Plastic Surgery Commons^™

Radiated Immediate Prepectoral Direct To Implant Reconstruction: A Retrospective Cohort Study, Kinan Sawar, Tala Al-Saghir, Jamie Hall, Michael Diffley, Madeleine Gonte, Donna Tepper, Vigen Darian, Maristella Evangelista, Amy Tang, Dunya Atisha

Medical Student Research Symposium

Purpose: Increasing use of prepectoral plane in post mastectomy implant-based reconstruction has made immediate direct to implant (DTI) reconstruction more achievable. There has been increased incidence of post mastectomy radiation therapy (PMRT) making it important to understand the complication profile of immediate DTI reconstruction in patients who may require adjuvant radiation therapy.

Methods: A retrospective cohort study of consecutive patients undergoing prepectoral DTI reconstruction with and without PMRT was performed. Patient and treatment level factors, operative, and post-operative outcomes were extracted on both the patient and breast level for the prepectoral radiated and nonradiated patients. The presence of at least …

A Nationwide Analysis Of Gunshot Wounds Of The Head And Neck: Morbidity, Mortality, And Cost, John M. Menezes, Kavita Batra, Vladislav Pavlovich Zhitny

Department of Plastic Surgery Faculty Research

Background:

Gun violence in the United States rose continuously from 2010 to 2022, spiking during the pandemic, and peaking in 2021 at 48,830 deaths (14.8 per 100,000). Previous reports investigated health and financial burden associated with gunshot wounds (GSWs) during 2004 to 2013; however estimates related specifically to head and neck (H&N) injuries have been lacking. This population-based study aims to examine incidence, morbidity, mortality, and health resource utilization of H&N injuries utilizing the Nationwide Inpatient Sample database.

Methods:

A population-based study was undertaken using the National (Nationwide) Inpatient Sample (NIS) database (2015Q4–2017Q4). The International Classification of Diseases, Tenth Revision …

Review Of Orthoplastic Techniques For Lower Extremity Reconstruction: Part One, Benjamin Heddy, Brady Webb

Advances in Clinical Medical Research and Healthcare Delivery

Orthoplastic techniques are effective tools for limb salvage in the lower extremity. In order to apply proper techniques successfully, a surgeon must be aware of all the different types of flaps available. Proper pre-operative evaluation and patient selection are also important factors. The following review covers six papers that give surgeons a strong foundation in the anatomical basis and surgical technique of intrinsic muscle flaps and other fasciocutaneous or adipofascial flaps of the foot. These flaps, along with split thickness skin grafts, external fixation, and dermal regenerative templates, quickly close soft tissue deficits in the foot and ankle that often …

Small Finger Reverse Ulnar Digital Artery Hypothenar Perforator Flap For Small Finger Proximal Interphalangeal Joint Reconstruction, Nicholas Kunda, Alexander Dagum

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: Local flaps are commonly used for digital reconstruction for soft tissue defects. There remains a paucity of options available for small finger volar proximal interphalangeal joint coverage. The purpose of this study was to analyze perforators along the hypothenar eminence arising from the artery of the ulnar side of the small finger as it comes off the superficial palmer arch for consistency and potential to be used for perforator-based flap reconstruction of the small finger proximal interphalangeal joint.

Methods: Four cadaveric upper extremities were injected with Microfil® silicone injection compound. Dissection was performed from the superficial palmer arch to …

Clinical And Radiographic Outcomes For Femoral Neck Fracture Fixation With Femoral Neck System Versus Multiple Cannulated Screws, Samer M. Al-Humadi, D’Arcy Marsh, Michael Doany, David Swanson, David E. Komatsu, Stephen A. Kottmeier, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The There are few studies in the orthopaedic surgery literature that examine clinical outcomes for femoral neck system (FNS) fixation of femoral neck fractures. The purpose of this study was to compare primary outcome of non-union for femoral neck fracture fixation using FNS versus multiple cannulated screws (MCS).

Methods: Retrospective electronic medical record search for patients 18 years or older who underwent surgery between March 01, 2018 and September 01, 2021 for femoral neck fracture fixation. Two reviewers examined radiographic and clinical data reaching consensus. Patients were called via telephone to complete Short Form 12-item (SF-12) surveys with consent. …

Alcohol And Opiate Abuse Are Risk Factors For Dislocation After Primary Reverse Shoulder Arthroplasty, Ryan P. Tantone, Kenny Ling, Michael E. Doany, Rosen Jeong, Emma Smolev, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: As indications for reverse total shoulder arthroplasty (RTSA) expand and patients present with increasing comorbidities, complications have become more frequent. Dislocation and instability are devastating complications and have become one of the leading causes of revision surgery. Current literature suggests multifactorial causes for dislocation, but studies are limited to physiologic and mechanical risk factors. The purpose of this study was to investigate social risk factors, including alcohol and drug abuse, and their association with dislocation after RTSA.

Methods: A retrospective cohort of all RTSA performed at a single center by the senior author between January 2012 and March 2021 …

Core Muscle Injuries: Functional Outcomes And Return To Sport In A Consecutive Series Of Twenty Athletes, Nicholas Tsouris, Jack Tesoriero, James A. Vosswinkel, James Penna

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Core muscle injury can cause significant dysfunction in athletes. A variety of surgical procedures have been described. This study examines an orthopaedic and general surgeon’s technique and patient reported outcomes of adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis.

Hypothesis: Surgical treatment of core muscle injuries with adductor tenotomy and rectus abdominus imbrication with ilioinguinal nerve neurolysis will result in decreased symptoms and high rates of return to play.

Study Design: Operative technique; retrospective case series.

Methods: Our electronic medical record system was searched for patients who underwent core muscle injury surgery by the treating surgeons. The …

The Utility Of The Axillary Shoulder Radiograph In The Management Of Clavicle Fractures, Stephen Bowen, Ryan Tantoe, Daniel Botros, Samer Al-Humadi, Nicholas Tsouris, Nicholas Divaris

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Prior literature is mixed on the necessity of an axillary shoulder radiograph in the setting of presumably isolated clavicle fractures, with some authors endorsing its need for any shoulder girdle trauma and others stating it is unnecessary. However, no studies to date have specifically evaluated this.

Hypothesis: We hypothesize that an axillary shoulder radiograph will offer no management changing information in the setting of clavicle fractures.

Methods: Ninety-five patients presented for follow-up for management of a clavicle fracture. Analysis was performed to determine if the axillary view was useful based on the discovery of a glenohumeral dislocation or a …

Outcomes In Early Versus Delayed Management Of Pediatric Femoral Shaft Fractures, Daniel Botros, Sofia Hidalgo Perea, Rachel Loyst, James Barsi

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: There is a paucity of literature regarding the timing of treatment for pediatric femur fractures.

Purpose: The purpose of this study was to analyze whether early versus delayed management of pediatric femoral shaft fractures would impact outcomes regarding time to union and return to baseline function.

Methods: Pediatric patients presenting with femoral shaft fractures from 01/01/2010-01/01/2021 were identified using the Database at a single level one Trauma Center and retrospectively reviewed. Demographic information, surgical details, associated injuries, length of follow-up, time to union, and return to baseline function was collected. Patients were then divided into two groups; the early …

Suture Tape Stabilization Of The Distal Ulna Following Darrach Procedure. A Biomechanical Study, Miles S. Parsons, Evan C. Olsen, David E. Komatsu, Samantha Muhlrad

Stony Brook Orthopaedic and Musculoskeletal Journal

Introduction: The Darrach procedure (complete resection of distal ulna) is commonly used for definitive treatment of end- stage distal radioulnar joint (DRUJ) arthritis. This resection alone often results in treatment failure due to ulnar stump instability in a dorsal-palmar direction and ulnar convergence. Modified Darrach procedures with tenodesis have improved outcomes, but none have completely resolved these issues. Thus, we propose a novel technique of fixation via an internal brace.

Purpose: To evaluate stability and degree of dorsal-palmar displacement with an internal brace fixation (IBF) versus a modified extensor carpi ulnaris tenodesis (ECUT) following a Darrach procedure.

Methods: We tested …

Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report, Jennie Tan, Jamie Johnson-Eddy, Wesley Tang, Yanchun Li

Cooper Rowan Medical Journal

This report aims to review a case of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) by comparing the patient's course with the current literature.

BIA-ALCL is a specific type of T-cell lymphoma that can develop after breast implantation, but has only recently been recognized within the last decade. Although overall rare, certain types of breast implants have increased association with developing subsequent lymphoma. This case occurred after mastectomy with breast reconstruction for unilateral invasive ductal carcinoma with a textured, saline Allergan breast implant. BIA-ALCL manifested and was symptomatic nine years after implantation.

Warren B. Davis And The Birth Of Plastic Surgery In Philadelphia: A Historical Vignette, Sarah F. Wagoner, Charles J. Yeo, Renee M. Tholey, James W. Fox, Steven E. Copit

Department of Surgery Faculty Papers

The field of plastic surgery, formally organized in 1931 with the founding of the American Society of Plastic and Reconstructive Surgery, was shaped in many ways by a small practice of Philadelphia physicians. At the center of the practice was Warren B. Davis, a Philadelphia otolaryngologist and plastics pioneer whose innovations in cleft palate surgery would lead to significant improvements in functional and cosmetic outcomes in his time. In addition to his own innovations, Davis was responsible for the training of John Reese, the inventor of the Reese dermatome that changed the face of burn medicine during World War II. …

Innovative Therapeutic Approach To Chemical Burns Produced By Vesicants; An Experimental Study, Cristina Anca Secara, Otilia Liudmila Cinteza, Diana Popescu, Claudia Valentina Popa, Camelia Andreea Hirjeu, Oana Cristina Voinea, Luiza Georgia Serbanescu, Andreea Marilena Pauna, Mihail Tudosie

Journal of Mind and Medical Sciences

Vesicants are compounds that cause severe toxic effects on various tissues. Such chemical action causes tissue necrosis, with clinical expression of skin lesions with a burning character and characteristic blisters. Clinical toxic effects of cutaneous vesicles are correlated with the absorbed dose and exposure time. The goals of the study are to evaluate in vitro the skin toxicity produced by the vesicant chemical compound 2-chloroethyl-ethyl sulfide (CEES), to develop a complex antidote formula, and to optimize the therapeutic efficacy by inclusion in controlled release systems. The experimental protocol aims at the in vitro evaluation of the cytotoxicity of the vesicant …

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 …

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 …

Gender Dysphoria And Its Non-Surgical And Surgical Treatments, Danyon Anderson, Himasa Wijetunge, Peyton Moore, Daniel Provenzano, Nathan Li, Jamal Hasoon, Omar Viswanath, Alan D. Kaye, Ivan Urits

School of Medicine Faculty Publications

Gender dysphoria is defined by severe or persistent distress associated with an incongruence between one’s gender identity and biological sex. It is estimated that 1.4 million Americans and 25 million people worldwide identify as transgender and that 0.6% of Americans experience gender dysphoria. The pathophysiology of gender dysphoria is multifactorial and incompletely understood. Genetics, androgen exposure, neuroanatomy, brain connectivity, history of trauma, parents with psychological disorders, and being raised by less than two parents are associated with gender dysphoria. Gender dysphoria most frequently presents in early teenage years but can present earlier or later. Anxiety and depression are the two …

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

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 …

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, …

The Use Of Two Types Of Suture And Stainless-Steel Wire Tension Banding For The Fixation Of Olecranon Fractures: A Biomechanical Comparison, Stuart Drew, Samer Al-Humadi, David Komatsu, Ann M. Meo

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: Tension band constructs are commonly used for olecranon fracture fixation. The purpose of this study was to determine if a tension band constructed of No. 2 Dynacord suture, a silicone and salt-filled core within a UHMWPE sheath that expands radially and shortens axially when exposed to saline aqueous environment will provide constant initial static ompression forces compared to No. 2 FiberWire and stainless 18-gauge metal wire tension band.

Methods: A transverse osteotomy was placed in two sawbones models. Two 1.6 K-wires were placed across the osteotomy site and a Tekscan pressure sensor placed into the osteotomy site. The figure …

Relation Of Neurovascular Structures Of The Elbow To An Accessory Anterolateral Approach To The Capitellum: A Cadaveric Study, Michael Okoli, Ryan Tantone, Chidi Okolo, Samantha Muhlrad, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: The purpose of this study is to describe an anterolateral portal technique to the capitellum and to investigate its anatomic relationship nearby neurovascular structures in the elbow.

Methods: The study included 6 arm-to-fingertip adult cadavers. The demographic information of the cadavers was recorded. We initially dissected the elbows using a lateral approach to the capitellum. Next, a 1.5-cm anterolateral portal to the radiocapitellar joint was made and tagged with heavy suture and passed through the lateral elbow wound, with the elbow and forearm in an extended, supinated position. We then dissected out neurovascular structures around the elbow and measuring …

Non-Weightbearing In Cam Boots After Foot/Ankle Fracture Fixation: Are Patients Compliant?, Amos Z. Dai, Michelle Regan, Megan Paulus

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The controlled ankle motion (CAM) boot has become an integral part of the management of both operative and nonoperative foot and ankle conditions. Similar to casts, CAM boots are used to immobilize the foot and ankle after injury or surgery. However, unlike casts, CAM boots can be readily removed for showering and range of motion (ROM) exercises. While CAM boots are well-designed for ambulation and are frequently utilized in early weightbearing (WB) and early ROM protocols, their usage in non-weightbearing (NWB) protocols is less clear.

Purpose: The purpose of the current study is to determine the patient compliance rate …

Comparison Of Early Active Range Of Motion In Primary Reverse Shoulder Arthroplasty Based On Indication: A Single Center Retrospective Review, Michael E. Doany, Kenny Ling, Rosen Jeong, Alireza K. Nazemi, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Reverse shoulder arthroplasty (RSA) is commonly used in the treatment of rotator cuff arthropathy.  Indications for RSA have expanded to include complex proximal humerus fractures. Studies directly comparing outcomes between traumatic and traditional elective indications are limited. The purpose of this study was to compare early active range of motion (aROM) within the first two years postoperatively between traumatic and non-traumatic primary RSA, as well as compare ASES scores, and patient satisfaction at final follow-up.

Methods: A retrospective analysis was conducted of all RSA performed by a single surgeon between January 2000 and December 2018. Patients were grouped by …

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.