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Ruffolo AM, Sommer NZ, Neumeister MW. Strategies to Reduce Congestion in the Resident Match: What Can Plastic Surgery Learn from Other Specialties? Plast Reconstr Surg Glob Open 2023; 11:e4830. [PMID: 36936461 PMCID: PMC10017395 DOI: 10.1097/gox.0000000000004830] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/04/2023] [Indexed: 03/17/2023]
Abstract
Many medical specialties are experiencing congestion in the residency match process because of increasing competition amongst applicants to secure a training position. With rising application numbers for a stable number of positions, the result is an inefficient use of time and financial resources on behalf of both the residency applicants and programs. Solutions to address congestion in the match process have been proposed in the literature, and other specialties have implemented specialty-wide reforms. Methods The Pubmed and Web of Science databases were queried using keywords related to the residency match and resident selection. The initial search yielded 372 results. Titles and abstracts were evaluated for inclusion and 93 articles met criteria for full-text evaluation. The bibliographies of these publications were reviewed for additional references. Results Numerous strategies to reduce congestion in the match were identified across specialties. Implemented reforms include a centralized preference signaling system, an interview cap, a staged or consortia match, and publication of transparent program-specific resident selection criteria. We discuss pros and cons of different strategies to reduce congestion in the match and summarize the effects that recent reforms have had on other specialties. Conclusions Plastic surgery as a field is at a distinct advantage to be a leader in transforming the residency match process, as we are a small and historically innovative group. We hope to spark discussion amongst students, residents, and program faculty with the goal of creating a more efficient match process.
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Affiliation(s)
- Alexis M. Ruffolo
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Nicole Z. Sommer
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Michael W. Neumeister
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
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Shah ND, Yuksel S, Sasson DC, Kearney AM, Neumeister MW, Gosain AK. A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty. Hand (N Y) 2023; 18:65S-73S. [PMID: 34969303 PMCID: PMC10052618 DOI: 10.1177/15589447211060421] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. METHODS The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a portion of its continuous certification (CC) process. Data on primary CMC arthroplasty from May 2006 through December 2013 were reviewed and compared to those from January 2014 to March 2020. National practice trends observed in these data were evaluated. Comprehensive evidence-based medicine reviews published in 2008, 2011, 2013, and 2017 were reviewed alongside the CC data. RESULTS In all, 570 primary CMC joint arthroplasty cases were included from May 2006 to March 2020. The average age at the time of repair was 62 years and the patient population was predominantly female (79%). Most cases were done under general anesthesia (69%), and there was an increase in the use of regional anesthesia with nerve block when our 2 cohorts were compared (27% vs 37%; P = .020). A trapezium excision with flexor carpi radialis tendon ligament reconstruction was the most popular technique (72%) and an increase in the use of simple trapeziectomy was observed (6% vs 14%; P = .001). One-third of patients did not receive any form of deep vein thrombosis prophylaxis. CONCLUSIONS The ABPS CC data provide a databank that allows for direct observation of national practice trends and sheds light on potential avenues for improvement in patient care.
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Affiliation(s)
- Nikhil D. Shah
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Selcen Yuksel
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Daniel C. Sasson
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Aaron M. Kearney
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | - Arun K. Gosain
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Neumeister MW, Winters JN, Maduakolum E. Phalangeal and Metacarpal Fractures of the Hand: Preventing Stiffness. Plast Reconstr Surg Glob Open 2021; 9:e3871. [PMID: 34729287 PMCID: PMC8553242 DOI: 10.1097/gox.0000000000003871] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
Abstract
Fractures of the phalangeal or metacarpal bones of the hand are common. Many of these fractures are treated without surgery. However, both conservative and operative management of fractures of the hand can result in stiffness. Stiffness is the most common complication in the management of hand fractures. The key to preventing stiffness is early range of motion exercises. This article challenges many of the current treatment regimens offered to patients with the so-called unstable fractures. The evaluation of the patients' function is the primary factor that should determine the course of conservation versus operative management. X-rays do not demonstrate function and therefore act as an adjunct only to the care of the patient. The goal of treating hand fractures is to restore function. Early motion may not only improve healing but may also hasten the return to normal hand function. The tenets of how to prevent stiffness are described in this review.
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Affiliation(s)
- Michael W. Neumeister
- From the Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - James N. Winters
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Gastman BR, Neumeister MW. Melanoma. Clin Plast Surg 2021. [DOI: 10.1016/s0094-1298(21)00081-x] [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]
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Bruce WJ, Koljonen JL, Romanelli MR, Khan AU, Neumeister MW. Adjuvant and Neoadjuvant Therapeutics for the Treatment of Cutaneous Melanoma. Clin Plast Surg 2021; 48:651-658. [PMID: 34503725 DOI: 10.1016/j.cps.2021.06.001] [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] [Indexed: 11/26/2022]
Abstract
Adjuvant therapy plays an integral role in the treatment algorithm for stage III and stage IV cutaneous melanoma. Current ongoing clinical trials are exploring the effects of neoadjuvant therapeutics, specifically for the presurgical treatment of high-risk, borderline resectable disease. In both the adjuvant and neoadjuvant settings, the early chemotherapeutic and biochemical antitumor agents are making way to newer immune therapies, mutation-specific targeted therapies, and oncolytic vaccines that are transforming the treatment of malignant melanoma. The use of these systemic therapies in addition to surgical resection has been shown to increase both overall and progression-free survival.
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Affiliation(s)
- William J Bruce
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Jessie L Koljonen
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Michael R Romanelli
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Aziz U Khan
- Division of Hematology/Oncology, Department of Internal Medicine, Southern Illinois University School of Medicine, 315 West Carpenter Street, Springfield, IL 62702, USA
| | - Michael W Neumeister
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, P.O. Box 19653, Springfield, IL 62794-9653, USA.
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Abstract
Mucosal melanoma is a rare but aggressive cancer arising in mucosal surfaces most commonly in the head and neck. The clinical presentation is often nonspecific and differs in relation to the site of origin so often diagnosis is delayed resulting in poor prognosis. Mucosal melanoma has a 5-year survival of only 25%. Surgery with negative margins is the mainstay of treatment but dependent on several variables including anatomic location, involved structures, and size of tumor. Although not well defined given the rarity of mucosal melanoma, there is a role for radiation and systemic therapy in the treatment of this disease.
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Affiliation(s)
- Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA
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Abstract
Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.
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Affiliation(s)
- Michael R Romanelli
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Alaa Mansour
- Southern Illinois University School of Medicine, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Allyne Topaz
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
| | - Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA.
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
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Abstract
The Spitz nevus is an uncommon melanocytic nevus. These lesions classically appear in childhood as a red, dome-shaped papule. They appear rarely in adults and may be pigmented. The Spitz nevus can develop suddenly and grow rapidly, reaching a 1-cm diameter in 6 months or less. There are 3 classes of spitzoid neoplasms: typical Spitz nevus, atypical Spitz nevus, and spitzoid melanoma. The diagnosis should be cautiously differentiated, especially in children. Immunohistochemistry and molecular studies have been helpful in differentiating difficult cases; however, no set of criteria has been accepted to predict biological behavior of atypical Spitz nevi.
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Affiliation(s)
- Amanda Brown
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 N. Rutledge Street, Springfield, IL 62704, USA
| | - Justin D Sawyer
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 N. Rutledge Street, Springfield, IL 62704, USA
| | - Michael W Neumeister
- The Institute for Plastic Surgery, Department of Surgery, Southern Illinois University, 747 N. Rutledge Street, Springfield, IL 62704 USA.
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Abstract
While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease.
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Affiliation(s)
- Parinaz J Dabestani
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | | | - Michael W Neumeister
- Southern Illinois University School of Medicine, Institute for Plastic Surgery, 747 N. Rutledge St #3, Springfield, IL 62702, USA
| | - C Matthew Bradbury
- Springfield Clinic Cancer Center and Southern Illinois University School of Medicine, 900 N. 1st Street, Springfield, IL 62702, USA
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Abstract
Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma in situ and thus confined to the epidermis. LM lesions that invade the dermis are termed lentigo maligna melanoma, 1 of the 4 subtypes of malignant melanoma.
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Affiliation(s)
- Jacob D Franke
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Katlyn M Woolford
- Southern Illinois University, School of Medicine, 747 N. Rutledge Street, Springfield, IL 62702, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 N Rutledge Street #3, Springfield, IL 62702, USA.
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Abstract
The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins.
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Affiliation(s)
- Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA.
| | - Anthony P Tufaro
- University Hospitals Cleveland Medical Center, 11100 Euclid Aveune, Suite 5206, Cleveland, OH 44106, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
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Abstract
Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid donor procurement through the elbow for mid to distal forearm-level hand allograft procurement. Methods: Nine arm procurements were performed on deceased tissue-only donors provided by the local organ procurement organization, including two bilateral and five unilateral cases. Technique highlights include using a fishmouth incision through the lateral and medical epicondyles, identification of the neurovascular structures, and disarticulating the elbow joint. Results: Procuring through the elbow provides straightforward anatomy, bypasses the need to cut through bone, and allows tissue allotransplantation teams to achieve procurement, flushing, and packaging within 20 minutes. Conclusions: Procurement through the elbow is a simple procedure that streamlines the process for multi-organ donors by minimizing the time needed for hand allograft procurement. Team coordination and surgical rehearsals are essential for successful hand and upper extremity procurement and allotransplantation.
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Affiliation(s)
- Shaun D. Mendenhall
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA,Shaun D. Mendenhall, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, 30 North 1900 E, 3B400, Salt Lake City, UT 84132, USA.
| | - Justyn Lutfy
- Kootenay Surgery Clinic, Trail, British Columbia, Canada
| | - Emily Graham
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Bo Overschmidt
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Arca MJ, Adams RB, Angelos P, Fanelli RD, Mammen JMV, Nelson MT, Neumeister MW, Robinson AJ, Buyske J. American Board of Surgery Statement on Assessment and Robotic Surgery. Am J Surg 2020; 221:424-426. [PMID: 33097190 DOI: 10.1016/j.amjsurg.2020.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Jo Buyske
- The American Board of Surgery, United States.
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Neumeister MW, Bueno RA. Pain Management in Plastic Surgery. Clin Plast Surg 2020. [DOI: 10.1016/s0094-1298(20)30008-0] [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: 11/27/2022]
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Neumeister MW, Bueno RA. The Maladies of Pain. Clin Plast Surg 2020; 47:xiii. [PMID: 32115059 DOI: 10.1016/j.cps.2020.01.005] [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: 11/19/2022]
Affiliation(s)
- Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, SIU School of Medicine, 747 North Rutledge, 3rd Floor, PO Box 19653, Springfield, IL 62794, USA.
| | - Reuben A Bueno
- Institute for Plastic Surgery at SIU School of Medicine, 747 North Rutledge, 3rd Floor, PO Box 19653, Springfield, IL 62794, USA.
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Abstract
This article discusses the pathophysiology, presentation, cause, and treatment of ischemic pain in the surgical patient. Causes of ischemic pain vary but all fundamentally cause local acidosis in the peripheral tissues, which causes signals to be passed through ascending pain pathways to the thalamus and eventual cerebral cortex where it is interpreted as ischemic pain. Ischemic pain is classically associated with an insidious onset but can present in the acute or chronic setting. Treatments are aimed at improving perfusion to the affected tissue. Surgical options include repairing damaged vessels, bypassing diseased vessels, performing thrombectomy, or embolectomy. Numerous conservative therapies exist.
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Affiliation(s)
- Michael R Romanelli
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street, 3rd Floor, PO Box 19653, Springfield, IL 62794-9653, USA
| | - Jacob A Thayer
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street, 3rd Floor, PO Box 19653, Springfield, IL 62794-9653, USA
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street, 3rd Floor, PO Box 19653, Springfield, IL 62794-9653, USA.
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Mendenhall SD, Brown S, Ben-Amotz O, Neumeister MW, Levin LS. Building a Hand and Upper Extremity Transplantation Program: Lessons Learned From the First 20 Years of Vascularized Composite Allotransplantation. Hand (N Y) 2020; 15:224-233. [PMID: 30060684 PMCID: PMC7076606 DOI: 10.1177/1558944718790579] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Upper extremity transplantation is a quality-of-life enhancing treatment for select patients with upper extremity loss. This article reviews the preoperative, intraoperative, and postoperative challenges in the upper extremity transplantation process and the lessons learned from the first 2 decades of hand transplantation. Methods: Key components of the author's hand transplantation protocol including patient selection, donor screening, surgical rehearsal, donor procurement, transplantation, immunosuppression, and patient outcome reporting/follow-up are reported to assist other teams who wish to establish a hand transplantation program. Results: There have been many advancements in the first 20 years of hand transplantation including better patient selection criteria, the recent addition of pediatric patients, improved surgical techniques such as the use of virtual surgical planning, and improved immunosuppression protocols. Improvement has also taken place in the tracking and reporting of hand transplant outcomes, but more work is clearly needed to fully define the benefits of transplantation, especially for pediatric patients. Conclusions: Over the past 20 years, significant progress has been made in upper extremity transplantation although a number of challenges remain including how to best document and share outcome measures, optimize immunosuppression, and diagnose/treat rejection. The authors encourage upper extremity transplant programs to report their experience and protocols to advance hand transplantation as standard of care for properly selected individuals.
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Affiliation(s)
- Shaun D. Mendenhall
- University of Utah School of Medicine, Salt Lake City, USA,Shaun D. Mendenhall, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
| | | | - Oded Ben-Amotz
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | | | - L. Scott Levin
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Abstract
CASE A 61-year-old woman with left shoulder osteoarthritis underwent a left shoulder hemiarthroplasty. The wound was closed using the Dermabond Prineo system. The patient had a severe and progressive reaction during the first 2 weeks that necessitated debridement and skin grafting. Three months after surgery, the patient was doing well. CONCLUSIONS Severe reactions to 2-octyl cyanoacrylate are uncommon. The severity of the presented reaction is rare. However, surgeons using this closure method should be aware of potential reactions that may initially mimic infection. It is important to initiate appropriate treatment including removing the dressing, topical steroids, and/or oral antihistamines, antibiotics, and possible surgical wound debridement.
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Affiliation(s)
- Ryan C Pate
- Baylor Scott & White Orthopedics, Round Rock, Texas
| | - Michael W Neumeister
- Division of Orthopaedics and, Division of Plastic Surgery, Department of Surgery, Southern Illinois University, Springfield, Illinois
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Abstract
Fibromyalgia is characterized by generalized pain, specific sites of musculoskeletal tenderness, fatigue, sleep disturbance, headaches, and many other visceral and cognitive maladies. The epidemiology is not well-elucidated and the diagnoses and management can be difficult. Surgery may not be the most appropriate management of some of these pain conditions like fibromyalgia. It may even be more difficult to discern some surgical conditions from points of heightened sensitivity in the fibromyalgia patient. Close attention to the current and past medical history in such patients should aid the surgeon in his attempt to rid the patient of painful conditions through surgery.
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Affiliation(s)
- Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Suite 357, Baylis Building, Springfield, IL 62702, USA.
| | - Evyn L Neumeister
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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Mendenhall SD, Sawyer JD, West BL, Neumeister MW, Shaked A, Levin LS. Pediatric vascularized composite allotransplantation: What is the landscape for obtaining appropriate donors in the United States? Pediatr Transplant 2019; 23:e13466. [PMID: 31081211 DOI: 10.1111/petr.13466] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/27/2018] [Indexed: 01/14/2023]
Abstract
Listing the world's first pediatric bilateral hand transplant patient for a donor posed many challenges including matching the appropriate donor age, bone size, skin tone, and growth potential in an already limited donor population. This study describes the prevalence and distribution of potential pediatric VCA donors in the United States. We assessed the UNOS database from 2008 to 2015 to identify the prevalence of potential pediatric VCA donors. Standard VCA inclusion and exclusion criteria were applied to the dataset for all pediatric solid organ donors. Frequency analyses were performed of characteristics important for VCA matching. The dataset began with 57 300 brain-dead donors and after applying the inclusion and exclusion criteria including age <18, decreased to 4663 (8.1%). The number of pediatric potential VCA donors per UNOS region ranged from 11 to 112/year. The majority of pediatric potential VCA donors were blood type O Whites, with the least common profile being blood type AB of "other" ethnicity. The present study confirmed that pediatric VCA donors are rare and may require longer travel times for procurement and listing at multiple centers in order to find a suitable donor. This will be a limiting factor for the expansion of pediatric VCA.
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Affiliation(s)
- Shaun D Mendenhall
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Justin D Sawyer
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Bradford L West
- Department of Transplant Nephrology, Springfield Clinic, Springfield, Illinois
| | - Michael W Neumeister
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Abraham Shaked
- Division of Transplant Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lawrence S Levin
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Lutfy J, Pietak A, Mendenhall SD, Neumeister MW. Clinical Application of Mathematical Long Bone Ratios to Calculate Appropriate Donor Limb Lengths in Bilateral Upper Limb Transplantation. Hand (N Y) 2019; 14:523-529. [PMID: 29363357 PMCID: PMC6760092 DOI: 10.1177/1558944717753672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Limited methods exist to aid in deciding the appropriate donor limb lengths in bilateral upper limb amputees qualifying for vascularized composite allotransplantation. We hypothesized mathematical equations could be created using long bone length ratios, and applied to radiographs, to approximate the patient's limb length prior to amputation. Methods: A data set of 30 skeletons' unilateral upper limb long bones measured using osteometric board and calipers was used. Anatomic segment ratios were calculated based on humerus length after multivariate linear regression analysis. For clinical application testing, 5 cadavers' upper limbs were radiographed. Radiographic bone lengths were then measured along the long axis of each long bone. These measured radiographic lengths were then compared with the predicted bone lengths, generated from the skeleton data set ratios, for each cadaver. Results: The chi-square goodness-of-fit test showed excellent fit (P < .01) between the predicted and radiographically measured lengths for the 5 cadavers, and interobserver measurements showed no statistical difference. Depending on the cadaver, percent error in total limb length predicted to measure ranged from 0.9% to 2.7%. The variables to multiply an individual humerus length to calculate a given anatomic segment thus proved to be effective. Conclusions: If a bilateral upper limb amputee has 1 intact humerus, ratios to the humerus length can be reliably applied to calculate the preamputation limb length based on the patient's radiographic humerus length. These formulas are indicated for finding the appropriate limb lengths, and smaller anatomic segments, for donor-recipient matching in upper limb transplantation.
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Affiliation(s)
- Justyn Lutfy
- Southern Illinois University School of
Medicine, Springfield, USA,Justyn Lutfy, The Institute for Plastic
Surgery, Southern Illinois University School of Medicine, 747 North Rutledge
Street, #3, Springfield, IL 62702, USA.
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Bjorklund KA, Sommer N, Neumeister MW, Kasten SJ. Establishing Validity Evidence for an Operative Performance Rating System for Plastic Surgery Residents. J Surg Educ 2019; 76:529-539. [PMID: 30253984 DOI: 10.1016/j.jsurg.2018.08.016] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 08/16/2018] [Accepted: 08/18/2018] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of this study was to describe an operative performance rating system for plastic surgery residents and provide validity evidence for the instrument. METHODS Three plastic surgery residents (PGY levels 1, 5, and 6) from Southern Illinois University School of Medicine (SIUSOM) performed a carpal tunnel release with audio video recording. The 3 videos were reviewed by 8 expert hand surgeons and 3 SIUSOM faculty using the operative performance rating system instrument to assess resident operative performance. Validity evidence including content, internal structure, and relationship to other variables was collected. RESULTS Inter-rater reliability was consistently fair to moderate (weighted Cohen's Kappa 0.44-0.84 for experts, 0.24-0.55 for SIUSOM raters), and all assessment items were highly correlated (Cronbach's alpha of 0.9867). Local SIUSOM faculty routinely demonstrated higher overall scores for PGY 1 and PGY 6 residents compared to expert raters. CONCLUSIONS Although limited by small numbers, this pilot study suggests that potential bias based upon PGY year, identity, and performance history may exist and independent assessment by unbiased raters or comparison to national operative norms may be valuable. Our study provides baseline validity evidence for a resident operative performance assessment tool that can be integrated into practice in plastic surgery training programs.
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Affiliation(s)
- Kim A Bjorklund
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Nicole Sommer
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael W Neumeister
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Steven J Kasten
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Mendenhall SD, Ginnetti MT, Sawyer JD, Verhulst SJ, West BL, Levin LS, Neumeister MW. Prevalence and Distribution of Potential Vascularized Composite Allotransplant Donors, Implications for Optimizing the Donor-recipient Match. Plast Reconstr Surg Glob Open 2018; 6:e1833. [PMID: 30276058 PMCID: PMC6157933 DOI: 10.1097/gox.0000000000001833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation (VCA) is an emerging and growing field. Little is known about the prevalence and distribution of the adult potential donor population in the United States now that it falls under the oversight of the United Network for Organ Sharing (UNOS). METHODS We assessed the UNOS database from 2008 to 2015 to estimate the prevalence and distribution of adult potential vascularized composite allograft donors. Donor inclusion and exclusion criteria were developed in a way to minimize risk to recipients and were applied to the dataset. Donors were categorized by factors that influence vascularized composite allograft matching including ABO blood type, cytomegalovirus status, and ethnicity (correlate for skin color) and sorted by UNOS region. RESULTS Just under half of all brain dead donors met the inclusion/exclusion criteria. Blood type O, cytomegalovirus+, White donors represented the most frequent donor profile while blood type AB, cytomegalovirus-, Asian donors were the least common. UNOS region 3 had the most and region 1 had the least potential VCA donors per year. Nearly all potential VCA donors were solid organ donors with the liver being the most commonly donated solid organ in this population. CONCLUSIONS A large portion of the solid organ donor pool would qualify as adult vascularized composite allograft donors in the current UNOS system. These data will assist transplant teams in determining the prevalence and distribution of vascularized composite allograft donors for their individual patients awaiting composite allografts based on relevant matching characteristics in addition to standard transplant criteria.
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Affiliation(s)
- Shaun D. Mendenhall
- From the Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Michael T. Ginnetti
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Justin D. Sawyer
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
| | - Steven J. Verhulst
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Ill
| | - Bradford L. West
- Department of Transplant Nephrology, Springfield Clinic, Springfield, Ill
| | - L. Scott Levin
- From the Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Michael W. Neumeister
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Ill
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Hultman CS, Neumeister MW. Wellness and Burnout in Burn Care Providers: Professionalism, the Social Covenant, and the 7 Habits of Highly Effective Teams. Clin Plast Surg 2017; 44:943-948. [PMID: 28888320 DOI: 10.1016/j.cps.2017.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores the functioning of highly effective teams in burn care. Critical to the success of the team is the health of burn care providers, who can experience burnout. Wellness must be promoted by health care organizations, which, in turn, are responsible for the health of the populations they serve. Professionalism not only frames the social covenant between patients and burn care physicians but may also serve as a critical force in protecting against burnout and promoting wellness.
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Affiliation(s)
- Charles Scott Hultman
- Division of Plastic Surgery, NC Jaycee Burn Center, University of North Carolina at Chapel Hill, Suite 7038, Burnett-Womack, Chapel Hill, NC 27599, USA.
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, Baylis Medical Building, 747 North Rutledge Street, 3rd Floor, Suite 357, Springfield, IL 62702, USA
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Abstract
Calcinosis associated with scleroderma is a well recognized phenomenon. Fifteen to 44% of patients with systemic scleroderma and associated CREST (calcifications, raynaud's phenomenon, esophageal motility disorder, sclerodactyly and telangiectasias) syndrome have deposition of calcium in the fingers and hands. The tumourous effect may limit motion, cause neuropraxia, compound microangiopathy or present as calcific ulcers. This report describes the case of a patient with scleroderma and CREST syndrome in whom calcinosis in the hand resulted in severe, debilitating pain necessitating surgical evacuation of the deposits. The patient had complete pain relief in the postopertive period. A further surgical extirpation of calcium was required for recurring pain at six months after surgery. The patient has remained symptom free since that time. The rare occurence of excruciating pain prompted this report and literature review.
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Affiliation(s)
- Michael W Neumeister
- Institute for Plastic & Reconstructive Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Kenneth A Murray
- Division of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba
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Hultman CS, Neumeister MW. Burn Care: Rescue, Resuscitation, and Resurfacing. Clin Plast Surg 2017. [DOI: 10.1016/s0094-1298(17)30065-2] [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: 11/25/2022]
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Hultman CS, Neumeister MW. Volume 1: Rescue, Resuscitation, and Resurfacing. Clin Plast Surg 2017; 44:xv. [PMID: 28576258 DOI: 10.1016/j.cps.2017.05.001] [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: 11/16/2022]
Affiliation(s)
- Charles Scott Hultman
- Department of Surgery, University of North Carolina School of Medicine, 7040 Burnett-Womack, Chapel Hill, NC 27599-7195, USA.
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, Baylis Medical Building, 747 North Rutledge Street, 3rd Floor, Suite 357, Springfield, IL 62702, USA.
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Neumeister MW. A Tribute to Jaiyoung Ryu, MD, From All of Us at the AAHS. Hand (N Y) 2017; 12:222. [PMID: 28453352 PMCID: PMC5480677 DOI: 10.1177/1558944717707736] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
In this review, the authors discuss the stages of skin wound healing, the role of stem cells in accelerating skin wound healing, and the mechanism by which these stem cells may reconstitute the skin in the context of tissue engineering.
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Affiliation(s)
- Amy L Strong
- Division of Plastic Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Michael W Neumeister
- Department of Surgery, Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge Street, Springfield, IL 62702, USA
| | - Benjamin Levi
- Division of Plastic Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA; Burn Wound and Regenerative Medicine Laboratory, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109, USA.
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Abstract
There is significant responsibility in being a Department of Surgery Chairman within a medical school. The Chairman is appointed by the Dean of Medicine to lead surgery in a path that serves the mission of the school. The Department of Surgery Chairman is charged with facilitating the academic, operational, and programmatic surgical initiatives of the School of Medicine. Traditionally the Chairman of Surgery has been a general surgeon but now our educational and clinical experiences have changed making traditional leadership less intuitive. Plastic surgeons appointed as current Chairman of the Department of Surgery are rare in the United States. Whereas, general surgeons may have less interaction with other surgical sub-specialties today, Plastic surgeons have more interaction crossing all disciplines of surgery. Innovation and creativity that defines our discipline, seems to fit well with Department leadership where strategic planning, vision and curriculum development, and the pursuit of academic and clinical quality remain core essentials to plastic surgery. This article is an editorial of my philosophy as a plastic surgeon leading a Department of Surgery.
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Affiliation(s)
- M W Neumeister
- Professor and Chair, Department of Surgery, Chief, Institute for Plastic Surgery
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Abrams TE, Ogletree RJ, Ratnapradipa D, Neumeister MW. Adult survivors’ lived experience of burns and post-burn health: A qualitative analysis. Burns 2016; 42:152-162. [DOI: 10.1016/j.burns.2015.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/07/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
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Schmucker RW, Mendenhall SD, Reichensperger JD, Yang M, Neumeister MW. Defining the Salvage Time Window for the Use of Ischemic Postconditioning in Skeletal Muscle Ischemia Reperfusion Injury. J Reconstr Microsurg 2015; 31:597-606. [PMID: 26165885 DOI: 10.1055/s-0035-1556066] [Citation(s) in RCA: 7] [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: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to determine the optimal salvage time window within which ischemic postconditioning can be used to ameliorate ischemia/reperfusion (I/R) injury in skeletal muscle. METHODS A total of 48 Sprague-Dawley rats were divided into two groups: I/R only (control) and I/R with postconditioning. Subgroups were divided by duration of ischemia (2, 4, 6, and 8 hours). A pedicled gracilis muscle model was used. The postconditioning protocol consisted of six cycles of 15 seconds of reperfusion followed by 15 seconds of ischemia (total time = 3 minutes). Muscles were harvested 24 hours after I/R injury to examine tissue viability, histology, myeloperoxidase activity, and protective gene expression. RESULTS Postconditioning groups showed improved muscle viability after 4 and 6 hours of ischemia time as compared with controls (p < 0.05). Higher expression of mitochondrial complexes I, II, III, endothelial nitric oxide synthase, inducible nitric oxide synthase, and Bcl-2 were observed in the postconditioning group after 4 and 6 hours of ischemia (p < 0.05). Lower expression of tumor necrosis factor-α and caspase 3 was observed in the postconditioning group at 4 hours (p < 0.05). Myeloperoxidase activity was similar in both groups at all-time points except 8 hours ischemia, where the control group had higher activity (p < 0.05). CONCLUSION Results of this study demonstrate that the effective time window within which postconditioning is most effective for the salvage of skeletal muscle is between 4 and 6 hours of ischemia. Postconditioning offered improved mitochondrial and vascular function with decreased inflammation and cell death. This may be clinically useful as a postinjury salvage technique to attenuate I/R injury after 4 to 6 hours of ischemia.
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Affiliation(s)
- Ryan W Schmucker
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Shaun D Mendenhall
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Joel D Reichensperger
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Mei Yang
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Michael W Neumeister
- The Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Abstract
BACKGROUND Tendon without paratenon presents the reconstructive surgeon with a tissue coverage challenge. Integra® dermal regenerative template has been shown to initiate a stable, vascularized bed for skin grafting over tendon. However, histological processes that occur during incorporation have not been described. The purpose of this study is to characterize the pattern of changes that occur when Integra® is applied to an avascular tendon. We hypothesize that vascular incorporation will originate from the wound periphery and proceed toward the tendon center. METHODS A full-thickness defect was created over a denuded Achilles tendon in a single hind limb in eight New Zealand white rabbits. Integra was placed over the avascular tendon, and the limb was dressed and splinted. Two animals were euthanized at each timepoint (weeks 1, 2, 3, and 4), and hematoxylin and eosin (H&E)-stained tissue specimens were microscopically evaluated. RESULTS Week 1 specimens demonstrated limited adherence between Integra and the tendon, while myofibroblasts were found encircling the tendon. No cellularity was noted centrally. At week 2, the dermis-Integra junction had increasing vascularity and the central portion developed increasing cellularity. By week 3, Integra was completely revascularized. At week 4, Integra had the histological appearance of normal dermis. CONCLUSION Neovascularization of Integra® over exposed tendon occurs from the peripheral tissue. Ingrowth proceeds from the dermis-Integra interface toward the center of the graft. Four weeks after application to the denuded tendon, Integra has the histological appearance of native dermis.
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Affiliation(s)
- John Hulsen
- />Department of Plastic Surgery, The Ohio State University, 915 Olentagy River Road, Suite 2100, Columbus, OH 43212-3153 USA
| | - Ryan Diederich
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
| | - Michael W. Neumeister
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
| | - Reuben A. Bueno
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
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Abstract
Metacarpal fractures are among the most common fractures of the upper extremity. Surgical management is generally offered for unstable or significantly displaced fractures. A more conservative, nonsurgical approach, however, may provide safe, rapid recovery while maintaining normal active range of motion. This article reviews the nonsurgical approach, protocols, and outcomes of metacarpal fractures.
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Affiliation(s)
- Michael W Neumeister
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Kelli Webb
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kate McKenna
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, The Hand Surgery Research Center, Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| | - Michael W Neumeister
- Department of Surgery, Southern Illinois University School of Medicine, 747 N Rutledge St Ste 301, Springfield, IL 62702, USA.
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Abstract
Although the mechanism is unknown, Btx-A injection may be an effective, localized, nonsurgical treatment option without addictive properties or systemic side effects for the treatment of ischemic digits. Clinical research supports the safety and efficacy of injection of Btx-A for the treatment of Raynaud phenomenon.
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Affiliation(s)
- Michael W Neumeister
- Department of Surgery - Institute for Plastic Surgery, SIU School of Medicine, 747 North Rutledge 3rd Floor, PO Box 19653, Springfield, IL 62794, USA.
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Derby BM, Dai H, Reichensperger J, Cox L, Harrison C, Cosenza N, Yang M, Bueno RA, Neumeister MW. Adipose-derived stem cell to epithelial stem cell transdifferentiation: a mechanism to potentially improve understanding of fat grafting's impact on skin rejuvenation. Aesthet Surg J 2014; 34:142-53. [PMID: 24334307 DOI: 10.1177/1090820x13515700] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 11/16/2022] Open
Abstract
BACKGROUND Recent evidence suggests that lipofilling improves overlying skin composition and appearance. Adipose-derived stem cells (ADSC) have been implicated. OBJECTIVE The authors identify ADSC transdifferentiation into epithelial stem cells through coexpression of GFP+ (green fluorescent protein positive) ADSC with the epithelial stem cell marker p63 in an in vivo fat grafting model. METHODS Six male, GFP+ mice served as adipose tissue donors. Twelve nude mice served as recipients. Recipients were subdivided into 2 arms (6 mice/each arm) and received either whole-fat specimen (group 1) or isolated and purified ADSC + peptide hydrogel carrier (group 2) engrafted into a 1-cm(2) left parascapular subdermal plane. The right parascapular subdermal plane served as control. Skin flaps were harvested at 8 weeks and subjected to (1) confocal fluorescent microscopy and (2) reverse transcriptase polymerase chain reaction (RT-PCR) for p63 mRNA expression levels. RESULTS Gross examination of skin flaps demonstrated subjectively increased dermal vessel presence surrounding whole-fat and ADSC specimens. The GFP+ cells were seen within overlying dermal architecture after engraftment and were found to coexpress p63. Significantly increased levels of p63 expression were found in the ADSC + hydrogel skin flaps. CONCLUSIONS We offer suggestive evidence that GFP+ ADSC are found within the dermis 8 weeks after engraftment and coexpress the epithelial stem cell marker p63, indicating that ADSC may transdifferentiate into epithelial stem cells after fat grafting. These findings complement current understanding of how fat grafts may rejuvenate overlying skin.
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Affiliation(s)
- Brian M Derby
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
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Abstract
Primary bone healing fails to occur in 5-15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole intuitively suggests a need for transfer of the vascularized bone to the nonunion site. Scaphoid nonunion treatment aims to prevent biological and mechanical subsidence of the involved bone, destabilization of the carpus, and early degenerative changes associated with scaphoid nonunion advanced collapse. Pedicled distal radius and free vascularized bone grafts (VBGs) offer hand surgeons an alternative treatment option in the management of carpal bone nonunion. VBGs are also indicated in the treatment of avascular necrosis of the scaphoid (Preiser's disease), lunate (Kienböck's disease), and capitate. Relative contraindications to pedicled dorsal radius vascularized bone grafting include humpback deformity, carpal instability, or collapse. The free medial femoral condyle bone graft has offered a novel treatment option for the humpback deformity to restore geometry of the carpus, otherwise not provided by pedicled grafts. In general, VBGs are contraindicated in the setting of a carpal bone without an intact cartilaginous shell, in advanced carpal collapse with degenerative changes, and in attempts to salvage small or collapsed bone fragments. Wrist salvage procedures are generally accepted as the more definitive treatment option under such circumstances. This manuscript offers a current review of the techniques and outcomes of VBGs to the carpal bones.
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Affiliation(s)
- Brian M. Derby
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | - Peter M. Murray
- />Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Alexander Y. Shin
- />Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905 USA
| | - Reuben A. Bueno
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | | | - Tim Ade
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
| | - Michael W. Neumeister
- />Institute for Plastic Surgery, Southern Illinois University School of Medicine, 747 North Rutledge 3rd Floor, P.O. Box 19653, Springfield, IL 62794 USA
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