Rodney K Chan

University of Texas Southwestern Medical Center, Dallas, Texas, United States

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Publications (48)100.96 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The goal of burn surgical therapy is to minimize mortality and to return survivors to their preinjury state. Prompt removal of the burn eschar, early durable coverage, and late corrections of functional deformities are the basic surgical principles. The operative burden, while presumed to be substantial and significant, is neither well described nor quantified. The burn registry at the U.S. Institute of Surgical Research Burn Center was queried from March 2003 to August 2011 for all active duty burn admissions; active duty subjects were chosen to eliminate subject follow-up as a significant variable. Subject demographics including age, sex, branch of service, injury type, injury severity score, transfusion, allograft use, length of stay, mechanism of injury, and survival were tabulated as were their percentage TBSA, specific body region involvement, and nature and dates of operations performed. Univariate analysis and multiple logistic regressions were performed to determine independent factors which predict early and late operative burden. In the 8-year study period, 864 active duty patients were admitted to the burn center. Among them, 569 (66%) were operative in nature. The operations that were performed during acute hospitalization were 62%, while the remaining 38% were performed following discharge. A linear relationship exists between TBSA and the number of acute operations with an average of one acute operation required per 5% TBSA. No direct relationships however were found between TBSA and the number of reconstructive operations. Based on multiple logistic regression, battle vs nonbattle (OR, 0.559; 95% confidence interval [CI], 0.298-1.050; P = .0706), injury severity score (OR, 1.021; 95% CI, 1.003-1.039; P = .0222), intensive care unit length of stay (OR, 1.076; 95% CI, 1.053-1.099; P ≤ .0001), allograft use (OR, 2.610; 95% CI, 1.472-4.628; P = .0010), and TBSA of the trunk (OR, 0.982; 95% CI, 0.965-1.000; P = .0439) (but not overall TBSA) were associated with a high acute operative burden. Battle vs nonbattle (OR, 0.546; 95% CI, 0.360-0.829; P = .0045), and TBSA of the upper extremities (OR, 1.008; 95% CI, 1.002-1.013; P = .0042) were noted to be significant variables in predicting late reconstruction operations. The operative burden of burn, not previously well characterized, consists of operations performed during as well as after the initial hospitalization. While injury severity and truncal involvement are significant determinants of acute surgical therapy, the presence of upper extremity burns is a significant determinant of reconstruction following discharge.
    Journal of burn care & research: official publication of the American Burn Association 08/2014; · 1.54 Impact Factor
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    ABSTRACT: Bone regeneration and healing is an area of extensive research providing an ever-expanding set of not only therapeutic solutions for surgeons but also diagnostic tools. Multiple factors such as an ideal graft, the appropriate biochemical and mechanical wound environment, and viable cell populations are essential components in promoting healing. While bony tissue performs many functions, critical is mechanical strength, followed closely by structure. Many tools are available to evaluate bone quality in terms of quantity, structure, and strength; the purpose of this article is to identify the factors that can be evaluated and the advantages and disadvantages of each in assessing the quality of bone healing in both preclinical research and clinical settings.
    Wound Repair and Regeneration 05/2014; 22(S1). · 2.76 Impact Factor
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    ABSTRACT: INTRODUCTION: Non-battle injuries (NBIs) can be a source of significant resource utilization for the armed forces in a deployed setting. While the incidence and severity of craniomaxillofacial (CMF) battle injuries (BIs) have reportedly increased in the ongoing U.S. military conflicts in Iraq and Afghanistan, the prevalence and the nature of NBIs are not well described. MATERIAL AND METHODS: The Joint Theater Trauma Registry was queried from October 2001 to February 2011, covering Operations Enduring Freedom and Iraqi Freedom, for both NBIs and BIs to the CMF region. Patient demographics, injury severity score, mechanism and type of injury were included in the query. Using ICD-9 diagnosis codes, CMF injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries). Statistical analysis was performed for comparative analysis. RESULTS: NBIs constituted 24.3% of all patients with CMF injuries evacuated to a regional combat support hospital (CMF BIs 75.4%). These injuries were characterized by blunt trauma, most commonly motor vehicle collisions (37%), and falls (20%). As compared to CMF BIs, CMF NBIs resulted in less mortality (1.3% vs. 3.1%, p < 0.0001), fewer injuries per patient (1.87 vs. 2.26, p = 0.055), and a decreased severity score (ISS) (8.38 vs. 12.98, p < 0.0001). However, a significant percentage of CMF NBIs still required evacuation out of theater (27.8% of NBIs vs. 42.2% of BIs, p < 0.0001), depleting the combat strength of the deployed forces. CONCLUSIONS: CMF NBIs accounted for a substantial portion of total CMF injuries. Though characterized predominantly by blunt trauma with an overall better prognosis, its burden to the limited resources of a deployment can be significant. This descriptive study highlights the need to allocate appropriate resources for treatment of these injuries as well as strategies to reduce both its incidence and severity. LEVEL OF EVIDENCE: IV Prognostic.
    Journal of cranio-maxillo-facial surgery: official publication of the European Association for Cranio-Maxillo-Facial Surgery 04/2013; · 1.25 Impact Factor
  • Atlas of the oral and maxillofacial surgery clinics of North America 03/2013; 21(1):61-8.
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    ABSTRACT: PURPOSE: The mandible is the most commonly fractured bone in the craniomaxillofacial skeleton among military casualties. The purpose of this study was to characterize the nature and severity of mandibular fractures incurred by US military personnel during combat. MATERIALS AND METHODS: We queried the Joint Theater Trauma Registry from October 2001 to April 2011 using all pertinent International Classification of Diseases, Ninth Revision codes to identify fractures of the mandible. Fractures were then classified based on type and location. Chart reviews were performed on the subset of patients who were treated at San Antonio Military Medical Center to further classify the anatomic pattern and treatment of these fractures. RESULTS: We identified 391 patients with mandibular fractures, of whom 45 were transferred to San Antonio Military Medical Center. Open fractures were seen in 75% of patients. Two or more fractures of the mandible were seen in 51% of patients. Comminuted fractures were present in 84%, and 31% had segmental losses. Eighty-six percent of fractures were operative; two-thirds of patients required a single surgical procedure, whereas the remaining one-third required multiple procedures. Forty-six percent of patients had pan-facial fractures. CONCLUSIONS: Mandibular fractures as a result of combat blast injuries were characterized by a high incidence of open, comminuted, multiple fractures. Associated facial fractures were common.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 01/2013; · 1.58 Impact Factor
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    ABSTRACT: This study provides objective data on the practice of allograft usage in severely burned patients. Furthermore, gaps in our knowledge are identified, and areas for further research are delineated. Using an institutional review board-approved protocol, active duty military patients injured while deployed in support of overseas contingency operations and treated at our burn center between March 2003 and December 2010 were identified. Their electronic medical records were reviewed for allograft use, TBSA burned, injury severity score, anatomic distribution of burns, operative burden, length of stay, transfusions, and outcome. Among 844 patients, 112 (13.3%) received allograft and 732 (86.7%) did not. The amount of allograft used per patient varied and was not normally distributed (median, 23.5; interquartile range, 69.5). Patients received allograft skin an average of 12.75 times during their admission. Allografted patients sustained severe burns (¼, 53.8% TBSA); most were transfused (71.2%) and grafted frequently, averaging every 7.45 days. Most commonly, allograft was placed on the extremities (66.5%) followed by the trunk (44.2%); however, the vast majority of allografted patients also had concomitant burns of the head (91.1%) and hands (87.5%). All-cause mortality among the allografted patients was 19.1%. In conclusion, allograft is commonly used in the surgical treatment of severe burns. Although there are no anatomic limitations to allograft placement, there are distinct patterns of use. Given the role of allograft in the acute management of large burns, there is need for further investigation of its effect on mortality, morbidity, and antigenicity.
    Journal of burn care & research: official publication of the American Burn Association 01/2013; 34(1):168-75. · 1.54 Impact Factor
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    ABSTRACT: Improved armor and battlefield medicine have led to better survival in the wars in Iraq and Afghanistan than any previous ones. Increased frequency and severity of craniomaxillofacial injuries have been proposed. A comprehensive characterization of the injury pattern sustained during this 10-year period to the craniomaxillofacial region is needed to improve our understanding of these unique injuries, to optimize the treatment for these patients, and to potentially direct strategic development of protective equipment in the future. The Joint Theater Trauma Registry was queried from October 19, 2001, to March 27, 2011, covering operations Enduring Freedom and Iraqi Freedom for battle injuries to the craniomaxillofacial region, including patient demographics and mechanism of injury. Injuries were classified according to type (wounds, fractures, burns, vascular injuries, and nerve injuries) using DRG International Classification of Diseases-9th Rev. diagnosis codes. In this 10-year period, craniomaxillofacial battle injuries to the head and neck were found in 42.2% of patients evacuated out of theater. There is a high preponderance of multiple wounds and open fractures in this region. The primary mechanism of injury involved explosive devices, followed by ballistic trauma. Modern combat, characterized by blast injuries, results in higher than previously reported incidence of injury to the craniomaxillofacial region. Epidemiologic study, level IV.
    The journal of trauma and acute care surgery. 12/2012; 73(6 Suppl 5):S453-8.
  • The journal of trauma and acute care surgery. 12/2012; 73(6 Suppl 5):S409-16.
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    ABSTRACT: Facial injuries sustained by US military personnel during the wars in Iraq and Afghanistan have increased compared with past conflicts. Characterization of midface fractures (orbits, maxilla, zygoma, and nasal bones) sustained on the battlefield is needed to improve our understanding of these injuries, to optimize treatment, and to potentially direct strategic development of protective equipment in the future. The military's Joint Theater Trauma Registry was queried for midface fractures from 2001 to 2011 using International Classification of Diseases, Ninth Revision diagnosis codes. Stratification was then performed, and individual treatment records from Brooke Army Medical Center were reviewed. Analysis of the fracture pattern, treatment, and complications was performed. One thousand seven hundred sixty individuals with midface fractures were identified. Those fractures sustained in battle were characterized by a predominance of open fractures, blast etiology, and associated injuries. Detailed record reviews of the patients treated at our institution revealed 45% of all midface fractures as operative. Thirty-one percent of these were treated at levels III and IV facilities outside the continental United States before arrival at our institution. Patients with midface fractures underwent multiple operations. There was a 30% rate of complication among operative fractures characterized by malalignment, implant exposure, and infection. Midface battle injuries also had a high incidence of orbital fractures and severe globe injuries. Midface fractures sustained in the battlefield have a high complication rate, likely as a result of the blast mechanism of injury with associated open fractures, multiple fractures, and associated injuries. These cases present unique challenges, often requiring both soft tissue and skeletal reconstruction.
    The Journal of craniofacial surgery 11/2012; 23(6):1587-91. · 0.81 Impact Factor
  • Davin Mellus, Rodney K. Chan
    Perioperative Nursing Clinics 03/2012;
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    ABSTRACT: Large body surface area burns pose significant therapeutic challenges. Clinically, the extent and depth of burn injury may mandate the use of allograft for temporary wound coverage while autografts are serially harvested from the same donor areas. The paucity of donor sites in patients with burns involving large surface areas highlights the need for better skin substitutes that can achieve early and complete coverage and retain normal skin durability with minimal donor requirements. We have isolated autologous stem cells from the adipose layer of surgically debrided burned skin (dsASCs), using a point-of-care stem cell isolation device. These cells, in a collagen-polyethylene glycol fibrin-based bilayer hydrogel, differentiate into an epithelial layer, a vascularized dermal layer, and a hypodermal layer. All-trans-retinoic acid and fenofibrate were used to differentiate dsASCs into epithelial-like cells. Immunocytochemical analysis showed a matrix- and time-dependent change in the expression of stromal, vascular, and epithelial cell markers. These results indicate that stem cells isolated from debrided skin can be used as a single autologous cell source to develop a vascularized skin construct without culture expansion or addition of exogenous growth factors. This technique may provide an alternative approach for cutaneous coverage after extensive burn injuries.
    Stem cells international. 01/2012; 2012:841203.
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    ABSTRACT: Oral incompetence following composite reconstruction of total and subtotal lower lip defects without any functioning lower lip muscle is a difficult problem for reconstructive surgeons. The authors retrospectively reviewed the use of a novel bilateral temporalis suspension technique for oral incompetence following lower lip reconstruction over a 10-year period. The timing of the reconstruction, cause of the defect, period of follow-up, and any complications were noted. Three cases of lower lip resuspension using bilateral temporalis flaps and fascia lata grafts were performed from 2000 to 2010. Two cases were secondary to burn trauma and one was from ballistic trauma. All patients underwent traditional means of reconstruction using free microvascular composite tissue transfer with and without fascial slings. All three patients presented with persistent lower lip incompetence. The average interval between the initial reconstructive operations and the resuspension operations was 1.6 years. All patients achieved dynamic oral competence at the first postoperative visit. At a mean follow-up of 3.6 years, all patients had maintained lower lip function. Dynamic lower lip resuspension with bilateral temporalis flaps and fascia lata grafts is an option for refractory lower lip drooping following total and subtotal loss, especially after conventional static reconstruction and without any functional orbicularis muscle. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
    Plastic and reconstructive surgery 01/2012; 129(1):119-22. · 2.74 Impact Factor
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    ABSTRACT: Locoregional breast cancer recurrence is a relatively rare event, occurring more frequently in patients diagnosed with more advanced stages of cancer and those with inflammatory features. While typical signs of recurrence after reconstruction include the development of a mass in the native skin or deep chest wall, oncologic relapse may also rarely be heralded by subtle cutaneous changes. This article describes a patient with inflammatory breast cancer who underwent neoadjuvant chemotherapy, mastectomy, radiation therapy, and hormonal therapy followed by delayed reconstruction with a deep inferior epigastric artery perforator flap and subsequently presented with a recurrence manifest as a localized rash over the upper abdomen. Surgeons who perform breast reconstruction should be attuned to both common and uncommon recurrence symptoms, as they may be the first to diagnose recrudescent disease.
    Annals of plastic surgery 03/2011; 66(3):233-4. · 1.29 Impact Factor
  • Journal of Plastic Reconstructive & Aesthetic Surgery 02/2011; 64(5):e135-6. · 1.44 Impact Factor
  • Journal of Oral and Maxillofacial Surgery - J ORAL MAXILLOFAC SURG. 01/2011; 69(9).
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    ABSTRACT: Mechanical stimuli are known to play an important role in determining the structure and function of living cells and tissues. Recent studies have highlighted the role of mechanical signals in mammalian dermal wound healing. However, the biological link between mechanical stimulation of wounded tissue and the subsequent cellular response has not been fully determined. The capacity for researchers to study this link is partially limited by the lack of instrumentation capable of applying controlled mechanical stimuli to wounded tissue. The studies outlined here tested the hypothesis that it was possible to control the magnitude of induced wound tissue deformation using a microfabricated dressing composed of an array of open-faced, hexagonally shaped microchambers rendered in a patch of silicone rubber. By connecting the dressing to a single vacuum source, the underlying wounded tissue was drawn up into each of the microchambers, thereby inducing tissue deformation. For these studies, the dressings were applied to full-thickness murine dermal wounds with 200 mmHg vacuum for 12 h. These studies demonstrated that the dressing was capable of inducing wound tissue deformation with values ranging from 11 to 29%. Through statistical analysis, the magnitude of the induced deformation was shown to be a function of both microchamber height and width. These results demonstrated that the dressing was capable of controlling the amount of deformation imparted in the underlying tissue. By allowing the application of mechanical stimulation with varying intensities, such a dressing will enable the performance of sophisticated mechanobiology studies in dermal wound healing.
    Journal of Biomedical Materials Research Part A 11/2010; 95(2):333-40. · 2.83 Impact Factor
  • Julian J Pribaz, Rodney K Chan
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    ABSTRACT: This article reviews historical aspects of flap development, leading up to the exciting recognition of perforator flaps. The role and use of perforator-type flaps in the reconstructive armamentarium is reviewed as it pertains to different regions of the body.
    Clinics in plastic surgery 10/2010; 37(4):571-9, xi. · 0.95 Impact Factor
  • Rodney K Chan, Julian J Pribaz
    Plastic and reconstructive surgery 07/2010; 126(1):37-9. · 2.74 Impact Factor
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    ABSTRACT: Deep inferior epigastric artery perforator (DIEP) flap is an excellent option for breast reconstruction in young and active patients who have a history of chest wall radiation. One drawback, however, is that the entire capacity of abdominal pannus cannot be reliably transferred on a single pedicle. The purpose of this case report is to demonstrate a method of maximizing the volume of reconstruction with a dual-pedicled DIEP flap. A case is reported in which both antegrade and retrograde internal mammary vessels were used as recipient sites for a dual-pedicled, folded, stacked DIEP flap. Good flows were observed in both sets of recipient vessels intraoperatively. Postoperative imaging revealed patent vascular anastomoses of both pedicles. At 1-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved. To maximize the volume of the reconstructed breast, the entire abdominal pannus can be utilized. The retrograde limb of internal mammary vessels can act as the recipient site for the second pedicle, minimizing donor site morbidity.
    Eplasty 01/2010; 10:e32.
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    ABSTRACT: Objective: Microvascular thrombosis is a dreaded complication of free tissue transfer, especially in breast reconstruction. Failure often leads to complete loss of the reconstruction and affects the patient both physically and psychologically. Fortunately, most vascular compromises occur early (within 24-36 hours) while the patient is still in the hospital and intervention takes place prior to irreversible thrombosis of the microvasculature. However, failures beyond 96 hours generally have dismal prognosis, especially because the patient is already home. Methods: A case of successful salvage is reported after an uncomplicated superior gluteal artery perforator flap performed for breast reconstruction returned from home with thrombosis of the venous pedicle the morning of postoperative day 5. Results: The pedicle was promptly explored and the venous patency reestablished using a combination of mechanical and chemical thrombolysis. At her 2-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved. Conclusion: Late salvage of failing free flap breast reconstruction from home is possible. Educating the patient on importance of self-examination is critical to salvage. The hospital system also needs to have the resources to handle such emergencies in order for rapid operative mobilization to expedite the patient's care.
    Eplasty 01/2010; 10:e63.

Publication Stats

536 Citations
100.96 Total Impact Points

Institutions

  • 2014
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
  • 2010–2014
    • U.S. Army Institute of Surgical Research
      Houston, Texas, United States
    • University of Virginia
      • Department of Surgery
      Charlottesville, VA, United States
  • 2013
    • San Antonio Military Medical Center
      Texas City, Texas, United States
  • 2011–2012
    • Brooke Army Medical Center
      Houston, Texas, United States
  • 2004–2012
    • Brigham and Women's Hospital
      • • Division of Plastic Surgery
      • • Center for Brain Mind Medicine
      • • Department of Medicine
      Boston, MA, United States
  • 2004–2010
    • Harvard Medical School
      • Department of Surgery
      Boston, Massachusetts, United States