[Show abstract][Hide abstract] ABSTRACT: Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease.
The Yale journal of biology and medicine 09/2014; 87(3):263-267.
[Show abstract][Hide abstract] ABSTRACT: Dermoid cysts are common, benign, embryologically derived soft tissue cysts that can arise at a variety of craniofacial sites. It is not known whether specific histological variations exist between the different craniofacial sites. This study aims to establish whether inter-site histologic differences exist between periorbital, nasal, scalp, and postauricular dermoid cysts and analyze these in context of their distinct embryological origin and varied clinical presentation.
The Yale journal of biology and medicine 09/2014; 87(3):349-57.
[Show abstract][Hide abstract] ABSTRACT: The prevalence of deformational plagiocephaly has risen dramatically in recent years, now affecting 15 percent or more of infants. Prior research using developmental scales suggests that these children may be at elevated risk for developmental delays. However, the low positive predictive value of such instruments in identifying long-term impairment, coupled with their poor reliability in infants, warrants the development of methods to more precisely measure brain function in craniofacial patients. Event-related potentials offer a direct measure of cortical activity that is highly applicable to young populations and has been implemented in other disorders to predict long-term cognitive functioning. The current study used event-related potentials to contrast neural correlates of auditory perception in infants with deformational plagiocephaly and typically developing children.
Plastic and reconstructive surgery. 06/2014; 133(6):835e-41e.
[Show abstract][Hide abstract] ABSTRACT: The optimal type of surgical management for isolated sagittal synostosis (ISS) remains a source of significant debate. A paucity of data exists on possible differences in long-term neuropsychological outcomes following treatment with whole vault cranioplasty or endoscopic strip craniectomy. This study provides the first comparative analysis examining the effects of the two techniques related to long-term intellectual functioning.
A total of 70 patients were enrolled in this multicenter study, 29 of whom had previously undergone endoscopic strip craniectomy and 41 of whom had previously undergone whole vault cranioplasty. All patients completed a battery of neurodevelopmental tests (Beery VMI, WASI, and Wechsler Fundamentals) in order to evaluate various domains of neuropsychological function.
In a group comparison of those treated before six months of age, whole vault patients obtained higher scores relative to endoscopic strip craniectomy patients on visual-motor integration, full scale IQ, verbal IQ, word reading, and reading comprehension (all p values < .05). When compared against strip craniectomy performed before three months of age, the whole vault group still showed significantly higher scores in verbal IQ, reading comprehension, and word reading (all p values < .05).
The type of surgical intervention for ISS impacts long-term neuropsychological outcomes. Patients undergoing early whole vault cranioplasty attained higher IQ and achievement scores relative to those undergoing strip craniectomy. Surgical management with whole vault cranioplasty performed before six months of age provides the most favorable long-term intellectual outcomes in patients with ISS.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutics, III.
Plastic & Reconstructive Surgery 05/2014; · 3.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Previous studies of outcomes following abdominal-based breast reconstruction largely use data from single-centre/surgeon experience. Such studies are limited in evaluating the effect of operative volume on outcomes. Abdominal-based breast reconstructive procedures were identified in the 2009-2010 HCUP Nationwide Inpatient Sample. Outcomes included in-hospital microvascular complications in free flap cases (requiring exploration/anastomosis revision), procedure-related and total complications in all cases, and length of stay (LOS). High-volume hospitals were defined as 90th percentile of case volume or higher (>30 flaps/year). Univariate and multivariate analyses were performed to identify predictors of outcomes. Of the 4107 patients identified, mean age was 50.7 years; 71% were white, 68% underwent free flap reconstruction, and 25% underwent bilateral reconstruction. The total complication rate was 13.2%, and the microvascular complication rate was 7.0%. Mean LOS was 4.5 days. There were 436 hospitals; 59% of cases were performed at high-volume institutions. Patients at high-volume hospitals more often underwent free flap reconstruction compared to low-volume hospitals (82.4% vs 50.5%, p < 0.001). On unadjusted analysis, microvascular complication rates of 6.4% vs 8.2% were observed for high-volume compared to low-volume hospitals (p = 0.080). After adjusting for case-mix, high-volume hospitals were associated with a decreased likelihood of suffering a microvascular complication (OR = 0.71, p = 0.026), procedure-related complication (OR = 0.79, p = 0.033), or total complication (OR = 0.75, p = 0.004). The majority of cases nationwide are performed at a small number of high-volume hospitals. These hospitals appear to discharge patients earlier and have lower microvascular, procedure-related, and total complication rates when controlling for case-mix.
Journal of plastic surgery and hand surgery. 03/2014;
[Show abstract][Hide abstract] ABSTRACT: There has been little discussion in the plastic surgery literature regarding breast shape preferences among plastic surgeons, despite strong evidence that such aesthetic preferences are influenced by multiple factors. Much effort has been focused on delineating the objective criteria by which an "attractive" breast might be defined. This study aimed at providing a better understanding of the presence and significance of differences in personal aesthetic perception, and how these relate to a plastic surgeon's demographic, ethnic, and cultural background, as well as practice type (academic vs private).
An interactive online survey was designed. Modifiable ranges of upper pole fullness and areola size were achieved via digital alteration, enabling participants to interactively change the shape of a model's breasts. The questionnaire was translated into multiple languages and sent to plastic surgeons worldwide. Demographic data were also collected. Analysis of variance was used to elucidate plastic surgeon's breast shape preferences in respect to sex and age, geographic and ethnic background, as well as practice type.
The authors gathered 614 responses from 29 different countries. Significant differences regarding preferences for upper pole fullness, areola size in the natural breast, and areola size in the augmented breast were identified across surgeons from the different countries. Further, significant relationships regarding breast shape preferences were distilled between the age and sex of the surgeon, as well as the practice type. No differences were found in respect to the surgeons' self-reported ethnic background.
Country of residence, age, and practice type significantly impact breast shape preferences of plastic surgeons. These findings have implications for both patients seeking and surgeons performing cosmetic and reconstructive breast surgery. In an increasingly global environment, cultural differences and international variability must be considered when defining and publishing new techniques and aesthetic outcomes. When both the plastic surgeon and the patient are able to adequately and effectively communicate their preferences regarding the shape and relations of the breast, they will be more successful at achieving satisfying results.
Annals of plastic surgery 03/2014; · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metopic synostosis represents an increasingly prevalent form of nonsyndromic craniosynostosis. Premature fusion of the metopic suture classically results in trigonocephaly, hypotelorism, temporal narrowing, and a pronounced midline forehead ridge. However, as varying degrees of skull deformity exist, there is confusion regarding the appropriate management for an infant with a metopic ridge. We report on a 2-month-old infant with clinical manifestations of metopic synostosis but with a patent metopic suture documented on computed tomography scan. We examine the implications for management related to fusion of the suture, age of the patient, and severity of the head deformity.
The Journal of craniofacial surgery 01/2014; 25(1):55-8. · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The relationship between age at the time of surgery and long-term neuropsychological (NP) outcomes in sagittal-suture craniosynostosis (SSC) remains equivocal. In current clinical practice, whole-vault cranioplasty (WVC) and strip-craniectomy (SC) are performed at various times in individuals with SSC. This study used comprehensive neurological testing to examine the relationship between age at the time of surgery and long-term NP function.
Methods: Seventy SSC patients who had previously undergone either WVC or SC were examined. Patients were divided by age of surgery into three groups: treatment before 6 months (n=41), between 6 and 12 months (n=21), and after 12 months (n=8). In order to examine long-term cognitive functioning, participants between the ages of 5 and 25 years underwent a battery of neurodevelopmental tests to evaluate intelligence, achievement, and learning disabilities (Beery VMI, WASI, and Wechsler Fundamentals).
Results: Compared to those treated between 6 and 12 months and after 12 months, patients who underwent surgery before 6 months demonstrated higher full-scale IQ (p < .01) and verbal IQ (p < .01). Patients who received surgery before 6 months also demonstrated superior abilities in word reading (p < .01), reading comprehension (p < .01), spelling (p < .01), and numerical operations (p <.05) relative to those who had surgery between 6 and 12 months of age. A statistically significant higher percentage of patients treated after 6 months had one or more reading-related learning disabilities as compared to those undergoing earlier surgery.
Conclusion: This study suggests that surgery before 6 months of age results in improved long-term neurological outcomes, as evaluated by intellect, achievement, and a reduction in learning disabilities. Future studies should examine how the technique of surgery impacts these neuropsychological measures.
Plastic & Reconstructive Surgery 01/2014; · 3.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Burns constitute a significant portion of the worldwide disability adjusted life years by compromising form and function. Through the field's numerous reconstructive techniques, plastic surgery can treat many of these deficiencies stemming from burn injuries. We describe the steps necessary to establish international burn missions including realizing synergies among nonprofits and academic plastic surgery centers to restore form and function to burn patients.
Annals of plastic surgery 07/2013; 71(1):31-33. · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The need for surgical care in Haiti remains vast despite the enormous relief efforts after the earthquake in 2010. As the poorest country in the Western hemisphere, Haiti lacks the necessary infrastructure to provide surgical care to its inhabitants. In light of this, a multidisciplinary approach led by Partners In Health and Dartmouth-Hitchcock Medical Center is improving the access to surgical care and offering treatment of a broad spectrum of pathology. This article discusses how postearthquake Haiti partnerships involving academic institutions can alleviate the surgical burden of disease and, in the process, serve as a profound educational experience for the academic community. The lessons learned from Haiti prove applicable in other resource-constrained settings and invaluable for the next generation of surgeons.
The Journal of craniofacial surgery 07/2013; 24(4):1244-1247. · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: Malposition of the lower eyelid may disrupt facial aesthetics and impair proper eyelid function. Multiple techniques have been proposed to restore lower eyelid position. The purpose of this study is to report on a modified bridge of bone canthopexy technique and assess its effect on lower eyelid and palpebral fissure restoration. METHODS: A retrospective chart review was conducted. Pre- and post-operative photographs of patients were evaluated by a blinded observer. Pair-wise and chi-square tests were conducted with an observed p-value of 0.05 or less considered statistically significant. RESULTS: 12 patients (7 females) with a mean age of 42 (range = 7-87) were included. Canthal tilt and scleral show decreased significantly following surgery (p = 0.05), and the eye fissure index and inferior coverage of the iris approached significance (p = 0.16 and p = 0.07, respectively). Two minor complications were encountered in our series. CONCLUSION: The modified bridge of bone canthopexy is a safe and effective technique for alteration of the lower eyelid and is broadly applicable to all causes of negative canthal angulation. Further studies are necessary to test the longevity and stability of this procedure.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2013; · 1.44 Impact Factor