Plastic Surgery Commons^™

Spare Parts Surgery For Oncologic Reconstruction To Preserve Local Advancement Flap For Decubitus Ulcer Reconstruction: A Case Report, Emily Zurbuchen, Nathan Foje, Sean Figy

Graduate Medical Education Research Journal

A 58-year-old male presented to our institution with synchronous large left thigh sarcoma and sacral decubitus ulcer requiring oncologic resection and reconstruction. Due to extensive tumor involvement, use of local flap for reconstruction was not feasible. Therefore, a spare parts free fillet flap from the disarticulated lower leg was utilized for reconstruction following oncologic resection. The benefits of this spare parts approach include no donor site morbidity, sufficient tissue padding for later use of prosthesis, and preservation of other flaps for future reconstruction of his sacral decubitus ulcer.

An Exploration Of Facial Skin Scarring, Its Impact And Contemporary Evaluation, Michael G. Brandt

Electronic Thesis and Dissertation Repository

Facial skin cancer secondary to surgical treatment may be distressing due to the malignancy itself and from the consequences of its treatment. A visible postsurgical scar is an obvious reminder of the condition. This investigation sought to broaden our understanding of facial scarring and develop a novel tool for its objective evaluation. To this end, skin cancer as the most common etiology of facial scarring was reviewed. The scar scale literature was evaluated in the context of assessing scars through a biopsychosocial lens. Finally, the development of a novel scar scale was presented. Thirty-four individuals completed 13,056 ratings using a …

Progressive Lowering Of Transverse Mastectomy Scars Onto The Inframammary Fold: A Novel Technique To Simultaneously Improve Cosmesis While Performing Implant-Based Breast Reconstruction, Annalisa Lopez

MEDI 9331 Scholarly Activities Clinical Years

The post-reconstruction appearance of mastectomy scars is a contributing factor that affects how patients perceive themselves after breast reconstruction.1 Patients that undergo a skin-sparing mastectomy (SSM) may often have a periareolar incision which can leave an unappealing transverse scar. Regardless of whether reconstruction is performed in a delayed or immediate fashion, the transverse mastectomy scar itself commonly lies in the center of the breast near the reconstructed nipple-areolar complex, causing psychological trauma and continued patient dissatisfaction.2 This also may lead to post-reconstruction multiple mastectomy scar revisions. This research aims to describe a novel technique to reliably avoid the presence of …

Modification Of Current Techniques: Increasing Nipple Projection In Patients Receiving Nipple-Areolar Complex (Nac) Reconstruction, Annalisa Lopez, Aidee C. Nunez, Mauricio De La Garza

MEDI 9331 Scholarly Activities Clinical Years

Breast cancer is the most common malignancy diagnosed in women aside from nonmelanoma skin cancer; 276,480 new cases of breast cancer are estimated to be diagnosed by the end of 2020.1 An estimated 76% of patients with stage III or IV breast cancer pursue mastectomy as part of their treatment.2 Recent breast reconstruction trends reveal an upsurge in the percentage of patients pursuing breast reconstruction following mastectomy recent studies reveal that 54-63% of women undergoing mastectomy decide to pursue breast reconstruction.3 Breast reconstruction is conventionally considered complete after the restoration of the Nipple-areolar complex (NAC), 71% of patients consider a …

Complex Reconstruction After Extreme Fournier’S Gangrene; A Case Report, Serban Dumitrache, Leonida A. Goman, Raluca Dutu, Raluca Capatina, Carmen Giuglea, Dan M. Enescu

Journal of Mind and Medical Sciences

In this article we present a severe case of Fournier's gangrene (FG) that affected a 64-year-old male patient, with no other known comorbidities. FG is a type of necrotizing fasciitis of the perineal and genital regions, that affects mostly males in the 5th-7th decades, with mortality rates that reach 70%. The infection usually advances through the superficial fascial layers of the perineum and abdomen and affects the skin. In our case the infection also affected the spermatic fasciae and advanced in the abdominal and pelvic cavities, abdominal muscles, and surrounding soft tissues. Subsequent debridement left the patient with large soft …

Clinical Features, Pathology, And Surgical Management Of Periocular Giant Basal Cell Carcinoma, Oxana Madalina Grosu, Vladimir Poroch, Natalia Velenciuc, Sorinel Lunca

Journal of Mind and Medical Sciences

Objectives. Basal cell carcinomas (BCCs) are malignant tumors which rarely metastasize, are slow-growing, and extensively locally destructive. BCCs more than 5 cm in diameter are defined as giant. Most often they arise as a result of neglect, as the patient avoids, delays, or refuses to see a doctor. The large tumor diameter and consequently of the post-excisional defect make these lesions difficult to treat surgically with respect to selecting the surgical reconstruction technique. Method. We studied a group of 9 patients, aged 60 to 85 years, diagnosed with giant basal cell carcinomas (GBCCs) with periocular location in which surgery was …

Covid-19 Outbreak Impact On Plastic Surgery Residents From Romania, Cristina N. Marina, Daniela E. Gheoca-Mutu, Laura Răducu, Adelaida Avino, Lăcrămioara A. Brîndușe, Corina M. Stefan, Razvan V. Scaunasu, Cristian R. Jecan

Journal of Mind and Medical Sciences

The COVID-19 outbreak triggered a global crisis with long-term effects on people’s daily lives. It has altered surgical practice and education and imposed major changes in healthcare systems and resources. In order to analyze the impact the COVID-19 pandemic has had on Romanian Plastic Surgery residents, we carried out an anonymous questionnaire through Google forms. Survey items addressed aspects such as how the pandemic has affected their surgical practice, their exposure to the virus, and the protective measures that have been implemented to minimize risk. Among other results, our study found that nearly 1 in 5 respondents had contact with …

The Use Of Ndyag Laser Combined With Pulsed Light In The Treatment Of Rosacea, Valeriu Ardeleanu, Lavinia Alexandra Moroianu, Vlad Denis Constantin, Petrisor Banu, Florin Silviu Groseanu, Ioana Paunica, Ana Maria Dascalu, Alin Laurentiu Tatu

Journal of Mind and Medical Sciences

Rosacea is a chronic inflammatory skin disease with a complex pathogenesis that mainly affects the central part of the face, with a global incidence of 5.46%. The present study was performed on a group of 68 patients with rosacea 1 and 2 subtypes, patients between 34-63 years old. The treatments were performed using a Cutera Xeo laser, using 2 types of probes: NdYag 1064nm for telangiectasias and LimeLight 520-1100nm for diffuse facial erythema, papules, and pustules, having an 10x30mm window. For patients with diffuse facial erythema, etc., the optimal number of sessions was between 3 and 6 with or without …

Simultaneous Bilateral Patellar Tendon Rupture In A Young Adult Male: A Case Report And Review Of The Literature., Adrian Moy, Ethan Song, Sean J. Wallace Md, Robert Teixeira Md, Daniel Torres

Department of Surgery

A bilateral patellar tendon rupture is extremely rare and has only been documented in case reports. Although the etiology remains unknown, predisposing factors include steroid usage, systemic diseases, and tendinopathies. In the present case, a healthy 33-year-old male with a prior history of bilateral patellar tendonitis and a diagnosis of Osgood-Schlatter disease during adolescence experienced simultaneous bilateral patellar tendon rupture after playing volleyball. He underwent bilateral patellar repair without complications. In the absence of trauma, spontaneous bilateral patellar tendon ruptures are associated with several predisposing factors, including systemic diseases, prior corticosteroid or fluoroquinolone usage, and history of tendinopathy. Injuries can …

A Multi-Institutional Analysis Of Sternoclavicular Joint Coverage Following Osteomyelitis, Sammy Othman, Omar Elfanagely, Saïd C Azoury, Geoffrey M Kozak, Jessica Cunning, Arturo J Rios-Diaz, Prashanth Palvannan, Patrick J. Greaney, Matthew Jenkins, Doraid Jarrar, Stephen J Kovach, John P Fischer

Department of Surgery Faculty Papers

BACKGROUND: Sternoclavicular joint (SCJ) osteomyelitis is a rare pathology requiring urgent intervention. Several operative approaches have been described with conflicting reports. Here, we present a multi-institutional study utilizing multiple surgical pathways for SCJ reconstruction.

METHODS: A multi-institutional retrospective cohort study was conducted to identify patients who underwent surgical repair for sternoclavicular osteomyelitis between 2008 and 2019. Patients were stratified according to reconstruction approach: single-stage reconstruction with advancement flap and delayed-reconstruction with flap following initial debridement. Demographics, operative approach, type of reconstruction, and postoperative outcomes were analyzed.

RESULTS: Thirty-two patients were identified. Mean patient age was 56.2±13.8 years and 68.8% were …

The Use Of Local Medial Plantar Artery Flap For Heel Reconstruction: A Systematic Review., Jude L Opoku-Agyeman, Amber Allen, Kayla Humenansky

Plastic Surgery Resident Research

BACKGROUND: Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic.

AIM: The aim of this article is to review the literature on the use of local medial plantar artery flap for …

A Simple Technique For Intraoperative Scalp Skin Graft Depilation Using Dermabond®, Jude L Opoku-Agyeman, Kayla Humenansky, Brooke Burkey

Plastic Surgery Resident Research

Skin grafting is an essential aspect of burn and wound reconstruction. Split-thickness skin grafts (STSGs) harvested from the scalp are used for wound and burn reconstruction. Skin grafts from the scalp bear hair and hair particles. Residual hair fragments and pieces of hair in the graft have been associated with many complications, including foreign body reaction similar to pseudofolliculitis and chronic inflammation that can lead to infections. It is important to remove the hair and the hair particles from the scalp graft before its application to the donor site. Traditionally, surgeons have employed some techniques including saline agitation and mechanical …

Cutaneous Carcinosarcoma: A Small Case Series And Review Of The Literature Of A Rare Skin Tumor., Ethan Y Song, Sean J. Wallace Md, Hina A. Sheikh, Randolph Wojcik Md, Chetan Nayak

Department of Surgery

Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with …

Effect Of Botulinum Toxin Injection On Asymmetric Lower Face And Chin Deviation, Dongwook Kim, Ju-Hyun Park, Vittorio Favero, James Mah, Young-Soo Jung, Seong Taek Kim

Dental Medicine Faculty Publications

The purpose of this study was to compare the efficacy of botulinum toxin (BoNT) in masseter muscle reduction depending on the amount of chin deviation. Exploring distinctive effects of BoNT relative to the characteristics of facial asymmetry will aid in planning and predicting treatment outcomes. Sixteen adult volunteers were classified into two groups according to the degree of menton deviation observed in posteroanterior cephalograms. Eight had a menton deviation of 3 mm or more and the other eight had less than 3 mm. A total of 25 Units of BoNT was injected into the unilateral masseter muscle of the prominent …

Use Of Cephalic Vein For Venous Anastomosis In Head And Neck Reconstruction: A Case Series, Mohammad Fazlur Rahman, Muhammad Asif Ahsan, Safdar Ali Shaikh, Muhammad Ubaid Khan, Sami Ullah

Department of Surgery

Purpose: To describe the use of the cephalic vein as a recipient vessel for venous outflow in head and neck reconstruction. The cephalic vein is used as a vessel in cases where there is a paucity of veins in the neck. This may be due to previous surgery, previous radiation therapy, or advanced cancer. The cephalic vein may also be used to salvage a failing free flap.
Methods: It is a retrospective review of 230 free flaps that had been used in head and neck reconstruction performed from July 2014 to July 2018 by a single surgeon.
Results: There were …

Comparing Motion Outcomes In Salvage Procedures For Wrist Arthritis, Stacy Fan

Electronic Thesis and Dissertation Repository

Scaphoidectomy and four corner fusion (4CF), and proximal row carpectomy (PRC) are salvage procedures that may be offered in advanced wrist arthritis. The optimal clinical treatment remains unclear. Biomechanical studies comparing outcomes of these procedures often only report uniplanar motion, rather than multiplanar motion which is more representative of functional wrist motion. Further, the impact of altering the relationship of the proximal and distal carpal rows in the coronal plane during 4CF has not been well-studied.

The purpose of this in-vitro biomechanical study was to quantify changes in wrist kinematics during wrist flexion-extension, radial-ulnar deviation, and circumduction in “anatomic 4CF”, …

Laser Therapy In Superficial Morphea Lesions – Indications, Limitations And Therapeutic Alternatives, Alin Laurentiu Tatu, Diana Sabina Radaschin, Vlad Denis Constantin, Paunica Stana, Valeriu Ardeleanu

Journal of Mind and Medical Sciences

Morphea or localized scleroderma is an uncommon autoimmune and inflammatory disease which affects patients of any age. Even if morphea lesions present systemic symptoms as myalgias or arthritis, it is distinct from systemic sclerosis because it does not associate Raynaud’s phenomena or sclerodactyly, which are encountered in systemic scleroderma. The most common form of morphea in children is `en coup de sabre`, which can alter the local anatomy by deep tissue involvement. In contrast, the most frequent form that affects adults is represented by circumscribed morphea. The initial lesions present an inflammatory phase that manifests in the form of erythematous …

Innovative Device For Indocianyne Green Navigational Surgery, Cătălin Aliuș, Nicolae Bacalbașa, Cristian Bălălău

Journal of Mind and Medical Sciences

Dynamic reality has been integrated into developing surgical techniques, with the goals of providing increased intraoperative accuracy, easier detection of critical anatomical landmarks, and better general results for the patient. Enhancement of the reality in surgical theaters using single or multi sensorial augmenters (haptic, thermic and visual) has been reported with various degrees of success. This paper presents a novel device for navigational surgery and ancillary clinical applications based on the fluorescent properties of Indocyanine Green (ICG), a safe, FDA-approved dye that emits fluorescence at higher wavelengths than endogenous proteins. The latest technological developments and the aforementioned convenient quantum behavior …

Treatment Of Lipomas And Diffuse Lipomatosis With Ndyag 1064 Nm Laser And Their Impact On The Quality Of Life, Valeriu Ardeleanu, Liliana Florina Andronache, Florentina Gherghiceanu, Stana Paunica, Cristian Balalau, Anca Pantea Stoian

Journal of Mind and Medical Sciences

Lipomas, the most common type of benign tumours, are generally developed from adipose tissue and present an incidence of 2.1 per 1000 inhabitants. In addition to lipomas, at least three other maladies of the adipose tissue lead patients to consult a doctor, especially for aesthetic purposes: multiple familial lipomatosis, diffuse congenital lipomatosis, and adiposa doloris. Unlike lipomas, these maladies are characterized by numerous lipomas, encapsulated or not, of different sizes, symmetrical or not, which may appear in the neck, limbs, or the trunk, sometimes being painful. The life quality of these patients is affected, not only from an aesthetic point …

Post-Surgical Pyoderma Gangrenosum After Breast Surgery: A Case Series, Jahan Tajran, Daniella Anderson, Arif Chaudhry, Dennis Hammond

Medical Student Research Symposium

Background:

Pyoderma gangrenosum (PG) is a rare inflammatory cutaneous disorder that is thought to be due to innate immune system dysfunction, specifically of neutrophils. PG has been well documented in patients with autoimmune disorders like Ulcerative Colitis and Rheumatoid Arthritis. PG can also present in surgical patients, imitating a potential wound infection and necrotizing fasciitis. Although PG is a diagnosis of exclusion, prompt recognition is essential to attaining desired aesthetic outcomes, especially with breast involvement. We present a case series of four patients who developed PG following breast surgery. We analyze each patient’s medical history, symptoms, wound progression and management …

Exophytic Adiposis Dolorosa (Dercum's Disease) Of The Thigh: A Case Report., Jude L Opoku-Agyeman, Lauren Coffua, Jamee Simone, Terrance Hanley, Amir Behnam

Plastic Surgery Resident Research

Adiposis dolorosa or Dercum's disease is a rare lipomatous disorder characterized by painful lipomas. In this article, we report a case of rather large exophytic adiposis dolorosa causing difficulties with ambulation, and our surgical management of the disorder. To our knowledge, this is the first reported case of a large exophytic adiposis dolorosa of the upper medial thigh causing problems with mobility. This is also the first reported case of the use of a delayed split-thickness skin graft (STSG) after interval use of wound vacuum-assisted closure (VAC) following dermolipectomy. A 77-year-old female presented with a chronic mass on the medial …

Free Flap Reconstruction After Lower Limb Trauma - Outcome Analysis Using National Surgical Quality Improvement Programme (Nsqip) Parameters, Muhammad Mehmood Alam Atiq, Shayan Shahid, Muhammad Ubaid, Mohammad Fazlur Rahman, Safdar Ali Shaikh

Department of Surgery

Objective: To assess the outcomes of free flap reconstructions performed for the management of lower limb trauma.
Methods: This retrospective study was conducted at Aga Khan University Hospital (AKUH), Karachi and included data from June 2017 to May 2019 of patients who underwent free flap reconstruction as part of management of lower limb trauma.
Results: The mean age of the 8 adult patients was 34±11 years. Also included were two paediatric patients aged 7 and 8 years. Nine of the total 10 patients were male. Road traffic accidents were the most common mechanism of injury, occurring in 5(50%), followed by …

The Effect Of Language Barriers On Variation And Receipt Of Early Stage Breast Cancer Treatment, Abigail R. Madans Do, Richard T. Zera Md, Phd, Rachel M. Nygaard Phd

Journal of Health Disparities Research and Practice

Background: Arriving at and implementing an appropriate patient centered treatment plan for early stage breast cancer requires significant dialogue between healthcare providers and patients. How language barriers affect this process has not been thoroughly explored in the literature. The aim of this paper is to examine the effect of language barrier on variation and receipt of early stage breast cancer treatment.

Methods: Rates of lumpectomy, mastectomy, and contralateral prophylactic mastectomy (CPM) with or without reconstruction were compared between English speaking and Low English Proficiency (LEP) cohorts. Patients with recurrent or bilateral breast cancer, male patients, and/or known genetic mutations …

Breast Implant-Associated Anaplastic Large Cell Lymphoma: Molecular Features, Epidemiological Risk Factors, And Evidence-Based Clinical Recommendations, Ryan Decoster

Theses and Dissertations--Clinical and Translational Science

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging cancer of the immune system that can form around textured-surface breast implants. In this dissertation, the cellular and molecular mechanisms of BIA-ALCL are reviewed with a focus on the role of oncogenic JAK-STAT3 signaling in BIA-ALCL tumorigenesis and progression. Herein, the epidemiology of BIA-ALCL is systematically studied to better define the risk of BIA-ALCL and to determine the oncologic safety of smooth surface devices relative to BIA-ALCL formation. Next, a systematic review is conducted which critically appraises current clinical guidelines in order to establish an evidence base to better inform …