A feasibility model for restructuring the role of the hand surgeon taking call at a level I trauma center.

Background: The discrepancy between the volume of hand-related consults and the concurrent lack of specialized hand surgeons available continues to strain an overburdened system. Recent attention has focused on the redistribution of this workload towards management in the outpatient realm.

Methods: This is a retrospective review of hand consults for the plastic surgery service over summer and winter intervals at a Level I trauma center.

Retrospective Cohort Analysis on the Use of Hydrolyzed Collagen Powder in Back Reconstruction Following Spinal Instrumentation.

Background: Nearly half a million interbody fusions are estimated to be performed in the US each year, many of which involve complex reconstruction. The ability to limit seroma formation is vital to a seamless postoperative recovery.

Methods: A retrospective review was performed for patients undergoing fusion procedures along with flap reconstruction over a period of 20 months.

A Prospective Cohort Study Re-examining Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction.

Background: The goal of inpatient monitoring after microsurgical breast reconstruction is to detect vascular compromise before flap loss. Near-infrared tissue oximetry (NITO) is commonly used for this purpose, but recent reports challenge its specificity and utility in current practice. Fifteen years after Keller published his initial study using this technology at our institution, we re-evaluate the role and limitations of this popular monitoring device.

Obesity and the Abdominal Wall Vasculature: Correlating BMI with Perforator Anatomy.

Background:  Given the national trends in obesity, reconstructive surgeons are faced with an increasing number of overweight and obese women interested in postmastectomy breast reconstruction. While the link between obesity and adverse postoperative outcomes is well established, few studies have explored the relationship between body mass index (BMI) and the vasculature of the anterior abdominal wall.

Methods:  A radiographic review was conducted on female patients who underwent computed tomographic angiography (CTA) of the anterior abdominal wall.

The Inclusion of Orbicularis Oculi Muscle in the SMAS Flap in Asian Facelift: Anatomical Consideration of Orbicularis Muscle and Zygomaticus Major Muscle.

Background: In the malar region, the SMAS flap can be thin and tear easily, making it difficult to securely fix it. And the surgical anatomy of the region may be unclear and confusing. The authors performed an anatomical study on the location of the lateral margin of the orbicularis oculi muscle (OOM) and the origin of the zygomaticus major muscle (ZMM) when using a high-SMAS facelift with finger-assisted spaces dissection technique, which included elevation of the SMAS flap with OOM.

Prospective Analysis of Payment per Hour in Head and Neck Reconstruction: Fiscally Feasible or Futile?

Background: The authors assess the fiscal viability of complex head and neck reconstructive surgery by evaluating its financial reimbursement in the setting of resources used.

Methods: The authors prospectively assessed provider reimbursement for consecutive patients undergoing head and neck reconstruction. Total care time was determined by adding 15 minutes to the operative time for each postoperative hospital day and each postoperative follow-up appointment within the 90-day global period.

High superficial musculoaponeurotic system facelift with finger-assisted facial spaces dissection for Asian patients.

Background: Few facelift methods are designed specifically for Asian patients. Because of their characteristic thick skin and flat, wide facial geometry, satisfactory facelift results can be difficult to achieve in these patients.

Objectives: The authors evaluated outcomes achieved with a high superficial musculoaponeurotic system (high-SMAS) facelift with finger-assisted facial spaces dissection to rejuvenate the aging Asian face.

Is there a role for a strict incision length criterion for determining conversions during laparoscopic colorectal resection?

Purpose: There's no consensus about what defines a conversion for laparoscopic-assisted colorectal resection (LACR). This study's goal was to assess the utility of a strict incision length (IL) definition of conversion (incision > 7 cm) and compare it with results obtained when the surgeon determined (SD) if a LACR had been successfully completed.

Methods: The demographic and perioperative data for 580 elective LACRs were reviewed.

Initial repair of iatrogenic colon perforation using laparoscopic methods.

Background: Iatrogenic perforation of the colon during elective colonoscopy is a rare but serious complication. Treatment using laparoscopic methods is a novel approach, only described in the recent literature. We hypothesized that laparoscopic treatment of iatrogenic colon perforation would result in equal therapeutic efficacy, less perioperative morbidity, smaller incisions and decreased length of stay, and an overall better short-term outcome compared to open methods.

Mesh infection in the era of laparoscopy.

Background: The incidence of mesh infection during open hernia repair has been reported to be as high as 3%. With the introduction of laparoscopy, the rate of infection is still a matter of debate.

Methods: All 1182 laparoscopic inguinal hernia repairs performed at our institution from September 1991 to June 2002 were retrospectively reviewed to identify both mesh and wound infections.

Experience with seven cases of massive splenomegaly.

Background: Laparoscopic excision of extremely large spleens has been variously reported, but the usual consensus in the literature is that any patient with a spleen anything over 3000 g is simply not a proper candidate for laparoscopy. This report details our experience with 7 patients (out of 95 operated on) with spleens ranging in size up to 4800 g.

Methods: Our operative procedure involved 3 or 4 trocars placed along a virtually semicircular line centered over the splenic hilum.