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Article ; Online: Efficacy of Epidermal Skin Grafts Over Complex, Chronic Wounds in Patients With Multiple Comorbidities.

Fearmonti, Regina M

Wounds : a compendium of clinical research and practice

2016 Volume 28, Issue 7, Page(s) 226–232

Abstract: Unlabelled: Epidermal skin grafting presents an alternative to traditional autografts since only epidermal skin is harvested from the donor site. Split-thickness skin grafts are associated with difficulties at the donor site, including excessive pain, ... ...

Abstract	Unlabelled: Epidermal skin grafting presents an alternative to traditional autografts since only epidermal skin is harvested from the donor site. Split-thickness skin grafts are associated with difficulties at the donor site, including excessive pain, delayed healing, fluid loss, and unsatisfactory cosmetic results - all exacerbated in patients with comorbidities. A new automated epidermal harvesting tool (CelluTome Epidermal Harvesting System, KCI, an Acelity company, San Antonio, TX) involves concurrent application of heat and suction to normal skin to produce epidermal grafts. This article outlines the author's experience using this automated epidermal harvesting tool to harvest epidermal grafts and apply them on 23 chronic lower extremity wounds of patients with multiple comorbidities. Methods and materials: Vacuum and heat were applied until epidermal microdomes were formed (30-45 minutes); an epidermal microdome array was collected onto a transfer dressing and applied over the wound. Results: The automated harvesting tool yielded viable epithelium with every use. In addition to the epidermal skin graft, 16 of 23 wounds (70%) received adjunctive wound treatment, including negative pressure wound therapy, hyperbaric oxygen therapy, and/or regenerative tissue matrix. The average reepithelialization rate was 88.1% during a mean follow-up period of 76.4 days; no use of an anesthetic/operating room was required for the procedure. All donor sites were completely healed within 2 weeks without complications or scarring. Conclusion: Epidermal skin grafting provided a simplified, office-based grafting option with no donor site morbidity, and assisted in closure or size reduction of chronic wounds in this series.
MeSH term(s)	Chronic Disease/therapy ; Cicatrix ; Comorbidity ; Epidermis/pathology ; Epidermis/transplantation ; Female ; Humans ; Male ; Middle Aged ; Negative-Pressure Wound Therapy/methods ; Skin Transplantation/methods ; Soft Tissue Injuries/pathology ; Soft Tissue Injuries/therapy ; Tissue and Organ Harvesting/methods ; Treatment Outcome ; Wound Healing
Language	English
Publishing date	2016-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1214936-6
ISSN	1943-2704 ; 1044-7946
ISSN (online)	1943-2704
ISSN	1044-7946
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The use of closed incision negative pressure therapy for incision and surrounding soft tissue management: Expert panel consensus recommendations.

Silverman, Ronald P / Apostolides, John / Chatterjee, Abhishek / Dardano, Anthony N / Fearmonti, Regina M / Gabriel, Allen / Grant, Robert T / Johnson, Owen N / Koneru, Suresh / Kuang, Anna A / Moreira, Andrea A / Sigalove, Steven R

International wound journal

2021 Volume 19, Issue 3, Page(s) 643–655

Abstract: As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate ... ...

Abstract	As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become available. To expand upon previous ciNPT recommendations and provide guidance on this new dressing, an expert panel of plastic surgeons convened to review the current literature, identify challenges to the implementation and sustainability of ciNPT, and use a modified Delphi technique to form a consensus on the appropriate use of ciNPT with full-coverage dressings. After three rounds of collecting expert opinion via the Delphi method, consensus was reached if 80% of the panel agreed upon a statement. This manuscript establishes 10 consensus statements regarding when ciNPT with full-coverage foam dressings should be considered or recommended in the presence of patient or incision risk factors, effective therapeutic settings and duration, precautions for use, and tools and techniques to support application. The panel also discussed areas of interest for future study of ciNPT with full-coverage dressings. High-quality, controlled studies are needed to expand the understanding of the benefits of ciNPT over the incision and surrounding tissues.
MeSH term(s)	Bandages ; Humans ; Negative-Pressure Wound Therapy/methods ; Risk Factors ; Surgical Wound/therapy ; Surgical Wound Infection/etiology
Language	English
Publishing date	2021-08-12
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2170920-8
ISSN	1742-481X ; 1742-4801
ISSN (online)	1742-481X
ISSN	1742-4801
DOI	10.1111/iwj.13662
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Article: Biomarkers in neoadjuvant trials.

Fearmonti, Regina M / Keyomarsi, Khandan / Hunt, Kelly K

Cancer treatment and research

2011 Volume 147, Page(s) 1–36

MeSH term(s)	Biomarkers ; Chemotherapy, Adjuvant ; Humans ; Neoadjuvant Therapy
Chemical Substances	Biomarkers
Language	English
Publishing date	2011-05-01
Publishing country	United States
Document type	Journal Article
ISSN	0927-3042
ISSN	0927-3042
DOI	10.1007/978-0-387-09463-2_8
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Cephalic Vein Transposition versus Vein Grafts for Venous Outflow in Free-flap Breast Reconstruction.

Chang, Edward I / Fearmonti, Regina M / Chang, David W / Butler, Charles E

Plastic and reconstructive surgery. Global open

2014 Volume 2, Issue 5, Page(s) e141

Abstract: Introduction: When recipient veins for free-flap breast reconstruction are unavailable or inadequate, vein grafts or cephalic vein transposition (CVT) an option to provide alternate venous outflow. There are no comparative data to elucidate the ... ...

Abstract	Introduction: When recipient veins for free-flap breast reconstruction are unavailable or inadequate, vein grafts or cephalic vein transposition (CVT) an option to provide alternate venous outflow. There are no comparative data to elucidate the indications and outcomes for each. We hypothesize that the CVT is as reliable as vein grafts when indicated. Methods: All consecutive cases where a CVT or venous vein grafts were used for free-flap breast reconstruction between 2000 and 2012 were reviewed. Patient demographics, operative notes, indications, and flap survival were compared between the 2 groups. Results: Ten patients underwent a CVT and 38 patients received a vein graft for insufficient venous outflow. There were no differences in average age, body mass index, or comorbid conditions between the groups. Similarly, there was no difference in previous radiotherapy, timing of reconstruction, or side of reconstruction. A CVT was used for salvage following venous thrombosis in 7 patients (70.0%) and for primary venous outflow in the remaining patients due to inability to use the internal mammary vein. Vein grafts were performed primarily in 31 patients, 22 for augmenting venous drainage (supercharge), 9 for the dominant venous outflow, and 7 for salvage of a thrombosis. One patient in each group suffered a complete loss of the free flap (cephalic: 10.0% vs vein graft: 14.3%, P = 0.36). Conclusions: The CVT is a reliable alternate venous outflow that can be used as a primary recipient vein or as a salvage option following venous thrombosis. Surgeons should consider a CVT when primary recipient veins are compromised or unavailable.
Language	English
Publishing date	2014-06-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000000056
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Zs.A 7091: Show issues

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Article ; Online: A review of scar scales and scar measuring devices.

Fearmonti, Regina / Bond, Jennifer / Erdmann, Detlev / Levinson, Howard

Eplasty

2010 Volume 10, Page(s) e43

Abstract: Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments.: Methods: This article reviews the literature on available tools and ... ...

Abstract	Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments. Methods: This article reviews the literature on available tools and existent assessment scales used to subjectively and objectively characterize scar. Results: We describe the attributes and deficiencies of each tool and scale and highlight areas where further development is critical. Conclusion: An optimal, universal scar scoring system is needed in order to better characterize, understand and treat pathologic scarring.
Language	English
Publishing date	2010-06-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2412803-X
ISSN	1937-5719 ; 1937-5719
ISSN (online)	1937-5719
ISSN	1937-5719
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: "Supersize" panniculectomy: indications, technique, and results.

Pestana, Ivo A / Campbell, Douglas / Fearmonti, Regina M / Bond, Jennifer E / Erdmann, Detlev

Annals of plastic surgery

2014 Volume 73, Issue 4, Page(s) 416–421

Abstract: Background: Obesity remains a significant health problem associated with considerable morbidity and mortality. Panniculectomy in the obese patient population aims at treating complications related to excess abdominal skin in an attempt to improve ... ...

Abstract	Background: Obesity remains a significant health problem associated with considerable morbidity and mortality. Panniculectomy in the obese patient population aims at treating complications related to excess abdominal skin in an attempt to improve quality of life, increase mobility, and potentially prepare the patient for subsequent bariatric surgery or enrollment in a weight-loss program. We describe the indications and outcomes of "supersize" panniculectomy in the extreme obesity patient population. Patients and methods: A Duke University institutional review board-approved retrospective chart review of patients who underwent a "supersize" panniculectomy by a single surgeon during a 6-year period was conducted. Data on patient demographics, operative indication, preoperative imaging, concomitant operations, and postoperative complications were collected. Results: Twenty-six patients underwent a "supersize" panniculectomy for indications including immobility secondary to excess abdominal skin, panniculitis, ventral hernia, and presence of a gynecologic tumor. The mean pannus resection weight was 15.6 kg and the mean follow-up was 15.7 months. Twelve patients underwent preoperative abdominal computed tomographic imaging. Eleven patients underwent concomitant surgical procedures at the time of their panniculectomy. The overall wound complication rate for the "supersize" panniculectomy was 42.3% (11/26 patients). However, the rate of major complications, defined as those complications requiring a return to the operating room, was only 11.5% (3/26 patients). Conclusions: "Supersize" panniculectomy is defined as a panniculectomy in the obese patient population with a resected pannus specimen weight greater than or equal to 10 kg, and a pannus formation that extends to the mid-thigh level or below. Despite the obstacles and reported high complication rates, the incidence of major complications in this series justifies the operative intervention in patients with an otherwise therapy-resistant "supersize" pannus. A preoperative computed tomographic imaging may rule out an underlying hernia in most cases and is recommended by the authors.
MeSH term(s)	Abdominoplasty/methods ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Obesity, Morbid/surgery ; Retrospective Studies ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2014-10
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0b013e31827f5496
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Zs.A 1419: Show issues

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Article ; Online: Changes in dermal histomorphology following surgical weight loss versus diet-induced weight loss in the morbidly obese patient.

Fearmonti, Regina M / Blanton, Matthew / Bond, Jennifer E / Pestana, Ivo A / Selim, M Angelica / Erdmann, Detlev

Annals of plastic surgery

2012 Volume 68, Issue 5, Page(s) 507–512

Abstract: Introduction: Patients with postgastric bypass and diet-induced weight loss present to the plastic surgeon for various body contouring procedures. Gross differences in skin dermal elasticity may exist between these populations; however, studies ... ...

Abstract	Introduction: Patients with postgastric bypass and diet-induced weight loss present to the plastic surgeon for various body contouring procedures. Gross differences in skin dermal elasticity may exist between these populations; however, studies evaluating histologic differences are lacking. This prospective study aims to evaluate histomorphologic differences in morbidly obese patients following surgical versus diet-induced (nonsurgical) weight loss. Further, we aim to elicit if postoperative complications are correlated with the mechanism of weight loss and potential histomorphologic differences. Methods: Defined infraumbilical skin specimens were collected during abdominal contouring procedures following weight loss achieved through surgical or nonsurgical means. Specimens were stained for elastic fiber content and morphology, collagen deposition, and inflammation. All sections underwent evaluation for quality and quantity of elastic fibers, collagen architecture, and presence of inflammation in the context of age-matched controls. Histomorphological results were compared between the 2 groups and subanalyzed according to clinical variables and postbody contouring wound complications. Results: Between July 2008 and December 2010, 30 consecutive patients with significant weight loss (17 surgical, 13 nonsurgical) underwent a panniculectomy (n = 15), abdominoplasty (n = 13), and lower body lift (n = 2), with an average age of 48.3 ± 11.10 years and a body mass index of 39.23 ± 13.65 kg/m. Demographic and clinical variables were not statistically significant between the 2 groups. Blinded histologic evaluation revealed a trend toward normal elastic fiber appearance (P = 0.255), increased wound complications (P = 0.546), and mild inflammation (P = 0.462) in the surgical group. Analysis of dermal histomorphology correlating with wound complications was not statistically significant at follow-up (4.76 ± 5.55 months). Interestingly, there was a persistent inflammatory component in both groups when compared with age-matched controls. Conclusions: Although the differences in histomorphology between the surgical and nonsurgical weight loss groups did not reach statistical significance, the results demonstrated an existence of weight loss-induced histomorphological skin changes that may impact future studies. The study did not demonstrate a relationship between dermal histomorphology and postoperative wound complications, suggesting that aberrant healing in body contouring procedures involves a multifactorial process.
MeSH term(s)	Adult ; Aged ; Collagen/metabolism ; Cosmetic Techniques ; Dermatologic Surgical Procedures ; Elastin/metabolism ; Female ; Follow-Up Studies ; Gastric Bypass ; Humans ; Male ; Middle Aged ; Obesity, Morbid/diet therapy ; Obesity, Morbid/surgery ; Obesity, Morbid/therapy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prospective Studies ; Skin/metabolism ; Skin/pathology ; Treatment Outcome ; Weight Loss ; Weight Reduction Programs ; Wound Healing
Chemical Substances	Collagen (9007-34-5) ; Elastin (9007-58-3)
Language	English
Publishing date	2012-05
Publishing country	United States
Document type	Clinical Trial ; Comparative Study ; Journal Article
ZDB-ID	423835-7
ISSN	1536-3708 ; 0148-7043
ISSN (online)	1536-3708
ISSN	0148-7043
DOI	10.1097/SAP.0b013e31823aefc3
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Article ; Online: The modified Patient and Observer Scar Assessment Scale: a novel approach to defining pathologic and nonpathologic scarring.

Fearmonti, Regina M / Bond, Jennifer E / Erdmann, Detlev / Levin, L Scott / Pizzo, Salvatore V / Levinson, Howard

Plastic and reconstructive surgery

2011 Volume 127, Issue 1, Page(s) 242–247

Abstract: Background: Scarring is a highly prevalent and multifactorial process, yet no studies to date have attempted to distinguish pathologic from nonpathologic scarring.: Methods: This article defines and proposes methods of classifying pathologic scarring ...

Abstract	Background: Scarring is a highly prevalent and multifactorial process, yet no studies to date have attempted to distinguish pathologic from nonpathologic scarring. Methods: This article defines and proposes methods of classifying pathologic scarring as it pertains to clinical presentation. Results: The authors propose a new scar scale that incorporates pain and functional impairment. Conclusions: The modified Patient and Observer Scar Assessment Scale is the first of its kind to factor in the functional deficits pain and pruritus of scarring into measurements of associated morbidity. This scale has great potential in evaluating patient response to treatment and analyzing clinical outcomes.
MeSH term(s)	Cicatrix/classification ; Cicatrix/pathology ; Cicatrix/physiopathology ; Clinical Trials as Topic ; Humans ; Pain/etiology ; Pruritus/etiology
Language	English
Publishing date	2011-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0b013e3181f959e8
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Conference proceedings: Histomorphologische Unterschiede in Hautbiopsien nach spontaner und operativ-induzierter Gewichtsreduktion

Erdmann, Detlef / Fearmonti, Regina / Blanton, Matthew / Bond, Jennifer / Selim, Angelica

2011 , Page(s) 11dgpraecV119

Event/congress	49. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPÄRC), 42. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 16. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC); Innsbruck; ; Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen; 2011
Keywords	Medizin, Gesundheit
Publishing date	2011-09-27
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/11dgpraec120
Database	German Medical Science

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Article ; Online: Wound Care Centers: Critical Thinking and Treatment Strategies for Wounds

de Leon, Jean / Bohn, Gregory A / DiDomenico, Lawrence / Fearmonti, Regina / Gottlieb, H David / Lincoln, Katherine / Shah, Jayesh B / Shaw, Mark / Taveau Iv, Horatio S / Thibodeaux, Kerry / Thomas, John D / Treadwell, Terry A

Wounds : a compendium of clinical research and practice

2016 Volume 28, Issue 10, Page(s) S1–S23

Abstract: Many wound care centers (WCCs) provide a specialized level of care using various wound care therapies and are managed by quali ed healthcare professionals (QHPs) from di erent specialty backgrounds such as family medicine, podiatry, and plastic surgery. ... ...

Abstract	Many wound care centers (WCCs) provide a specialized level of care using various wound care therapies and are managed by quali ed healthcare professionals (QHPs) from di erent specialty backgrounds such as family medicine, podiatry, and plastic surgery. However, these QHPs are sometimes challenged by reimbursement issues, limited therapy and dressing options, reduced access to multidisciplinary team members, and cost-driven factors unique to WCCs. To help address these issues, a meeting was convened by an expert panel of WCC physicians to discuss best practices for treating complex patients in a WCC. This publication presents an overview of WCC chal- lenges, describes a holistic approach to treating WCC patients, and provides clinical guidance on the decision-mak- ing process for selecting optimal treatment plans for the WCC patient. Clinical cases of atypical, surgical and chronic wounds seen in a WCC are also presented.
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	1214936-6
ISSN	1943-2704 ; 1044-7946
ISSN (online)	1943-2704
ISSN	1044-7946
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