Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations.

Osseodensification (OD) has emerged as a favorable osteotomy preparation technique that preserves and compacts autogenous bone along the osteotomy walls during site preparation, enhancing primary stability and implant osseointegration. While OD has demonstrated promising results in low-density trabecular bone, especially when used in conjunction with acid-etched (AE) implant surfaces, its efficacy in high-density cortical bone remains unclear—particularly in the context of varying implant surface characteristics. In this study, Grade V titanium alloy implants (Ti-6Al-4V, 4 mm × 10 mm) with deep threads, designated bone chambers and either as-machined (Mach) or AE surfaces were placed in 3.8 mm diameter osteotomies in the submandibular region of 16 adult sheep using either OD or conventional (Reg) drilling protocols. Insertion torque values (N·cm) were measured at the time of implant placement to evaluate primary stability. Mandibles were harvested at 3-, 6-, 12-, or 24-weeks post-implantation (n = 4 sheep/time point), and histologic sections were analyzed to quantify bone-to-implant contact (BIC) and bone area fractional occupancy (BAFO). Qualitative histological analysis confirmed successful osseointegration among all groups at each of the healing time points. No statistically significant differences were observed between OD and conventional drilling techniques in insertion torque (p > 0.628), BIC (p > 0.135), or BAFO (p > 0.060) values, regardless of implant surface type or healing interval. The findings indicate that neither drilling technique nor implant surface treatment significantly influences osseointegration in high density cortical bone. Furthermore, as the osteotomy was not considerably undersized, the use of OD instrumentation showed no signs of necrosis, inflammation, microfractures, or impaired osseointegration in dense cortical bone. Both OD and Reg techniques appear to be suitable for implant placement in dense bone, allowing flexibility based on surgeon preference and clinical circumstances.

Tricalcium phosphate (TCP) bioceramics, available as α- and β-polymorphs, are frequently employed in the production of three-dimensionally (3D) printed bone scaffolds. Although hydrothermal immersion processing (HP) and sintering (S) are commonly adopted as post-printing techniques for bioceramics, a comprehensive comparative analysis of their effects on the osteogenic performance of α- and β-polymorphs in vivo remains inadequately investigated. In this study, α-TCP and β-TCP scaffolds were fabricated via direct ink writing and subjected to hydrothermal immersion processing (α-TCP/HP) and sintering (β-TCP/S) prior to implantation in n = 12 skeletally mature sheep (n = 1 scaffold per group per animal), and the outcome variables were evaluated at 3 and 12 weeks postoperatively (n = 6 sheep per time point). The quantitative results showed no significant differences in bone deposition or scaffold resorption at 3 weeks postoperatively (p = 0.618 and p = 0.898, respectively). However, at 12 weeks, there was a significant increase in osteogenesis and scaffold resorption in the β-TCP/S cohort relative to the α-TCP/HP counterparts (p < 0.001 and p = 0.004, respectively). β-TCP scaffolds subjected to post-print sintering exhibited superior osteoconductive and resorptive profiles compared to hydrothermal immersion-processed α-TCP scaffolds over the 12-week healing period.

Tranexamic acid (TXA) has gained widespread use across surgical disciplines due to its antifibrinolytic properties and favorable safety profile, yet standardized protocols for its use in aesthetic plastic surgery remain lacking. This study aimed to assess international trends, perceptions, and practices regarding TXA administration among board-certified plastic surgeons. A cross-sectional, anonymous survey was distributed electronically to all active members of The Aesthetic Society. The survey captured demographics, procedural usage, routes of administration, and perceived benefits or barriers associated with TXA. A total of 256 surgeons responded, with 69% reporting active use of TXA. Geographic variability was notable: usage was highest in Australia (100%) and Canada (92%) and lowest in South America and Asia (67%). Intravenous administration was the most common (36%), followed by topical (20%), tumescent (14%), and oral (3%); 27% reported case-dependent variation. TXA was most frequently used in facelifts (79%) and abdominoplasty (54%). Among non-users, 45.6% cited lack of robust data as the main deterrent. Most surgeons believed TXA reduced blood loss (93%), improved surgical field visibility (81%), and minimized ecchymosis (85%) and edema (85%), with 70% noting faster recovery. Importantly, 98% reported no thrombotic events in their practice. This is the first large-scale international survey assessing TXA use in aesthetic plastic surgery. Findings highlight variability in practice patterns and underscore the need for evidence-based guidelines to promote safe and consistent TXA usage across aesthetic procedures worldwide.

Intraoral soft-tissue defects are traditionally managed with autogenous connective tissue grafts, though donor site morbidity has driven interest in xenogeneic collagen matrices as alternatives. However, the impact of matrix architecture on soft-tissue integration remains poorly understood. This study compared soft-tissue responses to a sheet-form collagen matrix (ShCM) and a spongy collagen matrix (SpCM) placed beneath full-thickness flaps in a beagle mandibular defect model. Standardized bilateral defects were created in 23 skeletally mature female beagles. Defects were then assigned to serve as the negative control (sham) or were treated with porcine collagen matrix in (i) sheet form (ShCM) (Regenity Biosciences, Oakland, NJ, USA), or (ii) porous/spongy form (SpCM) (Fibro-Gide^®, Geistlich Pharma North America, West Windsor Township, NJ, USA). The mandibular sites that received no surgical intervention served as positive controls. Experimental conditions were randomized and interpolated within each animal to minimize anatomical site bias and evaluated histologically at 4- (n = 7), 8- (n = 7), and 12-weeks (n = 9) postoperatively. Histologic sections were evaluated for matrix presence, inflammation, subepithelial healing, and matrix thickness. At 4 weeks, both matrices were present, though SpCM showed significantly higher inflammation scores (p = 0.013). By 8 weeks, ShCM demonstrated greater resorption (p = 0.003) alongside an organized collagen layer with fibroblasts and new microvessels, while SpCM remained thick and porous, with a persistent fibrous capsule and elevated inflammation versus both ShCM (p = 0.002) and sham (p = 0.009). At 12 weeks, inflammation declined and subepithelial healing improved similarly across matrix groups. These findings suggest matrix architecture influences soft-tissue healing outcomes in the oral cavity. Sheet-form matrices may be preferable where biocompatibility and predictable integration are priorities, while spongy matrices may better support long-term space maintenance and tissue ingrowth. However, clinical studies are needed to confirm these translational implications.