dependence. Reconstruction was staged to prioritize abdominal wall restoration to improve mobility and allow effective pressure offloading before sacral reconstruction. AWR was performed using transversus abdominis release (TAR) with retromuscular mesh placement, partial fascial bridging, and a free anterolateral thigh (ALT) musculocutaneous flap to provide durable fascial reinforcement and soft-tissue coverage. Restoration of abdominal domain significantly improved trunk stability and ambulation. Eight months later, the 14 × 10 cm sacral ulcer was definitively reconstructed using bilateral keystone perforator flaps. Both reconstructions healed without complication, resulting in marked functional recovery and elimination of wheelchair dependence. This case shows the effectiveness of a staged, multidisciplinary strategy for a patient with severe, multifocal soft-tissue defects and supports the notion that a carefully staged and individualized reconstructive approach may provide durable restoration, substantially improving mobility, functional independence, and overall quality of life.
Tunneled Peroneal Perforator Propeller Flap With De-Epithelialized Bridge for Coverage of Anterior Mid-Tibial Defect After Skin Cancer Resection: A Case Report.
Meroni M, Martini F, Scaglioni MF
Microsurgery · 2026 Jul · PMID 42274129 · Publisher ↗
Anterior mid-tibial defects are difficult to cover because the tibial crest lacks soft tissue and excess bulk impairs function and contour. Different procedures can be used in these cases, including split thickness skin...
Anterior mid-tibial defects are difficult to cover because the tibial crest lacks soft tissue and excess bulk impairs function and contour. Different procedures can be used in these cases, including split thickness skin graft (STSG), local random pattern flaps, or pedicled muscular flaps. STSG represents the most common and simple procedure; however, the aesthetic results are often poor and it cannot be performed if bone tissue is directly exposed. Local flaps are suboptimal in this region due to high skin tension, whereas muscle flaps yield poor aesthetic outcomes and are associated with increased morbidity and prolonged healing time. In this setting, there is still not a definitive solution able to provide the right amount of tissue, with a safe donor site morbidity. Here, we report a case of anterior tibial reconstruction after wide local excision of basal cell carcinoma in a 71 years old man using a peroneal artery perforator propeller flap. Color Doppler localized a reliable distal-lateral perforator, enabling a single-perforator skin island flap measuring 19 × 6 cm, with careful pedicle skeletonization; indocyanine-green angiography confirmed perfusion before inset. A generous subcutaneous tunnel minimized kinking, and a de-epithelialized central bridge created two paddles, one for the defect and one to assist tension-free donor closure. Recovery was uncomplicated; at 6 months the flap was stable, with good contour, color match, and no need for refinements. Key reliability enhancers were judicious perforator selection, gravity-assisted design, liberal tunneling, and the protective bridge. Compared with skin grafting, this approach improves durability and integration; compared to free flaps, it preserves major vessels while reducing operative complexity and morbidity.
Magnesium-Doped Artificial Bone Combined With Pedicled Peri-Acetabular Bone Flap for ARCO Stage II Osteonecrosis of the Femoral Head: A Comparative Study.
Wang F, Cheng L, Zhang T … +4 more , Ying J, Feng X, Su H, Zhao D
Microsurgery · 2026 Jul · PMID 42274094 · Publisher ↗
OBJECTIVE: Magnesium (Mg) ions promote bone regeneration. Combined with a vascularized periosteal flap providing blood supply and mechanical support, this approach may improve outcomes for osteonecrosis of the femoral he...
OBJECTIVE: Magnesium (Mg) ions promote bone regeneration. Combined with a vascularized periosteal flap providing blood supply and mechanical support, this approach may improve outcomes for osteonecrosis of the femoral head (ONFH), but its clinical efficacy is unclear. This study compared this approach with conventional core decompression (CD) for Association Research Circulation Osseous (ARCO) Stage II ONFH. METHODS: A retrospective analysis was conducted on 76 patients (82 hips) with ARCO Stage II ONFH. The observation group (OG) (39 patients, 44 hips) received Mg-doped artificial bone combined with pedicled peri-acetabular bone flap (MAB-PPBF), while the control group (CG) (37 patients, 38 hips) underwent CD. Operative time, intraoperative blood loss, Harris Hip Score (HHS), Visual Analog Scale (VAS), ARCO stage, Kerboul angle, and hip-preserving success rate were compared. RESULTS: Baseline characteristics were comparable between groups. The OG had longer operative time (47.9 ± 7.2 vs. 44.2 ± 3.5 min) and greater blood loss (36.2 ± 8.1 vs. 27.3 ± 7.1 mL) than the CG (p < 0.05). At final follow-up, the OG showed significantly higher HHS (84.12 ± 3.14 vs. 81.94 ± 2.09) and lower VAS (2.97 ± 0.43 vs. 3.32 ± 0.76) compared with controls (p < 0.05). The OG also had a higher proportion of ARCO Stage II (47.6% vs. 30.0%) and lower proportion of Stage IV (4.8% vs. 16.7%, p < 0.05). The Kerboul angle was significantly smaller in the OG (203.54° ± 32.84° vs. 221.39° ± 31.82°, p < 0.05). The hip-preserving success rate was significantly higher in the OG (90.9%, 40/44) than in the CG (65.8%, 25/38, p < 0.05). CONCLUSION: For ARCO Stage II ONFH, MAB-PPBF achieves more thorough necrotic bone removal, adequate grafting, accelerated bone regeneration, effective hip pain relief, improved hip function, and delayed disease progression compared with CD, showing superior clinical outcomes.
Impact of Tongue Tip Reconstruction on Articulatory Performance After Major Tongue Resections: Evidence From a Multicentric Study.
Caselli A, Gazzini L, Bassani S … +19 more , Togo G, Borghini C, Rubini A, Rosini M, Liberale C, Montenegro C, Comicini I, Di Domenico J, Camesasca V, Cremasco A, Calabrese A, Gregori D, Marchioni D, Dragonetti AG, Piazza C, Accorona R, Grammatica A, Mattioli F, Calabrese L
Microsurgery · 2026 Jul · PMID 42257252 · Publisher ↗
BACKGROUND: The anterior tongue is crucial in speech articulation; however, the functional implications of tongue tip resection and reconstruction following glossectomy remain inadequately elucidated. This multicentric s...
BACKGROUND: The anterior tongue is crucial in speech articulation; however, the functional implications of tongue tip resection and reconstruction following glossectomy remain inadequately elucidated. This multicentric study aimed to evaluate the impact of lingual tip reconstruction on postoperative articulatory performance and self-perceived speech outcomes in patients undergoing major tongue resections for oral squamous cell carcinoma (OSCC). METHODS: A retrospective analysis was performed on 57 patients who underwent hemiglossectomy or extended glossectomy across four tertiary referral centers between 2007 and 2023. Articulatory performance was assessed utilizing selected tests from the Fussi-Cantagallo test and the Speech Handicap Index (SHI). Patients were stratified into two groups based on tongue tip management: Group A, ipsilateral tip resection without reconstruction (contralateral tip preserved); Group B, ipsilateral tip resection with partial tip reconstruction. Comparative analyses and multivariate models examined the associations between reconstructive patterns, articulatory performance, and SHI scores. RESULTS: In tests 1 and 2, the difference between Groups A and B showed a clear trend towards significance in favor of Group A (p = 0.061). No significant difference was found between the two groups in the other tests. Younger age was independently associated with improved articulatory performance (p < 0.02). No differences were observed in outcomes associated with flap type or adjuvant therapy. CONCLUSIONS: Omitting apical reconstruction when the contralateral apex remains functional may be associated with superior speech outcomes by preserving residual mobility. A function-oriented reconstruction approach, emphasizing motility rather than morphological symmetry, should be prioritized to enhance postoperative communication quality.
Temporary Vascular Shunting to Prevent Excessive Ischemia Time for a Fillet-of-Leg Free Flap During External Hemipelvectomy: A Case Report.
Edgar M, Pourriyahi H, Bou Zeid N … +2 more , Wisselink W, Alkureishi L
Microsurgery · 2026 Jul · PMID 42249727 · Publisher ↗
The free fillet flap is a well-established reconstructive option following external hemipelvectomy. However, mitigating prolonged warm ischemia during the extensive tumor resection poses a significant challenge to flap v...
The free fillet flap is a well-established reconstructive option following external hemipelvectomy. However, mitigating prolonged warm ischemia during the extensive tumor resection poses a significant challenge to flap viability. Presented herein is a case illustrating the novel use of temporary intraoperative vascular shunting to overcome this limitation. During hemipelvectomy for a 17.7 × 16.9 × 19.3 cm osteosarcoma of the proximal left femur in a 74-year-old man, unplanned early ischemia of the lower extremity was addressed by placing carotid shunts between the external iliac and popliteal vessels. The technique maintained continuous perfusion to the future flap for 4 h during the concurrent pelvic resection and fillet flap harvest. Definitive microvascular anastomosis was performed subsequently and the 37 × 31 cm flap remained viable postoperatively for the 3 months of follow-up. This case report reintroduces temporary shunting as a simple, effective, and readily available technique to preserve flap perfusion in complex microsurgical reconstructions, mirroring damage-control principles from trauma surgery.
Comments on "Arterialized Saphenous Vein Transfer for Microvascular Free Flap Reconstruction of Complex Posterior Defects".
Akbar H, Hussain SH, Momin SM
Microsurgery · 2026 Jul · PMID 42249722 · Publisher ↗
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Free Composite Osteotomized Serratus Anterior Chondroosteomusculocutaneous Flap for Dynamic Reconstruction of a Pediatric Combined Maxillectomy and Hemimandibulectomy Defect: A Case Report.
Baghaki S, Yilmaz YZ, Özlüşen B
Microsurgery · 2026 Jul · PMID 42244345 · Publisher ↗
Pediatric mandibular reconstruction is challenging due to the need to restore mandibular continuity, temporomandibular joint (TMJ) function, and long-term craniofacial growth. Conventional osseous free flaps may not adeq...
Pediatric mandibular reconstruction is challenging due to the need to restore mandibular continuity, temporomandibular joint (TMJ) function, and long-term craniofacial growth. Conventional osseous free flaps may not adequately reproduce the ramus-condyle unit or provide a growth-capable cartilaginous component. The serratus anterior-rib composite flap offers vascularized bone and costochondral tissue but remains rarely used in children. We presented a 12-year-old pediatric patient with rhabdomyosarcoma who underwent en bloc resection including hemimandibulectomy and maxillectomy. Reconstruction was achieved using a free composite multi-segment osteotomized serratus anterior chondroosteomusculocutaneous flap incorporating the vascularized 6th rib, its costochondral junction, serratus anterior muscle, and a skin paddle. The rib was osteotomized to recreate mandibular contour, and the costochondral junction was shaped to form a neocondyle. The flap tolerated adjuvant radiotherapy and chemotherapy without complications over a 19-month follow-up period. No mandibular asymmetry was observed. Although larger series with longer follow-up periods are needed, this technique may offer a single-flap, growth-preserving solution for complex defects involving the ramus-condyle unit in pediatric patients.
Correction of Lateralization of the Perioral Insertion of Gracilis Muscle in Facial Reanimation in Children: A Report of Two Cases.
Haumer A, Engström O, Dong R … +1 more , Rodriguez-Lorenzo A
Microsurgery · 2026 Jul · PMID 42231546 · Publisher ↗
Facial palsy in pediatric patients can lead to severe functional impairments and psychosocial challenges. Free gracilis muscle transfer (FGMT) is to date the gold standard for dynamic facial reanimation, but suboptimal a...
Facial palsy in pediatric patients can lead to severe functional impairments and psychosocial challenges. Free gracilis muscle transfer (FGMT) is to date the gold standard for dynamic facial reanimation, but suboptimal aesthetic outcomes (SAO), due to malpositioning of the nasolabial fold, still represent a challenge to the surgeons. Especially, craniolateral displacement of the medial insertion of the gracilis muscle at the nasolabial fold represents a true challenge. The purpose of these two case reports is to propose a novel technique for the medialization of the perioral insertion of the gracilis muscle using fascia lata slings in pediatric patients, which might be useful to the reconstructive surgeon in dealing with this challenging complication. We present the cases of two male pediatric patients with complete unilateral facial palsy; a 7-year-old affected by congenital, complete, right-sided and an 11-year-old post-oncological complete right-sided facial palsy. Both patients underwent FGMT and suffered from craniolateral displacement of the nasolabial fold postoperatively after different time spans. (3- and 5-years post FGMT). To correct this SAO, we performed our herein proposed technique for secondary repositioning of the gracilis muscle to correct the malpositioned nasolabial fold. Pre- and postoperative outcomes were evaluated using photography, videography, and the Terzis Functional and Aesthetic Grading System by seven independent investigators. These independent investigators found that the overall Terzis score increased from poor to moderate through FGMT and sustained another relevant increase from moderate to good through our proposed medialization technique. Moreover, within our follow-up period of 17 months, we observed no major or minor complications. The take home message of this report is that our technique of medialization of the gracilis muscle insertion using fascia lata slings represents an effective and low-risk approach for correcting a lateralized nasolabial fold. In these challenging cases, this novel technique can offer a surgical alternative which can improve both functional and aesthetic outcomes in pediatric facial reanimation. However, further investigation with larger cohorts is necessary to validate our surgical approach.
Subunit-Based Intraflap Debulking Technique for Secondary Contouring After Free Flap Reconstruction.
Yoo KE, Lee KT
Microsurgery · 2026 Jul · PMID 42231540 · Publisher ↗
BACKGROUND: Despite advances in surgical technique for flap thinning, secondary debulking is often needed in areas with thin soft tissue coverage. Flaps spanning multiple anatomical subunits pose a particular challenge,...
BACKGROUND: Despite advances in surgical technique for flap thinning, secondary debulking is often needed in areas with thin soft tissue coverage. Flaps spanning multiple anatomical subunits pose a particular challenge, as central bulkiness, often located near subunit junctions, is difficult to address with traditional margin-based approaches and may obscure natural contours. We introduced a subunit-based intraflap debulking technique, placing incisions across the flap along anatomical subunit borders and evaluated its safety and effectiveness. METHODS: We retrospectively reviewed patients who underwent free flap reconstruction between 2021 and 2025 and later received secondary debulking using this technique. The procedure involved placing intraflap incisions along internal subunit borders, excising central redundant skin and adjacent fatty tissue in a cone-shaped fashion, and reapproximating the flap to restore natural subunit boundaries. Their postoperative outcomes were evaluated. RESULTS: A total of 22 cases were treated using the subunit-based intraflap approach, most commonly for lower extremity reconstructions, particularly of the foot, with the superficial circumflex iliac artery perforator flap being the most frequently used in the initial surgery. Debulking was performed at a median of 10 months following the initial reconstruction. No postoperative complications, including wound dehiscence, delayed wound healing, seroma, hematoma, or infection, were observed. The median time to complete healing was 14 days. All patients reported satisfaction with the aesthetic outcome. CONCLUSIONS: The subunit-based intraflap debulking technique appears to be a safe approach for secondary contouring after free flap reconstruction in selected cases, allowing effective central debulking and restoration of natural subunit borders.
What Is the Posteromedial Thigh Flap?
Hallock GG
Microsurgery · 2026 Jul · PMID 42216425 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Composite Radial Forearm Free Flap for Tibialis Anterior Tendon Reconstruction: A Case Report.
Shin SE, Newsom MR, Baek AE … +5 more , Kelly B, Bernabe R, Vemuri JP, Mountziaris P, DeJesus R
Microsurgery · 2026 Jul · PMID 42204834 · Publisher ↗
Distal leg reconstruction is particularly challenging due to limited local options. This challenge is accentuated when there is a concurrent tendon rupture and threatened hardware, making soft tissue coverage crucial for...
Distal leg reconstruction is particularly challenging due to limited local options. This challenge is accentuated when there is a concurrent tendon rupture and threatened hardware, making soft tissue coverage crucial for preserving limb function. This report describes a 37-year-old male with a 5 × 8 cm wound on the distal leg, including a 7.5 cm loss of tibialis anterior tendon (TAT) with underlying tibial hardware. A 5 × 9 cm composite left radial forearm free flap (FF), including flexor carpi radialis and palmaris longus tendons, was used to reconstruct the TAT and cover the tibial hardware. The patient's postoperative course was smooth, and he was able to walk without assistance after 6 weeks. At 10 months, the patient continued to show strong ankle dorsiflexion and ambulated independently. This case demonstrates that a composite radial forearm FF may be an effective autologous option for simultaneous soft tissue coverage and tendon reconstruction in the lower extremity.
Effect of Ultrasonic Dissection on Donor-Site Morbidity and Drainage in Latissimus Dorsi Free Flaps.
Park BY
Microsurgery · 2026 May · PMID 42174759 · Publisher ↗
BACKGROUND: Donor-site morbidity, particularly prolonged drainage and seroma formation, remains a persistent challenge in latissimus dorsi myocutaneous (LDMC) flap surgery. Although the Harmonic scalpel allows simultaneo...
BACKGROUND: Donor-site morbidity, particularly prolonged drainage and seroma formation, remains a persistent challenge in latissimus dorsi myocutaneous (LDMC) flap surgery. Although the Harmonic scalpel allows simultaneous cutting and coagulation and has demonstrated advantages in other surgical settings, its potential to mitigate drainage-related morbidity during full-muscle LDMC flap harvest has not been fully characterized. This study evaluated its impact on donor-site outcomes in free LDMC flap reconstruction. METHODS: A retrospective review was performed of patients who underwent free LDMC flap reconstruction for lower extremity defects (from 2015 to 2025). Patients were grouped by dissection method: Harmonic versus conventional electrocautery. Outcomes included total drain volume, mean daily drainage, drainage duration, and seroma. Group comparisons and multivariable regression were used to assess predictors. RESULTS: Forty-nine patients were analyzed (Harmonic, n = 21; Conventional, n = 28). Flap elevation time was significantly shorter in the Harmonic group (74.8 ± 14.7 vs. 120.2 ± 32.8 min, p < 0.001). Seroma occurred in six patients (21.4%) in the Conventional group but in none in the Harmonic group (p = 0.075). Mean total drainage volume was lower with Harmonic dissection (437.3 ± 242.0 vs. 610.7 ± 379.7 mL, p = 0.020), whereas mean daily drainage was similar (57.2 ± 21.5 vs. 54.8 ± 29.1 mL/day, p = 0.167). Drainage duration was significantly shorter in the Harmonic group (7.5 ± 2.4 vs. 10.9 ± 3.4 days, p = 0.004). On multivariable analysis, flap size independently predicted total drainage volume (β = 0.77, 95% CI 0.23-1.30, p = 0.006), and Harmonic use independently reduced drainage duration by 3.3 days (β = -3.32, 95% CI -5.54 to -1.09, p = 0.004). CONCLUSION: Harmonic dissection in free LDMC flap harvest shortened elevation time, reduced drainage duration, and eliminated seroma. These findings support its role in minimizing donor-site morbidity and improving efficiency.
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