Complex wounds pose a significant healthcare challenge due to their susceptibility to infections and delayed healing. This study focuses on developing electrospun polycaprolactone (PCL) nanofiber membranes coated with Type I collagen derived from bovine skin and functionalized with silver nanoparticles (AgNPs) to address these issues. The collagen coating enhances biocompatibility, while AgNPs synthesized through chemical reduction with sodium citrate provide broad-spectrum antimicrobial properties. The physical properties of the membranes were characterized using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Results showed the formation of nanofibers without defects and the uniform distribution of AgNPs. A swelling test and contact angle measurements confirmed that the membranes provided an optimal environment for wound healing. In vitro biological assays with murine 3T3 fibroblasts revealed statistically significant (p ≤ 0.05) differences in cell viability among the membranes at 24 h (p = 0.0002) and 72 h (p = 0.022), demonstrating the biocompatibility of collagen-coated membranes and the minimal cytotoxicity of AgNPs. Antibacterial efficacy was evaluated against Staphylococcus aureus (SA), Pseudomonas aeruginosa (PA), and Vancomycin-resistant Enterococcus (VRE), with the significant inhibition of biofilm formation observed for VRE (p = 0.006). Overall, this novel combination of collagen-coated electrospun PCL nanofibers with AgNPs offers a promising strategy for advanced wound dressings, providing antimicrobial benefits. Future in vivo studies are warranted to further validate its clinical and regenerative potential.

Introduction: Basal cell carcinoma (BCC) is the most common type of skin cancer globally, with its prevalence increasing due to chronic ultraviolet (UV) radiation exposure. Although surgical excision remains the cornerstone of treatment, achieving optimal outcomes requires a careful balance between complete tumor removal and the preservation of cosmetic appearance. Objective: This study aims to investigate the relationship between excision margins, reoperation rates, and BCC recurrence through a retrospective analysis of 3036 surgical excisions. Methods: Conducted at the Department of Plastic Surgery in Trieste, Italy, this study includes data from 2037 patients treated between 2014 and 2018. Excision procedures adhered to standardized hospital protocols. Tumor characteristics, excision margins, and involved anatomical sites were analyzed. Results: The study demonstrated an equal gender distribution (51.02% women), with the nodular subtype (45.85%) being the most common. The head was the most frequently affected site (54.74%). A complete excision rate of 93.3% was achieved, but incomplete excisions were more common in head and neck locations and certain histological subtypes. Surgical reinterventions were primarily performed for high-risk BCCs, significantly reducing recurrence rates (0.52%). Conclusion: Reoperation, especially for high-risk BCCs, should be prioritized over conservative management to minimize recurrence. Narrow excision margins were associated with higher recurrence rates, highlighting the importance of adequate margin clearance. This study enhances understanding of the complex interplay between excision techniques, reoperation, and long-term outcomes in BCC management.

Orthoplastic surgery, which combines orthopedic and plastic surgery principles, plays a crucial role in the treatment of open fractures of the lower limb. Clinical Practice Guidelines (CPGs) are valuable tools for standardizing and improving patient care. To assess the availability and quality of international CPGs for orthoplastic treatment of open fractures of the lower limb. A secondary objective was to provide a detailed analysis of the specific recommendations by comparing them among different CPGs. A systematic review was conducted in 2023 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines across major medical databases and gray literature. Inclusion criteria focused on guidelines specific to orthoplastic surgery for lower limb open fractures. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, a widely accepted instrument for guideline assessment, was utilized to evaluate the methodological rigor and transparency of the selected guidelines. Three orthoplasty CPGs have been identified, 2 of which were judged reliable according to the AGREE II methodology. Orthoplastic recommendations are no more than 7 per CPG. Consistent agreement was observed on the timing of debridement, the importance of early fixation, and definitive coverage. CPGs are critical to set up clinical pathways that are safe and evidence-based. Only 3 international CPGs address orthoplastic treatment of open lower limb fractures, 2 of which are judged reliable according to methodology. Therefore, it becomes essential to develop and disseminate high-quality, evidence-based guidelines, which are critical to improving patient outcomes and standardizing clinical practice worldwide.

Cutaneous Scedosporium infection represents an extremely rare opportunistic fungal complication in solid-organ transplant recipients, often mimicking post-transplant skin malignancies due to chronic immunosuppression. A 75-year-old woman, kidney transplanted in 2022 for IgA nephropathy on tacrolimus, mycophenolate, and prednisone, developed progressive firm nodular lesions on the left lower limb over two months. Punch biopsy revealed granulomatous inflammation with septate hyphae on Gomori-Grocott stain; culture confirmed Scedosporium spp. CT excluded dissemination. Voriconazole (6 mg/kg loading dose, then 4 mg/kg maintenance dose) combined with surgical debridement, negative-pressure wound therapy, and skin grafting achieved complete healing at three months, with no recurrence at 12 months. Early biopsy is crucial to differentiate this rare entity from squamous cell carcinoma, enabling multidisciplinary success.

Chronic and complex wounds require biomaterials that are both cytocompatible and antimicrobial. Herein, electrospun polycaprolactone (PCL) nanofiber membranes were coated with Type I collagen and functionalized with silver nanoparticles (AgNPs). The main objective was to assess fibroblast adhesion, proliferation, and cytotoxicity. Membrane morphology and surface characteristics were analyzed in a previous work by SEM, AFM, and wettability measurements, confirming the transformation from hydrophobic PCL to fully wettable collagen-coated surfaces. In this study, Murine 3T3 fibroblasts were cultured on PCL, PCL–Collagen, PCL–Collagen–Citrate, and PCL–Collagen–AgNPs membranes. Cellular activity was quantified using Alamar Blue assays at 24, 48, and 72 h, while cytotoxicity was determined by LDH release. Cellular viability and adhesion were studied using confocal microscopy. All membrane types supported fibroblast growth, with collagen-coated samples exhibiting the highest metabolic activity. AgNPs-functionalized membranes sustained overall cell viability above 90%, with cytotoxicity values of approximately 10% at 24 h and 20% at 48 h. Antimicrobial evaluations demonstrated complete inhibition of Pseudomonas aeruginosa and vancomycin-resistant Enterococcus, and partial inhibition of Staphylococcus aureus. These results indicate that collagen-coated, AgNPs-functionalized electrospun PCL membranes exhibit both high cytocompatibility and significant antimicrobial activity, supporting their potential as advanced wound-dressing materials.

The face occupies a central place in human experience. It represents the primary medium of interpersonal communication and a fundamental component of individual identity, conveying emotions, intentions, and social cues. At the same time, it is one of the anatomical regions most frequently affected by cutaneous malignancies, often necessitating surgical excision followed by reconstruction 1 . The dual functional and symbolic value of the face makes any therapeutic intervention particularly delicate, as surgical treatment inevitably extends beyond the mere removal of disease and may significantly influence a patient's appearance, self-perception, and quality of life 2 . For these reasons, considerable efforts have been devoted over the years to refining reconstructive strategies capable of achieving optimal oncologic control while preserving form and function.Techniques have evolved from secondary intention healing and skin grafting to increasingly sophisticated local and microsurgical flaps, allowing tailored solutions based on defect size, depth, and anatomical subunit.A similar degree of attention has characterized the management of aesthetic concerns and agerelated changes of the face, including tissue ptosis, volume depletion of facial fat compartments, blepharochalasis, and alterations in skin quality. Advances in surgical expertise and technological innovation have led to highly specialized and progressively less invasive procedures, such as endoscopic approaches in forehead lifting, as well as a growing integration of regenerative techniques and energy-based devices. 3 The aim of this Research Topic is therefore to provide a comprehensive overview of current standards and emerging perspectives in facial treatment, encompassing reconstructive and aesthetic surgery alongside regenerative medicine and minimally invasive or non-invasive therapies.The collection brings together ten contributions addressing these diverse yet interconnected themes, offering updated insights and novel viewpoints in the management of facial pathologies and aesthetic subunits.In the work of Chen et al., for example, the use of CO2 lasers was analyzed in comparison with standard surgical treatment for basal cell carcinoma: the use of this less invasive technique achieved comparable efficacy with reduced complication rates., while Brambullo et al. introduced a modification of the traditional forehead flap, known as the "dragonfly" technique. This variant enables the simultaneous reconstruction of both the internal and external nasal layers using a single vascular pedicle, thus allowing for total nasal restoration in a single stage.Other works emphasize the importance of evaluating outcomes beyond purely technical success. In conclusion, the contributions gathered within this Research Topic address several fundamental dimensions of facial surgery, spanning oncologic management, reconstructive strategies, aesthetic refinement, technical surgical considerations, and the psychological implications that inevitably accompany interventions in the cephalic region. Although often analyzed separately for methodological clarity, these domains are deeply interdependent in clinical practice. The treatment of facial conditions, whether driven by malignancy, trauma, congenital anomalies, or elective aesthetic indications, rarely allows for a compartmentalized approach, as each intervention carries functional, morphological, and emotional consequences. Across all included works, a recurring message emerges: successful facial treatment requires a careful balance between oncologic radicality, reconstructive foresight, aesthetic harmony, and psychosocial awareness. The face is not merely an anatomical district but the core of individual identity and social interaction, and this complexity must guide every therapeutic decision.Nevertheless, several challenges remain. The need for standardized and validated outcome measures that integrate functional, aesthetic, and psychological parameters is increasingly evident.Long-term prospective data are still limited for many minimally invasive and regenerative approaches. Moreover, the integration of predictive models and individualized risk assessment tools into routine practice represents an important future direction, particularly in rhinoplasty and reconstructive planning. Finally, strengthening multidisciplinary collaboration between surgeons, dermatologists, oncologists, and mental health professionals will be essential to ensure truly patientcentered care.