BACKGROUND:Jaw-in-a-Day (JIAD) reconstruction-combining osseous free tissue transfer, dental implant placement, and intraoperative prosthesis delivery-provides immediate functional and psychosocial rehabilitation after segmental jaw resection. Despite increasing adoption, the existing evidence remains heterogeneous and inconsistently reported. METHODS:A scoping review was conducted following PRISMA-ScR guidelines. PubMed/MEDLINE was searched through April 2025 for studies reporting true JIAD cases, defined strictly as simultaneous free-flap reconstruction, implant placement, and intraoperative delivery of a functional prosthesis. Data were extracted on study design, indications, reconstructive methods, prosthetic variables, implant and flap outcomes, soft-tissue findings, functional recovery, and complications. RESULTS:Thirty-two studies (2009-2025) met inclusion criteria, describing 274 JIAD patients. Most reports were single-center case reports or series (77% Level IV-V evidence) and originated from the United States, with publication frequency increasing sharply after 2021. Reconstruction involved the mandible in 82% of cases, predominantly using fibula flaps (> 95%). Immediate prostheses were fixed in 95% and nearly always provisional, with definitive prosthesis typically delivered 3-6 months postoperatively. Implant survival ranged 87.5%-100% across short- to mid-term follow-up intervals. Maxillary reconstructions and intraoral skin paddles were each associated with increased implant complications in isolated cohorts, but these findings were not replicated. A dedicated series reported peri-implant reactive tissues in 21% of implants, managed with local soft-tissue procedures. Flap survival remained high (92%-100%), and functional recovery was typically rapid, although no study employed validated patient-reported outcome measures. One comparative cohort suggested lower osteoradionecrosis rates when implants were placed before adjuvant radiation, though sample size was small. CONCLUSIONS:JIAD reconstruction yields high implant and flap survival with encouraging early functional outcomes. However, the evidence base is limited by small samples, short follow-up, and inconsistent reporting. Standardized definitions, validated outcome measures, and multicenter prospective studies are needed to clarify long-term durability and refine patient selection.

BACKGROUND:Traditional intraoperative flap assessments like capillary refill and distal bleeding can provide insight on flap viability and circulation; however, it is difficult to assess the cause of the vascular compromise or detect early "subclinical" thrombosis. This study was designed to determine the sensitivity and specificity of indocyanine green angiography (ICGA) in detecting subclinical intraoperative thrombosis during HN-MFTT. METHODS:A retrospective cohort study was performed on HN-MFTT cases at a single institution. Flaps where ICGA was employed after completing the anastomosis were reviewed. The frequency of subclinical intraoperative thrombosis was compared between cases with normal and abnormal ICGA prompting vessel exploration. RESULTS:A total of 67 patients who had intraoperative ICGA were included (male, 55 [82.1%]; median age, 64 [interquartile range, 56-72]). Most underwent anterolateral thigh (n = 56, 83.6%), fibula (n = 13, 19.4%), or radial forearm (n = 12, 17.9%) reconstruction. Of the flaps included, 11 (16.5%) had abnormal ICGA and 9 (13.4%) had subclinical thrombosis. For predicting subclinical thrombosis, abnormal ICGA had a sensitivity of 100% (95% CI: 66.4-100), specificity of 96.6% (95% CI: 88.1-99.6), positive predictive value of 81.8% (95% CI: 48.2-97.7), and negative predictive value of 100% (95% CI: 93.6-100). There was no significant difference in takebacks, flap loss, and complications between those with normal and abnormal ICGA (p > 0.05 for all tests). CONCLUSION:ICGA is a sensitive and specific technique for detecting intraoperative, subclinical thrombosis during HN-MFTT in properly selected patients. This warrants future research to define indications for ICGA use and evaluate how this technology affects clinical outcomes.

Introduction: This study introduces a comprehensive algorithmic approach for treating nasal dermoids with intracranial extension. The primary goals of this algorithm are to achieve complete resection of the dermoid while minimizing surgical morbidity. By providing surgeons with a clear, structured decision-making process, the algorithm aims to optimize surgical outcomes and ensure patient safety.

OBJECTIVE:The majority of maxillofacial trauma research is limited to objective and clinician-rated outcome metrics. This review was designed to characterize topic domains of patient-reported outcome measures (PROMs) previously used in the field. DATA SOURCES:PubMed, Cochrane, Scopus, and CINAHL. REVIEW METHODS:Publications through March 2025 reporting at least one PROM in maxillofacial trauma patients were included. Study metadata was recorded, and survey instruments were classified as established PROMs or "custom surveys." Each instrument was analyzed, and key topic domains were characterized. PRISMA-ScR guidelines were followed. RESULTS:Ninety-six studies from 23 different countries were identified. They included patients with mandible fractures (n = 38, 39.6%), midface fractures (n = 16, 16.7%), or both (n = 42, 43.8%). There were 73 studies that used 39 unique, established PROMs. These incorporated six key domains: Psychosocial Function (n = 32, 82.1%), Facial Function (n = 13, 33.3%), Facial Appearance (n = 9, 23.1%), Pain (n = 15, 38.5%), Daily Tasks (n = 14, 35.9%), and Satisfaction with Outcome (n = 5, 12.8%). The most common instruments were the Hospital Anxiety and Depression Scale (HADS), Oral Health Impact Profile (OHIP-14), Mandible Function Impairment Questionnaire (MFIQ), and the Short Form (SF) survey. Forty studies developed at least one custom survey question. These were more likely to address Facial Function (n = 23, 57.5%), Pain (n = 20, 50%), Facial Appearance (n = 15, 37.5%), and Satisfaction with Outcome (n = 13, 32.5%). CONCLUSION:PROMs used in maxillofacial trauma research are heterogeneous. Most address psychosocial function while only a minority address facial function and appearance. The six key domains identified here may be used to guide the development of novel PROMs.

BACKGROUND:There is a paucity of validated, patient-reported outcome measures for quality-of-life (QOL) in craniomaxillofacial (CMF) trauma. OBJECTIVE:To determine whether the Integrated Modular Patient-Reported Outcome Assessment for Craniomaxillofacial Trauma (IMPACT) independently measures QOL in patients presenting for routine follow-up within 3 months of injury by comparing with the 15-Dimension QOL survey (15D). METHODS:A mixed-methods, pilot validation was performed via literature review, expert opinion, patient interviews, and prospective survey collection. Criterion validity was determined by multivariable adjusted correlation coefficients (B) between IMPACT and 15D scores. Reliability was assessed by Cronbach's alpha (A). RESULTS:General (IMPACT-G), Nasal (IMPACT-N), Orbit (IMPACT-O), and Jaw (IMPACT-J) modules were developed. Domains include overall satisfaction, facial function, facial appearance, psychosocial function, general symptoms, and pain. Validation was performed in 53 patients with CMF trauma who had mandible (n = 27, 50.1%), nasal (n = 10, 18.9%), zygomaticomaxillary complex (n = 7, 13.2%), Le Fort (n = 6, 11.3%), and/or other fracture patterns. IMPACT scores independently predicted QOL (B > |0.4|; p < 0.05) and reliability was high (A >0.8; p < 0.05). CONCLUSIONS:The IMPACT was developed to measure QOL in patients suffering CMF trauma, and results from this initial validation study warrant expansion to a larger, diversified cohort.

A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors. Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed. A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]). Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.

Study Design Retrospective review.Objective Auricular hematomas are generally associated with sports-related injuries, with studies predominantly in white populations and high neighborhood socioeconomic status (NSES) compared to our county. A previous population-based study of trauma patients in our county, Shelby County, Tennessee, shows that those who live in high vs low NSES experienced socioeconomic variation in injury. We aim to determine if differences exist in clinical management and outcomes in this population.Methods Patients from two hospital systems diagnosed with auricular hematomas from 2008-2023 were reviewed retrospectively. Inclusion criteria included adequate follow-up, clinical description of the hematoma, and comment on any complications or recurrence.Results 48 patients, with a median age of 28 (range: 0-83), with the most common etiology being assault/non-accidental trauma (NAT) at 41.7%, equally distributed across all NSES (P = .30), with one sports-related injury. Facial trauma consults were associated with lower recurrence rates, 25% vs 62.5% (P = .003) and were less likely to be placed for self-pay patients (P = .019). Bolster placement resulted in lower recurrence rates, 23.3% compared to 58.3% (P = .030).Conclusions Higher rates of assault/NAT etiologies existed in our population, independent of NSES. Our study reiterates the importance of facial trauma consultation and bolster usage to reduce recurrence.

Abstract Objective To evaluate the feasibility and outcomes of porcine submucosal allograft (Biodesign Sinonasal Repair Graft [Cook Medical, Bloomington, IN]) in oral cavity and oropharynx reconstruction after ablative surgery. Methods We conducted a prospective and retrospective review of patients who underwent Biodesign Sinonasal Repair Graft reconstruction for oral and oropharyngeal surgical defects at a single institution between 2018 and 2020. A total of 11 patients were included in the study. Data points included their perioperative medical and demographic data, immediate postoperative course, and follow‐up visits at 10 days and at 2 months. The clinicopathologic characteristics of their disease, postoperative esthetic, and functional outcomes were recorded and analyzed. Results Eleven procedures have been performed, and all patients received Biodesign reconstruction either immediately after ablation or after they failed a previous reconstruction. None of the patients had bone exposure. The subsites included oral tongue (n = 6), floor of the mouth (n = 3), buccal mucosa (n = 1), and soft palate (n = 1). In all cases, the operations and the postoperative course were uneventful. The mean defect size was 22 cm2. The median start of oral intake was at 2 days postoperatively. The Biodesign graft healed well in all patients with no total graft loss. There was one complication that required revision surgery due to obstruction of Wharton's duct by the Biodesign material. Conclusions Biodesign can be a viable option for small and medium‐sized oral and oropharyngeal defects in patients who are medically unfit or do not want to undergo a free flap surgery. Level of Evidence 4.

INTRODUCTION:Patients undergoing adenotonsillectomy (T&A) for severe obstructive sleep apnea (OSA) are usually admitted for observation, and many surgeons use the intensive care unit (ICU) for observation due to the risk of postsurgical airway obstruction. Given the limited resources of the pediatric ICU (PICU), there is a push to better define the patients who require postoperative monitoring in the PICU for monitoring severe OSA.METHODS:Forty-five patients were evaluated. Patients who had cardiac or craniofacial comorbidities were excluded. Patients undergoing T&A for severe OSA were monitored in the postanesthesia care unit (PACU) postoperatively. If patients required supplemental oxygen or developed hypoxia while in the PACU within the 3-hour monitoring period, they were admitted to the PICU.RESULTS:Overall, 16 of 45 patients were admitted to the ICU for monitoring. Patients with an Apnea-Hypopnea Index (AHI) >50 or with an oxygen nadir <80% were significantly more likely to be admitted to the PICU. The mean AHI of patients admitted to the PICU was 40.5, and the mean oxygen nadir was 69.9%. Patients younger than 2 years were significantly more likely to be admitted to the PICU.CONCLUSION:Based on the data presented here and academy recommendations, not all patients with severe OSA require ICU monitoring.

Objective The iliac crest is the gold standard for cancellous bone grafting. This site is distant from head and neck reconstruction and may lead to significant postoperative morbidity. We propose an alternative harvest site within the head and neck with potentially less mobility deficits, the manubrium. Study Design Fresh-frozen cadaveric study. Setting Gross anatomy laboratory. Subjects and Methods Access to 18 cadavers was granted from the Medical Education and Research Institute in Memphis, Tennessee. The anterior iliac crests were exposed and H-type osteotomies performed. The manubrium was accessed through a substernal notch incision and a cortical window created through the anterior manubrium. Cancellous bone was harvested from these sites. Cadaveric demographics and noncompressed and compressed volumes were recorded with statistical comparisons. Results The population was predominantly male (12/18) with a mean age of 69.6 (95% confidence interval [CI], 64.0-75.3) years. The mean body mass index was 22.9 (95% CI, 18.8-27.1) kg/m2 with no sex propensity. Uncompressed volumes did not vary, ranging from 6.4 to 7.5 mL. Compressed volumes (mL) for the right iliac crest (4.3; 95% CI, 3.0-5.6), left iliac crest (3.5; 95% CI, 2.7-4.2), and manubrium (2.4; 95% CI, 1.8-3.0) varied (1-way analysis of variance: F(2, 51) = 4.63; P < .02). Furthermore, there was correlation between compressed volumes taken from either area ( r = 0.58; P < .02). Conclusions The manubrium can be used for cancellous bone grafting. This site affords a proximity to the head and neck rather than the distant iliac crest but with slightly lower yields. Potential applications include reconstructing small mandibular defects, mandible nonunion, or alveolar bone grafting.

Background: Cosmetic and reconstructive surgery relies extensively on the complex relationship between skin, soft tissue and the underlying bone skeleton. Soft tissue loss and acquired soft tissue deficits are some of the daily challenges faced by the plastic surgeon. Fat grafting has become one of the standard lines of care that has various applications in plastic surgery treatments. The ability of adipose stem cells to rejuvenate tissues is promising for plastic surgery. Bone disorders, including infection and poor healing, pose vexing problems to the reconstructive surgeon. Vascular surgery is a technique necessary for the reconstruction of the most challenging surgical defects, and has great potential for improvement through technology. Methods: We performed a structured search of all recent United States Patents with reference to plastic and reconstructive surgery. Two investigators then reviewed all patents with specific applications to plastic and reconstructive surgery, and regenerative medicine. Results: Eight specific patents were included for review in this article. Conclusion: Recent patents discussed in this article demonstrate promise to dramatically improve a number of specific patient conditions. Nanoscale refinements of current techniques may offer more efficient and improved surgical and non-surgical approaches for reconstruction. Such refinements will significantly expand our capabilities for innovative reconstructive interventions, with high efficiency, specificity and minimal invasiveness. Keywords: Bone reconstruction, fat graft vascular surgery, nanotechnology, patent, plastic and reconstructive surgery.

Aim: Limb salvage is the treatment of choice for lower extremity bone sarcomas in children. To date, peers have not described algorithms for soft tissue reconstruction of these defects. This paper is to report a large single center series of lower extremity salvage after sarcoma treatment, with algorithm.

Aim: Negative pressure wound therapy (NPWT) has been studied extensively in adult patients, but less is known about pediatric patients.This study assesses the efficacy and safety of vacuumassisted closure ® usage in pediatric oncology patients.Methods: Retrospective data on all patients treated with NPWT at a single pediatric oncology hospital were collected between April 2005 and September 2013.Details on pre-treatment factors, treatment course, and post-treatment events were collected.No control group was available for comparison.Results: Sixty-six patients were identified, with a total of 74 wounds.Median age at the time of NPWT application was 13 years (range, 10 months-23 years).Median duration of treatment was 21 days (range, 3-236 days).NPWT therapy was started with continuous high negative pressures (125 mmHg) in most patients.Sixty-nine percent of patients had their wounds healed without intervention, and 20% of patients required surgical closure.NPWT was discontinued temporarily secondary to skin maceration or cellulitis in 12% of patients.NPWT was used in a number of non-standard clinical situations, including primarily-closed incisional wound NPWT and bridging NPWT through adjuvant chemotherapy.Conclusion: In pediatric oncology patients, NPWT is safe, effective, and well-tolerated.Although this study is retrospective in nature, and there was no control group for comparison, these data are important for clinicians to guide therapy as device monitoring agencies and payors increasingly require outcomes data for the approval of therapeutic decisions.

Satisfactory treatment of burn pain continues to be elusive. The perioperative period is particularly challenging. The contributions of acute tolerance and opioid-induced hyperalgesia have not been previously explored in burn patients. As these phenomena have been identified perioperatively in other patient populations, we sought to characterize the burn perioperative period and to determine variables associated with poor postoperative (post-OR) pain control. A retrospective review of 130 adult burn patients who underwent surgical treatment for their burn injuries was performed. Variables collected included: demographics, burn injury data, perioperative self-reported pain scores, and perioperative opioid amounts. Correlations and multiple logistic regressions were used to assess the relationship between these variables and post-OR pain control. Pain increased throughout the perioperative period from 2.64 24 hours prior to the operation (pre-OR) to 3.81 24 hours following the OR (post-OR, P < .0001). Post-OR pain was correlated with pre-OR pain, pre-OR opioid amounts, OR opioid amounts, and post-OR opioid amounts. When the subgroup of patients with controlled pre-OR pain (<3 pain rating) was analyzed, only pre-OR opioids and post-OR opioids remained correlated with worse post-OR pain. While this study is retrospective, there is a suggestion that opioid amounts given pre-OR and intraoperatively are correlated with worse post-OR pain. While an increase in pain ratings postoperatively are anticipated, the additional contributions of acute tolerance and opioid-induced hyperalgesia need to be determined. Pharmacologic intervention directed at these mechanisms can then be administered to achieve better postoperative pain control.

The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. During a 2-year period, 282 patients, 59.4% of all burn patients transferred from outside hospitals, were enrolled in the study. In addition to the scripted call with the charge nurse (ChargeRN) and the accepting physician, nine hospitals also transmitted video images of the wounds before transfer as part of a store and forward telemedicine transfer program (77, 27.6%). The accuracy of burn size estimations (BSA burned) and management changes (fluid requirements, transfer mode, and final disposition) were analyzed between the telephones-only sites (T only) and the video-enhanced sites. Referringstaff participating in video-enhanced telemedicine were sent a Google survey assessing their experience the following day. The referring staff (Referringstaff) was correct in their burn assessment 20% of the time. Video assessment improved the ChargeRN BSA burned and resulted in more accurate fluid resuscitation (P =.030), changes in both transportation mode (P =.042), and disposition decisions (P =.20). The majority of the Referringstaff found that video-enhanced telemedicine helped them communicate with the burn staff more effectively (3.4 +/- 0.37, scale 1-4). This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with the addition of video to a telephone-only transfer program.

A Case Series of Virtual Surgical Planning in Mandibular Reconstruction Jon P. Ver Halen1*1, Anas Eid1 1Division of Plastic and Reconstructive Surgery, Baptist Cancer Center 2Department of Surgery,Vanderbilt-Ingram Cancer Center, Nashville, TN *Corresponding author: Dr. Jon P. Ver Halen, Division of Plastic, Reconstructive and Hand Surgery, Baptist Cancer Center Research Faculty, Vanderbilt Ingram Cancer Center Adjunct Clinical Member, St Jude Children’s Research Hospital, United States, Tel: (901)227-9820; Fax: (901) 227 9825; Email: jpverhalen@gmail.com Received: 05-25-2015 Accepted: 07-08-2015 Published: 07-16-2015 Copyright: © 2015 Jon Original Article

Cosmetic and reconstructive surgery relies extensively on the complex relationship between skin, soft tissue and the underlying bone skeleton. Soft tissue loss and acquired soft tissue deficits are some of the daily challenges faced by the plastic surgeon. Fat grafting has become one of the standard lines of care that has various applications in plastic surgery treatments. The ability of adipose stem cells to rejuvenate tissues is promising for plastic surgery. Bone disorders, including infection and poor healing, pose vexing problems to the reconstructive surgeon. Vascular surgery is a technique necessary for the reconstruction of the most challenging surgical defects, and has great potential for improvement through technology. Recent patents discussed in this article demonstrate promise to dramatically improve a number of specific patient conditions. Nanoscale refinements of current techniques may offer more efficient and improved surgical and non-surgical approaches for reconstruction. Such refinements will significantly expand our capabilities for innovative reconstructive interventions, with high efficiency, specificity and minimal invasiveness. Keywords: Bone reconstruction, fat graft, nanotechnology, patent, plastic and reconstructive surgery, regenerative medicine, vascular surgery.