Traumatic injuries often result in nerve tissue damage and functional deficits due to limited regeneration. Silk fibroin, a biopolymer with inherent biocompatibility and tunable properties, is a promising material for 3D-bioprinted neural tissue scaffolds. This review highlights recent advancements in silk-derived composite scaffolds, often incorporating additional materials like collagen or conductive polymers to enhance their performance. This review examines how material composition, scaffold architecture, and fabrication strategy influence biological response and functional recovery. This comprehensive review follows PRISMA guidelines and uses comprehensive searches of PubMed, MEDLINE, Embase, Web of Science, Cochrane Central, and ClinicalTrials.gov for studies published through 2025. Studies were screened for eligibility based on substance type, mechanical properties, production methods, and outcomes. Findings were synthesized qualitatively. Twelve studies were included, comprising rat (50%), canine (8.3%), and in vitro (41.7%) models. Analysis reveals that silk fibroin acts as a highly adaptable mechanical backbone. It can consistently integrate with bioactive additives (collagen, dECM) or conductive polymers (Polypyrrole, MXene) to meet specific therapeutic demands. For spinal cord injuries, composites reached a compressive modulus capable of resisting physiological pressures and preventing scaffold collapse. In soft tissue applications, silk–hydrogel blends provided localized release of exosomes and small molecules during the acute injury phase, reducing neuroinflammatory markers. Additionally, adding conductive materials allowed the scaffolds to bridge electrical gaps and promote Schwann cell proliferation and neuronal differentiation. Furthermore, 3D bioprinting enabled the creation of defined microchannels that replicate native fascicular architecture. In vivo outcomes consistently showed superior axonal regeneration, myelination, and synaptic reconnection compared to controls, correlating with significant improvements in electrophysiological and motor function. This review highlights the clinical potential of silk fibroin-based 3D-printed biomaterials for nerve regeneration, including neural repair and neural tissue engineering. More recent studies place greater emphasis on integrating mechanical, architectural, and biological considerations into scaffold design, resulting in increasingly multifunctional scaffold systems. Despite promising efficacy, the heterogeneity of fabrication methods and the predominance of rodent models highlight the need for standardized protocols and evaluations in relevant models to facilitate clinical translation.

Cartilage regeneration remains a major clinical challenge because cartilage has limited healing capacity and must withstand substantial mechanical loading. Silk fibroin, a cocoon-derived biomaterial with tunable mechanical properties, has emerged as a promising scaffold material for cartilage tissue engineering. This systematic review evaluates the biomechanical performance, fabrication approaches, and regenerative potential of silk fibroin bioprinted scaffolds for cartilage repair. A systematic review was conducted according to PRISMA guidelines. Primary outcomes included scaffold mechanical properties relevant to cartilage function. Secondary outcomes included scaffold composition, fabrication methods, biological performance, clinical applications, and reported limitations. Of 918 identified records, 24 studies published between 2014 and 2025 met the inclusion criteria. Most were preclinical studies using silk fibroin-based hydrogels, often combined with hyaluronic acid, gelatin, collagen, or synthetic polymers. Mechanical properties varied according to scaffold composition and crosslinking methods. Reinforced scaffolds generally demonstrated improved stiffness, structural support, and load distribution. Silk fibroin scaffolds consistently supported chondrogenesis and cartilage-like tissue formation. However, challenges remain, including mechanical mismatch with native cartilage, construct instability, cell loss, and suboptimal degradation profiles. Overall, silk fibroin bioprinted scaffolds demonstrated support for chondrogenesis and cartilage-like tissue formation in preclinical studies for cartilage regeneration. Future research should focus on standardized biomechanical testing, long-term in vivo evaluation, and clinically relevant scaffold designs to facilitate translation toward functional cartilage repair.

BACKGROUND:Dangling protocols are widely used in the postoperative management of lower extremity free flaps to promote microvascular adaptation. To optimize outcomes, surgeons use dangling protocols, gradually increasing limb dependency, to enhance venous adaptation. However, wide variability exists in their design, and the impact of dangling duration and frequency on complication rates remains unclear. METHODS:A systematic meta-analysis was performed to evaluate pooled complication rates associated with dangling protocols and to assess whether protocol duration (minutes per session) or frequency (number of sessions) was associated with adverse outcomes. Following PRISMA 2020 guidelines, we searched Medline, Embase, Web of Science, and Cochrane for relevant studies published through 2024. Then, a random-effects model was used to estimate pooled rates of partial flap loss, total flap loss, venous congestion, arterial compromise, hematoma, infection, wound dehiscence, return to the operating room, and donor site complications. Meta-regression was performed to examine associations with dangling protocol characteristics. RESULTS:Across pooled studies, overall complication rates were low, including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). No statistically significant associations were found between dangling duration and any complication type. While increased frequency of dangling was significantly associated with higher return-to-OR rates in the full model (slope = 0.0224; p = 0.0002), this relationship was entirely driven by a single study reporting 24 sessions/day. When this outlier was excluded, the association became non-significant. CONCLUSION:Dangling protocols appear safe and well tolerated, with low rates of major complications. While the duration of dangling sessions does not affect complication risk, higher frequency may increase the likelihood of surgical re-intervention. These findings support the need for standardized, evidence-based protocols and further research into the physiologic and clinical thresholds guiding postoperative flap care. A meta-analysis of lower extremity free flap studies demonstrated low complication rates across common endpoints including total flap loss (0.30%), arterial compromise (0.30%), and venous congestion (0.73%). LEVEL OF EVIDENCE: 3:

Collagenase Clostridium histolyticum (CCH; Xiaflex) is an established nonsurgical therapy for Dupuytren contracture. Although adverse effects such as edema, ecchymosis, and skin tears are common, vascular injury is rare and pseudoaneurysm formation has not been previously described. Clinical evaluation and operative management of a patient who developed a digital artery pseudoaneurysm after CCH injection and manipulation were reviewed. A 66-year-old man developed a pulsatile swelling on the volar-radial aspect of the small finger 1 week after manipulation. Duplex ultrasound demonstrated a 1.8 × 1.5 × 1.9 cm partially thrombosed pseudoaneurysm with a 1.2 × 0.5 × 1.0 cm patent lumen arising from the radial digital artery. Surgical exploration revealed the artery entering the pseudoaneurysm with the digital nerve displaced centrally. The diseased arterial segment was excised and clipped proximally and distally. Digital perfusion remained intact and recovery was uneventful. Digital artery pseudoaneurysm is a potential, previously unreported complication of CCH injection for Dupuytren contracture. New or pulsatile swelling after manipulation should prompt vascular imaging to exclude this diagnosis.

Background: In maxillofacial reconstruction, even small inaccuracies can compromise aesthetics, function, and safety. Surgeons currently rely on preoperative imaging; however, recent advances in intraoperative imaging now provide three-dimensional, real-time guidance, possibly enhancing surgical outcomes. This review evaluates the current application of intraoperative imaging in maxillary and mandibular surgery including its impact on accuracy, efficiency, and outcomes. Methods: Two separate systematic reviews (PROSPERO CRD420251125497, CRD420251124600), analyzing maxillary and mandibular repair were conducted through Cochrane, Medline, Embase, and Web of Science. Both reviews adhered to the PRISMA guidelines. Inclusion criteria encompassed intraoperative digital imaging or navigation in maxillary or mandibular surgery. Studies without human subjects, intraoperative imaging, or the surgery of interest were excluded. Bias was assessed with NIH Quality Assessment. Results: A combined total of 795 publications were screened, with 35 studies ultimately included in this review, encompassing 1643 patients. Techniques included intraoperative computed tomography (CT) (n = 12, 34.3%), stereotactic navigation (n = 16, 45.7%), augmented reality (n = 2, 5.7%), ultrasound, fluoroscopy, infrared stereoscopic and electromagnetic (n = 1, 2.9%, each). The most common indication for surgery was fracture repair. Reporting was heterogeneous, with variable metrics and reporting for accuracy, complications, and revisions. Overall, cone-beam CT (CBCT) and stereotactic navigation both demonstrated significant restoration of normal symmetry, and stereotactic navigation enabled accuracy of <2 mm. CBCT added the shortest amount of time intraoperatively, ranging from 1 to 20 min. Reporting on long-term outcomes was heterogeneous. Conclusions: A variety of intraoperative imaging and navigation techniques are being applied in maxillofacial surgery. However, inconsistent reporting metrics, small study size, and study feasibility-focused study design limit meaningful comparison across technologies. Rigorous prospective studies with standardized outcome measures are needed to further define their clinical value and guide adoption.

BACKGROUND:Deep inferior epigastric artery perforator (DIEP) flaps are widely used in autologous breast reconstruction and increasingly favored due to superior patient-reported outcomes. Preoperative imaging is central to efficient and safe DIEP flap planning, yet the optimal modality remains debated. While computed tomography angiography (CTA) is recommended by ERAS protocols, concerns over radiation exposure and cost have prompted interest in alternatives such as ultrasound (US) and magnetic resonance angiography (MRA). METHODS:A systematic review following PRISMA guidelines was conducted across five major databases, including clinical trials and observational studies published through 2025. Studies included patients undergoing DIEP flap reconstruction with preoperative imaging using CTA, US, MRA, or other modalities. Data extracted included imaging-to-surgical perforator correlation, operative time, complication rates, and flap outcomes. Meta-analyses and heterogeneity assessments were performed using STATA. RESULTS:Thirty-two studies encompassing 3238 patients were included. CTA was used in nearly all studies; US, MRA, SPY/ICG, and DIRT were evaluated in a subset. Pooled perforator utilization was highest with MRA (92%), followed by CTA (87%) and US (85%). Among 2967 patients with complication data, 410 (13.8%) experienced adverse outcomes. Complication rates differed significantly across strategies. Patients utilizing US alone experienced the highest complication rates (17.3%), compared to CTA alone (13.9%) and CTA and US (10.8%). The complication rate difference between US alone patients and CTA and US alone patients was statistically greater (RR = 0.63, p = 0.0123). The complication rates between CTA alone and US alone or CTA and US were not statistically different (US alone: RR = 0.81, p = 0.1040; CTA and US: RR = 0.78, p = 0.11). Complete flap loss occurred in 8.0% of complications, partial flap loss in 14%, and fat necrosis in 19%. CONCLUSION:CTA remains the most studied imaging modality for DIEP flap surgical planning, demonstrating high perforator utilization and low complication rates. Combining CTA with US may further improve outcomes by integrating anatomical precision with dynamic feedback. As newer, lower-risk imaging technologies emerge, comparative studies are needed to determine whether they can match or exceed the performance of CTA in DIEP reconstruction.

BACKGROUND:Oral mucositis (OM) is a frequent and debilitating side effect of chemotherapy and radiotherapy, affecting up to 80% of patients receiving high-dose regimens or head and neck radiation. It severely compromises oral function, quality of life, and treatment adherence, often necessitating opioid analgesia and nutritional support. Methylene blue (MB), known for its anti-inflammatory and analgesic properties, has recently emerged as a potential therapeutic agent for OM pain. OBJECTIVES:This systematic review aimed to evaluate the analgesic efficacy of methylene blue in the management of chemotherapy- and radiotherapy-induced OM, either as a topical oral rinse or as a photosensitizer in photodynamic therapy (PDT). METHODS:Following PROSPERO registration (CRD42024594258), we conducted a comprehensive search of five databases up to September 2024. Studies were eligible if they included cancer patients with chemotherapy- or radiotherapy-induced OM treated with MB. Data extraction and quality assessment were performed independently by two reviewers following PRISMA guidelines. Pain reduction was the primary outcome. A random-effects meta-analysis using inverse variance weighting was conducted; heterogeneity was assessed with I2 statistics. RESULTS:Out of 137 screened records, 6 studies comprising 9 treatment groups and 432 patients met inclusion criteria. MB was administered either as an oral rinse alone (7 groups) or in combination with laser therapy (2 groups). The pooled mean reduction in pain was -4.81 points on a 0-10 scale (95% CI -5.57 to -4.05; P < 0.001). Subgroup analysis showed a mean change of -5.01 with oral rinse alone and -3.80 with the combination, with no significant difference between the two strategies (P = 0.30). Sensitivity analyses confirmed the robustness of these findings. CONCLUSION:Methylene blue appears to be a safe and effective option for pain relief in OM, with significant reductions in pain scores observed across studies. Its simplicity, affordability, and favorable safety profile make it a promising adjunctive therapy. Larger randomized trials are needed to validate these findings and explore long-term outcomes.

BackgroundVenous thromboembolism (VTE) remains a critical concern in plastic and reconstructive surgery (PRS) due to prolonged operative duration, perioperative immobility, and procedure-specific risks. While low-molecular-weight heparin (LMWH) has been the prophylactic standard, use of direct oral anticoagulants (DOACs) and aspirin (ASA) has been gaining traction. This study summarizes prophylactic practices in PRS.MethodsA systematic search of three databases was conducted. Studies evaluating ASA, DOACs, or LMWH prophylaxis in PRS with VTE, bleeding, or 30-day reoperation rates were included. Mixed anticoagulant regimens were excluded. Data on dosage, duration, and complication rates were extracted. A random-effect meta-analysis of proportions was conducted.ResultsOf 884 studies screened, 7 met inclusion criteria, totaling 3,475 patients: ASA (n=402), DOACs (n=2056), and LMWH (n=802). Common regimens included ASA 325mg daily for 5 days and DOAC 10mg daily for 10 days; LMWH dosing varied. VTE rates were low across groups: 1.15% ASA, 0.3% DOACs, and 0.44% LMWH. Hematoma rates were similar for ASA (4.6%) and LMWH (4.5%), while DOACs had a higher rate (8.7%), largely influenced by an outlier. Reoperation rate was highest for ASA (16.9%), followed by DOACs (10.5%) and LMWH (8.0%).ConclusionDespite comparable VTE rates across agents, variability in bleeding and reoperation highlights the need for procedure-specific, individualized prophylaxis. ASA and LMWH may offer more predictable safety profiles, while DOACs remain promising but warrant further investigationLevel of Evidence IIIThis 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.

Microneedling (MN) has risen in popularity as a non-surgical treatment option for facial skin aging. We aimed to evaluate patient-reported outcomes (PROMs) and safety profiles associated with MN. A systematic review was conducted adhering to PRISMA guidelines. Articles were screened for relevance in a two-stage process. Descriptive statistics and a proportion meta-analysis was utilized for patient satisfaction using Stata statistical software. Of 346 studies identified, a total of 21 articles reporting outcomes of 723 patients undergoing MN for facial rejuvenation were included for review and meta-analysis. The patient cohort was majority female (72 www.springer.com/00266

BACKGROUND:Enhanced recovery after surgery (ERAS) protocols, introduced in 1997, are evidence-based strategies designed to reduce postoperative stress and improve recovery through a multidisciplinary approach. This systematic review evaluated the use of ERAS in plastic surgery, focusing on opioid use, pain management, hospital stay, and patient outcomes. METHODS:A literature search in PubMed/MEDLINE and Web of Science was conducted up to May 9, 2024, identifying 239 studies on ERAS in plastic surgery. Seventeen studies met the inclusion criteria, and 9 studies involving 1228 patients were included. Outcomes assessed were narcotic use, pain scores, hospital stay, and complications. Quality was assessed using the National Institute of Health (NIH) tool. RESULTS:Among the 9 studies, 4 were included in a meta-analysis (600 participants). ERAS protocols were associated with a significantly shorter hospital stay (mean difference: -0.58 days, P = 0.003) with no heterogeneity. Opioid use decreased (mean difference: -85.5 morphine milligram equivalents [MME]), although the results were uncertain due to high heterogeneity (I² = 99.9). ERAS also showed lower pain scores within 24 h postsurgery, but with considerable variability (mean difference: -1.56, P = 0.27). CONCLUSION:ERAS protocols reduce opioid consumption and hospital stays while maintaining or improving patient satisfaction in plastic surgery. Despite risks such as increased bleeding, the benefits suggest that ERAS enhances recovery. Future research should optimize protocols and address regional implementation challenges.

Suture anchors (SAs) are medical devices used to connect soft tissue to bone. Traditionally these were made of metal; however, in the past few decades, bio-absorbable suture anchors have been created to overcome revision surgeries and other complications caused by metallic SAs. This systematic review aims to analyze the biomechanical properties of these SAs to gain a better understanding of their safety and utilization. A comprehensive systematic review that adhered to the PRISMA guidelines was conducted. Primary outcomes were that the pull-out strength of SAs, the rate of degradation secondarily, and the biocompatibility of all SAs were analyzed. After screening 347 articles, 16 were included in this review. These studies revealed that the pull-out strength of bio-absorbable SAs was not inferior to that of their non-absorbable comparatives. The studies also revealed that the rate of degradation varies widely from 7 to 90 months. It also showed that not all absorbable SAs were fully absorbed within the expected timeframe. This systematic review demonstrates that existing suture anchor materials exhibit comparable pull-out strengths, material-specific degradation rates, and variable biocompatibility. All-suture anchors had promising results in biocompatibility, but evidence fails to identify a single most favorable material. Higher-powered studies that incorporate tissue-specific characteristics, such as rotator cuff tear size, are warranted. To meet demonstrated shortcomings in strength and biocompatibility, we propose silk fibroin as a novel material for suture anchor design for its customizable properties and superior strength.

Postoperative pain is a prevalent problem, often lasting from days to years. To minimize opioid use and associated risks of dependency, Enhanced Recovery After Surgery (ERAS) protocols increasingly incorporate multimodal analgesics. Sodium channel-selective blockers are a promising non-opioid alternative, yet their application in postoperative pain remains underexplored. This systematic review evaluates their efficacy in managing postoperative, neuropathic, and neuralgia-related pain. A systematic review was conducted using controlled keywords across multiple databases to identify studies on sodium channel-selective blockers published up to 2024. Eligible studies included clinical trials, observational studies, case series, and reports involving patients aged 18 or older. Data were extracted on therapeutic outcomes, dosages, complications, and comparisons with other analgesics. Five studies met the inclusion criteria, involving 804 patients, 81.58% of whom were women. One study addressed postoperative pain, while the remaining five focused on neuropathy- and neuralgia-related pain. All studies reported significant pain reduction in at least one treatment group compared with placebo. In the study on postoperative pain, the sodium channel-selective blocker significantly reduced pain scores without requiring opioid analgesia. Across all studies, only two patients needed concomitant opioid therapy, and one discontinued treatment due to adverse effects. Dosages varied, with no reports of severe complications. Comparative analyses showed that sodium channel-selective blockers were as effective, if not superior, to traditional pain medications in reducing pain intensity. Sodium channel-selective blockers demonstrate significant potential in pain management with minimal opioid reliance. While effective for neuropathic pain, further studies are essential to validate their role in acute postoperative settings and refine their use in multimodal analgesia regimens.

Many patients seek body contouring surgery (BCS) to address excess skin following significant weight loss (WL), including from GLP-1 receptor agonists such as semaglutide. Optimal BCS timing is crucial, as postoperative weight fluctuations can distort outcomes. While weight stabilizes 12-18 months after bariatric surgery, the timeline for semaglutide-associated WL is less clear, particularly with weight recurrence (WR) after drug discontinuation A systematic review of MEDLINE, Embase, Web of Science, and PubMed was performed. Randomized controlled trials (RCTs) and prospective observational studies measuring weight change over time with semaglutide use were included. Time to weight loss plateau (WLP), defined as ≥1 month with WL <3 www.springer.com/00266 .

Breast implant illness (BII) has raised concerns about breast implant safety, with some suggesting that heavy metals released from implants could contribute to systemic symptoms. This systematic review examines the presence of metal residues in breast implants and surrounding tissues, and their potential role in BII. A systematic literature search following PRISMA guidelines was conducted using EMBASE, Web of Science, and PUBMED for studies published until January 2024. Inclusion criteria targeted material science and clinical research on metal residues in patients with breast implants. Data on metal concentrations, detection techniques, sample types, and clinical outcomes were extracted. Our search identified 304 titles, from which seven unique studies met inclusion criteria. Platinum, the most frequently detected metal, was detected in implant gel, capsular tissue, and systemic samples (blood, urine, and hair), in concentrations ranging from 0.001 to 125.27 μg/g. No consistent correlation was identified between metal levels and BII symptoms. Tin, aluminum, arsenic, and zinc were detected at low levels, below established toxicity thresholds, and often attributed to environmental exposure due to their presence in control groups. Inconsistencies in metal concentrations across studies were linked to variations in metal detection techniques and sample preparation. We highlight the presence of metal residues, particularly platinum, in breast implants and adjacent tissue, but without a definitive link to BII. Current evidence does not support heavy metal toxicity as a primary justification for total capsulectomy in BII management. Further evidence-based clinical guidelines are needed to better inform management of BII. 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 drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. Methods: A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. Results: Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. Conclusions: Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery. (c) 2024 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

This literature review provides a novel exploration of zinc’s multifaceted roles in dermatology, with a particular focus on its potential integration into botulinum toxin formulations—an area that remains relatively underexplored in clinical practice. Zinc is widely recognized for its critical functions in skin health, including morphogenesis, regeneration, and protection, and its use in aesthetic medicine offers a unique opportunity for innovation. Specifically, incorporating zinc into botulinum toxin formulations could enhance the efficacy and stability of these treatments. Although zinc has historically been used in topical dermatological products and systemic health interventions, its potential in cosmetic preparations, such as anti-aging therapies or non-invasive aesthetic treatments, remains under-researched. Emerging patents suggest promising formulations combining zinc with botulinum toxin that may improve product stability and extend therapeutic effects. While current studies on oral zinc supplementation present mixed results concerning its ability to prolong botulinum toxin effects, this underscores the need for more rigorous investigation in the realm of aesthetic medicine. Zinc’s well-established role in stabilizing dermatological products, such as sunscreens, and its applications in wound healing and skin regeneration, further highlights its potential for broader therapeutic uses beyond cosmetic applications. This review identifies a critical gap in the literature and calls for future research to optimize zinc concentrations and delivery methods specifically for aesthetic medical procedures, offering new insights into improving dermatological treatments beyond the scope of traditional cosmetic preparations.

Objective: The objective of this study was to evaluate whether a systematic image assessment protocol using SPY Elite images (LifeCell Corp., US) of viable tissue at the periphery of the surgical field was associated with positive wound healing outcomes following mastectomy and breast reconstruction. Method: Patients undergoing mastectomy and subsequent breast reconstruction surgery at a single tertiary medical centre were included. SPY images were prospectively analysed using a systematic image assessment protocol, and an absolute value of mean fluorescence was calculated by measuring peripheral, in-situ tissue from each image. Patient medical records were retrospectively reviewed for demographics, surgical characteristics and postoperative outcomes. These variables were statistically tested for associations with mean fluorescence. Results: A total of 63 patients were included in the final analysis. We found that objectively determined mean fluorescence values were not statistically significantly associated with postoperative complications. Conclusion: In this study, objectively measured mean fluorescence values representing breast tissue remaining after dissection showed little utility in the assessment of postoperative wound healing outcomes as they did not identify patients who would later have complications of wound healing. Declaration of interest: The authors have no conflicts of interest to declare.

Carpal tunnel syndrome occurs due to entrapment of the median nerve by the transverse carpal ligament and is the most common entrapment neuropathy in the United States. 1 The purpose of our investigation was to identify preoperative factors that increased the odds of developing postoperative surgical site complications in a large group of patients undergoing treatment for carpal tunnel syndrome. To answer the research question, we implemented a cross-sectional study of consecutive median nerve decompressions reported to the American College of Surgeons National Surgical Quality Improvement Program database over a 15-year period. Our institution did not require IRB approval for this de-identi fi ed, population-based, retrospective descriptive study. Predictor variables of interest included: age, sex, obesity, and medical comorbidities (diabetes mellitus, smoking, chronic obstructive pulmonary disease [COPD], hypertension, local steroid use). The primary outcome was 30-day postoperative surgical site complication rates, including surgical site infections and wound dehiscence. To identify independent factors associated with our primary outcome, we fi rst performed a univariate analysis to compare patient cohorts ( χ 2 test and the Fisher exact test for categorical variables, the Mann-Whitney U test for non-parametric continuous variables, and the independent samples t test for parametric continuous variables). We then constructed a multivariate logistic regression model. Our dependent variable was the rate of surgical site-related complications, and all predictor variables were included as possible independent covariates. A

PURPOSE: There are numerous described rhytidectomy techniques, each offering specific advantages1. The goal of this study was to implement a novel surgical algorithm based on patient specific characteristics to compare the effects of the High SMAS, SMAS plication, and SMAS-ectomy techniques in rejuvenating various aspects of facial anatomy. METHODS: Sixty-eight patients underwent one of three different facelift techniques (High SMAS, SMAS plication, and SMAS-ectomy) based on a novel surgical algorithm utilizing patient specific characteristics by a single surgeon. The algorithm takes into account the patient’s BMI, SMAS quality, and shape of face. Before and after photos were rated by seven blinded evaluators for nasolabial fold (NLF) severity, malar concavity, jowling, anterior, and lateral neck appearance. Statistical analysis was performed to compare the changes in each variable among the three different techniques. RESULTS: Out of the 68 patients, 29 underwent a high SMAS, while 15 underwent SMAS-ectomy, and 24 underwent SMAS plication rhytidectomies. Regardless of the choice of rhytidectomy, all five variables showed improvement based on evaluator scores, with jowling and anterior neck showing the greatest mean improvement 1.75 ± 1.21, and 2.00 ± 1.52 respectively, p<0.001. When comparing the different techniques, high SMAS had the greatest impact on improving jowling, anterior neck, and lateral neck appearance compared to other techniques, p<0.001, p<0.003, and p<0.003. SMAS-ectomy improved NLF severity scores by 0.64 ± 0.32 slightly better than high SMAS 0.63 ± 0.62, p=0.034. Malar concavity did not differ statistically between techniques. CONCLUSION: Facial rhytidectomy surgery has continued to become more nuanced over the years. Patient characteristics are important in selecting a rhytidectomy technique and can lead to consistent results depending on the facial area that needs improvement1,2. The novel surgical algorithm utilized in this study is designed to optimize aesthetic results. The findings in this study support that appropriate patient selection may enhance all features regardless of facelift type and that the high SMAS technique may outperform other techniques in improving specific areas when using the mentioned algorithm. Additionally, when correcting malar aesthetics, one technique may not have an advantage over others even with appropriate patient selection. These findings have important implications in pre-operative surgical planning and may help in counseling patients on their final result3. References: 1. Quatela VC, Ahmedli NN. The Selection of Facelift Approach on the Basis of Midfacial Ptosis. Facial Plast Surg. 2021 Apr;37(2):149-159. doi: 10.1055/s-0041-1725105. Epub 2021 Mar 3. PMID: 33657627. 2. Derby BM, Codner MA. Evidence-Based Medicine: Face Lift. Plast Reconstr Surg. 2017 Jan;139(1):151e-167e. doi: 10.1097/PRS.0000000000002851. PMID: 28027252. 3. Rohrich RJ, Sinno S, Vaca EE. Getting Better Results in Facelifting. Plast Reconstr Surg Glob Open. 2019 Jun 27;7(6):e2270. doi: 10.1097/GOX.0000000000002270. PMID: 31624678; PMCID: PMC6635200.