Surgical Techniques · Free Flap
Free Flap Reconstruction of Lower Third Leg and Foot Defects: 100% Viability Rate in Prospective Series
A prospective observational study of 11 consecutive patients undergoing free flap reconstruction for composite defects of the distal lower limb reports 100% flap viability, with 72.7% achieving Grade 1 outcomes by the Srikant classification. The anterolateral thigh flap was used in 72.7% of cases and the anterior tibial artery served as the primary recipient vessel in 81.8%. Minor complications occurred in 18.2% and one major complication (9.1%) required secondary intervention, highlighting microsurgical reliability even in a resource-limited setting.
Surgical Techniques · Head and Neck
Next Generation of Head and Neck Free Flap Reconstruction: Precision Reconstruction, ICG Angiography, and Jaw-in-a-Day
A purpose-of-review article from a high-volume microsurgical team outlines emerging innovations in head and neck free flap reconstruction, including novel flap harvest techniques, unconventional donor sites, and flow-through configurations prioritized to minimize decisional regret and maximize functional and cosmetic outcomes. Vascular perfusion imaging with indocyanine green fluorescence angiography and Jaw-in-a-Day surgeries leveraging CAD/CAM technologies are highlighted as the leading near-term innovations. The authors argue that the next frontier is fully patient-specific 'precision reconstruction' tailored to unique anatomic, functional, and aesthetic needs.
Surgical Techniques · Robotic Microsurgery
Head and Neck Free Flap Reconstruction with the Symani® Surgical System: First Prospective Series of 93 Patients
A prospective single-centre study reports the first institutional series of robotic free flap anastomoses in head and neck reconstruction using the Symani Surgical System across 93 patients after ablative tumor surgery. Radial forearm and ulnar forearm flaps (each 30.1%) and fibula flaps (23.7%) were used most frequently; three revision surgeries were required and one flap was lost. The authors confirm feasibility with a steep learning curve and note that the full microsurgical spectrum — including supermicrosurgery — has yet to be explored with the system.
Surgical Techniques · Virtual Planning
Virtual Surgical Guidance Improves Quality of Life Following Scapular Free-Flap Reconstruction of Maxillary Defects: RCT
A prospective randomized controlled trial of 22 patients evaluates scapular free flap maxillary reconstruction with and without CAD/CAM customized osteotomy guides, finding statistically significant improvements in the CAD/CAM group across pain, appearance, chewing, swallowing, speech, and shoulder quality of life scores (all p ≤ 0.05). The study adds RCT-level evidence supporting virtual surgical planning as a meaningful driver of patient-reported outcomes in complex craniofacial reconstruction.
Wound Management · Bioelectronics
Self-Powered Permeable Electronic Dressing Integrating Exudate Management, Electrostimulation, and Drug Delivery for Chronic Wound Healing
Researchers developed a self-powered permeable electronic dressing (SPED) combining a Janus fiber substrate with asymmetric wettability, a triboelectric nanogenerator embedded in liquid metal circuits, and drug-loaded conductive microneedles. In diabetic mouse models, SPED markedly accelerated healing through simultaneous re-epithelialization, collagen deposition, M2 macrophage polarization, angiogenesis, and on-demand antibiotic release — all without an external power source. The ultrathin, permeable, tissue-adhesive design enables long-term wearable comfort, representing a new paradigm in bioelectronic wound care.
Wound Management · Topical Oxygen · RCT
Portable Continuous Topical Oxygen Therapy for Chronic Wounds: RCT Shows 13.5-Day Shorter Healing Time vs. Moist Wound Therapy
An 88-patient two-arm RCT comparing portable continuous diffusion of oxygen (CDO) therapy against standard moist wound therapy for 28 days found significantly greater reductions in wound area and depth in the TOT group at day 28 (p < 0.05), with a healing rate of 45.5% vs. 11.4% (p < 0.001). At 12-week follow-up, healing times were shorter in the TOT group by a mean of 13.5 days (p = 0.004), with lower wound bed pH suggesting improved microenvironment, and no TOT-related adverse events. These findings provide robust RCT-level support for portable oxygen therapy as a practical accelerant in chronic wound management.
Wound Management · Smart Biomaterials
Microenvironment-Responsive Nanozyme for All-Stage Infectious Chronic Wound Management Through Macrophage Reprogramming
A metal-polyphenol-coordinated nanozyme (F@Gala) synthesized from Fe³⁺ chelation with the flavonoid galangin switches catalytic activity based on wound pH: in the acidic infectious microenvironment, it generates bactericidal hydroxyl radicals under NIR irradiation; as infection resolves, it transitions to catalase/SOD-like antioxidant activity while galangin drives M1→M2 macrophage polarization. In diabetic wound models, combined with photothermal therapy, the platform achieved robust antibacterial activity, immune modulation, and tissue repair across all four healing phases. The study establishes a versatile, clinically translatable paradigm for all-stage microenvironment-targeted wound care.
Wound Management · PRP · RCT
PRF vs. PRP vs. Conventional Therapy in Chronic Non-Healing Ulcers: RCT Shows 81.4% Area Reduction with PRF at 8 Weeks
A randomized prospective trial of 36 patients with chronic non-healing ulcers found platelet-rich fibrin (PRF) superior to both PRP and conventional treatment: 81.4% mean ulcer area reduction at 8 weeks vs. 47.6% with PRP and 26.1% with controls (p < 0.001), with 58.3% complete healing in the PRF group vs. 41.7% and 0%, respectively. No adverse events were reported in any group, and PRF's superiority is attributed to its fibrin scaffold enabling sustained growth factor release over time. The authors conclude PRF is a low-cost, autologous, accessible regenerative alternative that warrants consideration in standard wound care protocols.
Skin Substitutes · ADM · Prepectoral
PU-Coated Implants vs. ADM in Prepectoral Breast Reconstruction: Lower Seroma, Infection, and Capsular Contracture at 5 Years
A retrospective cohort of 97 patients (135 breasts) comparing ADM-covered textured implants to polyurethane-coated implants without ADM in prepectoral reconstruction found PU implants associated with significantly lower early seroma (2.9% vs. 33.8%, p < 0.001), lower early infection (1.4% vs. 6.2%), and markedly lower 5-year severe capsular contracture (24.3% vs. 47.7%, p < 0.001). Aesthetic outcomes were also superior in the PU group on standardized Likert assessment (p = 0.021). The findings add to growing evidence that PU-coated implants may represent a compelling ADM-free alternative in appropriately selected prepectoral patients.
Skin Substitutes · ADM · Large Registry
ADM in Direct-to-Implant Breast Reconstruction Does Not Increase 30-Day Complications: Multi-institutional Analysis of 10,177 Cases
A multi-institutional NSQIP database analysis of 10,177 DTI breast reconstruction patients (4,605 ADM vs. 5,572 non-ADM) found comparable 30-day surgical complication rates after propensity score matching (OR 0.93, p = 0.52), with no significant differences in infection, wound dehiscence, or bleeding. While ADM patients presented with lower baseline comorbidity burden, confounder-adjusted analyses confirmed no increased short-term risk, providing large-scale registry-level evidence to support ADM's continued use in DTI reconstruction. The authors emphasize this addresses 30-day outcomes only and longer-term data remain necessary.
Skin Substitutes · ADM · Tissue Expander
ADM in Tissue Expander Breast Reconstruction Associated with Higher SSI and Dehiscence Rates: Retrospective Study
A retrospective study of 87 mastectomy patients undergoing tissue expander reconstruction found that after risk adjustment, ADM use was associated with a 7.62-fold higher odds of surgical site infection (p = 0.029) in the prepectoral plane and higher overall complications (OR 3.34, p = 0.05) and wound dehiscence (OR 6.04, p = 0.048) in the retropectoral plane. Smoking, radiotherapy, and ADM use were all identified as independent risk factors for complications. The study underscores the need for individualized surgical planning and patient selection when incorporating ADM into tissue expander-based reconstruction.
Regenerative Medicine · Exosomes · Meta-Analysis
Human Placental MSC-Derived Exosomes in Wound Healing and Scar Therapy: Systematic Review and Meta-Analysis of 738 Patients
A systematic review and meta-analysis encompassing 21 global preclinical studies (323 animals) and the author's own series of 738 patients treated with hpMSC-exosomes over 7 years demonstrates superior wound healing rates, neovascular density, re-epithelialization, and collagen deposition compared to controls across multiple parameters. Human clinical evidence confirms accelerated healing, improved collagen synthesis, and immunomodulatory effects with a clean safety profile across wound healing and scar therapy applications. The authors identify manufacturing standardization and FDA approval as the critical remaining barriers to widespread clinical implementation.
Regenerative Medicine · Exosomes · Reconstructive Surgery
Role of Exosome Therapy in Reconstructive Surgery: Comprehensive Review of Sources, Delivery Strategies, and Clinical Translation
A comprehensive review covers the biology, source-specific characteristics, isolation methods, and delivery strategies for exosomes in plastic and reconstructive surgery. ADSC exosomes provide high yields with strong angiogenic and anti-fibrotic effects; BM-MSC and dermal fibroblast exosomes offer immunomodulatory and ECM regulatory functions; UC-MSC exosomes show high proliferative and angiogenic potential. The review highlights that topical, hydrogel-based, and direct injection delivery routes each influence therapeutic outcomes, with hydrogel-encapsulated delivery emerging as particularly promising for controlled, sustained release in wound care.
Regenerative Medicine · Bioelectric Modulation
Bioelectric Modulation as a Systems-Level Adjunct to Regenerative Therapies in Facial Plastic Surgery and Hair Restoration
This review examines the mechanistic basis and emerging clinical evidence for bioelectric modulation — including electrical stimulation and electromagnetic field therapy — as an upstream regulator of regenerative pathways relevant to facial rejuvenation, wound healing, and hair restoration. The authors argue that conventional regenerative tools (PRF, PRP, fat grafting, biologics) have variable outcomes partly due to limited control of perfusion, ECM remodeling, and stem cell niche stability, and that bioelectric modulation may address these upstream gaps. Further studies are required to define optimal treatment parameters, efficacy benchmarks, and long-term safety.
Regenerative Medicine · Stem Cells · Fat Grafting
iPSC-Derived Mesenchymal Stem Cells (iMSCs) Enhance Fat Graft Survival to 82.3% vs. 50.6% in PBS Controls
Using xeno-free iPSC-derived mesenchymal stem cells (iMSCs) as a cellular adjunct to autologous fat grafts in a murine model, researchers demonstrated significantly preserved graft area (82.3% vs. 50.6% PBS controls, p < 0.025) with the lowest fibrosis and highest neovascularization in the iMSC group compared to standard ASCs. Adipogenic differentiation — measured by vimentin-positive/perilipin-positive cell proportion — was significantly higher with iMSCs (7.46% vs. 4.51%). The authors propose a dual paracrine/adipogenic mechanism and position iMSCs as a standardized, high-performance alternative to donor-variable ASCs for breast reconstruction and regenerative applications.
Aesthetic Devices · RF Microneedling
RF Microneedling vs. CO₂ Fractional Laser for Facial Rejuvenation: RFMN Shows Greater Improvement and Higher Satisfaction Across Skin Phototypes
A randomized, evaluator-blinded clinical trial of 60 adults comparing CO₂ fractional laser to radiofrequency microneedling (RFMN) for facial wrinkles and laxity found both effective (p < 0.001), but RFMN demonstrated a larger mean score reduction (to ~19.7 vs. ~40.2), a higher improvement percentage (~73.8% vs. ~46.1%), and greater patient satisfaction (~87.7 vs. ~74.2). RFMN's safety profile was more accommodating across darker skin phototypes, reducing the risk of post-inflammatory pigmentation. The authors conclude RFMN warrants consideration as a first-line energy-based option particularly for Fitzpatrick III–VI patients.
Aesthetic Devices · RF Microneedling · Periorbital
RF Microneedling for Periorbital Rejuvenation: Prospective Clinical Study Shows 25–37% Wrinkle Reduction with Minimal Downtime
A prospective evaluator-blinded clinical study of 25 patients receiving 1–3 RFMN sessions for periorbital wrinkles found mean wrinkle reductions of 25.3% in the infraorbital area and 37.3% in the crow's feet region by automated imaging analysis. Blinded dermatologists reported variable clinical improvement (mean score 3.21/5); all patients experienced transient erythema and edema resolving within days, with no severe adverse events. The authors identify RFMN as a promising periorbital rejuvenation option with minimal downtime but call for larger comparative studies to define its role relative to fractional lasers.
Aesthetic Devices · Multimodal Framework
Layering Energies Framework for Facial Aesthetic Optimization: Synergistic Multimodal Treatment Sequences
An evidence-based review of multimodal aesthetic treatment strategies proposes the Layering Energies Framework for sequencing radiofrequency, ultrasound, lasers, dermal fillers, and injectable biostimulators to optimize patient outcomes. The review presents data supporting synergistic combinations, including RF-first sequences for deeper structural tightening followed by laser resurfacing, and highlights the role of biostimulators in extending treatment durability. The framework is positioned as a practical clinical tool for reducing downtime while improving efficacy compared to monotherapy approaches.
Aesthetic Devices · GLP-1 Face
Medication-Driven Weight Loss Face ('Ozempic Face'): Clinical Framework for Multimodal Aesthetic Management
A comprehensive review characterizes the emerging aesthetic challenge of rapid GLP-1/GIP-driven facial volume loss ('Ozempic Face') across semaglutide, tirzepatide, and related agents, with survey data showing 93% of respondents noticed facial changes during treatment, primarily a slimmer face and cheek fullness loss within 1–6 months. The authors propose layered treatment algorithms addressing muscle harmony, structural volumization, contouring, resurfacing, and skin-envelope regeneration through injectables, biostimulators, fat transfer, and energy-based devices. Ethnic variation is emphasized — Caucasian patients more commonly present with hollowing/angularity while Asian patients more often show midface flattening and lower-face laxity.
Autologous Grafts · Fat Grafting · Irradiated Breast
Autologous Fat Transfer for Complete Breast Reconstruction in Irradiated Patients: Systematic Review of 783 Patients Shows Feasibility and High Satisfaction
A PRISMA-compliant systematic review of 11 studies encompassing 783 irradiated breast reconstruction patients finds total AFT reconstruction feasible, requiring a mean of 3.2–7.6 sessions and cumulative volumes of 490–1,109 mL across studies. Most studies report minor complications and high patient satisfaction; recurrence events were infrequently described, and comparative data with non-irradiated cohorts showed some studies reporting higher session counts in irradiated patients while others found comparable values. The authors conclude that while AFT appears safe and satisfying for irradiated patients, the evidence base remains predominantly retrospective and heterogeneous, warranting prospective standardized study.
Autologous Grafts · Fat Grafting · Processing
Lipoaspirate Processing Techniques in Breast Reconstruction Fat Grafting: RCT Finds No Significant Difference Between AWF, LPS, and AWFS at 3 Months
A prospective RCT of 30 patients randomized to active wash and filtration (AWF), low-pressure decantation (LPS), or active wash with surfactant (AWFS) for breast reconstruction fat grafting found average 3-month volume retentions of 55.3%, 58.7%, and 62.7% respectively — with no statistically significant difference between groups (p = 0.52). While AWFS trended highest and standard decantation had been shown inferior in prior work, these three techniques appear comparably effective based on this interim analysis. The authors note these are 3-month results and longer follow-up may clarify differential outcomes.
Autologous Grafts · Fat Grafting · Native Breast
Fat Graft Uptake in Native Breast Augmentation and Symmetrization: Meta-Analysis of 4,425 Patients Finds 53% Pooled Retention
A systematic review and meta-analysis of 47 studies (4,425 patients) quantifying AFT outcomes in native breast augmentation and post-reconstruction symmetrization found a pooled fat graft uptake of 53.26% per breast (95% CI 46.32–60.20, I² = 99.7%), with a fat necrosis incidence of 4.66% and need for additional AFT sessions in 11.83%. These figures support counseling patients about volume loss likelihood and the potential for multiple sessions to achieve target volume. The low fat necrosis rate across this large cohort confirms native breast AFT as a safe and viable option.
Autologous Grafts · AFT vs. DIEP · Patient Preference
AFT vs. DIEP Flap in Women Who Underwent Both: DIEP Superior on Physical Well-Being but AFT Valued for Minimal Scarring and Gradual Recovery
A mixed-methods cross-sectional study of 8 women who underwent both AFT and DIEP flap breast reconstruction found DIEP superior across domains with a statistically significant advantage in physical well-being (p = 0.029, Cohen d = 0.80), but qualitative data revealed AFT was valued for its gradual, less traumatic nature, minimal scarring, and perceived recovery advantages. Satisfaction and sensation differences were small to moderate and nuanced by social support, treatment availability, and patient values. The study provides unique within-patient comparative insight into how women weigh the trade-offs between these two reconstructive strategies.
Innovations · AI in Plastic Surgery · Bibliometric
The Rise of Intelligent Plastic Surgery: 10-Year Bibliometric Analysis of AI Applications Across 235 Publications (2016–2024)
A CiteSpace and VOSviewer-based bibliometric analysis of 235 Web of Science publications from 2016–2024 finds exponential growth in AI-plastic surgery research led by the USA, Germany, and Canada, with Harvard and Stanford dominating institutional output. Key AI application clusters identified include breast reconstruction outcome prediction, facial analysis, and automated aesthetic grading systems; burst terms such as 'deep learning,' 'risk assessment,' and 'attractiveness' highlight AI's expanding role in surgical decision-making. The analysis also exposes persistent challenges: Western-centric beauty standard bias in training datasets, limited cross-institutional collaboration, and ethical concerns around autonomous surgical AI decision-making.
Innovations · AI · Robotic Surgery
Transformative Role of AI in Plastic and Reconstructive Surgery: Preoperative Risk Prediction, Intraoperative Robotics, and Postoperative Monitoring
A systematic review of AI applications in plastic surgery maps the full perioperative pipeline: AI enhances preoperative risk assessment, outcome prediction, and surgical simulation; intraoperatively, AI-assisted robotics enables precision beyond human capability in microsurgery; postoperatively, AI improves complication detection, pain management, and outcome assessment. The review identifies implementation challenges including data heterogeneity, regulatory frameworks, and ethical considerations around algorithmic bias. The authors conclude that AI's transformative potential in plastic surgery is clear, but requires careful, evidence-guided deployment to translate research gains into clinical benefit.
Innovations · Robotics · Gynecologic Surgery
Emerging Robotic Platforms in Surgery: Systematic Review of 92 Studies Across 13 Platforms Shows Broad Feasibility with Steep Learning Curves
A PROSPERO-registered systematic review of 92 studies across 13 robotic surgical platforms — including da Vinci SP, HUGO RAS, Senhance, Versius, hinotori, and KANGDUO — finds broad technical feasibility and generally acceptable short-term perioperative safety across procedures, with learning-curve evidence strongest for da Vinci SP and HUGO RAS. Evidence remains predominantly retrospective, single-center, and methodologically limited, with heterogeneous outcome definitions hampering comparative conclusions. The authors call for rigorous prospective studies, standardized economic analyses, and longer follow-up before robotic platforms become standard of care across surgical specialties.