The aim of this manuscript was to describe a surgical technique to modify Tapia's flap for malar volume enhancement, to describe the results of an anatomical study of the transverse facial artery, and to present the results of a retrospective analysis of 42 clinical cases who received this flap as part of their facelift procedure. Tapia et al originally described a flap from the superior part of the superficial muscular aponeurotic system (SMAS) for malar enhancement during facelifting procedures. The flap remained attached at its base (random-type vascularization) and was folded to the malar area. This report presents a modification of this technique, raising the flap as an island, irrigated by the perforator of the transverse facial artery (which is consistently present at the inferolateral border of the zygoma). The flap is completely isolated as an island and is rotated 180° as a propeller to be placed in the prezygomatic space. The donor area is closed directly by advancement of the subcutaneous-SMAS during the facelifting procedure. The immediate postoperative period was uneventful in all patients. Flap viability was proved intraoperatively by indocyanine green staining. A series of 42 patients underwent this procedure from 2022 to 2024. Long-term results-evaluated clinically and with ultrasonography at 1 month and 1 year postoperatively-revealed that the volume remained permanent without reabsorption. Patient satisfaction evaluated with a satisfaction scale indicated in a high rate of excellent results. An anatomical study was performed in 14 fresh cadaveric specimens (28 hemifaces). The cutaneous branches of the transverse facial artery were dissected from their origin. These branches were consistently present in all the specimens, giving branches to the subcutaneous-SMAS system. This modification of the original Tapia flap reinforces its vascularization. It allows better flap placement and a longer medial reach in the tear trough area. Complete flap survival and long-term volume preservation was observed. Level of Evidence: 4 (Therapeutic).

BACKGROUND:Fluorescence-guided surgery has expanded across multiple surgical specialties, but current patterns of adoption and implementation in Latin America remain incompletely described. This study assessed current use, perceived value, barriers, and readiness for regional collaboration. METHODS:We conducted a multinational observational survey distributed to 100 surgeons in Latin America. The invited cohort represented a purposive convenience sample identified through regional professional networks. Survey domains included institutional availability, clinical indications, platform use, workflow access, perceived safety and benefit, barriers to implementation, reimbursement, and interest in collaborative data initiatives. RESULTS:Among surveyed respondents, fluorescence-guided surgery is established in parts of Latin America but not yet standardized. Use was most often selective rather than routine, indicating that access is present in many institutions but remains indication dependent. Adoption was concentrated in high-resource settings, particularly tertiary and specialized centers in major metropolitan areas. Clinical use spanned biliary, breast, urologic, and gastrointestinal perfusion applications, with indocyanine green as the dominant fluorophore. Operational access remained constrained, with many respondents reporting shared or inconsistent operating room availability. Barriers were primarily economic and logistical, including limited operating room access, equipment cost, indocyanine green cost, and absent or uncertain reimbursement. Surgeons nevertheless reported favorable safety perceptions, perceived clinical benefit, and strong willingness to participate in regional registries and data sharing. CONCLUSION:Among surveyed surgeons and participating practice settings, fluorescence-guided surgery implementation was heterogeneous and most often selective rather than routine. The findings should not be interpreted as regional prevalence estimates. Broader implementation may depend on operational access, financing, training, and coordinated data collection in more representative regional cohorts.

INTRODUCTION:Failure to successfully delineate ureters during pelvic surgery carries significant risks. The ureters are the most commonly injured retroperitoneal structures, and ureteral injuries are associated with prolonged hospital stays, higher health care costs, and increased morbidity. In this meta-analysis, we compared the retrograde ureteral injection of indocyanine green and ureteral stents to visualize ureters and prevent ureteral injury and other urinary tract complications during pelvic surgery. METHODS:Thorough reviews of PubMed, Embase, and Scopus were conducted to identify all studies evaluating the efficacy of retrograde ureteral indocyanine green injections and/or ureteral stents for ureteral injury prevention. Strict inclusion criteria were applied, incorporating a Modified Downs and Black Assessment score. Because no studies comparing these 2 approaches directly were identified, indirect comparisons were performed contrasting rates of successful stent or indocyanine green placement, ureteral injury, and urinary tract complications, including the Pearson χ2 or Fisher exact test and odds ratios with 95% confidence intervals. RESULTS:Twenty and 17 studies were eligible for meta-analysis for stents and indocyanine green, encompassing 25,784 and 569 patients, respectively. All 1,009 ureters that were injected with indocyanine green were injected successfully versus the successful insertion of only 99.1% of the 5,202 ureteral stents for which this approach was reported (P = .001). Ureteral injuries and other urinary tract complications occurred in 0.18% and 2.16% of ICG patients versus 1.12% and 11.58% of stent patients (P = .02 and P < .001), respectively. CONCLUSION:Although direct comparisons remain necessary, evidence suggests that retrograde intraureteral injections of indocyanine green are at least as good at preventing ureteral injury as stents, with a much lower rate of other urinary tract complications.

INTRODUCTION:Indocyanine green (ICG) fluorescence angiography is widely implemented for flap perfusion assessment. YouTube is commonly used for procedural learning despite variable educational rigor. This study evaluated the quality and reliability of YouTube videos on ICG-assisted flap perfusion and examined whether popularity metrics reflect educational value. METHODS:Videos were systematically identified and assessed using the Global Quality Score, modified DISCERN, and a procedure-specific Medical Content Index. Popularity metrics included views per day, like ratio and video power index. RESULTS:Twenty-nine videos were included. Perceived quality was generally high, but reliability and content completeness varied. Popularity metrics were strongly intercorrelated but did not correlate with overall educational quality. Higher like ratio was associated with greater reliability and completeness, whereas higher views per day predicted lower reliability. CONCLUSIONS:Viewer engagement metrics do not reliably indicate educational quality of YouTube content on ICG-assisted flap perfusion. Peer-informed standards are needed for online surgical education.

Facial nerve (FN) dysfunction remains a clinically important complication of parotidectomy, even when recovery is ultimately complete. Traditional nerve identification relies on anatomic dissection, selective stimulation, and, in many cases, intraoperative monitoring (IONM). These approaches may be limited when anatomy is distorted. This study evaluated the feasibility, safety, and utility of autofluorescence-guided FN identification during parotidectomy. A retrospective case series was conducted in 18 patients who underwent superficial or total parotidectomy for parotid gland tumors. All procedures were performed by the same surgical team using standard operative technique and selective electrical nerve stimulation. Near-ultraviolet (NUV) autofluorescence imaging was obtained immediately after FN exposure and before further dissection. Raw grayscale and real-time colored overlay images were acquired. Quantitative image analysis was performed using manually selected regions of interest to measure nerve and background intensities, nerve-to-background ratio, longitudinal signal homogeneity, and apparent branch width. Given the case series design, findings were summarized using descriptive statistics. The cohort included 18 patients, 15 women and 3 men, who underwent superficial or total parotidectomy for parotid neoplasms. Final pathology showed pleomorphic adenoma in 15 cases and carcinoma in 3 cases, with deep lobe involvement in 1 case. Autofluorescence imaging generated clear contrast between the FN and surrounding tissue on grayscale and colored overlay views. Mean native grayscale nerve intensities ranged from 244.3 to 247.4 px, compared with background intensities of 41.7 to 45.8 px, yielding nerve-to-background ratios of 5.40 to 5.86. Colored overlay rendering increased the maximum nerve-to-background ratio to 10.16. Longitudinal signal remained uniform, with coefficients of variation (CVs) ranging from 0.028 to 0.043. No postoperative FN paralysis occurred, and all patients had House-Brackmann grade I function at six months. In this retrospective case series, autofluorescence-guided FN imaging during parotidectomy was feasible and provided consistent visual contrast between nerve and surrounding tissue without identified imaging-related safety concerns. These findings support further study of this approach as a useful adjunct to standard FN identification strategies.

Carotid body tumors (CBTs) are rare paragangliomas arising at the carotid bifurcation, with Shamblin III lesions posing substantial operative risk due to circumferential arterial encasement. When arterial resection and reconstruction are required, reliable confirmation of carotid perfusion is essential. This is the case of a 24-year-old male patient with a right-sided Shamblin III CBT managed with preoperative embolization, segmental internal fluorescence-guided carotid artery resection, and end-to-end reconstruction. Intraoperative indocyanine green fluorescence angiography (ICG-FA) demonstrated immediate, homogeneous perfusion across the reconstructed segment, with no delay or focal hypofluorescence. The postoperative course was uneventful, with no neurologic or vascular complications. This case illustrates the potential role of intraoperative ICG-FA as a real-time adjunct to confirm carotid patency and perfusion following complex vascular tumor resection.

Accurate localization of non-palpable breast lesions remains challenging in clinical practice, and conventional methods carry procedural and patient-comfort limitations. Near-infrared (NIR) fluorescence imaging via indocyanine green (ICG) provides an innovative approach as a surgical adjunct for real-time, intraoperative visualization of target anatomy. In the context of performing safe surgery, fluorescence-guided surgery (FGS) effectively delivers a safe, feasible, and reproducible technique to localize non-palpable breast nodules, sparing the nuisances of suboptimal contemporary alternatives. This is the case of a 47-year-old woman with a BI-RADS 4, non-palpable left breast lesion, who underwent ultrasound-guided injection of a modified ICG solution immediately before surgery. Real-time fluorescence provided delineation of the lesion, and guided skin incision, dissection trajectory, and depth control. This approach underscores the technical feasibility, workflow integration, and intraoperative decision support conveyed by FGS in non-palpable breast lesions. The favorable outcomes of the present case report align with superior outcomes reported in the literature. Nonetheless, a larger, systematic comparison with established localization techniques is warranted to define indications, accuracy, and resource implications for broader surgical adoption.

BACKGROUND:Recurrent laryngeal nerve (RLN) injury is a common and serious complication of thyroidectomy. This study evaluates the sensitivity and specificity of nerve autofluorescence using near-ultraviolet (NUV) light for RLN identification during thyroidectomy. STUDY DESIGN:A retrospective review of prospectively collected data was performed on 614 patients undergoing thyroidectomy for various indications. RLNs were identified using both conventional white light (CWL) and NUV light autofluorescence techniques. RESULTS:Among the 614 patients, surgical indications included goiter (35%), well-differentiated thyroid carcinoma (WDTC, 20%), and thyroiditis (45%). A total of 1,230 RLN branches were identified using NUV light, compared to 840 identified under CWL. NUV light autofluorescence demonstrated a sensitivity of 100% (95% CI:99.2-100) and specificity of 98.5% (95% CI: 98.4-98.6) for RLN identification. Mean fluorescent light intensity (FLI) for RLN (134.3 ± 12.7 pixels [px]) was significantly higher than that of thyroid gland (33.7 ± 8.9 px) and adjacent tissues (14.4 ± 5.3 px) (one-way ANOV: F=842.1, p<0.001). NUV imaging enabled enhanced visualization of anatomical variations of the RLN. A single case (0.2%) of transient unilateral RLN palsy was observed, occurring in a patient with WDTC. CONCLUSIONS:NUV light-based nerve autofluorescence offers high sensitivity and specificity for RLN identification during thyroidectomy, outperforming traditional methods. Its real-time, non-invasive nature and ability to enhance anatomical visualization may contribute to improved surgical outcomes and reduced nerve injury risk.

Fluorescence guided surgery (FGS) has been progressively and globally adapted by multiple surgical disciplines over the last decade. Determining its reach and rate of expansion as a navigational surgical technique is challenging from traditional surveys. Google-trends (GT) was introduced as an ongoing-developing web-kit providing data on search trends to analyze the general population interest on specific topics. The purpose of this study is to implement GT data as an indicator for the world’s interest in FGS. GT was used to access data for specific medical subject headings (MeSH) terms associated with FGS, from 2019 to 2024. Collected data included interest over time, interest by country/continent, and related queries. Data were represented as search interest relative to the highest point on global charts for a given region and time. A value of 100

Parotidectomy is a commonly performed surgery for various indications, including inflammatory conditions, infection, congenital symptomatic malformations, and neoplasm resection. Irrespective of its indication, the performance requires meticulous surgical navigation by highly experienced surgeons because of its proximity to the facial nerve. While the surgical technique continues to evolve, nerve paralysis and nerve-related complications remain a significant concern following an intervention. Due to the high learning curve required to reduce the incidence of surgical iatrogenic events, a novel device has been developed to emit real-time nerve auto-fluorescence in parallel to artificial intelligence (AI) surgical navigation software (SNS) feedback to isolate and accurately identify nerve structures during surgery. The authors herein present one of the first cases of a benign parotid tumor excision implementing dual AI and nerve auto-fluorescence technology for a minimally invasive, nerve-sparing parotidectomy. This report underscores the potential of nerve auto-fluorescence-guided surgery to improve surgical precision and patient outcomes.

Oropharyngeal squamous cell carcinoma (OPSCC), commonly referred to as throat or tonsil cancer, is a type of head and neck malignancy arising from the base and posterior third of the tongue, tonsils, soft palate, and posterolateral pharyngeal walls. Standard treatment typically involves a single modality or a combination of surgery, radiotherapy, and/or chemotherapy. Despite favorable oncologic outcomes, chemoradiation is associated with considerable acute and long-term toxicities, including treatment-related mortality, debilitating dysphagia, fibrosis, severe xerostomia, and an increased risk of secondary malignancies. In this context, fluorescence-guided surgery (FGS) has emerged as a promising, minimally invasive intraoperative tool for OPSCC surgery. By leveraging indocyanine green (ICG), FGS offers enhanced visualization and real-time tissue differentiation, facilitating precise tumor resection and reducing the risk of surgical complications. This case presents an 83-year-old female patient who underwent radical OPSCC resection followed by complex reconstructive surgery utilizing a novel near-infrared FGS device.

Introduction:The radial forearm free flap (RFFF) is an established technique for the reconstruction of intraoral defects following oncological resection. The objective of this study was to evaluate the functional, aesthetic and complication-related outcomes of the RFFF in immediate microvascular reconstruction of intraoral defects. Materials and Methods:A retrospective, observational and descriptive study was conducted based on the clinical records of 15 patients who underwent resection and immediate reconstruction with a RFFF at Hospital de Clínicas "José de San Martín" between May 2019 and June 2024. Post-operative oral function was assessed using the functional oral intake scale for swallowing, the speech intelligibility rating for speech and the modified Vancouver Scar Scale for aesthetic outcomes. Complications were classified according to the Clavien-Dindo system adapted for reconstructive microsurgery. Descriptive and inferential statistical analyses were performed, with significance set at P < 0.05. Results:The mean age was 62.8 years; 60% were female. The most frequent diagnosis was oral cavity squamous cell carcinoma (80%). Flap survival was 100%. Swallowing function was adequate in 86.7% of cases, speech in 73.3% and aesthetic outcome in 80%. The overall complication rate was 20.0%, with only one case requiring microsurgical reintervention. No statistically significant association was found between the occurrence of complications and functional or aesthetic outcomes. Discussion:The RFFF proved to be a safe and effective technique for immediate reconstruction of intraoral defects, offering high survival rates and satisfactory functional and aesthetic outcomes.

INTRODUCTION:Iatrogenic injury to the ilioinguinal nerve and its branches during anterior inguinal hernia repair is a cause of chronic inguinal pain in up to 12 % of patients undergoing this operation. The risk of nerve injury is high, given the nerves' relatively small caliber and strictly-confined space through which they pass. In the current report, we describe using a novel fluorescence imaging system developed to detect nerve autofluorescence in a 66-year-old man who presented with a left-sided Type II inguinal hernia and underwent inguinal hernioplasty. CASE PRESENTATION:Under general anesthesia, a left inguinal hernioplasty with mesh was performed using the Lichtenstein technique through an anterior approach. During surgery, a Dendrite® Imaging camera (Dendrite® Imaging, Germany) was employed to allow the surgical team to alternate freely between standard operating room (white) light and near-ultraviolet light (NUVL), specifically to enhance visualization of the ilioinguinal nerve and its branches. Under white light, neither the ilioinguinal nerve nor any of its branches were clearly visible. However, under NUVL, all fluoresced brightly and were easily avoided throughout the course of the hernia repair. The operation proceeded with no intraoperative or postoperative complications. DISCUSSION:In this case, autofluorescence of the ilioinguinal nerve and its branches under NUVL utilizing a novel, hand-held fluorescent camera during hernia repair aided in their visualization and appeared to help prevent nerve injury. CONCLUSION:New intraoperative technology that allows nerves to auto-fluoresce intra-operatively under NUVL warrants larger series and comparative trials to evaluate its efficacy at reducing iatrogenic nerve injury during inguinal hernioplasties.

Thyroid cancer is a common malignancy that requires comprehensive clinical evaluation prior to adequate surgical management. Over the last three decades thyroid surgery has tripled and is considered one of the most commonly performed procedures in general surgery. These procedures are associated with potential postoperative complications with significant deterioration in the patient's quality of life. While the current rates of recurrent laryngeal nerve injury following thyroidectomy have decreased secondary to intraoperative neuromonitoring, thyroid surgery remains the leading cause of iatrogenic injury. The authors herein present a case of a thyroid nodule with cervical lymph node involvement undergoing total thyroidectomy guided by near-ultraviolet (NUV) imaging nerve auto-fluorescent technology to visualize, identify and protect vital structures.

Recurrent laryngeal nerve (RLN) injury is a critical complication in thyroidectomy, with the severe sequelae of operation-related vocal cord palsies. The primary therapy following RLN injury includes voice therapy and surgical reintervention, both of which render subpar results paired with a long road to recovery. Despite the development of technical measures to prevent inadvertent operational injury of the RLN, its occurrence is still a concern. A newly developed handheld device with nerve autofluorescence technology has emerged as a visual aid tool for the intraoperative identification of nervous anatomical landmarks in thyroid surgery, showcasing promising initial findings. This study evaluates the efficacy of the aforementioned device in the intraoperative identification and differentiation of sensory and motor branches of the RLN. Sixteen patients undergoing thyroid surgery were included in this study, of which 16 RLNs and its branches were examined. Basic demographics, indication for thyroid surgery, and postoperative outcomes were identified. Multiple intraoperative images were analyzed through image processing software programs for the total number of nerves and branches, type of branch (e.g., sensory versus motor branches), near-ultraviolet (NUV) light intensity emitted by the nerve structures, and length and angular aperture of branches. The ability to prevent operation-related RLN injury was clinically evaluated at postoperative follow-up. Following analyses, no significant difference was observed between NUV light intensity (p=0.70) or structural length (p=0.18) between sensory and motor nerve branches of the RLN. This was further confirmed by fast Fourier transform (FFT) analyses and three-dimensional surface plots. No partial or total vocal cord palsies were recorded in the perioperative period, thus confirming the accuracy for intraoperative identification of the RLN and the preservation of structural integrity irrespective of surgical technique or type of branch (sensory or motor). Altogether, these findings highlight the potential of autofluorescence technology to enhance surgical precision, improve nerve preservation, and reduce the risk of nerve injury via safe surgical navigation in comparison to current intraoperative neuromonitoring systems limited to motor branch detection.

Malignant chondroid syringoma (MCS) is an exceptionally rare cutaneous adnexal tumor arising from sweat gland epithelium. The standard treatment involves wide local excision with clear margins, frequently followed by regional lymphadenectomy and flap reconstructive surgery. In anatomically complex regions such as the gluteal area, achieving both oncologic safety and reliable soft-tissue coverage poses significant surgical challenges. In this context, fluorescence-guided surgery (FGS) has emerged as a valuable intraoperative adjunct. Utilizing indocyanine green (ICG), FGS enables real-time perfusion mapping and enhanced visualization of tissue vascularity, thereby improving flap planning and inset accuracy. This is the case of a 51-year-old female patient who underwent radical resection of a large gluteal MCS and ipsilateral lymphadenectomy, followed by advancement flap reconstruction guided by near-infrared (NIR) fluorescence imaging using the novel IC-Flow 2™ system (Diagnostic Green Ltd, Munich, Germany).

Deep neck space infections (DNSIs) are rare but potentially life-threatening conditions due to their rapid progression and proximity to vital structures. The conventional management of this condition is multidisciplinary, requiring broad-spectrum antibiotic therapy and surgical intervention when deemed necessary. The prognosis of DNSIs relies on the immune status of its host, severity, and anatomical location, with high and fluctuating mortality rates if inadequately managed. A timely intervention prevents the progression to higher-risk complications, including Lemierre syndrome, mediastinitis, and respiratory failure. The authors herein present the case of a complicated parapharyngeal abscess requiring a multidisciplinary medical and surgical approach via abscess drainage, pharyngeal defect repair, and muscle flap reinforcement. This case highlights the importance of early recognition, surgical expertise, and tailored postoperative care in the management of complex DNSIs.

Summary: Postoperative sensitivity of the nipple–areola complex (NAC) is an important concern for women after reduction mammoplasty. Previous studies have demonstrated that sensory branches of the fifth anterior intercostal nerve are important for innervating the NAC and that using an inferior pedicle technique is associated with improved sensory retention. The significance of this case report is that it demonstrates the importance of the fifth anterior intercostal sensory nerve branches using a prototype fluorescent imaging camera. The benefit of this device is that it can detect intraoperative auto-fluorescence of nerves and facilitate their identification and preservation, potentially facilitating the retention of sensation in the NAC and surrounding skin. The goals of this article are, therefore, to demonstrate the importance of this neurovascular pedicle when the inferior pedicle technique is used for breast reduction; and to provide demonstrative evidence of the nerve’s presence within the fifth anterior intercostal artery perforator pedicle. The case involved a woman with mammary hypertrophy who underwent bilateral reduction mammoplasty using the inferior pedicle technique. Full NAC sensation was demonstrated on postoperative day 3 with complete sensory recovery at 1- and 3-month follow-up confirmed. To our knowledge, this is the first reported instance of the fifth intercostal nerve being visualized during aesthetic breast surgery, demonstrating the importance of this neurovascular bundle for sensory preservation when an inferior pedicle reduction mammaplasty technique is used.