Publications by authors named "Uldis Bite"

27 Publications

  • Page 1 of 1

Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Periorbital Aging.

Plast Reconstr Surg 2022 Jun 24. Epub 2022 Jun 24.

Division of Plastic, Craniofacial, and Hand Surgery, Department of Surgery, Sidra Medicine and Weill Cornell Medical College-Qatar, Doha, Qatar.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0000000000009458DOI Listing
June 2022

Defining the Role for Topically Administered Tranexamic Acid in Panniculectomy Surgery.

Aesthet Surg J Open Forum 2022 5;4:ojac033. Epub 2022 May 5.

Background: Abdominal panniculectomy after weight loss is a commonly performed procedure with high patient satisfaction yet continues to have a high post-operative complication profile. Several risk-reducing surgical approaches, such as preservation of Scarpa's fascia, use of tissue adhesives, and progressive tension suture techniques have been described. However, the use of tranexamic acid (TXA) has not been previously reported in panniculectomy surgery.

Objectives: To improve the safety and predictability of this procedure, the authors investigate whether the use of topically administered TXA during panniculectomy surgery reduces seroma, hematoma, and drain duration.

Methods: Consecutive patients who underwent panniculectomy (January 2010 to January 2022) were retrospectively reviewed. Outcome measures included hematoma requiring surgical evacuation, seroma requiring percutaneous aspiration, and drain duration. Patients with thromboembolic diseases and those taking anticoagulation/antiplatelet medications were excluded. Patients who had received TXA were compared with a historical control group who had not received TXA.

Results: A total of 288 consecutive patients were included. Topical TXA was administered in 56 (19.4%) cases. The mean (standard deviation [SD]) follow-up was 43.9 (37.4) months (3.7 years). The median (range) resection weight was 2.6 kg (0.15-19.96 kg). Regarding seroma and hematoma formation, the use of TXA did not reduce the likelihood of developing seroma or hematoma (odds ratio [OR] = 1.7, 95% CI [0.56- 4.8], = 0.38 and OR = 2.1, 95% CI [0.4-11.8], = 0.42), respectively. The mean (SD) duration of drains was slightly lower in the TXA group (18.1 [12.1] days vs 19.8 [13.9] days); however, this difference was not statistically significant, albeit clinically significant.

Conclusions: As the use of TXA in plastic surgical procedures continues to expand, the utility of TXA in panniculectomy and abdominoplasty has not been elucidated. Although previous studies report hematoma and seroma risk reduction, the use of TXA was not associated with a statistically significant reduction in seroma, hematoma, or drain duration following panniculectomy surgery. Prospective, randomized controlled studies on the use of TXA in body contouring are needed.

Level Of Evidence 3:
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asjof/ojac033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9174740PMC
May 2022

Abdominal Panniculectomy: An Analysis of Outcomes in 238 Consecutive Patients over 10 Years.

Plast Reconstr Surg Glob Open 2021 Nov 24;9(11):e3955. Epub 2021 Nov 24.

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn.

Panniculectomy is a commonly performed body contouring procedure to address skin laxity and its related complications. This study aimed to assess clinical outcomes of abdominal panniculectomy and identify predictors of complications at a tertiary academic healthcare center.

Methods: A retrospective review of patients who underwent panniculectomy between January 2010 and January 2020 at our institution was performed. Exclusion criteria were a history of prior panniculectomy or abdominoplasty. Patient characteristics and clinical outcomes were collected. Univariate and multivariable analyses were performed to assess the risk factors of complications.

Results: The mean age in the included 238 patients was 51.7 ± 12.7 years, and the mean body mass index (BMI) at the time of panniculectomy was 33 ± 7.5 kg/m. Median resection weight was 2.7 kg (range: 0.15-14.6) and median length of hospital stay was 2 days (range: 0-24). Mean follow-up time was 50 ± 37 months. The rate of major complications was 22.3%. Revision surgery was performed in 3.4% of the cases. Multivariable analyses demonstrated that increase in BMI ( 0.007) and active smoking ( 0.026) were significantly associated with increased odds of major complication, and increase in BMI ( 0.0004), history of venous thromboembolism ( 0.034) and having a concomitant ventral hernia repair ( 0.0044) were significantly associated with having a length of hospital stay of 3 days or more.

Conclusions: Panniculectomy is generally safe to perform, with major postoperative complication rate of 22.3% in our series. Increase in BMI and active smoking were significantly associated with having a major complication. Higher BMI, concomitant hernia repair, and a history of venous thromboembolism were associated with length of hospital stay of 3 days or more.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GOX.0000000000003955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613336PMC
November 2021

Detection of Baseline Emotion in Brow Lift Patients Using Artificial Intelligence.

Aesthetic Plast Surg 2021 12 27;45(6):2742-2748. Epub 2021 Sep 27.

Plastic Surgery Division, Department of Surgery, Plastic Surgery Resident PGY4, Mayo Clinic, Rochester, MN, 55905, USA.

Background: The widespread popularity of browlifts and blepharoplasties speaks directly to the importance that patients place on the periorbital region of the face. In literature, most esthetic outcomes are based on instinctive analysis of the esthetic surgeon, rather than on patient assessments, public opinions, or other objective means. We employed an artificial intelligence system to objectively measure the impact of brow lifts and associated rejuvenation procedures on the appearance of emotion while the patient is in repose.

Methods: We retrospectively identified all patients who underwent bilateral brow lift for visual field obstruction between 2006 and 2019. Images were analyzed using a commercially available facial expression recognition software package (FaceReader™, Noldus Information Technology BV, Wageningen, Netherlands). The data generated reflected the proportion of each emotion expressed for any given facial movement and the action units associated.

Results: A total of 52 cases were identified after exclusion. Pre-operatively, the angry, happy, sad, scared, and surprised emotion were detected on average of 13.06%, 1.68%, 13.06%, 3.53%, and 0.97% among all the patients, respectively. Post-operatively, the angry emotion average decreased to 5.42% (p=0.009). The happy emotion increased to 9.35% (p=0.0013), while the sad emotion decreased to 5.42%. The scared emotion remained relatively the same at 3.4%, and the surprised emotion increased to 2.01%; however, these were not statistically significant.

Conclusion: This study proposes a paradigm shift in the clinical evaluation of brow lift and other facial esthetic surgery, implementing an existing facial emotion recognition system to quantify changes in expression associated with facial surgery.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00266-021-02430-0DOI Listing
December 2021

A 28-year single institution experience with primary skin malignancies in the pediatric population.

J Plast Surg Hand Surg 2022 Feb 25;56(1):53-57. Epub 2021 May 25.

Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.

The aim of this study is to report our institution's experience with pediatric skin malignancies. A single institution retrospective review of pediatric patients with a primary skin malignancy from 1992 to 2020 was performed. Demographics, tumor characteristics and treatment outcomes were reviewed. Ninety-nine patients with 109 primary malignant skin lesions were reviewed. The most common lesion was malignant melanoma [MM] ( = 50, 45.9%). Compared to non-melanoma skin cancer (NMSC), MM were more likely to present on trunk or extremities (=.01, OR = 3.2), and be misdiagnosed (=.03, OR = 2.7). NMSC were more common in the head and neck region (=.01, OR = 3.2), and were associated with a personal history of skin cancer (=.0005, OR = 17.1) or a known risk factor (=.04, OR = 2.5). Patients with MM were 12.4-times more likely to develop metastatic disease compared to NMSC (<.0001). Increased Breslow's thickness also increased the odds of developing metastatic disease (=.03, OR = 1.6 per 1-mm increase). Interval time between lesion recognition and diagnostic biopsy or surgical treatment did not impact overall survival. Malignant melanoma was the most common malignancy in our cohort, followed by basal cell carcinoma. Malignant melanoma was the most likely tumor to be misdiagnosed and/or metastasize. Treatment delays did not impact risk of metastasis, recurrence or survival rate, though some patients succumbed to disease. These results may be attributed to small sample size or the biology of melanoma in pediatric patients. Awareness of skin malignancies in the pediatric population is imperative to providers and the public, with low threshold for specialty consultation and excision when warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/2000656X.2021.1914639DOI Listing
February 2022

Remembering Ian T. Jackson at the Mayo Clinic.

J Craniofac Surg 2021 May;32(Suppl 3):1251-1255

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000007521DOI Listing
May 2021

Presentation of calcinosis cutis 35 years after silicone nasal implant reconstruction.

BMJ Case Rep 2021 Feb 1;14(2). Epub 2021 Feb 1.

Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, USA

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2020-239766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852974PMC
February 2021

Surgical and Patient-Reported Outcomes in Patients With PEEK Versus Titanium Cranioplasty Reconstruction.

J Craniofac Surg 2021 Jan-Feb 01;32(1):193-197

Division of Plastic Surgery, Mayo Clinic.

Background: Several materials are available for cranioplasty reconstruction and consensus regarding the ideal material is lacking. The goal of this study is to present surgical and patient-reported outcomes with PEEK versus Titanium alloplastic cranioplasty.

Methods: A retrospective review of all patients who underwent alloplastic cranioplasty with PEEK or Titanium from 2010 to 2017 was conducted. Patient demographics and complications were abstracted and analyzed. Information regarding patient-reported outcomes was collected through a telephone survey.

Results: A total of 72 patients (median age 55 years) who underwent 77 cranioplasties were identified (38% PEEK, n = 29; 62% Titanium, n = 48). Overall complication rates were similar between the PEEK (24%, n = 7) and Titanium groups (23%, n = 11), P = 0.902. Similarly, implant failure was similar between the 2 groups (7% in PEEK (n = 2), 13% in Titanium (n = 6), P = 0.703). History of radiation was associated with increased rate of infection in patients with Titanium mesh cranioplasty (38% in radiated patients (n = 3), 3% in nonradiated patients (n = 1), P = 0.012) but not PEEK implants (0% infection rate in radiated patients (n = 0), 15% in nonradiated patients (n = 4), P = 1.000). A total of 24 patients (33% response rate) participated in the telephone survey. All PEEK cranioplasty patients who responded to our survey (n = 13) reported good to excellent satisfaction, while 72% of our titanium mesh cohort (n = 8) described good or excellent satisfaction and 27% (n = 3) reported acceptable result.

Conclusion: Cranial reconstruction is associated with high satisfaction among cranioplasty patients with PEEK or Titanium showing comparable complications, failure, and patient-reported satisfaction rates. Patients with history of radiotherapy demonstrated a higher infection rate when titanium mesh was used.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000007192DOI Listing
June 2021

Eye-Tracking Technology in Plastic and Reconstructive Surgery: A Systematic Review.

Aesthet Surg J 2020 08;40(9):1022-1034

Division of Plastic Surgery, Mayo Clinic, Rochester, MN.

Background: The use of eye-tracking technology in plastic surgery has gained popularity over the past decade due to its ability to assess observers' visual preferences in an objective manner.

Objectives: The goal of this study was to provide a comprehensive review of eye-tracking studies in plastic and reconstructive surgery, which can aid in the design and conduct of high-quality eye-tracking studies.

Methods: Through application of Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines, a comprehensive search of articles published on eye-tracking across several databases was conducted from January 1946 to January 2019. Inclusion criteria included studies evaluating the use of eye-tracking technology in the field of plastic and reconstructive surgery. The resulting publications were screened by 2 independent reviewers.

Results: A total of 595 articles were identified, 23 of which met our inclusion criteria. The most common application of eye-tracking was to assess individuals with cleft lip/palate (9 studies). All 19 studies that evaluated fixation patterns among conditions vs controls reported significant differences between the 2 groups. Five out of 7 studies assessing visual data between preoperative and postoperative patients identified significant differences between the preoperative and postoperative groups, whereas 2 studies did not. Nine studies examined the relation between severity indices, attractiveness scores, or personality ratings and gaze patterns. Correlation was found in 7 out of the 9 studies.

Conclusions: This systematic review demonstrates the utility of eye-tracking technology as a quantifiable objective assessment and emerging research tool for evaluating outcomes in several domains of plastic and reconstructive surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/asj/sjz328DOI Listing
August 2020

Reconstruction of Oncologic Sternectomy Defects: Lessons Learned from 60 Cases at a Single Institution.

Plast Reconstr Surg Glob Open 2019 Jul 26;7(7):e2351. Epub 2019 Jul 26.

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn.

Oncologic sternectomy results in complex defects where preoperative planning is paramount to achieve best reconstructive outcomes. Although pectoralis major muscle flap (PMF) is the workhorse for sternal soft tissue coverage, additional flaps can be required. Our purpose is to evaluate defects in which other flaps beside PMF were required to achieve optimal reconstruction.

Methods: A retrospective review of consecutive patients at our institution who underwent reconstruction after sternal tumor resection was performed. Demographics, surgical characteristics, and outcomes were evaluated. Further analysis was performed to identify defect characteristics where additional flaps to PMF were needed to complete reconstruction.

Results: In 11 years, 60 consecutive patients were identified. Mean age was 58 (28-81) years old, with a mean follow-up of 40.6 (12-64) months. The majority were primary sternal tumors (67%) and the mean defect size was 148 cm (±81). Fourteen (23%) patients presented with postoperative complications, and the 30-day mortality rate was 1.6%. In 19 (32%) cases, additional flaps were required; the most common being the rectus abdominis muscle flaps. Larger thoracic defects ( = 0.011) and resections involving the inferior sternum ( = 0.021) or the skin ( = 0.011) were more likely to require additional flaps.

Conclusions: Reconstruction of oncologic sternal defects requires a multidisciplinary team approach. Larger thoracic defects, particularly those that involve the skin and the inferior sternum, are more likely to require additional flaps for optimal reconstruction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GOX.0000000000002351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952121PMC
July 2019

Lower Eyelid Reconstruction Using a Nasolabial, Perforator-based V-Y Advancement Flap: Expanding the Utility of Facial Perforator Flaps.

Ann Plast Surg 2019 01;82(1):46-52

From the Division of Plastic Surgery, Mayo Clinic.

Background: Reconstruction of the lower eyelid represents a unique challenge to the reconstructive surgeon. Studies evaluating the utility of the nasolabial V-Y advancement flap in lower eyelid reconstruction are limited and techniques to optimize outcomes following eyelid reconstruction with this technique are not well described. We seek to evaluate our experience and outcomes with lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap.

Methods: After institutional review board approval, medical charts of all patients who underwent lower eyelid reconstruction using the nasolabial perforator-based V-Y advancement flap between February 2013 and October 2017 were reviewed. Data regarding etiology, location of the lesion, lower eyelid defect, methods of reconstruction, postoperative complications, and follow up duration were collected and analyzed.

Results: Over the study period, 5 patients (3 male) underwent lower eyelid reconstruction after oncologic resection of melanoma (n = 1) and nonmelanoma (n = 4) skin cancer using the nasolabial perforator-based V-Y advancement flap at a mean age of 69 years (range, 56-82 years). Median follow-up duration was 5.9 months (interquartile range, 2.25-25.9). A mean of 5.4 (range, 2-10) perforators were included in the initial flap design. After completion of flap dissection and perforator division, a mean of 4.4 (range, 2-7) perforators were preserved and included in the flap. All flaps demonstrated clinical viability with no cases of partial or total flap loss. One patient developed an asymptomatic ectropion during the follow-up period.

Conclusions: The nasolabial, perforator-based V-Y advancement flap is a reliable reconstructive method for lower eyelid defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0000000000001576DOI Listing
January 2019

Branchial arch anomalies: Recurrence, malignant degeneration and operative complications.

Int J Pediatr Otorhinolaryngol 2017 Jun 14;97:24-29. Epub 2017 Mar 14.

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States. Electronic address:

Objective: Branchial arch anomalies (BAA) represent one of the commonest pediatric neck masses, but large case series are lacking with none specifically examining risk of recurrence, surgical complications, and malignancy.

Study Design: Retrospective study of patients with BAA at Mayo Clinic from 1/1/1976-7/29/2011.

Methods: Features studied include age, gender, location, BAA type, symptoms, recurrence, preoperative management, extent of surgery, pathology as well as presence of tracts. Associations with tracts, operative complications, and recurrence were evaluated.

Results: 421 subjects underwent BAA excision during the study period at our institution. Subjects with tracts were symptomatic earlier. Four cases (mean age 60.3 years) of malignancy were identified. Among the 358 (non-remenant) BAA patients with no previous excision, 3.6% recurred at a mean of 47.1 months following surgery. Patients who underwent incision and drainage prior to BAA excision were 3.4 times more likely to recur. 2% experienced complications. Age, BAA type, preoperative imaging and extent of surgery did not affect recurrence or complication rates.

Conclusion: Patients with history of preoperative incision and drainage should be followed closely for recurrence the first four years. Early BAA excision is not associated with higher complication rate. Extent of resection should be determined by gross margins of BAA. Malignant degeneration was not seen in children. Malignancies have been seen in older patients (over 45 years) diagnosed with BAA, and a thorough work-up is important for correct diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijporl.2017.03.014DOI Listing
June 2017

Caveat spectator: digital imaging and data manipulation.

Mayo Clin Proc 2014 Aug 21;89(8):1036-41. Epub 2014 Jun 21.

Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson, MS. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.mayocp.2014.04.021DOI Listing
August 2014

A long-term clinical and cephalometric study of cleft lip and palate patients following intraoral maxillary quadrangular le fort I osteotomy.

Cleft Palate Craniofac J 2015 05 30;52(3):311-26. Epub 2013 Dec 30.

Objective: To evaluate the horizontal and vertical stability of the quadrangular Le Fort I in patients with congenital cleft lip and palate.

Design: Prospective longitudinal study.

Patients: A total of 15 congenital cleft lip and palate patients treated with the maxillary quadrangular Le Fort I were enrolled.

Intervention: Lateral cephalometric radiographic examinations were obtained preoperatively, early postoperatively, and late postoperatively for four dental and skeletal landmarks. A questionnaire regarding patients' satisfaction with treatment and functional/cosmetic outcomes (airway, speech, mastication) was administered.

Main Outcome Measures: Surgical horizontal and vertical movement, late postsurgical horizontal and vertical movement, and surgical and postsurgical movement in relation to age and cleft type were evaluated using Spearman correlation coefficients, Wilcoxon signed rank tests, and Mann-Whitney tests.

Results: Surgical horizontal movements of all measured points showed significant changes. Significant differences of postsurgical horizontal movement were observed in younger patients versus adult patients. Significant differences of postsurgical horizontal movement were observed in unilateral cleft patients versus bilateral cleft patients. A high percentage of patients showed significant functional improvement in nasal airflow, speech, mastication, temporomandibular joint function, and mouth versus nose breathing.

Conclusions: The quadrangular Le Fort I is a functionally stable and a surgically predictable procedure for cleft lip and palate patients who present with midface deficiency. Patients under the age of 18 at the time of the osteotomy had a higher relapse rate than patients over 18 years of age. Younger patients who need surgery should be advised regarding the increased risk of skeletal relapse. Patients' satisfaction was high in all aesthetic- and function-related items on the questionnaire.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1597/13-095DOI Listing
May 2015

A systematic review of the use of Botulinum toxin type A with subpectoral breast implants.

J Plast Reconstr Aesthet Surg 2014 Jan 17;67(1):34-41. Epub 2013 Sep 17.

Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Electronic address:

Objective: To determine the efficacy of Botulinum toxin A (BTX-A) injections for pain relief following placement of subpectoral tissue expanders and breast implants.

Methods: MEDLINE and EMBASE were searched from their inception to December 2012 to identify studies reporting the efficacy of perioperative BTX-A injections following breast surgery with subpectoral prostheses. Study designs included controlled and uncontrolled studies.

Results: Seven studies met the inclusion criteria (2 prospective controlled cohort, 3 retrospective cohort and 2 case series). Five studies assessed the efficacy of BTX-A and three measured pain improvement as a primary outcome. The studies enrolled 427 women: 91.8% received intraoperative BTX-A injection at the time of tissue expander breast reconstruction and 4.7% following augmentation mammaplasty. Only 3.5% of women received BTX-A injections in the postoperative setting. Overall, all the studies demonstrated improvement in pain and favorable side effect profile without any major adverse effects. However, the quality of this evidence was low.

Conclusion: The results of this systematic review suggest that BTX-A may alleviate postoperative pain associated with the placement of subpectoral tissue expanders and implants. The available data on outcome assessment of this practice are inconsistent and lack methodological rigor. With paucity of high-level evidence to support this practice in implant-based breast surgery, further studies are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2013.09.012DOI Listing
January 2014

Microbial biofilms and breast tissue expanders.

Biomed Res Int 2013 16;2013:254940. Epub 2013 Jul 16.

Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA.

We previously developed and validated a vortexing-sonication technique for detection of biofilm bacteria on the surface of explanted prosthetic joints. Herein, we evaluated this technique for diagnosis of infected breast tissue expanders and used it to assess colonization of breast tissue expanders. From April 2008 to December 2011, we studied 328 breast tissue expanders at Mayo Clinic, Rochester, MN, USA. Of seven clinically infected breast tissue expanders, six (85.7%) had positive cultures, one of which grew Propionibacterium species. Fifty-two of 321 breast tissue expanders (16.2%, 95% CI, 12.3-20.7%) without clinical evidence of infection also had positive cultures, 45 growing Propionibacterium species and ten coagulase-negative staphylococci. While vortexing-sonication can detect clinically infected breast tissue expanders, 16 percent of breast tissue expanders appear to be asymptomatically colonized with normal skin flora, most commonly, Propionibacterium species.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2013/254940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730356PMC
April 2014

Use of dissimilar trifocals to equalize fields of view for asymmetric orbital positions secondary to progressive facial hemiatrophy.

Ophthalmic Plast Reconstr Surg 2011 Jan-Feb;27(1):e23-5

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.

A 58-year-old woman presented, complaining that the vertical field of view (henceforth referred to as "field") through the middle (intermediate distance) segment of her right trifocal lens was disturbingly narrower than the left. She had undergone facial surgery for Parry-Romberg syndrome, after which right enophthalmos and hypo-orbit persisted. The longer lens-to-eye distance in the enophthalmic right eye caused the 7-mm vertical dimension of the middle segment to subtend a smaller angle at the right eye than the left, producing unequal fields. Trifocals with a larger 10-mm right eye intermediate segment vertical dimension and unchanged 7-mm left eye dimension made the angular fields through the segments nearly equal. Trifocal segments of unequal vertical dimensions were an effective solution to unequal fields of view secondary to monocular enophthalmos.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IOP.0b013e3181e174eaDOI Listing
April 2011

Soft-tissue reconstruction of external hemipelvectomy defects.

Plast Reconstr Surg 2009 Jul;124(1):144-155

Rochester, Minn. From the Division of Plastic and Reconstructive Surgery, the Department of Orthopedics, and the Division of Biostatistics, Mayo Clinic.

Background: External hemipelvectomy is the ultimate salvage procedure for locally advanced pelvic tumors, infections, and failed revascularizations. It is associated with high wound morbidity requiring surgical management. In this study, the authors analyzed their experience with primary and secondary reconstruction of hemipelvectomy wounds.

Methods: The records of 160 consecutive hemipelvectomy patients from the authors' institution were reviewed to identify the incidence of soft-tissue coverage problems and approaches to their management.

Results: At the time of hemipelvectomy, a musculocutaneous hemipelvectomy flap was sufficient for closure in 159 patients, one patient needed a free lower leg fillet flap, and none required pedicle flaps. No hemipelvectomy hernias were observed, although abdominal wall reconstruction was performed in three patients. Wound complications were encountered in 62 patients (39 percent), and 51 patients required operative débridement. Thirty-three patients healed by secondary intention, and 25 underwent delayed reconstruction with local tissue rearrangements (n = 15), split-thickness skin grafting (n = 6), and pedicled flaps (n = 6). All pedicled flaps were contralateral inferiorly based rectus abdominis muscle (n = 2) and musculocutaneous (n = 4) flaps.

Conclusions: Hemipelvectomy is associated with high wound morbidity. When the hemipelvectomy flap has a musculocutaneous design, hernias are exceedingly rare. Although immediate reconstruction is accomplished with a hemipelvectomy flap in the vast majority of cases, secondary reconstructions are often required for management of wound complications. For large defects, a contralateral inferiorly based rectus abdominis muscle or musculocutaneous flap is the reconstruction of choice. The rectus abdominis muscle should therefore always be preserved in hemipelvectomy patients by careful preoperative planning, especially when creation of an ostomy is considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0b013e3181a80557DOI Listing
July 2009

Pilot study of association of bacteria on breast implants with capsular contracture.

J Clin Microbiol 2009 May 4;47(5):1333-7. Epub 2009 Mar 4.

Division of Clinical Microbiology and Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.

Capsular contracture is the most common and frustrating complication in women who have undergone breast implantation. Its cause and, accordingly, treatment and prevention remain to be elucidated fully. The aim of this prospective observational pilot study was to test the hypothesis that the presence of bacteria on breast implants is associated with capsular contracture. We prospectively studied consecutive patients who underwent breast implant removal for reasons other than overt infection at the Mayo Clinic from February through September 2008. Removed breast implants were processed using a vortexing/sonication procedure and then subjected to semiquantitative culture. Twenty-seven of the 45 implants collected were removed due to significant capsular contracture, among which 9 (33%) had >or=20 CFU bacteria/10 ml sonicate fluid; 18 were removed for reasons other than significant capsular contracture, among which 1 (5%) had >or=20 CFU/10 ml sonicate fluid (P = 0.034). Propionibacterium species, coagulase-negative staphylococci, and Corynebacterium species were the microorganisms isolated. The results of this study demonstrate that there is a significant association between capsular contracture and the presence of bacteria on the implant. The role of these bacteria in the pathogenesis of capsular contracture deserves further study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/JCM.00096-09DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681843PMC
May 2009

Predictors of complications and outcomes of external hemipelvectomy wounds: account of 160 consecutive cases.

Ann Surg Oncol 2008 Jan 23;15(1):355-63. Epub 2007 Oct 23.

Division of Plastic & Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.

Background: Hemipelvectomy has high wound complication rates. This study aimed to determine variables that may influence hemipelvectomy wound morbidity.

Methods: The records of 160 consecutive hemipelvectomy patients were reviewed with a focus on demographics, treatment, and surgical techniques. Multivariate analysis was used to determine risk factors for postoperative hemipelvectomy wound infection and flap necrosis.

Results: There were 31 standard, 62 modified, and 67 extended hemipelvectomy patients in whom 19 contiguous visceral, 62 spinal, 4 contralateral pelvic resections, and 1 contralateral hemipelvectomy were performed. Hospital mortality rate was 5%, and overall morbidity was 54%. Wound complications such as infection (39%) and flap necrosis (26%) were the most common. For modified, standard, and extended hemipelvectomies, rates of wound infection were 29%, 34%, and 51% (P = .036) and rates of flap necrosis were 16%, 25%, and 35% (P = .046), respectively. Longer operative time and increased complexity were associated with higher wound infection and flap necrosis rates. The hemipelvectomy flap design did not influence the frequency of wound infection (P = .173) or flap necrosis (P = .098). Common iliac vessel ligation was the most statistically significant predictor of flap necrosis and was associated with the 2.7-fold increase in flap necrosis rate (P = .001) in patients undergoing posterior flap hemipelvectomy.

Conclusions: External hemipelvectomy has low mortality but high morbidity. Postoperative wound infection and flap necrosis are multifactorial events related to length and extent of operation. Level of vascular ligation strongly influenced flap necrosis rate for posterior flap hemipelvectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1245/s10434-007-9672-5DOI Listing
January 2008

Distraction osteogenesis for cleft palate closure in a canine model.

Arch Facial Plast Surg 2005 Nov-Dec;7(6):398-404

Department of Otorhinolaryngology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Objective: To assess the utility of distraction osteogenesis (DO) when applied to closure of a hard palate cleft in dogs.

Methods: A midline hard palate cleft was created in 10 mature dogs. Two were controls and had no distraction; the other 8 dogs underwent osteotomies with installation of customized DO devices to the hard palate. After a 10-day latency, distraction commenced at 1 mm/d. After a 14-day consolidation period, the device was removed and the mucosa closed. Each dog was injected with fluorochrome labels and serially killed at 2-week intervals. Bone healing was analyzed further with traditional histologic analysis and fluorochrome labeling.

Results: No serious complications occurred. Bone resorption and cleft widening occurred in both control dogs. Complete bone closure of the hard palate cleft was achieved with DO in 5 of 8 experimental dogs. Three experimental dogs had bone resorption and incomplete palatal closure.

Conclusions: The application of DO techniques in closure of a hard palate cleft in a canine model is safe and well tolerated. Furthermore, in some cases, it proved effective in achieving bony closure of the cleft. Further investigation is warranted into innovative use of DO in treating children born with cleft palate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archfaci.7.6.398DOI Listing
February 2006

A comparative study of the influence of smoking on skin flap survival in pregnant rats.

Br J Plast Surg 2005 Sep;58(6):812-6

Division of Plastic Surgery, Meram Medical Faculty, Selcuk University, Konya, Turkey.

In this study, the effects of smoking on skin flap survival were evaluated. For purposes of comparison 12 female rats were divided into four groups. Group 1 comprised nonsmoker, nonpregnant rats; group 2 nonsmoker, pregnant rats; group 3 smoker, nonpregnant rats and group 4 smoker pregnant. On each subject a standard 4 x 10 cm McFarlane dorsal skin flap was raised. On the seventh day postoperatively, the flaps were traced on a transparent sheet marking off the necrotic areas. The area of skin flap necrosis was assessed by 'netcad' digital imaging analysis program. The area of skin flap viability in the pregnant groups was greater than in the nonpregnant groups. The nonsmoker pregnant group's flap viability was the highest and the smoker nonpregnant group's viability was the lowest. This result supports the conclusion that pregnancy enhances flap viability and produces some defensive factors against some of the adverse effects of smoking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2005.03.004DOI Listing
September 2005

Hard palate mucosal grafts in oculoplastic surgery: donor site lessons.

Am J Ophthalmol 2004 Jun;137(6):1021-5

Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.

Purpose: Hard palate mucosal grafts have been used successfully in posterior lamellar reconstruction. Atypical surgical findings, techniques, and complications related to the hard palate donor site are reported herein.

Design: Interventional case series.

Methods: The medical records of five patients who were cared for in an institutional practice between 1987 and 2002 were retrospectively reviewed. All patients had unusual donor site findings discovered during or after hard palate mucosal grafting for eyelid or socket reconstruction.

Results: Seven eyelid reconstructions with hard palate grafts were performed on the five patients (three male, two female), with an age range of 14 to 73 years at surgery. Patients were followed for an average of 6 years (range: 9 months to 11 years). Unusual hard palate findings during surgery or the postoperative period included hard palate and maxillary sinus malignancy, torus palatinus, and persistent donor site bleeding that provoked gastric variceal bleeding in a patient with preexisting liver disease. Atypical surgical techniques included both inadvertent and intentional harvesting of hard palate tissue over the midline palatine raphe.

Conclusion: Hard palate grafting is a successful and commonly practiced approach to eyelid and socket reconstruction. An awareness of unusual anatomic findings or techniques associated with the hard palate donor site may improve surgical outcomes and decrease patient morbidity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajo.2003.12.034DOI Listing
June 2004

Changing surgical therapy for melanoma of the external ear.

Ann Surg Oncol 2003 Jul;10(6):689-96

Department of Surgery, Mayo Clinic, Scottsdale, Arizona 85259, USA.

Background: The purpose of this study was to evaluate the prognostic variables and clinical ramifications of melanoma of the ear.

Methods: A retrospective chart review of patients treated since 1985 at the Mayo Clinic in Scottsdale, AZ, and Rochester, MN, identified 78 patients with complete follow-up.

Results: Of these 78 patients, 68 (87%) were men; the mean age was 64 years (range, 23-87 years). Melanoma thickness averaged 1.7 mm (range,.2-7.0 mm). Treatment of the primary melanoma included wedge resection (59%), Mohs resection (14%), partial amputation (11%), skin and subcutaneous resection with perichondrium preservation (9%), and total amputation (7%). Nineteen patients underwent an elective lymph node dissection, and lymph node metastases were found in seven (37%). Two patients presented with clinically positive lymph nodes. Sentinel lymph node biopsy was performed in 10 patients. After a mean follow-up of 55.7 months, 10 patients (13%) had local recurrence, 9 patients (12%) had regional recurrence, and systemic metastases had developed in 17 patients (22%). Tumor thickness, lymph node metastases, and local recurrence significantly affected systemic recurrence.

Conclusions: The treatment of malignant melanoma of the external ear should follow current standard guidelines, which require wide local excision with negative margins. Sentinel lymph node biopsy can be used to identify patients with lymph node metastases who are at high risk of recurrence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1245/aso.2003.09.017DOI Listing
July 2003

Liposuction: a less invasive surgical method of debulking plexiform neurofibromas.

Dermatol Surg 2003 Jul;29(7):785-7

Olmsted Medical Center Department of Medical Genetics Division of Plastic and Reconstructive Surgery, Mayo Clinic/Mayo Foundation, Rochester, Minnesota 55905, USA.

Background: Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder in humans. The hallmark of NF1 is development of neural tumors. Plexiform neurofibromas are a major source of morbidity associated with NF1. Surgical removal of these particular tumors is associated with a high risk of damage of surrounding vital structures as well as a risk of significant hemorrhage. Surgical debulking of tumors also sometimes leads to extensive scarring, which may be very disfiguring.

Objective And Methods: We report a novel approach to the surgical therapy of plexiform neurofibromas using liposuction in two patients.

Results: Debulking of plexiform neurofibromas with liposuction was successful in both patients. Postoperative follow-up 6 months later showed no evidence of tumor regrowth in either case.

Conclusion: Liposuction may be a preferable surgical method for debulking of superficial plexiform neurofibromas in patients with NF1. This method is less invasive than conventional surgical tumor debulking.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1046/j.1524-4725.2003.29199.xDOI Listing
July 2003

Tissue expansion-assisted closure of massive ventral hernias.

J Am Coll Surg 2003 Mar;196(3):484-8

Division of Plastic Surgery, Mayo Clinic, Rochester, MN 55905, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1072-7515(02)01896-3DOI Listing
March 2003
-->