Plastic Surgery

Selective prophylactic tracheostomy in head and neck free flaps maintains airway safety while reducing morbidity

Shifting from routine to selective prophylactic tracheostomy in 411 oral and oropharyngeal free-flap cases halved tracheostomy use without increasing airway compromise. Tracheostomy rates fell from 92.6% pre-2018 to 42.7% post-2018, with no rise in flap failure or airway events in non-tracheostomy patients. Post-2018, tracheostomy remained more common with oropharyngeal primaries, advanced nodal disease, bilateral neck dissection, longer surgery, and longer anesthesia. Patients who received tracheostomies had longer hospital stays and more postoperative complications, underscoring the morbidity of routine tracheostomy. 1

Risk-reducing mastectomy in BRCA1/2 carriers sharply lowers breast cancer incidence with low early major complication rates

In this Swedish cohort of 1208 BRCA1/2 carriers without prior breast cancer, 507 underwent risk-reducing mastectomy (RRM). After RRM, breast cancer incidence was 2 cases per 10 000 person-years versus 162 per 10 000 person-years without RRM, demonstrating marked risk reduction. Occult breast cancer was identified at surgery in 3.4% of RRM patients, relevant for preoperative counseling and pathology planning. Most RRM patients had implant-based reconstruction, and early major complications requiring reoperation occurred in 3.7% of women. 2

Baseline burden, chronicity, and adherence predict response to compression in breast cancer-related lymphedema

This meta-analysis of 67 studies (6401 patients) found mean excess-volume reduction with compression therapy around 45%, but with wide variability. Older age, higher baseline excess volume, and longer lymphedema duration were consistently associated with poorer percentage reduction in excess volume. Severe lymphedema, prior arm infection, and prior lymphedema therapy also predicted lower responses, suggesting diminishing returns in advanced disease. Higher treatment compliance and better lymphoscintigraphic tracer uptake predicted superior volume reduction, highlighting the importance of adherence and residual lymphatic function. 3

Injectable supramolecular hydrogels reduce flexor tendon adhesions in preclinical models

A dynamically crosslinked, bioresorbable supramolecular hydrogel was developed as an injectable peritendinous barrier for flexor tendon repair. The hydrogel maintained a lubricious interface with human tissues and preserved ex vivo tendon biomechanics, suggesting it does not impair tendon glide. In rat tendon-injury models, hydrogel application improved functional outcomes, including range of motion and maximal dorsiflexion, versus controls. 4