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.
Abdominoplasty is a widely performed cosmetic surgical procedure after pregnancy that results in significant weight loss. Although this procedure is considered safe, surgeons must be prepared for unexpected intraoperative findings. We report the case of a 40-year-old asymptomatic female, in whom a large intrauterine fibroid was found incidentally during abdominoplasty. This is the first documented case of such findings. The mass was not explored further during the surgery. Postoperative imaging reveals a large intramural fibroid. Additionally, we reviewed the literature on incidental findings encountered during abdominoplasty. We discuss the potential gaps in routine preoperative evaluations and suggest a practical approach for managing unexpected surprises intraoperatively. This case report aims to support better surgical preparedness and follow a multidisciplinary approach in managing cosmetic surgery procedures.
Background Orbital floor fractures, a common subtype of midfacial trauma, can result in significant morbidity, impact quality of life, and impose a substantial burden on the healthcare system. In the United Kingdom (UK), the National Health Service (NHS) provides emergency care for such injuries. This study aimed to examine the demographic trends of orbital floor fractures in the UK between 2012 and 2024 and to evaluate the temporal trend in the proportion of cases managed surgically. Methods Data were extracted from the NHS “Hospital Admitted Patient Care Activity” annual reports that includes data on orbital floor fractures. Following extraction to Microsoft Excel, data were standardized using census data from the Office for National Statistics to minimize bias. Statistical analyses were performed using Microsoft Excel and GraphPad software. Results Men were more potentially to develop orbital floor fractures. Presentations increased among patients aged ≥60, with the highest incidence in those ≥75 years. Fracture rates declined during the coronavirus disease 2019 (COVID-19) pandemic but increased after social distancing measures were lifted. Most fractures were managed conservatively, and surgical interventions decreased over time. Conclusion Orbital floor fractures predominantly affected men and older adults. Future studies should investigate geographic, socioeconomic, and behavioral factors to guide public health policies. Initiatives targeting fall prevention are warranted to address the rising fracture incidence among patients aged ≥60 years.
Keloids and hypertrophic scars stem from dysregulated wound healing, characterized by persistent inflammation, abnormal fibroblast activation, and excessive extracellular matrix (ECM) deposition. These pathological scars affect a large population worldwide and remain clinically challenging owing to high recurrence rates and limited efficacy of current therapies, primarily targeting downstream collagen accumulation rather than upstream drivers. In this review, the focus was on communication networks among different cell types in the scar tissue, elucidating their roles in scar formation and treatment, and summarizing current communication-based therapeutic strategies. Recent developments in single-cell and spatial transcriptomics revealed that pathological scarring is sustained by dysregulated intercellular communication among macrophages, fibroblasts, T cells, endothelial cells, Schwann cells, keratinocytes, and melanocytes. These interactions converge into fibrotic communication loops involving key mediators, including SPP1, CD44, IGFBP5, and TGF-β pathways, forming self-reinforcing cellular circuits maintaining fibrosis. Furthermore, exosomes propagate fibrotic signaling by delivering regulatory miRNAs and proteins; however, engineered exosomes and miRNA-based approaches (e.g., miR-29a-3p delivery) demonstrate emerging therapeutic potential. Understanding these communication networks reinforces the need for phase-specific therapeutic strategies, including early immune modulation, mid-stage inhibition of fibroblast–vascular crosstalk, late-stage ECM remodeling, and exosome-based interventions. Targeting upstream intercellular communication rather than isolated downstream fibrosis offers a promising precision-therapy framework for improving outcomes in pathological scar management.
The regeneration and repair of complex tissues in plastic and reconstructive surgery are fundamentally limited by the inability to rapidly form functional hierarchical vascular networks. This challenge is central to issues ranging from graft failure to the treatment of vascular anomalies. However, traditional experimental systems have long presented bottlenecks. Conventional two-dimensional cell cultures fail to replicate three-dimensional vascular microenvironments, whereas animal models are hampered by significant interspecies discrepancies. Although vascular organoids are a promising human-relevant model, they are limited by diffusion-limited necrosis, structural immaturity, and poor reproducibility. Microfluidic organoids-on-chips (OoCs) have emerged to overcome these hurdles by providing precise control of the cellular microenvironment and enabling the development of robust, perfusable, and mature vascular structures. This review describes how vascular organoids-on-chips (VOoCs) serve as a transformative platform with direct clinical implications for plastic and reconstructive surgeries. We highlight their unique utility in modeling vascular anomalies such as infantile hemangiomas, providing a human-specific system for deciphering disease mechanisms and screening therapeutics such as propranolol. Furthermore, we explore their role in engineering pre-vascularized tissues, where VOoCs could be leveraged to fabricate skin flaps and composite grafts with an embedded perfusable microvasculature designed for rapid anastomosis upon transplantation, thereby addressing the critical bottleneck of ischemia. Finally, we discuss the potential of VOoCs to enable personalized medical strategies through patient-specific disease modeling and drug testing. By bridging the long-standing gap between in vitro models and human physiology, VOoCs offer surgeons and tissue engineers powerful tools to refine disease models, enhance graft survival, and accelerate the development of novel regenerative therapies.
Oral and maxillofacial reconstruction represents one of the most complex challenges in plastic and reconstructive surgery, requiring the restoration of both form and function in highly specialized anatomical regions. Traditional strategies, including local flaps and autologous bone grafts, remain fundamental but are limited by donor-site morbidity, tissue availability, and unpredictable outcomes. Recent advances in regenerative medicine have shifted the paradigm from repair to true regeneration, harnessing stem cells, biomaterial scaffolds, and signaling molecules in a synergistic approach. Dental- and craniofacial tissue-derived mesenchymal stem cells, along with adipose-derived stem cells, demonstrate significant potential for alveolar bone repair, periodontal regeneration, and soft tissue augmentation. Innovations in three-dimensional printing and bioactive matrices have enabled precise scaffold design and improved vascularization, thereby enhancing both predictability and esthetic outcomes. This mini review focuses on the synergistic role of stem cells, scaffolds, and signaling molecules in oral and maxillofacial regeneration, with an emphasis on the unique contributions of periodontists. By integrating periodontal biology with reconstructive techniques, a new collaborative framework is emerging to optimize regenerative outcomes. Future research must address clinical translation, large-scale trials, cost-effectiveness, and personalized approaches to fully realize the promise of regenerative surgery.
Background Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous sarcoma that infrequently involves the head and face. Despite its low incidence, the complex anatomical subunits of this region and frequent misdiagnosis can result in functional impairment and challenging reconstruction. However, the distribution characteristics of DFSP in the head and face have not yet been systematically evaluated. This study aimed to characterize the distribution of DFSP in the head and face to provide guidance for clinical diagnosis. Methods We retrospectively reviewed patients who underwent treatment for DFSP involving the head and face at our hospital. The associations between tumor location and patient characteristics—including sex, age, tumor size, history of trauma, and histopathological features—were systematically analyzed. Results Among the 161 cases, 26 (16.1%) involved DFSP of the head and face. The highest tumor frequency was observed in the cheek region (65.38%). Patients with DFSP located in the cheek were older than those with DFSP in non-cheek regions (48.82 vs. 37.22 years, P=0.04). Histologically, among the 26 cases, 23 were classic DFSP and 3 were fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP), a more aggressive histologic subtype. The proportion of FS-DFSP was lower in the cheek region than in non-cheek areas (0 vs. 3, P=0.032). Conclusion DFSP of the head and face demonstrated a predilection for the cheek region. Recognition of this distribution pattern may assist dermatologists in the clinical assessment and management of patients, particularly for lesions involving the cheeks.
Infantile hemangiomas (IHs) are the most common benign vascular tumors observed in children. Owing to mechanical compression during the critical visual development period, periorbital IHs carry a high risk of irreversible ocular sequelae, such as strabismus, anisometropia, and amblyopia. Early multidisciplinary intervention is pivotal in preventing long-term impairment. However, evidence of infancy-to-adulthood outcomes remains limited. The first case describes a 24-year-old woman with right periorbital IH diagnosed in infancy. Despite the complete regression of the lesion in adulthood, the patient developed severe strabismus and monocular amblyopia. The second is a similar case of a 19-year-old woman with regressed IH yet evident strabismus. Despite lesion regression with residual scarring after electrochemical therapy, steroid injections, and surgical resection, significant strabismus persisted. These two long-term follow-up cases provide compelling evidence that periorbital IH may entail irreversible oculomotor dysfunction and refractive errors, highlighting the importance of early multidisciplinary intervention during the critical period of visual development.
Background Flexor tendon injuries in zones II–V are challenging because of the risk of adhesions and rupture. Although early passive mobilization limits rupture, it often compromises the functional recovery. Recent approaches favor early active mobilization with strong, multi-stranded core sutures to enhance outcomes. This study evaluated early active mobilization after eight-strand core repair in a tertiary care setting. Methods In this prospective study, 143 tendons from 30 patients who underwent surgery were followed up. The injured tendons were repaired using an eight-strand cross-locked cruciate technique with a double-stranded 4-0 suture, providing the tensile strength of eight strands with the same number of suture passes as in traditional four-core repairs, thereby reducing operative time without increasing bulk. Early active mobilization was initiated on postoperative day 2. The patients underwent digitally supervised physiotherapy and were monitored using a dedicated WhatsApp group, which enabled real-time guidance and compliance monitoring. The outcomes were measured in terms of total active motion, grip strength, pinch strength, time to return to work, postoperative pain, and complications. Results Of the 30 patients, 28 (93.3%) had fair-to-excellent outcomes, whereas only 2 (6.7%) had poor outcomes. Most patients (93.3%) returned to work within 12 weeks postoperatively. Four (13.3%) patients had complications, such as wound infection and skin necrosis. The patients showed significant changes in grip strength (45.2%) and pinch strength (70.7%) between weeks 8 and 12. No tendon ruptures were observed. Conclusion The eight-core suturing technique used for flexor tendon repair withstood the forces of early active mobilization, which began on the second day after surgery, resulting in fair-to-excellent outcomes. It supports digitally supervised physiotherapy through app-based monitoring, enhancing patient compliance, and reducing reliance on in-person therapy sessions. This combination led to excellent functional recovery with minimal complications.
Patient involvement in shared decision-making (SDM) is crucial, as it reduces decision conflict and post-decision regret, thereby improving the overall cosmetic surgery experience. the SDM process for these patients has received insufficient exploration during their surgical decision-making. The treatment goals of breast cosmetic surgery patients differ from those of surgical patients, and individual perceptions of aesthetics are subjective, which introduces specific challenges in medical decision-making. In the past, the lack of attention to patient-reported outcomes (PROs) made it difficult to identify key points that lead to decision regret. Therefore, to help patients make well-informed treatment decisions and enhance their readiness to participate in SDM, it is necessary to develop an effective, scientific decision-aid tool. This review aims to explore the decision-making experiences and current status of SDM among cosmetic breast surgery patients, and to develop a PRO-based decision aid specifically for this population.
Angiomatosis of soft tissue (AST) is a rare, benign vascular anomaly primarily characterized by extensive mesenchymal hyperplasia with a predilection for the lower extremities. It often presents in early life, complicating the diagnosis because of overlapping clinical and radiological features with other vascular malformations. The etiology of AST remains largely unknown, although somatic mutations, particularly in the PIK3CA gene, have been identified. Clinically, patients typically exhibit persistent swelling and pain, with imaging modalities revealing infiltrative soft tissue masses. Diagnosis is frequently confirmed postoperatively as specific criteria remain absent. Differential diagnoses include conditions such as venous malformations and fibro-adipose vascular anomalies. Current treatment mainly involves surgical excision; however, the high recurrence rates necessitate further exploration of targeted therapies. This review aimed to systematically discuss the current understanding of AST, emphasizing the need for improved diagnostic and management strategies.
Background This study aimed to develop and evaluate a patient-centered decision aid (PDA) to support shared decision-making among individuals undergoing aesthetic breast surgery in China. Methods The Ottawa Decision Support Framework served as the theoretical foundation for the development of the tool, which was created through a multistage process that included a literature review, expert focus group interviews, and a pilot clinical application involving 20 patients. The PDA was implemented using a WeChat mini-program and structured into six core modules: assessment of decision-making, evaluation of support resources, information acquisition, provider selection, surgical plan selection, and decision evaluation. Expert panels, comprised of experienced clinicians and patients, assessed the importance of each component, with all primary indicators receiving scores above 4.75 on a five-point scale. Results Pilot testing revealed that PDA enhanced patient understanding of risks and benefits, elucidated values and preferences, reduced decisional regret, and improved communication efficiency between patients and clinicians. The qualitative interviews confirmed their practical utility and cultural adaptability. Conclusion This tool offers a structured, evidence-informed, and interactive platform to empower patients to make well-aligned decisions regarding aesthetic breast procedures. Future research should focus on scaling its application and exploring artificial intelligence integration to personalize decision support.
Background There is a notable scarcity of comprehensive bibliometric studies examining plastic surgery research across extended or recent timeframes and diverse regions in relevant journals. The major objective of this study was to comprehensively map historical trends and the global distribution of plastic surgery research efforts. Methods We conducted a comprehensive bibliometric analysis (using the Scopus database) of 35 core plastic surgery journals identified in these studies. All the data were extracted from the Scopus database in June 2025. The timeframe was set from 1946 to June 2025, and only original research and review articles were included in the detailed analysis. Countries were grouped into seven regions (Europe, Asia, Latin America, the Middle East, Africa, Australia, and New Zealand, and the United States as standalone categories) to examine regional publication trends. Results From 1946 to June 2025, 208 381 documents were published in 35 journals, of which 162 014 were eligible for analysis. The annual publication output has grown steadily, peaking at 8 277 by 2024. The United States led with 66 174 publications, followed by Europe (46 688), and Asia (31 785). Citation analysis of the top 100 regional papers revealed that the United States (70 530 citations) was the most impactful, followed by Europe (43 869), Asia (28 657), and Australia and New Zealand (23 409). The 100 most-cited papers globally accrued 78 833 citations, were dominated by United States-based contributions (71%), and were primarily published in Plastic and Reconstructive Surgery (57 papers). Chung KC, Mulliken JB, and Coleman SR emerged as the top authors (among the 100 most-cited global publications). Authors’ performance is presented as the number of publications, citations, h-index, g-index, m-index, HG composite, and Q2 index. Conclusion This study extends prior bibliometric investigations by offering a complete historical and geographical perspective on plastic surgery research. This inclusive, regionalized methodology provides a robust framework for future benchmarking and global equity assessments in surgical scholarship.
Primary congenital lymphedema (PCL) is a rare lymphatic disorder that typically presents in early life and is usually managed conservatively. In severe neonatal cases, however, complications such as skin necrosis and coagulopathy can occur. We report the case of a term male infant with prenatally diagnosed vascular malformations who presented with progressive limb swelling, hemorrhagic skin necrosis, and systemic signs of infection. Laboratory findings revealed severe thrombocytopenia and coagulopathy, consistent with Kasabach-Merritt-like phenomenon. The patient underwent staged surgical management, including limb decompression and debridement, followed by negative pressure wound therapy (NPWT), application of an acellular dermal matrix (ADM), and full-thickness skin grafting. The combined use of ADM and NPWT promoted rapid granulation tissue formation and neovascularization, resulting in stable wound coverage and successful limb preservation. Follow-up at 12 months showed excellent graft take, improved limb function, and no recurrence of necrosis or infection. This case highlights the potential role of integrating NPWT and regenerative scaffolds in managing complex neonatal wounds associated with PCL and Kasabach-Merritt-like phenomenon. To our knowledge, this is the first report describing such an approach in a neonate, offering a viable limb-salvaging strategy in otherwise life-threatening presentations.
Injectable embolism is among the most severe complications associated with facial cosmetic injections. Occlusion of blood vessels by filler materials can have devastating consequences, including skin necrosis, ulceration, blindness, hemiplegia, and even death. This review provides a comprehensive analysis of the etiology, anatomical considerations, and thrombolytic therapies for vascular embolism caused by common dermal fillers. These findings offer evidence-based insights to improve the clinical diagnosis and management of injection-induced embolism.
Background Bat ear is a congenital condition that can have psychological effects on patients and is readily correctable, often yielding highly satisfactory outcomes for both patients and surgeons. It is crucial to select appropriate techniques in the surgical plan to ensure optimal outcomes. This study aimed to compare the outcomes of otoplasty using the cartilage scoring technique versus the cartilage excision technique for correcting the antihelix. Methods Twenty patients were divided into two groups: group A underwent the cartilage scoring technique, and group B received the cartilage excision technique. Symmetry, satisfaction, and complications were evaluated and compared between the groups. A visual analog score (VAS) was used to assess the perceived symmetry and satisfaction in both groups. Results Group A (cartilage scoring technique) demonstrated excellent postoperative symmetry, with a total symmetry score of 96/100 on cartilage grading. In group B, 6 of the 10 individuals reported high satisfaction (score: 10/10 points on VAS), whereas the remaining 4 reported moderate satisfaction (score: 5–9/10 points). The total symmetry score in group B (cartilage excision technique) was 92/100, which was lower than that in group A. No relapses in angle measurements were observed in group A. In contrast, group B showed six average and four slightly overcorrected angle measurements. In group B, the postoperative measures were less satisfactory. Angle measurements were average angles in four cases, and somewhat overcorrected in six. Regarding the helix-to-mastoid distance, three cases were within the average range, whereas seven were slightly overcorrected. No relapses were observed in either group. Concerning complications, we employed minus scoring to measure all complications. Group A had a negative score of −19, whereas group B had −24. Conclusion The outcomes were highly satisfactory for patients and surgeons treated using the cartilage scoring technique, and relatively less satisfactory for patients and surgeons treated using the cartilage excision technique.
