Background: Immediate lymphatic reconstruction (ILR) has emerged as an effective intervention to reduce breast cancer-related lymphedema, which affects 2–30% of patients who undergo axillary lymph node dissection (ALND). Our previous research validated ILR’s effectiveness over 14 months, but the duration was short and warranted further study. This study provides long-term evidence of its benefits in a well-defined patient cohort. Method: This retrospective cohort study included unilateral breast cancer patients who underwent ALND between November 2019 and February 2021 with ≥ 24 months of follow-up. Patients were grouped by whether ILR was attempted intraoperatively. Exclusion criteria were recurrence, prophylactic mastectomy, and pre-existing lymphedema. The primary outcome was lymphedema incidence at ≥ 24 months; the secondary was lymphedema-free survival. Outcomes were evaluated using Cox regression models. Results: Among 73 patients, we analyzed ALND patients divided into a control group (n = 57, defined as no-try or failure) and an ILR group (n = 16). The pooled median follow-up was 37 months. (range, 26~47 months). Among the ILR group, 13 underwent end-to-end anastomosis and 3 end-to-side. Postoperative lymphedema was higher in the control group (24.6%) compared to the ILR group (6.3%). Multivariate Cox regression analysis showed a significantly lower hazard ratio for the ILR group (HR: 0.117, 95% CI: 0.014–0.965), emphasizing ILR’s effectiveness in reducing lymphedema risk post-ALND. Additionally, survival plots illustrating lymphedema-free survival showed a significant difference. Conclusion: Our study emphasizes ILR’s efficacy over extended follow-up. The ILR group exhibited a lower rate of postoperative lymphedema, supporting ILR as an effective preventive measure against Breast Cancer-Related Lymphedema (BCRL) following ALND.

Background:Red breast syndrome (RBS) is represented as idiopathic cutaneous erythema overlying the acellular dermal matrix (ADM) after implant-based breast reconstruction without other signs and symptoms of infection. Although a number of etiologies including lymphatic disruption, delayed hypersensitivity reaction to ADM, and residual DNA within ADM have been suggested for RBS, consensus regarding risk factors and treatment for RBS has been reached yet. Thus, the aim of this study was to find risk factors for RBS and introduce our experience of successful treatment of RBS. Methods:A retrospective study was conducted for patients who underwent implant-based breast reconstruction using ADM from October 2018 to February 2021. Demographics, types of ADM used, reconstructive characteristics, and incidence of RBS were analyzed. Risk factors for RBS were investigated using the logistic regression model. Results:A total of 138 implant-based breast reconstructions using ADM were performed. Their average follow-up period was 17.33 months. The incidence of RBS was 5.8% (n=8) with a median onset time of 36 days. Based on the logistic regression analysis, prior history of radiotherapy [odds ratio (OR): 22.703, P=0.001] was the only significant risk factors for RBS. In most cases with RBS suspected (6 of 8), it was resolved with intravenous corticosteroid and 1 week course of oral antibiotics. Conclusions:Prior history of radiotherapy was found to be significant risk factor for RBS. Single dose IV corticosteroid with 1 week course of oral antibiotics might be useful for RBS treatment.

BACKGROUNDS:Many techniques have been described for reconstruction of the vaginal canal in gender affirmation surgery. However, none of the existing methods is known to be ideal. To overcome disadvantages of previous methods, we developed a method of vaginoplasty using a free jejunal graft. In this study, we describe the new method in detail and report postoperative results of our case series. METHODS:Between May 2022 and July 2023, 10 transfeminine patients underwent two-stage gender-affirming vaginoplasty at Korea University Anam Hospital. The first stage involved orchiectomy, urethroplasty, and neovaginal canal dissection. In the second stage, an average of 14.3 cm of jejunum was harvested via single-port laparoscopy, remodeled, and placed in the neovaginal canal. Patient characteristics, along with intra- and perioperative outcomes, were recorded. RESULTS:The median patient age was 27 years (range 21-52). The median BMI was 20.1 kg/m2, having received 50.6 months of hormonal replacement therapy, in average. No patient had history of gender-affirming surgery. The first surgery took 654 minutes (range 330-920 minutes) and the second surgery 283 minutes (range 150-441 minutes), in average. No major complication was noted. All patients were followed up for 6-18 months. In the donor site, two patients experienced paralytic ileus, which resolved within a week. No patient complained of persistent gastrointestinal discomfort. CONCLUSIONS:A two-staged free jejunal graft for neovagina construction is a safe and effective method of gender-affirming surgery for transfeminine individuals. This paper presents a novel approach of using a free jejunal graft to line the neovagina. The new technique comprises two stages of surgery to ensure hemostasis and minimize swelling of the neovaginal canal. No major complication was noted in the donor or the recipient site after follow-up of at least 6 months on 10 patients. LEVEL OF EVIDENCE II:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The nipple is a potential source of pathogens because its lactiferous ducts act as direct conduits from the nipple–areolar complex to the breast parenchyma. Our previous studies identified breast microbiota as a factor in postoperative complications following immediate breast reconstruction using silicone implants and acellular dermal matrix. This study aimed to investigate the correlation between preoperative nipple swab microbiota and the incidence of surgical site infections (SSIs) after autologous breast reconstruction. Methods We conducted a retrospective chart review of patients who underwent autologous breast reconstruction following total mastectomy. Preoperative nipple swab cultures were obtained. Patient demographics, surgical characteristics, and complication rates were compared between culture-positive and culture-negative groups. Microbiological data, including antibiotic‑resistance profiles, were collected. Results Among 39 reconstructed breasts, 18 (46.9%) had positive preoperative nipple cultures. The mean duration of drain placement was significantly longer in the culture‑positive group (14.39±3.96 days) than in the culture‑negative group (12.14±2.76 days, P=0.045). Methicillin‑susceptible Staphylococcus epidermidis accounted for 55.0% of isolates. Of the four SSIs observed, three occurred in patients with positive preoperative cultures. Conclusions Although pathogen strains differed between preoperative and postoperative settings, obtaining preoperative nipple microflora cultures and determining antibiotic‑resistance profiles can guide immediate antibiotic selection for SSIs and enhance postoperative management.

BackgroundAdipose-derived stem cells (ADSCs) promote lymphangiogenesis, though their integration with vascularized lymph node transfer (VLNT) is not well-explored. Unlike ADSCs, the stromal vascular fraction (SVF) can be obtained intraoperatively without the need for cell culture, making it ideal for incorporation into VLNT in a single-stage surgical procedure. This study evaluates the impacts of combined VLNT and SVF therapy using a rabbit hindlimb model.MethodNew Zealand white rabbits were divided into four groups: control, VLNT only, SVF only, and combined VLNT plus SVF. The VLNT procedure involved transferring a pedicled lymph node flap, while the SVF was harvested and injected into the perinodal tissue. Postoperative assessments included measuring edema volume, performing ICG lymphography, conducting histological analysis, and measuring VEGF-C and LYVE-1 expression.ResultsInitial increases in hindlimb edema volume were noted, but a significant decrease occurred by week 4, particularly in the VLNT group and VLNT plus SVF group compared to the control group. Histological evaluations indicated that the combined treatment group preserved superior structural integrity of the lymph nodes, with a decreased proportion of fibroadipose tissue compared to the VLNT-only group. Elevated VEGF-C expression was observed in the SVF-treated groups, as confirmed by both RT-PCR and ELISA analyses at week 4. Additionally, the combined VLNT plus SVF group showed increased LYVE-1 expression by week 8.ConclusionThe results suggest that SVF can be effectively integrated with VLNT in a single-stage procedure, enhancing the viability and structural integrity of vascularized lymph nodes. These results highlight the potential of this combined approach as a promising therapeutic strategy for advanced-stage lymphedema, meriting further exploration in clinical trials.

Background In breast surgeries, a lactiferous duct leading to lactic glands of breast parenchyma allows direct contamination by normal bacterial flora of the nipple-areola complex. Complete blockage of nipple flora from the intraoperative field is almost impossible. Objectives We aimed to analyze the microbiological profile of nipple flora of breast cancer patients who underwent an implant-based immediate breast reconstruction after a total mastectomy, and to evaluate the association of nipple bacterial flora with postoperative complications. Methods A retrospective chart review was performed of patients who underwent an implant-based immediate breast reconstruction after a total mastectomy. A nipple swab culture was performed preoperatively. Patient demographics, surgical characteristics, and complications were compared between positive and negative nipple swab culture groups. Microbiological profile data including antibacterial resistance were collected. Results Among 128 breasts, 60 cases (46.9%) had positive preoperative nipple swab culture results. Staphylococcus epidermidis accounted for 41.4% of microorganisms isolated. A multivariate logistic regression analysis of postoperative complications revealed that the presence of nipple bacterial flora was a risk factor for capsular contracture. Seven cases of postoperative infection were analyzed. In 2 cases (40% of pathogen-proven infection), the causative pathogen matched the patient's nipple bacterial flora, which was methicillin-resistant S. epidermidis in both cases. Conclusions Nipple bacterial flora was associated with an increased risk of capsular contracture. Preoperative analysis of nipple bacterial flora can be an informative source for treating clinically diagnosed postoperative infections. More studies are needed to determine the effectiveness of active antibiotic decolonization of the nipple. Level of Evidence: 3

Lymphedema is known to affect as many as 140 to 250 million people worldwide. Approximately 99% of lymphedemas are secondary cases after lymphadenectomy, radiation, or parasite infection. There has been no accurate estimate of the lymphedema population size in South Korea. This study aimed to quantify the epidemiology of lymphedema in South Korea and analyze the clinical characteristics of patients with lymphedema using a nationwide database. This large-scale cross-sectional study included patients who received one of the following three diagnostic codes - Q82.0 (hereditary lymphedema), I97.2 (breast cancer-related lymphedema), and I89.0 (unclassified lymphedema) from the Korean Health Insurance Review and Assessment service between January 2019 and July 2022 at tertiary hospitals, general hospitals, or other hospitals. The demographics of the lymphedema population, medication use, and medical characteristics were identified. Over the last 4 years, the annual incidence of lymphedema has steadily increased and peaked in 2021 with the number 1.85 out of 1000. Of all patients, 81% were located in the upper extremity, and 10.6% had previous cancer. Most patients were diagnosed in general hospitals (53.2%), at orthopedic surgery department (41.9%). On average, lymphedema patients spent 70.17 US dollar for medication and hospitalized for 16.9 days annually after diagnosis. Commonly prescribed medications were Entelon® (Vitis vinifera seed extract) (66.9%), steroids (40.5%), non-steroidal anti-inflammatory drugs (26.5%) and diuretics (21.8%). Only 5.7% of patients received surgery and 19.2% received herbal medicine. This is the first study in South Korea to quantify demographic and medical characteristics of lymphedema patients. These results will contribute to a comprehensive understanding of lymphedema diagnosis and treatment in our nation.

Background:Capsular contracture is one of the most common and severe complications after implant-based breast reconstruction. Recently, prepectoral implant-based breast reconstruction using acellular dermal matrix (ADM) has become an alternative to subpectoral implant-based reconstruction. However, risk factors for capsular contracture associated with recent prepectoral reconstruction trends are not well refined yet. Thus, the aim of this study was to determine risk factors for capsular contracture, and share our experience of treating capsular contracture in prepectoral reconstruction. Methods:This retrospective comparative study focused on 110 patients who underwent prepectoral implant-based breast reconstruction with ADM. Risk factors of capsular contracture were analyzed by comparing a capsular contracture group (27 cases) and a non-capsular contracture group (83 cases). Secondary treatment after capsular contracture development was analyzed in capsular contracture group. Results:According to univariate and multivariate analyses of risk factors for capsular contracture, single staged implant-based reconstruction (direct-to-implant), infection, and postoperative radiotherapy were significantly related to the development of capsular contracture. Also, surgical intervention including capsulectomy and capsulotomy with implant change showed a significant higher remission rate than other groups. Conclusions:Our study provides insights into risk factors and treatment choices for capsular contracture after prepectoral implant-based breast reconstruction with ADM. These findings can aid selection of patients, postoperative care and preventative treatment before reconstruction.

This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured. Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 +/- 7.0 mm, non-affected side: 115.2 +/- 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 +/- 3.4 mm, non-affected side: 34.5 +/- 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 +/- 5.8 degrees, non-affected side: 118.4 +/- 4.9 degrees, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry. (c) 2023 European Association for Cranio-Maxillo- Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Anbalcabtagene autoleucel is a novel anti-CD-19 CAR-T therapy that has shown promising clinical results, with a complete response (CR) rate of 73.7% in relapsed or refractory LBCL patients at interim analysis. This biomarker analysis aims to understand the mechanism associated with the treatment outcome. Patients with relapsed or refractory LBCL were enrolled to receive Anbal-cel at a dose of 2x106 cells/kg. Tumor biopsies were performed at baseline to assess the expression levels of CD19, PD-L1, and CD112/CD155. Peripheral blood mononuclear cell (PBMC) samples for immune phenotyping and serum sampled for ctDNA analysis were collected at day 0, 14, 28, and 3-month intervals thereafter until progression. PD-1 and TIGIT were highly expressed on baseline PBMC. PD-1 was expressed more on CD8+ CAR+ T-cells whereas TIGIT on CD4+ CAR+ T-cells. PD-1, LAG-3 and TIM-3 expressions were significantly increased from D14 at non-CR group. TIGIT expression was significantly increased at D28 at non-CR group. The non-CR group demonstrated the significantly increased level of IL-4+/ IL-5+ Th2 type CAR+ T-cells whereas GATA+ Th2/Tc2 type CAR+ T-cells were significantly lower in non-CR group. Additionally, CD57+CD27-CAR+ T-cells, a marker of terminal differentiation/ functional senescence, were significantly increased in the non-CR group from D14. CD226+ CAR+ T-cells were also significantly lower in the non-CR group. CD45RA+ CAR+ TEFF/EMRA cells post-infusion were significantly lower in the non-CR group and CD38+HLA-DR+ CAR+ T-cells, a marker of susceptibility of cell death, were significantly higher in the non-CR group. The activation of CAR+ T-cells measured by ICOS, 4-1BB, CD226 and CD94 was not different between the two groups. The most frequently detected mutations were related to cell cycling, epigenetic regulation, immune escape, apoptosis etc. Changes in ctDNA concentration were reversely correlated with treatment outcome. Anbal-cel’s unique immunologic and genetic changes demonstrated potential to correlate with treatment outcomes and warrant to confirm with more data.

Background: An immediate lymphatic reconstruction (ILR) combining axillary reverse lymphatic mapping (ARLM) and lymphovenous anastomosis (LVA) has been gradually in the spotlight as a novel surgical technique to prevent lymphedema. In this study, we investigate the preventive effect of ILR for the risk of upper extremity lymphedema. We will compare the incidence of postoperative lymphedema between the ILR treatment group and the no-try or failure group during the same period with analysis of the effects of different variables. Methods: In this retrospective cohort study, we analyzed 213 patients who had undergone mastectomy for node-positive unilateral breast cancer in our institution between November 1, 2019 and February 28, 2021. To assess the effect of preventive ILR, we divided the patients into a treatment group (n=30) and a control group (n=183). Univariate and multivariate Cox proportional hazards regression models were used to evaluate the association between ILR and lymphedema occurrence. Results: Of the 30 patients who were attempted, we successfully performed ILRs in 26 patients (86.7%). During a mean follow-up of 14 months, one patient (3.8%) was confirmed to have upper extremity lymphedema in the treatment group, whereas 14 out of 183 patients (7.7%) were diagnosed in the control group. In multivariate analysis, ILR success showed a borderline significant decrease in risk of lymphedema [hazard ratio (HR) =0.174; 95% confidence interval (CI): 0.022-1.374; P=0.097]. Conclusions: Our results suggested that ILR may be a promising surgical treatment to prevent postoperative lymphedema. There is a need for larger studies with longer follow-up to confirm the findings obtained in our study.

Our eternal teacher and the founder of plastic surgery in Korea, it seems like our hearts are falling apart when you leave us so suddenly, even though it's a road everyone has to go someday. It seems that the ground on which we should stand on is nowhere to find.

Background: Transgender and intersex populations have long remained under-documented in South Korea, largely due to the absence of comprehensive epidemiological data. With increasing societal acknowledgment, there's an urgent need to understand the demographics and health challenges faced by these communities. Methods: This retrospective, large-scale data study included people who received the F64 codes from the Korean Health Insurance Review & Assessment Service between January 2007 and December 2021. Demographics, gender-affirmative treatments, and psychiatric related medications were examined.Results: Between 2007 and 2021, 8,602 patients were diagnosed with "gender identity disorder" and 45 with "intersex." A steadily increasing annual prevalence was observed, peaking at 986 cases in 2021. The majority (79.8%) were aged between 10 and 30. Nearly half (53.2%) exhibited mental and behavioral disorders. Two-thirds had been prescribed anxiolytics or sedatives either before or after diagnosis. Merely 12.1% received hormone therapy covered by health insurance.Conclusion: This is the first large-scale study highlighting the demographics and clinical characteristics of the transgender and intersex populations in Korea. The study reveals a consistent growth of these communities over the past 15 years, with a significant proportion under 30 years of age facing mental and behavioral challenges. Findings underscore the need for targeted healthcare interventions, early psychological support, and comprehensive insurance coverage tailored to the specific needs of these individuals in Korea.

RATIONALE:The RoboticScope (BHS Technologies GmbH, Innsbruck, Austria) is a robotic exoscope, which consists of a robotic arm that holds a 3-dimensional camera. It has an advantage that a surgeon can perform an operation comfortably with a favorable ergonomic position. Also, it allows the delivery of clear and high-quality visualization for surgeons. In this study, we would like to share our initial experience with this newly developed microscope technology in lymphaticovenular anastomosis (LVA). To the best of our knowledge, it is the first experience of LVA using this microscope in Asia. PATIENT CONCERNS:A 65-year-old woman presented with bilateral lower extremity lymphedema after a hysterectomy that was performed 25 years back. Despite complex decongestive physiotherapy, an edematous symptom in both legs worsened. DIAGNOSES:In lymphoscintigraphy, a decreased visualization of main lymphatic flow in both the lower extremities was evident which was further suggestive of lymphatic obstruction. INTERVENTION:Although both sides showed edematous symptoms, we decided to proceed with the surgery on the left side first, because of the worsened condition. Four LVAs were performed at the dorsum of the foot (×2), ankle, and the superior edge of the knee using RoboticScope. OUTCOMES:At 6-months follow-up after operation, the postoperative circumference diameters were improved than preoperative in 10 cm above the knee (45 cm vs 49 cm), 10cm below the knee (37 cm vs 41 cm) and lateral malleolus (25 cm vs 28 cm). The lower extremity lymphedema index was also improved from 346.7 to 287.4 postoperatively. The RoboticScope provided a high-resolution image and a favorable ergonomic position during an operation. LESSONS:The results represent the possibility of the application of a robotic microscope in the field of microsurgery, and further studies are necessitated to confirm the efficacy of this system.

Background: Acellular dermal matrices (ADMs) play an essential role in prepectoral implant-based breast reconstructions; however, the most appropriate method for ADMs is unknown. Methods: We conducted a retrospective analysis of our institutional database. Patients who underwent mastectomy and prepectoral breast reconstruction using tissue expanders or breast implants covered with ADMs between March 2018 and June 2021 were included. Patient characteristics, postoperative complications, and long-term outcomes were investigated. Results: In total, 112 patients (126 breasts) were included. The anterior tenting and wrapping techniques were used in the reconstruction of 32 (25.3%) and 94 (74.7%) breasts, respectively. Using propensity score matching, nine breasts were selected for each technique within the direct-to-implant reconstruction group, while 16 breasts were selected for each technique within the 2-stage reconstruction group. The choice of technique (anterior vs. wrapping) in implementing ADM did not generate any significant differences in postoperative complications, including seroma formation and capsular contracture, for the direct-to-implant and 2-stage reconstruction groups. Regarding the direct-to-implant reconstruction group, the average postoperative drain volume was less in the anterior tenting group than that in the wrapping group (anterior tenting vs. wrapping; 495.09 +/- 156.118 mL vs. 673.43 +/- 307.954 mL, p = 0.006), but the difference was insignificant after propensity score matching. Conclusion: We report our experience with covering prosthetic devices with ADMs during postmastectomy breast reconstruction. No differences in the postoperative drain volume or postoperative outcomes were found between the study groups. Future studies are needed to determine the method that provides the most satisfactory results. (c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Breast cancer patients suffer from lowered quality of life (QoL) after surgery. Breast conservancy surgery (BCS) such as partial mastectomy is being practiced and studied as an alternative to solve this problem. This study confirmed breast tissue reconstruction in a pig model by fabricating a 3-dimensional (3D) printed Polycaprolactone spherical scaffold (PCL ball) to fit the tissue resected after partial mastectomy. A 3D printed Polycaprolactone spherical scaffold with a structure that can help adipose tissue regeneration was produced using computer-aided design (CAD). A physical property test was conducted for optimization. In order to enhance biocompatibility, collagen coating was applied and a comparative study was conducted for 3 months in a partial mastectomy pig model. In order to identify adipose tissue and fibroglandular tissue, which mainly constitute breast tissue, the degree of adipose tissue and collagen regeneration was confirmed in a pig model after 3 months. As a result, it was confirmed that a lot of adipose tissue was regenerated in the PCL ball, whereas more collagen was regenerated in the collagen-coated Polycaprolactone spherical scaffold (PCL–COL ball). In addition, as a result of confirming the expression levels of TNF-a and IL-6, it was confirmed that PCL ball showed higher levels than PCL–COL ball. Through this study, we were able to confirm the regeneration of adipose tissue through a 3-dimensional structure in a pig model. Studies were conducted on medium and large-sized animal models for the final purpose of clinical use and reconstruction of human breast tissue, and the possibility was confirmed.

BACKGROUND:Recurrent laryngeal nerve (RLN) injury and the resulting paralysis is the most common and known complication of thyroid surgery. Several surgical techniques, such as medialization thyroplasty with or without arytenoid adduction and injection laryngoplasty, have been developed to treat RLN injury, but these procedures have specific limitations and complications. In this study, we present the outcomes for our patients who underwent immediate RLN reconstruction during thyroid surgery by analyzing both subjective and objective outcomes. METHODS:A retrospective study was conducted for patients who underwent total or subtotal thyroidectomy between May 2012 and March 2020. Among them, patients who underwent immediate RLN reconstruction due to unilateral RLN injury were followed for at least 12 months. The voice perceptual evaluation, acoustic analysis, voice range profile, and Voice Handicap Index (VHI) scores were obtained preoperatively, 1 month, 6 months, and 12 months after surgery. RESULTS:Among the 11 patients, 6 patients (54.5%) underwent direct anastomosis, and 5 patients (45.5%) underwent nerve grafts using ansa cervicalis and great auricular nerve. The grade and breathiness in the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale and jitter item showed significant improvement at 12 months postoperatively, and although not statistically significant, the rest of the items also tended to improve. The total, functional, and physical scores on VHI improved significantly at 12 months postoperatively. Moreover, when comparing the voice analysis of the direct anastomosis group and the nerve graft group, there was no significant difference between the groups in objective and subjective results. CONCLUSION:Immediate RLN reconstruction demonstrated significant voice improvement postoperatively, and reconstructing the nerve immediately and combining follow-up treatment in the event of RLN injury will greatly help patients improve their long-term voice outcomes.

Anisotropically organized neural networks are indispensable routes for functional connectivity in the brain, which remains largely unknown. While prevailing animal models require additional preparation and stimulation-applying devices and have exhibited limited capabilities regarding localized stimulation, no in vitro platform exists that permits spatiotemporal control of chemo-stimulation in anisotropic three-dimensional (3D) neural networks. We present the integration of microchannels seamlessly into a fibril-aligned 3D scaffold by adapting a single fabrication principle. We investigated the underlying physics of elastic microchannels' ridges and interfacial sol-gel transition of collagen under compression to determine a critical window of geometry and strain. We demonstrated the spatiotemporally resolved neuromodulation in an aligned 3D neural network by local deliveries of KCl and Ca2+ signal inhibitors, such as tetrodotoxin, nifedipine, and mibefradil, and also visualized Ca2+ signal propagation with a speed of ~3.7 μm/s. We anticipate that our technology will pave the way to elucidate functional connectivity and neurological diseases associated with transsynaptic propagation.