Plastic Surgery

Modified Zelen design acceptable to most CAPS-THA participants after disclosure

Survey of 235 CAPS-THA participants (mean age 70.1) assessed reactions to delayed-consent modified Zelen randomization in THA pathways. After disclosure, 76% agreed the design was justified and 91% felt the study was conducted ethically. Trust in medical research was unchanged or increased for 94% of respondents, and 71% would strongly consider similar future participation. These results support using modified Zelen designs with a robust debriefing and meaningful post-randomization choice. 1

Symani robotic microsurgery shows high technical success and low device-related events

Multicenter post-market study of 412 patients reported technical success of 94.1% across 539 robotic anastomoses. Freedom from device-related events was 99.8%, with intraoperative patency 91.7% for free flaps and 96.2% for LVA. Free-flap survival at discharge was 97.8%, and intraoperative revision rates were modest (FF 8.4%, LVA 3.4%). Findings support Symani's safety and reliability in experienced centers, while local training and case selection remain important. 2

Small absolute IBTR differences for <1–2 mm margins in HR-positive DCIS with WBI and endocrine therapy

Ancillary analysis of NSABP B-35 included postmenopausal women receiving lumpectomy, WBI, and endocrine therapy (over 2700 patients for 1-mm analysis). Ten-year IBTR was 5.6% for margins <1 mm versus 4.0% for ≥1 mm, and 5.3% versus 3.8% using a 2-mm threshold. After adjustment, margin width was not a significant predictor of recurrence, indicating limited incremental benefit from reexcision for small margins. In appropriately selected postmenopausal HR-positive patients receiving adjuvant therapy, routine reexcisions for margins <1–2 mm may be unnecessary. 3