Search Results (2,331)

Objectives: To characterise longitudinal structural and functional retinal restoration after inverted internal limiting membrane (ILM) flap surgery for idiopathic full-thickness macular holes (FTMHs), with a particular emphasis on postoperative glial proliferation, outer retinal restoration, and structure–function relationships. Methods: This retrospective consecutive case series included 46 eyes of 44 patients with idiopathic FTMH treated using the inverted ILM flap technique. Spectral-domain optical coherence tomography (SD-OCT), best-corrected visual acuity (BCVA), microperimetry, fixation stability, and multifocal electroretinography (mfERG) were performed 1, 6, and 12 months postoperatively. Results: Anatomical closure was achieved in all eyes. Complete restoration of both the ELM and EZ increased from 8.7% at 1 month to 45.7% at 6 months and 54.3% at 12 months, whereas severe glial proliferation decreased from 30.4% to 15.2% at 12 months. BCVA, retinal sensitivity, fixation stability, and central mfERG responses improved predominantly between 1 and 6 months postoperatively. In multivariable analysis, lower closure-pattern grade (B = −0.073, 95% CI: −0.141 to −0.005; p = 0.035) and lower glial proliferation grade (B = −0.091, 95% CI: −0.155 to −0.027; p = 0.006) were independently associated with better BCVA at final visit. Conclusions: Retinal healing after inverted ILM flap surgery is a coordinated, time-dependent process involving regression of postoperative gliosis, restoration of the outer retinal microstructure, and multimodal functional recovery. Longitudinal integration of OCT with microperimetry, fixation analysis, and mfERG provides a comprehensive framework for understanding postoperative retinal remodelling beyond anatomical hole closure. Full article

Background: Phyllodes tumors (PTs) are rare fibroepithelial breast neoplasms spanning a benign-to-malignant spectrum, and the extent of surgery and reconstruction differs markedly by histologic grade. The primary aim of this study was to derive a grade-stratified surgical and reconstructive algorithm. Methods: The charts of patients diagnosed with phyllodes tumor at Kyungpook National University Chilgok Hospital between January 2011 and February 2026 were retrospectively reviewed. Tumors were classified by World Health Organization criteria as benign, borderline, or malignant, and the treatment protocols, extent of surgery, and immediate reconstruction after mastectomy were analyzed. Results: Of 417 patients charted, 401 were confirmed to have phyllodes tumors and 334 carried a definitive histologic grade. Together, they formed the analyzed cohort: 251 benign (75.1%), 55 borderline (16.5%), and 28 malignant (8.4%). Benign tumors were managed predominantly by breast-conserving surgery (BCS). Twenty-six patients formed the surgical cohort, defined by the reconstructive requirement of the resection defect: all total mastectomies (n = 19) together with all breast-conserving resections reconstructed by the plastic surgical team (oncoplastic breast-conserving surgery, n = 7). Reconstruction was performed in 21 (80.8%) with latissimus dorsi-based flaps, local flaps, or direct-to-implant reconstruction. Adjuvant radiotherapy was confined to malignant disease (7 of 15 malignant PTs, 46.7%; p = 0.010). Over a median follow-up of 32.7 months, local recurrence developed in four patients (15.4%) and two malignant tumors were fatal. In an illustrative case of recurrent malignant PT with rib metastasis, a widely opened pleural cavity was sealed with a single sheet of non-fenestrated acellular dermal matrix (ADM), which was found to be fully incorporated and still sealing the pleura at later implant explantation. Conclusions: A grade-stratified strategy (BCS for benign tumors and mastectomy with reconstruction for borderline/malignant disease) balances oncologic safety with aesthetic outcome. Full article

Background: Horizontal alveolar ridge deficiencies resulting from tooth loss, implant failure, trauma, or advanced ridge atrophy frequently require augmentation before prosthetically driven implant placement can be achieved. Flexible allogeneic cortical bone laminae have been introduced as biologic containment devices that also eliminate the need for titanium mesh or non-resorbable barrier membranes. Methods: Three patients presenting with horizontal ridge deficiencies were treated using guided bone regeneration (GBR) with flexible allogeneic laminar bone combined with particulate mineralized and demineralized cortical allografts. The laminar bone was adapted beneath full-thickness flaps to ensure semi-rigid containment of the graft material and maintenance of the regenerative space. Clinical and radiographic healing were evaluated using periapical radiographs and cone beam computed tomography (CBCT). Implants were placed following healing, and patients were followed up with for up to three years. Results: All treated sites demonstrated successful horizontal ridge augmentation with preservation of ridge contours and sufficient bone volume for implant placement. Primary implant stability of at least 35 Ncm was achieved in the documented cases. CBCT evaluation confirmed bone formation along the buccal aspect of the implants and maintenance of ridge dimensions. No graft collapse, membrane exposure, infection, or donor-site morbidity was observed. Long-term follow-ups demonstrated stable peri-implant hard- and soft-tissue conditions. Conclusions: Flexible allogeneic laminar bone used in combination with a particulate allograft appears to be a predictable and minimally invasive approach for horizontal ridge augmentation and implant site development. The technique offers effective space maintenance, favorable ridge contour preservation, and stable regenerative outcomes while reducing surgical morbidity associated with traditional augmentation procedures. This report demonstrates clinical feasibility and that larger prospective controlled studies with quantitative outcome assessments are needed to confirm these preliminary observations. Full article

A provenance-audited load transfer and structural screening workflow is presented for a 28 g, 25 Hz hummingbird-inspired mechanism. A saved unsteady vortex lattice case is linked to Autodesk Inventor load curves and motion load-informed static studies. The Curve_Example_90 record describes a 90 mm semi-span wing under prescribed 25 Hz kinematics. Its cycle 3–4 phasewise vector RMS difference is 0.0466 N (53.1% of the final-cycle vector RMS), so the latest complete cycle supports deterministic export rather than aerodynamic convergence. Positive-span panel forces were summed, transformed into Inventor axes, and interpolated without amplitude scaling; the maximum exported resultant is 0.17599 N. A normalized 16-position index map is declared between saved aerodynamic time and Inventor report time, but the retained files do not prove an encoder-defined absolute stroke-phase origin. All 96 intended component–phase records are identity-qualified. The aluminium 6061 maxima are 14.82 MPa for the force bar, 6.98 MPa for the wing-link bar, and 0.0134 MPa for the motion bar. Corrected PLA properties are serialized in the latest force bar link and wing bar reports, while the rotation pin report retains obsolete material metadata. Solution timestamps, displacements, and safety factors further show that the polymer export mixes refreshed and cached states, so polymer capacity is withheld. The common three-pass adaptive mesh setting improves within-study refinement but is not an independent mesh convergence study. The study is an empirical-to-numerical hypothesis check and design fault screen, not an aerodynamic or structural optimisation campaign; mesh-converged capacity, synchronized force/deformation validation, and print-calibrated material claims remain outside its evidence boundary. Full article

Stromal keratophakia was first introduced by Jose Ignacio Barraquer in the 1960s as a refractive procedure involving the implantation of a stromal lenticule into a lamellar keratectomy bed of a recipient cornea. By increasing central corneal thickness, the added lenticule induced steepening of the anterior corneal curvature, thereby increasing the refractive power. However, due to the technical limitations of the mechanical microkeratome and the use of cryolathed tissue, early clinical outcomes were often inconsistent and included risks of stromal necrosis, epithelial ingrowth, induced astigmatism, slow visual recovery, and corneal haze. Despite these limitations, Barraquer’s law of thickness laid the groundwork for modern refractive surgery, including Laser-In Situ Keratomileusis (LASIK). The advancement of femtosecond laser technology has enabled the creation of precise and accurate refractive lenticules, stromal flaps, and pockets. This, in turn, has renewed interest in stromal keratophakia and facilitated the emergence of keratorefractive lenticule extraction (KLEx) procedures, through which stromal lenticules are obtained. These lenticules can be preserved and repurposed for various therapeutic and refractive applications. In this review, we provide a comprehensive overview of KLEx-derived lenticule processing and biobanking, their reuse for hyperopia and presbyopia correction, and their therapeutic potential in stromal thickness restoration, cell-based tissue engineering, drug delivery, corneal structural and macular hole repair, and glaucoma drainage tube coverage. Full article

Background/Objectives: Early recovery after major head-and-neck reconstruction is not determined by flap survival alone. This exploratory study examined whether preoperative frailty-inflammatory phenotypes are associated with delayed swallowing recovery, persistent nutritional dependence, and poorer quality of life at 12 weeks. Methods: In a prospective single-center cohort study, 84 adults undergoing major head-and-neck oncologic reconstruction were assigned to three clinically defined phenotypes: low-risk (n = 28), intermediate (n = 29), and combined frailty-inflammatory (n = 27). Twelve-week outcomes included the Functional Oral Intake Scale (FOIS), MDADI, EORTC global health, PEG dependence, and a composite poor-recovery endpoint. Because of the small sample size, all estimates are reported to two significant figures, and every analysis is regarded as hypothesis-generating. Results: Compared with the low-risk group, the combined phenotype was older (63 ± 9 vs. 55 ± 9 years) and had a higher mFI-5 (3.2 ± 0.6 vs. 1.0 ± 0.7) and CRP/albumin ratio (2.2 ± 0.6 vs. 0.6 ± 0.2; all p < 0.001). At 12 weeks the combined phenotype showed greater weight loss (12 ± 2%), lower FOIS (3.2 ± 1.3), lower MDADI (51 ± 7), and PEG dependence in 52% (all p ≤ 0.002). A higher mFI-5 was associated with poor recovery (adjusted OR 2.1 per point; 95% CI 1.0–4.1; p = 0.04), an estimate whose confidence interval is wide and imprecise. Conclusions: In this small cohort a frailty-inflammatory framework was associated with clinically meaningful heterogeneity in early recovery. The findings are preliminary and require prospective, adequately powered, multicenter validation before any clinical use. Full article

Background/Objectives: This exploratory meta-research study evaluated study design, reconstructive modalities, and outcome documentation within a non-systematically assembled corpus of facial basal cell carcinoma (BCC) reconstruction studies. The corpus was curated for a parent project, coding relied on narrative matrix fields, and no duplicate full-text extraction was available; frequencies should therefore be interpreted as minimum documentation estimates within this corpus. Methods: We analyzed a frozen matrix of 72 clinical studies with final issue years from 2015 through 2026 (analytic cutoff, 31 July 2026). Prespecified coding distinguished BCC-only from mixed-histology studies and separated any patient-reported endpoint, validated patient-reported outcome measures (PROMs), nonvalidated satisfaction assessments, observer-rated measures, and mixed patient/observer instruments. Associations with prospective design were exploratory. Results: Fifty-nine studies (81.9%) were retrospective, seven (9.7%) comparative, and three (4.2%) multicenter; forty (55.6%) were coded BCC-only. Local or locoregional flaps appeared in 48 matrix records (66.7%). Aesthetic outcomes were documented in 47 (65.3%), complications in 45 (62.5%), function in 27 (37.5%), and any patient-reported endpoint in 9 (12.5%). Four records (5.6%) documented a validated PROM; five (6.9%) named any standardized instrument, including one observer-only VSS assessment. Prospective studies more often documented patient-reported endpoints (4/9 vs. 5/63; OR 9.28, 95% CI 1.87–46.01; p = 0.011) and validated PROMs (3/9 vs. 1/63; OR 31.00, 95% CI 2.77–346.32; p = 0.005), but event counts were sparse and estimates were unadjusted. No matrix record documented all five prespecified outcome domains. Conclusions: Within this curated corpus, retrospective and noncomparative designs predominated and validated patient-centered measurement was uncommon. These findings are hypothesis-generating, do not estimate comparative effectiveness, and should not be generalized to the complete facial BCC reconstruction literature. A reproducible systematic review with duplicate full-text extraction remains necessary. Full article

The free fibula flap (FFF) is a reference reconstructive option, particularly for extensive mandibular defects. This narrative review examines the evolution of implant–prosthetic rehabilitation from conventional free-hand reconstruction to prosthetically driven digital workflows. A structured, non-systematic search of PubMed/MEDLINE, Scopus, and Web of Science included English-language publications from 1989 to May 2026. Early approaches were limited by anatomical discrepancies, unfavorable implant positioning, excessive prosthetic space, and difficult peri-implant maintenance. Surgical refinements, including double-barrel reconstruction and soft-tissue procedures, improved rehabilitative conditions in selected cases. Virtual surgical planning, CAD/CAM guides, patient-specific fixation, and guided implant placement subsequently enabled closer coordination of reconstruction, implant positioning, and prosthetic design, supporting immediate protocols such as Jaw-in-a-Day. However, the available evidence remains heterogeneous and predominantly retrospective. Although digital workflows may improve accuracy and operative efficiency, their superiority in terms of long-term biological, prosthetic, functional, and patient-reported outcomes has not been conclusively demonstrated. Emerging technologies, including augmented reality, robotics, artificial intelligence, and digital twins, remain largely preliminary. Full article

Temporomandibular joint (TMJ) defects primarily arise from congenital malformations, bony ankylosis, and radical tumor resection. As a pivotal structure for regulating maxillofacial development and maintaining stomatognathic homeostasis, the anatomical restoration and functional reconstruction of the TMJ are essential for rehabilitating the dentofacial complex. Distinct from standard mandibular reconstruction, TMJ reconstruction is inherently more complex, with treatment heavily dependent on etiology, age, defect extent, and coexisting dentofacial deformities—factors that invariably require patient-specific protocols. This review systematically evaluates current reconstructive paradigms, including free bone grafting (costochondral and coronoid process grafting, vertical ramus osteotomy), vascularized free flaps (vascularized fibula, vascularized medial femoral condyle, and deep circumflex iliac artery flaps), mandibular ramus distraction osteogenesis, and total joint replacement. We provide a critical analysis of their respective clinical indications, advantages, and limitations, while discussing emerging trends and future perspectives in the field. Full article

Background: Reconstruction with megaprostheses is an important limb-salvage option in cases of bone tumors and metastases, as it allows extensive bone resection while preserving the limb. However, postoperative shoulder instability remains a frequent complication. Although implant instability is one of the leading causes of treatment failure, the factors contributing to it are still not clearly defined. This study analyzes the correlation between resection length, implant type, and involvement of the deltoid and rotator cuff in relation to postoperative instability and the risk of postoperative dislocation. Methods: Twenty-five patients treated at our institution between 2014 and 2025 who underwent proximal humerus replacement with a megaprosthesis were included. Patients were divided into two groups: those with postoperative dislocation (Group A) and those without (Group B). Functional outcomes were assessed using the MSTS and DASH scores. The mean follow-up was 20.38 ± 11.87 months. Results: Of the twenty-five patients included, six (24%) experienced instability and subsequent dislocation (Group A). Rotator cuff invasion was present in 100% of Group A and 36.8% of Group B (p < 0.001), while deltoid invasion was present in 83.3% of Group A and 21% of Group B (p = 0.001). The mean resection length was 14.4 ± 2.2 cm in Group A and 13.7 ± 3.7 cm in Group B (p = 0.636). No significant differences were found between the groups in DASH and MSTS scores. Conclusions: In this cohort, rotator cuff and deltoid involvement were significantly associated with postoperative shoulder instability following proximal humerus megaprosthetic reconstruction. These findings suggest that careful preoperative assessment of rotator cuff and deltoid involvement may help identify patients at higher risk of postoperative instability and optimize surgical planning. Future studies should focus on preoperative planning and the development of a risk score to identify patients at higher risk of instability, potentially allowing for additional procedures such as latissimus dorsi flap reconstruction. Full article

Dental rehabilitation of fibula free flap mandibular reconstructions can be limited by the reduced vertical bone height available for implant placement. This study evaluated the biomechanical influence of ultra-short, extra-short, and conventional implants in a reconstructed fibula. Methods: A patient-specific finite element model of a fibula-reconstructed mandible was developed. Three splinted implants with a diameter of 4 mm and lengths of 3, 5, or 12 mm were compared under postoperative unilateral molar loading. Von Mises stresses were evaluated in the implants, fibula, residual mandible, and fixation plates, while equivalent elastic strain was assessed in peri-implant bone. Results: Implant length had minimal influence on implant stress (36.8–37.1 MPa) and fibular cortical bone stress (52.5–53.1 MPa). The 5 mm implants produced the lowest peri-implant strains and the lowest posterior reconstruction-plate stress (71.3 MPa), compared with 75.4 MPa for 3 mm and 107.8 MPa for 12 mm implants. The 12 mm implants generated greater apical strain concentrations, exceeding the adopted mechanobiological threshold around the central and mesial implants. Conclusions: Within the limitations of this study and under the simulated immediate postoperative loading condition, shorter implants, particularly 5 mm implants, showed a favorable biomechanical response. Full article

Background: Pleomorphic adenoma is the most common benign salivary-gland neoplasm and frequently affects the minor salivary glands of the palate. Although surgical excision is generally curative, incomplete encapsulation, pseudopod-like extensions, and microscopic tumor deposits may contribute to recurrence, which can occur many years after initial treatment. Recurrent palatal pleomorphic adenoma is uncommon and may present diagnostic and reconstructive challenges. Case Presentation: A 64-year-old man was referred with a painless, slowly enlarging recurrent mass of the right posterior hard palate, six years after excision of a pleomorphic adenoma at another institution. Magnetic resonance imaging and contrast-enhanced computed tomography demonstrated a well-defined enhancing palatal lesion measuring approximately 2.1 × 1.9 × 1.9 cm on MRI and 1.8 × 2.2 × 1.9 on CT, without adjacent maxillary bone destruction or cervical lymphadenopathy. An incisional biopsy was consistent with pleomorphic adenoma. Wide local excision was performed, including the tumor, surrounding palatal soft tissue, and underlying periosteum. The resulting defect was reconstructed using a facial artery musculomucosal flap. The postoperative course was uneventful, with satisfactory flap healing and preservation of speech and swallowing. At six months of follow-up, there was no clinical evidence of recurrence or functional impairment. Conclusions: Recurrent pleomorphic adenoma of the palate may develop several years after primary treatment. Complete surgical excision with tumor-free margins and appropriate reconstruction is essential. Long-term clinical follow-up is recommended because late recurrence and, rarely, malignant transformation may occur. Full article

Background: Opaque bubble layers (OBLs) are a common intraoperative complication during flap creation in femtosecond laser-assisted LASIK (FS-LASIK). This study aims to evaluate how cone and flap sizes can be optimized to minimize OBL risk in VISUMAX 800 FS-LASIK. Methods: This was a retrospective chart review of patients who underwent LASIK with the VISUMAX 800. Eyes were grouped by cone size and laser settings into S cone/M settings and M cone/L settings, in addition to OBL status (OBL vs. non-OBL). Generalized estimating equations were used to account for inter-eye correlation. Flap–cone edge gap was quantified from intraoperative images using FIJI (version 2.17.0, ImageJ). Results: OBL developed in 17 of 226 eyes (7.5%). The majority of OBLs (15/17) occurred in the M cone with L setting group. Eyes that developed OBLs had larger WTWs (p < 0.001) and larger mean flap diameters (p < 0.001). Among eyes with M cones and L settings, image analysis revealed that the average gap between flap and cone edge was significantly larger in the OBL group (p = 0.007). Conclusions: Our findings support the use of VISUMAX 800 in FS-LASIK and suggest that OBL formation may be associated with the distance between flap and cone edges, with larger average flap–cone gaps observed in eyes that developed OBL. Full article

Background: Traumatic auricular amputation represents a rare but complex reconstructive challenge, and numerous surgical techniques have been developed over the past century to optimize functional and aesthetic outcomes. This historical review examines current auricular reattachment and replantation strategies by comparing established surgical techniques for traumatic auricular amputation. Methods: A historical literature search was conducted in PubMed to identify relevant case reports on auricular reconstruction following amputation, dating from 1898 to the present. Eligible studies were reviewed according to the surgical technique used: composite graft reattachment, local flap, pocket techniques, rib cartilage reconstruction, microsurgical replantation, and tissue engineering. Key milestones were documented chronologically and visualized in a timeline. Results: A total of six major reconstructive approaches were identified in the literature, highlighting the historical evolution of auricular replantation methods from 1898 to 2018. Compiled data were visualized to underscore the procedural development and categorize surgical innovations over time. Conclusions: This review presents a synthesized treatment algorithm that integrates historical context and modern adaptations of auricular replantation techniques. The integrated approach provides a structured framework for managing auricular amputations and promotes standardized practices to optimize functional and aesthetic outcomes in auricular reconstructive surgery. Full article

Background: Epithelial ingrowth is an uncommon but potentially vision-threatening complication after keratorefractive lenticule extraction (KLEx). Although this complication is well described after flap-based refractive surgery, its occurrence after flapless lenticule extraction remains rare and is mainly reported in isolated cases. This narrative review summarizes the available literature on epithelial ingrowth after KLEx, with particular attention to proposed mechanisms, clinical presentation, imaging findings, and surgical management. An illustrative case of severe epithelial ingrowth managed with crocodile-forceps extraction is also presented. Methods: A literature search was performed to identify published reports describing epithelial ingrowth after SMILE/KLEx. Relevant articles were reviewed and compared with regard to onset, suspected mechanism, clinical severity, treatment strategy, anatomical outcome, visual recovery, and recurrence. Results: The affected eye developed extensive epithelial ingrowth associated with a postoperative tunnel laceration and marked visual deterioration during the first postoperative week. Surgical clearance through the original incision was performed using crocodile forceps followed by copious interface irrigation. Approximately one hour after treatment, AS-OCT demonstrated complete clearance of the hyperreflective interface material, corneal topography showed marked regularization, and wavefront aberrometry demonstrated a reduction in overall OPD RMS from 1.21 to 0.58 µm and higher-order RMS from 1.03 to 0.37 µm at a 4 mm pupil. Visual acuity subsequently improved over the following postoperative days, with no recurrence during 6-month follow-up. Conclusions: Severe epithelial ingrowth after KLEx may require prompt surgical intervention when rapid progression and visual deterioration occur. In this case, crocodile-forceps-assisted interface clearance through the original incision was feasible and was associated with rapid anatomical and optical recovery without cap-to-flap conversion or chemical adjuvants. Further cases are required to determine the reproducibility, safety, and long-term outcomes of this approach. Full article