Plastic Surgery Weekly

This systematic review and meta-analysis of 17 comparative studies (2261 patients) pooled clinically diagnosed lymphedema after axillary or inguinal lymph node dissection with versus without prophylactic lymphovenous shunting performed as immediate lymphatic reconstruction (ILR). Random-effects models were used, with subgroup analysis by limb and trim-and-fill adjustment for publication bias.

• Lymphedema occurred in 12.5% (100/800) of ILR patients versus 24.2% (353/1461) of controls, a pooled OR of 0.27 (95% CI 0.17–0.42).
• Between-study heterogeneity was moderate (I² = 52.8%), although the direction of effect was consistent across included studies.
• The treatment effect showed no significant difference between upper- and lower-limb procedures (Qm = 0.47; p = 0.49).
• Trim-and-fill analysis suggested small-study effects, but the protective association persisted after adjustment (OR 0.37).

This retrospective matched cohort of 126 anticoagulated patients reviewed head and neck free flap reconstructions (2009–2023) in patients on therapeutic anticoagulation for more than 1 month preoperatively, comparing hemorrhagic, thromboembolic and flap outcomes with matched non-anticoagulated controls.

• Anticoagulation (mainly warfarin 49.2% and apixaban 36.5%, chiefly for atrial fibrillation or VTE) was held a mean of 4.4 days preoperatively and resumed 7.8 days postoperatively.
• Hemorrhagic complications occurred in 11.1% and thromboembolic complications in 7.1% of anticoagulated patients, with 6 of 9 thromboembolic events causing flap failure.
• Matched controls had lower odds of any complication (OR 0.41) and of hemorrhagic complications specifically (OR 0.26), while thromboembolic odds did not differ significantly (OR 0.47, p = 0.19).

This retrospective cohort of 292 patients at a tertiary major trauma centre compared presentation, orthoplastic management and outcomes of open tibia, fibula or ankle fractures between adults under 65 (n=183) and those 65 or older (n=109) over 2018–2022.

• Older patients were mostly female (71%) and injured by ground-level falls (61%), yet more often had Gustilo-Anderson grade III fractures, with 52% classified as GA-IIIb.
• Older patients more often underwent single-stage skeletal fixation and soft tissue coverage (55%).
• Median length of stay was longer in older patients (16 vs 10 days), while complication rates were comparable (20% vs 14%).
• In-hospital mortality occurred only in the older cohort (10%), with nearly half of deaths due to acute preoperative physiological decompensation.

This consensus-based position paper from the World Society for Reconstructive Microsurgery Task Force on Lymphedema sets out recommendations for assessment, conservative and surgical treatment, and postoperative follow-up of extremity lymphedema.

• Initial assessment combines history, examination, standardized limb circumference measurements and clinical photography, with lymphoscintigraphy and ICG lymphography described as essential for characterization and surgical planning.
• Conservative therapy and compression are positioned as a critical preoperative optimization step before any surgical intervention.
• Surgery is tailored to disease severity and patient factors, spanning physiologic procedures (LVA, VLNT, LNVA) and excisional techniques such as liposuction and direct excision.
• Postoperative surveillance comprises noninvasive assessment every 3 months with annual imaging, with follow-up extending up to 5 years.

This prospective service evaluation of 378 patients (530 surgical sites) at a single NHS trust compared sterile gloves and gowns with sterile gloves alone during elective skin surgery under local anaesthetic, assessing surgical site infection, cost and carbon footprint over about 10 weeks in 2024.

• SSI rates were 3.9% with gloves and gown versus 4.0% with gloves only (279 sites in 179 patients vs 251 sites in 199 patients).
• The gloves-only approach yielded an estimated saving of about £1920 and 393 kgCO2e over the study period.
• The authors note that these savings would translate into substantial national cost and carbon reductions if extrapolated across national skin surgery activity.

A retrospective cohort of 40 synkinetic patients (180 corneal examinations, all before any surgery) tracked punctate epithelial erosion (PEE) scores and photographic scleral show across four phases: acute paralysis (0–6 months), synkinesis development (6–16 months), synkinesis plateau (16–63 months), and long-term follow-up (>63 months).

• Mean PEE score was highest during acute paralysis (1.59) and fell to 0.81 at long-term follow-up, with significant improvement versus the acute phase at every later interval (all p<0.05).
• The largest improvement occurred during synkinesis development (6–16 months), when mean PEE dropped to 1.05, before smaller further gains at plateau (0.91).
• In 24 patients with photographic assessment, scleral show at repose decreased from 10.75 mm to 7.88 mm (p<0.001), with significant reductions also during gentle and forceful eye closure.
• Complete forceful eye closure increased from 30% during acute paralysis to 100% at long-term follow-up.

A retrospective case series of 14 patients (mean age 62 years) underwent thin thoracodorsal artery perforator (TDAP) free flap reconstruction of scalp defects after malignant skin tumor excision, performed by a single surgeon at two institutions between 2016 and 2026.

• TDAP elevation was completed in 14 of 16 attempts (87.5%); in the remaining two patients no reliable perforator was found and a latissimus dorsi flap was raised instead.
• Mean flap area was 97 cm² with a mean pedicle length of 9.7 cm, anastomosed to the superficial temporal vessels with one artery and one vein; mean operative time including excision was 134 min.
• All 14 flaps survived; one venous thrombosis was salvaged by re-exploration and one episode of transient venous congestion resolved spontaneously.
• Over a mean follow-up of 17 months there was no local recurrence at the reconstructed site; one patient with angiosarcoma developed regional and distant recurrence.

This prospective longitudinal cohort of 204 amputees compared primary TMR (≤14 days after amputation, n=101) with secondary TMR (>14 days, n=103), modeling pain trajectories with mixed-effects models over up to 5 years (median follow-up 2.5 years).

• Long-term pain mitigation was achieved in 66% after primary versus 69% after secondary TMR (p = 0.681).
• Median time to pain mitigation was 5.4 months for primary versus 12.9 months for secondary TMR (p < 0.001); at 6 months, primary TMR patients had 3.12-fold higher odds of sustained relief.
• Pain scores favored primary TMR through 18 months, with a peak difference of 1.52 points at 6 months and no significant differences thereafter.

This retrospective case series of 6 patients reported long-term outcomes of spinal accessory to musculocutaneous nerve transfer for elbow flexion in brachial plexus birth injury, performed at a mean age of 3 months in children with global plexus injuries and followed for a mean of 12 years.

• First muscle contraction (AMS grade 1) appeared a mean of 6 months after surgery, and all patients reached mBMRC grade 4 or better elbow flexion by final follow-up.
• Upper trapezius strength was mBMRC grade 5 in all patients at final follow-up.
• Mean Mallet scores were 3.2 for global abduction and 4.2 for external rotation; PROMIS pain interference (48.3) and physical function (49.0) were within normal limits.
• Four of 6 patients had secondary surgery, but none required further surgery for elbow flexion.

This two-part study combined a cadaveric biomechanical study of 15 repairs and a comparative clinical cohort of 37 patients with FDP zone 1a injuries, comparing a nondrilling pull-out technique (NDPT; n = 17) with the classical Bunnell pull-out technique (BPT; n = 20).

• Cadaveric testing showed no significant difference in maximum tensile stress or pull-out force between NDPT (n = 7) and BPT (n = 8) repairs.
• NDPT patients had significantly lower median VAS pain scores at 24 hours and 3 days postoperatively (P < .05).
• At 6 months, DIP joint range of motion and Moiemen-Elliot outcome distributions were clinically comparable between the two groups.

A retrospective review of 105 consecutive patients undergoing brachial plexus reconstruction at a tertiary referral center (2021–2024) correlated preoperative clinical examination and magnetic resonance neurography (MRN) with intraoperative findings to define injury patterns and spinal nerve root graftability.

• Injuries were panplexus in 40%, upper plexus in 42%, and infraclavicular in 14%; the most frequent pattern was complete C5–T1 root avulsion (21%), followed by panplexus injury with at least one graft-eligible root (19%).
• The proportion of spinal nerves used for grafting was 35.8% for C5, falling to 11.5% for C6 and 5.7% for C7.
• MRN showed similar rates of potentially graftable C5 in panplexus and upper plexus injuries (49% vs 36%), despite the greater severity of panplexus injuries.
• Intraoperative exploration confirmed graftability in 28 of 29 C5 roots predicted to be graft-eligible by MRN.

A retrospective cohort of 815 digital amputations in 689 patients at a single tertiary trauma center (2014–2021) assessed the incidence of symptomatic neuroma and its association with amputation etiology, anatomical level, and intraoperative nerve management technique.

• The overall incidence of symptomatic digital neuroma was 6.26%.
• Trauma was the indication in 86.3% of amputations, and neither etiology nor amputation level was significantly associated with neuroma development.
• The most common nerve management techniques were traction neurectomy (28.3%) and bipolar cautery (29.2%); neuroma occurred in 9.96% after traction neurectomy vs 5.04% after bipolar cautery.
• Traction neurectomy carried an unadjusted odds ratio of 2.08 (95% CI 1.01–4.29) for symptomatic neuroma compared with bipolar cautery.

A prospective comparative study of 125 patients compared endoscopic (n = 70) with open (n = 55) carpal tunnel release on QuickDASH change and time to return to daily activities, work, and recreation. Subgroups were defined by occupational and recreational hand-demand level.

• Mean QuickDASH change favored ECTR (−7.9 vs +2.9 points, P = .026), but standard deviations exceeded 25 points in both groups.
• Time to return to activities of daily living and to work did not differ significantly between ECTR and OCTR across the whole cohort.
• ECTR patients returned to recreational activities earlier than OCTR patients (14 vs 31 days, P = .002).
• Among patients with medium or heavy occupational demands, ECTR shortened return to work (14 vs 36 days). Among patients with high hand-demand recreation, it shortened return to those activities (25 vs 60 days).

A retrospective cohort of 84 patients (104 diaphyseal metacarpal fractures) at a level I trauma center compared closed reduction with percutaneous K-wire pinning, plate-and-screw ORIF, and intramedullary screw fixation. Outcomes were time to motion, time to full range of motion, union, complications, and reoperation, adjusted for patient and fracture factors.

• Motion began at a median of 16 days after intramedullary fixation and 14 days after ORIF, versus 33 days after K-wire pinning.
• Median time to full ROM was 37 days with intramedullary fixation, compared with 44 days after ORIF and 114 days after K-wire pinning (P < .001).
• Patients treated with intramedullary fixation were more likely than ORIF patients to reach full ROM at final follow-up (odds ratio 12.3, 95% CI 2.1–73.5).
• Complication and union rates were similar across the three techniques, with no fixation method showing an excess of adverse events.

A multicenter randomized controlled trial of 143 patients with chronic full-thickness diabetic foot wounds compared a composite ovine forestomach matrix and hyaluronic acid product (OFM-HA) plus standard of care against standard of care alone. The primary endpoint was the proportion of wounds healed by 12 weeks.

• In the modified intent-to-treat population, 46% vs 24% of wounds healed by 12 weeks (31/68 vs 17/72; p = 0.008).
• Kaplan-Meier time-to-healing analysis favored OFM-HA plus standard care over the 12-week period (log-rank p = 0.023).
• No unexpected safety-related events were observed.

A cross-sectional geospatial analysis of 3,109 US counties (population 329 million) estimated road-network drive time from each county's population-weighted centroid to the nearest verified burn center. Drive times were compared across census regions and rural-urban categories and related to median household income.

• Unweighted mean drive time was 1.96 hours, but the population-weighted mean was 0.92 hours, reflecting the concentration of residents in urban areas.
• 35.6% of counties (10.8% of the population) had drive times over 2 hours, and 8.6% of counties (1.7% of the population) exceeded 4 hours.
• The West had the longest mean drive time (3.08 hours; 63.3% of counties over 2 hours). Small-town and rural counties had median times of 2.18 and 1.76 hours, versus 0.86 hours for metropolitan counties.
• Lower median household income was associated with longer drive time, but the association was weak nationally (R² = 0.100). It was strongest in the West (regional R² up to 0.273).

A meta-analysis of 9 randomized comparisons (944 participants) pooled 12-week complete closure of diabetic foot ulcers treated with placental, amniotic, chorionic, or umbilical cord-derived CAMPs plus standard care versus standard care alone. It used random-effects models with Hartung-Knapp adjustment, RoB 2 for risk of bias, and GRADE for certainty.

• Complete closure at 12 weeks occurred in 59.0% of product-treated versus 35.8% of control participants (RR 1.70, 95% CI 1.31–2.20).
• Heterogeneity was moderate (I² = 51.9%), and the prediction interval crossed the null (0.93–3.11).
• The effect was robust in sensitivity analyses, including leave-one-out (RR 1.59–1.81) and exclusion of the single high-risk-of-bias trial (RR 1.73).
• Certainty of evidence was rated moderate, downgraded once for inconsistency across trials.

A single-centre pilot randomised controlled trial of 42 critically ill patients compared cold atmospheric plasma (1-minute applications on postoperative days 1, 3 and 5) plus standard wound care against standard care alone for early tracheostomy wound healing. The primary endpoint was percentage reduction in wound area through day 7, measured by a blinded outcome assessor.

• By postoperative day 7, wound area had decreased by 30.3% with CAP versus 23.6% with standard care, a difference that did not reach significance (p = 0.15).
• Mixed-effects modelling adjusted for baseline area estimated a wound area decline of 0.08 versus 0.06 cm²/day (p = 0.17), again favouring CAP without significance.
• No treatment-related adverse events were observed, and the protocol proved feasible in critically ill ICU patients.

The MATHCOW study, a prospective open-label cohort of 173 patients with hard-to-heal diabetic foot ulcers, venous leg ulcers or ulcers with an ischaemic component, evaluated RGTA (CACIPLIQ20) added to optimal local care. The primary outcome was complete ulcer closure within 20 weeks.

• Complete closure at 20 weeks occurred in 28.9% of the intention-to-treat population (50/173) and in 40.4% of the per-protocol population (46/114).
• Closure rates differed by aetiology: 43.7% for venous ulcers and 46.2% for diabetic foot ulcers, but only 14.6% for arterial ulcers.
• Clinician global impression, pain and ulcer area also improved, and adverse events were recorded in 4% of cases.

A structured narrative review of incisional NPWT literature from 2013 to 2026 synthesised clinical studies on closed surgical incisions across elective, emergency and reconstructive settings, with device technical characteristics extracted separately from manufacturers' instructions for use. The authors built a clinical-requirement-first framework for device selection, labelling each component by its evidence source.

• The evidence supports selective rather than routine use, with the greatest benefit in high-risk incisions and where oedema, superficial fluid accumulation or limited soft-tissue coverage drive wound morbidity.
• Published studies test complete proprietary systems rather than isolated technical variables, and the only randomised head-to-head comparison of two commercial systems was small and found no difference.
• Treatment-related adverse events remain relevant, particularly in fragile skin or when drainage exceeds the dressing's declared fluid capacity.
• The framework weighs anticipated fluid handling, perilesional skin tolerance, seal feasibility and intended duration, and is presented as decision support rather than a validated algorithm.

A PROSPERO-registered systematic review of 15 studies (1,020 patients) examined preoperative or postoperative physical therapy after implant-based or autologous breast reconstruction, assessing shoulder range of motion, pain, upper-limb function and quality of life by narrative synthesis.

• Early, structured physiotherapy consistently improved short-term shoulder range of motion, upper-limb function and quality of life without increasing surgical complications.
• Starting rehabilitation within two weeks postoperatively accelerated recovery of flexion and abduction compared with traditional four-week immobilisation protocols.
• Functional outcomes differed between implant-based and autologous reconstruction, suggesting distinct rehabilitation needs; adjuncts such as acupuncture or meditation added little benefit.

In a prospective cadaveric dissection of 100 thighs from 50 fresh female cadavers, perforators within the PAP flap harvest territory were traced back to their source vessels. Origin, pedicle number, course, branching, pedicle length, venous anatomy and spatial distribution were recorded and organized into a 4-level descriptive classification.

• Every thigh had a profunda femoris perforator, but non-profunda origins were also found: common femoral (14%), superficial femoral (7%), obturator (5%) and inferior gluteal (2%).
• Profunda pedicles were single in 64% of thighs, double in 33% and triple in 3%, with a mean pedicle length of 11.7 ± 2.2 cm; distal branching ranged from 1 to 5 perforators.
• Most perforators (97%) followed a musculocutaneous course, and paired venae comitantes were present in only 39% of profunda pedicles.
• The highest-density perforator zone lay about 13 cm distal to the genitofemoral fold and 2.8 cm posterior to the gracilis border.

This propensity score-matched retrospective cohort of 822 tissue expanders compared immediate expander-based breast reconstruction with versus without a standardized drain antisepsis protocol. The expanders were drawn from an unmatched pool of 1,765 expanders in 1,193 patients.

• The protocol used a chlorhexidine disc at the drain exit site, changed every 7 days, plus daily irrigation of the drain bulb with Dakin's solution, both continued until the drain was removed.
• After matching on comorbidities, surgical details and oncologic treatment (411 expanders per group), surgical site infection was 11.2% with antisepsis vs 16.3% in controls (p = 0.033).
• Infection-related expander explantation was also lower with the protocol (5.8% vs 10.2%), p = 0.021.

This prospectively maintained single-center cohort of 1,180 immediate implant reconstructions (924 patients, Paris Breast Centre, 2005–2024) evaluated direct-to-implant reconstruction aiming for total musculofascial coverage without acellular dermal matrix. Outcomes were early complications, implant loss, delays to adjuvant therapy and revision procedures.

• Over a median follow-up of 38 months, the early complication rate was 23.0%, mostly infection (5.6%) and seroma (5.5%).
• Implant loss occurred in 2.1% of reconstructions, and 7.3% needed an unplanned reoperation.
• On multivariate analysis, increasing age, breast weight and implant volume independently predicted complications; adjuvant chemotherapy and radiotherapy started within normal timeframes, with only minor delays in patients who had complications.
• Second-stage aesthetic procedures were performed in 51.9% of patients, most often fat grafting.

This matched retrospective cohort of 88 patients aged 65 or older (30 direct-to-implant, 58 two-stage expander) used 1:2 Mahalanobis matching on age, BMI, smoking, radiation, chemotherapy, diabetes and hypertension. It compared total hospital costs, from the index operation to one year after the final planned reconstruction, along with operative time and complications.

• Unadjusted mean total cost was $12,379 for direct-to-implant vs $16,653 for expanders (p = 0.003), and operative time was 201 vs 353 minutes (p < 0.001).
• After adjustment for implant plane, laterality and baseline characteristics, direct-to-implant remained associated with 15% lower costs (p = 0.03), driven by 36% shorter operating room time.
• The odds of any complication did not differ between groups (p = 0.22).

This CME review covers biologic matrices and synthetic meshes in breast reconstruction and in aesthetic operations including augmentation, mastopexy and reduction. Its learning objectives address material types, outcome evidence and patient-specific material selection.

• Materials are described by structural characteristics and clinical indications, covering reconstructive use and emerging roles in augmentation, mastopexy and reduction.
• The review compares complication rates, capsular contracture prevention and aesthetic outcomes across material types, including differences in safety, cost-effectiveness and long-term performance.
• Material selection is framed around patient-specific factors, procedural context and surgical goals, and the authors acknowledge gaps in the current literature.

This systematic review of 13 studies including 3,496 patients (randomized trials and cohort studies, PRISMA 2020, searched through March 2025) evaluated perioperative tranexamic acid in breast surgery. Outcomes were hematoma, seroma, drain output and duration, and other adverse events.

• In mastectomy and breast reconstruction, tranexamic acid consistently reduced drain output, seroma and hematoma.
• Drain output fell by 30–33% in several studies, and earlier drain removal was reported.
• In reduction mammaplasty, results were inconsistent: some studies found less hematoma and drainage, while others found no significant difference.

This nationwide retrospective claims analysis of 114,141 mastectomy and 44,374 reconstruction episodes used Korean Health Insurance Review and Assessment Service data from April 2015 through December 2023. It described trends in reconstruction volume, type, timing and hospital setting during the National Health Insurance reimbursement era.

• The ratio of reconstructions to mastectomies rose from 23.8% in 2015 to 56.9% in 2023 (p for trend < 0.001), although a July 2017 revision of mastectomy coding limits interpretation of the 2017–2018 jump.
• Implant-based reconstruction rose from 56.8% to 82.0% of all reconstructions, while the autologous share fell.
• Episodes classified as immediate reconstruction rose from 65.1% to 82.2%; autologous reconstruction made up a larger share of delayed cases.
• Reconstruction remained concentrated in tertiary hospitals throughout the study period.

This cross-sectional analysis of 389 explanted implants from 219 patients used 16S rRNA sequencing to compare implant microbiome diversity and composition by pocket plane (subpectoral vs subglandular) and incision (inframammary fold, periareolar, transaxillary), adjusting for capsular contracture, implantation time, surface texture, smoking and within-patient clustering.

• Subpectoral (n=336) and subglandular (n=53) implants showed no differences in diversity, community composition or dominant genera (Shannon 1.7 vs 1.7; PERMANOVA padj = 0.46).
• Periareolar implants (n=45) had higher richness and a distinct community composition compared with IMF implants (n=308; Bray-Curtis padj = 0.004).
• Microbiome composition did not differ significantly between IMF and transaxillary access (n=36; padj = 0.12).

This cross-sectional 3D surface imaging study of 667 participants (280 men, 387 women) compared averaged, landmarked facial scans of adults aged 25 to 35 with those aged 65 and older. Vector maps and landmark tracking were used to model the direction and magnitude of skin displacement with age.

• Across most of the face, skin moved from superior to inferior relative to the nasion in the averaged older model.
• The upper face and cheek down to the nasal base showed minimal displacement of 0 to 2 mm, with skin stretching progressively below that level toward the jawline.
• Retrusion of the lips emerged as a major determinant of the nasolabial crease/fold complex.
• Body weight had a major effect on the vectors of facial shape change with age.

This retrospective cohort of 423 consecutive patients at a high-volume aesthetic clinic compared transcutaneous (n=174) with transconjunctival (n=249) fixation in non-incisional double eyelid surgery. Crease retention was analyzed with Kaplan-Meier and Cox regression adjusted for age, sex, eyelid thickness, eyelid design, and puffy eyelid status.

• Kaplan-Meier analysis showed significantly higher crease retention with transconjunctival fixation (log-rank p < 0.001).
• Transconjunctival fixation was associated with a hazard ratio for crease loss of 0.43 (95% CI 0.29–0.64), unchanged after multivariable adjustment.
• Age, sex, eyelid thickness, and eyelid design were not independently associated with crease loss.
• Baseline demographic and anatomical characteristics were comparable between the two fixation groups.

This retrospective single-surgeon case series of 209 consecutive patients (2001–2024) reviewed saline implants lowered for superior malposition by lower capsulotomy alone or with limited lower partial capsulectomy. Patient, implant, and operative variables and intraoperative capsule findings were documented.

• All cases showed a normal fibrous capsule intraoperatively, without pathologic thickening.
• Mean time from augmentation to revision was 13.3 months (range 6–66), with most cases presenting within the first postoperative year.
• Ptosis was present in 46% of patients (mean nipple-to-crease distance 8.0 vs 6.11 cm in non-ptotic patients); 60% were parous and mean implant size was 429 cc.
• Lowering took a mean of 43.7 min unilaterally and 70.8 min bilaterally.

This retrospective single-surgeon cohort of 823 patients (2021–2023) compared conventional mattress suture fixation (n=405) with a novel kite-shaped fixation (n=418) of the rotated quadrangular cartilage flap to the anterior nasal spine in low septal strip preservation rhinoplasty. Outcomes were hump recurrence and revision surgery.

• Hump recurrence fell from 4.6% with conventional fixation to 1.2% with kite fixation.
• Revision surgery was required in 4.3% of the conventional group versus 1.1% of the kite group.
• The kite method redistributes suture loop tension into a triangular configuration intended to prevent backward rotation of the septal flap.
• Demographic characteristics were comparable between groups.

This retrospective CT angiography study of 385 adults (770 hemifaces) mapped six facial artery branches bilaterally, assessing terminal branching, dominance, ophthalmic-origin angular arteries, and facial-ophthalmic anastomoses, with demographic associations tested by chi-square.

• Branching was highly variable, with 70 distinct bilateral pattern combinations identified.
• The facial artery most commonly terminated as the nasal artery (35.5%) or the alar artery (27.7%).
• Facial-ophthalmic connections were common, with ophthalmic-origin angular arteries in 19.5% of individuals and direct anastomoses in 8.3%.
• Facial artery dominance was associated with more ipsilateral branches and more ophthalmic-origin angular arteries (p < 0.01); age and sex showed no association.

A systematic review of 44 studies (3043 patients) evaluated sentinel lymph node biopsy in non-mucosal cutaneous squamous cell carcinoma, assessing detection, positivity, false-negative and complication rates, and tumour features associated with nodal positivity.

• Among 2956 patients undergoing SLNB, a sentinel node was identified in 96.9% and 10.9% were positive; the complication rate was low at 3.2%.
• False negatives occurred in 1.7% of cases, corresponding to a false-negative rate of 13.2%.
• SLNB-positive patients had larger tumours (4.24 vs 2.88 cm) and deeper invasion (9.81 vs 4.75 mm), with more perineural invasion, poor differentiation, and T2 disease; sex, immunosuppression, and location did not differ significantly.
• A positive SLNB was associated with higher recurrence (24.3% vs 4.2%) and disease-specific mortality (18.2% vs 3.7%) (p < 0.0002).

A population-based SEER cohort of 1202 patients with primary Ewing sarcoma of bone (2000–2021) compared overall survival across limb-salvage surgery, local excision, amputation, and no surgery using Kaplan-Meier analysis and multivariable Cox regression.

• Median age was 16 years and overall 5-year OS was 65.3%; limb salvage was used in 36.9%, local excision in 16.1%, and amputation in 7.3%, with 5-year OS of 77.0% after limb salvage.
• On multivariable analysis, survival after limb salvage did not differ significantly from amputation (HR 1.356, 95% CI 0.906–2.029, p = 0.139).
• Local excision (HR 1.424) and no surgery (HR 1.504) were each independently associated with worse overall survival.
• Age ≥ 18 years, tumor size > 80 mm, distant disease, and absence of chemotherapy were also independent predictors of poorer survival (all p ≤ 0.001).

A retrospective single-centre cohort of 49 patients with melanoma or extremity soft tissue sarcoma treated with isolated hyperthermic limb perfusion (2014–2024) assessed complications (Clavien-Dindo), regional toxicity (Wieberdink), and clinical and laboratory predictors of adverse outcomes.

• Complications occurred in 32 patients (65.3%), mostly within the first 3 postoperative days; 11 (22.4%) were Clavien-Dindo grade ≥ 3.
• Severe regional toxicity (Wieberdink grade ≥ 4) was seen in 6.1%, and early mortality occurred in 3 patients.
• Pre- and postoperative albumin and CRP on postoperative days 3 and 5 were significantly associated with severe complications.
• Modified Systemic Inflammation Scores showed no significant relationship with postoperative outcomes.

A retrospective National Cancer Database cohort of 2241 patients with malignant peripheral nerve sheath tumors (2005–2023) assessed whether neoadjuvant radiotherapy, given to 24.2%, was associated with R0 resection and overall survival. Analyses tested an interaction with metastatic status using frailty Cox models, 1:1 propensity matching, guarantee-time sensitivity analyses, and causal mediation.

• Neoadjuvant radiotherapy more than doubled the odds of R0 resection (OR 2.17, 95% CI 1.60–2.98) but was not associated with improved overall survival in the full cohort.
• Metastatic status modified the association (interaction p < 0.001); in metastatic patients, neoadjuvant radiotherapy was associated with better survival (matched HR 0.41, 95% CI 0.23–0.72).
• In localized disease there was no survival benefit, and survival appeared worse in some analyses.
• The metastatic signal persisted across guarantee-time sensitivity analyses but was not mediated by margin status.

A retrospective series of 21 patients with Ewing sarcoma of the foot or ankle reviewed long-term survival and function after local control by surgery alone (n = 16), surgery with radiotherapy (n = 1), or definitive radiotherapy (n = 4); among surgical patients, 11 underwent amputation and 6 limb salvage.

• Disease-specific survival was 65% at 5 years and 46% at 10 years.
• Tumors arising in the hindfoot had the worst 5-year overall survival, at 16% (p = 0.003).
• Metastatic presentation was not significantly associated with disease-specific death (HR 2.45, p = 0.14) but was strongly associated with definitive radiotherapy (OR 22.5, p = 0.01).
• Five-year MSTS scores were similar after primary amputation and limb salvage (79% vs 78%, p = 0.14).

A scoping review of 77 studies reporting 98 explainable machine learning models for adult surgical site infection (SSI) prediction mapped data sources, modeling methods, and explanation outputs, with methodological quality assessed using PROBAST+AI.

• Of 98 models, 72 (73.5%) were prognostic and 26 diagnostic; 81.8% of studies addressed a single specialty, most commonly gastrointestinal surgery (42.9%).
• Forty models (40.8%) were black-box models explained post hoc, with SHAP combined with ensemble learning the leading approach (45%); regression made up half of the inherently interpretable models.
• Prognostic models most often included health and lifestyle factors (83.3%), which were also the most frequently important predictors across SSI types.
• Diagnostic predictors varied by SSI type: postoperative interventions for composite SSI, vital signs and administrative codes for superficial SSI, recovery status for deep SSI, and vital signs for organ-space SSI.

A single-center retrospective in silico study of 200 women (100 with tuberous breast deformity, 100 controls; 400 frontal and lateral photographs) benchmarked GPT-4o, Claude 3 Opus, Gemini 2.5 Pro, and DeepSeek V3 against a surgeon-established reference standard. Model-generated treatment plans were scored 1–5 by two blinded plastic surgeons.

• GPT-4o achieved the highest accuracy (0.94), with sensitivity 0.92, specificity 0.93, and AUROC 0.88.
• The remaining models reached accuracies of 0.82–0.90 (Claude 3 Opus 0.90, DeepSeek V3 0.85, Gemini 2.5 Pro 0.82).
• Treatment-plan quality tracked diagnostic performance, with GPT-4o scoring 4.0 ± 0.4 versus 2.3–2.8 for the other models; inter-rater agreement was excellent (ICC = 0.94).

A narrative review of 13 studies identified from MEDLINE, Embase, and the Cochrane Library mapped artificial intelligence applications in facial palsy onto stages of the facial reanimation care pathway, from diagnosis through rehabilitation.

• Evidence clustered in diagnosis, severity assessment, and postoperative follow-up, where AI automated facial grading scales, quantified asymmetry, and extracted dynamic motion features from photographs and video.
• Several machine learning and deep learning models showed strong correlation with clinician-assigned scores, often exceeding the inter-rater reliability of traditional grading systems.
• Prognostic modeling, preoperative planning, and rehabilitation were addressed by few studies; emerging uses included outcome prediction, three-dimensional symmetry analysis, and assessment of spontaneous emotional expression after reanimation.

This preclinical study in murine and canine models of volumetric muscle loss tested a decellularized extracellular matrix (dECM) yarn scaffold produced by 3D weaving of rotary-cut yarns, assessing functional regeneration and immune mechanisms with single-nucleus RNA sequencing.

• The woven scaffold achieved full interconnectivity and high porosity with precise structural control, addressing the dense architecture that limits cell infiltration into conventional dECM.
• In murine defects, the scaffold significantly improved muscle mass and strength restoration, together with vascularization and innervation.
• Single-nucleus sequencing showed fewer SPP1+ neutrophils and more CD206+/IGF-1+ macrophages, whose IGF-1 secretion stimulated PAX7+ muscle cell growth via IGF-1R signaling.
• Regenerative efficacy was reproduced in a canine model, which the authors cite as support for translational potential.

This review synthesizes high-throughput and single-cell sequencing data on the cellular composition of pathological scars (hypertrophic scars and keloids) and evaluates emerging precision medicine strategies.

• Pathological scars are characterized as a profibrotic and proangiogenic niche shaped by mesenchymal, endothelial, epithelial, and immune cell populations.
• Sequencing has resolved cellular heterogeneity and intercellular communication within the scar microenvironment, alongside disease-specific transcriptional changes.
• Precision strategies discussed span biomarker-driven diagnostics, targeted biological therapies, and novel drug delivery systems.

This review examines the mechanisms and translational potential of viable microalgae and microalgal products in burn, traumatic, infected, and diabetic wounds, and compares them with existing oxygenation and antimicrobial strategies.

• Viable microalgae combine light-regulated oxygen generation with antimicrobial, anti-inflammatory, antioxidant, immunomodulatory, and intrinsic bioimaging properties.
• Microalgal cells or products have been incorporated into hydrogels, 3D-bioprinted scaffolds, and microneedles, as well as electrospun matrices and coatings, for localized oxygen and drug delivery.
• Key barriers include immune-mediated clearance, uncertain survival and photosynthetic persistence in hostile wounds, limited light penetration, biosafety, and manufacturing standardization.
• The authors judge the field promising but early-stage, with platform suitability differing by wound type.

This preclinical in vitro and diabetic mouse study developed a photo-crosslinkable hyaluronic acid hydrogel bearing the integrin αvβ3 agonist peptide FZ1 via an acid-labile Schiff base bond (HA-c-FZ1) and tested it on infected full-thickness wounds, with transcriptomic and protein-level mechanistic analyses.

• The hydrogel showed high FZ1 loading and accelerated peptide release under acidic conditions, with tunable mechanics and predictable swelling.
• In vitro, it promoted keratinocyte proliferation and migration, reduced reactive oxygen species, and inhibited S. aureus and E. coli survival.
• In infected diabetic wounds, it accelerated wound closure with lower bacterial burden and enhanced re-epithelialization, collagen deposition, angiogenesis, and perfusion.
• Mechanistically, it attenuated NF-κB inflammatory signaling, promoted M2 macrophage polarization, and activated FAK-AKT-dependent angiogenesis.

A preclinical bench and mouse autologous fat-grafting study tested VEGF-loaded core-shell microneedles that pair a ROS-responsive silk fibroin shell with a grooved, lipid-adsorbing PLGA core. Graft retention, vascularization, inflammation, and adipose remodeling were assessed by imaging, histology, immunofluorescence, RNA sequencing, and western blotting.

• The ROS-responsive shell degraded early under oxidative stress, providing localized VEGF release while limiting ROS-induced cell and mitochondrial damage in vitro.
• Once the shell degraded, the exposed grooved PLGA core drew lipid away from the graft through capillary-driven directional adsorption, targeting the later lipid-accumulation phase.
• Treated mouse grafts showed improved retention with less cystic degeneration and fibrosis, along with increased vascularization and adipose remodeling.
• Transcriptomic and protein analyses showed activation of PPAR signaling, with suppression of NF-κB, TNF, IL-17, and toll-like receptor inflammatory pathways.

A preclinical bioengineering study in a murine hindlimb ischemia model evaluated human vascular organoid sheets bioprinted from hPSC-derived endothelial and smooth muscle cells in a GelMA bioink. Perfusion, limb salvage, graft integration, and graft-cell remodeling were assessed by laser speckle imaging, histology, intravital two-photon imaging, and single-cell RNA sequencing.

• Co-bioprinting endothelial with smooth muscle cells accelerated vascular network formation, producing stable, interconnected structures that matured progressively in culture.
• After transplantation, the sheets improved blood perfusion and limb salvage and promoted repair of ischemic tissue.
• Intravital imaging detected circulating dextran within graft-derived vessels at days 14 and 28, confirming perfusion of the construct by the host circulation.
• Post-transplant single-cell sequencing showed graft endothelial cells shifting toward venous-biased and inflammatory states, with NF-κB and stress-program activation.