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Atherton KM, Shope CN, Andrews LA, Robinson-Pirotte IS, Wine Lee L, Cotton CH. The management of pediatric hidradenitis suppurativa differs between dermatologic and non-dermatologic providers: A retrospective review. Pediatr Dermatol 2024; 41:28-33. [PMID: 38018236 PMCID: PMC10842160 DOI: 10.1111/pde.15466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/17/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND/OBJECTIVES There is a paucity of pediatric hidradenitis suppurativa (HS) literature. The objective of this study was to characterize differences in management of pediatric HS patients by dermatology versus non-dermatology clinicians. METHODS We examined a retrospective cohort of 195 pediatric patients with HS seen at our institution (3/1/19-3/1/20). Two-sample t-tests and two-proportion z-tests were performed. RESULTS A total of 76.1% of subjects were seen by dermatology at least once, and of these, 79.1% were referred. HS diagnosis was most often made by dermatology (36.6%), followed by pediatrics (21.6%). Patients managed by dermatology were significantly more likely to have used standard of care therapies (p < .001). Of dermatology-managed patients, 19.7% were currently prescribed a biologic, as compared with zero patients not managed by dermatology. Those managed by dermatology were less likely to undergo surgical excision (13.3% vs. 25.5%, p = .04). CONCLUSIONS Our results support increased likelihood of treatment escalation with medical management by dermatologists. Relatively high utilization of referral to dermatology exists, but with only moderate patient adherence. There is a need for improved access to dermatologic care and prospective studies to determine whether differences in specialty management translate to improved patient outcomes.
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Affiliation(s)
- Kelly M Atherton
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chelsea N Shope
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Laura A Andrews
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Lara Wine Lee
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colleen H Cotton
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
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2
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Panayi AC, Matar DY, Haug V, Wu M, Orgill DP. Characteristics and Outcomes of Patients Undergoing Surgical Management of Hidradenitis Suppurativa: An ACS-NSQIP Data Analysis. Adv Wound Care (New Rochelle) 2023; 12:256-268. [PMID: 35152778 DOI: 10.1089/wound.2021.0132] [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: 11/12/2022] Open
Abstract
Objective: Hidradenitis suppurativa (HS) is a painful inflammatory skin disease. Management is largely medical, with surgery reserved for severe refractory cases. In this study, we sought to conduct a retrospective analysis of a multi-institutional surgical database to investigate the surgical management of patients with HS and identify trends in the postoperative outcomes. Approach: The 2011-2019 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to identify patients who underwent surgery for management of HS. Postoperative outcomes were assessed, including surgical and medical complications, length of hospital stay, reoperation, readmission, and nonhome discharge. This article was reported according to the STROBE criteria. Results: We identified 1,030 patients, of which 62% were female and 50% were black. The most common comorbidity was obesity (61%). Surgery was mainly performed by general surgeons (62%) and plastic surgeons (31%). Complications were overall low, with readmission being the most common (7.1%, unplanned 6.0%), followed by reoperation (5.8%). The most common surgical complication was superficial incisional infection (5.1%) and most common medical complication was sepsis (3.8%). Obesity is seen to affect surgical complication rates, with patients with obesity having higher rates of dehiscence (obese: 3.1% and nonobese: 1.0%; p = 0.03) but lower rates of organ space infection (obese: 0.5% and nonobese: 2.0%; p = 0.03) and transfusion (obese: 2.5% and nonobese: 5.2%; p = 0.04). A focus on complications in patients undergoing flap reconstruction (n = 293; 23%), identified higher rates of surgical complications, with superficial incisional infection being the most common (flap reconstruction: 7.5% and incision and drainage, debridement, skin graft: 4.1%; p = 0.04). Innovation: The surgical management of HS is analyzed at the national level, with postoperative complications seen to depend on race and obesity-status. Conclusions: Surgical management for HS is associated with low postoperative complications, making surgery a viable treatment option for this debilitating disease.
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Affiliation(s)
- Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dany Y Matar
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biology, Washington University in St Louis, St Louis, Missouri, USA
| | - Valentin Haug
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Mengfan Wu
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Plastic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Dennis P Orgill
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Masson R, Parvathala N, Ma E, Shih T, Atluri S, Sayed CJ, Hogeling M, Shi VY, Hsiao JL. Efficacy of procedural treatments for pediatric hidradenitis suppurativa: A systematic review. Pediatr Dermatol 2023. [PMID: 37092729 DOI: 10.1111/pde.15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/01/2023] [Indexed: 04/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a painful, inflammatory skin disease that has historically been understudied in the pediatric population. Procedural interventions, such as surgical excisions, skin grafts, and lasers, are important for comprehensive HS disease management. However, there is a lack of data on procedural treatments for HS in pediatric patients. The purpose of this study was to conduct a systematic review of the literature on the efficacy and safety of procedural treatments for HS in pediatric patients. In April 2022, MEDLINE and EMBASE databases were searched for articles on the efficacy of procedural treatments for HS in patients <18 years of age. Two independent reviewers extracted data from relevant studies. From 1974 to 2021, 23 articles with 81 patients were identified. Patients' Hurley stages included stage I (9.1%, 1/11), II (36.4%, 4/11), and III (54.5%, 6/11). The most extensively studied procedural interventions include negative pressure wound therapy (n = 30), surgical excision with skin graft/flap (n = 19), and endoscopic electrode or laser treatment (n = 11). In all, promising response rates for procedural management strategies were observed in the literature but the findings were largely based on case reports/series. Randomized controlled trials (RCTs), especially those geared toward minimally invasive procedural treatments, are needed to help guide clinicians on the most efficacious treatment modalities for pediatric patients with HS.
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Affiliation(s)
- Rahul Masson
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Neha Parvathala
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Elaine Ma
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Swetha Atluri
- College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Christopher J Sayed
- Department of Dermatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcia Hogeling
- Division of Dermatology, University of California, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
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4
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Wound Closure with Transcutaneous Absorbable Polyglactin Sutures after Hidradenitis Suppurativa Excision. Adv Skin Wound Care 2022; 35:1-4. [PMID: 35050922 DOI: 10.1097/01.asw.0000805360.14633.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Wide surgical excision is the standard treatment for severe hidradenitis suppurativa (HS). Because of the nature of HS, these wounds are often nonsterile, located in moist intertriginous regions, and closed under tension, increasing the risk for surgical site complications. Although uncommon, absorbable sutures may confer benefits over nonabsorbable material for skin closure. Accordingly, the authors evaluated the use of absorbable, braided, transcutaneous polyglactin sutures after wide surgical excision of HS. METHODS The authors performed a retrospective chart review for all consecutive patients who underwent wide surgical excision of HS at a tertiary university hospital between January 2009 and March 2020. RESULTS Sixty consecutive patients with 174 operative sites were included in the study. The surgical site complication rate was 17.8%. Postoperative complications included wound dehiscence (n = 18), surgical site infection (n = 2), and scar contracture (n = 1). Sutures were removed from 12 (6.9%) operative sites. Factors influencing complications were Hurley grade and area of excision. Complications did not differ significantly among disease locations (P = .6417). CONCLUSIONS The results support the growing evidence that absorbable sutures are an appropriate option after wide surgical excision of HS.
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Okoji UK, Agim NG, Heath CR. Features of Common Skin Disorders in Pediatric Patients with Skin of Color. Dermatol Clin 2022; 40:83-93. [PMID: 34799038 DOI: 10.1016/j.det.2021.09.002] [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: 11/03/2022]
Abstract
Many dermatologic conditions common in the pediatric population may have unique presentations in skin of color or occur with greater incidence. This may be due to ethnic origin, socioeconomic factors, or other influences. Awareness of the potential variations in skin of color may enhance prompt diagnosis, appropriate treatment, and/or reassurance as indicated.
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Affiliation(s)
- Uchenna K Okoji
- Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Nnenna G Agim
- University of Texas Southwestern, 2350 North Stemmons Freeway, Dallas, TX 75220, USA
| | - Candrice R Heath
- Lewis Katz School of Medicine, Temple University, 3401 North Broad Street, 5-OPB Dermatology, Philadelphia, PA 19140, USA.
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The utility of incisional vacuum-assisted closure in surgical Management of Hidradenitis Suppurativa: a retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01788-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Țarcă E, Cojocaru E, Caba B, Luca AC, Roșu ST, Țarcă V, Stătescu L, Chiriac A, Lupu VV, Moroșan E, Trandafir L. Multidisciplinary Management of Adolescents with Hidradenitis Suppurativa - Series of Cases and Literature Review. J Multidiscip Healthc 2021; 14:2205-2216. [PMID: 34429610 PMCID: PMC8378912 DOI: 10.2147/jmdh.s324325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a recurrent chronic inflammatory condition of the skin with a debilitating potential, especially in adolescents who may experience psychosocial disorders and impaired quality of life. Recognition of typical, recurrent lesions, history of the disease and family investigation establishes the diagnosis. The rarity of the disease in males and the appearance of this condition in children, which is also rare, in two of our adolescent patients, respectively, are the reasons for publishing this article. We reviewed the literature and found that variation exists across international treatment for this HS, and much collaboration is needed to put forth unified and updated recommendations. It is of major importance that the early recognition of the condition and the establishment of treatment in the multidisciplinary team. Psychotherapy, health education, the adoption of a healthy lifestyle, the application of local prevention measures, and long-term medical treatment are components of a correct management. Extensive surgical treatment should be restricted only to severe cases because it may lead to complications, extend the hospitalization period and increase psychological problems in adolescents. The treatment will be personalized, performed according to the stage of evolution, and the approach will be a multidisciplinary one. ![]()
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Affiliation(s)
- Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania.,"Saint Mary" Emergency Children's Hospital, Iași, Romania
| | - Elena Cojocaru
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Bogdan Caba
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Biomedical Sciences, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Alina Costina Luca
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Solange Tamara Roșu
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Nursing, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Viorel Țarcă
- County Statistics Department, Iaşi, 700115, Romania
| | - Laura Stătescu
- Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Anca Chiriac
- Department of Dermatophysiology, Apollonia University, Iasi, 700613, Romania
| | - Valeriu Vasile Lupu
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Eugenia Moroșan
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Morphofunctional Sciences I - Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
| | - Laura Trandafir
- "Saint Mary" Emergency Children's Hospital, Iași, Romania.,Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, 700115, Romania
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8
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Hidradenitis suppurativa in pediatric patients. J Am Acad Dermatol 2020; 86:140-147. [PMID: 32822788 DOI: 10.1016/j.jaad.2020.08.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
Interest in and research on hidradenitis suppurativa (HS) have increased during the past decade, resulting in expanded knowledge about associated comorbidities and treatment efficacy. Knowledge about pediatric-onset HS is still limited, based on case studies, small case series, and extrapolation from adult studies. With increasing prevalence of childhood obesity, decreasing pubertal age, and increasing awareness of HS, physicians may start encountering younger HS patients. This review presents an updated discussion on the epidemiology, pathophysiology, and associated comorbidities in HS, with a focus on pediatric and adolescent patients. It also suggests recommendations for investigation and treatment based on current evidence.
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9
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Vaiopoulos AG, Nikolakis G, Zouboulis CC. Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature. J Eur Acad Dermatol Venereol 2020; 34:2140-2146. [PMID: 32324936 DOI: 10.1111/jdv.16520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle affecting apocrine glands-rich areas of the body. The disease usually occurs after puberty leading to painful nodules, abscesses, tunnels and scarring. Although uncommonly, HS can also occur in children and adolescents. OBJECTIVE Our objective was to describe the epidemiology, characteristics, predisposing factors and clinical course of HS in paediatric patients. METHODS The retrospective cohort study included patients with HS, who have been diagnosed in Dessau Medical Center and reported development of HS during childhood or adolescence, fulfilled the diagnostic criteria for HS and had a follow-up period of at least one year. A systematic review was conducted on MEDLINE, EMBASE and CENTRAL on 19 March 2020 using the terms 'hidradenitis' or 'acne inversa' together with the terms 'children', 'paediatric' and 'adolescence'. RESULTS Twenty paediatric patients [1 child (0.22%), 19 adolescents (4.25%)] were detected out of 447 patients evaluated (4.5%) with a male to female ratio of 1.86 : 1. The median age at diagnosis was 17 years [interquartile range (IQR) 16-18] and the median age at onset 15 years (IQR: 14-16.5). The majority of the patients suffered from moderate disease were overweight or obese and non-smokers. The most common comorbid disorder was acne vulgaris. The systematic review revealed reports with data heterogeneity and lack of systematic documentation of specific demographic characteristics. Most paediatric patients were female, obese and non-smokers, with considerable comorbid disorders. CONCLUSIONS Hidradenitis suppurativa in Germany may affect children and adolescents exhibiting a particular phenotype of mainly male non-smokers.
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Affiliation(s)
- A G Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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10
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Wu Y, Ngaage LM, Ge S, Rada EM, Silverman RP, Rasko YM. Reconstruction for axillary hidradenitis suppurativa using one-stage local tissue rearrangement: A retrospective analysis of 53 cases. Int Wound J 2020; 17:701-707. [PMID: 32067416 DOI: 10.1111/iwj.13319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Wide local excision offers a potential cure for severe axillary hidradenitis suppurativa. However, the gold standard for reconstruction has yet to be defined. Here, we describe our rotation advancement flap technique, which allows for one-stage closure of large axillary defects, with minimal functional morbidity to the axilla. We performed a retrospective review of all patients who underwent one-stage surgical management for axillary hidradenitis suppurativa at a single-centre tertiary care hospital from 2009 to 2018. We identified 34 patients, with a total of 53 operative sites. The majority were female (85%) with a mean age of 31 years and body mass index 35 kg/m2 . The median defect size was 84 cm2 and the majority were treated using the rotation advancement flap technique (86%). A quarter of operative sites experienced minor complications with only one requiring re-operation. At a median follow-up of 32 months, two (4%) sites showed decreased range of motion. However, all patients had achieved remission without any further recurrence of disease. We describe a one-stage rotation advancement flap technique for management of moderate to severe hidradenitis suppurativa that achieves a high local cure rate, minimal functional morbidity, and acceptable wound complication rates.
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Affiliation(s)
- Yinglun Wu
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shealinna Ge
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Erin M Rada
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ronald P Silverman
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.,Acelity Corporation, San Antonio, Texas
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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