Plastic Surgery Weekly

A meta-analysis of 30 studies comprising 2,080 patients treated with immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection, combining 17 comparative and 13 non-comparative series. The primary outcome was the incidence of breast cancer-related lymphedema, with a secondary analysis of risk factors for lymphedema despite ILR.

• Across the comparative studies, lymphedema developed in 14.5% of 1,030 ILR patients versus 25% of 1,260 control patients, corresponding to a 63% reduction in lymphedema risk.
• When all ILR patients were pooled, including those from non-comparative series, the overall lymphedema incidence was 11%.
• Body mass index and the number of lymph nodes removed trended toward higher lymphedema risk within the ILR group, but neither association reached statistical significance (p > 0.05).
• Studies with longer follow-up reported higher lymphedema rates, and follow-up duration, postoperative management, and diagnostic criteria varied substantially between series.

A retrospective multicenter cohort of 149 patients from nine European hospitals who underwent free vascularised fibula flap reconstruction of segmental long bone defects after oncological resection, acute trauma, or late post-traumatic sequelae. Intra-articular, trunk, and mandibular reconstructions were excluded; outcomes included bone union time and complication rates.

• Bone-healing time was comparable across oncological, acute trauma, and late trauma indications, averaging 8.3 months.
• Skin paddle complications were strongly associated with subsequent bone-healing complications (OR 5.79, p < 0.001), making the cutaneous component an early marker of construct trouble.
• Patients treated for late post-traumatic defects had undergone a mean of 5.15 prior operations versus 3.53 after acute trauma and 1.03 in the oncological group, and this prior-surgery burden tracked with the higher complication rate in trauma indications.
• Total flap loss occurred in two cases (1.34%), and 91% of patients reached radiological union once revision procedures were included.

A retrospective cohort of 133 patients born between 1994 and 2000 who underwent hard palate closure at a mean age of 10.3 years, performed synchronously with secondary alveolar bone grafting. Lateral cephalograms at ages 6, 9, and 17 years were digitally traced for SNA, SNB, and ANB and compared with previously published cohorts undergoing closure at 12 months and with unaffected individuals.

• Anteroposterior maxillary and mandibular position at skeletal maturity showed no difference from the published early-closure cohort (SNA p = 0.464; SNB p = 0.505).
• Both cleft cohorts differed significantly from unaffected individuals (SNA p = 0.001; SNB p = 0.002), so maxillary hypoplasia persisted in unilateral and bilateral clefts regardless of closure timing.
• Le Fort I osteotomy was ultimately performed in 18 patients (13.5%).
• Velopharyngoplasty, carried out in 49 patients (36.8%), did not influence maxillary growth on cephalometric analysis.

A retrospective propensity-matched cohort of 2,071 patients per group, drawn from 22,011 patients with cleft lip and/or palate in the TriNetX US Collaborative Network between 2010 and 2025 and stratified by neurodevelopmental disorder (NDD) diagnosis. Cohorts were matched for age at surgery, sex, race, congenital syndromes, and cleft type, and procedures were categorised by reconstructive stage using CPT codes.

• Airway- and feeding-related adverse events were significantly more frequent in the NDD cohort across all procedure types (p ≤ 0.03).
• Patients with NDD made more emergency department visits following primary cleft lip repair, primary and secondary palate repair, and rhinoplasty (p < 0.01).
• Velopharyngeal insufficiency after primary and secondary palate repair, and oronasal fistula formation after secondary palate repair, occurred more often in the NDD group.
• Revision surgery rates did not differ significantly between the matched cohorts despite the excess of medical events and complications.

A retrospective cohort of 932 free flaps performed over four years at a tertiary center, of which 302 were monitored postoperatively with the Masimo O3 regional oximetry near-infrared spectroscopy (NIRS) system in addition to standard clinical assessment. Outcomes were re-exploration, complete flap failure, and salvage following take-back.

• The overall re-exploration rate was 7.9%, and NIRS-monitored flaps showed higher salvage rates after take-back and lower complete failure rates than flaps followed by clinical assessment alone.
• NIRS use during the index reconstruction was independently associated with improved flap survival on multivariable analysis.
• Receiver operating characteristic analysis showed good discrimination for NIRS trend changes, with a 22.5% reduction in regional oxygen saturation emerging as the optimal threshold for detecting early vascular compromise.

This retrospective single-center review of 15 patients treated between 2009 and 2026 characterized the presentation, diagnostic course, and management of slowly progressive facial weakness or hemifacial spasm attributable to benign facial nerve tumors. Management ranged from observation and radiation to complete extirpation, with dynamic reanimation performed proactively, concomitantly with resection, or after radiation.

• Sixty-seven percent of patients were initially misdiagnosed, and 47% presented with synkinesis, reflecting the diagnostic ambiguity of a gradual and intermittent palsy course.
• Facial nerve schwannoma was the most common histology at 60%, and management was distributed across complete resection (40%), radiation (27%), and observation (27%).
• Six patients underwent dynamic facial reanimation, three of them proactively before extirpation, and all achieved recovery of motion at a mean of 3.7 months (range 2 to 7 months).

This retrospective cohort of 199 female patients treated in Medellín, Colombia between January 2022 and September 2024 evaluated a three-flap approach to removing illicitly injected biopolymer from the gluteal and lumbar regions. Preoperative assessment included clinical classification and magnetic resonance imaging, with outcomes drawn from clinical records and patient-reported symptoms.

• The operation was substantial in scope, averaging 270 minutes of operative time in patients with a mean age of 43.1 years and mean body mass index of 24.2 kg/m2.
• Wound morbidity was common, with dehiscence in 21.1% and tissue necrosis in 3.5%, alongside a mean postoperative hemoglobin drop of 3.3 g/dL.
• Symptom burden fell after resection, with reduced odds of myalgia (OR 0.15), asthenia (OR 0.03), and anxiety (OR 0.08); gluteal ptosis, sleep quality, and exercise frequency also improved.

This retrospective cohort of 324 patients with Gustilo III or higher lower extremity open fractures treated with flap reconstruction at a level 1 trauma center between 2012 and 2024 tested whether individual- and neighborhood-level sociodemographic factors predict time to weight bearing as tolerated. Secondary outcomes were minor complications not requiring reoperation and major complications requiring reoperation.

• Median time to weight bearing as tolerated was 88 days (IQR 55 to 137) among the 298 patients (92%) with documented clearance.
• Non-English-speaking patients reached weight bearing sooner (exp(β) = 0.66, 95% CI 0.47 to 0.92, p = 0.01), the only sociodemographic variable associated with the primary outcome.
• No neighborhood-level socioeconomic variable, including median income, employment rate, and distance from the trauma center, was associated with time to weight bearing.
• Major complications requiring reoperation occurred in 27.2% of patients and minor complications in 9.6%, with no individual- or neighborhood-level predictors identified.

This retrospective case series of 124 patients who underwent microsurgical limb reconstruction with a free adipofascial anterolateral thigh flap in Colombia between 2017 and 2023 reported flap survival and complications. A 2024 cross-sectional follow-up of 44 of these patients added survey and semistructured interview data on function and quality of life.

• The foot dorsum (42%) and ankle (26%) were the most common recipient sites, with an overall flap success rate of 85.5%.
• Recipient-site infection occurred in 11.3% and partial flap necrosis in 10.5%, and no patient required secondary debulking.
• Among the 44 patients reassessed at roughly one year, 61.4% maintained regular shoe use and 81.8% required no further orthopedic procedures, with a mean EQ-5D visual analog score of 78.8 (SD 16.0).
• Donor-site morbidity was modest, amounting to a mean inter-limb thigh circumference difference of 10.32 mm (P = 0.0106).

This single-center technique description drawn from 503 consecutive patients reports placement of a triangular silicone background sheet as an inter-vessel spacer after the initial posterior wall suture, used across 3,153 lymphaticovenous anastomoses performed over nine years. No comparison cohort undergoing conventional lymphaticovenous anastomosis was reported.

• The spacer is inserted between lymphatic vessel and recipient vein after the posterior wall suture, and tension is titrated by depth of insertion to give controlled, tremor-free exposure of both lumens.
• Strategic positioning can convert acute angulation between lymphatic and vein into a perpendicular or obtuse configuration, which the authors describe as improving conditions for anastomosis.
• The authors report that stable retraction enables a single-surgeon workflow and permits multiple lymphatic anastomoses to one recipient vein, with patency confirmed after each anastomosis by venous washout or venous-lymphatic reflux.

A propensity score-matched retrospective cohort of 34 vascularized toe proximal interphalangeal joint transfers (17 with subtendinous tissue dissection, 17 without), matched on sex, age at surgery, native toe passive range of motion, and follow-up duration. The primary outcome was extension lag of the transferred joint at final follow-up, with active range of motion, flexion, percentage of use, and revision burden as secondary outcomes.

• At 6 months, before any revision procedures, the dissected group showed less extension lag (15° versus 20°, p = 0.014) and greater active range of motion (55° versus 45°, p = 0.017).
• At final follow-up the extension lag advantage persisted (15° versus 20°, p = 0.032), whereas active range of motion, flexion, and percentage of use no longer differed between groups.
• Revision burden was similar between the two groups, and the additional donor-site dissection was not associated with perfusion problems in the transferred joint.

A prospective single-center cohort of 484 press-fit dual-mobility trapeziometacarpal implants in 407 patients (mean age 59 years, range 43 to 80), with tantalum beads placed in the trapezium at index surgery. Radiostereometric imaging at 3 weeks, 3 months, 1, 2, and 5 years quantified cup migration, alongside clinical outcomes to 5 years and Kaplan-Meier survival to 9 years.

• Total translation of the cup measured 0.28 mm at 3 months (95% CI 0.25 to 0.32) and remained unchanged through the 5-year follow-up, a migration pattern consistent with early osseointegration rather than progressive loosening.
• Female patients showed 0.15 mm more total translation than male patients at 5 years (95% CI 0.06 to 0.24).
• Grip strength, pain at rest and on activity, and QuickDASH scores improved to a clinically relevant degree by 1 year and remained stable to 5 years, with 96% patient satisfaction and 96% willing to repeat the procedure.
• Nine-year cumulative survival was 98% for cup removal due to aseptic loosening but 87% for removal or exchange of any component, indicating that most revisions were driven by causes other than cup loosening.

This propensity-matched database cohort of 17,700 obese patients identified in TriNetX compared 30- and 90-day outcomes after endoscopic versus open carpal tunnel release, with 1:1 matching on demographics, body mass index, comorbidities, and medication exposures. Outcomes were reported as risk ratios with 95% confidence intervals.

• Endoscopic release showed lower wound disruption (RR 0.34 at both 30 and 90 days) and lower infection (RR 0.24 at 30 days, RR 0.34 at 90 days), all p < 0.001.
• Readmissions were lower after endoscopic release at 30 days (RR 0.41, 95% CI 0.37 to 0.46) and 90 days (RR 0.51, 95% CI 0.47 to 0.56).
• Revision procedures were more frequent after endoscopic release at both 30 days (RR 1.28, 95% CI 1.17 to 1.39) and 90 days (RR 1.18, 95% CI 1.10 to 1.27).
• Deep vein thrombosis, acute kidney injury, myocardial infarction, stroke, pneumonia, stiffness, and mortality did not differ significantly between approaches, while sepsis and pulmonary embolism were lower after endoscopic release at 90 days.

This registry-based case series of 125 patients undergoing primary dual-mobility trapeziometacarpal implant arthroplasty examined determinants of satisfaction at five years, using a five-point Likert scale analyzed by top-box approach. Secondary outcomes included pain, brief Michigan Hand Outcomes Questionnaire (MHQ) scores, key pinch strength, and Kaplan-Meier implant survival.

• Of the 94 patients who completed the satisfaction questionnaire at five years, 87 (93%) were satisfied or very satisfied with the treatment outcome.
• Lower pain and higher brief MHQ scores at five years were associated with being very satisfied, whereas baseline characteristics, complications, and revision surgery were not.
• Pain, brief MHQ, and key pinch strength all improved significantly from baseline, and five-year implant survival was 96% (95% CI 92 to 100) after five revision operations.

This multicenter registry review of 247 extremities in 230 patients from the prospective Congenital Upper Limb Differences (CoULD) registry catalogued the operations performed for radial polydactyly, ancillary procedures, and complications, and examined their association with Wassel-Flatt classification type.

• Excision of the radial thumb with reconstruction of the dominant ulnar thumb accounted for 87% of index procedures, followed by simple excision at 7%; ligament reconstruction was the most common ancillary procedure.
• Index surgery was performed at a mean age of 1.4 years (range 24 days to 8.4 years), and thumbs of the hypoplastic subtype were more likely to undergo simple excision.
• Fifteen patients (7%) experienced 17 complications in total, and five thumbs required revision at a mean of 3.6 years (range 2.5 to 4.3 years) after the first operation.

A prospective non-randomized comparative study of 42 patients with Quinnell grade II-III trigger finger allocated sequentially to extracorporeal shockwave therapy (n = 21) or corticosteroid infiltration (n = 21), with pain, function, grip strength, satisfaction and surgical conversion assessed at 6 months, 1 year and 2 years.

• Outcomes were comparable between the groups at 6 months, with divergence appearing only at 1 and 2 years, when most shockwave patients reported substantial pain relief.
• Grip strength gains were maintained in the shockwave group and satisfaction remained stable, whereas satisfaction declined in the infiltration group over the same period.
• Conversion to surgery was less frequent after shockwave therapy than after corticosteroid infiltration at 2 years, although absolute numbers are not given in the abstract.

A single-surgeon case series of four consecutive patients with traumatic brachial plexus palsy and complete triceps weakness who underwent radial fascicular transfer, primarily using ECRL donor fibers, directly to medial or lateral head triceps motor branches, with clinical follow-up for elbow extension strength, range of motion and donor-site deficit.

• All four patients regained functional elbow extension, with MRC grade 4/5 in three and 5/5 in one at final follow-up (mean 19 months, range 10–24 months).
• No wrist or finger extensor weakness was detected after harvest of ECRL and adjacent extensor fascicles, and no postoperative surgical complications occurred.
• All patients had previously undergone nerve transfers for elbow flexion and shoulder function, so triceps reinnervation was pursued as a later stage in an already reconstructed limb rather than as a primary procedure.

A retrospective cohort of 41 adults with brachial plexus injury and a planned spinal accessory to suprascapular nerve transfer, reviewing how often distal suprascapular nerve injury was encountered intraoperatively and which demographic, injury and surgical factors were associated with it.

• The planned transfer was abandoned in 21 of 41 patients: 11 for distal suprascapular nerve injury, 8 for a suprascapular nerve that responded to intraoperative stimulation, and 2 for a non-functioning donor spinal accessory nerve.
• Distal suprascapular nerve injury was significantly associated with increased age and the presence of an associated shoulder injury (p = 0.03 and p = 0.02).
• Neither type of brachial plexus injury nor mechanism was associated with distal nerve injury, in a cohort dominated by high-energy ATV, motorcycle and snowmobile trauma (30 of 41 patients).

A retrospective cohort of 291 patients with severe carpal tunnel syndrome compared endoscopic release alone (n = 119, treated before March 2023) with release plus six months of neurotrophic supplementation (n = 172, treated afterwards), tracking sensory conduction velocity, VAS pain and DASH scores to 12 months.

• The supplemented group showed greater improvement in sensory conduction velocity and VAS scores at 1 and 3 months (P < 0.05).
• DASH scores fell by 44% at 3 months in the supplemented group versus 37% in the surgery-only group (P < 0.05).
• By 6 and 12 months the two groups were comparable across all outcomes, and complication rates were low and not significantly different.

A systematic review of 12 cohort studies (n = 876) pooling postoperative recurrence of hand giant cell tumor of the tendon sheath, supplemented by a separate logistic regression across 38 published case reports to explore predictors of recurrence.

• Pooled recurrence across 11 studies was 13% (95% CI 11%–15%; 107 of 838 patients).
• Mean follow-up was 4.2 years, and recurrences were typically identified around 40 months after surgery, well beyond routine postoperative surveillance windows.
• Fifth-digit involvement was strongly associated with recurrence in the case-report analysis (odds ratio 18.3, 95% CI 1.0–178.2), whereas symptom duration and imaging findings were not independent predictors.

A retrospective national longitudinal cohort of 582 adult burn survivors in the Burn Model System (2015–2021) linked three-year pre-burn residential PM2.5 exposure, estimated from home census tract, to mortality, ventilator days, tracheostomy, length of stay, PROMIS Global Health and employment at 6 and 12 months.

• In unadjusted models, higher PM2.5 exposure was associated with longer length of stay, worse PROMIS Global Health scores and lower likelihood of employment at pooled 6- and 12-month follow-up.
• These associations attenuated after adjustment for age, sex, race/ethnicity, TBSA and inhalation injury.
• Higher PM2.5 exposure was associated with a greater likelihood of inhalation injury, which was itself strongly associated with prolonged ventilation, tracheostomy, lower global health scores and lower employment.

A retrospective cohort study of burn patients treated with fractional CO2 laser assessed pre- and post-treatment Vancouver Scar Scale scores against baseline severity, TBSA and length of initial hospitalization, with a non-laser burn cohort for comparison of subsequent contracture release. The published abstract does not state the number of patients in either group.

• Baseline Vancouver Scar Scale score was the strongest predictor of treatment response, with more severe scars showing greater improvement after laser therapy.
• Neither TBSA nor length of initial hospitalization was significantly associated with responsiveness to laser treatment.
• Laser-treated patients underwent fewer scar contracture release procedures, but the difference did not reach statistical significance, which the authors attribute to limited sample size.

A retrospective cohort of 1057 patients with diabetic foot ulcers managed over 11 months at a specialized diabetes center in Kerala using culture-directed antibiotics, glycemic optimization, offloading, daily debridement and vascular assessment, with multivariable logistic regression for factors associated with poor outcome and delayed healing.

• Complete healing occurred in 74.7% of the full cohort, with a major amputation rate of 2.6%.
• Among the 887 patients with complete follow-up, 89.1% achieved a favorable outcome and 10.9% had a nonhealing ulcer or major amputation.
• Coronary artery disease and prior ulcer history were independently associated with poor outcome (OR 2.08, 95% CI 1.23–3.51 and OR 2.41, 95% CI 1.55–3.74).
• Chronic kidney disease was independently associated with healing taking longer than five months (OR 1.96, 95% CI 1.26–3.06) among the 766 patients with healing-time data.

Single-centre retrospective cohort of 1593 patients with second-degree burns, including an isolated single-region subgroup (n = 352) analysed separately. Regional perforator artery and hair follicle densities were taken from published anatomical references and correlated with length of stay.

• In the isolated single-region subgroup, length of stay varied significantly by anatomical site, with the lower extremity longest at 4.71 ± 4.35 days and the perineum shortest at 2.00 ± 1.73 days.
• Regional perforator density showed a strong negative correlation with length of stay (Spearman rs = -0.900; p = 0.037), and hair follicle density followed the same trend.
• The head and neck region, which carries the highest combined perforator and follicle density, had the shortest stay at 2.72 days, compared with 4.71 days for the lower extremity (post hoc p = 0.004).
• The cohort was predominantly paediatric, with 71.0% of patients under 18 years and scald injury accounting for 78.3% of burns.

Retrospective multicentre cohort of 239 laser encounters in 98 children with hypertrophic burn scars treated at two academic centres between 2020 and 2023. Perioperative anaesthetic approaches were characterised and modelled against opioid administration, pain and recovery outcomes.

• Intraoperative or postoperative opioids were given in 53% of encounters; preoperative opioid administration was associated with 86% lower odds of intraoperative or postoperative opioid use (OR 0.14; 95% CI 0.06–0.34; P < .001).
• A two-fold increase in treated total body surface area was associated with 32% higher odds of opioid administration (OR 1.32; 95% CI 1.11–1.58) and 23% greater odds of reported pain (OR 1.23; 95% CI 1.05–1.43).
• Laser type carried two-fold higher odds of pain (OR 2.11; 95% CI 1.07–4.14; P = .030), while emergence delirium was uncommon at 2.5% of the cohort.
• Laser selection and anaesthetic management differed between the two institutions, and these institutional differences were themselves reflected in pain and recovery outcomes.

Retrospective matched cohort of 132 adults admitted with burn injury between January 2015 and July 2024, in which 45 patients who fell were matched 1:2 to 87 non-fallers on age, sex, total burn surface area and inhalation injury. Medications, comorbidities, Fall Risk Assessment Score (FRAS) and therapy assessments were compared.

• Fallers were more likely to be taking antihypertensives (62.2% vs 39.1%, p = 0.016) and antiarrhythmics (75.6% vs 52.9%, p = 0.014) than matched non-fallers.
• Fallers entered the admission functionally weaker, with lower basic mobility scores (16 [11.3–20] vs 20 [14–24], p = 0.002) and lower daily activity scores (16 [12–19] vs 19 [14–22], p = 0.004).
• On multivariable analysis, requiring burn surgery (OR 3.35; 95% CI 1.12–10.1; p = 0.031) and FRAS (OR 1.12 per point; 95% CI 1.04–1.20; p = 0.003) were independently associated with falls.
• The FRAS alone performed only moderately as a discriminator (AUC 0.653; p = 0.009), leaving substantial misclassification of who actually fell.

Randomised preclinical study of 60 Sprague-Dawley rats allocated to six groups of ten differing in fluid resuscitation (1× vs 3× Ringer's lactate), thermal support (heating lamp vs incubator warming) and intravenous placenta-derived choriodecidual mesenchymal stem cell (pcMSC) therapy, with survival followed for 14 days.

• Mortality was concentrated early, with 93% of deaths occurring within the first three days; under low-volume resuscitation, survival rose from 30% untreated to 50% with pcMSC therapy.
• With adequate fluid resuscitation and thermal support, survival was already high at 80% and reached 90% with pcMSCs, a difference that was not statistically significant after adjustment.
• Thermal support exerted a marked independent effect on survival, with warmed animals outperforming unwarmed animals despite receiving similar or lower fluid volumes.
• Treated animals showed less post-burn hypothermia, less weight loss and dehydration, and significantly lower circulating TNF-α, IL-1β and IL-6.

Systematic review and meta-analysis of 8 randomised controlled trials totalling 1377 patients (707 NPWT, 670 conventional dressings) undergoing emergency abdominal surgery, searched across PubMed, Embase and Cochrane CENTRAL per PRISMA 2020. The primary outcome was surgical site infection incidence.

• NPWT reduced surgical site infection with a risk ratio of 0.43 (95% CI 0.26–0.73; p = 0.002), although between-trial heterogeneity was high (I² = 76%).
• Wound dehiscence was reduced more consistently, with a risk ratio of 0.32 (95% CI 0.18–0.58; p = 0.0002).
• No significant differences emerged for seroma formation (RR 0.59; 95% CI 0.34–1.01), length of hospital stay (mean difference -0.39 days) or 30-day mortality (RR 0.96; 95% CI 0.55–1.68).

Protocol for a multicentre, randomised, placebo-controlled trial of 382 patients with moderate-to-severe post-burn itch of the limbs (Worst Itch Numeric Rating Scale ≥ 4) across several Chinese burn centres. Patients are randomised 1:1 to active transcutaneous electrical nerve stimulation (TENS) or placebo stimulation.

• The intervention is TENS administered once daily for 30 minutes over seven consecutive days, with assessment on day 8 and follow-up on day 14.
• The primary endpoint is the 7-day itch improvement rate, defined as the proportion achieving a ≥50% reduction in Worst Itch NRS from prerandomisation baseline.
• Secondary and exploratory endpoints extend beyond itch severity to neuropathic symptoms, sleep, quality of life, scar severity and safety, plus neuroimaging markers and scar function parameters.
• Recruitment opened in April 2025 and is expected to close in October 2027 (ChiCTR2500099822).

Preclinical materials study of an injectable hydroxybutyl chitosan/microalgae extract hydrogel (HBC-MAE), characterised in vitro and then applied in a rodent burn wound model; the abstract does not report animal numbers or control group sizes.

• The sol-gel transition temperature and gelation time were tunable by adjusting the HBC/MAE ratio, allowing the material to be injected as a liquid and gel in situ for complete wound coverage.
• The hydrogel demonstrated antioxidant and antibacterial activity, resisting nonspecific protein adsorption and bacterial adhesion at the wound surface.
• In the burn model, the dressing suppressed local inflammation and redirected macrophage polarisation from M1 toward the M2 phenotype, which the authors link to the observed increase in healing rate.

A prospective registry cohort of 5,671 free flaps in 4,909 patients, recorded in the German Society of Plastic Surgeons quality assessment database across 22 certified centers between 2011 and 2018. Temporal trends in flap selection, operative parameters, and clinical outcomes were analysed at national, center, and individual surgeon level.

• Flap-loss rates showed no temporal trend, ranging from 2.6% to 4.2% across the study period (p = 0.894), despite increasing center participation and accumulating surgeon experience.
• Operative duration fell in high-volume centers (mean difference −38 minutes, 95% CI −69 to −7) and among more experienced surgeons (−30 minutes, 95% CI −49 to −11), yet no overall reduction over calendar time was observed.
• Additional flap techniques were introduced gradually with heterogeneous uptake between centers, and the DIEP flap remained the predominant option throughout.
• Ischemia time showed an overall trend toward prolongation over the study period, running counter to the operative-time gains seen in experienced hands.

Prospective comparative cohort of 88 patients undergoing immediate DIEP flap reconstruction after mastectomy, in which 42 patients treated before July 2023 served as controls and 46 subsequent patients received a single surgeon-administered TAP block with 60 mL of 0.25% levobupivacaine at the donor site.

• Pain scores on postoperative day 0 were lower in the block group (2.78 ± 0.97 vs 4.08 ± 1.05, p < 0.001), with comparable differences persisting on days 1 and 2.
• PCA demand on day 0 fell from 21 ± 8.6 doses in controls to 10.3 ± 5.52 doses with the block (p < 0.002), and PCA lockouts were likewise fewer in the block group.
• Independent mobilisation occurred 1.5 days earlier in the block group (mean 2.0 vs 3.5 days, p < 0.001).
• Opioid-related side effects, particularly nausea and constipation, were significantly less frequent after the block.

A retrospective cohort study of 539 patients treated with 1073 tissue expanders at a single institution used generalized estimating equation models to account for multiple expanders per patient and to identify predictors of overall and complication-specific adverse events.

• A total of 103 complications were recorded, an overall rate of 9.60%, with expander rupture (4.75%) and skin ulceration (3.54%) the most frequent events.
• On multivariate analysis, low preoperative red blood cell count and larger expander volume independently predicted overall complications (P = 0.005 and P = 0.003).
• Risk profiles diverged by complication type: low preoperative red blood cell count was the only independent predictor of rupture, whereas older age, larger expander volume, and non-head/trunk location predicted skin ulceration.
• Head and trunk location showed only a borderline association with rupture risk (P = 0.053), leaving anatomical site effects direction-dependent across the two dominant complications.

A systematic review and meta-analysis of nine comparative studies including 2535 patients compared postoperative complications, patient-reported outcomes, and aesthetic satisfaction after implant-based breast reconstruction with round versus anatomical devices, using random-effects odds ratios.

• Overall complication rates did not differ between shapes (odds ratio 0.46, 95% CI 0.14 to 1.48, P = 0.19).
• Specific complication categories and patient-reported outcomes, including aesthetic satisfaction, were similar across the two implant shapes.
• The evidence base was unbalanced, with 1578 patients receiving round and 957 anatomical implants, and the pooled confidence interval spanned substantial benefit through moderate harm.

A retrospective NSQIP analysis of 450,925 mastectomy patients (7445 male, 443,480 female) from 2005 to 2023 compared rates of immediate breast reconstruction, procedure mix by CPT code, and 30-day surgical outcomes between sexes.

• Immediate reconstruction was performed in 21.0% of male and 55.4% of female patients following mastectomy (P < 0.0001).
• Procedure mix differed markedly: nipple-areolar complex reconstruction (43.9%) and tissue expander placement (9.4%) predominated in men, whereas tissue expander (42.7%) and implant placement (23.3%) predominated in women.
• Thirty-day surgical-site complication rates after reconstruction were low in both groups, with women at 5.0% versus men at 3.2% (P < 0.001).
• Reconstruction rates rose over time in both sexes, with the annual increase steeper in men (beta 0.2036, 95% CI 0.1871 to 0.2203) than in women (beta 0.0428).

A single-center cohort study of 185 reconstructions in 104 patients undergoing skin- or nipple-sparing mastectomy applied intraoperative ICG angiography with quadrant-level quantitative perfusion measurement and a five-point Yale Grade, with 30-day mastectomy skin flap necrosis as the primary outcome.

• Mastectomy skin flap necrosis occurred in 24.3% of reconstructions, with incidence and severity falling stepwise across improving Yale Grades (P < 0.001).
• Average quantitative perfusion discriminated best for necrosis (AUC 0.792) at a threshold of 49.0, yielding 63.6% sensitivity and 83.2% specificity; minimum perfusion at 33.5 reached AUC 0.759.
• For nipple-areolar complex necrosis specifically, average quantitative perfusion reached AUC 0.899, and a Yale Grade of 3 or lower carried 89.2% specificity.
• On multivariable analysis, perfusion metrics remained independently predictive whereas clinical variables did not.

A retrospective single-center review of 114 patients (141 breasts) undergoing DIEP flap breast reconstruction between 2018 and 2024 compared 66 patients receiving an intraoperative 2000 IU unfractionated heparin bolus with 48 untreated controls, stratifying complications as intraoperative, acute (4 days or less), and delayed.

• Complication rates were statistically indistinguishable between groups in the intraoperative (P = 0.226), acute (P = 0.839), and delayed (P = 1.00) settings, including thrombosis.
• Bleeding-related events were not increased by heparin administration, with comparable hematoma rates in both cohorts.
• Ischemia time and total operative duration were significantly longer in the control group (P < 0.05), an unexpected asymmetry between the two cohorts.

A single-institution retrospective review of 862 women undergoing mastectomy with or without reconstruction after neoadjuvant chemotherapy between 2014 and 2024 evaluated 30-day complications and recurrence-free survival as a function of time to surgery, adjusting for age, smoking, mastectomy type, and surgical year.

• Thirty-day complications occurred in 6.3% of patients (54 of 862), most commonly surgical site infection (n = 19) and necrosis (n = 19).
• Median time to surgery was 32 days and did not differ between patients with and without complications; adjusted analysis showed no association between interval and complications (OR 1.30, 95% CI 0.75 to 2.29).
• Five-year recurrence-free survival was 78.9% versus 80.7% for intervals of 32 days or less versus more than 32 days, with no difference after stratification by residual cancer burden and tumor biology.

A retrospective study of 117 patients (144 flaps) undergoing DIEP flap breast reconstruction between 2018 and 2024 stratified outcomes into normal-weight, overweight, and obese groups according to WHO BMI classification.

• Abdominal seroma was significantly more frequent in patients with BMI of 30 kg/m2 or higher (P = 0.038), whereas infection, wound dehiscence, and hernia rates did not differ across groups.
• Fat necrosis and total flap loss occurred exclusively in the obese group, at 7.1% each, with both comparisons approaching significance (P = 0.056).
• Each unit increase in BMI was associated with a 0.20-day longer hospital stay (P = 0.006), yet BMI was not an independent predictor of donor-site, recipient-site, or flap complications on adjusted analysis.

A prospective cohort survey of 349 women undergoing lumpectomy or mastectomy at an academic hospital classified patients by reconstruction status, with 179 of the 199 non-reconstructed patients completing a structured questionnaire on reasons for declining reconstruction alongside open-text thematic analysis.

• 57% of participants (199 of 349) did not undergo reconstruction; this group was older (mean 62.6 versus 49.0 years) and more often received adjuvant radiation (76% versus 36%).
• Among non-reconstructed patients, 32% recalled discussing reconstruction with their breast surgeon, 13% were offered a plastic surgery consultation, and 3% attended one.
• The leading self-reported reasons for declining were acceptance of their appearance (48%), a belief that reconstruction was not essential to health (34%), and feeling they had already undergone enough intervention (16%).
• Thematic analysis of open-text responses identified perceived ineligibility after lumpectomy and gaps in treatment information alongside personal factors such as age.

Using a microvascular adaptation of the PULSAR arterial flow system, this benchtop simulation tested four CaHA-CMC dilutions at two bolus volumes across a branched network tapering from 1000 to 200 µm. Occlusion, retrograde propagation, and enzymatic recanalization with hyaluronidase versus cellulase were assessed videographically.

• Undiluted CaHA-CMC produced total microtubular occlusion, while progressively diluted preparations (1:0.5, 1:1, 1:2) occluded less frequently; all formulations nonetheless propagated distally into 200–300 µm branches.
• Increasing bolus volume from 0.2 ml to 1 ml raised occlusive frequency from 16.0% to 57.1% (p < 0.0001) and retrograde flow incidence from 10% to 100% (p = 0.005).
• Hyaluronidase had minimal effect on established occlusions, whereas systemic cellulase produced progressive recanalization within minutes and near-complete system patency by 60 minutes.

This retrospective series of 110 patients describes the 1/3 Selective Muscle Recruitment technique, in which the upper third of the implant sits submuscularly beneath segment 3 of pectoralis major while the lower two-thirds lies subfascially. Outcomes were assessed clinically, photographically, and with visual analog scale pain and satisfaction scores over a mean follow-up of 11.7 months.

• Animation deformity was absent in 92% of cases, and no seromas or capsular contractures were recorded during the follow-up period.
• The overall complication rate was 10%, with postoperative pain rated mild (VAS 2–5) and 87% of patients scoring satisfaction at 8 or higher.
• 84% of patients underwent concurrent mastopexy with implant placement, so the cohort largely reflects augmentation-mastopexy rather than isolated augmentation.

This retrospective single-arm series of 186 consecutive patients evaluated endoscopic-assisted septorhinoplasty with autologous septal cartilage grafting across Rohrich Type I, C-type, and S-type crooked nose deformities. Assessment combined digital photographic angle measurements, 10-point VAS obstruction and satisfaction scores, and objective nasal function testing in a 112-patient subset.

• Morphological measurements improved significantly, including dorsum deviation, tip deviation, nasolabial angle, and Goode ratio tip projection, alongside VAS obstruction and satisfaction scores (both P < 0.001).
• In the functional subset of 112 patients, objective testing showed increased nasal volume and minimal cross-sectional area with decreased expiratory resistance (all P < 0.001).
• Recurrent deviation occurred in 4.3% (8/186) and complications in 7.5%, with no major adverse events reported.

This retrospective single-arm series of 85 patients treated between 2019 and 2024 describes an anterior neck rejuvenation protocol using supraplatysmal liposuction, selective subplatysmal fat resection, partial transverse platysma myotomy at the hyoid, midline suprahyoid corset plication, and posterior skin redistribution without periauricular incisions. Minimum follow-up was 12 months.

• The authors report improvement in mandibular definition, cervicomandibular angle, and vertical neck length, with mean patient satisfaction of 4.5 out of 5.
• Complications were limited to three seromas treated by needle aspiration and three transient mental nerve paresthesias that resolved within weeks; no reoperations were required.
• Contour change was attributed to partial transverse myotomy at the hyoid combined with a submandibular-limited platysmal corset, with cervical skin redistributed posteriorly rather than excised through periauricular incisions.

This retrospective cohort of 618 patients undergoing primary breast augmentation in Greece and the UK between 2003 and 2023 examined outcomes among those travelling by air within 48 hours of surgery under a described 33-step perioperative protocol. Recorded endpoints included pain, postoperative nausea and vomiting, complications, discharge timing, and GAIS satisfaction.

• No hematomas, thrombotic events, or implant infections were recorded across the 20-year cohort.
• Pain and postoperative nausea and vomiting were mild and had improved by day 5, with 95.8% of patients reporting excellent improvement on the GAIS.
• Neither earlier discharge nor a shorter interval between surgery and flight was associated with worse outcomes.

This systematic review and meta-analysis of 9 studies comprising 847 patients compared FACE-Q Aesthetic Module satisfaction scores between open and closed neck rejuvenation, stratified by whether liposuction was performed. Weighted means, pooled standard deviations, and Welch's t-tests were used for between-group comparison.

• When liposuction was employed, open techniques achieved higher neck aesthetic satisfaction than closed techniques (FACE-Q 81.5 vs 77.5, P = .022), while chin scores were comparable (P = .268).
• Closed techniques without liposuction yielded the highest satisfaction scores overall (chin 86.4, neck 86.6), significantly exceeding open techniques with liposuction (P < .01).
• The authors attribute the pattern to case selection rather than intrinsic superiority, noting that open approaches retain value for patients requiring more extensive anatomical correction.

This systematic review of 28 studies, with meta-analysis of 10 studies totalling 7019 patients, compared autologous cartilage grafts against alloplastic implants in augmentation rhinoplasty across publications from 2000 to 2024. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for observational studies.

• Pooled analysis showed a significantly lower infection risk with autologous grafts (OR 0.19; 95% CI 0.09–0.42; p < 0.001).
• Autologous grafts, particularly costal cartilage, also showed lower extrusion rates, but carried warping and occasional resorption as their characteristic failure modes.
• Silicone and Gore-Tex implants offered operative efficiency, with their higher infection and extrusion rates becoming most apparent at longer follow-up.

This retrospective cohort of 86 patients undergoing rectus abdominis fat transfer measured intramuscular pressure intraoperatively with a compartment pressure monitoring system at three timepoints: before fat grafting, after fat grafting, and after abdominal plication. Measurements were taken in predefined rectus abdominis and external oblique zones using standardized grafting volumes.

• Fat grafting alone produced minimal and nonsignificant pressure changes across all measured anatomical regions.
• Abdominal plication was associated with consistent pressure increases, reaching statistical significance in the infraumbilical and inferior zones and in the external obliques.
• No fat necrosis, ischemia, or major complications occurred; the overall complication rate was 3.48%, limited to surgical site infections.

A single-center retrospective cohort of 100 post-bariatric patients with body mass index up to 30 kg/m² completed a modified Impact of Weight on Quality of Life-Lite questionnaire, recast into a satisfied/unsatisfied response format, before abdominoplasty and one year afterward. An independent staff member administered the seven-domain instrument, and changes were tested with McNemar analysis.

• Preoperative dissatisfaction dominated every domain, with only 11% of patients satisfied with self-esteem and 24% satisfied with general health; mobility and social relations stood at 26% and 32%.
• At one year, satisfaction reached 83% to 93% in every domain reported, including 92% for sexual life and 93% for work performance (all P < 0.05).
• The largest absolute shift was in self-esteem, from 11% to 84%, while domains with higher baseline satisfaction moved less in relative terms, such as work performance from 45% to 93%.

A PRISMA-compliant PICO search of PubMed, Embase, and Web of Science covering 2000 through September 2025 produced a critical review of 16 cohort and comparative reports on surgical rejuvenation. The question addressed was which rhytidectomy technique achieves durable correction of the nasolabial fold and midface laxity.

• The included reports were too heterogeneous to pool, differing in dissection plane and extent, vector of lift, suture fixation, measurement tools, and length of follow-up.
• No objective data supported any specific technique for long-term nasolabial fold effacement; the authors attribute the limited effect of extended SMAS and deep-plane techniques to absence or attenuation of the SMAS layer deep to the melolabial fat pad.
• Superficial SMAS imbrication was judged comparatively more favorable for the fold itself, although the underlying reports conflict and follow-up intervals were inconsistent between series.

A PROSPERO-registered, PRISMA 2020-compliant systematic review of 18 studies enrolling 312 patients across ten countries examined microsurgical reconstruction after oncologic facial nerve sacrifice. Six technique subgroups were compared for functional recovery, with risk of bias graded by the Newcastle-Ottawa Scale and MINORS and certainty of evidence by GRADE.

• House-Brackmann grade I to III was achieved in 44% of patients across the ten studies using standard grading, with wide variation between series (range 24% to 100%).
• Technique use was heavily skewed toward non-vascularised cable grafting (n=155), followed by vascularised thoracodorsal nerve free flap (n=46), combination approaches (n=43), mixed-donor graft (n=38), masseteric transfer (n=27), and venous conduit (n=3).
• Masseteric nerve transfer reinnervated at 4 to 6 months versus 6 to 13 months for cable grafting, and postoperative radiotherapy did not impair graft function in the four comparative studies that examined it.
• Risk of bias was moderate (NOS 6-9/9; MINORS 8-11/16) and overall certainty of evidence was rated Very Low on GRADE, with no comparative trials available in the field.

A query of ACS NSQIP-Pediatric from 2012 to 2023 assembled a retrospective cohort of 4500 pediatric limb-salvage extremity tumor operations (4295 lower extremity, 205 upper extremity) identified by comprehensive oncologic excision codes. Wound complications and overall 30-day morbidity were compared between cases with and without concurrent reconstructive codes.

• Immediate reconstruction was performed in 3.5% of cases overall (159/4500), and far more often in the upper extremity (12.2%) than the lower extremity (3.1%).
• Complications occurred in 27.7% of reconstructed versus 2.4% of nonreconstructed cases (44/159 vs 104/4341; P<0.001).
• In the lower extremity multivariable model, immediate reconstruction (OR 3.48, 95% CI 1.56-7.75) and ASA III to IV classification (OR 2.17, 95% CI 1.18-3.98) were independently associated with 30-day complications.
• Bone tumors made up 94.8% of the cohort and 87.7% underwent simple excision, indicating that most registry cases were anatomically straightforward and unlikely to need flap coverage.

A systematic review of 19 clinical series comprising 277 patients searched PubMed, Embase, Scopus, and Web of Science from inception through April 2026 for immediate, concurrent, or single-stage facial nerve reconstruction or reanimation at the time of oncologic nerve sacrifice. Findings were synthesized descriptively because techniques and outcome reporting were too heterogeneous to pool.

• The series spanned six distinct reconstructive strategies, from cable or interpositional nerve grafting and concurrent masseteric transfer to vascularized nerve grafting, temporalis-based dynamic reanimation, free functional muscle transfer, and composite flap reconstruction.
• Immediate reconstruction was associated with restored resting symmetry, oral competence, and ocular protection, whereas smile and oral commissure movement were reported mainly after dynamic approaches.
• Interpositional cable grafting yielded recovery in the House-Brackmann III range; reported complication rates were described as acceptable, with low donor-site morbidity and uncommon flap loss.
• The few radiotherapy-specific analyses suggested that postoperative radiotherapy did not uniformly preclude functional recovery after immediate reconstruction.

A single-center retrospective cohort of 83 patients undergoing neck dissection for stage III or higher head and neck melanoma at Whiston Hospital between 2017 and 2025 was divided into node-positive (n=45) and node-negative (n=38) groups. Clinicopathological predictors of nodal metastasis were tested with Firth-penalised logistic regression, alongside Kaplan-Meier and Cox survival analysis.

• Cumulative epithelioid morphology across all preoperative biopsies was the sole independent predictor of nodal metastasis (aOR 25.67, 95% CI 3.55-185.60, p=0.001).
• On univariable analysis, larger tumor size (median 16.0 vs 10.0 mm), greater Breslow thickness (3.9 vs 2.3 mm), and lymphovascular invasion (26.3% vs 5.4%; OR 6.25) were associated with a positive dissection.
• Among sentinel-node-positive patients, larger metastatic deposit size (3.0 vs 0.6 mm) and subcapsular deposit diameter (3.0 vs 0.5 mm) predicted a positive completion neck dissection.
• Eight patients developed nodal metastasis despite a negative sentinel node biopsy, which the authors read as support for risk-adapted surveillance imaging regardless of sentinel node status.

A narrative review of lymphatic malformation management surveys the shift from procedure-only treatment toward molecularly targeted therapy in a heterogeneous group of congenital lymphatic disorders. Medical agents, sclerotherapy, and operative resection are considered together rather than as competing single-specialty options.

• Activation of the PI3K/AKT/mTOR signaling pathway is presented as the central driver of pathogenesis, supplying the molecular rationale for systemic drug therapy in these lesions.
• Sirolimus and alpelisib are described as complementing rather than displacing sclerotherapy and resection, with selection tied to lesion genotype, extent, and anatomy.
• The authors frame successful care as requiring multidisciplinary collaboration across medical, interventional, and surgical teams, and name genotype-driven therapy, biomarkers, and long-term outcomes as the open research questions.

A multicenter retrospective study of 1008 patients undergoing elective noncardiac surgery under total intravenous anesthesia at six centers compared recommendations from an AI decision-support system (ZW-AA-001) with the decisions anesthesiologists actually recorded. Concordance rates, decision latency, and cross-center consistency were assessed using prevalence-adjusted and bias-adjusted kappa and Gwet's AC1.

• Overall decision agreement during anesthesia maintenance was 73.3% (95% CI 72.4% to 74.3%) and was broadly consistent across all six participating centers.
• For propofol, concordance was 91.1% for whether to adjust the dose but only 68.6% for the direction of that adjustment.
• Agreement on atropine, ephedrine, and urapidil dropped to 17.4% to 29.8%, and the system recommended hemodynamic intervention more frequently than clinicians for every drug studied.
• The system reached propofol decisions faster than anesthesiologists, with a pseudomedian difference of 77.5 seconds (95% CI 75.5 to 79.5; P<.001).

In a preclinical in vitro and in vivo study, lentiviral systems were used to generate SPARC-overexpressing and SPARC-knockdown mesenchymal stem cells. Conditioned media from each line were tested on human keratinocytes and fibroblasts and then applied in an animal wound-healing model.

• Conditioned medium from SPARC-overexpressing MSCs accelerated wound regeneration in vivo, whereas medium from SPARC-knockdown cells delayed the healing process.
• SPARC expression level altered cell migration and cell cycle progression, with the direction and magnitude of the effect differing between keratinocytes and fibroblasts.
• Because the in vivo effects were produced by cell-free conditioned medium, the benefit is attributed to secreted factors rather than to engraftment of transplanted cells.

This single-arm study of 30 participants with early-stage alopecia compared paired 3.5 mm scalp punch biopsies taken at baseline and at 6 months after intradermal injection of plant-derived exosomes. Immunohistochemistry covered beta-catenin, CD34, and an immune panel of CD68, CD3, CD20, and CD138.

• Posttreatment biopsies showed significantly increased beta-catenin expression within the follicular epithelium, interpreted by the authors as activation of Wnt-mediated regenerative signaling.
• CD34-positive stem cells surrounding the follicles were markedly increased at 6 months, which the authors read as recruitment of progenitor populations.
• Immune profiling showed reduced CD68-positive macrophages and CD3-positive T cells, while B-cell and plasma-cell populations remained stable.
• Clinical change was assessed only qualitatively on standardized photography and dermoscopy, with no hair count or density measurement reported.

This in vitro materials characterization study synthesized a tragacanth gum/polyaniline hydrogel copolymerized with HEMA and methacrylate-modified SiO2 nanoparticles. Swelling, degradation, protein adsorption, drug release, hemocompatibility, antibacterial activity, and MG-63 osteoblast-like cell proliferation were assessed against control groups.

• The scaffold formed a porous three-dimensional network with dispersed spherical SiO2 nanoparticles and a swelling ratio of 371.5 ± 12.1%.
• Ciprofloxacin release from the hydrogel was pH-dependent, and the composite showed antibacterial activity alongside acceptable hemocompatibility.
• MG-63 osteoblast-like cells reached 139 ± 3.2% viability versus 100 ± 3.5% in controls, indicating support of proliferation over prolonged culture.

This preclinical mouse study combined single-cell RNA sequencing and spatial transcriptomics of spinal cord injury scars with pharmacologic inhibition of CD36 (salvianolic acid B) or AP-1/c-Jun (T5224). Outcomes included fibroblast accumulation, matrix deposition, angiogenesis, axonal regeneration, and longitudinal locomotor testing.

• Spatial and single-cell analyses localized CD36 predominantly within the lesion scar, with preferential upregulation in defined fibroblast subclusters that tracked with fibrotic progression.
• CD36 inhibition with salvianolic acid B reduced P4HB-positive fibroblast accumulation and matrix deposition while enhancing angiogenesis, axonal regeneration, and hindlimb functional recovery.
• CUT&Tag and dual-luciferase reporter assays demonstrated c-Jun binding to the Irf8 promoter, with Irf8 in turn driving CD36 transcription.
• AP-1/c-Jun blockade with T5224 selectively suppressed expansion of CD36-positive fibroblast subclusters and reprogrammed their transcriptional state toward a less fibrotic phenotype.