F. J. Pérez Lara, F. J. Moya Donoso, R. Zubizarreta Jiménez, E. Ojeda Leiva, F. J. Muñoz Castillo, C. Rueda Cruces, C. Ríos Navas
Giant ventral hernias and loss-of-domain abdominal wall defects remain challenging because reintegration of hernia contents may increase intra-abdominal pressure and impair postoperative respiratory function. We describe a structured institutional protocol that integrates abdominopelvic CT volumetry, the hernia sac/abdominal cavity volume ratio, respiratory function testing during progressive simulated abdominal occupation, preoperative botulinum toxin, progressive pneumoperitoneum, transversus abdominis release and, only in selected high-risk cases, volume transposition. The protocol is intended to support individualized surgical planning by estimating both abdominal and respiratory consequences before definitive reconstruction. This manuscript should be interpreted as a methodological protocol and feasibility proposal rather than a validated predictive clinical model. Prospective validation with standardized endpoints is ongoing and will be required before the thresholds can be considered externally validated.
This study aimed to compare surgical characteristics, complications, clinical and radiographic outcomes among patients undergoing unilateral biportal endoscopic posterior lumbar interbody fusion (UBE-PLIF), percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF), and oblique lumbar interbody fusion (OLIF) for grade I-II lumbar spondylolisthesis (LS) combined with lumbar spinal stenosis (LSS). From July 2019 to May 2022, patients with grade I-II LS combined with LSS were retrospectively included and grouped into the UBE-PLIF, PE-TLIF, and OLIF groups based on the surgical procedure. Baseline characteristics, surgical data, and complications were collected during hospitalization and follow-up. Clinical outcomes, including the Visual Analog Scale (VAS) for low back pain (VAS-back) and leg pain (VAS-leg), the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association (JOA) score, were assessed preoperatively and at 1, 6, 12, 24, and 36 months postoperatively. Radiographic outcomes, such as intervertebral disc height (IDH), slip percentage, lumbar lordosis angle, and fusion rate, were evaluated at the same timepoints. The PE-TLIF and OLIF groups required longer operative times and greater blood loss than the UBE-PLIF group, with the OLIF group exhibiting the largest incision length, blood loss, and drainage volume ( P < 0.05). After the 36-month follow-up, the UBE-PLIF group demonstrated significantly better VAS-leg scores at 24 and 36 months, as well as superior ODI and JOA scores at 36 months, compared to the other two groups ( P < 0.05). Among radiographic outcomes, significant differences were found only in the interbody fusion rate at 6 months and IDH at 36 months ( P < 0.05), with no differences in other parameters at the remaining timepoints. The total complication rates for UBE-PLIF, PE-TLIF, and OLIF were 13.53%, 18.94%, and 16.79%, respectively, with no significant intergroup differences ( P > 0.05). UBE-PLIF, PE-TLIF, and OLIF demonstrate comparable safety and efficacy. UBE-PLIF is associated with less blood loss and modest advantages in selected late clinical outcomes, suggesting it is a viable alternative for grade I-II LS with LSS. Given the limitations of retrospective design, further validation through multicenter randomized controlled trials with longer follow-up is warranted.
Qingqing Du, Hailei Bian, Shan Wu, Fangyuan Sun, Li Ni
To systematically summarize the best available evidence on intraoperative barrier and no-touch techniques for the prevention of surgical site infection (SSI) in adult patients undergoing gastrointestinal (GI) surgery, and to provide an evidence base for developing standardized clinical practice protocols. Guided by the “6S” evidence model, a systematic literature search was conducted across multiple databases from their inception to March 1, 2026. The search encompassed all evidence pertaining to intraoperative barrier and no-touch techniques in GI surgery, including guideline organization websites (WHO, CDC, NICE, SHEA/IDSA, APIC, GIN, NGC, SIGN, RNAO, and medlive.cn), evidence-based databases (The Cochrane Library and JBI Evidence Synthesis), the trial registry ClinicalTrials.gov, and the databases PubMed, Web of Science, Embase, CINAHL, CBM, CNKI, VIP, and WanFang. Included studies comprised guidelines, expert consensus statements, evidence summaries, systematic reviews, narrative reviews, and randomized controlled trials (RCTs). Quality assessment, data extraction, and evidence grading were independently performed by two researchers trained in evidence-based nursing. A total of 18 publications were included: 5 guidelines, 3 expert consensus statements, 1 evidence summary, 3 systematic reviews, 3 narrative reviews, and 3 RCTs. Thirty best-evidence statements were synthesized across six domains: no-touch isolation technique (NTIT)–derived contamination control, intraoperative aseptic barrier precautions, intraoperative wound protection, selection of intraoperative irrigation solutions, intraoperative temperature management, and surgical teamwork and instrument management. This evidence summary provides a standardized, SSI-focused framework for barrier and no-touch practices in GI surgery. High-level evidence supports wound protectors, mechanical bowel preparation plus oral antibiotics in elective colorectal surgery, and intraoperative normothermia, whereas most NTIT-derived contamination-control practices are supported mainly by expert-consensus evidence and are recommended conditionally (Grade B). Clinical translation should be guided by the FAME (Feasibility, Appropriateness, Meaningfulness, and Effectiveness) framework and tailored to local hospital conditions and individual patient characteristics to minimize the risk of SSI.
Reconstruction of facial soft tissue defects remains a demanding task in plastic, reconstructive, and head and neck surgery because the face combines aesthetic units with essential functions such as oral competence, speech, swallowing, breathing, eyelid protection, and facial expression. The severity, depth, and composition of the defect are the primary determinants of flap selection, especially when defects extend beyond skin and subcutaneous tissue to expose the oral cavity, pharynx, nasal cavity, skull base, or critical structures. This narrative review summarizes evidence and technical progress regarding free flap selection for facial soft tissue reconstruction. Literature was identified through PubMed, Web of Science, and Google Scholar using combinations of the terms “facial soft tissue defect,” “free flap,” “perforator flap,” and “virtual surgical planning.” Priority was given to systematic reviews, meta-analyses, clinical series, and studies published between 2019 and 2026, while classic microsurgical reports were retained when foundational. Free flap choice should be guided by an integrative three-dimensional matrix: defect characteristics×patient profile×institutional resources. The anterolateral thigh flap remains a workhorse for moderate to large defects because of its thickness, long pedicle, availability of fascia lata, and nerve harvest. The radial forearm free flap remains valuable for thin and pliable resurfacing of the lips, eyelids, nasal lining, and oral lining. The deep inferior epigastric perforator flap is useful for large-volume contour restoration. Additional soft tissue options—including the lateral arm, parascapular, and medial sural artery perforator flaps—should be considered when color match, donor-site morbidity, or body habitus makes traditional workhorse flaps suboptimal. Facial soft tissue reconstruction requires not only flap survival but also restoration of contour, sensation, oral competence, facial animation, donor-site acceptability, and patient-reported quality of life. Mature technologies such as CTA, selective ultrasound, virtual surgical planning, intraoperative indocyanine green angiography, and structured postoperative monitoring should be distinguished from evolving tools such as augmented reality, artificial intelligence decision support, robotic-assisted anastomosis, artificial vascular conduits, and allogeneic or xenogeneic transplantation. Future research should focus on multicenter registries, standardized outcome measures, cost-effectiveness analyses, and externally validated decision-support models.
The escalating global burden of prostate cancer necessitates continuous refinement of diagnostic strategies. Although prostate biopsy remains the gold standard for diagnosis, key procedural aspects, including biopsy template, guidance methods, and biopsy route, remain subjects of ongoing debate. Current approaches have yet to achieve the dual goals of high sensitivity and high specificity in diagnostic performance. In recent years, ongoing advancements in related fields have generated substantial clinical evidence, offering further insights into optimizing biopsy strategies. This review provides a synthesized framework for navigating the paradigm shift from traditional, standardized biopsy toward personalized, precision-based approaches. We not only trace the evolution of biopsy techniques but also offer a comprehensive, in-depth exploration of how patient-specific factors, such as prostate volume, prostate-specific antigen density, and Prostate Imaging Reporting and Data System scores, can inform individualized biopsy decisions, thereby providing practical clinical guidance. In addition to critically evaluating conventional biopsy paradigms, we systematically examine emerging biopsy strategies and synthesize high-quality studies at the forefront of this field. Finally, against the backdrop of the artificial intelligence era, we highlight the transformative potential of artificial intelligence and robotic platforms across the diagnosis. By integrating current development and future directions, this review offers a structured framework for personalized biopsy decision-making, ultimately aiming to achieve both high sensitivity and high specificity in individualized prostate cancer diagnosis.
