Search Results (47)

Background: Mycobacterium ulcerans causes Buruli ulcer (BU), a necrotizing skin disease endemic in over 30 countries. Its toxin, mycolactone, drives tissue destruction, and the infection is transmitted via environmental reservoirs or vectors. Disease patterns vary globally, and an improved understanding of their pathogenesis may enhance current antimicrobial and surgical treatments. Methods: A comprehensive literature search from 1901 to 2025 was conducted across major databases to explore antimicrobial and reconstructive surgical strategies for Mycobacterium ulcerans. Search terms included BU, key antibiotics, and surgical interventions. Relevant English-language studies on treatment outcomes were reviewed to summarize evolving management trends and emerging therapeutic approaches. Results and Discussion: This review highlights the importance of early diagnosis and timely antimicrobial therapy in preventing disease progression and limb loss. It reviews WHO-recommended antibiotic regimens and discusses the theoretical risk of drug resistance, although clinical resistance remains rare and unreported in Australia. Surgical interventions in select cases are crucial, with timing being a significant factor in functional outcomes. The review also covers pediatric-specific challenges, including growth preservation and psychosocial support for young patients. Reconstructive options focus on limb salvage and staged reconstructions, with multidisciplinary care essential for optimal outcomes. The paper advocates for RCTs to refine treatment protocols, surgical guidelines, and explore emerging antibiotic therapies such as telacebec. Conclusions: BU remains a global health challenge, requiring early diagnosis, timely antimicrobial therapy, and surgery in selected cases. Future research will refine treatment and reduce long-term impacts. Full article

Background/Objectives: Artificial intelligence (AI) holds great potential to reshape the academic paradigm. They can process large volumes of information, assist in academic literature reviews, and augment the overall quality of scientific discourse. This narrative review examines the application of various AI tools in surgical research, its present capabilities, future directions, and potential challenges. Methods: A search was performed by two independent authors for relevant studies on PubMed, Cochrane Library, Web of Science, and EMBASE databases from January 1901 until March 2025. Studies were included if they were written in English and discussed the use of AI tools in surgical research. They were excluded if they were not in English and discussed the use of AI tools in medical research. Results: Forty-two articles were included in this review. The findings underscore a range of AI tools such as writing enhancers, LLMs, search engine optimizers, image interpreters and generators, content organization and search systems, and audio analysis tools, along with their influence on medical research. Despite the multitude of benefits presented by AI tools, risks such as data security, inherent biases, accuracy, and ethical dilemmas are of concern and warrant attention. Conclusions: AI could offer significant contributions to medical research in the form of superior data analysis, predictive abilities, personalized treatment strategies, enhanced diagnostic accuracy, amplified research, educational, and publication processes. However, to unlock the full potential of AI in surgical research, we must institute robust frameworks and ethical guidelines. Full article

Background: Microsurgery is a highly complex and technically demanding field within reconstructive surgery, with outcomes heavily dependent on meticulous planning, precision, and postoperative monitoring. Over the last five years, artificial intelligence (AI) has emerged as a transformative tool across all phases of microsurgical care, offering new capabilities in imaging analysis, intraoperative decision support, and outcome prediction. Methods: A comprehensive narrative review was conducted to evaluate the peer-reviewed literature published between 2020 and May 2025. Multiple databases, including PubMed, Embase, Cochrane, Scopus, and Web of Science, were searched using combinations of controlled vocabulary and free-text terms relating to AI and microsurgery. Studies were included if they described AI applications during the preoperative, intraoperative, or postoperative phases of microsurgical care in human subjects. Discussion: Using predictive models, AI demonstrated significant utility in preoperative planning through automated perforator mapping, flap design, and individualised risk stratification. AI-enhanced augmented reality and perfusion analysis tools improved precision intraoperatively, while innovative robotic platforms and intraoperative advisors showed early promise. Postoperatively, mobile-based deep learning applications enabled continuous flap monitoring with sensitivities exceeding 90%, and AI models accurately predicted surgical site infections, transfusion needs, and long-term outcomes. Despite these advances, most studies relied on retrospective single-centre data, and large-scale, prospective validation remains limited. Conclusions: AI is poised to enhance microsurgical precision, safety, and efficiency. However, its integration is challenged by data heterogeneity, generalisability concerns, and the need for human oversight in nuanced clinical scenarios. Standardised data collection and multicentre collaboration are vital for robust, equitable AI deployment. With careful validation and implementation, AI holds the potential to redefine microsurgical workflows and improve patient outcomes across diverse clinical settings. Full article

Preoperative facial markings are critical to surgical precision and aesthetic outcomes in plastic surgery, yet remain operator-dependent and variably documented. Generative artificial intelligence (AI), particularly large multimodal models, offers potential for the automated illustration of surgical plans. This study compares the performances of ChatGPT-4o and Gemini Advanced in generating standardised preoperative markings for aesthetic facial procedures. Methods: Six text prompts describing common facial aesthetic surgeries were developed using established marking protocols. Each prompt was submitted once to ChatGPT-4o and Gemini Advanced, yielding twelve illustrations. Three board-certified plastic surgeons independently evaluated the images using a five-domain Likert scale assessing incision clarity, anatomical accuracy, template conformity, clinical usefulness, and overall graphic quality. A composite score out of 25 was calculated. Data were analysed using paired t-tests, and interrater reliability was assessed with intraclass correlation coefficients. Results: ChatGPT-4o significantly outperformed Gemini Advanced in composite scores (mean 18.0 ± 1.4 vs. 13.9 ± 1.6, p = 0.001, Cohen’s d = 1.69). Superior performance was noted across all domains, particularly in clarity (mean difference 0.83, p = 0.002) and graphic quality (mean difference 0.90, p = 0.001). Interrater reliability was good (ICC = 0.82). Discussion: ChatGPT-4o demonstrated higher fidelity in translating surgical prompts into anatomically appropriate, clinically useful illustrations. However, neither system achieved the precision required for clinical implementation without revision. These models may serve as adjuncts in education and preliminary planning. Future work should explore model fine-tuning, surgeon-guided generation, and performance in reconstructive procedures. Full article

Background/Objectives: Mycobacterium ulcerans causes Buruli ulcers, typically manifesting as a single progressive necrotizing skin lesion. Rarely, non-contiguous “skip lesions” occur, complicating diagnosis and management. This report describes an atypical case and reviews similar presentations to emphasize early recognition and combined therapeutic strategies. Methods: A systematic literature review was performed using PubMed, Embase, Cochrane Library, Google Scholar, and Scopus databases until December 2024, focusing on cases involving skip lesions. Additionally, a detailed clinical case of a 68-year-old male from Mornington Peninsula, Australia, presenting skip lesions from the distal leg to the proximal knee was documented, including diagnostic PCR testing, surgical interventions, and antibiotic treatments. Results: Twelve studies were identified, totaling 1828 cases with 1179 exhibiting skip lesions. The majority achieved successful outcomes through combined antibiotic (rifampicin and clarithromycin) and surgical management. The reported case initially underwent surgical excision without antibiotics, leading to recurrence. Subsequent comprehensive management combining additional surgical debridement and adjusted antibiotics successfully resolved the infection. Conclusions: Although rare, skip lesions significantly complicate the clinical management of Buruli ulcers. Early diagnosis and a multidisciplinary approach integrating surgical debridement and antibiotic therapy are critical for optimal outcomes and minimizing recurrence risks. Full article

Background: Myopericytoma is a rare benign vascular tumour characterised by concentric spindle cell proliferation around blood vessels, often misdiagnosed due to its resemblance to other soft tissue masses. Dupuytren’s disease (DD), a fibroproliferative disorder of the palmar fascia, causes progressive contractures, typically affecting the ring and little fingers. While these conditions are well-documented individually, their coexistence in the same region is rare and diagnostically challenging. Case Presentation: This report highlights a 67-year-old male with longstanding DD and a recurrent palmar mass initially attributed to fibrosis. Magnetic resonance imaging revealed hallmark vascular features suggestive of myopericytoma, confirmed by histopathological analysis showing spindle cell proliferation and immunohistochemical positivity for alpha-smooth muscle actin and h-caldesmon. Concurrent DD, characterised by fibrosis and activated myofibroblasts, further complicated the clinical picture. Methodology: PubMed, Scopus, Web of Science, and Embase databases were searched from January 1901 to December 2024, and 20 studies were found, reporting 41 cases of myopericytoma in hand and upper extremity. Histopathological analysis consistently showed spindle cell proliferation and smooth muscle actin positivity. Coexistence with DD was rare, highlighting the need for detailed imaging and histological evaluation for accurate diagnosis. Conclusions: This case emphasises the complexity of differentiating overlapping pathologies. Surgical excision of myopericytoma and tailored DD management yielded favourable outcomes. Further research into shared fibroinflammatory pathways, including tumour necrosis factor-alpha and interleukin-6, may enhance diagnostic accuracy and treatment strategies for overlapping conditions. Full article

Background and Objectives: Along with the ageing of the population, cancer and cardiovascular (CV) diseases more frequently coexist, complicating patients’ management. Here, we focus on elderly oncologic patients, describing clinical features and comorbidities, discussing therapeutic management CV risk factors and CV complications risen during our CV follow-up, and exploring the different items of the comprehensive geriatric assessment (CGA) and the correlation between cardiac function by means of standard 2D echocardiography and each of the CGA items. Methods: A total of 108 consecutive patients (mean age 73.55 ± 5.43 years old; 40.7% females) referred to our cardio-oncology unit were enrolled, and three different groups were identified: Group 1, patients naïve for oncologic treatments (mean age 73.32 ± 5.40; 33% females); Group 2, patients already on antineoplastic protocols (mean age 73.46 ± 5.09; 44.1% females); and Group 3, patients who had already completed cancer treatments (mean age 74.34 ± 6.23; 55% female). The correlation between CGA, performed in a subgroup of 62 patients (57.4%), and echocardiographic parameters was assessed. Results: Group 2 patients had the highest incidence of CV events (CVEs) (61.8% vs. 14.8% in Group 1, 15% in Group 3; p ≤ 0.001) and withdrawals from oncologic treatments (8.8% vs. none in Group 1; p = 0.035). Group 2 had worse 48-month survival (47.1% vs. 22.2% in Group 1, 20% in Group 3; p = 0.05), which was even more evident when focusing on patients who died during follow-up. When assessing echocardiographic parameters, physical activity showed an inverse correlation with the left ventricular mass index (p = 0.034), while the Frailty index showed a direct correlation with the E/e’ ratio (p = 0.005). Conclusions: A thorough baseline CV assessment is important in elderly oncologic patients eligible for anticancer treatment. In this population, CGA can be a simple, feasible screening tool that might help identify patients at a greater risk of developing CVEs correlating to several pivotal cardiovascular parameters. Full article

Background: Burn injuries require accurate assessment for effective management, and artificial intelligence (AI) is gaining attention in burn care for diagnosis, treatment planning, and decision support. This study compares the effectiveness of AI-driven models with experienced plastic surgeons in burn assessment and management. Methods: Ten anonymized burn images of varying severity and anatomical location were selected from publicly available databases. Three AI systems (ChatGPT-4o, Claude, and Kimi AI) analyzed these images, generating clinical descriptions and management plans. Three experienced plastic surgeons reviewed the same images to establish a clinical reference standard and evaluated AI-generated recommendations using a five-point Likert scale for accuracy, relevance, and appropriateness. Statistical analyses, including Cohen’s kappa coefficient, assessed inter-rater reliability and comparative accuracy. Results: AI models showed high diagnostic agreement with clinicians, with ChatGPT-4o achieving the highest Likert ratings. However, treatment recommendations varied in specificity, occasionally lacking individualized considerations. Readability scores indicated that AI-generated outputs were more comprehensible than the traditional medical literature, though some recommendations were overly simplistic. Cohen’s kappa coefficient suggested moderate to high inter-rater agreement among human evaluators. Conclusions: While AI-driven models demonstrate strong diagnostic accuracy and readability, further refinements are needed to improve treatment specificity and personalization. This study highlights AI’s potential as a supplementary tool in burn management while emphasizing the need for clinical oversight to ensure safe and individualized patient care. Full article

Background: Artificial intelligence (AI) and large language models (LLMs) are increasingly used in healthcare, with applications in clinical decision-making and workflow optimization. In head and neck surgery, postoperative rehabilitation is a complex, multidisciplinary process requiring personalized care. This study evaluates the feasibility of using LLMs to generate tailored rehabilitation programs for patients undergoing major head and neck surgical procedures. Methods: Ten hypothetical head and neck surgical clinical scenarios were developed, representing oncologic resections with complex reconstructions. Four LLMs, ChatGPT-4o, DeepSeek V3, Gemini 2, and Copilot, were prompted with identical queries to generate rehabilitation plans. Three senior clinicians independently assessed their quality, accuracy, and clinical relevance using a five-point Likert scale. Readability and quality metrics, including the DISCERN score, Flesch Reading Ease, Flesch–Kincaid Grade Level, and Coleman–Liau Index, were applied. Results: ChatGPT-4o achieved the highest clinical relevance (Likert mean of 4.90 ± 0.32), followed by DeepSeek V3 (4.00 ± 0.82) and Gemini 2 (3.90 ± 0.74), while Copilot underperformed (2.70 ± 0.82). Gemini 2 produced the most readable content. A statistical analysis confirmed significant differences across the models (p < 0.001). Conclusions: LLMs can generate rehabilitation programs with varying quality and readability. ChatGPT-4o produced the most clinically relevant plans, while Gemini 2 generated more readable content. AI-generated rehabilitation plans may complement existing protocols, but further clinical validation is necessary to assess their impact on patient outcomes. Full article

Background: The superficial temporal artery (STA) typically bifurcates into frontal and parietal branches in the temporal region. This study describes a rare anatomical variation identified during a cadaveric dissection where the STA presented an early cervical bifurcation. Methods: A cadaveric dissection was performed on a 58-year-old Caucasian female specimen injected with synthetic polymers. The STA was meticulously dissected, and anatomical findings were documented through photographs and measurements. Results: An unusual cervical bifurcation of the STA was observed. The frontal and parietal branches originated at the level of the posterior belly of the digastric muscle, ascending separately. The anterior branch, identified as the frontal branch, coursed below the facial nerve and stylomastoid artery, reaching the temporal line without further branching after giving the transverse facial artery as the only collateral branch. The posterior parietal branch extended posteriorly to the external acoustic meatus, compensating for the absence of the posterior auricular artery. This anatomical variation might influence surgical approaches to the head and neck region, particularly in parotid and reconstructive surgeries. Discussion: Variations in STA anatomy can significantly impact clinical practices, including reconstructive surgery, vascular interventions, and esthetic procedures. Imaging techniques, though useful, may not detect such rare variants. Cadaveric dissection remains a crucial tool for detailed anatomical assessment. Conclusions: This study highlights the importance of recognizing the STA’s vascular variations for safe surgical planning and improving patient outcomes. Further studies correlating imaging findings with cadaveric dissections are recommended. Full article

Background: Hand fracture management requires precise diagnostic accuracy and complex decision-making. Advances in artificial intelligence (AI) suggest that large language models (LLMs) may assist or even rival traditional clinical approaches. This study evaluates the effectiveness of ChatGPT-4o, DeepSeek-V3, and Gemini 1.5 in diagnosing and recommending treatment strategies for hand fractures compared to experienced surgeons. Methods: A retrospective analysis of 58 anonymized hand fracture cases was conducted. Clinical details, including fracture site, displacement, and soft-tissue involvement, were provided to the AI models, which generated management plans. Their recommendations were compared to actual surgeon decisions, assessing accuracy, precision, recall, and F1 score. Results: ChatGPT-4o demonstrated the highest accuracy (98.28%) and recall (91.74%), effectively identifying most correct interventions but occasionally proposing extraneous options (precision 58.48%). DeepSeek-V3 showed moderate accuracy (63.79%), with balanced precision (61.17%) and recall (57.89%), sometimes omitting correct treatments. Gemini 1.5 performed poorly (accuracy 18.97%), with low precision and recall, indicating substantial limitations in clinical decision support. Conclusions: AI models can enhance clinical workflows, particularly in radiographic interpretation and triage, but their limitations highlight the irreplaceable role of human expertise in complex hand trauma management. ChatGPT-4o demonstrated promising accuracy but requires refinement. Ethical concerns regarding AI-driven medical decisions, including bias and transparency, must be addressed before widespread clinical implementation. Full article

Background: Dupuytren’s fibroproliferative disease affecting the hand’s palmar fascia leads to progressive finger contractures and functional limitations. Management of this condition relies heavily on the expertise of hand surgeons, who tailor interventions based on clinical assessment. With the growing interest in artificial intelligence (AI) in medical decision-making, this study aims to evaluate the feasibility of integrating AI into the clinical management of Dupuytren’s disease by comparing AI-generated recommendations with those of expert hand surgeons. Methods: This multicentric comparative study involved three experienced hand surgeons and five AI systems (ChatGPT, Gemini, Perplexity, DeepSeek, and Copilot). Twenty-two standardized clinical prompts representing various Dupuytren’s disease scenarios were used to assess decision-making. Surgeons and AI systems provided management recommendations, which were analyzed for concordance, rationale, and predicted outcomes. Key metrics included union accuracy, surgeon agreement, precision, recall, and F1 scores. The study also evaluated AI performance in unanimous versus non-unanimous cases and inter-AI agreements. Results: Gemini and ChatGPT demonstrated the highest union accuracy (86.4% and 81.8%, respectively), while Copilot showed the lowest (40.9%). Surgeon agreement was highest for Gemini (45.5%) and ChatGPT (42.4%). AI systems performed better in unanimous cases (accuracy up to 92.0%) than in non-unanimous cases (accuracy as low as 35.0%). Inter-AI agreements ranged from 75.0% (ChatGPT-Gemini) to 48.0% (DeepSeek-Copilot). Precision, recall, and F1 scores were consistently higher for ChatGPT and Gemini than for other systems. Conclusions: AI systems, particularly Gemini and ChatGPT, show promise in aligning with expert surgical recommendations, especially in straightforward cases. However, significant variability exists, particularly in complex scenarios. AI should be viewed as complementary to clinical judgment, requiring further refinement and validation for integration into clinical practice. Full article

Minimally invasive treatments for Dupuytren’s disease (DD), such as percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH), have become alternatives to open surgeries. This meta-analysis compared these treatments in terms of complications, patient satisfaction, clinical outcomes, and recurrence. Relevant studies up to June 2024 were identified through major databases, following PRISMA guidelines, and the study was registered on PROSPERO. Statistical analysis using Review Manager 5.4 found PNF had lower post-operative rates of oedema (RR = 0.15, 95% CI [0.09, 0.27], p < 0.00001), lymphadenopathy (RR = 0.09, 95% CI [0.02, 0.38], p = 0.0010), and pruritus (RR = 0.1, 95% CI [0.01, 0.73], p = 0.02) compared to CCH. However, there were no significant differences in skin tears, recurrence, reintervention, extension deficit, or residual flexion at metacarpal and proximal interphalangeal joints (p > 0.05). Patient-reported outcomes, including QuickDASH and URAM scores, also showed no significant differences. Eleven studies involving 1443 patients were analysed, and most were at a low-to-moderate risk of bias, as assessed using the Cochrane or Newcastle–Ottawa tools. While PNF showed fewer minor complications, overall clinical and patient-reported outcomes were comparable between the treatments. These findings highlight the need to tailor treatment choices to patient preferences and clinical context. Full article

Background/Objectives: Digital twin technology, initially developed for engineering and manufacturing, has entered healthcare. In plastic surgery, digital twins (DTs) have the potential to enhance surgical precision, personalise treatment plans, and improve patient outcomes. This systematic review aims to explore the current use of DTs in plastic surgery and evaluate their effectiveness, challenges, and future potential. Methods: A systematic review was conducted by searching PubMed, Scopus, Web of Science, and Embase databases from their infinity to October 2024. The search included terms related to digital twins and plastic surgery. Studies were included if they focused on applying DTs in reconstructive or cosmetic plastic surgery. Data extraction focused on study characteristics, technological aspects, outcomes, and limitations. Results: After 110 studies were selected for screening, 9 studies met the inclusion criteria, covering various areas of plastic surgery, such as breast reconstruction, craniofacial surgery, and microsurgery. DTs were primarily used in preoperative planning and intraoperative guidance, with reported improvements in surgical precision, complication rates, and patient satisfaction. However, challenges such as high costs, technical complexity, and the need for advanced imaging and computational tools were frequently noted. Limited research exists on using DTs in postoperative care and real-time monitoring. Conclusions: This systematic review highlights the potential of digital twins to revolutionise plastic surgery by providing personalised and precise surgical approaches. However, barriers such as cost, complexity, and ethical concerns must be addressed. Future research should focus on validating clinical outcomes through large-scale studies and developing soft tissue modelling and real-time monitoring capabilities. Full article

Soft tissue reconstruction in the lower limbs presents a significant challenge, particularly when addressing defects in the distal third of the leg, ankle, and foot. The reverse sural flap reliant on the perforating branches of the peroneal artery has emerged as a versatile option, offering a solution for patients for whom microsurgical techniques are not feasible. Despite its advantages, the procedure carries inherent risks, especially in populations with underlying conditions, such as venous insufficiency, cardiovascular disease, and diabetes, as well as in elderly patients, where the likelihood of flap necrosis is elevated. This report details a case of reverse sural flap necrosis in a patient with lupus-like syndrome, a complex scenario that underscores the need for meticulous preoperative assessment and planning. The case illustrates not only the technical considerations and challenges associated with the reverse sural flap but also the broader implications of systemic autoimmune disorders on postoperative outcomes. Through a comprehensive review of the literature, we explore the relationship between vascularization, autoimmune profiles, and the success of reverse sural flap procedures. We highlight the critical need for surgeons to adopt a holistic approach to patient evaluation, considering both local and systemic factors that may influence the viability of the flap and the overall reconstructive success. Full article