Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

Significance: Brain metastases are among the most severe complications of systemic breast cancer, and overexpression of the human epidermal growth factor receptor 2 (HER2) in breast cancer cells increases the incidence of brain metastases in patients. In this study, we engineered the human-derived, tumor cell tropic neural stem cells LM-NSC008 (LM008) to continuously secrete antibodies against HER2. These anti-HER2 antibodies impaired tumor cell proliferation by inhibiting the PI3K-Akt signaling pathway in HER2+ breast cancer cells in vitro. Importantly, our results demonstrate that the therapeutic combinatorial regimen consisting of LM-NSC008 anti-HER2 antibody-secreting cells and the HER2 kinase inhibitor tucatinib provide therapeutic benefit and prolong survival in preclinical models of HER2+ breast cancer brain metastases.

Targeted muscle reinnervation (TMR) is a surgical technique originally created to improve prosthetic function following upper extremity amputation. TMR has since been shown to be effective in the prevention and treatment of chronic postamputation phantom and residual limb pain in both upper and lower extremity amputees and for neurogenic pain in the nonamputee patient population. This article provides a current review of the various indications for TMR and surgical techniques, organized by amputation site, timing, and regional anatomy.

Case: A 19-year-old woman presented with bilateral mangled upper extremities after jumping in front of a moving train. After revascularization, osteocutaneous free vascularized fibula flap was performed to reconstruct the right humerus. The left forearm required transradial amputation with acute targeted muscle reinnervation. Finally, staged bilateral bipolar latissimus dorsi functional muscle flaps were performed to restore elbow flexion. Conclusion: Staged orthoplastic reconstruction of the upper extremities is an effective treatment approach for traumatic bone and soft-tissue defects. This patient’s recovery demonstrates improved quality of life after severe upper extremity trauma.

Background: Nontobacco nicotine use, including electronic cigarettes and vaping devices, has increased substantially in recent years. While the adverse effects of combustible tobacco on wound healing are well established, less is known about postoperative risks associated with nontobacco nicotine dependence (NTND). This study evaluated the association between NTND and postoperative complications following reconstructive and aesthetic breast surgery procedures. Methods: A retrospective cohort analysis was performed using the TriNetX research database. Patients undergoing reconstructive or aesthetic breast surgery were identified using Current Procedural Terminology codes and stratified by documented NTND within 1 year before surgery. Patients without nicotine dependence served as controls. Propensity score matching (1:1) was used to balance demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, and 1 year. Results: Among 227,098 patients, 4801 had NTND and 222,297 served as controls. After 1:1 matching, 4467 patients remained in each cohort. Across all timepoints, NTND was associated with higher rates of surgical site complications, wound-related complications, wound dehiscence or delayed healing, infection, and unplanned readmission (all P <0.01). Seroma, hematoma, and postoperative bleeding occurred less frequently among patients with NTND. Conclusions: Nontobacco nicotine dependence was associated with higher rates of wound complications, infection, and unplanned health care utilization following reconstructive and aesthetic breast surgery. These findings highlight the importance of assessing nicotine exposure during preoperative risk evaluation and counseling.