Microsurgery · Lymphedema · Breast Cancer
Lymphovenous Anastomosis: Microsurgical Innovation and Clinical Outcomes in Breast Cancer–Related Lymphedema Care
This review synthesizes the rapidly expanding evidence base for lymphovenous anastomosis (LVA) as a physiologic microsurgical option for breast cancer–related lymphedema, highlighting a 2024 multicenter RCT that demonstrated improvements in physical and mental function (Lymph-ICF) and a 42% compression-garment discontinuation rate. Meta-analyses encompassing more than 6,000 patients report average reductions of 30–35% in excess limb volume and nearly two fewer cellulitis episodes per year. Emerging adjuncts—prophylactic LYMPHA procedures, high-resolution lymphatic imaging, and robotic supermicrosurgery—are positioned to further refine patient selection and operative precision.
Perforator Flap · Geometric Design · Lower Limb
Re-Vision of Geometric Flap Design in Lower Limb Reconstruction: Enhanced Perforator-Based Propeller Flaps
This prospective study compared perforator-based geometric flap designs with traditional random-pattern flaps for lower limb reconstruction, finding that inclusion of at least one perforator significantly reduced complication rates—particularly partial flap loss and delayed healing—by improving vascular reliability and expanding tissue reach. The geometric perforator design allowed larger flap dimensions and greater rotation without the steep complication profile of propeller flaps. The authors provide an algorithm for perforator selection that optimizes the length-to-width ratio while minimizing venous congestion risk.
Flap Monitoring · Interstitial Glucose · Microsurgery
Monitoring of Venous and Arterial Occlusion With Remote Interstitial Tissue Glucose Measurement Systems in a Rabbit Free Flap Model
Using a rabbit perforator flap model and a wearable FreeStyle Libre continuous glucose sensor, investigators demonstrated that venous occlusion produces a rapid 47.8% rise in flap interstitial glucose within 15 minutes, while arterial occlusion causes a 56% fall within the same window—enabling reliable differentiation of occlusion type before surgical re-exploration. The two-week sensor life covers the critical early postoperative window when most free-flap failures occur, and the device is non-contact, low-cost, and does not require nursing expertise to interpret. Authors call for human translational trials to establish clinical thresholds.
DIEP Flap · Breast Reconstruction · Radiotherapy
The Impact of Radiotherapy on the Outcomes of Deep Inferior Epigastric Artery Perforator Flaps for Breast Reconstruction: A Systematic Review and Meta-Analysis
This meta-analysis quantified the adverse impact of radiation on DIEP flap outcomes: pre-DIEP radiotherapy significantly increased risk of wound healing disturbances, while post-DIEP radiotherapy was independently associated with reduced overall breast satisfaction on patient-reported outcome tools. Both surgical complication rates and aesthetic scores were measurably worse in the irradiated cohorts compared with non-irradiated controls. The findings underscore the need for tailored counseling and operative planning—including timing of reconstruction—when radiation is part of the oncologic treatment sequence.
Calcium Sulphate · Antibiotic Beads · Infection Control
Antibiotic-Loaded Calcium Sulphate Beads in Wound Management: A Scoping Review of Emerging Applications in Plastic and Reconstructive Surgery
The first comprehensive scoping review to examine antibiotic-loaded calcium sulphate beads (CSBs) specifically within plastic and reconstructive surgery, drawing on cases across breast reconstruction, soft-tissue infections, and complex wound coverage. CSBs are fully resorbable and elute antibiotics at concentrations exceeding minimum inhibitory thresholds for weeks, eliminating secondary removal procedures; in prepectoral breast reconstruction, surgical site infection dropped from 7.6% to 3.2% with prophylactic CSB use. Authors call for prospective randomized trials to standardize indications, antibiotic combinations, and dosing protocols.
Debridement · Consensus · Chronic Wounds
Toward a Practical Framework for Debridement in Chronic Wounds: Findings From a United States-Based Multidisciplinary Consensus Panel
A nine-member multidisciplinary expert panel (vascular surgery, podiatric surgery, plastic surgery, nursing, physical therapy, and basic science) convened to produce 17 consensus statements—finalized with high agreement (Kendall's W = 0.566)—reframing debridement as a biologically active intervention that reduces biofilm burden and reactivates healing, not simply tissue removal. The panel endorsed a dynamic 'chutes-and-ladders' escalation/de-escalation approach that matches debridement modality to wound goals, patient factors, and care setting. This framework is specifically designed to support flexible, evidence-informed clinical decision-making for complex wound bed preparation.
HBOT · Reconstructive Salvage · Tissue Viability
Hyperbaric Oxygen Therapy in Surgical Wound Healing and Tissue Salvage: A Structured Narrative Review
This structured narrative review synthesizes evidence through February 2026 on hyperbaric oxygen therapy (HBOT) across surgical wound contexts—chronic ischemic ulcers, burns, radiation wounds, compromised flaps and grafts, and necrotizing infections. HBOT enhances wound closure rates, graft integration, and flap viability through hyperoxia-mediated angiogenesis, VEGF upregulation, fibroblast activation, and leukocyte bactericidal potentiation. Expanding evidence now supports use in elective reconstructive and aesthetic contexts, and combination with NPWT appears synergistic for complex wound populations.
NPWT · Diabetic Foot · Meta-Analysis
Negative Pressure Wound Therapy for Diabetic Foot Ulcers: A Systematic Review of Randomized Controlled Trials
This PRISMA-compliant systematic review of RCTs found that NPWT significantly reduced wound closure time, shortened hospital stays, enhanced tissue granulation, and improved vascular regeneration in diabetic foot ulcer patients compared with conventional wound care—without increasing infection risk. NPWT also reduced neutrophil extracellular trap formation, modulating the inflammatory microenvironment. Authors conclude NPWT is a safe and effective adjunct but note the need for long-term outcome data and head-to-head comparisons with other advanced wound care modalities.
ADM · Breast Reconstruction · DTI · Meta-Analysis
Aesthetic Outcomes and Surgical Complications of Acellular Dermal Matrix in Immediate Direct-to-Implant Breast Reconstruction: A Meta-Analysis of Comparative Studies
This ten-study meta-analysis (416 ADM vs. 339 non-ADM direct-to-implant reconstructions, mean follow-up 25 months) found that ADM use was associated with a significantly higher risk of surgical site infection (OR 3.15, p = 0.0005) and a trend toward higher seroma and implant loss, while aesthetic outcomes were largely comparable between groups. ADM offers improved pocket coverage and lower animation deformity, but clinicians must weigh these benefits against the 3-fold infection risk in the direct-to-implant setting. The authors present a practical risk–benefit framework to guide intraoperative decision-making.
Prepectoral · ADM · Single-Stage · IBR
A Systematic Review and Meta-Analysis on the Prepectoral and Partial Subpectoral Immediate Single-Stage Implant-Based Breast Reconstruction Using ADM
Meta-analysis of 8 observational studies (1,557 reconstructed breasts) showed prepectoral reconstruction (PBR) with ADM had significantly lower total complications (23.85% vs. 31.36%, OR 0.70, p = 0.004), hematoma (OR 0.44), and skin-nipple necrosis (OR 0.50) compared with partial subpectoral reconstruction—and virtually eliminated animation deformity (0% PBR vs. 67.3% SBR). No significant differences were seen in seroma, implant loss, capsular contracture, or infection, suggesting PBR with ADM offers a superior safety and aesthetic profile for appropriately selected patients. The authors call for randomized controlled trials to confirm these findings.
NovoSorb BTM · Synthetic Matrix · Complex Wounds
The Role and Efficacy of NovoSorb Biodegradable Temporizing Matrix in Complex Reconstructive Wounds: A Systematic Review
A systematic review of 34 studies (208 patients) found that NovoSorb BTM—a fully synthetic polyurethane dermal substitute—achieved successful integration (median 41 days) across diverse etiologies including trauma, malignancy, radiation injury, and chronic wounds, with an overall complication rate of 27.9%. Chronic wounds carried a 4-fold independent increase in complication risk; radiation-exposed wounds had the highest complication rate (60%); upper extremity wounds fared significantly better than lower extremity wounds (OR 0.295). BTM's synthetic composition avoids immunogenicity and infection risks associated with biologic ADMs, expanding options for patients who are poor candidates for conventional dermal matrices.
Skin Substitutes · Regulatory · FDA · Access
Balancing Oversight and Innovation: The Case of Skin Substitutes
This perspective examines the regulatory landscape for skin substitute products at a pivotal inflection point: CMS withdrew Local Coverage Determinations for skin substitute grafts effective January 2026, creating uncertainty around coverage for cellular and tissue-based products used in diabetic foot ulcers and venous leg ulcers. The authors analyze the tension between accelerating innovation pathways and ensuring robust clinical evidence standards, arguing that clear evidence thresholds—rather than broad coverage restrictions—best serve patients. The piece has direct practical relevance for reconstructive surgeons who rely on these products as a bridge to definitive reconstruction.
Exosomes · Reconstructive Surgery · Wound Healing
Role of Exosome Therapy in Reconstructive Surgery: A Review
This comprehensive review characterizes the source-dependent properties of exosomes for reconstructive applications: adipose-derived stem cell exosomes provide high angiogenic and anti-fibrotic yield; bone marrow MSC exosomes modulate immunologic responses; umbilical cord MSC exosomes show high proliferative potential. Delivery via topical application, hydrogel incorporation, or direct injection each produces distinct outcomes, and preclinical data consistently show accelerated wound closure (up to 45% in diabetic models), scar modulation, and improved re-epithelialization. The author calls for GMP-compliant standardization of isolation protocols and adequately powered RCTs to advance clinical translation.
PRP · Fat Grafting · Vascularization · Retention
Perfusion-Limited Efficacy of Platelet-Rich Plasma in Adipose Tissue Bioink: A Dose-Response Analysis
Using a clinically validated adipose tissue bioink model, this study demonstrated a clear in vivo dose-response relationship for PRP concentration and fat graft performance: high-dose PRP produced an 8-fold increase in highly perfused regions, a 3.8-fold enhancement in adipocyte survival, a 2.5-fold increase in collagen III deposition, and 103% mass retention versus 50.6% in PRP-free native grafts. Early cytokine release was driven by platelet activation rather than quantity, while vascularization gains were dose-dependent. These findings provide mechanistic grounding for optimizing PRP-enhanced fat grafting protocols in reconstructive and aesthetic practice.
Cell-Assisted Lipotransfer · ADSCs · Fat Retention
Clinical Efficacy of Adipose-Derived Stem Cell-Enriched Lipotransfer Versus Conventional Fat Grafting: A Systematic Review and Meta-Analysis
This systematic review and meta-analysis of cell-assisted lipotransfer (CAL) versus conventional fat grafting found that ASC-enriched grafts trended toward higher retention rates—with Kolle et al. reporting a 5-fold superiority (80.9% vs. 16.3%, p < 0.0001) and Koh et al. showing 61.1% vs. 34.3%—but pooled estimates did not reach statistical significance due to heterogeneity in harvesting techniques and outcome measurement methods. Importantly, no oncologic safety signals were identified across breast reconstruction cohorts. The review argues that standardization of ASC concentration protocols and three-dimensional volumetric assessment is prerequisite for definitive clinical conclusions.
Fat Grafting · Adjuvants · Deferoxamine · Evidence Review
An Evidence-Based Assessment of Adjuvant Therapy in Autologous Fat Transfer: Ranking of the Potential Agents
Evaluating adjuvants for autologous fat grafting using a structured evidence-scoring framework, this study awarded deferoxamine the highest total score (22/28) based on its dual role as an iron chelator and hypoxia-mimetic agent that reduces oxidative injury, promotes HIF-1α–driven angiogenesis, and has demonstrated up to 50% improvement in fat retention in preclinical models. Insulin combined with β-fibroblast growth factor ranked second (18/28) but lacks FDA approval. The authors are currently conducting ex vivo studies applying deferoxamine to human adipose grafts to bridge the translational gap for clinical application.
Microwave Energy · HIFU · Facial Rejuvenation
Efficacy and Safety of Microwave Energy–Based Device for Facial Rejuvenation Versus High-Intensity Focused Ultrasound: A Retrospective Comparative Study
In 171 East Asian patients, microwave energy–based device (MEBD) produced faster initial improvements at 1 month—higher GAIS scores, elasticity gains (R2, R5), and FACE-Q satisfaction—with significantly lower pain (2.3 vs. 4.7 VAS, p < 0.001) and fewer adverse events than HIFU, using fat-compartment mapping to guide treatment. By 3 months, HIFU surpassed MEBD in sustained GAIS, FACE-Q scores, and elasticity measures, consistent with deeper SMAS-level neocollagenesis. The complementary temporal profiles support a staged combination strategy: MEBD for rapid early contouring and HIFU for durable structural lifting.
Energy Devices · Facelift · Tissue Planes · Safety
Invisible Scar: Energy-based Facial Tightening Through the Lens of the Deep-layer Facelift Surgeon
Rod Rohrich and colleagues provide a mechanistic review of how microfocused ultrasound, high-frequency parallel-beam ultrasound, and fractional RF microneedling alter tissue planes relevant to deep-layer facelift surgery—an increasingly common clinical scenario as prior energy-based treatments become ubiquitous. Devices that confine energy delivery to the dermis appear largely compatible with subsequent surgery; those reaching the subdermal interface, subcutaneous fat, or fibro-septal network may alter tissue compliance, plane definition, and vector control during flap elevation. The article provides a framework for preoperative assessment and operative adaptation when prior device use is disclosed.
HFUS · Fat Grafting · Ultrasound Guidance · Retention
Ultrasound-Assisted Facial Autologous Fat Grafting: A Systematic Review of Perioperative Safety and Volumetric Outcomes
This systematic review found that high-frequency ultrasound (HFUS) guidance during facial fat grafting enables safer vascular mapping, real-time cannula confirmation within intended planes, and objective postoperative volume monitoring—enabling higher injection volumes (22.32 vs. 10.55 mL in a comparative cohort) and satisfaction rates (92% vs. 74%) without increased complications. Fat retention typically stabilized after an initial 3–6 month decline at approximately 50–70% at one year, with supplementary grafting improving this to ~72%. Critically, no cases of blindness, stroke, or skin necrosis were reported across included studies, supporting HFUS as a risk-mitigation tool.
AI Bias · Image Generation · Diversity
A Blind Spot in the Algorithm: Assessing Bias in Artificial Intelligence–Generated Images of Plastic Surgery Patients
This first-of-its-kind study demonstrated that AI-generated images of plastic surgery patients exhibit significant demographic biases: aesthetic surgery images disproportionately featured young White females, while non-White individuals were underrepresented across reconstructive contexts, and AI tools consistently failed to accurately depict cleft lip anatomy. These biases—inherited from training data—risk misleading patients and surgical trainees, influencing treatment decisions, and perpetuating unrealistic aesthetic expectations. The authors call for diversity-aware training datasets and bias audits before AI imaging tools are deployed in clinical or educational settings.
Robotic DIEP · Breast Reconstruction · Perioperative Outcomes
Perioperative Outcomes of Robotic-Assisted versus Traditional Surgery for DIEP Flap Breast Reconstruction: A Systematic Review and Meta-Analysis
This systematic review and meta-analysis confirmed that robotic-assisted DIEP flap harvest is safe and feasible, associated with significantly shorter hospital stays (MD −0.61 days, p = 0.003) and longer operative times (MD +62.82 minutes, p < 0.001) versus conventional open harvest. No significant differences were found in complete flap loss, delayed wound healing, hematoma, or infection, indicating equivalent safety with potential ergonomic and recovery advantages. The authors position robotic assistance as a promising adjunct that may expand the adoption of complex autologous reconstruction as learning curves mature.
Hybrid Reconstruction · Lipofilling · Patient-Reported Outcomes
Hybrid Breast Reconstruction Revisited: Patient-Reported Outcomes Using the BREAST-Q Following Autologous Fat Grafting After Implant Placement
In 96 patients completing pre- and postoperative BREAST-Q questionnaires, hybrid breast reconstruction (implant + lipofilling) produced statistically significant improvements across satisfaction with breast appearance, psychosocial well-being, sexual well-being, and satisfaction with surgical outcomes (all p < 0.01), with the greatest absolute gain in surgical satisfaction (+7.28 points). Physical discomfort decreased significantly, and anticipatory anxiety about aesthetic outcomes was measurably reduced postoperatively. No oncologic recurrences were reported, supporting hybrid reconstruction as a safe, patient-centered refinement strategy after initial implant-based reconstruction.
Fat Grafting · Adjuvants · Deferoxamine · Ranking
An Evidence-Based Assessment of Adjuvant Therapy in Autologous Fat Transfer: Ranking of the Potential Agents
Evaluating adjuvants for autologous fat grafting using a structured evidence-scoring framework, deferoxamine ranked highest (22/28), demonstrating preclinical evidence for up to 50% improvement in fat retention through HIF-1α–driven angiogenesis and antioxidant effects at the recipient site. Insulin combined with β-FGF ranked second (18/28) but lacks FDA approval. Ex vivo human adipose graft studies are underway to bridge the translational gap and establish the first clinical protocol for deferoxamine-enhanced fat grafting.
NPWT · Skin Graft · Take Rate · Meta-Analysis
Efficacy and Safety of Combined Negative Pressure Therapy and Skin Grafting in Extremity Wounds: A Meta-Analysis
In 18 studies encompassing 1,098 patients, NPWT significantly improved split-thickness skin graft take rates (mean difference +11.04%, 95% CI 5.57–16.51, p < 0.0001) versus conventional dressings, while reducing infection, seroma, and reoperation rates and shortening hospital stay. Subgroup analyses revealed optimal outcomes with graft thickness ≤0.2 mm and negative pressure ≤100 mmHg. The findings support routine NPWT application as a graft bolster in extremity reconstruction, though upper extremity application protocols and long-term durability require further study.
AI · Plastic Surgery · LLM · Applications
Artificial Intelligence in Plastic Surgery: Current Status, Limitations, and Future Directions
This narrative review in the Aesthetic Surgery Journal maps the current scope of AI in plastic surgery—spanning surgical outcome evaluation, complication prediction, patient inquiry support, preoperative guidance, education, and patient communication—while candidly cataloguing limitations including algorithmic paternalism, cognitive debt, dataset bias, AI-generated misinformation, and synthetic images that may create unrealistic patient expectations. Proprietary models significantly outperform open-source alternatives in validated plastic surgery knowledge assessments (76.1% vs. 60.2% accuracy). The authors argue that reasoning-oriented models, bias auditing, and human oversight are prerequisites for safe clinical integration.
Robotic Surgery · Plastic Surgery · Microsurgery
Robotic Horizons in Plastic Surgery: A Look Toward the Future
This systematic review of robotic applications in plastic and reconstructive surgery spans flap harvest, microsurgery, breast and craniofacial reconstruction, aesthetic surgery, and gender-affirming surgery, finding consistent advantages in precision, motion stabilization, ergonomics, and support for supermicrosurgical procedures with vessel diameters below 0.8 mm. The Symani system has enabled robotic lymphaticovenous anastomosis in cases previously inaccessible to the human hand, and single-port robotic DIEP flap harvest is entering clinical trials. Authors frame the near-term future as a hybrid model where robotic adjuncts extend—rather than replace—conventional microsurgical skill.
3D Bioprinting · Ear Reconstruction · First-in-Human
3D Bioprinting of Patient-Cell–Derived Ear Cartilage: First FDA-Authorized Human Clinical Trial for Microtia Reconstruction
The world's first FDA-authorized Phase 1/2a clinical trial of 3D-bioprinted auricular cartilage for microtia reconstruction is actively enrolling, using chondrocytes derived from the patient's own residual ear tissue to print a patient-specific framework with nanocellulose-based bioink. Early results confirm safety, tolerability, and structural integrity of the bioprinted implant, representing the first time a living, fully 3D-bioprinted biological structure has been implanted as a medical device in humans. The trial carries FDA Breakthrough Device Designation, and positive Phase 2 outcomes could open a regulatory pathway for broader craniofacial bioprinting applications.
AI · State of the Art · Ethics · Plastic Surgery
State of the Art of Artificial Intelligence in Plastic Surgery
This comprehensive review in the journal Plastic Surgery examines large language models, generative AI, and neural networks across surgical planning, complication prediction, postoperative monitoring, patient education, and result evaluation, concluding that AI has demonstrated measurable utility in each domain. It simultaneously identifies risks—algorithmic paternalism, biased decision-making, misinformation generation, and synthetic imaging that creates unrealistic patient expectations—that must be addressed before wide deployment. The authors advocate for a model in which AI amplifies clinician capability rather than automating care, emphasizing the primacy of the surgeon–patient relationship.