The first web space of the hand plays a fundamental role in daily hand function, facilitating crucial movements, such as pinching, grasping, and opposition. The structural anomalies of acquired defects of this anatomical region, whether secondary to trauma, burns, or post-oncological surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced microsurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limitations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplantation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.

Epigastric tissue abundancy after abdominoplasty or liposuction is a complicated scenario that requires a precise and targeted approach. Especially when concurrent mammoplasty is planned or has already been done by the patient, a surgical operation through a submammary skin incision can solve this problem. To showcase our personal experience regarding reverse abdominoplasty and compare it to the state of the art. To identify indications, possible complications and outcomes, detailed surgical insights as well as graphical examples are provided. In addition, our personal experience from the last four years is showcased and compared with the literature using PubMed and Cochrane Library databases with Reverse AND Abdominoplasty as search strings. All the 12 patients operated in our facilities between 2020 and 2024 had either a pre-existing submammary scar or a plan to undergo a contestual mammoplasty; at a mean of 25,1 weeks follow up, one major complication occurred. There is a lack of publications on reverse abdominoplasty. Small case series are available in the literature, most of which focus on aesthetic indications. Only a few cases address the reconstructive implications of this surgical technique. In our experience, the concomitant desire or necessity of a mammoplasty and an already present inframammary scar favor the surgery. Careful recreation of a new inframammary sulcus must be considered to avoid unpleasant complications. Despite the poor literature supporting this technique, reverse abdominoplasty is a must-known procedure for successfully addressing thorny abdominal wall conditions and is characterized by consistent, replicable and safe outcomes.

Pediatric partial-thickness burns at function-critical sites require rapid epithelialization to limit hypertrophic scarring and contracture. We assessed outcomes after tangential dermabrasion with application of cryopreserved human amnion (hAM). Retrospective single-center cohort of children < 18 years treated from 2013 to June 2024. Standard care included early tangential dermabrasion and hAM fixation. Primary endpoint was days from injury to ≥ 95% re-epithelialization. Secondary endpoints included length of stay, autografting, hAM-related adverse events, hypertrophic scarring, contracture, and Patient and Observer Scar Assessment Scale (POSAS) at 12 months. Ninety-seven children were included (median age 1.8 years; 60.8% male; median total body surface area burned 10%). Median time to first dermabrasion and hAM application was 24 h. Median time to ≥ 95% re-epithelialization was 16 days. Larger burns healed more slowly (+1.22 days per 1% total body surface area; p < 0.001). Median length of stay was 8 days; autografting occurred in 19.6%. No adverse events were attributed to hAM. Hypertrophic scarring occurred in 34% and contracture in 13.4%. Longer time to closure increased the odds of hypertrophic scar (odds ratio per 5 days 1.20; p = 0.040) and contracture (odds ratio per 5 days 1.28; p = 0.002). After standardized dermabrasion, cryopreserved hAM supported closure within the expected healing window. Time to epithelialization remained the main determinant of scar outcomes.

The first web space of the hand plays a fundamental role in daily hand function, facili-tating crucial movements such as pinching, grasping, and opposition. Structural anom-alies and acquired defects of this anatomical region, whether congenital or secondary to trauma, burns, or surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced mi-crosurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limi-tations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplan-tation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.

Incisional negative pressure wound therapy has expanded from a niche adjunct to a widely adopted strategy for the prevention and management of wound complications in selected surgical settings. However, available systems differ in pressure profile, fluid handling, dressing interface, and suitability for fragile skin or anatomically challenging incisions, while practical guidance for device selection remains limited. Whether iNPWT should be used selectively is an established question; which system characteristics are relevant once its use has been judged appropriate is not. We conducted a structured narrative review of the literature on incisional negative pressure wound therapy published between January 2013 and September 2026, based on a targeted PubMed/MEDLINE search. Clinical studies addressing primarily closed surgical incisions were reviewed across elective, emergency, and reconstructive settings; conventional negative pressure wound therapy for open wounds was considered only in order to define the boundary between the two indications. Device technical characteristics were extracted separately from manufacturers' instructions for use and clinician guidelines. Evidence was synthesised in relation to clinical indication, incision and patient characteristics, device features, reported outcomes, and treatment‐related adverse events. On this basis, a clinical‐requirement‐first decision framework for bedside device selection was developed, with each component labelled as direct clinical evidence, indirect clinical evidence, documented technical characteristic, or expert clinical consideration. The available evidence supports a selective rather than routine use of incisional negative pressure wound therapy. The greatest clinical value appears in high‐risk incisions and in settings where oedema, superficial fluid accumulation, or limited soft‐tissue protection are likely to contribute to wound morbidity. Reported benefits vary according to procedure type, baseline risk, endpoint definition, and device configuration. Published studies evaluate complete proprietary systems rather than isolated technical variables. The only randomised comparison between two commercial systems identified was small and found no difference between them. Adverse events remain relevant and may limit treatment in fragile skin or when drainage exceeds the fluid‐handling capacity declared for the selected dressing. Incisional negative pressure wound therapy should be considered an adjunct to standard preventive measures, not a universal solution. A structured approach integrating anticipated fluid‐handling requirements, perilesional skin tolerance, seal feasibility over the relevant anatomy, and intended therapy duration may support more rational and transparent device selection once iNPWT has been judged appropriate. Current evidence does not establish a hierarchy among commercially available incisional systems, and the framework should be regarded as structured decision support rather than as a validated algorithm.