Peripheral nerve injuries often result in incomplete functional recovery, despite technically successful microsurgical repair. Traditional strategies focus on structural continuity but neglect the immunobiological environment critical for regeneration. CCL2 (monocyte chemoattractant protein-1, MCP-1), a chemokine that coordinates macrophage recruitment and polarization, has emerged as a key regulator of neuroimmune responses involved in nerve healing. This narrative review evaluates the scientific rationale, preclinical evidence, and translational strategies for using CCL2 as a bioactive adjunct in peripheral nerve microsurgery. We synthesize findings from preclinical studies involving CCL2 in nerve injury models, including knockout and overexpression systems, graft integration, stem cell-based therapies, and pain modulation, with emphasis on delivery mechanisms applicable to intraoperative settings such as hydrogels, microsutures, and cellular approaches. Across multiple preclinical injury models, CCL2 has been shown to enhance macrophage-driven repair, promote angiogenesis, facilitate Schwann cell activity, and accelerate axonal regrowth. Loss of CCL2 signaling impairs functional recovery, whereas targeted delivery during the early regenerative window improves outcomes without evidence of prolonged inflammation. These studies further support hydrogels, microsutures, and mesenchymal stromal cell-based therapies as feasible platforms for CCL2 delivery. Together, these data support intraoperative CCL2 modulation as a novel, mechanistically grounded strategy to integrate immune biology with microsurgical technique. This bioactive approach has the potential to improve regeneration and graft integration while minimizing the risk of neuropathic pain through precise temporal and anatomic control of CCL2 delivery.
Peripheral nerve injuries often result in incomplete functional recovery, despite technically successful microsurgical repair. Traditional strategies focus on structural continuity but neglect the immunobiological environment critical for regeneration. CCL2 (monocyte chemoattractant protein-1, MCP-1), a chemokine that coordinates macrophage recruitment and polarization, has emerged as a key regulator of neuroimmune responses involved in nerve healing. This narrative review evaluates the scientific rationale, preclinical evidence, and translational strategies for using CCL2 as a bioactive adjunct in peripheral nerve microsurgery. We synthesize findings from preclinical studies involving CCL2 in nerve injury models, including knockout and overexpression systems, graft integration, stem cell-based therapies, and pain modulation, with emphasis on delivery mechanisms applicable to intraoperative settings such as hydrogels, microsutures, and cellular approaches. Across multiple preclinical injury models, CCL2 has been shown to enhance macrophage-driven repair, promote angiogenesis, facilitate Schwann cell activity, and accelerate axonal regrowth. Loss of CCL2 signaling impairs functional recovery, whereas targeted delivery during the early regenerative window improves outcomes without evidence of prolonged inflammation. These studies further support hydrogels, microsutures, and mesenchymal stromal cell-based therapies as feasible platforms for CCL2 delivery. Together, these data support intraoperative CCL2 modulation as a novel, mechanistically grounded strategy to integrate immune biology with microsurgical technique. This bioactive approach has the potential to improve regeneration and graft integration while minimizing the risk of neuropathic pain through precise temporal and anatomic control of CCL2 delivery.
BACKGROUND:Postoperative bleeding and prolonged drainage remain relevant complications in soft tissue surgery and may result in revision surgery, extended hospital stay, and increased morbidity. Topical tranexamic acid (TXA), a synthetic lysine analog with antifibrinolytic effects, has gained increasing attention as a means of reducing these complications while minimizing systemic exposure. However, standardized application protocols and robust outcome data remain limited. METHODS:This single-center retrospective cohort study included 241 consecutive patients undergoing gender-affirming mastectomy, breast reduction, or abdominoplasty between May 2020 and April 2024. In May 2022, a standardized topical TXA protocol (500 mg per surgical site) was implemented. Primary outcomes were cumulative drain output at 72 hours and postoperative hematoma requiring surgical revision. Secondary outcomes included seroma formation and postoperative complications. RESULTS:Topical TXA was administered in 93 patients (38.6%). Cumulative 72-hour drain output was lower in TXA-treated patients in every procedure, with the greatest relative reduction in abdominoplasty (-62%, P<0.001), followed by gender-affirming mastectomy (-51%, P=0.001) and reduction mammoplasty (-47%, P=0.005). Across all procedures, hematoma requiring surgical revision occurred in 6.5% (6/93) of TXA-treated patients compared with 15.5% (23/148) of controls, showing a relative risk reduction of 58% (P=0.042). No thromboembolic events, seizures, or wound-healing complications were observed. CONCLUSION:Topical TXA significantly reduces postoperative drainage and hematoma rates in soft tissue surgery without an observed increase in complications. Given its low cost and ease of application, topical TXA represents a valuable adjunct to standardized surgical protocols.
Free tissue transfer is the standard reconstructive approach for complex head and neck defects; however, major recipient-site complications remain clinically significant. Reported risk factors for these complications have been inconsistent, partly because of heterogeneity in defect characteristics, reconstructive techniques, and perioperative management across institutions. This study aimed to identify independent predictors of major recipient-site complications and total flap or jejunal necrosis in patients with continuous intraoral-cervical composite defects managed in a standardized single-center setting. We retrospectively analyzed 183 consecutive patients who had undergone free tissue transfer within a standardized reconstructive program. The same 2 senior plastic surgeons primarily planned the reconstructions and performed the key steps, including flap design, vascular anastomosis, and flap inset. Techniques were standardized within each reconstructive category, with 3-dimensional planning when indicated and protocolized postoperative flap monitoring. Recipient-site complications were graded using the Clavien-Dindo (C-D) classification, and cumulative smoking exposure was quantified using the Brinkman index (BI; cigarettes/day×years). Severe (C-D ≥III) complications occurred in 20.8% of patients, and total necrosis occurred in 3.3%. Seventeen patients (9.3%) had grade IIIb complications, 13 of whom underwent reoperation requiring wound closure, revision reconstruction, or thoracic duct ligation. BI and bilateral neck dissection were independent predictors of severe complications, whereas BI was the only factor significantly associated with total necrosis. Each 100-unit increase in BI increased the odds of severe complications and necrosis, and receiver operating characteristic analysis yielded an area under the curve of 0.858 (95% CI: 0.735-0.981) for total necrosis. The length of hospital stay was significantly prolonged in patients with C-D ≥III complications and in those with total necrosis. In all necrosis cases, circulatory compromise was recognized after postoperative day 3 despite protocolized monitoring. Even under standardized reconstructive and monitoring conditions, clinically significant complications remained relatively common, suggesting that cumulative smoking exposure may reflect patient-related vascular vulnerability in a setting designed to minimize technical variation.
BACKGROUND:Total pelvic exenteration (TPE) creates a massive pelvic dead space associated with a high risk of severe postoperative complications. We evaluated the clinical outcomes of pelvic floor and perineal reconstruction using a modified posterior thigh flap including the gluteus maximus muscle in patients undergoing TPE for anal canal cancer. PATIENTS AND METHODS:We retrospectively reviewed 4 male patients who underwent this reconstruction at our institution between April 2020 and March 2025. Clinical outcomes, including operative details, postoperative complications, and ambulatory function (assessed through manual muscle testing), were analyzed. RESULTS:All flaps survived completely, effectively obliterating the pelvic dead space. No major complications, such as pelvic sepsis, fistula formation, or ambulatory dysfunction, were observed at 6 months postoperatively. Hip extension strength on the reconstructed side was preserved at manual muscle testing grade 5 in all patients. Minor donor-site complications consisted of one hematoma requiring surgical hemostasis and 2 minor wound dehiscences that healed with conservative management. CONCLUSIONS:The posterior thigh flap, including the gluteus maximus, provides ample vascularized tissue to fill the pelvic cavity, spares the abdominal wall, and allows for early mobilization. In addition, releasing the muscle insertion provides greater flap mobility. This technique is a reliable reconstructive option that may minimize postoperative morbidity following TPE.
Female genital mutilation/cutting (FGM/C) remains prevalent worldwide and has lasting physical and psychological consequences. In the United States, an estimated 513,000 women and girls have undergone or are at risk of FGM/C, yet clitorolabial reconstruction is rarely offered and performed by few specialists. This study aimed to identify barriers to accessing reconstructive surgery. Patients who underwent FGM/C reconstruction by a single plastic surgeon at a quaternary academic center between 2017 and 2024 were surveyed. The survey assessed access to care, perceived barriers, social support, and satisfaction with surgical outcomes. Of 38 eligible patients, 21 completed the survey (55.3% response rate). Median age was 37 years (IQR: 32.1-46.5). The majority identified as Black/African American (81.0%) or Middle Eastern/North African (14.3%) and as cisgender female (85.7%). Type 2 FGM/C was most common (85.7%). Over half (57.1%) had considered reconstruction for more than 3 years before pursuing care. Most (81.0%) independently located their surgeon online, and 85.7% had never consulted another provider regarding FGM/C. Patients in this cohort frequently considered reconstruction for several years before accessing surgical care. Although 92.5% had insurance, 57.1% reported financial hardship. Additional barriers included travel burden and limited emotional support. Despite these challenges, most respondents reported satisfaction with their surgical outcomes. Persistent financial, geographic, and social barriers highlight the need for increased provider awareness, improved referral pathways, and expanded reconstructive services to ensure timely and comprehensive care for individuals affected by FGM/C.
Beckwith-Wiedemann syndrome (BWS) is a rare congenital disorder whose main clinical feature is macroglossia. This frequent manifestation may impair respiratory, feeding, speech, and orofacial developmental functions. When significant functional and/or aesthetic repercussions are evident, surgical excision is the primary management approach, with several techniques described. In this study, we analyzed medical records from 29 patients diagnosed with BWS and macroglossia, and evaluated 26 cases of partial glossectomy performed between 2015 and 2025. Indications, surgical technique, postoperative course, and short-term and medium-term outcomes are discussed, emphasizing the importance of early and standardized intervention. A new clinical grading for macroglossia was developed in BWS. All procedures were performed by a single surgeon in a craniofacial surgery reference center in Southern Brazil, with patients aged between 5 months and 8.9 years. Epidemiologically, 65.4% of the patients were female and the average age of surgery was 18.5 months, the median was 10 months. Macroglossia was classified as mild in 11.5%, moderate in 46.2% and severe in 42.3% of cases. The average tongue reduction was 31.6% in length and 21% in width. Retrospective analysis of medical records demonstrated appropriate functional improvement, a low complication rate, and satisfactory aesthetic and respiratory outcomes in most cases. The findings reinforce the safety and effectiveness of partial glossectomy in managing macroglossia associated with BWS.
Beckwith-Wiedemann syndrome (BWS) is a rare congenital disorder whose main clinical feature is macroglossia. This frequent manifestation may impair respiratory, feeding, speech, and orofacial developmental functions. When significant functional and/or aesthetic repercussions are evident, surgical excision is the primary management approach, with several techniques described. In this study, we analyzed medical records from 29 patients diagnosed with BWS and macroglossia, and evaluated 26 cases of partial glossectomy performed between 2015 and 2025. Indications, surgical technique, postoperative course, and short-term and medium-term outcomes are discussed, emphasizing the importance of early and standardized intervention. A new clinical grading for macroglossia was developed in BWS. All procedures were performed by a single surgeon in a craniofacial surgery reference center in Southern Brazil, with patients aged between 5 months and 8.9 years. Epidemiologically, 65.4% of the patients were female and the average age of surgery was 18.5 months, the median was 10 months. Macroglossia was classified as mild in 11.5%, moderate in 46.2% and severe in 42.3% of cases. The average tongue reduction was 31.6% in length and 21% in width. Retrospective analysis of medical records demonstrated appropriate functional improvement, a low complication rate, and satisfactory aesthetic and respiratory outcomes in most cases. The findings reinforce the safety and effectiveness of partial glossectomy in managing macroglossia associated with BWS.
Purpose: Provider scarcity is one of the principal barriers to gender-affirming care (GAC) in the United States, with poorly characterized geographic variation. State-level legislation governing access to gender-affirming surgery (GAS) provides a framework for examining how the regulatory environment correlates with surgeon availability. This study examined the geographic distribution of GAS surgeons across the United States and its association with state legislative classification. Methods: Six provider databases were queried to identify surgeons offering gender-affirming procedures and their practice locations. Isochrone application programming interface (API) software mapped all counties within a 2-hour drive of each surgeon. Surgeon-to-transgender population ratios were calculated. Results: Surgeons per 10,000 transgender individuals ranged from 0 to 26.4 (national average 8.2). Chest surgery had the broadest access, with 65.4% of counties (83.9% of the population) within a 2-hour drive of at least one surgeon. Access declined substantially for more specialized procedures: 30.9% of counties (65.1% of the population) for facial feminization; 16.1% of counties (50.0% of the population) for chondrolaryngoplasty; and 15.0% of counties for vaginoplasty. Restrictive states averaged 5.91 surgeons per 10,000 transgender individuals, compared with 9.80 in neutral states and 10.83 in protective states; shield states averaged 7.65. Conclusions: Access to GAS varies markedly by procedure type and state legislative category. Chest surgery has the widest geographic availability, while access to genital reconstruction and voice surgery remains critically limited. Surgeon density is significantly lower in restrictive states than in neutral or protective states, a pattern consistent across parametric and nonparametric analyses.
BACKGROUND:Reconstruction of posterior body defects often requires intraoperative repositioning, which increases operative time and disrupts surgical workflow. Although the latissimus dorsi (LD) flap is a reliable option for posterior reconstruction, prone-position LD harvest has been infrequently described outside of breast reconstruction. This study introduces a proximal-first pedicle approach for LD flap harvest in the prone position and evaluates its clinical applicability for posterior body reconstruction. PATIENTS AND METHODS:A retrospective review was conducted of 28 patients who underwent prone-position LD flap harvest between March 2012 and February 2025 for reconstruction of sacrococcygeal, ischial, gluteal, popliteal, or transtibial defects. The operative technique focused on early identification of the thoracodorsal pedicle through the teres major-latissimus dorsi intermuscular window, allowing pedicle-first dissection before flap design. Both musculocutaneous (mcLD) and muscle-sparing (msLD) variants were analyzed. Patient demographics, flap characteristics, operative time, complications, and clinical outcomes were evaluated. Donor-site upper-extremity function was assessed using the QuickDASH questionnaire. RESULTS:Twenty-eight patients (19 males and 9 females; mean age, 55.8 y) underwent prone LD flap reconstruction. Twenty-five flaps were harvested as mcLD flaps and 3 as msLD flaps. The mean flap size was 234.4 cm², and the mean total operative time was 168.2 minutes (range: 105 to 270 min). One case of partial flap necrosis occurred, while all other flaps survived without major complications. Primary donor site closure was achieved in 53.6% of cases. The mean follow-up duration was 48.5 months. The mean QuickDASH score was 2.32±0.78 (n=21). CONCLUSION:Although a prone LD flap harvest has been described previously, a standardized pedicle-first strategy has not been established. The proximal-first pedicle approach introduced in this study provides consistent early exposure of the thoracodorsal system and facilitates flap harvest without intraoperative repositioning.
BACKGROUND:Reconstruction of wound defects with associated dead space requires adequate obliteration using well-vascularized tissue to reduce fluid accumulation and support infection control. Conventional musculocutaneous flaps are commonly used for this purpose, but may have limited flexibility in positioning the muscle component. This study evaluated the clinical utility of a chimeric pattern anterolateral thigh (ALT) flap with independently mobile skin and muscle components. PATIENTS AND METHODS:Between May 2016 and January 2024, 49 patients underwent reconstruction of wound defects with dead space using free or pedicled ALT flaps. Of these, 26 cases were reconstructed with the conventional musculocutaneous flap, employing the classic en bloc technique. The remaining 23 cases utilized a chimeric pattern perforator flap, consisting of separate skin and muscle components. The skin flap served to resurface the skin defect, while the independently mobile muscle flap was tailored to fill the dead space. RESULTS:Postoperative infection occurred in 3 of 26 patients in the conventional flap group and in none of the chimeric flap group, although the difference was not statistically significant. Both techniques achieved stable wound coverage. The chimeric flap allowed independent positioning of the muscle component according to the location and configuration of the dead space. CONCLUSION:The chimeric pattern ALT flap offers greater technical flexibility by allowing independent positioning of the skin and muscle components. This technique may facilitate reconstruction of wound defects with eccentrically located or deep dead spaces. Despite the limitations of this study, these findings suggest a potential technical advantage rather than superiority over conventional musculocutaneous ALT flaps.
BACKGROUND:Aesthetic outcomes after nipple-sparing mastectomy (NSM) with implant-based reconstruction are influenced by varying clinical and technical factors. BCCT.core, a validated objective assessment, provides a reproducible evaluation of postoperative symmetry. This study examined predictors of aesthetic outcome after bilateral NSM using BCCT.core. METHODS:A retrospective review of 123 patients undergoing bilateral NSM with immediate implant-based reconstruction was performed. BCCT.core software assigned postoperative cosmetic classifications (classes 1 to 4). Patients were stratified by reconstructive method [direct-to-implant (DTI) vs. tissue expander (TE)], implant pocket, post-mastectomy radiation therapy (PMRT), mastectomy weight, and prior augmentation. Logistic regression identified independent predictors of poor aesthetic outcome (class 3/4). RESULTS:Overall, 24.4% of patients achieved class 1, 60.2% class 2, and 15.4% class 3/4 results, with a mean classification of 1.93±0.64. PMRT had the strongest adverse effect on aesthetic outcome, with irradiated patients demonstrating markedly higher rates of class 3/4 results and worse mean postoperative classification. TE reconstruction produced more favorable outcomes than DTI, especially among nonirradiated patients, and remained an independent predictor on multivariable analysis. Higher mastectomy weight correlated with worse postoperative classification. Prior augmentation increased preoperative asymmetry but did not compromise postoperative aesthetic quality when TE reconstruction was used. Major complications were associated with poorer classification. CONCLUSION:PMRT and reconstructive methods are the strongest determinants of postoperative symmetry after NSM with implant-based reconstruction. TE reconstruction is associated with more favorable aesthetic outcomes than DTI, particularly in nonirradiated patients, while PMRT remains the principal driver of asymmetry. These retrospective findings support more individualized reconstructive planning and highlight the value of objective BCCT.core analysis in aesthetic evaluation.
BACKGROUND:Critical-sized peripheral nerve defects remain a major reconstructive challenge. Although autografts are considered the gold standard, their use is limited by donor-site morbidity and graft availability. Acellular nerve allografts (ANAs) offer a promising alternative but are often hampered by inadequate revascularization and limited functional outcomes in large defects. This study investigates whether combining mesenchymal stem cell-derived secretome therapy with surgical angiogenesis can enhance the regenerative capacity of ANAs. METHODS:Forty male Wistar rats were randomly assigned to 5 groups (n=8): group 1 (reversed autograft), group 2 (ANA), group 3 (ANA+secretome), group 4 (ANA+surgical angiogenesis), and group 5 (ANA+secretome+surgical angiogenesis). A 10 mm sciatic nerve defect was created in all animals. Functional recovery was evaluated using the Sciatic Functional Index (SFI) at 6 and 9 weeks. Electrophysiological, histologic, immunohistochemical (CD34), and muscle weight/volume assessments were performed at 9 weeks. RESULTS:Group 5 demonstrated the highest functional recovery among ANA-based interventions, achieving outcomes comparable to autografts. Groups 4 and 5 showed significantly improved axonal regeneration compared with ANA alone. CD34 immunostaining revealed enhanced vascularization in groups 4 and 5, with levels similar to the autograft group. No significant differences were observed in electrophysiological or muscle mass parameters. CONCLUSIONS:The combination of secretome therapy and surgical angiogenesis synergistically enhances the regenerative performance of acellular nerve allografts. This strategy may provide a clinically translatable alternative to autografts, particularly in challenging repair scenarios involving avascular or scarred recipient beds.
BACKGROUND:Double eyelid blepharoplasty is commonly performed in China. Incisional depression is an established postoperative contour concern, although several contemporary techniques are available to reduce its occurrence. We retrospectively describe outcomes after a full-incision technique using an elevated cephalad orbital septum flap. METHODS:We retrospectively reviewed the records of 898 consecutive patients (821 female and 77 male; mean age: 39.3±12.7 y) who underwent primary double eyelid blepharoplasty by one surgeon at one institution between January 2006 and June 2016. The technique used an elevated cephalad orbital septum flap. Six-month outcomes were summarized descriptively using patient-reported measures, a 4-grade incisional-depression assessment scored from standardized, deidentified photographs, and recorded complications. RESULTS:At 6 months, 845 of 898 patients (94.1%) were very satisfied or satisfied with their appearance. The 4-grade incisional-depression assessment was excellent in 805 patients (89.6%), good in 75 (8.4%), fair in 15 (1.7%), and poor in 3 (0.3%); fair or poor grades occurred in 18 patients (2.0%). Thirty-seven patients (4.1%) had a recorded complication. The most frequent were asymmetry (12/898, 1.3%), partial or complete fold disappearance (10/898, 1.1%), and a wide or narrow fold (6/898, 0.7%). Upper-eyelid contour depression or hollowing (2/898, 0.2%) was recorded separately from incisional scar depression. CONCLUSIONS:In this retrospective, single-surgeon case series, the elevated cephalad orbital septum flap technique was associated with high patient-reported satisfaction and generally favorable 6-month scar assessments. Comparative studies with prospectively defined outcomes are needed to determine whether the technique reduces incisional depression relative to other approaches. LEVELS OF EVIDENCE:Level IV-therapeutic.
BACKGROUND:Vitamin D, a fat-soluble hormone, is increasingly recognized for its critical roles in immunomodulation, inflammation control, and tissue regeneration. Its deficiency is a global public health concern, affecting postoperative outcomes across various surgical fields, including plastic and reconstructive surgery. OBJECTIVE:To systematically review the existing literature on the impact of preoperative and perioperative vitamin D levels on surgical outcomes in plastic and reconstructive surgery, combining findings from both animal and human studies. METHODS:A detailed literature search was conducted in Embase, PubMed, Ovid Medline, PubMed Central, Scopus, and Cochrane Central databases. Inclusion criteria encompassed human and animal studies examining the role of vitamin D in wound healing, aesthetic procedures, reconstructive surgeries, nerve regeneration, and orthognathic interventions. Data extraction and quality assessment were performed using standardized tools. A structured sensitivity analysis by study design and quality was also performed. RESULTS:Fifteen studies met the inclusion criteria, including 11 human studies and 4 animal studies. Lower preoperative vitamin D levels were consistently associated with poorer wound healing outcomes, such as hypertrophic scarring, keloid formation, and complication rates in aesthetic and reconstructive surgeries. Animal studies demonstrated that vitamin D supplementation improved flap survival by enhancing angiogenesis and reducing inflammation. Preclinical studies and case reports highlighted vitamin D's neuroregenerative benefits and its role in maintaining bone integrity in orthognathic surgeries. Conclusions regarding wound healing, scarring, and bone healing remained robust across exclusion scenarios. Findings related to nerve regeneration depended predominantly on preclinical evidence. CONCLUSION:Vitamin D emerges as a potential biomarker and therapeutic agent that could improve surgical outcomes in plastic and reconstructive surgery. Despite promising findings, current evidence faces limitations, including small sample sizes, heterogeneous populations, and inconsistent vitamin D measurement methods. Future large-scale, high-quality studies are necessary to establish definitive guidelines for vitamin D assessment and supplementation in surgical care.
INTRODUCTION:Occipital encephaloceles are rare neural tube defects characterized by herniation of intracranial contents through a posterior calvarial defect and are frequently associated with complex neurological and structural anomalies. While early surgical repair is essential, children with large occipital encephaloceles remain at risk for delayed sequelae, often necessitating staged craniofacial reconstruction. Among available reconstructive strategies, the Melbourne technique and its modified variants are established methods for posterior vault expansion in severe or late-presenting sagittal synostosis. However, to our knowledge, this technique has not previously been applied in the setting of a large posterior calvarial defect associated with an occipital encephalocele. CASE PRESENTATION:We report the case of a female infant with a prenatally diagnosed large occipital encephalocele measuring 10×12 cm, associated with Chiari III malformation, posterior fossa hypoplasia, and mild ventriculomegaly. She underwent neonatal encephalocele resection and dural repair, followed by ventriculoperitoneal shunt placement. Over time, she developed secondary sagittal craniosynostosis and a persistent large posterior calvarial defect. At 28 months of age, she underwent posterior cranial vault remodeling using a modified Melbourne technique combined with split-thickness calvarial grafting to reconstruct an 9×8 cm occipital defect. The procedure achieved posterior vault expansion, restoration of cranial integrity, and correction of her scaphocephaly deformity. CONCLUSION:This case highlights the evolving and multifactorial challenges associated with large occipital encephaloceles, and demonstrates a novel application of the modified Melbourne technique in the setting of secondary sagittal craniosynostosis, a large posterior vault defect, and Chiari III malformation.
Background: Vitamin D, a fat-soluble hormone, is increasingly recognized for its critical roles in immunomodulation, inflammation control, and tissue regeneration. Its deficiency is a global public health concern, affecting postoperative outcomes across various surgical fields, including plastic and reconstructive surgery. Objective: To systematically review the existing literature on the impact of preoperative and perioperative vitamin D levels on surgical outcomes in plastic and reconstructive surgery, combining findings from both animal and human studies. Methods: A detailed literature search was conducted in Embase, PubMed, Ovid Medline, PubMed Central, Scopus, and Cochrane Central databases. Inclusion criteria encompassed human and animal studies examining the role of vitamin D in wound healing, aesthetic procedures, reconstructive surgeries, nerve regeneration, and orthognathic interventions. Data extraction and quality assessment were performed using standardized tools. A structured sensitivity analysis by study design and quality was also performed. Results: Fifteen studies met the inclusion criteria, including 11 human studies and 4 animal studies. Lower preoperative vitamin D levels were consistently associated with poorer wound healing outcomes, such as hypertrophic scarring, keloid formation, and complication rates in aesthetic and reconstructive surgeries. Animal studies demonstrated that vitamin D supplementation improved flap survival by enhancing angiogenesis and reducing inflammation. Preclinical studies and case reports highlighted vitamin D’s neuroregenerative benefits and its role in maintaining bone integrity in orthognathic surgeries. Conclusions regarding wound healing, scarring, and bone healing remained robust across exclusion scenarios. Findings related to nerve regeneration depended predominantly on preclinical evidence. Conclusion: Vitamin D emerges as a potential biomarker and therapeutic agent that could improve surgical outcomes in plastic and reconstructive surgery. Despite promising findings, current evidence faces limitations, including small sample sizes, heterogeneous populations, and inconsistent vitamin D measurement methods. Future large-scale, high-quality studies are necessary to establish definitive guidelines for vitamin D assessment and supplementation in surgical care.
