The objective of this report was to present the successful management of a severely compromised breast following multiple implant failures, wound-healing complications, and infections. A 40-year-old female patient presented to our center with a severely compromised breast after treatment for breast cancer. Clinical examination revealed marked volume deficiency of the left breast, resulting in pronounced breast asymmetry compared with the right breast, following multiple infections and prior interventions. Our therapeutic approach was to reconstruct the breast using an muscle-sparing type II transverse rectus abdominis myocutaneous (MS-2 TRAM) flap followed by refinement with lipofilling. The reconstructed breast showed a stable and aesthetically satisfactory outcome, objectively documented during the 25-month follow-up using VECTRA 3D imaging and patient-reported outcome measures. This case demonstrates the potential of autologous tissue for breast reconstruction and may aid preoperative decision-making in complex reconstructive scenarios.
Postsurgical pyoderma gangrenosum (PSPG) is a rare, noninfectious neutrophilic dermatosis that can occur after breast surgery. Because it closely mimics a surgical site infection, the diagnosis is often delayed, and repeated surgical interventions may aggravate the disease through pathergy and result in extensive tissue loss and poor aesthetic outcomes. Therefore, early diagnosis is important. We report two cases of PSPG following breast surgery with contrasting clinical courses associated with delayed vs. early recognition. In Patient A, bilateral wound necrosis was misdiagnosed as an infection and treated accordingly, which led to multiple surgical interventions, including implant removal, flap reconstruction, and skin grafting. In Patient B, who presented with a similar picture, PSPG was suspected at presentation and systemic corticosteroid therapy was started one week after surgery, followed by rapid clinical improvement with the need for only one superficial necrosectomy after disease stabilization, which led to an acceptable aesthetic outcome. These cases show that atypical postoperative wound ulcerations or healing disturbances after breast surgery should raise suspicion of PSPG, particularly when cultures remain negative and wounds fail to respond to antibiotics. Increased awareness may allow earlier immunosuppressive treatment and help to avoid unnecessary surgical procedures.
Nasal septum reconstruction is an essential component of a successful rhinoplasty for both nasal cosmesis and function. In this review, we provide both historical strategies and contemporary updates in nasal septum surgery. Conventional septoplasty involves removal of deformed septal cartilage, with care taken to maintain the integrity of the dorsal and caudal cartilaginous L-strut and avoid opposing mucoperichondrial flap perforations that can cause septal perforations after the healing period. When these conditions cannot be met, advanced septal reconstruction techniques may be required to address caudal septal deviation, dorsal septal deviation, and septal perforations, including extracorporeal structural reconstruction in particularly severe cases. Recent refinements of these more extensive techniques also include subtotal and anterior modifications to total septal reconstruction to better preserve the keystone area and dorsal preservation techniques to minimize disruption of aesthetically desirable aspects of the native nose. We conclude with an algorithmic pathway containing major considerations that highlight advantages of each technique described in this review to guide the rhinoplasty surgeon toward appropriate maneuvers to achieve the desired cosmetic and functional result in septal reconstruction.
Aim: This systematic review and meta-analysis aims to evaluate the efficacy and safety of postoperative radiotherapy following surgical excision, with or without reconstruction by flap, for patients with ear keloids. Methods: A comprehensive literature search was performed in PubMed, Cochrane Library, ScienceDirect, and EBSCOHost through August 2025. We included randomized controlled trials, cohort studies, and case series involving patients with ear keloids treated with surgical excision and postoperative radiotherapy, with or without flap reconstruction. Data of recurrence, complications, aesthetic outcomes, and patient satisfaction were abstracted and analyzed. Results: Fourteen studies were included based on the criteria, with 735 treated keloids in total. Pooled recurrence proportions were 7.8% [95% confidence interval (CI): 0.0%-16.0%] in studies reporting excision with flap reconstruction plus postoperative radiotherapy and 20.0% (95%CI: 5.2%-34.8%) in studies reporting excision plus postoperative radiotherapy without flap reconstruction. Reported adverse effects were generally mild, most commonly pigmentary change and hypertrophic scarring; flap-related events were uncommon. However, long-term oncologic risk could not be reliably assessed, as most included studies had limited follow-up and were not designed to detect rare late events. Cosmetic outcomes and patient satisfaction were frequently reported as favorable across the subset of studies that assessed these outcomes. Conclusion: Postoperative radiotherapy is commonly reported as an effective adjuvant after excision of auricular keloids, with relatively low recurrence and generally mild short-term adverse effects. Cosmetic outcomes and patient satisfaction were frequently favorable, although interpretation is limited by substantial heterogeneity and predominantly non-comparative observational evidence, underscoring the need for well-designed comparative studies with standardized outcome reporting.
Adipose-derived stem cells (ADSCs) have emerged as a pivotal tool in the paradigm shift of plastic and reconstructive surgery from traditional tissue transposition toward regenerative medicine, owing to their abundance, minimally invasive harvesting, and potent regenerative capabilities. Beyond their multilineage differentiation potential, the therapeutic efficacy of ADSCs is increasingly attributed to their sophisticated paracrine activity and exosome-mediated signaling. This review provides a comprehensive synthesis of the biological characteristics of ADSCs, their underlying molecular mechanisms, and their diverse clinical applications in plastic surgery. We discuss the orchestrated roles of the ADSC secretome in promoting neoangiogenesis, modulating the immune microenvironment, and regulating extracellular matrix remodeling. Clinically, we highlight the latest evidence for cell-assisted lipotransfer (CAL) in fat grafting, the acceleration of chronic wound healing, anti-fibrotic strategies for scar management, and the emerging role of ADSCs in facial rejuvenation and anti-aging. While issues regarding standardization and long-term oncological safety remain, the integration of ADSCs with biofabrication and cell-free therapies represents a promising frontier. Ultimately, ADSCs hold the potential to achieve functional and scarless tissue regeneration and may redefine the future of plastic and reconstructive surgery.
