Surgery Commons^™

Instagram Versus Reality: Who Are Actually Plastic Surgeons?, Nikhi P Singh, Mary M Holohan, Cameron Harmon, Kasra N Fallah, Jeffrey Gross, Aadarsh Patel, Carter J Boyd, Matthew R Greives, Jorge De La Torre, Gayle Gordillo, Timothy W King

Faculty, Staff and Student Publications

Background: Instagram has become one of the most powerful marketing tools available to plastic surgeons because patients have increasingly turned to online resources to find physicians. Within, we review the online presence of self-ascribed plastic surgeons in the United States to identify potential misinformation and dishonest advertising.

Methods: The Inflact database was queried for the search terms: "plastic surgeon/surgery," "plastic and reconstructive surgeon/surgery," "aesthetic surgeon/surgery," and "cosmetic surgeon/surgery." US physician account information, history of medical training, American Board of Plastic Surgery (ABPS) certification status, and posts were reviewed.

Results: In total, 1399 physicians practicing within the United States were identified. …

Fibrinolysis For Apical Thrombus As A Bridge To Emergent Valve-In-Valve Transcatheter Aortic Valve Replacement, Nicholas J. Valle, Omar A. Saleh, Mani C. Akunuri, Parth K. Parikh, Joshua A. Cohen, Deepak R. Talreja, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Left ventricular (LV) thrombus is traditionally a contraindication to transcatheter aortic valve replacement due to embolic risk. Consequently, management of valvular cardiogenic shock complicated by LV thrombus identifies unique challenges that require innovative strategies.

Case Summary

A 58-year-old woman with critical bioprosthetic aortic stenosis, cardiogenic shock, and large LV thrombus (2.8 × 2.6 cm) underwent successful valve-in-valve transcatheter aortic valve replacement after systemic fibrinolysis bridge therapy.

Why Beyond the Guidelines

Current guidelines contraindicate transcatheter aortic valve replacement in patients with LV thrombus. This case demonstrates the novel use of low-dose, slow infusion tissue plasminogen activator as a bridge therapy …

Parenteral Nutritional Support In Surgical Patients: Expert Consensus Statements Regarding Intravenous Lipid Emulsions Containing Omega-3 Fatty Acids., Robert G Martindale, David C Evans, Dan Waitzberg, Malissa Warren, Manpreet S Mundi, Stanislaw Klek, Paul E Wischmeyer, Martin D Rosenthal

Surgery Articles

OBJECTIVES: The International Lipids in Parenteral Nutrition (PN) Summit was convened to offer practical guidance and expert consensus opinion regarding the use of intravenous lipid emulsions (ILEs) in various clinical settings. Herein, we briefly review aspects from this summit that are of particular importance for surgical/hospitalized patients.

METHODS: Summit participants identified and discussed new evidence, data, and analyses, that potentially influence the benefits and risks of ILEs in PN or their use in clinical practice. The summit meeting consisted of expert presentations that assessed recent clinical data and best practice, followed by periodic panel discussions to formulate consensus statements. Consensus …

Synthetic Versus Biologic Mesh For Complex Open Ventral Hernia Repair: 3-Year Follow-Up Of A Pilot Randomized Controlled Trial, Naila H Dhanani, Nicole B Lyons, Kyung Hyun Lee, Oscar A Olavarria, Aris R Arakelians, Julie L Holihan, Lillian S Kao, Ali Siddiqui, Connor Hogan, Tunmi Anwoju, Zuhair Ali, Mike K Liang

Faculty, Staff and Student Publications

Background: Biologic mesh is often used in complex hernia repair, but there has been limited clinical evidence to date to support this practice. The aim of this study was to compare clinical and patient-reported outcomes of biologic versus synthetic mesh for complex open ventral hernia repair (OVHR) at 3 years.

Methods: Patients from a single center, randomized, controlled, pilot trial comparing biologic versus synthetic mesh in complex OVHR were followed for 3 years. The primary outcome focused on major complications, namely mesh infections, hernia recurrences, reoperations, and deaths. Secondary outcomes included surgical site infections, surgical site occurrences, and patient-reported outcomes. …

Poor Oral Health Is Associated With Social Vulnerability In Critically Ill Trauma Patients, Mokunfayo O Fajemisin, Stephanie Martinez Ugarte, Chelsea J Guy-Frank, Gabrielle E Hatton, Kayli A Quinton, Sophia Syed, Erin E Fox, Charles E Wade, Kimberly A Mankiewicz, Lillian S Kao

Faculty, Staff and Student Publications

Background: Social factors affect oral health status, and poor oral health has been associated with worse health outcomes. Using the Oral Health Risk Assessment Value Index (OHRAVI), a bedside tool for non-dentists to assess oral health, we investigated the interplay of oral health with social drivers of health and social vulnerability, as measured by the Social Vulnerability Index (SVI), in severely injured patients.

Methods: Our retrospective study included dentulous critically ill trauma patients who were previously assigned an OHRAVI score (range 0-3; unhealthy score >1). Patient demographics, comorbidities, and self-reported social drivers were obtained from health records. SVI was calculated …

A Rare Complication Of Dilation And Evacuation: Unrecognized Extrauterine Retained Products Of Conception, Aviana Terschueren, Lauren Siewertsz Van Reesema, Joseph Hudgens

Department of Obstetrics & Gynecology Faculty Publications

Introduction: Surgical abortions, including dilation and evacuation, are among the safest gynecological procedures, with complication rates ranging from 0.5–4.0%. Uterine perforation, though rare (0.2–0.8%), can result in serious sequela, including translocation of retained products of conception into the abdominal cavity. We present a rare case of abdominal retained products of conception following a second-trimester dilation and evacuation.

Case Report: A 29-year-old G3P1112 underwent an elective surgical abortion at 17 weeks’ gestation, complicated by hemorrhage necessitating transfer to an outside hospital. She was treated with uterotonics and a blood transfusion and was discharged after a 6-day hospitalization. Initial transvaginal ultrasound showed …

Percutaneous Closure Of A Left Ventricular Pseudoaneurysm Using A Post-Infarct Vsd Device Guided By Intracardiac Echocardiography, Omar Jafar, Nicholas Valle, Rupinder Bahniwal, Matthew Summers

Department of Medicine Faculty Publications

Left ventricular pseudoaneurysm (LVPA) is a rare, life-threatening complication that may arise after cardiac surgery, myocardial infarctions, or infective endocarditis. We present a case of a 55-year-old woman with complex surgical history and prior infective endocarditis who developed an incidental LVPA. Due to lack of surgical repair options, a percutaneous approach was pursued using a post-infarct ventricular septal defect device (PIVSD) under guidance of fluoroscopy and intracardiac echocardiography (ICE) guidance with successful exclusion of LVPA. This case highlights the utility of multimodal imaging in the percutaneous management of complex left ventricular lesions.

Arthroscopic Inlay Biceps Tenodesis Using A Tendon-Docking Anchor, Mark G. Soliman, Katherine S. Worcester M.S., Thomas E. Herron, Kevin F. Bonner

Department of Medicine Faculty Publications

Pathology of the long head of the biceps tendon can be treated surgically with a multitude of tenodesis techniques; however, there is a lack of consensus on which technique provides the most optimal outcomes. Commonly used methods include inlay tenodesis with a bone tunnel and interference screw construct and onlay tenodesis with anchors or unicortical buttons. Although current methods typically provide satisfactory outcomes, many surgeons believe complications and failure rates remain suboptimal across techniques. In this article, we present an arthroscopic suprapectoral biceps tenodesis technique using an anchor device that was developed to address the shortcomings of current techniques, optimize …

A Primer On Anatomy, Biophysics, Pathology, Imaging And Treatment Of The Intervertebral Disc And The Anterior Spinal Column: The Discogenic, Intervertebral, Spinal Column (Disc) Aspn Workgroup., Jay S Grider, Timothy R Deer, Douglas P Beall, Melissa Z Murphy, Jacob W Fleming, Steven M Falowski, Christopher J Mallard, Hamzah A Ramawad, Rosa Amelia Garcia, Usman Latif, Chau M Vu, Anne Christopher, Michael E Harned, Raj G Patel, Anuj J Shah, Iden M Cowan, Kristin Jarzombek, Jordan L Tate, Nasir Khatri, Mateusz J Graca, Marcin K Karcz, Timothy T Davis, Kaku Barkoh, Olivier Clerk-Lamalice, Brian Durkin, Mark N Malinowski, Dagmar K Gross, Thomas Hedman, Matthew Green, Michael J Dorsi, Kasra Amirdelfan, Dawood Sayed

Surgery Articles

OBJECTIVE: As therapeutic options are rapidly expanding to treat pain of discogenic and vertebrogenic origin, it is important for the clinician to have an evidence-based understanding of the latest information regarding the normal and pathological anatomy of the intervertebral disc as well as imaging characteristics and treatment strategies. The American Society of Pain and Neuroscience (ASPN) commissioned the DISC project to inform and update the interventional spine community about anterior column pain syndromes.

METHODS: Using established literature review methods a clinical oversight group was convened to create an outline covering topics that will be key to meeting the objectives delineated …

Emergent Transcatheter Tricuspid Edge-To-Edge Repair For Right Ventricular Shock From Tricuspid Regurgitation In Hypertrophic Cardiomyopathy, Nicholas J. Valle, Amin Yehya, Animesh Rathore, Erich L. Kiehl, Matthew R. Summers

Department of Medicine Faculty Publications

Background

Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary

We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction. Why Beyond the Guidelines Currently, there are no guidelines addressing the nonsurgical emergent management of acute TR.

Discussion

The TriClip system (Abbott) may have certain advantages when used in managing acute …

Comparison Of Isoflurane To Sevoflurane In A Pediatric Patient With Refractory Status Asthmaticus: A Case Report, Janella Rianna N. Benitez Mba, Pharmd, Norm Fenn Bcps, Bcpps, Fashp

Parkview Pharmacy Department

Presented at Midyear Clinical Meeting.

Objective: To describe the use of inhaled anesthetics in a pediatric patient with severe, refractory status asthmaticus unresponsive to conventional therapies.

Switching To Tumescent Dissection In Mastectomy, Emna Bakillah, Ari Brooks, Seye Adekeye

Department of Surgery Faculty Papers

Introduction: Tumescent dissection (TUM) combines the use of crystalloid, local anesthetic, and epinephrine to create a bloodless plane to raise skin flaps. We aim to compare outcomes of TUM versus standard electrocautery dissection in mastectomies with and without reconstruction. Methods: We conducted a retrospective cohort study of patients who underwent mastectomy by a single surgeon between January 2016 and October 2020 utilizing the electronic medical record. The primary outcome was complication rate, and the secondary outcome was operative time. Chi-squared analysis and two-sample t-tests were used to examine outcomes. Results: Among 242 patients, 141 patients underwent TUM and 101 …

A Method For Ultrasound Servo Tracking For Puncture Needle, Shitong Ye, Bo Yang, Hao Quan, Shan Liu, Minyu Tang, Jiawei Tian

Electrical & Computer Engineering Faculty Publications

Computer-aided surgical navigation technology helps and guides doctors to complete the operation smoothly, which simulates the whole surgical environment with computer technology, and then visualizes the whole operation link in three dimensions. At present, common image-guided surgical techniques such as computed tomography (CT) and X-ray imaging (X-ray) will cause radiation damage to the human body during the imaging process. To address this, we propose a novel Extended Kalman filter-based model that tracks the puncture needle-point using an ultrasound probe. To address the limitations of Kalman filtering methods based on position and velocity, our method of Kalman filtering uses the position …

Independent Component Analysis Of Resting-State Fmri Identifies Regions Associated With Seizure Freedom After Laser Interstitial Thermal Therapy For Temporal Lobe Epilepsy, Mahdi Alizadeh, J. Miao, Caio Matias, Kevin J. Hines, Christopher T T. Skidmore, Michael R. Sperling, Joseph I Tracy, Ashwini Sharan, Chengyuan Wu

Department of Neurosurgery Faculty Papers

OBJECTIVE: Temporal lobe epilepsy (TLE) is a common form of drug-resistant epilepsy often treated with surgical interventions, including laser interstitial thermal therapy (LITT). However, patient-specific factors influencing LITT outcomes remain unclear. This retrospective study aimed to identify pre-operative resting-state functional MRI (rs-fMRI) patterns associated with seizure freedom following LITT in mesial TLE.

METHODS: We analyzed rs-fMRI data from 28 patients with mesial TLE who underwent LITT, classifying them into seizure-free (SF) and not seizure-free (NSF) groups based on 12-month post-operative outcomes. Independent component analysis (ICA) was used to identify subject-specific brain networks, and generalized linear models (GLM) were employed to …

Comparison Of Baumgaertner Reduction Quality Criteria , Chang Criteria And Ap3×Ml3 Classification And Their Ability To Predict Mechanical Complications Of Trochanteric Fractures Fixed With Proximal Femoral Nail, Amr Elhadidy Elhadidy, Ahmed Abdelbadie Ibrahim, Sallam Ibrahim Fawzy, Ehab Youssef Hassanin

Mansoura Medical Journal

Background Trochanteric fractures are common injuries among the elderly. Despite advances in fixation with proximal femoral nails (PFN), Mechanical complication remain significant. Several reduction quality systems have been proposed, but their predictive value and reproducibility remain debated. Aim To evaluate and compare the predictive value and reproducibility of Baumgaertner Reduction Quality Criteria (BRQC), Chang Reduction Quality Criteria (CRQC), and AP3×ML3 classification in patients with AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A1 and 31-A2 trochanteric fractures fixed with PFN. Methods A prospective observational study was conducted on 146 patients with 31-A1 and A2 trochanteric fractures treated by PFN. Postoperative radiographs were assessed …

The Impact Of State-Mandated Certification Of Surgical Technologists On Surgical Site Infection Rates: Evaluating Policy, Practice, And Patient Outcomes, Katherine E. Geiger

Graduate Student Theses, Dissertations, & Professional Papers

Abstract

Chairperson: Matthew Schertz, Ph.D.

Committee Member: Morgen J Alwell, Ph.D.

Committee Member: Jill Davis, M.Ed.

As a surgical technology instructor, I have witnessed firsthand the impact that certified surgical technologists (CSTs) have on patient safety, particularly in the prevention of surgical site infections (SSIs). This professional paper investigates the relationship between state-mandated certification of surgical technologists and SSI rates, with a focus on how standardized education and credentialing influence clinical outcomes. SSIs remain a significant concern in surgical environments, contributing to increased morbidity, longer hospital stays, and greater healthcare costs. The research presented here examines certification requirements across various …

Successful Treatment Of An Atypical Presentation Of Disseminated Retroperitoneal Seminoma: A Case Report, Mahmoud Abd-El-Hafez, Kylie Johnson, Joe Cates, Alosh Madala

HCA Healthcare Journal of Medicine

Background

Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.

Case Presentation

We present the unusual case of a 56-year-old male who had …

Endovascular Repair Of A Superior Mesenteric Arteriovenous Fistula And Pseudoaneurysm After A Single Gunshot Wound To The Abdomen, Robert Ringersen Iii, Michael Shockley, Sanjiv Gray, Tracy Bilski, Julio Calderin, Philip Kondylis

HCA Healthcare Journal of Medicine

Background

Traumatic arteriovenous fistulas (AVFs) are rare entities, especially when referring to visceral arterioportal AVFs. Currently, there are no large epidemiological studies looking specifically at traumatic visceral AVFs. When traumatic AVFs have been discussed in the literature, it is in the form of case reports or case series and focused on peripheral AVFs. The following case is a presentation of a traumatic arterioportal AVF and its management with an endovascular approach.

Case Presentation

A 16-year-old adolescent boy presented tachycardic and hypotensive with a single gunshot wound in his left abdomen. Multiple operations were required. His intensive care unit course was …

Assessment Of The European Hernia Society Classification Of Ventral Hernias And Clinical Outcomes, Oluwatunmininu A. Anwoju, Ashtyn Barrientes, Connor Hogan, Erik Askenasy, Jacob Greenberg, Keith Jerrod, Scott J. Roth, Zuhair Ali, Mike K. Liang

HCA Healthcare Journal of Medicine

Background

Ventral hernias are a common but heterogeneous disease. Communication among key stakeholders (eg, patients, clinicians, administrators, payers, and researchers) can be augmented by a widely utilized classification system. The European Hernia Society (EHS) developed an expert-opinion-based hernia classification system organized by hernia type (primary versus incisional) and size. We sought to assess what components of the EHS ventral hernia classification system were correlated to real-world clinical outcomes.

Methods

This was a multicenter cohort study. All hospitals contributing to the database were affiliated with 1 of 6 academic institutions. All adult patients who underwent ventral hernia repair over a 4-year …

Navigating Wound Closure Strategies: Primary Closure Vs. Delayed Primary Closure In Digestive Surgery—A Systematic Review And Meta-Analysis On Surgical Site Infections, Lam Sihardo, Arnetta Nl Lalisang, Afid B. Putra, Bagus A. Suryawiditya

The New Ropanasuri Journal of Surgery

Introduction. Surgical site infection (SSI) is a significant concern following digestive surgery, with varying incidence rates based on wound contamination levels. The choice between Primary Closure (PC) and Delayed Primary Closure (DPC) impacts SSI occurrence, making it essential to evaluate their comparative effectiveness. DPC is hypothesized superior to PC to prevent SSI or wound infection after a contaminated abdominal surgery.

Methods. This systematic review study was carried out through PubMed, Scopus, and Cochrane (CENTRAL). Quality was assessed using Risk of Bias (ROB-2) tool. All results were summarized, and quantitative analysis was performed using a random-effect model. This study …