Wan, Rou

Fibrous dysplasia (FD) is a benign bone neoplasm often considered a disease of childhood, with existing literature suggesting lesions typically become quiescent by young adulthood. Consequently, the presentations and surgical outcomes of adult patients remain poorly characterized. This retrospective review analyzed 50 adult patients treated surgically for craniofacial FD at a single institution between 1988 and 2024 to evaluate patterns of presentation, operative indications, and long-term outcomes. The cohort (54.0% male) had a mean follow-up of 15.8 years. Polyostotic involvement was present in 60.0% of patients, and the frontal bone was most affected (51.2%). The median age at presentation was 31 years, and the median age at initial surgery was 34.5 years. The most common surgical indications were visible growth (30.5%) and pain or headache (27.1%). Of the 59 surgeries performed to directly treat FD, bone contouring only was the most common initial operative approach (n=42), followed by en bloc resection and reconstruction (n=7). However, 12% of patients undergoing initial contouring required additional operations for continued growth. All secondary deformities requiring corrective surgery were ocular. In addition, several patients demonstrated delayed recurrence or progression decades after primary surgical intervention. These findings suggest that craniofacial FD may remain symptomatic or continue to progress into adulthood, challenging the traditional paradigm that these lesions necessarily become quiescent after skeletal maturity and highlighting the importance of long-term surveillance in the adult population.

Objective To evaluate cancer risk in individuals with cleft lip and/or cleft palate (CL/P). Design Retrospective chart review of patients with CL/P, including abstraction of information on cancer diagnoses was conducted. Cancer risk was compared with national population-based estimates using standardized incidence ratios (SIRs) and exact binomial tests. Subgroup analyses compared demographic and clinical characteristics between patients with and without cancer. Setting Study was performed at a single tertiary academic center with multidisciplinary surgical, pediatric, and genetic care. Patients/Participants Total of 2121 patients with CL/P from 1970 to 2024 with complete medical documentation were included. Main Outcome Measures Main outcomes included prevalence of cancer diagnoses, childhood cancer incidence, and differences in cancer occurrence by age, cleft type, syndromic status, and family history. Results Total of 144 patients (6.8%) had pathologically confirmed cancer diagnoses. Twelve childhood cancers were identified, with 10 cases presenting before age 15. Children younger than 15 with CL/P had a significantly elevated cancer risk (SIR 4.7; 95% confidence interval: 1.8-7.6; P < .00001). Pediatric cancers occurred mainly in syndromic cases. Cancer prevalence was higher in cleft palate only and cleft lip/palate cases compared with cleft lip only ( P < .05). Cancer occurrence was not higher in adults with CL/P compared to the general population. Conclusions Cancer risk is not uniformly elevated over the lifespan in individuals with CL/P. Increased cancer risk is observed in our pediatric cohort. Clinical care should include careful assessment of childhood cancers, syndromic features, and family history, with consideration for genetic counseling and multidisciplinary follow-up.

Chronic wounds remain a major unmet clinical challenge, often failing to progress to normal healing due to persistent inflammation, impaired angiogenesis, and cellular senescence. Exosomes have recently been investigated as promising acellular therapeutics capable of restoring intercellular communication and promoting tissue regeneration. Among these, the Purified Exosome Product (PEP) represents a next-generation, platelet-derived exosome formulation manufactured under Good Manufacturing Practice (GMP) conditions with high purity, stability, and reproducibility. This review summarizes the current advances in exosome-based chronic wound therapeutics and PEP delivery systems and their translational potentials. Incorporation of PEP into bioengineered carriers such as fibrin sealant, collagen scaffolds, and hyaluronic acid (HA) hydrogels enables localized and sustained exosome release, significantly prolonging therapeutic effects and improving regenerative outcomes. Fibrin-based PEP delivery achieved complete wound closure and functional skin regeneration in animal models, while collagen and HA-based systems showed promising results for injectable and dermatologic applications. Beyond its intrinsic healing effects, PEP may also serve as a nanocarrier for other drugs, offering a future direction in chronic wound management.

Background: Rupture at tendon repair sites in animal models impedes the study of healing. To address this, we investigated “safe incisions” – strategic partial transections to prevent rupture under excessive force. We hypothesized these would act as mechanical “fuses,” reducing repair site tension. Objectives: This in vitro biomechanical study optimized safe incision spacing to enhance tendon construct strength and minimize gap formation in a turkey flexor tendon model. Materials and Methods: Forty turkey flexor tendons were divided into five groups ( n = 8): Repaired without incisions, intact with 5 mm incisions, repaired with 5 mm incisions, intact with 10 mm incisions, and repaired with 10 mm incisions. Repairs used a modified Pennington suture. Safe incisions (opposing hemi-transections) with 5 mm or 10 mm longitudinal spacing were created proximally. Tendons were tested to failure at 1 mm/s, recording force-elongation, failure mode, gap formation (>2 mm at 10% strain), stiffness, and repair site elongation. Results: Repaired tendons without incisions (Group 1) showed 100% repair site failure (46.5 ± 10.96 N). With 5 mm safe incisions (Group 3), no repair site failures occurred (incision failure at 18.11 ± 10.96 N). 10 mm incisions (Group 5) offered partial protection (25% repair failure at 37.48 ± 11.35 N). Group 1 had higher gap formation (75% vs. 0% in Group 3, P < 0.01), stiffness, and repair site elongation than Groups 3 and 5. Gap formation force was similar for Group 1 (25.76 ± 9.18 N) and Group 5 (25.04 ± 12.21 N). Conclusions: In this in vitro model, 5 mm spaced safe incisions effectively shifted failure away from the repair and limited gap formation by reducing stiffness. 10 mm incisions provided partial protection. Strategically placed safe incisions show potential to protect tendon repairs from immediate rupture by enabling controlled lengthening at a weaker site. However, tendinopathy risk and clinical relevance require in vivo studies.

ABSTRACT Calcific tendinopathy is a common musculoskeletal disorder marked by calcium deposition within tendons, often accompanied by pain, impaired mobility, and in severe cases, ossification. However, the mechanisms underlying tendon mineralization remain poorly understood. In contrast to pathological human calcification, turkeys naturally develop tendon mineralization during growth without signs of inflammation or ossification. This study had two phases: an observational phase to assess onset and progression of calcification, and an interventional phase to evaluate the role of mechanical loading. In the observational phase, flexor tendons were collected from turkeys aged 1–16 weeks in a serial sacrifice study and analyzed by Von Kossa staining and biomechanical testing. Calcification began at 7 weeks, localized within organized collagen matrices, progressed through Weeks 8–14, and peaked by 16 weeks. In the interventional phase, nine female turkeys were randomized at 4 weeks into a transection group ( n = 3), sham group ( n = 3), and control group ( n = 3). Transection at the muscle–tendon junction eliminated mechanical loading. At 16 weeks, tendons were analyzed by histology, quantitative RT‐PCR, ICP‐MS, and biomechanical testing. Transected tendons showed a near‐complete absence of mineralization, reduced expression of osteogenic markers (osteopontin, osteocalcin, Runx‐2), and significantly lower calcium, magnesium, and phosphorus levels. Biomechanical testing indicated reduced stress relaxation, stiffness, and Young's modulus in the transected group. Tendon calcification in turkeys functioned as a mechanically regulated, nonpathological process. The study established a relevant model for early tendon mineralization and offered a basis for developing load‐dependent therapies for human tendon disease.

Abstract Column-type wrists, which exhibit increased scaphoid flexion during radial deviation, often experience greater loss of motion after periscaphoid arthrodesis compared with row-type wrists. Dynamic radiographic series are typically used to differentiate these kinematic patterns. In this study, we evaluate capitate morphology as a means of predicting column- or row-type carpal kinematics. This study investigated whether wrist kinematic patterns could be predicted using simple anteroposterior (AP) radiographs. We hypothesized that capitate morphology, given its close articulation with the scaphoid, influences these patterns. We analyzed 75 wrist motion radiographic series from 45 patients. Capitates were classified as either Type I (rectangular) or Type II (pentagonal) based on their shape. Wrist kinematic patterns were categorized as row- or column-type based on the degree of scaphoid length shortening during radial deviation. Our analysis revealed that a Type II capitate was a significant predictor of column-type wrists, with an odds ratio of 6.01 compared with Type I (p = 0.014). Furthermore, Type II capitates were associated with increased scaphoid flexion and reduced translation. Capitate morphology, as assessed from a plain AP radiograph, can serve as an easily accessible marker and reliable predictor of wrist motion patterns. This could potentially aid in surgical planning and patient counseling, particularly when dynamic radiographic series are not feasible. Diagnostic, Level III.

Introduction: This study investigated the association between capitate morphology and the success rates of non-vascularized bone graft (NVBG) and vascularized bone graft (VBG) operations for scaphoid nonunion. Methods: We retrospectively analysed 213 patients with established scaphoid non-union who underwent either non-vascularized bone graft ( n = 75) or vascularized bone graft ( n = 138). We analysed risk factors, including demographics, medical history, implant type, previous surgery, bone graft donor site and capitate morphology for their association with treatment outcome. We also assessed the relationship between capitate and scaphoid morphology in the uninjured wrists of 31 patients. Results: The overall success rate was 81% for NVBG and 86% for VBG, with no significant difference. For NVBG, Type II capitate, age 40 or older and tobacco use were significant risk factors for failure. For VBG, only previous surgery was a significant risk factor. In uninjured wrists, a Type II capitate was associated with a significantly thinner scaphoid waist and a lower waist index than a Type I capitate. Conclusion: Our study introduces a new radiographic classification of capitate morphology and establishes its significant association with scaphoid morphology. Beyond traditional factors, capitate morphology can help to assess scaphoid morphology and potentially infer vascularity, aiding the selection of the most appropriate bone graft type for treating scaphoid non-union. Level of evidence: III

Abstract Preiser's disease (PD), or idiopathic avascular necrosis of the scaphoid, is a debilitating condition leading to wrist pain, dysfunction, and pan-carpal arthritis. While impaired scaphoid vascularity is central to its pathogenesis, identifying individuals at risk is challenging due to the morphological distortion of the scaphoid as the disease progresses. This study aims to investigate the association between a novel capitate morphology classification, scaphoid morphology, and their impact on PD prevalence and characteristics. We also re-evaluate negative ulnar variance (NUV) as a potential risk factor for PD. This retrospective case–control study included 34 PD patients and 340 age-matched controls. Capitate morphology was classified into Type I/II on anteroposterior (AP) radiographs based on capitotrapezoid–scaphocapitate (CT–SC) joint line angle and ratio. Scaphoid morphology was assessed via the waist index on contralateral healthy wrists. Radiographic measurements of ulnar variance and PD staging were also performed. Statistical analyses compared morphological prevalence and risk factors between groups. Type II capitate was significantly more prevalent in the PD group (35.3%) than in controls (17.1%, p = 0.018). Similarly, NUV was significantly higher in PD patients (29%) compared with controls (6.8%, p < 0.001). We found a strong correlation between Type II capitate and slender (Type II) scaphoid morphology in healthy wrists. No significant differences in age, gender, or affected side were observed. Interobserver and intraobserver agreements for capitate classification were substantial (kappa ≥0.882). Our study introduces a reliable radiographic method for classifying capitate morphology, which strongly correlates with intrinsic scaphoid shape and potential vascular vulnerability. Both Type II capitate morphology and NUV are significant predisposing factors for PD. These findings offer valuable insights for identifying at-risk individuals and improving understanding of PD's multifactorial etiology. Diagnostic Level III.

Background: Inappropriate facial scarring can lead to significant physical and psychosocial morbidity. There is a need to better understand how scar perception varies across ethnic groups, and how it impacts broader quality-of-life domains such as career and sexual well-being. This study evaluates White and Asian patients’ perceptions of facial scars related to symptoms, appearance, psychosocial health, and career/sexual well-being. Methods: Facial surgery patients from 5 providers were recruited to complete the SCAR-Q and Career/Sexual Well-Being (CS) scales through phone or email. Higher scores on both assessments indicate more positive patient perceptions. Results: Among the 147 respondents, 50.3% were Asian and 49.7% were White. Procedures included blepharoplasty (n=56), rhinoplasty (n=20), eyelid revision (n=19), facelift (n=18), Mohs surgery (n=7), chin augmentation (n=6), craniotomy (n=6), and other facial procedures (n=16). White patients scored significantly higher than Asian patients on the SCAR-Q total (median=260 versus 234), appearance (76 versus 59), psychosocial (100 versus 87), and CS (16 versus 12.5) scales ( P =0.004, P <0.001, P =0.026, and P <0.001, respectively). Symptom scores positively correlated with time since surgery in both groups (Asian: r =0.326, P =0.004; White: r =0.319, P =0.011). Conclusions: Asian patients reported more negative perceptions of scar appearance, symptoms, psychosocial impact, and career/sexual well-being than White patients. These findings underscore the importance of tailored follow-up care and counseling to address ethnic differences in scar perception and quality-of-life outcomes.

Objective This study aimed to identify specific causes, clinical features, and contributing factors associated with early childhood mortality in a vulnerable subset of patients with cleft lip and/or palate (CL/P) who did not survive to undergo surgical repair. Design This was a retrospective chart review study. Setting The study was conducted at a single tertiary medical center. Patients/Participants We identified 26 liveborn CL/P patients who died without cleft repair from 1970 to 2024. Their data was compared to a control group of 2070 surgically repaired CL/P patients from the same institution. Main Outcome Measures Our primary goal was to characterize the clinical profile of patients experiencing prerepair mortality. Secondary outcomes included identifying causes of death, maternal and prenatal risk factors, and comparing these findings with the surgically repaired patients. Results All 26 unrepaired patients (100%) had genetic syndromes or isolated severe congenital anomalies, a significant difference compared to 24% in the surgically repaired group ( P < .0001). Trisomy 13 (30.8%), holoprosencephaly (23.1%), congenital cardiac defects (11.5%), and trisomy 18 (11.5%) were the leading causes of death. The median age at death for unrepaired patients was 25 days (interquartile range 4-125 days), significantly lower than the 61.9 years in the control group ( P < .0001). Multivariable logistic regression showed that genetic syndromes or severe congenital anomalies were strongly associated with early mortality ( P < .0001). Notably, all unrepaired patients who were born in the United States after 2005 had accurate prenatal diagnoses, which allowed clinical planning before the patients were born. Conclusions Prerepair mortality in CL/P is significantly driven by underlying genetic syndromes or congenital anomalies. For surgeons, this highlights the importance of genetic testing and prenatal care to guide appropriate surgical management. Considering a wait in surgical intervention until patients are approximately 4 months old may allow for better survival assessment and informed decisions for these high-risk individuals.