Basel Sharaf

Risk of major limb amputation in diabetic foot ulcer and accompanying disease: A meta-analysis

BACKGROUND Limb amputation in diabetic patients raises important issues regarding low quality of life and survival rates. This meta-analysis aimed to identify predictive factors accompanying diseases with high major amputation rates in diabetic patients. METHODS A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE and Cochrane databases. Eight variables were extracted from the included studies and evaluated according to major amputation rates. The Newcastle-Ottawa scale (NOS) was utilized to assess the quality of the studies. RESULTS The search strategy identified 101 publications. After screening, 10 articles were selected for review. Hypertension, ischemic heart disease, cerebrovascular disease, and peripheral vascular disease were identified as predictive variables of higher major amputation rates. CONCLUSIONS Although further investigation of long-term and prospective studies is needed, we identified four variables as predisposing factors for higher major amputation in diabetic patients through meta-analysis.

Endobronchial-Guided Vascularized Tissue Flaps for a Bronchopleural Fistula

The management of bronchopleural fistulas can be challenging. The initial treatment is usually conservative, but operative intervention with transposition of vascularized pedicled flaps may be required in refractory cases. We present the case of a 67-year-old man with stage IIIa squamous cell carcinoma of the lung who underwent a lower and middle bilobectomy after receiving neoadjuvant chemoradiation. His postoperative course was complicated by empyema and a bronchopleural fistula. Because of difficulty accessing the fistula, endobronchial-guided vascularized tissue flaps were successfully used to close the fistula.

Free Tissue Transfers for Head and Neck Reconstruction in Patients with End-Stage Renal Disease on Dialysis: Analysis of Outcomes Using the Taiwan National Health Insurance Research Database.

Background Patients diagnosed with end‐stage renal disease (ESRD) are increasing at around 5% annually. Some of these patients will require free tissue transfers to reconstruct their body after trauma or cancer resection. Comorbidities can increase the level of complexity during reconstruction. Aim Our goal is to describe the outcomes of ESRD patients under dialysis who underwent free tissue transfer for head and neck reconstruction. Methods Two cohorts were analyzed: ESRD group on dialysis and a non‐ESRD control group after free tissue transfer for head and neck reconstruction. Postoperative complications and mortality were recorded. For coexisting comorbidities, we determine the presence of diabetes mellitus (DM) and peripheral vascular disease (PVD). Results In this study, 85 cases with ESRD on dialysis and 841 controls were analyzed. Most patients were aged ≤ 65 years (82.5%) and nearly 92.9% of them were men. Types of head and neck cancer were neoplasm of other and unspecified parts of the mouth followed by neoplasm of tongue, the gingiva, hypopharynx, and floor of mouth. Patients with ESRD tended to have higher rates of DM and PVD (p < 0.001) and were significantly associated with an increased risk of stroke and increased risk of 30‐day mortality. However, there was no significant difference regarding flap failure among groups. Conclusion Despite greater preoperative risk factors, patients with renal failure on hemodialysis do not appear to have a higher rate of free flap failure following head and neck reconstruction. However, other complications can be minimized by optimizing patients medical condition to succeed with this reconstructive effort.

Helmet Wear and Craniofacial Trauma Burden: A Plea for Regulations Mandating Protective Helmet Wear

Helmet wear offers protection in various ways against craniomaxillofacial and brain trauma. The specific pattern and overall burden of craniofacial trauma among helmeted and unhelmeted patients has not been well defined. This is a retrospective review of trauma patients involved in documented helmet-associated injuries that presented to the Mayo Clinic Emergency Department in Rochester, Minnesota, and completed initial trauma evaluation between 1999 and 2015. A total of 417 patients (50% unhelmeted, 82% male) were identified. The median age at injury was 22.9 years (interquartile range [IQR]: 15.2–44.2]) and median follow-up was 26 months ([IQR: 2.2–64.8]). The majority of injuries involved motorcycle accidents (57.6%), bicycles (30.2%), and other modes of injury (12.7%). The mean Glasgow Coma Score (GSC) at the time of presentation was 14.2 (SD ± 2.4) and mean injury severity score (ISS) was 10.2 (SD ± 7.5). Motorcycle accidents had a higher mean ISS compared with other modes of injury (p = 0.048). Unhelmeted patients were more likely to sustain scalp lacerations (p < 0.0001), facial bone fractures (p = 0.01), scalp hematomas (p = 0.041), skull fractures (p = 0.017), and are more likely to require hospital admission (p = 0.0003). Unhelmeted patients’ hospital length of stay was on average 2 days longer than helmeted patients’ stay (p = 0.0721). Unhelmeted patients were more likely to require out-of-home placement than helmeted patients. Among trauma patients, helmet use was associated with less scalp lacerations and hematomas, facial bones fractures, skull fractures, and need for hospital admission. Adoption of legislation and regulations mandating protective helmet use in all states are strongly encouraged to minimize the burden of craniofacial injuries among unhelmeted patients.

Virtual surgical planning and three-dimensional printing in multidisciplinary oncologic chest wall resection and reconstruction: A case report

Highlights • Virtual surgical planning (VSP) and rapid prototyping in complex chest wall resection and reconstruction are valuable tools to the surgical team.• VSP and 3D printing allow for rehearsal of the surgical plan with emphasis on technical details that are paramount to the success of the reconstruction.• Accessibility and cost remain the key limiting factors in the clinical use of this technology. Outcome-based studies and cost-analysis are needed to validate the efficacy of 3D printing in complex surgical care.

Anastomosis of the Superficial Inferior Epigastric Vein to the Internal Mammary Vein to Augment Deep Inferior Artery Perforator Flaps

Use of the retrograde limb of the internal mammary vein has been described previously as a lifeboat for venous congestion but not prophylactically. Maximizing the length of the deep inferior artery perforator (DIEP) flap pedicle, identifying and dissecting the superficial inferior epigastric vein proximally in every patient, and taking advantage of the retrograde internal mammary vein are all technical details that facilitate the additional venous anastomosis and flap inset. Performing a second venous anastomosis routinely using the superficial inferior epigastric vein to the retrograde internal mammary vein helps with flap inset.

Maximizing the Utility of the Pedicled Anterolateral Thigh Flap for Locoregional Reconstruction. Technical Pearls and Pitfalls

The pedicled anterolateral thigh (PALT) flap is an underutilized flap for locoregional reconstruction largely because methods to maximize its reach are neither universally implemented nor fully understood. In addition, most of the available literature has focused on the utility of the free anterolateral thigh flap with less emphasis on the PALT flap. Moreover, flap design concepts to maximize its utility and reach and optimize outcomes have not been comprehensively described. In an effort to address this knowledge gap, the authors sought to review their institutions experience with the PALT flap for locoregional reconstruction.

Breast reconstruction in a patient with Noonan syndrome

Noonan syndrome (NS) is a relatively common genetic disorder with an autosomal dominant inheritance pattern affecting 1 in 1000–2500 births. Patients with this syndrome present with characteristic facial, musculoskeletal, cardiac and endocrine abnormalities. Lack of postpubertal breast development is a common manifestation of this syndrome and may result in severe hypomastia and a masculine appearance of the female chest. We report the first case of breast reconstruction in a 24-year-old woman with NS who lacked postpubertal breast development. Technical considerations for addressing the existing chest wall deformity, implant pocket selection as well as emphasis on the role of the plastic surgeon are presented.