Microsurgery[JOURNAL]
Sun
200 papers
Toe Transplantation and Digit Replantation in Post-Traumatic Hand Reconstruction: Complementary Roles in a Changing Landscape.
Karamitros G, Lamaris GA, Lineaweaver WC
Microsurgery · 2026 Mar · PMID 41748482 · Publisher ↗
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Preoperative Tranexamic Acid Use in Free Flap Breast Reconstruction: A Propensity-Matched Analysis of Postoperative Outcomes.
Shekouhi R, Byrd B, Branstetter C … +1 more , Chim H
Microsurgery · 2026 Mar · PMID 41748481 · Publisher ↗
INTRODUCTION: Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing perioperative bleeding across multiple surgical interventions. While increasingly utilized in breast reconstruction, e...
INTRODUCTION: Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in reducing perioperative bleeding across multiple surgical interventions. While increasingly utilized in breast reconstruction, evidence regarding its role in free flap procedures remains limited and inconsistent. This study evaluates the impact of preoperative TXA administration on postoperative outcomes in free flap breast reconstruction. METHODS: A retrospective cohort study was performed using the TriNetX research network to identify patients undergoing free flap breast reconstruction. Patients receiving preoperative TXA were compared with those who did not. Propensity score matching was applied to balance demographic and clinical variables. Primary outcomes included hematoma, seroma, bleeding, venous thrombosis, and flap loss. RESULTS: Among 20,778 patients, 524 (2.5%) received preoperative TXA. After 1:1 propensity score matching, 524 TXA patients were compared with 524 controls. Hematoma rates were significantly higher in the TXA group (21.2% vs. 15.3%, RR 0.72, 95% CI 0.55-0.94, p = 0.01). Seroma occurred more frequently in TXA patients (23.2% vs. 18.9%) but was not statistically significant (p > 0.05). Postoperative bleeding, venous thrombosis, and flap loss rates were comparable. Intraoperative hemorrhage occurred exclusively in the non-TXA group (≤ 1.9% vs. 0%, p = 0.001). CONCLUSIONS: Contrary to prior reports, preoperative TXA use in free flap breast reconstruction was associated with a higher incidence of hematoma, without significant reduction in the rate of other complications.
Jaw-In-a-Day Reconstruction: A Scoping Review of Clinical Outcomes and Evidence Gaps.
Soffer JM, Harrison DB, Zebolsky AL … +4 more , Clarke T, Gleysteen JP, Wood CB, Eid A
Microsurgery · 2026 Feb · PMID 41731682 · Publisher ↗
BACKGROUND: Jaw-in-a-Day (JIAD) reconstruction-combining osseous free tissue transfer, dental implant placement, and intraoperative prosthesis delivery-provides immediate functional and psychosocial rehabilitation after...
BACKGROUND: Jaw-in-a-Day (JIAD) reconstruction-combining osseous free tissue transfer, dental implant placement, and intraoperative prosthesis delivery-provides immediate functional and psychosocial rehabilitation after segmental jaw resection. Despite increasing adoption, the existing evidence remains heterogeneous and inconsistently reported. METHODS: A scoping review was conducted following PRISMA-ScR guidelines. PubMed/MEDLINE was searched through April 2025 for studies reporting true JIAD cases, defined strictly as simultaneous free-flap reconstruction, implant placement, and intraoperative delivery of a functional prosthesis. Data were extracted on study design, indications, reconstructive methods, prosthetic variables, implant and flap outcomes, soft-tissue findings, functional recovery, and complications. RESULTS: Thirty-two studies (2009-2025) met inclusion criteria, describing 274 JIAD patients. Most reports were single-center case reports or series (77% Level IV-V evidence) and originated from the United States, with publication frequency increasing sharply after 2021. Reconstruction involved the mandible in 82% of cases, predominantly using fibula flaps (> 95%). Immediate prostheses were fixed in 95% and nearly always provisional, with definitive prosthesis typically delivered 3-6 months postoperatively. Implant survival ranged 87.5%-100% across short- to mid-term follow-up intervals. Maxillary reconstructions and intraoral skin paddles were each associated with increased implant complications in isolated cohorts, but these findings were not replicated. A dedicated series reported peri-implant reactive tissues in 21% of implants, managed with local soft-tissue procedures. Flap survival remained high (92%-100%), and functional recovery was typically rapid, although no study employed validated patient-reported outcome measures. One comparative cohort suggested lower osteoradionecrosis rates when implants were placed before adjuvant radiation, though sample size was small. CONCLUSIONS: JIAD reconstruction yields high implant and flap survival with encouraging early functional outcomes. However, the evidence base is limited by small samples, short follow-up, and inconsistent reporting. Standardized definitions, validated outcome measures, and multicenter prospective studies are needed to clarify long-term durability and refine patient selection.
Three Steps Hybrid Treatment: En Bloc Resection, Endovascular Treatment and Microsurgical Reconstruction. Case Report of a Giant Dorsum-Abdominal-Pelvic Arteriovenous Malformation.
Marin IE, Tamburello S, Mori F … +4 more , Andreoli AL, Alessandro I, Santi R, Menichini G
Microsurgery · 2026 Feb · PMID 41721467 · Full text
Arteriovenous malformations (AVMs) are a rare condition involving the trunk. We present a case of a 55-year-old woman affected by a giant dorsum-abdominal-pelvic AVM, even after multiple endovascular and surgical treatme...
Arteriovenous malformations (AVMs) are a rare condition involving the trunk. We present a case of a 55-year-old woman affected by a giant dorsum-abdominal-pelvic AVM, even after multiple endovascular and surgical treatments over decades which required a different surgical approach. AngioCT scan was performed to identify the feeding vessels, the mass' extension and involvement of underlying tissues. Multidisciplinary discussion agreed on multistep treatment. First, we performed an en bloc resection starting from the right pelvis, moving cranially and laterally toward the right armpit, then removing medially toward the vertebral column, leaving a defect of 30 × 10 cm. Then a selective angiography and a paravertebral embolization of remaining AVM at the T7-level were performed. Reconstruction was then completed with a left hemiabdomen DIEP free flap. We anastomosed one branch of the DIEA to the SCIA and one comitantae vein to the SCIV to assure lateral flow. Then we performed the anastomosis between the DIEA and the second comitantae vein respectively to a branch of TDA and to a branch of the serratus vein. The follow up at 6 months has satisfactory results for both patient and surgeon. This challenging case could provide an alternative for radical surgical excision combined with an endovascular control and microsurgical reconstruction. We describe what we believe to be the first reported giant AVM treated with this sequence multistep surgeries.
Evaluation of the Effectiveness of Immediate Preoperative Team Discussion in Enhancing Surgical Safety and Clinical Outcomes in Head and Neck Free Flap Reconstruction.
Wang YC, Lee SS, Chang YT … +3 more , Lai CS, Wei FC, Kuo YR
Microsurgery · 2026 Feb · PMID 41709092 · Publisher ↗
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Medial Sural Artery Perforator Flap for Tongue and Oral Cavity Reconstruction With Native Tongue Tip Preservation: Report of Three Cases.
Mantovani GP, Baldelli S, Blessent CGF … +2 more , Pinelli M, Mattioli F
Microsurgery · 2026 Feb · PMID 41689568 · Full text
Compartmental hemiglossectomy for oral cavity squamous cell carcinoma creates composite tongue/floor defects in which balancing mobility, bulk, and a supple lining is challenging. We report three consecutive reconstructi...
Compartmental hemiglossectomy for oral cavity squamous cell carcinoma creates composite tongue/floor defects in which balancing mobility, bulk, and a supple lining is challenging. We report three consecutive reconstructions using a medial sural artery perforator (MSAP) flap, emphasizing preservation of the uninvolved tongue tip left intentionally unattached to maximize residual mobility. A 28-year-old woman, a 50-year-old man, and a 36-year-old woman with lateral tongue SCC underwent compartmental resection with selective neck dissection; defects measured ~4 × 3, 5 × 4, and 6 × 5 cm. Thin fasciocutaneous MSAP flaps (5 × 4, 6 × 5, and 7 × 6 cm) were harvested from the medial calf and inset intraorally after tumor ablation, with end-to-end microvascular anastomoses to cervical recipient vessels (typically the lingual or superior thyroid artery and the external or internal jugular vein). All flaps survived without surgical complications; donor sites were closed primarily. Oral feeding resumed on postoperative day 13, 18, and 12, respectively; speech was comprehensible in all cases after standard rehabilitation. Follow-up occurred 6 months after completion of adjuvant radiotherapy (case 1), during adjuvant radiotherapy (case 2), and 3 months after completion (case 3) with all patients tolerating a full oral diet of any consistency and calf scars were linear and inconspicuous with no lower-limb deficits. These findings suggest that, for medium-sized lateral tongue/floor defects, the MSAP provides a favorable balance of pliability and volume with low donor-site morbidity; when oncologically feasible, preserving and not suturing the native tongue tip may further enhance mobility and functional recovery.
Comments on "Anatomical Study of SCIAP (Superficial Circumflex Iliac Artery Perforator) and SIEA (Superificial Inferior Epigastric Artery) Flaps for Flap Harvest Training in the Swine Model".
Zuo Y
Microsurgery · 2026 Feb · PMID 41676977 · Publisher ↗
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Can AI Truly Assist the Microsurgeon? Comments on "Development of a Novel Artificial Intelligence Retrieval-Augmented Generation Model for Microsurgery Clinical Decision Support".
Karamitros G, Lamaris GA, Lineaweaver WC
Microsurgery · 2026 Feb · PMID 41665105 · Publisher ↗
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Where Do We Stand for Nerve Regeneration and Functional Recovery After Vascularized Composite Allotransplantation?
Mathieu O, Knoedler L, Schaschinger T … +5 more , Fenske J, Klimitz FJ, Jeljeli M, Cetrulo CL, Lellouch AG
Microsurgery · 2026 Feb · PMID 41665096 · Full text
INTRODUCTION: Vascularized composite allotransplantation (VCA) offers a reconstructive solution for patients with severe limb and facial defects by transplanting multiple tissue types-including skin, muscle, bone, and ne...
INTRODUCTION: Vascularized composite allotransplantation (VCA) offers a reconstructive solution for patients with severe limb and facial defects by transplanting multiple tissue types-including skin, muscle, bone, and nerves-as a single unit. This review examines current challenges in nerve regeneration and functional recovery following VCA, and assesses emerging strategies aimed at overcoming these hurdles. METHODS: A comprehensive literature review was conducted, focusing on clinical outcomes from upper limb and facial transplantation programs worldwide. Studies evaluating rehabilitation protocols, transplantation levels, follow-up durations, and experimental strategies (cellular therapies, biomaterials, and neurotrophic factor delivery) were analyzed to determine their impact on nerve regeneration and functional recovery. RESULTS: Clinical evidence indicates that while protective sensation can return within months after VCA, motor function recovery often extends over several years. Variability in outcomes has been noted, largely due to differences in rehabilitation practices, assessment metrics, and follow-up duration. Experimental approaches, including stem cell-based therapies-especially those using adipose-derived stem cells-demonstrate potential for enhancing axonal regeneration and modulating immune responses, although the long-term benefits and standardized measures remain to be fully established. CONCLUSIONS: Despite promising advancements in surgical techniques and immunosuppressive regimens, effective nerve regeneration in VCA remains a significant challenge. The variability in clinical outcomes underscores the need for standardized functional assessment protocols and further research into novel regenerative therapies. Future studies should focus on refining these therapeutic strategies to improve long-term functional recovery and minimize the reliance on chronic immunosuppression.
The Art and Science of Dangling: A Systematic Review of Free Flap Protocols.
Foppiani JA, Leung DC, Syal A … +7 more , Anderson RN, Zargari P, Patel N, Schwarz N, Suszynski T, Choudry U, Lin SJ
Microsurgery · 2026 Feb · PMID 41657266 · Publisher ↗
BACKGROUND: Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasin...
BACKGROUND: Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasing limb dependency, to enhance venous adaptation. However, wide variability exists in their design, and the impact of dangling duration and frequency on complication rates remains unclear. METHODS: A systematic meta-analysis was performed to evaluate pooled complication rates associated with dangling protocols and to assess whether protocol duration (minutes per session) or frequency (number of sessions) was associated with adverse outcomes. Following PRISMA 2020 guidelines, we searched Medline, Embase, Web of Science, and Cochrane for relevant studies published through 2024. Then, a random-effects model was used to estimate pooled rates of partial flap loss, total flap loss, venous congestion, arterial compromise, hematoma, infection, wound dehiscence, return to the operating room, and donor site complications. Meta-regression was performed to examine associations with dangling protocol characteristics. RESULTS: Across pooled studies, overall complication rates were low, including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). No statistically significant associations were found between dangling duration and any complication type. While increased frequency of dangling was significantly associated with higher return-to-OR rates in the full model (slope = 0.0224; p = 0.0002), this relationship was entirely driven by a single study reporting 24 sessions/day. When this outlier was excluded, the association became non-significant. CONCLUSION: Dangling protocols appear safe and well tolerated, with low rates of major complications. While the duration of dangling sessions does not affect complication risk, higher frequency may increase the likelihood of surgical re-intervention. These findings support the need for standardized, evidence-based protocols and further research into the physiologic and clinical thresholds guiding postoperative flap care. A meta-analysis of lower extremity free flap studies demonstrated low complication rates across common endpoints including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%).
Postmastectomy Breast Reconstruction Following Massive Weight Loss: An Updated Systematic Review and Identification of Research Gaps.
Paganini A, Löfstrand J, Mirzaei N … +1 more , Hansson E
Microsurgery · 2026 Feb · PMID 41614595 · Full text
BACKGROUND: As bariatric surgery becomes increasingly common, reconstructive surgeons are encountering more massive weight loss (MWL) patients requiring breast reconstruction. MWL alters breast anatomy, tissue characteri...
BACKGROUND: As bariatric surgery becomes increasingly common, reconstructive surgeons are encountering more massive weight loss (MWL) patients requiring breast reconstruction. MWL alters breast anatomy, tissue characteristics, and healing capacity, potentially impacting reconstructive outcomes. OBJECTIVE: To update and evaluate the evidence on how MWL affects complication and revision rates, flap-relevant anatomy, and patient-reported outcomes (PROMs) following postmastectomy breast reconstruction. In addition, research gaps were identified. METHODS: This systematic review updated a previous review and followed PRISMA guidelines. Eligible studies included cohort studies and case series of postmastectomy breast reconstruction after MWL. Data extraction and appraisal were performed independently by two reviewers, with evidence quality rated using the GRADE system. RESULTS: Fifteen studies met the inclusion criteria, including three case-control studies and twelve case series, reporting outcomes for 102 patients after massive weight loss (MWL). Most reconstructions used abdominally based free flaps, with few MWL-specific modifications. MWL patients experienced significantly higher rates of delayed wound healing, surgical-site infection, fat necrosis, and need for revision compared with controls, while total flap loss rates were similar. Evidence on implant-based reconstruction, vascular anatomy, and PROMs was scarce. The overall certainty of evidence was very low (GRADE ⊕⊝⊝⊝). CONCLUSION: Breast reconstruction after MWL is associated with increased wound-healing complications and revision rates, though patient satisfaction appears acceptable. Evidence remains limited by small, heterogeneous studies and a lack of controlled or prospective data. Future research should address optimal reconstructive techniques, timing, and patient selection, including the identification of modifiable risk factors and the use of PROMs to guide evidence-based care.
Autonomization of Microvascular Free Flaps in Reconstructive Surgery: A Narrative Review.
Wüster J, Knoedler L, Niederegger T … +4 more , Brandenburg LS, Hundeshagen G, Heiland M, Koerdt S
Microsurgery · 2026 Feb · PMID 41614570 · Full text
BACKGROUND: Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, s...
BACKGROUND: Microvascular free tissue transfer is a key technique in reconstructive surgery, enabling functional and aesthetic restoration of complex defects. While initial flap survival relies on the vascular pedicle, some flaps may become independent through a process known as autonomization, where new vascular connections form between the flap and recipient site. Understanding the timeline, mechanisms, and clinical relevance of this process is essential for safe surgical planning and postoperative interventions. METHODS: A narrative review was conducted to synthesize current literature on microvascular flap autonomization. Databases including PubMed and Google Scholar were searched up to June 2025, focusing on studies examining flap selection, neovascularization, perfusion monitoring, and predictors of flap vascular independence. Articles were screened based on relevance, methodological quality, and clinical applicability. RESULTS: Flap autonomization showed heterogeneous timelines in literature. Skin and muscle flaps generally tolerated earlier pedicle compromise than jejunal or osteocutaneous flaps, while tissue composition, vascular contact area, recipient bed quality, and comorbidities strongly influenced revascularization. Favorable conditions-such as thin fasciocutaneous or muscle flaps on well-perfused beds-were associated with earlier integration, whereas irradiated tissue and systemic vascular disease delayed independence. Monitoring tools (ICG angiography, laser Doppler, NIRS) aided perfusion assessment but could not confirm full autonomization. Complications were linked to delayed or incomplete neovascularization, particularly during secondary procedures. Adjunctive strategies, including ischemic conditioning and flap "training," showed potential to promote vascular remodeling, but clinical evidence remains limited. CONCLUSION: Flap autonomization is a critical but poorly understood process that varies by flap type and patient context. Despite early neovascular activity, the lack of reliable markers necessitates conservative postoperative protocols. Emerging technologies and bioengineered strategies hold promise but require further validation. Standardized criteria to assess vascular independence could significantly improve outcomes in microvascular reconstructive surgery.
Distal Nerve Transfers for Foot Drop: A Systematic Review and Meta-Analysis.
Jerome JTJ, Surendran G, Kuppusamy T
Microsurgery · 2026 Jan · PMID 41588939 · Publisher ↗
BACKGROUND: Foot drop from peroneal nerve palsy causes steppage gait and functional disability. Tendon transfer is reliable but sacrifices native biomechanics. Distal nerve transfer (DNT) reinnervates dorsiflexors, poten...
BACKGROUND: Foot drop from peroneal nerve palsy causes steppage gait and functional disability. Tendon transfer is reliable but sacrifices native biomechanics. Distal nerve transfer (DNT) reinnervates dorsiflexors, potentially restoring more physiologic function. This study aimed to systematically review and meta-analyze the clinical outcomes of DNT for foot drop and to identify key prognostic and technical factors that inform contemporary reconstructive decision-making. METHODS: Following PRISMA, we searched MEDLINE, EMBASE, and Cochrane (through September 2025) for clinical studies of DNT to the deep peroneal nerve (DPN) or its branches. Primary outcome was the proportion achieving Medical Research Council (MRC) grade ≥ 3 dorsiflexion; secondary outcome was MRC ≥ 4. Pooled proportions were estimated with random-effects meta-analyses using binomial generalized linear mixed models, reporting 95% confidence intervals, heterogeneity (I), and 95% prediction intervals; sensitivity and small-study analyses are detailed in the Supplement. RESULTS: Ten studies (nine clinical, one cadaveric; n = 120) met inclusion. Across k = 7 clinical series (N = 101) with extractable data, pooled MRC ≥ 3 was 0.57 (95% CI 0.41-0.72, I = 59.6%, τ = 0.032, 95% PI 0.29-0.83). Excluding the iatrogenic series yielded 0.50 (95% CI 0.35-0.66; I = 42.1%). For MRC ≥ 4 across k = 5 series (N = 42), the pooled estimate was 0.33 (95% CI 0.12-0.58; I = 67.9%, τ = 0.041, 95% PI 0.08-0.73). AFO independence paralleled strength recovery. Donor morbidity was low. CONCLUSIONS: DNT restores antigravity dorsiflexion in approximately half of appropriately selected patients, with one-third reaching near-normal strength. Early surgery (≤ 12 months) and viable anterior compartments optimize outcomes. Tendon transfer remains a reliable fallback and can be combined with DNT in complex cases.
Comments on "Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report".
Berkane Y, Girard P, Bertheuil N … +1 more , Bodin F
Microsurgery · 2026 Jan · PMID 41588931 · Publisher ↗
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Prevalence of Subclinical Internal Jugular Vein Thrombosis After Microvascular Head and Neck Reconstruction.
Kurita D, Miyamoto S, Saito Y … +3 more , Kobayashi K, Fujisawa K, Okazaki M
Microsurgery · 2026 Jan · PMID 41575013 · Full text
BACKGROUND: The risk of internal jugular vein thrombosis is a concern when using the internal jugular vein as a recipient vein in microvascular head and neck reconstruction. This study aimed to investigate the incidence...
BACKGROUND: The risk of internal jugular vein thrombosis is a concern when using the internal jugular vein as a recipient vein in microvascular head and neck reconstruction. This study aimed to investigate the incidence of internal jugular vein thrombosis within 2 weeks of microvascular head and neck reconstruction using computed tomographic angiography. METHODS: This retrospective study included 103 patients who underwent postoperative contrast-enhanced computed tomography within 2 weeks of microvascular head and neck reconstruction. The incidence, characteristics, treatment course, outcomes, and risk factors of internal jugular vein thrombosis were investigated. RESULTS: Internal jugular vein thrombosis was found in five cases (4.7%). In three of these cases (2.8%), internal jugular vein thrombosis occurred on the side of the microvascular anastomosis, and all of them were completely obstructed; however, the flaps survived without vascular compromise. No variables were considered risk factors for internal jugular vein thrombosis. CONCLUSIONS: The incidence of internal jugular vein thrombosis after microvascular head and neck reconstruction was lower than previously reported. Most cases of internal jugular vein thrombosis are assumed to be subclinical and do not lead to anastomotic failure. It remains unclear whether asymptomatic internal jugular vein thrombosis on the anastomotic side should be treated.
Sensory Recovery Following Digital Nerve Repair Using Conduits Versus Autologous Nerve Grafts: A Systematic Review and Meta-Analysis.
Omran AM, Hassan AA, Hamdeno S … +8 more , Elhendawy MA, Elghor MM, Khattab RF, Gaafar M, Mahmoud Ismail H, Elkasaby MH, Hassan AA, Abdelmaksoud SM
Microsurgery · 2026 Jan · PMID 41563884 · Publisher ↗
BACKGROUND: Peripheral nerve injuries (PNI), particularly digital nerve injuries, can lead to significant loss of function, pain, and sensory deficits. Autologous nerve grafting (ANG) has been the gold standard for nerve...
BACKGROUND: Peripheral nerve injuries (PNI), particularly digital nerve injuries, can lead to significant loss of function, pain, and sensory deficits. Autologous nerve grafting (ANG) has been the gold standard for nerve gap reconstruction, but it is associated with donor site morbidity and other complications. Nerve conduits, including collagen-based, chitosan-based, and muscle-in-vein conduits, have emerged as potential alternatives with the advantage of avoiding donor site morbidity. The objective of this systematic review and meta-analysis was to compare the efficacy and safety of nerve conduits versus autologous nerve grafts for digital nerve repair, with a particular focus on sensory recovery. METHODS: A systematic review and meta-analysis were performed following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies comparing nerve conduits to ANG for the treatment of digital nerve injuries were identified through comprehensive database searches up to July 2025 on PubMed, Scopus, Embase, and Web of Science. Primary outcomes included static and moving two-point discrimination (S2PD and M2PD). Secondary outcomes included the safety profile. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using a random-effects model. RESULTS: A total of five studies with a total number of 214 patients were included in the analysis. Nerve conduits showed comparable sensory recovery to ANG for both S2PD (MD = -0.21; 95% CI -2.25 to 1.83; p = 0.84) and M2PD (MD = -0.67; 95% CI -2.00 to 0.66; p = 0.84). Subgroup analysis indicated that chitosan-based conduits demonstrated significantly better outcomes than ANG for S2PD (MD = -2.57; 95% CI -3.40 to -1.74; p < 0.0001); however, overall pooled results across all conduit types showed comparable sensory recovery to ANG. Complication rates were comparable between the two treatments (RR = 2.36; 95% CI 0.90 to 6.22; p = 0.08), with low heterogeneity across studies (I = 0%). Pooled results from RCTs showed a lower rate of complications with the conduit compared to ANG, RR = 3.32 (95% CI: 1.15 to 9.64; p = 0.03), with no heterogeneity (I = 0%). CONCLUSIONS: Nerve conduits, particularly chitosan-based, collagen-based, and muscle-in-vein conduits, provide comparable sensory recovery to ANG without donor site morbidity, representing a viable alternative for digital nerve repair.
Reverse End-to-Side Abductor Digiti Minimi-to-Recurrent Motor Branch Nerve Transfer for Severe Carpal Tunnel Syndrome: Report of Three Cases.
Blum E, Brantingham A, Goodlin J … +2 more , Olafsen NP, Dy CJ
Microsurgery · 2026 Jan · PMID 41563882 · Publisher ↗
Severe carpal tunnel syndrome (CTS) with advanced thenar denervation has limited reconstructive options, and reliable reinnervation remains challenging. Reverse end-to-side (RETS) nerve transfers have been described in o...
Severe carpal tunnel syndrome (CTS) with advanced thenar denervation has limited reconstructive options, and reliable reinnervation remains challenging. Reverse end-to-side (RETS) nerve transfers have been described in other contexts but to our knowledge, have not been applied clinically to compressive median neuropathy at the wrist. Here, we present three patients, ages 59, 68, and 72 years, with severe CTS, visible thenar atrophy, and electrodiagnostic evidence of profound median motor axon loss who underwent carpal tunnel release with abductor digiti minimi (ADM)-to-recurrent motor branch (RMB) RETS transfer. All procedures were performed using a standardized microsurgical technique. Follow-up was 10 months (Case 1), 24 months (Case 2), and 8 months (Case 3). Postoperatively, each patient demonstrated early return of visible thenar contraction between 6 weeks and 4 months, with final abductor pollicis brevis (APB) strength of 4 to 4+. Sensory recovery improved across all cases, with two-point discrimination normalizing to 5-8 mm. Follow-up electrodiagnostic studies in two patients showed markedly greater APB compound muscle action potential (CMAP) amplitudes when stimulating through the ulnar nerve than through the median nerve, consistent with donor-derived reinnervation through the transfer. Patient-reported outcome measurement information system (PROMIS) upper extremity (UE) and physical function (PF) scores improved by 9-22 points. Although these early results suggest the potential for donor-derived reinnervation in severe CTS, the findings are preliminary and should be interpreted with caution. Larger prospective studies will be necessary to determine the true functional benefit, appropriate patient selection criteria, and comparative effectiveness of this technique.
Computer Aided Design/Computer Aided Manufacturing-Guided Scapular Tip Free Flap Reconstruction for Complex Maxillofacial Defects.
Laganà F, Marzi Manfroni A, Arcuri F … +2 more , Ferri A, Bianchi B
Microsurgery · 2026 Jan · PMID 41518152 · Publisher ↗
BACKGROUND: Reconstruction of maxillary and mandibular defects following oncologic resection remains challenging due to their three-dimensional complexity and critical role in function and aesthetics. The scapular tip fr...
BACKGROUND: Reconstruction of maxillary and mandibular defects following oncologic resection remains challenging due to their three-dimensional complexity and critical role in function and aesthetics. The scapular tip free flap (STFF) provides reliable vascularity, substantial bone stock, and chimeric versatility. Computer-Aided Design and Manufacturing (CAD/CAM) has been widely applied in reconstructive surgery to optimize resection accuracy and flap insetting, but its role in STFF supine harvest and inset has never been reported. This report aims to describe the advantages of application of CAD/CAM technology to guide resection and reconstruction in complex maxillary and mandibular oncological defects. PATIENTS AND METHODS: We retrospectively analyzed nine patients who underwent maxillary (n = 5) or mandibular (n = 4) reconstruction with STFF between January 2023 and December 2024 at IRCCS Policlinico San Martino, Genoa, Italy. Nine patients of mean age 67.4 years with malignant neoplasms of the mandible (n = 4) or maxilla (n = 5), including squamous cell carcinoma (n = 7) and carcinoma ex inverted papilloma (n = 2), were included in the study. Preoperative virtual surgical planning was performed in collaboration with biomedical engineers to design patient-specific cutting guides and titanium plates. Functional outcomes were assessed using the EORTC QLQ-HN35 questionnaire; morphological accuracy was evaluated by overlay analysis of pre- and postoperative 3D imaging. Operative and ischemia times, complications, and patient-reported satisfaction were recorded. RESULTS: All procedures were successfully completed without major intraoperative complications. CAD/CAM-assisted planning enabled precise osteotomies and facilitated flap contouring prior to pedicle division, resulting in reduced ischemia duration and streamlined operative workflow, particularly in mandibular reconstructions. Functional assessments showed preserved swallowing and speech with only mild limitations in social eating and social interaction. Morphological analysis demonstrated high concordance between pre- and postoperative reconstructions, with minimal surface differential in maxillary (range 198-258 mm) and mandibular (range 156-204 mm) bounding boxes, demonstrating satisfactory restoration of facial contour. Patient-reported satisfaction was high across the cohort, ranging from acceptable to excellent. CONCLUSION: CAD/CAM-assisted STFF reconstruction allows accurate three-dimensional restoration with shortened operative and ischemia times, leading to predictable functional recovery and favorable aesthetic outcomes. Despite the need for additional preoperative planning and resources, this approach enhances intraoperative efficiency and provides reproducible results, representing a valuable option for selected patients with complex maxillofacial defects.
Free Anterolateral Thigh Flap Reconstruction After Excision of Extensive Vascular Malformations in Toddlers: Report of Two Cases.
Fujisawa K, Miyamoto S, Okazaki M
Microsurgery · 2026 Jan · PMID 41510600 · Full text
Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report...
Vascular malformations often become symptomatic during childhood and require multidisciplinary intervention. However, reports of resection followed by free flap reconstruction in pediatric patients remain rare. We report two toddler cases of vascular malformations reconstructed with free anterolateral thigh (ALT) flaps. Case 1 was a 2-year-old boy with a submandibular venous malformation complicated by coagulopathy. After lesion resection with overlying skin (5 × 10 cm), an ALT flap (5.5 × 12 cm) was transferred. The flap artery was interposed with the transected facial artery, and the veins were anastomosed end-to-side to the internal and external jugular veins. The flap survived completely, and coagulation parameters normalized. Case 2 was a 3-year-old boy with a painful forearm ulcer caused by a capillary lymphatic venous malformation. After ulcer debridement (5.5 × 13 cm), the defect was reconstructed with an ALT flap (6 × 14 cm). The flap vessels were anastomosed to the radial artery and its concomitant veins in a flow-through manner. Partial flap necrosis required secondary wound closure, but the ulcer did not recur, and the pain resolved completely. No anastomotic failure or donor-site complications occurred in either case. Extensive resection followed by ALT flap reconstruction is a reliable option for pediatric vascular malformations. Meticulous microvascular techniques and multiple anastomoses may reduce microvascular complications in young patients.
Microsurgical Reconstruction of the Columella With a First Web Space Free Flap: A Case Report and Review of Techniques.
Cilingir S, Bicici P, Aksoy A
Microsurgery · 2026 Jan · PMID 41503949 · Publisher ↗
Reconstruction of the columella, one of the smallest facial subunits, presents significant aesthetic and functional challenges due to its complex anatomy, limited local tissue for repair, and restricted vascularisation....
Reconstruction of the columella, one of the smallest facial subunits, presents significant aesthetic and functional challenges due to its complex anatomy, limited local tissue for repair, and restricted vascularisation. Although many methods are described, literature on microsurgical solutions for complex secondary reconstructions, especially after conventional methods have failed, remains limited. This report introduces a tailored, single-stage approach that combines a first web space free flap from the foot with an iliac bone graft to provide both soft tissue coverage and structural support, while also reviewing other microsurgical techniques. A 24-year-old patient presented with a severe deformity, including a shortened columella, depressed nasal tip, and a scar extending to the right upper lip, causing alopecia in the mustache area due to a shrapnel injury during the Palestine War. After excising scar tissue and a necrotic L-strut from a previous failed surgery, a 2 × 3 cm columellar and septal defect was created. A fasciocutaneous free flap from the first web space of the foot was planned as a 2.5 × 4 cm rectangle, positioned transversely over the first web space and microsurgically transferred for end-to-end anastomosis to the angular artery and vein, then folded over an iliac bone graft to provide both external skin coverage and internal lining. The postoperative course was uneventful, and the patient was discharged on the fifth day. At the one-year follow-up, the reconstructed columella remained stable, and the patient expressed high satisfaction with the final aesthetic and functional results. This report shows that the first web space free flap, combined with a structural bone graft, offers a single-stage solution for complex columellar defects, providing a tailored approach when conventional methods have failed or are insufficient. The novelty of this approach lies in using an iliac bone graft, which offers strong and durable support capable of resisting scar contracture and maintaining long-term nasal tip projection despite heavily scarred tissue. Compared with other reviewed techniques, this single-stage approach avoids the multiple procedures required for prefabricated flaps and reduces donor site morbidity or bulkiness. Furthermore, its long vascular pedicle is an advantage over shorter-pedicled auricular or hand flaps, while the robust bone graft supplies a more durable framework against the contractile forces of compromised local tissue than cartilage-based reconstructions.
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