Surgery Commons^™

Left Atrial Venoarterial Extracorporeal Membrane Oxygenation Strategy In Postcardiotomy Cardiogenic Shock: A Case Series, Daniel Manzur-Sandoval Md, Gian Manuel Jiménez-Rodríguez Md, José Luis Elizalde-Silva Md, Meredith Fernanda Sánchez-Torres Md, Uriel Encarnación-Martínez Md, Cristhian Josué Gaytán-García Md, José Octavio Salazar-Delgado Md, Guadalupe Lisseth Hernández-González Md, Gustavo Rojas-Velasco Md

The VAD Journal

Postcardiotomy cardiogenic shock is a rare complication with high mortality. When patients do not respond to the placement of an intra-aortic balloon pump or pharmacological treatment, therapy with peripheral venoarterial extracorporeal membrane is a viable option that allows active resuscitation. The adjunct use of Impella® (Abiomed, Danvers, MA, USA) allows active unloading of the dysfunctional left ventricle. However, left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) is an appealing and effective strategy in cases of aortic dissection, aortic valve replacement, or bioprosthesis of the aorta. Insertion of an extraction cannula that can discharge both atria or only the left atrium allows …

Changing Landscape Of Liver Transplant In The United States—Time For A New Innovative Way To Define And Utilize The “Non-Standard Liver Allograft”—A Proposal, Rashmi Seth, Kenneth Andreoni

Department of Surgery Faculty Papers

Since the first liver transplant was performed over six decades ago, the landscape of liver transplantation in the US has seen dramatic evolution. Numerous advancements in perioperative and operative techniques have resulted in major improvements in graft and patient survival rates. Despite the increase in transplants performed over the years, the waitlist mortality rate continues to remain high. The obesity epidemic and the resultant metabolic sequelae continue to result in more marginal donors and challenging recipients. In this review, we aim to highlight the changing characteristics of liver transplant recipients and liver allograft donors. We focus on issues relevant in …

High-Grade Liver Injuries With Contrast Extravasation Managed Initially With Interventional Radiology Versus Observation: A Secondary Analysis Of A Wta Multicenter Study, Negaar Aryan, Areg Grigorian, Erika Tay-Lasso, Michael Cripps, Heather Carmichael, Robert Mcintyre, Shane Urban, Catherine Velopulos, Clay Cothren Burlew, Shana Ballow, Rachel C. Dirks, Aimee Lariccia, Michael S. Farrell, Deborah M. Stein, Michael S. Truitt, Heather M. Grossman Verner, Caleb J. Mentzer, T. J. Mack, Chad G. Ball, Kaushik Mukherjee, Georgi Mladenov, Daniel J. Haase, Hossam Abdou, Thomas J. Schroeppel, Jennifer Rodriquez, Miklosh Bala, Natasha Keric, Morgan Crigger, Navpreet K. Dhillon, Eric J. Ley, Tanya Egodage, John Williamson, Tatiana Cp Cardenas, Vadine Eugene, Kumash Patel, Kristen Costello, Stephanie Bonne, Fatima S. Elgammal, Warren Dorlac, Claire Pederson, Nicole L. Werner, James M. Haan, Kelly Lightwine, Gregory Semon, Kristen Spoor, Laura A. Harmon, Jason M. Samuels, M. C. Spalding, Jeffry Nahmias

Department of Surgery Faculty Publications

Background: High-grade liver injuries with extravasation (HGLI + Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI + Extrav. Therefore, we evaluated the management of HGLI + Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. Methods: HGLI + Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. Results: From 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) …

In-Hospital Risk Factors For Reintervention And Amputation In Brachial Arterial Trauma, Aast Proovit Study Group, Justin M. Robbins, Corinna Crayton, Isaac Koloditch, Casey Walk, Limayre Gramajo, Samantha Shugar, Peter Ekeh, Joseph Dubose, Yee Wong, Cathline Layba

Department of Surgery Faculty Publications

Introduction: Brachial artery trauma is a rare but potentially devastating injury. There is little data regarding risk factors for reintervention and amputation prevention in this population, as well as anticoagulant (AC) and antiplatelet (AP) regimens and outcomes after discharge in trauma patients with vascular injuries requiring repair. This study aims to identify in-hospital risk factors for reintervention and amputation and stratify outcomes of follow-up by discharge AC or AP regimen. Methods: The AAST Prospective Observational Vascular Injury Trial database was queried for all patients who underwent traumatic brachial arterial repair from 2013 to 2022. Patients were evaluated by need for …

Advanced Visualization In Minimally Invasive Spine Surgery: The Ergonomics, Economics, And Evolution Of Camera-Based Tubes And Retractors, Advith Sarikonda, Ahilan Sivaganesan, Sheeraz Qureshi

SKMC Student Presentations and Publications

BACKGROUND: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

OBJECTIVE: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

METHODS: This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular …

Chronic Recurrent Shoulder Instability Treated With A Hemiarthroplasty, Glenojet Allograft Glenoid Reconstruction, And Anterior Capsular Reconstruction: A Case Report., Matthew Glazier, Morgan Turnow, Peter Spencer, Vishvam Metha, Hunter Pharis, Nathaniel Long, Stephen Wiseman

Surgery Articles

No abstract provided.

Technical Considerations In Robotic Aberrant Right Subclavian Artery Resection For Dysphagia Lusoria, Luke Meredith, Emily Isch, Mohammed Ali, Michael Nooromid, Olugbenga Okusanya

Department of Surgery Faculty Papers

Dysphagia lusoria occurs due to compression of the esophagus as an aberrant right subclavian artery (ARSA) crosses the mediastinum. Surgical management includes open, hybrid, and endovascular techniques, with no consensus gold standard. There are few reports of robotic-assisted ARSA resection. We describe the innovative technique and outcomes for two patients who successfully underwent robotic-assisted transthoracic resection of an ARSA after right carotid–subclavian bypass for dysphagia lusoria. Both patients experienced improvement or resolution of their dysphagia and no major complications. In select patients with a noncalcified origin of the ARSA without aneurysmal degeneration, the robotic-assisted approach represents a viable option.

Acute Changes In Inflammatory Biomarkers Expression Following Cosmetic Surgery With Use Of Compression Garment, Michael James Sanchez

Open Access Theses & Dissertations

BACKGROUND: Inflammation is an acute phase response to physiological conditions such as infection, tissue injury, and tissue stress and malfunction (Medzhitov, 2008). Inflammation caused by surgical trauma (tissue injury) elicits a myriad of responses by the patient that is experienced far past the operation. It is estimated that American individuals will undergo nine surgeries throughout an 85 year lifespan (Lee & Gawande, 2008). Focus on surgical recovery modalities has grown over the past few decades. The use of compression garments (CG+) following surgery has been shown to be successful in preventing deep vein thrombosis, pulmonary embolisms, as well as aiding …

Editorial Comment: Diversity And Disparities In Orthopaedic Surgery: Update 2024, Kimberly J Templeton, Melvyn A Harrington

Faculty, Staff and Students Publications

No abstract provided.

Factors Associated With Failed Closed Reduction In Flexion And Gartland Type Iii Pediatric Supracondylar Humerus Fractures, Pablo Coello, Nathaniel Grey Loyd, David A Hsiou, Rachel S Silverstein, Scott B Rosenfeld

Faculty, Staff and Students Publications

Background: Most displaced supracondylar humerus fractures (SCHFs) are treated with closed reduction and percutaneous pinning. While there are only a few possible indications for converting to an open reduction, a failed closed reduction is a common cause. This study aims to elucidate possible risk factors for failed closed reductions of SCHF.

Methods: A retrospective review of SCHF from 2010 to 2020 at a pediatric tertiary medical center, which underwent operative fixation, was conducted. Exclusion criteria were open fractures and reasons for open reduction other than failed closed reduction. Rates of open reduction were assessed by preoperative fracture classification and assessed …

Risk Factors For Loss To Follow Up In Pediatric Supracondylar Humerus Fractures, Nathaniel Grey Loyd, David Hsiou, Armando Martinez, Pablo Coello, Lon Kai Pang, Muhammad Hamza Shamim, Jessica Mcgraw-Heinrich, Scott B Rosenfeld

Faculty, Staff and Students Publications

Background: This study seeks to analyze risk factors associated with loss to follow up (LTF) after pin pull in pediatric patients with operatively treated supracondylar humerus fractures (SCHF).

Methods: A retrospective cohort study of patients under 18 years with operative SCHF from 2010 to 2020 was conducted. Factors of interest included LTF, age, race, language, distance to the hospital, Gartland fracture type, and Social Deprivation Index (SDI) by ZIP code. Univariate logistic regression was performed for each independent variable and significant variables were additionally analyzed with multivariate logistic regression analysis.

Results: Six hundred ninety-eight patients were included in the study. …

Impact Of Frailty On Outcomes And Readmissions After Transcatheter And Surgical Aortic Valve Replacement In A National Cohort, Travis J Miles, Christopher T Ryan, Katie J Hogan, Bhavesh S Sayal, Christopher B Sylvester, Todd K Rosengart, Joseph S Coselli, Marc R Moon, Ravi K Ghanta, Subhasis Chatterjee

Faculty, Staff and Students Publications

OBJECTIVE: We examined the effect of frailty on in-hospital mortality, readmission rates, and hospitalization costs after transcatheter and surgical aortic valve replacement in a population-level cohort.

METHODS: The Nationwide Readmissions Database was queried for patients who underwent transcatheter or surgical aortic valve replacement during 2016-2018. Multivariate logistic regression was used to discern independent effects of frailty on outcomes. Kaplan-Meier time-to-event analysis was used to evaluate the effect of frailty on freedom from readmission.

RESULTS: A total of 243,619 patients underwent aortic valve replacement: 142,786 (58.6%) transcatheter aortic valve replacements and 100,833 (41.4%) surgical aortic valve replacements. Frail patients constituted 16,388 …

Assessing The State Of Obesity Care: Quality, Access, Guidelines, And Standards, Lee M Kaplan, Caroline M Apovian, Jamy D Ard, David B Allison, Louis J Aronne, Rachel L Batterham, Luca Busetto, Dror Dicker, Deborah B Horn, Aaron S Kelly, Jeffrey I Mechanick, Jonathan Q Purnell, Ximena Ramos-Salas, Assessing The State Of Obesity Care Writing Group

Faculty, Staff and Student Publications

BACKGROUND: An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence.

AIMS: The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity.

METHODS: The panel was held in Leesburg, Virginia in September 2019.

RESULTS: The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice …

Early Cold Stored Platelet Transfusion Following Severe Injury: A Randomized Clinical Trial, Jason L Sperry, Francis X Guyette, Bedda L Rosario-Rivera, Matthew E Kutcher, Lucy Z Kornblith, Bryan A Cotton, Chad T Wilson, Kenji Inaba, Eva V Zadorozny, Laura E Vincent, Ashley M Harner, Emily T Love, Joseph E Doherty, Joseph Cuschieri, Aaron E Kornblith, Erin E Fox, Yu Bai, Marcus K Hoffman, Catherine P Seger, Jay Hudgins, Sheila Mallett-Smith, Matthew D Neal, Christine M Leeper, Philip C Spinella, Mark H Yazer, Stephen R Wisniewski, Cold Stored Platelet For Hemorrhagic Shock (Crisp-Hs) Study Group

Faculty, Staff and Student Publications

OBJECTIVE: To determine the feasibility, efficacy, and safety of early cold stored platelet transfusion compared with standard care resuscitation in patients with hemorrhagic shock.

BACKGROUND: Data demonstrating the safety and efficacy of early cold stored platelet transfusion are lacking following severe injury.

METHODS: A phase 2, multicenter, randomized, open label, clinical trial was performed at 5 US trauma centers. Injured patients at risk of large volume blood transfusion and the need for hemorrhage control procedures were enrolled and randomized. The intervention was the early transfusion of a single apheresis cold stored platelet unit, stored for up to 14 days versus …

Where Do Plastic Surgery Leaders Come From? A Cross-Sectional Analysis Of Research Productivity, Megan M Rodriguez, Kylie R Swiekatowski, Robert C Tung, Matthew R Greives, David W Mathes, Phuong D Nguyen

Faculty, Staff and Student Publications

Background: It is increasingly apparent that plastic surgery residency applications with lengthy research publications are the new standard in applicant competitiveness. This study aims to evaluate the research history of plastic surgery program faculty leadership to understand the trends and evolution of research expectations.

Methods: The curriculum vitaes of faculty involved in residency admissions among all US Accreditation Council for Graduate Medical Education-accredited integrated and independent plastic surgery programs were reviewed. Doximity, program websites, and Scopus were used to gather information. H-index and publication count at the time of medical school and residency graduations were collected. Student t test and …

Geospatial Demand For Approved Cleft Care In The United States, Matthew J Parham, Austin D Williams, Sarah A Layon, Heather R Burns, Amjed Abu-Ghname, Larry H Hollier

Faculty, Staff and Students Publications

BACKGROUND: Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association-approved cleft teams.

METHODS: Natality data were queried from the National Vital Statistics System. Population and geographic data were obtained from the US Census Bureau. The Social Vulnerability Index (SVI) was utilized to account for social inequality. Total …

Can Anorectal Stenosis Be Managed With Dilations Alone? A Pcplc Review., Zoe M. Saenz, Kelly Austin, Jeffrey R. Avansino, Andrea Badillo, Casey M. Calkins, Megan M. Durham, Megan K. Fuller, Ankur Rana, Ron W. Reeder, Rebecca M. Rentea, Michael D. Rollins, K Elizabeth Speck, Richard J. Wood, Jamie C. Harris, Jamie Anderson, Maheen Hassan, Payam Saadai, Pediatric Colorectal And Pelvic Learning Consortium (Pcplc)

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Congenital anorectal stenosis is managed by dilations or operative repair. Recent studies now propose use of dilations as the primary treatment modality to potentially defer or eliminate the need for surgical repair. We aim to characterize the management and outcomes of these patients via a multi-institutional review using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry.

METHODS: A retrospective database review was performed using the PCPLC registry. The patients were evaluated for demographics, co-morbidities, diagnostic work-up, surgical intervention, current bowel management, and complications.

RESULTS: 64 patients with anal or rectal stenosis were identified (57 anal, 7 rectal) from …

Staged Endovascular And Open Surgical Approach For Treatment Of A Giant Left Upper Back Arteriovenous Malformation, Nitya Venkat, Avinash Saraiya, M. Irfan Ali, Matthew Jenkins, Stavropoula Tjoumakaris, Babak Abai

Department of Surgery Faculty Papers

We present a case of a symptomatic, giant, left upper back arteriovenous malformation that was treated through a staged endovascular and open approach. Through a series of embolizations, followed by resection, we were able to preserve the limb and upper back neurovascular supply, demonstrating an approach to preserve sensation and function and improving quality of life.

Use Of Pancreatic Endotherapy In Patients With Chronic Pancreatitis: Results From A Multicenter Cohort Study In The United States, Samuel Han, Darwin L Conwell, Jeffrey J Easler, Yunlong Yang, Dana K Andersen, William E Fisher, Evan L Fogel, Chris Forsmark, Phil A Hart, Steven J Hughes, Liang Li, Stephen J Pandol, Walter G Park, Jose Serrano, Stephen K Van Den Eeden, Santhi Swaroop Vege, Dhiraj Yadav, Consortium For The Study Of Chronic Pancreatitis, Diabetes, And Pancreatic Cancer

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Although pancreatic endotherapy (PET) is commonly used for treating adverse events of chronic pancreatitis, data on the frequency and factors associated with the use of PET are limited. Our aim was to define the use of and factors predictive for receiving PET in a well-characterized chronic pancreatitis cohort.

METHODS: This is a cross-sectional analysis of data from PROCEED, a multicenter U.S. cohort study of chronic pancreatitis. PET modalities primarily consisted of ERCP. A treatment course was defined as the number of sessions performed for a specific indication. A repeat course was defined as PET >1 year after …

The Effect Of Blood Flow Restriction Training On Quadriceps Activity After Anterior Cruciate Ligament Reconstruction: A Preliminary Randomized Controlled Trial, Florian Forelli, Camille Nguyen, Jean Mazeas, Georgios Kakavas, Timothy E. Hewett, Andreas Bjerregaard, Vasileios Korakakis, Alexandre Jm Rambaud

Marshall Journal of Medicine

Background

After anterior cruciate ligament reconstruction, a crucial priority is restoring knee muscle strength, especially the quadriceps, to reach the pre-injury strength levels as fast as possible. A feasible alternative to heavy loading might be blood flow restriction training that may elicit quadriceps muscle strength adaptations using low external loads. This study assessed whether quadriceps strengthening using low load blood flow restriction (LL-BFR) would enhance electromyographic (EMG) activity of the vastus medialis (VMO), vastus lateralis (VLO), and rectus femoris (RF) similar to quadriceps strengthening using heavy loads resistance training (HLRT). The secondary objective was to assess intra-quadriceps regional EMG differences …