Plastic Surgery Weekly

A single-arm phase 4 study of 99 patients undergoing aesthetic or reconstructive procedures in which opioids are commonly used for at least 72 hours postoperatively received suzetrigine (100 mg preoperatively, then 50 mg q12h) as part of multimodal therapy, with the primary endpoint being patient global assessment of pain control at end of treatment.

• 90.7% of patients rated pain control as good, very good, or excellent on the patient global assessment, consistently across procedure types.
• 90.9% required no opioid rescue; the minority who did received a mean of 2.4 tablets over a mean of 2.0 days.
• The most common regimen was suzetrigine with only acetaminophen and/or ibuprofen (78.8%), while 12.1% used suzetrigine alone.
• Suzetrigine was safe and well tolerated, with adverse events consistent with the postoperative setting.

A single-center retrospective descriptive series of 118 microsurgical procedures (36 robotic, 82 manual) across free flap breast reconstruction, immediate lymphatic reconstruction, and lymphaticovenous bypass characterized utilization and operative performance during initial adoption of the Symani system.

• Robotic use was most common in immediate lymphatic reconstruction (52.8%), followed by free flap breast reconstruction and lymphaticovenous bypass, with variation across surgeons.
• Mean operative duration was longer for robotic cases in both free flap (594.7 vs 532.1 min) and ILR procedures (92.4 vs 49.4 min).
• Postoperative complications and anastomotic revision showed no consistent pattern favoring either approach.
• Anastomosis time varied across sequential cases with a general reduction over time, consistent with a learning curve.

A single-institution retrospective review of 584 patients who underwent sternal wound reconstruction between 1995 and 2024 used multivariate analysis to identify predictors of 30-day complications, reoperation, and mortality.

• The overall complication rate was 42.1%, with reoperation at 11.8% and 30-day mortality at 6.9%.
• Chronic kidney disease, end-stage renal disease, and diabetes were significantly associated with higher complication rates.
• Longer intervals between index cardiac surgery and reconstruction correlated with more complications (41 vs. 27 days, p=0.0002).
• Over the study period, 30-day mortality improved from 10.3% to 4.8% (p=0.0441) despite patients presenting with more comorbidities.

A retrospective CTA analysis of 491 limbs from 247 patients yielding 812 septocutaneous fibular artery perforators compared perforator number and spatial distribution using fibula-based and artery-based reference systems.

• Limbs with fibular artery stenosis had fewer perforators than non-stenotic limbs (median 0.5 vs 2, p<0.001).
• Perforator distribution was nonuniform in both reference systems, with clustering in the mid-segments (p<0.001).
• Non-1A Kim run-off classification predicted a more proximal fibula-referenced position (β=-10.0 percentage points), whereas no factor affected artery-referenced position, supporting greater stability of artery-based mapping.

A single-centre retrospective series of 10 heart and lung transplant recipients managed surgically for deep sternal wound infection over 8 years described microbiology, reconstructive strategy, and outcomes alongside a PRISMA-compliant systematic review.

• Treatment courses were prolonged, with a median of 4 debridements, 42.5 days of negative pressure wound therapy, and a median DSWI-related length of stay of 147 days.
• Reconstruction was guided by prior incision, with reverse abdominoplasty predominating after clamshell thoracotomy (5/7) and bilateral pectoralis major advancement flaps after median sternotomy (2/3).
• All patients were successfully discharged with no perioperative mortality.

A retrospective single-institution cohort of 193 patients who underwent penile inversion vaginoplasty (2017–2023) were invited to complete the validated transgender-specific AFFIRM instrument (0–200 scale, lower scores better) covering appearance, urologic, and gynecologic domains; 47.8% of surveyed patients responded.

• 90% of respondents strongly agreed their anatomy aligned with their gender identity, most reported high satisfaction with genital appearance, and clitoral sensation was present in 93%, most often described as pleasurable.
• Although 59% reported a misdirected urine stream, the mean bother score was low (1.64 ± 1.77), indicating minimal urologic bother overall.
• Vaginal dryness and dyspareunia were reported by 43% and 44% of respondents respectively, with 27% describing symptoms as bothersome.
• Major complications occurred in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns (13.5%).

A prospective cohort of 44 microtia patients undergoing stage-III auricular reconstruction compared intraoperative subcutaneous 755 nm Alexandrite laser depilation (n = 23) with a standard external laser session one week preoperatively (n = 21), measuring hair-count reduction two months after treatment.

• The subcutaneous group achieved 48.3% mean hair-count reduction versus 44.7% in the external group (P < 0.001).
• The subcutaneous route delivered comparable depilation at lower laser fluence (11.04 vs 16.29 J/cm², P < 0.001).
• No laser-related complications occurred in either group, and patient satisfaction was high throughout.

This narrative review synthesizes evidence on lymphatic ultrasound (vessel characterization, differentiation from veins, subcutaneous tissue evaluation, and elastography) and proposes integrating previously described vessel- and tissue-based findings into a longitudinal decision framework spanning conservative and surgical lymphedema care.

• Lymphatic ultrasound enables repeated, noninvasive assessment of both lymphatic vessels and surrounding subcutaneous tissue within a single examination.
• Structured interpretation using NECST-aligned vessel assessment and D-CUPS may help clinicians adjust compression, identify windows for lymphaticovenular anastomosis, and reassess treatment targets over time.
• The review's principal contribution is a longitudinal, practice-oriented decision framework linking vessel status, tissue phenotype, and conservative versus surgical decision-making across the disease course.

A retrospective review of 65 free flaps in 64 patients monitored with portable laser Doppler flowmetry (pLDF) applied a mixed-effects model to identify the systemic factors influencing pLDF values.

• Each 1 mmHg rise in mean blood pressure raised pLDF by 0.098 mL/min (p < 0.001), and each 1 g/dL fall in hemoglobin raised it by 0.883 mL/min (p < 0.001).
• The authors derived an equivalence in which 1 g/dL of hemoglobin ≈ 9 mmHg of mean blood pressure in its effect on measured flow.
• Age, sex, recipient site, smoking, hypertension, and diabetes showed no significant influence on pLDF values.

A case series of 4 patients with refractory inguinal lymphatic leakage unresponsive to prior ligation used subcutaneous ICG fluorescence to identify and ligate leaking vessels, followed by negative pressure wound therapy (−75 to −125 mm Hg) until wound contraction.

• All four patients healed completely, with no recurrence or complications reported.
• Mean NPWT duration was 18 ± 4.5 days and mean time to epithelialization was 48 ± 14.0 days.
• Intraoperative ICG fluorescence enabled precise identification and cautery of the responsible lymphatic vessels that conventional ligation had failed to control.

A combined study using cadaveric dissection of 22 sides and intraoperative EMG of 30 sides during contralateral C7 nerve transfer characterized the prevalence and electrophysiology of cervical phrenic nerve variations.

• Phrenic nerve variation prevalence was 31.8% by anatomical dissection but 63.3% by intraoperative EMG, suggesting dissection underestimates true prevalence.
• The variant branch most often coursed lateral to the main phrenic nerve (47.4%), overlying the anterior scalene muscle.
• In 44.4% of cases with recordable signals, the variant amplitude reached ≥50% of the ipsilateral main phrenic nerve amplitude, implying a possible contribution to diaphragmatic innervation.
• The main phrenic nerve showed larger amplitudes (p<0.001), confirming its role as the primary diaphragmatic motor supply.

A prospective cohort of 23 patients with highly comminuted intraarticular distal radius fractures (AO/OTA 23-C2 or 23-C3) underwent combined dorsal spanning plate distraction plus volar locking plate buttressing, with DASH, PRWE, and radiographic outcomes assessed over a mean 30.8-month follow-up.

• All fractures achieved radiographic union, with restoration of volar tilt, radial inclination, and ulnar variance.
• Mean DASH was 14.5 ± 11.7 and mean PRWE 17.9 ± 13.8, reflecting favorable functional recovery.
• The cohort was young (mean age 34.3 years, 69.6% male) and followed for a mean of 30.8 months, providing medium-term data on the staged construct.

A retrospective series of 21 patients with severe axonal common peroneal nerve injury underwent selective tibial-to-peroneal motor nerve transfer, with tibialis anterior strength on the MRC scale analyzed over a mean 26.3-month follow-up.

• Median tibialis anterior strength reached MRC 4.1 (IQR 3–4.5), and 77% of patients achieved MRC ≥3 and walked without an ankle-foot orthosis.
• Transferring two or more fascicles was associated with significantly greater final tibialis anterior strength than a single fascicle.
• Adding common peroneal nerve neurolysis at the time of transfer was likewise associated with improved final strength.

A retrospective series of 6 patients (7 digits) under two years of age with fingertip amputations treated by chest or palm subcutaneous pocketing examined graft survival and its associated factors between 2013 and 2025.

• All 7 digits survived, although partial necrosis occurred in 3 of them (43%).
• The complete-recovery group had a longer mean pocketing period (13.5 vs 9.3 days) than digits with partial necrosis.
• Wet dressing after digit separation tended to be used more frequently in digits that achieved complete recovery.

A retrospective case series of 28 patients (32 fingers) with nail bed defects and underlying bone exposure treated by in situ or split-thickness autologous nail bed grafting, with outcomes scored across five domains over 12 months of follow-up.

• Excellent or good outcomes were recorded in 90.6% of fingers (29/32), spanning nail plate appearance, proximal nail fold adherence, and nail bed adherence.
• Four adverse cases were identified: three score-defined poor outcomes and one good-outcome finger with severe occupational dissatisfaction.
• No recurrent bone exposure, secondary flap coverage, or digital amputation occurred, and only one poor-outcome case required a secondary outpatient procedure.

A radiographic morphometric study of 250 digits (125 males, 125 females) measuring intramedullary and cortical dimensions of the proximal and middle phalanges on standardized PA and lateral views, compared against commercially available intramedullary headless screw specifications.

• On PA views, proximal phalanx isthmus diameter was largest in the thumb (4.8 mm) and smallest in the little finger (2.9 mm), with middle phalanx isthmus ranging 3.4 mm to 2.5 mm.
• Lateral-view intramedullary diameters were considerably narrower (1.5–2.4 mm) than PA-view diameters.
• Male participants had significantly larger osseous dimensions across most parameters.
• Screws ≤3.0 mm matched most middle and ring phalanges, whereas devices ≥3.0 mm were suitable mainly for the thumb and middle-finger proximal phalanges.

A cadaveric equivalence study of 10 capitates and 10 second metatarsals from five specimens comparing articular geometry (head width, length, thickness, and radius of curvature) using paired two one-sided equivalence testing, with 3D surface analysis of a representative specimen for validation.

• Head width in the frontal view met the predefined equivalence criteria between the capitate and the second metatarsal head.
• Radius of curvature consistently satisfied equivalence in sagittal analyses across both ipsilateral and crossed (nonipsilateral) orientations.
• Three-dimensional surface analysis showed close overall surface congruity after rigid registration, corroborating the two-dimensional findings.

A 4DCT comparison of healthy versus scapholunate ligament-injured wrists evaluating dynamic hysteresis (the path difference between motion directions) in scapholunate angle and intercarpal distances during radioulnar deviation and flexion-extension, reported as Level III evidence.

• Hysteresis was greater in scapholunate ligament-injured wrists than in healthy wrists for the scapholunate angle.
• Injured wrists also showed increased hysteresis in intercarpal distance during both radioulnar deviation and flexion-extension.
• The authors propose 4DCT-derived hysteresis as a dynamic marker of carpal instability.

A transcriptomic study of chronic venous leg ulcers using bulk and single-cell RNA sequencing to compare healing versus nonhealing ulcers (classified by ≥50% closure over 4 weeks) against acute wounds, complemented by a mouse model of pharmacological PTEN inhibition.

• Nonhealing ulcers showed marked suppression of inflammatory response, angiogenesis, and lymphangiogenesis, whereas healing ulcers resembled physiological acute-wound healing.
• Bioinformatic analysis identified PTEN as a master regulator of these pathways, with increased PTEN protein confirmed in nonhealing versus healing ulcers.
• Pharmacological PTEN inhibition accelerated acute wound closure in mice, enhancing immune response, angiogenesis, and lymphangiogenesis.

An open-label randomized controlled trial of 50 patients with Wagner grade 2 diabetic foot ulcers comparing standard care alone versus standard care plus twice-weekly helium-based cold atmospheric plasma over three weeks, with wound size and quantitative bacterial cultures tracked to day 21.

• The CAP group showed greater wound contraction (1.21 vs 0.79 cm/day) than the control group.
• Bacterial load fell more in the CAP group (32.8% vs 10.0% reduction) over the study period.
• CAP significantly reduced counts of all four targeted species (S. aureus, P. aeruginosa, E. coli, E. cloacae), indicating a broad-spectrum antimicrobial effect.

A secondary analysis of two prospective cohorts (Open Wound Master Protocol, n=419; c-Myc Biomarker, n=140) from the Diabetic Foot Consortium estimating longitudinal healing and amputation rates and testing baseline wound characteristics as predictors of healing to inform trial sample-size planning.

• In the Master Protocol cohort, healing reached 26% by week 12 and 49% by week 32, with amputation rates of 4% and 10% respectively.
• Baseline wound area and duration significantly predicted healing (AUC ≥0.70 by 24 weeks).
• Predicted healing rates varied by up to 40% between small and large wounds, materially affecting required sample sizes.
• Contemporary DFU trial designs and healing times have remained largely unchanged over two decades.

A narrative review of neuromodulation and regenerative strategies for diabetes-related neuropathy, diabetic foot ulcers, and chronic limb-threatening ischemia, organized around the unifying theme of generating physiologic effects remote from the primary intervention site.

• High-frequency (10-kHz) spinal cord stimulation is highlighted for pain relief and sensory improvement in refractory painful diabetic neuropathy.
• Peripheral and splenic-targeted focused ultrasound and remote ischemic conditioning are described as reducing systemic inflammation and enhancing microcirculation and wound repair.
• Surgical options such as tibial transverse transport and lateral tibial periosteum distraction are presented as stimulating angiogenesis and distal limb perfusion.

A multidisciplinary expert working-group framework (the USAID Burn Blast Injury Working Group) synthesized historical casualty data from the 1945 Hiroshima and Nagasaki bombings, scaled to modern moderate-yield tactical weapons, and combined it with population-impact models to derive a hypothetical survivor cohort and an actionable large-scale medical response plan.

• The plan was developed by the Burn Blast Injury Working Group, convened by USAID in February 2023 as a multidisciplinary panel spanning burns, trauma, radiation injury, disaster management, public health, and policy.
• Historical bombing data were selected because the 1945 detonations were comparable in scale to modern 1–20 kiloton tactical nuclear weapons, and were supplemented with population-impact models to estimate survivors requiring care.
• Although developed for the Ukraine conflict, the authors frame the concepts as a generalizable starting point for any region at heightened risk of a catastrophic nuclear event.

A single case report describes a 35-year-old man who, after an approximately 20% TBSA flame burn, developed a severe postburn deformity with loss of the lower third of the nose and prior skin grafting of both forehead and nasal dorsum, treated by staged reconstruction with an expanded grafted forehead flap, delayed turnover flaps for lining, costal cartilage grafts, and a paramedian forehead flap.

• Reconstruction combined tissue expansion of the grafted forehead, delayed bipedicled turnover flaps from grafted dorsal skin for internal lining, costal cartilage for structural support, and a paramedian forehead flap for external coverage.
• Intraoperative indocyanine green fluorescence angiography was used to assess perfusion and guide operative decision-making in the previously grafted, scarred tissues.
• The reconstruction restored nasal contour and airway patency without flap loss, infection, or major complication, and remained stable at long-term follow-up extending to 10 years.

A systematic review and meta-analysis of 10 comparative studies (N=498) pooled data on adipose-derived stem cell (ADSC) treatment versus controls for chronic wounds of any aetiology, assessing short-term healing and time to healing.

• ADSC-treated patients were more likely to heal at short-term follow-up, with an odds ratio of 6.54 (95% CI 3.80–11.27; I2 = 0%).
• Treated wounds also healed significantly faster than controls, with a mean difference of -1.90 (95% CI -2.28 to -1.51).
• GRADE assessment rated the pooled evidence as moderate certainty, and the authors characterized ADSC therapy as safe.

A retrospective analysis of 144 adult ICU burn patients compared a baseline clinical model (age, TBSA, inhalation injury) against the TBSA, revised Baux, ABSI, BOBI, and BUMP scores for mortality prediction, using ROC curves and DeLong comparisons.

• Overall mortality was 43.1%; non-survivors were older (59.2 vs 46.5 years), had larger burned surface area (42.3% vs 35.3%), and more often had inhalation injury (59.7% vs 26.8%).
• The baseline clinical model showed excellent discrimination (AUROC 0.87), with the revised Baux highest among the scores at 0.86 and BOBI and BUMP both at 0.83.
• Pairwise DeLong comparisons showed no statistically significant differences between the best-performing scoring systems and the clinical model.

A preclinical rat study examined whether plasma-derived small extracellular vesicles (sEVs) mediate the effect of tibial cortex transverse transport (TTT) on diabetic wound healing, combining in vitro HUVEC and macrophage assays with in vivo delivery of TTT-sEVs in a PF127 hydrogel.

• TTT accelerated wound healing, enhanced angiogenesis, and reduced inflammation, whereas inhibition of sEV release attenuated these effects.
• TTT-sEVs promoted endothelial proliferation, migration, and tube formation, upregulated pro-angiogenic factors, and suppressed inflammatory mediators in macrophages.
• In vivo delivery of TTT-sEVs via an sEV-loaded PF127 hydrogel markedly improved diabetic wound healing and angiogenic responses.

A retrospective and cross-sectional multicenter cohort of 1,095 reconstructions in 793 patients compared immediate versus delayed autologous breast reconstruction, stratified by receipt of postmastectomy radiotherapy, with major and minor complications and BREAST-Q outcomes as endpoints.

• Among irradiated patients, major complication rates were not significantly different between immediate (6.4%) and delayed (3.5%) reconstruction (p=.29), with similar findings for minor complications.
• At a median BREAST-Q follow-up of 5.0 years, irradiated immediate and delayed reconstruction yielded comparable health-related quality of life across all domains.
• On multivariate analysis, current smoking was an independent risk factor for complications in unirradiated patients, while harvesting multiple perforators was associated with reduced risk.

A multicenter randomized controlled trial of 74 patients (131 mastectomies) randomized women with early-stage breast cancer 1:1 to robotic (da Vinci SP) versus open nipple-sparing mastectomy with immediate implant reconstruction, with primary endpoints of conversion, 42-day adverse events, and positive margin rates.

• Operative time was longer for robotic surgery (141.6 versus 83.9 minutes), with no conversions to open surgery.
• Positive surgical margin rates were identical (six patients each), and nipple-areolar preservation at 42 days was 100% robotic versus 98.5% open.
• Serious adverse events (3 robotic vs 8 open) and BREAST-Q scores favored robotic surgery, but these differences were not statistically significant.

A systematic review and meta-analysis of 51 studies compared biologic versus synthetic mesh in irradiated patients undergoing implant-based breast reconstruction, with multivariate models adjusting for mesh type, implant plane, and radiotherapy timing.

• Pooled complication rates were 33% for biologic mesh and 30% for synthetic mesh, with no significant difference between mesh types.
• Subpectoral placement was associated with higher odds of implant loss (OR 2.32, 95% CI 1.24–4.33) and capsular contracture (OR 2.91, 95% CI 1.22–6.95) compared with prepectoral placement.
• Preoperative radiotherapy was linked to increased implant loss (OR 1.89, 95% CI 1.21–2.94), while mesh type did not significantly affect capsular contracture, implant loss, seroma, or necrosis.

A multi-institutional retrospective study of 253 patients (402 breasts) undergoing immediate prepectoral tissue-expander reconstruction with absorbable antibiotic-loaded calcium sulfate cement compared outcomes without postoperative oral antibiotics (178 patients) versus with 2 weeks of oral antibiotics (75 patients), all receiving perioperative IV antibiotics.

• Surgical-site infection occurred in 1.1% versus 2.3% of patients without versus with postoperative oral antibiotics (p=0.39).
• Tissue-expander removal was performed in 2.2% versus 6.2% of patients without versus with oral antibiotics (p=0.075).
• The authors concluded that oral antibiotics provide no synergistic effect when combined with antibiotic-eluting absorbable cement, supporting omission of postoperative oral antibiotics.

A quasi-experimental prospective cohort of 915 patients (1,500 breasts) with historical controls evaluated the 12-step GAPS protocol (gloves, antimicrobial soak, pocket irrigation, sterile field) for reducing surgical-site infection after immediate implant-based breast reconstruction at a single academic health system.

• The protocol cohort had lower SSI than historical controls, 5.7% versus 8.7% (p=.03), with an unadjusted relative risk of 0.66 (95% CI 0.45–0.96).
• The protective effect remained directionally consistent across single-covariate adjustments (RR range 0.57–0.76), but the fully adjusted total effect of RR 0.76 (95% CI 0.50–1.15) crossed 1.
• Protocol adherence was approximately 80%, with an absolute risk reduction of 2.96% and a number needed to treat of 34.

A single-institution prospective oncoplastic database (2008–2025) was queried to compare recurrence and survival between large, multifocal/multicentric tumors and standard tumors, all treated with reduction mammoplasty and whole breast irradiation, in a comparative study of 718 patients (340 with tumors >50 mm vs 378 with tumors ≤50 mm).

• Negative margins were slightly less frequent with extreme tumors (92.6% vs 96.8%; p = 0.01), and re-excision was roughly twice as common in the extreme group (10.9% vs 5.6%; p = 0.01).
• The 5-year local recurrence probability was 3.37% for extreme versus 1.44% for standard cases, a difference that did not reach statistical significance (p = 0.067).
• Distant recurrence, breast cancer-specific survival, and overall survival did not differ significantly between the two groups.

A single-institution retrospective cohort of 415 patients (709 breasts) undergoing tissue-expander implant-based reconstruction with acellular dermal matrix compared reconstructions with absorbable calcium sulfate beads containing vancomycin and gentamicin placed in the pocket (206 patients) against reconstructions without beads (209 patients), with both cohorts receiving standardized perioperative antibiotics.

• The infection rate was less than half that of controls (9.3% vs 21.4%; p < 0.0001).
• Total reconstructive loss fell from 18.0% in controls to 4.0% with beads (p < 0.0001).
• Reconstructive loss attributable to infection was likewise lower with beads (2.3% vs 14.0%; p < 0.0001).

A high-volume single-center retrospective cohort of 748 women undergoing immediate prepectoral tissue expander/implant placement with acellular dermal matrix (2015–2025) compared 24 hours of prophylactic antibiotics against extended prophylaxis up to 72 hours, with 222 patients per arm after propensity-score matching.

• 30-day surgical site infection rates showed no significant difference between matched cohorts (odds ratio 1.13, 95% CI 0.43–2.98).
• 90-day infection rates were also comparable across cohorts (odds ratio 1.67, 95% CI 0.85–3.28).
• Successful salvage of infected breasts with antibiotics alone versus surgical washout did not differ between groups (odds ratio 0.8, 95% CI 0.2–3.8).

A single-institution retrospective case series of 157 patients who underwent quadrantectomy with J-scar (J-mammaplasty) level II oncoplastic reduction over 3 years reported demographics, breast morphology, procedure-specific variables, and surgeon- and patient-reported outcomes at a minimum of 12 months.

• The overall complication rate was 7%, below the up-to-16% rate the authors cite as acceptable for oncoplastic surgery.
• The technique was applied across large breasts and third-degree ptosis as well as varied tumor locations, with lateral quadrants most common.
• At a minimum of 12 months, surgeon- and patient-reported outcomes indicated high satisfaction.

A retrospective comparative study of 187 patients compared bilateral oncoplastic reduction mammoplasty using superomedial (Group 1) or inferior (Group 2) pedicles against bilateral benign superomedial reduction (control), using pre- and postoperative BREAST-Q scores.

• Controls and the superomedial (Group 1) cohort improved across all BREAST-Q domains, whereas the inferior-pedicle (Group 2) cohort showed no significant gains in breast satisfaction or psychosocial well-being.
• Breast satisfaction was significantly higher in controls than in the inferior-pedicle group (p = 0.005).
• Sexual well-being ranked highest in controls, then superomedial, and lowest with the inferior pedicle (p < 0.001).
• Tumor location was the primary driver of pedicle selection (p < 0.001), and oncoplastic patients were older with higher BMI.

A single-surgeon series of 1,191 consecutive primary rhinoplasties (2010–2024) was analyzed as three chronological series to compare revision rates and clinical lessons as dorsal preservation techniques were introduced, expanded, and then consolidated under a unified framework.

• Revision rates rose from 3.4% in the initial series to 9.9% during uncontrolled expansion of indications, then fell to 3.3% after refinement (χ² = 21.61, p < 0.001).
• The authors characterize the trajectory as a U-shaped learning curve: proof-of-concept, over-extension, then consolidation.
• The final series applied a pyramidal classification with W-point septoplasty modulators to standardize terminology, technique, and patient selection.

In a Phase 2b, double-blind, placebo-controlled, dose-escalation trial, adults with moderate-to-severe glabellar lines were randomized 3:1 to trenibotulinumtoxinE or placebo across five dosage cohorts (five glabellar injections on Day 1) and followed through Day 42, with the primary endpoint being cumulative ≥2-grade improvement through Day 7.

• All five dosage cohorts outperformed placebo cumulatively through Day 7, with responder rates rising with dose from 40.6% (Cohort 1) to 96.8% (Cohort 5).
• Effect had rapid onset at the highest dose (16.1% responders by 8 hours, 41.9% by 24 hours) and peaked at 93.3% on Day 7.
• Efficacy was short-lived, declining to 33.3% between Day 14 and Day 42.
• No serious adverse events were reported, and no findings suggested local diffusion or distant toxin spread.

A multicenter cohort of 3805 female patients (aged 18–45, 8 countries, Oct 2022–Dec 2023) undergoing percutaneous ultrasound-guided rib remodeling (RibXcar) with or without liposuction was followed for 1 year to assess waist circumference change, rib angular variation, complications, and BODY-Q satisfaction.

• At 1 year the mean waist reduction was 11 cm, with a mean rib angular reduction of about 10 degrees for ribs 10–12.
• Major complications were rare: 4 pneumothoraces and 1 hemothorax across the 3805 patients.
• Minor complications included 2 cases of chronic pain associated with bicortical fractures.

A single-institution retrospective study of 37 female patients compared upper eyelid surgery using isolated orbital fat release (n=13) versus orbital fat release combined with lower eyelid fat transfer (n=24), applying Park's and Hirmand grading and the FACE-Q to assess periorbital esthetics, well-being, and satisfaction.

• Both groups showed significant improvements in eyelid esthetics and aging-appraisal VAS scores (p < 0.001).
• The fat release with transfer group achieved greater improvement in upper eyelid appraisal than fat release alone (p < 0.05).
• Minor complications occurred in six eyelids (8.1%) and resolved with conservative management, with a low 10.8% loss to follow-up.

A retrospective cohort of 39 patients undergoing frontal bone contouring and forehead lifting (2022–2024) assessed pre- and postoperative headache with the validated Persian Brief Pain Inventory and related intraoperative maneuvers (frontal recess widening, supraorbital nerve decompression) to outcomes.

• All pain measures improved significantly, with median worst pain falling from 7 to 2 and average pain from 5 to 0 (p < 0.001).
• Total pain intensity dropped from 4.66 to 0.66 and pain interference resolved to a median of 0 (p < 0.001).
• Subgroup analysis showed a trend toward greater improvement with frontal recess widening or supraorbital nerve decompression, though limited by sample size.

A controlled rabbit central ear-artery study compared intra-arterial injection of three polynucleotide formulations of differing viscosity (Rejuran S, Rejuran HB Plus, Conjuran) against normal saline and cross-linked hyaluronic acid, assessing arterial flow, 24-hour emboli, clinical ischemia, and histopathology.

• Among polynucleotides, Conjuran (higher-viscosity) showed the most frequent transient arterial occlusion, followed by Rejuran HB Plus, with Rejuran S the least.
• All polynucleotide-related flow disturbances were transient, with no emboli at 24 hours and no ischemia, necrosis, vasculitis, or vasculopathy by day 7.
• In contrast, cross-linked hyaluronic acid produced persistent intravascular emboli and extensive tissue necrosis.

A prospective observational cohort of 100 patients undergoing liposuction (2022–2024) compared conventional RF-assisted liposuction (n=36) with the plastic internal low-angular retraction (PILAR) technique (n=64), evaluating energy delivery, device time, complications, and BODY-Q satisfaction.

• The PILAR technique used significantly less total energy than conventional RF (44,195 J versus 84,939 J; P < 0.001).
• Weight reduction was comparable between groups.
• The authors reported reduced complication rates and high patient satisfaction with PILAR, though these outcomes were not quantified in the results.

This narrative review and historical synthesis traces the development of preservation rhinoplasty over roughly eight years, describes the prevailing techniques in a logical learning order for the novice surgeon, and summarizes known complications and pitfalls.

• The philosophy centers on preserving the natural dorsum and osseocartilaginous vault rather than resecting and rebuilding it, aiming to minimize secondary deformity.
• Techniques have become more accessible over the past five years through textbooks, journal articles, and in-person courses.
• The article organizes techniques for progressive learning and reviews known complications and pitfalls of the approach.

A PRISMA-aligned meta-analysis of 9 comparative studies (n=805) pooled patient-satisfaction outcomes for autologous fat grafting versus facial (mainly hyaluronic acid) fillers using random-effects standardized mean differences.

• Autologous fat grafting showed higher satisfaction than hyaluronic acid fillers (SMD 0.91), but the 95% CI (−0.32 to 2.14) crossed zero, indicating no statistically significant difference.
• Between-study heterogeneity was extreme (I² = 97%), and subgroup analyses were directionally consistent but did not explain the variability.
• Egger's test suggested possible small-study effects (p = 0.15), though interpretation is limited with fewer than 10 studies.

A retrospective analysis of 132 patients with puffy eyelids undergoing double-eyelid blepharoplasty classified deformities as mild, moderate, or severe and selected the three-point or incision (orbital septum) method by grade to target orbital fat and ROOF, with 3-month to 1-year follow-up.

• Of 132 patients, 68 were mild, 34 moderate, and 30 severe; all severe cases were treated by the incision method, while milder grades used either technique.
• Only one patient required revision surgery, with an overall satisfaction rate of 99.24%.
• There were no serious complications such as hematoma or infection, and all scars healed well.

A single-institution retrospective cohort of 43 patients with radiation-associated angiosarcoma of the breast (2000–2025) compared trimodality therapy (n=24: induction chemotherapy, preoperative chemoradiation, and wide resection with flap closure) with mono/dual therapy (n=19: surgery ± chemotherapy), estimating survival by Kaplan-Meier.

• Eight-year recurrence-free survival was 96% with trimodality therapy versus 50% with mono/dual therapy (p = 0.002).
• Eight-year overall survival was also higher with trimodality therapy (94% versus 65%; p = 0.047).
• By design, all trimodality patients received chemotherapy, chemoradiation, and wide resection, whereas no mono/dual patient received radiation and only 47% received chemotherapy.

A standardized consensus operating protocol developed by the International Network for Sharing Practices on Electrochemotherapy (InspECT) and collaborating centers for treating slow-flow vascular malformations. It codifies patient selection, imaging, anesthesia, lesion access, drug preparation, dosing, electrode selection, electrical parameters, and post-procedural care.

• After intralesional bleomycin, reversible electroporation enhances drug uptake through a vascular lock effect and endothelial disruption, building on electrochemotherapy principles and the reported selective sensitivity of dysplastic, proliferative endothelium.
• The procedure is delivered under ultrasound guidance using Cliniporator-validated ESOPE pulse parameters.
• It is positioned as suited to venous, lymphatic, capillary, and mixed slow-flow malformations, including primary, resistant, or recurrent lesions where intralesional injection and safe electrode placement are feasible.
• Clinical experience is cited as showing effective lesion reduction with lower cumulative bleomycin doses and fewer treatment sessions than conventional bleomycin sclerotherapy.

A case series of 3 women who underwent staged reconstruction with a meshed advancement flap after vulvar tumor excision. Following temporary coverage with artificial dermis, reconstruction was performed 21–25 days later once tumor-free margins were confirmed, for defects measuring 3 × 7, 3 × 5, and 4 × 10 cm.

• Reconstruction operative time was 30–40 minutes across the three cases.
• Complete epithelialization occurred 10–14 days after reconstruction, with a hospital stay of 5–10 days for the reconstructive stage.
• The authors observed no major complications or local recurrence during five years of follow-up.

A retrospective comparative study of 120 operative reports evaluating CPT code-set accuracy across baseline LLMs (OpenAI, Gemini, Anthropic), external professional auditors, and a fine-tuned hybrid LLM system (ProCode), using expert consensus coding as the reference standard. Reports were stratified by complexity into low (1–2 codes), medium (3 codes), and high (≥4 codes), with 40 cases each.

• ProCode achieved the highest accuracy at every complexity tier: 100% (low), 80% (medium), and 80% (high).
• Baseline LLM accuracy declined noticeably as coding complexity increased.
• ProCode outperformed both human auditors and baseline LLMs, with differences in correctness significant overall and within each complexity tier (all P < 0.05).

A proof-of-concept demonstration in which a board-certified plastic and reconstructive surgeon trained an AI-generated video avatar to deliver educational content. The report frames avatar technology for patient education, virtual consultation, and content creation while addressing authenticity and ethics.

• An AI-generated video avatar trained on a real board-certified surgeon delivered educational material with minimal time constraints and a realistic human presenter.
• The authors position the method for patient education, virtual consultation, and content creation or marketing in plastic surgery.
• The article foregrounds deepfake and authenticity concerns, emphasizing professional standards and ethical integrity when using synthesized likenesses.

A single-arm pre-post feasibility study of 11 residents at one academic plastic surgery program over 12 weeks, delivering six microlearning modules built with Google Gemini 2.5 Pro. Outcomes included acceptability, faculty content evaluation, item psychometrics, and pre-post self-perceived knowledge and confidence.

• Acceptability was high across all six subitems (medians ≥5/7) and faculty rated content quality at 4.68/5, though interrater reliability was poor (ICC 0.231).
• Among nine matched pairs, composite confidence improved significantly (median change 0.33; d = 0.65; P = .047), while composite knowledge showed a medium effect that did not reach significance (d = 0.71; P = .09).
• The largest gains appeared where baseline was lowest, in hand surgery knowledge (d = 1.48; P = .02) and confidence (d = 1.41; P = .02).

A structured narrative review of machine learning and deep learning methods in wound management. It summarizes commonly used architectures, data modalities, and evaluation strategies, then critically discusses barriers to clinical adoption and emerging directions.

• Reported applications span wound detection, segmentation, tissue characterization, infection assessment, and healing prediction, drawing on wound images, clinical records, and sensor-derived data.
• Persistent barriers include limited dataset size and diversity, annotation inconsistency, bias, poor generalizability, and a lack of external and prospective validation, alongside privacy, regulatory, and workflow challenges.
• Highlighted opportunities include multimodal learning, self-supervised learning, federated learning, explainable AI, and wearable continuous monitoring.

A preliminary expert evaluation of 210 LLM responses in which seven blinded board-certified spine surgeons rated single-turn answers from GPT-4, GPT-4o, and Google Gemini web interfaces to 10 author-curated spondylodiscitis frequently asked questions.

• Overall, 38.6% of responses were rated excellent and 39% satisfactory with minimal clarification, while 16.7% needed moderate clarification and 5.7% were unsatisfactory.
• The most common reason clarification was needed was insufficient information (41.1% of flagged responses), followed by language-related issues and overly detailed answers.
• Complication questions scored highest (mean 3.4/5) and treatment and prognosis questions lowest (2.7 and 2.9/5), and median overall ratings did not differ significantly among the three LLMs.

A controlled animal study of 59 athymic mice allocated to intramuscular injection of low-density fat, high-density fat, or saline into hind-limb muscles. Grip strength was measured weekly for six months, with endpoint ex vivo mechanical testing, histology, and human-specific immunofluorescence.

• There was no significant between-group difference in muscle strength; saline limbs generally showed higher final grip strength (78 gf) than high-density (61 gf) and low-density fat (50 gf) groups.
• By six months most adipocytes were resorbed and replaced by collagen-rich matrix, with fibrosis greater in high-density grafts (25.49%) than saline (19.42%) or low-density fat (19.61%).
• Only limited new muscle formation was observed, and it was predominantly of mouse (host) origin rather than derived from the human graft.

In a controlled animal study in Sprague-Dawley rats, 3 × 6 cm axial-pattern epigastric flaps underwent 8 hours of ischemia followed by reperfusion. KUS121 given 1 hour before elevation or immediately after reperfusion (then daily to day 6) was compared with untreated controls for flap survival, apoptosis, and endoplasmic reticulum stress.

• Posttreatment produced the highest day-7 flap survival at 96.2%, versus 80.7% with pretreatment and 48.8% in untreated controls (p<0.001 and p=0.002).
• In pretreated flaps, apoptotic TUNEL-positive cells fell to roughly a third of control levels (distal 2.3 vs 7.7; middle 2.3 vs 9.0 cells/field; p<0.001).
• The endoplasmic reticulum stress marker CHOP was markedly reduced in pretreated flaps (distal 9.0 vs 21.4; middle 6.8 vs 23.5 cells/field; p<0.001).

This preclinical mechanistic study across in vitro assays plus rabbit and porcine scar models tested whether ADSCP5, a peptide from adipose-derived stem cell-conditioned medium, suppresses hypertrophic scar fibroblast activity, and mapped its molecular targets using pull-down, docking, and binding assays.

• In scar fibroblasts, ADSCP5 reduced collagen (COL1A1, COL1A2, COL3A1) and α-SMA expression without changing cell proliferation, apoptosis, or migration.
• Mechanistically, ADSCP5 bound directly to pyruvate carboxylase or the NF-κB subunit p50, suppressing PI3K/AKT/mTOR signaling and lowering IL-6 transcription.
• In rabbit and porcine models, ADSCP5 attenuated collagen deposition and scar hyperplasia, reduced angiogenesis (lower VEGFA/CD34), and promoted autophagy (lower p62).

This narrative review synthesizes evidence on adipose-derived mesenchymal stromal cells and their acellular derivatives, including conditioned medium, soluble factors, extracellular vesicles, and apoptotic vesicles, in cutaneous wound healing and pathological scarring.

• Conventional scar-management options (steroids, excision, radiotherapy, laser, cryotherapy, silicone, pressure therapy) are described as limited by variable efficacy, recurrence, and adverse effects.
• ASC-based products are proposed to act on scar-relevant pathways, notably TGF-β/Smad signaling, myofibroblast activity, and MMP/TIMP balance, alongside macrophage polarization and angiogenesis.
• The evidence is characterized as predominantly preclinical and methodologically heterogeneous, with barriers including donor variability, product heterogeneity, and absent manufacturing standardization.

This narrative review examines micro-fragmented adipose tissue (MFAT) produced by Lipogems processing, comparing it with stromal vascular fraction and nanofat and summarizing its biology and clinical applications across specialties.

• Non-enzymatic Lipogems processing is described as preserving the native stromal vascular niche, including extracellular matrix architecture and the pericyte-endothelial complex, unlike enzymatic digestion or nanofat emulsification.
• The authors frame MFAT development as reverse translation, in which consistent clinical efficacy preceded and guided mechanistic investigation.
• Consolidated clinical use spans multiple medical and surgical specialties, with emerging translational applications proposed in oncology and sepsis.