Scientific Abstract Presentations: Global Partners Session 2 Friday, October 16 Fri, Oct 16 2:00-3:30 p.m. CDT

Background: Abdominoplasty is one of the most commonly performed body contouring procedures worldwide, partly due to the epidemic rise in obesity and subsequent weight loss following diet, medication, or bariatric surgery. Massive weight-loss patients present with a wide range of clinical manifestations and have specific risk factors. The surgeon must therefore consider several factors to plan both the optimal surgical approach and the assessment of operative risk to achieve the best possible outcome and minimize potential complications. We therefore conducted a retrospective study of patients operated during 2022-2025 to develop a risk-stratification model, evaluate the most effective strategies for preventing complications, and identify decision-making approaches for treating concomitant issues, such as rectus diastasis and mons pubis ptosis.

Materials and Methods: A retrospective study of abdominoplasty procedures performed in over 150 weight-loss patients between 2022 and 2025 at our center. Anamnestic data, including BMI, comorbidities, risk factors, and protective factors; abdominal wall assessment via CT scan; and surgical techniques were collected and compared with postoperative complications and other variables, such as length of hospital stay, duration of drainage placement, and healing time. A statistical analysis then confirmed the statistically significant correlations and predictive factors.

Results and Discussion: Certain factors, such as a high BMI, thick abdominal subcutaneous adipose tissue, or concurrent repair of an abdominal hernia with mesh, showed a statistically significant positive correlation with the occurrence of complications. The thickness of the abdominal subcutaneous adipose tissue showed a stronger positive correlation than BMI, and the regression model demonstrated that it is a statistically significant predictor of complications. Certain surgical techniques, such as the application of tranexamic acid via drains, proved more effective at preventing postoperative complications than fibrin glue or progressive tension sutures. The corrections of associated issues, such as plication of the rectus diastasis or pubic lift, have proven to be a safe practice, not increasing the incidence of complications, and yielding good long-term results.

Conclusions: A careful analysis of the patient's risk factors, including the use of alternatives to the conventional BMI, and the selection of appropriate intra- and perioperative techniques can minimize the risk of complications in patients undergoing body contouring procedures following significant weight loss, ensuring procedures that are not only safe but also yield long-lasting results.

Purpose Lymphatic reconstruction using a graft to bypass disrupted collecting lymphatics is a physiological strategy, yet autologous grafts can cause donor-site morbidity, creating demand for off-the-shelf artificial lymphatic grafts. Decellularized arterial grafts are established small-diameter vascular substitutes, but their performance in the lymphatic environment remains unclear　[1,2]. Therefore, the primary aim of this study was to determine whether decellularized arterial grafts can serve as artificial lymphatic grafts in vivo. A secondary aim was to compare two different decellularization protocols with respect to in vivo patency, histological remodeling, and structural characteristics of the grafts. Methods All experiments were performed using 24-week-old male Sprague–Dawley rats. Tail arteries were harvested and decellularized using either ultra-high pressure treatment at 1,000 MPa (UHP grafts) or a detergent-based decellularization protocol using sodium dodecyl sulfate (SDS grafts). Silicone tubes served as controls. Decellularized grafts underwent biomechanical characterization. UHP and SDS grafts were implanted allogeneically, and silicone tubes were implanted as controls, as interposition conduits (3 mm length) into abdominal lymphatic vessels under an operating microscope using 11-0 nylon sutures (n = 7 per group). Graft patency was evaluated by direct inspection at 3 weeks and 3 months after implantation, followed by histological assessment. Results SDS grafts exhibited greater translucency and a significantly reduced dry weight per unit length compared with native and UHP grafts. Mechanical testing demonstrated comparable suture retention strength between the UHP and SDS groups, whereas ultimate tensile stress was reduced in SDS grafts. However, no graft-related complications, such as rupture or aneurysmal dilation, were observed following implantation. Patency was 100% at 3 weeks in both groups, and at 3 months it was 85.7% in UHP and 100% in SDS. In contrast, all silicone tubes occluded within 3 weeks. Histological analysis at 3 months revealed continuous luminal coverage by podoplanin-positive cells in both decellularized graft groups. UHP grafts showed deep medial infiltration of αSMA-positive cells, whereas infiltration in SDS grafts was localized to the subendothelial space. Conclusions This study represents the first in vivo evaluation of artificial lymphatic grafts and demonstrates that decellularized arterial grafts can function as lymphatic grafts with sustained patency. While the UHP method preserved extracellular matrix integrity, SDS grafts exhibited reduced dry weight and increased translucency, consistent with partial matrix loss and lower tensile strength. Importantly, lymphatic vessels do not require the high mechanical strength demanded of arteries, and indeed, no perioperative structural fragility was observed during the 3-month observation period in this model. Furthermore, the enhanced translucency resulting from SDS treatment facilitated intraoperative handling. Overall, both UHP and SDS decellularization protocols yielded functional artificial lymphatic grafts. As an off-the-shelf platform, decellularized arterial segments could facilitate lymphatic reconstruction and may expand future therapeutic options.

References 1. Jia W, Hitchcock-Szilagyi H, He W, Goldman J, Zhao F. Engineering the Lymphatic Network: A Solution to Lymphedema. Adv Healthc Mater. 2021;10(6):e2001537. doi:10.1002/adhm.202001537 2. Yamanaka H, Yamaoka T, Mahara A, Morimoto N, Suzuki S. Tissue-engineered submillimeter-diameter vascular grafts for free flap survival in rat model. Biomaterials. 2018;179:156-163. doi:10.1016/j.biomaterials.2018.06.022

Background: Cleft palate classification systems primarily describe extent (complete vs incomplete) and laterality but often fail to quantify severity based on cleft width, despite its major influence on operative complexity and postoperative complications. "Wide cleft palate" is typically discussed in bilateral incomplete phenotypes, yet bilateral complete clefts meeting extreme width criteria appear to represent a particularly severe subgroup that is not routinely discussed in the literature. CLAPP Hospital has identified a substantial cohort of patients with wide bilateral complete cleft palate (BCCP) using standardized quantitative criteria. This study characterizes this phenotype and compares surgical management and outcomes with a large cohort of wide bilateral incomplete cleft palate (BICP). Methods: A retrospective observational study was performed at CLAPP Hospital over an 11-year period. Patients with wide BCCP and wide BICP were included based on institutional quantitative criteria for wideness (e.g., palatal shelf width <1/3 cleft width and/or cleft width exceeding combined shelf widths and/or cleft width ≈ 15 mm or greater). Syndromic patients and those with incomplete documentation were excluded. Extracted variables included demographics, cleft characteristics, quantitative width measurements (anterior/middle/posterior/max width where available), presurgical interventions (e.g., NAM, lip adhesion), operative strategies (palatoplasty type, relaxing incisions, tissue borrowing, staged vs single-stage repair), complications (particularly oronasal fistula), and long-term functional outcomes (speech/VPI, feeding, midfacial growth indicators, otologic and dental sequelae when documented). Comparative analyses were performed between wide BCCP and wide BICP cohorts using appropriate statistical tests for continuous and categorical variables. Results: Across the study period, 104 patients met criteria for wide BCCP and 293 for wide BICP, demonstrating that extreme wideness exists on a clinically meaningful spectrum within bilateral cleft phenotypes. Wide BCCP cases more frequently required escalation strategies aimed at tension reduction and tissue recruitment, including greater reliance on presurgical orthopedics, aggressive mobilization, relaxing incisions, tissue borrowing, and, in select patients, staged closure approaches. Comparative outcome assessment demonstrated measurable differences in operative burden and postoperative complication profiles between phenotypes, with fistula formation and secondary functional concerns (including velopharyngeal dysfunction/hypernasality and need for secondary speech procedures) representing key outcome domains. Functional follow-up data, where available, also supported the clinical relevance of phenotypic separation, as wide BCCP cases demonstrated a higher intensity of multidisciplinary needs (speech, otologic, dental/orthodontic, and growth surveillance) than wide BICP counterparts. Conclusion: Wide bilateral complete cleft palate represents a clinically distinct and underrecognized phenotype defined by quantitative severity rather than extent alone. Differentiating wide BCCP from wide BICP has meaningful implications for surgical planning, anticipatory counseling, complication risk stratification, and long-term multidisciplinary follow-up. Incorporating width-based severity modifiers into cleft classification and reporting systems may improve standardization, enable more valid comparisons across centers, and support phenotype-specific care pathways. Further multicenter validation is warranted to refine diagnostic thresholds and establish consensus management strategies for this high-severity subgroup.

INTRODUCTION / PURPOSE Face and neck lift remains a commonly performed aesthetic procedure with evolving techniques aimed at improving outcomes and reducing complications. The purpose of this presentation is to share our early experience during the last 2 years incorporating recent modifications into our long established vertical short-scar face and neck lift technique. These safe and effective innovations include limited skin undermining and a modified, tunneled, selective supra-SMAS release of the retaining ligaments to reposition and plicate the mobile SMAS and platysma muscle. This approach is presented as a surface plane option to the deep plane facelift, which requires more extensive dissection and a longer learning curve.

METHODS / TECHNIQUE
Preoperative markings delineate the transition between fixed and mobile SMAS along a line from the lateral canthus to the posterior mandibular angle. The locations of the retaining ligaments, facial artery, and marginal mandibular branch of the facial nerve are also marked. The face and neck are infiltrated with normal saline, lidocaine, epinephrine, and tranexamic acid. The neck is first addressed with subcutaneous liposuction. Through the submental incision, selective subcutaneous tunneled release of the osseocutaneous mandibular ligament is performed. A vertical short-scar incision is then made for the face and neck lift. Subcutaneous dissection proceeds only to the level of the mobile SMAS, avoiding entry into the deep plane. Traction is applied to the mobile SMAS at the level of the released mandibular ligament to assess correction of the marionette groove, jowl, and nasolabial fold. If additional release is required, blunt tunneled subcutaneous dissection is performed to release the supra-SMAS expansions of the masseteric ligament and create the masseteric space. When indicated, similar selective release of the zygomatic ligament is performed. The mobile SMAS is fixed to Lore's fascia or the fix SMAS. The lateral border of the platysma is secured to the mastoid fascia using a Reverdan needle technique, avoiding the post auricular incision and resulting scar. With ligament release and SMAS–platysma suspension, the skin is redraped under vertical cephalic traction. A temporary temporal scalp tacking suture is placed and removed at closure. A compensatory triangular excision preserves natural sideburn position.

EXPERIENCE This technique represents an evolution of a vertical short-scar subcutaneous face and neck lift performed over 19 years in hundreds of patients in private practice. During the last two years, February 2024 to February 2026, of incorporating the tunneled supra-SMAS innovation we have treated 19 selected patients, with a current follow up of 9 months.

RESULTS Early follow up demonstrates natural facial and cervical contour improvement with high patient satisfaction. No major complications have been observed.

CONCLUSIONS Selective tunneled supra-SMAS release of retaining ligaments combined with limited undermining and SMAS–platysma plication allows effective facial and neck rejuvenation without formal deep plane dissection. This surface plane approach provides anatomical control and may offer a safe, reproducible alternative for midface and neck correction. As stated, in different terms and by several plastic surgeons colleagues, it is not the technique, but the experience and mastery behind it.

Background: Plastic surgery has evolved into a discipline of extreme precision, tissue preservation, and biomaterial-dependent procedures, including advanced breast surgery, complex reconstructive rhinoplasty, and composite facial techniques. Despite this progress, operating room design has largely remained anchored in legacy airflow concepts and fragmented infrastructure solutions. Conventional turbulent or classical laminar airflow systems, combined with non-integrated room architecture and workflow layouts, introduce environmental variability, microturbulence, and contamination risks that directly limit procedural reproducibility, implant protection, and aesthetic outcome consistency. Concept and Innovation: We present an integrated, thermally engineered ultra-clean air operating room ecosystem based on Temperature-Controlled Airflow (TcAF) principles, combined with purpose-designed architecture and workflow optimization. This approach replaces volume-driven, directionally forced ventilation with physics-driven airflow control using precisely managed thermal gradients to create a stable, gravity-assisted, low-turbulence clean air field. The ecosystem integrates clean-room architecture (including smooth, sealed surfaces and transparent partitions), ceiling-mounted service columns, and dedicated storage systems to minimize clutter, reduce unnecessary movement, and separate clean and non-clean logistics-transforming the operating room from a collection of components into a single engineered system. This implementation of such a thermally engineered ultra-clean air represents the first operating room - and consequently the first hospital - in Poland, not only within plastic surgery but across all surgical disciplines, establishing a national reference point for next-generation operating room design. Methods: The ecosystem was implemented in high-demand plastic surgery procedures characterized by prolonged operative times, extensive soft-tissue exposure, and frequent use of implants and grafts. Environmental stability, workflow efficiency, and protection of the critical surgical zone were assessed in routine clinical practice, focusing on resistance to disruption from staff movement, equipment repositioning, and complex intraoperative workflows. Results: The thermally engineered ultra-clean air ecosystem produced a qualitatively different level of environmental stability compared to conventional operating room concepts. The TcAF-based airflow architecture maintained a persistent, low-turbulence clean air field across the critical zone, while the integrated architectural and workflow design reduced sources of contamination and environmental disturbance. Clinically, this translated into improved protection of implants and grafts, greater procedural predictability, and enhanced reproducibility of precise tissue handling and shaping. Importantly, the operating room environment became an active contributor to surgical quality rather than a passive background infrastructure. Conclusion: An integrated, thermally engineered ultra-clean air operating room ecosystem represents a paradigm shift in plastic surgery facility design. By uniting clean air physics, architecture, and workflow into a single performance-driven system - and demonstrating its feasibility in the first such implementation in Poland - this approach establishes a new reference standard in which patient safety and aesthetic outcome quality are co-determined by the engineered surgical environment itself. In the era of high-precision, tissue-preserving, and implant-dependent plastic surgery, such ecosystems should be regarded not as optional upgrades, but as foundational infrastructure for reproducible excellence.

Introduction: Treatment of septic complications after open fractures in the lower extremity, and especially in the lower leg is very challenging. These complications, i.e. osteitis, osteomyelitis, septic pseudarthrosis, non-union, need an aggressive debridement, which can result in soft tissue and, sometimes, bone defects. In such scenarios the use of local or free well vascularized flaps with/without bone segments represent the best solution. Materials and Methods: The study refers to 57 patients operated for septic posttraumatic defects in lower limb between March 1997 and March 2025, 15 females and 42 males, with an average age of 29,5 years (range, 19 to 72 years). The etiology of the defects was an open trauma with septic postoperative complications. In 40 cases, a vascularised bone transfer was used (fibula in 4 cases, and rib in 36 cases). In 21 cases, we used just a well vascularised free or local flap without bone. The average length of the bone defect was 4,2 cm (range, 1 to 7cm), and the surface of soft tissue defect ranged between 0 and 250 cm2. Results: The average follow-up was 32 months (range, 12 to 240 months). We had complete primary flap survival 54 cases In three cases with vasculkarized bone we registered partiaal loss of the muscle component in 2 cases and complete in one case; in all these three cases we left the bone graft in place and obtained a good further bon union. We registered a rate of primary bone union of 100%, with an average time of 9 months. In one patient with previous amputation of the contralateral lower leg we registered a stress fracture after 6 months. The patient was treated with casting, and obtained bone-union again after 6 months. Conclusions: The vascularised bone represents a good indication in septic complications after open fractures of the lower limb. Sometimes, in patients with compromised general status, the use of no bone free or local flaps can improve the local vascular regimen and help in curing the infection and obtaining bone healing.

Background Abdominal flap breast reconstruction is associated with donor-site pain, and local anesthetic techniques play a role in enhanced recovery after surgery protocols. While ultrasound-guided transversus abdominis plane (TAP) block is commonly used, multiple intramuscular injection has also been applied as an alternative in clinical practice. This study aimed to compare postoperative pain outcomes between these two clinical approaches. Methods A single-center, single-blinded, randomized controlled trial was conducted in patients undergoing abdominal flap breast reconstruction between July 2024 and December 2025. Patients were randomized to receive either TAP block or multiple intramuscular abdominal wall injection with ropivacaine. All patients followed a standardized multimodal postoperative analgesia protocol. Postoperative pain was assessed using visual analog scale (VAS) scores, and opioid consumption was calculated as morphine milligram equivalents (MME). Longitudinal pain outcomes were analyzed using linear mixed-effects models. Results Of the 167 randomized patients, 145 were included in the final analysis, with 74 in the TAP block group and 71 in the multiple intramuscular injection group. Baseline demographics and operative characteristics were comparable between groups. Mean VAS scores decreased over time in both groups, with no significant difference between groups. Linear mixed-effects modeling demonstrated no significant association between block type and VAS scores. There were no significant differences in cumulative postoperative opioid consumption, daily MME, or in-hospital duration between groups. Conclusions Multiple intramuscular abdominal wall injection provides postoperative analgesia comparable to ultrasound-guided TAP block following abdomen-based breast reconstruction. Given its technical simplicity, this technique may represent a practical alternative for perioperative pain management.

Introduction: Lower extremity free flap reconstruction frequently represents the definitive alternative between limb salvage and major amputation. Postoperative monitoring remains largely dependent on subjective clinical assessment, which may delay detection of vascular compromise. Regional tissue oximetry (rSO₂), measured through near-infrared spectroscopy (NIRS) using INVOS technology represents a transformative shift from intermittent, observer-dependent evaluation to objective, continuous, real-time physiological monitoring. Although not yet universally adopted in reconstructive microsurgery, its potential impact in lower limb reconstruction is profound. After 15 years of systematic implementation and protocolized use, we present an extensive clinical experience redefining the role of NIRS in free flap monitoring. We describe not only its application, but also a comprehensive physiological interpretation model based on continuous data acquisition (updated every 5 seconds), enabling dynamic understanding of flap behavior under both normal and pathological conditions. Furthermore, we propose a practical, algorithm-based decision-making framework for interpreting alarms and guiding immediate intervention.

Materials and Methods: We detail the structured integration of NIRS into routine microsurgical practice across three critical phases: 1. Intraoperative Phase NIRS enables direct comparison of flap rSO₂ values before pedicle division and immediately after microvascular anastomosis. This provides real-time functional validation prior to wound closure. Additionally, intraoperative fluctuations are correlated with systemic hemodynamic variables.This establishes objective confirmation of flap viability before leaving the operating room. 2. Immediate Postoperative Phase (72 Hours) Continuous monitoring during the critical ischemia-risk window allows: -Identification of physiological perfusion patterns. -Early detection of vascular compromise. -Pattern-based differentiation between: Arterial thrombosis (rapid rSO₂ drop), venous thrombosis (progressive rSO₂ drop), mechanical causes (hematoma, external compression) and systemic hemodynamic instability. This pattern recognition model dramatically reduces diagnostic uncertainty and minimizes time to surgical revision. We present our observational analysis of 148 lower extremity free flaps, demonstrating a statistically significant reduction in response time for surgical exploration in compromised flaps within our institution. 3. Intermediate Postoperative Phase (7 Days) Extended monitoring reduces unnecessary flap manipulation, repetitive dressing changes, and mechanical stress. It also enables safe early limb dependency while maintaining objective perfusion control. This phase consolidates flap stability while preserving microvascular integrity.

Results: Systematic NIRS implementation has allowed the development of a detailed physiological behavior model of lower extremity free flaps, revealed a reproducible correlations between flap oxygenation and systemic variables including mean arterial pressure, heart rate, hemoglobin concentration and vasopressor administration (notably norepinephrine). These correlations permit targeted hemodynamic optimization tailored specifically to flap physiology rather than generalized systemic parameters. Moreover, NIRS provides early, precise identification of microvascular anastomotic failure. The technology reliably distinguishes between arterial insufficiency, venous congestion, local mechanical compromise, and systemic perfusion-related alterations. This differentiation significantly enhances diagnostic accuracy and surgical decision-making. In our experience, implementation of this structured monitoring strategy has resulted in a marked increase in flap salvage rates and a substantial reduction in time to re-exploration.

Conclusions The integration of continuous NIRS monitoring into daily microsurgical practice represents more than an adjunctive tool and constitutes a paradigm shift in free flap surveillance. Fifteen years of systematic use have enabled us to move from reactive monitoring based on clinical suspicion to proactive, physiology-driven management guided by objective data. The ability to interpret dynamic rSO₂ patterns has deepened our understanding of both flap physiology and pathophysiology, transforming postoperative management. NIRS provides us a continuous, real-time, noninvasive monitoring, objective and reproducible perfusion data, early detection of vascular compromise, a clear differentiation between arterial, venous, local, and systemic causes, dramatic decrease in response time to complications and markedly improved salvage. In lower extremity reconstruction continuous tissue oximetry redefines the standard of care. Our 15-year experience supports its role not merely as a monitoring modality, but as an essential component of modern microsurgical strategy.

Purpose: Precise intraoperative localization of fibular flap perforators is critical for reducing surgical time and preventing ischemic complications. While Computed Tomography Angiography (CTA) provides high-resolution 3D data, translating these screen-based images to the patient's anatomy requires significant mental mapping. This study evaluates an Augmented Reality (AR) workflow using the HoloLens 2 and 3D-printed templates to provide intuitive navigation for perforator identification. Methods: Preoperative CTA data was segmented to create 3D models of the fibula, peroneal artery, and perforating branches. These models were integrated into the Unity game engine to establish spatial coordinates. Patient-specific 3D-printed aids featuring QR code fiducial markers were developed to serve as the AR coordinate system anchor. The workflow's accuracy was validated using 3D-printed phantom limb models. During simulated surgery, a HoloLens 2 headset was used to overlay the virtual vascular anatomy directly onto the phantom, facilitating real-time identification and skin paddle design. Results: The AR-assisted workflow successfully projected the internal vascular anatomy onto the phantom limb with high visual fidelity. The use of 3D-printed templates as anchors provided a stable coordinate system, minimizing "hologram drift" during head movement. Preliminary validation on phantom models demonstrated that the AR-guided perforator locations closely correlated with the underlying 3D-printed vascular structures, potentially reducing the reliance on handheld Doppler ultrasound for initial markings. Conclusions: This novel AR-assisted approach bridges the gap between preoperative 3D imaging and intraoperative execution. By integrating 3D-printed aids with image markers, the system offers a feasible, high-precision method for fibular flap planning. This technology has the potential to enhance surgical efficiency and improve the accuracy of flap design in complex reconstructive procedures.

Introduction: A 27-year-old Thai male with a known lymphatic malformation involving the right groin, mid-thigh, and retroperitoneum developed intractable chylous ascites and worsening right leg lymphedema after appendectomy. Conservative treatments failed.

Methods: The patient underwent attempted intra-abdominal lymphovenous anastomosis (LVA). Due to extensive chyle leakage from Cul-de-sac, a peritoneovenous shunt (PVS) was performed by reflecting the peritoneum at the posterior bladder and suturing it to the rectum to create a pre-rectal peritoneal sac, which was then connected to the right testicular vein. Distal LVAs were also performed on the right leg.

Results: Post-operatively, scrotal lymphatic leakage stopped by day 5. Within 3 weeks, ascites drainage significantly decreased to <30 ml/day before removal of the drain, right foot swelling reduced, and right leg swelling softened. Intractable chylous ascites resolved. Computed tomography (CT) abdomen confirmed resolution at 1 and 3 months, with substantial right leg swelling reduction observed at 6 months.

Conclusion: This case demonstrates that a combined surgical approach of peritoneovenous shunt and distal LVA can effectively treat intractable chylous ascites and associated lymphedema caused by complex lymphatic malformations, especially when conservative therapies fail.

Early Multicentre Experience of the use of a Mohs and Complex Skin Cancer Surgery Registry

Purpose: Robust evaluation of Mohs micrographic surgery (MMS) and complex skin cancer treatment requires data collection beyond margin clearance alone. This report is of cases included in the development of a new registry under the British Association of Plastic Reconstructive and Aesthetic Surgeons, aiming to capture the complete pathway of skin cancer cases. This large UK multicentre prospective case series highlights the value of comprehensive, standardised data fields encompassing the whole patient journey.

Methods: Over 500 consecutive skin cancer excisions from all anatomical sites were entered during the registry's demonstration and live phases across several plastic surgery centres, including patient demographics, tumour type, anatomical site, prior treatments, MMS stages and block numbers, margin status, reconstruction, complications, and postoperative interventions.

Results: Head and neck MMS cases were analysed for risk stratification, reconstructive complexity, complications, and adjuvant therapy. Overall, this prospective case series comprised 90% basal cell carcinoma, 7% squamous cell carcinoma, and 3% others. Mean clearance required 1.7 Mohs stages and 2.5 blocks per lesion. Reconstruction included primary closure (35%), local flaps (33%), full-thickness skin grafts (17%), dermal substitutes (7%), secondary healing (5%), partial closure (2%), and split-thickness grafts (1%).

Conclusion: As a large prospective multicentre case series, this report demonstrates the benefit of standardised data capture from resection through reconstruction to postoperative care. Comprehensive registry fields enable meaningful evaluation of surgical decision-making, risk factors, and outcomes, supporting benchmarking and evidence-based optimisation of skin cancer surgery.