Charalampos Siotos

Abstract 52: Health-Related Quality of Life Throughout the Breast Reconstruction Process

PURPOSE: Patients’ adherence to their immunosuppressive regimen is vital for favorable immunologic and functional outcomes. Poor medication adherence MA remains a major cause of preventable graft rejection. Selfand physician report are the common methods used to assess adherence in clinical settings, they are often inaccurate and may underestimate nonadherence. Data related to MA and accurate method to assess MA in upper extremity transplants (UETs) have not been adequately evaluated and are thus not available. We present our experience of MA monitoring utilizing an objective and subjective battery of measures including patient, protocol (drugs/endogenous materials level measurement), graft, and physician related metrics.

Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Background Resection of primary spinal tumors requires reconstruction for restoration of spinal column stability. Traditionally, some combination of bone grafting and instrumentation is implemented. However, delayed healing environments are associated with pseudoarthrodesis and failure. Implementation of vascularized bone grafting (VBG) to complement hardware may present a solution. We evaluated the use of VBG in oncologic spinal reconstruction via systematic review and pooled analysis of literature. Methods We searched PubMed/MEDLINE, Embase, Cochrane, and Scopus for studies published through September 2017 according to the PRISMA guidelines and performed a pooled analysis of studies with n > 5. Additionally, we performed retrospective review of patients at the Johns Hopkins Hospital that received spinal reconstruction with VBG. Results We identified 21 eligible studies and executed a pooled analysis of 12. Analysis indicated an 89% (95% confidence interval [CI]: 0.75‐1.03) rate of successful union when VBG is employed after primary tumor resection. The overall complication rate was 42% (95% CI: 0.23‐0.61) and reoperation rate was 27% (95% CI: 0.12‐0.41) in the pooled cohort. Wound complication rate was 18% (95% CI: 0.11‐0.26). Fifteen out of 209 patients (7.2%) had instrumentation failure and mean time‐to‐union was 6 months. Consensus in the literature and in the patients reviewed is that introduction of VBG into irradiated or infected tissue beds proves advantageous given decreased resorption, increased load bearing, and faster consolidation. Downsides to this technique included longer operations, donor‐site morbidity, and difficulty in coordinating care. Conclusions Our results demonstrate that complication rates using VBG are similar to those reported in studies using non‐VBG for similar spinal reconstructions; however, fusion rates are better. Given rapid fusion and possible hardware independence, VBG may be useful in reconstructing defects in patients with longer life expectancies and/or with a history of chemoradiation and/or infection at the site of tumor resection.

Abstract 114: Potential Risk Factors for Worsening Abdominal Well-Being after Abdominal Flap Breast Reconstruction

Sarday, M ay 6, 2017 persists until the infection is cleared by antibiotic therapy and/or surgical management. While the acute phase response is essential for tissue healing and regeneration, over-activation of the acute phase response is maladaptive and may lead to systemic complications including thrombosis, organ failure, and disseminated intravascular coagulation. In the setting of severe infections, continuous activation of the APR has the potential to become dysregulated. The magnitude of the acute phase reaction can be quantified by both the peak concentration of CRP as well as the total duration of CRP elevation through calculating the area under the curve. We hypothesize that the area under the CRP curve is increased in musculoskeletal infection due to continual tissue injury and we believe that this cumulative response over time correlates with the incidence of complications.

Abstract 63: Enhanced Recovery After Surgery Pathway for Microsurgical Breast Reconstruction

RESULTS: The decision tree shows the associated probabilities, QALYs and costs for each clinical outcome arising from either the LVOS arm or the SSIR arm. An ICUR of

Abstract P34: Variation in Transfusion Practice and Associated Postoperative Complications in Abdominally-Based Autologous Breast Reconstruction Surgery

644/QALY favoring LVOS was calculated based off of its clinical-effectiveness gain of 7.11 QALY at an additional cost of

Abstract 9. Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction Patients Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy

4,579.43 (partly due to the additional costs of radiation treatment and the bilateral operation needed for LVOS compared to no radiation and unilateral surgery for SSIR). This proved that LVOS is a cost-effective surgical option given that a surgical approach is deemed cost-effective if its ICUR is less than

Abstract 19. Enhanced Recovery after Surgery Pathway for Microsurgical Breast Reconstruction: A Systematic Review and Meta-Analysis

50,000/QALY. One-way sensitivity analyses underscored the degree by which LVOS was costeffective. For example, LVOS became cost-ineffective when a successful LVOS cost more than

Abstract: Women Continue to be Underrepresented in Plastic Surgery

50,000. Similarly, probabilistic sensitivity analysis using Monte-Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the costeffectiveness of LVOS.

Abstract 4: Morbidity and Quality of Life Outcomes of Breast Reconstruction for Unilateral Mastectomy vs. Additional Contralateral Prophylactic Mastectomy: a Cohort Study of 211 Breast Reconstruction Patients

RESULTS: Ten patients with lymphedema of the arm were enrolled for volume measurement. Arm volumes ranged from 1517 to 4050 cc. The Vectra 3D provided precise volume measurements (average standard deviation +/0.8%). Measurements of the forearm and upper arm correlated with circumference measurements (R = 0.991) and were in good agreement, with the mean difference between measurement techniques being 2.8 ± 2.0%. Three dimensional measurements of hand, forearm, and upper arm also correlated with water measurements (R = 0.994) and had a mean difference between measurement techniques of 2.2 ± 1.8%.

Abstract 113: Malpractice Litigation in Plastic Surgery

RESULTS: Hundred and sixteen pre-and post-operative 3D photo data sets were included. The sample included 29 subjects. The facial volume was analyzed both overall and comparing each subgroup (orthognathic versus orthognathic + fat grafting group). Post-operative facial volume increase averaged 23.7% for the entire cohort (FG and nFG). By week twelve, the swelling decreased about 62% from baseline. In all patients, there was a statistically significant decrease in facial volume with time. In the fat-grafted group, despite adding volume, was equal to the non-fat grafted group at week 1, yet the rate of decrease was faster with fat grafting at week 12.