Kreutz‐Rodrigues, Lucas

Abstract The age-related decline in tissue regenerative capacity drives demand for interventions restoring physiological repair mechanisms. Glycyl-L-histidyl-L-lysine-copper (GHK-Cu) has demonstrated significant regenerative, anti-inflammatory, and antioxidant properties in preclinical models, prompting its increasing integration into aesthetic practice despite a paucity of standardized clinical guidelines. This systematic review evaluates the efficacy, safety, and regenerative mechanisms of GHK-Cu in aesthetic medicine to clarify its clinical utility and inform future research. A systematic search of PubMed, Embase, and Cochrane CENTRAL was conducted from database inception through March 2026, following PRISMA guidelines. Eligible studies included clinical and preclinical models investigating GHK-Cu as a standalone intervention for aesthetic applications. 20 studies (18 preclinical; 2 RCTs) were included. Preclinical data consistently demonstrated that GHK-Cu enhances extracellular matrix synthesis (type I collagen and glycosaminoglycans), modulates metalloproteinase activity, and promotes angiogenesis and cellular proliferation. It also exhibited significant anti-inflammatory effects by suppressing TGF-β and IL-6. Clinically, GHK-Cu improved patient-reported satisfaction after laser resurfacing and significantly reduced wrinkle volume and depth compared with controls. Additionally, advanced delivery systems, including microneedles and liposomes, markedly improved its transdermal bioavailability and efficacy. GHK-Cu demonstrates a reasonable biological basis for use as a regenerative agent in aesthetic medicine, supported by available preclinical data. Nevertheless, the findings reported across studies were constrained by methodological variability and a limited number of well-designed clinical trials. Future research incorporating larger, controlled trials with standardized formulations, dosing regimens, and delivery methods will be necessary to close the translational gap and inform the development of consistent therapeutic protocols in clinical practice.

Abstract Carpal fractures are uncommon, representing a small proportion of hand fractures. This study aimed to determine the incidence, injury mechanisms, treatment patterns, and complication rates of carpal fractures in Olmsted County, Minnesota, United States. A retrospective review was performed using the Rochester Epidemiology Project registry to identify carpal fractures between 2013 and 2023. Fractures were confirmed by radiographs, computed tomography, or radiology reports. Demographic data, injury mechanism, fracture laterality, and fracture characteristics were recorded. A total of 699 carpal fractures were identified. Most patients were men (57%) with a mean age of 43 years. The most common fracture was the scaphoid (44%), followed by the triquetrum (31%), hamate (9%), and trapezium (3%). The overall incidence was 53.6 per 100,000 person-years. Concomitant wrist fractures occurred in 22%, and multiple ipsilateral carpal fractures in 4.6%. Patients with triquetrum fractures had the highest mean age (54 years) and low surgical rates (2%), whereas hamate and trapezoid fractures occurred at younger ages (39 and 38 years) and had the highest surgical rates (28 and 33%, respectively). The most common injury mechanism was a fall onto an outstretched hand (n = 438). Overall, 14% (n = 98) of patients underwent surgery, of whom 77% were men. The highest nonunion rate was seen in hamate fractures (10.9%), followed by scaphoid waist and proximal pole fractures (10.5%). Nonscaphoid carpal fractures occur more frequently than previously reported and demonstrate variable age distribution, treatment rates, and nonunion risks. Understanding these patterns can improve diagnosis, guide treatment planning, and inform patient expectations. IV.

ABSTRACT Background There is limited data regarding the surgical outcomes of urosymphyseal fistula (USF) repair with primary repair or autologous tissue transfer. We performed a study to compare outcomes of USF repair with primary repair, VRAM flap, and omental flap. Methods We retrospectively identified patients with a diagnosis of USF who underwent fistula decompression and urinary tract reconstruction. The minimal follow‐up was 3 months. Patients with distal urethral obstruction, radiation cystitis, or a non‐viable sphincter underwent anterior exenteration and flap transfer. Results Fifty‐six patients were included. Eleven patients underwent surgical management for USF using primary repair (19.6%), 34 had omental flap‐based reconstruction (60.8%), and a VRAM flap was used in 11 patients (19.6%). The 90‐day rate of sepsis was lower with omentum flap transposition (3%) compared with VRAM flap (27%) or primary repair (18%, p = 0.041). The rate of fistula recurrence was lower in the omentum flap group compared with USF primary repair (30%) or VRAM flap repair group (27.3%, p = 0.04). On multivariable analysis, USF repair with the omentum flap decreased the odds of fistula recurrence 90 days after surgery compared with primary repair (OR 0.012, p = 0.011) but not when compared with VRAM. Conclusion The omentum flap may offer a better safety profile in terms of decreasing the rate of early sepsis and rate of fistula recurrence for USF repair in comparison to primary repair. There is limited evidence regarding the superiority of the omentum flap to decrease the rate of late fistula recurrence when compared with the VRAM flap.

ABSTRACT Purpose There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among patients undergoing surgery for USF, comparing those treated in an early versus delayed fashion. Methods Fifty‐eight patients with diagnosis of USF and who underwent fistula decompression, pubic bone resection, and urinary tract reconstruction were included. Patients who underwent USF repair within 100 days of diagnosis were classified as having early repair, while those treated after 100 days were considered to have delayed repair. Results Thirty‐one underwent delayed USF repair (53.4%), while 27 underwent early repair (46.6%). Most patients were male (96.8%). The median age (72 years vs . 69 years, p = 0.13) and mean BMI (28.7 vs . 28.6, p = 0.97) were comparable between groups. The rate of overall 90‐day complications following USF repair was comparable between groups (77.4% vs . 63%, p = 0.228). We did not find a difference between the rates early complications among groups. The rates of long‐term recurrent pain (46.7% vs . 11.1%, p = 0.004), recurrent osteomyelitis (20% vs . 0%, p = 0.014), and fistula (23.3% vs . 3.7%, p = 0.033) were higher in the delayed USF repair group compared to the early USF repair group. The follow up time was similar between groups too (25.43‐months vs . 32.8‐months, p = 0.257). Conclusion While early USF repair might not affect the incidence of early complications within 90 days post‐surgery, it is associated with reduced rates of long‐term recurrent pain, recurrent osteomyelitis, and fistula recurrence compared to delayed USF repair.

Background: Macromastia causes significant physical and psychological distress in adolescents. Although reduction mammaplasty alleviates these symptoms, the mental health impact of macromastia in younger populations remains underexplored. This systematic review and meta-analysis aimed to evaluate mental health and quality of life outcomes in adolescents/young women undergoing reduction mammaplasty. Methods: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted from inception to September 2024. Studies reporting mental health or quality of life outcomes through the BREAST-Q, Short Form-36, Rosenberg Self-Esteem Scale, and Eating Attitudes Test were included. Odds ratios and mean difference with 95% confidence intervals were pooled using a random-effects model. Heterogeneity was assessed with I 2 statistics. The Risk of Bias in Nonrandomized Studies of Interventions tool was used to assess study quality. Meta-analysis was performed on 4 BREAST-Q domains. Results: Of 701 articles identified, 8 observational studies involving 660 patients were included. Pooled BREAST-Q scores postsurgery showed significant improvements across all 4 domains. Improvement in Short Form-36, Rosenberg Self-Esteem Scale, and Eating Attitudes Test scores was noted in individual studies, though meta-analysis was limited by incomplete data. Conclusions: These results indicate that reduction mammaplasty significantly improves the physical, psychosocial, and sexual well-being of adolescents/young women with macromastia.

Background: Massive weight loss after bariatric surgery (BS) often results in excess skin, leading to physical discomfort and impaired quality of life (QoL). Body contouring surgery (BCS) addresses these issues by restoring body image, improving function, and enhancing overall QoL, but its added value on patient-reported outcome measures (PROMs) remains underexplored. Methods: A systematic search of PubMed, Scopus, Embase, Web of Science, and Cochrane databases was conducted from inception to March of 2025. Studies comparing PROMs between patients undergoing BS alone and those undergoing BS + BCS were included. Retrieved studies were assessed using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. Outcomes were pooled using random effects models. Results: Fifteen non-randomized studies involving 7339 patients were included (BS, 4339 [59.1%]; BS + BCS, 3000 [40.9%]). Patients undergoing BS + BCS had a significantly greater percentage of total weight loss (mean difference [MD], 4.40% [95% CI, 1.69, 7.10]; P < 0.01). BODY-Q improvements favored the BS + BCS group in body image, physical, psychological, sexual, and social function (MD, 16.07 [95% CI, 12.14, 20.0]; P < 0.01). Among patients receiving only BS, those desiring BCS reported lower body satisfaction (MD, −0.40 [95% CI, −0.70, −0.10]; P < 0.01) and lower appraisal of excess skin scores (standardized MD, −1.09 [95% CI, −1.83, −0.36]; P = 0.02) than those without desire for BCS. Conclusions: BCS after BS yields substantial improvements in overall QoL. These findings highlight the importance of BCS as a fundamental element of comprehensive postbariatric care that significantly enhances long-term patient satisfaction and drives durable multidimensional recovery.

Background/Objectives: In the search for optimal meshes and matrices in breast surgery, poly-4-hydroxybutyrate (P4HB) has emerged as a promising alternative. This review evaluates the clinical application of P4HB scaffolds, focusing on complication rates and surgical outcomes. Methods: A systematic search was conducted using PubMed and ScienceDirect. Clinical studies assessing perioperative outcomes and complications associated with P4HB scaffolds in breast surgery were included. Results were stratified into aesthetic and reconstructive surgery categories. Meta-analysis was implemented to assess the rate of complications and satisfaction. Results: This systematic review included 13 studies evaluating the use of P4HB scaffold in breast reconstruction (636 cases) and aesthetic breast surgery (462 patients). Breast reconstruction studies were all retrospective, mainly reporting two-stage, prepectoral, immediate reconstructions. Aesthetic studies included both prospective and retrospective designs, with varied implant planes and incision patterns. P4HB use was associated with high satisfaction (95.5%) and favorable outcomes, including lower odds of wound complications (log-OR = −1.135, p = 0.003). Complication rates were low across both surgical categories. P4HB scaffold showed promise in supporting implant-based procedures and maintaining breast shape over time, with minimal increase in surgical time and stable anthropometric measurements. Conclusions: The use of P4HB scaffold in breast reconstruction and aesthetic surgery shows promising results, notably in reducing wound-related complications. Breast reconstruction studies report low complication rates and favorable patient-reported outcomes. In aesthetic procedures, P4HB contributes to improved long-term breast shape and high satisfaction. Despite encouraging findings, further research is necessary to validate long-term efficacy and refine surgical approaches.

Summary: Facial synkinesis manifests as involuntary muscle movements alongside volitional facial actions and is typically managed with a combination of neuromuscular retraining, botulinum toxin injections, and in some cases, selective neurectomy. Some patients with synkinesis describe persistent neck tightness or pain at the level of the mandibular angle and horizontally towards the midline, similar to the anatomic course of the posterior belly of digastric (PBD) and stylohyoid muscles. There are limited studies exploring the involvement of the PBD and stylohyoid muscles in facial synkinesis and the use of chemodenervation as treatment. Herein, we present 2 patients with facial synkinesis and ipsilateral neck tightness and pain who underwent novel surgical treatment in the form of the standard selective neurectomy procedure along with a myectomy of the PBD and stylohyoid muscles. Following completion of the standard steps of selective neurectomy, the PBD and stylohyoid muscles were carefully dissected and separated from the surrounding structures. Both muscles were divided using bipolar electrocautery. Both patients reported improvement of neck pain and tightness immediately after the intervention and at the 6.5-month follow-up visit. These preliminary results show promise in aiding a subset of patients with synkinesis-related neck pain and tightness.