Search Results (646)

Vascularised composite allotransplantation (VCA) has an evolving role in the reconstruction of complex functional and aesthetic deficits non-amenable to autologous or implant-based reconstructive modalities. International applications of VCA span upper extremity, face, abdominal wall, uterus, and penile transplantation, with more than 300 procedures performed worldwide. Among these, abdominal wall transplantation has uniquely contributed to the development of the sentinel skin flap (SSF) concept, in which solid organ transplant patients undergo simultaneous transplantation of a solid organ and a donor-derived vascularised skin flap, with the skin component of the SSF being trialled internationally as a means of monitoring for rejection within the solid organ allograft. Despite growing clinical success, VCA continues to face substantial barriers to wider adoption. Acute rejection remains highly prevalent, affecting up to 89% of recipients, with significant morbidity linked to intensive systemic immunosuppression. Challenges are further amplified by the unique immunological heterogeneity of composite grafts, ethical concerns surrounding identity-linked tissues, and the lack of standardised outcomes reporting across VCA subtypes. Advances in machine perfusion technologies and emerging cellular and biomaterial-based immunomodulation strategies show promise in reducing immunosuppression burden and improving graft longevity. This review outlines the current state of VCA, including clinical applications, outcomes, and mechanistic insights from pre-clinical studies, while highlighting key ethical considerations and evolving regulatory frameworks. Future progress will depend on standardised reporting systems, improved donor–recipient matching, better understanding of ischemia–reperfusion injury, and the development of next-generation immunosuppressive/immuno-modulatory therapies. Collectively, these innovations position VCA as a rapidly advancing field with significant potential to redefine reconstructive and transplant surgery. Full article

Background/Objectives: Radiotherapy of the chest wall after mastectomy frequently leads to fibrosis, reduced tissue elasticity, erythema, pain and chronic skin-related symptoms that complicate reconstructive strategies. Autologous fat grafting has been proposed as a regenerative option for radiation induced soft tissue damage, but clinical data focused on patient-reported symptoms remain limited. The objective of this study was to describe symptomatic and clinical changes after autologous fat grafting in irradiated postmastectomy chest wall tissue. Methods: This pilot observational study included five female patients with a history of mastectomy followed by adjuvant chest wall radiotherapy. All patients underwent a single session of standard autologous fat grafting without adipose derived stem cell enrichment. Patient-reported symptoms, including pruritus, local discomfort, burning sensation and erythema, were recorded preoperatively and at six months using a standardized 0 to 5 scale. Scar pliability was assessed by two experienced physicians using the same scale. Only descriptive statistical analysis was performed. Results: All patients demonstrated lower postoperative symptom scores at six months. Mean reductions were observed for erythema (71.4 percent), burning sensation (61.1 percent) and pruritus (57.1 percent). Local discomfort decreased by 33.3 percent. Mean scar pliability scores increased from 2.2 to 3.2. No postoperative complications, such as infection, fat necrosis or oil cyst formation, were recorded. All patients completed the six month follow up. Conclusions: In this small pilot observational study, autologous fat grafting was well tolerated and associated with descriptive improvement of patient-reported symptoms and scar pliability in irradiated postmastectomy chest wall tissue. These findings suggest a potential symptomatic benefit of fat grafting, while larger studies with objective imaging and histological correlation are required to confirm efficacy and durability. Full article

Background: Perforator flaps improved the reconstruction paradigm in the lower extremity, increasing coverage possibilities. This study aims to quantify how added perforators could enhance standard geometrical patterns (compared to random flaps). Methods: A total of 29 cases of lower limb soft tissue reconstruction (STR)—52% trauma, 21% osteomyelitis with skin fistulas, 21% healing disorders with unstable scarring and 6% cancer-related surgery—were performed in our institution between 2012 to 2023 with geometric random (GR) local flaps (34%), geometric perforator-enhanced (GP) flaps (32%) or pure propeller perforator (PP) flaps (34%), were retrospectively analysed. Patients with proximal thigh defects, a follow up of less than 3 months and those who received an axial, muscle or free flap were excluded. Geometric patterns (as length:width ratio (L:W)) were compared among groups, analysing healing outcomes and complications. Results: Leg defects were categorized into 62% distal, 14% middle, 14% proximal third and 10% distal thigh. No significant difference in defect size was detected among groups. Mean flap size was significantly larger for GP (70.5 cm², (p < 0.05)) and PP (74.4 cm², (p < 0.01)) than GR (53.7 cm²). The L:W ratio was significantly higher in GP (L:W 2.2:1, (p < 0.05)) and PP (L:W 2.8:1, (p < 0.01)) than in GR (1.5:1), but no significant difference was found between GP and PP. A reduced complications rate (partial flap loss, infection, healing, revision surgery, etc.) was observed in the GP group, when compared to GR. Conclusions: Flap geometric design can be significantly improved by the inclusion of perforators, maintaining spatial advantages with larger ductility and improved vascular solidity. Full article

Plant-derived exosome-like extracellular vesicles (PELVs) have recently emerged as novel bioactive materials. Although members of the Orchidaceae family have been reported to possess various biological activities and are widely used as cosmetic ingredients, no studies to date have investigated exosome-like extracellular vesicles derived from Phalaenopsis species. In the present study, we report for the first time a novel exosome-like extracellular vesicles preparation isolated from Phalaenopsis aphrodite (called Exorigin^® OR) and characterize its physical and biological properties. The purified vesicles exhibited a spherical shape surrounded by a bilayered membrane with an average particle size of approximately 98 nm and expressed a CD9 marker. Fluorescent labeling with BODIPY TR indicated that Exorigin^® OR can be internalized by cells. In in vitro assays, Exorigin^® OR alleviated hydrogen peroxide-induced damage in keratinocytes and inhibited melanin production in melanocytes, possibly associated with the downregulation of Tyrp1 expression as shown by qPCR analysis. Moreover, reconstructed human epidermis and cornea-like epithelium models demonstrated that Exorigin^® OR is non-irritant. Collectively, these findings suggest that Exorigin^® OR represent a promising and safe bioactive ingredient for promoting skin health in cosmeceutical applications. Full article

Humans could sensitively perceive and identify objects through dense mechanoreceptors distributed on the skin of curved fingertips. Inspired by this biological structure, this study presents a general conformal integration method for flexible tactile sensors on curved fingertip surfaces. By adopting a spherical partition design and an inverse mode auxiliary layering process, it ensures the uniform distribution of stress at different curvatures. The sensor adopts a 3 × 3 tactile array configuration, replicating the 3D curved surface distribution of human mechanoreceptors. By analyzing multi-point outputs, the sensor reconstructs contact pressure gradients and infers the softness or stiffness of touched objects, thereby realizing both structural and functional bionics. These sensors exhibit excellent linearity within 0–100 kPa (sensitivity ≈ 36.86 kPa⁻¹), fast response (2 ms), and outstanding durability (signal decay of only 1.94% after 30,000 cycles). It is worth noting that this conformal tactile fingertip integration method not only exhibits uniform responses at each unit, but also has the preload-free advantage, and then performs well in pulse detection and hardness discrimination. This work provides a novel bioinspired pathway for conformal integration of tactile sensors, enabling artificial skins and robotic fingertips with human-like tactile perception. Full article

Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by cutaneous and subcutaneous neurofibromas, which impact quality of life. Dermoscopy-guided high-frequency ultrasound (DG-HFUS) integrates dermoscopy with 33 MHz ultrasound, enabling precise lesion localization and reproducible measurements. Objective: To characterize neurofibromas in NF1 patients using DG-HFUS and identify imaging parameters for diagnosis, monitoring, and treatment planning. Methods: 14 genetically confirmed NF1 patients underwent DG-HFUS imaging (Dermus SkinScanner). 100 neurofibromas were assessed for size, location, shape, contours, surface, echogenicity, global echogenicity, and posterior acoustic features. Results: Lesions were dermal (79%) or subcutaneous (21%), round (28%), ovoid (63%), or spiked (9%). Mean vertical and lateral diameters were 5.37 ± 2.66 mm and 2.28 ± 1.39 mm. All were hypoechoic; 62% homogeneous, 38% heterogeneous. Margins were well-defined in 57% and poorly defined in 43%. Posterior enhancement occurred in 3% and shadowing in 10%. Conclusions: DG-HFUS provides a detailed, reproducible assessment of neurofibromas, supporting differential diagnosis, surgical planning, and longitudinal monitoring. The evaluated imaging parameters offer objective insights for optimizing NF1 management. Future developments, including 3D reconstruction and AI-assisted analysis, may further enhance its clinical utility. Full article

Reconstruction of the nipple is the final step of breast reconstruction following skin-sparing mastectomy (SSM) and plays a critical role in restoring breast symmetry and aesthetic completeness. Various nipple reconstruction techniques have been described, including split transplantation of normal nipples and flap-based procedures; however, long-term maintenance of nipple projection and volume remains challenging due to postoperative tissue loss. This study evaluates the clinical outcomes of a previously described long V-Y flap technique, focusing on its ability to mitigate postoperative nipple projection and volume loss. A retrospective analysis was performed on 27 patients who underwent nipple reconstruction using the long V-Y flap following SSM with tissue expander–implant reconstruction. Nipple projection and volume were measured immediately after surgery and at follow-up beyond six months, and volume loss rates were calculated. Outcomes were compared descriptively with projection loss rates reported for other commonly used flap techniques in the literature. The mean nipple volume loss was 34.23%, and the mean projection loss was 32.79%, while nipple width remained largely unchanged over time. These values were numerically lower than those reported for skate, star, bell, and arrow flaps in prior studies. The long V-Y flap appears to be a practical and reliable option for nipple reconstruction after SSM, particularly for larger nipples, with favorable short- to mid-term maintenance of projection and volume. Full article

This study outlines the design and evaluation of a biomimetic robotic hand tailored for Human–Robot Interaction (HRI), focusing on improvements in tactile fidelity driven by material choice. Thermoplastic polyurethane (TPU) was selected over polylactic acid (PLA) based on its reported elastomeric characteristics and mechanical compliance described in prior literature. Rather than directly matching human skin properties, TPU was perceived as providing a softer and more comfortable tactile interaction compared to rigid PLA. The robotic hand was anatomically reconstructed from an open-source model and integrated with AX-12A and MG90S actuators to simplify wiring and enhance motion precision. A custom PCB, built around an ATmega2560 microcontroller, enables real-time communication with ROS-based upper-level control systems. Angular displacement analysis of repeated gesture motions confirmed the high repeatability and consistency of the system. A repeated-measures user study involving 47 participants was conducted to compare the PLA- and TPU-based prototypes during interactive tasks such as handshakes and gesture commands. The TPU hand received significantly higher ratings in tactile realism, grip satisfaction, and perceived responsiveness (p < 0.05). Qualitative feedback further supported its superior emotional acceptance and comfort. These findings indicate that incorporating TPU in robotic hand design not only enhances mechanical performance but also plays a vital role in promoting emotionally engaging and natural human–robot interactions, making it a promising approach for affective HRI applications. Full article

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons. Full article

Background/Objectives: Nipple-sparing mastectomy (NSM) is a surgical procedure that significantly improves postoperative cosmetic outcomes and quality of life (QOL) while ensuring oncological safety. However, ischemic necrosis of the nipple–areolar complex (NAC), resulting from impaired blood flow, remains a serious complication, particularly in patients with risk factors. To mitigate this ischemic risk, the Nipple Delay (ND) procedure, which applies the principle of surgical delay, has been proposed. The objective of this study was to retrospectively review cases in which the ND procedure was performed prior to NSM with immediate autologous breast reconstruction and to evaluate the safety and clinical utility of this technique in preventing NAC necrosis. Methods: This study included 30 breasts from 30 patients who underwent the ND procedure prior to NSM with autologous reconstruction at our institution. ND was performed under local anesthesia two weeks before NSM. The skin around the NAC was dissected from the underlying breast tissue. Results: The median age of the patients was 49 years, and the mean BMI was 22.7 kg/m². Risk factors for NAC necrosis included periareolar incision in 24 patients (80.0%), a BMI of 25 kg/m² or higher in 7 patients (23.3%), and a history of smoking in 8 patients (26.7%). No cases of full-thickness necrosis requiring NAC excision were observed (0%). Partial-thickness necrosis, which healed with conservative treatment, was observed in 6 patients (20.0%). No malignant involvement was detected in subareolar specimens. Conclusions: A staged approach using the ND procedure before NSM suggests effectiveness for preventing serious ischemic complications and safely expanding the indications for NSM, even in patients at high risk of NAC necrosis. Full article

Background: The rising incidence of cutaneous non-melanoma skin cancers underscores the need for individualized reconstruction, particularly for cheek defects that pose distinctive anatomic and functional challenges. This study aimed to analyze reconstructive patterns for cheek skin lesions and to develop a simple, site- and size-based algorithm for small- to medium-sized defects. Methods: We retrospectively reviewed 129 consecutive patients treated between 2022 and 2025 for primary basal cell carcinoma, squamous cell carcinoma, or benign cheek skin tumors. After excision, defects were reconstructed with primary closure, local flaps, or skin grafts. Associations between the largest clinically measured lesion diameter (used as a proxy for the post-excision defect size), anatomical subsite, histopathology, and reconstructive technique were evaluated using ANOVA or Kruskal–Wallis tests, chi-square tests, and Spearman’s correlation. Results: The mean lesion diameter was 19.75 ± 12.93 mm. Reconstruction was performed using local flaps in 62 patients (48.06%), primary closure in 53 (41.09%), and skin grafts in 14 (10.85%). Larger defects were more frequently managed with grafts or flaps (F(2,110) = 4.84, p = 0.010), and lesion size correlated with reconstructive complexity (Spearman’s ρ = 0.229, p = 0.015). Lesion location was also significantly associated with the reconstruction method (χ²(10) = 48.29, p < 0.001; Cramér’s V = 0.44). Margin-negative (R0) excision was achieved in 95.35% of cases, with a low recurrence rate (3.91%) and complication rate (1.56%). Conclusions: Lesion size and anatomical location are key determinants of reconstructive strategy for cheek skin defects. In this cohort, lesions ≤ 20 mm were predominantly managed with primary closure, whereas lesions > 20 mm more frequently required flap reconstruction or skin grafting. This size-based split is cohort-derived and should be interpreted as a pragmatic framework that requires external validation. Full article

The design of smart skin with lightweight requirements utilizes high-performance composite materials, resulting in thin structural characteristics. When subjected to complex aerodynamic loads, the smart skin structure experiences warping deformation, which significantly impacts both flight efficiency and structural integrity. However, this deformation behavior has been largely overlooked in current shape sensing methods embedded within the structural health monitoring (SHM) systems of smart skin, leading to insufficient monitoring capabilities. To address this issue, this paper proposes a novel shape sensing methodology for the real-time monitoring of warping deformation in smart skin. Initially, the structural displacement field of the smart skin and the warping function are mathematically defined, incorporating constitutive relations and considering the influence of material parameters on sectional strains. Subsequently, the inverse finite element method (iFEM) is employed to establish a shape sensing model. The interpolation function and the actual sectional strains, derived from discrete strain measurements, are calculated based on the current constitutive equations. Finally, to validate the accuracy of the proposed iFEM for monitoring warping deformation, numerical tests are conducted on curved skin structures. The results indicate that the proposed methodology enhances reconstruction capability, with a 10% improvement in accuracy compared to traditional iFEM methods. Consequently, the shape sensing algorithm can be seamlessly integrated into the SHM system of smart skin to ensure the predicted performance. Full article

Background: Quantum Machine Learning (QML) has attracted significant attention in recent years. With quantum computing achievements in computationally costly domains, discovering its potential in improving the performance and efficiency of deep learning models in medical imaging has become a promising field of research. Methods: We investigate QML in healthcare by developing a novel quantum-enhanced U-Net (QU-Net). We experiment with six configurations of parameterized quantum circuits, varying the encoding technique (amplitude vs. angle), depth and entanglement. Using the ISIC-2017 skin cancer dataset, we compare QU-Net with classical U-Net on self-supervised image reconstruction and binary classification of benign and malignant skin cancer, where we combine bottleneck embeddings with patient metadata. Results: Our findings show that amplitude encoding stabilizes training, whereas angle encoding introduces fluctuations. The best performance is obtained with amplitude encoding and one layer. For reconstruction, QU-Net with entanglement converges faster (25 epochs vs. 44) with a lower Mean Squared Error per image (0.00015 vs. 0.00017) on unseen data. For classification, QU-Net with no entanglement embeddings reaches 79.03% F1-score compared with 74.14% for U-Net, despite compressing images to a smaller latent space (7 vs. 128). Conclusions: These results demonstrate that the quantum layer enhances U-Net’s expressive power with efficient data embedding. Full article

Background: Immediate breast reconstruction after mastectomy has progressively shifted toward less invasive approaches. The pre-pectoral approach, avoiding muscle dissection, may reduce post-operative pain, surgical trauma, and recovery time. However, concerns regarding surgical complications and their potential impact on the timing of adjuvant treatments still persist. Methods: A retrospective monocentric study was conducted, including all patients who underwent mastectomy with implant-based breast reconstruction at the Breast Unit of Policlinico Tor Vergata in Rome between January 2014 and March 2024. Patients were classified according to the reconstructive technique as either pre-pectoral or sub-pectoral. Demographic, oncologic, and surgical data were collected and analyzed, with a particular focus on post-operative complications and the timing of adjuvant treatment initiation. Results: Of 622 patients, 366 (58.9%) underwent sub-pectoral reconstruction and 235 (37.7%) pre-pectoral. Overall, the complication rates were comparable between the two reconstructions (23.8% vs. 20.2%, p = 0.310). Delayed wound healing was higher in the pre-pectoral group (9.0% vs. 4.3%, p = 0.035), whereas post-operative bleeding occurred more often in sub-pectoral cases (4.9% vs. 0.4%, p = 0.057). Operative time was significantly shorter in the pre-pectoral group (p < 0.001). Multivariate analysis identified skin-reducing mastectomy (OR 2.11), smoking (OR 2.89), and diabetes mellitus (OR 3.06) as predictors of delayed adjuvant therapy, whereas the reconstruction technique was not associated with delays. Full article

Background/Objectives: Basal cell carcinoma (BCC) is the most common form of skin cancer, typically exhibiting slow growth and limited metastatic potential. However, in rare, long-standing cases, particularly in high-risk facial regions, deep infiltration into structures such as bone may occur. This study aimed to evaluate whether BCC with bone involvement remains a relevant clinical issue, based on three decades of clinical experience, supplemented by a review of the existing literature. Methods: Medical records of patients treated for facial BCC between 1994 and 2025 at a dermatologic surgery department in Lower Silesia were retrospectively reviewed. Among more than 10,000 cases, eight instances of histologically confirmed bone invasion were identified. Clinical and surgical parameters were analyzed, including patient age, tumor size and location, prior treatment and reconstruction method. Relevant literature was incorporated to provide broader clinical context. Results: Patients with bone-invasive BCC were elderly (mean age: 75.3 years, SD: 10.94 years) and lesions were typically large (mean diameter 38.9 mm), most frequently located on the nose and forehead. Many cases lacked previous treatment. Smaller nasal tumors were managed with local flaps, while larger lesions on the forehead and temple required skin grafts. Findings from the literature confirm that bone invasion is rare and usually associated with long-standing tumors in anatomically high-risk areas. Conclusions: Although rare, BCC with bone infiltration remains a clinically relevant phenomenon, particularly in elderly patients with advanced or recurrent tumors. Early diagnosis, complete excision with histologically clear margins, and individualized surgical planning are essential to prevent deep tissue involvement. Imaging should be reserved for cases in which advanced local invasion is clinically suspected. Full article