Brian P. Thornton
University of Kentucky
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Annals of Plastic Surgery | 2006
Brian P. Thornton; Daniel H. Stewart; Patrick C. McGrath; Lee L. Q. Pu
Macromastia has been considered a relative contraindication to breast conservation therapy because of difficulties with postoperative radiation therapy and cosmesis. This study evaluates the feasibility of the inferior pedicle reduction mammaplasty as a component of breast conservation therapy for patients with early breast cancer. A retrospective review identified 6 patients with macromastia receiving oncologic treatment of breast cancer and simultaneous breast reduction. Mean age was 43.5 +/- 8.7 (mean +/- SD) years, and all breast cancers were stage I or II, averaging 2.3 +/- 1.5 cm in size. All patients underwent a Wise-pattern inferior pedicle breast reduction after cancer extirpation and received postoperative radiation as part of their treatment. They were evaluated for postoperative complications, esthetic outcome of the breasts, and local recurrence. Patients in this series were followed for an average of 30.3 months, with no significant postoperative complications and recurrences. Breast reduction incisions healed primarily and adjuvant radiation was completed without a delay. All patients were pleased with the esthetic result and had improvement of their symptoms related to macromastia. Thus, we believe that breast reduction is a reasonable and safe option for early breast cancer patients with macromastia who desire breast conservation therapy. Our combined oncologic and reconstructive approach may improve the outcome of this group of patients with early breast cancers.
Annals of Plastic Surgery | 2005
Brian P. Thornton; William J. Rosenblum; Lee L. Q. Pu
This study was conducted to analyze the cost and outcome of free-tissue transfers versus local muscle flaps for reconstruction of limited soft-tissue defects associated with tibial fractures in the distal third of the leg. Twelve adult patients underwent either free (n = 6) or local muscle (n = 6) flap reconstruction were retrospectively reviewed. Total operative time for local muscle flap reconstruction was 215 ± 47 minutes compared with 450 ± 90 minutes (P < 0.0002) for free-muscle transfer. Median length of hospital stay after reconstruction was 7 days for local muscle flap compared with 9 days for free-muscle transfer. Total cost of the local muscle flap procedure was
Annals of Plastic Surgery | 2014
Brian Rinker; Brian P. Thornton
11,729 ±
Annals of Plastic Surgery | 2007
Robert E. H. Ferguson; Kevin Schuler; Brian P. Thornton; Henry C. Vasconez; Brian Rinker
4460 compared with
Annals of Plastic Surgery | 2016
Kerry E. Drury; Steven T. Lanier; Nima Khavanin; Keith M. Hume; Karol A. Gutowski; Brian P. Thornton; Nora Hansen; Robert X. Murphy; Neil A. Fine; John Y. S. Kim
19,989 ±
Journal of Craniofacial Surgery | 2004
Forrest O. Moore; Brian P. Thornton; David Zabel; Henry C. Vasconez
3295 (P < 0.0004) for free-flap reconstruction. Five of 6 patients in each group had excellent soft-tissue contours. Fracture healing was evident in all patients of each group. Thus, a local muscle flap for reconstruction of a limited distal tibial wound appears to be more cost-effective than free-tissue transfer because of equivocal outcomes achieved but at approximately half of the cost.
Aesthetic Surgery Journal | 2006
Lee L. Q. Pu; Brian P. Thornton; Henry C. Vasconez
AbstractSkin-sparing mastectomy (SSM) with immediate tissue expander reconstruction poses a challenge in the patient with macromastia or excessive ptosis. Skin reduction via the Wise pattern has been described but is associated with high rates of skin necrosis. The study group consisted of 43 women with grade 2 or 3 ptosis who underwent SSM and immediate reconstruction with tissue expanders, using the Passot (horizontal) skin reduction pattern. Age ranged from 31 to 67 years (mean, 51 years). The endpoints measured were time to final expansion, mastectomy skin flap necrosis, infectious complications, and total complications. Thirty reconstructions were bilateral and 13 were unilateral (73 breasts total). Follow-up ranged from 6 to 55 months (mean, 20). Common comorbid conditions included hypertension (n = 16), obesity (n = 22), and smoking (n = 9). The mean body mass index was 30.6 (range, 19.4–58.6). Twenty-one patients underwent chemotherapy; 12 received radiation. The mean initial fill was 196 mL (range, 0–420 mL), and the mean time to final expansion was 84 days (range, 28–225 days). Five patients did not complete the reconstruction, 2 because of cancer recurrence and 3 because of infection. There were 3 cases of mastectomy flap necrosis occurring after tissue expander placement (7%). There were 7 infectious complications (16%). The use of a horizontal breast reduction pattern at the time of expander placement produces consistently good esthetic outcomes and a low rate of skin necrosis, and it should be considered as an option in patients with macromastia or ptosis undergoing SSM and immediate reconstruction.
Journal of Vascular Surgery | 2003
Brian P. Thornton; David J. Minion; Rhonda Quick; Henry C. Vasconez; Eric D. Endean
The plastic surgeon often operates in the oral cavity. Little or no information exists regarding the effect of saliva and oral intake upon the tensile properties of suture. Polyglactin 910 (Vicryl) and chromic gut were studied. Five sutures of each type were subjected to saline, saliva, milk, or soy milk over different durations of exposure. Suture breaking strength was tested. A 4-way interaction between suture type, size, liquid, and time was significant (P = 0.0046). Sutures soaked in saliva were significantly weaker. No significant difference was observed between sutures soaked in milk or soy. Saliva appears to enhance degradation rates in both sutures. Suture selection in the oral cavity should be predicated upon the demands of the repair and surgeons preference. Postoperative feeding instructions should limit tension across mucosal repairs, but the selection of formula should be based upon nutritional requirements and preferences of the child rather than concern over suture degradation.
Annals of Surgical Oncology | 2014
Nima Khavanin; Michael S. Gart; Tiffany S. Berry; Brian P. Thornton; Sujata Saha; John Y. S. Kim
BackgroundAlthough some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. Study DesignThe intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using &khgr;2 and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. ResultsA total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. ConclusionsWe did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.
Plastic and Reconstructive Surgery | 2014
Jeffrey A. Ascherman; John Castle; Amy S. Colwell; Yoon S. Chun; Gregory R. D. Evans; Debra Johnson; Donald J. Morris; R. Laurence Berkowitz; Ankit R. Desai; Kaveh Alizadeh; Scott T. Hollenbeck; James Appel; Brian P. Thornton; Khashayar Mohebali; Aldona Spiegel; Susan Downey; Kamakshi R. Zeidler
Congenital anomalies of the orbital roof are rare occurrences. The case of a 2-year-old child with vertical orbital dystopia and abnormalities of the right bony orbit is presented. The patient underwent right orbital reconstruction to restore facial symmetry. A coronal approach with a frontal craniotomy was used for intracranial exposure. The abnormal angulation of the roof was corrected, and the defect was reconstructed with a split-calvarial bone graft harvested from the parietal region. The bone graft was secured with resorbable plate fixation. To preserve vision, reconstruction of this type must be done at an early age, preferably before the age of 4 years. In this patient, there is good facial symmetry and normal globe positioning 5 years after surgery.