Mary Ellen McMahon

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly expanded in use for weight loss, resulting in a growing population of patients presenting for aesthetic and body-contouring procedures. Despite their increasing prevalence, the effects of GLP-1 RAs on postoperative wound healing and surgical outcomes remain poorly defined. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane CENTRAL were searched from database inception through May 2026. Studies comparing postoperative outcomes in patients undergoing aesthetic and/or body-contouring surgery with and without GLP-1 RA exposure were included. Primary outcomes included infection, wound dehiscence, delayed wound healing, hypertrophic scarring, seroma, hematoma, and venous thromboembolism (VTE). Random-effects meta-analyses were performed using risk ratios (RRs) with 95% confidence intervals (CIs). Results: Twelve studies comprising 29,357 patients met inclusion criteria, with 10 studies included in quantitative synthesis. In pooled observational analyses, GLP-1 RA exposure was associated with increased risk of delayed wound healing and hypertrophic scarring. Subgroup analysis comparing GLP-1 RA users with patients who had previously undergone bariatric surgery demonstrated decreased seroma rates in the GLP-1 RA group. Conclusions: GLP-1 RA use in patients undergoing aesthetic and body-contouring surgery was associated in pooled observational analyses with increased risks of delayed wound healing and hypertrophic scarring, while GLP-1 RA use was associated with lower seroma rates in comparison with patients who have undergone bariatric surgery. As GLP-1 RA use become increasingly prevalent, further prospective studies are needed to clarify their perioperative effects and optimize patient selection and surgical outcomes.

Acral melanoma (AM) is a rare, biologically distinct melanoma subtype arising on the palms, soles, and nail apparatus that is frequently diagnosed late and carries a worse prognosis than non-acral cutaneous melanoma. Population-specific AM data remain limited outside North America and East Asia, and Ireland’s comparatively homogeneous population has not previously been described. We performed a retrospective, bi-institutional cohort study of 41 AM patients treated at two Dublin tertiary referral centres (2017–2023), using data from prospectively maintained melanoma databases, medical records, and pathology reports. Patients were predominantly older adults (median age 73, range 39–88) with a long delay before presentation: 80.5% reported an enlarging lesion for six months or more before seeking care. Lesions were predominantly located on the foot (73.2%), and acral lentiginous melanoma was the predominant histological subtype (82.9%). Median Breslow Thickness was 3.0 mm, and 75.6% presented with T stage ≥ 3. Amputation was required in 65.9% of patients to achieve adequate margins, 47.4% of those assessed had confirmed nodal disease, and 36.6% developed recurrence. Mutation testing, performed in a subset of tumours, identified BRAF, NRAS, and KIT alterations in a minority of cases, with a substantial proportion classified as triple-wild-type. Despite Ireland’s unique germline background reported in cutaneous melanoma, this Irish cohort’s mutational profile and advanced stage at presentation were broadly consistent with international cohorts. Earlier clinical recognition, standardised nail-unit biopsy technique, and a national melanoma registry could improve outcomes for this rare, high-risk subtype.

Background: The use of PolyNovo NovoSorb biodegradable temporizing matrix (BTM) has become popular for the management of complex wounds, often with the subsequent application of a split-thickness skin graft. To date, there are no published case series describing healing via secondary intention over BTM in the management of small, complex nasal wounds following excision of skin malignancy in the elective setting. Methods: This study consisted of a single-center, consecutive case series. Inclusion criteria consisted of defects with exposed cartilage or bone in wounds located on the nasal dorsum or nasal sidewall resulting from the elective excision of nasal skin malignancies. BTM without skin grafting was used as a single-stage reconstruction in all patients following oncological clearance. After delamination, the wound was left to heal by secondary intention. The Patient and Observer Scar Assessment Scale was used to measure the aesthetic outcome. Results: All 32 cases exhibited 100% integration of BTM and successful wound closure. Two cases required further excision following review of the final histology. The median (SD) overall Patient and Observer Scar Assessment Scale score was 2.7 (±0.81), and the median overall observer score was 3.2 (±0.73). Conclusions: When planning nasal reconstruction following oncological resection, one should consider the patient’s comorbidities; their ability to tolerate the anesthetic, surgery, donor skin deficit, and risks; and the technical ability of the operating surgeon. We suggest that the use of BTM without harvesting a skin graft represents a simple, low-risk option for reconstruction of nasal defects that produces acceptable functional and aesthetic outcomes.

Background: This study introduces a novel method for the management of closed metacarpal neck fractures. Kirschner wires (K-wire) are introduced in a retrograde and the wires withdrawn through skin proximally at the base of the metacarpal. The fracture is reduced using traction and the reduction is maintained by antegrade advancement of the K-wires. The aim of this study is to report the outcomes of this technique. Methods: A total of 36 patients with severely angulated closed metacarpal neck fractures underwent reduction and fixation using this novel method from January 2017 to December 2020 in centres in Ireland and Saudi Arabia. We performed a retrospective review of these patients’ clinical data examining their outcomes. Results: Six months postoperatively, all fractures demonstrated bony union and correction of angulation. All patients exhibited excellent range of motion (ROM) with no significant impairment of hand function. Conclusions: The method detailed here is a simple, minimally invasive and reliable technique that has not previously been described. It is suitable for use in the management of closed metacarpal neck fractures of the fourth and fifth metacarpal, with dorsal angulation greater than 60°. Level of Evidence: Level IV (Therapeutic)

Lhermitte-Duclos Disease is a rare clinical entity involving a dysplastic lesion of the cerebellum. The dysplastic cerebellar ganglioblastoma is often seen in association with Cowden Syndrome, an autosomal dominant disorder consisting of a mutation in the phosphatase and homologous tensin (PTEN) gene. Characteristic findings on neuroimaging allow for a pre-operative diagnosis to be made, which guides further management of the condition. This report describes the diagnosis and management of Lhermitte-Duclos Disease in a 51-year-old lady, spanning a period of almost seven years. The characteristic radiological and histological findings are presented, along with the clinical features associated with Cowden Syndrome. This patient ultimately underwent surgical intervention for symptomatic relief, which is described here.