Anmol S. Chattha

Abstract: Surgical Site Infection in Immediate Breast Reconstruction: Does Chemotherapy Timing Make a Difference?

We aim to analyze the impact of chemotherapy timing on surgical site infections (SSI) after immediate breast reconstruction (IBR).

Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity

Background Subfascial anterolateral thigh (ALT) flap thickness can be problematic with regards to bulk, oral competence, shoe‐fit, or as a potential source of recurrent wound breakdown. We have utilized distinct upper thigh fascial planes to fashion thin (suprafascial) or super‐thin (periscarpal) ALT flaps to improve surface topography. We compared outcomes based on ALT flap thickness to determine any significant differences in extremity coverage and reconstruction. Methods Analysis was completed on patients who consecutively underwent ALT free tissue transfer at a single institution from May 2012 to January 2017. Patients operative, and postoperative characteristics were evaluated. Univariate analysis determined differences among matching as well as functional outcomes. A multivariable regression identified independent risk factors associated with patient, donor site, and flap complications. Results Fifty‐one patients met inclusion criteria. Of these, 16 (31.4%) underwent traditional subfascial ALT flaps, and 35 (68.6%) underwent suprafascial (N = 23) or super‐thin (N = 12) flaps. Thin flap patients were more likely to use tobacco (42.9% versus 6.3%; p < 0.01), have fewer perforators (1.20 ± 0.41 versus 1.64 ± 0.63; p < 0.009), and shorter mean operative times (425.9 ± 87.8 versus 511.9 ± 79.9; p < 0.002), but nearly identical flap sizes (163 cm2 versus 168 cm2). There were no significant differences in flap complications (18% versus 22%) or donor‐site complications (6.3% versus 5.7%) between the thick and thin cohorts, respectively (p > 0.05). In subgroup analysis, diabetes mellitus was an independent risk factor for donor site morbidity (odds ratio [OR] = 1.23; p = 0.027) for all groups, whereas tobacco use and obesity (body mass index [BMI] > 30) failed to significantly alter outcomes independently. Conclusions Tailoring ALT thickness can be performed safely without compromising flap outcomes or patient morbidity. Suprafascial and super‐thin ALTs allowed for safe, precise solutions for tissue coverage.

Abstract: Syndactyly: National Analysis of Trends in Epidemiology and Surgical Management from 1997–2012

Ten patients in the neurofibroma group and seven in the schwannoma groups responded to a post-operative survey. There were no significant differences for any responses. Both groups reported improvement in post-operative quality of life (p=0.7806), no regret with surgery (p=1.000), and a positive proclivity towards proceeding with surgery for potential future peripheral nerve tumors (p=0.8029).

Abstract: Institutional Diversity in Academic Plastic Surgery: A Collaborative Solution to Resource Limitations

RESULTS: From 2000–2013 the proportion of female surgeons among all female physicians has remained constant at 12–13%. The ratio of femaleto-male surgeons and residents has increased over time in all surgical specialties. While females outnumber males in one surgical specialty (obstetrics and gynecology), the female-to-male ratio in neurosurgery, orthopedic surgery, and thoracic surgery is 1:10 or higher. This discrepancy is lower among resident physicians (1:6 or lower). Presently, the female-to-male ratio of practicing surgeons in plastic surgery is approximately 1:5 with a smaller discrepancy among plastic surgery residents (integrated: 1 to 1.5; independent: 1 to 3.0). The proportion of Asian female surgeons has increased across all specialties.

Abstract P36. Quantifying the Development of Breast Cancer Surgery-Associated Lymphedema in High-risk Patients Undergoing Axillary Lymph Node Surgery in Consecutive Patients

P36. Quantifying the Development of Breast Cancer Surgery-Associated Lymphedema in High-risk Patients Undergoing Axillary Lymph Node Surgery in Consecutive Patients The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Chattha, Anmol, Parisa Kamali, Charlotte L. Van Veldhuisen, Renata Flecha-Hirsch, Alexandra Bucknor, Adam M. Tobias, Bernard T. Lee, and Samuel J. Lin. 2017. “Abstract P36. Quantifying the Development of Breast Cancer Surgery-Associated Lymphedema in High-risk Patients Undergoing Axillary Lymph Node Surgery in Consecutive Patients.” Plastic and Reconstructive Surgery Global Open 5 (2 Suppl): 18-19. doi:10.1097/01.GOX.0000513410.51978.bb. http://dx.doi.org/10.1097/01.GOX.0000513410.51978.bb. Published Version doi:10.1097/01.GOX.0000513410.51978.bb Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:32071930 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-ofuse#LAA

Abstract: Predictors of Hospital Costs in the Self-Pay Rhytidectomy Patient: Analysis of 1,890 Patients

INTRODUCTION: Rhytidectomy is one of the most commonly performed cosmetic procedures by plastic surgeons. Increasing attention to the development of a high-value, low-cost healthcare system is a priority of U.S. healthcare policy makers as projections of healthcare costs in the U.S. are shown to be unsustainable. This study aims to analyze specific patient and hospital factors that may augment the marginal charges of the procedure.

Abstract: Impact of Blood Thinners on Flap Failure and Hematoma Rates in Patients Undergoing Non-Breast Flap Reconstruction: Analysis of 79,915 Patients

INTRODUCTION: Maintaining optimal coagulation is vital for successful microvascular flap transfer. Hypercoagulate states are risk factors for pedicle thrombosis and flap loss.1 Therefore, identifying patients who are at risk for such events is paramount. The viscoelastic Thromboelastography (TEG) is a modern method to assess a patient’s coagulation status and in the past, it has predominantly been used in critical care, cardiac or trauma surgery.2 The aim of our study was to evaluate its diagnostic capabilities, its role compared to classic coagulation tests, and the effect of low-dose heparin in reconstructive breast microsurgery.

Comparison of risk factors and complications in patients by stratified mastectomy weight: An institutional review of 1041 consecutive cases

This study aims to investigate the specific complication rates, reconstructive differences, and delineate the pertinent independent risk factors in patients with different mastectomy weights.