Microsurgery[JOURNAL]
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200 papers
Anterior Interosseous Artery as a Recipient Vessel in Superficial Circumflex Iliac Artery Perforator Flap Transplantation to the Forearm.
Kodaira S, Fukumoto K, Koike T … +1 more , Okada Y
Microsurgery · 2026 May · PMID 41952244 · Publisher ↗
BACKGROUND: When transplanting a superficial circumflex iliac artery perforator (SCIP) flap to the forearm, the small diameter of the superficial circumflex iliac artery (SCIA) complicates end-to-end anastomosis with the...
BACKGROUND: When transplanting a superficial circumflex iliac artery perforator (SCIP) flap to the forearm, the small diameter of the superficial circumflex iliac artery (SCIA) complicates end-to-end anastomosis with the radial or ulnar artery. The small diameter of the anterior interosseous artery (AIA) may make it suitable for end-to-end anastomosis with the SCIA; however, no such cases have been reported to date. We assessed AIA diameter using computed tomography angiography (CTA) and analyzed six cases of SCIP flap transfer to the forearm using the AIA as the recipient vessel. METHODS: In 22 patients with traumatic hand or finger skin defects, we measured the diameters of the AIA and radial and ulnar arteries at the forearm center (point A) and distal quarter (point B) using CTA. Six cases of SCIP flap transfer to the forearm using the AIA as the recipient vessel were also analyzed. Defects were located in the distal part of the forearm in four cases, the middle part in one case, and the proximal part in one case, ranging from 5 × 10 to 12 × 16 mm. RESULTS: The AIA diameter (1.59 ± 0.05 mm at point A; 1.30 ± 0.07 mm at point B) was significantly smaller than that of the radial (2.64 ± 0.12 mm; 2.53 ± 0.10 mm) and ulnar arteries (2.25 ± 0.10 mm; 2.25 ± 0.09 mm) on CTA (p < 0.01). In the six surgical cases, the flap size ranged from 4.5 × 14.5 to 14 × 19 mm, and mean diameters of the anastomosed SCIA and AIA were 1.28 mm and 1.37 mm, respectively. The superficial circumflex iliac vein or SCIA accompanying vein was anastomosed to the cephalic vein. All flaps survived without postoperative circulatory complications. CONCLUSION: The findings suggest that the AIA is suitable for end-to-end anastomosis with the SCIA.
The use of serratus anterior artery as the pedicle for complex humerus reconstruction with a vascularized fibular graft: Anatomical study and clinical application in a case series.
Lovic A, Pérez-Rodríguez J
Microsurgery · 2026 May · PMID 41928499 · Publisher ↗
INTRODUCTION: Free vascularized fibular graft is an optimal option for the reconstruction of long, complex bone defects in the humerus. Previous surgeries, infection, and trauma, particularly with brachial artery revascu...
INTRODUCTION: Free vascularized fibular graft is an optimal option for the reconstruction of long, complex bone defects in the humerus. Previous surgeries, infection, and trauma, particularly with brachial artery revascularization, may limit the use of conventional recipient vessels. In this study, we review the use of the serratus anterior artery as a recipient vessel, the anatomical validation of its feasibility and its clinical application in a series of cases. METHODS: The anatomical study consisted of 14 dissections on 7 Thiel-embalmed cadavers. The distance from the origin of the serratus anterior pedicle to the most distal point where the artery had at least 1.2 mm of external diameter was measured, as well as to the surgical neck of the humerus. A retrospective review (2008-2024) included patients undergoing humeral reconstruction with a free vascularized fibular graft using the serratus anterior artery. Etiology, previous procedures, bone healing, complications, pain (Visual Analogue Scale, VAS), and function (quick Disabilities of the Arm, Shoulder and Hand score, quickDASH) were recorded. This study adheres to STROBE guidelines. RESULTS: The anatomical study showed that the mean pedicle length was 13.5 cm (range 11.8-15.5 cm), and in all dissections, the transposed pedicle reached distal to the humeral surgical neck. 5 patients (mean age 43 years, range 24-58 years) were included in the study. There were two posttraumatic and three post-oncologic reconstructions, with a mean of six previous surgeries. The mean follow-up was 9.7 years (range 1-17 years). All cases achieved bone union within the first postoperative year. There were two cases of postoperative complications: one case of fibular graft fracture that healed conservatively and one case of delayed healing of the fibular graft donor area. Mean VAS at last follow-up was 1.5 (range 0-4); mean quickDASH was 15.4 (range 0-32). CONCLUSION: The serratus anterior artery provides a reliable length and caliber for use as a recipient vessel for humeral reconstruction with a free vascularized fibular graft when conventional recipient vessels are not available.
Association of Systemic Inflammatory Markers With Complications in Free Flap Reconstruction: A Retrospective Cohort Study.
Acar B, Ünkar EA, Ertem H … +2 more , Şencan A, Orman O
Microsurgery · 2026 Mar · PMID 41885706 · Publisher ↗
INTRODUCTION: The association between preoperative systemic inflammatory markers and postoperative free flap complications remains insufficiently defined, particularly in trauma-related reconstructions. The aim of our st...
INTRODUCTION: The association between preoperative systemic inflammatory markers and postoperative free flap complications remains insufficiently defined, particularly in trauma-related reconstructions. The aim of our study was to investigate the association between systemic inflammatory markers and postoperative complications of free flaps used in soft tissue reconstruction. METHODS: This was a retrospective cohort study. The main independent variables were systemic inflammatory markers such as neutrophil, lymphocyte, monocyte, platelet, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), systemic inflammatory response index (SIRI), and systemic immune inflammatory index (SII). The relationship between complications and inflammatory markers was analyzed. Cut-off values, sensitivity, and specificity of the associated markers were determined. RESULTS: The study consisted of 55 patients, 40 (72.7%) were men and 15 (27.3%) were women. Their average age was 33.63 years with a standard deviation of 15.34 years. The cumulative complication rate was 40% (22 patients). In the group with complications, NLR, PLR, and SII values were significantly higher (p-values were 0.008, 0.002, and 0.002, respectively). Cut-off values with the sensitivity and specificity were NLR > 2.68 (63.6% sensitivity, 84.8% specificity), PLR > 148.64 (81.8% sensitivity, 57.5% specificity), SII > 656.91 (72.7% sensitivity, 78.7% specificity). CONCLUSION: The inflammatory indices NLR, PLR, SII were found to be associated with postoperative complications and demonstrated specific cut-off values; however, these findings should be interpreted as associative rather than predictive.
Flap Use for Wound Coverage After Spinal Hardware Infection: A Systematic Review of the Literature.
Jolibois MI, Manasyan A, Roohani I … +3 more , Williams E, Carey JN, Daar DA
Microsurgery · 2026 Mar · PMID 41885702 · Publisher ↗
BACKGROUND: Reconstructing spinal defects complicated by surgical site infection (SSI) is challenging, with SSIs occurring in 1%-4% of spine surgeries, often involving hardware exposure. These infections increase hospita...
BACKGROUND: Reconstructing spinal defects complicated by surgical site infection (SSI) is challenging, with SSIs occurring in 1%-4% of spine surgeries, often involving hardware exposure. These infections increase hospital stays, costs, and risks of poor outcomes. Effective management strategies are crucial for addressing infected spinal wounds. METHODS: We conducted a systematic review following PRISMA-P guidelines across six databases. Included studies reported flap coverage for spinal reconstructions with or without hardware. Outcomes of interest included flap loss, partial flap necrosis, wound dehiscence, venous thrombosis, and infection rates. Quality was evaluated using ASPS criteria and the ROBINS-I tool. RESULTS: Out of 4436 articles, 32 studies were included, comprising 969 patients, with 496 undergoing reconstructions for infected chronic wounds. The mean patient age was 52.1 years. Infection contributors included spinal instrumentation, radiotherapy, smoking, and diabetes, with Staphylococcus aureus being the most common organism (52.7%). Paraspinal muscle flaps and latissimus dorsi flaps were most frequently used. Out of the 27 studies that investigated the need for hardware removal, eight reported patients required it in the postoperative period. The pooled flap survival rate was 89%, with muscle flaps showing higher effectiveness compared to fasciocutaneous flaps (92% vs. 85%). Other complications included wound dehiscence (12%), flap necrosis (8%), and reinfection (10%). CONCLUSIONS: This study provides evidence-based insights into managing complex spinal defects. Flap reconstruction remains a viable solution for soft-tissue coverage, highlighting the importance of tailored surgical planning based on defect characteristics and patient factors.
Use of Silicone Drains to Prevent Pedicle Compression in Edematous Crush Trauma.
Özkan B, Şahin MA, Işık E
Microsurgery · 2026 Mar · PMID 41858216 · Publisher ↗
Abstract loading — click title to view on PubMed.
Optimizing Flap Selection for Urosymphyseal Fistula Repair: A Comparative Analysis of Surgical Outcomes.
Escandón JM, Kreutz-Rodrigues L, Fadel AE … +4 more , Kemble JP, Houdek MT, Viers B, Bakri K
Microsurgery · 2026 Mar · PMID 41846264 · Publisher ↗
BACKGROUND: There is limited data regarding the surgical outcomes of urosymphyseal fistula (USF) repair with primary repair or autologous tissue transfer. We performed a study to compare outcomes of USF repair with prima...
BACKGROUND: There is limited data regarding the surgical outcomes of urosymphyseal fistula (USF) repair with primary repair or autologous tissue transfer. We performed a study to compare outcomes of USF repair with primary repair, VRAM flap, and omental flap. METHODS: We retrospectively identified patients with a diagnosis of USF who underwent fistula decompression and urinary tract reconstruction. The minimal follow-up was 3 months. Patients with distal urethral obstruction, radiation cystitis, or a non-viable sphincter underwent anterior exenteration and flap transfer. RESULTS: Fifty-six patients were included. Eleven patients underwent surgical management for USF using primary repair (19.6%), 34 had omental flap-based reconstruction (60.8%), and a VRAM flap was used in 11 patients (19.6%). The 90-day rate of sepsis was lower with omentum flap transposition (3%) compared with VRAM flap (27%) or primary repair (18%, p = 0.041). The rate of fistula recurrence was lower in the omentum flap group compared with USF primary repair (30%) or VRAM flap repair group (27.3%, p = 0.04). On multivariable analysis, USF repair with the omentum flap decreased the odds of fistula recurrence 90 days after surgery compared with primary repair (OR 0.012, p = 0.011) but not when compared with VRAM. CONCLUSION: The omentum flap may offer a better safety profile in terms of decreasing the rate of early sepsis and rate of fistula recurrence for USF repair in comparison to primary repair. There is limited evidence regarding the superiority of the omentum flap to decrease the rate of late fistula recurrence when compared with the VRAM flap.
Monitoring of Venous and Arterial Occlusion With Remote Interstitial Tissue Glucose Measurement Systems in a Rabbit Free Flap Model.
Gurbuz CM, Uzun C, Eroglu O … +2 more , Yasar EK, Alagoz MS
Microsurgery · 2026 Mar · PMID 41834219 · Full text
BACKGROUND: Free tissue transfer requires meticulous postoperative monitoring to detect vascular occlusion. Although experimental studies have explored the relationship between interstitial glucose levels and tissue perf...
BACKGROUND: Free tissue transfer requires meticulous postoperative monitoring to detect vascular occlusion. Although experimental studies have explored the relationship between interstitial glucose levels and tissue perfusion, long-term evaluation of glucose levels during and after occlusion-reperfusion has not been thoroughly investigated. The study objective was to investigate the correlation between controlled venous and arterial occlusion and changes in interstitial tissue glucose, using a remote interstitial glucose monitoring device. MATERIALS AND METHODS: This experimental study was conducted on eight New Zealand White rabbits, each weighing between 3.2 and 3.8 kg, under general anesthesia, utilizing a 4 × 8 cm perforator flap supplied by skin perforators originating from the thoracodorsal artery. Interstitial glucose levels within the flaps were continuously monitored using FreeStyle Libre flash glucose monitoring system. Baseline glucose levels were recorded 1 day prior to vascular occlusion, followed by monitoring between 15 min intervals during experimental clamping of both venous ischemia (75 min), venous decongestion (75 min), and arterial occlusion (45 min). Criteria for detecting vessel occlusion were established based on changes in interstitial glucose concentration. RESULTS: Venous occlusion was associated with a significant increase in interstitial glucose levels. At 15 min post-occlusion, interstitial glucose increased by 47.8%, which was significantly higher than baseline (p = 0.018). However, at 30 min post-unclamping, interstitial glucose declined by 18.3% (p = 0.028) and by 57.4% over 75 min. In contrast, arterial occlusion was associated with a rapid decline in glucose levels. At 15 min post-occlusion, interstitial glucose decreased by 56% (p = 0.018). Total necrosis was observed in all flaps followed by arterial occlusion. CONCLUSIONS: Interstitial glucose monitoring appears to be a reliable method for detecting vascular occlusion in free tissue transfers within this experimental model. This technique may offer a rapid, minimally invasive, and cost-effective approach for postoperative vascular monitoring of free flaps. Further investigation in human trials is warranted to confirm these findings and assess clinical utility.
Baxter's Nerve Exists but Is Usually NOT the First Branch of the Lateral Plantar Nerve.
Williams NH, Senatore JR, Dellon AL … +1 more , Williams EH
Microsurgery · 2026 Mar · PMID 41834215 · Publisher ↗
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Renaming the Profunda Femoris Artery Perforator Flap as the Posteromedial Thigh Flap: Clarifying Nomenclature Through Anatomical Precision.
Hung JNM, Lee CC, Kuo YR
Microsurgery · 2026 Mar · PMID 41813610 · Publisher ↗
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Super-Thin ALT Flap for Composite Nasal Reconstruction in an Elderly Kidney Transplant Patient.
Longo B, Okoroafor J, Vannucchi L … +5 more , Marrano R, D'Orsi G, Nunziata I, Giacalone M, Cervelli V
Microsurgery · 2026 Mar · PMID 41804583 · Publisher ↗
Nasal reconstruction is one of the most challenging procedures in plastic surgery, requiring restoration of the three-dimensional structure, precise contour, internal lining, and airway function. These challenges are fur...
Nasal reconstruction is one of the most challenging procedures in plastic surgery, requiring restoration of the three-dimensional structure, precise contour, internal lining, and airway function. These challenges are further amplified when traditional donor sites are unavailable, particularly in elderly patients or those undergoing concomitant treatments. We report the case of a 78-year-old man on immunosuppressive therapy following kidney transplantation, presenting with recurrent basal cell carcinoma affecting the middle and lower thirds of the nose. After tumor excision resulting in a 7 × 5 cm defect, and given the patient's characteristics and limitations of conventional options, a customized super-thin anterolateral thigh (ALT) flap (7 × 16 × 0.8 cm) combined with nasal septal and auricular cartilage grafts was chosen for reconstruction. Postoperative recovery was uneventful, and at 6 months, the patient demonstrated normal nasal contour, an open airway, and no signs of recurrence. Despite inherent limitations related to skin and subcutaneous tissue quality and thickness, a super-thin ALT flap may represent a reliable single-stage alternative for total nasal reconstruction in selected high-risk patients.
Use of Internal Mammary Artery Branch for Small-Caliber Arterial Anastomosis in Autologous Breast Reconstruction.
Meroni M, Scaglioni MF
Microsurgery · 2026 Mar · PMID 41804575 · Publisher ↗
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Arterialized Saphenous Vein Transfer for Microvascular Free Flap Reconstruction of Complex Posterior Defects.
Sorenson TJ, Tran D, Boyd CJ … +5 more , Park JJ, Bekisz J, Volk A, Cohen O, Levine JP
Microsurgery · 2026 Mar · PMID 41797397 · Publisher ↗
PURPOSE: Complex posterior defects often present significant reconstructive challenges, particularly due to the scarcity of suitable recipient vessels. In these cases, an arterialized saphenous vein transfer can facilita...
PURPOSE: Complex posterior defects often present significant reconstructive challenges, particularly due to the scarcity of suitable recipient vessels. In these cases, an arterialized saphenous vein transfer can facilitate flap perfusion when direct anastomosis is not feasible. This study presents our institutional experience using an arterialized saphenous vein transfer for microvascular free flap (MVFF) reconstruction of posterior defects. METHODS: We retrospectively reviewed consecutive patients who underwent posterior MVFF reconstruction using an arterialized saphenous vein transfer. Patient demographics, comorbidities, defect etiologies (including trauma, silicone injection, malignancy, and congenital abnormalities), flap types, and perioperative outcomes were collected through manual chart review. RESULTS: Six patients with eight MVFFs were included. Five were adults and one was a child; four were females and two were males. All defects were located on the posterior trunk/buttocks. Flap types included four standard latissimus dorsi (LD), three anterolateral thigh (ALT), and one extended conjoined LD flap. Average skin paddle size was 232 cm (±73). Arterialized saphenous vein transfer arterial inflow sources included the descending branch of the lateral femoral circumflex artery (n = 6), deep inferior epigastric artery (n = 1), and transverse branch of the superficial femoral artery (n = 1). Average operative time was 11:00 h (±2:50); median hospital stay was 12 days (range: 6-76). There were no flap losses. One patient required two flap explorations; two patients required postoperative blood transfusions. At a mean follow-up of 1247 days (±393), all flaps had healed, including persistent minor wounds in the two silicone injection cases. CONCLUSIONS: Arterialized saphenous vein transfers enabled durable, successful MVFF reconstruction in complex posterior defects and represent a reliable option in anatomically challenging scenarios.
Comparison of Hand-Held Doppler, Infra-Red Thermography and Indocyanine Green Angiography for Identification of Perforator in Antero-Lateral Thigh Flap: A Randomized Controlled Trial.
Fatma A, Dixit PK, Katrolia D … +2 more , Karmakar S, Kala PC
Microsurgery · 2026 Mar · PMID 41795639 · Publisher ↗
BACKGROUND: Accurate preoperative localization of perforators is crucial for the success of perforator-based flaps. While handheld Doppler (HHD) is commonly used, newer modalities like infra-red (IR) thermography and ind...
BACKGROUND: Accurate preoperative localization of perforators is crucial for the success of perforator-based flaps. While handheld Doppler (HHD) is commonly used, newer modalities like infra-red (IR) thermography and indocyanine green (ICG) angiography may offer greater accuracy and precision. We aimed to compare the diagnostic accuracy of HHD, IR thermography, and ICG angiography in identifying perforators in the anterolateral thigh (ALT) flap. METHODS: This was a single-centre, three-arm parallel randomized controlled trial conducted from May 2023 to April 2025 in the Department of Burns and Plastic Surgery at a tertiary care center. Sixty patients undergoing ALT flap reconstruction were randomized (1:1:1) to HHD, IR thermography, or ICG angiography groups. The primary outcome was the diagnostic accuracy of each modality in perforator localization (defined as spatial concordance with intra-operative location). Secondary outcomes included flap complications and duration of flap harvest. Data were analyzed using ANOVA and chi-square tests. RESULTS: Oncological resection was the most common indication for flap surgery (53.3%), and the head and neck region was the commonest site of reconstruction. ICG angiography demonstrated the highest diagnostic accuracy (85%), sensitivity (94.4%), and positive predictive value (89.47%) compared to IR thermography (50%, 100%, and 50%) and HHD (15%, 75%, and 15.79%) (p < 0.0001). There was no significant difference in flap complication rates or hospital stay between groups. Diagnostic accuracy was lower in obese patients across all modalities. CONCLUSION: The accuracy of ICG was better than IR Thermography and HHD in detecting perforators pre-operatively in patients undergoing ALT flap surgery. TRIAL REGISTRATION: CTRI/2023/05/053290.
Free Tensor Fascia Lata Perforator Flap: An Alternative Lateral Thigh-Based Option for Head and Neck Oncologic Defect Reconstruction.
Hodea FV, Chen WY, Huang CH … +4 more , Chang CW, Chen MT, Ng KLB, Kuo YR
Microsurgery · 2026 Mar · PMID 41793426 · Publisher ↗
OBJECTIVE: Free tissue transfer is standard in head and neck reconstruction, with the thigh serving as a primary donor site. Contemporary evidence specifically addressing the tensor fascia lata perforator (TFLp) flap, pa...
OBJECTIVE: Free tissue transfer is standard in head and neck reconstruction, with the thigh serving as a primary donor site. Contemporary evidence specifically addressing the tensor fascia lata perforator (TFLp) flap, particularly as an immediate alternative when anterolateral thigh (ALT) perforators are absent or unreliable, remains limited. This study aimed to evaluate the TFLp flap as a reliable lateral thigh-based backup option and clinical relevance. METHODS: A retrospective study was conducted on 20 patients with oral cancer who underwent microsurgical reconstruction of head and neck defects using TFLp flaps, based on data collected from 957 thigh-based flap reconstructions over 5 years from 2019 to 2023. All TFLp flaps were harvested in cases without visible or sizable perforator of the ALT flap during dissection at the same donor thigh region. Patient demographics, clinical characteristics, flap dimensions, perforator characteristics, and surgical outcomes were retrospectively reviewed and analyzed. RESULTS: The harvested TFLp flaps ranged in size from 6 × 4 cm to 20 × 13 cm. Sixty percent of the musculocutaneous perforators required intramuscular dissection, while 40% were septocutaneous. Most flaps (70%) included a single perforator, whereas (30%) had two or more perforators. The overall flap success rate was 95%, with 19 out of 20 flaps surviving successfully. Complications occurred in five patients (25%), including two cases of vascular complications, two hematomas, and one infection. Four of these complications were successfully salvaged. Complications were observed in patients with higher BMI (p-value = 0.0049) and hypertension (p-value = 0.032). CONCLUSION: The TFLp flap is an effective alternative lateral thigh-based option in cases in which the ALT flap could not be used for complex head and neck reconstructions.
Expanding Flap Territory With Intraflap Anastomosis in Thoracodorsal Artery Perforator and Anterolateral Thigh Flaps: Feasibility and Strategic Considerations.
Kim J, Park C, Lee KT
Microsurgery · 2026 Mar · PMID 41793407 · Publisher ↗
PURPOSE: When reconstructing extensive defects with large perforator flaps, incorporating multiple perforators from different perforasomes may improve perfusion reliability, for which intraflap anastomosis can be an effe...
PURPOSE: When reconstructing extensive defects with large perforator flaps, incorporating multiple perforators from different perforasomes may improve perfusion reliability, for which intraflap anastomosis can be an effective strategy. Although well described in breast reconstruction, its application in other perforator flaps remains limited. This report reviews its application in thoracodorsal artery perforator (TDAP) and anterolateral thigh (ALT) flaps to explore feasible strategies. METHODS: Patients who underwent reconstruction with bipedicled ALT or TDAP flaps using intraflap anastomosis between 2019 and 2023 were reviewed. This technique was reserved for cases requiring large flaps without a single dominant perforator, necessitating multiple perforators from different source vessels. Operative details and postoperative outcomes were evaluated. RESULTS: Twelve cases (six TDAP and six ALT flaps) were analyzed. Median defect and flap sizes were 224 and 238.5 cm, respectively. In the TDAP group, the descending branch of the thoracodorsal artery was most commonly used as the primary pedicle, and its serratus branch served as the recipient for intraflap anastomosis with the dorsal intercostal or scapular artery perforator. In the ALT group, the descending branch of the lateral circumflex femoral artery was the primary pedicle, with the oblique or ascending branch as the secondary; the distal runoff of the descending branch served as the recipient. Except for one case of tip necrosis, no perfusion-related complications occurred. CONCLUSION: This small retrospective report suggests that the intraflap anastomosis technique appears to be a feasible approach for expanding vascular territories in TDAP and ALT flaps, offering a valuable option for extensive defect reconstruction when indicated.
Pedicled Latissimus Dorsi Flap and Gracilis Free Flap for Restoration of Elbow Flexion: Systematic Review and Indirect Comparative Meta-Analysis of Functional Outcomes.
Ramos SA, Lima BI, Medrano SS … +3 more , de Toro González SI, Soldado F, Pérez JB
Microsurgery · 2026 Mar · PMID 41792896 · Publisher ↗
INTRODUCTION: Pedicled latissimus dorsi flap (PLDF) and gracilis free flap (GFF) are techniques for restoration of elbow flexion after brachial plexus injuries with late presentation or poor outcomes following nerve surg...
INTRODUCTION: Pedicled latissimus dorsi flap (PLDF) and gracilis free flap (GFF) are techniques for restoration of elbow flexion after brachial plexus injuries with late presentation or poor outcomes following nerve surgery, as well as after traumatic or oncological loss of arm flexor muscles. The aim of this study is to compare the results of both techniques. MATERIAL AND METHODS: A systematic review was conducted following PRISMA guidelines, including articles providing information on the maximum degrees of elbow flexion or flexion strength according to the MRC scale. Outcomes were synthesized through single-arm meta-analyses using random-effects models, with indirect comparisons between PLDF and GFF performed using Z-tests. Study quality was appraised with MINORS and JBI tools, and publication bias was assessed using funnel plots and Egger's test. RESULTS: Forty-seven studies comprising 814 patients were included: 19 on PLDF (n = 122) and 28 on GFF (n = 692). PLDF achieved a higher mean elbow flexion angle (119.2°; 95% CI 112.5°-125.9°) compared to GFF (91.4°; 95% CI 82.9°-99.9°), a difference that was statistically significant. Likewise, mean muscle strength was greater with PLDF (MRC 3.85; 95% CI 3.61-4.09) than with GFF (MRC 2.95; 95% CI 2.72-3.18). In terms of functional thresholds, 95% of patients in the PLDF group achieved at least MRC ≥ 3 and 87% reached ≥ 4, whereas in the GFF group the corresponding rates were 72% and 65%. Heterogeneity across studies was moderate but consistent with the direction of effect. CONCLUSION: PLDF was associated with higher pooled flexion angles and strength values than GFF; however, due to the absence of direct comparative studies, these findings should be interpreted as comparative trends rather than evidence of superiority.
Vein Graft-Assisted LVA for Challenging Lymphedema Patient: A Case Report.
Martini F, Meroni M, Scaglioni MF
Microsurgery · 2026 Mar · PMID 41789736 · Publisher ↗
Lymphovenous anastomosis (LVA) is a cornerstone of physiologic lymphedema surgery. Its success, however, depends on the presence of a functional lymphatic vessel and a suitable reflux-free recipient vein in close proximi...
Lymphovenous anastomosis (LVA) is a cornerstone of physiologic lymphedema surgery. Its success, however, depends on the presence of a functional lymphatic vessel and a suitable reflux-free recipient vein in close proximity. In some cases, anatomical limitations make direct LVA impossible. In these situations, interposition of a vein graft may bridge the anatomical gap and allow completion of a functional bypass. In this case report, we present a case of a 58-year-old woman with secondary left upper-limb lymphedema following mastectomy, axillary lymphadenectomy, and autologous breast reconstruction. Preoperative indocyanine green (ICG) lymphography showed functional lymphatic channels, and LVA was planned. After an initial unsuccessful attempt on the dorsal wrist, a second incision on the volar forearm revealed a suitable lymphatic vessel and superficial vein, allowing an end-to-end anastomosis. Persistent retrograde lymphatic flow led to the creation of a second bypass using a short autologous vein graft, with an end-to-end anastomosis to the lymphatic vessel and an end-to-side anastomosis to the recipient vein. Intraoperative ICG confirmed that both LVAs were patent. The postoperative course was uneventful. At 1-year follow-up, the patient showed a clear reduction in limb swelling, subjective improvement, and less need for compression garments. This case report adds insight demonstrating that an interposition vein graft can enable successful LVA in anatomically challenging situations where a direct lymphaticovenous connection is not feasible. Vein graft-assisted LVA may expand the applicability of supermicrosurgery for lymphedema, though long-term data and larger series are needed to validate its durability and clinical efficacy.
Cervical Spine Musculoskeletal Work-Related Injuries in Microsurgery: Insights of an Often-Overlooked Aspect of Microsurgical Practice.
Giannas E, Gergoudis FR, Torres-Guzman RA … +3 more , Lee B, Dellon AL, Ghanem OA
Microsurgery · 2026 Mar · PMID 41787926 · Publisher ↗
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Free Flap Reconstruction of Xylazine-Associated Wounds: A Retrospective Review.
Makhoul AT, Morales CZ, Card EB … +7 more , Goldshore MA, Morris JB, Levin LS, Wink JD, Fischer JP, Lin IC, Kovach SJ
Microsurgery · 2026 Mar · PMID 41786676 · Full text
BACKGROUND: Xylazine is a veterinary sedative that is added to illicit fentanyl to enhance its effects. Xylazine-associated wounds differ from those found in patients who inject other drugs. They are larger and frequentl...
BACKGROUND: Xylazine is a veterinary sedative that is added to illicit fentanyl to enhance its effects. Xylazine-associated wounds differ from those found in patients who inject other drugs. They are larger and frequently involve deeper structures, such as bone. The outcomes of reconstruction using free tissue transfer are not well understood. METHODS: All consecutive free flap reconstructions of xylazine-associated wounds at a tertiary care center in the northeast US between January 2021 and December 2024 were retrospectively reviewed. Data were stored in a HIPAA-compliant REDCap database. RESULTS: Eleven free flap reconstructions were performed among 10 patients. Median age was 34 years (IQR: 31-38), all were White, 20% were Hispanic, and 90% were female. Median BMI was 20.9 (IQR: 19.9-39.3). Comorbidities included HCV (70%) and active tobacco smoking (60%). Wounds were located on the neck (9.1%), chest (18.2%), upper extremity (45.5%), and hand (27.3%). 81.8% presented with exposed bone. Median debridements were two (IQR 1-3). Free flaps included: four anterolateral thigh (36.4%), three gracilis (27.3%), one rectus abdominis (9.1%), one scapular (9.1%), one latissimus dorsi (9.1%), and one lateral arm (9.1%) flap. Two patients were discharged against medical advice (18.2%). Median follow-up was 364 days (IQR: 287-710). All flaps were viable at 3 weeks. Roughly half of patients (45.5%) continued to use injection drugs after reconstruction. Early complications included: one venous congestion requiring exploration and one partial flap dehiscence. Late complications included two surgical site infections and two wound recurrences due to continued xylazine use resulting in trans-humeral amputation (40% of those who continued to inject drugs). CONCLUSION: Free tissue transfer can effectively reconstruct xylazine-associated wounds and is necessary for limb salvage in patients with exposed bone. All flaps were viable at 3 weeks. Late wound recurrence due to continued xylazine use is associated with poor outcomes, including amputation. Abstinence from injection drug use is critical to optimizing the chances of recovery, and a multidisciplinary approach is essential.
BDNF-Enriched Wharton's Jelly-Derived Secretome Combined With 3D Biodegradable Chitosan-PCL Conduits Enhances Peripheral Nerve Regeneration in a Rat Model.
Demirtas S, Yildiran G, Cicek G … +5 more , Eren F, Akdeniz H, Celik ZE, Aktan TM, Tosun Z
Microsurgery · 2026 Mar · PMID 41772785 · Publisher ↗
INTRODUCTION: Peripheral nerve injuries often lead to significant functional impairment. While autografts remain the gold standard for repairing critical-sized nerve defects, donor site morbidity and limited graft availa...
INTRODUCTION: Peripheral nerve injuries often lead to significant functional impairment. While autografts remain the gold standard for repairing critical-sized nerve defects, donor site morbidity and limited graft availability have prompted the exploration of alternative strategies. Although studies investigating nerve regeneration using nerve conduits and biological agents are present in the literature, research investigating the effect of neurotrophic factors enriched secretome with biocompatible 3D conduits combination is insufficient. The aim of this study is to evaluate the regenerative potential of 3D biodegradable chitosan-PCL nerve conduit combined with BDNF-enriched secretome in peripheral nerve defects. METHODS: In this study, biodegradable three-dimensional (3D) nerve conduits composed of polycaprolactone (PCL) and chitosan (75:25 wt/wt) were fabricated and used to bridge 10 mm sciatic nerve defects in rats. The conduits were evaluated alone or in combination with the secretome derived from Wharton's Jelly mesenchymal stem cells (WJ-MSC), either in the native form or enriched with brain-derived neurotrophic factor (BDNF). Thirty-two adult male Wistar Albino rats (mean weight 300-400 g) were randomized into four groups: Autograft (Group 1), conduit only (Group 2), conduit and WJ-MSC derived secretome (Group 3), and conduit combined with BDNF-enriched WJ-MSC derived secretome (Group 4). Functional recovery was assessed using the sciatic functional index (SFI), electromyography (EMG), and gastrocnemius muscle wet weight. Morphological and histological evaluations were performed at 12 weeks postoperatively. RESULTS: At the end of 12 weeks, Group 4 (-49.48 ± 2.82) exhibited significantly improved SFI values compared to Group 2 (-66.62 ± 5.31) and Group 3 (-60.60 ± 5.34) (p < 0.05). Electromyographic analysis revealed higher compound muscle action potential amplitutes in Group 4 (19.72 ± 3.62 mV) than Group 2 and Group 3 (p < 0.05), with values compared to the autograft group. Gasrtrocnemius muscle wet weight ratios were also significantly higher in Group 4 (69.09% ± 9.88%) than in Groups 2 and 3. Histological analyses showed enhanced axonal regeneration, reduced inflammation, and better myelination in Group 4. Scanning electron microscopy confirmed the conduit structural integrity and stability over the 12-week period. CONCLUSION: The combination of a 3D biodegradable chitosan-PCL conduit with BDNF-enriched WJ-MSC-derived secretome significantly enhanced peripheral nerve regeneration in a rat model. This strategy shows strong potential as an alternative to autografts for treating critical-sized nerve defects.
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