Plastic Surgery

PRISM metabolic/anatomic score stratifies complications after oral/oropharyngeal free flaps

In 92 patients undergoing microvascular free flap reconstruction for advanced oral/oropharyngeal squamous cell carcinoma, abnormal BMI correlated with higher postoperative complication rates. Longer operative and flap ischemia times were associated with systemic inflammatory response syndrome and more complications. Lower postoperative albumin, total protein, and day-1 calcium levels were linked to increased complication burden and longer hospital stay. The authors developed the PRISM score, integrating these variables to classify patients into low-, moderate-, and high-risk groups for perioperative complications. They suggest using PRISM to guide preoperative optimization and intraoperative strategies to limit operative duration and ischemia exposure. 1

Localized GAS6 mRNA-LNP hydrogel drives scarless healing in large-animal models

This preclinical study identifies GAS6 as a key regulator of immune–fibroblast crosstalk in deep cutaneous wounds. Investigators engineered a lipid nanoparticle–GAS6 mRNA construct embedded in a thermosensitive hydrogel for localized, time-controlled delivery. Across murine, rabbit ear, and Bama minipig wound models, treatment accelerated wound closure and substantially reduced fibrotic scarring. Mechanistically, GAS6 mRNA enhanced macrophage efferocytosis and suppressed inflammatory fibroblast activation, promoting a more regenerative milieu. These data position GAS6 mRNA hydrogel as a candidate platform for future anti-scar interventions, though no human data exist yet. 2

Hyaluronic acid fillers in systemic sclerosis and morphea: functional and aesthetic gains with limited evidence

This systematic review included 19 studies on hyaluronic acid fillers in systemic sclerosis or morphea, mostly case reports and small series. Fillers were commonly used in the perioral region, forehead, and chin, sometimes combined with botulinum toxin or platelet-rich plasma. Patients with systemic sclerosis often showed improved mouth opening and microstomia relief, alongside high satisfaction with cosmetic outcomes. One controlled study found no significant difference in mouth opening versus autologous fat grafting, suggesting fillers are not clearly superior. Inactive morphea lesions responded better than inflammatory ones, and reported adverse events were mild without documented disease flares. The authors conclude that HA fillers appear safe and useful for functional and aesthetic rehabilitation, but robust randomized trials are lacking. 3