Peripheral nerve injury disrupts the function of the peripheral nervous system, leading to sensory, motor, and autonomic deficits. While peripheral nerves possess an intrinsic regenerative capacity, complete sensory and motor recovery remains challenging due to the unpredictable nature of the healing process, which is influenced by the extent of the injury, age, and timely intervention. Recent advances in microsurgical techniques, imaging technologies, and a deeper understanding of nerve microanatomy have enhanced functional outcomes in nerve repair. Nerve injury initiates complex pathophysiological responses, including Wallerian degeneration, macrophage activation, Schwann cell dedifferentiation, and axonal sprouting. Complete nerve disruptions require surgical intervention to restore nerve continuity and function. Direct nerve repair is the gold standard for clean transections with minimal nerve gaps. However, in cases with larger nerve gaps or when direct repair is not feasible, alternatives such as autologous nerve grafting, vascularized nerve grafts, nerve conduits, allografts, and nerve transfers may be employed. Autologous nerve grafts provide excellent biocompatibility but are limited by donor site morbidity and availability. Vascularized grafts are used for large nerve gaps and poorly vascularized recipient beds, while nerve conduits serve as a promising solution for smaller gaps. Nerve transfers are utilized when neither direct repair nor grafting is possible, often involving re-routing intact regional nerves to restore function. Nerve conduits play a pivotal role in nerve regeneration by bridging nerve gaps, with significant advancements made in material composition and design. Emerging trends in nerve regeneration include the use of 3D bioprinting for personalized conduits, gene therapy for targeted growth factor delivery, and nanotechnology for nanofiber-based conduits and stem cell therapy. Advancements in molecular sciences have provided critical insights into the cellular and biochemical mechanisms underlying nerve repair, leading to targeted therapies that enhance axonal regeneration, remyelination, and functional recovery in peripheral nerve injuries. This review explores the current strategies for the therapeutic management of peripheral nerve injuries, highlighting their indications, benefits, and limitations, while emphasizing the need for tailored approaches based on injury severity and patient factors.

Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients’ long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients.

Recent advancements in acute burn wound therapy are transforming the management of burn injuries, with a focus on improving healing times, graft integration, and minimizing complications. However, current clinical treatments face significant challenges, including the difficulty of accurately assessing wound depth and tissue viability, which can lead to suboptimal treatment planning. Traditional closure methods often struggle with issues such as delayed wound closure, limited graft survival, inadequate tissue regeneration, and insufficient vascularization. Furthermore, managing infection and minimizing scarring remain persistent obstacles, impacting functional recovery and aesthetic outcomes. Key areas of innovation include advanced imaging techniques that enable more precise assessment of wound depth, size, and tissue viability, allowing for more accurate treatment planning. In addition, new closure strategies are being developed to accelerate wound closure, enhance graft survival, and address challenges such as tissue regeneration, vascularization, and infection prevention. These strategies aim to optimize both functional recovery and aesthetic outcomes, reducing scarring and improving the quality of life for burn patients. While promising, these emerging techniques require further research and clinical validation to refine their effectiveness and expand their accessibility. Together, these innovations represent a significant shift in acute burn care, offering the potential for more personalized, efficient, and effective treatments.

Background: The development of microsurgical techniques has enabled reconstructive versatility in various clinical scenarios. Supermicrosurgery is an advanced microsurgical technique ensuring precise reconstructions by operating on small-caliber vessels and nerves, with applications in reconstructive surgeries. Objectives: This study aims to compare the effectiveness of four low-cost training models, thereby improving surgical precision and reducing the learning curve for novice surgeons. Materials and Methods: We conducted a prospective non-randomized study comparing the classic anastomosis technique, the intravascular stenting (IVaS) technique, the color contrast (CC) technique, and our newly introduced double-contrast (DC) technique, which combines IVaS with CC. We used a non-living experimental model represented by chicken wings, analyzing the vessel preparation and anastomosis time, anastomosis patency, and back wall biting through a standardized protocol. We performed 120 end-to-end anastomoses in total, with vessel diameters ranging from 0.5 to 0.8 mm. Results: CC demonstrated superior time efficiency and success rates, reaffirming it as a reliable option in supermicrosurgery, while DC showed slightly better time efficiency and patency compared to both IVaS alone and the classic method. CC outperformed the others in anastomosis time, patency, and back wall catching, reaffirming its reliability in supermicrosurgery. Conclusions: Although DC did not significantly improve patency, it reduced back wall engagement. This makes the DC technique beneficial for trainees working on vessels under 0.5 mm in diameter, where stenting is often required, improving surgical precision and reducing the learning curve, leading to better outcomes in supermicrosurgery.

Background: Microsurgery is a demanding surgical field requiring precision and extensive training. There is a continued need for standardized training models to improve skill acquisition and efficiency in microvascular anastomosis. Objectives: This study aimed to assess whether a standardized microsurgery training protocol, focusing on technique-specific objectives, improves performance among beginner trainees. Material and Methods: A three-month, non-randomized cohort study was conducted with entry-level plastic surgery residents. Participants were assigned to either a control group, practicing without structured guidance, or a test group, using a predefined microsurgery curriculum. Skill performance was measured at baseline, three weeks, and three months using a modified University of Western Ontario Microsurgical Skills Assessment (UWOMSA) tool. Results: While both groups improved over time, the test group demonstrated significantly greater improvement at the three-month mark (mean score: 59 vs. 38; p = 0.00027). The structured training model promoted more consistent progress and superior microsurgical technique. Conclusions: A standardized training protocol significantly enhances microsurgical proficiency over time. These findings suggest value in structured, low-cost training models for microsurgical education. Limitations include the small sample size, use of non-living models, and a non-randomized design.

Migraine is a prevalent and disabling neurological disorder with multifactorial origins and complex clinical manifestations. While pharmacologic therapies remain the cornerstone of management, a growing body of evidence highlights the role of extracranial peripheral nerve compression as a significant contributor to migraine pathophysiology in selected patients. This recognition has expanded the therapeutic role of plastic surgery, offering anatomically targeted interventions that complement or surpass traditional medical approaches for refractory cases. From a plastic surgeon’s perspective, optimal migraine care begins with accurate identification of clinical patterns, trigger-site mapping, and the judicious use of diagnostic tools such as nerve blocks and botulinum toxin. Surgical decompression techniques, including endoscopic and open approaches, address compression of the supraorbital, supratrochlear, zygomaticotemporal, greater and lesser occipital, auriculotemporal, and intranasal contact-point trigger sites. Adjunctive strategies such as autologous fat grafting further enhance outcomes by providing neuroprotective cushioning and modulating local inflammation through adipose-derived stem cell activity. Recent advances, including neuromodulation technologies, next-generation biologics, and innovations in surgical visualization, underscore the ongoing shift toward precision-based, mechanism-driven therapy. As understanding of migraine heterogeneity deepens, the integration of surgical expertise with modern neuroscience offers a comprehensive and personalized therapeutic framework. Plastic surgeons, equipped with detailed knowledge of peripheral nerve anatomy and minimally invasive techniques, play an increasingly pivotal role in the multidisciplinary management of refractory migraine.