Plastic Surgery Weekly

In a multicenter cohort study of patients undergoing unilateral LVA or vascularized lymph node transfer for chronic extremity lymphedema between 2016 and 2025, drawn from a prospectively maintained database, treatment response was quantified as the relative excess reduction rate from standardized limb circumference measurements. Sex, age, and BMI were examined as predictors of long-term response and of Clavien-Dindo graded complications.

• Men with lower extremity lymphedema showed greater treatment response than women at 12 and 24 months after LVA and at 12 months after vascularized lymph node transfer.
• Higher BMI was associated with less favorable response after upper extremity node transfer at 12 and 18 months, while no consistent BMI effect appeared in the lower extremity.
• Age showed no consistent association with treatment response across procedures, limbs, or follow-up intervals.
• Postoperative complication rates graded by Clavien-Dindo were not significantly influenced by sex or BMI.

Retrospective single-center review of 134 lower extremity free flap reconstructions performed between 2015 and 2023, comparing 81 flaps with a single venous anastomosis against 53 with a double anastomosis, the latter subdivided into double superficial, double deep, and dual-system configurations. Major complications were defined as total flap loss or return to the operating room.

• The single anastomosis group had significantly higher overall, major, and minor complication rates than the double anastomosis group (p < 0.05).
• Across the whole series there were 26 major complications and 9 total flap losses, and total flap loss rates were comparable between groups.
• Among the double anastomosis configurations, complication rates showed no significant differences between double superficial, double deep, and dual-system drainage.

Single-center cohort of 30 patients with secondary upper extremity lymphedema (14 stage 2a, 14 stage 2b, 2 stage 3) treated with lymphaticovenular anastomosis and followed for at least one year. Compression therapy was reduced or discontinued according to predefined institutional criteria once postoperative improvement and clinical stability were confirmed.

• Complete discontinuation of compression was achieved by 7 of 14 early-stage patients (50.0%) and none of the advanced-stage patients (p = 0.0017).
• Partial reduction of compression occurred exclusively in the advanced-stage group (8 of 16, 50.0%).
• Mean postoperative reduction in limb circumference was 4.5% ± 4.3%.
• Cellulitis incidence fell from 30.0% to 3.3% after surgery, an absolute decrease of 26.7 percentage points.

Single-institution retrospective cohort of 584 sternal wound reconstructions with pectoralis major flaps performed from 1995 to 2024, comparing patients who did and did not receive preoperative NPWT before flap coverage. The primary outcome was at least one complication within 30 days of reconstruction, analyzed with multivariable logistic regression and propensity-matched comparison.

• NPWT use was predicted by comorbidity burden, including chronic kidney disease (OR 2.30), prior cardiac surgery (OR 1.97), male sex (OR 1.82), and peripheral vascular disease (OR 1.55).
• The interval from the index cardiac procedure to definitive reconstruction was longer in NPWT patients, at a median of 51 versus 27 days.
• On univariate analysis the unadjusted complication rate was higher with NPWT (50.4% versus 40.1%, p = 0.046).
• After propensity matching, no differences in 30-day complications, reoperation, or mortality remained between the groups.

A retrospective analysis of 56 anterolateral thigh flap reconstructions performed between January and July 2024 compared preoperative indocyanine green angiography (ICGA) with color Doppler ultrasonography (CDU) against intraoperative findings. Diagnostic performance was calculated per modality and 20 variables were entered into multivariable models to identify determinants of accuracy.

• Indocyanine green angiography outperformed color Doppler on every diagnostic metric, with overall accuracy of 92.2% versus 82.3%, sensitivity 92.5% versus 84.9% and negative predictive value 90.2% versus 79.2%.
• Flap thickness was the only independent predictor of ICGA accuracy (odds ratio 0.16; 95% CI 0.04–0.62), with performance deteriorating beyond a 2.35 cm cutoff, whereas timing of surgery relative to imaging predicted CDU accuracy.
• Localization error did not differ significantly between modalities; septocutaneous perforators clustered proximally, making up 61.2% of perforators in that zone, while the hot zone carried the highest perforator density.

A PRISMA-guided systematic review and meta-analysis of 25 comparative studies searched PubMed and Embase to September 2025, comparing free with pedicled flap reconstruction in adults after head and neck oncologic resection. Operative time, length of stay and complications were pooled quantitatively, alongside narrative comparison of cost and functional outcomes.

• Free flap reconstruction required substantially longer surgery, with a mean difference of +172.5 minutes (95% CI 132.3 to 212.6); the prediction interval extended to roughly 342 minutes, indicating wide variation between centers.
• Length of hospital stay did not differ between groups (mean difference +0.6 days; 95% CI −2.7 to +3.9), despite the difference in operative complexity.
• Financial cost was 1.3 to 3 times higher for free flaps than for pedicled reconstruction across the included economic comparisons.
• Pedicled flaps showed slightly fewer overall complications, including wound dehiscence, infection and revision surgery, and flap failure was significantly more frequent with free flaps.

A retrospective single-arm series of 10 consecutive patients undergoing endoscope-assisted DIEP flap harvest evaluated a technique in which a 5 × 150 mm trocar assembled with a 0-degree rigid laparoscope was used to enter the retrorectus plane under direct vision. Feasibility, peritoneal breach, conversion to the transabdominal preperitoneal approach and abdominal wall complications were assessed.

• The retrorectus space was reproducibly established under continuous visualization, with blunt dissection following trocar entry and a mean space creation time of 3.9 minutes.
• Pedicle dissection was completed entirely within the extraperitoneal plane in every case, with no conversions to the transabdominal preperitoneal approach.
• No abdominal wall hernias or clinically evident bulges were observed over a median follow-up of 6.4 months.

A prospective single-center intraindividual comparison in 10 patients with 17 perforators evaluated color-coded duplex sonography (CCDS), flat-panel CT (FPCT) and non-contrast time-of-flight MR angiography (TOF-MRA) before anterolateral thigh free flap reconstruction. Intraoperative findings served as the reference standard for detection rate, fascial emergence point accuracy and prediction of the subfascial course.

• Perforator detection rates were statistically indistinguishable across modalities (CCDS 94%, TOF-MRA 91%, FPCT 87%; p = 0.82).
• Prediction of the subfascial perforator course diverged significantly, with FPCT accurate in only 50% of perforators compared with 93% for CCDS and 82% for TOF-MRA (p = 0.033).
• FPCT placed 25% of skin markings more than 2 cm from the true fascial emergence point, versus 6% for CCDS and 0% for TOF-MRA; one such error was attributed to thigh mobilization during acquisition.

The authors present refinements to the inset phase of free functional muscle transfer for dynamic facial reanimation as an uncontrolled technical report with no stated patient sample or outcome cohort. The described elements cover muscle preparation, suture organization and the sequence of distal and proximal fixation within a restricted operative field.

• Muscle length is set with the face in the neutral position, and fixation relies on preplaced multilayer sutures inserted before the muscle enters the narrow field.
• A load-distributing mesh constructed at the muscle ends is intended to spread tension across the inset rather than concentrate it on individual suture bites.
• Distal fixation uses a double-loop technique at the oral commissure followed by proximal anchoring to the deep temporal fascia, with sutures held on numbered instruments to prevent entanglement in a 3 to 4 cm field.

A cross-sectional 15-item survey of 82 microsurgeons drawn from the American Society for Reconstructive Microsurgery membership assessed psychological and physical symptoms after flap failure, symptom duration, coping strategies, and the gap between available and desired institutional support.

• Symptoms after flap loss were near-universal, with 67.1% reporting guilt, 61.0% fear of future poor outcomes, 58.5% difficulty sleeping and 56.1% anxiety with questioning of surgical ability.
• Most symptoms were short-lived, but 17.1% persisted for several months or longer; prolonged symptoms affected 30.0% of female-identifying versus 9.6% of male-identifying surgeons (p = 0.031).
• Working with five or fewer microsurgical colleagues was associated with prolonged symptoms (27.3% vs 5.3%, p = 0.009), and discussing events with colleagues was the commonest coping strategy at 72.8%.
• A clear support gap emerged: only 25.9% had access to counseling services, while 51.9% wanted structured peer support programs.

Single-center retrospective cohort of 60 nerve transfers in 46 adults (radial to axillary, or median/ulnar to musculocutaneous) performed between 2015 and 2025, comparing 16 procedures that received 10 minutes of continuous intraoperative electrical stimulation (2 mA, 100 μs) with 44 that did not. The primary outcome was postoperative Medical Research Council motor grade.

• Excellent recovery (M4–M5) was reached by 88% of stimulated versus 61% of non-stimulated patients, a difference that was not statistically significant on unadjusted comparison (p = .136).
• Controlling for age and time to surgery, stimulated patients were more likely to achieve at least M4, with an odds ratio of 6.0 (95% CI 1.03–35.34, p = .046).
• Groups were comparable in age, time to surgery, and transfer type, and all constructs were end-to-end, but median follow-up was shorter in the stimulated group (15 vs 26 months, p = .029).

A prospective multicenter cohort of 87 patients with 105 joints treated by proximal interphalangeal joint denervation between 2016 and 2024 with at least 12 months of follow-up assessed procedural success, defined as avoidance of subsequent arthroplasty or arthrodesis. Pain, function, satisfaction and willingness to repeat were assessed in the 76 joints not undergoing repeat surgery.

• At a median follow-up of 43 months (range 12 to 107), 81% of joints had avoided conversion to arthroplasty or arthrodesis, and most repeat procedures occurred within the first postoperative year.
• Visual analog pain scores fell from 44 to 18 at rest and from 63 to 29 during activity, a 34-point reduction in activity-related pain.
• Function improved by only 13 points on the 0 to 100 scale (47 to 60), a considerably smaller gain than the pain benefit.
• Satisfaction was rated excellent or good by 62% of patients, and 79% would choose the procedure again.

A prospective multicenter cohort of 112 patients with 114 wrists who underwent wrist denervation after failed non-operative treatment between 2012 and 2024, with a minimum of 12 months of follow-up, assessed procedural success defined as avoidance of further osteoarthritis-related wrist surgery. Pain, function, satisfaction and willingness to repeat were secondary outcomes.

• At a median follow-up of 4 years (range 1 to 13), 86% of wrists had undergone no further osteoarthritis-related surgery, and most reoperations occurred within the first 2 years.
• Visual analog pain at rest improved from 48 to 26, a 22-point reduction, while function rose from 55 to 69, a 14-point improvement.
• Satisfaction was good or excellent in 60% of patients, and 82% were willing to undergo the procedure again.

Observational series of 190 patients undergoing the modified Bilhaut-Cloquet procedure for Wassel type II to IV thumb duplication, in which the island flap raised from the radial thumb was classified intraoperatively according to the relative calibres of the proper digital artery and the communicating branches.

• Flap perfusion sorted into three blood supply patterns: fine communicating branch type in 134 thumbs, equal calibre type in 43 and coarse communicating branch type in 16.
• The fine communicating branch type, in which the proper digital artery dominates inflow, achieved a 100% success rate and accounted for roughly two thirds of the series.
• The coarse communicating branch type showed the lowest success rate of the three patterns, making it the configuration in which flap viability was least predictable.

Retrospective two-centre review of 49 patients (57 nerves) with motor or mixed motor-sensory nerve palsy after low-velocity extremity gunshot wounds, recording intraoperative nerve status and the reconstructive method chosen.

• Exploration showed neuroma in continuity in 33.3% of nerves, with complete transection in 21.1%, partial transection in 21.1% and grossly intact nerve in 24.6%.
• Only 1.8% of nerves were amenable to direct repair; nerve transfer and neurolysis were the most frequently performed procedures, followed by autologous grafting and decompression.
• Median time from injury to surgery was 99 days and 61.2% were explored for failure of functional recovery; patients explored early alongside fracture fixation had a considerably lower rate of neuroma in continuity.

Retrospective case series of 21 children with complete pronation palsy and supination deformity after severe brachial plexus birth injury, treated by radioulnar synostosis with an antegrade proximally pedicled vascularised radial periosteal flap transferred to the volar ulna and fixed in slight pronation.

• A partially ossified synostosis was radiographically visible at four weeks in all 21 cases, after Kirschner wire fixation in 10 to 20 degrees of pronation for that period.
• Mean forearm position moved from a preoperative passive pronation of minus 9 degrees to 20 degrees of pronation postoperatively (range 0 to 30 degrees) at a mean follow-up of 17.1 months.
• Harvesting the periosteal flap from the radius rather than the ulna places the donor site volarly, addressing the dorsal forearm scarring reported as the main drawback of the ulnar periosteal flap; all parents reported satisfaction with function and appearance.

Prospective pilot study of 370 wrists in 210 patients, in which the two new Szczecin tests were compared with the Schaeffer and AIIMS tests for detecting the palmaris longus tendon, using ultrasonography as the reference standard.

• Szczecin 2 was the most sensitive manoeuvre at 89% on the right hand and 91% on the left, with Szczecin 1 close behind at 87% and 88%.
• The established tests performed less well (Schaeffer 71% and 72%; AIIMS 63% and 65%), leaving a gap of roughly 16 to 26 percentage points in favour of the new tests.
• Ultrasound confirmed absence of the palmaris longus in 13% of patients and 16% of assessed hands, consistent with the agenesis rates usually quoted for European populations.

Retrospective external validation cohort of 40 patients with 85 mangled digits treated at a single level 1 trauma centre between 2019 and 2025, in which the published Mangled Digit Severity Score was tested against the actual outcome of revision amputation versus successful salvage.

• Applying the original published cutoffs, the score reached an accuracy of 76.2% with sensitivity 74.4%, specificity 77.2% and an area under the curve of 0.76.
• After institution-specific ROC optimisation, accuracy rose to 82.5% and the area under the curve to 0.84, with sensitivity improving to 87.5%.
• The refined thresholds (below 23 favouring salvage, 39 or above favouring amputation) differed only modestly from the published values but retained an indeterminate middle band, in which the score gives no directive answer.

Cross-sectional analysis of 313 adverse event reports for total wrist arthroplasty devices in the FDA MAUDE database between January 2015 and September 2025, with each narrative manually assigned a primary failure mode from a predefined taxonomy.

• Fixation-related failure dominated the reports, with loosening or component migration in 37% of cases with adequate narrative detail.
• Dislocation or instability ranked second at 18%, followed by infection at 13%; tendon or nerve injury, polyethylene wear or metallosis, implant fracture and periprosthetic fracture were less frequent.
• Annual reporting peaked in 2022 with additional clustering in 2018 and 2019; loosening was most frequent in the 2022 peak, whereas dislocation and instability clustered in 2019.

Prospective cohort of 86 adults enrolled between 2021 and 2025 with isolated carpal tunnel syndrome (n = 32), isolated cubital tunnel syndrome (n = 26) or concomitant disease (n = 28), compared on standardised sensory examination and MRC-graded intrinsic motor strength.

• The concomitant group had lower intrinsic strength at both nerve territories, with weaker abductor pollicis brevis than isolated carpal tunnel syndrome (P = .0308) and weaker abductor digiti minimi than isolated cubital tunnel syndrome (P = .0319).
• On multivariable analysis, concomitant disease independently predicted decreased abductor pollicis brevis strength (adjusted odds ratio 3.55, P = .0471).
• Sensory complaints and provocative test findings did not differ across the three groups; patients with isolated carpal tunnel syndrome were older, and cervical spine disease was more prevalent in the concomitant group.

Longitudinal multicenter cohort study of burn survivors enrolled in the national Burn Model System database, followed through 24 months after hospital discharge. Self-reported dyschromia and raised or thick scar were related to a validated satisfaction with appearance scale using multivariable logistic regression, survival analysis, and mixed-effects models.

• Dyschromia was highly prevalent at discharge and closely tracked fibrotic scar, with female sex and scar thickness independently associated with reporting it.
• Among participants identifying as Black, raised or thick scar predicted both the presence of dyschromia and its delayed resolution over time.
• Persistent dyschromia was associated with sustained dissatisfaction with appearance, whereas resolution of dyschromia coincided with improvement on the satisfaction scale.
• Across cross-sectional and longitudinal models, scar thickness was the most consistent determinant of poor psychosocial outcomes.

Systematic review of 99 studies from 13 countries published between 2000 and 2024 describing clinical use of skin cell suspension autograft for wound closure, with clinical, safety and health-economic outcomes extracted from the 27 comparative studies.

• Across comparative studies, skin cell suspension autograft consistently reduced donor skin requirement, whether used alone or combined with conventional autografting.
• Healing outcomes favoured the technique in 61% of the 27 comparative studies, with the remaining 39% reporting equivalence to the control treatment.
• Pain and aesthetic outcomes more often favoured the suspension autograft, whereas safety outcomes were generally similar between groups, with some studies favouring the comparator.
• Health-economic data suggested possible reductions in length of stay and resource use, but these findings were variable across studies and were not pooled.

A multicenter longitudinal burn database supplied a retrospective cohort of 67 pediatric burn survivors aged 8 to 17 years who completed PROMIS self-report measures 12 months after injury. General linear models tested whether pain intensity and pruritus scores were independently associated with demographic, functional, and psychosocial domains.

• Demographic and burn characteristics, including age and injury extent, were not significant predictors of either pain or pruritus at the 12-month assessment.
• Higher pain and higher itch scores were each independently associated with greater anxiety, depression, and fatigue (p = 0.0109 to p < 0.0001).
• Pruritus was additionally associated with worse physical function (p = 0.0396), an association not observed for pain intensity.

Patient-reported outcomes from the Burn Model System National Database were analyzed in a retrospective cohort of 266 adult burn survivors treated between 2015 and 2020. Logistic models identified predictors of PROMIS-29 anxiety severity and of the mental and physical component summary scores at one and two years after injury.

• At one year, burns to specific body regions and a pre-existing mental health diagnosis predicted both high anxiety severity and low mental component summary scores, while perineal burns predicted low physical component scores.
• At two years the mental health signal shifted entirely, with younger age emerging as the predictor of low mental component summary scores.
• Two-year physical component scores were predicted by leg burns, older age, and pre-existing diabetes, a different variable set from the one governing mental health outcomes.

A retrospective review of 228 patients undergoing split-thickness skin grafting for chronic atraumatic lower extremity wounds compared donor site infiltration with liposomal bupivacaine (n = 66), plain bupivacaine (n = 56), or lidocaine (n = 106). Pain scores immediately after surgery and at first follow-up were modeled against analgesic agent and patient factors including peripheral neuropathy.

• Median immediate postoperative pain was 0 for both liposomal and plain bupivacaine versus 2 for lidocaine (p = 0.027), with no separation between the two bupivacaine formulations.
• By first follow-up the between-group difference had narrowed to non-significance (p = 0.131), indicating the advantage was largely confined to the immediate postoperative window.
• On multivariate analysis, peripheral neuropathy was the strongest independent predictor of higher pain (β = +1.09, p = 0.007), ahead of female sex (β = +0.77) and lidocaine use (β = +0.89).

A single-center retrospective series of 12 adults with burns of 50% TBSA or greater described staged biodegradable temporizing matrix (BTM) application followed by Meek micrografting for definitive closure. Operative timing, coverage achieved, operative efficiency, and survival were abstracted from records, operative reports, and clinical photography.

• The cohort was severely injured, with mean burn size 63.1% TBSA, mean Baux score 104.6, and inhalation injury plus tracheostomy in every patient; 11 of 12 survived to discharge or inpatient rehabilitation.
• BTM was applied at a mean of 13.3 days after admission and Meek micrografting at 42.2 days, covering a mean of 32.5% TBSA, or 50.6% of the total burn surface.
• Documented Meek graft take exceeded 90% in evaluable cases, and no patient required secondary autografting of Meek-grafted BTM areas.
• Operative efficiency improved across the study period from 15.2 to roughly 10.8 minutes per 1% TBSA covered.

A single-center matched retrospective cohort of 54 geriatric burn patients (27 per arm) compared autografting plus autologous skin cell suspension (ASCS) with autografting alone, matched on age, sex, comorbidity index, TBSA, and ventilator days. The primary outcome was 95% re-epithelialization of the primary burn wound at four weeks.

• Most patients in both arms reached 95% re-epithelialization by four weeks, and time to wound healing was unchanged by the addition of skin cell suspension.
• ASCS use was independently associated with higher autograft mesh ratios (OR 6.37, 95% CI 1.61–25.15; p = 0.0082); ratios of 3:1 or greater were used in 29.0% of ASCS cases versus 3.7% of controls.
• Patients treated with ASCS received significantly thinner split-thickness grafts (p < 0.001), while autograft area, wound bed composition, anatomic location, and complication rates were comparable.

A two-phase quality improvement project covering 148 burn admissions compared universal MRSA screening with decolonization (intranasal mupirocin plus daily chlorhexidine bathing, 45 patients) against screening alone with no decolonization (103 patients). Endpoints were MRSA incidence, wound infection, length of stay, and mortality.

• Phase 1 achieved 93% screening compliance, 18% of screened patients were MRSA positive and all completed decolonization, and 2 of 45 patients (4%) developed MRSA wound infections requiring treatment.
• In Phase 2, screening compliance fell to 52.4%, 9.3% of screened patients were MRSA positive, and 13 patients developed wound infections, none of them MRSA.
• Length of stay, length of stay per percent TBSA, TBSA-adjusted infection incidence, and mortality showed no difference between the two phases, while screening and decolonization added cost and resource use.

A retrospective matched cohort of 10,862 patient pairs drawn from 100% Medicare fee-for-service files compared beneficiaries with diabetic foot ulcers who initiated purified native type 1 collagen matrix plus PHMB antimicrobial (PCMP) within six months of diagnosis against those who never received it. The outcome was non-traumatic lower limb amputation within six months of the index date.

• Before matching, PCMP recipients showed greater baseline disease severity, with longer active ulceration and higher pre-index amputation rates than the 657,233 beneficiaries who never received it.
• After 1:1 matching on balanced baseline characteristics, six-month amputation rates were 9.9% with PCMP versus 12.2% without (p < 0.001).
• Initiation within 45, 60, or 90 days of diagnosis was associated with amputation rates of 4.0%, 4.1%, and 4.8% respectively, against 8.4% among non-recipients.

A single-center retrospective analysis of 132 operative burn cases over one year evaluated a proposed Green, Yellow, and Red classification of anticipated anesthetic requirement based on TBSA, hemodynamic instability, and vasopressor dependence. Demographics, mechanism, TBSA, and intraoperative transfusion were compared across tiers and between pediatric and adult cohorts.

• Pediatric cases carried substantially larger burns than adult cases (43.3% versus 21.8% mean TBSA, p = 0.0017) and were over-represented in the Red tier (p = 0.0011), despite a similar distribution of injury mechanism (p = 0.50).
• Intraoperative blood product administration differed significantly across the three tiers (p < 0.001), the principal evidence offered that the categories separate physiologically distinct cases.
• Tier assignment rested on burn extent, hemodynamic instability, and vasopressor dependence rather than on any established burn morbidity or mortality score.

Prospectively collected data from the German national breast reconstruction registry supported a multicenter analysis of 4209 unilateral microsurgical reconstructions performed in 4113 patients at 22 centers between 2011 and 2018. Generalized linear and multivariable regression models tested how flap type, intraoperative repositioning, anastomosis technique, surgeon-related factors, and recipient vessel choice related to ischemia time, operative duration, and clinical outcomes.

• Procedures requiring intraoperative repositioning had substantially longer ischemia times than those without, with a mean difference of 43 minutes (p < 0.001).
• Hand-sewn venous anastomoses were associated with longer ischemia times than coupler-assisted anastomoses (mean difference 15 minutes, p = 0.003), and this gap widened over the study period.
• After adjustment, prolonged ischemia time remained associated with arterial revision and flap loss, while coupler-assisted anastomosis appeared less sensitive to surgeon-level variability and procedural complexity.
• Total operative duration, rather than ischemia time, showed the strongest and most robust association with venous anastomotic revision.

Retrospective cohort of 14,309 patients in the TriNetX federated database who underwent microsurgical autologous breast reconstruction, comparing 395 with a prior VTE history against 13,914 without. Thrombotic, wound, symptom, and utilization outcomes were assessed at 30, 60, and 90 days, with revision assessed at 2 years.

• At postoperative day 90, prior VTE was associated with roughly 16-fold higher rates of DVT (RR 16.2) and pulmonary embolism (RR 15.8).
• Wound and symptom outcomes were also more frequent at 90 days with prior VTE: infection (RR 1.70), pain (RR 1.67), and wound dehiscence (RR 1.35).
• Health care utilization was higher in the prior VTE group, with emergency department visits (RR 2.24) and hospitalizations (RR 1.34) more common at 90 days.
• Revision rates at 2 years did not differ significantly between the two cohorts.

A single-institution retrospective consecutive cohort of 232 patients undergoing unilateral DIEP flap breast reconstruction between January 2024 and January 2026 compared the 9 patients (4%) exposed to perioperative CDK4/6 inhibitors with the 223 unexposed patients. Preoperative haematological indices and postoperative minor and major complications were assessed.

• Exposed patients received abemaciclib (n=6), ribociclib (n=2) or palbociclib (n=1) and were advised a median of 2 weeks off treatment before surgery.
• Preoperative haemoglobin, white cell, neutrophil and lymphocyte counts were significantly lower in the CDK4/6 inhibitor group (p<0.05).
• Minor complications occurred in 0% of exposed versus 11% of unexposed patients (p=0.6), and major complications in 0% versus 2.2% (p=1.0).

A systematic review and proportion meta-analysis of 25 studies comprising 1033 patients assessed perioperative outcomes of medial pedicle breast reduction, with odds ratios calculated against inferior pedicle reduction. Mean BMI ranged from 27 to 42 kg/m² and mean resection weights from 412 to 3828 g.

• Pooled complication rates were low, with infection, seroma, haematoma and nipple-areola necrosis each at 1% and fat necrosis at 2%; dehiscence was the most frequent at 8% and reintervention was 5%.
• Odds of complications did not differ significantly from inferior pedicle reduction.
• Nipple-areola sensation typically recovered by 6 to 12 months, with no long-term deficits reported.
• Volumetric analyses showed stable breast shape after the first postoperative year with superior upper pole tissue maintained, and satisfaction ranged from 75% to 100%.

A PRISMA-registered systematic review and random-effects meta-analysis of 26 studies covering 863 patients and 1106 reconstructions compared prepectoral (n=432) with retropectoral (n=674) single-stage implant-based reconstruction after skin-reducing mastectomy. The primary outcome was breast complications, with aesthetic and patient-reported outcomes as secondary endpoints.

• The pooled complication rate was 20% for prepectoral versus 25% for retropectoral reconstruction, a difference that did not reach statistical significance.
• Rates of implant loss, skin and nipple-areola necrosis, wound dehiscence, superficial epidermolysis, capsular contracture and rippling showed no significant difference between planes.
• Patient-reported outcomes favoured prepectoral placement, with consistently high BREAST-Q scores across psychosocial, sexual and satisfaction domains, although differences did not reach significance.

A retrospective series of 204 patients (408 breasts) undergoing implant explantation between 2021 and 2025 describes the breast sculpting approach, which combines tissue recruitment, muscle repositioning and reshaping of the breast footprint to restore contour after implant removal. Reported outcomes were the implant plane distribution and early complications.

• Explanted implants were retroglandular in 78.6% of breasts, submuscular in 11.5% and dual plane in 9.8%.
• Thromboembolic events were uncommon, comprising two deep vein thromboses (0.98%) and one minor pulmonary embolism (0.49%).
• Unilateral breast haematoma was reported in five cases (1.22%), and the authors note the technique does not preclude subsequent lipofilling.

A retrospective cohort of 277 patients undergoing mastectomy with immediate reconstruction after neoadjuvant chemotherapy compared 54 patients treated with PD-1 inhibitor-based regimens against 223 treated without, using multivariable models for PACU opioid use per hour, postoperative pain and post-discharge refills.

• Despite comparable preoperative and intraoperative analgesia, PACU opioid consumption was higher with PD-1 exposure at 3.5 versus 2.1 OME per hour (p=0.029).
• Maximum PACU pain scores were higher (6.3 versus 5.4, p=0.011) and post-discharge refills more than doubled, 38.9% versus 17.0% (p=0.001).
• On multivariable analysis PD-1 exposure independently predicted refill likelihood (OR 3.57, p<0.001) and PACU opioid use per hour, alongside axillary dissection and breast volume above 700 cm³.

A retrospective single-centre series of 119 patients (181 breasts) evaluated immediate implant-based reconstruction with a standardised mesh-free subpectoral technique preserving the inframammary ligament, serratus anterior fascia and intercostal perforators. Outcomes were complication rates, revision surgery and BREAST-Q scores.

• Minor complications occurred in 28.6% of cases and major complications in 6.7%, with haematoma, infection and implant-related events in the lower range of published values.
• Revision surgery was required in 7.6% of patients, mainly for contour irregularity, and all revisions were corrected in a single stage.
• Mean BREAST-Q score among the 100 patients who completed the questionnaire was 76.6 ± 15.1 at a mean follow-up of 28.1 months.

A nationwide cohort of 5729 women surgically treated for primary breast cancer between 2015 and 2019 linked registry-derived treatment codes to a questionnaire on shoulder impairment, lymphoedema and fatigue completed 3 to 7 years postoperatively, with logistic regression adjusted for confounders.

• Relative to breast-conserving surgery with sentinel node biopsy and radiotherapy, mastectomy with sentinel node biopsy and radiotherapy carried the highest odds of late effects (ORadj 3.10, 95% CI 2.48 to 3.88).
• Mastectomy with axillary dissection and radiotherapy (ORadj 2.90, 95% CI 2.02 to 4.15) and breast-conserving surgery with axillary dissection and radiotherapy (ORadj 2.76, 95% CI 2.25 to 3.39) showed similarly elevated odds against the same reference.
• Shoulder impairment was the most frequently reported late effect in every treatment category.

This narrative review of preclinical, translational and clinical evidence synthesises animal model, capsule histology, proteomic and gene expression data on a specific 4 µm implant surface architecture, comparing it with conventional smooth and high-roughness surfaces and relating the findings to capsular contracture and breast tissue-preserving techniques.

• Across the assembled models, the 4 µm surface showed reduced proinflammatory macrophage infiltration compared with both smooth and high-roughness surfaces.
• Capsules around this surface were thinner yet elastic, with enhanced FoxP3+ regulatory T cell recruitment and decreased profibrotic signalling.
• The authors report low clinical capsular contracture rates without an increase in implant instability, and frame capsule behaviour as governed by structural organisation and immune profile rather than thickness alone.

A PRISMA-compliant systematic review and meta-analysis of 45 studies comprising 10,784 patients undergoing deep plane facelift, pooled under a random-effects model. Primary outcomes were overall and individual complications; secondary outcomes were aesthetic results compared with subcutaneous and SMAS techniques.

• The pooled overall complication rate was 6.6%, aggregated from randomised, cohort, case-control and case-series data on deep plane facelift.
• No instances of permanent facial nerve injury were observed across the pooled cohort; temporary facial nerve injury was estimated at 1.2%.
• Among individual events, hypertrophic scarring was the most frequent at 2.8%, followed by haematoma 1.8%, seroma 1.7%, epidermolysis 1.2%, infection 0.8% and skin necrosis 0.1%.
• Aesthetic outcomes were rated as superior to subcutaneous and SMAS facelifts, though the underlying assessments were subjective and not standardised between studies.

A prospective, randomised, evaluator-blinded split-face trial of 22 patients (44 facial sides) with facial photoaging. Both sides received microfocused ultrasound and one randomly assigned side additionally received 1550-nm non-ablative fractional laser over two sessions six weeks apart, with biometric and ultrasound assessment to 24 weeks.

• Both sides improved significantly from baseline in laxity, wrinkle and pigmentation scores as well as dermal thickness, skin relaxation time, melanin and erythema indices, confirming a measurable effect of microfocused ultrasound alone.
• The combined side outperformed the ultrasound-only side for wrinkle score, pigmentation score, dermal thickness, skin relaxation time and melanin index (all P < 0.05), indicating incremental benefit from the fractional laser.
• No between-side difference emerged in the laxity score or erythema index, so the added gain was confined to texture and pigment endpoints rather than lifting.

A retrospective single-centre review of 128 patients (239 breasts) operated between 2013 and 2023, comparing glandular excision alone, liposuction alone, combined excision with liposuction, and mastectomy with free nipple-areola grafting. Endpoints were postoperative complications, with patient-reported satisfaction and pain collected by telephone survey.

• Complications occurred in 18.8% of patients overall, but rates diverged by technique: 3.7% after combined excision-liposuction versus 31.4% after excision alone, 0% after liposuction alone and 37.5% after grafting (p = 0.0002).
• Major complications affected 4.7% of patients and consisted exclusively of haematomas requiring reoperation.
• Among the 43 patients who responded (33.6%), satisfaction was high for both excision (8.6/10) and the combined technique (8.5/10), while reported pain was lowest in the combined group at 2.8/10.

A retrospective review of 304 consecutive facial feminization cases performed at a single ambulatory surgery centre between July 2018 and January 2022. Primary outcome measures were postoperative transfer to hospital and emergency department visits, alongside procedures performed and case duration.

• Cases averaged 3.5 procedures each, with a mean operative duration of 3 hours 13 minutes and a range from 20 minutes to 8.5 hours.
• Unplanned transfer to a higher level of care occurred in 3 cases (0.99%), and none of those transfers resulted in long-term consequences for the patients.
• Complication rate was unrelated to the number of procedures, patient age or case duration, so operative complexity did not track with the need for escalation in this cohort.

A prospective single-centre observational study of 36 postpartum women with diastasis recti undergoing abdominoplasty combined with breast augmentation, reduction or mastopexy. Short Form Health Survey, Rosenberg Self-Esteem Scale and PGWBI-S scores were collected at baseline, 3 months and 12 months and modelled with linear mixed-effects analysis.

• Several SF-36 domains improved at 12 months, with the largest gain in Energy/Fatigue (+11.4; p = 0.031), alongside General Health Perception (+10.2), Physical Functioning (+10.1), Pain (-4.9) and Social Functioning (+1.9).
• Self-esteem rose by a mean of +4.53 points on the Rosenberg scale (p < 0.001), sustained across the full follow-up period.
• The PGWBI-S domains of Self-Control and Positive Well-Being improved significantly (p < 0.001), indicating change in psychological state rather than physical function alone.
• No major complications were reported and all 36 patients completed the 12-month protocol, giving complete outcome capture in this small cohort.

A prospective multicentre case series of 159 consecutive patients across five centres over six months, describing an inframammary minimally invasive breast augmentation using atraumatic tunneling, balloon-assisted pocket creation and sixth-generation silicone implants. Demographics, anesthesia modality, early complications, recovery and satisfaction were collected prospectively; 13% had concomitant fat transfer or mastopexy.

• All patients received tumescent infiltration and 95% of procedures used a bolus anesthesia technique, with 58% performed under local anesthesia with sedation rather than general anesthesia.
• No early postoperative haematomas, loss of breast sensation, sensory disturbances or abnormal pain were reported across the series.
• Satisfaction was high on both sides of the encounter, with 94% of patients satisfied or extremely satisfied and surgeon satisfaction recorded at 96%.

A retrospective single-surgeon series of 80 patients (160 eyelids) undergoing bilateral aponeurotic ptosis repair combined with subbrow blepharoplasty at one centre between March 2021 and December 2023. Outcomes were marginal reflex distance 1, lagophthalmos, complications, patient self-grading and blinded independent observer grading.

• Marginal reflex distance 1 increased by 2.35 ± 1.15 mm postoperatively (P < 0.001) in a cohort with a mean age of 56.5 years.
• Mean lagophthalmos at 3 months was 0.025 mm, and no patient developed exposure keratopathy or other postoperative complications.
• Three of 160 eyelids required revision for residual ptosis, and blinded observer grading was excellent in 67.5% and good in 27.5% of eyelids; mean patient self-grading was 8.6 out of 10.

A retrospective comparative study of 141 patients undergoing full abdominoplasty with Scarpa fascia preservation, comparing 61 patients given 1 g intravenous tranexamic acid at induction plus 50 mL of topical 3% solution before closure with 80 patients given none. Outcomes were drain output, drain duration, length of stay and local and systemic complications.

• Tranexamic acid was associated with a 27% reduction in total drain output (p < 0.001) alongside shorter drain duration and shorter hospital stay.
• Drains were removed on the first postoperative day in 42% of treated patients versus 2% of controls (p < 0.001), with 81% lower odds of prolonged drain use (OR 0.19, 95% CI 0.06 to 0.57).
• There was no significant difference in seroma, haematoma, wound healing problems or thromboembolic events between the two groups.

A narrative review of anatomical studies, autopsy reports, and clinical series examining the mechanisms of fatal fat embolism in cosmetic lipofilling, comparing risk profiles across gluteal, breast, and facial fat grafting.

• The excess mortality seen after gluteal augmentation is ascribed to the interplay of significant intramuscular gluteal veins, the grafting technique used, and the large fat volumes transferred.
• Breast and facial lipofilling take place in anatomical environments associated with substantially lower pulmonary fat embolism risk, while facial injection carries a distinct risk of arterial fat embolism.
• The review proposes that mortality reduction rests on strict subcutaneous-plane injection, ultrasound guidance during grafting, and enhanced surgeon training.
• Current evidence is limited by non-uniform complication reporting and absent denominator data on procedures performed, which the authors address by calling for mandatory complication registries.

A retrospective cohort of postpregnancy patients treated between January 2015 and April 2024 compared extensive flap dissection abdominoplasty alone against the same procedure combined with high-definition liposuction, assessing complications, aesthetic outcomes, and satisfaction over a mean follow-up of 8.6 months.

• Patients in the combined group showed significantly greater reduction in abdominal circumference than those undergoing abdominoplasty alone (P < 0.05).
• Postoperative visual analog scale scores were significantly higher in the combined group (P < 0.05), which the authors relate to a more natural anatomical contour.
• Despite the extensive undermining used, no infections or extensive flap necrosis were recorded in either group during the study period.

A systematic review and meta-analysis of 208 articles on non-invasive skin cancer diagnosis, quantifying the accuracy of imaging and artificial intelligence tools used alongside or instead of face-to-face clinician assessment.

• Artificial intelligence interpretation of dermatoscopic images showed high diagnostic performance for melanoma, basal cell carcinoma, and malignancy overall relative to dermatoscopic assessment by clinicians and experts alone.
• For melanoma, artificial intelligence demonstrated higher sensitivity than combined clinical and dermatoscopic assessment, whereas the equivalent comparison for basal cell and squamous cell carcinoma was not resolved by the available data.
• Reflectance confocal microscopy retained high sensitivity for cutaneous malignancy, which the authors position as a secondary-care application.

A retrospective comparative cohort of 28 patients aged 8 to 24 years with malignant femoral bone tumours treated between 2020 and 2024 compared liquid nitrogen-treated autograft combined with megaprosthesis (n = 10) against total femoral replacement (n = 18) for perioperative, functional, and oncological outcomes.

• Musculoskeletal Tumor Society scores favoured the hybrid reconstruction (27.0 ± 2.1 vs 24.4 ± 2.2, p = 0.014), alongside shorter operative time and lower blood loss; length of stay was comparable.
• Continuous disease-free survival was 90% with the hybrid reconstruction versus 44% after total femoral replacement (p = 0.058), with recurrence in 10% and 28% respectively.
• Bone union was achieved in 70% of hybrid cases at a mean of 9 months, and longer graft segments were associated with delayed union.

A multicentre observational cohort of 16 patients undergoing single-stage scalp reconstruction after excision of nonmelanoma skin cancer at two university hospitals compared cadaveric human acellular dermal matrix (n = 6) with Integra (n = 10), with time to complete epithelialization as the primary outcome.

• Mean healing time was 1.8 ± 0.3 months with acellular dermal matrix versus 3.5 ± 1.4 months with Integra (mean difference 1.7 months, 95% CI 0.48–2.92; p = 0.01; Cohen's d = 1.54).
• All grafts integrated without failure; one postoperative infection occurred in the matrix group and resolved with oral antibiotics, with none in the Integra group.
• Material cost was approximately 72% lower with the tissue bank-derived matrix (€500 versus €1,759 per reconstruction), while operative times were comparable.

A single-arm usability evaluation of 13 users spanning five training levels, from postgraduate year 1 to fellow, who completed sessions on a web platform integrating large language model case generation with generative anatomical diagrams, assessed by the System Usability Scale and an 8-item Likert survey.

• The mean System Usability Scale score was 82.9 ± 14.8, corresponding to grade B, with 84.6% of users scoring 72 or above.
• Educational perception averaged 4.70 of 5.0 ± 0.41, with procedural preparedness the highest-rated item at 4.92.
• Immediate feedback (45%) and critical thinking development (27%) were the most valued features, at an average cost of US $1.05 per session with no infrastructure cost.
• The complete platform was developed by a practicing plastic surgeon using AI-assisted coding, without an engineering team.

A single-cell RNA sequencing study of 43,303 dermal cells from freshly excised human hypertrophic scar and normal skin, combined with lentiviral YY1 overexpression in patient-derived scar fibroblasts for functional and epigenomic validation.

• Hypertrophic scar tissue showed pronounced pericyte expansion and reduced overall fibroblast abundance, yet the ADAM12+ COMP+ POSTNhi subcluster Fib_5 increased and displayed upregulated fibrotic gene expression.
• Pseudotime analysis placed Fib_5 in a scar-dominant differentiation branch in which YY1 was the only predicted transcription factor also differentially expressed; the subcluster was conserved across 21 samples from combined public fibrotic datasets.
• Lentiviral YY1 overexpression in patient-derived scar fibroblasts reversed fibrotic gene expression profiles, with Fib_5 identified as the primary responder and CUT&Tag confirming the effect at the epigenomic level.
• Cell-cell communication analysis showed marked reprogramming of fibroblast-pericyte signalling across multiple fibrosis-related pathways in hypertrophic scar.

A narrative review of microRNA-engineered mesenchymal stem cell-derived extracellular vesicles that proposes a burn-specific development framework aligning parental-cell programming, vesicle modification, and biomaterial-assisted delivery with the barriers particular to burn wounds.

• Native extracellular vesicle preparations remain constrained by low yield, heterogeneity, insufficient targeting, and incomplete cargo control.
• Much of the supporting efficacy evidence derives from non-burn wound models, leaving burn-specific barriers such as eschar, infection, hypoxia, and inhalation injury largely untested.
• The proposed framework maps interventions onto burn pathophysiology, including the systemic inflammatory response to compensatory anti-inflammatory response transition and its temporal immune dysregulation.
• Translational requirements highlighted include dose scaling for large total body surface area burns, repeat application, compatibility with debridement and grafting, and storage, thawing, and sterility in burn centres.

A controlled preclinical study in a rat comb scald burn model evaluated intraperitoneal melatonin at different doses given immediately after injury, with histological assessment of conversion in the interspace zone of stasis. Oxidative stress markers, inflammatory cytokines and autophagy/mitophagy signalling were profiled by ELISA, immunostaining, qRT-PCR and western blot, with pharmacological autophagy blockade used to probe mechanism.

• Melatonin blunted burn-induced HMGB1-NLRP3 inflammasome activation and reduced downstream inflammatory cytokine release in the injured tissue.
• Oxidative stress fell with treatment, indicated by decreased malondialdehyde alongside restored SOD and GPx activity; these changes tracked with better preserved mitochondrial integrity.
• The effect was attributed to PINK1-PARKIN-dependent mitophagy, and co-treatment with the autophagy inhibitor 3-MA abolished the protective effect of melatonin on wound conversion.

An in vitro study of human keloid fibroblasts compared with normal human skin fibroblasts tested whether miR-542-3p drives a profibrotic phenotype and whether ATG7 is its direct downstream target, using mimic and inhibitor transfection, viability and apoptosis assays, dual-luciferase reporter constructs and ATG7 knockdown epistasis experiments.

• miR-542-3p was significantly upregulated in keloid fibroblasts relative to normal skin fibroblasts; inhibiting it reduced viability and increased apoptosis, while overexpression produced the opposite pattern.
• Profibrotic protein expression moved with the microRNA, showing higher collagen I, collagen III and α-SMA after overexpression and lower levels after inhibition.
• Dual-luciferase assays confirmed direct binding of miR-542-3p to the ATG7 3'-UTR; ATG7 knockdown raised viability and profibrotic markers and blunted the antifibrotic effect of miR-542-3p inhibition.