Surgery Commons^™

Perspective On Lessons Not Learned: From Coley’S Toxins To Microbial Drug Delivery, Guidance For Institutional Review Boards (Irbs), Brian P. Hanley, Alejandro J. Betancourt, Gustavo Gross, Wilbur (Bo) Bowne

School of Medicine Publications

The bacterial and toxin methods of cancer treatment date back 130 years. This paradigm rests on nonspecific bacterial-toxin-generated immunotherapy. This high-risk oncology research is experiencing a renaissance of methods that are among the most effective yet. Glioblastomas and other resistant cancers are the modern touchpoint, because of remission history following sepsis. Spurred by recent research deaths, we discuss protocols IRBs should consider in live bacterial or synthetic immuno-stimulatory trials. Human systemic inflammatory response syndrome immunology is unique due to non-functioning SIGLEC-13 and 17, which control excessive Toll-like receptor 4 (TLR-4) signaling. This is not a technicality like human CD8+/CD4+ T …

Predictors Of Total Hip Arthroplasty Among Patients With Chronic Comorbidities: A Multivariate Analysis Of A Medically Underserved Region, Blake C. Martin, Manoj Peiris

School of Medicine Publications

Background

THA is a common orthopedic procedure that is expected to increase in the coming years. Obesity and osteoarthritis are major factors that increase the risk of individuals requiring THA. The Rio Grande Valley (RGV) is a distinctive health professional shortage area with high rates of obesity, arthritis, and diabetes. This study aims to examine the relationship between chronic medical conditions and the need for THA in this at-risk, medically underserved population.

Methods

This investigation employed a retrospective chart review encompassing patient records from January 1, 2018, through January 1, 2025, using the University of Texas Rio Grande Valley electronic …

Selective Retention Of Birdshot Pellets In The Rearfoot: A Case Demonstrating Tissue Preservation And Functional Recovery, Yasim Zafar, Steven Bolton, Alexandria Armstrong, Hooman Mir

School of Podiatric Medicine - Student Research

Level of Evidence: III (Case Study)

Statement of Purpose: Gunshot wounds to the foot pose a unique surgical dilemma—whether to pursue aggressive foreign body removal or to preserve soft tissue integrity. This case highlights the management of a birdshot injury to the rearfoot where selective non-removal of pellets near the neurovascular bundle led to complete healing and full functional recovery. The purpose is to emphasize tissue preservation over aggressive exploration in complex ballistic foot injuries.

Case Study: A 26-year-old female sustained a birdshot gunshot wound to the right rearfoot. Multiple small entry wounds were noted on the posterior and plantar …

Trends In Meningioma-Related Mortality Among U.S. Adults: A Cdc Wonder Analysis From 2000 To 2023, Tirath Patel, Rai Muhammad Umar Khan, Fatima Hussain, Meer Murtaza, Muhammad Shayan Tariq, Abuzar Khan, Sara Aleem, Maryam Athar, Sharoz Shahid, Nikhilesh Anand

School of Medicine Publications

Background: Meningiomas are the most common primary intracranial tumors in the United States, comprising nearly 41% of central nervous system tumors. While the majority are benign, atypical (World Health Organization Grade II) and malignant (Grade III) subtypes are clinically significant due to their aggressive biology, higher recurrence, and increased mortality risk. Despite their burden, national mortality trends and demographic disparities in meningioma-related deaths remain underexplored.

Methods: We conducted a population-based analysis of meningioma-related mortality among U.S. adults aged ≥65 years from 1999 to 2023 using the centers for disease control and prevention (CDC) wide-ranging online data for epidemiologic research (WONDER) …

External Fixation Assisted Intramedullary Total Femur Arthroplasty: A Case Report, Matthew Hnatow, Blake Martin, Emma Herrera

School of Medicine Publications

Introduction:Total femur replacement (TFR) is a salvage procedure for patients with multiple failed hip and knee arthroplasties and is associated with high complication rates. Intramedullary TFR has emerged as a technique to preserve critical soft tissue attachments; however, maintaining limb length, alignment, and rotation remains challenging.

Case Presentation: We describe a novel case of intramedullary TFR utilizing external fixation to address these technical challenges. A 64-year-old male with subsidence of a hinged knee tumor prosthesis to the level of the greater trochanter underwent intramedullary TFR. External fixation was applied to the residual femoral and tibial bones to maintain …

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before Or After Surgery? Results From A Social Media Cohort, John M. Gaddis, Amanda J. Wheeler, Erika Shults, Charles South, Stephen T. Duncan, Joel Wells

School of Medicine Publications

This study aimed to analyse the symptomatic differences of hip dysplasia before or after separate surgical interventions, including pain location and characteristics, severity, patient-reported outcomes, and a body pain diagram. A REDCap-based survey was distributed through social media from October 2023 to May 2024 and targeted individuals with current or past hip pain. The survey gathered data on demographics, comprehensive hip-specific history, and various patient-reported outcome measures. Of 509 completed surveys, 287 respondents reported a diagnosis of hip dysplasia and were divided into cohorts based on treatment history: no surgery (n = 65), post-periacetabular osteotomy (PAO) (n = 162), post-THA …

Multiplanar First-Ray Deformity And Its Impact On Tibial Sesamoid Assessment: A Radiographic Analysis​, Yasim Zafar, Madelaine Adkins, Jessica Sima

School of Podiatric Medicine - Student Research

This study evaluated whether discrepancies in tibial sesamoid position (TSP) between anteroposterior (AP) and sesamoid axial radiographs are associated with first-ray deformity parameters: first metatarsal rotation angle (MRA), sesamoid rotation angle (SRA), intermetatarsal angle (IMA), and hallux valgus angle (HVA). We hypothesized that increased frontal-plane external rotation of the first metatarsal would be the primary contributor to AP–axial TSP mismatch.

This secondary analysis used deidentified radiographs from Shibuya et al. (J Foot Ankle Surg. 2019). Adults aged 18–80 with measurable TSP on both AP and axial views were included; patients with prior foot trauma or osseous surgery were excluded. Only …

Literature Review On The Effectiveness Of Surgical Vs Non-Surgical Management In Elderly Patients With Distal Radius Fractures, Robert A. Weinberg

MEDI 9331 Scholarly Activities Clinical Years

Distal radius fractures are common in patients aged sixty years and older. The best management strategy remains debated, particularly in elderly patients where complications risk, radiological outcomes and functional recovery need to be considered. Several studies have compared surgical interventions including open reduction and internal fixation with conservative management including closed reduction and immobilization. The aim of this literature review is to synthesize current evidence on these outcomes for elderly patients with a distal radius fracture who were treated with surgical treatment or non-surgical treatment.

Acute Limb Ischemia Secondary To Left Brachial Artery Occlusion In A 45-Year-Old Woman: A Case Report, Osman Zada, Tirath Patel, Suliman Syed, Muhammad Hanif, Ayesha Haq, Nikhilesh Anand

School of Medicine Publications

Rationale: Acute limb ischemia is a vascular emergency that occurs when blood flow to a limb suddenly decreases, putting the limb at risk if not treated promptly. Acute limb ischemia accounts for 11% of all vascular emergencies, among which arm ischemia is relatively rare. It is caused by occlusion of the brachial artery, most commonly by vascular thromboembolism. We report a female patient with left upper limb ischemia induced by occlusion of the brachial artery.

Patient concerns: We report a 45-year-old female who presents with an acute onset of severe pain, numbness, and pallor in her left arm. Pulse was …

A Review Of Recent And Developing Studies Regarding Percutaneous Coronary Intervention (Pci): A Narrative Review, Bisher Alsabbagh, Azeez Shala, Joshua Rupert, Abdallah Elsayed

School of Integrative Biological & Chemical Sciences (Formerly Dept. of Biology)

This comprehensive literature review synthesizes the most recent evidence and evolving clinical guidelines concerning percutaneous coronary intervention (PCI) from 2015 to 2025. The study integrates findings from 42 peer-reviewed trials, meta-analyses, registries, and international guideline statements issued by the American College of Cardiology/American Heart Association (ACC/AHA), European Society of Cardiology (ESC), and related societies. Results reveal a decade-long evolution in PCI practice marked by a shift from anatomy-driven to physiology and imaging-guided decision-making, supported by tools such as fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), intravascular ultrasound (IVUS), and optical coherence tomography (OCT). Modern guidelines emphasize individualized, team-based revascularization …

Evaluating The Efficacy Of Extracorporeal Shockwave Therapy In Postoperative Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Meta-Analysis, Maryam Salimi, Alireza Keshtkar, Seyedarad Mosalamiaghili, Walter Lowe, Aamir Ahmad, Arash Sharafatvaziri

School of Medicine Publications

Background: Recovering from anterior cruciate ligament (ACL) reconstruction can be challenging. While standard rehabilitation helps restore knee function, many patients still face a slow or incomplete recovery. Extracorporeal shockwave therapy (ESWT) has recently gained attention as a potential way to speed up healing and improve outcomes when added to traditional rehab.

Aim: To explore whether combining ESWT with standard postoperative rehabilitation truly leads to better recovery compared with rehab alone.

Methods: A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, evaluating participant status following ACL reconstruction with standard rehabilitation and without …

Engaging And Empowering Future Female Surgeons: Development Of The Medical Student Section Of The Society Of Women In Urology, Allison G. Booher, Sasha Vereecken, Erin Kim, Neharika Penmetcha, Alexandra Aponte, Eman N. Chaudhri, Meghana Noonavath, Ibukunoluwa Omole, Joanna Orzel, Leigh Martin

School of Medicine Publications

Objective: To describe a replicable model for a large-scale, cross-institutional, and student-driven initiative to promote gender equity within surgical fields.

Methods: To address the lack of a national infrastructure to support female medical students pursuing careers in Urology, a historically male-dominated specialty, the society of women in urology (SWIU) established its medical student section, called SWIUdents, as a student-led initiative to offer mentorship, education, and networking resources for future female urologists. In 2022, SWIUdents convened its first medical student leadership board, comprised of two co-chairs and four subcommittees focused on membership, program implementation, mentorship, and community relations. SWIUdents membership was …

Patient-Defined Outcomes In Adults With Hip Dysplasia: What Activities Do Patients Hope To Improve With Treatment?, John Gaddis, Martin Salgado-Flores, Seunghoon Lee, Syed Ghazi, Hunter M. Butler, Edward P. Mulligan, Charles South, Joel Wells

School of Medicine Publications

Introduction: Patient-reported outcome measures have widely been used in the field of orthopaedics to determine treatment outcomes; however, they may not always align with the patient's goals for improvement following treatment. Therefore, we introduced the concept of patient-defined outcomes (PDOs): pretreatment goals or activities patients wish to improve following treatment, along with the patient-perceived difficulty and importance of these activities. This study aimed to evaluate PDOs in adults with hip dysplasia across 3 age groups while assessing patient variables for potential associations with choosing specific categories of activities.

Methods: We analyzed PDOs in 180 adults diagnosed with hip dysplasia, stratified …

Oncoplastic Nipple-Sparing Mastectomy And Immediate Reconstruction In Non-Ideal Candidates, Aaron Dadzie, Yossef Alsabawi, Sonia Y. Khan, Paul Berry

School of Medicine Publications

Mastectomies have long been used as a surgical treatment for malignant and benign disorders of the breast, both as a therapy and prophylaxis in high-risk patients. A nipple-sparing mastectomy (NSM) allows for the removal of most of the glandular and ductal tissues while preserving the surface architecture of the nipple-areola complex (NAC). This report summarizes the current mastectomy practices and suggests an expansion of the established surgical selection criteria for NSM in the context of immediate implant-based breast reconstruction. We present two cases in which a novel hybrid oncoplastic approach was used and discuss its safety and efficacy when performing …

Cultural And Socioeconomic Determinants Of Hip And Knee Arthroplasty In The Medically Underserved Rio Grande Valley Community, Blake C. Martin, Juan C. Lopez Alvarenga, John M. Gaddis

School of Medicine Publications

Introduction: Joint arthroplasty is a common procedure that is increasing worldwide. In this study, we aimed to discover if there were differences in demographics and social factors associated with individuals undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the Rio Grande Valley (RGV). We hypothesized that older individuals and those with higher body mass index (BMI) would have an increased risk of TKA.

Methods: We conducted a retrospective chart review using the University of Texas Rio Grande Valley UTHealth electronic database from January 1, 2018, to July 1, 2024. Individuals were selected using Current Procedural Terminology codes …

Exploring The Efficacy Of Various Minimally Invasive Surgery (Mis) Techniques In Spinal Fusion For Degenerative Spondylolisthesis: A Systematic Review, Yolanda V. Gutierrez, Blake Martin, Joshua Nwose, Alyssa A. Sepulveda, Ronald Shaju, Aamir Ahmad, Robert H. Ablove

School of Medicine Publications

Degenerative spondylolisthesis is a common etiology of low back pain characterized by the anterior displacement of one vertebral body relative to the one below it. A key contributing factor is intervertebral disc degeneration, which compromises spinal stability. In patients with a lack of neurological issues, conservative treatment is recommended. If conservative treatment is ineffective, surgery is deemed the next step, involving decompression and fusion of the vertebrae. Over the past several decades, minimally invasive surgical (MIS) techniques have been developed and refined. This systematic review aims to compare different types of MIS techniques for the treatment of degenerative spondylolisthesis to …

Addressing Glenoid Defects With Distal Clavicle Autograft In Revision Total Shoulder Arthroplasty, Ryan Bialaszewski, Ross Chapel, Frank Gerold

School of Medicine Publications

No abstract provided.

Investing In Limb Preservation: A Case Report In Avoiding Bilateral Amputation In A Vasculopathy Patient, Stephanie N. Campbell, Craig J. Verdin, Heather V. Tran, Nikita Gambhir

Research Symposium

Background: Limb salvage and prosthetics play vital roles in restoring function and mobility for patients with severe injuries or metabolic conditions. Limb salvage involves surgical techniques aimed at preserving a limb rather than resorting to amputation, while prosthetics provide artificial devices to replace lost limbs. Key considerations for limb salvage include restoring a functional foot, maintaining patient independence, minimizing hospitalizations, and avoiding bilateral lower limb amputations.

Case Presentation: The patient, already at single-limb status, presented with a necrotic heel ulcer, exposed calcaneus, and necrotic Achilles tendon. After vascular optimization, the risks and benefits of final aggressive measures were discussed, leading …

Assessing Patient Satisfaction: The Role Of Net Promoter Scores In Healthcare, Paul Bonilla, Victoria Elizondo, Juan Pablo Flanagan

Research Symposium

Background: The Net Promoter Score (NPS) is a widely used tool for measuring customer satisfaction and loyalty through a simple question: “How likely are you to recommend [company name] to a friend or colleague?” Responses categorize individuals as Promoters (9–10), Passives (7–8), or Detractors (0–6), with the final score calculated by subtracting the percentage of Detractors from Promoters. Introduced in 2003, NPS has become popular across industries for its simplicity, predictive value, and benchmarking capabilities. In healthcare, NPS adoption is increasing as hospitals seek concise, standardized tools to assess patient satisfaction—an essential metric in the shift toward value-based care. …

Outcomes Of Double Free Flap Reconstruction For Advanced Head And Neck Tumors In A Safety-Net Hospital Population, Yossef Alsabawi, John M. Gaddis, Angela D. Haskins, Jonathan Shum, David J. Hernandez

Research Symposium

Background: Double-free flap reconstruction has emerged as a viable option for addressing more complicated defects after oncologic resection. We aim to report the feasibility of this approach at a single-institutional safety net hospital.

Methods: A retrospective chart review was performed between November 2020 and October 2023 for adult patients who underwent multiple, simultaneous free tissue transfers for head and neck defects following tumor resection. This study occurs at Ben Taub Hospital, a safety net hospital in Houston, Texas. Data collected included demographics, risk factors, oncologic and operative details, complications, and functional and disease outcomes. Socioeconomic status was assessed …

Symptomatic Manifestations Of Hip Dysplasia In Young Adults: How Do Patients Present Before And After Surgery?, John M. Gaddis, Amanda Wheeler, Yossef Alsabawi, Erika Shults, Charles South, Joel E. Wells

Research Symposium

Background: Hip dysplasia is a common source of hip pain in young adults that can lead to early-onset osteoarthritis. The Bernese periacetabular osteotomy (PAO) and total hip arthroplasty (THA) have shown good results as surgical treatment options for this disorder, yet pain may persist after surgery. A previous study described the clinical features of pre-treated hip dysplasia in a traditional clinical cohort; however, to our knowledge, no previous studies have examined the symptomatic manifestations of hip dysplasia in young adults before and after various surgical treatments including the analysis of pain locations in numerous anatomical areas through a body pain …

Staged Reconstruction And Salvage Of 5th Finger With Corticocancellous Distal Radius Autograft: A Case Report, Emmanuel Franco, Zayd Ayas, Frank Gerold

Research Symposium

Background: Finger reconstruction in the aftermath of severe trauma poses significant challenges in restorative surgery, particularly when addressing extensive soft tissue damage, comminuted fractures, and simultaneous neurovascular complications. This study presents a case of a patient with a complicated distal phalangeal fracture that pursued digit salvage.

Case Presentation: Patient is a 31-year-old woman who sustained a severe injury to her right 5th digit during an ATV rollover. The trauma resulted in an exposed and comminuted fracture of the proximal phalanx with associated loss of soft tissues, flexor tendon, radial nerve injury, and vascular compromise. She elected to pursue digit salvage …

Intraoperative Imaging In Orthopedic Settings: An Assessment Of Changes In Adherence To Imaging Guidelines, Emmanuel Franco, Tabitha Abraham, Zayd Ayas, Frank Gerold

Research Symposium

Background: High-quality intraoperative photography is vital for treatment planning, patient counseling, and surgical education. Inconsistencies in image quality are prevalent in orthopedic literature due to the absence of formalized criteria specific to orthopedic settings. In 2014, "Medical Photography: Principles for Orthopedics" introduced guidelines intending to standardize protocols for capturing clinical images. By comparing the quality of images taken both before and after these proposed guidelines, this project aims to evaluate whether this has influenced a trend toward standardization and consistency in intraoperative orthopedic photography.

Methods: To assess quality differences in orthopedic images before and after the 2014 guidelines, 60 intraoperative …

Enhancing Surgical Interest Through Pre-Clerkship Interventions: Insights For Student-Run Interest Groups, Anesu K. Murambadoro, Antoinette Burrell, Karina Zamora, Daniela Gonzalez, Theresa M. Biju, Paul Bonilla, Blake Martin, Ayesha Usman

Research Symposium

Background: The Association of American Medical Colleges (AAMC) projects a shortage of 10,100 to 19,900 surgeons by 2036. Despite the need for physicians in surgical specialties, exposure to surgical education remains limited to the third and fourth year, posing a barrier to fostering early interest in surgical careers. Medical school student interest groups (SIGs) may be an avenue to increase surgical exposure pre-clerkship curriculum. We seek to establish effective interventions that can be utilized by SIGs to increase and maintain surgical interest to the point of matriculation into surgical residency.

Methods: We conducted a systematic review using electronic databases, …

Spine Surgery In South Texas: The Impact Of Rurality On Surgeon Demographics And Access To Care, Anesu K. Murambadoro, Kevin Garcia Valdez, Patrick De La Torre Schutz, Allison J. Mcadams, Anjali Rose Binoy, Kelsey Baker

Research Symposium

Introduction: Female representation in spine surgery remains low, with only 4% of orthopedic spine surgeons and 9% of neurosurgeons identifying as female. Studies have shown that factors such as societal perceptions, limited support for family planning, and a lack of mentorship deter women from pursuing surgical careers. We hypothesize that representation may be further impacted in US-Border regions. Specifically, over 90% of Texas' 32 border counties lack sufficient primary care services, including specialty care such as orthopedic surgery and neurosurgery, leading residents to seek care outside the region. Here, we sought to evaluate the demographics of spine surgeons (orthopedic and …

Cilostazol After Endovascular Therapy For Femoropopliteal Peripheral Arterial Disease: A Systematic Review And Meta-Analysis, Christian D. Cerecedo, Aaron Silva, Valentine S. Alia, Ana Vargas, Alejandro Garza, Omar El Shazly, Alejandro J. Candil

School of Medicine Publications

Background

Endovascular therapy (ET) outcomes for femoropopliteal peripheral arterial disease (FP-PAD) remain suboptimal. Cilostazol therapy may improve patency rates and decrease major adverse limb events after ET for FP-PAD. Our goal was to analyze published studies evaluating the use of cilostazol after ET for FP-PAD.

Methods

We searched MEDLINE, EMBASE, and CENTRAL for randomized and observational studies (OSs) evaluating cilostazol therapy after ET for FP-PAD. We only included OSs adjusting for confounding variables. We analyzed observational and randomized studies separately and explored heterogeneity by estimating an I2 statistic. A fixed-effects model was chosen if the I2 statistic was low. If …

Understanding Hip Pain Through Social Media: An Initial Overview Of An International Web-Based Survey, John M. Gaddis, Erika Shults, Bretton Laboret, Ryan Bialaszewski, Katerina Wells, Charles South, Joel Wells

School of Medicine Publications

Background: We aimed to understand the adult experience of hip pain through a web-based REDCap platform via social media. The purpose of this study was to assess the possibility of collecting patient-reported data through social media in people with hip pain while outlining the contents of the survey and analyzing the demographics of the sample population.

Methods: The survey link was active from October 1, 2023, to May 1, 2024, and available on social media platforms. Respondents provided consent prior to survey participation. Responses were anonymous, and only unique, fully complete surveys were analyzed. The comprehensive hip survey included demographic …

Cryoablation Of Primary Breast Cancer Tumors Induces A Systemic Abscopal Effect Altering Time (Tumor Immune Microenvironment) In Distant Tumors, Flávia Sardela De Miranda, Dalia Martinez-Marin, Rachel L. Babcock, Maribel Castro, Geetha P. Boligala, Sonia Y. Khan, Kathryn L. Furr, Isabel Castro-Piedras, Nicholas Wagner, Dakota E. Robison

School of Medicine Publications

Introduction: Despite recent advances, triple-negative breast cancer (TNBC) patients remain at high risk for recurrence and metastasis, which creates the need for innovative therapeutic approaches to improve patient outcomes. Cryoablation is a promising, less invasive alternative to surgical resection, capable of inducing tumor necrosis via freeze/thaw cycles. Necrotic cell death results in increased inflammatory signals and release of preserved tumor antigens, which have the potential to boost the local and systemic anti-tumor immune response. Thus, compared to surgery, cryoablation enhances the activation of T cells leading to an improved abscopal effect, defined as the occurrence of a systemic response after …

Unusual Metastatic Pathways: A Case Of Colorectal Adenocarcinoma Presenting As A Cervical Neck Mass, Taha Al Hassan, Jessica Flores, Adam Bender-Heine, Rachel A. Giese

School of Medicine Publications

Head and neck metastasis of colorectal adenocarcinoma is exceedingly rare with most cases presenting in the liver, lungs, or peritoneum. This report describes the case of a 53-year-old female patient with a past medical history significant for mucinous adenocarcinoma of the colon treated with a right hemicolectomy. She was thought to be in remission but presented a few years later with a new, isolated left cervical neck mass and symptoms of left eye ptosis and dryness. Diagnostic imaging and biopsy confirmed the neck mass to be a metastatic lesion from her prior mucinous adenocarcinoma, with immunohistochemical findings specific for colorectal …

Surgical Technique For Glenoid Bone Defect In Revision Shoulder Arthroplasty: Distal Clavicle Excision And Grafting For 1-Stage Reverse Total Shoulder Prosthesis, Ryan Bialaszewski, Ross Chapel, Frank Gerold

Research Colloquium

Introduction: Reverse shoulder arthroplasty (RSA) has expanded its indications and use in North America since the early 1990s. Because of this, the prevalence of revision reverse total shoulder arthroplasty cases has continued to rise. On occasion, the need for revision of RSA can be due to and is complicated by glenoid bone loss defects, making this one of the most challenging cases for arthroplasty surgeons to perform. Historically, iliac crest or tibial grafts are most commonly used for these defects, although this comes with the disadvantage of requiring two surgical sites to be prepped and draped. The purpose of this …