Advances in the use of microvascular flaps for postoperative defect repair in complex abdominal surgery: innovative approaches to recovery and functionality
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242677Keywords:
Microvascular flap surgery, Abdominal wall reconstruction, Advanced imaging, Perforator flaps, Flap engineeringAbstract
Flap reconstruction technique was introduced by Sir Harold Gillies during WWI which is now evolved into microsurgical advancements in the 1970s enabling precise tissue transfer for complex reconstructions. By the 1980s, microvascular flaps matured period, offering durable solutions for extensive abdominal defects especially after oncological resections, infections, or previous surgeries. Our systematic strategy of papers selection focused on microvascular flap techniques in abdominal wall reconstruction. Studies that disuses latest advancements are extracted from papers published from 2020-2024. Proper inclusion and exclusion criteria is followed, papers are selected from peer-reviewed Journals, clinical trials, systematic reviews and meta-analysis and reviews. Results show that advancements in microvascular flap surgery have improved postoperative abdominal defect repairs. Innovations include precise microvascular techniques, perforator and free flaps, composite and propeller flaps, and the gracilis free muscle flap. Enhanced preoperative imaging, such as magnetic resonance angiography (MRA) and computed tomography angiography (CTA) and improved flap engineering techniques lead us to superior outcomes with less complications. Recent innovations in microvascular flap techniques have innovated abdominal defect reconstruction and suppressed traditional techniques. These advancements are offering enhanced precision, functionality, and aesthetic results. Advanced imaging and novel flap engineering methods along with technological advancements has optimized surgical outcomes.
References
Piccinini PS, Girelli P, Dias GF, Chedid GB, Ramos R, Matta F, et al. History of plastic surgery: sir Harold Gillies, a pioneer of reconstructive plastic surgery. Revista Brasileira de Cirurgia Plástica. 2023;32:608-15.
Tamai S. History of microsurgery from the beginning until the end of the 1970s. Microsurgery. 1993;14(1):6-13.
Sugamata N, Okuyama T, Takeshita E, Oi H, Hakozaki Y, Miyazaki S, et al. Surgical site infection after laparoscopic resection of colorectal cancer is associated with compromised long-term oncological outcome. World J Surg Oncol. 2022;20(1):111.
Manktelow RT. Microvascular reconstruction: anatomy, applications and surgical technique. Springer Science & Business Media. 2012.
Nykiel M, Hunter C, Lee GK. Algorithmic approach to the design and harvest of abdominal flaps for microvascular breast reconstruction in patients with abdominal scars. Ann Plast Surg. 2015;74:S33-40.
Martineau J, Kalbermatten DF, Oranges CM. Safety and efficacy of the superior gluteal artery perforator (SGAP) flap in autologous breast reconstruction: Systematic review and meta-analysis. Cancers. 2022;14(18):4420.
Gaster RS, Bhatt KA, Shelton AA, Lee GK. Free transverse rectus abdominis myocutaneous flap reconstruction of a massive lumbosacral defect using superior gluteal artery perforator vessels. Microsurgery. 2012;32(5):388-92.
Weitz J, Kreutzer K, Bauer FJ, Wolff KD, Nobis CP, Kesting MR. Sandwich flaps as a feasible solution for the management of huge mandibular composite tissue defects. J Cranio-Maxillofac Surg. 2015;43(9):1769-75.
Ogunleye AA, Deptula PL, Inchauste SM, Zelones JT, Walters S, Gifford K, et al. The utility of three-dimensional models in complex microsurgical reconstruction. Arch Plast Surg. 2020;47(05):428-34.
Wagner RD, Carr L, Netscher DT. Current indications for abdominal-based flaps in hand and forearm reconstruction. Injury. 2020;51(12):2916-21.
Wenny R, Schmidt M, Zaussinger M, Zucal I, Duscher D, Huemer GM. Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity. Clin Hemorheol Microcirc. 2021;78(3):283-90.
Bauder A, Othman S, Asaad M, Butler CE, Kovach SJ. Microvascular free tissue transfer for reconstruction of complex abdominal wall defects. Plast Reconstruct Surg. 2022;149(1):74-8.
Kedar DJ, Pak CJ, Suh HP, Hong JP. Propeller flaps in the posterior trunk. Semin Plast Surg. 2020;34(03):176-83.
Hölzle F, Ehrenfeld M. Microsurgical Flaps. In: Oral and maxillofacial surgery: Surgical textbook and atlas. Berlin, Heidelberg: Springer Berlin Heidelberg. 2023;717-84.
Anolik RA, Sacks JM. Advances and innovations in Breast Microsurgery. Missouri Med. 2021;118(2):153.
Guo HL, Peng XF, Bao XQ, Wang L, Jia ZM, Huang YC, et al. Bladder reconstruction using autologous smooth muscle cell sheets grafted on a pre-vascularized capsule. Theranostics. 2020;10(23):10378.
Chuang DC, Fang F, Lu JC, Huang YL, Chang TN. Prefabricated venous flap, an advanced free venous flap for distant transfer: An experimental rat study. Formosan J Surg. 2024;57(2):43-51.
Kawai T, Pan CC, Okuzu Y, Shimizu T, Stahl AM, Matsuda S, et al. Combining a vascular bundle and 3D printed scaffold with BMP-2 improves bone repair and angiogenesis. Tissue Engineering Part A. 2021;27(23-24):1517-25.
Egro FM, Schilling BK, Fisher JD, Saadoun R, Rubin JP, Marra KG, et al. The future of microsurgery: vascularized composite allotransplantation and engineering vascularized tissue. J Hand Microsurg. 2022;14.
Lei C, Cai B, Chen X, Huang Z, Wang B. Introduction of ligated vessels promote the retention and regeneration of free fat: constructing a fat flap in tissue engineering chamber. Adipocyte. 2020;9(1):108-15.
Nassar AH, Maselli AM, Manstein S, Shiah E, Slatnick BL, Dowlatshahi AS, et al. Comparison of various modalities utilized for preoperative planning in microsurgical reconstructive surgery. J Reconstruct Microsurg. 2021;38(03):170-80.
Rozen WM, Yogaraj V, Siddiqui M, Lok E, Hunter-Smith DJ. Surgical delay in abdominal based flap surgery: a scoping review. Ann Transl Med. 2024;12(3):51.
Thimmappa ND. MRA for Preoperative Planning and Postoperative Management of Perforator Flap Surgeries: A Review. J Magnetic Resonance Imaging Internet. 2023;17.
Khajuria A, Charles WN, Prokopenko M, Beswick A, Pusic AL, Mosahebi A, et al. Immediate and delayed autologous abdominal microvascular flap breast reconstruction in patients receiving adjuvant, neoadjuvant or no radiotherapy: a meta-analysis of clinical and quality-of-life outcomes. BJS Open. 2020;4(2):182-96.
Bond ES, Soteropulos CE, Yang Q, Poore SO. The Impact of Prior Abdominal Surgery on Complications of Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis. J Reconstr Microsurg. 2021;37(7):566-79.
Escandon JM, Ciudad P, Mayer HF, Pencek M, Mantilla‐Rivas E, Mohammad A, et al. Free flap transfer with supermicrosurgical technique for soft tissue reconstruction: A systematic review and meta‐analysis. Microsurgery. 2023;43(2):171-84.
Escobar-Domingo MJ, Bustos VP, Akintayo R, Mahmoud AA, Fanning JE, Foppiani JA, et al. The versatility of the scapular free flap: A workhorse flap? A systematic review and meta-analysis. Microsurgery. 2024;44(5):e31203.
Chandra SR, Morlandt A, Ying Y, Rana M, Acero J, Parmar S. Deep Circumflex Iliac Artery-Based Composite Flap or Vascularized Iliac Crest Flap. Atlas Oral Maxillofac Surg Clin North Am. 2023;31(2):113-20.
Zhang Q, Chiu Y, Chen Y, Wu Y, Dunne LW, Largo RD, et al. Harnessing the synergy of perfusable muscle flap matrix and adipose-derived stem cells for prevascularization and macrophage polarization to reconstruct volumetric muscle loss. Bioactive Materials. 2023;22:588-614.
D'Arpa S, Toia F, Pirrello R, Moschella F, Cordova A. Propeller flaps: a review of indications, technique, and results. Biomed Res Int. 2014;2014:986829.
Lyons ME, Goldman JJ. Gracilis tissue transfer. StatPearls. 2023.
Kouniavski E, Egozi D, Wolf Y. Techniques and Innovations in Flap Engineering: A review. Plast Reconstruct Surg Global Open Internet. 2022;10(9):e4523.
Akhtar ZB. Exploring Biomedical Engineering (BME): Advances within Accelerated Computing and Regenerative Medicine for a Computational and Medical Science Perspective Exploration Analysis. J Emerg Med OA. 2024;2(1):1-23.
Mohammadi AT, Mohammadzadeh I, Sajedifar M, Shabani M, Khonche S, Asgari R, et al. Emerging Frontiers in Surgical Advancements: Exploring Cutting-Edge Technologies and Pioneering Techniques. Nobel Sciences. 2024.
Sureshkumar S, Sudharsanan S, Vijayakumar C, Anandhi A. Abdominal Wall Reconstruction: Advances in the Last Decade. Int J Adv Med Health Res. 2024;11(1):4-14.
Fry A, Cascarini L. Improving the success rates of composite flap reconstructions. Br J Oral Maxillofac Surg Internet. 2020;58(10):e176-7.