Search Results (469)

Autologous fat grafting is the main surgical technique for soft tissue reconstruction. However, its clinical use with more extended volumes is limited by repeated procedures due to the little possibility of banking tissue, donor-site morbidity and unpredictable graft resorption rates. To overcome these problems, adipose tissue engineering has focused on developing injectable scaffolds. Most of them are hydrogels that closely mimic the biological, structural and mechanical characteristics of native adipose tissue. This review provides an overview of current injectable scaffolds designed to restore soft tissue volume defects, emphasizing their translational potential and future directions. Natural injectable scaffolds exhibit excellent biocompatibility but degrade rapidly and lack mechanical strength. Synthetic injectable scaffolds provide tunable elasticity and degradation rates but require biofunctionalization to support cell adhesion and tissue integration. Adipose extracellular matrix-derived injectable scaffolds are fabricated by decellularization of adipose tissue. Accordingly, they combine bio-mimetic structure with intrinsic biological cues that stimulate host-driven adipogenesis and angiogenesis, thus representing a translatable “off-the-shelf” alternative to autologous fat grafting. However, despite this broad spectrum of available injectable scaffolds, the establishment of clinically reliable soft tissue substitutes capable of supporting large-volume and long-lasting soft tissue reconstruction still remains an open challenge. Full article

Recent advances in biomaterials, immunomodulation, stem cell therapy, and biofabrication are reshaping maxillofacial surgery, shifting reconstruction paradigms toward biologically integrated and patient-specific tissue regeneration. This review provides a comprehensive synthesis of current and emerging strategies for bone and soft-tissue regeneration in the craniofacial region, with particular emphasis on bioactive ceramics, biodegradable polymers, hybrid composites, and stimuli-responsive smart materials. We further examine translational technologies such as extracellular vesicles, decellularized extracellular matrices, organoids, and 3D bioprinting, highlighting key challenges such as bioink standardization, perfusion limitations, and regulatory classification. Maxillofacial surgery is positioned for a paradigm shift toward personalized, biologically active, and clinically scalable regenerative solutions. Full article

Background: Ameloblastomas account for roughly 1% of all jaw tumours and cysts, typically manifesting as slow-growing, painless swellings that expand both buccal and lingual cortical plates and may infiltrate adjacent soft tissue, often leading to a delayed diagnosis. These benign tumours, characterized by local invasiveness, originate from epithelial tissues and may develop from dental lamina cell rests, the enamel apparatus, the epithelial lining of odontogenic cysts, or basal epithelial cells of the oral mucosa. Methods: This paper aims to describe the comprehensive and interdisciplinary management of an extensive ameloblastoma in a 16-year-old patient, emphasizing the diagnostic challenges, surgical resection, reconstructive procedures, and subsequent oral rehabilitation. Results: At the eleven-year follow-up, clinical and radiographic examinations showed no signs of tumour recurrence. The patient presented no symptoms, indicating neither pain nor functional impairment. The prosthetic rehabilitation utilizing implant-supported fixed restorations was successfully completed, resulting in satisfactory masticatory function and aesthetics. This case adds to the existing evidence on the management of extensive ameloblastomas by demonstrating successful long-term outcomes following interdisciplinary surgical reconstruction and rehabilitation. Conclusions: The presented case highlights the complexity of restoring the lost tissues and functions, as well as the long-term clinical, functional, and aesthetic outcomes over an eleven-years follow-up period. Full article

Background/Objectives: Habitual patellar dislocation is a rare but debilitating form of patellofemoral instability in children and adolescents, frequently associated with underlying anatomical abnormalities and ligamentous laxity. Despite multiple surgical techniques, recurrence and suboptimal functional recovery remain concerns. This study aimed to identify the demographic, clinical, and imaging factors associated with postoperative recurrence and poorer functional outcomes in pediatric patients surgically treated for habitual patellar dislocation. Methods: A retrospective cohort study was conducted on pediatric patients treated between 2016 and 2024 for habitual patellar dislocation. Inclusion criteria required age ≤ 18 years, a minimum 12-month follow-up, and complete imaging documentation. Clinical evaluation included the Beighton hyperlaxity score, lower-limb alignment, and Lysholm Knee Score. Imaging parameters assessed patellar height (Caton–Deschamps Index), trochlear dysplasia, patellar tilt, patellar subluxation, genu valgum, and tibial tubercle–trochlear groove (TT–TG) distance. Surgical treatment consisted of individualized combinations of soft-tissue realignment, quadriceps lengthening, Roux–Goldthwait procedures, and MPFL reconstruction. Statistical analyses evaluated predictors of recurrence and postoperative Lysholm score. Results: Thirty-four patients (45 knees; mean age 12 years; 73.5% female) were included. Preoperative Lysholm scores improved from a mean of 73 to 94 postoperatively (p < 0.0001). Recurrence occurred in 32.35% of patients and was significantly associated with generalized hyperlaxity (p = 0.0041), trochlear dysplasia (p = 0.045), and lateral patellar subluxation (p = 0.039). Suboptimal postoperative Lysholm scores (<85) were observed in 11.76% of patients, all with recurrence, and were significantly associated with genu valgum (p = 0.0011) and patella alta (p = 0.036). No significant associations were found for rotational deformities or femoral condyle hypoplasia. Conclusions: Habitual patellar dislocation in children is multifactorial, and the likelihood of recurrence increases with cumulative risk factors such as hyperlaxity, trochlear dysplasia, lateral subluxation, patella alta, and genu valgum. Comprehensive preoperative assessment is essential to guide combined, individualized surgical strategies that optimize stability and functional recovery. No single technique is universally curative; rather, tailored multimodal approaches yield the most favorable outcomes. Full article

Background/Objectives: Heel reconstruction is a complex procedure that requires soft tissue reconstruction resistant to weight, pressure, and shear stress. Various flap reconstruction methods have been reported; among them, free fasciocutaneous flaps have advantages in terms of function and aesthetics, but also have challenges due to the longer operation time required and the possibility of failure. The primary aim of this study was to examine the functional outcomes of heel reconstruction using free lateral arm fasciocutaneous flaps after wide excision of heel skin cancer. Methods: Between January 2014 and December 2020, eight patients underwent wide excision of skin cancer and reconstruction of the heel with a lateral arm free flap. Perioperative clinical data and postoperative outcomes, including flap survival, complications, Lower Extremity Functional Scale (LEFS) score, and American Orthopaedic Foot and Ankle Society scale (AOFAS) score, were analyzed from clinical records. Functional assessments were performed at a minimum of 12 months postoperatively (mean 18.3 months, range 12–24 months) by a single blinded examiner who was not involved in the surgical procedures. Both preoperative and postoperative LEFS and AOFAS scores were recorded for comparison. Results: The mean size of the skin and soft tissue defect was 32 cm², the mean duration of surgery was 179 (range: 160–215) minutes, and the mean duration of hospital stay after surgery was 17 (range: 14–19) days, with a mean follow-up period of 48 (range: 33–59) months. Among the eight patients, two had diabetes mellitus (25%), one had peripheral neuropathy (12.5%), and none had clinically significant peripheral vasculopathy. All flaps survived, with one congestive episode. Satisfactory aesthetic and functional results were observed in all patients. The mean preoperative LEFS score was 28 (SD ± 6.1), which improved significantly to a postoperative mean of 57 (SD ± 8.3). Similarly, the mean preoperative AOFAS score was 45 (SD ± 5.8), improving to a postoperative mean of 61 (SD ± 6.2). Minor donor site complications included hypertrophic scarring in two patients (25%) and transient sensory changes in the lateral arm region in three patients (38%), all of which resolved with conservative management. Conclusions: This research suggests that the lateral arm free flap can be considered a reliable option in heel reconstruction, resulting in acceptable functional and aesthetic outcomes. It provides excellent durability, with solid bony union and good contour in small to moderate-sized heel defect cases. Full article

In the context of guided bone regeneration (GBR), the selection of an appropriate resorbable membrane plays a crucial role in the clinical success of the procedure. Precise knowledge about the distinct differences in properties is fundamental for correct selection of the membrane. This article presents an integrated comparative analysis between membranes, conducted for this given purpose and one step beyond: to fabricate a novel membrane with dedicated enhanced properties according to the targeted function. Our previous analysis showed that polymer membranes that met most histopathological criteria also produced the most remarkable results when radiologically observed. The most effective scaffolds were those containing active macromolecules released conditionally and staged. The PLGA and polycaprolactone scaffolds were found in this category and they granted a marked increase in bone density and improvement in osteoinduction. Based on these results, we decided to create a new polycaprolactone membrane in order to compare it with a standard currently on the market, the Jason membrane. The Jason^® membrane is a natural collagen scaffold derived from porcine pericardium. Due to the unique production process, the membrane shows a natural honeycomb-like, multilayered collagen structure with an increased content of collagen type III, leading to remarkable tear resistance and a slow degradation rate. Also, the low thickness of 0.05–0.35 mm facilitates the soft tissue management. The Jason scaffold was compared to an innovative synthetic membrane based on polycaprolactone (PCL), focusing on their physicochemical characteristics, biological behavior, and clinical applicability. The Jason^® membrane was distinguished by its high biocompatibility and rapid integration, while PCL offered superior mechanical stability and long-term durability, making it a preferred option for complex or customized 3D regenerations. Based on this integrated analysis, we fabricated an innovative electrospun PCL membrane, enriched with a novel synthesized nanohydroxyapatite, in order to enhance its specific properties for the beneficial use in targeted reconstructions. Full article

Background/Objectives: Chronic ulcers are often characterized by impaired microcirculation, delayed epithelialization, and persistent pain. Extracorporeal shock wave therapy (ESWT) has emerged as a regenerative approach capable of modulating angiogenesis and tissue repair. This study aimed to evaluate the effects of ESWT on wound healing, microvascular remodeling, sensory recovery, and joint mobility in patients with chronic ulcerative lesions. Methods: In this prospective observational study, patients with chronic ulcers underwent a standardized ESWT protocol in addition to conventional wound care. Clinical outcomes were assessed at baseline and at the end of follow-up using the Bates–Jensen Wound Assessment Tool (BWAT), pain visual analogue scale (VAS), capillaroscopy, Semmes–Weinstein monofilament test (SWMT), two-point discrimination (2PD), and range of motion (ROM). Results: ESWT was associated with a significant improvement in wound status, pain, sensory function, and ROM. Capillaroscopy showed robust correlations with clinical recovery, inversely with BWAT (ρ = −0.64, p < 0.01), SWMT (ρ = −0.55, p < 0.05), and 2PD (ρ = −0.49, p < 0.05), and positively with ROM recovery (ρ = 0.58, p < 0.01). Diabetic and smoking patients required a longer healing period (5.8 ± 1.3 weeks) than non-diabetic, non-smoking patients (4.2 ± 0.9 weeks, p = 0.03), although BWAT, capillaroscopy, and ROM values converged by week 8. Conclusions: ESWT was associated with meaningful structural, microvascular, and functional improvements in chronic ulcers. Microvascular remodeling, assessed by capillaroscopy, emerged as a key correlate of clinical recovery. Despite slower early healing in diabetic and smoking patients, final regenerative outcomes were ultimately comparable across risk profiles. Full article

Background/Objectives: The “bank-finger” or “spare-parts” principle offers an immediate reconstructive solution in mutilating hand injuries by repurposing viable tissues from non-salvageable digits to restore length, coverage, and function. Although described for decades, systematic evidence remains scarce. This study compared a single-center retrospective cohort with a systematic review of the specialized literature (2015–2025) to clarify the indications, reconstructive models, assessment of functional outcomes, and complication profiles associated with this technique. Methods: A retrospective analysis was performed on 35 adult patients treated for complex hand trauma between 2017 and 2024. It was compared with a systematic review of nine clinical studies identified across PubMed, Scopus, Embase, Web of Science, and Cochrane Library. Extracted variables included demographics, mechanisms of injury, type of tissues transferred, vascularization method, complications, and functional outcomes. Methodological quality was assessed using the Joanna Briggs Institute (JBI) criteria for case reports and case series. Results: Across 78 cases (43 from the literature and 35 institutional), vascularized fillet and osteo-cutaneous transfers constituted the predominant reconstructive approach, providing immediate skeletal stability and durable, sensate soft-tissue coverage. All flaps and grafts survived, and functional recovery was consistently favorable. In the retrospective cohort, standardized evaluation demonstrated excellent outcomes (mean DASH 14.6, MHQ 82.5, VAS 1.8). The overall complication rate remained below 10%, limited to transient venous congestion or mild postoperative stiffness. No infections, flap losses, or donor-site morbidity were reported. Conclusions: The bank-finger technique is a reliable, biologically efficient reconstructive strategy for acute mutilating hand trauma. When applied early and with appropriate tissue selection, it achieves outcomes comparable to conventional microsurgical options while avoiding additional donor-site morbidity. The present combined analysis highlights its reproducibility and underscores the need for prospective multicenter studies employing standardized functional metrics. Full article

Background: Reconstruction of the thigh extensor mechanism following wide excision of a soft-tissue sarcoma is difficult. The aim of this study was to describe the outcomes following complete quadriceps resection for large high-grade soft-tissue sarcomas. Methods: Ten patients with AJCC grade IIIB soft-tissue sarcomas of the anterior thigh were treated with total wide margin quadricectomy, with a mean follow-up of 4 years (range: 51–163 months) in the five surviving patients with conservative surgical procedures. The minimum follow-up period for four of these patients was 8 years. The extensor mechanism was reconstructed with local muscle transfers (eight cases) or a neurotized free flap of the contralateral vastus lateralis (two cases). Results: Four patients died, two due to non-tumor related causes and two due to metastatic disease at 50 months and 43 months. The remaining six were alive and disease-free at the final follow-up. All patients received surgical revision due to wound necrosis. Another patient required an external hemipelvectomy due to early local recurrence of the disease. Functional results of the five patients who remained alive and retained their limb were good or excellent in two cases, acceptable in one, and poor in two, according to their MSTS scores. Average knee flexion was 80° (range: 10–150°). Passive extension was complete in all cases, though no patients achieved it actively. Extensor strength was 2/5 in four patients and 4/5 in the other. Conclusion: Total quadricectomy for high-grade soft-tissue sarcomas of the anterior thigh compartment ensures wide resection margins and local disease control, although local wound complications are common, particularly in older patients. Resection appears to be technically easier if performed distally to proximally in the thigh. Local muscle transfers are more suited for low-demand patients, while neurotized free muscle flaps are mainly an option for young, motivated patients. Full article

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes. Full article

Acellular dermal matrices (ADMs) are widely used in soft-tissue reconstruction, yet the optimal timing for split-thickness skin grafting (STSG) remains unsettled. We conducted a single-center retrospective cohort study (January 2023–August 2025) of adults undergoing ADM-based reconstruction with Integra^® Double Layer (IDL), Integra^® Single Layer (ISL), or Nevelia^®. Primary endpoints included length of stay (LOS), STSG requirement and timing, and in-hospital complications; secondary endpoints included spontaneous epithelialization. Prespecified adjusted analyses (linear/logistic models) controlled for age, sex, etiology, anatomical site, diabetes/PAOD, smoking, wound size (when available), wound contamination, and matrix type. Histology and immunohistochemistry (H&E, Masson trichrome, CD105, D2-40) assessed matrix integration and vascular/lymphatic maturation. Seventy-five patients were included (IDL n = 40; ISL n = 20; Nevelia n = 15). On multivariable analysis, matrix type was not an independent predictor of LOS (ISL vs. IDL β = +2.84 days, 95% CI −17.34 to +23.02; Nevelia vs. IDL β = −4.49 days, 95% CI −16.24 to +7.26). Complications were infrequent (6/75, 8.0%) and comparable across matrices; spontaneous epithelialization occurred in 3/75 patients (4.0%). A day-14 grafting strategy, applied only after documented clinical integration, was feasible in 30/75 (40.0%) patients without excess complications. Histology/IHC at 3–4 weeks demonstrated CD105-positive, perfused capillary networks with abundant collagen; at 4–6 weeks, D2-40-positive lymphatic structures confirmed progressive neo-dermis maturation, supporting the biological plausibility of earlier grafting once integration criteria are met. In this cohort, outcomes were broadly similar across matrices after adjustment. A criteria-based early STSG approach (~day 14) appears safe and operationally advantageous when integration is confirmed, while a minority of defects may heal without grafting. Prospective multicenter studies with standardized scar/functional measures and cost analyses are needed to refine patient selection and graft timing strategies. Full article

Background: Covering the defects around the calcaneus is still a largely debatable subject. In the classical view, the defects at the level of the foot can be treated only by a free flap. In a modern approach, it has been observed that for small or moderate foot defects, a local flap can be used. Methodology: In this case series, we have retrospectively selected the patients who were admitted to the orthopedic department for a calcaneal fracture and who presented soft-tissue complications during the treatment. The patients have been selected from the past five years if they have undergone reconstructive surgery with a local or regional flap. Results: By applying the inclusion and exclusion criteria, we found that out of 79 patients who have been admitted to the orthopedic department, only two patients met the criteria. Two flaps have been used to treat the defects that developed at the level of the calcaneus after traumatic injury of the foot. The reverse-flow sural flap, as a tunneled flap, had a good evolution, without vascular suffering of the flap. On the other hand, for defects at the medial level of the calcaneus, we have used the dorsalis pedis flap. The healing was fast, and the patient presented no complications at the level of the donor site. Conclusions: Both flaps presented a good evolution. We try to emphasize through this article that soft tissue defects around the non-weight-bearing area of the heel can also be treated through a non-microsurgical option. These two options can help the ortho-plastic team to manage difficult cases by avoiding a free flap or a split-thickness skin graft. Full article

The chest wall represents a complex musculoskeletal structure that provides protection to intrathoracic organs, mechanical support for respiration, and mobility for the upper limbs. Neoplastic diseases of the chest wall encompass a heterogeneous group of benign and malignant lesions, which may be classified as primary—originating from bone, cartilage, muscle, or soft tissue—or secondary, resulting from direct invasion or metastatic spread, most commonly from breast or lung carcinomas. Approximately half of all chest wall tumors are malignant, and their management remains a significant diagnostic and therapeutic challenge. Surgical resection continues to represent the mainstay of curative treatment, with complete en bloc excision and adequate oncologic margins being critical to minimize local recurrence. Advances in reconstructive techniques, including the use of prosthetic materials, biological meshes, and myocutaneous flaps, have markedly improved postoperative stability, respiratory function, and aesthetic outcomes. Optimal management requires a multidisciplinary approach involving thoracic and plastic surgeons, oncologists, and radiotherapists to ensure individualized and comprehensive care. This review summarizes current evidence on the classification, diagnostic evaluation, surgical strategies, and reconstructive options for chest wall tumors, emphasizing recent innovations that have contributed to improved long-term survival and quality of life in affected patients. Full article

Background/Objectives: Oral cavity defects highlight the necessity for individualized reconstructive strategies given their anatomical and functional complexity. Reconstructive surgery should optimize healing and function, minimize complications, and reduce operative time and costs. Although free flaps remain the gold standard for oral cavity reconstruction, they require large teams, specialized microsurgical equipment, and extended operative times. Methods: A retrospective analysis was performed on 59 consecutive patients who underwent intraoral reconstruction for medium-sized oral cavity defects between 2022 and 2025, using either a facial artery musculomucosal (FAMM) flap or a free flap. Statistical comparisons were made for excision parameters, operative variables, length of hospitalization, and postoperative outcomes. Results: Comparison between the FAMM and free flap reconstruction groups revealed no significant differences in patient age, gender, histopathological diagnosis, lesion size, oncological radicality, or functional outcomes related to speech and alimentation. However, FAMM flap reconstruction was associated with significantly reduced operative time (196.7 ± 94.9 min vs. 427.1 ± 129.8 min; p < 0.001), representing a 54% reduction in procedure duration. Similarly, the mean hospital stay was 40% shorter in the FAMM group (12.7 ± 6.0 days vs. 21.1 ± 8.0 days; p < 0.001). Intensive care unit admission was also markedly less frequent following FAMM flap reconstruction (7.3% vs. 83.3%; p < 0.001). Conclusions: In cases of small and medium-sized oral cavity defects, reconstruction using FAMM flaps represents a favorable alternative to free flap reconstruction, offering comparable functional outcomes while significantly reducing operative time and length of hospitalization. Full article

The objective of the present study is to review the anatomical considerations, surgical techniques, clinical applications, and outcomes of myocutaneous and muscle flaps used in the reconstruction of limb defects in dogs and cats. Limb wounds in small animals often result from trauma, neoplasia, or infection and can involve significant soft tissue loss. Reconstruction of these defects is challenging due to limited local skin availability, particularly in distal regions, and the need to preserve function while preventing complications. Muscle and myocutaneous flaps provide well-vascularized tissue suitable for covering complex wounds, especially those with exposed bone, joints, or tendons. This review synthesizes current literature on commonly used flaps—including latissimus dorsi, cutaneous trunci, trapezius, sartorius, semitendinosus, and flexor carpi ulnaris; focusing on their anatomical basis, vascular supply, arc of rotation, surgical technique, indications, and complication rates. Comparative data between dogs and cats are highlighted, and experimental as well as clinical applications are discussed. Myocutaneous flaps offer durable and reliable coverage with lower infection and necrosis rates compared to skin grafts, particularly in contaminated or poorly vascularized wounds. Common complications include distal flap necrosis, wound dehiscence, seroma, and, occasionally, functional deficits. Muscle and myocutaneous flaps remain essential tools in limb reconstruction. Successful outcomes require careful flap planning, surgical expertise, and vigilant postoperative care. Further prospective studies are needed to optimize flap selection and reduce complication rates in both species. Full article