Vaginal hysterectomy in patients with pelvic organ prolapse: An eight-year experience from a tertiary care center.

Risk factors for skin graft loss in burn patients: A six-year cohort study in non-intensive care unit settings.

Academic publishing underpins surgical decision-making, but the rapid adoption of generative artificial intelligence (AI) raises concerns about research credibility and patient safety. To the best of our knowledge, no prior pilot study has examined its presence in plastic and reconstructive surgery. Detection tools remain imperfect, and journals lack consensus on disclosure policies, leaving a gap between rapid adoption and effective oversight. This pilot analysis sampled 10% (n=67) of articles published between July 1, 2024, and July 1, 2025, across leading plastic and reconstructive surgery and burn journals. We assembled a matched control cohort from 2014 to 2015 using identical criteria. Articles were analyzed using a combined RoBERTa classifier and perplexity-based evaluation to flag potential AI-like textual characteristics. At the article level, 18 of 67 articles (26.9%, 95% CI: 17.7-38.5) contained ≥1 flagged section, with 20 subsections (5.3%, 95% CI: 3.5-8.1) flagged. Flagged content clustered in methods (9.1%) and abstracts (7.5%), with lower prevalence in other sections. In our control cohort, 3 papers (4.5%, 95% CI: 1.5-12.5) and 3 subsections were flagged (0.9%, 95% CI: 0.3-2.7), representing ~6-fold and 5-fold increases, respectively. This difference was statistically significant at the article level (χ²=11.1, P <0.001). AI-like textual characteristics were more frequently detected in contemporary plastic and reconstructive surgery publications than in the pre-AI cohort. Although detection does not confirm authorship, these findings underscore the need for clearer and more consistent disclosure, standardized and graded reporting policies, and reviewer training to enable responsible integration of AI into surgical publishing.

Risk factors for aspiration pneumonia related to postoperative chemoradiotherapy for high-risk head and neck cancer: A supplementary analysis of a phase II/III JCOG1008 trial.

As large language models (LLMs) grow in sophistication, their potential role in scientific writing is being explored with growing interest and caution. However, LLMs vary in their performance, contextual accuracy, and reliability. This study compares the outputs of 3 leading LLMs (ChatGPT-4o, Deepseek, and Claude 3.7) against a manually curated bibliometric analysis of the most highly cited panniculectomy articles. The 50 most highly cited panniculectomy publications were manually extracted from Web of Science (WoS) to serve as a reference data set. ChatGPT-4o, Deepseek, and Claude 3.7 Sonnet were each prompted to generate their own list of the 50 most cited panniculectomy articles. Outputs were compared across citation totals and averages, publication year trends, journal distribution, author co-occurrence, and article authenticity. The manual data set totaled 2494 citations (density: 49.8). ChatGPT-4o, Deepseek, and Claude 3.7 produced 2111 (42.2), 4736 (94.7), and 8592 (171.8) citations, respectively. Overlap with the manual list was limited: ChatGPT-4o (14.00%), Claude 3.7 (4.00%), Deepseek (0.00%) ( P <0.001). "Plastic and Reconstructive Surgery" was the most cited journal across all outputs. Unique authors: manual (241), ChatGPT-4o (114), Deepseek (72), and Claude 3.7 (129). Article accuracy: ChatGPT-4o had 34.00% accurate, 26.00% confabulated, and 40.00% hallucinated articles. Claude 3.7: 4.00% accurate, 26.00% confabulated, and 70.00% hallucinated. Deepseek: 100.00% hallucinated ( P <0.001). Year trends and journal representation varied notably from the manual set. Current LLMs struggle to replicate accurate bibliometric data. ChatGPT-4o performed best but still showed major limitations. WoS remains the gold standard, and LLM-generated outputs should be treated cautiously in bibliometric analyses.

Quercetin enhances skin flap survival via SIRT1-regulated mitophagy promotion and pyroptosis inhibition.

Introduction. Modern advances in the development of reconstructive urology show high efficacy in treating urethral stricture (US) in men and maintaining an acceptable quality of life. An urgent task in the treatment of this category of patients is not only the restoration of physiological urination and relief of symptoms of emptying, but also the preservation and restoration of erectile function (EF). The purpose of the study. To evaluate the effect of preoperative risk factors for erectile dysfunction (ED) in men with stricture disease of the urethra on erectile function and hemodynamic parameters of penile blood flow. Material and methods. The study included 153 sexually active patients with US, who underwent reconstructive and reconstructive surgery on the urethra. The EF assessment was carried out using the IIEF-5 questionnaire. The study patients were divided into 2 groups, depending on the presence of risk factors for erectile dysfunction (hypertension, coronary heart disease, type 2 diabetes mellitus, tobacco smoking). Control points of assessment: initially (before surgery), 3, 12 months after urethroplasty. Penile hemodynamics in patients was assessed during preoperative preparation based on the results of pharmacodopplerography of penile vessels using alprostadil 10 micrograms. Results. The age of the study patients ranged from 18 to 80 years (Me = 53.00, Q1 – Q3 =38.00 – 64.00). Before urethroplasty, signs of ED were noted in 55.6% (n=85) of patients (median IIEF-5 - 19,0 [13,0- 22,0]). A significant progression of ED signs was noted 3 months after urethroplasty, the presence of ED signs was recorded in 75.8% (n=116) of patients (median IIEF-5: 13,0 [5,0; 20,0], p=0.001). According to the results of the EF examination for the 12th month of the postoperative period, a significant improvement in EF indicators was confirmed (median IIEF-5: 21,0 [18,0; 23,0], p &lt;0.001). The presence of ED risk factors was noted in 52.9% (n=81) of patients with US. With an increase in the World Health Organization (WHO) age group, there is an increase in the prevalence of ED risk factors. In the age group of patients from 18 to 45, risk factors for ED were identified in 29.6% (n=16), and in the group from 60 to 74 - 72.3% (n=34). According to the result of comparing groups of patients, depending on the presence of ED risk factors, during the preparation for urethroplasty, the EF indicators of the studied groups did not significantly differ. 3 and 12 months after urethroplasty, the EF scores of the group without ED risk factors were significantly better (median IIEF-5 - 16.0 [10.75-21.0] versus 10.0 [5.0-16.0], p&lt;0.001; 22.0 [21.00-24.0] versus 18.0 [15.0-22.0], p&lt;0.001). In the group of patients with risk factors for ED, there was a higher incidence of severe ED, reaching 56.8% (n=46) 3 months after urethroplasty, and a higher incidence of signs of ED during the 12th month of the postoperative period (50.6%, n=41). The presence of risk factors in patients with US is associated with poorer indicators of penile hemodynamics. According to the results of pharmacodopplerography of the vessels of the penis before surgery, in the group of patients with ED risk factors, higher values of the end diastolic velocity (EDV) and lower resistance index (RI) were recorded compared with the group without ED risk factors (EDV: 9.38 [6.46; 13.90] vs. 3.29 [0.10; 5.68], p&lt;0.001; RI: 0.70 [0.63; 0.73] vs. 0.84 [0.78; 1.00], p=0.001). According to the results of a multifactorial analysis, the predictors of ED development 3 months after surgery are age (AOR 1.082; 95% CO 1.038 – 1.127; p &lt; 0.001), hypertension (AOR 4.608; 95% CO - 1.089 – 19.511; p = 0.038) and baseline status of erectile function (AOR 0.046; 95% CO - 0.013 – 0.160; p &lt; 0.001). However, the examination after 12 months confirmed a decrease in the effect of concomitant pathology and age on the negative dynamics in EF indicators. Conclusion. The presence of modifiable and unmodifiable ED risk factors is associated with more pronounced EF changes in patients with US after urethroplasty. The predictors of the development of ED after urethroplasty are age, concomitant pathology (arterial hypertension) and the initial level of EF of the patient, followed by a decrease in the effect of predictors on EF by the 12th month of the postoperative period. Keywords: urethral stricture; urethral plastic surgery, erectile dysfunction, risk factors for erectile dysfunction.

A promising strategy to rapidly expand high-quality human limbal stem cells for tissue engineering and cornea reconstruction.

This video describes in detail our current technique for laparoscopic port placement in infants when using retroperitoneoscopy. More than 60 ablative and reconstructive renal surgeries have been performed since 2017 using this retroperitoneoscopic approach in infants weighing less than 10 Kg, with no conversions or complications linked to access or port placement. It is our impression that retroperitoneoscopy is very similar in smaller children, and might have some advantages such as shorter distance between entry point and target organ and more flexible abdominal wall. This video shows a combination of 5 mm and 3 mm ports, allowing use of all current types of energy devices, clip appliers and single use scissors, and also excellent vision during initial dissection. This approach has been used in our university centers for nephrectomies, hemi-nephrectomies, pyeloplaties and uretero-ureterostomies.

A multicenter study on microsurgical procedures to treat congenital and acquired breast abnormalities.

To examine how the clinical management of adults with laryngotracheal stenosis (LTS) by speech and language therapists (SLTs) has evolved over the past decade. The review highlights changes in assessment, counselling, and rehabilitation practices in response to advances in surgical interventions and explores implications for multidisciplinary care. Recent literature and clinical experience demonstrate that SLTs play a critical role in managing voice and swallowing outcomes for patients with LTS. While established care pathways exist for reconstructive surgery, the increasing use of minimally invasive endoscopic procedures and complex cases require more nuanced, individualized approaches. Prospective studies have defined the impact of LTS and its treatments on voice and swallowing, and a core outcome set (COS-LTS) has been developed to standardize outcome reporting in future research. Psychosocial support and patient-centred decision-making have become integral components of care. Adults with LTS experience multifaceted challenges affecting breathing, voice, and swallowing. SLTs are essential members of the multidisciplinary team, providing pre and postoperative assessment, counselling, and rehabilitation. Advances in treatment options and recognition of psychosocial impacts necessitate flexible, holistic care strategies. Future research should focus on validating outcome measures, implementing the COS-LTS, and incorporating patient priorities to optimize functional and quality-of-life outcomes.

Anterior cruciate ligament (ACL) tears are one of the most common orthopaedic injuries, and ACL reconstruction is often considered the standard of care for the active individual. Recently, attention-deficit/hyperactivity disorder (ADHD) has been shown to be a risk factor for adverse postoperative outcomes in patients undergoing ACL reconstruction. However, no studies have looked at the effect of stimulant medications on ACL reconstruction outcomes in patients with ADHD. This study aimed to compare postoperative outcomes between ADHD patients using stimulant medications and those not using stimulants following ACL reconstruction at 3- and 6-month follow-up. This retrospective cohort study used the TriNetX database to identify patients with ADHD who underwent ACL reconstruction surgery and divided them into cohorts based on the presence or absence of stimulant medication usage. Patient cohorts were 1:1 propensity score matched on age, sex, obesity, mood disorders, anxiety disorders, and nicotine dependence. Postoperative complications were analyzed within 3 and 6 months postoperatively, evaluating arthrofibrosis, infection, wound disruption, revision surgery, emergency department (ED) visits, hospital readmission, and deep vein thrombosis. Within 3 and 6 months postoperatively, ADHD patients not taking stimulants were markedly more likely to return to the ED and be readmitted to a hospital compared with those who were taking stimulants. In addition, at the 6-month time point, a statistically significant increase in arthrofibrosis was seen in nonstimulant users compared with stimulant users in patients with ADHD. This study found that patients with ADHD not taking stimulant medications are at an increased risk of returning to the ED, being readmitted to the hospital, and developing arthrofibrosis compared with those patients taking stimulants following ACL reconstruction. The results display the importance of identifying modifiable risk factors for ACL reconstruction surgery so that physicians can adequately adjust treatment regimens to each patient.

Extracellular vesicles secreted by LRP1+ ligament-derived stem cells promote tendon-bone healing after ACL reconstruction via miR-708-5p/Bambi axis.

As the population ages, there is an increasing demand for urologists who specialize in female pelvic surgery. However, 30% of residency programs lack a Urogynecology Reconstructive Pelvic Surgery (URPS)-trained attending, potentially limiting resident exposure. This study evaluated whether the presence of URPS faculty during residency would influence subsequent URPS practice patterns amongst general urologists. American Board of Urology case logs (2003-2023) were analyzed for general urologists aged ≤ 40 who graduated after 2013. Residency programs were assessed for URPS faculty presence using public databases and direct program contact. Female URPS procedures were identified by CPT codes. A total of 414 general urologists submitted 21 422 cases, including 2372 female URPS procedures. One hundred and eleven urologists without URPS attending in residency submitted 596 URPS cases (mean: 5.37 cases/urologist). Three hundred and three urologists with URPS attending in residency submitted 1776 URPS cases (mean: 5.86 cases/urologist). There was no statistical difference between the two groups in the total number of URPS procedures. Complex female URPS procedures were more likely to be performed by general urologists with URPS faculty during residency (p = 0.02). The most common procedure for both groups was sling (without URPS attending: 282/596, with URPS attending: 753/1776). General urologists who trained at a residency program that had an URPS attending on faculty were more likely to perform complex female URPS procedures. This finding underscores the potential importance and value of having an URPS attending during residency training for general urologists interested in performing more complex URPS procedures in practice.

This study evaluated the maturation of the peroneus longus (PL) tendon autograft by quantifying the key diffusion tensor imaging (DTI) parameters: fractional anisotropy (FA) and apparent diffusion coefficient (ADC) at 1 year of follow-up in patients undergoing all-inside anterior cruciate ligament (ACL) reconstruction surgery. Magnetic resonance imaging (MRI) of the knee with DTI sequences was done at 1 year of follow-up for 50 patients (mean age 26.6 ± 8.5 years; 41 males + 9 females), who underwent ACL reconstruction using PL tendon autograft. FA and ADC at different parts of the graft (femoral, mid-substance and tibial) were determined with regions of interest (ROI)-based measurements after assessing the fibre morphology on the proton density fat-saturated (PDFS) images. Figueroa scores using the conventional MRI sequences were also calculated at 1 year of follow-up and compared with the DTI parameters. The Tegner-Lysholm and knee society scores were used to evaluate functional outcomes. At 1 year, mean FA and ADC values were 0.2 ± 0.1 and 1.7 ± 0.1 × 10-3 mm²/s, both different from the reported values for native ACL. The majority of patients (35/50) had a Figueroa score of 4, indicating adequate but incomplete graft maturation. The FA and ADC values of the three individual regions of the graft, as well as the overall mean value, did not show any significant difference between the three Figueroa score groups (Figueroa score 3 vs. 4 vs. 5). There was a significant improvement (p < 0.001) in the patient-reported outcome measures at the final follow-up. DTI and conventional MRI parameters showed substantial but incomplete graft maturation, despite excellent functional recovery, at 1 year of follow-up. Our study supports the use of PL tendon as a reliable graft option, demonstrating acceptable graft maturation and favourable functional outcomes. Advanced imaging may assist in individualised return-to-sport decision-making. Level II.

Medicare reimbursements for orthopaedic surgeries have consistently declined over past decades, raising concerns about surgeons opting out of Medicare and reducing coverage for older adults. However, little is known about this phenomenon. We conducted a retrospective evaluation of orthopaedic surgeon Medicare opt-outs as of January 2025. We analyzed charge-payment ratios of orthopaedic surgeries performed in areas with versus without opt-outs and examined the 3-year moving averages and population demographics for areas with opt-outs. As of January 2025, 341 orthopaedic surgeons have opted out of Medicare, representing 0.7% of all opted-out practitioners and 1.7% of 2022 Medicare-enrolled orthopaedic surgeons. The median charge-payment ratio for all orthopaedic surgeries is 18.3% higher in areas with these opt-outs compared with those without (95% confidence interval [CI], 11.7% to 30.1%; P < 0.0001) and 34.5% higher for joint arthroplasty and reconstruction surgeries (95% CI, 9.2% to 51.9%; P = 0.0003). These opt-outs primarily occurred in high-cost regions, with approximately 70% of surgeons practicing in areas with regional price parities greater than 110% of the national average. Consequently, Medicare opt-outs by orthopaedic surgeons have risen from 0.3 to 32.0 annually from 2002-2004 to 2022-2024. In 2022, there were 958 reported Medicare beneficiaries of orthopaedic surgeries per zip code in areas with opt-outs, 612 higher than in areas without opt-outs (95% CI, 277 to 629; P < 0.0001). The median proportion of Medicare-eligible individuals by age in areas with opt-outs is 35.8%, 18.1% higher than the national rate (95% CI, 16.3% to 19.3%; P < 0.0001). Orthopaedic surgeons practicing in high-cost and relatively lower reimbursed areas are increasingly opting out of Medicare, disproportionately affecting older adults and higher need areas. These results suggest that correcting declining Medicare surgery reimbursements is critical to minimize coverage lapses for a growing older adult population, which is an important issue in orthopaedic surgery.

Distal ischemic necrosis remains a major challenge in reconstructive surgery. Mitochondria and lysosomes interact via signaling and membrane contacts to maintain cellular homeostasis. Mitochondrial-derived peptide MOTS-c, encoded by the MT-RNR1/12S rRNA open reading frame, enhances mitochondrial function by reducing reactive oxygen species (ROS) and stabilizing the membrane potential, potentially preserving lysosomal integrity and reducing lysosomal membrane permeabilization (LMP). This study investigated the protective effects and underlying mechanisms of MOTS-c in ischemic flaps. RNA sequencing explored MOTS-c mechanisms in ischemic flaps. Tissue clearing, laser speckle contrast imaging and Doppler analyses revealed improved blood flow perfusion following MOTS-c treatment. Histological staining (HE, Masson, F-CHP) demonstrated enhanced angiogenesis and collagen remodeling. Western blotting, ELISA, and immunofluorescence were used to assess pyroptosis, macroautophagy/autophagy, LMP, and MAPK1/ERK2-MAPK3/ERK1-NFKB/NF-κB pathway-related proteins. MOTS-c reduced endothelial pyroptosis, enhanced autophagy, and attenuated LMP in ischemic flaps. Mechanistically, in vivo overexpression of PLA2G4A/cPLA2 (phospholipase A2, group IVA (calcium, calcium dependent)) via AAV confirmed that MOTS-c enhances autophagy and reduces pyroptosis and LMP by suppressing PLA2G4A phosphorylation. Furthermore, MOTS-c inhibited PLA2G4A via the MAPK1-MAPK3-NFKB signaling cascade, thereby reducing LMP and enhancing flap survival. These findings suggest that MOTS-c restores cellular homeostasis by targeting the PLA2G4A-LMP axis, representing a promising therapeutic strategy for improving outcomes in ischemic flap surgery.

. Autologous fat transfer (AFT) is a well-established technique for cosmetic breast augmentation and reconstructive breast procedures. Historically, however, graft retention has been highly variable. The Viality™ system (Tiger Aesthetics Medical, Conshohocken, PA) is an FDA-cleared, in-line fat processing device designed to concentrate viable adipocytes, improving retention. . In this prospective, 14-center study (NCT05258305), 190 patients underwent AFT for cosmetic (n=85) or reconstructive (n=105) breast procedures. Harvested fat was processed with Viality and AuraClens™ surfactant wash. Volumetric analysis, based on 3D imaging, was performed at baseline and 1, 3, 6, and 12 months. Percentage retention and impact of patient factors on retention at 12 months were assessed. . Mean (95% CI) retention was 86.6% (85.4 to 87.7) at month 1, 83.1% (81.8 to 84.4) at month 3, 84.1% (82.8 to 85.5) at month 6, and 84.8% (83.2 to 86.5) at month 12. Mean retention was significantly greater at all timepoints than the historical benchmark of 70% (P <.0001) with no significant changes in retention over time. Similar trends were observed for reconstruction and cosmetic cohorts. Retention was affected by fat transfer volume (P<.0001), weight change (P<.0001), and graft-to-recipient breast volume ratio (P=.0187). . Early graft steady state, sustained high-percentage volume retention, and consistent results suggest that the Viality system is an effective, predictable modality for processing fat for cosmetic and reconstructive breast surgery, setting a new standard for sustained volume retention.

To systematically evaluate the safety and efficacy of flap reconstruction surgery and the associated influential factors in the treatment of diabetic foot ulcers (DFUs) and to provide an evidence-based basis for clinical flap selection and surgical strategies. The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify studies on comparative or single-arm flap reconstruction for the treatment of diabetic foot ulcers (DFUs). Eligible study designs included randomized controlled trials (RCTs), cohort studies, and case series published between 1998 and 2025. Two investigators independently screened the literature, extracted relevant data, and assessed the risk of bias using the Cochrane Risk of Bias tool and the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Meta-analyses were performed using Review Manager (RevMan) 5.4. The primary and secondary outcome measures included total flap loss, limb loss rate, and flap failure rate. Subgroup analyses were conducted according to flap type and regional differences. A total of 45 studies were included. The results of the meta-analysis showed that patients undergoing flap reconstruction had higher postoperative total flap loss (HR = 5.83; 95% CI 3.65-9.31), limb loss (HR = 11.09; 95% CI 7.22-17.03), and flap failure rate (HR = 10.01; 95% CI 8.31-12.05) compared with reference populations or expected baseline risks. Subgroup analyses revealed that the risk of free flap limb loss was significantly greater than that of non-free flaps (HR = 17.86 vs. 1.94; P = 0.02); the risk of limb loss was greater in Europe (HR = 22.97) and North America (HR = 17.42) than in East Asia (HR = 5.85; P < 0.001), and there was no regional difference in total flap loss (P = 0.67). The results of the sensitivity analysis were robust, with heterogeneity arising mainly from differences in study design and patient characteristics. Flap reconstruction remains a viable option for DFU wound closure, but it is associated with elevated risks of postoperative total flap loss and limb loss. Individualized surgical protocols, prioritization of non-free flaps for low- and intermediate-risk patients, and enhanced multidisciplinary collaboration and postoperative management are recommended. More high-quality studies are needed to validate the long-term efficacy of different flap techniques. Register with PROSPERP, Registration Information: ID: CRD420251075758. Date of first submission to PROSPERO: 25 June 2025. Upload data information: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251075758.

Scar sarcoidosis is a form of cutaneous sarcoidosis characterized by granulomatous inflammation arising within pre-existing scars or sites of previous trauma. These lesions may develop years after the initial injury and can mimic foreign body granulomatous reactions both clinically and histopathologically. We report a 23-year-old woman who developed erythematous indurated plaques within extensive burn scars 20 years after sustaining a full-thickness scald injury requiring reconstructive surgery with metallic staples. Histopathology revealed granulomatous dermatitis with polarizable foreign material. The presence of retained staples and subsequent development of uveitis complicated the diagnostic evaluation. This case highlights the diagnostic challenge of differentiating scar sarcoidosis from foreign body granulomatous reactions and emphasizes the potential role of retained foreign material as a trigger for sarcoidal granuloma formation.