Plastic Surgery Weekly

Single-surgeon time-trend analysis of 5,113 consecutive free flaps performed at Chang Gung Memorial Hospital between 1981 and 2023, using segmented regression and joinpoint modelling to map shifts in flap selection over time.

• Introduction of the ALT flap was associated with explosive growth of +21 flaps/year (p=0.003, 1996–1999) and rapid substitution of competing soft tissue flaps, with declines in latissimus dorsi, gracilis, and radial forearm use.
• Fibula uptake was modest until repurposing for mandible reconstruction in 1989, after which site-specific use tracked oral cancer incidence (incidence rate ratio 1.05, p<0.001).
• Toe transfers fell sharply (−33.7 cases) after Taiwan's 1991 national Safety Legislation, with a 4-year lag between policy and observed decline.

Retrospective NSQIP cohort of 61,819 axillary lymph node dissections performed between 2013 and 2022, of which 572 (0.93%) included concurrent prophylactic lymphovenous bypass identified by CPT codes.

• Prophylactic LVB use rose 14.6-fold over the decade, with linear growth of 0.24% per year (R²=0.88, p<0.001).
• LVB cases had higher 30-day rates of any complication (9.3% vs 7.0%, p=0.040), DVT (0.7% vs 0.2%), and superficial SSI (4.5% vs 2.7%).
• Multivariate analysis showed a trend toward lower reoperation risk with LVB (OR 0.64, 95% CI 0.40–1.01, p=0.056).

Retrospective single-institution analysis of 454 arterial anastomoses in 438 patients (2021–2025) evaluating the diagnostic accuracy of a routine 20-minute intraoperative patency check for arterial thrombosis.

• Intraoperative arterial thrombosis occurred in 9.0% of anastomoses, exclusively in non-breast reconstructions (10.8% in head and neck; no events in breast cases).
• The 20-minute check had 78% sensitivity and 98% specificity for intraoperative thrombosis, with 78% of events detected within that window.
• ROC analysis identified a 57-minute observation threshold that raised sensitivity to 93% while maintaining 94% specificity.

Cross-sectional study of 21 pediatric patients (mean age 7.0 ± 4.0 years, predominantly post-traumatic) assessed once after free latissimus dorsi transfer at a single tertiary center using DASH, SPADI, and Pedia-ASES instruments.

• Mean DASH score was 11.4 ± 12.4, indicating low upper-limb disability.
• SPADI pain (10.6) and disability (7.6) scores were low, and Pedia-ASES showed largely preserved shoulder function.
• Authors attribute outcomes to adaptive muscle compensation during ongoing musculoskeletal development.

Single-institution retrospective cohort of 178 groin closures (115 prophylactic, 63 complication-related, 2018–2022) comparing pedicled sartorius flap, pedicled rectus femoris flap, and incisional negative-pressure wound therapy alone after vascular operations with open groin exposure.

• For prophylactic closure, rectus femoris flap had lower infection risk than iNPWT alone (OR 0.30, 95% CI 0.09–0.93, p=0.04).
• Sartorius and rectus femoris flaps showed comparable rates of other complications and vascular patency in the prophylactic setting.
• For complication-related closures, rectus femoris flap was associated with higher incisional breakdown and dehiscence than sartorius (OR 4.92, 95% CI 1.26–27.66, p=0.02).

Single-center retrospective cohort of 129 patients with large palatal fistulae (>2 cm) after primary palatoplasty, treated exclusively with local or regional flaps and classified using the Pakistan Comprehensive Fistula Classification. Outcomes assessed included recurrence, speech, and predictors of failure.

• Bardach redo-palatoplasty was the most commonly used technique (53.5%), followed by buccinator myomucosal (22.5%), tongue (12.4%), and buccal sulcus myomucosal flaps (11.6%).
• Overall recurrence was 15.5% (20/129).
• Combined local flap procedures were independently associated with lower recurrence on multivariate analysis (aOR 0.20, p=0.04).
• Mean composite speech score improved from 15.2 to 6.4, with 86.1% of assessed patients achieving normal or mild resonance (G0/G1).

Single-surgeon consecutive cohort comparison of 49 infants with unilateral cleft lip (26 nasal elevator, 23 PLANA), evaluated using a validated 3D anthropometric grading system based on nostril width ratio, columellar angle, and subnasale lateral displacement.

• PLANA produced a more favorable post-PSIO severity distribution (p=0.049) and a higher proportion of Excellent outcomes with fewer Poor outcomes (χ²=7.48, p=0.024).
• Improvement in subnasale lateral displacement was significantly greater with PLANA (p=0.04).
• Improvements in nostril width ratio and columellar angle were comparable between techniques.

Single-surgeon retrospective review of 138 patients undergoing nasal reconstruction with Integra or ACell between 2013 and 2023, analyzing demographics, defect characteristics, revisions, and complications.

• ACell was used in 73.2% of cases; the ala was the most commonly affected subunit (25.4%) and mean defect size was 6.9 cm².
• Overall complication rate was 6.5% (9/138), spanning scar retraction to biologic loss.
• Complication rates did not differ by age >75, smoking, anticoagulation, or defect size and location.

Multi-surgeon retrospective cohort of 123 free-flap reconstructions comparing optical microscope (n=52) with early- (DM-T1, n=37) and late-phase (DM-T2, n=34) digital microscope use, with case assignment driven by operating room availability rather than surgeon preference.

• Mean microscope usage time was longer in DM-T1 (71.9 min) than DM-T2 (57.6) or OM (58.5; p=0.0055 and p=0.0021).
• Mean arterial anastomosis time was longer in DM-T1 (22.5 min) than DM-T2 (19.0) or OM (17.4; p=0.048 and p=0.0028).
• Venous anastomosis time showed a non-significant decreasing trend from DM-T1 to DM-T2.
• Intraoperative arterial thrombosis was similar across groups (18.9%, 14.7%, 15.4%; p≥0.05), with no postoperative thrombosis differences.

Narrative review outlining the technical definition, current applications, and enabling technologies of supermicrosurgery, with a focus on lower extremity reconstruction.

• Supermicrosurgery is defined as anastomosis of vessels smaller than 0.8 mm in diameter.
• Applications include lymphatic surgery, minimally invasive reconstruction, small-part replantation, and perforator-to-perforator anastomoses.
• Enabling tools span ultrafine instruments and microsutures, advanced imaging, and robotic microsurgery platforms and exoscopes.
• The authors frame supermicrosurgery as a distinct discipline rather than an incremental refinement of conventional microsurgery.

Expert opinion survey of 19 self-designated level-IV NTOS hand surgeons responding to six standardized NTOS case scenarios, including Gilliat-Sumner hand, upper plexus involvement with scapular winging, pectoralis minor syndrome, electrically negative TOS, concomitant double crush, and recurrent NTOS.

• Cervical spine or brachial plexus MRI was the most common initial investigation.
• The supraclavicular approach was preferred when brachial plexus exposure was indicated, often with concomitant pectoralis minor tenotomy.
• Without motor symptoms, all experts recommended surgery only after failed conservative treatment.
• For concomitant distal compression, most preferred a combined simultaneous decompression, while a minority favored a distal-first strategy.

Open-label, blinded-endpoint randomized trial of 190 patients with mild-to-moderate CTS comparing a single local methylprednisolone injection at the wrist with a single intramuscular deltoid injection, with primary outcome the Boston Symptom Severity Scale at 3 months.

• At 3 months, mean SSS was 1.51 vs 1.64 for local versus intramuscular (p=0.21).
• Local injection produced a significantly greater reduction in SSS and FSS at 1 month.
• Response rates at 3 months were 70.5% (local) vs 72.6% (intramuscular) with loss-to-follow-up counted as failure (p=0.75).
• Median nerve conduction changes were comparable between arms, with greater 3-month improvement from baseline in the local arm.

Narrative review of current strategies for bridging peripheral nerve gaps, comparing autograft, hollow conduits, and processed human nerve allograft across injury contexts.

• For digital nerve gaps <15 mm, autograft, hollow conduit, and processed allograft produce equivalent sensory recovery.
• Processed allograft outperforms hollow conduits for somewhat larger gaps.
• Direct comparison of allograft versus autograft across varied nerve injuries remains unclear.
• Outcomes of nerve repair and reconstruction remain often disappointing regardless of technique, motivating further work on regeneration biology.

This systematic review of 27 studies and 423 patients with proximal-pole scaphoid AVN compared MRI, CT, intraoperative punctate bleeding, and histology against subsequent bony healing versus failure to heal as the dichotomous outcome.

• Of patients diagnosed with AVN on MRI, 195 of 223 eventually healed, suggesting that MRI substantially overcalls irreversible bone death.
• Absence of intraoperative punctate bleeding still permitted healing in 308 of 356 patients, indicating limited specificity for true necrosis.
• Histologic evaluation had the lowest rate of subsequent healing (6 of 19 patients), but was applied to too few cases to serve as a reference standard.
• Across all four modalities, the literature uniformly labels both reversible and irreversible disease as 'AVN', and no standardized definition of irreversible bone death currently exists.

This PRISMA-compliant systematic review of 29 studies and 92 patients synthesized clinical and functional outcomes of free osteocutaneous flaps used to reconstruct composite bone-and-soft-tissue defects of the hand, most of them trauma-related.

• Most reconstructions used the fibula free flap (37%), followed by humerus-based radial collateral artery perforator and lateral arm flaps (24%) and iliac crest flaps (20%).
• Overall flap survival was 98.9%, with radiographic union at a median of 4 months and no reported donor-site morbidity.
• Flap selection showed anatomy-driven patterns: fibula and iliac crest for metacarpal reconstruction, humerus-based flaps for phalangeal defects requiring thin pliable tissue.
• Multilevel composite defects sometimes required chimeric or sequential constructs, with recipient vessels most often branches of the radial artery.

This single-center retrospective cohort of 6,195 shoulder-trauma patients identified 111 with brachial plexus injury and compared them to a randomly sampled BPI-free control group to define incidence, nerve distribution, and predictors of recovery at one year or more.

• BPI occurred in 1.8% of shoulder traumas, with affected patients younger than controls (51.5 vs 58.8 years) and more often presenting with fracture-dislocation.
• The axillary nerve was involved in 67.1% of injuries, followed by radial (41.5%), median (36.6%), ulnar (32.9%), and musculocutaneous (22.0%) nerves.
• Complete recovery occurred in 74.4% within one year, and 85.4% of patients were managed nonoperatively.
• Musculocutaneous involvement was independently associated with markedly reduced odds of recovery (OR 0.17), whereas dislocation and fracture-dislocation patterns predicted better recovery than isolated fracture.

This single-center retrospective case series of 27 patients evaluated a hybrid construct combining a fully reamed retrograde cannulated intramedullary screw with a double-stranded FiberLoop cerclage tied as a Nice knot for closed long-oblique or spiral metacarpal shaft fractures.

• All 27 patients achieved radiographic union within 3 months, with mean trabecular bridging of 90.1% on CT.
• At a mean 14-month follow-up, grip strength recovered to 96.6% of the contralateral hand, with mean total active motion of 166°.
• Patient-reported outcomes were strong, with median QuickDASH of 5 and median VAS of 0 at rest and during activity.
• There were no cases of implant failure, rotational deformity, or suture-related complications across the series.

This single-institution retrospective case series of 25 patients (38 digits) with pediatric trigger finger reviewed outcomes after A1 pulley release combined with partial A2 pulley release and flexor digitorum superficialis splitting.

• No recurrent triggering was observed at the first postoperative visit, and at a median final follow-up of 6 years no patient reported pain or recurrence.
• The middle finger was the most commonly treated digit (47%), followed by little (26%), ring (18%), and index (8%) fingers.
• Three patients reported transient postoperative stiffness and pain that resolved with continued mobilization.

This single-surgeon retrospective case series of 2 patients (3 thumb reconstructions) describes microvascular toe-to-thumb transfer following high-voltage electrical thumb amputation, accompanied by a narrative review of timing and recipient-vessel considerations.

• All 3 toe-to-thumb transfers survived, with restoration of sensibility and useful motion in both patients.
• Both patients regained sufficient pinch strength for activities of daily living, with minimal donor-site morbidity.
• The authors emphasise that the electrical zone of injury is difficult to delineate clinically, supporting careful recipient-vessel selection and individualized timing of reconstruction.

This narrative review discusses the trade-off between pursuing anatomically perfect reduction and the morbidity of overly invasive fixation in pediatric hand surgery, with emphasis on K-wire technique, growth-plate preservation, and soft-tissue handling.

• Overly aggressive K-wire placement is described as a route to loss of reduction, devascularisation, growth-plate failure, and scar contracture from poor wound healing.
• Children's remodelling capacity permits acceptance of imperfect reduction in many fracture patterns without functional compromise.
• The authors argue that 'good enough' reduction should be the operative goal when the alternative is extensive dissection or repeated fixation attempts.

Prospective, randomized, multicenter trial of 99 burn patients (mean 46% TBSA) comparing lactated Ringer's alone vs lactated Ringer's plus 5% albumin (2/3 LR + 1/3 5% albumin) for initial resuscitation, titrated to urine output.

• By intention to treat, the LR-alone arm required 1.5–2.1 mL/kg/%TBSA more fluid at 24 and 48 hours than the albumin arm (p=0.001).
• Twenty-six (51%) of LR patients crossed over to albumin for safety or excessive volume, whereas no albumin patients crossed to LR.
• There were no differences in mortality, time to healing, or acute kidney injury between arms.

This single-center Taiwanese retrospective cohort of 137 major burn patients compared outcomes before and after 2015 implementation of a standardized protocol (goal-directed fluid resuscitation, early albumin, proactive RRT initiation), using inverse probability of treatment weighting and a nationwide survey of practice across 8 burn centers.

• RRT use fell from 42.9% to 20.3% in the post-protocol era, despite similar TBSA between cohorts.
• Hospital mortality dropped from 47.6% to 8.1%, with a post-protocol IPTW-adjusted HR of 0.24 (95% CI 0.10-0.55).
• Within the RRT subgroup, hospital mortality fell from 85.2% to 40.0%, and 66.7% of post-protocol RRT initiations occurred at KDIGO Stage 0-1.
• The nationwide survey documented substantial variability in resuscitation formulas and RRT initiation criteria across Taiwanese burn centers.

Cross-sectional analysis of 705 adult burn survivors from the multi-institutional Burn Model System National Database evaluated chronic review-of-systems complaints at 12 months and their association with PROMIS-measured physical, psychological, and social outcomes.

• At 12 months, chronic sequelae were strikingly prevalent: neuropathic symptoms in 65%, joint pain in 41%, cold intolerance in 32%, memory difficulty in 27%, and vision problems in 16%.
• Chronic conditions were independently associated with lower physical function (β = -5.37) and social participation (β = -6.18) after adjustment for demographics, injury severity, insurance, and site (both p < 0.001).
• The same composite of chronic conditions also tracked with greater anxiety, depression, fatigue, sleep disturbance, and pain interference (all p < 0.001).

Single-arm expanded access program of 239 patients (215 adults, 24 children) across 23 US burn centers evaluated NexoBrid enzymatic debridement for deep partial- and full-thickness burns up to 30% TBSA, followed by standard care.

• Eschar removal within 4 hours was achieved in 95% of adults and 100% of pediatric patients, with no escharotomies required across the cohort that included 38 circumferential burns.
• Subsequent surgical excision was needed in only 4% of adults and in no pediatric cases, with a median hospital length of stay of 10 days.
• Wound closure occurred at a median of 22 days in adults and 28 days in children, and safety data were consistent with prior Phase III trials.

Systematic review and meta-analysis of 15 studies, with quantitative pooling of 7 studies on preoperative intravenous TXA in burn surgery, examined bleeding, transfusion needs, length of stay, complications, and mortality.

• Preoperative IV TXA significantly reduced total blood loss (SMD -0.65) and blood loss per area excised (SMD -3.66) versus controls.
• Intraoperative packed red cell transfusion units were lower (SMD -0.48) and length of stay was shorter (SMD -0.34) with TXA.
• No signal of increased thromboembolic or other complications emerged in the pooled safety data, although evidence on topical TXA remains preliminary.

Retrospective single-center cohort of 274 adults undergoing excision and grafting for second- and third-degree burns compared hypochlorous acid (11.3%) versus mafenide acetate (88.7%) as initial antiseptic wet dressings.

• Infection requiring antibiotics developed in 41.9% of hypochlorous acid versus 37.0% of mafenide acetate patients (p = 0.58), with similar time to infection of roughly 6.5 to 6.9 days.
• Mortality did not differ significantly between the two antiseptic groups.
• Length of stay, number of operations, and complication rates were also statistically similar across the two regimens.

Bayesian network meta-analysis of 51 randomized trials enrolling 6,161 patients compared 23 topical interventions for diabetic foot ulcers, with wound healing rate as the primary outcome.

• Placenta-derived products showed the greatest healing efficacy (OR 7.85, 95% CrI 4.62-14.15) and were uniquely associated with fewer adverse events than standard of care (OR 0.25).
• Twelve interventions significantly improved healing versus standard of care, including platelet-related products, ON101, epidermal growth factor, and tissue-engineered skin substitutes.
• No intervention differed significantly from standard of care in time to wound healing, serious adverse events, or infections.

Meta-analysis of 58 studies comprising 37,732 older adult burn patients stratified outcomes between cohorts aged 60-79 and 80 or older, with mortality and ICU admission as principal endpoints.

• Patients aged 60-79 had markedly lower mortality (RR 0.65) and ICU admission (RR 0.75) than those aged 80 and above.
• Mortality scaled with burn size (TBSA 1-9% vs 10-19% RR 0.31; 10-19% vs ≥20% RR 0.17), and flame burns carried nearly 4-fold higher mortality than scalds (RR 3.98).
• Inhalation injury (RR 2.95) and intubation (RR 5.66) further elevated mortality, whereas grafting was associated with reduced mortality (RR 0.67) versus conservative management.

Retrospective single-service review of 308 pediatric patients referred to the NSW Statewide Burns Injury Service from 2010-2024 with scald burns sustained from steam inhalation or vapourisers used for upper respiratory tract infections.

• 23.1% of children required surgical grafting, 16.9% needed hospital admission, and 18.8% developed hypertrophic scarring.
• Most injuries occurred in children aged 0-5 years, with the upper limbs and hands most frequently involved and a male predominance of 59.4%.
• Referrals peaked during autumn, winter, and the 2022 COVID-19 wave in NSW, paralleling the seasonality and surges of URTI symptoms.

Narrative review primer for plastic surgeons synthesizes biomechanical principles of the neuropathic foot, mapping common deformities and wound locations to specific bony and tendon procedures within a multidisciplinary limb-salvage framework.

• Plantar hindfoot wounds linked to ankle dorsiflexion instability are matched with tibiotalocalcaneal fusion, while forefoot wounds from plantarflexion contracture are addressed by Achilles tendon lengthening.
• Varus or valgus midfoot deformities may require tendon transfers or joint fusion, and Charcot neuroarthropathy often necessitates osteotomy or arthrodesis.
• Transmetatarsal amputation is framed as a reconstructive option that preserves ambulation when forefoot deformity and digital wounds are not amenable to local procedures.

Target-trial emulation cohort of 940 patients (1,398 breasts) undergoing implant-based breast reconstruction at three Danish hospitals between 2018 and 2024, comparing prepectoral vs subpectoral placement with doubly robust adjustment.

• Two-year implant loss was 8.4% in the prepectoral arm vs 7.1% in the subpectoral arm (risk difference 1.3%, p=0.67).
• Implant-associated infection (2.8%) and hematoma (0.5%) did not differ significantly between planes.
• Mastectomy skin flap necrosis was higher with subpectoral placement (absolute risk difference 3.4%, p=0.006).

Retrospective cohort of 5,202 consecutive breast procedures at a single private hospital (2019–2025), with inverse probability of treatment weighting used to compare hematoma rates by procedure type with vs without intraoperative TXA.

• In reduction mammaplasty, TXA reduced hematoma from 7.2% to 2.2% (adjusted OR 0.28, 95% CI 0.14–0.58, p<0.001; NNT 20).
• Explantation with mastopexy showed similar benefit (1.6% vs 6.0%, OR 0.42, 95% CI 0.20–0.88).
• Primary augmentation showed no detectable difference (1.2% vs 1.2%, OR 0.94, p=0.905), regardless of implant plane.
• No thromboembolic events occurred in either group.

Single-institution retrospective propensity-matched study of 99 patients with prior breast-conserving therapy (BCT) and their radiation-naïve controls between 2017 and 2025, comparing reconstructive outcomes in autologous and implant-based pathways and in a head-to-head BCT comparison.

• In the autologous cohort, prior BCT was associated with a higher rate of any complication (36.0% vs 20.0%, p=0.02) versus radiation-naïve controls, driven numerically by infection and mastectomy skin flap necrosis.
• In the implant-based cohort, prior BCT carried significantly higher major, minor, and any complication rates (all p≤0.001) compared with radiation-naïve controls.
• Among BCT patients matched head-to-head, autologous reconstruction had reconstruction failure of 2.2% vs 24.4% for implant-based (p<0.001), while other complications were comparable.

Prospective Mastectomy Reconstruction Outcomes Consortium cohort of 987 patients undergoing two-stage subpectoral implant-based breast reconstruction with SurgiMend (n=119) or without ADM (n=868), evaluated with an FDA-aligned analysis plan using BREAST-Q and two-year complication data.

• Composite clinical success at 1 year was significantly higher with SurgiMend (32.4% vs 21.1%; difference 11.2%, 95% CI 1.7 to 20.8; P=0.02).
• Propensity-adjusted major complications were lower with SurgiMend (33.7% vs 46.7%; difference -13.1%, 95% CI -22.5 to -3.7) within 2 years.
• BREAST-Q Physical Well-Being (Chest) at 1 year numerically favored SurgiMend (44.5% vs 39.1%; difference 5.4%, 95% CI -5.2 to 16.0), with a confidence interval that crossed zero.

Retrospective nationwide analysis of German inpatient records from 2006 to 2023 identifying all coded breast implantations, exchanges, and explantations, with segmented negative binomial and fractional logit modelling of pocket-plane migration, capsulectomy-associated revisions, and regional concentration.

• Primary inpatient implantations rose 181% between 2012 and 2023 (IRR 2.36, p<0.001).
• Prepectoral placement accounted for 76.6% of primary implantations by 2023, displacing the previously dominant subpectoral plane.
• Capsulectomy-associated revisions rose from 58% in 2006 to 67% in 2023 (p<0.001), with complex revisions increasingly consolidated in metropolitan centers.

Prospective single-cohort evaluation of 58 patients (83 breasts) undergoing staged tissue-expander breast reconstruction with intraoperative SPY-PHI Quantitative Perfusion imaging, testing predictive thresholds for mastectomy skin flap necrosis and accounting for nitroglycerin ointment as a potential confounder.

• A 33% perfusion threshold yielded sensitivity 87.5% and NPV 98.3% for mastectomy skin flap necrosis in the full cohort.
• After adjustment for nitroglycerin use, the association between low perfusion and necrosis was attenuated, suggesting topical vasodilator masks low-perfusion signal.
• In patients who did not receive nitroglycerin, a 30% threshold achieved sensitivity 100%, specificity 76.7%, and AUC 0.89.

Retrospective single-institution review of 404 DIEP flaps (105 buried, 299 non-buried) from 2017 to 2021 by three senior surgeons, with propensity-score matching to compare complications and total flap loss between buried and skin-paddle reconstructions.

• Total flap loss did not differ between buried and non-buried flaps (1.0% vs 2.7%; p=0.457) in the overall cohort.
• Before matching, the non-buried group had a higher 30-day readmission rate (9.0% vs 1.0%, p=0.003); in nipple-sparing cases, non-buried flaps had more flap loss while buried flaps had more dehiscence.
• After 1:1 propensity-score matching (n=94 per arm), complication rates including flap loss, takeback, infection, and readmission were similar between buried and non-buried flaps.

Prospective 14-center study of 190 patients (NCT05258305) undergoing autologous fat transfer to the breast for cosmetic (n=85) or reconstructive (n=105) indications with Viality processing and AuraClens surfactant wash, with serial 3D volumetric imaging through 12 months.

• Mean 12-month volume retention was 84.8% (95% CI 83.2 to 86.5), exceeding a 70% historical benchmark at every timepoint (P<0.0001).
• Retention was stable from month 1 to month 12 with no significant decline over time, consistent with an early graft steady state.
• Retention was influenced by fat transfer volume, interval weight change, and graft-to-recipient breast volume ratio, with similar trends in cosmetic and reconstructive cohorts.

Retrospective propensity-matched cohort of 1,518 patients (759 per arm) from the TriNetX research network comparing immediate implant-based breast reconstruction with versus without nerve-allograft neurotization, with complication ascertainment at 6 months, 1 year, and 3 years.

• No significant differences in major complications were observed between the neurotization and control cohorts at any of the 6-month, 1-year, or 3-year timepoints.
• Component endpoints (surgical site complications, infection, wound disruption, explantation, capsular contracture, ED visits, and readmission) were similar across follow-up.
• After 1:1 matching, baseline demographics, BMI, comorbidities, chemotherapy, and radiation exposure were balanced between cohorts.

Retrospective propensity-matched cohort of 56,992 patients (28,496 per arm) from the TriNetX global network comparing postoperative complications in patients undergoing breast reconstruction with versus without nicotine dependence documented in the 6 months before surgery.

• Nicotine-dependent patients had significantly higher infection (RR 1.34), dehiscence (RR 1.46), and implant-related mechanical complications (RR 1.33), all P<0.0001.
• Capsular contracture risk was elevated in the nicotine-dependent cohort (RR 1.17, 95% CI 1.13 to 1.20), alongside higher seroma, hematoma, fat necrosis, and revision rates.
• Postmastectomy lymphedema and flap loss did not differ significantly between cohorts.

This randomized single-blind placebo-controlled Phase 2b trial of 108 adults with Grade 3-4 abdominal subcutaneous fat compared up to four CBL-514 injection sessions (2 mg/cm², ≤600 mg per treatment, 3-week intervals) against placebo, using clinician- and patient-reported scales plus MRI as outcomes.

• On the Clinician-Reported Abdominal Fat Rating Scale at 12 weeks, 76.7% of CBL-514 participants achieved ≥1-grade improvement versus 18.9% with placebo (P<0.0001), with patient-reported scores nearly identical.
• MRI showed a least-squares mean abdominal fat volume reduction of -152.9 mL (-20.3% from baseline) in the CBL-514 arm, significantly greater than placebo (P<0.0001).
• Most responders improved after 1-2 treatment cycles, and adverse events were predominantly mild, transient injection-site reactions.

This PRISMA-compliant systematic review of 24 studies (3,142 adults, 1,456 single-stage repairs) including two randomized trials and two propensity-matched registry analyses pooled surgical-site occurrence, recurrence, reoperation and patient-reported outcomes for combined versus staged abdominoplasty plus ventral/incisional hernia repair.

• Median surgical-site occurrence after combined repair was 20% (range 0-51%), an absolute 7-8% increase over abdominoplasty alone, with most events being minor seromas or superficial infections.
• Thirty-day readmission was ≤3% and unplanned reoperation ~6%, with hernia recurrence of 1.4% at a median 23-month follow-up and no excess failure in either randomized trial.
• Validated instruments showed large gains in physical function (SF-36 +25), body-image distress (DAS-24 -16 to -33), and overall satisfaction above 90%.

This single-surgeon retrospective matched cohort of 541 consecutive facelift patients (34 men, 507 women) from 2014-2024 compared operative characteristics and postoperative complications between sexes, with propensity matching on age, BMI, primary/secondary status, TXA use, and comorbidities yielding 68 paired patients.

• In the full cohort, minor hematoma occurred in 0% of men versus 2.0% of women (P=1), with no operative evacuations in either group.
• Men had longer operative times (456 vs 407 minutes, P<0.001) and substantially higher blood loss (EBL ≥100 cc in 34.8% vs 2.9%, P<0.001), findings preserved after propensity matching.
• In the matched cohort, hematoma rates remained equivalent (0% vs 2.9%, P=1) and overall complication profiles were similar between sexes.

This comparative photogrammetric study of silicone augmentation rhinoplasty in Asian patients with mild dorsal deviation or hump evaluated 3D-printed customized implants against conventional prefabricated implants, with dorsal deviation, hump angle, and dorsal irregularity measured on standardized photographs.

• Customized implants achieved greater improvement in dorsal deviation and hump angle than prefabricated implants on photographic analysis.
• The customized group also showed better dorsal contour stability and less irregularity, consistent with more accurate anatomical conformity to the underlying skeleton.

This sequential two-cohort comparative study of 784 African American rhinoplasty patients (392 with AI 'Deep Surface' morphing, 392 without) evaluated patient-reported aesthetic outcomes, psychosocial indicators, complications, and one-year revision rates using validated surveys and Student's t-tests.

• Revision surgery was needed in 8% of the AI morphing cohort versus 19% of the no-morphing cohort, despite similar demographics, operative techniques, and overall complication rates (2% vs 3%).
• Aesthetic outcome scores were higher with AI morphing (3.2 ± 0.4 vs 2.0 ± 0.3), with larger reductions in anxiety (-8.4 vs -5.2) and depression (-7.8 vs -1.3) and greater gains in Meaning and Purpose.
• Both cohorts used a similar mix of operative techniques including spreader, septal extension, dorsal onlay and tip grafts, alar base resection, lateral wall osteotomy, and cadaveric structural cartilage.

This cadaveric biomechanical study using 21 fresh Korean cadavers and 3,664 cannula insertions quantified tissue penetration force with 21G-27G blunt cannulas at the temporal crest and zygomatic arch, advancing vertically and horizontally across the subdermal (L2) and inter-fascial (L4) planes with continuous digital force recording.

• Penetration force increased monotonically with cannula diameter, with 21G producing the greatest resistance and 27G the lowest (FDR-adjusted P<0.05).
• Force rose with depth (skin ≤ superficial temporal fascia < deep temporal fascia) and was higher with horizontal than vertical advancement (mixed-effects P=0.0068).
• Increasing donor age was associated with lower tissue penetration force, while no sex or laterality differences were detected.

This PRISMA-guided systematic review of 40 human studies synthesized clinical trials, observational studies, and case reports on dermatologic effects of GLP-1 receptor agonists (chiefly semaglutide and liraglutide), focusing on facial morphology, dermal structure, and skin elasticity.

• GLP-1 RA-associated weight loss was repeatedly linked to 'Ozempic face', dermal thinning, and decreased skin elasticity, attributed to loss of subcutaneous adipose volume and reductions in collagen and elastin.
• Localized fat loss across multiple compartments produced redundant skin folds and accelerated visible aging, with greater severity reported in older patients and those with long-standing obesity.
• Identified risk factors for more pronounced changes included rapid weight loss, poor hydration, and insufficient protein intake, with recommended mitigation focused on gradual loss and nutritional optimization.

This PRISMA-compliant narrative systematic review of 13 studies comprising 855 patients synthesized aesthetic, functional, and complication outcomes for dorsal preservation rhinoplasty techniques (push-down, let-down, subdorsal strip, and hybrid mix-down/LUHRS approaches), with a mean Newcastle-Ottawa score of 5.8.

• Rhinoplasty Outcome Evaluation scores exceeded 85 in up to 90.3% of patients, and functional measures showed increased nasal patency with reduced NOSE scores across the included techniques.
• Hybrid approaches such as mix-down and LUHRS were particularly useful in complex noses, with RHINO scores rising from 37.6 to 88.2.
• Reported revision rates across techniques ranged from 0 to 7.9%, typically for minor contour irregularities rather than major structural failure.

Single-center, assessor-blinded pilot randomized controlled trial of 60 patients with severe atrophic acne scars allocated to subcision plus SVF, subcision plus SVF+PRP, subcision plus PRP, or subcision alone, with 12-month clinical grading and flow cytometric characterization of the SVF preparations.

• Grade 3 (marked) physician satisfaction was achieved in 53.3% of the SVF+PRP arm versus 0% of the subcision-only control (p ≤ 0.001), with concordant gains in scar size and color.
• Flow cytometry showed significantly higher CD73+ and CD105+ mesenchymal stem cell marker expression in the SVF+PRP preparation than in SVF alone (p ≤ 0.001), supporting a biostimulatory mechanism.
• Patient-reported FACE-Q scores trended in favor of SVF+PRP but did not reach statistical significance across QoL sub-domains (p > 0.05).

Single-center retrospective cohort of 40 surveyed patients (20 lipofilling, 20 implant with glandular remodeling) treated for tuberous breast deformity between 2013 and 2024, compared on postoperative BREAST-Q domains, complications, procedure count, and hospital stay.

• Lipofilling scored higher on Physical Well-being (p < 0.01) and Satisfaction with Outcome (p = 0.01), while Satisfaction with Breasts, Psychosocial, and Sexual Well-being were statistically similar.
• Hospital stay was shorter after lipofilling (1.7 vs 2.1 days, p < 0.01) with significantly fewer complications (p = 0.014).
• Mean number of procedures did not differ between groups (1.53 lipofilling vs 1.41 implants, p = 0.28).

Retrospective single-center study of 530 sarcoma resections at Ghent University Hospital (2010 to 2022), comparing oncologic-only closure with combined oncologic-plastic closure using three multivariable logistic regression models for predictors and outcomes.

• Combined oncologic-plastic closure was used in 22.8% of resections, with the remainder closed by the oncologic surgeon alone.
• Independent predictors of plastic involvement were trunk location, myxofibrosarcoma histology, high-grade tumors, and superficial-to-fascia location, while upper-leg tumors were closed by the oncologic surgeon alone.
• Combined closure reduced seroma formation while R0 resection rates did not differ significantly between groups.

Narrative clinical review summarizing reconstructive strategies for the irradiated, oncologically resected lower extremity, covering local flap and free tissue transfer options, the impact of chemoradiation, and decision-support scoring.

• Free flap reconstruction in the lower extremity carries higher complication and failure rates than other anatomic regions due to compromised vascularity and high functional demands.
• Early microsurgical intervention improves outcomes, while negative pressure wound therapy can serve as a temporizing bridge to delayed coverage.
• Radiation and chemotherapy degrade tissue quality and recipient vessels, requiring meticulous planning and vessel selection outside the zone of injury.
• Risk-stratification tools such as the A-Sarc score support evidence-based reconstructive decision-making in this population.

Single-institution retrospective cohort of 27 patients with histologically confirmed parosteal osteosarcoma of the distal femur treated between 2000 and 2022, evaluating postoperative margin width against local recurrence and metastasis-free survival with at least 2 years of follow-up.

• Local recurrence occurred in 8 of 27 patients overall.
• Compared with margins ≥1 mm, the risk of local recurrence was higher for involved margins (RR 14.0, 95% CI 0.88-222) and <1 mm margins (RR 7.33, 95% CI 0.45-119).
• Metastasis risk followed the same direction, with involved and <1 mm margins associated with higher metastasis rates than ≥1 mm margins.
• Tumor grade did not correlate with local recurrence in this cohort.

Methodologic study introducing SurgWound, a dataset of 686 surgical wound images annotated by three surgeons across eight clinical attributes, together with a benchmark for visual question answering and report generation and a three-stage multimodal model (WoundQwen).

• The dataset comprises 686 images covering diverse wound types, each annotated by three professional surgeons across eight fine-grained clinical attributes.
• The accompanying benchmark provides visual question answering and report generation tasks to systematically evaluate multimodal large language models on surgical wounds.
• The proposed three-stage WoundQwen framework first predicts wound characteristics, then uses them to estimate infection risk and urgency, and finally generates a structured diagnostic report.

Multi-site mixed-methods implementation study of 23 end-users (surgeons, residents, fellows, and OR nurses) at a Canadian teaching hospital, comparing cloud- and edge-based AI deployments in the operating room across usability, cost, and carbon footprint over 396 hours of use.

• Cloud deployment showed greater task completion than edge but at the cost of increased physical strain, higher carbon emissions, and higher operational costs after 396 hours of use.
• Usability ratings were similar between the two infrastructures despite the workflow differences.
• Participants converged on suggested improvements to the cloud setup and to the interface design of both systems.

PRISMA-ScR scoping review of 40 studies published from 2020 onward, mapping artificial intelligence applications across preoperative, intraoperative, and postoperative phases of breast reconstruction.

• Preoperative applications dominated (28 of 40 studies), including LLM-generated counseling content, AI-based 3D and MRI segmentation, and predictive models for complications, donor-site morbidity, radiotherapy need, and dissatisfaction.
• Intraoperative AI focused on real-time perfusion assessment via thermal imaging and as cognitive support during reconstruction.
• Postoperative tools included LLM-clarified discharge instructions and neural networks enabling rapid breast symmetry evaluation.
• The authors conclude that current evidence is strongest preoperatively and that multicenter prospective validation is needed before broad clinical adoption.

Phase 1b open-label randomized trial of 7 patients with split-thickness skin graft donor sites, comparing low- or high-dose purified exosome product (PEP) against standard of care on paired donor sites within the same patient.

• No treatment-related adverse events occurred across low- and high-dose PEP groups, supporting the safety of a single topical application at concentrations up to 20%.
• Median time to 100% re-epithelialization was 18.5 days for PEP sites versus 19.25 days for standard-of-care sites, with no significant difference.
• Vancouver scar scale and photographic wound assessment tool scores were comparable between treatments, without statistical separation between PEP and standard-of-care donor sites.

Integrated transcriptomic analysis of five datasets combined with in vitro keloid fibroblast experiments characterised branched-chain amino acid (BCAA) catabolic gene expression, circulating and tissue BCAA levels, and the effects of leucine and the metabolic enhancer BT2.

• 72.5% of BCAA catabolic genes were systemically downregulated in keloids, defining a distinct catabolic-defective molecular subtype with enhanced epithelial-mesenchymal transition and angiogenic signatures.
• Keloid patients showed significantly higher circulating and tissue BCAA concentrations than controls, consistent with the transcriptomic findings.
• In vitro, leucine drove fibroblast proliferation and extracellular matrix deposition, and this phenotype was rescued by pharmacological enhancement of BCAA catabolism with BT2.

Preclinical bench and in vivo mouse study evaluating a cell-laden hydrogel gyroid scaffold for vascularised soft tissue construct engineering, including co-culture of HepG2 cells and HUVECs and subcutaneous implantation in mice.

• The gyroid's curved Gaussian curvature promoted endothelial self-assembly into dense microvascular networks throughout 3D constructs without active perfusion.
• High-density HepG2-HUVEC co-culture within the scaffold produced a vascularised 3D liver tumour model with enhanced tissue-specific function.
• Subcutaneous implantation in mice yielded enhanced neovascularisation of the constructs and supported subsequent tumour growth within the construct.

Experimental study of 40 Wistar Albino rats undergoing 8 hours of inferior epigastric island flap ischemia, comparing melatonin, vitamin C, and vitamin E given 7 days preoperatively, 30 minutes before ischemia, or 30 minutes before reperfusion.

• Mean flap necrosis was 6.3% with 7-day pretreatment versus 33.5% in the saline ischemia-reperfusion group (p < 0.001), with intermediate values for shorter pretreatment intervals.
• Histopathology showed improved inflammatory and vascular parameters across antioxidant groups, while collagen organisation improved only with 7-day pretreatment (p = 0.0014).
• Immunohistochemistry demonstrated reduced eNOS, caspase-3, and IL-1β across antioxidant groups, with higher VEGF expression restricted to the 7-day pretreatment arm.

In vitro endothelial-cell work paired with a nude mouse fat grafting model evaluated silicate ion solution derived from calcium silicate for its effects on HUVEC function and on fat graft survival, vascularity, and apoptosis.

• Silicate ion solution at biocompatible concentrations promoted HUVEC migration, tube formation, and VEGF expression in vitro.
• Fat graft retention reached 58.18% ± 4.24% with silicate versus 41.30% ± 6.09% in controls, alongside reduced fibrosis and decreased apoptosis on histology.
• Silicate-treated grafts showed increased CD31 vascular density and higher HIF-1α and VEGF expression, consistent with a VEGF-pathway-mediated angiogenic mechanism.

Narrative review of natural deep eutectic solvent (NADES)-based composite dressings, examining structure-property-function relationships, comparative performance against conventional dressings, and barriers to clinical translation.

• NADES act as both structural modulators and functional platforms within polymer composites, shaping microstructure, exudate management, antimicrobial activity, and antioxidant capacity.
• Comparative analysis highlights a recurring trade-off between antimicrobial efficacy and cytocompatibility, particularly relevant for chronic wound and burn dressings.
• Current evidence is largely restricted to in vitro and small-animal studies, with little burn-specific validation and limited data on long-term stability, sterilisation compatibility, or regulatory pathway.

Single-cell RNA sequencing study of keloid tissues characterised fibroblast heterogeneity, subpopulation trajectories, and ligand-receptor interactions with other resident cell types using CellChat-based analyses.

• Four fibroblast subpopulations were resolved (mesenchymal, secretory-reticular, secretory-papillary, and pro-inflammatory), with mesenchymal fibroblasts predominantly expanded in keloids.
• A senescent subset marked by TNFRSF9 expression was identified within mesenchymal fibroblasts and mapped by pseudotime to a mature differentiation endpoint.
• Cell-cell interaction analysis showed TNFRSF9+ senescent fibroblasts interact strongly with neural cells, implicating neuro-fibroblast crosstalk in keloid pathogenesis.

Human single-cell atlas of idiopathic pulmonary fibrosis lung stromal cells, combined with a single-cell foundation model, identified myofibroblast transcriptional states, their regulators, and conserved gene programs across chronic disease.

• Two distinct myofibroblast states were resolved, one wound-healing and proliferative and one profibrotic, with different predicted functions and surface marker expression.
• Fibroblast-intrinsic TGFβ signalling was the key regulator switching the wound-healing state to the profibrotic state, with conserved TGFβ-dependent and TGFβ-suppressed gene programs.
• LRRC15 was highly restricted to the ECM-remodelling profibrotic myofibroblast and could differentiate without an obligate inflammatory precursor; machine-learning analysis suggested broad applicability across human chronic disease.

This preclinical controlled study in Lewis rats compared PEG-fusion versus negative-control repair of viable peripheral nerve isografts across 4-mm and 8-mm sciatic gaps, with an added arm testing local FK506 in 10-mm isograft repairs. Outcomes included axonal morphology, Wallerian degeneration, and Sciatic Functional Index (SFI).

• PEG-fused isografts showed significantly larger axon diameters and lower g-ratios than negative controls at both 4-mm and 8-mm gap lengths.
• PEG-fusion repairs demonstrated less Wallerian degeneration of the distal nerve segment compared with controls.
• Behavioral recovery measured by SFI was better in PEG-fusion groups regardless of gap length.
• Local FK506 produced only transient improvements in axonal regeneration and ultimately impaired long-term SFI recovery.

This small-RNA sequencing and in vitro study using 5 paired burn and normal dermal samples profiled differentially expressed tRFs and validated the top candidate, tRF-Ser-GCT-108, in heat-injured HUVECs through proliferation, migration, apoptosis, and mechanistic binding assays.

• Sequencing identified 172 differentially expressed tRFs in burn-injured tissue, with tRF-Ser-GCT-108 the most upregulated fragment.
• Overexpression in heat-injured HUVECs reduced proliferation and migration and increased apoptosis, while inhibition normalized these parameters.
• Mechanistic work showed direct binding to the 3'-UTR of MAPK1 mRNA, lowering MAPK1 protein and disrupting downstream VEGF signaling.