External hemipelvectomy leaves large composite defects that are difficult to reconstruct. The free fillet of leg flap repurposes soft tissue from the amputated limb to provide durable coverage without additional donor-site morbidity. Pediatric applications are rarely reported. We conducted a PRISMA-guided systematic review (1999-2025) across PubMed and Google Scholar. Inclusion criteria were external hemipelvectomy reconstructed with a free flap and reporting at least flap survival and/or complications. Data were extracted at the case and study levels. We computed pooled proportions (Wilson 95% Confidence Intervals) for primary outcomes (flap survival/complications) overall and by flap category. We complement this synthesis with a detailed pediatric case from our institution. Forty-three studies comprising 94 cases met inclusion. Among cases with explicit reporting, pooled flap survival was 95% (65/69; 95% CI 86.0-97.7), and any complication occurred in 44% (28/64; 95% CI 32.3-55.9). By flap category, survival was reported in 36/38 fillet-of-leg, 7/8 fillet-of-leg with fibula only, 3/3 fillet-of-leg with fibula and tibia, 7/7 anterolateral thigh (ALT)/anterior thigh, 6/6 latissimus dorsi, 2/3 medial thigh, 3/3 other/unspecified, and 1/1 free vascularized fibular graft (FVFG) cases. Complications occurred in 14/34 fillet-of-leg, 5/7 fillet-of-leg with fibula only, 2/3 fillet-of-leg with fibula and tibia, 1/7 ALT/anterior thigh, 3/6 latissimus dorsi, 1/3 medial thigh, 3/3 other/unspecified, and 1/1 FVFG reconstructions. Our case involved an 11-year-old boy who underwent external hemipelvectomy with a free fillet-of-leg flap, achieving full healing by 6 weeks and ambulation by 5 months. Fillet-of-leg free flaps offer reliable, donor-site-sparing coverage for hemipelvectomy defects with high flap survival. This pediatric case supports feasibility and highlights strategies to minimize ischemia and manage venous congestion.

Seroma formation is a frequent and challenging complication after mastectomy surgery, with incidence rates ranging from 3 % to over 85 % (1). Despite numerous proposed interventions, no universally accepted standard for prevention exists. A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed was searched for randomized controlled trials, cohort studies, and systematic reviews published in the past 10 years that evaluated interventions to prevent seroma after mastectomy surgery. Thirty-four studies met inclusion criteria. Data were extracted on study design, intervention, comparator, seroma incidence, seroma volume, and statistical outcomes. Pooled odds ratios (OR) and 95 % confidence intervals (CI) were calculated for each intervention group using a random-effects model. Heterogeneity was assessed with the I² statistic. Quilting sutures demonstrated the greatest efficacy, reducing seroma incidence by 76 % compared to standard closure (pooled OR 0.24, 95 % CI: 0.11-0.52, I² = 0 %). Flap fixation also significantly reduced seroma rates (pooled OR 0.43, 95 % CI: 0.26-0.70, I² = 0 %). Steroids and selected adjuncts (OK-432, hemostatic powders, diuretics) were associated with a 59 % reduction in seroma incidence (pooled OR 0.41, 95 % CI: 0.26-0.64, I² = 36 %). Drain management strategies showed that early or no drain removal may increase seroma risk (pooled OR 1.99, 95 % CI: 0.96-4.14, I² = 54 %), though not statistically significant. Tissue adhesives (TissuGlu®, fibrin glue, cyanoacrylate) and harmonic scalpel showed modest or inconsistent benefits (adhesives pooled OR 0.63, 95 % CI: 0.35-1.14, I² = 57 %; harmonic scalpel pooled OR 0.59, 95 % CI: 0.36-0.96, I² = 0 %). Nitroglycerin ointment did not significantly reduce seroma formation (pooled OR 0.78, 95 % CI: 0.31-1.96, I² = 0 %). Quilting sutures and flap fixation are the most effective interventions for preventing seroma after mastectomy surgery, with strong supporting evidence and minimal heterogeneity. Output-based drain management and selective use of steroids or adjuncts may further reduce risk in high-risk patients. Routine use of tissue adhesives, harmonic scalpel, or nitroglycerin ointment is not supported by current evidence. Future research should focus on standardized outcome reporting and direct comparisons of effective strategies, particularly in the setting of mastectomy reconstruction.

Clinical observations indicate that some male patients with androgenic alopecia show varying degrees of hairline recession in the frontal and temporal regions on both sides, often with noticeable asymmetry between the left and right, which suggests a potential link to certain lifestyle habits. In this study, 161 male patients with androgenic alopecia were included, all exhibiting an "M"-shaped hairline. Patients' sleeping positions and combing directions were recorded and the areas of hairline recession in the frontal and temporal regions were calculated. Analysis of variance showed a significant difference in the ratio of the left and right receding hairline areas among patients with different sleeping positions (left lateral 1.19 ± 0.15 vs. right lateral 0.90 ± 0.10 vs. supine 1.00 ± 0.15 vs. no fixed position 1.00 ± 0.14, F = 24.84, p < 0.01). However, no significant difference in hairline recession was observed between patients who combed their hair to the left and those who combed to the right (p = 0.47). In conclusion, sleeping position may be an independent factor that influences the pattern of hairline recession of male patients with androgenic alopecia, particularly those with "M"-shaped hairlines, whereas combing direction appears to have no impact.

IntroductionThe existing literature on single-stage augmentation mastopexy is largely limited to short follow-up (<1 year), single surgeon series or outcomes in highly specific subgroups. The study aims to report long-term contemporary outcomes for single-stage augmentation mastopexy and to propose a risk stratification tool.MethodsTen-year outcomes of consecutive cases of single-stage augmentation mastopexy between 2014–2024 were reported from a single center. Multivariate logistic regression identified risk factors for complication and re-operation and a risk-stratification tool was proposed.Results289 cases of single-stage augmentation mastopexy (Wise, 40.5% [117/289]; vertical with lateral extension, 26.3% [76/289]; vertical, 24.6% [71/289]) were performed including 45 patients (15.6%) with a history of previous augmentation or mastopexy. At a median follow-up of 46 months, implant- and tissue-related related complications occurred in 6.6% (19/289) and 26.0% (75/289) of cases, respectively. Re-operation occurred in 19.4% (56/289), of which 21.6% (12/56) were performed under local anaesthetic. Re-operation rates under general anaesthetic were 10.6%, 14.6% and 18.4% at 1, 3 and 5 years, respectively. The most common re-operation was revision mastopexy (11/289, 3.8%), followed by nipple areolar complex revision (9/289, 3.1%). Previous augmentation or mastopexy (OR 3.58; 95% CI,1.27–10.07), high-projection implants (OR 1.84; 95% CI,1.02–3.32) and smoking (OR 2.46; 95% CI,1.13–5.33) were associated with complication and/or re-operation. Landmark analysis identified implant-related complications in 4.8% (5/104) beyond 3 years and 2.0% (1/50) after 5 years, while tissue-related complications occurred in 1.0% (1/104) after 3 years and were absent beyond 5 years.ConclusionsSingle-stage augmentation mastopexy can be performed safely in well-selected patients with promising long-term complication and re-operation rates.

Prominent ear is a common auricular malformation that can have long-term psychosocial consequences on affected individuals. Otoplasty remains the standard surgical corrective treatment; however, the optimal technique has long been debated, with >200 methods described in the literature. This systematic review, conducted in accordance with PRISMA guidelines, aimed to evaluate the available evidence on the most effective otoplasty approach. The outcomes assessed across different techniques (exclusive suture, exclusive cartilage-scoring, incisionless, suture + flap, suture + cartilage-scoring, and cartilage-scoring + flap hybrids) included: a) number of patients suffering a complication, b) recurrence, c) reoperation, d) infection, e) keloid or hypertrophic scar formation, and f) haematoma. A search of PubMed and MEDLINE identified 412 papers. Following PICOT framework-guided screening, application of inclusion and exclusion criteria, and quality assessment, 22 studies were included: 19 retrospective and three prospective cohort studies. Current medical literature suggests that suture + cartilage-scoring and cartilage-scoring + flap hybrid methods, may be associated with lower rates of recurrence, and reoperation when compared to single-technique or suture + flap approaches. However, high-quality, long-term randomised control trials are required to determine the superior technique for otoplasty.

BackgroundThe popularity and rapid growth of aesthetic injectables, in conjunction with the influx of competing specialties performing these procedures, underscores the importance of competence of plastic surgery residents and rigorous modalities of plastic surgery training.ObjectivesOur objective was to review injectables and outcomes from our plastic surgery resident aesthetic clinic. Outcomes and costs were compared to national averages and reports from the literature.MethodsA retrospective chart review identified all adult injectable patients at the Resident Aesthetic Surgery Clinic at NYU Langone Health in 2021. Patient demographics, procedural data, complications, touch-ups, and surgeon fees were compiled. Factors predictive of return patronage were investigated as well. Data were analyzed and visualized in R.ResultsIn 2021, 223/233 consultations led to an injection (95.7% conversion rate) for 148 patients. Neurotoxin was most commonly injected into the upper face, while fillers were most commonly injected into the midface. Two complications from fillers (0.9% complication rate) and one touch-up (0.4% touch-up rate) were recorded. Surgeon fees were substantially less than national averages and comparable to other academic settings. Patients who received filler only at their first visit were significantly less likely to be return patrons in the same year.ConclusionsThese data represent the largest and most detailed annual report of injectables from a plastic surgery resident aesthetic clinic, demonstrating high volume, low complication and revision rates, and reasonable costs to patients. Altogether, our study supports resident aesthetic clinics as a robust training modality.

BackgroundWith rising interest in breast reconstruction after mastectomy, patients are increasingly turning to online resources to supplement medical consultations. However, the quality and accessibility of these materials remain inconsistent. This study evaluates the readability, understandability, actionability, content coverage, and transparency of online breast reconstruction resources.MethodsThe top 20 Google search results were examined for five common breast reconstruction-related queries. Metrics assessed included SMOG readability level, PEMAT scores (understandability and actionability), content coverage, and a modified EQIP score for quality. Statistical analyses examined relationships among these variables and with factors like search rank, author type, and query.ResultsMean content coverage was 49 %, with significant gaps in preoperative planning, treatment side effects, and fat grafting. Readability was poor (mean SMOG 12.3). Understandability was high (80 %), but actionability (37 %) and quality (modEQIP of 40 %) were low. Academic authors produced shorter and lower-quality resources. Higher-ranked resources were generally longer and correlated with better performance across most metrics. Specific queries like ‘DIEP flap’ yielded narrower, lower-quality resources.ConclusionsOnline resources for breast reconstruction are highly variable and often fall short in readability, comprehensiveness, and transparency. Although understandability is generally acceptable, low actionability and inconsistent coverage hinder patient utility. Search engine rank modestly correlates with quality, suggesting some alignment between visibility and value. Improving these resources will require targeted efforts to simplify language, address topic gaps, and enhance actionable content—especially for specialized queries where quality remains lowest.

PurposeVacuum bell (VB) therapy is a non-invasive treatment option for pectus excavatum (PE), traditionally considered most effective in children under 12 due to greater skeletal remodeling potential. However, the extent and mechanisms of cosmetic improvement in older adolescents remain poorly understood.MethodsWe retrospectively analyzed 19 male patients (median age 14.8 years) who underwent VB therapy for at least 1 year. Real-time MRI was performed before and after therapy to assess morphological changes. Key parameters included the Haller Index (HI), Correction Index (CI), and pectus excavation depth (PED). Additionally subcutaneous soft tissue thickness was measured at the deformity site and at the lateral thoracic wall.ResultsAfter a median treatment duration of 1.8 years, HI and CI did not show significant reductions (HI: 5.4 to 5.3, p = 0.40; CI: constant 32 %, p = 0.96), while PED decreased significantly (16.7 mm to 112.7 mm, p = 0.009). Subcutaneous soft tissue at the deformity site increased markedly by a median of 6.5 mm, compared to a 0.5 mm increase at the lateral thoracic wall. Fat-selective T1-weighted Dixon MRI confirmed that the increased subcutaneous tissue consisted of adipose tissue.ConclusionsThe improvement in visual appearance of PE morphology during VB therapy results primarily from localized adipose tissue hypertrophy, while skeletal remodeling is likely to contribute to a much lesser degree. From a cosmetic perspective, these findings might justify the continued use of VB therapy beyond the traditional age threshold.

Immediate breast reconstruction (IBR) with polyurethane (PU)-coated implants has usually been performed to mitigate the capsular contracture (CC) rate, particularly in patients requiring post-mastectomy radiotherapy (PMRT). This retrospective study aimed to evaluate the long-term outcomes of direct-to-implant (DTI) reconstruction using Microthane® PU-coated implants placed prepectorally without additional devices. A total of 143 consecutive patients underwent mastectomy, followed by IBR with Microthane® implants in the prepectoral position. Demographic and clinical data, including complications and CC incidence, were retrospectively collected. Statistical analyses comprised descriptive statistics, Kaplan-Meier survival curves, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire for patient-reported outcomes. Over a median follow-up of 4.5 years, 18.9 % of patients experienced at least one complication, with adjuvant radiotherapy being the only factor significantly associated with increased complications (p = 0.0229). Kaplan-Meier analysis indicated a complication-free survival rate of 57.85 % for the patient and 58.00 % for the implant, and a contracture-free survival rate of 79.46 % and 81.56 %, respectively. Severe CC (Baker grade III/IV) occurred only in 9.1 % of patients, including several who underwent adjuvant radiotherapy (p = 0.0215). These rates remain notably lower than those historically reported with textured implants. Moreover, DASH scores revealed minimal disability (an overall mean score of 8.17 %), reflecting favorable patient-reported outcomes. Microthane® breast implants in a prepectoral position demonstrated low CC rates and high patient satisfaction, even among those receiving radiotherapy, benefiting from all the prepectoral surgical approaches. In addition, this technique obviates the need for supplementary devices such as meshes or acellular dermal matrices (ADMs), thereby reducing costs, operative times, and potential complications. The large cohort size and substantial follow-up strengthen these findings. The results support prepectoral reconstruction with Microthane® implants as a safe and effective option in breast reconstruction, offering both aesthetic and functional benefits.