Surgeries

Objectives: Reconstruction of complex midfacial defects remains challenging due to the need to restore three-dimensional anatomy, functional integrity, and facial symmetry. This study aimed to evaluate the clinical effectiveness, safety, and functional and aesthetic outcomes of patient-specific custom implants (PSCIs) in complex midfacial reconstruction. Additionally, we assessed whether virtual surgical planning (VSP) combined with PSCIs reduces operative time and improves postoperative symmetry and patient-reported outcomes. Materials and Methods: A retrospective comparative cohort study was conducted using prospectively recorded clinical data from patients treated with PSCI/VSP between January 2021 and June 2025 and a historical control cohort treated with standard pre-shaped implants. Eighty-seven consecutive patients undergoing reconstruction of acquired or post-oncologic midfacial defects using titanium or PEEK patient-specific implants were enrolled. Preoperative VSP was performed in all cases. The principal endpoint was postoperative facial symmetry assessed by three-dimensional photogrammetry. Secondary functional outcomes included ocular position and nasal airway patency. Secondary outcomes included operative time, complication rates, implant-related morbidity, and patient-reported outcome measures (FACE-Q) at 12 months. Outcomes were compared with a historical cohort reconstructed with standard pre-shaped implants. Results: Eighty-two patients completed at least 12 months of follow-up. PSCI reconstruction demonstrated significantly improved postoperative symmetry (mean deviation 1.8 ± 0.6 mm vs. 3.4 ± 1.1 mm in controls, p < 0.001) and higher patient satisfaction scores at 12 months (FACE-Q overall satisfaction score 82.8 ± 9.3 vs. 69.7 ± 11.2, p < 0.001). Mean operative time was reduced by approximately 24.7%, and intraoperative implant modification was required in only 6% of cases compared with 48% in the control group. The overall complication rate was 11%, with implant removal required in 2.4% of patients. Functional outcomes showed significant improvements in orbital positioning and nasal airway patency. Conclusions: Patient-specific custom implants combined with virtual surgical planning provide reliable and reproducible reconstruction of complex midfacial defects. This approach significantly improves facial symmetry, patient satisfaction, and operative efficiency while maintaining low complication rates. PSCIs should be considered a preferred reconstructive option in selected patients requiring complex maxillofacial reconstruction. Full article

Background/Objectives: Peripheral nerve injuries of the median and ulnar nerves frequently cause significant functional impairment in young patients. When primary repair is not possible, autologous sural nerve grafting remains the gold-standard reconstructive technique, although functional outcomes remain variable and often unpredictable. This study aimed to evaluate functional outcomes after sural nerve autografting for median and/or ulnar nerve defects and to identify factors associated with sensory and motor recovery. Methods: A retrospective case series was conducted on all patients who underwent autologous sural nerve grafting for median and/or ulnar nerve defects between 2016 and 2025, with a minimum follow-up of 12 months. Vascularized and partial nerve grafts, as well as brachial plexus or terminal branch injuries, were excluded. Functional recovery was assessed using the British Medical Research Council (BMRC) sensory and motor scales, and outcomes were classified as good, fair, or bad. Univariate analysis was performed to identify factors associated with functional outcomes. Results: Forty-three patients received 50 nerve grafts (mean follow-up: 30 months). Good sensory recovery (≥S3) was achieved in 80% of median and 52% of ulnar nerve grafts, while good motor recovery (≥M3) was observed in 48% and 32% of cases, respectively. Motor recovery was significantly better for median than ulnar nerve injuries. Factors significantly associated with recovery included patient age, injury type (isolated vs. combined), associated vascular injury, time to surgery, defect length, and number of cable grafts. Conclusions: Sural nerve autografting provides satisfactory functional outcomes, particularly for sensory recovery and median nerve defects, while motor recovery remains limited in ulnar and combined injuries. Early surgery, shorter defects, and adequate cable grafting may improve prognosis. Full article

Background/Objectives: To evaluate the clinical effects of alveolar ridge preservation using a hyaluronic acid-based product combined with a resorbable collagen cone compared with spontaneous healing. Methods: In this prospective pilot comparative clinical study, extraction sockets were treated either with hyaluronic acid and a collagen cone (test group) or left to heal spontaneously (control group). Mesial and distal ridge height changes (ΔHm, ΔHd), ridge width reduction (ΔW), buccal mucosal thickness changes (ΔTmb), and occlusal mucosal thickness at 3 months (TmoT3) were assessed. Early wound healing was appreciated at 14 days follow-up, and postoperative complications after 7 and 14 days. Results: Complete 3-month follow-up data were available for 18 test and 14 control patients. Mesial bone loss was significantly lower in the test group than in controls [test ΔHm = 1.0 (1.0–1.0) vs. control ΔHm = 2.0 (1.0–2.0); p < 0.001]. Horizontal ridge width reduction was significantly lower in the test group [ΔW = 1.0 (1.0–1.0) vs. 2.0 (1.0–2.0); p = 0.021]. Buccal mucosal thickness was better maintained in the test group [ΔTmb = 0.0 (0.0–0.5) vs. 1.0 (0.5–1.0); p < 0.001], while TmoT3 was greater in the test group, in an exploratory analysis (p = 0.049). A statistically significant difference in early wound-healing scores favoring the test group was observed [4.0 (4.0–5.0) vs. 4.0 (3.0–4.0); p = 0.032]. No statistically detectable difference in postoperative complications was observed between groups. Conclusions: Alveolar ridge preservation was associated with reduced mesial vertical and horizontal dimensional changes and more favorable soft tissue outcomes compared with spontaneous healing. These preliminary findings should be considered hypothesis-generating. Full article

Background/Objectives: Patients aged ≥65 years undergoing colorectal cancer surgery are at increased risk of postoperative complications and mortality due to advanced age, comorbidity burden, frailty, and reduced physiological reserve. The aim of this study was to evaluate perioperative predictors associated with early in-hospital mortality in patients aged ≥65 years undergoing colorectal cancer surgery. Methods: This single-center retrospective cohort study included 438 patients aged ≥65 years who underwent colorectal cancer surgery at a tertiary referral center between January 2017 and December 2018. Demographic characteristics, comorbidities, American Society of Anesthesiologists (ASA) classification, surgical urgency, perioperative laboratory parameters, and transfusion requirements were analyzed. The primary endpoint was early in-hospital mortality. Survival analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression analysis. Results: The overall in-hospital mortality rate was 9.4% (41/438). Emergency surgery was associated with significantly reduced in-hospital survival compared with elective procedures (log-rank p < 0.001). Non-survivors more frequently presented with emergency surgical indications, higher ASA scores, greater comorbidity burden, anemia, nutritional impairment, elevated inflammatory markers, renal dysfunction, and increased transfusion requirements. In univariate Cox regression analysis, emergency surgery, ASA score ≥ 3, elevated creatinine, leukocyte count, and C-reactive protein levels, lower hemoglobin, albumin and total protein levels, and red blood cell transfusion were significantly associated with mortality. In multivariate analysis, elevated creatinine (HR 1.004, p = 0.030), leukocyte count (HR 1.064, p = 0.004), C-reactive protein (HR 1.009, p < 0.001), and lower hemoglobin concentration (HR 0.938, p < 0.001) remained independent predictors of in-hospital mortality. Conclusions: Early in-hospital mortality after colorectal cancer surgery in patients aged ≥65 years is associated with systemic inflammation, anemia, and renal dysfunction. Routinely available clinical and laboratory parameters may assist in identifying high-risk patients and improving perioperative risk assessment and postoperative management. Full article

Background/Objectives: Maxillary sinus floor augmentation (MSFA) is a predictable procedure for the rehabilitation of the atrophic posterior maxilla. The prolonged healing time associated with particulate bone grafts poses a clinical challenge. This review aimed to evaluate the clinical, radiographic, and histomorphometric efficacy of autologous platelet-rich fibrin (PRF) combined with bone grafts versus bone grafts alone in MSFA. Methods: A search of databases was conducted until May 2026. We included randomized controlled trials, controlled clinical trials, and cohort studies. Random-effects meta-analyses were performed for new bone formation (NFB%), residual graft (RG%), implant stability quotient (ISQ), and vertical bone height gain. The certainty of the evidence was appraised using the GRADE framework. Results: Thirty-two studies encompassing 728 augmented sinuses in 563 patients met the inclusion criteria. The adjunctive use of PRF significantly increased NFB% (MD = 4.10%; 95% CI: 1.59–6.61; p = 0.005; 10 studies; 204 sinuses; I² = 20.9%; moderate certainty of evidence), with a 95% prediction interval that excluded the null. No statistically significant difference was demonstrated for RG% (MD = −2.71%; 95% CI: −6.08–0.67; p = 0.103; 10 studies; 204 sinuses; I² = 45.2%; very low certainty of evidence), the latter estimate being sensitive to the omission of individual studies. Exploratory subgroup analyses are reported as hypothesis-generating only; the significant between-subgroup contrasts for residual graft were generated by strata containing a single study each. There were no statistically significant differences in ISQ (MD = 1.74; 95% CI: −4.38–7.86; p = 0.432; 4 studies; 140 implants; I² = 92.1%) or vertical bone height gain (MD = −0.35 mm; 95% CI: −2.82–2.13; p = 0.687); both outcomes exhibited substantial heterogeneity and very low certainty of evidence, and their CIs remain compatible with a clinically relevant benefit. Conclusions: The incorporation of PRF into particulate bone grafts during MSFA enhances histological graft maturation by increasing NFB, without a demonstrable effect on RG. This histomorphometric benefit did not translate to improvements in radiographic bone height, bone density, or early implant stability, although the evidence for these outcomes remains imprecise. Therefore, PRF may be regarded as a low-cost autologous adjunct where accelerated histological graft maturation is the specific objective, but the present evidence does not justify a general recommendation for its routine use. Full article

Liver transplantation (LT) has evolved from a contraindicated procedure for malignancy into an established oncologic therapy for selected primary and secondary hepatic cancers. Advances in tumor biology, molecular profiling, immunotherapy, and peri-transplant management have expanded transplant indications beyond hepatocellular carcinoma (HCC) to include perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, colorectal liver metastasis (CRLM), neuroendocrine liver metastasis (NELM), and rare hepatic malignancies. The 2024 TransMet randomized controlled trial, demonstrating a 5-year overall survival (OS) of 73% with LT plus chemotherapy versus 9% with chemotherapy alone for unresectable CRLM, established the first Level 1 evidence supporting transplantation as a curative oncologic intervention in metastatic disease. These advances necessitate a modern framework for clinical trial design and research prioritization in transplant oncology. This manuscript proposes a comprehensive framework for future transplant oncology trials addressing endpoint selection, biomarker-driven patient selection, trial methodology, immunosuppression optimization, surveillance strategies, and ethical organ allocation. OS and transplant benefit are emphasized as the preferred primary endpoints for CRLM and NELM, whereas recurrence-free survival is recognized as retaining distinct clinical and prognostic value in HCC, underscoring that endpoint selection should be disease-specific rather than universally standardized. Emerging biomarkers—including circulating tumor DNA, AFP dynamics, and molecular and functional imaging profiling—are stratified into established, prospectively validated, and investigational categories to clarify their current clinical applicability. Randomized controlled trials, adaptive platform and enrichment designs, biomarker-stratified randomization, registry-based trials, and prospective registries are presented as complementary strategies tailored to disease prevalence and feasibility, alongside explicit consideration of how graft source—particularly the predominance of living donor liver transplantation in Asia versus deceased donor systems elsewhere—shapes trial design and interpretation. The manuscript further examines tumor biology-based immunosuppression, immune checkpoint inhibitor integration, and management of post-transplant recurrence. A precision medicine vision is proposed in which transplant candidacy is determined by biologic behavior and molecular signatures rather than morphology alone, with proposed trial frameworks offering an actionable research agenda for the next decade of transplant oncology. Full article

Background/Objectives: Enhanced Recovery After Surgery (ERAS) has substantially advanced perioperative care across multiple surgical disciplines. Research in colorectal surgery has clearly demonstrated the effectiveness of ERAS programs; however, evidence regarding the application of these protocols in elderly patients undergoing upper gastrointestinal (GI) surgery remains limited. This population has a high prevalence of multimorbidity, frailty, and diminished physiological reserve, factors that collectively increase vulnerability to postoperative complications and may influence adherence to ERAS pathways. Methods: This narrative review is based on a structured literature search of PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. The search identified randomized controlled trials (RCTs), observational studies, meta-analyses, and clinical guidelines evaluating ERAS protocols in elderly patients undergoing upper GI surgery. Results: Available evidence indicates that ERAS protocols are feasible and safe in elderly patients undergoing upper GI surgery, including gastrectomy and esophagectomy. Studies consistently associate their implementation with shorter hospital stays, faster gastrointestinal recovery, and no significant increase in postoperative complications or readmission rates. However, heterogeneity in study designs, ERAS components, and definitions of ‘elderly’ limits comparability across studies. Conclusions: ERAS protocols represent a promising perioperative strategy for elderly patients undergoing upper GI surgery. When implemented within a multidisciplinary framework and tailored to patients’ frailty and comorbidities, these protocols may improve postoperative recovery while maintaining safety. Future research should prioritize multicenter RCTs to identify the most effective ERAS components and evaluate long-term clinical and functional outcomes in this population. Full article

Background/Objectives: Caesarean section (CS) is the most frequently performed abdominal operation worldwide, and surgical technique continues to evolve to reduce peri-operative morbidity. Electrosurgery is now used in the majority of surgical procedures because it allows simultaneous tissue dissection and haemostasis, yet its systematic use during the abdominal-wall phase of CS remains debated, mainly because of concerns about neonatal safety and uncertain benefit in reducing maternal blood loss. This retrospective study aimed to compare the use of an electrosurgical unit with the conventional cold scalpel in women undergoing elective CS. The primary endpoint was maternal blood loss before hysterotomy; the secondary endpoint was the short-term neonatal effect assessed through umbilical cord blood gas analysis. Methods: We retrospectively reviewed 40 elective caesarean sections performed at a tertiary referral centre between September 2024 and May 2025. In 24 procedures (cold scalpel group), the abdominal wall was opened with a cold scalpel, whereas in 16 procedures (ESU group) an electrosurgical unit was used to dissect the subcutaneous abdominal tissues and the muscle fascia and to achieve subcutaneous haemostasis. Blood loss was quantified by weighing laparotomy gauze and by graduated suction. Continuous variables were compared with Student’s t-test for independent samples. Results: The distribution of pre-hysterotomy blood loss departed from normality in both groups (Shapiro–Wilk p < 0.001 and p = 0.003), and the comparison was therefore performed with the Mann–Whitney U test. Pre-hysterotomy blood loss was significantly lower in the ESU group (median 32.5 mL, IQR 25–50) than in the cold scalpel group (median 60 mL, IQR 50–75; Hodges–Lehmann difference −25 mL, 95% CI −45 to 0; p = 0.025; rank-biserial r = 0.42). Differences in haemoglobin, red blood cell and platelet counts measured 24 h after CS did not reach statistical significance (p = 0.27, 0.70 and 0.66, respectively), nor did total blood loss (p = 0.23). Umbilical cord blood gas analysis showed a mean pH of 7.29 ± 0.06 in the ESU group and 7.26 ± 0.08 in the cold scalpel group (p = 0.55), with comparable Apgar scores. Conclusions: In this retrospective series, the use of an electrosurgical unit during the abdominal-wall phase of elective CS was associated with a significant reduction in blood loss up to hysterotomy, with no detectable short-term effect on the neonate. Given the retrospective, non-randomised design and the limited sample size, these findings are hypothesis-generating and require confirmation in adequately powered randomised or prospective studies. Full article

Background: Management of high-grade carotid artery stenosis with concomitant ipsilateral parotid gland tumor presents a rare and challenging surgical condition. Due to the rarity of this dual pathology, standardized guidelines are lacking. Material and Methods: A retrospective study was conducted between January 2020 and May 2025. Six asymptomatic patients with significant carotid stenosis and coexisting ipsilateral Warthin’s tumor underwent simultaneous eversion CEA (carotid endarterectomy) and partial superficial parotidectomy/extracapsular enucleation via a single modified Blair’s incision. Results: Median follow-up was 43 months (range: 12–60 months). Postoperative and long-term survival at median follow-up was 100%, with a 5-year survival rate of 83.3% (one death at 50 months due to myocardial infarction). Disease-free survival at 5 years was 100% for Warthin’s tumor and 83.3% for carotid stenosis. No perioperative transient ischemic attacks (TIA), strokes, hematomas, salivary fistula or iatrogenic cranial nerve injuries occurred. Conclusions: In patients presenting with high-grade carotid stenosis and concomitant ipsilateral Warthin’s tumor, a simultaneous surgical approach is a feasible strategy. This approach eliminates the need for staged interventions, significantly reducing overall anesthetic risk, surgical burden, and healthcare resource utilization. Full article

Background: This study evaluated temporal changes in stage distribution, registry-recorded primary-site surgery, survival outcomes, and exploratory short-term mortality prediction among patients with early-onset testicular germ cell tumors, defined in this study as tumors diagnosed in patients aged 15–49 years, across the study periods. Materials and Methods: This retrospective cohort study used Incidence-SEER Research Data, 17 Registries, November 2025 Submission. Male patients aged 15–49 years diagnosed with malignant testicular germ cell tumors between 2018 and 2023 were included. Diagnosis periods were categorized as the pre-COVID-19 period (2018–2019), COVID-19 period (2020–2021), and 2022–2023 period. Logistic Regression was used to assess factors associated with regional or distant-stage disease. Overall survival was evaluated using Cox regression, while testicular cancer-specific death was additionally evaluated using Aalen–Johansen cumulative incidence estimates and Fine–Gray competing-risk regression. Follow-up was also restricted to 12 months in sensitivity analyses. Machine learning models were developed as an exploratory secondary analysis of 12-month all-cause mortality. Results: A total of 13,303 patients were included. Among patients with known stage, regional or distant-stage disease increased from 31.2% before the pandemic to 33.5% during the COVID-19 period and 34.4% during the 2022–2023 period. In adjusted analysis, COVID-19 (OR = 1.11, 95% CI: 1.02–1.22) and diagnoses during the 2022–2023 period (OR = 1.16, 95% CI: 1.06–1.28) were associated with higher odds of regional or distant-stage disease. In full follow-up analyses, diagnosis during the 2022–2023 period was associated with higher all-cause mortality (HR = 1.29, 95% CI: 1.01–1.65) and testicular cancer-specific death in both cause-specific Cox (HR = 1.49, 95% CI: 1.12–2.00) and Fine–Gray models (sHR = 1.45, 95% CI: 1.09–1.93). In 12-month analyses, the overall survival association was attenuated, whereas the association with testicular cancer-specific death remained significant in the Fine–Gray model (sHR = 1.46, 95% CI: 1.03–2.07). Conclusions: Early-onset testicular germ cell tumors diagnosed during the COVID-19 period and in 2022–2023 showed a modest shift toward regional or distant-stage presentation, while diagnosis in 2022–2023 was associated with higher testicular cancer-specific mortality in competing-risk analyses. Full article

Background: The growing awareness of breast cancer’s molecular diversity has not changed the technical foundations of surgery itself, but it has profoundly reshaped how surgeons think about surgery. Rather than molecular biology prescribing specific surgery, it is the surgeon’s interpretation of biological behavior—tumor subtype, genomic risk, treatment responsiveness—that influences surgical timing, extent, and feasibility. This is particularly important in the developing world, where mastectomy continues to be the default surgery, not always because it is required, but because biological nuance is underutilized in surgical planning. This review integrates existing evidence, guidelines, and real-world clinical experience to show how a surgeon who understands tumor biology can meaningfully expand safe breast conservation, de-escalate axillary surgery, and align operative choices with systemic therapy. In essence, molecular biology becomes a lens through which surgeons can practice more personalized, precise, and less invasive surgery, without compromising oncologic safety. Recent findings: We present evidence-based algorithms focusing on Luminal A, Luminal B, HER2-positive, and triple-negative subtypes, while discussing the nuances of multifocal and multicentric disease, metaplastic histologies, and discordant lesion management. The review addresses axillary management in the molecular era, specifying the appropriateness of sentinel lymph node biopsy, targeted axillary dissection, or completion axillary dissection, and how subtype-specific nodal responses to neoadjuvant therapy can guide de-escalation strategies. Through clinical vignettes, we exemplify how molecular integration into surgical planning can modify clinical courses, enabling oncoplastic conservation in downstaged tumors and justifying definitive resection in chemo-resistant cases. We examine the implications of germline and somatic genetic testing on surgical decision-making, particularly in relation to BRCA1/2 and PALB2 mutation carriers, alongside ethical and practical counseling considerations. Additionally, we review emerging biomarkers—such as circulating tumor DNA and immune and radiomic signatures—and propose research priorities for their incorporation into surgical trials. Conclusions: Effective implementation necessitates enhanced surgeon education, standardized assays, and multidisciplinary coordination to promote equitable access, consistent utilization of biology-driven algorithms, and rigorous quality oversight. This review furnishes breast surgeons with a pragmatic framework for translating molecular knowledge into multidisciplinary, patient-centered care pathways that optimize oncological safety, aesthetic outcomes, and overall quality of life. Full article

Background: Acute appendicitis is the leading pediatric surgical emergency. Identifying drivers of disease severity and laparoscopic-to-open conversion remains critical for surgical planning. We evaluated the discriminative performance of clinical scores and inflammatory biomarkers for both peritonitis and surgical conversion, and explored combined clinical–laboratory models among children with acute appendicitis undergoing an initially attempted laparoscopic appendectomy. Methods: A retrospective study was conducted, including pediatric patients with acute appendicitis who underwent surgical treatment. Clinical scores (Alvarado score and Pediatric Appendicitis Score) and laboratory parameters (C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio) were analyzed. Receiver operating characteristic (ROC) curve analysis was used to assess discriminative ability, with calculation of the area under the curve (AUC). Combined models based on standardized variables were constructed and evaluated. Comparisons between AUCs were performed using DeLong’s test. Results: For prediction of peritonitis, clinical scores suggested good discriminative ability within the sample, with AUC values of 0.805 for the Alvarado score and 0.812 for the Pediatric Appendicitis Score, whereas C-reactive protein showed moderate performance (AUC = 0.735). Combined models achieved AUC values of 0.823 for both zPAS + zCRP and zAlvarado + zCRP, and 0.773 for zCRP + zNLR. For surgical conversion, higher within-sample AUC values were observed, reaching 0.879 for the Alvarado score and up to 0.932 for the combined models (zAlvarado + zCRP), followed by 0.926 for zPAS + zCRP and 0.874 for zCRP + zNLR. However, these results should be interpreted with caution due to the limited number of conversion events. Conclusions: Clinical scoring systems and inflammatory biomarkers suggested good ability to predict peritonitis in pediatric acute appendicitis, while their performance for predicting surgical conversion appeared higher but remains exploratory. Combined clinical–laboratory models showed promising within-sample discriminative ability; however, given the very small number of conversion events, these findings should be regarded as exploratory and hypothesis-generating only. Full article

Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups. Full article

Background: This study aims to evaluate the effect of postoperative posturing on graft detachment and rebubbling rates following Descemet Membrane Endothelial Keratoplasty (DMEK). Methods: This was an interventional comparative cohort study, assessing patients with and without posturing. All consecutive eyes requiring DMEK or phaco-DMEK were included in two chronological cohorts. The first cohort received strict 48 h postoperative posturing instructions, while the subsequent cohort received no posturing advice. Primary outcomes were graft detachment and rebubbling rates. Secondary outcomes were other adverse events and 6 months functionality. Results: A total of 119 eyes were included: 29 eyes in the posturing cohort (PC) and 90 eyes in the no-posturing cohort (no-PC). Forty-five eyes developed a graft detachment and rebubbling was performed in 38 eyes (37.8% resp. 31.9%). There was no significant difference in detachments (37.9% PC vs. 37.8% no-PC, p = 0.99) or rebubbling (31.0% PC vs. 32.2% no-PC, p = 0.91) between cohorts. Graft failure occurred twice in both cohorts (6.9% PC vs. 2.2% no-PC, p = 0.23). Conclusions: Abstaining from postoperative posturing did not impact the clinical outcomes of DMEK surgery. Eliminating posturing could reduce patient discomfort, health risks, and broaden eligibility for endothelial keratoplasty. Full article

Laser technology has recently gained renewed interest in hysteroscopic surgery due to advances in fiber-optic delivery systems, device miniaturization, and the growing adoption of office-based procedures. In this context, laser energy represents a potential alternative to conventional mechanical and electrosurgical techniques, particularly in settings where precision and tissue preservation are clinically relevant. This narrative review provides a comprehensive and clinically oriented overview of the role of laser technology in modern hysteroscopy. A literature search was conducted in PubMed, Scopus, and Web of Science up to December 2025, focusing on studies addressing technical aspects, clinical applications, safety, and outpatient feasibility of laser-assisted hysteroscopy. Different laser systems, including Nd:YAG, diode, CO₂, Ho:YAG, and KTP lasers, are discussed in terms of physical properties and tissue interaction. Current clinical applications include the management of intrauterine adhesions, submucous myomas, endometrial polyps, septate uterus, and selected cases of endometrial ablation. Available evidence suggests that modern diode laser platforms are particularly suited for office-based procedures due to their combined cutting and coagulative effects and compatibility with small-caliber hysteroscopes. However, most of the current literature is based on small, heterogeneous studies, and robust comparative data with standard hysteroscopic techniques remain limited. As a result, laser hysteroscopy cannot yet be considered a standard approach across indications. To move beyond a purely technical appraisal, this review also frames laser hysteroscopy as a potential translational platform in which laser–tissue interaction, biomarker-informed patient selection, endometrial repair biology, fertility outcomes, and adhesion-formation mechanisms may be integrated into future functional precision medicine pathways. In conclusion, laser technology represents a promising and evolving tool in operative hysteroscopy, with potential advantages in selected clinical scenarios. Further prospective and comparative studies are required to better define its role and to support its broader integration into routine clinical practice. Full article

Objective: Traumatic dislocation and fracture–dislocation of the hip are rare and severe injuries often associated with high-energy trauma. Early recognition and rapid, stable reduction are essential for successful treatment; otherwise, this type of injury is associated with poor functional outcomes and high rates of complications such as avascular necrosis. This retrospective study aims to describe and analyze long-term outcomes and survival rates after a hip dislocation. Methods: Between 2008 and 2021, all patients with traumatic hip dislocation who were treated in a Level I Trauma Center were retrospectively assessed and analyzed. During the follow-up examination, two experienced surgeons carried out a clinical follow-up examination and evaluated the available X-ray images. Anterior and posterior fracture–dislocations and femoral head fractures were classified according to Stewart and Milford’s and Pipkin’s classification system, respectively. All patients were followed up using the Harris Hip Score (HHS) and Lequesne score. Results: Forty-four (38 male and 6 female) patients with a mean age of 46.02 (±19.48) years were included. The average follow-up period was 45.69 (±45.69) months. Traffic accidents were the main cause of traumatic dislocation in this series, accounting for 75% of all cases. Associated injuries were noted in 28 cases. Twenty-three and 21 patients were treated with closed and open reduction, respectively. Isolated hip dislocations without bony involvement according to Stewart and Milford type 1 occurred in five cases. Type 3 injuries were most common, followed by type 4 injuries. This study found that the type of reduction and the trauma mechanism are not significant factors in long-term prognosis (p = 0.463). Thirteen patients had subjective excellent or good results in the HHS and Lequesne score. Late post-traumatic osteoarthritis of the hip developed in 10 patients (22.7%). Patients received a hip replacement at 20.7 months (1–102) months. Thus, after 2 years, implantation of a hip prosthesis due to post-traumatic coxarthrosis was necessary in 22.7% of all cases. The type of hip dislocation classified according to Stewart and Milford had no significant influence on the implantation of a hip prosthesis. Conclusions: Excellent or good results in HHS were obtained in patients with early, stable, and accurate reduction by closed or open methods. After 2 years, 22.7% of the patients needed a total hip replacement. Full article

Background/Objectives: This paper synthesizes and evaluates the potential origins of ectopic salivary gland pathologies in the human nasopharynx. By combining historical reports with an original comparative analysis, this study aims to clarify the precise anatomical and functional status of the proposed tubarial salivary-type glands. Methods: A literature search through December 2025 across major electronic databases identified 84 relevant publications on nasopharyngeal glandular pathologies. The methodological quality in the histomorphological literature was evaluated using the AQUA tool. Concurrently, histological samples were harvested from the inner Eustachian tube opening/torus tubarius region of human, canine, and rodent cadavers and analyzed using histomorphological and immunohistochemical protocols. Results: Most of the literature addressing histologically indicated nasopharyngeal glandular pathology described these findings as controversial, largely overlooking salivary gland origins. The AQUA appraisal identified significant vulnerabilities, showing a high risk of bias in the Study Design domain and yielding moderate inter-rater agreement (κ = 0.435). The empirical morphological study revealed mixed glands with strong mucous predominance in the torus tubarius region of humans and dogs, whereas rodents displayed exclusive PAS positivity within a trabecular stroma. Human samples uniquely demonstrated distinct compartmentalization, duct- and capsule-like formations, and negative α-amylase immunoreactivity. Conclusions: Our pilot empirical evidence, combined with the literature data, suggests a possible pathogenetic link between specific nasopharyngeal neoplasms and the baseline glandular structures of the human torus tubarius. Exhibiting traits of both major and minor salivary systems, the tubarial glands may represent an intermediate structural entity. Furthermore, the animal models utilized do not provide a completely reliable translational framework, highlighting the need for standardized research using fresh human biopsies. Full article

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson’s tumor, is a rare benign vascular lesion first described in 1923. Its pathogenesis involves thrombus formation influenced by stasis, trauma, hormones, or radiation, followed by endothelial proliferation and papillary formation. IPEH occurs in various anatomical locations, including the hand and wrist, with a predilection for the skin and subcutaneous tissues. Clinical presentation varies according to the site, ranging from asymptomatic slow-growing masses to syndromes caused by the compression of surrounding structures. Diagnosis relies on histopathology, supported by immunohistochemistry. Complete surgical excision remains the treatment of choice, with excellent prognosis and low recurrence rates. Full article

Background and Objectives: A number of published studies comparing transanal haemorrhoidal dearterialization (THD) and conventional haemorrhoidectomy (CH) have primarily focused on short-term outcomes, while data on long-term results remains scarce. This study aimed to compare Doppler-guided THD and CH with emphasis on both early and long-term postoperative results. Methods: This retrospective study included 336 patients who underwent CH (Group 1, n = 189) or Doppler-guided THD (Group 2, n = 147). The groups were compared according to demographic data, HD stage, symptoms, complications, duration of hospital stay, postoperative pain, patient satisfaction, and recurrence rates after 18 months of surgery. Results: There was no difference between groups regarding gender, although there were statistically significant distinctions in terms of disease stage and age (p < 0.001), with the emphasis that in CH group patients had advanced stage of disease and were older. THD was associated with significantly lower postoperative pain, with median visual analogue scale (VAS) scores on postoperative days 1, 2, and 7 of 5, 3, and 1, compared with 7, 5, and 3 after CH (p < 0.001). There was no difference in VAS on POD 30 between groups. Median hospital stay was significantly shorter after THD (1 vs. 3 days; p < 0.001). Patients undergoing CH required more analgesics, laxatives, and follow-up visits within the first postoperative month (p ≤ 0.008). Postoperative complications occurred in nine patients, without significant differences between groups. During the 18-month follow-up period, HD recurrence occurred in seven patients and was more frequent after THD. Additionally, two THD patients developed anal fissures. Conclusions: Doppler-guided THD is a safe and effective treatment for HD, providing reduced postoperative pain, faster recovery, and shorter hospitalization. Long-term outcomes were favourable in both groups, with a trend of lower recurrence rate in the CH group. Full article