Plastic Surgery Weekly

A retrospective cohort of 40 patients undergoing extra-oral head and neck free flap reconstruction after oncologic resection compared general anesthesia (n = 20) with the Awake Integrated Microsurgical (AIM) approach using peripheral or neuraxial blocks plus sedation (n = 20).

• AIM patients were significantly older and more comorbid, yet none required conversion to general anesthesia.
• Operative time was shorter under AIM (p = 0.001), while ischemia time, transfusion rate, and flap outcomes were comparable.
• No AIM patient required ICU admission (p = 0.047), and rates of Clavien-Dindo ≥ III complications and total or partial flap loss were similar between groups.
• Latissimus dorsi and ALT/vastus lateralis flaps made up 85% of reconstructions; in the AIM group, peripheral blocks were used in 90% and neuraxial blocks in 40%.

A retrospective cohort of 54 patients undergoing migraine trigger-site surgery in Taiwan (2019–2024) evaluated whether years from migraine onset to operation predicted postoperative monthly headache frequency, adjusting for age, sex, preoperative frequency, number of trigger sites, and nerve block status.

• Overall, 87.0% achieved successful treatment (≥50% reduction in monthly frequency) and 29.6% achieved complete elimination; median time-to-surgery was 15 years.
• Longer time-to-surgery correlated with higher postoperative frequency (ρ = 0.397) and remained an independent predictor on multivariable regression (β = 0.342; 95% CI 0.107–0.577), alongside preoperative frequency.
• Patients operated on within the 15-year median had a 96% success rate with 43% elimination, compared with 77% success and 15% elimination for longer disease duration (p = 0.047 and p = 0.038).

A retrospective cohort of 39 patients with oral malignancy undergoing segmental or hemimandibular resection and anterolateral thigh flap reconstruction over a bridging plate without bone compared patient-specific implants (n = 21) with conventional bent reconstruction plates (n = 18).

• PSI reconstruction was associated with significantly shorter operative time (P = 0.0002) and lower intraoperative blood loss (P = 0.0039).
• No plate-related infections occurred with PSI, compared with three in the conventional plate group, over a median follow-up of 1322 days (range 91–3225).

A retrospective cohort of 158 free flaps at a single center compared 79 flaps anastomosed to temporal recipient vessels with 79 cervically anastomosed flaps from the same period, adjusting for defect location and surgical complexity; primary outcomes were vascular revision and flap survival.

• Vascular revision occurred in 6% of flaps in both groups (OR 1.00; 95% CI 0.28–3.60).
• Total flap loss was 1% with temporal and 5% with cervical vessels, a non-significant difference (OR 0.24; 95% CI 0.03–2.20).
• Operative time was shorter in the temporal group (P < 0.001), with comparable ischemia time.
• Temporal patients had higher ASA scores (P = 0.009) but no increase in medical complications or resource utilization.

A retrospective cohort of 105 patients with 358 implants placed in fibula, scapula, or deep circumflex iliac artery free flaps over 10 years at a single institution analyzed implant failure (removal for any reason) using Kaplan-Meier estimates and mixed-effects Cox regression accounting for patient-level clustering.

• Cumulative implant survival was 93.4% at 1 year, 89.2% at 2 years, and 83.9% at 3 years, remaining relatively stable thereafter.
• Adjuvant radiotherapy was the strongest independent risk factor for implant failure (HR 3.46; P = 0.009) in the adjusted model.
• Implants placed in a reconstructed maxilla failed more often than those in the mandible (HR 3.00; P = 0.040).
• Infection or peri-implantitis caused 68.5% of failures, followed by osteoradionecrosis; donor site and smoking were not associated with failure after adjustment.

This retrospective single-centre cohort of 80 patients (83 flaps, 2005–2025) reviewed pedicled circumflex scapular artery-based reconstructions. It analyzed defect characteristics, flap types, transfer patterns and outcomes, and used them to build a post hoc, defect-oriented framework for choosing the flap.

• Across 83 flaps, mean defect area was 203.4 cm² and the largest harvested flap measured 720 cm².
• Three transfer patterns were used: standard island flaps (n = 63) for back, upper extremity and latissimus donor-site defects; island flaps passed through the triangular space (n = 6) for anterior axillary and chest wall defects; and propeller flaps (n = 14) to reduce pedicle tension.
• Complications occurred in 9 cases (about 11%), mainly vascular compromise and partial flap loss.
• In axillary reconstruction, shoulder range of motion improved by 65.6 ± 24.1° (P < 0.001).

This retrospective case series of 26 consecutive reconstructions (2010–2025) by one senior surgeon evaluated a distally based posterior tibial artery perforator plus saphenous flap. The flap had planned end-to-end venous supercharging and a temporary skin bridge, and was used in patients at high risk of flap loss (crush or major trauma, older or comorbid patients, long flaps).

• Complete flap survival occurred in 24 of 26 flaps (92.3%).
• Venous supercharging used a great saphenous vein branch in 23 flaps and the lesser saphenous vein in 3, joined end-to-end to a superficial vein near the defect.
• Mean flap size was 5 × 16 cm (up to 20 cm long); the pivot perforator lay a mean 9 cm above the medial malleolus, and the mean arc of rotation was 100°.
• Trauma accounted for 21 cases, and 18 defects exposed tibia or ankle joint, with tendon exposure in 8.

This retrospective single-surgeon series of 40 consecutive procedures (March 2023 to April 2024) described how the Symani Surgical System was introduced for free tissue transfer, acute hand trauma including digital replantation, and lymphatic reconstruction, and reported feasibility and short-term outcomes.

• The cases comprised 26 free tissue transfers and 14 acute hand trauma cases, including digital replantations; two cases involved lymphovenous anastomoses, done with or separately from lymph node transfer.
• A total of 130 robot-assisted anastomoses were performed: 43 arterial, 57 venous, 7 vein-to-artery, 4 lymphovenous and 19 nerve coaptations.
• No flap loss or revisions occurred in the reported short-term follow-up.
• Mean anastomosis time was 16.4 ± 9.6 minutes; the authors describe longer operative times and higher costs as early barriers that fall with experience.

This retrospective comparative study of 45 patients with unilateral stage II–III breast cancer-related arm lymphedema compared two approaches after gastroepiploic vascularized lymph node transfer. The tailored ERAS protocol (n = 29) used early oral intake and mobilization, opioid-sparing analgesia, no nasogastric tube, and decongestive therapy from day 7; the comparison group (n = 16) received conventional perioperative care.

• Hospital stay was 2.34 versus 5.56 days with ERAS versus conventional care (p < 0.001).
• Estimated hospitalization costs were €1400 versus €3300 (p < 0.001).
• Flap survival was 100% in both groups, with no flap-related complications.
• Circumferential reduction (44.4% vs 47.5%), 12-month LYMQOL scores and yearly infection episodes were comparable between groups.

This multicentre retrospective cohort of 301 patients (411 flaps) from five centres was combined with data from 12 published studies (7189 flaps) in a pooled analysis. It assessed clinical and CT angiographic risk factors for intraoperative venous congestion that needed a secondary venous outflow procedure.

• Intraoperative venous congestion occurred in 8.8% of flaps (36 events) in the institutional cohort.
• Diabetes (OR 1.78, 95% CI 0.89–3.59) and prior abdominal surgery (OR 1.32, 95% CI 0.67–2.63) showed nonsignificant trends toward higher risk; smoking, hypertension and preoperative radiation showed no association.
• Perforator number and superficial inferior epigastric vein diameter were not predictive; thinner flaps trended toward congestion (mean difference -2.40 mm, 95% CI -5.24 to 0.54).
• Abnormal venous connections, reported in individual studies, showed the strongest association with congestion.

A case series of 103 patients (114 digits) underwent reconstruction with a modified great toe wrap-around flap plus iliac bone graft and full-thickness skin graft donor closure, for thumb defects distal to the MCP joint and finger defects distal to the PIP joint; sensory, functional, and esthetic outcomes were assessed.

• Five patients (4.9%) required re-exploration for vascular compromise, with one partial flap loss; all remaining flaps survived.
• At 6 months, mean static two-point discrimination was 8 mm (range 7–10 mm) and the mean Semmes-Weinstein score was 2.83; all digits achieved stable pinch and grasp.
• Mean iliac bone graft length was 17.7 mm, with resorption in one case over a mean follow-up of 28 months.
• No significant donor-site complications were observed, including ulceration, delayed healing, persistent pain, cold intolerance, or gait disturbance.

This single-session experimental study of 14 adults with chronic traumatic brachial plexus injury (six complete lesions, ten after nerve transfer) tested a soft wearable exosuit. The suit uses pneumatic actuation and inertial sensing to assist the shoulder and elbow, and arm function was compared with and without it.

• Active range of motion increased by 80–180% and static endurance by 160% with the device.
• Muscle activity fell by 30–60%, with perceived effort reduced to near zero and less fatigue.
• Participants kept a moderate-to-high sense of agency over their movements and reported good satisfaction with the device.
• In a subset of four participants, Action Research Arm Test scores improved by a mean of 4.5 points, and movements became smoother and less compensatory.

This national administrative claims database cost analysis compared payer reimbursements and day-of-surgery and 90-day costs for common soft tissue hand procedures done in the procedure room versus the operating room, with or without anesthesia. It also modeled 10-year savings from shifting 1000 cases per year to the procedure room.

• Surgeon reimbursement was higher in the procedure room than in the OR with anesthesia, by +24.2% to +85.7% (De Quervain release to endoscopic carpal tunnel release).
• Compared with the OR without anesthesia, surgeon reimbursement in the procedure room was 9.8% to 75.3% higher, with the same two procedures at either end of the range.
• Day-of-surgery costs were much lower in the procedure room, driven by elimination of the facility fee.
• Projected 10-year savings for 1000 cases per year exceeded $20 million for OR cases with anesthesia and ranged from $13 million to $20 million for OR cases without anesthesia.

This retrospective observational study of 99 patients having surgery for acute hand or wrist trauma over 2 years compared hospital costs between WALANT (n = 49) and conventional anesthesia (n = 50). Costs were adjusted for age and diagnostic group, and a sensitivity analysis was restricted to controls judged eligible for WALANT.

• Adjusted analyses showed lower total costs with WALANT.
• Savings came mainly from avoiding hospital admission, with smaller contributions from a smaller surgical team and no routine preoperative tests.
• Among controls retrospectively judged eligible for WALANT, lower total and direct costs and shorter length of stay remained significant.
• A hypothetical model suggested further potential savings if WALANT were used more widely.

A retrospective cohort of 181 patients (189 cysts) undergoing open ganglion excision by two surgeons between 2018 and 2024 compared recurrence after electrocauterization of cyst remnants (113 patients, 116 cysts) versus no cauterization (68 patients, 73 cysts). A secondary analysis examined cautery combined with tissue window excision or capsular closure.

• Recurrence occurred in 4.3% of cauterized versus 9.5% of non-cauterized cysts (5/116 vs 7/73), a difference that did not reach statistical significance.
• Cauterization combined with tissue window excision produced zero recurrences in 31 cysts, compared with 1 recurrence in 12 non-cauterized window excisions.
• Capsular closure alone was associated with higher recurrence (6/44), with 2/7 recurrences when closure was combined with cauterization; the authors hypothesize that leaving the capsular defect open permits continuous drainage of residual fluid.
• Recurrences predominantly involved dorsal cysts (69%); 46% of recurrent cysts were under 2 cm, and patients with manual occupations were frequently affected.

A retrospective cohort of 56 patients (63 thumbs) with thumb carpometacarpal osteoarthritis treated with an orthosis was assessed at baseline and 3 months. Linear mixed-effects models tested whether self-reported average daily wear time modified change in pain (100-mm VAS) and function (HAND20), adjusting for age, sex, and radiographic severity.

• Median VAS pain improved from 65 at baseline to 30 at 3 months (P < .001).
• HAND20 function scores improved significantly over the same interval, whereas pinch strength showed no significant change.
• Time-by-wear-duration interactions were not significant for either VAS or HAND20, giving no evidence that longer daily wear produced larger improvements.
• The authors interpret the findings as suggesting that appropriate, activity-specific use may matter more than maximizing total daily wear time.

A retrospective case series of 73 patients aged 90 years or older (mean age 92, 89% women) who underwent operative treatment of distal radius fractures assessed dorsal tilt, ulnar variance, radial inclination, and radial height preoperatively, immediately postoperatively, and at final follow-up. Radiographic parameters were correlated with DASH and VAS pain scores at final follow-up, and complications and reoperations were recorded.

• Dorsal tilt, ulnar variance, radial inclination, and radial height all improved postoperatively and were maintained at a mean final follow-up of 4.1 months.
• The mean final DASH score was 29, and preoperative radiographic alignment showed no significant correlation with final function.
• Only immediate postoperative radial height showed a weak correlation with final DASH score.
• Minor and major complications combined occurred in 15% of patients (n = 11).

A review (German-language) summarizes the epidemiology, diagnosis, injury patterns, operative management, and outcomes of carpometacarpal fracture-dislocations of the fourth and fifth rays.

• Affected patients are predominantly young men, with a high proportion of injuries caused by punching.
• Nonspecific clinical signs and poor visualization on conventional radiographs create a substantial risk of delayed diagnosis, which appears to be associated with inferior outcomes; early CT is considered essential when injury is suspected.
• The fifth metacarpal is consistently involved, and the fourth metacarpal and hamate are frequently injured, either alone or in combination.
• Conservative treatment appears sufficient only rarely; surgical fixation, ranging from transfixing or reduction K-wires to screw or plate osteosynthesis, is generally preferred and yields favorable outcomes, with salvage procedures available for symptomatic post-traumatic arthritis.

An ex vivo proof-of-concept study of 6 cords from 5 patients injected surgically excised Dupuytren cords with 0.5 mL of recombinant collagenase G (ColG) expressed in Escherichia coli (4 mg/mL; n = 4) or phosphate-buffered saline (n = 2). After incubation at 37 °C, cords underwent tensile testing to rupture on an Instron system.

• Mean maximum rupture force was about 32% lower with ColG than with PBS (0.047 vs 0.069 kN).
• Force-displacement curves of ColG-treated cords showed a reduced slope and lower peak force before rupture, consistent with collagenolytic activity.
• The authors frame the results as pilot data, with dose-response, formulation, exposure time, and safety still to be defined relative to current collagenase-based treatment.

A single-center retrospective case series of 48 patients treated between 2013 and 2025 with a radial nerve bridging plate (RNBP) for humeral shaft fracture or nonunion assessed iatrogenic radial nerve palsy (iRNP) after plate removal as the primary outcome. Secondary outcomes were iRNP, malunion, and nonunion after the primary operation, over a mean follow-up of 24 months.

• Among the 11 patients who underwent plate removal, no iRNP occurred.
• Of 41 patients without a fracture-related palsy, 7 (17%) developed temporary iRNP after primary fixation; all fully recovered at a mean of 12.3 weeks (range 1–32).
• There were three nonunions, including one pathological fracture and one surgical neck nonunion in a multilevel fracture.

A retrospective population-based cohort of 2512 patients identified from Hospital Episode Statistics for England (2002–2022) using ICD-10 and OPCS-4 codes described the incidence, demographics, comorbidities, deprivation, and outcomes of lower limb necrotising fasciitis.

• Incidence increased seven-fold, from 0.1 to 0.8 per 100,000, with most cases occurring in patients over 40 years.
• More than one-third of cases arose in the most socially deprived quintile, and 55% of patients had severe comorbidities.
• Morbidity was substantial, with over 17% of patients requiring limb amputation.
• Mortality was 12.6% at 30 days, rising to 17.4% at 90 days and 24% at 1 year.

A review (German-language) summarizes current therapeutic concepts for difficult-to-heal and chronic wounds and gives an overview of the mechanisms and evidence for newer local wound treatments.

• Management follows an algorithm in which diagnosis and treatment of the underlying cause of impaired healing come first.
• Local therapy aims to create a physiological, stage-adapted wound environment through wound cleansing to treat local infection, exudate management, and stabilization of the surrounding skin.
• The algorithm ends in secondary wound closure, and the authors also summarize the mode of action and evidence for current innovations in local wound therapy.

This narrative review of 41 publications, including 18 randomised trial reports, synthesises evidence for seven local DFU therapies: leucocyte-platelet-fibrin patches, placenta-derived products, sucrose octasulfate dressings, fish skin matrices, hyperbaric oxygen, topical oxygen and negative pressure wound therapy.

• A meta-analysis of 11 placental-product trials reported complete healing in 66.9% versus 34.1% with standard care (risk ratio 2.00).
• Pivotal single-product trials reported absolute healing gains of 12–18 percentage points: leucocyte-platelet-fibrin patch 34% vs 22% at 20 weeks, sucrose octasulfate (EXPLORER) 48% vs 30% at 20 weeks, and intact fish skin in deep ulcers (ODIN) 44% vs 26% at 16 weeks.
• Topical oxygen showed pooled benefit (risk ratio 1.59), whereas HBOT trials were discordant and NPWT evidence was clinically supportive but of low certainty.
• Trials commonly excluded severe infection, osteomyelitis and critical ischaemia, leaving complex ulcers largely unstudied.

Hauc and Janis conducted a narrative evidence synthesis of guidelines, randomised trials, observational studies and expert consensus on perioperative optimisation for pressure ulcer reconstruction, translating it into a practical prehabilitation framework across nutritional, mechanical and functional domains.

• An 8-week course of vitamins A, B9, C and E with zinc, selenium and copper was associated with improved outcomes after reconstruction.
• Albumin and prealbumin alone were considered insufficient markers; the NUTRIC score, dietary intake evaluation and body composition analysis gave more accurate nutritional risk stratification.
• Off-loading surfaces reduced shear and improved tissue perfusion, and smoking cessation for at least 30 days improved vascular and immune recovery.
• In ambulatory patients, metabolic equivalents below 4 identified higher perioperative risk, and physical therapy-based prehabilitation improved functional capacity.

This randomised animal study of 24 rats compared 30% TBSA scald burn with sham, sampling at four time points on post-burn days 2–3 to measure core clock genes in PBMCs and gastrocnemius muscle alongside markers of atrophy, autophagy, apoptosis and proliferation.

• Sham animals showed time-of-day variation in PBMC clock genes, whereas burned animals had significantly reduced Clock, Cry1, Cry2, Per1 and Per2 expression.
• In gastrocnemius muscle, burn suppressed Cry1 and Per2 and increased the atrophy genes Fbxo32 and Trim63.
• Protein changes were time-dependent: LC3 rose at 12:00 and 00:00, PCNA fell at 06:00, and caspase-3 and LC3 rose together at 12:00, consistent with transient apoptosis and autophagy.
• Paired PBMC and muscle clock gene expression showed no significant correlation for any gene analysed.

This review examines how medication, malabsorption, inflammation, overweight, obesity and renal insufficiency alter vitamin pharmacokinetics and requirements in patients with chronic wounds, and offers provisional recommendations for treating and preventing deficiencies.

• Vitamin deficiencies are prevalent in chronic wound populations, yet supplementation trials have produced inconsistent effects, which the authors attribute partly to suboptimal study designs and doses.
• Several co-existing factors can alter vitamin kinetics, with diabetes and advancing age acting as overarching drivers of medication use, malabsorption, inflammation and renal insufficiency.
• Limited evidence points to higher vitamin requirements in diabetes; data on treating combined deficiencies and on B-vitamins are entirely lacking.
• The authors propose that monitoring blood vitamin concentrations may be warranted given the prevalence and risk factors for deficiency.

This review combines clinical evidence on adjunct therapies with preclinical nanoplatform data for chronic cutaneous ulcers, organised around biofilm ecology and antimicrobial resistance.

• Chronic cutaneous ulcers affect an estimated 1–2% of the population in high-income countries, and standard care fails in many cases complicated by polymicrobial biofilm and resistance.
• Clinical adjuncts (low-intensity ultrasound, electrical microcurrent, photodynamic therapy, regenerative biomaterials, oxygen-based and advanced topical therapies) may improve contraction, microbial burden, pain and repair when added to standard care.
• In preclinical models, metallic, polymeric, inorganic and hybrid nanoplatforms target resistant bacteria and biofilms while promoting angiogenesis and matrix remodelling.
• Clinical evidence remains inconsistent, with small cohorts and non-standardised protocols across modalities.

This retrospective review of 12 patients with beta thalassaemia and leg ulcers at a tertiary centre compared seven transfusion-dependent with five non-transfusion-dependent patients across demographics, haemoglobin, ferritin, foetal haemoglobin, comorbidities and ulcer characteristics.

• Transfusion-dependent patients were younger (mean 31.9 vs 44.0 years), predominantly male, and had larger ulcers (mean 3.1 cm²), whereas non-transfusion-dependent patients had more episodes (mean 2.2).
• Transfusion-dependent patients had higher ferritin, while non-transfusion-dependent patients had higher foetal haemoglobin and slightly better resolution (80% vs 71%).
• Splenectomy had been performed in all transfusion-dependent patients and most non-transfusion-dependent patients.
• Chronic anaemia, iron overload, trauma and hypercoagulability were identified as exacerbating factors; higher foetal haemoglobin and hydroxyurea use, occasional transfusion and early conservative wound care appeared protective.

This narrative review of preclinical and clinical studies (PubMed/MEDLINE, Scopus and Web of Science through August 2026) examines how OSA-related intermittent hypoxia may impair skin wound healing directly and indirectly through diabetes, hypertension and obesity.

• OSA affects nearly one billion adults, up to 80% undiagnosed, and its cyclic desaturation-reoxygenation activates pathways distinct from acute or chronic hypoxia, including sustained inflammation, sympathetic activation and endothelial dysfunction.
• Preclinical data, mostly from in vitro scratch assays, show that intermittent hypoxia delays wound closure, downregulates HIF-2α and VEGF and shifts macrophages toward a pro-inflammatory phenotype.
• In diabetic foot ulcers, high OSA risk was associated with a doubled risk of poor healing; improved healing after CPAP has been described only in a small case series.

This retrospective single-arm series of 224 patients (232 breasts) reports per-breast complications after skin- or nipple-sparing mastectomy with immediate prepectoral implant reconstruction using the Ray extended ADM configuration (2020–2023), over a mean follow-up of 24.3 months.

• Wound dehiscence and seroma each occurred in 9.1% of breasts, with major seroma in 3.0%.
• Flap necrosis, hematoma and infection each occurred in under 1% of breasts (0.4%, 0.9% and 0.9%, respectively).
• Clinically significant Baker grade III/IV capsular contracture was observed in 2.2% of breasts.
• Implant failure occurred in 1.3% (3 breasts), and no implant rupture was recorded during follow-up.

This prospective multicenter study of 329 women compared shoulder function after oncologic mastectomy alone (n = 163) with mastectomy plus immediate, mostly implant-based reconstruction (n = 166). Pain (VAS), range of motion (ROM), QuickDASH, an exploratory shoulder function score (SFS) and satisfaction were measured at each patient's last available visit, 12–82 months after surgery.

• Reconstruction was associated with more frequent ROM limitation (41.0% vs. 23.9%), more SFS-defined functional limitation (39.2% vs. 27.6%) and higher mean VAS pain (2.19 vs. 1.39; p = .004).
• Validated QuickDASH scores were comparable between groups (14.98 vs. 12.55; p = .170). The exploratory SFS rated impairment as minimal in 93.4% of reconstructed patients and 95.7% of mastectomy-only patients.
• Among reconstructed patients, radiotherapy and hormonal therapy were associated with higher exploratory SFS values (p = .012 and p = .018). Leaner patients (BMI ≤25 kg/m²) also scored higher after reconstruction.
• Patient satisfaction was higher after reconstruction (82% vs. 63%; p < .001), even though pain and ROM limitation were more common in this group.

This propensity-matched retrospective cohort of 2,206 women from the TriNetX network compared 1,103 patients who gave birth after reduction mammoplasty with 1,103 who gave birth without prior aesthetic breast surgery. The primary outcome was breastfeeding-related complications within one year of delivery.

• Risk of lactation disorders was not significantly increased after reduction mammoplasty (HR 1.41; CI 0.87–2.27; p = 0.16).
• Rates of breast infection (HR 0.67; CI 0.39–1.16) and mastitis (HR 0.60; CI 0.31–1.15) were comparable between groups.
• Prior reduction was associated with more antibiotic prescriptions and emergency department visits (HR 1.20, CI 1.05–1.37; and HR 1.38, CI 1.13–1.67).

This retrospective cohort of 121 breast cancer patients had superomedial pedicle therapeutic mammoplasty with a sternal notch-to-nipple (SN-N) distance over 35 cm. It compared preoperative composite vascular mapping (n = 62) with conventional planning based on anatomical landmarks (n = 59), assessing operative time, nipple-areola complex (NAC) viability, complications and patient-reported satisfaction.

• NAC viability was 100% with mapping versus 91.5% without (p = 0.025). Wound-healing complications occurred in 0% versus 8.5%.
• Mean operative time was shorter with mapping (86.2 vs. 101.2 minutes; p < 0.001). The only baseline difference was age: the mapping group was older (58.4 vs. 54.3 years).
• Satisfaction with the nipples was higher in every category in the mapping group, including position, alignment, shape, appearance and sensation (p = 0.001–0.049).

This systematic review of 57 studies, searching PubMed/MEDLINE, Embase, Cochrane, KoreaMed and KMbase through March 2026, examined breast cancer-related lymphedema (BCRL). It covered diagnostic methods, intervention thresholds, patient self-monitoring and prospective surveillance, focusing on how surveillance measurements should lead to clinical action.

• Serial bioimpedance spectroscopy and limb-volume assessment, each compared with the patient's own baseline, were the most thoroughly studied methods for detecting meaningful change before overt BCRL.
• A lymphedema index rise of at least 6.5 units, or a relative limb-volume increase of 5–10%, was best interpreted as a trigger for confirmatory assessment and early conservative treatment, not as a diagnosis on its own.
• Ultrasonography and indocyanine green lymphography added complementary tissue and anatomical information but were better suited to selected assessment than to routine surveillance.
• Evidence supporting patient self-monitoring and health-system implementation remained limited. The authors propose a care pathway that links baseline-referenced monitoring to confirmation, intervention and reassessment.

This retrospective observational series of 24 women with Poland syndrome evaluated two-stage alloplastic breast reconstruction performed between 2012 and 2023. Anatomical tissue expanders were positioned individually to reshape the skin envelope and correct vertical and horizontal nipple-areola complex (NAC) malposition, with measurements taken before and after surgery.

• Affected-side sternal notch-to-nipple distance improved from 16.0 to 19.1 cm on average, reflecting correction of vertical NAC position.
• Midsternal line-to-nipple distance improved from 8.8 to 11.1 cm on average, correcting horizontal NAC position on the affected side.
• In an exploratory analysis, higher BMI was associated with more residual sternal notch-to-nipple asymmetry after surgery.

This retrospective single-surgeon case series of 11 patients describes open transversus abdominis release (TAR) with a large, well-fixed polypropylene mesh to repair abdominal bulge after abdominally based breast reconstruction (ABBR), performed between 2020 and 2025. Mean age was 58 years and mean BMI 29.3 kg/m².

• All patients reported complete resolution of bulge symptoms, with no clinical recurrence at a mean follow-up of 379 days.
• Five of the 11 patients had failed a previous bulge repair before TAR: onlay mesh with plication in three and plication alone in two.
• Bulges appeared a mean of 127 days after ABBR, and the repair used polypropylene mesh with a mean width of 17.6 cm.
• Reported complications were one seroma and one focal, superficial delay in wound healing, which resolved without treatment.

This single-surgeon case series of 7 patients describes a second harvest of residual skin and latissimus muscle from the same donor site after a previous muscle-sparing latissimus dorsi (MSLD) flap. The second flap was used to salvage radiated implant-based breast reconstructions.

• After an initial MSLD flap done for various reasons, residual back skin and muscle could be harvested again from the same donor site to salvage radiated implant-based reconstructions in all seven patients.
• The author argues that these cases challenge the view that the latissimus flap can be used only once. He proposes the MSLD for patients at high risk of reconstructive failure, to keep the latissimus available as a backup.

This retrospective single-center cohort of 56 patients evaluated immediate implant-based reconstruction within a standardized onco-aesthetic framework: individualized skin-envelope management, implant selection and selective contralateral symmetrization. Outcomes were BREAST-Q Reconstruction scores, Harris photographic aesthetic ratings and complications.

• BREAST-Q Satisfaction with Breasts improved by 34.9 points. Psychosocial Well-being rose by 20.7, Sexual Well-being by 33.5 and Physical Well-being: Chest by 19.0 (all P < .001).
• Physician-rated aesthetic outcomes were good to excellent in 62.5% of patients (35/56). Harris aesthetic quality correlated strongly with postoperative Satisfaction with Breasts (ρ = 0.904).
• Immediate contralateral symmetrization, performed in 24 patients (42.9%), was not independently associated with satisfaction once achieved aesthetic quality was taken into account.
• Complications occurred in 12 patients (21.4%) and 3 (5.4%) needed implant removal, giving an implant retention rate of 94.6%.

This retrospective single-center series of 253 patients covers risk-reducing mastectomies performed at the Toulouse-Oncopole University Cancer Institute between 2015 and 2022, reviewing surgical practice and postoperative complications. Patients had a mean age of 43 years; 48.6% carried BRCA1 and 38.3% BRCA2 mutations.

• Most reconstructions were prosthetic (67.6%); 17% had free-flap reconstruction and 7% had latissimus dorsi flap reconstruction.
• At least one postoperative complication occurred in 43% of patients. Most were wound healing disorders (34.9%).
• Most complications were minor: 32% of patients had a complication that needed no further intervention, while 11.1% required reoperation.
• Reconstruction failed in 3.5% of implant reconstructions and 5.9% of free flaps.

A systematic review and meta-analysis of 17 comparative trials (456 participants; 656 treatment sites) pooled standardized mean differences for perioperative or postoperative BoNT-A versus control and examined effect modification by injection timing, dose density, and anatomic site.

• BoNT-A reduced objective scar width (SMD −0.924; 95% CI −1.119 to −0.728; moderate certainty) and improved clinician composite scores (SMD −0.864; low certainty).
• Pooled clinician-composite analyses showed a larger effect with delayed injection (SMD −1.240) than with immediate injection (SMD −0.559), although direct within-site timing studies conflict.
• Timing and anatomic site jointly explained 81% of heterogeneity, with the largest effects on the chest and the smallest at fine facial sites.
• Cross-study dose escalation from 4 to 10 U/cm was not associated with additional benefit, and patient-reported outcomes remained uncertain.

This multicenter prospective observational study of 198 patients (213 enrolled; 72 primary and 126 revision) assessed East Asian rhinoplasty using thin cortical costal cartilage grafts to reinforce the alar arch, combined with nasal tip ligament reconstruction, following an Elastic Double Arch Model. Outcomes were VAS-cosmetic, FACE-Q Rhinoplasty, VAS-functional, NOSE, measured nasal tip mobility, and complications, with follow-up up to 36 months.

• In primary cases with 36-month data, FACE-Q Rhinoplasty scores rose from 42.5 to 84.2 and VAS-cosmetic from 5.02 to 8.40.
• Revision cases improved by a similar amount: FACE-Q went from 40.2 to 81.5 and VAS-cosmetic from 4.87 to 8.20.
• Measured nasal tip mobility was preserved in primary cases and markedly restored in revision cases. The authors present this as a response to the tip stiffness associated with conventional structural grafting.
• Functional scores (VAS-functional and NOSE) improved in both groups. Complications were described as uncommon.

This prospective randomized blinded trial of 64 patients with severe nasal axis deviation compared asymmetric let-down osteotomy (asymmetric bone impaction) in preservation rhinoplasty with conventional structural rhinoplasty using spreader flaps and grafts (32 per arm). Axis correction was measured on pre- and postoperative photographs over 12 months.

• Asymmetric let-down osteotomy corrected 90 ± 5.67% of the axis deviation at 12 months.
• Correction held, with no significant recurrence between month 1 and month 12 (p > 0.05).
• The let-down group had significantly better axis correction than the spreader flap and graft group (p < 0.01).

This prospective cohort study of 60 women compared Mia minimally invasive breast augmentation with hybrid augmentation (implant plus autologous fat grafting). BREAST-Q outcomes, pain, nipple sensitivity, and recovery were measured before surgery and at 1 week, 1 month, and 6 months.

• Both techniques produced significant improvements in BREAST-Q breast satisfaction, psychosocial well-being, and overall well-being, and overall satisfaction was similar between cohorts.
• Mia patients reported 74% less pain and a 61% faster recovery than the hybrid cohort.
• Patient-reported nipple sensitivity was 41% better after Mia than after hybrid augmentation.

This randomized trial of 34 patients with scars after cleft lip repair compared 595-nm pulsed dye laser (six sessions at 2-week intervals, n = 17) with CO2 fractional laser (two sessions at 3-month intervals, n = 17). Scars were assessed with the Vancouver Scar Scale one year after surgery.

• Both lasers produced significant VSS improvement from baseline at one year (p < 0.05).
• Differences between the two lasers were not significant for most VSS components, including pigmentation, pliability, and height.
• The pulsed dye laser group showed greater reduction in vascularity, the only parameter where one laser clearly outperformed the other.

This systematic review of 18 studies (768 patients) followed PRISMA and searched six databases through December 2024 for clinical outcomes and safety of nanofat in aesthetic and reconstructive use, including scars, skin quality, and hair.

• All eight studies (188 patients) that used the Vancouver Scar Scale or POSAS reported significant scar improvement.
• In the nine studies (512 patients) that measured satisfaction, most patients reported above-average satisfaction.
• Twelve studies reported no significant complications such as granulomas or cysts. Eight reported mild side effects, including erythema, hyperpigmentation, and edema.
• Newer uses rest on very small samples: collagen synthesis and TGF-β1 expression (n = 68), skin histology (n = 24), and hair density and thickness (n = 9).

This systematic review and meta-analysis of 242 studies, with case data from 71 additional reports, used random-effects models to pool the incidence of delayed inflammatory reactions after facial hyaluronic acid filler. Subgroup analysis compared crosslinking technologies.

• Pooled incidence was 0.0005 events per patient-year (95% CI 0.0002–0.0013), about one event per 2000 patients followed for one year.
• Rates per patient-year were highest for SHAPE (0.0044) and Vycross (0.0022), compared with 0.0007 for NASHA and 0.0006 for HICE. No incident cases were reported with CPM-based fillers.
• Median onset was 3 months (range 2 weeks to 12 years), and median time to resolution was 2.9 months (range 1 day to 6 years).
• Reactions mostly presented as nodules, redness, swelling, and induration, and were usually treated with hyaluronidase, corticosteroids, and antibiotics.

This 2-year experimental study in 30 rabbits measured new collagen formation after subcutaneous injection of polycaprolactone microsphere filler (Ellansé-S), compared with tissue that received no implant. Collagen density, alignment, and structure were quantified with second-harmonic generation microscopy and automated image analysis (CT-FIRE and CurveAlign).

• Collagen fiber density was 79.2% higher at 12 months than in tissue without implant, then began to decline.
• New collagen formation was detectable throughout the 24-month period, and improving fiber alignment indicated maturation of the collagen network.
• The new collagen showed no significant difference in structure or organization from native tissue.

An international cross-sectional survey of 4890 transgender and gender diverse adults (2022–2024) tested predefined hypotheses on group differences and inter-scale correlations for the 11 GENDER-Q face and neck scales. Construct validity was judged against the COSMIN threshold of at least 75% of hypotheses confirmed.

• Across the 11 scales, 78% to 100% of hypotheses met COSMIN criteria, clearing the 75% threshold for hypothesis-based construct validity in every scale.
• Participants who had undergone gender-affirming facial procedures reported significantly higher appearance satisfaction than those who still wanted surgery or required revision surgery.
• Nearly a quarter of respondents identified as nonbinary (24%), alongside women (37%), men (33%), and other genders (6%); all completed the Face Overall scale plus additional scales as relevant.

A retrospective case series of 42 Asian rhinoplasty patients (2023–2025) describes the dual-pillar technique, in which thin cartilage grafts (0.8–2.0 mm) are shaped and secured along each medial crus with interrupted 5-0 polydioxanone sutures without septal coupling. Indications were Goode ratio below 0.55, weak or asymmetric medial crura, and a preference for a mobile tip.

• Mean Goode ratio increased from 0.51 to 0.58 (P < 0.001), moving tip projection above the 0.55 indication threshold.
• Mean infratip break angle narrowed from 139 to 118 degrees (P < 0.001), indicating a more defined infratip break.
• Grade 3 physiological tip mobility was retained in 38 of 42 patients (90%) on a pragmatic 4-point clinical scale; the remaining 4 showed grade 2 mobility.
• Mean patient satisfaction was 8.7 of 10 on a visual analog scale, and no complications requiring revision occurred.

A retrospective single-center cohort of 59 patients with extremity synovial sarcoma (2000–2023) compared 23 upper- with 36 lower-extremity tumors for R1 margin at index resection and Clavien-Dindo complications within 8 weeks. Metastasis-free and overall survival were exploratory endpoints.

• R1 at the index resection occurred in 61% of upper- vs 14% of lower-extremity tumors (OR 9.64, 95% CI 2.73–34.1); neoadjuvant therapy was also more frequent in the upper extremity (39% vs 8%).
• Definitive R0 was ultimately achieved in every patient, despite the higher initial R1 rate in upper-extremity tumors.
• Any postoperative complication was more frequent after lower-extremity surgery (53% vs 13%; OR 0.13 for upper vs lower), as were major complications (39% vs 9%).
• Seven of nine distant metastases arose in lower-extremity tumors, several beyond six years; 10-year metastasis-free survival was 90% vs 56% favoring the upper extremity, without statistical significance (P = 0.095).

A German-language review summarizes local surgical strategy for primary malignant bone tumors within multimodal treatment, covering extent of resection, reconstruction options, and integration with chemotherapy and radiotherapy.

• Conventional chemotherapy leads first-line treatment, and complete R0 resection is the local procedure of choice in curative-intent care.
• In Ewing sarcoma, additional local radiotherapy must be accounted for in both surgical planning and the choice of reconstruction.
• The quality of tumor removal directly influences local recurrence rate, overall prognosis, and reconstruction type; palliative cases require individually adapted treatment.
• Because of disease rarity and the degree of specialization required, treatment is restricted to specialized centers.

A retrospective case series of 28 patients aged 65 or older with large post-oncologic facial defects (5 × 6 cm to 12 × 16 cm) describes an individualized algorithm assigning full-thickness skin grafts, regional or pedicled flaps, or free flaps by defect complexity and physiologic reserve. Outcomes were reassessed by two non-operating plastic surgeons using de-identified records, photographs, and a predefined functional checklist.

• Nearly half were managed with full-thickness skin grafts (13 of 28), with regional or pedicled flaps in 9 and free or bulky myocutaneous flaps in 6.
• Complete wound closure and survival of all 28 grafts and flaps were achieved.
• Five complications occurred within 30 days, all Clavien-Dindo grade I or II; no grade III–V events were recorded.
• No reconstruction failure was documented in the 27 curative-intent cases, and the single palliative case achieved stable coverage and local symptom control.

A preclinical ex vivo study of 45 surgically excised human soft tissue tumor specimens applied histotripsy with a custom 1 MHz, 8-element ultrasound transducer under ultrasound imaging guidance. Specimens ranged from benign adipocytic, myxoid, and nerve sheath tumors to aggressive fibrous and high-grade sarcomas.

• Histotripsy created an identifiable treatment effect across all tumor subtypes, including adipocytic tumors, benign myxoid and nerve sheath tumors, aggressive fibrous sarcomas, and high-grade sarcomas.
• Immediately after treatment, B-mode and shear-wave elastography ultrasound effectively evaluated the treated region.
• Histologic treatment effect varied with tissue structure heterogeneity among subtypes, pointing to a need for subtype-specific parameter optimization.

A systematic review and diagnostic accuracy meta-analysis of 18 studies (17 pooled quantitatively) estimated sensitivity, specificity, AUC, and diagnostic odds ratio of AI models for postoperative free flap monitoring and compromise prediction using a hierarchical bivariate random-effects model, with subgroup analyses by modality.

• Across all models, pooled sensitivity was 0.83 and specificity 0.87, with an AUC of 0.92; prediction intervals were very wide (specificity PI 0.03–1.00).
• Image-based models outperformed non-image models, with sensitivity 0.92, specificity 0.95, and AUC 0.98 versus 0.69, 0.72, and 0.79.
• For vascular compromise detection specifically, pooled sensitivity was 0.92 and specificity 0.91.
• Heterogeneity was substantial, QUADAS-2 flagged methodological concerns in several studies, and GRADE certainty was low.

A cross-sectional analysis of 600 consecutive postoperative rhinoplasty photographs from RealSelf.com applied the Facial Authenticity Localization (FAL) AI model, counting nasal-region heatmap activations as positives. Specificity was estimated on 200 presumed-unedited clinical photographs and sensitivity on 50 intentionally warped clinical photographs.

• FAL flagged 19.5% of public images (117/600) as probable nasal manipulations (95% CI 16.3–22.7%).
• The false-positive rate on presumed-unedited clinical photographs was 1.5% (3/200) (95% CI 0.51–4.32%).
• Sensitivity for Facetune-generated geometric warps was 100% (50/50) (95% CI 93.0–100%).

A structured literature review of PubMed/MEDLINE, Scopus, and Web of Science, with quality appraisal and narrative synthesis, evaluated CT-derived morphometrics, body composition, radiomics, and AI applications in complex ventral and incisional hernia repair.

• CT volumetrics, standardized loss-of-domain measures, muscle morphology, sarcopenia, myosteatosis, and adipose distribution were associated with fascial closure and need for component separation, as well as surgical-site occurrences.
• Emerging AI tools, including automated segmentation, radiomics, and machine-learning risk models, showed promising performance for quantitative image analysis and individualized risk prediction.
• The evidence base is predominantly retrospective and single-centre, with heterogeneous imaging definitions, small datasets, and limited external validation precluding widespread clinical implementation.

This development and evaluation study of 4538 CABG cases from MIMIC-IV tested LiteMedDoc, a locally deployable pipeline built on Llama 3.1 (8B) without fine-tuning, for generating brief hospital course summaries. Outputs on a 403-case held-out test set were compared with reference summaries using 8 NLP metrics and rated by 15 cardiac surgeons.

• Without any model training, LiteMedDoc nearly matched a fine-tuned model and exceeded a 70-billion-parameter model on all automated metrics spanning lexical overlap, semantic similarity, and clinical relevance.
• In a within-database cross-domain test on lobectomy cases, the framework after prompt adaptation outperformed both the base model and the CABG-fine-tuned model.
• Surgeons rated summaries above the prespecified acceptability threshold for completeness, correctness, readability, conciseness, and global quality, specifically noting their structure and conciseness.
• The pipeline combines chronological structuring of multisource inputs, retrieval of similar prior case summaries, and offline prompt optimization, with all processing performed locally.

This bibliometric analysis of the 50 most-cited articles on artificial intelligence in plastic and reconstructive surgery drew on a Web of Science Core Collection search (November 18, 2025), recording authorship, country, journal, funding, and citation counts. Articles were classified by AI application domain and plastic surgery subspecialty.

• The articles were published between 2001 and 2024, with citation counts ranging from 45 to 124.
• Most articles originated from the United States (n = 18; 1166 citations), and plastic surgeons were the most frequent authors (n = 17; 1332 citations).
• Imaging assessment was the most common AI application (n = 21; 1564 citations).
• Craniofacial surgery was the predominant subspecialty (n = 32; 2364 citations), with uneven adoption across other areas of plastic surgery.

This review summarizes the functional properties of electrospun piezoelectric nanofiber dressings and the biological mechanisms by which electrical stimulation promotes wound healing, with a focus on hard-to-heal wounds such as diabetic ulcers.

• The fibrous architecture of electrospun dressings is described as conforming to irregular wound contours, supporting rapid hemostasis, and acting as a barrier against microbial invasion.
• The piezoelectric effect converts micromechanical deformation into localized electrical signals in real time, which the authors link to modulation of cell behavior and accelerated tissue repair.
• The review compiles recent mechanistic studies of electrical stimulation in wound healing as a theoretical basis for the design and optimization of next-generation dressings.

This multiomics and mechanistic laboratory study integrated transcriptomic and proteomic profiling of patient-derived keloid and normal skin, then tested candidate regulators in primary keloid fibroblasts using gain- and loss-of-function, RIP-seq, and RNA stability assays, followed by two bleomycin-induced skin fibrosis mouse models.

• Multiomics profiling showed CAVIN1 consistently downregulated in keloids; its overexpression in keloid fibroblasts suppressed migration, invasion, collagen contraction, and extracellular matrix protein expression.
• CAVIN1 bound and stabilized the lncRNA GAS5, which inhibited Drp1/Fis1-mediated mitochondrial fission and ROS production, attenuating canonical TGF-β/Smad2/3 signaling.
• GAS5 silencing abrogated the antifibrotic effects of CAVIN1, supporting GAS5 as the required downstream mediator in fibroblasts.
• Database screening identified vorinostat as a CAVIN1-upregulating compound; both AAV-mediated CAVIN1 overexpression and vorinostat ameliorated fibrosis in the mouse models.

This preclinical study in female mouse models of proliferative vitreoretinopathy (PVR) tested intravitreal M1 macrophage-derived extracellular vesicles conjugated to anti-TGFβ1 antibodies via MMP-cleavable linkers (ACE), plus a variant adding anti-PDGFR antibodies (ACEPlus) evaluated in advanced disease and a patient-derived membrane xenograft model.

• Data mining of patient and mouse PVR tissue showed elevated TGFβ1 and M2 macrophage enrichment in the fibrotic microenvironment, which guided the vesicle design.
• After intravitreal injection, ACE selectively accumulated in lesions, where released antibodies neutralized TGFβ1 and the M1 vesicles inhibited M2 polarization, diminishing fibrosis.
• Adding anti-PDGFR antibodies (ACEPlus) prevented progression of retinal detachment in advanced-stage PVR, with efficacy confirmed in a patient-derived PVR membrane xenograft model.

This review synthesizes proposed mechanisms by which plant-derived exosome-like nanovesicles (PENs) act across the phases of skin wound healing and summarizes current isolation and characterization technologies.

• Compared with mammalian and microbial extracellular vesicles, PENs are described as offering scalable production, high biosafety, and low immunogenicity.
• In the inflammatory phase, PENs are reported to shift macrophage polarization, suppress inflammasome activation, and reduce oxidative stress.
• PENs are linked to enhanced angiogenesis via proangiogenic marker upregulation and ferroptosis inhibition, and to peripheral nerve repair through PI3K/ERK activation.
• Beyond wound closure, PENs are reported to support regeneration of hair follicles, sebaceous glands, and sweat glands, partly through Wnt/β-catenin signaling.

This experimental and computational mechanobiology study used reverse cell imprinting, atomic force microscopy, and a two-dimensional clutch model to examine focal adhesion (FA) tilting, then engineered rigid substrates with defined curvatures to impose tilt independently of stiffness.

• Imaging and atomic force microscopy showed a strong inverse correlation between FA tilting angle and substrate stiffness.
• The clutch model indicated that tilting emerges from force distribution across the FA-substrate interface and contributes to cell mechanosensing.
• Rigid substrates with defined curvatures imposed specific tilting angles and modulated the cellular mechanostate, allowing construction of a map linking curvature values to equivalent stiffness levels.