Microsurgery[JOURNAL]
Sun
200 papers
Reconstruction of Bilateral Paranasal Skin and Soft Tissue Defects Using a Free Bilobed Thoracoacromial Artery Perforator Flap Following Multiple Cutaneous Squamous Cell Carcinomas Resection: A Case Report and Literature Review.
Huang SQ, Zhou X, Mao TC … +4 more , Yan RS, Li X, Yang ZB, Lei ZY
Microsurgery · 2025 Jul · PMID 40709696 · Publisher ↗
In recent years, the thoracoacromial artery perforator (TAAP) flap has emerged as a promising option for the reconstruction of facial defects, typically utilized in the form of a pedicled flap. However, there remains rel...
In recent years, the thoracoacromial artery perforator (TAAP) flap has emerged as a promising option for the reconstruction of facial defects, typically utilized in the form of a pedicled flap. However, there remains relatively limited experience in using a free TAAP to repair facial defects. This case describes the first application of a free bilobed TAAP for one-stage reconstruction of multiple facial defects after resecting cutaneous squamous cell carcinomas (cSCC). The patient was a 76-year-old man who noticed progressive enlargement of two black neoplasms around the left and right nose for over 1 year and 3 months, respectively. A preoperative biopsy confirmed both lesions as cSCC. During surgery, two skin and soft tissue defects, measuring approximately 6.5 cm × 3.0 cm and 3.5 cm × 2.0 cm, were left in the bilateral paranasal regions after the removal of tumors. A free bilobed TAAP flap of the appropriate size was designed and harvested to repair these defects. The postoperative course was uneventful, and the patient recovered without complications. Good esthetic and functional outcomes were achieved during a 14-month follow-up period. This report suggests that a free bilobed TAAP flap may be an option for reconstructing multiple facial defects caused by trauma, tumor resection, or other lesions.
Outcomes of Parascapular Free Flap in Reconstructive Microsurgery: A Systematic Review and Meta-Analysis.
Posso AN, Mustoe A, Escobar-Domingo MJ … +7 more , Thomas C, Smith JE, Foppiani J, Schonebaum DI, Garbaccio N, Lin SJ, Lee BT
Microsurgery · 2025 Jul · PMID 40709603 · Publisher ↗
INTRODUCTION: The parascapular free flap (PFF), primarily harvested as a fasciocutaneous flap, is perfused by the parascapular branch of the circumflex scapular artery. Its anatomy enables modification and combination wi...
INTRODUCTION: The parascapular free flap (PFF), primarily harvested as a fasciocutaneous flap, is perfused by the parascapular branch of the circumflex scapular artery. Its anatomy enables modification and combination with other flaps. However, its use in reconstructive microsurgery has not been comprehensively characterized. This systematic review and meta-analysis aim to assess the key features and outcomes of the PFF. METHODS: The study protocol followed the PRISMA guidelines. Multiple online databases were used to identify articles published through 2024. Studies including patients who underwent PFF procedures were eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome (failure rate), secondary outcomes (other complications), and additional information. An analysis of pooled data was performed to evaluate rates of complications. RESULTS: Eighty-four articles were included in this review. A total of 647 patients and 664 PFFs were identified; among these, 57.38% were harvested solely as PFFs, while 42.62% involved combinations with other free flaps. The predominant recipient site was the head and neck, accounting for 72.52% of cases. The leading indications were malignancy (28.64%), post-burn scarring (17.35%), and trauma (13.26%). Meta-analysis of the primary outcome revealed no heterogeneity across the studies (I = 0.00%; Q statistic 17.50, p = 0.56), with a pooled failure rate of 0.99% (95% CI: 0%-2.63%). Other complication rates included partial necrosis (2.09%, 95% CI: 0%-5.45%), hematoma (5.18%, 95% CI: 1.34%-10.63%), wound dehiscence (5.98%, 95% CI: 0.38%-15.47%), infection (0.86%, 95% CI: 0.00%-3.97%), and venous thrombosis (1.57%, 95% CI: 0.00%-4.95%). CONCLUSION: The PFF is a versatile and reliable option in reconstructive microsurgery, offering low failure rates and minimal complications. Its applicability across various anatomical regions and indications makes it an invaluable option for microsurgeons.
Tactile Sensory Recovery in Neurotized Versus Non-Neurotized Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis.
Aristizábal A, Herrera H, Escandón JM … +5 more , Ciudad P, Del Corral G, Nazerali R, Mascaro A, Manrique OJ
Microsurgery · 2025 Jul · PMID 40682250 · Publisher ↗
BACKGROUND: Tactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non-neurotized outcomes are...
BACKGROUND: Tactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non-neurotized outcomes are still controversial due to methodological heterogeneity. This review uses consistent and objective outcomes to evaluate the current evidence's qualitative characteristics and quantitative tactile sensory recovery. METHODS: We conducted a systematic electronic literature search from database inception through 10 February 2024, of the following databases: PubMed, Ovid MEDLINE, Embase, SCOPUS, and CINAHL to identify all studies reporting outcomes of tactile sensory recovery using the Semmes-Weinstein Measuring scale in free-flap ABR comparing neurotization versus non-neurotization. The SWM scale score, demographic characteristics, and surgical features were extracted from each study. Due to the data heterogeneity within the studies, we transformed the data into means and pooled the qualitative information. RESULTS: We identified 264 articles. After thorough screening, 12 fulfilled the inclusion criteria and were included in the qualitative synthesis. Finally, 7 were quantitatively analyzed with a total of 251 breasts that underwent ABR with free flap neurotization and 244 breasts without neurotization. This revealed a mean SWM score difference of -0.67 and a significant p-value < 0.05. A subgroup DIEP flap analysis performed for 177 neurotized compared to 175 non-eurotized flaps yielded a significant mean difference of -0.86 p < 0.05. There were no significant differences between groups in age (48.8 vs. 49.8, p = 0.5), history of chemotherapy (72 vs. 74, p = 0.91), radiotherapy (61 vs. 56, p = 0.84), or follow-up time (21.85 vs. 25.09 months, p = < 0.05) that could have influenced tactile sensory recovery. CONCLUSION: Neurotization in free-flap ABR could allow better tactile sensory recovery than the spontaneous sensation gained without it. The additional surgical time required for coaptation is short, and no studies have reported associated complications, making it a safe procedure that can potentially improve patients´ quality of life. Nonetheless, higher-quality studies, such as randomized control trials with standardized sensation testing and more rigorous methodologies, are needed before making final clinical recommendations.
Impact of Vasopressors on Microvascular Free Flap Perfusion in Head and Neck Reconstruction.
Ooms M, Winnand P, Heitzer M … +5 more , Vohl N, Katz M, Bickenbach J, Hölzle F, Modabber A
Microsurgery · 2025 Jul · PMID 40657946 · Full text
INTRODUCTION: The use of vasopressors in microvascular head and neck reconstruction is still controversial in view of its potentially negative influence on microvascular flap perfusion, which is crucial for flap viabilit...
INTRODUCTION: The use of vasopressors in microvascular head and neck reconstruction is still controversial in view of its potentially negative influence on microvascular flap perfusion, which is crucial for flap viability and commonly used as a parameter in flap monitoring. The aim of this study was to investigate the influence of vasopressors on microvascular free flap perfusion. MATERIALS AND METHODS: Perfusion measurement data recorded intraoperatively and postoperatively using the Oxygen-2-see (O2C) analysis system in 274 patients undergoing microvascular head and neck reconstruction with fasciocutaneous free flaps (FFFs) or perforator free flaps (PFFs) between 2011 and 2020 were analyzed retrospectively. Vasopressor dose and perfusion parameters, such as flap blood flow, hemoglobin concentration, and hemoglobin oxygen saturation, as well as flap flow conductance (calculated as the ratio of flap blood flow and mean arterial blood pressure), were tested for associations. RESULTS: Intraoperative hemoglobin oxygen saturation and postoperative flap blood flow were negatively associated with vasopressor dose in PFFs (r = -0.307, p < 0.001; r = -0.211, p = 0.012, respectively). Both associations remained in multivariable analysis (p = 0.002; p = 0.022, respectively). Postoperative flap flow conductance was negatively associated with vasopressor dose in PFFs (r = -0.232, p = 0.008). This association remained in multivariable analysis (p = 0.023). CONCLUSION: The use of vasopressors influences microvascular free flap perfusion in PFFs in terms of intraoperative hemoglobin oxygen saturation, postoperative flap blood flow, and postoperative flap flow conductance. This suggests that the use of vasopressors in PFFs may be an adjustable variable for controlling flap perfusion and should be considered a confounding variable during flap monitoring based on flap perfusion.
Lower Extremity Nerve Decompression to Treat Complex Regional Pain Syndrome: A Case Report in Pediatric Age Group.
Poisler MA, Dellon AL, Williams EH
Microsurgery · 2025 Jul · PMID 40631792 · Publisher ↗
While much has been written about the persistence and symptoms of Complex Regional Pain syndrome, the role of peripheral nerve surgery as a treatment remains overlooked, especially in the lower extremity of the pediatric...
While much has been written about the persistence and symptoms of Complex Regional Pain syndrome, the role of peripheral nerve surgery as a treatment remains overlooked, especially in the lower extremity of the pediatric population. The purpose of this report is to describe the application of lower extremity peripheral nerve decompression to address specific injuries and entrapments, to provide meaningful relief and functional recovery in a pediatric patient with CRPS. A 14-year-old male presented with severe CRPS after several traumatic events involving the left lower extremity. After seeing 11 different physicians, failing physical therapy, and dropping out of high school, the patient was referred to a Peripheral Nerve Surgeon. On physical examination, multiple peripheral nerve entrapments were identified. The surgical approach included neurolysis of the tibial nerve at the soleal sling, a release of the four medial ankle tunnels, a neurolysis of the common peroneal nerve and lateral sural nerve at the fibular head, and a decompression of the saphenous nerve at the medial knee with the goal of treating multiple previously unrecognized peripheral nerve entrapments that had developed from the time of his injuries to his first consultation. At 1 year post-op, the patient reported full use of the extremity, a decrease in pain from 8 to 1. He had returned to physical activities and work, graduated from high school, and returned to the sport of fencing. He was off opiates. This report gives insight into how pain relief and functional restoration of lower extremity CRPS of a pediatric patient may be achieved by the same peripheral nerve approach to CRPS as in an adult patient.
Arterializing the Venous System in a SCIP Flap-Insights Into Tissue Perfusion Biomechanics: A Case Report.
Stanley EA, Illie V
Microsurgery · 2025 Jul · PMID 40622111 · Publisher ↗
This case report presents a novel observation on tissue perfusion biomechanics achieved through arterializing the deep venous system in a superficial circumflex iliac artery perforator (SCIP) flap. An 89-year-old male wi...
This case report presents a novel observation on tissue perfusion biomechanics achieved through arterializing the deep venous system in a superficial circumflex iliac artery perforator (SCIP) flap. An 89-year-old male with a cutaneous squamous cell carcinoma overlying the mandible underwent SCIP flap reconstruction. The flap was 5 mm thick and measured 8 cm × 7 cm. Due to pedicle damage, the venae comitantes served as the inflow system, anastomosed to a facial artery branch, while the superficial circumflex iliac vein served as the outflow system. The flap initially showed venous congestion but resolved without intervention, healing with an acceptable color match and contour over a six-month follow-up. This novel technique suggests that venous systems can be repurposed to support tissue perfusion effectively, offering new insights into tissue perfusion biomechanics. The broader implications of this approach include expanding our understanding of tissue perfusion mechanisms, which could lead to broader applications in reconstructive surgery. Ultimately, this method may enable the use of donor sites that do not rely on intrinsic arterial systems, potentially increasing the versatility of flap reconstruction techniques.
Forearm Synostosis Using A Vascularized Pedicled Ulnar Periosteal Graft for Supination Deformity in Brachial Plexus Birth Injury.
Soldado F, Díaz-Gallardo P, Rojas-Neira J … +3 more , De Avila-Diaz I, Cañizares-Betancourt D, Villafranca-Solano S
Microsurgery · 2025 Jul · PMID 40622056 · Publisher ↗
BACKGROUND: Forearm supination posture is a common secondary deformity in brachial plexus birth injury (BPBI), leading to functional impairment of the upper limb, as pronation is required for most activities of daily liv...
BACKGROUND: Forearm supination posture is a common secondary deformity in brachial plexus birth injury (BPBI), leading to functional impairment of the upper limb, as pronation is required for most activities of daily living. The purpose of this report is to analyze a series of children with forearm supination deformity secondary to severe BPBI and complete pronation palsy, who were treated with forearm fusion in slight pronation through the creation of a radioulnar synostosis using a novel distal pedicled vascularized ulnar periosteal flap (VUPF). METHODS: Retrospective analysis. Inclusion criteria included complete pronation paralysis with active wrist extension present and a minimum of 6 months follow-up. Demographic information, preoperative passive pronation, postoperative forearm rotational position, radiographic union, and parental satisfaction using a 4-point Likert-type ordinal scale (1-very unsatisfied, 2-unsatisfied, 3-satisfied, and 4-extremely satisfied) were analyzed. A retrograde distally pedicled vascularized ulnar periosteal flap covering approximately one third of the ulnar length and based on the posterior interosseous vessels-was transferred to the dorsal aspect of the radius and fixed for 4 weeks using Kirschner wires. RESULTS: Twenty children with a mean age of 53.6 months (range 20 to 115 months) and a mean passive forearm pronation of 9° (range 60° to 60°) with a mean follow-up of 13.7 months (range 8 to 18 months) were included in this report. All except one had complete residual BPBI. A partially ossified radioulnar synostosis was radiographically observed at 4 weeks in all cases. Mean immediate postoperative and final follow-up rotational values were similar, measuring 15° of pronation (range 0° to 30°). All parents reported extreme satisfaction with both functional and cosmetic outcomes. CONCLUSIONS: Forearm fusion in slight pronation by creating a radioulnar synostosis using a distal pedicled vascularized ulnar periosteal flap is an effective and fast technique to correct supination deformity and might be considered among other reported strategies.
Unconventional Combination of Thigh Flaps for Large Knee Defect Reconstruction After Sarcoma Resection: A Case Report.
Meroni M, Martini F, Scaglioni MF
Microsurgery · 2025 Jul · PMID 40616405 · Publisher ↗
Reconstructing large knee defects after sarcoma resection poses a significant surgical challenge, particularly when vascular anatomy variations or intraoperative vessel damage limit conventional reconstructive options. A...
Reconstructing large knee defects after sarcoma resection poses a significant surgical challenge, particularly when vascular anatomy variations or intraoperative vessel damage limit conventional reconstructive options. Achieving stable, tension-free coverage while preserving mobility is essential for optimal functional outcomes. We report the case of a 45-year-old male patient who underwent radical resection of a distal thigh myxofibrosarcoma, resulting in a large defect (24 × 18 cm) over the anterior knee region. A distally based anterolateral thigh (ALT) flap with two skin paddles was initially planned in order to achieve a "kissing" flap inset. However, intraoperative findings revealed that the distal part of the descending branch of the lateral circumflex femoral artery (DB-LCFA) had been compromised, necessitating modifications to the reconstruction strategy. The distal ALT skin paddle was utilized as a pedicled propeller flap, while the proximal ALT skin paddle, which had a separate vascular supply, was harvested as a free flap and anastomosed to a distal perforator from the DB-LCFA in a perforator-to-perforator fashion. Despite this approach, a significant residual defect remained. To achieve complete coverage, we performed an additional free flap using a vertical posterior medial thigh (vPMT) flap from the contralateral thigh, anastomosed to perforator vessels from the genicular artery. This case highlights the necessity of intraoperative adaptability when managing large oncologic defects, especially in the presence of vascular compromise. The combination of pedicled and free flaps, including an unconventional ALT flap configuration and a secondary vPMT flap, provided a stable, functional, and esthetically satisfactory outcome. Strategic integration of perforator-based techniques and intraoperative imaging optimized flap viability, demonstrating a reliable approach for complex lower limb reconstructions.
Comment on "Efficacy and Morbidity of Heparin Infusion in Salvaging Autologous Breast Reconstruction Free Flaps".
Sah S, Sah R
Microsurgery · 2025 Jul · PMID 40607708 · Publisher ↗
Abstract loading — click title to view on PubMed.
Assessment of Aesthetic Outcomes in Autologous Breast Reconstruction Using Profunda Femoris Artery Perforator Flap.
Gon C, Karakawa R, Yoshimatsu H … +3 more , Fuse Y, Ogawa R, Yano T
Microsurgery · 2025 Jul · PMID 40552687 · Publisher ↗
BACKGROUND: While autologous breast reconstruction using the profunda femoris artery perforator (PAP) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate...
BACKGROUND: While autologous breast reconstruction using the profunda femoris artery perforator (PAP) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate the reconstructed breast using the PAP flap quantitatively and to clarify which factors contribute to the aesthetically favorable results. METHODS: We identified 127 patients who underwent breast reconstructions using the vertically designed PAP flap for unilateral breast cancer between April 2018 and December 2021. The PAP flap was elevated vertically to avoid disrupting lymphatic pathways and was inserted between the pectoralis major muscle and the subcutaneous fat after the anastomoses. We classified cases into two groups: the "Favorable cosmesis group" and the "Unfavorable cosmesis group" based on aesthetic evaluations using the vectra three-dimensional (3D) imaging system. Patient characteristics and outcomes between two groups were compared. RESULTS: Of the 127 patients, 15 were excluded: three with stacked PAP flaps, two with flap necrosis, and 10 with missing aesthetic outcome data. Among the remaining 112 patients, 18 were classified in the "Favorable cosmesis group" and 94 in the "Unfavorable cosmesis group." Comparative analysis revealed that the "Favorable cosmesis group" showed significantly higher ratio with small volume in the upper pole of the unaffected side (21% vs. 72%, p < 0.01) and had a smaller final inset flap weight (147 vs. 190 g, p = 0.028) compared to the "Unfavorable cosmesis group." All 112 patients were evaluated using vectra 3D system at 12 months postoperatively, and their postoperative flap courses were uneventful. CONCLUSIONS: In our study, inherent small volume of the upper pole and smaller flap inset weight contribute to more favorable outcomes.
Comment on "Anatomical Study of SCIAP (Superficial Circumflex Iliac Artery Perforator) and SIEA (Superficial Inferior Epigastric Artery) Flaps for Flap Harvest Training in the Swine Model".
Veldi VDK, Mehta R, Sah R
Microsurgery · 2025 Jul · PMID 40552628 · Publisher ↗
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Free Flap Reconstruction in Burns: A Systematic Review of Current Practices and Evidence.
Fan C, Azam F, Hinson C … +5 more , Sink M, Jamison D, Awaida C, Fisher M, Odobescu A
Microsurgery · 2025 Jul · PMID 40552611 · Full text
BACKGROUND: The use of microsurgery remains extremely limited in burn management despite offering an alternative in cases where conventional burn reconstruction techniques fall short. This systematic review aims to evalu...
BACKGROUND: The use of microsurgery remains extremely limited in burn management despite offering an alternative in cases where conventional burn reconstruction techniques fall short. This systematic review aims to evaluate the success of microsurgical burn reconstruction in both acute and chronic burn patients and compare it to other surgical modalities as reported in current literature. METHODS: Adhering to PRISMA guidelines, a systematic literature search was conducted across Ovid Medline, Embase, PubMed/Google Scholar databases, spanning publications from 2005 to 2023. Thirteen studies met inclusion criteria. Data were sorted into categories such as study details, patient demographics, burn information, surgical management, and outcomes. RESULTS: The studies encompassed 396 microsurgical reconstructions with a wide age range and varied anatomical regions for both primary and secondary reconstruction. The most common burn etiology was flame, and most acute burn surgeries were performed five to 22 days after injury. The most common acute and nonacute complications were partial necrosis and hematomas, respectively. Findings revealed an average success rate per flap of 92.7% and 95.7% for acute and reconstructive free flaps, respectively. CONCLUSION: Microsurgery offers a promising alternative for complex burn injuries where conventional reconstructive options are exhausted or fall short. However, its success is contingent on patient selection, timing of intervention, and perioperative patient care. The success rate and complication profile of acute microsurgical burn reconstruction are similar to that seen in trauma reconstruction. Secondary microsurgical burn reconstructions have similar success rates to those seen in other elective flaps, such as breast reconstruction. Current usage of microsurgery in burns is low, yet the majority of literature supports expanding its application in the field.
Visualize and Identify Perforators With a Novel Three Dimensional-Computed Tomography Viewer.
Shinmi K, Shiraishi M, Miyamoto S … +4 more , Takeishi H, Kurita D, Fujisawa K, Okazaki M
Microsurgery · 2025 Jul · PMID 40536174 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Application of Augmented Reality Technology in Free Flap Reconstruction: A Systematic Review.
Wolbert TT, White AE, Han J … +5 more , Mirajkar S, Van Aalst JA, Johnson PJ, Wong SL, Figy SC
Microsurgery · 2025 Jul · PMID 40528539 · Publisher ↗
INTRODUCTION: Augmented reality (AR) is an emerging technology in microsurgery for free flap reconstruction. AR allows surgeons to superimpose preoperative CT images onto the patient, providing real-time insight into the...
INTRODUCTION: Augmented reality (AR) is an emerging technology in microsurgery for free flap reconstruction. AR allows surgeons to superimpose preoperative CT images onto the patient, providing real-time insight into the underlying anatomy and aiding in the decision-making process; however, there is limited empirical evidence supporting the effectiveness of this modality. We conducted a systematic review to investigate whether the use of AR devices in free flap reconstruction correlates with improved outcomes. METHODS: A comprehensive search of PubMed, Embase, and Scopus was performed on February 19, 2025. Our search included retrospective and prospective articles that demonstrated the use of AR technology intraoperatively and reported surgical outcomes in any type of free flap reconstruction. The initial search yielded 158 articles, with 8 ultimately included in the study. Articles were reviewed for technical accuracy, surgeon ease of use, operative time, complications, and operative costs. RESULTS: AR can guide surgeons, particularly those with less experience. As surgeons gain a better understanding of perforator locations, they operate with increased confidence and efficiency. AR outperformed Doppler ultrasound in perforator identification, demonstrating higher accuracy during flap planning and dissection. The time required to harvest flaps was significantly shorter when AR was used compared to traditional flap dissection techniques. Compared to computer-aided design and computer-aided manufacturing (CAD/CAM) navigation systems, AR surgical guidance exhibited greater accuracy and required significantly less time for flap design. AR devices surpassed cutting guides in various aspects, including cost savings, reduced preparation time, increased flexibility in surgical plan modification, intraoperative tissue drift, and a more favorable effect on hand-eye coordination. No conclusive postoperative complications were reported. CONCLUSION: The majority of the literature about AR in free flap surgery comes from small clinical studies. Widescale, multi-center studies are necessary to determine the true clinical impact of AR technology in microsurgery.
The Perfusion Territory of the Superficial Branch of the Superficial Circumflex Iliac Artery: It Might Extend More Medially Than Expected.
Martini F, Meroni M, Scaglioni MF
Microsurgery · 2025 Jul · PMID 40509784 · Publisher ↗
Abstract loading — click title to view on PubMed.
Reconstruction of Tongue Malignancy Defects: A Systematic Review and Treatment Algorithm.
Gearing PF, Devine M, Sim F … +2 more , Davies L, Ramakrishnan A
Microsurgery · 2025 Jul · PMID 40503748 · Publisher ↗
INTRODUCTION: The tongue is the most common site of oral malignancies, with surgical resection the mainstay of treatment. Tongue cancer resections have significant functional impacts. Ideal reconstruction would restore s...
INTRODUCTION: The tongue is the most common site of oral malignancies, with surgical resection the mainstay of treatment. Tongue cancer resections have significant functional impacts. Ideal reconstruction would restore speech intelligibility, facilitate swallowing of liquids and solids without significant dysphagia, and have minimal morbidity. We aimed to review and synthesize published outcomes of tongue reconstructive methods into a useful clinical treatment algorithm. METHODS: A systematic electronic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Medline (OVID), Embase (OVID), PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL) were reviewed for all studies published prior to October 12th, 2024. Conference abstracts, case reports, case series, and review papers were excluded. Quantitative data were extracted and tabulated. RESULTS: After screening 1268 abstracts and 321 full-text articles, 113 papers were included. Multiple free and locoregional flap reconstructive methods, skin grafting techniques, and tissue substitutes were identified. The anterolateral thigh (ALT) free flap and radial forearm free flap (RFFF) were the most common reconstructive methods. CONCLUSIONS: A treatment algorithm is proposed to facilitate structured surgical planning and intra-operative reconstructive decision-making for tongue malignancy defects. PROSPERO Registration: CRD420223818875.
The Great Auricular Nerve as a Nerve Graft Donor: An Anatomical and Clinical Study of the Maximum Harvestable Length and Branches.
Ueno M, Tanaka K, Murakami K … +1 more , Ishida N
Microsurgery · 2025 Jul · PMID 40481754 · Full text
BACKGROUND: For immediate facial nerve reconstruction during head and neck tumor resection, a great auricular nerve (GAN) graft can be potentially harvested in the same surgical field during tumor resection. However, it...
BACKGROUND: For immediate facial nerve reconstruction during head and neck tumor resection, a great auricular nerve (GAN) graft can be potentially harvested in the same surgical field during tumor resection. However, it is often avoided because a GAN graft is only approximately 5 cm long without any branches, and a sural nerve graft is recommended for larger defects. We investigated the length of the GAN that can be harvested in 18 patients, along with the evaluation of postoperative facial nerve palsy. METHODS: We retrospectively analyzed 18 cases of immediate facial nerve reconstruction using the GAN from 2018 to 2023 at our hospital. In most cases, we traced the GAN to the back surface of the sternocleidomastoid and harvested the nerve graft immediately before the loops of the cervical nerve plexus or bifurcation into the phrenic nerve. This tracing method allowed the collection of a longer nerve graft with more branches. RESULTS: The mean length of the harvested GAN was 8.16 cm (95% confidence interval 7.42-8.89 cm), with the longest graft being 10.5 cm. The GAN grafts had an average of 1.83 branches and were 1.76-2.23 mm in diameter. Three patients had two peripheral transected edges of the facial nerve, each of which was sutured with a branch of the GAN graft. Three patients had five-six peripheral edges and required additional nerve grafts, such as the sural nerve. Postoperative facial nerve palsy was grade III or IV by House-Brackmann and FNGS 2.0 in all cases. CONCLUSIONS: For immediate facial nerve reconstruction, the GAN can be harvested in a length of at least 8 cm and few branches by sufficient dissection of the back surface of the sternocleidomastoid muscle, including its branches and other sensory nerves, with few complications.
Reconstruction of a Large Perineal Defect After Radical Oncological Pelvic Exenteration in a Patient With Anal Cancer: An Interdisciplinary Approach and Literature Review.
Sabagh M, Cordts T, Sabetkish N … +5 more , Polychronidis G, Erhart P, Boecker A, Vogelpohl J, Al-Saeedi M
Microsurgery · 2025 Jul · PMID 40459570 · Publisher ↗
INTRODUCTION: Recurrent anal cancer (AC) often requires surgical intervention, especially when large perineal defects must be reconstructed. These cases are complicated by poor tissue vascularity and comorbid conditions...
INTRODUCTION: Recurrent anal cancer (AC) often requires surgical intervention, especially when large perineal defects must be reconstructed. These cases are complicated by poor tissue vascularity and comorbid conditions such as peripheral arterial disease (PAD). METHODS: We report the case of a 64-year-old male with PAD and recurrent AC, presenting with a large perineal defect following radical pelvic exenteration. Preoperative iliac artery stenting was performed to ensure adequate perfusion. Surgical reconstruction was conducted in two stages: first, a vertical rectus abdominis myocutaneous (VRAM) flap (7 × 15 cm) for pelvic floor coverage, followed by a free latissimus dorsi (LD) flap (17 × 30 cm) anastomosed to the superior gluteal vessels. RESULTS: Postoperative recovery was uneventful. Three vacuum-assisted closures were performed, and the patient was discharged 6 weeks postoperatively. At 6-month follow-up, the flap remained stable with no complications. CONCLUSION: This case underscores the importance of preoperative vascular optimization and a staged surgical strategy when addressing large, complex perineal defects. Multidisciplinary collaboration is critical for achieving optimal outcomes.
Successful Testis Replantation After Bilateral Traumatic Testis Amputation With a 15-Year Follow-Up of Functional Testis: A Case Report.
Erçöçen AR, Zereyak U
Microsurgery · 2025 Jul · PMID 40456122 · Publisher ↗
Bilateral traumatic amputation of the testis is a very rare condition. It is important to preserve the reproductive and endocrine functions of the testis after replantation. In this paper, we report on an 18-year-old mal...
Bilateral traumatic amputation of the testis is a very rare condition. It is important to preserve the reproductive and endocrine functions of the testis after replantation. In this paper, we report on an 18-year-old male patient with a history of a tractor accident who had a crush avulsion-amputation injury of both testes and lacerations on both sides of the scrotum. The left testicle could not be replanted due to severe damage to the vascular structures, but the right testicle was found to be suitable for replantation. After dissection of the recipient vessels in both inguinal canals under the appropriate magnification of the operating microscope, the testicular artery in the right spermatic cord and the internal spermatic vein of the pampiniform plexus were prepared as recipient vessels; at the same time, after dissection of the right vas deferens, microanastomosis of the artery, vein, and vas deferens was performed using the end-to-end microsurgical technique, and the right testis was successfully replanted orthotopically. No postoperative complications were observed; early (1-3 months) and late (1-15 years) follow-up were uneventful, and functional (endocrine and reproductive) recovery was confirmed based on clinical, laboratory, radiologic, and histopathologic evaluations. Although partial endocrine recovery after testicular replantation in traumatic testicular amputation has been reported in the literature, no case with preserved reproductive function has been reported. In this article, we review the literature and discuss that unilateral and bilateral as well as traumatic and self-mutilating (psychotic) conditions should be considered when deciding the indication for testicular replantation, and the critical ischemia period should not be exceeded. Our case of bilateral traumatic testicular amputation in which only one testicle could be replanted is a good example to show that both endocrine and reproductive testicular function can be fully preserved if the critical ischemia period is not exceeded.
Lipomatosis of Nerve Misdiagnosed as Primary Lymphedema: Report of Two Cases.
Maldonado AA, Marek T, Howe BM … +1 more , Spinner RJ
Microsurgery · 2025 Jul · PMID 40448973 · Publisher ↗
Primary lymphedema (i.e., a chronic condition characterized by the accumulation of protein-rich fluid in the interstitial spaces due to impaired lymphatic drainage) and lipomatosis of nerve (LN) (i.e., a congenital lesio...
Primary lymphedema (i.e., a chronic condition characterized by the accumulation of protein-rich fluid in the interstitial spaces due to impaired lymphatic drainage) and lipomatosis of nerve (LN) (i.e., a congenital lesion characterized by the presence of fat interspersed within nerve) can involve a significant overgrowth of the affected limb, but their pathophysiology and treatment are totally different. This report addresses the misdiagnosis of both entities. The purpose is to highlight how both entities can be differentiated through two case reports. The first patient, a 69-year-old man, presented in our lymphedema clinic with multiple debulking operations; he was diagnosed with right upper extremity lymphedema during childhood. The thumb, index, and middle fingers had previously been amputated due to sequelae from the bony overgrowth. MRI of the right upper extremity showed pathognomonic features of LN affecting the median nerve associated with soft tissue fatty overgrowth. He had a 3 months follow-up for this condition in our institution during which his symptoms remained stable. The second patient, an 81-year-old man, presented in our lymphedema clinic. He carried a long time diagnosis of primary left lower extremity lymphedema and had been followed at our institution for more than 25 years. Physical examination revealed overgrowth (increased volume) affecting the entire leg and foot. MRI showed pathognomonic features of LN of the left sciatic nerve. No surgical interventions were performed. At the last follow-up, his extremity showed slightly worsened diameter measurements. Based on our 2 cases presented and 2 additional cases identified in the literature, we believe that primary lymphedema and LN are two different entities that could be confused. Plastic surgeons treating patients with lymphedema should be aware of LN and rule out this condition clinically and with imaging (US or MRI).
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