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Dagi AF, LaValley MN, Diaddigo SE, Wu JK, Bogue JT. Trends in orthoplastic operative exposure for plastic surgery residents in the United States. J Plast Reconstr Aesthet Surg 2024; 90:224-226. [PMID: 38387419 DOI: 10.1016/j.bjps.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Recent trials have demonstrated clinical benefits to a combined orthoplastic approach for complex reconstructive surgery of the hand, upper and lower extremity. PURPOSE We sought to assess recent trends in exposure to orthoplastic-type procedures among plastic surgery residents training in the United States. METHODS Independent plastic surgery residents' case logs were extracted from the Accreditation Council for Graduate Medical Education (2011-2022). Select reconstructive procedure were taken as proxies for orthoplastic-type cases and analyzed by descriptive statistical analysis. RESULTS The average number of orthoplastic-type cases completed per resident per year increased from 168.2 to 189.2 (12.5% increase) between 2011-2022. The greatest increase was in exposure to peripheral nerve injury repair of the hand and upper extremity (22.6 to 39.1, 73% increase). As a proportion of total procedures during the study period, orthoplastic-type procedures remained relatively unchanged (range 9.5-10.4%). CONCLUSIONS Our findings suggest that plastic surgery residents may be increasingly well-prepared to contribute to orthoplastic care during and following their training. The steady proportion of cases that orthoplastic-type procedures represented over the study period suggests the increase in relevant orthoplastic case volume may be incidental and secondary to an overall rise among all procedures. Given evidence of the benefits of an orthoplastic approach, we recommend consideration of explicit benchmarks for orthoplastic training among plastic surgery residents.
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Affiliation(s)
- Alexander F Dagi
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Myles N LaValley
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Sarah E Diaddigo
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - June K Wu
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Jarrod T Bogue
- Division of Plastic and Reconstructive Surgery, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
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LaValley MN, Dugue D, Diaddigo SE, Kuonqui KG, Tyler WK, Bogue JT. A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00001. [PMID: 38421606 PMCID: PMC10906598 DOI: 10.5435/jaaosglobal-d-23-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
BACKGROUND The orthoplastic approach to patient care has changed the way patients with a wide variety of lower extremity pathology are treated. Through a systematic review, we aim to analyze outcomes in adult patients with lower extremity soft tissue sarcomas who undergo an orthoplastic flap management approach to their care. METHODS A systematic review of adult lower extremity soft tissue sarcoma excision with plastic surgery flap reconstruction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines searching the Pubmed, Embase, and Web of Science databases from inception to April 2023. RESULTS After removal of duplicates, title and abstract screening, and full-text review, 26 articles were accepted for inclusion. The total mean follow-up duration was 32.0 ± 24.3 months. Reconstruction used microvascular free flaps in 65.5% (487/743), while 34.5% (256/743) were local flaps. 85.8% (307/358) of patients ambulated postoperatively. Revision surgery was required in 21% of patients during their respective follow-up periods. The limb salvage rate was 93.4% (958/1,026). Among pooled surgical outcomes, 22.2% (225/1,012) of patients experienced a perioperative complication. DISCUSSION Our study demonstrates that although complication rates in lower extremity soft tissue sarcoma reconstruction may be further optimized, a multidisciplinary flap reconstructive approach provides high rates of limb salvage and functional postoperative ambulation.
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Affiliation(s)
- Myles N. LaValley
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - David Dugue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Sarah E. Diaddigo
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Kevin G. Kuonqui
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Wakenda K. Tyler
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
| | - Jarrod T. Bogue
- From the Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital/Columbia University Medical Center (Mr. LaValley, Dr. Dugue, Ms. Diaddigo, Mr. Kuonqui, and Dr. Bogue), and the Department of Orthopedic Surgery, New York-Presbyterian Hospital/Columbia University Medical, New York, NY (Dr. Tyler)
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Diaddigo SE, LaValley MN, Kuonqui K, Janhofer DE, Ascherman JA. Flap management following orthotopic heart transplantation: A single institution's review of 66 sternal wound complications. J Plast Reconstr Aesthet Surg 2024; 90:266-272. [PMID: 38401198 DOI: 10.1016/j.bjps.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Sternotomy wound complications are more frequent after orthotopic heart transplantation (OHT) compared to other cardiac surgeries, primarily due to additional risk factors, including immunosuppression. Flap closure often becomes necessary for definitive treatment, although there is a scarcity of data on the outcomes of sternal wound reconstruction in this specific population. METHODS A retrospective analysis was conducted on 604 sternal wound reconstructions performed by a single surgeon between 1996 and 2023. Inclusion criteria comprised patients who underwent OHT as their primary cardiac procedure. Surgical interventions involved sternal hardware removal, debridement, and muscle flap closure. RESULTS The study included 66 patients, with culture-positive wound infection being the most common indication for reconstruction (51.5%). The median duration between transplantation and sternal wound reconstruction was 25 days. Bilateral pectoralis major myocutaneous advancement flaps (n = 63), rectus abdominis flaps (n = 2), or pectoralis major turnover flaps (n = 1) were used. Intraoperative wound cultures revealed positivity in 48 patients (72.7%), with Staphylococcus epidermidis being the most frequently cultured organism (25.0%). The overall complication rate was 31.8%, and two patient deaths were related to sternal wounds, resulting from multiorgan failure following septic shock. The majority of the patients reported excellent long-term functional and esthetic outcomes. CONCLUSIONS Sternal wounds following OHT pose a significant morbidity risk. Our strategy focuses on immediate and aggressive antibiotic therapy, thorough debridement, and definitive closure with bilateral pectoralis myocutaneous advancement flaps. This approach has demonstrated complication and mortality rates comparable to the general cardiac surgery population, as well as excellent functional and esthetic results.
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Affiliation(s)
- Sarah E Diaddigo
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Myles N LaValley
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Kevin Kuonqui
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - David E Janhofer
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
| | - Jeffrey A Ascherman
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA.
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Diaddigo SE, LaValley MN, Asadourian PA, Rohde CH. "Barbie botox": The systematic review of a popular trend. J Plast Reconstr Aesthet Surg 2024; 88:45-46. [PMID: 37952434 DOI: 10.1016/j.bjps.2023.10.136] [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] [Received: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Sarah E Diaddigo
- New York-Presbyterian Hospital/Columbia University Medical Center Division of Plastic and Reconstructive Surgery, New York, NY, United States
| | - Myles N LaValley
- New York-Presbyterian Hospital/Columbia University Medical Center Division of Plastic and Reconstructive Surgery, New York, NY, United States
| | - Paul A Asadourian
- New York-Presbyterian Hospital/Columbia University Medical Center Division of Plastic and Reconstructive Surgery, New York, NY, United States
| | - Christine H Rohde
- New York-Presbyterian Hospital/Columbia University Medical Center Division of Plastic and Reconstructive Surgery, New York, NY, United States.
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Dagi AF, LaValley MN, Bogue JT. Three-dimensional Planning for Lower Extremity Soft-tissue Reconstruction after Sarcoma Resection: Systematic Review and Reflections. Plast Reconstr Surg Glob Open 2024; 12:e5529. [PMID: 38260760 PMCID: PMC10803016 DOI: 10.1097/gox.0000000000005529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/14/2023] [Indexed: 01/24/2024]
Affiliation(s)
- Alexander F. Dagi
- From the Division of Plastic and Reconstructive Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, N.Y
| | - Myles N. LaValley
- From the Division of Plastic and Reconstructive Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, N.Y
| | - Jarrod T. Bogue
- From the Division of Plastic and Reconstructive Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, N.Y
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LaValley MN, Diaddigo SE, Feuer GB, Warner PE, Ascherman JA. The impact of a shadowing program on medical students' interest in plastic surgery. J Plast Reconstr Aesthet Surg 2023; 87:205-207. [PMID: 37898025 DOI: 10.1016/j.bjps.2023.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/08/2023] [Indexed: 10/30/2023]
Abstract
Given the lack of formal education on plastic surgery services during the preclinical years of medical school, many medical students commonly misunderstand the breadth and depth of the field. Shadowing is highly impactful in shaping students' desire to pursue surgery, but the impact of plastic surgery shadowing remains unexplored. The study design utilized an anonymous web-based survey containing questions surrounding prior interest in surgery, race, gender, medical school progress, and clinical versus OR shadowing. All medical students who participated in an ongoing, voluntary plastic surgery shadowing program over a two-year period were invited to complete the survey. Of the 54 students who shadowed during the study period, 43 (79.6%) returned the survey. Students reported an overall greater impact of OR shadowing than clinic shadowing on their interest in plastic surgery, approaching significance (p = 0.0527). On simple and multivariate regression, the number of times a student shadowed in the OR was the only statistically significant predictor of students' interest in plastic surgery (p = 0.0003). In general, the majority of students reported that their shadowing experience "significantly increased" (24.2%) or "somewhat increased" (45.5%) their interest in pursuing a career in plastic surgery. The impact of shadowing, particularly in the operating room, on students' interest in plastic surgery demonstrates the value of structured shadowing programs. Additionally, given the particularly influential effect of shadowing in the operating room, our results indicate that efforts may benefit most from facilitating student exposure to the hands-on aspects of the field.
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Affiliation(s)
- Myles N LaValley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Sarah E Diaddigo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Grant B Feuer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Paige E Warner
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, United States
| | - Jeffrey A Ascherman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, United States.
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LaValley MN, Diaddigo SE, Asadourian PA, Feuer GB, Warner PE, Rohde CH. National Legislative Favorability and Insurance Coverage for Adult and Adolescent Gender-Affirming Surgery. Plast Reconstr Surg 2023:00006534-990000000-02158. [PMID: 37815328 DOI: 10.1097/prs.0000000000011123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Despite established medical necessity, laws prohibiting coverage discrimination, and increasing numbers of transgender and gender diverse patients seeking gender-affirming surgeries (GAS), cost and restrictive insurance policies continue to be the most common barriers. As recent legislation places further restrictions on GAS, this study aims to provide an updated review of insurance policies and assess the relationship between legislative favorability and coverage. METHODS Insurance policies of groups representing 80% market coverage in each state were collected for gender-affirming chest, genital and facial surgery. Policies were categorized based on previously published methodologies: never-covered (N), case-by-case (CC), and preauthorization (PA). The relationship between established scores of legislative favorability and policy coverage in each state was analyzed and compared across regions. RESULTS Of the 316 analyzed policies, coverage was preauthorized most often for genital (94.0%), masculinizing top (93%), feminizing top (74%), and facial reconstruction (24%), respectively. Higher legislative scores in the Northeast and West, as well as individual states were predictive of increased genital, facial, and all forms of adolescent GAS, but were not correlated to chest GAS. CONCLUSION Compared to previous studies, our findings suggest that there is a growing acceptance of GAS as medically necessary. However, the correlation between legislative scores and genital, face, and adolescent GAS coverage may suggest increased reliance on sociopolitical factors for access in the absence of comprehensive medical guidelines, which are more established for chest reconstruction. Significantly higher coverage of masculinizing versus feminizing chest surgery suggests additional burden of proof for GAS with a cosmetic overlap.
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Affiliation(s)
- Myles N LaValley
- New York-Presbyterian Hospital/Columbia University Medical Center Division of Plastic and Reconstructive Surgery, NY, NY
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Asadourian PA, Murphy AI, Diaddigo SE, LaValley MN, Marano AA, Rohde CH, Wu JK. And Then There Was One: 2021-2022 COVID-19 Single Away Rotation Policy's Impact on the Geography of the Integrated Plastic Surgery Match. Plast Reconstr Surg 2023; 151:1057e-1058e. [PMID: 37163457 DOI: 10.1097/prs.0000000000010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Paul A Asadourian
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Irving Medical Center New York Presbyterian Hospital, New York, NY
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LaValley MN, Zappi K, Guadix SW, Giantini-Larsen AM, Garton ALA, Heier LA, Imahiyerobo TA, Hoffman CE. Complications in craniosynostosis surgery in patients with rickets: illustrative case and systematic review of literature. J Neurosurg Case Lessons 2022; 4:CASE22388. [PMID: 36536525 PMCID: PMC9764373 DOI: 10.3171/case22388] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Craniosynostosis (CSS) is the premature fusion of calvarial sutures associated with identified genetic mutations or secondary to alterations in intracranial pressure, brain, or bone growth patterns. Of the metabolic etiologies implicated in CSS, X-linked hypophosphatemic rickets (XLHR) is the most common, with dysfunctional bone mineralization leading to progressive hyperostosis and delayed synostosis. There is a paucity of literature discussing the unique surgical considerations for XLHR-related CSS. OBSERVATIONS A 26-month-old male with XLHR-related sagittal CSS underwent cranial vault remodeling (CVR). Surgery was complicated by the presence of diploic hypertrophy with significant intraoperative estimated blood loss (EBL). EBL greatly exceeded reference ranges for CVR in all-cause CSS. As a result, the surgical goals were modified and the complete planned procedure aborted. Subsequent review of preoperative imaging revealed multiple fine vascular lacunae within the bone. A systematic literature review was conducted to identify reported complications relating to surgical intervention for rickets-associated CSS. LESSONS Future considerations for patients with XLHR-related CSS should emphasize awareness of metabolic risk factors with associated complications, and the need for selection of approach and operative management techniques to avoid EBL. Further research is required to elucidate underlying mechanisms and determine whether the encountered phenomenon is characteristic across this patient population and potentially minimized by preoperative medical therapy.
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Affiliation(s)
- Myles N. LaValley
- Department of Plastic Surgery, Columbia University Medical Center, New York, New York
| | | | | | | | | | - Linda A. Heier
- Radiology, Weill Cornell Medical Center, New York, New York; and
| | - Thomas A. Imahiyerobo
- Department of Plastic Surgery, Columbia University Medical Center, New York, New York
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