搜索结果：Journal of plastic, reconstructive & aesthetic surgery : JPRAS

Complications of aesthetic surgery performed in private practice pose significant risk to patients and resource burden to healthcare systems. Thorough understanding of this population is important to mitigate future complications. We evaluated demographic and complication patterns among patients presenting to our institution after aesthetic surgery, and the financial liability of their care on the hospital and payor. This was a retrospective chart review of patients with complications related to aesthetic procedures from 2020-2023. Extracted data include biologic sex, age, smoking status, geographic location of original procedure, index surgical complications, timing of presentation, imaging, length of hospital admission, hospital charges, and insurance payments. Univariable analyses identified associations with outcomes. A total 36 patients were included (mean age: 37.5 years). Patients were more likely to be Black (p = 0.04), Hispanic (p = 0.03), and on Medicaid (p < 0.001). Tobacco/cannabis use and obesity were prevalent in 25% and 47.2% of patients, respectively. Nearly half of patients had their procedures in Mexico (36.1%) and the Dominican Republic (11.4%). Patients using tobacco/cannabis were more likely to present with infection (p = 0.001) and undergo intervention (p = 0.01). The total median hospital charge was $43,324.96 (IQR $10,728.12, $80,803.18) and median insurance payment was $3947 (IQR $404.61, $24,516.00). In cases involving operative intervention, median hospital charge and insurance payments were $125,358.70 (IQR $51,065.52, $152,704.70) and $14,863.52 (IQR $3947, $49,031.13), respectively. There is a disproportionate number of patients from socioeconomically disadvantaged backgrounds who present with aesthetic complications and incur substantial costs, prompting the need for interventions that promote safe, equitable access to aesthetic procedures.

Aesthetic medical tourism among Swiss residents, driven by lower costs and shorter waiting times, is increasing. Complications after surgery abroad often require follow-up care upon return, with costs covered by the healthcare system. We aimed to assess patient motivations and the resulting financial impact on the Swiss healthcare system. This retrospective two-center study analyzed complications following aesthetic surgery performed abroad in patients who were treated at the Departments of Plastic Surgery of the Ente Ospedaliero Cantonale and Thurgau Hospital Group between 2020-2024. Complications occurring within three years after surgery, or capsular contracture within one year, were included. Patient motivations were assessed via structured telephone interviews. Among 275 screened patients, 32 met the inclusion criteria. A mean of 0.7 patients per month required hospitalization. The cohort underwent 53 surgeries in 10 countries. Swiss citizens accounted for 56% of all the patients, whereas 44% were foreign nationals. Complications included infections (36%), wound dehiscence (28%), hematomas (8%), and others (28%). They required 42 revision surgeries. The mean case mix index was 1.33. The motivations for seeking surgery abroad were lower cost (54%), influence of social media/friends (23%), and shorter waiting times to undergo surgery (23%). Treatment costs amounted to USD 691,838, whereas reimbursements reached USD 852,000. Complications following aesthetic surgery abroad impose a substantial burden on the Swiss healthcare system. Although reimbursed under current legislation, costs are ultimately borne by the public, thereby highlighting the need for improved patient awareness and ongoing policy evaluation in Switzerland and other high-income countries.

Sternal mediastinitis, the most severe form of deep sternal wound infection (DSWI), following heart and lung transplantation is uncommon but associated with substantial morbidity. Chronic immunosuppression, complex microbiological profiles and altered chest wall anatomy pose distinct reconstructive challenges. We present our experience from our tertiary transplant centre and evaluate the applicability of our reconstructive algorithm in this population. A retrospective review was conducted of all heart and lung transplant recipients who were surgically managed for DSWI at a tertiary cardiothoracic transplant centre between June 2017 and December 2025. Demographic data, microbiology, operative details, reconstructive interventions and outcomes were analysed. A PRISMA-compliant systematic review was performed alongside. Ten patients were identified (7 lung and 3 heart transplant recipients). Median time from transplant to DSWI diagnosis was 95 (4-1486) days. Following diagnosis, median time to definitive reconstruction was 90 (32-722) days, during which patients underwent a median of 4 (1-10) debridements and received prolonged antimicrobial therapy. Negative pressure wound therapy was used for a median of 42.5 days (8-122 days; n=9). Median DSWI-related length of stay was 147 (62-321) days. Reconstructive strategy was guided by previous incision type: reverse abdominoplasty predominated following clamshell thoracotomy (5/7), whereas bilateral pectoralis major advancement flaps were most employed following median sternotomy (2/3). All patients were successfully discharged. There was no perioperative mortality. Transplant-associated DSWI is characterised by prolonged treatment courses and complex microbiology. Aggressive source control within a multidisciplinary framework, combined with considered reconstructive planning, facilitates durable results and successful discharge in this high-risk population.

Artificial intelligence (AI) and machine learning (ML) are increasingly being applied to preoperative risk prediction in plastic surgery; however, the methodological quality and clinical readiness of these models are yet to be systematically evaluated. This systematic review assessed the quality, risk of bias, and predictive performance of AI/ML preoperative risk prediction models in plastic surgery using the PROBAST+AI framework. Five databases were searched from inception through October 2025. Ten studies met the inclusion criteria, encompassing autologous breast reconstruction (n = 2), alloplastic breast reconstruction (n = 5), head and neck reconstruction (n = 1), burn surgery (n = 1), and aesthetic surgery (n = 1). Random forest was the most frequently used algorithm (n = 4), followed by neural networks (n = 2), deep forest with RUSBoost (n = 1), support vector machine (n = 1), and logistic regression (n = 1). AUC ranged from 0.66 to 0.82 among the 8 studies reporting discrimination. Critical methodological limitations were identified: only 2 studies (20%) performed external validation, 5 of 7 development studies (71.4%) had events per variable <10 indicating inadequate sample size, and 7 studies (70%) did not report model calibration. Pre-reconciliation inter-rater reliability across 102 paired domain-level ratings yielded a Cohen's kappa of 0.240 and Prevalence-Adjusted Bias-Adjusted Kappa of 0.039, consistent with published benchmarks for PROBAST-based systematic reviews. All discrepancies were resolved via structured consensus. Current AI/ML models for preoperative risk prediction in plastic surgery demonstrate variable performance and substantial methodological limitations that preclude clinical implementation. Multi-institutional prospective validation studies with rigorous methodology are needed before clinical adoption.

Breast surgery encompasses oncoplastic, reconstructive and aesthetic procedures, with UK training delivered through both general surgery and plastic surgery pathways. Despite this, limited national data exist on medical student and early postgraduate exposure to breast surgery or their understanding and interest in the specialty. This study evaluates undergraduate and early postgraduate exposure, perceptions and career interest, and examines how factors such as clinical experience and training level influence these outcomes. A national cross-sectional online survey was conducted among UK medical students and postgraduate year 1-2 doctors between 1st April and 29th June 2025 following ethical approval. The questionnaire was disseminated via student and doctor collaborators using JISC Online Surveys. Statistical analysis included chi-squared tests, Mann-Whitney U tests, Kruskal-Wallis tests and Spearman's Rank correlation. A total of 1507 responses were received. Interest in breast surgery declined with advancing training level (p<0.001). Female respondents expressed significantly higher interest than male respondents (p=0.005). Awareness of the training pathways improved with seniority (p<0.001) but remained low overall. Perceptions of which speciality commonly performs core procedures varied significantly by training level for wide local excision, cancer excision and reconstruction (p<0.05). Observing or assisting in breast surgery was associated with higher specialty knowledge and interest (p<0.001), with a positive correlation between exposure and interest (r=0.30, p<0.001). Undergraduate clinical exposure and mentorship were the strongest contributors to career interest. UK doctors appear to show declining interest in breast surgery as they advance from university to early clinical practice. Women have greater interest in the career than men. There is generally poor understanding of the UK breast surgery training pathway. Overall clinical exposure to breast surgery is low with most medical students and doctors having not observed (50.5%) or assisted (71.7%) any breast operations. Improving clinical exposure, mentorship and dedicated support to accessing breast surgery training pathways are crucial to promote workforce planning and future recruitment to breast surgery.

Cardiac arrest rarely occurs during or after free flap surgery, and although multiple studies have reported the outcomes of in-hospital cardiac arrest, studies describing the outcomes of free flaps in patients who were successfully resuscitated after cardiac arrest are rare. We present herein the case of an 85-year-old woman who underwent an excisional biopsy after presenting to our dermatology department with a rapidly growing subcutaneous mass in her left forearm. A pathological examination of the biopsy specimen revealed the mass to be a malignant tumour; therefore, the patient subsequently underwent an extended excision, resulting in a 100 &#xd7; 250 mm defect in the dorsum of her left forearm. The defect was successfully reconstructed using a free anterolateral thigh flap from the right leg; however, 2 days post-reconstruction, the patient experienced cardiopulmonary arrest. Spontaneous circulation was returned after 10 min of cardiopulmonary resuscitation, during which 2 mg of adrenaline was administered. The free flap was closely observed for >30 days post-arrest and showed no signs of necrosis or infection during that time. The patient was transferred to a nursing facility on day 53 post-arrest owing to the loss of high cognitive function. Our institution has encountered two other cases of post-operative cardiac arrest after free flap transfer in the past 8 years, and a literature search of PubMed returned three documented cases of free flap survival after cardiac arrest and resuscitation. This case report and literature review aimed to demonstrate the characteristics of the free flaps that survived cardiac arrest and subsequent resuscitation. An analysis of these six aforementioned cases of free flaps that survived cardiac arrest demonstrated that post-operative cardiac arrest and cardiopulmonary resuscitation may not significantly decrease the survival of free flaps.

We have an opportunity to strengthen guidelines for global surgical initiatives, such as those established by the American Society of Plastic Surgeons (ASPS) and Lancet Commission on Global Surgery (LCOGS). To recommend improvements supporting health system resilience, we conducted a qualitative scoping review and thematic analysis of the literature on global surgical initiatives in Plastic and Reconstructive Surgery (PRS) and similar surgical and perioperative specialties. We queried four medical databases for publications from 2006 to 2023 pertaining to humanitarian surgical initiatives in PRS, otolaryngology, orthopedic surgery, ophthalmology, and anesthesiology. Two authors screened 1327 articles, yielding 366 articles for analysis with 91 qualitative markers/codes developed from the Partners in Health 5S framework (staff, stuff, space, systems, social support). We compared our findings with example guidelines from ASPS and LCOGS and provided evidence-based recommendations. The most discussed codes are staff education and training in the host country (39% of articles), surgical outreach sustainability (33%), and post-operative management (31%). Some important, but less frequently identified codes, include medical translators (11%), funding to offset patient cost burden (5%), and patient satisfaction (3%). Codes such as telehealth, patient-reported outcomes, cost burden, and medical translators were not identified in ASPS or LCOGS guidelines. We recommend that global surgical initiative guidelines (e.g., ASPS and LCOGS) be revisited to emphasize host capacity-building and offsetting costs associated with surgical care, extending existing recommendations to address barriers to patient care. Our findings can assist global surgical initiatives in ensuring safe, high-quality care delivery and strengthening local health systems.

This anatomical study aimed to demonstrate the co-dominance of the transverse cervical artery (TCA) and dorsal scapula artery (DSA) in their blood supply to the trapezius muscle. Dissection was performed on ten fresh cadavers (20 hemi-trunks), with the use of pigmented latex injections to trace the vascular course and methylene blue injections to delineate cutaneous territories. In 63% of specimens, the transverse cervical artery (TCA) and the dorsal scapular artery (DSA) originated separately, while 37% displayed a common origin from the thyrocervical trunk. The average calibre of the TCA was 2.70 mm and the DSA 2.66 mm. The DSA was found to be equal to or larger in calibre than the TCA in 56% of specimens. The cutaneous territory for the TCA measured 15 &#xd7; 10 cm and was located above the spine of the scapula. The cutaneous territory of the DSA measured 20 &#xd7; 15 cm and was seen below the spine of the scapula and extending 10 cm beyond the lateral border of the trapezius. There was significant overlap between these two cutaneous territories. Two clinical cases illustrate the application of simultaneous dual flaps harvested from the trapezius based on the TCA and DSA, highlighting the importance of recognising the DSA as a major vascular contributor. This study challenges the conventional notion of unilateral vascular dominance of the TCA, proposing that the trapezius muscle should be classified as a type III flap supplied by co-dominant vessels.

This study aimed to translate and culturally adapt the GENDER-Q into German and evaluate its feasibility and responsiveness when integrated into routine clinical care among patients undergoing masculinizing chest surgery. This mixed-methods translation and pilot implementation study was conducted between January 2025 and January 2026 at a tertiary academic transgender health program in Germany. Linguistic validation included forward translation and back-translation, developer review, and cognitive debriefing interviews with 14 transgender and gender-diverse adults. For the pilot implementation, 14 consecutive patients undergoing masculinizing chest surgery completed scales assessing chest appearance, nipples and areolas, body image, gender dysphoria, psychological well-being, psychological distress, and experience of care. Linguistic validation identified minor semantic and conceptual issues resolved through iterative revisions, resulting in a linguistically accurate and conceptually equivalent German version. In the pilot implementation with a final sample of 13 patients, postoperative scores improved significantly across all assessed outcome scales (all p < 0.013), with the largest changes observed for chest appearance (mean change = 64.23; standardized response mean [SRM] = 3.59) and body image (mean change = 36.85; SRM = 1.59). Significant improvements were also observed for gender dysphoria (mean change = 23.08; SRM = 1.64) and psychological distress (mean change = 26.84; SRM = 2.04). Experience of care scores were high at baseline (mean range, 87.6-94.3) and remained stable. The German GENDER-Q demonstrated linguistic and conceptual equivalence and showed feasibility and preliminary responsiveness in a small single-center pilot implementation.

Keystone-type fasciocutaneous flaps, derived from the angiosome concept, are island flaps that have demonstrated versatility and reliability in the reconstruction of multiple anatomical regions. However, evidence regarding their use in large dorsolumbar soft-tissue defects remains limited. This study describes clinical outcomes and explores flap design parameters, particularly pedicular area proportions, in this challenging anatomical region. A retrospective, non-comparative case series was conducted through medical record review of consecutive patients treated between 2021 and 2023. Patients presenting with large soft-tissue defects of the dorsolumbar region who underwent reconstruction using freestyle multiple-perforator island flaps were included. Sociodemographic data, defect characteristics, flap design variables, and postoperative outcomes were extracted and analyzed descriptively. Twenty-one flaps were performed in 21 patients, with a mean age of 35 years. The mean defect size was 120 cm&#xb2; (range, 12-353 cm&#xb2;), and the mean flap size was 283 cm&#xb2; (range, 27-589 cm&#xb2;). The mean pedicular area represented 15% of total flap surface. During follow-up, four flaps developed minor wound dehiscence managed conservatively, and one flap presented transient venous congestion. A single case of partial flap loss was observed, with no cases of total flap loss. Notably, flap viability was preserved even in cases with pedicular areas as low as 10%. In this retrospective series, freestyle multiple-perforator island flaps provided reliable coverage with low complication rates, even with pedicular areas as low as 10-15%, suggesting greater design flexibility than traditionally assumed. These findings support their role as a practical locoregional reconstructive option with limited donor-site morbidity and reduced technical complexity. Further comparative studies are required to validate these observations.

Peripheral nerve injury (PNI) represents a challenging frontier for the many surgical specialties dealing with these injuries. Improved surgical techniques and understanding have resulted in improvements in patient care, but a mastery of the processes of nerve regeneration and repair have proved elusive. This review intends to outline the changes at the neuromuscular junction in response to denervation injury. By reviewing the current literature, we aim to solidify the understanding of these morphological changes and identify future areas of research need. A literature search of PubMed, Embase and Web of Science including studies up to 22nd December 2023 was carried out. Search terms related to the motor endplate or neuromuscular junction, nerve degeneration, peripheral nerve injury and nerve regeneration. Three researchers independently performed screening of potentially relevant studies, using Covidence (Melbourne, Australia), a review workflow platform facilitating blinded reviewing. Results are reported in accordance with the Preferred Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. We identified 3595 records in the initial search, with no additional articles identified through backward and forward citation tracking. 350 full-text reports were assessed for eligibility. Ultimately, 118 studies were included for data extraction. The mechanisms of degeneration and regeneration at the NMJ summarized within provide multiple opportunities for ongoing research. Terminal Schwann cells and the constituents of the post synaptic apparatus may be able to be induced to survive for longer, or to be replenished to levels facilitating functional recovery from greater periods of denervation.

Precise anatomical mapping of the deep inferior epigastric perforator (DIEP) flap is essential for successful breast reconstruction. Although computed tomography angiography (CTA) is the gold standard for preoperative planning, manual identification of perforators is time-consuming and subject to inter-rater variability. We aimed to validate a self-developed image-processing tool designed to standardize coordinate extraction and automate two-dimensional spatial mapping of pre-selected abdominal wall perforators. A retrospective analysis was conducted on 52 patients who underwent DIEP flap reconstruction between 2017 and 2021. A total of 170 perforators were analyzed. The custom software processed axial CTA slices through histogram analysis and frequency-range filtering (1800-2200 HU) to enhance vascular visualization. Cartesian coordinates of clinician-selected perforators were calculated relative to the navel base (0, 0) and compared with manual radiological assessments to validate spatial fidelity. Analysis of 170 cutaneous perforators (n=52) showed predominant concentration in the lower abdominal quadrants. Centroids were (1.4, -20.2) mm for radiological assessment and (1.8, -21.2) mm for our software, relative to the umbilicus. Validation demonstrated high concordance, with a minimal systematic bias of (-0.4, 1.0) mm and a root mean square error of 6.04&#xa0;mm, within clinically acceptable margins. Standardized mapping and visual report generation averaged 8 &#xb1; 6&#xa0;min per patient, thereby providing a rapid turnaround for converting coordinate data into a standardized surgical guide. The validated tool provides a reliable, objective framework for standardizing and visualizing existing radiological data in DIEP flap planning. Although it does not alter clinical perforator selection or advance surgical technique, this technical utility provides an autonomous data-processing pathway to generate standardized spatial roadmaps, thereby optimizing the preoperative imaging workflow and safeguarding administrative timelines against potential interdepartmental reporting bottlenecks.

Radical parotidectomy with facial nerve sacrifice results in complete ipsilateral facial paralysis. Although immediate microsurgical reconstruction is the standard of care, no comparative trials have been conducted, and technique selection remains empirical. A PRISMA 2020-compliant systematic review (PROSPERO: CRD42025643307) was conducted. Scopus, Web of Science, and PubMed/MEDLINE were searched from inception to June 2025. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using the Newcastle-Ottawa Scale and MINORS. Certainty of evidence was evaluated using GRADE. Eighteen studies enroling 312 patients across ten countries (2000-2021) were included. Six technique subgroups were identified: non-vascularised cable graft (n=155), mixed-donor graft (n=38), vascularised thoracodorsal nerve free flap (n=46), masseteric nerve transfer (n=27), venous conduit (n=3) and combination approaches (n=43). House-Brackmann Grade I-III was achieved in 44% of patients across ten standard-grading studies (range, 24-100%). Postoperative radiotherapy did not impair graft function in four comparative studies. Masseteric nerve transfer yielded earlier reinnervation (4-6 months) than cable grafting (6-13 months). Risk of bias was moderate (NOS 6-9/9; MINORS 8-11/16). Overall certainty of evidence was Very Low (GRADE). Immediate facial nerve reconstruction provides meaningful functional recovery regardless of technique, and postoperative radiotherapy does not impair graft function. Masseteric nerve transfer offers earlier reinnervation; vascularised nerve-free flaps may be preferred for large defects or long neural gaps. A decision-making framework is proposed; prospective comparative trials with standardised outcome reporting are required.

Hidradenitis suppurativa is a chronic, inflammatory, recurrent, debilitating, skin follicular disease characterized by painful nodules and recurrent persistent drainage. Severe hidradenitis suppurativa not only reduces quality of life but also serves as a precursor to squamous cell carcinoma and can cause sepsis; therefore, complete excision of the lesion is recommended. We report a case of extensive hidradenitis suppurativa affecting most of the bilateral buttocks. Since it was determined that the extensive lesion in this case could not be covered in a single stage using any known single flap, we decided to perform reconstruction using a newly devised combined flap. For the area cephalad of the iliac crest, a large rotation flap centered on a lumbar artery perforator was designed. For the area caudal to the iliac crest, the superficial layer of the cephalic portion of the gluteus maximus muscle was split, and a musculocutaneous flap was designed to be elevated to include the perforating branch of the superior gluteal artery. These flaps were elevated as a single combined flap. Postoperatively, the flap blood flow was stable and the graft took well. There was no longer any persistent discharge from the lesion, and no functional impairment was observed following the elevation of the gluteus maximus musculocutaneous flap. Reconstruction using a combined lumbar artery perforator and split superior gluteus maximus musculocutaneous flap was considered a useful method, as the technique is simple and can cover extensive gluteal defects.

Severe breast hypertrophy presents a significant surgical challenge, especially in high body mass index (BMI) patients, due to the risks of poor projection, wound complications, and nipple-areolar complex (NAC) necrosis. This study evaluates a refined technique combining free NAC grafting with dual fascial fixation and minimal suture stabilization to optimize outcomes in this high-risk population. We retrospectively reviewed patients with severe breast hypertrophy who underwent reduction mammaplasty using the described technique between 2019 and 2023. Surgical indication for free NAC grafting was based on the presence of Grade 3 ptosis with required NAC elevation exceeding 8 cm and BMI &#x2265;29 kg/m&#xb2;, reflecting the high-risk nature of the cohort for NAC ischemia with pedicled techniques. The technique involved Wise pattern resection, dual fixation of medial and lateral pedicles to the superficial fascia, subdermal inverting sutures, and four-point fixation of a full-thickness free NAC graft. Postoperative outcomes were assessed clinically and photographically, focusing on breast projection, NAC survival, scar quality, and patient satisfaction. All 42 patients (mean age 42.2 years, mean BMI 35.5 kg/m&#xb2;) had no total NAC graft loss and maintained satisfactory breast projection and shape. The mean resection weight per breast was approximately 1135 g (range: 560-1710 g); the minimum value (560 g) represented the smaller breast of an asymmetric patient whose contralateral resection was 1470 g. Minor complications included focal areolar hypopigmentation in 2 patients and minor marginal necrosis in 4 cases (9.5%), all managed conservatively. Despite loss of lactation function and erogenous sensitivity, all patients reported high satisfaction with the aesthetic outcomes. Reduction mammaplasty using a refined free nipple-areolar complex grafting approach with dual fascial fixation and minimal suture stabilization represents a reliable and reproducible option for managing severe breast hypertrophy in high body mass index patients. When applied within a standardized operative framework and individualized patient selection, this technique allows for consistent breast projection, durable contour, and high patient satisfaction with a low complication profile.

Sickle cell trait (SCT) is considered a benign carrier state. Though not associated with vaso-occlusive crises of sickle cell disease (SCD), physiological stress like hypoxia, hypothermia, and sympathetic activation experienced during surgery can lead to sickling in patients with SCT. Some reports suggest that perioperative sickling may lead to thrombosis or flap loss. In the context of microsurgery, SCT is assumed to pose less risk than SCD due to lower hemoglobin S (HbS) levels. This study aims to characterize microsurgical outcomes in patients with SCT. We identified a series of patients with confirmed SCT who underwent microsurgical free flap reconstruction at one institution. Patient demographics, flap type, perioperative factors, postoperative complications, and overall flap survival were analyzed. Six free flaps were identified in five patients with sickle cell trait, including 4 DIEP flaps, 1 ALT flap, and 1 RFFF. All flaps survived with an average follow-up of 9.5 months. Four of six flaps (67%) experienced postoperative complications, including seroma (n = 1), donor site hematoma (n = 2), and wound dehiscence (n = 1). One patient developed venous thrombosis on postoperative day 1 requiring re-anastomosis. All but one maintained normothermia and adequate oxygenation. Preoperative hemoglobin averaged 11.1 g/dL, decreasing to 9.2 g/dL postoperatively, without transfusion. Despite concern for sickling events, this series of patients with SCT appear to tolerate free flap reconstruction. Even with transient intraoperative hypoxia and hypothermia, flap viability was preserved. Larger studies are needed to define microsurgical risk in SCT patients, particularly in relation to HbS levels and comorbidities.

Flap necrosis and graft failure remain significant sources of morbidity in reconstructive and aesthetic surgery, yet no cell-free biological adjunct has been established to improve tissue survival after transfer. Exosomes are nano-sized extracellular vesicles capable of simultaneously modulating angiogenesis, inflammation, apoptosis, and oxidative stress, and have been investigated as candidate regenerative adjuncts in plastic surgery. This PROSPERO-registered systematic review and meta-analysis (CRD420251146650), conducted per PRISMA 2020, searched PubMed, OVID, Scopus, Web of Science, and Google Scholar through September 2025 and included 24 animal studies (19 flap; 5 skin graft). Flap and graft studies were analysed as separate populations. Random-effects meta-analysis suggested increased flap survival (k = 19; MD 35.54%; 95% CI 25.11-45.97; p < 0.0001) and angiogenesis (k = 19; SMD 3.60; 95% CI 2.66-4.54; p < 0.00001). However, heterogeneity was extreme (I&#xb2; 76-97%), and funnel plot asymmetry with significant Egger's tests (both p < 0.001) indicated substantial small-study effects; the true effect is likely considerably smaller than these pooled estimates suggest, which should therefore be interpreted with caution. Perfusion, VEGF expression, and apoptosis generally favoured exosomes in narrative synthesis. In skin graft models, 4 of 5 studies reported improved graft take by days 10-14, but certainty was low. Allocation concealment was unreported in all studies and blinding unclear in most, representing a major methodological limitation that may further inflate observed effects. Preclinical evidence provides a biological rationale, but findings remain exploratory and hypothesis-generating. Standardised preclinical replication is required before clinical translation can be considered.

Free flap monitoring in the post-operative period is essential in modern practice. With a multitude of monitoring modalities, each institution will have varying monitoring protocols. A common mainstay of free flap monitoring is the use of an implantable doppler, such as the Cook-Swartz doppler (Cook Medical, Bloomington, Indiana, U.S.A), which allows for continuous, real time monitoring of flow through a flap. The doppler relies on a wired connection between the vascular cuff placed around the vessel being monitored, and its base unit where visual and audible representations of flow are produced for clinicians to interpret. The lead is composed of two, braided, insulated wires, which are protected by a plastic covering over the proximal 2/3rd (nearest the base unit); the distal 1/3rd (nearest the cuff) is unprotected. Here, we document our experience following accidental transection of the lead, and our innovative technique in repairing the Cook-Swartz doppler. The signal following repair was continuous and dynamic until planned removal at post-operative day 7.

Radical parotidectomy with facial nerve sacrifice produces major functional and aesthetic deficits. Immediate or single-stage facial nerve reconstruction and facial reanimation may restore symmetry, ocular protection, oral competence, and dynamic movement while avoiding the limitations of delayed intervention. This review synthesizes the available evidence on reconstructive strategies and outcomes in this setting. A systematic review was performed of studies evaluating immediate, concurrent, or single-stage facial nerve reconstruction or facial reanimation at the time of radical parotidectomy or oncologic facial nerve sacrifice. PubMed, Embase, Scopus, and Web of Science were searched from database inception through April 2026. Eligible studies were original clinical series reporting postoperative functional outcomes, patient-reported outcomes, complications, or revision procedures. Data were synthesized descriptively because of heterogeneity in techniques and outcome reporting. Nineteen studies comprising 277 patients met inclusion criteria. Reconstructive strategies included cable or interpositional nerve grafting, concurrent masseteric nerve transfer, vascularized nerve grafting, temporalis-based dynamic reanimation, free functional muscle transfer, and composite flap-based reconstruction. Across studies, immediate reconstruction was associated with restoration of resting symmetry, oral competence, and ocular protection, while dynamic approaches more often reported smile recovery and oral commissure movement. Interpositional cable grafting resulted in a postoperative recovery in the House-Brackmann III range. Reported complication rates were acceptable, with low donor-site morbidity and uncommon flap loss. Limited radiotherapy-specific analyses suggested that postoperative radiotherapy did not uniformly preclude functional recovery after immediate reconstruction. Immediate or single-stage facial nerve reconstruction and facial reanimation after radical parotidectomy appear feasible across a range of oncologic defects and are associated with reported postoperative restoration of facial tone, symmetry, oral competence, ocular protection, and, in selected series, dynamic facial movement. However, the current evidence is limited by retrospective design, small sample sizes, and heterogeneous outcome reporting. Larger comparative studies using standardized functional and patient-reported outcome measures are needed to better define the optimal reconstructive strategy.