Rami S. Kantar

Impact of Diabetes on 30-D Complications in Mastectomy and Implant-Based Breast Reconstruction

BACKGROUNDnDiabetic patients are known to be at increased risk of postoperative complications after multiple types of surgery. However, conflicting evidence exists regarding the association between diabetes and wound complications in mastectomy and breast reconstruction. This study evaluates the impact of diabetes on surgical outcomes after mastectomy procedures and implant-based breast reconstruction.nnnMETHODSnThe American College of Surgeons National Surgical Quality Improvement Program database review from 2010 to 2015 identified patients undergoing total, partial, or subcutaneous mastectomy, as well as immediate or delayed implant reconstruction. Primary outcomes included postoperative wound complications and implant failure. Preoperative variables and outcomes were compared between diabetic and nondiabetic patients. Multivariate regression was used to control for confounders.nnnRESULTSnThe following groups were identified: partial (nxa0=xa052,583), total (nxa0=xa041,540), and subcutaneous mastectomy (nxa0=xa03145), as well as immediate (nxa0=xa04663) and delayed (nxa0=xa04279) implant reconstruction. Diabetes was associated with higher rates of superficial incisional surgical site infection (SSI) in partial mastectomy (odds ratio [OR]xa0=xa08.66; Pxa0=xa00.03). Diabetes was also associated with higher rates of deep incisional SSI (ORxa0=xa01.61; Pxa0=xa00.01) in subcutaneous mastectomy and both superficial (ORxa0=xa01.56; Pxa0=xa00.04) and deep incisional SSI (ORxa0=xa02.07; Pxa0=xa00.04) in total mastectomy. Diabetes was not associated with any wound complications in immediate reconstruction but was associated with higher rates of superficial incisional SSI (ORxa0=xa017.46; Pxa0<xa00.001) in the delayed reconstruction group. There was no association with implant failure in either group.nnnCONCLUSIONSnEvaluation of the largest national cohort of mastectomy and implant reconstructive procedures suggests that diabetic patients are at significantly increased risk of 30-d postoperative infectious wound complications but present no difference in rates of early implant failure.

Abstract: Predictors of Adverse Outcomes in the Management of Mandibular Fractures

SSI, and operative complications (including osteomyelitis, nonunion, malocclusion, and hardware infections). PostAbx complications included Clostridium Difficile colitis, urinary tract infections, pulmonary infections, nervous system infections, blood stream infections and multidrug resistance identified on re-admission. Difference between groups were analyzed by running ANOVA test for continuous variables and Pearson Chi-squared test for categorical variables.

Abstract 42: Trends of Maintenance Immunosuppression in Hand and Facial Transplantation

PURPOSE: In select patients, vascularized composite allotransplantation (VCA) offers functional and aesthetic outcomes superior to autologous reconstruction. However, its role in the reconstructive armamentarium is limited by the need for life-long immunosuppression. Furthermore, some studies have suggested that skin-containing VCA requires greater maintenance immunosuppression than solid organ transplants due to higher antigenicity. This study evaluates trends of maintenance immunosuppression in skin-containing VCA recipients and kidney recipients to determine differences in therapeutic risk.

Advanced Age Is a Risk Factor for Complications Following Abdominal Panniculectomy

BackgroundWidespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65xa0years and older has not been evaluated.MethodsThe American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65xa0years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders.ResultsReview of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (ORu2009=u20091.81; 95% CI 1.35–2.42; pu2009<u20090.001) and all complications (ORu2009=u20091.46; 95% CI 1.15–1.87; pu2009=u20090.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications.ConclusionOur analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.

Diabetes is not associated with increased rates of free flap failure: Analysis of outcomes in 6030 patients from the ACS-NSQIP database

Diabetes affects a significant proportion of the population in the United States. Microsurgical procedures are common in this patient population, and despite many conflicting reports in the literature, there are no large studies evaluating the direct association between diabetes and outcomes, specifically failure, following free flap reconstruction. In this study, we sought to determine the impact of diabetes on postoperative outcomes following free flap reconstruction using a national multi‐institutional database.

Internet-Based Digital Simulation for Cleft Surgery Education: A 5-Year Assessment of Demographics, Usage, and Global Effect

BACKGROUNDnIn October 2012, a freely available, internet-based cleft simulator was created in partnership between academic, nonprofit, and industry sectors. The purpose of this educational resource was to address global disparities in cleft surgery education. This report assesses demographics, usage, and global effect of our simulator, in its fifth year since inception.nnnOBJECTIVEnEvaluate the global effect, usage, and demographics of an internet-based educational digital simulation cleft surgery software.nnnSETTING AND PARTICIPANTSnSimulator modules, available in five languages demonstrate surgical anatomy, markings, detailed procedures, and intraoperative footage to supplement digital animation. Available data regarding number of users, sessions, countries reached, and content access were recorded. Surveys evaluating the demographic characteristics of registered users and simulator use were collected by direct e-mail.nnnRESULTSnThe total number of simulator new and active users reached 2865 and 4086 in June 2017, respectively. By June 2017, users from 136 countries had accessed the simulator. From 2015 to 2017, the number of sessions was 11,176 with a monthly average of 399.0 ± 190.0. Developing countries accounted for 35% of sessions and the average session duration was 9.0 ± 7.3 minutes. This yields a total simulator screen time of 100,584 minutes (1676 hours). Most survey respondents were surgeons or trainees (87%) specializing in plastic, maxillofacial, or general surgery (89%). Most users found the simulator to be useful (88%), at least equivalent or more useful than other resources (83%), and used it for teaching (58%).nnnCONCLUSIONSnOur internet-based interactive cleft surgery platform reaches its intended target audience, is not restricted by socioeconomic barriers to access, and is judged to be useful by surgeons. More than 4000 active users have been reached since inception. The total screen time over approximately 2 years exceeded 1600 hours. This suggests that future surgical simulators of this kind may be sustainable by stakeholders interested in reaching this target audience.

Long-Distance Care of Face Transplant Recipients in the United States

Promising aesthetic and functional outcomes in facial transplantation have fueled the interest of patients and providers alike. However, there are currently only 11 active face transplant centers in the United States, and only five have accumulated operative experience to date, resulting in an extremely unbalanced geographical distribution of providers. Since face transplant recipients must receive life-long follow-up, this presents unique challenges for face transplant candidates and provider teams, as long-distance travel may add considerable difficulty to pre- and post-transplant care. Furthermore, by compromising follow-up, this burden of travel may impact the ability of experienced face transplant centers to collect data, share knowledge as these patients are followed, and continue to advance the field. This article highlights the unique logistical and ethical implications of the highly probable long-distance nature of face transplant care in the United States, a challenging aspect of management that has not been previously discussed in the literature. Furthermore, we review current strategies in the long-distance management of solid organ transplantation (SOT) recipients, and propose several possibilities to help address these challenges in facial transplantation based on SOT experience.

Facial Disfigurement and Identity: A Review of the Literature and Implications for Facial Transplantation

Facial disfigurement can significantly affect personal identity and access to social roles. Although conventional reconstruction can have positive effects with respect to identity, these procedures are often inadequate for more severe facial defects. In these cases, facial transplantation (FT) offers patients a viable reconstructive option. However, FTs effect on personal identity has been less well examined, and ethical questions remain regarding the psychosocial ramifications of the procedure. This article reviews the literature on the different roles of the face as well as psychological and social effects of facial disfigurement. The effects of facial reconstruction on personal identity are also reviewed with an emphasis on orthognathic, cleft, and head and neck surgery. Finally, FT is considered in this context, and future directions for research are explored.