Plastic Surgery

Mandibular fibula flap union depends more on biology and location than on osteotomy gap size

In 75 mandibulectomy patients with 202 fibula free flap osteotomies, mean initial gap was 1.68 mm and did not predict long-term union. Half of osteotomy sites achieved complete union, 36.6% partial union, and 13.4% nonunion on CBCT callus assessment. Fibula–fibula interfaces healed significantly better than fibula–native mandible junctions, emphasizing the importance of interface selection in planning. Symphyseal osteotomies showed superior union compared with body and angle regions, guiding segment positioning for high-risk patients. Systemic vascular comorbidities and alcohol use were strong negative predictors of union, while reconstructions using more than two segments paradoxically showed improved outcomes. 1

Where the money goes in jaw free flap reconstruction: ward, prostheses, and OR staffing

A micro-costing analysis of 100 mandibular or maxillary free flap reconstructions found a mean admission cost of about $36,400. Costs were split between operative (57.7%) and perioperative admission (42.3%) periods, highlighting the impact of ward-based care. Ward staffing and consumables contributed 35.7% of total cost, prostheses 25.0%, and operating room staffing 21.0%. Vasculopathy, ASA IV status, tracheostomy, and returns to the OR or ICU were each associated with substantial adjusted cost increases. Preventing major complications and optimizing high-risk patients offers the greatest leverage for cost control in reconstructive programs. 2

MSC-derived extracellular vesicles markedly reduce scar burden in preclinical keloid and hypertrophic models

This systematic review and meta-analysis included 15 animal studies with 253 subjects testing mesenchymal stem cell–derived extracellular vesicles (MSC-EVs) for raised scars. Across models, MSC-EVs significantly reduced hypertrophic and keloid scar dimensions versus controls, with a large standardized mean difference of -2.78. Treatment also markedly decreased collagen I and III content and downregulated TGF-β1 and α-SMA expression in scar tissue. MSC-EVs inhibited fibroblast migration and proliferation, suggesting a robust anti-fibrotic and anti-contracture mechanism. All data are preclinical, but they outline a plausible vesicle-based strategy targeting core drivers of pathologic scarring. 3

IFN-γ–licensed urine-derived stem cells in SIS hydrogel promote scar-light healing in vivo

This study used IFN-γ–pretreated urine-derived stem cells (γ-USCs) encapsulated in small intestinal submucosa hydrogel to target scar formation. IFN-γ licensing enhanced USC immunomodulatory capacity, driving macrophages toward an anti-inflammatory phenotype and normalizing the wound microenvironment. In vitro, γ-USCs suppressed keloid fibroblast hyperactivity and TGF-β–induced fibrotic responses, reducing collagen deposition and fibrotic markers. In a rabbit ear scar model, γ-USCs@SIS significantly reduced scar formation and improved tissue architecture and collagen remodeling. These data support a combined cell–matrix strategy that addresses inflammation, fibroblast activation, and matrix imbalance in pathological scarring. 4