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Redett RJ, Etra JW, Brandacher G, Burnett AL, Tuffaha SH, Sacks JM, Shores JT, Bivalacqua TJ, Bonawitz S, Cooney CM, Coon D, Pustavoitau A, Rizkalla NA, Jackson AM, Javia V, Fidder SAJ, Davis-Sproul J, Brennan DC, Sander IB, Shoham S, Sopko NA, Lee WPA, Cooney DS. Total Penis, Scrotum, and Lower Abdominal Wall Transplantation. N Engl J Med 2019; 381:1876-1878. [PMID: 31693813 DOI: 10.1056/nejmc1907956] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wong AL, Walia GS, Bello R, Aquino CS, Sacks JM. Pressure ulcer prevalence and perceptions on prevention: a hospital-wide survey of health professionals. J Wound Care 2019; 27:S29-S35. [PMID: 29641343 DOI: 10.12968/jowc.2018.27.sup4.s29] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hospital-acquired pressure ulcers (HAPUs) remain a problem despite numerous prevention initiatives. To understand why, it is necessary to know health professionals' perceptions regarding the importance of prevention, and the usability of current initiatives. We hypothesised that positive perceptions of existing initiatives would not be correlated with low HAPU prevalence, and that health professionals would perceive the initiatives to have a low usability. METHOD A two-part, online survey was developed and distributed electronically to nurses, in-training physicians and attending physicians, across all inpatient and perioperative departments of an academic hospital. Part one of the survey was the Agency for Healthcare Research and Quality (AHRQ) Staff Attitude Scale on beliefs regarding PU prevention; part two was additional questions on the usability of existing preventative initiatives. The results of the survey were compared with quarterly HAPU prevalence data by hospital unit. RESULTS In total, 839 health professionals completed the survey (579 nurses, 131 residents, 119 attending physicians). The mean score for the AHRQ survey was 42.5 (≥40 denoting positive perceptions). There was a moderate correlation between AHRQ scores and prevalence of HAPUs (r=-0.60, p=0.402). For usability, repositioning was felt to be the most effective intervention (mean: 4.54, standard deviation (SD): 0.64), while educational posters were felt to be the least effective (mean: 3.31, SD: 0.99). Respondents generally rated satisfaction much lower, with no single initiative significantly better than the others (range: 3.21-3.79). Perceived effectiveness and satisfaction were all positively correlated. CONCLUSION High HAPU prevalence, despite position perceptions, suggests that prevention methods are not as effective as thought, or they are not being used as widely as they should. Further research should take advantage of positive attitudes by prospectively investigating the usability of novel interventions.
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Byrd AS, Carmona-Rivera C, O’Neil LJ, Carlucci PM, Cisar C, Rosenberg AZ, Kerns ML, Caffrey JA, Milner SM, Sacks JM, Aliu O, Broderick KP, Reichner JS, Miller LS, Kang S, Robinson WH, Okoye GA, Kaplan MJ. Neutrophil extracellular traps, B cells, and type I interferons contribute to immune dysregulation in hidradenitis suppurativa. Sci Transl Med 2019; 11:11/508/eaav5908. [DOI: 10.1126/scitranslmed.aav5908] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/20/2019] [Accepted: 07/26/2019] [Indexed: 12/16/2022]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is an incapacitating skin disorder of unknown etiology manifested as abscess-like nodules and boils resulting in fistulas and tissue scarring as it progresses. Given that neutrophils are the predominant leukocyte infiltrate in HS lesions, the role of neutrophil extracellular traps (NETs) in the induction of local and systemic immune dysregulation in this disease was examined. Immunofluorescence microscopy was performed in HS lesions and detected the prominent presence of NETs. NET complexes correlated with disease severity, as measured by Hurley staging. Neutrophils from the peripheral blood of patients with HS peripheral also displayed enhanced spontaneous NET formation when compared to healthy control neutrophils. Sera from patients recognized antigens present in NETs and harbored increased antibodies reactive to citrullinated peptides. B cell dysregulation, as evidenced by elevated plasma cells and IgG, was observed in the circulation and skin from patients with HS. Peptidylarginine deiminases (PADs) 1 to 4, enzymes involved in citrullination, were differentially expressed in HS skin, when compared to controls, in association with enhanced tissue citrullination. NETs in HS skin coexisted with plasmacytoid dendritic cells, in association with a type I interferon (IFN) gene signature. Enhanced NET formation and immune responses to neutrophil and NET-related antigens may promote immune dysregulation and contribute to inflammation. This, along with evidence of up-regulation of the type I IFN pathway in HS skin, suggests that the innate immune system may play important pathogenic roles in this disease.
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Byrd AS, Dina Y, Okoh UJ, Quartey QQ, Carmona-Rivera C, Williams DW, Kerns ML, Miller RJ, Petukhova L, Naik HB, Barnes LA, Shipman WD, Caffrey JA, Sacks JM, Milner SM, Aliu O, Broderick KP, Kim D, Liu H, Dillen CA, Ahn R, Frew JW, Kaplan MJ, Kang S, Garza LA, Miller LS, Alavi A, Lowes MA, Okoye GA. Specimen Collection for Translational Studies in Hidradenitis Suppurativa. Sci Rep 2019; 9:12207. [PMID: 31434914 PMCID: PMC6704132 DOI: 10.1038/s41598-019-48226-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/22/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by painful nodules, sinus tracts, and scars occurring predominantly in intertriginous regions. The prevalence of HS is currently 0.053-4%, with a predominance in African-American women and has been linked to low socioeconomic status. The majority of the reported literature is retrospective, population based, epidemiologic studies. In this regard, there is a need to establish a repository of biospecimens, which represent appropriate gender and racial demographics amongst HS patients. These efforts will diminish knowledge gaps in understanding the disease pathophysiology. Hence, we sought to outline a step-by-step protocol detailing how we established our HS biobank to facilitate the formation of other HS tissue banks. Equipping researchers with carefully detailed processes for collection of HS specimens would accelerate the accumulation of well-organized human biological material. Over time, the scientific community will have access to a broad range of HS tissue biospecimens, ultimately leading to more rigorous basic and translational research. Moreover, an improved understanding of the pathophysiology is necessary for the discovery of novel therapies for this debilitating disease. We aim to provide high impact translational research methodology for cutaneous biology research and foster multidisciplinary collaboration and advancement of our understanding of cutaneous diseases.
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Kraenzlin FS, Saunders H, Aliu O, Cooney D, Rosson GD, Sacks JM, Broderick K, Manahan MA. Classification of breast tissue expander infections: Back to the basics. J Surg Oncol 2019; 120:142-147. [PMID: 31102461 DOI: 10.1002/jso.25500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infections following tissue expander (TE) placement are frequent complications in breast reconstruction. While breast surgery is a clean case, implant-based breast reconstruction has rates of infection up to 31%, decidedly higher than the typical 1% to 2% rate of surgical site infections (SSI). Few authors use the Center for Disease Control's (CDC) SSI definition for TE infections. We highlight how adoption of a consistent definition of TE infection may change how infections are researched, categorized, and ultimately managed. METHODS Two researchers with definitional discrepancies of infection performed an independent analysis of all postmastectomy patients receiving TEs (n = 175) in 2017. RESULTS Researcher One, using a clinical definition, delineated an infection rate of 19.4%. Antibiotics alone successfully treated 50% of cases. Researcher Two found an infection rate of 13.7% using CDC criteria. These infections were further delineated by a SSI rate of 6.3% and a TE infection rate post port access of 7.4%. Only 45.5% SSI's and 15.4% of TE infections were salvaged with antibiotics alone. CONCLUSIONS Rigorous adoption of CDC criteria for infection characterization in published research will help standardize the definition of infection and allow surgeons to create evidence-based infection prevention regimens.
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Lopez CD, Kraenzlin F, Frost C, Darrach H, Aravind P, Sacks JM. Latissimus Denervation: A Review of Evidence. J Reconstr Microsurg 2019; 35:609-615. [DOI: 10.1055/s-0039-1688748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Background Breast reconstruction is becoming an increasingly important and accessible component of breast cancer care. Among the many reconstructive options available, the latissimus dorsi flap has experienced a renewal in popularity because of its favorable properties and outcomes when used for breast reconstruction. However, a limitation unique to latissimus-based reconstruction is inappropriate breast animation postoperatively, due to persistent thoracodorsal innervation of the latissimus dorsi muscle after transfer to the mastectomy site.
Methods A comprehensive literature search of PubMed and MEDLINE was conducted for studies investigating the role of thoracodorsal denervation in latissimus-based breast reconstruction. Data on surgical techniques, type of intervention, objective outcome measurements, and patient satisfaction-based outcomes were reported. Additional data included patient sample size, follow-up length, and treatment of thoracodorsal nerve (e.g., resection versus transection and length of transection) when applicable.
Results Sixty-six search results were reviewed for inclusion and nine qualified after exclusion criteria for a total of 361 patients undergoing either unilateral or bilateral latissimus flap reconstruction. Successful thoracodorsal denervation rates were included in most studies and outcomes measurements were heterogeneous. Eight out of nine studies included patient-reported symptoms of breast animation postoperatively. Based on these findings, a systematic approach is presented.
Conclusion We present this review to elucidate successful practices, identify current gaps in knowledge, and offer a systematic approach to this clinical challenge.
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Carl HM, Calotta NA, Siotos C, Bos TJ, Foster DG, Manahan MA, Cooney CM, Sacks JM, Rosson GD. Reconstruction options and outcomes for breast sarcoma patients. Breast J 2019; 25:702-705. [PMID: 31025484 DOI: 10.1111/tbj.13243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 05/24/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
Breast sarcomas constitute a rare and heterogeneous group of tumors. Given their aggressive nature and the potential for extensive resections, rates of reconstruction have been low. We retrospectively reviewed subjects derived from our institutional registry presented between 2003 and 2015. Thirty-four patients with primary breast sarcoma were identified. The average age was 51.9 years and the average follow-up was 58 months. The most common histological type was malignant phyllodes (61.8%). Two patients suffered cancer recurrence. Twelve patients (35.3%) underwent reconstruction. Four underwent implant-based reconstruction, seven had autologous-based reconstruction, and one had combined reconstruction. Major complications were one flap loss and one implant removal. Our relatively high rates of breast reconstruction suggest a newly increased willingness to offer reconstruction to this rarer patient population.
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Khavanin N, Qiu C, Darrach H, Kraenzlin F, Kokosis G, Han T, Sacks JM. Intraoperative Perfusion Assessment in Mastectomy Skin Flaps: How Close are We to Preventing Complications? J Reconstr Microsurg 2019; 35:471-478. [DOI: 10.1055/s-0039-1679958] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Abstract
Background Mastectomy flap necrosis is the source of considerable morbidity and cost following breast reconstruction. A great deal of effort has been put forth to predicting and even preventing its incidence intraoperatively.
Methods A review of the literature was performed evaluating the evidence of mastectomy skin flap perfusion technologies.
Results Multiple technologies have leveraged spectroscopy and/or angiography to provide real-time assessment of flap perfusion, including indocyanine green, fluorescein, and light-based devices.
Conclusion This manuscript endeavors to review the evidence on mastectomy skin flap perfusion analysis, highlighting the benefits, and downsides of the current technologies and identifying exciting areas of future research and development.
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Darrach H, Kokosis G, Bridgham K, Stone JP, Lange JR, Sacks JM. Comparison of keystone flaps and skin grafts for oncologic reconstruction: A retrospective review. J Surg Oncol 2019; 119:843-849. [DOI: 10.1002/jso.25394] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/29/2018] [Accepted: 01/21/2019] [Indexed: 11/11/2022]
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Darrach H, Kraenzlin F, Khavanin N, Chopra K, Sacks JM. The role of fat grafting in prepectoral breast reconstruction. Gland Surg 2019; 8:61-66. [PMID: 30842929 DOI: 10.21037/gs.2018.10.09] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prepectoral breast reconstruction has reemerged as a promising alternative to submuscular implants, as they place the patient at lower risk for pain, muscular impairment, and animation deformity. However, the thinner amount of overlying tissue in prepectoral reconstruction presents its own unique set of challenges. A "rippling" deformity is seen in some prepectoral patients, which is typically corrected with fat grafting. This report details our recommended technique for fat grafting in the prepectorally implanted patient.
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Bridgham KM, El Abiad JM, Lu ZA, Bhat D, Darrach H, Morris CD, Levin AS, Sacks JM. Reconstructive limb‐salvage surgery after lower extremity soft tissue sarcoma resection: A 20‐year experience. J Surg Oncol 2019; 119:708-716. [DOI: 10.1002/jso.25358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/16/2018] [Indexed: 11/08/2022]
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Henn D, Abu-Halima M, Wermke D, Falkner F, Thomas B, Köpple C, Ludwig N, Schulte M, Brockmann MA, Kim YJ, Sacks JM, Kneser U, Keller A, Meese E, Schmidt VJ. MicroRNA-regulated pathways of flow-stimulated angiogenesis and vascular remodeling in vivo. J Transl Med 2019; 17:22. [PMID: 30635008 PMCID: PMC6330440 DOI: 10.1186/s12967-019-1767-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vascular shear stress promotes endothelial cell sprouting in vitro. The impact of hemodynamic forces on microRNA (miRNA) and gene expression within growing vascular networks in vivo, however, remain poorly investigated. Arteriovenous (AV) shunts are an established model for induction of neoangiogenesis in vivo and can serve as a tool for analysis of hemodynamic effects on miRNA and gene expression profiles over time. METHODS AV shunts were microsurgically created in rats and explanted on postoperative days 5, 10 and 15. Neoangiogenesis was confirmed by histologic analysis and micro-computed tomography. MiRNA and gene expression profiles were determined in tissue specimens from AV shunts by microarray analysis and quantitative real-time polymerase chain reaction and compared with sham-operated veins by bioinformatics analysis. Changes in protein expression within AV shunt endothelial cells were determined by immunohistochemistry. RESULTS Samples from AV shunts exhibited a strong overexpression of proangiogenic cytokines, oxygenation-associated genes (HIF1A, HMOX1), and angiopoetic growth factors. Significant inverse correlations of the expressions of miR-223-3p, miR-130b-3p, miR-19b-3p, miR-449a-5p, and miR-511-3p which were up-regulated in AV shunts, and miR-27b-3p, miR-10b-5p, let-7b-5p, and let-7c-5p, which were down-regulated in AV shunts, with their predicted interacting targets C-X-C chemokine receptor 2 (CXCR2), interleukin-1 alpha (IL1A), ephrin receptor kinase 2 (EPHA2), synaptojanin-2 binding protein (SYNJ2BP), forkhead box C1 (FOXC1) were present. CXCL2 and IL1A overexpression in AV shunt endothelium was confirmed at the protein level by immunohistochemistry. CONCLUSIONS Our data indicate that flow-stimulated angiogenesis is determined by an upregulation of cytokines, oxygenation associated genes and miRNA-dependent regulation of FOXC1, EPHA2 and SYNJ2BP.
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Smith JM, Broyles JM, Guo Y, Tuffaha SH, Mathes D, Sacks JM. Human acellular dermis increases surgical site infection and overall complication profile when compared with submuscular breast reconstruction: An updated meta-analysis incorporating new products✰. J Plast Reconstr Aesthet Surg 2018; 71:1547-1556. [DOI: 10.1016/j.bjps.2018.06.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 05/31/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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Calotta NA, Coon D, Bos TJ, Ostrander BT, Scott AV, Grant MC, Efron JE, Sacks JM. Early ambulation after colorectal oncologic resection with perineal reconstruction is safe and effective. Am J Surg 2018; 218:125-130. [PMID: 30471809 DOI: 10.1016/j.amjsurg.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/18/2018] [Accepted: 10/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-operative bedrest is common following perineal reconstruction despite little supporting data. We sought to determine the safety of early ambulation following colorectal oncologic resection and flap-based perineal reconstruction. METHODS A retrospective cohort study was conducted with two cohorts: standard bedrest (BC) and early ambulation (EAC). Ambulation capacity was objectively assessed. Regression analysis was performed to determine the effects of ambulation timing on 60-day reoperations or readmissions and other surgical outcomes. RESULTS There were 57 participants. Those in the EAC were significantly more ambulatory on post-operative days one through three (p < 0.0001). There was no significant difference in 60-day reoperations (25% BC versus 9% EAC, p = 0.14) or readmissions (33% BC versus 15% EAC, p = 0.12). Early ambulation significantly reduced minor complication rates (38% BC versus 9% EAC, p = 0.02). CONCLUSIONS Early ambulation following perineal reconstruction is safe and may potentially decrease wound complications. SUMMARY AND KEYWORDS Institution of early ambulation protocols is rapidly becoming the standard of care for many oncological surgery patients. In cases requiring perineal reconstruction with vascularized flaps, however, there is no data to uproot the historical practice of mandatory bedrest. Our study demonstrates that the benefits of early ambulation are attainable in these patients without compromising reconstructive outcomes.
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Musavi L, Sarmiento S, Sacks JM, Aliu O. Impact of Insurance, Hospital Type, and Sociodemographic Factors on Breast Reconstruction Rates: A Look at National Trends. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bridgham K, El Abiad JM, Lu ZA, Bhat D, Morris CD, Levin AS, Sacks JM. Outcomes of Lower Extremity Soft-Tissue Sarcoma Reconstruction: A 20-Year Experience. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bhat D, Kachniarz B, Seu M, Li X, Martin R, Cho B, Reddy S, Sacks JM, Mao HQ. Novel Nanofiber-Hydrogel Composite to Improve Fat Grafting Outcomes. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Iyer RR, Elder BD, Garzon-Muvdi T, Sacks JM, Suk I, Wolinsky JP. Use of an Articulating Hinge to Facilitate Cervicothoracic Deformity Correction During Vertebral Column Resection. Oper Neurosurg (Hagerstown) 2018; 15:278-284. [PMID: 29165712 DOI: 10.1093/ons/opx221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/31/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical treatment of severe cervicothoracic kyphotic deformity may require the use of 3-column osteotomies such as the pedicle subtraction osteotomy and vertebral column resection (VCR), or VCR with anterior longitudinal ligament resection. Such procedures are extensive and are associated with high intra- and perioperative morbidity, in part, due to the need for risky reduction maneuvers. OBJECTIVE To describe a novel technique utilizing a laterally placed articulating hinge to facilitate kyphotic deformity correction of the cervicothoracic spine. METHODS A patient with severe chin-on-chest deformity of the cervicothoracic spine presented for evaluation and a 2-stage VCR with anterior longitudinal ligament resection was planned. To reduce the risk of intraoperative neurological injury and for increased control during reduction maneuvers, lateral instrumentation was placed through the chest wall resection above and below the level of VCR, which was adjoined with an articulating hinge rod apparatus. RESULTS Satisfactory reduction of the kyphosis was achieved utilizing the hinge rod apparatus for controlled deformity correction. The patient remained neurologically intact following this procedure with improvement in their spinal alignment. CONCLUSION We present a novel technique utilizing a lateral hinge rod apparatus for efficient, controlled correction of severe kyphotic deformity.
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Byrd AS, Kerns ML, Williams DW, Zarif JC, Rosenberg AZ, Delsante M, Liu H, Dillen CA, Maynard JP, Caffrey JA, Sacks JM, Milner SM, Aliu O, Broderick KP, Lew LS, Miller LS, Kang S, Okoye GA. Collagen deposition in chronic hidradenitis suppurativa: potential role for CD163 + macrophages. Br J Dermatol 2018; 179:792-794. [PMID: 29603182 DOI: 10.1111/bjd.16600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carl HM, Ahmed AK, Abu-Bonsrah N, De la Garza Ramos R, Sankey EW, Pennington Z, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sacks JM, Goodwin CR, Sciubba DM. Risk factors for wound-related reoperations in patients with metastatic spine tumor. J Neurosurg Spine 2018; 28:663-668. [DOI: 10.3171/2017.10.spine1765] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.
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Seu MY, Haley A, Cho BH, Carl HM, Bos TJ, Hassanein AH, Wong AL, Morris CD, Sacks JM. Proximal femur reconstruction using a vascularized fibular epiphysis within a cadaveric femoral allograft in a child with Ewing sarcoma: a case report. ACTA ACUST UNITED AC 2017. [DOI: 10.20517/2347-9264.2017.47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hassanein AH, Bello RJ, Sacks JM, Manahan MA, Cooney CM, Rosson GD. Patient-Reported Outcomes for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction in the Severely Obese. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cho B, Li X, Reddy S, Martin R, Seu M, Walia G, Mao HQ, Sacks JM. Composite-Mediated Angiogenesis and Stem Cell Transplantation for Soft Tissue Regeneration. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hassanein AH, Sacks JM, Cooney DS. Optimizing perioperative lymphatic-venous anastomosis localization using transcutaneous vein illumination, isosulfan blue, and indocyanine green lymphangiography. Microsurgery 2017; 37:956-957. [PMID: 28858393 DOI: 10.1002/micr.30222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/10/2017] [Accepted: 08/18/2017] [Indexed: 11/07/2022]
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Leeds IL, Taylor JP, Pozo M, Safar B, Sacks JM, Fang SH. Gracilis Flap for Perineal Closures in Minimally Invasive Abdominoperineal Resection. Am Surg 2017. [DOI: 10.1177/000313481708300606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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