Frontiers in Surgery最新文献

{"title":"Context-dependent aesthetic perception after facial local flap reconstruction for cutaneous malignancies: a multi-observer study integrating patient-reported outcomes and public perspective.","authors":"Ersin Yavuz, Esra Zeynep Kurtoğlu, Levent Demir, Alp Ercan","doi":"10.3389/fsurg.2026.1982895","DOIUrl":"10.3389/fsurg.2026.1982895","url":null,"abstract":"<p><strong>Background: </strong>Local flaps are fundamental for reconstruction of facial defects after cutaneous tumor resection, yet perceived aesthetic success may differ among surgeons, patients, and the general public.</p><p><strong>Objectives: </strong>To investigate context-dependent aesthetic perception across facial regions and evaluator groups and its relationship with patient-reported FACE-Q outcomes.</p><p><strong>Methods: </strong>Twenty-three patients undergoing local flap reconstruction after facial tumor resection were evaluated using preoperative and 12-month postoperative photographs. Overall, 203 evaluators-plastic surgeons, non-plastic surgeons, non-surgical physicians, and the general public-rated outcomes on a five-point scale, first using postoperative images alone and subsequently after viewing corresponding preoperative photographs. FACE-Q Face Overall, Natural Appearance, and Psychological Function scales were assessed preoperatively and postoperatively.</p><p><strong>Results: </strong>Preoperative context resulted in significantly more critical ratings across perioral, periocular, and malar regions (all <i>p</i><0.001). Perceptual shifts differed among evaluator groups in perioral (<i>p</i>=0.007) and periocular (<i>p</i>=0.015) regions, with plastic surgeons showing smaller shifts. FACE-Q Face Overall and Natural Appearance scores improved significantly postoperatively. A study-specific summary score derived from the three selected FACE-Q scales was significantly associated with general-public ratings (<i>ρ</i> = -0.56, <i>p</i> = 0.008).</p><p><strong>Conclusions: </strong>Aesthetic assessment after facial local flap reconstruction is context-dependent. Integrating FACE-Q patient-reported outcomes with public perception may provide a more patient-centered assessment of reconstructive success.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1982895"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized 3D-printed osteotomy guide combined with an ultrasonic bone scalpel for precise periapical cystectomy: a case report.","authors":"Jieying Li, Haoyu Sun, Xiaoyang Shan, Zhimin Zhang, Huibin Sun, Kai Zhou","doi":"10.3389/fsurg.2026.1853640","DOIUrl":"10.3389/fsurg.2026.1853640","url":null,"abstract":"<p><p>Periapical lesions persisting after root canal treatment, particularly those radiographically suggestive of true cysts, often necessitate surgical management. This report introduces a synergistic technique for precise periapical surgery in anatomically challenging areas, combining a 3D-printed osteotomy guide with an ultrasonic bone scalpel. A personalized, tooth-supported osteotomy guide was designed based on fused cone-beam computed tomography (CBCT) and intraoral scan data to ensure accurate localization of the lesion and minimal buccal bone window dimensions. An ultrasonic bone scalpel was then employed to execute the planned osteotomy, facilitating the reflection of a buccal bone lid that remained attached to the mucoperiosteal flap. Following complete cyst enucleation and apical resection, retrograde root canal filling was performed under microscopic vision. The pedicled bone lid was subsequently repositioned to promote healing and prevent soft tissue ingrowth. This combined protocol effectively addresses the challenges of limited visibility and access in the posterior maxilla, demonstrating a precise and minimally invasive approach for managing complex periapical lesions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1853640"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The degeneration of uncovertebral joints on CT assessment and its association with postoperative heterotopic ossification in one- or two-level artificial cervical arthroplasty.","authors":"Yi Yang, Weiyang Zhong","doi":"10.3389/fsurg.2026.1911386","DOIUrl":"10.3389/fsurg.2026.1911386","url":null,"abstract":"<p><strong>Background: </strong>Artificial cervical arthroplasty (ACR) preserves segmental mobility and reduces adjacent segment degenerative disease risk, yet postoperative heterotopic ossification (HO) impairs prosthetic function. Preoperative uncovertebral joint degeneration (UJD) is hypothesized to relate to HO. This study evaluated UJD on computed tomography (CT) and explored its association with HO after one- or two-level ACR, adjusting for confounders.</p><p><strong>Methods: </strong>Forty patients undergoing one- or two-level ACR with a ≥1-year follow-up (2013-2019) were enrolled. UJD was graded using a modified Kellgren-Lawrence (K-L) CT system; final follow-up HO was assessed on radiographs using the McAfee classification. Generalized estimating equations (GEE) were used to address intrapatient clustering and confounders. Binary and ordinal logistic GEE, including proportional odds testing and sensitivity analyses, assessed independent UJD-HO associations. Stratified Spearman correlations were applied only for exploratory subgroup analyses.</p><p><strong>Results: </strong>Overall HO incidence was 92.0%, with four segments at McAfee grade 0. After adjusting for age, sex, follow-up duration, operative level number and preoperative range of mobility, GEE showed non-significant trends linking higher-grade UJD to greater HO occurrence [adjusted odds ratio (aOR) = 12.561, 95% CI 0.885-178.247, <i>P</i> = 0.061] and severity (aOR = 1.493, 95% CI 0.863-2.585, <i>P</i> = 0.152). Partial proportional odds sensitivity analyses showed consistent results. Severe HO distribution imbalance and a scarcity of HO-negative segments led to unstable effect estimates and wide confidence intervals.</p><p><strong>Conclusions: </strong>After adjusting for intrapatient clustering and confounders, preoperative UJD was not an independent predictor of HO onset or progression after ACR. Despite a positive trend, the high HO incidence caused a ceiling effect and limited statistical power, and thus, UJD's predictive value could not be confirmed. This CT-based modified K-L grading system reliably quantifies UJD and supports preoperative imaging evaluation for ACR candidates.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1911386"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beveled vs. perpendicular skin incisions on the back: a case report.","authors":"Yong Dong, Huang Lin, Bo Li","doi":"10.3389/fsurg.2026.1951272","DOIUrl":"10.3389/fsurg.2026.1951272","url":null,"abstract":"<p><p>This is a case report describing a within-patient self-controlled comparison of 45° beveled and 90° perpendicular skin incisions on the back in a 56-year-old female undergoing benign lipoma excision. Beveled skin incisions are routinely recommended in aesthetic surgery for their ability to enlarge dermal contact areas and facilitate favorable wound edge apposition, particularly in low-tension, thin cutaneous regions such as the face and neck. However, whether this cosmetic advantage extends to high-tension, thick-skin sites like the back remains unclear. This case report addresses this gap, and the specific novelty of this report is twofold: (1) it compares 45° beveled and 90° perpendicular incisions within the same patient and the same continuous dorsal wound, thereby reducing inter-individual confounding variables; (2) it focuses on a high-tension, thick-dermis, shear-prone dorsal site, whereas most prior evidence comes from low-tension facial or neck skin. This case report follows the CARE guidelines. One single continuous incision was split into two segments: the proximal segment adopted a 90° perpendicular full-thickness skin cut, and the distal segment a 45° beveled incision. All surgical steps and standardized postoperative anti-scar treatment were kept identical for both segments. Serial scar evaluations were conducted at 1, 3, 6, and 12 months postoperatively using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). At the 12-month follow-up, the beveled segment formed prominent, firm hypertrophic scars with pigment irregularities, while the perpendicular segment healed into flat, soft tissue with more favorable cosmetic outcomes. Differences in hypertrophic scar severity could be detected at every follow-up visit. However, exclusive causal attribution to incision angle cannot be confirmed, as subtle local differences between wound segments cannot be fully excluded. This case report is limited to a single patient and lacks comparison groups with intermediate bevel angles; therefore, it only offers hypothesis-generating preliminary observational evidence that the cosmetic advantages of beveled incisions may vary by anatomical site and may not translate to the back under high biomechanical stress. Observations raise the hypothesis that perpendicular skin incisions may merit consideration for dorsal operations; however, definitive clinical recommendations cannot be established from a single-patient experience alone.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1951272"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of PFNA vs. long-stem hemiarthroplasty for unstable proximal femur fractures in older adults: a retrospective cohort study.","authors":"Peiran Wei, Weihang Zhu, Yan Xu, Xuxiang Li, Zhicheng Cao, Liming Wang, Cheng Tang","doi":"10.3389/fsurg.2026.1889099","DOIUrl":"10.3389/fsurg.2026.1889099","url":null,"abstract":"<p><strong>Objective: </strong>The optimal surgical management of unstable extracapsular proximal femur fractures (AO/OTA types A2 and A3) in elderly patients with osteoporosis remains controversial. This study compared clinical outcomes of proximal femoral nail antirotation (PFNA) vs. primary uncemented bipolar hemiarthroplasty with long femoral stem in patients aged ≥75 years. The primary outcome was reoperation rate within 24 months; secondary outcomes included perioperative parameters, functional recovery, complications and mortality.</p><p><strong>Methods: </strong>A retrospective comparative study was conducted including 174 patients (mean age 82.2 ± 7.1 years, 61.5% female) treated between January 2018 and December 2023. Patients underwent either PFNA (<i>n</i> = 96) or hemiarthroplasty (HA, <i>n</i> = 78). Primary outcomes included perioperative parameters, functional recovery [Harris Hip Score (HHS), Barthel Index], complications, reoperations, and mortality at 12 and 24 months.</p><p><strong>Results: </strong>Mean operative time was shorter in the PFNA group (59.6 vs. 74.2 min, <i>P</i> < 0.001), while HA patients achieved earlier ambulation (2.8 vs. 6.2 days, <i>P</i> < 0.001) and full weight-bearing (4.2 vs. 62.8 days, <i>P</i> < 0.001). HHS was higher in the HA group at 3 months (71.6 vs. 66.8, <i>P</i> < 0.001) and 6 months (78.2 vs. 74.6, <i>P</i> = 0.004), but similar at 24 months. Reoperation rates (7.7% vs. 19.8%, <i>P</i> = 0.03) and 2-year mortality (2.6% vs. 11.5%, <i>P</i> = 0.02) were significantly lower in the HA group. Multivariable analysis identified PFNA as an independent risk factor for complications (OR = 1.92) and reoperation (sHR = 2.78).</p><p><strong>Conclusions: </strong>In geriatric patients with unstable extracapsular femoral fractures, long-stem hemiarthroplasty was associated with faster early recovery, lower reoperation rates, and a lower observed 2-year mortality compared to PFNA, which may be considered as an alternative primary option in appropriately selected elderly patients. However, given the retrospective design and potential for residual confounding, this observed association should not be interpreted as a causal effect, which should be confirmed by future prospective randomized trials.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1889099"},"PeriodicalIF":1.9,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: A case of severe chronic infection of an intraperitoneally placed composite mesh treated with complete mesh explantation and primary tissue repair using the anterior component separation technique.","authors":"Branko Bakula, Marko Sever, Ante Ivkošić, Zvonko Zadro, Maja Bakula, Ivan Romić, Davor Mijatović","doi":"10.3389/fsurg.2026.1892681","DOIUrl":"10.3389/fsurg.2026.1892681","url":null,"abstract":"<p><strong>Introduction: </strong>The introduction of synthetic mesh has fundamentally changed the management of ventral hernias by substantially reducing recurrence rates compared with primary suture repair. However, mesh implantation carries an inherent risk of foreign body-related complications, most notably mesh infection. Although uncommon, mesh infection following ventral hernia repair is a potentially devastating complication that often requires complex surgical management. Treatment strategies range from attempts at mesh preservation to complete mesh explantation followed by abdominal wall reconstruction with or without the use of a biologic mesh. The leading risk factors for mesh infection include postoperative wound complications and inappropriate mesh selection or placement.</p><p><strong>Case presentation: </strong>We present the case of a 29-year-old man who sustained a splenic rupture in a traffic accident. At another institution, he underwent emergency splenectomy, during which a large composite mesh was implanted in the intraperitoneal position. Approximately three months later, purulent discharge developed from the laparotomy wound, followed shortly thereafter by exposure of part of the mesh. He presented to our institution with a large ventral hernia, extensive exposure of an infected mesh, and persistent purulent drainage. Abdominal MSCT excluded an enteric fistula and demonstrated a ventral hernia with a transverse defect measuring 14 cm, together with conglomerates of contracted mesh located beneath the skin. Complete mesh explantation was performed, followed by definitive abdominal wall reconstruction without implantation of a new mesh. Primary tissue repair was achieved using anterior component separation to facilitate tension-free midline fascial closure. The operation and postoperative recovery were uneventful.</p><p><strong>Discussion: </strong>Mesh infection remains an important complication of ventral hernia repair and is likely to continue to be encountered in clinical practice. Nevertheless, the clinical benefits of mesh-based repair generally outweigh the associated risks, and mesh implantation remains the standard of care for most ventral hernias. Future efforts should therefore focus on preventing mesh infection, particularly through structured surgeon education on appropriate mesh selection, optimal mesh placement, and adherence to sound surgical principles in ventral hernia repair.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1892681"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of medial open wedge HTO in the treatment of medial unicompartmental knee osteoarthritis with mild and moderate varus.","authors":"Fuji Ren, Binyang Meng, Zi Zhang, Wenhe Li, Dong Zhao, Rui Wang, Jingmin Huang, Jiangang Cao","doi":"10.3389/fsurg.2026.1942837","DOIUrl":"10.3389/fsurg.2026.1942837","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of medial open wedge high tibial osteotomy (MOWHTO) in patients with medial unicompartmental knee osteoarthritis (OA) and mild to moderate varus deformity.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on knee OA patients who underwent MOWHTO between January 2019 and January 2021, with a minimum follow-up of two years. Patients with medial unicompartmental knee osteoarthritis of Kellgren-Lawrence grade II-III were categorized by preoperative hip-knee-ankle (HKA) angle into mild varus (0° < HKA < 5°) and moderate varus (5° ≤ HKA < 10°) groups. The mild varus group included 30 patients (mean age, 57 ± 6 years), and the moderate varus group included 30 patients (mean age, 58 ± 5 years). Pre- and postoperative assessments included radiographic evaluations, arthroscopic findings, and clinical outcome measures.</p><p><strong>Results: </strong>Both groups demonstrated significant postoperative changes in HKA angle and weight-bearing line ratio, together with a significant increase in medial joint space width (<i>P</i> < 0.05). The distribution of Kellgren-Lawrence grades shifted toward lower grades at the 2-year assessment in both groups. Similarly, second-look arthroscopy at two years showed a shift toward lower International Cartilage Repair Society (ICRS) grades in both groups, with no statistically significant between-group differences (<i>P</i> > 0.05). Both groups demonstrated significant improvements in Short Form-12 (SF-12) and Knee Injury and Osteoarthritis Outcome Score (KOOS) measures (<i>P</i> < 0.05), while no statistically significant between-group differences were detected in postoperative KOOS or SF-12 scores (<i>P</i> > 0.05). Changes in KOOS and SF-12 scores exceeded the minimal clinically important difference (MCID) thresholds in both groups.</p><p><strong>Conclusion: </strong>MOWHTO was associated with favorable short-term outcomes in carefully selected patients with medial compartment knee osteoarthritis and mild or moderate varus deformity. No statistically significant differences in postoperative outcomes were detected between the two groups. Further comparative studies are required to determine the relative effectiveness of MOWHTO in patients with mild varus alignment.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1942837"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive implementation of patient blood management and declining transfusion rates in major orthopedic surgery. A single-centre experience.","authors":"Matic Kolar, Boštjan Kocjančič","doi":"10.3389/fsurg.2026.1918812","DOIUrl":"10.3389/fsurg.2026.1918812","url":null,"abstract":"<p><strong>Introduction: </strong>Patient Blood Management (PBM) has become an essential component of contemporary perioperative medicine. Major orthopedic surgery has historically been associated with substantial perioperative blood loss and high allogeneic transfusion rates. The aim of this study was to describe the temporal association between the progressive implementation of a multidisciplinary PBM programme and transfusion rates in major orthopedic surgery at our institution.</p><p><strong>Materials and methods: </strong>This retrospective observational single-centre study on annual institutional aggregated data included patients undergoing major orthopedic procedures, including total hip arthroplasty (THA), total knee arthroplasty (TKA), and major spine surgery (MSS), between 2012 and 2018. The PBM programme incorporated a multidisciplinary perioperative approach consisting of preoperative anemia management, restrictive transfusion thresholds, a single-unit transfusion policy, routine tranexamic acid (TXA) administration, meticulous surgical hemostasis, minimally invasive surgical techniques, and selective use of intraoperative cell salvage systems. Annual transfusion rates and PBM-related interventions were analysed over the study period for the overall cohort and separately for each procedure group.</p><p><strong>Results: </strong>A total of 7,439 major orthopedic procedures were analysed. Overall transfusion rates decreased from 38.1% in 2012 to 9.2% in 2018, corresponding to an absolute reduction of 28.9% and a relative reduction of 76.0%. Similar reductions were observed for THA (45.0% to 13.6%), TKA (31.7% to 4.6%), and MSS (32.1% to 9.1%). Logistic regression demonstrated that each additional calendar year was associated with a significant reduction in the odds of transfusion in the overall cohort (OR 0.72, 95% CI 0.70-0.74; <i>p</i> < 0.001), with comparable trends observed for each surgical subgroup. During the same period, TXA utilization increased progressively, reaching a mean of 2.1 g per procedure in 2018, whereas intraoperative cell saver use became increasingly selective.</p><p><strong>Conclusion: </strong>The present study demonstrates that multidisciplinary PBM implementation substantially reduces transfusion requirements in major orthopedic surgery. PBM should not be regarded as a single intervention, but rather as a coordinated perioperative strategy based on synergistic implementation of multiple blood conservation measures, resulting in improved perioperative management.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1918812"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of bone marrow aspirate and bone marrow aspirate concentrate in orthopedic conditions: a systematic review of randomized controlled trials.","authors":"Joelington Dias Batista, Ludimila Dias Silva, Jobson Dias Batista, Gabrielly Santos Pereira, Marcelo Lourenço da Silva","doi":"10.3389/fsurg.2026.1932090","DOIUrl":"10.3389/fsurg.2026.1932090","url":null,"abstract":"<p><strong>Introduction: </strong>Bone marrow aspirate (BMA) and bone marrow aspirate concentrate (BMAC) have emerged as autologous orthobiologic strategies aimed at modulating inflammation and promoting tissue repair in orthopedic conditions. However, evidence from randomized controlled trials (RCTs) remains heterogeneous, and their clinical role relative to established treatments is still debated. This systematic review aimed to evaluate the efficacy, structural effects, and safety of BMA and BMAC in adults with orthopedic conditions based exclusively on RCT evidence.</p><p><strong>Methods: </strong>A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Web of Science were searched from December 2015 to December 2025. Eligible studies were RCTs comparing BMA or BMAC with placebo, conventional injective therapies, exercise therapy, or standard surgical procedures. Outcomes included pain, functional performance, imaging-based structural healing, treatment failure or revision, and safety. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and results were synthesized narratively.</p><p><strong>Results: </strong>Twenty-one RCTs involving knee osteoarthritis, ACL injury or reconstruction, rotator cuff tears, focal cartilage defects, osteonecrosis, discogenic low back pain, and glenohumeral osteoarthritis were included. Across trials, BMA/BMAC was generally associated with improvements in pain and function, although superiority over comparators was inconsistent and depended on the clinical condition and treatment strategy.</p><p><strong>Discussion: </strong>Signals of greater benefit were observed in selected patients with early-stage knee osteoarthritis, focal cartilage pathology, nonsurgical ligament injuries, and rotator cuff disorders.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251241519, identifier CRD420251241519.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1932090"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salivary microRNAs for oral cancer and oral potentially malignant disorder triage: a scoping review and evidence map.","authors":"Jianbang Ding, Han Jiang, Shanyue Lin, Dinghua Li, Ying Zeng","doi":"10.3389/fsurg.2026.1949232","DOIUrl":"10.3389/fsurg.2026.1949232","url":null,"abstract":"<p><strong>Background: </strong>Salivary microRNAs (miRNAs) have been investigated for oral cancer detection, but comparison with healthy volunteers does not establish performance among patients with oral mucosal lesions. This review maps evidence relevant to discrimination between oral squamous cell carcinoma or oral cancer (OSCC/OC) and oral potentially malignant disorders (OPMDs).</p><p><strong>Methods: </strong>The evidence was organized as a scoping review with study-specific diagnostic descriptions. Clinical comparators, assay methods, thresholds, participant overlap and data provenance were charted. No estimates were pooled. Searches were executed on 8 September 2026 in PubMed (<i>n</i> = 487), Web of Science Core Collection (<i>n</i> = 362), Scopus (<i>n</i> = 318) and the Cochrane Central Register of Controlled Trials (<i>n</i> = 34), with 28 additional records identified through citation chasing and reference-list checking, for a total of 1,229 records. After removal of 412 duplicates and 15 records before screening, 802 titles and abstracts were screened; 54 full-text reports were sought, of which 3 could not be retrieved and 51 were assessed. Sixteen sources were included in the evidence map, comprising 13 primary studies and 3 contextual systematic reviews.</p><p><strong>Results: </strong>Three diagnostic reports contained five assay-level results for cancer vs. OPMD or oral lichen planus. A four-miRNA panel was reported to have 90% sensitivity and 82.7% specificity in 50 OC and 52 OPMD participants. Two individual miRNAs evaluated in the same 30 OSCC and 30 OPMD participants each had reported sensitivity of 70% and specificity of 60%. An additional oral lichen planus comparison had uncertain ROC analysis denominators and was retained without reconstructed counts. Repeated assays within a cohort were not considered independent studies. Small selected samples, data-derived thresholds, inconsistent reporting and limited independent validation restricted interpretation.</p><p><strong>Conclusions: </strong>Salivary miRNAs have shown study-specific discrimination between cancer and selected OPMD groups. Evidence does not establish a transportable accuracy estimate or clinical benefit for lesion triage. Prospective evaluation in consecutive lesion cohorts is needed before these assays can inform biopsy, referral or surveillance decisions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1949232"},"PeriodicalIF":1.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}