A recent Plastic Surgery digest,
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Study Type: Retrospective cohort study

Key Question: Do auricular keloids have different recurrence rates and radiation-related side effects compared to nonauricular keloids following surgical excision with or without adjuvant radiotherapy?

Key Findings:

• No significant difference in recurrence rates between auricular and nonauricular keloids: 17.07% vs 16.22% with adjuvant radiation (P=0.91), and 47.37% vs 44.12% with surgery alone (P=0.82)
• Adjuvant radiotherapy dramatically reduced recurrence regardless of anatomical site compared to surgery alone
• Radiation-related side effects were significantly more frequent in nonauricular sites (37% vs 20%, P=0.022)

Clinical Relevance: Challenges the assumption that ear keloids respond better to treatment than keloids elsewhere, supporting uniform treatment protocols with adjuvant radiotherapy across anatomical sites in NHS practice.

Limitations: Single-surgeon retrospective study with relatively short follow-up period limiting generalisability of findings.

Study Type: Retrospective cohort study

Key Question: Do specific perioperative medical therapies improve wound healing times after hidradenitis suppurativa surgery, and do intraoperative cultures guide antibiotic management?

Key Findings:

• Perioperative trimethoprim-sulfamethoxazole (HR 2.55, 95% CI: 1.46-4.46) and spironolactone (HR 5.72, 95% CI: 2.08-15.74) significantly reduced time to documented healing
• Preoperative cephalexin improved healing times (HR 4.17, 95% CI: 1.40-12.44), but postoperative cephalexin did not
• Intraoperative cultures (collected in 28% of cases) showed no significant association with postoperative antibiotic selection

Clinical Relevance: This evidence could inform standardised perioperative protocols for HS surgery in NHS plastic surgery units, potentially reducing healing times and hospital resource utilisation while questioning routine culture collection.

Limitations: Retrospective design with potential confounding variables and subjective definition of "substantial wound-healing progress" from clinical notes.

Study Type: Narrative review

Key Question: What is the role of small joint denervation as a treatment option for hand and finger osteoarthritis compared to traditional surgical approaches?

Key Findings:

• Small joint denervation provides significant pain reduction while preserving joint range of motion and mechanics
• Recovery is more rapid compared to traditional procedures like arthrodesis, arthroplasty, or arthroscopy with debridement
• The technique maintains future surgical options as it does not alter joint anatomy or mechanics

Clinical Relevance: This motion-preserving procedure could offer UK plastic surgery units a minimally invasive alternative for managing hand osteoarthritis pain, potentially reducing recovery times and maintaining patients' functional capacity compared to more invasive joint procedures.

Limitations: The review acknowledges lack of standardised techniques, randomised controlled trials, and long-term follow-up data to establish the procedure's position in treatment algorithms.

Study Type: Personal commentary/memorial reflection

Key Question: What personal insights do family members provide about Dr Leonard Furlow's character and influence beyond his surgical contributions?

Key Findings:

• Sons shared intimate reflections at inaugural memorial symposium at Vanderbilt University Medical Center
• Personal accounts highlighted Furlow's intellectual rigour and innovative approach to surgery
• Family perspective revealed personal qualities that underpinned his enduring contributions to plastic and reconstructive surgery

Clinical Relevance: Provides valuable context about a pioneering figure in plastic surgery whose techniques and innovations continue to influence contemporary practice, offering insights into the personal attributes that drive surgical excellence.

Limitations: As a personal reflection rather than research study, findings are subjective and anecdotal rather than evidence-based.

Study Type: Retrospective analysis

Key Question: How accurate are conflict-of-interest disclosures by plastic surgery authors when compared to Open Payments database records?

Key Findings:

• 78.6% of 961 plastic surgeon authors had at least one discrepancy between self-reported disclosures and Open Payments database records across 8,040 reviewed articles (2017-2022)
• 4% of publications contained undisclosed relationships qualifying as conflicts of interest
• Authors with discrepancies received higher median payments than those without ($9,600 vs $2,500; P<0.001), with senior authors more likely to under-report

Clinical Relevance: This highlights significant under-reporting of financial conflicts among UK plastic surgery researchers, which could impact clinical decision-making and evidence interpretation in NHS practice.

Limitations: Limited to two journals and may not reflect disclosure practices across all plastic surgery publications or international contexts.

Study Type: Retrospective case series

Key Question: Does temporal subcutaneous brow lift with orbicularis repositioning achieve long-term crow's feet reduction through orbicularis oculi selective denervation?

Key Findings:

• 182 of 194 patients (93.8%) with baseline crow's feet scores ≥2 achieved significant improvement to scores of 0-1 post-operatively using the Merz five-point grading scale
• Improvement was sustained at 12 and 24 months with no statistically significant deterioration between follow-up timepoints
• The proposed mechanism is selective denervation of orbicularis oculi muscle during the repositioning procedure

Clinical Relevance: This technique may offer UK plastic surgeons a surgical alternative to repeated botulinum toxin injections for crow's feet correction, potentially providing cost-effective long-term results within NHS aesthetic services.

Limitations: Retrospective design with subjective photographic assessment and lack of comparison to alternative treatments or control groups limits evidence quality.

Study Type: Retrospective cohort study

Key Question: Which flap technique—reverse dorsal radial island flap or reverse thenar island flap—provides superior outcomes for distal thumb defect reconstruction?

Key Findings:

• Reverse thenar island flap demonstrated significantly shorter operative time compared to reverse dorsal radial island flap (specific times not provided)
• No significant differences between groups in two-point discrimination, thumb total active motion, hospital stay, pain scores, return-to-work time, or patient satisfaction
• Both techniques showed comparable functional outcomes at mean 13-14 month follow-up

Clinical Relevance: This evidence helps UK plastic surgeons choose between two established thumb reconstruction techniques, suggesting reverse thenar flaps may offer operative efficiency without compromising functional outcomes.

Limitations: Retrospective design limits control for confounding variables and introduces potential selection bias.

Study Type: Systematic review and meta-analysis

Key Question: What is the efficacy and safety of autologous fat grafting in post-mastectomy breast reconstruction?

Key Findings:

• Volume retention averaged 47% (95% CI 31.5-62.5%) at 3-12 months with standard techniques, dropping to 35.1% when flap-augmented methods were excluded
• No statistically significant increase in complications including fat necrosis (RR 2.37, 95% CI 0.80-7.01, p>0.05)
• Patient-reported outcomes consistently favoured fat grafting over controls across multiple studies

Clinical Relevance: This evidence supports fat grafting as a safe adjunctive technique for UK breast reconstruction services, particularly valuable given NHS emphasis on patient-reported outcomes and the need for cost-effective secondary procedures.

Limitations: Extreme heterogeneity between studies (I² = 99%) prevented reliable pooling of volume retention data.