A wound is defined as damage or loss of continuity to the skin or body tissue which can cause disruption to the body's anatomical structure. Wounds can be caused by several things, such as post-operative wounds, trauma, contact with heat sources, chemicals, and accidents. One of the potential complications from wounds and maxillofacial surgery is dehiscence. The combination of guava leaf ethanol extract (Psidium guajava Linn) and polyvinylpyrrolidone (PVP) hydrogel is expected to help the healing process of traumatic wounds on the oral mucosa by increasing the number of fibroblasts, epithelialization, vascular endothelial growth factor (VEGF) levels, and decreasing interleukin-16 (IL-16) levels. This research was an experimental test, using 28 rabbits as experimental animals. A traumatic wound is an incision made 2 cm laterally from the left central incisor and along the curve of the tooth. The wound reaches the gum line from the incision on the facial aspect to the midline of the papilla. The animals were divided into four treatment groups.: group 1 - the intervention group with wounds healed and given a combination gel; group 2 - the intervention group with wounds not healed and given a combination gel; group 3 - the observed group with wound healed and given placebo gel; group 4 - the observed group with wounds not healed and given placebo gel. There was an increase in the number of fibroblasts, epithelialization, VEGF levels, and a decrease in IL-16 levels between the treatment and control groups. This study showed an increase in fibroblast levels in the treatment group (64.50 ± 4.43) which was higher than the control group (55.67 ± 4.04), with P = 0.041 as well as an increase in epithelialization in the treatment group. The results of the analysis in this study support the superiority of this gel combination in accelerating wound healing through a positive influence on VEGF levels and angiogenesis. In this study, IL-6 levels on day 3 showed a decrease of 25% in the treatment group. The combination of guava leaf ethanol gel and PVP hydrogel is an innovative therapy with high potential to accelerate wound healing, especially in chronic or difficult-to-heal wounds, with minimal risk of excessive inflammation and scar tissue formation.

Trigger finger causes pain, catching, and locking of the finger, with corticosteroid injection being the first-line treatment. Injections with local anaesthetic may reduce immediate pain, but it has been suggested that added volume worsens pain. This systematic review aimed to evaluate studies investigating pain following corticosteroid injection for trigger finger, with or without local anaesthetic. Evaluation of the topic: We performed a prospectively registered systematic review (PROSPERO ID: CRD42024502361) following PRISMA guidelines. We searched PubMed, Cochrane Library, and Embase database for randomised trials or prospective cohort studies investigating pain following injection with corticosteroid with or without local anaesthetic. Patient demographic data, injection details and outcomes including visual analogue scale (VAS) pain scores were collected and summarised. Two articles including 98 patients (135 injections) were included. One article compared steroid injection with local anaesthetic and adrenaline to steroid injection with placebo (0.9% saline), and found that omitting local anaesthetic had a lower immediate VAS pain score (2.0 vs. 3.5; P < 0.01) however all injections contained the same volume. The second study measured VAS pain scores at multiple time points, and a recollection score for patients injected with either corticosteroid alone (1mL), corticosteroid and 1% xylocaine (2 mL), or corticosteroid and 0.9% saline (2 mL). VAS pain scores were similar in the steroid alone and steroid and local anaesthetic group at 1 minute post-injection and highest in the steroid and saline group. The local anaesthetic group had the lowest pain score 10 minutes post-injection. Meta-analysis of outcomes in these heterogeneously reported studies was not possible. Corticosteroid injection for trigger finger varies considerably and outcomes are reported inconsistently. The evidence suggests that the addition of local anaesthetic may increase immediate pain due to volume effect or lowered pH but reduce early post-injection pain. Further well-designed randomised studies are needed to guide treatment decisions.

Brachioplasty in the post-bariatric patient deserves special attention since a not negligible number of wound complications is reported in the literature. In this study, the authors present unique risk factors for wound dehiscence and delayed wound healing based on retrospective data in post-bariatric patients who underwent brachioplasty alone or with other procedures. A total 31 patients who underwent brachioplasty alone or combined with other procedures between 2017-2022 were included. Data analyzed encompassed demographic information, biometric data, type of brachioplasty if performed alone or in combination with other procedures, days to epithelization/closure, and its management. A total of 15 patients (48.38%) experienced surgical wound dehiscence, the majority (66%) being minor wound dehiscence. Subjects who underwent concomitant arm liposuction with brachioplasty showed a higher degree of dehiscence (P = 0.021) and more days to epithelialization/closure (P = 0.10). Fifty-seven percent of patients who underwent a combined procedure showed some degree of dehiscence, as well as more days to epithelialization/closure (41 vs 15.75 days). Brachioplasty and mastopexy as combined procedures demonstrated more days to epithelialization/closure (P = 0.05). Brachioplasty in the post-bariatric population is deemed safe and effective; nevertheless, it carries an increased risk of wound dehiscence and delayed wound healing when combined with liposuction and other procedures. The plastic surgeon needs to become familiar with variables that increase the risk of this complication, all of which can be anticipated in preoperative planning.

Breast cancer is a term that encompasses malignancy of any tissue structurally forming the breast. Due to its high prevalence, breast cancer places a significant burden on both patients and the healthcare system. Treatments such as radiotherapy, chemotherapy, hormonal therapy, and mastectomy are developed. Mastectomy is a lifesaving procedure but can cause decreased aesthetic and functional factors. Recent advances in medical technology have thankfully allowed surgeons to use advanced modalities that enable microscopic reconstruction of tissues, vessels, and nerves, giving sensation to the newly reconstructed breast. Surgical reinnervation is a procedure that describes the restoration of neurological function - both sensory and recovery - towards a body part that is lost or damaged. Reinnervation can be achieved both spontaneously and via surgery, hence termed surgical reinnervation. In this study, we review three surgical reinnervation interventions. First, end-to-end reinnervation comes under the neurorrhaphy group. Neurorrhaphy involves anastomosis of residual nerves in the proximal (healthy) and distal (denervated) tissues. Second, nerve allografts come under nerve transplantation. Third, nerve conduits mimic auto-transplantation but with an artificial conductor instead of a nerve donor. This study aims to measure and compare the overall and area-specific tactile recovery following different methods of surgical reinnervation following post-mastectomy breast reconstruction. Evaluation of the topic: This study is a systematic review and meta-analysis written according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Twelve studies used in this review, nine measured the difference between breasts receiving end-to-end nerve coaptation and those receiving no surgical reinnervation. Two studies used allogeneic nerve grafts, while one used polyglycolic acid (PGA) nerve conduit. Coincidentally, these three studies employ Pressure Specified Sensory Device (PSSD) instead of Semmes-Weinstein Monofilament Test to measure tactile recovery. The other nine studies measured tactile recovery using the earlier-found Semmes-Weinstein Monofilament Test (SWMT). Outcome of this study focused on tactile recovery to three interventions. The first group report from end-to-end coaptation, three studies report better outcome compared to flaps without surgical reinnervation. Pooled overall SWMT rod size in breasts with end-to-end nerve coaptation was found to be 3.96 (95% CI 2.96-4.96) with high heterogeneity (I2 94%, P < 0.01). Pooled overall SWMT rod size in breasts without surgical reinnervation was found to be 5.27 (95% CI 4.93-5.60) with high heterogeneity (I2 80%, P < 0.01). The second group report from nerve allograft, two studies report that nerve allograft has a significant effect to tactile recovery. The third group report from nerve conduit, one study report about nerve conduit reinnervation. The result of this study was lower that end-to-end nerve coaptation. We then performed an area-specific analysis and found that the largest SWMT rod sizes were generally in the flap nipple area. Pooled mean (95% CI) of SWMT rod size following end-to-end coaptation in the flap nipple area was 4.39 (95% CI 3.70-5.09), while in those not receiving surgical reinnervation 5.45 (95% CI 4.93-5.97). Pooled mean rod sizes were generally much lower in the non-flap areas than in the reconstructed breast. In conclusion, there is a significant difference in overall sensory recovery between breasts receiving and not receiving surgical reinnervation, particularly breasts receiving end-to-end coaptation. Area-specific analysis found this difference is specifically significant in the upper medial portion of the mastectomy skin. Further research is needed to investigate recovery by other surgical reinnervation methods, particularly end-to-side coaptation, side-to-side coaptation, neurotization, anastomosis using conduits, and nerve grafts.

External ear reconstructive surgery is often needed due to congenital malformations or acquired traumas, which requires surgeons to comprehend ear norms as morphological variations exist between ethnicities. This study presents the first set of anthropometric data specific to the Vietnamese adult ear. A cross-sectional study involving 2,000 Vietnamese participants (1,000 women and 1,000 men) aged 18-25 years without a history of ear malformations, trauma, or surgery was conducted. On the left ear, 14 anatomical landmarks were defined, and 13 ear dimensions were measured using a standardized photographic analysis method. The 13 ear dimensions measured on both genders are ear length, ear breadth, ear length above tragus, ear length below tragus, tragus length, concha length, concha breadth, lobule height, lobule width, distance from the tragus to antihelix, distance from the tragus to helix, the measurement between the posterior point of the tragus and a point of the helix, width of the intertragic incisura and depth of the intertragic incisura. Most notably, mean values of ear length, ear breadth, concha length, and concha breadth in female subjects were found to be 58.70 ± 4.20, 29.75 ± 2.53, 26.87 ± 2.27, and 15.92 ± 2.39, respectively. In males, the corresponding values were 63.11 ± 4.95, 30.81 ± 2.97, 29.02 ± 2.64, and 15.96 ± 2.63, respectively. Gender-based differences in left ear morphology were observed, with measurements being higher in males for 10 out of 13 variables. Furthermore, our findings highlight distinctive ear dimensions among Vietnamese individuals compared to other ethnic groups. However, since we only studied the left ear, further research should investigate the dimensions of the right ear and assess symmetry between both sides.

Brachymetacarpia is a rare deformity characterized by shortening of one or more metacarpals, most commonly the fourth. This study aimed to evaluate the outcomes of surgical treatment for brachymetacarpia using an internal mini distractor and to compare its advantages over external fixators and other surgical techniques. We retrospectively analyzed 9 patients treated between 2011 and 2021 using gradual distraction osteogenesis with an internal mini distractor. Evaluated parameters included pre- and postoperative metacarpal lengths, deviation from ideal length, complications, treatment duration, and patient satisfaction. The mean lengthening was 1.2 cm (range 0.7-1.5 cm), with minimal deviation from the ideal metacarpal length (+0.3 cm on average). The average distraction period was 68 days. Minor complications occurred in 3 patients, including synovitis and delayed consolidation, all managed successfully. Functional outcomes and patient satisfaction were uniformly excellent. The internal distraction system provides a reliable, safe, and patient-friendly method for metacarpal lengthening. Compared to external fixators, it offers superior stability, reduced the risk of infection, and improved aesthetic and functional outcomes in selected cases.

Malignant melanoma of the head and neck is a highly aggressive tumor with a significant risk of regional and distant metastases. Due to the complex anatomy and rich lymphatic drainage of this area, accurate and timely diagnosis and staging are essential for optimal treatment planning. The sentinel lymph node plays a key role in assessing tumor spread and staging. A retrospective study was conducted on 26 patients with head and neck melanoma who underwent sentinel lymph node biopsy at our institution between 2017 and 2023. We evaluated the success rate of sentinel node localization, presence of metastases, and subsequent lymphadenectomy. Sentinel lymph nodes were successfully identified in 23 patients; 5 had positive findings (3 macrometastases, 1 micrometastasis, 1 isolated tumor cells). Lymphadenectomy was indicated in patients with macrometastases, while follow up monitoring was preferred for micrometastases and isolated tumor cells. One patient experienced a complication after lymphadenectomy. Most patients with negative sentinel nodes remained disease-free during follow-up. Sentinel lymph node biopsy is a crucial tool for staging and treatment decision-making in head and neck malignant melanoma. The procedure's success depends on surgical expertise. Lymphadenectomy is indicated in cases of macrometastases, whereas micrometastases and isolated tumor cells warrant regular follow up. An individualized, multidisciplinary approach is essential.

Although complications from gel injection breast augmentation were documented over 20 years ago, they are still encountered today. This case report involves a 46-year-old patient who first had breast implants in 2004, with replacements in 2019. In April 2022, the implants were swapped for smaller ones. In December 2022, the patient underwent a gel injection boost augmentation. We first saw the patient in June 2023 when she was admitted to our emergency room in septic condition. Initial treatment included lavage and drainage, followed by intensive care unit admission. Once stabilized, a significant amount of gel was removed from the breast tissue. However, the procedure had to be repeated months later and hemostatic net sutures were added for 2 days. No more relapses occurred following this treatment. We strongly advise against using gel injections for breast augmentation, as they can lead to severe complications and unsatisfactory cosmetic outcomes.

Breast reconstruction using a silicone implant after mastectomy is a common part of the comprehensive treatment of breast cancer patients. One of the most serious complications is implant infection, which can significantly affect the surgical outcome as well as the patient's quality of life. The aim of this study was to analyse the incidence of infectious complications following breast reconstruction with a silicone implant. The study also sought to identify major risk factors, assess possible preventive measures, and compare the findings with data available in the scientific literature. Special attention was paid to immediate versus delayed reconstruction following mastectomy. A retrospective analysis was conducted on data from 17 patients who had surgery at Na Františku Hospital in Prague in 2024. Both clinical and surgical variables were evaluated, including the timing of reconstruction (immediate or delayed), incidence of infection, and microbiological findings in relation to the presence of risk factors (smoking, diabetes mellitus, radiotherapy, coagulopathy), reoperation, fat transfer prior to surgery, and length of hospitalization. The distal end of the Redon drain was sent for microbiological examination. Infection occurred in 7 out of 17 patients, with a higher incidence observed in cases of immediate reconstruction. The most common pathogens identified were Staphylococcus epidermidis and Staphylococcus capitis. The average length of hospitalization was 9.8 days (a median of 8 days). The most frequent complicating factors were immediate reconstruction, smoking (including IQOS), radiotherapy, and diabetes mellitus. A positive impact on reconstruction outcomes was observed in patients who had fat transfer prior to implant placement, which appeared to have a protective effect. Reoperation was required in 5 patients, and in 3 of these cases, implant removal was ultimately necessary. The importance of identifying risk factors for planning reconstruction and preventing complications was confirmed. Smoking, diabetes mellitus, and radiotherapy are significant risk factors for implant-related infections. Fat transfer prior to implant-based reconstruction may serve as a protective factor.

Cosmetic/aesthetic surgery has increased in popularity, reflecting the increased consumer demand. Modern women feel compelled to meet near-impossible standards of beauty. Most of those who undergo cosmetic/aesthetic surgery are (middle-aged) women. Women are often under pressure to meet near-impossible standards of beauty. This study examined cosmetic/aesthetic surgery attitudes and perceptions among 516 Czech middle-aged women. It assessed the perception and attitudes towards cosmetic/aesthetic procedures of middle-aged Czech women and determined the possible factors influencing their level of acceptance through a quantitative survey. The research findings are based on an online questionnaire survey. Based on our analyses, we revealed that acceptance and attitudes towards cosmetic/aesthetic surgery among women can be influenced by the variables such as marital status, place of living, fear of ageing, the importance of physical appearance, occupational status, and partner's influence. This study provided a first general look at the situation around cosmetic/aesthetic surgery in the context of the Czech Republic. However, to gain a more comprehensive understanding of the acceptance and attitudes towards cosmetic/aesthetic surgery in the Czech Republic, further research should be conducted across the country to assess the attitudes of the wider population (for example, different age groups).