Plastic Surgery Weekly

A retrospective cohort of 826 patients undergoing oral cavity cancer free flap reconstruction (2008–2019) used inverse probability of treatment weighting to assess how intraoperative vasopressor use and fluid volume relate to flap and medical complications.

• Vasopressor use rose from 69.7% to 81.7% after 2012, reflecting a shift in intraoperative hemodynamic management over the study period.
• Vasopressor use was not significantly associated with complications, either medical (OR 1.36, 95% CI 0.76–2.43) or flap-related (OR 2.24, 95% CI 0.66–7.57).
• Higher intraoperative fluid volume was associated with roughly 30% higher odds per liter of both medical (OR 1.33, 95% CI 1.17–1.52) and flap complications (OR 1.30, 95% CI 1.06–1.59).

A propensity-matched retrospective cohort of 27 pairs (from 118 patients) compared superficial circumflex iliac artery perforator (SCIP) flaps with radial forearm flaps for unilateral tongue reconstruction, matched on age, sex, T stage, BMI, and Charlson index, with emphasis on donor-site and complication outcomes.

• Flap survival was comparable, while SCIP achieved favorable donor-site aesthetics in 92.6% versus 40.7% of patients.
• Donor-limb strength was preserved in 100% versus 66.7% of patients, and hospital stay was shorter with SCIP (10.9 vs 11.9 days).
• Recipient-site and flap-related complications were 33.3% versus 3.7%, driven by Grade I–II events (25.9% vs 0%), although no individual complication category differed significantly.
• SCIP flaps had shorter pedicles and needed more tracheotomies and superior thyroid artery use; before matching, salvage failed in all 5 SCIP cases versus 2 of 5 radial forearm cases.

A retrospective cohort of 53 patients undergoing pharyngolaryngoesophagectomy with immediate reconstruction compared anterolateral thigh (ALT) flaps (n = 33) with free jejunal transfer (n = 20), assessing surgical, dietary, and speech outcomes and conduit position on postoperative CT.

• Free jejunum was preferentially used for caudally extended defects requiring deep esophageal anastomosis, whereas ALT was mainly used for cranial defects.
• Surgical outcomes, dietary status, and hospital stay were comparable between groups; anastomotic stricture occurred in 1 ALT (3%) and 2 jejunal patients (10%).
• ALT conduits lay lateral to the trachea on CT in 70% versus 45% of cases, without a corresponding difference in dietary status.
• Speech acquisition was higher with ALT, which also avoids laparotomy in patients whose defects allow a cervical anastomosis.

A diagnostic case-control study of 40 participants (20 patients with lower-limb lymphedema and 20 healthy volunteers) measured skin thickness at 10 lower-limb points with 15 MHz high-frequency ultrasound, compared findings with indocyanine green lymphography, and derived cut-offs by ROC analysis.

• Skin was significantly thicker in lymphedematous limbs than in controls (p < 0.001), and the examination took a mean of 5 minutes per patient.
• The medial ankle was the most informative site, with a 2 mm cut-off giving 95% sensitivity and 100% specificity; point-specific cut-offs overall reached 100% specificity and 70–95% sensitivity.
• A three-tier algorithm was proposed: values below 1.95 mm at all points are not suggestive, any value of 2.3 mm or more is highly suggestive, and 1.95–2.3 mm needs point-specific reading or confirmatory imaging.
• Ultrasound alone detected subclinical contralateral lymphedema in 4 patients (20%), ultrasound plus ICG lymphography in 3 more (15%), and only 6 limbs (7.5%) required confirmatory imaging.

A retrospective analysis of 468,850 patients in the National Inpatient Sample (2016–2022) used ICD-10 procedure codes to identify major upper- and lower-extremity amputations (lower-leg level or more proximal) and any RPNI surgery during the same admission. Multivariable models assessed how anatomic level, demographics, payer, and hospital type related to RPNI use, cost, and length of stay.

• Only 1030 patients (0.22%) received RPNI surgery during the same admission as their major extremity amputation.
• Upper arm and forearm amputations made up 1.8% of cases but were over three times more likely to include concurrent RPNI than lower-leg amputations (OR 3.25, 95% CI 2.53–4.12).
• Black patients were less likely than White patients to receive RPNI (OR 0.80), whereas the highest income quartile (OR 1.58) and private insurance versus Medicare (OR 1.65) were associated with greater use.
• RPNI was performed almost exclusively at urban teaching hospitals (98.0% vs 72.5% of amputation-only cases) and was associated with $16,059 higher total cost, with no adjusted difference in length of stay.

A systematic review and meta-analysis of 17 studies (44 patients) pooled outcomes of microvascular fillet flaps harvested from the amputated arm, forearm, or hand to reconstruct forequarter, interscapulothoracic, or shoulder-disarticulation defects. Complete flap survival, any complication, and reoperation were pooled with random-effects generalized linear mixed models.

• Most reconstructions followed forequarter amputation for malignancy (86.4%), and 75.0% had prior radiotherapy and/or chemotherapy.
• Pooled complete flap survival was 97.0% (95% CI 88.8–99.3), with no total flap losses and a single partial distal necrosis (2.3%).
• Any postoperative complication occurred in 31.2% of patients (95% CI 18.7–47.3), most often necrosis (16.1%), wound dehiscence (6.9%), and thrombosis (6.8%).
• Reoperation was required in 26.0% of patients (95% CI 14.6–42.0), despite the near-absence of flap loss.

A retrospective series of 23 consecutive patients underwent peri-knee reconstruction with retrograde pedicled ALT flaps after ultrasound perforator mapping, followed by a mandatory 40-minute intraoperative assessment of color, temperature, capillary refill, and distal bleeding. Flaps with persistent compromise received venous, arterial, or combined augmentation matched to the suspected mechanism.

• Eight flaps (34.8%) required vascular augmentation: venous in 4, arterial in 2, and combined in 2.
• All flaps survived without total loss over a mean 35-month follow-up; one postoperative vascular crisis was salvaged and one marginal proximal skin necrosis required limited grafting.
• Augmented flaps had significantly larger defect and flap areas (P = 0.034 and P = 0.015), but functional and scar outcomes did not differ from non-augmented flaps.
• Functional and cosmetic results were satisfactory overall, with a mean HSS knee score of 79.6, a mean Vancouver Scar Scale of 3.1, and a mean SCAR score of 5.7.

A comparative cohort of 28 patients with flaccid facial paralysis undergoing reanimation, in whom dynamic change was not expected for at least 4 months, compared 13 who received simultaneous suture stabilization of the nasolabial fold, upper lip, and oral commissure with 15 who received dynamic reanimation alone. Resting landmarks were measured with Emotrics and expressed as symmetry indices.

• Median resting nasolabial fold angle increased from 7.1° to 26.0°, raising its symmetry index from 22.7% to 88.9% (p < 0.001).
• Upper lip slope symmetry improved from 42.7% to 76.0% (p = 0.025), and oral commissure height asymmetry fell from 5.7 to 1.8 mm (p < 0.001).
• Patients who underwent dynamic reanimation alone showed no significant change in nasolabial fold angle, upper lip slope, or commissure height over the same interval.

A retrospective case series of 16 patients (mean age 14.5 years) with post-burn contracture, congenital melanocytic nevus, or hemangioma underwent staged reconstruction with a pre-expanded latissimus dorsi myocutaneous flap, with an adjacent flap expanded simultaneously to close the donor site. A narrative literature review of LDMF donor-site closure strategies informed a preoperative decision algorithm.

• Defects ranged from 25 × 10 cm to 32 × 21 cm, and the pre-expanded LDMFs measured up to 35 × 23 cm.
• The expanded adjacent flap achieved tension-free primary donor-site closure in all 16 patients, with no donor-site complications.
• Complete flap survival in 15 of 16 patients was reported, with one case of distal LDMF necrosis.
• A narrative review of 51 studies (512 LDMFs) found that closure method has depended on skin paddle width and recipient-site characteristics, forming the basis of the proposed planning framework.

A retrospective ACS-NSQIP cohort of 3894 adult cranioplasty patients (2011–2023) compared autograft (88%) with alloplastic (12%) reconstruction, stratified by defect size (≤5 vs >5 cm). Multivariable logistic regression adjusting for 21 covariates, interaction analyses, and machine-learning models assessed predictors of any 30-day complication.

• The overall 30-day complication rate was 22%, and material type was not independently associated with complications (p = 0.715).
• Defect size over 5 cm independently predicted complications (aOR 1.24, p = 0.032), with no significant material-by-size interaction reported.
• For large defects, alloplastic reconstruction shortened operative time by 90 minutes (189 vs 279 min; p < 0.001); alloplastic use rose five-fold over the study period.
• Ventilator dependence (aOR 8.44) and preoperative transfusion (aOR 4.35) were the strongest of nine independent predictors, and logistic regression gave the best predictive performance (AUC 0.737).

A propensity-matched cohort of 16,888 patients from the TriNetX US network compared 8444 collagenase-treated patients with 8444 surgically treated patients (fasciotomy or fasciectomy) for Dupuytren contracture, assessing complications, reintervention, therapy use, and emergency visits over 180 days.

• Postoperative infection occurred in 0.7% versus 1.4% of patients after collagenase versus surgery (OR 0.49, p < 0.001).
• Reintervention occurred in 31.7% versus 16.2% (OR 2.40, p < 0.001), roughly twice as often after collagenase.
• Nerve injury (0.2%) and hematoma (0.3%) rates were identical between groups.
• Occupational therapy use (35.9% vs 36.7%) and emergency department visits (24.6% vs 24.5%) did not differ between treatments.

An anatomical study of 20 fresh adult cadavers used posterior dissection to simulate transfers of radial nerve branches to the triceps onto the infraspinatus and teres minor motor branches, measuring length, diameter, and reach, with myelinated axon counts in 10 specimens.

• The typical radial nerve pattern comprised one long-head branch, two medial-head branches, and one or two lateral-head branches to the triceps.
• The second medial-head branch (bMHT2) was the longest and most axon-rich donor (93.0 ± 8.0 mm; 3646 ± 2333 axons) and had the best reach to the infraspinatus branch.
• The long-head branch and bMHT2 were the thickest branches (1.99 ± 0.49 mm and 2.07 ± 0.58 mm, respectively).
• Transfers of bMHT2 to the infraspinatus branch and bMHT1 to the teres minor branch were feasible in 100% of specimens, with diameter and axon counts supporting both pairings.

A prospective multicenter observational study of 149 patients across 7 sites underwent office-based ultrasound-guided carpal tunnel release under wide-awake local anesthesia without tourniquet (72 unilateral, 77 simultaneous bilateral). Return to activity and work, Boston Carpal Tunnel Questionnaire, Michigan Hand Questionnaire, pain, EQ-5D-5L, satisfaction, and complications were followed to 2 years.

• Median return to normal activities was 2 days and median return to work was 4 days after the office procedure.
• All patient-reported outcomes improved significantly from baseline, with 2-year BCTQ symptom and function scores of 1.25 and 1.19, a Michigan Hand score of 88, and mean pain of 0.5/10.
• Only one complication (0.4% per hand) occurred and no revisions for persistent or recurrent symptoms were performed, with 92.6% follow-up at 2 years.
• Unilateral and simultaneous bilateral procedures yielded comparable outcomes across all measures (all P > 0.1).

A single-unit cohort of 242 consecutive referrals with suspected Dupuytren's disease received postal information packs and were asked to return a functional questionnaire and hand photographs for review in a virtual hand clinic. Reviewers allocated patients to surgery, in-person review, or discharge, and satisfaction was surveyed by post 1 year after referral.

• Of 242 referred patients, 176 (73%) submitted photographs, with non-responders reminded after 1 month.
• Virtual review fast-tracked 68 patients to surgery, booked 68 for in-person review, and discharged 40, reducing non-essential clinic appointments by 46%.
• The satisfaction survey response rate was 44%, with 86% overall satisfaction and a net promoter score of 41.

A systematic review and meta-analysis of 10 RCTs (660 randomized units) compared minimally invasive carpal tunnel release (MI-OCTR) with standard open release. The analysis used random-effects pooling with Hartung-Knapp-Sidik-Jonkman adjustment and trial sequential analysis, and outcomes included BCTQ symptom and function scales, incision length, and return to work.

• Symptom severity on the BCTQ-SSS did not differ between approaches (MD −0.36, 95% CI −1.07 to 0.35), with extreme heterogeneity (I² = 98.2%); functional status was also similar (MD −0.27, 95% CI −0.75 to 0.21).
• Perioperatively, MI-OCTR produced a 2.0 cm shorter incision (P = 0.04) and return to work 9.7 days earlier (P = 0.02) than standard open release.
• Trial sequential analysis showed that only 1.2% of the required information size for BCTQ-SSS had accrued, and certainty of evidence was very low for most outcomes.

A systematic review of 51 studies (959 patients) summarized strength outcomes after nerve and tendon transfers for upper-extremity reconstruction following cervical spinal cord injury. Results were pooled as weighted averages, plus a random-effects estimate for brachialis-to-anterior interosseous nerve (AIN) transfer; mean patient age was 31.8 years.

• Elbow extension reached M3 or better in 68–79% of patients across techniques: 68% after nerve transfers, 79% after biceps-to-triceps, and 70% after deltoid-to-triceps tendon transfer.
• The pooled proportion achieving M3 or better after brachialis-to-AIN transfer was 0.50 (0.31–0.70), with better outcomes in younger patients; the authors describe these outcomes as poor.
• Supinator-to-posterior interosseous nerve transfer achieved M3 or better strength in 78% of patients.
• The authors identify no gold-standard reconstruction for tetraplegia; procedure choice remained patient-specific, and follow-up protocols for strength and patient-reported outcomes varied widely.

A prospective multicenter comparative study conducted over 2 years compared endoscopic (ECTR) and open carpal tunnel release (OCTR) performed by three fellowship-trained hand surgeons with standardized postoperative care and activity instructions. Pain, function, and return to work were assessed at postoperative days (POD) 3, 7, and 14.

• Pain on the Numeric Rating Scale and the PRWHE pain subscale was lower after ECTR at POD 3, 7, and 14, although both cohorts improved progressively.
• SANE and PRWHE function scores were higher after ECTR, indicating earlier return of hand function in the very early postoperative period.
• A larger proportion of ECTR patients had returned to work by POD 3 and POD 7 compared with OCTR patients.

A retrospective multicenter cohort of 327 surgically treated patients with traumatic brachial plexus injury (BPI) from 19 regional hospitals used multivariable logistic regression to identify factors associated with poor motor recovery (MRC), neuropathic pain (VAS), and depressive symptoms (PHQ-9). Mean follow-up was 45.8 months, and 195 patients underwent surgery within 3 months.

• 216 patients (66%) reached M3 or better; independent predictors of poor functional recovery were total BPI, delay >6 months, and neurotization (ORs 4.62, 4.41, and 4.38).
• Neuropathic pain occurred in 189 patients (58%), with surgical delay >6 months (OR 6.76) and total BPI (OR 6.22) as the main risk factors.
• Depressive symptoms were present in 192 patients (59%), most strongly associated with motorcycle accident (OR 6.18) and surgical delay >6 months (OR 3.42); all models showed acceptable discrimination (AUC ≥ 0.76).

A systematic review of 17 studies (302 patients), comprising 16 case series and one cohort study, assessed revision neurolysis combined with autologous (vein, fat, synovium) or nonautologous (amniotic membrane, extracellular matrix, collagen) nerve wraps for recurrent upper-extremity compressive neuropathies.

• VAS pain improved from 6.2 to 2.0, and QuickDASH scores fell from 59.9 to 28.0 after revision with wrapping.
• Grip strength rose from 43.3% to 77.0%, and sensory recovery and nerve conduction findings were consistently favorable.
• Complications occurred in 4.6% and reoperations in 0.7%, with no recurrences reported over a mean 26.6-month follow-up; satisfaction was 98.2%.
• Both autologous and nonautologous wraps appeared safe and effective, and material choice varied by surgical context and availability.

A retrospective single-center cohort of 53 patients undergoing triceps branch of radial nerve to axillary nerve transfer (2015–2025) was stratified by age (18–39, 40–59, and ≥60 years), with M4 or better deltoid strength as the primary outcome. Median follow-up was 16.7 months.

• Overall, 66.0% achieved M4 or better deltoid strength, although 77.4% of patients started from M0.
• M4 or better was reached by 75%, 68.8%, and 52.9% of patients aged 18–39, 40–59, and ≥60 years, a nonsignificant decline with age (P = .304).
• Younger patients more often had high-energy injuries (85% vs 43.8% vs 17.6%, P = .001), and end-to-end coaptation was nonsignificantly more common in the youngest group.
• Patients who received therapeutic stimulation were 2.75 times more likely to reach M4–M5; donor-site morbidity, reoperation, and wound complications did not differ by age.

A retrospective cohort of 626 procedural sedations in 208 pediatric burn patients at a single tertiary PICU (2016–2025) characterized adverse events of intensivist-led sedation, using GEE logistic regression adjusted for demographics, burn severity, and repeated encounters. Median age was 3 years and median TBSA 5%.

• The overall adverse event rate was 13.1%, consisting mainly of transient oxygen desaturation (9.1%) and airway obstruction (8.1%).
• There were zero serious adverse events over 9 years, with no unplanned intubations or deaths.
• Propofol use (OR 5.10) and ketamine use (OR 2.64) independently predicted adverse events after adjustment for case complexity and burn severity.
• Propofol risk was dose-dependent, whereas ketamine risk was independent of dose; multi-drug regimens were used in 79.9% of encounters.

A registry cohort of 24,046 burn patients undergoing autologous skin grafting (American Burn Association Burn Care Quality Platform, 2013–2022) was used to develop a random forest model predicting graft loss, with 70/15/15 training, validation, and testing splits. Discrimination was assessed by AUC-ROC.

• The random forest model discriminated graft loss with an AUC-ROC of 0.794.
• Burns covering ≥40% TBSA (OR 8.16) were the strongest independent predictor of graft loss.
• Other risk factors included alcohol abuse (OR 1.86), age >60 years (OR 1.70), contact burns (OR 1.70), hypertension (OR 1.52), active tobacco use (OR 1.45), and diabetes (OR 1.45).
• Male sex was associated with lower odds of graft loss (OR 0.74), and the model was released as an interactive web-based risk calculator.

A randomized controlled trial of 50 patients with chronic lower limb ulcers compared 12 sessions of vacuum compression therapy plus standard care against standard care alone over 4 weeks. Outcomes included wound dimensions, exudate, pain and quality of life, and dorsal foot tissue oxygenation was measured in the intervention arm only.

• Estimated wound volume (length × width × depth) fell by 61% in the vacuum compression group, whereas controls showed no statistically significant volume reduction.
• The intervention group showed greater improvements in wound width, depth and quality of life than the standard care group.
• Dorsal foot tissue oxygenation rose by 43% in treated patients; because it was not measured in controls, this finding is exploratory.
• Larger baseline wound size was associated with poorer quality of life.

A systematic review and meta-analysis of 19 studies (2,046 patients) compared negative pressure wound therapy with standard wound care in adults with diabetic foot ulcers, pooling randomized, quasi-randomized and prospective controlled studies published 2000–2025. The primary outcome was complete healing, analysed with random-effects models and the Hartung-Knapp adjustment.

• With one large outlier trial excluded, NPWT improved complete healing with an RR of 1.42 (95% CI 1.15–1.74), a prediction interval of 1.08–1.85 and I² of 33%; including that trial gave RR 1.67 (1.24–2.25).
• The healing benefit was robust to leave-one-out analysis (RR range 1.42–1.78) and to exclusion of high-risk-of-bias studies.
• Point estimates for amputation (RR 0.46; 5 studies) and wound infection (RR 0.52; 3 studies) favored NPWT, but both intervals crossed 1 (0.18–1.17 and 0.25–1.06).
• Time-to-healing data were too heterogeneous to pool (I² = 91%) and were summarized narratively.

A retrospective cohort of 666 critically ill burn patients undergoing CRRT was used to develop (2015–2023, n = 560) and temporally validate (2024–2026, n = 106) a model predicting unplanned CRRT interruption. Twelve variables selected by multivariable logistic regression were tested across 47 algorithms, yielding a stacked ensemble of bayesglm, fda, knn and naive Bayes base learners.

• In temporal validation, the ensemble achieved an AUC of 0.963, with accuracy of 0.943 and a Kappa of 0.887.
• Sensitivity was 1.000 with specificity of 0.896, alongside satisfactory calibration and reported clinical net benefit across a wide range of threshold probabilities.
• SHAP analysis identified CRRT circuit parameters (blood flow rate, anticoagulation strategy, filtration fraction) and hematocrit as major contributors to prediction.

This narrative literature review of PubMed and Scopus (inception to October 2024) synthesized evidence on how clinical assessment, color photography, superficial imaging, deep imaging and artificial intelligence perform across Fitzpatrick skin types in burns, scars, pressure injury, superficial infection and flap monitoring.

• Erythema, blanching and capillary refill were less reliable in darker skin across all conditions examined, and only 3 of 15 commonly used scar scales had been validated in pigmented skin.
• Sub-epidermal moisture assessment had the strongest evidence for superficial pathology, with validated performance in dark skin and meta-analytic reductions in stage 2 pressure injury.
• SFDI, hyperspectral imaging, NIRS and photoacoustic imaging were susceptible to melanin-related signal distortion, whereas ICG angiography and near-infrared laser Doppler were relatively robust.
• Flap loss after vascular compromise was 85.7% in Fitzpatrick type VI skin versus 21.4% in type I, and AI tools showed performance that varied by skin tone.

A retrospective single-center cohort of 71 diabetic patients treated with hyperbaric oxygen (2.5 ATA, 100% oxygen) for lower-limb wounds at Guadeloupe's only hyperbaric center (2020–2023) described healing, major amputation and candidate predictors of outcome. Peripheral arterial disease and osteitis were common, and only 7.9% of patients were current smokers.

• HBOT was used as a last resort after failure of prolonged conventional therapy in 63% of patients.
• Six-month healing was 34% (18 of 53 evaluable patients), and major amputation during or after HBOT occurred in 19%.
• Patients referred via the multidisciplinary Diabetic Foot Care Unit had fewer major amputations despite older age and greater vascular burden, although referral-related selection bias may explain this.
• No candidate factor, including glycemic control, referral pathway or delay to HBOT, reached statistical significance in univariable analysis.

A prospective single-center cohort of 168 patients with burns (n = 57), chronic ulcers (n = 70) or hand soft-tissue reconstruction wounds (n = 41) tested whether baseline digital wound features, thermography and wound-fluid inflammatory markers improved prediction of delayed healing beyond clinical variables. Models included wound type and were internally validated with 1000 bootstrap samples.

• Delayed healing occurred in 59 patients (35.1%), whose wounds were deeper, had more slough and necrosis, higher exudate scores, larger wound-reference temperature differences and higher IL-6.
• Optimism-corrected AUCs were 0.632, 0.660 and 0.649 for the clinical, baseline combined and day-7 updated models (apparent 0.691, 0.717 and 0.715).
• Neither the digital and inflammatory features (ΔAUC 0.026; p = 0.400) nor day-7 area reduction (ΔAUC −0.002; p = 0.662) significantly improved discrimination.

A retrospective cohort of 84 adults with severe or extremely severe burns (mean TBSA 50.6%) assessed whether a pre-grafting infection biomarker burden score (0–5) was associated with autologous split-thickness graft take at postoperative days 5–10. One point each was assigned for CRP ≥ 150 mg/L, procalcitonin ≥ 1.5 ng/mL, endotoxin ≥ 0.25 EU/mL, β-D-glucan ≥ 100 pg/mL and a positive pre-grafting wound culture.

• Mean graft take was 87.5% ± 9.5%, and 34 of 84 patients achieved take of 90% or greater.
• Mean take fell from 92.5% in patients scoring 0–1 to 75.7% in those scoring 4–5.
• After adjustment for prespecified clinical covariates, each one-point score increase was associated with a 3.84-percentage-point decrease in graft take.

A single-center retrospective propensity-matched cohort of 361 patients with diabetic foot ulcers compared nanosilver (n = 121) and alginate (n = 240) primary dressings within a multidisciplinary program (2020–2023), with 1:1 matching yielding 115 pairs. The primary endpoint was complete wound healing at week 12.

• Complete 12-week healing occurred in 75.7% vs 56.5% of matched nanosilver and alginate patients (OR 2.47, 95% CI 1.32–4.84; RR 1.34).
• At least 50% wound-area reduction at week 4 occurred in 82.6% vs 67.0% (OR 2.80; Holm-adjusted p = 0.015).
• Median time to complete healing was 45 vs 58 days (HR 1.58, 95% CI 1.22–2.05).
• The primary association persisted in an extended measured-confounding sensitivity analysis (adjusted OR 2.31, 95% CI 1.17–4.56).

A multicenter randomized trial of 312 patients across six centers compared stromal vascular fraction (SVF)-enriched with standard autologous fat grafting for breast hypoplasia, asymmetry, ptosis or pseudoptosis, and post-lumpectomy defects, with 3D MRI volumetric graft retention at 12 months as the primary endpoint.

• At 12 months, MRI graft retention was 71.8% versus 56.4% with SVF-enriched versus standard grafting (p < 0.001).
• The advantage persisted at 24 months (66.2% versus 49.8%, p < 0.001), with mean follow-up of 28.6 months.
• BREAST-Q scores were higher in the SVF group at both the 12- and 24-month assessments.
• Fat necrosis and oil cyst rates were similar between groups, and no suspicious MRI findings attributable to grafting were identified.

A retrospective two-center cohort of 622 patients compared BREAST-Q outcomes after autologous breast reconstruction at Memorial Sloan Kettering (USA, n=393) and Maastricht UMC (Netherlands, n=229) from 2016 to 2022. Multivariable models adjusted for baseline differences across the Satisfaction with Breasts, Psychosocial, Sexual, and Physical Well-Being (Chest and Abdomen) domains within 2 years of surgery.

• After adjustment, Dutch patients scored 8.6 points lower on Physical Well-Being of the Chest than US patients (95% CI -12 to -5.2).
• Psychosocial Well-Being was also 7.4 points lower in the Dutch cohort (95% CI -11 to -3.5).
• Overall complications were higher in the US cohort (43% vs 34%), which also carried a greater comorbidity burden.
• Because the score gaps ran opposite to complication rates, the authors attribute them to cultural rather than clinical factors and propose population-specific reference values.

A retrospective single-center cohort of 217 patients (340 DIEP flaps) examined whether intraoperative vasopressor use was associated with postoperative complications and flap loss after DIEP breast reconstruction (2023–2024). A subgroup analysis covered the roughly half of flaps exposed to radiation therapy.

• Vasopressors were given in 16% of cases and were not associated with complications after adjustment, in either the overall cohort or the irradiated subgroup.
• The overall complication rate was 19%, including fat necrosis in 8%, dehiscence in 6%, partial flap loss in 5%, and complete flap loss in under 1%.
• Postoperative transfusion independently predicted flap loss (OR 4.00, 95% CI 1.06–15.1).
• In irradiated patients, flap loss was associated with anastomotic revision (venous OR 8.25; arterial OR 6.25) and with prior hormone therapy (OR 6.54).

A retrospective cohort of 130 women undergoing volume-replacement oncoplastic breast-conserving surgery at an Indian tertiary cancer center had flaps chosen by anticipated resection ratio (ARR), radiological volume estimates, and a quadrant-based map. Choices were LICAP, MICAP, AICAP, or pedicled latissimus dorsi, and perforators were localized by counting intercostal spaces rather than by Doppler or ICG.

• The LICAP flap was used in 52.3%, followed by MICAP (22.3%), AICAP (16.2%), and pedicled latissimus dorsi (9.2%); 42.3% received neoadjuvant chemotherapy.
• Primary R0 resection was achieved in 95.4%, and all six margin-positive patients were cleared at re-excision.
• There was no total or partial flap loss; 30-day morbidity was 25.4% (maximum Clavien-Dindo IIIa) and late morbidity 16.9%.
• At a median follow-up of 15.9 months there were no recurrences, and median BREAST-Q Satisfaction with Breasts was 86.

A retrospective national database analysis spanning 2007–2023 used ICD-9, ICD-10, and CPT codes to track surgical nipple-areola complex (NAC) reconstruction and NAC tattooing after mastectomy. Logistic and quasi-Poisson regression were stratified by implant-based, autologous, and hybrid breast reconstruction.

• Surgical NAC reconstruction declined by 6.5% per year over the study period (p<0.001).
• NAC tattooing declined by 5.8% per year over the same period (p<0.001).
• Both downward trends persisted across implant-based, autologous, and hybrid reconstruction subgroups.

A randomized controlled trial of 56 patients undergoing reduction mammaplasty compared a bilateral surgeon-administered serratus anterior plane block plus multimodal analgesia against multimodal analgesia alone. The block was placed without ultrasound immediately before wound closure, and the primary endpoint was 24-hour tramadol consumption.

• Cumulative tramadol consumption at 24 hours was 43% lower in the block group, and opioid use stayed lower throughout the first 24 hours.
• Pain scores were lower in the early postoperative period but became comparable between groups later in follow-up.
• Time to first analgesic request was significantly prolonged in the block group.
• No block-related complications were observed.

A propensity-matched retrospective cohort of 444 patients from the TriNetX network compared 222 patients who received octreotide after axillary lymphadenectomy (alone or with radical, modified radical, or partial mastectomy) with 222 untreated controls, drawn from 69,955 eligible patients. Matching covered age, BMI, sex, race, radiation, and smoking.

• Octreotide recipients had a significantly lower risk of lymphedema (p<0.0001).
• Treated patients needed fewer manual therapy interventions, including lymphatic massage and drainage (p<0.05).
• Octreotide was associated with fewer plastic surgery consultations and surgical lymphedema corrections (p<0.05).
• There was no increase in bradycardia or hypothyroidism among octreotide recipients.

A systematic review and meta-analysis of 19 studies (1,304 patients, 1,552 breasts) pooled indications, safety, and aesthetic outcomes of autologous conversion after failed or unsatisfactory implant-based reconstruction. Where data allowed, conversion was compared with primary autologous reconstruction.

• Most conversions were elective, mainly for capsular contracture and dissatisfaction; obligatory conversions were mainly driven by infection and soft-tissue compromise.
• Conversions used free flaps in 91.5% of cases, most commonly abdominal-based flaps (72.8%).
• Pooled rates were 10.8% for major complications and 2.0% for total flap loss (95% CIs 8.1–14.2% and 1.4–2.8%).
• Major complications did not differ significantly from primary autologous reconstruction (RR 1.68, 95% CI 0.70–4.01); aesthetic outcomes improved after conversion in descriptive synthesis.

A cross-sectional analysis of 100 preoperative CTA scans for DIEP flap planning rated image quality on a 5-point Likert scale for perforator caliber, fascial penetration site, intramuscular course, intramuscular branching, and subcutaneous branching. Ordinal regression tested the association of each rating with BMI.

• Intramuscular branching was the least well-visualized feature (mean 3.35 of 5), and subcutaneous branching scored highest (mean 3.99).
• Higher BMI was associated with poorer visualization of the intramuscular course (coefficient -0.648) and of intramuscular branching (coefficient -0.801).
• Significant BMI effects were reported only for the intramuscular features, not for caliber, fascial penetration site, or subcutaneous branching.

A retrospective cohort of 275 patients undergoing ALND for breast cancer (2017–2021) compared 201 who had axillary reverse mapping with isosulfan blue arm injection against 74 treated with ALND alone. Outcomes were seroma, hematoma, and infection, plus long-term functional complications including cording, reduced range of motion, early physical therapy referral, pain, and paresthesia.

• Seroma, hematoma, and infection rates showed no significant difference between ARM and ALND alone (P = 1.000, .467, and 1.000, respectively).
• Cording occurred in 52.7% after ALND alone versus 49.2% after ARM (P = .668), and the other long-term functional outcomes were likewise similar.
• On multivariate analysis, ARM was not associated with a change in any functional complication (relative risk 0.78, CI 0.34–1.67, P = .500).
• Adjuvant radiotherapy carried a relative risk of 5.73 for functional complications (CI 2.52–13, P < .001); isosulfan blue caused hives in one patient and no anaphylaxis.

A triple-blind randomized placebo-controlled trial of 46 patients at a single tertiary center compared oral bromelain (200 mg, 500 GDU, every 8 hours for 2 weeks) with starch placebo after upper blepharoplasty, grading edema and ecchymosis photographically on postoperative days 1, 3, 7, and 11.

• Edema scores were significantly lower with bromelain on days 3, 7, and 11 (all p ≤ 0.001).
• Ecchymosis was reduced only on day 3 (p = 0.0002), with no between-group difference on days 7 and 11.
• Adverse effects were not significantly different between bromelain and placebo, and baseline characteristics were balanced.

A retrospective single-surgeon series of 922 patients (1,844 glands) underwent submandibular gland reduction during deep cervicoplasty between 2018 and 2022, drawn from 1,100 deep neck procedures. The authors describe a seven-step operative algorithm built around a controlled partial resection, termed the Carina technique, and report associated complications.

• The algorithm proceeds through incision placement, wide platysmal elevation, visual axis optimization, optical cavity creation, and gland mobilization before controlled reduction with the Carina technique and capsular reconstruction.
• Temporary bilateral lower lip dysfunction occurred in all patients undergoing anterior neck lift, with asymmetric recovery in 7.1%.
• No sialoceles, uncontrolled intraoperative hemorrhage, or postoperative hematomas were recorded across 1,844 glands.
• Salivary morbidity was limited to transient xerostomia in 2 patients and recurrent sialadenitis in 1.

A matched retrospective cohort of 194 patients (97 primary and 97 secondary facelifts) treated by a single surgeon between 2014 and 2024 compared operative technique, adjunctive procedures, operative time, and major and minor complications. The interval between primary and secondary procedures was analyzed as a proxy for durability.

• Secondary facelifts were 44.3 minutes shorter than primary procedures and were more often performed with SMAS plication (both P < .01).
• Major complications (unplanned admission, reoperation, persistent motor nerve injury) and minor complications did not differ between primary and secondary facelifts.
• The mean interval to secondary facelift was 10.7 ± 4.9 years; younger age at primary facelift correlated with a longer interval (r = -0.44, P < .01).

A systematic review of 48 studies, conducted per Cochrane and PRISMA guidance, pooled complication data after facial feminization surgery across six subgroups covering the face, neck, and combined procedures, graded by the Clavien-Dindo classification.

• Overall complication incidence, including infection, bony nonunion, and deep venous thrombosis, was below 5% in every face and neck subgroup.
• Combined feminization procedures carried a 5.3% complication rate, the highest of the subgroups reported.
• Included cohorts ranged from 4 to 1049 patients, with follow-up spanning 3 weeks to 110 months.

A single-author narrative review of literature from PubMed/Medline, Scopus, Web of Science, and Embase examined the anatomy of the thick nasal soft tissue envelope, intraoperative structural maneuvers, and perioperative medical management, with particular attention to isotretinoin.

• Thick nasal skin is inelastic and predisposes to prolonged postoperative edema, increased dead space, and masking of underlying cartilaginous definition.
• Structural grafting with columellar struts and septal extension grafts showed superior long-term projection compared with aggressive soft-tissue defatting, which carries a risk of vascular compromise.
• Oral or topical isotretinoin was described as a promising adjunct that reduces sebaceous activity and speeds edema resolution; supporting studies are small, heterogeneous, and lack validated measures such as FACE-Q.
• The review favors a multimodal approach that combines rigid cartilaginous support, dead-space management, and patient-specific medical therapy to limit postoperative fibrosis.

A consecutive case series of 214 patients (179 primary, 35 selected revisions) undergoing Asian rhinoplasty from 2022 to 2025 describes the fusion sling-SOON composite flap, an 8–10 mm fasciomuscular flap elevated through a sub-SMAS approach and suspended to a caudal septal soft hinge or septal extension graft, for acute nasolabial angles with deficient premaxillary support.

• Mean nasolabial angle increased from 93.4° to 101.0° (+7.6°) at a mean follow-up of 12.4 months (range 6–24), and the authors report reproducible mild, moderate, and large graded changes.
• Columellar base projection increased by 1.9 mm; three-dimensional Vectra analysis was available for only 63 of the 214 patients.
• No major complications, upper lip stiffness, animation deformities, or flap-related revisions were reported.

A single-author narrative review of literature up to 2024 from PubMed/Medline, Scopus, Web of Science, and Embase synthesized age-related anatomical and functional nasal changes and the structural techniques used for rejuvenation and airway restoration in older patients.

• Aging produces tip ptosis, dorsal pseudohump formation, and nasal valve collapse, driven by reduced skin elasticity, soft-tissue atrophy, and weakening of the cartilaginous suspensory ligaments.
• According to the reviewed literature, standard septoplasty often fails to relieve airway obstruction in older adults.
• Septal extension grafts, columellar struts, and tongue-in-groove positioning were reported to restore tip rotation and projection.
• Spreader grafts and alar strut grafts counteract dynamic internal and external valve collapse and were reported to improve nasal airflow.

A prospective cohort of 44 women undergoing primary breast augmentation completed the validated Polish BREAST-Q preoperatively and at 3, 6, and 12 months, with changes over time and correlations between domains analyzed.

• Psychosocial well-being rose from 50.8 ± 19.8 preoperatively to 91.5 ± 12.6 at 12 months, and satisfaction with breasts increased markedly over the same period.
• Sexual well-being improved from 47.1 ± 22.9 to 87.5 ± 14.9 at 12 months.
• Physical well-being showed a transient decline at 3 months, returning to near-baseline levels by 12 months.
• Complications were infrequent, with one major complication and no cases requiring reoperation.

A narrative review of English-language literature from PubMed/MEDLINE, Embase and Cochrane, supplemented by society advisories and by cadaveric, biomechanical, clinical and forensic reports, examined whether cannula diameter, tip design, rigidity and port configuration influence the risk of fatal pulmonary fat embolism in gluteal fat grafting.

• Survey and autopsy data link fatal embolism to deep intramuscular injection, downward cannula angulation and cannulas smaller than 4 mm.
• Cadaveric studies measure subcutaneous vessels at about 1 mm, whereas the superior and inferior gluteal veins measure about 7.6 mm and 13.7 mm, which supports large-bore blunt cannulas only when they stay subcutaneous.
• Dynamic studies show that subfascial or intramuscular fat can migrate into deep compartments and enter injured veins, whereas subcutaneous fat does not migrate in this way.
• Current consensus favours subcutaneous-only injection with a ≥4 mm blunt, rigid cannula, continuous motion, low-pressure delivery and real-time ultrasound confirmation.

A retrospective case series of 137 patients (female Han Chinese, primary rhinoplasty, 2016–2022, minimum 24-month follow-up) evaluated a custom-carved I-shaped ePTFE implant for dorsal augmentation and limited lengthening, combined with unilateral auricular cartilage grafting for tip support and distal implant shielding. Pre- and postoperative anthropometric measurements were compared with paired t tests.

• Mean nasal tip projection increased by 4 mm, from 19.0 ± 1.6 to 23.0 ± 1.7 mm (P < 0.001).
• Nasal lengthening was limited: mean length rose by 2 mm (43.0 to 45.0 mm), while the nasolabial angle decreased slightly from 100.7° to 98.2° (both P < 0.05).
• Implant deviation requiring revision occurred in 3 patients (2.2%); infection occurred early in 2 patients (1.5%) and late in 1 (0.7%).
• Inadequate dorsal height or tip projection was noted in 6 patients (4.3%), and no implant extrusion was observed over 24–60 months of follow-up (mean 36.2).

This review (German-language) summarizes practice-oriented principles for resecting locally advanced soft tissue sarcomas of the extremities, with a focus on reducing postoperative morbidity.

• Extremity soft tissue sarcomas account for less than 1% of malignancies, and the goal of multimodal treatment is complete R0 resection into healthy tissue.
• Tumour proximity to skin, vessels, nerves and bone calls for interdisciplinary treatment planning to balance complete resection with maximal preservation of function and limb.
• Vascular and plastic reconstructive procedures are integral to planning for locally advanced tumours, and preventing wound healing disorders, seromas and infections is emphasised to avoid delaying rehabilitation.

An observational study of 51 patients undergoing sarcoma resection compared intraoperative ICG signal-to-background ratio (SBR) and surgeons' impressions of margin adequacy against final histopathology, and related all three to local recurrence, to derive sarcoma-specific ICG thresholds.

• Pathology identified 15 positive margins (29.4%), but surgeons correctly flagged only 4 of them, a sensitivity of 26.7%, with a specificity of 88.9%.
• ROC analysis identified an optimal SBR cut point of 1.67 (Youden index 0.35), with modest overall discrimination (AUC 0.67).
• At this threshold, ICG sensitivity was 93.3% and negative predictive value was 93.8%, exceeding surgeon impression on both measures.
• Specificity fell to 41.7%, with a PPV of 40.0% and overall accuracy of 56.9%, so most ICG-positive margins were negative on pathology.

A retrospective single-centre review of 39 patients with epithelioid sarcoma treated at a tertiary orthopaedic sarcoma unit (1989–2025, median follow-up 88 months) assessed overall survival, locoregional recurrence and distant metastasis after primary treatment.

• Five-year overall survival was 68.4% (78.3% at 2 years, 59.9% at 10 years), and median survival was 139 months.
• At presentation, 12 patients (31%) had metastases, mostly to lymph nodes and identified on PET-CT; 33 patients underwent curative-intent excision.
• Ipsilateral limb recurrence occurred in 27% of patients at a median of 56 months after primary treatment, and more than half of them had multiple episodes.
• Distant metastases developed in 21% of patients, all in the chest.

A retrospective case series of 22 patients with venous malformations involving the buccal fat pad (single tertiary centre, 2015–2025) classified lesions by imaging-defined anatomical extension and reported staged treatment outcomes. Twelve previously published cases were reinterpreted alongside the series.

• 15 of 22 lesions (68.2%) extended beyond the buccal component, most commonly into the infratemporal and pterygomandibular regions; 7 were classified as Type I, 10 as Type II and 5 as Type III.
• Image-guided sclerotherapy was the initial treatment in all patients, followed by soft-tissue contouring in 10 and osteoplasty in 3.
• Symptoms resolved completely in 77.3% and improved in the remainder; facial symmetry was restored in 68.2% and improved in 31.8%.
• Reinterpretation of 12 published cases showed similar extension patterns, supporting the reproducibility of the classification.

A systematic review of 19 studies (2,346 patients) evaluated whether pathological response after neoadjuvant therapy for localised soft tissue sarcoma predicts local recurrence, distant metastasis and survival. Risk of bias was assessed with QUIPS and certainty of evidence with GRADE.

• Pathological complete response rates ranged from 0% to 29%, with the highest response frequencies in myxoid liposarcoma and undifferentiated pleomorphic sarcoma.
• Residual viable tumour and EORTC-STBSG response categories showed no reproducible association with oncological outcomes.
• Necrosis was either non-prognostic or paradoxically associated with worse outcomes, possibly reflecting intrinsic tumour aggressiveness; fibrosis and hyalinization showed conflicting associations.
• Sclerohyalinosis above 20% was linked to improved disease-free survival in one prospective trial, pending validation; certainty was low for complete response and sclerohyalinosis, and very low for necrosis and fibrosis.

This review (German-language) describes isolated limb perfusion for locally advanced extremity soft tissue sarcoma and melanoma, covering technique, complications and limb preservation outcomes.

• ILP temporarily isolates the limb from the systemic circulation and delivers hyperthermic perfusion with melphalan and recombinant TNF-alpha, achieving high regional drug concentrations with limited systemic exposure.
• The most common procedure-related complications are regional and systemic perfusion reactions, along with postoperative compartment syndrome.
• Limb preservation rates of up to 93% are reported in soft tissue sarcoma when ILP is performed in high-volume specialised centres.

Data from a nationwide Japanese survey cohort of 709 patients with superficial lymphatic malformations were analyzed with multivariable logistic regression to identify predictors of sclerotherapy success and build the 0–3 point SHALL-WE score. The session-count threshold for each score was set at the number of sessions beyond which success fell below the overall mean of 63.0%.

• Treatment success fell stepwise with score: 71.6%, 64.1%, 43.6%, and 20.0% for scores 0, 1, 2, and 3 (p < 0.001).
• Each of the three predictors scored 1 point: head and neck location, non-cystic histology, and severe disease.
• The derived thresholds were two sessions for score 0 and one session for score 1, with early escalation beyond sclerotherapy indicated for scores 2–3.
• Patients managed within their threshold had higher success than those treated beyond it (71.9% vs 51.2%; adjusted OR 1.92, 95% CI 1.34–2.75).

This proof-of-concept validation study of 105 patients (9,048 data points) from the NSQIP Breast Reconstruction pilot compared a customized ChatGPT 4.1 abstraction workflow with conventional human abstraction. A faculty plastic surgeon's review served as the reference standard.

• Overall accuracy was 99.33% for the LLM versus 98.19% for human abstractors (61 vs 164 errors; McNemar p < 0.001).
• The LLM was more accurate than humans for operative and postoperative variables but slightly less accurate for preoperative variables.
• Nearly half of LLM errors (29 of 61) involved prior breast surgical history. The next most common error was prepectoral versus subpectoral device placement, which often had to be inferred from the documentation.

This retrospective single-institution cohort of 1,585 adults with nonoperatively managed distal radius fractures (2020–2024) was used to develop an explainable machine learning model predicting the week of radiographic stability. The model combined demographics, fracture characteristics, comorbidities, and early radiographic changes.

• 40% of fractures reached radiographic stability by week 3, earlier than conventional protocols assume.
• Baseline radiographic measurements did not differ across stability groups, whereas first-week displacement differed significantly across all parameters.
• The model that included early radiographic change substantially outperformed a baseline-only model, and on decision curve analysis it gave greater net benefit than routine imaging strategies.
• SHAP analysis ranked first-week change in volar tilt as the most influential predictor, followed by change in radial inclination, patient age, and dorsal comminution.

This retrospective single-center study of 107 multidisciplinary team cases submitted standardized hepatopancreatobiliary oncology summaries four times each to GPT-4o, GPT-5.2, Gemini 3 Pro, and Claude Sonnet 4.5 through consumer web interfaces. It assessed response stability across repeats and concordance with the tumor board decision.

• Stability differed across models (P=.01), with discordance from the initial response ranging from 12.8% for Gemini 3 Pro to 30.2% for GPT-4o (Fleiss κ 0.737 vs 0.430).
• Concordance with MDT decisions was 48.6–72.9% using the initial response and 66.3–74.5% using the modal response, and the top-performing model depended on which definition was used.
• Models performed worse for surgical recommendations, with F1-scores of 0.400–0.520 versus 0.621–0.836 for chemotherapy.
• Complete discordance occurred in 15.9% of cases, none of them among the 31 unresectable cases. It was independently associated with recurrent or on-treatment disease, pancreatic location, and low MDT agreement.

This systematic review and meta-analysis of 34 studies pooled the discrimination of machine learning and deep learning sepsis prediction models in hospitalized adults, stratified by prediction window and validation maturity. It separately described sepsis-related burden using Korean national inpatient claims data.

• The pooled AUROC was 0.913 (95% CI 0.887–0.933), with a 95% prediction interval of 0.660–0.983, indicating wide expected variation in new settings.
• Subgroup AUROCs were 0.894 for models predicting within 4 hours and 0.926 for models predicting more than 4 hours before onset, but no prediction horizon was clearly superior because the intervals overlapped.
• Most studies were retrospective development or validation studies, and several reused MIMIC or PhysioNet cohorts, so the 34 reports did not represent independent populations.
• In the Korean claims data, sepsis-related episodes had longer hospital stays and higher unadjusted costs than general inpatient episodes. This analysis did not validate any model.

This preclinical in vitro, murine, and porcine study tested extracellular vesicles from self-feeder-layer 3D-cultured adipose-derived stem cells (tdASC-EVs) against high-glucose-induced senescence in dermal microvascular endothelial cells and in diabetic wound models. In a Bama miniature pig model, the vesicles were compared with conventional ADSC-EVs.

• In high-glucose-exposed dermal microvascular endothelial cells, tdASC-EVs reduced senescence, oxidative stress, and mitochondrial dysfunction and increased tube formation.
• The vesicles activated PI3K/AKT/mTOR/4EBP1 signaling, which promoted eIF4E–eIF4G assembly and cap-dependent translation; pathway inhibitors and a phosphomimetic 4EBP1 plasmid supported this mechanism.
• In diabetic mice, tdASC-EVs accelerated wound closure and increased microvascular density, with lower p16 and higher CD31 and p-4EBP1 expression.
• In diabetic miniature pigs, tdASC-EVs outperformed conventional ADSC-EVs, with faster closure, denser neovascularization, narrower scars, and more orderly collagen deposition.

This review summarizes how mitochondrial dysfunction impairs wound healing and describes the modes, triggers, and regulatory pathways of intercellular mitochondrial transfer. It also discusses mitochondrial transplantation as a potential wound therapy.

• During repair, mitochondria regulate inflammation, angiogenesis, and energy supply for the proliferation, differentiation, and migration of fibroblasts and epithelial cells.
• When dysfunction exceeds the cell's self-regulatory capacity, the resulting energy deficits, metabolic disturbance, and oxidative stress contribute to chronic nonhealing wounds.
• Cells can gain mitochondria through intercellular transfer, in addition to inheritance at cell division and biogenesis, which offers a route to rescue dysfunctional recipient cells.
• The authors present mitochondrial transplantation as a prospective therapy and discuss what clinical translation would require.

This preclinical in vitro and rodent study compared epithelial cells from the upper root, lower root, and bulb of human scalp hair follicles with epidermal keratinocytes. It assessed viability and proliferation in vitro, epithelialization after topical application to full-thickness wounds in immunodeficient mice, and donor-site regrowth in a rat whisker model.

• Bulb epithelial cells showed the highest viability and proliferative capacity, with a lower proportion of differentiated keratinocytes.
• All cell-treated wounds epithelialized better than controls, with bulb-cell-treated wounds improving most.
• Bulb-cell treatment was associated with reduced scar formation and greater retention of human-derived cells in the regenerated epidermis.
• In rats, whiskers regrew after bulb removal, but the regenerated whiskers were thinner and shorter than the originals.

This preclinical materials study with in vivo testing in diabetic mice developed a thermal-feedback modality switchable (TFMS) hydrogel. It combines N-isopropylacrylamide copolymerized with sulfobetaine vinylimidazolium (SBVI), loaded with glucose oxidase (GOx) and EGCG-Fe3+-modified Bi2Te3, and is designed to shift from bactericidal to mild hyperthermia as the wound heals. Infected diabetic wound repair was compared against the commercial bioactive dressing Flamigel.

• Adjusting SBVI content set the hydrogel's volume phase transition temperature, producing thermostatic photothermal antibacterial activity within a biologically safe temperature window.
• As repair progressed, GOx broke down the metal-polyphenol network, which self-limited the photothermal temperature and moved the dressing into a mild hyperthermia mode.
• At mild temperature, Bi2Te3 produced a thermoelectric effect, which the authors propose replaces the endogenous electric field that is lost in diabetic wounds.
• Compared with Flamigel, the TFMS hydrogel significantly accelerated wound closure and improved repair quality in infected diabetic mice.

This narrative review searching five databases through May 2026 evaluated peptide applications in wound healing, reconstructive surgery, scar modulation, aesthetic practice, safety and regulation. Evidence was graded with the OCEBM framework together with a rating of clinical readiness.

• Wound healing had the most mature evidence: antimicrobial and regenerative peptides have reached phase II and early phase III trials, but none is approved for a plastic surgical indication.
• Scar-modulating peptides have entered early clinical evaluation, whereas aesthetic peptides have accumulated only modest human data.
• Reconstructive applications rest predominantly on preclinical evidence, with no clinical data mature enough to guide practice.
• Common limitations were small samples, heterogeneous outcomes, short follow-up and manufacturer-funded aesthetic studies; short half-life, poor tissue penetration and a lack of powered RCTs further limit translation.

This controlled animal study of 27 rats placed silicone blocks under the panniculus carnosus and compared oral pirfenidone (100 mg/kg/day) and nintedanib (50 mg/kg/day), each given for eight weeks, with untreated controls. At nine weeks, capsules were analysed for thickness, inflammatory cells, α-SMA, TGF-β and collagen organization.

• Both drugs significantly reduced capsular thickness, inflammatory cell infiltration, α-SMA and TGF-β expression compared with controls (p<0.001).
• Nintedanib produced thinner capsules and lower α-SMA expression than pirfenidone (p<0.001), consistent with stronger inhibition of myofibroblast activity.
• Inflammatory cell counts and TGF-β expression were comparable between the two drugs.
• Masson's trichrome staining showed dense collagen in controls, whereas treated capsules had thinner, irregular collagen fibres, most markedly with nintedanib.

This in vitro study using tissue from 5 healthy volunteers tested autologous nanofat-PRF membranes (ratios 1:1, 1:2 and 2:1) and a microfat-nanofat-PRF membrane (1:1:1) by Kirby-Bauer disc diffusion. The organisms were P. aeruginosa, K. pneumoniae, S. aureus, E. coli and E. faecalis, with gentamicin and ampicillin as positive controls and injectable PRF and blank discs as negative controls.

• Every membrane composition showed antibacterial activity against all five strains tested.
• P. aeruginosa was the most susceptible organism, whereas S. aureus had the smallest inhibition zones across fat membrane compositions.
• Antibacterial efficacy did not differ significantly between compositions, including the microfat-containing membrane.
• Injectable PRF alone produced no inhibition, which the authors interpret as synergy between adipose-derived and platelet components.

This narrative review of the contemporary bioprinting literature covered printing technologies, bioinks, tissue-specific applications, translational studies and regulatory considerations relevant to reconstructive plastic surgery.

• Substantial progress was reported for skin, cartilage, bone, osteochondral, vascularized and composite craniofacial constructs.
• Extrusion, inkjet, laser and stereolithography platforms combined with more sophisticated bioinks have improved construct fidelity and cell viability.
• In situ bioprinting, patient-specific computer-aided design and hybrid biomaterial strategies have broadened potential clinical applications.
• Key barriers include inadequate vascularization of large constructs, limited mechanical maturation of load-bearing tissue, lack of manufacturing standardization and absent long-term clinical outcomes.

This broad review covered biomaterials, biofabrication and 3D bioprinting, stem and progenitor cell therapies, extracellular vesicles, immunomodulatory scaffolds, organoids, nanotechnology and AI-assisted design. It focused on reconstructive and aesthetic applications including wound repair, craniofacial bone and cartilage, peripheral nerve and vascularization.

• The authors describe a shift from passive tissue replacement toward instructive platforms that regulate cell behaviour, immune responses, vascularization and matrix remodelling.
• Biomodulators and skinboosters are presented as regenerative-aesthetic interventions aimed at dermal hydration, fibroblast activity and collagen remodelling rather than volume replacement.
• Technologies differ widely in translational maturity, from in vitro platforms to commercial products whose durable regenerative efficacy remains incompletely validated.
• The authors call for mechanism-linked potency assays and standardized characterization, together with outcome measures that capture durability, safety and aesthetic performance.

This review summarized recent work on epigenetic mechanisms in cleft lip and palate, a condition affecting about 1 in 500 live births in China. It considered how these mechanisms interact with genetic and environmental factors during craniofacial development.

• Four epigenetic layers were reviewed: DNA methylation, noncoding RNAs, histone modifications and X-chromosome inactivation.
• These modifications are described as interacting with genetic and environmental factors to disrupt craniofacial morphogenesis.
• The authors highlight candidate diagnostic biomarkers and therapeutic targets arising from epigenetic dysregulation.