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Wilson AC, Pisansky AJ, Tessier KM, Hui J, Choudry U, Lassig AAD. Use of SPY angiography in tissue assessment for wound healing outcomes after breast reconstruction. J Wound Care 2024; 33:S30-S41. [PMID: 38973640 DOI: 10.12968/jowc.2021.0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate whether a systematic image assessment protocol using SPY Elite images (LifeCell Corp., US) of viable tissue at the periphery of the surgical field was associated with positive wound healing outcomes following mastectomy and breast reconstruction. METHOD Patients undergoing mastectomy and subsequent breast reconstruction surgery at a single tertiary medical centre were included. SPY images were prospectively analysed using a systematic image assessment protocol, and an absolute value of mean fluorescence was calculated by measuring peripheral, in-situ tissue from each image. Patient medical records were retrospectively reviewed for demographics, surgical characteristics and postoperative outcomes. These variables were statistically tested for associations with mean fluorescence. RESULTS A total of 63 patients were included in the final analysis. We found that objectively determined mean fluorescence values were not statistically significantly associated with postoperative complications. CONCLUSION In this study, objectively measured mean fluorescence values representing breast tissue remaining after dissection showed little utility in the assessment of postoperative wound healing outcomes as they did not identify patients who would later have complications of wound healing. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Anna C Wilson
- Hennepin Healthcare Research Institute, Hennepin Healthcare/Hennepin County Medical Center, Department of Otolaryngology, Minneapolis, MN, US
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
| | - Andrew Jb Pisansky
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
- Vanderbilt University School of Medicine, Department of Anesthesiology, Divisions of Multispecialty Anesthesia/Pain Medicine, Nashville, TN, US
| | - Katelyn M Tessier
- University of Minnesota Masonic Cancer Center, Biostatistics Core, Minneapolis, MN, US
| | - Jane Hui
- University of Minnesota School of Medicine, Department of Surgery, Division of Surgical Oncology, Minneapolis, MN, US
| | - Umar Choudry
- University of Minnesota School of Medicine, Department of Surgery, Division of Plastic and Reconstructive Surgery, Minneapolis, MN, US
| | - Amy Anne D Lassig
- Hennepin Healthcare Research Institute, Hennepin Healthcare/Hennepin County Medical Center, Department of Otolaryngology, Minneapolis, MN, US
- University of Minnesota School of Medicine, Department of Otolaryngology - Head and Neck Surgery, Division of Head and Neck Surgery, Minneapolis, MN, US
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2
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Pumford AD, Staricha KL, Kunkel ET, Armstrong MF, Behfar A, Van Abel KM. Exosome Therapy for a Nonhealing Scalp Wound Following Chemoradiation and Surgical Therapy. Mayo Clin Proc 2024; 99:1006-1012. [PMID: 38839179 DOI: 10.1016/j.mayocp.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 06/07/2024]
Abstract
This case report describes the safety and utility of a noninvasive therapy, Purified Exosome Product (PEP), for poorly healing scalp wounds in the setting of prior chemoradiation and surgery. A man in his 60s with a history of high-grade angiosarcoma of the right temporoparietal scalp reconstruction had a 1-year history of 2 nonhealing scalp wounds after neoadjuvant chemotherapy followed by concurrent chemoradiation therapy, wide local excision, and latissimus dorsi free flap and split-thickness skin graft. The patient underwent débridement followed by 4 collagen (Bellafill)-PEP and 4 fibrin (Tisseel)-PEP applications during 7 months in 2022. Photographs of the area of exposed bone of the temporoparietal wound were measured and standardized by ImageJ open-source software. The frontal wound was not routinely measured and therefore was qualitatively assessed by reviewing photographs over time. The frontal wound completely healed, and the temporoparietal wound showed a 96% decrease in overall size. The patient had no adverse effects of treatment and continues to demonstrate ongoing healing. This case exhibits the safety and utility of topical PEP therapy for noninvasive treatment of poorly healing scalp wounds and offers the potential for an alternative treatment of patients who are poor candidates for additional surgical intervention.
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Affiliation(s)
| | - Kelly L Staricha
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN
| | - Elizabeth T Kunkel
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN
| | - Michael F Armstrong
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN.
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3
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Min S, Zhang G, Hu A, Petito GT, Tripathi SH, Shukla G, Kumar A, Shah S, Phillips KM, Forbes JA, Zuccarello M, Andaluz NO, Sedaghat AR. A Comprehensive Analysis of Tobacco Smoking History as a Risk for Outcomes after Endoscopic Transsphenoidal Resection of Pituitary Adenoma. J Neurol Surg B Skull Base 2024; 85:255-260. [PMID: 38778915 PMCID: PMC11111311 DOI: 10.1055/a-2043-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
Objectives This study seeks to comprehensively analyze the impact of smoking history on outcomes after endoscopic transsphenoidal hypophysectomy (TSH) for pituitary adenoma. Design This was a retrospective study. Setting This study was done at the tertiary care center. Participants Three hundred and ninety-eight adult patients undergoing TSH for a pituitary adenoma. Main Outcome Measures Clinical and tumor characteristics and operative factors were collected. Patients were categorized as never, former, or active smokers, and the pack-years of smoking history was collected. Years since cessation of smoking was obtained for former smokers. Specific outcomes included postoperative cerebrospinal fluid (CSF) leak, length of hospitalization, 30-day return to the operating room, and 30-day readmission. Smoking history details were comprehensively analyzed for association with outcomes. Results Any history of smoking tobacco was associated with return to the operating room (odds ratio [OR] = 2.67, 95% confidence interval [CI]: 1.05-6.76, p = 0.039), which was for persistent CSF leak in 58.3%. Among patients with postoperative CSF leak, any history of smoking was associated with need for return to the operating room to repair the CSF leak (OR = 5.25, 95% CI: 1.07-25.79, p = 0.041). Pack-years of smoking was positively associated with a return to the operating room (OR = 1.03, 95% CI: 1.01-1.06, p = 0.048). In all multivariable models, all negative outcomes were significantly associated with the covariate: occurrence of intraoperative CSF leak. Conclusion This is the first study to show smoking may have a negative impact on healing of CSF leak repairs after TSH, requiring a return to the operating room. This effect appears to be dose dependent on the smoking history. Secondarily, intraoperative CSF leak as covariate in multivariable models was significantly associated with all negative outcomes.
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Affiliation(s)
- Susie Min
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Grace Zhang
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Alex Hu
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Gabrielle T. Petito
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Siddhant H. Tripathi
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Geet Shukla
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Adithya Kumar
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Katie M. Phillips
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jonathan A. Forbes
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Norberto O. Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Ahmad R. Sedaghat
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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4
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Kypriotakis G, Kim S, Karam-Hage M, Robinson JD, Minnix JA, Blalock JA, Cui Y, Beneventi D, Kim B, Pan IW, Shih YCT, Cinciripini PM. Examining the Association between Abstinence from Smoking and Healthcare Costs among Patients with Cancer. Cancer Prev Res (Phila) 2024; 17:217-225. [PMID: 37940143 PMCID: PMC11097145 DOI: 10.1158/1940-6207.capr-23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Center's Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden. PREVENTION RELEVANCE This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.
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Affiliation(s)
- George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seokhun Kim
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janice A Blalock
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Beneventi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - I-Wen Pan
- Department of Health Services Research The University of Texas MD Anderson Cancer Center, Houston, Texas (All work on this manuscript was conducted prior to Dr. Pan’s departure from The University of Texas MD Anderson Cancer Center.)
| | - Ya-Chen Tina Shih
- Program in Cancer Health Economics Research, UCLA Jonsson Cancer Center and School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Liu T, Li F, Li Y, Li J, Chen L, Yang Z, Cao C. Epidemiological characteristics and factors influencing hospitalization burden among trauma patients: a retrospective analysis. Eur J Trauma Emerg Surg 2024; 50:425-437. [PMID: 37653128 DOI: 10.1007/s00068-023-02353-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE This investigation aimed to understand the epidemiological characteristics and hospitalization burden and its possible influencing factors of patients with different injury mechanisms. METHODS All trauma patients admitted via the emergency department at a trauma center from November 1, 2020, to April 30, 2022, were identified. The hospitalization burden, including the number of hospitalizations, deaths and in-hospital mortality, length of stay (LOS), and medical costs, was calculated. Univariate and multivariate logistic regression models were used to analyze the factors influencing the hospitalization burden of trauma. The receiver-operating characteristic (ROC) curves were drawn to evaluate the predictive value of the multivariate model. RESULTS 16 485 trauma patients with 16 552 hospitalizations were included, with an in-hospital mortality rate of 1.269‰, median LOS of 7 days, and median hospitalization costs of 54 725.28 CNY. The median age was 52 years. 62.54% were hospitalized due to falls. The upper and lower extremities were the most common injury regions. There are differences between the demographic, injury, and hospitalization characteristics and factors influencing hospitalization burden across injury mechanisms, but there were also common influencing factors. Injury region, surgery, transfusion, and ICU treatment are influential factors for prolonged LOS. Age, injury region, surgery, and transfusion were influential factors for high hospitalization costs. CONCLUSIONS This study provided primary evidence on the hospitalization burden of trauma. Considering demographics, injury and hospitalization characteristics as additional discriminators could further intervene in LOS and medical costs. Targeted efforts to use more early prevention measures could potentially lower future hospitalization burden.
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Affiliation(s)
- Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Fangguo Li
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Yue Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Liming Chen
- Department of Anorectal Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zhao Yang
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
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Gengler I, Min S, Jiang M, Zhang G, Altaye M, Radulesco T, Lechien JR, Hsieh TY. The Impact of the Post-Traumatic Facial Reconstruction on Postoperative Weight Loss. EAR, NOSE & THROAT JOURNAL 2024:1455613241241114. [PMID: 38509737 DOI: 10.1177/01455613241241114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Objectives: To identify risk factors and evaluate the impact of various facial fractures and reconstruction surgeries on postoperative weight change. Methods: Retrospective, monocentric study was performed at a tertiary care center. Medical history, type and mechanism of fracture, operative factors, and postoperative weights at follow-up appointments for 145 adult patients undergoing surgical repair for maxillofacial fractures were collected. Further information was obtained on postoperative diet and whether patients received maxillomandibular fixation (MMF). Univariate and multivariate analyses were utilized to evaluate effects of surgical reconstruction after facial trauma on postoperative weight loss. Results: Patients lost 3.2 ± 4.9 kg (95% confidence interval = 2.7-4.1, P < .0001) on average, with maximum loss between date of surgery and first follow-up. Univariate analysis demonstrated that intensive care unit admission (5.9 kg, SD 5.4, P = .001), nasogastric tube placement (5.1 kg, SD 4.6, P = .012), and MMF (4.4 kg, SD 5.4, P < .0001) were associated with more severe weight loss. Multivariate analyses showed that only MMF remained a significant risk factor for increased weight loss (avg. 6.0, standard error 1.93, t value 3.11, P = .0024). Conclusions: We report significant weight loss following facial trauma and reconstruction, which emphasizes the need to perform further studies on nutrition protocols for this patient population to optimize wound healing.
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Affiliation(s)
- Isabelle Gengler
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Megan Jiang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grace Zhang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mekibib Altaye
- Mekibib Altaye, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas Radulesco
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Aix-Marseille Univ, APHM, IUSTI, CNRS, Department of Oto-Rhino-Laryngology and Head and Neck Surgery, La Conception University Hospital, Marseille Cedex, France
| | - Jerome R Lechien
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Young Otolaryngologists of International Federation of Otorhinolaryngological Societies (YO-IFOS), Paris, France
- Department of Laryngology and Bronchoesophagology, EpiCURA Hospital, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
| | - Tsung-Yen Hsieh
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Bartold M, Ivanovski S. Biological processes and factors involved in soft and hard tissue healing. Periodontol 2000 2024. [PMID: 38243683 DOI: 10.1111/prd.12546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 01/21/2024]
Abstract
Wound healing is a complex and iterative process involving myriad cellular and biologic processes that are highly regulated to allow satisfactory repair and regeneration of damaged tissues. This review is intended to be an introductory chapter in a volume focusing on the use of platelet concentrates for tissue regeneration. In order to fully appreciate the clinical utility of these preparations, a sound understanding of the processes and factors involved in soft and hard tissue healing. This encompasses an appreciation of the cellular and biological mediators of both soft and hard tissues in general as well as specific consideration of the periodontal tissues. In light of good advances in this basic knowledge, there have been improvements in clinical strategies and therapeutic management of wound repair and regeneration. The use of platelet concentrates for tissue regeneration offers one such strategy and is based on the principles of cellular and biologic principles of wound repair discussed in this review.
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Affiliation(s)
- Mark Bartold
- University of Queensland, Brisbane, Queensland, Australia
| | - Saso Ivanovski
- University of Queensland, Brisbane, Queensland, Australia
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8
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D'Oto A, Baker H, Mau T, Childs LF, Tibbetts KM. Characteristics of Idiopathic Subglottic Stenosis in the Elderly. Laryngoscope 2023; 133:3075-3079. [PMID: 37166144 DOI: 10.1002/lary.30742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare characteristics of patients ≥65 years presenting with idiopathic subglottic stenosis (iSGS) to patients diagnosed at <65 years. We hypothesize that the groups have similar comorbidities and disease courses. DATA SOURCES Medical records of patients treated for iSGS at a tertiary care institution from January 2005-September 2022. REVIEW METHODS Patient demographics, time from symptom onset to diagnosis, medical history and comorbidities, and treatment modalities/intervals were recorded and analyzed. Characteristics of patients ≥65 and <65 years at presentation were compared using Chi-square analysis for non-numeric values and the Mann-Whitney U-test for numeric values. RESULTS One hundred seven patients with iSGS were identified and 16 (15%) were aged ≥65 years (mean age 72.6, 15 female) at presentation. These patients were compared to 91 patients aged <65 years (mean age = 47.6, 90 female). Patients ≥65 years had higher rates of type 2 diabetes mellitus (T2DM) (p = 0.004) and tobacco use (p = 0.004). There were no significant differences in body mass index, gastroesophageal reflux disease, hormone replacement therapy, time from symptom onset to presentation, or length of operative treatment intervals. CONCLUSION Patients ≥65 years with iSGS have higher rates of tobacco use, suggesting that alterations in wound healing may play a role in the development of iSGS in this age group. Although rates of T2DM were higher in the elderly group, clinical significance may be limited given the overall higher rate of diabetes mellitus in the elderly population. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3075-3079, 2023.
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Affiliation(s)
- Alexandra D'Oto
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hayley Baker
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ted Mau
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lesley F Childs
- Department of Otolaryngology- Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kathleen M Tibbetts
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Yoon Y, Lee N, Lee AD, Gehring MB, Constantine R, Mathes DW, Yu JW, Khechoyan D, Iorio ML, Kaoutzanis C. Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries. J Plast Reconstr Aesthet Surg 2023; 85:127-133. [PMID: 37482026 DOI: 10.1016/j.bjps.2023.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Cannabis is the third most used controlled substance in the world. Despite its widespread use, minimal research investigates cannabis usage in patients undergoing facial fracture surgeries. This study aimed to evaluate patterns of postoperative complications related to cannabis and tobacco usage after mandible fracture surgeries. MATERIALS AND METHODS PearlDiver™, a commercially available healthcare database, was used to identify patients endorsing the use of cannabis, tobacco, or both who underwent mandible fracture surgeries for cross-sectional analysis. The study population was categorized into groups using the Classification of Diseases, 9th revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. A chi-square analysis was performed to assess the influence of cannabis and tobacco use on postoperative complications. RESULTS A total of 8288 patients met the inclusion criteria, with 72 patients with cannabis-only usage, 914 patients with cannabis and tobacco usage, 3236 patients with tobacco-only usage, and 4066 in the control group. For patients using only cannabis, there was not an increased risk of developing postoperative complications compared with the control population. Patients with concurrent cannabis and tobacco usage and those with tobacco-only usage had an increased risk of surgical site infection, facial nonunion, facial abscess, debridement, and malocclusion after surgical repair of mandibular facial fracture. CONCLUSION Patients with tobacco-only as well as cannabis and tobacco usage had an increased risk of all postoperative complications, except malocclusion, compared with cannabis-only. Based on the results of this study, it is recommended that healthcare providers consider a patient's history of tobacco use when planning and performing surgical treatment for traumatic mandible fractures.
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Affiliation(s)
- YooJin Yoon
- University of Colorado School of Medicine, United States
| | - Nayun Lee
- University of Colorado School of Medicine, United States
| | - Anna D Lee
- University of Colorado School of Medicine, United States
| | - Michael B Gehring
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Ryan Constantine
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David W Mathes
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Jason W Yu
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - David Khechoyan
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Matthew L Iorio
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States
| | - Christodoulos Kaoutzanis
- University of Colorado School of Medicine Division of Plastic & Reconstructive Surgery, United States.
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10
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List MA, Knackstedt M, Liu L, Kasabali A, Mansour J, Pang J, Asarkar AA, Nathan C. Enhanced recovery after surgery, current, and future considerations in head and neck cancer. Laryngoscope Investig Otolaryngol 2023; 8:1240-1256. [PMID: 37899849 PMCID: PMC10601592 DOI: 10.1002/lio2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/15/2022] [Indexed: 10/31/2023] Open
Abstract
Objectives Review of the current and relevant literature to develop a list of evidence-based recommendations that can be implemented in head and neck surgical practices. To provide rationale for the multiple aspects of comprehensive care for head and neck surgical patients. To improve postsurgical outcomes for head and neck surgical patients. Methods Extensive review of the medical literature was performed and relevant studies in both the head and neck surgery and other surgical specialties were considered for inclusion. Results A total of 18 aspects of perioperative care were included in this review. The literature search included 276 publications considered to be the most relevant and up to date evidence. Each topic is concluded with recommendation grade and quality of evidence for the recommendation. Conclusion Since it's conception, enhanced recovery after surgery (ERAS) protocols have continued to push for comprehensive and evidence based postsurgical care to improve patient outcomes. Head and neck oncology is one of the newest fields to develop a protocol. Due to the complexity of this patient population and their postsurgical needs, a multidisciplinary approach is needed to facilitate recovery while minimizing complications. Current and future advances in head and neck cancer research will serve to strengthen and add new principles to a comprehensive ERAS protocol. Level of Evidence 2a.
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Affiliation(s)
- Marna A. List
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Mark Knackstedt
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Lucy Liu
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- College of MedicineLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Jobran Mansour
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - John Pang
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Ameya A. Asarkar
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology/HNSLouisiana State University Health‐ShreveportShreveportLouisianaUSA
- Feist‐Weiller Cancer CenterShreveportLouisianaUSA
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11
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Dey D. How to avoid pitfalls when referring patients to otolaryngology. JAAPA 2023; 36:1-4. [PMID: 37668487 DOI: 10.1097/01.jaa.0000937320.81549.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
ABSTRACT Delayed, faulty, incomplete, or misdiagnosed referrals to otolaryngology (also called ear, nose, and throat, or ENT) can result in physical and monetary harm to the patient and time spent by clinicians in reordering the appropriate diagnostic tests. This article describes how to refer patients to ENT in the most time- and cost-effective ways, and addresses initial management in primary care.
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Affiliation(s)
- Dennis Dey
- Dennis Dey practices in otolaryngology at Baptist St. Anthony Panhandle ENT of Amarillo, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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12
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Rudisill KE, Ratnasamy PP, Maloy GC, Grauer JN. Decline in Separate Incision Autograft for Spine Surgery Over the Past Decade: A Fading "gold standard". J Am Acad Orthop Surg 2023; 31:938-944. [PMID: 37332184 DOI: 10.5435/jaaos-d-22-01029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Spinal fusion is a common procedure for which bone grafting is a critical component. Although iliac crest (separate incision autograft) is typically referred to as the "gold standard" grafting material, it seems to be used less and less frequently. METHODS The 2010 to Q3 2020 MSpine PearlDiver data set was used to identify patients receiving separate incision autograft versus local autograft/allograft/graft supplement for spinal fusion. Grafting trends over the decade were determined. Patient age, sex, Elixhauser Comorbidity Index, smoking status, insurance plan, region of the country where the surgery was conducted, and surgeon specialty were characterized and compared by the type of bone graft using univariate and multivariate analyses. RESULTS Of 373,569 spinal bone grafting procedures, separate incision autografts were used for 32,401 (8.67%). A gradual decline was observed from 2010 (10.57% of spinal grafting procedures) to 2020 (4.69%, P -value < 0.00001). Independent predictors of having had a separate incision autograft in order of decreasing odds included surgeon specialty (relative to neurosurgery, orthopaedic odds ratio [OR], 2.45), smoking status (relative to nonsmokers, smokers OR, 1.45), region of the country (relative to Midwest, Northeast OR, 1.11; West OR, 1.42; and South OR, 1.48), insurance (relative to commercial, Medicare OR, 1.14), younger age (OR, 1.04 per decade increase), and lower Elixhauser Comorbidity Index (OR, 0.95 per two-point increase) ( P < 0.0001 for each). CONCLUSION Iliac crest autograft continues to be referred to as the gold standard grafting material for spine fusions. However, the use of this has faded over the past decade to only 4.69% of spinal fusions in 2020. While some patient factors had an effect on when separate incision autograft was used, nonsurgical factors, including surgeon specialty, geographic region where the surgery was conducted, and insurance factors, suggested that external factors/physician training influence this choice.
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Affiliation(s)
- Katelyn E Rudisill
- From the Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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13
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Prajapati S, Ninneman S, Zarrabi I, Daubert D, Wang IC, Hsu YT. Risk factors and longitudinal regenerative outcomes of sinus membrane perforation during lateral window sinus floor elevation: A retrospective analysis up to 9 years. J Periodontol 2023; 94:1045-1054. [PMID: 36748281 DOI: 10.1002/jper.22-0424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lateral-window sinus floor elevation (LSFE) is a reliable procedure to reconstruct the posterior maxilla for implant therapy. This retrospective study aimed to investigate risk factors associated with Schneiderian membrane perforation (SMP) occurrence during LSFE and longitudinal regenerative outcomes following LSFE up to 9 years. METHODS Patients who had LSFE between 2010 and 2019 were included. All demographic and surgical-related data were retrieved from existing electronic health records. Radiographs were used to evaluate the vertical dimensional changes of ridge and graft materials and the potential anatomic factors of SMP. RESULTS A total of 122 LSFE procedures in 99 patients were included in the study. Mean ridge height gain and graft shrinkages were 9.5 ± 3.47 and 1.57 ± 2.85 mm. The influence of the healing period on graft shrinkage showed a positive trend; the longer the healing period, the greater the graft shrinkage (p = 0.09). The pathology in the sinus showed a positive correlation with SMP (p = 0.07). However, other anatomical factors did not negatively impact SMP and subsequent ridge height gain (p > 0.05). CONCLUSIONS With inherent limitation, the findings with up to 9 years of follow-up indicate a consistent ridge remodeling lasting for about 3 years after LSFE procedures. SMP or membrane thickening may not significantly affect the ridge gain following LSFE. The healing period had the most significant influence on graft shrinkage, showing that the longer the healing time between LSFE and implant placement, the greater the graft shrinkage.
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Affiliation(s)
| | - Shale Ninneman
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | | | - Diane Daubert
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - I-Chung Wang
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Yung-Ting Hsu
- Department of Periodontics, University of Washington School of Dentistry, Seattle, Washington, USA
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14
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Froelich A, Jakubowska E, Wojtyłko M, Jadach B, Gackowski M, Gadziński P, Napierała O, Ravliv Y, Osmałek T. Alginate-Based Materials Loaded with Nanoparticles in Wound Healing. Pharmaceutics 2023; 15:pharmaceutics15041142. [PMID: 37111628 PMCID: PMC10143535 DOI: 10.3390/pharmaceutics15041142] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023] Open
Abstract
Alginate is a naturally derived polysaccharide widely applied in drug delivery, as well as regenerative medicine, tissue engineering and wound care. Due to its excellent biocompatibility, low toxicity, and the ability to absorb a high amount of exudate, it is widely used in modern wound dressings. Numerous studies indicate that alginate applied in wound care can be enhanced with the incorporation of nanoparticles, revealing additional properties beneficial in the healing process. Among the most extensively explored materials, composite dressings with alginate loaded with antimicrobial inorganic nanoparticles can be mentioned. However, other types of nanoparticles with antibiotics, growth factors, and other active ingredients are also investigated. This review article focuses on the most recent findings regarding novel alginate-based materials loaded with nanoparticles and their applicability as wound dressings, with special attention paid to the materials of potential use in the treatment of chronic wounds.
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Affiliation(s)
- Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Emilia Jakubowska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Monika Wojtyłko
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Barbara Jadach
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Michał Gackowski
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Piotr Gadziński
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Olga Napierała
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
| | - Yulia Ravliv
- Department of Pharmacy Management, Economics and Technology, I. Horbachevsky Ternopil National Medical University, 36 Ruska Street, 46000 Ternopil, Ukraine
| | - Tomasz Osmałek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 6 Grunwaldzka Street, 60-780 Poznań, Poland
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15
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Ríos S, Álvarez S, Smith PC, Sáez CG, Andrade C, Pinto N, Martínez CE. Smoking habits do not affect biological responses induced by leucocyte and platelet-rich fibrin in periodontal ligament cells. J Oral Pathol Med 2023; 52:169-180. [PMID: 36258298 DOI: 10.1111/jop.13374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Leucocyte- and platelet-rich fibrin has been developed to stimulate wound healing response. However, it is currently unknown whether smoking affects the biological responses elicited by leucocyte- and platelet-rich fibrin on periodontal ligament-derived mesenchymal stromal cells. This study analyzes the kinetics of biomolecule release from leucocyte- and platelet-rich fibrin derived from smokers and nonsmokers and their effect on periodontal ligament cell proliferation and migration as essential biological activities during wound healing. METHODS Biomolecules present in leucocyte- and platelet-rich fibrin exudates and conditioned media collected from smokers and nonsmokers were analyzed by Luminex arrays. Periodontal ligament-derived mesenchymal stromal cell obtained from one nonsmoker were treated with leucocyte- and platelet-rich fibrin exudates or leucocyte- and platelet-rich fibrin conditioned media derived from both smokers and nonsmokers. The parameters evaluated included cell proliferation, determined by Ki67 immunostaining and migration assessed using transwell assays. Also, cells were treated with nicotine in the presence of fetal bovine serum 10% or leucocyte- and platelet-rich fibrin conditioned media. RESULTS A similar biomolecular profile was detected in leucocyte- and platelet-rich fibrin exudates and leucocyte- and platelet-rich fibrin conditioned media from smokers and nonsmokers, stimulating (periodontal ligament-derived mesenchymal stromal cell) proliferation, and migration to a comparable degree. Nicotine reduced cell proliferation and migration of periodontal cells; however, this effect was recovered in the presence of leucocyte- and platelet-rich fibrin conditioned media. CONCLUSION Leucocyte- and platelet-rich fibrin derived from smokers could be an autologous source of biomolecules to stimulate cell biological activities involved in wound healing in smokers who have difficulties in ceasing this habit. Clinical trials are required to evaluate the impact of leucocyte- and platelet-rich fibrin on healing responses in smokers.
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Affiliation(s)
- Susana Ríos
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Simón Álvarez
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio C Smith
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia G Sáez
- School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Nelson Pinto
- Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Constanza E Martínez
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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16
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Yosefof E, Tsur N, Boldes T, Najjar E, Mizrachi A, Shpitzer T, Hamzany Y, Bachar G. The Predictors of Persistent Posttracheostomy Tracheocutaneous Fistula and Successful Surgical Closure. Otolaryngol Head Neck Surg 2023. [PMID: 36856603 DOI: 10.1002/ohn.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Persistent tracheocutaneous fistula is a well-described complication of prolonged tracheostomy, with a prevalence of about 70% when decannulation is performed after more than 16 weeks. Predictors of its occurrence and outcome of treatment in adults remain unclear. The aim of the study was to describe our experience with the treatment of persistent posttracheostomy tracheocutaneous fistula in adults and to investigate factors associated with its formation and with the success of surgical closure. STUDY DESIGN Retrospective cohort. SETTING Tertiary medical center. METHODS Patients who underwent open-approach tracheostomy between 2000 and 2020 were identified by database review. Data on background, need for surgical closure, and the surgical outcome was collected from the medical files and analyzed statistically between groups. RESULTS Of 516 patients identified, 127 with sufficient long-term follow-up data were included in the study. Compared to patients whose fistula closed spontaneously (n = 85), patients who required surgical closure (n = 42) had significantly higher rates of smoking, laryngeal or thyroid malignancy, and airway obstruction as the indication for tracheostomy, on both univariate and multivariate analysis. In a comparison of patients with successful (n = 29) or failed (n = 11) surgical closure, factors significantly associated with failure were prior radiotherapy and lower preoperative albumin level, on univariate analysis. CONCLUSION Smoking, thyroid or laryngeal malignancy, and airway obstruction indication are risk factors for persistent posttracheostomy tracheocutaneous fistula. Patients should be closely followed after tracheostomy and referred for surgery if the fistula fails to close. Before surgery, careful evaluation of the patient's nutritional status and consideration of prior radiation treatment is mandatory.
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Affiliation(s)
- Eyal Yosefof
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Tsur
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Boldes
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esmat Najjar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Hamzany
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Shi YC, Li J, Li SJ, Li ZP, Zhang HJ, Wu ZY, Wu ZY. Flap failure prediction in microvascular tissue reconstruction using machine learning algorithms. World J Clin Cases 2022; 10:3729-3738. [PMID: 35647170 PMCID: PMC9100718 DOI: 10.12998/wjcc.v10.i12.3729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Microvascular tissue reconstruction is a well-established, commonly used technique for a wide variety of the tissue defects. However, flap failure is associated with an additional hospital stay, medical cost burden, and mental stress. Therefore, understanding of the risk factors associated with this event is of utmost importance.
AIM To develop machine learning-based predictive models for flap failure to identify the potential factors and screen out high-risk patients.
METHODS Using the data set of 946 consecutive patients, who underwent microvascular tissue reconstruction of free flap reconstruction for head and neck, breast, back, and extremity, we established three machine learning models including random forest classifier, support vector machine, and gradient boosting. Model performances were evaluated by the indicators such as area under the curve of receiver operating characteristic curve, accuracy, precision, recall, and F1 score. A multivariable regression analysis was performed for the most critical variables in the random forest model.
RESULTS Post-surgery, the flap failure event occurred in 34 patients (3.6%). The machine learning models based on various preoperative and intraoperative variables were successfully developed. Among them, the random forest classifier reached the best performance in receiver operating characteristic curve, with an area under the curve score of 0.770 in the test set. The top 10 variables in the random forest were age, body mass index, ischemia time, smoking, diabetes, experience, prior chemotherapy, hypertension, insulin, and obesity. Interestingly, only age, body mass index, and ischemic time were statistically associated with the outcomes.
CONCLUSION Machine learning-based algorithms, especially the random forest classifier, were very important in categorizing patients at high risk of flap failure. The occurrence of flap failure was a multifactor-driven event and was identified with numerous factors that warrant further investigation. Importantly, the successful application of machine learning models may help the clinician in decision-making, understanding the underlying pathologic mechanisms of the disease, and improving the long-term outcome of patients.
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Affiliation(s)
- Yu-Cang Shi
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Jie Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Shao-Jie Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Zhan-Peng Li
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Hui-Jun Zhang
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Ze-Yong Wu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
| | - Zhi-Yuan Wu
- Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, Guangdong Province, China
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18
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Halboub E, Jafer MA, Khormi HI, Kariri AA, Atiah SA, Lughbi SJ, Ba-Hattab R, Al-Maweri SA. Attitudes and practices of tobacco cessation counseling among Saudi dental professionals: A nationwide cross-sectional survey. Niger J Clin Pract 2022; 25:502-508. [PMID: 35439911 DOI: 10.4103/njcp.njcp_1784_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Dental professionals can play a pivotal role in educating the public about the harmful effects of smoking and encouraging them to quit the habit. Aim This study assesses the attitudes and practices of tobacco cessation counseling (TCC) among dental professionals in Saudi Arabia. Patients and Methods This questionnaire-based cross-sectional study targeted dentists and dental interns working in government and private sectors in Saudi Arabia. We conducted a descriptive analysis by using SPSS Statistics, version 25.0. Results A total of 895 respondents (314 interns and 581 dentists) participated in this survey. Although the majority of respondents (93%) reported that they always ask patients about tobacco habits, only 59% reported recording tobacco habits in patients' files, and only 55% of the respondents reported explaining to patients the harmful effects of tobacco. Around 91% of the participants believe that a dental clinic is an appropriate place for TCC, and 22% believe that TCC has a negative impact on dental practice. Smoking status, work setting, and the number of years since graduation were found to be significantly associated with the respondents' attitudes and practices. Lack of training, time limitations, and lack of confidence were barriers for TCC. Conclusions Dental professionals in Saudi Arabia demonstrated relatively positive attitudes but weak practices of TCC. Continuous education and motivation are needed to improve dentists' confidence, attitudes, and willingness for TCC. Integration of tobacco control education in undergraduate curricula is recommended.
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Affiliation(s)
- E Halboub
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia; Department of Oral Medicine, Oral Pathology and Oral Radiology, Faculty of Dentistry, Sana'a University, Sana'a, Yemen
| | - M A Jafer
- Department of Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia; Honor Researcher, Maastricht University, The Netherlands
| | - H I Khormi
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - A A Kariri
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - S A Atiah
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - S J Lughbi
- College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - R Ba-Hattab
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - S A Al-Maweri
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Harvey J, Mellody KT, Cullum N, Watson REB, Dumville J. Wound fluid sampling methods for proteomic studies: A scoping review. Wound Repair Regen 2022; 30:317-333. [PMID: 35381119 PMCID: PMC9322564 DOI: 10.1111/wrr.13009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 01/02/2023]
Abstract
Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.
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Affiliation(s)
- Joe Harvey
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kieran T Mellody
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Nicky Cullum
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Rachel E B Watson
- Centre for Dermatology Research, School of Biological Sciences, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Institute for Collaborative Research on Ageing, The University of Manchester, Manchester, UK
| | - Jo Dumville
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
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20
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Panayi AC, Haug V, Kauke-Navarro M, Diehm YF, Pomahac B. The Impact of Metabolic Syndrome on Microvascular Head and Neck Reconstruction: An ACS-NSQIP data analysis. J Plast Reconstr Aesthet Surg 2021; 75:1360-1371. [PMID: 34955390 DOI: 10.1016/j.bjps.2021.11.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) can predispose patients to poorer surgical outcomes. In this study, we sought to evaluate the impact of MetS on the postoperative outcomes of head and neck microvascular reconstruction. METHODS Review of the 2015-2019 NSQIP database identified 5,323 cases of microvascular reconstruction, of which 3,809 were head and neck cases. Of the included patients, 184 had MetS and 3625 did not. The groups were compared in terms of demographics and comorbidities. Postoperative outcomes assessed included mortality, average operative time and length of hospital stay, surgical and medical complications, and nonhome discharge. RESULTS The MetS group had higher rates of medical complications (p<0.0001), sepsis (p=0.02), septic shock (p=0.01), and skilled care-discharge (p=0.0004). Analysis by flap type revealed that MetS patients receiving free skin flaps experienced higher rates of organ space infection (p=0.02), sepsis (p<0.0001), and lower home-discharge (p=0.01). In the free muscle group, superficial incisional infection (p=0.04), UTI (p=0.02), and septic shock (p=0.01) were higher in MetS patients. Stratification by surgical site showed that the occurrence of sepsis was significantly higher in the patients receiving microvascular flap reconstruction of the larynx (p=0.04) or tongue(p=0.03). Stratification of the MetS patients according to treatment for diabetes showed that patients receiving insulin experienced a higher rate of superficial incisional infection (p=0.04). A multivariate analysis verified significantly higher rates of medical complications (p<0.0001), sepsis (p=0.03) and septic shock (p=0.01) in the MetS group. CONCLUSION Patients with MetS undergoing head and neck microvascular reconstruction are at increased risk of postoperative medical complications, including sepsis and septic shock, and are more likely to be discharged to a skilled care facility. Surgical outcomes were found to depend on the type of flap and site of surgery.
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Affiliation(s)
- Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA
| | - Yannick F Diehm
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, 02115 Boston, USA.
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21
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Healy DW, Cloyd BH, Straker T, Brenner MJ, Damrose EJ, Spector ME, Saxena A, Atkins JH, Ramamurthi RJ, Mehta A, Aziz MF, Cattano D, Levine AI, Schechtman SA, Cavallone LF, Abdelmalak BB. Expert Consensus Statement on the Perioperative Management of Adult Patients Undergoing Head and Neck Surgery and Free Tissue Reconstruction From the Society for Head and Neck Anesthesia. Anesth Analg 2021; 133:274-283. [PMID: 34127591 DOI: 10.1213/ane.0000000000005564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The perioperative care of adult patients undergoing free tissue transfer during head and neck surgical (microvascular) reconstruction is inconsistent across practitioners and institutions. The executive board of the Society for Head and Neck Anesthesia (SHANA) nominated specialized anesthesiologists and head and neck surgeons to an expert group, to develop expert consensus statements. The group conducted an extensive review of the literature to identify evidence and gaps and to prioritize quality improvement opportunities. This report of expert consensus statements aims to improve and standardize perioperative care in this setting. The Modified Delphi method was used to evaluate the degree of agreement with draft consensus statements. Additional discussion and collaboration was performed via video conference and electronic communication to refine expert opinions and to achieve consensus on key statements. Thirty-one statements were initially formulated, 14 statements met criteria for consensus, 9 were near consensus, and 8 did not reach criteria for consensus. The expert statements reaching consensus described considerations for preoperative assessment and optimization, airway management, perioperative monitoring, fluid management, blood management, tracheal extubation, and postoperative care. This group also examined the role for vasopressors, communication, and other quality improvement efforts. This report provides the priorities and perspectives of a group of clinical experts to help guide perioperative care and provides actionable guidance for and opportunities for improvement in the care of patients undergoing free tissue transfer for head and neck reconstruction. The lack of consensus for some areas likely reflects differing clinical experiences and a limited available evidence base.
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Affiliation(s)
- David W Healy
- From the Department of Anesthesiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Benjamin H Cloyd
- Department of Anesthesiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Tracey Straker
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York
| | - Michael J Brenner
- Department of Otolaryngology, Michigan Medicine-University of Michigan, Ann Arbor, Michigan
| | - Edward J Damrose
- Department of Otolaryngology/Head & Neck Surgery & Anesthesiology/Perioperative Medicine (by courtesy)
| | - Matthew E Spector
- Department of Otolaryngology, Michigan Medicine-University of Michigan, Ann Arbor, Michigan
| | - Amit Saxena
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Joshua H Atkins
- Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Arpan Mehta
- Department of Anesthesiology, Perioperative Medicine & Pain Management, The University of Miami, Miami, Florida
| | - Michael F Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
| | - Davide Cattano
- Department of Anesthesiology, McGovern Medical School, UTHealth Houston, Houston, Texas
| | - Adam I Levine
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel A Schechtman
- Department of Anesthesiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Laura F Cavallone
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Basem B Abdelmalak
- Departments of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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Davies JC, Chan HHL, Yao CMKL, Ziai H, Dixon PR, Chepeha DB, Goldstein DP, de Almeida JR, Gilbert RW, Irish JC. Association of Plate Contouring With Hardware Complications Following Mandibular Reconstruction. Laryngoscope 2021; 132:61-66. [PMID: 34165789 DOI: 10.1002/lary.29706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Despite considerable effort being dedicated to contouring reconstruction plates, there remains limited evidence demonstrating an association between contour and reconstructive outcomes. We sought to evaluate whether optimizing mandibular reconstruction plate contouring is associated with reduced postoperative hardware complications. STUDY DESIGN Retrospective cohort study. METHODS A cohort study was performed with adult patients (age ≥18 years) who underwent mandibulectomy and osseous free flap reconstruction following oncologic ablation at the University Health Network in Toronto, Canada, between January 1, 2003 and December 31, 2014. Patients with computed tomography scans performed within 1 year of reconstruction were included. Computer-based three-dimensional models were generated and used to calculate the mean plate-to-bone gap (mm). The primary outcome was plate exposure. Secondary outcome included a composite of plate exposure or intraoral dehiscence. Logistic regression models were fitted for each outcome accounting for other patient and surgical characteristics associated with the primary outcome. RESULTS Ninety-four patients met inclusion criteria, with a mean age of 60.4 (standard deviation [SD] 14.9). The mean follow-up time was 31.4 months (range 3-94). Reconstruction was performed with fibular (57%) and scapular free flaps (43%). In the multivariable model, small mean plate-to-bone gap (<1 mm) was independently associated with 86% reduced odds of plate exposure (odds ratio [OR] 0.12; 95% confidence interval [CI] 0.02-0.55). Mean plate-to-bone gap less than 1 mm was also independently associated with reduced odds of developing a composite of plate exposure or intraoral dehiscence (OR, 0.29; 95%CI, 0.11-0.75). CONCLUSION Optimizing plate contouring during mandibular reconstruction may decrease the development of postoperative hardware complications. LEVEL OF EVIDENCE IV Laryngoscope, 2021.
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Affiliation(s)
- Joel C Davies
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Harley H L Chan
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Peter R Dixon
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre and Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
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Jaleel Z, Blasberg E, Troiano C, Montanaro P, Mazzilli S, Gertje HP, Crossland NA, Platt M, Spiegel J. Association of vaping with decreased vascular endothelial growth factor expression and decreased microvessel density in cutaneous wound healing tissue in rats. Wound Repair Regen 2021; 29:1024-1034. [PMID: 34129265 DOI: 10.1111/wrr.12945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/13/2021] [Accepted: 05/15/2021] [Indexed: 12/24/2022]
Abstract
Vaping is suggested to be a risk factor for poor wound healing akin to smoking. However, the molecular and histologic mechanisms underlying this postulation remain unknown. Our study sought to compare molecular and histologic changes in cutaneous flap and non-flap tissue between vaping, smoking and control cohorts. Animal study of 15 male Sprague-Dawley rats was randomized to three cohorts: negative control (n = 5), e-cigarette (n = 5) and cigarette (n = 5) and exposed to their respective treatments with serum cotinine monitoring. After 30 days, random pattern flaps were raised and healed for 2 weeks after which skin punch biopsies of flap and non-flap tissues were collected for quantitative-reverse transcription-polymerase chain reaction of three selected wound healing genes (transforming growth factor β [TGF-β], vascular endothelial growth factor [VEGF], matrix metalloproteinase-1 [MMP-1]); then, immunohistochemistry for CD68 expression, α-smooth muscle actin looking at microvessel density (MVD) and in situ hybridization to localize VEGF production were undertaken. In flap tissue, vaping (mean[SEM]) (0.61[0.07]) and smoking (0.70[0.04]) were associated with decreased fold change of VEGF expression compared with controls (0.91[0.03]) (p < 0.05, p < 0.05, respectively). In non-flap tissue, only vaping was associated with decreased VEGF expression (mean[SEM]) (0.81[0.07]), compared with controls (1.17[0.10]) (p < 0.05) with expression primarily localized to basal keratinocytes and dermal capillaries. Immunohistochemistry showed decreased MVD in smoking (0.27[0.06]) and vaping (0.26[0.04]) flap tissue compared to matched controls (0.65[0.14]) (p < 0.05, p < 0.05, respectively) and decreased areas of fibrosis compared with controls on gross histology. Vaping and smoking were similarly associated with decreased VEGF expression, MVD and fibrotic changes in flap tissue. The results suggest attenuated angiogenesis via decreased VEGF expression as a mechanism for poor wound healing in vaping-exposed rats.
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Affiliation(s)
- Zaroug Jaleel
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth Blasberg
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Chelsea Troiano
- Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Paige Montanaro
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah Mazzilli
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hans Peter Gertje
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nicholas A Crossland
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael Platt
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey Spiegel
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology/Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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Abstract
At the moment of soft tissue injury, an immediate wound healing ballet commences. This coordinated cascade of events works over minutes, hours, weeks, and months to restore tissue integrity and viability in an attempt to rebuild the site to its preinjured state. A thorough understanding of these processes, and options to navigate forks in the road, can help guide patient selection, surgical planning and execution, management of complications, and ultimately the restoration of tissue form and function for optimal outcomes. An exhaustive account of tissue healing mechanics is beyond the scope of this writing. However, a summation of much that is known of these processes and the directions research and therapeutic developments are currently aimed will help the facial plastic surgeon prevent or minimize debilitating functional and cosmetic consequences in the head and neck.
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Affiliation(s)
- Christian L Stallworth
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, UTHSC at San Antonio, San Antonio, Texas
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25
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Kükrek H, Aitzetmüller M, Vodiškar M, Moog P, Machens HG, Duscher D. Erythropoetin can partially restore cigarette smoke induced effects on Adipose derived Stem Cells. Clin Hemorheol Microcirc 2021; 77:27-36. [PMID: 32651309 DOI: 10.3233/ch-200852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Adipose derived Stem Cells (ASCs) have been proven to play a key role in tissue regeneration. However, exposure to large amounts of cigarette smoke can drastically diminish their function. Erythropoetin (EPO), can modulate cellular response to injury. Therefore, we investigated the ability of EPO to restore the regenerative function and differentiation capacity of ASCs. MATERIAL AND METHODS Human ASCs were isolated from abdominoplasty samples using standard isolation procedures. Cell identity was established by means of Fluorescence Activated Cell Scanning. Subsequently, isolated ASCs were cultivated with cigarette smoke extract both with and without EPO. Parameters investigated included cellular metabolic activity, adipogenic and osteogenic differentiation capacity, and in vitro wound closure capacity. For further enhancing wound closure, EPO was combined with Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) or Stromal Derived Factor-1 alpha (SDF-1 a). RESULTS Cigarette smoke reduces adipogenic differentiation, the osteogenic differentiation capacity as well as the in vitro wound healing ability of human derived ASCs. EPO did not change metabolic activity of ASCs significantly. The addition of EPO could partially restore their function. The combination of EPO with GM-CSF or SDF-1 did not result in a synergistic effect regarding wound healing ability. CONCLUSION Exposure to cigarette smoke significantly reduced the regenerative potential of ASCs. Treatment of ASCs exposed to cigarette smoke with EPO has the potential to partially restore their function.
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Affiliation(s)
- Haydar Kükrek
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Aitzetmüller
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mateja Vodiškar
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Philipp Moog
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Duscher
- Department for Plastic and Hand Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Staity G, Saadi RA, Pool C, Lighthall JG. The Safety Profile of Liposomal Bupivacaine Use in Septorhinoplasty. Facial Plast Surg Aesthet Med 2021; 24:202-206. [PMID: 33617355 DOI: 10.1089/fpsam.2020.0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Objective: To evaluate the safety profile, including adverse drug reactions and operative complications, of liposomal bupivacaine (LB) use for local anesthesia during functional septorhinoplasty. Study Design: Retrospective review. Subject and Methods: A database query was conducted for patients >18 years of age who underwent septorhinoplasty from January 1, 2019, to August 1, 2020. Adverse drug reactions and postoperative outcomes were compared between patients who received locally administered LB and patients who received standard local anesthetic at the completion of the surgery. Results: A total of 95 cases were included in our data analysis. No significant differences were found in adverse reactions overall (6.3% vs. 3.1%, p = 0.51) or complications, including rate of infection (3.2% vs. 3.1%, p = 1), cartilage warping (1.6% vs. 0%, p = 1), graft resorption (0% vs. 0%, p = 1), septal hematoma (0% vs. 0%, p = 1), and need for revision surgery (4.8% vs. 3.1%, p = 1) between LB and control groups. Conclusion: LB demonstrated an acceptable safety profile when compared with standard local anesthetics during septorhinoplasty, with no significant difference in systemic or local adverse drug reactions or postoperative complications.
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Affiliation(s)
- Ghazal Staity
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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Wen-Shen L, Sheng MLW, Yeo W, Beng TS, Mun YW, Ming GC, Siddiqui MMA. No Difference in Functional Outcome but Higher Revision Rate Among Smokers Undergoing Cervical Artificial Disc Replacement: Analysis of a Spine Registry. Int J Spine Surg 2020; 14:916-923. [PMID: 33560251 DOI: 10.14444/7140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking is a known predictor of negative outcomes in spinal surgery. However, its effect on the functional outcomes and revision rates after ADR is not well-documented. This study is a retrospective analysis of prospectively collected data at a major tertiary center. The objective was to elucidate the impact of smoking on functional outcomes in cervical artificial disc replacement (ADR). METHODS Patients who underwent cervical ADR for myelopathy or radiculopathy from 2004 to 2015 with a minimum of 2 years of follow-up were included in the study. Patient function was assessed using Short Form-36 (SF-36), American Association of Orthopaedic Surgery (AAOS) cervical spine, and Japanese Orthopaedic Association (JOA) scoring systems preoperatively and at 2 years postoperatively. Incidence of further surgery on affected and adjacent segments was analyzed as well. RESULTS A total of 137 patients were included in the study, consisting of 117 nonsmokers and 20 smokers. There were 60 patients who presented with myelopathy and 77 with radiculopathy. The mean age of smokers was 42.6 years, compared with 46.4 years in the nonsmoker group (P < .01). Statistical improvement was noted in postoperative range of motion, as well as AAOS, SF-36, and JOA scores in both groups, with no difference between groups at 2 years of follow-up. A total of 84.2% of nonsmokers and 87.5% of smokers reported as surgery having met their expectations. A total of 5 of 117 nonsmokers (5.1%) and 4 of 20 smokers (20%) needed revision surgery (P = .018). Three of the 4 smokers who required surgery for adjacent or multisegment disease, whereas only 2 of the nonsmokers needed an operation for adjacent segment disease. CONCLUSIONS Our analysis indicates that there is no difference in functional outcome or patient satisfaction between smokers and nonsmokers. Smokers have a higher chance of revision surgery after an artificial disc replacement compared with nonsmokers at 2 years. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Lee Wen-Shen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,Department of Surgery, The Alfred Hospital, Melbourne, Australia
| | | | - William Yeo
- Statistics and Clinical Research, Singapore General Hospital, Singapore
| | - Tan Seang Beng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yue Wai Mun
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Guo Chang Ming
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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The Effects of Smoking Cigarettes on Immediate Dental Implant Stability—A Prospective Case Series Study. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Smoking tobacco significantly affects the biology of periodontal tissues and contributes to the increased risk of peri-implant diseases. The aim of the study was to investigate whether smoking cigarettes affects the primary and secondary stability of maxillary dental implants, inserted into fresh sockets immediately after extraction. Methods: The study was conducted on 164 patients between the ages of 27–71 years old. 67 individuals smoked more than 20 cigarettes daily and 97 were non-smokers. 190 immediate implants were inserted in the maxilla. Immediate implantations were performed with simultaneous augmentation of the socket with xenogenic bone grafting material. In the posterior region, implants were inserted into the palatal alveolus. The stability of the implants was measured using Insertion Torque Value (ITV) and two types of devices: Periotest (PT) and Osstell (ISQ). Marginal bone loss was evaluated on cone beam computed tomography scans. Results: In an aesthetic area, the PT values at 6 months post-implantation were higher for smokers than non-smokers (p < 0.05), respectively. The ISQ values were significantly lower in smokers compared to non-smokers at 6 months post-implantation (p = 0.0226), respectively. In the posterior region PT values were higher in smokers both on the day of implantation (p = 0.0179), 6 months after surgery (p = 0.0003) as well as 24 months after surgery (p < 0.0001), as compared to non-smokers, respectively. Smokers revealed lower ISQ values than non-smokers (p = 0.0047) on the day of implantation, as well as 6 months after implantation (p = 0.0002), respectively. There were no significant differences in marginal bone loss after 18 months of loading between smokers and non-smokers in the aesthetic, as well as posterior regions (p > 0.05). ITV measurements were lower in smokers than non-smokers in the aesthetic (16.3 vs. 17.5 Ncm) and posterior area (16.8 vs. 17.9 Ncm). Conclusions: This study indicate that smoking cigarettes has a negative effect on the stability of immediate implants in the maxilla. Primary stability of immediate implants may be lower in the posterior area of the maxilla in smokers when compared to non-smokers, which may eliminate smokers from immediate implants in this region. Secondary stability of immediate implants may be lower in both the aesthetic and posterior areas in smokers compared to non-smokers, which may encourage the postponement of final crowns delivery at 6 months post op and the extension of the occlusaly temporary crowns use in some smoker cases.
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29
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Moroco AE, Saadi RA, Patel VA, Lehman EB, Gniady JP. 30-Day Postoperative Outcomes Following Transcervical Zenker's Diverticulectomy in the Elderly: Analysis of the NSQIP Database. Otolaryngol Head Neck Surg 2020; 165:129-136. [PMID: 33287659 DOI: 10.1177/0194599820970503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the effect of patient factors, including age, on 30-day postoperative outcomes and complications for patients undergoing transcervical Zenker's diverticulectomy. STUDY DESIGN Retrospective cross-sectional analysis. SETTING American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database. METHODS Patients who underwent open Zenker's diverticulectomy (Current Procedural Terminology code 43130) were queried via the NSQIP (2006-2018). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of admission, postoperative complication, readmission, and reoperation. RESULTS A total of 614 patients were identified. Mean age at time of surgery was 71.1 years, with 13.4% older than 85 years. Outpatient procedures were performed in 29.8%. Postoperative complications occurred in 6.7%, with reoperation and readmission rates of 6.4% and 7.2%, respectively. A mortality rate of 0.3% was observed. Only smoking status (odds ratio, 2.94; P = .008) and history of congestive heart failure (odds ratio, 10.00; P = .014) were shown to have a significant effect on postoperative complications. CONCLUSION Smoking status confers a high risk for postoperative complication. Age was not an independent risk factor associated with adverse outcomes following open diverticulectomy, suggesting this procedure can be safely performed in patients with advanced age.
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Affiliation(s)
- Annie E Moroco
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Vijay A Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - John P Gniady
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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30
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Perez D, Ellis E. Complications of Mandibular Fracture Repair and Secondary Reconstruction. Semin Plast Surg 2020; 34:225-231. [PMID: 33380907 PMCID: PMC7759430 DOI: 10.1055/s-0040-1721758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mandibular fractures are common facial injuries. Their treatment varies as do postoperative complications. This paper discusses the common complications that are associated with the treatment of mandibular fractures and presents management strategies.
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Affiliation(s)
- Daniel Perez
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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31
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Lenze NR, Ghodke A, Shah RN, Buckmire RA. Predictors of Increased Surgical Drain Output following Type I Thyroplasty for Glottic Insufficiency. Laryngoscope 2020; 131:1557-1560. [PMID: 32809241 DOI: 10.1002/lary.29015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine predictors of increased drain output following type I thyroplasty for glottic insufficiency. STUDY DESIGN Retrospective chart review. METHODS A retrospective review was conducted for patients who underwent type I thyroplasty for glottic insufficiency from 2014-2019. The primary outcome was 24-hour drain output. Increased drain output was defined as >50th percentile for the sample. Univariate logistic regression models and linear regression models were used. RESULTS There were 84 patients with a mean age of 58.9 (SD 16.9) years. Twenty-four-hour drain output ranged from 0 to 29 mL with a mean of 9.47 (SD 6.49) mL. Patients with a history of tobacco use (OR 3.33; 95% CI, 1.24-8.95; P = .017) and prior neck surgery (OR 3.52; 95% CI, 1.26 to 9.83; P = .016) were significantly more likely to have increased drain output following surgery; these patients had a mean increase in 24-hour drain output of 3.51 mL (95% CI, 0.52 to 6.51; P = .022) and 1.74 mL (95% CI, -1.41 to 4.89; P = .274), respectively. Type of implant (Gore-Tex vs. Silastic; P = .425) and operative technique (unilateral vs. bilateral; P = .506) were not significantly associated with drain output. CONCLUSION History of tobacco use and prior surgery of the neck predict increased drain output following type I thyroplasty surgery. These patients may derive the most benefit from surgical drain placement. More research is needed to confirm these findings and elucidate potential mechanisms. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1557-1560, 2021.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, University of School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Ameer Ghodke
- Department of Otolaryngology-Head and Neck Surgery, University of School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Rupali N Shah
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Chou DW, Tejani N, Kleinberger A, Shih C. Initial Facial Feminization Surgery Experience in a Multicenter Integrated Health Care System. Otolaryngol Head Neck Surg 2020; 163:737-742. [DOI: 10.1177/0194599820924635] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective There are few large studies on facial feminization surgery (FFS). We provide the largest comprehensive report to date of an FFS cohort regarding the safety of multilevel surgery, patient-specific considerations with FFS procedures, and complications of surgery. Study Design Retrospective cohort study. Setting Multicenter integrated health care system. Subjects and Methods We examined all patients undergoing FFS within our institution from April 2016 to October 2018. Patients over the age of 18 with a diagnosis of gender dysphoria underwent any combination of scalp advancement, cranioplasty, brow lift, rhinoplasty, upper lip lift, mandibuloplasty, chondrolaryngoplasty, and/or additional cosmetic procedures. Medical records were reviewed for preoperative characteristics, FFS procedures undergone, and postoperative complications. Results In total, 121 patients underwent a total of 594 FFS procedures. Seventy-five percent of patients had only 1 or no comorbidities, and 90% of patients underwent cranioplasty, scalp advancement, and brow lift. African American patients (n = 5) less commonly underwent cranioplasty compared to those of other ethnicities (white, P < .001; Asian, P = .022; Hispanic, P = .014; multiracial, P = .006). Asian patients less commonly underwent rhinoplasty than white patients (38% vs 73%, P = .023). Only 8 (6.6%) patients experienced a significant complication after surgery. Conclusions The population undergoing FFS is generally healthy, the upper third of the face is most commonly addressed, there are age and ethnic considerations in FFS, and major complications after multilevel surgery are uncommon.
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Affiliation(s)
- David W. Chou
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Nizar Tejani
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Andrew Kleinberger
- Department of Head and Neck Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA
| | - Charles Shih
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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Alford EN, Chagoya G, Elsayed GA, Bernstock JD, Bentley JN, Romeo A, Guthrie B. Risk factors for wound-related complications after microvascular decompression. Neurosurg Rev 2020; 44:1093-1101. [DOI: 10.1007/s10143-020-01296-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
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A Survey Study of Health Promotion, Wellness, and Prevention in Wound Management Environments. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Crippen MM, Patel N, Filimonov A, Brady JS, Merchant AM, Baredes S, Park RCW. Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery. JAMA FACIAL PLAST SU 2020; 21:20-26. [PMID: 30347003 DOI: 10.1001/jamafacial.2018.1176] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck. Objective To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck. Design, Setting, and Participants In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018. Main Outcomes and Measures Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked. Results Of the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications. Conclusions and Relevance Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit. Level of Evidence NA.
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Affiliation(s)
- Meghan M Crippen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Nirali Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Jacob S Brady
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Aziz M Merchant
- Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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Gherardini J, van Lessen M, Piccini I, Edelkamp J, Bertolini M. Human Wound Healing Ex Vivo Model with Focus on Molecular Markers. Methods Mol Biol 2020; 2154:249-254. [PMID: 32314223 DOI: 10.1007/978-1-0716-0648-3_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Wound healing is a complex, multifactorial process that is divided in sequential and overlapping phases in order to restore the skin barrier. For the study of wound healing, different in vivo, in vitro, and ex vivo models have been used in the past. Here we describe in detail the methodology of the human skin punch-in-a-punch ex vivo wound healing model.
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Affiliation(s)
- Jennifer Gherardini
- Monasterium Laboratories, Skin and Hair Research Solutions, Muenster, Germany
| | - Max van Lessen
- Monasterium Laboratories, Skin and Hair Research Solutions, Muenster, Germany
| | - Ilaria Piccini
- Monasterium Laboratories, Skin and Hair Research Solutions, Muenster, Germany
| | - Janin Edelkamp
- Monasterium Laboratories, Skin and Hair Research Solutions, Muenster, Germany
| | - Marta Bertolini
- Monasterium Laboratories, Skin and Hair Research Solutions, Muenster, Germany.
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An Intelligent and Smart Environment Monitoring System for Healthcare. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9194172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Skin wound healing is influenced by two kinds of environment i.e., exterior environment that is nearby to wound surface and interior environment that is the environment of the adjacent part under wound surface. Both types of environment play a vital role in wound healing, which may contribute to continuous or impaired wound healing. Although, different previous studies provided wound care solutions, but they focused on single environmental factors either wound moisture level, pH value or healing enzymes. Practically, it is insignificant to consider environmental effect by determination of single factors or two, as both types of environment contain a lot of other factors which must be part of investigation e.g., smoke, air pollution, air humidity, temperature, hydrogen gases etc. Also, previous studies didn’t classify overall healing either as continuous or impaired based on exterior environment effect. In current research work, we proposed an effective wound care solution based on exterior environment monitoring system integrated with Neural Network Model to consider exterior environment effect on wound healing process, either as continuous or impaired. Current research facilitates patients by providing them intelligent wound care solution to monitor and control wound healing at their home.
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Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
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Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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A review of the effects of tobacco smoking on cancer treatment: smoking cessation intervention should be integrated into the cancer care continuum. JOURNAL OF RADIOTHERAPY IN PRACTICE 2019. [DOI: 10.1017/s1460396919000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractBackground:The adverse health effects associated with smoking tobacco have been well investigated, and its detrimental effects on cancer treatment outcomes, efficacy and quality of life (QOL) for cancer patients have also been well documented. Tobacco smoke contains many thousands of chemicals, including a plethora of carcinogens, and the exposure of human cells to these carcinogens, and their metabolic activation, is the main mechanism by which smoking-related cancer is initiated.Materials and Methods:This paper reports on a narrative review of recent studies in the field of effects of tobacco smoking on cancer treatment, including the effects of carcinogens in smoke on carcinogenesis, cell mutations and the immune system. The health effects of smokeless tobacco, effects of tobacco smoking on cancer treatment, and its impact on surgery, radiation therapy and chemotherapy are reported. The potential risks of second primary cancers or recurrence from tobacco use, the effects of second-hand smoking and cancer treatment, the impact of smoking on the QOL after cancer treatment and the need to integrate smoking cessation programs into the cancer care continuum are also reported.Conclusions:Tobacco use has a direct impact on cellular function by inhibiting apoptosis, stimulating proliferation and decreasing the efficacy of cancer treatment; therefore, quitting its use has the potential to improve treatment response rates and survival, as well as reduces the risk of developing second cancers and potentially improves the QOL after treatment. Smoking cessation is one of the most important interventions to prevent cancer and is also essential after the diagnosis of cancer to improve clinical outcomes. Due to the numerous benefits of smoking cessation, it should become a critical component of the cancer care continuum in all oncology programs – from prevention of cancer through diagnosis, treatment, survivorship and palliative care. Evidence-based smoking cessation intervention should be sustainably integrated into any comprehensive cancer program, and the information should be targeted to the specific benefits of cessation in cancer patients.
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Lassig AAD, Lindgren BR, Itabiyi R, Joseph AM, Gupta K. Excessive inflammation portends complications: Wound cytokines and head and neck surgery outcomes. Laryngoscope 2019; 129:E238-E246. [DOI: 10.1002/lary.27796] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/06/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Amy Anne D. Lassig
- Department of Otolaryngology-Head and Neck Surgery; Hennepin County Medical Center, Minneapolis Medical Research Foundation; Minneapolis Minnesota
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Bruce R. Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Ridwan Itabiyi
- Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Surgery; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Anne M. Joseph
- Department of Medicine, Division of General Internal Medicine; University of Minnesota; Minneapolis Minnesota U.S.A
| | - Kalpna Gupta
- Department of Medicine, Hematology, Oncology, and Transplantation; University of Minnesota; Minneapolis Minnesota U.S.A
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