Plastic Surgery Weekly

A randomized controlled trial of 40 patients undergoing hemiglossectomy and anterolateral thigh flap reconstruction for tongue cancer compared simultaneous nerve anastomosis (n = 21) with a conventional non-innervated flap (n = 19). Sensory, speech, swallowing, quality-of-life, and flap volume outcomes were assessed at 2, 6, and 12 months.

• Sensory recovery favored the neurotized flap, with better two-point discrimination and touch pressure sensation in the N-ALT group (p < 0.05).
• Speech and swallowing function was superior in the N-ALT group at every time point, including the earliest assessment at 2 months.
• Quality of life on the University of Washington questionnaire favored neurorrhaphy, most clearly in the emotional and swallowing domains.
• Volumetric analysis of the transferred flap showed less atrophy in the neurotized group.

A systematic review and meta-analysis of eight studies covering 2179 free flap procedures (1098 of them controls) compared intraoperative indocyanine green fluorescence angiography with conventional clinical assessment for partial failure, total failure, and reoperation, with risk of bias assessed by ROBINS-I and RoB-2.

• ICG angiography was associated with a 90% reduction in the odds of partial flap failure (OR 0.10, 95% CI 0.04-0.26).
• The effect on total flap failure was smaller at a 41% odds reduction (OR 0.59, 95% CI 0.35-0.97).
• Reoperation was 53% less likely in the ICG groups (OR 0.47, 95% CI 0.25-0.88).

A retrospective single-center series of 48 patients who underwent unilateral microform cleft lip repair with nasolabial muscle tension line group reconstruction between 2010 and 2018 was assessed at a minimum of five years using visual analog scales and objective anthropometry comprising eight ratios and three angle measurements.

• At a median follow-up of 6.01 years (range 5.06-12.01 years), symmetry of the alar base, nostril, columella, nasal sill, philtrum, and vermillion was significantly improved over preoperative measurements.
• Subjective visual analog scale ratings described minimal scarring and improved symmetry after repair.
• The authors attribute reliable formation of the philtral column and nasal sill to precise reconstruction of the muscle tension line groups rather than to skin-level maneuvers.

A retrospective single-surgeon series of 132 patients with postparalytic facial synkinesis treated between 1995 and 2024 describes a two-period strategy: aggressive excision of aberrantly reinnervated nerve and muscle followed by functioning free muscle transplantation, with prophylactic dermal fat grafting added for the 29 patients treated from 2021 onward.

• 82% of the cohort underwent cross-face nerve graft-innervated gracilis transplantation after removal of the synkinetic neuromuscular substrate.
• Quantitative smile excursion, cortical adaptation, and synkinesis grading all showed statistically significant improvement following the staged approach.
• Adding a prophylactic dermal fat graft from 2021 onward virtually eliminated postoperative contracture of the upper lip and nasolabial fold.

This retrospective cohort study of 20,604 microsurgical cases drawn from ACS NSQIP between 2014 and 2023 compared observed morbidity against generalized model predictions, then tested whether calibration varied across operative time using quartiles, deciles, and continuous spline models. Sensitivity analyses restricted the cohort to exact principal CPT codes and excluded cases with a known morbidity component or reoperation on postoperative day 0 or 1.

• Overall observed morbidity of 12.52% closely matched the predicted 12.79% (O:E 0.98, 95% CI 0.94-1.02), while discrimination was modest, with an area under the curve of 0.639; mortality was rare, at 21 deaths.
• Calibration reversed across the operative-time gradient, with morbidity overpredicted in the shortest quartile (8.66% observed vs. 12.87% predicted) and underpredicted in the longest (16.94% vs. 12.96%): O:E 0.67 versus 1.31.
• The prespecified linear interaction term was nonsignificant (P = 0.183), whereas flexible continuous models demonstrated significant calibration variation both before and after global recalibration (both P < 0.001), and the pattern persisted in both sensitivity analyses.

A retrospective review of 41 consecutive patients undergoing freestyle perforator propeller flap reconstruction of large midline sacral defects from pressure ulcers (n=22), hidradenitis suppurativa (n=13), and sarcoma (n=6) reported complications and length of stay as primary outcomes. Patient- and observer-rated 5-point Likert aesthetic scores at 12 months served as secondary outcomes.

• Mean flap size was 134.9 ± 45.2 cm², and postoperative complications occurred in 12 patients (29.3%), including one total and one partial flap loss.
• Patient-rated aesthetic scores rose from a baseline of 1.41 ± 0.74 to 4.85 ± 0.36 at 12 months, with observer ratings improving in parallel from 1.35 ± 0.63 to 4.34 ± 0.42 (both P < 0.001).
• Mean hospitalization was 4.71 ± 4.01 days, a standard deviation nearly as large as the mean, indicating a subgroup with substantially prolonged stays.

A prospective cross-sectional study of 27 adults with complete unilateral facial nerve paralysis, evaluated at a tertiary clinic between January 2025 and January 2026, compared paralyzed and nonparalyzed sides using unilateral peak nasal inspiratory flow (PNIF), nasal Schirmer testing, rigid endoscopy with validated valve grading, Cottle maneuver, photographic analysis, and the Thai-NOSE scale.

• Peak nasal inspiratory flow was lower on the paralyzed side (48.21 vs. 61.17 L/min; p = 0.005), and mucosal secretion on Schirmer testing was likewise reduced (4.74 vs. 8.37 mm; p = 0.006).
• Subjective obstruction was reported by 81.5% of patients, yet internal and external valve grading did not differ between sides (p = 0.559 and p = 1.000), so standard endoscopic assessment did not register the physiologic deficit.
• Longer paralysis duration correlated with nasal morphologic distortion (r = 0.420, p = 0.029) but showed no association with functional impairment (r = -0.010, p = 0.961).

A cross-sectional survey of 93 patients who underwent lower limb free flap surgery assessed pain, emotional symptoms, perceived support, and desired interventions during postoperative bed rest. Chi-squared tests and logistic regression examined associations between reported symptoms and support preferences.

• Significant pain during bed rest was reported by 60% of patients and emotional symptoms by 93%, yet only 11% requested enhanced pain management and 10% requested psychological support.
• Structured daily routines were desired by 67% of patients, while 47% judged preoperative planning inadequate and 25% wanted more clinical information.
• Patients reporting insufficient preoperative planning were markedly more likely to prefer structured activation (OR 6.87, 95% CI 2.10-22.42, p = 0.001); a wish for more information trended in the same direction without reaching significance (OR 3.67, 95% CI 0.83-16.25, p = 0.087).

A retrospective single-center study of 30 patients reconstructed with pedicled perforator propeller flaps between 2014 and 2022 analyzed 48 ICG angiographic sequences acquired after flap elevation and after inset. Fluorescence intensity, perfusion distribution, and 20% and 30% contour levels were quantified in ImageJ across standardized 3-cm segments from the perforator to the distal flap edge.

• All flaps survived, and complications occurred in 6 patients (20%), comprising three minor wound-healing disorders and three cases of venous congestion requiring revision.
• Mean flap length was 15.8 cm, and the perfused area at the 20% fluorescence contour level represented 97.2% of total flap surface.
• Perfusion declined progressively with distance from the perforator and fell significantly in flaps exceeding 15 cm (p < 0.01), whereas flaps under 10 cm perfused homogeneously; lower extremity flaps showed more consistent patterns than truncal and gluteal flaps.

A retrospective analysis of 12 patients undergoing head and neck reconstruction with radial free forearm flaps between 2020 and 2022 tested whether intravenously administered norepinephrine was associated with flap tissue perfusion measured continuously for 8 postoperative hours by an attached surface probe using the Oxygen-to-see (O2C) system.

• No association was found between norepinephrine dose and flap blood flow (B = -110.509, p = 0.583) or hemoglobin oxygen saturation (B = -12.500, p = 0.912).
• Flow resistance, defined as mean arterial pressure divided by flap blood flow, was likewise unrelated to norepinephrine dose (B = 0.292, p = 0.825).
• The authors read this as support for fixed absolute O2C thresholds in detecting vascular compromise, on the reasoning that vasopressor administration does not systematically shift the monitored perfusion values.

A multicenter open randomized noninferiority trial of 200 patients with a stable, congruent proximal interphalangeal joint after dorsal dislocation or hyperextension injury with volar plate avulsion compared a self-management exercise regimen with supervised hand therapy. The primary endpoint was the three-month change in Michigan Hand Outcomes Questionnaire score against a prespecified noninferiority margin of -8 points.

• In the modified intention-to-treat set the mean difference in three-month MHQ change score was -0.6 points (95% CI -4.4 to 3.2), comfortably within the noninferiority margin.
• The per-protocol analysis gave a mean difference of 0.4 points in favor of self-management (95% CI -3.5 to 4.4), so noninferiority was met in both required analysis sets.
• No safety problems were observed with self-management, and the margin used was set at roughly half the minimal clinically important difference, making it a conservative threshold.

A prospective explorative two-center study of 200 patients (men over 50 and women over 60 without known amyloidosis) analyzed A1 pulley specimens from trigger finger release and cord or nodule specimens from limited fasciectomy using Congo red staining, with immunohistochemical subtyping of positive samples and cardiological referral.

• Among the 100 trigger finger release patients, 10 specimens stained Congo red positive and amyloid was confirmed in five, four of them transthyretin.
• Among the 100 limited fasciectomy patients, eight specimens stained Congo red positive but none were confirmed on immunohistochemistry.
• No patient in either group had clinically apparent cardiac amyloidosis on cardiological assessment, and amyloid positivity in the trigger finger group tracked with pre-existing heart failure.

A prospective cohort of 30 consecutive patients with symptomatic chronic distal radioulnar joint instability refractory to nonsurgical management underwent Adams-Berger ligament reconstruction using an autologous tendon graft, with patients showing advanced arthritis, fixed bony deformity, or infection excluded. Assessment spanned stress testing, pronation-supination range of motion, grip strength, Modified Mayo Wrist Score, Patient-Rated Wrist Evaluation, and DASH through 12 months.

• At 12 months, most patients demonstrated a restored firm end point with minimal residual translation on distal radioulnar joint stress testing.
• Grip strength increased over preoperative values while forearm rotation remained within functional limits, indicating that stability was not obtained at the cost of pronation-supination arc.
• Patient-reported measures showed marked reductions in pain and disability, and no graft failures or revision procedures were recorded during the follow-up period.

A case-control study of 27 patients with flexor tendon rupture and 73 nonrupture controls after volar distal radius plating compared demographic and radiographic parameters, including radial inclination, Soong class, volar tilt, and the capitate-to-axis-of-radius distance (CARD) as a measure of lateral carpal alignment. Univariable and multivariable logistic regression identified independent predictors.

• In the multivariable model, CARD was the only significant predictor of rupture in the setting of a prominent plate, outperforming radial inclination, Soong class, and volar tilt.
• Mean CARD was 9.8 mm in the rupture group (range 4.9 to 20 mm) versus 3.5 mm in controls (range -2.9 to 11.6 mm), with substantial overlap across the two ranges.
• The rupture cohort was almost entirely female (25 of 27 patients), with a mean age of 66.9 years at the time of tendon rupture.

A systematic review and meta-analysis of 434 patients across 16 studies pooled patient-reported outcomes after arthroscopic treatment of scapholunate interosseous ligament injury, with a minimum follow-up of 12 months. Four technique categories were represented: capsulodesis, electrothermal treatment, debridement with percutaneous K-wire fixation, and arthroscopic reduction and association of the scaphoid and lunate.

• Arthroscopic capsulodesis was the best-represented technique, appearing in seven of the 16 studies, followed by electrothermal treatment in four and debridement with percutaneous K-wire fixation in three.
• Meta-analysis of the six capsulodesis studies with extractable data (N = 250) showed a significant improvement in patient-reported outcomes from baseline to final follow-up.
• The authors report a low complication rate after capsulodesis in higher-grade scapholunate injuries, but the review contains no head-to-head comparison between the four arthroscopic techniques.

A retrospective cohort of 22 wrists undergoing scaphocapitate fusion for Kienböck disease within a single multicampus health system (1996–2025) tested whether a lower preoperative radiographic scaphoid waist index, measured independently by two observers on lateral radiographs, was associated with nonunion.

• Nonunion occurred in 5 of 22 wrists (23%) over a median available postoperative follow-up of 23.7 months (IQR 14.4–41.2 months).
• Rater-averaged waist index was lower in wrists that developed nonunion, at medians of 0.365 versus 0.429, with a Hodges-Lehmann median difference of -0.0568 (bootstrap 95% CI -0.0981 to 0.0087).
• In the exploratory dichotomized analysis, nonunion occurred in four of nine type II wrists versus one of 13 type I wrists, but the odds ratio was too imprecise to interpret (OR 9.60, exact 95% CI 0.64 to 510.98).
• Symptomatic adjacent-joint osteoarthritis within 1 year was uncommon, occurring in two of the 22 wrists.

A network meta-analysis of 34 studies and 962 patients (584 open reduction, 378 arthroscopic) compared open with arthroscopic reduction for perilunate and lunate dislocations, using Mayo Wrist Score and DASH as primary outcomes and complications, anatomical success, and grip strength recovery as secondary outcomes.

• Arthroscopic reduction was associated with superior functional outcomes in the pooled network, along with lower complication rates than open reduction.
• Direct comparative evidence was confined to three studies totalling 48 patients; the remainder of the network rests on indirect comparison across single-arm cohorts.
• Subgroup analysis identified surgeon experience as a significant modifier of both outcomes and complications, while greater arc fracture patterns carried higher complication rates regardless of approach.

An open-label randomized controlled trial of 50 patients with acute distal radius fracture compared ultrasound-guided supracondylar radial nerve block (n = 28) with hematoma block (n = 22) for closed reduction in the emergency department, recording numeric rating scale pain at admission, 10 minutes after the block, and during the reduction maneuver.

• Neither technique produced a clinically significant pain reduction (≥2 points on the numeric rating scale) between admission and 10 minutes after injection, or between injection and the reduction maneuver.
• Across the full interval from admission to reduction, the ultrasound-guided radial nerve block was associated with clinically significant pain improvement relative to hematoma block.
• Radiographic reduction quality did not differ between groups on any measured parameter, and no between-group differences in complications were registered during admission or at 2-week telephone follow-up.

A retrospective registry cohort of 59 digits reoperated for isolated arterial thrombosis after replantation or revascularization at Norway's national replantation unit (2010–2024) examined whether the duration of secondary ischemia correlated with digit survival, controlling for established replantation survival predictors.

• Binary logistic regression did not identify secondary ischemia time as a predictor of digit survival.
• Mean secondary ischemia time was no different between salvaged and non-salvaged digits, and the two groups were comparable with respect to known confounding survival predictors.
• Ischemia onset was operationalized as a surface skin temperature fall of 1 °C per hour or 1.5 °C over 2 hours, giving a consistent starting point for the ischemic interval across cases.

A single-center prospective registry review of 31 limbs in 29 patients with transradial or transhumeral amputation compared targeted muscle reinnervation performed within 30 days of amputation (21 limbs) with delayed TMR beyond 30 days (10 limbs), assessing pain, patient-reported outcomes, and complications at a minimum of 3 months.

• Final pain visual analog scale scores were lower after acute TMR (1.6 vs 5.1, P = .001), with no differences in demographics or comorbidities between the groups.
• Veterans-Rand 12-Item mental component scores were reported as better in the acute group (31.5 vs 55.9, P = .011), alongside a trend toward lower rates of depression.
• Complication rates did not differ between acute and delayed TMR (P = .99), so earlier reinnervation was not associated with added surgical risk in this cohort.

A prospective multicenter observational cohort of 448 adults admitted to six French burn centers within 72 hours of injury with burns exceeding 20% TBSA compared first excision within 48 hours (90 patients) with delayed excision (358 patients). Ninety-day all-cause mortality was the primary outcome, estimated using augmented inverse probability weighting and targeted maximum likelihood estimation.

• Delayed excision carried an adjusted odds ratio of 2.3 for 90-day mortality (95% CI 1.2-4.1) relative to excision within 48 hours.
• The same direction held for ICU mortality (aOR 3.1, 95% CI 1.5-6.3) and 28-day mortality (aOR 2.9, 95% CI 1.3-6.7), while no differences emerged for acute kidney injury, ARDS, organ failure, or ICU length of stay.
• Sepsis or septic shock occurred more often in the early-excision group, 53% versus 32%.
• Early excision was performed in only 20% of the cohort, and those patients had more extensive burns and higher severity scores at baseline.

A multicenter retrospective cohort of 475 adults with severe burns across 12 Chinese burn centers examined 24-hour fluid volume (ml/kg/%TBSA) against 28-day mortality using Cox models, with a mediation analysis in the 278 patients who had complete coagulation data.

• Higher 24-hour fluid volume was associated with an adjusted hazard ratio of 1.74 for 28-day mortality (95% CI 1.30-2.32).
• Larger volumes were also associated with prolonged APTT, lower platelet counts, and a higher incidence of coagulopathy.
• In the mediation analysis, the decline in platelet count partially mediated the fluid-mortality association (p = 0.002), whereas prothrombin time, INR, D-dimer, fibrinogen, and thrombin time showed no significant mediating effect.

A retrospective multi-institutional registry analysis of adult burn admissions drawn from the Burn Care Quality Platform (2016–2018) compared patients with and without diabetes mellitus on time to 95% wound closure, hospital and ICU length of stay, infectious and pulmonary complications, operative intervention, and in-hospital mortality.

• Patients with diabetes reached 95% wound closure later (25 vs 22 days, p = 0.0006) and had longer hospital stays (8 vs 5 days, p < 0.0001).
• In-hospital mortality was higher in the diabetic group (5.7% vs 4.1%, p = 0.045), with no differences in ARDS, ventilator-associated pneumonia, or central line-associated bloodstream infection.
• On multivariable analysis, diabetes was not an independent predictor of complications or mortality once other factors were accounted for.
• Early hyperglycemia after admission was the strongest modifiable predictor of ARDS, ventilator-associated pneumonia, and central line-associated bloodstream infection, alongside injury severity.

A systematic review of 10 studies published between 1998 and 2025 evaluated the type, severity, and duration of neurocognitive impairment in survivors of severe burn injury and its relation to burn severity, ICU stay, and sedation exposure. Heterogeneity in design, population, and cognitive instruments precluded pooling, so findings were synthesized narratively.

• Impairment clustered in memory, attention, and executive function, reported both during acute admission and at long-term follow-up, with effect estimates varying widely between studies.
• Acute delirium was reported in up to 52% of patients, with mechanical ventilation identified as a key risk factor.
• Depression, anxiety, and PTSD were consistently more prevalent in those studies that assessed them, frequently co-occurring with neurocognitive impairment.
• Certainty of evidence was rated very low for all outcomes owing to serious risk of bias, indirectness, and imprecision.

A systematic review and meta-analysis of 45 randomized trials (3806 participants) compared silicone gel combined with laser therapy against either modality as monotherapy for scar management, with a Bayesian network meta-analysis ranking silicone gel paired with different laser types.

• Combination therapy reduced Vancouver Scar Scale scores at six months with a standardized mean difference of -1.33 (95% CI, -1.85 to -0.81), and the effect held across prespecified subgroups.
• Patient satisfaction favored the combination, with an odds ratio of 4.21 (95% CI, 1.91 to 9.24) versus monotherapy.
• Treatment-emergent adverse events were less frequent with combination therapy than with either modality alone, arguing against an additive safety penalty.
• In network ranking probabilities, silicone gel plus nonablative laser placed first both for six-month Vancouver Scar Scale score and for score reduction from baseline.

A retrospective chart review of 417 burn patients at a regional burn center analyzed 43,737 daily pain scores using longitudinal k-means clustering to define pain trajectories and test their association with patient characteristics and length of stay.

• Two trajectories emerged: High Pain in 249 patients (59.7%) and Low Pain in 168 (40.3%), against a cohort median pain score of 7, median TBSA of 6%, and median stay of 11 days.
• High Pain patients were younger (median 46 vs 59 years) and received more opioid, at 24 versus 20 morphine milligram equivalents.
• After covariate adjustment, trajectory membership was not associated with length of stay, whereas TBSA, age, and burn depth remained strong predictors.

A propensity-matched retrospective cohort of 41,812 adult burn patients drawn from a multi-institution electronic health record database compared 20,906 patients with tobacco-free nicotine dependence against an equal number of matched burn patients without it, matched on sociodemographics, comorbidities, burn characteristics, and treatment.

• At 90 days, the nicotine-dependent cohort had higher rates of sepsis, wound dehiscence, and wound infection than matched controls.
• Healthcare utilization was also higher, with more antimicrobial prescriptions and emergency department visits within the same 90-day window.
• Mortality was elevated at both 90 days and one year in the tobacco-free nicotine dependence cohort.
• At one year, these patients were also more often diagnosed with new-onset opioid use disorder (p < 0.005).

A prospective observational cohort study of burn patients and healthy volunteers isolated neutrophils from patient blood and eschar and compared phenotype, phagocytosis, migration, reactive oxygen species production, and cytokine secretion against healthy blood neutrophils using multicolor flow cytometry and functional assays.

• Burn tissue neutrophils sampled at 15 ± 7 days post burn showed increased degranulation with elevated CD11b, CD63, and CD66b expression, indicating phenotypic activation.
• Phagocytosis of heat-killed S. aureus was reduced by 50% in both circulating and burn tissue neutrophils relative to healthy controls.
• Intracellular reactive oxygen species production fell 2-fold in burn tissue and 10 to 100-fold in blood; PMA stimulation failed to restore the oxidative burst in tissue neutrophils.
• IL-8-induced migration of burn tissue neutrophils was reduced by approximately 30%, while cytokine release from burn tissue did not differ significantly from healthy skin.

A systematic review and network meta-analysis of 84 randomized trials (7232 participants) grouped adjunctive diabetic foot ulcer treatments into eight categories and compared them with standard of care alone for ulcer area reduction, complete healing, time to healing, adverse events, and amputation.

• Six of the eight categories increased the likelihood of complete healing, including oxygen-based, matrix and skin substitute, device-based, placental, topical pharmacologic, and growth factor or blood-derived therapies.
• Greater ulcer area reduction was seen with device-based, placental, growth factor or blood-derived, matrix or skin substitute, and oxygen-based therapies compared with standard care alone.
• Time to healing was shortened only by cell-based or adipose-derived, growth factor or blood-derived, and matrix or skin substitute therapies.
• Most adjuncts did not increase adverse events, placental products were associated with lower adverse event risk, and oxygen-based and growth factor therapies suggested reduced amputation risk on limited data.

A single-center retrospective study of 98 critically ill burn patients admitted between 2016 and 2025 compared those who developed acute kidney injury within three days of injury against those who did not, using admission demographics, laboratory parameters, and inflammatory indices to build a logistic regression prediction model.

• Early acute kidney injury occurred in 28.6% of critically ill burn patients within the first three postinjury days.
• Multivariate regression identified blood urea nitrogen, cystatin C, and D-dimer as independent risk factors, with odds ratios of 1.52, 12.14, and 1.14 respectively.
• The three-variable model achieved an area under the ROC curve of 0.887 (95% CI, 0.816 to 0.958), with a Youden-derived probability cutoff of 0.235 defining high risk.

A clinical and histomorphometric analysis of 97 free flap breast reconstructions examined 2 to 3 mm segments of internal mammary artery and vein harvested during recipient vessel preparation, relating degenerative vessel changes, comorbidities, and oncologic treatments to anastomotic thrombosis over a mean 25-month follow-up.

• Anastomotic thrombosis occurred in 15 of 97 patients (15.4%), and neither intimal nor medial fibrosis of the artery or vein was related to its occurrence.
• Adjuvant chemotherapy was the clinical variable significantly associated with a higher rate of anastomotic thrombosis (p = 0.02).
• Degenerative changes tracked with distinct exposures: smoking with arterial medial fibrosis, radiotherapy and hormone therapy with venous intimal fibrosis, and hypertension with venous medial fibrosis.

A retrospective review of 552 prepectoral breast reconstructions in 333 patients treated between 2017 and 2024 compared 229 direct-to-implant with 323 two-stage implant-based reconstructions for major, minor, and aesthetic complications and for total operative burden across the reconstructive course.

• Major complications requiring readmission or reoperation were 7.0% after direct-to-implant versus 19.8% after two-stage reconstruction, with minor complications also lower at 21.0% versus 30.7%.
• Aesthetic revisions were more frequent after direct-to-implant, at 15.3% versus 5.3%, predominantly for fat grafting.
• Across the full reconstructive course, the mean number of operations per breast was 1.2 for direct-to-implant versus 2.3 for two-stage reconstruction.
• The two groups were not comparable at baseline: direct-to-implant patients had lower BMI (23.8 vs 26 kg/m²), lower mastectomy weights (561 vs 653 g), and more prophylactic mastectomies (59.4% vs 33.7%).

This single-institution study applied BCCT.core, a validated objective photographic symmetry tool, to a retrospective cohort of 123 patients undergoing bilateral nipple-sparing mastectomy with immediate implant-based reconstruction. Outcomes were stratified by reconstructive method, implant pocket, radiation exposure, mastectomy weight, and prior augmentation.

• Objective classification was favorable in most patients: 24.4% reached class 1 and 60.2% class 2, while 15.4% were graded class 3 or 4 (mean classification 1.93 ± 0.64).
• Post-mastectomy radiation carried the strongest adverse association, with irradiated patients showing markedly higher rates of class 3/4 results and worse mean postoperative classification.
• Tissue expander reconstruction outperformed direct-to-implant and remained an independent predictor on multivariable analysis, with the difference most evident among nonirradiated patients.
• Higher mastectomy weight and major complications both correlated with worse classification; prior augmentation increased preoperative asymmetry but did not compromise postoperative aesthetic quality when tissue expanders were used.

A retrospective single-institution cohort of 125 prepectoral implant-based reconstructions compared human-derived partial-coverage DermACELL (67 cases) with porcine-derived full-wrap Braxon (58 cases). Univariable comparison and multivariable logistic regression adjusted for demographic, operative, and adjuvant therapy confounders.

• The overall complication rate was 37.6%, comprising 18.4% minor and 19.2% major events, with seroma (14.4%) and wound dehiscence (13.6%) the most frequent problems.
• No significant between-group differences emerged in overall complications, major complications, specific complication types, or the timing of complications.
• Reoperation was required in 18.4% of cases overall and was numerically higher in the Braxon group, without reaching significance (p = 0.063); capsular contracture of grade III or above occurred in 7.2%.

A retrospective cohort of 591 patients undergoing DIEP flap breast reconstruction at a single academic center between 2015 and 2023 was stratified by perioperative transfusion status to identify predictors of transfusion and its association with postoperative complications.

• Perioperative transfusion was administered in 24.7% of patients, or 146 of 591 cases across the eight-year study period.
• The strongest independent predictor was urgent reoperation (OR 5.14), followed by hematoma (OR 3.73), bleeding disorders (OR 3.45), diabetes (OR 2.46), bilateral reconstruction (OR 2.08), and lower preoperative hemoglobin (OR 0.63).
• After adjustment for patient and procedural factors, transfusion remained independently associated with donor site dehiscence (OR 1.75), whereas mastectomy skin flap necrosis lost significance (OR 1.36).

This systematic review of 13 studies covering 3609 flaps in 3013 patients synthesized risk factors and predictive models for fat necrosis after DIEP flap breast reconstruction, searching six databases for work published between 2008 and 2025 with risk of bias assessed using ROBINS-I.

• Reported fat necrosis incidence varied widely across the included studies, from 7.5% to 59.5%, while total flap loss remained rare at under 1%.
• Flaps based on lateral row perforators showed less fat necrosis than medial row flaps (8.2% versus 24.5%, p < 0.001).
• Intraoperative indocyanine green angiography was associated with reduced fat necrosis (RR 0.49, 95% CI 0.25 to 0.97).
• Higher flap weight and a body mass index above 30 kg/m² emerged as consistent predictors across the included studies.

A retrospective review of 537 women undergoing mastectomy with immediate implant or tissue expander reconstruction compared four preoperative oral regimens: no medication, acetaminophen alone, acetaminophen plus gabapentin, and acetaminophen plus gabapentin plus celecoxib. Endpoints were patient-reported pain, opioid consumption, and postoperative length of stay.

• Against a 9.0 hour mean stay with no premedication, adjusted length of stay fell by 2.9 hours with acetaminophen alone, 3.0 hours with acetaminophen plus gabapentin, and 4.5 hours with the three-drug regimen.
• Same-day discharge increased stepwise with regimen intensity, reaching 100% with acetaminophen, gabapentin, and celecoxib versus 90%, 89%, and 77% in the remaining groups (p < 0.001).
• The three-drug regimen was independently associated with lower maximum pain scores (β = −2.24), and these differences emerged despite 98.5% of the cohort receiving a paravertebral block.

A retrospective claims-based cohort of 350,243 mastectomy patients treated between 2010 and 2020 was analyzed for trends in the interval between mastectomy and delayed reconstruction, inpatient length of stay, and outpatient setting utilization, with multivariable modeling of predictors of prolonged intervals.

• Median time to delayed reconstruction fell from 187 to 168 days for implant-based cases and from 337 to 288 days for autologous cases across the decade.
• The largest delays were driven by interval radiation therapy (+130.9 days) and interval chemotherapy (+70.3 days), with autologous technique (+38.3 days) and Medicaid insurance (+28.8 days) adding further time.
• Mean inpatient stay decreased for four of six surgery types, including immediate implant reconstruction (2.00 to 1.65 nights) and immediate autologous reconstruction (4.00 to 3.06 nights).
• Outpatient utilization rose for every nonautologous procedure type, accounting for 82.2% to 98.0% of such cases by 2020.

This bibliometric analysis of 46 clinical acellular dermal matrix studies published in four plastic surgery journals between 2020 and 2025 coded conclusions as positive, neutral, or negative and linked them to Open Payments records for first and senior authors, benchmarked against a 2014 to 2019 pre-warning cohort.

• Positive conclusions became less common after the FDA communication, dropping from 43.6% in the pre-warning era to 23.9% of studies afterward.
• Authors of positive studies had received substantially higher median industry payments than authors of neutral or negative studies ($8,792 versus $0, p < 0.001).
• Higher payments remained associated with favorable reporting on regression (OR 1.37, p < 0.001), and the payment threshold identified on ROC analysis rose five-fold, from $376 before the warning to $1,921 after.

A retrospective single-surgeon series of 134 reconstructions in 100 patients assessed rotation and complications after immediate or delayed implant-based breast reconstruction with microtextured anatomical implants placed between December 2020 and October 2025, analyzed on a per-patient basis with mean follow-up of 15.5 months.

• Clinically detectable rotation occurred in four patients, an overall rate of 4% across a mean follow-up of 15.5 months.
• Every rotation occurred in a revision procedure or at second-stage reconstruction rather than in primary reconstruction.
• Three of the four rotations were corrected by external manipulation, with a single case requiring surgical revision; other complication rates matched those reported in the literature.

This systematic review and meta-analysis of 14 studies pooled patient-reported outcomes after female genital cosmetic surgery, predominantly labiaplasty, performed in office-based and hospital settings. Primary endpoints were the Female Genital Self-Image Scale (FGSIS), the Female Sexual Function Index (FSFI), and the Sexual Quality of Life-Female (SQoL-F) instrument.

• Pooled analysis showed significant postoperative gains in FGSIS, total FSFI, and SQoL-F, with zero heterogeneity for the SQoL-F outcome across outpatient and hospital cohorts.
• Improvements reached significance in the lubrication, satisfaction, arousal, orgasm, and desire domains of the FSFI, whereas the sexual pain domain showed no significant pooled change.
• The authors report that functional gains tracked more closely with surgical technique and patient selection than with facility type or anesthetic protocol.

In this randomized, double-blind trial of 80 patients, four lower-face neuromodulator protocols differing in the number and distribution of injection points into the platysma and depressor anguli oris were compared. Tissue displacement on 3D stereophotogrammetry, GAIS, and FACE-Q satisfaction and adverse-effect modules were assessed at 15, 30, and 90 days.

• All protocols produced measurable lifting, but greater treatment extent was associated with increased tissue displacement at 15 days (p=0.004) and greater persistence of that displacement over follow-up.
• Patient-reported outcomes peaked at 30 days and remained higher in the intermediate-to-high extent groups, while perceived adverse effects were more frequent in the most extensive group at 90 days (p=0.006).
• Multivariable analysis showed a positive association between the number of injection points and displacement (β=1.875) and an inverse association with BMI (β=-4.361), suggesting BMI may modify response.

This prospective cohort of 331 consecutive patients undergoing modified V-shaped concealed flap canthoplasty recorded standardized intraoperative folding parameters of the anterior limb of the medial canthal tendon, including folding length, folding angle, fold-point position, fixation plane, and suture tension. The endpoint was medial canthal angle regression on standardized photographs at 6 months relative to a 1-week baseline.

• Medial canthal angle regression was observed in 24.6% of patients at 6 months.
• Greater folding length, folding angle, and fold-point position were protective against regression, whereas tendon or soft-tissue fixation, low suture tension, thick soft tissue, more severe epicanthal folds, a larger preoperative canthal angle, and longer operative time carried increased risk.
• The multivariable model showed an apparent AUC of 0.85 (95% CI 0.81–0.89) and an optimism-corrected AUC of 0.81 (95% CI 0.77–0.85) after bootstrap resampling.

This retrospective single-surgeon series of 898 consecutive patients describes primary full-incision double eyelid blepharoplasty performed with an elevated cephalad orbital septum flap between 2006 and 2016. Six-month outcomes comprised patient-reported satisfaction, a 4-grade photographic incisional depression score, and recorded complications.

• At 6 months, 845 of 898 patients (94.1%) were very satisfied or satisfied with their appearance.
• Photographic grading of incisional depression was excellent in 89.6% and good in 8.4%, with fair or poor grades in 18 patients (2.0%).
• Complications were recorded in 37 patients (4.1%), most often asymmetry (1.3%), partial or complete fold disappearance (1.1%), and a wide or narrow fold (0.7%); contour depression or hollowing was recorded separately in 0.2%.

This systematic review of 20 studies, 18 preclinical and 2 randomized trials, evaluated GHK-Cu as a standalone regenerative agent in aesthetic applications. Mechanistic, efficacy, and safety data were extracted alongside evidence on transdermal delivery systems.

• Preclinical models consistently showed that GHK-Cu increases type I collagen and glycosaminoglycan synthesis, modulates matrix metalloproteinase activity, and promotes angiogenesis and cellular proliferation.
• Anti-inflammatory activity was attributed to suppression of TGF-β and IL-6 in experimental systems.
• The two randomized trials reported improved patient satisfaction after laser resurfacing and significantly reduced wrinkle volume and depth versus controls.
• Microneedle and liposomal carriers markedly improved transdermal bioavailability compared with conventional topical delivery.

This retrospective review of 46 litigated cases identified from Westlaw and LexisNexis between 1967 and 2025 examined US civil claims involving aesthetic injectable fillers. Filler type, anatomical site, provider credentials, practice setting, FDA approval status, and consent documentation were tested against legal outcome.

• Verdicts split nearly evenly between plaintiffs and defendants (51% vs 49%), and neither provider credentialing, filler type, nor complication severity was significantly associated with the legal outcome.
• Documented informed consent was the strongest protective factor, with plaintiff verdicts in 8% of documented versus 65% of undocumented cases (p=0.001).
• Med-spa procedures and treatments using non-FDA-approved products each carried a 100% plaintiff verdict rate, compared with 47% in private clinic or hospital settings and 44% for approved products.
• Autologous fat (28.3%), hyaluronic acid (26.1%), and biostimulatory agents (26.1%) were the most implicated products, and the face, head, or neck accounted for 67.4% of claims.

This non-randomized controlled pilot study of 57 patients compared intravenous tranexamic acid (1 g at induction) plus TXA-containing vasoconstrictive infiltration against an identical infiltration solution without TXA in bilateral modified Liacyr Ribeiro reduction mammoplasty by one surgeon. Primary outcomes were total and daily drain output, with length of stay, time to drain removal, and complications as secondary endpoints.

• Total postoperative drain volume was reduced by an estimated 79% in the TXA group (p<0.001), with a parallel reduction in output at 24 hours (p<0.003).
• Unquantifiable drainage occurred in 53.8% of TXA patients versus 9.7% of controls (p=0.002), which the authors link to earlier drain removal.
• No differences were observed in hemorrhagic events, infection, or wound healing, although complication rates were low in both groups.

This descriptive case series of 50 patients reports one surgeon's initial experience with minimally invasive robotic endoscopic lipoabdominoplasty (MIRELA) for rectus diastasis repair. Demographics, diastasis severity, concomitant umbilical hernia, and preoperative complaints were tabulated.

• The cohort was young and lean (mean age 39.2 years, mean BMI 21.8 kg/m²), with a mean diastasis width of 3.27 ± 1.0 cm.
• Diastasis was moderate (3–5 cm) in 48% of patients, mild in 32%, and severe in 20%; umbilical hernia was present in 20% and repaired concomitantly when indicated.
• The dominant preoperative complaint was abdominal bulging or contour deformity (62%), with the remainder reporting other aesthetic and functional abdominal wall concerns.

A prospective single-center study of 25 lean women (BMI <21 kg/m²) delivered five sessions of 115-W continuous monopolar radiofrequency at 3-week intervals. Facial volume and soft tissue thickness were measured by two 3D imaging systems and ultrasound at baseline and 18 weeks, with paired skin biopsies in one participant.

• Ultrasound showed total facial fat thickness rising from 14.73 to 16.33 mm and superficial fat from 5.99 to 7.64 mm, a gain of roughly 1.6 mm in both compartments, while body weight remained stable throughout.
• Three-dimensional imaging confirmed increased soft tissue thickness on both systems, +0.86 mm by QuantifiCare and +1.01 mm by Morpheus, and Global Aesthetic Improvement Scale ratings showed gains in midface volume, texture, and elasticity.
• Paired biopsies from the single sampled participant demonstrated increased CD166, CD34, and CD31 expression, interpreted as transient mesenchymal stem/progenitor activation accompanied by angiogenesis.

A narrative review of the 2010 to 2026 literature across MEDLINE/PubMed, Embase, PsycINFO, and Scopus examined communication failure in aesthetic surgery, with sources selected by discussion between two authors against stated eligibility criteria. The review synthesises the evidence into a proposed framework of listening micro-skills.

• Unmet expectations account for 14.4% of malpractice claims in plastic surgery compared with 3.8% across other medical specialties, a disparity the authors attribute largely to communication failure.
• The literature consistently identifies attentiveness deficits, premature judgment, and failure to acknowledge patient emotion as the proximal mechanisms linking surgeon behaviour to complaints and litigation.
• These patterns are mapped onto five discrete listening micro-skills: adopting a learning stance, suspending judgment, paraphrasing, inquiry, and acknowledgment.
• The authors argue that listening is a precondition for valid informed consent in aesthetic surgery, because consent here requires alignment on a subjective goal that cannot be clinically examined.

An evidence-based narrative review of management after R1 resection in soft tissue sarcoma, a population for which no randomised trial exists. The authors integrate histological subtype, grade, anatomical site, margin context, and nomogram-derived risk into a staged treatment algorithm.

• Planned positive margins on critical anatomical structures, most often in retroperitoneal sarcoma, do not mandate re-excision, since local recurrence rates approximate those of R0 resection and management can proceed to histotype-tailored adjuvant radiotherapy.
• Inadvertent positive margins after unplanned or non-specialist excision carry a substantially higher local recurrence risk and warrant re-excision whenever secondary R0 is achievable without prohibitive morbidity, followed by adjuvant radiotherapy in high-grade or deep tumours.
• Validated nomograms such as Sarculator and PERSARC are used to identify high-risk patients for adjuvant anthracycline-ifosfamide chemotherapy, in whom R1 status is described as the strongest predictor of survival benefit.
• Referral to a specialist sarcoma centre before any initial intervention is presented as the single most impactful measure for reducing R1 incidence and is framed as the overarching standard of care.

A cross-sectional, observer-blinded diagnostic validation study enrolled patients with persistent finger range-of-motion limitation following hand injury. Each joint was measured by both manual goniometry and an AI-based 3D hand modelling system with virtual goniometry, and agreement plus intra- and inter-rater reliability were assessed.

• Virtual goniometry showed strong consistency with manual goniometry for MCP, PIP, and DIP flexion, with no systematic bias detected between the two methods at these joints.
• Repeated measurements were highly reliable both within and between raters for finger joint flexion, supporting the reproducibility of the virtual technique.
• Thumb IP flexion and total finger extension showed greater variability than the other motions, and the authors flag these outcomes for cautious interpretation in remote or technology-assisted assessment.

A case-based study of nine hand surgery vignettes with multiple-choice options, radiographs, and clinical images was distributed to 15 fellowship-trained hand surgeons from three institutions and put to four AI platforms (ChatGPT-4, Claude Opus 4.6, Gemini, and Open Evidence) using a standardised prompt, one query per case. The primary outcome was concordance with the surgeon plurality response.

• On the four cases classified as straightforward, all four platforms achieved 100% concordance with the surgeon plurality, against surgeon plurality agreement of 73% to 100%.
• Performance diverged on the five complex cases, where Claude Opus 4.6 and Gemini each matched on 3 of 5 while ChatGPT-4 and Open Evidence each matched on 1 of 5, a 60% versus 20% split.
• Overall concordance across all nine cases was 78% for Claude Opus 4.6 and Gemini versus 56% for ChatGPT-4 and Open Evidence.

A machine-learning development and temporal validation study using two separated cohorts trained six classifiers on routinely available clinical, laboratory, imaging, and vascular variables to predict major versus minor amputation after an initially limb-preserving strategy. The workflow used 20-repetition stratified outer splits, two-step feature selection, Optuna hyperparameter optimisation, training-only SMOTE, and threshold tuning to maximise F2 under a recall constraint of at least 0.70.

• In internal evaluation the multilayer perceptron performed best, with an average precision of 55.9% ± 13.6%.
• On the temporally separated cohort, k-nearest neighbors achieved the highest average precision at 65.1% ± 10.2% with recall of 72.8%, while the multilayer perceptron retained higher precision and specificity.
• The strongest contributors were necrotising fasciitis, neuropathy severity, haemoglobin, PEDIS classification, and inflammatory indices, consistent with the more severe baseline phenotype seen in the major-amputation group.

A Phase 1/2a first-in-human, open-label case report of one 47-year-old man with deep second-degree burns describes a single topical application of allogeneic bone marrow MSC-derived extracellular vesicles within 48 hours of injury. Follow-up to 52 weeks used POSAS scar scoring and laser Doppler perfusion imaging.

• The treated wound achieved more than 99% closure within one week, and healing remained durable for over one year.
• POSAS scores showed early resolution of pain and pruritus with minimal residual scarring at 52 weeks, and no adverse events were recorded.
• Laser Doppler imaging demonstrated improved perfusion within one week, which the authors interpret as prevention of burn wound conversion.

A preclinical mechanistic study in endothelial cell and rodent burn models characterised Polygonum cuspidatum-derived nanoparticles that co-encapsulate radical-scavenging metabolites with a functional microRNA. The work tested effects on Keap1/Nrf2 and NF-κB signalling, macrophage polarisation, and wound closure, including delivery via a thermosensitive hydrogel.

• Endothelial delivery of miR5054 directly targeted and silenced Keap1 mRNA, producing sustained Nrf2 pathway activation that cross-inhibited pro-inflammatory NF-κB signalling.
• Treated burns showed accelerated closure with enhanced collagen remodelling and an Nrf2-high, M2-dominant wound niche; the thermosensitive hydrogel formulation improved skin penetration and healing efficacy.
• The therapeutic effect was abolished by a complementary-sequence miR5054 inhibitor and reproduced by a synthetic miR5054 mimic, establishing the microRNA as the necessary active component.

A randomized animal study of 40 Wistar rats compared reversed autograft against acellular nerve allograft alone and allograft combined with mesenchymal stem cell secretome, surgical angiogenesis, or both across a 10 mm sciatic nerve defect. Endpoints at 9 weeks included Sciatic Functional Index, electrophysiology, histology, CD34 immunostaining, and muscle weight and volume.

• The group receiving both secretome and surgical angiogenesis achieved the highest functional recovery among allograft-based arms, with Sciatic Functional Index values comparable to reversed autograft.
• Both surgical angiogenesis groups showed significantly greater axonal regeneration than acellular allograft alone, and CD34 staining indicated vascularization approaching autograft levels.
• No significant differences appeared in electrophysiological parameters or muscle mass across the five groups, confining the measured benefit to functional and histologic endpoints.

A bench study of human hypertrophic scar tissue and cultured scar fibroblasts, seeded by a GEO expression dataset, tested whether the long noncoding RNA KCNQ1OT1 drives fibroblast activation through miR-324-5p and SP1. Loss- and gain-of-function experiments were paired with luciferase reporter, RIP, and RNA pull-down assays to confirm direct binding.

• KCNQ1OT1 and SP1 were elevated in hypertrophic scar tissue and fibroblast lines while miR-324-5p was reduced, and miR-324-5p correlated negatively with both.
• Silencing KCNQ1OT1 suppressed proliferation, migration, and α-SMA, COL1A1 and COL3A1 expression while inducing apoptosis and G0/G1 arrest; these effects were reversed by knocking down miR-324-5p.
• Reporter, RIP, and pull-down assays supported KCNQ1OT1 acting as a miR-324-5p sponge that de-represses SP1, and SP1 overexpression rescued the miR-324-5p phenotype.

A preclinical mechanistic study in diabetic mouse retina and vascular endothelial cells examined ALKBH3 as an epitranscriptomic driver of immature neovascularization, combining genetic removal with a neovasculature-targeting nanoparticle carrying the ALKBH3 inhibitor HUHS015.

• ALKBH3 was upregulated in diabetic endothelial cells and shifted them toward an unstable pro-angiogenic phenotype with blood-retinal barrier disruption and impaired vision, while its removal was protective.
• Mechanistically, ALKBH3 demethylated BMP2 mRNA and increased its stability through the YTHDF2 reader pathway.
• Nanoparticle-delivered HUHS015 normalized retinal neovascularization by simultaneously limiting vessel growth and promoting maturation, and acted synergistically with VEGF blockade.

A narrative review of exosome biology and engineering in burn injury covering mechanisms of action, source-cell preconditioning, genetic cargo enrichment, and delivery through hydrogels, scaffolds, and microneedle patches. No systematic search or quantitative pooling was performed.

• Exosomes are presented as cell-free alternatives to stem cell therapy, retaining much of the parent cell's regenerative signaling with lower immunogenicity, better stability, and reduced tumorigenic risk.
• Proposed healing mechanisms include activation of cell migration, immune modulation, and suppression of excessive collagen accumulation, tying wound closure and scar quality to the same vesicle cargo.
• Engineering strategies surveyed address short residence time and instability through preconditioning, genetic loading, and embedding vesicles in hydrogels, scaffolds, or microneedle patches.
• The authors state that supporting data remain largely preclinical animal work, with stringent validation and standardization still required before clinical use.

A preclinical rodent diabetic foot ulcer study paired RNA sequencing of quercetin-treated wounds with development of a GelMA-quercetin co-crosslinked hydrogel, comparing wound closure, histology, and macrophage polarization markers against saline and GelMA-only controls.

• Quercetin improved diabetic wound repair by driving M2 macrophage polarization, promoting reactive oxygen species clearance, and inhibiting NLRP3 inflammasome activation.
• RNA sequencing implicated Foxo3-mediated macrophage autophagy as the pathway connecting quercetin exposure to resolution of chronic wound inflammation.
• The hydrogel released 80% of loaded drug within 48 hours and outperformed saline and plain GelMA on wound closure, with less inflammation, more angiogenesis, and faster epithelial regeneration.

A secondary analysis of eight public diabetic foot ulcer cohorts, including 89 patients with outcome data, reprocessed raw 16S sequencing and host transcriptomes under a predefined evidence hierarchy, using nested cross-validation, label permutation, and independent external evaluation of the host signature.

• Baseline microbial diversity and community structure did not differ between healed and non-healed ulcers (Shannon P = 0.159; PERMANOVA R² = 0.0157), and the single nominally significant genus, Rothia, did not survive FDR correction.
• Host transcriptomics produced 2,873 differentially expressed genes with coherent epidermal repair enrichment and a leave-one-sample-out AUC of 0.990, supported by a repeated nested cross-validation median AUC of 0.981.
• External evaluation separated 6 ulcers from 3 control skin samples perfectly, yet the authors classify the framework as hypothesis-generating rather than a deployable biomarker, with no demonstrated causal coupling.

A preclinical mouse tendon-injury study combined BMSC treatment in vivo with tenocyte culture experiments, using dual luciferase reporter and MeRIP assays to test whether FTO-mediated m6A demethylation of ELOB underlies the repair effect.

• FTO was markedly downregulated in injured tendon tissue, and BMSC treatment restored its expression alongside improved histology and behavioral recovery.
• FTO overexpression increased tenocyte proliferation and migration and lowered intracellular reactive oxygen species, with the same pattern reproduced by ELOB knockdown.
• MeRIP and reporter assays placed ELOB downstream of FTO-mediated m6A modification, and in vivo FTO overexpression enhanced tendon repair through reduced ELOB expression.