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Taghlabi KM, Bhenderu LS, Guerrero JR, Hagopian ADLF, Farhat S, Rajendran S, Cruz-Garza JG, Dinh T, Faraji AH. Treatment of Intrathecal Drug Pump Flipping Using Fascial Flaps: A Technical Description and Case Series. Oper Neurosurg (Hagerstown) 2024; 26:309-313. [PMID: 37890096 DOI: 10.1227/ons.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intrathecal drug therapy is a common treatment for dystonia, pain, and spasticity using implanted pump and catheter systems. Standardized management of intrathecal drug pump (ITDP) migration and flipping has not been well established in the literature. This study reports the use of soft tissue to address less common pump complications such as pump flipping, migration, and difficulty in medication refill. METHODS A retrospective chart review of intrathecal pump cases performed by two surgeons between February 2020 and August 2022 was conducted. Patients with complications such as pump flipping, migration, or challenges in medication refill treated with soft tissue flaps were included. Patient demographics, comorbidities, and perioperative data were collected. RESULTS A total of five patients with ITDP complicated by pump flipping, migration, malposition, or difficulty in medication refill that were treated using fascial flaps were included in the study. Three technical considerations when revising ITDP complications are secure pump anchoring, reliable wound closure, and ease of pump medication refill. Cases 1 and 2 demonstrate the technique of secure pump anchoring with a rectus fascial flap. Cases 3 and 4 show a technique to achieve reliable vascularized wound closure, and case 5 describes a technique to solve an uncommon problem of a thick subcutaneous abdominal tissue preventing the refill of the ITDP medication. CONCLUSION Soft tissue flaps may serve as a treatment option for patients with uncommon ITDP complications. De-epithelialized dermal fasciocutaneous or fascial flaps may be developed to anchor the pump more securely. Cross-discipline collaboration may further delineate the technique, benefits, and outcomes of this approach.
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Affiliation(s)
- Khaled M Taghlabi
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
| | - Lokeshwar S Bhenderu
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
| | - Jaime R Guerrero
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
| | - Alexa De la Fuente Hagopian
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston , Texas , USA
| | - Souha Farhat
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston , Texas , USA
| | - Sibi Rajendran
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
| | - Jesus G Cruz-Garza
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
| | - Tue Dinh
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston , Texas , USA
| | - Amir H Faraji
- Department of Neurological Surgery, Houston Methodist Hospital, Houston , Texas , USA
- Clinical Innovations Laboratory, Houston Methodist Research Institute, Houston , Texas , USA
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De la Fuente Hagopian A, Guadarrama-Sistos Vazquez S, Farhat S, Reddy NK, Trakhtenbroit MA, Echo A. The emerging role of MRI neurography in the diagnosis of chronic inguinal pain. Langenbecks Arch Surg 2023; 408:319. [PMID: 37594580 DOI: 10.1007/s00423-023-03050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Chronic pain is a frequent and notable complication after inguinal hernia repair, it has been extensively studied, but its management and diagnosis are still difficult. The cause of chronic pain following inguinal hernia surgery is usually multifactorial. This case series highlights the utility of MRI neurography (MRN) in evaluating the damage to inguinal nerves after a hernia repair, with surgical confirmation of the preoperative imaging findings. MATERIALS AND METHODS A retrospective review was performed on patients who underwent inguinal mesh removal and triple denervation of the groin. Inclusion criteria included MRI neurography. All patients underwent surgical exploration of the inguinal canal for partial or complete mesh removal and triple denervation of the groin by the same senior surgeon. RESULTS A total of nine patients who underwent triple denervation were included in this case series. MRN was then performed on 100% of patients. The postoperative mean VAS score adjusted for all patients was 1.6 (SD p), resulting in a 7.5 score difference compared to the preoperative VAS score (p). Since chronic groin pain can be a severely debilitating condition, diagnosis, and treatment become imperative. CONCLUSION MRN can detect direct and indirect signs of neuropathy even in the absence of a detectable compressive cause aids in management and diagnosis by finding the precise site of injury, and grading nerve injury to aid pre-operative assessment for the nerve surgeon. Thus, it is a valuable diagnostic tool to help with the diagnosis of nerve injuries in the setting of post-inguinal hernia groin pain.
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Affiliation(s)
- Alexa De la Fuente Hagopian
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Souha Farhat
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Michael A Trakhtenbroit
- Department of Radiology, Houston Methodist Hospital, Houston, TX, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Anthony Echo
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA.
- Texas A&M Medicine, College Station, TX, USA.
- Weill Cornell Medicine, New York, NY, USA.
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Gravina P, Farhat S, Jaraki D, De la Fuente Hagopian A, Echo A, Dinh TA. Treatment of Symptomatic Labia Minora Neuroma After Labiaplasty to Prevent Recurrence. J Low Genit Tract Dis 2023; 27:180-182. [PMID: 36649239 DOI: 10.1097/lgt.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Paula Gravina
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Souha Farhat
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Dima Jaraki
- Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, TX
| | | | - Anthony Echo
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
| | - Tue A Dinh
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX
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De la Fuente Hagopian A, Farhat S, Doval AF, Reddy NK, Yazid MM, Echo A. Feasibility for Immediate Targeted Muscle Reinnervation Based on Lower Extremity Amputations Trends. Plast Reconstr Surg Glob Open 2023; 11:e4923. [PMID: 37073253 PMCID: PMC10106129 DOI: 10.1097/gox.0000000000004923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023]
Abstract
Targeted muscle reinnervation has been adopted as a strategy for the management and prevention of phantom limb pain and symptomatic neuroma formation for patients undergoing lower extremity amputation. The procedure is often performed by surgeons different from those performing the amputation, creating scheduling dilemmas. The purpose of this study was to analyze historic trends in lower extremity amputation scheduling in a single hospital system to evaluate if offering routine immediate targeted muscle reinnervation is practical. Methods De-identified data over a five-year period for all patients undergoing lower extremity amputation were collected. The data gathered included the specialty performing the amputation, weekly distribution of cases, start time, and end time, among others. Results A total of 1549 lower extremity amputations were performed. There was no statistically significant difference in average number of below-the-knee amputations (172.8) and above-the-knee amputations (137.4) per year. Top specialties performing amputations were vascular surgery (47.8%), orthopedic surgery (34.5%), and general surgery (13.85%). No significant difference was noted in the average number of amputations across the week, per year. Most cases started between 6 am and 6 pm (96.4%). The average length of stay after surgery was 8.26 days. Conclusions In a large, nontrauma hospital system, most lower extremity amputations are performed during typical working hours and are evenly distributed throughout the week. Understanding peak timing of amputations may allow for targeted muscle reinnervation to be performed concurrently with amputation procedure. Data presented will be a first step to optimizing amputation scheduling for patients in a large nontrauma health system.
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Affiliation(s)
- Alexa De la Fuente Hagopian
- From The Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex
| | - Souha Farhat
- From The Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex
| | - Andres F. Doval
- From The Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex
| | - Narainsai K. Reddy
- Texas A&M Health Science Center, Engineering Medicine (EnMed), Houston, Tex
| | - Mark M. Yazid
- From The Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex
| | - Anthony Echo
- From The Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Tex
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Yazid MM, De la Fuente Hagopian A, Farhat S, Doval AF, Echo A, Pei KY. Does Surgeon Specialty Make a Difference in Ventral Hernia Repair With the Component Separation Technique? Cureus 2022; 14:e26290. [PMID: 35898356 PMCID: PMC9308972 DOI: 10.7759/cureus.26290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
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