Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine.

Background: Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. Material and Methods: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. Results: Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. Conclusions: This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making.