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Microsurgery: Current and Future Perspectives
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Microsurgery: Current and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: 30 June 2025 | Viewed by 6541

Special Issue Editors

Prof. Pier Camillo Parodi

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Guest Editor
Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medicine (DMED), University of Udine, Udine, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Michele Riccio

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Guest Editor
Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Special Issues, Collections and Topics in MDPI journals
Prof. Luca Vaienti

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Guest Editor
Plastic and Reconstructive Surgery Department, Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Dr. Francesco De Francesco

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Guest Editor
Department of Reconstructive Surgery and Hand Surgery, AOU “Ospedali Riuniti”, Ancona, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Special Issues, Collections and Topics in MDPI journals
Dr. Nicola Zingaretti

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Guest Editor
Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medicine (DMED), University of Udine, Udine, Italy
Interests: plastic surgery; reconstructive surgery; microsurgery; free flap; free tissue transfer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the field of plastic surgery, in recent years, there has been a clear trend towards the use of microsurgical techniques.

A lot of different factors have contributed to this process, ranging from the development of more precise instruments to high-resolution imaging evaluations and a better understanding of anatomy and physiology.

Microsurgery represents a challenge that starts from the pre-operative design, the instrumentation in use, the personal technical skills, the intra-operative treatment (e.g., anesthesia), and the methods applicable in the post-operative period. Improving each of these aspects would allow us to achieve the best outcomes for our patients.

In recent years, there have been many evolutions in microsurgery, ranging from perforator flaps to supermicrosurgery. Each new approach has led to the overcoming of previous limitations and new challenges.

The purpose of this Special Issue is to present and discuss the latest trends in the reconstructive microsurgery field, including new techniques, as well as the new technologies and tools that have been employed in this setting.

We are looking for original articles and literature reviews that cover the most modern microsurgical techniques related to the reconstruction of defects throughout the human body. The proposal for clinical treatment is interesting.

Prof. Pier Camillo Parodi
Prof. Dr. Michele Riccio
Prof. Luca Vaienti
Dr. Francesco De Francesco
Dr. Nicola Zingaretti
Guest Editors

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

  • plastic surgery
  • reconstructive surgery
  • microsurgery
  • free flap
  • free tissue transfer

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Published Papers (5 papers)

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10 pages, 726 KiB  
Article
Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery
by Rihards Peteris Rocans, Janis Zarins, Evita Bine, Insana Mahauri, Renars Deksnis, Margarita Citovica, Simona Donina, Indulis Vanags, Sabine Gravelsina, Anda Vilmane, Santa Rasa-Dzelzkaleja and Biruta Mamaja
J. Clin. Med. 2024, 13(18), 5411; https://doi.org/10.3390/jcm13185411 - 12 Sep 2024
Cited by 1 | Viewed by 1152
Abstract
Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap [...] Read more.
Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap complications and explore the relationship between chronic inflammation and VWF:Ag. Methods: This prospective cohort study included 88 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws were collected on the day of surgery before initiation of crystalloids. The plasma concentration of VWF:Ag as well as albumin, neutrophil-to-lymphocyte ratio (NLR), interleukin-6, and fibrinogen were determined. Results: The overall complication rate was 27.3%, and true flap loss occurred in 11.4%. VWF:Ag levels were higher in true flap loss when compared to patients without complications (217.94 IU/dL [137.27–298.45] vs. 114.14 [95.67–132.71], p = 0.001). Regression analysis revealed the association between VWF:Ag and true flap loss at the cutoff of 163.73 IU/dL (OR 70.22 [10.74–485.28], p = 0.043). Increased VWF:Ag concentrations were linked to increases in plasma fibrinogen (p < 0.001), C-reactive protein (p < 0.001), interleukin-6 (p = 0.032), and NLR (p = 0.019). Conclusions: Preoperative plasma VWF:Ag concentration is linked to biomarkers of inflammation and may be valuable in predicting complications in microvascular flap surgery. Full article
(This article belongs to the Special Issue Microsurgery: Current and Future Perspectives)
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10 pages, 3187 KiB  
Article
Hand Digit Revascularization: Could Be an “Elective-Urgence” Surgery?
by Francesco De Francesco, Olimpia Mani, Pasquale Gravina and Michele Riccio
J. Clin. Med. 2024, 13(17), 5120; https://doi.org/10.3390/jcm13175120 - 29 Aug 2024
Viewed by 966
Abstract
Background: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm [...] Read more.
Background: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm ischemia and 12 h of cold ischemia are mostly based on theoretical considerations. Methods: Here we present a case of multi-digit revascularization after 72 h of warm ischemia using the microsurgical arteriovenous bypass technique. Results: In the reported case, revascularization was performed after a long ischemic period and showed good recovery of motor and sensory function. Conclusions: We identified significant limitations in the literature supporting time limits of ischemia and recent evidence demonstrating the feasibility of delayed finger replantation. The current treatment approach for amputation injuries often requires transfers or nighttime emergency procedures, increasing costs and limiting the national availability of finger replantation. Changes to finger replantation protocols based on evidence could expand access to this service and improve the quality of care. Full article
(This article belongs to the Special Issue Microsurgery: Current and Future Perspectives)
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8 pages, 1646 KiB  
Article
Flexor Tendon Continuity and Negative X-ray: The “Combo” Negative Features in Finger Subamputation
by Pierfrancesco Pugliese, Mariangela Vulpetti, Greta Tondini and Francesca Toia
J. Clin. Med. 2024, 13(11), 3331; https://doi.org/10.3390/jcm13113331 - 5 Jun 2024
Cited by 1 | Viewed by 1032
Abstract
Background: The subamputation of fingers with vascular compromise presents a surgical challenge. Although tissue continuity may be considered a favourable prognostic element, in our experience, we noticed that there is not always a direct correlation between soft tissue involvement, radiographic appearance and [...] Read more.
Background: The subamputation of fingers with vascular compromise presents a surgical challenge. Although tissue continuity may be considered a favourable prognostic element, in our experience, we noticed that there is not always a direct correlation between soft tissue involvement, radiographic appearance and final outcome. Methods: We included, in our study, all cases of vascular pedicle injury in which finger salvage was attempted with microsurgical revascularisation. Exclusion criteria were: integrity of both vascular pedicles, pedicle lesion without global circulatory compromise and patients treated immediately with amputation. Results: Between May 2018 and July 2023, 27 male patients with finger subamputation injuries were treated at our institution. In 11 cases of injured fingers, the only intact tissue was the flexor digitorum profundus (FDP) or flexor pollicis longus (FPL). Our global failure rate was 49%; whereas, in the subgroup of the 11 cases with continuity of the FDP or FPL, the failure rate rose to 73% and when the fingers showed flexor tendon integrity and radiographs demonstrated minimal bone damage, revascularisation failure was observed in all cases (100%). Conclusions: The results of the study show that subamputations with devascularisation, clinically presented with the combination of flexor tendon as the only element of tissue continuity and dislocation or minimal bone/articular injury, have a worse prognosis because of their trauma mechanism. We propose to add them to the Kay-Adani Classification as a subset of the poorest prognostic injuries group (III), to help surgeons to make decisions about the management of subamputation finger injuries. Full article
(This article belongs to the Special Issue Microsurgery: Current and Future Perspectives)
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12 pages, 1671 KiB  
Systematic Review
Robot-Assisted Versus Conventional Harvesting of DIEP and Latissimus Dorsi Flaps for Breast Reconstruction in Post-Mastectomy Women: A Systematic Review and Meta-Analysis
by Stiven Yusufov, Olesya Startseva, Sami Khalfaoui, Evgeniia Zhigailova, Mark Gabriyanchik, Dina Manasherova, Kakhaber Meskhi and Igor Reshetov
J. Clin. Med. 2025, 14(3), 744; https://doi.org/10.3390/jcm14030744 - 24 Jan 2025
Viewed by 882
Abstract
Background/Objectives: Robotic breast reconstruction is an innovative surgical technique that integrates robotic technology into breast reconstruction procedures, offering several advantages over conventional approaches. These benefits include enhanced visualization, increased surgical dexterity, and superior cosmetic outcomes. This study aims to comprehensively compare robotic-assisted [...] Read more.
Background/Objectives: Robotic breast reconstruction is an innovative surgical technique that integrates robotic technology into breast reconstruction procedures, offering several advantages over conventional approaches. These benefits include enhanced visualization, increased surgical dexterity, and superior cosmetic outcomes. This study aims to comprehensively compare robotic-assisted and conventional breast reconstruction approaches in terms of complication profiles and operation-related measurements. Methods: A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, CENTRAL, and VHL from inception to October 2024 to identify relevant studies. Risk ratios for the following complications were calculated between the groups: donor site seroma, hematoma, infection, and unplanned reoperation. Mean differences were also calculated for the duration of surgery, length of postoperative hospital stays, and opioid use. Results: A meta-analysis was performed on 9 studies including a total of 1094 patients. No significant differences were found between the groups in the risk ratios for reoperation, seroma formation, delayed healing, infections, and hematomas. Similarly, there were no significant differences in postoperative opioid use. The duration of surgery was longer in the robot-assisted reconstruction group, whereas the duration of hospital stay was shorter compared to the conventional group. Meta-regression analysis for the duration of surgery model showed that none of the moderators had a statistically significant effect on this outcome. ROBINS-I assessment indicated that all the included studies had a serious risk of bias. Conclusions: Our results suggest that using a robot-assisted approach is associated with a shorter duration of hospital stay and a longer duration of surgery. Full article
(This article belongs to the Special Issue Microsurgery: Current and Future Perspectives)
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11 pages, 434 KiB  
Systematic Review
Rate of Free Flap Failure and Return to the Operating Room in Lower Limb Reconstruction: A Systematic Review
by Pietro Luciano Serra, Filippo Boriani, Umraz Khan, Matteo Atzeni and Andrea Figus
J. Clin. Med. 2024, 13(15), 4295; https://doi.org/10.3390/jcm13154295 - 23 Jul 2024
Cited by 1 | Viewed by 1779
Abstract
Background: Soft tissue defects of the lower limbs pose significant challenges in reconstructive surgery, accounting for approximately 10% of all reconstructive free flaps performed. These reconstructions often encounter higher complication rates due to various factors such as inflammation, infection, impaired blood flow, and [...] Read more.
Background: Soft tissue defects of the lower limbs pose significant challenges in reconstructive surgery, accounting for approximately 10% of all reconstructive free flaps performed. These reconstructions often encounter higher complication rates due to various factors such as inflammation, infection, impaired blood flow, and nerve injuries. Methods: A systematic review was conducted following PRISMA guidelines, reviewing literature from 2017 to 2024. Eligible studies included those on free flap reconstruction of lower limb defects in living human subjects, with more than three cases and reported rates of flap failure and return to the operating room. Systematic reviews and metanalysis were excluded. Results: A total of 17 studies comprising 5061 patients and 5133 free flap reconstructions were included. The most common defects were in the lower leg (52.19%) due to trauma (79.40%). The total flap necrosis rate was 7.78%, the partial necrosis rate was 9.15%, and the rate of return to the operating room for suspected vascular compromise was 13.79%. Discussion: Lower limb reconstruction presents challenges due to diverse etiologies and variable tissue requirements. Factors such as recipient vessel availability, flap selection, and multidisciplinary approaches influence outcomes. Muscle and fasciocutaneous flaps remain common choices, each with advantages and limitations. This systematic review underscores the importance of individualized treatment planning. Conclusions: Microsurgical reconstruction of lower limb defects demonstrates safety and reliability, with overall favorable outcomes. Flap selection should be tailored to specific patient needs and defect characteristics, emphasizing meticulous surgical techniques and multidisciplinary collaboration. This systematic review provides valuable insights into current standards and encourages adherence to best practices in lower limb reconstruction. Full article
(This article belongs to the Special Issue Microsurgery: Current and Future Perspectives)
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