Plastic Surgery Weekly

This non-randomized, multicenter post-market study of 412 patients (NCT04843436) evaluated the Symani Surgical System for microsurgical anastomosis in free-flap, nerve-repair, and lymphovenous procedures, with robotic-procedure technical success and procedure-associated complications as primary endpoints.

• Robotic-procedure technical success was 94.1% (507/539 anastomoses; 95% CI 91.7%–95.9%), and freedom from device-related events was 99.8%.
• First-attempt intraoperative patency was high, at 91.7% for free flaps (331/361) and 96.2% for lymphovenous anastomoses (225/234).
• Intraoperative revision was required in 8.4% of free-flap anastomoses versus 3.4% for lymphovenous and 0% for nerve repair.
• Free-flap survival at discharge was 97.8% (268/274; 95% CI 95.3%–99.2%).

This retrospective single-surgeon cohort of 73 patients undergoing lower limb reconstruction compared free flaps (n=44) with local perforator flaps (n=29), reviewing revision rates and administering a 20-item aesthetic questionnaire covering donor and recipient domains at 12 months.

• Secondary aesthetic refinement, most often liposuction, occurred in 17.8% overall, with a higher revision rate after free flaps (24.1%) than local flaps (11.9%; p=0.04).
• Donor-site satisfaction was significantly greater in the local flap group for contour, scar appearance, skin colour, and comfort when clothed.
• Recipient-site satisfaction scores showed no significant differences between flap types.
• Several patients who had not voiced dissatisfaction during follow-up reported concerns on the questionnaire, indicating previously unexpressed aesthetic issues.

This ex-vivo anatomical study of 20 fresh human lower extremities used selective arterial cannulation and stepwise controlled perfusion (synchronous, isolated, and flow-reversal conditions) to characterize descending genicular artery perfusion territories, perforator morphometry, and inter-perforator connectivity of the medial femoral condyle flap.

• Under synchronous perfusion, the mean perfused cutaneous territory measured 312.6 cm² (range 210.6–415.6).
• Ninety-eight cutaneous perforators were identified (4.9 ± 1.1 per limb), with mean diameter 0.70 ± 0.24 mm and pedicle length 3.6 ± 0.8 cm.
• In 30% of limbs one descending genicular branch, most often the saphenous, arose independently from the femoral artery, a variation relevant to pedicle planning.
• Perfusion patterns indicated the descending genicular artery acts as a dynamic perfusion field rather than a fixed angiosome.

This retrospective comparative study of 148 patients with unilateral cleft lip and palate (≥12 years) undergoing secondary nasolabial repair compared non-grafting repair (n=50), conventional secondary alveolar bone grafting (n=50), and two-stage bone grafting (n=48), with nasal morphology assessed by standardized two-dimensional photogrammetry at baseline and at least 3 years postoperatively.

• At 3 years the two-stage group showed improved nasal symmetry, with the columellar angle reaching 86.99° versus 84.43° for conventional grafting (p<0.05).
• Alar base indicators also favoured two-stage grafting, with a nasal alar base internal angle of 133.52° (vs 137.04°) and alar base angle of 1.58° (vs 2.10°; both p<0.05).
• Conventional secondary alveolar bone grafting showed no significant differences from non-grafting repair on any measured parameter.

This systematic review of 8 studies (157 patients, 157 flaps), comprising mostly case reports and retrospective case series, evaluated indications, technique, and outcomes of Symani-assisted microsurgery in head and neck free-flap reconstruction, with flap success and anastomotic complications as primary outcomes.

• Random-effects meta-analysis showed a pooled flap loss rate of 3.3% (95% CI 1.1%–9.1%; I2 = 0%), with two flap losses and five returns to the operating room.
• The robot was used for arterial and/or venous anastomosis, most commonly in radial forearm flaps anastomosed to the facial vessels.
• Conversion to conventional technique occurred in one case due to technical malfunction, and anastomotic complication rates were reported as low.
• Anastomosis and operative times were poorly reported across the included studies.

This retrospective cohort of 60 patients with diabetic foot ulcers compared free flap reconstruction (n=30) with conservative wound care (n=30) after primary angioplasty, testing whether flap coverage protects against vascular restenosis and the need for re-angioplasty.

• Re-angioplasty was required in 10.0% of the free flap group versus 63.3% of the conservative group (p<0.001).
• Limb salvage reached 66.7% with free flaps versus 20.0% with conservative care (p<0.001).
• On multivariate analysis, free flap reconstruction was the only independent predictor of reduced re-angioplasty risk (aOR 0.073, p=0.003).
• End-stage renal disease on hemodialysis was the only demographic factor tied to re-angioplasty (68.2% vs 36.8%, p=0.019).

This retrospective review of 793 patients (1310 DIEP flaps) at two institutions measured subcutaneous abdominal wall thickness on preoperative CT angiography and compared it with BMI as a predictor of postoperative complications.

• BMI and abdominal wall thickness were strongly correlated (r=0.68), and both independently predicted complication rates.
• Wound dehiscence, infection, and fat necrosis increased stepwise across rising AWT groups.
• ROC analysis identified an AWT threshold of 26.3 mm for overall complications, with predictive ability comparable to BMI.
• Mismatched cases showed that BMI alone underestimated risk in patients with high BMI but a thin abdominal wall, and vice versa.

This analysis of a prospective institutional database of 542 patients undergoing oncologic head and neck microvascular reconstruction stratified intraoperative and postoperative outcomes by BMI category (underweight through obesity class III) and flap donor site.

• Underweight patients had higher odds of donor-site complications (OR 4.60) and recipient-site complications (OR 2.49), notably salivary leaks (24.0% vs ≤11.2%).
• Obesity class II patients undergoing thigh-based reconstruction showed increased flap loss (16.7% vs ≤2.4%).
• Obesity class II/III patients showed only non-significant trends toward more recipient-site hematoma and dehiscence.

This single-center retrospective analysis of 1015 patients undergoing their first head and neck free flap over 2013–2021 used logistic and linear regression to identify predictors of flap failure, complications, take-back, and length of stay.

• Flap failure occurred in 3.19% of cases, with complications in 16.85% and take-back procedures in 8.80%.
• Longer ischemia time independently increased the odds of flap failure (OR 1.01 per minute, p<0.001), as well as complications and prolonged stay.
• Preoperative radiotherapy or chemotherapy was associated with more complications (OR 1.90) and longer hospitalization but not with flap survival.

This multicenter study of 84 patients with head and neck neuralgias compared botulinum toxin and nerve block use before and after headache surgery and assessed patient-reported relief and projected injectable costs.

• Botulinum toxin use fell from 74% to 36% and nerve block use from 87% to 27% after surgery (both p<0.001).
• In paired comparison, nerve blocks provided significantly more relief than botulinum toxin, and surgeon-administered blocks outperformed those from outside providers.
• Preoperatively, botulinum toxin gave limited benefit, with relief lasting under 3 months in 86% of patients.
• The projected annualized cost reduction was $365,808 across the cohort.

This NSQIP analysis of 544 patients (2006–2022) identified adults undergoing brachial plexus injury reconstruction and compared specialty-specific nerve transfer adoption and 30-day outcomes against traditional reconstruction.

• Nerve transfers carried lower 30-day complication rates than traditional reconstruction (2.5% vs 11%, p=0.034), despite higher preoperative morbidity risk.
• Plastic surgeons performed 60% of nerve transfers while accounting for only 33.5% of all brachial plexus reconstructions.
• Orthopedic and neurosurgeons were significantly less likely than plastic surgeons to perform nerve transfers (OR 0.26 and 0.18), though neurosurgeon use rose in the final 4 years.

This prospective single-center cohort of 30 digits in 26 patients applied a locked 6-minute indocyanine green angiography protocol with prespecified temporal thresholds to Tamai zone II–V injuries with clinically equivocal perfusion.

• The dual-threshold rule achieved sensitivity of 1.00 (95% CI 0.84–1.00) and specificity of 0.78 (95% CI 0.40–0.97) for digit survival.
• Intraoperative review changed management in 12 of 30 digits, most often venous augmentation for delayed washout.
• All 26 threshold-positive digits survived at 30 days, while all 4 with no fluorescence at 5 minutes underwent revision amputation.

This single-center cohort of 113 patients with prospective inclusion compared four fragment-specific distal radius plate designs placed distal to the watershed line, assessing tendon irritation by 6-month ultrasound.

• Tendon irritation frequency differed significantly across the four plate designs (p<0.001).
• Adjustable anterior rim plates produced no cases of tendon irritation (0 of 21), versus 9 of 42 hook plates.
• Extradistal plates showed the most irritation (15 of 31), followed by babyfoot plates (10 of 19).

This is a single-surgeon technical description and case series of 15 consecutive patients who underwent thin posteromedial thigh / profunda artery perforator free flap reconstruction of hand and upper-extremity wounds, with preoperative perforator mapping by CT angiography and color Doppler ultrasound.

• Flap survival was 93.3% (14 of 15), with the single failure resulting from an unsalvageable intraoperative arterial spasm.
• Mean flap thickness was 7 ± 2.4 mm, allowing contour matching to adjacent hand and upper-extremity skin, and all flaps were raised on a single perforator.
• The mean discrepancy in proximal-distal perforator location between CT angiography and color Doppler ultrasound was 1.3 ± 0.7 cm, supporting precise preoperative mapping.
• Donor-site morbidity was limited to superficial wound dehiscence in two patients, both managed conservatively.

This paper pairs a systematic review of 22 studies (2017–2025) with a retrospective cohort of 89 patients (61.8% African American) who underwent carpal tunnel release with routine intraoperative biopsy of the transverse carpal ligament or A1 pulley, all analyzed for amyloid by Congo Red staining.

• Across the reviewed literature, 10% to 30% of carpal tunnel release specimens contained amyloid, with higher diagnostic yield from transverse carpal ligament sampling in high-risk patients.
• The review identified mass spectrometry as the superior analytic modality over standard staining for detecting and typing amyloid.
• In the institutional cohort, Congo Red staining identified no amyloid deposits in any of the 89 specimens, despite the predominantly African American, higher-risk population.

This retrospective review of 149 distal interphalangeal joint fusions compared three fixation devices, snap-off compression pins (18), headless compression screws (112), and angled compression screws (19), with QuickDASH at final follow-up as the primary outcome.

• QuickDASH improved significantly from baseline for the snap-off compression pin and headless compression screw groups, but not for the angled compression screw group.
• Complication profiles and reoperation rates were comparable across all three groups.
• Operative and tourniquet times were also similar between the three devices.

Using MarketScan claims from 2018–2022, this retrospective claims analysis of 57,867 carpal tunnel releases applied the Herfindahl-Hirschman Index to test whether regional surgeon market competition was associated with the type of release performed, costs, and complications.

• Endoscopic release accounted for 28.1% of cases (16,274 of 57,867), with open release making up the remainder.
• Competitive markets were associated with 12% higher odds of endoscopic release, adding $37.68 in patient out-of-pocket and $347.45 in total healthcare costs per case.
• Regional surgeon competition showed no association with post-release complications.

This biomechanical study of 16 porcine Achilles tendons randomized repairs to one-knot or two-knot configurations (n = 8 each) of an eight-strand looped-suture modified Adelaide repair and measured the force for 1-, 2-, and 3-mm gap formation and ultimate failure load.

• The one-knot group required significantly more force to produce gaps, needing nearly twice the force at 2 mm (20.4 vs 10.3 N), with similar advantages at 1 and 3 mm.
• Mean ultimate failure load did not differ significantly between configurations (100.1 vs 91.1 N, P = .175).
• Failure mode differed by group: knot failure predominated in the one-knot group (7 of 8), whereas suture breakage predominated in the two-knot group (7 of 8).

In a randomized animal study of 52 rats with an Achilles tendon partial-defect model, tendons received either a circumferential hydrophobically modified Alaska pollock gelatin (hm-ApGltn) sheet or no sheet, with biomechanical adhesion and tensile testing plus histology at 2 and 4 weeks.

• At both 2 and 4 weeks, the gelatin-sheet group showed significantly lower adhesion-detachment failure loads, indicating reduced adhesion formation.
• Tendon tensile strength did not differ between groups at either time point.
• Histology demonstrated improved adhesion quality in the treated group, with residual hm-ApGltn material still present at 4 weeks.

This narrative review and expert-opinion proposal critiques current radial polydactyly management and the Wassel-Flatt classification, then presents a simplified two-group framework combining transverse (modified Bilhaut-Cloquet) and longitudinal (on-top plasty) reconstructive concepts.

• The authors argue the widely used Wassel-Flatt classification fails to capture soft-tissue anomalies, axial deviation, and triphalangeal components needed for operative planning.
• When both duplicates are small (typically <70% of the contralateral thumb), achieving adequate thumb girth and a satisfactory nail complex often requires augmentation or combined procedures.
• The proposed two-group scheme organizes strategy around size discrepancy, axis deviation, soft-tissue quality, and nail deformity and is claimed to cover at least 95% of cases.

This double-blind randomized controlled trial of 70 patients with partial-thickness forearm burn scars compared 24 sessions of shock wave therapy (n=35) against conventional physical therapy with a deactivated applicator (n=35), assessing ultrasonography, the Vancouver Scar Scale, and the Burn Specific Health Scale-Brief at baseline, 8 weeks, and a further 8-week follow-up.

• Both groups showed statistically significant improvements in pain (VAS), scar thickness, Vancouver Scar Scale, and Burn Specific Health Scale scores from baseline to post-treatment and follow-up.
• The shock wave group showed large effect sizes for VAS (η²p = 0.82/0.80), VSS (0.80/0.79), and BSHS (0.85).
• Between-group confidence intervals overlapped substantially (e.g., VAS pre-post 4.70–6.36 for shock wave therapy vs 4.19–6.86 for conventional therapy), with only modest separation favouring shock wave therapy.

This systematic review and meta-analysis of 62 studies (1602 patients) examined classification systems and reconstructive outcomes for axillary burn contracture, synthesizing techniques qualitatively and pooling recurrence rates using a random-effects model.

• Pooled recurrence across 855 reconstructions was 13.0% (95% CI 10.7–15.8) with no heterogeneity (I2 = 0%), and meta-regression suggested higher recurrence with longer follow-up.
• Flap-based reconstructions achieved greater abduction gains (≈82°) than skin grafting (≈52°).
• Formal classification systems were inconsistently applied, with the Kurtzman and Stern classification used most often (16.1% of studies).
• Commonly reported techniques were trapeze flap plasties (n=277), skin grafting (n=239), skin grafting with local flaps (n=85), and Z-plasties (n=85).

This retrospective cohort of 240 burn patients (431 split-thickness skin grafts) at an ABA-verified burn center compared ultra-early (≤24 hours) versus late (>24 hours) postoperative mobilization, with graft loss (>50% of area, prolonged wound care, or reoperation) as the outcome.

• Graft loss rates were essentially identical between ultra-early and late mobilization (9% vs 9.2%, P = 0.93).
• Ultra-early mobilization did not increase the odds of graft loss (OR 0.59, 95% CI 0.20–1.73).
• Out-of-bed ambulation versus in-bed exercise also showed no increase in graft loss (OR 1.41, 95% CI 0.36–5.50).

In a noninferiority randomized controlled trial of 24 patients requiring skin-graft reconstruction, a low-cost reverse aqua pump negative pressure wound therapy (RAP-NPWT) system was compared with commercial NPWT for granulation outcomes and treatment cost.

• No significant difference in the degree of granulation was observed between RAP-NPWT and commercial NPWT from day 1 to the end of treatment, and NPWT duration was comparable between groups.
• Bone exposure did not affect granulation development in either arm.
• RAP-NPWT had significantly lower treatment costs, with a negative incremental cost-effectiveness ratio marking it the dominant intervention on cost-minimization analysis.

This prospective multicenter randomized controlled trial of 206 patients with challenging, complex venous leg ulcers compared hypothermically stored amniotic membrane (HSAM) plus standard of care with standard of care alone over 24 weeks.

• HSAM plus standard of care produced significantly higher wound-closure rates at weeks 12 and 16 across both wound-duration strata (>6 and >24 months).
• In the intent-to-treat population, HSAM plus standard of care achieved significantly greater reductions in wound area, depth, and volume compared with standard of care alone.
• Baseline demographics and wound characteristics were comparable between groups at randomization.

This prospective longitudinal study of 11 adults (13 joints) with upper-extremity burn contractures (>15% passive ROM loss) evaluated an individually tailored serial casting program after switching from at least 3 days of usual care, using a criterion-for-change design.

• Regular passive ROM, revised passive and active ROM, and scar thickness improved significantly during treatment.
• Participants reported improved upper-extremity function in 11 of 13 joints (median 16%, range 9–21%).
• Scar impression improved for all scars (median 6, range 4–10), and participants perceived that serial casting reduced their rehabilitation burden.

This retrospective cohort study of 149 adult burn patients at an Ethiopian burn center evaluated the discriminatory accuracy of the revised Baux (rBaux) score for in-hospital mortality using ROC curve analysis.

• The rBaux score showed excellent discrimination (AUC 0.923), with a 95% CI of 0.850–0.996.
• The optimal cutoff of 81.5 yielded 84.6% sensitivity and 94.3% specificity.
• On multivariable analysis, age (aOR 1.10), TBSA (aOR 1.18), and female sex (aOR 9.11) were independently associated with mortality.

This multicenter synthesis of frostbite care protocols from 16 FROST study sites across North America categorized documented practices as uniform agreement (≥90%), consensus (≥75%), or majority (≥50%).

• Uniform agreement (≥90%) was limited to rapid rewarming and thrombolytics, with thrombolytic use influenced by FROST site selection criteria.
• Consensus (≥75%) was reached on treatment urgency, perfusion assessment, therapeutic windows, and IV thrombolytic dosing.
• Protocols diverged on thrombolytic initiation grading, prostacyclin analogue use, and post-thrombolytic anticoagulation, as well as therapy, splinting, and wound care.

This retrospective cohort study of 56 adults admitted to a single ICU with major burns (TBSA ≥20%) described the hyperpyrexia (≥39.5°C) cohort and used interrupted time series analysis to evaluate the Thermogard XP intravascular temperature management device against historic controls.

• Hyperpyrexia developed in 30 of 56 patients, who more often had flame burns, greater TBSA, and longer hospital stays.
• Despite greater burn severity, mortality did not differ significantly between hyperpyrexic and non-hyperpyrexic patients.
• In the 8 patients managed with the Thermogard XP device, normothermia appeared to be achieved faster than with standard interventions.

This critical review synthesizes contemporary advances in ischial pressure ulcer reconstruction, framing a shift from anatomical wound closure toward functional-integrated reconstruction to break the recurrence cycle.

• The reviewed paradigm centers on radical debridement and transfer of well-vascularized perforator flaps to obliterate dead space, cover the wound, and restore protective sensation.
• Highlighted technical refinements include sensory nerve coaptation and chimeric flap designs, alongside precision, minimally invasive perforator techniques.
• Adjuncts discussed include antibiotic-loaded bone cement and fluorescence angiography, with regenerative approaches such as stem cells and 3D-bioprinting considered exploratory.

This systematic review and meta-analysis of 20 studies (3106 patients) compared deep inferior epigastric perforator (DIEP) flaps with implant-based reconstruction after mastectomy, pooling BREAST-Q scores, complications, reconstruction failures, and revision procedures.

• DIEP reconstruction produced higher overall BREAST-Q scores (mean difference +9.28; P = 0.008), with gains in breast satisfaction, psychosocial well-being, and sexual well-being.
• Reconstruction failure was lower with DIEP (odds ratio 0.15; P = 0.019).
• Infection, hematoma, and seroma rates were comparable between techniques, but donor-site morbidity and revision rates were higher with DIEP.
• Nipple satisfaction, chest physical well-being, and anxiety and depression outcomes showed no significant differences between groups.

This retrospective cohort of 1196 patients across five institutions characterized 90-day complications and unplanned reoperations after mastectomy with immediate alloplastic breast reconstruction and identified independent pre- and intraoperative predictors.

• Within 90 days, 18.1% of patients (217) experienced 367 complications, most commonly infection (9.2%), mastectomy skin necrosis (6.0%), and seroma (4.0%).
• Unplanned reoperation occurred in 12.8% (153 patients), mainly tissue expander/implant removal without replacement (6.9%) and debridement (6.7%).
• Independent predictors of 90-day complications were autoimmune conditions, prophylactic mastectomy, bilateral mastectomy, and BMI ≥30, with autoimmune conditions and prophylactic mastectomy also predicting reoperation.

This PRISMA-compliant systematic review and meta-analysis of 4574 patients across 12 retrospective comparative studies evaluated whether prior abdominal scarring affects flap viability and complication rates in abdominal-based breast reconstruction.

• Prior abdominal scarring was not associated with increased recipient-site complications, including hematoma, seroma, infection, venous congestion, partial or complete flap loss, and reoperation, and flap viability was comparable between groups.
• Donor-site wound dehiscence was more frequent with prior scarring (RR 1.68; P = 0.0001), as was abdominal wall laxity (RR 4.19; P = 0.04).
• The elevated dehiscence risk was greatest in DIEP-only reconstructions (RR 1.81; P < 0.0001).

This multicenter retrospective review of 631 patients (1155 breasts) compared return to the operating room for implant removal and postoperative complications across Allergan, Mentor, and Sientra implants in acellular dermal matrix-assisted implant-based reconstruction.

• After 60 days, there were no significant differences in overall complication rates among the three implant brands.
• Eventual reoperation occurred in 13.9% of breasts, including unplanned explantation in 8.2% and elective revision in 8.1%.
• Independent predictors of complications were patient and operative factors (BMI, diabetes, smoking, chemotherapy, radiation, skin-sparing mastectomy, incision type, tissue expander use) rather than implant brand.

This single-institution retrospective review of 866 patients undergoing axillary lymph node dissection compared immediate lymphatic reconstruction technical success across single-stage ALND, same-anesthetic staged, and separately staged sentinel or targeted axillary dissection.

• Overall immediate lymphatic reconstruction technical success was 93.4% and did not differ significantly by timing of axillary staging (p = 0.415).
• A median of 2 lymphatic channels (IQR 1-3) were reconstructed, with no significant difference between groups (p = 0.173).
• When reconstruction was not performed, the most common reasons were failure to identify blue lymphatic channels on reverse mapping (n = 21) and absence of suitable recipient veins (n = 11).
• On multivariable analysis, White race and lower BMI were significant predictors of technical success.

This retrospective cohort of 104 patients (208 breasts) compared intraoperative intravenous tranexamic acid against a historic control cohort for postoperative drainage after large-volume (≥500 g per breast) reduction mammaplasty.

• TXA was associated with lower drain output at 48 h (54 mL versus 80 mL) and 41.9% lower total drainage volume (68 mL versus 117 mL per breast).
• Drainage duration and length of hospital stay were significantly shorter with TXA (p < 0.0001).
• Bleeding-related complications were less frequent in the TXA group (1.7% versus 13.3%), with no thromboembolic events in either cohort.
• Absolute and relative hemoglobin decline on the first postoperative day did not differ between the groups.

This single-center retrospective cohort of 200 patients with Regnault grade II or III breast ptosis compared Wise pattern versus transverse pattern skin-sparing mastectomy with immediate two-stage implant-based reconstruction.

• On multivariable analysis, Wise pattern mastectomy was associated with decreased odds of major complications (OR 0.285, 95% CI 0.120-0.679, p=0.005).
• Wise pattern was associated with lower odds of undergoing breast revision (OR 0.247, 95% CI 0.117-0.523) and fewer total revisions on ordinal regression (OR 0.231, 95% CI 0.110-0.487).
• Minor complication rates were not significantly different between the Wise pattern and transverse pattern cohorts.

This single-center retrospective cohort of 927 patients (1102 reconstructed breasts) evaluated postoperative infection incidence before and after progressive implementation of a structured multidisciplinary pathway (CONMUL) integrating plastic surgery and infectious disease specialists.

• Annual infection incidence declined after pathway rollout, from 11.42% to 5.15% (2023 to 2025), corresponding to roughly 15 fewer infections per year.
• Overall, 8.9% of reconstructed breasts developed a postoperative infection over the study period.
• Once infection occurred, explantation remained the most frequent outcome, with no significant difference between multidisciplinary and standard management in time to explantation or reinfection.

This PRISMA-guided systematic review of 27 studies (>25,000 breast cancer survivors) evaluated the impact of breast reconstruction on sexual function and body image compared with mastectomy alone.

• Women undergoing breast reconstruction generally reported significantly higher sexual function and body image scores than those undergoing mastectomy alone.
• Autologous reconstruction was associated with superior long-term satisfaction and sexual well-being compared with implant-based techniques.
• Breast-conserving therapy was associated with better nipple sensation preservation than total mastectomy, and preoperative counseling on sexual health was frequently reported as insufficient.

This systematic review and meta-analysis of 10 comparative studies (five contributing quantitative data) compared DIEP and TRAM flaps for post-mastectomy reconstruction, with an exploratory network meta-analysis against other autologous techniques.

• Fat necrosis (OR 0.86, 95% CI 0.54-1.36) and total flap loss (OR 0.79, 95% CI 0.39-1.61) did not differ significantly between DIEP and TRAM flaps.
• DIEP reconstruction was consistently associated with fewer donor-site morbidities and better maintenance of abdominal wall integrity than TRAM.
• In the exploratory network meta-analysis, the TUG flap ranked highest for reduced total flap loss, while DIEP ranked favorably for donor-site outcomes and patient satisfaction.

This systematic review and meta-analysis of 4,482 patients across 50 studies compared autologous, irradiated homologous, Tutoplast-processed, and fresh-frozen costal cartilage grafts. Complication rates including warping, resorption, infection, extrusion, revision, and dissatisfaction were pooled with a random-effects model.

• Pooled complication rates were low across all graft types, including warping (2.9%), resorption (1.6%), and infection (1.9%), with no significant differences among the four graft types for any outcome (all P > .05).
• For autologous costal cartilage dorsal onlay grafts, laminated constructs showed lower warping than en bloc grafts (0.0% vs 5.42%; P = .004).
• Among en bloc dorsal grafts of all types, fresh-frozen cartilage had the lowest warping rate (0.60%), significantly lower than autologous cartilage (P = .030).

This single-surgeon prospective cohort of 166 patients compared deep plane (n = 45) with SMAS plication (n = 121) facelift, assessing aesthetic outcomes, satisfaction, recovery, and complications. Baseline characteristics were comparable between groups.

• Overall complication rates did not differ between deep plane and SMAS plication (28.7% vs 21.6%, p = 0.39), including transient facial nerve weakness (12.4% vs 11.1%, p = 0.70).
• Patient satisfaction was high in both groups (p = 0.09) and recovery duration was similar (median 30 vs 25.5 days, p = 0.65).
• Logistic regression identified no significant predictors of outcome or interaction effects between technique and other variables.

This multicenter, evaluator-blinded randomized trial of 151 patients with grade ≥3 nasolabial folds compared a novel absorbable micro-aesthetic lifting thread against a marketed polydioxanone thread. The primary endpoint was the 7-month Wrinkle Severity Rating Scale response rate.

• The 7-month response rate was 71.6% for the experimental thread versus 62.7% for the control, a difference of 8.95% (95% CI −6.06 to 23.97) that confirmed non-inferiority.
• The experimental thread was significantly superior at 3 months and in investigator satisfaction and barb-fixation performance (P < 0.05).
• Both groups showed comparable safety profiles with no serious adverse events.

This systematic review and meta-analysis of 3,283 procedures across 12 studies estimated complication incidence for office-based facial cosmetic surgery under local anesthesia, with or without sedation. Pooled weighted incidences were calculated with a random-effects Freeman-Tukey model.

• The pooled incidence of total complications was 5.6% (95% CI 2.8-9.3).
• Major complications occurred in 1.6% of cases (95% CI 0.1-4.3) and minor complications in 3.7% (95% CI 2.0-5.7).
• Combined facial procedures were uncommon, with only 9% of patients undergoing multiple procedures in one operative setting, indicating limited operative scope.

This randomized, double-blind, placebo-controlled phase II dose-ranging trial compared three MT921 injectable cholic acid regimens against placebo in subjects with moderate-to-severe submental fat. Primary endpoints were clinician- and patient-assessed submental fat rating improvements four weeks after the final treatment.

• A ≥1-grade improvement in clinician-assessed submental fat rating was achieved by 88.64% of the 1.5%/1.0 cm group versus 48.78% with placebo, with the other active doses at 72.73% and 79.07%.
• MRI-measured submental fat volume decreased in all MT921 groups but not with placebo, and caliper thickness and patient satisfaction also favored active treatment.
• Adverse events were more frequent with MT921 but were mostly mild or moderate.

This pooled analysis of two randomized, placebo-controlled phase 3 trials used validated patient-reported outcomes to compare onabotulinumtoxinA (26, 31, or 36 U) with placebo in participants with moderate-to-severe platysma prominence. Measures covered treatment satisfaction, bother, psychosocial impact, and jawline definition.

• At Day 14, treatment satisfaction was reported by 64.0% of onabotulinumtoxinA participants versus 11.5% with placebo.
• Satisfaction with jawline definition (43.3% vs 10.4%) and reduced bother with jawline (51.1% vs 11.0%) also favored onabotulinumtoxinA.
• Reduced bother with vertical neck bands (52.0% vs 19.0%) and lower appearance-related psychosocial impact were reported, and benefits were sustained throughout the study period.

This retrospective single-surgeon series of 240 patients analyzed the incidence, management, and outcomes of complications after extended deep plane facelift performed between 2021 and 2025. The learning curve was evaluated in consecutive groups of 60 cases.

• Complications occurred in 12.5% of patients, most commonly transient facial nerve dysfunction (5.8%) and skin necrosis (2.5%), and were largely transient.
• The overall complication rate declined with experience, from 16.7% in the first 60 cases to 8.3% in the last 60.
• Skin necrosis incidence fell from 6.7% to 0% across the same experience groups.

This systematic review and meta-analysis of 5 randomized controlled trials (536 participants) evaluated botulinum toxin type A against placebo for masseter muscle hypertrophy. The primary outcome was change in masseter muscle thickness during maximal clenching.

• At week 4, the pooled relative risk of achieving a masseter prominence/hypertrophy score ≤3 was 5.25 (95% CI 1.88-14.66) for 48 U and 3.66 (95% CI 1.29-10.34) for 72 U versus placebo.
• Botulinum toxin A was consistently associated with reduced masseter muscle thickness and higher patient satisfaction across follow-up time points.
• Current evidence was insufficient to define a formulation-adjusted dose-response relationship or an optimal treatment protocol.

This in vitro 3-dimensional adipose-tissue model with subsequent murine grafting cultured human fat constructs under 0, 6, or 12 mmHg of pressure to test how mechanical load affects structural integrity, solute permeability, cell viability, and downstream volume retention and fibrosis.

• A porous interstitial network supported graft survival to a depth of about 8 mm; increasing pressure dose-dependently collapsed this network and reduced solute permeability from 76.4% to 21.3%.
• Pressure induced a form of "latent injury" consistent with YAP-related mechanotransductive signaling, together with lineage-related molecular changes and metabolic stress.
• In vivo, gross volume retention was similar across groups, but pressure-conditioned grafts developed marked necrosis, with fibrosis rising from 22.1% in controls to 53.3% in the 12 mmHg group at 8 weeks.

This single-arm case series of 400 female patients (mean age 49 years) undergoing rhytidectomy evaluated a modified hairline-preserving incision (the Okumuş incision) using investigator-rated GAIS scores, patient-reported satisfaction, complications, and temporal-region aesthetic outcomes at 12 months.

• At 12 months, GAIS scores indicated exceptional improvement in 98% of patients, and 98% reported being very satisfied with the temporal-region outcome.
• There were no cases of temporal hairline distortion, sideburn irregularity, or visible anterior temporal scars.
• Complications included widened temporal scalp scars (4.2%), delayed wound healing (5.2%), and hypertrophic scarring (2.7%), all of which resolved without long-term functional or aesthetic sequelae.

This narrative review synthesizes current evidence on the etiology, clinical presentation, complications, and management of vascular anomalies, framed around their relevance to plastic and reconstructive surgery.

• Vascular anomalies are divided into vascular tumors (e.g., infantile and congenital hemangiomas, pyogenic granuloma, kaposiform hemangioendothelioma), which show abnormal cellular proliferation and natural histories ranging from spontaneous involution to aggressive growth.
• In contrast, vascular malformations (capillary, venous, lymphatic, and arteriovenous) arise from embryologic errors in vasculogenesis, persist throughout life, and enlarge progressively without regression.
• Management is individualized and multidisciplinary, spanning pharmacologic therapy (beta-blockers, sirolimus, targeted molecular agents), laser therapy, sclerotherapy, embolization, and surgery.

This four-round modified e-Delphi consensus survey of 25 UK skin-cancer MDT consultants (15 completing all rounds) sought agreement on early-stage melanoma care challenges and on how an IHC-based prognostic biomarker (AMBLor) could inform decisions about SLNB, adjuvant therapy, imaging, and follow-up.

• Strong consensus (≥75%) supported using the biomarker to target radiological surveillance to higher-risk patients (100%) and to reduce follow-up for lower-risk patients (100%).
• Strong consensus also backed prioritising adjuvant therapy for the highest-risk cases (95%) and improving SLNB selection (91%).
• Given a low-risk AMBLor result, only moderate consensus (50–74%) supported not offering SLNB for pT1b melanoma (66%) or withholding adjuvant therapy for stage IIB disease (72%).

This single-arm technique report in 24 patients describes a nasolabial-fold retrograde island flap for nasal reconstruction after basal cell carcinoma excision, modified with immediate postoperative multi-point local microinjection of heparin sodium to counter venous congestion.

• The protocol achieved a 100% flap survival rate across the 24 patients.
• Early severe venous congestion occurred in three cases (12.5%) and was reversed within one week with continued local heparin therapy.
• Flap size was not an independent predictor of venous congestion, and systemic assessments showed no clinically significant coagulation abnormalities or adverse events.

This single proof-of-concept benchtop study generated an in-house virtual surgical plan and patient-specific cutting template displayed through Microsoft HoloLens, then compared its tracings against an industry-made guide on an anatomically accurate 3D-printed skull, measuring the difference with calipers.

• Mixed-reality template markings differed from the commercial cutting guide by a mean of 1.89 mm (SD 1.52 mm).
• Total mixed-reality template production time was approximately 1.75 hours.
• The authors judged the approach feasible and potentially cost-effective but requiring more accurate real-time registration of projected guides in the operative field.

This systematic review and random-effects meta-analysis of 48 machine-learning algorithms pooled diagnostic performance for detecting scaphoid, distal radius, and other wrist fractures on skeletally mature radiographs and compared it with expert readers (orthopedic surgeons, hand surgeons, and radiologists).

• Pooled machine-learning AUCs were 0.88 for scaphoid, 0.97 for distal radius, and 0.93 for unspecified wrist fractures.
• Expert AUCs were 0.88 for scaphoid and 0.98 for distal radius fractures, indicating performance comparable to machine learning.
• Scaphoid fractures were detected less accurately than distal radius fractures by both algorithms and human readers, consistent with the greater difficulty of that diagnosis.

This randomized controlled animal study of 128 tendon-bone models in 64 rats compared control, exosome-only, scaffold-only, and exosome-loaded scaffold groups, assessing healing histologically, immunohistochemically, and biomechanically at 4 and 8 weeks.

• At both time points, the exosome-loaded scaffold group showed significantly greater vascularization, cellular activity, and collagen fiber continuity than all other groups.
• FGF-2 and BMP-2 expression was highest in the exosome-loaded scaffold group, which also reached the greatest maximum failure load (15.64 N at week 4 and 22.97 N at week 8).
• The exosome-only group demonstrated delayed but comparable improvements by week 8.

In a controlled preclinical study in nude mice, human lipoaspirate was mixed 1:1 with recombinant humanized type III collagen (rhCol III) at 0, 2, 4, or 8 mg/mL and grafted subcutaneously, with volume retention, histology, vascularization, and adipogenic gene expression assessed through 12 weeks.

• rhCol III reduced graft volume loss from week 2 onward, with maximal retention at 4 mg/mL and superior structural integrity on histology at that concentration.
• Perilipin 1 and CD31 rose with rhCol III and paralleled upregulation of PPARG, CEBPA, VEGFA, and FGF2, while collagen deposition increased dose-dependently and was greatest at 8 mg/mL.
• In vitro, rhCol III enhanced ADSC proliferation, adhesion, migration, and adipogenesis, again optimal at 4 mg/mL, with RNA-seq implicating PI3K-Akt and integrin/matrix-receptor signaling.

In a controlled study in diabetic Bama miniature pigs, a self-assembled aloe polysaccharide emulsion (AVBER) was applied to burn wounds for 21 days and compared against untreated control and basic fibroblast growth factor (bFGF), with healing rate, skin architecture, fibrosis, and proteomics assessed.

• Versus control and bFGF, AVBER significantly increased the wound healing rate and restored skin structure over 21 days.
• AVBER reduced dermal thickness and fibrosis deposition and improved collagen fiber ratio and organization.
• Histology and proteomics indicated AVBER modulated the TGF-β, Wnt, and Hippo pathways and cellular metabolism at the wound site, suggesting a dual pro-healing and anti-fibrotic mechanism.

In a within-subject study of 32 rats, autologous plasma gel (PG), fat graft (FG), and two commercial hyaluronic acid fillers were injected into predefined dorsal quadrants, with CT volumetry at 1, 3, and 5 months and histopathology for persistence, neovascularization, and inflammation.

• At 1-3 months, PG showed lower volume than the other materials, but by 5 months no significant volume differences remained across groups.
• PG demonstrated a more stable volumetric profile over time than fat graft and became comparable to HA fillers at later time points.
• Histologically, PG had lower inflammatory and neovascularization scores, while material persistence was similar across all groups.

In a randomized study of 240 rabbits, animals were assigned to eight groups (untreated control, three plant-derived extracellular vesicle monotherapies, their combinations with low-level laser therapy [LLLT], and LLLT alone) after standardized full-thickness laser-induced ear wounds, with collagen and CD31 microvascular density measured at days 7 and 14.

• All extracellular vesicle-treated groups showed significantly greater collagen deposition and microvascular density than controls.
• Combination with LLLT enhanced the early regenerative response relative to vesicle monotherapy.
• Outcomes differed among the three commercial products, which the authors attribute to formulation characteristics, though particle content and composition were poorly characterized.

In a preclinical large-animal study in nephrectomized pigs, researchers built a renal tubule assist device combining an immortalized human proximal tubule cell line on microcarriers with an antioxidant, hemocompatible nanofibrous membrane, then tested it in a bilaterally nephrectomized Bama miniature pig model of acute renal failure over a 4-hour circuit.

• The immortalized tubule cells expanded on microcarriers while retaining a proximal tubule phenotype and outperformed existing cell lines in transport, acid-base regulation, and endocrine responsiveness.
• The chlorogenic acid/poly-L-lysine membrane scavenged free radicals and remodeled the plasma protein corona, reducing complement and coagulation factor adsorption.
• In vivo the device safely sustained a 4-hour circuit and, versus hemofiltration alone, enhanced β2-microglobulin clearance while lowering outlet proinflammatory cytokines.

In a mechanistic cell-biology study, the authors used a pooled genetic screen (ReGenT-seq) in epidermal progenitor cells to probe chromatin factors controlling protrusion formation and characterized a moonlighting cytoplasmic function of CBX3 in localizing mRNAs to migrating protrusions and carcinoma invadopodia.

• The genetic screen unexpectedly identified Cbx3 as a critical determinant of protrusion formation in epidermal progenitors.
• Cytoplasmic CBX3 governs the subcellular localization of specific mRNAs within polarizing protrusions and squamous carcinoma invadopodia.
• CBX3-dependent mRNA transport supports localized assembly of endoplasmic reticulum and lysosomes within maturing protrusions and regulates focal adhesion dynamics.

This PRISMA-guided, PROSPERO-registered systematic review and meta-analysis of 24 animal studies (19 flap, 5 skin graft) searched five databases through September 2025 to assess exosomes as a cell-free adjunct for flap and graft survival.

• Random-effects pooling suggested increased flap survival (MD 35.54%, 95% CI 25.11-45.97) and greater angiogenesis (SMD 3.60).
• Heterogeneity was extreme (I² 76-97%) and funnel asymmetry with significant Egger's tests indicated substantial small-study effects, so pooled estimates likely overstate the true effect.
• In skin graft models, 4 of 5 studies reported improved graft take by days 10-14, though certainty was low.