A recent Plastic Surgery digest,
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Study Type: Systematic review (case-level synthesis)

Key Question: What are the mechanisms, risk factors, and outcomes of vision loss following nonsurgical rhinoplasty with dermal fillers, and how effective are current management strategies?

Key Findings:

• Across 22 reported cases (21 articles), patients were predominantly young females (mean age 33.4, 90.9% female); hyaluronic acid was the most common filler (50%), with nasal bridge/dorsum the most frequent injection site (57%).
• Vision loss was immediate in 82% of cases; despite treatment with hyaluronidase, corticosteroids, and antibiotics, full visual recovery occurred in only 27%, taking an average of 5.3 months.
• Hyperbaric oxygen therapy showed possible benefit but requires further evaluation.

Clinical Relevance: As nonsurgical rhinoplasty becomes increasingly popular in UK aesthetic practice, this review underscores the need for rigorous anatomical training, injection technique, and rapid recognition/management protocols given the largely irreversible nature of filler-induced vision loss.

Limitations: Findings are based on a small, heterogeneous pool of published case reports, limiting generalisability and introducing potential publication and reporting bias.

Study Type: Retrospective cohort study (single institution)

Key Question: What are the safety and outcomes of prosthesis-free breast reconstruction (aesthetic flat closure vs Goldilocks) using a standardised inferior adipodermal flap technique?

Key Findings:

• 55 patients (44 AFC, 11 GL); GL patients had significantly higher BMI (33.1 vs 26.3 kg/m², P=0.003).
• Median operative time 184 minutes; 60-day complication rate 9.1%, revision rate 7.3%.
• No mastectomy flap or nipple-areola complex necrosis, and no conversions to implant-based or autologous reconstruction.

Clinical Relevance: Supports wider adoption of IAF-based AFC/GL as low-morbidity, prosthesis-free reconstructive options for NHS patients—particularly those with higher BMI or wishing to avoid implant/autologous surgery—potentially reducing operative burden and revision surgery rates.

Limitations: Small, single-centre retrospective cohort without comparator group limits generalisability and causal inference.

Study Type: Retrospective case series (n=9)

Key Question: Does adding a periosteal-preserving fibula onlay bone graft to a vascularized fibula free flap safely achieve vertical augmentation in mandibular reconstruction?

Key Findings:

• Bone union achieved in 88.9% (8/9); 1 graft failure (11.1%) and 1 wound infection (11.1%).
• Onlay graft showed greater volume resorption (median 43.48%) than the vascularized flap (22.37%), but difference not statistically significant (P=0.136).
• Mean onlay graft length 5.9±1.7 cm; mean follow-up 2.19±1.69 years.

Clinical Relevance: Offers a technically feasible adjunct for achieving vertical bone height in mandibular reconstruction, relevant to UK units managing complex oncologic/traumatic mandibular defects where alveolar height limits dental rehabilitation.

Limitations: Very small, uncontrolled, single-centre sample precludes definitive conclusions on efficacy or comparative resorption risk.

Study Type: Retrospective case series (single UK regional burns centre, 2015–2025)

Key Question: What are the injury patterns, management, and outcomes of burns caused by e-cigarette (ENDS) explosions?

Key Findings:

• 47 patients identified (mean age 40y, 87% male); 94% of explosions occurred while devices were not in use, most commonly in trouser pockets (81%), causing thigh (77%) and hand (23%) burns.
• Mean TBSA was 2.34% (SD 1.79), predominantly partial/mixed-depth burns; 77% managed conservatively, but 36% required hospitalisation and 23% needed surgery.
• Complications occurred in 14%, with 9% requiring further surgical intervention.

Clinical Relevance: Highlights an underrecognised, preventable mechanism of significant burn injury relevant to UK burns/plastic surgery services, supporting calls for device regulation, patient education, and vigilance for lithium-ion battery-related trauma.

Limitations: Single-centre retrospective design with reliance on database coding limits generalisability and may underestimate true incidence.

Study Type: Prospective cohort study (single-institution, pre- and postoperative survey)

Key Question: Does gender-affirming chest surgery improve interoceptive awareness (IA) in transgender and gender diverse (TGD) patients?

Key Findings:

• Overall IA (MAIA-2) significantly improved at 1 week, 1 month, 3 months, and long-term follow-up (mean 2.10 years) versus preoperative baseline (P<0.05 at each interval).
• Trusting subscale improved significantly by 1 week, sustained long-term; not-worrying improved by 1 month, sustained long-term; not-distracting improved at 1 week and 3 months.
• Attention regulation and self-regulation showed nonsignificant upward trends.

Clinical Relevance: Supports UK gender-affirming surgery services in counselling patients on psychological benefits beyond cosmetic/functional outcomes, reinforcing the case for continued NHS provision of chest surgery in TGD care pathways.

Limitations: Small, single-centre sample with significant attrition (23 to 13 patients), limiting statistical power and generalisability.

Study Type: Preclinical animal study (porcine model)

Key Question: Can subcutaneous microdialysis biomarkers reliably substitute for intramuscular biomarkers to detect acute compartment syndrome (ACS)?

Key Findings:

• SC and IM glucose showed strongest correlation (R²=0.931), followed by pH (R²=0.911); lactate correlation was weaker (R²=0.667).
• SC pH <7.17 had the best diagnostic accuracy among SC metabolic markers (DTA 78%); SC glucose <6.6 mg/dL and SC lactate >3.85 mg/dL had DTAs of 75% and 70% respectively.
• Tissue oxygenation (SrO2 <58.5%) and hindlimb surface temperature (<27.8°C) showed near-perfect diagnostic accuracy (DTA 100% and 99.6%), detecting changes within 30 minutes of tourniquet inflation.

Clinical Relevance: SC microdialysis and non-invasive surface temperature/oxygenation monitoring could offer a less invasive alternative to intracompartmental pressure measurement for earlier, more accurate ACS diagnosis, relevant to UK trauma and limb reconstruction pathways where delayed diagnosis drives significant morbidity.

Limitations: Findings derive from an acute tourniquet-induced porcine model and require validation in human clinical trials before practice change.

Study Type: Retrospective case series (n=5)

Key Question: Can a hybrid pedicle envelope (artificial dermis plus small local skin flap) safely replace the conventional skin tube in pedicled abdominal flap reconstruction of extensive upper limb defects when free tissue transfer is not feasible?

Key Findings:

• All 5 flaps survived; pedicle segments enclosed measured 4–7 cm, with no pedicle compression, infection, or vascular crisis.
• One case of distal flap-tip necrosis managed conservatively; all flaps achieved satisfactory contour/texture integration.
• Good joint motion recovery and high patient satisfaction reported across all cases.

Clinical Relevance: Offers UK units without ready access to microsurgical reconstruction (or in patients unsuitable for free flaps) a donor-site-sparing, technically simple pedicled flap option with easier pedicle monitoring and earlier mobilisation.

Limitations: Very small, uncontrolled case series with no comparator group, limiting generalisability and assessment of complication rates.

Study Type: Narrative review with proposed conceptual framework

Key Question: How can existing decision-making algorithms for perineal/pelvic reconstruction after extirpative pelvic surgery be improved to systematically prevent complications such as perineal hernia, dead space infection, and empty pelvis syndrome?

Key Findings:

• Existing frameworks (defect morphology, operative context, multifactorial, flap-specific) match techniques to defects but do not consistently ensure all reconstructive objectives are met.
• The authors propose the "Pelvic Bowl" model, structured around three mechanistic layers: pelvic floor support, dead space obliteration, and perineal resurfacing.
• No comparative outcome data are presented; the framework is conceptual, intended to guide individualised planning.

Clinical Relevance: Offers UK plastic surgeons a structured, objective-based mental model to improve consistency and completeness of reconstructive planning in complex pelvic exenteration/APR cases, potentially reducing wound and hernia complications.

Limitations: As a narrative review proposing a new framework, it lacks empirical validation or outcome data supporting reduced complication rates.