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Novak M, Blough J, Falola R, Czerwinski W. Enhanced Recovery After Surgery: Standardized Postoperative Instructions in Hand Surgery. Hand (N Y) 2022:15589447211065075. [PMID: 34996302 DOI: 10.1177/15589447211065075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Enhanced Recovery After Surgery (ERAS) is a standardized approach to care of the surgical patient. Postoperative patient instructions, an aspect of ERAS protocols, are difficult to standardize in hand surgery because of the diversity of procedures. The aim of this study was to determine the effect of standardized hand surgery postoperative instructions on the number of unscheduled postoperative patient encounters. Methods: The study was an institutional review board-approved prospective cohort in which all hand surgery patients from 6 surgeons at a single, hospital-based academic institution were included. For a 6-month period, both before and after establishing a standardized postoperative instructional handout, data were collected on unscheduled postoperative encounters within 14 days of surgery. Results: There were 330 patients in the control group versus 282 who received standardized postoperative instructions. Trauma comprised 24.6% of cases in comparison to 75.4% elective. Individual surgeons did not significantly influence whether patients had an encounter. Overall, patients who received standardized instructions were just as likely as the control group to have unscheduled encounters (41.5% vs 43.9%, respectively). Notably, elective patients were significantly more likely to have encounters (46%) versus trauma patients (33.1%; P = .007); however, the standardized instructions did not influence the number of encounters for either group. Conclusions: This study did not demonstrate a difference in unscheduled postoperative encounters after initiation of standardized postoperative instructions for hand surgery patients. These findings may help providers save time and resources by tailoring the use of ERAS in this distinct patient population.
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Affiliation(s)
- Matthew Novak
- Baylor Scott & White Medical Center, Temple, TX, USA
| | - Jordan Blough
- Baylor Scott & White Medical Center, Temple, TX, USA
| | - Reuben Falola
- Baylor Scott & White Medical Center, Temple, TX, USA
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Walters ET, Han KD, Howell AC, DeFazio MV, Falola R, Sher SR, Fishbein TM, Matsumoto CS, Evans KK. Management of Complex Abdominal Wall Defects in the Intestinal Transplant and Multivisceral Transplant Populations: Review of Our Multidisciplinary Experience. Am Surg 2018; 84:e494-e497. [PMID: 30747664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Walters ET, Han KD, Howell AC, Defazio MV, Falola R, Sher SR, Fishbein TM, Matsumoto CS, Evans KK. Management of Complex Abdominal Wall Defects in the Intestinal Transplant and Multivisceral Transplant Populations: Review of Our Multidisciplinary Experience. Am Surg 2018. [DOI: 10.1177/000313481808401121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elliot T. Walters
- Department of Plastic and Reconstructive Surgery Center for Wound Healing and Hyperbaric Medicine MedStar Georgetown University Hospital Washington, DC
| | - Kevin D. Han
- Department of Surgery Division of Plastic Surgery Beth Israel Deaconess Medical Center Harvard Medical School Boston, Massachusetts
| | - Anna C. Howell
- Division of Plastic and Reconstructive Surgery University of Southern California Medical Center Los Angeles, California
| | - Michael V. Defazio
- Department of Plastic and Reconstructive Surgery Center for Wound Healing and Hyperbaric Medicine MedStar Georgetown University Hospital Washington, DC
| | - Reuben Falola
- Department of Plastic and Reconstructive Surgery Center for Wound Healing and Hyperbaric Medicine MedStar Georgetown University Hospital Washington, DC
| | - Sarah R. Sher
- Department of Plastic and Reconstructive Surgery Center for Wound Healing and Hyperbaric Medicine MedStar Georgetown University Hospital Washington, DC
| | - Thomas M. Fishbein
- MedStar Transplant Institute MedStar Georgetown University Hospital Washington, DC
| | - Cal S. Matsumoto
- MedStar Transplant Institute MedStar Georgetown University Hospital Washington, DC
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery Center for Wound Healing and Hyperbaric Medicine MedStar Georgetown University Hospital Washington, DC
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Falola R, Lakhiani C, Green J, Patil S, Jackson B, Bratescu R, Anghel E, Steinberg J, Kim P, Attinger C, Evans K. Assessment of Function after Free Tissue Transfer to the Lower Extremity for Chronic Wounds Using the Lower Extremity Functional Scale. J Reconstr Microsurg 2018; 34:327-333. [DOI: 10.1055/s-0037-1621736] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1–5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey.
Methods A retrospective chart review was conducted at a single academic medical center of 101 consecutive free flaps, from 2011 to 2016. Of the flaps that met inclusion criteria, 39 had completed LEFS surveys. Mean LEFS scores were calculated, and the effects of risk factors such as diabetes, age, and smoking status were analyzed.
Results The mean LEFS score after free tissue transfer was 50.3 (SD ± 21.1), with a mean follow up survey time of 3.0 years (SD ± 1.3). The score correlated with Stage 4 function, or "independent community ambulation,” and age was the only demographic factor associated with decreased functionality in this group. This is compared with mean LEFS score of 43.1 (SD ± 18.4) in cohort of 55 below knee amputations (BKAs), and 38.3 (SD ± 14.9) in 28 above knee amputations (AKAs), both correlating with Stage 3 function: “limited community ambulation.”
Conclusions Functional outcomes scores such as the LEFS demonstrate that patients can obtain an adequate level of functionality for independent community activity after free tissue transfer, although functional improvement diminishes with age.
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Affiliation(s)
- Reuben Falola
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chrisovalantis Lakhiani
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Jocelyn Green
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Siya Patil
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Brandon Jackson
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Rachel Bratescu
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Ersilia Anghel
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - John Steinberg
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Paul Kim
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Christopher Attinger
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Karen Evans
- Department of Plastic Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, District of Columbia
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Wang B, Wang HW, Guo H, Anderson E, Tang Q, Wu T, Falola R, Smith T, Andrews PM, Chen Y. Optical coherence tomography and computer-aided diagnosis of a murine model of chronic kidney disease. J Biomed Opt 2017; 22:1-11. [PMID: 29197178 PMCID: PMC5745648 DOI: 10.1117/1.jbo.22.12.121706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/13/2017] [Indexed: 05/02/2023]
Abstract
Chronic kidney disease (CKD) is characterized by a progressive loss of renal function over time. Histopathological analysis of the condition of glomeruli and the proximal convolutional tubules over time can provide valuable insights into the progression of CKD. Optical coherence tomography (OCT) is a technology that can analyze the microscopic structures of a kidney in a nondestructive manner. Recently, we have shown that OCT can provide real-time imaging of kidney microstructures in vivo without administering exogenous contrast agents. A murine model of CKD induced by intravenous Adriamycin (ADR) injection is evaluated by OCT. OCT images of the rat kidneys have been captured every week up to eight weeks. Tubular diameter and hypertrophic tubule population of the kidneys at multiple time points after ADR injection have been evaluated through a fully automated computer-vision system. Results revealed that mean tubular diameter and hypertrophic tubule population increase with time in post-ADR injection period. The results suggest that OCT images of the kidney contain abundant information about kidney histopathology. Fully automated computer-aided diagnosis based on OCT has the potential for clinical evaluation of CKD conditions.
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Affiliation(s)
- Bohan Wang
- University of Maryland, Department of Electrical and Computer Engineering, College Park, Maryland, United States
| | - Hsing-Wen Wang
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
| | - Hengchang Guo
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
| | - Erik Anderson
- Georgetown University Medical Center, Department of Biochemistry and Molecular and Cellular Biology, Washington, DC, United States
| | - Qinggong Tang
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
| | - Tongtong Wu
- University of Rochester, Department of Biostatistics and Computational Biology, Rochester, New York, United States
| | - Reuben Falola
- Georgetown University Medical Center, Department of Biochemistry and Molecular and Cellular Biology, Washington, DC, United States
| | - Tikina Smith
- University of Maryland, Central Animal Resources Facility, College Park, Maryland, United States
| | - Peter M. Andrews
- Georgetown University Medical Center, Department of Biochemistry and Molecular and Cellular Biology, Washington, DC, United States
| | - Yu Chen
- University of Maryland, Department of Electrical and Computer Engineering, College Park, Maryland, United States
- University of Maryland, Fischell Department of Bioengineering, College Park, Maryland, United States
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Johnson-Arbor K, Falola R, Kelty J, Barbour J, Attinger C. Use of indocyanine green fluorescent angiography in a hyperbaric patient with soft tissue radiation necrosis: a case report. Undersea Hyperb Med 2017; 44:273-278. [PMID: 28779583 DOI: 10.22462/5.6.2017.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Indocyanine green fluorescent angiography (ICFA), commonly used to assess vascularity in patients with non-healing lower extremity wounds, is emerging as a useful adjunct for hyperbaric oxygen (HBO₂)therapy patients. We describe the use of ICFA to measure vascularity and help tailor an appropriate HBO₂ regimen in a patient with breast soft tissue radiation necrosis (STRN). CASE REPORT 67-year-old female with a history of right breast cancer treated two years previously with lumpectomy and radiation therapy (6200 cGy), developed open wounds in the right breast. A diagnosis of STRN was established; the patient completed 20 HBO₂ treatments, followed by surgical closure of the right breast wounds. Intraoperative ICFA demonstrated a focal area of hypovascularity at the medial margin of the incision. Due to a concern of suboptimal vascularity, the patient returned for additional HBO₂ treatments. ICFA was performed after eight postoperative HBO₂ treatments, and showed improved vascularity in the previously identified area of concern. DISCUSSION Studies of patients previously irradiated for head and neck cancer suggest that HBO₂-induced vascularity is apparent after approximately eight HBO₂ treatments and peaks around 20 treatments. The results from this case indicate that the doses of HBO₂ needed for adequate neovascularization in patients with STRN may be variable. CONCLUSION The use of ICFA may provide additional insight regarding HBO₂-induced angiogenesis. Additional studies are required to establish the correct number of HBO₂ treatments required for angiogenesis in previously irradiated patients with STRN, and to explore the role of ICFA in patients treated with HBO₂.
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Affiliation(s)
| | - Reuben Falola
- Georgetown University School of Medicine, Washington, D.C., U.S
| | | | - John Barbour
- Nerve, Bone and Joint Institute, Washington, D.C., U.S
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Abstract
OBJECTIVES The aging kidney exhibits a progressive decline in renal function with characteristic histopathologic changes and is a risk factor for renal transplant. However, the degree to which the kidney exhibits this decline depends on several factors that vary from one individual to the next. Optical coherence tomography is an evolving noninvasive imaging technology that has recently been used to evaluate acute tubular necrosis of living-human donor kidneys before their transplant. With the increasing use of kidneys from older individuals, it is important to determine whether optical coherence tomography also can distinguish the histopathology associated with aging. MATERIALS AND METHODS In this investigation, we used Munich-Wistar rats to evaluate the ability of optical coherence tomography to detect histopathologic changes associated with aging. Optical coherence tomography observations were correlated with renal function and conventional light microscopic evaluation of these same kidneys. RESULTS With the onset of severe proteinuria at 10 to 12 months of age, optical coherence tomography revealed tubular necrosis/atrophy, interstitial fibrosis, tubular dilation, and glomerulosclerosis. With a further deterioration in kidney function at 16 to 18 months of age (as indicated by rising creatinine levels), optical coherence tomography revealed more extensive interstitial fibrosis and tubular atrophy, increased tubular dilation with cyst formation and more sclerotic glomeruli. CONCLUSIONS The foregoing observations suggest that optical coherence tomography can be used to detect the histopathology of progressive nephropathy associated with aging.
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Affiliation(s)
- Peter M Andrews
- From the Department of Biochemistry, Molecular and Cellular Biology, Georgetown University Medical Center, Washington DC 20007, USA
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Lakhiani C, DeFazio M, Han K, Falola R, Evans K. Donor-Site Morbidity Following Free Tissue Harvest from the Thigh: A Systematic Review and Pooled Analysis of Complications. J Reconstr Microsurg 2016; 32:342-57. [DOI: 10.1055/s-0036-1583301] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Chrisovalantis Lakhiani
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Michael DeFazio
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Kevin Han
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Reuben Falola
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
| | - Karen Evans
- Department of Plastic Surgery, Georgetown University Hospital, Washington, District of Columbia
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