Acellular matrices are frequently used in regenerative medicine due to their structural and biochemical similarity to the native extracellular matrix. However, comparative data on their morphological characteristics and early interaction with human adipose-derived stem cells (ASCs), particularly in the context of cartilage tissue engineering, remain limited. This study aimed to compare the architectural characteristics of eight commercially available acellular matrices to assess their early interaction with adipose-derived stem cells under standardized in vitro conditions. Scanning electron microscopy was used to analyze apparent two-dimensional pore size, porosity, and surface morphology. Adipose-derived stem cells from the adipose tissue of four female donors were isolated, pooled and characterized for typical stem cell markers (CD13, CD29, CD44, CD73, CD90, CD105) by flow cytometry. 1.25 × 105 cells were seeded onto biological triplicates of each matrix, and cell viability was assessed via Alamar Blue assay after 7 days of culture. Several matrices with porosity values of 40–60

BACKGROUND:Demand for aesthetic surgery has risen rapidly, and the parallel growth in cross-border medical travel is increasingly burdening European health systems with imported complications. The perspective of board-certified plastic surgeons themselves-as both providers of cross-border care and managers of its complications-has not been systematically captured at a European level. METHODS:An anonymous online questionnaire (43 items across three thematic sections) was distributed by the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) to its member national societies between December 2025 and February 2026. The instrument addressed (A) the practice of surgeons treating international patients, (B) the management of complications from procedures performed abroad, and (C) safeguards and policy reform. Quantitative data were summarised descriptively; free-text responses were analysed thematically. RESULTS:Two hundred and fifty board-certified plastic surgeons from 36 countries responded; 230/250 (92.0%) held national or international board certification. The most common procedures performed for international patients were breast augmentation (n=86), breast reduction/mastopexy (n=82), and abdominoplasty (n=80). Eighty-nine per cent of respondents had managed complications of procedures performed abroad in the preceding five years; abdominoplasty (n=144), breast augmentation (n=106), and liposuction (n=76) predominated, with wound dehiscence/necrosis (n=156) and infection (n=131) the most frequent patterns. Cost was the most often cited primary motivation for patients (49.8%); 79.2% of respondents identified board certification as the single most important verification criterion, and 77.2% identified profit prioritisation over patient safety as the principal facilitator-related risk. Mandatory international qualification standards (35.6%) and stricter facilitator regulation (23.6%) were the most frequently endorsed policy priorities. CONCLUSIONS:European plastic surgeons describe a fragmented landscape in which a regulated core coexists with an unregulated commercial periphery. ESPRAS proposes a four-pillar framework-public surgeon registries, facility and facilitator accreditation, mandatory complication insurance, and harmonised European patient- and surgeon-facing guidelines-as the basis of a coordinated European response.

Das Lymphödem ist eine chronische, fortschreitende Erkrankung, die primär oder sekundär nach lymphatischer Schädigung, z. B. nach Lymphadenektomie oder Radiatio, auftreten kann. Konservative Therapien bieten oft nur begrenzte Linderung, weshalb operative Verfahren wie die vaskularisierte omentale Lymphknotentransplantation (VOLT) zunehmend an Bedeutung gewinnen. Es werden 2 Patienten mit fortgeschrittenem sekundärem Lymphödem der unteren Extremität nach Lymphadenektomie vorgestellt. Beide wiesen in der Lymphszintigrafie und MRT eine ausgeprägte Transportstörung auf. In beiden Fällen erfolgte eine doppelte mikrovaskuläre Lymphknotentransplantation mittels VOLT, wobei das Omentum aufgrund seiner hohen Lymphknotendichte und lymphangiogenen Eigenschaften gewählt und intraoperativ geteilt wurde, um sowohl die Leiste als auch den Unterschenkel zu versorgen. Zusätzlich wurde eine systematische Literaturrecherche in PubMed durchgeführt. Postoperativ zeigten sich in beiden Fällen eine regelrechte Perfusion der Transplantate sowie eine klinische Besserung der Lymphödemsymptomatik. Die Literaturauswertung ergab konsistente Hinweise auf eine signifikante Volumenreduktion, verbesserte Lymphdrainage und eine deutliche Senkung der Zellulitisrate nach VOLT. Die VOLT stellt eine effektive Option für therapierefraktäre Lymphödeme dar und kann die Lebensqualität der Patienten verbessern. Trotz vielversprechender klinischer Ergebnisse sind weitere standardisierte, prospektive Langzeitstudien notwendig, um die Evidenz zur Wirksamkeit und Sicherheit dieser Technik zu stärken.

Free gracilis muscle (GM) flaps represent a reliable workhorse procedure in the field of plastic and trauma surgery. However, only a small number of studies have examined this large group of patients regarding the morbidity of flap harvest. The aim of this prospective study was therefore to objectively investigate the morbidity of free GM flaps. A control group (n = 100) without surgery was recruited to assess interindividual differences in strength and range of motion (ROM) in the hip and knee joint (dominant vs. nondominant side). Additionally, for 50 patients with free GM flap surgery, these parameters were assessed in an identical manner. The control group showed significant interindividual differences in strength for abduction and adduction in the hip joint when comparing the dominant to the nondominant side, but no significant differences in the ROM. GM flap harvest led to no significant differences in maximum force 20.3 (± 13.8) months after surgery in all parameters/movements that were assessed. However, the ROM for abduction in the ipsilateral hip joint was significantly reduced after surgery. The GM flap has a low donor site morbidity and should therefore be considered as a first-line option for microsurgical reconstructive procedures. Moreover, the low morbidity is not affected by preexisting differences in strength when comparing the dominant to the nondominant side.

Background and Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by chronic compression of the median nerve within the carpal tunnel. Patient education is a cornerstone of informed consent and postoperative outcomes, yet time constraints often limit traditional consultations. Recently, generative AI tools such as ChatGPT have emerged as potential adjuncts in delivering standardized medical information. Materials and Methods: This study evaluated the quality and comprehensiveness of ChatGPT-generated patient education on CTS and open carpal tunnel release. A standardized prompt was used with ChatGPT-4o to generate educational material. A structured and standardized questionnaire was then administered to both patients and physicians (n = 8) to assess content quality, clarity, comprehensiveness, and perceived usefulness. Results: Both patients and physicians reported high satisfaction with the information provided. The etiology, procedural risks, and general anatomical principles were well conveyed. However, certain intraoperative concepts—such as neurolysis, synovectomy, and hemostasis—were underrepresented. While conservative therapies were addressed, the omission of endoscopic surgical options limited informational completeness. Prognostic information and long-term consequences of untreated CTS were rated as average by some participants. Postoperative guidance was adequately covered but lacked individualized nuance. Conclusions: ChatGPT shows promise as an adjunct in surgical patient education, offering clear and standardized information. Nevertheless, it is not a substitute for clinician–patient interaction. While it may bridge preliminary knowledge gaps, emotional support and individualized consent discussions remain essential. Further refinement and clinical validation of AI-generated educational content are needed to ensure safe and effective integration into routine practice.

Aspirin (ASA) is one of the most used medications worldwide and has shown various effects on cellular processes, including stem cell differentiation. However, the effect of ASA on adipogenesis of adipose tissue-derived stem cells (ASCs) remains largely unknown. Considering the potential application of ASCs in regenerative medicine and cell-based therapies, this study investigates the effects of ASA on adipogenic differentiation in human ASCs. ASCs were exposed to varying concentrations of ASA (0 µM, 400 µM, and 1000 µM) and evaluated for changes in morphology, migration, and adipogenic differentiation. While ASA exposure did not affect self-renewal potential, migration ability, or cell morphology, it significantly reduced lipid vacuole formation at 1000 µM after 21 days of adipogenic differentiation (p = 0.0025). This visible inhibition correlated with decreased expression of adipogenic markers (PPARG, ADIPOQ, and FABP4) and the proliferation marker MKi67 under ASA exposure in comparison to the control (ns). Overall, the findings demonstrate that ASA inhibits adipogenic differentiation of human ASCs in a dose-dependent manner in vitro, contrasting its known role in promoting osteogenic differentiation. This research highlights ASA’s complex effects on ASCs and emphasizes the need for further investigation into its mechanisms and potential therapeutic applications in obesity and metabolic diseases. The inhibitory effects of ASA on adipogenesis should be considered in cell-based therapies using ASCs.

Ausgedehnte Thoraxwanddefekte können durch die Resektion maligner Tumoren oder durch eine Sternumosteomyelitis nach kardiochirurgischen Eingriffen entstehen. Das Ziel dieser Studie ist es, die Durchführbarkeit der Rekonstruktion mit freien Lappenplastiken unter Berücksichtigung der Anschlussgefäßsituation, operative Komplikationen und das rekonstruktive Ergebnis zu analysieren. In der bizentrischen retrospektiven klinischen Studie wurden alle Patienten eingeschlossen, bei denen im Zeitraum Januar 2013 bis September 2024 eine freie Lappenplastik zur Rekonstruktion eines ausgedehnten Thoraxwanddefektes transplantiert wurde. Das Ziel war es, operative Details und Ergebnisse sowie Komplikationsraten auszuwerten. In einer Subgruppenanalyse wurden außerdem Komplikationen und Ergebnisse von Lappenplastiken, bei denen zusätzlich eine arteriovenöser Gefäßschleife (AVL) als Anschlussgefäß notwendig war, mit denen ohne zusätzliche gefäßchirurgische Maßnahmen verglichen. Insgesamt wurde bei 107 Patienten (n = 66, 62% nach herzchirurgischer Operation; n = 41, 38% nach onkologischer Operation) eine Thoraxwandrekonstruktion mit einer freien myokutanen Tensor-fasciae-latae- (TFL, n = 47, 44%), myokutanen Vastus-lateralis-Muskellappenplastik (VL, n = 37, 35%), kombinierten Vastus-lateralis-Anterior-lateral-Thigh- (kVL-ALT, n = 17, 16%), kombinierten Vastus-lateralis-Tensor-fasciae-latae-Muskellappenplastik (kVL-TFL, n = 2, 2%), einer Anterior-lateral-Thigh- (ALT, n = 2, 2%) oder einer transversen Rectus-abdominis-Muskellappenplastik (TRAM, n = 2, 2%) durchgeführt. Bei 39 Rekonstruktion (36%) war simultan eine AVL-Anlage notwendig. Insgesamt traten postoperativ 6 Thrombosen der Lappenstielgefäße auf (6%). Vollständige Lappennekrosen traten in 3 Fällen (3%; VL, n = 2; kVL-ALTL, n = 1) und partielle Lappennekrosen traten bei 8 Lappenplastiken auf (8%; TFL, n = 3; kVL-ALT, n = 2; VL, n = 2; TRAM, n = 1). Der Vergleich postoperativer chirurgischer Komplikationen zwischen Rekonstruktionen mit und ohne simultane AVL-Anlage zeigte keine signifikanten Unterschiede hinsichtlich venöser Thrombosen (n = 0 vs. n = 3), arterieller Thrombosen (n = 2 vs. n = 1), partieller Lappennekrose (n = 3 vs. n = 5) sowie totaler Lappennekrose (n = 0 vs. n = 3). Diese Studie zeigt, dass die Rekonstruktion ausgedehnter Thoraxwanddefekte mit freien VL- oder TFL-Lappenplastiken mit nur geringen Komplikationsraten durchführbar ist, auch wenn dies simultan eine AVL-Anlage erfordert.

INTRODUCTION:The entrance of Generation Z (born 1997-2012) into professional life, including the practice of medicine, marks a transformational shift in priorities and values. This generation, shaped by digital immersion and a strong focus on work-life balance, is redefining the landscape of Plastic Surgery. Their preferences for inclusivity, innovation, and structured working hours challenge traditional models of mentorship, patient care, and surgical training. The aim of this survey was to explore the impact of Generation Z on the field of Plastic Surgery through insights offered by leaders of major Plastic Surgery societies in Europe and the United States, who together provide a comprehensive perspective on generational change and its implications for clinical practice, education, and healthcare systems in Plastic Surgery. METHODS:In October 2024 eight leaders of national Plastic Surgery societies and associations were invited to complete a structured questionnaire with five open-ended questions. They provided detailed responses on challenges, opportunities, and structural changes needed to address Generation Z's influence. RESULTS:Key findings highlight a generational shift in the approach to professional life, with an emphasis on digital innovation, work-life balance, and the interaction with social media. Respondents noted an increased interest in aesthetic over reconstructive surgery and a preference for private practice among younger surgeons, raising concerns about workforce shortages in public healthcare. Advances in digital learning and simulation-based training were identified as opportunities to facilitate medical education. However, the ethical challenges of misinformation on social media and a decline in hierarchical mentorship were emphasized as critical concerns. Despite generational tensions, the integration of Generation Z's strengths in technology and advocacy for systemic reform holds promise for addressing burnout and enhancing healthcare delivery. CONCLUSION:The arrival of Generation Z in Plastic Surgery represents a possible pivotal moment to reimagine traditional models of surgical education, patient care, and professional priorities. Collaboration between generations and proactive adaptation to these changes is an imperative to ensure a dynamic, inclusive, and sustainable future for the specialty.

Glucagon-like peptide-1 receptor agonists, originally developed for managing type 2 diabetes, have gained attention for their weight-reducing and broader biological effects. Among these, their influence on human mesenchymal stem cells remains underexplored, despite the critical role of mesenchymal stem cells in tissue regeneration and secretion of bioactive factors. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify and evaluate in vitro studies investigating the effects of glucagon-like peptide-1 receptor agonists and their analogues on human mesenchymal stem cell functions, including proliferation, differentiation, signaling, apoptosis, and tissue-specific applications. Risk of bias was assessed using an adapted Quality Assessment Tool for In Vitro Studies (QUIN) tool. Thirty-eight eligible studies were identified. Glucagon-like-peptide-1 receptor agonist, like native glucagon-like peptide-1, Exendin-4, and Liraglutide, exert context-, dose-, and timing-dependent effects on human mesenchymal stem cells. They modulate proliferation and overall promote osteogenesis while inhibiting adipogenesis. Key pathways, including Wnt/β-catenin, bone morphogenetic protein 2/Smad, phosphoinositide 3-kinase/Akt and protein kinase A, play a role in this. Furthermore, these agents modulate inflammation, reduce apoptosis, and improve stem cell functions even under diabetic or inflammatory conditions. Exendin-4 facilitated tenogenic and insulin-producing cell differentiation, particularly in engineered scaffolds or genetically engineered human mesenchymal stem cells. Glucagon-like peptide-1 receptor agonists modulate key pathways in human mesenchymal stem cells to influence survival, differentiation, and metabolic function, suggesting promising therapeutic potential beyond glycemic control. However, heterogeneous experimental designs and limited translational data necessitate further standardized and in vivo research to define clinical applications.

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance.

The management of anorectal carcinomas necessitates a multimodal therapeutic approach. Advances in modern medicine have reduced the incidence of complete rectal extirpations and permanent colostomies to below 10%. Despite these improvements, the reconstruction of anorectal defects, particularly following abdominoperineal extirpation (APE) or pelvic exenteration, remains a significant challenge. Deep tissue defects, the impact of neo- or adjuvant radiotherapy, and bacterial contamination contribute to compromised wound healing, with reported complication rates reaching up to 60%.This retrospective study analysed all patients presenting with anorectal defects following oncological surgery in 2024 at a university-based plastic surgery clinic providing maximum-care services. The study assessed various influencing factors, including radiochemotherapy, cachexia, diabetes mellitus, nicotine consumption, vascular diseases, and corticosteroid therapies. Additionally, the evaluation covered the effect of surgical defect coverage using pedicled gracilis flap reconstruction on the number of required interventions and the time to complete wound healing and patient mobilisation.Prolonged intensive care treatment and prior radiochemotherapy were identified as primary contributors to disorders in postoperative wound healing. Moreover, factors such as cachexia, diabetes mellitus, and nicotine consumption had a detrimental impact on wound healing. Plastic-surgical defect reconstruction utilising a pedicled gracilis flap significantly reduced the number of required interventions and expedited recovery time.The interdisciplinary management of patients with anorectal defects post-oncological surgery can be optimised through targeted reconstructive plastic surgery. Pedicled gracilis flap reconstruction has proven to be an effective technique for defect coverage and should be integrated into treatment protocols at an early stage. Further studies are warranted to standardise guidelines, particularly regarding the optimal timing of reconstructive interventions.

Complex abdominal wall defects lead to significant morbidity and require interdisciplinary therapeutic approaches. Plastic surgical techniques and the evolvement of microsurgery can provide a reliable means of reconstruction. For large defects involving the M. rectus abdominis, the free functional M. latissimus dorsi flap serves as a workhorse. Through microsurgical tissue transplantation, the abdominal wall can be functionally reinforced and reinnervated, while also covering the associated soft tissue defect.This study presents an interdisciplinary approach to complex abdominal wall reconstruction using a case example.Particularly as a chimeric flap, in combination with the scapular/parascapular flap, even exceptionally large defects can be reconstructed safely. By utilising a common vascular pedicle, these flaps can be transferred together via the subscapular vessel axis. The coaptation of the thoracodorsal nerve, which innervates the latissimus dorsi muscle, with a motor nerve branch leading to the rectus abdominis muscle enables functional muscular stabilisation of the abdominal wall following reinnervation.To achieve the best possible outcome and reduce hospitalisation, the early integration of plastic surgery into interdisciplinary treatment concept is essential.

Background/Objectives: The autologous reconstruction of the female breast using a microsurgical DIEP flap is a reliable and safe method. To detect impairments early and preserve the microvascular flap through timely revision, a better understanding of physiologic perfusion dynamics is necessary. This exploratory study examines changes in microcirculation in free DIEP flaps within the first 72 h after vascular anastomosis using laser Doppler flowmetry and white-light spectrophotometry. Methods: This single-center study analyzed retro- and prospectively collected data from female patients who underwent uneventful breast reconstruction using a DIEP flap and were monitored using the O2C device (LEA Medizintechnik, Giessen, Germany). Microcirculation was monitored continuously postoperatively for a period of 72 h. Results: A total of 36 patients with a mean age of 48.86 (9.36) years and a mean BMI of 26.78 (4.12) kg/m2 received 40 DIEP flaps (four bilateral reconstructions). Microcirculatory blood flow showed a continuous increase, reaching up to 15% above its initial value within the first 72 h following anastomosis. The average tissue oxygen saturation (sO2) and relative hemoglobin (rHB) levels remained fairly stable throughout the study period, with overall reductions of 5.46% and 5.30%, respectively. Conclusions: Autologous breast reconstruction using a microvascular DIEP flap is a safe and reliable technique. This study showed an increase in blood flow over the 72 h study period. At the same time, sO2 and rHb showed stable levels. Deviations in these values could be interpreted as indicators of a perfusion disorder of the microvascular flap.

Infections involving vascular prostheses in the groin region are a major surgical challenge, associated with substantial morbidity and mortality rates. The complex anatomical structures and high density of bacterial colonisation considerably complicate their surgical management. Consequently, reconstructive therapy demands individualised and interdisciplinary strategies to achieve optimal outcomes.A systematic search was conducted using PubMed and the Cochrane Library to collect and evaluate current evidence and recommendations regarding the reconstructive management of infected vascular prostheses. The developed algorithm incorporated essential factors, such as defect size, infection severity, and patient-specific characteristics to guide therapeutic decision making.Pedicled flap techniques, particularly those employing the M. sartorius or M. gracilis, are rapid and reliable reconstructive solutions - due to their robust vascular supply. In cases of larger defects, the transverse myocutaneous gracilis (TMG), Rectus femoris, and anterolateral thigh (ALT) flaps proved to be suitable alternatives. Prophylactic use of pedicled flaps was associated with a reduction in postoperative complications, particularly in high-risk patientsThe surgical management of deep groin infection requires meticulous individualised and interdisciplinary planning and plastic reconstructive experience. The proposed algorithm provides a structured and evidence-based framework to improve healing rates and minimise the risk of complications.

Extensive defects in the perineal or anterior/lateral pelvic region can occur as a result of tumour-related resections, infections, or postoperative complications. In cases where local or pedicled flap reconstructions are insufficient, microsurgical reconstruction using free flaps becomes necessary. Due to its location and calibre, the inferior epigastric artery (DIEA) is a suitable recipient vessel for microsurgical tissue transfer.In a retrospective case study conducted between June 2024 and March 2025, patients with perineal or pelvic defects underwent microsurgical reconstruction. Defect coverage was achieved using free flap techniques (musculocutaneous vastus lateralis [MVL], musculocutaneous latissimus dorsi [LD] and parascapular flaps) with end-to-end anastomosis to the DIEA. Preoperative planning included CT angiography to assess the vascular situation. Microsurgical anastomoses were performed in a standardised manner, with arterial anastomoses hand-sewn and venous anastomoses carried out using venous couplers. The perfusion of the anastomoses and the flap was assessed using ICG fluorescence. Postoperative care included structured offloading and mobilisation.During the study period, five patients (average age 64.6 years, ASA score 2.8) with perineal or pelvic defects averaging 413.4 cm² were treated. The underlying causes were tumours (3) and extensive infections (2). The DIEA was successfully used as a reliable recipient vessel in all cases. Venous anastomoses were performed using venous couplers with an average diameter of 2.5 mm (range: 2-3 mm). No flap losses or necroses occurred.The results confirm the suitability of the DIEA as a consistent, superficial, and easily dissectible recipient vessel with stable calibre and sufficient flow, even for large flaps. It enables safe microsurgical reconstructions in the anterior and lateral pelvic region and represents a valid alternative to the femoral artery, without compromising extremity perfusion. The study highlights the significant role of the DIEA in plastic and reconstructive surgery of complex pelvic and perineal defects.

Lymphoedema is a chronic, progressive condition that may occur as a primary disorder or secondarily following lymphatic damage, such as after lymphadenectomy or radiotherapy. Conservative therapies often provide only limited relief, so that surgical approaches like vascularised omental lymph node transfer (VOLT) are increasingly relevant.We present two cases of advanced secondary lower-limb lymphoedema following lymphadenectomy. Both patients demonstrated severe lymphatic transport dysfunction on lymphoscintigraphy and MRI. A double microsurgical lymph node transfer using VOLT was performed in each case. The omentum, selected for its high lymph node density and lymphangiogenic potential, was divided intraoperatively to reconstruct both the groin and lower leg regions. In addition, a systematic literature review on omental lymph node transfer for lymphoedema was conducted using PubMed.In both cases, postoperative assessment confirmed adequate perfusion of the grafts and clinical improvement of lymphoedema symptoms. The literature review revealed consistent evidence of significant limb volume reduction, improved lymphatic drainage, and a marked decrease in the incidence of cellulitis following VOLT.VOLT is an effective surgical option for therapy-refractory lymphoedema and may substantially improve patient quality of life. Despite promising results, further standardised prospective long-term studies are required to validate its efficacy and safety.