Plastic Surgery Commons^™

Modern Therapeutic Options In Diabetic Foot Ulcer, Denisa Tanasescu, Andrei Moisin, Radu Fleaca, Carmen Popa, Ciprian Bacila, Cosmin Mohor, Claudia Diana Gherman, Bogdan Gaspar, Ciprian Tanasescu

Journal of Mind and Medical Sciences

Diabetic foot is a severe complication of diabetes that occurs as a result of poor glycemic control, being associated with significant morbidity and mortality. Mortality associated with this disease is estimated at 5% in the first 12 months, and about 42% in the next 5 years. On average, it affects about 15% of people with diabetes during their lifetime, including as possible manifestations neuropathy, peripheral vascular disease, and subsequent ulceration which, if treated incorrectly, can lead to amputation.

This paper presents a retrospective and descriptive study of patients diagnosed and treated for diabetic foot ulcers in the Proctoven Clinic. The …

Limb Amputations; Etiopathogenesis, Diagnosis And The Multidisciplinary Therapeutic Approach, Vlad Denis Constantin, Bogdan Socea, Bogdan Severus Gaspar, Dragos Epistatu, Ioana Paunica, Anca Silvia Dumitriu, Stana Paunica, Adrian Silaghi

Journal of Mind and Medical Sciences

Despite remarkable advances in medicine, limb amputations remain a therapeutic measure that saves the lives of many patients. Given the varied etiopathogenesis, such operations are performed both as an emergency and as an elective procedure. Such interventions address either only the distal segments of a limb, or even the entire limb, having a great psychological, functional and social impact on the patient. Due to these multiple implications, limb amputations must be performed by specialized teams, in order to achieve the best possible functional and aesthetic results to be compatible with the correction of the remaining deficit with a prosthesis. The …

Surgical Delay Of The Thoracodorsal Artery Perforator Flap For Autologous Breast Reconstruction, Mark A. Maier, Ryan D. Hoffman, Joshua Levine, Hugo St. Hilaire, Robert J. Allen

Medical Student Research Poster Symposium

Background: When women are poor candidates for abdomen-based free flap reconstruction, the muscle-sparing thoracodorsal artery perforator (TDAP) flap may be considered for total autologous breast reconstruction due to its reliable perforator anatomy and function as a pedicled flap, requiring no vascular anastomosis. However, the TDAP flap is not as popular as other autologous breast reconstruction methods since it is often limited by flap size and distal tip necrosis. Objective: We aim to demonstrate a novel use of the delay phenomenon in TDAP flaps for total autologous breast reconstruction. Methods: This prospective IRB-approved study recruited patients between April 2021 and August …

The Impact Of Facial Feminization On Qol In Transgender Patients, Odette Rosales, Zane Sejdiu, Justin Michael Camacho, Ali Yasback, Caroline E. Quindlen, Sanjeev Herr, Amir Behnam Md

Tower Health Research Day

No abstract provided.

An Update And Report Failure Of Surgical Syndactyly Repair In Harlequin Ichthyosis., Elias H Kahan, Brian Temple, Logan Carr, Elizabeth Zellner

Plastic Surgery Resident Research

Harlequin ichthyosis (HI) is a rare congenital skin disorder caused by irregular epidermal differentiation. Syndactyly in HI is associated with thick hyperkeratotic skin flexion and angulation deformity of the hand and fingers resulting in limited function of the upper extremity. Traditional syndactyly release is limited as full-thickness skin grafts typically used in reconstruction are composed of diseased skin and require donor sites in a patient predisposed for adverse wound healing. This case report is a follow-up to a previous viewpoint written about digital escharotomies in a newborn with HI and outlines a second and fourth webspace syndactyly release with a …

The Virtual Peripheral Nerve Academy: Education For The Identification And Treatment Of Peripheral Nerve Disorders, Erica B. Lee, Allison Podsednik, Kimberly Khoo, Amal Cheema, Raysa Cabrejo, Chen Shen, Joseph Rosen, A Lee Dellon

School of Medicine Publications and Presentations

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders. However, medical school curricula are profoundly deficient in peripheral nerve education. This lack of knowledge within the healthcare profession may cause inadequate patient care. We developed the Virtual Peripheral Nerve Academy (VPNA) as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system (PNS). Students are introduced to the PNS through virtual 3D rendering of the human body, wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve. PNS …

Breaking Barriers To Breast Reconstruction Among Socioeconomically Disadvantaged Patients At A Large Safety-Net Hospital, Anna E Meade, Samantha M Cummins, Jordyn T Farewell, Sofia Duque, Sydney K Mulqueen, Ashleigh Chuah, Andrew Y Zhang

Department of Medicine Faculty Papers

Socioeconomic disparities remain prevalent among those who undergo breast reconstruction. At our institution, patients must meet certain criteria to become eligible for breast reconstruction. The purpose of this study was to determine the impact of socioeconomic factors on breast reconstruction eligibility, enrollment, choice, and completion at our large safety-net institution.

Methods: A retrospective chart review of patients who underwent partial or total mastectomy at a large safety-net hospital from 2016 to 2019 was completed. Surgical and demographic data were compared across varying socioeconomic factors.

Results: A total of 645 patients were included in the study. More patients of a racial …

Breast Augmentation: The Current Landscape, Khalifa Sh. Al-Ghanim

Electronic Thesis and Dissertation Repository

Primary breast augmentation is one of the most common surgeries performed by plastic surgeons. Breast augmentation, since its inception in 1895, has become a multimillion-dollar industry. Today, the two most common methods include implant-based and fat graft augmentation. Implant-based augmentation includes the use of silicone or saline prosthesis to enhance breast volume or shape. With fat grafting, a patient’s fat is harvested, processed, and injected into the breast to achieve the desired result. This thesis aims to outline the current literature on both methods of breast augmentation, review patient reported outcomes, as well as a proposed clinical trial to gain …

Development Of A Novel Rodent Model Of Radiation-Induced Implant Capsular Contracture, Tanya Delyzer

Electronic Thesis and Dissertation Repository

Radiation-induced implant capsular contracture is a challenging complication of post-mastectomy breast reconstruction. The objective of this thesis was to establish a novel rodent model that replicates the critical properties of this complication. Retired breeder female Sprague-Dawley rats underwent surgery with custom smooth silicone implants placed under the right 4^th mammary fat pad. Half these rats received 26Gy of ionizing radiation to the implant and fat pad. Radiated implants had both higher Baker grades of capsular contracture and Kumar scores denoting radiation-induced fibrosis. Irradiated capsules showed increased Masson’s trichrome staining and significantly higher hydroxyproline to total protein ratio compared to …

Predictive Factors For Length Of Hospital Stay In Pediatric Dog Bite Patients, Dominic Alessio-Bilowus, Nishant Kumar, Elika Ridelman Ph.D, Christina Shanti Md

Medical Student Research Symposium

Title: Predictive Factors for Length of Hospital Stay in Pediatric Dog Bite Patients

Authors: Alessio-Bilowus D¹, Kumar N², Ridelman E¹, Shanti C^2
1Wayne State University, Detroit, MI; ²Children’s Hospital of Michigan, Detroit, MI

Introduction: Dog bite injuries are a source of significant morbidity in the United States, with children being at increased risk compared to adults, yet there is a lack of published data on factors affecting hospital length of stay (LOS) in pediatric patients.

Methods: A full-text retrospective chart review was conducted of all patients presenting to our urban, academic …

Biostimulation With Low-Level Laser Therapy And Its Effects On Soft And Hard Tissue Regeneration. Literature Review, Anida Maria Babtan, Aranka Ilea, Claudia Nicoleta Feurdean, Sabino Ceci, Berate Pula, Sebastian Candrea, Daniela Azzollini, Fabio Piras, Luigi Curatoli, Alberto Corriero, Assunta Patano, Francesco Valente, Maria Elena Maggiore, Antonio Mancini, Delia Giovanniello, Ludovica Nucci, Rossella Elia, Adina Sirbu, Nausica Bianca Petrescu, Codruta Mirica, Andrea Galderisi, Filippo Cardarelli

Journal of Mind and Medical Sciences

Objective. Low-Level Laser Therapy encourages the healing process, reduces inflammation and pain. The aim of this study is to identify the impact of Low-Level Laser Therapy on tissue regeneration with special attention to hard tissues and to compare the effect of several wave lengths in the proliferation and differentiation of cells. Methods. The keywords used were “bone regeneration”, “laser therapy”, “photobiomodulation” OR “bio-stimulation”, “Low-Level Laser therapy” OR “LLLT”, “osteoblast proliferation” AND “differentiation”. Results. The bio-stimulation with Low-Level Laser Therapy also seems to interfere with the osseous integration of implants, by increasing its adherence on the bone-implant surfaces. Evidence has shown …

Anatomic Considerations Of Perinasal Musculature For Improved Dental Show During Smile In Facial Synkinesis, Laura T. Hetzler, Marcus Hershey, Todd Lambert, Jason Mussell, Lee Mcdaniel, Sara Macdowell

School of Medicine Faculty Publications

Introduction: There is an anatomic explanation for upper lip and midfacial tethering resulting in lack of motion in facial synkinesis. Objective: To measure the effect of perinasal chemodenervation on dental show in the synkinetic population and clarify the anatomic relationship of perinasal musculature. Methods: Literature search was performed on anatomy of the perinasal modiolus, and anatomic evaluation was performed through human anatomic specimen dissection. Photographic outcomes were observed in synkinetic patients receiving chemodenervation to smile antagonists with and without perinasal muscle injections and assessed through naive observer survey. Retrospective outcomes for all patients receiving perinasal chemodenervation was collected utilizing Facial …

Current Perspectives Of Oncoplastic Breast Surgery In Pakistan, Lubna Mushtaque Vohra, Dua Jabeen, Danish Ali, Syeda Sakina Abidi, Sana Zeeshan, Abida Khalil Sattar

Section of General Surgery

Oncoplastic breast surgery is based on the concept of tumour-specific immediate reconstruction. It combines both local and distant techniques to maintain breast texture, symmetry and cosmesis without compromising oncological outcome. The current narrative review was planned to highlight the current state and future of oncoplastic breast surgery in low- and middle-income countries where its utilisation in surgical practice remains insubstantial because majority of the surgeons who are treating breast cancer are either general surgeons or breast surgeons who do not have expertise in oncoplastic breast surgery or reconstructive surgery. Moreover, scarcity of financial resources, ignorance about oncoplastic breast surgery techniques, …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Adaptive Photo-Protection Trial, Giacomo Adoncecchi, Frank Lau, John Macmahon, Carmen Castilla, Catherine Powell

Medical Student Research Poster Symposium

Background A growing body of literature has demonstrated a moderate negative correlation between vitamin D insufficiency and morbidity and mortality from Covid-19 infection.1 Confounding this is the fact that serum vitamin D levels are also low in comorbidities that also correlate with higher Covid-19 mortality.2,3 However, studies of oral vitamin D have not consistently improved COVID outcomes.4,5 Vitamin D – and at least 30 other immunoregulatory compounds – is produced in response to ultraviolet B (UVB) light.1 UVB light is standard of care in several autoimmune diseases, including graft vs. host disease, cutaneous T-cell lymphoma, and psoriasis.6,7,8 To date, no …

Collagen-Based Biomaterials With Possible Therapeutic Effects, Ramona Mihaela Nedelcuţă, Gigi Călin, Mihai Cristian Nedelcuţă, Vlad Dumitru Baleanu, Dragos Virgil Davitoiu, Bogdan Socea, Bogdan-Petre Stănoiu

Journal of Mind and Medical Sciences

Epidermolysis bullosa (EB) is a rare, serious genetic disease, incurable through the current means. Apart from this initial definition, there was later some ease in the definition of the disease, including the manifestations of toxic epidermal necrolysis and Stevens Johnson syndrome in this entity. In medical practice, there are cases that do not overlap with the description in the literature, thus the treatment must be adapted and personalized to the particularities. We present the case of a female new-born, with "de novo" mutation for the early-onset antenatal epidermolysis and our personalized therapeutic management, based on collagen from bovine corneas by …

Does Full Transfixion Incision Decrease Tip Projection In Endonasal Septoplasty With Spreader Grafts?, William Wesley Heckman Md, Tyler Bliss Md, Sarah Schmoker Md, Katie Geelan-Hansen Md

Graduate Medical Education Research Journal

The classic teaching is that full transfixion incision decreases nasal tip projection by disrupting the attachment of the medial crura to the caudal septum. A significant decrease in tip projection after endonasal septoplasty with spreader grafts through a full transfixion incision has not been identified at our institution. A retrospective cohort study was performed at our institution. Inclusion criteria consisted of patients undergoing endonasal septoplasty with spreader graft placement and available preoperative and one-year postoperative photos. Patients who had undergone an open approach, cosmetic rhinoplasty, had intercartilaginous incisions, or other procedures to affect tip projection were excluded. A query identified …

Submental Paradoxical Adipose Hyperplasia Following Cryolipolysis: A Report And Management Recommendations, Demitri V. Franzoni, Miriam Al-Hamad Daubs, Mitchell E. Lyons, Jo-Lawrence Bigcas, Harry H. Ching, Joshua J. Goldman

School of Medicine Faculty Publications

Cryolipolysis (CoolSculpting®) is a Food and Drug Administration-cleared noninvasive fat-reduction technique that has gained popularity in recent years given its reduced cost, risk of adverse effects, and recovery time relative to traditional invasive methods, such as liposuction. Despite this low incidence of adverse effects, there have been increasing reports of a rare aesthetically displeasing phenomenon termed paradoxical adipose hyperplasia (PAH). PAH presents several months after cryolipolysis as a painless and well-demarcated enlargement of the tissue limited to the treatment area.1 With a reported incidence ranging from 0.005% to 2%, all known cases of PAH have been localized to the treatment …

4dct Analysis Of In-Vivo Carpal Kinematics During Fem, Manisha R. Mistry

Electronic Thesis and Dissertation Repository

A consensus, detailed understanding of carpal kinematics remains elusive. 4-dimensional CT (4DCT) is a validated modality capable of accurately studying in-vivokinematic motion. The objective of this work is to quantify normal, in-vivo kinematic motion of the carpus through a flexion-extension arc of motion using 4DCT. Ten healthy, un-injured volunteers underwent a 4DCT scanning protocol through a complete arc of flexion-extension motion. Kinematic changes in motion were quantified using helical axis motion data for each carpal bone. Helical axes were compared between bones and statistical analysis performed using repeated-measures ANOVA to identify difference in kinematic motion between bones (p<0.05). The carpus can be divided into four main kinematic blocks: the distal carpal block, the proximal carpal block and individual scaphoid and trapezial blocks. This work supports an additional segmentation of the trapezium from the distal carpal row, which suggests some modulation between the scaphoid and distal carpal row.

Outcomes Of Implant Removal And Capsulectomy For Breast Implant Illness In 248 Patients., Jacob Y. Katsnelson, Joseph R. Spaniol, Joshua C. Buinewicz, Frederick V. Ramsey, Brian R. Buinewicz

Abington Jefferson Health Papers

Background: Breast implant illness (BII) is a term popularized by social media to describe systemic symptoms that patients ascribe to their breast implants. Though the concept of implants as an underlying cause for a systemic illness remains controversial, few studies have delineated the implant characteristics, capsular histology, and outcomes of patients who undergo explantation for BII.

Methods: We retrospectively reviewed the demographics, presenting symptoms, outcomes, capsular histology, and culture results of all women who presented to the senior author with symptoms attributed to BII and underwent breast implant removal with capsulectomy from August 2016 to February 2020. Chi-square and logistic …

Is There A Difference Between Burn Patients Treated With Topical Mafenide Acetate Before And During Covid-19?, Morgan Anderson, Sigrid A. Blome-Eberwein Md

Research Scholars

No abstract provided.

Comparing Plastic Surgery And Otolaryngology Surgical Outcomes And Cartilage Graft Preferences In Pediatric Rhinoplasty: A Retrospective Cohort Study Analyzing 1839 Patients., Andres F. Doval, Ariel Ourian, Kieran S. Boochoon, Vishwanath Chegireddy, Michael Lypka, Anthony Echo

Manuscripts, Articles, Book Chapters and Other Papers

Rhinoplasty in children has raised concerns about its safety in the pediatric population. There is scarcity of evidence describing outcomes and surgical techniques performed in pediatric rhinoplasty. We analyzed post-operative complications and cartilage preferences between plastic surgeons and otolaryngologists.Data was collected through the Pediatric National Surgical Improvement Program from 2012 to 2017. Current Procedure Terminology codes were used for data extraction. Patients were grouped according to type of rhinoplasty procedures (primary, secondary, and cleft rhinoplasty). A comparison between plastic surgeons and otolaryngologists was made in each group in terms of postoperative complications. Additionally, a sub-group analysis based on cartilage graft …

First Profunda Artery Perforator Flap For Breast Reconstruction Performed At A Va Hospital, Kaitlynne Pak, Amanda Fang, Garrison Leach, Riley Dean, Sarah Crowley

Medical Student Research Symposium Abstracts and Posters

The profunda artery perforator (PAP) flap for breast reconstruction originated by Dr. Robert J. Allen in 2010 after multiple failed attempts at using muscle-sparing transverse rectus abdominal muscle (MS-TRAM) flap and implants. This flap method was initially approached due to the patient’s request for an autologous tissue graft that did not sacrifice muscle. The PAP flap has grown significantly in popularity and usage in breast reconstruction and makes up to about 16% of autologous breast reconstruction, coming second to DIEP flaps (76%). This well-tolerated, muscle-sparing approach is ideal for patients without sufficient abdominal fat (low BMI or previous abdominal liposuction) …

Reconstructionof Congenital Arhinia With Stereolithography, Kelly Spiller, Kaitlynne Pak, Lucas M. Harrison, Spencer Anderson, Steven Schmidt, Salim Mancho

Medical Student Research Symposium Abstracts and Posters

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and nasopharyngeal airway. In this study, we report our novel multi-staged reconstructive approach of congenital arhinia in addition to literature review. Reconstruction was achieved via several spaced operations. A nasal methyl methacrylate prosthesis was first created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 osteotomy with cannulization was then utilized for midface advancement and nasopharyngeal airway formation. External nasal framework was constructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. The patient was overall pleased …

An Inside Look: Oculoplastics And “Droopy Eyelids”, Payton Boere

inSIGHT

In writing this article, I had the pleasure of speaking with Dr. Alison Watson, an oculoplastic attending surgeon at Wills Eye Hospital, all about this exciting and innovative specialty. During our discussion, she said that one of the things she loves most about this field is its diversity, including the range of procedures she gets to perform and patients she is able to treat. While there are procedures common to all oculoplastic surgeons, such as cosmetic and functional eyelid surgery to address both upper and lower eyelid malposition, reconstruction following periocular cancer resection, along with nasolacrimal surgery, Dr. Watson explained …

Use Of Botulinum Toxin A To Treat Chemotherapy-Induced Raynaud's Phenomenon., Thrisha K Potluri, Frank G Lee, Ethan Song, Sean J. Wallace Md, Nathan F. Miller Md

Department of Surgery

Raynaud's phenomenon (RP) is a vasospastic disorder of the digital blood vessels leading to pain, paresthesias, and pallor in response to cold or stress. RP can develop secondary to a number of pathologies or factors, including the use of chemotherapy agents. Typical first-line therapies for secondary RP may be contraindicated in patients with certain comorbidities. Here, we discuss a case in which botulinum toxin A (BTX-A) was used to treat chemotherapy-induced RP in a patient with non-small cell lung cancer (NSCLC). We provide a review of the existing literature on the clinical course and treatment modalities, including the use of …

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 …