Michael W Neumeister's research while affiliated with Southern Illinois University School of Medicine and other places

Publications (160)

Article
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Background: Breast reconstruction is associated with improved quality of life after mastectomy. Options for breast reconstruction include autologous and implant-based methods. Although autologous reconstruction is more technically challenging and requires longer operative time, it is thought of as the gold standard. Our study examined differences...
Article
Background The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. Methods The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a porti...
Article
Fractures of the phalangeal or metacarpal bones of the hand are common. Many of these fractures are treated without surgery. However, both conservative and operative management of fractures of the hand can result in stiffness. Stiffness is the most common complication in the management of hand fractures. The key to preventing stiffness is early ran...
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The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions,...
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Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.
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Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma i...
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Adjuvant therapy plays an integral role in the treatment algorithm for stage III and stage IV cutaneous melanoma. Current ongoing clinical trials are exploring the effects of neoadjuvant therapeutics, specifically for the presurgical treatment of high-risk, borderline resectable disease. In both the adjuvant and neoadjuvant settings, the early chem...
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While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, an...
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Mucosal melanoma is a rare but aggressive cancer arising in mucosal surfaces most commonly in the head and neck. The clinical presentation is often nonspecific and differs in relation to the site of origin so often diagnosis is delayed resulting in poor prognosis. Mucosal melanoma has a 5-year survival of only 25%. Surgery with negative margins is...
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Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and...
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This article reviews the nomenclature, anatomic components, and physiologic growth involving the perionychium. Fingertip and nailbed injuries are commonly encountered problems in hand surgery. This article focuses primarily on dealing with chronic nailbed deformities following traumatic injury such as nonadherence, split nails, avulsion loss, and h...
Article
Purpose Targeted muscle reinnervation (TMR) has emerged as a treatment for, and prevention of, symptomatic neuromas and has been reported to be of benefit in the hand. Anatomical studies establishing landmarks for consistent identification of the motor entry points (MEPs) to the intrinsic muscles have not been performed. The purpose of this study w...
Article
Complex regional pain syndrome (CRPS) has been described as pain a patient feels that is disproportionate to the inciting event. CRPS is also associated with autonomic dysfunction, swelling, dystrophic skin changes, stiffness, functional impairment, and eventual atrophy. This hyperalgesic disease affects musculoskeletal, neural, and vascular struct...
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This article discusses the pathophysiology, presentation, cause, and treatment of ischemic pain in the surgical patient. Causes of ischemic pain vary but all fundamentally cause local acidosis in the peripheral tissues, which causes signals to be passed through ascending pain pathways to the thalamus and eventual cerebral cortex where it is interpr...
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Neuroma formation occurs because of some degree of nerve injury followed by improper intrinsic nerve repair. The cause of neuroma pain is incompletely understood, but appears to be multifactorial in nature, including local and system changes. A comprehensive understanding of nerve anatomy, injury, and repair techniques should be used when dealing w...
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Pain involves a complex interplay between messages sent from the periphery to the central nervous system and vice versa. Specific pathways play a vital role in carrying these messages, and modulating, or exacerbating their downstream effects. This review describes the anatomy and physiology of pain emphasizing targeted treatment pathways of pain.
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Fibromyalgia is characterized by generalized pain, specific sites of musculoskeletal tenderness, fatigue, sleep disturbance, headaches, and many other visceral and cognitive maladies. The epidemiology is not well-elucidated and the diagnoses and management can be difficult. Surgery may not be the most appropriate management of some of these pain co...
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Targeted muscle reinnervation (TMR) has been shown to decrease neuroma pain after major limb loss; however, it has not previously been described for the treatment of symptomatic neuromas in the hand after digit amputations. This report describes the use of TMR in the hand for treatment of a patient with recurrent neuromas after ray amputation of th...
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Background: Hand and distal forearm allotransplantation has advanced over the last 20 years from experimental to a viable treatment option for bilateral upper extremity amputation. Despite widespread growth of this field, there are few technical reports that elaborate the details of donor arm procurement. This article details a technique for rapid...
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Listing the world's first pediatric bilateral hand transplant patient for a donor posed many challenges including matching the appropriate donor age, bone size, skin tone, and growth potential in an already limited donor population. This study describes the prevalence and distribution of potential pediatric VCA donors in the United States. We asses...
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Objective: The aim of this study was to describe an operative performance rating system for plastic surgery residents and provide validity evidence for the instrument. Methods: Three plastic surgery residents (PGY levels 1, 5, and 6) from Southern Illinois University School of Medicine (SIUSOM) performed a carpal tunnel release with audio video...
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Background: Upper extremity transplantation is a quality-of-life enhancing treatment for select patients with upper extremity loss. This article reviews the preoperative, intraoperative, and postoperative challenges in the upper extremity transplantation process and the lessons learned from the first 2 decades of hand transplantation. Methods: K...
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Background Vascularized composite allotransplantation (VCA) is an emerging and growing field. Little is known about the prevalence and distribution of the adult potential donor population in the United States now that it falls under the oversight of the United Network for Organ Sharing (UNOS). Methods We assessed the UNOS database from 2008 to 201...
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Background Historically, external ear melanomas have been treated aggressively, due to early perceptions suggesting they had poor prognosis and aggressive biological behavior. More recent evidence has not supported these notions. Methods We completed a complete review of the literature involving malignant melanoma of the external ear. We then comp...
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Background: Limited methods exist to aid in deciding the appropriate donor limb lengths in bilateral upper limb amputees qualifying for vascularized composite allotransplantation. We hypothesized mathematical equations could be created using long bone length ratios, and applied to radiographs, to approximate the patient's limb length prior to ampu...
Article
This article provides a clinician's guide to nutritional support of the burn patient. The authors review the assessment and management of the needs of the thermally injured patient and provide recommendations on replacement and supplementation with calories, protein, carbohydrates, lipids, fluids, and minerals. Furthermore, the authors compare and...
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Background: Recent data suggest an increased risk for infection when acellular dermal matrix is used in breast reconstruction. This may be because some acellular dermal matrices are actually not terminally sterilized but are instead "aseptically processed." This study evaluates aseptic and sterile matrices for evidence of bacterial contamination a...
Article
This article describes the use of prefabricated flaps in burn reconstruction. Several case examples are provided that demonstrate the versatility and power of this approach to restoration of form and function after burn injury.
Article
Improvements in critical care and burn victim resuscitation have led to increased survival of burned patients. Initial resuscitation, early excision of burned tissues, prevention of burn wound sepsis, and wound coverage remain mainstays of care. Many burn wounds require complex reconstruction. This is particularly important in the hand. Coverage of...
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Objective: Postsurgical pyoderma gangrenosum is a rare but potentially devastating condition for surgical patients. While pyoderma gangrenosum has 2 subtypes, typical and atypical, each can be further classified by its heralding features. These include ulcerative, pustular, bullous, and vegetative. The presentation can be a result of trauma or, as...
Article
Background: Although there has been tremendous research in the ability of mesenchymal-derived adipose derived stem cells (ADSCs) to form bone, less is known regarding the molecular mechanisms that regulate the osteogenic potential of ADSCs. Notch, which consists of a key family of regulatory ligands involved in bone formation, is expressed in the...
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Background: As the use of acellular dermal matrices in breast reconstruction has become more commonplace and efforts are made to improve on postoperative outcomes, the method of acellular dermal matrix (ADM) processing (aseptic versus sterile) has become a subject of interest. This article provides an updated overview of the critical aspects of ADM...
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Introduction: Osteosynthesis in forearm-level allotransplantation is technically challenging. Achieving adequate cortical contact simultaneously between the radius and ulna proves difficult due to differing bone morphology of donor and recipient. In addition, the large area of dissection around the osteotomy sites and use of immunosuppressants furt...
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Objective: Hand burns are commonly seen in patients with burn injury. In the past, focus was on lifesaving measures, but with advances in burn care during the last century, the paradigm shifted to digital salvage and eventually to functional digital salvage. Good outcomes are heavily dependent on the care that is rendered during the initial manage...
Article
Background: Recent literature has shown that full-thickness wounds, devoid of the stem cell niche, can subsequently be reconstructed with functional skin elements following migration of the LGR6 epithelial stem cell into the wound bed. In this study, the authors use a variety of LGR6 epithelial stem cell-seeded scaffolds to determine therapeutic u...
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Introduction: The individual implications of major burns are likely to affect the full spectrum of patients' physical, emotional, psychological, social, environmental, spiritual and vocational health. Yet, not all of the post-burn health implications are inevitably negative. Utilizing a qualitative approach, this heuristic phenomenological study e...
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Background The aim of this study was to determine the optimal salvage time window within which ischemic postconditioning can be used to ameliorate ischemia/reperfusion (I/R) injury in skeletal muscle. Methods A total of 48 Sprague-Dawley rats were divided into two groups: I/R only (control) and I/R with postconditioning. Subgroups were divided by d...
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Digits 2 through 5 (index, middle, ring, and small) all have a distal, middle, and proximal phalanx. Digit 1, the thumb, has a distal and proximal phalanx only. A neurovascular bundle is on each side of the finger. Each of the five digits has both flexor and extensor tendons. There are six dorsal extensor tendons of the wrist. The extensor tendon i...
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Figures 5.1, 5.2, and 5.3 illustrate the surface anatomy of the proximal wrist. The wrist is composed of the distal radius and ulna, which articulate with each other to form the radioulnar joint. The distal radius also articulates with the scaphoid and lunate bones. The distal ulna articulates with the triangular fibrocartilage complex (TFCC), whic...
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Tendon without paratenon presents the reconstructive surgeon with a tissue coverage challenge. Integra® dermal regenerative template has been shown to initiate a stable, vascularized bed for skin grafting over tendon. However, histological processes that occur during incorporation have not been described. The purpose of this study is to characteriz...
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Raynaud phenomenon may be a primary disorder or associated with a variety of other autoimmune processes. Raynaud phenomenon produces digital vasospasm, which can lead to ischemia and ulceration. The treatment of Raynaud phenomenon has been difficult because multiple medical treatments have not provided uniform resolution of symptoms. Many patients...
Conference Paper
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BACKGROUND: Over the last decade, use of acellular dermal matrix in both breast surgery and abdominal wall reconstruction has gained popularity. Because the body's ability to integrate ADM, they have been touted as resistant to infection. Although this has been the case in hernia repair, 3 recent meta-analyses have demonstrated an increased risk of...
Article
Background: Subungual melanoma typically presents as a darkened longitudinal stripe under the nail plate; however, this disease is frequently misdiagnosed, which leads to a delay in proper diagnosis. Subsequently, subungual melanoma historically has a relatively poor prognosis compared with other cutaneous melanomas, with the 5-year survival rate...
Article
Metacarpal fractures are among the most common fractures of the upper extremity. Surgical management is generally offered for unstable or significantly displaced fractures. A more conservative, nonsurgical approach, however, may provide safe, rapid recovery while maintaining normal active range of motion. This article reviews the nonsurgical approa...
Article
This view of Early Practice of hand surgery presents the perspective of a PGY6 Resident followed by the perspective of the expert clinician and trainer of new hand surgeons. Tips from both Resident and Expert provide the early practitioner useful clinical advice as well thoughts on how to approach continued education through the course of a career...
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The management of mutilated upper extremity wounds offers challenges for all hand surgeons. Loss of composite tissues usually requires grafts or flaps to gain coverage and restore function. Nonsalvagable digits or amputated parts are a source of spare tissues that can be used for reconstruction of the hand or limb. Immediate tissue transplantation...
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The incidence of both benign and malignant bone tumors arising in the hand is relatively low in comparison with other locations. Although the overwhelming majority of these tumors are benign, even benign tumors can be locally destructive and compromise hand function. Intralesional tumor excision is the most appropriate surgical intervention for man...
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After studying this article, the participant should be able to: 1. Describe and apply the current evidence-based treatment of acute flexor tendon injuries. 2. Compare and contrast the current postoperative therapy regimens following repair of flexor tendons. 3. Apply an evidence-based decision-making process for suture techniques of flexor tendon i...
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The recently discovered leucine-rich repeat-containing G-protein coupled receptor 6 (LGR6) epithelial stem cell located within the follicular bulge of the adnexal compartment is capable of producing all cellular lineages of the skin. In this study, the authors sought to determine whether these cells can be transplanted for use as a type of cellular...
Article
Although the mechanism is unknown, botulinum toxin type A injection may be an effective, localized, nonsurgical treatment option without addictive properties or systemic side effects for the treatment of ischemic digits. Clinical research supports the safety and efficacy of injection of botulinum toxin type A for the treatment of Raynaud phenomenon...
Article
Hand tumors of the skin and soft tissue are frequently encountered by plastic surgeons. Although similar to lesions affecting other parts of the body, the presentation, workup, and treatment options often differ in the hand secondary to its complex anatomy and functional significance. The purpose of this article is to provide an overview of those l...
Chapter
Fully updated throughout, the second edition of the Manual of Botulinum Toxin Therapy provides practical guidance on the use of Botox in a wide variety of disorders. New chapters have been added on the use of botulinum toxin in wound healing, in focal hand dystonia and in thoracic outlet syndrome, as well as others. There are new chapters on the us...
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We present a single-case analysis of the taking of a stitch within a surgical procedure. All work carried out in the OR of a teaching hospital is held to exacting standards and scrutinized at all points regarding its adequacy. We examine how this kind of assessment is carried out with respect to a particular stitch taken by a surgeon-in-training in...
Chapter
Introduction: The cardiopulmonary, neurologic and psychiatric sequelae of cocaine are well documented. However, little is known of the devastating cutaneous manifestations of cocaine. When cocaine is cut with the common adulterant levamisole, significant impact on the integument ensues. Patients may suffer from a continuum of purpura and petichiae...
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Background: Recent evidence suggests that lipofilling improves overlying skin composition and appearance. Adipose-derived stem cells (ADSC) have been implicated. Objective: The authors identify ADSC transdifferentiation into epithelial stem cells through coexpression of GFP+ (green fluorescent protein positive) ADSC with the epithelial stem cell ma...
Article
Discovery of leucine-rich repeat-containing G-protein-coupled receptors 5 and 6 (LGR5 and LGR6) as markers of adult epithelial stem cells of the skin and intestine permits researchers to draw on the intrinsic cellular fundamentals of wound healing and proliferation dynamics of epithelial surfaces. In this study, the authors use the intestine-derive...
Conference Paper
Objective: Since Raynaud’s phenomenon affects an estimated 28 million Americans, causing ischemia, severe pain, and nonhealing ulcers, our objectives are to examine the short- and long-term effectiveness of Botulinum Toxin Type A (Btx-A) injections in treating digit ischemia and pain due to Raynaud’s disease/phenomenon. Methods: A prospective, ra...
Article
Cancer stem cells (CSCs) or circulating tumor cells play an important role in tumor initiation, invasion, metastasis and resistance to anticancer therapies. Therapies that target gastric tumor CSCs have potential clinical application for preventing malignant gastric tumor progression and metastasis. We isolated CD44+ gastric cancer cells from the g...
Article
Clinical data registries are commonly used worldwide and are implemented for a variety of purposes ranging from physician or facility clinic logs for tracking patients, to collecting outcomes data, to measuring quality improvement or safety of medical devices. In the United States, the U.S. Food and Drug Administration has used data collected throu...
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Full-text available
Primary bone healing fails to occur in 5–15 % of scaphoid bones that undergo fracture fixation. Untreated, occult fractures result in nonunion up to 12 % of the time. Conventional bone grafting is the accepted management in the treatment algorithm of scaphoid nonunion if the proximal pole is vascularized. Osteonecrosis of the proximal scaphoid pole...
Article
Background Controlled post-operative motion of extensor tendon repairs in zones IV–VII is intended to facilitate tendon excursion and minimize adhesion formation. The Wyndell Merritt “relative motion” digital yoke orthosis provides a low-profile option allowing for immediate controlled active motion (ICAM) of the extensor tendon repair. The additio...
Article
In 2011, the American Society of Plastic Surgeons (ASPS) created the Task Force on Regenerative Medicine to address the Society's strong interest in the emerging field of regenerative medicine, particularly cell- and tissue-based therapies applicable to plastic surgery procedures. The Task Force's U.S. Food and Drug Administration's Workgroup is in...
Article
Preconditioning has been considered promising for the treatment of ischemic flaps. In this study, the therapeutic effect of postconditioning was compared with that of preconditioning during ischemia/reperfusion (I/R) injury, and a role of inducible nitric oxide synthase (iNOS) in postconditioning treatment was also explored. Sixty rats were randoml...
Article
Adhesion formation limits functional recovery after flexor tendon repair. Various growth factors have been implicated in the adhesion scar process. Early growth response factor-1 (EGR-1), a transcription factor associated with synthesis of a variety of key fibrotic growth factors and expression of extracellular matrix genes, has never been identifi...
Article
Hyperbaric oxygen (HBO2) treatment has been shown to stimulate angiogenesis in prefabricated myocutaneous flaps. We conducted the current study to determine optimal HBO2 treatment intervals for peak angiogenesis. Lewis rats were implanted subcutaneously with silicone molds in the inguinal region. Molds contained inguinal fat, a vascular pedicle and...
Article
Ischemia of the hand remains an uncommon condition, but problems with arterial perfusion of the hand can arise from trauma (open and closed), thrombosis, or arteriovascular disease. Certain identifiable patterns are seen with hand ischemia, usually discernable according to which one of the major arteries (radial or ulnar) are involved. This article...