Steven P Davison's research while affiliated with American University Washington D.C. and other places

Publications (110)

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Background: Prescription opioid misuse has been recognized as a national epidemic. The implications of this problem are especially important to consider, as postoperative opioid abuse can give rise to true addiction for surgical patients. The concept of enhanced recovery after surgery is increasingly used across various specialties to decrease the...
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As healthcare costs continue to rise at unsustainable rates (at an average rate of 5.5% a year), expenses without measurable outcomes need review.1 In reconstructive surgery, empiric change of instruments between oncologic and reconstructive segments of surgery is one such practice. Breast surgery for ductal carcinoma in situ (DCIS), prophylaxis, a...
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With the growing opioid epidemic, plastic surgeons are being encouraged to transition away from reliance on postoperative opioids. However, many plastic surgeons hesitate to use nonopioid analgesics such as nonsteroidal antiinflammatory drugs and local anesthetic blocks because of concerns about their safety, particularly bleeding. The goal of this...
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Background: In recent years, the practice of cosmetic surgery has expanded to include oral and maxillofacial surgeons. The groundwork for this scope-of-practice expansion was laid in part by the American Dental Association's definition change of the practice of dentistry. This change modified the scope of dentistry from the earlier "teeth and surr...
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Medical tourism, or traveling abroad to obtain medical services, has evolved into a global health care phenomenon, with over 15 million U.S. patients each year seeking medical care internationally, representing a $50 billion dollar industry in 2017. Speculation and media fascination about the growing industry, diverse destinations, and rationale be...
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Background:. Capsular contracture is 1 of the most common complications after breast implant surgery and is a major indication for reoperation. Capsular contracture is believed to be a multifactorial process that is affected by implant texture, incision type, and ultimately pocket contamination. This contamination causes a biofilm that leads to cap...
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Background Psychoactive drug use is on the rise in the United States, with plastic surgery patients a potentially susceptible group. This study aimed to determine the incidence of cosmetic and reconstructive patients in our practice taking psychoactive drugs and to compare those values with the national average. Furthermore, we discuss the patient...
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Background and aim: Aside from topical skin preparations and surgical drapes, the medical literature inadequately addresses the flammability risks associated with the use of other potential fuel sources. The flammability risk of petroleum-based topical ointments and wound dressings requires particular attention. The purpose of this case report is t...
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Introduction: Operating costs are a significant part of delivering surgical care. Having a system to analyze these costs is imperative for decision making and efficiency. We present an analysis of surgical supply, labor and administrative costs, and remuneration of procedures as a means for a practice to analyze their cost effectiveness; this affec...
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Background: A best practice goal to reduce surgical site infection includes administration of antibiotics in the ideal preoperative window. This article evaluates an office surgical suite antibiotic administration rate and compares it with the timing of a local hospital treating a similar patient population. The hypothesis was that similar or bette...
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To date, the conversation about facial rejuvenation surgery has focused on one goal: youthfulness. However, human beings are judged throughout life based on many other characteristics and personal qualities conveyed by their faces. The term facial profiling has been used to describe this act of determining personality attributes through visual obse...
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Venous thromboembolism is a complication that results in a wide range of patient morbidity and potential mortality. Awareness of this risk has led to recent advances in both the perioperative planning of chemoprophylaxis and the stratification of risk factors. Together, these modifications have helped reduce the incidence and severity of venous thr...
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The transconjunctival technique for lower lid blepharoplasty, by virtue of a reduced rate of lower eyelid malposition, improved healing, and a concealed incision, has some appeal compared with the transcutaneous method. The transconjunctival approach to lower lid blepharoplasty provides access for both fat resection and transposition to soften tear...
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The orbicularis retaining ligament is the structure responsible for defining the palpebromalar groove and is a key structure in the appearance of aging of the midface. A major anatomic basis for the appearance of festoons seems to be the downward descent of tissues superior to a lax orbicularis retaining ligament and orbicularis muscle against the...
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The goal of this review was to identify the safety and medical care issues that surround the management of patients who had previously undergone medical care through tourism medicine. Medical tourism in plastic surgery occurs via three main referral patterns: macrotourism, in which a patient receives treatments abroad; microtourism, in which a pati...
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After studying this article, the participant should be able to: 1. Identify common precancerous and malignant cutaneous growths of the head and neck. 2. Recommend surgical treatment, including margins, based on consensus guidelines. 3. Counsel patients as to available evidence for expected recurrence, follow-up, and morbidity. Skin lesion excision...
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Two recent articles in Aesthetic Surgery Journal —by Alter1 and Bloom et al2—have addressed techniques for monsplasty, combined with either labia majora reduction or abdominoplasty, for massive weight loss patients. The techniques by Alter and Bloom et al also have a common theme: defatting and vertical pull.1,2 The problem with these techniques i...
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Background: Acellular dermal matrix (ADM) has been well described for use in breast reconstruction. The purpose of this study was to describe a novel use for ADM in areolar reconstruction. Methods: A total of 19 patients and 24 nipple-areolar complexes of breast cancer or BRCA-positive patients status postmastectomy were treated. After nipple fl...
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Background: Facial lipoatrophy is a common side effect of human immunodeficiency virus treatment with highly active antiretroviral therapy. To identify the most clinically durable and efficient way of addressing facial lipoatrophy, the authors reviewed all available evidence for the use of injectable dermal fillers and autologous fat transfers as...
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Benign lymphoepithelial cysts are a widely recognized cause of parotid gland swelling in patients infected with the human immunodeficiency virus (HIV). These cysts are pathognomonic for HIV. The cysts frequently grow to be exceptionally large, causing physical deformity and gross asymmetry of facial contour. This clinical commentary analyzes this c...
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National experience shows that 50 percent of physicians change positions within the first 2 years of practice. Because of market pressures, medicine in general and plastic surgery in particular are shifting away from solo practice. The authors examine the primary reasons for turnover and discuss job search priorities for recent plastic surgery grad...
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Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial artery isolat...
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Melanocytic proliferations with Spitz differentiation present a difficult clinicopathologic dilemma, as their spectrum ranges from benign to malignant. Distinct entities include Spitz nevus, atypical Spitz nevus, and Spitzoid melanoma. Their histopathologic differentiation can be challenging, and cases of Spitzoid melanoma initially diagnosed as be...
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Keloids occurring on the chest can be deforming with significant painful sequelae for patients. These lesions can pose a therapeutic dilemma for the dermatologic surgeon as certain excision defects may be too large to close primarily and recurrences tend to be high (40-100%). A collagen-glycosaminoglycan copolymer (Integra) has been found to be use...
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Little research to date has investigated musculoskeletal injury in the surgical workforce. This study estimates the prevalence and functional impact of work-related injury in plastic surgeons and other surgical specialists. A validated self-assessment of work-related injury was administered to surgeons at various professional conferences, over the...
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Using barbed suture for flexor tenorrhaphy could permit knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the tensile strength and repair-site profile of a technique of barbed suture tenorrhaphy. Thirty-eight cadaveric flexor digitorum profundus tendons were randomized to polyprop...
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Microvascular free flap techniques have improved over the past two decades such that flap failure rates have dropped to under 3 percent in most large series of high-volume centers. However, despite technical and patient-selection advances, some components of free flap failure might be attributable to undiagnosed patient factors. In this clinicopath...
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We identified 3 patients with chronic, asymptomatic HIV who presented between 2001 and 2005 with spontaneous nasal septal abscesses in the absence of previous trauma, nasal surgery, sinusitis, infection, or immunodeficiency. A MEDLINE search revealed no other cases of spontaneous isolated nasal septal abscesses. Each of our patients presented to th...
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Over the last five years, there has been a groundswell of interest in the prevention of venous thromboembolism (VTE). An increased level of understanding of the disease process coupled with data documenting the alarmingly high incidence of VTE has prompted a global awareness of the disease. Consequently, prevention of VTE has been targeted by hospi...
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Today, plastic surgeons are increasingly faced with the problem of complex abdominal wall reconstruction. Obesity, bariatric surgery, and failed prior herniorrhaphy contribute to high rates of hernia recurrence in these difficult tertiary cases. We reviewed 50 consecutive complex abdominal wall reconstructions to identify the roles of 3 technical v...
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Human immunodeficiency virus (HIV)-positive patients suffer from a unique set of aesthetic challenges, frequently requiring plastic and reconstructive surgical intervention. This study was designed to evaluate the overall wound infection rates for elective surgery in this patient population, focusing specifically on differences between transdermal...
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The goals of augmentation and mastopexy are diametrically opposed --volume enhancement with skin envelope reduction --yet they must be combined to yield the best results when breast augmentation alone will not suffice. Multiple variables such as volume, skin amount, nipple position, and inframammary distance must all be accounted for, requiring met...
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Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and multimodal therapy. The purpose of this study was to evaluate the efficacy of using a 5-fluorouracil (5-FU)/steroid mixture to treat keloids over the past 7 years, comparing the results with use of steroid treatment alone. Patient charts from...
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The purpose of this study was to stratify plastic surgery patients into venous thromboembolism risk categories; identify patients at highest risk for venous thromboembolism; and quantify rates of postoperative all-cause mortality, venous thromboembolism, and hematoma/bleeding on different forms of thromboprophylaxis. Furthermore, this study aimed t...
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The deep inferior epigastric perforator (DIEP) flap is presented as a potential source of tissue for head and neck reconstruction. It has been sparingly reported for pharyngeal reconstruction and to provide a large bulk of skin but not previously described for buried contour defects. We present a retrospective study of a consecutive series of six b...
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After studying this article, the participant should be able to: 1. Identify the fascial layers of the temporalis region. 2. Understand the three-dimensional nature of the orbit and upper maxillectomy defects. 3. Understand the surgical harvest of temporalis flaps and temporoparietal flaps with vascularized bone. 4. Appreciate preoperative risk fact...
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Human immunodeficiency virus (HIV)-positive patients with changes in body morphology can be challenging for the plastic surgeon. Uncertainty about the advisability of elective procedures for these patients and fears of infection transmission may cause trepidation. Plastic surgeons are likely to encounter these patients in increasing numbers. The au...
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Techniques such as tongue tip rotation, Z-plasty, and imbrication have not previously been emphasized in the literature for tongue reconstruction. However, there is no reason that the same creative concepts used to close complex cutaneous wounds should not be applied to the most challenging of microsurgical head and neck reconstructions. By using t...
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A significant increase in bariatric procedures has led to success in maintaining long-term weight loss. The increasing population of patients who have lost massive amounts of weight also has led to a growing responsibility placed on body-contouring surgeons to perform safe and cautious procedures in this inherently difficult patient population. We...
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The accepted standard for treatment of human immunodeficiency virus disease, highly active antiviral therapy, may cause significant side effects, such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated human immunodeficiency virus disease. In addition to facial wasting, cystic paroti...
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Tracheostomy scar management is aimed at filling lost deep tissue bulk, the correction of tracheal skin tug, and a tension-free closure that falls more naturally into the neck folds. Three cases are used to illustrate the major principles involved in the correction of tracheostomy scars. Those reconstructive principles are 1) re-approximation of in...
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Management of head and neck melanoma has changed dramatically with the use of sentinel node biopsy for staging. Nodal dissection may now be delayed or deferred based on the results of the sentinel node biopsy. The authors suggest using a face lift incision to access the nodal basins for sentinel node biopsy in head and neck melanoma. A face lift in...
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The inferior pedicle technique remains one of the most commonly used techniques in breast reduction surgery, despite lengthy operating times, poor nipple sensation, and bottoming-out over time. The superomedial pedicle in reduction mammaplasty has previously been described using limited incision patterns. This study evaluated the safety and reliabi...
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Obesity is an increasing national public health issue that has reached epidemic proportions over the past several decades. With new surgical advances in bariatric surgery, the massive-weight-loss patient population is on the rise. The generalized redundancy of skin following massive weight-loss, including lateral flank rolls, abdominal excesses, an...
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Infected sternotomy wounds occur in 0.5 to 8.4 percent of open heart operations. They are complex problems, with a mortality rate of 8.1 to 14.8 percent despite flap closure. For closure, the pectoralis major flap has had considerable success. However, in providing coverage to the lower third of the sternum, it may be deficient. Modifications to im...
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To illustrate the potential reconstructive opportunities that the Endotine suspension devices can provide for patients with soft tissue ptosis secondary to facial nerve dysfunction, posttraumatic deformity, and postablative deformity. A review was performed of 23 Endotine midface and eyebrow suspension devices in 10 patients with facial nerve sacri...
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We performed a retrospective chart review of a tertiary care medical center. Our objective was to report our experience with microvascular reconstruction in the head and neck in patients who presented with radiation-induced tissue damage. We will discuss the effects of radiation to soft tissues and bone in the head and neck as well as the challenge...
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To compare an open vs a closed approach to the nasal pyramid for the initial repair of nasal fractures. Retrospective medical record review of 49 patients with acute nasal fractures treated by a single surgeon during a 5-year period. Patients underwent a closed approach to the nasal pyramid (Boise elevator only) or an open approach using rhinoplast...
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The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and s...
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Although rare, perforations of the esophagus following spinal surgery via an anterior approach are serious life-threatening problems. Complications include abscess formation, mediastinitis, sepsis, and fistula that can carry a mortality rate of 20%-50%. Early diagnosis and treatment are imperative. A common method of repair is isolation and primary...
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Keloids are exuberant, disfiguring scars that result from an abnormal healing process. Current established treatment strategies include surgical resection, triamcinolone steroid injection, pressure therapy, silicone therapy, and radiotherapy. None of these therapies, either alone or in combination, offers consistent recurrence-free rates above 70 t...
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Keloid management can be difficult and frustrating, and the mechanisms underlying keloid formation are only partially understood. Using original and current literature in this field, this comprehensive review presents the major concepts of keloid pathogenesis and the treatment options stemming from them. Mechanisms for keloid formation include alte...
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Background: Keloids are exuberant, disfiguring scars that result from an abnormal healing process. Current established treatment strategies include surgical resection, triamcinolone steroid injection, pressure therapy, silicone therapy, and radiotherapy. None of these therapies, either alone or in combination, offers consistent recurrence-free rate...
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Nevus sebaceus of Jadassohn (NS) has the classic presentation on the head and neck of a yellow-orange-colored, waxy, pebble-like, papule or plaque. Its reported malignant potential varies between 0.8% and 50%. The common location of NS on the temporal hairline leaves a cosmetic defect. We retrospectively reviewed a consecutive series of patients wi...
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Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive and infiltrative tumor that requires Mohs' micrographic surgery or wide excision to treat. Adequate excision often leaves a cosmetic disfiguring defect, particularly if the tumor is located on the head and neck. Complex defects of the face present special problems, such as distortion, e...
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BACKGROUND AND OBJECTIVE: Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive and infiltrative tumor that requires Mohs' micrographic surgery or wide excision to treat. Adequate excision often leaves a cosmetic disfiguring defect, particularly if the tumor is located on the head and neck. Complex defects of the face present special probl...
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The term venous thromboembolism refers to a spectrum of disease that includes deep venous thrombosis and pulmonary embolism. Both deep venous thrombosis and pulmonary embolism are often clinically silent and thus difficult to diagnose, which leads to a substantial delay in treatment that results in high rates of morbidity and mortality. The purpose...
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Historically, a newly graduated plastic surgeon in the United States could build a practice from his or her emergency room coverage. The historical cliche was for the surgeon to be affable, able, and available, and from that basis one's practice would grow. Emergency room exposure was an avenue for starting a practice, developing recognition, and,...
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The reconstruction of maxillectomy defects is a complex problem encountered in plastic surgery. Defects can range in size and complexity from small defects requiring only soft tissue to complete maxillectomies requiring large tissue bulk, bone, and one or more skin paddles. The most difficult defects involve the skull base and orbit. The reconstruc...
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Augmentation mammaplasty is frequently used to fill out the soft tissue envelope of the breast. This is most successful with minimal skin laxity or when there is no need for significant nipple movement. The addition of a periareolar mastopexy can reduce the skin envelope; however, its value is limited to those with no more than mild second-degree p...
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Reduction mammaplasty combining a superomedial pedicle with a circumareolar/vertical pattern skin excision avoids an inferior pedicle that can interfere with vertical scar technique, yet it is flexible enough to allow for a short transverse skin excision. This technique is suitable for small to moderate-size reductions.
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Surgery for breast cancer has traditionally addressed the breast as if it were a geometric circle with associated quadrants. Cosmetic reconstruction should not follow geometric patterns but should emphasize perceived contour and normal clothing lines. Similar to nasal reconstruction, a subunit principle in breast reconstruction planning may signifi...
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Gouty tenosynovitis in the hand is a rare entity. To date the limited cases described have involved predominantly extensor tendons in the fingers and flexor tendons in the palm or wrist. Flexor tendon involvement is less common and has been reported only twice to our knowledge distal to the palm. We report 3 cases of extra-articular gout presenting...