Frontiers in Surgery最新文献

{"title":"Age is the wrong axis: rethinking surgical selection for octogenarians with early-stage non-small cell lung cancer.","authors":"Vasiliki Androutsopoulou, Prokopis-Andreas Zotos, Dimitrios E Magouliotis","doi":"10.3389/fsurg.2026.1961761","DOIUrl":"10.3389/fsurg.2026.1961761","url":null,"abstract":"<p><p>Lung cancer is increasingly a disease of older age, and as low-dose computed tomography screening extends into the ninth decade, a growing number of octogenarians present with early-stage, potentially curable non-small cell lung cancer. Faced with these patients, clinicians repeatedly ask a single question: is this patient too old for surgery? Recent prospective data show that selected octogenarians achieve long-term survival comparable to younger patients despite substantially higher complication rates, with quality of life that recovers over the first postoperative year. Yet the favorable result is attributed to careful selection that is rarely defined, and is seldom accompanied by any account of the patients who were assessed and not offered an operation. This article argues that chronological age is the wrong axis for the decision. Physiologic reserve, measurable through validated frailty instruments and established physiologic testing, predicts postoperative outcome far better than birth year, and aging is sufficiently heterogeneous that any age threshold misclassifies patients in both directions. A substantial competing risk of non-cancer death, compounded by overdiagnosis among screen-detected tumors, tempers the survival gain expected from aggressive treatment and makes overtreatment as real a hazard as age-based exclusion. A graded menu of options now exists, extending from minimally invasive lobectomy through sublobar resection and stereotactic ablative radiotherapy to active surveillance, and intensity should descend with reserve rather than with age. The task is to operationalize careful selection through structured geriatric assessment, multidisciplinary collaboration, prehabilitation, and shared decision-making, and to judge success by outcomes that older patients actually value.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1961761"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215954","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":"Pseudo-cerebrospinal fluid rhinorrhea following endoscopic endonasal transsphenoidal surgery for PitNET: a case report and literature review.","authors":"Guotao Peng, Jiankuai Zhou, Jun Mo","doi":"10.3389/fsurg.2026.1945557","DOIUrl":"10.3389/fsurg.2026.1945557","url":null,"abstract":"<p><p>Pseudo-cerebrospinal fluid (CSF) rhinorrhea, defined as non-CSF nasal discharge mimicking true CSF leakage, is a rare but clinically significant complication that may prompt unnecessary aggressive treatment. We report a case of a 64-year-old man who developed positional clear nasal discharge after endoscopic endonasal resection of recurrent pituitary neuroendocrine tumor (PitNET). Glucose oxidase testing was negative, and imaging demonstrated intact skull base reconstruction. Nasal endoscopy revealed bilateral crusting and purulent secretions without evidence of CSF leak. The condition was diagnosed as vasomotor rhinitis. Conservative management-including nasal debridement, antibiotic therapy, topical corticosteroids, and saline irrigation-led to complete symptom resolution. This case underscores the importance of differentiating pseudo-CSF rhinorrhea from true CSF rhinorrhea to avoid invasive interventions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1945557"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215816","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":"Risk factors and prediction model for post-endoscopic lithotripsy infections.","authors":"Xiaotao Liang, Ziyong Lei, Yuxi Chen, Wei Fang, Ruming Liu, Xiaoyu Liu, Yizhe Yang, Lianhong Gao, Yongming Jiang","doi":"10.3389/fsurg.2026.1861286","DOIUrl":"10.3389/fsurg.2026.1861286","url":null,"abstract":"<p><strong>Objective: </strong>To identify independent risk factors for infectious complications (fever, SIRS, sepsis) after endoscopic lithotripsy and construct a multi-outcome hierarchical prediction model.</p><p><strong>Methods: </strong>Retrospective study of 914 patients (<i>n</i> = 914). Primary analysis used multinomial logistic regression for sepsis; sensitivity analysis used binary logistic regression for fever and SIRS with backward elimination. Bootstrap validation, AUC, calibration (MAE), and DCA were performed.</p><p><strong>Results: </strong>Primary analysis: positive urine culture (OR = 3.36), previous surgery (OR = 3.62), radiological signs of infection (OR = 4.02), and combined surgery (OR = 4.95) were independent risk factors for sepsis (AUC=0.794, MAE=0.008). Fever model: radiological signs and surgical modality (AUC=0.715). SIRS model: radiological signs and ULE+++ (OR = 5.1, AUC=0.73). DCA showed net clinical benefit for all three models.</p><p><strong>Conclusion: </strong>The multi-outcome hierarchical model effectively predicts postoperative infection risk. Nomograms guide individualized perioperative interventions.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1861286"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215760","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":"Modern hysteroscopic management of congenital uterine anomalies: current techniques, emerging technologies, and future directions.","authors":"Mariana da Cunha Vieira, Giovanna C C Martin, Katherine A R Miller, Juliana A Oliveira, Ana Clara P Servidoni, Mauricio S Abrao","doi":"10.3389/fsurg.2026.1931279","DOIUrl":"10.3389/fsurg.2026.1931279","url":null,"abstract":"<p><strong>Background: </strong>Congenital uterine anomalies are clinically relevant in reproductive medicine, particularly among women with infertility, recurrent pregnancy loss, adverse obstetric outcomes, or obstructive symptoms. Hysteroscopy has transformed the management of correctable intracavitary anomalies by enabling conservative, image-guided reconstruction of the uterine cavity while avoiding the morbidity of historical abdominal metroplasty.</p><p><strong>Scope: </strong>This narrative review critically examines contemporary hysteroscopic management of septate uterus, dysmorphic uterus, bicorporeal septate uterus and rare obstructive malformations, such as Robert's uterus. We discuss the implications of the ESHRE/ESGE, CUME, and ASRM classification systems; the role of three-dimensional transvaginal ultrasound and magnetic resonance imaging in preoperative mapping; and the technical principles that guide metroplasty, cavity remodeling, ultrasound-guided hysteroscopy, office-based metroplasty, and staged approaches in complex anatomy.</p><p><strong>Discussion: </strong>Bipolar saline-based platforms, miniaturized resectoscopes, bipolar needle electrodes, cold scissors, and selected tissue removal systems have expanded the therapeutic spectrum and improved safety. The evidence supporting surgery remains heterogeneous: the TRUST randomized trial challenged routine septum resection in unselected women, whereas data for T-shaped and other dysmorphic uteri remain largely observational. Emerging technologies, including laser platforms, artificial intelligence-assisted hysteroscopy, and robotic concepts, are promising, but currently lack prospective validation.</p><p><strong>Conclusion: </strong>Optimal management should therefore be individualized, anatomy-driven, and grounded in shared decision-making, with careful preservation of endometrium and myometrium. Standardized reporting, multicenter registries, and prospective comparative studies are needed to define which patients benefit most from hysteroscopic correction.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1931279"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215567","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":"Cross-cultural adaptation, validation, and arabic translation of the rhinoplasty outcome evaluation.","authors":"Feras Alkholaiwi, Yazeed Alghonaim","doi":"10.3389/fsurg.2026.1744891","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1744891","url":null,"abstract":"<p><strong>Background & aim: </strong>Rhinoplasty is among the most commonly performed cosmetic surgeries, yet patient satisfaction with this procedure tends to be lower compared to other facial aesthetic surgeries. To measure patient satisfaction following rhinoplasty, the Rhinoplasty Outcome Evaluation (ROE) questionnaire is employed. Therefore, this research was designed to determine the dependability and accuracy of the Arabic version of the ROE questionnaire.</p><p><strong>Methods: </strong>In this prospective study, the ROE questionnaire was administered to 76 patients who underwent rhinoplasty and seventy-four (74) volunteers who did not require functional or cosmetic nasal surgery. Started from June 2019 up to February 2021, The patients were followed up at 3 and 9 months after the procedure. To compare the initial distribution of questionnaire items between patients and control groups, an unpaired <i>t</i>-test was conducted. Internal consistency was assessed using Cronbach's <i>α</i> (Alpha). Hypothesis testing was performed with a significance threshold of 5%.</p><p><strong>Results: </strong>The control group exhibited a notably higher average total ROE score compared to the patient group, with scores of seventy-eight point six percent (78.6%) and forty-five point six per cent (45.6%), respectively (<i>P</i> < 0.001). Additionally, significant variations were identified in the mean scores of all questionnaire items when comparing baseline responses to both the first and second follow-up responses. The study tool's reliability, determined by Cronbach's <i>α</i> (Alpha), was reported to be 0.83.</p><p><strong>Conclusion: </strong>The Rhinoplasty Outcome Evaluation (ROE) questionnaire has been proven to be a reliable and valid tool for assessing outcomes in Arabic-speaking patients who have undergone rhinoplasty.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1744891"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192524","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":"Changes in parent-rated attention-deficit/hyperactivity disorder symptom scores and sleep parameters during individualized multidisciplinary clinical management in children with comorbid obstructive sleep apnea: a prospective cohort study in Vietnam.","authors":"Mai Nguyen-Thi-Phuong, Mai Nguyen-Thi-Thanh, Robert Joel Goldberg, Hoa L Nguyen, Thang Dac Hoang","doi":"10.3389/fsurg.2026.1941040","DOIUrl":"10.3389/fsurg.2026.1941040","url":null,"abstract":"<p><strong>Objective: </strong>To describe changes in parent-rated attention-deficit/hyperactivity disorder (ADHD) symptom scores, respiratory-polygraphy-derived parameters, and sleep characteristics over 6 months in children with ADHD and comorbid obstructive sleep apnea (OSA) who received individualized multidisciplinary clinical management.</p><p><strong>Methods: </strong>This single-arm prospective cohort study was conducted at Vietnam National Children's Hospital from November 2022 to October 2024. Among 629 children with ADHD screened using the Pediatric Sleep Questionnaire (PSQ), 293 had at least 8 positive responses and underwent home respiratory polygraphy; 147 had clinical features consistent with pediatric OSA and met the prespecified respiratory-polygraphy criterion of a respiratory event index (REI) ≥ 1 event/hour, and 141 completed follow-up. Parent-rated Vanderbilt ADHD Diagnostic Rating Scale (VADRS) scores were assessed at baseline, 3 months, and 6 months. Respiratory-polygraphy and sleep-diary measures were assessed at baseline and 6 months.</p><p><strong>Results: </strong>The mean age was 7.8 years, and 85.8% were boys. After 6 months, mean REI decreased from 11.8 to 4.4 events/hour, and the lowest nocturnal peripheral oxygen saturation (SpO₂) increased from 78.9% to 83.4% (both <i>p</i> < 0.001). Prespecified respiratory-polygraphy severity categories shifted toward less severe categories (McNemar-Bowker <i>χ</i> ²[6] = 70.80, <i>p</i> < 0.001); 73 children (51.8%) improved by at least one category, and 47 children (33.3%; 95% CI, 26.1-41.5%) no longer met the prespecified respiratory-polygraphy criterion for OSA at 6 months. Sleep-onset latency and daytime sleep duration decreased. Nighttime sleep duration increased from 8.4 ± 1.1 to 8.7 ± 0.6 h (mean change, +0.3 h; 95% CI, +0.14 to +0.46; <i>p</i> < 0.001), whereas total 24-h sleep duration decreased by 0.5 h (<i>p</i> < 0.001). Parent-rated ADHD symptom scores decreased across all VADRS domains.</p><p><strong>Conclusion: </strong>Respiratory-polygraphy-derived indices, selected sleep characteristics, and parent-rated ADHD symptom scores improved during 6 months of individualized multidisciplinary clinical management. The uncontrolled design and concurrent interventions preclude causal attribution of these changes to OSA-directed treatment.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1941040"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181589","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":"Research trends in minimally invasive partial splenectomy: a bibliometric mapping review with cross-database comparison.","authors":"Wei Tian, Xu Deng, Chunyuan Yang, Jianxing Tian, Zonglong Zhu, Rui Huang, Wei Pan","doi":"10.3389/fsurg.2026.1941549","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1941549","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive partial splenectomy (MIPS) is used for hereditary hematologic disorders, splenic cysts, hydatid disease, benign tumors, and selected traumatic lesions. However, its literature remains dispersed across patient groups, indications, and surgical specialties. This study mapped the development, contributors, knowledge base, and thematic structure of MIPS research and examined the concordance of its principal patterns across databases.</p><p><strong>Methods: </strong>Articles and reviews published from 1 January 1995 to 29 August 2026 were retrieved from the Web of Science Core Collection (WoSCC), Scopus, and PubMed. WoSCC supported the primary bibliometric and knowledge-mapping analyses; Scopus and PubMed supported cross-database comparisons. Bibliometrix, VOSviewer, and CiteSpace were used to analyze publication output, contributors, keywords, co-cited references, and citation bursts. Database overlap, annual-output correlations, and journal and theme descriptive agreement were also assessed.</p><p><strong>Results: </strong>The final datasets comprised 150 WoSCC, 154 Scopus, and 161 PubMed publications. WoSCC output increased after 2015 and reached 15 publications in 2024, the highest total among complete years. China contributed the most publications (<i>n</i> = 53), while the United States had the highest country-level total link strength. <i>Surgical Endoscopy</i>, <i>Journal of Pediatric Surgery</i>, and <i>Journal of Laparoendoscopic & Advanced Surgical Techniques</i> were the leading sources. Keyword analysis identified eight moderately coherent clusters (Q = 0.4383; mean silhouette = 0.6477), covering partial splenectomy, laparoscopic surgery, hydatid disease, hereditary spherocytosis, pediatric surgery, and operative techniques. Cross-database linkage identified 183 unique publications; 122 (66.7%) occurred in all three databases. Annual publication counts were strongly correlated for 1995-2025 (Spearman's <i>ρ</i> = 0.960-0.979) and after inclusion of partial-year 2026 data (<i>ρ</i> = 0.963-0.978; all <i>P</i> < 0.001). Eight journals appeared in all three database-specific Top-10 lists, and the leading thematic distributions were broadly similar across databases.</p><p><strong>Conclusion: </strong>MIPS research has expanded but remains relatively small, institutionally dispersed, and focused on operative feasibility, technical refinement, and perioperative outcomes. These broad patterns were consistent across the three databases, although the comparisons do not constitute independent external validation. Disease-stratified multicenter studies with standardized long-term assessment of splenic function are needed.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1941549"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192537","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":"Local infiltration anesthesia (anterior field block) vs. general anesthesia for thyroidectomy: effects on operative time, complications, and cost-a GRADE-assessed systematic review and meta-analysis with subgroup analysis.","authors":"Khadeeja Ali Hamzah, Hassan H Eladl, Shehab Elfiqi, Ahmed Abdelkader Saad Elsehsah, Amr E Zeweta, Ahmed Nabil Ali, Mohamed Wagdy, Yousif Hameed Kurmasha, Yasmeen Jamal Alabdallat","doi":"10.3389/fsurg.2026.1697921","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1697921","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Thyroidectomy involves the removal of part or all of the thyroid gland, commonly performed for goiters, hyperthyroidism, or carcinomas, with 450,000-500,000 procedures performed annually in the United States. General anesthesia is traditionally used, providing optimal surgical conditions but associated with risks such as cardiovascular complications and longer hospital stays. Local anesthesia is gaining interest for high-risk patients, offering potentially similar outcomes to general anesthesia, while reducing postoperative complications and costs. The choice of anesthetic technique impacts patient safety, healthcare costs, and overall experience, yet no meta-analysis has previously compared local and general anesthesia for thyroidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;This systematic review and meta-analysis aimed to compare surgical and perioperative outcomes of general anesthesia vs. local anesthesia in thyroidectomy, focusing on operative time, complications, cost, and postoperative recovery, to inform clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was performed from database inception to August 2025. We included randomized controlled trials, cohort studies, and case-control studies comparing local infiltration anesthesia with general anesthesia in patients with thyroidectomy. Key outcomes included operative time, intraoperative and postoperative complications, hospital stay length, pain scores, patient satisfaction, and cost. Data were extracted independently by two authors. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized trials and the Risk of Bias In Non-Randomized Studies of Interventions tool for non-randomized studies. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation framework. Statistical analysis was performed using Review Manager (RevMan), calculating mean differences and risk ratios under a random-effects model, with heterogeneity assessed using the &lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; statistic. Statistical significance was set at &lt;i&gt;p&lt;/i&gt; &lt; 0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The systematic search identified 1,785 studies, of which 252 duplicates were removed. After screening, 1,508 studies were excluded, leading to a full-text review of 25 studies and ultimate inclusion of 5 studies comprising 508 patients undergoing thyroid surgery with either local or general anesthesia. Local anesthesia was associated with a shorter operative time than general anesthesia (mean difference -18.32 min, 95% CI: -27.31 to -9.15), but heterogeneity was high (&lt;i&gt;I&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt; = 95%), and the effect was significant only in cohort studies and not in randomized trials, and therefore, this finding should be interpreted with caution. No si","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1697921"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192513","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: Distal tibial physeal injury secondary to conservative treatment of acute hematogenous osteomyelitis resulting in ankle deformity - highlighting the necessity of regular follow-up.","authors":"Tuo Cheng, Jie Li","doi":"10.3389/fsurg.2026.1827366","DOIUrl":"https://doi.org/10.3389/fsurg.2026.1827366","url":null,"abstract":"<p><p>Ankle deformities most commonly result from physeal injuries following major trauma; those secondary to occult physeal injury without significant antecedent trauma are rarely documented. We report a case of ankle deformity in a 13-year-old boy resulting from distal tibial physeal injury following conservative treatment for acute hematogenous osteomyelitis(AHO) four years earlier; despite initial clinical improvement, the patient was subsequently lost to follow-up. At his return visit, significant ankle discomfort severely compromised daily activities. Following combined distal tibial osteotomy and distal fibular epiphysiodesis, the patient regained normal quality of life. This case highlights a frequently overlooked aspect of AHO in children: despite initial symptom resolution with conservative treatment, regular follow-up is essential to detect occult physeal injury and prevent irreversible deformity. Early diagnosis facilitates timely intervention and may obviate the need for osteotomy. In managing ankle deformity secondary to AHO, combined distal tibial osteotomy and epiphysiodesis effectively corrects the deformity while preserving subsequent growth balance, representing a reliable therapeutic option.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1827366"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192518","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":"Recommendations for microbiological sampling in infected hard-to-heal wounds: an Italian association for cutaneous ulcers (AIUC) perspective.","authors":"Sara Carella, Barbara De Angelis, Barbara Nardi, Francesco Branda, Diego Ceci, Caterina Borghetti, Alessandra Mercuri, Marino Cordellini, Cosimo Maglio, Monica Gonnelli, Riccardo Garcea, Giancarlo Ceccarelli","doi":"10.3389/fsurg.2026.1908843","DOIUrl":"10.3389/fsurg.2026.1908843","url":null,"abstract":"<p><p>Chronic and hard-to-heal wounds represent a significant and growing healthcare burden, frequently complicated by infection and impaired healing. Despite the availability of international guidelines, microbiological assessment in clinical practice remains highly heterogeneous, with substantial variability in sampling techniques, timing, and interpretation of results. This variability occurs within a broader One Health context, where antimicrobial resistance and microbial ecology are shaped by interconnected human, environmental, and healthcare factors. The present recommendations, developed by the Italian Association for Cutaneous Ulcers (AIUC), aim to provide a structured and operational framework for microbiological sampling in infected hard-to-heal wounds. A multidisciplinary expert panel conducted a structured review of the literature and developed consensus-based recommendations through iterative discussion. The resulting framework addresses key aspects of the diagnostic pathway, including indications for sampling, selection of techniques (swab, tissue biopsy, and fine needle aspiration), standard operating procedures, and principles for the interpretation of microbiological findings. The recommendations emphasise a context-driven approach to sampling, recognising the complementary roles of different techniques according to clinical presentation and depth of infection. Particular attention is given to the distinction between colonisation and infection, the limitations of quantitative thresholds, and the impact of biofilm, polymicrobial interactions, and host-related factors on diagnostic accuracy and antimicrobial response. The document also highlights the importance of integrating microbiological data with clinical assessment to support appropriate antimicrobial stewardship. By translating existing evidence into practical and reproducible procedures, these recommendations aim to reduce variability in clinical practice and improve the quality of microbiological diagnostics in wound care. Within a One Health perspective, standardised and reliable microbiological data may also support surveillance of antimicrobial resistance and inform more integrated infection control strategies. The proposed framework supports more consistent clinical decision-making and may contribute to optimising antimicrobial use and patient outcomes across diverse healthcare settings.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"13 ","pages":"1908843"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181853","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}