Plastic Surgery Weekly

Retrospective review of 53 patients with stage IV oral cavity cancer who underwent wide excision, neck dissection, and reconstruction with two or more simultaneous free flaps (2013–2023), analyzing complications, recurrence, and survival.

• Overall survival was 75% at 1 year, 61.2% at 2 years, and 43.3% at 5 years.
• On multivariable analysis, a positive surgical margin was independently associated with poorer survival (HR 0.14, p = 0.033).
• Complete flap loss occurred in only 2 of 53 patients, despite a mean operative time of 508 minutes.
• The most common combination was a fibula osteocutaneous flap with an anterolateral thigh flap, and all patients received adjuvant chemoradiotherapy.

Systematic review and meta-analysis of 19 studies (686 patients) pooling randomized and nonrandomized comparisons of botulinum toxin type A versus control for prevention of pathological scarring, with scar quality, patient satisfaction, and adverse effects as outcomes.

• BoNT-A improved Vancouver Scar Scale scores (MD −1.07, 95% CI −1.59 to −0.56) and visual analog scale ratings (MD 1.18, 95% CI 0.94 to 1.42).
• Scar width was reduced, with a mean difference of −0.21 (95% CI −0.33 to −0.09).
• Patients treated with BoNT-A reported higher satisfaction (RR 1.83, 95% CI 1.10 to 3.07).
• Adverse effects were minimal and transient, with no significant difference between groups.

Multicenter randomized non-inferiority trial of 83 patients undergoing extended abdominoperineal excision for rectal cancer, comparing an acellular porcine collagen implant with a unilateral gluteus maximus myocutaneous flap, with 6-month physical function on the timed-stands test as the primary outcome.

• At 6 months, 71% of implant patients versus 60% of flap patients underperformed on the timed-stands test relative to age- and sex-matched norms.
• The risk difference was −11% (one-sided 95% CI −30% to ∞), so non-inferiority of the implant was not demonstrated.
• The direction of effect favored the flap, with results compatible with worse functional recovery in the implant group.

Systematic review of 89 studies (467 patients) evaluating deep inferior epigastric artery perforator (DIEP) flaps used for nonbreast reconstruction across head and neck, upper and lower limb, vaginal, hip and thigh, and trunk sites.

• Overall pooled flap survival was 96%, with 19 total flap losses among 467 reconstructions.
• Region-specific survival ranged from 93% (lower limb) to 98% (hip and thigh), including 97% in head and neck.
• Donor-site complications were rare (2.78%, 13 cases), with 97.22% achieving primary closure without adverse events.
• The largest use categories were head and neck (n = 122) and lower limb (n = 115) reconstruction.

Multicenter study of 1022 individuals (6162 dynamic scans) with lower-extremity lymphedema, developing and testing LympClear, an nnU-Net–based deep-learning model for venous signal suppression on MR lymphangiography against radiologist consensus labels.

• LympClear segmented venous signal with a Dice score of 0.94, and venous-suppressed images scored higher for image quality, venous suppression, and reflux visibility (all p < .001).
• Reading time fell from 16.7 to 3.6 minutes per case with venous suppression.
• Readers identified 14.9% more reflux regions on suppressed images, and the case-level missed-detection rate dropped from 14.7% to 6.7%.
• Dynamic images improved contrast-agent flow visibility over static images (8.68 vs 6.85 on a 10-point scale).

A retrospective single-arm case series of 65 patients with secondary bilateral cleft lip and vertical prolabial deficiency who underwent prolabial lengthening by nasolabial muscle reconstruction, with philtral, vermilion, and lower-face measurements and a satisfaction questionnaire.

• Mean philtrum length rose from 9.8 ± 2.2 mm preoperatively to 13.5 ± 1.3 mm immediately after surgery (P < 0.05).
• The ratio of prolabial length to lower facial length improved from 0.32 ± 0.03 to 0.40 ± 0.04 postoperatively (P < 0.05).
• Lengthening is achieved by reconstructing and lengthening the nasolabial muscle rather than transferring lip tissue, with follow-up ranging from 6 months to 3 years.

A PRISMA-guided systematic review of 9 studies (210 patients, 164 flaps) examining how quantitative ICGA parameters have been used to assess venous outflow in free and pedicled flaps, with risk of bias rated by ROBINS-I.

• Abnormal angiographic trends, including prolonged Tmax, flattened egress slopes, and delayed washout, correlated with venous congestion and postoperative necrosis.
• Quantitative ICGA was applied across breast, head and neck, perineal, and lower extremity reconstructions using SPY, Quest, and Zeiss platforms, with metrics including ratio indices, time-to-maximum fluorescence, and inflow/outflow slopes.
• Heterogeneity in dosing, imaging timing, software, and the definition of outflow precluded meta-analysis.

A retrospective single-surgeon cohort of 65 patients with unilateral cleft palate (2015–2023), comparing modified asymmetric short-limb Z-plasty for V-shaped gaps ≤ 6 mm against straight-line repair with overlapping intravelar veloplasty for wider or U-shaped palates.

• Fistula formation occurred in 1 of 34 MASLZ versus 5 of 31 SLR patients (p = 0.0951).
• Secondary velopharyngeal insufficiency surgery was needed in 2 versus 6 patients (p = 0.1377), and surgical group was not an independent predictor of secondary VPI surgery on multivariable analysis.
• Both techniques were designed to maximize levator veli palatini overlap, with technique assigned by gap measurement at the uvular neck.

A retrospective cross-sectional study of 85 patients with unilateral incomplete cleft lip operated 2016–2018, with nasal and lip symmetry rated by 3 observers on standardized frontal and basilar photographs after at least 5 years of follow-up.

• Total nostril height symmetry was observed in 35 of 49 patients (71.4%).
• Total lip width symmetry was observed in 38 of 49 patients (77.6%).
• Surgery was performed at a median age of 3.8 months and the rotational flap required no donor-site graft, with few patients needing correction at the mixed-dentition stage.

A narrative review (book chapter) of the etiology, classification, prevention, and algorithmic surgical management of palatal fistulae, the most common complication after cleft palate repair.

• The Pakistan Comprehensive Fistula Classification grades fistulae across four domains (location, size, velopharyngeal competence, and dehiscence), addressing gaps in size-based and Pittsburgh systems.
• Repair is built on multilayered, tension-free closure with preserved vascularity, velopharyngeal port reconstruction, and regional flaps.
• Symptomatic fistulae are repaired after a 6 to 9 month healing period, with adjuncts such as levator retropositioning or pharyngeal flaps when velopharyngeal dysfunction is present.

Systematic review and meta-analysis of 17 studies (1300 flaps) of free great-toe or second-toe pulp transfer for fingertip, thumb pulp, and distal digital defects, with random-effects pooling of flap survival and descriptive synthesis of functional and complication outcomes.

• The pooled flap survival rate was 99.8% (95% CI 99–100%), with total loss in 9 of 1300 flaps and partial necrosis in 5.
• Reported mean static two-point discrimination ranged from 3.7 to 13.1 mm across studies.
• Cold intolerance was reported in 26.3% of assessed patients (42 of 160).
• Aesthetic and patient-reported outcomes were generally satisfactory where assessed.

Prospective nonrandomized cohort of 40 patients undergoing posterior spinal accessory–to–suprascapular nerve transfer, alternately allocated to ultrasound-guided versus landmark-based preoperative skin marking, comparing identification times, operative time, and need for wider dissection.

• Ultrasound shortened time to spinal accessory nerve identification (12.0 vs 20.1 min) and suprascapular nerve identification (58.2 vs 72.4 min).
• Total operative time was shorter with ultrasound (110.4 vs 132.6 min).
• Wider exploratory dissection was needed less often in the ultrasound group (15% vs 60%, p = 0.004).
• Ultrasound mapping added a mean of 3.0 min to the workflow yet preserved the overall time benefit.

A PRISMA-guided systematic review of 6 retrospective studies (16 patients) evaluating immediate or delayed TMR in amputees younger than 18, with outcomes including neuroma and pain resolution, NRS, PROMIS, and prosthetic and narcotic use.

• Neuroma and overall pain resolution were reported in 100% of patients, with mean NRS scores of 2.0 for residual limb pain and 3.7 for phantom limb pain.
• Of 11 patients using narcotics, 10 discontinued by final follow-up, and 9 of 12 proceeded with prosthetic use.
• Complications occurred in 12.5% (2 of 16) of patients and resolved after revision, with PROMIS scores comparable to adult outcomes.

A secondary analysis of a randomized trial of 113 patients with Eaton-Glickel stage ≥2 trapeziometacarpal osteoarthritis from 18 Dutch clinics, using linear regression to identify factors associated with the MHQ pain subscale at 3 months.

• Baseline MHQ pain score had the strongest independent association with better pain at 3 months.
• Higher baseline outcome expectations and improvement in grip strength were also associated with better pain outcomes.
• Among the other tested candidates, including psychological factors, therapy adherence, perceived attention, and treatment frequency, none were identified as independent associations with 3-month pain.

A scoping review of surgical treatments for symptomatic neuromas distal to the wrist, integrated with established peripheral nerve surgery principles to build a pragmatic operative decision algorithm.

• The available literature is predominantly retrospective and heterogeneous in neuroma types, techniques, and outcome reporting, limiting direct comparisons between approaches.
• Across studies, many patients reported meaningful pain improvement after surgical treatment.
• The algorithm prioritizes reconstruction when a distal target exists (primary repair when feasible, interposition autograft or allograft for gaps), and otherwise applies location-specific nerve-end management and biologic targeting.

A retrospective review of 114 patients treated from 2019 to 2023 compared in-office (n=64) versus operating-room (n=50) excision of type B ulnar polydactyly, analyzing charges to payers and underlying health-system costs.

• Total charges to the payer were far lower for in-office than OR excision ($2130 versus $10,731; P<0.001).
• Average cost per digit removed was also lower in the office setting ($1218 versus $5937; P<0.001).
• Health-system costs were lower in-office both overall ($845 vs $2349) and per digit removed ($472 versus $1272); all P<0.001.

A round-table discussion among five expert hand surgeons examining the clinical and ethical uncertainties of offering surgery for unmeasurable upper-extremity neuropathies that present as non-specific pain.

• The panel centers on the absence of objective reference tests to confirm diagnoses including pronator, supinator/radial tunnel, lacertus, and neurogenic thoracic outlet syndrome.
• Discussion addresses the ethical implications of surgical placebo effects and how to judge treatment effectiveness when no measurable disease is present.
• Surgeons diverged in risk tolerance and concern for overtreatment, with shared decision-making proposed as the route to proceeding in the absence of confirmable pathology.

A biomechanical study of 10 matched-pair cadaver arms compared a two-suture plus 4.5-mm headless compression screw tension band against the standard 1.6-mm K-wire and 18-gauge metal construct after transverse olecranon osteotomy, tested by cyclic loading to 300 N and load-to-failure.

• During cyclic loading, 2 of 5 metal constructs failed whereas none of the suture/screw constructs did.
• On load-to-failure, the suture/screw construct was on average 219 N stronger than the K-wire and metal tension band.

A narrative review of the indications for traditional limb salvage and finger replantation relative to elective amputation with bionic reconstruction.

• Replantation is recommended for thumb, multiple-digit, and single-digit amputations distal to the FDS insertion, given superior function compared with revision amputation.
• Replantation of distal forearm amputations is favored over prostheses, offering better postoperative function and a high likelihood of return to work.
• Elective amputation with bionic reconstruction is presented as a viable alternative when hand function and sensibility remain poor after major upper-limb replantation.

A retrospective cohort of over 339,000 patients in the PearlDiver database (2010–2022) compared cannabis-only, tobacco-only, concurrent, and matched non-user groups for complications after open carpal tunnel release.

• Surgical site infection was more common in concurrent, cannabis-only, and tobacco-only users than non-users at both 6 weeks and 3 months.
• Wound disruption was elevated in concurrent and tobacco-only users but not cannabis-only users.
• Complex regional pain syndrome was associated only with tobacco use, and no substance was associated with joint stiffness.

A retrospective single-center case series of 27 patients with deep partial-thickness and full-thickness burns treated with the Kerecis Omega3 Wound fish-skin scaffold, assessing healing, need for further surgery, and complications.

• Almost 50% of deep partial-thickness burns healed spontaneously after fish-skin treatment.
• All full-thickness burns went on to require skin grafting or other reconstructive measures.
• Postsurgical infection requiring product removal occurred in 4 patients, and contractures developed in 3 full-thickness cases.

A laboratory mechanistic study of keloid versus normal skin tissue and primary keloid fibroblasts used immunofluorescence, RT-qPCR, and western blot to map immune-cell infiltration and a collagen/CD44/YAP1/PD-L1 signaling axis.

• Keloid tissue showed increased CD4+ T cells, CD86+ macrophages, and FOXP3+ Treg infiltration alongside reduced CD8+ T-cell infiltration, consistent with an immunosuppressive microenvironment.
• PD-L1 was overexpressed in keloid fibroblasts relative to normal skin.
• Collagen I bound CD44 to activate YAP1 signaling, driving PD-L1 overexpression and sustained fibroblast proliferation in vitro.

A randomized in vivo human wound-model trial treated fractional CO2-laser microlesions on the volar forearm with one of two approved silicone-based formulations or left them untreated as control, tracking erythema and lesion microarchitecture by dermoscopy and line-field confocal OCT from Day 1 to Day 14.

• Silicone formulations significantly reduced acute erythema and its overall intensity versus untreated control.
• Treatment produced a highly significant reduction in lesion area and depth, with lower inter-individual variability than control.
• LC-OCT imaging showed faster restoration of the epidermal barrier with silicone treatment.

A retrospective analysis of 18,607 burn admissions in the 2022 Nationwide Readmissions Database compared 30-day burn-related readmission between unhoused (n=1,130) and housed patients and identified readmission risk factors specific to the unhoused group.

• Unhoused patients were readmitted with a burn diagnosis at 8.6% versus 5.2% for housed patients (p<0.001), a gap that persisted after adjustment for other readmission risk factors.
• Leaving against medical advice carried the highest readmission risk (OR 4.1, 95% CI 2.6–6.6) and was the only potentially modifiable factor identified.
• Injury severity and location also predicted readmission, including third-degree burns (OR 2.4) plus trunk, upper-extremity, and lower-extremity burns.
• Despite higher rates of schizophrenia, bipolar disorder, and substance use, these psychiatric and substance-use diagnoses did not increase readmission risk in the unhoused group.

A design-and-development report with pilot testing in eight burn survivors describes LIBRE GO!, a mobile application digitizing the LIBRE Profile and connecting users to community-based resources, evaluated with implementation-outcome measures and focus groups.

• The app is organized into four functions (new LIBRE survey, My Scores, Resources, and About), built through an iterative user-centered process involving survivors and clinicians.
• Implementation-outcome ratings were favorable: acceptability 4.13, appropriateness 4.28, and feasibility 4.31 out of 5.
• In focus groups, participants described the app as easy to use and valuable for tracking social engagement and finding resources.

A narrative review traces the evolution of diagnostic strategies for necrotizing soft tissue infections, from clinical scoring systems to emerging multi-omics and machine-learning methods, and proposes an integrated diagnostic roadmap.

• Scoring systems such as LRINEC and its variants are limited by variable sensitivity and insufficient predictive value across diverse populations, constraining early recognition.
• Multi-omics technologies and machine learning are highlighted for identifying molecular biomarkers and predictive patterns of NSTI onset and progression.
• The authors propose an integrated diagnostic roadmap combining clinical assessment, imaging, microbiology, host-response biomarkers, and omics data.

A qualitative meta-synthesis of published studies on burn survivors' lived experiences interprets findings through a Trauma Informed Care lens and psychological theory, yielding five interconnected themes grouped under two premises.

• The 'Internal Experiences' premise captured self-blame, loss of self, self-esteem, power, and altered body image, alongside physical and psychological suffering such as pain, itch, fear, and isolation.
• The 'Harms and Hindrances' premise described how service delivery, staff interactions, coping strategies, and social systems shaped survivors' adjustment.
• Survivors' accounts underscored the emotional saliency of healthcare systems in promoting or hindering psychological healing, supporting conscious integration of Trauma Informed Care.

A prospective, non-comparative multicenter study of 104 patients at 14 European sites evaluated a canister-based single-use negative-pressure wound therapy system in low-to-moderately exuding diabetic foot, venous leg, and pressure ulcers over up to 28 days.

• Wounds were judged improved since the prior visit at 76.3% of visits, with reductions in both absolute and relative wound size over the study period.
• The wound mix spanned diabetic foot (34), venous leg (34), and pressure ulcers (36) across inpatient (67.7%) and outpatient (32.3%) settings.
• Investigators rated the device effective and easy to apply, with no unexpected safety concerns reported.

A prospective single-arm study of 10 patients with chronic diabetic foot ulcers assessed sensory function and foot perfusion before and 12 months after Dellon tarsal tunnel decompression, using 99mTc-MIBI scintigraphy and Doppler ultrasonography.

• Posterior tibial artery mean flow velocity rose from 43.2 to 79.4 cm/s (P<0.0001), alongside significant improvement in two-point discrimination.
• Scintigraphy showed increased operative-foot uptake with a mean perfusion increase of 38.5% at rest and 36.8% under stress, plus shorter time-to-peak activity.
• All diabetic foot ulcers healed by the 12-month follow-up, which the authors link to improved microvascular perfusion.

A retrospective development study of 1938 diabetic patients at one center, with external validation in 695 patients at another, compared ten machine-learning models for classifying current diabetic-foot risk status.

• The best model, CatBoost, reached an internal-test AUC of 0.935 with accuracy, precision, and recall of 0.88.
• Performance held in the external validation cohort, with an AUC of 0.922 and accuracy, precision, recall, and F1 all equal to 0.88.
• The model used sixteen clinically accessible features selected by recursive feature elimination, with SHAP applied to make predictions interpretable.

Retrospective cohort of 20,415 women undergoing free-flap breast reconstruction in the ACS-NSQIP registry (2012–2022), comparing immediate versus delayed reconstruction for 30-day complications using inverse probability of treatment weighting.

• Immediate reconstruction carried higher odds of 30-day readmission (OR 1.35, 95% CI 1.18–1.54; 6.4% vs 5.1%).
• Perioperative transfusion was more common after immediate reconstruction (OR 1.43, 95% CI 1.28–1.59; 9.8% vs 7.5%).
• Unplanned return to the operating room was also more frequent (OR 1.27, 95% CI 1.16–1.40; 12.2% vs 10.7%).
• Major systemic events such as sepsis, stroke, myocardial infarction, and cardiac arrest were rare (<2%) and comparable between groups.

A retrospective cohort of 1874 patients undergoing tissue expander-based breast reconstruction evaluated the association between operative duration and 30-day complications, modeling odds per 10-minute increase for unilateral and bilateral cases.

• In unilateral cases, each 10-minute increase was associated with higher odds of mastectomy skin flap necrosis (aOR 1.04) and unplanned reoperation (aOR 1.03).
• In bilateral cases, each 10-minute increase raised odds of MSFN, unplanned readmission, and surgical site infection (each aOR 1.02).
• Mastectomy skin flap necrosis was the one outcome consistently associated with operative time across both unilateral and bilateral reconstructions.

Retrospective cohort of 204 patients undergoing DIEP breast reconstruction at a single tertiary center (2018–2021), using preoperative CT-derived skeletal muscle index and BMI to classify patients into four body-composition phenotypes and compare complication rates.

• Sarcopenic overweight (SMI <38.5 cm²/m² with BMI >25 kg/m²) was present in 14.2% of patients, while complications occurred in 18.1% overall.
• Sarcopenic overweight was associated with higher early-flap and overall complication rates than the other three phenotypes (p = 0.009 and p = 0.034).
• On multivariable analysis, sarcopenic overweight was the only independent predictor of overall complications (OR 8.66, 95% CI 1.68–44.62); neither sarcopenia nor overweight alone was independently associated.

Cohort study of 128,520 primary breast implant procedures (106,413 cosmetic and 22,107 reconstructive) from the Australian Breast Device Registry (2012–2023), developing and validating separate machine-learning models to predict revision surgery for device-related complications.

• In the cosmetic cohort, a random forest model achieved the best discrimination (AUC = 0.92), with Allergan manufacturer, macrotextured shell, and older patient age as key predictors.
• In the reconstructive cohort, the random forest model performed similarly (AUC = 0.91), with Allergan manufacturer, incision site, acellular dermal matrix use, older age, and concurrent mastectomy as significant predictors.
• Socioeconomic advantage was positively associated with revision in both cohorts.

Cadaveric study plus a prospective cohort of 123 breasts undergoing nipple-sparing mastectomy with immediate implant-based reconstruction, using near-infrared imaging to quantify peri-areolar vein branch loss and build a prediction model for clinically significant NAC necrosis, compared with intraoperative indocyanine green angiography in 32 breasts.

• Clinically significant NAC necrosis occurred in 19 of 123 breasts (15.4%).
• Higher vein branch loss, greater mastectomy weight, higher BMI, and diabetes were associated with necrosis on univariate analysis, and on multivariable analysis the effect of vein branch loss increased with mastectomy weight.
• The prediction model showed strong discrimination (AUROC 0.902, 95% CI 0.82–0.98) and identified a low-risk subset among breasts with poor ICG perfusion in which no significant necrosis occurred.

Single-institution retrospective series of 157 patients with early-stage breast cancer treated with chest wall perforator flaps for breast-conserving surgery at the Paris Breast Center (2005–2024), with complication, re-excision, and conversion-to-mastectomy rates as primary outcomes over a median follow-up exceeding 4 years.

• Early complications (grade ≥II) occurred in 5.1% of patients, with no partial or total flap loss.
• The re-excision rate was 5.7%, and completion mastectomy was required in only 0.6%.
• Over a median follow-up of 48 months, local recurrence occurred in 2.5% and distant recurrence in 6.4%, with no deaths.

Narrative review of thigh-based free flaps for autologous breast reconstruction, covering the gracilis myocutaneous, profunda artery perforator, and lateral thigh perforator flaps, including indications, anatomy, vascular pedicles, harvest technique, and donor-site management.

• Common critiques of thigh-based flaps, namely inadequate flap volume and donor-site issues (appearance, sensory change, healing), have been mitigated by technical refinements yielding more predictable outcomes.
• The article compares the gracilis myocutaneous, profunda artery perforator, and lateral thigh perforator flaps, detailing their anatomy, landmarks, and vascular pedicles.
• Practical pearls address flap harvest, aesthetic optimization, and management of donor-site healing and complications.

Retrospective longitudinal study of 517 patients with stage 0–III breast cancer treated with breast-conserving surgery, mastectomy alone, or mastectomy with immediate reconstruction (2015–2019), comparing change in BREAST-Q Physical Well-Being: Chest scores from before surgery to 1 year afterward.

• Breast-conserving surgery showed the greatest decline (15.3 points, 89.1 to 73.8) despite the highest baseline, followed by mastectomy alone at 12.7 points.
• Immediate breast reconstruction had the smallest decline (3.7 points), below the 4-point minimal important difference threshold.
• Among the 262 patients who received radiation, mean decline was 15.2 points, and regional node irradiation with boost showed the greatest decline at 21.5 points.

Single-center retrospective cohort of 174 confirmed prosthesis infections (67 implant and 107 tissue expander) treated 2017–2024, comparing infection recurrence within 12 months across one-stage exchange, two-stage exchange, and explantation.

• Recurrence occurred in 16% of implant and 21% of tissue expander infections, and one-stage exchange had the highest recurrence (38% implant, 60% tissue expander).
• Two-stage exchange and explantation were associated with lower recurrence risk, although some comparisons did not reach statistical significance.
• Among tissue expander cases, antibiotic spacer use was independently associated with increased recurrence (adjusted OR 5.38, 95% CI 1.06–27.22).

Retrospective propensity-matched cohort of 7,960 patients (3,980 with and 3,980 without biologic or immune-modulating exposure within six months of surgery) drawn from the TriNetX database, comparing postoperative complications after breast reconstruction or augmentation at 30 days, 90 days, and 6 months.

• Among 211,105 patients identified, 4,024 had biologic exposure, and after 1:1 propensity matching 3,980 patients remained in each cohort.
• Complication rates were comparable between groups at all timepoints (p > 0.05).
• Biologic exposure was not associated with increased wound, infectious, implant-revision, or readmission complications.

A propensity-matched retrospective cohort of 14,822 patients drawn from the TriNetX network compared adults undergoing bilateral breast reduction (2010–2025) with versus without recent antidepressant exposure, balancing demographics, comorbidities, and laboratory values to assess 90-day postoperative outcomes.

• Antidepressant users had higher rates of wound dehiscence (4.1% vs. 2.8%), surgical-site infection (5.1% vs. 4.1%), and sepsis (0.4% vs. 0.2%).
• Hematoma and seroma rates did not differ between groups, indicating no increase in bleeding complications.
• Postoperative opioid prescribing was higher among antidepressant users (29.1% vs. 23.8%).
• SSRIs carried slightly higher risk than SNRIs, and patients on two or more antidepressants had higher infection and overall complication rates than those on a single agent.

A retrospective cohort of 481 patients undergoing upper blepharoplasty (2017–2024) included 45 women who received additional sulcus correction with a medial-pedicled preseptal orbicularis oculi muscle flap, whose complications and FACE-Q outcomes were compared with those of conventional blepharoplasty.

• FACE-Q Adverse Effects scores showed no significant difference between the flap and conventional groups (U = 8828.0, p = 0.251).
• Transient supraorbital hypoesthesia occurred in 71% of flap patients and resolved within a few months, with no cases of flap necrosis.
• In the conventional group, medial canthal scarring developed in 16 patients, four of whom required revision.

A scoping review of nine studies (2018–2025), conducted per PRISMA-ScR and Joanna Briggs Institute methodology across six databases, examined intraoperative ultrasound use in adults undergoing gluteal fat grafting.

• The evidence base was predominantly observational case series plus one systematic review with meta-analysis, with no randomized or high-quality comparative studies identified.
• Ultrasound was used mainly to guide cannula positioning and confirm subcutaneous injection in real time, with verification relying on intraoperative visualization rather than standardized imaging-based confirmation.
• Across the included studies, no cases of fat embolism or procedure-related mortality were reported.

A prospective observational cohort of 74 patients with prior breast augmentation underwent secondary mastopexy using a modified dual-plane technique with muscular fixation, evaluated by standardized anthropometric measurements preoperatively, immediately postoperatively, and at 12 months.

• Ptosis correction was achieved in all cases, with a mean clavicle-to-nipple reduction of ~5.3 cm bilaterally (P < 0.001).
• Clavicle-to-upper-implant-border distance improved, indicating upper pole fullness, and inferior pole measurements showed controlled expansion without bottoming out.
• The overall complication rate was 6.76%, with no infection, hematoma, or total nipple-areola complex necrosis, and outcomes remained stable at 12 months.

A systematic review and meta-analysis of 23 studies searched across four databases pooled anatomical data on the superior and inferior labial arteries and introduced a proposed perioral perfusion hypothesis.

• The superior labial artery was absent in 3.55% of cases and, when present, most often arose above the oral commissure (80.71%) at a mean of 11.95 mm.
• The inferior labial artery was absent in 13.45% of cases and most frequently located below the commissure (72.44%) at a mean of 21.99 mm.
• Both vessels most commonly coursed in the submucosal plane (SLA up to 84.8%, ILA 81.25%), at a mean depth of approximately 5.2 mm.
• The authors propose a "steal phenomenon" of redistribution from the upper lip toward nasal and ophthalmic territories through pre-existing anastomoses to explain the upper lip's susceptibility.

A prospective controlled study of 90 women with regular ovulatory cycles, stratified into perimenstrual, periovulatory, and luteal groups, measured intraoperative blood loss (corrected suction and gravimetric sponge analysis) and 48-hour drainage after standardized lipoabdominoplasty.

• There was no significant difference in intraoperative blood loss across phases (480 vs. 460 vs. 455 mL; p = 0.62) or in postoperative drainage (p = 0.78).
• Hemoglobin decline, drain duration, and complication rates were comparable across groups (seroma 6%, hematoma 4%, transfusion 1%).
• On correlation analysis, BMI and excised tissue weight, but not menstrual phase, were independent predictors of blood loss.

A retrospective cohort of 110 patients who underwent primary augmentation with polyurethane-coated implants completed a 15-item device-specific instrument (PU-PRO) at a mean 5.2-year follow-up, with psychometric evaluation including factor analysis and test-retest reliability.

• Among the 90% who completed the 5-year assessment, mean scores (0–100) were highest for Aesthetic Satisfaction at 84.5 ± 11.9, alongside Perception (81.3) and Postoperative Experience (78.2).
• Only one patient (1%) reported clinically evident rippling, and no revision surgeries occurred during follow-up.
• The PU-PRO showed high internal consistency (Cronbach's α 0.84–0.91), a three-factor structure explaining 68% of variance, and ICC values of 0.88–0.93.

A cross-sectional study of 40 volunteers used standardized bilateral facial ultrasonography with a 20-MHz linear probe across six transducer positions to characterize the continuity of deep fatty and fascial layers between the temple and midface in treatment-naïve adults.

• Deep temporal fat transitioned from a multilaminar to a unilaminar pattern as it crossed the zygoma, then re-expanded to a continuous multilaminar arrangement in the lateral and medial midface.
• Lateral spread was limited by dense preauricular fascia, while anterior boundaries were formed by the zygomaticus major and minor muscles and associated ligaments.
• The imaging findings were corroborated by a second examiner, three body donors, and histology.

This cadaveric study of 36 hemifaces from 20 cadavers mapped the emergence point of the zygomaticotemporal nerve relative to the marginal tubercle and the lateral canthus, and examined its fascial relationships to the middle temporal vein and the frontal branch of the facial nerve.

• The emergence point lay 4.5 ± 1.6 mm superior to the marginal tubercle, and 17.6 ± 2.7 mm lateral and 9.5 ± 2.9 mm superior to the lateral canthus.
• The nerve and the middle temporal vein occupied the same fascial plane (vertical separation 7.3 ± 2.3 mm), whereas the frontal branch of the facial nerve coursed through a more superficial layer.
• Facial proportions influenced the nerve's absolute position but did not alter its spatial relationship to the marginal tubercle.

In this perception study of 101 participants, a single aged female 3D head-and-neck model was digitally rejuvenated one region at a time (eyes, lips, midface–lower face, or neck–jawline), and viewers ranked the animated variants from youngest to oldest.

• The neck–jawline ranked youngest most often (n = 54), while the perioral region ranked oldest most often (n = 71).
• Mean ranks ordered the regions from youngest to oldest as neck–jawline (1.8), midface–lower face (2.2), periocular (2.6), and perioral (3.6) (P < .001).
• All pairwise differences were significant except between the periocular and midface–lower face regions (P = 0.4).

This retrospective case series of 85 patients with eyelid-margin tumors used bilateral full-thickness advancement flaps incorporating the marginal arterial arcade for single-stage reconstruction after excision.

• All 85 flaps survived completely with primary healing in every case.
• Excised lesions were predominantly benign: 75 pigmented nevi, 8 basal cell carcinomas, and 2 squamous cell carcinomas.
• No major complications such as significant notching, ectropion, or lagophthalmos were observed during follow-up.

This systematic review of 265 articles and 220 patients from 183 primary reports evaluated how Maffucci syndrome has been defined and characterized the vascular anomalies described, benchmarked against ISSVA nomenclature.

• More than half of articles named 'hemangioma' nonspecifically as the defining vascular anomaly, and only 2 used the current ISSVA definition of venous malformations ± spindle-cell hemangiomas.
• Of 220 patients, only 36 (16%) had a diagnosis consistent with a specific ISSVA label, and just 9 (4%) had venous malformations per the 2018 definition.
• 23 patients (11%) had spindle-cell hemangiomas without venous malformations, suggesting either lesion may be diagnostic of the syndrome.

This survey of 53 dermatologists (57% response rate) in the Loire Valley, France used 9 clinical vignettes with dermoscopy and preoperative ultrasound measurements to assess attitudes toward single-stage melanoma surgery and perceived barriers.

• One-step surgery was selected in 28% of scenarios overall, rising to 47% when diagnosis was biopsy-confirmed and falling to 24.5% without histopathological confirmation (p < 0.0001).
• Most respondents rated ultrasound useful for thickness estimation (median Likert score 3, IQR 3–4) and believed patients would prefer a single procedure (median 4, IQR 3–5).
• Leading barriers were limited access to high-resolution ultrasound (n = 18), concern about overtreatment (n = 14), and medico-legal risk without histopathology (n = 9).

This systematic review of studies published from 2014 to 2025 assessed strategies to reduce wrong-site surgery in dermatologic and Mohs micrographic surgery, spanning site verification, documentation, photography, technology adjuncts, and team protocols.

• Effective strategies were multimodal, combining standardized documentation, pre-biopsy and patient-captured photography, and coordinate-based measurements.
• Useful technology adjuncts included ultraviolet imaging and smartphone applications, alongside structured team verification protocols.
• No single intervention was sufficient on its own; layered safeguards and patient engagement were described as critical to minimizing risk.

This study developed BCALN-Net, a deep learning model trained on 6,271 patients, a hierarchical multitask MRI model that simultaneously predicts sentinel-node metastasis, sentinel-node metastatic burden, and non-sentinel-node metastasis in breast cancer.

• The model predicted all three nodal endpoints with high and robust performance across molecular subtypes, tumor and nodal stages, receptor statuses, and menopausal status.
• In a pooled analysis of 4,081 patients, the model outperformed clinical criteria in predicting which patients could omit invasive axillary procedures.
• It packaged the three predictions into a single integrated, all-in-one diagnostic strategy intended to guide axillary surgery de-escalation.

This narrative review of literature from 2010 to 2025 synthesized work on AI, predictive modeling, and digital tools in burn care, supplemented by evidence from critical care, emergency medicine, radiology, dermatology, and oncology, focused on bias, fairness, and interpretability.

• Across medical domains, algorithms frequently misclassified outcomes for racial and ethnic minorities, socioeconomically disadvantaged patients, women, older adults, and those with complex comorbidities.
• Burn-specific models rarely evaluated subgroup performance or reported the demographic composition of their training data.
• Recurring problems included unrepresentative datasets, opaque modeling pipelines, and absent bias audits, with ethical analyses fragmented and seldom grounded in established frameworks.

This case-based comparative study of 30 simulated free flap compromise scenarios (15 intraoperative, 15 postoperative) had four consultant microsurgeons rate the diagnostic and management responses of three large language models (ChatGPT, Gemini, Copilot) on 5-point Likert scales.

• Clinical accuracy ratings were high across all three models in both intraoperative and postoperative scenarios, with no significant between-model differences.
• In intraoperative cases, usefulness of explanation differed significantly, with lower ratings for Copilot than Gemini.
• In postoperative cases, Gemini outscored ChatGPT and Copilot on management recommendations and usefulness of explanation, and exceeded Copilot on overall confidence.
• Potentially harmful recommendations were uncommon but differed between models in postoperative scenarios; interrater agreement was higher for intraoperative than postoperative cases.

In a retrospective predictive-modeling study of 5,996 surgical cases drawn from two academic medical centers, investigators tested machine-learning approaches that combined structured EHR data, clinical text notes, and temporal laboratory values to detect surgical site infections.

• Models combining structured data with clinical text outperformed structured data alone (F1 0.68 vs 0.55).
• Adding temporal laboratory features improved performance further to F1 0.70.
• Deep learning leveraging large language models beat the state-of-the-art rule-based system (F1 0.70 vs 0.43).
• The best configuration achieved a precision of 0.38 at 0.9 recall, implying many false positives when most true infections are captured.

This narrative review of intelligent biosensors for diabetic wound monitoring integrates front-end sensor-interface engineering with back-end data analysis for continuous, non-invasive tracking of the wound microenvironment.

• Material strategies including active fluid management, anti-biofouling zwitterionic networks, and nanozyme-based ROS scavenging are proposed to keep sensing interfaces stable in the hostile wound microenvironment.
• In situ sensing targets a defined biomarker panel of pH, temperature, glucose, ROS, and MMP-9, using multiparameter decoupling techniques.
• Portable devices and machine learning algorithms are highlighted for translating multimodal sensor signals into objective clinical metrics.

This randomized, open-label controlled trial of 40 patients with mild-to-moderate facial aging compared autologous fibroblast-containing micrografts (n=20) against a hyaluronic acid-based skin booster (n=20), with treatments at baseline, 1, and 3 months and follow-up to 12 months.

• At 12 months, the fibroblast group showed significantly greater improvement in wrinkle depth, skin elasticity, and WSRS score than the HA booster group (p<0.01).
• Both physician and patient evaluations favored the fibroblast group (p=0.049 and p=0.039), with higher reported satisfaction.
• The injected micrografts contained roughly 2.78 million nucleated cells/mL at 89.6% viability, with a CD44-high, CD34/CD45-low immunophenotype.

This narrative review of advanced hemostatic biomaterials surveys biomimetic designs, nanotechnology, stimuli-responsive polymers, 3D printing, and microfluidics for surgical and trauma bleeding control.

• Biomimetic platelet- and fibrin-inspired designs are presented as enabling targeted clotting at the bleeding site.
• Nanoparticle carriers, electrospun fibers, and stimuli-responsive polymers reportedly enable controlled drug release and enhanced wound adhesion.
• 3D printing and microfluidics are highlighted for precise material customization and improved hemostatic efficiency.
• Translation is constrained by biocompatibility, scalable manufacturing, and patient-specific customization challenges.

This narrative review (Level III) synthesized PubMed/MEDLINE, Web of Science, and Google Scholar evidence on PRP, platelet-rich fibrin, and platelet-derived extracellular vesicles in soft-tissue repair, with literature considered through March 2026.

• PRP is described as influencing multiple stages of soft-tissue remodeling, spanning inflammatory and immune regulation, angiogenesis, redox balance, and extracellular matrix turnover.
• Proposed mechanisms include macrophage phenotypic modulation, TGF-β/Smad signaling, MMP activity, and mitochondrial transfer.
• Preparation heterogeneity, including platelet concentration, leukocyte content, activation method, fibrin architecture, and release kinetics, is emphasized as a major source of variable biological behavior.

This critical narrative review reframes cutaneous tissue engineering around perfusion as the master functional endpoint rather than vessel density, analyzing the vascularization process as a staged sequence.

• The vascularization bottleneck is reframed as a sequence of internal network formation, host inosculation, flow initiation, and perfusion stability.
• The review distinguishes implantable skin substitutes from in vitro perfused platforms such as skin-on-chip systems, arguing they have different success criteria.
• A proposed research agenda centers on functional benchmarking of perfusion, scaffold spatiotemporal coordination, immune-mural-lymphatic-vascular crosstalk, and scalable hierarchical vascular fabrication.

This narrative review paired with a qualitative survey of 12 aesthetic physicians in Colombia examined the mechanisms, effectiveness, safety, and regulation of extracellular vesicle and small extracellular vesicle interventions across aesthetic and regenerative indications.

• EVs and sEVs are reported to promote extracellular matrix remodeling, angiogenesis, immunomodulation, and tissue repair across skin rejuvenation, hair restoration, wound healing, and pigmentation indications.
• The evidence base is heterogeneous and limited by variable biologic sources and isolation and administration protocols, with few high-quality clinical trials.
• Adverse reactions to unapproved products marketed as exosomes are highlighted as a driver for stronger regulatory oversight.