Search Results (216)

Background: HS is a chronic inflammatory skin disease in which inflammatory nodules and abscesses coexist with tunnels, fibrosis, and scarring. This dual biology explains why medical therapy often improves inflammatory dissease activity without fully addressing fixed tissue damage, whereas surgery can achieve durable local control but does not treat diffuse inflammatory burden. Contemporary international guidelines increasingly endorse multimodal and medicosurgical care. Objective: To critically compare the evidence supporting medical and surgical management of HS, with emphasis on outcomes, indications, limitations, and clinical decision-making relevant to contemporary practice. Methods: A structured review was undertaken using PubMed/MEDLINE, the Cochrane Library, and major dermatology guideline sources, with searches updated to 7 May 2026. Priority was given to clinical guidelines, systematic reviews and meta-analyses, randomized controlled trials, and higher-quality observational studies. Evidence was synthesized narratively because endpoints, populations, and follow-up intervals differed markedly across medical and surgical studies. Results: Medical evidence is strongest for biologic therapy in moderate-to-severe inflammatory HS. Weekly adalimumab improved week-12 HiSCR in the phase 3 PIONEER trials; secukinumab improved week-16 and week-52 outcomes in SUNSHINE/SUNRISE; and bimekizumab improved week-16 HiSCR50 in BE HEARD I/II. Surgical evidence is strongest for wide excision in structurally advanced disease, particularly when compared with local excision or incision and drainage. Meta-analytic data consistently show lower recurrence after wide excision than after local excision, and lower recurrence after flap or graft reconstruction than after primary closure. Combined therapy is increasingly supported: peri-operative adalimumab improved outcomes in SHARPS, and surgery plus adalimumab outperformed adalimumab alone in a pragmatic 12-month RCT. Conclusions: HS is best managed by matching treatment to disease phenotype. Medical therapy is essential for inflammatory control; surgery is essential for persistent tunnels, fibrosis, and scarred regional disease. The strongest overall clinical position is an integrated, multidisciplinary model in which systemic therapy reduces inflammatory load and surgery definitively treats irreversible tissue damage. Full article

Background and Objectives: Extramammary Paget’s Disease (EMPD) of the perineal region is a rare intraepidermal adenocarcinoma requiring wide excision, resulting in extensive defects that are challenging to reconstruct while preserving contour and function. This descriptive case series evaluated a reconstructive selection strategy using pedicled superficial circumflex iliac artery perforator (SCIP) flaps and pedicled anterolateral thigh (ALT) flaps for perineal defects following wide excision of EMPD. Materials and Methods: This retrospective case series reviewed patients with perineal EMPD who underwent wide excision followed by reconstruction using pedicled SCIP flaps or pedicled ALT flaps. Patient demographic and lesion characteristics, operative and flap characteristics, post-reconstruction complications, oncologic outcomes, and satisfaction were analyzed. Results: 15 patients (mean age 63 years, SD 7.3) were included in this case series. Ten patients underwent reconstruction using pedicled SCIP flaps (mean 106 cm², SD 23.3), and five patients with pedicled ALT flaps (mean 245.2 cm², SD 41.2). All flaps survived, but one patient developed limited partial necrosis managed with secondary healing. During a mean follow-up of 17.7 months (SD 1.3), one patient (6.7%) developed recurrence and eventually distant metastasis resulting in death. Among the 14 surviving patients, 13 (92.9%) reported overall satisfaction with cosmetic and functional outcomes assessed using a non-validated ordinal scale. Conclusions: Pedicled SCIP and ALT flap reconstruction provides reliable, well-vascularized tissue coverage for perineal EMPD defects and achieves generally favorable short-term outcomes. The choice between flap types should be tailored to the defect size, location, and patient characteristics. Full article

Digital infrastructure expansion in Europe raises a spatial planning problem: early-stage screening needs to compare regional conditions while also checking whether rankings remain stable when decision priorities change. This study evaluates 24 European Nomenclature of Territorial Units for Statistics level 2 (NUTS-2) regions for geo-distributed data center development. The 2022 decision matrix uses five Eurostat criteria: information and communications technology (ICT) specialists’ share in employment, average hourly labor cost, renewable electricity share, non-household electricity price and population density. Four criteria are national intensive proxies assigned to the selected NUTS-2 regions, while population density is directly observed at the NUTS-2 level. After a log₁₀ transformation of population density and min–max normalization, we compare the weighted sum model (WSM), TOPSIS and VIKOR across four weighting scenarios. We then apply a random-weighting audit based on Stochastic Multicriteria Acceptability Analysis (SMAA) principles, using 10,000 Dirichlet weight draws, followed by a local Dirichlet sensitivity analysis around the Balanced profile. Results show that the most stable high-performing profiles are not limited to the established FLAP-D market reference. Latvija (LV00), Stockholm (SE11), Helsinki-Uusimaa (FI1B), Eesti (EE00) and Área Metropolitana de Lisboa (PT17) form the main high-performing set across stochastic rank metrics, while several mature Western metropolitan regions remain more sensitive to cost and territorial-pressure criteria. The study provides a reproducible spatial decision support framework for macro-regional screening rather than micro-siting. Full article

Background/Objectives: Reconstruction of full-thickness soft-tissue defects of the heel can be challenging due to the specific structural and functional demands of this region. Local flaps are often used due to their ability to provide durable and sensate coverage. This case series and systematic review aim to assess their surgical efficacy and reported outcomes, particularly in the context of the rhomboid flap. Methods: A systematic review was conducted in accordance with PRISMA guidelines, using PubMed, Cochrane and EBSCO. Studies published up to March 2026 evaluating local flaps were included, whereas distant pedicled and microvascular flaps were excluded. Defect size, flap types and surgical outcome were extracted and synthesized in a comparative table. In addition, we present four clinical cases of full-thickness soft-tissue heel defects reconstructed with a local rhomboid flap. This retrospective, single-center case series includes patients treated at our institution between January 2023 and March 2026, with initial debridement followed by flap coverage. Results: The four patients had a mean defect size of 4.1 cm². All defects ultimately healed, though one case demonstrated delayed wound healing. Eventually, neither donor-site morbidity, nor recurrence were observed during a mean follow-up of 7.4 months (range 1 to 17 months). Nine studies were included in the review, encompassing 56 patients. Despite the variety of the studies regarding design and flaps used, all focused on outcomes, including flap survival, complication rate, and functional recovery. Local flaps appear to be a feasible option for this type of soft-tissue defect; however, they seem to be limited to small defects. Conclusions: Local flaps may represent a valuable option for small full-thickness heel defects up to 6 cm² according to the “like-with-like” principle. They are associated with low surgical morbidity and do not compromise subsequent reconstructive options, making them a reasonable first-line approach. Limitations include the small sample size, retrospective design, the unequal follow-up time, as well as the absence of standardized functional outcome assessment. Full article

Background: Recovery after major head-and-neck reconstruction extends beyond flap survival and wound closure, involving swallowing, psychological adaptation, body image, and overall quality of life. Integrated multidimensional assessments remain limited in routine reconstructive outcomes research. Aim: The aim of this study was to characterize and compare six-month multidimensional recovery—clinical, functional, nutritional, psychological, and body-image outcomes—between microvascular free-flap and regional pedicled-flap reconstruction and to identify factors that stratify risk for persistent functional and psychosocial impairment. Methods: We conducted a single-center prospective cohort study at the “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania, enrolling 87 adults undergoing major reconstructive surgery after ablative treatment of head-and-neck defects (52 microvascular free flaps; 35 regional pedicled flaps). Patients were assessed at baseline and 6 months using the SF-36, WHOQOL-BREF, Body Image Scale (BIS), HADS, PHQ-9, GAD-7, Functional Oral Intake Scale (FOIS), speech intelligibility, and PEG/tracheostomy dependence. Results: At 6 months, most SF-36 and WHOQOL-BREF domains improved with moderate effect sizes (d = 0.3–0.7; all p ≤ 0.009), and body image distress decreased significantly (ΔBIS −2.9 ± 4.6; p < 0.001), whereas social functioning showed no robust gain (p = 0.098; not surviving false-discovery-rate correction). Pedicled reconstruction was associated with higher PEG dependence (37.1% vs. 9.6%; p = 0.005) and worse FOIS (4.7 ± 1.4 vs. 5.6 ± 1.2; p = 0.003). Major complications were linked to blunted or worsening psychological trajectories and a threefold higher rate of clinically significant depression (HADS-D ≥ 11: 66.7% vs. 18.7%; p = 0.001). In a reduced four-predictor multivariable model, pedicled flap (aOR 4.6), adjuvant radiotherapy (aOR 2.8), major complication (aOR 3.3), and lower baseline FOIS (aOR 0.5 per point) were independently associated with PEG dependence (optimism-corrected AUC 0.79). Clustering identified three recovery phenotypes—functional/emotional responders, psychological/body-image responders, and global slow recovery—with significantly different PEG rates (5.9%, 21.4%, 40.0%; p = 0.006). Exploratory mediation analysis suggested that the association between reconstruction technique and mental quality-of-life recovery was partly statistically accounted for by swallowing and body-image improvement. Conclusions: Recovery after major head-and-neck reconstruction is multidimensional and heterogeneous. Baseline swallowing function, reconstruction technique, radiotherapy, and major complications jointly stratify risk for persistent functional and psychosocial impairment, supporting risk-adapted multidisciplinary rehabilitation and early psycho-oncologic screening. 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: Respectful maternity care (RMC) prioritizes dignity, privacy, and autonomy during childbirth. In low-resource primary health centers (PHCs), the lack of delivery gown availability compromises these aspects, leading to discomfort and reduced patient satisfaction in PHCs. This study on Maathru Samman Pants (MSPs), a culturally sensitive garment designed with functional flaps, aims to enhance privacy, comfort, and dignity during labor, as well as assess the satisfaction, acceptability, and demand for MSPs among pregnant women and their birth companions in PHC settings across four Indian regions. Methods: A cross-sectional study was conducted across eight PHCs in North, South, East, and West India. A total of 80 pregnant women and 60 birth companions participated. Data were collected through structured questionnaires and in-depth interviews. The quantitative data covered satisfaction, acceptability, and demand using Likert scales, yes/no, and open-ended formats. The qualitative data were analyzed thematically. Results: Most PW (pregnant women) were aged 21–30 years, mainly Hindu, 34 (42.5%), or Christian, 27 (33.75%), with 71.25% homemakers. PW highly rated MSPs for covering the body, preventing cold, comfort, and ease of use. They felt cared for and respected, with a mean ± SD of 4.47 ± 0.57, and agreed that MSPs maintained privacy and cultural norms. Demand was strong, with 76 (95%) supporting the introduction of MSPs and 74 (92.5%) willing to use them again. Most PW, 66 (82.5%), and BCs (birth companions), 49 (81.67%), accepted MSPs positively, with a few reporting discomfort or changes. Conclusions: MSPs demonstrated high satisfaction, strong acceptability, and future demand among PW. This study addresses key gaps in respectful maternity care at the PHC level by enhancing privacy, preserving cultural norms, and improving comfort. Integrating MSPs into maternal health protocols could significantly improve birthing experiences in resource-limited settings. Full article

Background/Objectives: Reconstruction of defects in the ankle, foot and heel is complex because of the limited availability of local tissue and multiple comorbidities like diabetes mellitus and peripheral vascular disease. Even though free and pedicled flaps are widely used, their comparative effectiveness remains incompletely defined. Methods: This study presents a narrative analysis of 21 studies. From each study, we extracted data related to flap type, characteristics of the patient, indications, and outcomes: flap survival, limb salvage, functional recovery and complications. Results: Free flaps were mainly used for the management of large, complex, infected, or weight-bearing plantar defects and generally showed high rates of survival (~95–97%) with good functional outcomes and limb salvage rates. On the other hand, pedicled flaps and perforator-based flaps were principally used for small-to-medium defects and showed comparable survival rates in selected cohorts (up to ~98–100%), although direct comparison is limited by differences in defect complexity and patient selection. Overall, the functional outcomes appeared comparable across techniques in appropriately selected patients. However, long-term complications, such as ulceration in weight-bearing heel regions, remained frequent (reported rates were up to 39–41% in some free flap series). Sensory recovery and vascular status were key elements of long-term success, often exceeding flap type in predicting outcomes. Conclusions: Both free and pedicled flaps are effective options for reconstructing lower limb defects when appropriately indicated. While pedicled flaps remain preferred for smaller defects and high-risk patients, free flaps are generally better suited for extensive and more complex defects. The outcomes are influenced by several factors: individualized reconstruction strategy, characteristics of the defects, vascular status and patient comorbidities. Full article

Introduction: Standard abdominoplasty inevitably causes scarring in the umbilical region. Given the aesthetic significance of the navel, as the central anatomical landmark of the anterior abdominal wall, techniques that preserve the natural anatomy are warranted. The criteria for patient selection for such operations remain poorly defined, limiting their clinical application. Objective: The aim of this study was to define the indications and contraindications for scarless abdominoplasty in the umbilical region through a comparative analysis of clinical and subjective outcomes. Materials and Methods: A comparative study was conducted involving 115 patients operated on between 2021 and 2026. The experimental group consisted of 32 patients who underwent abdominoplasty without scarring in the umbilical region, while the control group comprised 83 patients who underwent standard abdominoplasty with umbilical transposition. The technique of scarless abdominoplasty in the umbilical region entailed limited mobilization of the cutaneous–subcutaneous flap, energy-based ultrasound-assisted liposuction in the supraumbilical region, suturing of rectus abdominis diastasis when clinically indicated, and fixation of the umbilicus in its physiological position without a skin incision around it. Energy-based ultrasound-assisted liposuction permits skin contraction in the supraumbilical area through a controlled internal thermal effect. The incidence of complications and BODY-Q questionnaire outcomes were evaluated at 3 months, 6 months, and one year. No significant differences in baseline clinical characteristics were observed between the groups. Results: The overall rate of postoperative complications in the experimental group was 18.8% (n = 6), compared to 24.1% (n = 20) in the control group; the difference was not statistically significant (p > 0.05). According to the BODY-Q questionnaire, patients in the experimental group reported significantly higher satisfaction with scar appearance (91.0 ± 3.5 vs. 83.0 ± 5.7; p < 0.001) and the umbilical region. The umbilicus retained its anatomically natural shape and depth. The use of energy-based ultrasound-assisted liposuction in the supraumbilical area contributed to the contraction of the upper cutaneous–subcutaneous flap, which made it possible to prevent extensive mobilization and the formation of a significant scar around the umbilicus in these patients. Conclusions: Scarless abdominoplasty in the umbilical region is a safe and effective technique in appropriately selected patients. Energy-based ultrasound-assisted liposuction produces an internal thermal effect that enhances the contraction of the cutaneous flap. Indications for this method comprise a moderate amount of excess skin tissue in the supraumbilical region, preserved skin elasticity, a normal or high umbilical position, and rectus abdominis diastasis grade I–II. Contraindications include pronounced excess skin tissue in the supraumbilical region, a low umbilical position, and general somatic contraindications to surgery. Full article

Background: Over the past two decades, with the collaboration between periodontists and orthodontists, the concept of a surgically facilitated orthodontic therapy (SFOT) approach was developed, which not only provides acceleration in tooth movement as a result of a stimulated regional acceleratory phenomenon but also increases the alveolar bone volume for orthodontic tooth movement range by bone grafting. Despite the benefits, hard and soft tissue defects can sometimes be observed in patients post SFOT, especially among groups with thin periodontal phenotypes. Methods: In the current study, we compared the traditional SFOT with allograft only and the modified SFOT with allograft and collagen matrix to explore if the addition of a collagen matrix between the bone graft and periodontal flap could achieve soft tissue augmentation and reduce the prevalence of the complications of SFOT. Six patients were initially enrolled in the current study. Four patients showed up for the 1-week and 2-week post-operation evaluations. However, only one subject of each group agreed on periodontal evaluation by bone sounding and CBCT during the 6-month follow-up appointment. Results: Six months post SFOT, the patient with the modified SFOT presented with a larger amount of soft tissue thickening compared to the patient with traditional SFOT. However, the location of bone generation was different between groups, with the modified SFOT group presenting with bone generation more apically. In addition, patients with modified SFOT reported a more severe level of discomfort than patients with traditional SFOT. Conclusions: The modified SFOT may potentially improve soft tissue phenotype; however, further modifications are needed to reduce the patient’s discomfort level and to ensure that bone particles are contained more incisally. Full article

Background: The latissimus dorsi free flap is a workhorse for extensive lower-extremity soft tissue defects. Conventionally, the skin paddle is designed according to the anticipated defect and left in place on the muscle as a single composite unit. This report describes an alternative approach in which the skin paddle is secondarily mobilized through subcutaneous undermining and rotated as a separate propeller-type local extension flap on random-pattern vascularization, without a specifically identified perforator—a technique that has not been previously reported. Case Presentation: A 38-year-old male with a high-energy distal lower-extremity defect exposing bone, Achilles tendon, and hardware underwent free latissimus dorsi reconstruction with an empirically designed skin paddle over the constant perforator zone. The skin paddle was subsequently mobilized and rotated as a separate propeller-type extension flap to cover the Achilles region, with additional areas managed using split-thickness skin graft and a reverse soleus flap. Results: The latissimus dorsi flap and skin paddle remained viable, providing stable coverage of the defect. The additional reverse soleus flap achieved durable medial coverage, and the limb was ultimately preserved with satisfactory soft-tissue stability. Conclusion: A random-pattern latissimus dorsi skin paddle designed within the anatomically constant perforator zone can provide a feasible new option offering intraoperative flexibility in complex lower-extremity trauma when perforator mapping is impractical. Full article

Background/Objectives: Occipital defects with dural exposure represent a complex reconstructive challenge requiring reliable vascularized coverage to prevent severe complications. This study aims to describe a salvage reconstructive approach using a transverse cervical artery (TCA)-based inferior trapezius flap and to highlight a technical modification intended to increase flap reach. Methods: We report the case of a 61-year-old male presenting with a chronic occipital defect associated with infection following cerebellar abscess evacuation. After failure of primary closure, skin grafting, and local flap reconstruction, a regional pedicled inferior trapezius musculocutaneous flap was performed. Intraoperatively, the dorsal scapular artery (DSA) was selectively sacrificed after confirmation of dominant TCA perfusion to increase the arc of rotation. Flap perfusion was assessed clinically. Results: The flap provided adequate coverage of the defect with stable perfusion. The postoperative course was favorable, with resolution of a minor donor-site seroma. At 1- and 3-month follow-up, stable coverage, preserved cervical mobility, and satisfactory aesthetic outcomes were observed. These results were maintained at 1-year follow-up, with no functional limitation or late complications. Conclusions: This single case report suggests that a TCA-based inferior trapezius flap may represent a feasible salvage option in selected occipital defects. The intentional sacrifice of the DSA appeared to increase flap reach in this case; however, its safety and reproducibility remain uncertain. Further studies are required before this approach can be routinely recommended. Full article

Background: Complex elbow soft-tissue defects often combine exposed critical structures, unstable scars, and high mechanical stress, making durable coverage and early mobilization challenging. Among regional options, the reverse lateral arm flap provides thin fasciocutaneous tissue based on a reliable collateral circulation and preserves major forearm vessels. The aim of this study was to report our single-center experience with the pedicled reverse lateral arm flap for elbow soft-tissue reconstruction, focusing on stable coverage, donor-site morbidity, and functional recovery. Methods: A retrospective single-center case series was conducted at the Division of Plastic Surgery, University Hospital of Padua, Italy. All consecutive patients treated between 2013 and 2023 with a pedicled reverse lateral arm flap for elbow soft-tissue defects were included. Recorded variables included defect etiology, donor-site management, complications, range of motion, and follow-up. Elbow flexion–extension was recorded clinically preoperatively and at last follow-up. Minimum follow-up was 12 months in all patients. Results: Seven patients underwent reconstruction. Defect etiology was burn-related in four cases, shotgun trauma in one, crush injury in one, and melanoma resection in one. All defects were covered with a pedicled reverse lateral arm flap. All flaps survived completely without partial necrosis or flap-related reoperation. Donor-site closure was primary in four patients and required split-thickness skin grafting in three. One patient developed donor-site keloid, and one had donor-site skin-graft partial loss with delayed healing. Elbow flexion–extension improved in all seven cases, with a median gain in arc of motion of 25° (range 15–41°). Conclusions: In this series, the reverse lateral arm flap provided complete coverage of selected elbow defects with preserved motion and limited donor-site morbidity at a minimum follow-up of 12 months. Our findings suggest that it may represent a useful regional option in selected posterior and lateral elbow defects, particularly in post-burn and traumatic settings where thin vascularized tissue is needed, and free-flap reconstruction may be avoidable. Full article

Background/Objectives: Reconstruction of complex lower extremity soft tissue defects remains challenging, particularly in the proximal and middle tibial regions, including the knee, where suitable recipient vessels are often limited due to prior trauma, infection, or surgical intervention. This study aimed to evaluate the feasibility and clinical applicability of anterior tibial vessel turnover as an alternative recipient vessel strategy in free flap reconstruction. Methods: A retrospective review was conducted of seven patients who underwent free flap reconstruction using anterior tibial vessel turnover as the recipient vessel between 2019 and 2024. Preoperative imaging was performed to assess vascular status and collateral circulation. Clinical data, including patient demographics, defect characteristics, flap parameters, and postoperative outcomes, were analyzed. Results: The mean patient age was 62.7 years (range, 38–86 years). Defects were primarily located in the proximal and middle tibial regions and were associated with trauma, postoperative infection, chronic osteomyelitis, or burn injury. The mean flap size was 137.4 cm² (range, 49.5–280 cm²). All flaps survived, resulting in a flap survival rate of 100%, with no cases of total flap loss or re-exploration due to vascular compromise. One patient experienced partial flap loss, while no other flap-related complications were observed. Most patients achieved stable wound coverage and favorable functional recovery. Conclusions: Anterior tibial vessel turnover may serve as an alternative recipient vessel strategy for selected cases of complex lower extremity free flap reconstruction. This technique enables microvascular anastomosis in a more superficial and accessible field and expands reconstructive options in cases with compromised recipient vessels. Full article

In this work we propose a new strategy for the optimization of the flap position of a high-lift configuration in the framework of a hybrid electric regional aircraft. The approach is based on the multidisciplinary design optimization software GEMSEO and the high-performance CFD solver CODA. The CFD solver CODA solves the RANS equations on a body-fitted mesh along with immersed boundary methods, while the package GEMSEO employs the COBYQA optimization algorithm. The main airfoil is meshed in a body-fitted fashion, and a refined region is created just where the flap can be located. The employment of immersed boundary methods allows us to arbitrarily change the deflection angle and leading edge position of the flap inside this refined region without the need of remeshing the whole computational domain. The main advantage of this methodology with respect to a full body-fitted mesh scheme is the computational efficiency when hundreds or thousands of CFD-RANS simulations are required by the optimizer. We demonstrate the effectiveness of this optimization methodology in the computation of the optimal configuration of the flap during takeoff and landing phases of a high-lift airfoil. Full article