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Integrated plastic surgery (IPS) programs are competitive. The conversion of Step 1 to pass/fail has altered the landscape for how applications are evaluated, leaving uncertainties for prospective applicants. This analysis identifies valuable applicant factors through trends from recent match cycles and the literature. A cross-sectional study of National Residency Matching Program data from 2020 to 2024 was performed. Aspects of IPS applications were compared among matched and unmatched seniors with a medical degree, osteopathic medicine degree, and international medical graduates. A literature review using the PubMed database was performed. The number of IPS positions available and applications submitted have increased proportionally, resulting in a stable ratio from 2020 to 2024. The average Step 2 score of matched applicants differed only by a single point before and after the transition of Step 1 to pass/fail. Applicants with more publications and presentations, Alpha Omega Alpha honors, and degrees from a medical school designated with the highest National Institutes of Health funding had higher match success. Subjective factors identified as important included away rotations, interviews, and letters of recommendation. IPS remains competitive with applicants outnumbering available positions. Step 2 scores are an important objective measure; however, the average score of matched individuals has not increased since the elimination of Step 1 scores. Additional important aspects weighed by program directors are research publications and presentations, strong letters of recommendation, good performance on away rotations, and high-quality interviews.

Injectable aesthetic procedures, particularly botulinum toxin and hyaluronic acid fillers, have revolutionized minimally invasive facial rejuvenation. However, the global research landscape and thematic evolution of this field remain unclear. This study presents a bibliometric and thematic evolution analysis of injectable aesthetic medicine from 2000 to 2025. Bibliographic data were retrieved from the Dimensions database and analyzed using the bibliometrix R package. A total of 1153 English-language publications were evaluated for annual trends, journal distribution, keyword networks, and thematic transitions across 3 time periods (2000-2009, 2010-2016, and 2017-2025). Global publication output showed exponential growth, particularly after 2017, reflecting increasing clinical and academic interest in minimally invasive rejuvenation. The most frequent keywords-hyaluronic acid, botulinum toxin, complications, ultrasound, and artificial intelligence (AI)-highlighted the transition from material-focused studies to imaging- and technology-assisted precision aesthetics. Six major research clusters were identified, covering safety, anatomy, materials and technology, patient outcomes, ultrasound guidance, and AI-assisted analysis. Aesthetic Surgery Journal, Plastic and Reconstructive Surgery, and Dermatologic Surgery were the most productive sources. Over the past 25 years, injectable aesthetic research has evolved from empirical artistry toward evidence-based, technology-driven practice. Emerging trends emphasize vascular safety, ultrasound-guided injection, and AI-enhanced symmetry assessment. Future research should prioritize multicenter collaboration, standardized outcome reporting, and translational integration of clinical, material, and computational sciences to advance individualized, intelligent aesthetic medicine.

Chronic diabetic wounds remain a major clinical challenge owing to impaired angiogenesis, persistent inflammation and cellular dysfunction. In this study, we developed a bioadhesive composite hydrogel scaffold (gelatin methacryloyl/alginate methacrylate [GA]) fabricated using digital light processing three-dimensional (3D) bioprinting, in which human adipose-derived mesenchymal stem cells (ADSCs) or their conditioned medium (CM) was incorporated to generate 3D skin constructs, and compared the paracrine effects on skin regeneration. We characterized the microstructures of GA-ADSC and GA-CM scaffolds; profiled CM proteins and systematically compared the effects of GA-ADSCs and GA-CM on fibroblast proliferation, migration, angiogenesis and macrophage polarization in vitro. Their therapeutic efficacy was further evaluated in diabetic mouse wound models, including analyses of collagen deposition, angiogenesis and fibrosis markers. Furthermore, proteomic analysis was performed to understand the underlying mechanisms. In vitro, both GA-ADSCs and GA-CM promoted fibroblast proliferation, migration, angiogenesis and macrophage M2 polarization. Moreover, they accelerated wound closure in diabetic mice by enhancing collagen deposition and neovascularization (CD31) and suppressing α-smooth muscle actin and transforming growth factor-β1 expression. Notably, GA-ADSCs showed prolonged cell viability and exhibited stronger immunomodulatory and antifibrotic effects than GA-CM. Proteomic analysis revealed distinct mechanistic differences: GA-ADSCs markedly activated Toll-like receptor signaling, necroptosis and extracellular matrix remodeling pathways, suggesting their key roles in immune regulation and metabolic reprogramming. In contrast, GA-CM primarily activated the Hippo signaling pathway, consistent with its role in growth factor-mediated tissue repair. Furthermore, we compared the differentially regulated proteins between ADSCs and CM in diabetic wounds and showed that ADSCs significantly modulated RGL2, RSPH9 and CRTC3, which are associated with enhanced cellular function and energy metabolism. These findings provide mechanistic insights into ADSC- and CM-mediated effects and support the development of bioinspired stem cell-based therapeutic strategies for chronic diabetic wound repair.

Long-term sickness absence (LTSA) in young adults has important consequences for labour market participation and future work disability. Chronic pain and psychological distress are key risk factors and frequently co-occur, yet their combined impact during adolescence on later LTSA remains insufficiently understood. This study aims to explore factors that influence adolescents' and young people's risk of receiving LTSA benefits during emerging adulthood. This longitudinal study used data from the Young-HUNT1 (1995-1997; n = 8736) and Young-HUNT3 (2006-2008; n = 7935) cohorts linked to Norwegian registry data and followed into early adulthood. The outcome was time to LTSA (≥90 or ≥180 days). Associations were examined using Cox proportional hazards models and Kaplan-Meier analyses. Continuous- and discrete-time models were developed and evaluated using the concordance index, time-dependent AUC, and integrated Brier score. Risk factors were analysed using SurvSHAP, SHAP, and regression-based methods. Chronic pain and co-occurring pain and psychological distress were consistently associated with increased LTSA risk (adjusted HRs between 1.3 and 1.5 for pain and between 1.6 and 1.7 for co-occurrence). In contrast, psychological distress alone showed no consistent association. Model performance was moderate and similar across approaches (C-index between 0.63 and 0.67). Key predictors included female sex, low parental education, chronic pain, poor perceived health, and indicators of early health problems. Adolescent chronic pain, particularly when co-occurring with psychological distress, is an important predictor of LTSA in early adulthood. While absolute LTSA levels may vary across cohorts, underlying risk patterns remain stable. More complex models did not outperform traditional approaches. These findings highlight the importance of early-life conditions and support early identification and intervention to reduce later work absence.

Biologic and targeted immune-modulating agents are increasingly used to manage autoimmune diseases like rheumatoid arthritis, psoriasis, and inflammatory bowel disease. As more patients receiving these therapies undergo elective breast augmentation and implant-based reconstruction, the effect of biologic exposure on postoperative outcomes remains unclear. This study evaluated whether preoperative use of biologic or immune-modulating agents is associated with increased complications following reconstructive and aesthetic breast surgery procedures. A retrospective cohort analysis was performed using the TriNetX database. Patients who underwent breast reconstruction or augmentation were identified by Current Procedural Terminology codes and stratified by preoperative exposure to biologic or immune-modulating agents within six months of surgery. Agents included tumor necrosis factor-α, interleukin, Janus kinase, mammalian target of rapamycin, and calcineurin inhibitors, among others. Propensity score matching (1:1) controlled for demographic and clinical covariates. Postoperative complications were assessed at 30-days, 90-days, and 6-months and included wound dehiscence, infection, seroma or hematoma, implant revision, and hospital readmission. Among 211,105 patients, 4,024 had biologic exposure and 207,081 were controls. After propensity score matching, 3,980 patients remained in each cohort. Complication rates were comparable between groups at all timepoints (p > 0.05). Biologic exposure was not associated with increased risk of wound, infectious, implant revision, or hospital readmission complications. Preoperative biologic or immune-modulating therapy was not associated with a significant increase in postoperative surgical complications after breast reconstruction or augmentation procedures. Continuing these therapies in appropriate patients appears safe and may reduce unnecessary treatment interruptions.

Impaired wound healing and persistent infection are major challenges in diabetic wounds. This study aimed to investigate the therapeutic effects of topical thymoquinone formulated in peanut oil on wound healing and bacterial burden in an infected diabetic wound model. Diabetes was induced in rats using streptozotocin, followed by creation of standardized full-thickness excisional wounds that were subsequently infected with Staphylococcus aureus. Animals were randomly assigned to four groups: untreated negative control, vehicle (peanut oil), thymoquinone, and positive control (topical mupirocin). Treatments were applied topically once daily for 14 days. Wound closure was assessed at predefined time points, bacterial load was quantified as log₁₀ CFU/g tissue, and histopathological evaluation was performed using semi-quantitative scoring of re-epithelialization, inflammatory cell infiltration, granulation tissue formation, and collagen deposition. Mean wound closure rates in the thymoquinone group were 27.6 ± 6.1% on day 3, 55.1 ± 8.4% on day 7, 72.4 ± 7.5% on day 10, and 88.2 ± 5.6% on day 14, which were significantly higher than those observed in the untreated negative control group (12.4 ± 4.6%, 28.7 ± 6.9%, 41.9 ± 8.1%, and 58.6 ± 9.3%, respectively) and the vehicle (peanut oil) group (18.9 ± 5.2%, 36.4 ± 7.3%, 52.7 ± 8.6%, and 69.8 ± 8.9%, respectively; p = 0.004 on day 3, p = 0.002 on day 7, p = 0.001 on day 10, and p = 0.001 on day 14), while remaining comparable to the positive control (mupirocin) group without demonstrating statistical superiority. Mean bacterial counts were 5.94 ± 0.46 log₁₀ CFU/g on day 3 and 4.73 ± 0.51 log₁₀ CFU/g on day 7 in the thymoquinone group, compared with 7.62 ± 0.41 and 6.89 ± 0.44 log₁₀ CFU/g in the negative control group and 7.18 ± 0.38 and 6.32 ± 0.40 log₁₀ CFU/g in the peanut oil group (p = 0.003 on day 3 and p = 0.002 on day 7). Histopathological evaluation revealed significantly improved re-epithelialization (3.8 ± 0.4 vs. 1.6 ± 0.5 in controls, p = 0.002), increased granulation tissue formation (4.0 ± 0.5 vs. 1.8 ± 0.6, p = 0.003), and enhanced collagen deposition (3.9 ± 0.4 vs. 1.5 ± 0.5, p = 0.002), together with reduced inflammatory cell infiltration (1.9 ± 0.4 vs. 4.1 ± 0.4, p = 0.001) in thymoquinone-treated wounds compared with controls. Topical thymoquinone formulated in peanut oil improved wound closure, reduced bacterial burden, and enhanced histopathological indicators of tissue repair in this experimental infected diabetic wound model. Further studies are warranted to confirm these findings and explore their translational relevance.

Venous congestion remains a leading cause of potentially salvageable flap failure. Indocyanine green angiography (ICGA) provides real-time perfusion visualization, yet most applications emphasize arterial inflow. Quantitative analysis may enable earlier and more objective detection of venous compromise. This systematic review evaluates how quantitative ICGA has been used to assess venous outflow in free and pedicled flaps and summarizes its clinical utility. Following PRISMA 2020 guidelines, a search of PubMed, MEDLINE, Scopus, and Web of Science (2000-2025) was conducted to identify studies reporting quantitative ICGA parameters related to venous outflow in free or pedicled flaps assessed intra- or postoperatively. Two reviewers screened studies and extracted data on imaging systems, quantitative metrics, and outcomes; risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results were synthesized descriptively. Nine studies encompassing 210 patients and 164 flaps were included. Quantitative ICGA was applied across breast, head and neck, perineal, and lower extremity reconstructions using SPY, Quest, and Zeiss platforms. Reported measures included ratio-based indices, time-to-maximum fluorescence, inflow and outflow slopes, and washout or clearance analyses. Abnormal trends, such as prolonged Tmax, flattened egress slopes, or delayed washout, correlated with venous congestion and postoperative necrosis. Heterogeneity in dosing, imaging timing, software platforms, and definitions of "outflow" precluded meta-analysis. Quantitative ICGA can reliably detect subclinical perfusion abnormalities and may influence intraoperative decision-making. Standardized protocols and validated venous outflow metrics are needed to establish reproducible thresholds and confirm its prognostic value in flap monitoring.

The inferiorly based dermo-glandular sling is well described for implant coverage in post-mastectomy prosthetic reconstruction and attempted restoration of upper pole fullness in (therapeutic and aesthetic) mammaplasty procedures, to variable long-term effect. We reviewed the technique modifications by a single surgeon, over 13 years, and the aesthetic outcomes achieved, when used in the context of cosmetic breast implant removal. Breast explant patients with a Wise-pattern skin incision by a single surgeon between 2011 and 2024 were identified. implant exchange, explantation only and LeJour pattern breast lift. Demographics and perioperative data were recorded. Perioperative photographs were assessed using the established Breast Cancer Conservation Treatment. Cosmetic Results (BCCT.core) software to analyse the aesthetic result. 19 patients underwent implant removal and parenchymal re-draping with an inferiorly based dermo-glandular sling. Patients were: perimenopausal women (mean=54yrs) with raised BMI (mean=27.6kg/m2). Indications (overlapping) for explantation included: disharmony between implant and breast envelope (10/19; 52.6%), discomfort/ pain (8/19; 42.1%), concerns about BIA-ALCL (5/19; 26.3%) and symptoms of "breast implant illness" (6/19; 31.6%). Others claimed their augmented breasts were simply too large (9/19; 47.4%). Bra size decreased from pre-explant size of 36E to 36C (median). Post-operative photographs were available for 18/19 patients. BCCT.core ratings were wholly favourable, with five rated Excellent and the remainder rated as Good. An inferior, de-epithelialised dermo-glandular sling can reliably rejuvenate the female breast following breast implant removal, where there is disharmony between parenchymal volume, distribution and envelope. We illustrate a reliable technique that achieves objectively good to excellent aesthetic results, with long-term efficacy. (249 words) Most common presentations for seeking explantation in our cohort were concerns about the degree of ptosis, pain, anxiety about BIA-ALCL and symptoms of breast implant illness. This technique offers a reliable and aesthetically robust option to restore some volume and uplift and reshape the explanted breast, in patients declining re-implantation or staged surgeries. Suitable patients as determined by our cohort are middle-aged women with large, previously augmented breasts (~330cc mean, 36E median), with an above-average BMI (27.6) yielding suitable inferior pole tissue for suspension. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes. This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures. All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups. We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 &#xb1; 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p &#x2265; 0.06). The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.

Burn injuries impose substantial burdens in low- and middle-income countries, where prolonged hospitalization occurs due to limited specialized centers, resources, and surgical delays. This study examines factors associated with prolonged length of stay (LOS) and treatment costs relative to catastrophic health expenditure (CHE) thresholds among burn patients treated at a tertiary center in Ethiopia. Burn patients treated at the Addis Ababa Burn, Emergency, and Trauma Center from January 2023 to 2025 were prospectively enrolled in this observational cohort study. Univariable and multivariable analyses were performed to evaluate factors associated with LOS for the overall cohort and by age subgroup and treatment costs were compared with CHE thresholds. Among 196 patients (55.6% men; mean age 17.6 y), the mean LOS was 33.5&#x2005;&#xb1;&#x2005;28.8 days. Electrical (36.4%) and flame (35.2%) injuries predominated in adults versus scalds in children (73.1%). Total body surface area and sex distribution were similar across groups, but pediatric burns were more superficial and required fewer surgical procedures (0.6 versus 1.4). The number of procedures and systemic infections remained independently associated with log-transformed LOS in adjusted analyses for all groups (all P < 0.05). LOS independently predicted cost. Facility and out-of-pocket costs averaged 24,428 and 7283 Ethiopian birr, respectively, with out-of-pocket spending by subgroup approaching or exceeding CHE thresholds. Prolonged LOS after burn injury in Addis Ababa is driven by clinical severity and complications, escalating costs toward catastrophic levels. Prevention strategies and age-tailored clinical pathways may shorten LOS, reduce costs, and strengthen financial risk protection in low-resource settings.

Facial palsy is a debilitating condition that can lead to significant functional, aesthetic, and psychosocial impairments. Thus, this study aimed to systematically explore treatment preferences and values among Korean patients with facial palsy and develop clinically applicable recommendations to enhance patient-centered care. A cross-sectional questionnaire survey was conducted between June and July 2025 at a facial palsy clinic in a secondary referral hospital. A total of 51 patients with peripheral facial palsy completed a structured 21-item survey addressing preferences related to assessment and diagnosis, treatment modalities, multidisciplinary care, communication, information sources, and recovery concerns. The internal consistency of the questionnaire was evaluated using Cronbach's alpha (&#x3b1;). Participants (mean age 43.1 &#xb1; 12.4 years; 68.6% female) prioritized objective assessment methods and accurate prognostic information, favoring standardized tools and electrophysiological testing. Regarding treatment preferences, 82.4% supported active steroid therapy and 74.5% preferred combined steroid-antiviral treatment. Surgery was generally viewed as a last resort, with 51.0% favoring non-surgical rehabilitation even in chronic cases-those persisting for more than six months. Multidisciplinary care and clear, detailed communication were highly valued. The primary recovery concern was permanent facial sequelae (64.7%). Meanwhile, the internal consistency of the survey, which covered diverse and independent domains, was rather poor (Cronbach's &#x3b1; = 0.548), reflecting the multidimensional nature of the patient preferences. Korean patients with facial palsy express a strong fear of permanent sequelae, which shapes the preferences of patients toward objective information and treatments with high efficacy. Moreover, the patients were found to favor comprehensive multidisciplinary care, clear and transparent communication, and collaborative relationships with healthcare providers. These findings provide important insights for developing patient-centered clinical guidelines tailored to Korean patients with facial palsy.

Scaphoid fractures are often complicated by nonunion, but incidence, risk factors, and management have not been well-characterized for pediatric patients. Patients aged <18 years with scaphoid fracture were identified in the 2015 to 2023 PearlDiver M170 database. Patient and fracture characteristics, imaging, and surgeries were extracted. Predictive factors for nonunion were characterized with multivariable analyses. Among patients with nonunion, characteristics of those receiving surgical and nonsurgical management were compared with multivariable analyses. Of 26,364 pediatric scaphoid fractures, 64.5% were male, with an average age of 13.54 years. Of fractures with displacement and location specified, 22.8% were displaced and distal, middle, and proximal third fractures constituted 45.4%, 45.7%, and 8.9%, respectively. MRI was used for 11.5% and CT for 8.6%. Nonunion occurred in 1102 patients (4.2%). Nonunion was independently associated with clinical characteristics (older age [OR = 1.57 per year], male sex [OR = 2.11], and overweight/obesity [OR = 1.52]), nonclinical characteristics (relative to Northeast, Midwest region OR = 1.45), and fracture characteristics (displacement [OR = 2.45] and position [relative to distal, middle OR = 2.18 and proximal one third location OR = 4.74]) (P < 0.0003 for all). Of nonunions, 73% were diagnosed within 3 months of first fracture diagnosis. Of patients with nonunion, 784 (71.3%) had surgery. Surgery was independently associated with older age (OR = 1.15 per year) and Midwest region (relative to West, OR = 1.96) (P < 0.0063 for all). Pediatric scaphoid fracture patient and fracture characteristics roughly mirrored adult populations. The occurrence of most nonunion diagnoses shortly after initial fracture diagnosis suggests that many patients with nonunion presented late to care.

Free flap compromise after head and neck reconstruction requires rapid recognition and structured escalation. Large language models have shown potential for text-based clinical support, but their alignment with microsurgical decision-making in flap compromise remains unclear. This simulated case study evaluated three large language models, ChatGPT, Gemini, and Copilot, using 30 standardized head and neck free flap compromise scenarios, including 15 intraoperative and 15 postoperative cases. Each model received identical prompts requesting the suspected diagnosis, likely mechanism of compromise, and recommended management steps. Four consultant microsurgeons independently rated each response using 5-point Likert scales across clinical accuracy, management recommendations, assessment correctness, usefulness of explanation, and overall confidence. Potential for harm was rated as yes or no Ratings were aggregated to case level. Between-model comparisons were performed separately for intraoperative and postoperative scenarios using Friedman tests with Bonferroni-adjusted post hoc Wilcoxon signed-rank tests, while potential for harm was compared using chi-square tests. Clinical accuracy ratings were high across all models in both intraoperative and postoperative scenarios, with no significant between-model differences. In intraoperative cases, usefulness of explanation differed significantly between models, with lower ratings for Copilot than Gemini. In postoperative cases, Gemini received significantly higher ratings for management recommendations and usefulness of explanation than ChatGPT and Copilot, and higher overall confidence than Copilot. Potentially harmful recommendations were uncommon, but differed between models in postoperative scenarios. Interrater agreement was generally higher in intraoperative than postoperative cases. Large language models showed high alignment with expert ratings for recognition of flap compromise in standardized simulated scenarios. However, differences emerged in management planning, explanatory clarity, and confidence, particularly in postoperative cases. These findings support cautious interpretation and do not support independent clinical use in microsurgical care.

To systematically assess the efficacy and safety of the proximal femoral bionic nail (PFBN) compared with the InterTAN nail in the management of intertrochanteric femoral fractures (IFFs) among elderly individuals. Eligibility criteria (inclusion and exclusion) were established in accordance with the PICOS framework. Relevant clinical studies were systematically retrieved from both Chinese (CNKI, VIP, and Wanfang Data) and English databases (PubMed, Embase, Web of Science, the Cochrane Library) with a search cutoff date of October 31, 2025. The Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was employed to appraise methodological quality of the included literature. Meta-analyses of outcome measures, including intraoperative duration, intraoperative haemorrhage, length of hospital stay, postoperative weight-bearing duration, Harris Hip Score (HHS), and internal fixation-related complications, were conducted using RevMan 5.3 and Stata 15 software. Six relevant studies were finally enrolled in the present analysis, consisting of 2 prospective cohort studies and 4 retrospective cohort studies, with a total of 683 participants. Among all cases, 334 patients were allocated to the PFBN group and the remaining 349 cases received InterTAN nail fixation. Meta-analysis outcomes demonstrated no significant inter-group differences in intraoperative blood loss (P&#x2009;=&#x2009;0.17), postoperative weight-bearing time (P&#x2009;=&#x2009;0.47) and Harris Hip Score (HHS) (P&#x2009;=&#x2009;0.11). When compared with the InterTAN nail system, the PFBN group presented a shorter hospital stay (P&#x2009;=&#x2009;0.04) and a decreased rate of internal fixation-related complications (P&#x2009;=&#x2009;0.01), whereas the PFBN group had a longer operative time (P&#x2009;=&#x2009;0.03). Sensitivity analysis further confirmed the good overall stability and reliability of the pooled outcomes in this meta-analysis. Based on the limited evidence from current non-randomized studies, PFBN exhibits potential benefits in shortening hospital duration and reducing the risk of internal fixation-related complications among elderly patients with intertrochanteric femoral fractures. Meanwhile, this implant yields equivalent effects to the InterTAN nail with regard to functional recovery. Given the observational design of all included trials and substantial heterogeneity in several outcomes, these findings warrant cautious interpretation.

In the vast landscape of commercially available and newly emerging meshes for abdominal wall repair, surgeons must understand the biomechanical advantages of current synthetic and biologic mesh materials. A librarian conducted a literature search on PubMed, Web of Science, and CENTRAL, following PRISMA guidelines, to identify relevant articles published from January 2010 to January 2024. Two independent reviewers performed all screening steps. An exploratory quantitative synthesis was performed using generalized linear models with a Gamma distribution and log link. Our study identified 30 studies describing the physico-mechanical properties of 67 unique meshes. The majority of novel mesh materials were synthetic (85.07%, n&#x2009;=&#x2009;57), compared to biologic (14.92%, n&#x2009;=&#x2009;10). Pore sizes ranged from 0.10&#xa0;mm&#xb2; to 5.0&#xa0;mm&#xb2;. They were subcategorized as small (0.01-0.28 mm2), medium (0.28-0.79 mm2), large (0.79-3.14 mm2), and very large (>&#x2009;3.14 mm2), based on previous studies, which found these denominations to be more informative than the terms "microporous" and "macroporous." Suture retention strength, tensile strength, and burst strength were compared. Synthetic medium- to large-pore mesh performed sufficiently to withstand intra-abdominal pressures in terms of burst strength (>50&#xa0;N/cm), tensile strength (>50&#xa0;N/cm), and suture retention (>20&#xa0;N) compared to small-pore synthetic mesh. Among biologic meshes, cross-linked biologic meshes demonstrated strong tensile and suture-retention strengths; however, data on other biomechanical properties were lacking. These results demonstrate the need to understand how the structural characteristics of each fully mesh design, such as fabrication technique and pore size, in conjunction with mechanical properties such as tensile strength, burst strength, and suture retention strength, influence clinical outcomes.

Breast implants are a fundamental adjunct in aesthetic and reconstructive breast surgery, with more than 3.5 million recipients in the United States. Implant rupture risk increases with device age, although modern cohesive silicone implants demonstrate markedly improved durability. The Food and Drug Administration does not mandate routine replacement, but recommends surveillance screening for silicone implant rupture beginning 5-6 years postplacement and every 2-3 years thereafter. However, no guidelines exist for managing asymptomatic ruptures in older adult patients. A scoping review was conducted in MEDLINE, Embase, and the Cochrane Library through January 2025 for guidelines on the management of asymptomatic implant rupture in older adult patients; none was identified. Evidence indicates that although surveillance can detect silent ruptures and minimize silicone migration, the clinical impact in older adult patients is limited given the low incidence of symptomatic complications with modern devices and reduced life expectancy. Risks of surveillance include false positives, overdiagnosis, patient anxiety, and unnecessary surgery-particularly relevant in older patients with higher perioperative complication rates. The authors propose discontinuing surveillance for asymptomatic silicone implants after age 75 years and foregoing routine implant exchange. In asymptomatic patients older than 75 with known or suspected rupture, observation is reasonable unless symptoms develop. Symptomatic cases should undergo diagnostic imaging and individualized risk-benefit discussion using a comprehensive geriatric assessment framework. A shared decision-making approach is emphasized, balancing surgical risks, patient comfort with uncertainty, and aesthetic concerns. These recommendations aim to optimize quality of life and avoid overtreatment in older adult patients with breast implants.

Axillary reconstruction after wide excision for hidradenitis suppurativa (HS) remains challenging, with no consensus regarding the optimal technique. Although multiple reconstructive options exist, many are limited by prolonged operative time, imperfect tissue match, functional restriction, or significant donor-site morbidity. The posterior arm artery perforator (PAAP) flap offers a reliable and efficient alternative due to its constant anatomy, thin and pliable tissue, and low donor-site morbidity. We present a standardized, landmark-based, Doppler-free, ultrafast harvesting technique, designed to improve reproducibility and reduce operative time. Perforator localization is achieved using simple anatomical landmarks, enabling consistent flap elevation without routine preoperative Doppler mapping. We report 23 PAAP flaps undergoing radical excision for axillary HS. The mean flap elevation time was 9.1 minutes, the mean hospital stay was 2.1 days, and complications were rare (1 case of bilateral partial distal necrosis in a morbidly obese patient and 1 case of bilateral wound dehiscence related to substance abuse). Functional and aesthetic outcomes were favorable, with a discreet brachioplasty-like donor-site scar, preservation of shoulder mobility, rapid recovery, and no HS recurrence during a mean follow-up of 16.9 months. The principal limitation of the PAAP flap is the requirement for primary donor-site closure when excessive flap width is required, restricting its indication to small-to-moderate axillary defects (up to approximately 100&#x2009;cm2). By combining anatomical reliability, procedural simplification, and ultrafast elevation, the PAAP flap should be considered a first-line reconstructive choice in modern algorithms for axillary defect reconstruction.

Graphene-based collagen hydrogels have demonstrated anti-fibrotic potential in various diseases; however, their therapeutic efficacy in hypertrophic scars (HS) remains largely unexplored. Adipose stem cells (ASCs) and their extracellular vesicles have been shown to regulate HS progression, yet the role of ASCs derived apoptotic vesicles (ASCs-ApoVs) has not been fully investigated. In this study, we developed graphene-incorporated type I collagen cryogel (G-GEL(C)) and collected ASCs-ApoVs. We evaluated their individual and combined capacity to regulate HS and explored the potential of G-GEL(C) as a delivery system for ASCs-ApoVs. G-GEL(C) significantly inhibited fibrosis in HS derived fibroblasts (HS-fibroblasts), as evidenced by the downregulation of COL1A1 (p&#x2009;<&#x2009;0.001 for both protein and mRNA), &#x3b1;-SMA (p&#x2009;<&#x2009;0.001 for protein; p&#x2009;<&#x2009;0.0001 for mRNA), and Vimentin (p&#x2009;<&#x2009;0.05 for protein; p&#x2009;<&#x2009;0.0001 for mRNA). Additionally, G-GEL(C) suppressed cell proliferation (p&#x2009;<&#x2009;0.0001) and lateral migration (p&#x2009;<&#x2009;0.001). Treatment with ASCs-ApoVs also reduced COL1A1 (p&#x2009;<&#x2009;0.01 for protein; p&#x2009;<&#x2009;0.0001 for mRNA) and &#x3b1;-SMA (p&#x2009;<&#x2009;0.05 for both protein and mRNA), while Vimentin transcription was also downregulated (p&#x2009;<&#x2009;0.001). G-GEL(C), characterized by high porosity and selective adsorption capacity for ASCs-ApoVs, enabled efficient loading and delivery of these vesicles. In vivo, G-GEL(C) loaded with ASCs-ApoVs decreased the scar elevation index (SEI) (p&#x2009;<&#x2009;0.05), reduced &#x3b1;-SMA expression (p&#x2009;<&#x2009;0.0001), locally increased 8-OHdG levels and raised the proportion of M2 macrophages, indicating effective regulation of HS. ASCs-ApoVs exhibit anti-fibrotic effects in HS. G-GEL(C) functions both as a direct modulator of HS-fibroblast phenotypes and as an efficient carrier for apoptotic vesicles. Collectively, they form a potent combinatorial system that significantly attenuates hypertrophic scar.

Breast reduction surgery is the primary treatment for macromastia, yet the impact of preexisting anxiety and depressive disorders (ADD) in candidates for this procedure has not been thoroughly investigated. This study aimed to evaluate the association between preexisting ADD and the incidence of both short-term and long-term complications after breast reduction surgery. This retrospective cohort study used data obtained from the TriNetX Global Collaborative Network to identify female patients over 18&#xa0;years who had breast reduction. These patients were divided into two cohorts based on the presence or absence of ADD diagnosis. To reduce baseline differences and balance characteristics of the cohorts, we applied a propensity score matching. The primary objectives were short postoperative complications at 30, 60, and 90&#xa0;days. Secondary objectives were long-term complications after 1&#xa0;year. Each cohort included 15,846 patients after 1:1 PSM analysis. Thirty days after surgery, patients with preexisting ADD were associated with significantly higher risks of seroma (Relative Risk [RR] 1.895, CI 1.43-2.5); hematoma (RR 1.508, CI 1.2-1.88); wound dehiscence (RR 1.33, CI 1.12-1.57); surgical site infection (RR 1.495, CI 1.24-1.79); postoperative opioid use (RR 1.291, CI 1.25-1.34); inpatient hospitalization (RR 1.77, CI 1.505-2.101); readmission (RR 1.857, CI 1.46-2.35); and any surgical site complications (RR 1.358, CI 1.23-1.50) compared to the control cohort. These findings persisted after 60 and 90&#xa0;days of surgery. Comparable results were noted for long-term outcomes within 1&#xa0;year of surgery. Patients with preexisting anxiety or depression disorders demonstrated higher rates of short-term postoperative outcomes after breast reduction procedure. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .