Plastic Surgery Weekly

A single-center retrospective cohort of 79 oncologic amputees compared 54 patients who received targeted muscle reinnervation and/or regenerative peripheral nerve interface against 25 historic controls without nerve reconstruction, assessing patient-reported pain and controlled-substance use at least 10 months after amputation.

• The TMR/RPNI cohort had significantly lower residual limb pain (median 0.0 vs 2.0) and phantom limb pain (median 0.0 vs 4.0).
• PROMIS Pain Intensity and Behavior scores were significantly lower in the reconstruction group than in untreated controls.
• Opioid and benzodiazepine/pregabalin use were significantly reduced while gabapentin use was higher, indicating a shift toward non-opioid analgesia.

A model-based cost-effectiveness analysis from a payer perspective used a decision-tree framework with literature-derived inputs to compare three lymphedema-prevention strategies (immediate lymphatic reconstruction, prospective surveillance, and no intervention) in a base case of a 45-year-old undergoing axillary lymph node dissection for stage III breast cancer.

• No intervention was cheapest and least effective ($10,774; 17.94 QALYs), while prospective surveillance improved outcomes at minimal added cost with an ICER of $344/QALY.
• Immediate lymphatic reconstruction delivered the greatest health benefit (22.35 QALYs) at the highest cost ($15,426), with an ICER of $1,607/QALY that remained well under the willingness-to-pay threshold.
• Sensitivity analyses confirmed robustness of the cost-effectiveness conclusions across the range of model inputs tested.

A retrospective review of 51 patients who underwent free fibular flap transfer to the femur or tibia (2003–2024) compared external skeletal fixator, dynamic compression plate, locking compression plate, and other fixation methods, measuring hypertrophy as the ratio of fibular width on follow-up to immediate postoperative radiographs.

• At mean 5.7-year follow-up, mean hypertrophy ratios were highest with locking compression plates (1.69), followed by dynamic compression plate (1.48), others (1.20), and external skeletal fixator (1.08).
• Multivariable mixed-effects modeling identified dynamic compression plate fixation as significantly associated with greater hypertrophy than external fixation, as was younger age.
• Among 30 patients with at least 2-year follow-up, hypertrophy continued to progress beyond 2 years, with greater increases in patients younger than 20.

A case series of 23 patients with craniosynostosis (mean age 30.1 months, 2016–2021) underwent total cranial vault remodeling using a refined multidirectional cranial distraction osteogenesis technique with a full-circumference external frame, with morphology assessed by 3D CT preoperatively, after device removal, and at 1 year.

• In scaphocephaly (n=4), cephalic index improved from 68.1 to 81.7, and in brachycephaly (n=3) it decreased from 120.9 to 105.0.
• In 12 intracranial-volume-expansion cases, volume increased from 1221 to 1496 mL.
• Complications were limited to one CSF leak requiring reoperation and three anchor-pin loosenings managed by early device removal without affecting outcomes, with mean transfusion of 48.2 mL/kg.

This systematic review and meta-analysis of 24 studies (2246 patients) evaluated pre- and postoperative hyperbaric oxygen therapy (≥1.5 ATA) versus control, placebo, or sham in patients with soft-tissue injuries considered for skin flap or graft surgery, with meta-analysis of flap and graft survival within four weeks.

• Across four pooled randomized trials, hyperbaric oxygen therapy was associated with a large, statistically significant increase in flap and graft survival (log odds ratio 1.045; 95% CI 0.44–1.65; P<0.001).
• Risk of bias was uneven, ranging from low in one trial to high in two, while six of the nonrandomized studies carried serious risk of bias.
• Using GRADE, the authors issued 11 strong and 13 conditional recommendations, including a strong recommendation to use hyperbaric oxygen therapy to heal flaps and grafts in soft-tissue trauma wounds.

This retrospective review of 85 patients compared endoscopic-assisted radical greater occipital nerve decompression with complete occipital artery elimination (n=74) against standard open decompression with limited proximal artery elimination (n=11), tracking migraine headache index, intensity, frequency, and duration.

• Both techniques significantly improved all migraine measures; the endoscopic group showed a significantly greater reduction in migraine intensity (-5.44 vs -3.00, p<0.001), whereas differences in headache index and frequency did not reach significance.
• Complete migraine resolution was more common after endoscopic decompression, 69.8% versus 45.0% (p=0.04).
• On Cox regression, endoscopic-assisted decompression carried a higher likelihood of sustaining a 90% reduction in migraine frequency and headache index over follow-up.

This narrative review defines supermicrosurgery as microsurgical work on vessels smaller than 0.8 mm in diameter and surveys its enabling technologies and applications in lower extremity reconstruction.

• Supermicrosurgery is defined as microsurgical work on vessels smaller than 0.8 mm in diameter, extending to perforator-to-perforator anastomoses, small-part replantation, and lymphatic reconstruction.
• The authors attribute its growth to ultrafine instruments, microsutures, improved imaging, robotic platforms, and high-magnification microscopes or exoscopes.
• Supermicrosurgery is framed as a distinct emerging field rather than a simple refinement of microsurgery, deepening understanding of microvascular anatomy and physiology.

This retrospective cohort of 168 keloid cases (60 auricular, 108 nonauricular) treated by a single surgeon from 2020 to 2024 compared recurrence and radiation side effects after surgical excision with adjuvant radiation versus excision alone, with intralesional 5-fluorouracil and triamcinolone used in both groups.

• Recurrence did not differ by site among patients receiving surgery plus radiation: 17.07% of auricular versus 16.22% of nonauricular keloids recurred (P=0.91).
• Adjuvant radiation markedly reduced recurrence, to roughly 16–17% versus 44–47% with excision alone.
• Radiation-related side effects were more frequent at nonauricular sites (37% vs 20%, P=0.022).
• Age, sex, race, BMI, and radiation dose did not independently predict recurrence in the final model.

This retrospective case series of 50 patients reviewed reconstruction of defects involving the nasal 'no man's land' (the junction of tip, ala, soft triangle, and sidewall) from 2012 to 2023, categorizing cases by defect characteristics to derive a treatment algorithm.

• Five techniques were used, led by the paramedian forehead flap in 25 cases, then nasolabial (11), bilobed (9), full-thickness skin graft (4), and V-Y flaps (1).
• Cartilage grafting was required in 26 cases, almost always ear cartilage (25 cases), with septal cartilage used once.
• The authors derived an algorithm keyed to defect size, involved subunits, and distance from the alar rim to guide technique choice.

This continuing-education review article synthesizes current classification, molecular pathophysiology, diagnosis, and management of vascular anomalies.

• Management rests on the ISSVA biological classification, separating proliferative vascular tumors from structural vascular malformations.
• Doppler ultrasound and MRI distinguish high-flow from slow-flow malformations by hemodynamic characteristics.
• Driver mutations in the PI3K/AKT/mTOR and RAS/MAPK pathways underpin newer targeted medical therapies.
• Management options span observation, medical therapy with propranolol and sirolimus, laser, endovascular intervention, and resection, delivered by a multidisciplinary team.

A retrospective comparison of 109 patients with distal thumb defects (2018–2023) evaluated the reverse dorsal radial island flap (n=55) versus the reverse thenar island flap (n=54), both combined with analgesic control, across operative time, two-point discrimination, total active motion, hospital stay, pain, return to work, and satisfaction.

• The reverse thenar island flap group had significantly shorter operative time than the reverse dorsal radial island flap group.
• No significant differences were observed in static two-point discrimination, total active motion, hospital stay, pain scores, time to return to work, or hand-function satisfaction.
• Both flaps were safe and effective, and the authors highlight the thenar flap's more concealed donor site as a practical advantage.

This retrospective series of 46 patients drawn from a prospective database examined accessory-to-suprascapular nerve transfer, with or without axillary nerve reconstruction, for traumatic supraclavicular brachial plexus injury (2001–2023), assessing active shoulder abduction and external rotation.

• Across the cohort, median active shoulder abduction reached 80° (range 30–180) and external rotation 0° (range -40 to 70) at a mean 36 months.
• Axillary nerve grafts yielded a median abduction of 90°, versus 70° for triceps motor branch transfers and 50° with no axillary repair.
• Shoulder abduction declined with greater injury extent and longer surgical delay.
• Five patients developed scapular instability from lower trapezius weakness after accessory nerve transfer.

This retrospective cohort of 101 patients with MRI-confirmed scapholunate ligament injuries (2018–2023) had three musculoskeletal radiologists independently grade volar extrinsic, scaphotrapeziotrapezoidal, and dorsal extrinsic ligament injury and quantify scapholunate diastasis.

• Volar extrinsic ligament injury was present in 42% of cases with diastasis greater than 2 mm versus 11% without, and was independently associated with diastasis (OR 4.44; 95% CI 1.51–14.27).
• Dorsal extrinsic injury appeared in 60% of diastasis cases versus 25% without, and was likewise independently associated (OR 3.39; 95% CI 1.33–8.93).
• Interobserver agreement was fair to moderate for injured ligaments and substantial for uninjured extrinsic ligaments.

This multicenter cohort study of 47 patients (31 radial shortening osteotomies, 16 proximal row carpectomies) with Lichtman stage 2-4 Kienböck's disease compared patient-reported outcomes, function, and secondary-surgery rates at mid- to long-term follow-up.

• At a mean follow-up of 10.4 years, radial shortening osteotomy patients had lower (better) PRWE and QuickDASH scores than proximal row carpectomy patients (PRWE 23.5 vs 38.5; QuickDASH 11.4 vs 23.0).
• Patient satisfaction was higher after radial shortening osteotomy than proximal row carpectomy (86% vs 62%), while grip strength was comparable between groups.
• Reoperation rates were similar, but secondary procedures after radial shortening osteotomy were generally less morbid, typically hardware removal rather than total wrist fusion.
• Subgroup analysis showed the osteotomy retained its functional and satisfaction advantage even in late-stage Lichtman 3A/3B disease.

This propensity-matched database study of 1,080 patients (540 carpometacarpal denervation, 540 trapeziectomy) drawn from the PearlDiver Mariner database compared all-cause reoperation at 2 years for thumb carpometacarpal osteoarthritis.

• All-cause reoperation at 2 years was lower after denervation than trapeziectomy (3.3% vs 7.8%).
• On multivariable analysis, denervation carried roughly 60% lower adjusted odds of reoperation (aOR 0.4, 95% CI 0.2-0.7).
• The matched cohorts were well balanced for age, sex, and comorbidity burden, with all standardized mean differences below 0.1.

This narrative review surveys options for bridging nerve gaps, including autologous nerve graft, hollow conduits, and processed human nerve allograft, with emphasis on digital nerve reconstruction.

• For digital nerve gaps under 15 mm, sensory recovery is reported to be equivalent across autograft, hollow conduit, and processed allograft.
• Processed nerve allograft appears to outperform hollow conduits at slightly larger gap lengths, but its comparison with autograft across varied nerve injuries remains unclear.
• Autograft remains effective but adds operative time and donor-site morbidity, motivating off-the-shelf alternatives.
• The authors emphasize that results of nerve repair and reconstruction are often disappointing regardless of technique.

This cohort of 117 patients (136 wrists) with carpal tunnel syndrome undergoing endoscopic carpal tunnel release compared preoperative and 12-month ultrasonographic median nerve cross-sectional area against clinical and electrophysiological outcomes.

• Changes in median nerve inlet cross-sectional area showed no significant correlation with nerve conduction studies, monofilament testing, or symptom-severity and function scores.
• Cross-sectional area remained unchanged or increased at 12 months in 35 wrists (25.7%).
• Metabolic syndrome was independently associated with persistent or increased postoperative nerve swelling, as was male sex.

This geospatial isochrone analysis mapped registered U.S. hand trauma centers, using American Society for Surgery of the Hand data to define 6-hour and 12-hour travel catchments and per-capita center density by state.

• At a 6-hour catchment, 13.3% of the U.S. population lacked access to a registered hand trauma center, falling to 7.6% at a 12-hour catchment.
• Center density per million residents was highest in the District of Columbia, Oklahoma, and Minnesota, while Nevada, Montana, and Kansas had 0 registered trauma centers.
• Several metropolitan areas (Houston, Indianapolis, Columbus and Cincinnati, and major Northeast cities) each had more than 6 hand trauma centers, underscoring an urban-rural disparity.

This computer-assisted surgical anatomical mapping study characterized the number and course of medial antebrachial cutaneous nerve branches around the medial epicondyle of the elbow.

• The medial antebrachial cutaneous nerve showed large variation in the number and course of its branches.
• Mapping demonstrated no safe zone for surgery around the medial epicondyle.

This comparative imaging study of 43 participants (22 without instability, 21 with one symptomatic unstable wrist) compared stress radiographs and stress CT for detecting dynamic scapholunate instability using a semi-automated measurement method.

• Scapholunate distance was greater on clenched-fist plus ulnar-deviation views than on clenched-fist views alone in both groups.
• Scapholunate distance was greater in symptomatic unstable wrists than in stable wrists across all stress radiographs.
• Under stress CT, the radioscaphoid distance was higher in unstable than stable wrists (10 mm vs 6 mm).

This multicenter retrospective cohort of 712 older adult burn patients (aged 60 years and older; 442 nourished, 270 malnourished) across 12 North American burn centers assessed admission albumin against in-hospital mortality and complications.

• The binary albumin classification (3.0 g/dL and above versus below 3.0) was not significantly associated with morbidity or mortality on multivariable analysis.
• Treated as a continuous variable, each 1-point rise in admission albumin lowered the odds of death by 54% (aOR 0.46, 95% CI 0.26-0.81).
• Higher albumin was also associated with lower odds of multiple organ failure (59%) and ICU delirium (54%).

In this retrospective cohort of 274 adults with second- and third-degree burns who underwent excision and grafting at an ABA-verified burn center, initial antiseptic treatment with hypochlorous acid (11.3%) versus mafenide acetate (88.7%) was compared for infection, mortality, length of stay, number of operations, and complications.

• Infection requiring antibiotics occurred in 41.9% of hypochlorous acid patients (13 of ~31) versus 37.0% of mafenide acetate patients (90 of ~243), a nonsignificant difference (p=0.5840).
• Mean time to infection onset was comparable at 6.85 versus 6.50 days (p=0.4436).
• Mortality, length of stay, and complications did not differ significantly between the two antiseptic regimens.

This retrospective cohort of 194 HS surgeries at a quaternary care center used Kaplan-Meier and Cox proportional hazards models to test whether specific perioperative medical therapies were associated with shorter time to documented postoperative healing, and whether intraoperative cultures guided antibiotic management.

• Perioperative trimethoprim-sulfamethoxazole was associated with shorter time to documented healing (HR 2.55, 95% CI 1.46–4.46, P=0.00099).
• Perioperative spironolactone (HR 5.72, 95% CI 2.08–15.74) and preoperative cephalexin (HR 4.17, 95% CI 1.40–12.44) were also associated with faster healing, whereas postoperative cephalexin was not (HR 0.89).
• Intraoperative cultures, obtained in 28% of surgeries, showed only weak, nonsignificant associations with antibiotic exposure and did not significantly guide postoperative antibiotic selection.

This retrospective cohort of 1,372 adult burn survivors from the Burn Model System National Burn Database examined whether self-reported premorbid mobility impairment predicted length of stay, discharge disposition, and PROMIS Global Mental Health, with regression models adjusted for age, TBSA, and inhalation injury.

• Premorbid mobility impairment was associated with longer hospital stay (IRR 1.15, 95% CI 1.04–1.27, P=0.006).
• Impairment was associated with higher odds of discharge to a shelter (OR 1.75, 95% CI 1.41–2.19, P<0.001).
• A nonsignificant trend toward lower PROMIS Global Mental Health scores was observed in impaired survivors (β = -1.92, P=0.091).

This preclinical study in MRSA-infected mice and Bama mini-pigs evaluated an IrPtCu nanozyme embedded in a madecassoside-enriched hyaluronic acid hydrogel (HIPCM) designed to generate reactive oxygen species for bacterial killing and then scavenge ROS to support tissue repair.

• The IrPtCu nanozyme displayed pH-adaptive behavior, first generating reactive oxygen species via oxidase- and peroxidase-like activities to eradicate bacteria, then switching to ROS scavenging through superoxide dismutase- and catalase-like cascades to support repair.
• In the MRSA-infected mouse model, the hydrogel promoted M2 macrophage polarization and angiogenesis alongside accelerated wound closure.
• In Bama mini-pigs, treatment improved collagen deposition and hair follicle regeneration with functional restoration.

This systematic review and meta-analysis of 3 randomized trials (n=325) compared topical oxygen therapy plus standard care against sham or standard care in adults with diabetic foot ulcers, with complete closure at 12 weeks as the primary outcome and RoB 2 risk-of-bias assessment.

• Topical oxygen therapy increased complete closure at 12 weeks (RR 1.53, 95% CI 1.14–2.05), with low between-study heterogeneity (I²≈24%).
• A DerSimonian-Laird random-effects model gave a similar estimate (RR 1.50, 95% CI 1.07–2.10), while Hartung-Knapp adjustment widened the confidence interval, reflecting the small number of trials.

This single-institution retrospective series of 13 patients described intact fish skin graft placement over the fascia by one plastic surgeon for cervical, cervicothoracic, and lumbar revisions or high-risk closures, with at least 6 months of follow-up.

• Of 13 patients, 11 underwent revision for wound dehiscence and 2 had primary cervical or lumbar closures, with 4 requiring posterior hardware coverage.
• Only one patient developed a seroma, which resolved without surgical intervention; all others healed without complications.
• Treated wounds spanned a wide size range (5 to 1920 cm³) in a predominantly older cohort (median age 68 years).

This preclinical in vitro and murine burn-model study tested whether hypoxia-preconditioned gingival mesenchymal stem cell-conditioned medium (HP-GMSC-CM) promotes burn wound healing, using keratinocyte and macrophage assays plus a mouse burn model with pathway inhibition.

• In HaCaT keratinocytes, the conditioned medium promoted scratch closure and migration, with upregulation of LAMC2 and COL4A1.
• In M1-polarized macrophages, it suppressed TNF-α and IL-1β secretion.
• In a murine burn model, treatment accelerated wound closure and increased Pan-CK and TNC, with PI3K/AKT inhibition (LY294002) attenuating the effect.

This retrospective observational study of 27 patients (37 treatment courses) at a regional burn center assessed the change in ionized calcium at days 7 and 14 after IV pamidronate, with hypocalcemia and calcium replacement as secondary outcomes analyzed using descriptive statistics and mixed-effects regression.

• Ionized calcium fell by -0.26 mmol/L (-17.1%) at day 7 and -0.26 mmol/L (-17.0%) at day 14 after pamidronate.
• Most doses were 30 mg (96.2%), given for a mean peak ionized calcium of 1.45 mmol/L in a severely burned cohort (mean TBSA 60.2%).
• Hypocalcemia occurred after 5 of 37 administrations (13.5%).

A qualitative interview study of 25 burn patients and their partners treated at a single eastern Turkish burn center used semi-structured interviews and thematic analysis to explore body image perception.

• Thematic analysis identified four themes: body image and self-perception, emotional reflections, perception of sexuality, and the effect of burn scars on physical body perception.
• Participants reported that post-burn changes in appearance carried strong emotional and self-perception consequences rather than physical effects alone.
• Accounts from patients and partners indicated that scarring reshaped perceived sexuality and relational dynamics within the couple.

A PRISMA-compliant systematic review and meta-analysis of 13 studies (2010–2025) evaluated volume retention, complications, and patient-reported outcomes after autologous fat grafting in postmastectomy breast reconstruction, using random-effects modeling.

• Pooled volume retention across six nonenriched studies was 47% (95% CI 31.5–62.5) at 3–12 months with very high heterogeneity (I2=99%); excluding flap-augmented and water-jet techniques lowered pooled retention to 35.1%.
• Fat grafting showed a numerically higher rate of fat necrosis (RR 2.37, 95% CI 0.80–7.01) that did not reach statistical significance, with no significant differences in any complication category, including irradiated cohorts.
• Enriched grafting techniques reported higher retention (78–89%) but were too heterogeneous to pool quantitatively.
• Patient-reported outcomes, primarily from a breast-related quality-of-life questionnaire, consistently favored fat grafting.

A systematic review and meta-analysis of 12 studies (2000-2024) compared irradiated and nonirradiated flaps for viability, complications, aesthetic outcome, and patient satisfaction in the setting of postmastectomy radiation therapy.

• Irradiated flaps, particularly in immediate reconstructions, showed higher rates of complications such as fat necrosis and flap contracture.
• Delayed reconstruction after radiation was associated with lower postoperative complication rates and better reconstructive results, while flap survival did not differ between immediate and delayed reconstruction.
• Subgroup analysis found fat necrosis was lowest in DIEP flaps (≈12%) compared with TRAM (≈25%) and latissimus dorsi flaps (≈40%).

A retrospective propensity score-matched cohort study compared early oncologic outcomes of robot-assisted versus conventional nipple-sparing mastectomy with immediate reconstruction in patients treated for breast cancer between 2019 and 2022, excluding risk-reducing cases.

• Over a median follow-up of 37.5 months (robot) and 42.6 months (conventional), the robot group had no locoregional recurrence, distant metastasis, or death.
• All seven recurrences (3.5%) occurred in the conventional nipple-sparing mastectomy group.
• Kaplan-Meier analysis showed no significant differences in locoregional recurrence-free, distant metastasis-free, or disease-free survival between groups.

A retrospective cohort of 124 patients (63 prepectoral, 61 subpectoral) compared one-month upper-limb function after implant-based breast reconstruction using QuickDASH, shoulder range of motion, IPAQ, and the Body Image Scale.

• Prepectoral patients reported lower QuickDASH disability, better body image, and fewer pathological shoulder range-of-motion findings, particularly in internal rotation and flexion.
• Functional complications such as adherent scars, dysesthesia, and pain were less frequent in the prepectoral group, and fewer of these patients required postoperative rehabilitation.
• In multivariable analysis, only preexisting upper-limb dysfunction remained independently associated with higher QuickDASH scores.
• Within the prepectoral cohort, ADM- and mesh-based coverage was associated with lower disability than polyurethane-coated implants after adjustment.

A single-center retrospective series of 40 patients undergoing chest wall perforator flap reconstruction assessed patient-reported outcomes with the BREAST-Q reconstruction module, achieving a 78% response rate (n = 31).

• Lateral intercostal artery perforator flaps were most common at 70% (n = 28), followed by medial/anterior intercostal (25%) and lateral thoracic artery perforators (5%).
• Margin re-excision occurred in 23.1% and conversion to mastectomy in 10.3% of cases.
• Median BREAST-Q scores were highest for psychosocial well-being (83) and physical well-being of the chest (80), and lowest for sexual well-being (62).
• Postoperative events needing intervention, including seroma, were associated with diabetes mellitus (P = 0.02).

A retrospective cohort of 104 patients who underwent gender-affirming mastectomy with free nipple grafting used standardized serial photographs and blinded ImageJ quantification to track nipple-areola complex hypopigmentation over time.

• At early follow-up, 65% of patients (n = 68) showed measurable nipple-areola hypopigmentation.
• Mean hypopigmentation decreased from 13.4% to 7.4% at mid follow-up (p < 0.0001) and remained stable at 7.2% at late follow-up.
• Early hypopigmentation was greater in Black patients than White and Asian patients, with longitudinal improvement seen in Black and Asian but not White patients.

A 9-year retrospective review of 499 breasts in 270 patients by two surgeons compared an upsize group (implant larger than specimen, n = 361) with a downsize group (n = 138) for mastectomy skin flap necrosis and other complications after direct-to-implant nipple-sparing mastectomy.

• Mastectomy skin flap necrosis was nonsignificantly lower in the upsize group (3.59% vs 4.35%, P = .70).
• Where secondary outcomes differed significantly, complications were higher in the downsize group.
• In logistic regression, BMI rather than the implant-to-specimen size difference predicted flap necrosis.

A narrative review synthesizes contemporary evidence, recent meta-analyses, and national registries on the pathophysiology, risk factors, and controversies of capsular contracture in implant-based breast reconstruction.

• Clinically significant contracture persists at roughly 3-5% at five years in non-irradiated patients and escalates to 20-50% with postmastectomy radiation.
• The proposed etiology is multifactorial, involving subclinical biofilm, a dysregulated foreign-body immune response, and radiation-induced fibrosis.
• The review emphasizes unresolved controversies, including the lack of standardized diagnostic criteria, ADM versus polyurethane-coated implants, and the optimal radiation-to-reconstruction sequence.

A retrospective single-surgeon case series of 38 patients (40 procedures, 57 breasts) treated between 2006 and 2025, comparing placement of calcium sulfate beads loaded with 500 mg or 1 g of vancomycin versus no beads in the breast pocket following capsulectomy and implant exchange, with recurrent capsular contracture defined as Spear-Baker grade III or IV.

• Bead use was associated with a significant reduction in recurrent capsular contracture (P < 0.001).
• Accounting for all other factors, patients without beads had 15 times greater odds of developing recurrent contracture.
• After adjusting for length of follow-up, the elevated risk in the no-bead group fell to 8 times greater odds.

A narrative review of the historical development, current clinical applications, and emerging innovations in sentinel lymph node biopsy for breast cancer axillary staging, summarizing landmark randomized trials, technical refinements, and ongoing de-escalation studies.

• Early randomized trials (NSABP B-32, ALMANAC) established sentinel node biopsy as oncologically equivalent to axillary dissection for clinically node-negative patients while reducing lymphedema and other morbidity.
• Subsequent trials (ACOSOG Z0011, IBCSG 23-01, AMAROS) supported omission of completion axillary dissection in selected patients with limited sentinel node metastases.
• In the neoadjuvant setting, ACOSOG Z1071, SENTINA, and SN-FNAC informed techniques such as dual-tracer mapping and targeted axillary dissection to reduce false-negative rates.
• Imaging advances including indocyanine green fluorescence and technetium-99m radiotracers, plus superparamagnetic iron oxide tracers, have improved sentinel node identification.

A nationwide population-based case-control study of 1,634 augmentations and 7,023 control procedures (Swedish SOReg and BRIMP registries, 2004–2022) compared reoperation frequency, indications, and intraoperative findings after primary breast augmentation in massive-weight-loss patients versus matched controls, with mean follow-up of about 5.4–5.6 years.

• Reoperation was more frequent in massive-weight-loss patients (9.4% vs 7.1%) and occurred sooner, with shorter mean time to first revision (1.5 vs 2.3 years).
• Among revisions, massive-weight-loss patients had higher rates of implant malposition (20% vs 11%), rotation (9.5% vs 3.1%), and seroma (6.9% vs 1.7%).
• Indications for reoperation were similar between groups, most often patient-driven changes.

A retrospective review of 7,000 consecutive Brazilian Butt Lift procedures (2018–2024) evaluated embolic and thromboembolic events and overall safety using a standardized subcutaneous-only fat injection protocol with stiff cannulas, retrograde technique, and multimodal thromboembolism prophylaxis.

• No pulmonary fat embolism, fat embolism syndrome, deep vein thrombosis, or pulmonary embolism occurred across the entire series.
• Estimated fat graft survival was approximately 70%, with mean injection volumes of 1,200 cc per buttock.
• Minor complications included seroma (23%), anemia (6.6%), fat necrosis (1.9%), and infection (0.43%), with revision surgery in 0.21% of cases.

A single-center retrospective review of 44,133 consecutive cosmetic procedures performed by board-certified plastic surgeons between 1995 and 2024, evaluating hematoma rates before and after adoption of a structured 5-step prevention protocol incorporating tranexamic acid, with hematoma defined as a postoperative blood collection requiring reoperation within 30 days.

• Across the full cohort, 203 hematomas occurred, an overall rate of 0.46%.
• After protocol adoption, the hematoma rate fell to 0.2% during 2017–2024.
• In facial procedures, tranexamic acid use was associated with a 91% reduction in hematoma rate (0.74% vs 0.06%; p<0.0001).

A PRISMA-compliant systematic review and meta-analysis of 11 studies (1122 patients) comparing Scarpa's fascia preservation with classical abdominoplasty, with seroma as the primary outcome and total drain output, drain duration, and hospital stay as secondary outcomes.

• Across 10 studies (n=914), Scarpa's preservation significantly reduced seroma with no observed heterogeneity (RR 0.34; 95% CI 0.21–0.53; I²=0).
• Secondary outcomes favored preservation, with reductions in total drain output (MD -404 mL), drain duration (MD -3.35 days), and hospital stay (MD -2.04 days), though with high heterogeneity.
• Subgroup analyses showed consistent seroma reduction including in post-bariatric or massive weight loss cohorts, but results were not statistically significant in the RCT-only and no-liposuction subgroups.

A three-dimensional imaging study of 70 patients using pre- and postoperative CT scans and 3D photographs to compare bony modifications with perceived soft tissue changes across facial regions after facial feminization surgery, with multivariable regression testing predictors of the soft tissue response ratio.

• Soft tissue and bony changes were significantly correlated for all paired measures, but the response ratio was region-specific.
• At the gonial region, soft tissue reduction exceeded bony reduction (ratio 1.85), whereas forehead projection was near 1:1 (0.98).
• Response ratios were lower at the bossing angle (0.70), chin horizontal (0.83), and chin vertical projection (0.52), paralleling regional soft tissue thickness.
• Within regions, soft tissue thickness, BMI, age, and hormone therapy duration were not significant predictors of the response ratio.

A multicenter retrospective analysis of 1243 reduction mammaplasties performed between 2019 and 2024, stratifying patients by marijuana use and using multivariable logistic regression to identify complications independently associated with use.

• Marijuana users accounted for 20.2% of procedures (n=251) and were younger and more likely to use tobacco than non-users.
• Marijuana use was independently associated with increased hematoma formation (3.2% vs 1.0%; OR 2.97).
• Marijuana use was also independently associated with delayed wound healing (12.8% vs 8.3%; OR 1.95).

A randomized, blinded, split-scar trial of 105 patients with facial Mohs surgery wounds, comparing 5-0 rapidly absorbable polyglactin 910 (Vicryl Rapide) with 5-0 fast absorbing gut for epidermal closure, with two blinded raters scoring photographs at 6 months using the VAS, SBSES, and WES scales.

• At 6 months, the dermatologist's scores significantly favored polyglactin 910 on all three scales (e.g., SBSES 4.4 vs 4.0, p=.006).
• The plastic surgeon's scores also favored polyglactin 910 but did not reach statistical significance.
• Absolute differences between the two sutures were small (e.g., VAS 76.5 vs 73.2), even where statistically significant.

A prospective randomized controlled trial of patients undergoing open rhinoplasty with piezoelectric-assisted osteotomy, randomized to combined IV dexamethasone plus tranexamic acid (group 1), dexamethasone alone (group 2), or tranexamic acid alone (group 3), with periorbital edema and ecchymosis graded on postoperative days 1, 3, and 7 and intraoperative blood loss recorded.

• Combination therapy produced significantly lower edema than tranexamic acid alone on postoperative day 3, and by day 7 edema had significantly decreased only in the combination group.
• No significant differences in ecchymosis were observed between groups on any postoperative day.
• Intraoperative bleeding was highest in the combination group, attributed by the authors to lower mean arterial pressure at the start of surgery.

Retrospective morphometric study of 200 patients (400 facial arteries and veins) analyzed head and neck CT angiography to map the courses and bony-landmark distances of the facial artery (FA) and facial vein (FV).

• Ten facial artery and three facial vein types were identified, including one previously undescribed venous variation; the lateral nasal type was the most common arterial pattern, coursing medial to the nasolabial fold.
• In the infraorbital region, areas beyond 1.64 cm (right) and 1.55 cm (left) from the rhinion represented relatively lower vascular-density zones.
• Around the medial nasolabial fold, areas nearer than 1.53 cm (right) and 1.46 cm (left) to the anterior nasal spine (and within 2.23/2.07 cm of the maxillary alveolar process) showed lower arterial density.
• Vessel-to-bone distances were greater in males than females and in younger than older individuals.

Cadaveric dissection of 44 hemifaces from 22 formalin-fixed cadavers (11 male, 11 female) measured the corrugator supercilii muscle (CSM) and its relationship to the supratrochlear (STN) and supraorbital (SON) nerves and adjacent arteries using ImageJ.

• Corrugator length was significantly greater in females (30.53 ± 2.60 vs 28.93 ± 2.15 mm).
• The supratrochlear nerve showed complex branching (>3 branches) in 48% of cases, with 13.6% piercing the corrugator anteriorly.
• The supraorbital nerve medial branch pierced the muscle's lateral segments in every dissection, splitting between the third (46.5%) and second (53.5%) segments.
• The supratrochlear artery crossed the corrugator roughly 15 mm from the midline, with the supraorbital artery roughly 25 mm lateral to the midline.

Systematic review of 22 studies (82 cases) synthesized flap survival, MRC/MMT strength recovery, complications, and tumor recurrence after free functional muscle transfer (FFMT) following oncologic extremity resection, using pooled proportions with Wilson confidence intervals.

• Flap survival was 100% (77/77; 95% CI 95.3–100.0) among cases reporting this outcome.
• The pooled complication rate was 26.67% (16/60), most commonly wound-related events.
• Strength most often fell in the MRC/MMT >3 to ≤4 range (43.9%), while 15.9% reached >4 to ≤5.
• Mean strength was higher with vastus lateralis (4.21) and rectus femoris (4.17) than with latissimus dorsi (3.55) and gracilis (3.60), though subgroups were small.

Systematic review of 19 studies described 656 patients overall (185 propeller flaps used after sarcoma resection) and assessed indications, reconstructive outcomes, and oncologic reporting of perforator-based propeller flaps in extremity soft tissue sarcoma reconstruction.

• Reconstructions were overwhelmingly in the lower extremity (>95% of reported cases).
• Among studies with extractable data, complete flap survival was 92.7% (115/124), with 3.8% total flap loss and 9.6% partial necrosis.
• Venous congestion was the most frequently reported complication.
• Oncologic outcomes were inconsistently reported, with no clear signal of increased local recurrence but insufficient data to confirm oncologic safety or equivalence to other reconstructions.

Narrative review of lower extremity (LE) reconstruction after sarcoma resection, covering wound environment, compromised vascularity, timing of microsurgical coverage, and risk-stratified reconstructive decision-making.

• Lower extremity free flap reconstruction carries higher complication and failure rates than other anatomic regions, with early microsurgical intervention improving outcomes and negative pressure wound therapy bridging to delayed coverage.
• In oncologic patients, radiation and chemotherapy impair tissue and recipient vessels, favoring vessel selection outside the zone of injury.
• Reconstructive options span local flaps to free tissue transfer by anatomic location, with risk-stratification tools such as the A-Sarc score supporting decision-making.

Case series of 9 adult patients (median age 66) with soft tissue sarcoma enrolled in a phase II chemoradiotherapy trial underwent next-generation sequencing of FFPE core-needle biopsies to detect gene fusions, correlated with radiological and pathological treatment response.

• Gene fusions were detected in one-third of patients (3/9), exclusively in high-grade (G3) tumors.
• Identified fusions included SGSH-PRKCA (myxofibrosarcoma) and JAZF1-MYH7B (UPS), two pairs not previously described in these sarcoma subtypes, plus LINC01133-OGA in MPNST.
• Fusion-positive cases showed stable radiological disease with 5–20% residual viable tumor, whereas fusion-negative cases spanned partial response, progression, and stable disease.
• The detected rearrangements did not alter systemic treatment, and the authors state the data do not support prognostic, predictive, or therapeutic actionability.

Dataset and benchmark study of 686 surgical wound images, each annotated by three surgeons across eight clinical attributes, introduced the open-source SurgWound dataset, a diagnostic benchmark, and WoundQwen, a three-stage multimodal model for surgical wound assessment.

• SurgWound is presented as the first open-source surgical wound dataset covering diverse wound types, with 686 images annotated for eight fine-grained clinical attributes.
• The benchmark defines visual question answering and report-generation tasks for evaluating wound-diagnosis models.
• The proposed WoundQwen framework uses three stages: predicting wound characteristics, assessing infection risk and clinical urgency, then integrating these into a comprehensive report.

Comparative study of 200 experimental anastomoses (chicken-leg femoral artery, performed by novice to experienced microsurgeons) blindly compared two vision-capable LLMs (ChatGPT 5.2 Thinking Extended and Gemini 3.1 Pro) against adjudicated expert consensus, with exact-match agreement as the primary endpoint.

• The stronger model (LLM 1) reached higher exact-match agreement with expert consensus than LLM 2 (0.659 vs 0.539).
• Both models scored better on categorical than numeric items, with LLM 1 strongest for gaps, knots, oblique stitches, and wide bites.
• Allowing a ±1 tolerance on numeric counts raised agreement from 0.610 to 0.900 for LLM 1 and from 0.445 to 0.826 for LLM 2, suggesting only minor counting discrepancies.
• Krippendorff's alpha was positive for most endpoints with LLM 1 but negative throughout for LLM 2.

A registry-based model-development study of 8045 patients (≤36 months) undergoing craniectomy for craniosynostosis in the NSQIP Pediatric dataset, building and internally validating a classifier for transfusion risk and a probabilistic regressor for transfusion volume, evaluated by nested cross-validation.

• Among children in the NSQIP Pediatric cohort, about half received a perioperative transfusion (4091/8045, 50.9%).
• The best classifier (LightGBM) achieved a mean AUC-ROC of 0.77 (95% CI 0.75-0.78) with a Brier score of 0.20 across nested cross-validation.
• The volume model (NGBoost) had a median absolute error of 6.86 mL/kg, but its predicted interquartile ranges captured only 53% of observed values.

A multicenter study of 841 patients undergoing endometrial cancer surgery that compared 26 machine learning algorithms with various data-augmentation techniques to predict postoperative lower-extremity DVT, selecting an SVM model and applying SHAP for interpretability.

• Of 26 algorithms tested, a support vector machine refined by recursive feature elimination to a four-variable set (postoperative D-dimer, age, fibrinogen, clinical stage) performed best.
• The model reached an AUC of 0.828 internally and 0.819 in an independent external cohort.
• SHAP analysis quantified individual feature contributions and revealed a non-linear D-dimer risk threshold, delivered through a web-based decision-support interface.

A pre-implementation framework and synthetic-data feasibility study presenting NURSE-AI, a nurse-by-design pathway for deploying multi-sensor, AI-enabled wound assessment in community care, supported by usability testing with community nurses and segmentation metrics derived from a synthetic multimodal dataset.

• Community nurses rated usability favorably, with a mean System Usability Scale score of 74.5 (± 6.2).
• On the synthetic dataset, segmentation reached IoU values of 0.87-0.93, with simulated ICC ≥0.90 for wound-area estimation.
• Agreement between AI-generated wound-bed-preparation mappings and nurse interpretation was κ = 0.80-0.84.

A single-center observational pilot of 121 wrists (73 with CTS, 48 without) using a three-stage AI pipeline (YOLOv11 localization, U-Net segmentation, ConvNeXt classification) on carpal-tunnel-inlet ultrasound images, with CTS status determined by a hand surgeon using the CTS-6.

• The ConvNeXt classifier reached 94.1% accuracy with perfect sensitivity (PPV 0.86).
• The YOLOv11 localization step showed a PPV of 0.95 and sensitivity of 0.98.
• U-Net segmentation achieved a validation IoU of 0.86.

A validation study of 1795 standardized facial images, each rated by 30 crowd-sourced raters, comparing an AI algorithm's predictions of eight facial-impression traits plus perceived naturalness against the human ratings using Pearson and intraclass correlation.

• AI predictions correlated strongly with human ratings, with r > 0.7 for all eight traits plus naturalness.
• Intraclass correlation was excellent for seven of nine measures (attractive, trustworthy, rested, happy, healthy, sexy, and naturalness).
• Agreement was only fair for dominant and threatening, though those correlations remained highly significant.

An in vitro and in vivo (rat) mechanistic study using a custom controllable negative-pressure loading device, proteomics, genetic silencing, pharmacological modulation, and a rat NPWT model to identify the signaling pathway by which negative pressure activates dermal fibroblasts.

• Continuous negative pressure of -40 mmHg for 2 hours significantly activated dermal fibroblasts, with finite-element analysis confirming roughly -2 kPa compressive stress.
• Proteomic profiling showed Piezo1 upregulation, and pharmacological inhibition or knockdown attenuated fibroblast activation both in vitro and in vivo.
• Mechanistically, the effect depended on Piezo1-mediated Ca2+ influx and calcineurin/NFAT3 signaling.

A prospective observational follow-up of 104 patients from the ADMSC arm of a prior phase III trial, assessing WOMAC and VAS pain at 1, 2, and 3 years after a single injection and examining factors associated with favorable outcomes.

• WOMAC and VAS pain scores improved significantly after injection and were sustained through 3 years.
• The proportion of patients meeting the minimal clinically important difference showed a slight, non-significant decline over time.
• Favorable outcomes were associated with lower BMI (<25) and higher baseline clinical scores.

A preclinical in vitro and in vivo calvarial-defect study comparing extracellular vesicles from human adipose-derived stem cells conditioned with or without the TGFbeta inhibitor SB431542, testing their osteogenic effects in cell culture and in calvarial defects and profiling their miRNA cargo.

• EVs from SB431542-conditioned hASCs enhanced osteogenesis in cell culture and in calvarial defects.
• miR-20a-5p, enriched in these EVs, was identified as the key modulator, silencing BAMBI.
• Downstream, the EVs increased SMAD1/5 phosphorylation and beta-catenin activation, implicating BMP and canonical Wnt signaling.

A case series of 3 trauma patients applied dual extracellular-matrix biologic scaffolds (the SMART technique) to bridge acute full-thickness skeletal muscle defects across distinct anatomical regions after debridement and antibiotic irrigation, with assessment by bedside examination and Medical Research Council grading.

• All three repairs achieved immediate mechanical continuity without infection or early construct failure.
• Protected motion was tolerated within 8–12 weeks across the three cases.
• Constructs were applied across three distinct anatomical regions following debridement and antibiotic irrigation.

An experimental study in the colonial chordate Botryllus schlosseri tested whether a brief, clinically safe pulse of electrical current affects longevity, regeneration, and stem-cell function, combined with whole-transcriptome profiling of the response.

• Electrically stimulated colonies showed increased growth, enhanced reproduction, and improved survival, alongside better stem-cell-associated function.
• Transcriptomics revealed a biphasic program beginning with a 2-hour synchronized downregulation of the genomic engine, mitochondrial respiration, contractile apparatus, and ECM integrity.
• This systemic pause transitioned into a 24-hour rebound featuring a metabolic surge, cytoskeletal rebuilding, and ECM scaffold synthesis.
• Stimulation induced an immunometabolic shift from proinflammatory to reparative, mimicking exercise-induced changes seen in mammals.

A systems-biology study using two Boolean network models proposed how dysfunctional HHIP impairs epithelial wound healing, with predictions validated against published experimental evidence and single-cell and single-nucleus RNA-seq from COPD cohorts and Hhip heterozygous knockout mice.

• In both models, dysfunctional HHIP produced a loss of negative feedback on GLI, triggering full EMT instead of the partial EMT required for collective wound closure.
• Under full EMT, wound-edge cells became mesenchymal and failed to close the wound properly.
• Model predictions were consistent with single-cell and single-nucleus RNA-seq data from COPD cohorts and Hhip heterozygous knockout mice.

A narrative review synthesizes the molecular mechanisms, biomaterial delivery platforms, and translational challenges of localized tacrolimus delivery for peripheral nerve regeneration.

• Tacrolimus is presented as a calcineurin inhibitor with immunomodulatory and neuroregenerative activity, whose systemic use is constrained by dose-limiting toxicity.
• Delivery platforms covered include conduits, wraps, injectable hydrogels, electrospun scaffolds, and stimuli-responsive carriers, assessed for polymer composition, degradation kinetics, and pharmacological performance.
• The review highlights multimodal biomaterials combining tacrolimus with trophic factors, extracellular vesicles, or bioelectrical stimulation, and notes regulatory and manufacturing hurdles for drug-device combination products.

A narrative review summarizes exosome biogenesis, engineering strategies, biomaterial-assisted delivery systems, and the clinical-trial status of stem cell-derived exosomes for cutaneous wound healing and skin regeneration.

• Stem cell-derived exosomes are described as regulating inflammation, angiogenesis, re-epithelialization, ECM remodeling, and scar formation via paracrine signaling, without the risks of direct cell transplantation.
• Engineering approaches reviewed include cargo loading, surface modification, genetic engineering, and parental-cell preconditioning to improve targeting and bioavailability.
• Biomaterial carriers such as hydrogels, scaffolds, and nanofibers are reported to enhance exosome retention, stability, and controlled release at the wound site.

An experimental biofabrication study mapped native mouse-skin stiffness by atomic force microscopy, engineered gelatin methacryloyl hydrogels of matching moduli, and paired them with tissue-specific dermal extracts to direct mesenchymal stem cell spheroid differentiation before modular 3D bioprinting.

• AFM revealed two distinct mechanical niches: a compliant perifollicular dermis at 4.58 kPa and a stiffer peri-glandular microenvironment at 9.43 kPa.
• Matrix stiffness alone initiated epithelial commitment, but pairing physical and biochemical cues was required for lineage-specific maturation, with plantar and dorsal dermis extracts enriched in BMP and Sonic Hedgehog signaling respectively.
• Lineage-committed modules were assembled by 3D bioprinting into an integrated multi-appendage skin model that maintained cell viability and phenotype during long-term culture.

An in vitro laboratory study isolated and expanded keratinocytes and mesenchymal stem cells from plucked human hair follicles using an enzyme-free explant method, then characterized their reprogramming, differentiation, and secretome.

• Follicle-derived keratinocytes retained epithelial identity and were reprogrammed into induced pluripotent stem cells, then directed toward definitive endoderm and pancreatic progenitor fates.
• Follicle-derived MSCs showed a characteristic mesenchymal profile with trilineage plasticity and the ability to differentiate into dopaminergic neural progenitors.
• The autologous follicle secretome was enriched in regenerative cytokines and exosomes and demonstrated wound-healing bioactivity in vitro.