The quest for eternal youth has been a common theme in many cultures for centuries. While we have yet to discover a way to preserve youth eternally, we have made significant progress in understanding the aging process and in developing pharmaceuticals, surgical techniques, and technologies. In addition to rhinoplasty's facial beautification effect, we investigated whether it had a facial anti-aging effect using an artificial intelligence (AI)-based program. We also examined the correlation between patient satisfaction and the anti-aging effect of rhinoplasty.

Longitudinal trends in breast reconstruction after modified radical mastectomy remain under described. This study aims to assess procedural trends in autologous reconstruction (AR) and implant-based reconstruction (IBR), to analyse demographic shifts in these patients, and to examine differences in oncologic management. This retrospective study utilizes the Surveillance, Epidemiology, and End Results (SEER) database to investigate trends in immediate breast reconstruction from 2000 to 2020 following unilateral modified radical and radical mastectomy. Demographic and oncologic variables were collected, and reconstruction types were categorised as IBR, AR, or a combination. Subgroup analyses compared IBR and AR patients, and demographic changes between the 2000-2010 and 2010-2020 cohorts were examined. Chi-square tests in R studio were used for statistical analysis. Of the 25,649 patients, 51.8% underwent IBR and 48.2% AR. AR patients were typically younger, more frequently Black, had higher incomes, and were less likely to live in rural areas compared to IBR patients. A shift from AR to IBR was observed, with AR decreasing from 41.8% in 2000 to 24.5% in 2020. Significant demographic changes in AR patients included increased age, higher proportions of Black and Asian patients, reduced income, and increased non-marital status. Oncologic management differed, as AR patients were less likely to have received chemotherapy and radiation prior to their reconstruction, and experienced longer reconstruction times compared to IBR patients. This study highlights a decline in AR and rising IBR popularity, and reveals evolving patient characteristics. Understanding these trends is crucial for equitable access and informed decision-making in breast cancer reconstructive care.

Muscle sparing-transverse rectus abdominis flap has been widely used for breast reconstruction and the abdominal hernia or bulging at the donor site is relatively common complication. Previous studies have emphasized the fascial defects and the defect of muscle has been neglected. This study aims to investigate the relationship between the size of the rectus abdominis muscle defect and its impact on hernia or bulge formation after muscle sparing-transverse rectus abdominis flap.

This systematic review compared the efficacy of collagenase clostridium histolyticum (CCH) against percutaneous needle aponeurotomy (PNA) and limited fasciectomy (LF) for Dupuytren's contracture. Searches were conducted in PubMed, Embase, and Web of Science databases to March 2024. Randomised controlled trials (RCTs) were included. Primary outcomes included successful contracture correction as defined by included studies. Secondary outcomes included recurrence rates, patient-reported outcomes, and adverse events. A total of 11 studies (969 patients) were included. Meta-analysis showed no difference in efficacy between CCH and PNA (Relative Risk [RR]: 1.01, 95% Confidence Interval [CI]: 0.93-1.09). Recurrence rates were also similar (RR: 1.18, 95% CI: 0.95-1.48). Data suggested higher recurrence risk with CCH versus LF (RR: 6.84, 95% CI: 1.59-29.48). In some studies, CCH was associated with higher rates of haematoma, local pain, and oedema. CCH demonstrates comparable efficacy to PNA; however, it may have a higher risk of local complications and recurrence compared to LF. Treatment decisions should be made on a case-by-case basis.

Targeted muscle reinnervation (TMR) is a new technique for treating symptomatic neuroma, in which a sensory nerve after resection of a painful neuroma is coapted to an expendable motor nerve. There has been little information about optimal motor nerves for TMR of the vulnerable sensory nerves in the upper extremity.

Hydrocephalus is more common in patients with craniofacial syndromes (CS) relative to non-syndromic craniosynostosis, and the optimal management is challenging. This study examined the prevalence and treatment outcomes of hydrocephalus among children with CS.

The peroneal artery perforator flap is widely used to repair deep defects in the distal lower leg and ankle. However, the success of flap transplantation depends on the accurate location of the peroneal artery perforators, which can be a challenge due to potential vascular damage and anatomical variations. This study utilizes digital subtraction angiography and high-frequency ultrasound to clarify the anatomical features of the peroneal artery and its perforators and accurately locate these perforators, thereby improving preoperative design and clinical outcomes. Peroneal artery perforator sequential flaps were employed to repair the wounds and donor sites, with the second donor site sutured directly. A total of 36 peroneal artery perforators were identified in seven patients, with an average of 5.14 perforators per patient. The majority of these perforators (47.22%) were concentrated in the middle segment of the lower leg. All flaps underwent tension-free primary closure and survived successfully, presenting a smooth appearance, a fine texture, and a color similar to that of the surrounding skin. Only a linear scar was left in the secondary donor site, which did not affect the overall appearance of the limb. This technique can accurately localize peroneal artery perforators, optimize the design of peroneal artery perforator sequential flaps, and facilitate the success of the surgery and postoperative esthetic recovery.

This qualitative systematic review aims to get a better understanding of what it means to live with a rare congenital craniofacial condition according to patients and their parents. Eight patient representatives provided input to this study. After a systematic search, 1,291 studies were screened and 32 qualitative and mixed methods articles (> 691 participants) were included. ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ), Cochrane, and COnsolidated criteria for REporting Qualitative research (COREQ) checklists were used for reporting qualitative evidence synthesis and assessment of reporting of included studies. Studies predominantly included parents' perspectives and used mixed samples of diagnosis and sometimes combined the parent and patient perspectives. The results sections of the articles were analyzed inductively using Thematic Synthesis (i.e. line-by-line coding, generating descriptive and analytical themes). Five analytical themes were identified that describe experiences and perspectives: (1) Healthcare experiences, (2) Raising and Growing up, (3) Development of character, (4) Physical impact of the condition, and (5) Social experiences. Underlying themes illustrate that the different aspects throughout life are intertwined, that relationships in all different domains play an important role in shaping perspectives, and that experiences may change over time. Furthermore, it demonstrates that living with a craniofacial condition and undergoing treatment is multifaceted and that the perspectives of patients and parents may differ. In conclusion, well-being and quality of life of patients and their parents are dependent on many different aspects, and surgeons and other healthcare professionals should tailor their skills, expertise, and support to individual-specific needs besides medical indications and move beyond surgical excellence.

This study presents an innovative arthroscopy-assisted total wrist arthrodesis technique utilising three hollow screws, aimed at improving clinical outcomes for patients with severe wrist arthritis.

Health-related quality of life (HR-QoL) outcomes following maxillary reconstruction with the scapular osseous free flap (SOFF) are lacking.  Material and Methods: To determine these outcomes, a study of patients who completed maxillary reconstruction with flap survival of the SOFF between 2016 and 2023 was conducted, using Face-Q Head and Neck Cancer Module (FACE-Q).

Hemifacial microsomia (HFM) presentation includes gross distorted ramus, malposition temporomandibular joint, small glenoid fossa, distorted condyle and notch, malformed orbit, cupping ear or absent external ear, and facial nerve palsy. HFM is the second most prevalent congenital deformity of the face, with little literature from the South African population. This retrospective study elucidated the demographic characteristics and clinical presentations of HFM patients in a select South African population and compared it to the literature.  Methods: A retrospective study of HFM patients diagnosed through clinical presentation and confirmed by plain radiograph or computed tomography was conducted. The patient's charts were reviewed for age, sex, laterality, side, the severity of the deformity, and associated craniofacial and extra-craniofacial anomalies. The clinical presentation of malformations was categorised according to the OMENS classification, using five major craniofacial manifestations of HFM.

Pre- and postoperative photos to assess results are widely used in plastic and reconstructive surgery, for instance, in patients with cleft lip and palate (CL/P). Evaluations are often performed by assessment panels by viewing the photos. However, these are prone to be subjective. Measurements of soft tissues in photos could be an alternative method but have not been widely used so far. Some patients with CL/P develop a retrognathic maxilla in adolescence, with ensuing Class III malocclusion. In severe cases, distraction osteogenesis (DO) of the maxilla may be indicated. The effect of DO on the facial soft tissues is sparsely reported, perhaps due to the rare procedure. The primary aim of the present study is to provide a reliable and objective method of measuring soft tissue profiles in two-dimensional digital photos. Furthermore, the study aims at assessing changes in soft tissues following DO. Fourteen patients who had undergone DO at our unit were recruited. Preoperative and postoperative photos were identified, and long-term follow-up photos were taken. Three raters performed measurements of four angles and two distances. Inter- and intra-rater reliability and soft tissue changes were analyzed statistically. Inter- and intra-rater reliability was high overall for most variables. Two angles related to facial convexity changed significantly. So did the upper lip height. Soft tissues can be measured with a high degree of accuracy, but further evaluation of the method is necessary. DO causes a favorable increase in facial convexity, and an increased upper lip height.

Nonsyndromic unicoronal synostosis is associated with variability of severity in orbital morphology and ophthalmological manifestations. The relation between the two is not fully understood, nor how surgical treatment with fronto-orbital advancement and remodelling (FOAR) changes the relation. The aim of this study was to elucidate associations between ophthalmological manifestations and variations in orbital morphology and globe:orbit volume ratios preoperatively and at long-term follow-up after surgery. Twelve children referred to Uppsala Craniofacial Center who underwent computed tomography and standardized ophthalmological examinations regarding strabismus, spherical equivalent, astigmatism, anisometropia, and subnormal vision preoperatively and at 3 years of age were included. Orbits and globes were segmented. Principal component analysis elucidated morphological variation, and symmetry between orbital pairs was measured as the Dice similarity coefficient and globe:orbit volume ratios were calculated. The defined orbital shape variations were correlated with strabismus, refractive error, and subnormal vision. Different shape variations were associated with strabismus pre- and postoperatively and ipsi- and contralateral astigmatism. Greater improvement in orbital symmetry after surgery was associated with improvement in astigmatic anisometropia and new onset strabismus at follow-up. A small globe:orbit volume ratio was associated with preoperative strabismus, while the opposite was seen at follow-up. Different mechanisms seem to cause strabismus pre- and postoperatively, and FOAR might not sufficiently correct orbital morphology.

Head and neck cancer (HNC) and its treatment can result in permanent changes to a patient's appearance, speaking, eating, and psychosocial well-being. To better assess the impact of the disease on HNC patients, the FACE-Q Head and Neck Cancer Module, a health-related quality-of-life instrument, was developed. The aim of this study was to produce and linguistically validate a Finnish version of the module. The module was translated into Finnish following the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. A total of 51 patients who had undergone tumour resection and reconstruction of the oral cavity, tonsil, or tongue area between 2019 and 2021 were approached for a pilot study. They completed the translated module and provided feedback on any linguistic issues. Adjustments were made based on the pilot study comments. The FACE-Q Head and Neck Cancer Module translated well into Finnish. Twenty-one (41%) patients participated in the survey, 12 men (57%) and nine women (43%) with a median age of 66 years (range 48-89 years). The median time since surgery was 3 years (range 1-4 years). Based on the feedback from the pilot study participants, one word was changed, and one question was rewritten. Otherwise, no deficiencies were identified in the language of the module. In summary, this study produced a linguistically valid Finnish version of the FACE-Q Head and Neck Cancer Module, enabling its application in evaluating the health-related quality-of-life among Finnish HNC patients who have undergone reconstructive surgery.

Fronto-orbital remodelling for metopic synostosis is an extensive operation with substantial blood loss, particularly from emissary veins in the glabellar region. One possibility to reduce blood loss may be to stage dissection and cauterise anomalous emissary veins before dissecting in the subperiostal plane.  OBJECTIVE: The aim of the present study was to compare perioperative bleeding using a staged dissection in the glabellar region with the traditional subperiostal dissection technique during surgery for metopic synostosis.

Breast cancer can lead to changes in appearance and subsequent concerns about body image. This study aimed to translate the body investment instrument, Appearance Schemas Inventory-Revised (ASI-R), to Swedish, and perform a validation in women who underwent mastectomy and were awaiting breast reconstruction. The instrument was translated, and its psychometric properties were investigated according to current guidelines. Three hundred and ninety-seven women were eligible for the study, and 215 (54%) participants responded. An exploratory factor analysis (EFA) revealed that a three-factor structure was the most adequate solution. Three new subscales were suggested: body image investment cognition; breast and body image investment emotions; breast reflecting dysfunctional cognitive and emotional patterns of appearance investment and body image investment behaviors; breast reflecting positive ways of investing in body image. Consistent with previous findings, control over appearance is a central theme in women with breast cancer undergoing mastectomy and reconstruction. The obtained factor structure was considered similar to the original structure and three-factor solutions obtained from an American cohort of patients with breast cancer. The ASI-R has shown good psychometric properties in Swedish women undergoing mastectomy and reconstruction. Further studies on convergent validity and confirmatory factor analysis are required.

Breast animation is a common postoperative complication of breast reconstruction surgery. This study investigates the factors affecting the onset and degree of animation to suggest an ideal treatment strategy for this complication.

To investigate the anatomical basis and clinical efficiency of the advancement distance in dorsal digital V-Y advancement flap.

Volar locking plates (VLPs) are increasingly used for distal radius fractures (DRFs), yet their efficacy compared to cast immobilization remains debated. This meta-analysis aimed to compare VLPs versus cast immobilization for DRFs across various follow-up durations. Randomized controlled trials reporting patient-reported functional scores, wrist range of motion (ROM), radiological assessments, and complications were included. Meta-analysis was performed for 6-week, 3-month, 6-month, 12-month, and >12-month follow-ups. Subgroup analysis stratified studies by age group, ≥ 60 years and < 60 years. VLPs showed significantly lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores at 6 weeks (p < 0.001), 3 months (p < 0.001), 12 months (p = 0.012), and > 12 months (p < 0.001), and lower PRWE scores at 6 weeks (p < 0.001), 3 months (p = 0.048), and >12 months (p = 0.032). Wrist ROM favored VLPs at 6 weeks (p < 0.05), with higher flexion and supination at 3 months (p = 0.027) and 12 months (p = 0.003). Radiologically, VLPs showed improved parameters at 3- and 12-month follow-up. Overall complications did not significantly differ. Subgroup analysis in patients < 60 years generally supported these findings, while in patients ≥ 60 years, radiological outcomes aligned, yet only lower DASH scores were observed with VLPs at 3 months (p < 0.001). VLPs may offer superior clinical, functional, and radiological outcomes compared to cast immobilization at 3- and 12-month follow-up for patients < 60 years, with comparable safety profiles. For patients ≥ 60 years, VLPs may yield better radiological outcomes at 3- and 12-month follow-up, though clinical benefits remain uncertain.

This study evaluated spring-assisted posterior vault expansion (SA-PVE) in children aged > 2 years with craniosynostosis and signs of high intracranial pressure (ICP).

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.