BACKGROUND: Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to...BACKGROUND: Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes. PURPOSE: This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures. METHODS: All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups. RESULTS: We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 ± 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p ≥ 0.06). CONCLUSION: The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.
Faderani R, Kanapathy M, Bray J
… +12 more, Dehbi HM, Panca M, Vindrola-Padros C, Beecham E, Burr N, Williams N, De La Cruz Monroy M, Pywell M, Bhat W, Wong J, Mosahebi A, Nikkhah D
BACKGROUND: Wide-awake local anesthesia no tourniquet (WALANT) is increasingly used for flexor tendon repair, but comparative data versus general/regional anesthesia(GA/RA) are limited. The aims of the WAFER trial were t...BACKGROUND: Wide-awake local anesthesia no tourniquet (WALANT) is increasingly used for flexor tendon repair, but comparative data versus general/regional anesthesia(GA/RA) are limited. The aims of the WAFER trial were to generate high quality comparative data on WALANT versus GA/RA for flexor tendon repair and assess the feasibility of performing a large multicenter trial of this nature. METHODS: WAFER was a multicenter, assessor-blinded, parallel-group RCT with embedded qualitative and health economic components across four major hand units. Patients were randomized on a 1:1 basis to have flexor tendon repair under GA/RA or WALANT. The primary feasibility outcomes were recruitment, retention and trial acceptability in addition to clinical outcomes which included range of motion (Total-active-motion score), grip/pinch strength, finger circumference, complications and patient reported outcome measures(PROMS) (Michigan-Hand-Questionnaire, EQ-5D-5L). Qualitative interviews were conducted with clinicians and participants to assess acceptability and equipoise. Economic analyses summarized intra-operative costs and impact on productivity. The primary analysis set was per-protocol. RESULTS: Sixty participants were randomized across all sites (30 WALANT; 30 GA/RA); 56 were analyzed per-protocol. At 6 months, mean TAM score(SE) for GA/RA was 67.6(5.6) vs 60.3(6.3) in the WALANT group. Tendon rupture was reported in two patients in the GA/RA group and three in the WALANT group. PROMs improved over time in both groups, patients in the WALANT arm reported consistently higher MHQ scores across domains. Participants in WALANT arm returned to work earlier than participants in GA/RA arm (mean 3.0 vs 6.7weeks). Intra-operative costs were lower with WALANT by 54% (-£398, 95% CI -£509 to -£287). CONCLUSIONS: A pragmatic comparison of WALANT versus GA/RA with tourniquet for primary flexor tendon repair is deliverable and safe. Inter-arm clinical differences were small; however, WALANT showed lower intra-operative costs and a signal for earlier return to work.
BACKGROUND: Facial synkinesis (FS) is a common and disabling sequelae of facial nerve injury, yet no validated, condition-specific patient-reported outcome measure (PROM) exists to assess its functional and psychosocial...BACKGROUND: Facial synkinesis (FS) is a common and disabling sequelae of facial nerve injury, yet no validated, condition-specific patient-reported outcome measure (PROM) exists to assess its functional and psychosocial effects. This study aimed to develop and validate a reliable, patient-centered instrument for individuals with FS. METHODS: This prospective, multi-phase validation study (2023-2025) was performed at a tertiary academic medical center in accordance with established recommendations for PROM development and reported following guidelines for observational studies. The process included three phases: instrument development informed by direct patient input, content validation by international experts, and assessment of test-retest reliability. Ninety-nine patients with FS and 25 experts participated. Psychometric evaluation of the 45-item Facial Synkinesis PROM (FSP-45) included internal consistency using Cronbach's α and test-retest reliability using intraclass correlation coefficients. RESULTS: In Phase 1, 44 patients (mean age 55 years) informed a 67-item draft. In Phase 2, 25 experts evaluations resulted in a refined 46-item measure across five domains: symptoms, involuntary movements, daily activity limitations, social impact, and self-perception. In Phase 3, 55 patients (mean age 50 years) completed the questionnaire twice, approximately one month apart. Cronbach's α values ranged from 0.888 to 0.943 initially and 0.905 to 0.963 on retest. Intraclass correlation coefficients ranged from 0.553 to 0.839, indicating moderate to excellent test-retest reliability. CONCLUSION: The FSP-45 demonstrates strong reliability and internal consistency, capturing the physical and psychosocial burden of FS in adults. Responsiveness to clinical change and minimal clinically important difference remain to be established.
INTRODUCTION: Outcome measurement in aesthetic medicine is complicated by subjective definitions of beauty, psychosocial factors, and a lack of standardized assessment metrics. Outcome reporting heterogeneity limits phys...INTRODUCTION: Outcome measurement in aesthetic medicine is complicated by subjective definitions of beauty, psychosocial factors, and a lack of standardized assessment metrics. Outcome reporting heterogeneity limits physicians' ability to synthesize results from multiple studies. The purpose of this study was to identify the outcomes and outcome scales used in minimally-invasive facial rejuvenation clinical trials to determine the degree of outcome heterogeneity. METHODS: A systematic review was conducted to identify all randomized control trials published in 2020-2025 focusing on non-operative or minimally-invasive facial and neck rejuvenation treatments. We identified outcome measurements reported in each study, including investigator assessment scales, patient-reported outcome scales, and objective outcomes and metrics. RESULTS: Our search identified 242 articles for inclusion. From these, we identified 79 investigator assessment scales, 69 patient-reported outcome scales, and 53 objective outcomes reported. No investigator-reported or patient-reported outcome was used in greater than 40% of trials, and within studies comparing the same treatment type applied to the same facial region, there existed substantial heterogeneity in definitions of treatment efficacy. Furthermore, differences in reported measures existed between regions and funding sources. CONCLUSIONS: There is substantial heterogeneity in outcomes reporting among facial rejuvenation studies. Clinicians, researchers, and industry stakeholders should strive to develop a core outcome set to ensure that meaningful and consistent outcomes are reported in all clinical trials.
BACKGROUND: Ischemia-reperfusion (I/R) injury remains a major cause of partial skin flap necrosis following microsurgical reconstruction. This study evaluates the therapeutic potential of bovine colostrum-derived extrace...BACKGROUND: Ischemia-reperfusion (I/R) injury remains a major cause of partial skin flap necrosis following microsurgical reconstruction. This study evaluates the therapeutic potential of bovine colostrum-derived extracellular vesicles (C-EVs) as a scalable, cell-free alternative for enhancing skin flap survival. METHODS: Twenty-four Sprague-Dawley rats were randomly assigned to Sham, Control, and Exosome groups (n=8). A 3×6-cm 2 superficial inferior epigastric artery (SIEA) flap was elevated in all animals. The Control and Exosome groups were subjected to 8 hours of ischemia followed by reperfusion, while the Sham group underwent elevation alone. The Exosome group received 200 μg of C-EVs subcutaneously on Days 0 and 3, while Control and Sham groups received PBS. On Day 7, flap survival was evaluated via macroscopic analysis and laser Doppler perfusion imaging. Histological and immunohistochemical analyses were performed on tissue harvested from the standardized watershed zone to evaluate microvessel density (MVD), pro-inflammatory cytokines, and macrophage polarization. RESULTS: C-EVs significantly improved flap survival compared to the Control group (70.50±8.24 vs. 51.75±3.62 percent, p<0.05) and enhanced vascular perfusion (70.88±5.08 vs. 58.88±6.85 percent, p<0.05). Quantitative IHC analysis revealed that C-EV treatment significantly increased MVD (149.00±3.09 vs. 71.88±6.79 vessels/mm 2, p<0.01) and suppressed pro-inflammatory cytokine expression. Furthermore, C-EVs promoted M2 macrophage polarization, evidenced by a significantly lower CD86/CD206 ratio (p<0.01). CONCLUSIONS: This study provides early-stage preliminary evidence in a controlled rat model that C-EVs can mitigate I/R injury and improve skin flap survival. Given the proof-of-concept nature of these findings, further investigation in larger models is required to determine their clinical applicability.
BACKGROUND: Wide-awake local anesthesia no tourniquet (WALANT) and operating room-based anesthesia with sedation are both commonly used for carpal tunnel release (CTR), with similar clinical outcomes and satisfaction. Ho...BACKGROUND: Wide-awake local anesthesia no tourniquet (WALANT) and operating room-based anesthesia with sedation are both commonly used for carpal tunnel release (CTR), with similar clinical outcomes and satisfaction. However, the psychological and experiential factors that influence patients' anesthesia choice remain poorly characterized. This study aimed to evaluate cognitive, emotional, and experiential drivers of anesthesia selection for CTR using a mixed-methods approach. METHODS: 30 patients undergoing primary CTR were enrolled: 15 selected WALANT and 15 selected operating room-based anesthesia with sedation. Participants completed validated preoperative measures assessing pain severity, pain catastrophizing, pain sensitivity, pain self-efficacy, and PROMIS-29 domains. Semi-structured interviews were conducted preoperatively and postoperatively to explore expectations, decision-making processes, and reflections on the surgical experience. Quantitative outcomes were compared between groups, and qualitative data were analyzed using constant comparative methodology. RESULTS: There were no significant differences between groups in demographics, PROMIS-29 domains, or pain-related behavior domains. Qualitative analysis revealed distinct decision-making patterns. Patients choosing WALANT emphasized autonomy and desire for control and awareness during surgery, while patients selecting sedation described avoidance-oriented motivations and preference for relinquishing control. Locus of control behaviors were identified as a central differentiating construct between groups, independent of measured pain-related factors. CONCLUSIONS: Anesthesia choice for CTR may be driven by patient preferences related to control, awareness, and agency rather than by differences in pain perception or anxiety. Incorporating concepts of locus of control into preoperative counseling may improve alignment between anesthesia strategy and patient values.Level of Evidence: 2C Prognosis.