Plastic Surgery Weekly

A single-surgeon retrospective series of 23 patients undergoing 24 latissimus dorsi free flaps for infected or exposed cranioplasty between 2010 and 2020 recorded prosthesis management, flap configuration, microbiology, and long-term outcomes. Failed constructs were autologous-containing in 65.2% and purely alloplastic in 34.8%.

• Soft-tissue coverage itself was dependable: no flap was lost across the 24 reconstructions, and the technique was repeatable as a platform for recurrent disease.
• Infection behaved as a deep process rather than a wound problem, with epidural, cerebrospinal fluid, or intracranial extension documented in four patients and one death from septic shock (4.3%).
• One patient required a second free flap for recurrence approximately four years after the index operation, and two others developed late infection; late or fatal infection occurred across all prosthesis management strategies and both material types.

A systematic review of 21 studies published from 2015 to 2025 synthesized clinical outcomes, learning-curve dynamics, and technical features of dedicated robotic-assisted microsurgical systems (Symani, MUSA), with structured risk-of-bias appraisal. Outcomes included free flap survival, anastomotic patency, complications, operative time, and conversion.

• Free flap survival ranged from 96% to 100% and supermicrosurgical anastomotic patency from 96.6% to 100%, with conversion or failure infrequent at 0% to 4.3%.
• Robotic anastomosis times fell by 51% to 66% with accumulating experience (largest reduction 66.1% for deep-plane arterial anastomosis) yet stayed above manual benchmarks, for example 25.3 ± 12.3 versus 14.1 ± 4.3 minutes for mixed procedures.
• Motion scaling of up to 20× and tremor filtration were consistent advantages across platforms, while haptic feedback was universally absent.

A retrospective review of 26 patients with cleft lip and palate who underwent maxillary distraction osteogenesis (MaxDO) between 2007 and 2022 at ages 9.0 to 19.2 years examined predictors of long-term occlusal normalization and risk factors for relapse or additional orthognathic surgery, using chi-square testing and multivariable logistic regression.

• Among female patients, stable occlusion without further surgery was achieved in 83.3% of those treated after age 13.5 years compared with 20.0% of those treated earlier (P = 0.036).
• Among male patients, stable occlusion was achieved in 50.0% of those treated after age 17 years compared with 0% of those treated earlier (P = 0.018).
• On multivariable analysis, older age at the time of distraction was independently associated with long-term occlusal normalization without additional procedures (P = 0.045).
• MaxDO achieved stable maxillary advancements of greater than 12 mm, supporting its use in skeletally immature patients as an interim measure before definitive orthognathic surgery.

A single-center retrospective comparison of 72 patients treated between 2021 and 2023 evaluated 28 super thin anterolateral thigh (ALT) flaps elevated within the superficial fascial layer to a target thickness of 10 mm or less against 44 radial forearm free flaps (RFFF) for head and neck reconstruction. Postoperative drain amylase was analyzed as a surrogate for salivary leakage.

• Total complication rate did not differ significantly between groups at 7.1% versus 11.3%, nor did fistula formation (3.5% versus 6.8%) or reoperation (7.1% versus 11.3%).
• All thin ALT flaps survived without partial necrosis, giving no flap failures in the super thin ALT group against three failures (6.8%) with RFFF.
• Operative time was similar at 145 ± 34 versus 159 ± 42 minutes, and the ALT group showed lower postoperative drain amylase levels without reaching statistical significance.

A repeated-measures cohort study of 51 patients enrolled in the Dutch multicentre Dangle study assessed patient-reported capability (PROMIS Physical Function Mobility), quality of life (EQ-5D-5L) and discomfort (VAS) after lower extremity free flap reconstruction, using linear mixed-effects models to identify variables associated with outcome level and recovery trajectory.

• Male sex and the absence of diabetes were independently associated with greater capability, but neither variable was associated with the trajectory of recovery over time.
• Among all variables examined, only time since reconstruction was independently associated with better quality of life on the EQ-5D-5L.
• Reconstructions of the foot were associated with higher discomfort scores than lower leg reconstructions, again without a difference in the trajectory of discomfort.
• Individual capability subscales showed largely stable recovery trajectories, with no clinically meaningful differences between specific functional tasks.

A retrospective comparative cohort of 32 patients undergoing segmental mandibular resection and fibula free flap reconstruction between 2016 and 2023 compared model-assisted conventional reconstruction (n = 11) with CAD/CAM reconstruction using virtual surgical planning (n = 21), assessed with the Katsuragi Scale, FACE-Q, EORTC QLQ-H&N43, MDADI and Speech Handicap Index at a minimum of 12 months.

• Aesthetic outcomes on the Katsuragi Scale, rated by both patients and surgeons, were significantly better after CAD/CAM reconstruction (p = 0.0001).
• FACE-Q Satisfaction with Surgical Outcome scores were higher in the CAD/CAM group (p = 0.02).
• Self-reported speech disturbance on the Speech Handicap Index was lower after CAD/CAM reconstruction (p = 0.01).
• Remaining functional measures, including MDADI dysphagia and EORTC QLQ-H&N43 scores, showed favourable trends without reaching significance.

A narrative review of reconstructive and conservative treatment options for radiation-induced chest wall ulcers developing years after post-mastectomy radiotherapy, itemising local random-pattern flaps, pedicled flaps and free flaps alongside their reported outcomes, advantages and disadvantages.

• Regardless of the flap chosen, the authors identify complete excision of affected skin and bone as the cornerstone of management, followed by permanent closure with skin or muscle flaps.
• Chest wall reconstruction in this setting is characterised as safe and feasible, with low perioperative mortality.
• Properly applied flap reconstruction is reported to achieve healing in over 90% of ulcers, with corresponding improvement in quality of life.
• Method selection depends on careful patient selection and clear indication delineation, since conventional approaches applied without these safeguards can end badly.

A systematic review and meta-analysis of 51 studies pooled randomised trials, sparse controlled non-randomised studies and uncontrolled series to compare systemic corticosteroids, surgical decompression and observation for traumatic optic neuropathy, and to test the effect of time to treatment.

• Corticosteroids increased rates of improved visual acuity compared with observation in adolescents and adults, with a Peto OR of 2.7 (1.5 to 4.9) and NNT of 4 (2 to 9), from low-quality evidence.
• Surgical decompression did not significantly improve visual acuity relative to systemic corticosteroid therapy.
• When surgery was undertaken, early surgery produced greater rates of visual acuity improvement than later surgery in adults and children (Peto OR 6.0, 1.9 to 19.4).
• In children, early (under 24 hours) versus delayed (within 7 days) prednisolone showed no detectable difference in visual acuity improvement (Peto OR 2.8, 0.3 to 29.0).

A systematic review of 73 studies (36 radial forearm, 35 fibula, 2 both), identified from 1247 records and appraised with JBI checklists and OCEBM levels, synthesised the prevalence and assessment of donor-site sensory abnormalities, pain, neuropathic pain and cold intolerance after free flap harvest for head and neck reconstruction.

• For the radial forearm donor site, sensory abnormalities ranged from 0% to 100% (median 31.3%) with an exploratory pooled prevalence of 34.4% (95% CI 23.6 to 47.1) and I² of 88.4%.
• For the fibula donor site, pooled sensory abnormality prevalence was 24.0% (95% CI 16.5 to 33.6), with pooled general donor-site pain of 18.8% (95% CI 13.9 to 24.9).
• DN4-defined neuropathic pain was 18% for radial forearm and 21% for fibula donor sites in the dedicated studies; cold intolerance after forearm harvest ranged from 0% to 40% (median 16.2%).
• Objective assessment with quantitative sensory testing, monofilaments or two-point discrimination was applied inconsistently, and no included study used nerve conduction studies or EMG.

A retrospective case series of 5 patients with extensive proximal or mid-forearm soft-tissue defects treated between 2019 and 2025 with paraumbilical perforator-based pedicled abdominal flaps, in which the vascular pedicle was wrapped in a hybrid artificial dermis and skin flap conduit instead of a conventional wide skin tube.

• All 5 flaps survived, with the hybrid-enveloped pedicle segment measuring 4 to 7 cm in length.
• There were no episodes of pedicle compression, infection or vascular crisis; one patient developed distal flap-tip necrosis that healed with conservative management.
• Flaps showed satisfactory contour, texture and integration, and upper extremity joint motion recovered well in every case.
• All patients reported high satisfaction with the reconstructive result, and the authors position the technique for settings where free tissue transfer is contraindicated or unavailable.

A prospective cohort of 101 amputees undergoing secondary targeted muscle reinnervation for pain between 2018 and 2025 was assessed against five preoperative centralized pain criteria, with numeric rating scale trajectories modeled using multilevel mixed-effects regression. Sustained pain mitigation was defined as a reduction of at least 3 points or a final score of 3/10 or less lasting at least 3 months.

• Over a median follow-up of 2.5 years, 69% achieved sustained pain mitigation, while 30 patients (30%) met all five centralized pain criteria preoperatively.
• Meeting all criteria was associated with treatment failure, 45% versus 23%, corresponding to an odds ratio of 2.8 (95% CI 1.1 to 6.9).
• As a screening test the full criterion set was weakly positive but reasonably reassuring when negative: 45% sensitivity, 77% specificity, 47% positive predictive value, and 76% negative predictive value.
• Hypersensitivity beyond the injury zone was independently associated with failure to achieve sustained mitigation (42% versus 21%).

A retrospective claims-database analysis of 5,643 amputation patients from IQVIA PharMetrics Plus for Academics compared those receiving concomitant targeted muscle reinnervation (TMR) within 6 weeks with those undergoing amputation alone. Outcomes were one-year complication rates and total costs, with cost also modeled by linear regression.

• Complication rates were statistically indistinguishable between groups at 67.9% versus 70.1% (P = 0.725) in the first year after amputation.
• One-year total costs were $37,345 versus $39,359 (P = 0.67), and TMR remained non-significant as a cost predictor in the linear regression model.
• Uptake was very low in this insured population, with TMR performed in only 0.94% of amputations (53 of 5,643 patients).

A retrospective single-institution series of 296 trigger thumb releases in 249 children under 12 years, performed between 2015 and 2024, compared ketamine sedation-assisted local anaesthesia (SALA) with smartphone audiovisual distraction-assisted local anaesthesia (ADALA), with the technique chosen according to each child's ability to cooperate and caregivers present throughout.

• Mean age at surgery was 49.1 months, and children treated with SALA were significantly younger both at symptom recognition and at operation.
• Tourniquet duration in unilateral cases was longer in the ADALA group (9.92 ± 1.88 versus 8.70 ± 2.01 minutes, P < .001).
• Both protocols produced high caregiver satisfaction and comparable willingness to repeat the same anaesthesia method.
• No respiratory complications and no tourniquet-related discomfort were reported in either group.

A prospective single-surgeon case series of 113 arthroplasties in 99 patients operated between 2018 and 2023 applied cumulative sum (CUSUM) analysis to surgical time, complications and revisions, alongside 2-year clinical outcomes including pain, DASH, key pinch and range of motion.

• The surgical time CUSUM peaked at case 28, indicating stabilisation of operative efficiency, with a median surgical time of 51 minutes (IQR 18).
• Thirty-one complications occurred (27% of arthroplasties), most tendon- or soft tissue-related, with 8 (7%) attributed to suboptimal surgical technique, 11 reoperations (10%) and 4 revisions (4%).
• Outcome-based CUSUM crossed predefined thresholds for overall complications and for technique-related complications, while revision procedures remained within acceptable limits.
• All clinical outcomes improved significantly (P ≤ .001) and 2-year revision-free survival was 0.973 (95% CI 0.943 to 1.000).

A single-surgeon retrospective cohort of 46 patients who underwent ulnar tunnel foveal TFCC repair between 2018 and 2023 was analysed for PROMIS scores, range of motion, and complications. Thirty-two patients completed questionnaires at a minimum of two years, with mean follow-up of 32 months.

• PROMIS pain scores improved significantly by 12 weeks, whereas upper extremity and physical function domains did not; at a mean of 32 months all three domains were significantly improved.
• The vast majority of patients regained wrist and forearm motion by 12 weeks, but the highest activity level was reached only at a median of six months after surgery.
• At intermediate-term follow-up 77% had returned to full sports and activity, leaving roughly one quarter short of their previous level.
• A temporary setback during recovery occurred in 45% of patients; complication and reoperation rates were 8.7% and 4.3%.

A retrospective cohort of 66 patients with distal ulnar metaphyseal fractures accompanying plated distal radial fractures compared 35 conservatively managed patients with 31 who underwent fixation, with allocation driven by surgeon preference. Outcomes were DASH, range of motion, grip strength, and radiographic parameters at a mean follow-up of roughly 33 months.

• Mean DASH score was 14 in both groups, with no significant differences in range of motion or grip strength, and all fractures united in similar times.
• Median ulnar metaphyseal coronal angulation was 9° after conservative treatment versus 2° after fixation, with angulation exceeding 10° in 13 of 35 versus 3 of 31 patients.
• Despite the better alignment, additional surgery for implant-related complications was more frequent after fixation (5 patients versus 1).

A biomechanical cadaveric study of 40 proximal phalanges with simulated transverse fractures randomised specimens to intramedullary nail fixation in an I, Y, or X configuration, or to two crossed K-wires. Constructs were loaded in apex dorsal three-point bending to failure, with peak load and stiffness recorded.

• Peak load to failure did not differ significantly between any of the four fixation groups.
• The intramedullary X configuration was the stiffest construct at 210 N/mm, significantly stiffer than every other group.
• The Y configuration reached 150.9 N/mm, exceeding both the single I nail (107.7 N/mm) and crossed K-wires (91.8 N/mm), while the I nail and K-wire constructs were statistically indistinguishable.

A single-institution retrospective cohort of 94 patients undergoing supraclavicular brachial plexus decompression for neurogenic thoracic outlet syndrome between 2014 and 2025 compared 49 patients who received a VersaWrap hydrogel barrier after neurolysis with 45 who did not. Primary outcomes were persistent neuropathic pain and reintervention, with mean follow-up of 12 months.

• Persistent neuropathic pain occurred in 4.1% of wrapped patients versus 6.7% of controls, a difference the study was explicitly not powered to test.
• Reintervention for thoracic outlet syndrome was required in 1 of 49 wrapped patients (2%) versus 2 of 45 controls (4.4%).
• Postoperative paresthesias were marginally more common in the wrap group (8.2% versus 6.7%), and no device-related complications were observed.

A PRISMA-adherent scoping review of nine studies (eight retrospective, one prospective) searched PubMed, Embase, and Scopus for intraoperative use of nerve action potentials, somatosensory and motor evoked potentials, compound muscle action potentials, and electromyography in neonatal brachial plexus palsy surgery. All included cohorts comprised infants operated on for poor early functional recovery.

• Decision-making strategies were substantially heterogeneous, with several groups using preserved nerve action potentials, compound muscle action potentials, or stimulated muscle contraction to justify neurolysis and absent responses to prompt neuroma resection and grafting.
• Meaningful follow-up data were available from only one study, which reported better function and fewer secondary operations after resection and grafting than after neurolysis alone.
• The authors conclude that intraoperative electrodiagnosis is of limited demonstrable value in this population, and call for standardised diagnostic methods and prospective study.

A narrative review of assessment and outcome-evaluation strategies for first web space contracture synthesises current measurement approaches, their limitations, and the points at which published methods diverge.

• The three-dimensional anatomy of the web space and the biomechanics of the thumb are identified as the source of substantial variability in both assessment methods and treatment strategies.
• There is currently no universally accepted framework for defining, classifying, or measuring outcomes in first web space contracture, which limits comparability between reported series.
• Existing methodologies are clarified and gaps in the literature mapped, with the synthesis offered as groundwork for standardised, clinically meaningful evaluation rather than as a treatment algorithm.

A PRISMA 2020 systematic review and meta-analysis of 22 studies comprising 1,162 pregnant women with burn injuries searched four databases through March 2026 and pooled maternal and fetal mortality using random-effects models with Freeman-Tukey double arcsine transformation. Fifteen of the included studies were case series.

• Pooled maternal mortality was 43% (95% CI 36–50%), with individual study estimates ranging from 0% to 70% and substantial heterogeneity (I² = 72.9%).
• Pooled fetal mortality was 57% (95% CI 49–65%), with study-level estimates from 31.3% to 90.5% and I² of 78.6%.
• Burn severity, particularly TBSA of roughly 50% or more, was consistently associated with worse maternal and fetal outcomes across studies.
• Funnel plots suggested possible publication bias, and overall GRADE certainty of evidence was rated low.

A retrospective cohort of 6,045 patients from the American Burn Association Burn Care Quality Platform compared 1,046 obese with 4,999 non-obese patients undergoing burn wound excision. Multivariable regression assessed mortality as the primary outcome, with infection, graft loss, ventilator days, and length of stay as secondary outcomes.

• After adjustment, obesity showed no association with mortality and none with graft loss, arguing against an obesity paradox in this surgical population.
• Infection odds were 20% higher among obese patients (OR 1.20, 95% CI 1.01–1.42, p = 0.04).
• Ventilator days were 34% higher in the obese cohort (IRR 1.34, 95% CI 1.19–1.51), with length of stay trending longer (sHR 0.93, 95% CI 0.87–1.00, p = 0.06).

A retrospective review of 47 patients identified through the International Burns Injury Database captured all electronic nicotine delivery system (ENDS) burn injuries presenting to a UK regional burns centre between January 2015 and December 2025, with data on demographics, burn characteristics, management and outcome.

• Injuries occurred while the device was not in use in 94% of cases, typically carried in a trouser pocket (81%); patients were predominantly male (87%) with a mean age of 40 years.
• Burns clustered on the thigh (77%) and hand (23%), with a mean TBSA of 2.34% (SD 1.79) and predominantly partial- or mixed-depth injury.
• Although 77% were managed conservatively, 36% required hospitalisation and 23% underwent surgery; complications occurred in 14% of cases and 9% needed further surgery.

A modelled analysis of 178,545 weighted burn admissions from the National Inpatient Sample (2017 to 2022) applied cost-to-charge ratios and Congressional Budget Office enrolment projections within Monte Carlo simulations to estimate six-year revenue losses, with facilities stratified by burn centre and safety-net status.

• Annual US burn care costs were estimated at $3.19 billion, of which 28.4% falls to Medicaid; the share of burn encounters covered by Medicaid rose 7.0% over the six-year study period.
• Burn centre costs attributable to Medicaid increased by 18.9% across the same period, meaning the projected cuts apply to a growing rather than contracting share of activity.
• Safety-net hospitals handled 33.1% of Medicaid burn encounters and face a projected 2.70% reduction in burn centre funding, against 2.39% at non-safety-net hospitals.

A two-stage preclinical study pairing an MRSA-inoculated rat scald model (n = 19) with a porcine burn model compared a novel spray-on antimicrobial dressing against silver-impregnated foam and controls for bacterial burden, healing kinetics, skin biomechanics and histoarchitecture through day 13.

• In the rat model, both the spray-on dressing and silver foam produced significantly lower MRSA burden than positive controls at day 5 (p < 0.01), with no evidence of systemic dissemination.
• In the porcine model, re-epithelialisation reached 97.7% with the spray-on dressing versus 92.1% with foam (p = 0.3) by day 13.
• Tissue elasticity and stiffness in spray-treated wounds were indistinguishable from uninjured skin, and rete ridge ratio and epidermal thickness matched the foam comparator.

A propensity score-matched cohort of 138 patients with Wagner grade 2 to 4 diabetic foot ulcers compared deep fascial release with subcutaneous tibial PMMA bone cement implantation removed at 8 weeks (n = 69) against conventional debridement with vacuum sealing drainage (n = 69).

• The PMMA group achieved a 100% wound healing rate at a mean of 34.81 ± 3.56 days, significantly exceeding the control group (P < 0.001).
• Ulcer recurrence was 8.70% versus 39.13% in controls, and patients underwent fewer debridement procedures (1.29 ± 0.67 vs 2.64 ± 0.61; both P < 0.001).
• Postoperative dorsal foot skin temperature was higher (36.06 ± 0.24 °C vs 35.36 ± 0.41 °C) and VAS pain scores were substantially lower (1.41 ± 1.07 vs 4.60 ± 0.74), which the authors attribute to microcirculatory reconstruction and nerve decompression.

A retrospective cohort of 894 adults admitted to a single burn intensive care unit between 2015 and 2024 tested whether preoperative dental status, classified as unfavourable when two or more teeth were missing, loose or fractured, predicted 30-day postoperative pneumonia.

• Postoperative pneumonia occurred in 32.9% of the cohort overall, and in 47.7% of patients with unfavourable dental status versus 31.2% of those with favourable status (p < 0.001).
• On multivariable analysis, unfavourable dental status remained an independent predictor of 30-day pneumonia (odds ratio 1.681, 95% CI 1.084 to 2.599; p = 0.018).
• Patients with unfavourable dental status also had fewer 90-day hospital-free days (9 vs 22) and ICU-free days (65 vs 68).

A systematic review and meta-analysis of six randomized controlled trials totalling 629 patients pooled autologous whole blood clot, platelet-rich plasma and platelet-rich fibrin against standard of care, with complete healing at 12 weeks as the outcome and a random effects model for pooling.

• Autologous blood-derived products improved the odds of complete healing at 12 weeks (pooled odds ratio 2.24, 95% CI 1.47 to 3.41; P = .0045).
• Among the individual product classes examined, autologous whole blood clot demonstrated the highest efficacy.
• Assessment of small-study effects showed minimal indication of publication bias across the included trials.

A retrospective single-centre cohort of 2222 patients operated on for primary pilonidal sinus disease between 2006 and 2020 compared nine surgical techniques for long-term recurrence and postoperative infection using Kaplan-Meier estimates and multivariable Cox regression.

• Five-year cumulative recurrence was 7.9%, with postoperative infection in 6.9%, and both outcomes differed significantly across techniques (p < 0.001).
• Against lay-open treatment, recurrence risk was lower with the Karydakis flap (HR 0.19), Bascom cleft lift (HR 0.25), Dufourmentel flap (HR 0.26) and Limberg flap (HR 0.32).
• Higher body mass index (HR 1.05 per kg/m²) and current smoking (HR 1.98) were independently associated with increased recurrence risk.
• Most recurrences presented within the first two years, at a median of 20 months (IQR 12 to 36).

A prospective single-centre observational study of 76 adults with minor to moderate burns compared high-flow nasal oxygen (n = 38) with standard nasal oxygen (n = 38) during propofol-ketamine sedation targeted to a BIS of 60 to 80, with allocation by alternating admission order rather than randomisation.

• SpO2 of 90% or below occurred in 11% of high-flow patients versus 79% of standard nasal oxygen patients (p < 0.001).
• Severe hypoxia below 75% was recorded in 26% of the standard oxygen group and in none of the high-flow group, with SpO2 between 75% and 90% in 68% versus 0%.
• Airway rescue manoeuvres were far more frequent with standard oxygen, including jaw thrust in 84% versus 2.6% of high-flow patients.
• No between-group differences emerged in procedure interruptions, laryngospasm, BIS, NIRS or haemodynamic parameters.

A systematic review and meta-analysis of 17 comparative studies pooled axillary lymph node dissection plus immediate lymphatic reconstruction (ILR) against dissection alone, with lymphedema incidence as the primary outcome. Subgroup analyses were stratified by follow-up duration from 1 to 48 months using a random-effects model.

• ILR was associated with a lower incidence of breast cancer-related lymphedema, with a pooled risk ratio of 0.37 (95% CI 0.28 to 0.49) across the included comparative studies.
• The time-stratified analysis showed a prophylactic effect that was consistent throughout the first 2 postoperative years and peaked at 12 months (RR 0.13, 95% CI 0.04 to 0.46).
• Data contributing to time points beyond 24 months were sparse, leaving the durability of the risk reduction unresolved in the pooled dataset.

A single-surgeon retrospective review of 180 patients treated between April 2022 and May 2025 compared oncoplastic breast reconstruction (n = 64) with standard bilateral breast reduction (n = 116) across clinical safety, BREAST-Q patient-reported outcomes, and graded aesthetic results. Wise pattern incisions were used in all reduction cases and 97% of oncoplastic cases.

• The cohorts were not comparable at baseline: oncoplastic patients had higher BMI and ASA class, while reduction patients were younger and had greater resection weights.
• Minor wound breakdown was more frequent in the oncoplastic cohort, whereas major complication rates were comparable between groups.
• Both groups showed significant postoperative BREAST-Q improvement in psychosocial, sexual, and physical well-being as well as satisfaction with breasts, controlling for age and BMI.
• In a subset of 10 patients per group, aesthetic scores slightly favored bilateral reduction, but by less than 0.5 Likert points in all six domains.

A single-center cohort comparison of 379 patients set a prospective ERAS group (2021 to 2024, n = 216) against a retrospective non-ERAS group (2017 to 2020, n = 163) undergoing DIEP flap breast reconstruction. Outcomes included length of stay, pain scores, vital signs, inpatient opioid consumption, and discharge prescriptions.

• Hospital stay was shorter in the ERAS cohort at 2.97 versus 3.37 days, with lower average (2.37 versus 3.18) and peak (6.23 versus 7.47) pain scores.
• Inpatient opioid consumption fell by 51.4% (208.02 to 101.02 morphine milligram equivalents), and outpatient prescriptions at discharge fell by 22.2% (194.21 to 151.83 MME).
• Mean heart rate was lower in the ERAS group (85.5 versus 95.6 beats per minute) and tachycardia was less frequent at 10.7% versus 28.2%.
• Among the 35.2% of ERAS patients returning a 14-day survey, post-discharge opioid use averaged 70.78 MME with a median time to cessation of 3.0 days.

A retrospective cohort of 198 patients (285 breasts) undergoing predominantly immediate implant-based reconstruction between 2013 and 2023 was managed with an institutional salvage protocol of antibiotics with or without surgical intervention. Implant-threatening complications were defined as CDC-criteria surgical site infection, full-thickness skin necrosis, or deep wound dehiscence.

• Implant-threatening complications occurred in 28.3% of patients, and salvage was achieved in 51.8% of affected cases.
• Every patient in the salvage group reached final reconstruction, versus 44.4% of the nonsalvage group (p < 0.01).
• Skin necrosis and wound dehiscence were the most common presentations, ahead of infection, and Gram-negative organisms predominated among culture-positive cases.
• On logistic regression, resistant organisms, implant extrusion, and prior radiotherapy were independent predictors of salvage failure.

A retrospective single-institution series of 55 patients compared aesthetic flat closure (n = 44) with Goldilocks reconstruction (n = 11), all performed using a standardized inferior adipodermal flap technique between April 2021 and August 2024. Demographics, operative characteristics, and postoperative outcomes were compared between the two groups.

• Sixty-day complications occurred in 9.1% of patients with a revision rate of 7.3%; median operative time was 184 minutes.
• There was no mastectomy flap or nipple-areola complex necrosis, and no patient converted to implant-based or autologous reconstruction.
• Patients selected for Goldilocks reconstruction had a substantially higher body mass index at 33.1 versus 26.3 kg/m² (P = 0.003), consistent with the greater adipodermal volume the technique requires.

A single-institution case series of 5 patients with breast cancer recurrence after mastectomy and implant-based reconstruction describes a staged salvage approach rather than explantation or conversion to autologous tissue. No comparison group was included.

• The technique converts the existing implant to a tissue expander at wide excision with pocket revision and lowering, followed by overexpansion before radiotherapy and expander-to-implant exchange at least six months afterward.
• After the first stage there were two adverse events: one axillary seroma requiring drain placement in the setting of axillary lymph node dissection, and one moderate post-radiotherapy capsular contracture.
• The contracture was corrected during the planned second-stage exchange, and there were no complications after the second-stage procedure, with all five patients maintaining implant-based reconstruction.

A single-surgeon series of 30 consecutive patients describes the first application of the split-muscle support technique, previously used in augmentation and augmentation-mastopexy, to direct-to-implant breast reconstruction. The report is a technique description positioned against subpectoral and prepectoral alternatives rather than a controlled comparison.

• The pectoralis major is divided along its fiber direction and both divisions are elevated while the lateral and inferior attachments are preserved, creating an autologous inferolateral sling for the implant.
• In the authors' modification, a piece of acellular dermal matrix is interposed in the anterior window between the muscle edges, using less matrix than a typical prepectoral reconstruction.
• The superior muscle division is described as providing superomedial coverage without window-shading, with the stated aims of improved implant stabilization, less bottoming out, and less animation deformity than standard subpectoral placement.

A prospective paired-sample study of 71 women with breast implant illness at a tertiary clinic measured serum tryptase and total IgE before and after explantation, with a median interval of 8 months. Paired changes were analyzed for the whole cohort and for subgroups defined by allergy status and baseline IgE above 100 kU/L.

• Neither tryptase nor total IgE changed significantly across the full cohort, with median differences of +0.09 ng/mL and −1.2 kU/L respectively (both p > 0.1).
• Among the 13 women with baseline IgE above 100 kU/L, 9 showed declines (median −118 kU/L), while their tryptase levels remained unchanged and within normal limits.
• Of the five women with elevated baseline tryptase above 11.4 ng/mL, three decreased after explantation but only one normalized.

A cross-sectional survey of 82 patients and 38 plastic surgeons compared perceptions of the quality and availability of breast reconstruction educational resources. Patients had undergone reconstruction; surgeons were members of the American Council of Educators in Plastic Surgery.

• Outside clinic visits, patients relied most on internet searches (82%), followed by peer support groups (54%) and family and friends (49%).
• Surgeons substantially overestimated social media as a patient resource, at 50% to 75% estimated versus 19% actual use.
• Patients reported significantly more difficulty than surgeons anticipated in visualizing reconstructive stages and skin rippling (both p < 0.01) and requested more body image-related education (p < 0.05).
• Racial and ethnic minority patients were significantly more likely to want images reflecting their own skin tone and body type (p < 0.05).

A qualitative study of 12 women (mean age 44.5 years) who chose mastectomy tattoos combined thematic analysis of semistructured interviews conducted between June 2023 and April 2024 with social semiotic analysis of the tattoos themselves, framed by the Dual Process Model of Coping with Bereavement.

• Eleven of the twelve women had undergone breast reconstruction and one a flat closure, indicating that tattooing was sought alongside reconstruction rather than only as an alternative to it.
• Post-surgical bodily perceptions centered on damaged body image, alienation from the operated body, compromised femininity and wholeness, and difficulty with intimacy.
• Tattoos were described as restoration-focused planning and meaning-making, fostering belonging, confidence, and a renewed sense of bodily control.
• Semiotic analysis found the imagery symbolized personal growth and transformation, freedom, and reconnection to nature.

A systematic review of 22 cases of vision loss reported in 21 articles, retrieved from 1,498 screened records, catalogued patient characteristics, injection sites, filler types, treatments, and visual outcomes after nasal filler injection.

• Vision loss began immediately after injection in 82% of cases; patients were predominantly women (90.9%) with a mean age of 33.4 years, and hyaluronic acid accounted for half of the implicated fillers.
• The nasal bridge or dorsum was the most frequently injected site (12 patients, 57%), followed by the glabellar region (6 patients, 29%), and roughly a quarter of patients had been injected at multiple locations.
• Full visual recovery occurred in only 27% of cases and took a mean of 5.3 months, with hyaluronidase, corticosteroids, and antibiotics failing to reverse the deficit in most patients.
• The authors single out hyperbaric oxygen therapy as the intervention most deserving of further study, but the assembled case reports contain no comparative data on its effect.

A retrospective comparative cohort of 1,002 patients undergoing lower body lift after massive weight loss between January 2011 and May 2024 compared 598 patients managed without drains against 404 who received suction drainage, with complications graded by Clavien-Dindo and analysed univariately and multivariately.

• Overall complication rates did not differ significantly between groups, but wound complications were more frequent in the drained group (24% versus 17%, p<0.01).
• Patients with drains had longer hospitalization (4.29 versus 2.41 days) and longer operative times (179 versus 152 minutes), both p<0.001.
• On multivariate analysis drain use was not an independent risk factor for complications; active smoking was the only variable that predicted higher risk.

A prospective single-centre series of 267 patients undergoing primary lower blepharoplasty applied a three-type morphologic classification based on palpebro-malar groove width, inferior orbital rim position, and lower eyelid vertical length, with sub-orbicularis oculi fat advancement and orbicularis suspension tailored to each type.

• The left inferior orbital rim lay more posteriorly than the right in 96% of patients (259 of 267), and the left palpebro-malar groove was wider in 38% versus only 2% on the right.
• Patients divided almost evenly between type I (mild, 48%) and type II (severe, 50%), with type III (right-side dominant) accounting for only 6 patients (2%).
• Satisfactory correction was reported by 251 patients (94%) and independent evaluators confirmed symmetry in the same number; the 16 partially satisfied patients were attributed to inadequate lateral SOOF advancement.

A PRISMA-registered systematic review of 18 studies comprising 12,032 patients (mean age 34 years, 97.8% women) pooled the prevalence of non-embolic complications after gluteal fat transfer and appraised reported approaches to diagnosis, treatment, and prevention.

• The overall non-embolic complication rate was 2.67%, with irregularities (32.4% of complications) and asymmetries (25.6%) accounting for well over half of reported events.
• Among clinically more consequential events, fat necrosis (14.3%), infection (13.1%), and cyst formation (10.6%) made up most of the remainder, with abscesses in 2.2%.
• Mycobacterial infection and sciatic nerve injury were reviewed separately and appeared only as isolated reports, without consistent denominators to support a rate estimate.
• Injection plane, fat preparation method, and postoperative care were assessed as contributing factors, but the authors concluded that non-embolic complications remain broadly underreported in the literature.

A randomized controlled trial of 38 healthy adults allocated participants equally to six weekly sessions of a synchronized multi-muscle electromuscular stimulation protocol targeting abdominal, quadriceps, hamstring, and gluteal groups, or to a blank control, with functional testing at baseline, week 5, and week 9.

• The treatment group improved significantly on repetition- and endurance-based measures (prone hip extension, paced curl-ups, side plank endurance, seated quadriceps extension) relative to both baseline and controls.
• Improvements were maintained at the 4-week follow-up after the final session, although observation did not extend beyond week 9.
• Subject-reported body self-perception improved and the protocol was well tolerated, with low discomfort and no reported adverse events.

A randomized, double-blind, contralateral-controlled trial in 23 adults with chronic migraine compared three BoNT-A injection points along the superficial temporal artery on one side of the head against saline on the other, with serial ultrasound of the superficial temporal and supraorbital arteries and visual analogue pain scores through two months.

• Mean VAS on the treated side fell from 8.7 at baseline to 2.65 at 2 months (p<0.001).
• No difference in arterial diameter was detected between treated and control sides in either the superficial temporal or supraorbital arteries at 1 hour, 2 weeks, or 2 months, which the authors read as evidence against a vasodilatory mechanism.
• No adverse events were reported with the three-point, low-dose regimen, which the authors position as a simplification of standard chronic migraine injection protocols.

A retrospective cohort of 88 patients contributing 160 operated sides after transaxillary single-port endoscopic gynecomastia surgery tested whether side-specific 24-hour drainage volume before removal predicted ultrasound-confirmed, aspiration-verified seroma or hematoma within 14 days, using clustered bootstrap ROC analysis and GEE logistic regression.

• Fluid-related complications occurred in 32 of 160 sides (20.0%), and 24-hour drainage volume discriminated only moderately, with an AUC of 0.729 (95% CI 0.635–0.815).
• At the exploratory 15 mL threshold, sensitivity was 65.6% and specificity 63.3%, with a positive predictive value of 30.9% and a negative predictive value of 88.0%.
• Complication rates were 30.9% at or above 15 mL versus 12.0% below, and the association held after adjustment (OR 3.09, 95% CI 1.28–7.47).

A single-group technique report covering 864 facelifts performed over five years describes a deep plane approach centred on repositioning the mesoface fat pad, with the skin, subcutaneous fat, and fat pad treated as one cohesive unit.

• Across 864 procedures the authors report zero nerve complications and 37 hematomas, approximately 4%.
• The described approach treats the mesoface as a cohesive unit of skin, subcutaneous fat, and mesoface fat pad that is repositioned rather than separately dissected.
• Limited undermining is central to the technique, with the extent of dissection tailored to individual facial anatomy rather than following a fixed flap design.

A retrospective review of 52 transfeminine patients who underwent hybrid body feminization surgery (circumferential liposuction, gluteal augmentation, minimally invasive rib remodeling) between November 2023 and February 2025, all receiving standardized pharmacologic and mechanical thromboprophylaxis. Doppler ultrasound was scheduled on postoperative days 1, 3, 7, and 10 to detect early thromboembolic events.

• Three thromboembolic events were identified, an incidence of 5.7%: two deep vein thromboses (3.8%) and one pulmonary embolism (1.9%).
• Both deep vein thromboses were clinically silent and were detected only through the scheduled surveillance protocol rather than by symptom-triggered imaging.
• The single symptomatic pulmonary embolism followed unauthorized early long-haul travel, occurring despite completed pharmacologic and mechanical prophylaxis.
• Body contour outcomes improved concurrently, with a reported mean 32% reduction in waist-to-hip ratio (p < 0.001).

A technique description of percutaneous retrograde intramuscular echo-guided fat grafting (PRIME-GRAFT), supported by a retrospective series of 71 patients (21 men, 50 women; mean age approximately 43 years). The method is contrasted with conventional intramuscular fat grafting using larger cannulas and bolus deposition.

• The technique pairs a 2.1-mm blunt cannula with real-time ultrasound guidance, depositing fat in linear retrograde passes along the direction of the muscle fibres rather than as boluses.
• Across the series the authors report no complications, with consistent natural muscle definition achieved in several different muscle groups and at muscle origins and insertions.
• Color Doppler imaging was used intraoperatively to identify and avoid adjacent vascular structures, which the authors present as the principal safety argument over non-visualized intramuscular injection.

A retrospective cohort of 90 patients treated for cutaneous malignant melanoma at a tertiary cancer centre during 2005, in which Breslow thickness, dermal thickness, tumour width, and distance from tumour base to subcutaneous fat were remeasured histologically. Two proposed parameters, the Breslow-to-dermal-thickness ratio and tumour-to-fat distance, were tested against estimated tumour volume for prognostic value.

• Estimated tumour volume was significantly associated with adverse outcomes under both the conical and hemispherical geometric models (p < 0.001), with the two models concordant despite the crudeness of the estimation.
• The Breslow-to-dermal-thickness ratio was not significant on univariable analysis; the nominal significance seen when it was modelled alongside Breslow thickness most likely reflects collinearity between the two measures.
• Distance from tumour base to fat was not prognostic as a continuous variable, but every case with frank fat invasion (distance of zero) had an adverse outcome.

A retrospective single-institution analysis of 318 soft tissue sarcoma patients treated between April 2019 and June 2021, testing demographic, tumour, treatment, and operative variables as predictors of wound healing complications. Analyses used chi-square testing, Kaplan-Meier estimates, and multivariate regression.

• Wound healing complications occurred in 30.8% of patients and were associated with longer initial hospitalisation (p < 0.001) and an increased risk of death (p = 0.004).
• Significant predictors were high tumour grade (p = 0.018), presence of metastasis (p < 0.001), bone resection (p = 0.005), number of revision procedures (p < 0.001), secondary wound closure (p < 0.001), and relapse frequency (p = 0.012).
• Chemotherapy was associated with a protective effect on wound healing once analyses were stratified by tumour grade, contrary to the usual expectation of impaired healing.

A retrospective audit of 100 consecutive periocular basal cell carcinoma excisions performed at a secondary referral centre in England between August 2024 and August 2025 (58% male, mean age 75.7 years). Histological subtype, margin status, perineural invasion, and anatomical site were extracted from operative and pathology records.

• Nodular histology predominated at 83% of tumours, followed by infiltrative (14%), superficial (2%), and basosquamous (1%) variants.
• Margins were complete (≥0.4 mm) in 83% of excisions, while 8% were close (0.1–0.3 mm) and 9% incomplete.
• Perineural invasion was present in 2% of tumours, both infiltrative, producing a significant association between infiltrative subtype and perineural invasion (p = 0.007).
• The medial canthus was the most common site at 56%, a region the authors associate with greater operative difficulty and higher risk of incomplete excision.

A retrospective single-centre study of 75 children with 76 solitary osteochondromas excised between January 2015 and January 2026 (median age 13 years, 64% male). Clinical, radiological, operative, and histopathological variables were analysed at the level of individual exostoses.

• Most lesions were distally located (73.7%), with the femur the commonest site (48.7%) followed by the tibia (22.4%); pain was the leading indication (63.2%) and cosmetic concern the next (32.9%).
• Radiographic measurement underestimated lesion diameter relative to intraoperative measurement (median 3.0 cm versus 4.0 cm; p < 0.001), although the two correlated strongly (ρ = 0.77).
• Postoperative outcomes were favourable: 94.6% had no complication, wound infection and haematoma each occurred in 2.7%, and there were no recurrences or reoperations over a median 63 months.
• Neither diameter nor location was associated with symptomatic presentation, and logistic regression identified no significant predictor of symptoms among age, sex, location, or size.

A retrospective CTA-based study of 246 patients (490 limbs) in which each fibula was divided into 10 equal segments, yielding 4,900 limb-zone observations. Ridge-regularised logistic regression, random forest, XGBoost, and a generalised additive model were compared for predicting the presence of at least one septocutaneous perforator per segment, with patient-level data splitting.

• Segment-level perforator prevalence was 15.4%, and 20.6% of limbs had no septocutaneous perforator at all.
• Discrimination was moderate and broadly similar across model families, with ROC-AUC between 0.683 and 0.710 and precision-recall AUC between 0.231 and 0.245 against a 15.4% base rate.
• All four modelling approaches reproduced the characteristic midfibular peak in perforator probability, consistent with established anatomical descriptions of the fibular vascular territory.

A retrospective multi-centre cohort of 676 patients operated on by 65 surgeons across 22 states and provinces, drawn from curated ASPS before-and-after photographs of facelift, necklift, browlift, and eyelid surgery. Two machine learning models trained on unposed reference images generated perceived age and attractiveness scores before and after surgery, which were analysed by univariate and multivariate odds ratios.

• Older perceived preoperative age was associated with greater composite aesthetic benefit independent of procedure type (OR 1.04, 95% CI 1.02–1.06, p < 0.001).
• Procedural effects appeared additive, with patients undergoing combined facelift, necklift, browlift, and eyelid surgery showing the greatest composite benefit (OR 11.34, 95% CI 1.84–103.34).
• The relationship between perceived preoperative age and preoperative attractiveness was non-linear, so the two markers do not combine into a simple rule for identifying who will benefit most.

This experimental vignette study of 180 randomized upper-extremity scenarios tested whether GPT-5 could identify five common conditions (de Quervain tendinopathy, rotator cuff tendinopathy, lateral epicondylitis, trigger digit, trapeziometacarpal arthritis) when vignettes varied in symptom specificity and each included a patient self-diagnosis that was correct, a plausible alternative, or a common misconception. Multivariable logistic regression identified independent predictors of diagnostic accuracy and of deviation from the patient's proposed diagnosis.

• The model selected the intended diagnosis in 165 of 180 scenarios (92%), and accuracy was statistically unrelated to which self-diagnosis the vignette supplied.
• Accuracy was higher for characteristic than for vague symptom descriptions, and was lower for de Quervain tendinopathy than for the other four conditions.
• The model departed from the patient's proposed diagnosis in 117 scenarios (65%), and 104 of those 117 deviations (89%) matched the intended diagnosis; deviation was more likely when the proposed diagnosis was wrong, whether it was a plausible alternative or a misconception.

This scoping review of 11 studies mapped artificial intelligence-enabled digital tools for wound assessment and documentation, using Joanna Briggs Institute methodology with PRISMA-ScR reporting across MEDLINE, CINAHL, Embase, Scopus, and grey literature. The focus was feasibility, sustainability, and integration into routine clinical practice rather than diagnostic accuracy alone.

• Included technologies supported automated wound measurement, imaging, digital documentation, longitudinal monitoring, and clinical decision support across a range of care settings.
• Validation studies showed good agreement with conventional wound measurement methods, and implementation studies indicated the tools were feasible to deploy in routine settings.
• Evidence was thin for long-term sustainability, interoperability with electronic health record systems, and routine implementation at scale, which the authors identify as the main gap for future longitudinal work.

In a murine tail model of secondary lymphedema, systemic and topical rosiglitazone were compared for their effects on dermal fibrosis, adipogenesis, and systemic toxicity, with single-cell RNA sequencing used to justify PPARγ as a target and a novel topical formulation first characterized for penetration in ex vivo murine skin. Outcomes were assessed by histology, immunofluorescence, and bone marrow adiposity.

• Systemic rosiglitazone reduced fibrosis in lymphedematous tissue, increased expression of the anti-fibrotic adipokine adiponectin, and lowered CD4⁺ T cell infiltration.
• The topical formulation reproduced the anti-fibrotic and pro-adipogenic effects locally, raising epidermal and dermal adiponectin expression and achieving full-thickness dermal penetration.
• Unlike systemic dosing, topical delivery avoided bone marrow adipogenesis, the surrogate used here for off-target systemic PPARγ activation.

This mechanistic study of human hypertrophic scar and keloid tissue combined with murine and xenograft models characterized SNHG26, a long noncoding RNA enriched in scar-forming fibroblasts, using fibroblast-specific genetic deletion, antisense oligonucleotide silencing, single-cell transcriptomics, and RNA-protein interaction studies.

• SNHG26 was markedly enriched in CD90⁺ fibroblasts within human hypertrophic scars and keloids, the subset associated with fibrotic remodeling.
• Fibroblast-specific deletion or antisense oligonucleotide silencing disrupted mesenchymal identity, suppressed extracellular matrix synthesis, and attenuated scar formation in murine and xenograft models; single-cell data showed a shift toward a papillary fibroblast phenotype.
• Mechanistically, SNHG26 acts as a nuclear scaffold for PTBP1, driving alternative polyadenylation of AKT3 toward a stable long 3'UTR isoform that sustains pro-fibrotic signaling; TNFα-ERK-STAT3 signaling induces SNHG26 upstream.

This systematic review of 11 animal studies identified from 107 screened records catalogued experimental lymphaticovenous anastomosis models in rats, rabbits, piglets, and canines, extracting species, anastomosis configuration, patency assessment method, follow-up interval, patency rates, and histologic findings.

• The evidence base is small and rodent-dominated: 7 of 11 studies used rats, with two canine studies and single reports in rabbits and piglets; anastomoses were mainly end-to-end (n = 9).
• Intraoperative patency was uniformly at least 90% across studies, but only six studies reported any postoperative patency at all.
• Reported patency fell from 80%–100% at 7 days or less to 67% at 1 month in canines, and no study provided standardized long-term outcomes.
• Histology in three studies distinguished patent sites with smooth endothelium from failed sites showing irregular endothelium, thrombus, and fibrosis.

In a randomized animal study of 24 Sprague Dawley rats with 2.5 cm full-thickness dorsal wounds, tissue-engineered skin (acellular dermal matrix seeded intraoperatively with autologous epidermal stem cells plus a split-thickness graft) was compared with a conventional composite graft (matrix plus split-thickness graft) and with split-thickness graft alone. Outcomes included graft survival, contraction, perfusion, CD31⁺ vessel density, and histology at days 4, 7, 14, and 21.

• Rapid intraoperative isolation from split-thickness grafts yielded approximately 1.03 × 10⁵ epidermal stem cells per cm² at roughly 83.7% viability.
• Graft failure occurred in 1 of 8 tissue-engineered grafts versus 3 of 8 composite grafts, with full closure and near-normal texture in the tissue-engineered group by day 21.
• Wound contraction was lower in the tissue-engineered group than with split-thickness graft alone (20.85% versus 39.48%, P < 0.001), with faster closure at days 7, 14, and 21.
• Vascularization was enhanced, with higher perfusion on days 4, 7, and 14 (P < 0.01) and greater CD31⁺ vessel density at day 7 than in the composite graft group.

This narrative review in Nature Medicine traces the trajectory of induced pluripotent stem cell technology from the original reprogramming discovery to current clinical translation, covering nonintegrating reprogramming, differentiation protocols, tissue engineering, and genome editing, and analyzing the operational barriers to therapeutic development.

• Convergence of nonintegrating reprogramming, efficient differentiation, high-fidelity tissue engineering, and precise genome editing has produced a platform capable of modeling human disease in human cells and has enabled a first wave of trials and early regulatory approvals.
• The transition to standardized, widely deployable products remains constrained by inherent biological variability between cell lines, manufacturing complexity, and the need for long-term safety surveillance, particularly around tumorigenic risk.
• The authors argue that integrating automation and artificial intelligence into iPSC workflows is the route to scalable, reproducible production, and lay out a twenty-year roadmap toward standardized engineered biological medicines rather than bespoke experimental products.

This single-author conceptual review synthesizes historical and contemporary observations from skin allotransplantation, including experience with cryopreserved total skin allografts, into a proposed framework termed Immunoguided Cutaneous Regeneration. The article generates explicit, falsifiable predictions rather than reporting new experimental data.

• The recurring observation motivating the framework is progressive elimination of donor epidermis alongside relative preservation of the dermal extracellular matrix, suggesting immune-mediated remodeling and regeneration can coexist during graft incorporation.
• The framework proposes that regeneration depends not on prolonged donor cell survival but on convergence of a preserved dermal matrix with a regulated, resolving alloimmune response, with neither element sufficient alone.
• The graft is cast as a transient instructive microenvironment guiding recipient cell recruitment and matrix reorganization through four overlapping phases: biological barrier, immune activation and cellular colonization, selective epidermal elimination, and regenerative remodeling.

In a preclinical study of 20 female Wistar rats, localized soft tissue remodeling was induced with subcutaneous bleomycin (1 mg/kg/day for three days) and treated with autologous fat grafting on day 17. Semi-quantitative clinical scoring at baseline, day 17 and day 31 was paired with histological analysis of the treated region.

• Bleomycin produced reproducible early fibrotic remodeling, with collagen deposition, stromal hypercellularity, vascular remodeling and architectural distortion on histology.
• The mean composite clinical score rose from 0 at baseline to 9.10±1.75 on day 17, then fell to 7.75±1.35 two weeks after grafting (p=0.00024).
• Histology after grafting showed persistent fibrotic septa and fibroblast proliferation alongside partial integration of the grafted adipose tissue, consistent with ongoing rather than resolved remodeling.