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Escandón JM, Ciudad P, Mayer HF, Pencek M, Mantilla-Rivas E, Mohammad A, Langstein HN, Manrique OJ. Free flap transfer with supermicrosurgical technique for soft tissue reconstruction: A systematic review and meta-analysis. Microsurgery 2023; 43:171-184. [PMID: 35551691 DOI: 10.1002/micr.30894] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Supermicrosurgery is a technique that allows microsurgeons to accomplish dissections and anastomoses of vessels and nerve fascicles with diameters of ≤0.8 mm. Considering the potential benefits of this technique and limited literature synthesizing the outcomes of supermicrosurgery, the aim of this study was to summarize the available evidence of reconstructive supermicrosurgery and to estimate the success rate. METHODS We conducted a comprehensive search across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with free flaps specifying the use of supermicrosurgery. We excluded studies reporting on lymphatic surgery, solely peripheral nerve surgery, and tissue replantation. Our primary endpoint was to calculate the flap success rate. Pooled estimates were calculated using a random-effects meta-analytic model. RESULTS Forty-seven studies reporting outcomes of 698 flaps were included for qualitative synthesis. Overall, 15.75% of flaps were used for head and neck, 4.4% for breast and trunk, 9.3% for upper limb, and 69.2% for lower limb reconstruction. The most used flap was the superficial circumflex iliac artery perforator flap (41.5%). The overall flap success rate was 96.6% (95%CI 95.2%-98.1%). The cumulative rate of partial flap loss was 3.84% (95%CI 1.8%-5.9%). The overall vascular complication rate resulting in complete or partial flap loss was 5.93% (95%CI 3.5%-8.3%). CONCLUSIONS Supermicrosurgery displays a high success rate. Further studies are necessary to explore the true potential of supermicrosurgery. This technique reformulates the boundaries of reconstructive surgery due to its extensive application.
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Affiliation(s)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, Archbishop Loayza National Hospital, Lima, Peru
| | - Horacio F Mayer
- Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Megan Pencek
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, USA
| | - Arbab Mohammad
- School of Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
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Pamuk Ç. Supermicrosurgical Experience pertaining to Replantation of Tamai Zone 1 Fingertip Amputations. HANDCHIR MIKROCHIR P 2023; 55:28-34. [PMID: 36041461 DOI: 10.1055/a-1894-7320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With the advent of supermicrosurgery, the replantation of very distal finger amputations has become possible. The choice between replantation or flap surgeries in the treatment of Tamai Zone I finger amputations continues to be a matter of debate. This study aims to evaluate replantation results in Tamai Zone 1 finger amputations. The demographic characteristics and clinical results of 39 patients undergoing replantation for a Tamai Zone 1 finger amputation between 2018 and 2021 were retrospectively analyzed. The Cold Intolerance Severity Score (CISS), two-point discrimination test (2-PD) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were calculated and recorded after a minimum follow-up period of 6 months. The great majority of patients were males (92.3%, n=36) who had suffered the injuries during work accidents (89.7%, n=35). The socioeconomic status of the patients showed a homogeneous distribution. Replant survival was achieved in 69.2% (n=27) of all fingers. The duration of the surgical procedure in patients who underwent vein repair was significantly longer (p<0.001). However, there was no significant relationship between vein repair and survival rate (p=0.348). This study shows that replantation is a surgical intervention that should be given priority in patients with Tamai Zone 1 amputations. In most cases of unsuccessful replantation, secondary recovery results are also acceptable. Future studies with larger case series are needed.
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Affiliation(s)
- Çağdaş Pamuk
- Orthopaedics and Traumatology Department, Private Silivri Anadolu Hospital, Silivri, Turkey
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Lan X, Huang Y, Guo L, Lin J. Treatment of fingertip defect with reversed digital artery island flap through superficial vein anastomosis. ANZ J Surg 2021; 91:E584-E588. [PMID: 33634939 DOI: 10.1111/ans.16698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/09/2020] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study prospectively explored the clinical effect of a reversed digital artery island flap (RDAIF) in repairing fingertip defects and the impact of the anastomosis of superficial veins in the recipient area on the incidence of venous crisis. METHODS A total of 92 patients with fingertip defects who underwent RDAIF from February 2016 to February 2018 were enrolled in this prospective, randomized, controlled trial. Of these, 44 patients underwent superficial vein anastomosis. The perioperative data, clinical efficacy and complications of the two groups were compared by the chi-squared test and binary logistic regression analysis. RESULTS The average follow-up time was 7.0 ± 2.9 months. The incidence of venous congestion was significantly correlated with flap size, surgical time and anastomosis of superficial veins (Wald = 6.512, 9.353 and 11.662; P = 0.011, 0.002 and 0.001, respectively). The fingertips of the two groups of patients were well repaired, wear resistant and stable in holding, and the two-point discrimination was 5-8 mm. CONCLUSION RDAIF is a safe and effective method for the treatment of fingertip defects, especially in patients who require maintenance of function or contour of the fingertip. Anastomosis of the superficial veins and reduction of the flap area and surgical time can significantly reduce the incidence of venous congestion.
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Affiliation(s)
- Xianfeng Lan
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yuming Huang
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Liang Guo
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Jingui Lin
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
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Zhang X, Yao Y, Rao L, Qin Z, Zhang L, Xu Y, Chen Y, Yao J, Song D. [Free sensate intercostal artery perforator flap for hand soft tissue reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:497-500. [PMID: 32291988 DOI: 10.7507/1002-1892.201904072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction. Methods Between March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases). Results All of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
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Affiliation(s)
- Xingqun Zhang
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Yi Yao
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Lei Rao
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Zhenbo Qin
- Department of Hand Surgery and Plastic Surgery, the First People's Hospital of Yuhang District, Hangzhou Zhejiang, 311100, P.R.China
| | - Longchun Zhang
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Yibo Xu
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Ying Chen
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Jianmin Yao
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou Zhejiang, 310013, P.R.China
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
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Onoda S, Kinoshita M. Involved stich technique for super-microsurgical anastomosis. J Plast Reconstr Aesthet Surg 2020; 73:1174-1205. [PMID: 32113959 DOI: 10.1016/j.bjps.2020.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/25/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Satoshi Onoda
- Department of Plastic and Reconstructive Surgery, Kagawa Rosai Hospital, Kagawa, 3-3-1 Joto-cho, Marugame, Kagawa 763-8502, Japan.
| | - Masahito Kinoshita
- Department of Plastic and Reconstructive Surgery, Kagawa Rosai Hospital, Kagawa, 3-3-1 Joto-cho, Marugame, Kagawa 763-8502, Japan
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Wang KL, Zhang ZQ, Buckwalter JA, Yang Y. Supermicrosurgery in fingertip defects-split tibial flap of the second toe to reconstruct multiple fingertip defects: A case report. World J Clin Cases 2019; 7:2562-2566. [PMID: 31559293 PMCID: PMC6745310 DOI: 10.12998/wjcc.v7.i17.2562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/27/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Injuries to multiple fingertips pose a significant treatment dilemma. Numerous reconstructive options exist, all with the ultimate goal of restoring function and sensibility to the injured fingertips.
CASE SUMMARY A 24-year-old male suffered injury to multiple fingertips of the right hand, resulting in exposed distal phalanges of the middle, ring, and small fingers. The amputated distal stumps were not possible for replantation. Free flap coverage was selected in order to achieve better functional outcome. The fingertip defects were covered by performing a right second toe split tibial flap using local anesthesia at the harvest site and brachial plexus nerve block for the right upper extremity. At 6-month follow-up, all three of the reconstructed fingertips had some preserved nail growth, Semmes-Weinstein Monofilaments testing was equal to the contralateral side and the Static Two-Point Discrimination were comparable to the contralateral side.
CONCLUSION This report provides a novel reconstructive option for the management of multiple fingertip injuries and demonstrates the utility of supermicrosurgery in management of these injuries.
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Affiliation(s)
- Ke-Lie Wang
- Department of Microsurgery and Hand Surgery, the Longgang Orthopedics Hospital of Shenzhen, Shenzhen 518116, Guangdong Province, China
| | - Zi-Qing Zhang
- Department of Microsurgery and Hand Surgery, the Longgang Orthopedics Hospital of Shenzhen, Shenzhen 518116, Guangdong Province, China
| | - Joseph A Buckwalter
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA 52240, United States
| | - Yi Yang
- Department of Microsurgery and Orthopedic Trauma, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
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Zhao M, Wu J, Yuan Z, Tian D, Shao X, Li D, Li J, Liu J, Zhao L, Li H, Wang X. [Application of radial-lateral forearm free perforator flap on repairing of soft tissue defects in finger]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:586-589. [PMID: 31090352 DOI: 10.7507/1002-1892.201901057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of radial-lateral forearm free perforator flap on repairing of soft tissue defects in the finger. Methods Between January 2017 and May 2018, 26 cases of finger skin defects were treated with radial-lateral forearm free perforator flap based on the radial branch of the posterior interosseus artery. There were 21 males and 5 females, with an average age of 26.6 years (range, 19-56 years). The cause of injury included the cutting injury in 16 cases and crush injury in 10 cases. The interval between injury and admission was 30 minutes to 4 hours (mean, 1.5 hours). The injury located at thumb in 6 cases, index finger in 8 cases, middle finger in 6 cases, ring finger in 3 cases, and little finger in 3 cases; and at the dorsum of finger in 6 cases, the lateral side in 6 cases, and the palm in 14 cases. All wounds were accompanied with the tendon and bone exposures, and phalangeal fractures occurred in 10 cases. The size of the defects ranged from 2.0 cm×1.0 cm to 4.0 cm×2.5 cm. And the size of the flap ranged from 2.5 cm×1.5 cm to 4.5 cm×3.0 cm. All wounds at donor sites were sutured directly. Results All the 26 cases were followed up 4-12 months (mean, 7 months). The 24 flaps survived uneventfully after operation, and the wounds healed by first intention. Partial necrosis occurred at the distal part in 2 flaps, and secondary healing achieved after debridement and dressing. All incisions at donor sites healed by first intention. The appearance and texture of all flaps were satisfactory. The two-point discrimination of the flaps was 5-10 mm (mean, 8 mm) at 4 months after operation. Sensory of the flaps was grade S 3. Only linear scar was noted at the donor site. Conclusion The radial-lateral forearm free perforator flap in repairing of the soft tissues in finger can shorten the disease duration, reduce the damage of the donor site, and improve the patients' quality of life.
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Affiliation(s)
- Min Zhao
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Jinying Wu
- Department of Anatomy, Capital Medical University Yanjing Medical College, Beijing, 101300, P.R.China
| | - Zuoxiong Yuan
- Department of Anatomy, Capital Medical University Yanjing Medical College, Beijing, 101300, P.R.China
| | - Dehu Tian
- Department of Hand Surgery, the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China
| | - Xinzhong Shao
- Department of Hand Surgery, the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051,
| | - Dacun Li
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Jianfeng Li
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Jingda Liu
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Liang Zhao
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Hailei Li
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
| | - Xiaolei Wang
- Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China
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Hong JP(J, Song S, Suh HSP. Supermicrosurgery: Principles and applications. J Surg Oncol 2018; 118:832-839. [DOI: 10.1002/jso.25243] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Joon Pio (Jp) Hong
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Sinyoung Song
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
| | - Hyun Suk Peter Suh
- Department of Plastic SurgeryAsan Medical Center, University of Ulsan College of MedicineSeoul Korea
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Badash I, Gould DJ, Patel KM. Supermicrosurgery: History, Applications, Training and the Future. Front Surg 2018; 5:23. [PMID: 29740586 PMCID: PMC5931174 DOI: 10.3389/fsurg.2018.00023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Abstract
Supermicrosurgery, a technique of dissection and anastomosis of small vessels ranging from 0.3 to 0.8 mm, has revolutionized the fields of lymphedema treatment and soft tissue reconstruction. The technique offers several distinct benefits to microsurgeons, including the ability to manipulate small vessels that were previously inaccessible, and to minimize donor-site morbidity by dissecting short pedicles in a suprafascial plane. Thus, supermicrosurgery has become increasingly popular in recent years, and its applications have greatly expanded since it was first introduced 20 years ago. While supermicrosurgery was originally developed for procedures involving salvage of the digit tip, the technique is now routinely used in a wide variety of microsurgical cases, including lymphovenous anastomoses, vascularized lymph node transfers and perforator-to-perforator anastomoses. With continued experimentation, standardization of supermicrosurgical training, and high quality studies focusing on the outcomes of these novel procedures, supermicrosurgery can become a routine and valuable component of every microsurgeon's practice.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, United States
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