Plastic Surgery Weekly

A non-inferiority cohort study of 131 women undergoing delayed unilateral DIEP flap breast reconstruction compared an optimized non-contrast (radiation- and gadolinium-free) MRA protocol (n=81) against standard contrast-enhanced CTA (n=50) for preoperative perforator mapping.

• Diagnostic accuracy was statistically comparable (98.8% for MRA vs 99.6% for CTA, p=0.41), with sensitivity 98.3% vs 100% and a mean perforator localization difference of 7.38 vs 6.96 mm (p=0.238).
• MRA shortened operative time (333.0 vs 348.9 min, p=0.003) and pedicle dissection time (35.7 vs 40.1 min, p<0.001).
• Mean fascial incision length was shorter with MRA (9.1 vs 10.6 cm, p=0.025), and perfusion-related complication rates did not differ between groups.

A retrospective comparison of 22 patients with chronic unilateral facial paralysis treated with triple nerve transfer alone (n=14) or with added fascia lata suspension (n=8), assessed by pre- and postoperative Facial Clinimetric Evaluation (FaCE) scores at 12 months or more.

• Both groups improved significantly (TNT +18, p<0.001; TNTF +24, p<0.01), and despite worse baseline scores the fascia lata group reached comparable postoperative FaCE scores (49.1 vs 55.1, p=0.095).
• The fascia lata group showed greater mean improvement (Cohen's d ≈ 0.82, p=0.09), with significantly larger gains in oral function and social appearance (FaCE Q15: +3 vs +1, p=0.02).
• EMG severity correlated with baseline FaCE score (ρ ≈ 0.57, p<0.01).

A retrospective review of 14 patients (15 flaps) with traumatic limb-threatening injuries treated with emergency free flap reconstruction across two centres from 2016 to 2024, proposing a framework built around three indications: spare-part use, immediate critical-structure coverage, and flow-through revascularization.

• The flaps distributed across the three indications as spare-part utilization (47%), immediate coverage of exposed critical structures (20%), and distal revascularization with flow-through flaps (33%).
• Flap success was 87% with an overall complication rate of 47%; functional recovery averaged 5 months and mean hospital stay was 15 days.
• Spare-part flaps preserved functional amputation levels such as below-elbow or below-knee in multiple cases.

A retrospective analysis of 147 patients undergoing secondary alveolar bone grafting compared a modified expanded hexahedral graft bed with the standard pyramid-shaped bed, using pre- and postoperative CT to quantify bone formation rate and define thresholds for surgical success.

• Bone bridging required a minimum bone formation rate of 50%, while a rate of at least 80% consistently yielded favorable outcomes, with an optimal graft-to-defect volume ratio of 1.4 to 2.4.
• The trap door harvesting technique achieved higher bone formation than the burr hole method (65.5% vs 48.9%, p<0.001).
• In cleft palate cases, posterior wall suturing to build a contained hexahedral bed raised bone formation rate from 59% to 84%.

A retrospective study of 86 patients with unilateral microtia compared a conventional retro-auricular incision (n=40) with a novel supra-auricular incision (n=46) during the second stage of single-flap auricular reconstruction, assessing cranioauricular angle, satisfaction, and complications.

• The supra-auricular group had a larger cranioauricular angle at final follow-up (30.69° vs 27.83°, p<0.001).
• Functional wear of glasses and masks and patient satisfaction favored the supra-auricular group (mean score 1.87 vs 1.775).
• Complications were fewer in the supra-auricular group (one infection, one hypertrophic scar) than in the retro-auricular group (two flap necroses, two hypertrophic scars).

National database analysis of 451,260 admissions in the National Inpatient Sample (2017–2022) examined temporal trends in admission-based incidence, hospital charges, time to surgery, and seasonal periodicity of midface fractures by mechanism of injury.

• Falls were the most common mechanism at 41.8%, followed by motor vehicle accidents (29.9%) and assault (11.7%).
• Year-adjusted admission-based incidence rose from 1114 to 1522 per 100,000 admissions (p=0.024).
• Negative autocorrelation at a 6-month lag for the total cohort, MVAs, and assault indicated a cyclic seasonal periodicity, with peaks at opposite times of the year.
• Median hospital charge and mean time from admission to surgery both increased significantly across the study period (p<0.001).

Within-patient comparison of 20 patients (36 limbs, 88 predefined scanning sites) evaluated a superb microvascular imaging protocol (S-CUPS) against Doppler-based ultrasound (D-CUPS) in randomized order for preoperative LVA mapping, with all identified vessels confirmed intraoperatively.

• S-CUPS reduced per-site examination time to 51.7 versus 75.0 seconds with D-CUPS (P=0.0193).
• Examiner mental fatigue was lower with S-CUPS (1.24 versus 1.86 on a 10-point VAS; P<0.001), while physical fatigue did not differ (P=0.19).
• Larger lymphatic and venous diameters correlated with shorter examination times, and larger lymphatic diameter with lower physical fatigue.
• Ectasis-type lymphatic vessels predominated intraoperatively at 79.5%.

Systematic review of 172 studies comprising 4,421 patients synthesized outcomes of adult autologous flap-based abdominal wall reconstruction; substantial heterogeneity precluded meta-analysis, so data were analyzed descriptively.

• Pedicled flaps predominated at 92.6% (n=4,095), with free flaps in 3.3% and mixed approaches in 4.1%.
• Hernia-related pathology was the commonest indication at 84.8%, followed by malignancy (10.6%).
• Flap selection was defect-driven: fascia-bearing regional and turnover techniques for structural hernia repair, and composite flaps for oncologic, fistulating, contaminated, or full-thickness defects.
• Flap failure and long-term hernia recurrence were low, while free flaps were reserved for larger defects (weighted mean 401 versus 250 cm²).

Systematic review of 20 studies, screened from 394 records published between 2013 and 2024, assessed the efficacy of botulinum toxin injections for facial palsy across symmetry, function, patient satisfaction, and adverse effects.

• Botulinum toxin injections were associated with significant improvement in facial symmetry, reduced spasticity, and better functional outcomes.
• Subjective assessments indicated patient satisfaction, with effects sustained on long-term follow-up.
• Reported adverse effects were generally mild and transient.

Retrospective case series of 3 patients, drawn from 123 lower-extremity arteriovenous loop free flap reconstructions performed between 2003 and 2025, describes indocyanine green angiography (ICG-A) for assessing flap autonomization after late vascular thrombosis.

• Clinically apparent perfusion problems arose in 3 of 123 cases (2.4%), between postoperative days 30 and 86.
• Digital subtraction angiography confirmed arterial thrombosis in all three, whereas ICG-A demonstrated a centripetal skin perfusion pattern indicating flap autonomy.
• All three flaps stabilized with a 'wait-and-see' triple regimen of repeat ICG-A, therapeutic anticoagulation, and strict bed rest with limb elevation.

A case series of 39 patients (100 foliates across 46 flaps) with multiple finger skin defects exposing bone or tendon reconstructed in one stage using free poly-foliate perforator flaps from five donor sites, with only a single set of vascular anastomoses per patient.

• Complete flap survival occurred in 36 of 39 patients, and only 3 patients had necrosis of a single foliate.
• Excellent-to-good functional outcomes were achieved in 92.3% of patients, with no iatrogenic syndactyly and no need for secondary finger separation.
• Most donor sites were closed primarily, except dorsalis pedis flaps that required skin grafting, and all healed without functional impairment.

A retrospective single-centre study of 53 patients who underwent 360° scapholunate interosseous ligament reconstruction with a flexor carpi radialis graft between 2010 and 2021 examined which demographic, clinical, and radiographic variables predicted patient-reported symptoms and revision at a minimum of 3 years.

• Grip strength and patient-reported symptom scores improved while wrist motion decreased over a median 53-month follow-up.
• Older age and shorter symptom duration were independently associated with better patient-reported symptoms, whereas radiographic alignment (scapholunate distance and angle) was not.
• No variables were associated with revision surgery.

Case series of 25 open dorsal PIP joint dislocations reports functional outcomes after treatment without palmar plate reinsertion.

• Stiffness was frequent after treatment without palmar plate reinsertion.
• No residual dorsal instability was observed across the series.

Single-site randomized controlled trial of 41 military beneficiaries compared ultrasound-guided carpal tunnel release (CTR-US) with mini-open release (mOCTR), tracking patient-reported outcomes to 2 years with 100% follow-up.

• Both groups achieved clinically meaningful improvement in QuickDASH, Boston symptom severity, and pain scores by 1 month, sustained to 2 years.
• The CTR-US group reported less incisional pain and functionally limiting incisional pain during the first 4 and 3 weeks, respectively.
• Adverse events comprised a single infection in the CTR-US group.

Retrospective institutional series of 28 patients compared medial sural artery perforator (MSAP), medial plantar artery perforator (MPAP), and superficial palmar branch of the radial artery (SPBRA) free flaps for digital soft-tissue defects, assessing aesthetic (POSAS), functional (Sollerman), and sensory (2PD, cold intolerance) outcomes.

• SPBRA achieved significantly better static two-point discrimination at 8.10 mm versus MPAP (11.78) and MSAP (15.00) (p<0.05).
• Patients rated the SPBRA flap as more comfortable and aesthetically acceptable, whereas the MSAP flap was thicker with surface irregularity.
• Sollerman hand function scores were comparable across the three flaps (p>0.05).
• Cold intolerance (CISS) scores were significantly higher for SPBRA at 48 than MPAP (19.56) or MSAP (15.00), and 2PD correlated negatively with CISS (r=-0.536).

A comparative clinical study assessed whether the integrity of the pronator quadratus repair after anterior (volar) plating of distal radial fractures affects functional recovery, comparing grip strength, wrist range of motion, and Quick DASH scores in patients with a preserved versus disrupted repair at one year.

• Patients whose pronator quadratus repair remained intact had greater grip strength at one year of follow-up.
• Wrist range of motion and Quick DASH scores were similar between groups, showing no measurable functional advantage.
• The authors interpreted the pattern as a limited functional contribution from the integrity of the repair itself.

A narrative state-of-the-art review of Dupuytren's disease covering its epidemiology, risk factors, the mechanisms underlying progression, and the main non-surgical and surgical corrective options currently available.

• Dupuytren's disease presents with palpable fibrotic nodules and progresses to irreversible digital flexion contractures that impair hand function and quality of life.
• Available management is corrective rather than disease-modifying, addressing deformity without targeting the biological mechanisms of pathogenesis or progression.
• Non-surgical interventions are used for early-stage disease, while advanced disease requires surgical correction, with the review pointing to future early-stage treatment as a research frontier.

A retrospective service assessment of 243 patients undergoing operative fixation of isolated distal radial fractures compared perioperative outcomes across two control periods (2018–2019 and 2021–2022) and a post-implementation period after a dedicated day-case hand centre opened (2023–2024).

• Same-day discharge rose from 66.4% to 98.3%, and mean length of stay fell from 19.4 to 6.6 hours.
• Mean bed-day utilization per patient dropped from 0.69 to 0.06, an estimated 74 inpatient bed-days saved over one year.
• Regional anaesthesia use increased from 20.0% to 93.2%, and hand surgeon involvement rose from 70.4% to 97.5%.
• Overall complication rates were unchanged (17.6% versus 13.6%).

A retrospective review of 12 patients who underwent supraclavicular neurogenic thoracic outlet syndrome surgery with regenerative peripheral nerve interface (RPNI) of the divided supraclavicular nerve between 2021 and 2024, in which the nerve was coapted to an autologous free muscle graft secured within its epimysium.

• At a mean 11-month follow-up, no clinically evident supraclavicular neuromas were observed, and most patients reported improvement in thoracic outlet symptoms.
• Persistent discomfort in five patients was attributed to ongoing thoracic outlet syndrome rather than new focal neuropathic pain, and all five had prior thoracic outlet surgery.
• The omohyoid was the donor muscle in 7 of 12 cases, with scalene, trapezius, and sternocleidomastoid used in the remainder.

A retrospective review of 78 operations in 69 patients with neurofibromatosis type 1, neurofibromatosis type 2, or schwannomatosis (2009–2020) described a single surgeon's technique for excising peripheral nerve sheath tumors using intraoperative nerve monitoring, tourniquet control, magnification, and microsurgical repair.

• Across 157 tumors excised, the overall surgical complication rate was 2.7%, with neurological complications accounting for 16.7% of cases.
• Pain was the presenting symptom in 82.1% of patients, and lesions were most frequently located in the upper extremity (48.7%).
• Intraoperative nerve monitoring was used in 55.1% of cases, and nerve repair was required in 46.2%.

A prospective longitudinal study of 119 children (165 hands) followed for 2 years after hand burn injury validated the HANDFULS measure of in-hand manipulation and palmar workspace volume against age-matched non-injured peers using mixed-effects models.

• Palmar workspace volume improved by 1.5 marbles (p=0.005) and HANDFULS scores by 1.2 sec/marble (p=0.002) over two years, with the largest gains between 2 and 6 months.
• Surgical patients had lower palmar workspace volume at 2 and 6 months but showed no difference in HANDFULS scores, suggesting preserved dexterity despite reduced workspace.
• The proportion of burned hands within normal limits rose to 77.6% for palmar workspace volume and 78.1% for HANDFULS by 24 months, up from 45.2% and 31.8% at 2 months.

A single-center retrospective study of 211 patients undergoing 296 procedures compared quality and safety indicators for burn dressing changes under anesthesiologist-administered out-of-OR anesthesia between infants meeting expanded eligibility (8–12 months and/or 8–10 kg) and children meeting historical criteria (>10 kg and/or 12–24 months), from January 2022 to January 2024.

• No episodes of oxygen desaturation, hemodynamic instability, airway obstruction, or difficult mask ventilation occurred in either group; one laryngospasm in the expanded group resolved with conservative airway management.
• Procedure duration was shorter in the expanded-eligibility group, while time to discharge was slightly longer.
• Burn characteristics were comparable between groups, with scald injuries and partial-thickness burns predominating.

A retrospective quality-improvement report of 23 patients with Cauchy grade 2–4 frostbite treated on a protocolized, monitored intravenous epoprostenol pathway (December 2017 to November 2025) that incorporated rapid rewarming, clinical grading, antithromboxane therapy, dose titration, and multidisciplinary follow-up.

• Overall, 153 of 216 affected digits were preserved, and 12 patients avoided amputation altogether.
• Digit preservation varied by severity: 62 of 65 grade 2, 74 of 100 grade 3, and 7 of 41 grade 4 digits were preserved.
• Mean treatment duration was 3.8 days, and dose-limiting symptoms in nine patients were managed with dose reduction or temporary interruption, with no serious drug-attributed adverse events recorded.

A retrospective single-center cohort of 97 children (<18 years, 2013 to June 2024) treated with early tangential dermabrasion and cryopreserved human amnion for partial-thickness burns, with days from injury to ≥95% re-epithelialization as the primary endpoint.

• Median time to ≥95% re-epithelialization was 16 days, with larger burns healing more slowly (+1.22 days per 1% total body surface area).
• Autografting was required in 19.6%, hypertrophic scarring occurred in 34%, and contracture in 13.4%; no adverse events were attributed to the amnion.
• Longer time to closure raised the odds of hypertrophic scar (odds ratio 1.20 per 5 days) and contracture (odds ratio 1.28 per 5 days).

In a randomized intra-patient-controlled trial of 30 patients undergoing burn wound debridement, two comparable wound sites per patient were randomized to modified starch powder (AriClot) or epinephrine-saturated gauze, with time to hemostasis and bleeding flow rate as primary outcomes.

• Time to hemostasis was shorter with starch powder (median 1.5 vs 5 min; p<0.001), and bleeding flow rate was lower (median 3 vs 7 ml/min/TBSA%; p<0.001).
• Surgeons rated 76.67% of starch applications "Perfect" versus 10% for epinephrine gauze (p<0.001).
• Wound infection was lower with starch powder (p=0.027), while graft rejection and ischemia did not differ significantly between sites.

A single-center retrospective cohort of 109 patients aged 65 or older with acute burn injury (2018–2023) assessed the revised Baux (rBaux) score's discrimination and calibration and developed admission and 48-hour landmark logistic-regression models from routine physiologic variables.

• In-hospital mortality was 45.9%, and rBaux underpredicted mortality (observed-to-expected ratio 1.30, p=0.022) despite acceptable discrimination (AUC 0.839).
• Admission models adding age, burn extent, inhalation injury, and creatinine reached AUC 0.904 and 0.897, outperforming rBaux (p<0.02).
• Among 48-hour survivors (mortality 34.8%), landmark models incorporating mechanical ventilation, age, creatinine, and burn extent achieved AUC 0.919 and 0.910 versus 0.786 for rBaux.

A narrative review summarizes intensive-care management of the acute phase of epidermal necrolysis (Stevens-Johnson syndrome, toxic epidermal necrolysis, and overlap), covering supportive care and pharmacological interventions in expert, often burn-center, settings.

• Drugs trigger 85–90% of cases, typically 4–28 days after exposure, and the suspected agent should be withdrawn as early as possible.
• Mortality averages 15–20%, driven mainly by respiratory and septic complications during the acute phase.
• No immunomodulatory treatment has demonstrated efficacy in halting epidermal detachment or reducing mortality, leaving supportive care as the mainstay.

In a controlled porcine study of 36 full-thickness wounds in 18 pigs infected with Pseudomonas aeruginosa, wounds were treated with NPWT or gauze dressing and assessed for pH, bacterial burden, invasion depth, inflammation, and granulation over 13 days.

• NPWT reduced bacterial counts on days 9 and 13 (p<0.05 and p<0.001) and lowered bacterial invasion depth at all timepoints.
• Wound pH was lower with NPWT from day 5 onward (e.g., 7.23 vs 7.77 on day 13), shifting wounds away from alkalinity.
• NPWT reduced superficial neutrophil aggregation and enhanced neovascularization and granulation tissue thickness.

A retrospective cohort of 104 burn patients and 16 with post-burn hypertrophic scars used 371 serial serum angiotensin II (AngII) measurements, propensity score matching, and in vitro fibroblast assays to test AngII as a marker of scar proliferation.

• Serum AngII increased 2-3 fold during the proliferation and remodeling phases and stayed elevated after healing, tracking fibroblast activity.
• In patients with hypertrophic scars, AngII correlated with Vancouver Scar Scale scores (R²=0.797), and a linear predictive model was developed.
• AngII was higher in younger patients (200.61 vs 58.32 pg/ml, p<0.05) but did not correlate with burn index or sex; in vitro, AngII stimulated fibroblast proliferation.

A cross-sectional comparative study of 300 participants (healthy controls, mild diabetic foot infection, and severe infection) used 16S rRNA V3–V4 sequencing to characterize wound microbiome composition and relate it to infection severity.

• Microbial community composition differed significantly among groups (PERMANOVA p<0.001), though overall amplicon richness did not differ (p=0.12).
• Alpha diversity was highest in mild infection and declined significantly in severe infection (p<0.001), indicating progressive dysbiosis.
• Proteobacteria dominated all cohorts (>98.2%), with Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Delftia acidovorans among the most prevalent taxa.

A multicenter retrospective cohort of 298 patients undergoing two-stage breast reconstruction with postmastectomy radiation to the tissue expander (2016–2025) evaluated how the interval from radiation to implant exchange related to 90-day complications.

• Exchange earlier than 6.87 months carried a higher overall complication rate (14.8% vs 6.7%, p=0.025), including more major infection and wound dehiscence.
• After multivariable adjustment, earlier exchange remained independently associated with complications (OR 2.26, 95% CI 1.02–5.01, p=0.046).
• The ROC-derived 6.87-month threshold discriminated only weakly (AUC 0.558) despite the significant complication difference across it.

A retrospective propensity-matched cohort of 4,467 matched pairs drawn from the TriNetX database compared patients with documented nontobacco nicotine dependence against nicotine-free controls for complications after reconstructive or aesthetic breast surgery.

• Nontobacco nicotine dependence was associated with higher rates of wound-related complications, dehiscence or delayed healing, infection, and unplanned readmission (all p<0.01).
• These associations were consistent across 30-day, 90-day, and 1-year follow-up timepoints.
• Conversely, seroma, hematoma, and postoperative bleeding were less frequent in the nontobacco nicotine group.

This systematic review and meta-analysis of 2,570 patients across 11 studies compared prophylactic local antibiotic therapy (PLATE) against standard care in tissue expander-based breast reconstruction, pooling surgical site infection and expander loss with random-effects models.

• PLATE was associated with a 46% lower risk of overall infection (RR 0.54, 95% CI 0.38–0.77), with low heterogeneity (I2 26%).
• Expander loss was reduced by more than half in the PLATE group (RR 0.46, 95% CI 0.31–0.67), with no heterogeneity (I2 0%).
• Secondary analyses suggested possible reductions in capsular contracture, infections requiring surgery, and drain infections, but no difference in wound dehiscence, hematoma, seroma, or necrosis.
• Subgroup analysis indicated antibiotic delivery method may influence overall infection rates (p = 0.01) but not expander loss (p = 0.20).

This secondary analysis of 197 breast cancer survivors completing a 12-week supervised resistance training program stratified participants by breast surgery type (lumpectomy vs mastectomy) and axillary management (ALND vs no ALND) to test whether surgical extent influenced functional and strength outcomes.

• Both mastectomy and lumpectomy groups showed significant improvements in BMI, muscle mass, body fat, phase angle, Functional Movement Screen, and load lifted (all p<0.001).
• Gains were comparable with or without ALND, although patients without ALND achieved greater Y-balance improvement (p=0.036).
• Older age and radiation therapy predicted lower baseline Functional Movement Screen scores, and older age also predicted smaller FMS improvement.
• Breast and axillary surgical management was not independently associated with baseline function or degree of improvement.

This cross-sectional comparative study used the BREAST-Q and the Hospital Anxiety and Depression Scale to compare satisfaction, anxiety, and depression between postmastectomy women who did and did not undergo breast reconstruction.

• Reconstruction patients reported significantly higher BREAST-Q satisfaction, particularly in body image and psychosocial well-being.
• Anxiety and depression scores were lower in the reconstruction group on the Hospital Anxiety and Depression Scale.

This retrospective cohort of 76 Asian women undergoing bilateral no-vertical-scar reduction mammaplasty compared superior pedicle (n=29) and inferior pedicle (n=47) designs, assessing complications and BREAST-Q outcomes over a mean 14.5-month follow-up.

• Both cohorts showed significant improvement across all BREAST-Q domains versus baseline (P<0.0001), including breast satisfaction and psychosocial well-being.
• Complications were minor and infrequent, with no significant difference between pedicle groups (p>0.05).
• The superior pedicle facilitated inframammary fold remodeling in ptotic breasts, while the inferior pedicle's dual blood supply supported larger-volume resection for severe hypertrophy.

This single-center randomized feasibility trial of 69 patients undergoing breast-conserving surgery or mastectomy with immediate reconstruction compared standard patient-reported outcome feedback against feedback enhanced with the BREAST-Q REACT dashboard, which flags scores below the 25th percentile and generates intervention prompts.

• Feasibility thresholds were met, with 84% enrollment and, among the 25 patients with low scores, 52% receiving timely referrals.
• At six weeks, median BREAST-Q Physical Well-Being of the Chest was higher with REACT (76 vs 60, p=0.026).
• Physical-therapy referrals occurred more often (33% vs 24%) and earlier (1.7 vs 3.2 months) in the REACT group.

This systematic review and meta-analysis of 3,240 patients across nine cohort studies compared textured versus smooth implants for implant malposition in breast reconstruction and cosmetic augmentation, with capsular contracture, rippling, and infection as secondary outcomes.

• Malposition occurred in 5.2% of textured versus 8.9% of smooth breasts, but the pooled difference was not statistically significant.
• No significant differences were seen for capsular contracture, seroma, or rippling.
• A higher infection rate was observed with textured implants, though inconsistent across analyses, and no cases of BIA-ALCL were reported.

This retrospective review of 250 patients (439 breasts) undergoing reduction mammaplasty compared six wound-dressing strategies (Dermabond, Prineo, Histoacryl, Sylke, Steri-Strips, and combinations) for postoperative complications using univariate and multivariate analysis.

• On multivariate analysis, Sylke tape predicted lower skin reaction (OR 0.21, p=0.003) and lower dehiscence (OR 0.47, p=0.02).
• Prineo predicted higher reoperation (OR 6.4, p=0.01) and poor scarring (OR 34.8, p<0.001), but had contained higher-risk patients at baseline.
• Excluding Prineo, Histoacryl showed higher skin reaction and dehiscence rates than Sylke and combination dressings.

This retrospective series of 47 patients (12 reductions, 35 mastopexies) described a modified inferior pedicle technique that places a dermoglandular suspension flap beneath the pectoralis major, with upper pole fullness measured by ultrasonography and satisfaction assessed by BREAST-Q at 12 months.

• Mean BREAST-Q scores were high, at 84.2 for breast satisfaction and 91.7 for outcome satisfaction.
• Ultrasonography showed a significant increase in upper pole fullness at 12 months versus baseline (p=0.005).

A retrospective cohort of 3,195 patients undergoing 5,081 procedures at two Brazilian centers over 15 years compared three progressively refined intramuscular PMMA gluteal augmentation techniques: classic injection, ultrasound-guided mapping, and the sedation-based Advanced Gluteal Modeling (MAG) approach.

• Overall complication rates decreased from 2.1% to 1.4% across the three successive techniques, with nodules the most frequent adverse event.
• No cases of necrosis or long-term neurological deficit were recorded across the entire 15-year series.
• The ultrasound-guided, sedation-based MAG technique showed the lowest complication rate, which the authors attribute to improved needle-placement precision under imaging.

A systematic review and meta-analysis of 1,364 patients across nine comparative studies pooled aesthetic, functional (SNOT-22, minimal cross-sectional area), and safety outcomes for dorsal preservation (DPR) versus dorsal hump reduction (DHR) rhinoplasty.

• Postoperative dorsal airway measures were essentially comparable between techniques; a small MCA2 difference favored DHR but was of questionable clinical significance.
• Late complications significantly favored preservation, with a pooled OR of 0.21 (95% CI 0.13–0.33) for DPR versus DHR.
• Among 128 late complications overall, contour irregularities were most common (53 cases, 41%), followed by revisions in 27 patients (21%) and hump recurrence in 16 (12.5%).

A single-arm cohort of primary cosmetic rhinoplasty patients receiving prophylactic auto-spreader flaps was followed with NOSE and VAS scores and standardized photographic dorsal-width measurements preoperatively and at 1, 6, and 12 months.

• Dorsal width at the keystone area decreased significantly and remained reduced through 1 year.
• Width over the upper and lower lateral cartilages rose transiently at 1 and 6 months but normalized by 1 year, leaving only a non-significant 1 mm net increase versus baseline.
• NOSE and VAS scores worsened transiently at 1 month, then returned to preoperative levels by 1 year.

A retrospective comparative study of 379 female patients undergoing primary closed preservation rhinoplasty compared standard tip suturing (n = 223) with subdomal grafting (n = 156), assessing interdomal angle change and blinded domal symmetry at 12 months.

• Mean interdomal angle change from surgery to 12 months was smaller with grafting, 6.3° versus 12.5° with suturing alone.
• Blinded surgeons rated domal symmetry higher in the graft group (2.7 vs 2.3 on a 3-point scale).
• Revision surgery was infrequent and similar between groups (0.6% graft vs 0.9% suturing).

A Bayesian network meta-analysis of 56 RCTs (1,488 patients) compared 34 laser, microneedling/radiofrequency, chemical, subcision, filler, and combination interventions for moderate-to-severe atrophic acne scars across scar-score, improvement, satisfaction, and pain outcomes.

• Combination therapies generally ranked above monotherapies across the efficacy outcomes.
• CO2 laser combined with subcision or PRP ranked highest for Goodman-Baron scar improvement and patient satisfaction.
• For pain, microneedling + PRP, MFR + bFGF, and YAG laser carried the lowest pain rankings.
• Sensitivity analyses supported the robustness of CO2 laser-based combinations, though ECCA and pain rankings were sensitive to sparse network connectivity.

An observational cohort of 100 women with Stage I–III lipedema on stable benzodiazepine therapy underwent tumescent or water-assisted liposuction, with benzodiazepine use, anxiety, pain, sleep, and body image assessed before and six months after surgery.

• At six months, 77% had reduced or discontinued benzodiazepine use (32% stopped entirely), with mean daily dose falling from 3.2 to 1.4 mg.
• Significant improvements were also seen in anxiety, pain, sleep quality, and body image on validated instruments.
• Reductions in benzodiazepine use correlated with improvements in pain (r = 0.56), anxiety (r = 0.47), and body image (r = -0.52).
• Only minor complications (8%) occurred, with no major adverse events.

A double-blind, non-randomized split-body study of 40 samples compared four liposuction cannula configurations (3 vs 5 mm diameter; 1 vs 2.5 mm2 fenestration) for harvested adipose particle size, phase volumes, and histologic integrity.

• Differences in adipose particle area across configurations were not statistically significant (largest median 9.54 mm2 with the 5 mm/1 mm2 cannula).
• Cannula type was significantly associated with cellular debris (p = 0.03), and smaller 1 mm2 fenestrations produced greater septal disruption.
• The 3 mm cannulas yielded a higher oily fraction regardless of fenestration size, indicating more adipocyte lysis, while the 5 mm/2.5 mm2 configuration showed the least distortion.

A randomized immediate-versus-delayed-treatment trial evaluated diluted calcium hydroxylapatite-carboxymethylcellulose (Radiesse, diluted 1:2 with saline) for moderate-to-severe décolleté wrinkles, with blinded Merz Assessment Scale scoring at Week 24 and retrospective review of post-treatment breast imaging.

• The Week 24 responder rate was 71.2% in treated patients versus 6.3% in untreated controls, a statistically significant difference.
• Treatment was well tolerated, with predominantly transient, mild-to-moderate injection-site reactions.
• No interference on post-treatment breast imaging was attributable to the diluted filler.

This three-phase development project used qualitative interviews and cognitive debriefing to generate items, followed by a psychometric validation study of 260 primary rhinoplasty patients that tested structural validity, reliability, and convergent, discriminant, criterion-related, and known-groups validity of the Mirror-Confrontation and Early Adaptation Distress Scale.

• Exploratory and confirmatory factor analyses supported a five-factor, second-order structure with reportedly excellent model fit.
• The scale showed high internal consistency and test-retest reliability, with convergent and discriminant validity supported.
• MEADS-25 scores correlated strongly with appearance-related distress and social appearance anxiety, and moderately with general emotional distress measures.
• In known-groups analysis, scores significantly discriminated between patients with differing levels of postoperative appearance-related distress.

This retrospective analysis of 2533 drain-free abdominoplasties in post-bariatric massive-weight-loss patients, performed by one surgical team across two high-volume centers under a uniform progressive-tension-suture protocol, compared complication rates between BMI groups.

• Under the standardized progressive-tension-suture, drain-free protocol, overall complication rates were acceptable, supporting the technique's reproducibility in this population.
• Patients with BMI ≥30 kg/m² had significantly higher rates of seroma, umbilical necrosis, wound dehiscence, hematoma requiring re-intervention, and surgical site infection.
• Diabetes prevalence (5.4%) was evenly distributed across BMI groups, suggesting BMI itself rather than metabolic burden primarily drove the complication differences.

This single-center case series of 16 patients undergoing lower-lip reconstruction for defects spanning 33.3%–80% of lip length used a modiolus-preserving modification of the Bernard-Webster technique and reported functional, aesthetic, and complication outcomes over 12 months.

• All 16 reconstructions healed primarily with no major complications or tumor recurrence.
• Oral competence and speech intelligibility were preserved in every patient, and POSAS scores indicated favorable aesthetic outcomes.
• Transient early functional impairment and neurosensory deficits occurred in 56.25% and 37.5% of patients, respectively, all resolving by 12 months.

This retrospective single-center registry study compared healthcare resource use and direct costs of Mohs micrographic surgery versus traditional surgical excision for high-risk facial basal cell carcinoma at a Swedish university hospital (2020–2024), with regional registry data extending follow-up up to 10 years.

• Mohs surgery carried higher initial costs than surgical excision but accumulated costs more slowly over time.
• Patients treated first with excision who later required Mohs incurred the highest total costs, often after multiple prior procedures.
• Overall, early access to Mohs offset its higher upfront cost by avoiding downstream costs of treatment failure.

This retrospective single-center study of 25 children who underwent distal-femur reconstruction with expandable prostheses after primary bone-tumor resection (2001–2024) compared complications, deformity, and reconstruction survival between constrained-hinge and rotating-hinge designs.

• Medial tibial plateau deformity developed in 7 of 11 (63%) rotating-hinge reconstructions but in none of the 14 constrained-hinge reconstructions.
• Complications occurred in 48% of children, most commonly aseptic femoral-stem loosening (16%), with infection in 8%.
• Reconstruction survival was 79.3% at five years and 59.5% at ten years, and 36% required exchange to a definitive standard prosthesis.

This PRISMA-ScR scoping review of 23 studies (2020–2025) mapped machine-learning models developed to predict burn-care outcomes including mortality, sepsis, inhalation injury, delirium, intraoperative blood loss, and acute kidney injury.

• Mortality prediction was the most mature domain, with ML models consistently outperforming traditional scores using a few routinely collected predictors (age, TBSA, depth, inhalation injury).
• Sepsis models outperformed ABA sepsis criteria and Sepsis-3 definitions, particularly when built on focused feature sets.
• Acute kidney injury models based on neutrophil gelatinase-associated lipocalin reached AUROC values up to 0.97.

This proof-of-concept development study trained and compared nine object-detection models on 350 paired microscope images from chicken-wing vessel suturing practice, then deployed the best model in a LINE-based chatbot that returns an automated suture-quality report from two photographs.

• For inside-view detection, YOLOv10 achieved an F1 of about 0.89 and was selected for deployment.
• Outside-view detection performed markedly worse, with the best models reaching F1 of only about 0.55.
• Automated reports were delivered within 10 seconds, with a mean spacing error of roughly 0.4 mm and angular error of about 10 degrees.

This PRISMA 2020 systematic review screened 1832 records and included 29 studies of AI applications in facial aesthetic surgery, cataloging care stages, procedure types, AI architectures, and model sourcing, with risk of bias assessed using ROBINS-I and RoB 2.

• AI was applied mainly to treatment planning and outcome assessment, especially for facelift, rhinoplasty, and blepharoplasty.
• Most models used convolutional neural networks and were commercially available rather than custom-built.
• The literature centered on tool validation and development, with few interventional studies and predominantly Level 4 evidence.

This preclinical proof-of-concept study in rats evaluated a novel lymphatic tracer, methylene blue encapsulated in MPEG-PCL nanoparticles (MPEG-PCL@ME), delivered noninvasively via dissolvable microneedles and imaged with a portable near-infrared device, compared against free methylene blue and indocyanine green.

• The nanoparticle tracer showed superior fluorescence intensity, stability, and biocompatibility versus free methylene blue, and in vivo lymphography clearly delineated lymphatic vessel morphology.
• Compared with methylene blue and indocyanine green, MPEG-PCL@ME more readily identified the dominant lymphatic vessels and nodes with higher imaging quality.
• The tracer resolved segmental contracting sections of lymphatic vessels, allowing direct visualization of the lymphatic pump for functional assessment.

This preclinical dye-engineering study developed CETIF6a, a click chemistry-compatible heptamethine cyanine reporter, and characterized its tumor-margin delineation, target selectivity, and binding mechanism across multiple cancer types using intraoperative imaging, H&E comparison, and quantitative proteomics.

• CETIF6a delineated tumor margins across multiple cancer types with >90% concordance with H&E staining.
• Quantitative proteomics showed the dye engaged 5–15 times more tumor-specific proteins in tumor than in adjacent paracancerous tissue, with 491 conserved tumor-enriched proteins spanning ribosomal, proteasomal, and metabolic pathways.
• Fluorescence brightening occurred upon covalent binding to cysteine thiol residues via nucleophilic substitution within hydrophobic protein cavities.

This in vitro vessel-on-a-chip study used a magnetically actuated, endothelialized microchannel in a collagen matrix to test how the magnitude, frequency, and direction of dynamic mechanical strain (5–15%) shape endothelial behavior and angiogenic sprouting across three spatial dimensions over time.

• Physiological dynamic strain enhanced endothelial alignment and barrier function, with lower strain (5%) maximizing sprout initiation and higher strain (15%) promoting sprout elongation.
• Sequential reorientation of strain direction reprogrammed sprouting trajectories along the X, Y, and Z axes, generating complex geometries such as L-shaped branches.
• RNA sequencing revealed distinct mechanotransduction and ECM-remodeling transcriptional profiles, and PIEZO1 knockdown reduced strain-induced sprouting without affecting barrier function.

This preclinical in vitro and rabbit-ear model study engineered rejuvenated 3D dermal papilla cell spheroids on a self-feeder-layer platform, isolated their extracellular vesicles (tdDPC-EVs), and tested antifibrotic effects on human scar fibroblasts and in a rabbit ear hypertrophic scar model.

• The 3D platform enabled stable spheroid expansion beyond 10 passages with enhanced EV biogenesis compared with conventional cultures.
• miR-26a-5p-enriched tdDPC-EVs attenuated fibrosis by silencing CCNE2 to block PI3K/AKT-driven collagen overproduction and suppressing α-SMA+ myofibroblast differentiation.
• In the rabbit ear model, tdDPC-EV treatment reduced the scar elevation index and restored the collagen I/III ratio toward physiological levels.

This preclinical in vitro and diabetic-mouse study engineered RGD-functionalized exosomes from bFGF-overexpressing M2 macrophages, loaded them into dissolvable hyaluronic acid microneedles, and tested effects on high-glucose-injured endothelial cells and full-thickness diabetic wounds.

• The targeted engineered exosomes selectively homed to injured endothelial cells and enhanced proliferation, migration, and tube formation in vitro.
• Microneedle delivery in diabetic mice accelerated wound healing, with improved re-epithelialization, collagen deposition, and angiogenesis.
• Treatment shifted the wound immune microenvironment by reducing M1 and increasing M2 macrophages, with RNA sequencing implicating suppressed inflammation and activated angiogenic signaling.

This scoping review of 18 studies (from 2,394 screened across five databases) evaluated the clinical evidence for topical exosomes in skin rejuvenation and characterized 20 commercially available cosmetic exosome products identified through an incognito Google Shopping search.

• Of 2,394 articles screened, only 18 evaluated topical exosomes for skin rejuvenation, drawing on both human- and plant-derived exosome sources.
• Reported benefits included increased collagen and elastin plus improvements in wrinkles, elasticity, hydration, and pigmentation, though ten of the studies paired exosomes with additional delivery modalities.
• Commercial products showed minimal disclosure of isolation, processing, or shelf life, reflecting a heterogeneous and poorly standardized marketplace.

This narrative review summarizes current advances in autologous skin grafting and regenerative approaches, focusing on the biological barriers, scarring, immune rejection, and inadequate vascularization and innervation, that limit functional cutaneous regeneration.

• The review frames three converging next-generation strategies: seed cell reprogramming with iPSCs and MSCs, smart biomaterials with 3D bioprinting for pre-vascularized grafts, and spatiotemporally controlled bioactive-factor delivery.
• Persistent obstacles include an imbalanced regenerative microenvironment that drives scarring, immune rejection limiting graft survival, and poor vascularization and innervation impairing integration.
• The authors anticipate AI- and E-skin-enabled personalized systems for real-time monitoring, risk prediction, and implant design, contingent on adaptive regulatory and reimbursement frameworks.

This case-control study of 30 children (10 healthy controls, 10 normal healers, and 10 delayed healers) used flow cytometry and multiplex plasma cytokine assays on peripheral blood mononuclear cells to identify immune correlates of delayed burn wound healing.

• Major immune cell subsets did not differ between groups, but delayed healers showed higher CCR6+ frequencies and elevated IL-17/IL-23 in γδ T cells, NKT-like cells, and Tregs.
• Plasma IL-33, IL-23, TNF-α, and MCP-1 were significantly increased in the delayed-healing group.
• Normal healers had higher proportions of TGF-β-expressing Tregs, consistent with more effective inflammatory resolution.

Narrative review summarizing emerging methodologies and molecular mechanisms for system-level integration of organoids, framing the progression from tissue-level organization to organ-level coordination and ultimately system-level function.

• Current organoids are limited by the absence of vascular, neural, and immune integration, which the authors identify as essential for tissue development, homeostasis, and repair.
• Regeneration is framed as a progression through tissue-, organ-, and system-level organization, dependent on dynamic intercellular communication, feedback signaling, and niche interactions.
• Integration of biochemical, biomechanical, and bioelectrical cues is proposed to drive synchronized growth, patterning, and functional adaptation in multicellular systems.
• Bioengineering strategies that modulate spatial organization and intercellular connectivity are presented as complementary tools guiding intrinsic morphogenesis toward in vivo function.

Integrative multi-omics study pooling five bulk transcriptomic cohorts (46-sample training set) plus a single-cell RNA-seq dataset of 8592 cells, profiling mitochondrial-related genes to derive a diagnostic signature, molecular subtypes, and drug-repurposing hypotheses for keloid.

• A LASSO-selected seven-gene signature (RAB3GAP2, NCOA6, NSF, HEBP1, IDS, MSX1, BRWD1) reached AUC 0.881 in internal testing and 1.000 in a very small independent set of 7 samples.
• Among 648 mitochondrial-related differentially expressed genes, downregulated genes were enriched in cell cycle and mitotic pathways while upregulated genes were enriched in immune pathways; a stricter energy-metabolism subset showed the same predominantly downregulated direction.
• The keloid-associated score was higher in keloid than controls (P = 1.27 × 10⁻⁵) but generalized only moderately across cohorts, with AUC 0.667 in GSE188952.
• At single-cell resolution the keloid-associated score was highest in dendritic cells, and bulk immune correlations did not survive FDR correction.