Carlos Cordoba

Outcomes in the Management of Sternal Dehiscence by Plastic Surgery : A Ten-Year Review in One University Center

Purpose:Infection rates following median sternotomy vary between 0.2% and 10%. These cases are associated with morbidity and mortality rates between 10% and 25% and 5% and 20%, respectively. The purpose of this study was to evaluate patient outcomes following plastic surgery correction of sternotomy dehiscence (SD). Methods:All patients operated on for an SD following coronary artery bypass graft surgery (CABG), between 1995 and 2005, with 1 or more flaps, were included. Results:Eighty cases were identified over a 10-year period. The mean age was 64 (±9.1) years. Two or more procedures were required in 17.5% of patients, and the mortality rate within 30 days was 12.5%. Significant variability was revealed between the cumulative mortality rates of plastic surgeons, from 0.0% to 50.0%. Multiple associations were identified for poor outcome, including chronic renal insufficiency and early mortality, and obesity with risk of reintervention. Conclusion:Although patients who undergo surgical correction of a deep sternal infection usually tolerate their intervention well, the mortality within 30 days remains high. This study has identified several factors explaining morbidity and mortality in this patient population.

A review of materials currently used in orbital floor reconstruction

Orbital fractures are common fractures of the midface. As such, numerous techniques and materials exist for the repair of this region, each with inherent advantages and disadvantages. But does the ideal implant material exist? Should we stop and simply use readily available materials, or should the cycle of need and discovery continue? A comprehensive review of materials used in orbital reconstruction and possible new directions in orbital floor reconstruction are presented.

Paraspinous muscle flaps for the treatment and prevention of cerebrospinal fluid fistulas in neurosurgery.

Study Design. A prospective clinical study was conducted to evaluate the efficacy of paraspinous muscle flaps in preventing and managing cerebrospinal fluid fistulas in high-risk neurosurgery patients. Objectives. To evaluate the efficacy of paraspinous muscle flap coverage using a “vest-over-pants” closure in the prevention and treatment of cerebrospinal fluid fistulas. Summary of Background Data. Previous studies have described paraspinous muscle flaps for the closure of complex spinal wounds, but none has addressed their use for the prevention and treatment of cerebrospinal fluid fistulas. Methods. This prospective clinical study evaluated nine consecutive patients with either refractory cerebrospinal fluid fistulas or high risk for cerebrospinal fluid leaks after spinal surgery. Bilateral paraspinous muscle flaps were used as primary flaps and closed using an overlapping vest-over-pants technique in eight of nine cases. The latissimus dorsi and trapezius muscles were recruited as additional muscle flaps for closure of thoracolumbar and high thoracic deficits, respectively. Results. Paraspinous muscle flaps provided immediate wound coverage in seven high-risk patients undergoing spinal surgery and two patients with recurrent cerebrospinal fluid fistulas. Postoperative hospitalization averaged 14.4 days. There was no evidence of a cerebrospinal fluid fistula after an average follow-up of 176.7 days. No wound infections occurred. The only complications were a superficial hematoma, which was drained percutaneously on postoperative day 6, and a seroma, which was drained during the follow-up period and eventually resolved. Conclusions. Paraspinous muscle flaps allow effective treatment and prevention of cerebrospinal fluid fistulas in selected high-risk patients and provide simple durable coverage of complex spinal wounds with minimal morbidity.

Mechanical failure of a Fogarty catheter in a microsurgical procedure: A case report

Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

Esophageal Stricture and Metaplasia Following Abdominoplasty

Numerous complications have been reported following abdominoplasty. In this report, the case of a 48-year-old woman who developed an esophageal stricture, and subsequently Barrett’s esophagus, secondary to increased intra-abdominal pressure following abdominoplasty is presented.

Adhesive strips: a simple and inexpensive trick for finger holding in hand surgery

Many finger holding devices have been developed to retract digits and provide exposure during hand surgery. We describe a simple, and cheap trick to keep fingers out of the way using adhesive strips that has proven efficient and helpful.