International Microsurgery Journal (IMJ) is an open access journal with a comprehensive peer review policy and a rapid publication process. IMJ provides a global platform for scientists, clinicians, researchers and scholars to interact and share their latest research in all fields of microsurgery, including head and neck reconstruction, breast reconstruction, trunk and torso reconstruction, hand and upper extremities reconstruction, lower extremities reconstruction, lymphatic surgery, peripheral nerve, vascularized composite tissue allotransplantation, experimental microsurgery, microsurgical education, or other related topics.
IMJ is the official journal of International Microsurgery Club (IMC) and Internationl Course on Supermicrosurgery (国际超级显微外科学会, ICSM). International Microsurgery Club was created to facilitate discussion of complex cases and share knowledge of microsurgical techniques amongst experts around the world. Since its inauguration in May 2016, IMC now counts 5000 members and is one of the largest online educational platforms for microsurgery around the world. IMJ aims to make these educational case discussions available in written format to maximize the scholarly outreach and access to these valuable resources. IMJ welcomes submission of case reports, original articles, review papers, clinical studies, editorials, expert opinion and perspective articles, commentaries, and book reviews.
Dr. Tommy Nai-Jen Chang is a board-certified plastic surgeon in Taiwan. Currently, he is an Associate Professor in the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Microsurgery, Chang-Gung Memorial Hospital, Linkou Medical Center, Taiwan. Dr. Chang finished his residency at Chang-Gung Memorial Hospital in 2011 and was appointed as staff of the department. He learned peripheral nerve reconstruction from Prof. David Chwei-Chin Chuang since 2012. Between 2015 and 2016, Dr. Chang completed a peripheral nerve research fellowship at the Hospital for Sick Children (SickKids) in Toronto, Canada, supervised by Dr. Gregory Borschel, Dr. Tessa Gordon and Dr. Ronald Zuker. After several years of peripheral nerve training under the guidance of Dr. David Chuang and Dr. Gregory Borschel, Dr. Chang is now capable of performing all types of peripheral nerve surgery. Currently, Dr. Chang works with Professor David Chwei-Chin Chuang and Dr. Johnny Chuieng-Yi Lu for peripheral nerve reconstruction for adult and pediatric brachial plexus injury, facial paralysis, and reconstruction of upper and lower extremity defects, decompression neuropathy including carpal tunnel, cubital tunnel, thoracic outlet syndrome, and the neurogenic tumors.
In addition to exploring motor nerves, Dr. Chang has also explored the sensory and autonomic nervous system as well in recent years and advanced some new areas, such as breast and nipple neurotization, robotic-assisted sympathetic trunk reconstruction, and hyper-selective neurectomy to treat primary hyperhidrosis. Besides, Dr. Chang also does microvascular surgery for Head and Neck reconstruction, perineal reconstruction, and extremities reconstruction. A total of 80 articles have been published in literature until the year 2022, mainly in the field of reconstructive microsurgery.
His research interests include peripheral nerve regeneration and reconstruction, and social media for microsurgery education. Dr. Chang founded the International Microsurgery Club (IMC) in 2016; until now, this group represents the largest online microsurgery platform. Dr. Chang was invited as the editor-in-chief of International Microsurgery Journal (IMJ) in 2017 and established International Microsurgery Website (IMW) in 2018 to provide educational resources for microsurgery surgeons worldwide. Dr. Chang coordinates the IMC Webinar Series during the COVID-19 pandemic to provide continuous education to global microsurgeons in 2020. By April 2022, there had been over 210 events, and all of the recordings were available on the IMW for members to access for free.
Aside from IMC, in Sep 2020, Dr. Chang also coordinated the main microsurgery webinar hosts and created an International Microsurgery Webinar League. Over 500 free accessed microsurgery-related free webinar talks were then connected online automatically, and the power of online learning of this system continues to expand and benefit the global microsurgeons.
Prof. David Chwei-Chin Chuang is the first plastic surgeon who concentrated on peripheral nerve science that incorporated injuries, reconstruction, and research in Taiwan. It took him 30 years to be recognized as a world expert in the field of peripheral nerve injury and reconstruction. He started his microsurgical career in 1984 and became an academic professor in 2000. His phenomenal career was inspired largely by mentors namely: Dr. Samuel Noordhoff who motivated him to become a plastic surgeon, Dr. Fu-Chan Wei who influenced him to become a micro-surgeon; Dr. Julia K Terzis (USA), Dr. H. Millesi (Austria), Dr. A. Narakas (Switzerland), and Dr. Toru Kondo (Japan) - all four of whom had primed him to become a peripheral nerve microsurgeon.
In the process of aiming to make a solid contribution in the world of microsurgery, Prof. Chuang has developed many concepts and techniques related to the following: peripheral nerve reconstruction that deals with the classification level of brachial plexus injury; classification of level of radial nerve injury; classification of severity of post-paralysis facial synkinesis and strategy for treatment; the classification of traction avulsion amputation of the major limb; the technique of gracilis myocutaneous flap harvest; the technique revolution of FFMT for facial nerve reconstruction; the surgical treatment of thoracic outlet syndrome; the subfascial anterior transfer for cubital tunnel syndrome; the operative methods of nerve transfer for irreparable brachial plexus avulsion injury; the contralateral C7 transfer with free vascularized ulnar nerve graft; the intercostals nerve transfer to the musculocutaneous nerve, and other nerve transfer procedures.
Despite his already quite hectic schedule, he still found the time to get involved in many types of researches, which are related to peripheral nerve and free functioning muscle transplantation. Also, his numerous experimental types of research have been published in Plastic and Reconstructive Surgery, one of which is the research for arterialized venous flaps using vaso vasorum changes that he completed in 2015.
Because of his unique field of medical expertise, Prof. Chuang has been invited in countless local and worldwide meetings for special lectures, symposiums and panels in Japan, Korea, China, Thailand, Singapore, Indonesia, India, Argentina, Italy, Finland, Kuwait, Hong Kong, Mexico, Turkey, Germany and the USA. Furthermore, he also co-authored a chapter in three versions of the textbook entitled “Plastic Surgery” (2nd version 2006, third version 2013, and a new coming fourth version). Aside from these seemingly untiring achievements, he did several presentations locally and internationally, which were profiled in quite a number of publications for different medical journals.
Prof. Chuang has been similarly sought as the International Associate Editor of Plastic and Reconstructive Surgery from 2014 to 2016, and his term has been extended from 2016 to 2018. In relation to the foregoing, Prof. Chuang has twice hosted the "Instructional Course" for adult brachial plexus injury in 2009, and facial paralysis reconstruction in 2011. The third part (adult brachial plexus injury) of which, is coming soon this 2017.
To make his career in micro surgery more fulfilling, Prof. Chuang engaged himself with the Fellow Training Program of Chang Gung Memorial Hospital as one of the teachers, for hundreds of international foreign fellows. Along with this, he has treated international patients (approximately 100) from 20 different countries around the world.
As an authority figure in the field of micro-surgery, Prof. Chuang held vital positions as follows: Chief of Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei-Linkou; 13th President of Taiwan Plastic Surgical Association (2006-2008); 10th President of Taiwan Society for Surgery of the Hand (2009-2010); and First (1st) President of Taiwan Society for Reconstructive Microsurgery (2014-2016). At present, he is the 9th President of World Society for Reconstructive Microsurgery (WSRM) from March 2015 to June 2017. Prof. Chuang is undertaking every workable means and ways to fortify the relationship between the WSRM central office and the four regional societies (ASRM, ALAM, EFSM and APFSRM).
Prof. Chuang’s high hope is for the International Microsurgery Club and the International Microsurgery Journal to truly become the “World Society.”
Professor Koushima, president of the World Society for Reconstructive Microsurgery from 2017 to 2019, graduated from Okayama Prefectural Tsuyama High School and Tottori University Faculty of Medicine in the 1970s, and completed his residency training in plastic surgery at Tokyo Women's Medical University Surgery Department and The University of Tokyo Hospital Plastic Surgery Department.
In 1983, he joined the University of Tsukuba Plastic Surgery Faculty of Medicine as a lecturer. By the year of 1990, he became an associate professor at Kawasaki Medical School Plastic Surgery. He was then sent to Harvard University for further education in 1996 and became a professor at Okayama University Faculty of Medicine Plastic Reconstruction Surgery, The University of Tokyo Plastic Reconstruction Surgery, and National University of Singapore in the early 2000s. In 2010, he was the associate dean at The University of Tokyo Hospital and became emeritus professor at The University of Tokyo Hospital as well as distinguished professor at Hiroshima University International Lymphedema Treating Center in 2017.
Throughout his academic career, he performed live surgery in 22 hospitals through invitations from international societies since 1997, including Ghent University Hospital, Belgium (twice), Louisiana State University, USA , Kuwait University hospital, München , Universidade de São Paulo hospital, Sant Pau Hospital, Barcelona, Ankara Medicine University, Turkey, China-Japan Friendship Hospital, Beijing (twice), National University of Singapore, Planas Hospital, Barcelona, Coimbatore city hospital, India, Versailles, France (2009/Feb), Utrecht University Hospital, Nederland (2009/May), Tomsk State University, Russia (2009/Sep), Planas Hospital, Barcelona(2010/Mar), University of Picardie Jules Verne, France (2010/Jul), Mahidol University, Thailand (2010/Aug), Hospital General Dr. Manuel Gea González (2010/Oct), The Chinese University of Hong Kong( 2010/Nov), National University of Singapore (2010/Dec), and Mumbai, India (2011/Mar).
Prof. Koushima’s contribution to the field can be divided into basic medical sciences and clinical medical sciences. He specializes in neuro-degeneration and neuro-regeneration, nerve grafting, tendon transplantation, and vascular pedicle nerve grafting. He is very well known in multiple clinical fields, such as perforator flap reconstruction, microvascular anastomosis, head and neck reconstruction, facial nerve palsy reconstruction, extremities’ reconstruction, lymphedema surgeries, as well as transgender surgeries for those with gender identity disorders. He has performed penis reconstruction, hand reconstruction, breast reconstruction, and aesthetic plastic surgery.
Prof. Koushima is affiliated with many societies as he is the reviewer of Plastic & Reconstructive Surgery Journal of American Society of Plastic Surgeons and Japanese Society of Plastic Reconstruction Surgery, and the founder and operator of International perforator flap conference 1997, Asia Pacific super micro conference in Singapore 2007, and Europe super micro conference in Barcelona 2010. He was the chairman of the Japanese Society for Surgery of the Hand, Japanese Society of Reconstructive Microsurgery, and Japanese Society for Lymphoreticular Tissue. He is the supervisor of the Japanese Society of Tissue Transplantation and members of Japan Society for Head and Neck Surgery and Japanese Research Society of Clinical Anatomy.
Prof. Wang is the world-famous microsurgeon in China. He is currently the chief of Shandong Provincial Hospital Extremities Surgery Department, professor and chief physician of Chinese Association of Microsurgery, vice chairman of Chinese Medical Association Branch of Microsurgery and Branch of Hand Surgery, and committee member of Shandong Province Society for Surgery of the Hand, committee member of Chief Shandong Province Society for Trauma surgery, vice chief physician of Shandong Province Society for Reconstruction Surgery, and editorial board member of Chinese Journal of Clinical Anatomy.
Prof. Wang’s work is filled with creativity, mainly focusing on a combination of clinical research and basic medical research. He has published several world-class original results based on innovative techniques in the clinical medical field. For instance, Dr. Wang’s research made great improvements regarding low temperature organ preservation. He successfully replanted three cases of low temperature-preserved severed finger at -196°C. Moreover, he created assembled digit reconstruction, a procedure that brought to light a whole new vision of the traditional procedure which has been used for thirty years in the world by replanting digits through cutting off the index toe. This new technique allows reconstructed fingers to resemble original digits instead of toes. His creativity and innovative visionary leads the field of reconstructive surgery into a new era.
Moreover, Prof. Wang excelled above and beyond expectations by taking the time to review and revise microsurgery anatomy, which clarified certain anatomy structures associated with microsurgery. As a result of his contributions, reconstructive microsurgery has been significantly improved. Furthermore, he has written many literary works pertaining to such topics, such as the "Clinical Anatomy Atlas of Microsurgery".
It is indeed a significant step forward in the development of global microsurgery to have Prof. Wang serve as the honorary Editor-in-Chief of the International Microsurgery Journal since with this collaboration, we have succeeded in removing the barriers of language and platform, so people are able to learn the techniques from Chinese microsurgeons. There will be more cooperation not only in the journal, but also in the conference and the online platform in the future. This knowledge exchange and pooling should be beneficial to global microsurgeons and patients alike.
Dr. Peter Neligan is Irish and attended Trinity College Dublin, graduating in 1975. He obtained a General Surgery Fellowship in 1980 then Plastic Surgery training in Ireland. Moving to Toronto in 1983 and completing fellowships in research, pediatric plastic surgery, microvascular surgery and burn surgery. He received FRCSC in Plastic Surgery in 1988. He became Chair of Plastic Surgery at the University of Toronto in 1996 and Wharton Chair in Reconstructive Plastic Surgery in 1999. In 2007 he moved to Seattle as Professor of Surgery and Director of the Center for Reconstructive Surgery at the University of Washington. His practice is in microsurgery, perforator flaps, lymphatic surgery, facial re-animation and VCA. He was retired in 2020.
Publications include more than 12 books, 85 book chapters and over 200 peer-reviewed papers. He is the Editor-in-Chief of Plastic Surgery, a 6 Volume textbook which has become the standard text for Plastic Surgery Training Programs around the world. He’s been invited to over 300 universities or major societies as a visiting professor or honored guest. He sits on several editorial boards and is past Editor-in-Chief of the Journal of Reconstructive Microsurgery.
Dr. Neligan is Past-President of the PSF, ASRM as well as the NASBS. He is also a past board member of the AHNS. He is a past trustee of the ASPS. He is married to Gabrielle Kane, a radiation oncologist and they have 2 adult children and 4 grandchildren.
Dr. Ronald M. Zuker, graduated from the Faculty of Medicine at the University of Toronto and after completing his Plastic Surgery training under Dr. W. K. Lindsay, embarked on a McLaughlin Travelling Fellowship learning about microsurgery, cleft care and burns in Japan, Australia, New Zealand and Europe. Dr. Zuker was appointed to the staff at the Hospital for Sick Children in 1978 where he has remained and continues to be active to this day. He was Chief of the Division of Plastic & Reconstructive Surgery from 1986 to 2002.
Surprisingly Dr. Zuker began his medical career in the Amazon Basin as a river doctor working for the Hospital Amazonica Albert Schweitzer in Pucullpa, Peru where his fluency in Spanish paid dividends. To this day, his commitment to global health continues with strong representation in Operation Smile. After he completed his surgical training, he was integral in establishing the microsurgery program at the University of Toronto with Drs. Ralph Manktelow, Nancy McKee, Howard Clarke and Jim Mahoney. Quickly, Toronto became known as an epicenter of excellence and attracted dozens of trainees from around the globe including Professor Fu Chan Wei who, stimulated by his teachers, formed the world’s largest microsurgery unit at Chang Gung Hospital in Taipei.
Dr. Zuker is one of the original pioneers of microsurgery. He is a founding member of the American Society of Reconstructive Microsurgery and the Group for Advancement of Microsurgery (GAM – Canada). He has had key leadership positions in our specialty’s important societies including the American Academy of Pediatrics, the American Association of Plastic Surgeons, the American Association of Pediatric Plastic Surgeons, the American Burn Association, the American Cleft-Craniofacial Association, the American Society for Reconstructive Microsurgery, the American Society of Peripheral Nerve, the American Society of Plastic Surgeons, the Congress of the International Microsurgery Society, the Canadian Society of Plastic Surgeons amongst many others, culminating with the Presidency of the International Society of Plastic Reconstructive and Aesthetic Surgery Congress in Vancouver 2011.
His curriculum vitae is rich with accolades, honors, peer-review papers and scientific presentations. He has been teaching residents and medical students in Plastic Surgery since 1978. He has taught fellows from all over the world. He has given lectures on 4 of the 5 major continents. He has published more than 100 peer-reviewed scientific papers and book chapters. One of his most significant contributions has been his textbook entitled Principles and Practice of Pediatric Plastic Surgery (co-edited with Bruce Bauer and Mike Bentz) which has become the go-to book for Pediatric Plastic and Reconstructive Surgery and is heading for a 3rd edition any day now! He has acted as a great mentor for the latest generation of reconstructive microsurgeons and is generous in sharing his surgical secrets.
It is easy to say that the backbone of Dr. Zuker’s career has been his dedication to clinical excellence and innovation. The Zuker name has been integral in shaping the sub-specialty of pediatric plastic surgery through his contributions to microsurgery, cleft lip and palate and upper extremity surgery. However, Dr. Zuker will be best known for his work as the “Smile Doctor”. His passion has been the restoration of facial function in patients with facial paralysis and Moebius syndrome. To this end, he has revolutionized the approach to the management of established facial paralysis using free functioning muscle transfer with the gracilis muscle being the workhorse. With Dr. Ralph Manktelow, he developed innovative and novel techniques for transfer of the gracilis muscle from the leg to restore the smile in patients with facial paralysis. Surgeons from around the world visit him to learn this remarkable procedure. He has been recognized for his passion by the Moebius Foundation and the Smile Foundation of South Africa. There is a photo in the collage of Ron’s office memorabilia showing him shaking hands with Nelson Mandela in recognition of his service to patients with facial paralysis. Ron holds honorary degrees as Fellow of the Royal College of Surgeons of Edinburgh and Honorary Fellowship of the College of Plastic Surgeons of South Africa.
Everyone is well aware of Dr. Zuker’s interest in smile surgery but here are ten rarely known facts about Dr. Ron Zuker’s clinical achievements:
Dr. Zuker’s career began with a focus on the delivery of health care to those in greatest need. He continues to exhibit this high level of altruism by devoting a huge amount of his energy to helping children with clefts in low and middle-income countries spending time in South America, Africa and India with the Operation Smile group. His latest endeavor is the creation of the Pediatric Vascularized Composite Allotransplantation program at the Hospital for Sick Children pushing the clinical limits of reconstructive surgery.
It is a small world under the microscope, but it is incredible how far it can take you in the real one. His name is synonymous with excellence and innovation. In the arena of innovative reconstructive microsurgery, Ron has few equals. Dr. Ron Zuker has made significant innovations in the unique areas of conjoined twins, composite vascularized allotransplantation, free functioning muscle transfer, solid organ transplantation and global outreach. In the field of Plastic & Reconstructive Surgery, Ron is an icon and for his contributions to the specialty was awarded the Canadian Society Lifetime Achievement Award in June 2014.
Dr. Gregory Buncke is a plastic, hand, and microsurgeon. Currently, he is the director of the Buncke Clinic in San Francisco, and he is the son of the pioneering microsurgeon Harry J. Buncke. Dr. Buncke earned his medical degree from Georgetown University in Washington, DC. He completed his residency in Plastic and Reconstructive Surgery at Stanford University and did a fellowship in Hand and Microsurgery at the Davies Medical Center in San Francisco, where he remains in practice. Dr. Buncke is Board Certified by the American Board of Plastic Surgery and has a Certificate of Added Qualification in Surgery of the Hand. He is a Fellow of the American College of Surgeons, and a member of several societies, including the American Society of Plastic Surgeons, the American Society for Reconstructive Microsurgery, and the American Society for Surgery of the Hand. Dr. Buncke has published numerous articles related to a wide variety of plastic, hand, and microsurgery topics.
Since 1970 The Buncke Clinic has been at the forefront of the advancement of reconstructive surgery. The Buncke Clinic is not only known for its rich history, but also contributes to the advancement of microsurgery in numerous ways, including outstanding clinic service, research, and educational programs. Its customized website also provides all the essential background knowledge for microsurgeons and the updated master talk organized by Dr. Bauback Safa. You can find out more about the Buncke Clinic online, as well as all the secrets about microsurgery, by visiting their websites.
Dr. Jung-Ju Huang is a board-certified plastic surgeon from Taiwan. Currently, she is an associate professor in the Department of Plastic and Reconstructive Surgery and director of the breast reconstruction center at Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan. She majors in reconstructive microsurgery, in particular, microsurgical breast reconstruction, gynecological reconstruction, and surgical treatment for lymphedema. She also performs aesthetic breast surgery. Dr. Huang does basic and clinical research along with her clinical work. Her research has been highly acknowledged by the society of plastic surgery in Taiwan and the United States of America. She has been awarded several times for her work. She has been recognized as one of the top ten outstanding young women in Taiwan in 2017, as well as a rising star in the fields mentioned above. Her work was recognized by the American College of Surgeons as an International Guest Scholar in 2018.
Dr. Wei F Chen is a plastic surgeon with expertise in reconstructive micro- and supermicro-surgery and is currently a clinical professor of Plastic Surgery at Cleveland Clinic and is the head of the regional microsurgery and supermicrosurgery as well as the co-director of Cleveland Clinic Center for Lymphedema Research and Reconstruction. After graduating from the University of California at Berkeley with honor, he completed a general surgery residency at the State University of New York at Stony Brook. He went on to complete a plastic surgery training at University of Illinois at Chicago, and then advanced microsurgical training at the world-renowned Chang Gung Memorial Hospital, Taiwan. Dr. Chen is U.S. Board-certified in both general surgery and plastic surgery. Dr. Chen is a pioneer in the field of lymphedema reconstruction and is known for many technical innovations as well as having accomplished multiple regional firsts. Dr. Chen assumes leadership roles in many professional plastic surgery organizations and was the president of the Midwestern Association of Plastic Surgeons.
Dr. Luigi Troisi joined the University Department of Hand Surgery & Rehabilitation at the San Giuseppe Hospital - IRCCS MultiMedica Group Milan in February 2019. Dr. Troisi is currently the Head of the Reconstructive Microsurgery Service (MultiMedica Group), Adjunct Professor at the School of Specialisation in Plastic, Reconstructive and Aesthetic Surgery of the University of Milan, and Coordinator of the Fellowship in Reconstructive Microsurgery at the University of Milan. From August 2017 to February 2019, Dr. Troisi served as a Consultant at the Department of Plastic and Reconstructive Surgery, Salisbury NHS Foundation Trust, and at the University Hospital Southampton NHS Foundation Trust (UHS). He completed a specialist training program with Prof. Zoran M. Arnez in Trieste, Italy, before undertaking fellowship training (Microvascular / Lower Limb) in Bristol, UK. Dr. Troisi has been mentored by great microsurgeons such as Prof. Zoran M. Arnez, Prof. Bernard Devauchelle, Mr. Umraz Khan, and Prof. Moazzam Tarar during his training. He is primarily interested in Reconstructive Microsurgery, specifically Limb Reconstruction and Pressure Ulcers. In January 2022, Dr. Troisi became Visiting Professor at the Reconstructive Microsurgery Unit, Department of Plastic Surgery, The Royal London Hospital.
Dr. Takumi Yamamoto is currently the chief of the Department of Plastic and Reconstructive Surgery, the director of the Supermicrosurgery International Lymphedema Center (SILC), as well as the director of the Lymphatic Supermicrosurgery ACT program at the National Center for Global Health and Medicine (NCGM), Tokyo, Japan. With more than 200 PubMed-indexed articles in peer-reviewed international journals, Dr. Yamamoto rigorously works in every area of reconstructive surgery, especially supermicrosurgery and management of lymphatic disorders. In the area of supermicrosurgery, he specializes in short-pedicle toe flap transfer, small tissue replantation, day free flap transfer under local anesthesia, chimeric SCIP flap, any kind of true perforator flaps, pure skin perforator or super-thin flaps, and multiple free flap transfers up to 8 flaps simultaneous transfer. With respect to the treatment of lymphatic disorders, he specializes in ICG lymphography, Ultrasound, SPECT/CT, lymphaticolymphatic anastomosis, lymphaticovenular anastomosis, lymph node true perforator flaps, lymph-interpositional-flap transfer, and navigation lymphatic supermicrosurgery.
Dr. Javier López Mendoza is a Plastic and Reconstructive surgeon located in Mexico City, Mexico. He completed the Fellow in hand surgery, observership at Tokyo University, Japan, and microsurgery training at Asan Medical Center, Korea. In addition to being the head of the academic division of AMCPER (Plastic and Reconstructive Surgery Mexican Association), he also practices at the Angeles Pedregal Hospital in Mexico City.
Dr. Mohamed Ellabban was educated at the prestigious Amoun High School in Ismailia, Egypt before undertaking his medical studies at Suez Canal University. He was graduated in 2000 with the degree of “Excellent with Honours” and was offered a post at Suez Canal University Hospitals to continue his higher surgical training. He gained a Master Degree in Plastic Surgery in 2004 on a study of body contouring after restrictive bariatric surgery. He won the best research award from the Egyptian Society of Surgeons in 2005. Thereafter, he was granted MD scholarship from the Egyptian Ministry of Higher Education and Canniesburn Research Trust to join the team at Canniesburn Hospital in the United Kingdom as head and neck oncoplastic fellow for almost three years. He became a Fellow of the Royal College of Physicians and Surgeons of Glasgow in 2008 and the European Board of Plastic and Reconstructive Surgery in 2010 after passing the exams for both. He also completed his MD in 2010 on a study of functional outcome after oral cancer surgery. Dr. Ellabban was trained in Plastic and Reconstructive Surgery in Egypt initially followed by a number of the prominent British units and had his plastic surgery higher training rotation in Scotland. He was appointed as a Professor of Plastic and Reconstructive Surgery at Suez Canal University Hospitals and Medical School in 2021. He published over 30 articles in peer review journals and presented over 40 research topics nationally & internationally. He is a reviewer for many journals in the field of plastic and head and neck surgery. His main interest is head and neck microsurgical reconstruction and he is an executive board member of the Egyptian Society of Head and Neck Oncology. He is also the Secretary General of The Egyptian Society for Surgery of the Hand and Microsurgery.
Dr. Hari Venkatramani has been a Consultant Plastic & Reconstructive Surgeon for 21 years with a specialized interest in Major Limb Trauma Reconstruction, Brachial Plexus Injuries, Microsurgery for Cancer reconstruction, and Lymphedema. He is currently the Senior Consultant, Dept of Plastic, Hand, and Reconstructive Microsurgery at the prestigious Ganga Hospital, Coimbatore which is one of the largest Trauma, Plastic Surgery, and Orthopedic Hospitals in India. The center has attracted over 1500 trainees from 72 countries. The center is a recipient of many national awards for exemplary service. He is currently an associate editor of the Indian Journal of Plastic Surgery (IJPS). He has received many prestigious awards, including the APSI-Dr. S Raja Sabapathy Leadership Award for 2020, President's Peet Prize of APSI, Kilner Essay Award of APSI, IPRAS international fellowship, and Prof Robert Acland International Traveling Fellowship of ISSH. He is currently the Secretary of the Indian Society for Reconstructive Microsurgery as well as the Brachial Plexus Surgery Group of India. He has received the RN Sinha and NH Antia Awards for best publication and the Best Paper Prize of ISRM, ISSH on multiple occasions. He has published 75 peer-reviewed journal articles and 12 book chapters. He has delivered over 175 International and National papers and lectures and has been a Faculty for Live Operative Workshops across the country and abroad. He has traveled extensively as a brand ambassador of Reconstructive MicroSurgery and as a Visiting professor to Bangladesh, Japan, Sri Lanka, Switzerland, New Zealand, USA, and the United Kingdom.
Dr. Jorge Boretto is a board certified orthopedic and hand surgeon in Argentina. In 1999, he began his training in orthopedic surgery and traumatology. In 2004 he continued his training with a 2-year fellowship specializing in hand and upper limb surgery at the Hospital Italiano de Buenos Aires. His training continued in France at the Lapeyronie University Hospital in the city of Montpellier where he acquired training in peripheral nerve and brachial plexus surgery as well as obtaining a University Diploma in Microsurgery. Back in Argentina in 2007, Dr. Boretto joined the Hand and Upper Extremity Surgery Department of the Hospital Italiano de Buenos Aires where he currently develops his practice in hand surgery, reconstructive microsurgery and brachial plexus surgery. His activity in the different scientific societies of the country and abroad has allowed him to serve as Secretary General of the Argentine Association of Hand Surgery, Deputy Editor of the Journal of the Argentine Association of Orthopedics and Traumatology, Member of the Editorial Board of the Journal HAND and the Journal of Hand and Microsurgery as well as a Professor of the Argentine Association of Hand Surgery and the American Association of Orthopedic Surgeons. Currently, Dr. Boretto is the author or co-author of more than 50 articles published in peer-reviewed journals indexed in PubMed and several chapters in orthopedics’ books.
Dr. Andrea Moreira is a board-certified Plastic Surgeon at the Department of Plastic Surgery at the Cleveland Clinic, Ohio, USA. She is also an Assistant Professor at the Lerner School of Medicine Case Western Reserve University, Cleveland, Ohio. Dr. Moreira has accumulated extensive clinical knowledge of the treatment of breast cancer and breast reconstruction, as this particular subject is about 80-90% of her practice as a plastic surgeon. Dr. Moreira is the author of several peer-review articles and book chapters. She has received many awards of excellence due to her research and patient care. Her main areas of research focus on breast reconstruction techniques, outcomes, and microsurgery. She has also participated in many mission trips to under-developed countries to provide surgical care for patients in need of breast reconstruction. Her overall vision is to develop state-of-the-art ways to care for breast reconstruction patients, through clinical knowledge and research.
Dr. Johnny Lu is an Assistant Professor staffed at the Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery in Chang Gung Memorial Hospital, Linkou, Taiwan. He received his medical degree at Kaohsiung Medical University, followed by plastic surgery residency training at Chang Gung Memorial Hospital. He then joined the peripheral nerve surgery team where he learnt under the guidance of Professor David Chwei-Chin Chuang and Associate Professor Tommy Nai-Jen Chuang, and focusing his clinical expertise on brachial plexus injuries, facial reanimation, and peripheral nerve surgeries. Dr. Lu was also the co-chairman of the 2nd Brachial Plexus Instructional Course in 2017. He then received his fellowship training at Washington University in St. Louis from 2017 to 2020, where he acquired basic science knowledge under the guidance of Dr. Alison Snyder-Warwick focusing on Neuromuscular junction studies in peripheral nerve injuries, and on nerve graft studies from Dr. Susan Mackinnon and Dr. Mathew Wood. He also earned a Master of Science in Clinical Investigation Degree from the Medical School at Washington University in St. Louis. Currently he has one nationally funded grant and one hospital funded grant investigating the morphological changes of neuromuscular junctions after nerve grafting and also in ischemic muscle injuries.
Dr. Susana Heredero Jung has been serving as staff physician at the Department of Maxillofacial Surgery at the Reina Sofia University Hospital in Córdoba, Spain, for the past 10 years. It is her primary focus on Head & Neck Oncology, Traumatology, and Reconstruction of the head and neck. She is especially passionate about microsurgical reconstruction. Since 2011, she has been responsible for the Maxillofacial Surgery residency training program at the institution, and she has been a faculty member of the AOCMF since 2017.
Dr. Chihiro Matsui is a board-certified plastic and reconstructive surgeon in Japan. Her current research interests are focused on adipose-derived stem cells in the Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine. Clinical studies have included Head and Neck reconstruction with microsurgical free flap transfer, simulation surgery using a dental silicone surgical guide, and video capillaroscopy for monitoring blood circulation. Among her basic science research interests are paracrine effects of adipose-derived stem cells, and she has been awarded three Grants-in-Aid for Scientific Research in Japan. As an international member of the American Society of Plastic Surgeons, her abstract has been selected as Top 200 several times at Plastic Surgery the Meetings in the United States, and she is also a reviewer for PRS and PRSgo. Furthermore, she specializes in digital medical illustration, for which she has produced illustrations for various papers and textbooks.
Ruben Kannan is one of the world's leading authorities on facial reanimation surgery and super-microsurgery. He is currently based at the prestigious Queen Victoria Hospital in East Grinstead in the United Kingdom, where he is head of the facial palsy unit. Following graduation with a scholarship from the Christian Medical College (CMC), Vellore in India, he moved on to complete his basic surgical training at the Royal College of Surgeons in Edinburgh. He then proceeded on to obtain a PhD in Nanotechnology at University College London, during which he contributed to research that led to the world's first synthetic organ transplant. After completing his training as a plastic surgeon in the United Kingdom, he then completed advanced training in facial palsy, super-microsurgery and migraine surgery at the St. Andrew’s Centre (United Kingdom), Japan and the United States respectively. He has won many awards in the field of microsurgery and plastic surgery and has many innovations to his credit. Dr. Kannan is also an enthusiastic trainer and runs the McLaughlin and TIG facial fellowship programs at his hospital for international as well as UK trainees, respectively.
Dr. Weifeng Zeng is currently the Director of microsurgery training laboratory and Associate Scientist at the University of Wisconsin-Madison focusing on microsurgical education, neural interfacing, and transplantation. Before coming to the University of Wisconsin-Madison, he studied super-microsurgery and lymphedema reconstruction at the University of Iowa, mentored by Dr. Wei F. Chen. Prior to this, he was an Attending Surgeon in the Division of Hand and Microsurgery at the Second Hospital of Dalian Medical University in Liaoning, China. He has profound surgical experience in clinical practice and research. Dr. Zeng is an active member of the American Society of Reconstructive Microsurgery and an international member of the American Society of Plastic Surgery. Dr. Zeng has been committed to and passionate about resident microsurgical education. Dr. Zeng has developed novel high-realistic simulators and an efficient curriculum for residents in Plastic Surgery, Otolaryngology, Urology, and Neurosurgery. Dr. Zeng’s mentoring helps residents from multiple disciplines gain the confidence and competence needed in the operating room. Dr. Zeng also manages the multi-institutional Annual UW Microsurgery Training Course. Dr. Zeng also actively participates in basic scientific research. Dr. Zeng provides surgical service and support including limb/kidney/liver transplantation, engineering vessel transplantation, neural interface development for grants with over $15 million dollars in funding through the Defense Advanced Research Projects Administration (DARPA), the National Institutes of Health (NIH), the Department of Defense, and the Veteran’s Administration.
Dr. Federico Lo Torto is an Assistant Professor at the Department of Plastic Surgery of the University of Rome Sapienza. During his clinical training in Plastic and Reconstructive Surgery at the University of Rome Sapienza, he also completed a PhD degree. He earned his Fellowship in Microsurgery and Lymphatic Surgery from the China Medical University Hospital in Taiwan. Following that, he worked in the Breast Unit of the Riuniti Hospital in Livorno. Besides publication of more than 85 peer-reviewed articles and more than a dozen book chapters, he has also served as a reviewer for several journals in the field of plastic surgery.
Dr. Anvar S. Razzokov is a plastic surgeon with expertise in reconstructive microsurgery, especially in the field of pediatric surgery. In his current capacity he is a consultant in plastic surgery at the National Children's Medical Center in Tashkent, Uzbekistan. After completing his residency, he completed a 2-year fellowship at the Yonsei University Wonju Severance Hospital (South Korea) under the supervision of Prof. Chung Yoon Kyu, and at the Pusan National University Yangsan Hospital (South Korea) under the supervision of Prof. Nam Su Bong. Furthermore, he took part in two observerships at Asan Medical Center (South Korea), with Prof. Choi Jong Woo and Prof. Hong Joon Pio (South Korea), where he gained extensive experience in microsurgery. Aside from that, Dr. Anvar Razzokov has been mentored by the world-renowned hand surgeon Prof. Woo Sang-Hyun (W Hospital, South Korea) and involved in the first hand transplantation surgery in the history of South Korea. In his return to Uzbekistan, he took part in a pioneering effort of free flap surgery in the country, especially for pediatric patients.
Dr. Sofija Pejkova is an Associate Professor of Plastic Surgery at the Faculty of Medicine, Ss. Cyril and Methodius University of Skopje, North Macedonia. Currently, she is the head of the University Clinic for Plastic and Reconstructive Surgery in Skopje. She has received training in both general surgery and plastics and reconstructive surgery. Additional training has been completed with Prof. Dr. Oskar Aszmann at Medical University, Vienna, Austria. Dr. Pejkova is actively involved in teaching medical students and training residents in the field of plastic surgery at the Faculty of Medicine, Skopje. Her primary areas of expertise are hand surgery and peripheral nerve reconstruction, which includes preclinical research studies on nerve regeneration.
In a cost-effective and portable way, a novel method was developed to assist trainees in spinal surgery to gain and develop microsurgery skills, which will increase self-confidence. Residents at a spine surgery center were assessed before and after training on the effectiveness of a simulation training model. The participants who used the training model completed the exercise in less than 22 minutes, but none could do it in less than 30 minutes previously. The research team created a comprehensive model to train junior surgeons advanced spine microsurgery skills. The article contains valuable information for readers.
The likelihood of donor site ischemia following the harvesting of a fibula flap is extremely low, but it is potentially lethal if it occurs. The authors describe a case of ischemia of the lower extremity following a free fibula harvest for head and neck reconstruction. The authors discuss preoperative, intraoperative, and postoperative strategies to assist in diagnosing and managing risks associated with free fibula flap harvesting in this paper.
The senior author (Dr. Isao Koshima) designed a tibial osseo-periosteal (TOP) flap. TOP flap has a favorable anatomical position with a thin skin around it, hence it is a good option for an island flap. TOP flap can be used for various mild to moderately sized osteo-cutaneous defects with low morbidity. In this article, the authors describe their experience of the first reported cohort of TOP flaps in clinical practice.
The video presents a useful technique for microvascular anastomosis in reconstructive surgery of the head and neck. It is advantageous to use this series of sutures when working with limited space, weak vessels (vessels irradiated, or with atheroclastic plaques), suturing in tension, or suturing smaller vessels (less than 0.8 cm in diameter).
Osteoarthritic finger joints are often repaired with joint implants, arthrodesis, or a vascularized interphalangeal joint graft. However, grafts can damage the donor toe. Based on the results of this study, the authors suggest that vascularized distal interphalangeal joint transfers from the second toe may be suitable for reconstructing these defects through microsurgery.
Our belief is: “Stronger microsurgeons for a better world.”
The progress of microsurgery in developing low-income countries.
Professor David Chwei-Chin Chuang sincerely welcomes you to join them for this instructional course on Nov. 13-16, 2017 at Chang-Gung Memorial Hospital.
A novel technique of sequential ETS micro-venous anastomoses using three vessel loops for IJV occlusion and a single vascular clamp to retract and hold the anastomoses sites in position.
A personal experience in robotic microsurgery.
A Fantastic platform for learning, professional development, and camaraderie. It's all just a few clicks away.
Division of the lateral plantar artery does not jeopardize the foot circulation because of anastomosis of the lateral plantar artery with the dorsalis pedis artery at the first intermetatarsal space. However, care should be taken with patients with peripheral artery occlusive disease and the flow of dorsalis pedis artery should be confirmed before surgery. Given the advantages of sizable vessel, easy dissection, and proximity to the defect, we believe that the lateral plantar artery might be a valuable option as recipient vessel for lateral plantar forefoot reconstruction.
Health care systems in many countries are confronted with increasing economic limitations. Thus, complex microsurgical procedures and extensive rehabilitation programs are poorly compensated. However, this case demonstrates a dramatic reduction of socioeconomic expenses by allowing a potential radiocarpal amputee to return to work for another estimated 30 years.
The 2nd instructional course for adult brachial plexus injuries is a fantastic opportunity to meet and learn from experts in the field. We cordially invite you to visit Chang Gung Memorial Hospital to participate in this unique learning experience.
Pedicled anterolateral thigh flap is a versatile option for reconstruction of complex soft tissue defects in varied anatomical regions. Its wide arc of rotation and less donor site morbidity are its added advantages.
The authors reviewed the MDCT images to show the number of lymph nodes superior to the saphenofemoral junction. In this study, on average, 3.67 nodes existed. However, there were 4 percent of cases with no countable nodes. This result indicates that appropriate preoperative screening is needed for this procedure.
The communication among international microsurgeons have switched from one direction (from paper, textbook) to multiway interactions through the internet. The authors believe the online platform will play an immensely important role in the learning and development in the field of microsurgery.
A 29-year-old male suffered from total loss of function of his left shoulder and upper limb after a traffic accident while riding a motorcycle. He was treated by a brachial plexus specialist at another hospital and managed surgically under the impression of total root avulsion.
The authors present a novel synthetic vascular model for microanastomosis training. This model is suitable for trainees with intermediate level of microsurgical skills, and useful as a bridging model between simple suturing exercise and in vivo rat vessel anastomosis during pre-clinical training.
Combining intraoperative ICG lymphography with NIR vein visualization can aid supermicrosurgeons in identifying lymphatic vessels and superficial venules to guide LVA incision placement. This guided approach significantly improves successful creation of LVAs when compared to the blind (anatomic) approach. In addition, the absence of linear ICG lymphographic patterns does not prevent formation of successful LVAs.
Authors present a case of combined proximal median and ulnar nerves extensive injury that was successfully managed using a novel safe strategy implemented.
Authors report a case of lower extremity lymphedema treated by LVA that preoperatively mapped not only lymphatic vessels by PDE, but also veins and venules using Veinsite™ .
Shoulder instability and lack of shoulder mobility are common and exhausting problems in adult patients with traumatic brachial plexus injury. Although primary nerve reconstruction remains the “gold standard” for brachial plexus management, secondary shoulder reconstruction by trapezius transfer is needed in neglected cases.
Immediate limb compression following the LVA procedure facilitates lymphatic drainage and increases the surgical efficacy by increasing the number of functioning anastomoses, and is a recommended postoperative practice.
Optimum operating conditions are an integral part of a successful microvascular surgery. We hereby introduce a new technique to make a low- cost microsuction cannula, which will be helpful for microvascular surgeons.
Improving efficiency of microvascular anastomosis by combination of open-loop and airborne suture techniques.
The authors describe various patient and breast-related factors that influence surgical outcomes while also addressing some techniques and principles for aesthetic microsurgical reconstruction.
Supraclavicular flap is an excellent fasciocutaneous flap for head and neck reconstruction due to its close color and texture match. In general, long flaps are required, but with the risk of distal necrosis. The aim of this study is to assess the relationship between the length and distal end necrosis of the supraclavicular flap.
This case report demonstrates an important supermicrosurgical technique for lymphedema, which was established by Isao Koshima in 1994. So far, over 2,000 cases of limb edema have been treated by this surgical method.
The authors present a revised application of the composite iliac crest bone free flap for hemimaxillectomy defects. This flap solely can give a support to the eye globe and the dental implants without osteotomies and titanium meshes. The upper ridge of the flap can be shaped to replicate the curvature of the orbital floor. The inner oblique muscle and the deep fascia can serve as an additional material for separation of the oral cavity from the nasal airway. Utilization of the Customized Contour Implants gives a surgeon a refining instrument for aesthetic correction of facial projection.
The authors proposed a new less invasive island flap, namely the first metatarsal artery capillary perforator flap. The advantages of this flap include the preservation of the first metatarsal artery and the adiposal tissue in the web space, thereby preventing compression around the remaining deep peroneal nerve.
The authors present a retrospective review of 7 patients who underwent wide excision of the malignant tumors around the clavicle. Patient demographics, clinical details, the arc of rotation, outcome, and complications were analyzed.
Patients with gynecological abdominal wall malignancies can benefit significantly from radical resection and autologous reconstruction. The pedicled anterolateral thigh flap is the preferred donor site, offering a reliable solution to abdominal wall reconstruction in this setting. The satisfactory results should prompt a more aggressive surgical approach for these patients. This article describes the authors' experiences with the abdominal reconstruction following surgical resection of gynecological abdominal wall malignancy using pedicled anterolateral thigh flap.
Prof. Koushima, president of World Society for Reconstructive Microsurgery, proposes an innovative concept and technique of the multi-stage ‘Orochi’ combined flaps (sequential flaps in parallel). The technique opens a new vista in reconstructive microsurgery.
Brachial plexus imaging is challenging due to its anatomical complexity. Multiple sequences of MRI may be performed pre-operatively for an accurate radiological diagnosis of brachial plexus injury. This image shows the useful role of MRI in localization of acute brachial plexus injury.
Traditionally, suturing techniques have been the mainstay for microvascular anastomoses, but owing to its technical difficulty and labour intensity, considerable work has gone into the development of sutureless microvascular anastomoses. In this review, the authors take a brief look at the developments of this technology through the years, with a focus on the more recent developments of laser-assisted vascular anastomoses, the unilink system, vascular closure staples, tissue adhesives, and magnets. Their working principles, with what has been found concerning their advantages and disadvantages are discussed.
Vessel-compromised neck is a challenge for the microvascular surgeon planning for a free tissue transfer. This study describes the authors’ experience regarding a successful free tissue transfer in a vessel-compromised neck. The authors also propose an algorithm for management of vessel-compromised neck.
The authors demonstrated the utility of hemi-intravascular stenting technique in a pediatric thumb replant.
Facial palsy affects both the functional and aesthetic aspects of the face. Many techniques for both static and dynamic facial reanimation have been described. Authors present their series of facial reanimation using the functioning free gracilis muscle flap innervated by the masseteric nerve.
This study reviews the reconstruction modalities within the multidisciplinary approach for chest wall reconstruction. The authors have proposed an algorithm that is formulated based on their experience to manage chest wall defects following cancer resection.
LVA and vascularized lymph node transfer VLNT are established lymphedema treatments. However, LVA is only effective for early disease and VLNT can cause donor-site lymphedema and contour deformity. VLVT is free of these limitations. The authors described their experience of a new VLVT technique.
The ALT and AMT flaps are the most commonly used thigh free flaps for intraoral reconstruction. Recently, PAP flap has been proposed as an alternative. This study aimed to compare the thickness of these thigh flaps and to identify the factors influencing flap thickness in our population.
Authors discuss a silicone tube that provides structural support to vessels throughout the entire precarious suturing process. This modification of the conventional microvascular anastomosis technique may facilitate initial skill acquisition using the rat model.
Authors proposed a simple innovative technique that helps in achieving a clear surgical field at the time of venous repair by diverting the venous bleeding through a glove finger and at the same time preventing venous congestion of the flap.
PEDs can be used as alternative means of magnification in microsurgery training considering that they are superior to surgical loupes in magnification, FOV and WD ranges, allowing greater operational versatility in microsurgical maneuvers, its behavior being closer to that of surgical microscopes in some optical characteristics. These devices have a lower cost than microscopes and some brands of surgical loupes, greater accessibility in the market and innovation plasticity through technological and physical applications and accessories with respect to classical magnification devices. Although PEDs own advanced technological features such as high-quality cameras and electronic loupes applications to improve the visualizations, it is important to continue the development of better technological applications and accessories for microsurgical practice, and additionally, it is important to produce evidence of its application at surgery room.
Avulsion injuries and replantation of the upper arm are particularly challenging in the field of traumatic microsurgery. At present, the functional recovery of the avulsion injuries upper arm after the replantation is generally not ideal enough, and there is no guideline for the surgeries. The aim of this study was to analyze the causes of failure of the upper arm replantation for avulsion injuries, summarize the upper arm replantation’s indications, and improve the replantation methods.
VSG is a type of bariatric surgery that is accepted as the simplest but most efficient surgical modality to treat morbid obesity. A mouse model of VSG has been widely utilized to investigate the underlying mechanisms of VSG. There are numerous microsurgical techniques for VSG in mice, and we report herein a modified technique with 2 disposable micro-clamps to simplify the surgery.
This article presented 3 cases diagnosed with chronic fatigue syndrome, severe skin adjuvant infiltration and skin ulcers.
This case report describes authors successfully attempt to perform a topographically correct sural nerve transplantation in the extracranial facial nerve stem using the intraneural facial nerve stem topography proposed by Meissl in 1979. This is the first reported case of successful fascicular nerve grafting of the facial nerve stem following extensive laceration.
ICG lymphography is an invaluable tool in lymphedema management. Both immediate and delayed scans are needed when performing the study. The delayed scan needs to be performed at the time of the lymphographic plateau to appreciate the full extent of the pathology. Using a recumbent cross trainer, the lymphographic plateau can be achieved in 15 minutes following ICG injection. We have found this exercise enhanced ICG lymphography protocol worthwhile of adoption by high volume lymphedema centers to raise diagnostic accuracy and efficiency.
The implications of rebound heparin hypercoagulability following cessation of therapy in microsurgery is unreported. In this article the authors report two cases of late digit circulatory compromise shortly after withdrawal of heparin therapy. The authors also propose potential consideration for changes in perioperative anticoagulation practice to reduce this risk.
The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap with occasional anatomical variations in the course of the pedicle. The study shows how the determination of the dominant pedicle may be aided with indocyanine green angiography. Additionally, the authors demonstrate how they convert a supraclavicular flap to a free flap if the dominant pedicle is unfavorable to a pedicled flap design.
A thin profunda artery perforator flap harvested from the left thigh is shown in this video. Preoperative computed tomographic angiography is used to assess morphology of the perforators and its branches, pedicle length and vertical location of the two branches from the ischial tuberosity. These measurements are translated on to the patient. Locations of both branches are confirmed with a handheld doppler. The authors concluded that preoperative computed tomographic angiography is a useful technique to provide detailed anatomic information on morphology of perforators, course through the septum or muscle above the deep fascia and skin thickness. Computed tomographic angiography allows quick and easy assessment of the whole vascular anatomy of the leg and helps to arrive at the decision about selection of the best flaps based on the characteristics of the defect and on the individual anatomy of the patient.