Plastic Surgery Weekly

A retrospective review of 24 patients treated between 2019 and 2024 assessed secondary lymphaticovenous anastomosis (LVA) performed for refractory postoperative lymphorrhea (n = 16) or secondary lymphedema (n = 8) after resection of lower extremity soft tissue sarcoma. Outcomes were paired drainage volumes over five consecutive days before and after LVA, and the lower extremity lymphedema (LEL) Index at six months.

• In the lymphorrhea cohort, the median per-patient five-day mean daily drainage volume fell from 250.0 mL/day before surgery to 82.0 mL/day afterwards (p < 0.01).
• Among the six lymphedema patients with complete paired data, the circumference-based LEL Index decreased in every patient at six months (exact two-sided p = 0.031).
• Across 54 anastomoses the mean lymphatic vessel diameter was 0.65 mm, and 83% of vessels showed ectasia, a morphology the authors regard as favourable for anastomosis in this population.

An artificial intelligence-based morphometric analysis of 358 patients with nonsyndromic scaphocephaly, drawn from a 1369-patient database with 1544 frontal and lateral photographs, compared 130 children treated with Renier H-cranioplasty against 119 treated with total vault remodeling (TVR), with unaffected controls as reference. The pipeline combined automatic landmark detection, point-cloud superimposition, geometric morphometrics, texture analysis, and classification algorithms.

• Operated patients remained morphologically distinguishable from controls after surgery, indicating that neither technique normalised the craniofacial phenotype.
• Early Renier H-cranioplasty reduced the anteroposterior diameter more effectively than TVR performed later in infancy.
• Both procedures showed limited effect on posterior cranial vault morphology, with the measured differences concentrated in the anteroposterior dimension.

A systematic review and meta-analysis of 29 studies comprising 392 patients and 543 implants (447 PEEK, 96 titanium) compared patient-specific implants used for craniofacial contouring, augmentation, and reconstruction. Single-arm random-effects models estimated pooled event rates, with subgroup tests used for between-material comparison; mean follow-up across studies was 27.8 months.

• Pooled overall complication rates were 6.94% for PEEK and 4.77% for titanium, and the between-material subgroup test was not significant (P = 0.58).
• Component endpoints followed the same pattern, with infection at 1.51% versus 0.33%, explantation at 0.73% versus 0.00%, and healing-related issues at 2.61% versus 2.54%, and no endpoint reaching statistical significance between materials.
• Patient-reported satisfaction for PEEK rose from a mean of 41.8 preoperatively to 75.4 on a 0 to 100 scale postoperatively, while placement accuracy averaged 2.23 mm where reported and titanium data were sparse.

An observational cohort of 80 asymptomatic lower limbs in patients treated for gynecologic malignancy underwent indocyanine green (ICG) lymphography between 2021 and 2024, with 26 limbs classified as subclinical lymphedema (stage 1 or higher without symptoms). Limbs were followed at approximately six-month intervals without therapeutic intervention until objective edema developed, and analysed by Kaplan-Meier, Cox regression, and mixed-effects modelling.

• Objective edema developed in 50% of subclinical limbs versus 5.6% of nonsubclinical limbs over a median follow-up of 24 months (P < 0.001).
• Subclinical status remained independently associated with progression, with a hazard ratio of 8.57 (95% CI 2.36 to 31.2; P = 0.0011).
• Subjective symptoms appeared earlier in the subclinical group (P = 0.021), and mixed-effects modelling showed steeper longitudinal rises in the lower extremity lymphedema index in that group (P = 0.023).

A single-centre before-and-after cohort of 103 free flaps (53 pre-intervention, 50 post-intervention) evaluated a DMAIC-based quality-improvement initiative for lower extremity reconstruction comprising standardized preoperative planning, parallel operative workflows, and expanded co-surgeon use, with multivariable adjustment for case mix.

• Mean operative duration fell from 8.23 ± 2.29 hours to 3.98 ± 1.77 hours after implementation, a reduction of roughly 4.3 hours per case (p < 0.001).
• Co-surgeon utilization rose from 22.6% to 79.2% (p < 0.001), the most conspicuous process change accompanying the shorter operative times.
• Limb salvage was statistically unchanged at 96.0% versus 90.6% pre-intervention (p = 0.438), so the time reduction came with no measurable decrement in salvage.
• Operative blocks able to accommodate an additional procedure increased from 28.3% to 86.0%, corresponding to 52 additional operations completed within the same block time.

A retrospective two-centre cohort of 649 analysable free flap patients was used to develop and internally validate models predicting unplanned 30-day re-exploration for flap-related vascular complications, comparing LASSO, random forest, and XGBoost fitted on 19 strictly preoperative predictors with intraoperative and surgeon variables deliberately excluded.

• XGBoost gave the best discrimination at AUC 0.84 (95% CI 0.74–0.92) with acceptable calibration (intercept 0.02, slope 0.87, ICI 0.039).
• Random forest discriminated comparably (AUC 0.82) but was substantially miscalibrated (slope 1.33), and LASSO performed worst on discrimination (AUC 0.79).
• The XGBoost risk deciles rose monotonically, from 10% or fewer events in the lower deciles to 80% in the top decile (95% CI 58–92).
• Prior oncologic history, surgical indication, and flap composition were the most influential preoperative predictors, with an overall event rate of 17.1% (111/649).

A systematic review and meta-analysis of 16 studies comprising 1,859 patients undergoing abdominal wall reconstruction compared closed-incision negative-pressure wound therapy with standard wound dressings, pooling both observational and randomized data in a DerSimonian-Laird random-effects model.

• Surgical site occurrence favoured negative-pressure therapy at OR 0.56 (95% CI 0.36–0.86; p = 0.008), though between-study heterogeneity was substantial (I² 69.5%).
• Surgical site infection was similarly reduced at OR 0.61 (95% CI 0.39–0.91; p = 0.032), with moderate heterogeneity (I² 51.6%).
• Readmission (OR 0.61), reoperation (OR 0.69), and hernia recurrence (OR 0.61) all had confidence intervals crossing unity, showing no significant difference between dressing strategies.
• Length of stay was equivalent (mean difference 0.26 days) but the pooled estimate carried near-complete heterogeneity (I² 92.1%), limiting its interpretability.

A single-surgeon retrospective cohort of 65 patients treated between 2010 and 2024 describes one-stage reconstruction of full-thickness nasal defects involving the alar rim using a composite graft harvested from the mid-helical rim rather than the conventional helical root.

• Median defect length along the alar rim was 14 mm (range 9–20 mm), measured by the pathologist after formalin fixation.
• Graft loss occurred in 4 of 65 patients, with 3 of these losses in patients who had a smoking history.
• In 63 patients (97%) tumour excision and reconstruction were completed in a single procedure under local anaesthetic with intravenous sedation, almost always following basal cell carcinoma excision.
• The mid-helical donor site was closed without an additional flap, which the authors contrast with the upper-pole distortion and size ceiling of the helical root donor site.

A systematic review of acetic acid for Pseudomonas infection was paired with a retrospective single-centre case series of 6 patients who underwent head and neck ablation with microvascular free tissue transfer between 2020 and 2023 and developed postoperative Pseudomonas infection treated with two to three daily bedside 0.05% acetic acid washouts for 7 to 14 days plus culture-directed intravenous antibiotics.

• The registered literature search identified no comparable studies of acetic acid washout for postoperative Pseudomonas infection in head and neck reconstruction, leaving the case series without external comparison.
• All six flaps survived, with no flap failures or metalwork removals, although four of the six patients still required a return to theatre (mean 20.5 days postoperatively, range 5–44).
• Postoperative inpatient stays ranged from 9 to 38 days, and a full bedside washout course cost £28 to £84 per patient.

A retrospective cephalometric cohort of 59 non-growing cleft patients (19 with patient-specific implants, 40 with conventional miniplates) operated between 2017 and 2023 compared one-year skeletal stability after Le Fort I osteotomy planned either virtually with patient-specific implants or with cast model surgery and miniplate fixation, using superimposed preoperative, immediate, and one-year tracings.

• Horizontal relapse was smaller with patient-specific implants at 0.28 mm versus 0.9 mm, corresponding to 4% versus 21% of the achieved advancement (p < 0.001).
• Vertical relapse also favoured the implant group at 0.81 mm versus 1.6 mm, or 30% versus 41% of vertical movement (p = 0.004).
• Mean maxillary advancement was larger in the implant group (7.1 mm versus 4.3 mm; p < 0.001), and mean vertical movement differed as well (-0.8 mm versus -3.8 mm; p < 0.001), so the groups were not matched for movement magnitude.
• Advancement magnitude correlated with subsequent relapse only in the miniplate group (r = 0.329, p = 0.038), with no such relationship in the implant group.

A narrative review of severe post-burn hand deformity synthesising the authors' operative principles for contractures that abolish pinch and grasp. The article addresses deformity assessment, sequencing of releases, choice of soft tissue cover, and postoperative rehabilitation rather than reporting a patient series.

• Severity is defined functionally: a contracture counts as severe when it causes loss of prehension, that is, when the thumb can no longer be opposed to the fingers for pinch and grasp.
• The recurring anatomical components are first web contracture, metacarpophalangeal extension contracture, and finger flexion contracture, which the authors treat as a pattern rather than as isolated joint problems.
• Operative principles emphasised include achieving maximum correction on the operating table, addressing first the deformity that yields a perceivable functional gain, and selecting soft tissue cover accordingly, with staged reconstruction where a single procedure cannot suffice.
• Early operation is advocated in children to prevent fixed joint changes, and therapy with splintage is presented as the element that protects the correction from recurrence; attention to aesthetic outcome is linked to how well patients use the reconstructed hand.

A retrospective cohort of 302 patients who underwent surgical neurolysis for chronic pain in a peripheral nerve distribution, selected by a positive scratch collapse test and a preoperative corticosteroid injection at the suspected lesion, assessed self-reported visual analogue pain scores and used multivariable logistic regression to identify predictors of poor response.

• Mean pain score decreased from 6.6 to 2.8 after neurolysis, with 10% classified as poor responders (less than 20% relative pain reduction or an increase in pain).
• Diagnosis rested largely on clinical examination: 54% of patients had negative electrodiagnostic studies and only 46% had an attributable mechanism of injury.
• A positive response to the preoperative injection, reported by 80% of patients, and longer follow-up were both associated with lower odds of poor response, whereas workers' compensation status predicted higher odds.
• Nine nerves were addressed, most commonly the radial nerve (101 of 302), followed by peroneal (54), median (45), saphenous (39), and axillary (38).

A consecutive single-surgeon case series of 30 patients with complex thumb defects underwent FDMA flap reconstruction using a dual-pedicled design incorporating a secondary random-pattern fasciocutaneous pedicle from the radial side of the index finger, with a sterile finger tourniquet used intraoperatively to occlude the secondary pedicle and test the adequacy of axial perfusion alone.

• The intraoperative stress test prompted temporary retention of the secondary pedicle in 3 patients, while the remaining 27 had it divided immediately.
• Complete flap survival was achieved in all 30 patients with no vascular complications reported.
• Functional and sensory results were satisfactory, with a mean static two-point discrimination of 8.90 mm (SD 1.21) and a mean Kapandji score of 8.87 (SD 0.96).

A single-surgeon retrospective cohort of 116 patients with MRI-confirmed isolated scapholunate interosseous ligament injuries treated between 2013 and 2023 compared hypermobile (Beighton score 5 or greater) with nonhypermobile patients. All patients began conservative management, and failure was defined as persistent pain at three months.

• Conservative management failed in 45% of hypermobile versus 26% of nonhypermobile patients (P = 0.05), with hypermobility present in 27% of the cohort.
• After multivariable adjustment, hypermobility remained an independent predictor of conservative failure, with an odds ratio of 4.27 (95% CI 1.62-11.20).
• Among patients who proceeded to surgery with adequate follow-up, persistent pain at one year was comparable between groups (56% versus 45%, P = 0.61).

A prospective single-center study of 124 knees in 111 patients meeting the Hagert triad for dynamic common peroneal nerve compression evaluated the orthogonal kinesiotaping test, in which a 5-cm strip is applied perpendicular to the nerve at roughly 20% tension. A positive test required at least one Medical Research Council grade of improvement together with patient-reported and examiner-confirmed functional gain.

• Immediate strength improvement occurred in all but 4 patients, each of whom had complete paralysis at baseline.
• Pain decreased in every patient and fatigability improved in 96.4% of those tested.
• All benefits disappeared once the tape was removed, which the authors interpret as evidence of a reversible mechanical rather than fixed axonal deficit.

A retrospective cohort of 315 patients older than 65 with distal radius fractures fixed by volar locking plate between 2017 and 2023 compared osteoporotic (second metacarpal cortical percentage below 50%) and non-osteoporotic groups. Radial inclination, volar tilt, radial height and ulnar variance were measured immediately postoperatively and at a minimum of 12 weeks.

• Radiographic parameters changed significantly over follow-up, but the extent of reduction loss did not differ between bone density groups.
• Logistic regression instead linked reduction loss to screw positioning and fracture severity, including screw length and distance from the subchondral articular surface.
• 81% of the cohort (256 of 315) fell below the 50% cortical threshold, and those patients were older than the non-osteoporotic group (74.8 versus 72 years).

An electronic survey of 225 hand and upper limb surgeons trained through plastic or orthopaedic programmes presented a standardized scenario of a tattoo overlying the anterior distal forearm incision for distal radius fixation and recorded the preferred approach alongside specialty and seniority.

• 173 of 225 respondents (77%) would incise directly through the tattoo rather than modify the approach.
• Preserving options were uncommon, comprising incision along the tattoo margin in 15% and raising a skin flap in 3.1%.
• The sample skewed senior and orthopaedic, with 78% at consultant or post-CCT level and 80% from orthopaedic training; the authors propose the ART algorithm (assess safety, review size, talk to the patient) to structure consent.

A psychometric analysis of 442 adults with metacarpal or phalangeal fractures assessed the structural validity, construct validity and internal consistency of the Michigan Hand Outcomes Questionnaire using data collected three months after injury. Exploratory and confirmatory factor analysis tested whether the six domains can legitimately be collapsed into one overall score.

• Exploratory factor analysis recovered the six original MHQ domains, and confirmatory analysis showed poor fit for a unidimensional model while the six-factor model fit better.
• Domain scores separated clinical subgroups more clearly than the overall score, and known-group comparisons confirmed 83% of a priori hypotheses.
• Internal consistency was acceptable to high throughout, with Cronbach alpha between 0.79 and 0.95 across domains.

A registry-based cohort of all children aged 0-18 in Stockholm County captured every hand or forearm injury diagnosed between 2014 and 2019, with area of residence classified as low, average or high socioeconomic status. Poisson regression estimated incidence rate ratios overall and by injury type.

• The mean yearly incidence of any hand or forearm injury was 345 per 10,000 person-years, highest among children living in high socioeconomic areas.
• Burns and crush injuries were most common in children aged 0-2 living in low socioeconomic areas.
• Fractures, sprains and contusions were concentrated in children aged 11-14 residing in average or high socioeconomic areas.

A prospective series of 11 patients with severe non-traumatic cubital tunnel syndrome (modified McGowan grade IIB or III) underwent decompression, subcutaneous anterior transposition and supercharged end-to-side anterior interosseous to ulnar motor nerve transfer. Electrodiagnostic studies were performed preoperatively and at 3, 6 and 12 months, with strength and DASH assessed at one year.

• Abductor digiti minimi compound muscle action potential amplitude improved significantly at 12 months relative to baseline (p = 0.004).
• Nascent motor unit action potentials appeared in 8 patients, in every case within the first 6 months after surgery.
• Sensory recovery lagged behind motor recovery: among patients without a preoperative response who later regained one, the first potential was usually recorded at 12 months (5 of 6 ulnar, 5 of 7 dorsal ulnar cutaneous).
• Key-pinch strength and DASH scores improved significantly (p = 0.014 and p = 0.003), while grip strength was unchanged (p = 0.142).

A registry analysis of 32,052 burn admissions from the American Burn Association Noncommercial Burn Research Dataset compared inpatient complications and outcomes between patients with a prehospital opioid-positive toxicology screen and those screening negative. Half the cohort (50.5%) screened positive at presentation.

• Opioid-positive patients were more often female and more often admitted with scald injuries, and were less likely to be experiencing homelessness (p < 0.0001) or to carry a diagnosis of inhalation injury (p < 0.005).
• Opioid positivity was associated with increased odds of cellulitis (OR 2.7) and sepsis (OR 1.41), both statistically significant.
• The opioid-negative group carried a higher burden of organ dysfunction, including acute respiratory distress syndrome, acute kidney injury, respiratory failure, and cardiac arrest, together with more frequent critical care admission and higher overall mortality (p < 0.0001).
• The authors interpret the opioid-negative pattern as reflecting delayed presentation with more severe injury than initially recognised, rather than a protective effect of opioid exposure.

A retrospective single-center analysis of 140 adults admitted with burns of at least 20% TBSA between 2020 and 2024 characterized analgesic combinations, morphine milligram equivalents and numerical rating scale pain scores over time, adjusted for age, burn size and inhalation injury.

• Multimodal regimens made up 78% of prescribing versus 15% non-opioid-only and 7% opioid-only; acetaminophen with hydromorphone was the single most frequent combination (17%).
• Patients on multimodal or opioid-only regimens showed lower and more stable pain trajectories than those given non-opioids alone.
• Opioid requirements declined overall, but at day 25 patients with burns above 40% TBSA still needed 451 ± 980 MME versus 237 ± 388 in moderate burns (p = 0.023), and hydromorphone use rose with burn size, peaking above 80% TBSA.

A systematic review of 19 studies comprising 92 patients characterised the clinical features, management, and outcomes of xylazine-associated wounds, with case-level detail available for 27 patients. Descriptive statistics and Fisher exact tests were used to test associations between wound severity, algorithm-guided care, and surgical outcome.

• All 27 patients with case-level data had extremity involvement, with bone or tendon exposure in 56% and osteomyelitis in 30%.
• Surgical management was reported in 78% of these patients, comprising grafting in 41%, free flap reconstruction in 11%, and amputation in 26%.
• Algorithm-guided care, documented in 56% of cases, was associated with both bone or tendon exposure (P = 0.007) and amputation (P = 0.008), and at study level was more common in reports describing exposed deep structures (P = 0.048).

A prospective cohort study of 1075 patients attending a diabetic foot clinic assessed routinely collected baseline clinical and ulcer characteristics against healing outcome and healing duration. Ulcers healed in 1039 patients and failed to heal in 36 over a mean follow-up of 167 ± 408 days.

• Relative to SINBAD 3, scores of 4, 5, and 6 carried 50%, 60%, and 70% higher risk of non-healing, alongside 2.2-, 2.8-, and 3.3-fold longer healing duration respectively.
• Ulcer depth was the strongest constitutive component predictor of non-healing, raising risk by 68%; a previous ulcer history added a 47% increase and prolonged healing by 20%.
• Healing took 2.4 times longer for ulcers larger than 1 cm2 and 24% longer in patients with peripheral arterial disease, while each day of delayed presentation raised the risk of non-healing by 0.5%.

A systematic review and meta-analysis of 18 studies covering 1281 patients compared 786 patients treated with hyperbaric oxygen therapy against 495 untreated patients across wounds, grafts, flaps, infections, and extremity limb salvage. Included designs ranged from case series to randomised controlled trials.

• Meta-analysis showed a 52% reduction in complication rates with hyperbaric oxygen, though the confidence interval crossed unity (odds ratio 0.48; 95% CI 0.09–2.66; P = 0.40) and heterogeneity was high (I2 = 82.4%).
• Two-thirds of included studies were case series (66.6%), with cohort studies contributing 16.6%, randomised trials 11.1%, and case-control studies 5.6%.
• Benefit was otherwise reported as uncontrolled single-arm ranges: infection control up to 82.6%, wound healing 43.9%–100%, limb salvage 81%–94.4%, and flap or graft survival 64%–100%.

A retrospective comparative study of 75 patients undergoing split-thickness skin grafting for traumatic soft tissue defects compared negative pressure wound therapy fixation (n = 38) with conventional tie-over dressing (n = 37). Outcomes were operative time, complete graft take, complications, and Vancouver Scar Scale scores at 2 weeks and 6 months, with subgroup analysis by defect size above and below 100 cm2.

• At 2 weeks the NPWT group had lower Vancouver Scar Scale scores for vascularity, pliability, and height; by 6 months only pliability remained significantly lower overall, with height also lower in the ≥100 cm2 subgroup.
• Operative time was significantly shorter with NPWT fixation than with tie-over dressing (p < 0.001).
• Complete graft take was comparable between groups overall, but in defects ≥100 cm2 NPWT achieved a significantly higher complete take rate (p = 0.048).

A single-centre five-year review of 1418 incident reports assigned to an adult regional burn centre examined reporting categories, completeness of harm classification, and how interpretation changed when reports were weighted by severity rather than frequency.

• Harm level was not visible in structured form in 811 reports (57.2%), and the gap was patterned rather than random: 546 of 547 specimen or laboratory reports and all 130 pressure injury reports lacked it.
• Among the 607 reports with a specified harm level, only 16 were moderate and 4 severe, so high-harm events were rare relative to total reporting volume.
• Infection prevention and control accounted for 17 reports overall but 14 of the 20 moderate or severe harm events, a signal invisible when categories are ranked by frequency.
• Narrative follow-up was present in most high-harm reports, yet structured contributing factors were absent in 17 of 20, limiting aggregation and trend analysis.

A before-and-after quality improvement study of 139 patients undergoing 281 operations compared operative duration for adult excisional debridement in the year before and the year after introduction of a preoperative communication checklist (143 pre-checklist, 138 post-checklist operations). Mixed-effects models adjusted for surgeon, procedure type, and square area excised.

• Mean operative duration fell from 107.8 to 96.0 minutes, and in adjusted analysis checklist use was associated with a 17.99-minute reduction (p < 0.001).
• Autograft, ReCell, and biodegradable temporizing matrix procedures, along with greater area excised, were each associated with longer operative times.
• In interaction models the overall reduction was no longer statistically significant, while ReCell procedures showed a 30.49-minute reduction (p = 0.003).

A narrative review of preclinical and early clinical silk fibroin studies examines how scaffolds enhanced with bio-additives modulate cellular responses, vascularisation, and wound closure in diabetic wounds. Fabrication routes are compared and silk fibroin is situated alongside approved skin substitutes.

• Three fabrication routes are contrasted: electrospun fibrous mats with a high surface-area-to-volume ratio, freeze-dried porous constructs with interconnected architecture, and hydrogels designed for controlled drug delivery.
• Silk fibroin is presented as attractive for chronic wounds on the basis of biocompatibility, tunable degradation, and capacity for controlled delivery of bio-additives that target persistent inflammation, impaired vascularisation, and microbial burden.
• Evidence is synthesised against approved comparators such as the collagen–Manuka honey–hydroxyapatite patch (Apis); the authors then outline translational barriers and future directions rather than reporting comparative clinical outcomes for silk fibroin in diabetic foot ulcers.

A qualitative descriptive study of 16 participants (12 electrical injury survivors and 4 caregivers) treated at a trauma centre or rehabilitation hospital between 2000 and 2020 used semi-structured interviews with thematic analysis to explore daily life and social support during recovery.

• Recovery trajectories were described as marked by uncertainty, spanning physical, neurological, neuropsychological, psychological, and social challenges.
• Participants emphasised the burden of invisible symptoms: cognitive, emotional, and function-limiting difficulties that others found difficult to recognise or anticipate.
• Survivors stressed the value of diverse support networks, while caregivers described emotional and informational needs of their own.
• Peer and naturally occurring social supports emerged as critical, with engagement shaped by individual, social, and environmental factors.

A retrospective cohort of 40 irradiated and 72 non-irradiated DIEP reconstructions performed between 2017 and 2023 compared immediate single-stage, immediate two-stage tissue expander, and delayed single-stage timing strategies. Outcomes were BREAST-Q scores and Harris four-point aesthetic ratings at one year or more, with complications analysed by flap irradiation status.

• Within the irradiated cohort, BREAST-Q scores and aesthetic ratings did not differ significantly among the three timing groups; the same absence of a timing effect was seen in the non-irradiated cohort.
• Palpable fat necrosis or firmness was significantly more frequent when the flap itself had been irradiated (p = 0.0044).
• Revision procedures clustered in the delayed single-stage group (p = 0.0051), identifying a distinct trade-off for that strategy.
• Physical Well-Being: Chest scores were lower in the irradiated cohort than in the non-irradiated cohort (p = 0.0002), independent of when reconstruction was performed.

A retrospective single-institution cohort of 154 patients (160 breasts) undergoing free flap breast reconstruction between 2021 and 2025, comparing preoperative prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, and D-dimer between breasts that did and did not develop pedicle thrombosis. Patients were additionally stratified into asymptomatic hypercoagulable and non-hypercoagulable groups.

• Pedicle thrombosis occurred in nine of 160 breasts (5.6%), comprising two arterial and seven venous events.
• Thrombosis rates did not differ significantly between the asymptomatic hypercoagulable and non-hypercoagulable groups (9.6% vs 3.7%, p = 0.152).
• On multivariate logistic regression, immediate reconstruction was the only independent risk factor identified (p = 0.028); none of the five coagulation parameters predicted thrombosis.

Federated electronic health record analysis of the TriNetX Global Collaborative Network comparing patients with documented nontobacco nicotine dependence in the year before breast reconstruction against patients without any documented nicotine dependence, in a propensity-matched retrospective cohort of 2170 patients per arm drawn from 87,774 eligible records. Primary outcomes were 30- and 90-day postoperative complications.

• Within 30 days, the nicotine-dependent cohort had significantly higher rates of surgical site infection and wound dehiscence.
• By 90 days, those differences persisted and tissue expander removal was also significantly more frequent in the nicotine-dependent cohort.
• The association was consistent across subanalyses of both autologous and implant-based reconstruction, suggesting the risk is not confined to one technique.

A prospective cohort of 234 patients completing BREAST-Q surveys after breast reconstruction, comparing patient-reported outcome domains and reconstructive method selection across racial groups at multiple postoperative time points.

• Scores differed significantly between racial groups in the "Confidence," "Sensitivity," and "Sexual Well-being" domains at several time points.
• No between-group differences emerged for "How Clothes Fit," indicating the disparities were confined to specific domains rather than reflecting global dissatisfaction.
• Racial group was not associated with the choice of reconstructive method, so the outcome differences arose despite comparable procedure selection.

A cross-sectional survey of 104 respondents with a history of or considering gender-affirming mastectomy, who ranked connected and non-connected double-incision patterns for aesthetic appeal. Rankings were converted to weighted preference scores by Borda count and compared with Friedman testing.

• Preferences differed significantly across incision types overall (Friedman p < 0.001), with curved designs favored in all pairwise post hoc comparisons (p < 0.001).
• Among non-connected designs, curved incisions took the highest weighted score (460) and were ranked first by 66% of participants, ahead of angular incisions (345).
• Among connected designs, curved incisions again led (451; 65% first choice) followed by the inverted V (298), while large V and inverse-diagonal patterns ranked lowest.

A case report combined with a focused review of five published accounts of implant puncture or rupture associated with breast fat grafting, identified through PubMed and Embase, presented alongside an institutional case of delayed implant infection with intraoperatively confirmed intraprosthetic fat.

• Published cases presented heterogeneously, with pain, capsular contracture, shape change, or infection, and larger series reported low but non-zero rates of implant injury after fat grafting.
• The institutional case involved a radiated breast with delayed infection 18 months after fat grafting; explantation revealed multiple implant punctures and intraprosthetic fat without free silicone extrusion.
• Intraprosthetic fat has limited detectability on imaging, which the authors propose as a reason the complication is likely underreported relative to its true frequency.

A case report of a single patient undergoing surgical reversal after gender-affirming mastectomy, describing a staged autologous fat grafting approach and framing it within a discussion of reversal, detransition, and regret as distinct entities.

• Breast reconstruction was accomplished with staged autologous fat grafting alone, without implants or flap-based reconstruction.
• The authors separate surgical reversal, detransition, and regret as conceptually distinct phenomena, illustrated here by a reversal that occurred in the absence of regret.
• Reversal and regret after gender-affirming surgery are described as remaining very low in prevalence despite substantially increased utilization over the past 15 years.

A prospective comparative study of 95 patients assigned male at birth undergoing primary breast augmentation by two senior surgeons between 2016 and 2024 compared periareolar (n = 55) and inframammary (n = 40) incisions. Incision type was chosen by the patient after preoperative counselling, and the BREAST-Q Version 2 Augmentation Module was administered at 12 months or more postoperatively.

• The overall complication rate was 3.7%, with no significant difference between incision groups.
• Secondary aesthetic revisions were significantly more frequent after the inframammary approach, at 28.6% versus 7.5% (p = 0.026).
• BREAST-Q scores were high across all domains, with no significant differences between the two incision groups.
• The cohorts were comparable at baseline except for implant pocket location, which differed systematically between the incision groups.

A single-arm series of 504 patients with grade I to III lower eyelid bag deformities treated between 2021 and 2024 with a single combined protocol, assessed by photographic measurement, patient satisfaction, aesthetic improvement scoring, and complication rates stratified by deformity grade.

• Mean satisfaction was 4.456 ± 0.22, highest in grade III patients, with a total aesthetic improvement score of 90.98 ± 2.23 and the largest gains in grade II.
• More severe deformity corresponded to lower AC/AB ratios, higher AG/AB ratios, and greater ∠GOH on standardized photographic measurement.
• Preoperative thresholds of AC/AB > 0.82, ∠EDO > 7.79, AF/AB > 2.53, and ∠GOH > 18.65 were predictive of marked aesthetic improvement after surgery.

A single-center prospective cohort of 39 consecutive outpatients undergoing lipoabdominoplasty under intravenous sedation, tumescent local anesthesia, and a transversus abdominis plane block, comparing preoperative anesthetic expectations and anxiety with actual early postoperative experience using the International Pain Outcomes and BODY-Q questionnaires.

• Preoperatively, 56% anticipated intraoperative pain, while 28% anticipated nausea and 26% feared loss of control under anesthesia.
• Postoperatively all anesthesia-related concerns fell significantly, from a median of 3 to a median of 1 on a five-point scale.
• Functional recovery slightly outpaced expectation: indoor ambulation and stair climbing by day 1, independent dressing and showering by day 2, and a short outdoor walk with meal preparation by day 3.

A two-stage prospective study with a randomized, double-blind first stage compared botulinum toxin type A injection at upper versus lower depressor anguli oris (DAO) sites, followed by a non-randomized stage assessing the added effect of concurrent platysma injection. Outcomes were oral commissure position (OCDA, OCLA) and lip asymmetry (DSL) on three-dimensional photogrammetry, plus satisfaction, pain, and adverse events.

• Both injection strategies improved oral commissure downward and lateral angles at every time point, with the lower DAO site showing greater effect than the upper site.
• Combined DAO plus platysma injection further improved the lateral commissure angle at 1 month and the downward angle at 6 months, with higher patient satisfaction than DAO injection alone (P < 0.05).
• Between-group differences in the lip asymmetry measure remained under 1 mm, and no severe adverse events were recorded in either stage.

A hybrid longitudinal observational study of 35 patients compared an upper two-thirds face lift using a minimal endoscopic approach with blepharoplasty against a full face lift including deep SMAS dissection, with allocation by patient preference. Follow-up to 12 months included standardized sensory examination, House-Brackmann motor nerve grading, and FACE-Q self-reported outcomes.

• All motor nerve disturbances had resolved by 12 months, and sensory disturbances resolved in every patient but one.
• Other visible side effects had virtually disappeared at 12 months, leaving one persistent case of tightness and one of alopecia.
• Self-reported satisfaction was high, with median Rasch-transformed FACE-Q scores of 76 for facial appearance and 73 for surgical result.

A prospective study of 125 patients undergoing preoperative CT before open rhinoplasty with tailored osteoplasty and no osteotomies classified nasal bones as concave, planar, or convex and as thin, medium, or thick, yielding nine subtypes. Outcomes were assessed by CT comparison and the FACE-Q Rhinoplasty Module at 3, 6, and 12 months.

• CT demonstrated wide anatomical variability, with 47.2% of right nasal bones convex versus 24% concave, and 51.2% of medium thickness alongside 45.6% classified as thick.
• The most frequently encountered subtypes were convex-medium (3B) and convex-thick (3C), forming the bulk of the classification distribution.
• No unintended nasal bone fractures occurred with osteotomy-free tailored osteoplasty, and FACE-Q satisfaction improved significantly after surgery.

A systematic review and meta-analysis of 17 studies comprising 9570 patients examined demographics, patient selection criteria, and complications after high-definition liposuction. Pooled analyses were performed for seroma and hematoma, and univariable meta-regression tested mean age, BMI, and proportion of female patients against complication rates.

• Pooled complication incidence was low, at 7% for seroma and 1% for hematoma across the included studies.
• Meta-regression showed no significant association between complication rates and mean age, BMI, or the proportion of female patients.
• Treated patients averaged 36.0 years and a BMI of 25.8 kg/m2, with mean fat removal of 4268.8 mL over a mean operative time of 235 minutes.
• Selection criteria differed considerably, with BMI thresholds ranging from 30 to 34 kg/m2 and common exclusions for poorly controlled diabetes, heavy smoking, and thromboembolic history.

A retrospective review of 423 patients treated at a single Rio de Janeiro clinic between January 2019 and August 2023 described the Sequential Alar Base Resection (SABR) technique, its resection patterns, and its outcomes. Patient-reported satisfaction was captured with the Rhinoplasty Outcome Evaluation (ROE) questionnaire.

• Mean postoperative ROE scores indicated satisfactory nasal contour results across the cohort.
• All patients were reported to show significant improvement in symmetry and harmony of the nasal base after the two-step resection.
• No SABR-specific complications were observed, and morbidity at the alar resection site was described as minimal.

A systematic review of 14 studies covering randomized trials, comparative cohorts, and case series in adults evaluated cosmetic outcomes of adhesive taping applied after primary closure of surgical incisions. Comparisons included microporous tape, Steri-Strips, and silicone sheeting, assessed with a range of scar rating instruments.

• Microporous tapes and Steri-Strips were the most frequently studied adhesives, accounting for 217 and 159 patients respectively.
• Taping after primary closure was associated with significantly better scar cosmesis than no intervention, drawing on 75 untreated comparator patients.
• Some included studies suggested that inexpensive paper tapes gave clinically similar results to silicone sheets, the current prophylactic standard.
• Cosmetic outcomes were recorded at a mean of 5.13 months using heterogeneous instruments, including SCAR-Q, POSAS, the Vancouver Scar Scale, and visual analogue scales.

A prospective cohort of 54 patients with Rohrich grade I to IV gynecomastia underwent glandular-adipose aspiration through an anterior axillary incision using a patented cannula system. Ultrasound was applied preoperatively for glandular and pectoralis mapping, intraoperatively for residual tissue and resection plane assessment, and at 6 months for thickness and scar quantification.

• Mean tissue thickness fell from 13.87 to 5.48 mm on the left and from 13.39 to 5.71 mm on the right, a reduction of roughly 60% (p < 0.0001).
• BODY-Q chest satisfaction rose by 31.6 points (p < 0.001), and mean scar satisfaction reached 86.12 of 100 at 6 months.
• The overall complication rate was 1.85%, consisting of a single steroid-responsive hypertrophic scar.

A retrospective review of 50 adult patients treated surgically for craniofacial fibrous dysplasia at a single institution between 1988 and 2024, with a mean follow-up of 15.8 years, characterized presentation patterns, operative indications, and long-term outcomes. The cohort was 54.0% male, with a median age of 31 years at presentation and 34.5 years at first surgery.

• The leading operative indications were visible growth (30.5%) and pain or headache (27.1%), with surgery undertaken well beyond skeletal maturity.
• Bone contouring alone was the most common initial approach (42 of 59 procedures), yet 12% of contoured patients required additional operations for continued growth.
• Polyostotic involvement was present in 60.0% of patients, and the frontal bone was the most affected site (51.2%).
• Several patients showed recurrence or progression decades after primary surgery, and every secondary deformity needing corrective surgery was ocular.

This case report of a single 27-year-old patient describes radical en bloc craniofacial resection with modified radical neck dissection for secondary ameloblastic carcinoma involving the temporal bone, masticator and infratemporal spaces, orbit, parotid region, and skull base, followed by multilayer skull base reconstruction and adjuvant radiotherapy.

• Elective external carotid artery ligation for proximal vascular control removed most ipsilateral recipient vessels, making immediate free tissue transfer impracticable in this defect.
• Intracranial-extracranial separation after focal dural excision for margin control was achieved with a multilayer vascularized pericranial-galeal reconstruction reinforced by a dural substitute.
• At 42 months following resection and 72 Gy of adjuvant radiotherapy, the patient remained disease-free with preserved functional status and stable craniofacial contour.

This narrative review synthesizes current diagnostic and therapeutic approaches to soft-tissue sarcoma, covering clinical and radiologic assessment, biopsy technique, WHO fifth-edition histologic classification, AJCC-TNM staging, and multimodal treatment.

• Soft-tissue sarcomas represent approximately 1% of all cancers and span 50 to 70 histologic entities, most often diagnosed after age 40 and most commonly arising in the extremity.
• Recurrence and metastasis rates reach 40% to 50% in aggressive subtypes, with pulmonary spread in 80% of metastatic cases and hepatic, cerebral, osseous, or peritoneal involvement carrying poorer prognosis.
• Histologic diagnosis is frequently limited by scant biopsy material and divergent interpretation; immunophenotypic panels and molecular genetics are described as improving accuracy.
• Liposarcoma, synovial sarcoma, and undifferentiated pleomorphic sarcoma are singled out for high local recurrence and inconsistent outcomes, with immunotherapy, targeted agents, and newer radiation regimens under investigation.

This comparative diagnostic study of 50 adult rhinoplasty candidates evaluated ChatGPT 4o, Claude 3.7, Gemini 2.0, and Grok 2 against two expert surgeons, comparing total and component MIRA scores derived from standardised photographs alongside a Likert-rated qualitative classification of nasal type.

• The two expert surgeons showed near-perfect concordance on the MIRA scale (ICC = 0.997), establishing a stable reference standard for the comparison.
• Only Claude 3.7 produced total MIRA scores comparable to experts, while all four models differed significantly on MIRA sub-scores, with Grok 2 performing worst.
• Qualitative description of the major nasal type was strongest for ChatGPT 4o, which reached an accuracy of 70%, leaving roughly one in three noses misclassified.

This single-centre retrospective validation study of 1017 wound images (979 training, 38 testing) compared LabelMe-Seeded Auto-Recognition with a YOLO-gated variant for DESIGN-R staging of pressure injury size and pocket, using concordance rate, weighted Cohen's κ, and mean absolute area error.

• For wound size, the YOLO-gated model achieved 85.7% concordance (κ = 0.969) with smaller area errors than LabelMe segmentation alone.
• Pocket (undermining) assessment likewise improved with gating, though residual outliers persisted, consistent with the difficulty of delineating undermined margins from surface images.
• The improvement is attributed to YOLO-based wound localization constraining the segmentation step before area calculation, limiting the oversegmentation seen with conventional annotation.

This systematic-narrative hybrid review of 9 studies searched four databases from 2000 through February 2026 for AI-assisted postoperative free flap monitoring, examining model type, sensing modality, and clinically relevant outcomes including ischemia detection, venous congestion, thrombosis, and salvage.

• Reported diagnostic accuracy spanned 82% to 98.4%, often comparable to or exceeding conventional clinical monitoring in the source studies.
• Inputs were predominantly visible-light, infrared, photoplethysmographic, hyperspectral, or multimodal sensor data processed by supervised machine learning models.
• All but one included study was retrospective, and no prospective human clinical trial of AI-based flap surveillance was identified.
• Recurring limitations were small datasets, absent external validation, and uncertain generalizability across skin tones and care settings.

This proof-of-concept development study of a multimodal AI reasoning framework integrated digital photographs with B-mode and Tissue Doppler ultrasound imaging and assessed three-category burn depth classification against retrospective human evaluation.

• The framework pairs surface photography with subsurface ultrasound including Tissue Doppler, on the premise that tissue perfusion dynamics carry depth information the wound surface does not show.
• A chain-of-thought process links visual and acoustic cues to severity indicators, producing step-by-step explanations intended to let a non-specialist medic audit each classification.
• Classification across three clinically relevant depth categories was reported as accurate and as performing strongly relative to retrospective human assessment.

This narrative review examines the biogenesis of MSC-derived exosomes, microvesicles, and apoptotic vesicles, their functional performance across orofacial, barrier, musculoskeletal, and visceral regeneration, and the production, quality control, and regulatory steps required for clinical translation.

• The proposed therapeutic mechanisms are immunomodulation, angiogenesis, and anti-fibrosis, mediated by bioactive vesicle cargo rather than engraftment of living cells.
• Relative to live-cell therapy, MSC-EVs are presented as offering improved safety, standardization, and scalability, since no proliferating cells are transplanted.
• Engineering approaches reviewed include surface modification, cargo loading, biomaterial-integrated delivery, and EVs from engineered MSC aggregates modelled on organ morphogenesis.
• Translation is described as constrained by vesicle heterogeneity, limited targeting specificity, and manufacturing bottlenecks, with quality control and regulatory pathways still evolving.

This preclinical study using a 12-week nude mouse model combined histology, immunohistochemistry, DNA electrophoresis, and free lipid analysis to characterize a commercial human adipose tissue allograft and to track the fate of donor-derived DNA and protein after implantation.

• The allograft retained native adipose architecture with structurally intact adipocytes while lacking immunogenic cells and extracellular damage-associated molecular patterns.
• Following implantation, the graft was populated by host-derived cells that remodelled and replaced it with host tissue.
• Human DNA became undetectable beyond 4 weeks and human proteins degraded progressively, with no human adiponectin detected in mouse serum.

A bench and animal study spanning three rodent defect models developed a cryogenic extrusion bioprinting platform that directs ice crystal growth to impose internal anisotropy, then tested printed constructs against the structural requirements of bone graft substitutes, osteoporotic disease models, and soft tissue repair.

• Directional ice crystal growth during cryogenic extrusion generated aligned porous microarchitecture even with 2% w/v GelMA, an ultrasoft, low-viscosity ink that cannot otherwise hold shape at centimeter scale.
• Cryo-assembly and LEGO-assembly strategies circumvented the height ceiling of cryo-printing by joining printed units while preserving continuous internal alignment across the unit interfaces.
• In wound healing, cranial defect, and femoral defect models, the anisotropic cues were associated with spatially guided cell migration and site-specific ECM remodeling, as judged by extracellular matrix deposition patterns.

A narrative review synthesizes applications of spatiotemporal omics in skin biology, covering the integration of single-cell sequencing, spatial omics, and time-series analysis across development, aging, disease, and regeneration.

• Single-cell sequencing resolves cellular diversity but discards positional information; spatial platforms retain in situ cellular position, allowing cell states to be interpreted within their native microenvironment.
• Combining spatial data with serial time points has revised descriptions of wound healing dynamics, including how gene expression programs and intercellular networks reorganize after acute injury and in chronic wounds.
• The authors propose a high-resolution spatiotemporal cellular atlas spanning the human skin life cycle as the prerequisite for biomarker identification and personalized regenerative strategies.

A controlled animal study of 20 C57BL/6 mice randomized animals to four groups (PBS, hair follicle stem cell exosomes, negative-control-mimic exosomes, or miR-181a-5p-enriched exosomes), each receiving five subcutaneous injections after dorsal shaving, with regrowth assessed by gross observation, histology, and immunostaining.

• The miR-181a-5p-enriched exosomes produced approximately 90% newborn hair coverage at day 15, against roughly 40% in the unmodified and negative-control exosome groups and minimal regrowth with PBS.
• Exosome-treated skin showed increased Ki-67, Bcl-2, and β-catenin with decreased Bax (all P < 0.05), a pattern consistent with Wnt/β-catenin activation and reduced apoptosis, most pronounced in the miR-181a-5p group.
• Unmodified hair follicle stem cell exosomes alone accelerated the telogen-to-anagen transition relative to PBS, indicating baseline activity independent of miRNA enrichment.

A controlled rat experiment with three treatment arms compared sterile water, 40 μg minocycline, and 100 μg minocycline delivered in 20 μL fibrin gel onto the suture line after facial nerve transection and repair, with histopathology and LC-MS/MS metabolomics at 28 days and serial electrophysiology at weeks 1, 2, and 4.

• Control nerves showed intramyelin and subperineurial edema with myelin vacuolization, whereas both minocycline doses showed preserved fascicular architecture with minimal edema.
• Nerve fiber density did not differ across groups (p > 0.05), so the histological benefit appeared as qualitative structural preservation rather than as an increase in axon counts.
• Compound muscle action potentials improved most in the 40 μg group (p = 0.013), peaking at week 2, while the 100 μg group carried the stronger metabolomic signature of reduced betaine and elevated proline.

A randomized, blinded controlled animal study in healthy hamsters compared intradermal human adipose-derived secretomes, plant-derived exosomes, a hybrid formulation, and saline against untreated baseline controls, with biopsies at baseline, day 73, and day 93 assessed by histology and immunohistochemistry for Ki67, β-catenin, and CD34.

• Ki67-positive cells were most abundant after hybrid secretome injection, followed by plant exosomes and then human secretomes, with control skin lowest.
• Nuclear β-catenin localization was most pronounced in human secretome-treated follicles and largely absent in controls, indicating that the formulations engage partly different pathways.
• CD34 expression, a bulge stem cell-associated marker, was highest with hybrid secretomes, followed by human secretomes and plant exosomes, with minimal staining in controls.

A narrative review collates transcriptomic, proteomic, metabolomic, lipidomic, and emerging genomic or computational studies of secondary lymphedema arising after infection, surgery, or cancer treatment, and appraises what each platform has contributed and where it falls short.

• Omics data reframe lymphedema beyond an anatomic description of stasis, toward defined inflammatory, fibrotic, metabolic, lymphatic vascular, and genetic susceptibility programs that shape onset and progression.
• Candidate biomarkers, cell populations, and signaling pathways have been proposed as therapeutic targets, though the authors note that current platforms, sample types, and bioinformatic pipelines constrain confidence in them.
• The authors position multi-omics integration, rather than any single platform, as the route toward diagnosis, risk stratification, and treatment development.

A narrative review covers the principles of intestinal organoid-on-a-chip technology and its reported use in modeling barrier function, inflammatory responses, drug screening, regenerative approaches, and trauma-related barrier repair.

• These platforms combine stem cell-derived epithelium with microfluidic flow to reproduce key features of the intestinal microenvironment, including barrier integrity and physiological function that static culture does not sustain.
• Reported preclinical applications span mucosal injury and repair, inflammatory response modeling, and drug screening, with burn- and trauma-associated barrier failure as an explicit target.
• The dominant technical obstacles identified are scalability and reproducibility across laboratories, alongside incomplete representation of immune, vascular, and microbial compartments.