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Othman S, Robinson E, Kamdar D, Pereira L, Miles B, Kasabian A, Ricci JA, Knobel D. Microvascular Free-Flap Head and Neck Reconstruction: The Utility of the Modified Frailty Five-Item Index. J Reconstr Microsurg 2024. [PMID: 39038462 DOI: 10.1055/s-0044-1788540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Microvascular free tissue transfer is a common tool for the reconstruction of oncologic head and neck defects. Adequate preoperative assessment can aid in appropriate risk stratification and peri-operative optimization. The modified five-item frailty index (mFI-5) is a validated risk-assessment scale; however, its utility in head and neck free-flap reconstruction is unknown when compared with other common risk factors. METHODS A retrospective, single-institution chart review (2017-2020) was performed. Patient demographics, defect and repair characteristics, pre- and peri-operative factors, and flap outcomes were recorded. A high mFI-5 score was defined as greater than 2. The total score, as well as other patient factors, was correlated to postoperative flap complications. RESULTS A total of 214 patients were deemed appropriate for conclusion. The mean age was 63.9 ± 12.8 years. There were an even number of males (52.8%) and females (47.2%). A fifth of subjects (20.8%) underwent preoperative radiotherapy. There were 21 cases (9.8%) of complete flap loss. A total of 34 patients (29.4%) experienced any postoperative complication related to flap outcomes. An elevated mFI-5 was significantly associated with a higher overall rate of postoperative complications (39.7 vs. 29.4%, p < 0.019) and total flap loss (16.7% vs. 6.6%, p < 0.033). Preoperative radiation was found to be associated with an increased complication rate (p < 0.003). CONCLUSION The mFI-5 score may be a potentially significant tool in the risk stratification of patients undergoing head and neck free-flap reconstruction as opposed to commonly utilized risk factors. Preoperative radiotherapy is significantly associated with postoperative complications. Appropriate preoperative assessment may help tailor patient care preoperatively.
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Affiliation(s)
- Sammy Othman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New Hyde Park, New York, New York
| | - Emma Robinson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, New York, New York
| | - Dev Kamdar
- Department of Otolaryngology, Northwell Health, New Hyde Park, New York, New York
| | - Lucio Pereira
- Department of Otolaryngology, Northwell Health, New Hyde Park, New York, New York
| | - Brett Miles
- Department of Otolaryngology, Northwell Health, New Hyde Park, New York, New York
| | - Armen Kasabian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New Hyde Park, New York, New York
| | - Joseph A Ricci
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New Hyde Park, New York, New York
| | - Denis Knobel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New Hyde Park, New York, New York
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Yang AZ, Shelton E, Katave C, Fruge S, Talbot SG, Eberlin KR, Orgill DP, Ranganathan KL. Outcomes of Dermal Regeneration Templates in Irradiated and Nonirradiated Scalp Defects. J Craniofac Surg 2024:00001665-990000000-01426. [PMID: 38563558 DOI: 10.1097/scs.0000000000010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES Dermal regeneration templates (DRTs) are frequently used to treat scalp defects. The aim was to compare the time course of healing for DRTs in scalp defects with and without preoperative radiation. METHODS The authors conducted a retrospective cohort study of DRT-based scalp reconstruction at 2 academic medical centers between 2013 and 2022. Information was collected on demographic variables, comorbidities, medication use, history of radiation, and DRT outcomes. The primary outcome was DRT loss, defined as exposed calvarium or DRT detachment based on postoperative follow-up documentation. Kaplan-Meier survival analysis and multivariable Cox proportional-hazard regressions were used to compare DRT loss in irradiated and nonirradiated defects. Multivariable logistic regressions were used to compare 30-day postoperative complications (infection, hematoma, or seroma) in irradiated and nonirradiated defects. RESULTS In total, 158 cases were included. Twenty-eight (18%) patients had a preoperative history of radiation to the scalp. The mean follow-up time after DRT placement was 2.6 months (SD: 4.5 mo). The estimated probability of DRT survival at 2 months was 91% (95% CI: 83%-100%) in nonirradiated patients and 65% (95% CI: 48%-88%) in irradiated patients. In the 55 patients with a bony wound base, preoperative head radiation was associated with a higher likelihood of DRT loss (hazard ratio: 11). Half the irradiated defects experienced uncomplicated total wound closure using Integra Wound Matrix Dressing with or without second-stage reconstruction. CONCLUSIONS Dermal regeneration template can offer durable coverage in nonirradiated scalp defects. Although DRT loss is more likely in irradiated scalp defects, successful DRT-based reconstruction is possible in select cases.
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Affiliation(s)
- Alan Z Yang
- Division of Plastic and Reconstructive Surgery
| | - Eva Shelton
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Coral Katave
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Seth Fruge
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Simon G Talbot
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Kyle R Eberlin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Dennis P Orgill
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Kavitha L Ranganathan
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
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3
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Othman S, Glat P. Surgical Management for Hair Restoration: A Review of Contemporary Techniques. Aesthetic Plast Surg 2023; 47:2415-2424. [PMID: 37193885 DOI: 10.1007/s00266-023-03391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Hair loss can cause psychological distress for patients, regardless of the etiology or extent of the defect. Many conservative and pharmacological approaches are successful in management, but refractory or severe cases often mandate surgical treatment. Surgical techniques have been refined over the course of a century, and we aim to review the most contemporary strategies. METHODS A review of the literature was performed using the databases PubMed, Web of Science, and Embase, in May 2020. Articles were included if they discussed techniques used within the past 10 years, in search of more contemporary strategies and the most widely used approaches. RESULTS The use of local flaps, scalp reduction surgery, and hair transplantation techniques are all used for various indications. Modern hair transplantation can be further divided into follicular unit excision and follicular unit transplantation, each with its own advantages. Local flaps are most often used for post-traumatic and reconstructive indication, while hair transplantation can be used for smaller cosmetic lesions or in combination with a variety of other reconstructive techniques. CONCLUSION Hair loss continues to be a challenging pathology for both patients and physicians, regardless of etiology. When conservative treatment is inadequate, there exist multiple surgical techniques that can feasibly restore hair, though the exact degree of success may vary between patients. The proper technique is dependent upon etiology, patient specific factors, as well as surgeon experience and comfort. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sammy Othman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwell Health, New York, NY, USA
| | - Paul Glat
- Section of Plastic Surgery, Department of Surgery, St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA.
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4
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative Antibiotikaprophylaxe in der Dermatochirurgie - Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 2: Spezielle Indikationen und Situationen. J Dtsch Dermatol Ges 2023; 21:1109-1119. [PMID: 37845076 DOI: 10.1111/ddg.15153_g] [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: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungNeben der Vermeidung postoperativer Wundinfektionen nach dermatochirurgischen Eingriffen hat die perioperative Antibiotikaprophylaxe (PAP) das Ziel, das Auftreten weiterer postoperativer Infektionskomplikationen, insbesondere der bakteriellen Endokarditis oder hämatogener Gelenkprotheseninfektionen, zu verhindern. In der vorliegenden Arbeit werden spezielle Situationen dargestellt, in denen eine PAP notwendig werden kann. So benötigen Patienten nach Herzklappenersatz jeglicher Art, einschließlich Transkatheter‐Klappenersatz oder bei Verwendung von Prothesenmaterial zur Herzklappenkorrektur, oder Patienten nach einer durchgemachten bakteriellen Endokarditis bei zweizeitigen dermatochirurgischen Eingriffen, Eingriffen an der Schleimhaut oder ulzerierten Tumoren eine PAP.Auch die Anwendung einer PAP in speziellen Situationen wie bei sekundärer Wundheilung, septischen dermatochirurgischen Eingriffen oder Ulcus cruris‐Chirurgie werden in dieser Arbeit anhand der aktuellen wissenschaftlichen Literatur ausführlich dargestellt und diskutiert. Die vorliegende Arbeit ist der 2. Teil des Positionspapiers der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie und formuliert evidenzbasierte Empfehlungen für die Verabreichung einer PAP bei dermatochirurgischen Eingriffen bei speziellen Indikationen und Situationen. Dies ist von besonderer Wichtigkeit, da bei dermatochirurgischen Eingriffen, wie im ersten Teil dargelegt, im Regelfall auf eine PAP verzichtet werden kann und sollte.
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Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal
| | - Sören L Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Lukas Kofler
- Universitäts-Hautklinik, Universitätsklinikum Tübingen, Tübingen
| | - Christian Kunte
- Dermatochirurgie und Dermatologie, Artemed Fachklinik München GmbH & Co. KG, München
| | | | - Thomas Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, München
| | - Benjamin Kendziora
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Justin Gabriel Schlager
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, München
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Ludwigshafen
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5
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Balakirski G, Becker SL, Hartmann D, Kofler L, Kunte C, Müller CSL, Volz T, Kendziora B, Schlager JG, Löser CR. Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations. J Dtsch Dermatol Ges 2023; 21:1109-1117. [PMID: 37501398 DOI: 10.1111/ddg.15153] [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: 12/27/2022] [Accepted: 05/18/2023] [Indexed: 07/29/2023]
Abstract
In addition to prevention of surgical site infections after skin surgery, perioperative antibiotic prophylaxis (PAP) aims to prevent the occurrence of other postoperative infectious complications, especially bacterial endocarditis and hematogenous joint prosthesis infections. This article discusses specific indications for the use of PAP. For example, patients who have undergone any type of heart valve replacement, including transcatheter valve replacement or use of prosthetic material to correct the heart valve, or patients who have experienced bacterial endocarditis, require PAP during skin surgery on mucosal membranes or ulcerated tumors. The use of PAP in special situations such as secondary wound healing, septic dermatosurgery or ulcer surgery is also presented and discussed in detail in this paper based on the current scientific literature. This paper represents the second part of the position paper of the Antibiotic Stewardship Working Group of the German Society for Dermatologic Surgery (DGDC) and summarizes evidence-based recommendations for the administration of PAP during skin surgery for special indications and situations. This is particularly important because, as detailed in Part 1 of this position paper, PAP can and usually should be avoided in skin surgery.
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Affiliation(s)
- Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Lukas Kofler
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Clinic Munich, Munich, Germany
| | - Cornelia S L Müller
- Medical Supply Center for Histology, Cytology, and Molecular Diagnostics Trier, Trier, Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, University Medical Center, Technical University of Munich, Munich, Germany
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Justin Gabriel Schlager
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Christoph R Löser
- Department of Dermatology, Ludwigshafen City Hospital, Ludwigshafen, Germany
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6
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Luong D, Weisel A, Cohen R, Spector JA, Sapir-Lekhovitser Y. Successful reconstruction of full-thickness skin defects in a swine model using simultaneous split-thickness skin grafting and composite collagen microstructured dermal scaffolds. Wound Repair Regen 2023; 31:576-585. [PMID: 37314212 DOI: 10.1111/wrr.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/15/2023]
Abstract
Reconstitution of normal skin anatomy after full-thickness skin loss may be accomplished using a combination of a dermal regeneration template (DRT) and a split thickness skin graft (STSG). However, because of the relatively low rate of cell infiltration and vascularisation of currently available DRTs, reconstruction is almost always performed in a two-step procedure over the course of several weeks, resulting in multiple dressing changes, prolonged immobilisation and increased chance of infection. To mitigate the potential complications of this prolonged process, the collagen-based dermal template DermiSphere™ was developed and tested in a single-step procedure wherein DermiSphere and STSG were implanted simultaneously. When evaluated in a porcine, full thickness, excisional wound model, DermiSphere successfully supported simultaneous split thickness skin graft take and induced functional neodermal tissue deposition. When compared to a market leading product Integra Bilayer Wound Matrix, which was used in a multistep procedure (STSG placed 14 days after product implantation according to the product IFU), DermiSphere induced a similar moderate and transient inflammatory response that produced similar neodermal tissue maturity, thickness and vascularity, despite being implanted in a single surgical procedure leading to wound closure 2 weeks earlier. These data suggest that DermiSphere may be implanted in a single-step procedure with an STSG, which would significantly shorten the time course required for the reconstruction of both dermal and epidermal components of skin after full thickness loss.
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Affiliation(s)
- Derek Luong
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Adam Weisel
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Rachael Cohen
- FesariusTherapeutics, Inc., New York City, New York, USA
| | - Jason A Spector
- FesariusTherapeutics, Inc., New York City, New York, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York City, New York, USA
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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Shah A, Taupin P. Single-stage extremity reconstruction through the use of dermal matrices: the power of Integra ® bilayer wound matrix in the face of medical comorbidities, patient preference and non-compliance. Case Reports Plast Surg Hand Surg 2022; 9:75-83. [PMID: 35308805 PMCID: PMC8928820 DOI: 10.1080/23320885.2022.2047052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ajul Shah
- The Plastic Surgery Center, Institute for Advanced Reconstruction, Shrewsbury, NJ, USA
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8
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Dibbs RP, Depani M, Thornton JF. Technical Refinements with the Use of Biologic Healing Agents. Semin Plast Surg 2022; 36:8-16. [PMID: 35706558 PMCID: PMC9192159 DOI: 10.1055/s-0042-1742749] [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: 10/19/2022]
Abstract
Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.
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Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390
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