Head and neck malignancies pose a unique surgical challenge in which oncologic clearance must be achieved alongside the restoration of speech, swallowing, mastication, and facial aesthetics. Despite advances in ablative and microvascular techniques, reconstructive outcomes remain highly variable, largely due to differences in tumor biological behaviors that are not adequately captured by conventional histopathology alone. Increasing evidence suggests that molecular biomarkers may provide additional insights into tumor aggressiveness, invasive growth patterns, and recurrence risk, thereby influencing reconstructive complexity and long-term functional outcomes. Among these, metastasis-associated colon cancer 1 (MACC1) and salivary-derived miRNAs have emerged as promising indicators of biologically aggressive diseases in head and neck cancer. Elevated MACC1 expression is associated with infiltrative tumors and unpredictable resection margins, factors that frequently necessitate wider composite resections and robust vascularized reconstruction. In parallel, salivary miRNAs offer a non-invasive means of monitoring molecular activity in postoperative settings, where clinical examination and radiologic assessment may be limited by flap volume, fibrosis, or radiation-related changes. When interpreted through a reconstructive framework, these biomarkers may assist in the preoperative prediction of defect behavior, selection of a flap strategy, optimization of reconstruction timing, and individualization of postoperative surveillance and rehabilitation. Although current evidence remains largely translational and hypothesis-generating, the integration of molecular biomarkers into reconstructive decision-making represents a promising step toward precision reconstructive oncology. Future prospective studies correlating biomarker profiles with reconstructive outcomes are required to validate their clinical utility and to support the development of biologically informed reconstructive algorithms.
Engineered regeneration is a rapidly evolving interdisciplinary area of research that involves bioengineered bioconstructs, disease models, and translational strategies for enhancing the repair and restoration of human tissues. In this review, the most recent developments in engineered regeneration are discussed in detail, focusing on biomimetic scaffold design, stem cell-based constructs, and new disease-modeling systems applicable to plastic and reconstructive surgery. Biomimetic scaffolds, such as hydrogels, electrospun nanofibers, and decellularized matrices, provide structural, mechanochemical, and biochemical signals that control cell adhesion, differentiation, and tissue integration. Simultaneously, improved disease-modeling technologies, such as organoids and organ-on-chip systems, make it possible to recapitulate physiologically relevant tissue microenvironments, thereby providing better disease insights, aiding in translational studies, and accelerating the development of therapeutic applications. The clinical relevance of engineered constructs has advanced in recent years owing to advancements in enabling technologies such as three-dimensional bioprinting, gene editing, and bioreceptor-based maturation systems. Computational modeling and artificial intelligence have been successfully applied to the design, optimization, and personalization of regenerative therapies. Despite these developments, issues related to standardization, scalability, immune compatibility, and regulatory compliance continue to hinder large-scale clinical translation. However, continued advancement of intelligent biofabrication technologies, their combination with personalized medicine, and regulatory changes are expected to drive substantial progress in tissue repair and regenerative medicine. Collectively, the developments described herein highlight position-engineered regeneration as a revolutionary therapy for future reconstructive and regenerative therapies.
Background Soft-tissue defects of the limbs with exposed bone or orthopedic hardware remain a major reconstructive challenge, particularly in patients in whom free tissue transfer is not feasible. The keystone perforator island flap (KPIF) provides a simple, reliable, and resource-efficient local flap option based on perforator preservation and tension redistribution, and can be safely performed under local anesthesia. Methods This prospective clinical study included 12 patients (8 men and 4 women) with small-to moderate-sized limb soft-tissue defects with exposed bone or orthopedic hardware who underwent reconstruction using the KPIF between January 2021 and June 2025. Preoperative perforator mapping was performed using a handheld Doppler, and all dominant perforators were preserved during flap elevation. Wound beds were prepared using preoperative negative pressure wound therapy (NPWT) for contaminated or poorly granulating wounds. KPIF reconstruction was performed predominantly under epinephrine-free local anesthesia with or without tumescent infiltration, following a standardized surgical protocol. Results Complete flap survival was achieved in all patients with small defects (7/7), whereas one patient in the moderate defect group (1/5) developed minor distal partial flap necrosis that healed conservatively without additional surgical intervention. Most procedures were performed under epinephrine-free local anesthesia, with no need for conversion to general anesthesia and no anesthesia-related complications. No total flap loss, postoperative infection, or donor-site morbidity was observed. The mean operative time was 45 min and all donor sites were closed primarily. During a mean follow-up of 6 months, all patients achieved stable soft-tissue coverage with favorable patient-reported functional and aesthetic outcomes (mean patient-reported outcome measures-visual analog scale (PROM-VAS): 8.6 and 8.4 for small defects; 7.9 and 7.8 for moderate defects, respectively). Conclusion KPIF provides reliable coverage for small limb defects with exposed bone or hardware, and can be safely and effectively performed under local anesthesia, offering a practical alternative to microsurgical reconstruction in appropriately selected patients.
Oral and maxillofacial surgery (OMFS) continuously seeks biomaterials capable of meeting the complex regenerative requirements of the craniomaxillofacial region, which includes both hard and soft tissue repair. Historically valued for its textile applications, silk—particularly the protein silk fibroin (SF) derived from the Bombyx mori silkworm—has emerged as a highly biocompatible polymer. Upon removal of the immunogenic sericin coating, SF demonstrates excellent mechanical strength, tunable biodegradation rates, and the capacity to support stem cell differentiation. This review highlights the current landscape of SF applications in OMFS and identifies existing gaps in its utilization. Specifically, it discusses SF-based bone tissue engineering scaffolds, barrier membranes for guided bone regeneration, vehicles for drug and growth factor delivery, and adjuncts for soft tissue and nerve repair. Finally, the review addresses translational challenges that must be overcome before SF can become a standard-of-care material in clinical practice. Overall, SF represents an economical and minimally invasive biomaterial that promotes facial and intraoral harmony and can be seamlessly integrated into advanced dental practice.
Frontal sinus abscesses rarely result in permanent visual loss but can present substantial reconstructive challenges when associated with orbital and craniofacial structural compromise. Herein, we report the case of a 66-year-old man with a history of craniofacial trauma and prior frontal sinus surgery who presented with progressive orbitofrontal symptoms, marked exophthalmos, globe displacement, and acute visual deterioration. Delayed source control led to profound vision loss and progressive disruption of the frontal–orbital framework, with implications extending beyond infection control to craniofacial stability and function. The patient underwent unilateral endoscopic frontal sinusotomy and drainage through a scalp fistula, achieving rapid resolution of the infection and substantial improvement in proptosis and globe position; however, visual acuity did not recover due to ischemic optic neuropathy. This case underscores that prompt diagnosis and multidisciplinary management are essential not only to prevent related complications but also to facilitate early reconstructive assessment, staged reconstruction, and long-term surveillance to limit delayed craniofacial deformity.
