Faculty Bibliography

The loss of Royal Mail Ship (RMS) Titanic has been examined extensively through the lenses of engineering failure, maritime law, and social history, yet little attention has been paid to the conduct and professional identity of her medical officers. This surgical history examines the lives and final hours of the ship's 2 surgeons, Dr. William Francis Norman O'Loughlin and Dr. John Edward "Jack" Simpson, situating their actions within the evolving practice of maritime medicine in the early 20th century. Drawing on contemporary newspaper accounts, official inquiries, archival records, personal correspondence, and genealogical sources, this article reconstructs their careers, responsibilities, and conduct during the disaster. O'Loughlin, a senior surgeon with decades of maritime experience, and Simpson, a younger assistant surgeon at the outset of his career, represented 2 generations united by a shared professional ethic. Both remained at their posts, assisting passengers and crew, maintaining calm, and declining opportunities for self-preservation. Their actions exemplify the unwritten code of the surgeon: composure under pressure, disciplined and methodical judgment, and a steadfast respect for the dignity of every human life. Beyond documenting individual bravery, this article demonstrates that their conduct reflects enduring principles of surgical professionalism that transcend era, technology, and setting. In a tragedy remembered primarily for its scale, the surgeons' story highlights how judgment, humanity, and moral responsibility remain central to the identity of the surgeon, whether practiced in a modern operating room or a rolling hospital at sea.

OBJECTIVE:This study reports patient outcomes and predictors of outcomes after total contact casting (TCC) for diabetic stump ulceration in patients with partial-foot amputations. METHODS:Retrospective review of patients treated with TCC for diabetic stump ulcerations with ipsilateral partial-foot amputation at a tertiary center from 2015 to 2022 was performed. Patients lost to follow-up, those unable to tolerate TCC, and those with partial amputations of digits 2 to 5 were excluded. Patient demographics, outcomes, and complication rates of TCC were collected and compared. Multivariable linear regression was performed to identify demographic predictors of time to ulcer closure. RESULTS:Forty-three patients were included in this study, with a 93.5% rate of primary ulcer closure, 46.5% rate of re-ulceration, and 9.3% rate of re-amputation. Patients without re-ulceration were significantly more likely to be nonsmokers. Regression analysis also found that smoking history trended toward a longer delay to ulcer closure (P=.097). Age, body mass index, presence of contralateral amputation, and type of amputation did not affect patient outcomes or complication rates. CONCLUSIONS:TCC effectively promotes ulcer closure in diabetic patients with high comorbidity burden and partial-foot amputation, although smoking history increases re-ulceration rates.

We report a case of malignant transformation in a young woman with pilonidal disease-a rare manifestation of 'Marjolin's ulcer'. The patient initially presented to an outside hospital emergency department with an ulcer of the left buttock. Her family reported a longstanding mass present at this site prior to rupture. The patient had two ED visits and a surgical referral that did not result in biopsy, contributing to delayed diagnosis. She eventually presented to our wound clinic with a full-thickness, friable, frond-like ulcer with probable sacral extension. Immediate biopsy was performed and confirmed squamous cell carcinoma (SCC). Imaging revealed a buttock mass with lymphadenopathy. Fine-needle aspiration confirmed metastatic SCC in the inguinal lymph nodes. The disease was deemed unresectable and systemic therapy was begun. This case emphasizes the importance of biopsy in nonhealing ulcers, underscores the need for system-level processes to ensure follow-up, and demonstrates the enduring relevance of Marjolin's original 19th-century observations.

OBJECTIVE/UNASSIGNED:To determine the outcomes of patients receiving hyperbaric oxygen therapy for sudden sensorineural hearing loss and the impact of patient comorbidities on outcomes. STUDY DESIGN/UNASSIGNED:Retrospective chart review. SETTING/UNASSIGNED:Tertiary referral center. METHODS/UNASSIGNED:All patients over 18 diagnosed with sudden sensorineural hearing loss between 2018 and 2021 who were treated with hyperbaric oxygen therapy were included. Demographic information, treatment regimens and duration, and audiometric and speech perception outcomes were recorded and analyzed. RESULTS/UNASSIGNED:19 patients were included. The median age was 45 years. 53% were female and 21% had pre- existing rheumatologic disorders. The mean duration between hearing loss onset and physician visits was 9.6 days. All patients received an oral steroid course, while 95% also received a median of 3 intratympanic steroid injections. Patients began hyperbaric oxygen therapy an average of 34.2 days after the hearing loss onset for an average of 13 sessions. No significant relationships were found between patient comorbidities and outcomes. Of those who reported clinical improvement, 57% demonstrated complete recovery per Siegel's criteria. There was significant improvement after hyperbaric oxygen therapy for pure tone averages (50.3dB vs. 36.0dB, p<0.01) and word discrimination scores (73% vs 79%, p<0.05) for all patients regardless of reported clinical improvement. CONCLUSION/UNASSIGNED:Hyperbaric oxygen therapy, as an adjunct to steroids, significantly improves recovery from sudden sensorineural hearing loss. The Charlson comorbidity index was not significantly associated with patient outcome, but patients with rheumatologic disorders were less likely to respond. Differentiating the natural history of the disease from hyperbaric oxygen therapy-associated improvements remains a challenge.

OBJECTIVES/OBJECTIVE:Total contact casting (TCC) is used to promote wound closure in diabetic foot ulcers (DFUs); however, this technique is underused today. This study aims to further evaluate the efficacy of TCC in a large cohort, including patients with peripheral artery disease (PAD). METHODS:This was a retrospective analysis of patients with DFUs who underwent TCC from 2017 to 2021. PAD was defined as absence of pedal pulse or ABI <0.9. Demographic data, DFU characteristics, and peripheral arterial intervention were evaluated. Outcomes included complete healing, healing time, and rate of major amputation. Subgroup analysis was performed on patients undergoing peripheral intervention. RESULTS:= .0008) compared to patients without intervention. CONCLUSIONS:TCC remains an effective option for treatment of DFUs, as most were completely healed. Patients with PAD may benefit from TCC and revascularization, however, healing rates are lower in this cohort, necessitating the need for close observation.

Chopart's amputation is a limb length-preserving amputation that retains function but often suffers from stump ulcerations. We report a case of a 68-year-old male patient with poorly controlled type 2 diabetes mellitus and peripheral arterial disease who underwent left Chopart's amputation, presenting subsequently with nonhealing ulcers at the Chopart stump and heel for >1 year. Total contact casting was initiated, resulting in rapid wound healing without further interventions. This case highlights total contact casting's effectiveness in managing ulcerations post-Chopart's amputation, potentially preventing revision amputations, and extending its usefulness to complex foot anatomy in patients with diabetes and peripheral arterial disease.

BACKGROUND:Hyperbaric oxygen has been reported to improve disease activity in hospitalised ulcerative colitis (UC) patients. AIM/OBJECTIVE:To evaluate dosing strategies with hyperbaric oxygen for hospitalised UC patients. METHODS:We enrolled UC patients hospitalised for acute flares (Mayo score 6-12). Initially, all patients received 3 days of hyperbaric oxygen at 2.4 atmospheres (90 minutes with two air breaks) in addition to intravenous steroids. Day 3 responders (reduction of partial Mayo score ≥ 2 points and rectal bleeding score ≥ 1 point) were randomised to receive a total of 5 days vs 3 days of hyperbaric oxygen. RESULTS:We treated 20 patients with hyperbaric oxygen (75% prior biologic failure). Day 3 response was achieved in 55% (n = 11/20), with significant reductions in stool frequency, rectal bleeding and CRP (P < 0.01). A more significant reduction in disease activity was observed with 5 days vs 3 days of hyperbaric oxygen (P = 0.03). Infliximab or colectomy was required in only three patients (15%) despite a predicted probability of 80% for second-line therapy. Day 3 hyperbaric oxygen responders were less likely to require re-hospitalisation or colectomy by 3 months vs non-responders (0% vs 66%, P = 0.002). No treatment-related adverse events were observed. CONCLUSION/CONCLUSIONS:Hyperbaric oxygen appears to be effective for optimising response to intravenous steroids in UC patients hospitalised for acute flares, with low rates of re-hospitalisation or colectomy at 3 months. An optimal clinical response is achieved with 5 days of hyperbaric oxygen. Larger phase 3 trials are needed to confirm efficacy and obtain labelled approval.

The definition of medication-related osteonecrosis of the jaw (MRONJ) includes a stage 0 presentation where exposed bone, the hallmark of this condition, is absent. Numerous management strategies have been recommended for MRONJ including hyperbaric oxygen (HBO2) therapy. This report describes a 64-year-old woman with stage 0 MRONJ of the bilateral mandible, refractory to clindamycin and local debridement, who was subsequently managed successfully with amoxicillin/clavulanate and HBO2 therapy. The authors also explore the current literature on the pathophysiology of MRONJ and the potential role of hyperbaric oxygen in its treatment.

PURPOSE/OBJECTIVE:To describe the revenue from a collaboration between a dedicated wound care center and an interventional radiology (IR) practice for venous leg ulcer (VLU) management at a tertiary care center. MATERIALS AND METHODS/METHODS:This retrospective study included 36 patients with VLU referred from a wound care center to an IR division during the 10-month active study period (April 2017 to January 2018) with a 6-month surveillance period (January 2018 to June 2018). A total of 15 patients underwent endovascular therapy (intervention group), whereas 21 patients did not (nonintervention group). Work relative value units (wRVUs) and dollar revenue were calculated using the Centers for Medicare and Medicaid Services Physician Fee Schedule. RESULTS:Three sources of revenue were identified: evaluation and management (E&M), diagnostic imaging, and procedures. The pathway generated 518.15 wRVUs, translating to $37,522. Procedures contributed the most revenue (342.27 wRVUs, $18,042), followed by E&M (124.23 wRVUs, $8,881), and diagnostic imaging (51.65 wRVUs, $10,599). Intervention patients accounted for 86.7% of wRVUs (449.48) and 80.0% of the revenue ($30,010). An average of 33 minutes (38.3 hours total) and 2.06 hours (36.8 hours total) were spent on E&M visits and procedures, respectively. CONCLUSIONS:In this collaboration between the wound center and IR undertaken to treat VLU, IR and E&M visits generated revenue and enabled procedural and downstream imaging revenue.

OBJECTIVE: To report a case of refractory ulcerated necrobiosis lipoidica (NL) with significant response to treatment with topical tacrolimus. SUBJECT: A 55-year-old woman without diabetes and with a previous history of NL presented to the Helen L. and Martin S. Kimmel Hyperbaric and Advanced Wound Healing Center of NYU Langone Medical Center, New York, with bilateral lower-leg ulcerations resistant to wound healing techniques at other institutions. MATERIALS AND METHODS: Repeat biopsy performed at the author's institution confirmed the diagnosis of NL. Initial therapy was based on reports of other successful treatment methods, which included collagen wound grafts and collagen-based dressings coupled with compression. These methods initially showed promising results; however, the wounds reulcerated, and any gains in wound healing were lost. Alternative options were initiated, including topical clobetasol and narrowband ultraviolet B; however, no significant improvement was observed. The patient's lower-extremity wounds began to deteriorate. The patient also refused systemic therapy. Treatment was changed to topical 0.1% tacrolimus ointment and was applied daily for 10 months with multilayer compression wraps. RESULTS: Both lower-extremity ulcerations began to show significant improvement, with the ulcers progressing toward closure except for 1 very small area on the left lower extremity. CONCLUSIONS: Topical tacrolimus seems to be an effective treatment option for patients with refractory chronic ulcerated NL who do not want systemic oral therapy. The authors found that successful wound closure may require a multimodal approach, which promotes wound healing, but also concurrently addresses the underlying disease process.