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Clinical Progress in Microsurgical Reconstruction
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Clinical Progress in Microsurgical Reconstruction

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 30 September 2024 | Viewed by 1812

Special Issue Editor

Dr. Olindo Massarelli

E-Mail Website
Guest Editor
Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
Interests: plastic and reconstructive surgery; microsurgery; facial plastic surgery; maxillofacial surgery; head and neck surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues, 

Microsurgery is a fundamental cornerstone of the armamentarium of a reconstructive surgeon, and often represents the only resource available to manage complex and challenging post-traumatic or post-oncological defects, morbid conditions such as lymphedema and reconstructive needs like genital gender-affirming surgery, which is essential for a patient’s self-perception and social life. 

Since the 2000s, new technological tools, such as microvascular anastomotic coupling devices, major improvements in magnification in the surgical field associated with fluorescence for assessing patency and microvascular perfusion, the spread of effective software for Virtual Surgical Planning (VSP) and the introduction of augmented reality, have brought new excitement regarding microsurgery and its future applications. 

This progress in the field of microsurgery provides the opportunity to greatly increase the final treatment outcomes for patients in a predictable manner, with significant reductions in morbidity, invasivity and recovery time, and improvements in functional and aesthetic results.

The aim of this Special Issue is to emphasize these improvements through the publication of papers addressing the above topics with solid scientific evidence. Basic research papers, clinical papers and reviews focused on clinical progresses in microsurgical reconstruction are all highly encouraged for submission.

Dr. Olindo Massarelli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • microsurgery
  • supermicrosurgery
  • microvascular anastomosis
  • head and neck reconstruction
  • oro-maxillofacial re-construction
  • plastic and reconstructive surgery
  • limb reconstruction
  • breast reconstruction
  • genital reconstruction
  • lymphedema
  • lymph nodes transfer
  • facial reanimation

Published Papers (4 papers)

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Research

14 pages, 2187 KiB  
Article
Lower Abdominal vs. Lateral Thigh Perforator Flaps in Microsurgical Sarcoma Reconstruction: The Aesthetics of Donor Site Matters
by Beniamino Brunetti, Rosa Salzillo, Riccardo De Bernardis, Valeria Petrucci, Matteo Pazzaglia, Chiara Camilloni, Alessandra Putti, Marco Morelli Coppola, Stefania Tenna and Paolo Persichetti
J. Clin. Med. 2024, 13(12), 3622; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123622 - 20 Jun 2024
Viewed by 184
Abstract
Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome [...] Read more.
Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome and the patient’s perception regarding the donor site in a cohort of patients undergoing microsurgical reconstruction with lateral thigh and lower abdominal perforator flaps. Methods: A retrospective evaluation of all patients who underwent sarcoma reconstruction with flaps harvested from the lower abdominal region (deep inferior epigastric artery perforator flap, superficial circumflex iliac artery perforator flap) or lateral thigh region (anterolateral thigh perforator flap and its variations) was performed. Only patients with defects greater than 100 cm2 were included. Patient demographics and operative variables were recorded, together with complications. Patient satisfaction and quality of life with the donor site were registered using the SCAR-Q questionnaire, which was administered at least six months post-operatively. Results: Eighteen anterolateral thigh (ALT) perforator flaps and twenty-two deep inferior epigastric artery perforator (DIEP) and superficial circumflex iliac artery perforator (SCIP) flap procedures were performed. The two groups were homogeneous for major post-operative complications (p > 0.999). Patient satisfaction with the donor site measured using the SCAR-Q questionnaire showed significantly higher scores in the DIEP/SCIP group when compared with the thigh group (p < 0.001), indicating a superiority of the lower abdominal area as an aesthetic donor site. Conclusions: The DIEP and SCIP flaps are a versatile option for reconstructing large soft-tissue defects following sarcoma resection. Therefore, flaps harvested from the lower abdomen yield a higher patient satisfaction with the donor site, which is a feature worth considering when planning a reconstructive procedure. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
11 pages, 13590 KiB  
Article
The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction—A Case Series
by Christoph Steiner, Maximilian Neubert, Gian B. Bottini, Shinnosuke Nogami, Katharina Zeman-Kuhnert and Alexander Gaggl
J. Clin. Med. 2024, 13(12), 3613; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123613 - 20 Jun 2024
Viewed by 310
Abstract
Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the [...] Read more.
Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
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12 pages, 1974 KiB  
Article
Combination of Supramicrosurgical Lymphatico-Venular Anastomosis (sLVA) and Lymph-Sparing Liposuction in Treating Cancer-Related Lymphedema: Rationale for a Regional One-Stage Approach
by Guido Gabriele, Andrea Nigri, Glauco Chisci, Olindo Massarelli, Flavia Cascino, Ewa Komorowska-Timek, Kikuchi Kazuki, Hisako Hara, Makoto Mihara and Paolo Gennaro
J. Clin. Med. 2024, 13(10), 2872; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13102872 - 13 May 2024
Viewed by 528
Abstract
Objective: Cancer-related lymphedema represents a potential complication of cancer treatment. The aim of this study is to evaluate the effectiveness of the combination of lymphatico-venular anastomosis and liposuction in the treatment of secondary lymphedema. Methods: We present a retrospective analysis of patients affected [...] Read more.
Objective: Cancer-related lymphedema represents a potential complication of cancer treatment. The aim of this study is to evaluate the effectiveness of the combination of lymphatico-venular anastomosis and liposuction in the treatment of secondary lymphedema. Methods: We present a retrospective analysis of patients affected by cancer-related unilateral limb lymphedema. Inclusion criteria included previous neoplastic pathology with the consequent development of unilateral limb lymphedema, while the exclusion criteria included the presence of comorbidities and the persistence of cancer, as well as previous lymphatic surgery. The outcomes to be included were a reduction in the limb volume and lymphangitis rate, and an improvement in the quality of life. Patients’ data were assessed before surgery and 1 year after surgery. Perioperative management included clinical and ultrasonographical evaluations. Under local anesthesia, lymphatico-venular anastomosis with the supramicrosurgical technique and the liposuction of the affected limb was performed in the same surgical session. Results: A total of 24 patients were enrolled in the study. One year after the surgery, an average volume reduction of 37.9% was registered (p = 0.0000000596). The lymphangitis rate decreased after surgery from 4.67 to 0.95 per year (p = 0.000007899). The quality-of-life score improved from 68.7 to 16 according to the LLIS scale. Conclusions: The combination of LVA and liposuction represents a valid strategy for treating cancer-related lymphedema, ensuring stable results over time. In addition, it can be performed under local anesthesia, resulting in being minimally invasive and well-tolerated by patients. This paper reports on the short-term efficacy of this combined technique. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
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15 pages, 967 KiB  
Article
The Impact of Technical Innovations and Donor-Site Mesh Repair on Autologous Abdominal-Based Breast Reconstruction—A Retrospective Analysis
by Theresa Promny, Paula Huberth, Wibke Müller-Seubert, Dominik Promny, Aijia Cai, Raymund E. Horch and Andreas Arkudas
J. Clin. Med. 2024, 13(8), 2165; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13082165 - 9 Apr 2024
Viewed by 576
Abstract
Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. [...] Read more.
Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
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