The standard method for transporting tissues during limb transplantation and replantation is cold ischemic transport (CIT). However, CIT cannot completely prevent ischemia-reperfusion injury (IRI). As an alternative, extracorporeal perfusion (ECP) methods that provide an adequate metabolic environment for ischemic tissues could be considered. In this study, we investigated the differences between CIT and ECP in terms of their effects on IRI. An ischemia-reperfusion model was used to compare the CIT and ECP groups. This model includes a 6-hour ischemia period followed by a one-hour reperfusion period. Superoxide dismutase, catalase, total antioxidant status, total oxidant status, and total thiol levels in muscle and blood samples were biochemically analyzed to determine oxidative damage levels. TNF-α, NF-κB, and IL-10 levels were measured in the same samples to evaluate the degree of inflammation. Apoptosis was evaluated by measuring the levels of Bax and Bcl-2 proteins in muscle samples. Histopathologic examination was performed for tissue damage and mitochondria were evaluated by Cox staining. It was found that the ECP causes less oxidative and inflammatory damage than the CIT. Bax and bcl-2 levels did not differ between the 2 groups. Biochemical parameters were found to be higher in the CIT group. More mitochondrial damage was observed in the CIT system. ECP caused less inflammatory and oxidative damage compared with CIT. The promising results of our experimental study suggest that the clinical use of extracorporeal circulation machines for extremity transport may reduce histopathologic damage.

Gender-affirming mastectomy (GAM) often preserves residual breast tissue, conferring an unknown but nonzero risk of breast cancer. However, current breast screening guidelines are inconsistent and lack evidence-based specificity for this population. To date, no study has evaluated how plastic and breast surgeons approach post-GAM cancer surveillance or their confidence in doing so. Therefore, this study aimed to evaluate the practices and perspectives of plastic and breast surgeons regarding breast cancer screening following GAM. A 12-item electronic survey was distributed to 5802 ASPS and 707 ASBrS members (2024-2025), assessing practice profiles, guideline familiarity, screening practices, and provider confidence. The survey was completed by 586 ASPS (25.8% perform GAM) and 101 ASBrS members. In total, 34.1% of respondents were unaware of existing breast cancer screening recommendations for transgender patients while 40.5% reported not adhering to them. In comparing guideline utilization between ASPS and ASBrS members, ASPS members favored WPATH guidelines (ASPS: 31.8%; ASBrS: 11.9%, P < 0.001), whereas ASBrS members favored ACR criteria (ASBrS: 32.7%; ASPS: 12.6%, P < 0.001). For an average risk patient following GAM, ASPS members provided 25 distinct screening recommendations while ASBrS provided 16 distinct screening recommendations. Only 23.8% of providers felt confident in their recommendations. Nearly all respondents (ASPS: 94%, ASBrS: 93.1%) supported development of transgender-specific, evidence-based guidelines. This national, multidisciplinary cross-sectional study reveals substantial variability in screening practices and low provider confidence. Evidence-based, transgender-inclusive guidelines are urgently needed. Advancing inclusive cancer prevention will require data-driven guidelines, provider education, and system-level reforms to ensure equitable care for transgender and gender-diverse individuals.

The primary aim of this study was to investigate the effects of Incisional Negative Pressure Wound Therapy (iNPWT) on surgical site complication rates for abdominal body contouring following bariatric surgery that resulted in massive weight loss. A large 15-hospital retrospective case-control study was conducted. Inclusion criteria consisted of nonsmokers who achieved massive weight loss, defined as >100 lb or >50% excess body weight, and had an abdominal body contouring surgery between January 2021 and June 2024. We conducted separate unadjusted analyses comparing the iNPWT cohort to the control cohort using separate chi-square or Fisher exact tests for categorical variables, and independent samples t tests or Mann-Whitney rank sums tests for normally distributed and skewed continuous variables, respectively. Statistical significance was set to P = 0.05. Basic demographics were similar for a majority of the variables between the iNPWT cohort and the standard cohort. Minor wound complications following abdominal body contouring surgery did not significantly differ between the standard and iNPWT (40.54% vs 36.36%, P = 0.070) cohorts. However, among major wound complications, rates of wound dehiscence (22.97% vs 2.27%, P = 0.003) and infection (21.62% vs 6.82%, P = 0.040) were significantly lower in the iNPWT cohort. There was no significant difference in hematoma or seroma formation between the 2 groups. Given the high volume of patients undergoing abdominal body contouring surgery following bariatric surgery, iNPWT dressings can provide plastic surgeons with an adjunct to further reduce the incidence of wound dehiscence and wound infection.

Patients often use Google as a source of quick medical information, although the accuracy and clarity of search results can vary. ChatGPT has emerged as an alternative tool capable of providing conversational and potentially more reliable medical information. This study compares the readability, accuracy, and completeness of responses generated by ChatGPT with those obtained using Google for common patient questions regarding craniosynostosis and cleft palate. The terms "Craniosynostosis" and "Cleft Palate" were entered into Google, and the top 10 associated questions for each-identified using the "People Also Ask" tool-were recorded. Each question was then entered into both Google and ChatGPT, and the responses from each were recorded. The ease of readability for each response was determined by the Flesch-Kincaid instrument. Blinded reviewers evaluated accuracy and completeness using a 3-point scale (1 = fully incorrect, 2 = partially incorrect, 3 = correct). Reviewer scores were averaged, and comparisons between platforms were evaluated using t tests. A total of 20 questions yielded 40 unique responses. For cleft palate queries, Google responses had significantly lower reading levels than ChatGPT (9.95 vs 13.22, P = 0.006). No significant difference in readability was observed for craniosynostosis responses (14.66 vs 14.73, P = 0.467). Across all questions, ChatGPT responses were significantly more complete (2.60 vs 1.86, P < 0.0001) and more accurate (2.78 vs 2.09, P < 0.0001) than Google responses. These differences persisted when each condition was analyzed separately. ChatGPT provides more accurate and comprehensive information than Google for common patient questions about craniosynostosis without sacrificing readability. Patients can use this information to inform their future searches in order to obtain the most accurate information about their diagnoses. Further studies evaluating the information learned by patients from both search engines can help clinicians guide patients toward resources that best fit their individual care.

The proliferation of administrative databases, electronic health records, and large observational cohorts has profoundly expanded the scope of surgical research. At the same time, it has intensified a long-standing interpretive error: the routine conflation of statistical significance with clinical importance. In large data sets, small and often unstable numerical differences readily achieve conventional significance thresholds, driven by sample size, analytic flexibility, and selective reporting rather than by clinically meaningful or biologically coherent effects. Epidemiologic evidence demonstrates that null hypothesis significance testing (NHST) and dichotomous P -value thresholds are poorly suited for many observational, prognostic, and exploratory analyses common in surgical research, where effect size, precision, robustness, and plausibility are the true determinants of evidentiary value. This editorial synthesizes methodological insights from epidemiology, biostatistics, and surgical outcomes research to explain how selection processes, analytic latitude, publication bias, and large-sample artifacts systematically inflate the appearance of statistically "positive" findings. These concepts are translated into clinician-focused language, with illustrative examples drawn from surgery, where low-frequency but high-impact outcomes are particularly vulnerable to statistical fragility. To address these challenges, we introduce the CLARITY-SURG Statement (Clinical Linking of Association, Robustness, and Interpretability), a practical interpretive framework designed to help clinicians correctly evaluate observational study results. The framework provides a structured approach for assessing effect magnitude and precision, interrogating biological and surgical plausibility, examining analytic robustness, and determining the appropriate level of inference. By prioritizing clinical interpretability over threshold-based significance testing, the CLARITY-SURG Statement offers a reproducible, clinician-centered method for interpreting observational surgical research and for improving the quality, credibility, and clinical relevance of reported statistical findings.

Medical malpractice contributes to an estimated $55.6 billion in overall medical liability system costs per year. The rise of medspas has resulted in an increase in complications and litigation. In this study, we identified all publicly indexed litigation against medical spas and medical spa practitioners using the Westlaw legal database and characterized trends in these findings. A retrospective analysis of litigation against medical spas and medical providers performing care at medical spas was performed. Cases were indexed from 2006 to 2024 using the Westlaw legal database. Case documents were reviewed for the following datapoints: Patient characteristics (age, sex), legal case characteristics (state in which litigation occurred, reason for litigation, outcome, monetary payments, expert witness involvement), and medical procedure characteristics (type of procedure, location on the body in which the procedure was performed, complication, credentials of person who performed the procedure). Twenty legal cases met inclusion criteria, ranging in date from May 2006 to October 2024. The average patient age was 36 years old (SD 12.570). All plaintiffs were listed as female (n=20). 4 cases sued only the medspas, 15 sued only a medical practitioner, and in one case both the practitioner and medspa were sued. Each of the 20 cases were decided by jury decision at trial. 7 cases were won by the defendants (35%), whereas the remaining 13 cases were won by the plaintiffs. The average jury award was $2,489,128.69. Our findings highlight the importance of properly managing patient expectations and thorough discourse regarding the risks of the procedure to better align patient presurgery expectations with the final result. Our findings also emphasize the positive impact that tighter regulation of medical spas will have on patient safety. Our data is limited by the small sample size that was indexed on Westlaw legal database and descriptive in nature, so future studies analyzing larger cohorts of data may provide additional data to further benefit patient safety.

Impaired wound healing in patients with diabetes mellitus is a major clinical problem resulting from chronic hyperglycemia, which disrupts immune function and prolongs inflammation. Cell-based therapies such as mesenchymal stem cells (MSCs) and stromal vascular fraction (SVF) have shown promise in promoting tissue repair, yet comparative data between SVF and adipose-derived stem cells (ADSCs) remain limited. In this experimental study, a diabetic rat model was used to compare the effects of allogeneic SVF and allogeneic ADSCs on wound healing. Wound areas were measured on days 5, 10, and 14. Histological analyses, including assessments of reepithelialization, fibrosis, and epithelial tongue length, as well as cytokine level measurements, were performed to evaluate tissue regeneration and inflammation. Both SVF and ADSC groups demonstrated significantly smaller wound areas compared with controls at all time points (P<0.05). On days 5, 10, and 14, the wound areas were 3.127±0.382, 0.833±0.360, and 0.552±0.185cm2 in the control group; 1.968±0.533, 0.543±0.165, and 0.347±0.144cm2 in the SVF group; and 2.242±0.565, 0.432±0.137, and 0.276±0.131cm2 in the ADSC group, respectively. Histological evaluation revealed enhanced reepithelialization and greater epithelial tongue length in both treatment groups. No significant differences were observed between SVF and ADSC groups. IL-12 levels on day 5 decreased in the SVF group (76.01±13.65ng/L) and increased in the ADSC group (96.50±19.66ng/L) compared with the control group (84.81±15.03ng/L) (P=0.047). Both allogeneic SVF and ADSC therapies significantly accelerated wound healing in diabetic rats. Given its simpler and faster isolation process, lower cost, and comparable efficacy to ADSCs, SVF may represent a practical and effective alternative for enhancing diabetic wound repair.

Insurance coverage for surgical correction of adolescent gynecomastia remains highly variable. This study defines the rate of preauthorization denials and identifies patient and payer characteristics associated with denials. Secondary objectives include quantifying treatment rates among those denied coverage and characterizing reasons for denials. A retrospective review was performed of all pediatric patients evaluated for gynecomastia at the Children's Hospital of Philadelphia between January 2011 and June 2024. Demographic, clinical, insurance, and preauthorization data were collected. Multivariable logistic regression was used to identify predictive factors for denial and out-of-pocket payment. Among 360 patients, the mean age at the first visit was 16.3 years (SD 2.0), with a mean gynecomastia duration of 4.2 years (SD 2.7). Most had Grade 2 (n = 146, 40.8%) or Grade 3 (n = 104, 29.1%) gynecomastia. Of the 282 patients (78.3%) who pursued treatment, 66 (23.4%) received preauthorization from their primary insurance, 11 (3.9%) were approved through secondary coverage, and 205 (72.7%) were denied or offered out-of-pocket pricing. Denials often resulted from contract exclusions due to cosmetic classification (n = 99, 45.8%); however, 31 denials (14.4%) cited insufficient documentation. On multivariable analysis, approval was associated with Public Insurer A coverage (OR = 100.5, P < 0.001). Bilateral disease was associated with decreased odds of approval (OR = 0.1, P < 0.01) relative to unilateral disease. Of the 207 patients (57.5%) who underwent surgery (n = 137, 66.2%) paid out-of-pocket, with 85.6% of these opting for lower-cost adult facilities. Black patients (OR = 0.4, P = 0.01) were less likely to self-pay relative to White patients. Insurance coverage for adolescent gynecomastia is primarily restricted by policy-level exclusions rather than clinical factors, resulting in high denial rates and frequent reliance on self-pay options. These trends, along with observed racial differences in self-payment, underscore the need for standardized, evidence-based coverage criteria to address barriers to surgical access.