Search Results (3,247)

Bronchopleural fistula is a rare but severe complication of lung resection, associated with significant morbidity and mortality, especially when an open-window thoracostomy is required. The clinical and surgical management is complex and becomes even more challenging in the presence of underlying conditions such as recurrent infections or malignancy. Postoperative management is equally demanding, as local compression may help prevent fistula recurrence but can compromise flap perfusion. A 65-year-old male with a history of right upper lobectomy and subsequent sublobar resection for lung adenocarcinoma presented with an 8 × 4 cm open-window thoracostomy complicated by chronic bronchopleural fistula and empyema. Extensive fibrosis of the surrounding tissues, including the ipsilateral latissimus dorsi muscle, limited the available reconstructive locoregional options. Reconstruction was performed using primary fistula closure reinforced with a contralateral free latissimus dorsi musculocutaneous flap and a fascia patch graft secured with cyanoacrylate-based bioadhesive. Postoperatively, continuous near-infrared spectroscopy monitoring enabled safe application of compressive bandage while minimizing the risk of flap perfusion compromise. Complete fistula closure was achieved. Apart from a surgical site abscess requiring debridement on postoperative day 7, no further complications occurred. At the 2-year follow-up, the patient remains free of fistula recurrence, wound dehiscence, or oncological relapse. We describe a novel approach for open-window thoracostomy closure combining a free musculocutaneous flap with a fascia patch graft reinforced by bioadhesive, together with postoperative perfusion monitoring using near-infrared spectroscopy. This strategy may help address both the reconstructive and postoperative challenges associated with complex bronchopleural fistulas. Full article

Background: The Keystone Island Perforator Flap (KIPF) is a well-established reconstructive option for defect closures but poses challenges in regions with limited skin laxity, such as the pretibial region. This often leads to impaired wound healing and subpar cosmetic results. We examine a modified approach incorporating the fascial release technique to observe both functional and aesthetic outcomes. Methods: A retrospective review was conducted of 20 adult patients who underwent pretibial reconstruction with the modified KIPF at a single institution. All procedures were performed in an office setting under local anesthesia. Data on demographics, comorbidities, flap size, and postoperative outcomes was collected. Results: Patients ranged from 46 to 91 years of age (mean 69). The majority (60%) were female and nonsmokers (90%). Common comorbidities included hypertension (45%), hyperlipidemia (25%), and diabetes (10%). Most procedures (90%) were performed following oncologic excisions. Defect sizes ranged from 1.95 to 17.5 cm². No intraoperative flap failures were seen. Two patients developed minor wound dehiscence, both managed conservatively. Complete wound healing was often seen within one month. Conclusion: The modified KIPF provides a safe, reliable method of pretibial reconstruction. Its low complication rate and feasibility under local anesthesia support its expanded use in anatomically constrained regions. Full article

Background/Objectives: Temporomandibular disorders (TMDs) constitute an umbrella term encompassing a spectrum of conditions, including pain in the temporomandibular joint (TMJ), masticatory muscle pain, and restricted mandibular movement. The objective of the present study was to translate the Fonseca and TMD-7 questionnaires into Romanian, to assess their face validity, and to determine the reliability of the Romanian-language versions for use in the diagnosis of temporomandibular disorders (TMDs) and in subsequent epidemiological and clinical studies. A secondary objective was to establish a scoring scale for the TMD-7 questionnaire. Methods: Both questionnaires were translated from English into Romanian and back-translated by two independent teams of translators, after which the final versions were established for face validity assessment and reliability testing. Results: The study demonstrated reliability according to the Cronbach’s α coefficient, with values of 0.862 for the TMD-7 questionnaire and 0.840 for the Fonseca questionnaire. The scoring scale corresponding to the Fonseca questionnaire could not be implemented for the TMD-7 questionnaire. Conclusions: Both Romanian-language questionnaires demonstrated high corresponding Cronbach’s α coefficients; however, for clinical use, the Fonseca questionnaire will be utilized, as the TMD-7 questionnaire does not have a scoring scale. Full article

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

Reproducible experimental models of localized dermal–hypodermal fibrosis are essential for standardized investigation of regenerative interventions. Variability in bleomycin dosing, anatomical targeting, and assessment strategies limits cross-study comparability. This study describes a methodological framework for standardized induction of early dermal–hypodermal remodeling in a rat model followed by autologous subcutaneous tissue grafting and multimodal longitudinal evaluation. Female Wistar rats underwent subcutaneous bleomycin administration at 1 mg/kg/day for three consecutive days. Clinical documentation, high-frequency ultrasonography with fixed imaging parameters, and sequential biopsies from a predefined thoracic anatomical site were performed at baseline, intermediate reassessment, and final evaluation. Autologous subcutaneous tissue grafting was conducted at Day 17 after study initiation. The protocol enabled controlled induction of early structural remodeling and consistent longitudinal documentation of dermal–hypodermal thickness, echogenicity changes, and histological architecture within a standardized anatomical region. This protocol development study establishes a reproducible and spatially consistent experimental platform integrating imaging and histological assessment, facilitating future hypothesis-driven investigations of fibrotic remodeling and regenerative strategies. Full article

Background: Timely admission to a specialised burn unit is considered crucial for optimising outcomes in burn patients. However, the impact of delayed admission on hospital length of stay and clinical outcomes remains unclear, particularly in resource-constrained settings such as South Africa. This retrospective study aimed to determine whether admission to a burn unit more than 24 h after injury was associated with increased length of stay, sepsis, or mortality. Methods: A retrospective case-audit study was conducted at the Chris Hani Baragwanath Academic Hospital Adult Burn Unit, Johannesburg, from January 2018 to December 2022. Patients were categorised into early (≤24 h) and delayed (>24 h) admission groups. The primary outcome was length of stay; secondary outcomes included sepsis incidence and in-hospital mortality. Results: A total of 123 files were analysed; 71 (58%) were admitted within 24 h. The median length of stay was 14 days, with no statistical difference between the two groups (p = 0.7). The overall mortality rate was 13%, with 68% occurring in the early admission group. Sepsis occurred in 27% of patients. Multivariate analysis revealed that early admission was independently associated with longer length of stay. Conclusions: In this single-centre retrospective case note audit with a limited sample size and significant risk of selection bias, delayed admission to a burn unit was not associated with increased length of stay, mortality, or sepsis. However, these findings should be considered preliminary and require confirmation in larger, prospective studies. The higher rate of surgical intervention in the delayed admission group warrants further investigation. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy. The identification and management of precursor lesions, particularly the increasingly common intraductal papillary mucinous neoplasms (IPMNs), pose a significant challenge, creating a profound clinical dilemma between intercepting pancreatic ductal adenocarcinoma and avoiding surgical overtreatment. This literature review aims to synthesize the latest evidence to facilitate a transition from purely morphology-based surveillance toward a biologically informed risk stratification paradigm. This approach could provide a personalized risk-stratification algorithm that optimizes therapeutic management and enables timely intervention for pancreatic cancer. By using PubMed, Embase, Scopus, and Web of Science, we analyzed and summarized key findings from recent literature (2020–2025), including cohort studies, mechanistic analyses, evidence-based guidelines, and systematic reviews on cyst fluid biomarkers (CEA panels, DNA/RNA sequencing), and emerging AI applications. Prospective and multicenter studies consistently report that NOD is independently associated with high-risk stigmata, cyst progression, and malignant transformation. Mechanistic research suggests a bidirectional interplay between the evolving neoplasia and pancreatic endocrine dysfunction. Updated guidelines underscore the need for more precise diagnostic algorithms. Recent work demonstrates that advanced cyst fluid markers—CEA panels, DNA/RNA sequencing, and multi-omic signatures—significantly improve diagnostic accuracy. Furthermore, explainable AI models show encouraging performance in predicting malignancy and assisting patient triage. Risk stratification in PCLs is shifting from morphology-based assessment toward integrated, multimodal approaches combining clinical, endocrine, imaging, molecular, and computational data. Recent evidence positions new-onset diabetes as a clinically accessible and biologically plausible marker of high-risk IPMNs. Similarly, molecular assays and AI-enhanced analytics provide an additional layer of diagnostic precision. The development of personalized risk prediction algorithms could improve early detection of malignancy while reducing unnecessary surgical resections. Full article

Quadriceps muscle and tendon injuries are a significant cause of impairment of the knee extensor mechanism, ranging from minor muscle strains to complete tendon ruptures and extensive defects following oncologic resections. This narrative review provides a comprehensive analysis of contemporary concepts in anatomy, biomechanics, diagnosis, surgical management, and rehabilitation, with a particular focus on reconstructive techniques and functional outcomes. While most muscle injuries respond well to conservative management, complete quadriceps tendon ruptures typically require surgical repair to restore extensor continuity. Both transosseous suture techniques and suture anchor fixation demonstrate reliable outcomes, with no clear superiority in clinical results. Chronic ruptures present additional challenges due to tendon retraction and poor tissue quality, often necessitating advanced reconstruction methods such as V–Y tendon lengthening and augmentation with autografts, allografts, or synthetic materials. In cases of large defects, especially following soft-tissue sarcoma resection, free functional muscle transfer (FFMT) has emerged as a key reconstructive strategy. Common donor muscles include the latissimus dorsi, gracilis, rectus abdominis, and vastus lateralis, each offering specific biomechanical advantages. Functional recovery is strongly influenced by the extent of quadriceps preservation, with better outcomes observed when at least two muscle heads remain functional. Rehabilitation protocols vary depending on the surgical approach. Early controlled mobilisation is generally recommended after tendon repair, whereas FFMT requires a more cautious and prolonged rehabilitation process to allow for flap integration and reinnervation. Overall, optimal outcomes depend on a multidisciplinary approach combining appropriate surgical technique, individualized rehabilitation, and careful patient selection. Full article

Background: Despite the rise of endoscopic approaches, the direct brow lift remains one of the most effective procedures for correcting brow ptosis for both functional and cosmetic indications. It continues to offer superior control when correcting brow shape, height, and asymmetry. However, visible scarring remains a concern. This systematic review was conducted to synthesize recent evidence on strategies that minimize visible scarring in direct brow lift surgery. Methods: A systematic literature search was performed to retrieve English-language publications from the past decade, discussing scar-minimization strategies in direct brow lift. A total of 124 records were identified through database searches in Ovid MEDLINE and Embase. Records were screened manually according to predetermined criteria, and those not in English, not addressing scarring, or not focused on direct brow lift were excluded. After this process, ten publications were included in the final qualitative synthesis. Results: The qualitative synthesis of all included publications (together comprising data on approximately 900 patients) revealed several strategies for scar minimization. (1) Incision beveling: A shallow cranially directed bevel between 20° and 45° preserves brow hair follicles and allows hair regrowth through the scar, providing natural camouflage. (2) Undermining: Gentle subcutaneous undermining in a limited 1–2 cm field, while preserving subcutaneous fat, allows tension-free advancement and maintains brow volume. (3) Periosteal suspension: Anchoring the mobilized brow flap to the frontal periosteum redistributes tension away from the dermal closure, maintaining elevation and improving scar quality. (4) Layered closure: Two- or three-layered wound closure with deep dermal anchoring and fine everting skin sutures minimizes dermal traction and scar widening. (5) Adjunctive measures: Evidence for topical silicone gel was inconclusive, whereas postoperative laser therapy and perioperative neuromodulator use demonstrated improved scar appearance. Across studies, outcomes were consistent, with high patient satisfaction, inconspicuous scars in over 85% of cases, and low complication or revision rates. Conclusions: Direct brow lift has historically been criticized for conspicuous scarring, contributing to the popularity of endoscopic techniques. Nevertheless, the traditional direct brow lift remains a fundamental skill in the oculofacial plastic surgeon’s armamentarium, offering unmatched accuracy in brow repositioning, reliability, and symmetry. Contemporary evidence demonstrates refinements that can markedly minimize scar visibility. This systematic review and qualitative synthesis allow us to continue to refine and improve our techniques to minimize scarring in direct brow lift to the benefit of our patients. Full article

Objective: To describe the surgical technique and early clinical outcomes of prone-transpsoas single-position corpectomy (PTP-corpectomy) for the management of complex thoracolumbar spinal pathology. Background: PTP-corpectomy is an emerging technique for providing simultaneous lateral and posterior spinal access without patient repositioning. The previous literature describes the PTP approach for interbody fusions; however, evaluation of its use for corpectomy is limited. This case series reports our experience with the PTP-corpectomy procedure at our institution. Methods: We retrospectively reviewed seven patients who underwent PTP-corpectomy surgery for complex spinal pathologies, including severe kyphoscoliosis, traumatic burst fractures, and revision in 2022–2025. Collected variables included demographics, comorbidities, surgical history, perioperative details, radiographic imaging, and clinical outcomes. Results: All seven patients successfully underwent PTP-corpectomy. The average operative time was 460.6 ± 147.1 min, and the estimated blood loss (EBL) was 892.9 ± 898.3 mL. Average length of stay (LOS) postoperatively was 6.7 ± 3.0 days. One case required revision of a preexisting construct and complex wound closure with plastic surgery, which had significantly increased operative time and blood loss (767 min, 2700 mL). Excluding this complicated case, the average time was 409 ± 63.7 min, and EBL was 591.7 ± 454.3 mL. All seven patients maintained clinical stability postoperatively, demonstrating improvements in pain and functional status at latest follow-up. Follow-up time ranged from 41 to 375 days. Conclusions: Our experience adds to the limited body of evidence that the PTP approach is well suited for corpectomy procedures, and that it is feasible, safe, and effective at improving clinical outcomes for complex spinal pathologies. This series adds to the limited case volume describing this technique in the current literature. Future studies with larger patient populations are warranted to further validate these findings. Full article

The exon 3 deletion polymorphism in the growth hormone receptor gene (d3GHR) is associated with altered GH signaling and longevity-related phenotypes, yet its relationship with blood-based epigenetic aging remains unclear. We analyzed whole-blood DNA from 21 unrelated adults recruited at Laniado Medical Center to determine whether the d3GHR genotype was associated with differential DNA methylation in skin-aging-related genes and altered age acceleration across established DNA methylation clocks. Genome-wide methylation was profiled using the Infinium MethylationEPIC v2.0 array, focusing on 1098 CpG sites linked to wrinkling, pigmentation, and extracellular matrix remodeling. No significant single-CpG methylation differences were detected within the targeted panel. However, two promoter-proximal differentially methylated regions (DMRs) were identified near CYP1A1 (FWER = 0.014) and ACAT2 (FWER = 0.026). Notably, only the pan-tissue Horvath clock showed a significant genotype effect, with marked age acceleration in d3/d3 carriers (mean Δ ≈ +14.5 years, p = 0.0179) that persisted after adjustment for chronological age. In contrast, second-generation clocks such as PhenoAge showed a non-significant trend toward deceleration. These findings suggest a preliminary association between d3GHR genotype, clock-specific epigenetic age acceleration and promoter-level methylation signatures near metabolic and stress-response genes. The observed Horvath acceleration may reflect systemic metabolic or immune adaptation rather than direct structural senescence in core skin-aging gene programs in blood. Given the very small d3/d3 subgroup, these findings should be interpreted strictly as exploratory pilot observations and cannot establish reproducible genotype-specific effects without validation in larger independent cohorts. Full article

Apoptosis maintains tissue homeostasis, and its dysregulation is closely associated with breast cancer progression and therapeutic resistance. We performed an integrative analysis of apoptosis-related signaling in breast cancer tissues across five molecular subtypes and compared these patterns with systemic apoptotic responses following cryoablation of benign fibroadenomas. Gene expression profiling was conducted using mRNA microarrays and validated by qRT-PCR and ELISA. Apoptosis pathway activity was assessed with the MSigDB HALLMARK_APOPTOSIS gene set, including intrinsic and extrinsic pathway scoring and an apoptotic balance index (ABI). MicroRNA profiling combined with in silico analyses identified potential miRNA–mRNA interactions. A progressive shift toward reduced pro-apoptotic and enhanced stress-adaptive signaling was observed with increasing tumor aggressiveness, most pronounced in triple-negative and non-luminal HER2-positive cancers. This pattern included reduced intrinsic pathway activity, decreased ABI, downregulation of pro-apoptotic genes (BIK, BMF, TXNIP), and upregulation of stress-associated or cytoprotective genes (HSPB1, PPT1). Several expression patterns were accompanied by overexpression of miRNAs (miR-582-5p, miR-421, miR-106b-5p, miR-20a-5p, miR-20b-5p, miR-93-5p) predicted to target apoptosis-related genes. In contrast, fibroadenoma cryoablation was associated with transient systemic modulation of apoptosis-related genes and proteins followed by gradual normalization. These findings highlight differences between apoptosis-related dysregulation in malignant tissue and regulated systemic responses following benign tissue injury, supporting pathway-level interpretation and identifying candidate molecular networks warranting further mechanistic and translational investigation. Full article

Monopolar radiofrequency (MRF) is a well-established modality for non-invasive facial rejuvenation; however, its clinical utility is frequently constrained by patient discomfort and inconsistent thermal delivery. This study evaluated the efficacy, safety, and mechanistic profile of a novel MRF system incorporating continuous water cooling (RF-CWC) designed to optimize thermal distribution and enhance patient tolerance. In a prospective, single-arm clinical trial involving 22 female participants, a single RF-CWC treatment utilizing region-specific static and sliding delivery modes yielded statistically significant improvements in jawline lifting, alongside a volumetric increase in the midface and a concomitant volumetric reduction in the lower face (p < 0.001) over an 8-week follow-up period, with no adverse events reported. To elucidate the underlying cellular mechanisms, the system was further evaluated using an ultraviolet B (UVB)-induced ex vivo human skin model and an in vivo porcine model. Histological, immunohistochemical, and ELISA analyses revealed that RF-CWC effectively mitigated UVB-induced dermal degradation ex vivo by significantly up-regulating elastin, insulin-like growth factor, and hyaluronic acid, while down-regulating matrix metalloproteinase-1, interleukin-1α, and heat shock protein 72 (p < 0.05). Furthermore, the in vivo model demonstrated time-dependent increases in collagen types I and III and elastin without thermal tissue damage, with the sliding mode and higher shot counts correlating with enhanced extracellular matrix (ECM) remodeling. Comparative analyses demonstrated that RF-CWC achieved superior ECM restoration and reduced inflammatory cell infiltration relative to traditional cryogen spray-cooled RF systems. Taken together, these findings suggest that the RF-CWC system may promote robust ECM remodeling and significant facial neocollagenesis while minimizing inflammatory responses, potentially presenting an optimized, highly effective, and patient-friendly advancement in MRF technology. Full article

Background and Clinical Significance: Hidradenitis suppurativa (HS) is a chronic, debilitating skin disorder that often affects the inframammary fold (IMF). While surgical management, particularly wide local excision (WLE), is the gold standard for severe cases, less is known about the role of breast surgery techniques in treating HS in this area; Case Presentation: This report presents two cases of female patients with bilateral inframammary HS and mammary hypertrophy, both treated with reduction mammaplasty to excise diseased tissue while addressing breast volume and contour. Both patients had experienced inadequate response to medical therapies, including biologic treatments, and presented with distinct clinical features—one with significant asymmetry and active disease, and the other with more scarring and hypertrophic lesions. During follow-up, no recurrence of disease was observed and both patients reported improved breast appearance and satisfaction; Conclusions: These cases underscore the importance of a multidisciplinary approach, with dermatologists and surgeons both playing a key role in the management of this complex condition. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction represents the gold standard for autologous breast reconstruction, while profunda artery perforator (PAP) flap reconstruction has developed as a reliable alternative, particularly in patients with low body mass index or inadequate abdominal tissue. Even though several comparative studies have evaluated surgical and patient-reported outcomes between PAP and DIEP flaps, evidence regarding reconstructive timing, oncologic safety, and interactions with adjuvant therapies remains scarce, especially for PAP reconstruction. Methods: A narrative review of the literature was conducted using PubMed. Studies assessing PAP and DIEP flap breast reconstruction were included, with particular focus on surgical outcomes, patient-reported outcomes, reconstructive timing (immediate or delayed reconstruction), oncologic safety, recurrence, and the effects of radiotherapy and chemotherapy. Comparative studies, cohort studies, systematic reviews, and meta-analyses were synthesized through a narrative review. Results: Twenty studies were included. Comparative evidence showed similar flap survival rates and overall patient satisfaction between the two methods, with flap success rates approaching 98–100%. PAP reconstruction was associated with increased donor-site wound complications and, in some studies, increased fat necrosis rates, while long-term patient-reported and aesthetic outcomes remained equivalent between techniques. In contrast to the relatively limited PAP literature, DIEP reconstruction has been widely studied in terms of reconstructive timing and oncologic safety. Current evidence indicates that immediate DIEP reconstruction does not increase the risk of flap loss, major complications, or recurrence in comparison with delayed reconstruction and might optimize early postoperative recovery and patient-reported outcomes. Nevertheless, none of the identified studies directly compared PAP and DIEP reconstruction with respect to immediate versus delayed timing, exposure to radiotherapy or chemotherapy, or long-term oncologic outcomes. Conclusions: PAP flap appears to represent a reliable alternative to DIEP flap reconstruction. However, major gaps in the literature persist involving PAP reconstruction in oncologic and timing-related settings. Future prospective multicenter studies that directly compare PAP and DIEP flaps according to reconstructive timing, exposure to adjuvant therapy, recurrence, and patient-reported outcomes are warranted to establish evidence-based reconstructive strategies for oncologic breast reconstruction. Full article