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 SUM...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.展开更多
Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term ou...Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion.The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning.This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions.Depending on the types of undesirable surgical procedures,lymphaticovenular anastomoses are at risk of future occlusions in early,mid-,or late-postoperative course.The authors describe fundamental and essential techniques to perform supermicrosurgical LVA,and the true concept of Isao Koshima’s supermicrosurgery,in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles,but also the surgeons’skills to feel intima of the vessels and lymphatic flow itself.展开更多
The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supe...The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.展开更多
The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive ...The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.展开更多
Lymph node transfer(LNT)and lymphatic anastomosis are popular reconstructive surgeries in managing lymphedema.However,lymphatic anastomosis requires the operator to be adept at super microsurgery,and LNT has significa...Lymph node transfer(LNT)and lymphatic anastomosis are popular reconstructive surgeries in managing lymphedema.However,lymphatic anastomosis requires the operator to be adept at super microsurgery,and LNT has significant donor-site lymphedema risks.To address these drawbacks,lymph-interpositional-flap transfer(LIFT),a novel lymphatic reconstruction method that does not require lymph node transfers or supermicrosurgical techniques,has been introduced.Lymph circulation after tissue replantation and free flap transfer was evaluated using indocyanine green(ICG)lymphography.Postoperative ICG lymphography showed linear to linear lymphatic reconnection between an amputee/flap and a recipient site in cases where the stumps of the lymph vessels were only approximated.This was a frequent phenomenon observed in replantation cases and some free tissue transfers.Based on these results,we developed a new lymphatic reconstruction using a flap designed to include the collecting lymph vessels for bridging a lymphatic gap.ICG is injected at the peripheries of donor sites or the distal boundaries of the lymphosome where the recipient site resides in.This allows us to visualize the axial lymphatic pathways.When LIFT is used to reconstruct a soft tissue defect,ICG is also injected at the proximal edge of it to visualize proximal lymph flows.The LIFT flap is designed to include lymphatic channels seen on pre-operative ICG lymphography.As these collecting lymph vessels reside deep in the superficial fascia,the flap is elevated with the deep fat intact.Intra-operative ICG lymphography is utilized to identify the proximal and distal lymphatic stumps on the flap,and absorbable sutures are used to tag these stumps for ease of recognition during the flap inset.LIFT is indicated for soft tissue defects in major lymphosomes,resulting in a significant lymphatic gap.The advantage of the LIFT technique is the ability to perform simultaneous soft tissue and lymphatic reconstruction.LIFT can also be applied in established lymphedema and elephantiasis.展开更多
Aim: There is no previous description on the anatomy of the inferior belly of the omohyoid muscle. This muscle has specific morphological characteristic that make it appealing when solving specialized reconstructive p...Aim: There is no previous description on the anatomy of the inferior belly of the omohyoid muscle. This muscle has specific morphological characteristic that make it appealing when solving specialized reconstructive problems. Our objective is to describe the microsurgical anatomy of the inferior belly from the omohyoid muscle. Methods: Supraclavicular bilateral dissection in 5 anatomic models (fresh human cadavers). Measurements were taken with a millimetric caliper. Statistical analysis was performed with measures of central tendency. Results: Eight muscles were dissected in 5 anatomic models. Average dimensions were: 93 mm long, 12 mm wide, and 7.5 mm thickness. The vascular pedicles showed great anatomical variability. In 2 flaps (1 model) irrigation came exclusively from transverse cervical vessels, in the remaining models the pedicles came directly from the subclavian vessels;2 flaps had an accessory minor pedicle from the transverse cervical vessels. The diameter of all vascular pedicles was less than 0.8 mm, with an average length of 22.3 mm. The nerve pedicle came from ansa cervicalis in all flaps, with an average length of 27.8 mm. Conclusion: Based on the findings we conclude that omohyoid muscle could be a reconstructive option when small functional flaps are required, such as facial reanimation surgery, sphincters, ptosis and vocal cord reconstruction, and blink restoration surgery although more anatomical studies are required to determine the microsurgical feasibility, excursion and strength of the muscle, and axonal load in this new myofunctional flap.展开更多
Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients...Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients.Methods:An observational,prospective,longitudinal study was designed.20 consecutive patients were treated for lymphedema by means of LVA between 2015 and 2018.All were affected by secondary lymphedema(ISGⅡ-Ⅲ)following lymphadenectomy,radiation or both.All patients received preoperative rehabilitation as well as radiotherapy after oncological surgery.Limb volume was measured before surgery and at one year later.LVA was performed under general anesthesia with ICG guidance.ICG was also used to evaluate postoperative outcomes.Lympho-SPECT-CT was performed in all subjects at their first consultation and at one year after every surgical intervention.Description of findings included an absence of lymph nodes,new lymph node activity in anatomical areas and new lymphatic activity in extra-anatomical areas.Results:Limb volume decreased in 19 patients after LVA.Six patients showed preoperative linear ICG patterns,combined with areas presenting with another type of pattern.After LVA,the linear pattern was observed in 11 patients.SPECT-CT/lymphoscintigraphy before surgery showed a total absence of lymph nodes,except in two cases,in whom small nodes in anatomical locations were described.After LVA,we observed new landmarks in 16 patients corresponding to lymphatic circulation that was not present in preoperative studies.In six cases,newlymphatic activity compatible with lymph nodes was detectable after LVA.The Spearman correlation coefficient was negative when circumferences and lympho-SPECT-CT were tested(P=0.02).Conclusion:Results showed a postoperative decrease in volume that correlated inversely with lympho-SPECT/CT findings.Lympho-SPECT/CT provided additional information related to accurate identification and the anatomical location of lymphatic structures that were not observed before reconstructive surgery.It can be a complementary test to conventional lymphoscintigraphy.展开更多
A 24-year-old male presented after being involved in a motorcycle accident and was found to have soft tissue defects of the knee with exposure of patella.Due to the severe injury from the popliteal fossa to the poster...A 24-year-old male presented after being involved in a motorcycle accident and was found to have soft tissue defects of the knee with exposure of patella.Due to the severe injury from the popliteal fossa to the posterior aspects of the lower leg,repair with a free flap from anterolateral thigh perforator was planned instead of local calf muscle flap.Preoperative angiography was performed,and it showed that superior medial genicular perforator was patent compared with unreliable filling of the superior lateral genicular perforator.The soft tissue defect was repaired using the superior medial genicular perforator as the recipient vessel.This was performed by creating perforator to perforator anastomosis(supermicrosurgery).The flap survived successfully,and the patient was able to ambulate in a few weeks without serious complications.This case indicates that superior medial genicular perforator can be used as the recipient vessel for covering the soft tissue defects of the knee caused by blunt injury.展开更多
Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeut...Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.展开更多
Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the ...Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of occlusion,especially when the disorder has reached the late stage.The reasons of postoperative LVA occlusion are considered both a technical matter in performing LVA and a strategic matter in planning LVA.This article focuses on the effective preoperative LVA planning methodology of“functional LVA”for peripheral lymphedema,in which continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’natural motions at the selected incision point.The current functional LVAs which we have developed are the dynamic LVA method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity lymphedema.Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-venous flow at the LVA,functional LVAs keep long-term clinical effect in reduction of lymphedema.展开更多
Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)f...Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)for the treatment of advanced,fluid-predominant lymphedema,providing highly favorable outcomes with reduced donor-site complications.Lymphaticovenular anastomosis(LVA)has traditionally been reserved for early disease.However,technical refinements have improved its results and expanded its efficacy,creating an overlap between the indications for VLVT/VLNT and LVA.This article describes our technical approach to VLVT and LVA and explores the nuances of treatment selection in the light of their shifting indications.展开更多
Aim:Current microsurgical procedures are limited by the physiological tremor and dexterity of the surgeon.The MicroSurgical Assistant(MUSA,Microsure),the world’s first robotic platform for(super)microsurgery can aid ...Aim:Current microsurgical procedures are limited by the physiological tremor and dexterity of the surgeon.The MicroSurgical Assistant(MUSA,Microsure),the world’s first robotic platform for(super)microsurgery can aid in resolving issues encountered during microsurgery.This study presents an overview of the operating times and Structured Assessment of Microsurgery Skills(SAMS)scores to assess the duration and quality of microsurgical anastomoses for three microsurgical procedures currently performed using the MUSA.Methods:This study integrates data from one ongoing randomized controlled trial focusing on robotic-assisted lymphaticovenous anastomosis,along with findings from two separate prospective pilot studies concerning digital nerve repair and free tissue transplantation.SAMS scores and time needed per anastomosis were used to evaluate the quality and learning curve of the MUSA-assisted procedures.Results:Thirty-five robotic-assisted procedures were analyzed,including 18 lymphaticovenous anastomoses,9 digital nerve repairs,and 8 free tissue transplantations.All procedures showed a trend of a decrease in the time needed to perform the procedure.Moreover,the mean overall SAMS scores for all three procedures were rated above‘satisfactory’,with all procedures demonstrating a consistent trend of increasing SAMS scores over time.Conclusion:The evaluation of anastomosis’quality in the initial cohorts of patients undergoing robotic-assisted microsurgery using MUSA indicates satisfying outcomes across all three types of procedures.The reduction in anastomosis time and the improvement in SAMS scores imply an ongoing learning process among the operating surgeons.Subsequent reports are expected to provide information on reaching a plateau phase in procedural efficiency.展开更多
文摘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.
文摘Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The effect of LVA appears immediately after the creation of lymph-to-venous pathway.However,the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion.The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning.This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions.Depending on the types of undesirable surgical procedures,lymphaticovenular anastomoses are at risk of future occlusions in early,mid-,or late-postoperative course.The authors describe fundamental and essential techniques to perform supermicrosurgical LVA,and the true concept of Isao Koshima’s supermicrosurgery,in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles,but also the surgeons’skills to feel intima of the vessels and lymphatic flow itself.
文摘The effectiveness of supermicrosurgical lymphovenous anastomosis(LVA)for lymphedema treatment remains controversial.Currently,no evidence has been summarized.This study aimed to review the published literature on supermicrosurgical LVAs in the treatment of peripheral lymphedema and to analyze the surgical outcomes.Studies from databases(PubMed/MEDLINE,Cochrane Controlled Trial Data,and Embase)were collected to determine the effectiveness of supermicrosugrical LVAs for lymphedema.A systematic review was performed using individual patient data.Fifteen studies,including 578 patients(482 female,72 male,and 24 unknown)with a mean age of 51 years,satisfied the needs of the study requirements.Supermicrosurgical LVAs for peripheral lymphedema have demonstrated substantial improvements in both objective and subjective findings in many patients.Moreover,in the long-term follow-up,the effectiveness of this treatment modality maintained a high efficacy of LVA in lymphedema cases.However,most studies provided low-quality evidence,and the conclusion is still not finalized.
文摘The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.
文摘Lymph node transfer(LNT)and lymphatic anastomosis are popular reconstructive surgeries in managing lymphedema.However,lymphatic anastomosis requires the operator to be adept at super microsurgery,and LNT has significant donor-site lymphedema risks.To address these drawbacks,lymph-interpositional-flap transfer(LIFT),a novel lymphatic reconstruction method that does not require lymph node transfers or supermicrosurgical techniques,has been introduced.Lymph circulation after tissue replantation and free flap transfer was evaluated using indocyanine green(ICG)lymphography.Postoperative ICG lymphography showed linear to linear lymphatic reconnection between an amputee/flap and a recipient site in cases where the stumps of the lymph vessels were only approximated.This was a frequent phenomenon observed in replantation cases and some free tissue transfers.Based on these results,we developed a new lymphatic reconstruction using a flap designed to include the collecting lymph vessels for bridging a lymphatic gap.ICG is injected at the peripheries of donor sites or the distal boundaries of the lymphosome where the recipient site resides in.This allows us to visualize the axial lymphatic pathways.When LIFT is used to reconstruct a soft tissue defect,ICG is also injected at the proximal edge of it to visualize proximal lymph flows.The LIFT flap is designed to include lymphatic channels seen on pre-operative ICG lymphography.As these collecting lymph vessels reside deep in the superficial fascia,the flap is elevated with the deep fat intact.Intra-operative ICG lymphography is utilized to identify the proximal and distal lymphatic stumps on the flap,and absorbable sutures are used to tag these stumps for ease of recognition during the flap inset.LIFT is indicated for soft tissue defects in major lymphosomes,resulting in a significant lymphatic gap.The advantage of the LIFT technique is the ability to perform simultaneous soft tissue and lymphatic reconstruction.LIFT can also be applied in established lymphedema and elephantiasis.
文摘Aim: There is no previous description on the anatomy of the inferior belly of the omohyoid muscle. This muscle has specific morphological characteristic that make it appealing when solving specialized reconstructive problems. Our objective is to describe the microsurgical anatomy of the inferior belly from the omohyoid muscle. Methods: Supraclavicular bilateral dissection in 5 anatomic models (fresh human cadavers). Measurements were taken with a millimetric caliper. Statistical analysis was performed with measures of central tendency. Results: Eight muscles were dissected in 5 anatomic models. Average dimensions were: 93 mm long, 12 mm wide, and 7.5 mm thickness. The vascular pedicles showed great anatomical variability. In 2 flaps (1 model) irrigation came exclusively from transverse cervical vessels, in the remaining models the pedicles came directly from the subclavian vessels;2 flaps had an accessory minor pedicle from the transverse cervical vessels. The diameter of all vascular pedicles was less than 0.8 mm, with an average length of 22.3 mm. The nerve pedicle came from ansa cervicalis in all flaps, with an average length of 27.8 mm. Conclusion: Based on the findings we conclude that omohyoid muscle could be a reconstructive option when small functional flaps are required, such as facial reanimation surgery, sphincters, ptosis and vocal cord reconstruction, and blink restoration surgery although more anatomical studies are required to determine the microsurgical feasibility, excursion and strength of the muscle, and axonal load in this new myofunctional flap.
文摘Aim:To describe findings when comparing lympho-SPECT-CT images before and after lymphovenous anastomosis(LVA)surgeries and to correlate these results with pre-and post-operative volume changes in the limbs of patients.Methods:An observational,prospective,longitudinal study was designed.20 consecutive patients were treated for lymphedema by means of LVA between 2015 and 2018.All were affected by secondary lymphedema(ISGⅡ-Ⅲ)following lymphadenectomy,radiation or both.All patients received preoperative rehabilitation as well as radiotherapy after oncological surgery.Limb volume was measured before surgery and at one year later.LVA was performed under general anesthesia with ICG guidance.ICG was also used to evaluate postoperative outcomes.Lympho-SPECT-CT was performed in all subjects at their first consultation and at one year after every surgical intervention.Description of findings included an absence of lymph nodes,new lymph node activity in anatomical areas and new lymphatic activity in extra-anatomical areas.Results:Limb volume decreased in 19 patients after LVA.Six patients showed preoperative linear ICG patterns,combined with areas presenting with another type of pattern.After LVA,the linear pattern was observed in 11 patients.SPECT-CT/lymphoscintigraphy before surgery showed a total absence of lymph nodes,except in two cases,in whom small nodes in anatomical locations were described.After LVA,we observed new landmarks in 16 patients corresponding to lymphatic circulation that was not present in preoperative studies.In six cases,newlymphatic activity compatible with lymph nodes was detectable after LVA.The Spearman correlation coefficient was negative when circumferences and lympho-SPECT-CT were tested(P=0.02).Conclusion:Results showed a postoperative decrease in volume that correlated inversely with lympho-SPECT/CT findings.Lympho-SPECT/CT provided additional information related to accurate identification and the anatomical location of lymphatic structures that were not observed before reconstructive surgery.It can be a complementary test to conventional lymphoscintigraphy.
文摘A 24-year-old male presented after being involved in a motorcycle accident and was found to have soft tissue defects of the knee with exposure of patella.Due to the severe injury from the popliteal fossa to the posterior aspects of the lower leg,repair with a free flap from anterolateral thigh perforator was planned instead of local calf muscle flap.Preoperative angiography was performed,and it showed that superior medial genicular perforator was patent compared with unreliable filling of the superior lateral genicular perforator.The soft tissue defect was repaired using the superior medial genicular perforator as the recipient vessel.This was performed by creating perforator to perforator anastomosis(supermicrosurgery).The flap survived successfully,and the patient was able to ambulate in a few weeks without serious complications.This case indicates that superior medial genicular perforator can be used as the recipient vessel for covering the soft tissue defects of the knee caused by blunt injury.
文摘Axillary lymph node dissection-dependent chyle leakage is a rare complication with an incidence of<0.7%.The morbidity could be high,and the management prolonged and not clear.The literature offers us many therapeutical tools,yet there is no consensus about the management of this complication.Usually,the management focuses on reducing the chyle flow in the thoracic duct(central origin),neglecting the possibility of a parallel lymphorrhea from other regional lymphatic vessels(peripheral origin),which causes a prolonged approach with high morbidity.In this paper,we introduce the supermicrosurgery technique as a surgical therapeutic option for chyle leakage.To decrease morbidity and shorten treatment duration,we offer a therapeutic algorithm based on the literature and our experience.
基金JSPS KAKENHI Grant Number JP17K17038(to Seki Y).
文摘Lymphaticovenular anastomosis(LVA)is a highly effective,minimally invasive surgical treatment for lymphedema.The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway.However,the long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of occlusion,especially when the disorder has reached the late stage.The reasons of postoperative LVA occlusion are considered both a technical matter in performing LVA and a strategic matter in planning LVA.This article focuses on the effective preoperative LVA planning methodology of“functional LVA”for peripheral lymphedema,in which continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’natural motions at the selected incision point.The current functional LVAs which we have developed are the dynamic LVA method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity lymphedema.Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-venous flow at the LVA,functional LVAs keep long-term clinical effect in reduction of lymphedema.
文摘Early surgical intervention for lymphedema can delay,prevent,and even reverse lymphatic degeneration.Vascularized lymph vessel transplant(VLVT)has emerged as an alternative to vascularized lymph node transplant(VLNT)for the treatment of advanced,fluid-predominant lymphedema,providing highly favorable outcomes with reduced donor-site complications.Lymphaticovenular anastomosis(LVA)has traditionally been reserved for early disease.However,technical refinements have improved its results and expanded its efficacy,creating an overlap between the indications for VLVT/VLNT and LVA.This article describes our technical approach to VLVT and LVA and explores the nuances of treatment selection in the light of their shifting indications.
基金Ethical approval for this study was obtained from the Medical Ethics Committee(METC)azM/UM.(LVA:NL60199.068.16/METC 162053DNR:NL64178.068.17/METC 172045Free Flap:NL64506.068.17/METC 172047)。
文摘Aim:Current microsurgical procedures are limited by the physiological tremor and dexterity of the surgeon.The MicroSurgical Assistant(MUSA,Microsure),the world’s first robotic platform for(super)microsurgery can aid in resolving issues encountered during microsurgery.This study presents an overview of the operating times and Structured Assessment of Microsurgery Skills(SAMS)scores to assess the duration and quality of microsurgical anastomoses for three microsurgical procedures currently performed using the MUSA.Methods:This study integrates data from one ongoing randomized controlled trial focusing on robotic-assisted lymphaticovenous anastomosis,along with findings from two separate prospective pilot studies concerning digital nerve repair and free tissue transplantation.SAMS scores and time needed per anastomosis were used to evaluate the quality and learning curve of the MUSA-assisted procedures.Results:Thirty-five robotic-assisted procedures were analyzed,including 18 lymphaticovenous anastomoses,9 digital nerve repairs,and 8 free tissue transplantations.All procedures showed a trend of a decrease in the time needed to perform the procedure.Moreover,the mean overall SAMS scores for all three procedures were rated above‘satisfactory’,with all procedures demonstrating a consistent trend of increasing SAMS scores over time.Conclusion:The evaluation of anastomosis’quality in the initial cohorts of patients undergoing robotic-assisted microsurgery using MUSA indicates satisfying outcomes across all three types of procedures.The reduction in anastomosis time and the improvement in SAMS scores imply an ongoing learning process among the operating surgeons.Subsequent reports are expected to provide information on reaching a plateau phase in procedural efficiency.
