Animal-derived acellular dermal matrices (ADMs) are increasingly being used in prepectoral direct-to-implant (DTI) breast reconstruction. However, the indications and complication profile associated with this type of reconstruction remain unclear. This study aimed to perform a systematic review of the available literature on the use of animal-derived ADM in prepectoral DTI breast reconstruction. Three different literature databases, namely, PubMed, Web of Sciences, and Embase were screened using the following keywords: "immediate" AND "pre-pectoral" OR "prepectoral" AND "ADM breast reconstruction." Animal-derived ADM used (porcine - Braxon® and non-Braxon® - and bovine - Surgimend®) anthropometric information, clinical data, and complications profile were considered. A total of 340 articles were initially identified, of which only 45 articles (5089 patients and 6598 reconstructed breasts) satisfied our inclusion criteria. The most widely used ADM was Braxon® in the context of conservative mastectomies. In most studies, a subcutaneous layer > 1 cm and lack of previous radiotherapy were considered prerequisites for this type of reconstruction. An increased risk of complications was found in smokers, patients who underwent radiation treatment, patients with high breast volumes, and patients with cancers requiring axillary dissection. Data related to the role of diabetes, high body mass index, and breast implant size on surgical outcomes were instead inconcludent. Age was not directly proportional to the complications. The complications associated with different animal-derived ADMs are generally comparable. The profile of patients required for eligibility for this type of reconstruction appears to have been identified and is in line with current recommendations.

The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments.

Background: Propeller perforator flaps (PPFs) have gained increasing popularity in lower limb reconstruction. While their use in elective settings is well described, their role in acute post-traumatic reconstruction remains less defined. Methods: A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Cochrane Library were searched on 2 June 2025, for studies reporting on the use of propeller flaps in lower limb reconstruction after trauma. Only studies rated as “good” quality using the NIH quality assessment tool were included. Data on anatomical location, flap survival, complications, reinterventions, and functional and patient-reported outcomes were extracted and analyzed descriptively. Results: Twenty-eight studies published between 2008 and 2024 were included, accounting for 619 propeller flaps in a population of 838 patients. The majority of flaps were fasciocutaneous, with the posterior tibial artery being the most commonly used source vessel. Among the flaps included, 422 (68.2%) achieved complete survival without necrosis, 84 (13.6%) developed partial necrosis, and 23 (3.7%) failed completely. Considering all flaps that remained viable after any required revisions or conservative management, the overall survival rate was 97%. Venous congestion was the leading cause of flap compromise. The overall complication rate was 21.8%, increasing to 35.1% in acute trauma cases. A statistically significant correlation was found between wide rotation angles (≥150°) and higher complication rates (p = 0.015). The mean follow-up duration was 12.5 months. Functional and aesthetic outcomes were poorly reported, but when available, they were generally favorable. Conclusions: PPFs represent a valuable option for lower limb reconstruction, providing reliable coverage while preserving major vascular axes. Their application in acute trauma settings appears promising, although current evidence is limited by small verified cohorts and predominantly retrospective study designs. Despite higher complication rates in acute cases, flap survival remains consistently high, supporting their use in carefully selected patients. Further prospective studies with standardized outcome reporting are needed to clarify long-term functional results and refine selection strategies.

Thumb hypoplasia is a rare deformity of the hand. Type II and IIIA are the main indications for opponensplasty, together with thumbs with a residual weak opposition after pollicization. Our study operates a review of the current literature to establish which opponensplasty technique is the most appropriate for each patient. We conducted a systematic search using PubMed, Embase, and Web of Science databases. The keywords used were "thumb hypoplasia," AND "opponensplasty," "abductor digiti minimi opponensplasty," "thumb hypoplasia," AND "abductor digiti minimi," "opponensplasty," AND "hypoplasia," "flexor superficialis opponensplasty," "flexor digitorum superficialis opponensplasty." A minimum of 1 year of follow-up was required for inclusion. A total of 222 studies were recovered, of which only 9 articles satisfied our inclusion criteria. From the results obtained, the choice between abductor digiti minimi opponensplasty and flexor digitorum superficialis transfer should depend on the severity of the deformity and the main goal that should be achieved. Children with type IIIA hypoplasia characterized by more unstable joints should undergo flexor digitorum superficialis transfer to restore joint stability. On the contrary, when the instability is not of great concern, abductor digiti minimi opponensplasty, which aims at better defining the thenar eminence and restoring a better global hand function, should be preferred.

Buried free flaps monitoring cannot rely on clinical evaluation, which remains the gold standard in flaps with a skin paddle. A reliable way to monitor buried free flaps is through implantable dopplers, which provide a continuous and direct signal of anastomotic flow. Since the only way to ascertain a suspicion of vascular impairment in buried free flaps is through reoperative exploration, a high specificity is required together with a high sensitivity to avoid unnecessary theatre take-backs A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) and using the following keywords: “Cook Swartz” AND “doppler” AND “flap” AND “monitoring” and “Synovis” AND “Flow Coupler” AND “flap” AND “monitoring”. The indicators of efficacy and effectiveness of the two available implantable dopplers were analyzed and compared to our casistics. The search using Cook Swartz thesaurus identified 116 articles while that of Synovis Flow Coupler 25 articles, of which only 26 and 6, respectively, fully satisfied our inclusion criteria. The literature search seems to confirm our current practice, with Cook Swartz (Cook Medical, Bloomington, IN) arterial placement preferred for head and neck buried free flaps and Synovis Flow Coupler (Synovis Life Technologies, Inc., St. Paul, MN) for buried DIEP flaps. This preferential placement reflects the higher rate of false positives when a vein is monitored in the head and neck, which is high mobile and prone to respiratory oscillations leading to probe dislocation or missing signal.