Journal of Plastic Surgery and Hand Surgery
Journal of Plastic Surgery and Hand Surgery is as from 2023 an Open Access journal serving as an international forum for plastic surgery, hand surgery, and related research. Interest is focused on original articles on basic research and clinical evaluation. The journal is published for the Acta Chirurgica Scandinavica Society, Sweden.
Acta Chirurgica Scandinavica Society owns the copyright for all material published until Volume 57 (2023) unless otherwise specified. As from 2024 all published articles, unless otherwise specified, are published under CC-BY licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.
Functional results after extensor indicis proprius to extensor pollicis longus tendon transfer for ruptures associated with distal radius fractures
Rupture of the extensor pollicis longus (EPL) tendon is a recognised complication after distal radius fracture (DRF) that leads to loss of active thumb extension. Transfer of the extensor indicis proprius (EIP) tendon to the EPL is one of the most common reconstructive procedures, but prospective outcome data are limited. This study evaluated functional and patient-reported outcomes after EIP-to-EPL tendon transfer exclusively in patients with EPL rupture secondary to DRF. Thirty consecutive patients (26 women, 4 men; median age 65 years, range 17–80) underwent EIP-to-EPL tendon transfer between 2021 and 2025 for EPL rupture secondary to DRF. Thumb motion, grip and pinch strength and QuickDASH scores were recorded at 3 and 6 months postoperatively. All motion parameters improved between 3 and 6 months. At 6 months, lift-off height recovered to approximately two-thirds, total thumb flexion to > 80% and radial/palmar abduction to about 90% of the contralateral side. Grip and pinch strength reached 79–85% of the uninjured hand. Mean QuickDASH score improved from 29 to 21 points (p = 0.015). In conclusion, EIP-to-EPL tendon transfer restores satisfactory thumb motion, strength and patient-rated function following EPL rupture associated with DRF. Functional recovery at 6 months is comparable to that of patients with uncomplicated DRFs. Clinical Trials registry no. NCT05264675
Copyright (c) 2026 Ingrid Andreasson, Christos Ni. Sarigiannis, Michael Ullman, Anders Björkman https://creativecommons.org/licenses/by/4.0
Public healthcare costs of complications of cosmetic surgery in Sweden – a regional study
Background: Cosmetic surgery has increased during recent decades, both domestically and through cosmetic tourism. Patients who develop postoperative complications frequently seek care in the public healthcare system. The extent to which these complications generate healthcare workload and costs within Swedish public hospitals remains poorly described. Methods: This retrospective cohort study includes patients presenting with acute complications after cosmetic surgery to the three hospitals in Region Örebro County, Sweden, between 2018 and 2024. Patients were identified through medical records and administrative systems. Cosmetic procedures performed locally, elsewhere in Sweden, or abroad were included. The primary outcome was direct hospital cost per patient estimated using diagnosis-related group weights. Secondary outcomes included emergency department attendance, hospital admission, length of stay (LOS), diagnostic investigations, surgical interventions and outpatient follow-up. Statistical comparisons between groups were performed using chi-square tests, independent sample t-tests and non-parametric tests where appropriate. Results: A total of 53 patients were included. The majority were female (88.7%) with a mean age of 42.1 years. The most common procedures associated with complications were abdominoplasty, breast augmentation and reduction mammoplasty. Infection with or without abscess was the most frequent complication. Patients operated in Sweden had a higher rate of hospital admission compared with patients operated abroad (48.0% vs 13.6%, p = 0.01), while LOS was similar between groups. In contrast, patients operated abroad required more outpatient physician follow-up. The mean estimated healthcare cost per patient was 45,956 SEK, Swedish crowns (€3890). Patients operated in Sweden generated higher average costs compared with patients operated abroad (58,460 SEK vs 28,688 SEK). The total estimated cost for managing complications in the cohort was approximately 2.3 million SEK. Conclusions: Complications after cosmetic surgery generate a measurable workload and cost for the public healthcare system. In this regional Swedish cohort, a substantial proportion of complications originated from procedures performed domestically rather than abroad. These findings challenge the perception that the public healthcare burden from cosmetic surgery complications is primarily driven by cosmetic tourism. Improved coordination between private cosmetic providers and the public healthcare system may help reduce the clinical and economic impact of these complications.
Copyright (c) 2026 Sebastian Holm, Reza Tabrisi, Emma Wall, Carolina Nilsson, Rodi Ali, Johann Zdolsek https://creativecommons.org/licenses/by/4.0
Endoscopic cubital tunnel release: a modified surgery and clinical application
Background: Varied surgical alternatives for treating cubital tunnel syndromes have been used. A trend of endoscopic ulnar nerve release is emerging. The purpose of this study is to introduce a modified technique of endoscopic ulnar nerve decompression in association with anterior transposition of the ulnar nerve and to assess the feasibility and efficacy of the surgery. Materials and Methods: We introduced a modified method of endoscopic release and subfascial anterior transposition of the ulnar nerve. The technique was applied to six patients who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome. The patients were classified according to the Dellon classification preoperatively. The Bishop rating system was used to evaluate the postoperative outcomes. Trial registration number for the study is MR-31-25-090620. Results: Preoperatively, all six patients were classified as severe according to the Dellon classification. The endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition surgeries were performed with no difficulty in all patients. All the patients had improvement in symptoms and scored excellent or good according to the modified Bishop Rating System postoperatively. Conclusions: The modified endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition technique is technically feasible with satisfactory outcomes in six patients in this study.
Copyright (c) 2026 Yinglu Zhao, Jing Xu, Jie Lao, Jianyun Yang https://creativecommons.org/licenses/by/4.0
Towards consensus on the treatment of congenital craniofacial conditions: the discussion section of a doctoral thesis
Background: Congenital craniofacial conditions are a diverse group of rare and complex disorders, leading to significant functional and psychosocial challenges. Their rarity and variability hinder research and clinical standardisation, resulting in substantial practice variation across centres. International collaboration and high-quality evidence are therefore essential to improve and converge care for affected individuals. This article presents the discussion section of a doctoral thesis that addressed these challenges through multiple methodological approaches, the majority of which were conducted within the European Reference Network for Rare and Complex Craniofacial Conditions (ERN CRANIO). Methods: The studies combined systematic reviews, multicentre cohort analyses, expert consensus and registry development to advance understanding and care for three conditions: unilateral cleft lip and palate (UCLP), Treacher Collins syndrome and Miller syndrome. Results: The thesis provides evidence supporting early hard palate closure in UCLP, contributing to improved speech outcomes and fewer oronasal fistulas without increasing surgical burden. For facial dysostosis syndromes, the European clinical consensus statement and the establishment of the first international registry provide a foundation for more standardised multidisciplinary care and collaborative research. The systematic review on Miller syndrome clarifies its phenotypic spectrum and aids differential diagnosis with other syndromes. Conclusions: Through its comprehensive and collaborative approach, this thesis promotes the convergence of care for congenital craniofacial conditions in Europe. It highlights the importance of methodological rigour, standardisation and international collaboration to achieve evidence-based and equitable care for these rare and complex disorders.
Copyright (c) 2026 Victor van Roey, Irene M.J. Mathijssen, Aebele B. Mink van der Molen, Sarah L. Versnel https://creativecommons.org/licenses/by/4.0
Evaluation of severe radial translation of distal radius fractures which is a potential cause of distal radioulnar joint instability
Purpose: This study aimed to (1) introduce a simple and reproducible method to assess severe radial translation of distal radius fractures (DRF) which is a potential cause of distal radioulnar joint (DRUJ) instability, and (2) to construct a treatment-oriented classification. Materials and methods: From 2018 to 2023, stress test (ballottement test) was performed to detect DRUJ instability associated with DRF after treatment with locking plate fixation. Potential radiographic predictors of DRUJ instability focus on radial translation were accessed. The severity of radial translation was described by a readily and easily technique as ‘point- baseline’ method. According to this method, radial translation was categorized into three grades: no translation (the marking points not moved), moderate translation (the marking points moved, but were located on the ulnar side of the baseline), and severe translation (the marking points moved and reached the baseline position, or even completely moved to the radial side of the baseline). All these fractures were divided into two groups, namely Group A (cases with no translation or moderate translation) and Group B (cases with severe translation). Relationships between DRUJ instability and the radiographic parameter of radial translation were analyzed. To investigate the causes of DRUJ instability, all of the cases with DRUJ instability were further divided into two subgroups: subgroup A (cases with DRUJ instability in Group A) and subgroup B (cases with DRUJ instability in Group B). Practices to address DRUJ instability at the time of DRF fixation were explored. Results: There were 226 patients enrolled in this study. According to ‘point- baseline’ method, there were 174 wrists in Group A and 52 wrists in Group B. There were 34 cases (19.54%) diagnosed as having DRUJ instability intraoperatively via manual stress testing in Group A, while 36 cases (69.23%) in Group B. There was significant difference in the incidence of DRUJ instability between the two groups (p < 0.0001). Of the 70 cases with DRUJ instability, 18 cases regained stability by ulnar styloid fracture fixation, 12 cases by dorsal ulnar corner fragment (sigmoid notch fracture) fixation, and 40 cases by arthroscopy-assisted triangular fibrocartilage complex (TFCC) repair. To investigate the causes of DRUJ instability, there were 34 wrists in subgroup A, while 36 wrists in subgroup B. There were no significant differences between the two subgroups regarding the causes of DRUJ instability including ulnar styloid process fracture, dorsal ulnar corner fragment (sigmoid notch fracture), and traumatic TFCC injury. Conclusions: This study helped establish a ‘point- baseline’ method which can be readily and easily used to identify the severity of radial translation, which was a significant predictor of DRUJ instability. On the other hand, whether or not severe radial translation, treatment of DRUJ instability by the three major ways: (1) the ulnar styloid fracture fixation; (2) the dorsal ulnar corner fragment fixation; and (3) traumatic TFCC injuries repairing.
Copyright (c) 2026 Jiang Huajun, Liu Sida, Jiang Peilong, Zhang Borui, Yang Jingjing, Qu Wei https://creativecommons.org/licenses/by/4.0
Infiltration level of macrophages and its impact on fat graft retention in mouse free fat grafting model
Background: Autologous fat grafting faces the clinical challenge of unstable absorption rates, and the regulatory mechanisms of macrophages need to be elucidated. Objectives: It aimed to investigate the infiltration levels and phenotypic dynamics of macrophages and explore their impact on graft retention rate (RR). Methods: A total of 180 C57BL/6J mice were randomly divided into experimental (AG, fat grafting), sham (BG, no grafting), and intervention (CG, macrophage depletion followed by grafting) groups. Graft RR was assessed, and macrophage status was analyzed by flow cytometry and immunofluorescence postoperatively. Levels of inflammatory, pro-fibrotic, and angiogenic factors were also detected. Results: Macrophage infiltration in the AG peaked at week 2 (21.3 ± 1.5%) and then shifted from M1 to M2 phenotype. The graft RR in the AG was visibly higher as against the CG (p < 0.05). M2 macrophages were strongly positively correlated with RR (based on the aggregated data of all time points, r = 0.821, p < 0.0001), while pro-inflammatory factors suggested negative correlation. The AG had visibly elevated levels of angiogenic factors, which were strongly positively correlated with RR (p < 0.05). Conclusion: Macrophages (especially the M2 subtype) play a key role in fat graft survival by modulating inflammatory responses and promoting angiogenesis. Targeting macrophage polarization may be a novel strategy to improve fat grafting outcomes.
Copyright (c) 2026 Chengzhi Dong, Jian Zhang, Lijuan Peng https://creativecommons.org/licenses/by/4.0
Medial femoral condyle flap for ulnar reconstruction and structural bone allograft for radial reconstruction in post-traumatic forearm diaphyseal non-union: a two-case report
The successful treatment of forearm non-unions, which occur as a complication in 2–10% of all forearm fractures, poses a significant challenge in reconstructive surgery. Current treatment often involves revision fixation with non-vascularized bone grafts for atrophic non-unions. Large bony defects in both forearm bones, however, necessitate advanced reconstructive techniques. In isolated reconstructions of the radius or ulna, the vascularized medial femoral condyle (MFC) flap has gained popularity, achieving 98–100% union rate. Allogenic bone grafts have also been described for reconstruction of large bone defects, potentially reducing donor site morbidity and operation time. This two-case report investigates the performance of vascularized MFC cortico-cancellous flap for ulna reconstruction and tricortical allogenic bone graft of the iliac crest for radius reconstruction in excessive, post-traumatic, atrophic non-union of the forearm diaphysis. In May and June 2021, a 62-year-old and a 56-year-old male received reconstruction surgery 9 and 13 months after initial plate osteosynthesis after a motorcycle accident. The MFC flap showed successful bony union of the ulna after 3 months as well as consecutive remodeling. However, the reconstruction of the radius showed a recurrent non-union, which even led to plate breakage in one case. In both cases, ulnar reconstruction with a vascularized MFC flap achieved successful union. However, radial reconstruction using structural allograft did not achieve union, causing recurrent non-union, likely reflecting limited biological incorporation. Level of Evidence: V (Therapeutic)
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Correction of tear trough deformity in young patients without eyebags using orbital fat reposition and release of tear trough ligament
Background: Tear trough deformity (TTD) is a periorbital hollow extending from the medial canthus to the midpupillary line, which is mainly caused by the traction of the tear trough ligament (TTL). This study aimed to present a retroseptal transconjunctival lower-eyelid blepharoplasty with orbital fat reposition and release of TTL for correcting TTD in young patients without eyebags. Methods: Seventy-nine young patients with TTD without eyebags receiving the described technique were retrospectively reviewed from September 2020 to April 2023. TTD was preoperatively categorized into different Hirmand types. Cosmetic outcomes were evaluated through tear trough rating scale (TTRS), Barton grading system and patient self-assessment. Results: The average follow-up time was 14.7 months (range, 12–18 months). Average TTRS in Hirmand class I and II were significantly different between pre- and post-operation (p < 0.05), while there was no significant difference in class I (p > 0.05). As to Barton grading system, TTDs in Hirmand class I were all graded as 1 preoperatively and were all shifted to grade 0 postoperatively. In class II, grade 1 (20%), grade 2 (71.4%), and grade 3 (8.6%) TTDs were shifted to grade 0 (85.7%) and grade 1 (14.3%) postoperatively. In class III, grade 2 (54.5%) and grade 3 (45.5%) TTDs were shifted to grade 0 (18.2%), grade 1 (45.5%) and grade 2 (36.3%). The overall patient self-assessed satisfaction was 96.2%. Conclusions: Retroseptal transconjunctival lower-eyelid blepharoplasty with release of TTL and orbital fat reposition can achieve satisfactory outcomes to correct TTDs without eyebags.
Copyright (c) 2026 Xianyu Zhou, Mengmeng Hou, Shun Yu, Jun Yang, Yucheng Qiu, Fei Liu https://creativecommons.org/licenses/by/4.0
Clinical and histopathological effects of topical pentoxifylline on autonomisation processes in rat dorsal randomised skin flaps
Background: Staged pedicled skin flaps that require pedicle division are frequently employed in reconstructive surgery, rely on their pedicle for vascular supply following transfer until neovascularisation occurs at the recipient site, a phenomenon referred to as autonomisation (pedicle-independent flap viability following neovascularisation). This study sought to investigate the application of topical pentoxifylline to expedite the autonomisation process. Methods: Caudal-based skin flaps were surgically created in the dorsal region of 60 Wistar rats. On the fifth day, the bases of the flaps were surgically cut, and the flaps were subsequently monitored for an additional 7 days. The rats were divided into three groups: (1) Control group (Vaseline for 5 + 7 = 12 days), (2) Experimental-1 group (topical pentoxifylline for 5 days + vaseline for 7 days), and (3) Experimental-2 group (topical pentoxifylline for 5 + 7 = 12 days). Flap viability was assessed both macroscopically and microangiographically, and histopathological examinations were conducted. Results: On day 12, the viable flap areas were 40.7% in the control group, 95.5% in experimental-1 group, and 100.0% in experimental-2 group (p < 0.05). Microangiography was conducted on day 5 and 12, and both experimental groups exhibited markedly greater vascularisation compared to the control group. Histopathological and immunohistochemical analyses revealed that pentoxifylline significantly enhanced angiogenesis, new vessel formation, and epithelisation, while mitigating early-stage inflammation, edema, and late-stage fibrosis (p < 0.05). Conclusion: The application of topical pentoxifylline significantly promoted angiogenesis, thereby expediting the autonomisation of rat dorsal randomised skin flaps. Consequently, its use in reconstructive surgery may be considered, as it has the potential to reduce reliance on the pedicle, minimise complications, and enhance patient outcomes.
Copyright (c) 2026 Melike Zeynep Kuşçu, Selman Hakkı Altuntas, Özlem Özmen, Simge Garlı https://creativecommons.org/licenses/by/4.0
Duplex ultrasound analysis of hemodynamic changes following microsurgical repair of unilateral digital artery injuries: a retrospective follow-up study
Background: Whether unilateral digital artery injuries benefit from surgical repair remains controversial, as perfusion is typically preserved by the remaining, contralateral artery. Evidence on the long-term patency and hemodynamic effects of reconstructed unilateral arteries is limited. This study aimed to evaluate the patency and flow characteristics of digital arteries after microsurgical repair using duplex ultrasonography. Methods: A retrospective single-center study was conducted including patients with unilateral digital artery injuries at the level of the digit who underwent primary microsurgical anastomosis between 2017 and 2022. Patients with fractures, proximal injuries, or vein grafts were excluded. Duplex ultrasonography was used to assess arterial patency and blood flow at follow-up. Results: Twenty-seven patients were examined at a mean follow-up of 37 months (range 16–82). Duplex ultrasonography demonstrated anterograde flow in 26 of 27 reconstructed arteries (96.3%). The median flow volume in the repaired artery (1.1 ml/min, interquartile range [IQR]: 0.5–2.8) was significantly lower than in the contralateral artery of the same digit (3.6 ml/min, IQR: 1.4–7.7) and the corresponding artery of the contralateral hand (2.8 ml/min, IQR: 1.3–6.8). No significant compensatory increase was observed in the intact artery of the injured digit compared with its contralateral counterpart. Conclusion: Duplex sonography demonstrates that repaired unilateral digital arteries remain patent in the long term, despite reduced flow compared with contralateral controls. While the functional benefit of arterial repair remains uncertain, long-term patency suggests a potential role for repair in selected cases to support vascular integrity.
Copyright (c) 2026 Justus Osterloh, Bastian Drollmann, Luca Kümmerl, Andreas Arkudas, Raymund E. Horch, Aijia Cai https://creativecommons.org/licenses/by/4.0
Clinical outcomes of isolated ulnar shortening osteotomy for ulnar impaction syndrome with concomitant distal radioulnar joint instability
Background: This study aimed to evaluate the clinical outcomes and changes in distal radioulnar joint (DRUJ) stability in patients with ulnar impaction syndrome (UIS) combined with DRUJ instability, treated with ulnar shortening osteotomy (USO) without concomitant triangular fibrocartilage complex (TFCC) repair. Materials and methods: Between November 2017 and December 2024, a total of 16 patients (7 males, 9 females; mean age, 40 ± 12 years) underwent USO combined with wrist arthroscopy, followed by structured rehabilitation and regular follow-up. Clinical outcomes were assessed using ulnar variance, the Ballottement test, visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score, Patient-Rated Wrist Evaluation (PRWE), grip strength, and wrist range of motion. Preoperatively, all patients had positive Ballottement tests, and TFCC injuries were confirmed by arthroscopy. Results: At the final follow-up (mean, 31 months), ulnar variance was significantly reduced, and VAS, DASH, modified Mayo wrist score, PRWE, and grip strength all showed marked improvement. DRUJ stability was restored in all patients, with the Ballottement test converting to negative. Conclusions: These findings suggest that isolated USO effectively treats UIS with concurrent DRUJ instability and achieves satisfactory clinical outcomes without the need for simultaneous TFCC repair. Type of study/level of evidence: Therapeutic, Level IV.
Copyright (c) 2026 Xing Gao, Aozhengzheng Dong, Jingxin Li, Changliang Ma, Wencui Li, Jianquan Liu, Zhiqin Deng, Zhe Zhao https://creativecommons.org/licenses/by/4.0
Ulnar nerve innervation patterns and muscle fiber type composition of intrinsic hand muscles in mice
The motor function of the hand is crucial in daily life, with fine motor abilities relying on intrinsic hand muscles. Ulnar nerve injury causes atrophy of the intrinsic hand muscles it innervates, severely impacting patients’ daily activities. However, current understanding of the innervation patterns and muscle fiber composition of these muscles is limited, hindering the development of effective therapies for restoring hand function after such injuries. In this study, we investigated the anatomical basis of ulnar nerve innervation of the lumbrical and interosseous muscles in mice, a common neuromuscular research model. Our findings revealed that the ulnar nerve innervates the third and fourth lumbrical muscles and all interosseous muscles in mice. Six months after median nerve transection, motor endplate (MEP) areas in the ulnar-innervated fourth lumbrical muscle (152.200 ± 10.63 μm², n = 6) and dorsal interosseous muscles (e.g. third dorsal interosseous muscles: 171.100 ± 10.380 μm², n = 6) were preserved, whereas MEPs in the median-innervated first and second lumbricals were nearly abolished (e.g. LM1: 16.600 ± 1.126 μm², p < 0.001, n = 6).​ The third dorsal interosseous muscles predominantly consist of myosin heavy chain (MHC) -I (11.45% ± 1.92%, n = 6) and MHC-IIa (88.55% ± 1.92%, n = 6) fibers, whereas the lumbrical muscles mainly comprise MHC-IIa (31.67% ± 7.31%, n = 6) and MHC-IIb (64.44% ± 7.17%, n = 6) fibers. These results provide an essential anatomical and histological foundation for using mice to study the functional recovery of intrinsic hand muscles following ulnar nerve injury.
Copyright (c) 2026 Chuxiang Chen, Mingjie Zhou, Chenpei Xu, Tingzheng Jiang, Qianru He, Guillaume Prunieres, Philippe Liverneaux, Su Jiang https://creativecommons.org/licenses/by/4.0
Evaluation of modified abdominoplasty for excess skin in post-bariatric surgery patients with residual obesity
Excess skin after massive weight loss is especially discomforting on the abdomen due to physical and psychosocial symptoms, and many patients with excess skin have a lowered Quality of Life (QoL). Abdominoplasty may improve symptoms as well as QoL and is offered to post-bariatric patients in Sweden with a post-­operative body mass index (BMI) < 30 kg/m2. However, since > 50% never reach a BMI < 30, they are often left with an abdominal pannus that may hinder further weight loss. The reluctance to operate on patients with BMI > 30 is the increased risk of complications reported in several studies. Contradictorily, many studies have not found BMI > 30 to be an independent risk factor. Thus, the aim of this study was to prospectively evaluate a modified abdominoplasty technique on patients with a residual BMI 30–40, regarding complications and patient satisfaction. To contextualize, this was compared to a group of post-bariatric patients with a BMI < 30 that underwent standard abdominoplasties. A total of 110 patients underwent either a standard abdominoplasty (BMI < 30 group) or a modified abdominoplasty (BMI 30–40 group). Pre-, peri-, and post-operative data were analyzed. The complication rates were similar, apart from that the patients with BMI 30–40 had significantly more bleedings requiring re-interventions. There were no other significant differences in the complication panorama. The results from the questionnaires implied significant improvements in QoL and perception of excess skin, particularly in the BMI 30–40 group. In conclusion, this modified technique for abdominoplasty may be an acceptable compromise to a standard abdominoplasty for post-bariatric patients with residual obesity. Clinical trials registry: https://www.researchweb.org/is/sverige/project/203961.
Copyright (c) 2026 Jonas Ockell, Christina Biörserud, Monika Fagevik Olsén, Anna Elander https://creativecommons.org/licenses/by/4.0
Clinical outcomes in cutaneous squamous cell carcinoma of the head and neck: a retrospective analysis of risk factors, recurrence and metastasis
Introduction: Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer primarily affecting the head and neck area, with possibility of local recurrence and metastasis. Surgical excision is the standard treatment. The objective of this study was to investigate the treatment outcomes of cSCC including local recurrence, late-onset metastasis and mortality as well as to identify the associated risk factors. Material and methods: A retrospective single-center analysis was conducted involving patients with cSCC of the head and neck treated by surgical excision at Turku University Hospital between 2000 and 2021 with a minimum 2-year follow-up from primary surgery. Results: A total of 195 patients, with a mean age of 79.1 years, were included. During follow-up, 17 (8.7%) recurrences were diagnosed, nine (4.6%) patients developed late-onset metastasis, and 100 (51.3%) patients died. The significant risk factors for recurrences included age ≥ 80 years (p = 0.006), poor tumor differentiation (p = 0.02) and tumor invasion depth (p = 0.02). Tumor depth also increased metastasis risk (p < 0.0001). Poor tumor differentiation (p = 0.004) and metastasis (p = 0.04) were associated with higher mortality. Greater histological deep margins decreased the risk of recurrence (p = 0.01) and metastasis (p = 0.02) and improved survival (p = 0.006). All-cause 3-year and 5-year mortality rates were 27.7 and 36.4%, respectively. Conclusion: Deeper growing, poorly differentiated cSCC tumors of the head and neck carry a higher risk of recurrence and metastasis. Pursuing greater deep excision margins could reduce these risks. Given the high age and all-cause mortality rates of cSCC patients, close surveillance should be individualized.
Copyright (c) 2026 Veera Korhonen, Esko Veräjänkorva, Mari Koivisto, Susanna Pajula https://creativecommons.org/licenses/by/4.0
Minor modification of soft palate surgical technique resulted in a considerable increase of residual cleft dimensions for unilateral cleft lip and palate
Introduction: A two-stage surgical approach, starting with the soft palate, has been practiced in the Gothenburg cleft team for unilateral cleft lip and palate (UCLP) since decades. To improve the velopharyngeal function, a modified soft palate closure (SPC) technique was introduced. Clinical observations did however indicate that the novel technique resulted in a deviant residual cleft shape, potentially contributing to future compromised dental arch form. Aim: This study aimed to compare residual cleft dimensions (area, width and length) between different SPC techniques and at various age, in individuals born with UCLP. Material and methods: The sample consisted of three groups of children with non-syndromic UCLP: 1. 27 individuals who had original SPC and hard palate closure (HPC) at 3 years (GBG3) 2. 37 individuals who had a modified SPC and HPC at 2 years (GBGmod) 3. 29 individuals who had original SPC and HPC at 2 years (GBG2). Residual cleft area, length and width were measured on digitised cast models using Blender software. Multiple linear regression analysis was used to compare the groups. Results: Larger residual cleft dimensions (area and length) were found for GBGmod compared to both GBG3 (p < 0.001, p = 0.009) and GBG2 (p = 0.009, p = 0.009). In addition, GBGmod had increased cleft width in comparison with GBG3 and GBG2 in quartile 1. Conclusion: The modified SPC technique resulted in larger residual clefts in comparison with the groups operated with the original SPC method. Timing differences between GBG3 and GBG2 are likely one explanation of cleft width variations anteriorly.
Copyright (c) 2026 Midia Najar Chalien, Hans Mark, Josef Rizell, Sara Rizell https://creativecommons.org/licenses/by/4.0
Advances in epidermolysis bullosa hand deformity management: a 20-year journey of techniques and outcomes
Introduction: Epidermolysis bullosa (EB) is a rare disease involving the skin with the formation of synechiae and cicatricial retractions, especially on the hands. The objective of this study is the evaluation of the surgical technique of debridement of the amorphous hand in patients suffering from EB. Material and methods: All patients were treated according to the ethical principles of the Helsinki declaration. Data collection was performed in terms of patient’s hospitalization time, healing time (healing for more than 90% of the epidermis), possible recurrence and reoperation times, Visual Analogue Scale (VAS) for pain evaluation, and Disability of Arm-Shoulder-Hand (DASH) score in preoperative time and after 60 days from surgery. The clinical follow-up ranges from a minimum of 36 months up to 10 years. Results: Complete reepithelialization of the hands (<90% of the bloody surface) occurred in 19.2 days, with a range of 14–23 days. In our study, the improvement in the DASH score and pain evaluation with VAS scale were statistically significant (P < 0.05), and the goal of this treatment was the functional recovery of the hands with resumption of daily autonomy. Conclusion: The surgical technique shown is safe, simple, and repeatable with a rapid learning curve, and no complex instruments or large operating spaces are needed, which is why it should be easy to make it repeatable in other plastic or hand surgery centers. Our data regarding discomfort and the DASH scale give us encouraging premises to continue in this direction.
Copyright (c) 2026 Francesco Ciancio, Antonio Cuzzocrea, Caterina Alberti, Dario Melita, Paolo Marchica, Rosario Ranno, Giuseppe A.G. Lombardo https://creativecommons.org/licenses/by/4.0
Atlas of recipient vessels for the superficial venous system of DIEP-flaps – a systematic literature review and clinical practice review
Background: Venous congestion contributes to up to 40% of failures in abdominally based free flaps, underscoring the importance of optimising superficial venous drainage in deep inferior epigastric perforator (DIEP) flap breast reconstruction. The superficial inferior epigastric vein (SIEV) is sometimes essential to flap outflow. This systematic review investigates the choice of recipient vessels for superficial venous supercharging. Methods: A systematic review was performed according to a PROSPERO-registered protocol (CRD42022353591) and PRISMA guidelines. PubMed, CINAHL, Embase, and the Cochrane Library were searched for studies describing SIEV recipient vessels or vessel-selection algorithms. Extracted data included study design, recipient vessel, graft use, and decision strategies. A clinical practice review was also conducted at Sahlgrenska University Hospital, where prophylactic SIEV–cephalic vein (CV) anastomosis has been used for over two decades. Results: Twenty-nine studies were included. Reported recipient vessels outside the flap comprised, for example, the following veins: internal mammary, cephalic, thoracoacromial, and thoracodorsal. Intra-flap options included anastomoses to branches or the caudal end of the deep inferior epigastric vein. Three studies described interposition grafts, and eight proposed selection algorithms, with no consensus. The internal mammary vein was most frequently used. At Sahlgrenska, a short axillary-fold incision provides consistent and cosmetically favourable access to the CV, adding minimal operative time. Conclusion: Recipient vessel selection for SIEV anastomosis remains highly variable in the literature. Long-term institutional experience supports the CV as a reliable and versatile option. Prospective studies are needed to evaluate outcomes.
Copyright (c) 2026 Emma Hansson, Jonas Löfstrand https://creativecommons.org/licenses/by/4.0
Characteristics and prognosis of skin cancer arising from burn scars: a systematic review
Background: Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin’s ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis. Methods: We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools. Results: A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively. Conclusion: Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.
Current materials and techniques in cosmetic hand injections
Background: With the widespread popularity and development of aesthetic treatments, the focus has extended from facial aging to include the aging of hands. The primary aim of this study is to review the current materials, methods of injection, and testing procedures employed in cosmetic hand injections. Methods: PubMed database (from 1971 to April 2024) was searched to identify relevant studies on materials, injection techniques, and evaluation methods associated with aesthetic hand injections, excluding systematic reviews and medical record reports. Results: A total of 1815 articles were identified, of which 41 articles were included. This study summarizes the current materials, injection techniques, and outcome evaluation methods used for cosmetic hand injections, while discussing observations and making recommendations. Conclusion: Hand skin conditions tend to receive less attention than cosmetic facial injections. In existing studies of injected substances, hydroxyapatite remains the main material used for cosmetic hand injections. Poly-L-lactic acid (PLLA), platelet-rich plasma (PRP), and polycaprolactone injections were significantly more effective than other substances in the hand. In commonly used injection techniques, catheter-based injection methods are more accurate than needle positioning and dose. The most commonly used assessment methods remain ultrasound and the Merz hand partial scale. At present, there is still a relative lack of research on aesthetic hand injections, and extensive and in-depth research, such as randomized studies comparing hyaluronic acid and calcium hydroxylapatite and longitudinal data on the results of PLLA or PRP, is recommended to further develop hand injection techniques with lasting aesthetic results. Increased public awareness of hand injections derives from more reliable and valid studies. And we need standardized outcome measures and long-term follow-up data in future studies.
Copyright (c) 2026 Yutong Liang, Jun Zhuang, Xueshang Su, Ziming Zhang, Qingqian Wei, Jintian Hu https://creativecommons.org/licenses/by/4.0
Schwannomas of the deep motor branch of the ulnar nerve: a systematic review of the literature with an additional case report and anatomical analysis
Purpose: Schwannomas originating from the deep motor branch of the ulnar nerve (DMBUN) are exceptionally rare, presenting with variable and often heterogeneous clinical manifestations depending on their precise anatomical location. While these tumors have been described in the literature, reports specifically involving the DMBUN are exceedingly limited, rendering postoperative prognostication challenging. This study aims to systematically review the existing literature and present a novel case, with the objective of delineating anatomical characteristics and clarifying potential postoperative outcomes. Methods: A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the MEDLINE and Scopus databases. Data regarding patient demographics, clinical presentation, anatomical localization, and surgical outcomes were extracted and analyzed. Results: Seven articles met the inclusion criteria. A total of nine tumors were initially identified as schwannomas of the DMBUN over a 73-year period; however, only five cases – including the newly reported one – were confirmed. The median patient age was 59.6 years; complete recovery was achieved in three cases, with time to functional improvement ranging from 4 to 6 months. Conclusion: In this limited series, available data suggest that accurate preoperative imaging and careful intraoperative microsurgical dissection may lead to favorable outcomes, with complete recovery achievable in schwannomas of the DMBUN. No clear association was observed between postoperative nerve function and tumor size, patient age, or time since symptom onset.
Copyright (c) 2026 Filippo Pantaleoni, Mariia Kotova, Marta Montanari, Marco Passiatore, Davide Gravina, Paolo Boccolari, Danilo Donati, Marta Starnoni, Andrea Leti Acciaro https://creativecommons.org/licenses/by/4.0
Clinical outcome comparison of suture button suspensionplasty versus trapeziectomy with ligament reconstruction and tendon interposition in patients with carpometacarpal joint arthritis: a systematic review of direct comparison studies
Introduction: Trapeziectomy nowadays is predominantly done with Ligament Reconstruction and Tendon Interposition (LRTI) or Suture Button Suspensionplasty (SBS). This article is intended to highlight comparison between SBS and trapeziectomy with LRTI through direct comparison evidence. Material and Method: The LRTI technique involves the removal of the diseased trapezium bone and creating suspension through the use of flexor carpi radialis tendon, while SBS stabilize the metacarpal base by suspending the first metacarpal bone. The record screening process of this systematic and meta-analysis was in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. QuickDASH, post-operative strength, visual analog scale were set as the primary outcomes, while the adverse event reported and miscellaneous findings worth mentioning per study were set as the secondary outcomes. Results: Of the 102 records screened, 1 Randomized Control Trial (RCTs) and 1 Cohorts, consisting of 188 cases were included in the analysis. Both modalities showed comparable, non-significant difference in efficacy (alleviating pain associated with basal joint arthritis, improving strength and function of the affected thumb, in the long term) at the endpoint of the follow-up. Both procedures also showcased excellent safety and long-term functional profile. However, SBS displayed an advantage in post-operative recovery aspect as well as the biomechanical aspect compared to LRTI. Conclusions: Both LRTI & SBS demonstrated non-inferiority to each other, hence clinical judgment might be more based on the preference and tolerability of the patient, as well as the experience of the center. Further prospective, comparative study might be needed to truly erect the superiority of one of the procedures to another.
Copyright (c) 2026 Wildan Latief, Riky Setyawan, Winona Andrari Mardhitiyani https://creativecommons.org/licenses/by/4.0