Plastic Surgery Commons^™

Reconstruction Of Heel Soft Tissue Defects Using Sensate Medial Plantar Flap, Mihaela Pertea, Natalia Velenciuc, Oxana Grosu, Bogdan Veliceasa, Vladimir Poroch, Sorinel Lunca

Journal of Mind and Medical Sciences

Introduction. Reconstruction of heel soft tissue defects represents a true challenge for any surgeon due to the particularities of this anatomical region. The tissue used to reconstruct the heel area must be resistant, innervated, and adapted to take over the body weight. Innervated medial plantar fasciocutaneous flap is one of the best solutions to cover defects at the heel level.

Materials and Methods. We studied 5 patients, 4 males and one female, aged 42 to 67 years, who presented heel soft tissue defects of various etiologies. In all cases, the used reconstructive method was an insular innervated medial plantar fasciocutaneous …

Reducing The Donor Site Morbidity In Radial Forearm Free Flaps By Utilizing A Narrow Radial Forearm Free Flap, Safdar Ali Shaikh, Amber Bawa, Noman Shahzad, Zara Yousufzai, Muhammad Shahab Ghan

Section of General Surgery

Background: The radial forearm free flap (RFFF) has remained a leading choice of many plastic surgeons as a fasciocutaneous flap due to its versatility, pedicle length, and simple elevation technique. However, donor site morbidity has led many reconstructive surgeons to limit their use of the RFFF and to use other flaps instead. We propose that using a narrow RFFF (nRFFF) decreases the aesthetic and functional morbidity of the donor site.
Methods: We report our experiences with the nRFFF from April 2012 through May 2015 at the Department of Plastic, Reconstructive, and Hand Surgery at Liaquat National Hospital, Karachi. The donor …

Recurrent Vulvar Carcinoma: Complex Surgical Treatment Via Perineal Excision And Reconstruction With Musculocutaneous Flap, Dragoș Popa, Cosmin V. Obleagă, Ștefan Paitici, Stelian Ș. Mogoanta, Ionică D. Vîlcea, Pouya Pourgolafshan, Cristian Gheorghe, Manuela I. Vasile, Raluca Câmpeanu, Cecil S. Mirea

Journal of Mind and Medical Sciences

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion.

We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal …

Depression And Breast Cancer; Postoperative Short-Term Implications, Razvan V. Scaunasu, Ștefan Voiculescu, Bogdan Popescu, Roxana Popa, Denisa Bălălău, Laura Răducu, Cristina N. Cozma, Cristian R. Jecan

Journal of Mind and Medical Sciences

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer …

Titanium Hardware Extrusion Following Pediatric Cranioplasty, Cody L. Mullens, Luke J. Grome, Cesar A. Serrano, Rabia Qaiser, Aaron C. Mason

Faculty & Staff Scholarship

Aging pediatric cranioplasty patients with titanium implants are a population at risk for scalp breakdown and implant extrusion. Complications from titanium use in adult cranioplasty patients are well documented in the medical literature. Reports of complications focused on pediatric populations are sparse. In this case series, we report two examples of negative sequelae associated with titanium utilization in infant cranioplasty and discuss our treatment strategy for each case.

Mucinous Adenocarcinoma Of The Scalp: Primary Cutaneous Neoplasm Versus Underlying Metastatic Disease, Ciara A. Brown, Michael C. Lynch, Cristiane M. Ueno

Faculty & Staff Scholarship

Primary cutaneous mucinous carcinoma (PCMC) is a rare mucin-pro- ducing malignancy derived from epithelial glandular structures. The literature re- garding this topic is mostly in the form of case reports and case series. PCMC tends to present in the elderly with predilection for the head and neck and on initial assessment it can be easily mistaken for a simple inclusion cyst. Although PCMC is often indolent in nature, in rare instances it can metastasize and should remain a differential diagnosis in a selected population. The significance in identifying PCMC is reliably differentiating it from metastatic mucinous adenocarcinoma. We present a …

The Effects Of Emerging Technology On Healthcare And The Difficulties Of Integration, Skyler J. Pavlish-Carpenter

Honors Undergraduate Theses

Background: Disruptive technology describes technology that is significantly more advanced than previous iterations, such as: 3D printing, genetic manipulation, stem cell research, innovative surgical procedures, and computer-based charting software. These technologies often require extensive overhauls to implement into older systems and must overcome many difficult financial and societal complications before they can be widely used. In a field like healthcare that makes frequent advancements, these difficulties can mean that the technology will not be utilized to its full potential or implemented at all.

Objective: To determine the inhibiting factors that prevent disruptive technology from being implemented in conventional healthcare.

Methods: …

A Breast Prosthesis Infection Update: Two-Year Incidence, Risk Factors And Management At Single Institution, Ashley Nadia Boustany, Shady Elmaraghi, Nneamaka Agochukwu, Benjamin Cloyd, Adam J. Dugan, Brian Rinker

Surgery Faculty Publications

Background: Infection following augmentation and prosthetic-based breast reconstruction can cause significant physical and psychological distress for patients. It may delay adjuvant therapies and compromise aesthetic outcomes. The aim of this study is to identify modifiable risk factors for infection and identify common bacterial isolates to achieve optimal outcomes for patients.

Methods: A retrospective cohort study was performed for patients undergoing implant-based breast reconstruction over a 2-year period. In each case, we documented demographics, co-morbidities, complications and antibiotic use. We reviewed treatments, infectious species cultured where applicable and all outcomes.

Results: A total of 292 patients met the inclusion criteria. Fifty-five …

Impact Of Macra Legislation And Mips Scores On Cost Effective Analysis For Negative Pressure Wound Therapy Devices, Jeremy W. Kubiak, Subhas Gupta

Loma Linda University Student Journal

The Medicare Access and CHIP Reauthorization Act (MACRA) changes reimbursement from a fee-for-service payment system to fee-for-value. Physicians will be scored according to the quality of their care in the MIPS program and will receive a positive or negative modifier to their Medicare reimbursement based on that score.

Diverticulitis Resulting In Brain Abscess: A Case Report (Poster)., Sean J. Wallace Md, David Deisher Do, Thomas Daniel Harrison Do

Department of Surgery

No abstract provided.

Extra-Pleural Dermal Solitary Fibrous Tumor On The Posterior Shoulder: A Case Report., Sean J. Wallace Md, Robert Teixeira Md, Nathan F. Miller, Hina A. Sheikh, Genevieve Guzman, Rohit Sharma Md

Department of Surgery

No abstract provided.

Superficial Soft-Tissue Sarcomas Rarely Require Advanced Soft-Tissue Reconstruction Following Resection, William C. Eward, Alexander L. Lazarides, Anthony M. Griffin, Patrick W. O'Donnell, Amir Sternheim, Anne O'Neill, Stefan O. Hofer, Peter C. Ferguson, Jay S. Wunder

Markey Cancer Center Faculty Publications

Objective: Soft-tissue sarcomas are most frequently located deep within myofascial compartments. Superficial soft-tissue sarcomas (S-STS) are relatively less common and may be managed differently than deep sarcomas because generous resection margins are often possible without sacrificing critical structures. We sought to investigate the frequency and types of soft-tissue reconstructive procedures that are required following excision of S-STS.

Methods: We reviewed 457 consecutively treated patients with S-STS with a minimum 2-year follow-up from our prospectively maintained database between 1989 and 2009.

Results: Mean follow-up was 10.5 years (range, 2–23). Four hundred twenty-one tumors (91%) were excised with negative margins, 38 (8.3%) …

Necrotizing Fasciitis Of The Neck: Case Presentation, Emil Marginean, Ciprian Venter, Maria Domuta, Oana Valenas, Ildiko Sorban, Alina Pantis, Bogdan Popescu, Razvan V. Scăunașu

Journal of Mind and Medical Sciences

Necrotizing fasciitis represents a severe and rare infectious disease, which is accompanied by extended necrosis of subcutaneous tissues and fascia layers, having as a result gangrene of the teguments. To reduce mortality associated with this disease, a rapid diagnosis is necessary as well as aggressive surgical treatment, accompanied by adequate, aggressive antibiotic therapy. As a rule, etiology is teeth related, with the condition more common in immunology-depressed patients. This article presents the experience of the authors regarding a case presentation of necrotizing fasciitis with typical clinical expression and management of the disease in an immunological-depressed patient. Further data on diagnosis, …

The Psychological Influence Of The Diagnosis Of Breast Cancer On Therapeutic Options Selection, Razvan V. Scaunasu, Stefan Voiculescu, Bogdan Popescu, Cristina Cozma, Radu Jecan, Cristian Balalau

Journal of Mind and Medical Sciences

The therapeutic management decision-making process for breast cancer is complex, and is influenced by multiple factors including patient age, comorbidities, ethnicity, education, and availability of immediate or delayed reconstruction options. Our study analysed 276 patients diagnosed with breast cancer in the “Colțea” Clinical Hospital between 2014 and 2015. Mean patients age was 61.24, median 62, with a range of 31 to 89 years. Younger age was associated with a less advanced local disease and younger patients were more likely to choose and benefit from conservative surgery. Most patients (61.76%) came from rural areas. Place of origin had a significant influence …

Biochemical Effects Of Exercise On A Fasciocutaneous Flap In A Rat Model., Edita Aksamitiene, Adam L. Baker, Sudeep Roy, Salini Hota, Li-Hui Zhang, Julianna Rodin, Kealan Hobelmann, Jan B. Hoek, Edmund A. Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Importance: An overwhelming amount of data suggest that cardiovascular exercise has a positive effect on the mind and body, although the precise mechanism is not always clear.

Objective: To assess the clinical and biochemical effects of voluntary cardiovascular exercise on pedicled flaps in a rodent model.

Design, Setting, and Participants: Eighteen adult Sprague-Dawley male rats were randomized into a resting animal group (RAG) (n=9) and an exercise animal group (EAG) (n=9) for 14 days (July 23, 2013, through July 30, 2013). A pedicled transposition flap was performed on the ventral surface of the rat, and biopsy specimens were taken from …

Finite Element Simulation And Additive Manufacturing Of Stiffness-Matched Niti Fixation Hardware For Mandibular Reconstruction Surgery, Ahmadreza Jahadakbar, Narges Shayesteh Moghaddam, Amirhesam Amerinatanzi, David Dean, Haluk E. Karaca, Mohammad Elahinia

Mechanical Engineering Faculty Publications

Process parameters and post-processing heat treatment techniques have been developed to produce both shape memory and superelastic NiTi using Additive Manufacturing. By introducing engineered porosity, the stiffness of NiTi can be tuned to the level closely matching cortical bone. Using additively manufactured porous superelastic NiTi, we have proposed the use of patient-specific, stiffness-matched fixation hardware, for mandible skeletal reconstructive surgery. Currently, Ti-6Al-4V is the most commonly used material for skeletal fixation devices. Although this material offers more than sufficient strength for immobilization during the bone healing process, the high stiffness of Ti-6Al-4V implants can cause stress shielding. In this paper, …

Optimal Timing Of Free Flap Breast Reconstruction In A Highly Radiated Population, W. Mohiuddin, Kamini D. Patel, Steven E. Copit, Md, Patrick J. Greaney, Md, Facs

Department of Surgery Posters

Introduction

There has been an increasing use of postmastectomy radiation therapy (PMRT) in breast cancer patients, especially in cases of large tumors (T3 or greater) or node-positive disease (N1 or greater).1 When radiation for the treatment of breast cancer is expected, tissue-based breast reconstruction is generally preferred to implant-based reconstruction. This distinction is attributed to the high rate of complications with postoperative radiation after implant-based reconstruction, ranging from 20% to 70%.2

In cases when the need for radiation is likely, breast reconstruction with autologous tissue is typically deferred until the completion of the radiation therapy. Reasons for deferring include avoiding …

Versatility Of The Anterolateral Thigh Flap: An Akuh Experience, Muhammad Fazlur Rehman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan

Department of Surgery Docs

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects …

Versatility Of The Anterolateral Thigh Flap: An Akuh Experience, Muhammad Fazlur Rehman, Muhammad Asif Ahsan, Muhammad Ubaid Khan, Sami Ullah, Sara Khan

Department of Surgery Docs

Anterolateral thigh flap is used for reconstruction of various soft tissue defects. We planned the study to evaluate the versatility of the anterolateral thigh flap as it may be used for reconstruction of head and neck, torso and extremities with minimal donor-site morbidity. The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised date from October 2012 to December 2015. Of the 75 patients in which anterolateral thigh flap was used for reconstruction, 6(8%) flaps did not survive. The overall flap survival was 69(92%). Anterolateral thigh flap was versatile enough to provide soft tissue coverage to defects …

The Role Of Fat Grafting And Adipose-Derived Stem Cells In Breast Reconstruction, Krishna S. Vyas

Theses and Dissertations--Clinical and Translational Science

Fat grafting is a common surgical procedure that involves the transfer of fat from one area of the body to another in order to improve contour deformities, such as in breast reconstruction. Advantages of the technique include using autologous tissue rather than a foreign body and the added benefit of having liposuction to remove fat from an undesirable location. Although adipose tissue could be the ideal soft tissue filler, fat grafting is plagued by tremendous variability in long-term retention, with volume survival rates of 20-80%, resulting in suboptimal outcomes and repetitive procedures.

The mechanisms contributing to long-term fat graft survival …