Background:Laparoscopy has long been the standard minimally invasive approach for gallbladder removal. Proponents suggest robotic surgery may improve outcomes such as readmission rates and length of stay. Methods:A systematic review of the literature was conducted using articles from PubMed, EBSCO: Medline, and Cochrane databases. Peer-reviewed studies published between January 2015 and November 10, 2025, were included if they directly compared robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) outcomes in adult patients. Results:Nineteen studies were included, consisting primarily of retrospective cohort studies, along with prospective cohort studies, ambispective cohort studies, and one randomized controlled trial. The age and sex distributions of patients were similar between the RC and LC groups. Most studies reported no statistically significant difference in length of stay or readmission rates between groups. One larger multicenter study demonstrated significantly lower readmission rates and a modest reduction in length of stay favoring RC; however, these findings were not consistently observed across the remaining studies. Conclusion:RC appears to offer similar short-term postoperative outcomes compared with LC with only one multicenter study reporting modest improvements favoring RC. Further high-quality studies are needed to determine whether robotic approaches provide clinically meaningful benefits.
Background and Introduction Nipple-areola complex (NAC) reconstruction remains a challenging aspect of breast reconstruction, particularly due to long-term loss of nipple projection and variability in aesthetic outcomes associated with traditional techniques. The FixNip nipple prosthesis is a novel implant-based device designed to provide stable projection and improved aesthetic results. We report the first documented clinical application of the FixNip prosthesis in a male patient following mastectomy. Case Presentation A 53-year-old male patient with a history of left-sided mastectomy for breast cancer underwent delayed NAC reconstruction using the FixNip prosthesis after prior autologous reconstruction with lipofilling. The prosthesis, composed of a nitinol framework enclosed within a silicone cap, was implanted through a small subcutaneous pocket under local anesthesia. Postoperative follow-up was performed at 1 week, 1 month, 6 months, and 12 months. Results The procedure was completed without intraoperative or postoperative complications. At 6-month follow-up, the patient demonstrated stable nipple projection, satisfactory symmetry, and excellent aesthetic integration with the contralateral NAC. No signs of infection, implant displacement, skin necrosis, or adverse local reactions were observed. The patient reported high satisfaction with the aesthetic outcome and significant improvement in body image and quality of life. Discussion and Conclusions The FixNip prosthesis appears to be a safe and effective option for NAC reconstruction in selected patients, offering stable long-term projection with minimal surgical morbidity. This first reported application in a male patient highlights the potential role of implant-based NAC reconstruction in improving aesthetic and psychological outcomes following mastectomy. Further studies with larger patient cohorts and longer follow-up are needed to confirm long-term safety and efficacy
Background:Rhinoplasty and nasal reconstruction are technically demanding procedures in which optimization of the skin and soft-tissue envelope remains challenging, particularly in revision surgery and in patients with thin or scarred skin. Autologous fat-derived products have emerged as regenerative adjuncts that may improve scar quality, skin texture, and aesthetic outcomes beyond simple volumetric augmentation. Objective:To systematically evaluate the clinical outcomes of autologous fat-derived product grafting in rhinoplasty and nasal reconstruction, focusing on scar quality, skin characteristics, aesthetic outcomes, patient satisfaction, safety, and durability. Methods:This systematic review followed PRISMA 2020 guidelines and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251087473). A comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, and Google Scholar was conducted from database inception to June 2025. Human clinical studies reporting outcomes of autologous fat-derived products in rhinoplasty or nasal reconstruction were included. Study selection, data extraction, and risk-of-bias assessment were performed using predefined criteria. Because of substantial clinical and biological heterogeneity, a structured qualitative (narrative) synthesis informed by Synthesis Without Meta-analysis (SWiM) guidance was undertaken, with outcomes organised by product class. Results:Twelve studies published between 2007 and 2024, involving 768 patients in aggregate across non-pooled studies, met the inclusion criteria. Interventions included microfat, nanofat, stromal vascular fraction, adipose-derived stromal cells, platelet-rich fibrin-enriched fat, and diced fat composites. Most studies reported improvements in scar appearance, skin quality, and tissue pliability, with favorable aesthetic outcomes and high patient satisfaction. Only one study used objective three-dimensional imaging; the remainder relied on subjective assessment. Complications were infrequent and generally minor. Conclusions:Autologous fat-derived products appear to be well tolerated and may be useful adjuncts in rhinoplasty and nasal reconstruction, with a consistently low rate of minor, self-limiting complications. However, the available evidence is of low certainty: it is drawn predominantly from small, uncontrolled, subjectively assessed studies that pool biologically distinct fat preparations and is geographically concentrated in East Asian populations. Reported aesthetic benefits should be interpreted with caution. Well-designed comparative studies using standardised processing protocols, blinded three-dimensional outcome assessment, and adequate follow-up are needed before firm clinical recommendations can be made.
Myxoid liposarcoma is a malignant soft-tissue sarcoma with a high risk of local recurrence. Repeated surgery and adjuvant treatment may compromise soft tissues and therefore predispose patients to chronic infection, creating challenges for limb salvage. We report a case of recurrent myxoid liposarcoma complicated by chronic surgical-site infection that was successfully managed using gastrocnemius flap reconstruction combined with sub-flap irrigating vacuum-assisted closure therapy. A 33-year-old man presented with recurrent myxoid liposarcoma of the posterior left knee following multiple previous excisions, and chemotherapy. Tumor resection was done, along with chemotherapy and radiotherapy. After tumor resection, he developed wound dehiscence and deep surgical-site infection requiring serial debridement. Because of persistent infection and extensive soft-tissue loss, reconstruction was performed using a medial head gastrocnemius muscle flap. A sub-flap irrigating VAC system with continuous gentamicin-saline irrigation was applied to improve infection control and support flap viability. Wound cultures grew Acinetobacter baumannii, and antibiotic therapy was adjusted according to sensitivity testing. Split-thickness skin grafting was subsequently performed. At one-year follow-up, successful limb salvage was achieved without recurrent infection with complete defect coverage. This case suggests that combining gastrocnemius flap reconstruction with sub-flap irrigating VAC therapy may provide effective infection control and durable soft-tissue reconstruction in complex limb-salvage procedures.
Introduction:Risk stratification is essential when selecting the timing and technique of breast reconstruction. While several prediction models exist, none have incorporated prior massive weight loss (MWL), despite a growing population of such patients. This study aimed to develop cumulative risk prediction models for complications after implant-based breast reconstruction, explicitly including MWL as a candidate predictor. Methods:This nationwide, population-based case-control study used prospectively collected Swedish registry data. Patients with prior bariatric surgery who underwent immediate or delayed post-mastectomy implant-based breast reconstruction between 2007 and 2022 were identified and matched to at least 3 controls by age and body mass index. Candidate predictors were selected based on prior literature. Group least absolute shrinkage and selection operator (LASSO) regression with bootstrap resampling was used to develop prediction models, which were visualized as nomograms. Results:A total of 245 immediate and 602 delayed breast reconstructions were included; 11% and 6%, respectively, had a history of MWL. Complication rates were 16.3% for immediate and 14.5% for delayed reconstruction. Prior MWL was consistently selected as an independent predictor of complications in both immediate and delayed reconstruction models and of re-admission after delayed reconstruction. Other predictors included age, body mass index, radiotherapy, comorbidity-related medications, and antibiotic use. Conclusion:Prior massive weight loss following bariatric surgery is an independent risk factor for complications after both immediate and delayed implant-based breast reconstruction. Incorporating MWL into cumulative risk prediction models improves individualized risk assessment and supports informed, shared decision-making in reconstructive breast surgery.
Background The masseteric nerve (MN) is a reliable donor nerve in facial reanimation. Masseteric-to-facial nerve transfer offers advantages including close proximity to facial nerve branches, strong axonal input, and minimal donor-site morbidity. However, safe and efficient identification of the MN can be challenging, particularly for surgeons less familiar with this region. A structured, reproducible approach is therefore essential. Methods 14 fresh-frozen hemifaces were dissected to identify the MN and define its topographic relationships. Distances were measured relative to the apex of the tragus, the caudal edge of the zygomatic arch, and the superficial musculoaponeurotic system (SMAS). Based on these findings, a step-by-step surgical guide was developed, completed by schematic illustrations and an intraoperative video tutorial. Results The MN was consistently located 3.89 ± 0.27 cm anterior to the apex of the tragus, 1.01 ± 0.18 cm inferior to the zygomatic arch, and 1.11 ± 0.21 cm deep to the SMAS. It was found in close proximity to the frontal branch of the facial nerve, typically directly beneath it or slightly anterior or posterior to it. Despite minor anatomical variations, a reproducible dissection pathway was defined. The resulting illustrated guide and video tutorial highlight key anatomical landmarks and safe dissection zones. Conclusions This cadaveric study and surgical tutorial provide a practical, reliable guide to identify the MN. The structured, step-by-step approach is designed to support both trainees and experienced surgeons, thereby improving safety, precision, and surgical efficiency in facial reanimation.
Background Free and pedicled flaps remain the principal reconstructive options following head and neck oncologic surgery. Although free flaps are most frequently used, pedicled flaps have re-emerged with modern techniques offering comparable outcomes with reduced complexity. The aim was to systematically compare surgical, functional and economic outcomes between free and pedicled flaps in head and neck reconstruction. Methods A systematic search of PubMed and Embase was conducted from database inception to September 2025, following PRISMA guidelines. Comparative studies evaluating free versus pedicled flap reconstruction in adults were included. Two reviewers independently screened and extracted data. Pooled meta-analyses were performed for operative time, hospital stay and complications. Results Twenty-five studies met inclusion criteria. Free flap reconstruction required a longer operative time (mean difference = +172.5 min; 95% CI 132.3–212.6, PI 2.5 to +342.5 min) and higher financial cost (1.3–3 × greater) compared with pedicled flaps. Hospital stay was similar between groups (mean difference = +0.6 days; 95% CI -2.7 to +3.9). Pedicled flaps exhibited slightly fewer overall complications, including wound dehiscence, infection and revision surgery. Flap failure was significantly more frequent with free flaps. Conclusions Free flaps remain the standard for extensive or functionally demanding reconstructions, but pedicled flaps offer comparable outcomes with shorter surgery, lower costs and equivalent complication rates in selected cases. Flap choice should be individualised based on defect complexity, patient comorbidity and institutional expertise.
Purpose:Crossing vessels are commonly encountered during pyeloplasty for ureteropelvic junction obstruction (UPJO) and may influence surgical strategy. We aimed to describe the anatomical distribution of crossing vessels and their management options during retroperitoneal laparoscopic pyeloplasty (RLP) and report the long-term outcomes. Materials and Methods:We retrospectively reviewed consecutive adult patients who underwent RLP for UPJO between 2006 and 2025 by a single surgeon. Preoperative computed tomography (CT) or magnetic resonance (MR) urography was routinely performed to assess vascular anatomy. Surgical technique emphasized identification of crossing vessels, routine UPJ reconstruction, mobilization and/or transposition of arteries, selective ligation of nonessential veins, and creation of a dependent tension-free anastomosis. Results:The study included 165 patients with mean age of 58.2 years. Crossing vessels were identified in 114 patients (69.1%), most commonly gonadal vein variants (45.6%) and accessory renal arteries (31.6%). Mean operative time was 175 minutes, with no conversions to open surgery. Only 19 (16.67%) patients required ureteral transposition. Postoperative Clavien-Dindo grade III complications occurred in 5 (3%) patients, with no grade IV or V events. With median follow-up of 64 months, overall success rate was 96.1%. None of the variables were statistically linked to failed pyeloplasty (P > .5 for all variables). Conclusions:RLP with systematic identification of crossing vessels is associated with excellent long-term functional outcomes and low morbidity. Management of crossing vessels should be individualized according to the type and relation of the crossing vessel to the UPJ. Ureteral transposition should not be a routine part of RLP.
Background and Objectives:Uterine fibroids are common in women and can lead to symptoms of abnormal uterine bleeding, pelvic pain and bulk symptoms. Treatment can be medical or surgical. This study aims to describe characteristics and outcomes of women undergoing combined laparoscopic radiofrequency ablation (lap-RFA) and laparoscopic myomectomy (lap-MYO) to treat symptomatic uterine fibroids. Methods:This is a multicenter prospective cohort study including both academic centers and private practices. Women in the Uterine Leiomyoma Treatment by Radiofrequency Ablation (ULTRA) Study who were scheduled to undergo surgical management of fibroids underwent a combined lap-RFA and lap-MYO. We assessed quality of life and sexual function changes from before to 12 months after surgery using validated questionnaires. Results:Of the 480 participants in ULTRA, 49 underwent a combined lap-RFA and lap-MYO procedure between 2014 and 2022. The mean number of fibroids treated was 3.6 (standard deviation [SD] 2.0). The mean number of days to return to usual activities was 12.7 (SD 10.1). The Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire symptom severity score (0-100 points) improved by 36.4 points (SD 27.0, P < .001) at 12 months and the Sexual Health Outcomes in Women Questionnaire (0-100 points) assessment of pelvic problems interference with sex improved by 13 points (SD 34.4 P = .02) as early as 6 weeks. About 75% of women were satisfied with the surgery at 12 months. Conclusion:Combining lap-RFA and lap-MYO is associated with few peri-operative events, satisfactory recovery time, and significant improvement in quality-of-life measures with high patient satisfaction through 12 months after surgery.
Background and objectives The nasolabial flap is a reliable option in nasal subunit reconstruction, but its versatility often remains underappreciated. This study aims to highlight a plethora of different application options of the nasolabial flap for nasal defects, while proposing a reconstructive, defect-based algorithm. Patients and methods In a retrospective case series, patients with nasal subunit defects reconstructed using a nasolabial flap between 2014 – 2024 by a single plastic and reconstructive surgeon were included. Data analysis included patient demographics, defect characteristics, nasolabial flap characteristics, perioperative data, and postoperative outcome. Different nasolabial flap applications were categorized into eight variants according to defect analysis by nasal subunit, defect depth, and reconstructive complexity. Patient and surgeon satisfaction was rated applying a modified Whitaker scale. Results Twenty-three patients (n = 23) were included and classified into the subgroups according to the nasolabial flap applied. In 91.3%, nasal defects were caused by prior skin cancer resection or complications thereof. Defect size ranged from partial (4.3%) and single-subunit defects (78.3%) to multi-subunit defects (17.4%) with varying defect depth between partial- and full-thickness defect. Based on thorough defect analyses, a defect-based treatment algorithm was derived. Variants of the nasolabial flap included transposition and island flap designs, one- vs. two-staged flaps, the nasolabial flap as an enfolding flap or in combination with a turn-over flap with or without concha cartilage grafting. No major complications or flap losses occurred. Postoperative outcome rating showed a high patient satisfaction rate with only one patient demanding a corrective surgery. Conclusions The nasolabial flap is versatile and simple, making it highly suitable for facial reconstruction in everyday clinic. Use of the proposed defect-based treatment algorithm enables precise decision making depending on the defect to reconstruct.
Background Predicting nasal growth remains a major challenge in adolescent facial treatment. Current clinical decision-making relies primarily on chronological age and indirect skeletal maturity indicators, which poorly reflect individual nasal growth patterns. Three-dimensional facial imaging offers new possibilities for morphometric analysis; however, most existing growth models lack sufficient nasal resolution. This study aimed to clinically validate the geometric accuracy of a three-dimensional nasal growth prediction algorithm based on dense landmark-based morphometry. Methods The predictive model was developed using a cross-sectional dataset of approximately 2050 multi-ethnic subjects aged 6–19 years with equal sex distribution. A total of 84 facial landmarks were collected, including 54 nasal-specific landmarks. A supervised multivariable linear regression model was trained on the standardised morphometric parameters, with age (continuous) and biological sex as covariates; no dimensionality reduction was applied. External validation was performed on a cohort of 12 longitudinally followed adolescents (6 female, 6 male; baseline 12.7 ± 2.6 years, follow-up 15.4 ± 2.7 years), strictly independent of the development dataset. The predicted post-pubertal morphology was compared with the observed follow-up acquisition using three complementary analyses: surface-to-surface deviation, Bland-Altman concordance on the Goode ratio and the nasal tip projection, and comparison against a no-growth baseline scenario. Results The mean surface deviation between predicted and observed nasal morphology was 0.58 ± 0.20 mm (95% CI 0.46–0.70 mm; RMSE = 0.61 mm). 95.6 ± 5.0% of nasal surface points lay within the 1.5-mm clinical threshold and 99.5 ± 0.9% within 2.5 mm. Bland-Altman concordance analysis confirmed near-perfect proportional agreement on the Goode ratio (bias = −0.033; 95% limits of agreement [−0.145; +0.079]) and sub-threshold systematic bias on the nasal tip projection (bias = −1.01 mm, below the 1.5-mm clinical threshold; 95% limits of agreement [−4.10; +2.09] mm). The algorithm consistently outperformed the no-growth baseline scenario on both parameters, with the SD of the differences reduced by 12.3% and 8.7% respectively. Conclusion The proposed three-dimensional algorithm provides geometric and morphometric validation of nasal growth prediction on a longitudinal adolescent cohort, with sub-millimetric global accuracy and concordant prediction on clinically relevant nasal parameters. These findings support the clinical applicability of the algorithm in the assessment of adolescent nasal growth, therapeutic planning and patient counselling, while accumulation of larger prospective datasets will continue to refine the precision boundaries across diverse populations. Level of evidence Not applicable (Algorithm Validation Study)
Background:Nasal retainers (also referred to as conformers or stents) are increasingly used after rhinoplasty and nasal reconstruction in non-cleft patients, but their indications, outcomes, and safety profile are not well established. We aimed to summarize the available evidence and propose indications for their use. Methods:A narrative review was conducted. A structured search of PubMed, MEDLINE, and SciELO was performed between November 2025 and February 2026, without language or time restrictions, using predefined search terms and inclusion/exclusion criteria. Studies reporting postoperative use of nasal retainers after aesthetic-functional rhinoplasty or nasal reconstructive surgery were included, excluding those limited to patients with cleft lip and/or palate. Results:Thirteen studies were identified, comprising case reports, small case series, and a single randomized controlled trial involving non-cleft patients undergoing rhinoseptoplasty, correction of nostril stenosis, and reconstruction after trauma, burns, or oncologic resection. Across studies, retainers were typically custom-made or commercial silicone devices used for weeks to months postoperatively. Most reports describe improved nostril symmetry and nasal function, high patient tolerance, and infrequent minor complications. Discussion and conclusions:There is a biological rationale for the use of nasal retainers in modulating healing and scar formation after nasal surgery. Available evidence, though limited in quality, together with this biological rationale and clinical experience, suggests that nasal retainers may represent a useful adjunct in selected aesthetic and reconstructive nasal procedures, particularly in patients at higher risk of contracture or asymmetry. These observations are best understood as hypothesis-generating and expert opinion-based, as current evidence is limited and well-designed comparative studies are needed to more robustly define their effectiveness.
Background Flaps based on the subscapular artery are versatile options in reconstructive surgery. However, after extensive flap harvest, primary donor-site closure may be difficult, and skin grafting may be required. In pediatric patients, skin grafting may be associated with additional donor-site morbidity, scar contracture, contour mismatch, and potential growth-related concerns. Although local pedicled flaps have been used for donor-site closure in regions such as the anterolateral thigh and forearm, their application after subscapular artery system flap harvest remains limited. Methods We report three pediatric patients aged 4–7 years who underwent reconstruction with subscapular artery flaps for complex defects of the foot dorsum, upper arm, and heel. In each case, the subscapular donor-site defect could not be closed primarily. Instead of skin grafting, individualized local pedicled flaps, including triangular perforator-based, transposition, and keystone-like trapezoidal designs, were used to achieve tension-free closure. Flap design was based on donor-site geometry, adjacent tissue laxity, and available perforators. Results All subscapular artery flaps and local pedicled flaps survived completely. Donor-site defects were closed without skin grafting, wound dehiscence, or delayed healing. The donor sites healed with linear scars, and no donor-site complications were recorded during follow-up of 2 months to 3 years. Conclusion In selected pediatric patients, individualized local pedicled flaps may provide a feasible option for closing subscapular donor-site defects when primary closure is not possible. This approach may reduce closure tension and avoid skin grafting, but larger studies with longer follow-up are needed to better define its indications and long-term outcomes.
Objective:To compare perioperative outcomes of emergency gynecologic surgeries performed during working hours and off-hours, and to evaluate temporal trends in surgical approach, particularly laparoscopy. Methods:This retrospective cohort study included patients who underwent emergency surgery for ovarian torsion, ovarian cyst rupture, or ruptured tubal ectopic pregnancy between January 1, 2020 and October 1, 2025 at a tertiary referral center. Patients were grouped according to surgical timing as working hours or off-hours. Demographic characteristics, surgical approach, operative time, hemoglobin decrease, transfusion requirement, hospital stay, intraoperative and postoperative complications, and reoperation were compared within each diagnostic group. Annual trends in surgical approach were also analyzed, and multivariable linear regression assessed the association of off-hours surgery with operative time and length of hospital stay. Results:A total of 386 patients were included: 69 with ovarian torsion, 77 with ovarian cyst rupture, and 240 with ruptured tubal ectopic pregnancy. Most procedures were performed during off-hours. In ovarian torsion and ovarian cyst rupture, perioperative outcomes were comparable between groups. In ruptured tubal ectopic pregnancy, operative time was longer during off-hours than during working hours and remained independently associated with off-hours surgery after adjustment, while hemoglobin decrease, transfusion requirement, hospital stay, complications, and reoperation rates were similar. The proportion of laparoscopic procedures increased from 17.9% in 2020 to 90.0% in the first 9 months of 2025. Conclusion:Off-hours emergency gynecologic surgery showed largely comparable outcomes to working-hours surgery. The marked shift toward laparoscopy suggests increasing integration of minimally invasive surgery into emergency gynecologic practice.
Background:Esophageal squamous cell carcinoma (ESCC) is associated with high morbidity and mortality, and esophagectomy remains the mainstay of curative treatment. The optimal surgical technique transthoracic esophagectomy (TTE) versus transhiatal esophagectomy (THE) continues to be debated due to differences in surgical invasiveness and the extent of lymphadenectomy. This study aimed to compare clinical and oncological outcomes of TTE and THE in patients treated for ESCC. Materials and Methods:This retrospective study included patients who underwent curative-intent esophagectomy for histologically confirmed ESCC between 2015 and 2023. Patients were categorized according to surgical approach (TTE vs THE), and demographic characteristics, perioperative data, pathological findings, postoperative complications, and survival outcomes were compared between the 2 groups. Complications were classified according to the Clavien-Dindo system. Disease-free survival (DFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. Results:A total of 39 patients were analyzed (21 TTE, 18 THE). Baseline demographic features and most perioperative variables were comparable. TTE was associated with a significantly longer operative time and higher lymph node yield, whereas THE showed higher rates of intraoperative transfusion and pleural effusion. Other postoperative complications were similar between groups. The TTE approach demonstrated significantly better DFS (P = .004). No significant difference in OS was observed between the groups (P = .165). No additional clinical or pathological factors were associated with survival outcomes. Conclusion:TTE resulted in a greater lymph node yield and significantly improved DFS, indicating a clear oncologic advantage over the transhiatal approach.
Background:In the last 40 years, laparoscopic surgery has shown several benefits, including reduced pain and faster recovery, and has spread worldwide. Although international guidelines recommend closing ≥10-mm trocar sites, specific complications due to their ineffective closure, trocar-site hernia (TSH) and abdominal wall bleeding, are becoming an issue. Since various techniques/devices have been introduced for port-site closure, this review is aimed at assessing the state of the art of port-site closure in 2026. Methods:A systematic literature review of all articles reporting port-site closure techniques and devices was performed. Methods were classified according to Shaher's classification. Due to the heterogeneity of studies and collected data, statistical analysis was not feasible. Port-site closure methods are discussed with respect to risk factors, clinical evidence of port-site morbidity, and current surgical practice. Results:A total of 1,251 articles were screened and 36 were included in the review. Reported outcomes included patient body mass index (BMI), operative time, and morbidity. Operative time varied largely (from 19 seconds to 8 minutes), TSH recurrence was rare (0.2%), follow-up ranged from one week to seven years, averaging 21.2 months. Conclusion:Various devices and techniques have been introduced to address trocar-site closure. Despite more than four decades of development, no closure method has clearly demonstrated superiority over the others. Overall, the quality of the available literature remains low, and reported outcomes are not fully consistent with clinical practice. The current state of the art is therefore characterized by the absence of a gold-standard approach. Standardized comparative studies are needed.
Background Reconstruction of scalp defects after oncologic resection remains challenging because of limited tissue mobility and frequent periosteal involvement. In elderly or frail patients, complex procedures such as large local flaps or free tissue transfer carry significant morbidity. Acellular dermal matrices (ADMs) offer an alternative for single-stage wound coverage. This multicentre study compared a tissue bank–manufactured human ADM with the commercial dermal regeneration template Integra®. Methods A multicentre observational study was conducted between January 2023 and June 2025 at two university hospitals. Sixteen patients underwent scalp reconstruction after excision of nonmelanoma skin cancer: six received cadaveric human ADM and ten Integra®. The primary outcome was time to complete epithelialization. Secondary outcomes included graft integration, postoperative complications, operative time, and material cost. Results All grafts integrated successfully, with no failures. Mean healing time was shorter with ADM (1.8 ± 0.3 months) than with Integra® (3.5 ± 1.4 months; mean difference 1.7 months, 95% CI 0.48–2.92; p = 0.01; Cohen's d = 1.54). One postoperative infection occurred in the ADM group and resolved with oral antibiotics; none occurred with Integra®. Operative times were comparable. Material cost was approximately 72% lower with tissue bank–derived ADM (€500 vs. €1,759 per reconstruction). Conclusions In this multicentre pilot study, single-stage scalp reconstruction using tissue bank–manufactured human ADM achieved successful graft integration, faster healing, and substantially lower material cost than Integra®. Given the small sample size (n = 16) and observational design, these findings should be considered preliminary and hypothesis-generating.
Secondary lymphedema is a frequent long-term complication following cancer treatment. Although several surgical options exist, lymph node-to-vein anastomosis (LNVA) has recently gained renewed attention as a potential treatment for secondary lymphedema. This systematic review aimed to evaluate the current evidence regarding the efficacy of LNVA in the treatment of secondary lymphedema. A literature search was conducted on November 10, 2025, in Embase, MEDLINE, the Cochrane Library, and Google Scholar. ClinicalTrials.gov and the International Clinical Trials Registry Platform were also screened for ongoing studies. Studies reporting outcomes after LNVA in patients with secondary lymphedema were included. Two independent reviewers performed study screening and data extraction. Risk of bias was assessed using ROBINS-I and the JBI Critical Appraisal Checklist for Case Series, and the certainty of evidence was evaluated using GRADE. Three studies met the inclusion criteria: two retrospective cohort studies and one case series. Across studies, LNVA was associated with modest reductions in limb circumference and partial symptom relief in some patients. However, all studies demonstrated serious or high risk of bias, and the overall certainty of evidence was rated as very low. Current evidence supporting LNVA for secondary lymphedema is limited and of low methodological quality. Well-designed prospective studies are required to determine the true clinical value of LNVA.
Autologous fat grafting, or lipofilling, is a technique commonly employed in cosmetic/aesthetic procedures for facial, breast, and gluteal augmentation. Although it is considered a safe procedure, fat embolism is a known, albeit rare, catastrophic complication of lipofilling, and gluteal fat grafting is specifically associated with a high mortality rate. This narrative review aims to identify the mechanisms of fatal fat embolism in cosmetic lipofilling procedures and compare the risks of gluteal, breast, and facial fat grafting procedures. Anatomical studies, autopsy reports, and clinical studies suggest that the increased mortality rate associated with gluteal fat grafting is attributable to the interplay of three major contributing factors: the presence of significant intramuscular gluteal veins, the technique of fat grafting, and the amount of fat transferred in gluteal augmentation procedures. In contrast, breast and facial lipofilling procedures are associated with different anatomical environments and injection techniques, which are associated with significantly lower risks of pulmonary fat embolism, with unique risks of arterial fat embolism in facial procedures. The literature has highlighted certain shortcomings in the current body of evidence, including the lack of uniform reporting of complications and the lack of standardized data on procedures performed. It is suggested that enhanced training of surgeons, adherence to strict subcutaneous fat injection, and the use of ultrasound technology in fat grafting procedures, as well as the establishment of mandatory complication registries, are essential strategies for reducing mortality associated with gluteal fat grafting procedures.
Background:Facial aesthetic injectables are commonly discussed through an anatomic and cosmetic lens. However, patients often seek treatment for reasons that exceed physical correction or enhancement, including confidence, social functioning, self-perception, and appearance-related distress. Objective:To identify and critically appraise evidence evaluating psychological, social, and quality-of-life outcomes following single-modality, mixed/comparative, and multimodal facial aesthetic injectable treatments. Methods:An evidence-based literature review was performed using PubMed, Ovid MEDLINE, and the Cochrane Library from January 2006 through June 2026. Eligible studies included adults undergoing facial aesthetic injectable treatments with botulinum toxin, hyaluronic acid fillers, biostimulatory or hybrid injectable fillers, platelet-rich plasma, polynucleotides/PDRN, or exosome-based injectables. Studies reporting psychological, social, self-esteem, appearance-related distress, social-perception, or quality-of-life outcomes were included. Studies were categorized by treatment modality and appraised using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Results:Thirty-one studies were included. Facial aesthetic injectables were generally associated with improvements in psychological, social, self-perception, appearance-related distress, social-perception, and quality-of-life outcomes. The strongest evidence was identified for single-modality botulinum toxin A, largely because of randomized controlled trials. Evidence for hyaluronic acid fillers, mixed/comparative injectable approaches, and multimodal treatments was generally positive but more heterogeneous. Conclusions:Facial aesthetic injectables are associated with improvements in patient-reported psychosocial and quality-of-life outcomes, although the evidence remains heterogeneous. Emerging data also suggest favourable effects on observer-rated social perception. The proposed MOTIVE framework provides a pragmatic structure for integrating validated patient-reported outcome measures into routine aesthetic practice and warrants prospective evaluation.
