Medical Specialties Commons^™

Incidence, Risk Factors, And Outcomes Of Incidental Durotomy During Lumbar Spine Decompression With Or Without Fusion, Gregory Toci, Mark James Lambrechts, Tariq Issa, Brian A. Karamian, Nicholas Siegel, Nicholas D'Antonio, Jose Canseco, Mark Kurd, Barrett Woods, Ian D. Kaye, Alan Hilibrand, Christopher K. Kepler, Alexander Vaccaro, Gregory Schroeder

Rothman Institute Papers

STUDY DESIGN: Retrospective cohort study.

PURPOSE: The primary objective of this study was to determine the incidence and risk factors for incidental durotomies during lumbar decompression surgeries. In addition, we aimed to determine the changes in patient-reported outcome measures (PROMs) based on incidental durotomy status.

OVERVIEW OF LITERATURE: There is limited literature investigating the affect of incidental durotomy on patient reported outcome measures. While the majority of research does not suggest differences in complications, readmission, or revision rates, many studies rely on public databases, and their sensitivity and specificity for identifying incidental durotomies is unknown.

METHODS: Patients undergoing lumbar decompression …

Mass Spectrometry Imaging Reveals Abnormalities In Cardiolipin Composition And Distribution In Astrocytoma Tumor Tissues, Anna C Krieger, Luis A Macias, J Clay Goodman, Jennifer S Brodbelt, Livia S Eberlin

Faculty, Staff and Students Publications

Cardiolipin (CL) is a mitochondrial lipid with diverse roles in cellular respiration, signaling, and organelle membrane structure. CL content and composition are essential for proper mitochondrial function. Deranged mitochondrial energy production and signaling are key components of glial cell cancers and altered CL molecular species have been observed in mouse brain glial cell xenograft tumors. The objective of this study was to describe CL structural diversity trends in human astrocytoma tumors of varying grades and correlate these trends with histological regions within the heterogeneous astrocytoma microenvironment. To this aim, we applied desorption electrospray ionization coupled with high field asymmetric ion …

Risk Factors For Neonatal Brachial Plexus Injury: A Retrospective Review Of A Single-Institution’S Eleven-Year Experience, Annie Glenney, Meeti Mehta, Hilary Liu, Alexander Comerci, Yusuf Surucu, Tarek Arabi, Elizabeth Moroni, Alexander J. Davit Iii

St. Chris Research Day

No abstract provided.

Treatment Of Angular Deformity And Limb Length Discrepancy With A Retrograde Femur Magnetic Intramedullary Nail: A Fixator-Assisted, Blocking Screw Technique, Erik J. Geiger, Adam D Geffner, S Robert Rozbruch, Austin T Fragomen

Rothman Institute Papers

Background: Fixator-assisted nailing techniques that incorporate magnetic internal lengthening nails (MILNs) permit acute deformity correction and then gradual limb lengthening without needing postoperative external fixators.

Purposes: We sought to investigate the safety and accuracy of a fixator-assisted, blocking screw technique using retrograde MILNs for the correction of LLD and limb malalignment.

Methods: Forty-one patients (13 patients with genu varum and 28 patients with genu valgum) with LLD treated with fixator-assisted, blocking screw retrograde MILN reconstruction were included. Preoperative LLD, mechanical axis deviation, and joint orientation angles were compared with values at the end of treatment, and bone healing indices were …

Open-Label, Expanded-Access Study Of A Bioengineered Allogeneic Cellularized Construct In Adults With Deep Partial- Thickness Burns, Angela Gibson, Victor Joe, Joshua Carson, Jeff Litt, Jeffrey Carter, James Holmes

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

A Pilot Study Of Hand Autografts Treated With Autologous Skin Cell Suspension, Paige Deville, Jeffrey E. Carter, Madeline Lechtenberg, Herbert A. Phelan

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Donor Site Reduction With Combined Use Of Bromelain Enzymatic Debridement And Autologous Skin Cell Suspension, Steven A. Kahn, Jeffrey E. Carter, Gabriel G. Gaweda, Elizabeth Halicki, William L. Hickerson, Ashley Hink, James H. Holmes, Deepak Ozhathil, Narayan Raghava

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Select Survey Of Human Cadaver Skin Allograft Utilization By 21 Senior Academic Burn Surgeons, William Hickerson, Franco Aveau, Narayan Iyer, James Jeng, Victor Joe

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16-19,2023, Dallas, TX

Burn Injury Assessment Study (Bias): Is There Room To Improve?, Jeffrey Carter, Herbert Phelan, John Friedstat, William Hickerson, James Holmes, James Hwang, Steven Kahn, Alisa Savetamal, Jeffrey Shupp

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Secondary Immunohistochemical Analysis Of Viable Cells As Determined By Hematoxylin And Eosin Staining, Bonnie Carney, Cameron D'Orio, Jeffrey Shupp, Jeffrey Carter, William Hickerson, James Holmes, Herbert Phelan

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Autologous Skin Cell Suspensions For Reconstruction Of Nonthermal Soft Tissue Wounds: A Case Series, Paige Deville, Elle Lovick, Jeffrey Carter, Herbert Phelan

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

The Rising Use Of Fire As A Weapon, Jason Woods, Jeffrey Carter, Kathe Conlon, Carl Flores, Randy Kearns

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Characteristics Of Verified And Designated Burn Centers, Jeffrey Carter, Randy Kearns, Elle Lovick, Erica Murata, Bart Phillips

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Adipose Derived Stem Cell Paracrine Factor Release In Smokers Vs Non Smokers With Burn Injuries, Paige Deville, Alison Smith, Herbert Phelan, Jeffrey Carter, Olivia Warren, Cameron Fontenot

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Access To Burn Care: A 10 Year Perspective Of Burn Centers In The U.S, Elle Lovick, Jeffrey Carter, Herbert Phelan, Randy Kearns, Bart Phillips, William Hickerson

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Injury To Intervention: Is There Another Opportunity To Improve Burn Care?, William L. Hickerson, Jeffrey E. Carter, John Friedstat, James H. Holmes, James Hwang, Steven A. Kahn, Herbert A. Phelan, Alisa Savetamal

School of Medicine Faculty Publications

55th Annual Meeting of the American Burn Association, ABA 2023, May 16 - 19, 2023, Dallas, TX

Observations On The Present And The Future Of Hip Surgery, Alberto Di Martino

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Automated Subfield Volumetric Analysis Of Amygdala, Hippocampus, And Thalamic Nuclei In Mesial Temporal Lobe Epilepsy, Arichena Manmatharayan, Michael Kogan, Caio Matias, Mashaal Syed, India Shelley, Amar Chinni, Kichang Kang, Kiran Talekar, Scott H. Faro, Feroze B. Mohamed, Ashwini Sharan, Chengyuan Wu, Mahdi Alizadeh

Department of Neurosurgery Faculty Papers

Purpose: Identifying relationships between clinical features and quantitative characteristics of the amygdala-hippocampal and thalamic subregions in mesial temporal lobe epilepsy (mTLE) may offer insights into pathophysiology and the basis for imaging prognostic markers of treatment outcome. Our aim was to ascertain different patterns of atrophy or hypertrophy in mesial temporal sclerosis (MTS) patients and their associations with postsurgical seizure outcomes. To assess this aim, this study is designed in 2 folds: (1) hemispheric changes within MTS group and (2) association with postsurgical seizure outcomes.

Methods and materials: 27 mTLE subjects with mesial temporal sclerosis (MTS) were scanned for conventional 3D …

Two Ais Cases, Two Surgeons, One Operating Room, One Day. The Results Of A Quality Improvement Initiative, Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: We describe the results of this initiative and compare operative times and blood loss between cases to determine if operative time improves as experience with this structure increases.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were prospectively scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution. …

Preoperative Srs-22 Scores Predict Postoperative Achievement Of Distribution-Based Mcid In Ais Patients Treated With Posterior Spinal Instrumentation And Fusion, Jonathan Warren, Cyrus Etebari, Morgan Whitmire, Kenneth Furlough, Brant Ansley, John T. Anderson, Richard M. Schwend

Research Days

Background: There is a growing body of literature assessing the role of preoperative patientreported outcome measures in predicting postoperative achievement of the minimal clinically important difference (MCID). To the best of our knowledge, there are no studies assessing whether preoperative SRS-22 scores are predictive of postoperative achievement of MCID in patient with adolescent idiopathic scoliosis (AIS).

Objectives/Goal: Our purpose is to determine if preoperative SRS-22 scores in patients with AIS who undergo posterior spinal instrumentation and fusion can predict postoperative achievement of MCID.

Methods/Design: SRS-22 forms were provided to all patients scheduled to undergo posterior spinal instrumentation and fusion. MCID …

Common Misperceptions Of Child Abuse In Toddler Femur Fractures, Olivia Pruss, Jonathan Warren, Vincent Staggs, Grace Tideman, Collin Erickson, William L. Hennrikus, Richard M. Schwend

Research Days

Background: Current AAOS guidelines recommend that all children younger than thirty-six months with a femur fracture be evaluated for child abuse. However, the chance for abuse in walking-age children is highly unlikely at less than 20%.

Objectives/Goal: The purpose of this study is to identify how a patient’s age and femur fracture morphology impact the likelihood that providers assess a fracture as non-accidental and their decision to pursue further investigation of possible child abuse.

Methods/Design: This was a questionnaire study completed by clinicians from multiple specialties. There were 5 subgroup populations (6, 12, 18, 24, 35 months old) combined with …

Management Of Primary Spontaneous Pneumothorax In Children: A Single Institution Protocol Analysis, Shai Stewart Md, James Fraser, Nelimar Cruz-Centeno, Derek Marlor, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Research Days

Background: Primary spontaneous pneumothorax (PSP) affects 3.4 per 100,000 children in the United States. Regardless of the initial management, additional procedures, and prolonged hospital length of stay (LOS) may occur. There is currently no consensus in the pediatric surgical community on the optimal management of these patients, which has resulted in marked variability in management. The Midwest Pediatric Surgery Consortium (MWPSC), of which our site is a participant, suggested a management algorithm to include simple aspiration upon presentation, and if this fails, VATS should be considered.

Objectives/Goal: The purpose of this study was to evaluate the outcomes of instituting a …

Institutional Outcomes Of Blunt Liver & Splenic Injury In The Atomac Era, Shai Stewart Md, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: The Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) practice management guideline (PMG) was created to standardize management of blunt liver or spleen injury (BLSI) across pediatric trauma centers. Evaluations of institutional outcomes after its adoption remain scarce. We describe our outcomes since PMG adoption at our institution.

Objectives/Goal: The purpose of this study was to assess patient outcomes and resource utilization after implementation of this protocol. We hypothesized there is no difference in length of stay (LOS) or complications regardless of grade of isolated injuries to the liver or spleen. In addition, there is limited guidance on the management of concurrent injuries to …

Predicting Avascular Necrosis After Unstable Slipped Capital Femoral Epiphysis, Jonathan Warren, Alexander Metoxen, Michael Held, Brant Ansley, Berglund Lisa

Research Days

Background: There is no consensus in the literature on the risk of developing avascular necrosis (AVN) after unstable slipped capital femoral epiphysis (SCFE). In recent years, a number of studies have sought to better characterize risk factors for AVN in this population. However, to the best of our knowledge, there is no study that uses predictive modeling to assess the chance of developing AVN based on different patient-centric factors.

Objectives/Goal: Our goal is to assess whether or not previously-published risk factors for AVN in unstable SCFE such as duration of symptoms, reduction type, type of surgery, timing of surgery, and …

Laparoscopic Versus Open Inguinal Hernia Repair: A Single Institution Comparison Of 1200 Patients, Shai Stewart Md, Wendy Jo Svetanoff, James Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St.Peter, Tolulope A. Oyetunji

Research Days

Background: : Laparoscopy has become the standard of care for many pediatric surgical procedures; however, there is no consensus regarding the optimal approach for inguinal hernia repair (IHR). We report our experience over an 8-year period with open and laparoscopic inguinal hernia repair (LIHR).

Objectives/Goal: We aim to describe our experience within a free-standing tertiary care pediatric institution and compare outcomes between open and laparoscopic repair of pediatric inguinal hernias.

Methods/Design: A retrospective review of patients under 18 years who underwent IHR between June 2010 and June 2017 was performed. The open technique utilizes high ligation of the internal ring, …

A Novel Approach For Laparoscopic Direct Inguinal Hernia Repair In Children, Shai Stewart Md, Charlene Dekonenko, Nelimar Cruz-Centeno, Derek Marlor, Jason D. Fraser

Research Days

Background: Inguinal hernia repair is one of the most common operations performed by pediatric surgeons, and the frequency of laparoscopy for repair is increasing. The vast majority of these are indirect hernias and therefore how to best repair a direct defect when seen during laparoscopy is still unknown. Simple high ligation of the hernia sac (as is done in an indirect hernia) does not repair the inguinal floor weakness/defect seen in a direct hernia.

Objectives/Goal: We therefore present a case of laparoscopic bilateral indirect and direct inguinal hernia repair, commonly known as pantaloon hernia, repaired without mesh and utilizing the …

Institutional Use Of Ultrasound In The Evaluation Of Cryptorchidism, Shai Stewart Md, Dae H. Kim, Nelimar Cruz-Centeno, Derek Marlor, James Fraser, Tolulope A. Oyetunji Md Mph, Shawn D. St.Peter

Research Days

Background, Objectives/Goal, Methods/Design, Results, Conclusions limited to 500 words Background: In 2014, the American Urological Association guidelines recommended against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism prior to expert consultation. We hypothesized that ultrasound remains overused by referring physicians.

Objectives/Goal: We aimed to examine our institutional experience and measure adherence to currently available guidelines.

Methods/Design: An institutional review board (IRB) approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2018, at a single tertiary level pediatric hospital.

Results: We …

Antibiotic Monotherapy Vs Dual-Drug Therapy In Perforated Appendicitis: Single Center Retrospective Review, Shai Stewart Md, Nelimar Cruz-Centeno, Derek Marlor, Dae H. Kim, Shawn D. St Peter, Tolulope A. Oyetunji Md Mph

Research Days

Background: The optimal antibiotic regimen in perforated appendicitis to reduce intraabdominal abscess (IAA) formation has not yet been agreed upon in the pediatric surgery community. We aimed to evaluate the outcomes of patients with perforated appendicitis when intravenous antibiotic monotherapy with Piperacillin-Tazobactam (PT) versus dual-drug therapy with Ceftriaxone and Metronidazole (CM) are administered. We hypothesized there is no difference in the rate of IAA formation with antibiotic monotherapy, as opposed to our once-daily dosed, institutional standard dual-drug therapy.

Objectives/Goal: The goal was to determine if our current management protocols for acute appendicitis were delivering the best possible results for our …

Two Adolescent Idiopathic Scoliosis (Ais) Cases, Two Surgeons, One Operating Room, One Day. Faster And Safer Than One Case In A Day., Jonathan Warren, Robert C. Link, Sean Bonanni, John T. Anderson, Richard M. Schwend

Research Days

Background: To lessen surgical times for AIS patients undergoing posterior spinal instrumentation and fusion (PSIF), our department developed a quality improvement initiative where two AIS cases were completed in one day by a specialized team with two surgeons operating together in the same operating room (OR).

Objectives/Goal: Our purpose is to describe the results of this initiative and compare operative times and outcomes to single cases completed by a single surgeon during the same period.

Methods/Design: From 2017-2023, patients aged 10-18 years with AIS were scheduled to undergo primary PSIF on the dedicated “Two Spine Tuesday” at our institution (Group …

State Of The Art Bowel Management For Pediatric Colorectal Problems: Anorectal Malformations., Elizaveta Bokova, Wendy Jo Svetanoff, Joseph Lopez, Marc A. Levitt, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and …