Microsurgery[JOURNAL]
Sun
200 papers
A Simple and Novel Microsurgery Instrument for Atraumatic Vessel and Perforator Dissection.
Javed MU
Microsurgery · 2025 Sep · PMID 40919748 · Publisher ↗
Abstract loading — click title to view on PubMed.
Does the Timing, Type, and Method of Flap Coverage After Open Tibia Fracture Fixation Influence the Rate of Deep Infection?
Khan U, Gray K, Ghidei S … +5 more , Quigley C, Mehan V, Johnson E, Goch A, Gaski G
Microsurgery · 2025 Sep · PMID 40905622 · Publisher ↗
OBJECTIVES: To evaluate whether the timing of flap coverage following definitive fixation influences deep infection and nonunion in patients with Gustilo-Anderson (GA) Type 3B and 3C open tibia fractures, accounting for...
OBJECTIVES: To evaluate whether the timing of flap coverage following definitive fixation influences deep infection and nonunion in patients with Gustilo-Anderson (GA) Type 3B and 3C open tibia fractures, accounting for flap method (local vs. free) and tissue type (muscle vs. fasciocutaneous). METHODS: Retrospective cohort study of patients with GA 3B and 3C tibia fractures treated at a Level I trauma center (2013-2022) with fracture fixation and soft-tissue reconstruction. Primary outcomes were deep surgical site infection and nonunion, assessed by timing of flap coverage (≤ 72 vs. > 72 h), tissue type, and flap method. RESULTS: Fifty-one patients (52 extremities) met inclusion criteria. Deep infection was significantly higher after free (13/30, 43%) versus local flaps (0/22; p < 0.001). There was a trend toward increased infection rates when coverage occurred >72 h post-fixation (9/30, 30%) versus ≤ 72 h (4/22, 18%; p = 0.33). Among free flaps, coverage ≤ 72 h had fewer infections (4/13, 31%) than coverage > 72 h (9/17, 53%; p = 0.22). Tissue type and timing had no significant effect: muscle ≤ 72 h (4/20, 20%) vs. > 72 h (8/23, 35%; p = 0.28); fasciocutaneous ≤ 72 h (0/2) vs. > 72 h (1/7, 14%; p > 0.99). Nonunion was more common with free flaps (13/30) than local flaps (2/22; p = 0.007). Free flaps placed ≤ 72 h had fewer nonunions (4/13, 31%) than those placed > 72 h (9/17, 53%; p = 0.22). CONCLUSIONS: Free flaps were associated with higher rates of deep infection and nonunion. Although not statistically significant, there was a trend toward increased complications with coverage > 72 h, especially for free and muscle flaps.
Use of Contrast-Enhanced Ultrasound in Genital Lymphedema: A Report of Three Cases.
Rios-Sanchez MV, Bustos SS, Aristizábal A … +4 more , Bruces-Molina C, Lee CU, Tran NV, Fahradyan V
Microsurgery · 2025 Sep · PMID 40905543 · Publisher ↗
Genital lymphedema presents significant challenges in surgical management, with limited effective interventions. This case report explores the use of contrast-enhanced ultrasound (CEUS) with microbubble injection as an a...
Genital lymphedema presents significant challenges in surgical management, with limited effective interventions. This case report explores the use of contrast-enhanced ultrasound (CEUS) with microbubble injection as an alternative adjunct technique for lymphatic mapping in lymphaticovenous anastomosis (LVA) surgery for genital lymphedema. A retrospective chart review approved by our institutional review board was performed for patients with genital lymphedema undergoing LVA surgery between 2020 and 2024. Intraoperative CEUS for lymphatic mapping was used with intradermal injection of microbubble suspension Lumason (Bracco Suisse, Monroe Township, NJ, USA). Data regarding demographics, comorbidities, clinical and operative characteristics, complications, and surgical outcomes were retrieved. Three patients with genital lymphedema who underwent LVA were identified. The first patient was a 34-year-old female with recurrent lymphangioma circumscriptum and vesicular drainage. She successfully underwent CEUS-guided LVA followed by two debulking procedures. The second patient was a 16-year-old male with congenital scrotal and lower extremity lymphedema. He had two CEUS-guided LVAs and subsequent debulking for anterior scrotal swelling, with long-term reduction in edema. The third patient was a 31-year-old female with primary lymphedema of the right lower extremity and genital region. She underwent seven CEUS and indocyanine green lymphography (ICG) guided anastomoses targeting the mons and lower abdomen, resulting in substantial symptomatic and volumetric improvement. CEUS detected target lymphatic vessels in all cases, including cases where ICG imaging failed to identify candidate lymphatic vessels. CEUS with intradermal microbubble injection successfully identified target lymphatic vessels in the preoperative planning for LVA surgery in patients with genital lymphedema.
Augmented Reality for Lymphovenous Anastomosis Planning Based on ICG Lymphography Anatomy of the Healthy Limb.
Pereira N, López MA, Oñate V … +1 more , Roa R
Microsurgery · 2025 Sep · PMID 40904036 · Publisher ↗
BACKGROUND: When indocyanine green lymphography (ICG-L) fails to display a linear pattern, preoperative planning for lymphovenous anastomosis (LVA) becomes challenging. Given the anatomical symmetry of lymphatics in extr...
BACKGROUND: When indocyanine green lymphography (ICG-L) fails to display a linear pattern, preoperative planning for lymphovenous anastomosis (LVA) becomes challenging. Given the anatomical symmetry of lymphatics in extremities, the healthy limb can serve as a template for the affected one. This study introduces an accessible technique that uses augmented reality (AR) to mirror the lymphatic anatomy of the unaffected limb onto the affected side to assist in surgical planning. METHODS: Twelve patients with unilateral secondary lymphedema of the upper or lower extremity (Stage II or less) were included. After standard ICG-L mapping, the unaffected limb was photographed when it showed a linear lymphatic pattern. The image was mirrored and superimposed onto the affected limb using an AR smartphone app to guide incision planning for LVA. Volume reduction and clinical outcomes were measured postoperatively. RESULTS: A total of 39 LVAs were successfully performed at the planned locations, with 100% intraoperative accuracy. No modifications or extensions of incisions were needed. Patients experienced an average operative time of 142.5 min. Volume excess was reduced by 47% over a follow-up period of 3-24 months, with a notable reduction in episodes of cellulitis and improvements in symptoms and quality of life. CONCLUSIONS: "Mirror the lymph" is a reliable, low-cost AR-based planning method for identifying lymphatic vessels in patients with unilateral lymphedema when ICG-L mapping shows early dermal backflow. This technique improves surgical precision and efficiency and offers an innovative tool for resource-limited settings.
Combined Use of Peripheral Nerve Surgery and Peripheral Nerve Stimulation in Patients With Refractory Neuropathic Pain.
Raasveld FV, Johnston BR, Hao D … +2 more , Valerio IL, Eberlin KR
Microsurgery · 2025 Sep · PMID 40899988 · Publisher ↗
INTRODUCTION: Peripheral nerve injury (PNI) can lead to chronic neuropathic pain, significantly impacting quality of life. While surgical intervention may offer relief in some cases, outcomes are variable. Peripheral ner...
INTRODUCTION: Peripheral nerve injury (PNI) can lead to chronic neuropathic pain, significantly impacting quality of life. While surgical intervention may offer relief in some cases, outcomes are variable. Peripheral nerve stimulation (PNS) offers an alternative treatment approach for managing neuropathic pain in these patients. This study aims to describe the outcomes of a combined surgical and PNS approach for severe, refractory neuropathic pain following PNI or amputation. METHODS: A cross-sectional survey was conducted on seven patients who underwent combined peripheral nerve surgery and PNS at a specialized multidisciplinary nerve clinic. Patient-reported outcome measures, including pain scores, Patient's Global Impression of Change (PGIC), and quality of life metrics, were collected. Patient data were retrospectively reviewed. RESULTS: The cohort included five males and two females (mean age 58.3 ± 8.9 years), with four amputees and three non-amputees. The average follow-up duration was 2.4 ± 0.8 years. Six out of seven patients reported reduced pain when the stimulator was activated, with an average pain score reduction of 4.4 ± 1.5 points. All seven patients reported improvement on the PGIC scale. Mean pain intensity and pain interference scores averaged 54.7 ± 5.5 and 66.3 ± 6.5, respectively. One patient underwent device removal due to irritation from the topical adhesive. CONCLUSION: This proof-of-concept study suggests that combined peripheral nerve surgery and PNS may be a viable option for carefully selected patients with severe, refractory neuropathic pain. While pain reduction and functional improvement were observed in most patients, outcomes varied considerably. Future prospective studies with larger cohorts are needed to refine patient selection criteria and optimize this combined approach.
Larynx Preservation Surgery Revisited: A Case Series of Free-Flap Reconstructions for Various Laryngeal Compartments.
Werner J, Scaglioni MF, Martin A … +4 more , Ciritsis J, von Muralt A, Morand GB, Rajan GP
Microsurgery · 2025 Sep · PMID 40891279 · Publisher ↗
OBJECTIVE: Reconstruction after partial laryngectomy poses challenges in preserving voice, swallowing, and airway patency. Tailored laryngeal free-flap reconstructions using multiple chimeric perforator flaps aim to maxi...
OBJECTIVE: Reconstruction after partial laryngectomy poses challenges in preserving voice, swallowing, and airway patency. Tailored laryngeal free-flap reconstructions using multiple chimeric perforator flaps aim to maximize functional preservation of the larynx and facilitate swallowing rehabilitation by enhancing larynx mobility. METHODS: Various compartmental laryngeal reconstructions using chimeric free flaps were performed on seven male patients (aged 40-82) with laryngeal malignancies following open partial laryngectomy. Chimeric anterolateral thigh (ALT) flaps and triple chimeric superficial circumflex iliac artery perforator (SCIP) flaps were each used in two patients, while three patients received chimeric medial femoral condyle perforator (MFCP) flaps. Patients were regularly monitored for tumor recurrence, airway patency, and voice and swallowing functions. RESULTS: Postoperative courses were uneventful in all patients. Over a median follow-up of 30 months (range 9-41), five of seven patients were tracheostomy-independent, and four were on a full oral diet without a gastrostomy tube. Four patients had undergone prior radiotherapy, of whom two developed a second local recurrence, requiring total laryngectomy. One patient died from distant disease. CONCLUSION: Following partial laryngectomy, compartment reconstruction with chimeric perforator flaps enhances larynx mobility, potentially improving functional outcomes. In the salvage setting, laryngeal preservation procedures may compromise oncological control. Further studies comparing the presented techniques with conventional reconstruction methods are warranted.
Comments on "Use of Tranexamic Acid in Head and Neck Free Flap Reconstruction".
Herman C, Auger N
Microsurgery · 2025 Sep · PMID 40879497 · Publisher ↗
Abstract loading — click title to view on PubMed.
Efficacy of Immediate Lymphatic Reconstruction in Prevention of Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis.
Li MX, Zhang J, Howard MA … +1 more , Teven CM
Microsurgery · 2025 Sep · PMID 40862309 · Full text
BACKGROUND: Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer-related...
BACKGROUND: Immediate lymphatic reconstruction (ILR) is a technique in which lymphatics are visualized and lymphovenous bypass is done at the time of axillary lymph node dissection (ALND) to prevent breast cancer-related lymphedema (BCRL). This meta-analysis estimates the benefit of ILR in preventing lymphedema by incorporating double- and single-arm studies and stratifying by length of follow-up time. METHODS: Three databases were queried for studies with primary data on ILR. Both double- and single-armed studies were included, and papers with small sample sizes, overlapping samples, and unreported data were excluded. Treatment effects were calculated with risk ratios and converted to a logarithmic scale. A meta-analysis was performed using the inverse variance method and a random-effects model, with further analysis done by study design and length of follow-up time. RESULTS: A total of 17 studies were included (9 double-arm and 8 single-arm; n = 2607). The pooled treatment effect of ILR, expressed as log risk ratio (95% CI), was -0.89 (-1.18, -0.60; p < 0.0001). This corresponds to a relative risk of 0.41 (0.31, 0.55) and a number needed to treat of 9. Double- and single-arm studies showed no significant differences in effect sizes. Studies with < 1-year follow-up demonstrated a larger effect size than those with longer follow-up, and the benefits of ILR were no longer significant past 3 years. CONCLUSION: Patients receiving ILR were significantly less likely to develop BCRL than those receiving ALND alone. Further work is needed to examine whether benefits can truly be sustained long-term.
Lower Extremity Free Tissue Transfer in Peronea Arteria Magna: An Observational Retrospective Cohort Study of Anatomic and Microsurgical Considerations.
Rutland JW, Rohrich RN, Li KR … +5 more , Martinez PF, Youn RC, Attinger CE, Akbari CM, Evans KK
Microsurgery · 2025 Sep · PMID 40856465 · Publisher ↗
BACKGROUND: Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT...
BACKGROUND: Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT). The present study aims to leverage a high volume lower extremity reconstruction center to determine the incidence and microsurgical considerations in PAM. METHODS: A retrospective cohort study was conducted at a single tertiary limb salvage center, reviewing all patients who underwent lower LE FTT from July 2011 to January 2024. Patients were included if they had preoperative arteriography and underwent LE FTT for atraumatic wounds. Patient demographics, vascular anatomy, microsurgical technique, and postoperative outcomes were analyzed. RESULTS: Arteriograms for a total of 334 patients who underwent lower extremity FTT were reviewed, of which 34 patients (10.2%) had Kim-Lippert Class III variant patterns, and six patients (1.8%) had Class IIIc (PAM). Of these, all six anastomoses were performed in an end-to-side fashion. There were no instances of postoperative lower extremity devascularization or ischemia. There were no flap losses. One of the six patients required immediate return to the operating room for venous thrombosis with successful flap salvage after clot evacuation and a second venous anastomosis. CONCLUSION: PAM is a rare yet important anatomic variant that is occasionally observed in the lower extremity FTT population. The following features are important in managing patients with PAM undergoing FTT: the routine use of preoperative arteriography, an understanding of venous anatomic variability, the use of a smaller target window for microsurgery given the majority of vessels residing in the deep posterior compartment, the preservation of all peroneal side branches, and the use of ETS anastomosis when possible.
Hip Stiffness Fifteen Years After Reconstruction of Femoral Tumor With Vascularized Fibular Epiphyseal Transfer.
Carbonell-Rosell C, Knorr J, Soldado F
Microsurgery · 2025 Sep · PMID 40856412 · Publisher ↗
Abstract loading — click title to view on PubMed.
Lymphovenous Anastomosis Using Pedicled Deep Inferior Epigastric Perforator Flap Vein for Ulcer With Lymphorrhea: A Case Report.
Yamagiwa Y, Otani N, Oue T … +3 more , Shikano Y, Nomori M, Kubo T
Microsurgery · 2025 Sep · PMID 40852878 · Publisher ↗
Lymphovenous anastomosis (LVA) is an effective surgical treatment for inguinal lymphorrhea, a complication that can occur after surgery involving vessels. LVA, however, requires a suitable vein for anastomosis near the l...
Lymphovenous anastomosis (LVA) is an effective surgical treatment for inguinal lymphorrhea, a complication that can occur after surgery involving vessels. LVA, however, requires a suitable vein for anastomosis near the leaking lymphatic vessel, which is sometimes difficult to secure. Here we report the successful treatment of a refractory ulcer with lymphorrhea by anastomosis of a flap vein to the lymphatic vessel concerned, along with flap closure. The patient was a 26-year-old male who developed a lymphatic leak in the right inguinal region following cannula removal after mechanical circulatory support for fulminant cardiomyopathy. He received conservative therapy but developed an infected femoral artery aneurysm, leading to replacement with the femoral vein. However, because of the persistent, intractable ulcer with exposed graft vessels and continued lymphatic leakage, pedicled flap reconstruction and LVA were planned. A 14 × 6.5 cm spindle-shaped pedicled deep inferior epigastric perforator flap was elevated from the right lower abdomen with branches reserved for use in LVA, rotated 180° through the subcutaneous tunnel, and migrated to the ulcer site. The source of lymphorrhea in the ulcer was identified by indocyanine green (ICG) lymphangiography, and the lymphatic vessels were anastomosed to a branch of the flap pedicle vein. ICG lymphangiography confirmed unimpeded venous flow without the stagnation of lymphatic fluid. At 6 months postoperatively, there was no evidence of ulceration or recurrence of lymphorrhea or lymphedema. In cases of lymphorrhea with refractory ulceration, there often are no suitable veins for LVA in the wound area due to scarring or adhesions. The present case demonstrates the use of a flap pedicle vein to solve this problem, potentially offering a new treatment option for lymphorrhea with extensive ulceration.
Comprehensive Analysis on the Use of Superficial Temporal Vessels as Free Flap Recipients in Head and Neck Reconstruction: Systematic Review on Anatomic Characteristics and Surgical Outcomes.
Andresen-Lorca B, Pérez-García A, Heredia-Alcalde I … +3 more , Alvedro-Ruiz P, García-García M, Pérez-Del-Caz MD
Microsurgery · 2025 Sep · PMID 40827805 · Publisher ↗
BACKGROUND: Head and neck reconstruction often involves complex defects requiring microvascular free flaps. While cervical vessels are commonly used as recipients, anatomical variations and prior interventions may necess...
BACKGROUND: Head and neck reconstruction often involves complex defects requiring microvascular free flaps. While cervical vessels are commonly used as recipients, anatomical variations and prior interventions may necessitate alternative options. The superficial temporal vessels (STV) offer advantages such as accessibility, suitable caliber, and proximity to craniofacial defects. This study systematically evaluates the anatomical and surgical outcomes of STV in head and neck reconstruction. METHODS: A systematic review following PRISMA guidelines was conducted across PubMed and Scopus to identify studies on the anatomical characteristics and surgical outcomes of STV. Inclusion criteria focused on studies involving adult patients, reporting surgical outcomes with STV as recipient vessels, and presenting anatomical measurements. Statistical analysis of flap survival, complications, and vessel caliber was performed using IBM SPSS 30.0. RESULTS: Twenty-two studies on surgical outcomes (506 flaps) and 23 anatomical studies (976 specimens) were analyzed. STV exhibited a mean arterial caliber of 2.30 mm at the origin, 1.88 mm at the zygomatic arch, and 1.51 mm at the bifurcation, with vein diameters averaging 2.58 mm. The flap survival rate was 96.72%, with major complications in 15.4% of cases and anastomosis revision in 5.14%. The anterolateral thigh flap was the most common donor site (177 cases). STV use was most frequent in middle-third facial defects (33%). CONCLUSION: The STV are reliable alternatives for microvascular reconstruction in head and neck surgery, particularly for defects in the upper and middle thirds of the face. Their favorable anatomical characteristics and high flap survival rates underscore their potential as primary or secondary recipient vessels, especially in vessel-depleted necks.
Outcomes of Microsurgical Reconstruction of Post-Burn Joint Contracture-Systematic Review and Meta-Analysis.
Elemosho A, Raborn Macdonald LN, Bell DE … +1 more , Janis JE
Microsurgery · 2025 Sep · PMID 40817644 · Full text
BACKGROUND: Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rate...
BACKGROUND: Contracture recurrence is a common setback to burn reconstruction, especially for severe or large-area contractures. Flap-based burn reconstruction has been shown to result in lower recurrent contracture rates. This study aims to summarize and evaluate the outcomes of flap-based techniques used for post-burn joint contracture reconstruction. METHODS: A systematic review was performed following PRISMA guidelines. Databases searched included PUBMED, EMBASE, Scopus, and Web of Science. Articles that described the use of flaps with a known blood supply to reconstruct post-burn contractures of the joints were included. Studies with incomplete data, with multiple anatomic site contracture involvement, case reports, and non-English articles were excluded. Data on patient demographics, flap type, complications, and contracture resolution were extracted. A proportional meta-analysis was conducted using the DerSimonian and Laird random-effects model. RESULTS: Out of 850 studies screened, 27 met inclusion criteria. Reconstruction of 830 joint contractures was reported. Contractures resolved for 98.9% (I = 0% [95% CI: 97.7-99.6]) of pedicled and 90.1% (I = 82.8% [95% CI: 62.7-100]) of free flap reconstructions, recurring in 1.8% (I = 0% [95% CI: 0.7-3.3]) at sites reconstructed with pedicled flaps and 0.6% (I = 0% [95% CI: 0.1-1.7]) at sites reconstructed with free flaps. The rates of flap complications were low, with total flap loss reported at 1.5% (I = 0% [95% CI: 0.6-2.7]) and 2.9% (I = 37.9% [95% CI: 0.9-5.8]) of the time for pedicled and free flaps, respectively. Partial flap loss was 6.9% (I = 65.1% [95% CI: 3.4-11.5]) and 5.2% (I = 65% [95% CI: 1.7-10.4]) for pedicled and free flaps, respectively. No significant difference was identified in rates of contracture resolution (p = 0.50), contracture recurrence (p = 0.15), total flap loss (p = 0.18) or partial flap loss (p = 0.31) regardless of the flap type used. CONCLUSIONS: Burn contracture reconstruction using flap-based techniques shows minimal complications and low rates of contracture recurrence when used for joints. Pedicled and free flap reconstruction of burn contracture sites yield similar outcomes.
Immediate Versus Delayed Grafting: Re-Evaluating Graft Timing in Microsurgical Reconstruction.
Karamitros G, Lineaweaver WC
Microsurgery · 2025 Sep · PMID 40792379 · Publisher ↗
Abstract loading — click title to view on PubMed.
Free Tissue Transfer for the Management of Diabetic Lower Limb Ulcers: A Systematic Review and Meta-Analysis.
Sing QY, Borg TM, Yousif YF … +3 more , Chin KJ, Devetzis K, Sousi S
Microsurgery · 2025 Sep · PMID 40776704 · Publisher ↗
BACKGROUND: Diabetic foot ulcers are a major complication of diabetes, with resulting soft tissue defects increasing the risk of limb amputation and mortality. Reconstruction of defects may be in the form of local, pedic...
BACKGROUND: Diabetic foot ulcers are a major complication of diabetes, with resulting soft tissue defects increasing the risk of limb amputation and mortality. Reconstruction of defects may be in the form of local, pedicled, or free tissue transfer. This systematic review aims to confirm the role and benefit of free tissue transfer in this patient cohort. METHOD: This review is registered on PROSPERO (ID: 617657). A literature search was performed using the online databases EMBASE, MEDLINE, and Web of Science to identify literature reporting use of free flaps in the management of diabetic lower limb ulcers. Mesh terms used included "diabetes," "lower limb," "ulcer," and "free tissue transfer." A random-effect meta-analysis was implemented to assess the efficacy of free flaps as a treatment based on complication and limb salvage rates. RESULTS: Twenty-five studies were included in this systematic review, amounting to 547 free flaps. The total complication rate was 26% (95% CI = 21%-32%, I = 27%, p = 0.11). Partial flap loss was noted in 6% of cases (95% CI = 3%-11%, I = 0%, p = 0.96) while complete loss occurred in 4% of cases (95% CI = 2%-7%, I = 0%, p = 1.0). The most performed flap was the anterolateral thigh (ALT) flap. Revascularization was performed prior to free flap reconstruction in 15% of cases. The amputation-free rate was 95% at the latest follow-up point of each study. CONCLUSION: Free tissue transfer is a viable treatment option for patients with diabetic foot ulcers. The low complication including amputation rate supports its implementation in practice provided a myriad of factors and careful patient selection is maintained.
Optimizing Fingertip Reconstruction: A Comparative Analysis of Reverse Homodigital Island and Digital Artery Perforator Flaps.
Miyashima Y, Gotani H, Okada M … +5 more , Tanaka Y, Yagi H, Saito K, Okamoto K, Terai H
Microsurgery · 2025 Sep · PMID 40747956 · Publisher ↗
BACKGROUND: Fingertip amputations are a common form of hand trauma and often require soft tissue reconstruction when replantation is not feasible. The reverse homodigital island flap (RHI) and the digital artery perforat...
BACKGROUND: Fingertip amputations are a common form of hand trauma and often require soft tissue reconstruction when replantation is not feasible. The reverse homodigital island flap (RHI) and the digital artery perforator flap (DAP) are two widely used techniques for fingertip reconstruction; however, direct comparisons of their clinical outcomes remain limited. METHODS: This retrospective study analyzed 39 patients who underwent either RHI (n = 20) or DAP (n = 19) procedures for fingertip injuries. Patients with thumb injuries, multiple finger injuries, or insufficient follow-up data were excluded. Postoperative management included flap monitoring, limb elevation, and early rehabilitation. Outcomes assessed included flap survival, operative time, hospital stay, functional recovery, and complications such as flap congestion, necrosis, and nail deformities. RESULTS: No significant differences were found in baseline characteristics or affected digits. The RHI group mainly involved Ishikawa subzone II injuries with avulsion patterns, while the DAP group had predominantly subzone I crush injuries. Distal phalanx bone defect length was comparable between groups. Both RHI and DAP demonstrated high flap survival rates, with no cases of major necrosis. The mean operative time was significantly shorter in the DAP group (68 min) compared to the RHI group (101 min, p < 0.001). Similarly, the hospital stay was shorter in the DAP group (13 days) than in the RHI group (18 days, p < 0.05). While both flaps achieved good functional and sensory recovery, the DAP group exhibited a lower secondary procedure rate (21.1%) compared to the RHI group (70%, p < 0.002). However, nail deformities, particularly claw deformities, were more frequently observed in the DAP group (47.4%). CONCLUSION: The DAP flap offers a shorter operative time, faster recovery, and a lower secondary procedure rate, making it a preferable option for functional reconstruction. In contrast, although the RHI flap requires a longer treatment period, it may provide superior esthetic outcomes.
Free Chain-Linked Fillet Flaps From a Contralateral Chopart Amputation for Reconstruction of an Extensive Lower Extremity Defect: A Case Report and Literature Review.
Shimbo K, Aoki Y, Saiki T
Microsurgery · 2025 Sep · PMID 40742094 · Publisher ↗
Free fillet flap reconstruction transfers composite tissue from an unsalvageable limb to repair a separate defect. We report a case of free fillet flaps based on the posterior tibial artery (PTA) and anterior tibial arte...
Free fillet flap reconstruction transfers composite tissue from an unsalvageable limb to repair a separate defect. We report a case of free fillet flaps based on the posterior tibial artery (PTA) and anterior tibial artery (ATA). A 41-year-old man was crushed under a truck; his right leg suffered an open tibia and fibula fracture (Gustilo IIIB) with extensive soft tissue loss, while his left foot was amputated at the tarsal level. He initially underwent Chopart-level amputation of the left limb, which was subsequently revised to a below-knee amputation. Two free fillet flaps were harvested from the amputated limb: one based on the PTA (15 × 13 cm) and the other based on the ATA (20 × 8 cm). Two chain-linked fillet flaps via flow-through anastomosis were used to cover the soft tissue defect exposing the right tibia. Postoperatively, partial necrosis occurred in the ATA-based fillet flap, which healed after reoperation. The patient regained mobility with a prosthesis. Free chain-linked fillet flaps harvested from a limited amputation segment are a feasible and useful option for reconstructing complex soft tissue defects without additional donor site morbidity.
Machine Learning-Based Flap Takeback Prediction Modeling: Theory for a Real-Time, Patient-Specific Postoperative Flap Monitoring and Alert System.
Oleru OO, Nguyen KA, Taub P … +1 more , Kia A
Microsurgery · 2025 Sep · PMID 40742035 · Publisher ↗
BACKGROUND: Postoperative free flap monitoring is crucial yet taxing, requiring frequent and often subjective assessments to detect early signs of compromise. The present study aims to develop a machine learning model to...
BACKGROUND: Postoperative free flap monitoring is crucial yet taxing, requiring frequent and often subjective assessments to detect early signs of compromise. The present study aims to develop a machine learning model to predict the risk of flap take-back reoperation due to arterial and/or venous compromise, as a basis for real-time risk monitoring and alerts. METHODS: This retrospective cohort study utilized patient data from a New York City hospital system from 2019 to 2024. Adult patients undergoing free flap reconstruction were included. Data from electronic medical records (EMRs) included demographic and clinical variables. The primary outcome was flap takeback, defined as urgent or emergent microvascular exploration or revision surgery during the same admission. A random forest model was developed and trained on the data with oversampling to balance the training set. Model performance was evaluated using AUROC, sensitivity, specificity, accuracy, and precision. RESULTS: The study included 458 patient encounters, with a flap takeback rate of 6.1%. The final model achieved a train AUROC of 0.99 and a test AUROC of 0.86. Sensitivity and specificity on the test set were 75% and 78%, respectively, with 78% accuracy. Key predictors included skin integrity, pulse, and diastolic blood pressure. CONCLUSIONS: The machine learning model accurately predicts free flap takeback, offering a proactive approach to postoperative monitoring. Integrating this model into EMR platforms can provide real-time early warning systems (EWS), enhancing early detection and intervention for flap compromise. Future research should validate the model across diverse settings.
Fasciocutaneous Vascularized Lymph Node Transfer for Head and Neck Lymphedema: A Case Report.
Almadani H, Rhyu H, Cantor A … +1 more , Brazio PS
Microsurgery · 2025 Sep · PMID 40736143 · Publisher ↗
Head and neck lymphedema is a common complication of head and neck cancer treatment. Lymphovenous bypass is a promising surgical treatment but may not be an option for all patients after radiotherapy due to the obliterat...
Head and neck lymphedema is a common complication of head and neck cancer treatment. Lymphovenous bypass is a promising surgical treatment but may not be an option for all patients after radiotherapy due to the obliteration of local lymphatic targets for bypass. We aim to present vascularized lymph node transfer (VLNT) as a solution to this problem. We report the case of a 38-year-old patient with Stage 2 face and neck lymphedema after treatment for T4aN1oral squamous cell carcinoma, who had no targets for lymphovenous bypass. The patient was treated with a 6 by 14 cm fasciocutaneous VLNT based on the left superficial circumflex iliac artery and vein, to the right facial vein and facial artery. The patient was given a low-dose heparin infusion, placed in a head bolster to prevent neck rotation, and discharged with low-dose aspirin. 4.5 months after free flap reconstruction, the patient underwent revision of the flap including indocyanine green lymphatic mapping, thinning with lymph-sparing liposuction, and re-advancement with Z-plasty for contour. At 11 months, the patient experienced a reduction of swelling, improvement of symptoms, and no further need for compression and manual lymphatic drainage. The area of greatest mobility impairment was resurfaced with flap skin, improving subjective tightness. Indocyanine green imaging at 4 months and 11 months revealed linear lymphatics traversing from the facial skin into the flap. Facial dermal thickness on ultrasound decreased from 1.43 to 1.09 mm between 4 and 11 months postoperatively. Fasciocutaneous VLNT has the potential to restore lymphatic drainage, improving swelling and tightness for patients with head and neck lymphedema who do not have lymphatic targets for bypass. Future studies on head and neck lymphedema should routinely employ ultrasound measurement of dermal thickness as an objective measure.
Segmental Cylindrical Gracilis Free Flap for Dead Space Obliteration in Chronic Midfoot Osteomyelitis Secondary to Ballistic Injury: A Case Report.
Ertaş ES
Microsurgery · 2025 Jul · PMID 40717366 · Publisher ↗
Chronic osteomyelitis of the midfoot, particularly following high-energy trauma such as a landmine injury, presents a formidable challenge due to the region's limited soft tissue envelope, complex anatomy, and the critic...
Chronic osteomyelitis of the midfoot, particularly following high-energy trauma such as a landmine injury, presents a formidable challenge due to the region's limited soft tissue envelope, complex anatomy, and the critical need for effective and durable dead space obliteration. While various flap options have been described, there remains no consensus on the optimal approach for managing deep defects in the midfoot, especially in cases complicated by prior surgical procedures. We present the case of a 23-year-old male who developed chronic midfoot osteomyelitis following a landmine explosion. Despite multiple debridements, targeted antibiotic therapy, and initial soft tissue coverage with an anterolateral thigh (ALT) flap, a persistent 6 × 5 cm (30 cm) dead space remained, consistent with a Cierny-Mader type III-A classification. A segmentally harvested gracilis muscle flap was designed and sculpted to conform to the dimensions of the cavity, then inset into the defect. Microvascular end-to-side anastomosis was performed to the anterior tibial artery and two accompanying veins, and the flap was covered with a split-thickness skin graft. The postoperative course was uneventful at the recipient site. Mild serous drainage from the donor site, attributed to fat necrosis, resolved completely with conservative elastic compression therapy. At 12-month follow-up, the patient remained infection-free, was fully ambulatory without assistance, and imaging confirmed complete obliteration of the dead space. This case suggests that a segmentally harvested gracilis muscle flap may offer a viable, anatomically conforming single-stage option for managing complex midfoot osteomyelitis in selected patients. In individuals with prior treatment failure, this approach may help reduce surgical burden, enhance infection control, and support not only physical but also psychological recovery through resolution of a prolonged disease course.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe