Nevin Manimala

Ann Plast Surg. 2026 Mar 6. doi: 10.1097/SAP.0000000000004707. Online ahead of print.

ABSTRACT

BACKGROUND: Implant-based reconstruction represents the most common method of breast reconstruction today. Many surgeons approach implant-based breast reconstruction in 2 stages, with the first stage being placement of a tissue expander at the time of mastectomy. Neoadjuvant chemotherapy can have systemic effects that may place patients at risk for TE/implant loss, infection, wound, and other complications.

METHODS: A retrospective review of all cases of TE breast reconstruction at a single institution between 2017 and 2024 was performed. A total of 210 patients, representing 319 total breasts that underwent reconstruction, met the inclusion criteria. Sixty-five patients underwent neoadjuvant chemotherapy and 145 did not. Patients were separated into neoadjuvant chemotherapy (NACT) and nonneoadjuvant chemotherapy (non-NACT) cohorts. Primary outcomes of TE loss, wound, infection, and seroma were analyzed. Regression analysis was performed, matching patients for known risk factors.

RESULTS: The rate of all-cause TE loss in patients who underwent NACT was 18%, and 11% for patients who did not. The rate of pathologic TE loss was significantly higher at 14% in patients who underwent NACT and 7% in patients who did not undergo NACT (P=0.032). On regression analysis, neoadjuvant chemotherapy increased the rate of all-cause and pathologic TE loss by 17% (P<0.05). There were no statistically significant differences in wound, seroma, and infection.

CONCLUSIONS: In this study, neoadjuvant chemotherapy is an independent risk factor for TE loss after immediate tissue expander-based breast reconstruction. Further analysis of adjuncts, implant factors, and specific chemotherapeutic agents is needed.

PMID:41811191 | DOI:10.1097/SAP.0000000000004707

J Clin Rheumatol. 2026 Mar 11. doi: 10.1097/RHU.0000000000002328. Online ahead of print.

ABSTRACT

OBJECTIVES: Ankylosing spondylitis (AS) is an autoimmune disorder marked by chronic inflammation that may accelerate atherosclerosis and increase ischemic heart disease (IHD) risk. This study assessed the association between AS and IHD using nationwide data.

METHODS: A retrospective historical cohort study was performed using Korean National Health Insurance Service data (2012-2023). AS was defined by the ICD-10 code M45 and the rare disease code V140. After a 3-year washout, IHD was defined as ≥2 visits with codes I20 to I25. Propensity score-matched controls (1:10) were selected, and proportional hazards models were applied.

RESULTS: A total of 2869 patients with AS and 28,690 matched controls were followed for a mean of 4.2 years. IHD occurred in 7.08% of patients with AS and 5.05% of controls. The incidence rate ratio (IRR) was 1.42 (95% CI: 1.23-1.65). Subgroup analyses revealed a higher risk among current smokers (IRR, 1.85). The risk increased with longer follow-up periods, especially in older men.

CONCLUSIONS: AS was significantly associated with elevated IHD risk, particularly among smokers and low-income groups. Early cardiovascular risk management is warranted.

PMID:41811182 | DOI:10.1097/RHU.0000000000002328

Ann Plast Surg. 2026 Mar 6. doi: 10.1097/SAP.0000000000004703. Online ahead of print.

ABSTRACT

BACKGROUND: Forefoot and heel fat pad atrophy are debilitating conditions that compromise structural integrity of the plantar soft tissues, resulting in pain and disability. This localized destruction of soft tissue integrity has been associated with increased age, diabetes, and repetitive trauma. Although autologous fat grafting has shown improvements to short-term patient pain levels and quality of life, there is limited evidence as to the long-term benefit of this treatment.

OBJECTIVES: This study aims to evaluate the long-term outcomes of autologous fat grafting to the foot for fat pad atrophy treatment.

METHODS: This was a cross-sectional long-term follow-up of patients who underwent autologous fat grafting for pedal fat pad atrophy between 2015 and 2018. Patients received grafting at presentation (interventional cohort) or after 1 year of conservative management (crossover cohort). Demographic and procedural data were collected. Patient-reported outcomes were assessed using the Manchester Foot and Disability Index (MFDI) at baseline, final in-office follow-up, and long-term follow-up (mean: 9 y). After correction of raw data outliers, statistical analyses included Fisher exact and Wilcoxon rank-sum for baseline associations, Mann-Whitney U tests for long-term between-group comparisons, and repeated-measures ANOVA for within-group changes in forefoot patients only. Heel outcomes were reported descriptively due to small sample size.

RESULTS: Of 36 eligible patients, 25 participated (69.4% response rate; mean follow-up 9.0±1.2 y). Interventional (n=14) and crossover (n=11) cohorts showed no significant long-term differences across all domains (pain, function, appearance, work/leisure). Forefoot grafting significantly improved appearance (mean change: -2.9 to 0.8, P<0.001) but demonstrated functional decline at long-term follow-up (mean: 12.9 to 7.2, P=0.020). Heel grafting was associated with durable functional improvement (median difference, P=0.004) and trended towards pain reduction, although appearance outcomes were lower compared with forefoot patients (P=0.002). Work/leisure outcomes showed no significant long-term differences (P=0.087).

CONCLUSIONS: Autologous foot grafting confers durable, site-specific benefits nearly a decade post-procedure. Heel grafting restores long-term function, whereas forefoot grafting primarily improves cosmesis. Importantly, timing of grafting (immediate vs. delayed) does not alter durability, underscoring the need for location-specific treatment counseling and potential repeat procedures in forefoot patients.

PMID:41811175 | DOI:10.1097/SAP.0000000000004703

Ann Plast Surg. 2026 Mar 6. doi: 10.1097/SAP.0000000000004701. Online ahead of print.

ABSTRACT

BACKGROUND: Autologous fat grafting (AFG) is commonly used in breast reconstruction for volume restoration or contour correction. Our previous study demonstrated that standard decantation yields inferior volume retention compared to active wash and filtration (AWF) and low-pressure decantation (LPS). Building upon these findings, we replaced standard decantation with a new processing technique, active wash with surfactant (AWFS). This study aims to evaluate long-term volume retention among AWF, LPS, and AWFS.

METHODS: A prospective, randomized controlled trial was conducted at our institution between 2023 and 2025. Thirty patients were randomized in a 1:1:1 ratio to receive fat grafting processed by either AWF, LPS, or AWFS. Three-dimensional scans of the upper torso were obtained preoperatively and at 3 months postoperatively. Breast volume was measured using Autodesk Meshmixer, and volume retention was calculated as a percentage of the initial grafted volume. Differences in volume retention across groups were analyzed using one-way ANOVA.

RESULTS: The volume of fat injected during the procedure did not differ significantly between groups: 89.0 ± 56.0 cm3 for AWF, 125.8 ± 68.9 cm3 for LPS, and 127.5 ± 78.7 cm3 for AWFS (P=0.33). Average volume retention at 3 months was 55.3% ± 17.2% for AWF, 58.7% ± 17.8% for LPS, and 62.7% ± 15.7% for AWFS. No significant difference in volume retention was observed across groups (P=0.52).

CONCLUSIONS: Although AWFS demonstrated the highest average volume retention, differences between techniques were not statistically significant. These findings suggest comparable long-term outcomes among the 3 processing methods.

PMID:41811164 | DOI:10.1097/SAP.0000000000004701

Plast Reconstr Surg. 2026 Mar 11. doi: 10.1097/PRS.0000000000013017. Online ahead of print.

ABSTRACT

OBJECTIVE: Aim of this study is to evaluate the effectiveness of stromal vascular fraction (SVF) and nano-fat applications on photoaging and skin quality in the facial region, as well as their possible superiority over each other.

MATERIALS AND METHODS: Study was conducted on 20 volunteer patients aged 40-55 who applied to City Hospital Plastic Reconstructive and Aesthetic Surgery outpatient clinic between April-July 2024 with complaints of facial aging and skin complaints in facial area. After initial evaluation, patients were divided into two groups; SVF was injected into the facial region of 10 patients, and nano-fat was injected into facial region of the other 10 patients. Preoperative, postoperative 1st and 3rd month skin evaluations of the patients were made with the visa skin analysis system, and dermis thicknesses were measured with high-frequency ultrasound (HFU). The data obtained prospectively were statistically analyzed.

RESULTS: In the visia skin evaluations of the patients, it was observed that SVF and nano-fat injection reduced wrinkle scores significantly (p<0.05). Also, SVF injection reduced ultraviolet (UV) damage, red area and porphyrin score significantly (p<0.05). No significant dermis change was detected in the dermis thickness measurement performed with HFU preoperatively and postoperatively.

CONCLUSION: It was observed that SVF and nano-fat injections were effective on wrinkles and both applications were valuable in anti-aging treatments. SVF application was effective in reducing UV damage, vascular pathologies and inflammation. So, it can be said that SVF applications are useful treatment methods in reducing photoaging and improving skin quality.

PMID:41811159 | DOI:10.1097/PRS.0000000000013017

Aesthet Surg J. 2026 Mar 11:sjag054. doi: 10.1093/asj/sjag054. Online ahead of print.

ABSTRACT

BACKGROUND: The most common deformity of the ear or earlobe appearing after a facelift is the pixie ear deformity.

OBJECTIVES: The purpose of this study was to devise and exercise a method to prevent ear deformity, including pixie ear, when performing a facelift and to correct it if it has already occurred.

METHODS: Extended deep-plane rhytidectomy was performed between January 2017 and May 2024, and 76 patients who had passed 12 months post-surgery were included in this study. Group 1 consisted of 40 patients, who underwent W-plasty of incision and combined Botulinum neurotoxin type A (BoNTA) injection around the incision site. Group 2 consisted of 36 patients, who underwent rotation of the lower earlobe after W-plasty of incision and combined Botulinum neurotoxin type A (BoNTA) injection around the incision site.

RESULTS: In a postoperative comparison between the two groups, Group 2 demonstrated superior outcomes over Group 1 by 8.4% on the right and 8.9% on the left, which was statistically significant (p=0.007, p=0.006).

CONCLUSIONS: Partial rotation of the earlobe is demonstrated as a practical and effective surgical approach to prevent and correct pixie ear deformity.

PMID:41810509 | DOI:10.1093/asj/sjag054

Int Immunol. 2026 Mar 10:dxag013. doi: 10.1093/intimm/dxag013. Online ahead of print.

ABSTRACT

The gut microbiome has emerged as an important environmental factor in the pathogenesis of autoimmune diseases. Advances in high-throughput sequencing technologies have enabled comprehensive characterization of the gut microbiome, providing detailed insights into its composition and functional potential. These approaches have been widely applied in autoimmune disease research, revealing disease-associated alterations in the gut microbiome of patients with conditions such as rheumatoid arthritis and systemic lupus erythematosus. In addition, microbiome sequencing data can be leveraged to investigate the gut virome, including viruses residing in the intestinal ecosystem. This review summarizes current evidence linking autoimmune diseases and the gut microbiome, with a particular focus on studies employing microbiome sequencing-based analyses.

PMID:41810506 | DOI:10.1093/intimm/dxag013

Eur J Heart Fail. 2026 Mar 11:xuag071. doi: 10.1093/ejhf/xuag071. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of β-blockers on heart failure (HF) with preserved ejection fraction (HFpEF) remains controversial. One proposed reason is the confounding influence of common comorbidities such as atrial fibrillation (AF) and ischemic heart disease (IHD), which may obscure the influence of β-blockers on HFpEF outcomes.

METHODS AND RESULTS: From the PURSUIT-HFpEF registry (UMIN000021831), patients were divided into two groups: AF/IHD (with AF and/or IHD) and non-AF/IHD (without both). Prognosis was compared between β-blocker users and non-users in each group. Inverse probability of treatment weighting (IPTW) was performed as the primary adjustment method. In AF/IHD cohort (n=687; β-blocker 361, non-β-blocker 326), outcomes did not differ for the composite endpoint, all-cause death, or HF rehospitalization. In contrast, in non-AF/IHD patients (n=537; β-blocker 203, non-β-blocker 334), β-blocker use was linked to poorer outcomes. In IPTW-weighted analyses, β-blocker use was not associated with the composite endpoint, all-cause death, or HF rehospitalization in the AF/IHD group. In contrast, among non-AF/IHD patients, β-blocker use was associated with a higher risk of all-cause death (p=0.046, hazard ratio [HR] 1.448, 95% confidence interval [CI] 1.007-2.082) and cardiac death (p=0.001, HR 2.380, 95% CI 1.406-4.027), as well as a higher risk of cardiac composite outcomes (p=0.039, HR 1.441, 95% CI 1.018-2.039). Formal interaction testing between β-blocker use and AF/IHD status was not statistically significant across endpoints.

CONCLUSIONS: In HFpEF patients without AF or IHD, β-blocker use was associated with higher mortality-related risk, indicating that routine β-blocker use in this subgroup should be interpreted with caution.

PMID:41810505 | DOI:10.1093/ejhf/xuag071

Pol Przegl Chir. 2026 Jan 21;98(1):33-36. doi: 10.5604/01.3001.0055.5840.

ABSTRACT

&lt;b&gt;Introduction:&lt;/b&gt; Trauma remains the leading cause of death in the pediatric population under 18 years of age. Non-operative management (NOM) has become the standard of care for hemodynamically stable pediatric patients with nonpenetrating abdominal injuries. &lt;br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; This study evaluates the application of the American Pediatric Surgery Association (APSA) guidelines in a pediatric trauma center in Krakow, Poland, between 2017 and 2024. &lt;br&gt;&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was conducted on 295 pediatric patients hospitalized with multi-organ injuries, including the intra-abdominal ones. The data were analyzed with respect to injury severity, hospitalization duration, and outcomes. Statistical methods included Shapiro-Wilk tests, Mann-Whitney U tests, Spearman&apos;s rho correlation, and chi-square tests. P-value of less than 0.5 was considered significant. &lt;br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Conservative treatment was effective in all implemented cases, with no complications or rehospitalizations. Hospitalization duration correlated with age and presence of central nervous system (CNS) or thoracic injuries in multi-organ injuries, but not with sex or radiological American Association for the Surgery of Trauma (AAST) organ injury scales. Within abdominal organs, liver injury had the greatest impact on hospital stay length. Surgical intervention was required only in hemodynamically unstable patients or selected high-grade pancreatic injuries. Conservative management following APSA guidelines proved to be safe and effective, though concurrent injuries often prolonged hospitalization. Hospital stay length appeared to better reflect overall trauma severity than organ-specific injury grading. Imaging included eFAST (Extended Focused Assessment with Sonography in Trauma) and contrast-enhanced computed tomography (CEST); follow-up was typically conducted with standard ultrasound. No long-term complications were reported on. &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The application of APSA guidelines in diagnostic and therapeutic management in pediatric patients with blunt abdominal trauma is safe and effective. Nonoperative management remains the gold standard for stable pediatric abdominal trauma patients. &lt;br&gt;&lt;br&gt;&lt;b&gt;Significance for the field:&lt;/b&gt; Conservative treatment of blunt abdominal injuries in children is a safe way of patient management and needs a raised awareness, especially among non-pediatric surgeons.

PMID:41810499 | DOI:10.5604/01.3001.0055.5840

Pol Przegl Chir. 2026 Feb 16;98(1):37-44. doi: 10.5604/01.3001.0055.6392.

ABSTRACT

&lt;b&gt;Introduction:&lt;/b&gt; Adolescent gynecomastia is a common benign enlargement of male breast tissue that may cause significant psychosocial distress. Persistent cases often necessitate surgical intervention. This study aimed to evaluate clinical features, surgical techniques, outcomes, complications, and patient satisfaction in adolescents undergoing gynecomastia surgery at a single center. &lt;br&gt;&lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The present study was undertaken to retrospectively analyze the clinical characteristics, surgical techniques utilized, treatment outcomes, complications, and patient satisfaction following surgical management of gynecomastia in adolescent boys treated at a single surgical center for the macro-region of western Poland between 2000 and 2025. The study also aimed to identify factors associated with treatment results to improve and individualize patient care in this population. &lt;br&gt;&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; A retrospective observational study analyzed data from 26 boys aged 10-17 years who underwent surgical treatment for unilateral or bilateral gynecomastia between 2000 and 2025 at the Clinic of Pediatric Surgery, Traumatology, and Urology, Karol Jonscher Clinical Hospital, Poznan University of Medical Sciences. Surgical management primarily involved periareolar excision of glandular tissue, with selective liposuction or skin resection based on severity. Collected data included demographics, gynecomastia laterality, operative times, histopathology, complications, and patient satisfaction (5-point Likert scale). Statistical analyses included descriptive statistics, t-tests, Mann-Whitney U tests, chi-square tests, and Spearman correlation. &lt;br&gt;&lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; Bilateral gynecomastia was predominant (77%), with a median age at surgery of 16 years. Mean operative time was longer for bilateral procedures (58.5 min) than for unilateral ones (38.3 min). Histopathology confirmed benign glandular tissue in most cases. Postoperative complications were rare (11.5% hematomas; one transfusion), and no reoperations were required. Overall satisfaction was high (median 4/5), though older adolescents reported slightly lower satisfaction (Rs = -0.395, p = 0.046). &lt;br&gt;&lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Surgical management of adolescent gynecomastia is safe, effective, and associated with high patient satisfaction. Bilateral cases require longer operative times, but complication rates remain low. Individualized preoperative planning, including weight optimization and age-appropriate counseling, enhances cosmetic and psychosocial outcomes. These results support timely surgical intervention in adolescents with persistent gynecomastia causing aesthetic or psychological concerns.

PMID:41810498 | DOI:10.5604/01.3001.0055.6392