Journal of Clinical Medicine

Research

12 pages, 1111 KiB

Open AccessArticle

Changes in the Microcirculation and Physiologic Perfusion Dynamics of Free DIEP Flaps in the First 72 h After Breast Reconstruction

by Denis Ehrl, Verena Alt, Sara Taha, Konstantin Frank, Nikolaus Wachtel, Karl J. Bodenschatz, Wolfram Demmer, Benedikt Fuchs, Riccardo E. Giunta and Nicholas Moellhoff

J. Clin. Med. 2025, 14(2), 520; https://doi.org/10.3390/jcm14020520 - 15 Jan 2025

Viewed by 824

Abstract

Background/Objectives: The autologous reconstruction of the female breast using a microsurgical DIEP flap is a reliable and safe method. To detect impairments early and preserve the microvascular flap through timely revision, a better understanding of physiologic perfusion dynamics is necessary. This exploratory study [...] Read more.

Background/Objectives: The autologous reconstruction of the female breast using a microsurgical DIEP flap is a reliable and safe method. To detect impairments early and preserve the microvascular flap through timely revision, a better understanding of physiologic perfusion dynamics is necessary. This exploratory study examines changes in microcirculation in free DIEP flaps within the first 72 h after vascular anastomosis using laser Doppler flowmetry and white-light spectrophotometry. Methods: This single-center study analyzed retro- and prospectively collected data from female patients who underwent uneventful breast reconstruction using a DIEP flap and were monitored using the O2C device (LEA Medizintechnik, Giessen, Germany). Microcirculation was monitored continuously postoperatively for a period of 72 h. Results: A total of 36 patients with a mean age of 48.86 (9.36) years and a mean BMI of 26.78 (4.12) kg/m² received 40 DIEP flaps (four bilateral reconstructions). Microcirculatory blood flow showed a continuous increase, reaching up to 15% above its initial value within the first 72 h following anastomosis. The average tissue oxygen saturation (sO2) and relative hemoglobin (rHB) levels remained fairly stable throughout the study period, with overall reductions of 5.46% and 5.30%, respectively. Conclusions: Autologous breast reconstruction using a microvascular DIEP flap is a safe and reliable technique. This study showed an increase in blood flow over the 72 h study period. At the same time, sO2 and rHb showed stable levels. Deviations in these values could be interpreted as indicators of a perfusion disorder of the microvascular flap. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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14 pages, 1633 KiB

Open AccessArticle

Impact of Postoperative Norepinephrine Administration on Free Flap Flow

by Denis Ehrl, Svenja Pistek, Clemens Rieder, Michael Irlbeck, Klaus Hofmann-Kiefer, David Braig, Frederic Klein, Philipp Groene, Riccardo E. Giunta and Nicholas Moellhoff

J. Clin. Med. 2024, 13(24), 7816; https://doi.org/10.3390/jcm13247816 - 20 Dec 2024

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Abstract

Background/Objectives: The perioperative interplay between blood pressure, vasopressors, and macrocirculation is well established. However, in the context of free flap surgery, the potential impact of these factors on microvascular flow remains elusive. The aim was to evaluate the impact of norepinephrine administration on [...] Read more.

Background/Objectives: The perioperative interplay between blood pressure, vasopressors, and macrocirculation is well established. However, in the context of free flap surgery, the potential impact of these factors on microvascular flow remains elusive. The aim was to evaluate the impact of norepinephrine administration on the microcirculation of free flaps. Methods: Postoperative systolic blood pressure (sBP), norepinephrine infusion rates (NIRs), and free flap microcirculation were monitored prospectively and analyzed retrospectively in patients receiving free flap surgery who required postoperative intermediate (IMC) or intensive care (ICU). Blood flow, hemoglobin oxygenation (SO₂), and relative hemoglobin levels (rHbs) were measured over a period of 24 hours post-anastomosis by laser-doppler flowmetry and white light spectroscopy using the “Oxygen to See” device (O2C, LEA Medizintechnik, Gießen, Germany). Multivariate analysis was performed to determine the impact of NIR on microvascular flow, adjusting for several confounding factors. Subgroup analysis was conducted by categorizing into three groups based on patients’ postoperative sBP. Results: Flaps were performed in 105 patients with a mean age of 61.46 ± 16.29 years. Postoperatively, an increase in microvascular flow over time was observed across all free flaps, while NIR decreased and sBP maintained stable values. Multivariate analysis revealed that the time post-anastomosis (B = 3.76, p < 0.001), SO₂ (B = 0.55, p < 0.001), rHb (B= −0.79, p < 0.001), female gender (B = 29.25, p = 0.02), and no previous radiation therapy (B = 41.21, p = 0.04) had a significant impact on postoperative microvascular flow in free flaps. NIR, sBP, smoking status, old age, and ASA score showed no significant impact on free flap flow. Further, NIR showed no significant impact on microvascular flow in any of the subgroups investigated. Conclusions: These findings support the safety of using norepinephrine for maintaining stable blood pressure without compromising microvascular flow, offering valuable guidance for postoperative management. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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13 pages, 482 KiB

Open AccessArticle

The Effects of Systemic Tranexamic Acid Administration on Drainage Volume, Duration of Drain Placement, and Length of Hospital Stay in Skin- and Nipple-Sparing Mastectomies with Immediate Expander-Based Breast Reconstruction

by Leon Guggenheim, Sara Magni, Armin Catic, Alberto Pagnamenta, Yves Harder and Daniel Schmauss

J. Clin. Med. 2024, 13(21), 6507; https://doi.org/10.3390/jcm13216507 - 30 Oct 2024

Cited by 1 | Viewed by 1247

Abstract

Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and, specifically, breast [...] Read more.

Background: Skin- (SSM) and nipple-sparing (NSM) mastectomies are frequently performed surgeries with a considerable risk for post-operative hematoma or seroma. Tranexamic acid (TXA) is a potent antifibrinolytic drug commonly used in many surgical fields but rather novel in plastic and, specifically, breast surgery. This study investigates the influence of TXA in patients undergoing SSM or NSM with expander-based reconstruction (EbR) on post-operative outcomes. Methodology: A retrospective study was conducted on 132 patients undergoing uni- or bilateral SSM or NSM with EbR between May 2015 and March 2022. Patients receiving systemic TXA treatment for 48 h following a standardized protocol were compared to those who received no treatment. Multivariable linear regression was performed to identify influencing factors and quantify their effect on drainage volume, duration of drain placement, length of hospital stay, post-operative bleeding, and seroma formation. Results: The 132 patients underwent a total of 155 mastectomies (72 in the TXA group, 83 in the control group). TXA significantly reduced drainage volume (−22.3 mL, p = 0.011). Duration of drain placement and length of hospital stay were significantly shorter in the TXA group (p < 0.001 and p = 0.001). No significant side effects were reported. Conclusion: TXA is a safe drug if administered respecting the well-defined contraindications. Systemic TXA administration significantly reduces drainage volume in patients undergoing SSM or NSM and should encourage surgeons to reconsider using drains in post-operative protocols. Duration of drain placement and length of hospital stay were significantly reduced in the TXA group but other factors like resection weight might have a more substantial impact. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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11 pages, 5129 KiB

Open AccessArticle

Neo-Omphaloplasty within a Vertical Scar: The Double Trapezium Flap Technique

by Thomas Holzbach, Katarina Danuser, Christine Sophie Hagen, Denis Ehrl and Sebastian Leitsch

J. Clin. Med. 2024, 13(19), 5659; https://doi.org/10.3390/jcm13195659 - 24 Sep 2024

Viewed by 1265

Abstract

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two “cross-border” trapezium flaps that come together [...] Read more.

Background: Various techniques for neo-omphaloplasty (or umbilicoplasty/umbiliconeoplasty) have been established in recent decades. However, when the omphaloplasty must be integrated into a vertical scar, most of these techniques are unsuitable. Method: We established a technique comprising two “cross-border” trapezium flaps that come together in a key-lock fashion to be applicable for umbilical reconstruction in vertical scars. Between 2020 and 2023, we performed the double trapezium flap technique in 11 patients requiring abdominal wall correction due to previous operations resulting in the loss of the original navel and a vertical midline scar. The follow-up period was 12 months. Results: We encountered two minor wound healing disorders not involving the omphaloplasty. One patient experienced a more severe wound healing complication involving the vertical scar and the lower flap of the neo-umbilicus. No cases of umbilical flattening or detachment of the anchorage stitches were detected. Patients ranked the aesthetic outcomes as “excellent” (n = 9) or “good” (n = 2). Physicians ranked the results as “excellent” (n = 7), “good” (n = 4), and “average” (n = 1). Conclusions: For the selected patients, this technique appears to be a good and reliable option to create a natural looking neo-umbilicus, creating sufficient umbilical depth with minimal scarring. While a study population of 11 patients is hardly enough to endorse a new technique, appropriate cases are comparatively rare and very specific. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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11 pages, 1571 KiB

Open AccessArticle

Impact of Negative Pressure Wound Therapy on Perfusion Dynamics in Free Latissimus Dorsi Muscle Flaps

by Nicholas Moellhoff, Wolfram Demmer, Svenja Pistek, Nikolaus Wachtel, Karl Bodenschatz, Lulin Lui, Michael Alfertshofer, Konstantin Frank, Riccardo E. Giunta and Denis Ehrl

J. Clin. Med. 2024, 13(17), 5261; https://doi.org/10.3390/jcm13175261 - 5 Sep 2024

Viewed by 1034

Abstract

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in [...] Read more.

Background: Free muscle flaps can develop significant postoperative edema and wound exudation, thereby increasing interstitial pressure and potentially compromising microcirculation. While concerns exist regarding negative pressure wound therapy (NPWT) to compress free flaps and hinder monitoring, recent studies have indicated a reduction in edema and an increase in blood flow. Objective: To compare microcirculation in free latissimus dorsi muscle (LDM) flaps dressed with and without NPWT. Methods: This retrospective cohort study analyzed prospectively collected data of patients who received free LDM flap reconstruction. Patients were separated into two groups according to management with or without NPWT. Microcirculation was evaluated continuously for up to 72 h utilizing laser doppler flowmetry and tissue spectrometry. Results: In total, n = 61 patients (26 females, 35 males) with an average age of 56.90 (17.4) years were included. NPWT was applied in 12 patients, while a regular cotton dressing was used in 49 patients. Overall, no significant differences in the number of minor and major complications were observed between groups. Both groups showed an increase in microvascular flow over the investigated time period. The flow showed higher absolute values in the NPWT group, reaching statistical significance at 12 h post-anastomosis, p = 0.038. There was a tendency for lower rHb values in the NPWT group, without reaching statistical significance. Conclusions: The presented study confirms the increase in microvascular flow after NPWT application. Whilst ensuring continuous free flap monitoring utilizing laser doppler flowmetry and spectrometry, the data further support the safety of NPWT application without risking vascular compromise due to external compression. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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10 pages, 5130 KiB

Open AccessArticle

Correction of Post-Surgical Temporal Hollowing with Adipo-Dermal Grafts: A Case Series

by Stefano Andreoli, Davide Brucato, Daniel Schmauss and Yves Harder

J. Clin. Med. 2024, 13(16), 4936; https://doi.org/10.3390/jcm13164936 - 21 Aug 2024

Viewed by 1310

Abstract

Background: Surgical dissection and partial detachment of the temporalis muscle during neurosurgical procedures might result in a temporal depression known as “temporal hollowing”. Reconstructive procedures to correct this condition include the implantation of synthetic materials (e.g., hydroxyapatite, methacrylate or polyethylene), injection of autologous [...] Read more.

Background: Surgical dissection and partial detachment of the temporalis muscle during neurosurgical procedures might result in a temporal depression known as “temporal hollowing”. Reconstructive procedures to correct this condition include the implantation of synthetic materials (e.g., hydroxyapatite, methacrylate or polyethylene), injection of autologous fat or fillers as well as the use of flaps (e.g., temporo-parietal local flap and latissimus dorsi free flap). However, none of these techniques proved to be an ideal option due to a high complication rate or need for invasive and complex surgery. Adipo-dermal grafts are autologous; the resorption rate seems to be limited and the complexity of the procedure is minor. Moreover, autologous fat grafting can be performed to enhance the final outcome by correcting residual contour deformities. Methods: In this series of five patients, an institutional experience is presented using multi-layered adipo-dermal grafts harvested from the supra-pubic area for the restoration of volume and contour in post-surgical temporal hollowing. During the last follow-up, patients were asked to express their satisfaction, which was assessed by a survey. Results: this approach demonstrates a marked improvement in temporal hollowing associated with a low complication rate and good patient satisfaction. Conclusions: the aim of this consecutive case series is to emphasize the effectiveness of this surgical technique as one of the options to address temporal hollowing. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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17 pages, 2621 KiB

Open AccessArticle

Algorithm-Guided Treatment of Ulna Impaction Syndrome: A 10-Year Follow-Up Study of Ulna Shortening Osteotomy and Wafer Procedure

by Irene Mesas Aranda, Elisabeth Maria Haas-Lützenberger, Sara Imam, Riccardo E. Giunta and Elias Volkmer

J. Clin. Med. 2024, 13(13), 3972; https://doi.org/10.3390/jcm13133972 - 7 Jul 2024

Viewed by 2556

Abstract

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative [...] Read more.

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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18 pages, 15761 KiB

Open AccessArticle

Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants—An Accuracy Study of Digital High-Tech Procedures

by Bilal Msallem, Lara Veronesi, Michel Beyer, Florian S. Halbeisen, Michaela Maintz, Adrian Franke, Paula Korn, Adrian Dragu and Florian M. Thieringer

J. Clin. Med. 2024, 13(12), 3594; https://doi.org/10.3390/jcm13123594 - 19 Jun 2024

Cited by 4 | Viewed by 1759

Abstract

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling [...] Read more.

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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10 pages, 1004 KiB

Open AccessArticle

Microvascular Muscle vs. Fascio-Cutaneous Free Flaps for Reconstruction of Plantar Load-Bearing Foot Defects—An International Survey

by Sinan Mert, Paul I. Heidekrueger, Benedikt Fuchs, Tim Nuernberger, Elisabeth M. Haas-Lützenberger, Riccardo E. Giunta, Denis Ehrl and Wolfram Demmer

J. Clin. Med. 2024, 13(5), 1287; https://doi.org/10.3390/jcm13051287 - 24 Feb 2024

Cited by 2 | Viewed by 1107

Abstract

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, [...] Read more.

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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10 pages, 19376 KiB

Open AccessArticle

How Reliable Is Breast Volume Assessment When the Patient Is Lying Flat?—Volumetric Assessment of Breast Volume Using a Vectra H2 Handheld Device in Different Positions

by Aljosa Macek, Sebastian Leitsch, Konstantin Christoph Koban, Julius Michael Mayer, Rafael Loucas and Thomas Holzbach

J. Clin. Med. 2024, 13(3), 709; https://doi.org/10.3390/jcm13030709 - 25 Jan 2024

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(1) Background: Three-dimensional (3D) volumetric assessment is receiving increased recognition in breast surgery. It is commonly used for preoperative planning and postoperative control with the patient standing in an upright position. Recently, intraoperative use was evaluated with patients in the supine position. [...] Read more.

(1) Background: Three-dimensional (3D) volumetric assessment is receiving increased recognition in breast surgery. It is commonly used for preoperative planning and postoperative control with the patient standing in an upright position. Recently, intraoperative use was evaluated with patients in the supine position. The aim of this prospective study was to evaluate the volumetric changes in 3D surface imaging depending on the patient’s position. (2) Methods: 3D volumetric analysis was performed using a Vectra-H2 device with patients in standing, sitting, and supine positions. A total of 100 complete datasets of female breasts were included in the study. The measured volumes of each evaluated breast (n = 200) were compared between the three positions. (3) Results: The mean difference between the 3D volumetric assessments of the sitting and standing positions per breast was 7.15 cc and, thus, statistically insignificant (p = 0.28). However, the difference between supine and standing positions, at 120.31 cc, was significant (p < 0.01). (4) Conclusions: The 3D volumetric assessment of breasts in the supine position did not statistically correlate with the validated assessment of breast volume in the standing position while breast volume in the sitting position is reliable and correlates with the assessment of a standing patient. We conclude that intraoperative volumetric assessment should be performed with patients in an upright sitting position. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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15 pages, 2693 KiB

Open AccessArticle

Intraoperative Blood Flow Analysis of Free Flaps with Arteriovenous Loops for Autologous Microsurgical Reconstruction

by Alexander Geierlehner, Raymund E. Horch, Ingo Ludolph, Werner Lang, Ulrich Rother, Alexander Meyer and Andreas Arkudas

J. Clin. Med. 2023, 12(23), 7477; https://doi.org/10.3390/jcm12237477 - 2 Dec 2023

Cited by 3 | Viewed by 1797

Abstract

Background: Arteriovenous (AV) loops help to overcome absent or poor-quality recipient vessels in highly complex microvascular free flap reconstruction cases. There are no studies on blood flow and perfusion patterns. The purpose of this study was to evaluate and compare intraoperative hemodynamic characteristics [...] Read more.

Background: Arteriovenous (AV) loops help to overcome absent or poor-quality recipient vessels in highly complex microvascular free flap reconstruction cases. There are no studies on blood flow and perfusion patterns. The purpose of this study was to evaluate and compare intraoperative hemodynamic characteristics of AV loops followed by free tissue transfer for thoracic wall and lower extremity reconstruction. Methods: this prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the assessment of blood flow volume, arterial vascular resistance and intrinsic transit time at the time of AV loop construction and on the day of free flap transfer. Results: A total of 11 patients underwent AV loop creation, of whom five required chest wall reconstruction and six required reconstruction of the lower extremities. In seven of these cases, the latissimus dorsi flap and in four cases the vertical rectus abdominis myocutaneous (VRAM) flap was used as a free flap. At the time of loop construction, the blood flow volume of AV loops was 466 ± 180 mL/min, which increased to 698 ± 464 mL/min on the day of free tissue transfer (p > 0.1). After free flap anastomosis, the blood flow volume significantly decreased to 18.5 ± 8.3 mL/min (p < 0.001). There was no significant difference in blood flow volume or arterial vascular resistance between latissimus dorsi and VRAM flaps, nor between thoracic wall and lower extremity reconstruction. However, a significant correlation between the flap weight and the blood flow volume, as well as to the arterial vascular resistance, was found (p < 0.05). Conclusion: This is the first study to perform intraoperative blood flow and hemodynamic measurements of AV loops followed by free tissue transfer. Our results show hemodynamic differences and contribute to deeper understanding of the properties of AV loops for free flap reconstruction. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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Review

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14 pages, 4271 KiB

Open AccessReview

Advances in Modern Microsurgery

by Oliver C. Thamm, Johannes Eschborn, Ruth C. Schäfer and Jeremias Schmidt

J. Clin. Med. 2024, 13(17), 5284; https://doi.org/10.3390/jcm13175284 - 6 Sep 2024

Cited by 4 | Viewed by 1936

Abstract

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores [...] Read more.

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores the historical development, advancements, and current applications of microsurgery in plastic surgery. Methods: The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term “(((microsurgery) OR (advances)) OR (robotic)) OR (AI)) AND (((lymphatic surgery) OR (peripheral nerve surgery)) OR (allotransplantation))” and manually checked for relevance. Additionally, a supplementary search among the references of all publications included was performed. Articles were included that were published in English or German up to June 2024. Results: Modern microsurgical techniques have revolutionized plastic surgery, enabling precise tissue transfers, improved nerve reconstruction, and effective lymphedema treatments. The evolution of robotic-assisted surgery, with systems like da Vinci and MUSA, has enhanced precision and reduced operative times. Innovations in imaging, such as magnetic resonance (MR) lymphography and near-infrared fluorescence, have significantly improved surgical planning and outcomes. Conclusions: The continuous advancements in microsurgery, including supermicrosurgical techniques and robotic assistance, have significantly enhanced the capabilities and outcomes of plastic surgery. Future developments in AI and robotics promise further improvements in precision and efficiency, while new imaging modalities and surgical techniques expand the scope and success of microsurgical interventions. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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12 pages, 1294 KiB

Open AccessSystematic Review

Physical and Psychological Burden of Bed Rest on Patients Following Free Flap Reconstruction of the Lower Limb: A Systematic Review and Possible Solutions

by Léna G. Dietrich and Cédric Zubler

J. Clin. Med. 2025, 14(3), 705; https://doi.org/10.3390/jcm14030705 - 22 Jan 2025

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Abstract

Background: Postoperative bed rest is considered essential after free flap reconstruction of the lower limb to ensure microsurgical success, but prolonged inactivity can lead to physical deconditioning and psychosocial challenges, even in otherwise healthy patients. While early mobilization protocols improve physical recovery, their [...] Read more.

Background: Postoperative bed rest is considered essential after free flap reconstruction of the lower limb to ensure microsurgical success, but prolonged inactivity can lead to physical deconditioning and psychosocial challenges, even in otherwise healthy patients. While early mobilization protocols improve physical recovery, their impact on psychological wellbeing remains underexplored. This review evaluates the current literature on postoperative protocols in microvascular lower extremity reconstruction, focusing on both physical and mental health outcomes, and explores potential strategies for optimizing recovery. Methods: A systematic review was conducted following the PRISMA guidelines to search PubMed, Cochrane Library, and Embase databases. Studies were included if they explicitly described postoperative immobilization or mobilization protocols and their impact on recovery outcomes, including complications and psychological effects. Results: Sixteen studies met the inclusion criteria, highlighting the potential of early mobilization protocols in reducing complications such as pneumonia, deep vein thrombosis, and prolonged hospital stays. Structured mobilization strategies, such as early dangling and perfusion-controlled mobilization, demonstrated improved microcirculatory adaptation and enhanced recovery outcomes. However, limited to no research addressed psychological resilience and the impact of immobility on patient mental health. Conclusions: Early mobilization protocols significantly improve physical outcomes after free flap surgery, but the psychological and mental effects of postoperative bed rest remain insufficiently studied. Adapting strategies from space medicine, including structured routines, cognitive training, and social engagement, offers promising avenues for enhancing recovery. Future research should focus on integrating physical and psychological interventions into comprehensive, evidence-based recovery protocols to optimize patient outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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