Plastic Surgery Weekly

An exploratory retrospective cohort of 34 consecutive patients compared vascularized (n=6) with non-vascularized (n=28) motor nerve to vastus lateralis grafts for reconstruction of the upper division of the facial nerve after radical parotidectomy. Return of graft-driven eye closure was assessed on structured videotaped recordings, with a median follow-up of 15.0 months.

• Most patients receiving a vascularized graft demonstrated re-innervation of the coapted zygomatic branches, and the time-to-event comparison favoured vascularization (log-rank p<0.0001).
• Secondary oculoprotective procedures were needed in 1 of 6 vascularized versus 10 of 28 non-vascularized cases.
• The cohort was heavily irradiated, with 29 of 34 patients (85%) receiving preoperative or adjuvant radiotherapy; coaptation was performed distal to the zygomatic branches innervating orbicularis oculi in every case.

A retrospective single-centre series of 200 consecutive delayed unilateral, three-zone, single-pedicled DIEP flap reconstructions graded superficial venous midline crossover on preoperative CT angiography as Grade I (poor) or Grades II to III (good). Grades were correlated with intraoperative congestion, SIEV anastomosis laterality, and postoperative outcomes.

• Good crossover was seen in 120 flaps (60.0%) and poor crossover in 80 (40.0%); additional SIEV anastomosis was required in 59 cases (29.5%), and crossover grade did not predict that need (p=0.841).
• Crossover grade strongly predicted drainage laterality: Grade I anatomy was managed with contralateral drainage in 20 of 22 cases, whereas Grades II to III favoured ipsilateral drainage in 28 of 37.
• Among flaps that received additional superficial drainage, postoperative venous congestion showed no association with anastomosis laterality (p=1.00).

A systematic review of 46 studies totalling 3380 anterolateral thigh and 50 parascapular flaps pooled binary donor-site outcomes including hematoma, seroma, delayed healing, dehiscence, weakness, functional deficit, and numbness. Rates were compared with Fisher's exact or chi-square tests.

• Donor-site numbness was more common after ALT harvest, at 51.7% versus 26.3% for parascapular flaps (p=0.01).
• Functional deficit was more common after parascapular harvest, at 10.0% versus 1.5% for ALT flaps (p=0.04).
• No other outcome differed significantly, with ALT rates of dehiscence 9.6%, delayed healing 7.5%, weakness 5.0%, seroma 4.5%, and hematoma 1.3% against parascapular rates of 16.7%, 10.0%, 10.0%, 8.0%, and 0%.

A single-centre, single-blinded randomized controlled trial of 60 patients undergoing head and neck tumour resection with free flap reconstruction allocated participants 1:1 to intraoperative remote ischemic preconditioning (four 5-minute cycles of upper extremity occlusion) or sham. Ten plasma cytokines were measured preoperatively, 6 hours after the intervention, and on the first postoperative day.

• At every individual sampling point, no cytokine differed significantly between the preconditioning and sham groups.
• TNF-α, IL-6, IL-8, IL-12p70, and IFN-γ all showed significant change from preoperative levels to the first postoperative day (p<0.001 for each), consistent with a marked perioperative inflammatory response in both arms.
• The authors conclude that remote ischemic preconditioning does not attenuate pro-inflammatory cytokine release in this population.

A systematic review of 45 studies comprising 2586 patients published between January 2000 and September 2025 compared surgical technique, complication profiles, and reporting quality across an earlier period (2000 to 2010) and a later period (2011 to 2025). Studies required more than three patients and gender affirmation as the indication.

• Radial forearm free flap phalloplasty accounted for 65.3% of all cases, and tube-in-a-tube neourethral reconstruction fell from 85.8% in the earlier period to 64.4% in the later one (p<0.01).
• The later cohort showed a significant increase in pedicled flap use, in radial forearm free flap urethroplasty alone, and in sensory reconstruction (all p<0.01).
• Complication burden barely shifted, at 0.74 and 0.66 complications per patient across the two periods, with urethral fistula in 25.7% then 36.6% and stricture in 16.1% then 12.8%.
• Functional endpoints including urinary function, tactile and erogenous sensation, and cosmesis were poorly and inconsistently reported throughout.

Retrospective cohort of 82 patients with unilateral cleft lip repaired by a single senior surgeon between 2010 and 2019, all with at least five years of follow-up (median surgical age 4.1 months, median follow-up 5.87 years). Standardized frontal and submental photographs were assessed with predefined anthropometric indices and compared against age- and sex-matched normal individuals.

• Philtrum and columellar angles, philtral height ratio, nostril width ratio, and nasal alar to oral width ratio all improved significantly (p < 0.001) from preoperative values and approached those of unaffected individuals.
• The postoperative nostril sill ratio was 0.93 (IQR 0.84–1.13), showing no significant difference from matched normal individuals at long-term follow-up.
• Regression analysis identified cleft severity as the only factor independently associated with residual nostril width asymmetry; scars remained camouflaged along the philtral column with preserved nasolabial contours.

Retrospective single-institution review of 23 patients treated between 2010 and 2024 for complex knee periprosthetic joint infection who underwent muscle flap coverage followed by flap re-elevation for repeat joint access. Re-elevations were analyzed at the event level and infection and joint outcomes at the patient level.

• Across 39 re-elevation events (mean 1.69 per patient, range 1 to 5), flaps were viable at re-entry in 38 of 39 events (97.6%) and were successfully re-inset in every case, with no partial or total flap loss.
• Procedure-level wound complications were predominantly minor, comprising superficial dehiscence and delayed healing at 7.7% each, draining ulceration at 5.1%, and deep dehiscence in 2.6%.
• At last follow-up, 65.2% of patients achieved functional joint preservation, while recurrent periprosthetic joint infection occurred in 39.1%, indicating that flap reliability and infection cure diverge.

Systematic review and meta-analysis of 7 comparative studies comprising 1553 patients (807 receiving antimicrobial-impregnated sutures, 746 controls) undergoing plastic surgical procedures. Surgical site infection rates were pooled using a random-effects model and reported as risk ratios, with secondary analysis of wound healing and cosmetic outcomes.

• Antimicrobial-impregnated suture use was associated with an overall surgical site infection risk ratio of 0.68 (95% CI 0.51–0.90, P = 0.0066) compared with conventional sutures.
• The reduction was significant in abdominal procedures (RR 0.51, 95% CI 0.35–0.74) but not in breast surgery (RR 0.71, 95% CI 0.44–1.15, P = 0.1657).
• A pooled cosmetic outcome analysis favored antimicrobial sutures, but the reported risk ratio of 0 (95% CI 0–0.2058) reflects zero events in one arm and is statistically unstable.

Retrospective comparative study of 39 patients who underwent radial forearm free flap reconstruction for head and neck defects and received skin grafting for donor-site coverage. Ipsilateral inner-arm full-thickness grafts were compared with lateral-thigh split-thickness grafts using dE2000 colour disparity scores and gray-level co-occurrence matrix texture metrics.

• Colour disparity from adjacent normal skin was lower with full-thickness grafting (dE2000 4.9 ± 3.5 versus 8.8 ± 3.8, P = 0.002), corresponding to "very good" versus "fair" on published reference bands.
• Texture analysis favored the full-thickness group, with higher homogeneity (0.46 ± 0.10 versus 0.36 ± 0.11, P = 0.004) and lower entropy (6.0 ± 0.6 versus 6.5 ± 0.8, P = 0.043).
• Contrast did not differ between groups (108.3 ± 26.3 versus 110.9 ± 40.7, P = 0.814), suggesting the advantage lies in surface uniformity rather than in overall tonal range.

Retrospective series of 9 patients (mean age 66.7 years) treated between 2012 and 2022 for advanced cervicothoracic malignancy. Reconstruction after cervical exenteration and anterior mediastinal tracheostomy followed a proposed framework of primary goals (form and function), secondary goals (intraoperative complication prevention), and tertiary goals (long-term structural maintenance).

• Single-stage restoration of airway and alimentary continuity was achieved in 8 of 9 patients (88.9%) using free jejunal flap or gastric pull-up with inferolateral tracheal transposition.
• Secondary goals of preventing great vessel rupture and catastrophic mediastinitis were met in all 9 patients, which the authors attribute to the pillowing effect of the jejunal mesentery and the pectoralis major muscle wrap.
• Tertiary goals were met in 7 of 9 cases; the one postoperative flail chest followed use of a thinner fasciocutaneous flap, prompting a stated preference for the pectoralis major musculocutaneous flap in massive defects.

Prospective case series of 6 patients (12 injured digits) with multiple digital soft tissue defects reconstructed in a single stage using the "like-with-like" split toe flap, incorporating layered debridement, a three-anchor-point flap design, and microanastomosis to proper digital arteries and superficial or dorsal digital veins.

• All flaps survived completely over a mean follow-up of 10.2 ± 2.8 months, with 12 digits resurfaced through a single-pedicle multiple-flap design.
• Sensory recovery reached a mean static two-point discrimination of 4.9 ± 0.8 mm, and patient-reported satisfaction averaged 9.2 ± 0.7 on a visual analogue scale.
• Donor foot function was clinically preserved, but the uniform AOFAS score of 100 in every patient indicates a ceiling effect that limits what the instrument could detect.

Retrospective propensity-matched cohort of 2181 patients aged 65 years or older with closed distal radial fractures, comparing volar locked plating (1375 matched patients) with dorsal bridge plating (275 patients). Outcomes included six-month range of motion, radiographic parameters, PROMIS scores, and complications.

• Multivariate analysis showed greater flexion, extension, radial and ulnar deviation, supination, pronation, and grip strength in the volar plating group, along with higher PROMIS physical function and pain interference scores.
• At six months, volar plating was associated with greater radial inclination (21.2 versus 20.3 degrees) and lower articular step-off (0.76 versus 0.86 mm), with comparable volar tilt and radial height.
• Dorsal bridge plating carried higher rates of malunion (6.2 versus 3.0%), nonunion (4.0 versus 2.0%), and tendon rupture (2.5 versus 0.9%), while revision surgery and infection rates were similar between groups.
• Even after matching, the bridge plating group contained a higher proportion of AO/OTA 23-C intra-articular patterns and fewer 23-A patterns than the volar plating group.

Multicenter retrospective case series of 80 patients with 91 affected hands, identified from electronic records at three hospitals on the basis of vascular abnormalities and ischemic hand symptoms. Digital subtraction angiograms were classified with the existing Kaji system, and an expanded classification adding aneurysmal deformation and radial artery involvement was proposed.

• Most hands showed stenotic or occlusive ulnar artery disease, while 7 cases had an ulnar artery aneurysm and 3 had concomitant radial artery occlusion, patterns the original Kaji system does not encode.
• Type of stenosis showed no significant association with most presenting symptoms, with numbness the single exception (p = 0.009).
• Severe presentations such as digital necrosis were more frequent when the radial artery was also occluded, although this trend did not reach statistical significance.

This single-centre retrospective review of 34 patients treated between 2016 and 2020 assessed surgical excision of benign soft tissue tumours causing upper extremity nerve compression, comparing preoperative and six-month postoperative DASH and visual analogue pain scores.

• Lipoma (n = 13) and schwannoma (n = 7) were the most common pathologies, and median DASH improved from 41 to 15 between the preoperative assessment and six months.
• Median visual analogue pain score decreased from 6.5 to 2.0 over the same interval, with a correspondingly narrower interquartile range.
• Preoperative motor neuropathy (n = 9), larger tumour volume and diabetes mellitus (n = 8) were each associated with worse postoperative functional scores (p < 0.05).
• No major complications or recurrences were recorded during the six-month follow-up period.

A double-blinded randomized controlled trial of 79 patients undergoing upper extremity surgery compared a fixed tourniquet pressure of 250 mm Hg with a systolic blood pressure-based protocol adding 60, 80 or 100 mm Hg according to baseline pressure. Outcomes were intraoperative pressure adjustments, surgeon-rated field quality and patient-reported tourniquet pain.

• Mean tourniquet pressure in the intervention arm was 192.8 ± 27.3 mm Hg compared with the fixed 250 mm Hg used in controls.
• Quality of the bloodless field was comparable between arms (93.8% versus 97.9%, p = 0.56), and no major complications occurred in either group.
• Patient-reported tourniquet pain did not differ (1.60 ± 2.50 versus 2.14 ± 2.34, p = 0.27), and intraoperative pressure adjustment was needed in only 2.1% of cases, all in the intervention arm.

A retrospective cohort study of patients diagnosed with carpal tunnel syndrome between 2010 and 2019 in the TriNetX Research Network examined the incidence of amyloidosis within six years and tested 30 hypothesized preexisting risk factors, analysing men and women separately in yearly increments.

• Of the 30 candidate risk factors, 18 in men and 19 in women aged 50 and older were associated with an increased likelihood of amyloidosis within six years of the carpal tunnel diagnosis.
• Heart failure was the strongest risk factor in both sexes, though the absolute risk difference was substantially lower in women (261 per 100,000) than in men (702 per 100,000).
• Even for the strongest predictors, absolute risk differences remained in the range of hundreds per 100,000, so the enriched groups still comprise a small minority of carpal tunnel patients.

A prognosis systematic review and meta-analysis of 199 studies comprising 15,636 patients and 578 healthy controls pooled electrodiagnostic, quantitative sensory, strength, nerve fibre density and patient-reported outcomes after carpal tunnel release, stratified into time windows from under two months to beyond twelve months.

• Grip and pinch strength showed no marked recovery until 5 to 7 months after surgery, despite earlier improvement in symptom scores.
• Relative to healthy controls, operated patients retained persistent deficits in several electrodiagnostic measures even one year after release.
• Impairments in warm, vibration and mechanical detection thresholds persisted for up to six months postoperatively before approaching normal values.
• Improvement was time-dependent across most domains, yet key measures including intraepidermal nerve fibre density and electrodiagnostic parameters often remained below normal at final assessment.

A single-institution observational case series of 28 patients treated between 2004 and 2022 for arthroscopically confirmed volar scapholunate ligament tears underwent volar capsulodesis with or without dorsal repair, stratified by static versus dynamic/predynamic diastasis and by isolated volar versus combined volar and dorsal injury.

• At a mean follow-up of 86.3 months, mean DASH was 16.4 and PRWE 24.6, and 15 of 19 patients (78.9%) returned to their prior employment.
• Postoperative motion averaged 56 degrees of flexion and 61 degrees of extension, with grip strength at 78.8% of the contralateral side (n = 14).
• Scapholunate widening greater than 3 mm was seen in 2 of 6 static injuries and none of the dynamic/predynamic injuries (p = 0.165); radial deviation was greater in the dynamic/predynamic group.
• Complications were limited to two surgical site infections, with two patients requiring secondary surgery for persistent pain at a median of 48 months.

A therapeutic prospective single-arm cohort of 14 patients with persistent first carpometacarpal joint pain received embolic agents delivered by microcatheter into the radial artery, with visual analogue pain scores collected at baseline and at 1 and 6 months.

• Mean visual analogue score fell from 8.0 at baseline to 3.1 at one month and 2.6 at six months, significant at both checkpoints on Wilcoxon signed-rank testing.
• 79% of patients achieved at least a 50% reduction in visual analogue score by the end of the study period.
• No major adverse outcomes were reported, and procedural success was defined by abolition of arterial blush following embolization.

A systematic review of 17 studies published between 2000 and 2023 evaluated corrective osteotomy for extra-articular distal radius malunion, comparing volar with dorsal approaches and grafted with ungrafted fixation using patient-reported outcome measures, radiographic parameters and complication rates.

• Ten studies reported volar plate fixation, five with and five without bone grafting, and both groups improved significantly in patient-reported outcomes, radiographic measures and grip strength.
• Four ungrafted series reported zero cases of nonunion, while one study was discontinued because of persistent malunion in 20% of cases; one comparison found no difference between autologous and synthetic grafts.
• In the two studies that directly compared approaches, the volar approach yielded significantly greater wrist flexion (p = 0.012) and fewer hardware-related complications than dorsal plating.

A meta-analysis of five randomized trials, four of which contributed 336 patients to the primary per-patient analysis, compared bromelain-based enzymatic debridement with standard of care in acute deep partial- and full-thickness thermal burns. The primary outcome was the proportion of patients requiring surgical excision, pooled with random-effects models.

• Surgical excision was needed in far fewer patients after enzymatic debridement than after standard care (RR 0.11, 95% CI 0.06–0.23), with no measurable heterogeneity across the four per-patient trials.
• The pooled absolute risk reduction of 65% corresponds to a number needed to treat of 1.5 to avoid one operative excision.
• Enzymatic debridement was also associated with reduced autograft use and shorter time to debridement, while blinded scar assessments at 12 months were comparable to or better than standard care.

A retrospective cohort of 127 children treated between 2014 and 2024 compared composite grafting with decellularized allogeneic dermis plus a thin autologous split-thickness graft (n=74) against thick autologous split-thickness grafting alone (n=53) for joint-area scar contracture. Perioperative measures and 12-month outcomes were analysed with multivariable regression to adjust for baseline differences.

• Donor-site healing time was shorter in the composite group (6.91 ± 0.29 versus 10.26 ± 2.60 days, P<0.001), and donor-site Vancouver Scar Scale scores were zero at both 6 and 12 months.
• Recipient-site scar scores improved over time in both groups, but the degree of improvement did not differ significantly between them.
• Joint range of motion recovered satisfactorily and complication rates were similar; the authors attribute the donor-site advantage to thin scalp harvesting rather than the dermal substitute itself.

A single-centre retrospective analysis of 2566 patients with scald burns compared cooling first aid, defined as running tap water and/or Burnshield hydrogel applied within 8 hours of injury, against inappropriate or absent first aid, with outcomes including time to epithelialization, debridement, grafting, systemic antibiotics and admission.

• Median time to complete epithelialization was 11 days with cooling first aid versus 16 days in both the inappropriate and no-first-aid groups (p < 0.001).
• Cooling first aid was associated with lower rates of debridement, grafting, systemic antibiotic use and hospitalization (17.1%, 5.2%, 11.8% and 17.3% respectively; all p < 0.001).
• Tap water combined with hydrogel produced the shortest median healing time at 10 days and the lowest intervention rates of any first aid strategy.
• Healing was slower in geriatric patients (median 17 days) than in paediatric and adult patients (12 days each), and admission within 24 hours was associated with better outcomes.

A multicenter propensity-matched cohort of 813 patients with major burn injury treated at 12 verified US burn centers between June 2022 and June 2025 compared testosterone, oxandrolone, human growth hormone, and no anabolic supplementation on weight maintenance, length of stay, mortality, and thrombotic complications.

• Anabolic supplementation showed no association with improved inpatient weight maintenance compared with no supplementation (p = 0.064), and median weight change did not differ between groups.
• Patients receiving anabolic therapy had longer hospital and intensive care unit stays (p = 0.026).
• Overall mortality was similar between treated and untreated patients (p = 0.885), but mortality was higher with oxandrolone than with testosterone (p = 0.001).
• Anabolic therapy was associated with higher rates of venous thromboembolic events (p = 0.019).

A single-center retrospective study of 176 burn inpatients admitted to a Japanese advanced critical care and emergency center between April 2018 and March 2024 compared pre-transfer burn surface area estimates from ambulance crews or referring hospitals with post-transfer specialist assessment, using both qualitative and quantitative frameworks.

• Of the admitted patients, 134 (76.1%) arrived directly from the scene by ambulance and 42 (23.9%) were transferred from other hospitals.
• Pre-transfer estimates systematically exceeded specialist post-transfer assessments in both the direct transport and inter-hospital transfer groups.
• The direction of error favored over-triage rather than under-triage, and the authors judged the magnitude of overestimation to be clinically unimportant, supporting the current referral pathway.

A retrospective single-center series of 22 pediatric and adult patients treated between January 2021 and September 2025 assessed a reconstruction strategy prioritizing functional stability over isolated deformity correction, with outcomes rated on a 5-point Likert scale alongside functional evaluation of photographs, video, and radiographs.

• Across 28 operative sessions, more than 100 individual procedures were performed, including contracture release, tendon transfer, joint fusion, graft and flap coverage, nerve procedures, and amputation or reconstruction of absent digits.
• Pediatric patients underwent repeated procedures more often than adults, attributed to skeletal growth and contracture recurrence.
• Satisfaction scores improved significantly in both pediatric and adult groups, with the largest gains reported in functional stability, hand use, and aesthetic appearance.
• Functional recovery remained limited in long-standing deformities, even though overall hand utility and patient or caregiver satisfaction still improved.

A narrative review of delirium in burn patients synthesizing epidemiology, risk factors, diagnostic challenges, management, and prevention across pediatric and adult populations, with emphasis on features specific to burn care rather than general critical illness.

• Burn-specific mechanisms include intense systemic inflammation, blood–brain barrier disruption and neuroinflammation, neurotransmitter imbalance, and impaired cerebral energy metabolism.
• Delirium presents as hyperactive, hypoactive, or mixed phenotypes, and the review identifies recognition and diagnosis as a persistent challenge in this population.
• The condition is associated with prolonged hospitalization, increased morbidity and mortality, and possible lasting cognitive and psychological effects.
• Care-related contributors are prominent, including frequent painful procedures, heavy sedation and analgesia requirements, and the inherent risks of ICU admission.

A retrospective cohort of 3282 burn patients initially admitted to or treated at an ABA-verified burn unit within a level 1 trauma center between 2017 and 2025 compared recipients of fractional CO2 laser therapy with non-laser controls, using multivariable regression to identify predictors of treatment, time to initiation, and number of sessions.

• Only 290 patients (8.8%) received fractional CO2 laser therapy; recipients were younger, more often female, more often Hispanic/Latino or Asian, and predominantly insured through Medicaid.
• In multivariable analysis, younger age, female sex, and insurance status raised the odds of treatment, while non-White racial and ethnic groups collectively had lower adjusted odds than White patients (OR 0.939, P < 0.001).
• Among recipients, greater TBSA, psychiatric history, and insurance status predicted a higher number of laser sessions.
• Psychiatric history was associated with earlier initiation of therapy, whereas younger age was associated with a longer interval to the first session.

A prospective cohort of 274 adults admitted to a tertiary burns centre in Queensland, Australia between October 2015 and December 2017 was assessed with the PHQ-9 and PTSD Checklist-Civilian at baseline and 3, 6, and 12 months post-burn, with trajectory modelling used to identify distinct symptom groups.

• Depression symptoms resolved into three distinct PHQ-9 trajectories: 'Always Mild', 'Always Moderate', and 'Moderately-Severe to Moderate'.
• PTSD symptoms resolved into three parallel PCL-C trajectories: 'Always Low', 'Always Moderate', and 'High to Moderate'.
• Pre-injury mental health diagnoses and intentional injuries were observed more frequently in both the most symptomatic depression and PTSD groups.
• Although symptoms declined overall, two of the three groups in each domain never reached the low symptom range, so aggregate improvement conceals subgroups with sustained burden.

A prospective observational study of 24 burn ICU patients treated with meropenem or piperacillin/tazobactam between 2023 and 2025 generated 84 plasma drug levels paired with measured creatinine clearance and MIC data, comparing 100% ƒT > MIC target attainment with and without augmented renal clearance (creatinine clearance > 130 mL/min).

• Using isolate-specific MICs, target attainment was 100% without augmented clearance versus 71.4% with it (OR 0.019, 95% CI 0.001–0.38, p < 0.001).
• Using EUCAST breakpoint MICs, the corresponding attainment was 74.6% versus 38.1% (OR 0.21, 95% CI 0.07–0.60, p = 0.004), so breakpoint-based thresholds were frequently subtherapeutic.
• Exploratory analyses linked preserved renal function and lower organ failure scores to subtherapeutic drug levels, placing the least physiologically deranged patients at greatest risk of underexposure.

A systematic review of 100 studies with meta-analysis of 42 comparative studies covering 9704 flaps examined factors predictive of postoperative fat necrosis after DIEP flap breast reconstruction. Pooled risk ratios were derived for variables supported by at least four comparative studies.

• Intraoperative indocyanine green fluorescence was associated with lower fat necrosis risk (RR 0.64, 95% CI 0.49–0.83), while preoperative CT angiography was not significantly associated (RR 0.60, 95% CI 0.33–1.11).
• Perforator strategy mattered: flaps based on lateral row perforators alone carried lower risk than mixed medial and lateral designs (RR 0.59, 95% CI 0.43–0.82), as did harvesting two or more perforators (RR 0.68, 95% CI 0.48–0.96).
• Venous outflow augmentation with the SIEV showed the largest single reduction (RR 0.48, 95% CI 0.28–0.84).
• Risk was higher with unilateral than bilateral reconstruction (RR 1.53, 95% CI 1.13–2.06) and with BMI of 25 or above (RR 1.60, 95% CI 1.05–2.43).

A retrospective comparative study of 100 consecutive patients after massive weight loss (64 autoaugmentation, 36 implant-based augmentation mastopexy) compared complication and revision rates with postoperative BREAST-Q scores, 36-item Short Form Health Survey scores, and aesthetic outcomes at a median follow-up of 2.8 years.

• The autoaugmentation group scored significantly higher on BREAST-Q Satisfaction with Breasts and Satisfaction with Outcome (both P < 0.001) and on most aesthetic evaluation criteria.
• By Clavien-Dindo classification, complications in the autoaugmentation group were mainly managed conservatively, while most implant-group complications required surgical revision (P = 0.009).
• Recurrent ptosis occurred more frequently in the implant group during follow-up.
• The 36-item Short Form Health Survey showed no significant differences between the two groups, indicating comparable generic health-related quality of life.

A prospective cohort of 108 patients undergoing 134 immediate DIEP flap reconstructions over a 3-year period compared those who received postmastectomy radiotherapy (n = 53) with those who did not (n = 55). Endpoints were surgical complications, panel-rated aesthetic scores from standardized photographs, and BREAST-Q patient-reported outcomes.

• Major and minor surgical complications were similar between irradiated and non-irradiated reconstructions, and the rate of clinically significant fat necrosis was low in both groups.
• Surgeon panel global aesthetic scores were high and statistically indistinguishable (8.58 without radiotherapy versus 8.17 with radiotherapy; P = 0.218).
• Overall BREAST-Q satisfaction with outcome was equivalent (87 versus 86), whereas satisfaction with breasts was lower in the irradiated group (84 versus 76; P = 0.039).
• Most patients in both groups underwent at least one further surgical episode to finalize the aesthetic result.

A retrospective cohort of 241 patients treated between 2017 and 2024 compared the flap after short tissue expansion (FAST) protocol (n = 26) with immediate (n = 162), traditional staged (n = 35), and delayed (n = 18) autologous reconstruction. Multivariable logistic regression modelled complication odds across the four timing strategies.

• Traditional staged reconstruction carried significantly higher adjusted odds of infection than the FAST protocol (P = 0.02), which the authors attribute to shorter prosthesis dwell time.
• Immediate reconstruction was associated with higher adjusted odds of mastectomy skin necrosis than FAST (P = 0.01) and with longer mean operative time (P = 0.03).
• Donor-site complications, hospital length of stay, unplanned readmissions, and reoperations showed no differences between the four cohorts.

A retrospective analysis of 1934 mastectomy specimens from consecutive breast cancer patients operated between 2010 and 2022 weighed each specimen and related breast weight to BMI and patient age. The aim was to derive a data-driven reference range separating normal breast size from hypertrophy and gigantomastia.

• BMI accounted for approximately 60% of the variation in breast weight (R² = 0.588), whereas patient age accounted for less than 2% (R² = 0.017).
• Mean breast weight rose almost perfectly linearly across BMI categories (R² = 0.988), with a single breast averaging 1 kg at a BMI of 31 kg/m².
• A single breast represented 0.5% of body weight at BMI 15, 1% at BMI 27, and 1.5% at BMI 38, indicating that breast mass scales faster than body mass.
• Weights were approximately normally distributed within BMI strata, and 95.7% of specimens fell within two standard deviations of the BMI-adjusted mean, the threshold proposed to define normal size.

A single-institution comparative study of 161 patients irradiated after mastectomy or lumpectomy between 2021 and 2024 compared 80 reconstructed cases (29 implants, 51 tissue expanders; 41 prepectoral, 39 subpectoral) with 81 non-reconstructed cases. Endpoints included mean heart dose, irradiated lung volume, cold and hot spot volumes, internal mammary node coverage, and time to treatment.

• Both prepectoral and subpectoral reconstructions were associated with increased mean heart dose and reduced volume of cold spots compared with non-reconstructed chest walls.
• Subpectoral placement was associated with reduced ipsilateral lung dose relative to no reconstruction, which is most relevant when internal mammary nodes require treatment.
• Prepectoral devices were the configuration most frequently associated with omission of internal mammary node coverage.
• Time to radiotherapy, nodal coverage, expander deflations, and complications showed no differences by device type or position.

A prospective comparative study of 87 patients undergoing mastectomy with direct-to-implant reconstruction assessed 195 measurement units, comprising nipple-areola complex and peri-incisional skin, using both laser speckle contrast imaging and indocyanine green fluorescence intraoperatively and postoperatively. Perfusion values were compared against subsequent flap survival or necrosis.

• Perfusion values differed significantly between surviving and necrotic flaps with both imaging modalities.
• Laser speckle contrast imaging was the more sensitive test for impending necrosis (87.10% versus 81.82% for indocyanine green).
• Indocyanine green achieved higher specificity (80.42% versus 71.60%) but was limited to a single intraoperative injection.
• Laser speckle perfusion thresholds for necrosis were 37.93% intraoperatively and 22.84% postoperatively, and the dye-free technique permitted repeated postoperative measurement.

A retrospective series of 75 consecutive patients who underwent breast implant explantation with mastopexy and dermoglandular flap autoaugmentation between 2019 and 2024 was reviewed at a mean follow-up of 16 ± 6 months. Univariate and exploratory multivariable analyses assessed factors associated with recurrent ptosis.

• Explantation was prompted by implant illness or ASIA-related symptoms in 31% of patients, followed by rupture (24%), grade III to IV capsular contracture (23%), and aesthetic concerns (20%).
• Lateral dermoglandular flaps were used in 72% of cases, with inferior (20%), superior (7%), and bipedicled (1%) designs making up the remainder.
• The overall complication rate was 15%, with recurrent ptosis in 4% of patients and pseudoptosis or bottoming-out in a further 4%.
• Patients with recurrent ptosis had larger explanted implant volumes (P < 0.05), an association the authors themselves label exploratory given the small number of events.

A prospective multicentre cohort of 269 patients undergoing 362 implant-based breast reconstructions supported by non-resorbable titanized polypropylene mesh (TiLOOP Bra) was followed within the PRO-BRA trial. Complication rates 24 months after reconstruction were analysed by univariable and multivariable logistic regression to identify risk factors.

• On univariable analysis, implant volume and BMI were associated with complications overall as well as with seroma and wound complications specifically.
• Adjuvant radiotherapy was associated with capsular fibrosis, and adjuvant chemotherapy with infection or inflammation.
• Age of 50 years or over and a higher Charlson Comorbidity Index tracked seroma formation, while transverse or vertical incisions were linked to wound complications.
• In multivariable analysis, only neoadjuvant chemotherapy persisted as an independent risk factor for complications.

A prospectively collected cohort of 474 women undergoing unilateral axillary lymph node dissection for breast cancer at a single cancer centre between 2016 and 2024 was used to train and internally validate supervised machine learning models alongside multivariable logistic regression. Performance was compared using AUC, accuracy, sensitivity, specificity, and Brier score.

• Lymphedema developed in 23.8% of patients at a mean of 16.6 ± 7.5 months after surgery.
• The best-performing machine learning model, a random forest, reached an AUC of 0.83, against an optimism-corrected AUC of 0.62 for multivariable logistic regression.
• Shapley additive explanations identified clinical cancer stage, body mass index, age, and neoadjuvant chemotherapy as the dominant predictors of lymphedema.

This propensity-matched analysis of the TriNetX electronic health record network compared 90-day outcomes in adults with and without nicotine dependence undergoing body contouring between 2005 and 2025 (matched retrospective cohort of 34,130 patients, 17,065 per arm, drawn from 110,287 identified cases). Endpoints included wound complications, complications requiring operative intervention, seroma, venous thromboembolism, and opioid prescriptions.

• Patients with nicotine dependence had significantly higher odds of wound complications at 90 days, including wound complications requiring return to the operating room.
• Postoperative opioid prescriptions were more frequent in the nicotine-dependent cohort, as was seroma formation.
• No between-group difference in venous thromboembolism was observed, in contrast to the consistent excess in wound-related endpoints.
• The abstract reports directions of effect without absolute rates or odds ratios, so the clinical magnitude of each association cannot be judged from the published summary.

Retrospective cohort of 167 consecutive patients undergoing deep-plane facelift with dual-plane deep reduction neck lift, of whom 95 met the Auersvald criterion for short neck (neck-clavicle distance ≤24% of vertex-clavicle height) and were analyzed. The technique combined deep neck reduction, hyoid fasciotomy, complete platysma transection, and differential repositioning of the cranial and caudal platysma segments.

• The mean postoperative-to-preoperative anterior neck length ratio was 2.49 ± 0.11 (p < 0.001), and every patient was judged to have improved cervical contour.
• FACE-Q assessment found 94.7% of patients very satisfied, and blinded evaluators estimated a mean perceived age reduction of 16 years.
• Complications were limited to transient neuropraxia in 4.3% and sialoma in 3.1%, with no permanent sequelae reported.

Manufacturer-sponsored prospective, multicenter, single-arm postmarketing study of 101 patients undergoing bilateral primary augmentation with lightweight B-Lite implants (200-755 cc, round or anatomical) through inframammary incisions. The primary endpoint was at least a one bra-cup increase at 12 months, with quality of life, satisfaction, and adverse events as secondary endpoints through 3 to 5 years.

• At 12 months, 92% of patients achieved at least a one-cup increase (95% CI, 84%-97%).
• No Baker III/IV contracture, implant rupture, or BIA-ALCL occurred; the most frequent adverse event was transient sensory change in 8.9%.
• Kaplan-Meier reoperation risk was 6.9% at 1 year and 9.9% at 5 years.
• Patient satisfaction averaged 98.6% with 0% regret, with durable gains in body esteem and self-esteem while SF-36 composites remained stable.

Retrospective review of 643 consecutive patients undergoing bilateral superomedial pedicle reduction mammaplasty for macromastia between January 2004 and December 2024. Logistic regression tested age, BMI or obesity class, smoking, hypertension, and diabetes as predictors of minor complications (delayed healing, infection, seroma, hematoma, necrosis) and major complications (readmission or reoperation).

• The overall complication rate was 22.2% (15.4% minor, 6.8% major) across a mean follow-up of 5.5 years.
• All obesity classes predicted minor complications and delayed healing, whereas only classes II to III predicted any complication and infection; each 1 kg/m² increase in BMI predicted any complication, minor complications, and delayed healing.
• Smoking predicted major complications and reoperation, and hypertension predicted any complication and readmission.
• Total resection weight was not a predictor of most complications, with nipple necrosis the single exception.

Single-surgeon retrospective chart review of 38 patients (72 nipples) undergoing the Lahey modification, an inferiorly based bell-curve pedicle adapted from the modified Robertson reduction technique, for gender-affirming top surgery from October 2018 to November 2024. Outcomes were stratified by resection weight above or below the cohort mean of 571.5 g to inform patient selection.

• Partial necrosis occurred in seven of 72 nipples (9.7%), and no patient experienced complete nipple loss.
• Decreased sensation was recorded in seven nipples (9.7%) and complete sensory loss in one nipple (1.4%), with retained piloerection reported in the remainder.
• Satisfaction was described as high but was assessed subjectively, without a validated patient-reported outcome instrument.

Retrospective study of 184 women with ptotic breasts (Regnault classification) undergoing vertical short-scar reduction between September 2021 and December 2024, relating intraoperatively recorded excision weight to cup size change assessed at follow-up visits up to 3 months. Patients with prior breast lumps or cancer were excluded.

• Excised tissue ranged from 200 g to 800 g and yielded reductions of 1 to 4.5 cup sizes, with substantial scatter between patients.
• No direct correlation was observed between resected tissue weight and final cup size.
• The authors attributed the dispersion to breast density, composition, and anatomical variation, and argued for planning based on imaging and anthropometric measurement rather than target weight alone.

Retrospective analysis of a randomized comparative cohort of 82 patients aged 18 to 40 undergoing primary double-eyelid blepharoplasty between June 2023 and October 2024, assigned to septoaponeurotic junctional thickening (n = 42) or the bridge technique (n = 40). Outcomes included operative time, edema resolution, complications, objective aesthetic results at 6 and 12 months, dynamic eyelid movement score, and patient satisfaction.

• The septoaponeurotic junctional thickening group had shorter operative time and faster postoperative edema resolution (P < 0.05).
• Overall improvement rates and patient satisfaction were comparable between groups at both 6 and 12 months.
• Dynamic eyelid movement scores favoured septoaponeurotic junctional thickening at 6 and 12 months.
• Crease attenuation or disappearance occurred in three of 42 septoaponeurotic cases and two of 40 bridge cases at 6 months; hematoma was numerically less frequent in the septoaponeurotic group without reaching significance.

Retrospective single-center cohort of 217 adults undergoing abdominoplasty after massive weight loss (excess weight loss ≥50%) at a single university hospital between 2012 and 2023. Multivariable linear and logistic regression identified factors associated with resection weight and tested whether resection weight predicted Clavien-Dindo complications.

• Mean resection weight was 1,727 g, and preoperative BMI showed the strongest bivariate association with it (Spearman r = 0.620).
• Preoperative BMI (209.9 g per kg/m²), female sex (+363.5 g), metabolic disease (+346.0 g), and concomitant belt lipectomy (+365.6 g) together explained 56% of the variance in resection weight.
• Complications occurred in 35.0% of patients; younger age (OR 0.969 per year) and preoperative anemia (OR 2.153) were independently associated with the composite endpoint.
• Resection weight was not associated with composite, major, or wound-specific complications (OR 1.015 per 100 g, P = 0.245).

A retrospective single-surgeon series of 45 consecutive patients treated between 2018 and 2023 evaluated preservation breast reduction, a technique using vertical dermal plication along the breast meridian plus en bloc inferior quadrant resection to elevate the NAC without pedicle dissection. Complications and 4-point Likert satisfaction were recorded at a minimum of 12 months.

• The NAC-to-inframammary fold distance fell from a preoperative mean of 17.5 cm to 8–10 cm and was reported as stable at follow-up, with the vertical dimension change driving base redefinition and restored projection.
• No cases of NAC necrosis occurred; morbidity was limited to one hematoma (2.2%) and three cases (6.6%) of localized, self-limited nodular adiponecrosis of roughly 2 cm along the vertical plication line.
• Candidate selection was reframed around a NAC-to-fold distance exceeding 15 cm rather than sternal notch-to-nipple distance, on the argument that this measure defines the ellipsoid bell-shaped morphology in which pedicle-based transposition becomes dispensable.
• Reported patient satisfaction was 91% on a 4-point Likert scale at 12 months or later, in a series where NAC elevation to the Pitanguy point was achieved without any dermoglandular pedicle dissection.

A retrospective cohort of 615 patients (461 women, 154 men, aged 18–60 years) treated in Bogotá between 2021 and 2024 assessed segmental liposuction performed with ultrasound guidance and preservation of the Scarpa fascia. Demographics, operative details, complications, and a 0–10 visual analogue satisfaction score were extracted.

• Mean aspirated volume was 3.4 L in a cohort with mean age 35.4 years and mean body mass index 24.6 kg/m², after exclusion of smokers, patients above 30 kg/m², and those with major comorbidity.
• Recorded complications amounted to six events across 615 cases, or under 1% overall: three seromas (0.49%), two hematomas (0.32%), and one infection (0.16%).
• The described approach couples ultrasound assessment and adipose compression with Scarpa fascia preservation, treating each anatomical segment separately so that the underlying muscular contours are delimited rather than uniformly debulked.

A retrospective cohort of 479 patients undergoing surgery for primary pelvic bone sarcoma between 2003 and 2023 compared a historical group (2003–2012) with a modern group (2013–2023). Postoperative complications, rates of return to theatre, and factors associated with improved outcomes were analyzed.

• Return to theatre within six weeks decreased from 22% in the historical cohort to 14% in the modern cohort (p=0.021), a change the authors attribute to accumulated small refinements rather than any single intervention.
• The ilioinguinal incision carried a 44% early return-to-theatre rate historically, compared with 10% for the question mark incision used in the modern cohort.
• Early return to theatre was comparable between prosthetic (17%) and non-prosthetic (13%) reconstructions (p=0.344), but the long-term rate remained significantly higher after prosthetic reconstruction (p=0.007).
• Concurrent changes over the study period included increased use of navigation and patient-specific implants, improved preoperative imaging and planning, and centralization of cases into higher-volume subspecialized teams.

A retrospective case series of 15 patients (mean age 63 years) reviewed a flap selection strategy using pedicled superficial circumflex iliac artery perforator flaps or pedicled anterolateral thigh flaps for perineal defects after wide excision of extramammary Paget's disease. Operative characteristics, complications, oncologic outcomes, and satisfaction were assessed.

• SCIP flaps were used in 10 patients for defects averaging 106 cm², while ALT flaps were reserved for the five largest defects at a mean of 245.2 cm², with selection driven by defect size, location, and patient characteristics.
• All 15 flaps survived, and the only reconstructive complication was one case of limited partial necrosis managed with secondary healing.
• Over a mean follow-up of 17.7 months, one patient (6.7%) recurred and subsequently developed distant metastasis and died; among the 14 survivors, 13 (92.9%) reported satisfaction with cosmetic and functional outcomes.

A post hoc artificial intelligence reanalysis of all 266 randomized STRASS patients trained a random survival forest to predict 5-year abdominal recurrence-free survival under radiotherapy plus surgery versus surgery alone, then fitted an optimal policy tree to partition patients by predicted treatment benefit. Model-defined subgroups were compared against the original STRASS and STREXIT subgroups within the same trial dataset.

• The policy tree split the cohort into seven subgroups, of which three (152 of 266 patients) were predicted to benefit from radiotherapy, and only two reached statistical significance.
• In those two subgroups combined, 3-year abdominal recurrence-free survival was 79% with radiotherapy versus 58% without (HR 0.40, 95% CI 0.22–0.71, p=0.0016), and cumulative abdominal recurrence was 17% versus 33% (HR 0.40, p=0.0090).
• A Cox model confirmed a significant radiotherapy-by-age interaction (p=0.012), whereas the previously proposed STRASS and STREXIT subgroups showed no significant benefit when re-evaluated within the trial data.

A systematic review of 10 studies identified across five databases through October 2025 appraised the methodological quality, risk of bias, and predictive performance of artificial intelligence and machine learning preoperative risk prediction models in plastic surgery using the PROBAST+AI framework.

• Discrimination ranged from AUC 0.66 to 0.82 among the eight studies reporting it, with random forest the most frequently used algorithm (four studies), followed by neural networks (two).
• Only 2 of 10 studies (20%) performed external validation, and seven of ten (70%) reported no model calibration at all, leaving predicted risks unanchored to observed event rates.
• 5 of 7 development studies (71.4%) had fewer than 10 events per variable, a sample size inadequate for the model complexity being fitted and a strong driver of overfitting.
• Applications clustered heavily in breast surgery, with seven of the ten studies addressing alloplastic (five) or autologous (two) breast reconstruction and single studies covering head and neck reconstruction, burns, and aesthetic surgery.

A cross-sectional comparative evaluation of 5 large language models (ChatGPT-4o, Gemini-2.5-Pro, OpenEvidence, Zhipu Qingyan, DeepSeek) tested ten high-priority perioperative questions rated by 23 pediatric urology experts and 36 primary caregivers under double-blind forced ranking. Reference authenticity was independently verified and an eight-reviewer audit graded clinical safety on a four-level severity scheme.

• Gemini-2.5-Pro ranked first with both audiences (expert median 5.0, caregiver median 4.0) and OpenEvidence ranked last (2.0 in both), with expert and caregiver rankings closely correlated (Spearman rho 0.89).
• Fabricated references were most frequent for DeepSeek (33%) and Zhipu Qingyan (24%), while OpenEvidence was 100% verifiable and Gemini-2.5-Pro fabricated none but relied on nonspecific guideline citations in 85% of instances.
• The safety audit produced 78 flags including nine severe-level flags across five question-model combinations, and OpenEvidence accounted for five of the nine severe flags despite its perfect citation record, dissociating bibliographic accuracy from clinical safety.

A qualitative interview study of 30 participants (20 patients and 10 clinical staff) nested within a randomized feasibility trial of digital surgical wound monitoring at two English cardiac surgery hospitals explored acceptability of the AI-based platform. Semi-structured interviews were analyzed using the theoretical framework of acceptability.

• Patients and staff were broadly supportive of AI-assisted wound monitoring, describing perceived gains in safety, access to review, and efficiency of the postoperative pathway.
• Participants expected the platform to enable earlier detection and treatment of wound complications and to make routine monitoring feasible for all patients rather than a selected subset.
• Reservations clustered around three themes: data security, staff over-reliance on AI, and loss of human interaction in postoperative follow-up.

An umbrella review of seven systematic reviews and meta-analyses synthesized cell-based and cell-free regenerative therapies for skin wound healing across clinical and preclinical studies, appraising methodological quality with AMSTAR-2 and study overlap with the corrected covered area.

• Mesenchymal stromal cell-derived extracellular vesicles produced large, consistent improvements in wound closure, angiogenesis, collagen deposition, and inflammatory modulation in animal models, yet no randomized human trials of vesicle-based wound therapy were identified.
• Clinically relevant benefit from cell-based therapy was confined to specific settings, namely autologous skin cell suspensions for burns and biologic skin substitutes for diabetic foot ulcers, with certainty of evidence rated low to moderate.
• The underlying evidence base was dominated by diabetic wound models, particularly preclinical animal work, so the synthesis speaks only indirectly to burns and other complex wound aetiologies.

A paired tissue study of 10 hypertrophic scar and normal skin specimens from burn patients assessed IL-17A and Wnt pathway-related molecules by immunohistochemistry and Western blot, with pharmacological confirmation in a rabbit ear scar model.

• IL-17A protein was significantly higher in hypertrophic scar than in paired normal skin from the same patients, while Wnt signalling pathway-related molecules were downregulated in scar tissue.
• In the rabbit ear model, Wnt pathway inhibitors aggravated hypertrophic scar development, whereas activators partially suppressed scar formation.
• The authors propose that IL-17A acts through cyclin D1 downstream of Wnt/β-catenin, linking chronic inflammation to the fibroblast phenotypic change seen in scarring.

A preclinical in vivo study in acutely injured and dystrophic mouse muscle compared RADA16-I hydrogels functionalized with SDF1 or IL4 mimicking peptides, injected alone or together with human iPSC-derived myoblasts, against the corresponding unmodified conditions.

• In acutely injured muscle, functionalized hydrogels engrafted successfully and produced improved treadmill outcomes alongside higher expression of myogenesis, angiogenesis, and neurogenesis markers.
• Co-injection of hydrogel with hiPSC-derived DMD myoblasts further increased these effects in the acute injury model, whereas in dystrophic muscle the transplanted cells were rapidly cleared and did not alter the result.
• In the dystrophic environment, only the SDF1-functionalized hydrogel raised myogenic, neurogenic, and angiogenic marker expression, so the host milieu determined which construct worked.

An in vitro study of keloid-derived fibroblasts combined network target overlap analysis, molecular docking and dynamics simulation, and treatment with ferulic acid at 20, 40, and 60 µM, with viability, flow-cytometric apoptosis, and Western blot readouts.

• Ferulic acid dose-dependently downregulated Bcl-xL and raised cleaved caspase-3 in keloid fibroblasts, accompanied by an increase in measured apoptosis.
• The apoptotic rate plateaued beyond 40 µM despite continued caspase-3 activation, which the authors read as a threshold-driven rather than linear mechanism.
• Docking and molecular dynamics simulation predicted stable binding of ferulic acid to Bcl-xL and caspase-3, the hub targets shared between the compound and keloid-associated genes.

A laboratory study of human lipoaspirate samples compared CELT and CELTPLUS mechanical processing of the stromal vascular fraction, using qPCR, ELISA over 96 hours, and 24-hour electrical stimulation at 2 V to characterize the neurotrophic and angiogenic secretome.

• CELTPLUS processing, which incorporates mechanical intersyringe shifting, doubled gene expression of NGF, VEGF, and BDNF compared with CELT-processed lipoaspirate (p = 0.015, 0.02, and 0.04 respectively).
• ELISA showed time-dependent secretion of NGF and VEGF protein across 96 hours of culture, confirming the transcriptional signal at protein level.
• A 24-hour period of 2 V electrical stimulation significantly enhanced NGF protein release (p < 0.001) from the processed tissue.