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Hollenbeck, Scott Thomas

Overview:

Breast Cancer, Adipose Biology, Lower Extremity Reconstruction

Positions:

Associate Professor of Surgery

Surgery, Plastic, Maxillofacial, and Oral Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2000

M.D. — Ohio State University

Assistant Surgeon, Cancer Center

New York Presbyterian Hospital

Research Fellow, Surgery

Weill Cornell Medical College

Assistant Surgeon, Cancer Center

New York Presbyterian Hospital

Resident In Plastic Surgery, Surgery

Duke University

Grants:

Effects of Lavender Oil on Postoperative Pain, Sleep Quality and Mood

Administered By
Surgery, Plastic, Maxillofacial, and Oral Surgery
AwardedBy
doTERRA International LLC
Role
Principal Investigator
Start Date
May 17, 2017
End Date
December 31, 2018

2016 Duke Oncological Reconstruction Course

Administered By
Surgery, Plastic, Maxillofacial, and Oral Surgery
AwardedBy
Davol, Inc
Role
Principal Investigator
Start Date
October 18, 2016
End Date
March 31, 2017

Nanoplatform for Tracking Adipose-Derived Stem Cell Migration

Administered By
Surgery, Plastic, Maxillofacial, and Oral Surgery
AwardedBy
Southeastern Society of Plastic and Reconstructive Surgeons
Role
Principal Investigator
Start Date
June 01, 2015
End Date
May 31, 2016

The Role of Hypoxia and Adipokines in Breast Cancer

Administered By
Surgery, Plastic, Maxillofacial, and Oral Surgery
AwardedBy
The Plastic Surgery Foundation
Role
Mentor
Start Date
July 01, 2013
End Date
June 30, 2014
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Publications:

Assessing the effort associated with teaching residents.

Intraoperative resident education is an integral mission of academic medical centers and serves as the basis for training the next generation of surgeons. The actual effort associated with teaching residents is unknown as it pertains to additional operative time. Using a large validated multi-institutional dataset, this study aims to quantify the effect of having a resident present in common plastic surgery procedures on operative time. Future directions for developing standardized methods to record and report teaching time are proposed, which can help inform prospective studies.The 2006-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify seven isolated plastic surgical procedures that were categorized based on resident involvement and supervision. Linear regression models were used to calculate the difference in operative time with respect to resident participation while controlling for patient and operative factors.Resident involvement was associated with longer operative times for muscle flap trunk procedures (53 min, 95% CI = [25, 80], p-value = 0.0002) and breast reconstruction procedures with a latissimus dorsi flap (55 min, 95% CI = [22, 88], p-value = 0.001). For six of the seven surgeries evaluated, resident involvement was associated with longer operative times, as compared to no resident involvement.Resident involvement is associated with an increase in operative time for certain plastic surgery procedures. This finding underscores the need for a mechanism to quantify the time and effort that the attending surgeons allocate toward intraoperative resident education. Further study is also necessary to determine the causal impact on patient care.

Authors
Aibel, KR; Truong, T; Shammas, RL; Cho, EH; Buretta, KJ; Pomann, G-M; Hollenbeck, ST
MLA Citation
Aibel, KR, Truong, T, Shammas, RL, Cho, EH, Buretta, KJ, Pomann, G-M, and Hollenbeck, ST. "Assessing the effort associated with teaching residents. (Accepted)" Journal of plastic, reconstructive & aesthetic surgery : JPRAS 70.12 (December 2017): 1725-1731.
PMID
28882492
Source
epmc
Published In
Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume
70
Issue
12
Publish Date
2017
Start Page
1725
End Page
1731
DOI
10.1016/j.bjps.2017.07.014

Institutional Outcomes of Leech Therapy for Venous Congestion in 87 Patients.

Authors
Cornejo, A; Shammas, RL; Poveromo, LP; Lee, H-J; Hollenbeck, ST
MLA Citation
Cornejo, A, Shammas, RL, Poveromo, LP, Lee, H-J, and Hollenbeck, ST. "Institutional Outcomes of Leech Therapy for Venous Congestion in 87 Patients." Journal of reconstructive microsurgery 33.9 (November 2017): 612-618.
PMID
28675913
Source
epmc
Published In
Journal of Reconstructive Microsurgery
Volume
33
Issue
9
Publish Date
2017
Start Page
612
End Page
618
DOI
10.1055/s-0037-1604082

Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps.

The American Society of Plastic Surgeons commissioned a multistakeholder Work Group to develop recommendations for autologous breast reconstruction with abdominal flaps. A systematic literature review was performed and a stringent appraisal process was used to rate the quality of relevant scientific research. The Work Group assigned to draft this guideline was unable to find evidence of superiority of one technique over the other (deep inferior epigastric perforator versus pedicled transverse rectus abdominis musculocutaneous flap) in autologous tissue reconstruction of the breast after mastectomy. Presently, based on the evidence reported here, the Work Group recommends that surgeons contemplating breast reconstruction on their next patient consider the following: the patient's preferences and risk factors, the setting in which the surgeon works (academic versus community practice), resources available, the evidence shown in this guideline, and, equally important, the surgeon's technical expertise. Although theoretical superiority of one technique may exist, this remains to be reported in the literature, and future methodologically robust studies are needed.

Authors
Lee, BT; Agarwal, JP; Ascherman, JA; Caterson, SA; Gray, DD; Hollenbeck, ST; Khan, SA; Loeding, LD; Mahabir, RC; Miller, AS; Perdikis, G; Schwartz, JS; Sieling, BA; Thoma, A; Wolfman, JA; Wright, JL
MLA Citation
Lee, BT, Agarwal, JP, Ascherman, JA, Caterson, SA, Gray, DD, Hollenbeck, ST, Khan, SA, Loeding, LD, Mahabir, RC, Miller, AS, Perdikis, G, Schwartz, JS, Sieling, BA, Thoma, A, Wolfman, JA, and Wright, JL. "Evidence-Based Clinical Practice Guideline: Autologous Breast Reconstruction with DIEP or Pedicled TRAM Abdominal Flaps." Plastic and reconstructive surgery 140.5 (November 2017): 651e-664e.
PMID
29068921
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
140
Issue
5
Publish Date
2017
Start Page
651e
End Page
664e
DOI
10.1097/prs.0000000000003768

Acute Treatment Patterns for Lower Extremity Trauma in the United States: Flaps versus Amputation.

Authors
Mundy, LR; Truong, T; Shammas, RL; Gage, MJ; Pomann, G-M; Hollenbeck, ST
MLA Citation
Mundy, LR, Truong, T, Shammas, RL, Gage, MJ, Pomann, G-M, and Hollenbeck, ST. "Acute Treatment Patterns for Lower Extremity Trauma in the United States: Flaps versus Amputation." Journal of reconstructive microsurgery 33.8 (October 2017): 563-570.
PMID
28514793
Source
epmc
Published In
Journal of Reconstructive Microsurgery
Volume
33
Issue
8
Publish Date
2017
Start Page
563
End Page
570
DOI
10.1055/s-0037-1603332

Association Between Targeted HER-2 Therapy and Breast Reconstruction Outcomes: A Propensity Score-Matched Analysis.

Current treatment for HER-2+ breast cancer includes chemotherapy and targeted HER-2 therapy with trastuzumab and/or pertuzumab. Evidence is lacking on the safety of breast reconstructive operations in these patients. We hypothesized that targeted HER-2 therapy was not associated with post-mastectomy reconstructive outcomes.Women receiving chemotherapy and post-mastectomy reconstruction at Duke University Medical Center from 2006 to 2016 were retrospectively identified. Patients receiving targeted HER-2 therapy with trastuzumab and/or pertuzumab within 6 weeks before breast reconstruction were propensity score-matched 1:1 to patients who did not receive targeted HER-2 therapy, based on the following factors: age, obesity, diabetes, tobacco use, receipt of neoadjuvant chemotherapy, chemotherapy regimen, and radiation therapy. Primary study outcomes included the occurrence of hematoma, seroma, infection, wound breakdown, mastectomy skin flap necrosis, and postoperative flap thrombosis.A total of 481 women were identified, resulting in 107 propensity score-matched pairs. Administration of combined trastuzumab and pertuzumab therapy before breast reconstruction was independently associated with increased risk of postoperative wound breakdown requiring operative intervention for closure, compared with patients not undergoing targeted HER-2 therapy (odds ratio 65.29; 95% CI 1.63 to 2,611.50; p = 0.03). In addition, larger tumor size (2 to 5 cm) was significantly associated with a reduced risk of postoperative wound breakdown, compared with smaller tumors (<2 cm) (odds ratio 0.41; 95% CI 0.19 to 0.87; p = 0.02). Single-agent targeted HER-2 therapy with trastuzumab was not significantly associated with reconstructive complications.Our study suggests that trastuzumab therapy in conjunction with breast reconstructive operation is not associated with reconstructive complications, and breast reconstruction does not need to be delayed due to the administration of trastuzumab. Future studies are needed to evaluate the impact of pertuzumab on surgical outcomes.

Authors
Shammas, RL; Cho, EH; Glener, AD; Poveromo, LP; Mundy, LR; Greenup, RA; Blackwell, KL; Hollenbeck, ST
MLA Citation
Shammas, RL, Cho, EH, Glener, AD, Poveromo, LP, Mundy, LR, Greenup, RA, Blackwell, KL, and Hollenbeck, ST. "Association Between Targeted HER-2 Therapy and Breast Reconstruction Outcomes: A Propensity Score-Matched Analysis." Journal of the American College of Surgeons (September 26, 2017).
PMID
28985927
Source
epmc
Published In
Journal of The American College of Surgeons
Publish Date
2017
DOI
10.1016/j.jamcollsurg.2017.08.023

Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis.

Clinical indications are expanding for the use of fasciocutaneous free flaps in lower extremity traumatic reconstruction. We assessed the impact of muscle versus fasciocutaneous free flap coverage on reconstructive and functional outcomes.A multicenter retrospective review was conducted on all lower extremity traumatic free flaps performed at Duke University (1997-2013) and the University of Pennsylvania (2002-2013). Muscle and fasciocutaneous flaps were compared in two subgroups (acute trauma and chronic traumatic sequelae), according to limb salvage, return to ambulation, flap outcomes, and secondary flap procedures.A total of 518 lower extremity free flaps were performed for acute traumatic injuries (n=238) or chronic traumatic sequelae (n=280). Muscle (n=307) and fasciocutaneous (n=211) flaps achieved similar cumulative limb salvage rates in acute trauma (90% versus 94%; p=0.56) and chronic trauma subgroups (90% versus 88%; p=0.51). In addition, flap choice did not impact functional recovery (p=0.83 for acute trauma; p=0.49 for chronic trauma). Flap groups did not differ in the rates of flap thrombosis, flap salvage, flap loss, or nonunion requiring bone grafting in Gustilo IIIb tibial fractures. Fasciocutaneous flaps were more commonly re-elevated for subsequent orthopedic procedures (p<0.01) and required fewer secondary skin grafting procedures (p=0.01). Reconstructive and functional outcomes were heavily influenced by the severity of the original defect.Muscle and fasciocutaneous free flaps achieved comparable rates of limb salvage and functional recovery. Fasciocutaneous flaps enabled re-elevation for orthopedic procedures and limited the need for secondary skin grafting. Flap selection should be guided by defect characteristics and reconstructive needs.

Authors
Cho, EH; Shammas, RL; Carney, MJ; Weissler, JM; Bauder, AR; Glener, AD; Kovach, SJ; Hollenbeck, ST; Levin, LS
MLA Citation
Cho, EH, Shammas, RL, Carney, MJ, Weissler, JM, Bauder, AR, Glener, AD, Kovach, SJ, Hollenbeck, ST, and Levin, LS. "Muscle versus Fasciocutaneous Free Flaps in Lower Extremity Traumatic Reconstruction: A Multicenter Outcomes Analysis." Plastic and reconstructive surgery (September 15, 2017).
PMID
28938362
Source
epmc
Published In
Plastic and Reconstructive Surgery
Publish Date
2017
DOI
10.1097/prs.0000000000003927

Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer.

The appropriate management of breast cancer risk in BRCA mutation carriers following ovarian cancer diagnosis remains unclear. We sought to determine the survival benefit and cost effectiveness of risk-reducing mastectomy (RRM) among women with BRCA1/2 mutations following stage II-IV ovarian cancer.We constructed a decision model from a third-party payer perspective to compare annual screening with magnetic resonance imaging (MRI) and mammography to annual screening followed by RRM with reconstruction following ovarian cancer diagnosis. Survival, overall costs, and cost effectiveness were determined by decade at diagnosis using 2015 US dollars. All inputs were obtained from the literature and public databases. Monte Carlo probabilistic sensitivity analysis was performed with a $100,000 willingness-to-pay threshold.The incremental cost-effectiveness ratio (ICER) per year of life saved (YLS) for RRM increased with age and BRCA2 mutation status, with greater survival benefit demonstrated in younger patients with BRCA1 mutations. RRM delayed 5 years in 40-year-old BRCA1 mutation carriers was associated with 5 months of life gained (ICER $72,739/YLS), and in 60-year-old BRCA2 mutation carriers was associated with 0.8 months of life gained (ICER $334,906/YLS). In all scenarios, $/YLS and mastectomies per breast cancer prevented were lowest with RRM performed 5-10 years after ovarian cancer diagnosis.For most BRCA1/2 mutation carriers following ovarian cancer diagnosis, RRM performed within 5 years is not cost effective when compared with breast cancer screening. Imaging surveillance should be advocated during the first several years after ovarian cancer diagnosis, after which point the benefits of RRM can be considered based on patient age and BRCA mutation status.

Authors
Gamble, C; Havrilesky, LJ; Myers, ER; Chino, JP; Hollenbeck, S; Plichta, JK; Kelly Marcom, P; Shelley Hwang, E; Kauff, ND; Greenup, RA
MLA Citation
Gamble, C, Havrilesky, LJ, Myers, ER, Chino, JP, Hollenbeck, S, Plichta, JK, Kelly Marcom, P, Shelley Hwang, E, Kauff, ND, and Greenup, RA. "Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer." Annals of surgical oncology (July 11, 2017).
PMID
28699130
Source
epmc
Published In
Annals of Surgical Oncology
Publish Date
2017
DOI
10.1245/s10434-017-5995-z

Fat Grafting-More Than Just the Hype.

Authors
Hollenbeck, ST; Hwang, ES
MLA Citation
Hollenbeck, ST, and Hwang, ES. "Fat Grafting-More Than Just the Hype." JAMA surgery (June 28, 2017).
PMID
28658466
Source
epmc
Published In
JAMA Surgery
Publish Date
2017
DOI
10.1001/jamasurg.2017.1717

Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy.

Breast augmentation with subglandular versus subpectoral implants may differentially impact the early detection of breast cancer and treatment recommendations. The authors assessed the impact of prior augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy.Breast cancer diagnosis and management were retrospectively analyzed in all women with prior augmentation undergoing therapeutic mastectomy at the authors' institution from 1993 to 2014. Comparison was made to all women with no prior augmentation undergoing mastectomy in 2010. Subanalyses were performed according to prior implant placement.A total of 260 women with (n = 89) and without (n = 171) prior augmentation underwent mastectomy for 95 and 179 breast cancers, respectively. Prior implant placement was subglandular (n = 27) or subpectoral (n = 63) (For five breasts, the placement was unknown). Breast cancer stage at diagnosis (p = 0.19) and detection method (p = 0.48) did not differ for women with and without prior augmentation. Compared to subpectoral augmentation, subglandular augmentation was associated with the diagnosis of invasive breast cancer rather than ductal carcinoma in situ (p = 0.01) and detection by self-palpation rather than screening mammography (p = 0.03). Immediate two-stage implant reconstruction was the preferred reconstructive method in women with augmentation (p < 0.01).Breast cancer stage at diagnosis was similar for women with and without prior augmentation. Among women with augmentation, however, subglandular implants were associated with more advanced breast tumors commonly detected on palpation rather than mammography. Increased vigilance in breast cancer screening is recommended among women with subglandular augmentation.Therapeutic, III.

Authors
Cho, EH; Shammas, RL; Phillips, BT; Greenup, RA; Hwang, ES; Hollenbeck, ST
MLA Citation
Cho, EH, Shammas, RL, Phillips, BT, Greenup, RA, Hwang, ES, and Hollenbeck, ST. "Breast Cancer after Augmentation: Oncologic and Reconstructive Considerations among Women Undergoing Mastectomy." Plastic and reconstructive surgery 139.6 (June 2017): 1240e-1249e.
PMID
28538550
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
139
Issue
6
Publish Date
2017
Start Page
1240e
End Page
1249e
DOI
10.1097/prs.0000000000003342

Human Adipose-Derived Stem Cells Labeled with Plasmonic Gold Nanostars for Cellular Tracking and Photothermal Cancer Cell Ablation.

Gold nanostars are unique nanoplatforms that can be imaged in real time and transform light energy into heat to ablate cells. Adipose-derived stem cells migrate toward tumor niches in response to chemokines. The ability of adipose-derived stem cells to migrate and integrate into tumors makes them ideal vehicles for the targeted delivery of cancer nanotherapeutics.To test the labeling efficiency of gold nanostars, undifferentiated adipose-derived stem cells were incubated with gold nanostars and a commercially available nanoparticle (Qtracker), then imaged using two-photon photoluminescence microscopy. The effects of gold nanostars on cell phenotype, proliferation, and viability were assessed with flow cytometry, 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide metabolic assay, and trypan blue, respectively. Trilineage differentiation of gold nanostar-labeled adipose-derived stem cells was induced with the appropriate media. Photothermolysis was performed on adipose-derived stem cells cultured alone or in co-culture with SKBR3 cancer cells.Efficient uptake of gold nanostars occurred in adipose-derived stem cells, with persistence of the luminescent signal over 4 days. Labeling efficiency and signal quality were greater than with Qtracker. Gold nanostars did not affect cell phenotype, viability, or proliferation, and exhibited stronger luminescence than Qtracker throughout differentiation. Zones of complete ablation surrounding the gold nanostar-labeled adipose-derived stem cells were observed following photothermolysis in both monoculture and co-culture models.Gold nanostars effectively label adipose-derived stem cells without altering cell phenotype. Once labeled, photoactivation of gold nanostar-labeled adipose-derived stem cells ablates neighboring cancer cells, demonstrating the potential of adipose-derived stem cells as a vehicle for the delivery of site-specific cancer therapy.

Authors
Shammas, RL; Fales, AM; Crawford, BM; Wisdom, AJ; Devi, GR; Brown, DA; Vo-Dinh, T; Hollenbeck, ST
MLA Citation
Shammas, RL, Fales, AM, Crawford, BM, Wisdom, AJ, Devi, GR, Brown, DA, Vo-Dinh, T, and Hollenbeck, ST. "Human Adipose-Derived Stem Cells Labeled with Plasmonic Gold Nanostars for Cellular Tracking and Photothermal Cancer Cell Ablation." Plastic and reconstructive surgery 139.4 (April 2017): 900e-910e.
PMID
28350664
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
139
Issue
4
Publish Date
2017
Start Page
900e
End Page
910e
DOI
10.1097/prs.0000000000003187

Abstract P3-16-02: Nanotheranostics using plasmonic gold nanostars to target inflammatory breast cancer cells and tumor emboli

Authors
Shammas, RL; Fales, AM; Crawford, BM; Hollenbeck, ST; Vo-Dinh, T; Devi, GR
MLA Citation
Shammas, RL, Fales, AM, Crawford, BM, Hollenbeck, ST, Vo-Dinh, T, and Devi, GR. "Abstract P3-16-02: Nanotheranostics using plasmonic gold nanostars to target inflammatory breast cancer cells and tumor emboli." February 15, 2017.
Source
crossref
Published In
Cancer Research
Volume
77
Issue
4 Supplement
Publish Date
2017
Start Page
P3-16-02
End Page
P3-16-02
DOI
10.1158/1538-7445.SABCS16-P3-16-02

Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience.

Thrombocytosis in patients undergoing lower extremity free tissue transfer may be associated with increased risk of microvascular complications. This study assessed whether preoperative platelet counts predict lower extremity free flap thrombosis.All patients undergoing lower extremity free tissue transfer at Duke University from 1997 to 2013 and at the University of Pennsylvania from 2002 to 2013 were retrospectively identified. Logistic regression was used to assess whether preoperative platelet counts independently predict flap thrombosis, controlling for baseline and operative factors.A total of 565 patients underwent lower extremity free tissue transfer, with an overall flap thrombosis rate of 16 percent (n = 91). Elevated preoperative platelet counts were independently associated with both intraoperative thrombosis (500 ± 120 versus 316 ± 144 × 10/liter; p < 0.001) and postoperative thrombosis (410 ± 183 versus 320 ± 143 × 10/liter; p = 0.040) in 215 patients who sustained acute lower extremity trauma within 30 days before reconstruction. In acute trauma patients, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 403 × 10/liter; OR, 4.08; p < 0.001) and a two-fold increased risk of postoperative thrombosis (cutoff value, 361 × 10/liter; OR, 2.16; p = 0.005). In patients who did not sustain acute trauma, preoperative platelet counts predicted a four-fold increased risk of intraoperative thrombosis (cutoff value, 352 × 10/liter; OR, 3.82; p = 0.002).Acute trauma patients with elevated preoperative platelet counts are at increased risk for lower extremity free flap complications. Prospective evaluation is warranted for guiding risk stratification and targeted treatment strategies.Risk, III.

Authors
Cho, EH; Bauder, AR; Centkowski, S; Shammas, RL; Mundy, L; Kovach, SJ; Levin, LS; Hollenbeck, ST
MLA Citation
Cho, EH, Bauder, AR, Centkowski, S, Shammas, RL, Mundy, L, Kovach, SJ, Levin, LS, and Hollenbeck, ST. "Preoperative Platelet Count Predicts Lower Extremity Free Flap Thrombosis: A Multi-Institutional Experience." Plastic and reconstructive surgery 139.1 (January 2017): 220-230.
PMID
27632402
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
139
Issue
1
Publish Date
2017
Start Page
220
End Page
230
DOI
10.1097/prs.0000000000002893

Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement.

To compare early outcomes of skin closure with octyl cyanoacrylate skin adhesive versus subcuticular suture closure.Over a 7-month period, 109 subjects (28 men and 81 women; mean age, 58.6 y) scheduled to undergo single-lumen implantable venous port insertion for chemotherapy were randomly assigned to skin closure with either octyl cyanoacrylate skin adhesive or absorbable subcuticular suture after suturing the deep dermal layer. Subjects were followed for episodes of infection or dehiscence within 3 months of port implantation. At 3 months, photographs of the healed incision were obtained and reviewed by a plastic surgeon in a blinded fashion who rated cosmetic scar appearance based on a validated 10-point cosmesis score.Of subjects, 54 were randomly assigned to skin adhesive, and 55 were randomly assigned to subcuticular suture. No subjects had incision dehiscence. Infection rates at 3 months were similar between groups (2.1% vs 4.0%; P = 1.0). The mean cosmesis scores were 4.40 for skin adhesive and 4.46 for subcuticular suture (P = .898). The superficial skin closure time was 8.6 minutes for suture versus 1.4 minutes for skin adhesive (P < .001).Scar cosmesis and patient outcomes did not significantly vary between skin adhesive versus subcuticular suture, although skin closure time was significantly less with skin adhesive.

Authors
Martin, JG; Hollenbeck, ST; Janas, G; Makar, RA; Pabon-Ramos, WM; Suhocki, PV; Miller, MJ; Sopko, DR; Smith, TP; Kim, CY
MLA Citation
Martin, JG, Hollenbeck, ST, Janas, G, Makar, RA, Pabon-Ramos, WM, Suhocki, PV, Miller, MJ, Sopko, DR, Smith, TP, and Kim, CY. "Randomized Controlled Trial of Octyl Cyanoacrylate Skin Adhesive versus Subcuticular Suture for Skin Closure after Implantable Venous Port Placement." Journal of vascular and interventional radiology : JVIR 28.1 (January 2017): 111-116.
PMID
27836404
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
28
Issue
1
Publish Date
2017
Start Page
111
End Page
116
DOI
10.1016/j.jvir.2016.08.009

Photothermal ablation of inflammatory breast cancer tumor emboli using plasmonic gold nanostars.

Inflammatory breast cancer (IBC) is rare, but it is the most aggressive subtype of breast cancer. IBC has a unique presentation of diffuse tumor cell clusters called tumor emboli in the dermis of the chest wall that block lymph vessels causing a painful, erythematous, and edematous breast. Lack of effective therapeutic treatments has caused mortality rates of this cancer to reach 20%-30% in case of women with stage III-IV disease. Plasmonic nanoparticles, via photothermal ablation, are emerging as lead candidates in next-generation cancer treatment for site-specific cell death. Plasmonic gold nanostars (GNS) have an extremely large two-photon luminescence cross-section that allows real-time imaging through multiphoton microscopy, as well as superior photothermal conversion efficiency with highly concentrated heating due to its tip-enhanced plasmonic effect. To effectively study the use of GNS as a clinically plausible treatment of IBC, accurate three-dimensional (3D) preclinical models are needed. Here, we demonstrate a unique in vitro preclinical model that mimics the tumor emboli structures assumed by IBC in vivo using IBC cell lines SUM149 and SUM190. Furthermore, we demonstrate that GNS are endocytosed into multiple cancer cell lines irrespective of receptor status or drug resistance and that these nanoparticles penetrate the tumor embolic core in 3D culture, allowing effective photothermal ablation of the IBC tumor emboli. These results not only provide an avenue for optimizing the diagnostic and therapeutic application of GNS in the treatment of IBC but also support the continuous development of 3D in vitro models for investigating the efficacy of photothermal therapy as well as to further evaluate photothermal therapy in an IBC in vivo model.

Authors
Crawford, BM; Shammas, RL; Fales, AM; Brown, DA; Hollenbeck, ST; Vo-Dinh, T; Devi, GR
MLA Citation
Crawford, BM, Shammas, RL, Fales, AM, Brown, DA, Hollenbeck, ST, Vo-Dinh, T, and Devi, GR. "Photothermal ablation of inflammatory breast cancer tumor emboli using plasmonic gold nanostars." International journal of nanomedicine 12 (January 2017): 6259-6272.
PMID
28894365
Source
epmc
Published In
International journal of nanomedicine
Volume
12
Publish Date
2017
Start Page
6259
End Page
6272
DOI
10.2147/ijn.s141164

Value Added from Plastic and Reconstructive Surgery Care at Major Medical Centers

Authors
Buretta, KJ; Sobol, DL; Cho, EH; Hollenbeck, ST
MLA Citation
Buretta, KJ, Sobol, DL, Cho, EH, and Hollenbeck, ST. "Value Added from Plastic and Reconstructive Surgery Care at Major Medical Centers." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S103
End Page
S103

Walking on Sunshine: Continued Surveillance of Industry Payments to General Surgeons

Authors
Ahmed, R; Hicks, CW; Bae, S; Chow, EKH; Orandi, BJ; Lopez, J; Hollenbeck, ST; Segev, DL
MLA Citation
Ahmed, R, Hicks, CW, Bae, S, Chow, EKH, Orandi, BJ, Lopez, J, Hollenbeck, ST, and Segev, DL. "Walking on Sunshine: Continued Surveillance of Industry Payments to General Surgeons." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S49
End Page
S49

Practice Makes Perfect: Surgical Efficiency During Free Flap Breast Reconstruction Is Associated with Improved Outcomes

Authors
Blau, JA; Cornejo, A; Thomas, AB; Shammas, RL; Aibel, K; Hollenbeck, ST
MLA Citation
Blau, JA, Cornejo, A, Thomas, AB, Shammas, RL, Aibel, K, and Hollenbeck, ST. "Practice Makes Perfect: Surgical Efficiency During Free Flap Breast Reconstruction Is Associated with Improved Outcomes." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S100
End Page
S101

Plasmonic Gold-Nanostars for Tracking of Adult Stem Cells and for Selective Photothermal Ablation

Authors
Shammas, RL; Fales, AM; Crawford, BM; Klitzman, B; Hollenbeck, ST; VoDinh, T
MLA Citation
Shammas, RL, Fales, AM, Crawford, BM, Klitzman, B, Hollenbeck, ST, and VoDinh, T. "Plasmonic Gold-Nanostars for Tracking of Adult Stem Cells and for Selective Photothermal Ablation." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S100
End Page
S100

Analysis of Bleeding Complications in Plastic Surgery

Authors
Thomas, AB; Shammas, RL; Glener, AD; Aibel, K; Hollenbeck, ST
MLA Citation
Thomas, AB, Shammas, RL, Glener, AD, Aibel, K, and Hollenbeck, ST. "Analysis of Bleeding Complications in Plastic Surgery." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S93
End Page
S93

Outcomes of Leech Therapy for Venous Congestion after Reconstructive Surgery

Authors
Shammas, RL; Cornejo, A; Poveromo, LP; Glener, AD; Hollenbeck, ST
MLA Citation
Shammas, RL, Cornejo, A, Poveromo, LP, Glener, AD, and Hollenbeck, ST. "Outcomes of Leech Therapy for Venous Congestion after Reconstructive Surgery." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S100
End Page
S100

Predictors of Amputation Rates in Open Tibia Fractures

Authors
Mundy, LR; Gage, MJ; Hollenbeck, ST
MLA Citation
Mundy, LR, Gage, MJ, and Hollenbeck, ST. "Predictors of Amputation Rates in Open Tibia Fractures." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
S85
End Page
S85

Comparison of Single vs Double Free Flap Breast Reconstruction: 30-Day Outcomes from the American College of Surgeons NSQIP Dataset

Authors
Blau, JA; Shammas, RL; Carlson, AR; Anolik, RA; Buretta, KJ; Hollenbeck, ST
MLA Citation
Blau, JA, Shammas, RL, Carlson, AR, Anolik, RA, Buretta, KJ, and Hollenbeck, ST. "Comparison of Single vs Double Free Flap Breast Reconstruction: 30-Day Outcomes from the American College of Surgeons NSQIP Dataset." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
E162
End Page
E162

Impact of Resident Participation on Surgical Efficiency and Outcomes in General Surgery

Authors
Aibel, K; Blau, JA; Hollenbeck, ST
MLA Citation
Aibel, K, Blau, JA, and Hollenbeck, ST. "Impact of Resident Participation on Surgical Efficiency and Outcomes in General Surgery." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
E181
End Page
E182

Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?

Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM.Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications. Magnetic resonance images were reviewed by 2 radiologists, blinded to outcomes, for the presence of dual vs single blood supply to the breast. The association between blood supply on MRI with ischemic and necrotic complications after NSM was analyzed.One hundred and sixty-four NSM procedures were performed in 105 patients (mean age 45.5 years, range 25 to 69 years) who had a preoperative MRI. The majority of procedures were performed for malignancy (89 of 164 [54.3%]) or prophylaxis (73 of 164 [44.5%]). Nipple-areola complex or skin flap ischemia or necrosis occurred in 40 (24.4%) breasts. Ischemia or necrosis after NSM was less likely to occur in breasts with dual compared with single blood supply (20.8% vs 38.2%; p = 0.03). There was no association between surgical complications and age, BMI, smoking history, previous radiation therapy, indication for NSM, surgical specimen weight, surgical incision type, reconstruction approach, or operating surgeon on univariate analysis.Preoperative MRI characterization of breast vascularity can be considered when planning NSM. The presence of a dual blood supply to the breast on MRI is associated with a decreased risk of nipple-areola complex and skin flap ischemia and necrosis after NSM.

Authors
Bahl, M; Pien, IJ; Buretta, KJ; Hwang, ES; Greenup, RA; Ghate, SV; Hollenbeck, ST
MLA Citation
Bahl, M, Pien, IJ, Buretta, KJ, Hwang, ES, Greenup, RA, Ghate, SV, and Hollenbeck, ST. "Can Vascular Patterns on Preoperative Magnetic Resonance Imaging Help Predict Skin Necrosis after Nipple-Sparing Mastectomy?." Journal of the American College of Surgeons 223.2 (August 2016): 279-285.
PMID
27182036
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
223
Issue
2
Publish Date
2016
Start Page
279
End Page
285
DOI
10.1016/j.jamcollsurg.2016.04.045

Evolving Trends in Autologous Breast Reconstruction: Is the Deep Inferior Epigastric Artery Perforator Flap Taking Over?

Enthusiasm for the deep inferior epigastric artery perforator (DIEP) flap for autologous breast reconstruction has grown in recent years. However, this flap is not performed at all centers or by all plastic surgeons for breast reconstruction, and it is unclear whether practice patterns have measurably changed. This study aimed to (1) evaluate changing trends in breast flap use in the United States in recent years and (2) identify how these trends have affected charges and costs associated with autologous breast reconstruction.Patients undergoing autologous breast reconstruction [latissimus dorsi (LD), pedicled transverse rectus abdominus myocutaneous (pTRAM), free TRAM (fTRAM), and DIEP] were identified using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2009-2011). A total of 19,182 hospital discharges were reviewed. Patient demographics, hospital teaching center status, payer status, length of stay, total charges, and total costs per discharge were reviewed. Statistical analysis was performed using linear regression, t test, and analysis of variance models.Between 2009 and 2011, the total number of discharges did not change significantly. Patient age distribution was similar for all flap groups. For individual flaps, there was a significant increase in DIEP flaps (P = 0.03), with a decreasing trend for other abdominal-based flaps. The patients receiving DIEP flap breast reconstruction were covered by private insurance at a higher rate than all other flap procedures (P = 0.03), whereas other potential cost determinants did not differ significantly between the groups. The mean charge per flap was $40,704 for LD, $51,933 for pTRAM, $69,909 for fTRAM, and $82,320 for DIEP. The mean cost per flap was $12,017 for LD, $15,538 for pTRAM, $20,756 for fTRAM, and $23,616 for DIEP.Between 2009 and 2011, the total amount of autologous breast reconstruction discharges was relatively stable, but the number of DIEP flaps increased significantly. Review of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample data shows that, compared with LD, pTRAM, and fTRAM flaps, the DIEP flap is associated with higher charges and costs.

Authors
Pien, I; Caccavale, S; Cheung, MC; Butala, P; Hughes, DB; Ligh, C; Zenn, MR; Hollenbeck, ST
MLA Citation
Pien, I, Caccavale, S, Cheung, MC, Butala, P, Hughes, DB, Ligh, C, Zenn, MR, and Hollenbeck, ST. "Evolving Trends in Autologous Breast Reconstruction: Is the Deep Inferior Epigastric Artery Perforator Flap Taking Over?." Annals of plastic surgery 76.5 (May 2016): 489-493.
PMID
25180959
Source
epmc
Published In
Annals of Plastic Surgery
Volume
76
Issue
5
Publish Date
2016
Start Page
489
End Page
493
DOI
10.1097/sap.0000000000000339

Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps.

Successful foot and ankle soft tissue reconstruction is dependent on a clear understanding of the vascular supply to the foot. The aim of this study was to identify risk factors for reconstructive failure following foot and ankle free tissue transfer.The authors retrospectively reviewed their 17-year institutional experience with 231 foot and ankle free flaps performed in 225 patients to determine predictors of postoperative foot ischemia and flap failure. Postoperative foot ischemia was defined as ischemia resulting in tissue necrosis, separate from the reconstruction site.Six (3%) patients developed postoperative foot ischemia, and 28 (12%) patients experienced flap failure. Chronic ulceration (P = 0.02) and an elevated preoperative platelet count (P = 0.04) were independent predictors of foot ischemia. The presence of diabetes was predictive of flap failure (P = 0.05). Flap failure rates were higher in the setting of an abnormal preoperative angiogram (P = 0.04), although the type and number of occluded arteries did not influence outcome. Foot ischemia was more frequent following surgical revascularization in conjunction with free tissue transfer and the use of the distal arterial bypass graft for flap anastomosis (P < 0.01). Overall, no differences were observed in foot ischemia (P = 0.17) and flap failure (P = 0.75) rates when the flap anastomosis was performed to the diseased artery noted on angiography, compared with an unobstructed native tibial artery.Foot and ankle free tissue transfer may be performed with a low incidence of foot ischemia. Patients with diabetes, chronic ulceration, and an elevated preoperative platelet count are at higher risk for reconstructive failure. © 2015 Wiley Periodicals, Inc. Microsurgery 36:276-283, 2016.

Authors
Cho, EH; Garcia, RM; Pien, I; Kuchibhatla, M; Levinson, H; Erdmann, D; Levin, LS; Hollenbeck, ST
MLA Citation
Cho, EH, Garcia, RM, Pien, I, Kuchibhatla, M, Levinson, H, Erdmann, D, Levin, LS, and Hollenbeck, ST. "Vascular considerations in foot and ankle free tissue transfer: Analysis of 231 free flaps." Microsurgery 36.4 (May 2016): 276-283.
PMID
25808692
Source
epmc
Published In
Microsurgery
Volume
36
Issue
4
Publish Date
2016
Start Page
276
End Page
283
DOI
10.1002/micr.22406

Microvascular Anastomoses Using End-to-End versus End-to-Side Technique in Lower Extremity Free Tissue Transfer.

The decision to perform an end-to-end (ETE) or end-to-side (ETS) arterial anastomosis in lower extremity free tissue transfer has not been thoroughly evaluated in a large multisurgeon setting. The authors compared the reconstructive outcomes of lower extremity free flaps with ETE and ETS arterial anastomoses.The authors retrospectively reviewed their 17-year institutional experience with lower extremity free flaps to determine whether ETE or ETS arterial anastomoses were associated with foot ischemic complications and flap failure.From 1996 to 2013, 398 patients underwent 413 lower extremity free flaps with ETE (66%) or ETS (34%) arterial anastomoses. The incidence of postoperative foot ischemia was 2% (n = 8). The flap failure rate was 11% (n = 45). The ETS technique was preferred in patients with fewer intact vessels to the foot (32% ETS for three-vessel runoff, 36% ETS for two-vessel runoff, and 50% ETS for single-vessel runoff) and when an intact recipient vessel was selected for anastomosis (60% ETS for intact vessel vs. 25% ETS for distally occluded vessel). No differences were observed in the foot ischemia (p = 0.45) and flap failure rates (p = 0.59) for ETE versus ETS arterial anastomoses. In subset analyses, the incidence of foot ischemia did not differ for either technique in the context of impaired vascular runoff or recipient vessel selection.No advantage was noted for ETE or ETS arterial anastomoses based on reconstructive outcomes. The choice of anastomotic technique in lower extremity free tissue transfer should be based on patient factors and the clinical circumstances encountered.

Authors
Cho, EH; Garcia, RM; Blau, J; Levinson, H; Erdmann, D; Levin, LS; Hollenbeck, ST
MLA Citation
Cho, EH, Garcia, RM, Blau, J, Levinson, H, Erdmann, D, Levin, LS, and Hollenbeck, ST. "Microvascular Anastomoses Using End-to-End versus End-to-Side Technique in Lower Extremity Free Tissue Transfer." Journal of reconstructive microsurgery 32.2 (February 2016): 114-120.
PMID
26322491
Source
epmc
Published In
Journal of Reconstructive Microsurgery
Volume
32
Issue
2
Publish Date
2016
Start Page
114
End Page
120
DOI
10.1055/s-0035-1563397

Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis.In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire.No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14.The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring.

Authors
Hirche, C; Senghaas, A; Fischer, S; Hollenbeck, ST; Kremer, T; Kneser, U
MLA Citation
Hirche, C, Senghaas, A, Fischer, S, Hollenbeck, ST, Kremer, T, and Kneser, U. "Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up." Burns : journal of the International Society for Burn Injuries 42.1 (February 2016): e1-e7.
PMID
26652220
Source
epmc
Published In
Burns
Volume
42
Issue
1
Publish Date
2016
Start Page
e1
End Page
e7
DOI
10.1016/j.burns.2015.10.013

Current Concepts in Lower Extremity Reconstruction.

After studying this article, the participant should be able to: 1. Understand the existing principles for lower extremity reconstruction for both traumatic and ablative defects. 2. Understand the important factors for lower extremity reconstruction-based anatomical regions. 3. Discuss perforator flaps and their application in lower extremity reconstruction.The Gustilo-Anderson open fracture classification is briefly reviewed. A comprehensive overview of the available flaps and methods for lower extremity reconstruction is provided.

Authors
Soltanian, H; Garcia, RM; Hollenbeck, ST
MLA Citation
Soltanian, H, Garcia, RM, and Hollenbeck, ST. "Current Concepts in Lower Extremity Reconstruction." Plastic and reconstructive surgery 136.6 (December 2015): 815e-829e.
PMID
26595037
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
136
Issue
6
Publish Date
2015
Start Page
815e
End Page
829e
DOI
10.1097/prs.0000000000001807

Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm.

Craniomaxillofacial (CMF) fractures are typically treated with open reduction and internal fixation. Open reduction and internal fixation can be complicated by hardware exposure or infection. The literature often does not differentiate between these 2 entities; so for this study, we have considered all hardware exposures as hardware infections. Approximately 5% of adults with CMF trauma are thought to develop hardware infections. Management consists of either removing the hardware versus leaving it in situ. The optimal approach has not been investigated. Thus, a systematic review of the literature was undertaken and a resultant evidence-based approach to the treatment and management of CMF hardware infections was devised.A comprehensive search of journal articles was performed in parallel using MEDLINE, Web of Science, and ScienceDirect electronic databases. Keywords and phrases used were maxillofacial injuries; facial bones; wounds and injuries; fracture fixation, internal; wound infection; and infection. Our search yielded 529 articles. To focus on CMF fractures with hardware infections, the full text of English-language articles was reviewed to identify articles focusing on the evaluation and management of infected hardware in CMF trauma. Each article's reference list was manually reviewed and citation analysis performed to identify articles missed by the search strategy. There were 259 articles that met the full inclusion criteria and form the basis of this systematic review. The articles were rated based on the level of evidence. There were 81 grade II articles included in the meta-analysis.Our meta-analysis revealed that 7503 patients were treated with hardware for CMF fractures in the 81 grade II articles. Hardware infection occurred in 510 (6.8%) of these patients. Of those infections, hardware removal occurred in 264 (51.8%) patients; hardware was left in place in 166 (32.6%) patients; and in 80 (15.6%) cases, there was no report as to hardware management. Finally, our review revealed that there were no reported differences in outcomes between groups.Management of CMF hardware infections should be performed in a sequential and consistent manner to optimize outcome. An evidence-based algorithm for management of CMF hardware infections based on this critical review of the literature is presented and discussed.

Authors
Cahill, TJ; Gandhi, R; Allori, AC; Marcus, JR; Powers, D; Erdmann, D; Hollenbeck, ST; Levinson, H
MLA Citation
Cahill, TJ, Gandhi, R, Allori, AC, Marcus, JR, Powers, D, Erdmann, D, Hollenbeck, ST, and Levinson, H. "Hardware Removal in Craniomaxillofacial Trauma: A Systematic Review of the Literature and Management Algorithm." Annals of plastic surgery 75.5 (November 2015): 572-578. (Review)
PMID
25393499
Source
epmc
Published In
Annals of Plastic Surgery
Volume
75
Issue
5
Publish Date
2015
Start Page
572
End Page
578
DOI
10.1097/sap.0000000000000194

Combining Prophylactic Oophorectomy with Mastectomy Does Not Adversely Affect Surgical Outcomes: Results from the NSQIP Database

Authors
Blau, J; Gamble, C; Anolik, RA; Havrilesky, L; Greenup, RA; Hollenbeck, ST
MLA Citation
Blau, J, Gamble, C, Anolik, RA, Havrilesky, L, Greenup, RA, and Hollenbeck, ST. "Combining Prophylactic Oophorectomy with Mastectomy Does Not Adversely Affect Surgical Outcomes: Results from the NSQIP Database." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S113
End Page
S113

Vascular Patterns on Preoperative Breast MRI Predict Ischemia and Necrosis after Nipple-Sparing Mastectomy

Authors
Pien, IJ; Bahl, M; Buretta, KJ; Greenup, RA; Ghate, SV; Hollenbeck, ST
MLA Citation
Pien, IJ, Bahl, M, Buretta, KJ, Greenup, RA, Ghate, SV, and Hollenbeck, ST. "Vascular Patterns on Preoperative Breast MRI Predict Ischemia and Necrosis after Nipple-Sparing Mastectomy." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S120
End Page
S120

Surgical management of patients with hidradenitis suppurativa: results from the NSQIP database

Authors
Blau, J; Cornejo, A; Erdmann, D; Levinson, H; Hollenbeck, ST
MLA Citation
Blau, J, Cornejo, A, Erdmann, D, Levinson, H, and Hollenbeck, ST. "Surgical management of patients with hidradenitis suppurativa: results from the NSQIP database." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
E122
End Page
E123

Book Review: Operative Microsurgery.

Authors
Suh, Y; Hollenbeck, ST
MLA Citation
Suh, Y, and Hollenbeck, ST. "Book Review: Operative Microsurgery." Annals of plastic surgery 75.2 (August 2015): 127-.
PMID
26101987
Source
epmc
Published In
Annals of Plastic Surgery
Volume
75
Issue
2
Publish Date
2015
Start Page
127
DOI
10.1097/sap.0000000000000555

Commentary: "Professional Burnout Among Plastic Surgery Residents; Can it be Prevented? Outcomes of a National Survey".

Authors
Hollenbeck, ST; Anolik, R
MLA Citation
Hollenbeck, ST, and Anolik, R. "Commentary: "Professional Burnout Among Plastic Surgery Residents; Can it be Prevented? Outcomes of a National Survey"." Annals of plastic surgery 75.1 (July 2015): 9-.
PMID
26068419
Source
epmc
Published In
Annals of Plastic Surgery
Volume
75
Issue
1
Publish Date
2015
Start Page
9
DOI
10.1097/sap.0000000000000567

Delayed implant augmentation of breast free flaps.

Two commonly used breast reconstruction techniques are (1) implant-based and (2) abdominal tissue-based procedures. When the two modalities are combined, the result is a unique construct that shares advantages and disadvantages of both approaches. Combining breast flaps and implants has been reported, yet the specific techniques associated with a reliable outcome remain unclear.Between July 2010 and 2014, a review of all patients who underwent delayed implant augmentation of a breast free flap reconstruction by the senior author was performed. Data were collected on patient characteristics, implants used, timing of reconstruction, and position of implant relative to the flap.During the study period, 101 patients underwent breast reconstruction with 161 abdominal free flaps. Of these, 12 patients (12%) and 17 flaps (11%) had delayed implant augmentation. Of the 17 augmented flaps, 12 had expanders placed before final implant placement. Eleven implants were placed in the subflap position and 6 in the subpectoralis major position. The mean final implant size was 296.5 mL (range, 125-510 mL). At a mean follow-up of 17.1 months, there was one expander removed before complete expansion for impending extrusion and one silicone gel implant revision for malposition.The results of delayed breast flap implant augmentation can be reliable and generate results that may not be obtainable with flaps or implants alone. Admittedly, the addition of an implant to a flap reconstruction exposes the patient to implant-related complications that would otherwise have been circumvented by a pure autologous reconstruction.

Authors
Pien, IJ; Anolik, R; Blau, J; Hollenbeck, ST
MLA Citation
Pien, IJ, Anolik, R, Blau, J, and Hollenbeck, ST. "Delayed implant augmentation of breast free flaps." Journal of reconstructive microsurgery 31.4 (May 2015): 254-260.
PMID
25785652
Source
epmc
Published In
Journal of Reconstructive Microsurgery
Volume
31
Issue
4
Publish Date
2015
Start Page
254
End Page
260
DOI
10.1055/s-0034-1395416

Free flap reconstruction of the knee: an outcome study of 34 cases.

BACKGROUND: Open wounds around the knee joint can often be managed with local flaps; however, free tissue transfer may be required when local tissue options are unavailable or inadequate. Free tissue transfer around the knee can be challenging due to unique anatomic features of the joint. The outcomes of such procedures remain largely unreported. METHODS: We retrospectively analyzed 33 patients who underwent 34 free tissue transfer reconstructions to the knee from 1993 to 2010. Twenty-four flaps were composed of soft tissue only and 10 flaps included a bony component. Patient demographics, details of the defect, operative characteristics, and clinical outcomes were reviewed. Outcomes included rates of flap failure, flap reexploration, and limb salvage. RESULTS: Thirty-three (97%) of 34 flaps survived. One flap failed secondary to arterial thrombosis. In total, 6/34 flaps (18%) required reexploration (2 arterial thromboses and 4 venous thromboses). A wide variety of donor and recipient vessels were used. Vessel selection did not affect vascular reexploration. Overall, 88% of lower extremities were salvaged. Four of 10 (40%) patients receiving bone free flap reconstruction experienced delayed union and 2 (20%) of these required amputation for eventual nonunion. CONCLUSIONS: Free flap reconstruction of the knee has a high flap survival and limb preservation rate in threatened extremities. Flap survival rates in the knee are similar to reported rates elsewhere in the lower extremity. Despite flap survival, infected nonunions that occur after bone free flap reconstruction result in a high limb amputation rate.

Authors
Louer, CR; Garcia, RM; Earle, SA; Hollenbeck, ST; Erdmann, D; Levin, LS
MLA Citation
Louer, CR, Garcia, RM, Earle, SA, Hollenbeck, ST, Erdmann, D, and Levin, LS. "Free flap reconstruction of the knee: an outcome study of 34 cases." Ann Plast Surg 74.1 (January 2015): 57-63.
PMID
23759972
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
74
Issue
1
Publish Date
2015
Start Page
57
End Page
63
DOI
10.1097/SAP.0b013e31828d7558

Role of platelet inhibition in microvascular surgery.

Thrombosis remains a significant complication of microvascular free tissue transfer. Recent discoveries in the field of vascular biology have led to a greater understanding of thrombogenesis and the pivotal role that platelets play in the formation of a clot. However, current antithrombotic strategies in the clinical practice of free tissue transfer have not typically focused on platelet inhibition. Decades of cardiovascular clinical trials have delineated the essential role of platelet inhibitor therapy in patients with acute coronary syndromes and those undergoing percutaneous coronary interventions. Understanding the current treatment guidelines for antiplatelet therapy across the spectrum of patients with coronary heart disease may provide insights into their use in the prevention and treatment of thrombosis in microvascular surgery. In this review, we examine the current antiplatelet agents in clinical use and discuss the potential role of platelet inhibition in free flap surgery, particularly in the setting of repeated microvascular thrombosis.

Authors
Cho, EH; Ligh, C; Hodulik, KL; Hollenbeck, ST
MLA Citation
Cho, EH, Ligh, C, Hodulik, KL, and Hollenbeck, ST. "Role of platelet inhibition in microvascular surgery." Journal of reconstructive microsurgery 30.9 (November 2014): 589-598. (Review)
PMID
25089565
Source
epmc
Published In
Journal of Reconstructive Microsurgery
Volume
30
Issue
9
Publish Date
2014
Start Page
589
End Page
598
DOI
10.1055/s-0034-1381955

An algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle.

BACKGROUND: Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue coverage. The foot and ankle region is challenging to reconstruct for orthopaedic and plastic surgeons owing to its complex bony anatomy and unique functional demands. Therefore, identifying strategies for plastic surgery of these wounds may help guide surgeons in defining the best treatment plan. QUESTIONS/PURPOSES: We evaluated our current algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle with respect to whether (1) prophylactic or simultaneous soft tissue coverage affected wound-healing complications (secondary plastic surgery, orthopaedic hardware removal, malunion, further orthopaedic surgery, ultimate failure) and (2) postoperative referral for soft tissue management was associated with wound location, size, and orthopaedic procedure. METHODS: We retrospectively reviewed 112 patients who underwent elective orthopaedic foot or ankle surgery and required concomitant plastic surgery at our institution. Study end points included secondary plastic surgery procedures, hardware removal for infection, foot or ankle malunion, further orthopaedic surgery, and wound-healing failure as defined by a chronic nonhealing wound or need for amputation. Minimum followup was 0.6 months (mean, 24.9 months; range, 0.6-197 months). Four patients were lost to complete followup. We developed an algorithm that centers on two critical points of care: preoperative evaluation by the orthopaedic surgeon and evaluation and treatment by the plastic surgeon after referral. RESULTS: Compared with postoperative intervention, prophylactic or simultaneous soft tissue coverage did not lead to differences in frequency of secondary plastic surgery procedures (p = 0.55), hardware removal procedures (p = 0.13), malunions (p = 0.47), further orthopaedic surgery (p = 0.48), and ultimate failure (p = 0.27). Patients referred postoperatively for soft tissue management most frequently had dorsal ankle wounds (p < 0.001) of smaller size (p = 0.03), most commonly associated with total ankle arthroplasty (p = 0.004). CONCLUSIONS: Using our algorithmic approach, prophylactic or simultaneous soft tissue coverage did not improve the study end points. In addition, unexpected postoperative wound breakdown necessitating a plastic surgery consultation most commonly occurred on the dorsal ankle after total ankle arthroplasty. Our algorithm facilitates early identification of skin instability and enables prompt soft tissue coverage before or concurrently with orthopaedic procedures. The effect of prophylactic or simultaneous soft tissue coverage on postoperative wound healing requires further investigation. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Authors
Cho, EH; Garcia, R; Pien, I; Thomas, S; Levin, LS; Hollenbeck, ST
MLA Citation
Cho, EH, Garcia, R, Pien, I, Thomas, S, Levin, LS, and Hollenbeck, ST. "An algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle." Clinical orthopaedics and related research 472.6 (June 2014): 1921-1929.
PMID
24577615
Source
epmc
Published In
Clinical Orthopaedics and Related Research ®
Volume
472
Issue
6
Publish Date
2014
Start Page
1921
End Page
1929
DOI
10.1007/s11999-014-3536-7

AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial.

BACKGROUND: Prosthetic reconstruction of the breast, as a 2-staged procedure using tissue expanders followed by placement of permanent implants, offers favorable aesthetic results with minimal additional surgical intervention. However, the current outpatient process to fill saline expanders can be lengthy and onerous, involving months of office visits and discomfort from the bolus saline expansions. We present a new technology (AeroForm Tissue Expansion System), which has the potential to improve the process of breast tissue expansion by providing a method for low-volume incremental filling, eliminating the need for injections and directly involving the patient by allowing her some control over the expansion process. METHODS: The described study is a 2:1 randomized controlled trial of the investigational CO2 expansion system and saline expanders. Of the 82 women receiving expanders, 58 (39 bilateral and 19 unilateral; bilateral rate, 67%) were implanted with CO2 tissue expanders and 24 subjects (15 bilateral and 9 unilateral; bilateral rate, 63%) were implanted with saline expanders. RESULTS: Preliminary validated expansion results were available for 55 women. Available mean time for active expansion in the CO2 group was 18.2 (9.2) days (median, 14.0; range, 5-39; number of expanders, 53), which was less than the mean time for active expansion in the saline group: 57.4 (33.6) days (median, 55; range, 5-137; number of expanders, 33). Available mean time from implant placement to exchange for a permanent prosthesis in the CO2 group was shorter [106.3 (42.9) days; median, 99; range, 42-237; number of expanders, 53] than for the women in the control group [151.7 (62.6) days; median, 140; range, 69-433; number of expanders, 33]. After 2 events--underexpansion (n=1) and erosion (n=1)--in the CO2 group, the internal membrane was redesigned and the expander bulk was decreased to minimize the risk of underexpansion and erosion in subsequent patients. CONCLUSIONS: Preliminary evidence indicates that the CO2-based tissue expansion system performs the same function as saline expansion devices without significantly altering the risk to the patient and that the device has the potential to make the expansion process faster and more convenient for both the patient and the physician.

Authors
Zeidler, KR; Berkowitz, RL; Chun, YS; Alizadeh, K; Castle, J; Colwell, AS; Desai, AR; Evans, G; Hollenbeck, S; Johnson, DJ; Morris, D; Ascherman, JA
MLA Citation
Zeidler, KR, Berkowitz, RL, Chun, YS, Alizadeh, K, Castle, J, Colwell, AS, Desai, AR, Evans, G, Hollenbeck, S, Johnson, DJ, Morris, D, and Ascherman, JA. "AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial." Annals of plastic surgery 72 Suppl 1 (May 2014): S51-S55.
PMID
24740025
Source
epmc
Published In
Annals of Plastic Surgery
Volume
72 Suppl 1
Publish Date
2014
Start Page
S51
End Page
S55
DOI
10.1097/sap.0000000000000175

Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases.

BACKGROUND: The transfer of patients with hand injuries involves a commitment of substantial resources, emphasizing the importance of understanding factors that may influence referral patterns. Anecdotal experience suggests that the likelihood of transfer increases during nights and weekends. This study aimed to analyze patterns of hand trauma transfers to Duke University Medical Center with respect to timing and patient insurance status. METHODS: The authors performed a retrospective chart review and analysis of 1147 consecutive patient transfers from 2005 to 2010 at a single level 1 university trauma center. Data categories included timing of transfer, patient demographics, insurance status, diagnosis, and procedures performed. Statistical analysis was performed using SAS software (SAS Institute Inc., Cary, N.C.). RESULTS: Of the patient sample, 39.8 percent was female, 30 percent were African American, and 57.3 percent were white. Contrary to our expectations, transfers were more likely during the day (p = 0.0001). Likewise, patients were more likely to present on weekdays than on weekends (p = .001). Although uninsured patients were not disproportionately represented overall, they were more frequently transferred at night (p = 0.0001), despite having the same complexity of injuries as privately insured patients. Conversely, patients with private insurance were less likely to be transferred at night (p = 0.0001). CONCLUSIONS: Similar to studies in other surgical specialties, this analysis demonstrates significant associations between insurance status and hand injury transfer patterns. The current climate, including declining numbers of surgeons willing to provide emergency hand care, diminishing reimbursements, and an expanding uninsured patient population, threatens to exacerbate these concerning trends in trauma patient management.

Authors
Butala, P; Fisher, MD; Blueschke, G; Ruch, DS; Richard, MJ; Hollenbeck, ST; Levinson, H; Leversedge, FJ; Erdmann, D
MLA Citation
Butala, P, Fisher, MD, Blueschke, G, Ruch, DS, Richard, MJ, Hollenbeck, ST, Levinson, H, Leversedge, FJ, and Erdmann, D. "Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases." Plastic and reconstructive surgery 133.4 (April 2014): 842-848.
PMID
24675188
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
133
Issue
4
Publish Date
2014
Start Page
842
End Page
848
DOI
10.1097/prs.0000000000000017

Abstract 23: Comparison of Early Outcomes between Plastic Surgeons and Otolaryngologists Performing Head and Neck Free Flap Reconstruction: Based on the American College of Surgeons National Surgical Quality Improvement Program.

Authors
Butala, P; Cheung, MC; Wilk, A; Anolik, RA; Hollenbeck, ST
MLA Citation
Butala, P, Cheung, MC, Wilk, A, Anolik, RA, and Hollenbeck, ST. "Abstract 23: Comparison of Early Outcomes between Plastic Surgeons and Otolaryngologists Performing Head and Neck Free Flap Reconstruction: Based on the American College of Surgeons National Surgical Quality Improvement Program." April 2014.
PMID
24675316
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
133
Issue
4 Suppl
Publish Date
2014
Start Page
989
End Page
990
DOI
10.1097/01.prs.0000445806.26559.45

Abstract 30: the economic implications of changing trends in breast flap reconstruction in the United States.

Authors
Caccavale, S; Pien, I; Cheung, M; Butala, P; Hughes, D; Ligh, C; Zenn, MR; Hollenbeck, ST
MLA Citation
Caccavale, S, Pien, I, Cheung, M, Butala, P, Hughes, D, Ligh, C, Zenn, MR, and Hollenbeck, ST. "Abstract 30: the economic implications of changing trends in breast flap reconstruction in the United States." March 2014.
PMID
25942141
Source
epmc
Published In
Plastic and Reconstructive Surgery
Volume
133
Issue
3 Suppl
Publish Date
2014
Start Page
39
End Page
40
DOI
10.1097/01.prs.0000445063.25225.47

Book review: reconstructive surgery of the lower extremity.

Authors
Hollenbeck, ST
MLA Citation
Hollenbeck, ST. "Book review: reconstructive surgery of the lower extremity." Ann Plast Surg 72.1 (January 2014): 2-.
PMID
24343318
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
72
Issue
1
Publish Date
2014
Start Page
2
DOI
10.1097/SAP.0000000000000028

Interstitial engraftment of adipose-derived stem cells into an acellular dermal matrix results in improved inward angiogenesis and tissue incorporation.

Acellular dermal matrices (ADM) are commonly used in reconstructive procedures and rely on host cell invasion to become incorporated into host tissues. We investigated different approaches to adipose-derived stem cells (ASCs) engraftment into ADM to enhance this process. Lewis rat adipose-derived stem cells were isolated and grafted (3.0 × 10(5) cells) to porcine ADM disks (1.5 mm thick × 6 mm diameter) using either passive onlay or interstitial injection seeding techniques. Following incubation, seeding efficiency and seeded cell viability were measured in vitro. In addition, Eighteen Lewis rats underwent subcutaneous placement of ADM disk either as control or seeded with PKH67 labeled ASCs. ADM disks were seeded with ASCs using either onlay or injection techniques. On day 7 and or 14, ADM disks were harvested and analyzed for host cell infiltration. Onlay and injection techniques resulted in unique seeding patterns; however cell seeding efficiency and cell viability were similar. In-vivo studies showed significantly increased host cell infiltration towards the ASCs foci following injection seeding in comparison to control group (p < 0.05). Moreover, regional endothelial cell invasion was significantly greater in ASCs injected grafts in comparison to onlay seeding (p < 0.05). ADM can successfully be engrafted with ASCs. Interstitial engraftment of ASCs into ADM via injection enhances regional infiltration of host cells and angiogenesis, whereas onlay seeding showed relatively broad and superficial cell infiltration. These findings may be applied to improve the incorporation of avascular engineered constructs.

Authors
Komatsu, I; Yang, J; Zhang, Y; Levin, LS; Erdmann, D; Klitzman, B; Hollenbeck, ST
MLA Citation
Komatsu, I, Yang, J, Zhang, Y, Levin, LS, Erdmann, D, Klitzman, B, and Hollenbeck, ST. "Interstitial engraftment of adipose-derived stem cells into an acellular dermal matrix results in improved inward angiogenesis and tissue incorporation." J Biomed Mater Res A 101.10 (October 2013): 2939-2947.
Website
http://hdl.handle.net/10161/10342
PMID
23554077
Source
pubmed
Published In
Journal of Biomedical Materials Research Part A
Volume
101
Issue
10
Publish Date
2013
Start Page
2939
End Page
2947
DOI
10.1002/jbm.a.34582

Autologous blood use for free flap breast reconstruction: a comparative evaluation of a preoperative blood donation program.

BACKGROUND: New insights into potential adverse effects of banked blood and improved infectious surveillance have led to questions regarding the utility of preoperative autologous blood donation. METHODS: A retrospective chart review of 153 patients undergoing abdominal free flap breast reconstruction was performed with the goal of determining the effect of an autologous blood donation program on clinical outcomes. Demographic and premorbid conditions were evaluated along with outcome variables including complication and transfusion rates. RESULTS: As expected, the autologous blood donor group (n = 96) was more likely to receive a blood transfusion of any kind compared with the nondonors (98% vs. 18%, P < 0.0001). Surprisingly, the mean number of allogeneic transfusions was not decreased (0.26 vs. 0.84, P = 0.066). The mean number of complications between groups were comparable (0.53 vs. 0.57, P = 0.687). CONCLUSION: We found neither significant benefit nor adverse effect from the practice of autologous blood banking for free flap breast reconstruction. The practice should be considered safe but not routinely recommended for free flap breast surgery.

Authors
Louer, CR; Chang, JB; Hollenbeck, ST; Zenn, MR
MLA Citation
Louer, CR, Chang, JB, Hollenbeck, ST, and Zenn, MR. "Autologous blood use for free flap breast reconstruction: a comparative evaluation of a preoperative blood donation program." Ann Plast Surg 70.2 (February 2013): 158-161.
PMID
22214797
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
70
Issue
2
Publish Date
2013
Start Page
158
End Page
161
DOI
10.1097/SAP.0b013e3182321b17

Mammographic density: intersection of science, the law, and clinical practice.

High mammographic density is associated with a two- to sixfold increased risk of breast cancer. Mammographic density can be altered by endogenous and exogenous hormonal factors and generally declines with age. Mammographic density is affected by confounding factors such as age, parity, menopausal status, and body mass index (BMI), thus making interpretation of mammographic density challenging. None of the established means of measuring mammographic density are entirely satisfactory because they are time consuming and/or subjective. Although mammographic density has been shown to predict breast cancer risk, the role of mammographic density in precisely assessing a woman's breast cancer risk over her lifetime and evaluating response to risk-reduction strategies cannot be fully realized until we have a better understanding of the biology that links mammographic density to breast cancer risk.

Authors
Hollenbeck, S; Keely, P; Seewaldt, V
MLA Citation
Hollenbeck, S, Keely, P, and Seewaldt, V. "Mammographic density: intersection of science, the law, and clinical practice." American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Meeting (January 2013).
PMID
23714458
Source
epmc
Published In
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting
Publish Date
2013
DOI
10.1200/edbook_am.2013.33.e63

Free partial latissimus dorsi myocutaneous flap for coverage of severe achilles contracture in children

Achilles tendon and soft-tissue contractures caused by trauma to the foot and ankle are complex injuries. An array of techniques, including local and distant flaps, has been used and described to reconstruct these challenging wounds. However, the management of these injuries in a growing child who develops abnormal gait due to equinus deformity has not been categorically reported. The latissimus dorsi myocutaneous flap has the advantage of a rich blood supply making specific partial muscle harvest possible. In this case series, we report on five paediatric patients with severe contracture of the Achilles tendon and posterior ankle, who were reconstructed with free partial latissimus dorsi myocutaneous flaps. All flaps survived and satisfactory form and function of the ankle joint were achieved with minimal donor morbidity. We believe that the free partial latissimus dorsi myocutaneous flap is an excellent option for the soft-tissue reconstruction of severe Achilles tendon contracture in children. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Authors
Zhu, L; Wei, J; Daluvoy, S; Hollenbeck, ST; Chuan, D; Xu, H; Dong, J
MLA Citation
Zhu, L, Wei, J, Daluvoy, S, Hollenbeck, ST, Chuan, D, Xu, H, and Dong, J. "Free partial latissimus dorsi myocutaneous flap for coverage of severe achilles contracture in children." Journal of Plastic, Reconstructive and Aesthetic Surgery 66.1 (2013): 113-119.
PMID
23026473
Source
scival
Published In
Journal of Plastic, Reconstructive & Aesthetic Surgery
Volume
66
Issue
1
Publish Date
2013
Start Page
113
End Page
119
DOI
10.1016/j.bjps.2012.08.010

Tissue engraftment of hypoxic-preconditioned adipose-derived stem cells improves flap viability.

Adipose-derived stem cells (ASCs) have the ability to release multiple growth factors in response to hypoxia. In this study, we investigated the potential of ASCs to prevent tissue ischemia. We found conditioned media from hypoxic ASCs had increased levels of vascular endothelial growth factor (VEGF) and enhanced endothelial cell tubule formation. To investigate the effect of injecting rat ASCs into ischemic flaps, 21 Lewis rats were divided into three groups: control, normal oxygen ASCs (10(6) cells), and hypoxic preconditioned ASCs (10(6) cells). At the time of flap elevation, the distal third of the flap was injected with the treatment group. At 7 days post flap elevation, flap viability was significantly improved with injection of hypoxic preconditioned ASCs. Cluster of differentiation-31-positive cells were more abundant along the margins of flaps injected with ASCs. Fluorescent labeled ASCs localized aside blood vessels or throughout the tissue, dependent on oxygen preconditioning status. Next, we evaluated the effect of hypoxic preconditioning on ASC migration and chemotaxis. Hypoxia did not affect ASC migration on scratch assay or chemotaxis to collagen and laminin. Thus, hypoxic preconditioning of injected ASCs improves flap viability likely through the effects of VEGF release. These effects are modest and represent the limitations of cellular and growth factor-induced angiogenesis in the acute setting of ischemia.

Authors
Hollenbeck, ST; Senghaas, A; Komatsu, I; Zhang, Y; Erdmann, D; Klitzman, B
MLA Citation
Hollenbeck, ST, Senghaas, A, Komatsu, I, Zhang, Y, Erdmann, D, and Klitzman, B. "Tissue engraftment of hypoxic-preconditioned adipose-derived stem cells improves flap viability." Wound Repair Regen 20.6 (November 2012): 872-878.
Website
http://hdl.handle.net/10161/10341
PMID
23110692
Source
pubmed
Published In
Wound Repair and Regeneration
Volume
20
Issue
6
Publish Date
2012
Start Page
872
End Page
878
DOI
10.1111/j.1524-475X.2012.00854.x

Use of vascularized posterior rectus sheath allograft in pediatric multivisceral transplantation--report of two cases.

Restoring abdominal wall cover and contour in children undergoing bowel and multivisceral transplantation is often challenging due to discrepancy in size between donor and recipient, poor musculature related to birth defects and loss of abdominal wall integrity from multiple surgeries. A recent innovation is the use of vascularized posterior rectus sheath to enable closure of abdomen. We describe the application of this technique in two pediatric multivisceral transplant recipients--one to buttress a lax abdominal wall in a 22-month-old child with megacystis microcolon intestinal hypoperistalsis syndrome and another to accommodate transplanted viscera in a 10-month child with short bowel secondary to gastoschisis and loss of domain. This is the first successful report of this procedure with long-term survival. The procedure has potential application to facilitate difficult abdominal closure in both adults and pediatric liver and multivisceral transplantation.

Authors
Ravindra, KV; Martin, AE; Vikraman, DS; Brennan, TV; Collins, BH; Rege, AS; Hollenbeck, ST; Chinappa-Nagappa, L; Eager, K; Cousino, D; Sudan, DL
MLA Citation
Ravindra, KV, Martin, AE, Vikraman, DS, Brennan, TV, Collins, BH, Rege, AS, Hollenbeck, ST, Chinappa-Nagappa, L, Eager, K, Cousino, D, and Sudan, DL. "Use of vascularized posterior rectus sheath allograft in pediatric multivisceral transplantation--report of two cases." Am J Transplant 12.8 (August 2012): 2242-2246.
PMID
22594310
Source
pubmed
Published In
American Journal of Transplantation
Volume
12
Issue
8
Publish Date
2012
Start Page
2242
End Page
2246
DOI
10.1111/j.1600-6143.2012.04088.x

[Femur reconstruction using combined autologous fibula transfer and humeral allograft].

Wide resection far into the femoral metaphysis may be required to treat malignant bone tumors in the pediatric and adolescent patient population. Biological reconstruction using a free, vascularized fibular graft is a well-established surgical technique. A short remaining femoral medullary canal and a relatively small fibula diameter can make fixation of the vascularized bone transfer difficult. Stable fixation and short fusion times, however, can be achieved with the use of an additional humeral allograft and plate osteosynthesis.

Authors
Kokosis, G; Stolberg-Stolberg, J; Eward, WC; Richard, MJ; Hollenbeck, ST; Levinson, H; Brigman, BE; Erdmann, D
MLA Citation
Kokosis, G, Stolberg-Stolberg, J, Eward, WC, Richard, MJ, Hollenbeck, ST, Levinson, H, Brigman, BE, and Erdmann, D. "[Femur reconstruction using combined autologous fibula transfer and humeral allograft]." Chirurg 82.12 (December 2011): 1120-1123.
PMID
21901467
Source
pubmed
Published In
Der Chirurg
Volume
82
Issue
12
Publish Date
2011
Start Page
1120
End Page
1123
DOI
10.1007/s00104-011-2165-x

WITHDRAWN: The extended abdominal wall flap for transplantation.

INTRODUCTION: Patients with extensive loss of abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. MATERIALS AND METHODS: Five human cadaver abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, superficial inferior epigastric, and the superficial circumflex iliac arteries. RESULTS: Abdominal wall flaps were taken full thickness from the costal margin to the mid-axial line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and the superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5 +/- 4% versus 57.2 +/- 5%; Student t test, P < .05). CONCLUSIONS: Perfusion of a large portion of the abdominal wall is possible using single-vessel anastomosis through a short segment of the external iliac/femoral system. Perfusion is significantly greater than that based on the DIEA vessel alone.

Authors
Hollenbeck, ST; Senghaas, A; Turley, R; Ravindra, KV; Zenn, MR; Levin, LS; Erdmann, D
MLA Citation
Hollenbeck, ST, Senghaas, A, Turley, R, Ravindra, KV, Zenn, MR, Levin, LS, and Erdmann, D. "WITHDRAWN: The extended abdominal wall flap for transplantation." Transplant Proc 43.9 (November 2011): 3535-3540.
PMID
22099836
Source
pubmed
Published In
Transplantation Proceedings
Volume
43
Issue
9
Publish Date
2011
Start Page
3535
End Page
3540
DOI
10.1016/j.transproceed.2011.08.047

Perineal and lower extremity reconstruction.

LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. Perform a preoperative assessment of patients undergoing perineal and lower extremity reconstruction. 2. Describe the various tissue flaps used to perform these reconstructions and the advantages and disadvantages of each. 3. Provide appropriate postoperative care and interventions to maximize outcomes. BACKGROUND: The lower extremity and perineum provide the foundation for upright posture and ambulation. These areas are made up of intricate contours with variable skin types and must withstand the functional demands of organ orifice support and weight-bearing forces. Successful reconstruction calls for careful preoperative planning and consideration of the site-specific demands. METHODS: The authors reviewed literature regarding the most current treatment strategies for lower extremity and perineal reconstruction. RESULTS: Perineal reconstruction is typically related to genitourinary or digestive tract abnormalities, mainly malignancies. Local and regional flaps are the mainstay of therapy, depending on their availability and the need for adjuvant therapy. Postoperatively, pressure reduction and closed-suction drainage are of major consideration. The lower extremities are prone to trauma, and these wounds often involve underlying and exposed bony abnormalities, and this must be considered in operative planning. Significant defects may be reconstructed with local or regional flaps and free-tissue transfer. The location of the wound and extent of surrounding tissue compromise are of major concern when determining flap coverage. Postoperatively, transition to ambulation and weight-bearing status is paramount. CONCLUSIONS: Reconstruction of the lower extremity and perineum requires recognition of the high functional demands of these areas. Local and regional flaps and free tissue transfer allow reconstruction of complex wounds in these areas. Selecting the correct flap and navigating the postoperative recovery to arrive at functional restoration remain a significant challenge.

Authors
Hollenbeck, ST; Toranto, JD; Taylor, BJ; Ho, TQ; Zenn, MR; Erdmann, D; Levin, LS
MLA Citation
Hollenbeck, ST, Toranto, JD, Taylor, BJ, Ho, TQ, Zenn, MR, Erdmann, D, and Levin, LS. "Perineal and lower extremity reconstruction." Plast Reconstr Surg 128.5 (November 2011): 551e-563e. (Review)
PMID
22030517
Source
pubmed
Published In
Plastic and Reconstructive Surgery
Volume
128
Issue
5
Publish Date
2011
Start Page
551e
End Page
563e
DOI
10.1097/PRS.0b013e31822b6b87

The extended abdominal wall flap for transplantation.

INTRODUCTION AND AIMS: Patients with extensive loss of the abdominal wall tissue have few options for restoring the abdominal cavity. Composite tissue allotransplantation has been used for limited abdominal wall reconstruction in the setting of visceral transplantation, yet replacement of the entire abdominal wall has not been described. The purpose of this study was to determine the maximal abdominal skin surface available through an external iliac/femoral cuff-based pedicle. MATERIALS AND METHODS: Five human cadaveric abdominal walls were injected with methylene blue to analyze skin perfusion based on either the deep inferior epigastric artery (DIEA; n = 5) or a cuff of external iliac/femoral artery (n = 5) containing the deep circumflex iliac, deep inferior epigastric, and superficial inferior epigastric, and superficial circumflex iliac arteries. RESULTS: Abdominal wall flaps were taken full thickness from the costal margin to the midaxillary line and down to the pubic tubercle and proximal thigh. In all specimens, the deep inferior epigastric, deep circumflex iliac, superficial inferior epigastric, and superficial circumflex iliac arteries were found to originate within a 4-cm cuff of the external iliac/femoral artery. Abdominal wall flaps injected through a unilateral external iliac/femoral segment had a significantly greater degree of total flap perfusion than those injected through the DIEA alone (76.5% ± 4% vs 57.2% ± 5%; Student t test, P < .05). CONCLUSIONS: Perfusion of a large portion of the abdominal wall is possible using a single-vessel anastomosis through a short segment of the external iliac/femoral system. Perfusion is significantly greater than that based on the DIEA vessel alone.

Authors
Hollenbeck, ST; Senghaas, A; Turley, R; Ravindra, KV; Zenn, MR; Levin, LS; Erdmann, D
MLA Citation
Hollenbeck, ST, Senghaas, A, Turley, R, Ravindra, KV, Zenn, MR, Levin, LS, and Erdmann, D. "The extended abdominal wall flap for transplantation." Transplant Proc 43.5 (June 2011): 1701-1705.
PMID
21693261
Source
pubmed
Published In
Transplantation Proceedings
Volume
43
Issue
5
Publish Date
2011
Start Page
1701
End Page
1705
DOI
10.1016/j.transproceed.2011.01.176

The current role of the vascularized-fibular osteocutaneous graft in the treatment of segmental defects of the upper extremity.

Large osseous defects of the upper extremity can be a challenging problem for the reconstructive surgeon. There are numerous treatment options reported in the literature with variable results. We review our experience with the vascularized-fibular osteocutaneous graft for these complex defects with a focus on surgical techniques and outcomes.

Authors
Hollenbeck, ST; Komatsu, I; Woo, S; Schoeman, M; Yang, J; Erdmann, D; Levin, LS
MLA Citation
Hollenbeck, ST, Komatsu, I, Woo, S, Schoeman, M, Yang, J, Erdmann, D, and Levin, LS. "The current role of the vascularized-fibular osteocutaneous graft in the treatment of segmental defects of the upper extremity." Microsurgery 31.3 (March 2011): 183-189. (Review)
PMID
19760793
Source
pubmed
Published In
Microsurgery
Volume
31
Issue
3
Publish Date
2011
Start Page
183
End Page
189
DOI
10.1002/micr.20703

Subunit principle for microvascular foot reconstruction

Authors
Hollenbeck, ST; Levin, LS
MLA Citation
Hollenbeck, ST, and Levin, LS. "Subunit principle for microvascular foot reconstruction." Plastic and Reconstructive Surgery 127.3 (2011): 1395-1396.
Source
scival
Published In
Plastic and Reconstructive Surgery
Volume
127
Issue
3
Publish Date
2011
Start Page
1395
End Page
1396
DOI
10.1097/PRS.0b013e31820631c8

A model of sequential heart and composite tissue allotransplant in rats.

BACKGROUND: Some of the 600,000 patients with solid organ allotransplants need reconstruction with a composite tissue allotransplant, such as the hand, abdominal wall, or face. The aim of this study was to develop a rat model for assessing the effects of a secondary composite tissue allotransplant on a primary heart allotransplant. METHODS: Hearts of Wistar Kyoto rats were harvested and transplanted heterotopically to the neck of recipient Fisher 344 rats. The anastomoses were performed between the donor brachiocephalic artery and the recipient left common carotid artery, and between the donor pulmonary artery and the recipient external jugular vein. Recipients received cyclosporine A for 10 days only. Heart rate was assessed noninvasively. The sequential composite tissue allotransplant consisted of a 3 x 3-cm abdominal musculocutaneous flap harvested from Lewis rats and transplanted to the abdomen of the heart allotransplant recipients. The abdominal flap vessels were connected to the femoral vessels. No further immunosuppression was administered following the composite tissue allotransplant. Ten days after composite tissue allotransplantation, rejection of the heart and abdominal flap was assessed histologically. RESULTS: The rat survival rate of the two-stage transplant surgery was 80 percent. The transplanted heart rate decreased from 150 +/- 22 beats per minute immediately after transplant to 83 +/- 12 beats per minute on day 20 (10 days after stopping immunosuppression). CONCLUSIONS: This sequential allotransplant model is technically demanding. It will facilitate investigation of the effects of a secondary composite tissue allotransplant following primary solid organ transplantation and could be useful in developing future immunotherapeutic strategies.

Authors
Yang, J; Erdmann, D; Chang, JC; Komatsu, I; Zhang, Y; Wang, D; Hodavance, MS; Hollenbeck, ST; Levinson, H; Klitzman, B; Levin, LS
MLA Citation
Yang, J, Erdmann, D, Chang, JC, Komatsu, I, Zhang, Y, Wang, D, Hodavance, MS, Hollenbeck, ST, Levinson, H, Klitzman, B, and Levin, LS. "A model of sequential heart and composite tissue allotransplant in rats." Plast Reconstr Surg 126.1 (July 2010): 80-86.
Website
http://hdl.handle.net/10161/10346
PMID
20595859
Source
pubmed
Published In
Plastic and Reconstructive Surgery
Volume
126
Issue
1
Publish Date
2010
Start Page
80
End Page
86
DOI
10.1097/PRS.0b013e3181dbbb64

Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers.

BACKGROUND: Free tissue transfer to the lower extremity has become a well-established reconstructive modality. The purpose of this study was to develop a "subunit" approach to patients undergoing free tissue transfer for foot and ankle wounds to help further define subunit-specific functional and aesthetic operative goals. METHODS: The institutional review board approved this retrospective review of 161 patients who underwent free tissue transplantation for foot and ankle wounds between March 1, 1997, and February 28, 2007, at a single institution. Endpoints included flap-related complications, secondary surgery, time to ambulation, flap stability, and limb salvage. RESULTS: The most common types of wounds treated were trauma-related [n = 120 (75 percent)], diabetes-related [n = 24 (15 percent)], and oncologic defects [n = 8 (5 percent)]. Ten different donor sites were used for reconstruction, with the latissimus dorsi flap being the most common. The mean follow-up time was 26.9 months (range, 0.5 to 130 months). Mean time to ambulation was 3.1 months (range, 0.75 to 14 months). Overall, 11 percent of patients required revision surgery for flap instability at a mean time of 25.3 months after flap surgery. Wounds located over the heel (subunit 5) were most likely to develop instability (Fisher's exact test, p < 0.05). The overall 5-year limb salvage rate as determined by Kaplan-Meier analysis was 89 percent. CONCLUSIONS: The use of free tissue transplantation for treatment of foot and ankle wounds is associated with a high rate of limb salvage. Although a variety of flaps may be used, the application of the subunit principle can assist surgeons in designing flaps that will address subunit-specific functional and aesthetic concerns.

Authors
Hollenbeck, ST; Woo, S; Komatsu, I; Erdmann, D; Zenn, MR; Levin, LS
MLA Citation
Hollenbeck, ST, Woo, S, Komatsu, I, Erdmann, D, Zenn, MR, and Levin, LS. "Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers." Plast Reconstr Surg 125.3 (March 2010): 924-934.
PMID
20009789
Source
pubmed
Published In
Plastic and Reconstructive Surgery
Volume
125
Issue
3
Publish Date
2010
Start Page
924
End Page
934
DOI
10.1097/PRS.0b013e3181cc9630

Successful revascularization for delayed presentation of radiation-induced distal upper extremity ischemia.

Despite several reports of proximal arm ischemia due to radiation therapy, there are no reports of hand ischemia, presumably due to the rarity of radiation treatment of the distal upper extremity. We present a case of a 42-year-old male presenting with acute hand ischemia 36 years after being treated with forearm radiation for Ewing's sarcoma. Angiography demonstrated a patent brachial artery, occluded radial and ulnar arteries in the forearm, and a normal-caliber reconstituted radial artery at the anatomical snuffbox feeding a patent palmar arch. Transluminal balloon angioplasty was attempted initially without improvement. The patient was successfully revascularized with a reversed saphenous vein graft bypass from the distal brachial artery to the distal radial artery. At 22 months of follow-up, the graft remains patent with a palpable distal pulse. The patient continues to report acceptable function and range of motion.

Authors
Goldstein, LJ; Ayers, JD; Hollenbeck, S; Spector, JA; Vouyouka, AG
MLA Citation
Goldstein, LJ, Ayers, JD, Hollenbeck, S, Spector, JA, and Vouyouka, AG. "Successful revascularization for delayed presentation of radiation-induced distal upper extremity ischemia." Ann Vasc Surg 24.2 (February 2010): 257.e5-257.e8.
PMID
19892514
Source
pubmed
Published In
Annals of Vascular Surgery
Volume
24
Issue
2
Publish Date
2010
Start Page
257.e5
End Page
257.e8
DOI
10.1016/j.avsg.2009.07.024

Reply

Authors
Hollenbeck, ST; Levin, LS
MLA Citation
Hollenbeck, ST, and Levin, LS. "Reply." Plastic and Reconstructive Surgery 126.2 (2010): 686-687.
Source
scival
Published In
Plastic and Reconstructive Surgery
Volume
126
Issue
2
Publish Date
2010
Start Page
686
End Page
687
DOI
10.1097/PRS.0b013e3181de19ad

Arterial gene transfer of the TGF-beta signalling protein Smad3 induces adaptive remodelling following angioplasty: a role for CTGF.

AIMS: Although transforming growth factor-beta (TGF-beta) is believed to stimulate intimal hyperplasia after arterial injury, its role in remodelling remains unclear. We investigate whether Smad3, a TGF-beta signalling protein, might facilitate its effect on remodelling. METHODS AND RESULTS: Using the rat carotid angioplasty model, we assess Smad3 expression following arterial injury. We then test the effect of arterial Smad3 overexpression on the response to injury, and use a conditioned media experimental design to confirm an Smad3-dependent soluble factor that mediates this response. We use small interfering RNA (siRNA) to identify this factor as connective tissue growth factor (CTGF). Finally, we attempt to replicate the effect of medial Smad3 overexpression through adventitial application of recombinant CTGF. Injury induced medial expression of Smad3; overexpression of Smad3 caused neointimal thickening and luminal expansion, suggesting adaptive remodelling. Smad3 overexpression, though exclusively medial, caused adventitial changes: myofibroblast transformation, proliferation, and collagen production, all of which are associated with adaptive remodelling. Supporting the hypothesis that Smad3 initiated remodelling and these adventitial changes via a secreted product of medial smooth muscle cells (SMCs), we found that media conditioned by Smad3-expressing recombinant adenoviral vector (AdSmad3)-infected SMCs stimulated adventitial fibroblast transformation, proliferation, and collagen production in vitro. This effect was attenuated by pre-treatment of SMCs with siRNA specific for CTGF, abundantly produced by AdSmad3-infected SMCs, and significantly up-regulated in Smad3-overexpressing arteries. Moreover, periadventitial administration of CTGF replicated the effect of medial Smad3 overexpression on adaptive remodelling and neointimal hyperplasia. CONCLUSION: Medial gene transfer of Smad3 promotes adaptive remodelling by indirectly influencing the behaviour of adventitial fibroblasts. This arterial cell-cell communication is likely to be mediated by Smad3-dependent production of CTGF.

Authors
Kundi, R; Hollenbeck, ST; Yamanouchi, D; Herman, BC; Edlin, R; Ryer, EJ; Wang, C; Tsai, S; Liu, B; Kent, KC
MLA Citation
Kundi, R, Hollenbeck, ST, Yamanouchi, D, Herman, BC, Edlin, R, Ryer, EJ, Wang, C, Tsai, S, Liu, B, and Kent, KC. "Arterial gene transfer of the TGF-beta signalling protein Smad3 induces adaptive remodelling following angioplasty: a role for CTGF." Cardiovasc Res 84.2 (November 1, 2009): 326-335.
PMID
19570811
Source
pubmed
Published In
Cardiovascular Research
Volume
84
Issue
2
Publish Date
2009
Start Page
326
End Page
335
DOI
10.1093/cvr/cvp220

TGF-beta through Smad3 signaling stimulates vascular smooth muscle cell proliferation and neointimal formation.

The objective of this study was to better understand the role of transforming growth factor-beta (TGF-beta) and its primary signaling protein Smad3 in the development of intimal hyperplasia. Male Sprague-Dawley rats underwent left carotid balloon injury followed by intra-arterial infection with adenovirus-expressing Smad3 (AdSmad3). In uninfected injured arteries, endogenous Smad3 was upregulated with the expression peaking at 14 days. Moreover, in arteries infected with AdSmad3, we observed an enhancement of intimal hyperplasia and increased vascular smooth muscle cell (VSMC) proliferation. The novel finding, that TGF-beta/Smad3 stimulated rather than inhibited VSMC proliferation, was confirmed in cultured VSMCs infected with AdSmad3 and treated with TGF-beta. To identify the mechanism underlying TGF-beta/Smad3-mediated VSMC proliferation, we studied the cyclin-dependent kinase inhibitor p27. Although the upregulation of Smad3 in VSMCs had no significant effect on total p27 levels, Smad3 did stimulate the phosphorylation of p27 at serine-10 as well as the nuclear export of p27, events associated with cell proliferation. Furthermore, serine-10-phosphorylated p27 was also increased in AdSmad3-infected injured rat carotid arteries, demonstrating the existence of this same mechanism in vivo. In conclusion, our findings identify a novel mechanism for the effect of TGF-beta on intimal hyperplasia. In the presence of elevated levels of Smad3 that develop in response to injury, TGF-beta stimulates smooth muscle cell proliferation through a mechanism involving the phosphorylation and nuclear export of p27.

Authors
Tsai, S; Hollenbeck, ST; Ryer, EJ; Edlin, R; Yamanouchi, D; Kundi, R; Wang, C; Liu, B; Kent, KC
MLA Citation
Tsai, S, Hollenbeck, ST, Ryer, EJ, Edlin, R, Yamanouchi, D, Kundi, R, Wang, C, Liu, B, and Kent, KC. "TGF-beta through Smad3 signaling stimulates vascular smooth muscle cell proliferation and neointimal formation." Am J Physiol Heart Circ Physiol 297.2 (August 2009): H540-H549.
PMID
19525370
Source
pubmed
Published In
American journal of physiology. Heart and circulatory physiology
Volume
297
Issue
2
Publish Date
2009
Start Page
H540
End Page
H549
DOI
10.1152/ajpheart.91478.2007

The combined use of the Ilizarov method and microsurgical techniques for limb salvage.

The purpose of this article is to review clinical outcomes and propose a new classification scheme for combined use of Ilizarov Method with free tissue transfer for limb salvage. This is an Institutional Review Board-approved retrospective review of 62 patients treated with free tissue transfer and Ilizarov method over the past 15 years at a single institution. The surgical management of these patients is classified into 4 distinct approaches. The mean age was 37 years with the most common injury being Gustillo IIIB tibial fractures (61%). Eighty-seven percent of patients had failed prior fixation and 63% had osteomyelitis with a draining wound. The overall flap survival rate was 97%. The mean duration of Ilizarov fixation was 6.9 months with a mean limb length correction of 3 cm. The overall rate of primary bony union was 74%. With a mean follow-up of 42 months, the combined techniques resulted in limb salvage for 84% of cases. Failure of primary bony union was the only predictor of limb amputation. This multidisciplinary approach to limb salvage combines reconstructive microsurgery and the Ilizarov method.

Authors
Hollenbeck, ST; Woo, S; Ong, S; Fitch, RD; Erdmann, D; Levin, LS
MLA Citation
Hollenbeck, ST, Woo, S, Ong, S, Fitch, RD, Erdmann, D, and Levin, LS. "The combined use of the Ilizarov method and microsurgical techniques for limb salvage." Ann Plast Surg 62.5 (May 2009): 486-491.
PMID
19387146
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
62
Issue
5
Publish Date
2009
Start Page
486
End Page
491
DOI
10.1097/SAP.0b013e318189a9e5

Current indications for hand and face allotransplantation.

There is growing excitement centered on the possibilities of composite tissue allotransplantation (CTA) in many medical centers around the United States. As CTA programs begin to form, criteria to guide patient selection for these highly complex procedures is warranted. At this time the contraindications for CTA are more easily defined than the indications. What is clear is that a thorough multidisciplinary evaluation of each individual patient will be needed to determine the global impact and complexity of the defect. The role of the surgeon is to identify the feasibility of the CTA reconstruction and balance this with a complete knowledge of conventional reconstructive techniques. Conventional treatments may be used in place of CTA or as salvage for CTA failure.

Authors
Hollenbeck, ST; Erdmann, D; Levin, LS
MLA Citation
Hollenbeck, ST, Erdmann, D, and Levin, LS. "Current indications for hand and face allotransplantation." Transplant Proc 41.2 (March 2009): 495-498.
PMID
19328911
Source
pubmed
Published In
Transplantation Proceedings
Volume
41
Issue
2
Publish Date
2009
Start Page
495
End Page
498
DOI
10.1016/j.transproceed.2009.01.065

Roux-en-Y reconstruction after pancreaticoduodenectomy.

HYPOTHESIS: Roux-en-Y reconstruction (RYR) is associated with a reduction in morbidity and mortality associated with pancreatic anastomotic failure after pancreaticoduodenectomy compared with conventional loop reconstruction (CLR). DESIGN: Retrospective study of patients from 1991 to 2006. SETTING: Tertiary care center. PATIENTS: Records of patients undergoing CLR (n = 588) and patients undergoing RYR (n = 112) between February 1, 1991, and June 30, 2006, for pancreatic ductal adenocarcinoma at a single institution were retrospectively reviewed and compared. MAIN OUTCOME MEASURES: Perioperative outcome and mortality were compared for patients who underwent RYR compared with those who underwent CLR. RESULTS: Overall, both groups required a similar rate of postoperative interventional radiology procedures (CLR, 6.8%; RYR, 9.8%; P = .24) and subsequent operations (CLR, 6.9%; RYR, 9.1%; P = .62). No significant difference was found in the rate of overall postoperative mortality (CLR, 2.6%; RYR, 0.9%; P = .49). The overall rate of pancreatic anastomotic failure was 7.2%, and pancreatic anastomotic failure was associated with a 6% mortality rate. Among patients who developed pancreatic anastomotic failure, no significant difference was seen between CLR (n = 32) and RYR (n = 16) in length of hospital stay (18 vs 19 days; P = .98) or postoperative mortality (3 patients [9.4%] vs none [0%]; P = .54). CONCLUSION: We found that RYR is not associated with a reduction in morbidity after pancreaticoduodenectomy for pancreatic adenocarcinoma compared with CLR, even among patients who develop pancreatic anastomotic failure.

Authors
Grobmyer, SR; Hollenbeck, ST; Jaques, DP; Jarnagin, WR; DeMatteo, R; Coit, DG; Blumgart, LH; Brennan, MF; Fong, Y
MLA Citation
Grobmyer, SR, Hollenbeck, ST, Jaques, DP, Jarnagin, WR, DeMatteo, R, Coit, DG, Blumgart, LH, Brennan, MF, and Fong, Y. "Roux-en-Y reconstruction after pancreaticoduodenectomy." Arch Surg 143.12 (December 2008): 1184-1188.
PMID
19075170
Source
pubmed
Published In
Archives of Surgery
Volume
143
Issue
12
Publish Date
2008
Start Page
1184
End Page
1188
DOI
10.1001/archsurg.2008.501

Rapamycin inhibits fibronectin-induced migration of the human arterial smooth muscle line (E47) through the mammalian target of rapamycin.

The matrix protein fibronectin (FN) is a potent agoinst of vascular smooth muscle cell (SMC) migration. The role of rapamycin and the mammalian target of rapamycin (mTOR) in matrix protein-induced migration has not yet been defined. In these studies, we found that rapamycin (10 nM) markedly diminished chemotaxis of E47 cells (a cell line derived from human atherosclerotic plaques) and rat aortic SMCs toward FN as well as type I collagen and laminin; however, a period of preincubation >20 h was required. Subsequently, we showed that treatment with FN induced a rapid activation of mTOR as well as its downstream effector, S6 kinase (S6K). Moreover, FN-induced activation of both proteins was inhibited by preincubation with rapamycin for only 30 min. We then explored the upstream signaling pathway through which FN might mediate mTOR activation. A blocking antibody to alpha(v)beta(3) inhibited FN-induced mTOR/S6K activation as well as E47 cell chemotaxis, implicating alpha(v)beta(3) as the integrin receptor responsible for initiating FN-induced migration. Moreover, preincubation of E47 cells with wortmannin or LY-294002 blocked FN-induced mTOR/S6K activation, demonstrating that phosphatidylinositol 3-kinase (PI3K) plays a critical role in this rapamycin-sensitive signaling pathway. It has been previously suggested that rapamycin's effect on migration maybe related to enhancement of p27(kip1). However, treatment of E47 cells with rapamycin did not alter the level of p27(kip1) in the presence or absence of FN. Taken together, our data demonstrate that rapamycin inhibits FN-induced SMC migration through a pathway that involves at least alpha(v)beta(3)-integrin, PI3K, mTOR, and S6K.

Authors
Sakakibara, K; Liu, B; Hollenbeck, S; Kent, KC
MLA Citation
Sakakibara, K, Liu, B, Hollenbeck, S, and Kent, KC. "Rapamycin inhibits fibronectin-induced migration of the human arterial smooth muscle line (E47) through the mammalian target of rapamycin." Am J Physiol Heart Circ Physiol 288.6 (June 2005): H2861-H2868.
PMID
15708965
Source
pubmed
Published In
American journal of physiology. Heart and circulatory physiology
Volume
288
Issue
6
Publish Date
2005
Start Page
H2861
End Page
H2868
DOI
10.1152/ajpheart.00561.2004

Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach-a case report.

Phlegmasia cerulea dolens is a limb-threatening form of deep venous thrombosis and should be treated aggressively. The authors report a patient who presented with iliocaval and femoral deep venous thrombosis and posed an additional therapeutic challenge based on a recent history of heparin-induced thrombocytopenia. Catheter-directed pharmacologic thrombolysis and balloon venoplasty were applied in treatment. The direct thrombin inhibitor argatroban was used in place of heparin for concurrent anticoagulation. This multimodality endovascular approach (chemical and mechanical interventions) was successful in relieving the venous occlusion and salvaging the limb, while maintaining appropriate treatment for heparin-induced thrombocytopenia.

Authors
Lin, SC; Mousa, A; Bernheim, J; Dayal, R; Henderson, P; Hollenbeck, S; Kent, KC; Faries, PL
MLA Citation
Lin, SC, Mousa, A, Bernheim, J, Dayal, R, Henderson, P, Hollenbeck, S, Kent, KC, and Faries, PL. "Endoluminal recanalization in a patient with phlegmasia cerulea dolens using a multimodality approach-a case report." Vasc Endovascular Surg 39.3 (May 2005): 273-279.
PMID
15920657
Source
pubmed
Published In
Vascular and Endovascular Surgery
Volume
39
Issue
3
Publish Date
2005
Start Page
273
End Page
279
DOI
10.1177/153857440503900309

Multimodal percutaneous intervention for critical venous occlusive disease.

Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease, who exhibit severe symptomatology. This study examined the results of multimodal percutaneous therapy for the treatment of complex critical venous thrombotic and occlusive disease. Twenty-five patients presented with critical venous thromboses or occlusions (11 with debilitating unilateral lower extremity edema causing ambulatory impairment, 2 with debilitating bilateral lower extremity edema, 3 with phlegmasia cerulea dolens, 2 with venous claudication, 2 with superior vena cava (SVS) syndrome with respiratory compromise, 4 with debilitating upper extremity edema, and 1 with renal insufficiency). Therapeutic modalities including thrombolysis, mechanical thrombectomy, percutaneous venoplasty and stent placement, temporary inferior vena cava filtration, and ultrasound guidance were used in all cases in conjunction with long-term systemic anticoagulation. The venous access site was determined by the anatomic location of the lesion and included popliteal, femoral, brachial, and lesser saphenous. Patients were followed with clinical exam and duplex surveillance. Resolution of symptoms was achieved in 18 of 25 patients (72%) and partial resolution occurred in 4 of 25 (16%). Failure of treatment identified as both lack of clinical response and evidence of continued venous thrombosis occurred 3 of 25 patients (12%). Restoration of arterial pulses and limb salvage was achieved in the three patients with phlegmasia cerulea dolens and acute limb-threatening ischemia. Both patients with SVC syndrome experienced resolution of respiratory compromise and facial edema. The mean length of follow-up was 11 +/- 2.7 months. Complications included transfusion requirement (2), hematuria (2), retroperitoneal hematoma (1), and cellulitis (1). Acute critical venous thrombotic and occlusive disease is responsive to multimodal percutaneous treatment. The relief of pain and resolution of acutely life and limb-threatening conditions in this most severely symptomatic subset of patients represents the immediate goal of treatment.

Authors
Dayal, R; Bernheim, J; Clair, DG; Mousa, AY; Hollenbeck, S; DeRubertis, B; McKinsey, J; Morrissey, NJ; Kent, KC; Faries, PL
MLA Citation
Dayal, R, Bernheim, J, Clair, DG, Mousa, AY, Hollenbeck, S, DeRubertis, B, McKinsey, J, Morrissey, NJ, Kent, KC, and Faries, PL. "Multimodal percutaneous intervention for critical venous occlusive disease." Ann Vasc Surg 19.2 (March 2005): 235-240.
PMID
15770366
Source
pubmed
Published In
Annals of Vascular Surgery
Volume
19
Issue
2
Publish Date
2005
Start Page
235
End Page
240
DOI
10.1007/s10016-004-0167-6

Postcarotid endarterectomy pseudoaneurysm treated with combined stent graft and coil embolization--a case report.

Pseudoaneurysm formation is a rare complication following carotid endarterectomy (CEA); however, its occurrence is associated with significant risk of morbidity. The patient in this report presented 2 years following CEA with headache and lateral neck mass. The diagnosis of a 3.5 x 3.0 cm carotid artery bifurcation pseudoaneurysm was made by using magnetic resonance angiography (MRA). Endovascular exclusion of the aneurysm was accomplished with coil embolization of the external carotid artery followed by deployment of a 7 x 50 mm wall stent graft into the common carotid artery-internal carotid artery (CCA-ICA). The patient's symptoms improved and at 6-months postexclusion, duplex ultrasound demonstrated a significant reduction in pseudoaneurysm size. This case highlights the feasibility and safety of using endovascular techniques in the treatment of post-CEA pseudoaneurysm.

Authors
Mousa, A; Bernheim, J; Lyon, R; Dayal, R; Hollenbeck, S; Henderson, P; Clair, D; Kent, KC; Faries, PL
MLA Citation
Mousa, A, Bernheim, J, Lyon, R, Dayal, R, Hollenbeck, S, Henderson, P, Clair, D, Kent, KC, and Faries, PL. "Postcarotid endarterectomy pseudoaneurysm treated with combined stent graft and coil embolization--a case report." Vasc Endovascular Surg 39.2 (March 2005): 191-194.
PMID
15806281
Source
pubmed
Published In
Vascular and Endovascular Surgery
Volume
39
Issue
2
Publish Date
2005
Start Page
191
End Page
194
DOI
10.1177/153857440503900209

A canine model to study the significance and hemodynamics of type II endoleaks.

OBJECTIVE: The clinical significance of Type 2 endoleak after endovascular repair of abdominal aortic aneurysms (AAA) remains incompletely delineated. This study describes the development of a novel canine model that allows for continuous monitoring of intraaneurysmal pressure in the setting of Type 2 endoleak. METHODS: Infrarenal AAA were created in 10 mongrel dogs by implanting a prosthetic aneurysm containing an intraluminal, solid-state, strain gauge pressure transducer which is able to measure pressures in both solid and liquid media. A segment of native aorta with two or more patent side branch vessels was reimplanted into the prosthetic aneurysm using a Carrel patch. Four animals had two lumbar vessels implanted; two had two lumbar vessels and the caudal mesenteric artery implanted, and four control animals had no vessels reimplanted. Retrograde flow in the aneurysmal side branches caused a Type 2 endoleak after the aneurysm was excluded from antegrade flow by deploying a stent graft. Both systemic and intra-sac pressures were measured daily for up to 90 days after endovascular exclusion and indexed to systemic pressure. Endoleak patency and flow were assessed with digital subtraction angiography, duplex ultrasound, and cine-magnetic resonance angiography (MRA). Histological characterization of the intraaneurysmal contents was performed. RESULTS: Before endovascular exclusion, the systolic, mean arterial, and pulse pressure within the aneurysmal sac closely matched that of the systemic circulation (systolic, 0.96 +/- 0.22; mean, 0.94 +/- 0.21; pulse pressure, 0.97 +/- 0.22) (R value, 0.97). Endovascular exclusion in animals with no collateral side branch vessels resulted in no endoleak and significantly reduced intraaneurysmal pressure when compared to systemic pressure, with systolic, mean arterial, and pulse pressure 0.172 +/- 0.05, 0.137 +/- 0.05, and 0.098 +/- 0.02, respectively (P < 0.001). In animals with Type 2 endoleaks, the pressures were lower than systemic pressure, but statistically significant in their difference from the control group. The systolic pressure of those with Type 2 endoleaks was 0.702 +/- 0.048; mean arterial pressure was 0.784 +/- 0.028, and pulse pressure was 0.406 +/- 0.031 when indexed to systemic pressure (P < 0.001). Cine-MRA and Duplex ultrasound documented persistent patency of the Type 2 endoleaks throughout the study period in animals with multiple side branches. CONCLUSION: Intraaneurysmal pressure in the setting of Type 2 endoleaks may be accurately determined using this canine model. Intraaneurysmal pressure is maintained at a significant level in the context of this retrograde collateral perfusion, suggesting that persistent Type 2 endoleaks are of clinical significance. This model may serve to allow further evaluation and characterization of Type 2 endoleaks.

Authors
Mousa, A; Dayal, R; Bernheim, J; Henderson, P; Hollenbeck, S; Trocciola, S; Prince, M; Gordon, R; Badimon, J; Fuster, V; Marin, ML; Kent, KC; Faries, PL
MLA Citation
Mousa, A, Dayal, R, Bernheim, J, Henderson, P, Hollenbeck, S, Trocciola, S, Prince, M, Gordon, R, Badimon, J, Fuster, V, Marin, ML, Kent, KC, and Faries, PL. "A canine model to study the significance and hemodynamics of type II endoleaks." J Surg Res 123.2 (February 2005): 275-283.
PMID
15680390
Source
pubmed
Published In
Journal of Surgical Research
Volume
123
Issue
2
Publish Date
2005
Start Page
275
End Page
283
DOI
10.1016/j.jss.2004.08.022

Type I collagen synergistically enhances PDGF-induced smooth muscle cell proliferation through pp60src-dependent crosstalk between the alpha2beta1 integrin and PDGFbeta receptor.

Smooth muscle cells (SMCs) are exposed to both platelet-derived growth factor (PDGF) and type I collagen (CNI) at the time of arterial injury. In these studies we explore the individual and combined effects of these agonists on human saphenous vein SMC proliferation. PDGF-BB produced a 5.5-fold increase in SMC DNA synthesis whereas CNI stimulated DNA synthesis to a much lesser extent (1.6-fold increase). Alternatively, we observed an 8.3-fold increase in DNA synthesis when SMCs were co-incubated with CNI and PDGF-BB. Furthermore, stimulation of SMCs with PDGF-BB produced a significant increase in ERK-2 activity whereas CNI alone had no effect. Co-incubation of SMCs with PDGF-BB and CNI resulted in ERK-2 activity that was markedly greater than that produced by PDGF-BB alone. In a similar fashion, PDGF-BB induced phosphorylation of the PDGF receptor beta (PDGFRbeta) and CNI did not, whereas concurrent agonist stimulation produced a synergistic increase in receptor activity. Blocking antibodies to the alpha2 and beta1 subunits eliminated this synergistic interaction, implicating the alpha2beta1 integrin as the mediator of this effect. Immunoprecipitation of the alpha2beta1 integrin in unstimulated SMCs followed by immunoblotting for the PDGFRbeta as well as Src family members, pp60(src), Fyn, Lyn, and Yes demonstrated coassociation of alpha2beta1 and the PDGFRbeta as well as pp60(src). Incubation of cells with CNI and/or PDGF-BB did not change the degree of association. Finally, inhibition of Src activity with SU6656 eliminated the synergistic effect of CNI on PDGF-induced PDGFRbeta phosphorylation suggesting an important role for pp60(src) in the observed receptor crosstalk. Together, these data demonstrate that CNI synergistically enhances PDGF-induced SMC proliferation through Src-dependent crosstalk between the alpha2beta1 integrin and the PDGFRbeta.

Authors
Hollenbeck, ST; Itoh, H; Louie, O; Faries, PL; Liu, B; Kent, KC
MLA Citation
Hollenbeck, ST, Itoh, H, Louie, O, Faries, PL, Liu, B, and Kent, KC. "Type I collagen synergistically enhances PDGF-induced smooth muscle cell proliferation through pp60src-dependent crosstalk between the alpha2beta1 integrin and PDGFbeta receptor." Biochem Biophys Res Commun 325.1 (December 3, 2004): 328-337.
PMID
15522237
Source
pubmed
Published In
Biochemical and Biophysical Research Communications
Volume
325
Issue
1
Publish Date
2004
Start Page
328
End Page
337
DOI
10.1016/j.bbrc.2004.10.031

Computer simulation as a component of catheter-based training.

INTRODUCTION: Computer simulation has been used in a variety of training programs, ranging from airline piloting to general surgery. In this study we evaluate the use of simulation to train novice and advanced interventionalists in catheter-based techniques. METHODS: Twenty-one physicians underwent evaluation in a simulator training program that involved placement of a carotid stent. Five participants were highly experienced in catheter-based techniques (>300 percutaneous cases), including carotid angioplasty and stenting (CAS); the remaining 16 participants were interventional novices (<5 percutaneous cases). The Procedicus VIST simulator, composed of real-time vascular imaging simulation software and a tactile interface coupled to angiographic catheters and guide wires, was used. After didactic instruction regarding CAS and use of the simulator, each participant performed a simulated CAS procedure. The participant's performance was supervised and evaluated by an expert interventionalist on the basis of 50 specific procedural steps with a maximal score of 100. Specific techniques of guide wire and catheter manipulation were subjectively assessed on a scale of 0 to 5 points based on ability. After evaluation of the initial simulated CAS procedure, each participant received a minimum of 2 hours of individualized training by the expert interventionalist, with the VIST simulator. Each participant then performed a second simulated CAS procedure, which was graded with the same scale. After completion, participants assessed the training program and its utility via survey questionnaire. RESULTS: The average simulated score for novice participants after the training program improved significantly from 17.8 +/- 15.6 to 69.8 +/- 9.8 (P < .01), time to complete simulation decreased from 44 +/- 10 minutes to 30 +/- 8 minutes (P < .01), and fluoroscopy time decreased from 31 +/- 7 minutes to 23 +/- 7 minutes ( P < .01). No statistically significant difference in score, total time, or fluoroscopy time was noted for experienced interventionalists. Improvement was noted in guide wire and catheter manipulation skills in novices. Analysis of survey data from experienced interventionalists indicated that the simulated clinical scenarios were realistic and that the simulator could be a valuable tool if clinical and tactile feedback were improved. Novices also thought the simulated training was a valuable experience, and desired further training time. CONCLUSIONS: An endovascular training program using the Procedicus VIST haptic simulator resulted in significant improvement in trainee facility with catheter-based techniques in a simulated clinical setting. Novice participants derived the greatest benefit from simulator training in a mentored program, whereas experienced interventionalists did not seem to derive significant benefit.

Authors
Dayal, R; Faries, PL; Lin, SC; Bernheim, J; Hollenbeck, S; DeRubertis, B; Trocciola, S; Rhee, J; McKinsey, J; Morrissey, NJ; Kent, KC
MLA Citation
Dayal, R, Faries, PL, Lin, SC, Bernheim, J, Hollenbeck, S, DeRubertis, B, Trocciola, S, Rhee, J, McKinsey, J, Morrissey, NJ, and Kent, KC. "Computer simulation as a component of catheter-based training." J Vasc Surg 40.6 (December 2004): 1112-1117.
PMID
15622364
Source
pubmed
Published In
Journal of Vascular Surgery
Volume
40
Issue
6
Publish Date
2004
Start Page
1112
End Page
1117
DOI
10.1016/j.jvs.2004.09.028

Rupture of excluded popliteal artery aneurysm: implications for type II endoleaks--a case report.

The fate of popliteal artery aneurysms after ligation and bypass is believed to be relatively innocuous. The patient presented in this report, however, experienced spontaneous rupture of a popliteal aneurysm 11 years after ligation and bypass. Magnetic resonance angiography was used to establish the diagnosis of rupture, which was subsequently confirmed at surgery. Intraoperative arteriography demonstrated persistent collateral arterial perfusion of the excluded popliteal aneurysm sac. The collateral arterial flow originated from the superior and inferior lateral genicular arteries. The persistent arterial perfusion resulted in growth of the aneurysm from 4.2 to 7.0 cm over the 11-year period. The ruptured aneurysm was successfully treated by direct arterial exposure and suture ligation of the collateral vessels performed from within the aneurysm sac. The development of popliteal aneurysm expansion and rupture as a result of collateral arterial perfusion suggests that persistent collateral perfusion of abdominal aortic aneurysms after endovascular repair (type II endoleak) may lead to aneurysm rupture. Therefore, close observation and intervention for aneurysm expansion to prevent rupture of the excluded aneurysm are warranted.

Authors
Mousa, A; Faries, PL; Bernheim, J; Dayal, R; DeRubertis, B; Hollenbeck, S; Henderson, P; Mahanor, EA; Kent, KC
MLA Citation
Mousa, A, Faries, PL, Bernheim, J, Dayal, R, DeRubertis, B, Hollenbeck, S, Henderson, P, Mahanor, EA, and Kent, KC. "Rupture of excluded popliteal artery aneurysm: implications for type II endoleaks--a case report." Vasc Endovascular Surg 38.6 (November 2004): 575-578.
PMID
15592640
Source
pubmed
Published In
Vascular and Endovascular Surgery
Volume
38
Issue
6
Publish Date
2004
Start Page
575
End Page
578
DOI
10.1177/153857440403800613

Characterization of retrograde collateral (type II) endoleak using a new canine model.

OBJECTIVE: The clinical significance of retrograde collateral arterial perfusion of abdominal aortic aneurysms after endovascular repair (type II endoleak) has not been completely characterized. In this study a canine model was used to analyze intra-aneurysmal pressure, thrombus histologic characteristics, endoleak patency, and radiographic appearance of type II endoleaks originating from single and multiple aneurysm side branches. METHODS: Prosthetic aneurysms with an intraluminal solid-state strain-gauge pressure transducer were created in the infrarenal aorta of 14 mongrel dogs. A single collateral side branch was reimplanted in 4 animals, multiple side branches were reimplanted in 6 animals, and no side branches were reimplanted in 4 control animals. Intra-aneurysmal and systemic pressure was measured for 60 to 90 days after creation of the type II endoleak. Endoleak patency and flow were assessed with duplex ultrasound scanning and cine-magnetic resonance angiography. Histologic analysis of the intra-aneurysmal thrombus was also performed. RESULTS: Stent-graft exclusion reduced intra-aneurysmal pressure significantly in all animals, as compared with systemic pressure (P < .001). All intra-aneurysmal pressure values are indexed to the systemic pressure, and are represented as a percentage of the simultaneously obtained systemic pressure, which has a value of 1.0. Type II endoleaks originating from multiple side branches exhibited significantly increased intra-aneurysmal systolic pressure, mean pressure, and pulse pressure, as compared with endoleaks derived from either a single side branch (systolic pressure: multiple, 0.70 +/- 0.28 vs single, 0.50 +/- 0.19; P < .001; mean pressure: multiple, 0.78 +/- 0.23 vs single, 0.59 +/- 0.22, P < .001; pulse pressure: multiple, 0.41 +/- 0.25 vs single, 0.17 +/- 0.15, P < .001) or excluded control aneurysms that had no side branches and no endoleak (systolic pressure, 0.17 +/- 0.09; mean pressure, 0.14 +/- 0.10; pulse pressure, 0.098 +/- 0.08; P < .001). Cine-magnetic resonance angiograms and duplex ultrasound scans documented persistent patency of multiple branch endoleaks up to the time of euthanasia. In contrast, single side branch endoleaks thrombosed within 3 days (P < .001). Thrombus in the aneurysm sac in close proximity to the endoleak contained intact red blood cells and limited fibrin. Thrombus distant from the endoleak demonstrated extensive fibrin deposition and degraded red blood cells. CONCLUSION: The canine model may be used to reliably measure intra-aneurysmal pressure in the presence of patent and thrombosed type II endoleaks. In this model 2 or more side branches are necessary to maintain persistent patency of type II endoleaks. These endoleaks are associated with significantly elevated intra-aneurysmal pressure, that is, 70% to 80% of systemic pressure. These results suggest that persistent type II endoleaks have clinical significance. CLINICAL RELEVANCE: Endoleaks originating from retrograde flow in the side branch vessels of the aneurysm generate significant levels of intra-aneurysmal pressure, that is, 70% to 80% of systemic pressure. At least 2 patent side branch vessels appear to be necessary to cause persistent patency of type II endoleak in the canine model. Further studies will be necessary to enable more complete characterization of retrograde endoleaks and to extend these findings to allow clinical application. However, these results suggest that persistently patent type II endoleaks are clinical significance and may require more intensive follow-up intervention.

Authors
Dayal, R; Mousa, A; Bernheim, J; Hollenbeck, S; Henderson, P; Prince, M; Gordon, R; Badimon, J; Fuster, V; Marin, ML; Kent, KC; Faries, PL
MLA Citation
Dayal, R, Mousa, A, Bernheim, J, Hollenbeck, S, Henderson, P, Prince, M, Gordon, R, Badimon, J, Fuster, V, Marin, ML, Kent, KC, and Faries, PL. "Characterization of retrograde collateral (type II) endoleak using a new canine model." J Vasc Surg 40.5 (November 2004): 985-994.
PMID
15557915
Source
pubmed
Published In
Journal of Vascular Surgery
Volume
40
Issue
5
Publish Date
2004
Start Page
985
End Page
994
DOI
10.1016/j.jvs.2004.07.049

Continuity in the treatment of carotid artery disease: results of a carotid stenting program initiated by vascular surgeons.

The treatment of carotid artery stenosis currently constitutes a major component of vascular surgical practice. Carotid angioplasty and stenting (CAS), however, is mainly performed by nonvascular surgeon interventionalists with cerebral protection devices available only through investigational protocols. This study reports the initial results of a CAS program initiated and performed by vascular surgeons using commercially available cerebral protection devices. Fifty-seven patients were enrolled in the study over a 14-month period. All patients were at high risk for conventional endarterectomy (7 resentosis, 4 irradiation, and 46 medically high-risk ASA III). Mean age was 75.7 years (range, 45-93 years). High-grade stenosis of the carotid artery was present in all cases (mean stenosis, 85%; range, 80-99%). Twenty-four percent of patients were symptomatic. Cerebral protection was performed with an occlusion balloon-wire in 32 cases and with a filter-wire device in 24; no cerebral protection was used in 1 patient with restenosis after endarterectomy. Initially in the study, atropine was administered selectively for the development of bradycardia. Currently atropine is administered routinely prior to the initial balloon angioplasty of the carotid bulb. Clopidogrel (75 mg/day) was administered for 5 days prior to CAS and for 30 days after CAS. All 57 patients underwent successful dilatation of their carotid stenoses without occlusion or dissection. Ten of 32 patients in whom balloon occlusion was used for cerebral protection exhibited transient evidence of cerebral ischemia during protection balloon occlusion. These symptoms resolved completely without permanent neurological deficit in all cases. Development of bradycardia with a heart rate <50 bpm was significantly reduced by routine administration of atropine prior to the initial dilatation within the carotid bulb (p = 0.01). Mean hospital length of stay was 1.33 days (range, 1-5 days). There were two periprocedure myocardial infarctions, two postprocedure transient ischemic attacks, and one reversible ischemic neurologic deficit. There was no 30-day mortality. There have been no instances of hemodynamically significant restenosis during a mean follow-up period of 5.4 months. From these results we have concluded that CAS can be performed effectively and safely using commercially available cerebral protection devices. A program initiated and performed exclusively by vascular surgeons is effective and should be the standard model used in the endovascular treatment of carotid artery stenosis.

Authors
Faries, PL; Dayal, R; Clair, DG; Bernheim, J; Morrissey, N; Trociola, S; Hollenbeck, S; Mousa, A; Mahanor, E; Nowygrod, R; Bush, H; McKinsey, J; Kent, KC
MLA Citation
Faries, PL, Dayal, R, Clair, DG, Bernheim, J, Morrissey, N, Trociola, S, Hollenbeck, S, Mousa, A, Mahanor, E, Nowygrod, R, Bush, H, McKinsey, J, and Kent, KC. "Continuity in the treatment of carotid artery disease: results of a carotid stenting program initiated by vascular surgeons." Ann Vasc Surg 18.6 (November 2004): 669-676.
PMID
15599624
Source
pubmed
Published In
Annals of Vascular Surgery
Volume
18
Issue
6
Publish Date
2004
Start Page
669
End Page
676
DOI
10.1007/s10016-004-0101-y

Factors associated with residual breast cancer after re-excision for close or positive margins.

BACKGROUND: Successful breast conservation surgery (BCS) requires complete tumor excision. Margin status of the initial specimen determines the need for additional surgery. We explored factors associated with residual cancer (RC) upon follow-up surgery in patients with close, positive, or undetermined margins following BCS. METHODS: A retrospective analysis of 276 patients with initial close, positive, or undetermined margins who underwent re-excision (RE) or mastectomy was conducted. All initial excisions were intended as definitive procedures. Chi-square analysis was used to identify factors that may predict RC. RESULTS: Of 276 patients, 87 had close, 168 had positive, and 21 had undetermined margins on initial excision. Of this group, 63% (175/276) had RC upon RE or mastectomy. Of positive-margin patients, 68% had RC, compared with 53% of close-margin and 67% of undetermined-margin patients (P = .006). Tumors >/=2 cm were more often associated with RC than smaller tumors (70.8% vs. 56.5%; P = .07). This association was strongest in positive-margin patients (P = .04). High tumor grade was associated with RC in all groups. RC linearly increased with the number of involved margins (P = .02). Specimen inking with multiple colors was associated with decreased risk of RC (P = .004). CONCLUSIONS: Over half of patients with involved or undetermined margins had RC upon RE or mastectomy. Positive and undetermined margins were more often associated with RC than close margins. Larger tumor size was associated with RC in patients with positive. Increasing tumor grade suggests a greater chance of detecting RC in all groups. Multiple involved margins led to a greater risk of RC.

Authors
Cellini, C; Hollenbeck, ST; Christos, P; Martins, D; Carson, J; Kemper, S; Lavigne, E; Chan, E; Simmons, R
MLA Citation
Cellini, C, Hollenbeck, ST, Christos, P, Martins, D, Carson, J, Kemper, S, Lavigne, E, Chan, E, and Simmons, R. "Factors associated with residual breast cancer after re-excision for close or positive margins." Ann Surg Oncol 11.10 (October 2004): 915-920.
PMID
15383425
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
11
Issue
10
Publish Date
2004
Start Page
915
End Page
920
DOI
10.1245/ASO.2004.12.037

Two-year follow-up of areola-sparing mastectomy with immediate reconstruction.

OBJECTIVE: Areola-sparing mastectomy (ASM) is defined as resecting the nipple and any existing surgical biopsy scar, removing all breast parenchyma, and leaving a natural envelope of skin (including the areola), which improves the aesthetic result of immediate reconstruction. We previously demonstrated a <1% incidence of malignant involvement of the areola in a retrospective mastectomy series. Subsequently, we performed ASM on selected patients undergoing mastectomy. We report here our results from an ongoing study of ASM at our institution. METHODS: During a 20-month period, 17 ASMs with immediate reconstruction were performed on 12 patients. Patients were followed-up prospectively by the surgical oncologist for complications and recurrence. RESULTS: ASM was performed for breast cancer prophylaxis (n = 10), ductal carcinoma in situ (DCIS) (n = 4), and <2-cm peripheral infiltrating carcinoma (n = 3). The mean patient age was 47.7 years (range 37 to 61). Thirteen patients were reconstructed with tissue expanders and 4 with pedicle transverse rectus abdominus myocutaneous flaps. Ten patients underwent sentinel lymph node biopsy. None of the ten patients showed sentinel lymph node metastasis. Two patients with DCIS and microinvasion underwent subareolar touch-prep cytology, both of which were negative for malignancy. All mastectomy specimens had negative histologic margins. No patient received chemotherapy or radiation therapy. One postoperative consisted of a localized wound infection that resolved with oral antibiotics. At a median follow-up of 24 months (range 11 to 28), there were no instances of local or distant recurrence. CONCLUSIONS: Overall, we found that ASM with immediate reconstruction provides excellent aesthetic results with infrequent complications. Furthermore, in this small series we showed no recurrence at 2 years. We continue to offer ASM for selected patients including those desiring surgical breast cancer prophylaxis as well as those with DCIS or small peripheral infiltrating ductal carcinoma.

Authors
Simmons, RM; Hollenbeck, ST; Latrenta, GS
MLA Citation
Simmons, RM, Hollenbeck, ST, and Latrenta, GS. "Two-year follow-up of areola-sparing mastectomy with immediate reconstruction." Am J Surg 188.4 (October 2004): 403-406.
PMID
15474435
Source
pubmed
Published In
The American Journal of Surgery
Volume
188
Issue
4
Publish Date
2004
Start Page
403
End Page
406
DOI
10.1016/j.amjsurg.2004.07.001

Experimental analysis of transvenous ultrasonography in localizing and grading renal artery stenosis.

This study evaluated the potential for transvenous ultrasonography to assess renal artery stenosis (RAS), the most common correctable cause of hypertension in the United States. We developed a porcine model for studying RAS using TVUS. An endovascular ultrasound probe was placed into the inferior vena cava and renal veins to image renal arteries in which stenoses had been surgically created in varied locations and to varied degrees. TVUS was then used to identify and assess these stenotic lesions. The accuracy of TVUS for determining the degree and location of the stenoses was then determined using contrast arteriography as the standard. When compared with arteriography, TVUS identified and properly located all six lesions and correctly quantified the degree of stenosis in five of the six lesions. TVUS is an effective means of assessing the presence, degree, and location of stenotic lesions of the renal arteries in this animal model. Study of this method in humans may be warranted.

Authors
Mousa, A; Bernheim, J; Dayal, R; Deitch, J; Henderson, P; Hollenbeck, S; DeRubertis, B; Mahanor, EA; Kent, KC; Faries, PL
MLA Citation
Mousa, A, Bernheim, J, Dayal, R, Deitch, J, Henderson, P, Hollenbeck, S, DeRubertis, B, Mahanor, EA, Kent, KC, and Faries, PL. "Experimental analysis of transvenous ultrasonography in localizing and grading renal artery stenosis." Vascular 12.5 (September 2004): 301-306.
PMID
15765911
Source
pubmed
Published In
Vascular
Volume
12
Issue
5
Publish Date
2004
Start Page
301
End Page
306
DOI
10.1258/rsmvasc.12.5.301

Intracellular calcium transients are necessary for platelet-derived growth factor but not extracellular matrix protein-induced vascular smooth muscle cell migration.

PURPOSE: Vascular smooth muscle cell (SMC) migration is a critical component of the hyperplastic response that leads to recurrent stenosis after interventions to treat arterial occlusive disease. We investigated the relationship between intracellular calcium ([Ca(2+)](i)) and migration of vascular SMCs in response to platelet-derived growth factor (PDGF) and extracellular matrix (ECM) proteins. METHODS: Human saphenous vein SMCs were used for all experiments. SMC migration in response to agonists was measured with a microchemotaxis assay. A standard fluorimetric assay was used to assess changes in [Ca(2+)](i) in response to the various combinations of growth factors and ECM proteins. RESULTS: The calcium ionophore A23187 produced a rapid rise in [Ca(2+)](i) and a corresponding 60% increase in SMC migration, whereas chelation of [Ca(2+)](i) with BAPTA (1,2-bis [aminophenoxy] ethane-N,N,N',N'-tetraacetic acid) produced a fivefold decrease in PDGF-induced chemotaxis, suggesting that [Ca(2+)](i) is both sufficient and necessary for SMC migration. Stimulation of SMCs with PDGF produced an early peak followed by a late plateau in [Ca(2+)](i). To establish a relationship between temporal fluctuations in [Ca(2+)](i) and SMC migration, SMCs were pretreated with caffeine and ryanadine, which eliminated the initial peak but not the late plateau in [Ca(2+)](i), and had no effect on chemotaxis in response to PDGF. Incubation of SMCs with nickel chloride eliminated the late plateau, but had no effect on the initial peak in [Ca(2+)](i), and reduced PDGF-stimulated migration by fivefold. We then evaluated the role of calcium in SMC migration induced by ECM proteins such as laminin, fibronectin, and collagen types I and IV. All four matrix proteins stimulated SMC migration, but none produced an elevation in [Ca(2+)](i). Moreover, preincubation of SMCs with caffeine and ryanadine or nickel chloride had no effect on ECM protein-induced chemotaxis. CONCLUSION: [Ca(2+)](i) transients are necessary for PDGF but not ECM protein-induced SMC chemotaxis. Moreover, the ability of PDGF to stimulate vascular SMC migration appears dependent on influx of extracellular calcium through membrane channels. CLINICAL RELEVANCE: Recurrent stenosis after angioplasty or surgical bypass remains a significant challenge in treating vascular occlusive disease. In addition to growth factors, extracellular matrix (ECM) proteins may be potent agonists of this process. In this study we show that the influx of extracellular calcium is an important mechanism for platelet-derived growth factor-induced smooth muscle cell migration but not ECM-induced migration. Of note, in clinical trials calcium channel blockers failed to inhibit recurrent stenosis. Our data provide mechanistic insight to help explain this negative outcome in that therapies designed to inhibit restenosis depend on the effects of both growth factors and ECM proteins.

Authors
Hollenbeck, ST; Nelson, PR; Yamamura, S; Faries, PL; Liu, B; Kent, KC
MLA Citation
Hollenbeck, ST, Nelson, PR, Yamamura, S, Faries, PL, Liu, B, and Kent, KC. "Intracellular calcium transients are necessary for platelet-derived growth factor but not extracellular matrix protein-induced vascular smooth muscle cell migration." J Vasc Surg 40.2 (August 2004): 351-358.
PMID
15297833
Source
pubmed
Published In
Journal of Vascular Surgery
Volume
40
Issue
2
Publish Date
2004
Start Page
351
End Page
358
DOI
10.1016/j.jvs.2004.03.047

Stem cell factor and c-kit are expressed by and may affect vascular SMCs through an autocrine pathway.

INTRODUCTION: Stem cell factor (SCF) is a membrane-bound and soluble growth factor that activates the c-kit tyrosine kinase receptor. Given the similarities between c-kit and platelet-derived growth factor (PDGF) receptors, we hypothesized that similar to PDGF, SCF/c-kit signaling may play a role in smooth muscle cell (SMC) function and thus the development of intimal hyperplasia. MATERIALS AND METHODS: Human saphenous vein SMCs were harvested from veins procured at the time of bypass grafting. Carotid arteries from rats that were balloon injured (n = 12) at variable time points were compared to sham-operated controls (n = 3). Expression of SCF and c-kit was measured by immunohistochemistry (IHC) and Western blotting. RESULTS: Western blotting revealed that human SMCs express membrane-bound SCF. In separate experiments, we found that this growth factor undergoes proteolytic cleavage to its soluble form following exposure to matrix metalloproteinase-9 (MMP-9), a ubiquitous MMP released at the time of arterial injury. We next evaluated in human SMCs, expression of the SCF receptor, c-kit. Western blotting of human SMC lysates revealed minor but consistent expression of c-kit. IHC demonstrated c-kit expression to be localized to the media. To determine if c-kit is up-regulated during the development of intimal hyperplasia, we evaluated expression of this receptor in a rat carotid balloon injury model. Quantification of IHC staining on injured vessels revealed that c-kit expression within the media was significantly increased at 3, 7, 14, and 28 days following injury (28.1, 30.8, 16, and 10.4% increase over sham controls, respectively, P < 0.05). Furthermore, c-kit expression was prominent within the neointima and maximal at 7 days (53.4 +/- 7.8% of area c-kit positive). CONCLUSION: Human vascular SMCs express the growth factor SCF and its receptor, c-kit. SCF is released from its membrane-bound form via MMP-9. This finding and the dramatic increase in c-kit expression observed in the rat carotid artery after balloon injury suggests SCF/c-kit signaling may affect SMC function via an autocrine pathway.

Authors
Hollenbeck, ST; Sakakibara, K; Faries, PL; Workhu, B; Liu, B; Kent, KC
MLA Citation
Hollenbeck, ST, Sakakibara, K, Faries, PL, Workhu, B, Liu, B, and Kent, KC. "Stem cell factor and c-kit are expressed by and may affect vascular SMCs through an autocrine pathway." J Surg Res 120.2 (August 2004): 288-294.
PMID
15234225
Source
pubmed
Published In
Journal of Surgical Research
Volume
120
Issue
2
Publish Date
2004
Start Page
288
End Page
294
DOI
10.1016/j.jss.2004.01.005

Minimally invasive operation for breast cancer.

Authors
Singletary, SE; Dowlatshahi, K; Dooley, W; Hollenbeck, ST; Kern, K; Kuerer, H; Newman, LA; Simmons, R; Whitworth, P
MLA Citation
Singletary, SE, Dowlatshahi, K, Dooley, W, Hollenbeck, ST, Kern, K, Kuerer, H, Newman, LA, Simmons, R, and Whitworth, P. "Minimally invasive operation for breast cancer." Curr Probl Surg 41.4 (April 2004): 394-447. (Review)
PMID
15114298
Source
pubmed
Published In
Current Problems in Surgery
Volume
41
Issue
4
Publish Date
2004
Start Page
394
End Page
447
DOI
10.1016/j.cpsurg.2003.12.002

Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment.

BACKGROUND: Accurate assessment of tumor size for patients with breast cancer undergoing re-excision following breast-conserving therapy is important for appropriate staging and adjuvant treatment. We investigated the accuracy of additive vs. nonadditive size assessment in determining final tumor stage. METHODS: Patients with infiltrating carcinoma in the initial excision and in at least one additional re-excision (re-excision positive; n = 89) had tumor size assessed with additive and nonadditive techniques. This group was compared with patients undergoing re-excision but without identifiable residual carcinoma (re-excision negative; n = 105) regarding rates of lymph node (LN) metastasis. RESULTS: The re-excision positive patients had a different median final tumor size depending on the size assessment technique used (nonadditive: 1.8 cm; additive: 3.0 cm; P <.0001). Both groups of patients had a median tumor size consistent with T1c staging in nonadditive size assessment. However, re-excision positive patients had a significantly higher incidence of LN metastasis (P <.05) than did re-excision negative patients. Both groups were then separated into T1 and T2 stages and the LN metastasis rates were assessed. Compared with nonadditive size assessment, additive size assessment distributed re-excision positive patients into T stages whereby the LN metastasis rates more closely approximated those of re-excision negative patients (T1, 3% vs. 6% difference; T2, 4% vs. 13% difference). CONCLUSIONS: With regard to LN metastasis, staging for patients with residual invasive carcinoma in re-excision specimens is more accurate with additive tumor size assessment.

Authors
Hollenbeck, ST; Cellini, C; Christos, P; Varnado-Rhodes, Y; Martins, D; Nussbaum, M; Osborne, MP; Simmons, RM
MLA Citation
Hollenbeck, ST, Cellini, C, Christos, P, Varnado-Rhodes, Y, Martins, D, Nussbaum, M, Osborne, MP, and Simmons, RM. "Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment." Ann Surg Oncol 11.1 (January 2004): 59-64.
PMID
14699035
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
11
Issue
1
Publish Date
2004
Start Page
59
End Page
64

Screening for abdominal aortic aneurysm: a consensus statement.

Authors
Kent, KC; Zwolak, RM; Jaff, MR; Hollenbeck, ST; Thompson, RW; Schermerhorn, ML; Sicard, GA; Riles, TS; Cronenwett, JL; Society for Vascular Surgery, ; American Association of Vascular Surgery, ; Society for Vascular Medicine and Biology,
MLA Citation
Kent, KC, Zwolak, RM, Jaff, MR, Hollenbeck, ST, Thompson, RW, Schermerhorn, ML, Sicard, GA, Riles, TS, Cronenwett, JL, Society for Vascular Surgery, , American Association of Vascular Surgery, , and Society for Vascular Medicine and Biology, . "Screening for abdominal aortic aneurysm: a consensus statement." J Vasc Surg 39.1 (January 2004): 267-269.
PMID
14718853
Source
pubmed
Published In
Journal of Vascular Surgery
Volume
39
Issue
1
Publish Date
2004
Start Page
267
End Page
269
DOI
10.1016/j.jvs.2003.08.019

Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment

Authors
Hollenbeck, ST; Cellini, C; Christos, P; Breslin, TM
MLA Citation
Hollenbeck, ST, Cellini, C, Christos, P, and Breslin, TM. "Breast cancer in patients with residual invasive carcinoma is more accurately staged with additive tumor size assessment." Breast Diseases 15.3 (2004): 289--.
Source
scival
Published In
Breast Diseases
Volume
15
Issue
3
Publish Date
2004
Start Page
289-

Areola-sparing mastectomy with immediate breast reconstruction

Authors
Simmons, RM; Hollenbeck, ST; Latrenta, GS; Laronga, C
MLA Citation
Simmons, RM, Hollenbeck, ST, Latrenta, GS, and Laronga, C. "Areola-sparing mastectomy with immediate breast reconstruction." Breast Diseases 15.3 (2004): 330--.
Source
scival
Published In
Breast Diseases
Volume
15
Issue
3
Publish Date
2004
Start Page
330-

Regarding "screening for abdominal aortic aneurysm: A consensus statement" [1] (multiple letters)

Authors
Koelemay, M; Hollenbeck, ST; Kent, KC
MLA Citation
Koelemay, M, Hollenbeck, ST, and Kent, KC. "Regarding "screening for abdominal aortic aneurysm: A consensus statement" [1] (multiple letters)." Journal of Vascular Surgery 40.2 (2004): 402-403.
PMID
15303272
Source
scival
Published In
Journal of Vascular Surgery
Volume
40
Issue
2
Publish Date
2004
Start Page
402
End Page
403
DOI
10.1016/j.jvs.2004.03.052

In brief

Authors
Singletary, SE; Dowlatshahi, K; Dooley, W; Hollenbeck, ST; Kern, K; Kuerer, H; Newman, LA; Simmons, R; Whitworth, P
MLA Citation
Singletary, SE, Dowlatshahi, K, Dooley, W, Hollenbeck, ST, Kern, K, Kuerer, H, Newman, LA, Simmons, R, and Whitworth, P. "In brief." Current Problems in Surgery 41.4 (2004): 386-390.
Source
scival
Published In
Current Problems in Surgery
Volume
41
Issue
4
Publish Date
2004
Start Page
386
End Page
390
DOI
10.1016/j.cpsurg.2003.12.001

Areola-sparing mastectomy with immediate breast reconstruction.

Skin-sparing mastectomy with immediate breast reconstruction is a proved option for patients with early-stage breast cancer requiring mastectomy. Based on the authors' recent pathologic analysis of mastectomy specimens showing less than 1% malignant involvement of the areola, they have begun to perform areola-sparing mastectomies (ASMs) on a select group of patients. They report their results from an ongoing study of ASM at their institution. During a 20-month period, 17 ASMs with immediate reconstruction were performed on 12 patients. Mastectomy was performed for breast cancer prophylaxis (n = 10), ductal carcinoma in situ (n = 4), and less than 2 cm of peripheral infiltrating carcinoma (n = 3). The most frequent incision performed was intraareola (n = 13). Thirteen patients were reconstructed with tissue expanders and 4 with pedicled transverse rectus abdominis musculocutaneous flaps. There was 1 postoperative complication, which consisted of a localized wound infection. Overall the authors found that ASM with immediate reconstruction provides excellent aesthetic results with infrequent complications.

Authors
Simmons, RM; Hollenbeck, ST; Latrenta, GS
MLA Citation
Simmons, RM, Hollenbeck, ST, and Latrenta, GS. "Areola-sparing mastectomy with immediate breast reconstruction." Ann Plast Surg 51.6 (December 2003): 547-551.
PMID
14646645
Source
pubmed
Published In
Annals of Plastic Surgery
Volume
51
Issue
6
Publish Date
2003
Start Page
547
End Page
551
DOI
10.1097/01.sap.0000095659.93306.48

Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma.

BACKGROUND: The inferior vena cava (IVC) is a rare site for primary soft tissue sarcoma. There are limited data in the literature regarding surgical management of the IVC and longterm survival of these patients. STUDY DESIGN: From 1982 to 2002, a total of 25 patients with primary IVC leiomyosarcoma was treated as inpatients and followed in a prospective database at Memorial Sloan-Kettering. Presenting symptoms, tumor characteristics, operative management, postoperative morbidity, and disease-specific survival were assessed for each patient. RESULTS: The 25 patients with primary IVC leiomyosarcoma accounted for 0.5% of all adult patients with soft tissue sarcoma treated during this time. The median patient age was 56 years (range 41 to 79 years). The three most common presenting symptoms were abdominal pain (52%), distention (20%), and deep venous thrombosis (12%). Of the patients, 21 (84%) underwent complete resection of the tumor. The IVC was managed in one of three ways: ligation (n = 11), primary/patch repair (n = 8), and expanded polytetrafluoroethylene tube grafting (n = 2). Among patients undergoing IVC ligation and primary/patch repair (n = 19), 11% had severe postoperative edema and none had worsening renal function. Local recurrence occurred in 33% of patients and distant recurrence occurred in 48% of patients. Patients undergoing complete resection had 3-year and 5-year disease-specific survival rates of 76% and 33%, respectively. There were no 3-year survivors among patients with incomplete resections. CONCLUSIONS: Complete resection of primary IVC leiomyosarcomas is feasible and associated with improved survival. The IVC can be managed by primary repair or ligation with a low risk of severe postoperative edema.

Authors
Hollenbeck, ST; Grobmyer, SR; Kent, KC; Brennan, MF
MLA Citation
Hollenbeck, ST, Grobmyer, SR, Kent, KC, and Brennan, MF. "Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma." J Am Coll Surg 197.4 (October 2003): 575-579.
PMID
14522326
Source
pubmed
Published In
Journal of The American College of Surgeons
Volume
197
Issue
4
Publish Date
2003
Start Page
575
End Page
579
DOI
10.1016/S1072-7515(03)00433-2

Selecting stent grafts for the endovascular treatment of abdominal aortic aneurysms.

Minimally invasive endovascular techniques for the treatment of abdominal aortic aneurysms (AAA) have significantly reduced the morbidity of these procedures as compared with standard surgical repair. In addition, patients with extensive comorbid medical illnesses in whom standard operative repair is contra-indicated, may be successfully treated using endovascular means. A variety of endovascular stent grafts are currently being used clinically for endovascular AAA repair. The characteristics of these stent grafts vary significantly. In selecting the specific stent graft to be used for endovascular AAA repair, these specific characteristics must be considered particularly with regard to the individual patient's anatomic and physiologic characteristics. In addition, the indications for use of endovascular grafts as compared to standard open surgery have not yet been fully defined. Endovascular stent grafts in current use have limitations and their use must be tempered accordingly, until their long-term effectiveness is more completely evaluated. This article describes the general principles of use for endovascular devices for the repair of AAA. It details the features and results for the devices in current use and highlights the factors that influence the selection of specific stent graft types.

Authors
Faries, PL; Bernheim, J; Kilaru, S; Hollenbeck, S; Clair, D; Kent, KC
MLA Citation
Faries, PL, Bernheim, J, Kilaru, S, Hollenbeck, S, Clair, D, and Kent, KC. "Selecting stent grafts for the endovascular treatment of abdominal aortic aneurysms." J Cardiovasc Surg (Torino) 44.4 (August 2003): 511-518. (Review)
PMID
14627223
Source
pubmed
Published In
The Journal of cardiovascular surgery
Volume
44
Issue
4
Publish Date
2003
Start Page
511
End Page
518

JACS CME-1 Featured Articles, Volume 197, October 2003

Authors
Hollenbeck, ST; Grobmyer, SR; Kent, KC; Brennan, MF; Vles, WJ; Veen, EJ; Roukema, JA
MLA Citation
Hollenbeck, ST, Grobmyer, SR, Kent, KC, Brennan, MF, Vles, WJ, Veen, EJ, and Roukema, JA. "JACS CME-1 Featured Articles, Volume 197, October 2003." Journal of the American College of Surgeons 197.4 (2003): 707-709.
Source
scival
Published In
Journal of the American College of Surgeons
Volume
197
Issue
4
Publish Date
2003
Start Page
707
End Page
709
DOI
10.1016/j.jamcollsurg.2003.08.002

Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer.

BACKGROUND: This study was designed to compare the postoperative morbidity and socioeconomic impact of sentinel lymph node biopsy (SLNB) with axillary lymph node dissection (ALND) in patients with early stage breast cancer. METHODS: A prospective, nonrandomized, controlled study was designed to include patients who underwent breast conservation surgery and SLNB +/- ALND. Group A consisted of patients who had a negative SLNB and did not go on to completion ALND. Group B consisted of patients who underwent a SLNB followed by a completion ALND because either (1) their sentinel node contained cancer or (2) they were within the validation phase of our institution's sentinel lymph node protocol. Patients were evaluated with a questionnaire and underwent a standardized physical examination to determine arm circumference. RESULTS: Data were obtained from 96 patients with a mean follow-up period of 15 months (range 8 to 29). Significant differences were seen in subjective measurements of arm complaints and arm numbness (P <0.001), with fewer complaints reported in group A. The difference in mid-bicep and antecubital fossa circumferences was significant when comparing the ratio of the procedure arm with the nonprocedure arm and when subtracting the nonprocedure arm from the procedure arm (P <0.003 and P <0.016, respectively) in favor of group A. Axillary surgery was performed as an outpatient procedure in 88% of group A patients, compared with 15% in group B (P <0.001). Furthermore, 71% of group A patients returned to "normal activity" in less than 4 days, in comparison with 7% of group B (P <0.001). CONCLUSIONS: SLNB results in less postoperative morbidity in terms of subjective arm complaints and mid-arm swelling. Expeditious return to work or normal activity after SLNB has potentially significant socioeconomic consequences.

Authors
Burak, WE; Hollenbeck, ST; Zervos, EE; Hock, KL; Kemp, LC; Young, DC
MLA Citation
Burak, WE, Hollenbeck, ST, Zervos, EE, Hock, KL, Kemp, LC, and Young, DC. "Sentinel lymph node biopsy results in less postoperative morbidity compared with axillary lymph node dissection for breast cancer." Am J Surg 183.1 (January 2002): 23-27.
PMID
11869698
Source
pubmed
Published In
The American Journal of Surgery
Volume
183
Issue
1
Publish Date
2002
Start Page
23
End Page
27
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