Scientific Abstract Presentations: Posters Day 1 (Not for CME) Friday, October 16 Fri, Oct 16 9:30 a.m.-5:00 p.m. CDT

Background: Artificial intelligence (AI) has become increasingly incorporated into contemporary healthcare delivery, including diagnostic support, perioperative planning, and clinical decision-making. Surgical fields such as plastic surgery (PS) have experienced significant perioperative advancements through AI integration, particularly in perioperative planning and surgical assistance. Although many studies have evaluated the utility of AI tools in PS, few studies have explored patient perspectives on their integration into their clinical plastic surgery care. This study aims to characterize patient preferences regarding the degree and type of AI involvement in their PS care.

Methods: An anonymous 48-question cross-sectional survey was distributed to patients at four outpatient plastic surgery clinics within a single institution. The survey collected patient demographic information, surgical history, technology use and degree AI familiarity, baseline knowledge of AI, and preferences regarding the type and degree of AI involvement across perioperative stages of PS care. The Wilcoxon signed-rank test was used to compare patient trust, comfort, and support of AI integration across nonmedical, medical, and surgical contexts. Responses were further aggregated by age, race, AI familiarity, surgical history, and reported technology use. Spearman's rank correlation test was used to evaluate associations between demographic characteristics and reported attitudes toward AI.

Results: A total of 352 patients were approached over a 10-week period, with 184 consenting to participate. A total of 149 (81%) complete surveys were collected and included in the analysis. Respondents were predominantly female (76.5%), aged 35-54 years (42.3%), white (85.2%), and were receiving breast reconstruction care (44.4%). Patients were equally supportive of AI integration into medical and nonmedical contexts (p = 0.29) but were less trusting of AI in medical compared with nonmedical context (p = 0.01). When comparing AI use in nonsurgical medical care versus surgical care, patients reported being less comfortable and less supportive of AI in their surgical care (p = 0.026). Support for AI integration was comparable across perioperative stages. Higher self-reported internet use demonstrated weak positive correlations with greater support for AI integration across nonmedical, medical, and surgical contexts and was associated with increased trust and comfort in medical settings (all p < 0.05; ρ = 0.17–0.32). Additionally, higher educational attainment weakly correlated with greater perioperative support for AI use and with higher trust and comfort in both medical and surgical applications (all p < 0.05; ρ = 0.17–0.23).

Conclusions: Findings suggest that support for AI integration in healthcare is context dependent, with patients generally supportive of AI integration in PS care but reporting lower trust and comfort in use in surgical contexts compared with nonsurgical settings. Greater technology use and educational attainment were modestly associated with more favorable perceptions of AI. These findings underscore the importance of patient-centered education and transparent implementation strategies to promote trust and facilitate responsible AI adoption in plastic surgery practice.

Introduction: Sagittal craniosynostosis (SC) is the most common primary craniosynostosis but represents the widest disparity in surgical management. For patients older than 6 months of age, several techniques exist for reshaping the cranial vault in sagittal craniosynostosis. The Melbourne method and Pi-procedure are two widely utilized surgical techniques for open cranial vault remodeling. However, there is sparsity of literature comparing these two techniques directly. This study aims to compare operative characteristics and post-operative outcomes between a modified form of the PI procedure and Melbourne technique for cranial vault remodeling.

Methods: A retrospective chart review of patients evaluated for craniosynostosis was performed between 2015 and 2025. Untreated patients with primary sagittal craniosynostosis and at least 1 year follow up were included and grouped into either the "modified Pi" or "Melbourne" groups. Demographic profiles, operative characteristics including blood loss and need for blood transfusions, postoperative course, and complications were compared.

Results: A total of 23 patients were included, 10 who underwent repair via the Melbourne technique and 13 who underwent repair via the modified-Pi procedure. Age at time of surgery was 6.2 (SD = 0.6) months for patients in the Melbourne group and 8.3 (SD = 3.8) months for patients in the modified-Pi group. Compared to the modified-Pi procedure, the Melbourne technique demonstrated significantly shorter operative times [118 min vs. 314 min, (p = <0.005)], lower intraoperative blood loss [175 mL vs 538 mL, (p = 0.014)], lower intraoperative transfusion volume [176 mL vs. 453 mL, (p = 0.011)] and lower length of ICU stay [2.4 days vs. 3.5 days, (p = 0.005)]. There were no significant differences in total length of hospital stay or postoperative complication rates.

Conclusion: While post-operative complication rates were comparable between both techniques, the Melbourne technique demonstrated significantly shorter operative times, less blood loss, and shorter ICU stay in comparison to the modified-Pi method in our cohort of 23 patients. These findings might be associated with the more extensive grafting and fixation steps required in the modified-Pi method.

Purpose: To describe a novel acellular dermal matrix (ADM) technique for autologous deep inferior epigastric perforator (DIEP) flap breast reconstruction and to report on early clinical and aesthetic outcomes, with particular attention to flap shaping, operative ergonomics, and short-term complications.

Methods: Consecutive patients undergoing autologous flap breast reconstruction with the ADM technique at a single institution were retrospectively reviewed from July 2025 to February 2026. After harvest and de-epithelization of the DIEP flap, a monitoring skin paddle was preserved. A sheet of AlloDerm Restore XLTM was rehydrated and fashioned into a pouch with a purse-string 2-0 PDS suture. The flap, skin paddle side down, was centered on the epidermal surface of the ADM. Flap edges were tucked into the pouch to create a rounded, breast-like shape, and microvascular anastomoses were performed to standard recipient vessels. Demographic and clinical data was collected including race, age, body mass index (BMI), mastectomy pattern, recipient vessel, need for intraoperative anastomosis, follow-up interval, and complications.

Results: Six patients (11 DIEP flaps) underwent reconstruction with the ADM pouch technique. The cohort included Black (33.3%), multiracial (16.7%), and White patients (50.0%) with one patient (16.7%) identifying as Hispanic. Mean age was 57 ± 7 years and mean BMI was 28.5 ± 3.7kg/m2. Follow-up ranged from 9-122 days (mean 56 ± 49 days). Most reconstructions followed skin-sparing mastectomy (81.8%). Internal mammary and thoracodorsal vessels were used as recipients in 90.9% and 9.1% of flaps, respectively. Intraoperative re-anastomosis to address clots was required in three flaps (27.3%), yet no flaps required operative takeback, and no total or partial flap loss occurred. Mastectomy flap necrosis occurred in three flaps (27.3%), resulting in wound dehiscence in one case (9.1%), and one hematoma (9.1%), which was successfully managed with aspiration. No fat necrosis has been observed in areas that would typically require tacking sutures.

Conclusions: This new technique using an ADM in autologous breast reconstruction appears safe and feasible in this early experience and may offer advantages in aesthetic shaping and intraoperative handling. By converting the traditional triangular flap into a more anatomical, rounded configuration and eliminating the need for tacking sutures, this approach may reduce lateral bulk, simplify pocket inset, and decrease the risk of fat necrosis at suture sites. Larger studies with longer follow-up and formal aesthetic assessments are warranted to evaluate its durability.

Introduction Aesthetic contouring of the posterior trunk and back has become increasingly common, particularly in patients seeking body reshaping after weight loss or for improvement of back contour deformities. Multiple surgical techniques have been described, but reported outcomes, complication profiles, and patient satisfaction vary across approaches. We performed a systematic review of the literature to evaluate reported outcomes, complications, and patient-reported satisfaction following aesthetic back contouring. To our knowledge, this represents the first systematic review focused specifically on aesthetic back contouring procedures.

Methods A systematic review of published studies reporting outcomes and complications of aesthetic back or posterior trunk contouring procedures was performed in early 2026. PubMed, Embase, and Cochrane Library databases were searched without publication date restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Extracted data included study design, patient characteristics, surgical technique, complications, revisions, and patient satisfaction reports.

Results Twelve studies including 1,195 patients met inclusion criteria, consisting primarily of case series (75%) and cohort studies (25%). Techniques included liposuction-based procedures, flankplasty, bra-line back lift, lower body lift, and combined procedures with fat grafting or extended abdominoplasty. Studies reported improvements in posterior trunk contour, torso definition, and gluteal frame aesthetics based on aesthetic outcome assessments and patient satisfaction measures. Patient satisfaction was consistently high, with several reporting satisfaction rates exceeding 80–100%. The most common complications included seroma (up to 14.3%), wound dehiscence (up to 14.3%), hematoma (up to 11.9%), and hypertrophic or widened scar (up to 28.6%). Major complications were uncommon and included blood transfusions (up to 9.5%). Revision rates were low when reported. Follow-up duration ranged from 2 months to over 8 years.

Conclusions Aesthetic back contouring procedures demonstrate favorable aesthetic outcomes, high patient satisfaction, and acceptable complication rates across a range of surgical techniques. Current evidence is limited by heterogeneous study designs, outcome reporting, and lack of standardized assessment measures. Prospective studies using standardized assessment measures are needed to define optimal surgical approaches and improve comparability across techniques. Further work to establish a structured subunit analysis of the back may enhance surgical planning, outcome evaluation, and overall aesthetic optimization.

Purpose: Velopharyngeal insufficiency (VPI) can result from both a shortened soft palate and abnormal alignment of the levator veli palatini muscles. This dysfunction often leads to speech abnormalities, including hypernasal resonance, unintentional nasal airflow during speech, and noticeable physical strain during articulation (1). While surgical procedures such as palatoplasty, sphincter pharyngoplasty, pharyngeal wall augmentation, and pharyngeal flap are routinely used to improve velopharyngeal closure in patients with cleft palate, some of these interventions may be less appropriate for individuals with VPI following palatal tumor resection or other non-cleft causes (2). Our case describes the use of a novel surgical technique in a 57-year-old female who developed severe, new-onset hypernasal speech following resection of a tumor involving the anterior soft palate.

Methods: The Arrow Revision Palatoplasty (ARP) is a novel surgical technique that simultaneously reconstructs the levator sling and lengthens the palate without the creation of obstructive pharygneal flaps. Under general anesthesia, arrowhead incisions were made to elevate composite oral mucosa and muscular flaps while preserving nasal lining. The levator muscles were dissected, with notable fibrosis on the left and hypoplasia on the right, then repositioned and reconstructed at the midline. A 16 mm elongation of the soft palate was achieved by separating nasal mucosa from the hard palate. A large junctional defect was closed using bilateral buccal flaps, inset with buccinator muscle for structural support-one oriented with mucosa facing the nasal side and the other facing the oral side.

Results: While the primary intervention significantly improved velopharyngeal function, some residual speech discomfort persisted. At 5 weeks postoperatively, speech evaluation demonstrated severe nasal air escape and hypernasality despite a velopharyngeal closure ratio of 0.9. Consequently, the patient underwent a secondary procedure at 6 weeks postoperatively involving division and inset of the buccal flap to enhance comfort during speech and eating. At 3.5 months postoperatively, nasoendoscopy demonstrated sustained closure with minimal hypernasality, and final speech assessment showed a 38.85-point improvement in VELO-Youth score.

Conclusion: ARP enables targeted levator reconstruction and palatal lengthening after partial soft palate resection, achieving elongation while preserving the airway and future surgical options. Initial outcomes are promising, but long-term function and generalizability require further study.

References 1. Kummer AW. Disorders of resonance and airflow secondary to cleft palate and/or velopharyngeal dysfunction. Semin Speech Lang. 2011;32(2):141-149. doi:10.1055/s-0031-1277716 2. Losee J, Kirschner R. Comprehensive Cleft Care, Second Edition: Volume Two. Thieme Medical Publishers, Incorporated; 2015. Accessed June 12, 2025. http://ebookcentral.proquest.com/lib/nyulibrary-ebooks/detail.action?docID=4822569

Purpose: The quantitative assessment of hand and wrist range of motion (ROM) is fundamental for evaluating surgical outcomes and guiding rehabilitation in plastic surgery (1). However, traditional manual goniometry suffers from significant inter-rater variability (2). Existing digital solutions often rely on cloud-processing, which introduces latency and profound patient data privacy concerns. This study introduces Articulo: a 100% client-side, edge-computing platform that provides real-time, hospital-grade kinematic assessment without requiring sensitive data to leave the user's device.

Methods: Articulo was developed using a Single Page Application (SPA) architecture leveraging WebRTC and WebGPU for accelerated computation. The system utilizes machine learning models to infer 21 3D landmarks of the hand from a single standard camera frame (3). To ensure measurements are stable for clinical use, we implemented a dimensionally-independent One Euro Filter to mitigate high-frequency tracking jitter (4). The platform incorporates four structured clinical protocols-Baseline ROM, Ulnar and Median Nerve screenings, and De Quervain's guidance-providing automated joint angle computation and movement smoothness metrics.

Experience: The platform has undergone internal technical validation and feasibility testing (February 2026). The system was evaluated across various consumer hardware environments to assess computational throughput and joint angle stability. Validation focused on the correlation between software-calculated kinematics and established anatomical ranges for standard hand screening movements. Internal testing confirms high reliability in high-contrast environments and consistent performance across desktop and mobile-web browsers.

Results: Preliminary results demonstrate that Articulo sustains processing speeds of 30 to 60 frames per second on standard consumer hardware. The adaptive filtering architecture reduced spatial coordinate variance by approximately 85.0% during static sessions, significantly minimizing recording artifacts compared to raw tracking data. All data persisted locally via IndexedDB with AES-256-GCM encryption, ensuring compliance with health data privacy standards by design. Mean error margins for primary joint angles remained within clinically acceptable ranges for screening applications.

Conclusions: Articulo demonstrates the viability of executing complex clinical screening applications entirely within the edge-computing environment of modern browsers. By localizing computation, the platform eliminates traditional telemedicine barriers associated with data privacy and connectivity. This represents a scalable, privacy-first infrastructure that provides surgeons and therapists with an objective, accessible aid for remote kinematic assessment in hand and reconstructive surgery.

References: 1. Norkin, C. C., & White, D. Measurement of Joint Motion: A Guide to Goniometry (5th ed.). Philadelphia, PA: FA Davis; 2021. - A standard clinical textbook on goniometric measurement of joint ranges. https://fadavispt.mhmedical.com/book.aspx?bookID=2124 2. Nakai, T., Amano, S., Murao, C., et al. Intra- and inter-rater reliability of goniometric finger range of motion using a written protocol. Archives of Physiotherapy. 2024;14:83-88. PubMed: https://pubmed.ncbi.nlm.nih.gov/39386320/ 3. Zhang, F., Bazarevsky, V., Vakunov, A., et al. MediaPipe Hands: On-device real-time hand tracking. arXiv preprint arXiv:2006.10214. June 11 2020. arXiv link: https://arxiv.org/abs/2006.10214 4. Casiez, G., Roussel, N., & Vogel, D. 1€ Filter: A simple speed-based low-pass filter for noisy input in interactive systems. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI). 2012:2527-2530. ACM/CHI citation: https://dl.acm.org/doi/10.1145/2207676.2208639

Background: Migraine surgery is a specialized subset of plastic surgery that can be difficult for patients to understand due to complex terminology and limited accessible information online. Artificial intelligence (AI) becomes increasingly present in clinical and academic environments and may have the potential to generate patient-oriented summaries. This study aimed to evaluate whether generative AI could produce more accessible content on migraine surgery compared with typical online resources.

Methods: The first ten publicly available websites providing information on migraine surgery was identified using systematic keyword searches, designed to simulate typical patient information-seeking behaviour. Nine generative-AI platform (ChatGPT, Gemini, Perplexity, Elicit, Scispace, Consensus, PaperPal, Julius, and Mistral) were prompted using standardized queries to generate summaries of the procedure. Readability was assessed using seven validated indices: Flesch Reading Ease, Flesch–Kincaid Grade Level, Gunning Fog, Coleman Liau, Automated Readability Index, SMOG index. Website content was independently assessed by an expert in the field for accuracy and for the presence of supporting scientific references. Finally, AI output we compared with websites to evaluate accessibility.

Results: While Gen-AI–generated content showed slightly better readability compared with websites (mean score 18.05 vs 20.84), both remained well above the recommended grade 6 level for patient education, generally requiring a college-level education, indicating that general AI tools do not automatically produce simpler patient-facing content. AI-generated content was generally complete and well-cited. The most comprehensive and detailed answers were provided, in order, by Mistral, Julius, Scispace and Consensus; the most readable by Mistral, ChatGPT and Elicit. ChatGPT, Perplexity and Gemini often incorporate information from general websites rather that only reputable scientific sources.

Conclusions: Both online resources and AI-generated content exhibit readability above recommended levels, highlighting the need to improve the clarity and accessibility of patient education materials. AI tools specifically designed to simplify patient-facing materials (e.g. Gemini, ChatGPT, Copilot), may represent an useful adjunct to improve accessibility when using to simplify existing medical content from reputable institutions under medical supervision. Complementary tools, such as Google Trends and Glimpse can further support this goal by helping clinicians tailor communication strategies to actual patient interests, promoting better alignment between public needs and scientific evidence. This study highlights the potential of AI as a tool for patient education in plastic surgery and the importance of integrating high-quality information into clinical practice. For the future, it will be essential to conduct prospective studies to strengthen the validation of AI tools.

Purpose: Gender-affirming mastectomy (GAM) is an important component of gender-affirming care for transmasculine and gender-diverse individuals. Testosterone therapy is frequently used in this population and is known to influence coagulation and wound healing. However, the impact of recent testosterone exposure on postoperative outcomes following mastectomy remains poorly characterized. We hypothesized that testosterone exposure within 30 days prior to mastectomy would increase postoperative bleeding. Methods: A retrospective cohort study was performed using the TriNetX database. Adult patients with a diagnosis of gender dysphoria undergoing mastectomy were identified. Individuals with a diagnosis of breast cancer and patients <18 years old were excluded. The primary exposure was documented subcutaneous testosterone administration within 30 days prior to mastectomy. A 60-day exposure window was evaluated in sensitivity analysis. A matched control cohort with no documented history of testosterone exposure was constructed. Propensity score matching for age, race, diabetes, hypertension, hyperlipidemia, chronic kidney disease, immune disorders, coagulation disorders, nicotine use, antihemorrhagic/anticoagulant therapy was used to control for confounders. The primary outcome was postoperative bleeding/hematoma. Secondary outcomes included seroma, infection, wound dehiscence, fat necrosis, major complications (defined as hematoma/seroma requiring drainage, infection requiring drainage, or debridement) hypertrophic scar, and VTE. Preoperative hematocrit and erythrocyte counts were compared to biologically validate androgen exposure. Outcomes were identified within 90 days following the index procedure. Results: After propensity score matching, there were 1,513 patients in each cohort. The average age of the testosterone exposed group was 25.1 ± 7.93, while the average age of the non-exposed group was 24.8 ± 7.25 (p=0.21). Preoperative hematocrit in the testosterone-exposed group was significantly higher than the non-exposed group (44.9 ± 3.88 vs 42.3 ± 4.4; p<0.0001). Similarly, erythrocyte count was significantly higher in the testosterone exposed group than the control (5.06 ± 0.54 vs 4.78 ± 0.72 ×10⁶/µL; p<0.0001). Seroma was the most common complication in the testosterone-exposed cohort (2.58%), whereas hematoma was most common in the non-exposed cohort (1.79%). Hematoma rates were not significantly different between groups (2.31% vs 1.79%; p=0.305) and this remained non-significant at 60 days (2.225 vs 1.84%; p=0.38). In contrast, the seroma rate was significantly higher in the testosterone exposed cohort (2.58% vs 1.32%, RR 1.95, 95% CI 1.14 –3.33; p=0.013). This effect trended towards significance at 60 days (2.08% vs 1.32%; p=0.057). Major complications were not significantly increased in the testosterone exposure cohort (2.18% vs 1.52%; p=0.177). Among major complications, hematoma or seroma requiring drainage was not significantly different between cohorts ((1.66% vs 1.32%, p=0.45. Sensitivity analysis at 60 days was unchanged. Other complications (infection, fat necrosis, wound dehiscence, hypertrophic scar, VTE) were too low to report individually. Conclusion: Testosterone exposure within 30 days prior to surgery did not significantly increase rates of hematoma following GAM. However, seroma rates did show a temporal association with testosterone exposure, suggesting a potential, though modest, association.

Introduction Over the past decade, synthetic dermal substitutes have reshaped the reconstructive ladder by offering alternatives that facilitate wound closure and improve graft take (1). Among these, biodegradable temporizing matrix (BTM) is well established for its ability to resist infection and generate a durable neodermis (2). Nonetheless, BTM remains susceptible to infections that may compromise healing, precipitate sepsis, necessitate removal of the matrix, and increase morbidity (3). With proper response, these infections can be mitigated, and the matrix can be salvaged. This study aims to identify risk factors associated with BTM infection and to evaluate the effectiveness of treatment strategies in managing these cases.

Methods A retrospective chart review was performed at a level 1 trauma and burn center for patients 18 years and older who underwent BTM placement between September 2023 and April 2025 for burn, trauma and other injuries.

Results In our cohort, 150 BTM applications were performed: 90 on burn wounds, 51 on traumatic wounds, and 9 on wounds of other etiologies. Forty-four of the cases showed local signs of infection, most frequently presented as increased drainage under the silicone layer and offensive smell. Placement on the lower extremities and use in burn injuries were associated with a higher risk of local infection, most commonly with Pseudomonas or MRSA species. The management approach consisted of early recognition and local infection control through irrigation beneath the silicone layer and application of sodium hypochlorite dressings. Early partial delamination was required only in rare cases, 3 applications. With this approach, BTM salvage was achieved in all cases, and no patient required acute surgical excision of the dermal substitute. Moreover, the success of grafting was comparable in the cases that showed signs of infection.

Conclusion Our study demonstrated predisposing factors for clinical infection of BTM that may assist clinicians with early diagnosis and treatment. Moreover, we present a salvage strategy that can be applied in cases of local infection, allowing the majority of patients to achieve successful integration of the BTM followed by favorable graft take.

External Funding No external funding was received for this study

References 1. Janis J, Kwon R, Attinger C. The New Reconstructive Ladder: Modifications to the Traditional Model. Plastic and Reconstructive Surgery. 2011; 127 205S-212S. doi: 10.1097/PRS.0b013e318201271c. 2. Rajaram R, Zhang M, Premaratne G, Ng S. Novosorb® BTM- history, production and application in challenging wounds. Front Bioeng Biotechnol. 2024;12:1450973. doi:10.3389/fbioe.2024.1450973 3. Lane G, Fitzpatrick NJ, Kastritsi O, et al. Biodegradable Temporising matrix in the reconstruction of complex wounds: A systematic review and meta-analysis. Int Wound J. 2024;21(10):e70025. doi:10.1111/iwj.70025

Purpose: Breast cancer-related lymphedema (BCRL) affects up to 40% of breast cancer survivors (1). Known risk factors associated with BCRL include axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB), radiation, and obesity (2-4). Lymphatic Microsurgical Preventative Healing Approach (LYMPHA) is a prophylactic procedure shown to decrease the absolute incidence risk of lymphedema by 23.1% in breast cancer patients who have received ALND and regional nodal radiation (4). However, the impact of adjuvant radiation therapy on LYMPHA patients in the perioperative period has yet to be clearly characterized. This study evaluates the association of radiation exposure and timing of radiation therapy on the development of lymphedema following LYMPHA for breast cancer treatment.

Methods: Retrospective review of breast cancer patients who underwent simultaneous ALND and LYMPHA at a single institution from 2018 to 2025 was completed. Patients were considered to have a diagnosis of lymphedema if they had both clinical symptoms and a Lymphedema Index (L-DEX) score of ≥ 10. Lymphedema was defined as permanent lymphedema when patients met criteria for lymphedema for >1 clinic visit up to their most recent follow-up. Patients were identified to have radiation-associated lymphedema if lymphedema onset was within 1 month of radiation therapy. Student's T-test, Chi-squared/Fischer's Exact, or logistic regression analysis were used to compare postoperative outcomes.

Results: 273 patients were included: 38 (13.9%) developed lymphedema and 16 (8.8%) went on to develop permanent lymphedema. Incidence rate per 100 person-years for lymphedema and permanent lymphedema were 9.71 [95% CI 6.87, 13.33] and 4.89 [95% CI 2.80, 7.94] respectively. Patients with lymphedema were older (55.8 vs. 51.4, p=0.04), had a higher BMI (32.0 vs. 28.1, p<0.01), and had longer follow-up (824.3 days vs. 474.7 days, p<0.01). SLNB was found to be protective against permanent lymphedema (OR = 0.3 [95% CI 0.09-0.86]). Radiation-associated lymphedema increased the odds of developing permanent lymphedema by 16 times (OR = 16.00 [95% CI 4.32- 60.81]).

Conclusions: Increased age, BMI, and development of lymphedema symptoms within 1 month of radiation are associated with an increased risk of developing permanent lymphedema after LYMPHA. These findings suggest that patients who experience lymphedema symptoms acutely with radiation therapy may require further counseling and postoperative surveillance to reduce or prevent progression of disease.

References 1. Rockson SG. Lymphedema after Breast Cancer Treatment. N Engl J Med. 2018;379(20):1937-1944. doi:10.1056/NEJMcp1803290 2. McLaughlin SA, Wright MJ, Morris KT, et al. Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol. 2008;26(32):5213-5219. doi:10.1200/JCO.2008.16.3725 3. Helyer LK, Varnic M, Le LW, Leong W, McCready D. Obesity is a risk factor for developing postoperative lymphedema in breast cancer patients. Breast J. 2010;16(1):48-54. doi:10.1111/j.1524-4741.2009.00855.x 4. Johnson AR, Kimball S, Epstein S, et al. Lymphedema Incidence After Axillary Lymph Node Dissection: Quantifying the Impact of Radiation and the Lymphatic Microsurgical Preventive Healing Approach. Ann Plast Surg. 2019;82(4S Suppl 3):S234-S241. doi:10.1097/SAP.0000000000001864

Introduction: Abdominal compartment syndrome (ACS) is a severe and life-threatening complication in burn patients, often associated with excessive fluid resuscitation (1). While prior studies have described the acute physiologic course and early outcomes of ACS after burn injury, long-term outcomes among survivors, including abdominal wall complications, chronic pain, gastrointestinal dysfunction, and renal sequelae, remain incompletely characterized and are largely limited to small single-center series (2)(3)(4)(5). The objective of this study was to evaluate risk factors and outcome associations in burn patients who subsequently developed ACS.

Methods: We conducted a retrospective cohort study using the real-world database TriNetX. Adult burn patients were identified using ICD-10 burn codes, and those who developed ACS within one month following burn injury were included. Burn patients without ACS were propensity score matched for comparative outcome analyses. Outcomes, including surgical procedures, were assessed at one month and one year after burn injury. Results are presented as absolute risks for single-cohort analyses and as risk ratios (RRs) with 95% confidence intervals (CIs) for matched outcome comparisons. Statistical significance was defined as p < 0.05.

Results: A total of 310 burn patients with ACS were identified, representing 0.03% of the total burn population in the database. Seventy percent of patients were male, with a mean age of 50 ± 23 years. Mortality among patients with ACS was 50.9% at one month and 66% at one year following burn injury. Renal and respiratory impairment were common and occurred at significantly higher rates compared with matched burn patients without ACS (p < 0.05). Sepsis developed in approximately half of patients with ACS. In addition, patients who developed ACS exhibited a substantial comorbidity burden, particularly with respect to pre-existing cardiovascular disease.

Conclusion: ACS is a rare but highly morbid complication following burn injury, associated with substantial short- and long-term mortality and organ dysfunction. Early recognition of at-risk patients and timely intervention are critical to mitigate downstream complications and improve outcomes.

1. Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primer 2020;6:11. https://doi.org/10.1038/s41572-020-0145-5
2. Hershberger RC, Hunt JL, Arnoldo BD, Purdue GF. Abdominal compartment syndrome in the severely burned patient. J Burn Care Res Off Publ Am Burn Assoc 2007;28:708–14. https://doi.org/10.1097/BCR.0b013E318148C988
3. Wise R, Jacobs J, Pilate S, Jacobs A, Peeters Y, Vandervelden S, et al. Incidence and prognosis of intra-abdominal hypertension and abdominal compartment syndrome in severely burned patients: Pilot study and review of the literature. Anaesthesiol Intensive Ther 2016;48:95–109. https://doi.org/10.5603/AIT.a2015.0083
4. Vigneswaran J, Chavez J, Gottlieb LJ. Abdominal Compartment Syndrome in Burn Patients: Not Always a Consequence of Excess Fluid Resuscitation. ACS Case Rev Surg 2022;3
5. Kollias S, Stampolidis N, kourakos P, Mantzari E, Koupidis S, Tsaousi S, et al. Abdominal compartment syndrome (ACS) in a severely burned patient. Ann Burns Fire Disasters 2015;28:5–8.

Aim: In this study, we compared immediate and delayed application of superficial cryotherapy and selective cryolysis using a rat wound model. Method: Model 16 rats were divided into two groups based on the timing of cryotherapy initiation. The immediate group (I) began treatment immediately after wound formation, and the delayed group (D) began treatment 3 days after wound formation. Cryotherapy Both groups received TargetCool at 3°C and -3°C for 10 seconds. Cryotherapy was administered once daily for a total of three sessions. Tissue samples were collected from eight mice (four from each group) on days 7 & 14 to assess the healing process on those days. Wound Healing Rate (WHR) Before each cryotherapy session, dorsal photographs were taken. A wound healing index was calculated to assess wound re-epithelialization. Histopathological Analysis Tissue samples collected on days 7 and 14 were embedded in paraffin, and histopathological analysis was performed using 1) H&E & 2 ) Sirius Red staining. Results / Discussion : The immediate/-3℃ group showed the highest WHR on day 7, but there was no statistically significant difference. PCR analysis showed that TNF-α expression was significantly lower in the immediate/-3℃ group on day 7 compared to the immediate/3℃ and delayed/3℃ groups. CD34 expression was significantly lower in the delayed/3℃ group than in the other groups. A significant difference was observed between days 4 and 7, and by day 14, both groups showed almost complete healing. Photographically, epithelialization was observed earlier in the immediate group than in the delayed group. Conclusion: The anticipated benefits of applying cryotherapy to acute wounds include inducing angiogenesis and promoting healthy granulation tissue formation. The researchers speculate that immediate cryotherapy, compared to delayed application, will promote keratinocyte migration and increase cytokines that induce angiogenesis. Specifically, immediate cryotherapy at -3°C demonstrated a positive effect on wound healing.

Purpose: Virtual surgical planning (VSP) and tangible three dimensional (3D) models are presurgical interventions that optimize the outcomes of craniosynostosis patients compared to surgery without preparation. While there exists substantial evidence on the benefits of presurgical planning, there is little research differentiating the benefits and disadvantages of both modalities. This systematic review compares the contexts in which VSP and 3D models become uniquely beneficial during craniosynostosis treatment.

Methods: The systematic review was registered on PROSPERO and performed according to PRISMA guidelines. A literature search was conducted using MEDLINE, Cochrane CENTRAL, and EMBASE databases for studies in English published through January 2026. Inclusion criteria included articles that investigated the use of VSP/3D models for presurgical purposes, such as functionality of models based on surgeon preference, impact on patient outcomes (e.g. surgical outcomes, aesthetic satisfaction), and improvement on existing presurgical planning models. Technical notes, commentaries, abstracts and duplicate studies were excluded. Databases were searched up to January 2026. All studies were screened by two independent reviewers and assessed for bias using the Cochrane RoB tool.

Results: 400 studies in total were identified from the literature search, of which 23 studies were used for data extraction. Types of studies included retrospective/prospective cohort studies comparing control to 3D-modelling groups, and case reports addressing specific aspects of utility in either VSP or 3D-printed models. Of the identified studies, 13/23 (57%) focused on the use of VSP and 10/23 (43%) focused on the application of 3D-printed and/or hybrid models in craniosynostosis repair. The large majority of studies focused on craniosynostosis correction in the pediatric population (<5 yrs of age). For each study, patient age, type of craniosynostosis, and the use of either VSP/3D-printed preoperative model were noted. Outcomes assessed during data extraction include intraoperative, postoperative, aesthetic satisfaction (based on parental and surgeon judgement), financial feasibility, and user preference. VSP/3D-printed patient specific preoperative models were used for a variety of forms of craniosynostosis including unicoronal, bicoronal, multisuture, metopic, lamboid, and sagittal synostosis. Most operations assessing VSP/3D-printed models used cranial vault reconstruction and fronto-orbital advancement techniques for craniosynostosis repair.

Conclusion: Due to the heterogeneity of technology available, the effectiveness of VSP and 3D-printed and/or hybrid models varies between centers. Users indicate that preoperative 3D-modelling is particularly beneficial in complex cases. VSP has shown similar surgical outcomes when compared to control groups with no VSP, but this may be cofounded with the surgical experience of surgeons. 3D-printed models were more frequently used for educational components in surgical training and repurposed for patient education. Physical 3D models have also become more financially accessible in recent years with the popularity of 3D-printed models and intraoperative guides in craniosynostosis surgical repair. Additionally, hybrid models and augmented reality versions of VSP are in the process of being developed and show promise in becoming an alternative option for preoperative planning to help improve surgical outcomes and surgical training.

Purpose: Relative Value Units (RVUs) are used for performance metrics, calculating physician salaries, determining insurance reimbursements, and identifying staffing needs. As healthcare systems begin to investigate the use of Artificial Intelligence (AI) in medical billing, research on the reliability of open-source AI models for billing calculations becomes essential. This study aims to compare the accuracy and precision of ChatGPT, Gemini, and FetchCPT, an agent-based model developed using Meta Llama 3 70B, which reads uploaded prompts and uses an application programming interface (API) to access the CMS Physician Fee Schedule (CMS-PFS) and retrieve the corresponding RVUs.

Methods: 100 hand trauma operations from January 2018 to December 2023, chosen for their differing complexity and RVUs, and their corresponding Current Procedural Terminology (CPT) codes were compiled into a dataset. Three independent users queried ChatGPT-4.0, Gemini 3.0, and FetchCPT with the query: "Use the [year] Centers for Medicare and Medicaid Services Relative Value Units and calculate the appropriate work RVUs." AI-generated RVUs were then compared between users and to the CMS-PFS using R software (v.4.2.0).

Results: ChatGPT underreported RVUs by 14.1%, Gemini by 4.7%, and FetchCPT overreported by 1%. The mean per-operation difference in RVU assignments between each model and the CMS-PFS was -2.58 for ChatGPT (range: -91.5 to 91.4), -0.68 for Gemini (range: -47.1 to 34.5), and 0.20 for FetchCPT (range: 0.0 to 9.2). ChatGPT's mean absolute error was 8.05, Gemini was 3.06, and FetchCPT was 0.20. Additionally, both ChatGPT and Gemini yielded inconsistent results between users, with ChatGPT having a standard deviation of 19.6 and limits of agreement (LOA) of -31.9 to 26.8, and Gemini having a standard deviation of 8.0 and LOA of -13.2 to 11.9. In comparison, FetchCPT had a standard deviation of 1.3 and LOA from -2.3 to 2.7.

Conclusion: Currently, Gemini has greater utility as an open-source AI tool for RVU assignment than ChatGPT. However, the superior performance of FetchCPT compared to both tools demonstrates the accuracy and reliability benefits of billing models that utilize direct access to CMS-PFS via API. More specifically, large language models such as ChatGPT and Gemini are trained on massive amounts of data and use probabilistic language prediction, which enables them to be multi-purpose but also causes them to hallucinate values. When integrating AI tools into medical billing, verification and supervision of AI-generated results is essential, and the alternative use of simpler tools with direct access to structured data is strongly recommended.

Objective: To compare the surgical complications and functional voice outcomes of voice reconstruction using skin flaps (especially with the J-flap technique) versus ileocolon flaps following total laryngopharyngectomy. Data sources A systematic search was done across PubMed (MEDLINE), Embase, and Google Scholar for studies published up to October 30, 2025. In addition to the literature search, we included our institutional case series of 221 patients (205 ileocolon flaps and 16 skin flaps using radial forearm flap, anterolateral flap, and pectoralis major myocutaneous flap).

Review Methods The study was following PRISMA 2020 guidelines. A meta-analysis using a random-effects model was conducted to assess the pooled meta-rates and Odds Ratios (OR) for donor site complications. Functional outcomes including Maximal Phonation Time (MPT), fundamental frequency, and loudness, were analyzed using Weighted Mean Differences (WMD). Results The original search identified 42 reviews. Eight were chosen for the meta-analysis. A total of 390 cases were analyzed (297 ileocolon flaps and 93 skin flaps). The average follow-up period in this systematic review was 21.99 months(1-72 months). The meta-analysis revealed that the ileocolon flap had significantly lower rates of donor site complications, which including anastomotic leakage (2.21% vs. 35.57%; OR 70.47, p<0.001) , obstruction rate(0.78% vs. 20.00%; OR 9.03, p=0.046), and lower aspiration pneumonia rate compared to the skin group (2.69% vs. 28.71%; OR 14.55, p<0.001). Functional outcome assessment also showed that the ileocolon flap provided better voice sustainability (MPT: 10.84 s vs. 8.06 s, p<0.001), lower pitch((108.5 Hz vs. 172.57 Hz, p<0.001), and louder sound (56.46 dB vs. 38.5 dB, p<0.001). In our series, 90% of aspiration events in skin-tube patients occurred during long-term follow-up due to a lack of natural valve protection. We presented a case from the database of our institution to demonstrate the voice of ileocolon flap.

Conclusions The meta-analysis study indicated that ileocolon flap was statistically superior to skin-flap reconstructions (J-flap) in terms of both surgical complications and vocal quality. The ileocecal valve was crucial in preventing long-term aspiration pneumonia. Despite the technical complexity, the ileocolon flap may be considered the primary choice for durable voice rehabilitation.

Background: Healthcare expenditures in the United States continues to escalate, and hospital reimbursement for plastic surgery procedures has generally increased proportionally with rising healthcare costs and inflation (1-3). Conversely, compensation received by plastic surgeons has not demonstrated comparable growth (4). Despite this disparity, there is a paucity of literature comparing longitudinal reimbursement trends between hospitals and physicians within plastic surgery.

Objectives: This narrative review aims to compare the trends in reimbursement rates for surgeons and hospitals across multiple plastic surgery subspecialties.

Methods: A literature search on plastic surgery physician and hospital reimbursement trends was performed on the PubMed and Google Scholar databases using the search terms 'plastic surgery reimbursement', 'plastic surgery hospital reimbursement', and 'plastic surgery facility reimbursement'. These searches yielded over 5,000 articles related to surgeon reimbursement and over 4,000 related to hospital reimbursement. Article abstracts were scanned for relevance and articles with quantitative reimbursement data were included. Additional descriptive studies were included to capture qualitative trends for the review. Duplicate articles were excluded. Compound annual growth rates were used as the measure to compare the yearly change in reimbursement across subspecialties.

Results: Across six subspecialties, plastic surgeons experienced yearly changes in Medicare reimbursement rates ranging from -3.31% to +2.43% between 2000 and 2023, with only one study analyzing hand surgery procedures demonstrating an increase in reimbursement. This is in stark contrast to hospital reimbursement rates which showed overall increases in facility charges and payments. Stricter regulations limiting growth for physician reimbursement, such as the budget neutrality, may have contributed to the general decline in physician compensation. Together with specific payment requirements and criteria set by insurers, this has impacted clinical decision making, timely access to plastic surgery services, and patient out-of-pocket costs.

Conclusions: Plastic surgeons have been experiencing declining Medicare reimbursement rates compared to the increasing compensation received by hospitals. Given that plastic surgeons contribute substantially to patient care, interdisciplinary collaboration, and institutional success, recognizing the ongoing decline in surgeon reimbursement is imperative to support future advocacy for equitable compensation.

References: (1) Billig JI, Lu Y, Momoh AO, Chung KC. A Nationwide Analysis of Cost Variation for Autologous Free Flap Breast Reconstruction. JAMA Surg. 2017;152(11):1039-1047. doi:10.1001/jamasurg.2017.2339 (2) Terry PH, Campbell CA, Black JS, Stranix JT, Forster GL, DeGeorge BR. The cost of ambulatory breast reduction: hospital reimbursement versus surgeon payments. Plast Surg (Oakv). 2024;32(1):11-18. doi:10.1177/22925503221078716 (3) Gong JH, Koh DJ, Sobti N, et al. Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020. Journal of Reconstructive Microsurgery. 2024;40:489-495. doi:10.1055/a-2222-8676 (4) Stoffel V, Shim JY, Pacella SJ, Gosman AA, Reid CM. Comparing trends in Medicare reimbursement and inflation within plastic surgery subspecialties. Plastic & Reconstructive Surgery. 2024;153(4):957-962. doi:10.1097/prs.0000000000010697

Background: Post-bariatric body contouring surgery has increased substantially with the growing number of patients achieving massive weight loss (1,2). Although these procedures offer functional and psychosocial benefits, they are associated with a considerable rate of postoperative complications, mainly related to wound healing (1,2). Identifying procedure-specific and patient-related risk factors is essential for surgical planning and risk stratification. Methods: A retrospective observational study analyzed 688 post-bariatric body contouring procedures performed in 393 patients at a tertiary referral center. Demographic data, body mass index (BMI), type of procedure, and postoperative complications were collected. Complications were classified as minor (managed conservatively) or major (requiring surgical reintervention and/or hospitalization) according to previously published criteria (3). Univariate and multivariate logistic regression analyses were performed to identify factors associated with complication occurrence. Receiver operating characteristic (ROC) curve analysis evaluated the discriminative ability of BMI for predicting postoperative complications and identified an optimal cutoff value using the Youden index. The study was conducted and reported in accordance with STROBE guidelines (4). Results: Of the 688 procedures analyzed, 64.1% had no complications, while 35.9% presented at least one postoperative adverse event. Minor complications accounted for 32.7% of all procedures, whereas major complications occurred in 3.2%. Wound dehiscence was the most frequent complication (24.4%), followed by seroma (7.0%), epithelolysis (3.3%), and surgical site infection (3.2%). Abdominoplasty was the most commonly performed procedure (43.3%). In univariate analysis, cruroplasty demonstrated significantly higher odds of complications compared with abdominoplasty (OR 1.87; p=0.010). In multivariate analysis, age over 60 years remained an independent risk factor for complications (OR 1.60; p=0.026). Mammoplasty was associated with a significantly lower risk of complications compared with abdominoplasty (OR 0.57; p=0.014). BMI was not associated with complication occurrence, and ROC analysis demonstrated poor discriminative ability (AUC 0.502). Conclusions: Post-bariatric body contouring surgery is associated with a considerable rate of postoperative complications, predominantly minor and manageable. Cruroplasty presents a higher risk of complications, whereas mammoplasty demonstrates a more favorable safety profile. Advanced age is an independent risk factor for postoperative complications, while BMI alone is not a reliable predictor. These findings emphasize the importance of procedure-specific risk assessment and individualized preoperative counseling in post-bariatric patients. 1. Coon D, Gusenoff JA, Kannan N, El Khoudary SR, Naghshineh N, Rubin JP. Ann Surg. 2009;249(3):397-401. 2. Marouf A, Mortada H. Aesthetic Plast Surg. 2021;45(6):2810-2820. 3. Cintra Junior W, Modolin MLA, Colferai DR, Rocha RI, Gemperli R. Rev Col Bras Cir. 2021;48:e20202767. 4. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Lancet. 2007;370(9596):1453-1457.

Background: Understanding financial drivers in higher costs of cleft palate repair (CPR) is increasingly relevant for value-based pediatric cleft palate surgical care. Variation in hospital charges for CPR remains under studied. While illness severity and institutional characteristics are plausible drivers of cost, the independent contribution of insurance payer type is unclear. The Healthcare Cost and Utilization Project (HCUP) 2022 Kids' Inpatient Database (KID) was analyzed to evaluate whether payer type independently influences adjusted hospital charges for CPR (1).

Methods: A cross-sectional analysis of the 2022 KID was performed using STATA SE statistical software. Pediatric cleft palate repair discharges (n=172; analytic n=170) were identified using ICD-10-CM diagnosis codes Q35.x and ICD-10-PCS procedure codes corresponding to palate repair (e.g., 0CQ0xZZ, 0CQ1xZZ, 0CQ2xZZ). Survey-weighted multivariable linear regression of log-transformed total charges was conducted using discharge weights, stratification, and hospital clustering. Covariates included payer type, All Patient Refined Diagnosis Related Groups (APR-DRG) severity category (eg. Minor, Moderate, Major/Extreme), age, sex, hospital region, bed size, urbanicity and teaching status (composite variable), and sponsorship. Adjusted mean charges were estimated using predictive margins with back-transformation to dollar values. All financial values reflect nominal 2022 U.S. dollars. Inflation adjustment was not performed due to the use of one year of data.

Results: The analytic cohort included 172 unweighted discharges, representing an estimated 234 nationally. The weighted mean age of those who received PCR was 2.09 years (95% CI, 1.57–2.60), with 50.2% female patients (95% CI, 41.9–58.5). Mean total charges were $75,182 (95% CI, $41,289–$109,074). The adjusted model demonstrated significant overall explanatory capacity (F(16,48)=13.50, p<0.001; R²=0.312). After controlling for payer type and hospital structural characteristics, higher severity classification remained strongly and independently associated with greater financial burden. Compared with Minor severity, Major/Extreme severity was associated with a 1.108 increase in log charges (p<0.001), corresponding to an approximate 3-fold increase in total charges.

After multivariable adjustment, payer type was not independently associated with charges (all p>0.10). Pairwise comparisons within the categories of severity, payer type, hospital urbanicity and teaching status, region, bed size, and sponsorship, did not reach statistical significance. Hospital urbanicity and teaching status was independently associated with increased charges. Compared with rural teaching hospitals, urban teaching hospitals were associated with a 71% increase in adjusted total charges (β=0.537, p<0.001). However, interpretation is limited by the small number of rural hospitals represented in the analytic cohort. In contrast, hospital region, bed size, and sponsorship status were not independently associated with charges after multivariable adjustment.

Conclusions: In this nationally representative pediatric cohort, financial variation in cleft palate repair charges are primarily driven by clinical severity and hospital characteristics rather than a patient's insurance type (payer status). These findings highlight the role of hospital factors in value-based pediatric cleft palate surgical care. Future multi-year analyses are warranted to confirm payer neutrality and assess cost-adjusted outcomes.

1. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). Kids' Inpatient Database (KID), 2022. Rockville, MD.

Introduction: Targeted therapies are increasingly administered to patients undergoing breast reconstruction. Although targeted therapies are well-established adjuvant cancer treatments, recent studies suggest that these agents may increase post-operative risks through attenuation of immune and inflammatory pathways. Moreover, there are few established guidelines on the perioperative management of these treatments, especially for newly approved therapies. To address this gap, large language models (LLMs) combined with retrieval-augmented generation (RAG) can function as a reasoning framework that provides targeted clinical recommendations based on the retrieval and integration of emerging evidence. We developed an automated RAG-based LLM pipeline to provide perioperative recommendations for patients on targeted therapies who are scheduled for breast reconstruction procedures.

Methods: Our RAG workflow was built as a command-line clinical query interface, which accepts therapy name, patient context, and specific perioperative questions. The RAG system retrieves up-to-date evidence from OpenFDA, CORE, and ClinicalTrials.gov. It then integrates this evidence into a retrieval-augmented generation framework. Finally, the pipeline produces structured responses using Claude 4.6 Sonnet. We validated the final responses from our RAG pipeline using an "LLM-as-a-judge" framework, which provided composite scores ranging from 0 to 75 based on metrics such as safety, evidence quality, hallucination rate, and relevance. As a secondary analysis, we compared perioperative timing recommendations generated by the RAG workflow, ChatGPT 5.2, and Claude 4.6 Opus to consensus guidelines established by panelists from breast oncology, breast surgery, and plastic surgery.

Results: Across thirty distinct queries, our RAG system achieved a mean composite score of 59.7/75. There were no significant differences noted between RAG pipeline-generated responses and consensus perioperative timing recommendations (pre‑op p = 0.22; post‑op p = 0.19). Similarly, there were no significant differences between timing recommendations from ChatGPT 5.2 and Claude 4.6 Opus compared to the consensus guidelines (p = 1.00).

Conclusions: Our RAG-enabled LLM workflow generated perioperative recommendations for patients receiving targeted therapies that were evidence-based and consistent with established guidelines. These findings highlight the potential of LLM pipelines to serve as decision-support tools for plastic surgeons practicing in an evolving therapeutic landscape. Future studies of LLM workflows should focus on large-scale validation, clinical integration studies, and quality improvement.

Purpose: The use of vasopressors in head and neck free flap reconstruction has historically sparked contention due to concerns of vessel spasm and flap ischemia. Many studies have disproven this theory in the context of intraoperative use, but limited evidence is available regarding the effect of vasoconstrictive agents in the postoperative setting for head and neck patients. This study investigates the relationship between vasopressors in the postoperative period and complication rate.
Methods: A retrospective study was performed on 472 head and neck free flap reconstruction patients treated at a single academic institution from 2020-2024. Descriptive statistics and logistic regression analyses were applied to the dataset, with significance level of p <0.05. Results: 23 (4.9%) patients received vasopressors during the 30-day postoperative period. Vasopressor recipients were more likely to be older males with a history of smoking. Significantly more patients in the pressor group received anticoagulation (p < 0.001), whereas patients who were administered vasopressors had longer hospital stays (11 v.s. 18 days, p < 0.001). Patients who received pressors were significantly more likely to experience complications overall than those who did not receive pressors (60% v.s. 33.3%, p = 0.019). Analysis of individual complication rates revealed that seromas (p = 0.017) were significantly more common in the pressor group. Conclusion: Postoperative use of vasopressors in head and neck reconstruction may increase the risk of complications. These findings support limiting the use of vasoconstrictors in the postoperative management of head and neck free flaps, though further evidence is needed to offer definitive recommendations.

Background: The optimal donor-site dressing following split-thickness skin grafting (STSG) remains controversial, with wide variation observable in clinical practice. Comparative studies in this field tend to focus on individual products rather than on the underlying dressing mechanisms, complicating analysis. This systematic review and meta-analysis aimed to evaluate whether dressing category, defined by the primary mechanism of action, influences donor-site healing and morbidity.

Methods: A systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE, Embase and CINAHL for relevant studies published between January 2000 and December 2025. Randomised controlled trials, quasi-randomised trials, and comparative cohort studies including adults (≥18 years) undergoing STSG were eligible. Individual donor-site dressings were classified by the review authors into pre-defined categories based upon their dominant mechanism of action. The primary outcome was the mean time to re-epithelialisation of the donor site. Secondary outcomes included donor-site pain, infection, unplanned dressing changes, scarring, cost, and patient satisfaction. Risk of bias was assessed using the Cochrane RoB 2 tool and the ROBINS-I tool. The certainty of evidence was evaluated using GRADE. Random-effects meta-analysis was performed where appropriate.

Results: 16 studies involving 1,109 patients met the inclusion criteria. Dressings were categorised into six mechanism-based groups: passive, semi-occlusive, occlusive, antimicrobial, bioactive/moisture-interactive and biological/biosynthetic. Substantial heterogeneity was observed in study design, outcome selection and definitions. Meta-analysis of the mean time to re-epithelialisation was feasible for a subset of studies, and each class of dressings was compared with passive dressings as the control. Occlusive dressings demonstrated the greatest reduction in healing time; however, results were non-significant (MD −3.85 days, 95% CI −56.20 to 48.50). Similarly, biological/biosynthetic dressings also demonstrated a non-significant trend towards faster re-epithelialisation (MD -2.65 days, 95% CI -7.28 to 1.99). No dressing category demonstrated statistically significant superiority over passive dressings. Secondary outcomes were heterogeneously reported, precluding pooled analysis. Definitions of infection varied, and event rates were low. Overall certainty of evidence was low due to risk of bias, inconsistency and imprecision.

Conclusion: Current comparative evidence does not demonstrate a clear superiority of any donor-site dressing mechanism for accelerating re-epithelialisation following STSG. In the absence of high-certainty evidence, dressing selection should prioritise pain control, patient comfort, cost, and clinical context.

Background: Timely identification of wound infection remains challenging because clinical signs are subjective and culture results are delayed. Near-infrared autofluorescence imaging can visualize microbial signals without exogenous agents, while forward-looking infrared thermal imaging may reflect inflammation-related temperature changes. We evaluated the clinical utility of combining these modalities for detecting bacterial and fungal infections in chronic wounds.

Methods: This retrospective study included 33 patients with suspected chronic wound infection who underwent near-infrared autofluorescence imaging (Fluobeam) and forward-looking infrared thermal imaging. Wound culture served as the reference standard. Diagnostic performance (sensitivity, specificity, predictive values, accuracy) was calculated. Fluorescence signal intensity was correlated with microbial burden and clinical indicators of infection.

Results: Of 33 wounds, 23 (69.7%) were culture-positive and 10 (30.3%) were culture-negative. Autofluorescence imaging was positive in 20 and negative in 13 wounds, yielding 18 true positives, 5 false negatives, 8 true negatives, and 2 false positives. Sensitivity was 78.3% and specificity 80.0%, with positive predictive value 90.0%, negative predictive value 61.5%, and overall accuracy 78.8%. Fluorescence signal intensity correlated with microbial burden (r = 0.76, p < 0.01) and with clinical indicators including exudate (r = 0.72, p = 0.004), swelling (r = 0.68, p = 0.006), and foul odor (r = 0.68, p = 0.008). Mean surface temperature was slightly higher in fluorescence-positive than fluorescence-negative wounds (36.8 ± 0.3°C vs 36.5 ± 0.2°C).

Conclusion: Near-infrared autofluorescence imaging demonstrated clinically useful diagnostic performance against culture and correlated with microbial burden and infection-related clinical signs, while forward-looking infrared thermal imaging provided complementary physiologic context. Prospective controlled studies with standardized protocols are needed to validate generalizability and clarify the incremental clinical value of dual-modality assessment in chronic wound infection.

Background: Acellular dermal matrix (ADM) is widely utilized in reconstructive surgery because of its favorable biocompatibility, low immunogenicity, and ability to support cellular infiltration and tissue integration. ADM has been successfully applied in a variety of reconstructive settings, including soft tissue augmentation, abdominal wall reconstruction, and implant-based procedures. Despite these advantages, its relatively limited mechanical strength remains a critical limitation, particularly in reconstructions that require resistance to tensile load or durability during surgical manipulation.(1,2) To address this issue, various reinforcement strategies have been introduced. Chemical cross-linking and irradiation-based approaches have demonstrated potential to increase mechanical strength. However, these methods may alter extracellular matrix architecture, introduce residual chemical concerns, or compromise long-term biological performance.

Purpose: The purpose of this study was to introduce a pressure–drying–hydration (PDH) physical conditioning method and to evaluate its mechanical properties in comparison with acellular dermal matrix (ADM) modified using chemical cross-linking and irradiation-based approaches. Methods and Materials: Human-derived ADM was processed using a PDH conditioning protocol and compared with pristine ADM, glutaraldehyde cross-linked ADM, and electron-beam–irradiated ADM. Structural preservation and collagen fiber organization were evaluated using histological analysis and scanning electron microscopy. Mechanical performance was assessed through uniaxial tensile testing to evaluate tensile strength and elastic behavior.

Results: PDH-conditioned ADM demonstrated a significant increase in ultimate tensile strength compared with pristine ADM (10.18 ± 1.31 MPa versus 18.03 ± 2.06 MPa, p** ≤ 0.0001). Young's modulus was higher in the PDH group than in pristine ADM, indicating a tendency toward increased tensile stiffness; however, this difference did not reach statistical significance. Importantly, displacement did not differ significantly between PDH-conditioned and pristine ADM (60.03 ± 5.80% versus 66.75 ± 7.56%, ns), suggesting that mechanical reinforcement was achieved without loss of elastic behavior. Microstructural analysis revealed increased collagen fiber alignment and matrix densification following PDH conditioning. In contrast, glutaraldehyde cross-linking and electron-beam irradiation resulted in minimal or inconsistent improvements in tensile strength and stiffness.

Conclusion: PDH physical conditioning represents a simple and biocompatible strategy to reinforce human-derived ADM through controlled physical modulation of collagen organization rather than chemical or irradiation-based modification. By enhancing mechanical durability while maintaining native structural characteristics, this approach may address an important limitation of conventional ADM. PDH-conditioned ADM has the potential to expand the clinical applicability of ADM in reconstructive procedures that require improved mechanical performance without compromising tissue integration.

References (1) Wainwright DJ. Use of an acellular allograft dermal matrix in the management of full-thickness burns. Burns. 1995;21:243–248. (2) Gilbert TW, Sellaro TL, Badylak SF. Decellularization of tissues and organs. Biomaterials. 2006;27:3675–3683.

Background: Timely referral and surgical treatment are critical to optimizing morphological and neurodevelopmental outcomes in children with craniosynostosis, yet the role of neighborhood-level socioeconomic (SES) factors on care timing remains unclear. SES differences may reasonably contribute to delays given known barriers to specialty access including finding transportation, childcare needs, insurance navigation difficulties, and poor health literacy, among others. No study to date has evaluated the Child Opportunity Index (COI), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI) concurrently within a craniosynostosis cohort. This study examined whether neighborhood-level SES vulnerability, as measured by COI, ADI, and SVI, is associated with differences in referral patterns and timing of milestones throughout the early craniosynostosis care pathway.

Methods: A retrospective cohort study of 268 patients with craniosynostosis examined differences in seven timing outcomes and referral provider type by 2020 COI, national ADI, and SVI scores: age at referral, first plastic surgery consultation, radiographically confirmed diagnosis, and surgery, as well as intervals from referral to consultation, consultation to diagnosis, and diagnosis to surgery. Univariable and multivariable linear regression models were performed with significance of p-value less than 0.05. Cohort characteristics were summarized via descriptive analysis. Continuous variables are non-normal and presented as median (interquartile range, IQR).

Results: The cohort was predominantly male (71.3%), White (81.7%), and Non-Hispanic (86.9%); 66.0% carried private insurance and 30.6% had public insurance. Median SES scores were 61 (48–77) for ADI, 0.5 (0.2–0.5) for SVI, and 0.0 (−0.3–0.7) for COI. Median milestone ages were 2.9 months (1.1–8.1) at referral, 3.0 months (1.2–7.6) at diagnosis, 3.3 months (1.4–8.6) at first plastic surgery appointment, and 5.2 months (3.4–11.0) at surgery. Median intervals were 0.4 months (IQR 0.1–0.9) from referral to first appointment, 0.4 months (0.1–0.9) from first appointment to diagnosis, and 2.6 months (1.2–4.1) from diagnosis to surgery. The majority of referrals originated from Pediatrics (40.7%), followed by Family Medicine (11.9%), Pediatric Neurosurgery (10.1%), self-referral (10.1%), and Pediatric Neurology (7.5%), with smaller contributions from other specialties. No statistically significant associations were observed between SES indices and milestone timing in univariable or multivariables analyses (all p>0.05). Referring provider type was not associated with differences in SES measures or in early craniosynostosis care timing (all p>0.05).

Conclusions: In this cohort, median ages at referral, diagnosis, and surgery were congruent with recommended timing in the literature. Interval durations between milestones appeared to be expedited. Neighborhood-level socioeconomic vulnerability was not associated with delays in early craniosynostosis care. Together, these findings suggest that within this referral network, structural barriers may not translate into clinically meaningful delays in craniofacial care. Given the heterogeneous distribution of neighborhood indices in our cohort, future studies should examine the impact of race, ethnicity, insurance status, and other non-composite SES variables on care timing, which may act more directly than area-level indices.

Purpose: Plastic surgery remains at the forefront of surgical innovation, academic scholarship, and multidisciplinary collaboration. Its flagship journal, Plastic and Reconstructive Surgery, has served as the specialty's primary academic platform for over six decades, while its open-access counterpart, Plastic and Reconstructive Surgery–Global Open, was established in 2013 to expand global dissemination. Network analysis provides a quantitative and visual framework to evaluate relational structures and connectivity within complex systems, enabling both graphical representation and metric-based assessment of collaboration patterns and academic influence. We aimed to characterize the evolution of co-authorship networks in Plastic and Reconstructive Surgery from January 1960 to December 2025 and in Plastic and Reconstructive Surgery–Global Open from 2013 to December 2025. Methods: A bibliometric network analysis was performed of all articles published in Plastic and Reconstructive Surgery (PRS) from January 1960 through December 2025 and Plastic and Reconstuctive Surgery–Global Open (PRS-GO) from 2013 through December 2025. Publication metadata, including author names and publication dates, were extracted and cleaned to standardize author identities. Co-authorship networks were constructed in Gephi, in which nodes represented individual authors and edges represented co-authorship relationships, weighted by the number of shared publications. Network metrics were calculated by decade for PRS and across the full publication period for PRS-GO, including number of publications, authors (nodes), collaborative ties (edges), and average degree. Eigenvector centrality and other centrality measures were used to assess network influence and structural hierarchy. Descriptive network statistics were analyzed to evaluate longitudinal trends in collaboration and network connectivity. Results: Across six decades, PRS demonstrated substantial growth in scholarly output, authorship participation, and collaborative connectivity. Publications increased from 1,218 in the 1960s to 8,888 in the 2010s, while the number of contributing authors rose from 1,403 to 16,877. Co-authorship ties increased disproportionately, expanding from 1,871 in the 1960s to more than 71,000 in the 2010s, reflecting intensifying collaboration across institutions and subspecialties. Average degree increased steadily from 2.67 to 9.37, indicating progressive network densification and a shift toward team-based research. The most recent five-year period (2020–2025) demonstrates continued acceleration, with publication volume and collaboration levels on pace to exceed prior decade totals despite representing a partial interval. PRS-GO similarly exhibited rapid growth following its 2013 launch, reflecting expanding global participation and dissemination. Conclusions: Authorship network analysis demonstrates that plastic surgery scholarship has evolved from a relatively small, sparsely connected academic community into a large, densely interconnected global collaboration network. Collaboration has increased at a faster rate than authorship alone, reflecting network densification and the growing importance of multidisciplinary and multi-institutional scholarship. The continued upward trajectory observed in recent years suggests that collaborative, team-based science will remain central to innovation, knowledge dissemination, and academic influence within plastic surgery. References: 1. Bastian M, Heymann S, Jacomy M. Gephi: An Open Source Software for Exploring and Manipulating Networks. Proc Int AAAI Conf Web Soc Media. 2009;3(1):361-362. doi:10.1609/icwsm.v3i1.13937 2. M.E.J. Newman, Modularity and community structure in networks, Proc. Natl. Acad. Sci. U.S.A. 103 (23) 8577-8582, https://doi.org/10.1073/pnas.0601602103 (2006).

Background Diabetes mellitus (DM) is associated with impaired wound healing and increased postoperative complications. However, short- and intermediate-term outcomes following body contouring operations/surgery (BCOS) have not been well characterized in large, matched cohorts. Understanding these risks is essential for perioperative optimization and risk stratification. Therefore, this study evaluates 6 and 12-month postoperative outcomes in one of the largest database analyses to date.

Methods A retrospective cohort study was conducted using the TriNetX Research Network database (2006-2026), comprising over 280 million patients, to evaluate postoperative complications among adults undergoing BCOS. Patients with a diagnosis of diabetes mellitus were compared with non-diabetic controls. Complication rates were assessed at 6 and 12 months following surgery. The study population included all adult patients who underwent BCOS. Surgical procedures were identified using CPT codes including panniculectomy/abdominoplasty (15830, 15847), thigh (15832), leg (15833), hip (15834), buttock (15835), arm (15836), forearm/hand (15837), submental fat pad (15838), and other areas (15839), as well as mastopexy (19316), mastectomy for gynecomastia (19300), and unlisted skin/subcutaneous tissue procedures (17999). Cohorts were defined by the presence or absence of DM. Postoperative outcomes included wound infection, postoperative pain, nerve-related complications, delayed wound healing, hypertrophic scarring, and post-gastric surgery syndrome. To reduce confounding, propensity score matching was performed based on age, sex/gender, race/ethnicity, and medical comorbidities other than type 2 diabetes.

Results Among patients undergoing BCOS, 23,570 individuals with DM and 113,431 individuals without DM were identified prior to matching. After propensity score matching, 20,490 patients were included in each cohort. At both 6 and 12 months postoperatively, patients with DM demonstrated a significantly higher risk of most postoperative complications compared with non-diabetic controls, with the exception of hypertrophic scarring. At 6 months, the DM cohort had increased risk of wound infection (risk difference [RD] 0.012, p<0.0001), postoperative pain (RD 0.005, p=0.011), delayed wound healing (RD 0.012, p<0.0001), and post-gastric surgery syndrome (RD 0.006, p=0.001). Nerve complications were not significantly different at 6 months (RD 0.001, p=0.155). At 12 months, elevated risk persisted for wound infection (RD 0.012, p<0.0001), postoperative pain (RD 0.006, p=0.004), nerve complications (RD 0.002, p=0.021), delayed wound healing (RD 0.013, p<0.0001), and post-gastric surgery syndrome (RD 0.011, p<0.0001). In contrast, hypertrophic scarring was less common among patients with DM at both 6 months (RD -0.005, p<0.0001) and 12 months (RD -0.007, p<0.0001).

Conclusions Our findings demonstrate that BCOS patients with DM experience higher postoperative complication rates at both 6 and 12 months compared to non-diabetic controls, with the exception of postoperative hypertrophic scarring. These findings underscore the importance of rigorous perioperative glycemic control monitoring, targeted risk mitigation strategies, and extended postoperative monitoring for diabetic populations. They also highlight the need for further research to evaluate interventions aimed at reducing long-term complications in this high-risk group.

Introduction: Rhinoplasty is uniquely positioned at the intersection of functional reconstruction and aesthetic identity. Published clinical photography does more than document outcomes. In fact, it establishes normative facial standards, informs surgical technique, and shapes perceptions of candidacy. As leading journals define the visual language of plastic surgery, disparities in skin tone representation may influence both surgical education and aesthetic paradigms. As there has not yet been such an analysis, the objective of this study was to evaluate Fitzpatrick skin type representation in rhinoplasty-related imagery across five major plastic surgery journals over a ten-year period.

Methods: A cross-sectional review of rhinoplasty-focused publications from 2015–2025 was conducted in Plastic and Reconstructive Surgery (PRS), PRS Global Open (PRS GO), Aesthetic Surgery Journal (ASJ), Journal of Plastic, Reconstructive & Aesthetic Surgery (JPRAS), and Annals of Plastic Surgery (APS). Eligible studies included original investigations, case series, and technical reports in which rhinoplasty was the primary procedure and at least one clinical patient photograph or graphical illustration depicting visible facial skin tone was present. Patient photographs were independently assigned a Fitzpatrick skin type (I–VI) and categorized as "lighter" (Fitzpatrick I–III) or "darker" (Fitzpatrick IV–VI). Graphical illustrations were similarly categorized when skin tone was discernible. Journal, publication year, and geographic region of the corresponding author were recorded. Differences between groups were assessed using chi-square testing, and temporal trends were evaluated using linear regression. Statistical significance was set at p<0.05.

Results: A total of 9,412 figures were screened, of which 2,845 met inclusion criteria. These included 1,902 real patient image sets (66.9%) and 943 graphical illustrations (33.1%). Among real patient photographs, 26.9% depicted Fitzpatrick IV–VI skin types, compared with 73.1% Fitzpatrick I–III (p < 0.001). Representation was lower in graphical illustrations, where 15.4% depicted Fitzpatrick IV–VI tones (p < 0.001 versus real patient images). Significant variation existed across journals (p = 0.002), as JPRAS demonstrated the highest proportion of darker skin representation in clinical imagery (32.4%), while ASJ (23.1%) and PRS (24.6%) included lower proportions. Across the decade analyzed, overall representation of Fitzpatrick IV–VI patient images did not demonstrate sustained increase. PRS and ASJ demonstrated significant declines in representation of Fitzpatrick IV-VI patient imagery over the study period, with PRS decreasing from 30.2% in 2015 to 21.4% in 2025 (p=0.001) and ASJ declining from 27.8% to 19.6% (p=0.003). In contrast, PRS Global Open showed a modest but significant increase in darker skin representation, rising from 18.5% in 2015 to 26.3% in 2025 (p=0.004). Notably, graphical depictions consistently favored lighter skin tones across all journals and years. (p < 0.001). No journal demonstrated a significant upward trend in graphical representation of Fitzpatrick IV–VI skin types.

Conclusion: Rhinoplasty imagery in leading plastic surgery journals disproportionately reflects lighter skin tones, particularly within graphical illustrations. Despite increasing dialogue surrounding diversity in surgery, representation of darker skin types has not meaningfully improved over the past decade. As journals shape the visual framework of aesthetic surgery, intentional efforts toward inclusive imagery are encouraged to ensure that published standards reflect the diversity of patients served.

Purpose: Lip reconstruction following oncologic resection must restore both aesthetic form and essential functions, including phonation, mastication, oral competence, and facial expression (1). Successful reconstruction requires preservation of functional subunits and harmony between the upper and lower lips in both vertical and transverse planes (2). For full-thickness defects not involving the oral commissure, the Abbe flap has become a favored reconstructive option, particularly for defects involving one-third to two-thirds of the lip (3). While existing literature extensively describes technique and aesthetic outcomes, objective reporting of long-term functional and sensory results remains limited. This case report aims to address this gap by presenting quantitative outcome measures following Abbe flap reconstruction.

Methods: A 60-year-old female with recurrent basal cell carcinoma of the right upper lip underwent excision, resulting in a defect extending from the lateral commissure to near the midline. Primary closure and local rotational flaps were not feasible due to the defect size and risk of excessive scarring. Reconstruction was performed using a pedicled Abbe flap harvested from the lower lip based on the inferior labial artery, with staged division at 19 days.

Experience: One patient was followed for three years postoperatively with objective functional assessment, sensory testing, and patient-reported outcome measures.

Results: Functional evaluation demonstrated preserved oral competence, bilabial articulation, and volitional lip movement. Quantified asymmetry was observed in upper lip elevation (7 mm reconstructed side vs. 10 mm contralateral) and lateral commissure excursion (10 mm vs. 14 mm). Lower lip depression remained symmetric. The patient reported no difficulty with eating, drinking, speaking, or social comfort across all domains. Sensory testing demonstrated intact two-point discrimination bilaterally, with mild reductions in nociception and temperature perception on the reconstructed side.

Conclusions: The Abbe flap provided durable restoration of both function and aesthetics for a large upper lip defect following oncologic resection. Objective long-term functional and sensory measurements support its reliability and highlight its effectiveness in preserving oral competence and articulation. This case contributes quantitative outcome data to an area of reconstructive literature that remains underreported.

References 1) Piccinin MA, Zito PM. Anatomy, head and neck, lips. StatPearls Publishing; 2025. 2) Luce EA. Upper lip reconstruction. Plast Reconstr Surg. 2017;140(5):999–1007. 3) Nyame TT, Pathak A, Talbot SG. The Abbe flap for upper lip reconstruction. Eplasty. 2014;14:ic30.

Background: Poland syndrome (PS) is characterized by the congenital absence or hypoplasia of the pectoralis major muscle, often associated with variable thoracic and upper limb anomalies. The latissimus dorsi flap is commonly used for reconstructive purposes in these patients, assuming a negligible functional role of this muscle. However, its actual contribution to shoulder motor control in the absence of the pectoralis major remains unclear. This study aims to investigate muscles activations of the scapulo-humeral region in patients with Poland syndrome to determine the functional deficit caused by the absence of pectoral muscles. Materials and Methods: A group of patients affected by PS were evaluated by a multidisciplinary team to assess shoulder joint mobility through specific and ultrasound tests followed by a bilateral surface electromyographic assessment characterized by a standardized protocol with specific tasks for the upper limbs (flexion, extension, abduction, adduction, and an arc-reaching task), for a total of 24 probes. Moreover, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb disability was completed by the patient during the visit. Synergy composition and temporal activation profiles were compared across tasks and groups. Results: Flexion tasks showed preserved synergy organization in Poland subjects, with no evidence of compensatory activation. In contrast, adduction and abduction revealed significant reorganization of muscle synergies in the agenesis group, with compensatory recruitment of the latissimus dorsi, upper trapezius, and triceps. This pattern was amplified under load and extended to complex multi-directional movements, suggesting an adaptive, task-dependent overactivation of the latissimus dorsi. Conclusions: The latissimus dorsi plays a selective compensatory role in shoulder movements requiring adduction and stabilization, partially supporting the absent pectoralis major. These findings highlight the importance of preserving the latissimus dorsi for functional balance and caution against its routine use in reconstructive surgery for Poland syndrome.

Background: Secondary lymphedema remains a frequent and disabling complication after deep axillary lymph node removal, and no pharmacologic prophylaxis is established. GLP 1 receptor agonists have metabolic and anti inflammatory effects that could plausibly modify lymphatic injury responses.

Methods: We performed a database study using the TriNetX-Research-Network. Female adults aged 18 years or older with breast cancer who underwent lumpectomy with either open excision of deep axillary lymph nodes (CPT 38525) or lumpectomy with axillary lymphadenectomy (CPT 19302) between July 2010 and July 2020 were eligible. Exposure was defined as any GLP 1 receptor agonist in ATC class A10BJ occurring from 3 months before the index procedure through 4.5 years after. Unexposed patients had no GLP 1 receptor agonist exposure at any time. Patients with prior lymphedema were excluded from outcome. One to one propensity score matching without replacement was performed separately for the axillary lymph node biopsy cohort and the axillary lymph node dissection cohort using demographics, body mass index, hemoglobin A1c reporting, cardiopulmonary comorbidities, tobacco use, chemotherapy, and radiation, with additional matching for hypertension and diabetes in the axillary lymph node dissection cohort. The primary outcome was incident lymphedema within five years, assessed using Kaplan Meier analysis and Cox proportional hazards models.

Results: In the axillary lymph node biopsy analysis, five year incident lymphedema occurred in 57 of 715 GLP 1 receptor agonist recipients (8.0%) and 119 of 756 matched controls (15.7%). GLP 1 receptor agonist exposure was associated with lower lymphedema risk (hazard ratio 0.508, 95% confidence interval 0.370 to 0.696, p < 0.001). In the axillary lymph node dissection analysis, lymphedema occurred in 25 of 103 exposed patients (24.3%) and 44 of 103 matched controls (42.7%), with lower risk in the exposed group (hazard ratio 0.513, 95% confidence interval 0.314 to 0.839, p < 0.007). Restricted mean lymphedema free survival time through five years favored exposure by 0.48 years, corresponding to approximately 173 additional lymphedema free days. In a supplemental matched analysis within GLP 1 receptor agonist unexposed patients, postoperative reduction in body mass index below 30 was not associated with a lower five year lymphedema incidence.

Conclusions: Among breast cancer patients undergoing lumpectomy with either deep axillary lymph node biopsy or complete axillary lymph node dissection, GLP 1 receptor agonist exposure was associated with substantially lower five year lymphedema risk in two independent surgical cohorts. The magnitude and consistency of the association, including a clinically interpretable gain in lymphedema free time after axillary lymph node dissection, supports the possibility that GLP 1 receptor agonists influence postoperative lymphatic outcomes beyond weight change alone. These findings are directly relevant as GLP 1 receptor agonist use continues to expand for metabolic and cardiovascular indications, meaning a growing subset of breast cancer patients may already be receiving these agents at the time of axillary surgery. Prospective studies should evaluate perioperative timing, dose and duration effects, and objective lymphatic endpoints to determine whether GLP 1 receptor agonists can be leveraged as a pragmatic risk modification strategy for secondary lymphedema.

Background: "Complete" and "incomplete" are commonly used descriptors of cleft lip in clinical documentation, outcomes research, and surgical technique reporting. However, the criteria that distinctly define these labels are inconsistently specified. Ambiguity in this definition can complicate patient stratification and constrain cross-sectional comparability. To address this gap, this review maps how the literature operationally defines cleft lip completeness and identifies the anatomic landmarks, classification systems, and terminology used to distinguish "complete" from "incomplete" cleft lips.

Methods: A scoping review was conducted using systematic search methods and a narrative synthesis. Five databases were queried in October 2025: PubMed, CINAHL, Cochrane, and Embase. The database query included cleft lip terms with severity descriptors. Two independent reviewers screened the records, with conflicts resolved by a third reviewer. Articles were included if the full text was in English and the literature provided explicit criteria, landmarks, or notations distinguishing between complete and incomplete cleft lips. Data extraction included verbatim definitions, severity/classification framework used, and a custom 0 to 2 utility appraisal across clarity, reproducibility, and generalizability.

Results: After removal of duplicates, a total of 1677 abstracts were screened. On secondary screening, 181 full text papers were reviewed and 35 studies met inclusion criteria. The included studies were published between 1962 and 2025, with the majority being cohort (n = 14, 40.0%) or educational (n = 9, 25.7%) studies. In most studies, the definition of complete or incomplete cleft lip was secondarily mentioned, while few studies explicitly sought to clarify the terminology or develop a new classification system. Definitions were clustered into five conceptual approaches: anatomical structures involved (n = 16, 45.7%), vertical height/length (n = 10, 28.6%), visual diagram (n = 6, 17.1%), musculature (n = 4, 11.4%), and other descriptive criteria not fitting into prior listed approaches (n = 8, 22.9%). Median clarity, reproducibility, and generalizability scores were each 1 on a 0-2 scale, indicating partially operational but nonstandardized criteria across studies.

Conclusion: Across the cleft literature, "complete" and "incomplete" are frequently invoked but often lack landmark-based, reproducible criteria. This lack of consistency impedes reproducibility in phenotypic reporting and limits the reliability of outcomes research. Harmonized terminology anchored to explicit anatomic landmarks and/or standardized notation may improve comparability in clinical reporting and advance precision in cleft care research.

Purpose: Immediate breast reconstruction may have psychosocial and aesthetic effects but may also result in more postoperative morbidity in patients with oncologic risk factors. This study examines early postoperative complication rates of immediate versus delayed-immediate breast reconstruction and identifies risk factors.

Methods: A retrospective cohort study was done using an institutional database of patients undergoing breast reconstruction after oncologic breast surgery. Patients were stratified through the timing of their reconstruction into immediate or delayed-immediate cohorts. Demographic characteristics, comorbidities, oncologic treatments, reconstructive modality, and perioperative variables were collected. The key outcome was any complication after surgery in the early postoperative period, such as infection, seroma/hematoma, wound complications, reoperation, or readmission. Analysis performed in univariate form and after performing multivariable logistic regression, independent predictors of complications were found.

Experience: Out of 100 patients that met the inclusion criteria, 72% underwent immediate reconstruction and 28% received delayed-immediate reconstruction. We present reconstruction procedures of implant and autologous type. Delayed-immediate reconstruction patients were more likely to have received adjuvant radiation therapy and neoadjuvant chemotherapy, and individuals undergoing immediate reconstruction had the same tendency to have received single-stage surgery compared with delayed-immediate reconstruction.

Results: 47% of patients had early postoperative complications. Immediate reconstruction was significantly more correlated with postoperative infection, wound complications and reoperation (p < 0.05) when applying univariate analysis. Multivariable analysis taking into account age, BMI, smoking history and radiation therapy, immediate reconstruction was also individually related to increased odds of postoperative complications (OR ~1.8–2.2, 95% CI ~1.1–3.5, p < 0.05). Radiation therapy and high BMI were also independent predictors of complications.

Conclusions: Immediate breast reconstruction is associated with an increased risk of early postoperative complications compared with delayed-immediate reconstruction, adjusting for patient and oncologic considerations. These observations confirm the value of personalized surgical design and risk stratification for counseling on the timing of reconstruction.

Purpose: Autologous fibrin sealants have been used as adjunctive materials to stabilize wound surfaces and control postoperative exudate in various surgical fields. CryoSeal®, an autologous fibrin sealant prepared from the patient's own plasma, offers theoretical advantages in safety over allogeneic products. However, its clinical impact on postoperative wound management in orthognathic surgery has not been well investigated. This study aimed to evaluate the effect of autologous fibrin sealant on postoperative mandibular drain output following orthognathic surgery. Methods: A retrospective cohort study was conducted including patients who underwent sagittal split ramus osteotomy (SSRO) with mandibular drain placement. Twenty-three consecutive patients treated with CryoSeal® between August and November 2025 were compared with twenty-four patients who underwent surgery without CryoSeal® between March and July 2025. Patients with concomitant genioplasty or syndromic craniofacial conditions were excluded to ensure cohort homogeneity. The primary outcome was cumulative mandibular drain output from postoperative day POD 1 to POD 4. Secondary analysis included multivariable linear regression in mandibular-only cases, adjusting for intraoperative blood loss. Results: The median cumulative mandibular drain output from POD 1 to POD 4 was lower in the CryoSeal® group compared with the non-use group (137 mL vs. 187.5 mL), although the difference did not reach statistical significance. In mandibular-only cases, multivariable linear regression demonstrated that CryoSeal® use was associated with a reduction in total drain output by approximately 25 mL; however, this association was not statistically significant. Intraoperative blood loss was not independently correlated with postoperative drain output. Conclusions: CryoSeal® use did not result in a statistically significant reduction in postoperative mandibular drain output following orthognathic surgery. Nevertheless, the consistent trend toward reduced drainage observed in regression analysis suggests a potential modest effect on postoperative wound environment stabilization. Given that drain output is a multifactorial surrogate marker influenced by surgical invasiveness and individual variability, the effect of autologous fibrin sealants may have been diluted in this outcome measure. CryoSeal® may serve as a safe adjunct for postoperative wound management rather than a potent hemostatic agent. Further prospective studies using more sensitive wound-related outcomes, such as hematoma formation or postoperative swelling, are warranted.

Purpose: Topical nitroglycerin is used commonly in breast reconstruction to prevent mastectomy flap necrosis but comes with a risk of developing clinically significant hypotension. We aimed to examine hypotension following Nitropaste administration in breast reconstruction patients and to identify associated risk factors.

Methods: We conducted a retrospective cohort study at a single tertiary academic center. Data were obtained using a SlicerDicer query to identify Nitropaste administrations by plastic surgeons between September 2023 and September 2025. Adult patients who underwent breast reconstruction procedures and received postoperative topical nitroglycerin paste were eligible for inclusion. Patients were excluded if they had other procedures or lacked documented blood pressure measurements after medication administration.

Blood pressure readings collected between 15 minutes and 8 hours following Nitropaste application were analyzed to correspond with the medication's expected duration of action. Hypotension was defined as either absolute mean arterial pressure (MAP) <65 mmHg or a relative decrease in MAP greater than 20% from baseline. The greatest observed reductions in MAP, systolic blood pressure, and diastolic blood pressure within this timeframe were recorded to assess the severity of hypotension.

Pre-operative data collected included age, sex, BMI, BSA, baseline blood pressure (last reading before surgery), presence of hypertension diagnosis, and antihypertensive medications; intra-operative data collected included procedure type, estimated blood loss (EBL), fluid administration, and laterality. Mastectomy weight was also recorded, including prior mastectomy if it was not performed at the time of reconstruction. Statistical analyses, including descriptive statistics, univariate testing, correlations, and linear regression models, were conducted using IBM SPSS Statistics Version 31.0.0.0. Linear regression models included the following independent variables: age, BMI, baseline MAP, EBL, intra-operative fluids, laterality, and antihypertensive medications.

Results: The query identified 120 patients who received topical Nitropaste to the breast(s) following post-mastectomy breast reconstruction by plastic surgeons. Within the defined pharmacokinetic window, 34 patients (28.3%) experienced at least one episode of absolute hypotension (MAP <65 mmHg), and 64 patients (53.3%) had a relative MAP decrease greater than 20% from baseline.

On linear regression analysis, higher baseline MAP (β = 0.632, 95% CI 0.448–0.815, p <0.001) and greater estimated blood loss (β = 0.026, 95% CI 0.004–0.048, p = 0.022) were significantly associated with a greater reduction in MAP after Nitropaste administration. (Model adjusted R² = 0.308.) In a second multivariable model evaluating systolic blood pressure, higher baseline MAP (β = 0.790, 95% CI 0.515–1.065, p <0.001) and greater estimated blood loss (β = 0.038, 95% CI 0.004–0.071, p = 0.027) were significantly associated with a greater decrease in systolic blood pressure. (Model adjusted R² = 0.276.) No other included variables were significantly associated with either MAP or systolic blood pressure reduction.

Conclusions: Hypotension following topical nitroglycerin application in breast reconstruction patients is not uncommon. Higher baseline MAP and greater intra-operative blood loss were independently associated with greater post-operative blood pressure decline. These findings may assist surgeons in identifying patients at higher risk for this complication and optimizing post-operative management.

Introduction The inframammary fold (IMF) represents an essential anatomical landmark for the aesthetic and functional definition of the breast. Its integrity provides inferior support, determines nipple projection, and contributes decisively to thoracic symmetry. Recreation of the IMF poses a technical challenge, requiring stable fixation, appropriate curvature, and minimal morbidity (1). Various methods have been proposed for IMF recreation, which can be classified into four main categories: use of local tissues, suture suspension, external devices, and acellular dermal matrices (2). In this article, we describe the technique originally utilized by Handel and Jensen since 1988, which employs local tissues (adipofascial flap) for IMF recreation (3). However, in this clinical case, it was adapted from its original description for implant- or expander-based breast reconstruction to use solely autologous local tissues.

Clinical Case A 52-year-old woman sustained high-energy motor vehicle trauma with seatbelt-related right thoracic injury: multiple rib fractures, pectoralis major disinsertion, medial IMF loss with inferior pole deficit, and nipple-areola complex displacement. Reconstructive committee planned secondary breast reconstruction with pectoralis repositioning, volume symmetrization, and IMF recreation.

Surgical Technique Under general anesthesia, a lateral IMF incision was performed, followed by subglandular dissection and pectoralis muscle mobilization; the pectoralis muscle flap was then advanced and fixated. An inferior skin flap was dissected in a deep plane above the thoracoabdominal fascia to mobilize it to the neofold position. An adipofascial flap incorporating Scarpa's fascia was created. The adipofascial flap was anchored to the thoracic wall, forming the neo-IMF. Finally, the breast gland was mobilized and positioned to fill the inferior pole. In a second-stage procedure, lipotransfer was performed for right breast symmetrization.

Results The patient exhibited favorable evolution without complications. The neo-IMF demonstrated adequate definition and symmetry with the contralateral breast from the first follow-up visit. Subsequent lipotransfer achieved mammary symmetrization. The patient reported high satisfaction with the aesthetic outcome and improvement in body image.

Conclusions Although multiple techniques exist for its reconstruction, they must be selected and tailored to each case. In this instance, the patient's adipofascial flap and autologous breast gland mobilization were utilized instead of implants or expanders. This modification of the Handel and Jensen technique demonstrates an innovative and effective adaptation for managing post-traumatic breast defects. This approach not only preserved native tissue, minimizing complications associated with prostheses or expanders, but also achieved satisfactory aesthetic and functional reconstruction with appropriate IMF restoration and breast symmetry. These findings underscore the value of customizing established techniques to the clinical context, promoting safe and accessible reconstructive options in acute trauma settings, particularly in resource-limited environments.

References 1. Nava M, Quattrone P, Riggio E. Focus on the breast fascial system: a new approach for inframammary fold reconstruction. Plast Reconstr Surg. 1998;102(4):1034-1045. 2. Kraft CT, Rendon JL, Koutz CA, et al. Inframammary fold reconstruction in the previously reconstructed breast: a comprehensive review. Plast Reconstr Surg. 2019;143(4):1019-1029. 3. Handel N, Jensen JA. An improved technique for creation of the inframammary fold in silicone implant breast reconstruction. Plast Reconstr Surg. 1992;89(3):558-562.

Purpose: Oronasal fistula formation and velopharyngeal insufficiency remain significant complications following cleft palate repair. Intraoral flaps and biologic tissue adjuncts have been increasingly adopted to reinforce palatal closure and improve functional outcomes. This systematic review evaluates the impact of intraoral flaps and tissue adjuncts on fistula formation, velopharyngeal outcomes, reoperation rates, and flap-related complications in primary and secondary palatoplasty.

Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane was conducted through January 2026. Comparative and analytical studies evaluating intraoral flaps or tissue adjuncts in pediatric or adolescent patients undergoing primary or secondary palatoplasty were included. Outcomes of interest were oronasal fistula formation, velopharyngeal insufficiency, hypernasality, speech intelligibility, need for reoperation, and flap-related complications. Case reports, narrative reviews, non-peer-reviewed literature, and studies without postoperative outcomes were excluded. A total of 1,563 records were identified. After duplicate removal, 1,263 records underwent screening. Fifty-three full-text articles were assessed for eligibility, and 25 studies comprising 2,415 patients met inclusion criteria.

Results: Included studies were predominantly retrospective cohorts, with limited prospective studies and randomized controlled trials. Interventions included buccinator myomucosal flap, buccal fat pad flap, double-opposing Z-plasty with or without flap reinforcement, facial artery musculomucosal flap, acellular dermal matrix, and platelet-rich plasma. Across studies reporting fistula outcomes, intraoral flap use was consistently associated with lower fistula rates compared with conventional techniques. Reported fistula incidence ranged from 0% to 6.1% in flap-augmented repairs, compared with rates up to 18.8% in non-reinforced groups. In comparative cohorts, buccinator myomucosal flap use demonstrated lower fistula rates (1.4% vs 9.1%) and lower overall reoperation rates (7.1% vs 36.4%). Velopharyngeal outcomes were heterogeneously reported using ordinal scales and continuous measures. Studies demonstrated higher proportions of competent velopharyngeal function and lower grades of hypernasality in flap-reinforced groups. Continuous assessments showed significant reductions in hypernasality following buccinator flap–augmented repair, with mean reductions exceeding one severity grade in selected cohorts. Reoperation rates were generally lower in reinforced repairs, though variability across techniques and study designs was substantial. Flap-related complications were infrequently reported. Partial buccal fat pad necrosis occurred in one series but resolved without long-term sequelae. Only one study evaluated morphometric palatal development, demonstrating improved transverse dimensions in flap-augmented repairs.

Conclusions: Intraoral flaps and biologic adjuncts in cleft palate repair are associated with consistently lower fistula rates and favorable velopharyngeal outcomes compared with non-reinforced techniques. However, heterogeneity in outcome reporting and the limited number of randomized studies constrain definitive conclusions. Current evidence supports flap reinforcement as a valuable adjunct in both primary and secondary palatoplasty while highlighting the need for standardized outcome measures and prospective comparative research.

Background: Parry-Romberg syndrome (PRS) is a rare progressive hemifacial atrophy with limited data detailing long-term outcomes of reconstruction. Given variability in disease progression and treatment strategies, longitudinal outcomes of management are seldom reported. We present a woman with moderate PRS nearly six decades from disease onset and over 40 years since first surgical intervention, detailing multiple reconstructive and revision procedures throughout her lifetime.

Case Presentation: Hemifacial atrophy was first noted around age 5 (circa 1967) and progressed throughout childhood. She underwent initial reconstruction as a teenager (circa 1980) with placement of an alloplastic malar implant. At age 28, she was formally diagnosed with PRS and underwent omental free flap reconstruction. Between 1990 and 2007, she required multiple revision procedures including flap resuspension, implant removal due to infection, and soft tissue augmentation with AlloDerm.

Seventeen years later, at age 61, she presented with progressive left facial ptosis and associated pain. Between 2024 to 2025, she underwent staged procedures including elevation and repositioning of previously placed adipofascial flap, removal of calcified implant material, autologous fat grafting, and liposuction contouring. She also underwent adjunctive procedures including right-sided neck lift and bilateral upper and lower blepharoplasties. She recovered without complications and remains satisfied with her results at most recent follow-up.

Conclusion: This case represents one of the longest documented follow-ups of PRS reconstruction, spanning nearly six decades from disease onset and over 40 years since initial surgical intervention. It highlights the durability of free tissue transfer despite repeat revision procedures and the role of serial fat grafting in managing progressive hemifacial atrophy. Long-term follow-up underscores the need for adaptable, lifelong reconstructive planning in treating PRS and may help guide expectations for future patients considering surgical management.

Capsular contracture (CC) remains a common complication of implant-based breast surgery. Subclinical biofilm formation has been implicated as a potential driver of chronic periprosthetic inflammation and capsular fibrosis (1,2). This study evaluates the presence, diversity, frequency, and relative intensity of biofilm-associated microorganisms in patients undergoing implant removal for CC within a single-surgeon practice using polymerase chain reaction (PCR) analysis.

A retrospective cohort study was conducted from 2019 to 2025 in a single-surgeon practice. Inclusion criteria consisted of patients undergoing implant removal for capsular contracture. Patients with incomplete medical records or explantation for unrelated causes, including active infection, hematoma, extrusion, or implant exchange solely for aesthetic concerns, were excluded. Collected variables included age, ethnicity, body mass index, smoking status, and comorbidities such as diabetes and autoimmune disorders. Surgical management was categorized as en bloc capsulectomy, implant removal without capsulectomy, or implant exchange. Periprosthetic specimens were analyzed via PCR to assess microbial presence and relative burden.

Fifty-three patients representing 62 breasts met inclusion criteria. Forty-four patients underwent bilateral explantation and 9 underwent unilateral procedures. Mean age was 48 years (SD 10). PCR detected microbial DNA in 29 patients (47%), while 53% demonstrated no detectable growth. Forty-seven distinct microbial species were identified, including 8% fungal organisms.

Among the 12 most common organisms by frequency and relative intensity, Cutibacterium acnes was most prevalent, followed by Staphylococcus epidermidis and Corynebacterium tuberculostearicum. Heat map analysis demonstrated highest PCR signal intensity among Pseudomonas fluorescens, Bacillus cereus, Cutibacterium acnes, Staphylococcus epidermidis, Malassezia restricta, Staphylococcus saccharolyticus, and Staphylococcus simulans. These findings support a polymicrobial biofilm profile consistent with prior literature identifying low-virulence skin commensals in implant-associated capsule pathology (1,3).

Compared with previously published series, including those by Cook and colleagues and Virden et al., this cohort demonstrated a slightly lower overall PCR positivity rate but a higher relative incidence of Cutibacterium acnes, Staphylococcus epidermidis, and Corynebacterium tuberculostearicum (3,4). Differences in detection methodology and sampling technique may contribute to interstudy variability (5).

In this single-surgeon cohort, nearly half of breasts undergoing explantation for capsular contracture demonstrated detectable periprosthetic microbial DNA. The predominance of biofilm-capable organisms and observed microbial diversity support the hypothesis that chronic polymicrobial colonization may contribute to capsular fibrosis. Prospective, multi-institutional studies with standardized sampling protocols are warranted to further clarify causality and optimize prevention strategies.

References

Tamboto H, Vickery K, Deva AK. Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg. 2010;126:835–842.

Hu H, Johani K, Almatroudi A, et al. Bacterial biofilm infection detected in breast implant-associated capsular contracture. Plast Reconstr Surg. 2016;137:1659–1669.

Cook JL, Ahn C, et al. Microbial profiles in capsular contracture: culture and molecular analysis. Aesthet Surg J. 2012;32:xxx–xxx.

Virden CP, Dobke MK, Stein P, et al. Subclinical infection of the breast prosthesis capsule. Plast Reconstr Surg. 1992;89:1091–1098.

Achermann Y, Goldstein EJC, Coenye T, Shirtliff ME. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev. 2014;27:419–440.

Introduction and Aims:

Longitudinal melanonychia (LM) is a common nail pigmentation presentation, often benign but occasionally indicative of subungual melanoma, a rare yet aggressive malignancy. This study has been conducted to assess whether nail bed biopsy is mandatory in every case of LM and to review diagnostic outcomes and complications associated with nail bed biopsy.

Methods:

A retrospective cohort study of 110 consecutive patients presenting with longitudinal melanonychia were all biopsied and assessed over 12 months (January 2023- December 2023). Demographics, family and personal history of melanoma, clinical features, management strategies, complications and histopathological findings were reviewed.

Results:

Mean age was 57 years (Range 18-90 years). 59.1% of patients were female. Lesion duration ranged from 1-9 months, with the mean duration being 3 months. 92.7% of the patients had single nail involvement. Trauma association was 5.5%. Family and personal history of melanoma was present 4.5% and 2.7% of patients respectively. Subungual melanoma was diagnosed in only 1 patient (0.9%) (obvious clinical features, wide dark asymmetrical melanonychia and positive Hutchinson sign), with the majority (109/110) being benign or non-specific. Complications occurred in 20% of patients including nail deformities, ridging and refractory complex regional pain syndrome.

Conclusion:

Nail bed biopsy remains the gold standard for diagnosis in cases with suspected clinical features but carries a risk of complications. Careful selection of patients and thorough consent is critical. This study has demonstrated that nail bed biopsy is not necessary in majority of low-risk patients and can be managed conservatively with clinical and photographic follow up.

Purpose: Treacher Collins syndrome (TCS) is classically described as a bilateral and symmetric mandibulofacial dysostosis. In clinical practice, however, meaningful left–right differences are observed. Although mandibular and zygomatic hypoplasia correlate in magnitude, it remains unclear whether asymmetry, when present, is coordinated in sidedness across structures. We sought to characterize the relationship between mandibular and zygomatic asymmetry in a genetically confirmed TCS cohort and determine the morphologic drivers of discordance. Methods: Patients with genetically confirmed TCS treated between 2012 and 2026 were retrospectively reviewed. Inclusion required preoperative CT imaging prior to skeletal reconstruction. Right and left hemifaces were graded independently for mandibular and zygomatic severity. Asymmetry was defined as a ≥1-grade difference between sides within a structure. Ipsilateral severity correlations were assessed using Spearman correlation with partial correlation controlling for age. Angular and condylar components of mandibular morphology were analyzed separately. Results: Twenty-eight patients (56 hemifaces) were included at a mean age of 6.4 ± 5.4 years. Ipsilateral mandibular and zygomatic severity were significantly correlated (ρ = 0.52, p < 0.001) and remained significant after controlling for age (partial ρ = 0.46, p = 0.00030), confirming coordinated overall skeletal burden. Despite concordance in magnitude, laterality was largely discordant. Most patients (71%) were symmetric in both structures. Mandibular asymmetry occurred in 18% of patients and zygomatic asymmetry in 14%, yet only one patient (3.6%) demonstrated asymmetry in both structures with concordant sidedness (Fisher's exact p = 1.0). Asymmetry in the mandible and zygoma therefore appeared independent rather than coordinated. Among mandibular-asymmetric patients, discordance was driven primarily by angular variation. All five asymmetric patients (100%) demonstrated inter-side Co–Go–Me grade differences, whereas only two (40%) had discordant condylar grades. Inter-side Co–Go–Me angle differences ranged from 5° to 12° (mean 8° ± 3°), frequently crossing grading thresholds and resulting in side-to-side composite grade differences. From a reconstructive standpoint, 77% of hemifaces demonstrated condylar morphology amenable to distraction, while 23% had absent condyles. Condylar absence corresponded strongly with higher composite mandibular severity (median grade 4 vs 2, p < 0.001), although 21% of hemifaces with a present condyle still exhibited composite grades ≥3. Age-related differences were observed in angular measures, with Co–Go–Me angle correlating inversely with age (ρ = −0.42, p = 0.0015) and SNB correlating positively (ρ = 0.50, p = 0.0074), whereas condylar grade did not correlate with age (p = 0.11). Conclusions: In genetically confirmed TCS, mandibular and zygomatic hypoplasia correlate in overall severity but not in laterality. Asymmetry, when present, is structure-specific and predominantly angular rather than condylar. These findings support a model in which global neural crest depletion produces coordinated skeletal severity, while stochastic regional effects determine sidedness. Clinically, this dissociation reinforces the need for hemiface-specific evaluation and side-specific reconstructive planning, particularly when determining distraction candidacy and vector design.

Lint is a fuzzy accumulation of tiny fibers that can deposit on surgical materials such as sutures, guidewires, or catheters and elicit a foreign body reaction (1). Sutures may act as a vector to transport lint during invasive procedures and surgery. Knotless or barbed sutures are used in plastic and reconstructive surgery to evenly distribute tension and reduce operating times (2), but whether their engineered barbs capture lint is unknown. This pilot study quantifies the number of lint fibers that adhere to regular versus barbed absorbable poliglecaprone 25 sutures dragged across commonly used operative fabrics. 24 Ethicon Monocryl (regular) and 48 Ethicon Stratafix (barbed) sutures were dragged across surgical textile in reproducible linear motion, using a 13.5-degree incline plane design with weighted trolleys. The following textiles were used: Halyard Ultra Surgical Gown (SMS polypropylene), Medline Deluxe X-ray OR Towels (100% cotton), Medline Full Drape (100% polypropylene SMS), and Rx Only Towels (100% cotton). Sutures were dragged a 21.5 cm distance in single-pass or five-pass conditions. Using light microscopy, a human grader quantified the number of lint particles. Wilcoxon rank-sum tests were used to evaluate differences in lint accumulation for two-group comparisons, and Kruskal–Wallis tests for comparisons across multiple textile brands. Statistical significance was defined as a two-sided p-value < 0.05. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Mean lint accumulation was statistically significant with a significantly greater lint accumulation on barbed sutures compared to regular sutures (23.5 [IQR 27.0] vs 0.0 [0.0]; p < 0.001). Lint fibers were seen clustered around the barbs. Sutures exposed to five passes demonstrated twice the number of lint accumulation compared to those with a single pass (35.5 [25.0] vs 14.5 [12.5]; p = 0.0002). There was a statistically significant difference across all the textile brands (p=0.0022), with a higher lint accumulation using Medline Deluxe X-ray OR Towels (49.0 [37.5]). The second highest lint accumulated using Rx Only Towels (27.5 [22.5]) followed by Medline Full Drape (22.0 [19.0]) and the least lint accumulated using Halyard Ultra Surgical Gown (15.5[10.0]). A striking amount of microscopic lint accumulated on barbed sutures, clustered around the barbs. This supports the hypothesis that lint adheres to barbed sutures as compared to smooth monofilament sutures. Twice the lint fibers accumulated from one to five passes, suggesting that lint progressively accumulates at the attachment site (barbs) over repeated passes. Our results also suggest that that cotton textiles transfer the most lint to barbs. Surgeons should minimize the times a barbed suture is dragged over the sterile field to minimize foreign body reactions.

1. Truscott W. Lint Fiber–Associated Medical Complications Following Invasive Procedures | AAMI News. April 28, 2021. Accessed February 11, 2026. https://array.aami.org/content/news/lint-fiber-associated-medical-complications-following-invasive-procedures
2. Nambi Gowri K, King MW. A Review of Barbed Sutures-Evolution, Applications and Clinical Significance. Bioengineering. 2023;10(4):419. doi:10.3390/bioengineering10040419

Background: Mental health conditions such as anxiety and depression are common among patients seeking body contouring procedures, yet psychiatric comorbidities are often under-recognized during preoperative evaluation and their impact on surgical outcomes remains poorly defined. (1) Understanding whether these diagnoses independently increase postoperative risk is directly relevant to perioperative optimization, complication counseling, and shared decision-making in aesthetic and reconstructive practice. (2) We hypothesized that patients with anxiety and/or depression would demonstrate higher 30-day postoperative complication rates following abdominoplasty compared to panniculectomy compared with patients without psychiatric diagnoses, even after controlling for medical comorbidities. We also hypothesized that patients undergoing abdominoplasty would have greater post-operative complications than patients undergoing panniculectomy.

Methods: A retrospective cohort study was performed using the TriNetX federated electronic health record database. Adult patients undergoing abdominoplasty (CPT15847) or panniculectomy (CPT15830) between 2012 and 2022 were identified. Anxiety and depression were defined using ICD-10 codes (F32–33, F40–41). Propensity score matching controlled for age, sex, race, ethnicity, BMI, diabetes mellitus, and nicotine dependence. Thirty-day postoperative complications included hematoma, seroma, surgical site infection (SSI), wound dehiscence, deep vein thrombosis (DVT), pulmonary embolism (PE), incision and drainage (I&D), debridement, and overall complication rate. Odds ratios (OR) with 95% confidence intervals were calculated.

Results: Among 22,911 patients undergoing abdominal body contouring procedures, 35% carried a diagnosis of anxiety and/or depression. After matching, 3,068 abdominoplasty patients and 3,551 panniculectomy patients were analyzed. In abdominoplasty patients, psychiatric comorbidity was associated with a significantly increased overall complication rate (7.66% vs 4.79%; OR 1.64, 95% CI 1.32–2.02; p<0.001), increased risk of SSI (OR 1.79, p=0.015), wound dehiscence (OR 1.55, p=0.015), and I&D (OR 2.06, p=0.002). No differences were observed in hematoma, seroma, DVT/PE, or debridement. In panniculectomy patients, psychiatric comorbidity was not associated with an increased overall complication rate (8.90% vs 8.03%; OR 1.12, p=0.186), although I&D remained higher (OR 1.48, p=0.035).

Conclusion: Anxiety and depression were associated with increased 30-day post-operative complication rates following cosmetic abdominoplasty, particularly infection-related and wound-healing complications. In contrast, panniculectomy patients with psychiatric comorbidities did not demonstrate increased overall complication rates, apart from increased I&D. The functional nature of panniculectomy and potentially larger resection volumes may play a greater role in outcomes for this cohort. Additionally, the impact that underlying anxiety and depression has on postoperative behaviors including compliance with wound care and activity restriction may contribute to the increased complications observed after abdominoplasty in this patient population. These findings highlight the importance of incorporating mental health assessment into preoperative evaluation, particularly in aesthetic body contouring patients. Future prospective studies evaluating resection characteristics, adherence metrics, and perioperative mental health optimization strategies are warranted.

1. Marron Mendes V, Diluiso G, Jidjouc Kamdem C, et al. Prevalence of Psychiatric Disorders in Aesthetic Surgery. Ann Plast Surg. 2023;91(4):413-421. doi:10.1097/SAP.0000000000003682
2. Amro C, Chang AE, Ewing JN, et al. The Impact of Psychiatric Comorbidities on Outcomes and Quality of Life in Plastic Surgery: A Literature Review & Matched Analysis. Plast Reconstr Surg. Published online August 26, 2025. doi:10.1097/PRS.0000000000012410

Purpose:

Nailbed injuries are traditionally repaired by removing the entire nail plate to repair the sterile matrix. The nail is then replaced under the eponychium to prevent synechiae and provide stability, especially when there is an associated fracture. In recent years, we have begun repairing nailbed injuries by lifting up the nail plate without removing it from the nailbed, and suturing the proximal end of the nail plate back under the eponychium after completing the repair. We propose that repairing simple nailbed lacerations or proximal nail avulsions without removal of the nail plate does not significantly affect outcomes of nail cosmesis or fracture healing.

Methods:

Patients who sustained nailbed lacerations or proximal nail avulsion injuries between 2012-2025 and subsequently followed up at a single hand surgery institution were included. Demographic, injury pattern, operative, and postoperative variables were recorded. Patients were stratified by whether they underwent repair of the nailbed injury with the nail removed (open repair) or not removed. Univariate analyses were performed.

Results:

In total, 90 nailbed injuries were included in the study. Injuries occurred most frequently on middle (34.4%) and ring (25.6%) fingers, and on the non-dominant hand (56.3%). Distal phalanx fractures were commonly associated with nailbed injuries (87.8%). Of all cases, 47% were repaired open and 53% were repaired with the nail left attached distally on the nailbed. Whether the nail plate was removed for the repair was not significantly associated with presence of fracture (p=0.8964) or mechanism of injury (p=0.1517) but was more frequently performed when there was damage to the germinal matrix (p=0.0261). There was no significant difference in average time to new nail growth (p=0.5329) or clinical fracture healing (0.6583) associated with repair type. Rates of cosmetic deformity (p=0.2883) and necessity for revision or reconstruction of the nail bed (p=0.0635) were also not significantly different with or without nail plate removal.

Conclusion:

Nailbed injuries are one of the most common traumatic hand injuries, and nail plates are conventionally removed for repair. We have found that keeping the nail plate in place where it remains adherent to the nailbed while the repair is completed does not significantly affect outcomes.

Background: Loss of breast sensation following mastectomy and reconstruction with a Deep Inferior Epigastric Perforator flap (DIEP) remains a significant contributor to patient dissatisfaction, impaired body image, and reduced quality of life. Flap neurotization, a specialized microsurgical technique involving sensory nerve coaptation, has gained increasing attention as a strategy to restore sensation. However, neurotization is technically demanding, performed in select centers, and remains relatively uncommon. Its benefits are debated, given the increased operative time and cost. Furthermore, outcomes such as new mental health diagnoses and clinically coded sensory disturbances are relatively infrequent, making them difficult to detect in smaller institutional studies. Large, multi-institutional databases may therefore provide a more reliable assessment of population-level effects.

Methods: A retrospective cohort study was conducted using the TriNetX Global Research Network. Patients undergoing DIEP flap breast reconstruction were identified using CPT codes. Cohorts were stratified by concurrent nerve-graft coding (neurotized vs. non-neurotized flaps). Propensity score matching (1:1) was performed for age, ethnicity, history of radiation therapy, diabetes, and smoking status, resulting in 586 patients per group (1,172 total). Outcomes assessed included acute and chronic postprocedural pain, new diagnoses of postoperative depression or anxiety, and sensory disturbances, including hyperparesthesia. Statistical significance was defined as p < 0.05.

Results: After matching, 1,172 patients were included (586 neurotized; 586 non-neurotized). Rates of acute postoperative pain and chronic pain were similar between groups, with no statistically significant differences observed. Likewise, the incidence of new postoperative depression or anxiety diagnoses did not differ between cohorts. Sensory disturbance rates were comparable overall; however, there was a trend toward increased hyperparesthesia in the neurotized group (mean 2.79 vs. 1.93), which approached but did not reach statistical significance (p = 0.06).  

Conclusions: In this large, propensity-matched analysis of DIEP flap breast reconstruction, neurotization was not associated with reduced postoperative pain or lower rates of depression or anxiety. A non-significant trend toward increased hyperparesthesia was observed in the neurotized cohort. While large database studies are particularly useful when evaluating uncommon procedures and relatively rare outcomes, administrative data may not capture subtle sensory improvements or patient-reported quality-of-life changes. Prospective studies incorporating standardized sensory testing and validated patient-reported outcome measures are needed to more definitively determine the clinical value of flap neurotization and whether its additional operative time and cost are justified.

Background: Severe burn injury induces a prolonged hypermetabolic and hypercatabolic response contributing to muscle loss, immune dysfunction, and delayed wound healing (1). Early nutritional support is a cornerstone of burn care and is associated with improved recovery and clinical outcomes (2). Burn injury also leads to micronutrient depletion and oxidative stress, prompting investigation into supplementation strategies (3). Despite documented disparities in burn incidence and outcomes, nutrition studies rarely evaluate differences across racial and socioeconomic groups (4). This study aims to characterize the literature on nutritional interventions in burn wound healing and identify gaps in reporting race, ethnicity, and socioeconomic status. Methods: This systematic review followed PRISMA 2020 guidelines. Scopus and Embase were searched without date restrictions for human studies evaluating nutritional interventions in burn populations. Eligible studies included randomized controlled trials and prospective or retrospective cohort studies reporting wound-related or clinically relevant burn outcomes. Extracted variables included study design, intervention type, route and timing of delivery, outcomes assessed, and reporting of race, ethnicity, and socioeconomic indicators. Owing to heterogeneity in design and outcomes, findings were synthesized descriptively. Results: Of 3,351 records identified, 18 studies met the inclusion criteria. Interventions included micronutrient supplementation (38.9%), macronutrient-focused strategies (27.8%), and mixed immunonutrition approaches (22.2%). Enteral nutrition was the predominant route of delivery, with wound healing, infection rates, and length of stay being the most frequently reported outcomes. Zinc and vitamin D were the most commonly studied micronutrients, while early enteral feeding and high-protein regimens formed the basis of macronutrient interventions. Overall, studies suggested potential benefits in metabolic, infectious, and wound-related outcomes, although findings were heterogeneous. Reporting of race, ethnicity, and socioeconomic status was limited: race or ethnicity was reported in only 22.2% of studies, socioeconomic indicators in 16.7%, and no study performed stratified analyses by demographic subgroup. Conclusion: Nutritional interventions are consistently recognized as integral to burn recovery, yet the evidence base remains heterogeneous and lacks equity-focused reporting. The limited inclusion and analysis of race, ethnicity, and socioeconomic factors represent a critical gap that constrains the generalizability of current recommendations. Future research should incorporate standardized demographic reporting and evaluate differential intervention effects across diverse populations to support more equitable, evidence-based burn nutrition care. References: (1) Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Primers. 2020;6(1):11. Published 2020 Feb 13. (2) Rousseau AF, Losser MR, Ichai C, Berger MM. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32(4):497-502. (3) Berger MM, Baines M, Raffoul W, et al. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations. Am J Clin Nutr. 2007;85(5):1293-1300. (4) Peters J, Bello MS, Spera L, Gillenwater TJ, Yenikomshian HA. The Impact of Race/Ethnicity on the Outcomes of Burn Patients: A Systematic Review of the Literature. J Burn Care Res. 2022;43(2):323-335.

Purpose: Velopharyngeal insufficiency (VPI) is a structural defect characterized by inadequate closure of the velum against the posterior pharyngeal wall, resulting in inappropriate nasal airflow during speech production (1). Clinically, VPI presents with hypernasal resonance, particularly during production of non-nasal phonemes, and is commonly associated with cleft lip and/or palate and other soft palate abnormalities (2). While surgical interventions such as pharyngoplasty are effective for severe VPI, management of mild to moderate cases remains variable (3). Autologous fat grafting (FG) has emerged as a less invasive alternative; however, data regarding patient selection, operative technique, and objective speech outcomes remain limited (4,5). This study evaluates speech outcomes following fat grafting in pediatric patients with VPI using changes in Simplified Nasometric Assessment Procedures (SNAP) scores as the primary outcome measure.

Methods: A 10-year longitudinal case series was conducted at a single institution. Pediatric patients with confirmed VPI who underwent fat grafting as their primary surgical intervention and had available pre- and postoperative SNAP scores were included. Demographic variables, operative details, and speech outcomes were analyzed. Descriptive statistics were used for continuous variables. Changes in SNAP scores were evaluated using the Hodges–Lehmann estimator to calculate median differences, and statistical significance was assessed using the Wilcoxon rank-sum test. A nonparametric approach was selected given the small sample size and anticipated non-normal distribution of speech outcome data.

Results: Seven patients (8 procedures) met inclusion criteria. Mean age was 6.3 ± 2.3 years, and mean BMI was 16.6 ± 2.0 kg/m². All patients were Caucasian. Five patients had previously repaired cleft lip and/or palate, and two had associated syndromes. Mean graft volume was 7.4 ± 2.3 mL. No perioperative complications occurred. One patient required repeat fat grafting, and one subsequently underwent pharyngoplasty. The mean interval from preoperative assessment to FG was 160 days, and from FG to postoperative assessment was 118 days.

Median reductions in SNAP scores were −11 (bilabial), −16 (lingual-alveolar), −12 (velar), −13 (sibilant fricative), and −1 (nasal). Hodges–Lehmann confidence intervals and corresponding Wilcoxon p-values were: bilabial (−24 to 1; p=0.078), lingual-alveolar (−31 to 0; p=0.075), velar (−25 to 3; p=0.078), sibilant fricative (−21 to −8; p=0.078), and nasal (−6 to 3; p=0.469).

Conclusion: Clinically meaningful improvements in speech were observed following a single fat grafting procedure in select pediatric patients with VPI. Although statistical significance was not achieved, likely due to limited sample size, the direction and magnitude of improvement were consistent across non-nasal phoneme categories. Fat grafting may represent a viable minimally invasive option for patients with elevated SNAP scores who do not meet criteria for more invasive surgical intervention. Larger studies are needed to define optimal patient selection and evaluate long-term durability of outcomes.

References: 1. Adams S, Xoagus EA, Lazarus D, Lentin R, Hudson DA. Autologous Fat Grafting for the Treatment of Mild to Moderate Velopharyngeal Insufficiency. Journal of Craniofacial Surgery. 2019 Nov;30(8):2441–4. doi:10.1097/SCS.0000000000005337 2. Panizza R, Ghiglione M, Zingarelli EM, Massa M, Carlini C, Arnoldi R, et al. Autologous fat grafting in the treatment of velopharyngeal insufficiency: Clinical outcomes and treatment tolerability survey in a case series of 21 patients. Indian J Plast Surg. 2018;51(2):145–54. doi:10.4103/ijps.IJPS18317 PubMed PMID: 30505084; PubMed Central PMCID: PMC6219368. 3. Impieri D, Tønseth KA, Hide Ø, Feragen KJB, Høgevold HE, Filip C. Autologous fat transplantation to the velopharynx for treating mild velopharyngeal insufficiency: A 10-year experience. J Plast Reconstr Aesthet Surg. 2019 Aug;72(8):1403–10. doi:10.1016/j.bjps.2019.03.040 PubMed PMID: 31103609. 4. Denadai R, Sabbag A, Vieira PR, Raposo-Amaral CA, Buzzo CL, Raposo-Amaral CE. Predictors of Speech Outcome in Posterior Pharyngeal Fat Graft Surgery for Velopharyngeal Insufficiency Management. J Craniofac Surg. 2020;31(1):41–5. doi:10.1097/SCS.0000000000005802 PubMed PMID: 31369510. 5. Phua YS, Edmondson MJ, Kerr RJ, Macgill KA, Teixeira RP, Burge JA. Safety and Efficacy Concerns of Autologous Fat Grafting for Velopharyngeal Insufficiency. Cleft Palate Craniofac J. 2018 Mar;55(3):383–8. doi:10.1177/1055665617739002 PubMed PMID: 29437518.

Background: Postoperative morbidity associated with inguinal lymph node dissection (ILND) for the management of regional metastases in cutaneous melanoma patients has been well documented with high rates of lymphoedema, wound site infection, dehiscence, seroma, and haematoma formation.

Objective: This study systematically reviewed current strategies to optimise wound healing and reduce post-operative complications in patients undergoing open ILND for cutaneous melanoma.

Methods: In accordance with PRISMA guidelines, a literature search from January 2000 to April 2025 was conducted across Embase, Cochrane and MEDLINE databases. Randomised controlled trials (RCTs) and non-randomised cohort studies with interventions aimed at reducing wound complications were included.

Results: Of the 449 articles initially identified, 19 studies (9 RCTs and 10 comparative cohort studies) were included. Notable interventions included the use of negative pressure wound therapy (NPWT) which showed significant reduction in seroma formation and re-operation rates. Output-guided drain removal was associated with significant reductions in seroma formation, infection, and length of hospital stay compared to time-based removal.

Conclusion: Few interventions are supported by high-quality, reproducible evidence, largely due to small or unbalanced sample sizes. Further prospective, standardised trials are needed to establish effective, evidence-based protocols for minimising wound complications following ILND in melanoma patients.

Purpose: Preoperative optimization, or "prehabilitation," has emerged as a critical component of surgical care, particularly within oncological, colorectal, and orthopaedic surgery. In these specialties, prehabilitation focused on improving sleep, nutrition, and exercise has been associated with decreased postoperative complications, particularly in high-risk patients with modifiable risk factors. Despite the growing evidence and adaptation of prehabilitation in other surgical specialties, its use in plastic surgery remains unexplored. This systematic review aims to characterize how prehabilitation interventions are currently being used in plastic surgery and allow for greater insight into areas where prehabilitation can be expanded.

Methods: A systematic literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines across PubMed, MEDLINE, Embase, and Cochrane databases. Articles were included if they described clinical implementations of prehabilitation protocols before plastic and reconstructive surgery procedures between 2000 and 2025. Each article was independently reviewed, extracted and assessed for bias by 2 individuals.

Results: 18 studies met inclusion criteria and were included in our review. 903 plastic surgery patients were included in clinical prehabilitation interventions prior to abdominal wall reconstruction, head and neck free flap reconstruction, breast reconstruction, abdominoplasty, fat grafting, and hand surgery. Notably, only 19% (n = 3) of the included studies focused exclusively on plastic surgery, while the remaining 81% (n = 15) included PRS patients alongside populations from general or other surgical specialties. The included literature was published between 2008 and 2025 and spanned multiple countries, predominantly the USA (n = 9), followed by the UK (n = 3), Brazil (n = 2), and Canada (n =2). Study designs varied widely, featuring randomized controlled trials, feasibility studies, retrospective and prospective cohort reviews, and quality improvement/survey studies.

Interventions were primarily unimodal (n = 14), though several protocols successfully utilized a multimodal approach (n = 4). Core strategies targeted nutritional optimization (n = 6), physical exercise/respiratory therapy (n = 4), psychological support or music therapy (n = 3), and smoking cessation (n = 2). Intervention durations ranged from acute preoperative protocols (e.g., carbohydrate loading 2 hours prior to surgery) to extended 4-week regimens. Across the included studies, prehabilitation was consistently associated with positive outcomes, including statistically significant reductions in hospital length of stay (LOS), decreased postoperative complications (such as wound occurrences), and high rates of patient satisfaction and program feasibility.

Conclusion: Unimodal and multimodal prehabilitation interventions are promising and feasible avenues for surgical patient optimization within plastic surgery that can reduce complications and improve patient outcomes. Beyond patient care, reducing complications through prehabilitative measures may have potential downstream implications for subsequent healthcare utilization, including avoidable hospitalizations and emergency room visits. Our findings support the broader integration of prehabilitation across plastic surgery subspecialties, alongside prospective evaluation to define standardized protocols and assess long-term benefit.

Title: Outcomes of 100 Consecutive Extended Deep Plane Face and Neck Lifts Performed Under Local Anesthesia

Background: The extended deep plane face and neck lift has gained popularity for its ability to achieve durable, natural facial rejuvenation by addressing both superficial and deep facial structures. While traditionally performed under general anesthesia or intravenous sedation, increasing interest exists in performing comprehensive facial rejuvenation procedures under local anesthesia to enhance safety and recovery.

Methods: A retrospective review was conducted of 100 consecutive patients who underwent extended deep plane face and neck lift under local anesthesia in a private surgical practice. All procedures were performed by a single surgeon using a standardized technique incorporating sub-SMAS dissection with extended cervical release. Patients were followed postoperatively to evaluate complications and need for revision procedures.

Results: Among the 100 consecutive cases, complication rates were low. Two patients (2%) developed minor hematomas, both successfully managed in the office without operative intervention. Three patients (3%) experienced delayed wound healing, which resolved with conservative management. No patients required scar revision. There were no infections, hospitalizations, nerve injuries, thromboembolic events, or other systemic medical complications. All procedures were completed under local anesthesia without conversion to general anesthesia.

Conclusion: Extended deep plane face and neck lift can be safely and effectively performed under local anesthesia in appropriately selected patients. In this consecutive series of 100 cases, complication rates were low and limited to minor events manageable in the outpatient setting. These findings support local anesthesia as a viable and safe option for comprehensive deep plane facial rejuvenation, potentially reducing anesthesia-related risks while maintaining favorable surgical outcomes.

Introduction Abdominoplasty is a commonly performed aesthetic body contouring procedure that improves abdominal contour through excision of excess skin and fat. Although satisfaction rates are high, some patients require revision surgery, increasing operative risk, healthcare utilization, and patient burden (1, 2). While technical factors contributing to revision have been described, large-scale multi-institutional data evaluating patient characteristics associated with revision remain limited (3, 4). This study characterizes demographic, clinical, and pharmacologic factors associated with revision abdominoplasty using a large multi-institutional database.

Methods This retrospective cohort study utilized the TriNetX Research Network to identify patients who underwent abdominoplasty between 2012 and 2026. Patients were stratified into revision and non-revision cohorts using SNOMED code 17725006. Group differences were assessed using t-tests and two-proportion z-tests with statistical significance set at p < 0.05.

Results Among 28,407 patients, 1,034 (3.64%) underwent revision surgery. Patients undergoing revision were older (51.2 vs 48.6 years), more frequently male (12% vs 9%), and more likely to be White compared to those without revision (61% vs 28%), all p < 0.001.

Revision was also associated with higher rates of endocrine, nutritional, and metabolic disorders, including diabetes mellitus, overweight and obesity, disorders of lipoprotein metabolism, and thyroid disease (all p < 0.001). Cardiovascular and hematologic conditions, including hypertensive, ischemic, and cerebrovascular disease, coagulation defects, and bone marrow failure syndromes, were more prevalent in the revision cohort (all p < 0.001). Musculoskeletal and connective tissue diseases, particularly rheumatoid arthritis, inflammatory polyarthropathies, osteoarthritis, and disorders of bone, were also more common among revision patients (all p < 0.001). Psychiatric conditions, including anxiety and stress-related disorders, mood disorders, and nicotine dependence, were more frequently observed in patients undergoing revision. Additionally, use of antiplatelet agents, anticoagulants, and systemic glucocorticoids was higher in the revision cohort (all p < 0.001).

Conclusion Multiple demographic, medical, psychiatric, and pharmacologic factors were associated with revision abdominoplasty in this large multi-institutional cohort. Many of these conditions are potentially modifiable, underscoring the importance of comprehensive preoperative risk assessment and targeted optimization. Incorporating patient-level risk profiles into individualized surgical planning and informed counseling may reduce revision rates, improve outcomes, and enhance long-term patient satisfaction following abdominoplasty. Further prospective studies are warranted to better understand the relationship between these factors and revision risk.

References 1. Hammond DC, Chandler AR, Baca ME, Li YK, Lynn JV. Abdominoplasty in the Overweight and Obese Population: Outcomes and Patient Satisfaction. Plast Reconstr Surg. 2019;144(4):847-853. doi:10.1097/PRS.0000000000006018 2. De Paep K, Van Campenhout I, Van Cauwenberge S, Dillemans B. Post-bariatric Abdominoplasty: Identification of Risk Factors for Complications. Obes Surg. 2021;31(7):3203-3209. doi:10.1007/s11695-021-05383-0 3. Cormenzana PS, Samprón NM, Escudero-Nafs FJ. Secondary abdominoplasty. Aesthetic Plast Surg. 2008;32(3):503-508. doi:10.1007/s00266-008-9135-9 4. Nguyen AT, Bajaj K, Adam TH, Galiano RD. Outcomes and Indications in Revision Abdominoplasty: A Systematic Review. Ann Plast Surg. 2025;95(5):490-498. doi:10.1097/SAP.0000000000004513

Background: Full-thickness burns involve damage to epidermal and dermal layers with potential extension into underlying tissue. Reconstructive strategies include autologous split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), flap procedures, and/or use of acellular dermal matrices or synthetic dermal substitutes (DS). This cross-sectional study compares trends in usage and post-reconstructive outcomes of STSG combined with dermal substitute (STSG+DS) versus FTSG for management of full-thickness burns.

Methods: We conducted a cross-sectional analysis with 1:1 propensity score matching using data from 69 healthcare organizations within the TriNetX U.S. Collaborative Network, identifying patients with full-thickness burns treated with STSG+DS or FTSG. Primary outcomes included graft failure, wound dehiscence, surgical site infection, hospital readmission, hypertrophic scarring, contracture, and mortality. Secondary outcomes included patient demographic characteristics including age, sex, race, and ethnicity.

Results: 1,271 matched patients were included in each reconstructive cohort. Mean age at reconstruction across groups was 33.7 years; mean follow-up was 1,152.5 days. Readmission rates were significantly higher in patients treated with STSG+DS vs. FTSG alone across anatomic regions (p<0.0146). Hypertrophic scarring occurred more frequently in patients with STSG+DS across anatomic regions; differences were significant for head and neck, upper extremity, and lower extremity burns (p<0.0074, RD 9.206-17.342 pp). Rates across anatomic regions ranged from 24.444-30.975% in STSG+DS patients and from 13.636-14.082 in FTSG patients. Contracture rate varied by anatomic region; head and neck contractures were more common following FTSG application vs. STSG+DS (p=0.0061). Contracture rates were similar across regions (range, STSG+DS: 41.485-56.477%; FTSG: 41.048-69.948%). Wound dehiscence was rare and occurred most frequently in upper extremities (STSG+DS: 1.955%; FTSG: 2.56%). SSI occurred most frequently in upper extremities (STSG+DS: 4.012% of STSG+DS; FTSG: 1.81%). Death was not associated with any repair method and occurred at rates from 5.655-7.424% (STSG+DS) and from 4.012-5.677% (FTSG).

Conclusion: STSG+DS and FTSG coverage of full-thickness burns provide comparable reconstructive options overall with some variability in readmission, hypertrophic scarring, and contracture rates. Greatest disparities were observed in trunk and head and neck burns, highlighting the importance of region-specific reconstructive decision making. Further prospective studies are warranted to refine reconstructive decision-making in full-thickness burn care.

Citations: Ziegler B, Hundeshagen G, Warszawski J, Gazyakan E, Kneser U, Hirche C. Implementation and Validation of Free Flaps in Acute and Reconstructive Burn Care. Medicina (Kaunas). 2021;57(7):718. Published 2021 Jul 16. doi:10.3390/medicina57070718 Šuca H, Čoma M, Tomšů J, et al. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res. 2024;296:383-403. doi:10.1016/j.jss.2023.12.043 Alsaif A, Karam M, Hayre A, Abul A, Aldubaikhi A, Kahlar N. Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: Systematic review and meta-analysis. Burns. 2023;49(5):1017-1027. doi:10.1016/j.burns.2022.09.010 Iordache M, Avram L, Lascar I, Frunza A. The Role of Skin Substitutes in the Therapeutical Management of Burns Affecting Functional Areas. Medicina. 2025; 61(6):947. https://doi.org/10.3390/medicina61060947

Purpose: The PEAK PlasmaBlade (PPB)¹ is an innovative electrosurgical technology designed to minimize thermal injury while providing effective hemostasis. Clinical studies in abdominal flap reconstruction demonstrate that PPB is associated with reduced seroma and complication rates. This meta-analysis aims to compare the efficacy of PPB with other electrical coagulation devices in postoperative outcomes.

Methods: This PRISMA-compliant meta-analysis (PubMed, Embase, and Cochrane, up to December 2025) compared plasma-based versus conventional electrosurgery in abdominal free-flap breast reconstruction. The primary outcome was seroma; secondary outcomes included seroma requiring treatment, drain volume/duration, and hematoma. Data were pooled using Odds Ratio (OR) for dichotomous and Mean Difference (MD) for continuous outcomes, both with 95% CI. Heterogeneity was assessed via Cochran's Q and I² statistics, with significance set at p < 0.05.

Experience: Three studies (276 patients)²⁻⁴ were included, comparing PlasmaBlade (n=132) and conventional electrocautery (n=144). Patients had a mean age of 48–55 years, BMI of 25.3–29.1 kg/m², and flap weights of 812–987g. Unilateral DIEP flaps predominated, with minimal use of MS-TRAM flaps.

Results: PlasmaBlade use was associated with a significantly lower incidence of seroma at postoperative day 14 (OR 0.43; 95% CI 0.21–0.86; p = 0.02; I² = 0%) and a reduction in total wound fluid volume (MD -51.75 mL; 95% CI -103.18 to -0.33; p = 0.05; I² = 0%). No significant differences were observed for seroma at day 42 (OR 0.73; 95% CI 0.34–1.58; p = 0.42), seroma requiring treatment (OR 0.61; 95% CI 0.16–2.28; p = 0.458), hematoma (OR 0.87; 95% CI 0.27–2.77; p = 0.812), or drain duration (MD -0.09; 95% CI -0.57–0.39; p = 0.72). No heterogeneity was detected across all analyses (I² = 0%)

Conclusion: The Peak PlasmaBlade significantly reduced seroma and total wound fluid in abdominal flap dissection for breast reconstruction, which may be attributed to less thermal damage. However, larger future studies are needed to strengthen the external validity of these findings.

References 1. Vankov A, Palanker D. Nanosecond plasma-mediated electrosurgery with elongated electrodes. J Appl Phys. 2007;101(12):124701. doi:10.1063/1.2738374 2. Chow WTH, Oni G, Ramakrishnan VV, Griffiths M. The use of plasmakinetic cautery compared to conventional electrocautery for dissection of abdominal free flap for breast reconstruction: single-centre, randomized controlled study. Gland Surg. 2019;8(3):242-248. doi:10.21037/gs.2018.12.04 3. Friebel TR, Narayan N, Ramakrishnan V, Morgan M, Cellek S, Griffiths M. Comparison of PEAK PlasmaBladeTM to conventional diathermy in abdominal-based free-flap breast reconstruction surgery-A single-centre double-blinded randomised controlled trial. J Plast Reconstr Aesthet Surg. 2021;74(8):1731-1742. doi:10.1016/j.bjps.2020.12.007 4. Augustin A, Schoberleitner I, Unterhumer SM, Krapf J, Bauer T, Wolfram D. PlasmaBlade versus Electrocautery for Deep Inferior Epigastric Perforator Flap Harvesting in Autologous Breast Reconstruction: A Comparative Clinical Outcome Study. J Clin Med. 2024;13(8):2388. doi:10.3390/jcm13082388

Ballistic injuries to the pediatric craniofacial region pose unique reconstructive challenges given the complex anatomy and growth potential of the developing skeleton (1). These high-energy injuries frequently result in complex soft tissue and bony defects with high rates of concomitant injuries, requiring staged repair and long-term multidisciplinary follow-up (2,3). Although survival rates have improved with advances in acute management, this injury pattern continues to carry significant functional and aesthetic morbidities necessitating specialized surgical expertise. Furthermore, minority populations are disproportionately impacted by long-term sequalae particularly with poor psychosocial outcomes. This study describes the demographic patterns, injury distribution, and clinical severity of pediatric craniofacial ballistic injuries to inform reconstructive pathways and decision making.

A retrospective review utilizing the Trauma Registry at a Level I pediatric trauma center was conducted for pediatric patients with ballistic craniofacial injuries between 2017 and 2023. Patients were identified using ICD-10 codes S00-S09. Data collected included demographics, mechanism of injury (penetrating vs blunt per NTDB definitions), injury severity, length of stay, intensive care unit stay (ICU), ventilator days, and diagnosis. Descriptive statistics were used to report trends.

119 patients were included. The cohort was predominantly male (78%), with a mean age of 9.99 years, and African American children comprised the largest demographic affected (59.7%). Penetrating trauma (63%) accounted for most injuries, typically secondary to handguns. The most common primary diagnoses were orbital (eye or orbit), soft tissue (open wounds to the head), and bony injuries (skull fractures). Injury severity varied widely, with most patients demonstrating relatively low ISS scores (mean: 6.8). This low ISS score overall classifies these craniofacial injuries as minor despite significant reconstructive complexity inherent to craniofacial ballistic wounds, thus highlighting this scoring system may underestimate the surgical burden in this population. Mean TRISS was 92.5%, consistent with high predicted survival. However, 13.4% required ICU admission and mechanical ventilation (mean ICU stay: 2.8 days; mean ventilator days: 1.9), and mean overall LOS was 5.6 days. While survival rates were high, these injuries carried significant morbidity, particularly in cases involving ocular and midface trauma.

Injuries were predominantly penetrating and disproportionately affected African American males. The high prevalence of orbital, soft tissue, and bony defects supports early involvement of plastic surgery in multidisciplinary trauma pathways to facilitate reconstructive protocols anticipating staged repair and long-term follow-up. The discordance between low ISS scores and high reconstructive complexity suggests additional metrics outside of the standard trauma severity metrics may streamline resource allocation and follow-up planning in pediatric craniofacial ballistic trauma.

References 1. Vyas RM, Dickinson BP, Wasson KL, Roostaeian J, Bradley JP. Pediatric facial fractures: current national incidence, distribution, and health care resource use. J Craniofac Surg. Mar 2008;19(2):339-49; 350. doi:10.1097/SCS.0b013e31814fb5e3 2. Hu K, Parikh N, Allam O, et al. The Epidemiology and Mechanisms of Pediatric Facial Fractures. J Craniofac Surg. Jul-Aug 01 2025;36(5):1543-1546. doi:10.1097/SCS.0000000000011163 3. Hoppe IC, Kordahi AM, Paik AM, Lee ES, Granick MS. Pediatric facial fractures as a result of gunshot injuries: an examination of associated injuries and trends in management. J Craniofac Surg. Mar 2014;25(2):400-5. doi:10.1097/SCS.0000000000000657

Purpose: Malar prominence is a key sexually dimorphic landmark and a central component of facial feminization surgery (FFS). Although malar augmentation is frequently incorporated into FFS, surgeons currently lack objective, standardized reference measurements to guide implant selection, positioning, and outcome evaluation. The purpose of this study is to establish a reproducible three-dimensional CT-based quantitative framework and reference values to guide surgical decision-making in malar augmentation for facial feminization. Methods: We retrospectively analyzed 35 consecutive transgender male-to-female patients planned for facial feminization surgery (FFS). Two patients were excluded: one procedure was cancelled preoperatively, and in the other case malar implants were not placed intraoperatively. Custom poly-ether-ether-ketone (PEEK) malar implants were placed in 33 patients between February 2023 and August 2025. Pre-operative and virtual post-operative measurements were performed on three-dimensional CT reconstructions using a standardized XYZ coordinate system based on the Frankfort plane. Quantitative metrics integrated total implant volume and malar projection measurements with and without implants, including linear distances from the temporomandibular joint (TMJ) to the malar apex, from the clivus to the malar apex, from the malar apex to the menton, as well as intermalar distance. Angular analysis included the nasion–malar apex angle. Complications, revision rates, and patient-reported satisfaction were recorded. Results: Mean patient age was 38.9 ± 2.2 years, with a mean bilateral implant volume of 1.8 cm³ [IQR 1.55–2.13]. Mean bilateral malar projection increased by 5.5 mm from the clivus (P < 0.0001) and by 4.9 mm from the temporomandibular joint (TMJ) (P < 0.0001). The nasion–malar apex angle decreased by 5.4° (P < 0.0001), intermalar distance decreased by 9.8 mm (P < 0.0001), and the malar apex–to–menton distance decreased by 2.9 mm (P < 0.0001). Standardized response mean (SRM) analysis identified clivus- and TMJ-based malar projection measurements as the most sensitive and comparable morphometric parameters to implant-induced changes. Three complications (3/33) were observed, with no revision procedures required over a median follow-up of 8 months [IQR 4.3–13]. Conclusions: Custom malar implants provide a reliable and safe method for malar augmentation in facial feminization surgery, with a low complication rate and high patient-reported satisfaction. Quantitative CT-based metrics derived from three-dimensional implant simulation, particularly clivus- and TMJ-referenced malar apex projections, malar apex to menton distance, and intermalar width, enable objective and reproducible assessment of surgically induced malar changes. Malar augmentation was characterized by increased anterior projection, reduced malar to menton vertical height, and narrowing of intermalar width, supporting the use of these measurements for outcome evaluation and future implant design optimization.

Goals/Purpose Preservation abdominoplasty represents an evolution in abdominal contouring that prioritizes maintenance of the superficial fascial system rather than wide disruption. Continuous preservation of Scarpa's fascia allows this layer to function as an internal suspension platform, transmitting tension to the pubic region and proximal thighs while maintaining lymphovascular integrity. We describe a standardized drainless preservation abdominoplasty technique incorporating circumferential contouring, multi-vector rectus plication, and Scarpa's reapproximation, and evaluate early outcomes in a consecutive patient cohort.

Methods/Technique We performed a retrospective review of consecutive patients undergoing primary aesthetic abdominoplasty by the senior author using a standardized preservation technique applicable to traditional, extended, and circumferential cases.

Posterior contouring is performed first with energy-assisted and power-assisted liposuction, with posterior skin excision in circumferential cases. Anteriorly, flap elevation proceeds in the superficial plane, preserving Scarpa's fascia in continuity from the pubis to approximately 4 cm below the umbilicus. The umbilicus is isolated on its stalk, and limited central undermining is performed to the xiphoid while maintaining lateral perforators.

Scarpa's fascia is incised superiorly to create an inferiorly based Scarpa's flap. Multi-vector rectus plication is performed with differential tensioning to optimize midline support and waist definition. The preserved Scarpa's flap is advanced and reapproximated cephalad under tension, functioning as a continuous fascial sling that supports the lower abdomen, pubic region, and proximal thighs via its continuity with Colles' fascia and fascia lata.

Progressive tension sutures are placed to eliminate dead space. Drains are not used. Standardized postoperative protocols include early ambulation, compression therapy, and venous thromboembolism prophylaxis.

Results/Complications One hundred consecutive patients underwent drainless preservation abdominoplasty. No intraoperative complications or conversions to wide undermining occurred. Seroma occurred in 2 patients (4.1%), both <30 mL and managed conservatively without aspiration. No hematomas, skin or flap necrosis, or reoperations were observed. Superficial infection occurred in 4 patients (8.2%) and resolved with local wound care with or without oral antibiotics. Minor wound dehiscence occurred in 8 patients (16.3%), typically small tension-point separations that healed with conservative management. One patient (2.0%) developed a postoperative deep venous thrombosis treated with anticoagulation. No pulmonary embolism occurred.

All cases were completed without drains, and no patient required postoperative seroma drainage.

Conclusion Continuous preservation and cephalad reapproximation of Scarpa's fascia enables elimination of routine drains while enhancing lower trunk contour through internal fascial suspension. When combined with limited undermining, multi-vector plication, and progressive tension suturing, this technique maintains lymphovascular integrity, reduces dead space, and produces reproducible aesthetic outcomes with low morbidity.

Drainless preservation abdominoplasty represents a refined anatomic approach that maintains the aesthetic power of traditional techniques while improving postoperative recovery and lower trunk support.

Purpose: Presurgical Virtual planning (PVP) is well established in elective craniomaxillofacial and orthognathic surgery. However, its adoption in the surgical management of acute trauma has been limited due to logistical barriers, despite the potential for improvements in functional outcomes and reduction in operative time and complications. As such, we aimed to study the utility of PVP in acute trauma cases as compared to conventional surgical planning.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, querying four major databases including Embase, Scopus, Pubmed and Web of Science. The search strategy was designed to identify all comparative studies examining the use of PVP versus conventional surgical planning in acute trauma settings. Data points extracted from included studies were publication information, study settings, patient demographics, type of trauma and/or fracture site, the method, means and duration of PVP and conventional planning, as well as perioperative information including mean operative time and intraoperative bleeding and outcomes.

Results: A total of 1,766 records were screened and ultimately 34 comparative studies, published between 2015 and 2025, with a total of 3,287 patients, including 1,436 in PVP and 1,851 in the non-PVP control groups were included. The studies focused on trauma leading to craniomaxillofacial (62%), pelvic and lower extremity (32%), as well as humeral fractures (6%). PVP was utilized through 3D modeling, surgical and reduction planning, personalized guides, 3D printed or pre-contoured plates, patient specific implants and splints through computer-aided design and manufacturing (CAD/CAM). The different means of PVP were collectively associated with significantly reduced operative times in 94% of reporting studies and significantly reduced intraoperative blood loss in 82% of reporting studies.

Conclusions: Acute trauma demands both rapid and accurate solutions. This systematic review presents evidence that PVP offers measurable perioperative advantages in acute post-traumatic reconstruction, despite the perceived challenges of its implementation in trauma settings. The consistent findings of reduced operative times and intraoperative blood loss with PVP showcase its potential to improve surgical efficiency, patient recovery and healthcare resource utilization. Planning times, costs, and access to these technologies remain as barriers but the trends identified in this review indicate that the move toward more personalized, data-driven, and outcome-focused trauma care facilitated through presurgical virtual planning is becoming an achievable reality in the restoration of form and function after severe injury.

Background: Abdominal wall reconstruction (AWR) for complex hernias is associated with substantial morbidity, and many patients have undergone prior cosmetic abdominal contouring procedures that may alter perfusion, lymphatic drainage, and tissue compliance. The extent to which these aesthetic procedures influence outcomes after subsequent AWR is not well defined.

Methods: Using the TriNetX Global Collaborative Network, we identified adults undergoing AWR and stratified them by whether they had received cosmetic abdominal contouring-abdominoplasty, panniculectomy, or trunk liposuction-within the preceding five years. The first AWR served as the index event. One-year postoperative outcomes included infection, wound dehiscence, necrosis, hematoma, ileus/obstruction, hernia recurrence, deep venous thrombosis (DVT), and seroma. Propensity score matching (1:1) was performed to balance demographics and baseline characteristics.

Results: After matching, 8,439 patients remained in each cohort with comparable age, sex, and race/ethnicity distributions. Prior cosmetic contouring was associated with significantly higher one-year complication risks across all outcomes examined. Compared with reconstruction-only patients, those with prior contouring exhibited increased risks of infection (12.7% vs 6.0%; RR≈2.1), wound dehiscence (11.2% vs 4.9%; RR≈2.3), necrosis (3.0% vs 1.6%; RR≈1.9), hematoma (1.6% vs 1.1%; RR≈1.4), ileus/obstruction (3.8% vs 2.8%; RR≈1.4), hernia recurrence (0.7% vs 0.3%; RR≈2.1), DVT (1.6% vs 0.5%; RR≈3.4), and seroma (2.2% vs 1.6%; RR≈1.3) (all P≤0.003).

Conclusions: Prior aesthetic abdominal surgery is a significant and previously underrecognized risk factor for adverse outcomes after AWR. The consistent increases in wound complications, systemic morbidity, and early recurrence underscore the lasting impact of cosmetic contouring on abdominal wall vascularity and soft-tissue integrity. Surgeons should incorporate cosmetic surgical history into preoperative counseling, risk stratification, and operative planning, and consider enhanced perioperative optimization and surveillance in this higher-risk population.

Purpose: We examined the feasibility of bilateral deep inferior epigastric artery perforator (DIEP) reconstruction with simultaneous flap harvesting and prolonged ischemia time of one flap as a method to improve intraoperative efficiency by providing an opportunity to maximize parallel work with PAs without increasing complications.

Methods:
Between 2023-2024, of 117 total DIEP patients, 68 DIEP flaps were performed in 34 patients following a prolonged ischemia time methodology, wherein there was at least a 60-minute difference in ischemia time between each of the breast flaps. The 34 flaps with the shortest ischemia time ("Normal" ischemia) served as an internal control. Variables analyzed included rate of fat necrosis and flap loss, operative time, flap ischemia time, and difference in ischemia time

Results: There was no significant difference in fat necrosis and flap loss between flaps with normal and prolonged ischemic times (p > 0.05). There was one flap failure and one instance of fat necrosis in the prolonged ischemia flaps. There were no instances of flap failure or fat necrosis in the normal ischemia flaps. The mean normal ischemia time was 78.23 minutes ± 29.1 (SD) while the mean prolonged ischemia time was 167.85 minutes ± 51.7. Mean operative time with prolonged ischemia protocol was 455.24 minutes ± 49.8 in comparison to 488.38 ± 78.6 minutes for standard DIEP procedures. There was a significant decrease in mean operative time between prolonged ischemia and standard methodology (p = 0.0294).

Conclusions: DIEP reconstruction with a prolonged flap ischemia time is not associated with increased fat necrosis or flap failure. Harvesting both flaps simultaneously allows for complete closure of the abdomen concurrently with the microsurgical portion, providing an opportunity to maximize intraoperative efficiency, especially in the event of a single surgeon.

Purpose: Endoscopic-assisted and other minimally invasive craniosynostosis repairs are time-sensitive and typically restricted to early infancy. Delays in recognition, referral, or craniofacial consultation may eliminate eligibility and shift patients to open cranial vault reconstruction. This narrative review synthesizes evidence on how race, ethnicity, insurance status, and socioeconomic context influence timing along the craniosynostosis care pathway and access to minimally invasive or endoscopic repair.

Methods: Ovid (MEDLINE+Embase) and PubMed were searched from inception through January 9, 2026 for English language human studies evaluating referral or consultation timing, age at diagnosis or surgery, or operative approach in relation to race, ethnicity, insurance, or socioeconomic measures. Study design, timing definitions, sociodemographic variables, and key findings were abstracted and synthesized narratively.

Results: Eleven retrospective studies met inclusion criteria, including single center cohorts measuring referral to consultation timelines and national datasets reporting age at surgery and procedure selection. Timing definitions varied (e.g., consultation or eligibility thresholds in early infancy; surgical cutoffs after 6 months or 1 year), limiting cross-study comparability. Studies capturing upstream steps consistently demonstrated that public insurance and socioeconomic disadvantage were associated with delayed referral and older age at presentation. Medicaid insurance was independently associated with an 83-day referral delay, diagnosis after 3 months (RR 1.3), and surgery after 1 year (RR 3.9) (1). Public insurance increased odds of presentation after 4 months (OR 1.90), and higher Area Deprivation Index independently predicted older presentation (2). Race- and ethnicity-associated differences were also reported, including disproportionate use of open repair and older operative timing among Black and Hispanic patients in institutional and National Surgical Quality Improvement Program Pediatric (NSQIP) pediatric cohorts (3,4). Although national utilization of minimally invasive repair increased from 2013 to 2022, minimally invasive cohorts remained younger and predominantly White, with gradual improvement in access among Hispanic patients (5).

Conclusions: Disparities in craniosynostosis care extend beyond surgical timing and reflect upstream structural barriers in recognition, referral, and specialty consultation as mechanisms that narrow minimally invasive options. Because minimally invasive repair is eligibility-limited by age, inequities early in the care continuum directly narrow treatment options. Equity focused interventions should prioritize standardized early referral pathways, community education, and payer-aligned policies that support timely minimally invasive protocols.

References: 1. Badiee RK, Maru J, Yang SC, et al. Racial and socioeconomic disparities in prompt craniosynostosis workup and treatment. J Craniofac Surg. 2022;33(8):2422-2426. 2. Jolibois MI, Roohani I, Moshal T, et al. Sociodemographic factors associated with delayed presentation in craniosynostosis surgery at a tertiary children's hospital. Plast Reconstr Surg Glob Open. 2024;12(8):e6035. 3. Akbari SHA, Mooney J, Lepard J, et al. Racial differences in the care of pediatric sagittal craniosynostosis: a single-institution cohort study affecting state Medicaid policy. J Neurosurg Pediatr. 2023;32(4):464-471. 4. Wallace ER, Birgfeld C, Speltz ML, Starr JR, Collett BR. Surgical approach and periprocedural outcomes by race and ethnicity of children undergoing craniosynostosis surgery. Plast Reconstr Surg. 2019;144(6):1384-1391. 5. Fung E, Yu BZ, Roth JM, et al. Trends in open versus minimally invasive craniosynostosis repair: a 10-year national analysis. J Craniofac Surg. 2025;36(8):2773-2777.

Background: Lymphedema is a chronic condition characterized by failure of the lymphatic system and tissue edema, significantly affecting patients both physically and psychologically. Traditional clinical assessments fail to capture the patient's perspective or the full impact of the disease on quality of life. Although general health questionnaires exist, they lack sufficient sensitivity for lymphedema. Keeley developed a simple, convenient assessment tool in 2010 that includes adaptations for the upper and lower limbs (1). This study aims to validate a Thai version of the Lymphedema Quality of Life (LYMQOL) questionnaire, a tool specifically designed for routine clinical practice to assess function, appearance, symptoms, and mood in patients with limb lymphedema. Methods. A prospective descriptive study was conducted at the lymphedema clinic of Prince of Songkla University Hospital between April and November 2025. The original LYMQOL was translated using a forward-backward translation process and cross-cultural adaptation. Validity was assessed via construct validity tests comparing LYMQOL scores with the SF-36. Reliability was evaluated through internal consistency (Cronbach's alpha) and temporal stability (test-retest analysis using the Intraclass Correlation Coefficient [ICC]). Result: A total of 101 participants (51 in the arm group, 50 in the leg group) were enrolled. Internal consistency was high, with Cronbach's alpha scores ranging from 0.841 to 0.907 for the arm group and 0.77 to 0.911 for the leg group. Test-retest reliability was excellent, with Intraclass Correlation Coefficients (ICC) between 0.883 and 0.98 for arms and 0.824 and 0.956 for legs. Construct validity was confirmed by significant, moderate correlations with the SF-36, ranging from -0.318 to -0.516. Conclusion: The Thai version of the LYMQOL is a reliable and valid instrument for evaluating the quality of life in Thai patients with extremity lymphedema. It accurately reflects both physical and psychological impacts, offering a more detailed clinical perspective than traditional staging alone. Implementation of this tool at Prince of Songkla University and other centers will enhance patient-centered care and promote standardized data collection for future prospective research.

1. A quality of life measure for limb lymphoedema (LYMQOL) – Wounds International [Internet]. [cited 2026 Feb 6]. Available from: https://woundsinternational.com/journal-articles/a-quality-of-life-measure-for-limb-lymphoedema/

In 2024 more than 300 thousand women in the United States were diagnosed with invasive breast cancer (1). Despite significant advances in chemotherapy and radiation, surgery continues to be a central tenet to these patient's care, with most patients requiring surgery for definitive treatment. Postoperative pain control and anxiety surrounding options for pain relief consistently ranks as a major concern of patients prior to surgery (2). As a nation recovering from an opioid epidemic with over 100 thousand overdose deaths a year both patients and providers alike are looking for non-narcotic, and non-pharmaceutical approaches to mitigate pain(3). This highlights an opportunity for adjunctive, non-pharmacologic tools that are simple, patient-directed, and easily integrated into postoperative care. This study is a proof of concept and initial investigation of a novel vibratory device (Relievvr) that is applied directly to the breast to provide sensory input that may modulate patient-perceived discomfort in the post-operative setting. The study enrolled 22 women undergoing outpatient breast surgery who were given the device as part of their postoperative pain management protocol. All patients were contacted 2 weeks post-operatively and no patients were lost to follow up. Most patients found the device to be a valuable tool in facilitating postoperative recovery, giving it a rating of 4.4 out of 5 on the Likert scale. Twenty one of the twenty-two patients reported they would recommend the device to a friend undergoing the same surgery. The device ranked highest with regards to comfort with a score of 4.8 out of 5 and second highest with a score of 4.7 out of 5 on their likelihood to use the device again. Patient's described the device as "convenient and easy to manage," while another called it "user-friendly". Numerous patients reported the device worked as a helpful distraction allowing them to focus on the vibrations as opposed to their surgical pain. Postoperative pain management following breast surgery continues to evolve, with increased emphasis on multimodal strategies that extend beyond pharmacologic interventions. These findings serve as proof of concept that a vibrating device based on the gate control theory of pain can be a feasible, non-opioid adjunct for managing postoperative breast surgery pain, with high levels of patient satisfaction and ease of use.

References: 1. 1. American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society; 2024. 2. Montgomery GH, Schnur JB, Erblich J, Diefenbach MA, Bovbjerg DH. Presurgery Psychological Factors Predict Pain, Nausea, and Fatigue One Week After Breast Cancer Surgery. J Pain Symptom Manage. 2010;39(6):1043-1052. doi:10.1016/j.jpainsymman.2009.11.318 3. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2025. DOI: https://dx.doi.org/10.15620/cdc/20250305008

Background Central skull base osteoradionecrosis is a rare but severe sequela of radiation therapy for nasopharyngeal carcinoma. 1–3 Advanced cases may result in full-thickness mucosal loss, exposed devascularized bone, chronic infection, and persistent communication between the sinonasal tract and oropharynx, producing refractory drainage, velopharyngeal insufficiency and speech dysfunction.1, 2, 4 Conservative and endoscopic approaches are often insufficient when vascular compromise and structural loss are extensive. Definitive reconstruction in this region remains challenging due to limited access to deep midline skull base structures.

Methods A 57-year-old male with prior radiation treatment for nasopharyngeal carcinoma developed progressive sphenoid and clival osteoradionecrosis with complete absence of nasopharyngeal lining. He presented with chronic foul nasal drainage, sinusitis, headaches, and significant speech impairment despite prolonged conservative management, including hyperbaric oxygen therapy. Imaging confirmed central skull base osteoradionecrosis with surrounding fibrotic, poorly vascularized tissue. A multidisciplinary team involving plastic surgery, otolaryngology, and neurosurgery developed a reconstructive plan. A transmaxillary approach with controlled medial maxillectomy was performed to create a direct reconstructive corridor to the central skull base. A radial forearm free flap (RFFF) was harvested and transferred through this corridor to provide biologic resurfacing of the sphenoid and clival defect. Microvascular anastomoses were performed to the facial vessels in the neck. The flap was inset to restore a stable vascularized lining and reinforced with fibrin sealant and structural packing to optimize integration and compartmental separation. Given elevated risk for donor-site morbidity, the radial forearm donor site was reconstructed using a superficial circumflex iliac artery perforator (SCIP) flap to avoid graft-dependent closure.

Results Postoperative imaging demonstrated robust perfusion of the RFFF and stable skull base resurfacing. Endoscopic evaluation confirmed healthy mucosal integration.

Clinically, the patient experienced: -Resolution of chronic nasal drainage -Improved speech function -Elimination of recurrent sinonasal and otologic infections Tracheostomy decannulation was achieved within one month postoperatively. At follow-up, reconstruction remained durable without flap compromise or recurrent infection.

Conclusion This case demonstrates that transmaxillary access combined with radial forearm free flap transfer provides a reproducible reconstructive solution for extensive central skull base osteoradionecrosis with complete nasopharyngeal lining loss - a condition for which traditional endoscopic or conservative approaches are often inadequate. This approach enables: Creation of a controlled reconstructive corridor to the midline skull base Delivery of thin, pliable vascularized tissue for biologic resurfacing Restoration of functional separation between sinonasal and intracranial compartments Immediate SCIP flap reconstruction of the forearm represents a proactive donor-site strategy in medically complex patients and may mitigate graft-related morbidity.

This multidisciplinary microvascular strategy shifts management of severe radiation-induced skull base injury from salvage toward definitive reconstruction and expands the role of free tissue transfer in anatomically constrained central skull base defects.

1. Clinical features and outcomes of skull base osteoradionecrosis in nasopharyngeal carcinoma patients: a systematic review and meta-analysis. Rhinology 63:416–430 2 Treatment Outcomes for Osteoradionecrosis of the Central Skull Base: A Systematic Review. J Neurol Surg B Skull Base 83:E521–E529 3 Features and Management of Osteoradionecrosis of the Skull Base A Systematic Review and Meta-Analysis. Head Neck 47:2716–2724

Objective. There are several reconstructive methods in a plastic surgeon's toolbox for reconstruction of soft tissue deficits in the lower extremity. This study aimed to perform a comprehensive review of literature pertaining to reconstruction of the lower extremity with the reverse anterolateral thigh (ALT) flap. Design. The review was conducted based off of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodology. A total of four databases were used for the literature search based off of the search criteria. Main Outcome Measures. Procedure performed, region of soft tissue deficit, complications, follow-up, need for reoperation. Results. A total of 1088 studies were imported for screening, of which 6 studies were selected based on our inclusion and exclusion criteria. A total of 70 patients were included in this review with the majority of defects involving the peripatellar region, followed by the proximal and middle third of the lower extremity, and the thigh. Aggregate complication rate was 21.4% with flap loss occurring in 3 patients (4.3%). A total of 9 patients (12.9%) required reoperation either due to complete flap loss or delayed healing requiring an operative debridement. Conclusions. The reverse ALT flap is a versatile option for reconstruction of defects localized to the knee and the proximal and middle third of the lower extremity. Particularly, the flap should be considered in patients that are otherwise not candidates for typical forms of reconstruction with the gastrocnemius or soleus flap or with a free flap.

Background Dupuytren's contracture and tenosynovitis (trigger finger) share overlapping fibroproliferative pathology, and their co-occurrence has been frequently observed in clinical practice. However, it remains unclear whether the development of trigger finger following treatment for Dupuytren's contracture is driven by a shared underlying pathophysiology or by iatrogenic factors related to the intervention itself. This retrospective cohort study investigates the incidence of trigger finger following different treatment modalities for Dupuytren's contracture, including fasciectomy, fasciotomy (open and percutaneous aponeurotomy), collagenase injection, and a no-treatment control group.

Methods A retrospective cohort study was conducted using the PearlDiver Mariner database, which includes adjudicated claims data from over 170 million patients between January 2010 and October 2022. The study compared rates of newly diagnosed trigger finger (tenosynovitis) following treatment for Dupuytren's contracture. Treatment groups included fasciectomy, fasciotomy, collagenase injection, and a non-interventional control cohort. Trigger finger incidence was assessed at 60 days, 120 days, 180 days, and 1-year post-treatment. Chi-square tests were used to evaluate differences in complication rates between treatment groups at each time point. The initial significance threshold was set at 0.05, and Bonferroni correction was applied to adjust for multiple comparisons and minimize the risk of type I error.

Results A total of 31,968 patients were analyzed across four matched cohorts (n = 7,992 each). At 1-year follow-up, cumulative incidence of trigger finger was highest in the no-treatment group (3.7%) and lowest after collagenase injection (1.0%). Fasciectomy and fasciotomy showed intermediate rates (2.1% and 1.7%, respectively). Global chi-square analysis revealed significant differences in TF incidence across all time points (60 days, 120 days, 180 days, and 1 year; p < 0.001), with post hoc pairwise comparisons confirming statistical significance in five of six group comparisons (Bonferroni-adjusted p < 0.0042). Notably, no difference was observed between fasciectomy and fasciotomy. Compared to collagenase, fasciectomy conferred a 1.0% increased absolute risk of TF at 1 year (number needed to harm [NNH] = 99), while no-treatment conferred a 2.9% increase (NNH = 34). TF-free survival curves demonstrated sustained divergence between treatment groups beginning as early as 60 days post-procedure.

Conclusion Trigger finger affects 2% of the general population and has been shown to frequently co-occur with Dupuytren's contracture, though the extent to which this relationship is driven by shared pathophysiology versus iatrogenic factors remains unclear. In this study, the risk of developing trigger finger following treatment for Dupuytren's contracture varied significantly by procedural approach. Collagenase demonstrated the most favorable risk profile, while fasciectomy and nonoperative management were associated with higher rates of trigger finger. The absence of a significant difference between fasciectomy and fasciotomy suggests a potential shared iatrogenic mechanism, reinforcing the idea that procedural factors, beyond underlying disease, may contribute to trigger finger development. These findings may inform procedural decision-making and underscore the importance of long-term monitoring in high-risk patients.

Introduction: Lymphedema is a chronic complication of gynecological cancer treatment that can lead to severe lifelong consequences and have a profound negative impact on a patient's quality of life (QoL). With advancements in gynecological cancer treatment resulting in improved patient survival, it is important to reduce the risk for complications such as lymphedema that lead to significant long-term morbidity. Despite the substantial burden, its risk factors remain inconsistently reported.

Methods: A Systematic Review was conducted in accordance with PRISMA guidelines. Databases utilized include MEDLINE, Embase, and Cochrane. Inclusion criteria consisted of clinical studies that covered gynecological cancer (uterine cervical, endometrial, ovarian, uterine, vaginal, and vulvar neoplasms) and lymphedema from 2010-2025. Specific lymphedema risk factors explored include extent of surgery, number and anatomic site of LN removal, type of LN assessment, adjuvant therapy, and BMI.

Results: 427 articles were screened, and 49 articles were included. The most frequently reported lymphedema risk factor was adjuvant chemoradiation (53.06%), followed by lymphadenectomy (38.78%), increased LN removal (36.73%), obesity (26.53%), circumflex iliac or suprafemoral LN dissection (22.45%), and extent of surgery (12.24%).

Conclusion: The most frequently reported lymphedema risk factor was adjuvant chemoradiation, often caused by radiotherapy-induced fibrosis. Lymphadenectomy is another key lymphedema risk factor, with sentinel lymph node biopsy being a promising alternative. Increased LN removal (15-30+) is also strongly associated with lymphedema. These findings highlight the key risk factors for lymphedema following gynecological cancer treatment, and encourage the medical community to find new solutions to limit its incidence and improve patient QoL.

PURPOSE: Sensory rehabilitation (SR) protocols have demonstrated benefit in peripheral nerve repair, yet no standardized approach exists for post-mastectomy breast reconstruction despite emerging evidence supporting flap neurotization. This systematic review synthesizes SR evidence across reconstructive contexts and proposes a phase-based protocol for breast reconstruction. METHODS: A systematic literature search was conducted across five databases (PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov) through August 2025, following PRISMA 2020 guidelines (PROSPERO CRD420251079522). Studies were included if they reported quantitative sensory outcomes following SR interventions in adults undergoing nerve repair or reconstructive procedures. Two independent reviewers screened 2,149 records, with 13 studies meeting inclusion criteria for qualitative synthesis. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I tools. EXPERIENCE AND FOLLOW-UP: Meta-analyses of breast neurotization demonstrate significant improvements in Semmes-Weinstein monofilament thresholds favoring innervated flaps (MD −1.55, 95% CI −2.35 to −0.75, p=0.0001) with follow-up ranging from 8 to 77 months (1). Prospective cohort data showed neurotized DIEP flaps achieved significantly better sensory recovery compared to non-neurotized controls (adjusted difference −0.48, p0.001), with continued improvement over time (2). In upper extremity nerve repair, early mirror therapy improved hand function (Rosen Score) and dexterity compared to standard rehabilitation, though effects on objective sensory thresholds were inconsistent (3). A multicenter double-blind RCT following orthognathic surgery demonstrated reduced altered sensation with graded sensory retraining (4). No randomized controlled trials evaluating postoperative SR protocols in breast reconstruction were identified. RESULTS: Based on neuroplasticity principles, we developed a four-phase SR protocol: Phase 1 (preoperative) establishes baseline sensory mapping and patient education; Phase 2 (postoperative days 3 through week 4) employs visual attention and mirror strategies to maintain cortical representation; Phase 3 (weeks 4-12) initiates active sensory re-education targeting specific mechanoreceptor populations (Merkel cells, Meissner corpuscles, Pacinian corpuscles); Phase 4 (months 3-12) advances to functional integration with proprioceptive loading. The protocol incorporates explicit thermal safety parameters given documented burn vulnerability in insensate reconstructed breasts. Outcome assessment integrates the BREAST-Q Sensation Module with objective measures including Semmes-Weinstein monofilament testing and two-point discrimination (5). CONCLUSIONS: This evidence-based SR protocol addresses a significant rehabilitation gap following breast reconstruction with neurotization. By leveraging established neuroplasticity mechanisms-visual-sensory priming for cortical maintenance during nerve regeneration and graded discrimination training for cortical refinement post-reinnervation-this protocol provides a structured approach to optimize sensory recovery. Future prospective trials incorporating standardized objective sensory mapping and validated patient-reported measures are necessary to define best practices and quantify clinical impact. (1) Tajziehchi P, et al. J Plast Reconstr Aesthet Surg. 2024;90:280-91. (2) Beugels J, et al. Plast Reconstr Surg. 2021;148(2):273-84. (3) Rosén B, et al. J Hand Surg Eur Vol. 2015;40(6):598-606. (4) Phillips C, et al. J Oral Maxillofac Surg. 2007;65(6):1162-73. (5) Tsangaris E, et al. Ann Surg Oncol. 2021;28(12):7842-53.

Introduction Complex extremity wounds with exposed bone or tendon remain difficult to reconstruct. Flap surgery is effective but carries donor site morbidity. Dermal substitutes offer a less complex alternative. Biodegradable temporizing matrix (BTM) provides a durable neodermis over several weeks, whereas collagen-elastin templates enable earlier incorporation.1-4 Sequential use may maximize their complementary strengths, and this is the first case series describing sequential use of different skin substitute.

Methods and Materials: A retrospective case series was conducted at a Level I trauma and American Burn Association-verified burn center. Six patients with complex extremity wounds from burns, crush injuries, or chronic ischemic disease were treated using a staged strategy of BTM followed by collagen-elastin template in areas of delayed or incomplete incorporation. Split-thickness skin grafting (STSG) was performed once a healthy neodermis was achieved. Patient demographics, operative details, and outcomes were reviewed.

Experience: Six patients were included with mean wound size of 498 cm² (range 94–1416 cm²) and frequent exposure of tendon, bone, or joint capsule. All patients had a follow up of at least 6 months after STSG.

Results: BTM demonstrated reliable initial integration, ranging from 85–97% across cases. Following selective application of collagen-elastin template to areas of suboptimal BTM maturation, secondary incorporation improved to 90–100%. The mean time to sufficient incorporation was 43.8 days for BTM compared with 22.6 days for Matriderm. Definitive STSG was performed in all patients. Graft takes ranged from 90–100%, with four of six patients achieving complete take. No patients required regrafting or flap reconstruction. Durable wound closure was achieved in all cases, including coverage over exposed critical structures. One patient developed a localized wound infection during BTM maturation that resolved with oral antibiotics and local wound care without operative revision.

Conclusions: Sequential use of BTM and collagen-elastin template provided reliable complementary coverage for complex extremity wounds, allowing reconstruction for patients who are not good candidates for a flap. This staged approach leverages the durability of BTM and the rapid incorporation of collagen-elastin template to optimize wound bed preparation and facilitate successful skin grafting while avoiding flap morbidity.

References 1. Dadlani, Shashi, Porcine Acellular Dermal Matrix: An Alternative to Connective Tissue Graft-A Narrative Review, International Journal of Dentistry, 2021, 1652032, 7 pages, 2021. https://doi.org/10.1155/2021/1652032 2. Mello DF. Dermal regeneration matrix in the treatment of acute complex wounds. Wounds Compend Clin Res Pract. 2022;34(6):154-158. doi:10.25270/wnds/2022.154158 3. Tapking C, Panayi AC, Hundeshagen G, et al. The Application of a Synthetic Biodegradable Temporizing Matrix in Extensive Burn Injury: A Unicenter Experience of 175 Cases. J Clin Med. 2024;13(9):2661. doi:10.3390/jcm13092661 4. Lane G, Fitzpatrick NJ, Kastritsi O, et al. Biodegradable Temporising matrix in the reconstruction of complex wounds: A systematic review and meta-analysis. Int Wound J. 2024;21(10):e70025. doi:10.1111/iwj.70025

Background Adipose‑derived stem cells (ASCs) are known in regenerative medicine due to their multipotency, immunomodulatory function, and facile isolation from the stromal vascular fraction (SVF). However, the specific SVF cell types that contribute to therapeutic efficacy and the mechanisms by which either fresh SVF or ASCs promote repair remain poorly defined. Fresh SVF is a heterogeneous mixture of hematopoietic cells, endothelial cells, pericytes, fibroblasts, and stromal progenitors (1). Upon culture expansion, this mixture shifts toward a mesenchymal stromal cell–enriched population dominated by CD73⁺CD90⁺CD105⁺ ASCs, accompanied by loss of immune and endothelial lineages (2). Although these phenotypic changes are well recognized, the transcriptional trajectories, lineage relationships, and cell–cell communication events underlying this transition have not been fully resolved at single‑cell resolution. To address this gap, we mapped SVF composition through initial culture expansion, defined accompanying gene‑expression profiles, and characterized ligand–receptor–mediated communication using a genomics‑driven single‑cell RNA analysis.

Methods Stromal vascular fraction (SVF) was obtained from human adipose samples, and ASCs were isolated through standard adherence‑based culture techniques. RNA was extracted with a TRIzol kit. Single‑cell RNA sequencing libraries were generated, and transcriptomic profiles were analyzed using Loupe Browser and BBrowserX. Cell identities were assigned based on canonical lineage markers and integrated with established reference datasets to annotation of cell.

Results Relative to fresh SVF, P0 cultures exhibited marked reductions in M2 tissue‑resident macrophages (20.23%→0.21%), ICAM1⁺/F3⁺ preadipocytes (11.84%→3.34%), fibroblasts (5.51%→0.07%), and complete loss of lymphoid cells. In contrast, endothelial cells (2.94%→9.52%), pericytes (2.05%→7.26%), adipose‑derived stem cells (14.72%→48.56%), DPP4⁺ progenitors (5.06%→11.15%), and ICAM⁺/F3⁺/MSCA1⁺ adipogenic preadipocytes (1.37%→7.28%) expanded substantially. These compositional shifts were accompanied by decreased adipogenic and inflammatory gene programs and increased extracellular matrix–remodeling and oxidative‑metabolism signatures, supported by gene‑set enrichment analysis. Single‑cell ligand–receptor modeling further revealed that while fresh SVF displayed robust ASC‑ and modest pericyte‑mediated communication with endothelial cells and fibroblasts, P0 cultures showed increased preadipocyte engagement, along with enhanced pericyte interactions with endothelial and myofibroblast/smooth muscle cells, and increased cell division interactions.

Conclusion Single‑cell profiling of human SVF through initial culture expansion reveals a pronounced shift from a heterogeneous immune‑ and stromal‑rich compartment toward a mesenchymal stromal cell–dominated population. This transition is accompanied by coordinated transcriptional remodeling with a loss of the adipogenic profile and inflammatory profiles and substantial rewiring of cell–cell communication networks with enhanced pericyte and preadipocyte interactions. Together, these findings define the cellular, molecular, and communication dynamics underlying early ASC culture adaptation and provide a framework for understanding how fresh SVF and culture‑expanded ASCs may contribute to tissue repair.

References 1. Bourin P, Bunnell BA, Casteilla L, et al. Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the International Federation for Adipose Therapeutics and Science (IFATS) and the International Society for Cellular Therapy (ISCT). Cytotherapy. 2013;15(6):641-648. doi:10.1016/j.jcyt.2013.02.006 2. Chatterjee S, Laliberte M, Blelloch S, et al. Adipose-Derived Stromal Vascular Fraction Differentially Expands Breast Progenitors in Tissue Adjacent to Tumors Compared to Healthy Breast Tissue. Plast Reconstr Surg. 2015;136(4):414e-425e. doi:10.1097/PRS.0000000000001635.

Background: Restoration of the nipple-areolar complex (NAC) is an important contributor to aesthetic and psychosocial outcomes following mastectomy and breast reconstruction (1). Nipple-areolar complex (NAC) reconstruction and tattooing are among the most widely used techniques, yet their relative use remains poorly defined, especially with advancements in mastectomy and reconstructive care (2, 3). Our study aims to use a national claims database to analyze trends in NAC reconstruction methods to better characterize how practices and patient preference have evolved over time.

Methods A national insurance database was queried to identify female patients with breast cancer who underwent post-mastectomy NAC reconstruction (CPT 19350) and nipple tattooing (11920, 11921, 11922) from 2007-2023. Total procedural claims for NAC local flap reconstruction and nipple tattooing were included in temporal analysis with Poisson regression. Procedures were also aggregated per patient to analyze NAC restoration trends stratified by reconstructive procedure. Poisson regression models were used to analyze temporal trends in rates of NAC reconstruction per mastectomy by reconstruction type.

Results Among 179,962 patients, 11.3% (n =20,296) underwent surgical NAC reconstruction, 2.2% (n=3,896) underwent nipple tattooing alone, and 6.6% (n=11,929) underwent both procedures. From 2007 to 2023, surgical NAC reconstruction and nipple tattooing declined annually by 6.5% and 5.8%, respectively (p < 0.001 for both). These downward trends remained significant for both NAC reconstruction types among patients receiving implant, autologous and hybrid reconstruction (p<0.001).

Conclusion National practice patterns in NAC restoration are shifting away from tattooing and surgical reconstruction. The parallel decline in nipple tattooing and NAC reconstruction may reflect broader adoption of nipple-preserving approaches such as nipple-sparing mastectomy (NSM) and evolving methods for delayed reconstruction. These findings have implications for surgical planning and patient counseling, particularly in setting expectations for long-term outcomes across a diverse patient population.

References: 1. Graziano FD, Levy J, Kim M, et al. Impact of Nipple-Areolar Complex Reconstruction on Patient Reported Outcomes After Alloplastic Breast Reconstruction: A BREAST-Q Analysis. Plast Reconstr Surg. Published online August 13, 2025. doi:https://doi.org/10.1097/prs.0000000000012388 2. Baker NF, Marxen T, Nguyen J, et al. Techniques in Nipple Areolar Reconstruction: A Retrospective Analysis of Surgical Interventions and Patient-reported Satisfaction Scores. Plast Reconstr Surg Glob Open. 2024;12(3):e5667. doi:https://doi.org/10.1097/gox.0000000000005667 3. ‌Byrnes YM, Lin YA, Kwon CM, Agarwal N, Wang S, Kauffman CA. Increasing Popularity of Tattoo-Only Nipple-Areolar Complex Reconstruction. Ann Plast Surg. 2024;94(1):26-31. doi:https://doi.org/10.1097/sap.000000000000417

Background:
Gender-affirming top surgery (chest masculinization surgery) is an increasingly performed procedure within plastic surgery. Social media platforms serve as primary sources of education, support, journey-sharing, and expectation-setting for individuals considering surgery. However, differences in content characteristics and engagement between patient- and physician-generated posts across platforms remain poorly characterized.

Objective:
To characterize social discourse surrounding gender-affirming top surgery and compare content patterns, tone, and engagement between patient- and physician-generated posts across platforms.

Methods:
A cross-platform content analysis of publicly available posts on TikTok, Instagram, and Facebook, is ongoing. Posts were identified using the search term "top surgery." Posts published between January 1, 2025, and March 1, 2026 are eligible. Using a structured sampling strategy, we aimed to include 50 patient-generated and 25 physician-generated posts per platform (target n = 225). Posts are categorized by author type, content, tone, surgical timeframe, and engagement metrics. Descriptive statistics were conducted.

Results:
Preliminary analysis of 60 posts (20 per platform) demonstrated that 88% were patient-generated. TikTok showed the highest average engagement across all measured metrics. Content was predominantly centered on personal experience and recovery journeys (68.3%), with most posts occurring in the postoperative period (67.7%). Overall tone was largely positive (81.7%).

Conclusion:
These findings suggest social discourse surrounding top surgery is largely patient-driven, experience-focused, and concentrated in the postoperative phase. Engagement patterns, particularly on TikTok, highlight the influential role of platform specific dynamics in post visibility and audience interaction. Understanding these trends may inform surgeon counseling, expectation management, and engagement strategies in gender-affirming care.

Background: Music is commonly played in operating rooms (ORs) to reduce stress, improve mood, and enhance workflow. However, it may also impair communication, mask alarms, and introduce distractions that threaten patient safety. Despite widespread use, there is no standardized framework guiding safe implementation of OR music. This study synthesizes existing evidence on the benefits and risks of OR music and proposes a practical, team-centered framework for safer integration.

Methods: A systematic review following PRISMA guidelines was conducted using PubMed/MEDLINE from database inception through 2025 to evaluate the effects of OR music on team performance, communication, and patient safety. Eligible studies included randomized trials, controlled studies, observational research, and surveys conducted in intraoperative settings. In parallel, a scoping review of qualitative literature was performed to capture broader perspectives on OR music use. Data extracted included study design, intervention characteristics, and reported outcomes.

Results: Fourteen studies met inclusion criteria, comprising randomized or crossover trials (29%), controlled nonrandomized studies (14%), observational studies (43%), and cross-sectional surveys (14%). Surgeon-directed music was associated with improved mood, reduced perceived stress, and enhanced task efficiency, particularly during routine procedures. However, team-level outcomes were mixed: 64% of studies reported impaired communication, distraction, reduced situational awareness, or interference with auditory cues such as monitor alarms. Anesthesia providers and nursing staff more frequently reported negative impacts and limited control over music selection and volume. No study identified a formal guideline for safe OR music management; recommendations were limited to general suggestions such as maintaining low volume or using instrumental music. Across qualitative reports, music was perceived as beneficial for morale and concentration but potentially hazardous during critical operative phases.

Conclusions: OR music exerts both beneficial and detrimental effects on surgical teams and workflow, with potential implications for patient safety. Current literature lacks evidence-based guidelines for responsible use. We propose a pragmatic, team-driven framework emphasizing inclusive decision-making, defined quiet periods during critical tasks, appropriate volume control, and periodic reassessment. Such grassroots strategies may achieve greater acceptance and sustainability than rigid top-down policies while preserving the positive effects of music. Further prospective studies are needed to evaluate the impact of structured OR music protocols on communication, efficiency, and clinical outcomes.

1. Faraj AA, Wright AP, Haneef JHS, Jones A. Listen while you work? The attitude of healthcare professionals to music in the operating theatre. J Perioper Pract. 2014;24(9):199-204. doi:10.1177/175045891402400903
2. Fu VX, Oomens P, Merkus N, Jeekel J. The Perception and Attitude Toward Noise and Music in the Operating Room: A Systematic Review. J Surg Res. 2021;263:193-206. doi:10.1016/j.jss.2021.01.038
3. George S, Ahmed S, Mammen K, John G. Influence of music on operation theatre staff. J Anaesthesiol Clin Pharmacol. 2011;27(3):354. doi:10.4103/0970-9185.83681
4. Kacem I, Kahloul M, El Arem S, et al. Effects of music therapy on occupational stress and burn-out risk of operating room staff. Libyan J Med. 2020;15(1):1768024. doi:10.1080/19932820.2020.1768024
5. Lies SR, Zhang AY. Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures. Aesthet Surg J. 2015;35(7):858-863. doi:10.1093/asj/sju161

Purpose: Vulvar cancer is a rare gynecologic malignancy that often requires radical surgical resection, resulting in significant perineal soft tissue defects and potential impairment in quality of life.(1) Contemporary guidelines emphasize individualized, multidisciplinary management, with treatment decisions influenced by tumor characteristics, comorbidities, and functional outcomes.(2) Reconstruction presents unique challenges, with multiple approaches depending on defect size, location, and patient factors.(3) HPV-related disease considerations further highlight care complexity.(4) Comparative data evaluating morbidity across closure techniques remain limited. We evaluated 30-day outcomes following radical vulvar resection, comparing primary closure, complex repair/adjacent tissue transfer, and flap reconstruction.

Methods: A retrospective review from 2022 to 2025 using the National Surgical Quality Improvement data registry was performed. Vulvar cancer patients undergoing radical resection were analyzed for 30-day morbidity across primary closure, complex repair/adjacent tissue transfer, trunk and lower extremity flap closure.

Results: A total of 1038 patients were identified, median age was 67 (IQR: 59-77) and median BMI was 30 (IQR: 25-35.5). Primary closure was performed in 95% of patients (N=992) followed by 1.35% trunk flaps (N=14), 1.35% lower extremity flaps (N=18) and 1.73% complex closure/adjacent tissue transfer (N=4). There was no statistically significant difference in rates of DM, HTN, CKD, CHF, COPD, functional status, current smokers, steroid use, albumin levels or ASA class between the groups. However, morbidity likelihood was significantly higher for lower extremity flaps (p < 0.001) compared to the other techniques. Surgical outcomes showed lower extremity flaps with a higher rate of return to the OR 21.4% (p < 0.001) and readmission 35.7% (p < 0.001), while wound dehiscence did not show statistical significance. Logistic regression showed hypoalbuminemia, smoking and diabetes as predictors for major complications. Hypoalbuminemia OR=2.77 (95%CI=1.43-5.36, P=0.003), smoking OR=1.92 (95%CI=1.21-3.05, P=0.006) and diabetes OR=1.10 (95%CI=1.11-3.47, P=0.02), while controlling for other comorbidities.

Conclusions: Vulvar cancer resection and reconstruction could lead to significant morbidity. Smoking and hypoalbuminemia are modifiable factors that are associated with morbidity and therefore should be taken into consideration to attempt to ameliorate wound complications.

References: 1. Nogueira-Rodrigues A, Oonk MHM, Lorusso D, Slomovitz B, Leitão MM, Baiocchi G. Comprehensive management of vulvovaginal cancers. CA Cancer J Clin. 2025;75(5):410-435. 2. Abu-Rustum NR, Yashar CM, Arend R, Barber E, Bradley K, Brooks R, et al. Vulvar cancer, version 3.2024, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2024;22(2):117-135. 3. Chelmow D, Cejtin H, Conageski C, Farid H, Gecsi K, Kesterson J, et al. Executive summary of the lower anogenital tract cancer evidence review conference. Obstet Gynecol. 2023;142(3):708-724. 4. Jodry D, Obedin-Maliver J, Flowers L, Jay N, Floyd S, Teoh D, et al. Understanding sexual and gender minority populations and organ-based screening recommendations for human papillomavirus-related cancers. J Low Genit Tract Dis. 2023;27(4):307-321.

Introduction: Peripheral nerve injuries (PNI) pose a significant clinical challenge, resulting in reduced quality of life, financial burden, pain, and functional deficits. Most injuries are traumatic or iatrogenic. Current standards of care are limited by the slow rate of nerve regeneration (~ 1 mm/day) and difficulty assessing regeneration. Given the need for improved therapeutic and diagnostic modalities, this review synthesizes clinically translatable research on nerve regeneration in large animal models.

Methods: Scopus, Embase, Web of Science, and PubMed were systematically searched using keywords related to PNI and large animal models. Two authors independently screened studies in two stages (title/abstract and full-text review). Inclusion criteria comprised large animal studies evaluating interventions to improve nerve recovery or diagnostics in PNI. The primary outcome measure is motor and/or sensation recovery. Secondary outcomes include animal characteristics, injury details, intervention type, follow-up duration, complications, reinnervation success, pain, function, electrodiagnostics, and molecular imaging. Risk of bias was evaluated using the SYRCLE assessment.

Results: Of 2,082 studies, 91 were included. A total of 86 (94.5%) studies reported successful interventions. Animal models included canine (n=27, 29.7%), ovine (n=25, 27.5%), non-human primate (n=24, 26.4%), porcine (n=14, 15.4%), and caprine (n=1, 1.1%).

Lower extremity nerves were most frequently studied (n=58, 63%), including peroneal (n=20, 22%), sciatic (n=20, 22%), tibial (n=8, 8.8%), and femoral (n=1, 1.1%). Upper extremity nerves comprised 33.7% (n=31), including median (n=13, 14.3%), ulnar (n=12, 13.2%), and radial (n=6, 6.6%). Facial nerves comprised 12% (n=11). Transection was the predominant injury model (n=85, 93.4%), followed by crush (n=7, 7.7%), and single (n=1, 2.2%) studies of ischemia, compression, and medication toxicity. Gap models were used in 64 studies (70.3%) with gap length ranging from 2mm to 100mm (mean 34.1 ± 22.7mm).

Electrophysiologic assessment was the most common outcome measure (n=78, 85.7%), followed by motor function evaluation (n=39, 42.9%), withdrawal reflex (n=7, 7.7%), molecular imaging studies (n=5, 5.5%), sensory function evaluation (n= 3, 2.2%), and pain (n=2, 2.2%). Follow-up ranged from 0-1,100 days (mean 238 ± 173 days).

Among interventions, 74 (81.3%) studies evaluated novel graft materials or techniques, with 70 reporting success (82.4%). Of the 17 (18.7%) studies that used pharmacological intervention, 14 were successful (82.3%). All 14 (15.4%) stem cell studies and all 5 (5.5%) imaging technique studies reported success. Both (2.2%) electrophysiological therapy studies and one (1.1%) prosthetic study reported success.

Conclusion: Given their anatomical and physiological similarity to humans, large animal models are a critical intermediate between small animal models and human trials. Significant heterogeneity exists in species selection, injury characteristics, gap length, follow-up duration, and outcome measures, which limits cross-study comparison. Greater emphasis on standardization and clinically relevant functional outcome measures is needed to enhance translational validity.

Objectives To describe the ten surgical modifications to the Millard technique developed at our national referral center (Hospital General Dr. Manuel Gea González), analyze their impact on aesthetic and functional outcomes in unilateral cleft lip repair and obtain patient-reported outcomes through the validated CLEFT-Q scale. Methods A retrospective analysis of 108 from 150 patients who completed the cuestionary successfully, with unilateral cleft lip operated with the Millard´s modified technique between 2010–2024 at our hospital,. The CLEFT-Q scale was used to evaluate the functional and aesthetic satisfaction of the patients. The ten surgical modifications implemented are: 1. Pre- and Post-operative Botulinum Toxin A Injection: Reduces muscle tension, dehiscence, and hypertrophic scarring. 2. Infraorbital Nerve Block with Ropivacaine 0.2%: Improves analgesia and decreases anesthetic dosage. 3. More Circular Rotation ("A") Flap: Enhances philtral height and Cupid's bow symmetry. 4. Elongation of the "C" Flap: Lengthen columella and facilitates nasal floor closure. 5. Internal Dissection of Nasal Ala and Caudal Septum Release: Corrects nasal asymmetry. 6. Incision and Internal Suturing of the Nasal Ala: Refines alar contour and stability. 7. Reinforced Reconstruction of the Nasal Floor (Nasal and Oral Mucosal Lining): Reduces nasal vestibular fistulas and increases nasal volume. 8. Orbicularis Oris Muscle Release and Reapproximation at Wet–Dry Junction: Restores continuity, prevents whistle deformity. 9. Z-Plasty in the Upper Lip Vestibule: Elongates the vestibule and relieves tension, improving oral continence. 10. Transfixion Sutures on Alar Cartilage: They maintain nasal projection and symmetry. Finally the individual results were translated to the Rasch System and reported as measures of standard deviation. Results In this cohort, 57.6% were male; mean age at surgery was 1.6 ± 4.03 years and at interview 8.81 ± 6.38 years; 61.5% had left-sided clefts and 80.4% were incomplete. Appearance scores were jaw 72.67 ± 4.17, face 71.87 ± 7.23, and nose 64.8 ± 4.44. Quality-of-life scores were social 83.81 ± 12.37, school 82.81 ± 13.62, psychological 79.38 ± 15.52, and speech 79.88 ± 13.92, with favorable eating and drinking outcomes. Conclusions: The ten refinements to the Millard technique provide a reproducible algorithm for achieving tension-free closure and balanced nasal-lip contour. Patients demonstrated high satisfaction in aesthetic domains, excellent psychosocial well-being, and strong functional outcomes. Results Blanco-Davila F. Incidence of cleft lip and palate in the northeast of Mexico: a 10-year study. J Craniofac Surg. 2003;14(4):533-537. doi:10.1097/00001665-200307000-00027. Hozyasz K, Mazur J, Chełchowska M. Stezenia alpha-tokoferolu u matek dzieci z rozszczepami wargi oraz z rozszczepami wargi i podniebienia [Alpha-tocopherol levels in mothers of children with cleft lip or with cleft lip and palate]. Ginekol Pol. 2006;77(4):255-262. Fisher DM, Sommerlad BC. Cleft lip, cleft palate, and velopharyngeal insufficiency. Plast Reconstr Surg. 2011;128(4):342e-360e. doi:10.1097/PRS.0b013e3182268e1b Mohamed Elekiaby, Tarek Gobran, Ahmad Rozik, Wael Mansy, Omar Elekiaby. (2021). Postoperative Parents' Satisfaction in Cases of Unilateral Cleft Lip Repaired by Millard's Procedure. Annals of the Romanian Society for Cell Biology, 25(6), 18266–18277. Knezevic P, Blivajs I, Dediol E, Macan D, Virag M. The modification of rotation-advancement flap made in 1950. Act Stomatol Croat. 2017; 51(1):60-4. doi:10.15644/asc51/1/8

Background: Craniosynostosis (CS) is a rare disorder with premature fusion of one or more cranial sutures, potentially causing abnormal skull growth, elevated intracranial pressure, and neurodevelopmental impairment (1). Delayed diagnosis may require more invasive surgical approaches and potentially poorer functional outcomes. Positional plagiocephaly (PP) is a much more common cause of abnormal head shape and is managed conservatively with repositioning or helmet therapy. Due to the similarities in presentation, CS may initially be misdiagnosed as PP (2). With the paucity of literature on this topic, this study explores how initial PP diagnosis may obscure and delay the diagnosis of CS.

Methods: A retrospective case series at Texas Children's Hospital was conducted to identify patients who were initially diagnosed with PP and subsequently presented after six months of age with CS between January 2011 and July 2025. Information on demographic factors, PP and CS diagnosis, referrals, imaging studies, and treatment was reviewed.

Results: The diagnostic course of 10 patients was reviewed. The median age of diagnosis was two months old for PP and eight months for CS. Abnormal head shape was first recognized by pediatricians in all cases and helmet therapy was initiated in 50% of patients to address PP. When no improvements were made, three patients initially received X-ray imaging, two of which had no evidence of CS, and all patients eventually had CT imaging which confirmed CS. Subsequently, 60% of patients underwent surgical intervention (three cranial vault remodeling, two frontal orbital advancement, and one posterior cranial vault distraction), all of which were open approaches, to correct the CS. Despite the delayed presentation, no patients presented with neurologic impairment, however, concern for future neurodevelopmental impacts often prompted operative management.

Conclusions: This case series highlights how an initial diagnosis of PP may obscure CS, leading to delayed presentation and more invasive surgery. Awareness among pediatric providers regarding atypical features or poor response to PP management may prompt earlier imaging and referral to craniofacial teams. Further, enhanced collaboration between plastic surgery and neurosurgery may facilitate timely intervention and reduce the risk of long-term functional or developmental sequelae.

(1) Dempsey RF, Monson LA, Maricevich RS, et al. Nonsyndromic Craniosynostosis. Clinics in Plastic Surgery. 2019;46(2):123-139. doi:10.1016/j.cps.2018.11.001 (2) Daly GE, Ferrin P, Carboy JA, Howell LK, Selden NR, Wolfswinkel EM. Concurrent Craniosynostosis and Positional Plagiocephaly: A Scoping Review. FACE. 2024;5(3):469-477. doi:10.1177/27325016241252953

Background: Millions of patients suffer from chronic wounds, leading to reduced quality of life and rising healthcare costs. Despite antibiotics and proper surgical care, many chronic wounds fail to fully heal (1,2). Biofilms are frequently implicated, acting as barriers to treatment and immune defense (1). Although these wounds persist, they rarely progress to life-threatening infection, suggesting an adaptive host-microbe balance that favors low virulence and chronicity over mortality (2). This review synthesizes current evidence to propose that bacterial populations and host defenses have co-evolved adaptations to support sustained, localized infections.

Methods: A comprehensive literature review of PubMed and Scopus (January 1990 to January 2025) was conducted using search terms including "skin microbiome," "chronic wounds," "biofilm," "immune evasion," and "immune response to chronic wounds." Peer-reviewed English-language studies on the interaction between the skin microbiome and immune defenses in chronic, non-healing wounds were included. Case reports and studies limited to acute wounds were excluded. Relevant titles and abstracts were screened, followed by full-text review and thematic synthesis on bacterial and host immune adaptations, and the pathological host-microbe equilibrium in chronic wounds.

Results: A total of 137 studies met inclusion criteria. Chronic wounds were consistently characterized by a dynamic interplay between microbial persistence and host immune dysregulation (1,2). In chronic wounds, bacterial populations adopt adaptations favoring long-term survival by forming impenetrable biofilms, downregulating metabolism of acute virulence factors, and coordinating pathogenic activity through quorum sensing (1,2). Commonly implicated bacteria such as Staphylococcus aureus, Pseudomonas aeruginosa, and Enterococcus faecalis demonstrate reduced acute virulence but increased resilience against immune clearance (e.g., P. aeruginosa elastase cleaves thrombin to form FYT21, which dampens host immune responses)(3). Concurrently, chronic wound environments exhibit persistent recruitment of neutrophils, macrophages, proinflammatory cytokines, and proteases, perpetuating tissue damage and delayed healing (1,2). While innate immune activation remains high, systemic and adaptive responses remain limited, suggesting an evolved tolerance towards subacute inflammation that prevents widespread infection. Together, these interactions create a localized, low-inflammation environment that sustains bacterial survival yet contains tissue injury, supporting a pathological host-microbe equilibrium (1,2,4).

Conclusion: Chronic wounds exhibit a stable pathological equilibrium in which bacterial populations and host immunity modulate one another to maintain persistent, localized infections. This co-evolutionary framework helps explain why chronic wounds neither heal nor progress to systemic disease. Future therapies aimed at disrupting this pathologic equilibrium may enhance chronic wound healing, surgical wound management, and reconstructive outcomes.

References: 1. Uberoi, A., McCready-Vangi, A. & Grice, E.A. The wound microbiota: microbial mechanisms of impaired wound healing and infection. Nat Rev Microbiol 22, 507–521 (2024). https://doi.org/10.1038/s41579-024-01035-z 2. Sachdeva, C., Satyamoorthy, K. & Murali, T.S. Microbial Interplay in Skin and Chronic Wounds. Curr Clin Micro Rpt 9, 21–31 (2022). https://doi.org/10.1007/s40588-022-00180-4 3. van der Plas, M., Bhongir, R., Kjellström, S. et al. Pseudomonas aeruginosa elastase cleaves a C-terminal peptide from human thrombin that inhibits host inflammatory responses. Nat Commun 7, 11567 (2016). https://doi.org/10.1038/ncomms11567 4. Bjarnsholt T, Kirketerp-Møller K, Jensen PØ, et al. Why chronic wounds will not heal: a novel hypothesis. Wound Repair Regen. 2008;16(1):2-10. doi:10.1111/j.1524-475X.2007.00283.x

Background

Soft tissue sarcomas are rare malignancies that require coordinated multidisciplinary management often including coordination of orthopedic and plastic and reconstructive surgical teams for optimal care. Prior studies showed improved complication outcomes in high-risk and complex spine closure cases. The purpose of this study is to evaluate a single institution association between plastic and reconstructive surgery (PRS) involvement and postoperative complications following soft tissue sarcoma resection.

Methods

A single-institution retrospective cohort study evaluating patients who underwent soft tissue sarcoma resection and closure by either the primary orthopedic surgeon or plastic and reconstructive surgeon between 2018 and 2023 was performed. Demographic, tumor, surgical, hospital admission and outcome variables of patients who underwent reconstruction by a plastic surgeon were analyzed and compared to the cohort of patients that did not undergo reconstructive closure.

Results

A total of 99 patients were identified, of which 15 underwent local or free flap reconstruction by a plastic and reconstructive surgeon, and 84 were closed by the orthopedic surgeon. Plastic surgery was involved in patients with larger defect sizes (222.4 cm^3 compared to 111.7 cm^3 in non-PRS cases), although the trend did not reach significance (p=0.060). Eighty percent of reconstruction was performed in delayed fashion, with 53% of the cases taking place during secondary admission. Sixty six percent of patients underwent reconstruction with local flap, 13.3% underwent a free flap and 20% were closed primarily. Patients undergoing reconstruction were more likely to have complications (73.3% vs 33.3%, p=0.001), particularly associated with partial graft loss (p=0.008). Notably, 14 patients in non-reconstructed group had dehiscence, compared to none in reconstructed group. There were no differences in other complications, including infection, seroma and hematoma rates. Patients in reconstructed cohort were significantly younger (57.0 +/-19.5 compared to 68.5 +/- 15.2 in non-reconstructed group). There were no significant differences in the other patient's demographics or tumor characteristics between the two groups.

Conclusion

Previous studies demonstrated superior outcomes in cases where there was immediate and planned plastic surgery involvement. Our study showed that within our institution, plastic and reconstructive surgery is involved in younger patients with larger defect sizes. Most of the reconstructions were performed in delayed fashion and were associated with greater complication rates. Our study found that sarcoma patients had initial failure of closure by plastic and reconstructive surgery, which subsequently prompted the need for plastic surgery involvement as a secondary closure. Prompt and proactive involvement of plastic and reconstructive has the potential to minimize initial wound healing complications and is crucial for optimal treatment in otherwise medically and surgically complex groups of patients.

Background: Artificial intelligence (AI) is increasingly being integrated into plastic and reconstructive surgery, promising to revolutionize clinical practice, research, and patient education. As the volume of literature in this domain expands, a comprehensive understanding of the most influential research is crucial for identifying key trends, recognizing leading contributors, and guiding future investigations. This study aimed to provide a bibliometric and visual analysis of the top 100 most-cited articles on AI in plastic and reconstructive surgery, offering a detailed map of the current intellectual landscape.

Methods: A systematic search of the Scopus database was conducted to identify publications related to AI in plastic and reconstructive surgery published between 2014 and 2025. The search was restricted to original research articles and review papers. The 100 most-cited articles were selected for in-depth bibliometric analysis. Extracted variables included citation counts, publication year, authorship, institutional affiliations, and journal metrics. Network analyses of co-authorship, country collaboration, and keyword co-occurrence were generated using VOSviewer and R (version 4.4.1) to visualize the structure and evolution of the research landscape.

Results: The initial search identified 3,827 publications, of which 3,108 met the inclusion criteria. The top 100 most-cited articles totalled 2,701 citations, with a mean of 27 ± 22 citations per article. A marked increase in publication activity was observed after 2022, with 79% of the top-cited articles published within the past three years. The United States was the most prolific contributor, accounting for 45 articles and 1,205 citations, followed by Australia with 10 articles and 445 citations. The most influential authors were primarily affiliated with Australian institutions, with Rozen, W.M., and Seth, I. (Peninsula Health) emerging as the most productive contributors. Aesthetic Plastic Surgery and Aesthetic Surgery Journal were the leading journals, contributing 16 and 10 articles, respectively. Keyword analysis revealed dominant themes including "machine learning," "deep learning," and large language models such as "ChatGPT," with major clinical applications in cleft lip and palate surgery, rhinoplasty, and breast reconstruction.

Conclusions: Research on artificial intelligence in plastic and reconstructive surgery has expanded rapidly in recent years, marked by a surge in high-impact publications. The field is largely driven by contributions from the United States and Australia, with a strong focus on aesthetic and craniofacial applications. The emergence of large language models represents a dynamic and evolving research frontier with significant implications for future clinical practice and scholarship.

Background: The mainstream use of GLP-1 receptor agonists has significantly increased in non-diabetic populations due to their effectiveness in weight management. While these medications have demonstrated metabolic and cardiovascular benefits, their perioperative implications remain underexplored, particularly in elective plastic surgery populations. Methods: A retrospective cohort study was conducted using the MarketScan Commercial Claim and Encounters database from January 2018 to January 2023. Adult patients without a diagnosis of diabetes mellitus who underwent elective plastic surgery procedures were identified using CPT codes. GLP-1 agonist use was defined as an active prescription within 90 days prior to surgery. Temporal trends in GLP-1 agonist use were analyzed across the study period. Results: A total of 3,995,376 non-diabetic patients who underwent elective plastic surgery procedures between 2018 and 2023 were identified, of whom 44,553 (1.1%) had an active GLP-1 agonist prescription within 90 days of their operation. The number of procedures involving patients with an active GLP-1 prescription increased steadily from 7,795 (2018) to 9,135 (2019), 7,799 (2020), 9,675 (2021), and 10,149 (2022). Although total surgical volume fluctuated over the study period, the proportion of procedures with an active GLP-1 prescription increased from 0.21% in 2018 to 2.2% in 2023, demonstrating a consistent upward trajectory. Conclusions: The use of GLP-1 receptor agonists among non-diabetic patients undergoing elective plastic surgery has increased substantially in recent years, paralleling their expanding off-label use for weight management. Given the unique pharmacologic profile of these agents, further research is warranted to assess their impact on perioperative safety, wound healing, and surgical outcomes.

Purpose: Despite the popularity of equestrian activities among adults, U.S. studies of horse-related facial fractures are limited to pediatric populations or ocular injuries (1-3). This study characterizes injury patterns, protective headgear use, and outcomes following adult equestrian-related facial fractures at a high-volume trauma center.

Methods: A retrospective review was performed of patients presenting to a single high-volume trauma center with equestrian facial fractures confirmed on imaging from January 2019 to December 2022. Isolated soft-tissue injuries and non-equine mechanisms were excluded. Fractures were categorized by anatomic location and mechanism. Protective equipment use was documented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included operative management and need for reoperation.

Results: Eight adults met inclusion criteria. Median age was 57 years (range 22–64), and 75% were female. Mechanisms included horse kick (50%), fall from a horse (37.5%), and fall from a horse-drawn buggy (12.5%). No patients were documented to be wearing protective headgear at the time of injury. Horse kicks more frequently resulted in complex pan-facial fractures, including LeFort patterns, compared with falls. The most common fractures were orbital floor (75%), nasal bone (75%), and maxillary sinus (62.5%) fractures. Median total fracture count was 4 (range 1–11). Non-facial skeletal injuries occurred in 37.5% of patients, including axial and thoracic fractures. Three patients (37.5%) underwent operative fixation in their initial hospital visit, of which one patient returned to the operating room for persistent nasal obstruction. Operatively managed patients demonstrated higher fracture burden and pan-facial patterns, all following horse kick injuries. Delayed surgery was implemented in one operative patient requiring orbital reconstruction with custom implants and one nonoperative patient with nasal obstruction refractory to medical management. Median LOS was 2 days (IQR 0.5–3.0) and did not differ between operative and non-operative groups (p = 1.00) or single- versus multi-region fractures (p = 0.29). Concomitant intracranial injury occurred in 88% of patients, including radiographic intracranial findings or clinician-documented concussion.

Conclusion: Adult equestrian facial fractures are uncommon but demonstrate distinct patterns, with frequent orbital involvement and concomitant intracranial injury. Horse kicks more often result in complex pan-facial injuries requiring operative management. Despite injury severity and associated polytrauma, hospital LOS remains short. Use of protective headgear remains an important consideration in this patient population, as existing literature suggests improved outcomes with helmet use (4). Larger studies are needed to further characterize these injuries and inform surgical management and patient counseling.

References: 1. Thomas KE, Annest JL, Gilchrist J, Bixby-Hammett DM. Non-fatal horse related injuries treated in emergency departments in the United States, 2001-2003. Br J Sports Med. 2006;40(7):619-626. 2. Loder RT, et al. Injury patterns and associated demographic characteristics in children with a fracture from equines: A US national based study. Injury. 2024;55(1):101677. 3. Moran K, et al. Horsing around: A retrospective study of equestrian related eye injuries in the emergency department. Am J Emerg Med. 2025;50:41-45. 4. Stier R, et al. Retrospective analysis of 15 years of horse-related maxillofacial fracture data at a major German trauma center. Oral Maxillofac Surg. 2020;24(3):343-349.