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Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: 30 September 2026 | Viewed by 17603

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Special Issue Editors

Prof. Dr. Radu Jecan

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Guest Editor

Prof. Dr. Agripa Ionescu Clinical Emergency Hospital, Bucharest, Romania
Interests: plastic surgery

Dr. Cristian-Sorin Hariga

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Guest Editor Assistant

1. Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
2. Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania
Interests: plastic surgery

Special Issue Information

Dear Colleagues,

In the field of Plastic Surgery, thorough analysis of the results obtained and innovation are essential. Consequently, sharing the latest conclusions and launching hypotheses contribute essentially to the development of this field. In this Special Issue, we aim to gather the most recent articles from all areas of Plastic Surgery, including interdisciplinary topics, in order to provide evolutionary support. Many of the topics are multidisciplinary in nature, especially those in the area of aesthetic surgery. While maintaining scientific rigor, we want to encourage authors to express their new approaches and results, even preliminary ones, and also to encourage them to build working hypotheses that will be subsequently validated. The presentation of avant-garde works is usually done within scientific events, but dedicating a Special Issue of a journal offers a special opportunity due to the much wider access it offers. Also, the objective of this Special Issue is to analyze some aspects within systematic or comprehensive reviews regarding the fastest evolving topics in the field. Equally important are rare cases that are often missed because they cannot be included in a series with standard statistical significance. For these reasons, we encourage potential authors to publish significant case series of rare pathologies. Finally, the scientifically supported opinions of authors are welcomed, even if they do not fit the mainstream opinion.

What kind of papers we are soliciting:

Article, Review, Systematic Review, Case Series, Hypothesis, Opinion.

Prof. Dr. Radu Jecan
Guest Editor

Dr. Cristian-Sorin Hariga
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

surgical techniques
microsurgical techniques
soft tissue tumors
breast surgery
breast implants
BIA diseases
breast reconstruction
tissue regeneration
PRP therapy
HA therapy

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Published Papers (9 papers)

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Research

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16 pages, 1773 KB

Open AccessArticle

Conical Implants in Tuberous Breast Correction: Clinical and Patient-Reported Outcomes

by Jorge González-Prieto, Antonio González-Nicolás and Barbara Helena Barcaro Machado

Medicina 2026, 62(5), 930; https://doi.org/10.3390/medicina62050930 (registering DOI) - 10 May 2026

Viewed by 205

Abstract

Background and Objectives: Tuberous breast is a complex congenital deformity that requires correction of the underlying stenotic anatomy. Clinical evidence on the use of conical polyurethane implants in this setting is limited. To evaluate clinical outcomes and patient-reported satisfaction following correction of tuberous breast deformity using a standardized, implant-assisted reconstructive protocol with exclusive use of conical polyurethane implants. Materials and Methods: An ambispective study included 50 patients with tuberous breast deformity treated between 2020 and 2025 by two surgeons using a standardized implant-assisted reconstructive protocol. All patients underwent systematic glandular ring release and inframammary fold repositioning, followed by placement of conical polyurethane implants. Outcomes included complications, reoperations, and BREAST-Q Augmentation V2.0 scores. The mean follow-up was 17 months (range, 9–24 months). Results: The mean patient age was 29.8 years. According to the Grolleau classification, 62% of patients were type I, 30% type II, and 8% type III. The mean implant volume was 258.2 cc. Overall complication rate was 10%, including one case (2%) of capsular contracture secondary to infection, with a reoperation rate of 8%. Postoperative BREAST-Q scores showed high levels of patient satisfaction, with mean “satisfaction with breasts” scores of 90.1 ± 11.9 and 92.0 ± 9.7 at the first and second postoperative assessments, respectively. Conclusions: Within a standardized reconstructive protocol, conical polyurethane implants were associated with high postoperative patient satisfaction and acceptable complication rates during early-to-mid-term follow-up in the correction of tuberous breast deformity. These findings suggest that the use of conical polyurethane implants within a standardized reconstructive approach is feasible in selected cases. Further comparative studies with longer follow-up are warranted. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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20 pages, 3047 KB

Open AccessArticle

Integrating Negative-Pressure Wound Therapy in the Therapeutic Protocol of Extensive Pediatric Burns: Current Practice and Further Treatment Decision Algorithm

by Doina Iulia Nacea, Dan Mircea Enescu, Mihaela Pertea, Petruța Mitrache, Iulia Mihaela Gavrila and Raluca Tatar

Medicina 2026, 62(5), 852; https://doi.org/10.3390/medicina62050852 - 30 Apr 2026

Viewed by 295

Abstract

Background and Objectives: Extensive burns are devastating injuries, especially in children, associating high risk of morbidity and mortality in the absence of immediate and appropriate treatment. Negative-pressure wound therapy (NPWT) has emerged as a versatile tool for the local treatment of burn wounds. This study aims to present our approach in using NPWT for extensive burns in children, emphasizing the indications and outcomes of these very challenging cases, and proposing an algorithm for NPWT use for extensive burn patients, even in low-resource settings. Materials and Methods: We retrospectively analyzed pediatric burn patients admitted between January 2020 and December 2024, selecting the cases with at least 20% TBSA burn and the application of NPWT during treatment, recording indications and parameters of use, treatment period, and results. Results: We identified 12 patients with a burn surface ranging from 20% to 80% TBSA, caused by high-voltage electrical current (6 cases), flame (4 cases), and scalds (2 cases). NWPT was used for 3–25% TBSA for obtaining granulation tissue in very deep burn wounds with bone and tendon exposure, for reducing edema and enhancing spontaneous re-epithelialization in intermediate circumferential burns, and for preparing the wound bed for re-grafting after local infection and graft failure. There were no complications related with the NPWT use and no fatalities. Conclusions: NPWT represents a reliable option for several clinical situations in local burn treatment, for temporary closure of burn areas, graft fixation, burn wound preparation, local infection control, or enhancing re-epithelialization. The proposed algorithm offers a comprehensive overview of indications of NPWT for burn local management and may guide clinical decisions, easing the identification of the best situation and moment to use the device. Our study contributes to the body of knowledge that enforces the evidence of the safe and effective use of NPWT for burn management in the pediatric population. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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24 pages, 1067 KB

Open AccessArticle

Early Rehabilitation Versus Conventional Approaches in Post-Traumatic Hand Injuries with Multiple Lesions: Clinical Outcomes and Future Directions

by Adriana Serban, Andreea Grosu-Bularda, Eliza-Maria Bordeanu-Diaconescu, Georgiana-Ozana Tache and Marius Stoica

Medicina 2025, 61(11), 2063; https://doi.org/10.3390/medicina61112063 - 19 Nov 2025

Cited by 2 | Viewed by 2115

Abstract

Background and Objectives: Complex hand injuries often lead to long-term functional impairment and require structured rehabilitation following surgery. While early rehabilitation may improve outcomes by preventing stiffness and adhesions, it can also increase pain and psychological distress. In contrast, delayed rehabilitation may offer short-term comfort but risks slower recovery. The study aimed to compare the outcomes of early versus delayed rehabilitation through a four-phase therapeutic protocol, with standardized assessments at baseline, 4 weeks, and 12 weeks. Materials and Methods: This study included 90 patients with complex hand trauma who underwent emergency surgical intervention followed by a structured rehabilitation program. Key parameters included active range of motion (TAM), grip strength, pain (VAS), edema, hand function (QuickDASH), and anxiety levels (GAD-7). Statistical analysis was used to evaluate differences in physical and psychological recovery over time between the two rehabilitation approaches. Results: This study demonstrated that both early and delayed postoperative rehabilitation significantly improved physical and psychological outcomes in patients with complex hand trauma. However, early rehabilitation was associated with faster resolution of edema, quicker gains in functional mobility, and earlier improvement in grip strength, despite causing higher initial levels of pain and anxiety. Conversely, delayed rehabilitation resulted in lower early pain and anxiety but showed slower functional recovery. Subgroup analysis revealed that patients with flexor tendon injuries benefited most from early rehabilitation in terms of mobility, strength, and anxiety reduction, while those with multifocal or complex injuries achieved greater long-term pain relief. Conclusions: As rehabilitation continues to evolve, the adoption of personalized, multimodal, and technologically integrated strategies holds promise for improving both the speed and quality of recovery while addressing the psychological and functional dimensions of patient care. Overall, the study supports early, structured, and individualized rehabilitation protocols, emphasizing a multidisciplinary approach that integrates both physical and psychological recovery strategies. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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10 pages, 1186 KB

Open AccessArticle

Augmenting Patient Education in Hand Surgery—Evaluation of ChatGPT as an Informational Tool in Carpal Tunnel Syndrome

by Benedikt Fuchs, Nikolaus Thierfelder, Irene Mesas Aranda, Verena Alt, Constanze Kuhlmann, Elisabeth M. Haas-Lützenberger, Konstantin C. Koban, Riccardo E. Giunta and Sinan Mert

Medicina 2025, 61(9), 1677; https://doi.org/10.3390/medicina61091677 - 16 Sep 2025

Cited by 1 | Viewed by 1786

Abstract

Background and Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy caused by chronic compression of the median nerve within the carpal tunnel. Patient education is a cornerstone of informed consent and postoperative outcomes, yet time constraints often limit traditional consultations. Recently, generative AI tools such as ChatGPT have emerged as potential adjuncts in delivering standardized medical information. Materials and Methods: This study evaluated the quality and comprehensiveness of ChatGPT-generated patient education on CTS and open carpal tunnel release. A standardized prompt was used with ChatGPT-4o to generate educational material. A structured and standardized questionnaire was then administered to both patients and physicians (n = 8) to assess content quality, clarity, comprehensiveness, and perceived usefulness. Results: Both patients and physicians reported high satisfaction with the information provided. The etiology, procedural risks, and general anatomical principles were well conveyed. However, certain intraoperative concepts—such as neurolysis, synovectomy, and hemostasis—were underrepresented. While conservative therapies were addressed, the omission of endoscopic surgical options limited informational completeness. Prognostic information and long-term consequences of untreated CTS were rated as average by some participants. Postoperative guidance was adequately covered but lacked individualized nuance. Conclusions: ChatGPT shows promise as an adjunct in surgical patient education, offering clear and standardized information. Nevertheless, it is not a substitute for clinician–patient interaction. While it may bridge preliminary knowledge gaps, emotional support and individualized consent discussions remain essential. Further refinement and clinical validation of AI-generated educational content are needed to ensure safe and effective integration into routine practice. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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17 pages, 1097 KB

Open AccessArticle

Mapping Perfusion and Predicting Success: Infrared Thermography-Guided Perforator Flaps for Lower Limb Defects

by Abdalah Abu-Baker, Andrada-Elena Ţigăran, Teodora Timofan, Daniela-Elena Ion, Daniela-Elena Gheoca-Mutu, Adelaida Avino, Cristina-Nicoleta Marina, Adrian Daniel Tulin, Laura Raducu and Radu-Cristian Jecan

Medicina 2025, 61(8), 1410; https://doi.org/10.3390/medicina61081410 - 3 Aug 2025

Cited by 2 | Viewed by 1347

Abstract

Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography (IRT) in preoperative planning and postoperative monitoring of perforator-based flaps, assessing its accuracy in identifying perforators, predicting complications, and optimizing outcomes. Materials and Methods: A prospective observational study was conducted on 76 patients undergoing lower limb reconstruction with fascio-cutaneous perforator flaps between 2022 and 2024. Perforator mapping was performed concurrently with IRT and Doppler ultrasonography (D-US), with intraoperative confirmation. Flap design variables and systemic parameters were recorded. Postoperative monitoring employed thermal imaging on days 1 and 7. Outcomes were correlated with thermal, anatomical, and systemic factors using statistical analyses, including t-tests and Pearson correlation. Results: IRT showed high sensitivity (97.4%) and positive predictive value (96.8%) for perforator detection. A total of nine minor complications occurred, predominantly in patients with diabetes mellitus and/or elevated glycemia (p = 0.05). Larger flap-to-defect ratios (A/C and B/C) correlated with increased complications in propeller flaps, while smaller ratios posed risks for V-Y and Keystone flaps. Thermal analysis indicated significantly lower flap temperatures and greater temperature gradients in flaps with complications by postoperative day 7 (p < 0.05). CRP levels correlated with glycemia and white blood cell counts, highlighting systemic inflammation’s impact on outcomes. Conclusions: IRT proves to be a reliable, non-invasive method for perforator localization and flap monitoring, enhancing surgical planning and early complication detection. Combined with D-US, it improves perforator selection and perfusion assessment. Thermographic parameters, systemic factors, and flap design metrics collectively predict flap viability. Integration of IRT into surgical workflows offers a cost-effective tool for optimizing reconstructive outcomes in lower limb surgery. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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Review

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20 pages, 365 KB

Open AccessReview

Pregnancy Associated Melanoma: Diagnostic and Therapeutic Challenges

by Vlad-Petre Atanasescu, Ioana-Emanuela Atanasescu, Claudia Mehedintu, Marius Razvan Ristea, Adrian Nicolae Alexandru, Ioana Mihaela Dogaru, Bianca Mihaela Boga and Ana-Maria Oproiu

Medicina 2026, 62(4), 642; https://doi.org/10.3390/medicina62040642 - 27 Mar 2026

Viewed by 573

Abstract

A rare clinical condition associated with numerous diagnostic and treatment challenges, pregnancy-associated melanoma (PAM), is defined as melanoma diagnosed either during pregnancy or within the first year postpartum. The physiological changes in pregnancy (hormonal changes and immune modulation), along with the normal changes in the pregnant woman’s skin (skin color changes, etc.), may all hinder early detection of this disease and create concerns regarding the advancement of melanoma and the well-being of both the mother and her fetus. The purpose of this review article was to summarize the current literature on the incidence, biology, diagnostic methods and treatments of PAM, with an emphasis on comparison between the two forms of melanoma. More recent research indicates that pregnancy itself is not typically associated with decreased melanoma-specific survival rates. However, when worse results are reported, it appears that this may be more due to delays in initial diagnoses (diagnosis of cancer after delivery) or detection of cancer postpartum, as well as the increased number of stages of melanoma at which women were diagnosed at the time of their first evaluation compared to non-pregnant controls, rather than being a result of enhanced biologic aggressiveness in melanoma driven by pregnancy itself. The preclinical and translational models have suggested that pregnancy may influence melanoma biology through the mechanisms of hormonal signaling, immune system modulation and vascular remodeling; however, these mechanisms remain hypothesis-generating, and current clinical evidence does not indicate that changes in hormone levels during pregnancy negatively affect melanoma survival. Surgical excision is the mainstay of treatment and can be performed safely during pregnancy. In select patients, a sentinel lymph node biopsy may also be performed. Due to the risk of fetal harm, systemic therapy (targeted agents and/or immune checkpoint inhibitors) cannot be used for the treatment of PAM during pregnancy. Post-pregnancy treatment of PAM will follow standard melanoma treatment guidelines; however, the treatment options will need to take into consideration whether or not the patient is breastfeeding and if she desires to become pregnant again in the future. In summary, PAM will require a multidisciplinary, individualized approach to maximize oncologic outcomes while protecting the health of both the mother and her fetus. Awareness of this disease and timely diagnosis are critical to maximizing the prognosis. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

51 pages, 2219 KB

Open AccessReview

Integrative Migraine Therapy: From Current Concepts to Future Directions—A Plastic Surgeon’s Perspective

by Cristian-Sorin Hariga, Eliza-Maria Bordeanu-Diaconescu, Andrei Cretu, Dragos-Constantin Lunca, Catalina-Stefania Dumitru, Cristian-Vladimir Vancea, Florin-Vlad Hodea, Stefan Cacior, Vladut-Alin Ratoiu and Andreea Grosu-Bularda

Medicina 2026, 62(1), 50; https://doi.org/10.3390/medicina62010050 - 26 Dec 2025

Viewed by 1717

Abstract

Migraine is a prevalent and disabling neurological disorder with multifactorial origins and complex clinical manifestations. While pharmacologic therapies remain the cornerstone of management, a growing body of evidence highlights the role of extracranial peripheral nerve compression as a significant contributor to migraine pathophysiology in selected patients. This recognition has expanded the therapeutic role of plastic surgery, offering anatomically targeted interventions that complement or surpass traditional medical approaches for refractory cases. From a plastic surgeon’s perspective, optimal migraine care begins with accurate identification of clinical patterns, trigger-site mapping, and the judicious use of diagnostic tools such as nerve blocks and botulinum toxin. Surgical decompression techniques, including endoscopic and open approaches, address compression of the supraorbital, supratrochlear, zygomaticotemporal, greater and lesser occipital, auriculotemporal, and intranasal contact-point trigger sites. Adjunctive strategies such as autologous fat grafting further enhance outcomes by providing neuroprotective cushioning and modulating local inflammation through adipose-derived stem cell activity. Recent advances, including neuromodulation technologies, next-generation biologics, and innovations in surgical visualization, underscore the ongoing shift toward precision-based, mechanism-driven therapy. As understanding of migraine heterogeneity deepens, the integration of surgical expertise with modern neuroscience offers a comprehensive and personalized therapeutic framework. Plastic surgeons, equipped with detailed knowledge of peripheral nerve anatomy and minimally invasive techniques, play an increasingly pivotal role in the multidisciplinary management of refractory migraine. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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15 pages, 303 KB

Open AccessEditor’s ChoiceReview

The Role of Skin Substitutes in the Therapeutical Management of Burns Affecting Functional Areas

by Matei Iordache, Luca Avram, Ioan Lascar and Adrian Frunza

Medicina 2025, 61(6), 947; https://doi.org/10.3390/medicina61060947 - 22 May 2025

Cited by 3 | Viewed by 5438

Abstract

Considered one of the most severe types of trauma with a high impact upon patient survival, burns are the leading cause of disability-adjusted life-years (DALYs), and are responsible for high morbidity, prolonged hospitalization, disfigurement and social stigma. Of particular interest are injuries that affect the functional areas: face, neck, hand and fingers, joints, feet and soles and perineum. Burns to these regions highly influence the day-to-day activities of patients due to the formation of vicious scars and contractures, which may affect both quality of life and functional capacity. One of the primary challenges in the management of burn patients is the effective coverage of tissue defects resulting from such injuries. Cases that have a large area of burned surface also have a limited amount of total available skin. As such, the importance of skin substitutes increases, particularly in the treatment of these areas. Skin substitutes are widely utilized in plastic surgery due to their ability to promote wound healing by providing an extracellular matrix. Consequently, ongoing research has focused on developing skin substitutes that can serve as alternatives to autografts, addressing the challenges associated with large-scale tissue loss. This article aims to present and compare the most used skin substitutes, highlighting their respective advantages and limitations. This topic continues to be a subject of significant debate, as an ideal substitute has yet to be created. The cost–efficiency ratio is a practical consideration that must be tailored to each specific medical system. The available data in the literature usually present general guidelines, not rules, and as such, they need to be adapted to each patient’s necessities. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

Other

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12 pages, 596 KB

Open AccessSystematic Review

Scrotal Flaps for Penile Skin Reconstruction: A Systematic Review

by Sorin V. Parasca, Andrei Dumitrescu, Florin R. Stanescu and Ruxandra D. Sinescu

Medicina 2025, 61(6), 1052; https://doi.org/10.3390/medicina61061052 - 6 Jun 2025

Cited by 1 | Viewed by 3100

Abstract

Background and Objectives: Infection, trauma, skin cancer, foreign substance injections and lymphedema are among the most frequent causes of penile skin defects. Scrotal flaps are a promising reconstructive option for penile resurfacing, offering improved functional and aesthetic outcomes; however, there is no clear consensus on their superiority. Materials and Methods: A review of the literature was performed in PubMed Central and Scopus, and multiple keywords were employed. The initial search retrieved 9181 articles; 32 articles were finally selected, of which 13 were case reports and 19 were case series. Results: A total of 368 patients were included, the majority (71%) consulting for sclerosing lipogranuloma. Seven types of scrotal flaps were used: unilateral scrotal flap (n = 1), bilateral anterior scrotal flaps (n = 149), two-stage scrotal flap (n = 57), bipedicled bilateral anterior scrotal flaps (n = 140), apron-style scrotal flap (n = 1), scrotal pull-up (n = 13), and island dartos musculocutaneous flap (n = 7). Patient satisfaction was high in all studies. Outcome evaluation was typically conducted using subjective questionnaires with 2 or 5 items or visual analog scales. Few studies employed validated sexual function questionnaires, as the IIEF-5 or the EHS. Conclusions: Scrotal flaps provide good quality tissue for penile resurfacing, having the closest resemblance to normal penis skin. For a better understanding of the outcomes of different scrotal flaps, a thorough evaluation of postoperative complications should be made. The LOS and revision surgery rates may serve as surrogates for the financial burden of the procedure. Erectile function should be thoroughly evaluated with a 10-item Likert scale, IIEF-5, EHS, and POSAS. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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