Surgeries, Volume 7, Issue 2 (June 2026) – 34 articles

Background/Objectives: This investigation was performed because corticosteroid injections are commonly used for symptomatic relief in patients with meniscal deficiency, yet their effect on graft survivorship and postoperative outcomes following meniscal allograft transplantation (MAT) remains poorly understood, with limited literature specifically addressing this topic. The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (ICS) are associated with reoperation after MAT. Secondary aims included comparing reoperation-free survival, patient-reported outcome measures (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective review of 130 adults undergoing meniscal allograft transplantation (MAT) between 2011 and 2023 was performed. Patients with documented corticosteroid injection (CSI) status and ≥2 years of follow-up were included. Exclusion criteria included prior meniscal allograft transplantation, receipt of non-corticosteroid injections (e.g., hyaluronic acid or platelet-rich plasma), concomitant osteotomy procedures, multi-ligament knee reconstruction or inadequate follow-up. Propensity score matching (2:1 no steroid: steroid) based on age, sex, body mass index, fixation technique, operative compartment, and concomitant procedures yielded 54 matched patients (35 no steroid, 19 steroid). The primary outcome was ipsilateral knee reoperation, categorized as major reoperation (revision MAT, anterior cruciate ligament reconstruction, osteochondral allograft transplantation, conversion to total knee arthroplasty, meniscectomy and meniscus repair). Minor reoperations included irrigation and debridement, lysis of adhesions or manipulation under anesthesia, hardware removal, chondroplasty, and synovectomy. Reoperation-free survival was assessed using Kaplan–Meier analysis. PROMs and PASS were compared using adjusted regression models. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up were comparable between groups (7.6 ± 3.5 vs. 6.6 ± 3.2 years; p = 0.30). Overall reoperation occurred in 37.1% of patients in the no-steroid group and 31.6% in the steroid group (p = 0.771). Major reoperation rates were similar (17.1% vs. 15.8%; p = 1.000. There was no significant difference in minor reoperations between groups (20.0% vs. 10.5%; p = 0.468). Kaplan–Meier analysis demonstrated no difference in reoperation-free survival (p = 0.903), with comparable survival at the 1-, 2-, and 5-year time points. No individual subtypes differed significantly between groups. PROMs and PASS achievement were also similar, with no statistically significant differences observed. Conclusions: Preoperative corticosteroid injection was not associated with increased reoperation risk, inferior reoperation-free survival, or worse patient-reported outcomes following meniscal allograft transplantation. However, given the study’s limited power, lack of detailed injection characteristics, and the use of a heterogeneous complication outcome, these findings should be interpreted cautiously, as further investigation is warranted. Full article

Background: Forearm nonunions represent a challenging clinical condition that significantly impairs upper limb function. Various surgical techniques have been proposed, including vascularized bone grafts. Although these procedures are not considered first-line treatment, they play a crucial role in complex or recalcitrant cases, particularly after failure of conventional methods, where their superior biological potential can significantly enhance bone healing. Despite the widespread use of the medial femoral condyle corticoperiosteal flap, simultaneous bilateral harvest has not been previously described in the literature. Case Presentation: We report the case of a 50-year-old male presenting with persistent nonunions of both the radius and ulna following previous osteosynthesis and revision surgery with iliac crest bone graft. The patient was successfully treated using bilateral vascularized corticoperiosteal free flaps harvested from both medial femoral condyles. Conclusions: Double vascularized corticoperiosteal free flaps may represent an effective and reliable option for the treatment of complex forearm nonunions, especially in cases with multiple previous surgical failures. To the best of our knowledge, this case represents the first report of simultaneous bilateral medial femoral condyle corticoperiosteal flap harvest. Full article

Background/Objectives: Lymph node metastasis within the prostatic anterior fat pad (PAFP) is uncommon but may refine nodal staging when pelvic lymph node dissection and PSMA PET/CT are negative. Case Presentation: A 58-year-old man with PSA 59 ng/mL, negative digital rectal examination, and a PI-RADS 5 anterior lesion underwent transperineal MRI/US fusion biopsy, showing an acinar adenocarcinoma (Gleason score 5 + 5 = 10, ISUP grade group 5) confined to anterior cores. 18F-PSMA-1007 PET/CT showed intense intraprostatic uptake (SUVmax 55.2) without nodal or distant disease. Retropubic radical prostatectomy, bilateral extended pelvic lymph node dissection (ePLND), and separate PAFP submission were performed. Final pathology showed a 38 mm bilateral anterior tumor involving 35% of the prostate, focal anterior extraprostatic extension, negative margins, absent seminal vesicle and bladder neck invasion, perineural and lymphovascular invasion, and no cribriform or intraductal carcinoma. All 15 pelvic nodes were negative. One of two PAFP nodes contained a 3 mm PSA-positive metastasis without extranodal extension, resulting in pT3aN1 staging. Postoperative PSA persistence prompted radiotherapy plus androgen deprivation therapy; PSA was 0.01 ng/mL at 6 months. Conclusions: In very-high-risk anterior prostate cancer, separate PAFP evaluation may provide clinically relevant staging information when PSMA PET/CT and pelvic lymph nodes are negative. This case highlights the PAFP as a potential site of occult regional nodal disease. Full article

Background/objectives: Prostate cancer is the most common cancer in men over 60 years of age. The development of assisted robotic surgery has improved surgical performance across several variables in dynamic ways, introducing new reconstruction techniques. The present study aims to show differences between Retzius-sparing robotic-assisted prostatectomy vs. Retzius-sparing and posterolateral fascial reconstruction in patients diagnosed with localized prostate cancer. Methods: A retrospective study was performed in a 3-year time period by a single surgeon using the Da Vinci X platform. Two groups were assessed for the study, with and without posterolateral fascial reconstruction. Demographic data were analyzed with central tendency measures, and mean differences were calculated with the Mann–Whitney test and t-test, being significant if p < 0.05. Results: A total of 199 patients were included. The posterolateral reconstruction group had 81 patients, and outcomes saw similar performances to the non-reconstruction group. Urinary continence showed a positive trend of higher percentages in the first week after surgery but had similar results after one year, with no statistically significant differences. Oncologic results and sexual dysfunction showed no statistically significant differences between groups. Conclusions: Posterolateral reconstruction combined with Retzius-sparing radical prostatectomy demonstrated improved continence and was shown to be safe, without increasing overall complications such as bleeding. Full article

Background/Objectives: In laparoscopic and robot-assisted surgery, bleeding may rapidly impair operative-field readability and procedural safety. In the broader Robin Heart teleoperation framework, interpretation of such events is relevant not only for scene understanding but also as a potential prerequisite for future safety-oriented supervisory functions under communication-degraded conditions. The aim of this study was to assess whether a deep learning model for blood segmentation could provide outputs suitable for preliminary image-level temporal characterization of visible blood-region behavior in laparoscopic video. Methods: A U-Net-based binary blood-segmentation model was implemented in-house in PyTorch and evaluated on three paired image–mask datasets: a simulated bleeding dataset prepared under controlled laboratory conditions, an internal operative laparoscopic dataset, and an external-domain subset derived from the public GynSurg dataset. Segmentation performance was assessed using 5-fold cross-validation and reported using the Dice coefficient and Intersection over Union (IoU). Training dynamics were analyzed using training and validation loss and Dice curves. Additional baseline comparisons were performed on the internal operative dataset using U-Net++ and DeepLabV3+. Temporal analysis was performed on selected video fragments, including a low-motion reference sequence without active bleeding progression, internal bleeding-related sequences, and external-domain sequences, using mask-derived descriptors and auxiliary optical-flow-based motion descriptors computed after camera-motion compensation within the detected blood-related ROI. Results: In 5-fold cross-validation, the U-Net-based model achieved Dice coefficient and IoU values of 0.915 ± 0.012 and 0.851 ± 0.019 on the simulated dataset, 0.856 ± 0.013 and 0.756 ± 0.025 on the internal operative dataset, and 0.707 ± 0.053 and 0.570 ± 0.056 on the external-domain GynSurg subset, respectively. On the internal operative dataset, the proposed model performed comparably to U-Net++ and slightly above DeepLabV3+ under the same cross-validation protocol. The temporal descriptor set differentiated low-motion reference behavior, more spatially coherent progression, rapid coherent expansion, and dynamic or motion-active progression profiles. Peak dA/dt reflected abrupt visible blood-area expansion, temporal IoU described mask stability over time, and optical-flow-based descriptors provided additional information on local motion activity within the detected blood-related ROI. Conclusions: The results support the feasibility of combining deep-learning-based blood segmentation with temporal and optical-flow-based descriptors for exploratory image-level characterization of visible blood-region behavior in laparoscopic video. Within the Robin Heart development pathway, such descriptors may, in the future, serve as candidate components of image-analysis support modules for safety-oriented teleoperative scenarios. At this stage, they should be interpreted as exploratory image-derived indicators rather than clinically validated markers of bleeding severity. Full article

Background: Periprosthetic joint infection is a severe complication after hip and knee arthroplasty, and using perioperative antibiotic prophylaxis (PABP) per guidelines and recommendations is one step in its prevention. The current study aimed to evaluate the attitude of Egyptian joint replacement surgeons toward PABP, their adherence to guidelines, and their insight into developing national guidelines. Methods: We conducted an online cross-sectional questionnaire study comprising three sections to collect information on various aspects of PABP and to gather insights into the development of national guidelines among members of the Egyptian Pelvis, Hip, and Knee Society (EPHAKS). The questionnaire targeted active practicing hip or knee replacement surgeons and was first sent by email to all members two weeks before the eighth EPHAKS annual conference. A reminder was announced during the conference, and subsequent email reminders were sent one week apart after the conference. The study was registered in clinicaltrials.gov (NCT06451224). Results: Out of 469 EPHAKS members, and among the 434 successfully delivered email invitations, 105 responded, giving a response rate of 24.2%. All were males, with a mean age of 42.98 ± 10.12 years; a total of 70.5% were consultants, and 13.3% performed more than 100 procedures annually. Most participants reported not following national or international guidelines, with response percentages of 80.9% and 62.9%, respectively. Consultants and surgeons performing more than 50 procedures annually showed significantly higher adherence to guidelines than others, with p-values of 0.046 and 0.004, respectively. Adherence to national or international guidelines for prescribing first- or second-generation cephalosporins was reported by 65.7% (preoperatively) and 59% (postoperatively). Only 9.5% reported prescribing antibiotics for the first 24 h postoperatively. Overall, 80% agreed that Egyptian patients are different and that PABP international guidelines do not suit them, and 98.1% agreed that developing national Egyptian PJI prevention guidelines is necessary owing to deficiencies and the broad applicability of the current national guidelines. Conclusions: Egyptian joint replacement surgeons rarely adhere to national or international guidelines for PABP, with higher adherence noticed among more experienced surgeons. The majority agreed that our patients are different and that international guidelines might not suit them, and nearly all participants expressed a strong desire to develop national guidelines. Full article

Background: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure with generally favorable outcomes, yet graft failure remains a significant challenge, particularly in young and active patients. While various anatomical and biomechanical risk factors for graft failure have been proposed, the influence of the sagittal tibial tubercle–trochlear groove (sTTTG) distance, representing anterior–posterior alignment of the tibial tubercle, has not been sufficiently explored. This study aimed to evaluate the association between sTTTG and ACL graft failure and assess contributing biomechanical variables, including tibiofemoral rotation (TFR), posterior tibial slope (PTS), and knee flexion angle. Methods: For this secondary analysis, a retrospective matched case–control study was conducted, involving 151 patients with ACL graft failure who underwent revision ACLR and 151 controls with intact grafts after a minimum 2-year follow-up period. sTTTG was measured on axial MRI as the anteroposterior distance from the trochlear groove to the tibial tubercle, perpendicular to the posterior femoral condylar axis. Secondary measurements included TT-TG, TFR, medial and lateral PTS, and knee flexion angle. Group differences as well as factors predictive of sTTTG were analyzed. Results: The ACLR failure group demonstrated a significantly lower sTTTG distance compared to controls (0.5 ± 4.6 mm vs. 2.4 ± 4.8 mm, p = 0.001). Logistic regression analysis revealed that a 1 mm increase in sTTTG was associated with an 8% reduction in revision risk (OR = 0.93 per 1 mm increase; 95% CI, 0.88–0.97; p = 0.003), although the predictive accuracy was low (AUC = 0.6). Multivariable analysis identified lateral PTS and knee flexion as significant independent predictors of sTTTG. Conclusions: A decreased sTTTG distance was significantly associated with ACL graft failure, underscoring the relevance of sagittal tibial tubercle positioning in ACL biomechanics. While not an independent clinical decision-making tool, sTTTG appears relevant to graft failure and may be considered in future risk assessment strategies. Full article

Background/Objectives: Robot-assisted surgery (RAS) has grown rapidly over the past few decades. To determine the effect of high stress levels on the performance of RAS, monitoring some parameters of surgeons is critical. This can be aided by the development of Artificial Intelligence (AI), which has exponentially grown in recent years. This study aims to predict the surgeon’s stress level based on ergonomic, kinematic and physiological parameters of the surgeon obtained in the immediately previous situation during RAS activities. Methods: Physiological data were recorded from surgeons during twenty-six surgical sessions involving twelve participants with different levels of experience and surgical specialties. After dataset generation, two preprocessing procedures (scaling and normalization) were applied to the recorded signals. The processed data were then partitioned into two subsets: 80% of the samples were used for model training and cross-validation, while the remaining 20% were reserved for testing. Six AI approaches were evaluated to build predictive models: multiple linear regression (MLR), a support vector machine (SVM), a multilayer perceptron (MLP), a convolutional neural network (CNN), random forest (RF), and a U-Net algorithm (UNET). These algorithms were trained using the training dataset and subsequently assessed on the independent test set. In addition, after each surgical session, surgeons completed a questionnaire reporting their perceived stress level, which was later compared with the stress estimates generated by the predictive models. Results: The results obtained showed that MLR and scaling pre-processing reached the highest R² coefficients and the lowest error for each studied parameter. The results of the surgeons’ surveys were highly correlated for microsurgery activities (R² = 0.7989) and for laparoscopy RAS (R² = 0.8381). Conclusions: The linear models proposed were correctly validated on cross-validation and the test dataset. This fact demonstrates the possibility of predicting factors that help us to improve the surgeon’s health during RAS. Full article

Background: Interstitial ectopic pregnancy (IEP) is a rare but potentially life-threatening form of ectopic pregnancy because rupture can result in catastrophic hemorrhage. Accurate diagnosis is particularly challenging when implantation occurs near a previously operated interstitial/cornual region, where postoperative scarring and anatomical distortion may mimic recurrent IEP. We report a case of two surgically managed interstitial/cornual pregnancies at the same anatomical site, followed by a third pregnancy that initially appeared to be recurrent IEP but ultimately progressed to term delivery. Case Presentation: A 35-year-old woman underwent IVF-ET after unsuccessful intrauterine insemination and a prior failed IVF-ET attempt. After a missed abortion from the second IVF-ET cycle requiring dilatation and curettage, she conceived again through a third IVF-ET cycle. Transvaginal ultrasound demonstrated a gestational sac in the right interstitial/cornual region with outward bulging, thinning of the overlying myometrium, and delayed embryonic growth. Because of the high risk of rupture, laparoscopic wedge-shaped excision of the bulging gestational sac with uterine repair was performed. Three months later, she conceived spontaneously, and the gestational sac again developed at the previous interstitial/cornual surgical site. The surrounding myometrium was extremely thin, and serum β-hCG increased despite methotrexate treatment. Laparoscopic cornuostomy with right salpingectomy was therefore performed. After another 3-month recovery period, she conceived spontaneously again. The third pregnancy was initially suspected to represent recurrent IEP because the gestational sac was located near the same right posterior interstitial/cornual region. However, unlike the previous pregnancies, the gestational sac maintained broad contact with the endometrial cavity, showed no narrowed connection, preserved myometrial thickness of at least 5 mm, and expanded inward toward the uterine cavity rather than outward. With intensive ultrasound surveillance and fully informed consent, expectant management was continued. A healthy male infant weighing 2930 g was delivered by planned cesarean section at 37 + 0 weeks of gestation. Conclusions: This case highlights the importance of serial sonographic assessment in pregnancies suspected to be recurrent IEP. In a surgically altered cornual region, eccentric intrauterine implantation may mimic recurrent interstitial ectopic pregnancy at initial presentation. Broad communication with the endometrial cavity, absence of a narrowed connection, maintained myometrial thickness, and inward progression may help distinguish such cases from true recurrent IEP. Expectant management should be considered only in exceptional cases with hemodynamic stability, intensive imaging surveillance, immediate surgical availability, and fully informed patient consent. Full article

Background/Objectives: Open fasciectomy is the standard treatment for Dupuytren’s disease, but recent Australian outcome data are scarce. This study assessed outcomes and predictors of recurrence after open fasciectomy at a tertiary centre. Methods: We retrospectively reviewed all open fasciectomy procedures for Dupuytren’s disease at Peninsula Health, Victoria (January 2023–October 2024). Data included contracture correction, functional scores (URAM, Southampton), recurrence at 6 and 12 months, complications, and demographic predictors. Appropriate statistical tests were used (significance: p < 0.05). Results: Among 152 procedures (mean age 63.8; 70.2% male), contracture correction was significant for all joints. URAM and Southampton scores improved by 15.3 and 7.6 points (p < 0.001). Complications (22.4%) were mainly transient neuropraxia. Recurrence was 10.5% at six months and 13.8% at twelve months. Smoking and female sex increased recurrence risk. Conclusions: Open fasciectomy provides effective correction, functional gain, and low early recurrence rates. Smoking and female sex predict recurrence, supporting tailored counselling and reaffirming open fasciectomy as the standard for advanced Dupuytren’s disease. Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries are common in sports; they can be seen with an arthroscope in more than half of instances of acute traumatic hemarthrosis and are frequently associated with meniscal tears. By reducing soft tissue injury and enabling faster recovery while attaining comparable long-term outcomes, the switch from open surgery to arthroscopic ACL repair (ACLR) has transformed treatment. However, maintaining efficient intra-articular visualization is essential for both patient safety and surgical precision. Methods: Using the PRISMA guidelines, a comprehensive systematic search was conducted across major medical databases, including PubMed, Web of Science, and ScienceDirect. The search strategy incorporated key terms such as epinephrine, irrigation fluid, and ACL reconstruction to identify relevant studies. The study focused on English-language clinical studies within the last 10 years that clearly assessed the safety and efficacy of epinephrine-added irrigation in ACL repair. The study design, patient demographics, specific outcomes (visualization, operation time, hemodynamics), and statistical findings were all carefully retrieved. The results were combined to determine the intervention’s safety profile and clinical value. Results: The pooled analysis demonstrated that the intervention group significantly decreased operating time (SMD = −0.51, 95% CI: −0.90 to −0.12, p = 0.01; I² = 24%). However, postoperative knee function showed no statistically significant difference between groups (OR = 1.80, 95% CI: 0.61 to 5.30, p = 0.29; I² = 0%). Postoperative pain levels also did not differ significantly between groups (SMD = −0.27, 95% CI: −0.63 to 0.09, p = 0.14; I² = 0%). Heterogeneity was low across all analyses (I² = 0–24%). Conclusions: Low-dose epinephrine in irrigation fluid significantly reduces operative time during arthroscopic ACL reconstruction, suggesting improved surgical efficiency. However, it does not significantly improve postoperative knee function or reduce pain compared to control irrigation. The intervention appears to be a reasonable alternative to tourniquets without major systemic cardiovascular effects. Nevertheless, preclinical data indicate potential chondrotoxicity. Therefore, while epinephrine can be considered to improve operating efficiency and reduce tourniquet-related problems, surgeons should weigh its use cautiously, especially in younger patients or those with susceptible cartilage. Full article

Background/Objectives: Minimally invasive aortic valve replacement via right anterior thoracotomy (Mini-AVR) has been proven safe and effective. However, the restricted surgical field through this approach makes this surgery challenging and therefore limits its application. A simple modification of an exposure technique involving third-rib detachment from the sternum in a wedge shape allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, which may shorten the learning curve for surgeons, and make this surgery applicable to patients with less favorable anatomy. Methods: This is a retrospective study. From 2019 to 2024, 176 patients aged 62.9 ± 17.5 years old underwent Mini-AVR via right anterior thoracotomy with third-rib detachment at our hospital in Vietnam. Results: A mechanical prosthesis was used in 98 patients (55.7%) and bioprosthesis in 78 patients (44.3%). Leftward and deep aorta position were seen in 57 (32.4%) and 18 (10.2%) patients, respectively. The aortic cross-clamp and bypass time were 78.69 ± 24.1 and 128.1 ± 26.3 min, respectively. Root enlargement was performed in 2 patients (1.1%). Conclusions: Wedge-shape detachment of the third rib from the sternum in Mini-AVR allows for expansion of the surgical field to the left, facilitating surgical exposure and performance, especially in patients with less favorable anatomy. Full article

Context: Prosthetic rehabilitation of acquired maxillary defects with Maxillary Resection Prostheses (MRPs) remains biomechanically challenging, particularly in partially edentulous patients, where conventional clasp-retained designs often yield suboptimal retention, stability, and functional outcomes. Research Gap: The integration of telescopic crown systems with semi-precision attachments incorporating a rotational latching mechanism has not been previously described as a unified approach to optimise load distribution and prosthesis stability in maxillary defect rehabilitation. Objective: To describe and clinically evaluate a novel prosthetic design combining telescopic crowns and a semi-precision rotational latching attachment to enhance retention, stability, and functional performance of MRPs. Methodology: A 31-year-old patient with a unilateral maxillary defect following partial maxillectomy presented with an unstable interim prosthesis and impaired speech and mastication. A definitive MRP was designed using telescopic crowns on the remaining dentition to establish a controlled path of insertion and improved axial load transfer. A semi-precision attachment with a key–keyway rotational latching mechanism was incorporated into the secondary framework to engage specific undercuts while minimising lateral forces on abutment teeth. A provisional prosthesis was used for 3 months to evaluate base extension, phonetics, and functional parameters before fabrication of the definitive prosthesis. Results: Serial follow-up at 1, 3, and 6 months demonstrate consistent prosthesis stability, precise seating, and favourable retention. Marked improvements were observed in speech intelligibility, masticatory efficiency, and patient-reported comfort. Conclusions: This combined prosthetic strategy represents a novel and biomechanically optimised approach for the rehabilitation of partially edentulous maxillary defects, with promising clinical and functional outcomes. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly proposed to improve surgical planning, guidance, and postoperative surveillance. Yet many promising applications remain disconnected from the full surgical pathway and the feasible limitations of clinical deployment. In contrast to prior reviews that primarily catalog AI use cases, this review combines the literature to define the translational pathway—from label design through staged validation to workflow integration—required for clinically deployable computed tomography (CT)-based surgical AI. CT and particularly computed tomography angiography (CTA) are especially usable sources for surgical AI because they provide a standardized three-dimensional anatomic model that is already embedded in many clinical workflows. In autologous breast reconstruction, deep inferior epigastric perforator (DIEP) flap CTA offers an unusually strong model system: the anatomy is discrete, surgeon decisions are actionable, and downstream operative and postoperative outcomes are measurable. These characteristics make DIEP reconstruction suitable not only for technical model development, but also for exacting testing of how CT-based AI should be annotated, validated, displayed, and governed. Methods: This focused narrative review combines evidence across the surgical workflow, spanning preoperative planning and risk stratification, intraoperative support, and postoperative monitoring. Reporting standards, implementation frameworks, governance, and regulatory sources were also considered when directly relevant to clinical deployment. Results: Across the available literature on breast reconstruction with the DIEP flap, preoperative CTA has been associated with reductions in operative time of approximately 54–76 min in individual studies. Semi-automated perforator mapping can reduce review time from 2 to 3 h to approximately 30 min. Intraoperative extended-reality tools and surgeon-facing navigation systems illustrate the importance of the ‘last mile’ of translation, while postoperative monitoring models show how imaging-linked data can support a closed-loop learning system. Across these stages, recurring limits include target mismatch, weak external validation, protocol variability, inconsistent reporting, limited subgroup analysis, and inadequate integration of economic and governance considerations. Conclusions: We argue that the next important step is not a generic autonomous model, but a clinically deployable DIEP-CTA-AI program. The practical blueprint proposed here is staged: structured anatomical labels, separate imaging, surgeons’ decisions, and outcome reference standards, dense intermediate endpoints, retrospective and external validation, reader studies, prospective silent deployment, and workflow-impact assessment. If implemented in this way, DIEP flap CTA can serve as a practical blueprint for CT-based AI translation in surgery more broadly. Full article

Background: Complex elbow soft-tissue defects often combine exposed critical structures, unstable scars, and high mechanical stress, making durable coverage and early mobilization challenging. Among regional options, the reverse lateral arm flap provides thin fasciocutaneous tissue based on a reliable collateral circulation and preserves major forearm vessels. The aim of this study was to report our single-center experience with the pedicled reverse lateral arm flap for elbow soft-tissue reconstruction, focusing on stable coverage, donor-site morbidity, and functional recovery. Methods: A retrospective single-center case series was conducted at the Division of Plastic Surgery, University Hospital of Padua, Italy. All consecutive patients treated between 2013 and 2023 with a pedicled reverse lateral arm flap for elbow soft-tissue defects were included. Recorded variables included defect etiology, donor-site management, complications, range of motion, and follow-up. Elbow flexion–extension was recorded clinically preoperatively and at last follow-up. Minimum follow-up was 12 months in all patients. Results: Seven patients underwent reconstruction. Defect etiology was burn-related in four cases, shotgun trauma in one, crush injury in one, and melanoma resection in one. All defects were covered with a pedicled reverse lateral arm flap. All flaps survived completely without partial necrosis or flap-related reoperation. Donor-site closure was primary in four patients and required split-thickness skin grafting in three. One patient developed donor-site keloid, and one had donor-site skin-graft partial loss with delayed healing. Elbow flexion–extension improved in all seven cases, with a median gain in arc of motion of 25° (range 15–41°). Conclusions: In this series, the reverse lateral arm flap provided complete coverage of selected elbow defects with preserved motion and limited donor-site morbidity at a minimum follow-up of 12 months. Our findings suggest that it may represent a useful regional option in selected posterior and lateral elbow defects, particularly in post-burn and traumatic settings where thin vascularized tissue is needed, and free-flap reconstruction may be avoidable. Full article

Traumatic thumb loss causes severe functional impairment, as the thumb provides approximately 40% of total hand function. Toe-to-thumb transfer remains the gold standard for thumb reconstruction, yet donor site morbidity represents a significant functional and aesthetic limitation. A total thumb reconstruction using a “trimmed” right great toe transfer, combined with immediate donor site reconstruction using a free SCIP (superficial circumflex iliac perforator) flap and iliac crest bone graft. The flap was designed as a tubular skin island to create a neo-hallux with optimal contour and volume, minimizing visible scarring and avoiding microcirculatory compression. The patient, a 33-year-old man with post-traumatic thumb avulsion, underwent delayed reconstruction three months after injury. The postoperative course was uneventful, with no vascular or wound complications. At 12 months, he resumed full ambulation and manual activities, including motorcycle driving and work tasks. Baropodometric analysis demonstrated symmetric load distribution and gait dynamics. Thumb opposition was satisfactory (Kapandji score: seven); the patient rated the aesthetic results as excellent. This case demonstrates that SCIP flap reconstruction with iliac crest bone graft enables complete functional and aesthetic restoration of the great toe donor site after total toe transfer. Compared to previous techniques using cross-flaps, skin grafts, or peroneal flaps, this approach minimizes morbidity, optimizes cosmetic outcomes, and preserves gait. Although representing a single case, this constitutes the first documented instance of total hallux reconstruction following toe-to-thumb transfer, emphasizing the importance of the foot as a functional and aesthetic unit and the need for donor-site preservation in microsurgical reconstructive planning. Full article

Background: Several surgical techniques are available for the treatment of thumb trapeziometacarpal (TMC) osteoarthritis. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is a widely accepted procedure, while suspensionplasty techniques have been introduced to improve first metacarpal stability after trapeziectomy. A simplified transosseous suture suspensionplasty (SUSP) has recently been introduced as an alternative to implant-based constructs, but comparative clinical data remain limited. This study aimed to compare the clinical and functional outcomes between LRTI and SUSP techniques in patients with TMC osteoarthritis. Methods: A retrospective comparative study was conducted on 54 consecutive patients treated surgically for TMC osteoarthritis between 2018 and 2022. Thirty-three patients underwent trapeziectomy with ligament reconstruction and tendon interposition (LRTI group), and 21 underwent trapeziectomy with transosseous suture suspensionplasty (SUSP group). At a minimum follow-up of 2 years, 44 patients were available for evaluation. Assessments were performed using DASH, 10 cm VAS, key pinch strength, Kapandji score, and radial/palmar abduction. Results: At 2 years, there were no significant between-group differences in DASH (median 4 vs. 16.5; p = 0.190), VAS (2.0 ± 2.1 vs. 2.9 ± 2.3; p = 0.235), key pinch (median 4 vs. 3 kg; p = 0.136), Kapandji score, or abduction. Both groups improved significantly over time in DASH and VAS (p < 0.001). Key pinch increased progressively in LRTI group (p < 0.001) but showed less consistent change in SUSP group. Conclusions: Both techniques provided comparable mid-term clinical and functional outcomes in patients with TMC osteoarthritis. No clear clinical advantage of suspensionplasty over tendon interposition was demonstrated. Transosseous suture suspensionplasty represents a valid alternative, while tendon interposition arthroplasty remains a reliable reference technique. Full article

Background/objectives: Total knee arthroplasty is one of the most commonly performed orthopedic procedures of the lower extremities, primarily for patients with osteoarthritis or rheumatoid arthritis. Despite its widespread use, evidence remains limited regarding the association between patient satisfaction, kinesiophobia, and pain during the early postoperative period. The purpose of the present study was to examine the relationships and differences among satisfaction, kinesiophobia, and pain in hospitalized patients following total knee arthroplasty, as well as to compare these variables across four postoperative time points. Methods: A total of 41 patients, aged 65–85 years, participated in this study. Patient satisfaction was assessed using a structured satisfaction questionnaire, kinesiophobia was assessed using the Greek version of Tampa Scale of Kinesiophobia, and pain was assessed using the Visual Analogue Scale. Measurements were obtained on the first postoperative day, on the day of hospital discharge, fifteen days after discharge, and four weeks after discharge. Normality was assessed using the Shapiro–Wilk test, indicating non-normally distributed data. The relationship between the variables were examined using Spearman’s correlation coefficient. Comparisons between the four postoperative time points were conducted using the Friedman test with Kendall’s W for effect size estimation, followed by Wilcoxon post hoc analyses with Bonferroni corrections. Results: The results showed that a significant negative correlation between satisfaction and kinesiophobia was observed at the fourth phase (r = −0.41, p = 0.04). Satisfaction was also negatively correlated with pain from the third to the fourth phase (r = −0.41, p = 0.008), whereas kinesiophobia demonstrated a significant positive correlation with pain from the second to the fourth phase (r = 0.47–0.56, p = 0.002). Friedman test comparisons revealed a significant increase in satisfaction over time (χ² (3) = 13.88, p = 0.003), a significant progressive decrease in kinesiophobia with a moderate effect size (χ² (3) = 76.40, p < 0.001; Kendall’s W = 0.62), and a significant progressive reduction in pain with a large effect size (χ² (3) = 89.60, p < 0.001; Kendall’s W = 0.73). Conclusions: These findings indicate that satisfaction, kinesiophobia, and pain are significantly interrelated during the early postoperative period following total knee arthroplasty. Further studies with larger samples and longer follow-up periods are required to confirm these associations and support the development of targeted rehabilitation strategies. Full article

Background: Nasal glioma (NG), also known as nasal glial heterotopia, is an extremely rare congenital anomaly characterized by the presence of mature glial tissue outside the cranial cavity. Most patients present with midline craniofacial malformations at birth. However, a small subset of them is entirely intranasal and have no accompanying visible features. We present an unusual case of delayed diagnosis of NG, in tandem with a systematic literature review. Methods: A previously well 2-year-old male presented with obstructive apnea secondary to an intranasal mass. Neuroimaging of his paranasal sinuses demonstrated a bony defect in the anterior cribriform plate with herniation of a soft tissue structure into the right nasal cavity. He underwent craniotomy, total excision of the lesion and repair of skull base defect. His postoperative period was uneventful with resolution of his symptoms. Histology reported infiltrates of mature glial tissue with rare neurons forming the excised nasal mass. We conducted a structured literature review using PRISMA guidelines to evaluate clinical features of NG. Results: A comprehensive search of PubMed and Scopus databases featured 133 published cases of NG relevant to our case. Overall, NG is more common in males, with most cases diagnosed within the first year of life. Clinical presentation usually involved an external nasal mass (82.8%) and/or respiratory symptoms (28.7%), with prenatal detection reported in a subset of cases. Magnetic resonance imaging was the preferred imaging modality. Surgical excision was the mainstay of treatment. Postoperative outcomes were favorable in most patients, with 84.7% showing no complications or recurrence. Incomplete excision was associated with recurrence (10%). Conclusions: We present an intranasal case of NG with late diagnosis that was successfully managed with surgery. Our review underscores the importance of early imaging, accurate diagnosis, and complete surgical resection for best outcomes in affected children. Full article

In recent times, extracorporeal membrane oxygenation is increasingly employed in pregnant and postpartum patients with severe cardiopulmonary failure. This article presents two illustrative cases from our tertiary care center, highlighting the complexities of obstetric extracorporeal membrane oxygenation management. These cases are described within a synthesis of recent systematic reviews, registry data, and large case series focusing on maternal and fetal outcomes, extracorporeal membrane oxygenation modality impacts, timing of intervention, complication profiles, and anesthetic considerations. The concordance and contrasts between these cases and the existing literature underscore the evolving indications, improving survival rates, and critical perioperative management issues. Emphasis on multidisciplinary care and planning remains essential to optimize outcomes in this unique patient population. Full article

Background/Objectives: Bronchogenic cysts are rare congenital cystic lesions caused by congenital bronchopulmonary dysplasia; incidental discovery during preoperative investigations or unrelated procedures raises operative management questions. We report successful concurrent resection during laparoscopic Nissen fundoplication. Methods/Case presentation: During elective laparoscopic Nissen fundoplication, a cystic lesion adjacent to the distal oesophagus, previously identified on preoperative imaging, was encountered. Laparoscopic enucleation was performed without compromising the integrity of the gastrointestinal tract or the cyst wall, and the 360° fundoplication was then completed. The specimen was sent for histopathology. Results: Resection was completed without conversion. Histology showed a glandular epithelial lining without features of malignancy, consistent with a bronchogenic cyst. The patient recovered uneventfully with resolution of reflux symptoms. Conclusions: Distal oesophageal bronchogenic cysts accessible via the hiatus can be safely enucleated during laparoscopic Nissen fundoplication in experienced hands, allowing definitive treatment in a single operation. Careful dissection, assessment of gastrointestinal patency and integrity, and histopathological confirmation are essential. Full article

Background/Objectives: Trapeziometacarpal osteoarthritis (TMC OA) is a common disabling condition. This study compared clinical and radiographic outcomes of trapeziectomy with suspension arthroplasty and dual mobility TMC joint replacement in a prospective comparative cohort study design. Methods: A prospective comparative study was conducted on 122 patients contributing 129 hands with Eaton–Littler stage II–III TMC osteoarthritis. Patients were treated with trapeziectomy with suspension arthroplasty (58 patients, 60 hands) or TMC joint replacement with a dual mobility prosthesis (64 patients, 69 hands), based on surgical indication and shared decision-making. Clinical and radiographic evaluations were performed up to 24 months postoperatively. Results: Both techniques significantly improved pain, function, range of motion, and strength (p < 0.05). Joint replacement provided faster pain relief and functional recovery, with superior strength at all follow-up points. At 12 months, pain and functional outcomes were comparable between groups. No implant loosening or failures were observed. Conclusions: Both surgical techniques are effective for TMC osteoarthritis. Dual mobility TMC joint replacement allows faster recovery and greater strength, while achieving comparable mid-term clinical outcomes to suspension arthroplasty. Full article

Background/Objectives: Adenomyosis is a common disorder of the uterus in those of reproductive age. Robotic-assisted surgery has been adopted to address the technical challenges of adenomyomectomy. This systematic review evaluated the current evidence regarding the feasibility, safety, and clinical outcomes of robotic-assisted conservative surgery for uterine adenomyosis. Methods: A systematic review of literature was performed on five databases, from the beginning to 21 December 2025, to identify studies reporting robotic-assisted uterus-sparing surgical approaches to adenomyosis. Data were collected on patient characteristics, surgical techniques used, pre- and post-operative pain, fertility outcomes, and complications. Risk of bias was evaluated using the ROBINS-I framework. Results: A total of 514 articles were found; six studies met the inclusion criteria. Most included studies were small and retrospective. The operative time ranged from 279 to 147 min. Mean blood loss ranged between 25 and 296 mL with a low rate of conversion and perioperative complications. Dysmenorrhea improved after surgery as reflected by the post operative visual analog scale pain score and serum CA-125 level. Few reproductive data were collected about successive spontaneous pregnancies. Risk of bias was serious or moderate in all studies included. Conclusions: Robotic-assisted conservative surgery for adenomyosis may represent a feasible and safe option for women with symptomatic adenomyosis who wish preserve the uterus, with a positive impact on patients’ symptoms. Large prospective, multicenter studies with standardized protocols and long-term follow-up are needed to clarify the real impact of robotic surgery in adenomyosis management. Full article

Background: Hepatitis C viral infection (HCV) has historically been a leading indication for liver transplantation (LTx), primarily due to its progression to cirrhosis and hepatocellular carcinoma (HCC). However, the advent of direct-acting antiviral agents (DAAs) over a decade ago has revolutionized HCV treatment, achieving sustained virologic response (SVR) in over 90% of patients and potentially altering LTx indications. Aim: To investigate the impact of DAAs on HCV-related indications, with or without HCC, and model future trends in LTx indications. Methods: We retrospectively reviewed 1504 liver transplants performed between 2000 and 2024 at a single center. Patients were categorized into three cohorts: HCV-only, HCC-only, and HCC with HCV co-infection (HCC/HCV). Relative transplant volumes by-year, post-operative outcomes, and HCC recurrence rates were analyzed across pre- and post-DAA eras. ARIMA modeling was employed to project trends in transplant indications through the year 2030. Results: The proportion of transplants for HCV alone declined by 82.3% from 2015 to 2020, while HCC/HCV transplants decreased by 68.8%. Conversely, the total number of transplants for HCC alone increased during this period, with a modest proportional decrease of 8.3% from 2015 to 2020. ARIMA modeling suggests that by 2030, LTxs for HCV alone may be nearly eliminated. The projected proportion of transplants conducted for HCC alone remains the highest of all three study indications at 4.3%. Conclusions: DAAs have reduced LTx due to HCV. By 2030, LTx for HCV-related cirrhosis, particularly without HCC, may be obviated. This underscores the need to reevaluate allocation for emerging oncologic indications. Full article

Background: Pancreatic tumors in pediatric and adolescent patients are rare, and guidance on prognostication and management is limited. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (2004–2021), we analyzed clinicopathological characteristics, treatment patterns, and survival outcomes in patients younger than 20 years with pancreatic tumors. Analyses integrated conventional survival models with machine learning approaches to identify key predictors. Results: The cohort included 203 patients, of whom 108 (53.2%) had solid pseudopapillary neoplasms (SPNs), 59 (29.1%) neuroendocrine neoplasms, 16 (7.9%) pancreatoblastomas, 5 (2.5%) adenocarcinoma variants, 4 (2.0%) acinar cell carcinomas, and 11 (5.4%) other rare histologies. Most patients had localized disease (61.1%) and underwent surgical resection (85.2%). Estimated 5-year and 10-year overall survival rates were 87.8% and 84.0%, respectively. Survival differed significantly by histology, stage, and surgery status (all log-rank p < 0.001). In multivariable analysis, SPN histology was associated with lower mortality (hazard ratio (HR) 0.03, 95% confidence interval (CI) 0.01–0.13; p < 0.001), whereas distant disease was associated with markedly higher mortality (HR 21.49, 95% CI 7.52–133.41; p < 0.001). Surgical resection was independently associated with lower mortality (HR 0.13, 95% CI 0.02–0.29; p = 0.003). Among patients with known 5-year status, the Random Forest and Gradient Boosting models achieved cross-validated area under the curve values of 0.935 ± 0.060 and 0.886 ± 0.093, respectively; stage and surgery were the dominant predictors in both models. Conclusions: Surgery remains the cornerstone of management for pediatric pancreatic tumors, and advanced analytic approaches may enhance risk stratification in this rare population. Full article

Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH₂O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Full article

Background: Chronic reducible scapholunate instability (SLI) remains a challenging condition, with multiple surgical options described, often associated with soft tissue disruption and postoperative stiffness. We describe a mini-invasive dorsal capsulodesis technique aimed at restoring carpal alignment while minimizing surgical morbidity, and we report preliminary clinical and radiographic outcomes. Methods: This study includes a retrospective analysis of the first 10 consecutive patients treated with this technique who had a minimum follow-up of 3 years. All patients presented with chronic, reducible scapholunate instability. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for pain and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Radiographic evaluation was performed to assess maintenance of scapholunate alignment and progression to degenerative changes. Results: At a mean follow-up of approximately 4 years, patients showed a substantial reduction in pain (mean VAS from 8 preoperatively to 2 postoperatively) and improvement in function (mean QuickDASH from 74.6 to 16.5). Radiographic evaluation demonstrated maintenance of carpal alignment in all cases, with no progression to scapholunate advanced collapse (SLAC) observed. Wrist range of motion improved postoperatively, with extension reaching approximately 80° and flexion 70°, without significant functional limitations. No major complications or reoperations were recorded. Patient satisfaction was high, with 9 patients reporting being extremely satisfied and 1 satisfied. Conclusions: This mini-invasive dorsal capsulodesis appears to be a feasible and tissue-sparing option for selected cases of chronic reducible scapholunate instability. In this preliminary series, the technique was associated with favorable clinical and radiographic outcomes at mid-term follow-up. Further studies with larger cohorts and comparative designs are needed to confirm these findings. Full article

Background: Percutaneous needle fasciotomy has been practiced for many years as a therapeutic alternative to open fasciectomy in Dupuytren’s disease. In addition to collagenase injection, it has established itself as a minimally invasive procedure in everyday clinical practice. This study analyzes the treatment results of 1146 patients. Methods: Patients at a center for needle fasciotomy were surveyed retrospectively by means of a questionnaire. In addition to previous illnesses and the localization and number of affected fingers, the frequency of recurrences, the need for renewed treatment, and satisfaction with the surgical result were also surveyed. Results: Between 1994 and 2012, 1146 patients with 1803 finger rays were treated and their data analyzed on the basis of records. In addition, a questionnaire survey on patient satisfaction was conducted and 174 questionnaires were analyzed. Overall, 83% of the patients were male and 16% female. In 50% of cases the right side was treated, in 45% of cases the left side (5% unknown), while 46% of the finger rays treated were on the little finger and ring finger. In all but one case, an improvement in the contracture was achieved. Complications included skin tears (264 cases), increased swelling (five cases), hypesthesia (one case), flexor tendon rupture (four cases) and a mid-limb base fracture (one case). The mean operation time was 26.9 min, the duration of pain was 2.7 days, and patient satisfaction on a scale of 1–10 was 7.2. Overall, 77% of patients stated that there had been a further deterioration or recurrence within one year of treatment, and 35% of these patients stated that further treatment was necessary. Conclusions: Needle fasciotomy is a safe and effective method with a low complication rate, but targeted and stringent follow-up treatment is necessary, as is information about possible recurrences or further deterioration of the result. Full article

Background: Anastomotic leakage remains a serious complication of colorectal surgery, often linked to impaired blood supply at the incision site. Objective: To develop and validate a reproducible rat model of colonic anastomotic leakage induced by graded mesocolon ischemia. Methods: Of 144 operated rats, 138 survived surgery and underwent end-to-end colonic anastomosis with five levels of mesocolon ligation (0–2 cm of unilateral mesocolic ischemia). Postoperative outcomes, including anastomotic integrity, abscess formation, and mortality, were assessed on postoperative day 10. Anastomotic bursting pressures were also measured in a subset of animals. Results: Leak rates increased with ischemia severity: 0% in controls, 16.7% at 0.2 cm, 42.6% at 0.4 cm, 95.8% at 1 cm, and 100% at 2 cm (p < 0.0001, trend test). Bursting pressures decreased progressively with increasing anastomotic severity. The 0.4 cm ischemia condition produced a reproducible intermediate leak rate suitable for experimental interventions. Conclusions: This rat model reliably induces graded anastomotic leaks and can serve as a platform for testing strategies to prevent leakage in high-risk colorectal surgery. Full article