Plastic Surgery Weekly

A retrospective analysis of prospectively collected data from 87 patients (109 examinations) assessed preoperative ultrasound mapping of LVA sites in scintigraphically confirmed limb lymphedema, with intraoperative findings as the reference standard. Positive predictive value, Bland-Altman agreement, and examination time were evaluated.

• Of 285 ultrasound-localized sites selected for surgery, 272 were confirmed intraoperatively, a PPV of 95.4% (95% CI 92.3–97.5).
• The 13 false positives were independent of tissue thickness, vessel size, depth, and distance (all p > 0.17).
• Ultrasound diameters showed minimal bias against intraoperative measurement: +0.13 mm for lymphatics and −0.10 mm for veins.
• Mean total examination time was 34.7 minutes, and per-image analysis time (7.2 minutes) was unrelated to diagnostic accuracy.

A systematic review and meta-analysis of 188 studies (15,551 patients) pooled proportions of total flap failure, deep infection or osteomyelitis, and amputation after soft tissue reconstruction of complex open lower limb fractures. Of the 10,856 reconstructions, 69.9% were free flaps, and road traffic accidents caused 55.6% of injuries.

• Pooled total flap failure was 8.0% (95% CI 6.9–9.2) across the 6071 flaps with reported outcomes.
• Deep infection or osteomyelitis occurred in 12.9% of reconstructed limbs (95% CI 10.6–15.6), the most frequent of the three pooled adverse outcomes.
• Amputation was required in 6.3% of limbs (95% CI 5.2–7.6) among the 5276 limbs with reported data.
• Risk of bias was moderate in 64.5% of studies, low in 21.0%, and high in 14.5%.

A case series of 21 patients with advanced secondary lower limb lymphedema and limited distal ICG-visible lymphatics underwent LVA with an intraluminal guidewire (LymTracer) advanced proximally under fluoroscopy from a distal functional lymphatic. When the wire traveled at least 10 cm, a second incision and proximal LVA were added.

• The wire advanced proximally in 11 of 21 patients, enabling anastomosis to previously unvisualized proximal collecting vessels; mean advance was 11.3 ± 10.0 cm.
• Wire-identified proximal vessels were deeper (13.2 vs 6.2 mm) than conventionally located vessels (p = 0.00009), with similar diameter.
• Bioimpedance limb water reduction was 13.0% vs 3.0% in patients with versus without an additional proximal LVA (p = 0.03).

A systematic review of 13 studies (1089 patients), 12 observational and one randomized, summarized short-term (≤12 months) and long-term (>12 months) patency after therapeutic and prophylactic LVA for extremity lymphedema. Results were synthesized narratively without pooling.

• Short-term patency after therapeutic LVA ranged from 32% to 93%, and long-term patency from 36% to 97%.
• Prophylactic LVA showed 80% patency at 18 months, comparable in durability to therapeutic procedures.
• Studies using indocyanine green lymphography consistently reported lower short-term patency than those using lymphoscintigraphy.
• Most included studies carried a serious risk of bias, and patency definitions differed between studies.

A meta-analysis of 28 studies (824 patients), combined with Delphi consensus from an orthopedic expert committee, pooled union rate, union time, and complications for Ilizarov bone transport, free vascularized bone grafting, nonvascularized autografting, and the Masquelet technique in post-traumatic segmental tibial diaphyseal defects. The results informed a clinical practice guideline.

• Pooled union rates were 95–96% for bone transport, vascularized grafts, and autograft, compared with 81% for the Masquelet technique.
• Complication rates were highest with free vascularized bone grafts (94%), followed by bone transport (82%), Masquelet (53%), and autograft (44%).
• Mean union time was longest with free vascularized grafts at 37.8 weeks, versus 33.0 weeks for bone transport and about 29.7 weeks for autograft and Masquelet.
• The consensus panel preferred bone transport and vascularized grafts for large or complex defects, reserving autograft and Masquelet for selected cases, alongside early stabilization and antimicrobial therapy.

In a case series of 46 patients with breast cancer-related trunk lymphedema, patients who had completed more than 6 months of complex decongestive therapy underwent upper extremity lymphaticovenular anastomosis. Trunk symptoms were scored with the novel TuLIP instrument, and arm outcomes with volume, the body size-adjusted UELI, and LeQOLiS, before surgery and 6 months after.

• Among the 29 patients with paired assessments, the total TuLIP trunk symptom score fell from 16.7 to 10.3 at 6 months (P = 0.020).
• Upper extremity volume was not significantly reduced (1125.4 to 1095.8, P = 0.095), although the body size-adjusted UELI decreased slightly from 108.3 to 105.2 (P = 0.040).
• Arm-related quality of life improved, with total LeQOLiS decreasing from 22.5 to 15.6 (P = 0.005).

A comparative cohort of 32 patients with late post-traumatic orbital-zygomaticomaxillary complex deformity was divided equally between virtual mirrored-image planning and traditional intraoperative visual estimation over 12 years. The groups were compared on orbital volume, globe position, malar projection, malar soft-tissue volume, and PROMIS scores.

• Postoperative deviation from the ideal malar coordinate was smaller with virtual planning (1.6 ± 0.4 mm vs 4.3 ± 3.1 mm).
• Mean orbital volumes were similar (25.5 vs 26.1 cc), but the traditional group showed greater variability in orbital volume (SD 5.1 vs 1.7 cc) and in globe position.
• Malar soft-tissue volume improved in both groups, with tighter clustering after virtual planning (102.2 ± 2.8 cc vs 98.2 ± 8.1 cc).
• PROMIS scores favored virtual planning, with lower anxiety and depression scores (anxiety 56 vs 61; depression 54 vs 59).

A retrospective two-center review of 61 patients with Apert, Crouzon, Pfeiffer, Muenke, or Saethre-Chotzen syndromes compared management algorithms at CHOP and CHLA. Outcomes were the type, timing, and number of craniofacial surgeries.

• All CHOP patients underwent posterior vault distraction osteogenesis at a mean 10.2 months; at CHLA, 36.7% had early PVDO at 3.9 months and all underwent fronto-orbital advancement at 9.6 months.
• Among the 28 patients aged 10 years or older, CHOP patients had more major procedures but fewer frontofacial procedures in the first decade (2.3 vs 1.8, p = .023; 1.2 vs 1.7, p = .044).
• In Apert, Crouzon, and Pfeiffer syndromes, CHOP performed midface surgery earlier and more often transcranially (6.0 vs 7.5 years; 61.9% vs 20.8%); midface distraction used external devices at CHOP and internal devices at CHLA.

A randomized trial of 33 analyzed patients (50 enrolled) with C5–C6 or C5–C7 brachial plexus injuries compared ulnar nerve fascicle transfer (n = 18) with median nerve fascicle transfer (n = 15) to the biceps motor branch. The primary outcome was elbow flexion against gravity.

• Elbow flexion against gravity was achieved in 14 of 18 ulnar-transfer patients and 13 of 15 median-transfer patients (78% vs 87%, P = .665).
• Intraoperative stimulation overrode the randomized donor in 12 of 50 patients because one nerve was clearly stronger, and 5 more were excluded for less than 6 months of follow-up.

A retrospective series of 73 patients aged 4–16 years with residual brachial plexus birth injury underwent transfer of two flexor digitorum superficialis tendons to restore wrist extension between 2008 and 2024. Postoperative wrist extension strength was graded on the MRC scale over a mean follow-up of 45 months.

• After transfer, 89% of patients achieved M4 wrist extension, meaning extension against resistance with power grip.
• Transfers routed through the interosseous membrane and patients with preoperative M3 wrist extension had higher-than-expected rates of postoperative M4 strength; the tendon route and metacarpal insertion site changed over the study period.
• Reported complications included swan neck deformity, ulnar or radial deviation, and supination or pronation contractures.

A retrospective cohort of 110 patients underwent pedicled reverse-flow posterior interosseous artery flap reconstruction of the hand and wrist between 2010 and 2025. Multivariable logistic regression identified predictors of venous congestion, flap loss, and donor-site grafting, and early revision was compared with conservative management of venous compromise.

• Venous congestion occurred in 27.3% of patients, with total flap loss in 4.5% and partial flap loss in 13.6%.
• Flap length independently predicted venous congestion (OR 1.45, 95% CI 1.17–1.79) and flap loss (OR 1.47, 95% CI 1.17–1.85); ROC analysis placed a practical threshold at 9 cm, with high specificity but modest sensitivity.
• Traumatic etiology independently predicted donor-site grafting (OR 8.00, 95% CI 2.20–29.03), whereas flap width greater than 4 cm was only borderline after adjustment (OR 1.60, p = 0.059).
• Among patients with venous congestion, early revision was associated with lower flap loss than conservative management (43.75% vs 92.86%, p = 0.007).

A systematic review and pooled analysis of 7 RCTs (409 hands) indirectly compared reconstructive, non-reconstructive, and dual-mobility implant procedures for first carpometacarpal osteoarthritis. Outcomes were VAS pain, DASH, grip and pinch strength, and complications at 3 and 12 months.

• At 3 months, VAS pain fell most with dual-mobility implants (Δ = 6.05), compared with reconstructive (Δ = 3.52) and non-reconstructive procedures (Δ = 2.86).
• DASH scores improved in all groups and most with implants (Δ = 29.48 at 3 months; Δ = 35.35 at 12 months), although 12-month pain and function were comparable overall.
• Grip and pinch strength results varied between groups, with implants showing the greatest lateral pinch gain at 12 months.
• Complication rates were 20.61% for reconstructive procedures, 24.49% for implants, and 51.61% for non-reconstructive procedures, though the last figure comes from a single study.

In a cohort study of 51 patients with clinically diagnosed double crush syndrome, median nerve compression at both the lacertus fibrosus and the carpal tunnel was treated with concomitant single-stage release. Symptoms, return to work, and satisfaction were assessed at three months.

• Concomitant lacertus and carpal tunnel release improved symptoms.
• Return to work took five weeks.
• At three months, 73% of patients were satisfied with treatment.

A retrospective review of 45 consecutive patients undergoing lower extremity nerve decompression (LEND) assessed whether the scratch collapse test (SCT) could localize common and uncommon compression sites, and compared it with Tinel's sign. Postoperative functional outcomes and patient-reported outcomes (VAS, Patient Satisfaction Scale, Norfolk QOL-DN, LEFS, MNSI) were described.

• Ten compression sites were identified, most often the common peroneal (42.2%), superficial peroneal (37.8%), and tibial (28.9%) nerves; the SCT was positive in all 45 patients, compared with 38 (84.4%) for Tinel's sign.
• After surgery, sensory deficits improved in 73.3% of patients, whereas muscle weakness improved in only 35.6%.
• Among the 10 patients with paired clinical pain scores, mean pain fell from 8.9 ± 1.8 to 4.3 ± 3.5 (p = 0.003).
• Postoperative PROMs were available for only 18 patients (40.0%), with a mean VAS of 4.8 ± 2.8, Patient Satisfaction Scale of 3.6 ± 1.6, and LEFS of 47.5 ± 24.5.

A systematic review of 8 studies (119 patients, 165 digits) evaluated outcomes of surgery for congenital clinodactyly, comparing physiolysis (76% of cases) with osteotomy (24%). Risk of bias was assessed with the Newcastle-Ottawa Scale, and outcomes were synthesized descriptively.

• Mean angulation improved from 41° preoperatively to 21° after surgery, and every technique produced angular improvement; mean age was 6.1 years for physiolysis and 7.2 years for osteotomy.
• The overall complication rate was 7.3%, and reoperation was required in 9% of cases, most often after physiolysis.
• Surgical thresholds varied between studies, with some citing more than 20° to 25° as an indication, and there were no clear criteria for choosing physiolysis over osteotomy.
• No included study used validated PROMs; limited qualitative feedback suggested high patient or parental satisfaction despite residual deformity.

A randomized controlled trial of 36 patients with 10–40% TBSA deep burns compared early excision and grafting (within 7 days) with delayed excision at a tertiary center in North India. The primary outcome was length of stay; secondary outcomes included day-10 SOFA score, wound microbiology, graft take, and transfusion.

• Early excision reduced median hospital stay to 13.5 vs 28.5 days (p = 0.009); median time to excision was 4.5 vs 30.5 days.
• Day-10 SOFA score, transfusion requirements, and mortality showed no significant differences between groups.
• Polymicrobial wound infection occurred in 44.4% vs 5.6% of delayed vs early patients (p = 0.017), although overall culture positivity did not differ (p = 0.092).
• Graft take during the index admission was lower in the early excision group.

A retrospective nationwide registry cohort of 884 patients with severe burns (≥20% TBSA, or ≥10% in children under 5) transported directly from the scene in Japan between 2019 and 2023 compared outcomes with and without prehospital fluid administration. Confounding was addressed with stabilized inverse probability weighting based on propensity scores, and 48-hour all-cause mortality was the primary outcome.

• Prehospital fluid was given to only 94 patients (10.6%), while the remaining 790 were transported without fluid administration.
• Crude mortality was higher in the fluid group, with 48-hour death in 23.4% versus 13.4% and in-hospital death in 44.7% versus 28.4%.
• After weighting, prehospital fluid was not significantly associated with mortality, with odds ratios of 0.88 (95% CI 0.32–2.39) for 48-hour death and 1.30 (95% CI 0.75–2.25) for in-hospital death.

A cross-sectional study of 82 referred patients at a Swedish national burn center in Linköping compared real-time TBSA% estimates by referring non-expert physicians with burn specialist assessments using the Lund & Browder chart. Agreement was evaluated with Bland-Altman analysis, and predictors of discrepancy with multivariable linear regression.

• Non-experts overestimated TBSA% in 76% of cases, with a median estimate of 10% versus 6% for specialists (p < 0.001).
• Bland-Altman analysis showed proportional bias, with discrepancies widening as burn size increased.
• Larger discrepancies were predicted by more than 2 non-confluent burn spots (β = 2.525), larger burns, male patients, and a longer interval between assessments.
• The presence of deep burns was associated with smaller discrepancies (β = −3.422, p < 0.001) between non-expert and specialist estimates.

A randomized controlled trial of 82 patients compared passive 360° immersive virtual reality (VR) plus standard multimodal analgesia with multimodal analgesia alone during dressing changes after burn autograft surgery. The primary outcome was cumulative peri-procedural opioid consumption over the first two dressing changes; secondary outcomes were pain, anxiety, and satisfaction.

• Passive VR produced no significant reduction in opioid consumption, the primary outcome, compared with multimodal analgesia alone across the first two dressing changes.
• Secondary outcomes showed no between-group difference in numeric pain or anxiety scores during dressing changes.
• Acceptability was high, with 37 of 41 VR participants stating they would recommend immersive VR for patient care (31 highly and 6 slightly agreeing), particularly for anxiety reduction.

A preclinical mouse model study evaluated whether second-window indocyanine green (SWIG) imaging, which relies on delayed ICG retention through the enhanced permeability and retention effect, can distinguish necrotic from inflamed tissue in early burn wounds. ICG angiography was used to characterize perfusion and permeability over time in burned tissue and in lipopolysaccharide (LPS)-induced non-burn inflammation.

• SWIG showed distinct fluorescence properties that differentiated inflamed from necrotic tissue in the mouse burn model.
• Early burn hyperperfusion and increased permeability enhanced ICG delivery to the wound bed, providing the substrate for SWIG imaging.
• In LPS-induced inflammation, ICG fluorescence varied with the inflammatory mechanism, independent of the necrosis-avid behavior of ICG, a signal that will need to be separated from necrosis-specific uptake.

A propensity-matched retrospective cohort of 4,722 adults (2,361 amputees and 2,361 non-amputees) with burn injury from the TriNetX network compared new-onset psychiatric diagnoses at 6 months, 1 year, and 2 years. Matching covered demographics, comorbidities, substance use, psychiatric history, antidepressant use, and burn extent, with secondary analyses of opioid use, mental health service use, and amputation level.

• At 6 months, amputees had higher rates of anxiety (11.0% vs 5.6%, HR 2.06), depression (HR 1.75), and adjustment disorder (HR 2.59), each persisting through 2 years after multiple-comparison correction.
• Antidepressant initiation was higher among amputees (19.4% vs 11.2%, HR 1.73), while psychotherapy use (9.4% vs 5.5%) ran at under half the rate of antidepressant initiation.
• Opioid use was higher at every interval (81.5% vs 58.0% at 6 months, HR 1.92); PTSD was elevated through 1 year and substance use disorder at 6 months only, while sleep disorders and suicidal ideation did not differ.
• Proximal amputation carried roughly twice the 6-month incidence of anxiety and adjustment disorder seen after distal amputation, a difference persisting through 2 years.

A prospective observational study of 22 adults with burns of at least 15% TBSA used serial sublingual incident dark field (IDF) imaging at baseline and 4, 8, 12, and 24 hours, together with plasma endothelial biomarkers (syndecan-1, glypican-1, ICAM-1, VE-cadherin), to track tissue perfusion during early resuscitation. Lactated Ringer's was started at 3 mL/kg/%TBSA and titrated to urine output and hemodynamics.

• Total and functional capillary density decreased significantly over 24 hours, whereas the proportion of perfused vessels and red blood cell velocity increased (both p < 0.01).
• These changes occurred despite stable conventional endpoints: mean arterial pressure was stable, urine output was maintained at 0.8 mL/kg/h, and lactate did not change.
• Glypican-1 and VE-cadherin decreased over time while syndecan-1 remained stable, consistent with endothelial alteration without clear evidence of ongoing glycocalyx shedding.
• Patients received a mean of 4.0 ± 1.8 mL/kg/%TBSA; high fluid exposure above 5 mL/kg/%TBSA (21.1% of patients) was not associated with improved tissue perfusion.

This longitudinal database cohort of 2117 employed adult burn survivors from the Burn Model System (2015–2024) grouped patients by injury circumstance: work-related, recreational, or non-work/non-recreational. Employment status and patient-reported pain, anxiety, depression, fatigue, physical function, and social reintegration were compared at 12 months.

• After adjustment, there was no difference in 12-month employment for recreational injuries compared with work-related (OR 0.91, p = 0.62) or non-work/non-recreational injuries (OR 1.02, p = 0.73).
• Work-related burns, which made up 34.7% of the cohort, were associated with greater pain interference at 12 months than recreational burns (p = 0.02).
• Both the work-related (p = 0.03) and non-work/non-recreational (p = 0.02) cohorts reported more difficulty with social reintegration than the recreational cohort, independent of injury severity.

This systematic review and meta-analysis of 12 studies (10 pooled, all in post-mastectomy skin flaps) assessed the diagnostic accuracy of indocyanine green angiography against postoperative clinical necrosis. It compared absolute and relative perfusion quantification and derived cut-off values.

• Absolute perfusion thresholds (6 studies) yielded a pooled sensitivity of 85.1% and specificity of 61.4%, with an AUC of 0.77.
• Relative perfusion (5 studies) performed slightly worse, with pooled sensitivity of 68.4% and specificity of 69.1% (AUC 0.74) and a wide sensitivity confidence interval (32.2–90.8%).
• At the observed necrosis rate of 10.9%, pooled negative predictive value was high (94.7–97.1%), whereas positive predictive value was only 21.3%.
• The analysis identified cut-off values of 18.3 for absolute perfusion and 31.7% for relative perfusion for predicting skin necrosis.

This multicenter retrospective cohort of 948 patients (1,592 reconstructions) undergoing immediate prepectoral two-stage expander reconstruction (2016–2025) compared outcomes with versus without mesh at expander placement. Logistic regression assessed predictors of complications, reconstructive failure, and secondary revision.

• Mesh was used in 84.4% of reconstructions, and complications were more frequent with mesh (18.2% vs 12.9%) (p = 0.039), mainly because of infection (8.7% vs 4.8%).
• On multivariable analysis, mesh was associated with higher odds of complication (OR 1.574, 95% CI 1.047–2.437) but not with reconstructive failure (OR 1.222, 95% CI 0.684–2.181).
• Secondary revision rates did not differ between cohorts (21.5% vs 24.4%, p = 0.333), and mesh was not protective against revision (OR 1.165, 95% CI 0.821–1.653).

This single-center retrospective cohort of 516 women (577 DIEP flaps) undergoing delayed reconstruction (2005–2022) was grouped by history of implant-based reconstruction (IBR) and radiotherapy. Perioperative microvascular re-anastomosis and 30-day flap necrosis were compared using logistic regression adjusted for age, BMI, and smoking.

• Of 577 flaps, 213 followed prior IBR and 441 followed radiotherapy; among irradiated patients, re-anastomosis was more frequent after prior IBR than after mastectomy alone (14.7% vs 7.4%, p = 0.013).
• After adjustment, prior IBR in irradiated patients carried nearly twofold odds of re-anastomosis (OR 1.98, 95% CI 1.04–3.76).
• Rates of partial or total flap necrosis did not differ across groups, and prior IBR was not significantly associated with necrosis (OR 2.17, 95% CI 0.84–5.62).
• Venous coupler size was smaller in irradiated than non-irradiated patients (2.03 vs 2.32 mm, p < 0.001).

This population-based retrospective cohort of 1537 women with primary breast cancer and implant-based immediate reconstruction in Stockholm (2005–2015) compared local recurrence and overall survival after nipple-sparing (218 breasts) versus skin-sparing mastectomy (1376 breasts), with up to 12 years of follow-up.

• Local recurrence occurred in 50 breasts (13 NSM, 37 SSM), with a 12-year cumulative incidence of 14.1% after NSM vs 3.7% after SSM (P = 0.001).
• The association held after multivariable adjustment (HR 2.08, 95% CI 1.01–4.28; unadjusted HR 3.18), and 4 of the 13 NSM recurrences (30.8%) arose in or beneath the nipple-areola complex.
• Overall survival did not differ significantly between NSM and SSM (HR 0.74, 95% CI 0.38–1.44).
• NSM use rose from 7.6% to 26.6% between 2005–2007 and 2014–2015 (P < 0.001), and median follow-up was shorter after NSM (60 vs 75 months).

This single-center retrospective review of 295 patients undergoing immediate two-stage prepectoral tissue expander reconstruction (2018–2022) compared outcomes after neoadjuvant, adjuvant, or no chemotherapy, with perioperative leukopenia analyzed separately. Major complications were modeled with multivariable mixed-effects logistic regression.

• After expander placement, major complications occurred in 14.1% with NACT, 41.8% with ACT, and 28.5% without chemotherapy (p = 0.0012).
• After implant exchange, the chemotherapy groups showed no significant differences in individual complications or outcomes.
• Perioperative leukopenia was associated with lower major infection rates but higher hematoma rates after expander placement (p < 0.05).
• After implant exchange, patients with leukopenia had lower explantation rates but higher reoperation and skin necrosis rates (p < 0.05).

This retrospective cohort of 481 DIEP flap patients (2019–2023) compared tumescent local anesthesia with bupivacaine, given as TAP, intercostal, and local infiltration at the breast and abdominal sites (n = 271), against a standard TAP block alone (n = 210). Opioid use, length of stay, and complications were analyzed with multivariable regression.

• Inpatient opioid use was 29.4 MME lower with TLA (95% CI -45.29 to -13.45), and discharge prescriptions were 36.1 MME lower (95% CI -58.27 to -13.98).
• Hospital stay was shorter with TLA (3.4 vs 3.9 days) (p < 0.001).
• Breast hematoma was less frequent with TLA (2.2% vs 6.2%) (p = 0.033).
• Baseline imbalances were present: TLA patients were younger (50.3 vs 53.7 years), and controls more often had hormonal therapy (43.8% vs 34.7%) and prior radiation (52.9% vs 39.1%).

This single-center retrospective cohort of 738 patients (1385 implants) receiving breast implants (2018–2023) assessed whether preoperative nasal Staphylococcus aureus screening, with decolonization of carriers, was associated with 12-month surgical site infection. Generalized estimating equations accounted for multiple implants per patient.

• Screening was performed before 73.9% of procedures, and the overall 12-month surgical site infection incidence was 5.8% (95% CI 4.7–7.2).
• Screening was independently associated with reduced infection risk (OR 0.59, 95% CI 0.35–0.98) on multivariable analysis.
• Obesity and reconstruction type were associated with infection (p < 0.001); compared with implant mastopexy or implant exchange, immediate reconstruction carried higher odds of infection (OR 2.61, 95% CI 1.62–4.22), whereas delayed reconstruction did not (OR 0.67).

A retrospective two-site cohort of 757 patients (757 oncologic DIEP flaps, 2017–2024) examined whether flap weight was associated with postoperative complications, using adjusted logistic regression stratified by BMI (<25, 25–30, 30–35, >35 kg/m2) over a mean follow-up of 9.6 months.

• BMI correlated strongly with flap weight (r = 0.79), and both were associated with overall complication rates (P < 0.001 for each).
• Within the BMI 30–35 group, flap weight was associated with higher adjusted odds of overall complications (OR 1.17), minor complications (OR 1.18), fat necrosis (OR 1.27), and wound dehiscence (OR 1.29).
• Outside that stratum, associations were isolated: heavier flaps were linked to skin necrosis in the BMI <25 group (OR 2.31) and to hematoma in the BMI 25–30 group (OR 1.37).
• Further stratification by flap weight showed trends toward more minor complications, skin necrosis, and dehiscence, but associations were inconsistent across strata.

A systematic review and meta-analysis of 12 studies (29,357 patients) compared postoperative outcomes of aesthetic and body contouring surgery with versus without GLP-1 receptor agonist exposure, with 10 studies entering random-effects pooling. Outcomes included infection, dehiscence, delayed healing, hypertrophic scarring, seroma, hematoma, and venous thromboembolism.

• GLP-1 receptor agonist exposure was associated with an increased risk of delayed wound healing in pooled observational analyses.
• Hypertrophic scarring was also more frequent with GLP-1 receptor agonist exposure, the second outcome with a pooled adverse association.
• In subgroup analysis against patients with prior bariatric surgery, GLP-1 receptor agonist users had lower seroma rates.

A three-arm randomized trial compared lipoabdominoplasty with limited undermining, traditional abdominoplasty with wide undermining and no flap liposuction, and a combined technique with wide undermining plus flap liposuction. Outcomes included epigastric pinch thickness, horizontal laxity, operative time, aesthetic results, and complications.

• Complication rates showed no significant differences across individual groups, between liposuction and no-liposuction arms, or between limited and wide undermining.
• Liposuction, with or without wide undermining, reduced epigastric pinch thickness more and was associated with better aesthetic outcomes.
• Undermining extent had no significant effect on flap thickness, horizontal skin laxity, or overall aesthetic results.
• The combined technique had the longest operative time, attributed to extensive dissection, sub-Scarpa fat removal, and liposuction.

A prospective consecutive cohort of 590 patients with silicone breast implants underwent in-office high-resolution ultrasound at routine follow-up across 7 US sites over 4 months, to estimate the prevalence of implant flipping and identify device, pocket, and patient factors associated with it.

• Implant flipping, with the posterior patch rotated anteriorly, was detected in 75 of 590 patients (12.7%).
• Larger implant volume, prepectoral placement, and lack of soft tissue support were independently associated with flipping.
• The cohort comprised 64.6% primary and 35.4% revision augmentations, with mean age 43 years, mean BMI 23, and devices from Allergan (63.9%), Motiva (15.9%), Mentor (12.4%), and Sientra (7.1%).

A retrospective single-center cohort of 282 adults undergoing body contouring after massive weight loss (Aalborg, Denmark, 2022–2025) compared complications by weight-loss modality (lifestyle, bariatric surgery, or GLP-1 RA), adjusting for age, sex, BMI, ASA class, diabetes, and procedure type.

• Compared with lifestyle weight loss, GLP-1 RA exposure was independently associated with postoperative infection (OR 3.72, 95% CI 1.52–9.07).
• GLP-1 RA exposure was also associated with wound dehiscence requiring repair under general anesthesia (OR 16.71), with a very wide 95% CI of 1.99–139.88.
• No association was found for dehiscence managed under local anesthesia or for bleeding, and prior bariatric surgery was not associated with any investigated complication.

A retrospective comparative cohort of 561 patients compared 356 consecutive facelifts using an internal hemostatic network (progressive tension plus quilting sutures, without drains or compressive dressings; 2018–2025) with 205 historical controls who had SMAS plication or SMASectomy with suction drains (2011–2017).

• There were no hematomas requiring surgical evacuation in the network group versus 12 (5.9%) in controls (p < 0.00001); three network patients (0.8%) had small collections managed by aspiration.
• Transient facial nerve weakness occurred in 10.4% of network patients, predominantly marginal mandibular, with complete recovery at a mean of 7 weeks and no permanent deficits.
• No seromas or flap necrosis occurred in the network group, and all patients were discharged the same day (mean stay 5 hours).

A retrospective series of 282 patients (2011–2026) describes subciliary excision of intractable lower eyelid granulomas from non-biodegradable fillers after at least 6 months of failed medical management, using sequential layer-by-layer delamination with release of the orbital retaining and tear trough ligaments.

• Clinical success, defined as resolution of preoperative complaints without recurrence requiring surgery, was 100% at a mean follow-up of 277 days in a cohort of 261 women and 21 men (mean age 36.7 years).
• In the high-risk subgroup (age ≥50, prior periorbital surgery), transient ectropion occurred in 61.7% despite universal canthal support; all cases resolved conservatively at a mean of 62.2 days.
• The author attributes the ectropion partly to traction-induced neuropraxia and, for infiltrative materials, favors maximal safe debulking over complete removal to avoid musculocutaneous devascularization.

A systematic review and meta-analysis of 13 studies (3264 patients), 2175 of them treated with a hemostatic net and six studies comparative, pooled hematoma, necrosis, seroma, and hyperpigmentation outcomes in facial aesthetic surgery using random-effects models.

• In cervicofacial rhytidectomy, the hemostatic net was associated with lower odds of hematoma than drain-based closure (OR 0.07, 95% CI 0.02–0.24; I² = 25%).
• There was no difference in skin necrosis between techniques (OR 0.73, 95% CI 0.20–2.63; I² = 0%), and sensitivity analyses supported the robustness of the estimates.
• Single-arm pooled incidences showed low absolute complication rates: hematoma 1.09%, seroma 1.66%, necrosis 0.96%, and persistent hyperpigmentation 0.28%.
• Pigmentary change at suture entry sites was the most frequent visible adverse event; it was usually self-limited but could take up to 3 months to resolve.

A retrospective single-center cohort of 669 patients (490 functional and 179 aesthetic septorhinoplasties, 2019–2024) compared NOSE and SCHNOS scores and revision rates between patients with and without diagnosed anxiety and/or depression.

• After functional septorhinoplasty, both groups improved, but the anxiety/depression group had higher (worse) postoperative NOSE scores (35.3 vs 24.1) and SCHNOS-Obstructive scores (32.1 vs 24.1).
• Anxiety or depression was associated with higher odds of revision after functional surgery (OR 2.56, 95% CI 1.51–4.39).
• After aesthetic septorhinoplasty, SCHNOS-Cosmetic scores improved in both groups, with no differences in pre- or postoperative scores or revision rates.

A nationwide retrospective registry cohort of 109 patients under 18 years (Dutch Childhood Cancer Group, 2003–2025), of whom 78 and 69 were evaluable, assessed the prevalence and predictors of persistent and suspected neuropathic pain after extremity soft tissue sarcoma resection, supplemented by cross-sectional NRS and DN4 questionnaires.

• Pain persisting 3 months or more after surgery was documented in 37 of 78 patients (47%), and suspected neuropathic pain in 24 of 69 (35%).
• Neoadjuvant chemotherapy was independently associated with chronic postsurgical pain (OR 3.98, 95% CI 1.47–10.83).
• Intended nerve resection showed a nonsignificant trend toward neuropathic pain (OR 5.90, 95% CI 0.88–39.66; p = 0.067).
• Questionnaires were returned by 43 of 62 eligible survivors (69%), and DN4 scores were consistent with the retrospectively observed neuropathic pain prevalence.

Time-to-event machine learning models for local recurrence, distant metastasis, and overall survival, with death treated as a competing risk, were developed in a single-center cohort of 188 patients with upper extremity soft tissue sarcoma. Five survival algorithms were compared within nested cross-validation and benchmarked against the Sarculator, PERSARC, and MSKCC nomograms.

• Over a median follow-up of 3.9 years, 5-year event rates were 24% local recurrence, 20% distant metastasis, and 13% death.
• Best-performing models reached competing-risks concordance indices of 0.79 (local recurrence), 0.67 (distant metastasis), and 0.75 (overall survival); parsimonious models performed comparably.
• Discrimination was similar to Sarculator and PERSARC and higher than the MSKCC nomogram for local recurrence (C-index 0.90 vs. 0.68).
• Predicted-risk groups separated clearly on cumulative-incidence and survival curves (p < 0.001).

This systematic review of 42 observational studies descriptively summarized surgical management, adjuvant therapy, nodal management, recurrence, and Merkel cell carcinoma-related mortality for tumors of the digits, hand, and wrist. Heterogeneity precluded meta-analysis.

• Of 25 digital lesions, 15 underwent wide local excision and 10 ray amputation; recurrence was comparable at 2/7 (29%) and 2/8 (25%), and disease-related mortality was 2/9 (22%) in each group.
• Hand and wrist lesions (n = 19) were treated mainly by wide local excision (89%), with recurrence in 7/14 (50%) and disease-related mortality in 2/12 (17%).
• Adjuvant radiotherapy was given in 10/19 (53%) hand and wrist cases and chemotherapy in 4/19 (21%); nodal management included sentinel lymph node biopsy in 5/13 (38%) and dissection in 4/13 (31%).

This case series of 17 patients with lateral nasal ala defects after carcinoma resection describes a 1-stage nasal sidewall propeller flap (NSPF), a freestyle perforator flap based on facial or internal nasal artery perforators, used in 12 patients, with melolabial propeller flaps in the remaining 5.

• No flap necrosis occurred among the 12 NSPF and 5 melolabial propeller flap reconstructions.
• Secondary aesthetic refinement was needed in 3 of 12 NSPF cases, compared with all 5 melolabial propeller flap cases.
• For defects extending into the upper lip triangle, the NSPF was combined with a transverse jugal advancement flap to restore continuity of the upper lip aesthetic subunit.
• The authors report good color and texture match with limited donor site morbidity, positioning the flap as an alternative to multistage flaps and free cartilage grafts.

This narrative review assessed the biological behavior of cutaneous leiomyosarcoma, with particular attention to head and neck lesions, covering recurrence, metastasis, risk factors, adjuvant treatment, and survival.

• The head and neck accounts for 21%–33% of cutaneous leiomyosarcomas, and reported local recurrence rates range from 2% to 18%, with most recurrences local and within the first few years.
• Only 3% develop metastatic disease at 10 years, and 5-year disease-specific survival is 96%–100%.
• Positive or close surgical margins are the main risk factor for recurrence, with a trend toward higher risk at head and neck sites.
• No data support adjuvant treatment, and the authors propose surveillance centered on physical examination and limited in duration.

This case series of 11 patients from a tertiary Australian head and neck oncology service (2019–2024) describes immediate reconstruction of marginal mandibulectomy defects with split-thickness skin grafts placed directly on bone, bolstered with prefabricated partial dentures or intraoperatively fashioned foam.

• All grafts took successfully, supported by either prefabricated partial dentures or foam bolsters fashioned intraoperatively.
• Minor complications occurred in 4 of 11 patients, including small areas of bone exposure and donor site discomfort, all managed conservatively.
• All patients who sought dental rehabilitation received implant-supported or removable prostheses, with functional speech and oral intake maintained.

In a comparative evaluation of 50 clinical photographs (25 burns, 25 nonburns), four multimodal large language models (GPT-5.4 Pro, Grok 4.1, Gemini 3.1 Pro, Claude Opus 4.6) classified burn presence and recommended debridement versus immediate skin grafting across 5 independent runs (4000 assessments). Plastic surgeon expert consensus served as ground truth.

• Burn detection was near-perfect at 97.2%–100% (κ = 0.896–1.000), with equivalent performance across Fitzpatrick skin tone strata.
• Treatment accuracy in burn cases ranged from 24.8% to 72.8%, and 3 of 4 models performed below the majority-class baseline.
• Reproducibility of treatment decisions fell to κ = 0.132–0.385 in 3 models, with inconsistent recommendations for identical images; error patterns were systematic and opposite in direction across models.

This article outlines how AI is being used in plastic surgery practice, the medical and legal liabilities it creates for plastic surgeons, including those who do not use it directly, and proposed risk-reduction strategies for patients, surgeons, and practices.

• The article argues that liability exposure extends to non-users, because other physicians, patients, and cybercriminals use AI in ways that affect a surgeon's patients and practice.
• Surgeons and their staff are described as responsible for understanding both the potential advantages and the liabilities of AI tools.
• The author proposes risk-reduction strategies to safeguard patients, surgeons, and practices.

This single-center validation study compared wound height and width estimates from two deep-learning segmentation models (TransNeXt and VW-Conv) and from five physicians working from bedside photographs with ArUco size markers against in-person ruler measurements by two experienced raters.

• For wound height, both AI models showed excellent agreement (ICC 0.95–0.96) with in-person measurement, with mean absolute errors of 0.68–0.82 cm and minimal bias.
• For width, agreement was moderate to strong (ICC 0.77–0.86) with systematic underestimation (bias -0.42 and -0.64 cm).
• Single physician estimates were heterogeneous; pooled as a consensus, physicians reached height ICC 0.94 and width ICC 0.91, exceeding both AI models for width.
• At pixel level, TransNeXt achieved a macro-averaged Dice of 0.886 (IoU 0.805) versus 0.818 for VW-Conv, with more consistent per-image performance.

A cross-sectional survey of 102 physicians (specialists, senior residents, and certified cosmetic medicine practitioners) tested an extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. The predictors were performance expectancy, effort expectancy, AI anxiety, and perceived barriers, and the outcome was intention to adopt AI, analyzed with exploratory factor analysis, Pearson correlation, and multiple linear regression.

• Performance expectancy was the strongest positive predictor (β = 0.431) of adoption intention, followed by effort expectancy (β = 0.287); both p < 0.001.
• Performance and effort expectancy together accounted for 52% of the variance in adoption intention (R² = 0.52).
• AI anxiety (β = −0.251, p < 0.001) and perceived barriers (β = −0.189, p = 0.004) each had a significant negative effect on adoption intention.
• Demographic variables, including age and years of professional experience, showed no significant association with adoption intention.

This narrative review drawing on a six-database search (PubMed, Google Scholar, EMBASE, Cochrane CENTRAL, Scopus, and Web of Science through March 2025) summarized machine learning applications for diagnosing hand fractures, tendon injuries, and nerve compression across history analysis, clinical examination, and imaging.

• Convolutional neural networks (CNNs) demonstrated high diagnostic accuracy for fracture detection, the most prominent application identified in the review.
• In validation studies, CNNs for distal radius and ulna fractures outperformed trainees and urgent care physicians at detection.
• Wearable motion sensors combined with machine learning enabled objective joint assessment as an adjunct to the clinical examination.
• Limited external validation, poor model interpretability, and difficult integration into clinical workflows were the main barriers to broader adoption.

In a comparative simulation study of 30 standardized scenarios spanning low-, moderate-, and high-risk complications after aesthetic surgery, each scenario was submitted to ChatGPT, Gemini, and Claude with a standardized prompt. Responses were rated on 5-point Likert scales for diagnostic accuracy, management appropriateness, triage accuracy, patient safety, and completeness, with critical management errors and dangerous reassurance recorded separately.

• ChatGPT had the highest mean diagnostic accuracy (3.99 ± 0.57) compared with Claude (3.90 ± 0.62) and Gemini (3.61 ± 0.62; p < 0.001), and led in most other domains.
• In high-risk scenarios, appropriate emergency referral was recommended in 96.7% of Claude, 93.3% of ChatGPT, and 76.7% of Gemini evaluations (p = 0.018).
• Critical management errors were uncommon overall but most frequent with Gemini.

This phase 2, multicenter, single-blind randomized controlled trial of 267 patients with androgenetic alopecia at three tertiary hospitals in China allocated participants 1:1:1 to concentrated growth factor (CGF) prepared without anticoagulant, with 3.2% sodium citrate, or with heparin sodium, given as five intradermal injection sessions over 12 months. Primary endpoints were injection pain (VAS) and change in hair density at 3, 6, and 12 months.

• Injection pain on VAS was significantly lower with sodium citrate than with heparin or no anticoagulant (P < 0.001).
• At 6 and 12 months, the sodium citrate group showed greater hair density increases and higher rates of ≥50% subjective clinical improvement (P < 0.001).
• In vitro, sodium citrate best preserved growth factor levels and platelet function among the three preparations.
• Satisfaction and willingness for re-treatment were highest in the sodium citrate group (87.6%).

This study combined a bibliometric analysis of 286 Web of Science publications with a PRISMA-based systematic review of 77 clinical studies (2,737 patients), mapping publication trends, leading contributors, and keyword networks and grouping human clinical applications of nanofat and mechanically emulsified adipose-derived products by indication.

• Of 286 publications, 241 appeared after nanofat was introduced in 2013; output rose markedly after 2019 and peaked in 2025 with 45 publications.
• The corpus accumulated 4,320 citations (H-index 37), with China, the United States, Italy, Switzerland, and Germany as the leading contributors.
• Across the 77 clinical studies, 2,304 of 2,737 patients received nanofat-based or mechanically emulsified adipose-derived interventions.
• Applications fell into eight clinical domains, with scar remodeling, facial/skin rejuvenation, wound healing, and periorbital rejuvenation the most frequent indications.

This preclinical study in rabbit and porcine models tested 3D-printed porous minichannel scaffolds loaded with cartilage granules, platelet-rich plasma, and adipose-derived stem cells (ASCs), matured by short-term ectopic incubation before orthotopic transplantation into segmental tracheal defects.

• Two weeks of ectopic incubation gave the grafts native-like mechanical resilience together with transmural vascularization.
• After orthotopic repair of segmental defects, the grafts maintained airway patency and supported survival for up to 115 days in rabbits and pigs.
• Mechanistically, ASCs improved cartilage granule survival within the hypoxic minichannels by upregulating chondrocyte glycolysis.
• Using cartilage granules directly eliminates chondrocyte isolation and expansion, the time-consuming step that limits conventional tracheal tissue engineering.

This laboratory comparison of 38 patients (17 with full-thickness burns, 21 elective breast surgery controls) cultured adipose-derived stem cells (ADSCs) from fat collected at the index burn operation or elective surgery and analyzed culture supernatants with a ten-analyte cytokine multiplex, alongside histologic staining of the source fat for immune cells.

• Flow cytometric sorting confirmed ADSC identity by expression of CD90, CD105, and CD73 in the cultured cells.
• IL-8 was significantly higher in supernatant from burn-derived ADSCs (p < 0.05) on Wilcoxon testing, with Tobit regression used for multivariable analysis.
• Histology showed more lymphocytes and macrophages in burn fat than in non-burn fat.

This double-blind, non-randomized split-body trial of 16 patients undergoing abdominal liposuction harvested fat with three 4-mm cannulas (Basket, Accelerator, and Candy Cane). The resulting 48 samples were assessed for phase separation, parcel area on stereoscopic imaging, and histologic adipocyte alteration, septal disorganization, and debris.

• The Accelerator cannula produced the largest and most heterogeneous parcels, whereas the Candy Cane and Basket cannulas yielded smaller, more uniform parcels.
• Cannula type had no significant effect on aqueous, adipose, or oily phase proportions or on histologic adipocyte alteration, septal disorganization, or debris.
• Patient age correlated significantly with adipose-phase volume and parcel size across all three cannulas.

A review summarizing the structure and gating mechanics of Piezo1/2 mechanosensitive channels in lymphatic endothelial cells, their roles in lymphatic development and disease, and emerging strategies to modulate them therapeutically.

• Piezo1 converts fluid shear stress and interstitial pressure into calcium influx, integrating Orai1/Notch, ANGPT/TIE/FOXO1, and EPHB4/RASA1 signaling to control lymphatic sprouting, valve morphogenesis, and meningeal lymphatic development.
• Piezo1 dysregulation is linked to congenital lymphedema, as well as to tumor lymphatic metastasis and neurological conditions including hydrocephalus and craniosynostosis.
• The authors highlight a possible role for Piezo2 in lymphedema-associated sensory impairment, an area they flag as warranting further investigation.
• Candidate interventions include small-molecule agonists and inhibitors, gene editing, physical modulation, and targeted drug delivery; poor tissue specificity and limited spatiotemporal control remain the main barriers.