Nicholas A. Flugstad

Does systemic isotretinoin inhibit healing in a porcine wound model

BACKGROUND Within the plastic surgery community, it is widely believed that waiting a minimum of 6 to 12 months after patient cessation of systemic retinoid therapy is necessary before proceeding with elective surgery. OBJECTIVE The authors investigate partial- and full-thickness wound healing after treatment with systemic isotretinoin in a porcine model. METHODS Following institutional approval, 2 Hanford miniature pigs were obtained. One pig received isotretinoin at a dose of 2 mg/kg/d, administered orally along with pig feed over a 60-day period; the other (control) pig received only pig feed over the same time period. After the treatment period ended, a total of 24 full-thickness wounds and 24 partial-thickness wounds were made on each pig. The wounds were evaluated by photographic and histological analysis at 7, 14, and 28 days. RESULTS The average full-thickness wound size in the control animal was 0.4346 cm(2) at 14 days and 0.0689 cm(2) at 28 days. The average full-thickness wound size in the isotretinoin-treated animal was 0.4685 cm(2) at 14 days and 0.0363 cm(2) at 28 days. The differences were not statistically significant between the 2 animals at either time point. On histological analysis, the healing characteristics of partial- and full-thickness wounds were similar at 7, 14, and 28 days for both animals. CONCLUSIONS Invasive surgery might be safely performed even in the presence of recent isotretinoin therapy. This finding challenges the current practice of waiting longer than 6 months after completion of therapy to perform surgery.

C7 nerve root sensory distribution in peripheral nerves: a bold functional magnetic resonance imaging investigation at 9.4 T.

Introduction: In this study we used a rat model to elucidate the linear make‐up of each major nerve of the upper limb by the C7 root through sensory stimulation and functional magnetic resonance imaging (fMRI). Methods: The C7 nerve root and major nerves of the right forelimb were stimulated electrically. Blood oxygen level–dependent functional magnetic resonance imaging (BOLD fMRI) was performed concurrently. Voxel overlap within the primary sensory cortex was calculated. Results: C7 comprised sensation in <1% in the musculocutaneous nerve, 6% in the ulnar nerve, 16% in the radial nerve, and 19% in the median nerve (P < 0.005 for each). The overlap was always <25% for each major nerve. Conclusions: This study helps explain why C7 is a suitable donor for brachial plexus injury treatment and why there is only a transient sensory deficit after transfer. Muscle Nerve 49: 40–46, 2014

Transaxillary Endoscopic Subfascial Breast Augmentation

Transaxillary endoscopic breast augmentation (in the submuscular pocket) was described by Price et al. in 1994. Compared with previously described blind transaxillary approaches, the transaxillary endoscopic approach maintains the advantage of inconspicuous scars and in addition affords direct vision for excellent control of the pocket dissection. The endoscopic camera also allows a magnified image of the dissection plane.

Response to "An Alternative Method of Breast Implant Insertion".

I admire the authors ingenuity in repurposing the SurgiSleeve (Covidien-Medtronic, Minneapolis, MN) for this use.1 Most authors agree that minimizing implant contact with the skin can prevent implant contamination with skin flora. They have made several direct comparisons to the Keller Funnel (Keller Medical, Inc., Stuart, FL), so I will make some comments on these. 1. The SurgiSleeve appears to do an excellent job of shielding the implant from skin contact. Many authors concur that this is a major source of implant contamination and possibly capsular contracture. It appears to be similar to the Keller Funnel in this function. There is existing data indicating that the …

C7 nerve root sensory distribution in peripheral nerves: A bold functional magnetic resonance imaging investigation at 9.4 T: fMRI Study of C7 Nerve Distribution

Introduction: In this study we used a rat model to elucidate the linear make‐up of each major nerve of the upper limb by the C7 root through sensory stimulation and functional magnetic resonance imaging (fMRI). Methods: The C7 nerve root and major nerves of the right forelimb were stimulated electrically. Blood oxygen level–dependent functional magnetic resonance imaging (BOLD fMRI) was performed concurrently. Voxel overlap within the primary sensory cortex was calculated. Results: C7 comprised sensation in <1% in the musculocutaneous nerve, 6% in the ulnar nerve, 16% in the radial nerve, and 19% in the median nerve (P < 0.005 for each). The overlap was always <25% for each major nerve. Conclusions: This study helps explain why C7 is a suitable donor for brachial plexus injury treatment and why there is only a transient sensory deficit after transfer. Muscle Nerve 49: 40–46, 2014

C7 Nerve Root Sensory Distribution in Peripheral Nerves: A BOLD fMRI Investigation at 9.4T

Introduction: In this study we used a rat model to elucidate the linear make‐up of each major nerve of the upper limb by the C7 root through sensory stimulation and functional magnetic resonance imaging (fMRI). Methods: The C7 nerve root and major nerves of the right forelimb were stimulated electrically. Blood oxygen level–dependent functional magnetic resonance imaging (BOLD fMRI) was performed concurrently. Voxel overlap within the primary sensory cortex was calculated. Results: C7 comprised sensation in <1% in the musculocutaneous nerve, 6% in the ulnar nerve, 16% in the radial nerve, and 19% in the median nerve (P < 0.005 for each). The overlap was always <25% for each major nerve. Conclusions: This study helps explain why C7 is a suitable donor for brachial plexus injury treatment and why there is only a transient sensory deficit after transfer. Muscle Nerve 49: 40–46, 2014

Abstract 9: Cortical Plasticity in a Rat Survival Model of Brachial Plexus Avulsion and Cross C7 Nerve Transfer Utilizing Bold Fmri at 9.4 Tesla

Introduction: Total brachial plexus nerve root avulsion results in severe functional deficit of the upper extremity. Contralateral C7 nerve root transfer is shown to improve outcomes for total brachial plexus avulsion. In this study, a rat survival model for brachial plexus avulsion injury with and without contralateral C7 nerve transfer surgery was implemented. Blood oxygen level dependent (BOLD) fMRI was used to record remodeling of the primary sensory cortex of the forepaw (S1FL) over 10 months’ time.