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Alfonso AR, Park JJ, Kalra A, DeMitchell-Rodriguez EM, Kussie HC, Shen C, Staffenberg DA, Flores RL, Shetye PR. The Burden of Care of Nasoalveolar Molding: An Institutional Experience. J Craniofac Surg 2024:00001665-990000000-01282. [PMID: 38231199 DOI: 10.1097/scs.0000000000009960] [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] [Received: 06/27/2023] [Accepted: 12/02/2023] [Indexed: 01/18/2024] Open
Abstract
Nasoalveolar molding (NAM) is an early presurgical intervention to facilitate primary cleft lip repair by reducing cleft severity and improving labial and nasal form. However, it continues to be associated with the burden of care that influences access and completion of therapy. The authors, therefore, aim to determine the burden of care of NAM therapy for families seeking treatment at a high-volume urban cleft center. A retrospective study of all patients undergoing primary cleft repair between 2012 and 2020 was performed. Patients were grouped based on whether or not NAM therapy was offered. Variables including physical, psychosocial, and financial factors were assessed. Two hundred and thirty patients underwent primary cleft repair between 2012 and 2020. Of these, 176 patients were indicated for NAM, with 4% discontinuing, and 54 patients did not undergo NAM. The 169 patients who completed NAM had a mean duration of treatment of 13.6±8.8 wks consisting of 15±6 scheduled NAM adjustment visits and 1±1 unscheduled visit made urgently to assess caregiver concerns. The mean travel distance was 28.6±37.1 miles. Eighty-four percent of caregivers were married, and 16% did not have English as a primary language. Though 57% had private insurance, 43% of patients received charity support for their treatment. NAM is a finite presurgical intervention that requires caregivers to participate in patient care for approximately three months of their early life. The decision to pursue NAM should be considered alongside the burden of care for caregivers to complete treatment.
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Affiliation(s)
- Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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Park JJ, Alfonso AR, Kalra A, Staffenberg DA, Flores RL, Shetye PR. Defining the Treatment Gap in Nasoalveolar Molding: Factors Affecting the Utilization of NAM in an Urban Cleft Center. Cleft Palate Craniofac J 2024; 61:131-137. [PMID: 36560912 DOI: 10.1177/10556656221148030] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Many cleft centers incorporate NasoAlveolar Molding (NAM) into their presurgical treatment protocols. However, there are limited data on eligible patients who do not receive or complete NAM. This study characterizes the demographics associated with non-utilization or completion of NAM. METHODS A single-institution retrospective review was performed of all patients with cleft lip and alveolus undergoing primary unilateral and bilateral cleft lip repair from 2012-2020. Patients were grouped based on utilization or non-utilization of NAM. Demographic and treatment data were collected, including documented reasons for not pursuing or completing NAM. RESULTS Of 230 eligible patients, 61 patients (27%) did not undergo or complete NAM (no-NAM). In this group, 37 (60.7%) received no presurgical intervention, 12 (19.7%) received presurgical nostril retainers, 3 (4.9%) received lip taping, 1 (1.6%) received a combination of taping/nostril retainers, and 8 (13.1%) discontinued NAM. The most common reasons for not receiving NAM were sufficiently aligned cleft alveolus (21.3%), medical complexity (16.4%), late presentation (16.4%), and alveolar notching (18%). Compared to the NAM group, the no-NAM group had significantly lower rates of prenatal cleft diagnosis/consult, and significantly higher proportion of non-married and non-English speaking caregivers. Multivariable analysis controlling for insurance type, primary language, prenatal consult, marital status, and age at first appointment found that age at first appointment is the only statistically significant predictor of NAM utilization (P < .001). CONCLUSIONS Common reasons for non-utilization of NAM include well-aligned cleft alveolus, medical complexity, and late presentation. Early presentation is an important modifiable factor affecting rates of NAM utilization.
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Affiliation(s)
- Jenn J Park
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Aneesh Kalra
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
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Lee ZH, Diep GK, Brydges HT, Berman ZP, Alfonso AR, Ramly EP, Chaya BF, Thanik VD. Do Corporate Payments Influence Research Related to the Use of Acellular Dermal Matrices in Breast Surgery? Plast Reconstr Surg 2023; 152:376e-384e. [PMID: 36827475 DOI: 10.1097/prs.0000000000010320] [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: 02/26/2023]
Abstract
BACKGROUND No study has assessed the impact of financial conflicts of interests (COIs) on the reporting of breast reconstruction outcomes with acellular dermal matrix (ADM) in peer-reviewed publications. The authors hypothesized that there is (1) an association between financial COIs and likelihood of studies reporting benefits in using ADM, and (2) inconsistent reporting of financial COIs. METHODS The PubMed database was used to identify articles that reported on the use of ADM in breast surgery in four leading plastic surgery journals from January of 2014 to December of 2019. Financial COIs for authors were determined using the open payments database. RESULTS Fifty-five articles were included. Twenty-four articles (43.6%) supported use of ADM, 12 (21.8%) did not promote ADM use, and 19 (34.5%) were neutral. Fifty-one studies (92.7%) had either a first or senior author with a COI, and authors with a COI more commonly reported positive outcomes ( P = 0.02). Studies with positive outcomes featured first authors who received significantly larger financial payments ($95,955 versus $15,642; P = 0.029) compared with studies with negative or neutral outcomes. Receiver operating characteristic curve demonstrated that studies with first authors receiving over $376.28 were more likely to report positive results. Eight senior authors and three first authors received greater than $500 from ADM producers yet did not report any financial disclosure. CONCLUSIONS Financial COI is associated with higher likelihood of studies reporting benefit of using ADM in breast surgery. There remains inconsistent reporting of COIs, and better oversight is needed to ensure unbiased publication on the use of ADM in breast surgery.
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Affiliation(s)
- Z-Hye Lee
- From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Vishal D Thanik
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Azevedo RT, Diaz-Siso JR, Alfonso AR, Ramly EP, Kantar RS, Berman ZP, Diep GK, Rifkin WJ, Rodriguez ED, Tsakiris M. Re-cognizing the new self: The neurocognitive plasticity of self-processing following facial transplantation. Proc Natl Acad Sci U S A 2023; 120:e2211966120. [PMID: 36972456 PMCID: PMC10083597 DOI: 10.1073/pnas.2211966120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/21/2022] [Indexed: 03/29/2023] Open
Abstract
The face is a defining feature of our individuality, crucial for our social interactions. But what happens when the face connected to the self is radically altered or replaced? We address the plasticity of self-face recognition in the context of facial transplantation. While the acquisition of a new face following facial transplantation is a medical fact, the experience of a new identity is an unexplored psychological outcome. We traced the changes in self-face recognition before and after facial transplantation to understand if and how the transplanted face gradually comes to be perceived and recognized as the recipient's own new face. Neurobehavioral evidence documents a strong representation of the pre-injury appearance pre-operatively, while following the transplantation, the recipient incorporates the new face into his self-identity. The acquisition of this new facial identity is supported by neural activity in medial frontal regions that are considered to integrate psychological and perceptual aspects of the self.
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Affiliation(s)
- Ruben T. Azevedo
- Department of Psychology, University of Kent, CanterburyCT2 7NP, UK
| | - J. Rodrigo Diaz-Siso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Allyson R. Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Elie P. Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Rami S. Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Zoe P. Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Gustave K. Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - William J. Rifkin
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Eduardo D. Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY10016
| | - Manos Tsakiris
- Department of Psychology, Royal Holloway, University of London, EghamTW20 0EX, UK
- The Warburg Institute, School of Advanced Studies, University of London, LondonWC1H 0AB, UK
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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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Delmore B, Sprigle S, Samim M, Alfonso AR, Lin L, Chiu E. Does Sacrococcygeal Skeletal Morphology and Morphometry Influence Pressure Injury Formation in Adults? Adv Skin Wound Care 2022; 35:586-595. [PMID: 36264750 DOI: 10.1097/01.asw.0000874180.84660.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
GENERAL PURPOSE To present a study that investigated sacrococcygeal skeletal structure as a possible nonmodifiable intrinsic risk factor for pressure injury and identify possible issues caused by its morphology. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Recognize the background information the authors considered when planning and conducting their study of sacrococcygeal skeletal structure as a possible pressure injury risk factor.2. Identify the characteristics of the two groups of study participants.3. Choose the results of the study clinicians may consider when implementing evidence-based practice.
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Ramly EP, Berman ZP, Diep GK, Alfonso AR, Kimberly LL, Rodriguez ED. Reply: Vascularized Composite Allotransplantation in a Post-COVID-19 Pandemic World. Plast Reconstr Surg 2021; 148:317e-318e. [PMID: 34228027 DOI: 10.1097/prs.0000000000008135] [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: 11/25/2022]
Affiliation(s)
- Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, N.Y
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Wolfe EM, Alfonso AR, Diep GK, Berman ZP, Mills EC, Park JJ, Hoffman AF, Felsenheld JH, Ramly EP, Rodriguez ED. Is Digital Animation Superior to Text Resources for Facial Transplantation Education? A Randomized Controlled Trial. Plast Reconstr Surg 2021; 148:419-426. [PMID: 34181597 DOI: 10.1097/prs.0000000000008166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/25/2022]
Abstract
BACKGROUND Facial transplantation is a complex surgical procedure that requires education of medical professionals, patients, and the general public. The objective of this randomized controlled trial was to compare the educational efficacy of facial transplantation digital animation versus text resources for teaching medical students a complex surgical procedure and its applicable anatomical and surgical principles. METHODS Medical student volunteers were recruited and prospectively randomized to an animation or a text group. Students completed preintervention and postintervention assessments of confidence and knowledge of head and neck anatomy and facial transplantation. Student Evaluations of Educational Quality survey assessed student satisfaction with both tools following study crossover. Knowledge assessment was developed using National Board of Medical Examiners guidelines and content validated by four experts. The Cohen d statistic was used to measure the effect size of each intervention. RESULTS Thirty-six students were assigned randomly to the animation group (n = 19) or the text (n = 17) group. Postintervention analysis demonstrated significantly higher performance scores in the animation group compared to the text group (p = 0.029). The animation group had a larger effect size (Cohen d = 1.96 versus 1.27). Only students in the animation group reported significantly improved confidence in head and neck anatomy after the intervention (p = 0.002). Both groups demonstrated significantly increased postintervention confidence in knowledge of facial transplantation (p < 0.001). Satisfaction scores revealed that students significantly favored the animation resource (p < 0.001). CONCLUSIONS Animation can be an effective tool for facial transplantation education and results in improved student knowledge, confidence, and satisfaction compared to text resources. Facial transplantation can also be used as an educational framework for teaching medical students anatomical and surgical principles.
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Affiliation(s)
- Erin M Wolfe
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Allyson R Alfonso
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Gustave K Diep
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Zoe P Berman
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Emily C Mills
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Jenn J Park
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Alexandra F Hoffman
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Julia H Felsenheld
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Elie P Ramly
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Eduardo D Rodriguez
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Kantar RS, Breugem CC, Alfonso AR, Keith K, Kassam S, Annan B, Chahine EM, Wasicek PJ, Patel KG, Flores RL, Hamdan US. Perceived Barriers to Comprehensive Cleft Care Delivery: Results From A Capacity-Building Educational Initiative and Implications. Ann Plast Surg 2021; 87:194-198. [PMID: 34253700 DOI: 10.1097/sap.0000000000002604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/26/2022]
Abstract
INTRODUCTION We analyzed the perceptions of participants and faculty members in simulation-based comprehensive cleft care workshops regarding comprehensive cleft care delivery in developing countries. METHODS Data were collected from participants and faculty members in 2 simulation-based comprehensive cleft care workshops organized by Global Smile Foundation. We collected demographic data and surveyed what they believed was the most significant barrier to comprehensive cleft care delivery and the most important intervention to deliver comprehensive cleft care in developing countries. We also compared participant and faculty responses. RESULTS The total number of participants and faculty members was 313 from 44 countries. The response rate was 57.8%. The majority reported that the most significant barrier facing the delivery of comprehensive cleft care in developing countries was financial (35.0%), followed by the absence of multidisciplinary cleft teams (30.8%). The majority reported that the most important intervention to deliver comprehensive cleft care was creating multidisciplinary cleft teams (32.2%), followed by providing cleft training (22.6%). We found no significant differences in what participants and faculty perceived as the greatest barrier to comprehensive cleft care delivery (P = 0.46), or most important intervention to deliver comprehensive cleft care in developing countries (P = 0.38). CONCLUSIONS Our study provides an appraisal of barriers facing comprehensive cleft care delivery and interventions required to overcome these barriers in developing countries. Future studies will be critical to validate or refute our findings, as well as determine country-specific roadmaps for delivering comprehensive cleft care to those who need it the most.
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Affiliation(s)
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | | | | | | | | | - Philip J Wasicek
- Department of Surgery, The University of Maryland Medical System, Baltimore, MD
| | | | - Roberto L Flores
- The Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York City, NY
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Lee ZH, Ramly EP, Alfonso AR, Daar DA, Kaoutzanis C, Kantar RS, Thanik V, Saadeh PB, Levine JP. Dangle Protocols in Lower Extremity Reconstruction. J Surg Res 2021; 266:77-87. [PMID: 33989891 DOI: 10.1016/j.jss.2021.03.028] [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: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dangling protocols are known to vary by surgeon and center, and their specific regimen is often largely based on single surgeon or institutional experience. A systematic review was conducted to derive evidence-based recommendations for dangling protocols according to patient-specific and flap-specific considerations. METHODS A systematic review was performed using PubMed, Embase-OVID and Cochrane-CENTRAL. Study design, patient and flap characteristics, protocol details, dangling-related complications, and flap success rate were recorded. Studies were graded using the Oxford Center for Evidence-Based Medicine Levels of Evidence Scale. Data heterogeneity precluded quantitative analysis. RESULTS Eleven articles were included (level of evidence (range):IIb-IV; N (range):8-150; age (range):6-89). Dangling initiation, time, and frequency varied considerably. Flap success rate ranged from 94 to 100%. Active smoking, diabetes, and hypertension are associated with characteristic physiologic changes that require vigilance and potential protocol modification. Early dangling appears to be safe across a variety of free flap locations, sizes, and indications. Axial fasciocutaneous flaps may tolerate more aggressive protocols than muscular flaps. While flaps with single venous anastomosis tolerate dangling, double venous or flow-through anastomoses may provide additional benefit. Major limitations included small sample sizes, uncontrolled study designs, and heterogeneous patient selection, dangling practices, monitoring methods, and outcome measures. CONCLUSIONS Significant heterogeneity persists in postoperative dangling protocols after lower extremity microvascular reconstruction. Patient comorbidities and flap characteristics appear to affect tolerance to dangling. We propose two different standardized pathways based on risk factors. Clinical vigilance should be exercised in tailoring lower extremity protocols to patients' individual characteristics and postoperative course.
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Affiliation(s)
- Z-Hye Lee
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - David A Daar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Christodoulos Kaoutzanis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Vishal Thanik
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Pierre B Saadeh
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
| | - Jamie P Levine
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY.
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Dammeyer K, Alfonso AR, Diep GK, Kantar RS, Berman ZP, Daar DA, Ramly EP, Sosin M, Ceradini DJ. Predicting postoperative complications following mastectomy in the elderly: Evidence for the 5-factor frailty index. Breast J 2021; 27:509-513. [PMID: 33650221 DOI: 10.1111/tbj.14208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/03/2020] [Revised: 01/11/2021] [Accepted: 02/10/2021] [Indexed: 01/01/2023]
Abstract
Understanding the risk factors that contribute to post-mastectomy complications can better inform preoperative discussions. Here, we assess the impact of the 5-Factor Frailty Index Score (mFI-5) in predicting 30-day postoperative complications in patients undergoing mastectomy. A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data base was conducted for patients older than 65 undergoing mastectomy between 2010 and 2015. We assessed each patient's Frailty Index Score using the mFI-5. Primary outcomes included wound complications and overall complications. Multivariate logistic and linear regression analyses were used to determine the ability of the mFI-5 to predict postoperative outcomes. A total of 13,783 patients were analyzed. The rate of wound complications was 3.0%, while the rate of overall complications was 6.0%. An mFI-5 score greater than 2 was an independent risk factor for wound complications and overall complications. Overall, patients undergoing mastectomy with an mFI-5 of 2 or greater experienced higher rates of postoperative complications. The mFI-5 is an accessible tool that can be used to risk-stratify patients undergoing mastectomy and can positively contribute to the informed consent and shared decision-making process.
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Affiliation(s)
- Kristen Dammeyer
- 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
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - David A Daar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Michael Sosin
- 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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12
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Robinson IS, Salibian AA, Alfonso AR, Lin LJ, Janis JE, Chiu ES. Surgical Management of Occipital Neuralgia: A Systematic Review of the Literature. Ann Plast Surg 2021; 86:S322-S331. [PMID: 33651020 DOI: 10.1097/sap.0000000000002766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/03/2023]
Abstract
BACKGROUND Occipital neuralgia (ON) is a primary headache disorder characterized by severe, paroxysmal, shooting or stabbing pain in the distribution of the greater occipital, lesser occipital, and/or third occipital nerves. Both medical and surgical options exist for treating headaches related to ON. The purposes of this study are to summarize the current state of surgical ON management through a systematic review of the literature and, in doing so, objectively identify future directions of investigation. METHODS We performed a systematic review of primary literature on surgical management for ON of at least level IV evidence. Included studies were analyzed for level of evidence, therapeutic intervention, study design, sample size, follow-up duration, outcomes measured, results, and risk of bias. RESULTS Twenty-two studies met the inclusion criteria. All 22 studies used patient-reported pain scores as an outcome metric. Other outcome metrics included complication rates (7 studies; 32%), patient satisfaction (7 studies; 32%), quality of life (7 studies; 18%), and analgesic usage (3 studies; 14%). Using the ROBINS-I tool for risk of bias in nonrandomized studies, 7 studies (32%) were found to be at critical risk of bias, whereas the remaining 15 studies (68%) were found to be at serious risk of bias. CONCLUSIONS Greater occipital nerve decompression seems to be a useful treatment modality for medically refractory ON, but further prospective, randomized data are required.
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Affiliation(s)
- Isabel S Robinson
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Ara A Salibian
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Allyson R Alfonso
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Lawrence J Lin
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
| | - Jeffrey E Janis
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, OH
| | - Ernest S Chiu
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY
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13
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Kantar RS, Berman ZP, Diep GK, Ramly EP, Alfonso AR, Sosin M, Lee ZH, Rifkin WJ, Kaoutzanis C, Yu JW, Ceradini DJ, Dagher NN, Levine JP. Hepatic Artery Microvascular Anastomosis in Liver Transplantation: A Systematic Review of the Literature. Ann Plast Surg 2021; 86:96-102. [PMID: 33315357 DOI: 10.1097/sap.0000000000002486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/25/2022]
Abstract
BACKGROUND The operating microscope is used in many centers for microvascular hepatic arterial reconstruction in living as well as deceased donor liver transplantation in adult and pediatric recipients. To date, a systematic review of the literature examining this topic is lacking. METHODS This systematic review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three different electronic databases (PubMed, Embase OVID, and Cochrane CENTRAL) were queried. RESULTS A total of 34 studies were included. The rate of hepatic artery thrombosis (HAT) in noncomparative studies (28) ranged from 0% to 10%, with 8 studies reporting patient deaths resulting from HAT. Within comparative studies, the rate of HAT in patients who underwent arterial reconstruction using the operating microscope ranged from 0% to 5.3%, whereas the rate of HAT in patients who underwent arterial reconstruction using loupe magnification ranged from 0% up to 28.6%, and 2 studies reported patient deaths resulting from HAT. Two comparative studies did not find statistically significant differences between the 2 groups. CONCLUSIONS Our comprehensive systematic review of the literature seems to suggest that overall, rates of HAT may be lower when the operating microscope is used for hepatic arterial reconstruction in liver transplantation. However, matched comparisons are lacking and surgical teams need to be mindful of the learning curve associated with the use of the operating microscope as compared with loupe magnification, as well as the logistical and time constraints associated with setup of the operating microscope.
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Affiliation(s)
- Rami S Kantar
- From the Hansjörg Wyss Department of Plastic Surgery
| | - Zoe P Berman
- From the Hansjörg Wyss Department of Plastic Surgery
| | | | - Elie P Ramly
- From the Hansjörg Wyss Department of Plastic Surgery
| | | | - Michael Sosin
- From the Hansjörg Wyss Department of Plastic Surgery
| | - Z-Hye Lee
- From the Hansjörg Wyss Department of Plastic Surgery
| | | | | | - Jason W Yu
- From the Hansjörg Wyss Department of Plastic Surgery
| | | | - Nabil N Dagher
- Transplant Institute, New York University Langone Health, New York, NY
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14
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Park JJ, Diep GK, Alfonso AR, Berman ZP, Hoffman AF, Mills EC, Wolfe EM, Felsenheld JH, Ramly EP, Rodriguez ED. Have We Achieved Optimal Skin Color Matching in Partial Facial Transplantation? A Survey Study of the General Public and Medical Professionals. J Craniofac Surg 2020; 31:2213-2216. [PMID: 33136857 DOI: 10.1097/scs.0000000000006895] [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: 11/25/2022] Open
Abstract
BACKGROUND Skin color matching is an essential factor in achieving optimal aesthetic outcome in partial facial transplantation. However, there is no published literature evaluating the success of color matching to date. Furthermore, a medical professional's perception of an optimal color match may not necessarily translate to that of the general public. The purpose of our study was to evaluate skin color matching between the donor allograft and recipient native tissue in partial facial transplantations to determine the level of success perceived by the general public and medical professionals. METHODS Published photographs of partial face transplant recipients were used to create a survey where recipient native and donor allograft skin samples were juxtaposed. Thirty-three members of the general public and 30 medical professionals were asked to rate skin color match on a scale from "excellent match" to "not a match." RESULTS Overall, 47% of given ratings were positive, indicating an "excellent" or "good match," and 53% of ratings were negative, indicating a "poor match" or "lack of match" between the skin sample pairings shown. Of the 19 partial face transplant patients who were rated, 9 patients received >50% positive ratings, and 10 patients received <50% positive ratings. Medical professionals consistently gave more positive ratings, with statistically significant differences in 7 of the 19 rated patients (P < 0.05). CONCLUSION The results suggest that there is need for improvement in color matching in partial facial transplantation, and that the general public is more critical of skin color matching compared to medical professionals.
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Affiliation(s)
- Jenn J Park
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY
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15
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Kimberly LL, Ramly EP, Alfonso AR, Diep GK, Berman ZP, Rodriguez ED. Equity in access to facial transplantation. J Med Ethics 2020; 47:medethics-2020-106129. [PMID: 33060187 DOI: 10.1136/medethics-2020-106129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
We examine ethical considerations in access to facial transplantation (FT), with implications for promoting health equity. As a form of vascularised composite allotransplantation, FT is still considered innovative with a relatively low volume of procedures performed to date by a small number of active FT programmes worldwide. However, as numbers continue to increase and institutions look to establish new FT programmes, we anticipate that attention will shift from feasibility towards ensuring the benefits of FT are equitably available to those in need. This manuscript assesses barriers to care and their ethical implications across a number of considerations, with the intent of mapping various factors relating to health equity and fair access to FT. Evidence is drawn from an evolving clinical experience as well as published scholarship addressing several dimensions of access to FT. We also explore novel concerns that have yet to be mentioned in the literature.
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Affiliation(s)
- Laura L Kimberly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
- Division of Medical Ethics, Department of Population Health, NYU Langone Health, New York, NY, United States
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, United States
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16
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Berman ZP, Alfonso AR, Diep GK, Ramly EP, Wolfe EM, Raheem S, Irving H, Rodriguez ED. Development of Donor Family-Oriented Resources to Facilitate Authorization for Reconstructive Transplantation. Prog Transplant 2020; 30:398-399. [PMID: 32912042 DOI: 10.1177/1526924820958122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
| | - Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
| | - Erin M Wolfe
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
| | | | | | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, 12297NYU Langone Health, NY, USA
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17
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Diep GK, Ramly EP, Alfonso AR, Berman ZP, Rodriguez ED. Enhancing Face Transplant Outcomes: Fundamental Principles of Facial Allograft Revision. Plast Reconstr Surg Glob Open 2020; 8:e2949. [PMID: 32983759 PMCID: PMC7489753 DOI: 10.1097/gox.0000000000002949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/13/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
Facial transplantation (FT) has become a feasible reconstructive solution for patients with devastating facial injuries. Secondary revisions to optimize functional and aesthetic outcomes are to be expected, yet the optimal timing and approach remain to be determined. The purpose of this study was to analyze all facial allograft revisions reported to date, including the senior author's experience with 3 FTs. Methods A literature review was performed, with 2 reviewers independently conducting title and abstract screening, followed by a full-text review. All articles mentioning FT revision surgeries were evaluated. The medical records of the senior author's 3 FT recipients were additionally reviewed. Results Initially, 721 articles were captured and 37 were included in the final analysis. Thirty-two FTs were reported to have involved posttransplant allograft revisions, with FT recipients undergoing a mean of 4.8 ± 4.6 revision procedures. The mean duration between FT and the first revision procedure was 149 ± 179 days. A wide spectrum of revisions was identified and categorized as involving the soft tissues, craniofacial skeleton, dentition, oronasal cavity, salivary glands, facial nerve, or ocular region. In the senior author's experience, when indicated, posttransplant occlusal changes and integrity of the donor-recipient intraoral interface were successfully addressed with secondary procedures without allograft compromise or loss. Conclusions The worldwide experience shows that secondary procedures are nearly ubiquitous after FT and can be safely performed at various timepoints. The authors thereby establish 5 distinct categories of facial allograft revisions and define 7 critical principles to optimize posttransplant procedures.
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Affiliation(s)
- Gustave K Diep
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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18
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Kantar RS, Breugem CC, Keith K, Kassam S, Vijayakumar C, Bow M, Alfonso AR, Chahine EM, Ghotmi LH, Patel KG, Shetye PR, Santiago PE, Losee JE, Steinbacher DM, Rossell-Perry P, Garib DG, Alonso N, Mann RJ, Prada-Madrid JR, Esenlik E, Pamplona MDC, Collares MVM, Bennun RD, Kummer A, Giugliano C, Padwa BL, Raposo-Amaral CE, Tse R, Sommerlad B, Flores RL, Hamdan US. Simulation-Based Comprehensive Cleft Care Workshops: A Reproducible Model for Sustainable Education. Cleft Palate Craniofac J 2020; 57:1238-1246. [PMID: 32729337 DOI: 10.1177/1055665620944781] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Evaluate simulation-based comprehensive cleft care workshops as a reproducible model for education with sustained impact. DESIGN Cross-sectional survey-based evaluation. SETTING Simulation-based comprehensive cleft care workshop. PARTICIPANTS Total of 180 participants. INTERVENTIONS Three-day simulation-based comprehensive cleft care workshop. MAIN OUTCOME MEASURES Number of workshop participants stratified by specialty, satisfaction with the workshop, satisfaction with simulation-based workshops as educational tools, impact on cleft surgery procedural confidence, short-term impact on clinical practice, medium-term impact on clinical practice. RESULTS The workshop included 180 participants from 5 continents. The response rate was 54.5%, with participants reporting high satisfaction with all aspects of the workshop and with simulation-based workshops as educational tools. Participants reported a significant improvement in cleft lip (33.3 ± 5.7 vs 25.7 ± 7.6; P < .001) and palate (32.4 ± 7.1 vs 23.7 ± 6.6; P < .001) surgery procedural confidence following the simulation sessions. Participants also reported a positive short-term and medium-term impact on their clinical practices. CONCLUSION Simulation-based comprehensive cleft care workshops are well received by participants, lead to improved cleft surgery procedural confidence, and have a sustained positive impact on participants' clinical practices. Future efforts should focus on evaluating and quantifying this perceived positive impact, as well reproducing these efforts in other areas of need.
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Affiliation(s)
- Rami S Kantar
- Global Smile Foundation, Norwood, MA, USA
- Department of Surgery, The University of Maryland Medical System, Baltimore, MD, USA
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Serena Kassam
- Global Smile Foundation, Norwood, MA, USA
- Department of Pediatric Dentistry, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Charanya Vijayakumar
- Cleft and Craniofacial Center, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | | | - Allyson R Alfonso
- Global Smile Foundation, Norwood, MA, USA
- The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, NY, USA
| | | | | | - Krishna G Patel
- Global Smile Foundation, Norwood, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Pradip R Shetye
- The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, NY, USA
| | | | - Joseph E Losee
- Department of Plastic Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, PA, USA
| | - Derek M Steinbacher
- Division of Plastic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Percy Rossell-Perry
- Edgardo Rebagliati Hospital ESSALUD and San Martin de Porres University, Lima, Peru
| | - Daniela G Garib
- Department of Orthodontics, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil
| | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - Robert J Mann
- Division of Pediatric Plastic Surgery, Spectrum Health Medical Group, Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Jose Rolando Prada-Madrid
- Department of Plastic and Reconstructive Surgery, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Elçin Esenlik
- Department of Orthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - María Del Carmen Pamplona
- Hablarte e Integrarte, AC, Cleft Palate Clinic, Hospital Gea Gonzalez and Universidad San Sebastián, Mexico City, Mexico
| | - Marcus Vinícius Martins Collares
- Plastic and Craniomaxillofacial Surgery Division, School of Medicine, Rio Grande do Sul Federal University, Porto Alegre, Brazil
| | - Ricardo D Bennun
- Asociacion PIEL and School of Medicine, National University of Buenos Aires, Buenos Aires, Argentina
| | - Ann Kummer
- Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carlos Giugliano
- Plastic Surgery Unit, Alfredo Gantz Mann Foundation, and Clínica Alemana, Santiago, Chile
| | - Bonnie L Padwa
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Raymond Tse
- University of Washington and Seattle Children's Hospital, Seattle, WA, USA
| | - Brian Sommerlad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Roberto L Flores
- The Hansjörg Department of Plastic Surgery, New York University Langone Health, New York City, NY, USA
| | - Usama S Hamdan
- Global Smile Foundation, Norwood, MA, USA
- Otology and Laryngology, Harvard Medical School, Boston, MA, USA
- Otolaryngology, Tufts University School of Medicine, Boston, MA, USA
- Otolaryngology, Boston University School of Medicine, MA, USA
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Alfonso AR, Ramly EP, Kantar RS, Wang MM, Eisemann BS, Staffenberg DA, Shetye PR, Flores RL. What Is the Burden of Care of Nasoalveolar Molding? Cleft Palate Craniofac J 2020; 57:1078-1092. [PMID: 32500737 DOI: 10.1177/1055665620929224] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This systematic review aims to evaluate nasoalveolar molding (NAM) in the context of burden of care defined as physical, psychosocial, or financial burden on caregivers. SEARCH METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 5 databases were searched from inception through December 24, 2019, for keywords and subject headings pertaining to cleft lip and/or palate and NAM. ELIGIBILITY CRITERIA Clinical studies on NAM with reference to physical (access to care, number of visits, distance traveled), psychosocial (caregiver perceptions, family interactions, breast milk feeding), and financial (direct and indirect costs) burden were included. DATA COLLECTION AND ANALYSIS Study selection was performed by 2 independent reviewers. RESULTS The search identified 1107 articles and 114 articles remained for qualitative synthesis. Burden of care domains were discussed but not measured in 43% of articles and only 25% assessed burden of care through a primary outcome. Of these, 20 articles reported on physical, 8 articles on psychosocial, and 12 articles on financial burden. Quality of evidence is limited by study design and risk of bias. CONCLUSION Nasoalveolar molding has been indiscriminately associated with burden of care in the literature. Although NAM may not be the ideal treatment option for all patients and families, the physical considerations are limited when accounting for the observed psychosocial advantages. Financial burden appears to be offset, but further research is required. Teams should directly assess the impact of this early intervention on the well-being of caregivers and advance strategies that improve access to care.
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Affiliation(s)
- Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Maxime M Wang
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Bradley S Eisemann
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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20
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Yu JW, Rifkin WJ, Lee ZH, Borab Z, Alfonso AR, Thanik VD, Levine JP. Does Laterality of Lower Extremity Donor Site Affect Outcomes in Microvascular Soft Tissue Lower Extremity Reconstruction? J Reconstr Microsurg 2020; 36:289-293. [PMID: 31994158 DOI: 10.1055/s-0039-1701037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND There are many different variables to consider in lower extremity microvascular soft tissue reconstruction including flap choice. Our aim is to objectively evaluate recipient complications related to lower extremity donor flap laterality. METHODS A total of 77 lower extremity soft tissue reconstructions utilizing microvascular free tissue transfers for Gustilo type III between 1979 and 2016 were collected. We compared complication rates between ipsilateral and contralateral donor sites relative to the injured leg. The following parameters were analyzed: overall complications, total flap failure, partial flap failure, major complications, operative takebacks, and salvage rates. RESULTS In this study, 25 ipsilateral reconstructions were performed, while 52 cases utilized the contralateral leg. Overall complication rates were higher in the ipsilateral group (40.0%) compared with the contralateral side (23.1%) but were not statistically significant (p = 0.12). The ipsilateral group was four times as likely to experience vascular compromise (24.0 vs. 5.8%; p = 0.05). However, there were no significant differences in complications, flap failures or flap survival. Mean operative time was significantly greater in the same side group as compared with the contralateral group (11.3 vs. 7.5 hours; p = 0.006). CONCLUSION Although there is a higher risk of anastomotic thrombosis, particularly venous thrombosis, associated with ipsilateral donor-site group, there were no significant differences in complications or flap survival. Flaps can be harvested from a traumatized leg with acceptable complication rates while avoiding the morbidity of operating on an uninjured limb.
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Affiliation(s)
- Jason W Yu
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
| | - William J Rifkin
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
| | - Z-Hye Lee
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
| | - Zachary Borab
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
| | | | - Vishal D Thanik
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
| | - Jamie P Levine
- Department of Plastic and Reconstructive Surgery, Hansjörg Wyss, NYU Langone Health, New York, New York
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Kimberly LL, Alfonso AR, Ramly EP, Kantar RS, Caplan AL, Rodriguez ED. How to Integrate Lived Experience Into Quality-of-Life Assessment in Patients Considering Facial Transplantation. AMA J Ethics 2019; 21:E980-E987. [PMID: 31742547 DOI: 10.1001/amajethics.2019.980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/10/2023]
Abstract
Facial transplantation has gained increasing acceptance as a treatment option to improve quality of life (QoL) for persons suffering from severe facial disfigurement. Despite its growth, the field has yet to establish a consistent approach to assessing QoL in face transplant candidates and recipients that includes integration of meaningful patient-reported outcomes. The published literature suggests that face transplant programs currently use a wide variety of assessment tools and strategies. Moreover, confusion remains as to how best to weigh patients' lived experiences and incorporate them into QoL assessments. Qualitative research can illuminate the dimensions of QoL that are meaningful to face transplant candidates and recipients. Coupled with collaboration and data sharing across face transplant programs, qualitative research will help to bring conceptual clarity and transparency to the assessment process.
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Affiliation(s)
- Laura L Kimberly
- An assistant research scientist in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York City, where she is also an associate in the Department of Population Health Division of Medical Ethics
| | - Allyson R Alfonso
- A medical student at NYU School of Medicine and a predoctoral research fellow investigating facial transplantation in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York City
| | - Elie P Ramly
- A surgery resident and postdoctoral research fellow investigating facial transplantation in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York City
| | - Rami S Kantar
- A surgery resident and postdoctoral research fellow investigating facial transplantation in the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York City
| | - Arthur L Caplan
- The Drs William F. and Virginia Connolly Mitty Professor of Bioethics and the founding director of the Division of Medical Ethics at NYU School of Medicine in New York City
| | - Eduardo D Rodriguez
- The Helen L. Kimmel Professor of Reconstructive Plastic Surgery and chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone Health in New York City
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Ramly EP, Kantar RS, Diaz-Siso JR, Alfonso AR, Shetye PR, Rodriguez ED. Outcomes After Tooth-Bearing Maxillomandibular Facial Transplantation: Insights and Lessons Learned. J Oral Maxillofac Surg 2019; 77:2085-2103. [DOI: 10.1016/j.joms.2019.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022]
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Kantar RS, Alfonso AR, Ramly EP, Diaz-Siso JR, Breugem CC, Flores RL. Simulation in Cleft Surgery. Plast Reconstr Surg Glob Open 2019; 7:e2438. [PMID: 31942398 PMCID: PMC6908384 DOI: 10.1097/gox.0000000000002438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
A number of digital and haptic simulators have been developed to address challenges facing cleft surgery education. However, to date, a comprehensive review of available simulators has yet to be performed. Our goal is to appraise cleft surgery simulators that have been described to date, their role within a simulation-based educational strategy, the costs associated with their use, and data supporting or refuting their utility.
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Affiliation(s)
- Rami S Kantar
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Allyson R Alfonso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Elie P Ramly
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - J Rodrigo Diaz-Siso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roberto L Flores
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Ramly EP, Alfonso AR, Kantar RS, Wang MM, Siso JRD, Ibrahim A, Coelho PG, Flores RL. Safety and Efficacy of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) in Craniofacial Surgery. Plast Reconstr Surg Glob Open 2019; 7:e2347. [PMID: 31592029 PMCID: PMC6756658 DOI: 10.1097/gox.0000000000002347] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/29/2019] [Indexed: 12/18/2022]
Abstract
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is one of the most commonly used osteogenic agents in the craniofacial skeleton. This study reviews the safety and efficacy of rhBMP-2 as applied to craniofacial reconstruction and assesses the level of scientific evidence currently available.
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Affiliation(s)
- Elie P Ramly
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Allyson R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Rami S Kantar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Maxime M Wang
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - J Rodrigo Diaz Siso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Amel Ibrahim
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Paulo G Coelho
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Alfonso AR, Hutzler L, Lajam C, Bosco J, Goldstein J. Institution-Wide Blood Management Protocol Reduces Transfusion Rates Following Spine Surgery. Int J Spine Surg 2019; 13:270-274. [PMID: 31328091 DOI: 10.14444/6036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Spine surgery is associated with significant intraoperative blood loss, often leading to transfusion. Patients who receive transfusions have an increased length of stay and risk of perioperative complications. To decrease the transfusion rate, we implemented an evidence-based institution-wide restrictive transfusion blood management guideline. The goal of this study is to describe the impact of this guideline on our spine surgery patients. Methods We analyzed the incidence of transfusion following 3709 single-institution, inpatient spine procedures before and after implementation of a revised blood transfusion protocol. The baseline period (1742 patients) from January 2014 to March 2015 was compared to the study period (1967 patients) of April 2015 to July 2016. One patient was excluded because of incomplete medical records. The revised protocol included establishing a postoperative blood transfusion trigger at hemoglobin < 7g/dL, instituting a computerized provider order entry, and appointing a physician champion to monitor and report progress. Results Transfusion rate decreased from 16.2% to 9.7% from baseline to study period, respectively (P < .001). The number of transfusions in patients with hemoglobin > 7g/dL decreased to 4.9% from 6.1% (P = .09). The rate of transfusions with a prior hemoglobin test increased from 42.0% to 59.1% (P < .001). Length of stay was reduced from 3.67 to 3.46 days (P = .04), and postsurgical infection rate was reduced from 1.5% to 0.6% (P = .01). There was no significant difference in total hospital costs following protocol implementation. Conclusions Implementation of a restrictive transfusion protocol through use of a computerized provider order entry and a physician champion to oversee clinician compliance led to a 40.1% reduction in blood transfusion following spine surgery. Behavior changes were visible with a 40.7% increase in hemoglobin documentation before transfusion, and patients benefited from a reduction in length of stay and postsurgical infection rate. Future study is encouraged to understand the long-term impact of this intervention and its role in hospital expenditure.
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Affiliation(s)
| | | | | | - Joseph Bosco
- NYU Langone Orthopedic Hospital, New York, New York
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26
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DeMitchell-Rodriguez EM, Irving H, Friedman AL, Alfonso AR, Ramly EP, Diaz-Siso JR, Gelb BE, Kantar RS, Rodriguez ED. Toward Increased Organ Procurement Organization Involvement in Vascularized Composite Allograft Donation. Prog Transplant 2019; 29:294-295. [PMID: 31232160 DOI: 10.1177/1526924819856613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Allyson R Alfonso
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Elie P Ramly
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - J Rodrigo Diaz-Siso
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Bruce E Gelb
- 3 Transplant Institute, New York University Langone Health, New York, NY, USA
| | - Rami S Kantar
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Eduardo D Rodriguez
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
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Alfonso AR, DeMitchell-Rodriguez EM, Ramly EP, Noel DY, Levy-Lambert D, Wang MM, Kantar RS, Flores RL. Assessment of American Cleft Palate-Craniofacial Association-Approved Teams' Websites for Patient-Oriented Content and Readability. Cleft Palate Craniofac J 2019; 56:1213-1219. [PMID: 31129984 DOI: 10.1177/1055665619850441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/15/2022] Open
Abstract
OBJECTIVE Informed decision-making relies on available information, including online resources. We evaluated the content and readability of websites published by American Cleft Palate-Craniofacial Association (ACPA)-approved cleft lip and/or palate (CLP) teams in the United States. DESIGN Team websites were reviewed, and teams with no accessible website or <30 sentences of content were excluded. Website content was scored by presence/absence of 20 variables derived from ACPA approval standards. Readability was evaluated with 8 scales. Readability was then compared to American Medical Association (AMA) recommendations. The relationship between website content and readability was assessed. MAIN OUTCOME MEASURE(S) Content and readability of team websites. RESULTS From 167 reviewed teams, 47 (28.1%) had nonfunctional links, 17 (10.2%) had no accessible website, and 39 (23.4%) had <30 sentences. The average content score for all 111 team websites included was 14.5 (2.6) of 20. The combined average reading level across all scales (10.7 [1.9]) exceeded the AMA-recommended sixth-grade reading level; this finding held true for each individual website. Children's Hospital-affiliated teams (n = 86) had a significantly higher content score (14.8 vs 13.5; P = .03) and better readability as evidenced by lower reading grade level (10.5 vs 11.4; P = .04). On linear regression, a higher content score significantly predicted better readability (β = -0.226; P < .001). CONCLUSIONS Websites published by ACPA-approved CLP teams vary in accessibility and content and exceed the recommended reading level. These findings could inform future efforts to improve patient-oriented resources.
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Affiliation(s)
- Allyson R Alfonso
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Elie P Ramly
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Daphney Y Noel
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Dina Levy-Lambert
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Maxime M Wang
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Rami S Kantar
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Roberto L Flores
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
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Kantar RS, Maliha SG, Alfonso AR, Wang MM, Ramly EP, Eisemann BS, Shetye PR, Grayson BH, Flores RL. Nasolabial Aesthetics Following Cleft Repair: An Objective Evaluation of Subjective Assessment. Cleft Palate Craniofac J 2019; 56:1157-1163. [PMID: 31117813 DOI: 10.1177/1055665619851432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2022] Open
Abstract
OBJECTIVE Assess the weight and contribution of each of the parameters of the Asher-McDade Scale to overall subjective assessment of nasolabial aesthetics following cleft lip repair. DESIGN Retrospective cohort evaluation. SETTING Cleft and craniofacial center. PARTICIPANTS Forty-one patients who underwent unilateral cleft lip repair. INTERVENTIONS Unilateral cleft lip repair. MAIN OUTCOME MEASURES Nasolabial rating using the Asher-McDade scale and overall subjective assessment of nasolabial aesthetics using a rank score following unilateral cleft lip repair. RESULTS Strong interrater reliability was observed between the 3 raters. Significant association was determined on bivariate analysis between nasal form score (β = 27.06; P < .001), nasal symmetry score (β = 26.41; P < .001), nasal profile score (β = 28.75; P < .001), vermilion border score (β = 13.40; P = .012), and the ranking score. Adjusted β coefficients obtained from multivariate regression analysis were used to develop a modified nasolabial appearance score (over 5), that is, weighted for each of the 4 parameters: nasal form (over 8, adjusted β = 14.33), nasal symmetry (over 5, adjusted β = 7.96), nasal profile (over 5, adjusted β = 9.44), and vermilion (over 2, adjusted β = 3.31). Regression analysis between our modified nasolabial appearance score and patient ranking score demonstrated superior goodness of fit when compared to the Asher-McDade overall nasolabial appearance score (R2 = .80; P < .001 vs R2 = .69; P < .001). CONCLUSION The parameters evaluated in the Asher-McDade scale have different weights and contribute differently to overall subjective assessment of nasolabial aesthetic outcomes following cleft lip repair. Adjusting for their weights results in a modified score that demonstrates superior correlation with overall subjective assessment of nasolabial aesthetic outcomes.
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Affiliation(s)
- Rami S Kantar
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Samantha G Maliha
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Allyson R Alfonso
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Maxime M Wang
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Elie P Ramly
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Bradley S Eisemann
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Pradip R Shetye
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Barry H Grayson
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - Roberto L Flores
- 1 The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
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Lee ZH, Alfonso AR, Stranix JT, Anzai L, Daar DA, Ceradini DJ, Levine JP, Saadeh PB, Thanik V. Vein Size Mismatch Increases Flap Failure in Lower Extremity Trauma Free Flap Reconstruction. J Reconstr Microsurg 2019; 35:587-593. [DOI: 10.1055/s-0039-1688718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Abstract
Background Venous outflow problems are the most common reasons for perioperative flap complications. Size mismatch in venous anastomoses poses a theoretical problem by promoting turbulent flow and subsequent thrombus formation. The purpose of this study was to determine if increased vein size mismatch is predictive of flap failure.
Methods Retrospective review of our institutional flap registry from 1979 to 2016 identified 410 free flaps performed for reconstruction of lower extremity trauma. Patient demographics, flap characteristics, and flap outcomes were examined. Venous size mismatch was defined as a difference in size ≥ 1 mm between the recipient vein and flap vein.
Results Vein size mismatch ≥ 1mm was present in 17.1% (n = 70) of patients. The majority of anastomoses were end-to-end (n = 379, 92.4%), and end-to-side anastomoses were preferentially used in the presence of vein size mismatch (p < 0.001). Major complications occurred in 119 (29%) flaps, with 35 (8.5%) partial flap losses and 34 (8.3%) total flap losses. Looking specifically at flaps with end-to-end venous anastomoses, venous size mismatch was associated with increased total flap failure (p = 0.031) and takeback for vascular compromise (p = 0.030). Recipient vein size relative to flap vein size (larger or smaller) had no effect on flap outcomes. Multivariable regression analysis controlling for age, sex, flap type, number of veins, recipient vein size, flap vein size, venous coupler use, and vein size mismatch demonstrated that flaps with ≥ 1 mm vein mismatch were predictive of total flap failure (p = 0.045; odds ratio: 2.58).
Conclusion Flaps with vein size mismatch ≥ 1 mm demonstrated increased flap complication rates in the setting of end-to-end venous anastomoses. End-to-side anastomosis was preferentially used in vein size mismatch and carried a higher risk of flap failure. Our results support using veins of similar size for anastomosis whenever feasible to protect against flap complications.
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Affiliation(s)
- Z-Hye Lee
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Allyson R. Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - John T. Stranix
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Lavinia Anzai
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - David A. Daar
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Daniel J. Ceradini
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Jamie P. Levine
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Pierre B. Saadeh
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
| | - Vishal Thanik
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, United States
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Alfonso AR, Kantar RS, Ramly EP, Daar DA, Rifkin WJ, Levine JP, Ceradini DJ. Diabetes is associated with an increased risk of wound complications and readmission in patients with surgically managed pressure ulcers. Wound Repair Regen 2019; 27:249-256. [DOI: 10.1111/wrr.12694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Allyson R. Alfonso
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Rami S. Kantar
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Elie P. Ramly
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - David A. Daar
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | | | - Jamie P. Levine
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
| | - Daniel J. Ceradini
- Hansjörg Wyss Department of Plastic SurgeryNYU Langone Health New York New York
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Jevotovsky DS, Alfonso AR, Einhorn TA, Chiu ES. Osteoarthritis and stem cell therapy in humans: a systematic review. Osteoarthritis Cartilage 2018; 26:711-729. [PMID: 29544858 DOI: 10.1016/j.joca.2018.02.906] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [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] [Received: 07/24/2017] [Revised: 01/21/2018] [Accepted: 02/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a leading cause of disability in the world. Mesenchymal stem cells (MSCs) have been studied to treat OA. This review was performed to systematically assess the quality of literature and compare the procedural specifics surrounding MSC therapy for osteoarthritis. DESIGN PubMed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials were searched for studies using MSCs for OA treatment (final search December 2017). Outcomes of interest included study evidence level, patient demographics, MSC protocol, treatment results and adverse events. Level I and II evidence articles were further analyzed. RESULTS Sixty-one of 3,172 articles were identified. These studies treated 2,390 patients with osteoarthritis. Most used adipose-derived stem cells (ADSCs) (n = 29) or bone marrow-derived stem cells (BMSCs) (n = 30) though the preparation varied within group. 57% of the sixty-one studies were level IV evidence, leaving five level I and nine level II studies containing 288 patients to be further analyzed. Eight studies used BMSCs, five ADSCs and one peripheral blood stem cells (PBSCs). The risk of bias in these studies showed five level I studies at low risk with seven level II at moderate and two at high risk. CONCLUSION While studies support the notion that MSC therapy has a positive effect on OA patients, there is limited high quality evidence and long-term follow-up. The present study summarizes the specifics of high level evidence studies and identifies a lack of consistency, including a diversity of MSC preparations, and thus a lack of reproducibility amongst these articles' methods.
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Affiliation(s)
- D S Jevotovsky
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
| | - A R Alfonso
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA
| | - T A Einhorn
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - E S Chiu
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, NY, USA.
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