Objective: To evaluate the clinical application of a dynamic skin temperature monitor combined with structured nursing handover in postoperative skin flap monitoring and to assess its impact on the early identification of vascular crisis and flap prognosis. Methods: A retrospective analysis was performed on 46 patients undergoing free flap transplantation in the Department of Orthopedics of a tertiary class A hospital between July 2025 and May 2026. Patients assigned to the preprotocol group (July 2025 to December 2025, n=29) received routine clinical monitoring and traditional verbal nursing handover. For the postprotocol group (January 2026 to May 2026, n=17), continuous skin temperature monitoring with a dynamic skin temperature monitor was implemented, alongside a structured nursing handover process based on the Microsurgery Skin Flap Postoperative Registration Form and an immediate notification mechanism for abnormal data. The primary outcomes included vascular crisis incidence and flap survival rate, while secondary outcomes covered the time from abnormality detection to intervention, handover completeness score, and nurse satisfaction. Results: Among the 46 patients undergoing free flap transplantation, the overall vascular crisis incidence was 17.4% (8/46). The postprotocol group had a lower vascular crisis rate compared with the preprotocol group (11.8% vs. 20.7%, P =0.441). Time from abnormality to detection was significantly shorter in the postprotocol group (15.5±4.9 min vs. 52.3±20.0 min, P =0.002), as was time from detection to intervention (22.0±9.9 min vs. 39.2±8.0 min, P =0.018). Handover completeness scores improved from 70.7±9.4% to 92.2±4.2% ( P <0.001), and information omission items decreased from 3.1±1.3 to 0.3±0.7 ( P <0.001). The AUC for temperature monitoring in diagnosing vascular crisis was 0.92 (95% CI: 0.86-0.98). Conclusion: The combination of dynamic skin temperature monitoring and structured nursing handover was associated with earlier identification of vascular crisis, shorter detection-to-intervention intervals, and improved nursing handover quality in patients undergoing flap surgery. These findings suggest that the integrated protocol may be associated with improved postoperative outcomes. However, the retrospective before-and-after design cannot eliminate the interference of temporal trends and other secular confounding factors, which precludes definitive causal inference.
BACKGROUND Plastic surgeons commonly irrigate breast implant pockets with antimicrobial solutions to reduce the risk of capsular contracture. Since its introduction ∼ a decade ago, 0.025% hypochlorous acid irrigation has been adopted in many practices. However, a review of this method has not been published. METHODS A literature review was conducted to identify publications that evaluated hypochlorous acid for breast implant pocket irrigation. RESULTS The literature search produced 13 publications, all appearing in the Aesthetic Surgery Journal, including 3 laboratory studies and 2 clinical chart reviews. The first study, published in 2021, evaluated 71 breast augmentation patients undergoing revision for capsular contracture. The authors reported 3 recurrences (4.2%). The second study, published in 2026 by the same senior author, evaluated patients undergoing primary breast augmentation who were treated with various irrigation solutions, including 40 women who received hypochlorous acid irrigation. The inclusion rate was 62.6%. No capsular contractures were reported for this subset of patients. Most publications included authors with financial conflicts of interest, such as equity ownership, employment, or medical advisory positions with the product's manufacturer. One laboratory study by unconflicted investigators was not supportive. DISCUSSION No microorganism has been linked to this common complication. The 2 clinical studies are affected by selection bias and conflict of interest, undermining reliability. No independent researchers have corroborated a reduced capsular contracture rate. CONCLUSIONS Both clinical studies have limitations that undermine the reliability of the authors' conclusions. Without knowledge of a responsible microbe to target and of a change in the breast microenvironment, the scientific rationale for antimicrobial breast pocket irrigation remains unclear.
BACKGROUND Surgical ablations of eyelid tumors, trauma, and burns, which encroach on the tarsal plate and eyelid margin, often create full-layer eyelid defects. However, the reconstruction of defects with marginal loss presents a challenge for plastic surgeons. In this report, we present a new modified surgical technique using "∏" flaps depending on the arterial arch of the palpebral margin to reconstruct eyelid defects with minimal loss. METHODS We reviewed 39 patients who underwent surgery using this technique from 2010 to 2021. "∏" Flaps, which include the tarsal plate, the conjunctiva, the orbicularis muscle, and the skin, were designed on 2 sides of the defect and then advanced horizontally to close the defect. RESULTS All the flaps survived with satisfactory functional and aesthetic outcomes. One minor complication occurred 1 month after the operation: dry eyes (n=1), which was improved 6 months later. CONCLUSION This technique can be readily used for moderate and large full-layer defects (1/6 to 1/2 involvement) with marginal loss of the upper/lower eyelid, not exceeding the upper edge of the tarsal plate. By using neighboring tissue, reconstruction can achieve pleasing aesthetic outcomes. LEVEL OF EVIDENCE Level IV-therapeutic study.
BACKGROUND Chronic nonhealing wounds represent a major complication of diabetes mellitus and impose a substantial clinical burden worldwide. Impaired reparative function of Schwann cells (SCs), along with the subsequent loss of paracrine repair signals, has been identified as a critical pathologic driver of delayed diabetic wound healing. Decellularized dermal matrix hydrogels have emerged as promising biomimetic platforms for local factor delivery and tissue regeneration. Nevertheless, the therapeutic potential of combining SC-derived conditioned medium with decellularized extracellular matrix hydrogels (dECMMA) for diabetic wound repair remains unexplored. MATERIALS AND METHODS In this study, a photocrosslinkable methacrylated porcine dermal dECMMA loaded with RSC96 SC conditioned medium (dECMMA@RC) was fabricated. The microstructure of the hydrogels was characterized through scanning electron microscopy. In vitro, cytocompatibility, cell proliferation, and migration were evaluated in L929 fibroblasts, and pro-angiogenic capacity was assessed using a human umbilical vein endothelial cell tube formation assay. In vivo, full-thickness skin wounds were established in streptozotocin-induced type 1 diabetic mice. Wound healing outcomes were systematically evaluated by gross observation, histologic staining, immunofluorescence, and quantitative real-time polymerase chain reaction. RESULTS The dECMMA@RC hydrogel maintained a favorable porous microstructure and exhibited no obvious cytotoxicity. Compared with the control and pure dECMMA groups, dECMMA@RC significantly promoted L929 cell proliferation and migration, as well as capillary-like tube formation of human umbilical vein endothelial cells in vitro. In diabetic mice, dECMMA@RC treatment markedly accelerated wound closure, enhanced reepithelialization, and increased the number of regenerated hair follicles and sebaceous glands. Mechanistic analysis revealed that dECMMA@RC downregulated the mRNA levels of pro-inflammatory cytokines (interleukin-6, tumor necrosis factor alpha), and upregulated the expression of angiogenic markers (CD31, VEGF-A) and neuroregenerative markers (growth associated protein 43, nerve growth factor) in wound tissues. CONCLUSIONS The dECMMA@RC composite hydrogel effectively accelerates diabetic wound healing through the synergistic effects of anti-inflammation, pro-angiogenesis, and neuroregeneration. This strategy provides a novel and feasible approach for the development of bioactive dressings for chronic diabetic wounds.
