Faculty Bibliography

Vascularized composite allotransplantation (VCA) involves immunologically heterogeneous tissues with a high incidence of acute rejection. Reliable and timely detection of rejection onset remains a major unmet challenge in VCA management. This longitudinal exploratory case study assessed blood- and tissue-derived biomarkers for acute rejection monitoring in a full-face and bilateral hand transplant recipient over 4.6 years. Of these biomarkers, donor-derived cell-free DNA (dd-cfDNA) and short tandem repeats (STR) showed trends toward elevated recipient levels during acute rejection, though differences were not statistically significant. CD8⁺ T-cell percentages increased before acute rejection onset, highlighting a temporal association. Anti-angiotensin II type 1 receptor antibody (AT1R-Ab) levels did not differ significantly between acute rejection and non-rejection episodes, possibly due to prophylactic immune cell depletion. While dd-cfDNA and STR levels correlate with rejection episodes and reflect key graft cellular events, CD8⁺ T-cell dynamics demonstrated the strongest temporal association with rejection episodes in this patient, though no biomarker showed statistically significant differences. These exploratory findings support the need for further longitudinal, multi-patient studies to validate emerging biomarkers and refine rejection monitoring strategies in VCA.

BACKGROUND/UNASSIGNED:Citation analysis is a useful bibliometric tool to identify impactful publications and trace the evolution of a specialty or a technique. In the past three decades, the research on vascularized composite allotransplantation (VCA) has grown exponentially but very few studies have examined the most influential papers in this field. METHODS/UNASSIGNED:The Web of Science Core Collection database was searched for articles published from inception to August 4th, 2025. Titles, full authors' names, years of publication, source journals, regions of origin, and numbers of citations were recorded. VCA anatomical location, main topics, and citation density were determined. Articles were ranked based on number of citations and citation density; they were then categorized based on methodology, study design, and main topic. RESULTS/UNASSIGNED: = 51) were classified as level 4. DISCUSSION/UNASSIGNED:This list of the top 100 most-cited articles highlights seminal and influential papers in VCA. It also demonstrates the relative novelty of this field with ongoing efforts in immunological research to allow its further expansion. The present study provides an understanding of VCA evolution while directing future clinical and preclinical studies.

Full facial vascularized composite allotransplantation (VCA) offers a reconstructive option for patients with severe facial disfigurement who cannot be treated with conventional methods. This article details a surgical protocol for donor procurement of a full facial allograft, focusing on soft tissue with limited bony harvest restricted to the nasal framework, and emphasizes key anatomical landmarks and technical considerations for safe and efficient harvest. The procedure involves dissection of the entire facial soft tissues while preserving the external carotid artery, internal jugular veins and subsequent thyro-linguofacial, and branches of the facial and maxillary nerves to maximize pedicle length for later neurorrhaphy. The protocol describes systematic exposure of the vascular pedicles at their origin in the neck, subperiosteal elevation of the scalp, identification and division of the supraorbital and infraorbital nerves, and preparation of the facial nerve at its root to achieve optimal length. Strategies to minimize ischemia time and ensure allograft integrity are highlighted. This article provides a comprehensive visual guide to the procurement phase of a full soft tissue face allograft and aims to standardize the technique for research application and surgical training in advanced vascularized composite allotransplantation.

BACKGROUND:Whole eye transplantation (WET) has long been looked to as a potential solution for the aesthetic and functional deficits caused by severe ocular pathology and trauma. Here, we describe the first successful combined face and whole eye transplantation (FT/WET), highlighting the logistical, ethical, and technical considerations that enabled this milestone. METHODS:A 46-year-old male with severe facial and ocular deficits underwent multidisciplinary evaluation and was deemed a candidate for FT/WET. Subsequently, a surgical algorithm was developed through rigorous preoperative planning and team based surgical simulations. This process focused on techniques that would allow for efficient graft procurement and inset, while simultaneously limiting trauma to the globe and its adnexa. RESULTS:Longitudinal monitoring demonstrated maintained graft viability throughout the postoperative period. Fluorescein angiography and ICG angiography confirmed robust retinal and choroidal perfusion. Diffusion-weighted MRI revealed structural preservation of the optic tracts, despite inner retinal atrophy. The patient has also experienced significant improvement in facial aesthetics and functionality with no episodes of graft rejection to date. CONCLUSIONS:This case demonstrates the feasibility of addressing deficits once deemed irreparable through advanced surgical techniques, preoperative planning, and multidisciplinary collaboration. Although functional vision recovery has not been observed, this innovation expands the reconstructive options available for patients with severe facial and ocular deficits, paving the way for future advancements in vascularized composite allotransplantation.

Implant-based breast reconstruction (IBBR) remains the most common form of post-mastectomy reconstruction worldwide, offering patients a reliable and accessible option to restore breast contour. Advances in surgical technique, biomaterials, and implant technology have driven rapid evolution in the field, with the dual goals of improving aesthetic outcomes and minimizing patient morbidity. The prepectoral plane has been popularized due to the eliminated risk of animation deformity and reduced postoperative pain. Some concerns remain regarding mastectomy flap thickness and long-term oncologic and aesthetic outcomes. Concurrently, nipple-sparing mastectomy has improved aesthetic results and enabled surgeons to move beyond just restoring breast form and improve functional recovery as well, as demonstrated by surgical efforts aimed at restoring nipple-areolar complex (NAC) sensation. Adjunctive use of biologic matrices and synthetic meshes has broadened reconstructive options, while next-generation implants seek to further enhance outcomes. Balanced against these innovations are important oncologic and systemic safety concerns, including breast implant-related cancers and the ongoing debate over breast implant illness (BII). This review highlights eight current "hot topics" in implant-based breast reconstruction: (1) prepectoral reconstruction, (2) nipple-sparing mastectomy, (3) oncoplastic techniques, (4) nipple-areolar complex (NAC) neurotization, (5) biologic matrices and synthetic meshes, (6) next-generation implants, (7) optimizing aesthetic outcomes, and (8) implant-associated cancer and systemic concerns. Together, these areas define the current landscape of innovation, controversy, and future directions in implant-based reconstruction.

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.

Chronic wounds, especially in diabetic patients, pose a significant clinical challenge due to impaired microvasculature and delayed healing. This study presents Exo-Q, a novel thermoresponsive hydrogel formed by co-gelation of engineered Q protein nanofibers with exosomes, a class of vesicular intercellular communication mediators. Exo-Q transitions from a gel to a viscoelastic solution at physiological temperature, enabling localized, topical delivery of exosomes with an initial burst release followed by sustained release. In a diabetic mouse wound model, Exo-Q effectively delivered human bone marrow multipotent stromal cell-derived exosomes directly to the wound bed, where they accumulated in endothelial cells of granulation tissue without detectable systemic distribution. Exosomes produced under stringent and replicable cell culture conditions consistently carried biomacromolecular cargo enriched for miRNAs with validated targets in angiogenesis-associated genes, indicative of their therapeutic potential. Topical application of Exo-Q resulted in extensive neovascularized granulation tissue, significantly accelerating wound closure to levels comparable to non-diabetic wounds. Importantly, the hydrogel's modular design maintained the functional integrity of Q protein nanofibers and exosomes, demonstrating compatibility with full-thickness human wounds. This platform allows for tailored customization to address critical stages of diabetic wound healing while ensuring efficacy at low dosages, potentially enabling patient-administered treatment. By leveraging advanced biomaterials, Exo-Q advances the therapeutic efficacy of exosome-based interventions for diabetic wounds, offering a localized, non-invasive solution to chronic, non-healing wounds. This innovative hydrogel platform represents a modular therapeutic strategy with significant potential for clinical applications in regenerative medicine.

BACKGROUND:Body contouring surgery (BCS) is a common postoperative trajectory for adults following bariatric surgery, yet research on its application to adolescents is lacking. This scoping review aimed to map the available literature on quality of life (QoL) and potential for BCS in adolescents after bariatric surgery. METHODS:This review followed the Joanna Briggs Institute (JBI) guidance for scoping reviews and is reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). Three electronic databases were queried for studies regarding QoL and BCS in adolescents following bariatric surgery within the last 20 years. A descriptive and thematic analysis was conducted. RESULTS:Twenty-three studies met inclusion criteria. A total of 19 (82.6%) evaluated QoL and 4 (17.4%) explored the role of BCS in adolescents following bariatric surgery. The most common method of data collection was prospective study (65.2%). Two themes were described: QoL after bariatric surgery, which expressed improvement in several domains within 6 months, and role for BCS, which showed high interest in addressing residual excess skin and appearance. Gaps in the literature were identified, including a need for studies exploring mediators of QoL, predictors of compliance, and outcomes of BCS. CONCLUSIONS:Studies describing residual symptoms and BCS in adolescents following bariatric surgery are lacking. BCS may complement bariatric surgery, but further research must be conducted to assess its safety in adolescents. By addressing the research gaps described in this review, physicians may have a better understanding of the needs of this population and how to counsel them. LEVEL OF EVIDENCE AND TYPE OF STUDY/UNASSIGNED:Level IV; Systematic Scoping Review.