Background:Systemic sclerosis (SSc) features microvascular injury and progressive fibrosis, often culminating in peripheral ischemia, digital ulcers, and tissue loss. Existing animal models typically capture either fibrosis (e.g., bleomycin [BLM] skin models) or ischemia (surgical hindlimb ligation) but rarely both simultaneously in an extremity. Methods:We established a non-surgical, localized model by administering subcutaneous BLM (300 μg per day) to four peri-ankle sites of the right hindlimb in BALB/c and C57BL/6 mice for 14 consecutive days, followed by a 7-day rest. Outcomes included clinical scoring (edema, joint stiffness, skin thickening), laser Doppler perfusion imaging (LDPI; ischemic/contralateral perfusion ratio), histology (hematoxylin and eosin; dermal thickness; inflammation; collagen deposition), quantitative RT-PCR (RT-qPCR) for fibrotic and vascular markers, and immunohistochemical (IHC) staining for collagen type I alpha 1 chain (COL1A1), alpha-smooth muscle actin (α-SMA), cluster of differentiation (CD)31, and CD34 with ImageJ-based quantification. Results:BLM induced persistent hindlimb edema and contracture with significantly reduced perfusion measured by LDPI compared with the contralateral limb, persisting after the rest period. Histology revealed marked dermal thickening with dense collagen and leukocyte infiltration. RT-qPCR demonstrated dose-dependent upregulation of α-SMA and transforming growth factor β (TGF-β) mRNA, and IHC confirmed increased COL1A1- and α-SMA-positive areas alongside reduced CD31/CD34 capillary density in BLM-treated limbs. The protocol was technically simple and showed reproducible results. Conclusions:Local peri-ankle BLM produces a chronic fibrotic phenotype accompanied by microvascular alteration in an accessible limb, complementing classic SSc models and surgical hindlimb ischemia. This platform enables functional perfusion readouts alongside fibrosis endpoints and is well-suited for preclinical screening of proangiogenic or antifibrotic strategies of interest to reconstructive surgery.
Background: Patient age influences diagnosis, operative planning, and recovery in facial fracture care. We aimed to delineate age-dependent patterns in fracture sites, injury mechanisms, and management across pediatric, working-age, and elderly cohorts at a regional trauma center. Methods: We retrospectively analyzed 4,975 patients with CT-confirmed facial fractures (2016–2021), stratified into <20, 20–64, and ≥65 years. Fracture sites, mechanisms, and management (conservative, closed reduction, ORIF) were recorded. Group differences used chi-square/ANOVA with Holm adjustment. Multivariable logistic regression identified independent predictors of operative management. Results: The cohort was predominantly male (~3:1). Nasal fractures were most common (42.3%) but declined with age (60.1%, 41.7%, 31.5%). Zygomaticomaxillary complex (ZMC) and orbital fractures increased with age (ZMC: 10.3%, 20.7%, 30.8%; orbital: 14.2%, 25.6%, 28.1%). Mandibular fractures were more frequent in younger patients (11.6% vs 5.7% in ≥65). In the elderly, falls (slip/roll/fall-down combined 52.6%) predominated, whereas assault and sports were proportionally higher in younger groups. Mechanism was strongly associated with fracture site (p < 0.001). Operative treatment was less frequent in the elderly, in whom conservative care predominated. In multivariable analysis, increasing age independently predicted lower odds of surgery (p < 0.001), whereas multiple fractures were the strongest predictor of operative intervention (adjusted OR = 2.50, p < 0.001). Conclusions: Facial fracture patterns, mechanisms, and treatment differ by age. Findings support age-tailored prevention—fall prevention for older adults and high-energy injury mitigation for younger cohorts—and individualized strategies balancing functional priorities against systemic risk in the elderly.
Monkeypox (Mpox) is a viral infection that has shown increased global incidence, particularly affecting immunocompromised populations. We present a case of a 45-year-old human immunodeficiency virus (HIV)-positive man with progressive penile ulceration and necrosis. Mpox was confirmed via polymerase chain reaction testing of skin and oropharyngeal lesions. Despite antiviral therapy and antibiotics, the patient developed full-thickness necrosis of the penile shaft, scrotum, and suprapubic region. Surgical incision, drainage, and debridement were performed, followed by reconstruction using a pedicled anterolateral thigh flap. Secondary intention healing was selected for the penile shaft to preserve tissue elasticity and erectile function. The patient achieved complete wound healing within 3 months without complications. This case highlights a severe and rare manifestation of mpox in the setting of advanced HIV infection, emphasizing the importance of early diagnosis, multidisciplinary management, and tailored surgical planning to optimize both functional and aesthetic outcomes in immunocompromised patients.
Background The readability and length of informed consent forms have been debated for over three decades. Despite national guidelines promoting patient-friendly language, many forms fall short. This study compares the readability and content quality of informed consents from the American Society of Plastic Surgeons (ASPS) and ChatGPT for common plastic and reconstructive surgery (PRS) procedures. Methods ASPS consents for seven common PRS procedures were obtained online. ChatGPT was then queried to create equivalent consents. Readability was assessed using the Flesch Reading Ease Score, Flesch-Kincaid Grade Level, and Lexical Density. Quality was graded using a modified National Quality Forum-based scale across domains: Procedure description, clinical rationale, patient-oriented benefit, quantitative and qualitative risks, and alternatives. Scores were compared between ASPS and ChatGPT consent forms. Results ASPS versus ChatGPT conversion yielded mean Flesch scores of 30.09 versus 46.18 ( p = 0.00003), grade levels of 13.59 versus 10.53 ( p = 0.000004), and lexical densities of 56.7% versus 46.6% ( p = 0.00008). Word count decreased by 81% after conversion. ASPS consents exceeded ChatGPT quality in three of seven procedures (by 12.8 percentage points on average), while ChatGPT exceeded ASPS in four of seven (by 25 points on average). Average quality scores were not significantly different (64.83% vs. 73.63%, p = 0.27). Conclusion ChatGPT improved the readability and brevity of PRS consent forms while maintaining accuracy. Readily available artificial intelligence (AI) tools may enhance descriptions of procedures, rationale, patient benefits, and quantitative risks, offering a practical tool to aid in patient-provider communication.
