Plastic Surgery Weekly

A retrospective ACS-NSQIP cohort of 406 adults who had fibula free flap reconstruction for head and neck defects (2009–2023) was used to examine the association between the 5-item Modified Frailty Index (mFI-5) and 30-day outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.

• Medical complications rose with frailty, from 14.1% at mFI-5 = 0 to 34.3% at mFI-5 = 2 (p = 0.02), and included pneumonia and myocardial infarction.
• After adjustment, mFI-5 = 1 (aOR 1.84, 95% CI 1.01–3.47) and mFI-5 = 2 (aOR 3.45, 95% CI 1.38–8.57) independently predicted medical complications.
• An mFI-5 of 2 also predicted surgical complications (aOR 2.27, 95% CI 1.00–5.43), with the lower confidence bound at 1.00.

A multicenter retrospective cohort of 16 patients younger than 18 years underwent segmental mandibular resection for benign lesions, followed by immediate vascularized fibula free flap reconstruction with simultaneous immediate jaw reconstruction (IJR) and dental implant placement, at three US hospitals between 2020 and 2026. Clinical, functional, and growth outcomes were compared between immediate and long-term follow-up.

• There was no flap loss or bony non-union over a mean follow-up of about 3.5 years (range 381–2,161 days), and 6.5% of dental implants failed.
• All patients achieved normal oral function, and no developmental abnormalities were observed at the fibula donor site.
• The reconstructed mandible continued to grow, with mean vertical growth of 1.4 cm; condylar height increased by a mean of 2.84–5.84 mm (P < 0.01) and mandibular length by 1.43 mm (P = 0.037).

A systematic review of 19 studies reporting 25 VCA recipients with patient-level data identified 22 allograft explantations and three retransplantations (two face, one abdominal wall). Indications, rejection management, timing, and operative considerations were extracted.

• Uterus (32%), face (24%), and hand (16%) were the most common graft types, and median time to explantation was 12.5 months.
• Chronic rejection (44%) was the leading indication for removal, followed by perfusion-related complications (32%), medication non-compliance (24%), and patient request (12%).
• Retransplantation took place at a median of 7.3 years and was more technically demanding than the primary procedure because of scarring, distorted anatomy, and rejection-affected vessels, requiring more proximal anastomoses and nerve coaptations.

A single-center retrospective cohort of 31 patients with cT1–2 N0 oral tongue or floor-of-mouth SCC compared reconstruction with the islanded facial artery myomucosal (iFAMM) flap (n = 16) and the free anterolateral thigh (ALT) flap (n = 15). Operative time, complications, function (mouth opening, swallowing, speech), aesthetics, and hospitalization costs were compared with multivariable adjustment.

• Mouth opening, swallowing, and speech outcomes were comparable between the two pathways.
• Operative time was about 88 minutes shorter with iFAMM (514 vs. 603 min, p = 0.005).
• Aesthetic VAS scores were higher with iFAMM (6.8 vs. 4.9, p = 0.001).
• Hospitalization costs were about 38% lower with iFAMM (8,849 vs. 14,213 USD, p < 0.0001); flap pathway remained an independent predictor of all three primary outcomes on multivariable regression.

A systematic review of 19 studies (11 preclinical, 8 clinical; 6,743 records screened) assessed the learning curve for microvascular anastomosis on dedicated robotic platforms compared with hand-sewn technique. Outcomes included anastomosis time, time per stitch, microsurgical skill scores, and anastomosis quality.

• In preclinical studies, robotic anastomosis time fell by a mean of 18.5 minutes across attempts versus 8.4 minutes for hand-sewn, and time per stitch fell by 2.96 versus 1.58 minutes.
• Despite the steeper improvement, final robotic anastomosis time was still longer than hand-sewn (20.9 vs. 14.8 minutes).
• Preclinical skill scores improved slightly more with the robot (0.99 vs. 0.76), and Anastomosis Lapse Index scores were comparable between techniques.
• In clinical studies, robotic anastomosis time decreased by 18.0 minutes over successive attempts, and immediate patency ranged from 95.7% to 100%.

A structured narrative review of PubMed/MEDLINE literature on reconstruction after necrotizing fasciitis synthesizes evidence on debridement, wound-bed preparation, and coverage options to propose a timing-based, region-specific reconstructive algorithm.

• Radical initial debridement, repeated at 12- to 24-hour intervals, defines the final defect and is presented as the biological precondition for durable closure.
• Skin-sparing debridement reduces the wound area requiring graft coverage and increases delayed primary closure rates; negative pressure wound therapy, including instillation variants, serves as a bridge to definitive reconstruction.
• The proposed region-based algorithm matches delayed closure or split-thickness grafting to large planar wounds, local and pedicled flaps to perineal and scrotal defects, dermal templates to poorly vascularized beds, and free flaps to exposed critical structures or volume loss.
• Small retrospective series suggest high free-flap survival once source control and physiological stabilization are achieved, although these estimates are likely affected by selection bias.

A narrative review with illustrative clinical cases contrasts contemporary hair transplantation techniques with conventional non-transplantation approaches, such as tissue expansion and scar excision, for reconstructing scar alopecia of the scalp and facial hair-bearing areas after burns, trauma, and congenital conditions.

• Hair transplantation permits anatomically unrestricted transfer of follicular units to areas of aesthetic priority, restoring natural hairline morphology as well as facial hair-bearing subunits.
• Conventional expansion and excision are limited by geometric constraints, residual scars, prolonged treatment timelines, and an inability to recreate natural hairline transition zones.
• Transplantation is performed as staged local-anaesthetic day-case procedures, with reduced treatment morbidity, avoidance of visible scarring, and high patient acceptability reported by the authors.

A retrospective single-surgeon cohort of 10 consecutive adults with traumatic complete or extended partial brachial plexus injury and M0 elbow extension underwent long thoracic nerve transfer, either to the native triceps (early referral) or to a free functioning gracilis muscle transfer (late referral). Motor recovery was graded on the MRC scale, with ≥M4 defined as success, after at least 38 months of follow-up.

• Direct transfer to the native triceps in early-referred patients achieved M4 recovery in 5 of 6.
• In late-referred patients reconstructed with free functioning muscle transfer, 2 of 4 reached M4 and the other 2 reached M3.
• No major donor-site morbidity occurred, consistent with the rationale that selective distal harvest spares the segmental serratus anterior innervation.

A single-center retrospective study of 102 patients who had surgery for traumatic brachial plexus injury between 2013 and 2025 assessed neuropathic pain (S-LANSS, NPSI, VAS, IMBPIQ) before surgery, after analgesic therapy, and after surgery under a strict pain-tapering protocol. Logistic regression identified predictors of pain improvement (NPSI reduction >7.95 points), analgesic response, and motor recovery (MRC ≥3).

• Over a mean follow-up of 51 months, 57.8% achieved meaningful motor recovery and 50% achieved clinically meaningful pain improvement.
• Preoperative analgesics gave limited relief, with only 22% reaching meaningful improvement on medication alone.
• Postoperative motor recovery was the strongest independent predictor of pain improvement (OR 10.75, 95% CI 2.68–43.48).
• Higher preoperative NPSI scores also independently predicted improvement (OR 1.057, 95% CI 1.035–1.079), so patients with more severe baseline pain were more likely to reach the improvement threshold.

A retrospective cohort of 327 patients with posttraumatic neuropathic pain referred to a tertiary pain clinic was classified into three psychological clusters using a previously developed 15-item psychometric prediction model, and clusters were compared by psychological profile, treatment received, and global perceived outcome.

• A small cluster (n=21, 6.4%) showed the highest psychological burden, together with the highest rate of daily smoking and no employment.
• The largest group (n=193, 59.0%) showed intermediate features, while a third cluster (n=113, 34.6%) had the most favorable psychosocial profile and highest employment rate; psychological profiles differed significantly across clusters (p<0.001).
• Surgical interventions were performed in 20% of patients (n=67), and psychotherapy was applied most frequently in the high-burden cluster.

A multicenter retrospective review of 207 patients across nine level I trauma centers (2019–2023) characterized upper-extremity injury patterns, operative management, and outcomes in adults evaluated by hand surgery services after side-by-side all-terrain vehicle crashes.

• The hand was the most frequently injured region (76.8%), and open fractures occurred in 66.7% of patients, including 28% with Gustilo type IIIB or IIIC injuries.
• Patients averaged 1.5 operations during the index admission; reconstruction used dermal substitutes in 27%, rotation flaps in 10%, and free flaps in 4%.
• Among 158 patients (76.3%) followed for a mean of 31 weeks, infection occurred in 19.6% and 15.2% required operative debridement, with a mean of 2.6 total operations.
• Early amputation occurred in 18.4% and late amputation in 9.5% of patients with follow-up, for an overall amputation rate of 25.6%.

A multicenter matched cohort of 47 patients (50 repairs) compared processed nerve allograft with nerve autograft for mixed and motor nerve transections of the upper extremity distal to the axilla, testing noninferiority of motor recovery graded on the British Medical Research Council scale.

• Meaningful recovery (≥M3) was achieved in 80% of allograft repairs versus 64% of autograft repairs.
• Enhanced recovery (≥M4) was reached in 60% of allograft versus 28% of autograft repairs.
• Median MRC score was 4.0 with allograft versus 3.0 with autograft, and mean scores were 3.2 versus 2.5, with overlapping confidence intervals.

A systematic review of 18 studies (8 comparative cohorts, 10 noncomparative series) descriptively synthesized postoperative surgical complications and operative time for targeted muscle reinnervation and regenerative peripheral nerve interface after upper or lower extremity amputation.

• Comparative RPNI studies generally showed lower rates of delayed wound healing, surgical site infection, and revision surgery than standard amputation controls.
• Comparative TMR studies showed mixed complication findings, with some cohorts reporting higher delayed wound healing and infection rates, although revision surgery was often less frequent than after standard amputation.
• Both techniques lengthened operative time, by roughly 20 minutes to more than 2 hours depending on operative approach and institutional experience.

A retrospective cohort of 48 patients with severe cubital tunnel syndrome (2016–2024) compared subcutaneous ulnar nerve transposition alone (n=24) with transposition plus supercharged end-to-side anterior interosseous nerve transfer (n=24), with intrinsic muscle strength recovery at 12 months as the primary outcome.

• At 12 months, 75.0% of SETS patients (18/24) reached MRC grade 4 first dorsal interosseous strength, compared with none in the transposition-alone group (P<0.001).
• FDI compound muscle action potential amplitude improved by a mean of 1.87 mV with SETS versus 0.70 mV with transposition alone (P<0.001); complication rates did not differ significantly between groups.
• Disease duration under 12 months (OR 4.2, 95% CI 1.6–11.0) was the strongest independent predictor of favorable recovery after SETS, followed by preoperative FDI strength of MRC grade 2 or higher (OR 3.5) and age under 60 years (OR 2.7).

A retrospective single-center cohort of 167 adult burn patients treated with NexoBrid between 2020 and 2024 was divided into on-label (≤15% TBSA treated, n = 110) and off-label (>15% TBSA treated, n = 57) groups. Electrolytes, pH, base excess, lactate, hemoglobin, and hematocrit were tracked from baseline to day 3–4 after application.

• Off-label patients had much larger burns (mean TBSA 35% vs. 14%) and higher mortality (17.9% vs. 13%).
• Electrolyte shifts were transient: potassium rose and calcium fell briefly, and both normalized quickly without clinical consequence.
• Acid-base status remained stable, with improving base excess and no sustained lactate elevation.
• Hemoglobin and hematocrit declined significantly over time, more so in the off-label group; the authors attribute this to burn severity and treatment extent rather than to the enzyme itself.

A systematic review of 8 studies (64 to over 300,000 patients each) evaluated outcomes in hospitalized burn patients stratified by cannabis exposure, identified by toxicology, history, or administrative coding, including mortality, infection, thromboembolism, ventilation, length of stay, and opioid use.

• Cannabis exposure was not consistently associated with inpatient mortality, and national database studies found lower adjusted mortality among cannabis users.
• National database studies reported higher rates of ventilator-associated pneumonia, venous thromboembolism, and prolonged ICU stay in cannabis-using patients.
• Some single-center analyses reported increased opioid and anxiolytic requirements, along with higher wound infection rates, longer ICU stays, and more reoperations.

A longitudinal cohort of 26 adults with mid-dermal to full-thickness burns under 10% TBSA had swabs taken from the burn wound, the split-skin donor site and matched uninjured skin at surgery, graft check and clinic review (170 infection-free samples). The study tested whether the pre-grafting wound microbiome relates to subsequent graft healing.

• Before grafting, burn wounds already showed reduced microbial diversity and a distinct community structure compared with matched control skin. Commensal anaerobes (Finegoldia, Anaerococcus) were depleted and Pseudomonas and Acinetobacter were enriched.
• Donor sites acquired a wound-like microbiome and changed in parallel with the burns. However, post-grafting burn microbiota were not preferentially similar to matched donor sites, which argues against donor-to-burn microbial transfer.
• Lower burn wound diversity at surgery was associated with delayed healing, and baseline community structure differed in wounds that later required regrafting.

A systematic review of 10 studies with 414 patients (415 wounds) assessed whether early dermal scaffold application reduces later grafting and flap requirements in burn or trauma extremity wounds with exposed tendon or bone. Heterogeneity precluded meta-analysis, so outcomes were synthesized descriptively and stratified by aetiology.

• Across nine non-randomized studies (393 patients), only 9.7% healed without grafting, while 89.6% went on to skin grafting.
• Graft avoidance occurred in 16.7% of trauma patients versus 0% of burn patients. All graft-free trauma healing came from three studies of small, highly selected defects.
• In the single randomized trial, scaffold take succeeded in only 22.7% of patients and all needed grafting, whereas the graft-only arm achieved complete coverage. Scar quality was better with the scaffold (Vancouver Scar Scale 2.40 vs 7.45).
• No study included a flap comparator, so flap avoidance could not be assessed. Certainty of evidence was very low for five of seven outcomes and low for the other two.

A systematic review of 16 studies comprising 239 patients evaluated follicular unit grafts, split-thickness scalp grafts and hair follicle-derived biologic preparations for chronic cutaneous wounds. The primary endpoint was complete re-epithelialization during follow-up.

• Follicular unit grafts achieved an 84% overall closure rate across 80 wounds.
• Split-thickness scalp grafts achieved 100% complete healing across 54 wounds, with healing times of 24–35 days.
• Biologic follicular preparations were less consistent, with closure rates ranging from 30% to 100% across 70 wounds.
• Comparative studies consistently favoured hair follicle-containing grafts over inter-wound or between-patient controls. Adverse events were limited and mild.

A randomized non-inferiority trial of 102 patients with open venous leg ulcers (CEAP C6) at a French university hospital compared heel-free with conventional heel-wrapped compression bandaging over 4–6 weeks. The primary outcome was interface pressure 48 hours after the final bandage, analysed in the 85-patient per-protocol population.

• Mean interface pressure was 30.1 mmHg heel-free versus 28.4 mmHg heel-wrapped (difference 1.7 mmHg; 95% CI −1.3 to 4.6), which met the non-inferiority criterion.
• After adjustment for baseline circumference and sex, ankle circumference was 1.7 cm lower in the heel-free group, although the 95% CI (−3.35 to 0.04) just crossed zero.
• Among 48 patients who experienced both techniques, 23 (47.9%) preferred heel-free bandaging, indicating roughly evenly split preference.

A multicentre randomized controlled trial of 170 patients across 25 US sites compared purified native type 1 collagen matrix plus polyhexamethylene biguanide (PCMP) with standard care against standard care alone in hard-to-heal diabetic foot ulcers of 1–25 cm². Ulcers that shrank by 40% or more during a 4-week screening run-in were excluded, and the primary endpoint was complete closure within 12 weeks, confirmed 2 weeks later.

• Complete wound closure occurred in 42% with PCMP versus 27% with standard care alone (absolute difference 14.6%; 95% CI 0.15% to 27.9%; p = 0.047).
• Mean percent area reduction was 75.2% versus 58.1% in favour of PCMP.
• No adverse events or serious adverse events were attributed to PCMP.

A meta-analysis of 20 studies with 2,287 patients (6 RCTs and 14 observational studies; 3,376 breasts) compared prophylactic closed-incision negative pressure wound therapy with standard dressings after mastectomy, implant-based reconstruction or mammoplasty. Outcomes included total wound complications, infection, dehiscence, necrosis, seroma, haematoma, reoperation and implant loss.

• ciNPWT reduced total wound complications (RR 0.56, 95% CI 0.42–0.74; I² 71.9%; moderate certainty), an absolute risk reduction of 14% (31.8% to 17.8%).
• Dehiscence and necrosis were both significantly reduced (RR 0.48 and 0.67, respectively), with low heterogeneity for both.
• Subgroup analyses suggested stronger effects with BMI ≥30 and −125 mmHg settings (RR 0.41 vs 0.61 and 0.46 vs 0.65), but the subgroup differences were not statistically significant.

A retrospective single-centre cohort of 569 patients (600 breasts) compared immediate direct-to-implant reconstruction (465 breasts) with two-stage tissue expander/implant reconstruction (135 breasts) performed in China from 2014 to 2023, using propensity score full matching. Subgroup analyses examined whether postoperative radiotherapy modified complication risk.

• After matching, the expander group had significantly higher risks of any complication, reconstructive failure, device removal and exposure (all p ≤ 0.002).
• Without radiotherapy, the expander group still had higher failure, removal and exposure risks. With radiotherapy, most complications did not differ between techniques.
• In the radiotherapy subgroup, two-stage reconstruction was associated with a significantly lower risk of flap necrosis (p = 0.002).

A retrospective propensity-matched TriNetX cohort of 1,944 matched pairs of obese adults (from 6,082 eligible) compared immediate with delayed implant-based breast reconstruction. Short-term complications and long-term outcomes, including postmastectomy lymphedema, were assessed with risk ratios and survival analyses.

• Immediate reconstruction was associated with higher 90-day complication rates than delayed reconstruction.
• The increased lymphedema risk after immediate reconstruction persisted through 5 years and was confirmed by both Kaplan-Meier and Cox regression analyses.

This prospective multicenter observational study of 105 women with nipple-areola complex (NAC) loss, all reconstructed without NAC reconstruction, used a structured questionnaire to assess awareness, preferences, and decision-making about NAC replacement. It focused on customized silicone nipple epitheses (CNE).

• Of 105 participants, 82.9% had considered NAC replacement despite not having undergone it.
• Customized nipple epitheses were preferred by 20.2%, whereas surgical NAC reconstruction remained the leading choice at 56.4%.
• Women favoring epitheses tended to be older and earlier in recovery, and more often had breast-conserving therapy or skin-sparing mastectomy with implant-based reconstruction.
• The authors attribute limited epithesis uptake to insufficient patient education rather than lack of interest.

This propensity score-matched retrospective cohort of 415 immediate breast reconstructions (176 free flap, 239 implant-based; 2017–2023) at a single academic center compared patients living ≥30 versus <30 miles away. Analysis used 70 matched flap pairs and 79 matched implant pairs, assessing complications, resource use, opioid requirements, and costs.

• In the matched free flap cohort, far and near patients showed no significant differences in operative time, length of stay, ICU use, emergency visits, opioid use, complications, revisions, or financial outcomes.
• Total flap loss and thromboembolic events were rare in both groups and did not differ by distance from the center.
• In the matched implant-based cohort, distance was likewise not associated with differences in postoperative communication, emergency visits, complications, revisions, or cost measures.

This SANRA-guided narrative review of literature published from 2000 to March 2026 synthesizes evidence linking germline BRCA1/2 and TP53 mutations to breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). Studies were graded by Oxford CEBM levels, and the review sets out implications for reconstructive counseling and follow-up.

• Four evidence streams spanning 15 years consistently associate germline BRCA1/2 and TP53 mutations with elevated BIA-ALCL risk.
• A 2025 Memorial Sloan Kettering prospective cohort reported a 16-fold increased age-adjusted risk in BRCA1/2 carriers, with a wide 95% CI of 3.6–76.1.
• Mutation carriers appear to show compressed disease latency; the author proposes that impaired homologous recombination repair lowers the threshold for clonal T-cell expansion in the inflamed peri-implant capsule.
• The author recommends discussing autologous and smooth-implant reconstruction explicitly with BRCA carriers, avoiding textured devices, and adopting structured long-term surveillance.

This preregistered systematic review of 56 studies synthesized quantitative, qualitative, and mixed-methods research on shared decision-making processes, interventions, measurement, and implementation among women considering postmastectomy breast reconstruction. Quality was appraised with QualSyst, and findings were narratively synthesized.

• Randomized and quasi-experimental studies generally showed improved knowledge and values clarification after decision-support interventions.
• Effects on decisional conflict and preference concordance were heterogeneous across intervention studies.
• Reconstruction decisions were shaped by patient preferences, cultural factors, and clinical context rather than clinical factors alone.
• Major implementation barriers were time constraints, workflow limitations, and variable clinician engagement.

This retrospective consecutive series of 443 male massive-weight-loss patients (2018–2024) describes a single standardized protocol combining posterior body lift, chest reduction or mastopexy, and standard or fleur-de-lis abdominoplasty. Outcomes were assessed with BODY-Q and prospectively recorded complications, without a comparison group.

• Planning combined Pascal's Rule of 16 for circumferential marking with a pedicle-length-based decision pathway for chest management; mean resections were 1006 g posteriorly, 2148 g abdominally, and about 240 g per breast.
• Seroma (11.7%) was the most common complication, followed by abdominal hematoma (3.6%) and breast hematoma (2.9%).
• Partial nipple-areola necrosis occurred in 1.8%, with one T-junction necrosis requiring grafting and five patients needing revision surgery.
• BODY-Q satisfaction scores rose from the low 40s to above 80 postoperatively across all domains (p < 0.001).

This retrospective comparative cohort of 1,036 patients underwent combined facial and cervical rhytidectomy under IV sedation by a single surgeon between 2012 and 2025. It compared complications with (n = 556) and without (n = 480) TXA added to local anesthetic infiltration at standardized concentrations.

• TXA was given at 9.1 mg/mL for incisional infiltration and 0.8 mg/mL in tumescent solution, averaging 582.6 mg per case.
• TXA use was not associated with more minor or major ischemic events or with systemic complications.
• Distal flap vascular compromise requiring topical nitroglycerin occurred at similar rates in both cohorts, serving as a marker of mild flap vascular stress.
• No permanent nerve paralysis was observed in either cohort.

This randomized controlled trial of 60 patients compared a modified sub-brow blepharoplasty with orbicularis oculi muscle flap crossover fixation blepharoplasty for moderate-to-severe upper eyelid aging. Subjective and objective outcomes were assessed over 6 months.

• Groups were comparable at baseline in sex, age, and upper eyelid skin laxity grading.
• At 3 months, the modified technique showed a lower incidence of abnormal directional wrinkles in the upper eyelid.
• The modified-technique group also had higher physician GAIS scores and lower anxiety at 3 months.
• By 6 months, no between-group differences persisted in any subjective or objective outcome.

This anatomical study of 300 facial arteries in 150 individuals imaged with 3D CT angiography, supplemented by 10 arteries from 6 cadavers, characterized course, branching, termination type, and anastomoses using 10 morphometric parameters. Findings were analyzed by age and sex.

• The most common termination patterns were Type 2 (32%) and Type 1 (22%), and a columellar branch was present in 74% of cases.
• The artery ran significantly more laterally in men in the mandibular and perioral segments, whereas it was more lateral in women in the nasal segment.
• Older individuals showed a tendency toward a more superomedial course, closer to the orbital region and medial canthus, although these differences were modest.

This PRISMA-guided systematic review and single-arm meta-analysis of 39 studies (2064 patients, 3096 eyelids) pooled MRD1 change, anatomical success and reoperation rates after retractor-lengthening surgery for upper eyelid retraction. Subgroup analyses and meta-regression examined baseline severity, surgical macro-area, approach, etiology and spacer material.

• Pooled anatomical success was 85% (95% CI 80.6–89.1%), with a mean MRD1 change of 2.71 mm (95% CI 2.36–3.06).
• Preoperative severity explained most of the heterogeneity (β = 0.72 mm/mm), while surgical technique had no independent effect on lid position after adjustment; undercorrection correlated inversely with baseline severity (β = -0.33).
• The overall reoperation rate was 12%, with higher odds after levator-only procedures (OR 3.5) and levator/Müller recession-resection (OR 2.5); levator-only techniques also carried more overcorrection (OR 5.6).
• Autologous spacers were associated with higher success (88% vs 76%) and fewer reoperations (5% vs 25%) than non-autologous grafts.

This retrospective series of 50 consecutive patients undergoing tensioned reverse abdominoplasty (TRA) for aesthetic indications between 2019 and 2024 assessed preoperative inframammary fold position and its relationship to the nipple-areola complex. The aim was to determine how fold position affects the need for, and extent of, associated breast surgery.

• A caudally displaced inframammary fold was found in 19 patients (38%), all of whom had prior breast surgery; 78% of the whole cohort had a history of breast surgery.
• Concomitant breast surgery was performed in 29 patients (58%); among patients with a displaced fold, 10 underwent breast-base mastopexy, 8 full mastopexy and 1 unilateral breast-base mastopexy after declining bilateral correction.
• At 12 months, no secondary inferior migration of the inframammary fold was observed in any patient.

This review combines a literature overview with a retrospective cohort of 76 lower-limb soft tissue reconstructions after soft tissue sarcoma resection, mostly following external resections. All cases were managed with staged wound coverage.

• All reconstructions used staged wound coverage, with a mean interval of 18 days between resection and definitive reconstruction; more than half were completed within 14 days.
• The authors name plastic and reconstructive expertise within the sarcoma center as a key prerequisite for oncological safety and reconstructive reliability without delaying adjuvant treatment.
• Expedited pathological margin assessment and close collaboration with vascular surgery and radiotherapy are named as further prerequisites.

This single-patient case report describes nasal reconstruction in a 79-year-old man after hemi-rhinectomy for malignant melanoma. A free temporal artery posterior auricular skin (TAPAS) flap provided the internal lining, combined with a forehead flap and cartilage grafts.

• A free TAPAS flap restored the internal lining of the nasal vault and septum on one side of the nasal cavity, and a homolateral forehead flap resurfaced the external skin.
• The nasal framework was rebuilt with septal and auricular conchal cartilage, completing a three-layer reconstruction.
• The authors describe the technique as allowing one-stage lining reconstruction and note the flap's thin, pliable tissue and negligible donor-site aesthetic impact.

This single-patient case report describes an extended superolateral periosteal flap harvested along the superior orbital rim to within 2–3 mm of the supraorbital notch, reaching 35 mm in length. The flap was used for single-stage total lower eyelid reconstruction in a 71-year-old woman with basosquamous carcinoma.

• Excision with 5-mm margins created a 30 × 35 mm defect. The periosteal flap formed the posterior lamella, anchored to the medial canthal tendon and lined with advanced conjunctiva, and a cheek rotation flap reconstructed the anterior lamella.
• Early follow-up showed satisfactory eyelid position with transient chemosis; at 3 months a stable margin position was maintained without ectropion, entropion, symblepharon or lagophthalmos.
• The single-stage design avoided a period of monocular vision. Unlike a free tarsoconjunctival graft, the vascularized flap brings its own blood supply when the recipient bed is poorly vascularized.

This retrospective development and validation study of 14,679 ultrasound images from 908 patients (1,022 implant sequences) built a deep learning model to classify rupture, capsular contracture and hematoma. Four convolutional backbones were benchmarked on an independent patient-level test set of 197 implants.

• The DenseNet-based model reached 96.97% balanced accuracy with expert-guided spatial priors, falling to 88.67% under autonomous baseline conditions.
• Sensitivity was 100% for normal, rupture and hematoma classes and 87.88% for capsular contracture; false negatives were traced to variable morphology and coexisting pathologies.
• The system also generated quantitative morphometrics and five-zone spatial localization, including mean relative capsule thickness of 2.4 ± 0.4% in capsular contracture and mean relative fluid area of 13.9 ± 6.4% in hematoma.

This systematic review of 7 studies (5284 patients) evaluated machine learning and deep learning models for predicting breast cancer-related lymphedema. The authors extracted accuracy, sensitivity and specificity and, where available, comparisons with non-AI methods.

• Across the 5 studies reporting classification performance, AI models achieved a mean accuracy of 87.2% (range 81%–93.75%), with mean sensitivity of 85.5% and mean specificity of 87.6%.
• Commonly reported predictors were higher BMI, greater lymph node burden and receipt of chemotherapy or radiotherapy.
• Some studies also linked younger age and neoadjuvant chemotherapy to higher predicted risk.

This cross-sectional comparison of consent forms for 7 common procedures set American Society of Plastic Surgeons (ASPS) consents against ChatGPT-generated versions. Forms were scored for readability (Flesch Reading Ease, Flesch-Kincaid Grade Level, lexical density) and for content quality on a modified National Quality Forum-based scale.

• The ChatGPT versions were more readable: the Flesch Reading Ease score rose from 30.09 to 46.18 and the grade level fell from 13.59 to 10.53 (p < 0.001 for both).
• Conversion cut word count by 81% and lowered lexical density from 56.7% to 46.6%.
• Mean quality scores did not differ significantly (64.83% for ASPS vs 73.63% for ChatGPT, p = 0.27); ChatGPT scored higher for 4 of 7 procedures and ASPS for 3.

A phenotypic screen of focused compound libraries in human lymphatic endothelial cell spheroids tested epigenetic regulators, kinase inhibitors and stem cell modulators for prolymphangiogenic activity, seeking an alternative to the short-lived VEGF-C variant VEGFC-C156S. The lead compound then underwent target identification and testing in a mouse myocardial infarction model.

• Automated imaging of the sprouting assay identified several kinase inhibitors previously characterised as GSK3β inhibitors as prolymphangiogenic, with kenpaullone the most potent.
• Kenpaullone activated the canonical ERK pathway used by VEGF-C, but treated spheroids showed a transcriptional response distinct from VEGF-C stimulation.
• Kenpaullone-derived chemical probes and target-validation experiments identified MAP4K4 as the molecular target mediating the prolymphangiogenic effect.
• In mice after myocardial infarction, kenpaullone enhanced cardiac lymphangiogenesis and improved cardiac function.

An in vitro comparison of primary human mesenchymal stromal cells from three tissue sources (foetal skin, adult dermis and burn eschar) quantified ECM deposition, collagen and total protein content and ECM-related gene expression after culture optimisation with magnesium ascorbyl phosphate. Collagen maturity was also compared in native foetal versus adult skin.

• Foetal skin MSCs produced matrix with higher total protein and collagen content, at both gene and protein level, whereas matrices from adult dermal and burn eschar MSCs contained a larger proportion of non-collagenous proteins.
• Collagen subtype ratios differed by source: the collagen I:V gene ratio was lower in foetal MSCs, while the I:III ratio was higher in burn eschar than in adult dermal MSCs.
• Burn eschar MSCs showed greater matrix contraction with higher PLOD2 and fibronectin expression; both foetal and burn eschar MSCs showed increased ECM deposition and collagen insolubility.
• In native tissue, foetal skin contained more immature collagen, whereas adult skin contained more mature collagen.

An in vitro study of human adipose-derived stromal cells (ASCs) tested metformin preconditioning for effects on proliferation, fibroblast migration in co-culture, angiogenic factor secretion, endothelial-like differentiation under normal and high glucose, and adhesion to small intestinal submucosa scaffolds. Wound tissue transcriptomics were used to identify relevant pathways, including PI3K-AKT, JAK-STAT and AGE-RAGE signalling.

• Metformin increased ASC proliferation in a concentration-dependent manner with sustained expansion over time, and treated ASCs enhanced fibroblast migration in co-culture.
• Metformin-treated ASCs secreted more VEGF and FGF, consistent with a pro-angiogenic secretory profile.
• CD31 expression and tube formation increased under normoglycaemic conditions, particularly with added VEGF, but these effects were attenuated under high glucose.
• Metformin improved ASC adhesion to small intestinal submucosa scaffolds and supported endothelial marker expression in a three-dimensional environment.

A mechanistic study combining human scar tissue, primary hypertrophic scar fibroblasts and a rabbit ear model examined the collagen receptor DDR1. Scar was compared with adjacent normal skin, fibroblasts were stimulated with collagen III to activate DDR1, and a selective DDR1 inhibitor was given locally in vivo.

• Hypertrophic scar tissue showed increased DDR1 expression and phosphorylation, together with reduced PTEN, compared with adjacent normal skin.
• Collagen III-induced DDR1 activation enhanced fibroblast proliferation and myofibroblast differentiation, with increased collagen III and α-SMA expression.
• DDR1 activation suppressed PTEN expression and promoted nuclear translocation of NF-κB p65, a known inhibitor of PTEN transcription.
• In the rabbit ear model, local administration of a selective DDR1 inhibitor significantly attenuated scar formation.

A preclinical study using a diabetic mouse wound model and in vitro endothelial progenitor cell (EPC) assays tested exosomes from adipose-derived stem cells pretreated with combined hypoxia and substance P. CXCR4 knockdown, ChIP and dual-luciferase assays were used to define the mechanism.

• Exosomes from hypoxia plus substance P pretreated cells improved wound healing and angiogenesis in diabetic mice, assessed by wound area and CD31 and CD34 expression.
• In vitro, the pretreated exosomes promoted EPC migration, endothelial differentiation and tube formation.
• Pretreatment raised CXCR4 in the stem cells, their exosomes and on the EPC surface; CXCR4 knockdown abolished the pro-angiogenic effects in diabetic mice.
• Hypoxia plus substance P activated YAP signalling, driving TEAD3-mediated CXCR4 transcription, and blocking the YAP-TEAD interaction reduced CXCR4 expression.