Chen B, Glenney A, Gerndt S
… +4 more, Interval E, Low G, Swegal W, Murariu D
Microsurgery
· 2026 Jan · PMID 41503926
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INTRODUCTION: Traditional oropharyngeal resection may require lip-split mandibulotomy approach (LSMA) which risks high morbidity. Transoral robotic surgery (TORS) through the oral pharynx mitigates these risks. Free flap...INTRODUCTION: Traditional oropharyngeal resection may require lip-split mandibulotomy approach (LSMA) which risks high morbidity. Transoral robotic surgery (TORS) through the oral pharynx mitigates these risks. Free flap (FF) inset following resection is challenging and may require open approaches, negating the benefits of TORS resection. We present our case series utilizing the single port (SP) robot for FF inset, which has improved visualization and functionality compared with a multiport robot. METHODS: A retrospective review of robotic FF inset following TORS using the SP from 2021 to 2022. Patient and tumor characteristics as well as operative and postoperative details were gathered. RESULTS: Five cases were performed with an average age of 62.4 (50-78) years. Radial forearm FF was used in three cases and anterolateral thigh flap in two. Mean operative time was 528 (423-742) minutes with an average ischemia time of 156.6 (124-198) min. Average functional oral intake score was 5.8 (3-7) out of 7. There were no FF losses or wound healing issues at an average of 17.6 (7-27) months follow-up. CONCLUSION: Robotic FF inset following TORS is feasible with the SP robot already used by ENTs for resection. The platform has 6 mm instruments capable of 7 degrees of freedom, use of a third arm for dynamic retraction, and the ability to assume a "cobra-like" position to leverage a tight space. This gives plastic surgeons an opportunity to decrease the complication profile from FF inset that would otherwise require potentially morbid exposures.
Alnemri A, Moroco A, Garg N
… +7 more, Bridgham K, Davis M, Kaki P, McCann A, Thal A, Krein H, Heffelfinger R
Microsurgery
· 2026 Jan · PMID 41499483
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INTRODUCTION: The radial forearm free flap (RFFF) is a versatile free flap in the reconstruction of head and neck defects. There is little consensus on the optimal technique for reconstructing RFFF donor site defects. Ou...INTRODUCTION: The radial forearm free flap (RFFF) is a versatile free flap in the reconstruction of head and neck defects. There is little consensus on the optimal technique for reconstructing RFFF donor site defects. Our group previously reported early results using staged reconstruction with initial placement of Integra, a dermal regeneration matrix, followed by a split thickness skin graft (STSG), resulting in excellent aesthetic and functional outcomes. Here we provide our long-term experience using staged STSG compared to primary STSG for the reconstruction of RFFF donor site defects. METHODS: Patients undergoing RFFF reconstruction of head and neck defects at a single institution between May 2012 and April 2023 were retrospectively reviewed. Primary versus staged STSG placement was compared in terms of donor site morbidity. RESULTS: A total of 179 patients were included: 46 (25.7%) primary STSG and 133 (73.3%) staged STSG. Following primary STSG, 34 (73.9%) patients had a vacuum-assisted closure (VAC) and 12 (26.1%) had an iodine-coated petroleum gauze bolster placed. In the staged STSG group, all patients had a VAC after Integra placement. After the second stage, 30 (22.6%) patients had a VAC, and 103 (77.4%) patients had a bolster placed. Compared to the staged group, the primary group had a significantly higher rate of skin graft breakdown (21.7% vs. 6.0%; p = 0.008) and tendon exposure (19.6% vs. 3.8%; p = 0.002). In the staged group, bolster placement was associated with a lower rate of skin graft breakdown compared to VAC (2.9% vs. 16.7%; p = 0.015). CONCLUSION: When reconstructing donor site defects following RFFFs, staged reconstruction with initial placement of Integra followed by STSG and bolster placement may result in lower rates of skin graft breakdown and tendon exposure.
Microsurgery
· 2026 Jan · PMID 41499474
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Reconstruction of pretibial defects remains challenging due to frequent bone exposure, lack of local flap options, and thin soft tissue coverage. These factors make achieving durable and aesthetically pleasing coverage d...Reconstruction of pretibial defects remains challenging due to frequent bone exposure, lack of local flap options, and thin soft tissue coverage. These factors make achieving durable and aesthetically pleasing coverage difficult, often necessitating the use of free flaps to ensure successful reconstruction. This case report presents the case of a 68-year-old woman with a pretibial undifferentiated pleomorphic sarcoma treated with neoadjuvant radiotherapy and wide local excision, resulting in a 12 × 10 cm soft tissue defect with tibial bone exposure. Reconstruction was achieved using a combination of two perforator-based local flaps: A pedicled medial sural artery perforator (MSAP) flap for the medial aspect and a V-Y advancement flap based on an anterior tibial artery perforator for the lateral aspect. Postoperative recovery was uneventful. At one-year follow-up, the reconstruction showed stable coverage, satisfactory contour, and no signs of recurrence of the tumor or lymphedema. The combination of local perforator flaps offers a reliable and aesthetically favorable solution for complex pretibial defects. It allows surgeons to avoid microsurgical procedures, thereby reducing operative time, technical demands, and perioperative risks. This case highlights the potential of combining local flaps, preserving uninvolved donor sites, and minimizing overall morbidity. This solution represents a practical and effective alternative to free flap reconstruction and may contribute to expanding the reconstructive options available for managing complex lower limb defects.
Wang E, Cleff B, Basta A
… +7 more, Green JC, Swiekatowski KR, Won P, Slaughter K, Goldstein R, Sputova K, Freet D
Microsurgery
· 2026 Jan · PMID 41492140
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BACKGROUND: Phalloplasty plays an important role in female-to-male (FTM) gender affirmation surgery to create a neophallus that prioritizes aesthetic and functional outcomes. Patients have a variety of flap choices for p...BACKGROUND: Phalloplasty plays an important role in female-to-male (FTM) gender affirmation surgery to create a neophallus that prioritizes aesthetic and functional outcomes. Patients have a variety of flap choices for phalloplasty, but they can often come with complications. This study aimed to evaluate the impact of flap choice on the rate of complications in phalloplasty. METHODS: This retrospective cohort study was conducted at a single institution of adult patients who underwent either phalloplasty with radial forearm (RFFF), anterolateral thigh (ALT) pedicled flaps, or pedicled abdominal flaps. Complications of urethral stricture, urethral fistula, necrosis of neophallus, infection, wound dehiscence, and flap loss were analyzed. RESULTS: A total of 57 patients underwent phalloplasty. RFFF was used in 25 (43.9%) patients, ALT flaps in 10 (17.5%) patients, and pedicled abdominal flaps in 22 (38.6%) patients. The overall complication rate was 61.4%. RFFF had the highest complication rate (80%), followed by ALT (60%) and pedicled abdominal flaps (40.9%) (p = 0.023). RFFF had the highest rate of urological complications (60%) (p = 0.013), including fistulas (48%) compared to ALT (20%) and pedicled abdominal flaps (9.1%) (p = 0.011), and urethral strictures (44%) compared to ALT (20%) and pedicled abdominal flaps (22.7%) (p = 0.24). RFFF required more reoperations (64%) compared to ALT (40%) and pedicled abdominal flaps (31.8%) (p = 0.082). On multivariate analysis, patients experiencing complications were more likely to have blood thinners (OR = 1.85, 95% CI: 1.05-3.25, p = 0.039) and less likely to undergo staged phalloplasty (OR = 0.91, 95% CI: 0.32-2.61). DISCUSSION: Flap choice for phalloplasty requires careful consideration between patients and providers. Pedicled abdominal flaps were associated with fewer complications, such as fistulas, urethral strictures, and reoperations. However, patients may opt for RFFF to maximize aesthetic outcomes despite such risks. Insight into clinical outcomes is vital to both surgeons and their patients to enhance the shared decision-making process.
Microsurgery
· 2026 Jan · PMID 41489491
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BACKGROUND: Dorsal hand defects, often caused by trauma or tumor excision, remain a surgical challenge owing to the complex anatomy and functional demands of the hand. Various methods such as skin grafts, local flaps, an...BACKGROUND: Dorsal hand defects, often caused by trauma or tumor excision, remain a surgical challenge owing to the complex anatomy and functional demands of the hand. Various methods such as skin grafts, local flaps, and free tissue transfers are available, but each has limitations. The bilobed flap, traditionally used in nasal reconstruction, offers reliable vascularity and favorable aesthetic outcomes; however, its use in dorsal hand defects has rarely been reported. MATERIALS AND METHODS: This retrospective study evaluated 16 patients treated for dorsal hand defects following tumor excision between 2016 and 2021. Reconstruction was performed by using bilobed perforator flaps. Patients with comorbidities, such as diabetes, peripheral vascular disease, vascular sclerosis, or a history of smoking, were excluded. Data collected included patient demographics, defect and flap sizes, complications, postoperative Michigan Hand Outcomes Questionnaire (MHQ) and Vancouver Scar Scale (VSS) scores, and follow-up durations. Flaps were designed based on perforator localization, with primary and secondary lobes proportionally constructed to ensure optimal coverage and minimal tension. RESULTS: The average age was 55.63 years. Squamous cell carcinoma was the most common type of cancer. The mean defect size was 4.31 cm, and the average follow-up was 16.06 months. Postoperative VSS and MHQ scores indicated satisfactory aesthetic and functional outcomes. Minor complications such as venous congestion and partial necrosis were successfully managed. CONCLUSION: Bilobed perforator flaps provide a reliable, functional, and cosmetically favorable option for dorsal hand reconstruction. Their rotational flexibility and minimal donor site morbidity make them a promising alternative for carefully selected patients, expanding their potential utility beyond traditional nasal applications.
Zhang SM, Laustsen-Kiel CM, Ørholt M
… +7 more, Herly M, Nielsen LJ, Wolthers MS, Jensen LT, Andersen PS, Vester-Glowinski P, Jensen DH
Microsurgery
· 2026 Jan · PMID 41472532
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BACKGROUND: The deep inferior epigastric perforator (DIEP) flap is a favored option for autologous breast reconstruction. However, complications related to insufficient perfusion, such as flap loss and fat necrosis, rema...BACKGROUND: The deep inferior epigastric perforator (DIEP) flap is a favored option for autologous breast reconstruction. However, complications related to insufficient perfusion, such as flap loss and fat necrosis, remain significant concerns. SPY Elite Fluorescence Imaging enables real-time tissue perfusion assessment during surgery, potentially reducing complications through superior visualization compared with clinical assessment alone. This study evaluates surgical outcomes and healthcare utilization patterns before and after the implementation of SPY imaging for DIEP flap breast reconstruction. PATIENTS AND METHODS: This retrospective study examined 271 breast cancer patients undergoing DIEP flap reconstruction at Rigshospitalet, Copenhagen (November 2016-June 2024), with 164 in the SPY group and 107 in the non-SPY group. Outcomes included flap complications and frequency of postoperative visits. RESULTS: The interrupted time series revealed a significant decrease in complications over time (β = -0.110, p < 0.001) with SPY implementation. Overall rate of flap complications saw a relative risk reduction of 21.3%, explained by a reduction in rates of flap infection, flap loss, and seroma. Healthcare utilization decreased across all categories: hospital visits (-21.6%), doctor visits (-17.4%), and nurse visits (-23.6%). The number needed to treat to prevent one complication was 6.0. CONCLUSIONS: SPY imaging implementation was associated with significant reductions in flap complications and healthcare utilization. While our interrupted time series design strengthens causal inference by accounting for temporal trends and learning curves, the observational nature precludes definitive causal claims. The technology shows potential clinical and economic value. Prospective studies are needed to validate these findings and establish standardized protocols for optimal application.
Cevik J, Zhang H, Ichikawa Y
… +4 more, Cheong E, Li P, Varma A, Ramakrishnan A
Microsurgery
· 2026 Jan · PMID 41462016
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BACKGROUND: Unplanned return to theater (URTT) following head and neck cancer reconstruction presents significant clinical and economic challenges. Identifying risk factors for URTT can aid in surgical planning and patie...BACKGROUND: Unplanned return to theater (URTT) following head and neck cancer reconstruction presents significant clinical and economic challenges. Identifying risk factors for URTT can aid in surgical planning and patient risk stratification. This study evaluates preoperative and intraoperative factors associated with URTT in patients undergoing free flap reconstruction after head and neck tumor resection. METHODS: A retrospective cohort study was conducted on patients undergoing head and neck tumor resection with free flap reconstruction between July 2015 and January 2024. Demographic, clinical, and operative data were analyzed using univariable and multivariable logistic regression. RESULTS: Of 609 patients included, 199 (32.7%) experienced URTT within 90 days postoperatively. Common indications for URTT included infected collections (33.7%), hematoma (24.6%), and flap dehiscence (16.1%). On univariable analysis, preoperative PEG tube use (unadjusted odds ratio (OR) 1.78 [95% confidence interval (CI) 1.03-3.07], p = 0.04), higher frailty index scores (1.27 [1.03-1.58], p = 0.03), longer operative duration (1.15 [1.06-1.24], p < 0.001), use of bony free flaps (2.08 [1.44-3.01], p < 0.001), and tracheostomy (2.09 [1.22-3.56], p = 0.01) were associated with URTT. Yet, on multivariable analysis, only higher frailty index score (adjusted OR 1.32, 95% CI 1.03-1.70, p = 0.03) and use of bony free flaps (adjusted OR 1.92, 95% CI 1.19-3.11, p < 0.01) retained statistical significance. CONCLUSIONS: The findings of this study suggest that frailty and the use of bony free flaps are key risk factors for URTT among reconstructive head and neck cancer patients. These findings support patient risk stratification preoperatively and targeted interventions to reduce the risk of URTT and improve resource utilization in head and neck cancer surgery.
Microsurgery
· 2026 Jan · PMID 41462012
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BACKGROUND: The superficial palmar branch of the radial artery (SUPBRA) flap provides glabrous, sensate, and pliable skin, making it a valuable option for digital reconstruction. The flap's skin island can be oriented ei...BACKGROUND: The superficial palmar branch of the radial artery (SUPBRA) flap provides glabrous, sensate, and pliable skin, making it a valuable option for digital reconstruction. The flap's skin island can be oriented either vertically or transversely; however, no prior study has compared these designs. This study presents the first clinical comparison of these two orientations, highlighting their anatomical and functional differences. METHODS: Between 2018 and 2022, 29 patients underwent free SUPBRA flap reconstruction. Fourteen received vertical skin islands (vSupbra) and 15 received transverse designs (tSupbra). Flap anatomy, surgical parameters, sensory recovery, joint mobility, and donor-site aesthetics were evaluated using standard clinical and statistical methods. RESULTS: The average skin island size was 9.0 ± 2.1 cm for vSupbra and 10.2 ± 2.4 cm for tSupbra. The vSupbra flap had a significantly longer pedicle (2.0 ± 0.6 vs. 1.6 ± 0.4 cm, p = 0.0385), whereas the tSupbra flap had thinner skin (2.0 ± 0.5 vs. 3.4 ± 0.8 mm, p = 0.0043). Three complications occurred in each group, with no total flap loss. Functional outcomes showed better active range of motion (93.1° ± 2.4° vs. 80.4° ± 1.8°, p = 0.0139) and donor site aesthetics (VAS 8.4 ± 0.6 vs. 6.7 ± 0.7, p = 0.0030) in the vSupbra group. Sensory recovery did not differ significantly between groups (S2PD 5.7 ± 0.8 vs. 6.1 ± 0.9 mm, p = 0.6987). CONCLUSIONS: The vSupbra flap provides glabrous, adherent skin suitable for volar defects, while the tSupbra flap is more pliable and favorable for dorsal and articular reconstructions. Flap design should be tailored to the defect's anatomical and functional requirements. Flap selection should therefore be based on the anatomical and functional requirements of the defect. Previous literature has not described that the SUPBRA flap can be designed in two distinct orientations-vertical and transverse. This study is the first to demonstrate that these two skin island designs have different anatomical characteristics that provide distinct reconstructive advantages and limitations, guiding flap selection according to defect requirements.
Microsurgery
· 2025 Dec · PMID 41427487
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Hypospadias is a congenital anomaly affecting 1 in 300 male infants. When urethral stricture develops after the initial surgery, it tends to become intractable, often necessitating multiple corrective surgeries. We previ...Hypospadias is a congenital anomaly affecting 1 in 300 male infants. When urethral stricture develops after the initial surgery, it tends to become intractable, often necessitating multiple corrective surgeries. We previously reported favorable outcomes using an ulnar forearm flap for urethral reconstruction in such refractory cases. Here, we describe the long-term outcomes of three cases treated by this method. All had undergone surgery for hypospadias during childhood and repeated urethral stricture surgeries before undergoing urethral reconstruction using our method. Case 1 was a 40-year-old man who underwent this surgery at age 21. The flap size was 3.0 × 12.5 cm. Postoperatively, the patient had favorable outcomes for 12 years. Subsequently, urethral stricture recurred, requiring corrective surgery using a skin graft. Case 2 was a 58-year-old man who underwent this surgery at age 40 years. The flap size was 3.5 × 10.0 cm. Postoperatively, the patient had favorable outcomes for 11 years. Subsequently, urethral stricture recurred, but symptoms were improved by balloon dilation alone. Case 3 was a 48-year-old man who underwent this surgery at age 45 years. The flap size was 3.2 × 10.0 cm. Postoperatively, urethral stricture recurred at 6 months, necessitating correction using a penile skin flap. The donor site exhibited prominent hypertrophy, suggesting a predisposition for hypertrophic scar development. The follow-up periods were 19 years for Case 1, 18 years for Case 2, and 4 years for Case 3, without stricture recurrence. Compared with long-term outcomes for urethral reconstruction using skin or buccal mucosa grafts, our method showed the potential for more favorable outcomes. This method may be a good treatment option, but may lead to early stricture recurrence depending on the patient's constitution, requiring careful follow-up.
Phuyal D, Perozzo FAG, Abbas F
… +7 more, Jou C, Desai A, Tadisina K, Catinchi JRM, Djohan R, Gurunian R, Bishop SN
Microsurgery
· 2025 Dec · PMID 41424015
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BACKGROUND: Complex abdominal wall reconstruction (AWR) is a technically demanding procedure often required in patients with large fascial defects and significant comorbidities. When primary closure is not feasible, thig...BACKGROUND: Complex abdominal wall reconstruction (AWR) is a technically demanding procedure often required in patients with large fascial defects and significant comorbidities. When primary closure is not feasible, thigh-based flaps can provide durable soft tissue coverage and structural support. However, literature on flap-based AWR remains limited. METHODS: A retrospective cohort study of patients who underwent thigh-based AWR between 2014 and 2024 at a single tertiary center was conducted. All patients had significant loss of domain and underwent reconstruction with pedicled or free flaps, with or without mesh. Data on demographics, defect characteristics, comorbidities, surgical techniques, and postoperative outcomes were analyzed. RESULTS: Fifteen patients (9 males, 6 females; mean age 53.7 ± 7 years; BMI 30.8 ± 5.9 kg/m) underwent reconstruction. Comorbidities were common: 53% had a smoking history, 40% had diabetes, 67% had hypertension, and 93% of patients had a median of 8 previous abdominal surgeries. Defects averaged 840 cm (fascial) and 504 cm (skin). Mesh was used in all cases, and 67% of patients required free flaps. Flap types included anterolateral thigh (ALT), chimeric, and vastus lateralis myocutaneous configurations. The median hospital stay was 15 days. Any complications occurred in 80% of patients, with 20% experiencing Clavien-Dindo (CD) grade III events. Long-term outcomes included low rates of abdominal bulge (6.7%) and fistula recurrence (7%). CONCLUSIONS: Our 10-year experience demonstrates consistent achievement of definitive fascial closure, reliable flap survival, and manageable complication rates, even in the presence of significant comorbidities and prior surgical complexity.
Phuyal D, Gaston J, Hoffner N
… +5 more, Darras O, Djohan R, Schwarz G, Gurunian R, Bishop SN
Microsurgery
· 2025 Dec · PMID 41422373
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INTRODUCTION: Minimally invasive techniques for DIEP flap harvest, including transabdominal (TAPP) and totally extraperitoneal (TEP) approaches, have been reported to be beneficial in reducing morbidity; however, direct...INTRODUCTION: Minimally invasive techniques for DIEP flap harvest, including transabdominal (TAPP) and totally extraperitoneal (TEP) approaches, have been reported to be beneficial in reducing morbidity; however, direct comparative synthesis between these methods remains scarce, limiting consensus on the optimal approach. METHOD: Following PRISMA guidelines, we searched MEDLINE, Embase, and Cochrane Central for prospective and retrospective studies on robotic or laparoscopic DIEP harvest in breast reconstruction. Cadaveric studies and non-DIEP procedures were excluded. Primary operative outcomes included harvest time, type of robot, fascial incision length, intramuscular length, and intraoperative complications, while secondary clinical outcomes were postoperative complications, length of stay, and pain. A structured narrative synthesis was conducted using pooled descriptive data, without inferential statistical analysis. RESULTS: Ten studies were included, including six describing TAPP harvest, two robotic TEP, and two laparoscopic TEP. Reported unilateral reconstruction times averaged 442.6 ± 63.4 min for TAPP and 460.3 ± 90.4 min for TEP, while bilateral procedures averaged 682.6 ± 115.1 min for TAPP compared with 453.0 ± 81.5 min for TEP. Fascial incisions were longer with TAPP (3.75 ± 1.34 cm) compared to TEP (2.59 ± 0.49 cm), and intramuscular pedicle dissection length was greater in TAPP (4.1 ± 0.7 vs. 2.25 ± 0.27 cm). No study reported bowel injury or postoperative ileus, and overall complication rates-including vessel avulsion, flap loss, infection, and seroma-were similar. Postoperative pain scores were 1.9 ± 0.9 in TAPP versus 2.3 ± 0.9 in TEP, while hospital stay averaged 3.9 ± 1.3 days for TAPP and 4.5 ± 0.9 days for TEP. CONCLUSION: Both TAPP and TEP appear safe and effective for minimally invasive DIEP flap harvest. Trends suggest bilateral TAPP requires longer operative times, while TEP results in shorter fascial incisions and had shorter intramuscular pedicle lengths. Pain and complication rates were comparable, although study heterogeneity and small sample sizes limit generalizability. Larger, prospective comparative studies are essential to better define technique selection.
Hovav OV, Sparks DS, Velli G
… +3 more, David M, Rowe D, Read T
Microsurgery
· 2025 Dec · PMID 41399915
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BACKGROUND: The treatment of tongue malignancies frequently produces deficits in feeding, swallowing, and speech intelligibility. These have a significant impact on patients' quality-of-life. Free tissue transfer is the...BACKGROUND: The treatment of tongue malignancies frequently produces deficits in feeding, swallowing, and speech intelligibility. These have a significant impact on patients' quality-of-life. Free tissue transfer is the preferred method for reconstructing larger, complex defects, and aims to restore both mechanical and sensory function while protecting the airway. The role of dynamic free flap designs incorporating motor reinnervation remains unclear, particularly in cases with more extensive glossectomy defects. The objective of this systematic review is to evaluate the speech and swallow outcomes of patients undergoing dynamic free flap reconstruction following ablative tongue surgery. METHODS: A systematic review was performed to determine the role of dynamic free flap surgery for functional tongue reconstruction. Searches were conducted in MEDLINE (PubMed), EMBASE, the Cochrane Library, Google Scholar, and included English-language studies from 1980 onward. Search terms included: glossectomy in combination with functional reconstruction and related outcomes. Primary outcome measures were flap compromise, competent swallow, and intelligible speech. A meta-analysis was performed using pooled data from comparative studies. Key data analysis was undertaken to calculate weighted effect sizes using random-effects models. RESULTS: Thirteen studies reported on the use of dynamic free flaps for tongue reconstruction. A total of 168 innervated flaps were available for comparison after pooling data. The non-weighted flap failure rate was 1.2% within this cohort. Competent swallow varied from 43% to 100% with a mean value of 80.2%. Rates of satisfactory speech were between 73% and 100% with a mean value of 91.7%. The mean follow-up duration was 21.8 months and ranged between 9.5 and 47.6 months. With further analyses of comparative sub-groups, there was a marked improvement in swallow competency with dynamic flap types over static designs (OR = 4.09, 95% CI: 1.75, 9.58, p = < 0.01). CONCLUSION: Current evidence indicates that dynamic free flap designs enhance functional recovery and may benefit both swallow and speech outcomes postoperatively.
Abbadi SE, Dang RR, Lee EM
… +2 more, Pindur L, Tsao CK
Microsurgery
· 2025 Dec · PMID 41399914
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BACKGROUND: Segmental mandibular reconstruction with osteocutaneous fibular free flaps commonly employs end-to-end (E-T-E) wedge osteotomies. However, excessive osteotomies or limited fibular length can compromise vascul...BACKGROUND: Segmental mandibular reconstruction with osteocutaneous fibular free flaps commonly employs end-to-end (E-T-E) wedge osteotomies. However, excessive osteotomies or limited fibular length can compromise vascularity, bony union, available pedicle length. This study evaluates the outcomes of a modified end-to-side (E-T-S) fibular strut configuration in mandibular reconstruction. METHODS: A retrospective analysis was conducted on 11 patients who underwent mandibular reconstruction using fibular free flaps with at least one E-T-S osteotomy between 2017 and 2021. Bony union was assessed radiographically ≥ 12 months postoperatively and categorized as complete (CBU) or incomplete bony union (IBU). Complication rates were also analyzed. RESULTS: Among 33 junctions, 11 were reconstructed using the modified E-T-S approach. Of these, 7 achieved complete bony union. In the remaining 22 junctions reconstructed with E-T-E osteotomies, 15 achieved complete bony union. CONCLUSION: Descriptively, the union rates observed in modified E-T-S osteotomies were similar to those seen in conventional E-T-E reconstructions. It offers a viable alternative in complex reconstructions where pedicle length, anatomy, or perfusion constraints preclude standard approaches.
Soldado F, Buendía-Pérez J, Sinclair V
… +5 more, Carbonell-Rosell C, Romero-Larrauri P, Fouad A, Nguyen DM, Diáz-Gallardo P
Microsurgery
· 2025 Dec · PMID 41395700
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BACKGROUND: Pediatric cases of bone nonunion are rare and often a result of complex local vascular limitations. The periosteum plays a key role in bone healing through its regenerative properties. Vascularized periosteal...BACKGROUND: Pediatric cases of bone nonunion are rare and often a result of complex local vascular limitations. The periosteum plays a key role in bone healing through its regenerative properties. Vascularized periosteal grafts have previously been effective in treating complex cases. This study explores the vascular anatomy of the radial periosteum supplied by the anterior interosseous vessels and introduces the vascularized radial periosteal graft (VRPG), successfully implemented in a case of ulnar nonunion. MATERIAL AND METHODS: Cadaveric studies of ten upper limbs were conducted under ×2.5 loupe magnification following injection of colored natural latex through the brachial artery. Anterior interosseous vessels (AIOV) branches supplying the radial shaft periosteum were studied with regards to AIOV length, number of periosteal branches, and their respective distances from the distal radioulnar joint (DRUJ). As part of our case report, two pediatric cases of complex ulnar shaft nonunion underwent treatment with a VRPG: one a 15-year-old with a multioperated ulnar nonunion and the other a 5-year-old with congenital pseudoarthrosis. RESULTS: The mean AIOV length was 15.9 cm (range 14.2-17.8). They were found to have an average of 9.6 (range 8-13) periosteal branches with a mean distance to the DRUJ of 16 mm (range 11-23 mm) from the most distal branch and 111 mm (98-136) from the most proximal periosteal branch. Case report follow-up of both cases showed a very early initially ossified prominent callus and early bone union and callus remodeling with excellent function. CONCLUSIONS: The AIOV reliably supplies the radial periosteal shaft, allowing for successful harvest of a pedicled periosteal flap. This flap has proven effective in treating 2 cases of pediatric ulnar nonunion and warrants further evaluation and consideration in similar cases in the future.