Abstract

Surgical decompression of Carpal Tunnel Syndrome (CTS) by the standard open carpal tunnel release (OCTR) technique is associated with postoperative pain and tenderness. To address these limitations, endoscopic carpal tunnel release (ECTR) was introduced, offering a minimally invasive alternative aimed at reducing complications through a shorter incision, thereby decreasing scar pain and enabling faster recovery. This study aims to compare the outcomes of OCTR and ECTR based on randomized controlled trial (RCT) evidence. A systematic literature search was conducted across PubMed, Web of Science, EBSCO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) software. Standard mean difference and 95% confidence intervals were used for continuous outcomes, while odds ratios with 95% confidence intervals were employed for dichotomous outcomes. A total of 34 studies were included in the analysis. The findings demonstrated that ECTR significantly reduces scar pain and shortens recovery time compared to OCTR. However, no significant differences were observed between the two techniques regarding complication rates, incidence of local pain, mean pain scores, subjective complete or near-complete symptom relief, subjective satisfaction rates, mean satisfaction scores, symptom severity scores, functional status scores, or mean operative time. In conclusion, both ECTR and OCTR are safe and effective for managing CTS, but ECTR provides advantages in terms of reduced scar pain and faster postoperative recovery.

Abstract

Cleft rhinoplasty presents unique challenges due to the complex interplay of structural, soft tissue, and functional deformities associated with cleft lip and palate. Patients typically exhibit significant nasal

asymmetry, soft tissue discrepancies, septal deformities, and deficient nasal tip support, all compounded by scarring from previous surgeries and unpredictable wound healing. Functional concerns, such as nasal airway obstruction, further complicate management, necessitating a careful balance between aesthetic and functional outcomes. Primary rhinoplasty, performed during initial cleft lip repair, aims to restore nasal contour, symmetry, and projection by repositioning the lower lateral cartilages and correcting septal alignment, while considering the nose’s and lip’s interrelationship. Secondary rhinoplasty is reserved after facial growth

completion, utilizing an open approach for optimal visualization and anatomical reconstruction. Techniques include cartilage grafting for structural support, osteotomies for dorsal realignment, and various grafts to enhance tip definition and correct alar malposition. Preoperative interventions, such as alveolar bone grafting and maxillary osteotomies, are crucial for establishing skeletal support. Despite advances in surgical

technique, achieving ideal symmetry and patient satisfaction remains challenging due to intrinsic anatomical limitations and high patient expectations. Ultimately, successful cleft rhinoplasty requires individualized planning, meticulous surgical execution, and realistic goal-setting to optimize form and function in this

complex patient population

Abstract

Hyperspectral imaging (HSI) has emerged as a transformative technology especially in terms of diagnostics in medicine and therewith also in plastic surgery. HSI captures a wide spectrum of light wavelengths beyond the visible range and those of other clinically used imaging technologies such as MSI (Multispectral Imaging) and NIRS (Near-Infrared-Spectroscopy). Therefore the amount of acquired data increases drastically and can provide broader information to support clinicians regarding tissue viability assessment, monitoring of (burn-) wound healing and surgical intervention guidance. The following article aims to provide an overview of the current scientific understanding and HSI applications already used (and in the making) focusing on burn care, flap surgery and wound management while also mentioning possible applications in the discipline. 

Fundamentals of Hyperspectral Imaging

HSI, originally invented for assessing soil quality and geological analysis of examined land, gained interest in the field of medicine in the past 30 years for good reason. HSI involves collecting and processing information from across the electromagnetic spectrum normally ranging between 400-1000 nm which enables this technology to provide information in depth of the skin estimated from 5 to 8mm under skin level. By this HSI can collect information on the microcirculation of skin or other tissue with blood flow.  Since every biochemical structure is unique in its traits of absorbing and re-emitting light, statements on perfusion and distribution of tissue components can be made. To gain the remission spectrum, skin areas are getting illuminated with normal white light throughout the imaging process, while the re-emitted wavelengths of the skin are getting collected. Usually the imaging process takes no longer than 5 seconds, delivers accessible data while still being non-invasive.

Applications in Burn Care

The classification of burn depth and severity remains uncertain and often subjective depending on the experience of the burn surgeon but is crucial for determining the appropriate treatment strategy. In recent years different approaches for the assessment of burn depths and severity categorisation have been published. Hyperspectral Imaging is considered a promising technology to be used for burn classification due to its abilities of tissue evaluation. Parasca et al. 2022 suggested object-oriented wound mapping based on HSI for better surgical guidance performing with high accuracy, precision, sensitivity and specificity all above 95%. Schulz et al. 2022 suggested a skin layer based assessment tool for perfusion level of burned skin to predict the healing process and burn severity within the first days after burn, performing with a sensitivity of 92% and a specificity of 71%. But still some work has to be done since Wild et al. 2025 proceeded on this approach and found that the deepening process in the first few days even hinders HSI in predicting wound dynamics to certain extent. Nevertheless Hyperspectral Imaging facilitates early and precise decision-making regarding the need for surgical intervention, such as debridement or grafting, ultimately improving patient outcomes and in-time and objective data-based reevaluation of burn wounds in the future.​

Enhancing Flap Surgery

Flap procedures, which involve the transfer of tissue with its blood supply to reconstruct defects, are fundamental in plastic and reconstructive surgery. The success of these procedures heavily relies on the viability of the transplanted tissue. By detecting early signs of ischemia or compromised blood flow, HSI enables timely interventions to salvage at-risk flaps, thereby reducing the incidence of flap failure and associated complications. Kohler et al. 2021 stated that HSI can play a significant role in intra- and post-operative flap perfusion and viability screening, since it provides essential parameters like hemoglobin oxygenation and perfusion rate c what seems to make HSI superior to LSI or others. According to Schulz et al. 2023 HSI is more sensitive to free-flap failure within the first 24 h after transplantation but clinical examination has been found superior to HSI within the first 72 h post surgery. In the end hyperspectral imaging can already have an impact in assisting clinical examination of flaps, while still not being gold standard on its own. Yet it holds a good prospect to emerge more impactful in the next few years with ongoing research and technology development.

Advancements in Wound Management

The healing of wounds is directly related to perfusion status of the wound bed. That is why the examination of the related parameters should be key to the prediction of wound healing and the decision on most suitable wound care. HSI can supply such data about tissue oxygenation, hemoglobin concentration, and the presence of necrotic tissue by multiple parameters instantly available after imagetaking. Daeschlein et al. 2017 found it suitable for wound monitoring in multiple cases. This direction is supported by the reviewing from Seiko et al. 2020 according to which HSI can highly impact and enhance wound prevention and treatment but still needs point of care testing and comparison based evaluation with other diagnostic tools.

Perspectives in Aesthetic Surgery
Even in the field of aesthetic surgery, HSI can provide guidelines for treatment evaluation, monitoring, healing assessment, and visualization. Almost no reliable research has been conducted specifically to test HSI for aesthetic applications. However, drawing on basic HSI parameters, the previously mentioned TWI, in combination with inflammation-related HSI markers, can aid in identifying suitable sites for hyaluronan or botox injections in facial areas. Moreover, HSI can map collagen (Vyas et al., 2013) and distinguish between types I and III, both of which are crucial for evaluating the scarring process.Additionally, the integration of HSI with 3D photography for improved skin surface, depth, and breast surgery evaluation is a promising tool in aesthetic surgery and treatment consultation, as already implemented in some practices.

Abstract

Acetabular reconstruction in revision total hip arthroplasty presents a complex surgical challenge due to factors such as bone loss, implant loosening, and compromised soft tissue. The goal of reconstruction is to restore hip biomechanics, achieve implant stability, and promote biological fixation. A variety of techniques have been developed to address the spectrum of acetabular deficiencies, ranging from minor cavitary defects to massive segmental bone loss.

Reconstruction strategies are typically guided by classification systems like the Paprosky or AAOS classifications, which help assess the severity and type of bone loss. In cases of mild to moderate defects, options such as cementless hemispherical cups with or without bone grafting can be effective. For more extensive defects, porous metal augments, custom triflange components, and cages may be required to restore the integrity of the acetabular column and achieve implant fixation.

Structural allografts and impaction bone grafting continue to have a role in specific scenarios, particularly in younger patients where biological restoration is prioritized. The key features of the technique of acetabular bone grafting include restoration of bone stock with all its inherent benefits, providing a stable acetabular component and restoration of an anatomical hip center.  The procedure requires the impaction of cancellous bone chips into a contained bone defect. Impaction is achieved through careful employment of various impactors, and is an essential part of the success of the technique. Morcellisation of the bone graft allows adaptation to any shape of the contained defect.

Despite advances in surgical technique and implant design, acetabular reconstruction remains associated with a higher risk of complications such as infection, dislocation, and implant failure. Success depends on accurate preoperative planning, selection of appropriate reconstructive strategy, and meticulous surgical execution. This review summarizes current techniques of bone grafting in acetabular reconstruction, highlighting the need for individualized approaches to optimize results in complex revision hip revision cases.