Search Results (3,139)

Background/Objectives: Myxoid liposarcoma (MLS) is a malignant soft-tissue tumor and the second-most common subtype of liposarcoma, often occurring in the lower limbs of middle-aged patients. Case presentation: A 38-year-old male patient presented to the ultrasound outpatient clinic with a large mass in the right femoral region. It has been present for 15 years and mostly stable in size. Over the last two years, it has been slowly increasing in size, more rapidly in the previous 10 months, and has started to limit his range of motion. After multiparametric ultrasound and magnetic resonance imaging evaluation, the proposed diagnosis was myxoid liposarcoma. Following imaging workup, the patient was referred to the tertiary sarcoma center, where a biopsy was performed, and pathohistological diagnosis was low-grade myxoid liposarcoma. Contrast-enhanced computed tomography (CT) evaluation of the thorax, abdomen, and pelvis showed no signs of dissemination, and CT angiography showed no signs of vessel infiltration. Plastic surgery and vascular surgery specialists performed the extirpation of the mass with the partial resection of the adjacent sartorius muscle and the complete resection of the great saphenous vein. Subsequent pathohistological analysis of the mass and local lymph nodes showed clear surgical margins and no lymphatic or vascular invasion. The patient is currently under regular surveillance by an oncology specialist and awaiting adjuvant radiotherapy. Conclusions: A multidisciplinary approach is essential in the management of patients with MLS, as it provides a tailored, individualized assessment from diagnosis through treatment to ensure the best possible outcome. Full article

Ossification of the vascular pedicle following fibula free flap (FFF) reconstruction is an uncommon and typically asymptomatic complication. Symptomatic cases requiring intervention are rare. We report a 29-year-old man with anterior maxillary osteosarcoma who underwent tumor resection followed by reconstruction with an osteocutaneous FFF. Calcification within the surgical site region was noted on imaging at two months after fibular reconstruction. By five months, he developed progressive trismus and pain with mastication. Computed tomography demonstrated a calcified structure extending from the mandible to the reconstructed maxilla along the flap pedicle, raising concern for tumor recurrence. Surgical excision was performed, and histopathology revealed benign woven bone without evidence of malignancy. Postoperatively, trismus improved, and flap viability was preserved. Retained periosteum during FFF harvest maintains osteogenic potential and may result in pedicle ossification. In symptomatic patients, particularly when recurrence is suspected, surgical resection is both diagnostic and therapeutic. Full article

Objective: To explore the application value of indocyanine green lymphography (ICGL) in the treatment of microcystic lymphatic malformation (mLM). Methods: This study was a prospective, randomized controlled clinical trial. Children with mLM who presented between November 2023 and November 2025 were recruited as subjects. They were randomly assigned in a 1:1 ratio to two groups: experimental group (ICGL-guided partial resection of mLM + penetration sclerotherapy), or control group (conventional partial resection of mLM + penetration sclerotherapy). Clinical baseline data were recorded, including gender, age, lesion location, and maximum lesion diameter. The primary outcomes were efficacy-related parameters (cure rate, effective rate, and number of subsequent treatments). Secondary outcome measures included intraoperative and postoperative parameters (operative time, postoperative drainage, follow-up duration) and related complications. Results: A total of 39 children completed the treatment and follow-up and were included in the final analysis (20 in experimental group and 19 in control group). The baseline characteristics were balanced and comparable between the two groups (p > 0.05). Regarding the primary outcomes, efficacy analysis revealed that the cure rate was significantly higher in the experimental group than in the control group (65.0% vs. 26.3%, p < 0.05). However, there were no significant differences between the groups in effective rate (experimental group: 95.0% vs. control group: 89.5%) or the number of cases requiring subsequent treatment (experimental group: 2 cases vs. control group: 3 cases) (p > 0.05). Furthermore, no statistical difference was observed between the two groups in secondary outcomes, including operative time, postoperative drainage, follow-up duration, or the incidence of postoperative complications (p > 0.05). Conclusions: ICGL-guided partial resection of mLM + penetration sclerotherapy improves postoperative outcomes in mLM. By enabling real-time intraoperative assessment of mLM lesion extent, this strategy facilitates resection of the main lesion and precise sclerotherapy of residual microcysts. These findings validate the significant application value of the ICGL in personalized treatment for mLM. Full article

Objective: To investigate the method and clinical outcomes of employing plantar propeller perforator flaps for the repair of defects in the plantar region. Methods: This was a retrospective case series of 40 patients (20 males, 20 females; age range 20–75 years) who underwent plantar defect reconstruction using the horn-shaped perforator flap technique between January 2020 and October 2025. Defect etiologies included malignant melanoma (n = 24), melanocytic nevus (n = 3), and refractory wounds (n = 13). Defect sizes ranged from 2 cm × 1.5 cm to 5 cm × 5 cm. The primary outcome was flap survival; secondary outcomes included functional recovery (American Orthopaedic Foot and Ankle Society AOFAS score), sensory recovery (Semmes–Weinstein monofilaments), and time to full weight-bearing. Results: Complete flap survival was achieved in 38/40 patients (95%). Two patients (5%) experienced minor distal wound dehiscence and necrosis, successfully managed with full-thickness skin grafting and dressing changes without compromising final outcomes. Mean follow-up was 14.2 ± 6.8 months (range 3–24 months). Mean AOFAS score was 91.3 ± 5.6, with 80% achieving excellent functional recovery. Protective sensation was present in 87.1% of the tested patients. Mean time to full weight-bearing was 6.4 ± 1.8 weeks. No local tumor recurrence occurred in melanoma patients during follow-up. Conclusions: The horn-shaped perforator flap provides a reliable source of homologous glabrous skin for reconstructing small-to-medium-sized plantar defects while avoiding skin grafting at the donor site. Its combined rotation–advancement mechanism, flexible triangular leading-edge strategies, and preservation of multiple perforators contribute to favorable functional and aesthetic outcomes. Prospective comparative studies with standardized plantar-specific outcome measures are warranted. Full article

Background: Eyelid reconstruction is particularly challenging because of the delicate anatomy and its critical functional and aesthetic roles. Although various methods have been described for anterior and posterior lamellar repairs, no standardized approach has been established. We developed a single-stage technique integrating reconstruction of both lamellae. Methods: This retrospective case series included seven consecutive patients who underwent full-thickness eyelid reconstruction between 2012 and 2024. Patients were included if they had full-thickness defects requiring reconstruction of both lamellae, underwent reconstruction using a nasal septal chondromucosal graft combined with a large local flap, and had at least 12 months of follow-up. The posterior lamella was reconstructed using nasal septal chondromucosal grafts, and the anterior lamella using large local flaps. Donor sites were managed using various methods. Results: All patients (7/7) achieved complete graft survival without partial or total graft loss. All patients achieved complete eyelid closure without lagophthalmos, and no cases of ectropion, corneal complications, or graft failure were observed. Buccal mucosal grafting demonstrated the most favorable donor-site outcomes, with uneventful healing and no septal perforation or airway-related complications. Conclusions: This single-stage approach combining chondromucosal grafts and local flaps is a feasible and reproducible option for selected patients, providing reliable structural support and satisfactory functional outcomes. Full article

Breast lymphedema is characterized by skin thickening/swelling of the breast and is common following partial mastectomy and radiation. Oncoplastic reduction performed during partial mastectomy removes additional breast tissue compared to partial mastectomy alone to optimize breast contour. Recent literature has suggested oncoplastic reduction in patients with macromastia undergoing breast-conservation surgery is protective of breast lymphedema, decreasing rates from 11% to 3%. The purpose of this study is to assess the rates of breast lymphedema after partial mastectomy and oncoplastic reduction and identify risk factors. A single-center retrospective study was performed of breast cancer patients following partial mastectomy and oncoplastic reduction (2018–2023). Patients underwent contralateral breast reduction for symmetry. Breast lymphedema was assessed. Demographics data and risk factors were evaluated. This study included 158 patients who underwent partial mastectomy and oncoplastic reduction. Breast lymphedema incidence was 3.2% (5/158). Including contralateral non-cancerous breast symmetry reduction, lymphedema occurred in 3.6% (5/140) of irradiated breasts and 0% (0/176) of non-irradiated breasts (p = 0.0164). Among irradiated breasts, skin necrosis occurred in 11.4% (16/140) compared to 4.5% (8/176) of non-irradiated breasts (p = 0.031). Breast lymphedema developed 207.4 ± 37.6 days postoperatively and 101.6 ± 15.9 days following adjuvant radiation. Mean follow-up was 639 days. Breast lymphedema incidence following partial mastectomy and oncoplastic reduction was 3.6% in this series and occurs 3–4 months after radiation. Radiation was the only significant risk factor for developing breast lymphedema. This largest series on breast lymphedema after oncoplastic reduction corroborates that oncoplastic reduction may be protective. Full article

The Chopart amputation is a controversial amputation level and has been described as a relatively non-functional amputation due to the increased risk for stump deformity and subsequent complications. Recent literature has shown that a tibiotalocalcaneal arthrodesis can subjectively increase function in the Chopart amputation. We describe the use of a tibiotalocalcaneal arthrodesis in a 44-year-old diabetic male with a Chopart amputation for the purpose of limb and gait salvage. After 292 days and an uneventful postoperative course, the patient consented to gait analysis. The case allows us to objectively conclude that the tibiotalocalcaneal arthrodesis can quantitatively increase the functionality of the Chopart amputation and, in turn, expand its indication for use within the more functional populations. Full article

Background: Despite advances in cleft rhinoplasty, the nasal sill remains an underappreciated subunit, yet it plays a crucial role in nostril symmetry and aesthetic balance. Hypoplasia or absence of the nasal sill on the cleft side often persists after primary repair and may complicate secondary nasal base correction. Current methods for sill reconstruction are limited by donor site morbidity, variability in tissue match, or non-anatomic tissue substitution. Methods: This technical note describes a surgical protocol utilizing the Tela Cutis Nasi flap, a pedicled fibro-adipose flap harvested from the adjacent nasal base, to reconstruct the deficient sill in patients with previously repaired unilateral cleft lip. The flap concept, anatomical rationale, stepwise operative steps, and patient selection considerations are outlined. Results: This technical note details the surgical steps, anatomical rationale, and flap design. No formal morphometric or patient-reported outcome analysis is included in this report; these data are being collected within an ongoing prospective outcome study designed to evaluate efficacy and long-term stability. Conclusions: The Tela Cutis Nasi flap is intended as an anatomically based local option for nasal sill reconstruction that can be integrated into secondary cleft nasal base surgery. This article contributes a standardized operative description, indications, technical constraints, and anticipated pitfalls, without assessment of clinical outcomes or long-term stability. Full article

Background: Pre-pectoral direct-to-implant breast reconstruction is increasingly adopted after mastectomy because it avoids pectoralis major dissection, reduces postoperative pain, and eliminates animation deformity. However, reconstruction in patients with large or markedly ptotic breasts remains challenging because of skin envelope management, nipple–areola complex (NAC) viability, and implant stability. This study evaluated batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction. Methods: We conducted a retrospective single-center study of consecutive patients who underwent batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction between November 2022 and January 2025. Demographic, oncologic, operative, postoperative, and BREAST-Q data were collected. Primary outcomes included complications, oncologic events, and 12-month patient-reported outcomes. Results: Thirteen patients underwent reconstruction, accounting for 18 breasts, with a mean follow-up of 12.85 months. Mean age was 54.5 ± 9.7 years, mean body mass index was 27.0 ± 3.4 kg/m², and mean Regnault ptosis grade was 3.46 ± 0.52. No seromas or oncologic recurrences were observed. One hematoma and one late infection requiring implant removal occurred. Superficial NAC/central flap epidermolysis developed in four patients and resolved conservatively; no full-thickness NAC necrosis occurred. BREAST-Q scores improved significantly in all domains at 12 months, including satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being (all p < 0.05). Conclusions: Batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane implant reconstruction appears safe and reproducible in selected patients with advanced ptosis, with acceptable complication rates and significant improvement in patient-reported outcomes. Full article

Over the past years, burn care has evolved from a discipline focused on survival to one centered on restoring long-term health, function, and quality of life. Significant advances in critical care, early excision and grafting, infection control, and metabolic support have transformed survival outcomes for even the most severe injuries. As a result, the field now faces a new frontier: understanding and managing the long-term physical, psychological, and systemic sequelae of survival. This review traces the evolution of burn care over the last century and outlines the challenges and priorities for the next 25 years. The first era of progress, defined by innovations in resuscitation, surgery, and critical care, has given rise to a growing cohort of long-term survivors. Research over the past decade has revealed that major burns induce chronic multisystem alterations, including metabolic, cardiovascular, neurocognitive, and immunological dysfunctions. Emerging concepts such as burn-associated heart failure exemplify this shift from acute to chronic disease understanding. Looking ahead, the future of burn medicine lies in personalized and lifelong care, supported by translational research, digital health, regenerative therapies, and interdisciplinary collaboration. Overall, burn care stands at a pivotal crossroads. By integrating precision medicine, rehabilitation science, and psychosocial care, we aim to move the field from survival toward sustained, holistic recovery over the next 25 years. Full article

Background: Robot-assisted surgery has become increasingly used across multiple specialties; however, its integration into aesthetic plastic surgery remains limited. Individualized patient requirements, such as concealed scar placement, superficial soft tissue dissection, and patient-specific docking angles, are major challenges to its adoption, unlike in other specialties. This review aimed to evaluate the current use of robotic systems in plastic surgery, with a particular focus on aesthetic procedures, operative outcomes, and existing technological limitations. Methods: Multiple databases, including PubMed, Scopus, and Google Scholar, were extensively searched to identify studies published between 2011 and 2026. Data on robotic platforms, operative duration, rehabilitation outcomes, and aesthetic indications were extracted and analyzed. Robotic systems such as da Vinci, Symani, MUSA, and ARTAS demonstrated feasibility across reconstructive subspecialties. However, their clinical application remains limited, as purely aesthetic procedures are rare, highlighting a significant lack of standardized docking methods and dedicated instruments. Results: The data show that robotic platforms offer great advantages, such as precision and minimally invasive access; however, their high costs, bulky instrumentation, and limited docking methods represent barriers to their adoption in aesthetic surgery. Conclusions: Robot-assisted aesthetic plastic surgery remains in the early stage of development. Further research is required to establish reproducible docking standards and expand its clinical indications. Advancements in single-port systems, artificial intelligence integration, and surgeon training will facilitate broader clinical implementation. Full article

Current evidence suggests that achieving the desired level of osseointegration necessitates a hierarchical approach to implant design. This is particularly relevant for osseointegration around implant systems such as those presenting vertical decompression chambers and acid-etched surfaces which could further be augmented by non-thermal plasma (NTP) treatment. Three implant systems were compared in this study: (i) ND (GM Helix Acqua Implant; Neodent^®, Curitiba, PR, Brazil—hybrid, acid-etched thread design treated with isotonic sodium chloride solution), (ii) Sin (Epikut Plus; S.I.N. Implant System, São Paulo, Brazil—V-shaped, acid-etched thread design treated with nano-hydroxyapatite), and (iii) Mp (Maestro; Implacil De Bortoli, São Paulo, Brazil—buttress, acid-etched thread design with decompressing vertical chambers). The ND and Sin implants were used directly as supplied by the manufacturer. For the Mp implants, the manufacturer-supplied surface was subjected to supplemental acid etching with 37% hydrochloric acid followed by Argon-based NTP treatment administered with a pulsed plasma generator prior to implantation into the iliac crest of n = 12 adult female sheep. Histomorphometric analysis was conducted at 3- and 12-week post-implantation (n = 6 sheep per time point) to assess bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). After 3 weeks in vivo, the healing chambers of all implant groups consisted predominantly of newly forming woven bone. By 12 weeks, bone maturation was observed, with the presence of remodeling sites and some areas of well-organized lamellar structures occupying the healing chambers. At both 3 and 12 weeks, the Mp implants demonstrated significantly higher BAFO values relative to ND (p = 0.015 and p = 0.008, respectively). The combination of vertical healing chambers, acid etching, and NTP treatment promoted early vascular infiltration and sustained bone deposition. Full article

The electrocardiogram (ECG) is a central tool in cardiovascular diagnostics, yet interpretation requires expertise and remains subject to variability. Multimodal large language models (MLLMs) have shown emerging capabilities in medical image analysis, but their performance in ECG interpretation remains insufficiently characterized. This study evaluated the diagnostic accuracy and inter-run reliability of five MLLMs across ECG interpretation tasks. Thirteen standard 12-lead ECGs were presented to five models (ChatGPT-5.3, Gemini 3.1 Pro, Claude Opus 4.6, Grok 4.1, and ERNIE 5.0) across five independent runs per case, yielding 2275 task-level assessments. Six categorical interpretation tasks (rhythm, electrical axis, PR/P-wave morphology, QRS duration, ST/T-wave morphology, and QTc interval) were compared with expert-consensus ground truth, while heart rate estimation was evaluated using mean absolute error (MAE). Overall categorical accuracy ranged from 52.3% to 64.9%. QRS duration classification achieved the highest accuracy (66.2–90.8%), whereas ST/T-wave assessment showed the lowest performance (20.0–41.5%). Heart rate MAE ranged from 14.8 to 46.7 bpm. A dissociation between diagnostic accuracy and inter-run reliability was observed across models. These findings indicate that current MLLMs do not achieve clinically reliable ECG interpretation performance and highlight the importance of assessing diagnostic accuracy and inter-run reliability when evaluating artificial intelligence systems in biomedical diagnostics. Full article

Background: Wrist osteomyelitis caused by Scedosporium apiospermum is exceedingly rare. Its indolent course and destructive potential may result in extensive bone loss and pose substantial diagnostic and therapeutic challenges. Methods: We report a case of chronic wrist osteomyelitis caused by Scedosporium apiospermum in a 68-year-old kidney–pancreas transplant recipient. Results: Following diagnosis, systemic antifungal therapy with voriconazole was initiated, and multiple surgical debridements were performed to achieve local disease control, resulting in a large defect of the carpus and distal forearm. Hand salvage was attempted using an osteocutaneous triple-barrel fibula flap. The postoperative course was complicated by congestion of the fibula skin island, which was managed with leech therapy. Subsequent infection with a multi-resistant Aeromonas spp. and Morganella morganii led to flap necrosis, ultimately requiring transradial forearm amputation. Conclusions: Destructive Scedosporium apiospermum osteomyelitis in immunocompromised patients is a major challenge for reconstructive surgeons. Interdisciplinary management is essential as mold eradication is only achievable through a combined surgical and antimicrobial approach. In advanced destructive osteomyelitis, the choice between limb salvage and amputation should be individualized, considering patient comorbidities, reconstructive risk, and patients’ preferences. This case highlights the importance of balancing careful indication and patient counseling in complex clinical scenarios. Full article