Rodger H Brown

Baylor College of Medicine, Houston, Texas, United States

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Publications (11)14.25 Total impact

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    ABSTRACT: Biodegradable plates have been used extensively in fracture fixation since the 1960s. They rarely cause stress-protection atrophy or problems requiring secondary plate removal, common complications seen with metallic plates. However, aseptic foreign-body reactions have been reported, sometimes years after the original implantation. Both inadequate polymer degradation and debris accumulation have been implicated as causes. The current generation of commercial biodegradable plates is formulated to minimize this complication by altering the ratio of polylactic and polyglycolic acids. This in vivo study compares the degree of local foreign-body reaction of two commercially available resorbable plates in rabbits. Two types of biodegradable plates were examined: poly(D/L)lactide acid (PDLLA) and polylactide-co-glycolide acid (PLGA). Each plate was placed into a periosteal pericalvarial pocket created beneath the anterior or posterior scalp of a rabbit. Humane killing occurred at 3, 6, and 12 months postoperatively. Foreign-body reaction was evaluated histologically. The PDLLA plates demonstrated marked local foreign-body reactions within the implant capsule as early as 3 months after implantation, with presence of inflammatory cells and granulomatous giant cells in close association with the implant material. All local foreign-body reactions were subclinical with no corresponding tissue swelling requiring drainage. PLGA plates did not demonstrate any signs of inflammatory reactions. In addition, the PLGA plates did not appear to resorb or integrate at 12 months. Neither PDLLA nor PLGA plates demonstrated inflammation of the soft tissue or adjacent bone outside the implant capsule. In our study, the PDLLA plates demonstrated histological evidence of foreign-body reaction that is confined within the implant capsule, which was not seen with the PLGA plates. This finding may be attributable to the lack of significant resorption seen in the PLGA plates. Both PDLLA and PLGA plates were biocompatible with the rabbit tissue environment and should be considered for continued use in craniofacial, maxillofacial, and orthopedic reconstruction.
    Craniomaxillofacial Trauma and Reconstruction 03/2014; 7(1):27-34.
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    ABSTRACT: The use of left ventricular assist devices has become common for the treatment of end-stage heart failure, both as a bridge to transplantation and as destination therapy. The nature of these devices and the comorbid conditions of the patients in whom the devices are implanted lead to high rates of device infection that are related directly to mortality. Over 2 years, the senior author (S.A.I.) treated 26 patients with left ventricular assist device infections, ranging from superficial driveline infections to deeper pocket infections and device infections. An algorithm involving the use of repeated d├ębridement and placement of antibiotic beads was used in treatment of these infections. Once cleared of infection, patients were treated with definitive closure or flap coverage of the formerly infected device component. Seventeen of 26 patients with left ventricular assist device-related infections were cleared of their infection using this method. Ten of these patients underwent flap coverage of the device after their infection was cleared. In patients that were cleared of infection, mortality was 29 percent, whereas patients with recalcitrant infections had a mortality of 67 percent over the course of the study. A systematic approach to treating left ventricular assist device-related infections has the potential to treat and clear these infections, with promising overall survival rates. This proposed algorithm led to high infection clearance rates compared with previously published literature. Infection clearance in patients on left ventricular assist device destination therapy may result in mortality rates approaching those of their uninfected peers. Therapeutic, IV.
    Plastic and reconstructive surgery 01/2014; 133(1):28e-38e. · 2.74 Impact Factor
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    ABSTRACT: This article reflects on the changing management of frontal sinus fractures. Severity of these injuries has decreased tremendously since the universal adoption of seat belts and air bags. Recently, there has been a shift from aggressive surgical management to more conservative management strategies, some forgoing surgery all together. New technologies, such as bioabsorbable plates and endoscopic sinus surgery, are leading the way in improved surgical management strategies and offer promising alternatives to the more traditional approaches.
    Craniomaxillofacial Trauma and Reconstruction 09/2013; 6(3):155-160.
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    Surgery for Obesity and Related Diseases 04/2013; · 4.12 Impact Factor
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    ABSTRACT: BACKGROUND: Infection can be a devastating complication associated with prosthetic incisional hernia repair. It is unclear whether the type of mesh used affects the risk of infection. METHODS: A retrospective review was performed of all patients who underwent elective incisional hernia repair with permanent prosthetic mesh between January 1, 2000, and August 1, 2007. RESULTS: A total of 176 patients underwent elective incisional hernia repair with mesh. The overall infection rate with the use of goretex (Flagstaff, AZ, USA) was 12 of 86 (14%) and 2 of 90 (2.2%) in cases in which nongoretex material was used (P = .016). In the goretex group, infection rates were significantly higher in open versus laparoscopic cases (26.5% vs 5.8%, P = .030). Methicillin-resistant Staphylococcus aureus was the most common organism recovered. CONCLUSIONS: The risk of mesh infection with the use of goretex was found to be higher than with the use of nongoretex mesh. Laparoscopic placement of goretex reduces this risk of infection. No significant differences in recurrence rates were found.
    American journal of surgery 02/2013; 205(2):182-187. · 2.36 Impact Factor
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    ABSTRACT: Implant-associated anaplastic large cell lymphoma (ALCL) is the subject of much debate in the field of plastic surgery. Only a few published cases have been reported and the rarity of the disease may make proving causality exceedingly difficult. Despite this, it is of utmost importance that full attention be devoted to this subject to ensure the safety and well-being of patients. The authors report one new case of implant-associated ALCL that recently presented to their institution. Implant-associated ALCL is a poorly understood disease. It should likely be considered its own clinical entity and categorized into two subtypes: one presenting as a seroma and the other as a distinct mass or masses. When reported, only textured implants have been associated with ALCL. The United States Food and Drug Administration and American Society of Plastic Surgeons have initiated a registry and have collected critical data to gain further understanding of this disease.
    The Canadian journal of plastic surgery, Journal canadien de chirurgie plastique 01/2013; 21(2):95-8. · 0.21 Impact Factor
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    ABSTRACT: Background Obese patients now constitute a larger proportion of women seeking postmastectomy reconstruction. Achieving optimal results with a low number of complications in the obese population is challenging. This meta-analysis compares the complication risks for obese and nonobese patients receiving abdominal-based free flaps for breast reconstruction. Methods A retrospective case series of obese and nonobese patients undergoing abdominal-based free flaps for breast reconstruction was performed and included in the meta-analysis. A literature search yielded 103 citations, and multilevel screening identified 7 relevant studies. An eight study meta-analysis, using the DerSimonian and Laird random effects models, compared pooled relative risks for complications. Results There was a twofold risk of infection (relative risk (RR), 1.97; 95 % CI, 1.23, 3.14), two and one half times the risk of mastectomy flap necrosis (RR, 2.61; CI, 1.62, 4.20), and partial flap loss (RR, 2.62; CI, 1.23, 5.59) for obese patients compared to nonobese patients. Additionally, there was a fourfold increase in risk for total flap loss (RR, 4.12; CI, 1.01, 16.79) and donor-site seroma (RR, 4.03; CI, 2.46, 6.59). There was no significant difference in the risk for overall donor-site complications between the two populations (RR, 1.09; CI, 0.58, 2.05). Conclusions The findings reveal that obese patients have a higher risk of complications than nonobese patients receiving abdominal-based free flaps for breast reconstruction. As we move toward a pay-for-performance reimbursement system, appropriate risk adjustments will be a vital component, allowing provision of optimal treatment techniques for obese patients. Level of Evidence: Level IV, prognostic/risk study
    European Journal of Plastic Surgery 01/2013;
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    ABSTRACT: The treatment of pediatric facial fractures, although similar to that of adults, requires a separate and thorough understanding of the unique developmental issues inherent to this age group. The contribution of several of these factors allows for a large portion of these injuries to be managed more conservatively; however, operative indications still exist. The optimal form of management in these situations must balance the risks of impacting dentition or future skeletal growth versus obtaining acceptable stability and reduction for healing. Although these principles have remained largely unchanged over the years, a more current discussion on the state of resorbable and titanium fixation is offered to highlight evolving management considerations. Although uniquely challenging, the proper management of pediatric facial trauma is possible if the treating physician remains aware of key anatomic, epidemiological, evaluation, and management issues.
    The Journal of craniofacial surgery 07/2011; 22(4):1190-5. · 0.81 Impact Factor
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    Rodger H Brown, Cara Downey, Shayan Izaddoost
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    ABSTRACT: While isolated limb injuries often lead to suspicion for and treatment of compartment syndrome, multi-limb compartment syndrome induced by a systemic disease is a rare entity, in which lack of immediate diagnosis can have catastrophic consequences to the patient. We present a patient with idiopathic systemic capillary leak syndrome (SCLS) resulting in compartment syndrome in all four extremities. Treatment required bilateral hand, forearm, calf, and thigh fasciotomies. Presenting symptoms included pain in all four extremities, malaise, and confusion. Laboratory data included polycythemia, hypoalbuminemia, leukocytosis, and elevated creatinine, but not a monoclonal spike on serum electrophoresis as is common in SCLS. Thus, when faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders, such as SCLS, and aggressively treat the compartment syndrome as well as the underlying disease.
    Hand 03/2011; 6(1):110-4.
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    ABSTRACT: The phenomena of "bottoming out" (pseudoptosis) and "star-gazing" (the upward rotation of the nipple-areola complex) is a common postoperative problem when using the inferior pedicle breast reduction technique. Multiple techniques have been described to help prevent this problem, including internal suspension techniques and the use of mesh to support the pedicle. We describe our technique and present a case series in which acellular dermal matrix (AlloDerm(®)) is used as an internal brassiere or sling to support the inferior pedicle and prevent postoperative "bottoming out" and "star-gazing." Twenty-seven patients underwent inferior pedicle reduction mammaplasty through a Wise pattern performed by a single surgeon. In each case, acellular dermal matrix (0.79-2.03 mm thick) was sutured to the chest wall as a sling or internal brassiere to support the inferior pedicle. The pedicle was also plicated in a horizontal fashion to increase the projection of the breast and to improve the position of the nipple-areola complex. The mean weight of reduction per breast was 850 g. The mean distance from the nipple to the inframammary fold was 16.4 cm. The mean distance from the sternal notch to the nipple was 32.2 cm. Only one patient developed cellulitis and one patient had partial skin flap necrosis. There was no nipple loss. At routine follow-up it was found that the aesthetic breast shape has been retained and pseudoptosis or "bottoming out" was not significant in any patient. The longest follow-up is 29 months. The use of an acellular dermal matrix internal brassiere is a safe and effective technique for preventing the "bottoming out" and "star-gazing" phenomena that occurs after inferior pedicle breast reduction. Longer-term follow-up will be required to assess the longevity of these results.
    Aesthetic Plastic Surgery 12/2010; 34(6):760-7. · 1.26 Impact Factor
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    ABSTRACT: Of all the methods for repair of the unilateral cleft lip, none has gained as much popularity as the rotation-advancement. Millard's original principle of 50 years ago continues to guide surgeons in closure of the cleft lip. Unlike earlier procedures, the brilliance of the rotation-advancement is that it permits individual manipulation and modifications while maintaining Millard's original surgical and anatomical goals. Millard and many other surgeons have made modifications to adjust the procedure to each specific patient, to address some of its faults, and to gain new advantages. In this article, the authors review the techniques of Drs. Ralph Millard, Steve Byrd, Court Cutting, John Mulliken, and Samuel Stal. The variations from Millard's original technique are highlighted, including a discussion of the benefits of each modification.
    Plastic and reconstructive surgery 05/2009; 123(4):1364-77. · 2.74 Impact Factor