Allen Gabriel

Allen Gabriel
PeaceHealth · Department of Plastic Surgery

MD, FACS

About

147
Publications
18,674
Reads
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3,686
Citations
Citations since 2017
52 Research Items
2303 Citations
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20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500

Publications

Publications (147)
Article
Full-text available
Matching breast implant gel cohesivity to the patient’s needs based on anatomical and soft tissue considerations and patient preferences is essential to optimizing aesthetic outcomes and patient satisfaction. Generally, gel cohesivity contributes to the feel and shape of the breast, which reflects volume distribution within the breast. Studies on t...
Article
Full-text available
Background:. Surgical site complications (SSCs) after median sternotomy, such as deep sternal wound infection and sternal dehiscence, are rare but can be catastrophic. If undetected, there is an elevated risk of mortality. Reconstructive surgery consisting of debridement, sternectomy, and muscle flap coverage is widely used as standard of care for...
Article
Background: Prepectoral implant-based breast reconstruction is gaining in popularity. Acellular dermal matrices (ADMs) are an integral part of prepectoral reconstruction. However, large quantities of ADM are required for total implant coverage and the cost of ADMs could be a deterrent to reconstruction. To minimize the cost, the authors have resor...
Article
Full-text available
Prosthetic breast reconstruction via the subpectoral approach in morbidly obese patients (body mass index: ≥40 kg/m2) has been reported to be associated with an increased risk of perioperative complications and poor outcomes. Further, immediate reconstruction appears to carry a higher risk of poor outcomes than delayed reconstruction in this popula...
Article
Full-text available
Background: Prepectoral implant-based breast reconstruction is an alternative to subpectoral/dual-plane reconstruction. Methods: This study examined outcomes of prepectoral reconstruction using a meta-analysis of data pooled with data from our previous review. Thirty studies were included. Results: Explantation, seroma, and infection were the...
Article
Full-text available
An economic model was developed to estimate the cost of negative pressure wound therapy with instillation and dwelling of a topical wound solution vs control therapies. Economic model inputs were means derived from the results of a recently published systematic review and meta‐analysis of 13 comparative studies of negative pressure wound therapy wi...
Article
Full-text available
As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become...
Article
Textured breast implants have garnered increased attention recently because of their risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon and treatable type of T-cell lymphoma. Treatment involves bilateral en bloc capsulectomy, which is curative in the majority of cases. At present, there is no defined management...
Article
Background: Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d. Methods: A systematic...
Article
Complex lower extremity wounds can present challenges in healing due to the cause of injury or previous surgery, presence of infection or tissue necrosis, patient comorbidities, or a combination of these factors. Negative pressure wound therapy (NPWT) modalities play a major role in the perioperative management of patients with complex wounds and t...
Article
Full-text available
Wounds from orthopedic limb reconstruction are often difficult to heal due to the surgery, patient comorbidities, or a combination of these factors. The role of negative pressure wound therapy (NPWT) modalities in the perioperative management of patients with complex lower extremity wounds is evolving. Here, we present a case study using adjunctive...
Article
Full-text available
Background: Povidone-iodine has been traditionally used as an antimicrobial agent to irrigate the breast pocket and rinse the prosthesis before placement in the pocket. Use of povidone-iodine with breast implants was banned from 2000 to 2017. During this period, acellular dermal matrix (ADM) was introduced to breast surgery. In nonclinical studies...
Article
Background: Breast reconstruction in patients with high body mass index (BMI ≥30 kg/m) is technically challenging and is associated with increased postoperative complications. The optimal reconstructive approach for these patients remains to be determined. This study compared outcomes of prepectoral and dual-plane reconstruction in high BMI patien...
Article
Impaired wound healing is estimated to affect about 2% of the US population, and a major goal of health care providers (HCPs) is to better understand delayed healing so they can effectively choose advanced wound dressings to manage these wounds. However, there are estimated to be more than 3000 dressing options available, making dressing selection...
Article
Breast augmentation remains one of the most commonly performed aesthetic procedures in the United States and worldwide. Throughout the last few decades, the implants used for this procedure have undergone significant advancements, which has allowed surgeons to provide safer and more aesthetically pleasing outcomes. This article discusses the histor...
Article
Full-text available
Guided wave-optics has emerged as a promising platform for label free biosensing. However, device sensitivity toward surface-bound small molecules is directly limited by the evanescent interaction and low confinement factor with the active sensing region. Here, we report a mesoporous silicon waveguide design and inverse fabrication technique that r...
Article
Background: Body mass index (BMI) has been shown to be a predictor of outcomes after subpectoral expander/implant reconstruction, with every unit increase in BMI increasing the risk of complications by about 6%. The effect of BMI on complications after prepectoral reconstruction has not yet been evaluated and is the purpose of this study. Methods...
Article
Full-text available
Background: Closed incision negative pressure therapy (ciNPT) is an emerging approach to managing closed incisions of patients at risk of postoperative complications. There are primarily 2 different commercially available ciNPT systems. Both systems consist of a single-use, battery-powered device and foam- or gauze-based peel-and-place dressing de...
Article
Full-text available
An important component of practicing evidence-based medicine (EBM) in plastic surgery is staying current with published research, an increasingly difficult task given the rapid growth of the literature. This article reviews the methodological aspects specific to the aesthetic surgery field that should be considered when evaluating the quality of ev...
Article
Implants vary in width, height, projection, volume, fill consistency, shell surface, and shape. Given the wide variety of implants that are available, selecting an implant that best suits a patient can be challenging. This article reviews the principles governing implant selection. Based on the authors' clinical experience, an algorithm for implant...
Article
BACKGROUND: Breast cancer accounts for 30% of all new cancer diagnoses in women. Although more options are now available regarding breast reconstruction, the risk of complications (eg, infection, dehiscence, and expander exposure) is also prevalent and must be considered when choosing a reconstruction option because the cost for complications can b...
Article
BACKGROUND: Surgical site infections (SSIs) pose a significant surgical complication. Application of closed-incision negative-pressure therapy (ciNPT) has been associated with reduced SSI rates in published literature. This meta-analysis examines the effect of ciNPT use over closed incisions in reducing SSIs versus traditional dressings. METHODS: A...
Article
Postoperative complications such as surgical site infections, dehiscence, seromas, and hematomas prolong wound care and impose significant cost increases to patients and healthcare providers. Clinicians aiming to reduce the incidence of these complications should be aware of risk factors associated with surgical type, procedures used, patient chara...
Article
Full-text available
Background:. Studies report that incision management with closed incision negative pressure therapy (ciNPT) may provide clinical benefits, including protecting surgical incisions, for postsurgical closed incisions (eg, orthopedic, sternotomy, and colorectal). This retrospective analysis compared postoperative outcomes in patients who received ciNPT...
Article
The increase in wound prevalence means more patients with wounds are being transferred through care settings than ever before. Although the goals of therapy may be the same in both settings, wound care therapies and dressings differ in availability and appropriateness for each setting. Negative pressure wound therapy (NPWT) modalities and oxidized...
Article
Full-text available
Background Several growth factors and hyaluronic acid (HA) are implicated in fetal scarless healing. Whether these factors can be applied toward an adult scar to improve scar characteristics is unknown. Objective This study compared the efficacy and safety of SKN2017B, a proprietary topical cream consisting of selective synthetic recombinant human...
Article
Full-text available
Background: AlloDerm Ready To Use (RTU) is a sterile version of AlloDerm regenerative tissue matrix, developed in response to concerns regarding the potential risk of infectious complications with the latter aseptic matrix. Clinical data on AlloDerm RTU use is, however, limited, particularly with respect to histologic evidence of graft integration...
Article
Full-text available
Importance Understanding what drives breast cancer (BC) patient’s surgical decision-making and why, as survival continues to improve, are women continuing to choose mastectomy in increasing numbers. Objective We sought to understand better what drives patient choice in surgical decision-making regarding BC treatment options. Design We used a dyna...
Article
Background Animation deformity is a direct consequence of subpectoral implant placement for breast reconstruction following mastectomy. Current treatment options ameliorate but do not address the source of the problem. Moving the implant from subpectoral to prepectoral has the potential to eliminate animation deformity. Objectives Describe the tec...
Article
Background: Pre-pectoral breast reconstruction is an emerging surgical approach. This study provides an early assessment of outcomes with the technique. Methods: A comprehensive literature review was performed through searches of PubMed® /MEDLINE® to identify studies on pre-pectoral reconstruction. Patient characteristics and outcomes were extra...
Conference Paper
We report a porous silicon photonics platform that addresses the evanescent limitations of guided wave surface adlayer biosensors. Devices are realized through an inverse fabrication process and ultra-high sensitivity to small molecule adlayers is demonstrated.
Chapter
The goal of breast reconstruction is to recreate a breast that looks and feels like the natural breast. In order to achieve this goal, a collaborative approach to the surgical planning should be undertaken prior to any incisions. To have an excellent outcome in reconstruction, the plastic surgeon must have an excellent mastectomy flap quality. This...
Article
Implant-based reconstructions continue to remain on the forefront of breast reconstruction as the prepectoral approach gains popularity. This article reviews the challenging patients that surgeons face when evaluating their candidacy for prepectoral reconstruction. The prepectoral approach for thin, high body mass index and previously radiated pati...
Article
Background Prosthetic breast reconstruction in the setting of radiotherapy is associated with poor outcomes. Until recently, prosthetic breast reconstruction was predominantly performed by placing the prosthesis in a subpectoral space. Placement of the prosthesis in a prepectoral space is currently emerging as a simpler, alternative approach to sub...
Chapter
As different chest wall and breast correction procedures continue to be reported, it is important to identify and understand the existing chest and breast deformities. This chapter reviews the incidence of these deformities with pictures of patients with advanced photography. An explanation for these deformities is hypothesized that they may be dir...
Article
Implant-based breast reconstruction is currently performed with placement of the implant in a subpectoral pocket beneath the pectoralis major muscle, by means of the dual-plane approach. Although the safety and breast aesthetics of this approach are well recognized, it is not without concerns. Animation deformities and accompanying patient discomfo...
Article
Full-text available
Background: Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes. Objectives: To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and process...
Article
Full-text available
Although immediate postmastectomy breast reconstruction is favored over delayed reconstruction, it remains associated with high complication rates. Potential complications include seroma formation, dehiscence, infection, and tissue necrosis along incision edges. Closed incision negative pressure therapy (ciNPT; Prevena Incision Management System, K...
Article
Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an...
Article
Addition of an instilled topical wound solution to negative pressure wound therapy (NPWT) is designed to facilitate regular wound cleansing to help improve outcomes of some complex wounds, but the addition of instillation to NPWT adds a level of complexity to the wound care process. The paucity of knowledge and experience with instillation may affe...
Article
Summary: Breasts reconstructed with implants, following mastectomy, lack the soft-tissue envelope of natural breasts. Further implant-related complications such as implant visibility, rippling/wrinkling, and/or hollowing/depression of the skin that often appear in the vicinity of the upper pole may be attributed to soft-tissue deficits. To address...
Chapter
In 2008, the Centers for Medicare and Medicaid Services adapted a list from the National Quality Forum consisting of ten hospital-acquired conditions (HAC), also known as never events. Deeming such events as preventable in a safe hospital setting, reimbursement is no longer provided for treatments arising secondary to these events. A retrospective...
Article
Negative pressure wound therapy with instillation (NPWTi) and dwell time is an adjunctive treatment modality for selected complex wounds. Because of the greater amount of research now available, a multidisciplinary expert panel comprising the fields of podiatry, plastic and general surgery, burn treatment, infectious diseases, and orthopedics was c...
Article
Full-text available
Cicero Urban and Mario Rietjens, eds. Oncoplastic and Reconstructive Breast Surgery . New York, NY: Springer, 2013. ISBN-10: 8847026512, ISBN-13: 978-8847026513, $239.00. ![Graphic][1] Oncoplastic and Reconstructive Breast Surgery is a nice addition to existing reference guides for breast reconstructive surgery. Many principles are discussed by...
Article
Autologous fat grafting is widely used in breast surgery to refine and optimize aesthetic outcomes. Despite its widespread use, obtaining predictable, reliable, and consistent outcomes remains a significant challenge and is influenced by the technique used for procurement, processing, and placement of the fat. At present, there is no published cons...
Article
Full-text available
Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advance...
Article
Full-text available
Background: Botulinum toxin A has been successfully used in a variety of areas to temporarily obliterate muscle mobility for either functional or aesthetic gain. Tissue expander-based breast reconstruction has been plagued with pain and discomfort. Objective: The purpose of this pilot study was to evaluate the role of a neurotoxin (Botulinum tox...
Article
Seth Thaller and Zubin Panthaki. eds. Aesthetic and Reconstructive Breast Surgery. Boca Raton, FL: CRC Press; 2012. ISBN-10: 1841848476, ISBN-13: 978-1841848471, $279.95. ![Graphic][1] The text Aesthetic and Reconstructive Breast Surgery is an additional book that adds to the existing base of breast surgery texts that have been published. Nowada...
Article
Full-text available
A growing body of literature supports use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) with positive clinical outcomes and potential cost savings. A retrospective analysis was performed to compare clinical outcomes of wounds treated with NPWTi-d versus NPWT and to estimate cost-differences between treatments...
Article
Revisionary breast surgery in previously augmented patients is complex, with many variables that have to be considered. Obtaining durable repairs is challenging because these patients often present with thinned breast tissue, inadequate local tissue, and/or scarred breast envelope from multiple procedures. Capsular contracture, ptosis, tissue atrop...
Article
Introduction: Skin grafts have long been an important tool in reconstructive surgery. However, traditional autografts have several disadvantages, including the need for a surgical procedure with anesthesia, creation of a second wound at the donor site, difficulty in obtaining uniform graft thickness, scarring, and pain. Epidermal skin grafts offer...
Article
Full-text available
Background: Body dysmorphic disorder (BDD) is characterized by a preoccupation with a slight or imagined defect in physical appearance. It has significant implications for patients who desire breast reconstruction, because patient satisfaction with the aesthetic outcome is a substantial contributor to the success of the procedure. Objectives: The a...
Conference Paper
Previous commercially available negative pressure wound therapy (NPWT) systems with instillation (NPWTi) have typically delivered solutions continuously (without soak time) to the wound bed. However, recent studies have demonstrated the successful use of NPWTi using volumetric automated instillation during wound healing. We evaluated the efficacy o...
Article
Background: Revision breast surgery represents a significant problem among patients who have undergone augmentation mammaplasty. Current techniques do not adequately prevent recurrence, thus requiring novel approaches, including placement of Strattice (LifeCell, Branchburg, New Jersey), a non–cross-linked porcine acellular dermal matrix, to minimiz...
Article
Positive results have been demonstrated with the adjunctive use of negative pressure wound therapy (NPWT) and instillation (NPWTi) for stalled and/or complex wounds. With these combined therapies, instillation assists in wound bed preparation and cleansing by loosening soluble material in the wound bed, which can be subsequently removed during the...
Article
Combined use of adjunctive negative pressure wound therapy (NPWT) and instillation of topical wound solutions and suspensions (NPWTi) has proven to be an effective next-generation NPWT technique for wounds at risk for compromised healing. Fluid instillation has been shown to enhance exudate and debris removal, provide regular cleansing of the wound...
Article
Negative pressure wound therapy with instillation (NPWTi) is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy. A panel of experts was convened to provide guidance regarding the appropriate use of NPWT...
Article
Effective postoperative analgesia is a prerequisite to enhance the recovery process and reduce morbidity. The use of local anesthetic techniques is well documented to be effective, but single-dose techniques (infiltration, peripheral blocks, neuraxial blocks) have been of limited value in major operations because of their short duration of analgesi...
Article
Background: Augmentation mammaplasty and augmentation mastopexy are associated with a substantial primary and secondary revision rate. Capsular contracture (CC), implant malposition, ptosis, asymmetry, and rippling are the main reasons for revisionary surgery in these patients. Traditional corrective techniques have not been completely reliable in...
Conference Paper
BACKGROUND: Acellular dermal matrices (ADMs) used in two-stage breast reconstructions continue to evolve to meet the needs of patients and plastic surgeons. Two features, ready to use and sterility are of particular importance, however, maintaining a product that continues to incorporate is desired in order to avoid adverse effects on recovery. The...
Article
The literature has reported that surgical site infections account for 17-22% of health care-associated infections, while surgical wound dehiscence rates range from 0.25% to 3.0% (post laparatomies), 1.6% to 42.3% (post-caesarean incisions) and 0.5% to 2.5% (sternal incisions). These types of incisional complications can become a significant cost bu...
Article
Nearly all wounds are at risk for compromised healing due to excessive exudation, oedema, contaminants and presence of inflammatory mediators. Compromised wounds have the potential to develop complications, such as infection, which may lead to delayed wound healing, prolonged hospitalisation and more frequent readmissions. It is generally believed...
Article
Female glandular hypomastia is a frequently encountered entity that occurs either developmentally or by postpartum involution. Historically, women have long sought breast enlargement to improve physical proportions, to foster a more feminine appearance, or to enhance self-image. This chapter explores the evolution of breast implants, and discusses...
Article
Background: Soft tissue deficits associated with exposed tendon and absent paratenon pose difficult reconstructive problems due to tendon adhesions, poor range of motion, poor cosmesis, and donor site morbidity. Integra Bilayer Matrix Wound Dressing (Integra Lifesciences Corp Plainsboro, NJ) is a skin substitute widely used in reconstructive surge...
Article
As negative pressure wound therapy (NPWT) use over skin grafts has increased, traditional methods of NPWT system reimbursement and application are increasingly being challenged. A simplified method of accessing and operating NPWT in the outpatient setting is needed, particularly in cases where immediate outpatient use of NPWT is optimal. We evaluat...
Article
Various techniques for obtaining expedient aesthetic coverage of soft tissue defects with limited donor site morbidity have been developed, including the use of a dermal regeneration template (DRT) as the first step in a two-stage surgical approach. Use of DRT in reconstruction has increased as a result of reports suggesting improved cosmetic resul...