Aim: In the digital age, artificial intelligence (AI) platforms have gradually replaced traditional manual techniques for information retrieval. However, their effectiveness in conducting academic literature searches remains unclear, necessitating a comparative assessment. This study examined the efficacy of AI search engines (Elicit, Consensus, ChatGPT) vs. manual search for literature retrieval, focusing on the surgical management of trapeziometacarpal osteoarthritis.

Methods: The study was executed per the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. AI platforms were given relevant keywords and prompts, while manual searches used PubMed, Cochrane CENTRAL, Web of Science, and Scopus databases from January 1901 to April 2024. The study focused on English-language randomized controlled trials (RCTs) comparing surgical management of trapeziometacarpal osteoarthritis (TMCJ OA). Two independent evaluators screened and extracted data from the studies. Primary outcomes involved the quality and relevancy of studies chosen by both search methods, evaluated by false positive rates and number of studies, including outcomes of interest.

Results: The manual search yielded the most results (6,018), followed by Elicit (4,980), Consensus (3,436), and ChatGPT (6). Elicit identified the highest number of RCTs (205) but also had the greatest false positive rate (94%). Ultimately, the manual search identified 23 suitable studies, Elicit found 10, Consensus found 9, and ChatGPT identified only 1. No additional studies were found by AI search engines that were not discovered in the manual search.

Conclusion: The findings highlight the potential advantages and drawbacks of AI search engines for literature searches. While Elicit was prone to error, Consensus and ChatGPT were less comprehensive. Significant enhancements in the precision and thoroughness of AI search engines are required before they can be effectively utilized in academia.

The peripheral nervous system is a complex anatomical structure essential for the normal functioning of the human body. Defects in peripheral nerves can lead to significant morbidity and a marked decline in quality of life. These defects may arise iatrogenically, from trauma, or as a result of degeneration. Among these, head and neck surgeons most frequently encounter nerve damage or sacrifice during surgical procedures. In the treatment of head and neck cancer, nerve resection - whether complete or partial - is often necessary, compromising the nerve’s anatomic and functional integrity. Despite advances in treatment, a well-defined, universally accepted paradigm for the functional rehabilitation of patients with sensory or motor deficits remains elusive. This review summarizes recent breakthroughs in peripheral nerve repair, highlights novel repair strategies, and identifies critical gaps that must be addressed to advance the field.

Distal radius fractures (DRFs) are very common fractures and can result in additional nerve injuries. Median nerve lesions occur more frequently than ulnar nerve injuries, with reported incidences ranging from 0.2% to 32%. Studies on ulnar nerve injuries are limited to case reports or very small case series. Dorsal angulated fractures, open fractures, and high-impact injuries are particularly associated with a high risk of nerve injuries. The optimal management and timing of treatment for patients with nerve pathology following DRF remain unclear. Clinically distinguishing between the various types and causes of nerve injuries in the acute phase can be very challenging, making close monitoring of these patients crucial. To provide a current overview of this important issue, we reviewed the literature regarding median and ulnar nerve injuries secondary to DRFs, with a special focus on treatment strategies and timing. In addition, an illustrative case of ulnar nerve injury after a DRF is presented. In this case, the ulnar nerve was translocated between the fractured parts of the distal radius. Surgical exploration and relocation of the nerve, along with fracture stabilization 8 days after the trauma, resulted in improved sensorimotor function at a 16-month follow-up.

Aim: This study presents an experimental approach for the long-term (16 years) in vivo observation of deeper structures in human scalp hair follicles, focusing on shortened hair cycles. When hair follicles entered a prolonged dormancy stage (3 years), rapid regrowth of thinning hair was stimulated by the topical application of a drug approved for promoting hair growth.

Methods: While intra-epidermal chambers were ineffective as recipient sites, the most superficial dermal implantation proved successful for heterotopic transplantation of single scalp hair follicle grafts, enabling hair growth during successive cycles.

Results: The study confirms the known reduction in daily hair growth rates while maintaining hair diameter. Notably, a unique and exceptional “non-correlation” was observed between scalp hair diameter and linear growth rates. While the initial shortening of the hair cycle duration was recorded in the first 3 years post-grafting, a further reduction eventually led to a “dormancy” phase in the long term (16 years post-grafting). Pharmacodynamics revealed that reactivation of hair production, following less than 3 months of topical application of a 5% minoxidil solution, suggested very slow daily growth rates and a substantial reduction in hair diameter.

Conclusion: The initial findings suggest that non-invasive methods can be used for real-time structural-functional observation of scalp hair roots, enabling the study of cellular activity and movement during successive phases of the hair cycle, including aging and drug effects.

The advent of artificial intelligence (AI) heralds a new era in the field of robotic surgery. This article discusses recent trends in the integration of AI technology with robotic surgical procedures, highlighting the latest advancements in robotic breast surgery. The application of AI in robotic surgery ranges from preoperative planning to intraoperative assistance. Machine learning algorithms are now utilized to analyze medical imaging data, enabling surgeons to devise detailed surgical plans tailored to the unique characteristics of each patient’s tumor. This approach leads to more precise tumor excision and better preservation of healthy tissue. Robotic systems equipped with advanced visualization and sensor technologies can provide real-time feedback during surgery and training. Additionally, AI algorithms can predict the occurrence of postoperative complications, allowing for early intervention. With the ongoing development of AI and robotic technologies, significant progress has been made in robotic automation. The future of robotic breast surgery holds the promise of even greater accuracy, and the quality of life for breast cancer patients may be significantly improved.

Lymphoedema is a common and debilitating condition for which there is no single satisfactory management modality. Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence. Surgery is effective in the earlier stages of disease progression but can be morbid and demanding for patients. An evolving surgical technique known as non-vascularised lymph node transfer (NVLNT) aims to tackle the underlying lymphatic drainage deficit in lymphoedema in a minimally invasive manner. Emerging evidence demonstrates promise in animal models and there is very nascent human evidence with mixed results. This is a narrative review that examines the available animal and human literature on NVLNT and draws comparisons between the two to discover methods of translating animal research to human applications. A systematic search was conducted. PubMed and Embase were searched using MeSH terms for NVLNT. Ultimately, 17 papers, including 14 animal and 3 human studies, were found. Within animal studies, NVLNT is efficacious, with results being repeated multiple times. Additionally, methods of optimising lymphangiogenesis, such as the addition of platelet-rich plasma and VEGF-C in addition to fragmentation and pre-inflammation techniques, have been investigated with general success. To date, evidence from human studies is sparse, with few studies, small sample sizes, and variable outcomes. NVLNT is promising as a minimally invasive surgical treatment for lymphoedema; however, further high-quality research in humans with advanced lymphoedema is necessary to prove its validity. Furthermore, adjuvants to grafting explored in animal studies, such as VEGF-C therapy, may increase the efficacy of lymph node grafting in humans.

Aim: Gender dysphoria causes significant psychological distress in individuals, leading many to seek medical interventions, including hormone therapy and gender-affirming surgery (GAS). This study sought to enhance the understanding of life satisfaction and self-harm and suicidal thoughts among transgender women after genital GAS.

Methods: A retrospective cohort of 102 transgender women who underwent GAS during 2011-2021 at Sahlgrenska University Hospital, with a follow-up period of at least 1 year after genital GAS, was studied. Data were collected as part of a larger initiative that focused on transgender women. The participants were surveyed using the Life Satisfaction Questionnaire, Gender Congruence and Life Satisfaction Scale, and a general demographic health survey. Data were analyzed using descriptive statistics.

Results: Of the 98 eligible participants, 50 completed the questionnaire. Although 28% of the respondents experienced thoughts of self-harm or suicidal ideation postoperatively, they reported overall satisfaction with life and mental health, suggesting that surgical treatment may have had a positive impact on life satisfaction and gender congruence.

Conclusion: Our study highlights the significant issues of thoughts of self-harm or suicidal ideation among transgender women after genital GAS. Although the prevalence thereof was lower than that reported previously, it remains concerning. Nevertheless, most participants reported life satisfaction and finding life meaningful post-surgery. These findings emphasize the need for integrating continuous mental health support with access to GAS to address the mental health challenges of transgender women after genital GAS, while aiming to improve the quality of life as the primary goal.

Aim: Deep dermal and full-thickness burns typically require reconstruction with split-thickness skin grafting, usually following a traditional Tanner mesh technique. An alternate is the modified Meek technique, which has the benefit of reducing the required donor site size. The study presents our experience with the modified Meek technique over thirteen years, involving 64 patients with varying total body surface area (TBSA) sizes, aiming to evaluate outcomes including length of stay, time to heal, and patient and observer scar assessment scale (POSAS) scores. Additionally, we conducted a review of the current literature.

Methods: Patients who underwent skin grafting using the modified Meek technique at the Adult Burns Centre at Chelsea and Westminster Hospital between 2011 and 2024 were identified retrospectively using theatre logs. A dual-investigator literature review was carried out using Ovid and PubMed.

Results: The mean length of stay was 64 days, with a mortality rate of 4.6%. The mean time to achieve 95% healing was 76 days. The median POSAS score was 5. The literature search identified 27 relevant papers for analysis.

Conclusion: The modified Meek technique results in smaller donor sites, and safely and effectively heals a wound in a more timely way using the same expansion ratio as conventional meshed grafts. Areas for ongoing future research from our review include the use of Meek for smaller TBSA injuries and its potential combination with dermal templates.

Aim: Severely burn injured patients present in an immunocompromised state with loss of skin integrity. Systemic antibiotics are necessary to treat infection in this population, but even small doses may select resistant organisms and alter the host microbiome. Despite this, preoperative antibiotics in burn injury remain debated and their impact on the host microbiome has not been fully elucidated. This work examined the effect of a single preoperative antibiotic dose on the microbiome and clinical outcomes in burn patients.

Methods: Patients with burns < 10% total body surface area (TBSA) requiring a single excision and grafting operation were enrolled and randomized to receive a single preoperative dose of cefazolin (ABX) or no antibiotics (no-ABX). Blood samples, wound swabs, and buccal swabs were obtained serially during and after hospitalization to determine bacterial taxonomy characteristics. Graft loss was determined at clinic follow-up.

Results: In ABX patients, there were 29 enriched bacterial taxa within wound beds at dressing takedown [log(LDA) ≥ 2, P ≤ 0.05] and greater than 10 bacterial taxa in buccal swabs at follow-up [log(LDA) ≥ 2, P ≤ 0.05]. There was increasing alpha diversity in ABX patients intraoperatively and at dressing takedown. There were no significant differences in graft loss between groups. Extremophile infiltration was noted in oral and wound microbiomes in ABX patients.

Conclusion: Though not affected clinically, these data suggest that a single preoperative antibiotic dose significantly impacts the wound and oral microbiome. Innovative approaches to examining the antibiotic impact on the host microbiome of burn patients may help better tailor antibiotic stewardship.

Aim: This study evaluates the application of three-dimensional (3D) reconstruction technology in cranio-maxillofacial surgery, focusing on its ability to provide accurate anatomical data and essential support for preoperative planning.

Methods: A comparative analysis was conducted using three commonly utilized 3D reconstruction software programs: 3D Slicer, ProPlan CMF, and Mimics. Each was assessed based on modeling accuracy, operational efficiency, and functional specialization. Data were collected and analyzed to identify the strengths and weaknesses of each software in different surgical contexts.

Results: The findings demonstrate that all three software programs provide consistent modeling accuracy. However, significant differences were observed in terms of operational efficiency and functional specialization, which influence their applicability in various scenarios. Specifically, 3D Slicer excels in flexibility, ProPlan CMF in cranio-maxillofacial applications, and Mimics in precision and comprehensive functionality.

Conclusion: 3D reconstruction technology has significant potential for optimizing preoperative planning in plastic surgery, especially in cranio-maxillofacial surgery. This study offers critical insights into the selection and optimization of 3D reconstruction software, paving the way for more effective and tailored surgical planning. Future research may focus on integrating AI-driven tools to enhance operational efficiency and broaden the application scope of 3D reconstruction in cranio-maxillofacial surgery.

Artificial Intelligence (AI) is reshaping preoperative preparation for both patients and surgeons in plastic surgery, offering innovative tools that improve efficiency, precision, and outcomes. This manuscript examines the growing role of AI in preoperative patient education, surgeon preparation, and clinical workflows, and provides an overview of its main domains of impact. AI-powered tools show great promise in consultations, providing personalized, clear patient education, simplifying administrative tasks such as drafting consultation letters, and enhancing communication. For surgeons, AI can support preoperative planning with reinforcement learning, advanced imaging algorithms, and virtual simulations. These technologies assist in accurate surgical decision making, as seen in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, where AI may be able to reduce perforator analysis times while maintaining precision. In aesthetic surgery, AI-driven 3D imaging and generative algorithms enable realistic postoperative simulations, improving communication and helping patients set realistic expectations. From a patient communication perspective, AI promotes patient-centered care by simplifying medical jargon, making information more accessible, and fostering better understanding and adherence. Despite challenges such as ethical considerations, data security, and algorithmic bias, AI’s integration into preoperative workflows highlights its potential to improve patient and surgeon experiences. By enhancing patient education, refining surgical strategies, and optimizing preparation, AI is redefining how care is delivered in plastic surgery, aiming for better patient satisfaction and outcomes. Collaboration among clinicians, engineers, and ethicists remains crucial to ensure the responsible use of AI, balancing innovation with the core values of medical care.

Macrophages are highly plastic cells central to pathogen removal, tissue regeneration, and inflammation, making them key targets in biomaterial design for improved clinical outcomes. Foreign body responses (FBRs) to implanted biomaterials often involve excessive macrophage-mediated inflammation, leading to fibrotic encapsulation, infection, and implant failure. Advances in tissue engineering demonstrate that macrophage polarization - the transition from pro-inflammatory M1 to anti-inflammatory M2 phenotypes - can be influenced by biomaterial properties to mitigate these responses and enhance regeneration. This review synthesizes the relationship between biomaterial properties, such as surface chemistry, structure, and stiffness, and their ability to modulate macrophage behavior. Key innovations, including tailored scaffold architectures, bioactive coatings, and cytokine delivery systems, have shown promise in guiding macrophage polarization for improved bone, soft tissue, and head and neck reconstruction outcomes. Strategies like hydrogels and nanostructured materials enable spatially and temporally controlled macrophage modulation, mimicking native extracellular matrix dynamics, mitigating chronic inflammation, and accelerating vascularization, extracellular matrix remodeling, and tissue integration. By integrating recent findings, this review provides a framework for designing biomaterials that actively modulate macrophage activity to overcome FBR and enhance healing. It identifies critical gaps, such as understanding macrophage-stromal interactions, developing personalized biomaterial designs to address patient variability, and leveraging advanced technologies like artificial intelligence in scaffold optimization. These insights advance the development of biomaterials that restore tissue function and address unmet clinical needs in regenerative medicine.

Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon adverse event of antiresorptive and antiangiogenic medications that can result in severe bony complications. Pentoxifylline and tocopherol (PENTOCO) and bone morphogenic protein (BMP) have shown promise as two therapies that could be effective in the management of MRONJ. The present paper reviews the findings of a total of 12 studies investigating the effectiveness of PENTOCO and BMP in the management of 417 patients with MRONJ. Additionally, three patient cases that were managed at our institution are discussed to supplement the findings of the review. While the available literature on the efficacy of PENTOCO and BMP use in the management of MRONJ is limited, the present study’s findings support the potential effectiveness of these therapies as supplements to medical and surgical interventions currently employed.

Contrast-enhanced ultrasound (CEUS) offers vascular-based real-time visualization of anatomy and pathology while maintaining the advantages of ultrasound: no radiation exposure and cost-effectiveness. This review provides an overview of the past, the current technology, and the future prospects of using CEUS to evaluate the lymphatic system. It has been demonstrated that lymphatic vessels and the lymph nodes they drain to can be successfully identified in patients who have undergone CEUS lymphography. For lymphaticovenous anastomosis (LVA) surgery planning, CEUS has shown capability in identifying target lymphatic vessels, sometimes outperforming conventional indocyanine green (ICG) fluorescent lymphography. While these preliminary findings are encouraging, further research is needed to establish standardized protocols and validate long-term outcomes. This review suggests that CEUS technology holds significant potential for advancing lymphatic imaging and improving surgical outcomes in lymphedema management.

Aim: Menstrual irregularities are frequently reported by women following liposuction (L group), yet few studies have explored this phenomenon. This study aimed to investigate potential changes in the menses among women who underwent L group.

Methods: A total of 516 patients were included in this retrospective study: 369 underwent L group, and 147 underwent other types of plastic surgery (O group). A paired t-test was used to compare preoperative and postoperative menstrual cycles/periods within each group. A hypothesis test was used to compare the incidence of menstrual changes between the two groups. Logistic regression and contingency tests were used to identify potential explanatory variables within each group.

Results: In the L group, a statistically significant difference was observed in menstrual cycle length before and after surgery (P = 0.02; 30.01 ± 2.54 days vs. 30.11 ± 3.04 days). The incidence of menstrual cycle changes was significantly higher in the L group compared to the O group (P = 0.0002; 1.6% vs. 0.46%). Among variables such as aspirated fat volume, body weight, and anesthesia method, the L group site correlated most closely with menstrual changes (P = 0.006). Postoperative menstrual changes were observed in all subjects who underwent L group on both upper arms, bilateral accessory breast tissue, both sides of the waist and abdomen, both upper arms and axillae, or the hip and both upper arms.

Conclusion: Compared with other plastic surgeries, L group has a greater impact on menstrual changes. The anatomical site of L group was identified as the most influential factor.

Information available on gender-affirming surgeries is often limited to those classified by the binary standard of masculinizing or feminizing genital aesthetics. Scant information is available on surgical options for non-binary and gender-diverse individuals who may opt for less frequently requested surgeries. We discuss preoperative counseling, surgical techniques, and postoperative care of such procedures, including a discussion of scrotectomy, penile-sparing vaginoplasty, and nullification procedures for non-binary and gender-diverse individuals assigned male at birth (AMAB). Frequent and open discussions are key to helping manage expectations of surgical outcomes. Creating an inclusive and safe environment is pivotal in understanding the needs and goals of all gender-diverse patients.

Computed tomography angiography (CTA) offers substantial benefits for reconstructive surgeons in preoperative planning for abdomen-based flap procedures in breast reconstruction. The abdominal perforator-based autologous breast reconstruction has become the gold standard due to its superior cosmetic outcomes and high patient satisfaction. Meticulous preoperative planning is crucial for the success of deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. In this context, CTA, recognized as the gold standard for perforator mapping, provides crucial insights into patient anatomy, optimizing flap design and elevation. This study aims to go beyond the role of CTA for perforator mapping and summarize the wealth of information that can be obtained from preoperative imaging tools for abdomen-based flaps in breast reconstruction. Such information not only aids in assessing the risk of postoperative complications but also supports the design of various flaps beyond DIEP. Furthermore, we will introduce the latest methods for utilizing this information to assist during preoperative planning and intraoperative decision making.

Breast implant infections are a critical concern in post-reconstructive surgery, often requiring implant removal and delayed reconstruction. To address this challenge, we implemented a “fast-track protocol” integrating rapid molecular diagnostics with advanced surgical techniques to salvage the implant and reduce patient morbidity. A case series of 11 patients treated with this brand-new protocol at our Institution from January 2023 to October 2024 was collected. Each patient underwent preoperative screening and, upon signs of infection, received immediate analysis of periprosthetic fluid using the FilmArray^TM PCR system. This approach enabled the rapid identification of pathogens and the initiation of targeted antibiotic therapy within 24 h after implant removal. The surgical intervention included debridement, Negative-Pressure Wound Therapy with saline instillation, and the use of a tissue expander to maintain pocket integrity and width. The integration of the FilmArray^TM PCR system and Negative-Pressure Wound Therapy with instillation resulted in successful salvage of breast reconstructions in 11 out of 11 cases within a medium ten-day timeframe. This series underscores the potential of combining rapid molecular diagnostics with tailored surgical strategies to enhance outcomes in breast implant infections.

Robotic surgery has expanded significantly across all surgical specialties due to the benefits of high-definition 3D visualization and 360-degree articulation of instruments. In the field of gender affirmation surgery (GAS), robotic surgery has numerous applications in both primary and revision surgery. We sought to review the current literature to discuss emerging robotic techniques for genital GAS in both the transmasculine and transfeminine population to determine feasibility, complication rates, and outcomes.

Craniofacial tissue engineering offers promising solutions for addressing large bone defects caused by congenital abnormalities, trauma, or disease. Traditional approaches, such as autografts and synthetic materials, are widely used but face limitations, including donor site morbidity, immune rejection, and poor graft integration. Recent advancements in biomaterials, including nanoscale scaffold design, bioceramics, cell-laden hydrogels, and bioactive modifications, present promising strategies to replicate the biological, mechanical, and structural properties of native bone. This review explores innovative strategies to enhance osteoconductivity, osteoinductivity, and osteogenicity of engineered grafts, including the use of advanced biomaterials, immunomodulatory scaffolds, and bioprinting technologies. Key biological challenges are discussed alongside translational barriers. Future directions emphasize the integration of bioprinted, vascularized, multiphasic tissues, alongside personalized therapies and advanced fabrication techniques, to accelerate clinical adoption. By bridging nanoscale innovations with the demands of large-scale clinical application, this review outlines pathways toward scalable, personalized, and clinically effective solutions to restore functionality and aesthetics in craniofacial reconstruction.

Aim: Postmastectomy radiation therapy (PMRT) has played an important role in advanced breast cancer. It may negatively impact the outcomes of implant-based reconstruction. The aim of this study was to investigate the impact of PMRT on the outcome of implant-based reconstruction.

Methods: A total of 36 patients from 2009 to 2019 were included, with 12 in the two-stage group (TE-XRT ± Implant), who received PMRT after mastectomy and tissue expander insertion, 14 received PMRT after immediate direct-to-implant (DTI-XRT) breast reconstruction, and 10 with history of breast conservation surgery and PMRT received mastectomy and DTI reconstruction for cancer recurrence (XRT-DTI). Morbidities, including acute and late poor wound healing, implant or expander loss, and final revision surgeries, were reviewed.

Results: There were no significant differences in age, gender, BMI, or histological type among groups. Overall, complications were higher in the TE-XRT ± Implant group than in the DTI-XRT group (83.3% vs. 35.7%, P = 0.02). Wound breakdown was more frequent in the TE-XRT ± Implant group than in the DTI-XRT group (33.3% vs. 0.0%, P = 0.03). In two-stage reconstruction, implant exposure occurred predominantly in the late stage of the stage II surgery and stage II surgery tended to present higher overall and late complications than XRT-DTI or DTI-XRT.

Conclusion: For patients requiring PMRT, two-stage implant-based breast reconstruction tends to have a higher complication rate than DTI breast reconstruction. Our results suggest that radiation’s impact on wound healing might outweigh other negative effects, and conversion from implant-based reconstruction to two-stage reconstruction may not always be necessary.

Aim: This study aimed to investigate the impact of combining cold laser therapy with hyaluronic acid skin booster injections on intraoral wound healing, specifically comparing two different incision techniques.

Materials and methods: A total of 24 Wistar Albino rats were included in this study and randomly assigned to four groups; two treatment groups and two control groups. In the treatment groups, incisions using blade or 976 nm diode laser were made, followed by cold laser therapy combined with hyaluronic acid skin booster injections. The control groups underwent incisions using either a surgical blade or a 976 nm diode laser (Woodpecker LX16 Plus, Woodpecker, China) without any additional treatment. Tissue samples were collected at baseline and on postoperative days 3 and 7. Histological analysis was performed using Hematoxylin and Eosin staining and Masson’s Trichrome staining to evaluate the wound healing process.

Results: Among the experimental groups, the second treatment group demonstrated significantly enhanced wound healing, particularly on days 3 and 7. This group showed increased collagen deposition, better tissue organization, and enhanced angiogenesis compared to the control groups.

Conclusion: The combination of cold laser therapy and hyaluronic acid skin booster injections significantly accelerated wound healing following both laser and scalpel incisions. Notably, wounds created using the 976 nm diode laser showed superior healing outcomes compared to those made with a scalpel.

Breast reconstruction after mastectomy is a critical aspect of breast cancer treatment. This retrospective study analyzes the efficacy and safety of the sharp needle intradermal fat (SNIF) technique in immediate two-stage prepectoral breast reconstruction (PPBR) after mastectomy. A retrospective cohort analysis was conducted on patients who underwent SNIF fat grafting after mastectomy and PPBR. Demographics, surgical indications, procedures, and complications were analyzed. The SNIF procedure involves the precise injection of small fat particles into the dermal layer, aiming to improve skin texture and correct minor surface irregularities. Sixty-seven patients underwent the SNIF procedure after PPBR. The mean age was 53.2 years, with a range of 33 to 71 years. No serious complications, such as infection or fat embolism, were observed. Minor complications included ecchymosis in 30 patients and redness with mild swelling in 13 patients, all of which resolved within a few days after surgery. Patients and surgeons reported satisfactory cosmetic results. The SNIF technique, using small-diameter fat particles injected intradermally, shows promise for improving aesthetic results and minimizing complications in two-stage PPBR.

Dorsiflexion deformity of the metacarpophalangeal (MCP) joint is a common complication of hand burns, often leading to severely compromised hand function and aesthetics. Traditional surgical techniques typically involve extensive skin harvesting and grafting with splicing, which may increase procedural risks and donor site morbidity, as well as complications such as graft failure, infection, and necrosis. These limitations highlight the need for a surgical approach that can effectively correct scar contracture deformities while minimizing operative challenges and risks, improving graft survival, and promoting functional recovery. Based on the clinical surgical outcomes of 12 patients, we propose a novel technique involving asymmetric spindle-shaped excision combined with continuous Z skin grafting. This approach aims to optimize therapeutic outcomes through personalized scar excision and contracture release, utilizing asymmetric fusiform skin removal, an ultra-tension-reducing suture technique, continuous Z skin grafting, and functional fixation. This article outlines the surgical procedure, technical points, and clinical effects of the proposed method. Ultimately, this method effectively corrects MCP joint dorsiflexion deformities in burn patients, significantly improving both hand function and appearance.

Microneedles, as minimally invasive tools for percutaneous delivery, have undergone significant technological advancements over the past decade, greatly expanding their application in the treatment of hair loss. Traditional microneedle devices promote hair regrowth by stimulating vascularization and the release of growth factors through controlled skin disruption. In addition, microneedle-mediated drug delivery enhances local drug penetration and absorption, thereby regulating the hair growth cycle more effectively. During hair transplantation procedures, microneedle-assisted techniques can notably improve follicle survival rates due to their precision and advanced design. For individuals with baldness, tissue-engineered hair follicle regeneration offers an innovative and effective strategy to increase the total number of hair follicles. However, these engineered follicles often face challenges, such as difficulty in emerging through the skin and growing in excessively dense or disorganized patterns. Integrating microneedle arrays with tissue engineering approaches may help address these issues by enabling better control over the direction and density of regenerated hair. This article reviews the historical development of microneedles, examines their current applications in hair loss therapy, and discusses ongoing challenges in the field. The goal is to explore the therapeutic potential of microneedles in hair regeneration and to offer insights that may guide future treatment strategies.

Aim: To evaluate the clinical efficacy of scar split-thickness skin replantation combined with LCR (laser-carbon dioxide-radiotherapy) therapy in improving healing outcomes and reducing recurrence rates in patients with multiple nodular or hypertrophic keloid lesions.

Methods: A retrospective review was conducted on 11 patients who underwent surgical excision of keloids, followed by replantation of split-thickness skin graft onto the thinned keloid dermis. Postoperatively, all patients received LCR therapy. Clinical outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) before and after treatment. Postoperative epithelialization time and adverse events were also recorded.

Results: All patients achieved complete epithelialization within four weeks after surgery. Significant improvement in scar quality was observed, with POSAS scores decreasing from 92.35 ± 6.09 pre-treatment to 18.58 ± 7.38 post-treatment (P < 0.001). No severe complications such as infection or ulceration occurred during the follow-up period.

Conclusion: Scar split-thickness skin replantation combined with LCR therapy is a safe, cost-effective, and efficacious treatment modality for keloids. By preserving the dermal scaffold and enhancing epithelial regeneration, this approach significantly improves scar appearance and reduces recurrence, particularly in challenging cases involving multiple or hypertrophic keloid nodules.

For many individuals, sexual health is an important part of overall health and well-being, yet it remains an overlooked aspect of care for transgender and gender diverse (TGD) patients. While cisgender and TGD individuals share many sexual health needs, TGD patients face unique clinical considerations that physicians - particularly surgeons - must understand in the context of gender-affirming surgery (GAS). As demand for GAS grows, it is essential that plastic surgeons and other surgical specialists recognize how these procedures affect sexual health, sexual function, and satisfaction. This review summarizes current evidence on sexual health outcomes in TGD populations following commonly performed GASs, including chest masculinization, breast augmentation, phalloplasty, metoidioplasty, vaginoplasty, and vulvoplasty. These procedures can substantially enhance quality of life (QOL) by improving body congruence and sexual well-being; however, they may also introduce anatomical, neurological, or psychosocial challenges that influence sexual health. To ensure that patients can provide fully informed consent, surgeons must understand these outcomes and communicate them effectively as part of surgical planning and throughout both pre- and postoperative care.

Aim: To evaluate surgical and functional outcomes of assigned male at birth (AMAB) transgender patients who received penoscrotal vaginoplasty at an Italian referral center.

Methods: A retrospective analysis included AMAB transgender patients who received penoscrotal vaginoplasty between April 2018 and April 2024. Patient demographic data, surgical outcomes, complications, and functional outcomes were collected and analyzed. Functional outcomes were assessed using validated questionnaires, including the Operated Male-to-Female Sexual Function Index (oMtFSFI), the Female Sexual Function Index (FSFI), and the Female Genital Self-Image Scale (FGSIS). A follow-up period of 12 months was used, with statistical analyses to identify predictors of complications and patient dissatisfaction.

Results: The study included 47 AMAB transgender patients, with 30 providing complete functional outcome data. Surgical outcomes showed that the median operative time was 315 min, with a median neovaginal depth of 14 cm. Major complications occurred in 21.2%, including meatal stenosis and one case of rectovaginal fistula. Functional outcomes showed significant improvement, with 63.3% of patients achieving normal oMtFSFI scores at 12 months. FSFI scores also improved across all domains, and genital self-image progressively improved over time.

Conclusion: Penoscrotal vaginoplasty demonstrates favorable surgical and functional outcomes in AMAB transgender patients, with high levels of patient satisfaction. Despite the complexity and potential for complications, penoscrotal vaginoplasty represents an effective surgical option for aligning physical appearance with gender identity, with progressive improvements in sexual function and genital self-image observed over the first postoperative year.

A critical component of gender-affirming vaginoplasty is the creation of a functional neovaginal canal capable of penetrative intercourse. Canal creation is inherently challenging due to the deep pelvic anatomy and risk of injury to the urethra, bladder, and rectum. These challenges are amplified in revision cases undertaken to correct neovaginal stenosis or convert minimal-depth to full-depth canals.

With increasing interest in and access to gender-affirming surgery, myriad techniques for canal creation have arisen. These utilize a variety of donor tissues to line the canal, including genital and extragenital skin grafts, xenografts, allografts, peritoneum, and intestine. Moreover, the rectoprostatic dissection necessary for canal creation can be performed via a perineal approach or with robotic assistance. However, few comparative studies exist to inform the choice of surgical approach or donor tissue.

In this article, we briefly review the donor tissue options available for neovaginal canal creation, discuss the associated advantages and disadvantages, and reference pertinent contemporary research. We additionally describe our institutional approach for canal creation in primary and revision vaginoplasties, highlighting technical nuances for success.

Aim: One of the main goals of neophalloplasty is to provide the possibility of penetrative sexual intercourse. For individuals undergoing neophalloplasty, the implantation of malleable or inflatable penile prostheses is currently the main option for achieving reliable erectile function. The aim of this study was to assess surgical outcomes after the implantation of specially designed malleable and inflatable penile implants for transgender men, following musculocutaneous latissimus dorsi free flap neophalloplasty.

Methods: Between January 2022 and January 2025, 20 transgender men underwent ZSI FTM 475 or ZSI FTM 100 penile prostheses insertion following musculocutaneous latissimus dorsi free flap neophalloplasty. The dorsal approach was used in all cases for prostheses insertion and plate fixation to the pubic periosteum. The space for the prosthesis was created in the neophallus, behind the muscle. For inflatable prostheses, the pump was placed into the left hemiscrotum and connected to the reservoir in the left inguinal region. Patient satisfaction was evaluated using the International Index of Erectile Function (IIEF).

Results: The mean follow-up period was 21 months (range 4-36 months), and the mean interval between neophalloplasty and prosthesis implantation was 44 months (range 6-120 months). No intraoperative complications occurred. The most significant complication observed was fracture of the penile implant (n = 2, 10%). All patients who engaged in penetrative sexual intercourse reported satisfactory penetration, with a mean IIEF score of 21.1.

Conclusion: These novel penile prostheses for transgender men demonstrate favorable surgical outcomes after latissimus dorsi neophalloplasty, with a high rate of patient satisfaction.

The paramedian forehead flap (PMFF) is an interpolated flap commonly used to reconstruct a variety of nasal defects. It is the preferred reconstructive method for moderate to large nasal defects, with advantages of robust blood supply, close color and texture matching with native nasal skin, relatively acceptable donor site morbidity, and ability to customize size and thickness. It may involve two or three stages to permit addition of cartilage grafts, debulking or other modifications, and pedicle division. Recent literature has supported numerous variations on the classically described forehead flap. These include shortened time to pedicle division, single-stage flaps, two-stage flaps for complex major reconstruction, pre-laminated flaps, and use of the forehead flap in total nasal reconstruction. Recent updates in the literature on PMFF in nasal reconstruction will be reviewed.

Facial paralysis often results in retraction, lid lag and malposition of the lower eyelid, with a consequent increased risk of exposure keratopathy. Therefore, repair of the paralyzed eyelid is central to periocular management in patients with facial paralysis. We aim to evaluate current techniques using biomaterials for lower eyelid reconstruction. A literature review was conducted, including posterior lamellar anatomy, traditional grafting techniques, and recent advancements in biomaterial-based reconstruction. Biomaterials were categorized as acellular matrices, natural polymers, and synthetic polymers. Their biomechanical properties, integration, and clinical utility were examined in the management of the paralyzed eyelid. We describe our surgical technique, highlighting its versatility regardless of the biomaterial graft used. While acellular dermal matrices are the most widely used biomaterials, synthetic polymers, and natural polymers have also been shown to have favorable integration and compatibility for posterior lamellar augmentation and reconstruction. Future directions include the application of bioengineered stem cells with regenerative capacity. Biomaterials can provide a viable and effective alternative for posterior lamellar reconstruction in the treatment of paralyzed lower eyelid malposition and retraction. Specifically, acellular matrices offer a balance of support and biocompatibility.

A contracted nose deformity is a challenging and distinct complication of rhinoplasty, particularly prevalent among Asian patients due to implant-related complications and infection-induced scar formation. Clinical presentations range from mild nasal tip upturning to severe distortion of nasal structures. This review outlines comprehensive surgical strategies for managing the contracted Asian nose, including wide release of the skin-soft tissue envelope, structural framework reconstruction with autologous rib cartilage, nasal tip elongation, and skin redraping techniques. Special considerations such as platelet-rich plasma, nanofat injection, and hyperbaric oxygen therapy are also discussed. Successful outcomes require meticulous planning, surgical expertise, and realistic patient expectations.

The double incision mastectomy with free nipple graft (DIFNG) remains the most widely performed technique in gender-affirming chest surgery. However, as patient goals and models of gender-affirming care have evolved, a more individualized, patient-centered approach has emerged. This study reviews historical and current trends in the literature and retrospectively examines 250 consecutive gender-affirming chest surgeries performed by the senior author to assess the breadth of surgical techniques utilized beyond the traditional DIFNG. A total of 70 cases (28%) employed alternative approaches, including double incision without nipple grafts, keyhole, buttonhole, nipple-sparing mastectomy, targeted nipple reinnervation, breast reduction, radical reduction, and mastopexy. These variations reflect a growing diversity in aesthetic, functional, and psychosocial goals, including preservation of nipple sensation, minimized scarring, the option to forgo nipple reconstruction, and maintaining the potential for chest-feeding. This paper outlines the indications and technical considerations for each method and presents a decision-making algorithm to guide individualized surgical planning. As the field of gender-affirming surgery continues to evolve, expanding the operative toolkit is essential to support patients across the gender spectrum and deliver affirming, patient-specific outcomes.

This article provides an updated, comprehensive overview of grafting principles and techniques in reconstructive rhinoplasty. It reviews current options for grafting material and recent literature regarding the advantages and disadvantages of different graft sources. Various grafts, their indications, and recommended surgical techniques are also described in detail. Finally, the use of three-dimensional imaging and printing technology in reconstructive rhinoplasty is discussed.

Congenital nasal deformities represent a diverse group of structural anomalies present at birth, often resulting in significant functional impairments and aesthetic challenges. Historically, surgical correction has been deferred until adolescence due to concerns about disrupting facial growth; however, emerging evidence supports earlier intervention, prompting a reevaluation of traditional paradigms. This review provides a comprehensive overview of major congenital nasal deformities, with a particular focus on cleft nasal deformities and frontonasal dysplasia. We explore evolving trends in surgical timing and techniques, key anatomical considerations, and reported outcomes. Special attention is given to the balance between early aesthetic and functional normalization and the preservation of midfacial growth. Advances in surgical planning, including individualized approaches, have improved outcomes and minimized risks associated with early intervention. Comparative data suggest that appropriately timed early correction may offer psychosocial and developmental benefits without significantly compromising facial growth. Overall, the management of congenital nasal anomalies is undergoing a paradigm shift toward earlier, more tailored surgical approaches. This evolution reflects a growing consensus that strategic early intervention can address both functional deficits and psychosocial impacts during critical developmental periods, while still safeguarding long-term facial growth and aesthetics.