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Background: With major advances in microsurgical techniques, free tissue transfer has become a widely adopted approach to treat complex soft-tissue defects. However, sensory recovery is poor, leaving the anesthetic skin prone to injuries., Methods: Twenty-eight patients with 22 anterior lateral thigh flaps and six latissimus dorsi flaps on their extremities participated in the study. Quantitative sensory testing and two-point discrimination was performed in three test areas and one control on the contralateral unaffected extremity. Physical disability, mental health, quality of life, and characteristics of pain were assessed by the painDetect, Disabilities of the Arm, Shoulder, and Hand, Lower Extremity Functional Scale, and 12-Item Short Form questionnaires, respectively., Results: Somatosensory profiles of all flaps were characterized by an overall loss of nerve function. Small-fiber function was mostly recovered, whereas large-fiber function, and thus touch discrimination, was severely impaired. Mechanical detection thresholds improved over time and from center to the periphery. Reported pain was mild to moderate and correlated with decreased physical function., Conclusions: Standardized quantitative sensory testing provides a useful tool kit to assess the sensory regeneration after surgical treatment of soft-tissue defects. After free tissue transfer, small-fiber function recovers with nerve ingrowth in a centripetal direction from the flap margins to the center, likely by way of collateral axonal sprouting from the undamaged nerves surrounding the flap. Myelinated fibers recover slowly and inefficiently., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Competing Interests: Disclosure:The authors have financial disclosures or conflicts of interest to declare.

Background: Wound healing after resection of large soft-tissue tumors is often impaired by large dead space and fluid collection. Recently, the authors were able to show an association of wound complications with worse oncologic outcome in soft-tissue sarcomas. The aim of the study was to examine the value of closed-incision negative pressure wound therapy on postoperative wound drainage and wound complications after soft-tissue tumor resection., Methods: Patients for whom resection is planned of a soft-tissue tumor larger than 10 cm in diameter of the extremities or the trunk were allocated randomly to one of two groups. After wound closure, patients in the study group received closed-incision negative-pressure wound therapy for a duration of 5 days, whereas those in the control group received regular dressings. The amount of drainage fluid, course of wound healing, length of hospital stay, and wound edge perfusion at postoperative day 5 measured by white-light infrared spectroscopy were compared., Results: Sixty patients could be included in the study with even distribution to both study arms, meeting the goal. The postoperative course of wound drainage volume was significantly lower in the study group, and hospital stay was significantly shorter, with 9.1 ± 3.8 days versus 13.9 ± 11.8 days. The occurrence of wound complications was significantly lower in the study group on time-to-event analysis (one versus six). Tissue spectroscopy revealed a significantly higher oxygen saturation increase in the wound edge for the study group versus the control group., Conclusion: Closed-incision negative-pressure wound therapy should be considered for patients undergoing resection of large soft-tissue tumors., Clinical Question/level of Evidence: Therapeutic, II., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Background: Augmentation mastopexy may be a one- or two-stage procedure. Because of the opposing force vectors in augmentation and in mastopexy, some surgeons advocate a two-stage procedure. The literature appears divided on which operation has a more favorable complication profile. The purpose of this review was to benchmark the outcomes of single-stage augmentation mastopexy against those of a commonly performed aesthetic breast operation (primary breast augmentation)., Methods: THE AUTHORS: reviewed electronic patient records of all consecutive female patients who underwent single-stage augmentation mastopexy and primary breast augmentation performed by the first author at our clinic between April of 2009 and May of 2017 with at least a 6-month follow-up. Data from single-stage augmentation mastopexy were benchmarked against the outcomes of primary breast augmentations performed by the same surgeon, for the same period, and at the same clinic., Results: ONE HUNDRED FOUR: single-stage augmentation mastopexies and 801 primary breast augmentations were performed during this period, with mean follow-up of 15.4 months and 14.0 months, respectively. Augmentation mastopexy patients were significantly more likely to be older, have a higher body mass index, have more children, and were significantly less likely to use oral contraceptives. There was no statistically significant difference in overall complication rate between the two groups., Conclusions: THE AUTHORS': experience suggests that single-stage augmentation mastopexy has outcomes comparable to those of primary breast augmentation. Smokers were more likely to undergo reoperation because of postoperative complication (seroma), but the rate of implant exchange was not different., Clinical Question/level of Evidence: THERAPEUTIC, III.

Stem cells are self-renewing cells capable of differentiating into multiple cell lines and are classified according to their origin and their ability to differentiate. Enormous potential exists in use of stem cells for regenerative medicine. To produce effective stem cell-based treatments for a range of diseases, an improved understanding of stem cell biology and better control over stem cell fate are necessary. In addition, the barriers to clinical translation, such as potential oncologic properties of stem cells, need to be addressed. With renewed government support and continued refinement of current stem cell methodologies, the future of stem cell research is exciting and promises to provide novel reconstructive options for patients and surgeons limited by traditional paradigms.

Background: The preoperative diagnostic imaging of peripheral nerve lesions and the postoperative monitoring of microsurgically coapted nerves remain unsolved problems. The aim of this study was to investigate peripheral nerve regeneration after complete neurotmesis with magnetic resonance imaging techniques., Methods: Study groups included 70 rats. Their right sciatic nerve was either cut and left untreated or epineurially coapted. After postoperative days 3, 6, 10, and 14 and then weekly until postoperative day 84, these rats underwent scanning at 4.7 T. T2 signal intensities of the nerves were analyzed. In parallel, on postoperative days 3, 6, 10, 14, 21, 28, 42, 63, or 84, rats were killed for histologic processing. These findings were related to the corresponding images., Results: After an initial T2 signal increase of the nerves in both groups, the coapted group demonstrated a major T2 signal decrease in the distal part of the nerve after postoperative day 21, whereas in the unrepaired group a signal decrease was not observed until postoperative day 42. Differences between the two groups were significant at postoperative days 3, 6, and 28 and thereafter. The signal decrease in the coapted nerves could be correlated to the ingrowth of regenerating axons observed by histology. Moreover, the continuity of coapted nerves or an explicit gap in the unrepaired group was detectable at every time point., Conclusions: This study presents novel magnetic resonance imaging data regarding regeneration after neurotmesis. High-field-strength magnetic resonance imaging has the potential to diagnose a discontinuity within a nerve of interest and monitor its regeneration after coaptation.