Background: Primary malignant bone tumors are most commonly associated with mutilating surgical procedures that can significantly disturb the motor development of a young patient and are frequently affiliated with major postoperative complications. Unfortunately, despite available autologous tissue donor sites, artificial materials are still most commonly used for the reconstruction of post-resection defects. Reconstructive microsurgery is increasingly recognized as an effective method of functional reconstruction, creating the possibility of performing limb-sparing surgery (LSS) with significant limitation of major postoperative complications at the same time. Methods: The study group consisted of 9 pediatric patients diagnosed with primary malignant bone tumor in the limb location. In order to perform microvascular reconstruction, 9 free fibula flaps were used in combination with a bone allograft (Capanna method). The functional outcome of the reconstruction was assessed on the basis of the MSTS (Musculoskeletal Tumor Society Scoring System) scale. Results: The presented analysis proves the effectiveness of this reconstructive procedure and the possibility of performing LSS with reasonable functional outcomes after appropriate patient qualification. In this study, all limbs included were spared. In all cases, the R0 surgical margins were achieved and no reports of local recurrences were reported during the follow-up. The average score on the MSTS scale was 27/30 points. Conclusions: Microvascular reconstructive surgery is an individually personalized and highly effective method of treating patients with primary bone tumors in the limb location and provides satisfactory functional outcomes.

Radial forearm free flap (RFFF) is one of the most popular free flaps in the history of reconstructive microsurgery. Due to its characteristics, it has found its main application in reconstructions in the head and neck region. Before harvesting this flap due to the removal of 1 of the 2 major forearm arteries, an Allen test has historically been recommended. However, is it necessary to use this test in every patient? During the period of 2013 to 2023, 237 RFFF reconstructions were performed on 220 patients. Each surgeon performing a given procedure received a questionnaire to complete, which concentrated on only 2 questions, each had 2 possible answers. The first, whether the Allen test was performed before harvesting the radial forearm free flap, and second, if there was, whether it ever resulted in the change of the approach to reconstruction. In a whole analyzed group of 237 harvested flaps, there were no acute or chronic ischemic complications regarding the hand itself. Three surgeons who performed the RFFF most frequently stated that they had never done Allen test during the last decade. The remaining number of operators have assured that they always have used Allen test, but the result has never forced them to change the approach. Our study shows that the Allen test has limited utility in patients where the radial forearm flap was harvested from a previously intact donor site.

Accurate preoperative mapping of skin-paddle perforators is vital for osteocutaneous fibula free flap (FFF) success. While handheld Doppler (HHD) is widely used due to its convenience, its performance compared with color Doppler ultrasound (CDU) in FFF planning remains uncertain. In this prospective study, 50 consecutive patients undergoing FFF reconstruction after head and neck cancer resection were evaluated. Each patient underwent HHD and CDU mapping on the day before surgery. Perforator skin surface location, anatomical type (septocutaneous vs. musculoseptocutaneous), peak systolic velocity, and source vessel (peroneal vs. posterior tibial) were recorded. Mapping marks were concealed between examinations. A total of 185 perforators were confirmed intraoperatively (mean 3.7 per limb). CDU identified 179 candidates, yielding 95% sensitivity, 92% specificity, and 94% accuracy. HHD detected 155 sites, achieving 59% sensitivity, 6% specificity, and 48% accuracy, with significantly more false positives and negatives (p < 0.001). Both overall and dominant perforators clustered in the fourth decile of the lower leg (counting from lateral malleolus to fibular head). Distal regions were dominated by septocutaneous vessels, while musculoseptocutaneous types were more common in proximal regions. Anatomical variants—perforators draining into the posterior tibial instead of the peroneal vessels—occurred in 8% of cases and were identified exclusively by CDU. CDU outperforms HHD for preoperative perforator mapping in osteocutaneous FFF, combining high spatial precision with reliable hemodynamic assessment and variant detection. Incorporation of CDU into routine surgical planning promises to enhance flap design accuracy and minimize intraoperative uncertainty.

The design and preoperative planning of microsurgical free flaps are crucial for successful outcomes. Studies have shown that preoperative vascular mapping significantly shortens operative time, reduces complication rates, and lowers overall costs. Various methods of perforator detection have been introduced; however, none is ideal. Some surgeons propose that combining two or even three different methods could better meet clinical expectations. Therefore, this study sought to determine the effect of augmenting color Doppler ultrasound (CDUS) preoperative perforator detection with smartphone-based dynamic infrared thermography (DIRT) on concordance with intraoperative findings. The study included 46 patients scheduled for anterolateral thigh flap (ALTF) reconstruction. Patients were divided into two groups according to the method of perforator mapping: Group 1 underwent CDUS alone, while Group 2 underwent DIRT followed by CDUS. Assessments were performed by novice surgeons with limited ultrasound experience. The time required for perforator mapping was significantly shorter in Group 2 (9 min vs. 16 min, p < 0.0001). The mean number of detected perforators in the evaluated area was 2.5 in Group 1 and 2.96 in Group 2 (p = 0.046). Combining CDUS with DIRT significantly reduced the number of overlooked vessels (p < 0.01). DIRT plays an important role in perforator flap planning by identifying likely perforator locations before CDUS. In turn, CDUS provides detailed information on the perforator's course and hemodynamic properties. The combination of these two techniques offers a rapid, easily interpretable method for preoperative flap planning that can be used by any microsurgeon.

None Received: 29 December 2024 Accepted: 12 March 2025 Accepted Manuscript online: 24 March 2025 © . Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor , NY 10001 New York, USA

Background: Individually personalized reconstructive microsurgery is more and more universally recognized and applied as a one-time, part of a few, or even the only highly effective treatment of patients with locally advanced midface cancer. Among the increasing number of publications focused on this field, most present different reconstructive techniques used for a single patient (case reports), and fewer papers evaluate a group including more than 100 patients. Methods: A dataset of 119 locally advanced midface cancers in stage T₃ or T₄ was used to analyze whether there is any correlation between clinical factors, resection defect parameters, and the free flaps chosen for reconstruction. Results: In general, the 5-year OS was 95% and 77% for the DFS, which inversely correlated with the increasing Cordeiro’s type of resective defects. Local recurrence occurred in 23% of cases. Taxonomic dendrograms allow the selection of four (A–D) different case clusters. Cluster B, which characterizes a tumor size of 8–18 cm², Cordeiro type IIIA, and an uncertain radicalism of resection, has the worst prognosis with a very high (89%) risk of local recurrence. On the contrary, the most favorable was found in cluster C, characterized by Cordeiro type IIA, a tumor size of 8 cm², and negative resective margins, because it has a very low (6%) risk of local recurrence. Conclusions: The results of the present analysis have led to design algorithms for midface resection and reconstruction. However, these should not be considered obligatory but rather as a useful general guideline.