BACKGROUND:Breast reduction surgery effectively alleviates symptoms of macromastia, but the impact of diabetes on surgical outcomes remains insufficiently studied. OBJECTIVES:The authors of this study aim to evaluate the effect of diabetes, stratified by treatment modality, on postoperative outcomes following breast reduction surgery. METHODS:The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried (2017-2023) to identify female patients undergoing breast reduction. Patients were classified as nondiabetic or diabetic, with the latter further stratified into diabetes mellitus treated with oral agents (DM-ORAL) or with insulin (DM-INS). Preoperative characteristics and 30-day postoperative outcomes were compared, and multivariable confounder-adjusted regression analyses were performed. RESULTS:The cohort included 29,346 female patients, of whom 4.3% (n = 1261) had diabetes. Among diabetic patients, 83% (n = 1046) had DM-ORAL and 17% (n = 215) DM-INS. Compared with nondiabetic patients, those with diabetes were significantly older (49.8 ± 13.0 vs 39.0 ± 14.5 years; P < .0001), had a higher body mass index (31.5 ± 11.2 vs 28.4 ± 10.0 kg/m2; P < .0001), and exhibited a greater overall burden of comorbidities. Multivariable analysis revealed that DM-INS was associated with a significantly increased risk of overall adverse events (odds ratio [OR] 1.9; P = .001), surgical complications (OR 1.6; P = .04), medical complications (OR 3.1; P = .02), and unplanned readmission (OR 4.9; P < .0001). In contrast, DM-ORAL did not correlate with an increased risk of postoperative complications (OR 1.1; P = .6). CONCLUSIONS:DM-INS is associated with an increased perioperative risk following breast reduction surgery. These findings underscore the need for tailored perioperative strategies and support risk-specific guidelines in this population. LEVEL OF EVIDENCE: 3 (THERAPEUTIC):

Introduction: The wide-awake-local-anaesthesia-no-tourniquet (WALANT) technique is increasingly used in hand surgery, avoiding general or regional anaesthesia and upper arm tourniquets. Clinical and economic benefits have been shown especially for trigger finger and carpal tunnel release; however, its impact on fracture treatment warrants evaluation.Methods: We conducted a single-centre retrospective analysis of 921 metacarpal and phalangeal hand operations for fracture treatment, including both fixation and removal of metalwork. The operation time and cost of procedures performed under WALANT were compared with those using regional anaesthesia (RA) with brachial plexus block. Reimbursement for the procedures were compared with the cost.Results: The WALANT technique significantly reduced the operation time and treatment cost compared with RA. However, we found that the reimbursement structure did not fully cover the procedural expenses in either group. Despite this, WALANT reduced financial deficits, demonstrating superior cost-effectiveness.Conclusion: In addition to reducing operative time and overall procedural costs, WALANT decreased dependence on anaesthesia capacity, thereby improving the efficiency of surgical workflows. This approach also promotes a more sustainable model of healthcare delivery by minimizing resource consumption and simplifying logistics. Moreover, its cost-effectiveness may enhance the long-term economic feasibility of reimbursement and funding systems within modern healthcare structures.Level of evidence: IV

Background Autologous breast reconstruction (ABR) offers superior quality of life compared with implant-based reconstruction or mastectomy alone but carries substantial perioperative risk. Diabetes mellitus is a known predictor of postoperative morbidity but is often treated as a binary variable, obscuring differences between patients on oral antihyperglycemic agents (diabetes managed with oral antihyperglycemic agents [DM-ORAL]) and insulin (diabetes requiring insulin therapy [DM-INS]). Materials and Methods Using the National Surgical Quality Improvement Program, we identified female breast cancer patients undergoing immediate ABR (2008-2021). Diabetes status was categorized as nondiabetic, DM-ORAL, or DM-INS. Primary outcomes were 30-day adverse events, reoperation, unplanned readmission, and surgical and medical complications. Groups were compared and multivariable regression used to adjust for confounders. Results Of 8121 patients, 559 (6.9%) had diabetes, including 457 (81.8%) DM-ORAL and 102 (18.2%) DM-INS. Diabetes prevalence increased over time with a 0.3 percentage-point annual rise (R2 = 0.58; P = .003), driven mainly by DM-ORAL (R2 = 0.52; P = .005), while DM-INS showed a nonsignificant trend (R2 = 0.28; P = .07). Compared with nondiabetic patients, diabetics had higher overall complication rates (34.7% vs. 24.1%), including medical (6.4% vs. 2.8%) and surgical complications (23.6% vs. 15.2%) (all P < .0001). Within diabetics, DM-INS demonstrated higher morbidity, including unplanned readmission (14.7% vs. 6.3%, P = .008) and superficial infection (10.8% vs. 5.3%, P = .04) compared to DM-ORAL. On multivariable analysis, diabetes independently predicted complications (OR 1.4), with higher risk in DM-INS (OR 1.9) than DM-ORAL (OR 1.3); DM-INS more than doubled surgical complication risk (OR 2.5). Conclusion Diabetes is a significant but heterogeneous risk factor in ABR, with insulin-treated patients at particularly elevated perioperative risk, supporting treatment-specific risk stratification.

Background/Objectives: In plastic surgery, the administration of tranexamic acid (TXA) has gained increasing support by current literature, highlighting its relevance in clinical practice. This study evaluates the perioperative impact of prophylactic intravenous TXA administration in abdominoplasty, focusing on surgical outcome, drainage pattern, complications, and laboratory parameters (hematocrit/hemoglobin). Methods: This retrospective, single-center cohort study analyzed 58 abdominoplasties, which were divided into two groups: patients treated perioperatively with tranexamic acid for 48 h (TXA group; n = 24) and without TXA (no-TXA group; n = 34). Results: Patients in the TXA group had a significantly shorter length of hospital stay (p = 0.008) and a lower postoperative daily drainage volume on postoperative days: 3 (p = 0.047), 4 (p = 0.011), 7 (p = 0.014), 8 (p = 0.024), and 9 (p = 0.042). The overall complication rate was also significantly reduced with TXA (25.0% vs. 52.9% in the no-TXA group; p = 0.033). Postoperative declines in hematocrit and hemoglobin were less pronounced in the TXA group (p = 0.353 and p = 0.255, respectively). Furthermore, the intravenous administration of TXA was well tolerated, and no associated thromboembolic events were observed. Conclusions: Intravenous TXA appears to reduce complications, drainage volumes, and hospital stay in abdominoplasty patients, while being safe and well tolerated. Although further studies are needed to define optimal dosing, administration protocols, and long-term safety, these findings support the potential benefits of TXA for both patients and healthcare systems, thereby enabling a standardized approach to body contouring surgery.

Breast cancer is the most common malignancy among women worldwide, with breast-conserving surgery (BCS) being a key treatment. The modified 5-item frailty index (mFI-5), a well-validated tool for assessing frailty, has shown predictive utility in other surgical contexts but remains under-explored in BCS. Using the American College of Surgeons National Surgical Quality Improvement Program database (2008–2021), we identified adult female patients with breast cancer who underwent BCS. Frailty was assessed using the mFI-5 and scored from 0 to 5, with higher scores indicating greater frailty. Multivariable logistic regression was employed to evaluate associations between mFI-5 scores and postoperative outcomes. A total of 96,586 patients were included. Higher mFI-5 scores were significantly associated with older age, higher body mass index (BMI), and increased ASA scores. Multivariate analysis showed greater frailty was linked to higher risks of any (mFI = 1: OR 1.06; mFI = 2: OR 1.26; mFI ≥ 3: OR 2.45), surgical (mFI = 1: OR 1.18; mFI = 2: OR 1.65; mFI ≥ 3: OR 3.17), and medical complications (mFI = 1: OR 1.72; mFI = 2: OR 2.56; mFI ≥ 3: OR 6.05). Similarly, frail patients had significantly higher odds of mortality (mFI = 1: OR 2.27; mFI = 2: OR 4.3; mFI ≥ 3: OR 11.05) and unplanned readmission (mFI = 1: OR 1.38; mFI = 2: OR 2.25; mFI ≥ 3: OR 6.05). Reoperation risk decreased with higher mFI-5 scores (mFI = 1: OR 0.92; mFI = 2: OR 0.73; mFI ≥ 3: OR 0.92). The mFI-5 is strongly associated with postoperative outcomes after BCS and serves as a valuable tool for risk stratification. Our findings reinforce its role as a critical preoperative index to identify high-risk patients and guide surgical planning.

The failure of wound repair, particularly in cases of refractory wounds, is closely associated with immune disorders, leading to serious consequences such as scarring and ulcers. To address this issue, Poly [octanediol-co- (citric acid)] (POCA)/gelatin curcumin-loaded nanofibrous mats responsive to inflammatory microenvironments are developed. POCA serves as a cross-linker for gelatin, providing the nanofibrous mat with skin-like J-shaped stress-strain behavior. Moreover, the pendant carboxyl groups of POCA enable adhesion ability in the wet state, thereby increasing wound sealing. Most importantly, the as-prepared nanofibers are sensitive to MMP-2. Amorphous curcumin is responsively released in response to high MMP levels present in inflammatory wounds. This significantly enhances curcumin's efficiency. The mat exhibits substantial therapeutic effects on chronic diabetic wounds and tension-loaded wounds, nudging wound healing toward regenerative repair. Moreover, it was also shown to promote basement membrane renewal by activating wound fibroblasts, which mitigates the immune response and reinstate homeostasis.

Racial disparities in surgical outcomes are well documented across various procedures, including oncological and reconstructive breast surgery. However, it remains unclear whether these inequalities extend to reduction mammoplasty. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database between 2011 and 2022 to identify adult female patients who underwent breast reduction and reported their racial identity. 30-day postoperative outcomes were compared across four racial groups—Asian, Black/African American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander—against White patients using univariate and confounder-adjusted multivariate analyses. The study cohort included 26,329 female patients, with 64

Lung fibrosis development utilizes alveolar macrophages, with mechanisms that are incompletely understood. Here, we fate map connective tissue during mouse lung fibrosis and observe disassembly and transfer of connective tissue macromolecules from pleuro-alveolar junctions (PAJs) into deep lung tissue, to activate fibroblasts and fibrosis. Disassembly and transfer of PAJ macromolecules into deep lung tissue occurs by alveolar macrophages, activating cysteine-type proteolysis on pleural mesothelium. The PAJ niche and the disassembly cascade is active in patient lung biopsies, persists in chronic fibrosis models, and wanes down in acute fibrosis models. Pleural-specific viral therapeutic carrying the cysteine protease inhibitor Cystatin A shuts down PAJ disassembly, reverses fibrosis and regenerates chronic fibrotic lungs. Targeting PAJ disassembly by targeting the pleura may provide a unique therapeutic avenue to treat lung fibrotic diseases.

Background Liposuction for stage III lipoedema is a guideline-based but also time-consuming treatment, which can be carried out under specific conditions at the expense of the German statutory health insurance companies (SHI) based on a decision made by the German Federal Joint Committee ("Gemeinsamer Bundesausschuss", G-BA), the highest decision-making body in the German healthcare system, in 09/2019. We postulate that the treatment is not reflected in a cost-covering manner in the university cost system. Methods This monocentric, retrospective study examined the economic aspects of 92 cases in 48 lipoedema patients treated during the period from 09/2019 to 08/2023 at the expense of the SHI. These cases were filtered out using DRG coding and the Operation and Procedure Classification system ("Operationen- und Prozedurenschl & uuml;ssel", OPS), and the costs and revenues per patient were calculated using the data from our internal service accounting. Results After an inpatient stay of 2.64 +/- 1.33 days, the total revenue was 4,726.79 +/- 680.98. This included 1,532.92 +/- 856.99 inpatient costs, 2,686.02 +/- 1,174.70 in operating costs, 940.76 +/- 189.18 in anaesthesia costs and 63.19 +/- 125.38 in other costs that had to be paid within the clinic. On average across all treatments, this resulted in a loss of - 875.22 /case. In 54 cases (59%), the costs exceeded the revenue. In total, the calculation of all cases resulted in a loss of -80,520.63. If medical personnel costs are included, this amount rises to over 100,000. Conclusion The results show that the surgical treatment of lipoedema in the German DRG and university cost systems is not cost-covering. This could be relevant in the final economic assessment of the G-BA, which may result in an adjustment of the DRG revenue.

Electrospinning is a remarkably straightforward and adaptable technique that can be employed to process an array of synthetic and natural materials, resulting in the production of nanoscale fibers. It has emerged as a novel technique for biomedical applications and has gained increasing popularity in the research community in recent times. In the context of tissue repair and tissue engineering, there is a growing tendency toward the integration of biomimetic scaffolds and bioactive macromolecules, particularly proteins and growth factors. The design of 'smart' systems provides not merely physical support, but also microenvironmental cues that can guide regenerative tissue repair. Electrospun nanofibrous matrices are regarded as a highly promising tool in this area, as they can serve as both an extracellular matrix (ECM)-mimicking scaffold and a vehicle for the delivery of bioactive proteins. Their highly porous architecture and high surface-to-volume ratio facilitate the loading of drugs and mass transfer. By employing a judicious selection of materials and processing techniques, there is considerable flexibility in efficiently customizing nanofiber architecture and incorporating bioactive proteins. This article presents a review of the strategies employed for the structural modification and protein delivery of electrospun nanofibrous materials, with a focus on the objective of achieving a tailored tissue response. The article goes on to discuss the challenges currently facing the field and to suggest future research directions.

Background: A variety of breast reconstruction (BR) options are available. The significance of timing on outcomes remains debated. This study aims to compare complications in breast cancer patients undergoing implant-based and autologous BR immediately after mastectomy or at a delayed time point.Methods: We reviewed the ACS-NSQIP database (2008-2021) to identify all female patients who underwent BR for oncological purposes. Outcomes were stratified by technique (implant-based versus autologous) and timing (immediate versus delayed), and included 30-day mortality, re -operation, (unplanned) readmission, and surgical and medical complications.Results: A total of 21,560 patients were included: 11,237 (52%) implant-based (9791/87% immediate, 1446/13% delayed) and 10,323 (48%) autologous (8378/81% immediate, 1945/19% delayed). Complications occurred in 3666 (17%) patients (implant-based: n = 1112/11% immediate, n = 64/4.4% delayed cohorts; Autologous: n = 2073/25% immediate, n = 417/21% delayed cohorts). In propensity score weighting (PSW) analyses, immediate BR was associated with significantly more complications than delayed BR (p < 0.0001). This was the case for both implant-based and autologous BR, with a greater difference between the two time points noted in implant-based. Confounder-adjusted multivariable analyses confirmed these results.Conclusion: At the 30-day time point, delayed BR is associated with significantly lower com-plication rates than immediate BR, in both the implant-based and autologous cohorts. These findings are not a blanket recommendation in favor of immediate and/or delayed BR. Instead, our insights may guide surgeons and patients in decision-making and help refine patients' eligibility in a case-by-case workup. (c) 2023 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Background: There exists a paucity of large-scale, multi-institutional studies that investigate the outcomes of surgery for Bell’s palsy (BP). Here, we utilize a large, multi-institutional database to study the risk factors and early-stage outcomes following surgical procedures in BP. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program database (2008–2019) to identify patients who underwent surgery for the diagnosis of BP. We extracted data on comorbidities and preoperative blood values, and 30-day postoperative outcomes. Results: Two hundred fifty-seven patients who underwent surgery for BP symptoms over the 12-year review period were identified. Muscle grafts (n=50; 19%) and fascial grafts (n=48; 19%) accounted for the majority of procedures. The most common comorbidities were hypertension (n=89; 35%) and obesity (n=79; 31%). Complications occurred in 26 (10.1%) cases. Additionally, length of hospital stay was significantly associated with both surgical and medical complications (3.9±4.7 versus 1.5±2.0; P<0.01) and (3.2±3.8 versus 1.4±2.0; P<0.01), respectively. Preoperative creatinine, blood urea nitrogen, and alkaline phosphatase were identified as potential predictors of poor postoperative outcomes. Conclusion: Based on multi-institutional analysis, complication rates following surgery for BP were found to be overall low and seen to correlate with length of hospital stay. Reoperations and readmissions were the most frequent complications after surgery for BP. The preoperative evaluation of routine laboratory values may help refine patient eligibility and risk stratification. In addition, our findings call for future large-scale prospective studies in the field of facial palsy surgery to further improve the quality of care and optimize perioperative protocols.

Background: Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy. Study design: The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge. Results: The study population included 222 947 patients, 68% (n=151 522) of whom were white, 11% (n=23 987) Black/African American, 5% (n=11 217) Asian, 0.5% (n=1198) American Indian/Alaska Native, and 0.5% (n=1018) Native Hawaiian/Pacific Islander. While 136 690 (61%) patients underwent partial mastectomy, 54 490 (24%) and 31 767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17 222 (7.7%) patients, the largest portion of which were surgical complications (n=7246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications [odds ratio (OR)=0.71; P<0.001], whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P<0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P<0.001) and surgical complications (OR=0.60; P<0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P=0.045) following partial mastectomy was significantly increased. Conclusion: The authors identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. The authors' analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Their findings call for care equalization in the field of breast cancer surgery.

BackgroundThe study examines, for the first time, the impact on quality of life after liposuction for lipoedema. The influence of aesthetic plastic interventions and their effects on treatment outcomes has been a major focus of our research group over the past 20 years.MethodsA total of 35 patients were invited to participate in our prospective study, with 30 responding to both the pre- and postoperative questionnaires. The patients received the questionnaires pre-operatively, and 6 months after the liposuction. Our questionnaire set included a self-developed, indication-specific part, along with standardised and validated questionnaires such as the Questions on Life Satisfaction (FLZM), Patient Health Questionnaire (PHQ-4), Rosenberg Self-Esteem Scale (RSES) and the Freiburg personality inventory-revised (FPI-R).ResultsOur self-developed questionnaire showed that our patients feel more balanced, more attractive and more self-confident after the treatment. The FLZM showed significant improvements in all three modules: the general satisfaction with life, the state of health and the outer appearance (body image). Using the PHQ-4, a significant improvement in the two subscales of anxiety and depression could be determined, as well as a reduction in overall mental stress. In addition, the RSES showed a significant improvement in self-esteem post-operatively. Furthermore, the FPI-R indicated a significant improvement in emotional stability.ConclusionsLiposuction improves the quality of life in lipoedema patients. Post-operatively, our patients reported less pain and were more satisfied with their bodies and appearance. The hypothesis that liposuction in lipoedema improves the quality of life as a multidimensional construct could be confirmed.

Zusammenfassung Hintergrund Die Liposuktion des Lipödems Stadium III ist eine leitliniengerechte Behandlung, welche seit dem Beschluss des Gemeinsamen Bundesausschusses 09/2019 (G-BA) unter bestimmten Bedingungen zu Lasten der gesetzlichen Krankenkasse (GKV) durchgeführt werden kann. Wir vertreten die These, dass die Behandlung im universitären Kostensystem nicht kostendeckend abgebildet wird. Material und Methoden In dieser monozentrischen, retrospektiven Studie konnten die ökonomischen Aspekte von 92 Fällen bei 48 Lipödem-Patientinnen, die im Zeitraum vom 09/2019–08/2023 zu Lasten der GKV stationär behandelt wurden, untersucht werden. Diese Fälle wurden anhand der DRG-Kodierung und des Operationen- und Prozedurenschlüssels (OPS) herausgefiltert und die Kosten und Erlöse pro Patienten anhand der Daten unserer Innerbetrieblichen Leistungsverrechnung (IBVL) berechnet. Ergebnisse Es zeigte sich nach einem stationären Aufenthalt von 2,64±1,33 Tagen ein Gesamt-Erlös von 4.726,79±680,98 €. Hiervon mussten klinikintern 1.532,92±856,99 € stationäre Kosten, 2.686,02±1.174,70 € OP-Verrechnungskosten, 940,76±189,18 € Anästhesie Kosten sowie 63,19±125,38 € übrige Kosten bezahlt werden. Im Mittelwert aller Behandlungen ergab das einen Verlust von 875,22 €/Fall. In 54 Fällen (59%) überstiegen die Kosten den Erlös. Insgesamt ergab die Kalkulation aller Fälle einen Verlust von 80.520,63 €. Unter Einbeziehung der ärztlichen Personalkosten steigt dieser Betrag auf über 100.000 €. Schlussfolgerung Die Ergebnisse zeigen, dass die operative Behandlung des Lipödems im deutschen DRG- und im universitären Kostensystem nicht kostendeckend ist, was für die abschließende wirtschaftliche Bewertung des G-BA und die Anpassung des DRG-Entgeltes relevant sein kann.

The transient receptor potential vanilloid 4 (TRPV4) specifically functions as a mechanosensitive ion channel and is responsible for conveying changes in physical stimuli such as mechanical stress, osmotic pressure, and temperature. TRPV4 enables the entry of cation ions, particularly calcium ions, into the cell. Activation of TRPV4 channels initiates calcium oscillations, which trigger intracellular signaling pathways involved in a plethora of cellular processes, including tissue repair. Widely expressed throughout the body, TRPV4 can be activated by a wide array of physicochemical stimuli, thus contributing to sensory and physiological functions in multiple organs. This review focuses on how TRPV4 senses environmental cues and thereby initiates and maintains calcium oscillations, critical for responses to organ injury, tissue repair, and fibrosis. We provide a summary of TRPV4-induced calcium oscillations in distinct organ systems, along with the upstream and downstream signaling pathways involved. In addition, we delineate current animal and disease models supporting TRPV4 research and shed light on potential therapeutic targets for modulating TRPV4-induced calcium oscillation to promote tissue repair while reducing tissue fibrosis.

Optimal tissue recovery and organismal survival are achieved by spatiotemporal tuning of tissue inflammation, contraction and scar formation 1 . Here we identify a multipotent fibroblast progenitor marked by CD201 expression in the fascia, the deepest connective tissue layer of the skin. Using skin injury models in mice, single-cell transcriptomics and genetic lineage tracing, ablation and gene deletion models, we demonstrate that CD201 + progenitors control the pace of wound healing by generating multiple specialized cell types, from proinflammatory fibroblasts to myofibroblasts, in a spatiotemporally tuned sequence. We identified retinoic acid and hypoxia signalling as the entry checkpoints into proinflammatory and myofibroblast states. Modulating CD201 + progenitor differentiation impaired the spatiotemporal appearances of fibroblasts and chronically delayed wound healing. The discovery of proinflammatory and myofibroblast progenitors and their differentiation pathways provide a new roadmap to understand and clinically treat impaired wound healing.