Free Flap · Lower Extremity
Free Flap Reconstruction of Lower Third Leg and Foot Defects: 100% Viability Rate in Prospective Series
A prospective observational study of free flap reconstruction for composite defects of the lower third leg and foot reports a 100% flap viability rate across 11 cases, with the anterolateral thigh flap used in 72.7% and the anterior tibial artery serving as the primary recipient vessel in 81.8%. Minor complications occurred in 18.2% of cases with one major complication requiring reoperation, and 72.7% of flaps achieved Grade 1 Srikant classification outcomes. The results reinforce microsurgical reconstruction as the standard for this anatomically demanding region.
Tongue Reconstruction · Oncology
ALT vs. Radial Forearm Free Flap in Oncologic Tongue Reconstruction: Systematic Review
A systematic review directly comparing the anterolateral thigh (ALT) and radial forearm free flap (RFFF) for oncologic tongue reconstruction evaluates functional outcomes, donor-site morbidity, and complication profiles. The review synthesizes evidence on swallowing, speech, and flap reliability to provide guidance on flap selection based on defect size, patient anatomy, and institutional expertise, an area where standardized head-to-head data has historically been limited.
DIEP Flap · Augmented Reality
Projected Augmented Reality with Dynamic Infrared Thermography for DIEP Flap Perforator Mapping
A proof-of-principle study demonstrates that projected augmented reality using dynamic infrared thermography (DIRT) can display real-time perforator heat maps directly onto the patient's abdomen prior to DIEP flap breast reconstruction. Among 514 projected hotspots in 50 patients, 97.3% were confirmed by Doppler and the positive predictive value for CTA was 74.5%. The Anatomy Projector prototype eliminates the need for clinicians to transfer mental maps between screen and patient, streamlining perforator selection.
Autologous Breast Reconstruction · Review
State of the Art in Autologous Breast Reconstruction: Robotic-Assisted Surgery, Multi-Flap Techniques, and Neurotization
A comprehensive review of contemporary autologous breast reconstruction addresses technical challenges and the evolution of DIEP, TRAM, and SIEA flaps, with emphasis on bipedicled configurations, multi-flap reconstruction for larger defects, and innervated flap neurotization to restore sensation. The authors highlight robotic-assisted flap harvest as an emerging access technique and discuss personalized medicine applications — including CT angiography-based planning and AI-assisted perforator mapping — as the next frontier in individualizing reconstruction.
Nanofat · Wound Healing
Autologous Nanofat for Wound Healing and Scar Management: Systematic Review of 22 Studies
A systematic review of 22 studies evaluating autologous nanofat in wound healing and scar management finds 100% of wound-healing studies reported accelerated healing or improved epithelialization, and all scar-outcome studies reported improvement in pigmentation, pliability, texture, or appearance. Mechanical emulsification was used in 91% of studies and the treatment was well tolerated with 77% reporting minimal or no complications. The review positions nanofat as a promising, regulatory-friendly regenerative adjunct that avoids the complexity of extensively manipulated cellular products.
Amniotic Membrane · Meta-Analysis
Human Amniotic Membrane for Chronic Wounds: Meta-Analysis of 14 RCTs Shows 1.82× Healing Rate
A systematic review and meta-analysis of 14 RCTs encompassing 1,056 patients finds that human amniotic membrane (HAM) therapy achieves a relative risk of 1.82 for complete wound healing versus conventional treatment alone in chronic ulcers. In diabetic foot ulcers specifically, HAM reduced mean healing time by 22 days and tripled the rate of complete healing at 6 weeks. Adverse event rates were comparable between groups, supporting HAM as a safe and effective escalation option for non-healing chronic wounds.
Probiotics · Wound Dressings
Probiotic and Postbiotic Delivery Systems for Chronic Wound Management: Emerging Strategies Review
A review of probiotic and postbiotic dressing systems for diabetic foot ulcers and burn wounds synthesizes evidence for strains including Lactobacillus plantarum, L. reuteri, and Saccharomyces spp., which reduce pathogen bioburden, modulate inflammation, and stimulate growth factors. Microneedle-based probiotic delivery and biofilm-embedded dressings are highlighted as next-generation platforms beyond conventional ointments. The authors note that while in vitro and animal evidence is compelling, robust human RCT data remain scarce.
Prophylactic NPWT · SSI Prevention
Prophylactic Closed-Incision NPWT Reduces Superficial SSI by Half in Emergency Laparotomy RCT
A multicenter randomized trial of 90 emergency laparotomy patients finds that prophylactic closed-incision negative pressure wound therapy (ciNPWT) applied for 5 days reduces overall surgical site infection from 44.4% to 22.2% (p = 0.025), with superficial SSI rates halved (40% to 20%). Deep SSI rates were not significantly different between groups. The data strengthen the evidence base for routine ciNPWT in contaminated or high-risk primary closure scenarios relevant to reconstructive planning.
ADM · DTI Breast Reconstruction
ADM in Direct-to-Implant Breast Reconstruction Meta-Analysis: 3.15× Infection Risk Confirmed
A meta-analysis of 10 comparative studies (755 patients, mean follow-up 25 months) finds ADM use in immediate direct-to-implant breast reconstruction is associated with a significantly higher risk of infection (OR 3.15, p = 0.0005, I² = 0%) versus non-ADM reconstruction, with seroma and implant loss trends warranting cautious interpretation. Hematoma, capsular contracture, skin necrosis, and wound dehiscence rates were comparable. Aesthetic outcomes were mostly equivalent, prompting a re-examination of ADM indications and patient selection criteria.
Porcine ADM · Prepectoral Reconstruction
Prepectoral IBR with Braxon® ADM: Zero Red Breast Syndrome, 15.8% Major Complication Rate
A retrospective cohort of 95 patients undergoing prepectoral reconstruction with Braxon® porcine ADM reports zero cases of red breast syndrome, supporting evidence of its declining incidence with newer ADM formulations. The overall implant loss rate was 13.7%, with preoperative radiotherapy conferring a 6-fold increase in implant loss risk (RR 6.17, p = 0.007) and postoperative radiotherapy significantly predicting capsular contracture. Smoking, infection, and skin necrosis were additional significant predictors of implant loss.
ADM · Orbital Exenteration
ADM for Orbital Exenteration Reconstruction: 85% Prosthesis Fitting Rate in Meta-Analysis
A systematic review and meta-analysis of ADM use in orbital exenteration reconstruction across 42 patients reports a pooled prosthesis fitting rate of 85% with mean re-epithelialization time of approximately 10 weeks. Complications including sino-orbital fistula and delayed healing were infrequent, and radiotherapy did not appear to significantly affect epithelialization time or prosthetic outcomes. The data support ADM as a useful scaffold for lining exenteration defects, expanding its reconstructive indications beyond breast and abdominal applications.
Fish Skin Graft · Burns Registry
Intact Fish Skin Graft vs. Synthetic/Biosynthetic Dermal Substitutes in Acute Burns: ABA Registry Propensity-Matched Study
A retrospective propensity score-matched cohort study using American Burn Association Registry data compares intact fish skin graft against synthetic and biosynthetic dermal substitutes for acute burns requiring dermal substitution and autografting. The study provides registry-scale comparative effectiveness data for omega-3-rich fish skin as an alternative biological scaffold, contributing real-world evidence on outcomes, complications, and resource utilization in a domain where prospective RCT data are limited.
ADSC Exosomes · Mechanisms
Adipose-Derived Stem Cell Exosomes in Wound Healing: Mechanisms, Engineering Strategies, and Clinical Translation
A comprehensive mechanistic review of ADSC-derived exosomes in wound repair catalogs how their miRNA, cytokine, and protein cargo modulates inflammation, promotes keratinocyte and endothelial proliferation, and drives collagen remodeling. Engineering strategies — including pharmacological preconditioning, hypoxic treatment, genetic modification, and hydrogel or scaffold integration — are synthesized with an emphasis on translational readiness. Key barriers to clinical adoption including large-scale production standardization, isolation protocols, and regulatory pathways are addressed with a practical roadmap.
Hypoxic Exosomes · Signaling
Hypoxic ADSC-Derived Exosomes Carry High-Abundance USP22 to Stabilize HIF-1α and Upregulate lncRNA H19 for Wound Healing
Hypoxic preconditioning of ADSCs produces exosomes enriched in USP22, a deubiquitinase that stabilizes HIF-1α and transcriptionally activates lncRNA H19, together driving endothelial proliferation, migration, and angiogenesis in H₂O₂-stressed HUVECs. In vivo murine wound models confirm that hypoxic ADSC exosomes outperform normoxic counterparts in closure rate and neovascularization. This USP22/HIF-1α/H19 axis provides a mechanistically defined target for engineering next-generation hypoxia-primed exosome therapeutics.
Exosome Hydrogel · Diabetic Wounds
Glycyrrhizic Acid Hydrogel Microparticles Loaded with MSC Exosomes: Photothermal-Triggered Release for Diabetic Wound Healing
Novel glycyrrhizic acid hydrogel microparticles co-loaded with stem cell exosomes and black phosphorus enable near-infrared photothermal-triggered on-demand exosome release at infected diabetic wounds. The system simultaneously provides antibacterial activity (from GA), radical scavenging, and pro-angiogenic exosome cargo, achieving superior wound closure, inflammation suppression, and collagen deposition versus individual components in infected in vivo diabetic wound models. The stimuli-responsive design represents a significant advance in intelligent exosome delivery.
Antler Stem Cell Exosomes · Scarless Healing
Antler Stem Cell-Derived Exosomes Promote Scarless Wound Healing by Inhibiting Fibroblast-to-Myofibroblast Transition
Exosomes derived from antler stem cells — a rare naturally regenerating mammalian tissue — significantly accelerate wound healing and improve quality in rat full-thickness wounds, including regeneration of hair follicles, sebaceous glands, and basket-weave collagen patterns characteristic of scarless repair. Their effects were comparable to live AnSC transplantation and superior to bone marrow MSC exosomes, mediated through inhibition of fibroblast-to-myofibroblast transition. The findings introduce a novel exosome source with uniquely potent regenerative properties.
Helium Plasma RF · Meta-Analysis
Helium Plasma Radiofrequency (Renuvion) Systematic Review: 92% Satisfaction Across 3,508 Patients
A PRISMA-compliant systematic review and meta-analysis of 34 studies encompassing 3,508 patients evaluates helium plasma RF (Renuvion) for aesthetic subdermal applications. Pooled complication rates were 5% standalone, 8% with liposuction, and 15% with multimodal excisional surgery — differences not statistically significant. Pooled patient satisfaction was 92%, with meta-regression showing higher satisfaction at longer follow-up (p = 0.003), establishing the most comprehensive safety and efficacy summary to date for this rapidly adopted device.
RF Microneedling · Melasma
Radiofrequency Microneedling for Melasma: Systematic Review Shows Efficacy with Low PIH Risk in Darker Phototypes
A PRISMA 2020-compliant systematic review of 12 studies finds radiofrequency microneedling (RFMN) consistently improves Melasma Area and Severity Index scores and melanin indices with effects maintained up to 6 months and a favorable safety profile in Fitzpatrick phototypes III–V where conventional pigment lasers carry hyperpigmentation risk. Histological evidence confirms reductions in dermal senescence markers and partial basement membrane restoration. RFMN combined with low-fluence Q-switched Nd:YAG laser demonstrated the greatest pigment reduction.
Monopolar RF · Skin Tightening RCT
Novel Monopolar Radiofrequency Device for Skin Tightening: Multicenter 6-Month Non-Inferiority RCT
A multicenter, randomized, assessor-blind, parallel-controlled non-inferiority trial evaluating a novel monopolar RF device for skin tightening over 6 months provides the highest level of evidence to date for this device category. The study design — with standardized endpoints and blinded assessment — addresses the methodological limitations common in the energy-based device literature and offers clinically actionable efficacy benchmarks against established active controls.
Dual-Mode RF · Challenging Skin
Dual-Mode RF (DENSITY) in Atopic-Prone and Previously Treated Patients: Safety Confirmed in Case Series
Two challenging clinical scenarios for RF skin tightening — atopic dermatitis and prior aesthetic procedures — are evaluated with a dual-mode monopolar-bipolar RF system (DENSITY). The patient with atopic-prone skin tolerated treatment without flares, and the previously treated patient reported complementary benefits beyond prior Ultherapy, botulinum toxin, and PDLLA injections. Both rated satisfaction at 4/5, with the AD patient reporting moderate discomfort (6/10 VAS). The results expand the indicated population for dual-mode RF in aesthetic practice.
Fat Grafting · Post-Mastectomy Meta-Analysis
Fat Grafting in Post-Mastectomy Breast Reconstruction: Meta-Analysis Shows 47% Pooled Retention, No Increased Morbidity
A PROSPERO-registered systematic review and meta-analysis of 13 studies finds pooled autologous fat grafting (AFG) volume retention of 47% (95% CI 31.5–62.5) at 3–12 months post-mastectomy, rising to 78–89% with enriched grafting techniques. AFG showed a numerically higher fat necrosis rate (RR 2.37) that did not reach significance, and complication rates were comparable in irradiated cohorts. Patient-reported outcomes consistently favored AFG, supporting its role as a safe adjunct with meaningful quality-of-life benefit.
SVF-Enriched Fat Grafting · Retention
SVF-Enriched Penile Fat Grafting: 82% vs 50% Volume Retention vs Coleman Technique at 12 Months
A retrospective comparative study of 50 patients receiving SVF-enriched fat and 38 receiving standard Coleman fat grafting for penile girth augmentation demonstrates significantly greater volume retention at 12 months across all dimensions in the SVF-fat group (82% vs ~50% flaccid girth retention, p < 0.001). Among patients with mild erectile dysfunction, the SVF-fat group showed higher IIEF domain scores (26.2 vs 23.9) and 88% returned to normal erection. The results contribute to the broader SVF-enrichment literature supporting improved graft survival through angiogenesis and paracrine mechanisms.
Ultrasound-Guided Fat Grafting · Systematic Review
Ultrasound-Assisted Facial Autologous Fat Grafting: Safety, Vascular Mapping, and 50–70% Retention at 1 Year
A PRISMA-compliant systematic review of 12 studies (885 patients, 2017–2024) finds high-frequency ultrasound supports pre-injection vascular mapping, real-time cannula confirmation in safe planes, and postoperative volume monitoring, with typical retention declining during the first 3–6 months and then stabilizing at ~50–70% at 1 year. In a comparative temple augmentation cohort, ultrasound guidance enabled higher injection volumes and 92% versus 74% satisfaction without increased complications. No cases of blindness or stroke occurred across all included studies.
Cell-Assisted Lipotransfer · Meta-Analysis
CAL vs. Conventional Fat Grafting: Meta-Analysis Shows SMD 2.44 Retention Benefit, But High Heterogeneity Limits Generalizability
A meta-analysis of 15 studies finds cell-assisted lipotransfer (CAL) using ASCs or SVF achieves a statistically significant improvement in graft survival versus conventional fat grafting (SMD 2.44, 95% CI 1.00–3.88), with strongest effects in facial applications and standard aspiration techniques. However, I² = 97.19% extreme heterogeneity limits generalizability, and water-assisted liposuction cohorts showed no enrichment benefit, suggesting a harvest-quality ceiling effect. No increased oncological risk was identified across follow-up periods reported.
Robotics · Comprehensive Review
Smart Hands: Symani, MUSA, AI, and AR as an Integrated Surgical Ecosystem in Plastic Surgery
A comprehensive review covers Symani® and MUSA® robotic microsurgical platforms alongside AI and augmented reality in plastic and reconstructive surgery, synthesizing early clinical results showing successful lymphatic and microvascular anastomoses, improved ergonomics, and reduced surgeon fatigue. AI-enabled perforator mapping, flap selection, complication prediction, and automated documentation are cataloged alongside AR-based intraoperative navigation and simulation training tools. The authors describe a convergent trajectory toward an integrated, AI-augmented surgical ecosystem where preoperative planning, robotic execution, and outcome learning operate in a unified workflow.
Robotic Surgery · Systematic Review
Robotic Systems in Plastic and Reconstructive Surgery: Systematic Review of 31 Studies Across Microsurgery, Breast, and Craniofacial
A PRISMA-compliant systematic review of 31 clinical studies evaluating robotic-assisted plastic surgery finds applications predominantly in microsurgery (n = 16), breast reconstruction (n = 8), and craniofacial/aesthetic surgery (n = 7), with platforms including Symani, Da Vinci, and ARTAS. Robotic approaches improved precision, aesthetic outcomes, flap survival, and satisfaction — particularly in lymphaticovenous anastomosis and nipple-sparing mastectomy — but challenges included steep learning curves, longer operative times, high costs, and absent haptic feedback. All studies were rated moderate quality, highlighting the need for prospective comparative trials.
AI · Plastic Surgery Review
Transformative Role of AI in Plastic and Reconstructive Surgery: Risk Assessment, Robotic Precision, and Complication Detection
A comprehensive narrative review examines AI across the plastic surgery care continuum: preoperative risk stratification and outcome simulation, intraoperative robotic precision beyond human capability (particularly in microsurgery), and postoperative complication detection and pain management optimization. Implementation barriers including data privacy, algorithmic bias, liability frameworks, and regulatory gaps are analyzed alongside emerging directions — multimodal AI systems, federated learning, and integration with extended reality and regenerative medicine. The authors frame AI not as a surgeon replacement but as a precision-augmentation layer aligned with reconstructive surgery's core mission.
FDA-Approved AI · Plastic Surgery
FDA-Approved AI Devices in Plastic Surgery: Smart Sponges, Robotic Tools, and High-Resolution Intraoperative Imaging
A review of FDA-approved AI-enabled devices specifically cleared for use in plastic and reconstructive surgery catalogs innovations including AI-powered blood loss estimation via smart sponges, minimally invasive robotic instruments, and high-resolution intraoperative medical imaging systems. The analysis provides a current-state inventory of clinically available AI tools — distinct from research prototypes — offering surgeons a reference for approved technologies that can be incorporated into practice today versus those still in the development pipeline.