Background/Objectives: Digital twin technology, initially developed for engineering and manufacturing, has entered healthcare. In plastic surgery, digital twins (DTs) have the potential to enhance surgical precision, personalise treatment plans, and improve patient outcomes. This systematic review aims to explore the current use of DTs in plastic surgery and evaluate their effectiveness, challenges, and future potential. Methods: A systematic review was conducted by searching PubMed, Scopus, Web of Science, and Embase databases from their infinity to October 2024. The search included terms related to digital twins and plastic surgery. Studies were included if they focused on applying DTs in reconstructive or cosmetic plastic surgery. Data extraction focused on study characteristics, technological aspects, outcomes, and limitations. Results: After 110 studies were selected for screening, 9 studies met the inclusion criteria, covering various areas of plastic surgery, such as breast reconstruction, craniofacial surgery, and microsurgery. DTs were primarily used in preoperative planning and intraoperative guidance, with reported improvements in surgical precision, complication rates, and patient satisfaction. However, challenges such as high costs, technical complexity, and the need for advanced imaging and computational tools were frequently noted. Limited research exists on using DTs in postoperative care and real-time monitoring. Conclusions: This systematic review highlights the potential of digital twins to revolutionise plastic surgery by providing personalised and precise surgical approaches. However, barriers such as cost, complexity, and ethical concerns must be addressed. Future research should focus on validating clinical outcomes through large-scale studies and developing soft tissue modelling and real-time monitoring capabilities.

Objectives: Abdominal aortic aneurysm (AAA) is often fatal when ruptured, and current guidelines suggest surgical management at suprathreshold sizes (50 mm for women or 55 mm for men) or with rapid expansion (>5 mm/year). Many medical therapies have been assessed for reducing subthreshold AAA expansion, though the evidence remains inconclusive. This network meta-analysis (NMA) compares AAA growth and mortality amongst medical treatments for AAAs. Methods: MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library databases were searched for relevant randomized controlled trials (RCTs) from database inception to 2024. Outcomes assessed included AAA growth rate, rate of referral for aneurysm surgery, overall mortality, and discontinuation from adverse effects. Data were analysed using R software, and P-score were used to rank different treatments. The GRADE framework was performed to assess the quality of evidence. Results: Thirteen RCTs comprising 3084 patients were included in this NMA. Abdominal aortic aneurysm diameters ranged from 3.1 to 4.6 cm in the intervention group and 3.5-4.5 cm in the placebo group. Study-level mean annual growth rate ranged from 1.2 to 2.8 mm/year in the intervention group compared with placebo (1.2-2.6 mm/year). There were no significant differences in AAA growth among the compared groups (P-score probability in brackets): propranolol (0.73), telmisartan (0.66), antibiotics (0.53), placebo (0.53), ACE inhibitors (0.52), ticagrelor (0.46), and pemirolast (0.06). There were no significant differences among the compared groups in terms of aneurysm surgery referral rates, with propranolol (0.91), antibiotics (0.56), placebo (0.45), and pemirolast (0.08) showing similar outcomes. Similarly, no significant differences were observed in overall mortality rates across the groups, including telmisartan (0.87), antibiotics (0.57), ACE inhibitors (0.51), placebo (0.35), and propranolol (0.17). However, propranolol (OR = 3.14, 95% CI, 1.34-7.35) and ticagrelor (OR = 5.10, 95% CI, 1.12-23.18) were associated with a higher rate of discontinuation due to adverse events. Most of the studies analysed demonstrated moderate quality evidence. Conclusions: Current evidence highlights ongoing uncertainty regarding the efficacy of medical therapies in reducing subthreshold AAA growth rates, rates of referral for surgical repair, or overall mortality. The absence of statistically significant benefit may reflect underpowered datasets rather than definitive treatment inefficacy. Future large-scale, appropriately powered RCTs evaluating emerging medical treatments are required to accurately assess their clinical potential.

Objectives: Angiosarcoma is a rare, aggressive endothelial malignancy with a poor prognosis; diagnosis is often delayed by vague symptoms, nonspecific imaging, and challenging histopathology. Case reports have suggested an association with prior vascular procedures, with or without prosthetic material, but no causal link is established. We reviewed angiosarcoma across the full spectrum of vascular reconstruction. Methods: We systematically reviewed English-language human studies in PubMed, Embase, and the Cochrane Library for histologically confirmed angiosarcomas diagnosed after and anatomically related to vascular procedures. The review was registered on PROSPERO (CRD42024602643). Results: We describe 3 patients with metastatic angiosarcoma contiguous with vascular prostheses: a 75-year-old male with left inguinal angiosarcoma 7 years after PTFE bypass grafting; a 69-year-old male with angiosarcoma within the aneurysm sac 7 years after endovascular aortic aneurysm repair (EVAR); and an 80-year-old male with intraluminal angiosarcoma within an EVAR limb presenting as distal embolization. Systematic review identified 44 studies comprising 46 additional cases. Including these, 49 patients were analysed: 27 associated with endovascular prostheses, 14 with open prosthetic or mixed grafts, and 8 with autologous-vein bypass. Mean diagnostic latency was 7 years (range 5 months to 18 years); mean age was 70.5 years; 12.2% were female. Conclusions: Angiosarcoma is difficult to diagnose given its nonspecific presentation but should be considered in atypical or refractory post-procedural presentations. This is the largest synthesis to date and the first to describe intraluminal EVAR-limb angiosarcoma with distal embolization. Inclusion of autologous-vein reconstructions argues against a purely prosthetic-material explanation; further investigation is needed to clarify causality.

Background/Objectives: Mycobacterium ulcerans causes Buruli ulcers, typically manifesting as a single progressive necrotizing skin lesion. Rarely, non-contiguous “skip lesions” occur, complicating diagnosis and management. This report describes an atypical case and reviews similar presentations to emphasize early recognition and combined therapeutic strategies. Methods: A systematic literature review was performed using PubMed, Embase, Cochrane Library, Google Scholar, and Scopus databases until December 2024, focusing on cases involving skip lesions. Additionally, a detailed clinical case of a 68-year-old male from Mornington Peninsula, Australia, presenting skip lesions from the distal leg to the proximal knee was documented, including diagnostic PCR testing, surgical interventions, and antibiotic treatments. Results: Twelve studies were identified, totaling 1828 cases with 1179 exhibiting skip lesions. The majority achieved successful outcomes through combined antibiotic (rifampicin and clarithromycin) and surgical management. The reported case initially underwent surgical excision without antibiotics, leading to recurrence. Subsequent comprehensive management combining additional surgical debridement and adjusted antibiotics successfully resolved the infection. Conclusions: Although rare, skip lesions significantly complicate the clinical management of Buruli ulcers. Early diagnosis and a multidisciplinary approach integrating surgical debridement and antibiotic therapy are critical for optimal outcomes and minimizing recurrence risks.