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Introduction: The global aesthetic medicine industry is rapidly expanding, with conferences serving as crucial platforms for knowledge exchange and collaboration. However, concerns have emerged about the increasing prioritisation of commercial content over scientifically rigorous presentations. This study critically evaluates the balance between commercial and scientific content at aesthetic medicine conferences, utilising artificial intelligence (AI) tools to analyse the impact of industry sponsorship and live procedural demonstrations on educational value., Method: Using the Punctuated Equilibrium Framework (PEF), AI-driven content analysis, social network analysis (SNA), and sentiment analysis were applied to evaluate conference data, including programs, sponsorship details, speaker affiliations, and attendee engagement metrics. The study analysed global and regional aesthetic medicine conferences from 2014 to 2024, identifying patterns and punctuated shifts in the balance between scientific and commercially driven content., Results: AI-based analysis of 487 conferences, comprising over 28,000 sessions and 2 million social media posts, revealed an increasing trend towards commercially focused content, particularly in industry-sponsored events. Approximately 44% of sessions were commercially oriented, with significant spikes during product launches. Academic and clinical speakers were more prevalent in scientific conferences, while industry-affiliated speakers dominated commercial sessions. Social media sentiment, analysed using AI tools, reflected high engagement with procedural demonstrations but also highlighted concerns about educational quality., Conclusion: While industry-driven sessions garnered higher immediate engagement, they reduced long-term cognitive retention and compromised the educational integrity of conferences. The use of AI in this study enabled a deeper understanding of content trends and their effects. Aesthetic medicine conferences must recalibrate the balance between commercial interests and scientific rigour to ensure sustainable professional development and patient safety., Evidence Level: IV., Competing Interests: Conflict of Interest Statement and Financial Disclosure Statement: Dr Rahman worked as a consultant and speaker for Allergan Aesthetics an Abbvie company (Irvine, CA); Karim Sayed is a consultant to, speaker for, and has received honoraria from L’oréal/Skinceuticals, Teoxane, Lutronic Cynosure and Allergan, an AbbVie Company; Dr Rao is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Rao, Dr Ioannidis, is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA; Dr Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie company (Irvine, CA), Galderma (Lausanne, Switzerland), Merz Pharmaceuticals GmbH and Evolus. He is also Senior President of the German Society for Botulinum and Filler Treatment (DGBT); Dr Carruthers has been a consultant and researcher for Alastin, Appiell, Allergan Aesthetics, an AbbVie Company, Avari, Bonti (now with Allergan/AbbVie), Evolus, Fount Bio, In Mode, Jeune Aesthetics, Merz, and Revance Biopharma and also own shares in Galderma. She is an author and editor for Elsevier and “Up to Date” Neuromodulators and Fillers, as well as an assistant editor for Dermatologic Surgery; Dr Webb, Dr Garcia , Dr Yu and Dr Wang has nothing to disclose., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: Although the efficacy of botulinum toxin type A (BoNTA) has been shown to vary depending on injection layer, reconstitution volume, and BoNTA formulation, the effect of injection pattern has rarely been mentioned. The authors compared the therapeutic effects in patients treated with BoNTA with retrograde linear and traditional spot injection techniques., Methods: Twenty-eight participants were enrolled in a split-face, patient-blinded randomized clinical trial. Each patient received BoNTA injected with linear injection technique on one side and with spot injection technique on the other side. Outcomes included wrinkle improvement rates (WIRs) of the 2 injection techniques determined by wrinkle scores derived from an Antera 3-dimensional camera, muscle activity assessed by ultrasound, and patient-reported pain rating on a numeric rating scale., Results: All participants completed the study. For forehead wrinkles, WIR on the linear side was significantly larger than that on the spot side at 1 week and 1 month ( P < 0.02). For glabellar wrinkles, WIR on the linear injection side was significantly larger than that on the spot side at 1 week ( P = 0.04). However, for periorbital wrinkles, WIR on the spot side was significantly larger than that on the linear side at 1 week ( P < 0.03). No significant difference was observed between the injection patterns in terms of muscle contraction and numeric rating scale pain scores., Conclusions: Compared with the traditional spot injection, retrograde linear injection was superior in reducing forehead lines and glabellar lines, but less effective in reducing periorbital lines when identical dosages were injected., Clinical Question/level of Evidence: Therapeutic, II., (Copyright © 2023 by the American Society of Plastic Surgeons.)

Background: Localized scleroderma (LoS) is an autoimmune disease characterized by fibrosis of the skin and atrophy of the subcutaneous fat tissue. Adipose-derived mesenchymal stem cells (ASCs) is a promising treatment approach for LoS. However, ASCs from scleroderma patients (LoS-ASCs) have been shown to exhibit altered characteristics compared to ASCs from healthy donors (healthy-ASCs). This study aimed to compare the abilities of LoS-ASCs and healthy-ASCs in treating skin fibrosis., Methods: The paracrine ability of ASCs was tested with cytokine array. Bleomycin-challenged mice models received subcutaneous injection of LoS-ASCs and healthy-ASCs. Pathological staining and western blotting of COL1, α-SMA was performed. Fibroblasts derived from LoS lesions (LoS-FB) was co-cultured with ASCs, and subjected to RNA sequencing to further explore the similarities and differences in the treatment mechanism., Results: In vivo comparison revealed that healthy ASCs had a stronger proliferation ability and secreted higher levels of growth factors and cytokines, including VEGFA, PDGFB, and IL-10. Pathological staining of the skin in mice models treated with ASCs demonstrated that healthy ASCs were more effective in reducing dermal thickness and collagen deposition, while increasing microvessel density and the proportion of M2 macrophages. Co-culture with both healthy-ASCs and LoS-ASCs reduced the proliferation and migration abilities of LoS-FB, as well as the protein expression of α-SMA and COL1. RNA sequencing and validation revealed potential difference in the canonical Wnt pathway., Conclusions: Healthy-ASCs exhibited stronger proliferation, paracrine, anti-fibrosis, pro-angiogenesis, and immunomodulation abilities in treating skin fibrosis in scleroderma mouse models., Clinical Relevance Statement: Allogenic ASCs obtained from healthy donors are more efficient in treating skin fibrosis, and could serve as a potential alternative for patients who are not suitable candidates for liposuction surgery in the future., Competing Interests: Conflict of interest statement: Dr. Yuemei Yang is currently in the employment of Beijing AeglesStem Technology Co., Ltd., Beijing AeglesStem Technology Co., Ltd. did not provide funding or other assistances for this research. The authors state no other conflict of interest., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Introduction: Botulinum toxin A (BoNT-A), derived from Clostridium botulinum, is widely used in medical and aesthetic treatments. Its clinical application extends from managing chronic conditions like cervical dystonia and migraine to reducing facial wrinkles. Despite its efficacy, a significant challenge associated with BoNT-A therapy is immunogenicity, where the immune system produces neutralising antibodies (NAbs) against BoNT-A, reducing its effectiveness over time. This issue is critical for patients requiring repeated treatments. The study aims to compare FDA-approved BoNT-A products, examining the factors influencing NAbs development using advanced machine learning techniques., Method: This research analysed data from randomised controlled trials (RCTs) involving five main BoNT-A products. The study selected trials based on detailed immunogenic responses to these treatments, particularly for glabellar lines. Machine learning models, including logistic regression, random forest classifiers, and Bayesian logistic regression, were employed to assess how treatment specifics and BoNT-A product types affect the development of NAbs., Results: Analysis of 14 studies with 8,190 participants revealed that dosage and treatment frequency are key factors influencing the risk of NAbs development. Among BoNT-A products, IncobotulinumtoxinA shows the lowest, and AbobotulinumtoxinA the highest likelihood of inducing NAbs. The study's machine learning and logistic regression findings indicated that treatment planning must consider these variables to minimise immunogenicity., Conclusion: The study underscores the importance of understanding BoNT-A immunogenicity in clinical practice. By identifying the main predictors of NAbs development and differentiating the immunogenic potential of BoNT-A products, the research provides insights for clinicians in optimising treatment strategies. It highlights the need for careful treatment customisation to reduce immunogenic risks, advocating for further research into the mechanisms of BoNT-A immunogenicity., Competing Interests: Conflict of Interest Statement: Dr Rahman worked as a consultant and speaker for Allergan Aesthetics an Abbvie company (Irvine, CA); Dr Carruthers has been a consultant and researcher for Alastin, Appiell, Allergan Aesthetics, an AbbVie Company, Avari, Bonti (now with Allergan/AbbVie), Evolus, Fount Bio, In Mode, Jeune Aesthetics, Merz, and Revance Biopharma and also own shares in Galderma. She is an author and editor for Elsevier and “Up to Date” Neuromodulators and Fillers, as well as an assistant editor for Dermatologic Surgery. Dr Rao is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie company (Irvine, CA), Galderma (Lausanne, Switzerland), Merz Pharmaceuticals GmbH and Evolus. He is also Senior President of the German Society for Botulinum and Filler Treatment (DGBT) Dr Webb and Dr Yu has nothing to disclose., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: We conducted a bibliometric analysis of blepharoptosis, obtained the top 100 most-cited articles, and then researched the characteristics of every article., Materials and Methods: The Web of Science Citation Index was utilized to identify articles related to blepharoptosis written in English published from 1900 to 2021 using predefined search terms. Then, the returned results were screened, and the top 100 most-cited articles were individually classified based on publication year, country of publication, source journal, total citations, authors' specialty, level of evidence, main subject, and type of study., Results: The 100 most-cited articles were published between 1948 and 2014. The number of citations/articles ranged from 49 to 743. Ophthalmology journals made the greatest contributions to landmark literature (n=61). The primary focus of these 100 studies was the surgical technique (n=41). The majority of them (n=52) only achieved level 4 evidence, as a high proportion of these articles were case series (n=52). The most common country of publication was the United States (n=59)., Conclusions: Our bibliometric analysis provides insight into the citation frequency of the most-cited articles on blepharoptosis. The landmark, highly cited articles that have shaped the landscape of blepharoptosis were identified. The results from these top 100 cited articles are helpful for present current surgical decision-making., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by Mutaz B. Habal, MD.)

Background: Hypertrophy of the labia minora with lateral clitoral hood redundancy is common, but the excess clitoral hood is often overlooked during labiaplasty, which may result in imbalanced and unsatisfactory outcomes. The purpose of this study was to present an easy method of three-step excision for composite labia minora and lateral clitoral hood reduction., Methods: The procedure was performed in three steps: the prominent clitoral hood skin parallel to the labia majora and the clitoral hood sulcus was removed first; then, the protuberant portion of the labia minora was removed by wedge resection; and finally, a triangle at the junction between the labia minora and the clitoral hood was trimmed. Patients were required to return for examination on the first day and within 14 days after surgery. Follow-ups were arranged on the Internet or at the outpatient clinic. Satisfaction questionnaires were completed during follow-up., Results: Between January of 2016 and January of 2020, 136 patients underwent composite labia minora and lateral clitoral hood reduction. Ages ranged from 9 to 55 years. Six patients experienced complications (4.4 percent) and five underwent revision surgery (3.7 percent). The overall satisfaction rate within 14 days and after 3 months following surgery was 91.0 percent and 95.5 percent, respectively. Preoperative discomfort was resolved in 43.0 percent and significantly relieved in 54.2 percent, and sex life was improved in 70.9 percent., Conclusions: Three-step excision is effective and safe for composite labia minora and lateral clitoral hood reduction with very high satisfaction. Considering the advantages of easy preoperative design and controllable tissue removal, this method could be a better alternative to the present procedures., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Rationale: Pseudodiphallia, as a rare kind of diphallia, which is characterized by a small accessory penile-like tissue without a normal penile anatomy structure. Only a few cases have been reported. Here, we report a case of pseudodiphallia with phimosis and bilateral extrarenal pelvis., Patient Concerns: A 23-year-old male visited our hospital with a complaint of external genitalia malformation. Physical examination revealed a normal-sized penis with phimosis, and an extra half glans horizontally attached to the right side of the normal glans penis is visible after completely retracting the foreskin. The CT urography showed a bilateral extrarenal pelvis, and no other abnormalities were found in the kidneys, ureter, bladder, and vertebral bodies., Diagnosis: Based on the physical examination and the CT urography results, the 23-year-old male was diagnosed with Pseudodiphallia., Intervention: Excessive penile tissue was resected, and a foreskin circumcision operation was performed under general anesthesia., Outcomes: The patient recovered smoothly without complications (no infection, hematoma, or wound dehiscence) after surgery. At 6 months follow-up, the patient was content with the external genitalia's appearance, and the urination and erectile function were normal., Lessons: Pseudodiphallia is a rare kind of diphallia, and this is the first report on pseudodiphallia with a bilateral extrarenal pelvis. CT urography can be used to assess the associated internal anomalies before surgery.

To explore the necessity of indwelling drainage in dual-plane breast augmentation mammoplasty patients.Female patients (123 in total) were selected from June 2015 to June 2018 in the Department of Plastic Surgery at Peking Union Medical College Hospital and were randomly divided into 2 different groups: the with drainage group (WD group, 57 patients) and the without drainage group (WOD group, 66 patients). In the 2 groups, the operation time, postoperative stay, and hospitalization expenses were recorded. The BREAST-Q Version 2.0 Augmentation Module Pre- and Postoperative Scales (Chinese Version) were used to evaluate psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts preoperatively and postoperatively (1 year after operation).Before the operation, no significant differences were found in psychosocial well-being, sexual well-being, physical well-being, or satisfaction with breasts between these 2 groups. In the WOD group, postoperative stay and hospitalization expenses were remarkably decreased, but the operation time was similar, compared with the WD group. Compared with before the operation, both groups had significantly increased scores in psychosocial well-being, sexual well-being, and satisfaction with breasts after the operation. However, no significant differences were found between the 2 groups. No complications were found in any of the patients.Although the operation time was not significantly decreased, patients without drainage could save much more time and money and simultaneously reach similar postoperative effects in psychosocial well-being, sexual well-being, physical well-being, and satisfaction with breasts. Therefore, drainage may not be necessary in patients who undergo dual-plane breast augmentation mammoplasty.

Introduction: Hyaluronic acid injections is relatively safe with little risk of complications. Although herpes reactivation after the injection of hyaluronic acid is rare, it produces quite a huge pressure and panic on patients. Quite a lot cosmetic practitioners have no awareness of preventing, diagnosing, and giving correct treatment in time due to lack of experience., Patient Concerns: A 24-year-old woman presented with erythema, crusted papules, pain and swelling on the nose after receiving the injection of hyaluronic acid. A swab of the discharge fluid was obtained for bacterial and viral culture, showing positive for herpes simplex virus., Diagnosis: The patient was diagnosed as herpes reactivation after the injection of hyaluronic acid., Interventions: The patient underwent antiviral therapy with acyclovir 400 mg, 3 times daily for seven days., Outcomes: After a week of antiviral treatment, the clinical signs improved., Conclusion: Herpes reactivation after the injection of hyaluronic acid is quite rare but needed sufficient attention of cosmetic practitioners to make the proper diagnosis, prevention and treatment.

Thread lift boasts the advantage of minimal invasion for facial rejuvenation and has been increasingly used nowadays. The purpose of this study was to evaluate the outcomes and safety of elastic thread when it was used in the modified minimal access cranial suspension (MACS) lift for rejuvenation of the lower and middle third of the face.Forty-six patients with sagging and laxity of the lower face treated by the elastic thread modified MACS lift from December 2015 and December 2017 were enrolled in this study. A retrospective chart review was conducted. The degree of Wrinkle Severity Rating Scale (WSRS) score and satisfaction score were evaluated immediately, 6 months and 12 months after procedure. Complications during the study were also recorded.All the patients were female, with a mean age of 50.7 ± 6.4 years and a mean follow-up period of 15.4 ± 2.1 months. The mean operation time was 114 ± 13 minutes. For the left face, the mean WSRS score was 4.0 ± 0.8 preoperatively and 3.1 ± 0.8 on the 1-year follow-up; and 4.1 ± 0.9 and 3.1 ± 0.7 on the right face (P < .01). Thirty-nine (84.8%) patients considered the long-term results satisfactory. There were no major complications during the follow-up period.The elastic thread modified MACS lift is a minimally invasive, effective and safe method to improve lagging middle and lower third of the face without significant postoperative morbidity or complications.

Background: Fat grafting is an adjuvant that may improve the quality of radiation-damaged tissue. However, fat grafting for volume restoration in irradiated sites may be less effective because of a poorly vascularized fibrotic recipient bed. External volume expansion has emerged as a potential technique to prepare the recipient sites for improved survival of grafted fat. The authors previously demonstrated increased vasculature with external volume expansion stimulation of irradiated tissues. The authors now hypothesize that external volume expansion's improvements in recipient-site vascularity will increase the volume retention and quality of fat grafts in fibrotic irradiated sites., Methods: Athymic mice were irradiated until development of chronic radiation injury. Then, the irradiated site was stimulated by external volume expansion (external volume expansion group), followed by subcutaneous fat grafting. Grafts in an irradiated site without external volume expansion stimulation (irradiated control group) and grafts in a healthy nonirradiated (nonirradiated control group) site were used as controls. All grafts were monitored for 8 weeks and evaluated both histologically and by micro-computed tomography for analysis of volume retention., Results: Hyperspectral imaging confirmed a 25 percent decrease in vascularity of irradiated tissue (irradiated control group) compared with nonirradiated tissue (nonirradiated control group). Grafts in the irradiated control group retained 11 percent less volume than grafts in the nonirradiated control group. The experimental external volume expansion group achieved a 20 percent (p = 0.01) increase in retained graft volume compared with the irradiated control group., Conclusions: External volume expansion stimulation can mitigate the effects of irradiation at the recipient site and in turn help preserve fat graft volume retention. Possible mechanisms include increased vascularity, adipogenic conversion, and increased compliance of a fibrotic recipient site.

Rationale: Micro-plasma radio-frequency (MPR) technology has been demonstrated a safe and effective treatment for kinds of scars, but there is no report about the application of the MPR on keloids. In this investigation, we creatively use MPR technology combining with hypofractionated electron-beam radiation to cure keloids., Patient Concerns and Diagnoses: From February 2013 to December 2016, 22 Asian patients (16 male, 6 female, age 19-46 years, mean age 28.14 ± 7.31 years) with keloids over half a year were enrolled in this study., Interventions and Outcomes: All patients received a single MPR technology treatment by roller tip at 80-100 watt, and then hypofractionated electron-beam radiation of 6 MeV were performed twice, within 24 hours and one week after the operation with 9 Gy per time. Improvement were determined by the Vancouver Scar Scales (VSS) according to digital photographs. The results show that the volume of keloids reduced significantly among most patients. Only 3 patients encountered with mild to moderate hyperpigmentation, and none of malignance and worsening or recurrence of scars was observed., Lessons: MPR technology combined with post-operative hypofractionated electron-beam radiation therapy is an effective method for patients with multiple keloids distributed widely on the body with minimal complications, especially for patients with widely distributed keloids.

Rationale: Prepubertal unilateral gynecomastia is extremely rare, whose etiology and management strategy are not familiar. We would like to present a case and a literature review of unilateral prepubertal gynecomastia., Patient Concerns: A 11-year old male patient with complaints of unilateral enlargement of breast tissue presented in our clinic, whose physical examination, biochemical, hormonal and oncologic findings were normal., Diagnoses: This patient was diagnosed as idiopathic unilateral prepubertal gynecomastia (IUPG) and self-abasement, social isolation and sensitive of interpersonal relationship., Interventions: The patient received subcutaneous mastectomy. Histopathological examinations showed idiopathic gynecomastia of ductal epithelial hyperplasia and active interstitial fibrous hyperplasia, with no evidence of any pathological finding. Immunohistochemical examination showed estrogen receptor (ER)-α positive (70%), epidermal growth factor receptor (EGFR) positive, Her-2 positive (1+), Progesterone Receptor (PR) positive (80%)., Outcomes: A remarkable improvement was observed both in the physical and mental conditions at the post-surgical 6-month follow-up visit, showing no evidence of recurrence., Lessons: Further investigation is needed to clarify the pathogenesis of IUPG. All patients with IUPG should have a full endocrine and oncologic evaluation, and surgical excision may be the individually designed for each patient with the help of MRI of breast.

Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability.We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers.We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded.Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention.Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

Background: The authors aimed to analyze factors related to lipotransfer for localized scleroderma, and to explore the feasibility of cell-assisted lipotransfer for localized scleroderma treatment., Methods: Abdominal fat samples were taken from six scleroderma patients without corticosteroid therapy, five scleroderma patients with corticosteroid therapy, and 10 normal liposuction patients. Their quantity, morphology, and proliferation ability were measured. Blood flow was measured by laser speckle contrast imaging in localized scleroderma lesions and normal contralateral regions for eight localized scleroderma patients. Bleomycin-induced skin fibrosis nude mice were also used to investigate differences between lipotransfer and cell-assisted lipotransfer. Fat weight was measured, and expression of transforming growth factor (TGF)-β1 and type III collagen in the injected skin was determined by immunohistochemistry., Results: The number of stem cells from scleroderma patients with corticosteroid treatment was significantly reduced. Mean blood perfusion in localized scleroderma lesions was not significantly different than in the contralateral normal regions. In normal nude mice, there were no significant changes in TGF-β1 and type III collagen between the control, lipotransfer, and cell-assisted lipotransfer groups, whereas in bleomycin-induced skin fibrosis nude mice, lipotransfer and cell-assisted lipotransfer reduced TGF-β1 and type III collagen expression., Conclusions: For scleroderma patients, fewer adipose-derived stem cells, because of a history of corticosteroid therapy and a local inflammatory microenvironment, are more important factors, whereas blood supply showed no significant change. Therefore, cell-assisted lipotransfer not only improves the survival rate of transplanted fat but also improves skin texture in bleomycin-induced skin fibrosis nude mice.

Background: Lower limb lymphedema (LLL) is an important concern for patients with vulvar cancer. Studies of the incidence of vulvar cancer-related lymphedema and its risk factors have substantially increased in the new millennium., Objectives: This article is a meta-analysis that aimed to systematically evaluate the incidence of LLL and its risk factors related to vulvar cancer., Data Sources: Data were collected from eligible studies from PubMed, ScienceDirect, and Web of Science., Synthesis Methods: Random effects models were used to calculate a pooled overall estimate of LLL incidence, and subgroup analyses were performed to assess the effects of different study designs, countries of study origin, diagnostic methods, and extent of lymph node surgery. Risk factors for lymphedema were also evaluated., Results: Twenty-seven studies met the inclusion criteria for the assessment of lymphedema incidence with a pooled estimate of 28.8% [95% confidence interval (CI) 22.1-35.5]. The estimate was 16.7% (95% CI 9.7-23.7) when data were restricted to prospective cohort studies (7 studies). The incidence of LLL was increased by approximately 5-fold in women who underwent inguinofemoral lymph node dissection compared to those who underwent sentinel lymph node biopsy. The reported risk factors included wound infection, inguinofemoral lymphadenectomy, older age, body mass index (BMI), and radiation therapy., Conclusions: Approximately 3 in 10 women who survive vulvar cancer will develop lower limb lymphedema. More studies are needed to improve the understanding of its risk factors and to develop prevention and management strategies to alleviate this distressing disorder.

Background: The keystone design perforator island flap is useful for the reconstruction of lower extremity defects. We performed a systematic review with the objective of identifying complication rates associated with using the keystone design perforator island flap to treat such defects., Methods: The MEDLINE, PubMed Central, Embase, and Cochrane databases were searched from January 2003 to August 2016 for articles describing keystone design perforator island flaps in lower extremities. The study selection was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement., Results: Nine articles that involved a total of 282 keystone design perforator island flaps satisfied the inclusion criteria. In these articles, the most common cause of lower extremity defects was oncologic resection (89.0%). Most such defects were in the middle third of the lower leg (32.7%). Complications occurred in 9.6% of patients; these complications included partial flap loss (1.1%) and complete flap loss (0.7%)., Conclusion: Given its high success rate and low technical complexity, if applicable, the keystone design perforator island flap should be the preferred approach for lower extremity reconstruction.