Plastic Surgery Commons^™

Infection And Nonunion Rates In Open Fractures, Roman M. Natoli, Lucas S. Marchand, Sofia Bzovsky, Jennifer E. Hagen, Mark J. Gage, Christina A. Stennett, Nathan N. O’Hara, Kyle J. Jeray, Brad Petrisor, Sheila Sprague, Gerard P. Slobogean, Jeffrey Wells, Mohit Bhandari, Anthony D. Harris, C. Daniel Mullins, Lehana Thabane, Amber Wood, Gregory J. Della Rocca, Joan Hebden, Lyndsay M. O’Hara, Robert Zura, Christopher Lee, Joseph Patterson, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang, Monica Taljaard, The Flow Investigators, The Prep-It Investigators

Orthopaedic Surgery Faculty Publications

Background: Infection and nonunion are common sequelae of open fractures. Studies have shown infection and nonunion rates ranging from 2% to 52% and 12% to 17%, respectively. The present article describes the rates of surgical site infection (SSI) and delayed union/nonunion following open fractures in a large contemporary series of patients from prospective clinical trials with adjudicated outcomes. Methods: A descriptive analysis was performed with use of patient data from the FLOW, Aqueous-PREP, and PREPARE-Open studies. These studies, published within the past 10 years, included multiple international trauma centers and shared definitions for SSI and delayed union/nonunion. SSI and delayed …

Expansion Of Hand Trauma Transfers At A Level 1 Trauma Center Following Integration With The Assh Hand Trauma Center Network, William Delahoussaye, Madeline Gautreaux, Patrick A. Palines, Ramin Shekouhi, Kelly L. Babineaux

School of Medicine Faculty Publications

Purpose: This study sought to evaluate how joining the National Hand Trauma Center Network (NHTCN) affected the volume, demographics, and severity of hand trauma transfers to our institution. Methods: Data for this study were collected retrospectively over a 6-year period from 2016 to 2021 from our institutional trauma registry. Patients were selected based on the criterion of being transferred to our facility because of isolated hand trauma. Analyses of transfer rates, transfer distance, sending facilities, injury patterns, insurance type, path of care, and hospital charges prior to and after joining the NHTCN were performed. Results: There was a total of …

Bladder Prolapse (Cystocele) Among African, Asian, And Middle Eastern Women: A Clinical And Socio-Cultural Perspective.Intraoperative Frozen Section Analysis (Ifsa): One Plastic Surgeon’S Experience With 1598 Consecutive Skin Cancer Removals, Lawrence Chiang, Michael Chang, Steven Chang, Matthew Delancy, James Monihan, Ray Armand

SKMC Student Presentations and Publications

BACKGROUND: Skin cancer continues to be the most frequently diagnosed cancer in the United States. Since 1990, the prevalence of melanoma and non-melanoma skin cancer (NMSC) has been steadily increasing.¹ NCCN guidelines recommend complete excision of NMSC to preserve function and optimize aesthetic outcomes.² The gold standard surgical treatment is Mohs Micrographic Surgery (MMS) with a reported cure rate of 99-100%.³ However, MMS requires specialized training and thus is more geographically and financially limited. The traditional technique utilized for skin cancer removal is intraoperative frozen section assessment (IFSA). IFSA is a common histopathological technique that facilitates microscopic …

Fascia Iliaca Compartment Block And Pericapsular Nerve Group Block Effect On Opioid Consumption In Hip Fracture Patients, David A. Brueggeman, Garrhett G. Via, Prachi Lele, Andrew W. Froehle, Michael J. Prayson, Scott J. Hadaway

Orthopaedic Surgery Faculty Publications

Background Effective pain control and reduced opioid consumption improve hip fracture outcomes. Fascia iliaca compartment blocks (FICB) effectively and safely manage acute hip fracture pain while reducing opioid consumption. Alternatively, pericapsular nerve group (PENG) blocks may provide similar analgesia while better-preserving motor function by targeting the highly innervated anterior hip capsule and sensory branches of the femoral, obturator, and accessory obturator nerves. Evidence for PENG's effectiveness is limited. The present retrospective study compared pain and MME in hip fracture patients receiving FICB (n = 1596) or PENG (n = 254), vs. a no-block (NB; n = 287) reference group. Methods …

Synthetic Electrospun Fiber Matrix In The Management Of Acute Wounds Following Excision Of Hidradenitis Suppurativa Lesions: A Prospective Pilot Study, Michael Madueke, Frank Lau

School of Medicine Faculty Publications

Hurley Stage II or III hidradenitis suppurativa (HS) may necessitate surgical excision of diseased skin and subcutaneous fat for symptom control and disease management. These excisions result in open wounds in topographically challenging regions and typically cannot be primarily closed. This study evaluates the use of a synthetic electrospun fiber matrix (SEFM) as a post-resection regeneration template to accelerate re-granulation and improve subsequent skin graft incorporation. This prospective pilot study enrolled Hurley Stage II or III patients undergoing surgical resection of HS lesions. SEFM was applied to the resulting wounds in conjunction with negative pressure wound therapy (NPWT). Patients were …

Digitally Fabricated Interocclusal Wafer Versus Wafer-Less Distal Segment Repositioning For Bilateral Sagittal Split Osteotomy (Bsso) In Skeletal Mandibular Deformities (Randomized Controlled Trial), Hesham Osama Morsi Ass.Lect., Mohammed Abdelsalam Omara Ass.Prof., Mostafa Ibrahim Shindy Prof, Galal Gamal El Behairy Prof.

Dentistry

Objective: This study aimed to compare the accuracy of condylar positioning between 2 computer-guided orthognathic surgical protocols: a waferless screw hole plate locating (WSL CPD) technique versus an occlusal splint with distal extending arms (OWDA-CPD) approach. Materials and Methods: Twenty-four patients requiring mandibular orthognathic surgery (class II or III deformities) were randomly allocated into 2 groups (n=12 each). Group I underwent a waferless protocol utilizing 3D-printed osteotomy and screw hole locating guides, while group II received an occlusal splint with distal extensions for condylar positioning. Preoperative and postoperative cone-beam computed tomography (CBCT) scans were used to assess condylar displacement in …

Breast Reconstruction In Becker Nevus Syndrome, Alexis K. Schlosser, Mohammed S. Rais, Ruston J. Sanchez

School of Medicine Faculty Publications

Becker nevus syndrome is a rare cutaneous disorder characterized by the presence of a hyperpigmented patch of skin typically occurring on the upper trunk, often associated with hypertrichosis, and sometimes associated with musculoskeletal abnormalities ipsilateral to the nevus. Becker nevus syndrome can lead to breast hypoplasia. Unlike other forms of breast hypoplasia, treatment should begin before the completion of breast development. Due to the rarity of the disease, breast reconstruction in these patients has no gold-standard approach, and treatment is often delayed. Therefore, our case report highlighted the need for early treatment and provided options for reconstruction in this population. …

Unpacking Violence: Examining Socioeconomic, Psychological, And Genetic Drivers Of Gun-Related Homicide And Potential Solutions, John Menezes, Kavita Batra

Department of Plastic Surgery Faculty Research

Background: Gun-related homicide remains a persistent public health crisis in the United States, with over 48,000 firearm-related deaths reported in 2022, including 19,651 homicides and 27,032 suicides. Despite frequent calls for tighter gun control, firearm access alone does not explain the complexity of violence. Objective: This commentary aims to unpack the socioeconomic, psychological, and biological drivers of gun-related homicide and propose integrative, evidence-based solutions that extend beyond legislative reform. Methods: We synthesized data from peer-reviewed literature, national crime and health databases (e.g., Centers for Disease Control and Prevention and Federal Bureau of Investigation), and international reports. We examined patterns related …

The Need For Innovative Changes In The Jackson-Pratt (Jp) Drain, Elizabeth Goldstein, Bs, Spencer Haber, Krishna Koka, Bs, Devin Williams, Bs, Andrew Newman, Md

Health Equity and Quality Improvement (HEQI) Summit

Purpose

The JP drain is a closed suction drain used in surgeries throughout the body. This design, introduced by Dr. Frederick Jackson and Dr. Richard Pratt in 1971, prevents seroma formation through continual negative pressure drainage while resisting drain collapse and obstruction. Through a focused literature review, we summarized findings on JP drain-related complications in breast reconstruction and mastectomy. Though the JP drain effectively reduces seroma formation, there has been a profound lack of innovation in how its design addresses Surgical Site Infection (SSI), Surgical Site Pain (SSP), and Quality of Life (QOL). In addition, there is no standardized, evidence-based …

Normobaric And Hyperbaric Oxygen Therapy In Pediatric Dog Bite Nasal Tip Avulsion/Replantation, Paul G. Harch, Adam Shalek, Jen Karen Erbil, Brett J. King, Abigail E. Chaffin

School of Medicine Faculty Publications

A 4-year-old healthy girl sustained a composite dog bite avulsion of the tip of her nose that was intraoperatively replanted without vascular reanastomosis 2 hours and 45 minutes after the avulsion. The replanted tip initially appeared viable, but became dusky at 16 hours and cyanotic at 32 hours postreplantation. Hyperbaric oxygen therapy commenced at 40 hours postreplantation, and intermittent normobaric oxygen was added at night after the fourth hyperbaric oxygen treatment. Hyperbaric oxygen therapy was dosed according to tissue response/appearance and signs of patient oxidative stress with progressive improvement in viability. The patient received 30 hyperbaric oxygen treatments in 26 …

Mapping Fat Embolism As A Complication Of Liposuction And Fat Grafting: A Systematic Review Of Anatomical And Technical Risk Factors, Jared Garfinkle, Jack Hennen, Wen Luo

Rowan-Virtua Research Day

Fat grafting (FG) and liposuction are widely performed aesthetic procedures with associated fat embolism risks. However, no comprehensive review has specifically mapped the anatomical distribution and technical causes of fat embolism events across these procedures. This review aims to characterize regional and procedural frequencies of fat embolism to inform safer surgical practices. A review was conducted using PubMed, Embase, Scopus, and Cochrane. Included studies were English-language case reports/series, retrospective reviews, and systematic analyses reporting fat embolism following liposuction or FG. Among 227 FG cases, the most frequent regions were the face (n=120), gluteal region (n=91), genitalia (n=9), and chest (n=7). …

Publication Trends Among Integrated Plastic Surgery Residency Applicants After The Elimination Of Numeric Step 1 Scores, Forrest Bohler, James Burmeister, Ethan Dimock, Ava Harvey, Zachary Koenig, Kongkrit Chaiyasate, Cameron Davidson

Posters

No abstract provided.

Complications Of Breast Reconstruction: Does The Area Deprivation Index Predict Risk?, Andrew Hannoudi, Noah M. Atisha, Amolak S. Jhand, Kinan Sawar, Dunya M. Atisha

Medical Student Research Symposium

INTRODUCTION: Despite mandated post-mastectomy reconstruction coverage since the Women’s Health and Cancer Rights Act (1998), vulnerable populations may be prone to breast reconstruction complications. The Area Deprivation Index (ADI) reflects neighborhood socioeconomic status utilizing US census data. This study investigates ADI's relationship to breast reconstruction complications.
METHODS: A retrospective study of immediate pre-pectoral direct-to-implant reconstruction patients at a metropolitan healthcare system from 2018-2022 was conducted. Patients were stratified by ADI: <50th percentile (ADI=1-5) and ≥50th percentile (ADI=6-10). Demographics, medical history, treatment history, and postoperative outcomes were compared. Descriptive statistics identified differences between ADI groups. Minor complications were defined as incidence of hematoma, seroma, superficial wounds, full thickness necrosis, or oral antibiotic-treated cellulitis. Major complications were defined as incidence of hospital readmission or return to OR. Long-term complications were defined as incidence of capsular contracture or ≥3 revisions. Logistic regression assessed ADI’s predictive value, accounting for confounds between cohorts.
RESULTS: Of 195 patients, 147 had low ADI and 48 had high ADI. Significant differences in BMI and race were found between groups. Low ADI demonstrated higher …

It’S All In The Wrist: Postoperative Complications Of Patients With Menopause In Endoscopic Versus Open Treatment Of Carpal Tunnel Syndrome, Sharon Shania Ms, Charlotte Floria Do, David Matera Do, Amir B. Behnam Md

Tower Health Research Day

No abstract provided.

International Expert Consensus On The Current Status And Future Prospects Of Artificial Intelligence In Metabolic And Bariatric Surgery, Mohammad Kermansaravi, Sonja Chiappetta, Shahab Shahabi Shahmiri, Julian Varas, Chetan Parmar, Yung Lee, Jerry T. Dang, Asim Shabbir, Daniel Hashimoto, Amir Hossein Davarpanah Jazi, Ozanan R. Meireles, Edo Aarts, Hazem Almomani, Aayad Alqahtani, Ali Aminian, Estuardo Behrens, Dieter Birk, Felipe J. Cantu, Ricardo V. Cohen, Maurizio De Luca, Nicola Di Lorenzo, Bruno Dillemans, Mohamad Hayssam Elfawal, Daniel Moritz Felsenreich, Michel Gagner, Hector Gabriel Galvan, Carlos Galvani, Khaled Gawdat, Omar M. Ghanem, Et Al

School of Medicine Faculty Publications

Artificial intelligence (AI) is transforming the landscape of medicine, including surgical science and practice. The evolution of AI from rule-based systems to advanced machine learning and deep learning algorithms has opened new avenues for its application in metabolic and bariatric surgery (MBS). AI has the potential to enhance various aspects of MBS, including education and training, decision-making, procedure planning, cost and time efficiency, optimization of surgical techniques, outcome and complication prediction, patient education, and access to care. However, concerns persist regarding the reliability of AI-generated decisions and associated ethical considerations. This study aims to establish a consensus on the role …

A Narrative Review Of Barriers To Utilization Of Surgical Risk Assessment Calculators, Jacob Lahti, Kaiya A. Noe, Abigail Veenstra, Sarah Gallitto, Victoria I. De Leon, Thomas C. Varkey, Nimit Agarwal

Annual Research Symposium

Over the last several decades, it has become the desire of surgical and medical teams to decrease risk levels involved for patients undergoing surgery. However, despite the advent of risk assessment calculators to help physicians obtain more accurate and objective judgements for postoperative complications, these tools are underutilized in standard clinical practices in comparison to other methods of risk assessment. This is likely due at least in part to certain barriers that decrease their functionality and ease of use. This review discusses the major barriers to the utilization of current risk calculators so as to allow for a better understanding …

Mental Health And Wellness Among Plastic Surgeons During Oral Board Certification Examination Preparation., Hannah J. Bergman, Charles C. Jehle, Ibrahim Khansa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: The field of plastic and reconstructive surgery has recently made a dramatic shift toward attention to mental health, with residency curricula expanding to include training on burnout prevention and the promotion of well-being. After graduation, however, new surgeons face a difficult year of preparation for the oral board certification examination. This group of young surgeons remains largely unstudied and undersupported throughout what may be the most challenging period of their educational journey.

METHODS: In spring of 2024, an electronic survey was sent to members of the American Society of Plastic Surgeons who had completed their oral board examination within …

Understanding The Impacts Of Surgical Drains On Postoperative Pain And Quality Of Life, Goutam K. Gadiraju, Matthew R. Prospero, Finn Tobias, Andrew J. Malek, Erik Reiche, Justin M. Broyles

School of Medicine Faculty Publications

Background: Surgical drains are commonly used in breast surgery and breast reconstruction for seroma prevention. Although many surgeons are aware that surgical drains can cause considerable discomfort to patients, less is understood about the specific impacts of drains on postoperative pain and quality of life (QOL). Methods: A cross-sectional survey was conducted among patients at our institution who had previously undergone mastectomy or breast reconstruction procedures to better understand patients' experiences with surgical drains. Patients were asked to report their attitudes toward a series of QOL statements and rate postoperative pain using numeric pain scales. Pair-wise analysis was used to …

Trends And Outcomes In Fixation Of Distal Radius Fractures In Elderly Patients: Should Gender Play A Role In Surgical Decision Making?, Rabia Qureshi, Kenny Ling, Sydney Laramie

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

Impact Of Teriparatide On Surgical And Medical Outcomes In Osteoporotic Patients Undergoing Multilevel Anterior Cervical Discectomy And Fusion, Samuel Akhnoukh, Uttsav Patel, Kenny Ling, Ivan Zapolsky

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF) are at increased risk of pseudarthrosis and perioperative complications, including higher rates of reoperation compared to non-osteoporotic individuals. Teriparatide, an anabolic agent used in osteoporosis treatment, has shown promise in enhancing fusion and reducing complications in lumbar spine procedures, but its role in multi-level ACDF remains unclear.

Purpose: The purpose of this study was to evaluate the impact of postoperative teriparatide use on outcomes in osteoporotic patients undergoing multi-level anterior cervical discectomy and fusion (ACDF). Specifically, the study aimed to determine whether teriparatide could reduce long-term complications such as …

Identifying Authenticity In Orthopaedic Residency Applications: Can Selection Committees Detect Ai-Written Personal Statements, Samir Baig, Lekha Yaramada, David E. Komatsu, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

See article.

Hypertensive Status Predicts 30-Day Postoperative Complications Following Open Reduction Internal Fixation Of Distal Radius Fractures, Nishank Mehta, Emma Smolev, Dorian Cohen, Kenny Ling, Becka Konnayil, Samantha Muhlrad, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The primary objective of this study was to investigate the association between preoperative hypertension and postoperative complications following open reduction internal fixation of distal radius fractures.

Methods: All patients who underwent open reduction internal fixation (ORIF) for distal radius fractures (DRF) between 2015 to 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Postoperative complications were reported within 30 days of procedure. We identified a total of 26,138 patients and 31.5% (n=8,225) of patients had hypertension. Hypertension was defined as blood pressure greater than 140/90 as documented in the medical record, requiring …

Femoral Avascular Necrosis And Triptan Therapy: A Multicenter Retrospective Study, Joseph Bisiani, Francisco Martos Jr., Brian Lynch

Stony Brook Orthopaedic and Musculoskeletal Journal

Aims: Migraines are one of the most common neurological disorders that patients typically suffer from. One of the more common prescription medications for migraines are triptans, which can lead to vasoconstriction throughout the peripheral vasculature as a potential side effect. However, a possible risk of femoral avascular necrosis may arise from these treatments, as it has been well known that a lack of blood flow to the femur can arise due to this peripheral vasoconstriction. Therefore, research is warranted for whether taking anti-migraine medications is associated with a higher risk of developing avascular necrosis within the femur, an area highly …

Extensor Tendon Injuries: Does Repair Technique Influence Re- Rupture Rate?, Rahul Rai, Joseph Bisiani, Athikur Rahman, David Komatsu, Lawrence Hurst

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Extensor tendon injuries are common injuries to the hand. When poorly managed, these injuries can have significant long-term effects on a patient’s hand function. There are multiple described repair techniques to repair an injured extensor tendon. The aim of this study was to determine if there was a correlation between extensor tendon repair technique and subsequent re-rupture rate.

Methods: A retrospective analysis was conducted on patients who underwent extensor tendon repair at our institution, utilizing the electronic medical record database of patients with extensor tendon injuries from 2015 to 2024. Data were collected on patient demographics, injury mechanisms, tendon …

Biomechanical Comparison Of Posterolateral Fibula Plating With Independent Syndesmotic Screw Fixation Versus Direct Lateral Plating With Syndesmotic Screw Fixation Through Plate, Dmitriy Butsenko, Zack Bonick, J Gary Bledsoe, Michael E. Doany

Stony Brook Orthopaedic and Musculoskeletal Journal

Syndesmotic fixation has been extensively investigated. Screw size, number, position, orientation, and flexible fixation options have all been investigated at length. There is however a lack of knowledge of any difference between an independent syndesmotic screw versus onethrough a lateral plate. The purpose therefore is to perform a biomechanical assessment of syndesmotic fixation comparing independent screw vs screw through plate combination, analyzing torsional strength of both constructs. To perform this, seven matched cadaveric through tibia-fibula lower leg specimens were prepared by creating an oblique fracture performing surgical syndesmotic disruption. The specimens were then randomized into the direct lateral through plate …

Association Between Glp-1 Agonist Use And Site-Specific Fracture Risk: A Retrospective Cohort Analysis, Nathan Zou, Joseph Bisiani, Brian Lynch

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Type 2 diabetes and obesity rates are expected to rise, possibly increasing the usage of Glucagon-like peptide-1 (GLP-1) agonists. Use of these agents for nondiabetic patients for weight loss I s approaching the number prescribed for diabetes. GLP-1 agonists may influence bone metabolism by promoting formation and reducing resorption, but their impact on fracture risk remains unclear. While some studies show no association, others suggest increased vulnerability. Most prior research has examined overall fracture risk without considering specific skeletal sites. This study aimed to compare site-specific fracture rates in adults with T2DM or obesity receiving GLP-1 therapy with those …

All Inside Meniscus Repair - How Close Is Too Close?, Frederick Hance, Kenny Ling, Liam Edwards-Gaherty, Diana Patterson

Stony Brook Orthopaedic and Musculoskeletal Journal

Although rare, neurovascular injuries are major complications. The purpose of this study was to use cadaveric dissection to determine the proximity of medial and lateral meniscus repair to major neurovascular structures in the posterior knee. We hypothesized that repair of the posterior horn of the medial and lateral menisci would be within 1 centimeter proximity of a key neurovascular structure.

The study was performed on 4 fresh-frozen cadaveric specimens that included the full knee joint spanning from the distal femur to proximal tibia and fibula. Following identification and tagging of the key structures, arthroscopic meniscus repair was simulated using Arthrex …

Investigation Using Single Point Incremental Forming (Spif) To Fabricate Patient-Specific, Titanium Orbital Floor Implants, Elizabeth M. Mamros, Lauren E. Blaha Md, Christian A. Kauffman Md

Faculty Conference Papers and Presentations

The floor of the human orbit is composed of thin bone that is prone to traumatic fracture. This leads to a loss of support for the eye, which can cause vision changes. Therefore, fractures may need surgical reconstruction using a thin, sheet-like implant. Titanium implants are available off-the-shelf in standard sizes, but fitting to each patient’s unique anatomy requires surgeons to cut, file, and bend these plates. This can be time-consuming and imprecise. To both save time and ensure a perfect fit for the patient, a custom plate can be created prior to surgery. This investigation focuses on single-point incremental …

A Customized Large Single-Piece Bifrontal Implant For Post-Craniectomy Defect Reconstruction: A Case Study, Omid Ghaderzadeh, Ehsan Amirbeyk, Seyed Roholah Ghodsi, Zahra Namazi, Lobat Tayebi

Electrical & Computer Engineering Faculty Publications

Background: Large bifrontal defects pose unique reconstruction challenges due to their complex curvature and mechanical requirements. This case demonstrated how computer-aided design/manufacturing (CAD/CAM) enabled precise single-piece polymethyl methacrylate (PMMA) implant fabrication, thereby overcoming traditional limitations. Case presentation: A 25-year-old male who had undergone bifrontal decompressive craniectomy suffered a severe traumatic brain injury. The autologous bone flap had been temporarily stored in a subcutaneous fat area of the abdomen for 3 months to preserve its viability. A secondary cranioplasty was then performed using titanium miniplates and self-tapping screws for final fixation. After 2 years, the patient developed empyema and a brain …