Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Plastic Surgery
Total Results:
5788
Dual venous outflow improves lower extremity trauma free flap reconstructions
BACKGROUND: Venous outflow problems are the most common reasons for perioperative flap complications. The benefit of a second venous anastomosis, however, remains unclear in lower extremity trauma free flap reconstruction and warrants further investigation. MATERIALS AND METHODS: Retrospective review of our institutional flap registry from 1979 to 2014 identified 464 free flaps performed for lower leg trauma reconstruction. Patient demographics, flap characteristics, and outcomes were examined. RESULTS: A total of 219 flaps were randomly selected for preliminary analysis. Single-vein outflow was more common (72.6%) than dual-vein (27.4%); most of the recipients were in deep venous system (83.6%) versus superficial (11.9%) or both (4.6%). Two-vein anastomoses were more likely in fasciocutaneous flaps than muscle flaps (P = 0.001) and in smaller (<300 cm(2)) flaps (P = 0.002). Complications occurred in 98 flaps (44.7%); with 54 partial flap losses (24.7%), and 11 complete flap losses (5.0%). Multivariable regression analysis controlling for age, sex, flap type, presence of bone gap, flap size, vein size mismatch, and time since injury demonstrated dual-vein outflow to be protective against complications (relative risk [RR] = 0.269, P = 0.001), partial flap failure (RR = 0.351, P = 0.031), and any flap failure (RR = 0.31, P = 0.010). No significant difference in operative time was found (P = 0.664). CONCLUSIONS: Dual-vein outflow demonstrated 73% reduction in overall complications and 69% reduction in flap failure rate compared to single-vein flaps. These results suggest a protective effect of a dual-vein outflow system, and when considered together with our findings of unchanged operative time, provide evidence for preferential use of two venous anastomoses when possible for free flap reconstruction of lower extremity trauma.
PMID: 27229095
ISSN: 1095-8673
CID: 2115092
EdnrB Governs Regenerative Response of Melanocyte Stem Cells by Crosstalk with Wnt Signaling
Delineating the crosstalk between distinct signaling pathways is key to understanding the diverse and dynamic responses of adult stem cells during tissue regeneration. Here, we demonstrate that the Edn/EdnrB signaling pathway can interact with other signaling pathways to elicit distinct stem cell functions during tissue regeneration. EdnrB signaling promotes proliferation and differentiation of melanocyte stem cells (McSCs), dramatically enhancing the regeneration of hair and epidermal melanocytes. This effect is dependent upon active Wnt signaling that is initiated by Wnt ligand secretion from the hair follicle epithelial niche. Further, this Wnt-dependent EdnrB signaling can rescue the defects in melanocyte regeneration caused by Mc1R loss. This suggests that targeting Edn/EdnrB signaling in McSCs can be a therapeutic approach to promote photoprotective-melanocyte regeneration, which may be useful for those with increased risk of skin cancers due to Mc1R variants.
PMCID:5391032
PMID: 27134165
ISSN: 2211-1247
CID: 2228102
Analysis of Cases in Which a Biopsy Specimen Is Positive and an Excised Lesion Is Negative for Nonmelanoma Skin Cancer
PMID: 26719953
ISSN: 2168-6262
CID: 2111342
A Novel Approach to Surgical Markings Based on a Topographic Map and a Projected Three-Dimensional Image
UNLABELLED:Surgical markings play a crucial role in the planning of plastic surgery procedures. However, despite their importance, they are often imprecise. For instance, when assessing patients in need of autologous fat grafting, surgeons often base markings on estimations of where volume deficiency exists and how much volume will correct the deficiency. In this article, the authors describe a novel approach to lipostructure, guided by a computer-based roadmap. A digital three-dimensional topographic surgical map is created using three-dimensional photography and analytic software and then projected as an image onto the patient in the operating room. This unique concept can be applied to most soft-tissue procedures in plastic surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.
PMID: 27119948
ISSN: 1529-4242
CID: 3102552
American journal of orthodontics & dentofacial orthopedics. 2016:149(5):766-8.DOI: 10.1016/j.ajodo.2016.02.008
It's just a phase [Editorial]
PMID: 27131259
ISSN: 1097-6752
CID: 2092862
Plastic Surgery Mortality: An 11-Year, Single-Institution Experience
BACKGROUND: Systematic reporting of mortality data is lacking in many surgical fields including plastic surgery. Current plastic surgery literature is largely limited to adverse events associated with specific procedures. Without mortality data, it is unclear how the recent growth of patient safety initiatives can rationally impact outcomes. METHODS: We evaluated 11 years of patient outcome data collected prospectively and updated monthly by our department. Paper records were entered into a Health Insurance Portability and Accountability Act-compliant digital database capable of prospectively maintaining future data. Data were reviewed for 5 surgical services in 4 different hospitals that comprise our department's activity. RESULTS: Between 2000 and 2011, a total of 60,834 cases were performed. In this time, a total of 829 (1.4%) negative outcome reports were identified. Of these, a total of 25 (0.04%) cases had an outcome of death (24) or brain death (1). Deaths were either directly or indirectly associated with cardiopulmonary causes, multisystem organ failure, sepsis, massive bleeding, CVA, saddle embolism, or unknown causes. CONCLUSIONS: This study is the largest reported series of cases performed by a single academic plastic surgery service to report overall mortality data.
PMID: 25389714
ISSN: 0148-7043
CID: 1349002
Effects of ovariectomy on periodontal tissues following tooth replantation
OBJECTIVES: The aim of the study was to analyze the effects of ovariectomy on periodontal tissues following immediate tooth replantation by histomorphometric, immunohistochemistry, and muCT analysis. MATERIALS AND METHODS: Eighty wistar rats (Rattus norvegicus albinos) with normal estrous cycles were randomly divided into two groups: ovariectomized (OVX) and Sham. Two months after surgery, the rats' upper right incisor was extracted followed by immediate reimplantation. The animals were sacrificed after 28, 45, and 60days healing time. Histomorphometric and immunohistochemical analysis were performed by evaluation of PCNA and TRAP straining. RESULTS: The periodontal ligament was reinserted into the bone and cementum in the both groups. The immunohistochemical analysis revealed PCNA positive cells on the periodontal ligament in both groups at 28 days. Root resorption was noted at 45days with immunoreactive cells for TRAP present in bone and tooth surface however no statistical differences between the groups were noticed. Histomorphometric analysis showed significant difference between groups in the periodontal ligament and root resorption parameters for the sub-items: intensity of chronic inflammatory infiltrate at 60days (p<0.01), the organization of the periodontal ligament at 28days (p<0.05), depth of root resorption at 45days (p<0.05) and at 60days (p<0.001). The muCT analysis showed multiple areas of bone resorption in association with OVX at 28 and 60days with no significant differences between times in vivo. CONCLUSION: The ovariectomy did not have significant influence in periodontal tissue parameters following tooth reimplantation.
PMID: 26828678
ISSN: 1879-1506
CID: 1933412
Rhabdomyomatous mesenchymal hamartoma presenting as a skin tag in a newborn
PMCID:4890107
PMID: 27299150
ISSN: 2352-5126
CID: 2654472
Primary Premaxillary Setback and Repair of Bilateral Complete Cleft Lip: Indications, Technique, and Outcomes
OBJECTIVE: To analyze indications and outcomes for primary premaxillary setback. DESIGN: Retrospective. SETTING: Academic children's hospital. PATIENTS: All children with bilateral complete cleft lip age
PMID: 26575966
ISSN: 1545-1569
CID: 2040352
Total Face, Eyelids, Ears, Scalp, and Skeletal Subunit Transplant Research Procurement: A Translational Simulation Model
BACKGROUND: Cadaveric face transplant models are routinely used for technical allograft design, perfusion assessment, and transplant simulation but are associated with substantial limitations. The purpose of this study was to describe the experience of implementing a translational donor research facial procurement and solid organ allograft recovery model. METHODS: Institutional review board approval was obtained, and a 49-year-old, brain-dead donor was identified for facial vascularized composite allograft research procurement. The family generously consented to donation of solid organs and the total face, eyelids, ears, scalp, and skeletal subunit allograft. RESULTS: The successful sequence of computed tomographic scanning, fabrication and postprocessing of patient-specific cutting guides, tracheostomy placement, preoperative fluorescent angiography, silicone mask facial impression, donor facial allograft recovery, postprocurement fluorescent angiography, and successful recovery of kidneys and liver occurred without any donor instability. Preservation of the bilateral external carotid arteries, facial arteries, occipital arteries, and bilateral thyrolinguofacial and internal jugular veins provided reliable and robust perfusion to the entirety of the allograft. Total time of facial procurement was 10 hours 57 minutes. CONCLUSIONS: Essential to clinical face transplant outcomes is the preparedness of the institution, multidisciplinary face transplant team, organ procurement organization, and solid organ transplant colleagues. A translational facial research procurement and solid organ recovery model serves as an educational experience to modify processes and address procedural, anatomical, and logistical concerns for institutions developing a clinical face transplantation program. This methodical approach best simulates the stressors and challenges that can be expected during clinical face transplantation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
PMID: 27119947
ISSN: 1529-4242
CID: 2092082
