발표 논문
| 이달의 논문 2026년 9월 | ||
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| 등록일 : 2026.08.21 | ||
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An Algorithmic Approach to Arterial Coupler Use in Microsurgical Breast Reconstruction: Comparison with Hand-Sewn SuturesAffiliations
AbstractBackground: Microsurgical breast reconstruction offers superior outcomes after mastectomy, but vascular microanastomosis remains technically demanding. Venous couplers are widely adopted, whereas the use of arterial couplers remains controversial. This study aimed to establish an algorithmic approach for arterial coupler use and compare outcomes with hand-sewn sutures. Methods: A retrospective review was performed on 105 patients undergoing deep inferior epigastric perforator flap breast reconstruction by a single surgeon. Patients were divided into an arterial coupler group (n = 62) and a hand-sewn suture group (n = 43). An intraoperative algorithm guided coupler use, requiring the absence of atherosclerosis, intact intima, and adequate vessel laxity. Demographics, operative details, microanastomosis time, and postoperative outcomes were analyzed. Results: Patients in the coupler group were younger (47.6 ± 8.6 vs. 53.0 ± 7.9 years, p = 0.001) and underwent more robot-assisted procedures (16.1% vs. 2.3%, p = 0.025). Microanastomosis time was significantly shorter with couplers (19.6 ± 8.9 vs. 26.1 ± 6.5 minutes, p < 0.01). Flap survival was comparable between groups (96.8% vs. 100%, p = 0.512). Complication rates, including arterial/venous insufficiency, hematoma, and infection, showed no significant differences. Two coupler failures occurred: One venous congestion and one late thrombosis, both attributed to multifactorial causes rather than device failure. Conclusion: Arterial couplers, when used under strict algorithmic selection criteria, provide reliable outcomes comparable to hand-sewn sutures while significantly reducing operative time. This approach enhances efficiency in microsurgical breast reconstruction and may guide future standardized practice.
Differential Perfusion Patterns of Perforator and Random Flaps Assessed by Indocyanine Green ImagingAffiliations
AbstractBackground: Indocyanine green angiography (ICGA) is widely used to evaluate flap perfusion in reconstructive surgery, but the optimal timing for assessment may differ by flap type. This study compared the perfusion dynamics of perforator and random pattern flaps in a rat model using ICGA. Methods: ICGA dynamics were compared between perforator and random flaps in a rat model. Sixteen Sprague-Dawley rats (275-300 g) were randomly assigned to either a perforator or a random flap group. A 0.25-mg dose of indocyanine green (ICG) was administered via the femoral vein, and fluorescence images were acquired at predefined intervals over 4 minutes. Hypoperfusion was defined as fluorescence intensity below 30% of the peak value. Necrosis was assessed on postoperative day 7. Statistical analyses included the Mann-Whitney U and log-rank tests with Expectation-Maximization Iterative Convex Minorant (EMICM) modeling. Results: In the perforator flap group, the final area of necrosis corresponded to the ICGA-defined perfusion boundary observed between 10 and 50 seconds postinjection. In contrast, necrosis in the random flap group aligned with the ICGA-defined perfusion boundary captured between 30 and 150 seconds. The most accurate time points for necrosis prediction were 50 seconds for perforator flaps and 150 seconds for random flaps, both demonstrating statistical significance (p = 0.0028). Conclusion: ICGA timing requirements differ between flap types. Implementing flap-specific assessment windows may enhance intraoperative interpretation and reduce false-positive findings. These findings support the development of flap-specific ICGA protocols to improve intraoperative decision-making in reconstructive surgery. |
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