Plastic Surgery Weekly

Systematic review of 28 studies comprising 157 patients (162 ALT/VL-based flaps) used for complex abdominal wall reconstruction, analyzing indications, flap configurations, motor innervation, mesh use, and reported outcomes descriptively alongside an illustrative institutional case.

• Reconstructions were predominantly pedicled (91.9%), with free flaps (8.1%) reserved for selected defects, and configurations scaled modularly with defect size and complexity.
• Abdominal complications occurred in 24.2% of patients, while total flap loss was not reported in any case.
• Complications were not associated with flap configuration or mesh use but were increased without motor innervation, which was preserved or restored in 50.6% of cases.

Retrospective multicenter study of 57 patients undergoing hemiglossectomy or extended glossectomy for oral squamous cell carcinoma across four tertiary centers, comparing ipsilateral tip resection without reconstruction (contralateral tip preserved) versus with partial tip reconstruction on Fussi-Cantagallo articulatory tests and the Speech Handicap Index.

• On articulatory tests 1 and 2, the no-reconstruction group showed a trend toward better performance (p = 0.061), with no significant difference on the remaining tests.
• Younger age was independently associated with improved articulatory performance (p < 0.02).
• No differences in outcomes were associated with flap type or adjuvant therapy.

Retrospective comparative study of 76 patients (82 hips) with ARCO Stage II osteonecrosis of the femoral head, comparing magnesium-doped artificial bone plus pedicled peri-acetabular bone flap (44 hips) with conventional core decompression (38 hips) on hip function, pain, radiographic progression, and hip survival.

• The flap group had a higher hip-preserving success rate (90.9% vs 65.8%) and less progression to Stage IV (4.8% vs 16.7%).
• At final follow-up, the flap group showed higher Harris Hip Scores (84.12 vs 81.94) and lower VAS pain scores (2.97 vs 3.32).
• The flap procedure carried longer operative time (47.9 vs 44.2 min) and greater blood loss (36.2 vs 27.3 mL).

Systematic review and pooled analysis of 20 studies comprising 511 patients with nonsyndromic unicoronal craniosynostosis, comparing unilateral (n=196) versus bilateral (n=315) fronto-orbital advancement on surgical outcomes, complication profiles, and long-term stability with at least 12 months of follow-up.

• Contour deformity was significantly more frequent after unilateral FOAR (75.0% vs 27.5%, P<0.05).
• Bilateral procedures required longer operative times (213 vs 162 min), with no significant difference in overall complication rate, hospital stay, or relapse incidence.
• Postoperative strabismus outcomes could not be pooled because of heterogeneous reporting across studies.

Exploratory preclinical study in a rodent face vascularized composite allotransplantation model that extracted plasma and tissue cell-free DNA at the time of histologically and immunofluorescence-confirmed graft injury and used next-generation sequencing with donor-specific single nucleotide polymorphisms to identify donor-derived cfDNA.

• Donor-specific SNPs absent from the recipient genome were detected in circulating cfDNA, confirming feasibility of detecting donor-derived cfDNA after face transplantation.
• Donor-derived cfDNA was elevated at clinically apparent graft injury, comprising approximately 0.31% of total sequenced fragments.
• Across donor–recipient pairings, 313 donor-specific SNPs mapping to 49 genes were consistently detectable, suggesting a reproducible signal in this model.

In a retrospective single-centre cohort of 213 patients treated for vestibular schwannoma (2006–2024, retrosigmoid 121 and translabyrinthine 92), multivariable logistic regression assessed predictors of partial or severe facial palsy at 12 months, including postoperative Day 1 function, Koos grade, sex, and surgical approach.

• Overall, 30% of patients had any facial palsy at 12 months (23.5% partial and 6.6% severe).
• Severe palsy on postoperative Day 1 carried an adjusted odds ratio of 222 for 12-month palsy (95% CI 26.45–1864.44; Firth-corrected OR 128), dominating every other variable in the model.
• Recovery diverged sharply by Day 1 status: 90% of patients with normal Day 1 function remained palsy-free at one year versus 4.5% of those with severe Day 1 palsy.
• Female sex was independently associated with palsy (OR 2.87, p = 0.013), whereas neither surgical approach nor Koos grade predicted outcome.

In a controlled animal study of 32 Sprague-Dawley rats with pedicled groin flaps, simulated arterial or venous occlusion was monitored with a portable infrared camera (FlirOne), with the contralateral side serving as positive or negative control and an intracutaneous thermistor as the comparator.

• Venous occlusion produced a consistent rise in flap surface temperature, whereas arterial occlusion did not yield a reliable temperature decrease.
• Temperature changes after arterial ischemia appeared to develop more slowly than those of venous congestion.
• Agreement between the infrared camera and the intracutaneous thermistor was moderate.

This case series of 14 patients (11 men, 3 women; mean age 40.4 years; mean follow-up 19.2 months) describes the distally based saphenous neurocutaneous perforator flap for complex post-traumatic distal lower-leg defects, with the pivot point kept 5–7 cm above the medial malleolus to preserve the distal-most perforator.

• The procedure was uneventful in 13 of 14 patients, with no flap loss reported.
• A single patient developed slight venous congestion that resolved with conservative treatment and secondary healing.
• Four flaps were harvested with bulky subcutaneous tissue to obliterate dead space, illustrating the design's adaptability to composite defects.

This surgical technique article details a combined approach to primary bilateral cleft lip repair that integrates three components: the sliding V-cheiloplasty, the step-down technique, and primary rhinoplasty performed concurrently with the lip repair.

• The sliding V-cheiloplasty is used to create adequate lip length and mobilize the alar base medially to counteract the lateralizing forces of healing.
• The step-down technique, with relaxing incisions into the membranous septum, lengthens the prolabial flap, refines Cupid's bow, and enhances nasal tip projection.
• Primary rhinoplasty performed concurrently with the lip repair addresses nasal tip and columellar deformities early in management.

In a retrospective chart review and survey of 66 patients (mean age 66.2 years) with post-facial-paralysis synkinesis, ocular dominance assessed by the Miles test was correlated with symptom severity on a standardized synkinesis questionnaire.

• Patients with bilateral ocular dominance had significantly higher synkinesis questionnaire scores (p < 0.05) than those with same-side or opposite-side dominance.
• No difference emerged across dominance groups in botulinum toxin use (total units or number of treatments) or in the presence of surgical intervention.

Retrospective propensity-matched cohort study of up to 22,585 matched pairs drawn from 65,786 patients in the TriNetX electronic health record network, comparing early and late sequelae over 10 years after closed management of distal radius fractures in patients aged 50–69 versus 70–89 years.

• The younger cohort had higher rates of delayed surgery at all timepoints (5.03% vs 3.51% at 1 year; HR 1.49, P < .001).
• Nonunion, malunion, and posttraumatic arthritis were uncommon (<1%) and did not differ between age strata.
• The 50–69 cohort showed higher hazards of complex regional pain syndrome, De Quervain tenosynovitis, and late-onset carpal tunnel syndrome, along with corrective and reconstructive procedures beyond 90 days.

In a retrospective cohort of 341 patients treated for Dupuytren contracture (141 initial fasciectomy, 200 initial collagenase; 2015–2019), the need for subsequent treatment in the same digit, another digit, or the contralateral hand was tracked over a mean 5.3 years, with demographic and contracture predictors assessed.

• At a mean 5.3 years, 42% of patients underwent additional treatment, comprising 26% on the same digit, 10% on another digit of the same hand, and 23% on the contralateral hand.
• Same-digit reintervention was associated with procedure type, multiple digits treated, and initially untreated contracture.
• Reintervention on another digit of the same hand was associated with younger age, active smoking, and initially untreated contracture.
• Contralateral-hand reintervention was associated with initial treatment of the dominant hand and untreated contracture.

This retrospective case series of 99 patients assessed union after open reduction internal fixation with nonvascularized autograft (45 cancellous-only, 52 corticocancellous, 2 osteochondral) for scaphoid nonunion at a single hospital (2014–2024), with healing defined as ≥50% bridging bone on CT.

• Overall, 95% of patients healed, with a median time to radiographic healing of 81 days.
• Among patients showing bridging bone on the first postoperative CT (median 77 days), 99% went on to union.
• There were no significant differences in healing odds or time between corticocancellous and cancellous-only autograft.
• All 13 patients with a prior failed fixation elsewhere healed after revision surgery with nonvascularized autograft.

This diagnostic study of 50 patients with 51 extra-articular distal radial fractures compared published radiographic malrotation characteristics (Giddins and Sassi) on post-reduction radiographs against two CT-based measurement methods, a new 'fracture level' method and a modified Filer's method.

• By CT, 35–41% of wrists had a rotated distal fragment after reduction, depending on the measurement method used.
• Giddins' radiographic characteristics predicted malrotation with 100% sensitivity and 70% specificity against the fracture-level CT method as reference.
• The 70% specificity indicates that the radiographic characteristics over-call some non-rotated fractures, while missing no truly rotated fragment.

This matched retrospective cohort study from a 2010–2022 national administrative database compared 90-day complications and 5-year ipsilateral revision after endoscopic versus open carpal tunnel release, with separate 1:1 matching within obese (BMI > 30) and nonobese cohorts.

• Among obese patients, endoscopic release was associated with lower rates of surgical site infection and wound dehiscence (0.46% vs 0.73% and 0.39% vs 0.72%), confirmed on multivariable analysis (OR 0.62 and 0.53).
• Among nonobese patients, endoscopic release was similarly associated with reduced surgical site infection (OR 0.64) and wound dehiscence (OR 0.47), although revision rates were slightly higher with endoscopic release (1.49% vs 1.39%).
• Revision in the obese cohort did not differ between approaches (1.92% vs 2.01%), and there were no differences in hematoma or median nerve injury in either cohort.

This randomized controlled trial of 32 patients with isolated traumatic digital nerve injuries compared a single one-hour postoperative session of 20 Hz transcutaneous electrical stimulation against sham, with sensory recovery assessed by Semmes-Weinstein monofilament testing and two-point discrimination over three months.

• Both groups improved progressively and approached normal sensory values by 3 months, with no statistically significant differences between stimulation and sham on any outcome.
• Confidence intervals for the group comparisons overlapped and no clinically meaningful differences were detected.
• No adverse effects were reported in either group.

This retrospective propensity-matched cohort of 1,080 adults with type 2 diabetes undergoing open distal radius fracture fixation (TriNetX, 2018–2024) compared those with active GLP-1 receptor agonist use within 180 days preoperatively against matched non-users for 90-day medical and 180-day surgical complications.

• GLP-1 receptor agonist use showed no significant difference in composite 90-day medical complications or composite 180-day surgical complications, with individual adverse events uncommon in both groups.
• GLP-1 receptor agonist use was associated with lower odds of emergency department visit and/or hospital readmission at 180 days.
• Healthcare use at 30 and 90 days was similar between cohorts.

This is a descriptive single-centre report of the UK clinical psychology protocols (UKCPP) used in over 60 candidates at the only UK centre performing hand and upper limb transplantation, outlining semi-structured interview and psychometric assessment of recipient attributes.

• The protocol uses semi-structured interview and psychometric testing to assess decision-making capacity and informed consent, alongside the patient's personal and social setting.
• It evaluates whether candidates hold realistic expectations of physical and psychological outcomes and demonstrate strong motivation and ability to cope with a demanding, lifelong process.
• The protocols have been applied to over 60 patients and judged fit for purpose by the centre.

This retrospective review of 73 telephone-interviewed patients (37 with concurrent posterior interosseous nerve neurectomy, 36 without), drawn from 173 who underwent open primary dorsal wrist ganglion excision, compared QuickDASH scores, pain, recurrence, and satisfaction at mean follow-up of 4–6 years.

• There were no statistically significant differences in QuickDASH, satisfaction, pain level, or pain improvement between the neurectomy and non-neurectomy groups (P = .7).
• Cyst recurrence was 13.5% with neurectomy versus 27.8% without, a nonsignificant difference (P = .16).
• Among patients with recurrence, none in the neurectomy group sought reintervention versus 4 of 10 in the non-neurectomy group.

This single-arm case series of 47 patients with hand bone malunions evaluated percutaneous opening-wedge osteotomy, realignment, and fixation, assessing angulation correction and total active motion over a mean 26-month follow-up.

• Mean finger apex angulation improved from 43° preoperatively to 2° at final follow-up, and thumb angulation from 40° to 0°.
• Bone healing was achieved in all 47 patients at a mean of 6 weeks.
• Functional outcomes were 36 excellent and 11 good results, with a mean total active motion of 257°.

Randomized, double-blind, placebo-controlled phase 3 trial of 238 patients with deep second- and/or third-degree burns covering 20% or more of total body surface area and requiring grafting, conducted across 24 international burn centers, comparing intravenous vitamin C (50 mg/kg every 6 hours for 96 hours) with matched placebo on a composite of 28-day mortality and persistent organ dysfunction.

• The primary composite of 28-day mortality and persistent organ dysfunction occurred more often with vitamin C (40.8% vs 29.7%; adjusted RR 1.28, 95% CI 0.99–1.65), crossing the prespecified futility/harm threshold and prompting early termination.
• Twenty-eight-day mortality was roughly doubled in the vitamin C group (15.0% vs 7.6%; adjusted RR 1.96, 95% CI 1.32–2.90), and hospital mortality was likewise higher (23.3% vs 16.1%).
• Time to discharge alive from hospital within 90 days was not improved (adjusted subdistribution HR 0.85, 95% CI 0.62–1.16).

Prospective single-center observational study of 180 patients with major burns over four years, comparing early-resuscitation hemodynamics, fluid administration, and biomarkers between patients with inhalation injury (n=84) and those with 20% or greater TBSA burns without inhalation injury (n=96), who had similar severity scores.

• Patients with inhalation injury showed reduced initial cardiac index, higher lactate, increased stroke volume variation, greater late extravascular lung water, and elevated NT-proBNP despite comparable fluid requirements.
• Mechanical ventilation was more frequent with inhalation injury (88% vs 59%), with a non-significant trend toward higher mortality (28% vs 18%, p=0.10).
• Among inhalation-injury patients, non-survivors had lower initial cardiac index and higher troponin, lactate, extravascular lung water, and NT-proBNP despite similar intrathoracic blood volume.

This systematic review and meta-analysis of 19 studies (9 pooled) evaluated admission serum albumin as a prognostic marker for mortality, acute kidney injury, length of stay, ventilatory requirements, sepsis, and pulmonary infection in burn patients.

• Admission hypoalbuminaemia was associated with markedly increased in-hospital mortality (OR 9.51; 95% CI 3.04–29.78).
• Admission hypoalbuminaemia was also associated with increased risk of acute kidney injury (OR 2.83; 95% CI 2.49–3.22; I² 0%).
• Evidence for length of stay, ventilation, sepsis, and pulmonary infection was limited and heterogeneous.

This single-center retrospective cohort of 86 patients with hand burns and documented long-term outpatient occupational hand therapy (2015–2024) reviewed range of motion, activities of daily living status, pain, and return to work.

• Improvement was seen in 75.6% of patients for ADL function and 72.1% for range of motion.
• Pain as a major limitation fell from 50% at intake to 23% by the end of therapy.
• Patients who did not require surgery and had good therapist-rated compliance had a higher likelihood of ROM improvement (OR 1.26 and 1.27).

A national multi-database analysis of 420,383 burn encounters (NIS 2016–2021 and BCQP 2016–2022) used 1:1 propensity-score matching to test whether burn center care and inpatient psychosocial or behavioral interventions were associated with discharge against medical advice (AMA).

• AMA discharge occurred in 2.8% of NIS and 1.4% of BCQP encounters, and its incidence rose over the study period in both databases (IRR 1.2).
• Significant predictors of AMA discharge included male sex, Medicaid or self-pay status, and smaller burns (P<0.01).
• In the propensity-matched model, burn center care was associated with a 1.2% absolute reduction in AMA discharge (ATE −0.01; P=0.01).
• Inpatient psychosocial or behavioral interventions had no measurable effect on AMA discharge (P=0.85).

A single-centre randomised controlled trial of 66 patients with deep second-degree burns compared collagenase ointment with silver sulfadiazine over 21 days, with time to wound healing as the primary outcome.

• Total wound healing time was comparable between arms, with a median of 10 days in both groups (P=0.672).
• Median time to necrotic tissue removal was shorter with collagenase, 2 days versus 9 days with silver sulfadiazine (P=0.001).
• Inflammation scores were slightly lower with collagenase (P=0.043), while re-epithelialisation (92.8% vs 89.5%) and necrosis debridement rates (93.9% vs 90.8%) were similar, with no adverse events in either arm.

A single-institution retrospective cohort of 119 patients receiving three or more fractional ablative CO2 laser treatments for burn hypertrophic scars stratified subjects into younger, middle-aged, and older cohorts by k-means clustering and tracked outcomes with POSAS, VSS, and durometry.

• The older cohort improved significantly in POSAS observer pliability after a single session, whereas younger and middle-aged groups required two or more sessions.
• Middle-aged patients reported the highest baseline pain and itch (6.17/10 and 6.64/10) compared with younger and older groups.
• POSAS and VSS scores improved in all groups, but durometer measurements changed significantly only in the middle-aged cohort.

A propensity-matched cohort of 13,664 burn patients (6832 vitamin D-deficient, 6832 nondeficient controls) from the TriNetX network compared hypertrophic scarring and scar-related interventions over 24 months using Cox proportional hazards models.

• At 3 months, hypertrophic scarring affected 5.82% of deficient patients versus 2.55% of controls, a more than twofold increase (HR 2.33).
• The association persisted over time, with deficient patients reaching 10.61% versus 5.26% scarring by 24 months (HR 2.09).
• Deficient patients also underwent more reconstructive and adjunctive procedures, including Z-plasty (HR 1.86–2.38) and intralesional corticosteroid injection (HR 3.14–3.56).

An integrative gene regulatory network analysis of adult human palate and skin wounds sampled over seven days combined gene expression with transcription factor binding and protein-protein interaction data to compare regenerative versus scar-forming healing.

• Even before injury, palate and skin networks displayed tissue-specific transcription factor targeting and divergent gene co-expression.
• The acute injury response was characterized by transcription factor-mediated gene repression, followed by tissue-specific gene activation at later healing stages.
• The palate-enriched factor BATF3 promoted cell migration and re-epithelialization after injury but did not affect proliferation.

A retrospective cohort of 28 patients (109 fasciotomy incisions across 60 extremities) treated after the 2023 Kahramanmaraş earthquakes compared negative pressure wound therapy (78 wounds) with wet-to-dry dressings (31 wounds), with allocation determined by device availability.

• The NPWT group required significantly fewer debridements than the wet-to-dry group (P<0.05).
• Dressing-related complications and the need for additional dressing interventions were significantly more frequent with wet-to-dry care (P<0.05).
• There were no significant differences in infection rate, primary closure, graft requirement, or length of stay (P>0.05).

A systematic review and meta-analysis of five observational studies comprising 409 patients (75 treated with HBOT) undergoing immediate or first-stage breast reconstruction used single-arm random-effects pooling to estimate salvage and complication rates after early postoperative HBOT.

• Pooled flap salvage was 82% (95% CI 72–90%) and pocket salvage was 78% (95% CI 65–88%).
• Reoperation occurred in 15% and explantation in 8%, with postoperative infection in 3%.
• Therapy typically began within the first 10 postoperative days (10–20 sessions at 2.0–2.5 ATA), and adverse events were mild and infrequent.

A systematic review and proportional meta-analysis of acellular dermal matrix-assisted implant-based breast reconstruction in patients receiving postmastectomy radiotherapy pooled complication rates with subgroup comparisons by ADM type, implant plane, and radiotherapy timing.

• Pooled complication rates were 16.8% for capsular contracture, 8.3% for infection, 5.8% for seroma, and 10.6% for implant loss.
• Prepectoral placement showed lower capsular contracture and infection than submuscular or mixed planes, while mixed-plane placement was associated with more implant malposition.
• Postoperative radiotherapy carried the highest rates of capsular contracture, implant loss, and reoperation, whereas preoperative radiotherapy had the lowest.
• Bovine matrices showed lower capsular contracture, implant loss, and reoperation, with overall patient satisfaction reaching 80.8%.

Systematic review of 11 studies encompassing 783 patients (irradiated cohorts of 9 to 54 patients per study) describing outcomes, safety data, and patient- and surgeon-reported results after total autologous fat transfer breast reconstruction in patients treated with radiotherapy.

• Irradiated patients underwent a mean of 3.2 to 7.6 grafting sessions, with mean cumulative volumes for completed reconstructions ranging from 490 to 1109.2 mL.
• Some authors reported higher session counts and greater cumulative volumes in irradiated versus non-irradiated breasts, whereas others observed comparable values between groups.
• Most included studies reported minor complications and high satisfaction, while recurrence events were only infrequently described.

Retrospective analysis of 92 reconstructions (42 fat-grafted, 50 non-grafted) assessed with BCCT.core and the Harvard Scale at 6 to 12 months, comparing aesthetic trajectories across reconstruction types and prior radiotherapy exposure.

• Non-grafted reconstructions showed significant aesthetic deterioration in 46% of cases (BCCT.core p = 0.027; Harvard p < 0.001), uniformly across modalities.
• Fat grafting achieved 88.1% versus 4% complete complaint resolution compared with non-grafted reconstructions (Mann-Whitney p < 0.001), with the greatest gains in irradiated breasts.
• Conventional 3-week radiotherapy produced greater deterioration than 5-day regimens (p = 0.036; p = 0.024), and one to two grafting sessions typically sufficed.

Retrospective population-based cohort of 2634 patients undergoing autologous breast reconstruction in Ontario (2005 to 2020), comparing pedicled TRAM and free tissue transfer and using generalized linear models to identify factors associated with hospital admission cost.

• Free flap reconstruction was associated with a 13% cost increase versus pedicled TRAM (95% CI 5% to 22%; p < 0.001).
• Age older than 70 years carried the largest increase at 31% (95% CI 7% to 61%), with bilateral reconstruction adding 11% and lower income quintile adding 10%.
• Hospital type, geographic region, timing of reconstruction, comorbidities, and rurality were not significantly associated with cost.

Retrospective review of 175 patients undergoing tissue expander breast reconstruction, comparing complication rates across four groups defined by whether drains with prolonged high output were removed based on output volume or on elapsed time.

• Patients whose drains were removed only after output dropped below 30 mL/d had complications comparable to controls (16.7% versus 11.9%; P = 0.54).
• Drains removed before output criteria were met carried a markedly higher complication rate of 55.6%, with infection the most common type (60%).
• The authors concluded that removal decisions should be guided by output volume rather than indwelling duration.

Retrospective cohort of 6164 patients aged 10 to 21 years undergoing reduction mammaplasty in the Pediatric Health Information System database (2007 to 2025), analyzing inflation-adjusted hospital costs, standardized resource utilization, and time to surgery.

• Standardized resource utilization fell by 0.3% per year while inflation-adjusted hospital costs rose by 0.3% per year (p = 0.003).
• Cost inflation was concentrated among publicly insured (p < 0.001) and uninsured (p = 0.018) cases, while private-insurance costs remained stable (p = 0.741).
• Black patients and those with complex chronic conditions incurred significantly higher costs (both p < 0.001).
• Public insurance (OR 1.46) and Hispanic ethnicity (OR 1.67) were independent predictors of a delay between diagnosis and surgery.

Single-surgeon retrospective series of 71 reconstructions in 46 patients undergoing abdominally based DIEP free-flap breast reconstruction with routine perioperative tranexamic acid (1 g at induction and 1 g at closing), evaluating thrombotic and bleeding outcomes.

• Flap survival was 100%, with no hematomas, flap thrombosis events, or transfusions and no inpatient complications.
• Delayed complications occurred in 19.6% of patients, most often donor-site (8.7%) and skin-paddle (4.3%) wound-healing issues.
• One patient experienced a segmental pulmonary embolism, and two required interventional radiology drainage for an abscess or seroma.

Retrospective cohort of 20 patients with upper inner quadrant breast tumors undergoing partial breast reconstruction with chest wall perforator flaps, assessed objectively with BCCT.core software and by BREAST-Q patient-reported outcomes at 12 months.

• The anterior intercostal artery perforator (AICAP) flap was the most common (40%), followed by combined LICAP/LTAP flaps (25%), with a mean operative time of 79 minutes.
• Postoperative complications occurred in 20% of patients (seroma 10%, wound infection 5%, fat necrosis 5%), with no major flap loss or positive surgical margins.
• Excellent or good cosmetic outcomes were achieved in 95% of patients, alongside favorable BREAST-Q well-being and satisfaction scores.

Claims-based analysis of 11,670 records for female patients undergoing reduction mammaplasty (CPT 19318) in the PearlDiver Mariner database (2010 to 2023), comparing reimbursement across the four US census-defined regions and by payer type.

• Average reimbursement ranged from $3426.60 per record in the South to $4550.22 in the West, the lowest and highest regional values respectively.
• The West also showed the greatest interstate variability, at $7049.89 per record.
• Across all regions, private insurers reimbursed at higher rates than public insurers and accounted for the majority of claims.

This retrospective cohort of 80 patients undergoing primary lipoabdominoplasty compared four groups defined by semaglutide timing (continued to surgery, stopped 2 weeks prior, stopped 4 weeks prior, and semaglutide-naïve controls), matched for age, BMI, and surgical technique, with 30-day complications as the endpoint.

• Patients who continued semaglutide until surgery had the highest complication rate at 45%, including wound dehiscence, infection, and seroma formation.
• Complications fell in a stepwise fashion with longer discontinuation: 30% at 2 weeks and 10% at 4 weeks, the latter matching the 10% rate seen in naïve controls.
• Gastrointestinal intolerance and prolonged drain duration were more frequent with ongoing semaglutide use, and no reoperations or readmissions occurred in any group.

This hybrid prospective-retrospective cohort of 144 facial feminization surgery patients (32 PREFACE participants vs 112 comparison) evaluated a multimedia prehabilitation program of video modules, a guidebook, and a mobile app using the RE-AIM framework, with length of stay, 30-day complications, pain, and perioperative opioid use as clinical outcomes.

• Program engagement reached 94.4% with mean satisfaction of 9.1±1.1; the guidebook was the most used format (82.3%), followed by the mobile app (58.8%).
• Compared with controls, PREFACE participants reported lower inpatient pain (1.7 vs 2.8, p=0.03) and fewer postoperative messages and phone calls (1.0 vs 2.0, p=0.01).
• Among ecological momentary assessment responders, PREFACE participants had lower PROMIS Pain Intensity scores at 4–5 days postoperatively (4.0 vs 6.0, p=0.02).

This observational self-controlled study of 50 patients (100 eyes) undergoing full-incision double-eyelid blepharoplasty assessed ocular surface and meibomian gland parameters preoperatively and at 1 week, 1 month, and 3 months.

• OSDI scores, meibum quality, gland expressibility, and incomplete blinking rate deteriorated significantly at 1 week and 1 month (all p<0.001).
• Tear film break-up time, corneal staining, Schirmer I, lipid layer thickness, and gland dropout showed no significant change at any time point.
• By 3 months, all altered parameters had recovered to baseline, with no statistically significant difference from preoperative values.

This retrospective review of 45 consecutive patients undergoing primary augmentation mastopexy used an inverted-T, superior-pedicle approach in which the posterior lamella of the superficial fascial system was preserved as a vascularized flap to reinforce the lower pole, with a mean follow-up of 21.5 months.

• Only three minor complications (6.7%) occurred (one late infection, one seroma with partial dehiscence, one isolated dehiscence), all managed conservatively without implant removal or revision.
• There were no cases of implant malposition, bottoming out, or exposure across the cohort.
• BREAST-Q scores improved significantly in all domains, including +30.4% in satisfaction with breasts (p<0.001), with consistent gains regardless of implant pocket plane.

This cross-sectional study of 200 subjects stratified by age and sex into 10 subgroups characterized lower facial aging using the Jowl Appearance Scale, quantitative marionette line measurements, and a newly established prejowl sulcus appearance scale.

• All evaluated parameters increased significantly with age in both men and women, indicating a progressive lower facial aging pattern captured by the combined metrics.
• Marionette line angle showed the strongest correlation with age (r=0.90), followed by maximum color depth (0.88) and marionette line length (0.86).
• The newly established prejowl sulcus appearance scale also correlated highly with age (r=0.86).

This retrospective review of 41 patients with upper eyelid dermatochalasis and levator function over 10 mm evaluated a modified infrabrow blepharoplasty incorporating superomedial skin-orbicularis repositioning, using the Strasser Grading System at 3 and 6 months and a 6-item satisfaction questionnaire.

• The upper eyelid contour was smooth from the early postoperative period, avoiding the abnormal skin wrinkling associated with conventional elliptical-excision infrabrow blepharoplasty.
• Strasser scar assessment at 6 months showed good to excellent results.
• Patients reported satisfaction with the infrabrow scar and good overall satisfaction throughout the follow-up period.

This single-arm study of 40 patients with lower eyelid bags and tear trough deformities and no significant skin laxity assessed transconjunctival orbital fat repositioning plus orbicularis oculi plication and suspension, evaluating operative duration, pain, Allergan grading, satisfaction, and ultrasonographic soft tissue changes.

• Soft tissue thickness over the infraorbital rim peaked at 5 days and then declined but remained significantly greater than baseline at 6 months (p<0.05).
• The 30–40-year-old subgroup showed the greatest improvement in Allergan scores between pre- and postoperative assessment (p<0.05).
• Patient satisfaction at 6 months was 96.6%, with short operative times (28–49 min) and low intraoperative pain scores (2–4).

This prospective single-arm trial of 203 volunteers with signs of facial aging evaluated the efficacy and safety of a single injection of BtHCROSS, a hyaluronic acid filler made with a novel crosslinking (SARE) technology, over 9 months using validated aesthetic scales, GAIS, satisfaction questionnaires, and biometric instruments.

• Mid-Face Volume Loss and Wrinkle Severity scores improved significantly at both 6 and 9 months, with early changes already visible at 21 days.
• The treating physician rated GAIS improvement in more than 88%, 92%, and 76% of volunteers at 21 days, 6 months, and 9 months, with satisfaction above 70% throughout.
• Biometric analysis showed rapid, statistically significant improvement that was maintained across the follow-up period.

Retrospective cohort of 52 patients undergoing primary rhinoplasty with Intermediate Alar Resection (IAR) between 2024 and 2025, using standardized photographic anthropometry and the validated Rhinoplasty Outcome Evaluation (ROE) questionnaire to compare pre- versus postoperative tip parameters and satisfaction.

• Median nasolabial angle rose from 97.1° to 105.6° and the nasofacial angle from 35.6° to 37.9°, indicating increased tip rotation (both p < 0.001).
• Tip width decreased by 12% on average while nasal projection decreased by 7.5%, and Goode's ratio remained stable.
• Median postoperative ROE score was 22 of 24 (IQR 2), with no major complications reported.

Systematic review of 12 studies (PRISMA 2020, 2014–2025) evaluating radiofrequency microneedling (RFMN) alone or in combination for melasma, with a qualitative synthesis performed because of clinical and methodological heterogeneity.

• RFMN consistently improved MASI or modified MASI scores and melanin indices, with effects maintained up to 6 months.
• Histological analysis showed reduced dermal senescence markers and partial restoration of basement-membrane integrity.
• Combination with low-fluence Q-switched Nd:YAG laser produced greater pigment reduction than monotherapy, with a low incidence of PIH in darker phototypes.

Scoping review of 27 studies mapping patient- and caregiver-reported outcomes in children with bone or soft-tissue sarcomas after limb salvage or amputation, with data charted and synthesized narratively across quality-of-life domains.

• Physical functioning was the most assessed domain, showing generally moderate-to-good outcomes with limited differences between limb salvage and amputation.
• Pain remained common months to years after surgery, and psychosocial findings were mixed across body image, recreation, and school participation.
• Only four studies included caregivers, who reported anxiety, depression, financial strain, and shifting family roles.

Retrospective cohort of 1826 patients in which preoperative questionnaires and postoperative dispute data were used to compare DeepSeek-LLM-generated psychological risk scores against ratings from three blinded plastic surgeons via Bland-Altman analysis and Pearson correlation.

• LLM-generated risk scores showed strong concordance with physician evaluations (Pearson r = 0.883), with 93.9% of points within the 95% limits of agreement.
• Patients with BDD (12.0%) and those with postoperative disputes (2.4%) had significantly elevated preoperative risk scores versus controls (p = 0.027 and p = 0.015).
• "Satisfaction with previous surgical outcomes" and "surgical financial stress" emerged as the strongest risk factors for postoperative disputes.

Multicentre retrospective heuristic evaluation across five UK burn services in which 49 burn-team members (21 doctors, 28 nurses) completed a 12-item Likert usability survey mapped to six Nielsen heuristic domains, supplemented by free-text feedback.

• Domain means ranged 3.93 to 4.35 with medians at or above 4.0 and positive-response rates of 65.3% to 87.8%.
• There were no significant differences between professions or centers, with only small-to-moderate effect sizes.
• Free-text feedback highlighted speed, output clarity, and portability, while requesting a lighter imaging head, longer battery life, and streamlined data entry.

Narrative review of studies published 2015–2025 synthesizing artificial intelligence in burn and wound care across three domains: image-based recognition and segmentation, predictive modeling of outcomes, and integration into telemedicine and smart-device platforms.

• Convolutional neural networks achieved segmentation Dice coefficients frequently exceeding 0.85 and burn-depth or tissue-type classification sensitivities above 0.90.
• Multimodal prediction models for healing, graft success, infection, and amputation reached accuracies and AUCs of roughly 0.80–0.95.
• Persistent barriers included algorithmic bias across skin tones, limited dataset diversity, opaque model behavior, and evolving regulatory frameworks.

Scoping review of 23 studies (PRISMA-ScR, databases searched to April 2025) synthesizing the development, performance, and validation of machine-learning models for predicting intraoperative bleeding, with bias assessed using PROBAST.

• Tree-based ensemble models were used most often (70% of studies), and discrimination varied widely (mean AUC 0.82, range 0.63–0.93).
• Only 6 of 23 studies (26%) performed external validation, and performance frequently declined externally (AUC fell from 0.85 to 0.63 in one study).
• PROBAST indicated a high risk of bias in all 23 studies (100%), with calibration and precision metrics frequently omitted.

Narrative review synthesizing applications, challenges, and future directions for large language models in emergency and critical care medicine, organized around four methodological pillars: domain adaptation, knowledge integration, multimodal and temporal modeling, and transparency.

• The authors frame effective LLM deployment around four methodological pillars: domain adaptation, knowledge integration, multimodal and temporal modeling, and transparency.
• Proposed applications span clinical decision support, documentation, education, and research, including dynamic risk stratification for conditions such as sepsis by integrating physiological waveforms with multi-omics data.
• Translation to routine care remains constrained by model hallucinations, multimodal integration barriers, and unresolved ethical governance, prompting calls for human-in-the-loop design and multicenter prospective validation.

This conceptual letter outlines how reasoning capability could be integrated into Vision-Language-Action (VLA) models that underpin AI copilot robots for endoscopic surgery, and what such reasoning would need to accomplish.

• Effective reasoning is framed as the capacity to integrate multimodal cues, interpret surgical intent, and infer hidden tissue dynamics, thereby easing intraoperative uncertainty and surgeon cognitive load.
• The authors argue that reasoning-driven autonomy could move AI copilots from reactive executors to cognitive collaborators, with potential gains in precision and safety.
• Reasoning capability within the surgical VLA setting is identified as largely unexplored, positioning it as an open research direction rather than a demonstrated capability.

In a methods study using 7197 minutes of Chinese clinical recordings (plus 240 minutes of English dialogue as a portability check), the authors built and evaluated an agent framework (Planner, Memory, Executor) that converts raw unstructured transcripts into structured transcripts for LLM fine-tuning.

• The agent reached 94.7% denoising, 96.9% content correction, 88.6% speaker identification, and 92.7% segmentation accuracy and ran 3.6 times faster than manual processing.
• Fine-tuning an open-weight model (Qwen3-32B) on agent-structured versus raw transcripts raised blinded expert quality scores from 3.1 to 3.7 (P < 0.001) and improved external benchmark (HealthBench) performance.
• Removing the Planner or Memory module degraded performance markedly, with up to a 47.6% reduction in speaker identification, supporting the value of coordinated task decomposition and cross-step state retention.

In this registered clinical study, a 660 nm low-level laser therapy (LLLT) protocol was applied to wound sites and skin stiffness was quantified using optical coherence tomography (OCT) with an air-jet indentation system, with a U-Net model automating layer-specific OCT segmentation.

• The U-Net segmentation model reached 92% accuracy, enabling precise delineation of skin layers for layer-specific stiffness measurement.
• LLLT significantly reduced skin stiffness immediately after treatment, indicating acute modulation of tissue compliance.
• The combined OCT and air-jet indentation approach provided non-contact, layer-specific biomechanical assessment of wound tissue.

This narrative review examines the mechanistic basis of mitochondrial dysfunction in the diabetic wound microenvironment and evaluates intercellular mitochondrial transfer and mitochondrion-targeted biomaterials as candidate therapies.

• Persistent hyperglycemia and chronic inflammation are described as disrupting mitochondrial homeostasis via impaired bioenergetics, excess reactive oxygen species, and dysregulated quality control, undermining proliferation, angiogenesis, and immunomodulation.
• Intercellular mitochondrial transfer through tunneling nanotubes, extracellular vesicles, gap junctions, and cell fusion is presented as an endogenous rescue mechanism that could restore bioenergetic and redox balance in damaged cells.
• Key translational barriers identified include insufficient protocol standardization, absence of robust characterization criteria, and a lack of quantitative benchmarks for transfer efficacy.

In this preclinical in vitro and in vivo study, the authors developed a peptide/Talin1-plasmid/PLA-HA/GelMA scaffold (PTPG) and tested whether bidirectional activation of integrin beta1 (ITGB1) drives neurovascularized bone regeneration.

• The REDV-IKVAV peptide drove 'outside-in' and the Talin1 plasmid drove 'inside-out' ITGB1 activation, jointly enhancing cell proliferation, migration, and secretion; these effects were abolished by ITGB1 silencing.
• In vivo, the scaffold promoted aligned neurovascular networks that guided bone deposition.
• Single-cell RNA sequencing showed enrichment of endothelial H-type and repair-associated Schwann cell phenotypes with activation of ITGB1-FAK-paxillin signaling.

This mechanistic study used 3D Skin-iDISCO+ imaging and patient-derived telocyte in vitro models to investigate the role of stromal telocytes in vascular remodeling during infantile hemangioma (IH) regression.

• Perivascular telocytes showed increased dendricity during regression, indicating activation, and their secretome featured pentraxin 3 (PTX3) as a central inhibitory effector.
• In 3D multicellular models, PTX3 exerted a paracrine block of endothelial FGFR signaling via FGF2-PTX3 interaction, regulating endothelial proliferation, sprouting, and activation.
• Mechanistic study and collagen IV staining indicated that regression occurs at least partly through vascular pruning.

This in vitro bioprinting study compared three co-culture configurations of HUVECs and bone marrow-derived MSCs in a fibrin-gelatin bioink (co-printed in one filament, adjacent filaments, or paracrine without contact), assessing viability, metabolic activity, and endothelial network formation over 14 days.

• Only configurations including MSCs supported extensive, stable CD31-positive endothelial networks, while all designs maintained high viability and metabolic activity.
• Both co-printed and adjacent-filament constructs produced significantly greater tubular surface area than paracrine-only conditions.
• Endothelial network formation in adjacent-filament constructs was comparable to co-printing, indicating co-localization within the same filament is not required when cells are within migratory distance.

This prospective observational cohort of 120 septic adults undergoing major (>2 h) non-cardiac surgery measured plasma exosomal miRNAs at preoperative, intraoperative, and 24-hour postoperative time points to test their ability to predict KDIGO-defined and subclinical AKI.

• Patients who developed AKI showed distinct perioperative changes in specific exosomal miRNAs compared with those who did not.
• Several miRNAs demonstrated measurable discriminatory ability (ROC AUCs in a clinically relevant range) for early AKI detection across sampling time points.
• Subclinical AKI was defined by urinary TIMP-2 x IGFBP7 > 0.3 without a creatinine rise, allowing detection before conventional markers changed.

In a preclinical murine acute kidney injury study, a self-assembled IL-4 peptide hydrogel was used to encapsulate mesenchymal stem cells (MSCs) and reprogram them toward a CD106+ subset, with encapsulated cells delivered by renal capsule transplantation and compared against untreated MSCs.

• The IL-4 peptide hydrogel shifted MSC populations toward a homogeneous CD106+ subset with enhanced regenerative and immunomodulatory capacity.
• Compared with untreated cells, hydrogel-encapsulated MSCs delivered by renal capsule transplantation showed superior engraftment and survival.
• Treated animals had improved renal function, with reduced serum creatinine, attenuated tubular necrosis, and fewer inflammatory infiltrates.

This narrative review summarizes preclinical and translational evidence on adipose-derived mesenchymal stem cell (ADMSC) exosomes as a paracrine-based therapy for diabetic foot ulcers (DFU), framed against current standards of surgical debridement, negative-pressure therapy, and anti-infection measures.

• Standard DFU treatments (debridement, negative-pressure therapy, anti-infection) are described as limited by prolonged duration, high cost, and suboptimal outcomes.
• ADMSCs support wound repair largely through paracrine secretion of cytokines, with exosomes acting as key mediators of these effects.
• The review positions ADMSC-derived exosomes as promising agents for DFU repair warranting further clinical investigation.

This narrative review integrates historical and contemporary literature on craniofacial critical-size defects (CSDs), examining how age, dura mater biology, and stem cell dynamics shape regenerative potential and proposing an age-stratified reclassification.

• Healing capacity is strongly age-dependent: pediatric patients benefit from metabolically active dura and rich stem cell niches, while aging patients show reduced osteogenesis from inflammaging and stem cell senescence.
• Experimental models indicate that defect size, embryonic bone origin, and proximity to cranial sutures influence calvarial healing.
• Bioceramic composites, dura-integrative hydrogels, and dura-targeted regenerative strategies are highlighted as promising directions across age groups.
• The authors propose an age-stratified reclassification of CSDs integrating biological, structural, and clinical variables.

In an in vitro bioprinted human dermis model, collagen-based constructs seeded with human dermal fibroblasts were treated with non-invasive monopolar radiofrequency (NMRF) and assessed by histology, immunofluorescence, SEM, compression testing, and conditioned-media paracrine assays.

• NMRF increased fibroblast activity and produced a denser, more organized collagen network, with greater type I collagen deposition around activated fibroblasts.
• Biomechanical testing showed an increased compressive modulus and reduced construct dimensions, consistent with enhanced dermal stiffness and matrix remodeling.
• Conditioned media from treated constructs exerted paracrine effects, promoting fibroblast migration, suppressing melanogenesis-related genes (MITF, tyrosinase, Trp-1, Trp-2), and improving keratinocyte survival under oxidative stress.

In a stirred-tank bioreactor expansion study, adipose-derived stem cells (ASCs) were grown on microcarriers across varied operating conditions (B1–B5), with growth kinetics, metabolic profiling, and DNA damage assessed together in a genotoxicity-informed optimization framework.

• Optimized conditions (B5) achieved high cell productivity within 9 days while maintaining >90% viability, mesenchymal immunophenotype, and differentiation capacity.
• Enhanced proliferation under optimized conditions was associated with increased glycolytic activity.
• Genotoxicity testing revealed progressive, time-dependent DNA damage and rising micronucleus frequency during expansion.
• These genomic changes did not impair proliferation, phenotype, or differentiation, indicating that conventional optimization metrics may miss them.