The correlation of matrix metalloproteinase 9-to-albumin ratio in wound fluid with postsurgical complications after body contouring.

Background: The authors' earlier retrospective report of surgical complications after abdominal contouring surgery provided evidence that post-bariatric surgery patients are at increased risk of developing wound complications compared with a normal population. This prospective pilot study was designed as a comparative analysis of both surgical and wound healing characteristics between massive weight loss and normal patients who present for abdominal contouring surgery.

Methods: Excisional wounds were created and polytetrafluoroethylene tubing was inserted during the preoperative period for later harvesting in patients undergoing abdominal contouring following Roux-en-Y gastric bypass for weight loss (n = 16) or abdominoplasty (n = 17).

The impact of reduction mammaplasty on breast sensation: an analysis of multiple surgical techniques.

Our prospective clinical trial collected sensory data using a computerized pressure-specified sensory device comparing 4 procedures for reduction mammaplasty. A total of 48 patients were assessed at baseline, 6 weeks (n = 42), 6 months (n = 15), and 1 year (n = 24) postoperatively. The findings of our study showed pressure sensitivity for women <43 years of age improved by pressure-specified sensory device assessment; whereas, outcome data merely indicated return to baseline in pressure sensitivity for women ≥ 43 years of age.

Association between preoperative measurements and resection weight in patients undergoing reduction mammaplasty.

Current guidelines used to predict appropriate resection weight for patients undergoing reduction mammaplasty are typically based on relatively nondescript patient characteristics and are most often inaccurate. The determination of patient measurements that correlate with resection weight could enable appropriate resection weight to be predicted more precisely and on an individualized basis. To better elucidate this, data from 348 patients undergoing bilateral reduction mammaplasty (696 breasts) between October 2001 and March 2009 were reviewed retrospectively.

Setting up your office for clinical photography.

Most clinical photographs utilized in a plastic surgical practice are taken in the office setting, primarily to document surgical results. This article will discuss the various ways that the office environment can be optimized for clinical photography.

Clinical photography for the plastic surgery practice--the basics.

Accurate clinical photography is essential in today's plastic and reconstructive surgery practice. Quality photographs are a reflection of the care and attention to detail exhibited in the plastic surgery practice, and there should be no excuse for poor quality clinical photographs. This article presents basic photographic principles.

The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations.

Abdominal contouring operations are in high demand after massive weight loss. Anecdotally, wound problems seemed to occur frequently in this patient population. Our study was designed to delineate risk factors for wound complications after body contouring.

Autologous breast reconstruction: the Vanderbilt experience (1998 to 2005) of independent predictors of displeasing outcomes.

Background: Optimal surgical outcomes are dependent on an appreciation of comorbid conditions that may handicap results. The purpose of this retrospective analysis was to delineate risk factors for complications after autologous breast reconstruction.

Study Design: An institutional database was constructed of patients who underwent autologous breast reconstruction from 1998 to 2005.

Photography and plastic surgery: part 1.

Plastic surgery and photography are inseparable and with present-day technology, it is much easier and more affordable than ever before to incorporate high-quality and standardized images into clinical practice. Perfecting digital photography can have a learning curve that is many times hindered by old habits from the days of slide photography, macro lenses, and specialized flashes, which made it more difficult and complex to incorporate into a busy plastic surgery practice. With the current digital revolution, many of these barriers have been or can be eliminated and anyone can become a proficient photographer.

Hybrid ventricular assist device: Heartmate XVE LVAD and Abiomed AB5000 RVAD.

The need for a right ventricular assist device following an implantable left ventricular assist device creates a complex situation for the surgeon, nursing staff, and the patient. The purpose of this report is to describe the rationale, technical, and perioperative issues of a hybrid ventricular assist device consisting of a Heartmate XVE (Thoratec, Inc., Pleasonton, CA) left ventricular assist device and Abiomed AB5000 right ventricular assist device (Abiomed, Inc.

Argatroban as a primary or secondary postoperative anticoagulant in patients implanted with ventricular assist devices.

Background: We describe our experience with argatroban as a primary or secondary postoperative anticoagulant to heparin in patients receiving ventricular assist devices.

Methods: This is a retrospective review of all Abiomed (BVS5000, AB5000) and Thoratec (PVAD and IVAD) ventricular assist devices from May 2003 through May 2006 at a single institution. Postoperatively, patients received either heparin or argatroban as their anticoagulant.

Postcardiotomy cardiogenic shock: the role of ventricular assist devices.

Postcardiotomy cardiogenic shock (PCCS) remains a life-threatening complication of cardiac surgery. Although survival rates have doubled in the past decade, PCCS continues to result in significant morbidity and mortality. Factors contributing to improved outcomes include early recognition of shock, early application of ventricular assist device (VAD) technology in cases of refractory shock, better technology, better surgical application (less technical error), application of treatment protocols, and assignment of management to specially trained personnel.

Cardiogenic shock: collaboration between cardiac surgery and cardiology subspecialties to bridge to recovery.

Acute cardiogenic shock is a lethal condition that results in death from myocardial failure, arrhythmia, or combinations of both. Aggressive medical, surgical, and interventional maneuvers have helped reduce the mortality. For the most advanced cases, ventricular assist devices have been used for persistent shock states.

Incorporation of an in-line filter for ultrafiltration or hemodialysis to the Abiomed BVS5000 ventricular assist device.

Multiple organ system dysfunction is an associated finding in patients requiring acute ventricular assist device (VAD) support. In the setting of acute renal failure, percutaneous catheters are placed for hemodialysis and/or ultrafiltration. Incorporation of an ultrafiltration or hemodialysis system in the Abiomed BVS5000 VAD circuit is a simple maneuver that eliminates the need for an additional catheter, thereby reducing the vascular and infectious complications associated with these catheters.

The Thoratec Implantable Ventricular Assist Device (IVAD): initial clinical experience.

Background: The Thoratec Implantable Ventricular Assist Device (IVAD) is the only FDA-approved intracorporeal biventricular cardiac assist device. It is a titanium-coated version of its predecessor, the Paracorporeal Ventricular Assist Device (PVAD). The blood pump is compatible with the portable TLC-II driver, making home discharge feasible.

Effect of augmentation mammaplasty on breast sensation.

Background: Studies of alterations in breast sensibility after augmentation mammaplasty have produced conflicting results. Such discrepancies may be attributed to unsophisticated measuring devices used in earlier studies leading to less accurate measurements and to the comparison of results to different surgical techniques. The primary purpose of our study was to conduct a prospective clinical trial to quantify specific sensory outcomes before and after submuscular breast augmentation.

The lived experience of NCLEX failure.

Educators help coach, focus, and prepare students for the National Council Licensure Examination (NCLEX), but often fall short in providing support when graduates are not successful. Most research to date has focused solely on predicting failure, with little to no attention given to interventions after failure. This study presents the voices of unsuccessful candidates, their responses to failure, their perspectives of the factors that contributed to their failure, and the changes they made that led to subsequent success.