Plastic Surgery Weekly

A retrospective single-center series of 351 free jejunal flaps (1984-2025) paired with a PRISMA systematic review, used to formalize a composite 0-12 monitoring score (peristalsis, luminal secretion, serosal color, pin-prick bleeding) assessed via an exteriorized sentinel segment.

• Overall flap survival was 97.7%, with vascular compromise in 3.4% of cases at a median detection time of 2.5 h (IQR 2.0-4.0).
• Among compromised flaps, salvage was achieved in 33.3%.
• In the alert subgroup, the score showed 100% sensitivity and 76.5% specificity (PPV 75%) with no missed events.

A systematic review and meta-analysis of 32 studies (3238 patients) comparing preoperative imaging modalities (CTA, ultrasound, MRA, and others) for DIEP flap breast reconstruction, with imaging-to-surgical perforator correlation and complications as outcomes.

• Pooled perforator utilization was highest with MRA (92%), followed by CTA (87%) and ultrasound (85%).
• Overall complications occurred in 13.8% of patients, with ultrasound alone showing the highest rate (17.3%) versus CTA alone (13.9%) and CTA+US (10.8%).
• The difference between ultrasound alone and CTA+US was statistically significant (RR=0.63, p=0.0123), whereas CTA alone did not differ significantly from the other strategies.

A systematic review and single-arm meta-analysis of 1976 phalloplasty cases from 46 articles comparing deep inferior epigastric artery (DIEA, 71.5%) versus femoral artery (FA, 28.5%) recipient vessels for thrombosis and flap outcomes.

• Pooled arterial and venous thrombosis rates were 2.0% and 2.2% across all cases.
• An interpositional vein graft or AV loop with the FA carried a markedly higher arterial thrombosis rate (16.0%) than direct FA anastomosis (0.1%) or DIEA (1.2%, both p<0.001).
• With patent vessels, partial flap necrosis was less frequent with direct FA anastomosis (0.6%) than with the DIEA (6.2%, p=0.016).

A secondary analysis of the multicenter BIOPEX-2 RCT (165 of 175 patients) comparing perineal closure with a gluteal turnover flap versus primary closure after abdominoperineal resection for rectal cancer, evaluating 12-month cost-effectiveness and quality of life.

• Mean total cost was €45,079 with the gluteal turnover flap versus €53,397 with primary closure, a reduction of €8318 (95% CI €928 to €15,709).
• Primary closure incurred higher outpatient, specialized wound (mean €1200 vs €720), and home care (mean €3842 vs €2504) costs.
• Patients with perineal complications reported lower EQ-VAS and EQ-5D scores, but no significant quality-of-life difference between randomization groups was observed.

A systematic review and meta-analysis of 11 studies totaling 1775 free flaps (876 monitored with flow couplers) pooled diagnostic accuracy and flap outcomes for flow couplers against conventional monitoring techniques.

• Pooled sensitivity for detecting flap compromise was 96.5%, with specificity of 90.9%.
• Flap failure occurred in 2.2% of flow-coupler-monitored flaps versus 3.1% of controls.
• Flow couplers showed high negative predictive value but variable positive predictive value, with false-positive signal losses driven mainly by technical issues rather than true thrombosis; false negatives were uncommon.

A retrospective national insurance-database study of 1213 patients with plastic surgery involvement (among 320,072 posterior spine surgeries without it, 2010–2019) compared 90-day wound complications, ED visits, admissions, and reoperations by timing of plastic surgery closure.

• Same-day plastic surgery closure had far lower 90-day wound complications than closure within 1 month (25.2% vs. 70.8%, P<0.001).
• ED visits, hospital admissions, and reoperations were also significantly lower with same-day closure than with closure within 1 month.
• Greater odds of plastic surgery consultation were associated with spinal fracture, prior spine revision, multilevel fixation, sacral fracture, male sex, and higher Charlson Comorbidity Index.

A prospective multi-phase validation study of 99 patients and 25 experts (2023–2025) at a single tertiary center developed and validated the 45-item Facial Synkinesis PROM through patient-informed item generation, expert content validation, and test-retest assessment.

• Cronbach's α ranged from 0.888 to 0.943 initially and from 0.905 to 0.963 on retest, indicating strong internal consistency.
• Intraclass correlation coefficients ranged from 0.553 to 0.839, indicating moderate to excellent test-retest reliability.
• The instrument spans five domains: symptoms, involuntary movements, daily activity limitations, social impact, and self-perception.

A retrospective cohort of 41 patients compared transcranial (n=23) and transmaxillary (n=18) microvascular free flap insetting for anterior skull base defects, assessing defect size, recurrence, survival, and complications.

• The transcranial group reconstructed larger defects than the transmaxillary group, with vastus lateralis the primary flap choice.
• Recurrence-free rates at 20 months were 90% (transcranial) versus 78% (transmaxillary), and 40-month overall survival was 74% versus 88%.
• Clavien-Dindo ≥3b complications occurred in 34.7% (transcranial) versus 38.9% (transmaxillary), 35.7% overall.

A retrospective cohort of 136 patients undergoing urethrocutaneous fistula repair (2013–2022) assessed whether coronal location and other factors predict recurrence, using modified Poisson regression with stratification by fistula number.

• Independent predictors of recurrence included coronal location (RR 2.13), repeated repair (RR 2.34), higher urethral defect ratio (RR 4.30), and lack of prior corpora cavernosa reconstruction (RR 1.90).
• Coronal location remained a significant risk factor in single-fistula patients (aRR 2.68) but not in those with multiple fistulas (aRR 0.82).
• Overall, 31 of 136 patients (23%) developed recurrent fistula over a median follow-up of 36.2 months.

A retrospective study of 112 free parascapular flaps for lower extremity reconstruction compared intraoperative ICG near-infrared video angiography (n=45) with conventional clinical evaluation (n=67) for distal perfusion assessment.

• ICG identified poorly perfused distal segments in 15 of 45 cases (33%), all of which had uncomplicated postoperative courses.
• Partial flap necrosis occurred in 6.7% (3 of 45) of ICG flaps versus 18.0% (12 of 67) controls (p=0.09).
• ICG-assisted reconstructions required fewer recipient-site revisions (20.0% vs. 35.8%, p=0.10) and showed a negative predictive value of 98%.

A multicenter, assessor-blinded RCT of 60 patients randomized 1:1 to primary flexor tendon repair under WALANT or general/regional anesthesia with tourniquet, assessing trial feasibility alongside range of motion, strength, complications, costs, and patient-reported outcomes (per-protocol n=56).

• At 6 months, mean total active motion was 67.6 (GA/RA) versus 60.3 (WALANT), a small between-arm difference.
• Tendon rupture occurred in two GA/RA and three WALANT patients, while Michigan Hand Questionnaire scores were consistently higher in the WALANT arm across domains.
• WALANT patients returned to work earlier (mean 3.0 vs 6.7 weeks), and intraoperative costs were 54% lower (-£398, 95% CI -£509 to -£287).

A retrospective cohort of 742 patients undergoing primary unilateral carpal tunnel release (2008–2013) with a minimum 10-year follow-up assessed the incidence, timing, and predictors of subsequent contralateral release.

• Contralateral release occurred in 314 patients (42%) at a median of 10.6 months, with cumulative incidence of 22%, 26%, 34%, and 40% at 1, 2, 5, and 10 years.
• The strongest predictor was contralateral carpal tunnel symptoms at the index surgery (OR 7.2).
• Contralateral electrodiagnostic severity (OR 1.43 per unit) and concurrent trigger finger (OR 1.80) raised the odds, whereas Black race was associated with lower odds (OR 0.44).

A single-surgeon case series of 36 patients with acute perilunate injuries treated by radial-sided-only fixation (K-wire for ligamentous injury or headless compression screw for scaphoid fractures) assessed radiographic alignment.

• All patients achieved stable carpal alignment with radial-sided-only fixation, with no lunotriquetral pinning performed.
• At final follow-up, mean scapholunate angle was 55° (range 34°–84°), with mean scapholunate interval 1.8 mm and lunotriquetral interval 1.7 mm.
• No patients developed VISI deformity during follow-up.

A retrospective study of 53 patients with severe carpal tunnel syndrome and absent preoperative compound muscle and/or sensory nerve action potentials who underwent open carpal tunnel release, with nerve conduction studies repeated at 3 months and multivariable logistic regression used to identify predictors of reappearance of potentials.

• A subset of patients regained CMAP and/or SNAP by 3 months postoperatively, demonstrating electrophysiological recovery despite absent preoperative potentials.
• On multivariable analysis, younger age and higher body weight were independently associated with SNAP recovery (P < .01 and P = .04).
• Age showed the strongest association with CMAP recovery but did not reach statistical significance, and neither symptom duration nor metabolic laboratory parameters were independent predictors.

A retrospective review of 16 patients (mean age 40 years, mean follow-up 55 weeks) with adult brachial plexus injury, prior elbow flexion reconstruction, and preoperative mBMRC grade below 3 who subsequently underwent glenohumeral arthrodesis, assessing change in elbow flexion strength and motion.

• Elbow flexion motion, total arc of motion, and mBMRC flexion grade all showed significant postoperative improvement.
• Preoperative elbow flexion strength was inversely correlated with postoperative strength and arc of motion, so the weakest starting limbs gained the most.
• Four of 16 patients failed to reach antigravity strength and two failed to improve at all, with increased age identified as a risk factor for failure to improve.

A systematic review and meta-analysis of 16 studies comprising 447 patients reporting outcomes after supercharged end-to-side anterior interosseous-to-ulnar motor nerve transfer for ulnar nerve pathology, using random-effects pooling of binary outcomes.

• Pooled intrinsic muscle recovery to MRC grade ≥3 was 80.6%, with recovery to near-normal strength (MRC ≥4) in 64.4%.
• Near-normal recovery was markedly higher in traumatic injuries (85.5%) than in compressive (52.9%) or mixed (33.3%) pathologies, and surgery within 12 months was associated with better MRC ≥3 recovery.
• Mean grip strength reached 75.7% of the contralateral side, and the overall complication rate was 7.9%.
• Residual clinical signs persisted, including Wartenberg's sign in 59.1%, Froment's sign in 17.6%, and ulnar clawing in 12.1%.

A prospective multicenter registry of 887 patients (1,082 hands) treated with ultrasound-guided carpal tunnel release after failed nonsurgical management at 22 US sites, tracking recovery time, Boston Carpal Tunnel Questionnaire scores, pain, quality of life, satisfaction, and adverse events through 6 months.

• Median time to resume normal activities was 3 days (IQR 1–5) and to return to work 4 days (IQR 2–7).
• All patient-reported outcomes improved significantly, including a −1.66-point change on the Boston Symptom Severity Scale and a −3.9-point reduction in pain severity.
• Patient satisfaction was 89.9%, no serious adverse events occurred, and the reoperation rate was 0.1%.
• Most procedures used wide-awake local anesthesia (82.1%) with a mean incision of 5 mm, and outcomes were similar for unilateral and simultaneous bilateral release.

A web-based cross-sectional survey of 1,373 participants from 44 countries, recruited via the Prolific platform and convenience sampling and excluding anyone with a hand condition or trauma, to generate normative values for the appearance, function, life impact, and symptoms HAND-Q scales.

• The study delivers the first normative HAND-Q reference values for the appearance, function, life impact, and symptoms scales from a healthy population.
• Smoking status, skin type, age, and occupational factors were significantly associated with specific scales, while former smokers showed incremental gains with longer time since cessation.
• No significant gender differences were observed across the four scales.

A PRISMA-aligned systematic review of 32 studies (412 patients, 589 procedures) on nonsurgical and surgical upper limb reconstruction in arthrogryposis multiplex congenita, with a treatment algorithm developed from 13 joint-specific interventional studies.

• Posterior elbow release consistently improved passive elbow flexion and functional hand-to-mouth reach.
• Muscle transfers (latissimus dorsi, pectoralis major, Steindler flexorplasty, selective triceps) restored meaningful active elbow flexion in selected patients, though outcomes depended heavily on donor muscle quality.
• Distal humeral rotation and carpal wedge osteotomies improved hand orientation, bimanual grasp, and rigid wrist flexion deformity.
• Thumb-in-palm deformity was most effectively managed with first-web reconstruction and metacarpophalangeal stabilization, with emerging support for severity-based staged reconstruction.

A retrospective case-control study of 972 participants (243 patients with ganglion cysts, 729 controls) comparing Beighton scores, occupation, body mass index, and physical activity, with univariate and multivariable logistic regression to identify independent risk factors.

• Hypermobility prevalence was 64% in the ganglion group versus 19% in controls, an adjusted odds ratio of 7.1 (95% CI 5.1–9.9).
• Manual occupation was a second independent risk factor (adjusted OR 1.4, 95% CI 1.0–1.9).
• Risk rose with greater hypermobility severity (significant positive trend across Beighton categories), while age, sex, body mass index, and physical activity did not differ between groups.

A multicenter RCT of 184 patients in China with partial-thickness burns randomized 1:1 to PermeaDerm or porcine acellular dermal matrix (ADM), with complete re-epithelialization by day 14 (superficial) or 21 (deep) as the primary endpoint.

• PermeaDerm was non-inferior to ADM for the primary endpoint of complete re-epithelialization.
• By day 7, more wounds had re-epithelialized with PermeaDerm for both superficial (55.6% vs 27.0%, p=0.012) and deep (37.2% vs 12.7%, p=0.005) burns.
• Median time to complete re-epithelialization was 3 days shorter with PermeaDerm for both depths, while pain and complication rates were similar.

A single-center retrospective cohort of 42 men with type II/III electrical wrist burns treated with free flap coverage, comparing 20 who received secondary tendon/nerve reconstruction with 22 who did not, using QuickDASH at ≥6 months as the primary outcome.

• The reconstruction group had a significantly better median QuickDASH (26.0 vs 39.5, p<0.001) than the non-reconstruction group.
• Reconstruction comprised tendon grafting (80%), tenolysis (80%), and nerve grafting (20%), performed at a mean of 6.15 months post-injury.
• The two groups were comparable in age, injury severity, and initial flap outcomes at baseline.

A retrospective multicenter longitudinal analysis of 815 adults with at least 20% total body surface area burns from the Burn Model System database, stratified into large, very large, and massive burn groups, with PROMIS, community integration, and employment outcomes assessed at 6, 12, and 24 months using mixed-effects models.

• Depression and anxiety remained elevated relative to population norms, whereas social participation improved over time across all burn sizes.
• Survivors with massive burns (≥70% TBSA) showed the greatest 24-month improvement in mental health, reaching clinically meaningful magnitude.
• Their community integration at 24 months was comparatively preserved, coming closest to pre-injury levels despite lower perceived social-role ability and employment.

A retrospective multicenter validation of 527,197 adult burn patients in the TriNetX U.S. Collaborative Network compared the diagnostic accuracy and prognostic value of Sepsis-3, American Burn Association (ABA), and Mann-Salinas criteria, using ICD-10 coded sepsis within 7 days as the reference standard.

• Sensitivity was high across all three definitions (ABA 86.7%, Mann-Salinas 86.6%, Sepsis-3 81.4%), while specificity varied substantially, ranging from 45.8% for Sepsis-3 to 77.0% for Mann-Salinas.
• Positive predictive values were uniformly low (2.5%–6.0%), reflecting overclassification in a population where only 1.4% had documented sepsis, whereas negative predictive values exceeded 99% across all criteria.
• No significant differences in 28-day mortality emerged between definitions in propensity-matched cohorts, with all pairwise hazard ratios crossing unity.

A 3-year retrospective review of 149 patients at a single verified adult burn center examined split-thickness skin grafting and/or autologous skin cell suspension to the lower extremities, testing whether the timing of early ambulation related to graft loss.

• First ambulation occurred at postoperative day 1–3 (mean POD 1.05), and timing of initial ambulation showed no significant association with graft loss.
• Twelve of 149 patients experienced minor graft loss, all of which healed with conservative management.
• Graft loss was instead significantly associated with history of stroke, renal disorder, and previous amputation (p=0.006, 0.012, and 0.006, respectively).

A retrospective single-center study of 243 patients aged over 65 with burns exceeding 10% TBSA (2012–2025, French national burn center) evaluated the lactate/albumin ratio (LAR) and Charlson Comorbidity Index (CCI) as mortality predictors; overall mortality was 35.0%.

• The lactate/albumin ratio discriminated mortality strongly (AUC 0.84), comparable to lactate alone (0.81) but superior to albumin (0.74), with LAR >1.0 identified as a critical threshold.
• On multivariate analysis the Charlson Comorbidity Index was an independent predictor of mortality (OR 1.71), alongside TBSA, inhalation injury, and LAR (OR 2.15).
• The lethal area 50% (LA50) threshold was established at 34% TBSA.

An international survey of 106 burn units across 50 countries (44% response rate) described diagnostic, debridement, and coverage practices through four case scenarios and standard-practice questions, comparing responses by regional economic status.

• Early surgical debridement (<48 h) was most commonly described as standard care, although definitions of early grafting varied across respondents.
• Low/middle-income and high-income countries differed in the availability of diagnostic tools, enzymatic debridement, and wound coverage techniques.
• Further regional variation appeared among high-income countries in Europe, North America, and Oceania.

A single-center retrospective study of 87 patients with confirmed necrotising fasciitis (2015–2025) at a tertiary center assessed mortality predictors and the prognostic utility of the LRINEC score using univariate and multivariate logistic regression.

• Overall mortality was 36.8% (23.0% within 30 days), with ICU admission required in 58.6% of cases and a median time to theatre of 8.8 h.
• Independent predictors of mortality included age (OR 1.104), immunosuppression (OR 6.03), and white cell count (OR 0.860), with the strongest being the need for renal replacement and/or ventilatory support (OR 23.6).
• A LRINEC score >6 was not independently predictive of mortality.

A retrospective single-center cohort of 106 patients admitted within 24 h of severe burn injury (2018–2022) compared serum creatinine, urine output, urinary creatinine, and creatinine clearance for predicting Major Adverse Kidney Events at 30 days (MAKE30).

• AKI developed in 47.2% within 48 h and 29.2% experienced MAKE30; creatinine clearance was the strongest predictor (AUC 0.80), outperforming serum creatinine (0.72), urine output (0.68), and urinary creatinine (0.63).
• Minimum urine output did not differ significantly between MAKE30 and non-MAKE30 groups (0.54 vs 0.92 mL/kg/h, p=0.11).
• A stricter urine-output threshold of <0.3 mL/kg/h was independently associated with MAKE30, whereas the guideline-recommended <0.5 mL/kg/h cutoff was not.

A retrospective cohort of 309 patients with small (<1% TBSA) low-temperature deep burns that progressed after delayed presentation compared a triple therapy (n=165) with a nano-silver dressing regimen (n=144) for healing time, pain, infection, and cost.

• Wound healing was faster with triple therapy (28±4 vs 41±5 days) and required fewer dressing changes (14±3 vs 21±4).
• Pain scores were lower in the triple-therapy group from the second dressing change onward, with no significant difference in infection rates (2.4% vs 3.5%).
• Both total and out-of-pocket costs were markedly lower with triple therapy (total 1508±360 vs 3735±480 CNY; out-of-pocket 302±72 vs 1904±96 CNY).

An interim analysis of a multicenter RCT of 53 women undergoing total breast reconstruction by autologous fat transfer, randomized 2:1 to perioperative external vacuum expansion (EVE) or none, with MRI-based augmentation and graft retention at six months as primary outcomes.

• Mean augmentation was 190.7% with EVE versus 176.4% without (adjusted difference 14.6%, 95% CI -80.0 to 109.1, p=0.757).
• Graft retention was 39.3% with EVE versus 34.9% without (difference 4.5%, 95% CI -6.4 to 15.4, p=0.405), with no significant between-group difference.
• The EVE group had more adverse events (22 AEs and 5 SAEs versus 3 AEs and 2 SAEs), predominantly skin-related.

A systematic review and meta-analysis of 30 studies (3985 patients) compared robot-assisted mastectomy with immediate breast reconstruction against conventional mastectomy, using both a comparative and a single-arm meta-analysis.

• Margin status was comparable between groups (OR 1.04), while robot-assisted mastectomy was associated with lower overall complications (OR 0.76, 95% CI 0.63–0.92) and reduced intraoperative blood loss.
• Operative time was significantly longer with the robotic approach, with an estimated learning curve of 17 procedures before a significant reduction in operating time.
• A non-significant trend toward improved BREAST-Q scores and fewer individual complications was observed with the robotic approach, although hospital stay was longer.

A prospective observational cohort of 140 patients (221 breasts) across two Italian cancer centers underwent immediate prepectoral implant reconstruction with Braxon ADM and smooth round implants, with binary logistic regression used to identify predictors of complications.

• Complications occurred in 43.4% of breasts (96 events), comprising 29.0% mastectomy-related and 14.4% reconstruction-related; reoperation was required in 14.9% and implant removal in 7.4%.
• Neoadjuvant chemotherapy independently predicted reconstruction-related complications (OR 18.8; p=0.026).
• Braxon Fast versus Regular ADM (OR 0.092; p=0.013) and extended antibiotic prophylaxis (OR 0.013; p=0.004) were protective against reconstruction-related events.
• Mastectomy flap necrosis (6.9%) and infection (3.6%) were the most frequent complications leading to implant removal.

A PRISMA-guided systematic review and meta-analysis of seven non-randomized studies compared ischemic complications after breast reconstruction in patients receiving hyperbaric oxygen therapy (HBOT) versus standard care, with risk of bias assessed by ROBINS-I and certainty by GRADE.

• HBOT showed no significant reduction in hematoma (OR 2.92; 95% CI 0.47–18.06), skin necrosis (OR 4.72; 95% CI 0.13–172.44), or reoperation (OR 2.42; 95% CI 0.89–6.55).
• Pooled single-arm HBOT cohorts had rates of seroma 16.1%, surgical site infection 18.8%, return to the operating room for debridement 12.6%, and explantation 21.6%.
• The authors graded the comparative evidence as insufficient and inconclusive to determine whether HBOT reduces ischemic complications.

A retrospective cohort of 192,618 breast cancer patients in the TriNetX network who underwent mastectomy (2005–2023) was stratified by presence of a somatoform disorder diagnosis (ICD-10 F45) and propensity-score matched to compare reconstruction timing and method.

• Somatoform disorders were documented in 1.6% of the cohort (3067 patients).
• Immediate reconstruction rates were not significantly different between groups.
• Patients with somatoform disorders were more likely to undergo delayed reconstruction, with HR 1.59 (95% CI 1.21–2.09) for autologous and HR 1.24 (95% CI 1.06–1.45) for implant-based.
• Overall reconstruction rates within two years were modestly higher in the somatoform disorder group.

A propensity-matched retrospective cohort of 29,610 patients (14,805 per arm) from the TriNetX Global Collaborative Network compared new psychiatric diagnoses within 6 months to 5 years after autologous versus implant-based breast reconstruction.

• No significant differences emerged for anxiety (p=0.135), depression (p=0.366), or mood disorders (p=0.991).
• Rates were also comparable for psychotic (p=0.52), personality (p=0.61), and behavioral disorders (p=0.149).
• Findings were consistent across the full 6-month to 5-year window, with previously reported patient-reported advantages of autologous reconstruction not reflected in psychiatric outcomes.

A 12-year retrospective comparative analysis of 572 breast lipofillings assessed patient satisfaction (modified BREAST-Q) and complications across three fat-processing methods: filtration, sedimentation, and cell-enriched lipotransfer (CELT).

• Surgical-site complication rates were lowest with CELT at 8.0%, versus 14.9% for filtration and 16.4% for sedimentation.
• CELT achieved the highest satisfaction (mean score 1.70, where 1 indicates very satisfied; p<0.001), compared with 2.31 for filtration and 2.43 for sedimentation.
• Within the CELT group, complications included oil cyst formation 4.8%, hematoma 1.6%, wound-healing disorders 1.6%, and no infections.
• Outcomes did not differ between irradiated and non-irradiated patients (p≥0.06).

This case series of five patients treated with pembrolizumab before breast reconstruction, accompanied by a narrative review of immune-related adverse events, describes unexpected perioperative and postoperative complications.

• The five patients experienced complications including thyroid dysregulation, cardiac failure, and epidermolysis after pembrolizumab and reconstruction.
• Pembrolizumab use surged after the KEYNOTE-522 trial showed improved pathologic complete response in early-stage triple-negative breast cancer.
• The authors note a paucity of data on how immunotherapy affects perioperative and reconstructive outcomes.

A single-institution retrospective cohort of 89 patients undergoing mastectomy with reconstruction compared pre-incision versus surgeon-administered post-incision PECS II blocks for postoperative pain scores and opioid use (oral morphine equivalents).

• Pre-incision patients reported a higher median maximum pain score during admission (8 vs 7; p=0.046).
• First PACU and last recorded pain scores, along with 4-hour and total admission opioid use, were similar between groups.
• On multivariate analysis adjusting for multiple clinical factors, block timing showed no association with pain scores or opioid need.

A retrospective review of 31 patients (52 treated breasts) examined indications, surgical applications, and early postoperative outcomes of bioresorbable P4HB (GalaFLEX) scaffold reinforcement in implant-based breast surgery.

• Indications were evenly split between oncologic and non-oncologic breasts, with diseased breasts treated in post-mastectomy reconstruction and non-diseased breasts used mainly for contralateral symmetrization.
• Most cases involved primary implant placement, and fat grafting was a frequent adjunct technique.
• The overall postoperative complication rate was low, with most patients recovering uneventfully.

A systematic review and meta-analysis of 57 studies (381,199 patients) pooling quantitative breastfeeding success rates after breast augmentation, reduction, and nipple-correction procedures, with random-effects subgroup comparisons across surgical techniques.

• Breast augmentation showed no significant difference in overall breastfeeding success regardless of technique (73.4% vs 86%, p=0.405).
• Reduction outcomes varied significantly by technique (p=0.021), with classic reduction mastopexy using horizontal (14.4%) and vertical (26.2%) pedicles producing the lowest breastfeeding success.
• Central, superior-lateral, superomedial, and central-superior-lateral pedicle reductions preserved breastfeeding success at roughly 88-100%.
• Nipple-correction methods did not substantially reduce breastfeeding success (84%, CI 76-89%).

A retrospective single-center cohort of 656 consecutive patients undergoing reduction mammaplasty (2019-2024), comparing those who received intraoperative TXA (intravenous, topical, or both) with unexposed patients for postoperative hematoma and complications.

• Hematomas requiring reoperation were lower with TXA, 2.1% vs 5.1% (OR 2.3, 95% CI 1.1-5.0; p=0.042).
• Operative time was longer in the TXA group, 133 vs 122 minutes (p<0.001), and these patients also had higher intraoperative blood loss and breast resection weights.
• Superficial infections were more frequent without TXA (3.8% vs 0.7%, p=0.022), with no difference in overall complications or 30-day reoperation and no reported TXA-related adverse events.

A retrospective cohort of 1120 patients undergoing aesthetic surgery (2020-2025), comparing a triple-procedure group (BBL, liposuction, abdominoplasty; n=550) with a BBL-plus-liposuction group (n=570) across intraoperative variables and 30-day complications.

• The overall complication rate was 0.8% (9 of 1120 patients), one-third of whom had a history of bariatric surgery.
• The triple-procedure group had significantly higher surgical duration, crystalloid volume, aspirate removed, fat injected, and urine output (all p<0.001).
• Prolonged surgical duration (OR 2.12) and prior surgical history (OR 1.87) were associated with complications but neither reached statistical significance, while the multivariate ROC model reported an AUC of 0.94.

A retrospective NSQIP cohort of 10,311 patients (adult women undergoing elective cosmetic procedures, 2008-2022) stratified by mFI-5 score of 0, 1, or >1, with multivariable regression and ROC analysis assessing 30-day outcomes and predictive performance.

• Complication rates rose stepwise with frailty: 3%, 6%, and 12% for mFI-5 scores of 0, 1, and >1, respectively (p<0.001).
• An mFI-5 score >1 independently predicted higher overall and surgical complications, readmission, and unplanned reoperation.
• Elevated scores were driven almost entirely by hypertension (present in 87% of mFI-5=1 and 99% of mFI-5>1) and diabetes, with other frailty components uncommon.
• The composite mFI-5 showed slightly superior discrimination and precision-recall performance compared with models built on individual comorbidities.

A targeted narrative review of perioperative safety, body-composition, and body contouring literature relevant to GLP-1 receptor agonist users, integrating massive-weight-loss contouring principles into a surgeon-facing perioperative framework.

• Aesthetic and body contouring cohorts signaled higher wound complications, including wound dehiscence in semaglutide users of 5.19% vs 2.78% in matched controls.
• Some GLP-1 RA users showed retained gastric contents despite standard preoperative fasting, supporting individualized risk and symptom screening.
• GLP-1-associated weight loss may coincide with clinically relevant lean-mass reductions that influence tissue quality and contouring strategy.

A PRISMA-guided systematic review of PubMed (2000-2024) capturing English-language reports of irreversible dermal-filler complications persisting beyond 12 months, synthesizing prevention and management principles.

• The most severe irreversible outcomes were blindness, stroke, chronic granulomatous inflammation, and tissue necrosis.
• Irreversible injury was determined principally by anatomic injection site, technique, and filler permanence rather than injected volume alone.
• Hyaluronic acid fillers were favored for their reversibility, whereas permanent fillers carried greater long-term complication risk.

A retrospective review of 129 patients scheduled for outpatient rhytidectomy at a tertiary center (2022-2025), comparing same-day discharge with unplanned admission across demographics, comorbidities, surgical characteristics, and anesthetic agents.

• Of 129 outpatient rhytidectomy patients, 16.3% (21 patients) required unplanned admission.
• Admission was associated with longer anesthesia duration, 574.6 vs 485.7 minutes (p=0.001), and more concurrent procedures (4.3 vs 3.3, p=0.002).
• Obesity, higher ASA class, and hypertension were each associated with unplanned admission.
• Dexmedetomidine and hydromorphone were associated with admission, while remifentanil was associated with same-day discharge.

A prospective case series of 488 women (cup A-D, grade I-II ptosis) undergoing total pedicle preservation mastopexy by a single surgeon (2012-2022), followed to 24 months for nipple position, breast density, areolar diameter, and complications.

• Mean sternal notch-to-nipple distance decreased from 25.22 to 20.65 cm at 24 months (p<0.001).
• Nipple-to-inframammary-fold distance drifted from 7.2 to 8.1 cm, a 52.9% relapse of the initial correction with 47.1% maintained.
• The overall complication rate was 2.5% (12 events in 488 patients), with no NAC necrosis, hematoma, dehiscence, or infection.
• Areolar diameter decreased from 64.2 to 42.0 mm, while breast density rose modestly from 7.6 to 8.8 Shore O units at 24 months.

A prospective longitudinal study of 44 transmasculine patients undergoing chest masculinization surgery at a single Paris center collected BODY-Q scores preoperatively and at 6 months. Pre-post changes and associations with surgical, morphological, and demographic covariates were examined.

• Chest satisfaction increased from 24% to 82% between baseline and 6 months (P < 0.0001).
• Psychological well-being rose from 24% to 62%, and all BODY-Q appearance and health-related quality-of-life domains improved significantly (all P < 0.0001).
• There were no statistically significant associations between postoperative BODY-Q scores and surgical technique, BMI, or demographic variables.
• Postoperative expectations remained stable from baseline, which the authors interpret as evidence of realistic preoperative counseling.

A retrospective HCUP-NIS analysis of 485 inpatient genioplasty admissions (2000–2022) characterized complications by procedural approach, age, and socioeconomic markers. Univariate and multivariate logistic regression identified independent correlates of inpatient-coded complications.

• Complications occurred in 10.3% overall and were higher in older versus younger patients (14.8% vs 5.8%; p = 0.002).
• Osseous genioplasty made up 63.5% of admissions and had higher complication rates than non-osseous procedures (12.7% vs 6.2%; p = 0.04), along with longer stays and higher charges.
• Prolonged length of stay was the most consistent independent predictor of complications across both procedural subgroups.
• Lower-income patients had longer hospitalizations despite similar complication rates, pointing to persistent socioeconomic disparities.

A single-center retrospective review of 42 consecutive Marjolin ulcer patients (2010–2025) applied AJCC 8th edition and Brigham and Women's Hospital staging systems and analyzed clinicopathological predictors of recurrence and survival, including depth of invasion in millimeters.

• At median 48-month follow-up, recurrence occurred in 26.2% and overall mortality in 21.4%.
• AJCC classified 71% of tumors as T3 and did not discriminate recurrence or mortality (p = 0.537 and p = 0.760), and BWH staging was similarly nonsignificant.
• Using oral cavity SCC depth thresholds, DOI ≤ 5 mm had no distant metastasis (0/23) while DOI > 10 mm showed 80% recurrence and 60% distant metastasis (log-rank p < 0.001).
• Pathological nodal metastasis was the strongest independent predictor of recurrence-free survival (HR 5.91; p = 0.012).

A systematic review and meta-analysis of 16 studies (1,387 specimens) evaluated ex vivo confocal laser scanning microscopy against conventional histopathology for BCC diagnosis and micrographic margin assessment. Pooled sensitivity and specificity were estimated with bivariate random-effects models.

• For BCC diagnosis in tissue specimens, pooled sensitivity was 91.4% and specificity 91.1%.
• For margin assessment, pooled sensitivity was 79.5% with specificity of 92.2%, indicating high specificity but moderate sensitivity.
• Mean confocal acquisition time was 7.0 minutes (95% CI 5.3–9.4), supporting its use when rapid diagnosis is desired.

A retrospective analysis of 815 melanoma patients who underwent surgery and sentinel lymph node biopsy (2008–2024) compared those with isolated hematogenous metastasis against the remaining cohort across age, sex, location, subtype, Breslow thickness, ulceration, and regression.

• Male sex remained an independent risk factor for isolated hematogenous metastasis (OR 2.93, 95% CI 1.08–7.95; P = 0.034).
• Head and neck primary location was also independent (OR 5.30, 95% CI 1.08–26.10; P = 0.040).
• Breslow thickness and ulceration were significant on univariate testing but lost significance in the multivariate model.
• Tumor regression was entirely absent in the hematogenous metastasis group, which the authors link to possible host immune failure.

A single-patient case report (Level of Evidence V) describes deliberate use of an auricular composite graft for midline nasal dorsum skin reconstruction following BCC excision, with preservation of the underlying cartilaginous framework.

• The graft showed complete survival with no partial or total necrosis.
• At 6 months the reconstruction had stable contour with satisfactory color and texture match and no graft contraction or secondary deformity.
• Structural support of the dorsum and internal nasal valve plus preserved airway patency were achieved without additional cutaneous incisions.

A single-blind randomized controlled trial of 134 patients planning rhinoplasty compared a society-issued information document (n = 66) with ChatGPT-3.5 interaction (n = 68). State-Trait Anxiety Inventory scores were measured before and after the intervention.

• Baseline state anxiety showed no significant difference between groups (medians 36 vs 39; p = 0.573).
• Both groups had significant post-intervention reductions in state anxiety, to medians of 31 (control) and 28 (ChatGPT) (both p < 0.001).
• The median anxiety reduction was greater with ChatGPT (-6.0 vs -4; p = 0.035).

A repeated-inference evaluation of four multimodal large language models on 50 clinical burn photographs (GPT-5.4 Pro, Grok 4.1, Gemini 3.1 Pro, Claude Opus 4.6) ran five independent inferences per model to assess burn depth classification and ordinal TBSA estimation.

• Burn depth accuracy ranged from 34.0% to 76.4% and TBSA accuracy from 32.8% to 68.4% across models.
• Inter-run reliability (Fleiss' κ) spanned slight (0.171) to almost perfect (0.916), and no model combined high accuracy and high reliability.
• All models showed overestimation of burn depth, including assigning fourth-degree burns despite none being present in the dataset.
• Agreement between numeric and text-based classifications was 99.6–100%, indicating format-invariant but systematically biased outputs.

A focused review of bias in AI systems used for facial attractiveness prediction and surgical outcome simulation, examining how bias enters at each stage of model development and synthesizing existing mitigation strategies into a unified framework.

• Benchmark datasets including SCUT-FBP and the Chicago Face Database underrepresent older adults, non-White, and ethnically diverse populations, limiting model accuracy for these groups.
• Current training pipelines lack fairness-aware techniques, and evaluation typically reports overall accuracy rather than demographic-stratified performance.
• The authors propose a six-pillar framework spanning diverse data collection with synthetic augmentation, fairness-aware training, complementary fairness metrics, explainable AI, stakeholder engagement, and continuous monitoring.

A scoping review of 75 studies (selected from 1562 identified across PubMed, arXiv, and IEEE Xplore) assessing reporting standards and ethical practices in computer-vision research that uses burn image datasets.

• Reporting standards varied widely across studies, with unavailable code and data among the most common shortcomings.
• Many studies omitted statements about consent and ethical review, raising questions about dataset provenance.
• Dataset descriptions were frequently sparse, prompting the authors to propose a preliminary reporting checklist tailored to burn image datasets used in AI research.

A blinded comparison across 12 questions in which 10 EBOPRAS-certified plastic surgeons rated answers from ChatGPT-4.5 and Google Gemini to the most frequently asked breast augmentation questions using the Global Quality Score.

• ChatGPT-4.5 answers received a higher mean Global Quality Score than Gemini (3.867 vs 2.842).
• The advantage for ChatGPT-4.5 was statistically significant (p=0.003, Wilcoxon signed-rank test).
• Both platforms scored in the mid-range of the 5-point GQS scale, with neither reaching the top quality tier.

A deep-learning framework study integrating EfficientNet-B0 classification, U-Net segmentation, MiDaS-based monocular depth estimation, and explainability tools (Grad-CAM and LIME) for automated diabetic foot ulcer assessment from single RGB images.

• An EfficientNet-B0 classifier distinguished ulcerated from healthy skin with strong reported accuracy.
• A U-Net with an EfficientNet-B0 encoder delineated ulcer boundaries, enabling quantitative area and width measurement.
• MiDaS-based monocular estimation generated relative pseudo-depth maps from single RGB images, feeding an automated clinician-facing reporting module.

A retrospective cohort of 41,218 patients (46,135 ECG-surgery pairs) undergoing noncardiac surgery, evaluating whether a multitask AI-ECG could identify low-risk candidates and curb low-yield preoperative cardiovascular testing; the primary endpoint was a 30-day composite of all-cause mortality and unplanned PCI.

• The AI-ECG classified 92.3% of cases as low-risk, with a 30-day composite event rate of 0.2% versus 2.9% in high-risk cases.
• In low-risk cases, event rates stayed 0.2–0.4% regardless of whether advanced testing was performed, while only 16.3% of all tests returned positive findings.
• High-risk classification was associated with consistently higher event rates across ESC surgical risk and Revised Cardiac Risk Index strata.

A preclinical study in 38 rabbits evaluating a decellularized porcine meniscus scaffold (MEND) recellularized with ear-derived cartilage progenitor cells against autologous costal cartilage, the standard of care, in a laryngotracheal reconstruction model.

• The MEND scaffold was fully recellularized within 3 days and reached implant-ready maturation after 3 weeks of chondrogenic differentiation.
• At 3 months, grafts showed airway expansion, re-epithelialization, and neocartilage integration, outperforming autologous costal cartilage on all outcomes.
• No adverse events such as extrusion, granulation, infection, or calcification occurred in any of the 38 rabbits.

A narrative review dissecting neutrophil- and NET-mediated mechanisms of ischaemia-reperfusion injury across the heart, brain, kidney, liver, and transplanted organs, with emphasis on endothelial crosstalk, immunothrombosis, and metabolic regulation.

• Activated neutrophils release damage-associated molecular patterns and form neutrophil extracellular traps that amplify inflammation, promote coagulation, and impair tissue repair.
• NET-associated biomarkers, including cell-free DNA and myeloperoxidase-DNA complexes, are emerging for diagnosis and prognosis of ischaemia-reperfusion injury.
• Candidate therapies target neutrophil recruitment, immune metabolism, and NET clearance, though substantial translational challenges remain.

A preclinical mouse and cell study investigating whether adipose-derived stem cell exosomes promote diabetic wound healing, using high-throughput sequencing, endothelial progenitor cell assays, and a diabetic ulceration mouse model.

• ADSC-derived exosomes enhanced diabetic wound healing by inhibiting ROS deposition and restoring angiogenic function under high-glucose conditions.
• Sequencing identified PRDX4 upregulation, and PRDX4 knockdown abolished the exosomes' protective effect.
• PRDX4 overexpression rescued high-glucose-induced endothelial progenitor cell dysfunction and augmented the therapeutic effect of the exosomes.

A randomized controlled animal study of 24 Sprague-Dawley rats compared bovine colostrum-derived extracellular vesicles against PBS control and sham in a superficial inferior epigastric artery flap subjected to 8 hours of ischemia, testing flap survival, perfusion, and inflammatory markers on day 7.

• Exosome treatment improved flap survival to 70.5% versus 51.8% in controls and enhanced laser Doppler perfusion (70.9% versus 58.9%).
• Microvessel density more than doubled with treatment at 149.0 versus 71.9 vessels/mm², alongside suppressed pro-inflammatory cytokine expression.
• Exosomes promoted M2 macrophage polarization, reflected in a significantly lower CD86/CD206 ratio.

An exploratory bioinformatic study of 24 samples (12 keloid versus 12 control) used differential expression, weighted co-expression network analysis, and two machine-learning approaches to screen for mitochondria- and cell-death-related keloid biomarkers.

• Three biomarkers, UQCRC1, PRDX4, and PDK2, were identified, all involved in oxidative phosphorylation and ribosome function.
• Immune-cell deconvolution showed six differentially infiltrated immune populations, including central memory CD8+ T cells.
• Molecular docking found bisphenol A bound the biomarkers strongly, though its multisystem toxicity restricts it to a mechanistic structural probe rather than a therapeutic candidate.

A narrative review synthesizes evidence on Piezo1/2 mechanosensitive channels in organ fibrosis, spanning association studies through genetic interventions, and proposes a framework to resolve contradictory findings.

• Reported Piezo effects span both pro-fibrotic and anti-fibrotic directions, which the authors attribute to genuine context dependence rather than biological noise.
• Discrepancies are traced to differences in experimental models and methodological pitfalls such as in vitro stiffness models, off-target drug effects, and genetic-model caveats.
• The authors offer a cell- and context-resolved framework to guide future anti-fibrotic targeting of Piezo channels.

An integrated bioinformatic and in vitro study analyzed dataset GSE145725 and used luciferase assays and functional rescue experiments to define how FOXM1 regulates BMP4/Smad1/5/8 signaling in keloid fibroblasts.

• BMP4 emerged as a central hub gene, and luciferase assays confirmed that FOXM1 directly binds the BMP4 promoter to repress its transcription.
• BMP4 overexpression inhibited fibroblast proliferation, migration, and ECM synthesis by activating Smad1/5/8 phosphorylation.
• FOXM1 overexpression abrogated these BMP4 effects via reduced Smad1/5/8 phosphorylation, confirmed by rescue experiments.

An in vitro and rat in vivo study combined Cdc42-overexpressing BMSC-derived exosomes with an acellular nerve allograft and evaluated Schwann-cell responses, sciatic functional index, muscle weight, and histology in a sciatic nerve defect.

• In vitro, Cdc42-modified exosomes enhanced Schwann cell proliferation, migration, and neurotrophic factor secretion (BDNF, NGF, CNTF).
• In vivo, the combination graft improved functional recovery, with higher sciatic functional index scores and greater muscle weight.
• Histology showed enhanced regeneration with thicker myelin sheaths and larger axon diameters.

An in vitro and murine co-transplantation study treated mature adipocytes with lactate or PLLA in ceiling culture and grafted PLLA with adipose tissue, assessing dedifferentiation mechanisms and graft survival at 7, 30, and 90 days.

• PLLA-derived lactate drove adipocyte dedifferentiation at low-to-moderate concentrations, an effect abolished by monocarboxylate transporter inhibition.
• Lactate-induced dedifferentiated adipocytes showed enhanced angiogenic potential.
• Co-transplantation significantly improved volume retention and neovascularization, with only transient inflammation and no chronic fibrosis.

A controlled animal study of 16 New Zealand rabbits compared botulinum toxin type A, decorin, their combination, and saline in an auricular hypertrophic scar model, measuring scar height, collagen, and TGF-β1/Smad pathway proteins at weeks 4 and 8.

• All treatment groups showed lower scar height, collagen deposition, and TGF-β1 expression than controls at weeks 4 and 8.
• Botulinum toxin and/or decorin suppressed Smad2/3 phosphorylation, inhibited MMP2 activity, and reduced α-SMA and collagen I expression.