Julia Visgauss

Overview:

I specialize in pelvic resection and reconstructive surgery.  I have a special interest in researching and understanding how people’s gait is affected by pelvic surgery, and how we can improve reconstructive techniques in order to optimally balance restoration of anatomy and function.

 

My translational research is focused on understanding what drives disease progression and treatment resistance in sarcoma.  Currently my focus is in chondrosarcoma, a subtype of bone sarcoma that produces cartilage, and has extremely limited treatment options beyond surgery.  My lab is working to uncover the cellular derangements and immune interactions that allow these cells to metastasize, and develop targeted systemic therapies to improve patient outcomes.

 

Positions:

Assistant Professor of Orthopaedic Surgery

Orthopaedic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2012

Johns Hopkins University School of Medicine

Resident, Orthopaedic Surgery

Duke University School of Medicine

Grants:

Genetic Profiling of Chondrosarcoma: A Clinical and Histologic Correlative Study

Awarded By
Piedmont Orthopedic Foundation
Role
Principal Investigator
Start Date
End Date

Investigating the role of LCP1 in metastatic progression of chondrosarcoma

Administered By
Orthopaedic Surgery
Awarded By
The Musculoskeletal Tumor Society
Role
Principal Investigator
Start Date
End Date

Publications:

Regional anesthesia is associated with improved metastasis free survival after surgical resection of bone sarcomas.

There is increasing evidence that perioperative factors, including type of anesthesia, may be an important consideration regarding oncological disease progression. Previous studies have suggested that regional anesthesia can improve oncological outcomes by reducing the surgical stress response that occurs during tumor resection surgery and that may promote metastatic progression. The purpose of this study is to provide the first robust investigation of the impact of adding regional anesthesia to general anesthesia on oncological outcomes following sarcoma resection. One hundred patients with bone sarcoma were retrospectively analyzed in this study. After adjusting for confounding variables such as age and grade of the tumor, patients with bone sarcoma receiving regional anesthesia in addition to general anesthesia during resection had improved metastasis free survival (multivariate hazard ratio of 0.47 and p = 0.034). Future studies are needed to confer the beneficial effect of regional anesthesia, and to further investigate the potential mechanism. Clinical significance: The results from this study provide evidence that regional anesthesia may be advantageous in the setting of bone sarcoma resection surgery, reducing pain while also improving oncological outcomes and should be considered when clinically appropriate.
Authors
Abar, B; Gao, J; Fletcher, AN; Sachs, E; Wong, AH; Lazarides, AL; Okafor, C; Brigman, BE; Eward, WC; Jung, S-H; Kumar, AH; Visgauss, JD
MLA Citation
Abar, Bijan, et al. “Regional anesthesia is associated with improved metastasis free survival after surgical resection of bone sarcomas.J Orthop Res, May 2023. Pubmed, doi:10.1002/jor.25597.
URI
https://scholars.duke.edu/individual/pub1575442
PMID
37151123
Source
pubmed
Published In
J Orthop Res
Published Date
DOI
10.1002/jor.25597

Giant cell tumor of bone in the pediatric population: a retrospective study highlighting cases of metaphyseal only location and increased local recurrence rates in skeletally immature patients.

OBJECTIVE: To describe the presentation of giant cell tumors (GCT) of the bone in the pediatric population to (1) improve the differential diagnosis of pediatric bone tumors and (2) identify the origin of GCT. Understanding the origin of bone tumors assists in establishing appropriate diagnoses and recommending treatment options. This is particularly important in children, where evaluating the need for invasive procedures is balanced with the desire to avoid overtreatment. GCT have historically been considered epiphyseal lesions with potential metaphyseal extension. Therefore, GCT may be inappropriately excluded from the differential diagnosis of metaphyseal lesions in the skeletally immature. MATERIALS AND METHODS: We identified 14 patients from 1981 to 2021 at a single institution who had histologic confirmation of GCT and were less than 18 years old at diagnosis. Patient characteristics, tumor location, surgical treatment, and local recurrence rates were collected. RESULTS AND CONCLUSIONS: Ten (71%) patients were female. Eleven (78.6%) were epiphysiometaphyseal (1 epiphyseal, 4 metaphyseal, 6 epiphysiometaphyseal). Five patients had an open adjacent physis, of which three (60%) had tumors confined solely to the metaphysis. Of the five patients with open physis, four (80%) developed local recurrence while only one patient (11%) with a closed physis had local recurrence (p value = 0.0023). Our results illustrate that for the skeletally immature, GCT can (and in our results more commonly did) occur in the metaphyseal location. These findings suggest that GCT should be included in the differential diagnosis of primary metaphyseal-only lesions in the skeletally immature.
Authors
Tabarestani, TQ; Levine, N; Sachs, E; Scholl, A; Colglazier, R; French, R; Al-Rohil, R; Brigman, B; Eward, W; Visgauss, J
URI
https://scholars.duke.edu/individual/pub1575443
PMID
37154873
Source
pubmed
Published In
Skeletal Radiol
Published Date
DOI
10.1007/s00256-023-04359-8

Hydropneumodissection-Assisted Cryoablation of Recurrent Sarcoma Adjacent to the Sciatic Nerve as a Limb-Sparing Alternative to Hindquarter Amputation.

MLA Citation
Sag, Alan A., et al. “Hydropneumodissection-Assisted Cryoablation of Recurrent Sarcoma Adjacent to the Sciatic Nerve as a Limb-Sparing Alternative to Hindquarter Amputation.J Vasc Interv Radiol, vol. 34, no. 5, May 2023, pp. 923-926.e1. Pubmed, doi:10.1016/j.jvir.2022.12.469.
URI
https://scholars.duke.edu/individual/pub1561049
PMID
36584809
Source
pubmed
Published In
J Vasc Interv Radiol
Volume
34
Published Date
Start Page
923
End Page
926.e1
DOI
10.1016/j.jvir.2022.12.469

Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration.

In orthopedic oncology, the implant of a megaprosthetic device is standard of care after large-scale tumor resection involving segmental removal of bone. Infection remains the leading cause of implant failure, often resulting in major morbidity. Perioperative antibiotic practices for megaprosthetic reconstructions are not standardized and are based on guidelines for conventional joint arthroplasties. This study aims to evaluate the efficacy of current prophylactic strategies for megaprosthetic reconstructions. We conducted a retrospective review of megaprosthetic reconstructions performed at Duke University from 2001 to 2021. Logistic regression with GEE was used to assess whether a prolonged course of postoperative antibiotics is associated with infection risk. We assessed the microbial profile and corresponding susceptibilities of megaprosthetic infections through record review. Additionally, we designed a pharmacokinetic subgroup analysis using liquid chromatography-tandem mass spectrometry to quantify antibiotic concentrations in surgical tissue. Wilcoxon rank-sum tests were used to correlate tissue concentrations with infection risk. Out of 184 cases, 23 (12.5%) developed infection within 1 year. Extended postoperative antibiotics were not significantly associated with infection risk (P = 0.23). Among 18 culture-positive cases, 4 (22.2%) were caused by cefazolin-susceptible organisms. Median bone and muscle concentrations of cefazolin among cases that developed postoperative infection (0.065 ng/mL and 0.2 ng/mL, respectively) were significantly lower than those of cases that did not (0.42 ng/mL and 1.95 ng/mL, P < 0.01 and P = 0.03). This study is the first to comprehensively assess aspects of perioperative prophylaxis for megaprosthetic reconstructions. Extending postoperative antibiotics did not reduce infection risk. We detected a high frequency of cefazolin nonsusceptible organisms among postoperative infections. Additionally, intraoperative antibiotic tissue concentrations may be predictive of later infection. Future studies ought to examine optimal drug choices and dosing strategies.
Authors
Byers, IS; Turner, NA; Levine, NL; Lazarides, AL; Evans, DR; Spasojevic, I; Fan, P; Jung, S-H; Gao, J; Visgauss, JD; Brigman, BE; Eward, WC
MLA Citation
Byers, Isabelle S., et al. “Antibiotic Prophylaxis for Megaprosthetic Reconstructions: Drug and Dosing May Matter More than Duration.Antimicrob Agents Chemother, vol. 66, no. 10, Oct. 2022, p. e0014022. Pubmed, doi:10.1128/aac.00140-22.
URI
https://scholars.duke.edu/individual/pub1553045
PMID
36165615
Source
pubmed
Published In
Antimicrob Agents Chemother
Volume
66
Published Date
Start Page
e0014022
DOI
10.1128/aac.00140-22

Juxtametallic Bipolar Bone Radiofrequency Ablation: Thermal Monitoring in an Ex-Vivo Model with Specimen MRI and Histopathologic Correlation.

PURPOSE: To measure the ablation zone temperature and nontarget tissue temperature during radiofrequency (RF) ablation in bone containing metal instrumentation versus no metal instrumentation (control group). MATERIALS AND METHODS: Ex vivo experiments were performed on 15 swine vertebrae (control, n = 5; titanium screw, n = 5; stainless steel screw, n = 5). Screws and RF ablation probe were inserted identically under fluoroscopy. During RF ablation (3 W, 5 minutes), temperature was measured 10 mm from RF ablation centerpoint and in muscle contacting the screw. Magnetic resonance (MR) imaging, gross pathologic, and histopathologic analyses were performed on 1 specimen from each group. RESULTS: Ablation zone temperatures at 2.5 and 5 minutes increased by 12.2 °C ± 2.6 °C and 21.5 °C ± 2.1 °C (control); 11.0 °C ± 4.1 °C and 20.0 °C ± 2.9 °C (juxta-titanium screw), and 10.0 °C ± 3.4 °C and 17.2 °C ± 3.5 °C (juxta-stainless steel) screw; differences among groups did not reach significance by analysis of variance (P = .87). Mixed-effects linear regression revealed a statistically significant increase in temperature over time in all 3 groups (4.2 °C/min ± 0.4 °C/min, P < .001). Compared with the control, there was no significant difference in the temperature change over time for titanium (-0.3 °C/min ± 0.5 °C/min, P = .53) or steel groups (-0.4 °C/min ± 0.5 °C/min, P = .38). The mean screw temperature at the final time point did not show a statistically significant change compared with baseline in either the titanium group (-1.2 °C ± 2.3 °C, P = .50) or steel group (2.6 °C ± 2.9 °C, P = .11). MR imaging and pathologic analyses revealed homogeneous ablation without sparing of the peri-hardware zones. CONCLUSIONS: Adjacent metallic instrumentation did not affect the rate of or absolute increase in temperature in the ablation zone, did not create peri-metallic ablation inhomogeneities, and did not result in significant nontarget heating of muscle tissue in contact with the metal instrumentation.
Authors
Sag, AA; Sperduto, WAL; Eward, W; Ronald, J; Davis, H; Jiang, XS; Enterline, DS; Visgauss, J; Brigman, B; Goodwin, CR; Qadri, YJ; Kim, CY
MLA Citation
Sag, Alan A., et al. “Juxtametallic Bipolar Bone Radiofrequency Ablation: Thermal Monitoring in an Ex-Vivo Model with Specimen MRI and Histopathologic Correlation.J Vasc Interv Radiol, vol. 33, no. 12, Dec. 2022, pp. 1594–600. Pubmed, doi:10.1016/j.jvir.2022.08.019.
URI
https://scholars.duke.edu/individual/pub1533606
PMID
36007783
Source
pubmed
Published In
J Vasc Interv Radiol
Volume
33
Published Date
Start Page
1594
End Page
1600
DOI
10.1016/j.jvir.2022.08.019