This week
Real-world Safety and Performance of the Symani Surgical System® in Microsurgical Reconstructive Procedures: Primary Results from the PRIMO Study. Comparative Outcomes of Deep Inferior Epigastric Perforator Flap and Breast Implants in Breast Reconstruction Postmastectomy: A Systematic Review and Meta-analysis. Beyond Flap Survival: Aesthetic Satisfaction and Patient-Reported Outcomes in Microsurgical Lower Limb Reconstruction. Classification Systems & Clinical Outcomes of Axillary Burn Contracture: A Systematic Review & Meta Analysis. Shock wave therapy versus conventional physical therapy for partial-thickness forearm burn scars: A randomized controlled trial. Angiosomes of the medial femoral condyle: Anatomical study of cutaneous perforators. Two-stage bone grafting for nasal correction in late-presenting patients with unilateral cleft: A 3-year comparative study. Symani-Assisted Microsurgery in Head and Neck Reconstruction: A Systematic Review of Indications, Techniques, and Pooled Analysis of Clinical Outcomes. Protective association of free flap reconstruction with vascular restenosis after angioplasty in patients with diabetic foot. Beyond BMI: Using Abdominal Wall Thickness to Guide Patient Selection for DIEP Flap Breast Reconstruction.
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As published in the WeeklyIssue 8 · July 5, 2026

Real-world Safety and Performance of the Symani Surgical System® in Microsurgical Reconstructive Procedures: Primary Results from the PRIMO Study.

Innocenti M et al.·Ann Surg·2026 Jul 3 Reconstruction & Microsurgery
In real-world use across ten centres, robotic microsurgery with the Symani system achieved a 94.1% anastomotic technical success rate and 97.8% free-flap survival at discharge, suggesting the platform performs reliably for microsurgical reconstruction.
Overview

This non-randomized, multicenter post-market study of 412 patients (NCT04843436) evaluated the Symani Surgical System for microsurgical anastomosis in free-flap, nerve-repair, and lymphovenous procedures, with robotic-procedure technical success and procedure-associated complications as primary endpoints.

Key Findings
  • Robotic-procedure technical success was 94.1% (507/539 anastomoses; 95% CI 91.7%–95.9%), and freedom from device-related events was 99.8%.
  • First-attempt intraoperative patency was high, at 91.7% for free flaps (331/361) and 96.2% for lymphovenous anastomoses (225/234).
  • Intraoperative revision was required in 8.4% of free-flap anastomoses versus 3.4% for lymphovenous and 0% for nerve repair.
  • Free-flap survival at discharge was 97.8% (268/274; 95% CI 95.3%–99.2%).
Caveat

The study was single-arm and non-randomized with no conventional-microsurgery comparator, and cases were enrolled both prospectively and retrospectively, so it cannot show whether robotic assistance improves on standard technique.

PubMed (PMID 42393823) Read in the issue
As published in the WeeklyIssue 8 · July 5, 2026

Comparative Outcomes of Deep Inferior Epigastric Perforator Flap and Breast Implants in Breast Reconstruction Postmastectomy: A Systematic Review and Meta-analysis.

Garcia-Romero JM et al.·Plast Reconstr Surg Glob Open·2026 Jun 29 Review Breast
In pooled data, DIEP flaps yielded higher patient-reported satisfaction (BREAST-Q mean difference +9.28) and a lower reconstruction failure rate than implant-based reconstruction, though at the cost of greater donor-site morbidity.
Overview

This systematic review and meta-analysis of 20 studies (3106 patients) compared deep inferior epigastric perforator (DIEP) flaps with implant-based reconstruction after mastectomy, pooling BREAST-Q scores, complications, reconstruction failures, and revision procedures.

Key Findings
  • DIEP reconstruction produced higher overall BREAST-Q scores (mean difference +9.28; P = 0.008), with gains in breast satisfaction, psychosocial well-being, and sexual well-being.
  • Reconstruction failure was lower with DIEP (odds ratio 0.15; P = 0.019).
  • Infection, hematoma, and seroma rates were comparable between techniques, but donor-site morbidity and revision rates were higher with DIEP.
  • Nipple satisfaction, chest physical well-being, and anxiety and depression outcomes showed no significant differences between groups.
Caveat

Most included studies were nonrandomized, leaving the pooled estimates vulnerable to selection bias and residual confounding between patients who receive autologous versus implant reconstruction.

PubMed (PMID 42367714) Read in the issue
As published in the WeeklyIssue 8 · July 5, 2026

Beyond Flap Survival: Aesthetic Satisfaction and Patient-Reported Outcomes in Microsurgical Lower Limb Reconstruction.

Giunta G et al.·Plast Reconstr Surg·2026 Jun 29 Reconstruction & Microsurgery
Local perforator flaps were associated with higher donor-site aesthetic satisfaction and fewer secondary refinements than free flaps in lower limb reconstruction, suggesting donor-site factors drive patient-perceived aesthetic outcome.
Overview

This retrospective single-surgeon cohort of 73 patients undergoing lower limb reconstruction compared free flaps (n=44) with local perforator flaps (n=29), reviewing revision rates and administering a 20-item aesthetic questionnaire covering donor and recipient domains at 12 months.

Key Findings
  • Secondary aesthetic refinement, most often liposuction, occurred in 17.8% overall, with a higher revision rate after free flaps (24.1%) than local flaps (11.9%; p=0.04).
  • Donor-site satisfaction was significantly greater in the local flap group for contour, scar appearance, skin colour, and comfort when clothed.
  • Recipient-site satisfaction scores showed no significant differences between flap types.
  • Several patients who had not voiced dissatisfaction during follow-up reported concerns on the questionnaire, indicating previously unexpressed aesthetic issues.
Caveat

This was a small, single-surgeon retrospective study using a non-validated questionnaire, and only 44 of 73 patients responded, limiting generalizability and raising the potential for responder bias.

PubMed (PMID 42370945) Read in the issue
As published in the WeeklyIssue 8 · July 5, 2026

Classification Systems & Clinical Outcomes of Axillary Burn Contracture: A Systematic Review & Meta Analysis.

Frigic GM et al.·J Burn Care Res·2026 Jul 1 Review Burns & Wounds
Across burn-contracture studies, flap-based axillary reconstruction showed a pooled recurrence rate of 13% and greater abduction gains than skin grafting, suggesting flaps may outperform grafts for both stability and range of motion.
Overview

This systematic review and meta-analysis of 62 studies (1602 patients) examined classification systems and reconstructive outcomes for axillary burn contracture, synthesizing techniques qualitatively and pooling recurrence rates using a random-effects model.

Key Findings
  • Pooled recurrence across 855 reconstructions was 13.0% (95% CI 10.7–15.8) with no heterogeneity (I2 = 0%), and meta-regression suggested higher recurrence with longer follow-up.
  • Flap-based reconstructions achieved greater abduction gains (≈82°) than skin grafting (≈52°).
  • Formal classification systems were inconsistently applied, with the Kurtzman and Stern classification used most often (16.1% of studies).
  • Commonly reported techniques were trapeze flap plasties (n=277), skin grafting (n=239), skin grafting with local flaps (n=85), and Z-plasties (n=85).
Caveat

Most included studies were observational with inconsistent outcome and classification reporting, and planned subgroup analyses by contracture type were not feasible, so technique comparisons may reflect case selection rather than true differences.

PubMed (PMID 42384946) Read in the issue
As published in the WeeklyIssue 8 · July 5, 2026

Shock wave therapy versus conventional physical therapy for partial-thickness forearm burn scars: A randomized controlled trial.

Elgohary HM, Elfeky HM, Elfahl AM·Burns·2026 Jul 1 Burns & Wounds
In a double-blind trial, shock wave therapy improved pain, scar thickness, and scar appearance in partial-thickness forearm burn scars, with somewhat larger gains than conventional physical therapy.
Overview

This double-blind randomized controlled trial of 70 patients with partial-thickness forearm burn scars compared 24 sessions of shock wave therapy (n=35) against conventional physical therapy with a deactivated applicator (n=35), assessing ultrasonography, the Vancouver Scar Scale, and the Burn Specific Health Scale-Brief at baseline, 8 weeks, and a further 8-week follow-up.

Key Findings
  • Both groups showed statistically significant improvements in pain (VAS), scar thickness, Vancouver Scar Scale, and Burn Specific Health Scale scores from baseline to post-treatment and follow-up.
  • The shock wave group showed large effect sizes for VAS (η²p = 0.82/0.80), VSS (0.80/0.79), and BSHS (0.85).
  • Between-group confidence intervals overlapped substantially (e.g., VAS pre-post 4.70–6.36 for shock wave therapy vs 4.19–6.86 for conventional therapy), with only modest separation favouring shock wave therapy.
Caveat

Outcomes were reported mainly as within-group changes with overlapping between-group confidence intervals rather than a direct between-group significance test, so the trial does not clearly establish that shock wave therapy outperforms conventional physical therapy.

PubMed (PMID 42385475) Read in the issue

How it's made

  1. 01

    Scan

    The week's new papers across the field, from PubMed.

    40 journals · 25 searches
  2. 02

    Score

    Every abstract read and ranked for relevance and rigour.

    a few hundred papers
  3. 03

    Write

    The top-ranked written up as structured evidence briefs.

    the top-ranked
  4. 04

    Publish

    The week in brief and the picks up front, then every subspecialty in depth.

    one issue, every Sunday
Tell me more about how this works

Behind each issue, an automated pipeline runs end to end, every Sunday.

Sunday run 4 phases · 8 steps · 3 agents
  1. 01

    Gather

    pubmed

    Pull the week from the specialty journals and standing searches.

    dedup

    Drop anything already covered.

  2. 02

    Read & sort

    scoringagent

    Score each paper for relevance and rigour.

    classify

    Assign a subspecialty and section.

  3. 03

    Write

    summarizeagent

    Pearl, key findings, and caveat, per paper.

    editorialagent

    The week at a glance, per subtopic.

  4. 04

    Assemble & publish

    render

    Select the picks and sections, lay out the issue.

    publish

    Push it live; the site rebuilds.

agent a step handled by an AI agent; everything else is plain code.

What we read

Plastic & Reconstructive SurgeryPlast Reconstr Surg · Plast Reconstr Surg Glob Open · J Plast Reconstr Aesthet Surg · JPRAS Open · Ann Plast Surg · Eur J Plast Surg · Handchir Mikrochir Plast Chir
SubspecialtiesMicrosurgery · J Reconstr Microsurg · J Reconstr Microsurg Open · J Hand Surg Am · J Hand Surg Eur Vol · Hand (N Y) · J Hand Surg Glob Online · J Wrist Surg · Burns · Burns Open · J Burn Care Res · Burns & Trauma · Aesthet Surg J · Aesthet Surg J Open Forum · Aesthetic Plast Surg
General surgery & scienceAnn Surg · JAMA Surg · Br J Surg · Ann Surg Oncol · N Engl J Med · Lancet · JAMA · NPJ Digit Med · Lancet Digit Health · JAMA Netw Open · J Med Internet Res · JMIR Med Inform · Nat Med · Sci Transl Med · Nat Commun · Cell · PNAS · Sci Rep

Plus 25 standing MeSH searches across all of PubMed each week, by topic, so strong work published outside these journals still makes it in.

Free flapsMicrosurgeryBreast reconstructionBrachial plexusBurnsLymphedemaFat graftingSkin cancerAI in surgery+ 16 more

Missing a journal or a paper? Tell me.

Inside every issue

Every issue is built in the same three layers, week after week: the whole field in two minutes up top, your own subspecialty in full below.

In Brief

The week at a glance

Every issue opens with an overview and a subtopic-by-subtopic read of the week: what moved across the field, in a few paragraphs.

Editor's Picks

The five to read

The five papers the week's scoring ranks highest: the most relevant, most rigorous work. If you read nothing else, read these.

The sections

Your subspecialty in depth

Every selected paper, sorted by subspecialty, each written up with the takeaway, key findings, and caveat, the picks included. Read what's yours in full.

Why this exists

Keeping up with the plastic surgery literature has become quite difficult. Every week brings more new papers, across more journals, than any of us has time to read, and the papers that change practice rarely announce themselves.

So every Sunday the Weekly runs the same pipeline. It looks through the relevant journals, adds standing MeSH searches across all of PubMed, and scores every new paper for clinical relevance and methodological rigour. The criteria are the same every week, and selection is independent of journals, publishers, and industry.

An issue opens with the week in brief and an overview of the field, subtopic by subtopic. Then come the five picks, and after them the sections, where every selected paper is written up in structured form: the takeaway, the key findings, and the caveat that keeps the finding honest. Numbers are verified against the abstracts, and every entry links back to its source, so when a finding touches your practice you can go straight to the paper and judge it yourself.

I read these issues the way you will, as a surgeon trying to stay on top of the literature. The Weekly is the tool I wanted for myself: the field's week, in a few minutes. I hope it saves you some time.

Marius Drysch, MD, MHBA

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