Plastic Surgery Weekly

A ten-year single-center retrospective cohort of 1582 microtia patients compared three auricular reconstruction techniques: the modified two-step method (n = 402), the expanded two-flap technique (n = 462), and the single-expanded flap procedure (n = 718). Cumulative operative time, postoperative hospital stay, duration of therapy, complications across all stages, and patient satisfaction were analyzed.

• The single-expanded flap technique achieved the highest satisfaction scores, which the authors attribute to minimal scarring and a more uniform colour match of the reconstructed auricle.
• The modified two-step method produced the shortest cumulative operative time and the shortest overall duration of therapy across all surgical stages.
• Follow-up ranged from 6 months to 10 years, and the authors conclude that no single technique suited every patient, with preoperative assessment and indication selection driving outcome.

A single-center retrospective analysis of 113 free-flap revision operations over six years partitioned registration-to-incision time into arrival latency, anesthesia lead time, operating-room preparation, and surgery lead time. Each interval, plus operative duration and time of day, was tested against the primary outcome of salvage versus total flap loss.

• Total flap loss occurred in 14.2% of re-explorations, and median registration-to-incision time was essentially identical between salvaged and lost flaps (78 vs 77 min, p = 0.89).
• Arrival latency (19 vs 20 min), operating-room preparation (25 vs 22 min), and door-to-incision time (52 vs 53 min) were all indistinguishable between outcomes, so no logistic interval separated salvage from failure.
• Failures trended toward longer anesthesia lead time (28 vs 38 min) and operative duration (83 vs 109 min), although neither reached significance (p = 0.48 and p = 0.12).
• Night-time operations were not associated with failure, whereas weekend cases carried a higher proportion of losses (25% vs 12%, p = 0.06, a trend only).

A single-center retrospective cohort of 191 consecutive patients undergoing paraspinous muscle flap reconstruction for posterior spinal wounds compared drain utilization, complications, and mortality across superficial release (n = 33), deep release (n = 106), and combined release (n = 52) techniques. Multivariable models tested drain number as an independent predictor of complications.

• Drain use varied sharply by technique, occurring in 93.9% of superficial, 88.5% of combined, and 30.2% of deep release cases (p < 0.001), while overall complication rates did not differ across techniques (23.6% overall, p = 0.17).
• Complication rates rose stepwise with drain burden, from 15.9% with no drain to 25.6%, 42.9%, and 50.0% with one, two, and three drains.
• In the principal multivariable model, each additional drain carried higher odds of complication (OR 1.83; 95% CI 1.06–3.16; p = 0.030), alongside prior radiation and preoperative infection.
• The drain association was attenuated in expanded and time-to-event models, so its magnitude depends materially on model specification.

A systematic review and meta-analysis of 9 studies of surgical facial trauma reconstruction in adults, searched through December 2024, of which 7 contributed to a random-effects pooled analysis restricted to orbital fracture outcomes. Non-orbital outcomes were synthesized narratively because of clinical and anatomical heterogeneity.

• Pooled prevalence of postoperative diplopia was 0.16 (95% CI 0.00–0.33) with substantial heterogeneity (I² = 80%), leaving a confidence interval that extends down to essentially no cases.
• Enophthalmos pooled at 0.15 (95% CI 0.05–0.26) with no detectable heterogeneity (I² = 0%), making it the more stable of the two estimates.
• Complications after non-orbital facial fractures, including infection, nonunion, dehiscence, malunion, malocclusion, and nerve paraesthesia, were too heterogeneous to pool and were reported narratively with wide variation across studies.

A single-centre retrospective review of 24 women (41 limbs) undergoing lymphaticovenous anastomosis quantified preoperative 18-MHz lymphatic ultrasound examination time and intraoperative time to identify recipient veins and lymphatic vessels. Examination times were compared between limbs mapped with and without prior indocyanine green lymphography.

• Mean ultrasonography duration was 26.4 minutes (range 16–48) and did not differ between patients with and without prior indocyanine green lymphography (P = 0.077), nor did it correlate with body mass index (r = −0.057).
• Across 83 anastomosis sites (mean 2.1 per limb), intraoperative identification averaged 2 minutes 10 seconds for recipient veins and 8 minutes 5 seconds for lymphatic vessels.
• Lymphatic identification time rose with advancing International Society of Lymphology stage, from 4 minutes 53 seconds at stage 1 to 9 minutes 35 seconds at stage 3 (P = 0.039), with the stage 1 versus stage 3 difference significant (P = 0.0014).

A prospective within-patient comparison of 12 patients undergoing anterolateral thigh perforator flap reconstruction after oral and maxillofacial tumour resection mapped each perforator by hand-held Doppler, a CTA-based digital guide, and CTA with integrated mixed reality. The intraoperatively confirmed fascial emergence point of 32 perforators served as the reference standard.

• Localisation accuracy was 91.2% for CTA with mixed reality versus 85.3% for the CTA-based guide and 75.7% for hand-held Doppler; corresponding sensitivities were 96.9%, 90.6%, and 87.5%.
• Estimated marginal mean localisation error differed significantly across methods (P < 0.001): 5.82 mm for CTA-mixed reality, 8.01 mm for the digital guide, and 11.56 mm for hand-held Doppler.
• Mixed reality required less preparation time than guide fabrication but a longer intraoperative localisation step than guide placement; all flaps survived and no donor-site complications occurred.

An anatomical cadaveric study of 21 flap dissections in 13 donors (11 formalin-embalmed, 2 fresh) defined the origin, calibre, and dye-delineated territory of the transverse cervical artery anterior perforator, with angiography and cone beam computed tomography in one fresh specimen. A parallel Doppler ultrasonography survey of 50 volunteers assessed in vivo detectability and origin.

• The anterior thoracic perforator consistently originated from the transverse cervical artery with a median diameter of 1.6 mm, confirmed on cone beam computed tomography.
• Landmarks were reproducible, with the perforator bounded by the clavicle inferiorly, anterior scalene deeply, sternocleidomastoid medially, and omohyoid laterally, and a median dye-perfused skin territory of 201.1 cm².
• Doppler identified the perforator in 75 of 100 volunteer sides, and 98% of those detected arose from the scalenic segment of the transverse cervical artery.

A single-centre retrospective cohort of 70 patients with unilateral orbital floor trapdoor fractures incarcerating orbital fat and the inferior oblique muscle branch of the oculomotor nerve was assembled over 12.5 years. Postoperative Hess area ratio and binocular single vision were compared across injury-to-surgery intervals of 0–7, 8–14, and more than 14 days.

• Surgical repair improved mean Hess area ratio from 66.2% to 95.8% and mean binocular single vision from 42.5% to 81.1% (both P < 0.001).
• Postoperative Hess area ratio and binocular single vision showed no significant difference across the early, intermediate, and delayed groups (all P > 0.05).
• The cohort was predominantly young and male, with a mean age at injury of 13.4 ± 6.6 years (range 1–42) and 24.3% female, consistent with the paediatric predominance of trapdoor-type fractures.

A single-centre case series of 18 patients undergoing free jejunal transfer after pharyngolaryngoesophagectomy evaluated a modified externalised mesentery monitoring technique. Assessment covered the reliability of venous Doppler signals, the need for ligation or resection of the externalised segment, and midterm healing and scar quality.

• Arterial Doppler signals were detectable in all cases, whereas venous signals were absent in 6; mesenteric colour change acted as the adjunctive indicator that prompted early intervention for venous congestion.
• Ligation or resection of the externalised mesentery proved unnecessary in 15 of 18 patients, who were managed conservatively and healed by secondary intention without infection or bleeding.
• Among 9 patients with outpatient follow-up, complete epithelialisation occurred by 6 months with a mean Vancouver Scar Scale score of 1.11 (range 0–4), independent of mesenteric exposure width.

A PRISMA-guided systematic review of 47 studies comprising 92 microvascular ear replantations pooled patient-level data to compare arterial plus venous repair (n = 64), artery-only repair (n = 25), and arteriovenous anastomosis (n = 3). Exploratory logistic regression assessed factors associated with replantation failure.

• Success was achieved in 58/64 arterial-and-venous cases (90.6%) versus 17/25 artery-only cases (68.0%), with failure significantly more frequent after artery-only reconstruction (OR 4.55, 95% CI 1.39–14.93; P = 0.019).
• Artery-only cases had markedly higher rates of postoperative venous congestion (92.0% vs 50.8%) and of blood transfusion requirement (82.4% vs 48.1%; P = 0.030).
• In exploratory multivariable analysis, artery-only reconstruction remained associated with failure at an adjusted OR of 6.16 (95% CI 1.65–23.02; P = 0.007).

A single-center randomized controlled trial of 59 patients with recurrent Dupuytren contracture compared fasciectomy (n = 28) with collagenase injection (n = 31). Primary endpoints were change in total active extension deficit (TAED) at 12 weeks and re-recurrence, defined as TAED worsening of at least 20° between 12 weeks and 2 years.

• Mean TAED improvement at 12 weeks was 52° after fasciectomy versus 49° after collagenase (adjusted mean difference -1; 95% CI -9 to 8), and at 2 years 47° versus 34° (adjusted mean difference -8; 95% CI -23 to 7).
• Re-recurrence occurred in 14.8% of fasciectomy and 27.6% of collagenase patients, but the estimate was imprecise (RR 1.9; 95% CI 0.6 to 5.6) and compatible with both a substantial difference and none.
• QuickDASH worsened by a clinically important margin from baseline to 3 weeks in the fasciectomy group only (adjusted between-group difference -11.7; 95% CI -18.5 to -5.0); no other score differed significantly between groups.

A single-centre retrospective comparative study of 89 unilateral proper palmar digital neurovascular bundle injuries with at least 1 year of follow-up compared digits with a patent digital artery (n = 58) against non-patent digits (n = 31), patency being assessed by Doppler ultrasonography with superb microvascular imaging. Outcomes were static two-point discrimination, British Medical Research Council sensory grade, and cold intolerance.

• Median static two-point discrimination (p = 0.49) and combined S3+/S4 British Medical Research Council grades (p = 0.87) showed no difference between patent and non-patent digits.
• Perilesional arterial collateralisation was significantly more common in the non-patent group (74.2% vs 43.1%; p = 0.003), interpreted as compensatory maintenance of a vascular environment favourable to nerve regeneration.
• Cold intolerance affected 32 of 58 patients with a patent artery and 18 of 31 without, a comparable proportion in both groups, although no formal statistical comparison was reported.

A retrospective database analysis of 1,047 procedural coding events in the Pediatric Health Information System (2005–2024) identified children under 24 months undergoing surgery for brachial plexus birth injury. Nerve autografting (n = 585) was compared with nerve transfer (n = 462) by calendar year, patient age, treating specialty, and census region.

• Autografts accounted for 585 procedures (55.9%) and nerve transfers for 462 (44.1%), with the odds of transfer rising 21% with each calendar year (P < .001).
• Children undergoing autograft were younger at surgery (6.3 ± 3.5 vs 10.2 ± 4.9 months; P < .001), and age older than 8 months conferred nearly 7-fold greater odds of transfer.
• Among patients older than 8 months in the contemporary period, care by orthopaedic surgeons was associated with a 68-fold increase in odds of nerve transfer versus 5-fold for plastic surgeons; transfers predominated in the West and were least frequent in the Northeast.

A PRISMA-guided systematic review of 17 studies published between 1997 and 2024 examined whether preoperative objective severity measures predict recovery after transverse carpal ligament release, covering nerve conduction studies, ultrasound, electromyography and carpal tunnel pressure measurement.

• Of the included studies, 11 reported an association between preoperative objective severity and clinical outcome, while 6 found no association at all.
• Nerve conduction studies were by far the most frequently used preoperative modality, followed by ultrasound, electromyography and carpal tunnel pressure measurement.
• Modalities other than nerve conduction consistently showed positive associations with recovery, but they appeared in only a small minority of the included studies.

A single-center retrospective cohort of 249 acute scaphoid fractures treated by percutaneous screw fixation between 2017 and 2026 tested whether screw length, diameter, fixation direction and duration of postoperative immobilization were associated with union and with CT-detected articular protrusion of 1 mm or more.

• Union was achieved in 93.2% of cases, while CT-detected articular protrusion was present in 52.2%, so protrusion was common even in radiographically successful fixations.
• Protrusion was less frequent with screws of 20 mm or less than with screws of 22 mm or more (25.9% versus 60.2%), while union rates were essentially identical at 93.1% and 93.2%.
• Each additional millimetre of screw length independently raised the odds of protrusion (OR 1.32, 95% CI 1.16–1.50), and the effect held after normalization to scaphoid length (OR 1.73 per 0.10 increase in ratio).
• Screw diameter, fixation direction and duration of postoperative immobilization showed no significant association with union.

A case series of 16 pediatric patients describes a closed reduction technique for complex dorsal dislocation of the index metacarpophalangeal joint, an injury termed complex because interposed soft tissue blocks reduction by simple longitudinal traction.

• The described maneuver relies on hyperextension, rotation and ulnar deviation of the proximal phalanx rather than traction, which tends to tighten the entrapping structures.
• The series addresses Kaplan dislocation of the index finger, described as uncommon in children and therefore seldom reported in pediatric cohorts of this size.

A prospective comparative trial of 270 adults undergoing minor outpatient hand procedures allocated patients in alternating two-week blocks to skin closure with 5-0 polyglactin 910 or 5-0 monofilament nylon, comparing infection, dehiscence, patient-reported pain at follow-up and nursing time.

• Pain during dressing change or suture removal was significantly lower in the absorbable group (p < 0.001), the only endpoint that separated the two arms.
• Infection requiring antibiotics occurred in one patient in each group, and superficial dehiscence in 13 absorbable versus 11 non-absorbable cases, none requiring reoperation.
• Median time spent on wound care at the two-week visit was five minutes in both groups, so avoiding suture removal did not shorten the encounter.

A retrospective case series of 35 patients undergoing thumb carpometacarpal arthrodesis with a precontoured low-profile locking plate supplemented by a 3.0 mm cannulated compression screw reports radiographic union, alignment and patient-reported function through 12 months.

• Radiographic union was documented in 91.4% at three months and in all 35 patients by six months, with no revision surgery required.
• Postoperative palmar and radial abduction alignment was maintained without significant interval change, and pain scores improved significantly by three months and continued improving through 12 months.
• Grip and key pinch strength reached statistical significance at six months and QuickDASH from six months onward; hardware problems were limited to minor irritation in 3 patients (8.6%), all managed conservatively.

A retrospective diagnostic study of 33 patients with spontaneous anterior interosseous neuropathy compared preoperative high-resolution ultrasound, read jointly by two radiologists, against intraoperative findings as the reference standard.

• Surgery confirmed 4 focal swellings and 56 focal narrowings; ultrasound detected all swellings and 45 narrowings, giving a sensitivity and overall accuracy of 81.7% with a positive predictive value of 100%.
• Specificity and negative predictive value could not be calculated, since there were no false positives in a cohort composed entirely of operated patients.
• Interrater reliability was good to excellent (ICC 0.856), and ultrasound additionally showed denervated muscle change in 5 patients, median nerve trunk compression in 2 and posterior interosseous nerve narrowing in 2.

A single-arm series of 144 patients with thoracic outlet syndrome, selected on coracoid tenderness and scapular protraction, underwent pectoralis minor tenotomy with infraclavicular plexus neurolysis alone, with pain, shoulder abduction, headaches and need for secondary neurolysis as outcomes.

• Median pain fell from 8 to 2 out of 10 and median shoulder abduction rose from 90 to 180 degrees (both p < 0.001), at a median follow-up of 15 months.
• Occipital headaches resolved in nearly the whole cohort, falling from 120 patients (83%) to 2 patients (1%).
• Secondary neurolysis was needed in roughly 16% of patients but in only 1% at the thoracic outlet itself, which the authors read as support for a pectoralis minor-driven mechanism rather than neurovascular compression.

A targeted drug-evaluation review of anacaulase-bcdb, a standardized pineapple stem-derived proteolytic biologic licensed for enzymatic eschar removal in adult and paediatric thermal burns, synthesizing the phase 3 DETECT trial, the randomized paediatric CIDS trial, systematic reviews, consensus guidance, prescribing information and postmarketing data.

• Across the reviewed evidence the agent delivered rapid eschar removal while reducing both the need for surgical excision and debridement-related blood loss.
• Preservation of viable dermis keeps conservative healing or delayed grafting available afterwards, which is the central argument for the tissue-sparing positioning.
• Reported constraints include procedural pain and hypersensitivity, together with strict eligibility criteria and the requirement for a trained specialist team.
• The greatest value is placed in eligible deep partial-thickness and selected full-thickness burns treated within protocolized burn-center pathways, with wider adoption contingent on comparative and cost-effectiveness data.

A single-center retrospective observational study of 110 adults with acute upper extremity burns measured perceived function with the QuickDASH and related it to AM-PAC Daily Activity scores and pain ratings from initial evaluation to discharge.

• Perceived upper extremity function was poor at evaluation, and change during hospitalization was inconsistent: 54.3% improved and 30.9% exceeded the 15.9-point minimal clinically important difference, but the overall group change did not reach statistical significance.
• AM-PAC Daily Activity scores rose significantly over the same interval, from a mean of 17.96 at evaluation to 19.86 at discharge (p < 0.001), indicating measurable gains in performance of daily activities.
• QuickDASH scores were moderately correlated with pain (Spearman r = 0.56, p = 0.004), and the authors report that gains in perceived function tracked with reductions in pain.

A longitudinal cohort of 166 adult burn survivors with baseline demographic, clinical, and psychosocial assessment underwent occupational follow-up at 24 months, examining employment status, job change, perceived career impact, and a composite high-occupational-impact outcome by multivariable logistic regression.

• Ongoing work participation was reported by 51.2% of survivors, burn-attributed workforce detachment by 41.0%, and changes unrelated to the burn by 7.8%.
• Among survivors who remained employed, job change was common at 60.0%; 43.4% reported negative perceived career impact and 54.2% met the composite definition of high occupational impact.
• Greater burn severity, higher baseline distress, and older age were each associated with higher odds of high occupational impact, with moderate model discrimination (AUC 0.733, 95% CI 0.656–0.810); baseline posttraumatic growth showed an inverse exploratory trend.

A cross-sectional online survey of 178 burn survivors recruited through the Phoenix Society in 2023 assessed financial toxicity, defined as naming financial assistance or income impact among greatest unmet needs, with multivariable logistic regression for independent predictors and thematic analysis of free-text responses.

• Financial toxicity was reported by 31.5% of respondents overall, rising to 41.8% among those aged 18–44 and 50.0% among those within three years of injury.
• Burn size showed a graded association: aOR 4.76 for 21–40% TBSA and 7.85 for greater than 40% TBSA, with younger age also independent (aOR 3.37, 95% CI 1.21–9.40).
• Shorter time since injury remained independently associated with financial toxicity (aOR 5.98 at 1–3 years and 4.72 at under 1 year), and free-text responses centered on insurance coverage and access to reconstructive and supportive therapies.

A retrospective cohort of 95 patients treated for Fournier's gangrene at a tertiary referral center between 2022 and 2025 compared conventional dressings (n=31) with NPWT/VAC (n=64), using multivariable logistic regression to identify independent predictors of in-hospital mortality.

• Overall in-hospital mortality was 20.0% (19/95) and was lower in the NPWT group than in the conventional dressing group (15.6% vs 29.0%, p<0.05).
• NPWT remained independently associated with lower mortality after adjustment (adjusted OR 0.42, 95% CI 0.18–0.95, p<0.05).
• Higher Fournier's gangrene severity index (OR 1.28 per point, 95% CI 1.10–1.55) and higher procalcitonin (OR 1.95, 95% CI 1.35–2.75) were independently associated with higher mortality.

A narrative review of cord blood-derived platelet gel (CBPG), an allogeneic fibrin scaffold enriched with neonatal platelet-derived growth factors, covering its biological rationale, the clinical evidence by wound indication, and the regulatory, ethical, and translational issues facing its adoption.

• CBPG delivers a fibrin-based scaffold carrying high concentrations of VEGF, HGF and FGF directly to the wound bed without requiring blood collection from the patient, which is the stated rationale for use in fragile populations.
• Reported clinical experience spans recessive dystrophic epidermolysis bullosa, cutaneous and oral chronic graft-versus-host disease, partial-thickness burns, neonatal pressure injuries, and diabetic foot ulcers, with safety consistent across indications.
• Progress toward validated clinical use is constrained by absent manufacturing standardization and unsettled regulatory classification, alongside the need for multicenter randomized trials with health-economic endpoints and governance of cord blood allocation.

A retrospective case series of 13 defects in 10 patients reconstructed with a novel hydrogel-based dermal regenerative template of type I bovine collagen microspheres in a lower-density collagen hydrogel, applied to face, scalp, and extremity defects with immediate grafting, delayed grafting, or no grafting.

• All defects demonstrated wound bed vascularization 8 days after template application, across defect sizes from 2 to 100 cm² and oncologic, traumatic, and donor-site etiologies.
• Mean total time to healing was 8 days with immediate skin grafting, 15 days with delayed grafting, and 18 days when the template was left to heal by secondary intention.
• Healed defects were aesthetically acceptable with minimal to no contour deformity, including wounds with exposed tendon, bone, nerve, and galea.

A randomized animal experiment in 72 diabetic rabbits compared remote periosteal distraction, sham implantation, and wound creation alone in an ischemic foot wound model, with a subperiosteal tibial plate distracted outward for 7 days and returned inward for a further 7 days.

• Residual wound area was smaller after periosteal distraction than in sham and control animals at both day 8 and day 16, accompanied by greater epithelial thickness and collagen deposition.
• Distraction was associated with higher serum VEGF, increased VEGF mRNA, and larger CD31-, VEGF- and VEGFR2-positive areas in wound tissue.
• Ex vivo micro-CT angiography at day 16 demonstrated higher vascular volume in the wound region after distraction, consistent with the immunohistochemical angiogenesis signal.

An experimental study of 24 Wistar-albino rats, each with two standardized 2 cm² deep second-degree dorsal burns, compared non-cultured autologous cell spray harvested from 2 cm² and 1 cm² donor sites against 0.5 cm² and 0.25 cm² donor sites and untreated or tangentially excised wounds, assessed at day 14.

• The lowest necrotic area, 6%, occurred with the larger donor sites of 2 cm² and 1 cm², compared with 17% and 9% in the small-donor group and 15% and 13% in the control group.
• Ulcer size and inflammation scores followed the same gradient, with the 1:2 donor-to-burn ratio giving the smallest ulcer (0.1 mm) and lowest inflammation score (0.5).
• Statistical significance versus untreated wounds was reached only at the second burn site of the larger-donor group, across necrosis, ulcer size, and inflammation (p = 0.007, 0.041, 0.043).

A prospective comparison of 380 patients enrolled in the multicenter FABREC radiation-fractionation trial evaluated prepectoral (n = 224) versus subpectoral (n = 156) implant-based reconstruction after post-mastectomy radiotherapy. Outcomes were FACT-B and BREAST-Q scores plus blinded aesthetic ratings at 6 and 18 months, analyzed with multivariable adjustment.

• No significant differences emerged in any patient-reported outcome domain at either timepoint, covering FACT-B physical, social, emotional, and functional well-being and BREAST-Q satisfaction with breasts, psychosocial, sexual, and physical well-being.
• Blinded reviewers scored subpectoral reconstructions lower aesthetically at 6 months, but that difference no longer held at 18 months, when only age remained a significant predictor of aesthetic score.
• Higher BMI was associated with lower sexual well-being at both 6 and 18 months (estimate -0.60, p = 0.03), and complication rates did not differ between the two planes.

A retrospective cohort of 730 breasts (541 non-irradiated, 189 irradiated) undergoing immediate prepectoral implant-based reconstruction with the wrap-around technique tested whether the ADM-to-implant surface area ratio predicted Baker grade III–IV capsular contracture. Logistic regression with generalized estimating equations accounted for within-patient clustering.

• Capsular contracture occurred in 7.4% of non-irradiated and 23.8% of irradiated breasts during the first two postoperative years.
• A higher ADM-to-implant surface area ratio was independently associated with lower odds of capsular contracture (OR 0.781; p = 0.013) on multivariable analysis.
• Radiotherapy remained the strongest risk factor, increasing the odds of capsular contracture 4.10-fold relative to non-irradiated breasts (p < 0.001).

A prospective single-surgeon series of 210 consecutive patients (349 breasts) undergoing immediate prepectoral direct-to-implant reconstruction with 4-micron surface implants (Motiva Ergonomix2) and no ADM or mesh, between September 2023 and March 2025. Early and mid-term complications, aesthetic ratings, and BREAST-Q scores were analysed at a median follow-up of 12 months.

• Early complications affected 26.1% of breasts, led by incision dehiscence (5.2%), hematoma (3.7%), and partial nipple-areola-complex necrosis (2.9%).
• Grade III/IV capsular contracture occurred in 7.7% of breasts and rippling in 6%; total implant loss was 1.1%, with unplanned reoperation in 8%.
• Cosmetic outcomes (n=143) were rated excellent or good in more than 75% of cases, rising to 92% in bilateral prophylactic mastectomies.
• BREAST-Q responders (n=129) reported a postoperative breast satisfaction score of 65 and implant satisfaction of 6.6 out of 8.

A retrospective cohort of 388 single-stage implant-based reconstructions performed by a single surgeon at a tertiary breast unit, comparing 194 subpectoral cases (2014–2017) with 194 prepectoral cases (2016–2019). The primary outcome was the number of secondary procedures performed within 5 years to improve aesthetic outcome.

• Secondary aesthetic procedures at 5 years were comparable between groups at 53.1% versus 53.6% (P = 0.650), and fat grafting rates were similar (32.5% versus 37.6%; P = 0.338).
• Pocket revision was more frequent after subpectoral reconstruction (9.3% versus 2.6%; P = 0.005), whereas implant exchange did not differ significantly (7.7% versus 3.1%; P = 0.216).
• Overall complication rates were similar (20.1% versus 22.2%; P = 0.709), and implant loss was 5.2% in both groups.

A case-control proteomic analysis of 48 capsule biopsies (24 from women with Baker III/IV capsular contracture, 24 from Baker I non-contracture controls), profiled by liquid chromatography-tandem mass spectrometry with label-free quantification. Differential expression, co-expression network, and functional enrichment analyses were combined with validated histopathological scoring.

• Profiling quantified 7,258 proteins (median 5,879 per sample), and unsupervised analysis separated contracture from control capsules without prior grouping information (P = 0.001).
• Seventy-seven proteins were differentially expressed (31 up, 46 down), with extracellular matrix remodelling dominating: MMP9 was upregulated alongside its inhibitors TIMP1 and TIMP3.
• A profibrotic TGF-beta signature (THBS1, THBS2, periostin, TGM2) accompanied innate immune activation (MPO, FCGR1A, S100A8, S100A9), and network analysis isolated a contracture-associated neutrophil degranulation module.
• A separate adaptive immune module correlated with implantation time and implant rupture rather than with contracture grade.

A single-centre retrospective cohort of 83 patients undergoing nipple-sparing mastectomy with immediate DIEP flap reconstruction between 2019 and 2023, grouped as no neoadjuvant therapy, chemotherapy alone, or chemotherapy plus radiotherapy. Internal mammary and deep inferior epigastric arterial segments were examined histologically for tunica media thickness, lumen area, atherosclerosis, calcification, and elastic fibre fragmentation.

• No histological parameter differed significantly between groups in either vessel, including tunica media thickness (IMA p = 0.230; DIEA p = 0.327), lumen area (p = 0.061 and p = 0.134), atherosclerosis, and calcification.
• Flap loss occurred in 5 of 83 patients (6%) and was comparable across the three treatment groups (p = 0.131).
• Anastomosis time did differ, with a mean of 66.1 minutes in the chemotherapy-plus-radiotherapy group versus 55.1 minutes for chemotherapy alone and 60.7 minutes for no neoadjuvant therapy (p = 0.011).

A prospective randomized single-blind trial of 40 women undergoing preservation breast augmentation, allocated 1:1 to a preoperative deep serratus anterior plane block (20 mL of 0.25% bupivacaine bilaterally) or standard care, with all procedures performed under tumescent local anaesthesia and propofol sedation. Endpoints were 24-hour NRS scores, rescue propofol and fentanyl consumption, haemodynamic response, and postoperative analgesic use.

• The block group required less rescue propofol (45 ± 3 versus 55 ± 4 mg) and less fentanyl (12 ± 5 versus 22 ± 9 µg), both p < 0.001.
• NRS scores favoured the block at 60 minutes (3.4 versus 4.5; p = 0.011) and 6 hours (3.8 versus 4.7; p = 0.035) but converged by 24 hours (3.4 versus 3.2; p = 0.377).
• Both arms remained within a low pain range (NRS ≤ 3.5) across the study period, and no major complications were recorded.

A nationwide population-based case-control study of 847 implant-based reconstructions (245 immediate, 602 delayed) drawn from prospectively collected Swedish registry data for 2007–2022, in which post-bariatric patients were matched to at least three controls by age and BMI. Group LASSO regression with bootstrap resampling was used to build cumulative risk prediction models, visualised as nomograms.

• Complication rates were 16.3% after immediate and 14.5% after delayed reconstruction, with a history of massive weight loss present in 11% and 6% of the respective cohorts.
• Prior massive weight loss was consistently retained as an independent predictor of complications in both the immediate and delayed models, and additionally predicted re-admission after delayed reconstruction.
• Other retained predictors were age, BMI, radiotherapy, comorbidity-related medications, and antibiotic use, indicating that current weight alone does not capture the residual risk.

A proportional meta-analysis of 71 studies comprising 12,739 patients and 16,915 DIEP flaps, searched to June 2025 across PubMed, Web of Science, and the Cochrane Library. Seroma incidence was pooled with a DerSimonian-Laird random-effects model, and smoking and diabetes were examined by univariable meta-regression.

• A total of 736 seromas were reported, giving a pooled incidence of 6% (95% CI 4%–7%) in a population with mean BMI 27.2 kg/m2 and mean age 50.4 years.
• Heterogeneity was substantial (I² = 85.3%, τ² = 0.05, P < 0.001), so the single pooled figure spans widely divergent study-level rates.
• Meta-regression showed no significant association with smoking (P = 0.57) or diabetes (P = 0.07), which the authors read as pointing toward technical and perioperative determinants rather than comorbidity.

A retrospective single-institution review of 258 gender-affirming mastectomies performed between January 2011 and December 2022, using multivariable logistic regression to test whether patient age was associated with postoperative complications or revision surgery after adjustment for clinically relevant confounders.

• Median age was 24 years (range 16–61), and surgical volume rose over the study period alongside a trend toward younger patients.
• Overall complication and revision rates were 15.1% and 22.8% respectively, and both declined significantly over the 12 years.
• After multivariable adjustment, age showed no association with either outcome, while year of surgery remained the only independent predictor (OR 0.89 for complications, P = 0.040; OR 0.88 for revision, P = 0.009).

A prospective multicenter cohort of 1,248 patients undergoing abdominal, flank, thigh, back or circumferential liposuction at eight tertiary centers was followed for a mean of 52.4 months. Contour durability, BODY-Q scores, weight variation and complications were assessed at standardized intervals out to five years.

• Stable contour improvement was maintained in 78.6% of patients at five years, and BODY-Q scores remained significantly above baseline across follow-up (p < 0.001).
• The overall complication rate was 14.8%, with major complications in 1.9%; contour irregularity (5.8%), edema (4.9%), seroma (2.6%) and fibrosis (2.3%) were the most frequent events.
• Revision surgery was required in 8.7% of patients, in a cohort with a mean aspirated fat volume of 3,180 ± 920 mL.
• High BMI, smoking, aspirate volume above 5 L and combined procedures predicted complications on multivariate logistic regression.

A cadaveric anatomical study of 53 heads (106 sides) used lead oxide perfusion with three-dimensional CT angiography and gross dissection to map the medial temporal artery. Origin, course, branching pattern and anastomoses were characterized and summarized in a vascular distribution heat map.

• The artery was present on all 106 sides, arising from the superficial temporal artery at the zygomaticotemporal suture and running between the temporalis muscle and the periosteum.
• Branching was single-trunk in 56.6%, bifurcated in 29.2% and trifurcated in 14.2%, with an initial posterior course of 27.21° ± 7.21° followed by a posterosuperior turn of 67.75° ± 7.27°.
• A high-probability vascular zone was mapped 1–2 cm posterior and 1–2 cm superior to the superior auricular point.
• Extensive anastomoses with the posterior auricular and deep temporal arteries form the anatomic substrate the authors cite for retrograde embolization toward the ophthalmic artery.

A retrospective comparative cohort of 196 patients undergoing high-definition lipoabdominoplasty under general anesthesia compared 98 patients receiving semaglutide or tirzepatide with 98 patients not on such therapy. Outcomes were intraoperative adverse events together with recovery metrics and early postoperative complications.

• Intraoperative parameters including EtCO₂ and SpO₂ remained stable in both groups, with no clinically relevant respiratory events reported in either arm.
• Recovery profiles were similar, with comparable times to awakening, mobilization and discharge between GLP-1-treated patients and controls.
• Postoperative nausea and vomiting, pain scores and early complications (seroma, infection, delayed wound healing, hyperpigmentation) did not differ significantly between groups.

This retrospective single-center series of 600 female patients evaluated SMAS-based subnasal lip lifting performed between 2020 and 2024, with plication or excision chosen according to lip volume and tissue characteristics. Standardized photographs at a minimum of 12 months were reviewed for scar quality, lip eversion, complications and revisions.

• Tension was transferred to the SMAS layer through either plication or excision, which the authors report allowed controlled lip eversion with reduced skin-closure tension.
• Minor scar elevation occurred in 11 of 600 patients (1.8%) and was managed successfully with fractionated carbon dioxide laser therapy.
• No surgical revision procedures were required across a mean follow-up of 14.6 months in a cohort of mean age 36.4 years.

A retrospective review of 239 patients treated with botulinum toxin type A for masseter hypertrophy assessed a fan-shaped injection targeting the deep-inferior masseter through a single entry point. Facial width on standardized frontal photographs, injection pain, satisfaction and complications were recorded at a mean of 4.86 months.

• Facial width decreased significantly at all three horizontal reference lines, with the greatest reduction recorded at the oral-commissure level.
• Injection-related discomfort was low (VAS 1.02 ± 0.82) and patient-reported satisfaction on GAIS and Likert scales was high.
• Two patients (0.8%) developed transient localized bulging that resolved spontaneously; no cheek depression, persistent smile asymmetry or masticatory weakness requiring intervention was identified.

A retrospective cohort of 219 women undergoing primary hybrid breast augmentation, combining silicone gel implants with autologous fat grafting, was followed for 12 months. Breast circumference, BREAST-Q satisfaction, a surgeon-rated aesthetic score and complications were assessed without an implant-only comparison arm.

• Breast circumference increased by a mean of 12.6 ± 1.3 cm at 6 months and remained augmented at 12 months (mean gain 10.3 ± 2.5 cm; both P < 0.001).
• BREAST-Q satisfaction with breasts rose from 54.4 ± 5.9 preoperatively to 82.2 ± 5.4 at 12 months (mean improvement +27.8; 95% CI 26.9 to 28.8).
• Satisfaction was unrelated to the magnitude of size gain (r = 0.05 at 6 months and r = 0.06 at 12 months; both P > 0.3).
• Complications occurred in 5.9% (13/219), all minor and with no Baker grade IV contracture; neither smoking history nor BMI was associated with complications.

A prospective observational cohort of 68 women with upper-extremity lipedema undergoing circumferential arm liposuction was assessed by standardized digital goniometry before surgery and at 1, 3, 6 and 12 months. QuickDASH, pain, perceived heaviness and upper-arm circumference were recorded alongside shoulder range of motion.

• Mean active shoulder abduction improved from 132.4° ± 13.8° at baseline to 154.7° ± 11.5° at 6 months and remained stable at 12 months (p < 0.001).
• Stage II and III patients showed the largest absolute functional gains, reaching postoperative range-of-motion values comparable with those seen in earlier-stage disease.
• QuickDASH, pain and perceived heaviness all decreased significantly, and upper-arm circumference reduction correlated moderately with abduction gain (r = 0.42, p < 0.01), with goniometry reliability excellent (ICC ≥ 0.93).

A systematic review and meta-analysis of nine randomized trials compared fractional laser therapy with microneedling for non-acne scars and scar-like dermal fibrotic lesions. Random-effects models pooled scar scores, histological measures and adverse events across parallel-group and split-body designs.

• Overall scar severity favored fractional laser over microneedling (SMD -0.99, 95% CI -1.83 to -0.15; P = 0.02), with the same direction for collagen fiber regeneration (SMD -2.14, 95% CI -3.57 to -0.72).
• No significant differences were found for elastic fiber improvement, epidermal thickness or adverse-event incidence.
• Subgroup analyses by laser type, including CO₂ versus non-CO₂ and traditional versus non-traditional fractional systems, showed no clear or consistent separation.

In this observer-blinded randomized trial of 56 patients undergoing bilateral upper eyelid blepharoplasty, one eyelid received a compression dressing while the fellow eyelid was left undressed, and masked graders scored edema, ecchymosis, and aesthetic outcome on postoperative days 1, 7, 30, and 90.

• Day-1 ecchymosis was significantly lower on the dressed eyelid (Holm-adjusted p = 0.012), the only between-side difference to survive correction for multiple comparisons.
• Day-1 edema and Global Aesthetic Improvement scores also favoured the dressed side, but neither retained significance after Holm-Bonferroni adjustment (adjusted p = 0.060 and p = 0.138).
• At postoperative days 7, 30, and 90, no measured parameter differed between the two eyelids, confining any observed benefit to the first day.
• Corneal staining scores were comparable at every visit with no erosions recorded, and day-1 pain scores were effectively identical between sides (p = 0.977).

This dual-cohort anatomical study of 35 healthy volunteers and 15 cadavers combined 12 MHz color Doppler ultrasound at the radix, rhinion, and nasal tip with dissection of 30 hemifaces, measuring arterial depth, caliber, clearance to the framework, and distance from midline relevant to filler rhinoplasty.

• Macroscopic arteries were detected at the radix or rhinion in 80.0% of ultrasound subjects and at the nasal tip in 71.4%.
• A central paucivascular corridor measured 8.62 ± 1.07 mm at the radix and 8.04 ± 1.01 mm at the rhinion, but terminal vessels converged progressively toward the midline at the tip.
• Vascular asymmetry was frequent and concordant across methods, with bilateral macro-arteries in 60.0% by ultrasound and 53.3% by dissection.
• Dorsal arteries lay significantly deeper in male subjects at all three measurement sites (p < 0.05).

A single-surgeon retrospective review of 128 patients undergoing periocular reconstruction after Mohs micrographic surgery compared Integra Dermal Regeneration Template (n = 88) with NovoSorb Biodegradable Temporizing Matrix (n = 40). Multivariable logistic regression identified independent predictors of complications, additional procedures, and revision surgery.

• Overall complications affected 44.3% of Integra versus 20.0% of BTM patients (p = 0.006), with ocular complications in 37.5% versus 15.0% (p = 0.007).
• Ectropion drove most of that gap, occurring in 28.4% of Integra and 2.5% of BTM patients (p < 0.001).
• After adjustment for defect size and subunit, Integra remained independently associated with ectropion (OR 14.84), additional surgery (OR 19.78), and revision surgery (OR 6.67).
• Lower eyelid involvement was the dominant independent predictor of any complication and of any ocular complication, regardless of which matrix was used.

This retrospective controlled study of 45 patients who underwent en-bloc resection of sacral tumours between 2020 and 2024 compared those reconstructed with artificial mesh anchored at five defined points (bilateral sacroiliac joints, bilateral ischial spine ligaments, and the anococcygeal ligament) against those left unreconstructed, with pelvic floor function graded by the Motor, Urinary, and Defecation (MUD) score.

• Sacral hernia occurred in none of the mesh group versus 40.9% of the non-mesh group (P = 0.002).
• Total MUD score was higher after mesh reconstruction (20.22 ± 2.83 vs 17.59 ± 3.62, P = 0.01).
• The defecation subscore showed the largest between-group difference (6.70 ± 1.52 vs 4.91 ± 1.82, P < 0.001), and perioperative parameters and complication rates also favoured the mesh group.

This retrospective cohort of 131 patients treated with parotidectomy and neck dissection at a single Sydney institution between 2000 and 2025 (110 with parotid metastases and 21 with preauricular cutaneous SCC) assessed the rate of pathological Level IA involvement, the nodal basin harvested for submental island flap reconstruction.

• Level IA involvement was pathologically confirmed in 4 of 131 patients (3.6%), with a 95% confidence interval of 1% to 9%.
• No clinically node-negative neck harboured Level IA disease, giving an occult involvement rate of 0% (95% CI 0% to 3.3%).
• Level IA positivity tracked with extent of neck dissection, pathological nodal status, and median nodal burden (all p ≤ 0.02), occurring only in high-burden nodal disease.

This two-patient case series reports en bloc resection of extensive extracranial Schobinger stage III/Yakes type IV arteriovenous malformations involving the orbital region, with the resulting craniofacial defects closed by a foldable extended vertical trapezius myocutaneous island flap; one patient underwent simultaneous radical neck dissection for a concomitant T4a maxillary squamous cell carcinoma.

• Both malformations were resected completely without surgical complications, and the foldable trapezius myocutaneous island flap covered the resulting large defects, including full-thickness cheek loss.
• Swallowing, mastication, and speech returned to preoperative levels in both patients, with quality-of-life scores rising by 40 percentage points to 80% and 60% respectively.
• Disease outcomes diverged sharply: one patient remained disease-free at 36 months, while the patient with concomitant T4a maxillary SCC died of local recurrence 8 months after surgery.

This narrative review synthesizes imaging, operative, and pharmacological evidence on plexiform neurofibromas in neurofibromatosis type 1, covering how MRI, angiography, and FDG-PET inform the trade-off between complete resection and function-preserving debulking, and how reconstruction and surveillance are staged afterward.

• MRI is positioned as central to perioperative assessment, with whole-body MRI for baseline mapping and regional MRI for high-resolution operative planning; FDG-PET improves detection of distinct nodular and atypical lesions carrying higher malignant potential.
• Preoperative embolization is proposed for highly vascular lesions identified angiographically, on the rationale that it reduces intraoperative haemorrhage.
• Complete resection is described as offering maximal oncologic control at the cost of permanent deficit risk, while subtotal debulking preserves function and accepts recurrence; fluorescein guidance, neurophysiological monitoring, and 3D planning are listed as adjuncts.
• MEK inhibitors including selumetinib are presented as effective non-surgical therapy for progressive or unresectable lesions, with MRI surveillance emphasized after subtotal resection.

The protocol sets out a multicentre, open-label phase III randomised trial of 396 participants recruited from UK skin cancer surgery centres and allocated 1:1 to standard care alone or standard care plus compression therapy after excision of lower limb keratinocyte cancers, with blinded endpoint assessment and an embedded internal pilot.

• The primary outcome is time to healing from randomisation, followed to a maximum of 52 weeks and analysed by multivariable Cox proportional hazards in the intention-to-treat population.
• Secondary outcomes cover infection, antibiotic use, scar quality, safety, quality of life, and cost-effectiveness, the last evaluated both within-trial and through decision-analytic modelling.
• Exploratory objectives include the relationship between post-partial-closure wound area and time to healing, plus a qualitative sub-study on patient acceptability, adherence, and decision-making around compression.

This narrative review examines artificial intelligence tools now entering hand surgery, including neural networks reading scaphoid and distal radius radiographs, machine learning models predicting outcomes after carpal tunnel release, and large language models drafting patient communication, and proposes a stewardship framework for the surgeon adopting them.

• The authors observe that most hand surgery AI tools are tested only on data resembling their training set, deployed into workflows that have not been audited, and rarely remeasured after release.
• The framework has four components: external validation on the population the model will actually see, transparent disclosure of intended use and known failure modes, defined escalation paths when surgeon and model disagree, and prospective post-deployment audit.
• The surgeon is framed as clinically accountable for the outcomes these tools shape even when the model's internal workings remain opaque, with specific vendor questions, reporting-checklist items, and performance metrics mapped to each component.
• The authors extend the implications to residency training, board certification, journal editorial standards, and regulatory pathways for tool approval.

A model development and internal evaluation study built on 260 clinical images from 18 patients with epidermolysis bullosa and 536 expert-annotated masks. Five architectures, including convolutional networks and transformer-based models, were trained to segment seven wound categories and benchmarked against human inter-annotator agreement.

• Mask2Former reached a mean Dice similarity coefficient of 52.9% across all categories versus 55.9% for inter-annotator agreement, with near-expert accuracy in five of seven wound classes and performance above human agreement in two.
• Convolutional architectures performed noticeably worse than transformer-based models and generally failed to segment rarely occurring wound classes.
• The authors frame the model as a decision support layer for automated wound measurement, progression monitoring and documentation, including a planned smartphone-based telemedicine application.

A preclinical study in rat and beagle tendinopathy models testing AsPep-FTSQ, a self-assembling peptide composed entirely of natural amino acids, injected into the pathological tendon. The endpoints were TGF-β1 sequestration, pro-fibrotic signaling, collagen organisation and functional repair.

• After injection the peptide formed an interconnected nanofibrous network in situ that selectively sequestered excess TGF-β1 within the tendon niche.
• Local cytokine capture suppressed pro-fibrotic signaling, limited pathological tendon cell state transitions and promoted collagen realignment.
• Improvements in tendon structure and function were reproduced in both the rodent and the canine model, supporting a modular strategy for local cytokine sequestration.

A narrative review of plant-derived extracellular vesicle (PDEV) delivery in engineered biomaterials for chronic non-healing wounds, with diabetic foot ulcers as the main clinical target. It synthesises loading strategies, scaffold design principles and translational barriers.

• PDEVs are characterised as nanoscale lipid carriers with low immunogenicity, antioxidant and anti-inflammatory activity and pro-angiogenic effects on the wound bed.
• The dominant translational barrier is instability in the wound microenvironment: enzymatic degradation, pH fluctuation and clearance by exudate cause premature cargo loss.
• Engineered scaffolds preserve vesicle integrity and extend residency through modulated release; composite systems surpassed single-component therapies across the wound models reviewed.
• The authors propose a development framework combining artificial intelligence-driven material design with mechanism-guided optimisation.

A first-in-human, single-arm trial in ten women with advanced-stage osteoporosis receiving one intravenous infusion of autologous bone marrow MSCs glycocalyx-edited to express sialylated Lewis X for bone homing. Protocol evaluation spanned two years, with fracture and safety follow-up continuing more than three further years per patient.

• No serious adverse events occurred across the two-year protocol evaluation or the subsequent extended safety monitoring.
• Fragility fractures were markedly and durably reduced after the single infusion, the trial's principal clinical signal.
• Bone turnover markers shifted in an osteoanabolic direction alongside increases in bone tissue area and volumetric bone mineral density.
• Cells harvested from older women with diseased marrow remained osteoregenerative, which the authors read as evidence against intrinsic age- and disease-related MSC compromise.

A preclinical antibody development study in diabetic mouse models of peripheral neuropathy, testing a panel of selective, proteolytically stable MMP-9 inhibitory monoclonal antibodies given systemically. Findings were cross-checked against human dorsal root ganglion expression and human genetic association data.

• Systemic MMP-9 inhibitory antibodies alleviated mechanical and cold pain symptoms in diabetic mice.
• Treatment restored hind paw wound healing and reduced epidermal nerve fibre degeneration, with improved nerve mitochondrial function and increased cutaneous angiogenesis.
• Human support was indirect: MMP-9 expression was elevated in dorsal root ganglia of patients with diabetes, and both rare coding and common MMP9 variants associated with neuropathic pain phenotypes.

A controlled animal study in 24 Wistar rats in which four subdermal auricular cartilage grafts per animal were allocated to control, nanofat, adipose-derived MSC or ADMSC-derived exosome treatment. Grafts were assessed histologically and by type II collagen immunohistochemistry at 4, 12 and 24 weeks.

• Exosome treatment produced a significant rise in type II collagen expression at 12 weeks (p = 0.035), with the improvement sustained at 24 weeks.
• Nanofat and ADMSC application increased proteoglycan staining relative to controls but did not raise type II collagen expression.
• Graft architecture was preserved in all four groups with no adverse effects attributable to any adjunct, giving no safety signal to separate the arms.

A multiomics profiling study of clinical wound samples combined with animal wound-healing experiments identifying metabolic drivers of the reparative phase. Systemic α-ketoglutarate (αKG) administration was compared with untreated wounds, and a gelatin methacryloyl microneedle platform was developed for localised delivery.

• Profiling of clinical samples showed marked TCA cycle activation and identified α-ketoglutarate as a central regulator of the reparative phase.
• Systemic αKG promoted wound closure and re-epithelialisation, with enhanced neo-tissue formation and an extended epithelial tongue.
• Mechanistically αKG drove cell cycle progression and enhanced fibroblast-derived TGF-β signaling, inducing epithelial-mesenchymal transition-like programs in keratinocytes.
• A transdermal microneedle patch for localised αKG delivery addressed spatial metabolic heterogeneity and further accelerated tissue repair.

A descriptive animal study establishing a third-degree burn model in adult Cynops pyrrhogaster, followed for one year. Regeneration was characterised macroscopically, histologically and ultrastructurally, with blood cell dynamics, PCNA immunohistochemistry and semi-quantitative RT-PCR of inflammatory markers.

• Burn wounds were completely re-epithelialised by post-burn day 8, even though damaged deeper tissue was still present.
• By day 365 the site resembled normal skin macroscopically without contracture, with organised dermal collagen and restored muscle sarcomere structure and no fibrotic scar.
• Neutrophils peaked early and declined after re-epithelialisation while erythrocytes accumulated transiently to a day 12 peak; PCNA-positive proliferating cells peaked on day 30 in dermis and subcutaneous tissue.

A PRISMA-compliant systematic review of 33 publications, of which 14 were direct graft-specific animal studies, evaluated technical graft-preparation and interface strategies alongside local and systemic biologic interventions intended to reduce cartilage graft resorption and preserve chondrocyte viability. Heterogeneity in models, strategies, follow-up, and outcomes precluded meta-analysis, so findings were synthesized narratively.

• Direct evidence derived predominantly from rabbit models and covered graft-preparation and interface comparisons together with locally delivered platelet-derived products, fibrin-based materials, and perichondrial support.
• Several studies reported favorable graft-related outcomes, but heterogeneity in model, follow-up, and endpoints meant that no comparison across strategy categories was possible and no inferential analysis was attempted.
• No direct graft-specific systemic intervention study was identified; the rationale for systemic approaches rested entirely on indirect literature covering oxidative stress, inflammation, apoptosis, extracellular matrix biology, and tissue repair.

A computational study built on 44,837 numerical homogenization simulations combined with systematic multi-objective optimization derived geometric bounds for non-stochastic three-dimensional meta-biomaterials, then validated selected optimized designs after additive manufacture at both macro- and microscale.

• Poisson's ratio and relative mass density were decoupled from all other mechanical, morphometric, and transport properties, with average deviations below roughly 14%.
• Optimized lattices were fabricated by PolyJet 3D printing and two-photon polymerization at macro- and microscale respectively, and experimentally validated for effective elastic modulus, Poisson's ratio, and permeability.
• Explicit geometrical relationships defined upper and lower bounds on the input parameters, keeping pore size and surface-to-volume ratio within ranges relevant to in vitro biological conditions.

A randomized four-arm animal study in a Wistar rat burn model compared placebo gel, standard BMSC conditioned medium, conditioned medium from berberine-preconditioned BMSCs, and silver sulfadiazine cream, with wound closure monitored macroscopically and tissue harvested at day 21 for histology, CD31 immunofluorescence, and Western blot.

• Berberine-preconditioned conditioned medium produced the fastest wound closure of the four treatments, with improved epidermal regeneration and better organized collagen on H&E and Masson's trichrome staining.
• CD31 immunofluorescence showed a marked increase in capillary density, and Western blot demonstrated upregulation of collagen I and collagen III in the same group.
• Treated wounds showed increased phosphorylation of PI3K and AKT together with elevated eNOS protein, implicating the PI3K/AKT/eNOS pathway as the proposed mechanism of action.