Clinical Journal of Plastic and Reconstructive Surgery

Autologous Fat and its Derivatives in Clinical Practice: A Narrative Review of Global Regulatory Frameworks

Devi Prasad Mohapatra, Srinath R, Tanya Gupta — Sun, 09 Aug 2026 00:00:00 +0530

Autologous fat grafting has transitioned from traditional reconstructive soft-tissue filling to an expansive platform for reconstructive surgery, regenerative medicine, and point-of-care cellular therapy. This clinical evolution has driven the development of various adipose-derived derivatives, including micro-fat, nano-fat, micro-fragmented adipose tissue (MFAT), and enzymatically isolated stromal vascular fraction (SVF). However, clinical translation is complex due to a highly fragmented global regulatory landscape.
Central to international oversight are the thresholds of "minimal manipulation" and "homologous use". Crossing these thresholds, such as utilizing enzymatic digestion to isolate SVF or applying adipose tissue for non-homologous indications like joint regeneration, generally triggers classification as a drug, biologic, or Advanced Therapy Medicinal Product (ATMP). Such classifications demand stringent clinical trial validation, Good Manufacturing Practice (GMP) compliance, and pre-market approvals under frameworks like the US FDA and EU EMA. Conversely, jurisdictions like Australia and Japan offer alternative pathways, including hospital-based exclusions or tiered clinical practice oversight under the Act on the Safety of Regenerative Medicine (ASRM). Evolving guidelines under India's CDSCO similarly categorise enzymatic processing as substantial manipulation, defining the final output as a "New Drug".
This narrative review compares these regulatory pathways, highlighting how jurisdictional variation drives a geographic split in clinical innovation and underscores the necessity of regulatory literacy for clinicians and device developers alike.

Training the Plastic Surgeon of Tomorrow: What Should Change?

Vidush Kumar, Sakshi Bhat, Vijay Kumar — Sun, 09 Aug 2026 00:00:00 +0530

Plastic surgery as an entity has evolved dramatically over time. To remain viable, this specialty relies on innovative techniques, new anatomical understandings, and the ability to challenge conventional wisdom. Every generational period has seen the emergence of new technological advances in the field— technological advances from traditional surgical approaches to microsurgical reconstructive procedures; from craniofacial reconstructive procedures to perforator flaps and vascularized composite allotransplantations; from regenerative medicine to emerging technologies such as artificial intelligence, robotic surgery, three-dimensional printing, indocyanine green angiography, virtual planning, and precision medicine.

The resident will need to understand how to build prompts, check their findings against primary literature, and recognize hallucinated references within referenced literature. The resident needs to ensure that they maintain patient confidentiality and avoid manipulating images inappropriately.

The plastic surgeon of the future will not just be defined by new flaps, machines, or algorithms.He/She will be defined by the type of surgeon we train. Tomorrow's plastic surgeons will have to be technically proficient, capable microsurgeons in their work with scientific curiosity, digital literacy, ethical foundations, emotional maturity, and adaptability. The most important innovation in plastic surgery will not be a robot, an algorithm, or a new flap. It will be the ‘surgeon’, Mentors prepare to use them.

Solitary Extra Digital Glomangioma at the Infra-clavicular Region: A Rare Case Report

Nanthini Dhevi, Fahima Hussaina, Jaishree Tamilmani — Sun, 09 Aug 2026 00:00:00 +0530

Glomangioma is an uncommon benign vascular neoplasm of the glomus body, typically encountered in the digits. Extradigital presentation is rare and may lead to delayed or missed diagnosis. We report a case of a 31-year-old male who presented with a two-year history of pain in the left infraclavicular region, worsened by palpation, without any externally visible swelling. MRI demonstrated a soft tissue lesion in an unusual deep location beneath the subscapularis and pectoral muscles. The lesion was managed by complete excision under general anaesthesia. Gross examination revealed an oval purplish mass measuring 2.5 × 1.5 × 1.5 cm, and histopathology confirmed the diagnosis of glomangioma. Postoperatively, the patient had complete relief of symptoms. This case underscores the need to include glomangioma in the differential diagnosis of painful extradigital lesions and highlights surgical excision as the definitive treatment.

Surgical Correction of Rare Deformity: Congenital Double Upper Lip

Sun, 09 Aug 2026 00:00:00 +0530

Congenital double lip is a rare developmental anomaly characterized by redundant mucosal tissue, usually affecting the upper lip and becoming more prominent during smiling. A 36-year-old male presented with an unaesthetic smile and recurrent lip biting. Clinical examination revealed a congenital double upper lip without systemic features of Ascher syndrome. Surgical excision of the redundant tissue was performed under local anesthesia. Healing was uneventful, and at one month the patient demonstrated excellent esthetic improvement and complete resolution of functional complaints.

A Multidisciplinary Limb Salvage Strategy for Complex Bilateral High-Voltage Electrical Burns Injury of the Ankle

Sun, 09 Aug 2026 00:00:00 +0530

Background: High-voltage electrical injuries, though less common than domestic electrocution in developing countries, can be devastating, particularly when involving bilateral lower limbs. These injuries pose significant challenges due to prolonged immobilisation and complications such as deep vein thrombosis, pressure ulcers, and potential limb loss.
Case Presentation: We report the case of a 60-year-old male who sustained bilateral ankle high-voltage electrical burns following accidental contact with an overhead transmission line. The injuries resulted in extensive soft-tissue loss and exposed joints.
Management: The patient was managed through a multidisciplinary approach involving the burns team, orthopaedic surgeons, rehabilitation specialists, and social counsellors. The treatment strategy included serial debridements, negative pressure wound therapy (NPWT), skeletal stabilisation using hybrid Ilizarov external fixators, and staged soft-tissue reconstruction with a reverse sural artery flap and split-thickness skin grafting.
Outcome: The limb salvage outcome was successful, with progressive wound healing and functional recovery. The coordinated involvement of multiple specialties played a pivotal role in managing this complex case.
Conclusion: This case highlights the importance of early multidisciplinary collaboration in the successful management of high-voltage electrical injuries, particularly those involving bilateral lower extremities with joint exposure.

Versatility of Medial Sural Artery Perforator Free Flap for Head and Neck Reconstruction: An Institutional Experience

Rohit kumar Rai, Vijay Kumar, Bhasker Chowdhary — Sun, 09 Aug 2026 00:00:00 +0530

Background: The choice of flap in reconstruction post head and neck cancer ablation has been continuously modified with addition of novel free flaps. The medial sural artery perforator (MSAP) free flap is gaining traction among reconstructive surgeons because of reliable pedicle which is thin,of satisfactorily length and acceptable donor site morbidity. Through this study,we would like to present our institutional experience about clinical outcome of usage of MSAP free flap in head and neck reconstruction.

Material and Methods: 15 cases of head and neck defects were resurfaced with MSAP free flap depending on site and size of defect and also based on location of perforators for flap harvest.

Results: All flaps survived with no major post-operative complications. Skin grafting was required in two case for donor site of flap while primary closure was achieved in rest of the cases.

Conclusion: MSAP perforator free flap can be effectively used to reconstruct small to medium size defects of tongue, buccal mucosa and palatal defects. Donor site complications and long learning curve are the only disadvantages attributed to this flap.

Lower Lip Reconstruction by Estlander Flap

Sakshi Bhat, Sandhya Pandey, Mukta Verma, Vijay Kumar — Sun, 09 Aug 2026 00:00:00 +0530

Introduction: Animal-induced trauma is an important public health concern. Trauma can range from simple to complex injuries, and can present as perforations, avulsions, lacerations or fractures. It has been found that dog bites are the most common among animal bites. In the patients having facial trauma, the lips are most commonly involved. Reconstruction of lower lip injuries is customised based on size of defect. Small defects (less than ⅓rd) can be closed primarily.But for larger defects,local tissue flaps like Abbe-Estlander,Karapandzic,Webster-Bernard have to be done.

Methods: In this study, we hereby analyse the efficacy of the Estlander flap in patients with dog bite over Lower lip. A 32 yr old male patient sustained injury to lower lip due to dog bite. One third of the total volume of the lower lip was involved. An Estlander flap was successfully done for the patient.

Results: Estlander flap provides adequate wound healing. Phonation is good which resulted in patient satisfaction. Oral continence was present. There was no leakage of liquids or solid food. Absolute closure of the lips was achieved.

Conclusions: In cases of upper and lower lip reconstruction, the Estlander flap is a good local flap .It is used when the involved area is mostly upto one third of the total volume of lip. The aesthetic as well as functional objectives are successfully obtained using this flap.

Comparative Evaluation of Gingival Depigmentation Using Scalpel, Diode Laser, Vitamin C, and Bur Abrasion Techniques: A Case Series

Sun, 09 Aug 2026 00:00:00 +0530

Background: Gingival hyperpigmentation is a common physiological condition caused by excessive melanin deposition within the basal and suprabasal layers of the gingival epithelium. Although benign, excessive pigmentation often presents an esthetic concern, particularly in patients with a high smile line. Various surgical and non-surgical techniques have been introduced to eliminate gingival pigmentation, each possessing distinct advantages and limitations.

Objective: To compare the clinical outcomes of four gingival depigmentation techniques—scalpel surgery, diode laser, vitamin C injection, and bur abrasion—with respect to pain, healing, and esthetic outcome.

Methods: Patients presenting with moderate to severe gingival pigmentation (Dummett Oral Pigmentation Index ≥3) underwent gingival depigmentation using one of the four treatment modalities. Clinical evaluation included postoperative pain using the Visual Analog Scale (VAS), wound healing using the Modified Healing Index described by Landry et al., and assessment of gingival pigmentation using the Dummett Oral Pigmentation Index.

Results: The scalpel technique demonstrated rapid healing, excellent esthetic outcome, and remained the most economical approach, although intraoperative bleeding was comparatively greater. The diode laser provided a relatively bloodless surgical field with minimal postoperative discomfort but was associated with a burning odor during treatment and slower healing. Bur abrasion achieved satisfactory depigmentation but required meticulous technique because of the risk of thermal injury. Vitamin C injection produced the least satisfactory depigmentation among the evaluated techniques.

Conclusion: Scalpel surgery remains a reliable and cost-effective technique for gingival depigmentation. Diode laser offers superior patient comfort and hemostasis, whereas bur abrasion serves as an acceptable alternative. Vitamin C injection demonstrated limited clinical effectiveness for moderate to severe gingival pigmentation.

Clinical Outcomes of Phenol Burns Managed with Polyethylene Glycol–Glycerine Dressing: A Retrospective Case Series

Sun, 09 Aug 2026 00:00:00 +0530

Background: Chemical injury by phenol is a rare type of chemical burn that can lead to progressive local tissue damage and systemic toxic effects post-dermal absorption. Clinical studies on polyethylene glycol (PEG) and glycerine for phenol exposures exist due to PEG's solvent properties; however, literature exists in both clinical and limited quantities. The purpose of this case series was to document the clinical presentation and short-term treatment results of those individuals who were treated for phenol burns using a PEG-glycerine dressing and supportive burn care.

Case Series: A retrospective review was conducted on six patients who suffered phenol burns. Four of the patients were children and two were adults. The age ranged from 1 to 43 years, with a median age was 4.71 years. Five patients were male. Total body surface area burned averaged 27.83±10.52 % (Range = 15%-42%). Superficial to deep partial thickness burns occurred in five cases; one case involved superficial burns. The mean length of time prior to being presented for treatment was 24.17±23.91 hours. A PEG-glycerine dressing was applied to each patient's burns in addition to standard supportive burn care. Two patients developed infection. None of the patients underwent an operative procedure for debridement or skin grafting. Systemic toxicity was noted in none of the available medical records. The average length of hospitalization was 12.83±6.11 days. Each of the six patients survived, and all discharged with either healing or stable wounds.

Conclusion: Favorable short term wound progression was seen in patients with phenol burns treated with PEG-glycerine dressing and supportive care in this small retrospective case series. This should however be interpreted with caution due to the limited number of cases within the series; lack of a control/comparator group for comparison purposes; no information regarding the extent or type of irrigation performed prior to hospital arrival (pre-hospital); and a failure to document the precise time intervals between application of the PEG and any systemic monitoring.