Edward J Caterson

Brigham and Women's Hospital, Boston, Massachusetts, United States

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Publications (56)157.28 Total impact

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    ABSTRACT: American Board of Plastic Surgery (ABPS) recently celebrated its 75 anniversary as an established specialty board. This historical article provides an outline of the events that led to the formation of the ABPS and gives insight into the personalities and achievements of the key individuals whose unique talents coalesced into a common vision of making plastic surgery the diverse and well respected specialty that it is today. This is a historical literature review outlining the circumstances leading to the formation of ABPS. The emphasis on the role of founding fathers of ABPS is reviewed and detailed in the manuscript. The founding figures of ABPS continue to inspire us, through their unrelenting dedication to the field of Plastic Surgery. Over the past 75 years, the field of plastic surgery has been very well served by their successors and these founding figures of the ABPS have fostered a surgical specialty of great repute.
    Plastic and reconstructive surgery. 02/2015;
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    ABSTRACT: Large facial tissue defects are traditionally treated with staged conventional reconstruction. Facial allograft transplantation has emerged as a treatment modality. Facial allografts are procured from a dead donor and transplanted to the recipient. Recipients are then subjected to lifelong global immunosuppression to prevent immunologic rejection. This study analyzes the cost of facial allograft transplantation in comparison with conventional reconstruction. Hospital billing records from facial allograft transplantation (2009 to 2011) and conventional reconstruction (2000 to 2010) patients were compiled. Comparative 1-year costs were calculated, segregated by physician, hospital, and hospital's department costs. Because most conventional reconstruction patients had smaller facial deficits than their facial allograft transplantation counterparts, regression models were used to estimate costs of conventional reconstruction for full facial defects, mirroring the facial transplantation cohort. All costs were adjusted using the medical consumer price index. One-year costs for facial allograft transplantation were significantly higher than those for conventional reconstruction (mean/median, $337,360/$313,068 versus $70,230/$64,451, respectively). One-year costs for a hypothetical full-face conventional reconstruction were $184,061 (95 percent CI, $89,358 to $278,763). The per-patient cost in a hypothetical cohort of conventional reconstruction patients with deficits identical to four facial allograft transplantation recipients was $155,475 (95 percent CI, $69,021 to $241,929). Initial cost comparison portrays facial allograft transplantation as significantly more costly than conventional reconstruction. However, after adjustments for case severity, the cost profiles are similar. Gains in efficiency and experience are expected to lower costs. Additional unmeasured benefits may also positively influence the cost-to-benefit ratio of facial allograft transplantation.
    Plastic and reconstructive surgery. 01/2015; 135(1):260-7.
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    ABSTRACT: Injury to the skin can predispose individuals to invasive infection. The standard of care for infected wounds is treatment with intravenous antibiotics. However, antibiotics delivered intravenously may have poor tissue penetration and be dose limited by systemic side effects. Topical delivery of antibiotics reduces systemic complications and delivers increased drug concentrations directly to the wound. Porcine full-thickness wounds infected with Staphylococcus aureus were treated with ultrahigh concentrations (over 1000 times the minimum inhibitory concentration) of gentamicin using an incubator-like wound healing platform. The aim of the present study was to evaluate clearance of infection and reduction in inflammation following treatment. Gentamicin cytotoxicity was evaluated by in vitro assays. Application of 2000 μg/ml gentamicin decreased bacterial counts in wound tissue from 7.2 ± 0.3 log colony-forming units/g to 2.6 ± 0.6 log colony-forming units/g in 6 hours, with no reduction observed in saline controls (p < 0.005). Bacterial counts in wound fluid decreased from 5.7 ± 0.9 log colony-forming units/ml to 0.0 ± 0 log colony-forming units/ml in 1 hour, with no reduction observed in saline controls (p < 0.005). Levels of interleukin-1β were significantly reduced in gentamicin-treated wounds compared with saline controls (p < 0.005). In vitro, keratinocyte migration and proliferation were reduced at gentamicin concentrations between 100 and 1000 μg/ml. Topical delivery of ultrahigh concentrations of gentamicin rapidly decontaminates acutely infected wounds and maintains safe systemic levels. Treatment of infected wounds using the proposed methodology protects the wound and establishes a favorable baseline for subsequent treatment.
    Plastic and reconstructive surgery. 01/2015; 135(1):151-9.
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    Radiological Society of North America (RSNA); 12/2014
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    ABSTRACT: BACKGROUND: Severe facial injuries can compromise the upper airway by reducing airway volume, obstructing or obliterating the nasal passage, and interfering with oral airflow. Besides the significant impact on quality of life, upper airway impairments can have life-threatening or life-altering consequences. The authors evaluated improvements in functional airway after face transplantation. METHODS: Between 2009 and 2011, four patients underwent face transplantation at the authors' institution, the Brigham and Women's Hospital. Patients were examined preoperatively and postoperatively and their records reviewed for upper airway infections and sleeping disorders. The nasal mucosa was biopsied after face transplantation and analyzed using scanning electron microscopy. Volumetric imaging software was used to evaluate computed tomographic scans of the upper airway and assess airway volume changes before and after transplantation. RESULTS: Before transplantation, two patients presented an exposed naked nasal cavity and two suffered from occlusion of the nasal passage. Two patients required tracheostomy tubes and one had a prosthetic nose. Sleeping disorders were seen in three patients, and chronic cough was diagnosed in one. After transplantation, there was no significant improvement in sleeping disorders. The incidence of sinusitis increased because of mechanical interference of the donor septum and disappeared after surgical correction. All patients were decannulated after transplantation and were capable of nose breathing. Scanning electron micrographs of the respiratory mucosa revealed viable tissue capable of mucin production. Airway volume significantly increased in all patients. CONCLUSIONS: Face transplantation successfully restored the upper airway in four patients. Unhindered nasal breathing, viable respiratory mucosa, and a significant increase in airway volume contributed to tracheostomy decannulation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
    Plastic &amp Reconstructive Surgery 12/2014; 134:946e-54e. · 3.33 Impact Factor
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    ABSTRACT: High energy tibial plafond (pilon) fractures are known to have a high rate of complication, particularly wound dehiscence and infection. Wound infection, requiring debridement of both soft tissue and bone can be especially challenging to reconstruct due to the combination of high load-bearing requirements within a thin soft tissue envelope.Method We present a case of a pilon fracture with a post-operative complication of wound dehiscence and infection necessitating bone debridement, ultimately resulting in chronic osteomyelitis. We used a medial femoral osteocutaneous free flap to provide vascularized structure to the defect. Included is a comprehensive literature review for the use of the MFC osteocutaneous free flaps in lower extremities.ResultsThis flap provided restoration of the medial column of the ankle. The use of vascularized bone resulted in rapid post-operative bony union. The vascularized bone flap was press fit into the defect ruling out the potential for further hardware related infections. We report follow up of over one year.Conclusion The MFC free osteocutaneous flap is a good option for small bone and soft tissue defects of lower extremities, especially in setting of chronic osteomyelitis. It can be custom fabricated and either fixated or press fit into a chronic pilon fracture cavity to obliterate dead space with vascularized bone.Level of Evidence: Level IV, Retrospective case study
    Injury 11/2014; · 2.46 Impact Factor
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    ABSTRACT: Occult submucous cleft palate is a congenital deformity characterized by deficient union of the muscles that normally cross the velum and aid in elevation of the soft palate. Despite this insufficient muscle coverage, occult submucous cleft palate by definition lacks clear external anatomic landmarks. This absence of anatomic signs makes diagnosis of occult submucous cleft less obvious, more dependent on ancillary tests, and potentially missed entirely. Current diagnostic methodologies are limited and often are unrevealing in the presurgical patient; however, a missed diagnosis of occult submucous cleft palate can result in velopharyngeal insufficiency and major functional impairment in patients after surgery on the oropharynx. By accurately and easily diagnosing occult submucous cleft palate, it is possible to defer or modify pharyngeal surgical intervention that may further impair velopharyngeal function in susceptible patients. In this report, we introduce transillumination of the soft palate using a transnasal or transoral flexible endoscope as an inexpensive and simple technique for identification of submucous cleft palate. The use of transillumination of an occult submucous cleft palate is illustrated in a patient case and is compared to other current diagnostic methodologies.
    Journal of Craniofacial Surgery 10/2014; · 0.68 Impact Factor
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    ABSTRACT: Purpose Submucous cleft palate is a congenital deformity characterized by deficient union of the muscles that normally cross the velum and aid in elevation of the soft palate. Unlike overt submucous cleft palate, occult submucous cleft palate lacks clear external anatomic landmarks while still exhibiting insufficient median muscle interdigitation and abnormal function (Figure 1). This absence of anatomic markers makes the diagnosis of occult submucous cleft less obvious, more dependent on ancillary tests, and potentially missed entirely. Current diagnostic methodologies are limited and often are unrevealing in the pre-surgical patient, however a missed diagnosis of occult submucous cleft palate can result in velopharyngeal insufficiency (VPI) and major functional impairment in patients following surgery on the oropharynx. By accurately and easily diagnosing occult submucous cleft palate, it is possible to defer or modify pharyngeal surgical intervention that may further impair velopharyngeal function in susceptible patients. Methods and Materials In this report, we introduce transillumination of the soft palate as a simple diagnostic technique for submucous cleft palate identification, illustrate its facile use in the pre-operative patient work-up in comparison to other diagnostic methods, and describe its utility in a patient case. As part of a thorough assessment of patients undergoing oropharyngeal surgery, a flexible fiberoptic nasopharyngoscope is routinely used to examine the velum, oropharynx and hypopharynx. We propose that the same scope be used to improve diagnosis of occult submucous cleft palate through transillumination. Following introduction of the scope through the nose or mouth, the lighted distal end of the scope should be directed anteriorly as to provide a backlight for the soft palate (Figure 2). Conclusions Occult submucous cleft palate is a frequently missed diagnosis that is often not recognized until a patient develops symptoms of VPI, sometimes secondary to surgery on the oropharynx. As illustrated in our patient, the appearance of VPI symptoms following routine surgery can be debilitating for the patient and defeating for the surgeon in cases of missed occult submucous cleft. In patients undergoing oropharyngeal surgery, transillumination of the palate is an inexpensive, quick, and easily incorporated technique that can screen for undiagnosed occult submucous cleft palate and decrease the incidence of iatrogenic VPI post-operatively. Figures Figure 1: Abnormal muscular attachments of submucous cleft palate. Figure 2: Appearance of submucous cleft palate on transillumination.
    Plastic Surgery: The Meeting 2014; 10/2014
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    ABSTRACT: Reconstruction of the ascending portion of the mandible, including the angle, ramus, and condyle, can be a challenging surgical problem. Many treatment options are available, but no single procedure has been able to restore long-term form and function in every case. Currently, autologous nonvascularized bone grafts are the most common treatment, with the costochondral graft as the historic leader. Nonvascularized grafts can often restore vertical height and normal function but may face the challenge of long-term durability secondary to bone resorption. Emerging techniques in microvascular surgery may offer an alternative approach with the benefits of resistance to resorption and infection by maintaining a viable blood supply to the graft. Vascularized grafts may thus be used to full advantage in cases where prior surgery, scarring, disrupted vasculature, or radiation damage may compromise the long-term surgical success of a nonvascularized graft. This article reviews the literature and summarizes key points regarding nonvascularized and vascularized treatment modalities for reconstruction of the ascending mandible. In addition, we present the use of the femoral medial epicondyle free flap based on the descending genicular vascular pedicle as a novel reconstruction of the ascending portion of the mandible with minimal donor-site morbidity. Knowledge of all available options will aid the surgeon in achieving the optimal reconstruction for their patient and improve long-term outcomes.
    Journal of Craniofacial Surgery 08/2014; · 0.68 Impact Factor
  • Advances in Wound Care. 08/2014;
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    ABSTRACT: Objective: In the United States, around 50% of all musculoskeletal injuries are soft tissue injuries including ligaments and tendons. The objective of this study is to assess the role of amnion-derived cellular cytokine solution (ACCS) in carboxy-methyl cellulose (CMC) gel in the healing of Achilles tendon in a rat model, and to examine its effects on mechanical properties and collagen content. Methods: Achilles tendons of Sprague-Dawley rats were exposed and transected. The distal and proximal ends were injected with either saline or ACCS in CMC, in a standardized fashion, and then sutured using a Kessler technique. Tendons from both groups were collected at 1, 2, 4, 6, and 8 weeks postoperatively and assessed for material properties. Collagen studies were performed, including collagen content, collagen cross-linking, tendon hydration, and immunohistochemistry. Tendons were also evaluated histologically for cross-sectional area. Results: Mechanical testing demonstrated that treatment with ACCS in CMC significantly enhances breaking strength, ultimate tensile strength, yield strength, and Young's modulus in the tendon repair at early time points. In context, collagen content, as well as collagen cross-linking, was also significantly affected by the treatment. Conclusion: The application of ACCS in CMC has a positive effect on healing tendons by improving mechanical properties at early time points. Previous studies on onetime application of ACCS (not in CMC) did not show significant improvement on tendon healing at any time point. Therefore, the delivery in a slow release media like CMC seems to be essential for the effects of ACCS demonstrated in this study.
    Eplasty 08/2014; 14:e29.
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Cell migration requires spatiotemporal integration of signals that regulate cytoskeletal dynamics. In response to a migration-promoting agent, cells begin to polarise and extend protrusions in the direction of migration. These cytoskeletal rearrangements are orchestrated by a variety of proteins, including focal adhesion kinase (FAK) and the Rho family of GTPases. CCN2, also known as connective tissue growth factor, has emerged as a regulator of cell migration but the mechanism by which CCN2 regulates keratinocyte function is not well understood. In this article, we sought to elucidate the basic mechanism of CCN2-induced cell migration in human keratinocytes. Immunohistochemical staining was used to demonstrate that treatment with CCN2 induces a migratory phenotype through actin disassembly, spreading of lamellipodia and re-orientation of the Golgi. In vitro assays were used to show that CCN2-induced cell migration is dependent on FAK, RhoA and Cdc42, but independent of Rac1. CCN2-treated keratinocytes displayed increased Cdc42 activity and decreased RhoA activity up to 12 hours post-treatment, with upregulation of p190RhoGAP. An improved understanding of how CCN2 regulates cell migration may establish the foundation for future therapeutics in fibrotic and neoplastic diseases.
    International Wound Journal 08/2014; · 2.02 Impact Factor
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    ABSTRACT: The process of wound healing is dynamic and takes place over months to years, during which there is a resolution of angiogenesis, continued wound contraction, and connective tissue remodeling. The outcome of this process is most commonly the formation of a scar, defined as a fibrous tissue replacing normal tissues destroyed by injury or disease. Scars often have a lowered or total loss of vital skin functions and imbue a large burden on both the patient and the health care system as a whole. Scar treatments are plentiful but are often unsatisfactory or inconsistent. No single treatment method has been universally adopted. To evaluate the clinical treatment as well as research focused on developing novel methods for scar management, objective studies of the progression of scar formation and the properties of mature scars are needed. Several parameters, including barrier function as well as mechanical and physiological properties, need to be taken into account when both categorizing and treating healing wounds and scars. To date, there is no available methodology that provides a comprehensive evaluation of a scar's properties. This review aims at presenting an overview of available scar assessment methods and devices, ranging from analysis of collagen properties in tissue biopsies to noninvasive methods for studies of mechanical parameters such as breaking strength and skin elasticity. In the cases where conclusive studies have been performed, the differences between normal skin and scar with respect to the above parameters are presented. Furthermore, this review highlights areas where the development of additional modalities are needed.
    Wound Repair and Regeneration 05/2014; 22(S1). · 2.77 Impact Factor
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    ABSTRACT: Skeletal muscle injury is common in everyday physical activity and athletics, as well as in orthopedic trauma and disease. The overall functional disability resulting from muscle injury is directly related to the intrinsic healing properties of muscle and extrinsic treatment options designed to maximize repair and/or regeneration of muscle tissue all while minimizing pathologic healing pathways. It is important to understand the injury and repair pathways in order to improve the speed and quality of recovery. Recent military conflicts in Iraq and Afghanistan have highlighted the importance of successfully addressing muscular injury and showed the need for novel treatment options that will maximize functional regeneration of the damaged tissue. These severe, wartime injuries, when juxtaposed to peacetime, sports-related injuries, provide us with interesting case examples of the two extreme forms of muscular damage. Comparing and contrasting the differences in these healing pathways will likely provide helpful cues that will help physicians recapitulate the near complete repair and regeneration in less traumatic injuries in addition to more severe cases.
    Wound Repair and Regeneration 05/2014; 22(S1). · 2.77 Impact Factor
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    Eplasty 01/2014; 14:e38.
  • Berit Hackenberg, Cameron Lee, E J Caterson
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    ABSTRACT: The treatment of subcondylar mandible fractures is a topic of debate and can be variable even though these fractures are commonly seen. Historically, the treatment algorithm was between open reduction and closed treatment. Now, recent technical advances regarding the use of the endoscope in the field of craniofacial surgery provide additional treatment options. This article aimed to evaluate 3 current management strategies: closed reduction with maxillomandibular fixation, open reduction with internal fixation, and endoscopic-assisted reduction with internal fixation. We present our rationale for surgical decision making and attempt to develop an algorithmic approach to subcondylar fractures.Ankylosis of the temporomandibular joint is a feared complication in these fractures that can lead to the decision to apply maxillomandibular fixation for potentially too short of a period. It is the condylar head fractures within the joint's capsule that contain the hemarthrosis that are often responsible for ankylosis. Subcondylar fractures are, by definition, below the attachment of the joint capsule and in general are devoid of ankylosis. Therefore, maxillomandibular fixation is recommended to be applied for a period of 4 to 6 weeks in most cases. Open reduction with internal fixation can increase the risk for facial nerve damage during the operative approach. However, open reduction is often necessary in fracture patterns with a high degree of displacement. In these cases, facial nerve monitoring can successfully mitigate risks to allow safe exposure for open reduction with internal fixation of subcondylar fractures. Endoscopic-assisted reduction with internal fixation combines the benefits of both techniques while minimizing their associated risks. Nevertheless, reduction can be difficult especially when there is significant medial displacement of the proximal fracture fragment. In our experience, the endoscopic option is optimal for mildly displaced fractures and for the patient with multiple injuries who cannot tolerate closed reduction.
    The Journal of craniofacial surgery 01/2014; 25(1):166-71. · 0.68 Impact Factor
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    David M Tsai, Edward J Caterson
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    ABSTRACT: Healthcare-associated infections (HAIs) continue to be a tremendous issue today. It is estimated 1.7 million HAIs occur per year, and cost the healthcare system up to $45 billion annually. Surgical site infections (SSIs) alone account for 290,000 of total HAIs and approximately 8,000 deaths. In today's rapidly changing world of medicine, it is ever important to remain cognizant of this matter and its impact both globally and on the individual lives of our patients. This review aims to impress upon the reader the unremitting significance of HAIs in the daily practice of medicine. Further, we discuss the etiology of HAIs and review successful preventive measures that have been demonstrated in the literature. In particular, we highlight preoperative, intraoperative, and postoperative interventions to combat SSIs. Finally, we contend that current systems in place are often insufficient, and emphasize the benefits of institution-wide adoption of multiple preventive interventions. We hope this concise update and review can inspire additional dialogue for the continuing progress towards improving patient care and patient lives.
    Patient Safety in Surgery 01/2014; 8(1):42.
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    ABSTRACT: Plastic surgery is presently typified by the existence of discrete clinical identities, namely that of the cosmetic plastic surgeon and the reconstructive plastic surgeon. The emergence of vascularized composite allotransplantation has been accompanied by the development of a third distinct clinical identity, that of the restorative plastic surgeon. The authors describe the core competencies that characterize this new identity, and discuss the implications of the advent of this new professional paradigm.
    Plastic and Reconstructive Surgery 01/2014; 133(1):182-6. · 3.33 Impact Factor
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    ABSTRACT: The 2013 Boston Marathon bombings resulted in a large and unexpected influx of patients requiring acute multidisciplinary surgical care. The authors describe the surgical management experience of these patients at Brigham & Women's Hospital and Brigham & Women's Faulkner Hospital, with a particular focus on the important role played by reconstructive plastic surgery. The authors suggest that this experience illustrates the value of reconstructive plastic surgery in the treatment of these patients specifically and of trauma patients in general, and argue for the increasing importance of promoting our identity as a specialty.
    Plastic and Reconstructive Surgery 12/2013; 132(6):1623-7. · 3.33 Impact Factor
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    ABSTRACT: Zygomatic arch fractures are common facial fractures; the management depends on the extent of the injury, the displacement of the bone, and coronoid impingement. For fractures without a need for fixation, an intraoral approach, known as Keen, or a temporal hairline approach, known as Gillies, can be used. However, without direct visualization of the fracture line, there is a risk for inadequate reduction. We have therefore begun to use ultrasound assistance to confirm proper reduction. We believe that intraoperative ultrasound guidance can be used to guide the surgeon toward the most precise fracture reduction and present 3 examples from our practice. We recommend the use of ultrasound in the reduction of zygomatic arch fractures.
    The Journal of craniofacial surgery 11/2013; 24(6):2036-8. · 0.68 Impact Factor

Publication Stats

1k Citations
157.28 Total Impact Points

Institutions

  • 2013–2014
    • Brigham and Women's Hospital
      • Center for Brain Mind Medicine
      Boston, Massachusetts, United States
    • American Society of Ophthalmic Plastic and Reconstructive Surgery
      New York City, New York, United States
    • Uppsala University
      • Department of Surgical Sciences
      Uppsala, Uppsala, Sweden
  • 2007–2014
    • Harvard Medical School
      • Department of Pathology
      Boston, Massachusetts, United States
  • 2012
    • NYU Langone Medical Center
      New York, New York, United States
  • 2001–2002
    • Thomas Jefferson University
      • Department of Orthopaedic Surgery
      Philadelphia, PA, United States
    • Thomas Jefferson University Hospitals
      Philadelphia, Pennsylvania, United States