Faculty Bibliography

Bone defects are often linked to congenital disorders, high impact traumas, tumors or oncological resections. Potential treatment options include autografts, allografts, or synthetic grafts, such as bioactive ceramic-based materials which have been successfully utilized in an effort to regenerate bone. β-tricalcium phosphate (β-TCP), is a commonly utilized bioactive ceramic for regenerative purposes with favorable osteoconductive properties. Alternatively, Synthetic Bone Mineral (SBM) has been previously utilized in in vivo experiments as a supplement for bone loss treatment. As a potential alternative to β-TCP, it is also a bioactive ceramic, which consists of a carbonate hydroxyapatite with ionic substitutions such as F^−, Zn²⁺ and Mg²⁺. The objective of this work was to characterize the physiochemical properties of the colloidal gel obtained from a formulation of SBM and compare the properties directly to β-TCP. Mechanical properties were evaluated for both materials in bulk, using Biaxial Flexural Strength tests. Scanning electron microscopy and micro-computed tomography were utilized to explore the structure of the bulk material and the three dimensionally (3D) printed scaffolds. Inductive coupled plasma (ICP), X-ray diffraction (XRD), and Fourier transform infrared spectrometry (FT-IR), were utilized to determine the calcium-phosphorous ratio (Ca:P), quantitative analysis of crystalline phases, and functional groups, respectively. Thermogravimetric analysis (TGA) was used to quantify the weight percent of water, organic components, carbonate and mineral in the SBM colloidal gel. Flexural strength of SBM discs sintered at 700°C were statistically analogous to β-TCP sintered at 900°C. The Ca:P ratio of the sintered SBM was found to be 1.47 ± 0.04, statistically different from β-TCP sintered at higher temperatures. The carbonate content of the SBM was determined to be ~2.8% ± 0.9. The novel SBM colloidal gel has hence been characterized chemically and physically for its potential use in 3D printing grafts to repair critical sized bone defects.

BACKGROUND:Implant-based breast reconstruction accounts for the vast majority of breast reconstruction procedures and is commonly performed with human acellular dermal matrix. There is no consensus as to the optimal human acellular dermal matrix preparation, and high-quality evidence concerning comparative effectiveness is lacking. This study is the first prospective, multicenter, randomized controlled clinical trial to compare human acellular dermal matrix-related complications of the two most commonly used human acellular dermal matrices in implant-based breast reconstruction. The authors hypothesize that there will be no difference in infection, seroma, and reconstructive failure between FlexHD Pliable and AlloDerm RTU. METHODS:The authors conducted a Level 1 prospective, randomized, controlled, multicenter clinical trial to assess complications associated with the use of two human acellular dermal matrices in immediate postmastectomy implant-based breast reconstruction across seven clinical sites. Group A patients received FlexHD Pliable (113 patients with 187 breast reconstructions), and group B patients received AlloDerm RTU (117 patients with 197 breast reconstructions). RESULTS:There was no significant difference with respect to patient demographics, indications, comorbidities, and reconstruction approach between groups. Mean follow-up time was 10.7 ± 3.2 months. There was no statistical difference in the overall matrix-related complications between groups A and B (4.3 percent versus 7.1 percent, p = 0.233). Obesity (OR, 1.14; 95 percent CI, 1.05 to 1.24; p = 0.001) and prepectoral placement of matrix (OR, 4.53; 95 percent CI, 1.82 to 11.3; p = 0.001) were independently associated with greater risks of overall matrix-related complications. CONCLUSION/CONCLUSIONS:This work supports the use of human acellular dermal matrices in implant-based breast reconstruction and demonstrates no significant difference in matrix-related complication rates between FlexHD Pliable and AlloDerm RTU.

OBJECTIVE:The purpose of this study was to provide a cross-sectional view of all registered clinical trials enrolling patients with osteonecrosis of the jaw (ONJ). The primary aim was to report predictors of trial completion and publication of results. MATERIALS AND METHODS/METHODS:This is a cross-sectional study of ONJ trials registered with ClinicalTrials.gov. For each included entry, trial characteristics and endpoints were recorded. Predictors were enrollment size, etiology, study type, intervention type, sponsor, funding, study locations, number of centers, and specialty of the principal investigator. Outcomes were trial status, publication on PubMed, journal of publication, and length of time between endpoints. Associations between predictors and outcomes were evaluated using chi-square tests and t-tests. RESULTS:The final sample included 26 trials. Overall, 50% of trials were completed and 69% of completed trials were published. Three out of four terminated trials were suspended due to lack of funding. The median enrollment for completed trials was 149 participants with a mean length of five years. All trials included medication-related osteonecrosis of the jaw (MRONJ) patients and 26% also included osteoradionecrosis of the jaw (ORNJ) patients. The majority of trials were observational (65%), conducted internationally (62%), and involved multiple centers (54%). Published trials had a mean time of 5.9 years between trial start and publication, which was comparable to trial length (p=0.90) and appeared in either dental (44%) or cancer (56%) journals. Completion and publication rates were not significantly increased by industry sponsorship/funding, larger enrollment sizes, or multi-center involvement. Oral and maxillofacial surgery was the most represented dental specialty of principal investigators (56%). CONCLUSIONS:The majority of completed ONJ trials had their results published in a timely manner. Evidence-based investigation of ONJ is a multi-disciplinary and international effort. Among all specialists, oral and maxillofacial surgeons led the most ONJ trials.

Introduction/UNASSIGNED:The COVID-19 pandemic posed unique challenges for breast reconstruction. Many professional organizations initially placed restrictions on breast reconstruction, leading surgeons to conceive innovative protocols for offering breast reconstruction. This study reviewed the current evidence on breast reconstruction during the COVID-19 pandemic to provide guidance for surgeons facing future crises. Methods/UNASSIGNED:The MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews were searched for studies (1) describing implant and autologous breast reconstruction following mastectomy and (2) occurring during or pertaining to the COVID-19 pandemic. Results/UNASSIGNED:Of the 1347 studies identified, 26 were included. Studies discussed type of reconstruction (18, 69%), complications (11, 42%), timing of reconstruction (10, 38%), protocols (10, 38%), COVID-19 screening (7, 27%), and length of hospital stay (7, 27%). The type of reconstruction varied depending on the stage of the pandemic: early on, autologous breast reconstruction was halted to preserve resources, but was later resumed. Within implant-based reconstruction, direct-to-implant was favored over serial tissue expansion. Several protocols were developed, with many emphasizing multidisciplinary collaborations for patient selection, use of specialized measures to reduce risk of COVID-19 transmission, and optimization of same-day discharge. Complication rates following breast reconstruction were similar to pre-pandemic rates. Conclusions/UNASSIGNED:The COVID-19 pandemic has forever changed the landscape of breast reconstruction by raising important questions about delivery of care, cost, and resource utilization. The findings of this review may inform surgeons as they plan for similar future crises or strive for improved patient care and efficacy even during nonpandemic times.

PURPOSE/OBJECTIVE:The purpose of this study was to measure the association between the magnitude of advancement and dental and skeletal relapse in patients with cleft lip and palate (CLP). METHODS:A single-institution retrospective cohort study of skeletally matured patients with CLP who underwent isolated Le Fort I advancement surgery between 2013 and 2019 was studied. Patients were included if they had lateral cephalograms or cone-beam computed tomography (CBCT) at preoperative (T1), immediately postoperative (T2), and 1-year follow-up (T3). Lateral cephalometric landmarks were digitized and measured. The sample was divided on the basis of the magnitude of skeletal advancement: minor (<5 mm), moderate (≥5 but <10 mm), and major (≥10 mm) advancement groups. The mean advancement and relapse were compared between groups using 1-way ANOVA. Correlation between the amount of surgical advancement and relapse was evaluated. RESULTS:Forty-nine patients with nonsyndromic CLP with hypoplastic maxilla met inclusion criteria and the sample consisted of 36 males and 13 females with the mean age of 19.5 years. In the minor, moderate, and major advancement groups, the mean advancement at point A was +4.1 ± 0.4, + 7.5 ± 1.4, and +11.3 ± 1.3 mm, respectively. At 1-year follow-up, the mean relapse at point A was -1.3 ± 1.2, -1.1 ± 1.2, and -1.7 ± 1.5 mm, respectively. There was no significant difference in the relapse amount between all surgical groups. No correlation between the magnitude of advancement and relapse was found. CONCLUSIONS:This study demonstrated no statistically significant difference in skeletal stability between a minor (<5 mm), moderate (≥5 but <10 mm), and major (≥10 mm) Le Fort I advancement groups in patients with clefts. Regardless of the degree of advancement, mild skeletal relapse was observed in all 3 groups.

BACKGROUND: All women undergoing a mastectomy have the right to reconstruction. However, many women do not receive reconstruction and many more are not aware of all the reconstructive options available to them. Travel distance to a center that provides reconstruction and subsequent follow-up may be a contributing factor to this disparity especially among those who seek microsurgical options. Telehealth, which provides patients with remote video consultations and decreases the travel burden, may be a solution to optimize the accessibility of breast reconstruction for these patients. The purpose of this study was to discuss the efficacy and reliability of telehealth to overcome geographic barriers. METHODS: Patients who received breast reconstruction and participated in video telehealth visits between February and May 2020 were included in this study. Patient demographics, comorbidities, and clinical outcomes were collected. Video telehealth encounters were reviewed to determine specific concerns and questions discussed during these encounters. RESULTS: A total of 235 breast reconstruction surgery patient encounters were recorded for 4 plastic surgeons who offer microsurgical breast reconstruction. Eighty-eight patients (37.4%) were seen as telehealth visits, 20 (22.7%) of which were new patient visits. Eight (9.09%) patients were microsurgical breast reconstruction candidates and 25 (28.4%) were following-up after microsurgical breast reconstruction. The majority of telehealth visits included normally healing wounds in the postoperative patient. CONCLUSION/CONCLUSIONS: Telehealth provides an avenue for premastectomy consultation, second opinion visits, and postoperative follow-up for patients who have geographical barriers precluding them from reaching plastic surgeons who perform all types of breast reconstruction.

Introduction: Diabetic neuropathy (DN) is a debilitating disorder characterized by sensory loss and pain. Although common, DN has no effective treatment. A notable pathologic finding of DN is loss of sensory apparatus in the skin, causing sensory abnormalities and pain. Given that diabetic patients frequently develop skin complications, we hypothesize that skin microenvironment is important for the pathogenesis of DN.
Method(s): Our investigation focused on a skin molecule epidermal sirtuin 1 (SIRT1), which is an NAD + -dependent deacetylase known to regulate metabolism and senescence. To address the role of epidermal SIRT1 in neuroprotection against DN, we created a tamoxifeninducible epidermal SIRT1 knockout (KO) and a doxycycline-inducible epidermal SIRT1 overexpression (OE) mouse model. The KO and control mice were placed on high-fat diets (HFDs), and were subsequently assessed by behavioral, morphologic and transcriptome analyses. SIRT1 overexpression was induced in mice after three months of HFDs.
Result(s): The DN phenotype was greatly exacerbated by depletion of epidermal SIRT1, as mice developed extreme mechanical allodynia after HFD. There was also evidence of large-fiber neuropathy, including loss of Meissner corpuscles, tail sensory nerve conduction defects and degeneration of large-diameter axons, while small nerve fibers and the corresponding nociception were largely intact. The phenotype could not be rescued by treatment with the NAD+ precursor nicotinamide riboside. In comparison, induction of epidermal SIRT1 overexpression alleviated the diabetic mechanical allodynia in mice. One potential mechanism of achieving epidermal SIRT1-mediated neuroprotection is increasing the expression of epidermal brainderived neurotrophic factor (BDNF), which could preserve the morphologic and functional integrity of Meissner corpuscles.
Conclusion(s): Our data suggest an important role of epidermal SIRT1 in maintaining skin sensory apparatus and preventing mechanical allodynia in the setting of diabetes. The findings also highlight epidermal SIRT1 as a promising therapeutic target for DN due to easy accessibility of SIRT1 in skin keratinocytes