Background: Perforator flaps account for a fraction of reconstructive procedures despite their growing popularity. Specific microsurgical skills are required for successful harvesting of perforator flaps, which are difficult to attain through direct operating room training. Cadaver and small animal dissection cannot simulate human perforator dissection, lacking either bleeding and vessel feedback or providing too small calibers. Thus, we have developed and refined over the last ten years five perforator flaps models in living pig, described their harvesting technique and provided evidence for their effectiveness as perforator flap training models. Method: CT angiography data from ten living pigs was used for detailed examination of the integument’s vascular anatomy. Microsurgical techniques were used to standardize and harvest the perforator flaps in acute models. The same operator-assistant team, with no prior perforator flap harvesting experience, raised all flaps in a sequential manner, one animal per day, during a 7 weeks timespan. Porcine flaps were compared to human counterparts in terms of vessel caliber, dissection times. Immediate flap survival was measured as duration of perforator pulsation after completion of flap harvesting, measured every 10 minutes for up to two hours. Results: Five perforator flaps were standardized, based on the deep cranial epigastric, thoracodorsal, lateral intercostal, cranial gluteal and dorsal cervical arteries and the operative technique was described in detail. Mean pig perforator size was 1.24±0.36 mm and mean pedicle diameter was 2.78±0.8 mm, which matched closely the human calibers for each flap. Total harvesting time increased 22.4% between the first two experiments due to a more cautious approach following the lack of perforator pulsation in all flaps in the first experimental animal. A total decrease of 44.4% harvesting time between second and last experiment was observed, as expected with all repetitive surgical procedures. Post-operative perforator pulsation time revealed a steep learning curve, with no or short-term pulsatile perforators in the first five pigs, followed by a 275% increase in total perforator pulsation time between 5^th and 6^th experimental animal. Based on these findings we provide a description of the most common mistakes, their consequences and gestures which can be trained using the pig perforator flaps, in order to overcome these mistakes. Conclusion: These five pig perforator flap models provide a fast and efficient learning tool to develop perforator flap harvesting skills safely. Surgical training using these five experimental models offers a similar hands-on perforator flap dissection experience as with human tissue, based on the similar sized calibers of both perforators and pedicles with their human counterparts.

Fluorescence imaging with indocyanine green is increasingly used during lymphedema patient management. However, to date, no guidelines exist on when it should and should not be used or how it should be performed. Our objective was to have an international panel of experts identify areas of consensus and nonconsensus in current attitudes and practices in fluorescence imaging with indocyanine green use during lymphedema surgery patient management. A 2-round Delphi study was conducted involving 18 experts in the use of fluorescence imaging during lymphatic surgery, all asked to vote on 49 statements on patient preparation and contraindications (n = 7 statements), indocyanine green dosing and administration (n = 10), fluorescence imaging uses and potential advantages (n = 16), and potential disadvantages and training needs (n = 16). Consensus ultimately was reached on 40/49 statements, including consistent consensus regarding the value of fluorescence imaging with indocyanine green in almost all facets of lymphedema patient management, including early detection, assessing disease extent, preoperative work-up, surgical planning, intraoperative guidance, monitoring short- and longer-term outcomes, quality control, and resident training. All experts felt it was very safe, while 94% felt it should be part of routine care and that indocyanine green was superior to colored dyes and ultrasound. Nonetheless, there also was consensus that limited high-quality evidence remains a barrier to its widespread use and that patients should still be provided with specific information and asked to sign specific consent for both fluorescence imaging and indocyanine green. Fluorescence imaging with or without indocyanine green appears to have several roles in lymphedema prevention, diagnosis, assessment, and treatment.

Background: In burn injuries, wound healing effectiveness is complex and influenced significantly by the local biochemical environment and the physicochemical properties of topical preparations. pH lesions modulation can influence protection barrier integrity, inflammatory responses, and microbial colonization. Their antioxidant, antimicrobial, and anti-inflammatory properties, of the topical formulations enriched with plant extracts have demonstrated promising results. Objective: The aim of the study was to develop and characterize topical oleogel and hydrogel formulations containing ethanolic and hydroalcoholic extracts of medicinal plants (Boswellia serrata, Ocimum basilicum, Sambucus nigra, and Galium verum), and to evaluate the impact of their physicochemical properties, rheological behavior, in contrast with the wound pH modulation, and healing efficacy in an experimental burn model. Methods: Second-degree burns were induced uniformly on Wistar rats using the validated RAPID-3D device. All formulations were applied daily for 21 days, and wound healing was assessed through several measurements specific to the wound surface, skin temperature, pH, and, last but not least, histological analyses. Formulations’ physicochemical and rheological properties, including pH, viscosity, and spreadability, were also analyzed and systematically characterized. Results: Oleogel formulations demonstrated superior wound healing performance compared to hydrogels. Formulations containing Boswellia serrata and Ocimum basilicum extracts significantly reduced wound size, inflammation, and melanin production by days 9 and 21 (p < 0.05). The beneficial outcomes correlated strongly with formulation acidity (pH < 6), high viscosity, and enhanced thixotropic behavior, indicating improved adherence and sustained bioactive compound release. Histological evaluations confirmed enhanced epithelialization and reduced inflammation. Conclusions: Particularly Boswellia serrata and Ocimum basilicum in oleogel formulations in ethanolic solvent effectively modulated wound pH, enhanced topical adherence, and improved burn wound healing. These findings highlight their potential clinical application and justify further clinical investigations.

Background: Scald burns pose significant morbidity, and effective topical treatments remain a clinical priority. Burn injuries pose a significant clinical challenge due to the prolonged inflammation and high infection risk. Traditional treatments focus on moisture retention and infection prevention, but biocompatible formulations such as hydrogels and oleogels offer advantages. Hydrogels hydrate, cool, and promote epidermal regeneration, while oleogels form a lipid barrier that enhances the absorption of lipophilic bioactive compounds. There is an increasing demand for novel topical alternatives that can effectively improve wound healing by modulating the inflammatory cascade, accelerating epithelial and dermal regeneration, and restoring barrier function. Objective: This study aimed to determine the most effective plant-based topical formulations for enhancing second-degree scald burn wound healing. Methods: Utilizing a standardized rat model, we compared 21 distinct topical formulations, consisting of oleogel and hydrogel bases enriched with extracts from Boswellia serrata (frankincense), Ocimum basilicum (basil), Sambucus nigra flower (elderflower), and Galium verum (lady’s bedstraw). Second-degree burns were uniformly induced in 24 Wistar rats using boiling water (100 °C for 8 s) using the RAPID-3D device, a validated 3D-printed tool that ensures reproducible burns through controlled exposure to boiling water. Post-burn, rats were divided into three equal subgroups, and topical formulations were applied daily. Wound healing efficacy was evaluated through wound surface area measurements, transepidermal water loss (TEWL), skin hydration, sebum production, pigmentation, inflammation (erythema), skin perfusion, and histological parameters at multiple timepoints (days 1, 4, 9, 14, and 21 post-burn induction). Results: Statistical analyses indicated significant advantages of oleogel-based formulations over hydrogel-based formulations. Specifically, formulations containing Boswellia serrata and Ocimum basilicum extracts significantly reduced wound size and inflammation, improved skin hydration, and decreased melanin production by days 9 and 21 (p < 0.05). Conclusions: These findings underscore the potential clinical value of oleogel-based topical preparations containing specific plant extracts for improving scald burn wound healing outcomes, warranting further clinical evaluation.

Background: Scald burns are common thermal injuries in clinical settings, yet existing animal models lack standardization in burn size, exposure time, and severity control. Traditional burn induction methods, such as manual immersion or heated metal contact, suffer from high variability, limited reproducibility, and are operator-dependent, reducing their translational relevance. This study presents RAPID-3D (rat printed induction device—3D), a novel 3D-printed system designed to induce uniform and reproducible scald burns in a rat model, ensuring precise exposure control and minimal variability. Methods: RAPID-3D features four burn exposure windows (10 × 20 mm each, 10 mm spacing), allowing for controlled boiling water (100 °C, 8 s) exposure while immobilizing the anesthetized rat’s dorsum. N = 10 female Wistar rats were subjected to eight controlled burns per animal. Internal unburned control areas were used in each rat for intra-animal comparison. Burn evolution was assessed using digital planimetry, histological evaluation, and real-time microvascular perfusion analysis via laser Doppler line scanning (LDLS) at 1 h, which was repeated on day 4, 9 and 21 post-burn. Results: RAPID-3D generated highly consistent burn sizes (198 ± 3.54 mm²) across all rats, with low inter-animal variability. Histological analysis confirmed full-thickness epidermal necrosis and deep partial-thickness dermal damage (600–900 µm depth). Microvascular Trends: Perfusion dropped immediately post-burn, remained low at day 4, and gradually increased from day 9 onward, suggesting progressive neovascularization and vascular remodeling. RAPID-3D provides a standardized, reproducible, and clinically relevant scald burn model, eliminates operator-induced variability, enhances experimental consistency, and offers strong translational relevance for burn treatment development and wound healing research.