Background This study assesses surgical practices and complications related to risk-reducing mastectomy in patients at very high risk for breast cancer. Methods A retrospective study was conducted among women over 18 years of age who had undergone risk-reducing mastectomy from January 2015 to April 2022 at the Toulouse-Oncopole University Cancer Institute. Results For the 253 patients having undergone risk-reducing mastectomy between 2015 and 2022, mean age was 43 years, with a majority of patients carrying BRCA1 (48.6%) or BRCA2 mutations (38.3%). Three-quarters of patients (67.6%) underwent prosthetic reconstruction, 17% free-flap reconstruction, and 7% latissimus dorsi flap reconstruction. At least one postoperative complication was experienced by 43% of patients, mostly wound healing disorders (34.9%). A complication requiring no further intervention was recorded in 32% of patients. A further 11.1% required reoperation. Implant loss occurred in 3.5% of patients undergoing prosthetic reconstruction. The rate of free flap loss was 5.9%. Discussion and Conclusion The overall complication rate of 43% aligns with findings from other studies on risk-reducing mastectomy, with notable variations between prosthetic and autologous reconstructions. This study highlights the high complication rates associated with risk-reducing mastectomies, especially in patients undergoing free-flap reconstruction. Despite these challenges, the rates of reconstruction failure and severe complications remain relatively low. Understanding patient-specific risk factors and surgical modalities can help in counseling patients and managing their expectations about potential postoperative issues.
Gluteal fat grafting, or Brazilian butt lift, is a rapidly growing aesthetic procedure but remains associated with the highest mortality among cosmetic operations, primarily because of fatal pulmonary fat embolism after injury to the deep gluteal veins. Although safety discussions have focused mainly on injection plane, cannula diameter, tip design, rigidity and port configuration are modifiable technical factors that may influence vascular penetration and intravascular fat delivery. This narrative review synthesised English-language evidence from PubMed/MEDLINE, Embase and the Cochrane Library, supplemented by society advisories, cadaveric studies, biomechanical data, clinical series and forensic reports. Survey and autopsy data link fatal embolism to deep intramuscular injection, downward cannula angulation and cannulas smaller than 4 mm. Cadaveric studies show that subcutaneous vessels are approximately 1 mm in diameter, whereas the superior and inferior gluteal veins measure about 7.6 mm and 13.7 mm, respectively, supporting the rationale for large-bore blunt cannulas only when maintained in the subcutaneous plane. Dynamic studies demonstrate that subfascial or intramuscular fat can migrate into deep compartments and enter injured veins, whereas subcutaneous fat does not. Current consensus recommendations therefore support subcutaneous-only injection using a large-bore (≥4 mm), blunt, rigid cannula with continuous motion, low-pressure delivery and real-time ultrasound confirmation. However, evidence remains indirect, with no controlled studies isolating cannula geometry as an independent determinant of mortality. Standardised reporting and prospective registries are needed.
Background Extensive scalp avulsions in pediatric patients are rare and represent a significant reconstructive challenge, particularly when compounded by contamination, periosteal damage, and bone exposure—factors that limit conventional surgical options. Management focuses on achieving optimal functional and aesthetic outcomes. Case Presentation We report the case of a 6-year-old girl who sustained an extensive scalp avulsion following a severe attack by three Rottweiler dogs. A staged reconstructive approach using the TEMPO-Mi protocol was implemented, enabling progressive granulation tissue formation and subsequent definitive coverage with successful graft integration within a relatively short timeframe. Conclusion The TEMPO-Mi protocol represents an alternative reconstructive strategy for the management of complex wounds with exposed bone and extensive soft-tissue avulsion. Its primary objective is to promote the early development of a well-vascularized recipient bed, enabling definitive functional reconstruction within a shorter timeframe than that typically required with conventional reconstructive strategies.
Background The most common form of breast reconstruction is implant-based breast reconstruction (IBBR), accounting for approximately 81% of all such procedures. However, like all surgical procedures, IBBR has potential complications. The most notable of these complications is infection, which can occur in up to 35% of such cases. In an effort to reduce the frequency of infections in these cases, plastic surgeons are constantly evolving their techniques, including the use of various irrigation solutions to decontaminate the breast pocket at the time of surgery. One of the more novel irrigation solutions being utilized is hypochlorous acid (HOCl), a naturally occurring chemical produced by white blood cells. While there have been studies examining the antimicrobial effect of HOCl, few studies to date have addressed if the addition of HOCl irrigation with IBBR can reduce surgical infections. Methods We undertook an IRB-approved, retrospective cohort study of adult female patients, aged 18 years and older, who underwent IBBR from 09/01/2021 – 06/30/2024 at our single institution. Descriptive statistics and Fisher’s exact test were conducted on the dataset to derive sample characteristics and compare outcomes. Results The study included 193 breast procedures in total. The group that did not undergo HOCl irrigation during IBBR included 38 breast with a 13% rate of infection. The group that underwent HOCl irrigation during IBBR included 155 breasts with a 3% rate of infection. The rate of infection was significantly decreased in the patients who received HOCl irrigation intra-operatively, p-value 0.026. There was no significant difference in characteristics between the 2 groups. Conclusion Our study supports the addition of HOCl irrigation to decontaminate the breast pocket during IBBR. The rate of post-operative infection rates significantly decreased after hypochlorous acid irrigation was instituted during IBBR.
Introduction Oncoplastic breast reconstruction using implants or autologous tissue is increasingly popular for its aesthetic and psychological benefits without compromising oncologic safety. This study introduces a novel pre-pectoral implant technique combining a lower dermal sling with fascial flaps to enhance coverage and reduce complications. Materials and Methods This retrospective study included 82 patients (January 2020–January 2024). Inclusion required tumors >1 cm from the pectoralis muscle and patient preference. Exclusion criteria included inflammatory cancer, unstable medical conditions, and prior chest irradiation. Results Of 82 patients (6 prophylactic, 76 therapeutic), 63 underwent nipple-sparing mastectomy. Pain scores were low (mean 2.1 ± 1.5). Severe rippling occurred in two cases; no implant loss or severe capsular contracture was observed at 1-year follow-up. BREAST-Q scores showed significant improvement in satisfaction and quality of life domains. Conclusion The combined dermal sling and fascial flap technique offers safe, cost-effective, and reliable autologous coverage for pre-pectoral implants with favorable outcomes and minimal complications.
Background Amniotic band syndrome (ABS) is a rare sporadic disorder in which fibrous bands of amniotic origin encircle and progressively constrict developing fetal structures. Humeral involvement is exceptionally rare and threatens the brachial neurovascular bundle. Case Presentation A male infant born at 28 weeks and 4 days of gestation was referred at 6 months of chronological age with a single circumferential constriction band of the proximal third of the left humerus (Patterson type 2). Active motion was globally restricted at the shoulder, elbow and wrist, with moderate distal lymphoedema, active finger flexion reduced but present, preserved finger extension and no wrist drop. Perfusion and withdrawal to tactile stimulation were preserved in all digits; the thenar eminence was hypotrophic and the affected hand was smaller than the contralateral hand. Preoperative radiographs confirmed maintained osseous alignment. Surgery was undertaken at 9 months of chronological age, approximately 6.5 months corrected. The band was excised in its entirety using multiple interdigitating Z-plasties; the brachial artery and the radial, median and ulnar nerves were individually identified and decompressed, were normal in calibre, and neurolysis was not required. At 16 months the wounds were healed, all flaps viable, the distal lymphoedema resolved and the groove fully effaced. Electrodiagnostic studies were not performed preoperatively; nerve conduction studies have since been requested. Conclusions Single-stage circumferential Z-plasty release with decompression of the brachial neurovascular bundle can be performed safely at the humeral level in an extremely preterm infant. We make no claim regarding neurological recovery, since electrodiagnostic studies were not obtained; the coexisting thenar hypotrophy and reduced hand size raise the possibility of a distal developmental component that decompression would not address, underlining the value of an objective neurological baseline at first presentation.
Background High-frequency ultrasound (HFUS) is a versatile but underutilised imaging modality in breast surgery. Its high resolution offers a unique imaging perspective when compared to other modalities such as magnetic resonance imaging (MRI) and conventional, lower frequency ultrasound (<10MHz). This narrative review synthesises current literature on the applications of HFUS in breast surgery including future directions. Methods A comprehensive search of PubMed, Embase, Web of Science, CiNAHL, Cochrane CENTRAL and Scopus was conducted for studies published between January 2020 and September 2025. Eligible articles included clinical studies, reviews, and technical evaluations using probes >10MHz in breast surgery applications. Results HFUS demonstrates strong clinical utility in implant monitoring, lymphatic supermicrosurgery and breast reconstruction. Compared to MRI, emerging evidence indicates that HFUS can produce concordant results in 87–100% of cases, whilst displaying additional advantages such as greater accessibility and real-time imaging. The high definition offered by HFUS facilitates flap reconstruction planning, and its ability to visualise lymphatic channels and dermal thickness is also a useful tool for the planning of lymphaticovenous anastomoses for lymphoedema. Conclusion HFUS imaging appears to show great promise for breast surgery, although future research on comparative studies to develop imaging protocols is needed. More widespread adoption will also require integration into surgical training curricula.
Background The optimal cranioplasty material remains controversial in the context of defect size and patient risk. We analyzed multi-institutional data over 13 years to evaluate the interaction between material type and defect size. Methods We performed a retrospective cohort analysis of adult cranioplasty patients in the ACS-NSQIP (2011–2023), stratifying by material type (autograft vs. alloplastic) and defect size (≤5 cm vs. >5 cm). The primary outcome was any 30-day complication. Multivariable logistic regression adjusting for 21 covariates, interaction analyses, and machine learning models were applied. Results Among 3,894 patients, 88% underwent autograft and 12% alloplastic cranioplasty. The 30-day complication rate was 22%, with no significant difference between material types (p=0.72). On multivariable analysis, material type was not independently associated with complications (p=0.715); defect size >5 cm was an independent predictor (aOR 1.24, p=0.032). For large defects, alloplastic reconstruction reduced operative time by 90 minutes (189 vs. 279 min; p<0.001). Nine independent predictors were identified; ventilator dependence (aOR 8.44) and preoperative transfusion (aOR 4.35) were strongest. Alloplastic use increased five-fold while adjusted complication risk decreased by 4.5% annually. Logistic regression achieved the highest predictive performance (AUC 0.737). Conclusion Material type is not an independent predictor of short-term complications following cranioplasty, regardless of defect size or patient risk profile. Larger defects are associated with increased morbidity, but alloplastic materials offer significant operative efficiency without compromising short-term perioperative safety. Prospective studies with extended follow-up stratified by alloplastic subtype are needed.
Background Plexiform neurofibromas (PNFs) are benign tumours associated with neurofibromatosis type 1 (NF1) that may cause significant functional and cosmetic impairment. Surgical management is challenging because of diffuse infiltration and marked vascularity, increasing the risk of severe intraoperative bleeding. Case Report A 70-year-old woman with NF1 presented with a progressively enlarging mass of the left flank causing contour deformity with functional impairment. Previous resection 20 years earlier had been complicated by major haemorrhage requiring transfusion of red blood cells. MRI demonstrated a 40 × 25 cm subcutaneous infiltrative PNF without neither muscular nor neurological involvement. Following multidisciplinary discussion, partial surgical debulking was performed using a hemicircular dermolipectomy approach. Intraoperative haemostasis was complicated because of diffuse vascular abnormalities and extensive infiltrative growing pattern of the tumour. Visible bleeding was mainly controlled using vascular clips. Postoperatively, tranexamic acid and incisional negative pressure wound therapy were used. Symptomatic postoperative anaemia required transfusion of red blood cells. Recovery was otherwise uneventful, and histopathology confirmed benign neurofibroma without atypia. At 9 months, functional and cosmetic outcomes were satisfactory without recurrence. Conclusion PNFs in NF1 patients remain surgically challenging because of their infiltrative growth and abnormal vascularity. Careful perioperative planning and meticulous haemostatic strategies are essential to reduce bleeding-related morbidity and optimize outcomes.
Introduction Tracheostomy is common in head and neck reconstructive surgeries and is associated with bacterial tracheitis. However, the influence of additional risk factors on the development of this complication remains unclear. This study aimed to estimate the incidence of bacterial tracheitis and describe associated factors in patients treated at a high-complexity center in Bogotá, Colombia. Methods A retrospective observational cohort study was conducted at a fourth-level hospital in Bogotá between March 2023 and July 2024. Adult patients with head and neck cancer who underwent resection, flap reconstruction, and open or percutaneous tracheostomy with at least one month follow-up were included. Data were obtained from medical records, analyzed using SPSS v.31, and reported with an exploratory analysis.The study was approved by the institutional ethics committee. Results Among 24 patients undergoing head and neck oncologic reconstruction, bacterial tracheitis occurred in 45.8% of cases. The condition was more frequent after open tracheostomy and among patients with delayed cannula replacement, although these differences were not statistically significant. Klebsiella pneumoniae was the predominant isolated microorganism. Patients with tracheitis had longer ICU and hospital stays, and sepsis was significantly associated with its occurrence (p=0.031). In contrast, more frequent stoma care was associated with a lower incidence of tracheitis (p=0.033). Conclusion Bacterial tracheitis was a frequent complication in patients undergoing head and neck free flap reconstruction with tracheostomy. More frequent stoma care may play a protective role, although larger prospective studies are needed to better identify associated risk factors and preventive strategies.
Purpose To evaluate patient experience after a revised pathway combining same-day shared medical appointments with in-office wide-awake local anesthesia with no tourniquet (WALANT) carpal tunnel release, and to assess efficiency, waste generation, and costs. Methods This prospective observational pilot study included patients undergoing carpal tunnel release using a revised pathway at a Swedish hand surgery department. Approximately six patients per half-day session attended a structured preoperative shared group information session before surgery, with an opportunity for individual questions before local anesthesia. Procedures were performed in two consultation rooms using WALANT, field sterility, limited draping, absorbable sutures, and simplified follow-up. No anesthesiologist or anesthesia personnel were involved. Patient experience was assessed with the Picker Patient Experience-15 (PPE-15) questionnaire and postoperative questions. Waste was weighed and a cost-reduction analysis was performed. Results Sixty patients (mean age 55 years, 70% women) underwent 62 carpal tunnel releases. The mean PPE-15 score was 97.8, and 57 of 60 respondents reported no pain. Of the 17 patients with previous contralateral standard carpal tunnel release, 16 rated the revised pathway as better and one as equal. Five patients met the criteria for physician wound assessment; none had infection. Waste was reduced from 2.20 kg to 0.55 kg per procedure. The estimated saving was 225 Euro per procedure at the clinic level and 289 Euro at the regional level when reduced follow-up was included. Conclusion Same-day shared medical appointments combined with in-office WALANT carpal tunnel release were associated with high patient satisfaction, low reported pain, reduced waste, improved efficiency, and lower estimated costs. Larger comparative studies are needed to confirm the safety and evaluate the independent effect of group information.
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
Implant-associated lymphomas of the breast are rare. Among breast-implant-associated lymphomas, anaplastic large cell lymphoma (BIA-ALCL) has gained significant attention in recent years and is recognized as a distinct entity. While ALCL is a well-known T-cell lymphoma, there are only a few reports concerning breast-implant-associated B-cell lymphomas. In our report, the lymphoma showed large blasts which were positive for CD20, highly proliferative and associated with Epstein-Barr-Virus. There was no tumor mass present, the cells were seroma associated. BIA-DLCBL has only been known for a few years. They are limited to lymphoma by definition and, unlike DLCBL, BIA-DLCBL is always EBV-positive. A comprehensive evaluation of immunohistochemical markers is crucial for establishing a differential diagnosis between BIA-ALCL and BIA-DLBCL, as overlapping features, particularly CD30 positivity, may lead to misdiagnosis. Other than ALCL, DLCBL typically do not show ALK, CD2, CD3, and other B-cell markers but are positive to CD20, CD5, BCL-2, CD21, CD23, IgD and IgM. This underscores the importance of referring patients to specialized centers to ensure accurate diagnosis and appropriate treatment. The subsequent therapy of BIA-DLCBL should include an en-bloc-resection of the capsule-implant-unit. There is currently no consensus on the optimal therapy for these cases, highlighting the need for further research and expert collaborationWe report on a case of breast-implant-associated diffuse large cell B-cell lymphoma, a review of the literature and a diagnostic algorithm based on the available data in the literature.
Background Prepectoral prosthetic breast reconstruction following mastectomy is an increasingly adopted alternative to the subpectoral. Despite its growing use, contemporary UK data specifically examining pre-pectoral practice among plastic surgeons remains limited. Variation also exists in surgical technique, acellular dermal matrix (ADM) use and clinical decision-making. Methods A national cross-sectional online survey was distributed to UK consultant plastic surgeons performing breast reconstruction within the NHS. The survey captured geographical distribution, annual reconstruction volumes, frequency of prepectoral implant use, ADM preferences, implant coverage technique and factors influencing clinical decision-making. Descriptive statistics, Friedman’s test and pairwise Wilcoxon signed-rank tests with Bonferroni adjustment were employed for statistical analysis. Results Twenty UK plastic surgeons responded. Of these, 80% (n=16) reported performing pre-pectoral reconstruction. Among all respondents, 75% (n=15) reported using the pre-pectoral plane in at least 50.0% of their implant-based reconstructions. Soft tissue coverage was rated the most important factor influencing plane selection, and was ranked significantly higher than smoking status (p=0.01). Porcine ADM was used by 14 of 16 respondents (87.5%), and ADM availability was the only factor reaching significance on pairwise testing for product selection (p=0.022). Complete anterior-posterior implant coverage was used by 10 of 16 surgeons (62.5%). Free-text responses suggested a perceived reduction in implant-based reconstruction within plastic surgery practice, with increasing involvement of breast and oncoplastic surgeons. Conclusion This survey identified variation in pre-pectoral implant-based breast reconstruction practice among responding UK consultant plastic surgeons, particularly in relation to ADM selection and implant coverage technique. Porcine ADM predominated, and local availability appeared to influence product selection. Free-text responses raised relevant questions regarding changing patterns of service delivery, trainee exposure and outcome monitoring in implant-based breast reconstruction.
Purpose Cannabis use disorder (CUD) is increasingly prevalent among surgical patients, yet its association with postoperative complications following breast surgery remains poorly characterized. This study compared rates of surgical site complications and emergency department (ED) utilization after mastopexy and reduction mammaplasty between patients with and without documented CUD. Methods A retrospective, propensity-matched cohort study was performed using the TriNetX federated research network. Patients undergoing mastopexy or reduction mammaplasty with documented CUD within 3 years before surgery (cannabis cohort) were matched 1:1 to patients without CUD (control cohort) on age, sex, race, ethnicity, comorbidities, and procedure type. Patients with cocaine or methamphetamine use were excluded from both cohorts. Primary outcomes included 90-day rates of surgical site infection (SSI), wound dehiscence, and seroma or hematoma, as well as 30-day ED visits. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Among 2,444 matched patients (1,222 per group), CUD was associated with higher rates of surgical site infection (3.8% vs 2.0%; RR, 1.84; P = 0.011), seroma or hematoma (3.6% vs 2.0%; RR, 1.83; P = 0.014), and 30-day ED visits (14.2% vs 9.6%; RR, 1.48; P < 0.001). Wound dehiscence rates did not differ significantly (5.6% vs 4.2%; RR, 1.35; P = 0.092). Causal attribution of outcomes to the index procedure could not be established. Conclusions CUD was associated with modestly increased rates of wound complications and ED utilization following mastopexy and reduction mammaplasty. While absolute risk differences were small, these findings may inform preoperative counseling and postoperative monitoring in this population.
Background:Pediatric rhinoplasty and septoplasty are performed for both functional and reconstructive indications, including airway obstruction, trauma, and orofacial cleft (OFC)-associated nasal deformities. Despite increasing national case volume, limited data exist on utilization patterns, procedural trends, and healthcare costs in this population. Methods:Using the Pediatric Health Information System (PHIS) database, we conducted a retrospective cohort study of patients 3-17 years old who underwent septoplasty, rhinoplasty, or septorhinoplasty between 2015 and 2022. Patients were stratified by OFC diagnosis and age group (3-14 vs. 15-17 years). Sub-analyses were performed for septoplasty-only and rhinoplasty/septorhinoplasty cohorts. Results:A total of 10,762 cases were identified; 24% had OFC. Septoplasty was nearly exclusive to non-cleft patients (98%) and increased with age, reflecting deferral until skeletal maturity. Septorhinoplasty showed a sharp volume increase after age 14, with earlier use in cleft patients as part of staged reconstruction. Graft use was significantly higher in OFC cases (21% vs. 5.5%, p < 0.0001), especially for auricular and dermal/fascial grafts. Turbinate reduction was more common in non-cleft patients. Complication and readmission rates were low across all groups (<2%). Total costs were higher in the OFC cohort but were comparable between cleft and non-cleft patients undergoing rhinoplasty/septorhinoplasty, suggesting procedure type was the primary cost driver. Conclusion:Pediatric septoplasty and rhinoplasty are safe, low-complication procedures across cleft and non-cleft populations. Trends reflect ongoing caution around timing of intervention, greater surgical complexity in cleft patients, and the need for standardized care pathways that balance functional, aesthetic, and developmental goals.
Background Knowledge of potentially modifiable variables influencing the recovery and the trajectory of recovery after lower limb salvage with free flap reconstruction might aid in improving outcomes and support targeted rehabilitation strategies. Therefore, we asked: (1) what variables are independently associated with capability, quality of life, and discomfort, and their trajectory? (2) Is there a difference in recovery trajectories between specific capability tasks? Methods Patients who were enrolled in the “Dangle study” and underwent lower extremity free flap reconstruction at four Dutch academic medical centers were invited to complete patient-reported outcome measures. Capability was assessed using PROMIS Physical Function – Mobility, quality of life using the EQ-5D-5L, and discomfort using a numerical visual analogue scale (VAS). Questionnaires were completed at various times after surgery. Linear mixed-effects models were used to account for the repeated measures design. Results Fifty-one participants completed 113 questionnaires. Male sex and the absence of diabetes were independently associated with greater capability, but not with recovery trajectories. Only time since reconstruction was independently associated with greater quality of life. Reconstructions of the foot were associated with increased levels of discomfort compared to lower leg reconstructions, but not with the trajectory of discomfort. Individual capability subscales demonstrated largely stable recovery trajectories without clinically meaningful differences between tasks. Conclusion Although the variables identified are mostly non-modifiable, they can inform appropriate expectations before and after deciding on limb salvage. In addition, they can help identify people at greater risk for reduced recovery, who might benefit from targeted interventions such as the integrated involvement of rehabilitation, mental health, and pain management services.
Objective Diabetic foot ulcers (DFU) are a serious complication of type 2 diabetes. For Wagner grade 2–4 ulcers, whichinvolve deep infection and microcirculatory impairment, conventional negative pressure wound therapy often produces suboptimal results. This study aimed to evaluate the clinical efficacy of the polymethylmethacrylate (PMMA) bone cement–induced membrane technique combined with deep fascial release in treating refractory DFU. Methods In this propensity score–matched cohort analysis, 138 patients with Wagner grade 2–4 DFU were enrolled, divided into a PMMA group (n = 69) and a control group (n = 69). The PMMA group underwent deep fascial release followed by subcutaneous tunnel implantation of PMMA bone cement in the distal medial intermuscular space of the tibia, with removal at 8 weeks. The control group received conventional debridement and vacuum sealing drainage (VSD). Primary outcome measures included wound healing rate, healing time, dorsal foot skin temperature, Visual Analog Scale (VAS) score, ulcer recurrence rate, and frequency of debridement procedures. Results The PMMA group achieved a 100% wound healing rate, significantly exceeding the control group (P < 0.001). The mean healing time was notably shorter in the PMMA group (34.81±3.56 days). Postoperative dorsal foot skin temperature was higher in the PMMA group (36.06 ± 0.24 °C vs. 35.36 ± 0.41 °C, P < 0.001), and VAS scores were significantly lower (1.41 ± 1.07 vs. 4.60 ± 0.74, P < 0.001). Additionally, the PMMA group showed better outcomes in secondary indicators, including ulcer recurrence rate (8.70%vs. 39.13%, P < 0.001) and number of debridement procedures (1.29 ± 0.67 vs. 2.64 ± 0.61, P < 0.001). Conclusion The combination of PMMA bone cement and deep fascial release significantly accelerates DFU healing, reduces pain, and lowers recurrence risk through mechanisms of microcirculation reconstruction and nerve decompression. This integrated strategy offers an effective adjunctive treatment for refractory DFU, although its long–term efficacy requires further validation in prospective studies.
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.
The presence of gynaecomastia can result in significant psychological distress. Surgical intervention should aim to remove glandular tissue whilst ensuring an aesthetically pleasing result. We present a case of excisional gynaecomastia correction with simultaneous enhancement of the pectoral contour with a modified dermal flap. This method utilises otherwise redundant autologous tissue without an additional donor site. We report an aesthetically pleasing result and discuss other modalities of pectoral enhancement currently described in the literature.
