Scientific Abstract Presentations: Resident Only Hand & Research & Technology Abstracts Session 5 Friday, October 10 Fri, Oct 10 8:00-9:30 a.m. CDT

Background: Free tissue transfers, while revolutionizing reconstructive surgery, remain highly vulnerable to vascular compromise, leading to increased morbidity and reoperation rates. Although surgical revascularization remains the standard for flap salvage, botulinum toxin (Botox), through its vasodilatory properties, has emerged as a potential adjunct to improve microvascular perfusion. Despite promising preclinical studies, no human trials have directly evaluated Botox in free tissue transfer. This systematic review summarizes existing human trial data on the use of botulinum toxin in ischemic upper limb conditions to inform its potential application in free flap optimization and salvage.

Methods: A systematic search of PubMed/MEDLINE, Embase, and Web of Science was conducted according to PRISMA guidelines. Eligible studies included randomized and non-randomized trials evaluating botulinum toxin type A or B for ischemic conditions of the upper extremity in adults. Data extraction and risk of bias assessment were performed in duplicate.

Results: Thirteen studies involving 310 patients were included. Given significant heterogeneity of included studies, meta-analysis could not be performed. Narrative synthesis of the results demonstrated consistent improvements in markers of perfusion, including improved pain, distal blood flow, oximetry, temperature, ulcer healing, and functional outcomes. Reported complications were rare, mild, and self-limiting. Included studies were found to have moderate to serious risk of bias.

Conclusions: Botulinum toxin demonstrates promising clinical benefits in ischemic upper limb conditions. These findings support further investigation into its role as a pharmacologic adjunct to improve perfusion and outcomes in free tissue transfer.

Introduction: Hyperbaric oxygen therapy (HBOT) has been established as a vital adjunct in the management of complex lower extremity wounds, particularly in cases involving necrotizing infections, ischemia-reperfusion injury, and chronic diabetic ulcers. However, its application in upper extremity (UE) cases such as crush injuries, compartment syndrome, chronic osteomyelitis, and diabetic-related wounds remains underexplored with inadequate clinical guidelines for hand surgeons. As such, the present systematic review sought to evaluate the current literature on HBOT for UE wounds systematically to better delineate its role within reconstructive hand surgery.

Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane and SCOPUS databases were queried for studies on HBOT in UE cases. The search strategy encompassed MeSH terms and keyword strategies such as "upper extremity" and "wound". Studies that met the inclusion criteria and reported clinical outcomes following HBOT for UE pathology were included.

Results: A total of 46 studies met inclusion criteria. Most studies were case reports or case series (n=43), with one case-control study and two retrospective cohort studies. From these, 274 patients with UE wound were included; 63% were male and all were between the ages of 2 and 70. Notably, wound healing comorbidities were reported among 15% (n=41) of patients, which included diabetes mellitus, smoking, immunosuppression, and peripheral vascular disease. Crush injuries represented the most common indication for HBOT (72%), followed by snake envenomation (15%), frostbite (9%), necrotizing fasciitis (2%), and thermal burns (2%). Less frequently reported etiologies included mucormycosis, intravenous extravasation, and pyoderma gangrenosum (<1%). HBOT was employed with surgical debridement in 71% of cases and conservative wound care in the remaining 29%. Administration of HBOT demonstrated marked heterogeneity with session counts ranging from 1 to 139, atmospheric pressures from 1.5 to 4 atmospheres absolute (ATA), and session durations from 45 to 90 minutes, spanning 1 day to 3 weeks of total therapy. Wound healing timelines were also widely variable (8 days to 10 months), and no standardized wound assessment scales were utilized. HBOT-related complications were reported among 9% of cases, which comprised middle ear barotrauma, gastrointestinal upset, and psychological intolerance.

Conclusion: HBOT appears to be a safe adjunctive treatment for complex UE wounds. Despite the promising clinical utility of HBOT, the lack of standardized protocols and high-quality evidence highlights the need for large-scale studies to confirm its efficacy and refine the treatment protocols for UE injuries.

Background: Smoking is a commonly cited risk factor for Dupuytren's disease [1]; however, evidence on both the directionality and strength of its association has remained inconclusive [2]. The current study aimed to quantify the association between smoking and the prevalence of Dupuytren's disease.

Methods: A systematic database search was conducted across Ovid MEDLINE (1946 to March 17 2025), Embase (1974 to March 17 2025), Cochrane CENTRAL (February 2025) and Web of Science (1976 to March 17 2025) to identify comparative studies reporting Dupuytren's disease prevalence in smokers and non-smokers (CRD420251043113). Studies were included if they reported original data on the prevalence of Dupuytren's disease among individuals who have never smoked versus individuals who currently or previously smoked. Case-control, cross-sectional, and cohort studies were included. At least two independent reviewers completed title and abstract screening, full-text review, data extraction and risk of bias evaluation, with discrepancies resolved through discussion with a third reviewer. Results were pooled using pairwise meta-analysis with a random-effects model.

Results: 22 studies were included in the analysis, encompassing 609,195 smokers and 906,297 non-smokers. The prevalence of Dupuytren's disease was 5.6% among smokers and 4.4% among non-smokers. Current active smokers were at increased odds of Dupuytren's disease compared to non-smokers (OR 1.45, 95% CI 1.06-1.98, I² = 95.8%). To a lesser degree, this risk was also increased among former smokers (OR 1.39, 95% CI 1.14-1.7, I² = 97.5%). Overall, any smoking history conferred a 1.5-fold increased odds for Dupuytren's disease (OR 1.50, 95% CI 1.20-1.88, I² = 95.5%), which remained statistically significant on exclusion of studies with high risk of bias and leave-one-out sensitivity analysis.

Conclusions: This study found a statistically significant association of smoking with Dupuytren's disease. Smoking cessation should be encouraged in patients with Dupuytren's disease, although further research is needed to identify if smoking cessation could slow disease progression or prevent recurrence.

References: Geoghegan L, Man J, Jain A, et al. Factors Associated with the Development, Progression, and Outcome of Dupuytren Disease Treatment: A Systematic Review. Plast Reconstr Surg. 2021;148(5):753e-763e. doi:10.1097/PRS.0000000000008420 Alser OH, Kuo RYL, Furniss D. Nongenetic Factors Associated with Dupuytren's Disease: A Systematic Review. Plast Reconstr Surg. 2020;146(4):799-807. doi:10.1097/PRS.0000000000007146

Neonatal brachial plexus palsy (NBPP) presents as weakness or flaccid paralysis of the upper extremity following injury to the C5–T1 nerve roots during the perinatal period (1). While many patients experience spontaneous recovery, up to 30% require surgical reconstruction to optimize function (2-4). However, accurately predicting which patients will require surgery remains challenging. This study aims to identify early clinical and radiographic predictors of surgical intervention in NBPP through a retrospective multi-surgeon cohort. A retrospective review of patients with NBPP was conducted between 2008-2024. Patients were included if they had Active Movement Scale (AMS) scores at baseline and two follow-up scores less than 3 months and between 3 and 6 months after presentation. Demographics, injury location, radiographic findings, operative details, and pre/post-operative AMS scores were recorded. Logistic regressions were used to identify factors associated with eventual need for surgery, and positive and negative predictive values (PPV and NPV) were calculated for key clinical and radiographic characteristics. We studied a total of 73 patients with NBPP, 25 who eventually received operative treatment, and 48 who did not. Presence or absence of a pseudomeningocele on MRI was the strongest predictor of eventual need for surgery (PPV=0.75, NPV=0.86). Initial AMS scores less than 4 for shoulder flexion and elbow extension were moderately predictive of need for surgery (PPV=0.43 for each) but had high negative predictive value (NPV 1.0 and 0.9, respectively). Similarly, lack of a greater than 2-point improvement in these AMS scores within 3 months of presentation had moderate PPV (0.41 for shoulder flexion, 0.47 for elbow flexion) but high NPV (0.80 for both). NPV and PPV for lack of a >2-point improvement in these scores at 6 months were similar to those at 3 months. After controlling for initial AMS scores and age at presentation, the odds ratio for presence of pseudomengingocele regarding need for surgery was 16.6 (CI 2.0-255, p=0.02), while lack of a >2-point improvement in shoulder flexion 3 months after presentation was not significantly associated with need for operation. In a large cohort of patients with NBPP, presence of a pseudomeningocele on MRI was the strongest predictor of eventual need for surgery among characteristics tested. Good initial motor function and strong recovery within 3 months of presentation predicted non-operative treatment, though poor motor function and recovery were only moderately predictive of surgery. The extent of motor improvement at 6 months was not significantly more predictive than at 3 months. Assessing these characteristics may allow earlier and more accurate treatment planning, affording earlier surgery to infants who need it, and avoiding unnecessary risk to those who do not.

References 1. Shah V, Coroneos CJ, Ng E. The evaluation and management of neonatal brachial plexus palsy. Paediatr Child Health. 2021;26(8):493-497 2. Govindan M, Burrows HL. Neonatal Brachial Plexus Injury. Pediatr Rev. 2019;40(9):494-496 3. Terzis JK, Kokkalis ZT. Elbow flexion after primary reconstruction in obstetric brachial plexus palsy. J Hand Surg Eur Vol. 2009;34(4):449-458 4. Zafeiriou DI, Psychogiou K. Obstetrical brachial plexus palsy. Pediatr Neurol. 2008;38(4):235-242

Background Scaphoid fractures account for 60-85% of all carpal bone fractures in adults, with estimates of its incidence approximating 12.4 in 100,000 each year (1). These injuries have significant implications, both economically and in terms of quality of life (2,3). While surgical management often yields superior outcomes compared to conservative approaches, the procedure is complicated by the challenge of accurately identifying the ideal axis for guidewire placement (4,5). To address this issue, we developed the Scaphoid Advanced Fixation Equipment (SAFE), a novel, adjustable drill guide that leverages computer vision to calculate precise drill parameters. The purpose of this study is to develop and validate the accuracy and precision of the SAFE device in the pre-clinical setting.

Methods The efficacy of the SAFE device was evaluated in synthetic models and animal specimens. To determine the operator's ability to accurately identify an appropriate drill entry point, surgeons with greater than 10 years of experience in hand and wrist surgery were asked to independently select the optimal guidewire entry point on seven different synthetic scaphoid models, six repetitions each, using fluoroscopic guidance only. Variability in their selections was quantified in cartesian coordinates using an optical navigation system (NDI Polaris Vega). Evaluation of device-software performance was assessed on five synthetic scaphoid models, and these were drilled according to entry-point coordinates calculated by our proprietary SAFE image analysis software. Final guidewire trajectories were confirmed with fluoroscopic imaging. Usability and performance refinements were conducted iteratively using a series of prototype SAFE devices tested on porcine wrist specimens to simulate surgical conditions more closely. Descriptive statistics were performed.

Results Evaluation of the operator's ability to reliably identify an appropriate drill entry point yielded a mean deviation of 1.79 mm (SD 0.43 mm) from the cumulative average of their selections. In the assessment of the device-software performance, SAFE demonstrated high precision in guidewire placement with consistent central axis targeting in all test models and no breach of cortical surfaces. User feedback emphasized improved procedural confidence, with specific suggestions for enhancing the mounting interface and coordinate reference system. No device-related failures were encountered during the testing period.

Conclusion In this study, SAFE has demonstrated the ability to address the key technical challenges in scaphoid fracture fixation: accurate and reproducible guidewire placement. It has the potential to transform scaphoid fracture management by improving procedural consistency within and between surgeons' practices, thus reducing complications and enhancing patient outcomes. Ongoing efforts will focus on iterative development in cadaveric models, refining usability and performance, and conducting clinical trials against unassisted operative interventions.

References 1. Zander MEL, Sward E, Bjorkman A, Wilcke M. Carpal fractures: epidemiology, classification and treatment of 6542 fractures from the Swedish Fracture Registry. J Hand Surg Eur Vol. Sep 25 2023:17531934231202012. doi:10.1177/17531934231202012 2. de Putter CE, Selles RW, Polinder S, Panneman MJM, Hovius SER, van Beeck EF. Economic Impact of Hand and Wrist Injuries: Health-Care Costs and Productivity Costs in a Population-Based Study. JBJS. 2012;94(9):e56. doi:10.2106/jbjs.K.00561 3. Fusetti C, Garavaglia G, Papaloizos MY, Wasserfallen JB, Büchler U, Nagy L. Direct and indirect costs in the conservative management of undisplaced scaphoid fractures. European Journal of Orthopaedic Surgery & Traumatology. 2003/12/01 2003;13(4):241-244. doi:10.1007/s00590-003-0101-6 4. Pichler W, Windisch G, Schaffler G, Heidari N, Dorr K, Grechenig W. Computer-assisted 3-dimensional anthropometry of the scaphoid. Orthopedics. Feb 2010;33(2):85-8. doi:10.3928/01477447-20100104-16 5. Davis EN, Chung KC, Kotsis SV, Lau FH, Vijan S. A cost/utility analysis of open reduction and internal fixation versus cast immobilization for acute nondisplaced mid-waist scaphoid fractures. Plast Reconstr Surg. Apr 2006;117(4):1223-35; discussion 1236-8. doi:10.1097/01.prs.0000201461.71055.83

Purpose: Robotic microsurgical procedures in plastic surgery demand exceptional precision, operating on structures often less than 0.8mm in diameter. Traditional training relies on subjective evaluation with inherent limitations in assessment consistency. This study evaluates the feasibility of artificial intelligence (AI) integration with robotic platforms to objectively quantify microsurgical skill acquisition in plastic surgery training. Methods: A comprehensive analysis of recent AI applications in microsurgery training was conducted, focusing on systems developed within the last two years. We examined multimodal data collection methodologies including: (1) kinematic data capturing motion efficiency, smoothness, and bimanual dexterity; (2) force data measuring tissue handling precision; and (3) video data for gesture segmentation. We identified specific AI algorithms applied to microsurgical skill assessment including deep learning architectures (CLDNN, TCN, Transformers) and computer vision techniques. Validation studies differentiating novice versus expert performance were evaluated. Experience: The review included multiple AI-driven systems specifically designed for microsurgical skill assessment. The Proficiency Index in Microsurgical Education (PRIME) system demonstrated accuracy improvement from 0.2 to 0.6 in microsurgical skills1. Force-based classification systems achieved remarkably high accuracy exceeding 96% in distinguishing expert from novice surgeons using sensorized gloves2. Gholami's framework successfully differentiated skill levels using metrics including completion time, idle time, path length, motion smoothness, and economy of volume, correlating well with established subjective assessment tools3. Results: AI systems successfully identified objective differences in microsurgical skill performance. Key advances included: (1) transition from basic metrics to complex pattern recognition in movement quality; (2) integration of force data for tissue handling assessment - crucial for microsurgery but previously difficult to quantify objectively; (3) automated, granular feedback on specific technical deficiencies; and (4) potential for standardized, reproducible assessment across training environments. Implementation challenges included validation limitations, high system costs, and standardization issues across training programs. Conclusions: AI integration in robotic microsurgery training represents a significant advancement in objectively quantifying surgical skill. These systems demonstrate substantial potential to shorten the notoriously steep learning curves in microsurgery by providing immediate, objective feedback on previously unmeasurable aspects of performance. The technology is particularly valuable for supermicrosurgery training, where extreme precision is required. Further validation studies correlating simulator performance with operating room outcomes are needed, along with standardized curricula development to fully realize the potential of AI-driven robotic training in plastic surgery education. References: 1. Kapila AK, Georgiou L, Hamdi M. Decoding the Impact of AI on Microsurgery: Systematic Review and Classification of Six Subdomains for Future Development. Plast Reconstr Surg Glob Open. 2024;12(11):e6323. Published 2024 Nov 20. doi:10.1097/GOX.0000000000006323 2. Xu J, Anastasiou D, Booker J, Burton OE, Layard Horsfall H, Salvadores Fernandez C, Xue Y, Stoyanov D, Tiwari MK, Marcus HJ, et al. A Deep Learning Approach to Classify Surgical Skill in Microsurgery Using Force Data from a Novel Sensorised Surgical Glove. Sensors. 2023; 23(21):8947. https://doi.org/10.3390/s23218947 3. Gholami S, Manon A, Yao K, Billard A, Meling TR. An objective skill assessment framework for microsurgical anastomosis based on ALI scores. Acta Neurochir

Introduction Wound care and dressing change are major responsibilities of Clinical Nursing Specialists in the Plastic Surgery Ward. Up to 90% of patients have complex or extensive wounds that are challenging and laborious to manage. This prolonged time to perform dressing changes results in increased work burden on the Registered Nurses, and decreased patient satisfaction. From January 2020, we implemented the Team Resource Management (TRM) workflow to reduce the time taken for dressing changes. This protocol focuses on 2 critical aspects: 1. The recruitment of additional manpower in the form of Registered Nurses, Specialist Nurses and doctors for dressing change, and 2. Team-based discussion of each patient detailing the dressing choice, sequence of activities, and allocation of manpower. The criteria for activating the TRM workflow are as follows: 1. Wounds that require more than 30 minutes for dressing change, 2. Wounds involving more than 1 anatomical region, and 3. Multiple wounds at different sites. The purpose of this study is to examine the difference in the time taken for dressing changes before and after the implementation of the TRM workflow.

Methods From January 2020 to December 2024, a prospective trial was performed involving patients admitted to the Plastic Surgery Ward in E-Da Hospital, Kaohsiung, Taiwan. Patients underwent their first dressing change by the Registered Nurse and if their wounds fulfil the inclusion criteria stated above, the duration of dressing change was recorded and the TRM workflow was activated for the subsequent dressing changes. The time taken to perform the next dressing change under the TRM workflow was recorded. Enrolled patients also completed a Patient Satisfaction Questionnaire using a Likert 5-point scale, before and after TRM was implemented. The results were tested for statistical significance using the Student's t-test.

Results A total of 212 eligible patients were enrolled into this study. The mean time taken pre-TRM was 36.0 minutes, while the mean time taken post-TRM was 18.5 minutes. Comparing the pre- and post-TRM timings for each patient, the mean reduction in time was 49%. The mean patient satisfaction score pre-TRM was 3.57 and post-TRM was 4.82. All differences were statistically significant.

Conclusion The Team Resource Management workflow is an effective strategy to decrease dressing time for difficult wounds and increase patients' satisfaction, allowing the efficient provision of quality wound care even in challenging and complicated scenarios.

Introduction: Artificial intelligence (AI) is increasingly influencing healthcare, particularly in medical education, where it supports learning, teaching, and career advising. Large language models (LLMs) like OpenAI ChatGPT have shown promise but raise concerns about potential biases inherited from historical trained data. This study is the first to examine racial and gender bias in LLMs applied to medical student career advising. Methods: A structured dataset of 200 synthetic medical student profiles was created, systematically varying demographic (sex, race/ethnicity) and academic variables (USMLE STEP 2 CK score, number of publications). Each profile was evaluated using ChatGPT-4o, and the top three specialty recommendations were recorded. Specialties were assigned competitiveness scores based on NRMP data. Univariate and multivariate analyses assessed associations between applicant characteristics and predicted outcomes. A compensatory scoring analysis calculated the additional STEP 2 CK points needed for applicants of different demographic groups to match competitiveness scores of a White male reference profile. Results: Male applicants were rated significantly more competitive than females (p < 0.0001). Black and Hispanic applicants were deemed significantly less competitive than White applicants (p = 0.0019 and p = 0.0108, respectively). Higher STEP 2 CK scores and publication counts positively correlated with competitiveness. Male applicants were over ten times more likely to receive surgical specialty recommendations than females (OR = 10.23, p < 0.0001). Black and Hispanic applicants were significantly less likely to receive surgical recommendations compared to White applicants. Compensatory scoring revealed that White female applicants needed 56 additional STEP 2 CK points to match competitiveness perceptions, while Black and Hispanic females required 95 and 88 additional points, respectively. Conclusion: Our findings demonstrate that LLMs like ChatGPT-4o perpetuate racial and gender biases when advising medical students, even when controlling for academic achievement. These biases reflect and amplify historical inequities in medicine and highlight the urgent need for targeted mitigation strategies. AI software should not be deployed in medical education settings without rigorous oversight, continuous bias auditing, and intervention frameworks to ensure equitable and ethical use.

Purpose: Mental health conditions are known to disproportionately impact transgender individuals. Gender-affirming surgeries (GAS) aim to alleviate both gender dysphoria and psychiatric comorbidities (1). The purpose of this study is to evaluate quality of life, mental health, and gender satisfaction before and after GAS.

Methods: Patients 18 years and older were enrolled from December 2021 through present who underwent the following gender-affirming surgeries were included: breast augmentation, mastectomy, female-to-male (FTM) chest wall reconstruction, and facial feminization. Patients completed the Transgender Congruence Scale (TCS), PHQ-9, and GAD-7 questionnaire preoperatively and at 6-months and 12-months postoperatively.

Results: In total 94 surveys were completed preoperatively, and subsequently at 6 months and 12 months postoperative. The majority of patients underwent chest masculinization followed by breast augmentation and then facial feminization. Overall, when compared to pre-operative scoring, at 6 and 12 months post-operative, GAD-7 and PHQ-9 scores decreased and TCS scores significantly increased.

Conclusion: Gender-affirming surgery improves depression and anxiety scores and significantly decreases gender dysphoria scores at 6 and 12 months postoperatively.

References:
Javier C, Crimston CR, Barlow FK. Surgical satisfaction and quality of life outcomes reported by transgender men and women at least one year post gender-affirming surgery: A systematic literature review. Int J Transgend Health. 2022;23(3):255-273. Published 2022 Mar 18. doi:10.1080/26895269.2022.2038334

Introduction: Barriers to professional development among female plastic surgeons are well documented and vary by practice setting. [1-2] Limited understanding exists regarding how these barriers evolve throughout career stages and which types of support most effectively promote advancement. This study evaluated barriers experienced by female plastic surgeons across career stages and examine how perceptions of professional awards and related supports differ across these stages.

Methods: Female members of the American Association of Plastic Surgeons were invited to complete an anonymous 48-item survey administered through Qualtrics from March 2025 to April 2025. Career and practice characteristics, and professional goals were collected via multiple-choice questions and open-ended text responses. Major personal experiences, barriers to career growth, importance of various professional and personal supports, desirability of different career awards, barriers to awards acceptance, and importance of award characteristics were assessed via multiple-select and rank-order questions. Analyses were stratified by career stage, defined as early (<5 years), mid-career (5-15 years), and senior (>15 years).

Results: Of the 113 surgeons invited, 72 (63.7%) responded. The mean participant age was 56.2 years (SD 11.2), with an average of 22.9 years (SD 12.0) in practice. Most (79.2%) worked in academic settings: 52.6% full professors, 36.8% associate professors, and 7.0% assistant professors. Common major life events included marriage (87.5%), childbirth (75%), and death/illness of a family member (84.7%). Reported barriers varied by career stage. Surgeons with ≤15 years in practice cited lack of mentorship, personal responsibilities, and limited research funding, while those with >15 years reported challenges such as adversarial colleagues, RVU pressures, and restricted OR time. Desired professional supports included stronger leadership, leadership training, and promotion support; key personal supports were flexible scheduling, expanded childcare options, and improved parental leave. Award preferences also differed by stage. Early and mid-career surgeons prioritized grant and travel funding, while senior surgeons valued visiting professorships, leadership training, and honorary board appointments. Award participation barriers included travel burden and lack of nomination mentors among early and mid-career surgeons, and burnout and competing responsibilities among senior surgeons. Regardless of stage, the most valued award features were travel funding and opportunities for leadership or board appointments.

Conclusion: Barriers to career advancement among female plastic surgeons differ significantly across career stages, highlighting the need for tailored support strategies. Early and mid-career surgeons face mentorship gaps and logistical hurdles, while senior surgeons encounter systemic challenges such as burnout and institutional demands. Despite these differences, there is a shared emphasis on the value of leadership opportunities and travel funding across all stages. These findings underscore the importance of stage-specific interventions and equitable access to resources supporting sustained growth and leadership of female plastic surgeons.

References: 1. Maini RS, Jelneck SL, Zimmerman WB. Evaluating the Paucity of Female Surgeons in Plastic Surgery: A Review of the Systemic Barriers to Entry and Success. Cureus. 2024;16(12):e75529. Published 2024 Dec 11.doi:10.7759/cureus.75529 2. Benyamein P, Sheahan L, Becker M, et al. A Work in Progress: Women's Status in the Plastic Surgery Workforce and Recommendations for Success. Aesthet Surg J. 2024;44(11):1227-1237.doi:10.1093/asj/sjae121

Introduction: Optimal cutaneous wound healing is a complex process involving intricate biochemical and physiological interactions.1 Disruptions in this process can lead to aberrant scarring.2-3 Low-Level Laser Therapy (LLLT) has been explored as a modulator of tissue repair.4-5 This study aimed to investigate the impact of pre-incisional LLLT, utilizing red and infrared wavelengths, on the healing of standardized skin incisions in rats, focusing on collagen deposition and inflammatory cell infiltration.

Methods: Ninety male Wistar rats were randomly assigned to three groups (n=30 per group): a Sham Group (SG) receiving no laser treatment, a Red Laser Group (RLG) treated with a red laser (λ=660 nm), and an Infrared Laser Group (ILG) treated with an infrared laser (λ=808 nm). In the RLG and ILG, a total energy of 180J (60J per point, three equidistant points along the intended incision line, 600s total application time) was administered transcutaneously for five consecutive days prior to surgical incision. A 3cm full-thickness skin incision was created on the dorsal midline of all animals. Each group was further subdivided into three subgroups (n=10 per subgroup) for histological evaluation at 3, 7, and 14 days post-incision. Tissue samples from the mid-portion of the scar were harvested and processed for histological analysis, including hematoxylin and eosin (H&E) staining for general morphology and vessel identification, toluidine blue staining for mast cell quantification, and picrosirius red staining with polarized light microscopy for the qualitative and semi-quantitative assessment of total collagen content. Quantitative analysis of vessels and mast cells was performed, and collagen birefringence was assessed to estimate total collagen deposition. Statistical analysis employed two-way ANOVA followed by Tukey's post-hoc test to determine significant differences between groups and time points (p≤0.05).

Results: Quantitative analysis revealed no statistically significant differences in the number of blood vessels or mast cells between the SG, RLG, and ILG groups at any of the evaluated time points (3, 7, and 14 days). However, significant differences were observed in total collagen deposition as assessed by picrosirius red staining. In the SG, a progressive increase in total collagen was noted, with the 14-day subgroup exhibiting significantly higher collagen content compared to the 3 and 7-day subgroups (p<0.05). Notably, both the RLG and ILG 14-day subgroups demonstrated a statistically significant reduction in total collagen deposition when compared to the SG 14-day subgroup (p<0.05). No significant difference in total collagen was found between the RLG 14-day and ILG 14-day subgroups.

Conclusion: Pre-incisional application of both red and infrared Low-Level Laser Therapy resulted in a significant reduction in total collagen deposition in the incisional wounds of rats at the 14-day evaluation period. These findings suggest that pre-operative LLLT may modulate the later stages of scar formation by potentially influencing fibroblast activity and collagen synthesis. Further investigation is warranted to elucidate the underlying mechanisms and the potential clinical implications of pre-incisional LLLT in preventing or mitigating fibroproliferative scarring.

1. Ferreira LM, Gragnani A, Furtado F, Hochman B. Control of the skin scarring response. An Acad Bras Cienc. 2009 Sep;81(3):623-9.
2. Brandi C, Grimaldi L, Nisi G, Brafa A, Campa A, Calabrò M, Campana M, D'Aniello C. The role of carbon dioxide therapy in the treatment of chronic wounds. In Vivo. 2010 Mar-Apr;24(2):223-6.
3. Hochman B, Vilas Boas FC, Mariano M, Ferreira LM. Keloid heterograft in the hamster (Mesocricetus auratus) cheek pouch, Brazil. Acta Cir Bras. 2005 May-Jun;20(3):200-12.
4. Lubart R, Eichler M, Lavi R, Friedman H, Shainberg A. Low-energy laser irradiation promotes cellular redox activity. Photomed Laser Surg. 2005 Feb;23(1):3-9.
5. Evans DH, Abrahamse H. Efficacy of three different laser wavelengths for invitro wound healing. Photodermatol Photoimmunol Photomed. 2008 Aug;24(4):199-210.

Background: Lymphedema is a chronic, progressive disorder characterized by lymphatic dysfunction, tissue fibrosis, and debilitating fluid accumulation, leading to significant morbidity and reduced quality of life. Despite its growing prevalence, especially among cancer survivors and obese populations, pharmacologic treatment options remain limited. Increasing recognition of shared pathophysiological pathways between diabetes mellitus and lymphatic dysfunction - including chronic inflammation, insulin resistance, endothelial damage, and adipose tissue expansion. This suggests that anti-diabetic medications may have unintended effects on lymphedema development and progression. This systematic review aims to synthesize current preclinical and clinical evidence on how various anti-diabetic drug classes influence lymphatic function and their potential therapeutic role in lymphedema management.

Methods: A comprehensive search was conducted across MEDLINE, PubMed, Web of Science, Embase, and Scopus through February 2025. Studies evaluating the impact of anti-diabetic medications on lymphatic physiology, lymphedema risk, or edema modulation in animal models or human subjects were included. Data were analyzed by drug class, focusing on mechanistic pathways, clinical outcomes, and potential therapeutic implications.

Results: Twenty-seven studies met inclusion criteria, comprising 12 animal studies and 15 clinical studies involving a total of 11,698 patients. Reviewed drug classes included sulfonylureas (2 studies), glucagon-like peptide-1 receptor agonists (GLP-1 RAs, 4 studies), sodium-glucose cotransporter-2 (SGLT2) inhibitors (3 studies), meglitinides (1 study), thiazolidinediones (TZDs, 3 studies), and alpha-glucosidase inhibitors (AGIs, 1 study). Notably, no human studies specifically addressed insulin, metformin, or dipeptidyl peptidase-4 (DPP-4) inhibitors in relation to lymphedema. Insulin resistance consistently emerged as a central driver of lymphatic dysfunction, contributing to impaired lymphatic pumping, vessel integrity loss, and chronic inflammation. Metformin demonstrated promising preclinical benefits, including lymphangiogenic, anti-inflammatory, and anti-fibrotic effects, positioning it as a potential adjunct therapy in lymphedema. Sulfonylureas improved lymphatic contractility through KATP channel blockade but posed risks of weight gain and hypoglycemia that may offset their benefits. Among the drug classes, GLP-1 RAs exhibited the most robust protective effect, with retrospective human studies showing reduced lymphedema incidence. Proposed mechanisms include weight loss, reduced visceral adiposity, anti-inflammatory effects, and direct enhancement of lymphatic vessel function. SGLT2 inhibitors offered indirect benefits via diuresis, weight reduction, and improved glycemic control, but direct effects on lymphatic biology remain uncertain. Conversely, TZDs were associated with adverse outcomes, including fluid retention and impaired lymphangiogenesis, potentially exacerbating lymphedema symptoms. DPP-4 inhibitors and AGIs exhibited theoretical anti-inflammatory properties but require further research to elucidate their clinical impact.

Conclusions: Anti-diabetic medications exert diverse and class-specific effects on lymphatic function and lymphedema risk. Metformin and GLP-1 RAs show promising therapeutic potential, while TZDs may worsen lymphatic dysfunction. These findings reveal an underrecognized link between metabolic disease management and lymphatic health, highlighting the need for prospective studies to clarify these relationships. Tailoring anti-diabetic regimens may represent a novel strategy to mitigate lymphedema risk, particularly in metabolically vulnerable populations, such as cancer survivors, the obese, and diabetic patients.

Introduction: Despite advances in multimodal analgesia, opioid medications remain a mainstay for postoperative pain control in plastic surgery, contributing to the ongoing opioid crisis and associated morbidity. There is a critical and unmet need for effective, non-opioid alternatives that can treat moderate to severe pain and reduce or eliminate the need for narcotic use. Suzetrigine, or Journavx, is a selective NaV1.8 pain signal inhibitor which acts on the peripheral nervous system to treat pain.1,2 Many early-phase clinical trials, with the administration of suzetrigine at a 100mg loading dose followed by 50mg every 12 hours, have demonstrated suzetrigine's analgesic potential for neuropathic and acute pain.3 This pilot study aimed to investigate the efficacy and safety profile of suzetrigine in a plastic surgical population.

Methods: A prospective analysis was conducted on five patients undergoing elective plastic surgery procedures between March and April 2025. Procedures included breast reconstruction with a pedicled latissimus dorsi myocutaneous flap, partial radius resection for chronic pain, breast implant exchange, abdominoplasty, and delayed implant-based breast reconstruction. Suzetrigine was administered using a standardized perioperative protocol of 100mg loading dose followed by 50mg every 12 hours. Primary outcomes included postoperative opioid consumption. Secondary outcomes included incidence of medication-related side effects.

Results: All five patients completed their postoperative follow-up. None required opioid analgesics following surgery. No medication-related side effects were reported during the observation period.

Conclusion: Suzetrigine demonstrated promising efficacy in eliminating the need for postoperative opioid analgesia across a variety of plastic surgery procedures, with minimal adverse effects. These preliminary findings support further investigation into its role in multimodal, opioid-sparing pain management strategies.

References: 1. Osteen JD, Immani S, Tapley TL, et al. Pharmacology and Mechanism of Action of Suzetrigine, a Potent and Selective Na(V)1.8 Pain Signal Inhibitor for the Treatment of Moderate to Severe Pain. Pain Ther. 2025;14(2):655-674. 2. Vertex Announces FDA Approval of JOURNAVX™ (suzetrigine), a First-in-Class Treatment for Adults With Moderate-to-Severe Acute Pain. https://investors.vrtx.com/ news-releases/news-release-details/vertex-announcesfda-approval-journavxtm-suzetrigine-first-class 3. Hu S, Lyu D, Gao J. Suzetrigine: The first Nav1.8 inhibitor approved for the treatment of moderate to severe acute pain. Drug Discov Ther. 2025;19(1):80-82.