BACKGROUND:Surgical possibilities and implant options in reconstructive and corrective breast surgery have expanded considerably, making comparative outcome data essential for informed preoperative decision-making. OBJECTIVES:This study presents and compares a single surgeon's long-term experience with Becker expander and fixed-volume implants in a large patient series, supplemented by a systematic review of the literature on postoperative and long-term complications. METHODS:Records of 183 patients (247 implants) who underwent reconstructive or corrective breast surgery using fixed-volume or Becker expander implants in a single-surgeon setting were retrospectively reviewed. Patient characteristics, risk factors, and surgical indications were analyzed within each implant group. Complications were categorized as minor or major, the latter defined as any event leading to revision surgery and implant loss. Results were compared to other large (n > 100) retrospective studies identified through a PubMed literature review. RESULTS:Cohorts of 90 patients with 112 Becker expander implants and 93 patients with 135 fixed-volume implants were compared. Groups did not differ significantly in patient history or risk factors. Complications were documented over a minimum follow-up of 24 months (median 5.87 years). Overall complication rates did not differ significantly between groups (31.25% vs. 32.59%, p ≥ 0.05). Major complications leading to implant loss were significantly more frequent in the Becker group (9.73% vs. 2.21%, p < 0.05), though this difference could not be reproduced in any individual subgroup. CONCLUSIONS:Despite the higher rate of major complications, overall complication rates in both groups were lower than average rates reported in the literature. Becker expanders remain a valid alternative to fixed-volume implants in single-stage reconstruction when patient selection is made carefully and aesthetic expectations favor volume adjustability.

PURPOSE:This study aimed to translate and culturally adapt the GENDER-Q into German and evaluate its feasibility and responsiveness when integrated into routine clinical care among patients undergoing masculinizing chest surgery. METHODS:This mixed-methods translation and pilot implementation study was conducted between January 2025 and January 2026 at a tertiary academic transgender health program in Germany. Linguistic validation included forward translation and back-translation, developer review, and cognitive debriefing interviews with 14 transgender and gender-diverse adults. For the pilot implementation, 14 consecutive patients undergoing masculinizing chest surgery completed scales assessing chest appearance, nipples and areolas, body image, gender dysphoria, psychological well-being, psychological distress, and experience of care. RESULTS:Linguistic validation identified minor semantic and conceptual issues resolved through iterative revisions, resulting in a linguistically accurate and conceptually equivalent German version. In the pilot implementation with a final sample of 13 patients, postoperative scores improved significantly across all assessed outcome scales (all p < 0.013), with the largest changes observed for chest appearance (mean change = 64.23; standardized response mean [SRM] = 3.59) and body image (mean change = 36.85; SRM = 1.59). Significant improvements were also observed for gender dysphoria (mean change = 23.08; SRM = 1.64) and psychological distress (mean change = 26.84; SRM = 2.04). Experience of care scores were high at baseline (mean range, 87.6-94.3) and remained stable. CONCLUSION:The German GENDER-Q demonstrated linguistic and conceptual equivalence and showed feasibility and preliminary responsiveness in a small single-center pilot implementation.

Background and Objectives:Despite ongoing research, the prevalence of lipoedema still relies on estimates, with figures in the recent literature ranging from 1% to 10%. Large-scale epidemiological studies on lipoedema are lacking. Patients and Methods:This retrospective observational study analysed health insurance claims data from the second-largest health insurance fund in Germany (8.7 million insured individuals), focusing on women with lipoedema stages I-III. Propensity score matching was performed to compare co-morbidities in lipoedema patients with those in the general patient population and in patients with grade III obesity. Results:Between 2017 and 2021, the documented prevalence of lipoedema increased by 123.5% (from 3.89 to 8.69 cases per 1,000 insured individuals). Stage II lipoedema was the most common, with a prevalence of 0.34% in 2021. Extrapolation of the data to the total population suggests approximately 338.200 affected women in Germany in 2021, corresponding to a prevalence of 0.95%. Conclusions:This study is the first to provide a robust nationwide extrapolation of lipoedema prevalence. The findings highlight the underutilisation of conservative treatment and the significant comorbidities present in the affected patient population.

Background: Post-bariatric abdominoplasty is associated with a high risk of bleeding and wound complications due to extensive tissue resection and impaired tissue quality. Tranexamic acid (TXA) reduces perioperative bleeding in multiple surgical disciplines, but evidence in massive-weight-loss abdominoplasty is limited. The aim of our study was to evaluate the association between perioperative TXA use and bleeding-related and surgical outcomes in post-bariatric abdominoplasty. Methods: This retrospective cohort study included 97 patients undergoing post-bariatric abdominoplasty, of whom 49 received perioperative TXA and 48 did not. The primary outcome was a composite of bleeding-related complications within 30 days, including hematoma, clinically relevant bleeding, or reoperation. Secondary outcomes included overall and specific surgical site complications, drain output and duration, length of hospital stay, and perioperative hemoglobin changes. Multivariable regression analyses adjusted for body mass index, abdominoplasty type, and year of surgery. Results: Bleeding-related complications were significantly lower in the TXA group compared with controls (4.1% vs. 33.3%; unadjusted OR 0.09, 95% CI 0.02-0.40; p < 0.001). This association remained significant after adjustment (adjusted OR 0.13, 95% CI 0.03-0.68; p = 0.016). TXA use was associated with lower cumulative drain output (median 200 vs. 382.5 mL; p < 0.001) and shorter drainage duration (median 4 vs. 5 days; p < 0.001). Overall complications were reduced in the TXA group (42.9% vs. 66.7%; p = 0.025), driven by fewer wound healing disturbances. Hemoglobin changes, seroma, and infection rates were similar between groups. Conclusions: Perioperative TXA use in post-bariatric abdominoplasty is associated with significantly fewer bleeding-related and wound complications without increased adverse effects, supporting its use in this high-risk population.

Pectus excavatum (PE) is the most common congenital anterior chest wall anomaly, often requiring surgical correction due to both functional and aesthetic concerns. Gender-affirming surgery has seen a significant increase in recent decades, with mastectomy being the primary procedure for transgender men. For transmasculine patients with PE seeking chest masculinization, the possibility of addressing both conditions in a single surgery has not been well explored. We report the first known case of a 33-year-old transgender patient with PE undergoing a combined procedure of masculinization top surgery and chest wall reconstruction. A novel bilateral inferiorly pedicled adipocutaneous flap, supplied by vessels of the anterior intercostal artery perforators, was used to correct the sternal depression while performing a mastectomy. This technique provided an immediate, well-perfused autologous reconstruction, eliminating the need for foreign implants or multiple procedures. The patient had an uneventful recovery and, at 1-year follow-up, demonstrated a satisfactory chest contour with complete correction of the funnel chest deformity and a masculinized thorax. This approach offers a viable, single-stage solution for transgender patients with PE, avoiding complications associated with implants or fat grafting. By using autologous tissue and preserving vascular integrity, this method expands the surgical options for chest wall reconstruction in gender-affirming care.

Background and Objectives Despite ongoing research, the prevalence of lipoedema still relies on estimates, with figures in the recent literature ranging from 1% to 10%. Large-scale epidemiological studies on lipoedema are lacking.Patients and Methods This retrospective observational study analysed health insurance claims data from the second-largest health insurance fund in Germany (8.7 million insured individuals), focusing on women with lipoedema stages I-III. Propensity score matching was performed to compare co-morbidities in lipoedema patients with those in the general patient population and in patients with grade III obesity.Results Between 2017 and 2021, the documented prevalence of lipoedema increased by 123.5% (from 3.89 to 8.69 cases per 1,000 insured individuals). Stage II lipoedema was the most common, with a prevalence of 0.34% in 2021. Extrapolation of the data to the total population suggests approximately 338.200 affected women in Germany in 2021, corresponding to a prevalence of 0.95%.Conclusions This study is the first to provide a robust nationwide extrapolation of lipoedema prevalence. The findings highlight the underutilisation of conservative treatment and the significant comorbidities present in the affected patient population.

Breast augmentation is the most frequently performed gender-affirming surgery (GAS) for transfeminine individuals. Because of anatomical differences between transfeminine and cisgender women, implant selection requires tailored planning. The "Number Y" is an established method for implant height selection in cisgender patients. Since its adoption for transfeminine patients at our institution in 2016, its reliability in this population has not been validated. The aim of this study was to validate the Number Y in transfeminine patients, identify anatomical factors influencing implant height prediction, and propose an adjusted "Number trans-Y" to improve surgical planning. This retrospective study included 21 transfeminine patients undergoing breast augmentation as part of GAS. Preoperative implant height predictions using the Number Y were compared with actual intraoperative implant choices. Implant shapes were categorized as vertical-elliptical, circular, or horizontal-elliptical. Patient and implant characteristics were analyzed for concordance. The mean patient age was 39.62 years, BMI of 25.42, and the mean Number Y of 4.31, higher than reported in cisgender cohorts. Implant height prediction was accurate in 16 patients (76.19%). Discordant cases (23.81%) had significantly smaller thoracic perimeters (9 cm difference, P = .01) and lower Number Y (3.96 ± 0.11 vs 4.42 ± 0.28; P < .001). Most concordant cases received low-height implants, whereas discordant cases were predicted to require middle-height implants but ultimately received low-height implants. The Number Y has limited predictive accuracy in transfeminine patients because of distinct thoracic anatomy and higher Y factors. An adjusted Number trans-Y is proposed to optimize implant selection and surgical outcomes in this population. Level of Evidence: 4 (Therapeutic).

BackgroundSuperficial ALK-rearranged soft tissue tumors are rare mesenchymal neoplasms showing heterogenous morphology and clinical behavior. They usually present as slowly enlarging nodules in young adults and can mimic other spindle cell tumors. While some ALK-altered mesenchymal neoplasms can be classified into defined WHO categories (e.g., inflammatory myofibroblastic tumor, epithelioid fibrous histiocytoma, and a few others), the nosology of many tumors has not yet been delineated, and they are currently reported descriptively. A case of a young man with a three-year follow-up is presented, providing prognostic insights into this entity.Case descriptionA healthy 23-year-old male presented with a purplish mass on the plantar left foot that had enlarged over one year. MRI showed a well-defined lesion without bone involvement. Histopathology revealed sheets of bland round to oval cells within myxohyaline stroma containing focal pseudorosette-like hyalinized nodules and increased mitotic activity. Immunohistochemistry demonstrated strong cytoplasmic ALK expression with heterogeneous expression for CD34, and S100. Focal EMA and pancytokeratin expression were noted. Next-generation sequencing confirmed a MYH10::ALK fusion. After excision with positive margins, re-excision revealed residual tumor as well. Further surgery was declined, and the patient developed metastatic disease during follow-up.DiscussionThis case broadens the spectrum of acral ALK-rearranged unclassified mesenchymal tumors and identifies MYH10 as a potential fusion partner in metastatic disease. Although these tumors are typically indolent, features such as increased mitotic activity may indicate more aggressive behavior. Diagnosis requires integrated histologic, immunophenotypic, and molecular assessment. This case highlights the metastatic potential of ALK-rearranged unclassified mesenchymal neoplasms, particularly those exhibiting a tyrosine kinase phenotype (co-expression of S100 and CD34), supporting their classification within the intermediate, rarely metastasizing category according to soft tissue tumor stratification principles. It further emphasizes the need for heightened clinical vigilance and thorough surgical management, which may influence long-term outcomes.

BACKGROUND:In autologous breast reconstruction, the internal mammary artery is the preferred recipient vessel. Although rib-resecting is usually performed, the rib-preserving technique has gained increasing attention in recent years without being scientifically evaluated. METHODS:In our retrospective study, we analyzed 234 autologous breast reconstructions performed between 2018 and 2023 at a single hospital, comparing 163 patients who underwent rib resection with 71 patients who received the rib-preserving technique. Intraoperative data, postoperative pain medication usage, and follow-up interventions over a minimum of one year were screened. RESULTS:Ischemia time was significantly shorter in the rib-resecting group (45:00 min, IQR 37:44-60:00) compared with the rib-sparing group (50:59 min, IQR 43:59-71:00; p = 0.006). However, the rib-sparing group had longer pedicle lengths (11, IQR 10-12 vs. 10, IQR 9.5-11 cm; p = 0.074) and larger arterial diameters (p = 0.084). Postoperatively, rib-resecting patients required longer opioid treatment (3, IQR 2-4.25 vs. 2.5, IQR 1.63-3 days; p = 0.019), reported greater pain on the first postoperative day (p = 0.049), and exhibited more blood loss and drainage volume (p = 0.033, p = <0.001). Follow-up procedures were more frequent in the rib-resecting group (1, IQR 1-3) than in the rib-sparing group (1, IQR 0-1; p = 0.001), including lipofilling (35% vs. 20.3%, p = 0.029). CONCLUSION:The rib-sparing approach shows significant advantages over rib-resection, particularly in terms of reduced postoperative morbidity and more aesthetically pleasing result with fewer secondary interventions. When technically feasible, it should be considered the preferred method in autologous breast reconstruction.Clinical Question/Level of Evidence.

Merkel cell carcinoma (MCC)is a rare but aggressive cutaneous malignancy with increasing incidence and poor prognosis. Host immune status is a key determinant of MCCmerkel cell carcinoma development and outcome. While the AEIOU criteria are widely used to facilitate clinical recognition, their value for prognostic assessment remains unclear. To evaluate the association between individual AEIOU presentation features and disease progression in patients with merkel cell carcinoma, with particular emphasis on immunosuppression. We performed a retrospective single-centre cohort study including 400 patients diagnosed with merkel cell carcinoma. Disease progression, defined as local recurrence, nodal involvement or distant metastasis, served as the primary endpoint. AEIOU criteria were assessed at diagnosis and analysed using logistic regression. Complete follow-up data were available for 241 patients, of whom 81 (33.6%) experienced disease progression. Patients with progression were significantly older and more frequently male. Among the AEIOU components, immunosuppression was the only criterion significantly associated with disease progression, conferring an increased risk compared with immunocompetent patients (p<0.001). Other AEIOU features showed no consistent prognostic association. Complete follow-up data were available for 241 patients, of whom 81 (33.6%) experienced disease progression. Patients with progression were significantly older and more frequently male. Among the AEIOU components, immunosuppression was the only criterion significantly associated with disease progression, conferring an increased risk compared with immunocompetent patients (p<0.001). Other AEIOU features showed no consistent prognostic association.

Background:Liposuction in lipedema is a safe and effective treatment, but there currently are no studies analyzing the individual complications of water-jet-assisted liposuction in lipedema or the impact of the cannula's design. Objectives:The aim of the authors of this study is to answer the question which WAL cannula is the safest in lipedema patients and provide practitioners with the data they need to make an informed decision about the cannula they choose. Methods:The authors retrospectively analyzed complications and their underlying risk factors in 117 patients across 243 cases. Groups were formed by diameter (Ø) and number of ports of the used cannulas. Unpaired t-tests, Fisher's exact tests, and χ2 tests were used to analyze the patients' characteristics for the complication rates across the cannulas. Results:Cannulas with 8 ports showed statistically significantly higher hemoglobin loss (P = .011), shorter incision-to-suture time (P = .023), and higher volume of aspirated fat (P < .001). The same results occurred when comparing the Ø3.8 mm cannulas that differ in the number of ports (4 vs 8 ports). The Ø4.8 mm group showed a significantly increased rate of wound-healing disorders compared with the Ø3.8 mm group (P = .041) and a statistically significantly higher aspirated fat volume (P = .014). Conclusions:No specific cannula showed superior safety in terms of complication rates. However, 8-port cannulas facilitated a faster aspiration of large volumes and reduced the incision-to-suture time compared with 4-port cannulas. This benefit was accompanied by a greater loss of hemoglobin. In contrast, cannula diameter played a less significant role in aspiration speed and did not increase the hemoglobin loss. Level of Evidence 3 Therapeutic:

Die Behandlung offener Frakturen der Extremitäten stellt eine interdisziplinäre Herausforderung dar, die neben unfallchirurgischer und plastisch-rekonstruktiver Expertise multiples Fachwissen, wie Gefäßchirurgische, Infektiologische, Radiologische und Mikrobiologische Kompetenz erfordert. Trotz der hohen Morbidität und des signifikanten gesundheitsökonomischen Aufwands existieren in Deutschland bislang keine etablierten interdisziplinären Leitlinien zur Versorgung dieser Verletzungen. Diese Übersichtsarbeit beleuchtet verschiedene Aspekte des orthoplastischen Behandlungskonzepts und untersucht am Beispiel des Innovationsfondsprojekts EXPERT am Universitätsklinikum Münster die Rolle telemedizinischer Extremitätenboards zur Optimierung von Behandlungsabläufen. Ebenfalls wird die Qualität bestehender internationaler Leitlinien anhand der British Orthopaedic Association Standard for Trauma (BOAST) 4 Guidelines bewertet. Im Zuge der Krankenhausstrukturreformen und der Konzentration hochspezialisierter Leistungen gewinnen sektorenübergreifende, digitale Versorgungskonzepte zunehmend an Relevanz. Die Etablierung interdisziplinärer Standards, Leitlinien und strukturierter Kommunikation über telemedizinische Plattformen erscheint dabei essenziell, um die Versorgungsqualität langfristig zu sichern und dem drohenden Kompetenzverlust in der Fläche entgegenzuwirken.

Im Rahmen der Evaluation eines virtuellen, multidisziplinären Experten-Boards zur Verbesserung der Behandlung von Traumata der unteren Extremitäten (Projekt EXPERT) werden neben medizinischen und ökonomischen Outcomes auch arbeitsbezogene Aspekte untersucht. Erste Ergebnisse einer Befragung von Mitarbeitenden, die in EXPERT eingebunden sind, werden hier vorgestellt. Klinikmitarbeitende bearbeiteten einen Online-Fragebogen zu den Themen Arbeitsbelastung, Arbeitsengagement, Technikbereitschaft und arbeitsbezogene Ressourcen. Arbeitsbezogene Ressourcen sind physische, soziale und organisationale Aspekte zur Bewältigung von Arbeitsanforderungen wie kollegiale Unterstützung und Bedeutung der Arbeit. Erfasst wurden Faktoren, die signifikant auf Arbeitsengagement und Technikbereitschaft einwirken. Zu Beginn des Projekts war das Arbeitsengagement sehr hoch, obwohl die individuelle Arbeitsbelastung ebenfalls hoch war. Bei hoher individueller Belastung stieg die Bereitschaft, Technik zu nutzen, wenn ausreichend arbeitsbezogene Ressourcen verfügbar waren. Nichtärztliches Personal wies insbesondere bei geringen Ressourcen eine höhere Technikbereitschaft auf. Bei hoher teambezogener Belastung, z. B. durch Konflikte, und nur wenigen Ressourcen war die Technikbereitschaft besonders gering. Vielfältige arbeitsbezogene Ressourcen stärken nicht nur das Arbeitsengagement, sondern auch die Akzeptanz digitaler Innovationen. Bei hoher individueller Beanspruchung nehmen Mitarbeitende, insbesondere Angehörige der nichtärztlichen Berufe, Technikeinsatz als hilfreich wahr. Voraussetzung dafür ist, dass die Zusammenarbeit im Team funktioniert.

Hintergrund und Ziel Die junktionale Epidermolysis bullosa (JEB) ist eine Unterform der Epidermolysis bullosa, einer Erkrankung, die durch eine Mutation im LAMB3-Gen verursacht wird. Wir behandelten einen Patienten mit JEB mit genetisch korrigierten autologen epidermalen Kulturen unter Verwendung eines retroviralen Vektors, der die funktionelle Gensequenz des LAMB3-Gens enth & auml;lt. Ziel dieser Studie war es, das Hautmikrobiom des Patienten, insbesondere der transgenen Haut, zu analysieren und mit dem Hautmikrobiom gesunder Kontrollpersonen sowie Patienten mit atopischer Dermatitis und bekannter mikrobieller Dysbiose zu vergleichen.Patienten und Methodik Die Analyse des Hautmikrobioms wurde 72 Monate nach kombinierter Gen- und Stammzelltherapie bei einem JEB-Patienten durchgef & uuml;hrt. Hautabstriche von altersentsprechenden gesunden Kontrollpersonen und Patienten mit atopischer Dermatitis wurden aus der ProRaD-Studie von CK-CARE einbezogen.Ergebnisse Die transgene Haut wies vergleichbar hohe relative und absolute H & auml;ufigkeiten von Staphylococcus (S.) aureus auf wie die blasenbildende und nicht-blasenbildende Haut des JEB-Patienten, w & auml;hrend die Gesamtbakterienlast geringer war. In der blasenbildenden Haut war die erh & ouml;hte Bakterienlast durch S. aureus bedingt.Schlussfolgerungen Unsere Untersuchung best & auml;tigt eine einzigartige Zusammensetzung des Mikrobioms bei JEB, die durch S.-aureus-getriebene bakterielle & Uuml;berwucherung charakterisiert ist. Die Dysbiose wurde in transgenen, nicht-blasenbildenden Hautbereichen nicht r & uuml;ckg & auml;ngig gemacht. Allerdings zeigt die transgene Haut Stabilit & auml;t in einer Umgebung mit bakterieller Dysbiose.

INTRODUCTION There is an ongoing increase in the percentage of females in the field of Plastic Surgery in Germany. Currently, 29,1% of fellows and 46% of residents in Germany are female. Several studies have pointed out the various obstacles that female doctors, especially female plastic surgeons, are confronted with in their professional life. The aim of this study is to examine gender parity among plastic surgeons in Germany. Furthermore, we aim to evaluate the opinion of both women and men on gender-specific discrimination. METHODS In a nonrandomized, cross-sectional study an anonymous questionnaire covering various subjects such as education/training, career path, the compatibility of family and career, as well as the subjective perception of gender equality in Plastic Surgery was distributed among members of the German Association of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) as well as through social media. Data was collected with Google Docs. RESULTS The sample group (n = 285) composition was 162 female (56,8%), 122 (42,9%) male and 1 nonbinary (0,4%). The majority of women (54.3%) and men (49.1%) rated work-life balance as "difficult". In 82.1% of women and 44.3% of men, family planning was influenced by the profession. Most of the respondents work in hospitals (62.9% of women and 50.0% of men). The main motivation of 61.4% of women to go to in private practice was family reasons, 51.8% of men gave financial reasons. 64.1% of women and 54.1% of men have a doctoral degree, whereas 6.9% of women and 13.3% of the men have a postdoctoral degree.While 33.6% of the men believe that their own gender had no influence on their respective career decision, career progress or success, only 4.9% of women had the same opinion. In addition, 43.8% of women and 22.1% of men reported having experienced sexual harassment in their professional lives. CONCLUSION This study reveals significant gender differences in career development in Plastic Surgery. Family planning, motivations for establishment and academic careers, as well as the experience of sexual harassment, are of primary concern. Actively helping to shape the work environment of career development opportunities in light of this study may help to reduce gender disparities in Plastic Surgery in the future.

Die Venenthrombose und deren mögliche Folgen besitzen einen besonderen Stellenwert als Gegenstand der gefäßmedizinischen Begutachtung. Dieser begründet sich u. a. darin, dass die Erkrankung oft als Komplikation von Verletzungen und medizinischen Behandlungen auftritt, welche einen speziellen versicherungsrechtlichen Schutz besitzen. Daraus resultieren Entschädigungsansprüche, die kausal begründet und quantitativ bewertet werden müssen. Je nach Rechtsgebiet müssen verschiedene Kausalitätstheorien angewendet werden. Auch die Bewertungsgrundlage weist eine Reihe von Unterschieden aus. Während in der gesetzlichen Unfallversicherung eine Minderung der Erwerbsfähigkeit zu bemessen ist, stellt in der privaten Unfallversicherung die Gliedertaxe die Grundlage der Invaliditätsbewertung dar. Im Schwerbehindertengesetz ist der Grad der Behinderung relevant, im sozialen Entschädigungsgesetz der Grad der Schädigungsfolge. Zum Beweis der Kausalität thromboembolischer Ereignisse im Zusammenhang mit dem verletzten Rechtsgut muss das Überschreiten der sog. thrombogenen Schwelle erörtert werden. Gutachterlich relevante Krankheitsbilder sind die Beinvenenthrombose und die Armvenenthrombose sowie die chronisch thromboembolische pulmonale Hypertonie. Thromboembolische Ereignisse im Rahmen einer Covid-19-Infektion stellen eine neu hinzugetretene Krankheitsentität dar. Zur pathophysiologischen Charakterisierung der Erkrankungen finden international verwendete Scores Anwendung. Die Bemessungsgrundlage für die einzelnen Entschädigungsmodalitäten ist der sozialmedizinischen Literatur und Gesetzestexten zu entnehmen.

Background: In recent years, the profunda artery perforator (PAP) flap has gained recognition as a viable technique in autologous breast reconstruction, demonstrating low donor site morbidity and favorable reconstructive outcomes. This study aims to highlight the recent refinements using the PAP flap for breast reconstruction focusing on preoperative volume prediction. Methods: A retrospective study was conducted to evaluate the outcomes of breast reconstruction surgeries using the PAP flap at our institution between May 2018 and December 2022. A total of 114 PAP flaps performed in 96 patients were included. Statistical analysis was performed to analyze flap volume in relation to body mass index (BMI). Surgical details, such as donor site-related complications and patient characteristics, were also collected. Results: BMI was identified as a statistically significant predictor (p < 0.001) for flap weight in the resulting model. The average BMI observed was 23.0, while the mean flap weight was 304.2 g. The predictive model for flap weight was determined as follows: flap weight (g) = (19.252 × BMI) − 143.572. This model underscores the relationship between BMI and flap weight, quantifying the influence of BMI on flap weight prediction. Conclusions: Our study indicates that it is feasible to harvest an adequate volume for breast reconstruction even in patients with a low BMI. To facilitate preoperative prediction of PAP flap volume, we developed an algorithm designed to enhance preoperative planning and estimate the need for supplementary procedures to achieve the desired volume.

BACKGROUND AND OBJECTIVE:Junctional epidermolysis bullosa (JEB) is a subtype of epidermolysis bullosa caused by mutations in the LAMB3 gene. We treated a patient with JEB using genetically corrected autologous epidermal cultures retrovirally transduced with the functional LAMB3 gene sequence. The objective of this study was to analyze the skin microbiome of this patient, with a particular focus on transgenic skin, and to compare the findings to the skin microbiome of healthy controls and patients with atopic dermatitis and well-documented microbial dysbiosis. PATIENTS AND METHODS:Skin microbiome analysis was performed on a JEB patient 72 months after combined gene and stem cell therapy. Skin swabs from age-matched healthy controls and atopic dermatitis patients were included from the ProRaD study of CK-CARE. RESULTS:The transgenic skin had comparably high relative and absolute Staphylococcus (S.) aureus abundance to blistering and non-blistering skin of the JEB patient, while the total bacterial load was lower. In blistering skin of the JEB patient, higher bacterial load was driven by S. aureus. CONCLUSIONS:Our investigation confirms a unique microbiome composition in JEB, characterized by S. aureus driven bacterial overgrowth. The dysbiosis was not reversed in transgenic, non-blistering skin areas. However, the transgenic skin demonstrates stability in an environment of bacterial dysbiosis.