Gabriele Delia

Background: Restoration of sensory feedback has become one of the major goals of modern bidirectional neuroprosthetic rehabilitation, enabling the transition from conventional prosthetic replacement toward bidirectional neuroprosthetic systems capable of restoring physiological sensorimotor communication. This narrative review aims to provide a comprehensive and clinically oriented overview of current neural and related sensorimotor interfaces for upper- and lower-limb prostheses, focusing on their mechanisms of sensory restoration, clinical performance, and translational potential. Methods: A targeted literature search was conducted in PubMed, Scopus, and Web of Science to identify clinical, translational, and landmark studies published between January 2010 and June 30, 2026. Sources were selected according to prespecified relevance criteria consistent with the narrative design of the review. Owing to the heterogeneity of the included technologies, study designs, populations, and outcomes, the evidence was synthesized narratively. Earlier seminal publications were included when relevant to the physiological basis of sensory restoration and the historical evolution of neural interfaces. The selected literature was analyzed thematically according to neural interface technology, sensory restoration strategies, functional outcomes, and clinical translation. Results: Evidence from small pilot studies and experimental evaluations suggests that direct peripheral and central neural interfaces, biological or regenerative interfaces, neuromuscular signal interfaces, non-invasive sensory-feedback systems, and integrated prosthetic platforms may contribute to the restoration or substitution of tactile, proprioceptive, thermal, and multimodal sensory information. Emerging technologies, including regenerative peripheral nerve interfaces, fully implantable wireless systems, biomimetic sensory encoding, adaptive closed-loop control, and artificial intelligence-assisted decoding, may support further clinical translation, although most remain investigational. However, the available evidence remains limited by small patient cohorts, heterogeneous methodologies, and a lack of standardized long-term outcome measures. Conclusions: Neural and related sensorimotor interfaces have shown the feasibility of providing sensory feedback in selected experimental and early clinical settings. Although no single technology currently fulfils all clinical requirements, the integration of complementary biological, neural, and computational approaches appears to represent the most promising pathway toward personalized neuroprosthetic systems with the potential to improve sensorimotor function, although long-term clinical and quality-of-life benefits remain uncertain.

Background: Large segmental bone defects remain a major challenge in reconstructive surgery, particularly in the presence of impaired vascularization. Despite advances in scaffold design and biomaterials, insufficient vascular supply continues to represent the primary limitation in bone tissue engineering, often leading to impaired osteogenesis and graft failure. Objective: This review aims to analyze the role of vascularized flaps as “living bioreactors” in bone tissue engineering, focusing on their capacity to enhance scaffold vascularization, support osteogenesis, and facilitate clinical translation. Methods: A narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science using combinations of the following keywords: “bone tissue engineering”, “vascularized flaps”, “arteriovenous loop”, and “in vivo bioreactor”. Relevant preclinical and clinical studies were selected based on their contribution to vascularization strategies in scaffold-based bone regeneration, with the aim of illustrating the evolution and integration of these approaches. Results: Vascularized flaps provide an established vascular network and a biologically active microenvironment that promote scaffold integration and tissue regeneration. Periosteal flaps demonstrate strong osteogenic potential, whereas muscle and omental flaps primarily act as vascular carriers and adaptable regenerative environments. AV loop-based strategies enable intrinsic axial vascularization, ensuring rapid and homogeneous perfusion of large constructs. Hybrid approaches, including regenerative matching axial vascularization (RMAV), integrate vascularized tissues with advanced biomaterials and show promising translational outcomes. Conclusions: Vascularization-driven strategies represent a paradigm shift in bone tissue engineering, moving from passive scaffold implantation to actively engineered, vascularized constructs. The integration of microsurgical techniques with advanced biomaterials offers significant potential for the development of personalized and clinically applicable bone regeneration strategies.

Background/Objectives: Nasal reconstruction after non-melanoma skin cancer excision remains challenging due to the need to restore both nasal form and function while ensuring oncologic safety. Beyond surgical success, patient-reported outcomes are increasingly recognized as essential components of postoperative evaluation. The aim of this study was to retrospectively assess oncologic, surgical, and patient-reported outcomes in a real-world cohort of patients undergoing nasal reconstruction following skin cancer excision. Methods: A retrospective cohort study was conducted on 60 patients treated at the University Hospital “G. Martino” (Messina, Italy) between 2019 and 2022. Reconstructive techniques included direct closure, full-thickness skin grafts, local or regional flaps. Oncologic outcomes and postoperative complications were recorded during routine follow-up. Patient-reported outcomes were evaluated using a semi-structured PROM-derived questionnaire adapted from the FACE-Q Skin Cancer Module, NOSE, and SCaFF domains. Internal consistency of the questionnaire was assessed using Cronbach’s alpha. Results: Basal cell carcinoma was the most frequent diagnosis (55%), and the nasal ala, dorsum, and tip were the most commonly involved subunits. Local flaps were performed in 42% of cases. No histologically confirmed recurrences were observed in the flap-reconstructed subgroup during the available follow-up, whereas recurrences were observed in patients managed with non-flap reconstructive approaches. Postoperative complications were uncommon; however, one fatal infectious event occurred in a high-risk patient undergoing complex reconstruction for recurrent disease. The PROM-derived questionnaire demonstrated good internal consistency (Cronbach’s α = 0.82). Functional symptoms were rare, with 93% of patients reporting no snoring or nasal obstruction and 97% reporting no nasal voice alteration. Aesthetic satisfaction was rated as satisfactory or very satisfactory by 63% of patients, and social relationships were not affected in 85%. Patient-perceived recurrence risk (38%) exceeded histologically confirmed recurrence (15%). Conclusions: In this elderly real-world cohort, flap-based nasal reconstruction was associated with generally favorable patient-centered outcomes and low complication rates. The discrepancy between patient-perceived and confirmed recurrence highlights the role of oncologic anxiety. Prospective studies using fully validated PROMs are warranted to support standardized outcome comparison and guide clinical decision-making.

Background: Hand tumors encompass a heterogeneous spectrum of benign, malignant, and tumor-like lesions with diverse clinical behavior. While international studies have reported epidemiological and clinicopathological features, large-scale data in Italian populations are scarce. This retrospective analysis represents one of the largest Italian surgical series of histologically confirmed hand tumors. The objective was to evaluate clinicopathological characteristics, anatomical distribution, and surgical outcomes of these lesions over a 5-year period. Methods: A total of 250 patients who underwent surgery for hand tumors at the Department of Plastic and Reconstructive Surgery, University Hospital “G. Martino,” Messina, Italy, from January 2020 to December 2024, were retrospectively reviewed. Data from clinical records, imaging, and histopathology were categorized as tumor-like lesions, benign neoplasms, or malignant tumors. Demographic and clinical variables were compared across diagnostic groups. Results: The cohort included 127 males and 123 females (mean age 49.3 ± 18.6 years). Lesions were most frequently located in the digits (62%), followed by palm (21%), dorsum (11%), and wrist (6%). Tumor-like lesions represented 37.6% of cases, predominantly mucous cysts and foreign body granulomas. Benign tumors accounted for 49.2%, with giant cell tumors of the tendon sheath as the most common (31.7%). Malignant tumors were rare (10.4%), mainly squamous cell carcinoma, basal cell carcinoma, and melanoma. Patients with malignant lesions were significantly older (67.4 years) compared with those with benign or tumor-like lesions (p < 0.01). Conclusions: Benign and tumor-like lesions predominate among hand tumors, whereas malignancies are infrequent but clinically important. Surgical excision remains the treatment of choice, guided by preoperative imaging and confirmed histopathologically. Expanding this cohort and integrating molecular diagnostics with patient-reported outcomes may enhance future management strategies.

Background/Objectives: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. Traditional diagnostics like EMG and NCSs are invasive and do not visualize nerve morphology. This study aims to evaluate the diagnostic and prognostic value of high-resolution ultrasonography in patients with CTS using a standardized scanning protocol and to evaluate the relationship between sonographic findings and traditional electrodiagnostic results. Methods: In this observational study with both prospective and retrospective components, 31 subjects were included. Between November 2023 and June 2024, 11 symptomatic CTS patients were scheduled for surgical decompression and 14 healthy controls were prospectively enrolled. Additionally, six post-surgical CTS patients who had undergone decompression between 2016 and 2021 were retrospectively included for comparative analysis. All underwent clinical and ultrasonographic assessments of the median nerve at predefined anatomical landmarks. EMG was performed in the CTS groups. Ultrasound was repeated at 1, 3, and 6 months postoperatively to monitor morphological changes. Results: CTS patients had significantly increased the median nerve CSA compared to controls. Postoperative ultrasound showed progressive CSA reduction correlating with clinical improvement and EMG recovery. The CSA correlated moderately to strongly with distal motor latency. Conclusions: High-resolution ultrasound is a reliable, non-invasive tool for diagnosing and monitoring CTS. Standardized protocols are needed to support broader clinical adoption and establish it as a standalone diagnostic method.

Scarring resulting from wound healing has significant physical and emotional implications, especially in visible areas. This study explores advancements in scar management using hybrid laser therapy. Scar prevention methods, including laser therapy, have gained attention. The research aims to evaluate the effectiveness of combining fractional ablative CO2 and non-ablative Erbium glass 1570 nm lasers, both independently. The study involved 51 patients with diverse scars, grouped based on intervention timing and scar characteristics. Laser treatments utilized fractional ablative CO2 and non-ablative Erbium glass 1570 nm lasers. Patients were evaluated using clinical features and subjective assessments. The Vancouver Scar Scale measured scar improvement. Adverse effects were documented. Data collection involved consistent photography and evaluations at intervals. The study demonstrated significant improvements in scar appearance across various parameters, especially with early interventions. The hybrid laser therapy approach yielded positive outcomes. Scar improvement was observed in terms of extension, size, shape, pigmentation, vascularity, and elasticity. Subjects reported reduced discomfort, itching, pain, and tension. Patient satisfaction was high. Adverse effects were mild and well-tolerated. This research underscores the importance of addressing scar management with hybrid laser therapy. Early interventions showed pronounced improvements in scar appearance and subjective satisfaction. The study provides insights into scar treatment, offering a comprehensive guideline for optimizing outcomes. By merging technology and regenerative approaches, scars are redefined as symbols of healing and resilience. The study showcases the potential for individualized care and emphasizes the transformative impact of combining cutting-edge techniques in scar management.