Stelios C Wilson

American Society of Ophthalmic Plastic and Reconstructive Surgery, New York City, New York, United States

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Publications (9)15.64 Total impact

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    ABSTRACT: Systematic reporting of mortality data is lacking in many surgical fields including plastic surgery. Current plastic surgery literature is largely limited to adverse events associated with specific procedures. Without mortality data, it is unclear how the recent growth of patient safety initiatives can rationally impact outcomes.
    Annals of plastic surgery. 11/2014;
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    ABSTRACT: Purpose: Morbidity and mortality (M&M) conferences have been an integral part of medical and surgical education for nearly a century. Despite this fact, the systematic reporting of mortality data is lacking in many surgical fields including plastic and reconstructive surgery. Current plastic surgery literature is mainly limited to adverse events associated with specific procedures. Methods: We evaluated 13 years of data collected at our monthly M&M conference. Paper records were entered into a HIPAA compliant digital database capable of prospectively maintaining future data. Data was reviewed for five surgical services in four different hospitals that comprise the vast majority of our department’s activity. Results: Between 2000 and 2013, our plastic surgery department performed a total of 60,834 cases. In this time, a total of 829 M&M case reports were submitted (1.4%). Of the submitted M&M case reports, a total of 25 cases (0.04%) had an end outcome of death (24) or brain death (1). Deaths were either directly or indirectly associated with cardiopulmonary causes, multisystem organ failure, sepsis, massive bleeding, CVA, saddle embolism, or unknown causes. Conclusions: To our knowledge, this study uses the largest sample of cases performed by a single academic plastic surgery service to report overall mortality data.
    Plastic and reconstructive surgery. 10/2014; 134(4S-1 Suppl):48.
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    ABSTRACT: Aesthetic procedures are significant sources of revenue for plastic surgeons. With the popularity of nonsurgical aesthetic procedures, many plastic surgeons question how to best tailor their aesthetic practice.
    Plastic &amp Reconstructive Surgery 06/2014; 133(6):783e-9e. · 3.54 Impact Factor
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    ABSTRACT: Subungual melanoma is a rare but lethal form of melanoma. Amputation at the level of the interphalangeal joint or proximal has been described as appropriate surgical management for all stages of subungal melanoma. In cases of subungual melanoma in situ (SMIS), wide local excision can improve functional and aesthetic outcomes. We reviewed our experience of wide local excision for the treatment of SMIS. Between 2003 and 2010, we treated 9 cases of SMIS. We performed a retrospective review of this series looking at the primary outcomes of recurrence or metastasis. Average age was 40 years (range, 5-65 years). Presenting lesions were on the thumb (5) and index finger (4). All patients underwent definitive reconstruction with a combination of full-thickness skin graft (8) and paronychial advancement flap (6). Reexcision was performed when disease-free margins could not be confirmed. To date, there have been no cases of metastasis or local recurrence in any of our 9 patients (mean follow-up time of more than 4 years). Wide local excision can improve functional and aesthetic outcomes with similar success in rates of local recurrence and metastasis when compared to treatment by amputation in SMIS.
    Annals of plastic surgery 07/2013; · 1.29 Impact Factor
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    ABSTRACT: Autologous breast reconstruction offers higher rates of patient satisfaction, but not all patients are ideal candidates, often due to inadequate volume of donor sites. Although autologous fat grafting is frequently used to augment volume and contour abnormalities in implant-based breast reconstruction, its clear utility in microsurgical breast reconstruction has yet to be defined. Here, we examined patients undergoing autologous microsurgical breast reconstruction with and without the adjunct of autologous fat grafting to clearly define utility and indications for use. A retrospective review of all patients undergoing autologous breast reconstruction with microvascular free flaps at a single institution between November 2007 and October 2011 was conducted. Patients were divided into 2 groups as follows: those requiring postoperative fat grafting and those not requiring fat grafting. Patient demographics, indications for surgery, history of radiation therapy, patient body mass index, mastectomy specimen weight, need for rib resection, flap weight, and complications were analyzed in comparison. Two hundred twenty-eight patients underwent 374 microvascular free flaps for breast reconstruction. One hundred (26.7%) reconstructed breasts underwent postoperative fat grafting, with an average of 1.12 operative sessions. Fat was most commonly injected in the medial and superior medial poles of the breast and the average volume injected was 147.8 mL per breast (22-564 mL). The average ratio of fat injected to initial flap weight was 0.59 (0.07-1.39). Patients undergoing fat grafting were more likely to have had deep inferior epigastric perforator and profunda artery perforator flaps as compared to muscle-sparing transverse rectus abdominis myocutaneous. Patients additionally were more likely to have a prophylactic indication 58% (n = 58) versus 42% (n = 117) (P = 0.0087), rib resection 68% (n = 68) versus 54% (n = 148) (P < 0.0153), and acute postoperative complications requiring operative intervention 7% (n = 7) versus 2.1% (n = 8) (P < 0.0480). Additionally, patients undergoing autologous fat grafting had smaller body mass index, mastectomy weight, and flap weight. Fat grafting is most commonly used in those breasts with rib harvest, deep inferior epigastric perforator flap reconstructions, and those with acute postoperative complications. It should be considered a powerful adjunct to improve aesthetic outcomes in volume-deficient autologous breast reconstructions and additionally optimize contour in volume-adequate breast reconstructions.
    Annals of plastic surgery 07/2013; 71(1):24-30. · 1.29 Impact Factor
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    ABSTRACT: BACKGROUND:: Acellular dermal matrix (ADM) has become a commonly used adjunct in immediate implant based breast reconstruction. It was popularized for its proposed benefits, which include lower pole coverage and greater initial tissue expansion. Several recent studies have revealed increased perioperative complications associated with its use. As a result of these findings, our institution placed strict limitations regarding the use of ADM. Recently, sterile "ready to use"(RTU) ADM was introduced and utilized as an alternative to the aseptic predecessor. The purpose of this investigation is to compare the infectious complications of breasts undergoing reconstruction with aseptic ADM and sterile "ready to use" ADM. METHODS:: After obtaining IRB approval and instituting strict guidelines for ADM use, a review of all patients undergoing immediate implant based breast reconstruction at New York University Medical Center over a two-year period, November 2010-October 2012, was conducted. Alloderm (Life Cell. Branchburg, NJ) was used solely as the source of ADM and RTU alloderm was introduced into use one year after initiating guidelines. Breasts were divided into three cohorts: total submuscular coverage, aseptic ADM, and sterile RTU ADM. These were then analyzed in comparison based on age, specimen weight, body mass index (BMI), the need for lymph node dissection, medical history, indication for surgery, breast cancer stage, use adjuvant/neoadjuvant chemotherapy and radiation, history of recent and remote breast surgery, smoking history, tissue expander (TE) size, initial TE fill, percentage TE fill, and complications including mastectomy skin flap necrosis, infection and need for explantation. RESULTS:: 546 breasts underwent immediate implant based breast reconstruction, including tissue expanders and immediate permanent implants, during the study period. 64.2% (n=351) had reconstruction without ADM, 16.4% (n=90) had reconstruction with aseptic ADM and 19.2% (n=105) had reconstruction with RTU ADM. When comparing breasts reconstructed with aseptic ADM to those with RTU ADM patients were similar in age, BMI, incidence of TE and implant reconstructions, indication for surgery, TE size, fill, and percentage fill, medical comorbidities and smoking status. However, patients undergoing reconstruction with RTU ADM were found to have a significant decrease in overall infection (8.5% versus 20.0% (p=0.0088)), major infection requiring IV antibiotics (4.7% versus 12.2% p=0.069), and need for explantation (1.9% versus 6.6% (p=0.1470) when compared to the aseptic cohort. The incidence of seroma and mastectomy skin flap necrosis was similar in both cohorts. When comparing patients undergoing reconstruction with RTU ADM to those having total submuscular coverage patients had similar overall infectious complications at 8.5% versus 5.7% (p=0.3602) respectively. Diabetes mellitus, postoperative seroma, mastectomy skin flap necrosis, and reconstruction with aseptic ADM were found to be independent predictors of infectious complications. CONCLUSION:: While not indicated for all patients, the use of RTU ADM in immediate implant based breast reconstruction provides an acceptable and useful adjunct. Additionally, RTU ADM mitigates the risks of infectious complications in patients undergoing immediate implant based breast reconstruction when compared to aseptic ADM.
    Plastic and reconstructive surgery 06/2013; · 2.74 Impact Factor
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    ABSTRACT: BACKGROUND: Infection requiring explantation remains the most devastating complication associated with implant-based breast reconstruction. There are many treatment algorithms to prevent reconstructive failure in face of infection using both oral and intravenous antibiotics. In the absence of patient-specific culture data, antibiotic selection is generally directed toward broad-spectrum coverage based on historical data. We hypothesize that reviewing our institution's microbiology data obtained from explanted implant-based breast reconstructions would provide a rational basis for antibiotic selection in the future. METHODS: A retrospective review of 902 consecutive immediate implant-based breast reconstructions at a single institution from November 2007 to May 2011 was conducted. Implant reconstructions requiring explantation or drainage by interventional radiology were identified. Patient demographics, implant characteristics, presence of skin necrosis, microbiological data, and outcomes were reviewed. RESULTS: Forty-three (4.76%) implant reconstructions requiring explantation or drainage by interventional radiology met the inclusion criteria for this study. Five patients (11.6%) had round, smooth silicone implants, and 36 (88.4%) had textured tissue expanders. Twenty-six implants were explanted because of infection; 3, because of exposure from skin necrosis; and 11, because of the combination of flap necrosis and infection; and 1, secondarily because of cancer invasion into the skin. Reconstruction was salvaged in 21 breasts (51.2%): 12 (57.1%) by implant reconstruction, 5 (23.8%) by pedicled latissimus dorsi flaps, and 4 (19.1%) with a microvascular free flap. Thirty explants had microbiology data available. The most common organism isolated was Staphylococcus epidermidis (10), followed by methicillin-sensitive Staphylococcus aureus (5), Serratia marcescens (5), Pseudomonas aeruginosa (4), enterococcus (3), Escherichia coli (2), Enterobacter (2), group B streptococcus (1), and Morganella morganii (1). Forty percent of the organisms were resistant to cefazolin; however, 86% were sensitive to gentamicin, 80% were sensitive to Levaquin, and 63% were sensitive to ciprofloxacin. CONCLUSIONS: Infection associated with implant-based breast reconstructions continues to threaten explantation and reconstructive failure. Based on our microbiological data, initial cellulitis amenable to oral antibiotics should be treated with oral fluoroquinolones as a first-line treatment. If this regimen fails, intravenous imipenem or gentamicin and vancomycin should be initiated. Obviously, clinical judgment regarding specific patient risk factors and compliance should play a role in decision making, but these data provide an evidence-based rationale for first-line oral antibiotic selection.
    Annals of plastic surgery 03/2013; · 1.29 Impact Factor
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    ABSTRACT: BACKGROUND:: Fingertip injuries are the most common hand injuries presenting for acute care. Treatment algorithms have been described based on defect size, bone exposure, and injury geometry. However, most of the outcomes data is associated with specific procedures and there is a dearth of comparative data across injury type. We hypothesized that despite accepted algorithms many fingertip injuries can be treated conservatively. METHODS:: A prospectively collected retrospective review of all fingertip injuries presenting to Bellevue Hospital between January 2011 and May 2011 was conducted. Patients were entered into an electronic database upon presentation. Follow-up care was tracked through the electronic medical record. Patients lost to follow-up were questioned via telephone. Patients were analyzed based on age, mechanism of injury, handedness, occupation, wound geometry, defect size, bone exposure, emergency room procedures performed, need for surgical intervention, and outcome. RESULTS:: 100 fingertips were injured. Injuries occurred by crush(46%), laceration(30%), and avulsion(24%). 64% of patients healed without surgery, 18% required operative intervention, and 18% were lost to follow up. Patients requiring operative intervention were more likely to have a larger defect, 3.28cm vs. 1.75 cm(p<0.005), volar oblique injury, 50% vs. 8.8%(p<0.005), exposed bone, 81.3% vs. 35.3%(p<0.005) and an associated distal phalanx fracture, 81.3% vs. 47.1%(p<0.05). Patients requiring surgical intervention had a longer average return to work time when compared to those not requiring surgical intervention, 4.33 vs. 2.98 weeks(p<0.001). CONCLUSION:: Despite current accepted algorithms, many fingertip injuries can be treated non-operatively to achieve optimal sensation, fine motor, and earlier return to work. LEVEL OF EVIDENCE:: Therapeutic Level 3.
    Plastic and reconstructive surgery 09/2012; · 2.74 Impact Factor
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    ABSTRACT: Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use. A retrospective analysis of 628 consecutive immediate two-stage tissue expander breast reconstructions at a single institution over a 3-year period was conducted. The reconstructions were divided into two groups: reconstruction with acellular dermal matrix and reconstruction without it. Demographic information, patient characteristics, surface area of acellular dermal matrix, and complications were analyzed and compared. A total of 407 patients underwent 628 immediate two-stage, implant-based breast reconstructions; 442 reconstructions (70.3 percent) used acellular dermal matrix and 186 (29.6 percent) did not. The groups had similar patient characteristics; however, major complications were significantly increased in the acellular dermal matrix group (15.3 versus 5.4 percent; p = 0.001). These complications included infection requiring intravenous antibiotics (8.6 versus 2.7 percent; p = 0.001), flap necrosis requiring excision (6.7 versus 2.7 percent; p = 0.015), and explantation of the tissue expander (7.7 versus 2.7 percent; p = 0.004). Use of acellular dermal matrix in immediate two-stage, implant-based breast cancer reconstruction is associated with a significant increase in major complications. Therefore, it should only be used in specific patients and in minimal amounts. Indications for its use include single-stage permanent implant reconstruction and inadequate local muscle coverage of the tissue expander. Therapeutic, III.
    Plastic and reconstructive surgery 05/2012; 129(5):1049-58. · 2.74 Impact Factor