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Brydges HT, Onuh OC, Friedman R, Barrett J, Betensky RA, Lu CP, Caplan AS, Alavi A, Chiu ES. Autoimmune, Autoinflammatory Disease and Cutaneous Malignancy Associations with Hidradenitis Suppurativa: A Cross-Sectional Study. Am J Clin Dermatol 2024; 25:473-484. [PMID: 38337127 DOI: 10.1007/s40257-024-00844-5] [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] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating cutaneous disease characterized by severe painful inflammatory nodules/abscesses. At present, data regarding the epidemiology and pathophysiology of this disease are limited. OBJECTIVE To define the prevalence and comorbidity associations of HS. METHODS This was a cross-sectional study of EPICTM Cosmos© examining over 180 million US patients. Prevalences were calculated by demographic and odds ratios (OR) and identified comorbidity correlations. RESULTS All examined metabolism-related, psychological, and autoimmune/autoinflammatory (AI) diseases correlated with HS. The strongest associations were with pyoderma gangrenosum [OR 26.56; confidence interval (CI): 24.98-28.23], Down syndrome (OR 11.31; CI 10.93-11.70), and polycystic ovarian syndrome (OR 11.24; CI 11.09-11.38). Novel AI associations were found between HS and lupus (OR 6.60; CI 6.26-6.94) and multiple sclerosis (MS; OR 2.38; CI 2.29-2.48). Cutaneous malignancies were largely not associated in the unsegmented cohort; however, among Black patients, novel associations with melanoma (OR 2.39; CI 1.86-3.08) and basal cell carcinoma (OR 2.69; CI 2.15-3.36) were identified. LIMITATIONS International Classification of Diseases (ICD)-based disease identification relies on coding fidelity and diagnostic accuracy. CONCLUSION This is the first study to identify correlations between HS with melanoma and basal cell carcinoma (BCC) among Black patients as well as MS and lupus in all patients with HS.
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Affiliation(s)
- Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Rebecca Friedman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Joy Barrett
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | | | - Catherine P Lu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA.
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Laspro M, Stead TS, Barrow B, Brydges HT, Onuh OC, Gelb BE, Chiu ES. Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients. Clin Transplant 2024; 38:e15226. [PMID: 38289878 DOI: 10.1111/ctr.15226] [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: 08/26/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND As the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body-habitus related comorbidities with End-Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population. METHODS In order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population. RESULTS From the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub-analysis of specific types of complications, the only retained association was between diabetes and wound complication. CONCLUSION Preliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post-transplantation outcomes, including long-term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation.
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Affiliation(s)
- Matteo Laspro
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Thor S Stead
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Brooke Barrow
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Bruce E Gelb
- Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, New York, USA
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Stead TS, Brydges HT, Laspro M, Onuh OC, Chaya BF, Rabbani PS, Lu CP, Ceradini DJ, Gelb BE, Rodriguez ED. Minimally and Non-invasive Approaches to Rejection Identification in Vascularized Composite Allotransplantation. Transplant Rev (Orlando) 2023; 37:100790. [PMID: 37625211 DOI: 10.1016/j.trre.2023.100790] [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: 06/30/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Rejection is common and pernicious following Vascularized Composite Allotransplantation (VCA). Current monitoring and diagnostic modalities include the clinical exam which is subjective and biopsy with dermatohistopathologic Banff grading, which is subjective and invasive. We reviewed literature exploring non- and minimally invasive modalities for diagnosing and monitoring rejection (NIMMs) in VCA. METHODS PubMed, Cochrane, and Embase databases were queried, 3125 unique articles were reviewed, yielding 26 included studies exploring 17 distinct NIMMs. Broadly, NIMMs involved Imaging, Liquid Biomarkers, Epidermal Sampling, Clinical Grading Scales, and Introduction of Additional Donor Tissue. RESULTS Serum biomarkers including MMP3 and donor-derived microparticles rose with rejection onset. Epidermal sampling non-invasively enabled measurement of cytokine & gene expression profiles implicated in rejection. Both hold promise for monitoring. Clinical grading scales were useful diagnostically as was reflection confocal microscopy. Introducing additional donor tissue showed promise for preemptively identifying rejection but requires additional allograft tissue burden for the recipient. CONCLUSION NIMMs have the potential to dramatically improve monitoring and diagnosis in VCA. Many modalities show promise however, additional research is needed and a multimodal algorithmic approach should be explored.
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Affiliation(s)
- Thor S Stead
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America.
| | - Hilliard T Brydges
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Matteo Laspro
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Ogechukwu C Onuh
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Bachar F Chaya
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Piul S Rabbani
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Catherine P Lu
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Daniel J Ceradini
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
| | - Bruce E Gelb
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Eduardo D Rodriguez
- Hansjorg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, United States of America
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Laspro M, Onuh OC, Carrion K, Brydges HT, Tran DL, Chaya BF, Parker A, Thanik VD, Sharma S, Rodriguez ED. Vascularized Composite Allotransplantation of the Hand: A Systematic Review of Eligibility Criteria. Ann Plast Surg 2023; 91:771-778. [PMID: 37553908 DOI: 10.1097/sap.0000000000003659] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND Hand transplantation (HT) has emerged as an intervention of last resort for those who endured amputation or irreparable loss of upper extremity function. However, because of the considerable effort required for allograft management and the risks of lifelong immunosuppression, patient eligibility is critical to treatment success. Thus, the objective of this article is to investigate the reported eligibility criteria of HT centers globally. METHODS A systematic review of the HT literature was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, using PubMed, Cochrane, Ovid/Medline, and Scopus. Program Web sites and clinicaltrials.gov entries were included where available. RESULTS A total of 354 articles were reviewed, 101 of which met inclusion criteria. Furthermore, 10 patient-facing Web sites and 11 clinical trials were included. The most reported criteria related to the capacity to manage the allograft posttransplantation, including access to follow-up, insurance coverage, psychological stability, and history of medical compliance. Other factors related to the impact of immunosuppression, such as active pregnancy and patient immune status, were less emphasized. CONCLUSIONS Because of the novelty of the field, eligibility criteria continue to evolve. While there is consensus on certain eligibility factors, other criteria diverge between programs, and very few factors were considered absolute contraindications. As the popularity of the field continues to grow, we encourage the development of consensus evidence-based eligibility criteria.
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Affiliation(s)
- Matteo Laspro
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Ogechukwu C Onuh
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | | | - Hilliard T Brydges
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - David L Tran
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Bachar F Chaya
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Augustus Parker
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Vishal D Thanik
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Sheel Sharma
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
| | - Eduardo D Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine
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Brydges HT, Onuh OC, Chaya BF, Tran DL, Cassidy MF, Dedania VS, Ceradini DJ, Rodriguez ED. Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment. Plast Reconstr Surg Glob Open 2023; 11:e5409. [PMID: 38025647 PMCID: PMC10653600 DOI: 10.1097/gox.0000000000005409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
Background In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessment for FWET to date, including rehearsal allograft procurement on a brain-dead donor. Methods Over a 2-year period, 15 rehearsal dissections were performed on 21 cadavers and one brain-dead donor. After identification of a potential recipient, rehearsals assessed clinical feasibility and enabled operative planning, technical practice, refinement of personalized equipment, and improved communication among team members. Operative techniques are described. Results Facial allograft procurement closely followed previously described face transplant techniques. Ophthalmic to superficial temporal (O-ST) vessel anastomosis for globe survival was assessed. Craniectomy allowed for maximal optic nerve and ophthalmic vessel pedicle length. Appropriate pedicle length and vessel caliber for O-ST anastomosis was seen. Research procurement demonstrated collateral blood flow to the orbit and surrounding structures from the external carotid system as well as confirmed the feasibility of timely O-ST anastomosis. Personalized cutting guides enabled highly accurate bony inset. Conclusions This study formalizes an approach to FWET, which is feasible for clinical translation in judiciously selected patients. O-ST anastomosis seems to minimize retinal ischemia time and allow perfusion of the combined allograft on a single external carotid pedicle. Although restoration of vision likely remains out of reach, globe survival is possible.
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Affiliation(s)
- Hilliard T. Brydges
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - Ogechukwu C. Onuh
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - Bachar F. Chaya
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - David L. Tran
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - Michael F. Cassidy
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - Vaidehi S. Dedania
- Department of Ophthalmology at NYU Grossman School of Medicine, New York, N.Y
| | - Daniel J. Ceradini
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
| | - Eduardo D. Rodriguez
- From Hansjorg Wyss Department of Plastic Surgery at NYU Grossman School of Medicine, New York, N.Y
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Trilles J, Onuh OC, Chaya BF, Rodriguez ED. Mandible Reconstruction in the Setting of Face Transplant. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:187-196. [PMID: 37500202 DOI: 10.1016/j.cxom.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | | | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA.
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Laspro M, Onuh OC, Cohen RF, Cooper BT, Chiu ES. The Role of Radiation Therapy in Adult and Pediatric Keloid Management: A National Survey of Radiation Oncologists. Ann Plast Surg 2023; 91:215-219. [PMID: 37489962 DOI: 10.1097/sap.0000000000003609] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Radiation therapy is a promising modality for treating keloids after surgical excision. However, it is currently not standard practice among physicians because of concern surrounding the risk of radiation-induced secondary cancers, especially among pediatric patients. There is minimal research assessing the complications for radiation therapy in keloid management. AIM The goal of this study was to determine radiation oncologists' perspectives about the utility and appropriateness of radiation therapy for keloid management in both adult and pediatric patients. This study also aimed to characterize radiation modality, dose, fractionation, and secondary complications observed by providers. METHODS An electronic survey was delivered to 3102 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the United States. Rates of responses were analyzed. RESULTS A total of 114 responses from practicing radiation oncologists were received. Of these, 113 providers (99.1%) supported radiation therapy for keloid management in adults, whereas only 54.9% supported radiation therapy for pediatric patients. Of 101 providers that treated adults in the past year, the majority used external beam: electrons (84.2%), applied 3 fraction regimens (54.4%), and delivered radiation within 24 hours postexcision (45.5%). In pediatric patients, only 42 providers reported treating at least 1 patient. The majority used electron beam radiation (76.2%), applied 3 faction regimens (65%), and delivered radiation on the same day of keloid excision (50.0%) The main concern when treating pediatric patients were risk of secondary malignancy (92.1%). CONCLUSION Although radiation therapy appears to be a widely accepted adjuvant treatment option for adults with keloids, the use of radiation therapy for pediatric patients is less widely accepted because of concerns regarding secondary malignancy. The findings suggest additional studies need to be carried out to assess the risk of those complications.
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Affiliation(s)
- Matteo Laspro
- From the Hansjörg Wyss Department of Plastic Surgery
| | | | - Richard F Cohen
- Department of Radiation Oncology, New York University, Langone Health, New York, NY
| | - Benjamin T Cooper
- Department of Radiation Oncology, New York University, Langone Health, New York, NY
| | - Ernest S Chiu
- From the Hansjörg Wyss Department of Plastic Surgery
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Chaya BF, Rodriguez Colon R, Diep GK, Brydges H, Tran D, Laspro M, Onuh OC, Trilles J, Boczar D, Rodriguez ED. Comparative Outcomes of Malar Implants Versus Fat Transfer to Cheeks Among Transfeminine Individuals Undergoing Malar Augmentation. Ann Plast Surg 2023; 90:S457-S461. [PMID: 37399477 DOI: 10.1097/sap.0000000000003491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Malar augmentation is a key procedure sought out by transfeminine individuals seeking to feminize their facial appearance. Different surgical techniques have been described in the literature including fat transfer to the cheeks and malar implant placement. Because of the paucity of information in the literature, there is no consensus on best practices for this procedure. The objective of our study is to determine the effectiveness and safety of malar implants as compared with fat transfer to the cheeks in transfeminine individuals. METHODS We examined all patients with the diagnosis of gender dysphoria that were referred to the senior author seeking consultation for feminizing facial procedures between June 2017 and August 2022. Patients who underwent fat transfer to the cheeks or malar implant placement were included in our study. We reviewed the electronic medical record of each patient, and we retrieved and analyzed data regarding demographics, medical and surgical history, operative dictations, clinic notes, and postoperative follow-up. Univariate analysis was used to assess for differences in postoperative complications between these 2 groups. RESULTS We identified 231 patients underwent feminizing facial gender affirming surgery, with 152 patients receiving malar augmentation through malar implants or fat grafting. One hundred twenty-nine patients (84.9%) underwent malar implant placement and 23 (15.1%) underwent fat grafting to the cheeks. The mean follow-up time was 3.6 ± 2.7 months. Patient satisfaction was greater in the malar implant group (126/129, 97.7%) compared with the fat transfer group (20/23, 87%, P < 0.045). Two patients who received implants (1.8%) experienced postoperative complications. No patient undergoing fat transfer experiences similar adverse outcomes. Nevertheless, the difference was not statistically significant (P = 1.00). CONCLUSIONS Our findings support the contention that malar implants are a safe alternative for malar augmentation among transfeminine individuals. While autologous fat transfer to the cheek is an indispensable option in patients requiring minor malar enhancement, malar implants offer a more permanent option with a better aesthetic outcome in patients requiring major malar enhancement. To minimize postoperative complications, surgeons should emphasize patient compliance with postoperative directions.
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Affiliation(s)
- Bachar F Chaya
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine; New York, NY
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Laspro M, Chaya BF, Brydges HT, Dave N, Thys E, Onuh OC, Tran D, Kimberly LL, Ceradini DJ, Rodriguez ED. Technical Feasibility of Whole-eye Vascular Composite Allotransplantation: A Systematic Review. Plast Reconstr Surg Glob Open 2023; 11:e4946. [PMID: 37113307 PMCID: PMC10129168 DOI: 10.1097/gox.0000000000004946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/22/2023] [Indexed: 04/29/2023]
Abstract
There are over 43 million individuals in the world who are blind. As retinal ganglion cells are incapable of regeneration, treatment modalities for this condition are limited. Since first incepted in 1885, whole-eye transplantation (WET) has been proposed as the ultimate cure for blindness. As the field evolves, different aspects of the surgery have been individually explored, including allograft viability, retinal survival, and optic nerve regeneration. Due to the paucity in the WET literature, we aimed to systematically review proposed WET surgical techniques to assess surgical feasibility. Additionally, we hope to identify barriers to future clinical application and potential ethical concerns that could be raised with surgery. Methods We conducted a systematic review of PubMed, Embase, Cochrane Library, and Scopus from inception to June 10, 2022, to identify articles pertaining to WET. Data collection included model organisms studied, surgical techniques utilized, and postoperative functional outcomes. Results Our results yielded 33 articles, including 14 mammalian and 19 cold-blooded models. In studies performing microvascular anastomosis in mammals, 96% of allografts survived after surgery. With nervous coaptation, 82.9% of retinas had positive electroretinogram signals after surgery, indicating functional retinal cells after transplantation. Results on optic nerve function were inconclusive. Ocular-motor functionality was rarely addressed. Conclusions Regarding allograft survival, WET appears feasible with no complications to the recipient recorded in previous literature. Functional restoration is potentially achievable with a demonstrated positive retinal survival in live models. Nevertheless, the potential of optic nerve regeneration remains undetermined.
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Affiliation(s)
- Matteo Laspro
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Bachar F. Chaya
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Hilliard T. Brydges
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Nikhil Dave
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Erika Thys
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Ogechukwu C. Onuh
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - David Tran
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Laura L. Kimberly
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
- Department of Population Health, NYU Grossman School of Medicine, New York, N.Y
| | - Daniel J. Ceradini
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
| | - Eduardo D. Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, N.Y
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Brydges HT, McDonnell G, Nasr HY, Chaya BF, Onuh OC, Alfonso AR, Ceradini DJ. The impact of youth-onset type 2 diabetes on postoperative wound healing complications. Wound Repair Regen 2023; 31:187-192. [PMID: 36515565 DOI: 10.1111/wrr.13064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/04/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Youth-onset type 2 diabetes mellitus is associated with a more rapid decline in β cells, and earlier onset of medical complications compared to adult-onset diabetes. However, its impact on surgical wounds remains less clear. Therefore, this study aimed to determine whether youth-onset diabetes is a risk factor for wound healing complications in the 30-day postoperative period. To do so, the National Surgical Quality Improvement Program Database years 2012-2019 was analysed. Patients aged 18-24 with non-insulin-dependent diabetes were included. Outcomes assessed included wound infections, wound dehiscence, readmissions, and reoperation. Univariate analysis identified differences between the diabetic and non-diabetic cohorts after which, multivariate logistic regression was employed to control for potential confounding. Analysis included 1589 diabetic and 196,902 non-diabetic patients ages 18-24. The diabetic cohort exhibited a higher proportion of female (83.8% vs. 55.2%, p < 0.001), non-white (22.7% vs. 19.5%, p = 0.001), and Hispanic patients (16.2% vs. 13.6%, p = 0.002). Diabetic patients were less likely to have dirty or contaminated wounds (16.2% vs. 25.2%, p < 0.001); however had increased rates of superficial surgical site infections (SSSIs; 2.0% vs. 0.8%, p < 0.001) and readmission (4.0% vs. 3.0%, p = 0.026). After regression, diabetes remained a significant positive predictor of SSSI (odds ratio: 1.546, p = 0.022); however, it no longer significantly predicted 30-day readmission. Overall, this analysis of a large multicentre surgical outcomes database found that when compared to non-diabetics, youth-onset diabetic patients exhibited a higher proportion of SSSIs in the 30-day postoperative period. These infections were found, despite the diabetic cohort exhibiting lower rates of wound contamination. After controlling for confounding variables, youth-onset diabetes remained a significant predictor of SSSI. Clinically, prevention and treatment of diabetes along with judicious wound care is recommended.
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Affiliation(s)
- Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Grace McDonnell
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Hani Y Nasr
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel J Ceradini
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
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Kimberly LL, Onuh OC, Thys E, Rodriguez ED. Social support criteria in vascularized composite allotransplantation versus solid organ transplantation: Should the same ethical considerations apply? Front Psychol 2022; 13:1055503. [PMID: 36483709 PMCID: PMC9723137 DOI: 10.3389/fpsyg.2022.1055503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/03/2022] [Indexed: 02/13/2024] Open
Abstract
The field of vascularized composite allotransplantation (VCA) is evolving, with some procedures poised to transition from highly experimental research toward standard of care. At present, the use of social support as an eligibility criterion for VCA candidacy is at the discretion of individual VCA programs, allowing VCA teams to consider the unique needs of each potential candidate. Yet this flexibility also creates potential for bias during the evaluation process which may disproportionately impact members of certain communities where social configurations may not resemble the model considered "optimal." We examine the extent to which ethical considerations for social support in solid organ transplantation (SOT) may be applied to or adapted for VCA, and the ethically meaningful ways in which VCA procedures differ from SOT. We conclude that VCA programs must retain some flexibility in determining criteria for candidacy at present; however, considerations of equity will become more pressing as VCA procedures evolve toward standard of care, and further empirical evidence will be needed to demonstrate the association between social support and post-operative success. The field of VCA has an opportunity to proactively address considerations of equity and justice and incorporate fair, inclusive practices into this innovative area of transplantation.
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Affiliation(s)
- Laura L. Kimberly
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, United States
- Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Ogechukwu C. Onuh
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, United States
| | - Erika Thys
- University of Nevada, Reno School of Medicine, Reno, NV, United States
| | - Eduardo D. Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, United States
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Onuh OC, Brydges HT, Nasr H, Savage E, Gorenstein S, Chiu E. Capturing essentials in wound photography past, present, and future: A proposed algorithm for standardization. Nurs Manag (Harrow) 2022; 53:12-23. [PMID: 36040729 DOI: 10.1097/01.numa.0000855948.88672.7a] [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: 06/15/2023]
Affiliation(s)
- Ogechukwu C Onuh
- Ogechukwu C. Onuh and Hilliard T. Brydges are clinical research fellows in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York, N.Y. Hani Nasr is a general surgery resident at Brookdale Hospital and Medical Center in Brooklyn, N.Y., and a postdoctoral clinical research fellow in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health, New York, N.Y. Elizabeth Savage is an adult health clinical nurse specialist, a certified wound care nurse, a certified ostomy nurse, and manager of the Wound and Ostomy Program at NYU Langone Health in New York, N.Y. Scott Gorenstein is an associate professor in the Department of Surgery at NYU Langone Hospital in Long Island, Mineola, N.Y. Ernest Chiu is a professor at Hansjörg Wyss Department of Plastic Surgery, the director of the Kimmel Hyperbaric and Advanced Wound Healing Center, and the inpatient director, Consultative Wound Service at Tisch Hospital, NYU Langone Health in New York, N.Y
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13
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Brydges HT, Onuh OC, Nasr HY, Gonda TA, Chiu ES, Caplan AS. Terbinafine Induced Pancreatitis in a Healthy Young Adult Male. Dermatol Ther 2022; 35:e15604. [PMID: 35620915 DOI: 10.1111/dth.15604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/13/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Hani Y Nasr
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Tamas A Gonda
- Department of Medicine at NYU Grossman School of Medicine
| | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine
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League GP, Onuh OC, Hillyer JF. Comparative structural and functional analysis of the larval and adult dorsal vessel and its role in hemolymph circulation in the mosquito Anopheles gambiae. ACTA ACUST UNITED AC 2014; 218:370-80. [PMID: 25524976 DOI: 10.1242/jeb.114942] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Hemolymph circulation in insects is driven primarily by the contractile action of a dorsal vessel, which is divided into an abdominal heart and a thoracic aorta. As holometabolous insects, mosquitoes undergo striking morphological and physiological changes during metamorphosis. This study presents a comprehensive structural and functional analysis of the larval and adult dorsal vessel in the malaria mosquito Anopheles gambiae. Using intravital video imaging we show that, unlike the adult heart, the larval heart contracts exclusively in the anterograde direction and does not undergo heartbeat directional reversals. The larval heart contracts 24% slower than the adult heart, and hemolymph travels across the larval dorsal vessel at a velocity that is 68% slower than what is seen in adults. By fluorescently labeling muscle tissue we show that although the general structure of the heart and its ostia are similar across life stages, the heart-associated alary muscles are significantly less robust in larvae. Furthermore, unlike the adult ostia, which are the entry points for hemolymph into the heart, the larval ostia are almost entirely lacking in incurrent function. Instead, hemolymph enters the larval heart through incurrent openings located at the posterior terminus of the heart. These posterior openings are structurally similar across life stages, but in adults have an opposite, excurrent function. Finally, the larval aorta and heart differ significantly in the arrangement of their cardiomyocytes. In summary, this study provides an in-depth developmental comparison of the circulatory system of larval and adult mosquitoes.
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Affiliation(s)
- Garrett P League
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA
| | - Ogechukwu C Onuh
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA
| | - Julián F Hillyer
- Department of Biological Sciences, Vanderbilt University, Nashville, TN 37235, USA
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