Mark J. Landau

Vectra 3d Imaging for Quantitative Volumetric Analysis of the Upper Limb: A Feasibility Study for Tracking Outcomes of Lymphedema Treatment

Background: Secondary lymphedema of the upper limb is a common sequela following lymphadenectomy during oncologic surgery. The gold standard for evaluating treatment outcomes in upper limb lymphedema is limb volume measurement. However, current techniques lack sensitivity to localized changes. In this study, the Vectra 3D imaging system was used to accurately and precisely obtain volume measurements of the upper limb in patients with lymphedema. Methods: A feasibility study was performed in 11 patients with lymphedema and 22 upper extremities; 24 arms were evaluated in total. Three-dimensional images were taken of the upper extremities, and Vectra 3D software was used to calculate the volume of the hand, forearm, and upper arm. These measurements were compared to traditional circumference (tape) and water displacement measurements. Results: The 24 arm volumes ranged from 1517 to 4050 cc. The Vectra 3D provided precise and accurate volume measurements (average SD ± 1.0 percent of total volume). Measurements of the forearm and upper arm correlated with circumference measurements (R2 = 0.991) and were in good agreement, with the mean difference between measurement techniques being 2.8 ± 2.0 percent. Three-dimensional measurements of hand, forearm, and upper arm correlated with water measurements (R2 = 0.990) and had a mean difference between measurement techniques of 2.6 ± 2.1 percent. Conclusions: The Vectra 3D system provides precise and accurate data comparable to those of the most commonly used technique to estimate limb volume (tape measurement) and gold-standard water volume measurement. Three-dimensional imaging also offers several advantages, including time efficiency and obtaining localized measurements with high spatial resolution. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Commentary: Trends in the Use of Deep Brain Stimulation for Parkinson Disease

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Free vascularized fibula grafting in the operative treatment of malignant bone tumors of the upper extremity: A systematic review of outcomes and complications

Vascularized bone grafting after tumor resection can be an important component in the treatment of bony neoplasms of the upper extremity. The purpose of this study was to determine the outcomes of free vascularized fibula grafting (FVFG) in the treatment of upper extremity sarcomas.

Primary tumors of the hand: Functional and restorative management: BOWEN et al.

Primary malignant tumors of the hand are rare. Most cases present to clinics unaffiliated with cancer centers, making it incumbent on all hand surgeons to understand the pathology indicative of malignancy and the proper course of treatment of hand neoplasms. In this review, we report, based on tumor type, the anatomical considerations, proper management, staging, surgical approaches, reconstructive considerations, and long‐term surveillance of primary malignant tumors of the hand.

EC-IC bypass for cerebral revascularization following skull base tumor resection: Current practices and innovations: WOLFSWINKEL et al.

Complex skull base tumors can involve critical vessels of the head and neck. To achieve a gross total resection, vessel sacrifice may be necessary. In cases where vessel sacrifice will cause symptomatic cerebral ischemia, surgical revascularization is required. The purpose of this paper is to review cerebral revascularization for skull base tumors, the indications for these procedures, outcomes, advances, and future directions.

Options for Covering Large Soft Tissue Defects in the Setting of Trauma

Purpose of ReviewThis review aims to describe the multiple surgical options available for soft tissue coverage following trauma.Recent FindingsWhile advances in microsurgical techniques have provided additional options for wound coverage by free tissue transfer, these options have been limited by donor site morbidity. Recent developments in artificial dermal substitutes have provided surgeons with the ability to cover larger wounds while minimizing donor site morbidity. This has the potential to improve surgical outcomes while increasing overall patient satisfaction.SummaryThis review describes the various surgical options for wound coverage of soft tissue defects secondary to trauma and discusses the factors that must be emphasized in surgical decision making to select a wound coverage option that will provide the patient with the best esthetic and functional outcomes.

The utility of abnormal initial arterial blood gas values in determining clinical futility of trauma cases with severe hemorrhage

Background: Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients. Methods: An IRB approved retrospective study was performed at LAC + USC Medical Center Level I Trauma Center. Data was collected from trauma patients with severe hemorrhage admitted between June 2015 and April 2016 who were immediately admitted to the OR following entry into the ER. Baseline variables of age, sex and mechanism of trauma were collected. The pH readings from the initial three ABG data were obtained, and mortality was determined for each patient. Results: We identified 247 patients, 84.2% of which were male. Ages ranged from 1 to 91 years (average = 38.4). Overall mortality was 13.8%. The average initial pH value for non‐survivors (7.10 ± 0.13) was significantly lower than for survivors (7.34 ± 0.07) [p < 0.001]. Among patients whose initial three ABG pH values averaged ≤7.15, the survival rate was 8.7%. Ten patients had any single recorded pH value ≤ 6.91. The mortality rate among these patients was 90%. Conclusions: Consideration should be given to initial pH values when resuscitating “red blanket” patients. However, the pH values alone cannot reliably be used to determine clinical futility in individual patients in the early period after injury.

Abstract: Validation of Vectra 3D Imaging for Quantitative Volumetric Measurement of Upper Extremity Lymphedema

PSRC Abstract Supplement P oter P rofs gel concentrations. Mechanical tests were carried out with an indentation test, and the deformation distance of the gel construct was used as an indicator of relative gel stiffness. A total of 5 different concentrations were used with relative stiffness including: <1, 5, 9, 18 and 25 kPa. The 3D gels were cultured as a single droplet on a 48-well suspension cell culture plate with exchange of fresh media and 100ng/ mL of VEGF-A/C every 2–3 days. The gels were directly observed daily under the light microscope and recorded.