In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.

Facial palsy affects millions worldwide. Botulinum toxin Type A (BoNT-A) is an established treatment for non-flaccid facial palsy, yet objective evidence remains limited. This study evaluates the effects of BoNT-A using AI-based tools and patient-reported outcome measures (PROMs). In this prospective observational study, patients with non-flaccid facial palsy received individualized BoNT-A injections. Exclusion criteria included age < 18, hypersensitivity to BoNT-A, or lack of follow-up. Assessments were conducted before and 3 weeks after treatment, including facial symmetry (Emotrics^®), emotion expression (FaceReader™), and PROMs (FaCE and FDI). Eleven patients (mean age 50.1 ± 18 years) were included. BoNT-A significantly improved dynamic facial symmetry: eyebrow raising (p = 0.032), smile angle (p = 0.005), and lower lip height (p = 0.042). Emotion analysis showed no significant changes. PROMs revealed improvements in social well-being (FDI, p = 0.004) and aesthetic satisfaction (FaCE, p = 0.035), while functional FDI scores remained unchanged (p = 0.406). BoNT-A improves objective symmetry and patient satisfaction in non-flaccid facial palsy. The lack of change in emotional expression may reflect improved symmetry at the cost of dynamic muscle activation.

Reconstruction of large craniofacial bone defects typically relies on vascularized autografts, but involves donor-site morbidity and limited availability. Tissue-engineered vascularized grafts could address this gap; however, current strategies remain limited by in vitro cell manipulation, regulatory complexity, high costs, and difficult clinical scaling up t. We previously prefabricated a maxillary graft combining devitalized bone matrix (DBM), freshly-isolated human adipose-derived cells, known as the stromal vascular fraction (SVF), and Bone Morphogenetic protein-2 (BMP-2). We tested if cells were essential by developing a cell-free approach with only DBM (SmartBone) and BMP-2. SmartBone blocks were loaded with BMP-2 (60 µg/mL in a fibrin hydrogel) with or without SVF cells and implanted subcutaneously in nude mice for 12 weeks (ectopic model) or combined to an axial arteriovenous (AV) bundle in nude rats (785 mm³) for 2 or 12 weeks (vascularized model). Bone formation was assessed by X-ray tomography and histology. Across both mice and rats, BMP-2 alone was sufficient to generate robust and organized bone, and adding SVF cells provided no additional benefit. In mice, BMP-2 grafts formed lamellar bone with marrow, while grafts without BMP-2 produced only calcified fibrous tissue. Bone and marrow volumes did not differ between BMP-2 and BMP-2+SVF groups (p>0.05). In rats, both conditions showed significant increases in mineralized volume from 2 to 12 weeks (p<0.05). In conclusion, BMP-2 combined to DBM is enough to robustly generate vascularized bone grafts while using off-the-shelf, approved materials and microsurgical prefabrication, providing a simplified, translationally-feasible approach for reconstruction of large bone defects.

Reconstruction of large craniofacial bone defects typically relies on vascularized autografts, but involves donor-site morbidity and limited availability. Tissue-engineered vascularized grafts could address this gap; however, current strategies remain limited by in vitro cell manipulation, regulatory complexity, high costs, and difficult clinical scaling up. We previously prefabricated a maxillary graft combining a devitalized bone matrix (DBM), freshly isolated human adipose-derived cells, known as the stromal vascular fraction (SVF), and Bone Morphogenetic protein-2 (BMP-2). Here, we tested if cells were essential by developing a cell-free approach with only DBM (SmartBone) and BMP-2. SmartBone blocks were loaded with BMP-2 (60 µg/mL in a fibrin hydrogel) with or without SVF cells and implanted subcutaneously in nude mice for 12 weeks (ectopic model) or combined to an axial arteriovenous (AV) bundle in nude rats (785 mm³) for 2 or 12 weeks (vascularized model). Bone formation was assessed by X-ray tomography and histology. Across both mice and rats, BMP-2 alone was sufficient to generate robust and organized bone, and adding SVF cells provided no additional benefit at this BMP-2 dosage. In mice, BMP-2 grafts formed lamellar bone with marrow, while grafts without BMP-2 produced only calcified fibrous tissue. Bone and marrow volumes did not differ between BMP-2 and BMP-2 + SVF groups (p > 0.05). In rats, both conditions showed significant increases in mineralized volume from 2 to 12 weeks (p < 0.05). In conclusion, the dose of BMP-2 tested here, combined with DBM, is enough to robustly generate pedicled bone grafts while using off-the-shelf, approved materials and microsurgical prefabrication, providing a simplified, translationally feasible approach for the reconstruction of large bone defects.