Gaby Doumit

Massachusetts General Hospital, Boston, Massachusetts, United States

Are you Gaby Doumit?

Claim your profile

Publications (24)44.39 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Constriction rings are associated with amniotic band syndrome and most often present in the extremities. Constriction bands of the trunk are rare, and a standard of surgical care remains elusive. Traditional methods of constriction ring excision rely on soft-tissue rearrangement with multiple Z-plasties, but renewed interest in linear closure and limited Z-plasty has emerged. The authors review contemporary literature and report two cases of abdominopelvic constriction ring reconstruction with long-term follow-up. Novel techniques including anterior sheath Y-V plasty, pteruges release of the Scarpa fascia, and limited Z-plasty closure may minimize the need for serrated scar patterns.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Epitheloid hemangioma (EH) is a vascular tumor characterized by an epithelioid endothelial cell. Predominantly affecting the head and neck, fewer than 30 cases involving the scrotum have been published. As this represents an extremely rare entity, a multitude of anecdotal treatment modalities have been utilized including systemic/intralesional steroid therapy, radiotherapy, and chemical therapy. However, surgical excision remains the most widely accepted treatment option.We present a case of EH of the scrotum in a 14-year-old male patient that regressed after treatment with naproxen sodium. To the best of our knowledge, this represents the first reported case of scrotal EH regression following treatment with naproxen sodium.
    Journal of Craniofacial Surgery 11/2014; 25(6):2059-61. DOI:10.1097/SCS.0000000000001144 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A systematic review was conducted to compare the speech outcomes and fistula rates following repair of the cleft palate with Furlow double-opposing Z-plasty and straight-line intravelar veloplasty techniques. Methods: A systematic search of the English literature published in the MEDLINE, Ovid, and Embase electronic databases was performed using the following keywords: cleft palate, intravelar veloplasty, velopharyngeal insufficiency, and speech outcome. The exclusion criteria were as follows: syndromic patients, no description or poor description of the technique used, data not stratified by cleft palate type, two-stage cleft palate repair, average age at repair younger than 9 months or older than 18 months, and age at the last follow-up younger than 4 years. Statistical analysis was used to compare the rate of secondary operations and the incidence of velopharyngeal insufficiency. Results: Twelve studies satisfied the inclusion criteria. In the isolated cleft palate group, the mean failure rates were 9.7 and 16.5 percent for Furlow double-opposing Z-plasty and straight-line intravelar veloplasty closure, respectively. In the unilateral cleft lip-cleft palate group, the mean failure rates were 11.1 and 17.1 percent for Furlow and straight-line intravelar veloplasty closure, respectively. The difference in the odds of requiring secondary surgery in the straight-line intravelar veloplasty repair group versus the Furlow group was statistically significant (p = 0.03) in unilateral cleft lip-cleft palate. Conclusion: This systematic review indicated an increased incidence of velopharyngeal insufficiency as revealed by higher odds of secondary operations in the straight-line intravelar veloplasty repair of unilateral cleft lip-cleft palate when compared with Furlow Z-plasty.
    Plastic &amp Reconstructive Surgery 11/2014; 134(5):1014-22. DOI:10.1097/PRS.0000000000000637 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose-Maxillary artery has been traditionally considered the main blood supply of the facial skeleton(1). However, the deep and concealed location of the artery in the infratemporal and pterygopalatine fossae enclosed by the cranial base, mandible and maxilla makes the harvest of facial allografts based on this artery challenging and preference has been given to the facial artery to vascularize the facial allografts(2,3). The purpose of this study was to investigate the vascular territories of the maxillary artery and vein and modify the available craniofacial techniques in order to allow reliable harvest of a facial osteomyocutaneous allograft based on the maxillary vessels. Methods-Eighteen fresh cadaver heads were used in this study. Ten full facial allografts containing mandible, maxilla, zygomatic and nasal bones were harvested through a traditional Le Fort III approach. In 6 cadaver heads, maxillary artery and internal jugular vein were injected with red and blue latex respectively. In two cadaver heads colored lead oxide gel was injected in the maxillary artery (1) or internal jugular vein (1). A modified Le Fort III approach was designed: the orbital floor osteotomy was performed at the posterior-most aspect of the orbit. The zygomatic arch and mandibular condyle were osteotomized and removed. The pterygomaxillary disjunction was performed under direct vision after excising the temporalis and lateral pterygoid muscles. Eight full facial allografts were harvested through the modified approach. Maxillary artery and vein were dissected to assess for damage during the procurement. CT scans were performed of the 2 specimen injected with lead oxide. Results- When the traditional Le Fort III approach was used to harvest the facial allograft, the terminal branches of the maxillary artery (the infraorbital and the sphenopalatine arteries) and the pterygoid plexus were injured constantly. The modified approach preserved these branches and allowed the dissection of the maxillary artery and vein under direct vision. Conclusions- Maxillary artery should be considered as the main blood supply of the facial allograft when a major portion of the facial bones is to be harvested along with limited amount of facial soft tissues. The described modified Le Fort III approach allowed the safe dissection of the maxillary artery and vein, preserving the main blood supply to the facial skeleton.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Craniosynostosis is a pathologic condition which is characterized by the premature fusion of cranial sutures. It may occur alone or in association with other anomalies making up various syndromes. Crouzon syndrome is the most common craniosynostosis syndrome. Bicoronal sutures fusion is most commonly involved in Crouzon syndrome. There have only been a handful of cases of squamosal suture synostosis described in the surgery literature with the few ones described in Crouzon syndrome associated with other types of craniosynostosis. To the best of our knowledge, we are presenting the first case of isolated bilateral squamosal suture synostosis in a patient with Crouzon syndrome in a radiology journal with emphasis on its radiological appearance.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Vascularized composite allotransplantation (VCA) has experienced a growing acceptance, which has led to a debate centered on extending the indications of the procedure to include pediatric patients. The aim of this article was to discuss such indications based on the evidence in pediatric solid organ transplantation, reconstructive surgery in children, and VCA in adult patients. Methods: Papers published on the outcomes of pediatric solid organ transplantation, growth after replantation of extremities, vascularized autologous tissue transfer, craniofacial surgery, orthognathic procedures, facial fractures, and outcomes after repair of peripheral nerves in children were reviewed. Results: Although the outcomes of solid organ transplantation in children have improved, the transplanted organs continue to have a limited lifespan. Long-term immunosuppressive therapy exposes the patients to an increased lifetime risk of infections, diabetes, hypertension, dyslipidemia, cardiovascular disease, and malignancy. Growth impairment and learning disabilities are other relevant drawbacks, which affect the pediatric recipients. Nonadherence to medication is a common cause of graft dysfunction and loss among the adolescent transplant recipients. Rejection episodes, hospitalizations, and medication adverse effects contribute negatively to the quality of life of the patients. Although normal growth after limb transplantation could be expected, pediatric facial transplant recipients may present with arrest of growth of transplanted midfacial skeleton. Conclusions: Considering the non-life-threatening nature of the conditions that lead to eligibility for VCA, it is suggested that it is premature to extend the indications of VCA to include pediatric patients under the currently available immunosuppressive protocols.
    Annals of Plastic Surgery 07/2014; 73(4). DOI:10.1097/SAP.0000000000000300 · 1.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Graves ophthalmopathy is a chronic, multisystem, autoimmune disorder characterized by increased volume of intraorbital fat and hypertrophic extraocular muscles. Proptosis, impaired ocular motility, diplopia, lid retraction, and impaired visual acuity are treated with orbit decompression and fat reduction. The authors present the addition of skeletal augmentation to further improve periorbital aesthetics. Methods: Through a transconjunctival with lateral canthotomy incision, a balanced orbital decompression was executed, removing medial and lateral walls and medial floor. Intraorbital fat was excised. All patients underwent placement of porous polyethylene infraorbital rim implants and midface soft-tissue elevation, increasing inferior orbital rim projection and improving the globe-cheek relationship. From 2009 to 2012, 13 patients (11 female and two male; 26 eyes) with Graves ophthalmopathy underwent surgery at two institutions. Outcomes were evaluated for improvements of proptosis, diplopia, dry eye symptoms, and cosmetic satisfaction. Results: Postoperative follow-up ranged from 0.5 to 3 years (median, 1.5 years). The mean improvement on Hertel exophthalmometry was 5.4 mm. Diplopia resolved in three patients (23 percent). No patients had worsening diplopia, and 12 (92 percent) discontinued use of eye lubricants. All patients had cosmetic satisfaction. One patient suffered temporary inferior orbital nerve paresthesia. There were no infections, hematomas, or ocular complications. Conclusions: Skeletal augmentation is a useful adjunct to orbital decompression and fat excision for treating Graves ophthalmopathy. Balanced orbital decompression with infraorbital rim implants is reliable, effective, and safe, with good, lasting results. Resolution of ocular symptoms is improved, as are the patient's personal well-being and social life, with a high-benefit to low-risk.
    Plastic and Reconstructive Surgery 05/2014; 134(3). DOI:10.1097/PRS.0000000000000453 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since 2009, a synthetic material known as kryptonite has become increasingly utilized during cranioplasty to repair bony defects. It provides bone-like strength and adhesive properties that make it a suitable replacement for bone. However, applications have been observed in the immediate postoperative period that demonstrates an increase in its original volume, giving rise to irregularities in the cranial surface. Ten kryptonite samples were reconstituted and allowed to polymerize according to the manufacturer's directions. The kryptonite samples were molded into a cylindrical shape, and they were immersed in 10 graduated cylinders filled with normal saline. Measurements of the rise in saline relative to baseline were taken at 0, 10, 20, 30, 40, 50, and 60 minutes, and then hourly through 5 hours, with the final measurement recorded at 24 hours. The mean expansion of kryptonite was approximately 49% with an SD of 22%. The bulk of the expansion occurred within the first 2 hours, after which the rate tended to plateau for the remaining 22 hours. Kryptonite has been touted as an excellent alternative for repairing contour abnormalities manifested in cranioplasty. Given the unpredictability of its expansile properties, the surgeon must take this variability into careful consideration when planning the desired surgical outcome.The results of the current study were communicated with the manufacture. Immediately thereafter, the manufacturer withdrew the product from the US market and is no longer Food and Drug Administration approved for cranioplasty.
    The Journal of craniofacial surgery 04/2014; 25(3). DOI:10.1097/SCS.0000000000000508 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present the complete results of our 2013 survey of the members of the American Society of Maxillofacial Surgery (ASMS). We surveyed all 799 members of the Society from around the world regarding educational themes and modalities they wish to add to future ASMS educational programs. We also asked our members about surgical modalities and care paths in which they have the most expertise.The objective of the survey was to provide data that can be used to improve the education and training of the ASMS members. The results suggest that some widely taught topics perhaps should be taught less, whereas coverage of other topics should be increased.
    The Journal of craniofacial surgery 03/2014; 25(3). DOI:10.1097/SCS.0000000000000702 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Enophthalmos, the posterior displacement of a normal-size ocular globe relative to the orbital cavity, is usually repaired using autogenous grafts or alloplastic materials. We present the case of a 40-year-old man with bilateral idiopathic enophthalmos whose symptoms recurred 8 years after initial successful surgical repair. We describe the successful and safe use of a bilateral temporoparietal adipofascial flap in the treatment of recurrent idiopathic enophthalmos.
    The Journal of craniofacial surgery 03/2014; 25(2):676-8. DOI:10.1097/SCS.0000000000000490 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the craniofacial surgery literature, there is a wide disparity of opinions regarding the appropriate treatment of nonsyndromic sagittal synostosis. With the lack of level 1 evidence to support a particular regimen, our study aims to elucidate the current state of practice among craniofacial surgeons with the hope of establishing a standard of care. An internet-based survey was sent to 102 craniofacial surgeons in 14 countries on 4 continents. Data were collected regarding the following parameters: primary indication for surgery, preference of timing, and choice of operative intervention for patients presenting with nonsyndromic isolated sagittal synostosis with normative intracranial pressure values. Surgeons were also queried regarding preoperative, intraoperative, and postoperative protocols. After 2 mailings, the response rate was 58% (59/102). For 63% of respondents, skull deformity was the primary indication for treatment of craniosynostosis.Open surgical management of sagittal craniosynostosis was most commonly performed at 6 months (35%) of age. Total cranial vault remodeling was the most commonly performed procedure (37%). Thirty-five percent of craniofacial surgeons chose an endoscopic surgical approach for patients presenting at younger than 4 months. Only 10% of craniofacial surgeons selected spring-assisted strip craniectomy. Seventy-one percent of polled surgeons performed computed tomographic scans of the skull in all cases, irrespective of presentation. Our survey demonstrates that there exists a wide disparity of opinion regarding diagnosis and treatment of nonsyndromic sagittal synostosis. When current practice is compared to findings in the literature, significant discrepancies exist.
    The Journal of craniofacial surgery 01/2014; 25(4). DOI:10.1097/SCS.0b013e3182a24635 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Muenke syndrome caused by point mutation (C749G) in the FGFR3 gene affects 1 in 30,000 newborns and accounts for 25% to 30% of genetic causes of craniosynostosis. Anomalies in patients with Muenke syndrome include craniosynostosis, hypertelorism, sensorineural hearing loss, and developmental delay, among others. Most craniosynostoses in patients with Muenke syndrome involve bicoronal suture fusion. This article reports, for the first time, the existence of squamosal craniosynostosis in patients with Muenke syndrome.
    The Journal of craniofacial surgery 01/2014; 25(2). DOI:10.1097/SCS.0000000000000394 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maxillary artery is recognized as the main vascular supply of the facial bones; nonetheless clinical evidence supports a co-dominant role for the facial artery. This study explores the extent of the facial skeleton within a facial allograft that can be harvested based on the facial artery. Twenty-three cadaver heads were used in this study. In 12 heads, the right facial, superficial temporal and maxillary arteries were injected. In 1 head, facial artery angiography was performed. Ten facial allografts containing the mandible, naso-orbito-maxillo-zygomatic complex and tongue were raised. The soft tissues were dissected to show the arterial anastomotic connections and thereafter removed. Radiograms and CT scans were performed. Constant anastomosis between the facial, inferior alveolar and infraorbital arteries at the mental and infraorbital foramina were found. Facial artery vascularized the homolateral mandibular symphysis, body and ramus. The condylar and coronoid processes were vascularized in 67% of the allografts. The homolateral maxilla was contrasted in all allografts with the exception of the alveolar and palatine processes which contained the contrast in 83% of specimens. The maxillary process of the zygomatic bone was perfused in all allografts, followed by the body, frontal (83%) and temporal processes (67%). The nasal lateral wall and septum were vascularized in 83% of the allografts. The medial and lateral orbital walls and the orbital floor were stained in all specimens. The zygomatic process of the temporal bone was the least perfused bone. A composite allograft containing 90-95% of the facial bones can be based on bilateral facial arteries.
    Plastic and Reconstructive Surgery 01/2014; 133(5). DOI:10.1097/PRS.0000000000000111 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In health care, it is widely known that evidence-based medicine (EBM) has a significant impact on clinical practice, and opinion leaders can enhance the clinician's application of EBM in various disciplines. In this article, we examine the existence and impact of opinion leaders in craniofacial surgery as well as barriers to evidence-based practice. We compiled the answers of an Internet questionnaire, which was sent to 102 craniofacial surgeons. Our results demonstrate that opinion leaders most definitely can be identified in craniofacial surgery. They are tightly connected to their field's social network and promote EBM. In this survey, 44% of craniofacial surgeons reported that their greatest obstacle to clinical decision making in the management of nonsyndromic synostosis was lack of surgical consensus. In addition, craniofacial surgeons stated that EBM and opinion leaders are the most influential factors that caused them to change their management of craniosynostosis. We expect that the use of opinion leaders can further enhance the uptake of EBM in craniofacial surgery.
    The Journal of craniofacial surgery 01/2014; 25(1):106-10. DOI:10.1097/SCS.0b013e3182a2ea31 · 0.68 Impact Factor
  • Plastic &amp Reconstructive Surgery 01/2014; 133:1034. DOI:10.1097/01.prs.0000445859.18523.e0 · 3.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION Glabellar frown lines may produce a cosmetically unappealing appearance. Botulinum toxin and other injectable dermal fillers may reduce the appearance of these frown lines but their results are temporary.1 Percutaneous selective radiofrequency nerve ablation (RFA) is a minimally invasive method for treating the glabellar area.2 Several small series have reported success using RFA to treat glabellar furrowing, but there is morbidity associated with burns and extraneous damage to non-targeted tissue.3 Tumescence can be used to control temperature, pain, electrical conductivity and ease of needle penetration into different tissue layers. No studies have monitored the target muscles or looked at the histopathologic changes that can occur after muscle and nerve have been targeted with and without tumescent. In an effort to better target facial muscles and determine the histopathologic effects of RFA and tumescence on nerve and muscle tissue, we conducted a pilot study. METHODS Each gastrocnemius muscle (GC) of eight Lewis rats was ablated for either 30 (N=8) or 60 seconds (N=8) at 80°C with a 22-gauge custom made electrode. Sciatic nerves were ablated at the same temperature for 15 (N=8) or 30 seconds (N=8). Two rats were injected with 0.5mL of normal saline tumescent. Five rats were sacrificed at 4 days and three at 4 weeks. All nerves and muscles were stained with hematoxylin and eosin (H&E) and analyzed. RESULTS At longer ablation times the nerves showed inflammation, necrosis and degeneration at 4 days. With tumescent there was less inflammation, no necrosis and milder degeneration compared to the group without. The muscles ablated for 60 seconds without tumescent showed inflammation and necrosis and those ablated with tumescent showed minimal or no inflammation. At 4 weeks, the nerves showed severe constriction and the muscles were severely atrophic in rats without tumescent and with longer ablation times. No ambulation defects were observed. CONCLUSIONS RFA is effective in producing muscle and nerve damage in the Lewis rat GC without causing a noticeable ambulation defect. In this model, the use of directional tumescent lessens the degree of muscle inflammation and nerve necrosis on histopathologic examination. A larger study is needed to determine optimal variables for percutaneous RFA to produce a desired defect and if directional tumescence can be used as an adjunct to reduce morbidity.
    Plastic Surgery: The Meeting 2013; 10/2013
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction.
    The Journal of craniofacial surgery 07/2013; 24(4):1319-1321. DOI:10.1097/SCS.0b013e3182953a63 · 0.68 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cutaneous metastasis of esophageal cancer, in particular esophageal adenocarcinoma, is rare and metastasis to the scalp is extremely rare. We describe such a case that was originally diagnosed as an adnexal carcinoma. A 77-year-old male with a history of esophageal adenocarcinoma status after esophagectomy at our institution 4.5 years prior, presented to our plastic surgery clinic with a 2-month history of 2 temporoparietal scalp lesions. He was referred to our clinic by a community dermatologist who had performed a shave biopsy of the lesions. The clinical diagnosis was adnexal cyst. The history of esophageal carcinoma was not provided to the pathologist. The dermatopathology report came back as malignant adnexal neoplasm and considerations included apocrine carcinoma. We reexamined the pathologist's slides from the outside facility, comparing them to the histopathology from his esophagectomy. Histopathologic changes were identical. Thus, our surgical and postoperative approach changed significantly. Clinical suspicion should be high for cutaneous metastases in patients with a history of solid organ cancers. It is important for clinicians to illicit a history of malignancy. A biopsy should be performed on any suspicious lesions, and clinical data along with histopathology of the prior cancer resection(s) should be provided to the pathologist for comparison. Diagnosis of the suspicious lesion should be made before definitive excision, as this may change the approach, with the potential for postoperative chemotherapy and radiation. The definitive operative approach consists of surgical debulking with the evidence of negative margins. On the scalp, we feel that 5-mm margins are appropriate to obtain clear margins. One should appreciate the subdermal extent of metastases and adjust the margins accordingly. We recommend excising the galea with the skin as an en bloc resection. This will both assure clear deep margins of resection and assist in a tension-free closure of the scalp.
    Annals of plastic surgery 02/2013; 71(1). DOI:10.1097/SAP.0b013e318248b5e9 · 1.29 Impact Factor
  • The American surgeon 06/2011; 77(6):793-5. · 0.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Alloplastic implants can be adjunctive to orthognathic surgery by correcting contour irregularities or disharmonies after skeletal movements. Implant augmentation can also simulate the visual effect of osteotomies in patients with skeletal deficiencies whose occlusion is normal or has been corrected. Although sometimes it is an adjunct or an alternative to facial skeletal rearrangements, facial skeleton augmentation is not a substitute for orthognathic surgery. Alloplastic implants designed specifically to augment the infraorbital rim can correct the residual upper midface deficiency remaining after Le Fort I maxillary advancement. When used with paranasal and malar implants, they can simulate the visual effect of the Le Fort III osteotomy with advancement. Paranasal implants can simulate the appearance after Le Fort I advancement. Mandible and extended chin implants can correct skeletal irregularities and deficiencies after sagittal and horizontal osteotomies. They can also simulate the visual effect of these osteotomies. The application of these concepts has been effective, with low morbidity, in 294 patients. No implants extruded or migrated. Eight patients (3 percent) had early postoperative infections. There were no late infections. Ten of 108 patients (9 percent) with midface implants had implant visibility with time. Alloplastic augmentation of the facial skeleton can be a useful adjunct or an alternative to orthognathic surgical procedures in situations when the occlusion is normal or has been corrected.
    Plastic and Reconstructive Surgery 05/2011; 127(5):2021-30. DOI:10.1097/PRS.0b013e31820e9263 · 3.33 Impact Factor

Publication Stats

294 Citations
44.39 Total Impact Points

Institutions

  • 2014
    • Massachusetts General Hospital
      • Department of Surgery
      Boston, Massachusetts, United States
    • Case Western Reserve University School of Medicine
      • Department of Radiology
      Cleveland, Ohio, United States
  • 2013–2014
    • Cleveland Clinic
      • Department of Plastic Surgery
      Cleveland, Ohio, United States
    • Northeast Ohio Medical University
      Ravenna, Ohio, United States
  • 2007
    • The Ottawa Hospital
      Ottawa, Ontario, Canada