Background: Rhytidectomy is one of the most performed facial rejuvenation procedures, yet postoperative hematoma remains its most frequent and consequential complication, driving patient morbidity and compromising aesthetic outcomes. Tranexamic acid (TXA), a potent antifibrinolytic agent, has been widely adopted to mitigate surgical bleeding; however, a definitive high-level synthesis of evidence for its local application in rhytidectomy remains limited. We conducted a comprehensive systematic review and meta-analysis to highlight the efficacy and safety profile of local administration of TXA compared with control interventions in patients undergoing rhytidectomy. Methods: A systematic search of PubMed, Embase, MEDLINE (EBSCO), and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted from database inception through December 2025. Studies comparing the effects of local administration of TXA with a control in adults undergoing rhytidectomy were included. Pooled effect estimates were calculated using a random-effects model; risk of bias was assessed with risk of bias in non-randomized studies-of interventions (ROBINS-I); and the certainty of evidence was appraised using the grading of recommendations assessment, development, and evaluation (GRADE) framework. Results: Seven studies met the inclusion criteria, comprising 1122 patients (596 local TXA and 526 controls). Meta-analysis revealed that local TXA was associated with a significant reduction in estimated blood loss (in milliliters) (standardized mean difference, −4.53; 95% confidence interval [CI], −8.09 to −0.97; P = 0.01), 24-hour postoperative drain output (in milliliters) (standardized mean difference, −1.10; 95% CI, −1.40 to −0.79; P < 0.01), and hematoma rates (odds ratio, 0.35; 95% CI, 0.15–0.81; P = 0.014). Conclusions: In patients undergoing rhytidectomy, the application of local TXA significantly enhances surgical efficiency and patient safety by reducing blood loss, drain output, and postoperative hematologic complications.

Background: Bile leaks complicate 5–25% of liver transplants and are among the most common early postoperative biliary events. Their management within the first 14 postoperative days has traditionally been framed around the timing of intervention. Objective: To evaluate whether leak characteristics and patient stability provide more consistent guidance than intervention timing for early post-transplant bile leaks. Methods: A structured narrative review using a dual-source search (AI-assisted semantic search [Elicit Plus] and PubMed/MEDLINE) was conducted. A PICO-informed (Population, Intervention, Comparator, Outcome) framework guided inclusion; two independent reviewers preformed screening, with senior adjudication, yielding 37 sources. Because “early” was defined heterogeneously—by leak onset in most studies (definitions exceeding 14 days) and by intervention timing in others—and no study compared timing within a 14-day window, quantitative pooling was not undertaken. Results: No included study directly compared intervention timing within the first 14 postoperative days. In the largest available analysis of ERCP timing, resolution and adverse event rates did not differ by whether endoscopy was performed within one day, on days two to three, or after three days; endoscopic success was consistently high (80–98%) across temporal windows. Leak type was a consistent correlate of management intensity and resolution: anastomotic leaks were associated with higher surgical-intervention rates (40% vs. 8.3% for T-tube exit-site leaks in one cohort) and lower resolution rates (58–69%) than non-anastomotic leaks (90–100%). Within endoscopic therapy, bridging stent placement—not leak location—was the strongest independent predictor of resolution, and any bile leak, irrespective of subtype, independently predicted subsequent biliary stricture (pooled adjusted OR ≈ 4). Ultra-early leaks (≤72 h), frequently technical failures, formed the one subset favoring early surgical re-exploration. Conclusions: The absence of a demonstrated timing effect reflects a lack of direct comparative data rather than proof that timing is unimportant. Leak type, patient stability, and management modality offer more consistent and actionable guidance than temporal urgency, forming the basis for a leak-stratified framework. Prospective multicenter registries with standardized timing strata and leak type stratification are needed to test whether timing independently influences outcomes.

Introduction: Anterior skull base (ASB) oncologic resection can create composite defects involving bone, dura, sinonasal cavities, orbit, and soft tissue. Although endoscopic techniques have expanded, open reconstruction remains essential for extensive tumors with intracranial, orbital, or craniofacial involvement. We systematically reviewed techniques and outcomes after open ASB reconstruction following oncologic resection. Methods: Following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science were searched through December 2025. Eligible studies included English-language original reports of patients undergoing oncologic tumor resection requiring open ASB reconstruction, with reported reconstructive technique and at least one clinical or surgical outcome. Data were extracted on study characteristics, surgical approach, flap or graft strategy, dural closure, structural support, adjuncts, and outcomes. Complications were categorized using a structured framework. Results: Twenty-seven studies comprising 554 cases/procedures were included: 17 retrospective studies (13 cohorts and 4 case series) and 10 case reports. Tumor histologies were heterogeneous, with meningioma, esthesioneuroblastoma, and squamous cell carcinoma among the most frequently reported pathologies. Reconstruction strategies included pedicled regional flaps in 12 studies, free (microvascular) flaps in 7, non-vascularized free grafts in 4, a mixed local-and-free-flap strategy in 2, artificial dural grafts in 1, and an autologous fascia-muscle-fat composite in 1. Dural patch grafts were used in 18 studies, while watertight closure was explicitly reported in 12. Bone grafts were used in 12 studies, and titanium mesh in 7. Flap survival was reported in 20 studies, with 9 failures across the series. CSF leak was reported in 26 studies; 17 reported no leaks, while 9 documented leaks, with the highest cohort rate of 11.8%. Revision surgery was reported in 24 studies and occurred in 10. Complications included infectious, CSF-related, flap-related, and donor-site events. Conclusion: Open anterior skull base reconstruction has been reported as feasible across heterogeneous clinical series; however, the predominantly retrospective evidence does not support comparative conclusions regarding reconstructive superiority. Recurring practices included defect-specific multilayer closure, vascularized tissue coverage in compromised fields, and structural reconstruction when required.