Plastic Surgery Weekly

Using the TriNetX federated network, adults undergoing free flap reconstruction were stratified by intraoperative vasopressor exposure in a propensity-matched retrospective cohort of 17,970 matched pairs drawn from 43,157 identified patients. Ninety-day flap-related, wound, reoperation, and mortality outcomes were compared, with subgroup analyses by flap type and vasopressor agent.

• Vasopressor exposure was associated with modest increases in infection (RR 1.10, 95% CI 1.05–1.15) and wound dehiscence (RR 1.09, 95% CI 1.02–1.15), alongside a lower rate of debridement (RR 0.84).
• Phenylephrine showed the most consistent adverse association, spanning infection (RR 1.17), dehiscence (RR 1.15), skin graft failure (RR 1.17), and anastomotic revision (RR 1.29), whereas other agents were more neutral.
• Effects varied by recipient site: breast reconstructions had higher complication rates and head and neck cases showed more infection, skin graft failure and mortality, while extremity reconstructions differed minimally.
• Across the matched cohort there was no consistent increase in flap failure or reoperation with vasopressor exposure.

A national retrospective cohort of 286,295 NSQIP plastic surgery cases from 2014 to 2023 classified stacking burden as 0, 1, 2, or ≥3 additional CPT-coded procedures. Multivariable models related burden to 30-day wound complications, reoperation, readmission, and medical complications, adjusting for patient factors, operative time, primary-procedure wRVUs, and procedure family.

• More than half of cases (55.9%) included at least one additional procedure; ≥3 additional procedures were associated most strongly with reoperation (OR 1.54, 95% CI 1.46–1.63) and readmission (OR 1.41, 95% CI 1.33–1.50).
• Adjusted absolute increases were small at 0.51 to 1.48 percentage points, corresponding to numbers needed to harm of 67 for reoperation and 251 for medical complications.
• Absolute increases were concentrated in operations lasting ≥240 minutes (wound complications +1.76, reoperation +2.54, readmission +1.90 percentage points), and cross-family stacking tracked with wound complications and readmission.
• Despite the consistent associations, adding stacking burden did not improve model discrimination (ΔAUC 0.000–0.005).

A systematic review and meta-analysis of 95 studies comprising 3,874 patients covering January 2005 to May 2025 examined clinical outcomes after facial reanimation using cross-facial neural input for flaccid facial paralysis. The review assessed how often spontaneity was reported, which assessment tools were used, and the pooled success rate.

• Spontaneity outcomes were reported in only 39 of 95 studies (41.1%), and most of those described it as simple binary presence or absence rather than with a graded or quantitative tool.
• Pooled presence of spontaneity was 88.25% (95% CI 77.49–96.32) across 1,456 patients in 31 studies, with extreme between-study heterogeneity (I² = 93.7%).
• The literature is dominated by cross-facial grafting for neurotization of free muscle transfer (n=3,487) rather than to native musculature (n=384), and 599 patients received dual innervation with an added masseteric or hypoglossal transfer.

A retrospective comparative cohort of 198 patients with unilateral microtia undergoing first-stage expander implantation between 2022 and 2025 compared a modified dual-plane "bio-hammock" pocket (n=99) with the conventional single-plane technique (n=99). All 80 mL expanders were over-inflated to roughly 110 mL, and the primary outcome was inferior displacement distance before the second stage.

• Median inferior displacement was 0.30 cm (IQR 0.22–0.38) versus 1.40 cm (IQR 1.15–1.70) in the conventional group, a 78.6% reduction (P<0.001).
• Overall complications were 2.0% versus 7.1% without reaching significance (P=0.170), and expander exposure occurred in no dual-plane patient versus 4.0% of single-plane patients (P=0.121).
• Early postoperative VAS pain scores were marginally higher after the dual-plane technique but had normalized by postoperative day 7.

A single-centre case series of 56 consecutive primary patients undergoing selective neurectomy for post-paralytic facial synkinesis, all with at least 12 months of follow-up. Outcomes combined patient-reported VAS, clinician-graded eFACE scores, and objective Emotrics landmark analysis before and after surgery.

• Mean aggregate VAS improved from 35.5 ± 19.8 preoperatively to 67.7 ± 16.5 postoperatively (p < 0.001), assessed at a mean of 19.7 ± 7.5 months after surgery.
• All eFACE subscores improved significantly and Emotrics symmetry parameters improved across regions, with the periocular region the sole exception on both clinician-graded and objective measures.
• Functional deterioration was reported by a minority: 3.7% described worse manipulation of food in the mouth and 7.5% reported worse drooling after neurectomy.

A retrospective cohort of 4,966 infants aged 12 months or younger undergoing primary cleft lip repair in the 2021 to 2024 ACS Pediatric Surgical Antibiotic Prophylaxis Data Files. Three exposure groups (no prophylaxis, prophylaxis without postoperative continuation, prophylaxis with continued intravenous antibiotics) were compared for 30-day surgical site infection and readmission using Firth penalized logistic regression.

• Prophylaxis was given to 90.4% of patients, most often cefazolin (87.2%), yet the overall surgical site infection rate was only 0.7%.
• Neither single-dose prophylaxis (OR 0.69, 95% CI 0.27 to 2.19) nor continued postoperative antibiotics (OR 0.61, 95% CI 0.20 to 2.12) was associated with reduced infection, and readmissions and composite complications were likewise unchanged.
• In the prespecified bilateral cleft lip repair subgroup, both prophylaxis strategies were associated with significantly lower odds of infection (OR 0.19 and 0.17, both p < 0.05).

A retrospective cohort of 183 consecutive patients undergoing free tissue transfer for continuous intraoral-cervical composite defects within a standardized programme, in which two senior surgeons performed flap design, anastomosis, and inset under protocolized monitoring. Predictors of major recipient-site complications (Clavien-Dindo grade III or higher) and of total flap or jejunal necrosis were modelled, with smoking quantified by the Brinkman index.

• Severe (Clavien-Dindo grade III or higher) complications occurred in 20.8% of patients and total necrosis in 3.3%; 17 patients (9.3%) had grade IIIb events, 13 of whom required reoperation.
• Brinkman index and bilateral neck dissection were independent predictors of severe complications, with each 100-unit increase in cumulative smoking exposure raising the odds.
• For total necrosis, cumulative smoking exposure was the only significant factor, with a receiver operating characteristic area under the curve of 0.858 (95% CI 0.735 to 0.981).
• In every necrosis case, circulatory compromise was recognized after postoperative day 3 despite protocolized flap monitoring, and length of stay was prolonged in patients with severe complications.

An international prospective observational study of 1314 major lower limb amputations from 46 centres, recruiting consecutive patients over 8 months with 30-day follow-up. Outcomes included CDC-defined surgical site infection, wound dehiscence, further intervention, mortality, and predictors of infection.

• Surgical site infection occurred in 10.9% (135 of 1238) and wound breakdown in 16.7% (204 of 1217) of amputations within 30 days.
• Low glomerular filtration rate, cardiac disease, dirty or infected wound class, and transtibial amputation were independent predictors of surgical site infection.
• Infection was associated with increased postoperative morbidity, wound breakdown, further intervention, and delayed fitness for discharge, but 30-day mortality of 7.0% showed no significant association with infection.

A prospective single-centre series of 41 patients undergoing 47 nonvascularized rectus fascia allotransplantation procedures between 2020 and 2025, using grafts from 48 deceased donors preserved at 2°C and implanted without HLA matching. Solid organ transplant recipients (n = 17) were compared with non-transplant patients without immunosuppression (n = 24) for closure success, graft failure, functional outcome, HLA donor-specific antibodies, and histology.

• The graft failed to integrate in 2 patients (4.9%), in the setting of pancreatic leakage and vasopressor therapy, while the remaining procedures achieved successful functional closure.
• Available histology (n = 5) showed integration by host fibrotic remodelling, with neovascularization evident from 1 month after implantation.
• De novo HLA donor-specific antibodies developed more frequently in non-transplant recipients than in solid organ transplant recipients, who were already immunosuppressed.

A retrospective comparative study of 49 patients treated between May 2016 and January 2024 for wound defects with associated dead space using free or pedicled anterolateral thigh flaps. Twenty-six conventional en bloc musculocutaneous flaps were compared with 23 chimeric perforator flaps in which the skin paddle resurfaced the defect and a separately mobile muscle component obliterated the dead space.

• Postoperative infection occurred in 3 of 26 conventional cases and in none of the 23 chimeric cases, a difference that was not statistically significant.
• Both techniques achieved stable wound coverage, while the chimeric design permitted independent positioning of the muscle component according to the location and configuration of the dead space.
• The authors frame the results as a technical advantage rather than demonstrated superiority, particularly for eccentrically located or deep dead spaces.

A retrospective single-center cohort of 154 patients treated between 2006 and 2022 for isolated axillary nerve injury or C5–C6 brachial plexus injury with deltoid paralysis compared interposition nerve grafting (n=67) with medial head triceps motor branch transfer (n=87). The primary outcome was BMRC-graded deltoid reinnervation at a minimum of 24 months.

• Functional recovery (BMRC ≥M3) was reached in 86.2% after nerve transfer versus 50.7% after grafting (RR 1.70, 95% CI 1.32–2.18; risk difference +35.5%, 95% CI +21.5 to +49.5).
• Recovery quality also separated the groups: transfer produced M4 in 70.1% and M4+ in 10.3% of patients, whereas grafting yielded predominantly M3 recovery with M4 in only 6.0%.
• The advantage of transfer was consistent in both isolated axillary nerve injury and brachial plexus-associated palsy on subgroup analysis.

A single-centre before-after comparative study of 347 patients undergoing carpal tunnel release with tenosynovial biopsy, comparing a non-targeted cohort recruited from October 2021 to July 2023 with a red-flag-targeted cohort from October 2023 to May 2026. Histopathology used Congo red staining with immunohistochemical confirmation of transthyretin, and multivariable models assessed both the targeting strategy and individual clinical factors.

• Overall, 82 of 347 biopsies were positive, with positivity of 37% in the targeted cohort versus 18% in the non-targeted cohort.
• Male sex and previously treated trigger finger were associated with increased positivity for transthyretin amyloid deposits.
• Diabetes was associated with lower positivity, 12% versus 26%, and the inverse association persisted after multivariable adjustment.

A retrospective review of 95 patients undergoing primary release of congenital syndactyly, comprising 143 hands immobilized in casts and 25 in bulky soft dressings. Surgical and medical complications, dressing replacement, unplanned clinic or emergency department visits, and caregiver telephone calls were compared between the two immobilization strategies.

• There were no significant differences in surgical or medical complications between groups; the most common events overall were hypertrophic scarring (12.5%), web creep (10.1%), and scar contracture (6.0%).
• Unplanned emergency department visits occurred in 1.4% of casts versus 4.0% of bulky dressings and clinic visits in 7.0% versus 8.0%, with caregiver phone calls in 14.0% versus 24.0%, none of which reached significance.
• Independent of dressing type, hypertrophic scarring was more prevalent in non-White patients (22.9% versus 7.9%, P = 0.03), and web creep was more common in male patients (14.4% versus 1.8%, P = 0.01).

Using the TriNetX federated research network, adults with type 2 diabetes who received a first corticosteroid injection for trigger finger were compared by GLP-1 receptor agonist exposure in a propensity-matched retrospective cohort of 11,726 patients (5,863 per arm, drawn from 69,222 eligible). The outcome was progression to A1 pulley release at 6, 12 and 24 months.

• Release rates at 6 months were 6.1% in GLP-1 receptor agonist users versus 6.8% in nonusers, a difference that did not reach significance.
• By 12 months users had lower release rates (10.6% vs 11.9%; RR 0.89, 95% CI 0.81-0.99), and the separation persisted at 24 months (14.2% vs 15.7%; RR 0.90, 95% CI 0.83-0.98).
• The absolute risk reductions were 1.4% and 1.7%, corresponding to numbers needed to treat of 71 and 59 at 12 and 24 months respectively.

A retrospective single-center study of 68 patients undergoing isolated open carpal tunnel release compared PROMIS pain-interference and upper-extremity scores at 2 weeks, 6 weeks and 3 months against the scores five hand surgeons predicted for matched theoretical patient profiles.

• Among patients with minimal comorbidities and mild disease (n = 33), surgeons predicted far better 3-month function than patients reported (PROMIS upper-extremity 59.8 predicted vs 35.5 observed) and less pain interference (38.7 vs 54.8).
• In patients with multiple comorbidities and mild disease (n = 17), the same optimism appeared at 3 months for pain interference (40.7 vs 52.7) and function (53.0 vs 41.3); at 2 weeks the reported function values ran in the opposite numerical direction (predicted 30.4 vs observed 36.2).
• For severe carpal tunnel syndrome (n = 18) the mismatch surfaced at 6 weeks, with predicted pain interference of 45.6 versus an observed 54.3 and predicted function of 37.9 versus 28.5.

A cross-sectional ultrasound study of 87 children and adolescents with spastic cerebral palsy measured muscle thickness, anatomical cross-sectional area and pennation angle of the biceps brachii and forearm muscles, stratified by forearm pronation (Gschwind and Tonkin) and wrist and finger deformity (Zancolli) grades.

• Muscle thickness and anatomical cross-sectional area of the biceps brachii, pronator teres and flexor carpi radialis decreased as forearm, wrist and finger deformity became more severe.
• The pennation angle of extensor digitorum moved the other way, increasing with greater deformity severity at both the forearm and the wrist and finger level.
• The gradients were seen across both grading systems used, the Gschwind and Tonkin classification for pronation and the Zancolli classification for wrist and finger posture, so the association held across two independent deformity axes.

A biomechanical bench study of 180 constructs compared five materials (SutureTape, LabralTape, FiberTape, Ethibond, Mersilene) in one-, two- and four-strand configurations, each passed through a 2.5 mm transverse tibial bone tunnel with knotless fixation, cycled 1,000 times from 0 to 100 N and then ramp-loaded to 300 N.

• Single-strand SutureTape, Mersilene and Ethibond elongated more at 100 N than single-strand LabralTape and FiberTape (p < 0.001), and Mersilene and Ethibond elongated more than SutureTape.
• No single- or double-strand LabralTape or FiberTape construct failed at the bone tunnel edge, while single-strand Ethibond and Mersilene showed the highest failure rates and the lowest failure loads.
• Adding strands reduced elongation, but the improvement was not proportional to strand number, so a four-strand construct did not behave like four single strands.

A multicenter retrospective cohort of 26 male patients treated between 2020 and 2023 compared 10 who received postoperative pulsed electromagnetic field (PEMF) stimulation with 16 controls, all after cannulated screw fixation with an early mobilization protocol and more than one year of follow-up.

• Radiographic consolidation occurred significantly earlier in the PEMF group (P = 0.024), the study's primary signal.
• Pain at rest was lower in PEMF-treated patients (P = 0.048) at follow-up beyond one year.
• No differences emerged in return to work or Patient-Rated Wrist Evaluation scores between the two groups.

A retrospective single-center case series of 14 patients assessed long-term outcomes of Joshi and Pho island flap reconstruction for subtotal digital pulp defects performed between 2010 and 2022, with DASH as the primary endpoint and pain, mobility, sensibility, scar quality and complications as secondary endpoints.

• At a mean follow-up of 78 months (range 12-183), the mean DASH score was 22.2 (range 5-45), with low pain scores (VAS 0.64, DN4 0.5).
• Sensory recovery was serviceable: two-point discrimination averaged 5.4 mm, and Semmes-Weinstein testing was reported at a mean of 3.5 with 6 patients (43%) at grade 6.
• Distal interphalangeal flexion was statistically reduced on the injured side (58° vs 63°, p < 0.01), which the authors judged of limited clinical relevance; POSAS scores were 13.9/60 (patient) and 17.7/50 (observer).
• No flap necrosis was observed; one infection led to secondary amputation, and donor sites showed no hook nail deformity or nail dystrophy.

A retrospective cohort of 79 patients (120 fingers) treated with subcutaneous Kenacort injection for trigger finger at a single military medical center between 2021 and 2025 was reviewed for symptom resolution and subsequent surgery; patients with prior surgical release were excluded.

• Complete resolution was reached in 57.5% of patients, with 25.0% partially improved and 17.5% reporting no improvement over a median follow-up of 7.5 months (range 3-41).
• Despite injection therapy, 25.8% of treated fingers went on to surgical release during the observation period.
• The thumb (32.5%) and ring finger (24.7%) were the most frequently involved digits, and most fingers presented at stage II disease.

A multi-institution randomized trial of 263 patients undergoing above- or below-knee amputation compared negative pressure therapy (n=134) with standard dressings (n=129). The primary endpoint was any wound complication within 30 days, with reoperation, readmission, and length of stay as secondary endpoints.

• Wound complications occurred in 19.4% with negative pressure therapy versus 24% with standard dressings, a non-significant difference (RR 0.80, 95% CI 0.51–1.26) at P=0.339.
• There were no significant differences in reoperation (3.7% vs 8.5%), readmission (9% vs 11.6%), or length of stay (10 vs 9.3 days); overall 30-day mortality was 3.4%.
• Post hoc analyses suggested larger reductions in patients without diabetes (9.8% vs 27.6%) and without tissue loss at presentation (3.6% vs 35.5%), with smaller signals in end-stage renal disease and obesity.

A retrospective review of 1,021 patients undergoing split-thickness skin grafting at a regional burn center from 2015 to 2024, including 559 with at least one follow-up visit documenting donor site appearance, tested demographic, comorbidity, surgical and dressing factors against dyspigmentation and hypertrophic features.

• Fitzpatrick skin types IV to VI made up 14.7% of the population but 46.6% of patients presenting with hypertrophic features (P < .001).
• Dyspigmentation was more likely with older age (OR 1.017 per year) and BMI ≥ 25 (OR 2.00); hypertension alone nearly doubled the risk (OR 1.92) and diabetes plus hypertension raised it further (OR 2.71).
• Dressing choice tracked with appearance: calcium alginate and silver dressings carried lower odds of dyspigmentation (OR 0.368), while film-only dressings more than doubled the odds (OR 2.31).
• Graft thickness and healing time were not significant predictors of donor site appearance in this cohort.

A retrospective single-center cohort of 52 burn ICU patients compared opioid and benzodiazepine exposure during wound care before and after initiation of oral ketamine premedication between August 2022 and 2024. Only medications administered during wound care were counted, and the primary outcome was oral morphine equivalents (OMEs).

• Median OMEs during wound care fell from 225 mg to 180 mg after oral ketamine was introduced (P = 0.008), with all patients also receiving IV fentanyl.
• Midazolam requirements were essentially unchanged (6 mg vs 5 mg; P = 0.21), despite 90% of patients receiving IV benzodiazepine during procedures.
• The cohort had substantial burn burden (median 31% TBSA, IQR 20–48) and received a median oral ketamine dose of 100 mg (IQR 100–125) before wound care.

A retrospective age- and sex-matched cohort of 94 patients treated at a single center compared intermittent vacuum therapy (three 30–40 minute sessions weekly) plus standard wound care against standard wound care alone in chronic lower limb wounds not amenable to further vascular reconstruction. Complete epithelialization was the event in Kaplan-Meier and Cox analyses stratified by wound aetiology.

• Complete healing occurred in 76.6% of IVT-treated wounds versus 48.9% of controls (36/47 vs 23/47) over the observation period.
• Kaplan-Meier median time to complete epithelialization was 4.0 months with IVT versus 17.0 months with standard care alone.
• After multivariable adjustment the healing rate favoured IVT with a hazard ratio of 10.73 (95% CI 4.37–26.38), and sensitivity analyses supported the direction of the association.

A retrospective propensity score-matched cohort of 39 patient pairs compared minimally invasive excision with epidermal autografting and poly-lactic acid skin substitute (MEP) against standard of care in adults with mid-deep dermal burns. The primary outcome was at least 90% wound healing by postoperative day 10, with length of stay, complications and hospital financial outcomes as secondary endpoints.

• Achievement of at least 90% wound healing by postoperative day 10 occurred in 82.1% of MEP patients versus 45.5% of matched controls (p = 0.001).
• MEP-treated patients experienced fewer complications than matched standard-of-care patients, without any increase in hospital length of stay.
• MEP carried higher upfront hospital costs, but reimbursement rates were comparable between the two treatment pathways.

A randomized within-patient trial of 30 patients undergoing split-thickness skin grafting divided each donor site into two equal zones randomly allocated to a foam or a superabsorbent dressing. Absorption capacity, epithelialization, pain scores and complications were assessed at three-day intervals through postoperative day 15.

• Measured absorption favoured the superabsorbent dressing at every assessment through day 9: 104.09 vs 71.87 mg/cm²/day at day 3 (p = 0.034), 84.45 vs 40.91 at day 6 (p < 0.001) and 76.59 vs 19.74 at day 9 (p = 0.022).
• Bench testing showed a 10 × 10 cm superabsorbent pad absorbed 93 mL of saline versus 75 mL for foam, at a lower dressing weight (5.5 g vs 7.5 g).
• Wound epithelialization was comparable between the two zones, with no allergic reactions, infections or other complications recorded in either group.
• Pain scores trended lower with the superabsorbent dressing on days 6 and 9, but the differences were not statistically significant.

A secondary analysis of a randomized controlled trial including 74 adult burn survivors linked baseline addresses to nationally referenced Area Deprivation Index scores across 239,780 US block groups. Three ADI-3 domains (Financial Strength, Economic Hardship, Educational Attainment) were tested in separate adjusted hierarchical regressions predicting BPI Pain Severity, PROMIS Pain Interference and BSHS Functional Abilities.

• The global ADI explained additional variance in functional abilities (ΔR² = .085, p = .012) but showed no association with either pain outcome.
• Both Financial Strength (β = 2.55) and Economic Hardship (β = -2.22) were independently associated with functional abilities after FDR correction and remained robust in sensitivity analyses.
• The Educational Attainment domain showed no association with any outcome, and a Financial Strength signal for pain severity (β = -0.52) did not survive multiple comparison correction (p-FDR = .057).

A three-phase multimethod development and implementation study comprising 8 patient interviews, a 34-respondent clinician survey and a 6-month pilot covering 42 patients was conducted in a Dutch burn care setting between September 2023 and October 2025. The aid was designed to support the choice between early surgery and conservative management in deep partial-thickness burns.

• Patient interviews identified two distinct information needs: some patients wanted detailed treatment information, others preferred to defer the decision to their clinician.
• The clinician survey showed that burn physicians typically make the final treatment decision although shared decision-making was considered preferable, and 91.2% (31/34) supported use of a decision aid.
• The final aid combined a paper handout, an interactive website and a preference summary sheet; during the pilot it was distributed 42 times and used by 28 patients (67% participation).
• Professional engagement and local support were the main implementation facilitators, while infrastructure was the principal barrier identified by clinicians.

A retrospective comparative cohort of 63 children with partial-thickness burns treated at a tertiary paediatric burns centre during 2023 compared outcomes before and after the routine transition from silver-containing gel-forming fibre dressings (n = 34) to dialkylcarbamoyl chloride-coated dressings (n = 29). Infection episodes, bacterial growth, antibiotic use, debridement and re-epithelialisation were extracted from electronic health records.

• Infection episodes were recorded in 20.7% of the DACC group versus 47.1% of the silver group (χ² p = 0.028), with shorter time to infection resolution in the DACC group.
• Fewer DACC patients showed significant bacterial growth (≥10⁵ CFU/mL), while systemic antibiotic requirement was comparable between the two dressing protocols.
• There was no significant difference in surgical debridement requirement or time to re-epithelialisation, although absolute values were lower with DACC; four silver-group patients with persistent infection were switched to DACC.

An ex vivo immunohistochemical comparison of human chronic wound epidermis examined tissue obtained either from routine debridement procedures or from end-stage wounds at the time of limb amputation. Keratinocyte differentiation and activation markers, oxidative stress transcription factors and biomacromolecule oxidation were mapped spatially relative to the wound edge.

• Debridement specimens typically showed hyperproliferative wound edge epithelium with or without epibole, whereas end-stage wounds displayed a much thinner epidermis.
• Cytokeratin 14 was increased throughout the suprabasal epidermis with cytokeratin 10 and filaggrin attenuated, and in end-stage wounds this downregulation extended further from the wound edge.
• Activation keratins 6, 16 and 17 were present at the wound edge and adjacent uninjured epidermis in both groups, with cytokeratin 16 and 17 also expressed in non-involved interfollicular epidermis of end-stage limbs.
• Nuclear phospho-NF-κB and phospho-Nrf2 were increased in end-stage keratinocytes, accompanied by greater oxidative damage to lipids, protein and DNA.

A multicentre retrospective cohort of 2211 DIEP flaps performed at three Dutch centres between 2010 and 2024 compared the incidence, type, and complications of recipient-site corrective procedures in irradiated (n=717, 32.4%) and non-irradiated patients. Mixed-effects models identified factors associated with the number of corrections.

• The observed mean number of corrective procedures per flap was essentially identical between groups (2.83 irradiated vs 2.84 non-irradiated), and complications after corrective surgery were rare in both.
• After adjustment for reconstruction timing and laterality, irradiated patients underwent slightly fewer corrections (β = -0.144, p = 0.033), an absolute difference the authors describe as clinically negligible.
• Independent predictors of more corrections were increasing age, immediate reconstruction, university hospital setting, and complications after the initial reconstruction, pointing to treatment setting rather than radiation as the driver.

A propensity-matched retrospective cohort of 992 patients per group drawn from the TriNetX US Collaborative Network compared free flap breast reconstruction with and without partial rib excision, matching on age and type of prior mastectomy. Complications were tabulated at 3 months, 8 to 18 months, and 6 to 10 years.

• Early complications were statistically indistinguishable between techniques: hematoma or seroma 8.1% versus 8.1%, infection 14.4% versus 12.3%, dehiscence or necrosis 9.2% versus 7.6%, and venous thromboembolism 5.1% versus 5.3%.
• Fat necrosis within 3 months was more frequent after rib sacrifice (12.9% versus 10.1%), corresponding to a 1.28-fold increased risk with a confidence interval whose lower bound touched unity (95% CI 1.00 to 1.64, p = 0.049).
• Revision within 6 to 10 years was more common in the rib-sacrificing cohort (35.9% versus 32.2%), a 1.21-fold increased risk (95% CI 1.08 to 1.35, p < 0.001).
• At 8 to 18 months, mastodynia (4.8% versus 3.5%) and dehiscence or necrosis (24.8% versus 26.8%) showed no divergence between cohorts.

A retrospective comparative study of 46 patients after unilateral pedicled latissimus dorsi flap breast reconstruction compared those with functional inactivation of the flap (nerve division and/or tenotomy, n = 16) with those without (n = 30). Isometric adduction, extension and internal rotation strength were measured bilaterally by handheld dynamometry alongside the Oxford Shoulder Score and BREAST-Q.

• Compared with the contralateral shoulder, the operated side showed significant strength deficits in all three movements tested (adduction, extension and internal rotation, all p < 0.001).
• Functional inactivation was not associated with any measured outcome: strength deficits, Oxford Shoulder Score and every BREAST-Q domain differed between groups with p > 0.15.
• On multivariate analysis, surgery on the dominant side was the only independent predictor of adduction deficit (B = +22.7, p = 0.008).
• Fibromyalgia independently predicted poorer BREAST-Q physical well-being of the back and shoulder (B = −38.7, p = 0.001), and a sensitivity analysis excluding one outlier reproduced the findings.

A comparative device study of eight unopened implants covering two current-generation models each from Allergan, Mentor, Motiva and Sientra applied eight assessment methods: tilt-table and time-in-motion analysis, pinch-roll testing, BTC 2000 biomechanical gel evaluation, tensiometer gel-shell peel testing, high-resolution ultrasound, blinded patient tactile assessment and matrix usability scoring.

• Mentor MemoryGel BOOST was the most form-stable device across all five BTC 2000 parameters, with the longest pinch-roll endpoint and the longest peel time with retained gel, indicating the strongest gel-shell interaction; Sientra 106 was consistently the least form-stable.
• Form stability did not track with tactile preference: BOOST placed third on blinded patient tactile assessment, while the less form-stable MemoryGel Xtra ranked first.
• Allergan devices produced the clearest shell visualization on high-resolution ultrasound and achieved the highest matrix usability score, reflecting the breadth of available profiles across aesthetic and reconstructive indications.

A single-institution retrospective series of 19 patients (32 breasts) treated between 2021 and 2025 describes the SAFE-DTI protocol, in which permanent implants are placed one to three weeks after mastectomy in patients otherwise eligible for immediate direct-to-implant reconstruction but with concern for flap necrosis, pending pathology, or scheduling constraints.

• Nearly all breasts were reconstructed after nipple-sparing mastectomy (96.9%), with a median implant volume of 398 cc (IQR 264 to 445 cc).
• The overall complication rate was 18.8%, comprising infection in 6.3% (two breasts in one patient), hematoma in 3.1%, and partial nipple-areolar complex necrosis in 9.4%, all three of which were apparent before implant placement.
• Four patients (8 breasts, 25% of the series) underwent revision within 6 months, consisting predominantly of autologous fat grafting for aesthetic optimization.

A four-part validation study covering 647 patients across four breast procedure groups assessed construct validity of the Clavien-Dindo classification against length of stay and surgical complexity, then tested inter-rater reliability using 35 clinical scenarios graded by five plastic surgeons before and after a procedure-specific reinterpretation.

• Across 202 graded complications, length of stay increased with grade, with significantly longer hospitalization for Grade IIIb than Grade I (p = 0.021), and complication severity was associated with surgical complexity (p = 0.014).
• Inter-rater reliability was substantial for the original classification (κ = 0.72) and rose to κ = 0.94 under the revised interpretation in a purposively selected subset of scenarios.
• Recurring sources of disagreement were seroma and hematoma management, donor-site complications, and the prophylactic versus therapeutic distinction; the proposed suffixes encoded reconstructive failure and the anatomical site of the complication.

A single-center randomized controlled trial of 100 patients undergoing radical mastectomy with implant-based reconstruction compared a preinduction ultrasound-guided T5 erector spinae plane block (30 mL of 0.375% ropivacaine plus dexmedetomidine 1 μg/kg) with no block, using standardized general anesthesia and postoperative PCA, blinded assessors and a primary outcome of resting NRS at 6 hours.

• The primary endpoint was not met: the adjusted median difference in resting NRS at 6 hours was −0.9 (p = 0.08), short of the prespecified minimal clinically important difference of 1 point.
• Benefit appeared at the upper tail of pain intensity (τ = 0.75, difference −1.8, p < 0.01) and repeated-measures analysis showed lower scores at 6, 12 and 24 hours, although confidence intervals still spanned the MCID.
• Opioid consumption fell by 13.5 mg at 24 hours and 6.6 mg at 48 hours (both p < 0.01), and quality of recovery was 5 points higher at 24 hours but no different later.
• There were no differences in intraoperative hemodynamics or postoperative nausea and vomiting between groups.

A technique report with a series of 7 patients (9 breasts) describes the Fujiyama procedure for conversion from implant-based to autologous reconstruction using pedicled or free abdominal flaps and profunda artery perforator flaps, in which a triangular skin paddle is deliberately exposed at the lower pole after implant and capsule removal.

• The design inverts the inverted-T mastopexy concept, using an exposed triangular skin paddle to redistribute and expand a lower pole envelope contracted by long-term implant placement.
• The pectoralis major is repositioned to the chest wall and the flap inset into a newly created prepectoral pocket, with contour assessed intraoperatively in the sitting position under negative pressure and the inframammary fold reinforced by tacking sutures when required.
• All nine breasts achieved complete flap survival with no major or minor complications, together with a stable inframammary fold, natural ptosis and lower pole projection without secondary revision.

A cross-sectional BREAST-Q survey of 171 women (85 after breast-conserving therapy, 86 after mastectomy without reconstruction) operated between June 2016 and August 2018 compared long-term health-related quality of life at a mean of 3.3 years postoperatively, using the corresponding BCT and mastectomy modules.

• Psychosocial well-being (78 versus 66), sexual well-being (61 versus 41) and physical well-being of the chest (86 versus 77) all favoured breast-conserving therapy (all p < 0.01), with the widest gap in sexual well-being at 20 points.
• Satisfaction with breasts was substantially higher after conservation, at 72 versus 52 (p < 0.01).
• Reported radiotherapy side effects were marginally lower in the conservation group (7 versus 8, p = 0.01), a difference whose clinical meaning is unclear given the narrow scale range and comparable absolute scores in both arms.

A retrospective cohort of 6412 autologous breast reconstructions drawn from the TriNetX Global Collaborative Network (2000 to 2024) compared incidence rates in women with preexisting psychiatric diagnoses (n = 1877) against those without (n = 4535). Temporal trends were modeled with Poisson and negative binomial regression, reporting incidence rate ratios across predefined periods.

• Incidence in the psychiatric cohort rose from 33.5 to 895.1 per 100,000 person-years across the study period, while the nonpsychiatric cohort rose from 108.1 to 700.9 over the same interval.
• Early incidence rate ratios favored women without psychiatric diagnoses, but the gap attenuated to near unity in the later periods, consistent with convergence of access.
• Lower reconstruction rates persisted in women with schizophrenia, which remained the one diagnostic subgroup that did not converge with the nonpsychiatric comparison group.

A PRISMA-compliant systematic review and meta-analysis of 40 studies including 5,684 patients evaluated autologous fat grafting for aesthetic breast augmentation and remodeling. Random-effects models pooled complications, radiologic findings, graft retention, and patient-reported satisfaction, with risk of bias assessed by RoB2, ROBINS-I, and the Newcastle-Ottawa Scale.

• The pooled complication rate was 25.9% (95% CI 22.4–29.6), consisting mainly of minor radiologic or palpable findings, with fat necrosis the most frequent adverse event.
• Benign imaging findings comprised fat necrosis in 8.8% and calcifications in 1.1%, with no evidence of impaired cancer detection across the included studies.
• Mean injected volume was 310 mL per breast and twelve-month retention was 61.3% (95% CI 57.1–65.4), with higher retention in SVF- or PRP-enriched grafts (68.9% vs 56.1%, p<0.01).
• Pooled patient satisfaction reached 93.1% (95% CI 90.4–95.8), although the instruments used to measure it varied considerably between studies.

A PRISMA-registered systematic review and meta-analysis of 7 studies comprising 1184 patients compared homologous costal cartilage with autologous rib cartilage in rhinoplasty. Homologous grafts were stratified by preservation method (fresh-frozen, irradiated, alcohol-preserved) and assessed for resorption, warping, infection, and operative time.

• Elevated resorption risk was confined to the irradiated subgroup (RR 4.60, 95% CI 1.279 to 16.503), while fresh-frozen (RR 1.588) and alcohol-preserved (RR 1.479) grafts did not differ significantly from autologous controls.
• Alcohol-preserved grafts showed a significant reduction in warping risk (RR 0.106, 95% CI 0.012 to 0.934); fresh-frozen and irradiated preparations warped at rates comparable to autologous cartilage.
• Infection rates were comparable between homologous and autologous cohorts (RR 0.701, 95% CI 0.284 to 1.731), with confidence intervals spanning both benefit and harm.
• Operative time was shorter with homologous grafts by a weighted mean difference of 66.6 minutes (95% CI 51.71 to 81.42 minutes).

A retrospective series of 240 East Asian patients underwent deep neck contouring with partial submandibular gland resection between August 2024 and July 2025, with concomitant facelift or neck lift when indicated. Outcomes comprised complications, surgeon-rated Likert scores on standardized photographs, and patient satisfaction.

• Reduction was performed through medial capsular entry with lobule-by-lobule bipolar dissection and targeted cauterization of intraglandular vessels, followed by thin-film fibrin sealant and low-dose botulinum toxin A on the residual gland.
• Complications were uncommon: hematoma and seroma each in 1.3%, infection in 0.8%, and sialocele in 0.4%; one hematoma required reoperation and the single sialocele resolved with aspiration plus adjunctive botulinum toxin A.
• Transient lower-lip depressor dysfunction occurred in 4 patients (1.7%), with no permanent nerve injury or clinically evident salivary dysfunction observed during follow-up.
• Standardized photographic assessment demonstrated consistent improvement in mandibular contour across the cohort.

A single-arm technique series of 75 women undergoing inverted-T scar central mound mastopexy in which dermal grafts were routed across the presternal region to link the medial breast pillars. The construct adds a horizontal support vector to the conventional vertical one, and outcomes were assessed by clinical follow-up.

• The grafts form a dual-vector suspension system connecting the medial pillars across the sternum, intended to counter gravitational descent and asymmetric settling that vertical support alone does not resist.
• Clinical follow-up described stable breast shape with improved upper pole fullness, enhanced projection, and satisfactory symmetry over time.
• Morbidity was limited to minor wound-healing problems and hypertrophic scarring in a small number of patients, and nipple-areola sensation was preserved in all patients.

A prospective single-arm multicenter study of 60 subjects evaluated PLLA-LASYNPRO (JULÄINE) for nasolabial fold correction, with up to three bilateral injections at 2 to 4 week intervals. Patient-reported outcomes (FACE-Q Appraisal of Lines, FACE-Q Satisfaction with Outcome, GAIS, and a 12-item satisfaction questionnaire) were collected 6 and 12 months after the final injection.

• FACE-Q Appraisal of Lines improved by a mean of 20.7 points at 12 months (P < .0001, d = 1.14), an effect that continued to grow between the 6- and 12-month assessments.
• The subject-rated GAIS responder rate was 83.3% at both timepoints, with more than 90% of subjects describing the results as natural-looking.
• Overall satisfaction declined from 88.9% at 6 months to 77.8% at 12 months, while 83% to 85% said they would repeat the treatment and 90% to 94% would recommend it.
• Safety reporting recorded no serious adverse events and no device deficiencies over the 12-month observation period.

A prospective randomized evaluator-blinded study of 234 patients with androgenetic alopecia (135 men, 99 women) received three autologous non-activated PRP sessions at 30-day intervals using a standardized intradermal protocol of 0.2 mL/cm2. Hair density, thickness, and total count were measured by computerized trichoscopy and phototrichogram at baseline, 12, 36, 60, and 120 months.

• At 12 months, hair density increased by 31.4%, hair thickness by 26.8%, and total hair count by 29.7% compared with baseline (p < 0.001).
• Improvement attenuated over time, with hair density +24.1% at 36 months and +17.3% at 60 months, and an 11.2% gain at 120 months among patients continuing maintenance treatment.
• Women showed greater preservation of hair shaft diameter than men, while prior COVID-19 infection (25 patients) was not associated with a different response and no severe adverse events occurred.

A population-based survey of 1134 weighted respondents representative of the Dutch general population completed four aesthetic rhinoplasty PROMs: the Utrecht Questionnaire, the SCHNOS cosmetic subscale, the FACE-Q rhinoplasty module, and a numeric rating scale. Ordinal regression tested associations between nasal satisfaction and age, gender, migration background, education, income, and residence.

• Population means were UQ 6.28, SCHNOS-C 11.38, FACE-Q nose 75.2, FACE-Q nostrils 80.09, and NRS 7.67, indicating high baseline satisfaction with nasal appearance in an untreated general population.
• Aesthetic satisfaction increased significantly with age on all four instruments, with the shift occurring more rapidly in male respondents.
• Respondents with a non-Western migration background reported lower satisfaction on FACE-Q nose (OR 1.819, p = 0.004), FACE-Q nostrils (OR 1.586, p = 0.031), and SCHNOS-C (OR 0.417, p < 0.001), while gender, education, income, and residence showed no significant association.

A single-center retrospective cohort of 241 consecutive patients undergoing gender-affirming mastectomy, breast reduction, or abdominoplasty compared outcomes before and after implementation of a standardized topical tranexamic acid protocol (500 mg per surgical site) in May 2022. Primary outcomes were cumulative 72-hour drain output and hematoma requiring surgical revision.

• Cumulative 72-hour drain output was lower with topical tranexamic acid in every procedure, with the largest relative reduction in abdominoplasty (62%, P < 0.001), followed by gender-affirming mastectomy (51%) and reduction mammoplasty (47%).
• Hematoma requiring surgical revision occurred in 6.5% of treated patients versus 15.5% of controls (6/93 vs 23/148), a 58% relative risk reduction (P = 0.042).
• The series recorded no thromboembolic events, seizures, or wound-healing complications attributable to topical administration.

A systematic review and meta-analysis of seven studies comprising 1122 rhytidectomy patients compared local tranexamic acid (n = 596) with control (n = 526). Random-effects pooling addressed estimated blood loss, 24-hour drain output, and hematoma rate, with bias assessed by ROBINS-I and certainty by GRADE.

• Hematoma occurred less often in the local TXA group, with a pooled odds ratio of 0.35 (95% CI 0.15–0.81; P = 0.014).
• Drain output over the first 24 hours was lower with local TXA (standardized mean difference −1.10, 95% CI −1.40 to −0.79; P < 0.01).
• Estimated blood loss also favored TXA, but the pooled estimate was extreme and imprecise (SMD −4.53, 95% CI −8.09 to −0.97), pointing to substantial between-study heterogeneity.
• Reported outcomes were confined to bleeding-related endpoints; no thromboembolic or systemic adverse-event rates were quantified despite the review's stated safety aim.

A retrospective single-surgeon cohort of 127 adults undergoing abdominal panniculectomy between 2019 and 2024, 38 of whom (29.9%) had concomitant ventral hernia repair, compared complications, reoperation, and postoperative intervention between the two groups. Multivariable logistic regression tested bariatric history, transplant status, and other clinical factors as predictors.

• Complications occurred in 31.5% of the cohort overall, with no significant difference between concomitant hernia repair and panniculectomy alone (26.3% versus 33.7%; relative risk 0.78, 95% CI 0.43–1.43; P = 0.532).
• Reoperation occurred in 15.7% and postoperative intervention in 18.9%; in adjusted models concomitant hernia repair remained unassociated with either outcome.
• A history of abdominal surgery was the only independent predictor of postoperative intervention (adjusted odds ratio 7.9, 95% CI 2.6–24.0; P < 0.001), while body mass index and transplant status were not.

A narrative review of vascular anomalies of the upper extremity, covering the malformation-versus-tumor classification and how location, extent, genetics, and functional impact determine whether treatment is surgical, medical, interventional, or combined.

• Management is anchored to the malformation-versus-tumor distinction, which determines whether medical, interventional, or operative therapy takes the lead.
• Operative resection in the limb is presented as requiring maximal lesion clearance balanced against neurovascular safety, since diligence in both dimensions governs the functional result.
• Advances in genetics and drug development have made targeted medical therapy an increasingly routine component of care rather than a salvage option.

A narrative review of combined vascular malformations, including Klippel-Trenaunay, CLOVES, and capillary malformation-arteriovenous malformation syndromes, summarizing anatomic and genetic classification, imaging workup, and the shift toward targeted pharmacotherapy alongside individualized surgery.

• Classification is organized around anatomic components together with genetic drivers, principally the PI3K/AKT/mTOR pathway (PROS) and RASA1 mutations.
• Phenotypes combine soft-tissue hypertrophy, skeletal overgrowth, and mixed vascular components, with thromboembolism, localized intravascular coagulopathy, and limb-length discrepancy as the complications driving multidisciplinary follow-up.
• Diagnosis rests on ultrasound and MRI, while therapy has moved from compression and sclerotherapy toward targeted pharmacotherapy with sirolimus or alpelisib combined with selective debulking.

A narrative review of extracranial arteriovenous malformations covering epidemiology, etiology and pathogenesis including sporadic and syndromic gene mutations, clinical features, diagnosis, and endovascular, surgical, and emerging medical management.

• AVMs are defined by direct arterial-to-venous communication with no intervening capillary bed and are characterized as among the most difficult vascular anomalies to treat.
• Untreated lesions are described as progressing to ulceration, bleeding, and in some cases high-output cardiac failure, which frames the decision to intervene despite operative morbidity.
• The genetic basis of sporadic and syndromic AVM is presented as the rationale for new and emerging medical treatments that complement embolization and resection.

A narrative review of venous malformations spanning sporadic, hereditary, and syndromic phenotypes, compiling subtype clinical characteristics, diagnostic and coagulopathy assessment protocols, and a proposed staged treatment algorithm.

• Venous malformations are attributed to hyperactivation of the TIE2-PI3K-AKT-mTOR pathway, which links sporadic lesions to the hereditary and syndromic forms.
• Diagnostic workup includes explicit assessment for localized intravascular coagulopathy, which is relevant before sclerotherapy or resection is undertaken.
• The authors propose a treatment algorithm keyed to VM subtype and affected tissue, with staged combinations of conservative measures, sclerotherapy, surgery, and targeted therapy in complex cases.

A narrative review of lymphatic malformations covering the 2025 ISSVA classification into isolated lesions, complex anomalies, and lymphedemas, together with imaging workup and the current multimodal treatment pathway.

• Lymphatic malformations most often involve the cervicofacial region and frequently harbor somatic PIK3CA mutations.
• The 2025 ISSVA guidelines separate isolated lesions, complex anomalies, and lymphedemas, and diagnosis draws on ultrasound, MRI, and magnetic resonance lymphangiography for anatomic and functional assessment.
• Sclerotherapy and sirolimus now hold the central therapeutic role, with surgery retained mainly for reconstruction and deformity correction and with bleomycin electrosclerotherapy and laser as newer adjuncts.

A narrative review of the operative management of vascular anomalies, setting out how lesion type, location, symptoms, and available nonsurgical options determine whether, when, and how extensively to resect.

• A confirmed diagnosis is required before management is selected, and complete resection is rarely necessary for control of the lesion.
• The governing operative principle is that intervention should not produce a worse deformity than the anomaly itself.
• Lesions managed primarily by operation are pyogenic granuloma, congenital hemangioma, and arteriovenous malformation.
• Infantile hemangioma, kaposiform hemangioendothelioma, and capillary, lymphatic, and venous malformations are typically resected only after medication, laser, or sclerotherapy has been applied.

This biomechanical cadaver study of 12 middle finger metacarpals (6 matched pairs) compared fibular allograft reconstruction with dual plating, performed after simulated resection of an expansile lytic lesion, against contralateral transverse fractures fixed with a standard 8-hole dorsal plate. Constructs were loaded in cantilever bending to failure by a 6-degree-of-freedom robotic manipulator.

• Mean load to failure was 494.7 N for the dual-plate allograft constructs versus 342.2 N for standard dorsal plating, a difference that did not reach statistical significance (P = .19).
• Failure modes differed by construct: reconstructions gave way at the proximal allograft-native bone interface, whereas control specimens failed through fracture displacement.
• Variability was far greater in the reconstructed group (SD 239.1 N vs 99.9 N), and the 95% confidence intervals of the two constructs overlapped widely (243.8 to 745.6 N vs 237.5 to 447.0 N).

This retrospective single-center cohort of 120 patients aged 80 years or older examined complications, functional decline, length of stay, and survival after resection of localized malignant soft tissue tumors of the limbs or trunk between 2012 and 2024. Logistic regression identified factors associated with complications and postoperative care dependency.

• Sixty-six of 120 patients (55%) developed Clavien-Dindo grade II or higher complications, both surgery- and non-surgery-related, with no postoperative deaths.
• On multivariable analysis, Geriatric Nutritional Risk Index risk category and longer operative time were the factors significantly associated with complications.
• Postoperative delirium emerged as the strongest predictor of subsequent decline in activities of daily living.
• Complications lengthened hospital stay by 10.5 days but were not associated with overall survival (2-year rate 74.3%), whereas frailty was independently associated with poorer survival.

This narrative review summarizes the pathophysiology, syndromic associations, and treatment of capillary malformation (port wine birthmark), with particular attention to facial lesions and their evolution over time.

• Capillary malformation is a congenital low-flow lesion of dilated capillaries and postcapillary venules that commonly involves the face and may darken, thicken, and develop nodules with age.
• Although most lesions are isolated, a facial capillary malformation may signal Sturge-Weber syndrome, defined by an associated leptomeningeal vascular malformation and ocular findings such as glaucoma; other syndromic associations make thorough clinical evaluation necessary.
• Pulsed-dye laser is presented as the gold standard treatment within multidisciplinary management, with excision reserved for lesions that develop tissue overgrowth.

This narrative review covers the diagnosis, natural history, and treatment of infantile hemangioma, the most common benign soft tissue tumor of infancy, and situates surgery relative to first-line pharmacotherapy.

• Diagnosis rests largely on clinical appearance, most often the characteristic strawberry-red surface lesion, rather than on imaging or biopsy, and the pathogenesis remains unelucidated.
• Infantile hemangiomas follow a stereotyped life cycle of rapid growth, plateau, and eventual involution, and most require no treatment at all.
• Oral propranolol is described as the first-line medical treatment for complicated lesions and the most commonly used and efficacious agent; surgery remains an option but is reserved primarily for lesions unresponsive to medical treatment.

This scoping review of PubMed/MEDLINE from inception to June 2025 collected peer-reviewed primary studies applying artificial intelligence to lymphedema diagnosis, monitoring, and surgical management, excluding editorials, reviews, and commentaries. Findings were synthesized qualitatively and grouped by clinical task.

• Published work clusters around four tasks: risk prediction, symptom- or image-based screening, automated limb volumetry, and interpretation of lymphatic imaging.
• Reported performance is frequently high in single-center retrospective datasets, but external validation and prospective workflow evaluation remain uncommon, so current applications are rarely used in routine practice.
• Roles in robotic (super-)microsurgery, including surgical simulation, training, and real-time intraoperative support, are characterized as projected rather than demonstrated, pending evidence of clinical utility, cost-effectiveness, and safety.

This literature review of 25 studies published between 2015 and 2025 examined artificial intelligence and machine learning applied to prediction of surgical, aesthetic, and patient-reported outcomes after breast reconstruction, using a conceptual progress, pitfalls, and path-forward framework.

• Twenty-five of 442 screened records met inclusion criteria and were sorted into surgical, aesthetic, and patient-reported outcome domains.
• Ten studies demonstrated working models predicting complications, donor-site morbidity, tissue expander loss, and patient-reported satisfaction.
• Three studies documented the principal obstacles: limited generalizability from small, single-center datasets, alongside technical barriers to clinical implementation.
• Twelve studies addressed future directions rather than validated models, covering perfusion-related events, tissue expansion dynamics, and automated aesthetic assessment, leaving roughly half the literature at the proposal stage.

In this workflow validation study spanning three in vivo angiogenesis models, the commercial deep learning tool IKOSA CAM was compared with manual vessel tracing on images from the chorioallantoic membrane assay, the rodent retina, and the dorsal skinfold chamber, with human re-evaluation of tracings and total workflow duration also recorded.

• Agreement between automated and manual quantification varied by image type and was highest for the chorioallantoic membrane assay.
• The largest discrepancies involved branching point detection in the dorsal skinfold chamber, where Bland-Altman plots showed a systematic downward trend; retinal images were likewise analyzed less reliably.
• Repeated runs of the automated analysis returned identical results in all three models, and total workflow duration was shorter than for manual tracing.

This in vitro study compared extracellular vesicles isolated from rat platelet-rich plasma, platelet-poor plasma, and adipose-derived stromal cell culture, applying three doses of each plasma vesicle preparation to primary rat Schwann cell cultures and pairing the biological readouts with a cost and working-hour analysis.

• Vesicles from all three sources were of comparable size, but plasma yielded significantly higher vesicle concentrations than adipose-derived stromal cell culture.
• Among all conditions tested, only adipose-derived stromal cell vesicles and the highest concentration of platelet-rich plasma vesicles significantly increased Schwann cell proliferation; whole platelet-rich plasma, platelet-poor plasma, and platelet-poor plasma vesicles did not.
• Cost and labor analysis favored the plasma route, with platelet-rich plasma vesicles obtained at lower cost and shorter preparation time than the cell culture-derived product.

A preclinical study combining in vitro assays with a rat full-thickness skin defect model compared exosomes from apheresis platelets stored for 3 days (D3-Exos) versus 7 days (D7-Exos) and platelet lysate, assessing growth factor content, keratinocyte, fibroblast and endothelial responses, and wound closure.

• D7-Exos showed higher particle concentration and greater TGF-β1 and PDGF-BB content than D3-Exos, indicating that storage to expiry did not deplete the growth-factor cargo.
• In culture, D7-Exos increased proliferation across cell types, raised collagen secretion by human skin fibroblasts, and increased VEGF secretion and tube formation in HUVECs.
• The angiogenic effect was accompanied by PI3K/Akt pathway activation in HUVECs together with upregulated VEGF expression.
• In the rat model, D7-Exos produced faster wound closure, re-epithelialisation and collagen deposition than both D3-Exos and platelet lysate.

A narrative review of preclinical CCL2 literature synthesises knockout, overexpression, graft-integration and stem-cell studies in peripheral nerve injury models, with emphasis on delivery platforms compatible with intraoperative use.

• Across injury models, CCL2 was reported to enhance macrophage-driven repair and accelerate axonal regrowth, alongside effects on angiogenesis and Schwann cell activity.
• Loss of CCL2 signalling impaired functional recovery, whereas targeted delivery during the early regenerative window improved outcomes without evidence of prolonged inflammation.
• Hydrogels, microsutures and mesenchymal stromal cell carriers are identified as feasible intraoperative delivery platforms, none of which has yet been tested clinically for this indication.
• Because sustained CCL2 exposure is linked to nociceptive sensitisation, the authors frame precise temporal and anatomic control of delivery as the condition for avoiding neuropathic pain.

A review article advancing a mechanistic framework synthesises mechanotransduction literature to define an early interval, gated by PIEZO mechanosensitive ion channels, during which tensile load, matrix resistance and spatial confinement determine whether repair remains plastic or commits to fibrosis.

• Force sensed through PIEZO channels is positioned as the initiating event of scar commitment, triggering calcium-dependent cytoskeletal remodelling and transcriptional reprogramming rather than acting as a downstream consequence of fibrosis.
• Commitment becomes irreversible once contractility-stiffness feedback turns self-reinforcing, after which fibrotic lineage identity persists even when upstream mechanical signals decline.
• The model predicts a timing-dependent therapeutic ceiling: intervention inside the window can redirect repair toward regenerative architecture, while later treatment reduces fibrotic burden without restoring native tissue organisation.

A controlled animal study of 40 female Wistar rats compared subdermal saline, BoNT-A, Argireline and BoNT-A plus Argireline given one week before elevation of a 9 × 3 cm caudally based McFarlane flap, with day-10 flap survival, collagen type I/III and Substance P expression as outcomes.

• Flap survival did not differ between the four groups (p = 0.327), despite the one-week pre-conditioning interval before elevation.
• BoNT-A-containing groups showed lower type I and higher type III collagen than control and Argireline (p < 0.001), a shift toward a less mature matrix profile.
• Argireline alone was indistinguishable from saline control on collagen composition, arguing against a tissue-level effect of the peptide under these conditions.
• Substance P was elevated in the combination group versus control and Argireline (p = 0.002), an exploratory neurogenic signal the authors attribute mainly to BoNT-A.

A comparative in vivo study using a 10 mm rat sciatic nerve gap model tested demineralised, decellularised conduits derived from rat femoral diaphysis and chicken ulna against axotomy controls, with functional, histological and extracellular matrix gene expression outcomes assessed over 16 weeks.

• Chicken ulna conduits showed superior tensile strength and elasticity compared with rat femur scaffolds; both supported hydration-dependent ionic conductivity.
• Both conduit groups achieved significant motor and sensory recovery versus axotomy controls across sciatic functional index, hot-plate latency and gastrocnemius mass ratio.
• Histology showed progressive conduit resorption with axonal infiltration, neovascularisation and remyelination, while COL1A1, FN1, LAMB2 and Tenascin-C expression followed scaffold-specific temporal patterns.

A preclinical materials study with in vitro assays and a rat long-gap nerve defect model developed a scaffold combining MXene-loaded sacrificial alginate microfibers, a gas-foamed three-dimensional nanofiber sponge, and a gelatin methacryloyl hydrogel carrying neurotrophic and angiogenic factors.

• Sacrificing the alginate microfibers produced longitudinal microchannels lined with conductive MXene nanosheets, reproducing elements of native fascicular architecture.
• In vitro, the scaffold induced neuronal differentiation of PC12 cells and supported endothelial tube formation, indicating combined neurogenic and angiogenic activity.
• In rat long-gap defects, the scaffold significantly enhanced nerve regeneration and functional motor recovery compared with controls.

A narrative review of preclinical and early clinical evidence covers synthetic electrospun fiber materials, bioresorbable polymer scaffolds engineered to resemble extracellular matrix, summarising their mechanical properties, antimicrobial testing and reported use in soft-tissue management after musculoskeletal trauma.

• Preclinical work reports tensile strength comparable to human skin, alongside cellular infiltration and revascularisation of the fiber matrix.
• The materials passed United States Pharmacopeia <51> Antimicrobial Effectiveness testing in vitro, which underlies the claims regarding infection risk.
• Reported clinical applications span open fractures, degloving injuries, Achilles repairs and amputations, with high closure rates and low complication rates in the cited series.