Plastic and Reconstructive Surgery Best Paper Awards 2025

Every fall, as part of our gathering at Plastic Surgery The Meeting, we present awards to authors of the best papers in Plastic and Reconstructive Surgery from the previous calendar year. The winners are celebrated across PRSJournal.com and all of our social media channels. This year, we are taking that recognition a step further by highlighting the Best Paper award winners within the Journal itself. We are grateful to the authors of this editorial, who are drawn from the ranks of the Journal’s co-editor, section editors, and associate editors, for providing brief reflections on each award-winning article. How does one define what is the “best” article in a given year? Certainly, all articles published in Plastic and Reconstructive Surgery have already been through the gauntlet of multiple rounds of peer review and revision; all have been scrutinized for clerical adherence and multimedia excellence by our staff; and all have been intensely edited, proofed, and edited again by our expert copy editors. In that sense, every article published in Plastic and Reconstructive Surgery has achieved a certain level of excellence. We congratulate all of our published authors on this feat, and we thank them profusely for their contributions. To distinguish the Best Paper award winners from among the already-outstanding publications in the Journal, the editorial and publishing staff analyzed citation data for all articles published in 2024 for up to 16 months after publication. The articles were sorted by citation score and selected based on preexisting categories. Authors were not allowed to win twice, even for different articles or different awards. The editor-in-chief, co-editor, the American Society of Plastic Surgeons/Plastic Surgery Foundation board of directors, and members of the 2025 editorial board were ineligible. So, as selected by the broad-based academic community who reads, researches, and cites articles in the plastic surgery literature, we are proud to present the Plastic and Reconstructive Surgery Best Paper awards (Fig. 1). Congratulations to all of the authors of these best paper winners!Fig. 1.: Plastic and Reconstructive Surgery presents the Best Paper awards for articles published in 2024.Kevin C. Chung, MD, MS Plastic and Reconstructive Surgery, Editor-in-Chief Aaron Weinstein, MS Plastic and Reconstructive Surgery, Editorial Director BEST BREAST PAPER The Best Breast Paper is “Prevention of Postoperative Complications by Prepectoral versus Subpectoral Breast Reconstruction: A Systematic Review and Meta-Analysis,” by Kim et al.1 This systematic review and meta-analysis evaluated postoperative complications in prepectoral and subpectoral implant-based breast reconstruction (IBBR). This is particularly important because, for the past several decades, IBBR has been subpectoral; however, in the past decade, there has been a steady shift to prepectoral IBBR. The authors evaluated 857 studies and selected 63 for inclusion in the analysis. The analysis revealed that infection rates and prevention of capsular contracture were statistically better with prepectoral reconstruction. Furthermore, postoperative pain, upper arm mobility, and BREAST-Q score were also significantly better with prepectoral reconstruction. Rates of hematoma, mastectomy skin flap necrosis, reconstructive failure, seroma, and wound dehiscence were not different between the prepectoral and subpectoral IBBR groups. With respect to infection, these findings are significant, as other studies have shown infection rates that are higher2 or similar3 in prepectoral reconstruction compared with subpectoral reconstruction. Joseph J. Disa, MD Memorial Sloan Kettering Cancer Center New York, NY BEST OVERALL COSMETIC PAPER The Best Overall Cosmetic Paper is “The Superficial Musculoaponeurotic System: Does It Really Exist as an Anatomical Entity?” by Minelli, van der Lei, and Mendelson.4 Since the description of the superficial musculoaponeurotic system (SMAS) by Mitz and Peyronie in 1976,5 other investigators6–9 have attempted to confirm and enhance their findings. Some consider the SMAS to be the superficial fascia of the face that invests the superficial mimetic muscles and divides the superficial from the deep fat compartments. It is contiguous with superficial cervical fascia caudally and the superficial temporal parietal fascia cranially.6 Others, including our authors, question its presence and boundaries.7,8 Using cadaver dissections, sheet plastination, and histologic assessments, Minelli et al. demonstrated what others hypothesized, that the anatomic SMAS only exists where its aponeurotic layer invests the platysma inferiorly, the orbicularis oculi and zygomaticus major muscles superiorly, and the posterior portion of the parotid centrally. The cheek region, devoid of superficial musculature, does not contain an aponeurosis; hence, in the true sense of the term, the SMAS is not a contiguous structure throughout the face. However, they identified a layered fibrofatty connective tissue structure throughout the cheek. It divided the superficial and deep fat compartments between the platysma and superficial mimetic muscles running horizontal to the skin. The combined entity is described as the surgical SMAS, an amalgamated structure that plays a critical role in the clinical realm of operative facial rejuvenation procedures.9 Bernard L. Markowitz, MD David Geffen School of Medicine at UCLA Los Angeles, CA BEST COSMETIC SURGERY PAPER The Best Cosmetic Surgery Paper is “Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review,” by Tran et al.10 The indications and progression of fat grafting over time—from Coleman’s technique11 to the current state of nanografting—have brought a host of techniques for processing this fat, which has yielded the most basic stromal elements of fat lipoaspirate.12,13 Nanofat has taken hold in other indications as well, including hair transplantation,14 scleroderma,15 lichen sclerosus,16 and periorbital melanosis,17 among other indications outside of more traditional plastic surgery indications. As an Outcomes article, this systematic review was categorized under the Prevention domain for its adherence to strict methodologic criteria.18 The article nicely outlines the inclusion and exclusion criteria, along with detailing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria that were followed. As seen in the award-winning article, the main indications for nanofat are primarily scar treatment and intradermal indications where facial or neck rejuvenation is the primary location, with low-volume nanofat placement (range, 0.1 to 25 mL in the article). Not surprisingly, there are only a few common procedural similarities outside the emulsification process, which usually consisted of multiple passes through a 3-way connector. I would predict that advising patients on the outcomes of fat grafting “take” in this patient population will be predicated on outcomes surveys as compared with standardized imaging, both of which are subjective, though the article does highlight histologic findings in experimental studies. Samuel J. Lin, MD, MBA Beth Israel Deaconess Medical Center/Harvard Medical School Boston, MA BEST COSMETIC MEDICINE PAPER The Best Cosmetic Medicine Paper is awarded to “The Effect of Topical Tranexamic Acid on Postrhinoplasty Periorbital Ecchymosis and Eyelid Edema.”19 Rhinoplasty is one of the most common aesthetic procedures in plastic surgery.20 Any intervention that limits downtime secondary to bruising and swelling is attractive because it gets patients back to their normal routines. Furthermore, these interventions may allow rhinoplasty to be accessible to another subset of patients with busy schedules. In this article, utilizing a randomized, triple-blinded study, Vural et al. found that topical tranexamic acid (TXA) reduced ecchymosis and early postoperative edema.19 A randomized, blinded study is a rarity in plastic surgery for many reasons, and the authors should be congratulated on this accomplishment.21 Further, the article was novel in assessing the role of topical TXA on the outcomes of interest. The information from this study is relevant to surgeons and patients, as it may expedite healing after the procedure. This article adds to the growing body of literature solidifying the role of TXA in plastic surgery. Amy S. Colwell, MD Harvard Medical School Boston, MA BEST EXPERIMENTAL PAPER The Best Experimental Paper is “Combined Use of Autologous Sustained-Release Scaffold of Adipokines and Acellular Adipose Matrix to Construct Vascularized Adipose Tissue.”22 Xu and colleagues chose to tackle a central challenge in plastic surgery: how to control delivery of soft-tissue volume in the simplest and most predictable manner.22 Using a novel regenerative technology that combined an acellular adipose matrix with the extracellular matrix of adipose tissue called the adipose collagen fragment, the authors demonstrated a substantial increase in more mature vascularized adipose tissue in both in vitro and in vivo models. Using proteomics analyses, the authors showed that this phenomenon was driven by adipokines carried by the adipose collagen fragment, promoting both adipogenesis and vasculogenesis. This study is particularly compelling in that the methodology for adipose collagen fragment isolation is a centrifugation step following lipoaspirate harvest, suggesting that the technique is both simple and scalable. In the context of regenerative technologies, this work presents a promising, translational strategy that may transform future clinical reconstruction paradigms. Justine C. Lee, MD, PhD University of California, Los Angeles Los Angeles, CA BEST HAND/PERIPHERAL NERVE PAPER The article titled “Targeted Muscle Reinnervation at the Time of Amputation Decreases Recurrent Symptomatic Neuroma Formation”23 is the Best Hand/Peripheral Nerve Paper for Plastic and Reconstructive Surgery in 2024. This article addresses a central, critical, and contemporary question for peripheral nerve surgeons: should we perform preemptive peripheral nerve surgery, such as targeted muscle reinnervation (TMR) or regenerative peripheral nerve interface, at the time of amputation? This study is impactful because it directly compared, with a moderate number of patients, pain outcomes of individuals undergoing primary TMR with those undergoing secondary TMR. This retrospective analysis found that only 1% of patients undergoing primary TMR developed symptomatic neuromas, and that their pain scores were significantly lower than those of patients undergoing secondary TMR. This article joins a growing body of literature suggesting that early peripheral nerve surgical intervention is most likely beneficial and may be able to obviate the development of neuropathic pain following amputation.24–26 Moving forward, it will be essential to develop personalized treatment strategies for primary amputations and a more granular understanding about which specific patients will benefit the most from prophylactic techniques. This study’s data and conclusions argue in favor of prophylactic (primary) TMR at the time of amputation for the prevention of neuropathic pain. Kyle R. Eberlin, MD Massachusetts General Hospital Boston, MA BEST PEDIATRIC/CRANIOFACIAL PAPER “Magnetic Resonance Imaging of the Velopharynx: Clinical Findings in Patients with Velopharyngeal Insufficiency,” by Sitzman et al.,27 is the Best Pediatric/Craniofacial Paper of 2024. This study addressed the use of magnetic resonance imaging (MRI) in diagnosing causes of velopharyngeal insufficiency after cleft repair. Although nasopharyngoscopy and videofluoroscopy are the most common methods used to evaluate velopharyngeal insufficiency, both have shortcomings.28,29 In their study, the authors were able to diagnose anatomic abnormalities in patients with velopharyngeal insufficiency after cleft repair; their findings included short velar length, levator veli palatini discontinuity, and inferior base positioning of pharyngeal flaps as potential causes. Of note, 96% of the 118 patients had awake, nonsedated MRIs completed, despite a mean age of 10 years, with the youngest patient being 3 years old. While cost is often cited as a concern in using MRI, the cost was similar to that of nasopharyngoscopy and less than that of videofluoroscopy, and it was a covered medical expense for all patients’ preoperative evaluation. Given the anatomic precision inherent with MRI, its tolerance by even very young patients, and its acceptable cost profile, cleft centers should reconsider MRI as a primary method of evaluation in patients being considered for speech surgery. Larry Hollier, MD Texas Children’s Hospital | Baylor College of Medicine Houston, TX BEST RECONSTRUCTIVE HEAD AND NECK PAPER The Best Reconstructive Head and Neck Paper is “Color Match following Free Flap Surgery in Head and Neck Reconstruction: A Colorimetric and Aesthetic Analysis,” by Dermody et al.30 With the advancements and increased experience in microvascular reconstruction, successful outcomes are no longer measured solely in terms of flap survival. In the modern era of perforator flaps, sensate and innervated flaps, and supermicrosurgery, optimizing both the aesthetic and functional outcomes has emerged as the standard of care, and inclusion of patient quality-of-life measures has become a requisite component of most outcome studies. The present study focused on external cutaneous defects with the aim of determining the most optimal donor site to use to achieve the best color match. The authors employed advanced, standardized colorimetric analyses and demonstrated that the lateral arm, parascapular, and medial sural artery perforator flaps provided significantly superior color match to the facial skin compared with the traditional workhorse flaps. For those performing high-volume microvascular head and neck reconstruction, it becomes imperative to include these flaps in one’s armamentarium to provide the most optimal aesthetic outcomes when reconstructing complex head and neck defects. Edward I. Chang, MD The University of Texas MD Anderson Cancer Center Houston, TX BEST RECONSTRUCTIVE TRUNK PAPER The Best Reconstructive Trunk Paper is “Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia: 5-Year Follow-Up,” by Karlsson et al.31 This notable study addressed the management of chronic, late-stage lymphedema, a challenging clinical entity characterized by irreversible adipose deposition and functional impairment recalcitrant to conservative therapy. The significance of this contribution lies in its provision of compelling, long-term evidence validating the procedure’s efficacy. Although the concept of liposuction for lymphedema is established, this prospective 5-year follow-up of a substantial cohort robustly demonstrates its safety and durability. The objective outcomes, particularly the 98% sustained volume reduction in the upper extremity, provide strong support for its clinical application. A critical insight from this work is the reinforcement of the principle that liposuction is a dual-component treatment; while surgery removes the solid tissue excess, enduring success is entirely contingent on lifelong, rigorous compression therapy. Within the modern surgical armamentarium, this article helps to codify the treatment algorithm for lymphedema. It establishes liposuction as the definitive procedure for the solid-volume component of late-stage disease, thereby delineating its role from physiologic procedures, such as lymphovenous anastomoses, which are indicated for earlier, fluid-predominant stages.32 John P. Fischer, MD, MPH University of Pennsylvania Philadelphia, PA BEST RECONSTRUCTIVE LOWER EXTREMITY PAPER “Outcomes of Flap Reconstruction for Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Clinical Studies,” by Reed et al.,33 was selected as the Best Reconstructive Lower Extremity Paper. Diabetic foot ulcers are a significant problem, affecting up to 26.1 million people annually. They may result in limb loss or even loss of life, with surgical treatment falling on the shoulders of plastic surgeons.34 Using pooled data, Reed et al. identified 1681 patients who underwent local, regional, or free flap reconstruction for diabetic foot ulcers. Following reconstruction, the 1-year mortality rate was 6.35%, and the 1-year limb loss rate was 11.39%. Risk-of-bias assessment was carried out, and results ranged from “fair” to “poor” for most studies.35 In this article, critical knowledge gaps are highlighted, including a lack of studies comparing the effectiveness of flap reconstruction and nonflap treatment on mortality rates, limb loss, and function, as well as a lack of high-quality studies identifying the optimal flap type. Matthew M. Hanasono, MD The University of Texas MD Anderson Cancer Center Houston, TX BEST PLASTIC SURGERY FOCUS SPECIAL TOPIC PAPER The Best Special Topic Paper is “The Global Macroeconomic Burden of Burn Injuries,” by Gerstl et al.36 This study quantified the global macroeconomic burden of burn injuries and their geographic distribution and applied a standardized value of lost welfare framework—a method that incorporates and the value of across The results revealed geographic and not only of also have to include targeted prevention the use of to and in burn and This study a global analysis specific to that on and Global Burden of that In it findings in studies about the for prevention strategies in and and the for University BEST PAPER The Best Paper is and by et has been an important of surgery. 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