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Hintze JM, Afshar S, Taghinia A, Labow B, Green M, Robson CD, Marcus K, Mack J, Perez-Atayde A, Rahbar R. A multi-disciplinary team approach to pediatric malignant mandibular tumors. Int J Pediatr Otorhinolaryngol 2023; 168:111547. [PMID: 37079945 DOI: 10.1016/j.ijporl.2023.111547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Mandibular tumors in the pediatric population are rare. These malignancies are variable in their histology, and combined with their rarity, has made it difficult to describe their clinical course, and treatment guidelines. The aim of this paper is to describe the experience of Boston Children's Hospital, a pediatric tertiary referral center, with treating malignant mandibular malignancies, as well as provide multi-disciplinary team approach in managing this clinical entity. METHODS A retrospective search was performed for mandibular malignancies in pediatric patients between 1995 and 2020 via the pathological database at Boston Children's Hospital. Only patients with malignant solid mandibular neoplasms were included, leaving 15 patients for final analysis. RESULTS The median age at presentation was 10.1 ± 10.3 years. Nine of 15 patients (60%) presented with jaw mass which was the most common clinical presentation. The most commonly identified histological diagnosis was rhabdomayosarcoma and osteosarcoma (n = 4, 26% each). A mandibulectomy was performed in 12 (80%) cases. Reconstruction of the mandible was performed using a fibular free flap in 6 (40%) cases, and a plate in 3 (20%) cases. Mean follow-up was 4.6 ± 4.9 years. CONCLUSION Malignant tumors most commonly present with a jaw mass, however asymptomatic and incidental presentations follow closely and pathologies can vary greatly. Surgical resection and reconstruction is often indicated, multidisciplinary tumor board review is required to determine when children are best treated with neo-/adjuvant treatment with chemo- and radiotherapy.
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Affiliation(s)
- Justin M Hintze
- Department of Otolaryngology and Communication Enhancement, USA; Harvard Medical School, Boston, MA, USA.
| | - Salim Afshar
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Brian Labow
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Mark Green
- Department of Plastic and Oral Surgery, USA; Harvard Medical School, Boston, MA, USA
| | - Caroline D Robson
- Department of Neuroradiology, USA; Harvard Medical School, Boston, MA, USA
| | - Karen Marcus
- Department of Radiation Oncology, USA; Harvard Medical School, Boston, MA, USA
| | - Jennifer Mack
- Department of Hematology and Oncology, USA; Harvard Medical School, Boston, MA, USA
| | - Antonio Perez-Atayde
- Department of Pathology, Boston Children's Hospital, USA; Harvard Medical School, Boston, MA, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, USA; Harvard Medical School, Boston, MA, USA
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Ali B, Choi EE, Barlas V, Nuzzi L, Morrell NT, Labow B, Borah G, Taghinia A. Perioperative Safety of Combined Augmentation-Mastopexy: An Evaluation of National Database. Ann Plast Surg 2021; 87:493-500. [PMID: 34699429 DOI: 10.1097/sap.0000000000003022] [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: 11/26/2022]
Abstract
INTRODUCTION The safety of combined augmentation-mastopexy is controversial. This study evaluates a national database to analyze the perioperative safety of combined augmentation-mastopexy to either augmentation or mastopexy alone. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients undergoing augmentation mammaplasty and mastopexy from 2005 to 2018. The patients were divided into the following groups: group I, augmentation; group II, mastopexy; group III, combined augmentation-mastopexy. Baseline characteristics and outcomes were compared. Outcomes were 30-day complications, reoperation, and readmission. RESULTS We found 5868 (74.2%) augmentation only, 1508 (19.1%) mastopexy only and 534 (6.6%) combined augmentation-mastopexy cases. Mean operative time was highest among the combined group at 129 minutes compared with 127 minutes for mastopexy alone and 66 minutes for augmentation alone (P < 0.01). Rates of any complications and readmission were different among groups (0.8% vs 2.5% vs 1.5% respectively, P < 0.01 and 0.7% vs 1.5% vs 1.5% respectively, P = 0.049), whereas reoperation was not statistically different (1.2% vs 1.4% vs 1.5%, P = 0.75). The incidence of dehiscence (0.6%; P < 0.01) was highest in the combined group. Multivariable logistic regression analysis did not reveal an increased odds of complications, reoperation, or readmission with combined augmentation-mastopexy. CONCLUSIONS An evaluation of the nationwide cohort suggests that combined augmentation-mastopexy is a safe procedure in the perioperative period.
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Affiliation(s)
- Barkat Ali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - EunHo Eunice Choi
- Statistics and Epidemiology and Research Designs, Clinical and Translational Science Center, University of New Mexico, Health Sciences Center
| | | | - Laura Nuzzi
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nathan T Morrell
- Department of Orthopedic Surgery, Hand, Upper Extremity and Microsurgery, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Brian Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Gregory Borah
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
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3
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Grimstad F, Boskey ER, Taghinia A, Ganor O. Gender-Affirming Surgeries in Transgender and Gender Diverse Adolescent and Young Adults: A Pediatric and Adolescent Gynecology Primer. J Pediatr Adolesc Gynecol 2021; 34:442-448. [PMID: 33852937 DOI: 10.1016/j.jpag.2021.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/28/2021] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
Transgender and gender diverse adolescent and young adults (AYA) may seek gender-affirming surgeries (GAS) as part of their gender affirmation. A number of GAS are related to reproductive and sexual health, and pediatric and adolescent gynecology (PAG) clinicians are well positioned as sexual and reproductive health experts to provide care in this area. PAG clinicians may encounter patients presenting for preoperative counseling (including discussions regarding fertility, family building, future sexual function, and choice of oophorectomy at time of hysterectomy), requesting referrals to GAS clinicians, or requiring GAS aftercare, or those seeking general sexual and reproductive health care who have a history of GAS. This article reviews presurgical considerations for AYA seeking GAS, types of GAS, their impact on pelvic, sexual, and reproductive health, and aftercare that may involve PAG providers, with the goal of helping PAG clinicians to better understand these procedures and to empower them to engage collaboratively with GAS teams. With this knowledge, reproductive health clinicians can have an integral role as skilled collaborators in the world of AYA GAS in partnership with GAS surgeons.
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Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, 02115 Boston, Massachusetts; Center for Gender Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts.
| | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Surgery, Harvard Medical School, 02115 Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, Massachusetts
| | - Amir Taghinia
- Center for Gender Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Surgery, Harvard Medical School, 02115 Boston, Massachusetts
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Plastic and Oral Surgery, Boston Children's Hospital, 02115 Boston, Massachusetts; Department of Surgery, Harvard Medical School, 02115 Boston, Massachusetts
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4
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Grimstad F, Boskey ER, Taghinia A, Estrada CR, Ganor O. The role of androgens in clitorophallus development and possible applications to transgender patients. Andrology 2021; 9:1719-1728. [PMID: 33834632 DOI: 10.1111/andr.13016] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clitorophallus, or glans, is a critical structure in sexual development and plays an important role in how gender is conceptualized across the life span. This can be seen in both the evaluation and treatment of intersex individuals and the use of gender-affirming masculinizing therapies to help those born with a clitoris (small clitorophallus with separate urethra) enlarge or alter the function of that structure. OBJECTIVES To review the role of testosterone in clitorophallus development from embryo to adulthood, including how exogenous testosterone is used to stimulate clitorophallus enlargement in masculinizing gender-affirming therapy. MATERIALS AND METHODS Relevant English-language literature was identified and evaluated for data regarding clitorophallus development in endosex and intersex individuals and the utilization of hormonal and surgical masculinizing therapies on the clitorophallus. Studies included evaluated the spectrum of terms regarding the clitorophallus (genital tubercle, clitoris, micropenis, penis). RESULTS Endogenous testosterone, and its more active metabolite dihydrotestosterone, plays an important role in the development of the genital tubercle into the clitorophallus, primarily during the prenatal and early postnatal periods and then again during puberty. Androgens contribute to not only growth but also the inclusion of a urethra on the ventral aspect. Exogenous testosterone can be used to enlarge the small clitorophallus (clitoris or micropenis) as part of both intersex and gender-affirming care (in transmasculine patients, up to 2 cm of additional growth). Where testosterone is insufficient to provide the degree of masculinization desired, surgical options including phalloplasty and metoidioplasty are available. DISCUSSION AND CONCLUSION Endogenous testosterone plays an important role in clitorophallus development, and there are circumstances where exogenous testosterone may be useful for masculinization. Surgical options may also help some patients reach their personal goals. As masculinizing gender-affirming care advances, the options available for clitorophallus modifications will likely continue to expand and improve.
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Affiliation(s)
- Frances Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA.,Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Amir Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Carlos R Estrada
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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Thompson K, Zendejas B, Svetanoff WJ, Labow B, Taghinia A, Ganor O, Manfredi M, Ngo P, Smithers CJ, Hamilton TE, Jennings RW. Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children. Surgery 2021; 170:114-125. [PMID: 33812755 DOI: 10.1016/j.surg.2021.01.036] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The jejunal interposition is our preferred esophageal replacement route when the native esophagus cannot be reconstructed. We report the evolution of our approach and outcomes. METHODS The study was a single-center retrospective review of children undergoing jejunal interposition for esophageal replacement. Outcomes were compared between historical (2010-2015) and contemporary cohorts (2016-2019). RESULTS Fifty-five patients, 58% male, median age 4 years (interquartile range 2.4-8.3), with history of esophageal atresia (87%), caustic (9%) or peptic (4%) injury, underwent a jejunal interposition (historical cohort n = 14; contemporary cohort n = 41). Duration of intubation (11 vs 6 days; P = .01), intensive care unit (22 vs 13 days; P = .03), and hospital stay (50 vs 27 days; P = .004) were shorter in the contemporary cohort. Anastomotic leaks (7% vs 5%; P = .78), anastomotic stricture resection (7% vs 10%; P = .74), and need for reoperation (57% vs 46%; P = .48) were similar between cohorts. Most reoperations were elective conduit revisions. Microvascular augmentation, used in 70% of cases, was associated with 0% anastomotic leaks vs 18% without augmentation; P = .007. With median follow-up of 1.9 years (interquartile range 1.1, 3.8), 78% of patients are predominantly orally fed. Those with preoperative oral intake were more likely to achieve consistent postoperative oral intake (87.5% vs 64%; P = .04). CONCLUSION We have made continuous improvements in our management of patients undergoing a jejunal interposition. Of these, microvascular augmentation was associated with no anastomotic leaks. Despite its complexity and potential need for conduit revision, the jejunal interposition remains our preferred esophageal replacement, given its excellent long-term functional outcomes in these complex children who have often undergone multiple procedures before the jejunal interposition.
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Affiliation(s)
- Kyle Thompson
- Department of General Surgery, Boston Children's Hospital, MA
| | - Benjamin Zendejas
- Department of General Surgery, Boston Children's Hospital, MA. https://twitter.com/benzendejas
| | - Wendy Jo Svetanoff
- Department of General Surgery, Boston Children's Hospital, MA; Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO. https://twitter.com/WJSvetanoff
| | - Brian Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital, MA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, MA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, MA
| | - Michael Manfredi
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, MA
| | - Peter Ngo
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, MA
| | - C Jason Smithers
- Department of General Surgery, Boston Children's Hospital, MA; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
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Ali B, Panossian A, Taghinia A, Mulliken JB, Alomari A, Adams DM, Fishman SJ, Upton J. Diffuse Venous Malformations of the Upper Extremity (Bockenheimer Disease): Diagnosis and Management. Plast Reconstr Surg 2020; 146:1317-1324. [PMID: 33234962 DOI: 10.1097/prs.0000000000007365] [Citation(s) in RCA: 5] [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: 01/02/2023]
Abstract
BACKGROUND Diffuse venous malformations that involve all tissues in the upper limb and ipsilateral chest wall are known as "phlebectasia of Bockenheimer." The authors describe their experience with management of this uncommon vascular anomaly. METHODS The authors' Vascular Anomalies Center registry comprised 18,766 patients over a 40-year period. This review identified 2036 patients with venous malformations of the extremities (10.8 percent), of whom only 80 (0.43 percent) had Bockenheimer disease. The authors retrospectively analyzed patient characteristics, diagnostics, treatments, and complications. RESULTS The venous malformation was first noted at birth or within the first few years of life with slow and gradual progression. Pain was related to engorgement of the limb. Thromboses and phleboliths were common, but diffuse intravascular coagulopathy occurred in only 12 patients (15 percent). Skeletal involvement was demonstrated as lytic lesions, cortical scalloping, osteopenia, and pathologic fractures. Management included compression garments (100 percent), sclerotherapy (27.5 percent), and resection of symptomatic areas in 35 percent of patients. Adjunctive pharmacologic medication was given in 7.5 percent. Following resection, 17 patients (60 percent) had one or more complications: hematoma, wound dehiscence, flap loss, contracture, and psychosis. There were no deaths. Symptoms improved in all patients with useful functional outcomes. CONCLUSIONS The decision to pursue compression, sclerotherapy, pharmacologic treatment, or resection alone or in combination was made by an interdisciplinary team. Although extensive venous malformations cannot be completely ablated, debulking of symptomatic regions, resection of neuromas, and noninvasive treatments improve the quality of life. Despite the bulk and weight of the arm, forearm, and hand, and the ominous appearance on magnetic resonance imaging, these patients remain functional. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Barkat Ali
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Andre Panossian
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Amir Taghinia
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - John B Mulliken
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Ahmad Alomari
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Denise M Adams
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Stephen J Fishman
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
| | - Joseph Upton
- From the Division of Plastic Surgery, Department of Surgery, University of New Mexico; the Division of Plastic Surgery, Shriners Hospital for Children; and the Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School
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Abstract
Lymphedema is the chronic, progressive swelling of tissue due to inadequate lymphatic function. Over time, protein-rich fluid accumulates in the tissue causing it to enlarge. Lymphedema is a specific disease and should not be used as a generic term for an enlarged extremity. The diagnosis is made by history and physical examination, and confirmed with lymphoscintigraphy. Intervention includes patient education, compression, and rarely, surgery. Patients are advised to exercise, maintain a normal body mass index, and moisturize / protect the diseased limb from incidental trauma. Conservative management consists of compression regimens. Operative interventions either attempt to address the underlying lymphatic anomaly or the excess tissue. Lymphatic-venous anastomosis and lymph node transfer attempt to create new lymphatic connections to improve lymph flow. Suction-assisted lipectomy and cutaneous excision reduce the size of the area by removing fibroadipose hypertrophy.
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Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States.
| | - Christopher L Sudduth
- Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, United States
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Cuccolo NG, Kang CO, Boskey ER, Ibrahim AMS, Blankensteijn LL, Taghinia A, Lee BT, Lin SJ, Ganor O. Masculinizing Chest Reconstruction in Transgender and Nonbinary Individuals: An Analysis of Epidemiology, Surgical Technique, and Postoperative Outcomes. Aesthetic Plast Surg 2019; 43:1575-1585. [PMID: 31451850 DOI: 10.1007/s00266-019-01479-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest reconstruction ('top surgery') is an important component of transition in the transmasculine population that can substantially improve gender incongruence. The aim of this study was to evaluate the demographic characteristics, surgical technique, and postoperative outcomes following transmasculine chest surgery. METHODS Using ICD codes, we identified all cases of gender-affirming transmasculine chest surgery from the ACS NSQIP database (2010-2017). CPT codes were used to categorize patients by reconstructive modality: reduction versus mastectomy (± free nipple grafting [FNG]). Univariate analysis was conducted to assess for differences in demographics, comorbidities, and postoperative complications. Multivariable regression analysis was used to control for confounders. RESULTS A total of 755 cases were identified, of whom 591 (78.3%) were mastectomies and 164 (21.7%) were reductions. No significant differences were noted in terms of age or BMI. Mastectomies had shorter operative times, but similar length of stay compared to reductions. Rates of postoperative complications were low, with 4.7% (n = 28) of mastectomies and 3.7% (n = 6) of reductions experiencing at least one all-cause complications. Postoperative complication rates were not statistically different between mastectomy with (3.4%) and without (5.6%) FNG. After controlling for confounders, there was no difference in terms of risk of all-cause complications between reduction and mastectomy, with or without FNG. CONCLUSION Mastectomy and reduction mammaplasty are both safe procedures for chest reconstruction in the transmasculine population. These results may be used to encourage shared decision making between patient and surgeon such that the reconstructive modality of choice best aligns with the desired aesthetic outcome. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Nicholas G Cuccolo
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Christine O Kang
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Elizabeth R Boskey
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA.
- Center for Gender Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA.
| | - Ahmed M S Ibrahim
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Louise L Blankensteijn
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
- Center for Gender Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA
| | - Oren Ganor
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
- Center for Gender Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
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Abstract
Public accommodation laws (PALs) are used to address discrimination against minorities. There is broad discussion about using such laws to either protect or prohibit access to sex-segregated spaces for transgender people. Health care facilities are subject to PALs, which affect rooming assignments and access to sex-segregated environments. Around the time that a Massachusetts transgender PAL went into effect in October 2016, the first author (EB) facilitated 18 professional trainings at 5 health care facilities in greater Boston. During these trainings, staff repeatedly brought up 2 areas of moral concern reflecting public conversations about transgender rights: risk posed by the presence of transwomen in sex-segregated spaces and feelings of unpreparedness for dealing with anti-trans bias. This article discusses the role of education in responding to gender panic in inpatient settings.
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Affiliation(s)
- Elizabeth Boskey
- A social worker and researcher in the Center for Gender Surgery at Boston Children's Hospital in Boston, Massachusetts
| | - Amir Taghinia
- A plastic and microvascular surgeon at Boston Children's Hospital, where he is also the co-director of the Center for Gender Surgery, and an assistant professor of surgery at Harvard Medical School in Boston, Massachusetts
| | - Oren Ganor
- A plastic and reconstructive surgeon at Boston Children's Hospital in Boston, Massachusetts, where he is the founder and co-director of the hospital's Center for Gender Surgery
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10
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Resnick CM, Genuth J, Calabrese CE, Taghinia A, Labow BI, Padwa BL. Temporomandibular Joint Ankylosis After Ramus Construction With Free Fibula Flaps in Children With Hemifacial Microsomia. J Oral Maxillofac Surg 2018; 76:2001.e1-2001.e15. [DOI: 10.1016/j.joms.2018.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022]
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Kotick JD, Taghinia A. Prolonged Bleeding after a Single Leech Application in Pediatric Hand Surgery. J Hand Microsurg 2017; 9:98-100. [PMID: 28867911 DOI: 10.1055/s-0037-1604348] [Citation(s) in RCA: 3] [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] [Received: 03/29/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022] Open
Abstract
Use of the medicinal leech in microsurgery is common place for venous decongestion and can be associated with the need for transfusion over time and multiple applications. Here the authors present a case of profound, ongoing, life-threatening bleeding after a single leech application in pediatric microscopic surgery. There are no reports of such profound bleeding in the literature, and this case serves as a warning of the need for close surveillance in this subset of patients.
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Affiliation(s)
- James D Kotick
- Department of Plastic, Reconstructive, and Hand Surgery, Lahey Hospital and Medical Clinic, Tufts Medical School, Burlington, Massachusetts, United States
| | - Amir Taghinia
- Department of Plastic and Hand Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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12
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Hirji SA, Knell JK, Kim HB, Fishman SJ, Taghinia A. Spontaneous isolated true aneurysms of the brachial artery in children. Journal of Pediatric Surgery Case Reports 2017. [DOI: 10.1016/j.epsc.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ricci J, Vargas C, Lin S, Tobias A, Taghinia A, Lee B. A Novel Free Flap Monitoring System Using Tissue Oximetry with Text Message Alerts. J Reconstr Microsurg 2016; 32:415-20. [DOI: 10.1055/s-0036-1582264] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joseph Ricci
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christina Vargas
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Samuel Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adam Tobias
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Amir Taghinia
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Bernard Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
Skin excisions are common procedures in children. They may be performed in the clinic using field sterility or the operating room with strict sterile technique. We compared the effect of these locations and the use of antibiotics on the incidence of surgical site infection (SSI) after skin excisions. Patients ages 0-18 years presenting to our department for the excision of lesions from 2006 to 2010 with complete medical records were included in our study. Records were reviewed for demographic characteristics, presentation, perioperative conditions, and postoperative SSI and other wound complications. Analyses were performed to estimate the costs associated with sterility technique and perioperative antibiotic use. We identified 700 patients with a mean age of 9.1 years. Of 872 lesions excised, 0.3% resulted in SSI and 1.8% had other wound complications. The incidence of SSI did not vary according to sterility technique, antibiotic usage, surgeon, age, or lesion size, type, or location. The equipment costs to excise a lesion in the operating room were 200% greater than in the clinic. The incidence of SSI after excision of benign lesions in children did not differ between those performed using clinic field sterility and those using the standard aseptic sterile technique in the operating room. A considerable cost savings could be realized by adopting field sterility for simple excisions performed in the operating room and avoiding routine perioperative antibiotics in pediatric skin excisions.
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Affiliation(s)
- Laura C Nuzzi
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - John G Meara
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian I Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Nuzzi LC, Pike CM, Lewine EB, Cerrato FE, Alexander ME, Ferrari LR, Bae DS, Taghinia A, Waters PM, Labow BI. Preoperative electrocardiograms for nonsyndromic children with hand syndactyly. J Hand Surg Am 2015; 40:452-5. [PMID: 25542431 DOI: 10.1016/j.jhsa.2014.10.053] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the efficacy of preoperative electrocardiogram (EKG) screening for Timothy syndrome, a rare and fatal condition characterized by prolonged QT, in children referred for syndactyly release. METHODS We reviewed the records of nonsyndromic syndactyly patients seen by a hand surgeon at our institution between 2007 and 2013. All underwent a preoperative screening EKG for Timothy syndrome. We reviewed the medical records for demographics, presentation, EKG results, and operative findings, and calculated median age at the time of EKG and surgery and frequency distributions for sex, side affected, EKG result, and clinical finding. The mean patient charge for EKG and interpretation was calculated. RESULTS We identified 128 syndactyly patients, 72% of which were boys. Median age at the time of EKG testing and syndactyly release was 1 year. A total of 92% of patients had normal EKG results; one patient exhibited a prolonged QT. Ten patients (8%) had further cardiac evaluation because of the EKG result and were found to be normal on repeat testing. No patient met QT threshold for Timothy syndrome and all patients were cleared for surgery. The minimum patient charge for EKG testing was $183. CONCLUSIONS To improve patient safety, some have advocated preoperative EKG testing for all children undergoing syndactyly release to rule out Timothy syndrome. Analysis of our experience failed to yield an instance of Timothy syndrome over a 7-year period. Although EKG charges were relatively low, costs resulting from additional testing, cardiology consultation, and provider and parent time should be considered. Our study does not support routine EKG testing for children referred for syndactyly release, and we have abandoned this practice. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Laura C Nuzzi
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Carolyn M Pike
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Eliza B Lewine
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Felecia E Cerrato
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mark E Alexander
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Lynne R Ferrari
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Donald S Bae
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Peter M Waters
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Brian I Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Theman TA, Labow BI, Taghinia A. Discrepancies between meeting abstracts and subsequent full text publications in hand surgery. J Hand Surg Am 2014; 39:1585-90.e3. [PMID: 24934603 DOI: 10.1016/j.jhsa.2014.04.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 02/21/2014] [Revised: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Research abstracts presented during the proceedings of an annual meeting are often cited and can influence clinical practice. Prior studies show that roughly 50% of abstracts at American Society for Surgery of the Hand meetings are eventually published. Yet, it is unknown how often the results or conclusions of published studies differ from the podium presentation. The objective of this study was to quantify the differences between abstracts presented during the annual meeting of the American Society for Surgery of the Hand and the resulting manuscripts. METHODS We retrospectively reviewed every abstract delivered as a podium presentation at the American Society for Surgery of the Hand annual meeting from 2000 to 2010. We searched the PubMed database for matching publications and compared authorship, country of origin, hypothesis, study design and methodology, changes in study groups or populations, results, and conclusions. RESULTS Of 798 total abstracts, we analyzed 719 involving the hand, wrist, and brachial plexus. Fifty-six different journals published 393 of the abstracts, for a 49% publication rate. Mean time to publication was 18 months with a median of 14 and maximum of 122 months. There were inconsistencies between the results and/or conclusions in 14% of full-length articles compared with the abstract presented at the meeting. A total of 9% of articles were published with fewer subjects. Authorships changes were noted in 54% of publications. CONCLUSIONS Abstracts represent preliminary investigations and major and minor changes occur before subsequent publication. Caution should be exercised in referencing abstracts or altering clinical practice based on their content. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/decision analysis IV.
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Affiliation(s)
- Todd A Theman
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Brian I Labow
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA.
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Cerrato F, Eberlin KR, Waters P, Upton J, Taghinia A, Labow BI. Presentation and treatment of macrodactyly in children. J Hand Surg Am 2013; 38:2112-23. [PMID: 24060511 DOI: 10.1016/j.jhsa.2013.08.095] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [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: 03/11/2013] [Revised: 08/01/2013] [Accepted: 08/01/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the presentation, treatment, and early outcomes of children with isolated congenital macrodactyly of the hand. METHODS We performed a retrospective chart review of isolated hand macrodactyly cases treated at our institution over a 15-year period. Data on clinical presentation, procedure details, and outcomes were collected. RESULTS A total of 21 patients, 8 boys and 13 girls, were identified. Patients had a mean of 1.8 affected digits (median, 2; range, 1-3); most (n = 12; 57%) presented with multiple affected digits. The middle finger was most commonly affected (67%). Most patients had progressive overgrowth (n = 13; 67%). Twelve patients (57%) had nerve territory-oriented macrodactyly, whereas 9 (43%) presented with lipomatous type. There were no differences between the types of macrodactyly in sex, affected side, rate of growth, digits affected, or number of procedures. Patients underwent a mean of 3.2 staged corrective operations (median, 2; range, 1-12), including soft tissue debulking (n = 19 patients; 90%), ostectomy for volume reduction or partial amputation (n = 9; 43%), closing wedge osteotomy (n = 11; 52%), epiphysiodesis (n = 7; 33%), digit transfer (n = 3; 14%), toe transfer (n = 1; 5%), and ray amputation (n = 6; 29%). Patients with progressive growth underwent more procedures than patients with static growth. No major complications were reported. CONCLUSIONS The diagnosis of macrodactyly should be reserved for patients with isolated congenital digit overgrowth affecting all tissue types, but clinical presentation and natural history of macrodactyly can vary greatly among patients. A variety of surgical techniques exist to reconstruct rather than amputate affected digits primarily. Although reconstruction will not result in a normal digit and requires multiple operations, our observations suggest that they are well tolerated and may offer some restored function and aesthetics. More long-term outcomes and insight into the biological basis of this disorder are needed to make better-informed treatment decisions. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Felecia Cerrato
- Departments of Plastic and Oral Surgery, Orthopedic Surgery, and Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
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Benoit MM, Vargas SO, Bhattacharyya N, McGill TA, Robson CD, Ferraro N, Didas AE, Labow BI, Upton J, Taghinia A, Meara JG, Marcus KJ, Mack J, Rodriguez-Galindo C, Rahbar R. The presentation and management of mandibular tumors in the pediatric population. Laryngoscope 2013; 123:2035-42. [DOI: 10.1002/lary.24020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/29/2012] [Accepted: 01/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Margo McKenna Benoit
- Department of Otolaryngology; Strong Memorial Hospital, University of Rochester Medical Center; Rochester; New York
| | - Sara O. Vargas
- Department of Pathology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Neil Bhattacharyya
- Department of Otolaryngology; Brigham and Women's Hospital; Boston; Massachusetts
| | - Trevor A. McGill
- Department of Otolaryngology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Caroline D. Robson
- Division of Neuroradiology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Nalton Ferraro
- Children's Hospital Boston; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Amanda E. Didas
- Department of Otolaryngology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Brian I. Labow
- Department of Plastic Surgery; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Joseph Upton
- Department of Plastic Surgery; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Amir Taghinia
- Department of Plastic Surgery; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - John G. Meara
- Department of Plastic Surgery; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Karen J. Marcus
- Division of Radiation Oncology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | - Jennifer Mack
- Department of Hematology and Oncology; Harvard Medical School; Boston; Massachusetts; U.S.A
| | | | - Reza Rahbar
- Department of Otolaryngology; Harvard Medical School; Boston; Massachusetts; U.S.A
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Lau FH, Xia F, Kaplan A, Cerrato F, Greene AK, Taghinia A, Cowan CA, Labow BI. Expression analysis of macrodactyly identifies pleiotrophin upregulation. PLoS One 2012; 7:e40423. [PMID: 22848377 PMCID: PMC3407187 DOI: 10.1371/journal.pone.0040423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/05/2012] [Indexed: 11/18/2022] Open
Abstract
Macrodactyly is a rare family of congenital disorders characterized by the diffuse enlargement of 1 or more digits. Multiple tissue types within the affected digits are involved, but skeletal patterning and gross morphological features are preserved. Not all tissues are equally involved and there is marked heterogeneity with respect to clinical phenotype. The molecular mechanisms responsible for these growth disturbances offer unique insight into normal limb growth and development, in general. To date, no genes or loci have been implicated in the development of macrodactyly. In this study, we performed the first transcriptional profiling of macrodactyly tissue. We found that pleiotrophin (PTN) was significantly overexpressed across all our macrodactyly samples. The mitogenic functions of PTN correlate closely with the clinical characteristics of macrodactyly. PTN thus represents a promising target for further investigation into the etiology of overgrowth phenotypes.
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Affiliation(s)
- Frank H. Lau
- Center for Regenerative Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Plastic and Oral Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Fang Xia
- Center for Regenerative Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Adam Kaplan
- Center for Regenerative Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Felecia Cerrato
- Department of Plastic and Oral Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Arin K. Greene
- Department of Plastic and Oral Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Amir Taghinia
- Department of Plastic and Oral Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
| | - Chad A. Cowan
- Center for Regenerative Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Brian I. Labow
- Department of Plastic and Oral Surgery, Children’s Hospital Boston, Boston, Massachusetts, United States of America
- * E-mail:
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20
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Webb ML, Rosen H, Taghinia A, McCarty ER, Cerrato F, Upton J, Labow BI. Incidence of Fanconi anemia in children with congenital thumb anomalies referred for diepoxybutane testing. J Hand Surg Am 2011; 36:1052-7. [PMID: 21514743 DOI: 10.1016/j.jhsa.2011.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Fanconi anemia (FA) is a rare genetic disorder of DNA repair that with near uniformity leads to bone marrow failure and resulting morbidity and mortality. Approximately 50% of FA patients are born with anomalies of the thumb or thumb and radius, and it has been recommended that all patients born with thumb anomalies undergo testing. However, the risk of FA in this population is unknown. We determined the incidence of FA in children with congenital thumb anomalies referred for FA testing and characterized those who tested positive. METHODS We queried our database for patients who presented with congenital thumb anomalies and who underwent diepoxybutane (DEB) testing for FA between 1999 and 2008 at Children's Hospital Boston and the Dana-Farber Cancer Institute. RESULTS During this time period, 543 congenital thumb anomaly patients (235 with thumb hypoplasia) presented to our institution. A total of 81 patients with thumb abnormalities underwent DEB testing. Six patients (7% of those tested; 1% of the total; 3% of thumb hypoplasia patients) had a positive DEB test consistent with the diagnosis of FA; all had other non-upper-extremity anomalies associated with FA. Of 6 FA patients, 5 had bilateral involvement; all had some degree of thumb hypoplasia (3 also had radial dysplasia). Mean age at testing was 2.6 years (SD 4.3). Most of the patients tested had multiple physical anomalies (n = 66). The anomaly distribution was: thumb hypoplasia and radial dysplasia (n = 29), thumb hypoplasia (n = 26), radial polydactyly (n = 12), radial polydactyly and radial dysplasia (n = 1), and proximally placed thumb and radial dysplasia (n = 1). Twelve patients had other thumb anomalies. CONCLUSIONS Although the incidence of FA in patients with thumb anomalies may be low, patients with thumb hypoplasia and other physical findings associated with FA, specifically café au lait spots and short stature, appear to have an increased risk of FA. Because hand surgeons see these patients early in life, they have the opportunity to refer these patients for FA testing to initiate early education, family genetic counseling, and treatment if warranted. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Michelle L Webb
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA, USA
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Makhni EC, Taghinia A, Ewald T, Zurakowski D, Day CS. Comminution of the dorsal metaphysis and its effects on the radiographic outcomes of distal radius fractures. J Hand Surg Eur Vol 2010; 35:652-8. [PMID: 20237191 DOI: 10.1177/1753193409338750] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Comminution of the dorsal metaphysis is a relatively common feature of distal radius fractures. However, its effects on the radiographic outcomes of these fractures are not entirely understood. One hundred and twenty-four conservatively managed distal radius fractures were analysed retrospectively to assess the effect of dorsal metaphyseal comminution on fracture stability, especially with respect to initial displacement (minimally displaced versus displaced) and age group. Seventy-seven fractures (62%) had radiographic evidence of dorsal comminution. The secondary displacement rate of these fractures was 75%, compared to 45% in non-comminuted counterparts (P<0.001). In minimally displaced fractures, the secondary displacement rate was higher in those with dorsal comminution as compared to those without (57% vs. 31%, P=0.086). Dorsal metaphyseal comminution was found in 75% of fractures in patients 65+years old (P=0.05). Among those with dorsal comminution, the secondary displacement rates were similar for both men and women (63% vs. 79%; P=0.20). In conclusion, distal radius fractures with dorsal metaphyseal comminution had significantly higher rates of secondary displacement compared to non-comminuted counterparts, and there exists a correlation with this displacement and increasing patient age but not gender.
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Affiliation(s)
- E C Makhni
- Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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22
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Ridgway E, Taghinia A, Donelan M. Scalp-tissue expansion for a chronic burn wound with exposed calvarium. J Plast Reconstr Aesthet Surg 2009; 62:e629-30. [DOI: 10.1016/j.bjps.2008.11.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 11/14/2008] [Accepted: 11/15/2008] [Indexed: 11/27/2022]
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Parrett BM, Winograd JM, Lin SJ, Borud LJ, Taghinia A, Lee BT. The posterior tibial artery perforator flap: an alternative to free-flap closure in the comorbid patient. J Reconstr Microsurg 2008; 25:105-9. [PMID: 18924067 DOI: 10.1055/s-0028-1090616] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Wounds of the distal third of the leg with exposed bone traditionally require free flaps for coverage. Although this often provides good results, patients with multiple comorbidities cannot undergo the long operating times and multiple surgical sites required for these complex procedures. We reviewed the use of posterior tibial (PT) perforator flaps as an alternative to free flaps for distal leg wound coverage in ill patients. Six patients (mean age, 53 years) with multiple comorbidities that precluded free-flap closures were treated with PT perforator flaps to cover complex distal leg wounds. The most common comorbidity was cardiac disease. Five patients had Gustilo grade IIIB open tibial fractures and one had a chronic wound. Mean flap size was 8x5.5 cm with a mean of one perforator per flap. Mean operating room time was 103 minutes. Four flaps were done without general anesthesia. There were no perioperative cardiopulmonary events. With a mean follow-up of 15 months, all flaps survived and all patients were ambulatory. There were no cases of malunion, nonunion, infection, wound breakdown, or partial flap loss. The PT perforator flap is a reliable choice for patients with open leg wounds and comorbidities precluding free-flap closure.
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Affiliation(s)
- Brian M Parrett
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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