Myelomeningocele (MMC) reconstruction remains a challenging aspect of pediatric neurosurgery because defect size and anatomical characteristics often influence reconstructive decision-making and postoperative outcomes. Despite the availability of various reconstructive techniques, evidence guiding technique selection according to objective defect measurements is limited. Therefore, this study evaluated our institutional experience with different reconstructive options based on absolute defect area and relative defect ratio and examined their association with early clinical outcomes and postoperative complications. A retrospective review was conducted of patients who underwent MMC surgery between August 2020 and July 2024. Neural tube repair was performed by pediatric neurosurgery, followed by soft-tissue reconstruction planned according to defect characteristics. Absolute defect area and total dorsal surface area were measured, and the relative defect ratio was calculated. Reconstructive options were selected according to defect size, relative defect ratio, tissue availability, and intraoperative assessment. Postoperative complications were recorded. Thirty-two patients were included. The mean defect area was 18.0 cm2. Primary tension-free closure was performed in 10 patients, while the remainder required flap reconstruction, most commonly rotation-based and Limberg flaps. Postoperative complications occurred in 8 patients, with wound dehiscence being the most frequent event. Partial flap necrosis occurred in two patients; no total flap loss was observed. Wound-related complications were more frequently observed in larger defects requiring flap-based reconstruction. Assessment of absolute defect size and relative defect ratio may help guide individualized reconstruction in MMC, while larger defects requiring flap-based reconstruction should be considered at increased risk for wound-related complications. Level of Evidence: Level III, therapeutic study
Engagement with research can strengthen the academic development of residents by enhancing their ability to critically appraise literature, interpret evidence, and contribute to the advancement of clinical knowledge. However, surgical residents are often burdened with clinical demands that limit their scholarly engagement. Incentive-based recognition programs are frequently proposed to encourage research productivity, but their efficacy in surgical residency programs remains poorly studied. This study aimed to evaluate residents’ perceptions of a Research Excellence Award across several key domains. A cross-sectional survey was conducted among plastic surgery residents. Participants from each postgraduate year (PGY-1 to PGY-7) were invited to participate. Three main domains—(1) Motivation and Behavioral Impact, (2) Mental Perception and Research Culture, and (3) Sustainability and Career Impact—were assessed using a questionnaire, with responses recorded using a five-point Likert scale. Statistical analyses were conducted to summarize the results and assess associations. Nine participants representing all the training levels were included in the study. Overall, participants had a positive perception of the award, as the majority reported that it increased their motivation to initiate and complete research projects. Senior residents had higher mean scores across all domains compared with junior residents. The findings of this study suggest that Research Excellence Award have a positive impact on residents’ research motivation, perception, and scholarly behavior, which may encourage sustained scholarly development. Level of Evidence: not gradable.
Keloids disproportionately affect individuals with darker Fitzpatrick skin types; however, it is unclear whether this is reflected in clinical trial reporting. This systematic review evaluates current reporting practices of Fitzpatrick skin type in adult keloid clinical trials, including documentation of skin tone, quantification of Fitzpatrick skin type, and outcome stratification. A systematic review was conducted in accordance with PRISMA guidelines using Ovid MEDLINE, PubMed, and Cochrane Library to identify adult keloid clinical trials published in English between 2015 and 2025. Two independent reviewers extracted study characteristics, Fitzpatrick skin type quantification, patient image representation, and outcome stratification, with a third reviewer consulted to resolve any disagreements. Reporting practices were summarized with descriptive statistics; associations with study characteristics were evaluated using Wilcoxon rank-sum tests and binary logistic regression. Seventy-one eligible trials were identified. 21.1
The internal mammary artery (IMA) is a critical vessel for both autologous breast reconstruction (ABR) and coronary artery bypass grafting (CABG), creating potential conflict when both procedures are needed. This review evaluates evidence on the feasibility, safety, and vascular consequences of using the IMA in ABR while preserving future CABG options. A PRISMA-2020 aligned systematic review assessed IMA use in ABR and implications for future CABG. PubMed, EMBASE, and Web of Science were searched through March 10, 2025, using terms related to ABR and CABG. Ten studies (2004–2025) met inclusion criteria, involving female patients aged 24–77 years. Most studies used the deep inferior epigastric perforator flap for ABR, with the IMA as the predominant recipient vessel. Notably, end-to-side arterial anastomosis and dissection at or below the fourth intercostal space were frequently applied to preserve IMA length and integrity for future CABG. Myocardial complication rates after ABR were comparable to flap loss rates, and one patient subsequently underwent CABG using an alternative graft due to prior IMA harvest. Importantly, one cohort study introduced the Breast Reconstruction and Internal Mammary Artery Assessment (BRIMA) score, a cardiovascular risk-stratification tool designed to guide IMA selection in reconstructive planning. The IMA may be used in selected ABR cases without significantly limiting future CABG if end-to-side anastomoses or internal mammary artery perforators preserve conduit integrity. Because the IMA is the primary CABG graft, careful surgical planning and cardiovascular risk assessment are crucial. Further prospective data are needed to guide long-term management as the population ages. Level of Evidence: no gradable.
Cat bites constitute a significant and underrecognized source of upper extremity trauma, particularly in the domain of hand surgery. We aimed to characterize seasonal and demographic trends in feline-related upper extremity injuries presenting to the emergency department over 10 years, and to inform resource allocation, surgical workload, and injury prevention strategies. We performed a retrospective observational cohort study of all emergency department visits for cat bites or scratches to the upper extremity within a large Midwestern health system from January 2014 to January 2024. Encounters were identified using ICD-10 diagnosis codes and merged with regional monthly climate data. Months were classified as warm (May–September) or cold (October–April). Hospital admission was used as a surrogate for clinically significant injury. Operative case data were extracted to characterize surgical burden, repeat washout rates, temporal trends, and sex-based differences in operative utilization. Cat bite presentations were significantly more frequent in warm months (74.6 ± 19.3) versus cold months (55.5 ± 14.3; p < 0.0001), with temperature explaining 26.3
Reconstruction of small-to-medium perineal defects (maximal diameter < 10 cm, or area < 100cm2) after Fournier’s gangrene is challenging due to aesthetic requirements and the characteristic of high sensitivity in this area. The anterior obturator artery perforator(aOAP) propeller flap offers a reliable alternative. We retrospectively studied 11 male patients (mean age 55; range 36–74) treated from March 2021 to March 2025. A two-stage approach was used: radical debridement and Negative pressure wound therapy (NPWT), followed by aOAP propeller flap reconstruction after infection was controlled. Donor sites were closed primarily. Nine of 11 flaps survived without complications. Of the remaining two, one flap had distal cyanosis, the other a hematoma, both healed well after further intervention. All donor sites healed primarily. Over a mean follow-up of 7.4 months (range: 3–14 months), the reconstructed areas maintained satisfactory aesthetic appearance, soft texture, and minimal donor-site morbidity with only linear scarring. This staged NPWT-assisted wound-bed preparation and subsequent aOAP propeller flap reconstruction is effective for perineal defects with moderate soft tissue loss. Level of Evidence: Level IV, therapeutic study.
The method of tissue dissection in reduction mammaplasty may influence intraoperative efficiency, postoperative recovery, and scar quality. While scalpel dissection remains the traditional standard, monopolar electrocautery is increasingly used due to its hemostatic advantages. This retrospective split-breast study included patients undergoing bilateral reduction mammaplasty. One breast was dissected using a scalpel and the contralateral breast using monopolar electrocautery. Intraoperative parameters, postoperative pain, drainage, and scar quality, assessed using the Patient and Observer Scar Assessment Scale (POSAS) were compared within the same patient. Forty patients were analyzed. Monopolar electrocautery resulted in significantly reduced intraoperative bleeding and shorter hemostasis time, although excision time was longer. Early postoperative pain and drainage volume were higher on the electrocautery side but equalized during follow-up. Scar quality at 6 months was comparable between techniques. Monopolar electrocautery provides effective hemostasis with comparable mid-term cosmetic outcomes to scalpel dissection in reduction mammaplasty. When used with careful technique, it represents a reliable alternative to cold knife dissection. Although electrocautery reduces bleeding and hemostasis time, early postoperative pain may be higher. Mid-term scar quality seems comparable between techniques. Level III, therapeutic study.
Ganglion cysts are the most common benign hand and wrist masses, with surgical excision often required when symptomatic. This systematic review and meta-analysis reported and compared recurrence and complication rates between arthroscopic and open excision of wrist ganglion cysts. A comprehensive search was conducted across multiple databases, and eligible studies included randomized controlled trials, cohort studies, and case series with a minimum of 10 patients. Data on recurrence, complications, and patient-reported outcomes were extracted and analyzed using a meta-analysis of proportions performed in R software. Fifty-four studies, including more than 7,000 patients, were analyzed. The pooled recurrence rate was 8.4
Buried suture double eyelid blepharoplasty (BSB) is among the most frequently performed cosmetic procedures in East Asia. We previously reported that concurrent upper eyelid lipectomy (UEL) reduced early postoperative complications after BSB; however, the mean follow-up was only 7.5 months, leaving the mid-term effect on the persistence of the double eyelid crease unknown. This study extended follow-up and used survival analysis to assess whether concurrent UEL reduces buried suture–related events. This single-centre, single-surgeon retrospective cohort study included 102 consecutive patients who underwent BSB between January and December 2024, followed until February 2026. Patients were grouped as BSB alone (monotherapy, n = 61) or BSB with concurrent UEL (combination, n = 41). The primary endpoint was a buried suture–related event, defined as reoperation or suture removal for loss or loosening of the double eyelid line. Event-free survival was estimated using the Kaplan–Meier method, compared by the log-rank test. The median follow-up was 19 months (interquartile range 16–22). Buried suture–related events occurred in 17 patients (16.7
Nasal skin thickness influences rhinoplasty outcomes and may vary across anatomical regions and ethnic groups. This study evaluated regional and inter-ethnic differences in nasal skin thickness among Iranian adults using ultrasonography. In this cross-sectional study, 188 participants underwent ultrasound measurement of skin thickness at the tip, supratip, and keystone regions. Linear regression assessed associations with age, and ANCOVA evaluated ethnic differences adjusting for age and sex. Significant differences were observed among nasal regions (F(2,374)=333.4, p<0.001), with the supratip being the thickest and the keystone the thinnest. No significant differences were found between males and females. An inverse age-related trend was noted in the supratip and keystone areas but did not reach statistical significance. No significant differences were detected among ethnic groups after adjustment for age and sex. Nasal skin thickness varies by anatomical subunit but not by sex or ethnicity within this population. These findings highlight the importance of subunit-specific evaluation rather than reliance on demographic assumptions when planning rhinoplasty to facilitate surgical planning and expectation management. Level of Evidence: Level III, diagnostic study.
Deep dermal burns are common injuries characterized by prolonged healing time. The wound healing process involves inflammatory, proliferative, and remodeling phases regulated by growth factors, including FGF2 and EGF, which play roles in angiogenesis, fibroblast proliferation, re-epithelialization, and tissue repair. UC-MSC secretome contains cytokines and growth factors that may enhance wound healing. This pilot study aims to evaluate the effect of topical UC-MSC secretome on serum FGF2 and EGF levels and wound healing in deep dermal burns in Wistar rats. This study used a post-test control group design in Wistar rats with deep dermal burns. Animals were divided into secretome-treated, vaseline-treated, and untreated groups, with evaluations on days 3 and 14. Serum FGF2 and EGF levels were measured using ELISA, while wound healing was assessed through wound width analysis and histopathology. Trends in serum FGF2 and EGF levels increased in all groups, with the secretome-treated group showing higer mean levels. Histopathology demonstrated better epidermal and dermal regeneration and higher healing scores in the secretome group. Clinical assessment also showed greater reduction in wound width. Topical UC-MSC secretome was possibly associated with increased serum FGF2 and EGF levels and improved wound healing in deep dermal burns in Wistar rats. Level of Evidence: not ratable.
Artificial intelligence (AI) is reshaping the field of contemporary healthcare, providing cutting-edge tools that improve diagnostic precision, treatment results, and clinical effectiveness. This review is designed to enhance our understanding of how AI is used and managed in the fields of plastic and reconstructive surgery. It delves into the advantages, challenges, and current applications of AI in aesthetic, plastic, and reconstructive procedures. A narrative review was carried out using the EMBASE and MEDLINE databases to identify studies that explored the use of AI in plastic surgery published in the past decade. This evaluation offers valuable perspectives on contemporary methods, demonstrated with practical examples and possible future developments. Although the benefits of AI are clear, the drawbacks must also be recognized. This evaluation is intended to emphasize potential dangers, hazards, and causes of mistakes linked to AI technology and its uses. Consequently, this review seeks to direct potential concerns regarding artificial intelligence in plastic and reconstructive surgery while providing a truly balanced experience. Moreover, basic ethical and legal principles will be canalized together with possible “guidelines for the use and implementation of artificial intelligence in plastic surgical practices.” Developments in this field are often viewed as remarkable, making it crucial to evaluate them thoughtfully and objectively. Even though we’ve come a long way with AI, it’s really important to keep improving the methods we’ve created and to maintain a wider perspective. Artificial intelligence has shown significant promise in revolutionizing the field of plastic and reconstructive surgery. It has the potential to greatly enhance the capabilities of plastic surgeons, improving efficiency, accuracy, and patient well-being and outcomes. Level of Evidence: not gradable.
Accurate breast volumetry is essential for preoperative surgical planning and objective monitoring in autologous fat transplantation (AFT). Magnetic resonance imaging (MRI) is the current clinical reference but is constrained by high costs and labor-intensive manual segmentation. This study evaluates a refined volumetric algorithm for the VECTRA XT 3D imaging system, comparing its accuracy and reliability against MRI and plastic surgeons’ estimations. In this retrospective cross-sectional study, 49 breasts from 27 patients undergoing therapeutic or risk-reducing breast surgery were analyzed. Breast volumes were assessed using three methods: 3D-imaging, MRI, and clinical estimations by plastic surgeons. The refined algorithm was applied to a previously established database which used identical landmarks as the previous algorithm. Statistical analysis included paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots to assess agreement and bias. MRI measurements demonstrated excellent inter-observer reliability (ICC 0.975). The refined 3D algorithm showed good reliability compared to MRI (ICC 0.774; p < 0.001) with no statistically significant difference in mean volumes (p = 0.173). A mean bias of -34.1 cc was found between this algorithm and MRI. Surgeons’ estimation showed moderate reliability compared to 3D imaging (ICC 0.517) with significantly different means and a mean bias of 173.9 cc. The updated VECTRA 3D algorithm provides good agreement with MRI and reliable breast volume measurements, significantly outperforming the previous algorithm and clinical estimations. While MRI remains the reference standard, this refined tool is excellent for broader clinical integration, given the non-invasive nature and workflow efficiency. Level of Evidence: Level II, diagnostic study.
Reconstruction of soft tissue defects overlying the Achilles tendon remains a challenging problem in plastic and reconstructive surgery, owing to the tendon’s functional importance, limited surrounding soft tissue, and the diverse spectrum of pathology encountered. The variety of reconstructive options reported in the literature reflects the complexity of this clinical problem. We aimed to investigate the differences between pedicled flaps and free flaps in coverage of the exposed Achilles tendon regarding functional and aesthetic outcome, operative time, postoperative stay, postoperative wound complications, and donor-site morbidities. A prospective comparative randomized clinical study was conducted on 20 patients with exposed Achilles tendon. Patients were divided randomly into two equal groups; Group A was managed with pedicled flaps and Group B was managed with free flaps. Free flaps were associated with significantly larger flap dimensions, longer operative time (7.32 ± 0.71 vs. 2.51 ± 0.52 h), a greater number and duration of drains, prolonged hospital stay (9.10 ± 0.88 vs. 6.70 ± 0.48 days), and delayed wound healing (14.6 ± 0.97 vs. 12.7 ± 1.20 days) compared with pedicled flaps (all p ≤ 0.001). However, there was no statistically significant difference between groups regarding recipient- and donor-site complication rates, functional outcomes, aesthetic outcomes, or patient psychological satisfaction, with the majority of patients in both groups reporting being very satisfied (40.0
