A supportive clinical learning environment is critical for effective surgical training, promoting professional growth and problem-solving skills. Despite global use of tools like the Postgraduate Hospital Educational Environment Measure (PHEEM), Ethiopia lacks data on the training environment for plastic and reconstructive surgery, limiting efforts toward educational quality improvement.This study aims to explore and assess the perceptions and experiences of trainees and educators in Ethiopia's plastic, reconstructive, and hand surgery programs regarding the training environment. A mixed-methods design was used at Addis Ababa University and St. Paul's Hospital Millennium Medical College. Quantitative data were collected using the validated PHEEM questionnaire, whereas qualitative data were gathered through in-depth interviews and focus group discussions. Purposeful sampling was used, and data collection continued until thematic saturation. Thematic analysis was conducted using NVivo software. Forty-eight residents participated (56.3% male), with a mean age of 28. The average PHEEM score was 85 of 160 (53% satisfaction). Subscale scores indicated moderate satisfaction across domains: autonomy (51.9%), teaching (55.3%), and social support (51.8%). Teaching received the highest score, whereas social support was the lowest. Qualitative analysis identified 4 key themes: poor training environment, the importance of collaboration and networking, the role of resilience, and the need to move from general to specialized plastic surgery practice. Although residents appreciated aspects of teaching, there is a clear need to strengthen social support and overall training quality. Findings highlight opportunities for targeted improvements in Ethiopia's surgical education system.
Evidence-based nutrition and physical activity influence perioperative optimization and surgical outcomes, yet formal training in these domains during plastic surgery residency remains unclear. This study surveyed US plastic surgery residents to assess their self-reported knowledge, counseling confidence, and curricular preparation. A 28-item REDCap survey was distributed to residents in the Northeastern, Southeastern, and Midwestern plastic surgery societies (September 2024-February 2025). Questions covered training level, self-rated counseling skill, 17 knowledge domains, and 4 preparation Likert scales. Categorical variables were reported as counts/percentages, and ordinal skill and curriculum preparation scores were numerically coded and reported as mean ± SD. Two-sample t tests compared integrated versus independent tracks and junior (postgraduate year [PGY] 1-3) versus senior (PGY ≥ 4) residents (α = 0.05). Fifty-two residents responded (12% rate); 75% were in integrated programs and 73.1 % were senior (PGY 4+). Most felt comfortable with weight management counseling, but knowledge was lowest for counseling special populations (children, pregnancy, older adults). Counseling skills were largely "competent," with 25 % (nutrition) and 31 % (physical activity) reporting "advanced" competence. Preparation scores were neutral (~3/5) and less than10% strongly endorsed curricular adequacy. Skill scores trended higher for seniors and integrated residents, but only the nutrition skill difference between senior and junior residents reached statistical significance (P < 0.05). Plastic surgery residents report moderate self-perceived preparedness and confidence in nutrition and physical activity counseling, with opportunities for enhanced curricular support. These findings highlighted the potential value of structured education to support comprehensive perioperative patient care.
Autologous fat transfer (AFT) for total breast reconstruction and augmentation is increasingly applied due to its advantages over implants and autologous flaps, including minimal invasiveness, minimal donor-site morbidity, and quick recovery. However, AFT is not without complications when applied for full breast reconstruction, underscoring the need to evaluate its safety and effectiveness. This systematic review and meta-analysis assesses the oncological and surgical safety of AFT as a stand-alone procedure for total breast reconstruction and augmentation, including the effectiveness of different AFT techniques and patient-reported satisfaction. A MEDLINE, Embase, and Web of Science search (from inception to December 2024) focusing solely on randomized controlled trials evaluating AFT outcomes for total breast reconstruction or augmentation was performed. Animal studies, partial reconstruction/augmentation, and combined procedures were excluded. Data were extracted and analyzed using random-effects meta-analyses, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Risk of bias was assessed using the Cochrane tool. From 2323 identified articles, 9 randomized controlled trials were included. AFT showed fewer surgical complications compared with implant-based reconstruction. Oncological safety was similar between AFT and implant-based reconstruction. AFT-related complications (eg, oil cysts, fat necrosis) occurred at similar rates across different AFT techniques, but using fat sedimentation and retropectoral grafting were associated with fewer complications. Meta-analysis showed that all enriched AFT techniques-including stromal vascular fraction and botulinum toxin-improved fat retention rates. AFT is an effective and technically and oncologically safe option for total breast reconstruction and total breast augmentation. However, limited follow-up duration prevents definitive conclusions on long-term oncological outcomes.
Facial tumor resections often require invasive surgical approaches such as the Weber-Fergusson incision, which, despite oncological effectiveness, is associated with significant aesthetic and functional drawbacks. Based on our observational experience in 2 cases, we introduce the "tau" incision as a potential modification designed to optimize exposure while reducing aesthetic compromise. These impressions remain preliminary and require further validation. This study introduces the tau incision, a modified approach designed to optimize exposure while minimizing aesthetic compromise. Two cases of advanced maxillary tumors were treated using this technique, which avoids upper lip splitting, preserves hard palate mucosa, and facilitates improved reconstructive stability. The tau incision seems to offer adequate surgical exposure and maintained oncological efficacy. The approach in these 2 patients resulted in improved postoperative healing and mastication and reduced scarring, and allowed earlier initiation of radiotherapy. Both patients reported satisfaction with their cosmetic and functional outcomes. Due to the shorter length of the tau incision compared with the Weber-Ferguson incision, tumor resection is more challenging but remains accurate and safe. Moreover, this modification leads to improved aesthetic and functional outcomes. Although the tau incision is a very small modification of the Weber-Ferguson incision, it still represents a significant advancement in facial tumor surgery, offering excellent functional and aesthetic results while addressing the limitations of conventional techniques. Nevertheless, its proposed advantages should be interpreted as theoretical until confirmed through systematic evaluation and validated outcome measures.
Breast reconstruction is an important aspect of the process of recovery for patients recovering from mastectomy. However, postmastectomy radiation therapy (PMRT) disrupts flap perfusion and cosmetic results. These complications have prompted comparisons of irradiated and nonirradiated flaps, especially in immediate and delayed reconstruction. Using preferred reporting items for systematic reviews and meta-analyses guidelines, a PubMed and Cochrane Library search from the year 2000 to 2024 was performed to compare the irradiated and nonirradiated flaps. The inclusion criteria restricted the analysis to comparing flap viability, flap complications, aesthetic outcome, or satisfaction level of patients. The meta-analysis was used, and variance was reduced by using fixed- and random-effects models. The analysis involved 12 studies showing that flaps receiving irradiation, particularly in immediate reconstructions, had higher complication rates, including fat necrosis and flap contracture. Nevertheless, delayed reconstruction following PMRT was linked to reduced postoperative complication rates and favorable reconstructive results, whereas flap survival did not differ between immediate and delayed reconstruction. Subgroup analysis demonstrated lower fat necrosis in deep inferior epigastric perforator flaps (≈12%) compared with transverse rectus abdominis muscle (≈25%) and latissimus dorsi flaps (≈40%), suggesting that flap-specific planning is necessary for irradiated patients. These pooled percentages reflect averaged values across included studies. Patients undergoing immediate reconstruction in the PMRT setting have increased rates of postoperative complications, especially fat necrosis, fibrosis, and flap contracture, and worse aesthetic outcomes. On the contrary, delayed reconstruction is associated with lower complications and better cosmetic results, whereas no significant difference is noted in flap survival between immediate and delayed reconstruction.
This systematic review aims to determine whether pre- and postoperative hyperbaric oxygen therapy (HBOT) incurs any benefits or harms in soft tissue injuries (STIs) considered for skin flap or graft surgery. We included adequately powered clinical trials that enrolled patients with STIs serious enough for skin flaps or grafts; evaluated HBOT (≥1.5 ATA) versus control, placebo, or sham procedures; and analyzed survival/healing and complication rates. MEDLINE, Google Scholar, and Embase were searched for relevant literature through June 30, 2024. The Cochrane risk of bias (RoB 2) and the ROBINS-I tools assessed RoB. Meta-analysis and random effects models analyzed randomized controlled trial (RCTs) evaluating flap/graft survival rates within 4 weeks of HBOT (2-2.5 ATA). The GRADE approach determined the evidence recommendations. Among 743 records screened, 45 were assessed; 25 reports from 24 studies (13 RCTs; 11 non-RCTs; 2246 patients) were included. RCT RoB ranged from low RoB (1 trial) to high (2 trials). Nonrandomized trials had moderate RoB (n = 5, 45%), whereas 6 had serious RoB. Four RCTs showed a large, horizontal overall effect size (log odds ratio, 1.045; standard error, 0.3104; z, 3.3.67; P < 0.001; 95% confidence interval, 0.44-1.65). Evidence levels were very low to moderate, with 11 strong and 13 conditional recommendations, including a strong recommendation to use HBOT to heal flaps/grafts in STI/trauma wounds. A strong recommendation for pre- and postoperative HBOT is warranted to mitigate the need for flap/graft surgery and heal flaps and grafts, given the potentially life- and/or limb-threatening harms that could otherwise occur.
Lymphedema care requires multidisciplinary collaboration, substantial documentation, and interfacility communication. Large language models, including ChatGPT, may streamline these processes and support team-based care; however, concerns remain regarding accuracy, privacy, and governance. We conducted a cross-sectional, anonymous survey at a lymphedema specialty clinic in Tokyo 24 months after ChatGPT implementation (May 2023), following STROBE guidelines. All staff (N = 12; physicians, nurses, therapists, and administrative staff; mean age 39.6 y) participated. Responses were collected using 5-point Likert scales and multiple-choice formats, and descriptive statistics were summarized. All staff reported using ChatGPT at least once, with frequent use reported by 58.3%. Efficiency improved in 83.3% (Likert 4-5), and preparation time for information-sharing materials decreased in all respondents (≤50% in 33.3%, ≤30% in 41.7%). Primary uses included drafting documents/emails (~92%) and referral reports (~83%). ChatGPT improved external communication (mean Likert score 4.42/5), reduced perceived work-related stress, and increased confidence (≥4 in 66.7%). Staff reported moderate trust, occasional hallucinations, and the need for training and guidelines. Privacy concerns were noted by more than half of respondents. ChatGPT enhanced efficiency, communication, and teamwork in a lymphedema clinic while reducing stress. Safe use requires human oversight, verification processes, and privacy safeguards. Under appropriate governance, large language models may facilitate task sharing and support clinical education, including prelearning for lymphatic ultrasound. We believe this version retains the essential points while meeting the journal's requirements.
Hand injuries account for a significant portion of emergency department visits. This study assessed the competency of emergency physicians in the initial management of common hand injuries and identified areas for improvement in assessment and treatment. We distributed a case scenario-based questionnaire among emergency physicians in Saudi Arabia registered in the Saudi Commission for Health Specialist database. The questionnaire assessed the adequacy of their management of the most common hand injuries. Overall, 282 physicians were included; 66.3% were men, and only 8.2% were consultants. The overall mean hand injury knowledge score was 10.46 points out of 20 (SD = 3.92), indicating moderate knowledge. Male physicians scored significantly lower (M = 9.89 points) compared with female physicians (M = 11.55 points) (P < 0.001). Medical resident physicians had lower scores compared with the other physicians (resident-2 to consultants) (P < 0.001). Years of experience and type of medical centers in which physicians worked correlated significantly with their knowledge score. The questions most often answered correctly were on morbidity and limb-threatening conditions. Conversely, the most commonly incorrect responses were related to specific aspects of nail trephination, the management of hand burns, and mallet finger injuries. This study identified gaps in emergency physician management of common hand injuries, highlighting the need for targeted training. Enhancing assessment and treatment skills will improve patient outcomes, triage efficiency, and overall quality of emergency care.
Severe postburn scar contracture of the neck compromises cervical motion and facial aesthetics. It may also distort the lower lip and dentoalveolar arch. Traditional single‑flap reconstructions often produce flaps that are too thick to adequately restore both regions. A 27-year-old woman presented with a severe contracture extending from the lower lip to the anterior neck, which was reconstructed with a full-thickness skin graft for the perioral region and a circumflex scapular artery and vein-augmented occipito-cervico-dorsal flap for the neck region. Specifically, after complete release of the cicatricial band, the lower lip margin and orbicularis oris were resurfaced with a full-thickness skin graft to restore contour and eliminate lip eversion. Immediately thereafter, the neck was resurfaced with a large, thin occipito-cervico-dorsal flap that was supercharged with the circumflex scapular artery and vein and anastomosed to the facial vessels. Secondary defatting was performed at 7 and 12 months to improve flap pliability and contour. At the 18-month follow-up, the patient had a normal cervicomental angle, adequate neck extension, and a well-matched perioral color. Oral continence was also restored. A region‑oriented strategy-combining a full‑thickness skin graft for the dynamic perioral unit with a large supercharged occipito‑cervico‑dorsal flap for the neck-provides thin, well‑vascularized tissue that can be secondarily contoured. This 2‑stage approach achieved excellent functional and aesthetic outcomes and may serve as a template for similar complex burn‑scar contractures involving both the perioral and cervicomental regions.
Fingertip and nail bed injuries present a clinical challenge, requiring restoration of sensory, functional, and cosmetic integrity without donor-site morbidity. Multilayer dermal regeneration templates (DRTs), including Integra and Terudermis, offer a promising alternative to traditional flap techniques. This retrospective comparative study included 30 patients with Allen type I-III fingertip injuries treated at a tertiary medical center in Taiwan between January 2020 and December 2022. Reconstructions utilized Integra (n = 12) or Terudermis (n = 18). At 6 months, outcomes were assessed for wound-healing efficacy, cosmetic appearance, sensory recovery, functional restoration, and patient satisfaction. Data were analyzed using the Mann-Whitney U test and Fisher exact test (P < 0.05). Both Integra and Terudermis achieved comparable outcomes (P > 0.05). Differences in finger length (0.37 cm) and nail bed area (0.34 cm2) were minimal. Vancouver Scar Scale scores ranged from 4 to 5. The mean 2-point discrimination on the affected side was 5.83 mm, with a 13.4% incidence of hook nail. Average distal interphalangeal joint range of motion was 79.0 degrees, and patient satisfaction averaged 4.8 out of 5. Complete epithelialization occurred within 38.9 days. Multilayer DRTs are effective for fingertip and nail bed reconstruction, offering comparable healing efficiency, reliable sensory and functional recovery, and favorable cosmetic and patient-reported outcomes. Integra and Terudermis demonstrated comparable outcomes, supporting their use as viable, donor-site-free options in fingertip reconstruction.
Reconstruction of distal radius defects following oncological resection remains technically challenging. Free fibula flap (FFF) arthrodesis offers a biological and durable reconstructive option; however, reports remain limited. We retrospectively reviewed 8 patients who underwent en bloc resection of Campanacci grade III giant cell tumors (2017-2024) of the distal radius, followed by reconstruction with FFF arthrodesis. Clinical, radiological, and functional outcomes were analyzed, including union, recurrence, complications, donor-site morbidity, and Musculoskeletal Tumor Society, Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale scores. All patients achieved radiographic union (mean 7 mo proximally, 11 mo distally). Median follow-up was 36 months. Seven (87.5%) patients remained disease-free; 1 patient developed multicentric soft-tissue local recurrence with pulmonary metastases, which was managed surgically along with radiotherapy and medical treatment. The patient remained disease-free at last follow-up. Mean Musculoskeletal Tumor Society score was 24.5, DASH score was 20.3, and visual analog scale score was 2.3, indicating satisfactory limb function and minimal pain. Donor-site morbidity was minimal. FFF arthrodesis maintained viability even after postoperative fractures, soft-tissue recurrences, and adjuvant therapy, underscoring its robustness. It represents a valuable microsurgical option when long-term stability and biological incorporation are prioritized.
This systematic review evaluates the translational readiness of carbon nanodot (CD)-enabled nerve conduits within the broader context of peripheral nerve repair. Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, major databases were searched through January 2025 for clinical, preclinical, biomaterial, imaging, degradation, and economic studies related to autograft, allograft, conduit repair, CDs, and fluorescence-guided nerve visualization. Sixty-eight studies met the inclusion criteria. CD-containing conduits, including fruit-peel-derived systems, have demonstrated tunable fluorescence, neural-range conductivity, and favorable Schwann cell and axonal responses but remain limited to small-animal proof-of-concept models, without good laboratory practice toxicology, large-animal studies, investigational device exemption-enabling data, or human trials. In contrast, fluorescence-guided nerve imaging with near-infrared agents and nerve autofluorescence is already clinically validated under standard operating room lighting, defining target emission windows and signal-to-background thresholds for future CD-based scaffolds. CDs undergo enzyme-mediated biodegradation and can be immobilized within hydrogels for controlled, degradation-linked release; however, their long-term in vivo fate and mass balance remain incompletely characterized. Across studies, CD synthesis is hindered by major reproducibility and quality-control gaps in quantum yield, particle size, and surface chemistry. Economic analyses highlight substantial donor-site morbidity and operative time costs for autografts, a lack of transparent device-level pricing for allografts and conduits, and preliminary evidence of cost-effectiveness advantages for allografts over nonoperative management. Overall, CDs are scientifically promising but translationally immature compared with established passive conduits, and targeted advances in manufacturing, safety, imaging performance, and economic evaluation will be required for clinical adoption.
Treating complex hand defects from cobra bites is a significant challenge for plastic surgeons. Microsurgical fascia flaps, especially the free anterolateral thigh (ALT) fascial flap, have been successfully used to reconstruct exposed tendons and soft-tissue injuries in single-stage procedures. This study discusses the use of the free ALT adipofascial (AF) flap for the successful reconstruction of venomous cobra bite injuries. After debridement, the resulting wounds were complex, often presenting full-thickness soft-tissue defects with exposed tendons. We covered these with the flap and immediately applied full-thickness skin grafts. Thirty free ALT-AF flaps were used, with an average flap length of 11 cm and width of 5.6 cm, covering an area of 65.8 cm2, with a thickness of 2-3 mm. Donor sites were primarily closed, and the overall flap success rate was 97.7%. Hand function recovered to approximately two-thirds of the normal range of motion. There was 1 total flap failure and 2 partial skin graft losses. No secondary flap defatting or donor-site complications occurred. The free ALT-AF flap with a skin graft is effective for reconstructing complex hand injuries and may improve aesthetic and functional outcomes in snakebite cases.
Facial asymmetry is universal, yet its directionality and its relationship with patients' self-perception remain underexplored. This study evaluates the association between 3-dimensional-measured malar asymmetry and the patient's declared "better side" in an aesthetic population. One hundred twenty consecutive patients were photographed in standardized frontal view using the Vectra H2 system. Malar width was assessed by measuring the zygion-midline distance on each side, recorded twice and averaged. Patients completed a 10-item ad hoc questionnaire addressing their preferred side, perceived asymmetries, photographic habits, and mirror-photograph differences. Observed frequencies were compared to a theoretical 50/50 distribution using chi-square testing. Objective asymmetry was present in 98.3% of subjects, with a wider left side in 118 cases (P < 0.001). In contrast, side preferences were evenly distributed between left (45%) and right (52%) (P = 0.41). No correlation was found between the anatomically wider side and the declared preferred side (P = 0.62). Forty percent of patients reported noticeable differences between their mirror image and photographs. Although a left-sided directional asymmetry predominates, it does not align with patients' stated preferences or their subjective self-image. Recognizing this dissociation between structure and perception during consultation improves expectation management and reduces postoperative misunderstandings in facial aesthetic procedures.
General anesthesia (GA) has been the standard for complex facial reconstructive surgery but is associated with perioperative risks and increased resource consumption. Wide awake facial reconstruction (WAFR), performed under local anesthesia (LA)/regional anesthesia (RA), offers an alternative that avoids these limitations. Nonetheless, WAFR remains underreported, and best practices are not well established. A literature review was conducted to identify studies involving WAFR, from which data were analyzed. Additionally, the costs of performing forehead flap reconstruction using LA/RA were compared with those under GA. Finally, a practical guide was developed to highlight key strategies for optimizing patient comfort. Thirty studies involving 1249 patients and 1262 flaps were included. Forehead (n = 443, 35.1%) and nasolabial (n = 387, 30.7%) flaps were the most frequently implemented. Minor (n = 126, 10.0%) and major (n = 34, 2.7%) complications were uncommon. Most patients expressed minimal to no pain during surgery and were consistently satisfied with their experience. No conversions to GA were required. The total cost of performing a forehead flap using WAFR is considerably lower when compared with GA ($1280.03 versus $6646.74; difference: $5366.71). WAFR is a safe, well-tolerated and effective alternative to facial reconstruction under GA. Advanced procedures, such as loco-regional flaps, can be successfully performed under LA/RA. This approach also improves access to revision surgery, a key factor in achieving the best possible final outcomes. The avoidance of GA significantly reduces healthcare costs. Further research is needed to incorporate patient-reported outcomes and expand the role of WAFR across diverse techniques.
Pain is a highly individual experience that can challenge effective patient-doctor communication. Patient drawings of pain (PDs) have been proposed as a tool to enhance communication and understanding. We aimed to evaluate the strengths and limitations of PDs for (1) screening and diagnosis of pain conditions, (2) prediction of surgical outcomes, and (3) postoperative pain monitoring in pediatric and adult surgical patients. We conducted a systematic literature search of PubMed/MEDLINE, Embase, Web of Science, and CENTRAL up to June 1, 2023. Studies assessing PDs in surgical populations were screened, and data on study design, patient population, and outcomes were extracted. The search identified 10,815 articles, of which 26 met the inclusion criteria, encompassing 5977 patients. Six studies (23%) assessed PDs as screening or diagnostic tools; 4 of these (67%) reported PDs to be effective in identifying neuropathic pain. Nine studies (35%) examined PDs as predictors of postoperative outcomes, particularly after nerve decompression and spine surgery. Eleven studies (42%) evaluated PDs for postoperative follow-up, demonstrating their utility in tracking pain evolution over time. PDs represent a promising tool for preoperative screening and diagnosis of neuropathic pain, prediction of surgical response, and postoperative pain monitoring. However, heterogeneity in methodology highlights the need for standardized parameters and assessment criteria. Future prospective trials are warranted to establish consistent evaluation frameworks and to further define the clinical utility of PDs.
Large, complex defects in the anterior skull base may require microvascular free flaps. This study compares the clinical outcomes of transcranial and transmaxillary microvascular free flap insertion. A total of 41 adult patients were included in this study. The medical records provided information on patient demographics, defect measurements, flap characteristics, survival, recurrence, and complications of the patients. Computed tomography images were used to measure skull base defect size (mm2). Kaplan-Meier analysis was carried out to analyze survival. Logistic and multiple logistic regression analyses were used to evaluate the interactions between the clinical variables and outcomes. Twenty-three patients underwent transcranial flap insetting, and 18 underwent flap insetting using the transmaxillary approach. The 2 groups were comparable in terms of sex, age, and comorbidities but differed in tumor type and staging. The reconstructed defect size was larger in the transcranial insetting group (SD 1371.97 versus 991.3 mm2). The vastus lateralis muscle was the primary choice for reconstruction. At 20 months postoperatively, 90% in the transcranial and 78% in the transmaxillary group were recurrence-free. Overall survival at 40 months was 74% in the transcranial group and 88% in the transmaxillary inset group. The complication rate of Clavien-Dindo 3b or higher was 35.7% overall, with 34.7% in the transcranial group and 38.9% in the transmaxillary group. The transmaxillary flap insetting approach is feasible for tumors with a large sinonasal component, although it has a higher rate of complications, possibly related to the surgical learning curve.
In complex soft tissue reconstruction, pedicled muscle and fasciocutaneous flaps continue to serve as fundamental techniques. Nevertheless, flap insufficiency, stemming from limited reach, tension, or insufficient bulk, frequently requires secondary flap or grafting procedures, resulting in additional donor site morbidity. This study evaluates the intraoperative application of intact fish skin grafts (IFSGs) as a biological scaffold to assist with wound closure and achieve complete wound coverage without the need for additional donor sites. A retrospective case series involving 11 patients who underwent soft tissue reconstruction using muscle (n = 3) or fasciocutaneous (n = 8) flaps integrated with IFSG was conducted by a single plastic surgeon. The application of IFSG was performed intraoperatively when the flap volume or reach proved inadequate. Clinical outcomes, healing timelines, and the necessity for reoperation were systematically evaluated. Indications for reconstruction included exposed joints, hardware, bone, tendons without paratenon, and aesthetically critical facial defects. All flaps survived, and IFSGs demonstrated full integration. Ten of 11 wounds achieved complete closure without further surgery. The remaining case, complicated by severe lymphedema, achieved flap survival and coverage of the intended exposed bone but did not go on to fully heal. No secondary tissue harvests were required. The mean healing time was 66.6 days. Intraoperative IFSG integration demonstrates the potential to enhance the functional coverage and healing potential of pedicled muscle and fasciocutaneous flaps, eliminating the need for secondary grafting, and warrants further study.
Acellular dermal matrix (ADM) has improved aesthetic and structural outcomes in implant-based postmastectomy breast reconstruction. However, outcomes in patients receiving postmastectomy radiotherapy (PMRT) remain inconsistent due to radiation-induced fibrosis and vascular compromise. This meta-analysis evaluates complication rates associated with ADM use in irradiated implant-based reconstruction. A PRISMA-guided search was conducted to identify studies reporting outcomes of ADM-assisted, irradiated postmastectomy breast reconstruction. Eligible studies were analyzed using proportional meta-analysis with subgroup comparisons based on ADM type, implant placement plane, and timing of radiotherapy. Across all included studies, pooled complication rates were 16.8% for capsular contracture, 8.3% for infection, 5.8% for seroma, and 10.6% for implant loss. Implant plane significantly affected outcomes: prepectoral reconstruction demonstrated significantly lower rates of capsular contracture and infection compared with submuscular or mixed approaches, whereas mixed-plane placement was significantly associated with higher rates of implant malposition. Radiotherapy timing significantly influenced long-term outcomes: postoperative PMRT was associated with the highest rates of capsular contracture, implant loss, and reoperation, whereas preoperative PMRT demonstrated the lowest rates. ADM type also showed significant differences in capsular contracture, implant loss, and reoperation, with bovine matrices demonstrating significantly lower complication rates and porcine matrices showing favorable satisfaction outcomes. Overall patient satisfaction reached 80.8%. ADM-assisted implant reconstruction in irradiated patients is associated with variable complication rates influenced by ADM type, implant plane, and radiotherapy timing. Preoperative radiation and selected ADM materials, particularly bovine matrices, were associated with more favorable outcomes, whereas postoperative radiation was linked to higher long-term complication rates.
Perceptions of physical beauty vary across cultures and are shaped by evolving social norms and media influences. In this context, body contouring procedures have gained increasing popularity; however, conventional approaches such as liposuction may be limited in patients with a wider thoracic framework. Consequently, waist-narrowing procedures, including rib remodeling techniques, have emerged as adjunctive or alternative strategies to enhance waist definition. Recent advances in rib remodeling aim to achieve a reduction in waist circumference while promoting an "hourglass" silhouette with minimal visible scarring. Accordingly, the present study aims to compare straight and oblique rib-remodeling techniques in terms of waist circumference reduction and recurrence over time. A retrospective cohort study included 240 female patients: 100 underwent the straight approach and 140, the oblique approach. Preoperative variables included age, weight, body mass index, and abdominal circumference. Postoperative abdominal circumference was evaluated immediately and at 3, 6, and 12 months. Recurrence was defined as an increase in abdominal circumference during follow-up. Group differences were analyzed using the z-test. Baseline characteristics were comparable between groups. The oblique approach was associated with a shorter operative time (P < 0.01) and significantly lower recurrence rates at all follow-up intervals compared with the straight approach (P < 0.001), with sustained differences at 3, 6, and 12 months. The oblique rib-remodeling technique provides more durable waist circumference reduction with lower recurrence rates, supporting its role as an effective body contouring option.