Vascularised composite allotransplantation (VCA) has an evolving role in the reconstruction of complex functional and aesthetic deficits non-amenable to autologous or implant-based reconstructive modalities. International applications of VCA span upper extremity, face, abdominal wall, uterus, and penile transplantation, with more than 300 procedures performed worldwide. Among these, abdominal wall transplantation has uniquely contributed to the development of the sentinel skin flap (SSF) concept, in which solid organ transplant patients undergo simultaneous transplantation of a solid organ and a donor-derived vascularised skin flap, with the skin component of the SSF being trialled internationally as a means of monitoring for rejection within the solid organ allograft. Despite growing clinical success, VCA continues to face substantial barriers to wider adoption. Acute rejection remains highly prevalent, affecting up to 89% of recipients, with significant morbidity linked to intensive systemic immunosuppression. Challenges are further amplified by the unique immunological heterogeneity of composite grafts, ethical concerns surrounding identity-linked tissues, and the lack of standardised outcomes reporting across VCA subtypes. Advances in machine perfusion technologies and emerging cellular and biomaterial-based immunomodulation strategies show promise in reducing immunosuppression burden and improving graft longevity. This review outlines the current state of VCA, including clinical applications, outcomes, and mechanistic insights from pre-clinical studies, while highlighting key ethical considerations and evolving regulatory frameworks. Future progress will depend on standardised reporting systems, improved donor–recipient matching, better understanding of ischemia–reperfusion injury, and the development of next-generation immunosuppressive/immuno-modulatory therapies. Collectively, these innovations position VCA as a rapidly advancing field with significant potential to redefine reconstructive and transplant surgery.

Introduction: Psychotropic medications are commonly prescribed among adults with intellectual disability (ID), often in the absence of a psychiatric diagnosis. As such, there is great disparity between the estimated prevalence of mental illness and the rates of psychotropic medication use amongst people with ID. ‘Off-label’ use of these medications may account for much of this discrepancy, in particular their use in the management of challenging behaviour. This has come under scrutiny due to the myriad of side effects and the deficiency of high-quality data supporting their use for this indication. Understanding the causes and justifications for such disparity is essential in discerning the efficacy of current prescription practice. Objective: To explore the existing evidence base regarding the prescription and management of psychotropic medications in adults with ID. The aim will be achieved through identifying the psychotropic medications commonly prescribed, the underlying rationale(s) for their prescription and the evidence available that demonstrates their appropriateness and effectiveness. Additionally, the paper will seek to evaluate the availability of any existing guidance that informs the management of these medications, and the evidence and outcomes of psychotropic medication dose reduction and/or cessation interventions. Inclusion criteria: This review will consider studies that focus on the use of psychotropic medications amongst patients with ID. Methods: Research studies (qualitative, quantitative and mixed design) and Grey Literature (English) will be included. The search will be conducted without time restrictions. Databases will include: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Databased of Systematic Reviews, PsycINFO and Scopus. A three-step search strategy will be followed, with results screened by two independent reviewers. Data will be extracted independently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams.

Inflammatory fibroid polyps (IFP) are rare benign neoplasms most commonly occurring within the respiratory tract but are rarely also observed in the gastro-intestinal tract. Herein we present the case of a 73-year-old female presenting with ileo-ileal intussusception secondary to IFP. The patient was treated with emergency laparotomy with segmental bowel resection and primary anastomosis. Histopathological analysis of the excised bowel segment initially revealed a low-grade, mural based spindle cell neoplasm with surrounding benign, reactive lymphadenopathy. Immunohistochemical analysis demonstrated that the lesional cells stained positive for Vimentin, Smooth Muscle Actin (SMA), and CD34. On secondary analysis of the specimen, the morphology and immunohistochemical profile of the mass was in keeping with IFP. No invasive malignancy was identified. Such cases have been previously reported under the pseudonym ‘the great mimicker’, due to their striking similarity to malignant processes. This case report aims to add to the small body of research reporting such atypical presentations.

Objective: To critically evaluate the existing evidence base surrounding the efficacy of preoperative 5‐alpha reductase inhibitor (5ARI) administration in the reduction of perioperative complication rates in transurethral resection of prostate (TURP). Methods: In April 2025, a systematic search of on‐line databases was conducted to identify randomised controlled trials (RCTs) that compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated preoperatively with 5ARI (finasteride or dutasteride) as compared to placebo/none. The efficacy of preoperative finasteride was evaluated through outcomes related to blood loss, rate of blood transfusion, and operative time. The physiological mechanism of 5ARI treatment was evaluated through microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of the resected specimen. Results: A total of 30 RCTs met the inclusion criteria for this meta‐analysis in which a total of 2974 patients underwent TURP for BPH (1464 5ARI: 1410 Control). Intraoperative blood loss was significantly lower among 5ARI‐treated patients ( Z = 6.37, mean difference [MD] = −82.58 mL, 95% confidence interval [CI] −107.98 to −57.18; P < 0.001), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day ( Z = 6.84, MD = −0.90 g/dL, 95% CI−1.16 to −0.64; P < 0.001). The MVD was significantly lower in resected specimens from 5ARI‐treated patients (MD = −6.18 vessels/mm ³ , P < 0.001), whilst expressing significantly less VEGF (MD = −3.25, P < 0.001). Patients treated with 5ARI required blood transfusion less frequently than controls (odds ratio 0.31, P < 0.001). The use of 5ARI was associated with shorter operative time (MD = −3.47 min, P = 0.02) and lower volume of irrigation agents (MD = –2.07 L, P < 0.001). Conclusion: Preoperative administration of 5ARIs significantly reduces intraoperative blood loss and risk of requiring blood transfusion in patients undergoing TURP for BPH. Even short durations (2 weeks) of 5ARI therapy can significantly reduce prostate vascularity.

Sarcopenia refers to a loss of muscle mass combined with an associated loss of muscle function and has been demonstrated to predict post operative complications across a range of surgical procedures. The effect of sarcopenia on patient outcomes following autologous breast reconstruction (ABR) remains unknown. This systematic review and meta-analysis aims to assess the impact of sarcopenia on complications following ABR. A systematic review of electronic databases was performed in conjunction with PRISMA guidelines. Studies reporting on postoperative complications in sarcopenic versus non-sarcopenic patients undergoing autologous breast reconstruction were included. Sarcopenia was identified in all included studies by objectively measuring psoas muscle index (PMI) or skeletal muscle index (SMI) on computed tomography (CT) scan. Six studies were included in this meta-analysis, which reported outcomes of 1315 patients undergoing ABR following mastectomy (407:908, Sarcopenic: Non-Sarcopenic). Sarcopenic patients had an increased risk of haematoma formation (OR= 1.84, 95% CI=1.06-3.18, p=0.03), but this was not associated with an increased risk of return to theatre due to haematoma (OR=1.11, 95% CI=0.36-3.38, p=0.86). There was no significant difference in risk of total flap loss, recipient site infection, recipient site seroma formation, donor site complications, risk of re-operation or wound dehiscence between sarcopenic and non-sarcopenic patients following ABR. This study reports a higher haematoma risk in sarcopenic patients undergoing autologous breast reconstruction. Prospective studies reporting on BMI, PMI/SMI, radiographic muscle attenuation, and patient-reported return to function are required to comprehensively evaluate the potential impact of sarcopenia on post-mastectomy autologous breast reconstruction.

The impact of academic research is not just important within the clinical domain but within society as a whole. Altmetric Attention Score (AAS) offers a means of assessing how scholarly outputs are interacted with online. Vascularised Composite Allotransplantation (VCA) is a modern but rapidly evolving topic which encompasses a broad range of complex and clinically significant surgical interventions. Primarily VCA is utilised in the reconstruction of complex, composite tissue defects, including limb and face transplantation. There is also a growing interest in the role of VCA as an early means of real-time immuno-monitoring, in sentinel skin flap transplant (SSF). In July 2024, a search was conducted using the Altmetric Explorer (AE) database using the search term 'vascular-composite' AND 'allograft' OR 'allotransplant'. A simultaneous literature search was carried out using Web of Science (WoS) database utilising the same search terms with extraction of traditional citation-based metrics as well as relevant 'meso' and 'micro' subject headings. Corresponding citation-based metrics were extracted utilising SCImago. Data was compiled and analysed using a linear regression model with level of significance set at p < 0.05. The Top 100 (T100) performing articles relating to VCA displayed a mean Altmetric Attention Score (AAS) of 3.31. All T100 papers were published in the English language. Sixty percent (n = 60) of T100 papers were published in Q1 Journals. News outlet mentions (r = 6.95), blog mentions (r = 6.20), and Twitter/X mentions (r = 0.52) demonstrated the greatest positive impact on AAS upon application of a linear regression model (p < 0.05). Altmetric Scores offer a means of appraising the impact of research outputs in both academic and societal domains. Such modern metrics are useful in evolving topics such as VCA as AAS is not dependent on citation counts. Publishing of outputs in high quartile, open access journals with timely utilisation of news and social media outlets should be utilised by researchers aiming to maximise dissemination of research outputs in the field of VCA.