Post-traumatic breast implant and tissue expander (TE) complications are increasingly relevant as more patients undergo reconstructive or cosmetic breast surgery. Prior studies are limited to case reports, with little known about the mechanisms of injury or timing of clinical recognition. Using the Nationwide Readmission Database (2017-2020), we identified adults with trauma admissions followed by breast implant-related diagnoses or procedures. Mechanisms of injury (MOI) and clinical presentations were characterized using ICD-10 codes. Patients were classified as having received "immediate" management (diagnosis or procedure during index admission) or "delayed" (on readmission). Cox regression identified predictors of earlier diagnosis or intervention. A total of 573 patients with post-traumatic implant complications were included (488 breast implants, 85 TEs). Falls were the most common MOI (53.2%), followed by transport accidents (25.0%). TEs were disproportionately associated with burn injuries (20.5% vs. 4.9% in non-TEs). At presentation, 78.2% of patients were diagnosed with implant rupture or underwent surgical correction. Rib or clavicle fractures (21.1%) and breast symptoms (12.6%) were associated with earlier diagnosis, but not with likelihood of surgery. Plastic surgery consultation significantly decreased time to surgery. Age, sex, and ZIP code did not have notable effects on diagnostic and surgical timing. Post-traumatic breast implant complications often present without breast-specific symptoms, resulting in diagnostic delays. Trauma protocols should include routine breast imaging in patients with implants, especially after transport, burn, or blunt-force injuries. TE patients may be uniquely susceptible to thermal injury and warrant focused preventive counseling. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abdominal wall reconstruction in the presence of midline hernia (MH) and lateral hernia (LH) is a challenging procedure. The purpose of this study was to introduce surgical method combining the retromuscular sublay technique and component separation technique with mesh augmentation for the simultaneous repair of midline and lateral hernias. Between January 2006 and January 2025, 67 consecutive patients who underwent abdominal wall reconstruction for combined MH and LH or parastomal hernia (PH) were retrospectively analysed. The abdominal wall was reconstructed using a combination of the retromuscular sublay technique and the component separation technique, followed by mesh reinforcement. Of 67 patients, 53 underwent reconstruction surgery for simultaneous MH and LH, and 14 patients underwent surgery for MH and PH. LH was incisional (after previous pararectal, oblique, subcostal, or "J" incisions) in 58.5%, at the site of stoma closure in 37.7%, and as a consequence of blunt trauma in 3.8%. The median total defect width was 15cm (range, 11-18) for the entire cohort. The median operative time was 150min. Overall morbidity was 17.9%. After a median follow-up period of 24 months (range, 1-58), recurrence developed in 2 (3%) patients and abdominal wall bulging in 1 (1.5%). The combination of the retromuscular sublay technique, the component separation technique and mesh reinforcement is a safe and effective method for the simultaneous repair of MH and LH or PH.

Background and Objectives: Tubal reanastomosis is an alternative option for women seeking fertility after sterilization. Thus, anastomosis healing quality and peri-tubal adhesions play a crucial role. TISSEEL® fibrin sealant may enhance tissue repair and reduce foreign-body reaction. We evaluated the effect of TISSEEL®, used alone or with sutures, on anastomotic healing and adhesion formation in a rat uterine horn model. Materials and Methods: Thirty female Wistar rats were randomized to Suture, TISSEEL®, or Suture + TISSEEL® groups (n = 10 each). After bilateral uterine horn transection, reanastomosis was performed with sutures alone, fibrin sealant alone, or combined sutures and sealant. On postoperative day 14, reanastomosis segments were collected for blinded histologic assessment and evaluation of modified Ehrlich–Hunt score parameters (inflammation, fibrosis, neovascularization and collagen production). Intra-abdominal adhesions were also macroscopically assessed. Results: Two animals died perioperatively and 56 uterine horns were included in the final analysis (Suture n = 18, TISSEEL® n = 18, Suture + TISSEEL® n = 20). The distribution of inflammation and fibrosis severity grades, as assessed by the modified Ehrlich–Hunt scoring system, did not differ significantly between the study groups (p = 0.208 and p = 0.652, respectively). In contrast, high-grade neovascularization (grades 3–4) was more common in TISSEEL® groups (77.8% TISSEEL®, 80.0% Suture + TISSEEL®, 33.3% Suture, p = 0.004), while increased collagen deposition was also more common in the TISSEEL® groups (p = 0.011), after binary analysis. Severe adhesions were more common in the Suture group (66.7% vs. 11.1% in the TISSEEL® group and 30.0% in the Suture + TISSEEL® group, p = 0.037). Conclusions: TISSEEL®, alone or as an adjunct to sutures, improves neovascularization and collagen production and is associated with milder adhesions without increased inflammation or fibrosis. The use of fibrin sealant TISSEEL® may be a useful tool in tubal reconstructive surgery.

Robot-assisted latissimus dorsi flap harvest for breast reconstruction: a minimally invasive reconstructive surgery

Background:Telemedicine has rapidly evolved in the field of plastic and reconstructive surgery, particularly since the COVID-19 pandemic, offering new opportunities for patient care, especially in wound management, pediatric consultations, and postoperative follow-ups. Despite its growing use, questions remain regarding user satisfaction and technological limitations. This study aims to systematically evaluate the satisfaction and usability of telemedicine among patients and providers in plastic surgery and to present a single-center experience with telehealth during the early months of the COVID-19 pandemic.Methods:A systematic review was conducted across PubMed, Cochrane, Scopus, and Google Scholar databases for articles published between January 2017 and April 2025. Inclusion criteria focused on studies addressing satisfaction with telemedicine in plastic surgery. Additionally, a prospective survey was conducted of 63 patients, mean age of 59.6 ± 23.86, at our center using a modified Telehealth Usability Questionnaire between May and August 2020. Statistical analyses included descriptive statistics and comparative tests.Results:Twenty-one studies were included, spanning burns, pediatric, aesthetic, and reconstructive surgery. Overall, telemedicine demonstrated high patient satisfaction (72%–98%), provider satisfaction (74%–97%), and diagnostic reliability (up to 94.4%). In our local cohort, 77.8% completed their scheduled virtual appointments, and usefulness received the highest satisfaction score (mean 6.68 of 7). No significant differences were observed by age or sex.Conclusions:Telemedicine is a highly satisfactory and feasible adjunct to traditional plastic surgery care, especially for follow-ups and wound care. Continued technological improvements and standardized protocols are essential for broader adoption.

Secondary cleft lip nasal deformity presents a persistent challenge in reconstructive surgery, with fundamental differences existing between unilateral and bilateral presentations that dictate distinct management approaches. This systematic review delineates the contrasting anatomical underpinnings of these deformities, where unilateral cases are characterized by marked asymmetry and bilateral cases by a symmetric deficiency marked by severe columellar shortening. It further synthesizes the evolution of assessment methodologies, from traditional anthropometry to advanced three-dimensional (3D) technologies like stereophotogrammetry and CT reconstruction, which enable precise preoperative planning. The review elaborates on differentiated repair strategies, emphasizing symmetry restoration in unilateral deformities versus midline structural reconstruction in bilateral cases, often necessitating substantial costal cartilage grafts. Despite advancements, challenges remain in achieving long-term stability and managing soft tissue limitations. The integration of computational modeling, artificial intelligence (AI), and tissue engineering represents the future direction for progressing toward personalized and predictable reconstruction. This synthesis provides a comprehensive framework to guide clinical decision-making and future research.

Tranexamic acid (TXA) is widely used in surgery to reduce perioperative bleeding, but concerns persist regarding its potential thromboembolic risks. This study evaluates the association between intraoperative intravenous (IV) TXA use and 90-day postoperative venous thromboembolism (VTE) risk in patients undergoing plastic and reconstructive surgery of the head and neck. We conducted a retrospective cohort study using the Fortuna database, a national administrative claims dataset with over 200 million patients. Adult patients undergoing plastic and reconstructive surgery between 2010 and 2024 were identified using CPT codes, and whether they received IV TXA on the index day of procedure was determined. The primary outcome was VTE diagnosis within 90 days postoperatively. Use of enoxaparin or heparin was also documented. High-dimensional propensity score matching with inverse probability of treatment weighting (IPTW) was used to adjust for baseline demographics, comorbidities, medication exposures, and healthcare utilization. Logistic regression was used to evaluate the association between treatment and the binary outcome. A total of 1,011 patients received IV TXA and 157,959 did not. After propensity score matching, the two groups were well-balanced. The incidence of VTE was 0.2% in the TXA group, and 0.28% in the non-TXA group. Weighted logistic regression demonstrated no statistically significant difference in VTE risk (OR 0.62, 95% CI: 0.13-3.04, p = 0.55). IV TXA use was not associated with increased postoperative VTE risk in plastic and reconstructive surgery of the head and neck, supporting its continued use as a safe hemostatic adjunct in this patient population.

Intentional placement of an epidural catheter toward the operative side can produce a predominantly ipsilateral effect, which may benefit patients undergoing unilateral knee surgery. In this study, we retrospectively evaluated the success rate and efficacy of intentional ipsilateral epidural catheter placement in patients undergoing anterior cruciate ligament reconstruction (ACLR). With IRB approval, we retrospectively analyzed existing clinical data that had been routinely collected from patients who underwent ACLR and received intentional ipsilateral epidural catheter placement combined with spinal anesthesia between January 2021 and December 2023. All epidural catheters were advanced toward the operative side and used for continuous infusion for 3days. Catheter tip position was evaluated by X-ray on postoperative day (POD) 1. Pain scores on the Numerical Rating Scale (NRS), analgesic requirements, distribution of sensory blockade, motor function, and complications through POD4 were evaluated. Of 307 patients undergoing ACLR, 297 patients were included in the analysis. Catheters were inserted between the T11/12 and L1/2 intervertebral spaces. X-rays revealed that the epidural catheter tip was located on the operated side in 274 patients (92.3%). An ipsilateral-dominant sensory block covering lumbar segments was observed in more than 90% of patients throughout 3 PODs. Median NRS scores during mobilization remained below 3 with epidural infusion, and 263 patients (88.6%) could perform active straight leg raise on the operative side on POD1. Intentional ipsilateral epidural catheter placement demonstrated a high success rate, provided motor-sparing and satisfactory analgesia in patients undergoing ACLR.

Letter to the Editor: "Forward Strides in Academic Plastic and Reconstructive Surgery Gender Representation: 2025 Update".

Women remain underrepresented in surgery, with dropouts occurring at every stage of training, and women representing under 20% of consultant surgeons. This study explored the relationship between sex, applications for national selection for Higher Specialty Training (ST3), and receipt of an offer. This retrospective longitudinal cohort study used data from the UK Medical Education Database. The study population included 1,960 doctors eligible to progress to higher training between 2014 and 2019. The primary outcomes of interest were application for and offer of an ST3 post. Logistic regression analysis was conducted after adjusting for confounders using a directed acyclic graph. Within the cohort, paediatrics and ear, nose and throat (ENT) had the highest proportion of female applicants (50%), followed by plastic and reconstructive surgery, general surgery (including vascular surgery applicants), urology, and trauma and orthopaedics, with the lowest (22%). Significant (p<0.01) associations were identified between being female and applying for ST3 general, paediatric, and plastic surgery, while applications to orthopaedics favoured men. No association was found between sex and ENT or urology applications. For ST3 offers, significant sex associations favouring women were identified for general surgery and urology. No associations were observed for the other specialties or the cohort as a whole. Differences exist in the proportion of women applying for ST3 across surgical specialties, with women more likely to obtain a post in general and urological surgery. Recognising these disparities and promoting efforts to cultivate a more diverse and inclusive workforce remains critical.

The indications for reconstructing asymptomatic orbital blowout fractures remain controversial. We aimed to evaluate whether these fractures can be managed using a symptom-based protocol, disregarding radiological criteria. In this single-center prospective follow-up study, we included adult patients with unilateral, isolated, and dislocated blowout fractures. The recommendation for surgical treatment was based exclusively on clinical symptoms and findings: obvious diplopia, restricted eye movements, or >2 mm of globe malposition (GMP). We assessed clinical outcomes and patient satisfaction over a 9-month follow-up. The reduction in surgical interventions was compared to historical data. A total of 206 consecutive patients were included. Of these, 35 (57% male, mean age 38 years) underwent early reconstruction, while 171 (53% male, mean age 55 years) were managed non-surgically. At 9 months, >2 mm of GMP was observed in 11% of the follow-up group and in 7.1% of the early reconstruction group. All patients who developed >2 mm GMP during follow-up declined reconstructive surgery. Compared to the surgical group, the follow-up group had lower rates of obvious diplopia (0% vs. 14%), any diplopia (13% vs. 63%), restricted eye movements (0% vs. 7%), and paresthesia (19% vs. 39%). Satisfaction with diplopia (97% vs. 64%) was also higher. Implementation of the new protocol reduced the reconstruction rate from 41.6% to 17.0%. Development of subjectively disturbing late GMP in asymptomatic orbital blowout fractures is rare. Ocular function tends to recover spontaneously. A symptom-based approach is a safe and effective way to treat orbital blowout fracture patients.

Influence of pressure on mandibular angiosomes: What implications for decellularization?

Reconstructive Surgery at Hysterectomy for Patients With Uterine Prolapse and Gynecologic Malignancy: Correction.

Strategies to minimize postoperative complications in microsurgical free tissue transfer: The role of anticoagulation, antiplatelets, and ambulation.

The impact of vascular endothelial growth factor containing collagen-binding domain on fat graft survival.

Efficacy of autologous intestinal reconstruction surgery on bowel dilatation in pediatric small bowel syndrome.

Early and Long-Term Outcomes of Cryopreserved Arterial Allograft Reconstruction in Concomitant Aortic and Spinal Infections Managed with a Multidisciplinary Approach.

Burn reconstruction restores function and appearance after initial burn treatment, yet these interventions may remain underutilized due to fragmented care systems and inadequate follow-up. National datasets and procedural coding systems often fail to capture the scope of secondary reconstruction, limiting insights into long-term care needs. Therefore, this prospective analysis employs a prospective registry to track the volume, procedural patterns, and care settings of secondary burn reconstruction to create a basis of practice development of reconstructive burn surgery within a burn unit practice. A prospective registry was implemented from January 2023 to December 2024 to track secondary burn reconstruction procedures. Data collected included procedural type, timing from initial injury, original total body surface area burned, and the types of healthcare systems in which the procedures were performed. Registry data were compared to institutional acute burn care data from 2023 and 2024 to contextualize reconstructive volume and demographics. From 2023 to 2024, 353 reconstructive cases were identified. Laser scar revision was the most common procedure (50.4% in 2023; 44.7% in 2024). Most patients had initially minor injuries (<10% total body surface area). Average time to reconstruction was 319 days (2023) and 425 days (2024). Cases were performed across diverse settings, including rural hospitals (12-18%) and outpatient clinics (0.5-5%). The registry provided detailed procedural data not available in administrative datasets. This prospective burn reconstruction registry identified a number of reconstructive burn cases performed in the initial years of focus on the burn patient population. The characteristics of these patients create a basis for concentration on increased patient recruitment, faster time to reconstruction, and better analysis of indications and outcomes.

Incidence and risk factors of loss of motion following anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

The dermal medical rhinoplasty: From blindness to safety.