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Artikel ; Online: Etiologies of Brain Arteriovenous Malformation Recurrence: A Focus on Pediatric Disease.

Lauzier, David C / Chiang, Sarah N / Moran, Christopher J

2023 Band 148, Seite(n) 94–100

Abstract: Pediatric brain arteriovenous malformations are a major cause of morbidity and mortality, with the harmful effects of this disease compounded by the additional disability-years experienced by children with ruptured or other symptomatic arteriovenous ... ...

Abstract	Pediatric brain arteriovenous malformations are a major cause of morbidity and mortality, with the harmful effects of this disease compounded by the additional disability-years experienced by children with ruptured or other symptomatic arteriovenous malformations. In addition to the risks shared with their adult counterparts, pediatric patients frequently experience recurrence following radiographic cure, which presents an additional source of morbidity and mortality. Therefore, there is a need to synthesize potential mechanisms contributing to the elevated recurrence risk in the pediatric population and discuss how these translate to practical considerations for managing these patients.
Sprache	Englisch
Erscheinungsdatum	2023-08-22
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Review
ZDB-ID	639164-3
ISSN	1873-5150 ; 0887-8994
ISSN (online)	1873-5150
ISSN	0887-8994
DOI	10.1016/j.pediatrneurol.2023.08.022
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Direct-to-Implant vs Tissue Expander Placement in Immediate Breast Reconstruction: A Prospective Cohort Study.

Chiang, Sarah N / Keane, Alexandra M / Ribaudo, Joseph G / Tao, Yu / Margenthaler, Julie A / Tenenbaum, Marissa M / Myckatyn, Terence M

Aesthetic surgery journal

2024

Abstract: Background: Direct-to-implant (DTI) breast reconstruction after mastectomy has gained increasing popularity. While concerns over ischemic complications related to tension on the mastectomy flap persist, newer techniques and technologies have enhanced ... ...

Abstract	Background: Direct-to-implant (DTI) breast reconstruction after mastectomy has gained increasing popularity. While concerns over ischemic complications related to tension on the mastectomy flap persist, newer techniques and technologies have enhanced safety of this technique. Objectives: To compare clinical and patient-reported outcomes of DTI and two-stage tissue expander (TE) reconstruction. Methods: A prospective cohort design was utilized to compare the incidence of reconstructive failure among patients undergoing DTI and TE reconstruction via unadjusted bivariate and adjusted multivariable logistic regression analyses. Secondary clinical outcomes of interest included specific complications requiring intervention (infection, seroma, hematoma, mastectomy flap necrosis, incisional dehiscence, device exposure) and time to final drain removal. Patient-reported outcomes (PROs) via BREAST-Q were also compared. Results: A total of 134 patients (257 breasts) underwent DTI reconstruction and 222 patients (405 breasts) received TEs. DTI patients were significantly younger with lower BMIs, less diabetes, hypertension, and smoking, and smaller breast sizes, and underwent more nipple-sparing mastectomies with prepectoral reconstructions. Rates of any complication (18% DTI vs 24% TE, p=0.047), reconstructive failure (5.1% vs 12%, p=0.004), and seroma (3.9% vs 11%, p<0.001) were significantly lower in the DTI cohort on unadjusted analyses; however, there were no significant differences in adjusted regressions. Patient-reported satisfaction with breasts, psychosocial well-being, and sexual well-being were more substantively improved with DTI reconstruction. Conclusions: Prepectoral DTI reconstruction is a viable option for post-mastectomy reconstruction in carefully selected patients, with no significant increase in reconstructive failure or other complications.
Sprache	Englisch
Erscheinungsdatum	2024-03-07
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	2087022-X
ISSN	1527-330X ; 1090-820X ; 1084-0761
ISSN (online)	1527-330X
ISSN	1090-820X ; 1084-0761
DOI	10.1093/asj/sjae054
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries.

Varagur, Kaamya / Sullivan, Janessa / Chiang, Sarah N / Skolnick, Gary B / Sacks, Justin M / Christensen, Joani M

Plastic and reconstructive surgery. Global open

2023 Band 11, Heft 10, Seite(n) e5345

Abstract: Background: Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after ... ...

Abstract	Background: Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. Methods: The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Results: Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends ( Conclusion: Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.
Sprache	Englisch
Erscheinungsdatum	2023-10-16
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000005345
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height.

Chiang, Sarah N / Zubovic, Ema / Skolnick, Gary B / Patel, Kamlesh B

Plastic and reconstructive surgery. Global open

2022 Band 10, Heft 2, Seite(n) e4125

Abstract: Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry.: ... ...

Abstract	Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry. Methods: Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut "poker incision" to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry. Results: Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], Conclusions: Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry.
Sprache	Englisch
Erscheinungsdatum	2022-02-17
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2851682-5
ISSN	2169-7574 ; 2169-7574
ISSN (online)	2169-7574
ISSN	2169-7574
DOI	10.1097/GOX.0000000000004125
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: What do patients want to know about gender-affirming surgery? Analysis of common patient concerns and online health materials.

Fotouhi, Annahita R / Chiang, Sarah N / Said, Abdullah M / Skolnick, Gary B / Snyder-Warwick, Alison K

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2023 Band 85, Seite(n) 55–58

Abstract: Purpose: Patients considering gender-affirming surgery often utilize online health materials to obtain information about procedures. However, the distribution of patient concerns and content of online resources for gender-affirming surgery have not been ...

Abstract	Purpose: Patients considering gender-affirming surgery often utilize online health materials to obtain information about procedures. However, the distribution of patient concerns and content of online resources for gender-affirming surgery have not been examined. We aimed to quantify and comprehensively analyze the most searched questions of patients seeking gender-affirming surgery and to examine the quality and readability of associated websites providing the answers. Methods: Questions were extracted from Google using the search phrases "gender-affirming surgery," "transgender surgery," "top surgery," and "bottom surgery." Questions were categorized by topic and average search volume per month was determined. Websites linked to questions were categorized by type, and quality of the health information was evaluated utilizing the DISCERN instrument (16-80). Readability was assessed with the Flesch Reading Ease Score and Flesch-Kincaid Grade Level. Results: Ninety questions and associated websites were analyzed. Common questions were most frequently answered by academic websites (30%). Topics included cost (27%), technical details of surgery (23%), and preoperative considerations (11%). Median (interquartile range) DISCERN score across all website categories was 42 (18). The mean readability was of a 12th-grade level, well above the grade six reading level recommended by the American Medical Association. Conclusions: Online gender-affirming surgery materials are difficult to comprehend and of poor quality. To enhance patient knowledge, informed consent, and shared decision-making, there is a substantial need to create understandable and high-quality online health information for those seeking gender-affirming surgery.
Mesh-Begriff(e)	United States ; Humans ; Sex Reassignment Surgery ; Comprehension ; Internet
Sprache	Englisch
Erscheinungsdatum	2023-06-29
Erscheinungsland	Netherlands
Dokumenttyp	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2217750-4
ISSN	1878-0539 ; 1748-6815 ; 0007-1226
ISSN (online)	1878-0539
ISSN	1748-6815 ; 0007-1226
DOI	10.1016/j.bjps.2023.06.060
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Idiopathic Intracranial Hypertension and Vascular Anomalies in Chiari I Malformation.

Lauzier, David C / Chiang, Sarah N / Chatterjee, Arindam R / Osbun, Joshua W

Neurosurgery clinics of North America

2022 Band 34, Heft 1, Seite(n) 175–183

Abstract: Mounting evidence has suggested a relationship between Chiari I malformation and idiopathic intracranial hypertension, with some studies implicating anomalies of the cerebral venous system in the development of these conditions. However, precise ... ...

Abstract	Mounting evidence has suggested a relationship between Chiari I malformation and idiopathic intracranial hypertension, with some studies implicating anomalies of the cerebral venous system in the development of these conditions. However, precise mechanisms explaining these associations are not well described. There is a clear need to clarify the interplay between these conditions to guide further study in this area. In tandem with these efforts, it is necessary to review proper diagnosis and management to improve outcomes in patients suffering from these diseases.
Mesh-Begriff(e)	Humans ; Pseudotumor Cerebri/complications ; Pseudotumor Cerebri/diagnosis ; Arnold-Chiari Malformation/complications ; Arnold-Chiari Malformation/diagnosis ; Arnold-Chiari Malformation/surgery
Sprache	Englisch
Erscheinungsdatum	2022-11-03
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Review
ZDB-ID	1196855-2
ISSN	1558-1349 ; 1042-3680
ISSN (online)	1558-1349
ISSN	1042-3680
DOI	10.1016/j.nec.2022.09.008
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Outcomes after Endoscope-Assisted Strip Craniectomy and Orthotic Therapy for Syndromic Craniosynostosis.

Chiang, Sarah N / Skolnick, Gary B / Naidoo, Sybill D / Smyth, Matthew D / Patel, Kamlesh B

Plastic and reconstructive surgery

2022 Band 151, Heft 4, Seite(n) 832–842

Abstract: Background: Endoscopic craniosynostosis repair has emerged as an effective alternative to open repair, but data are limited on treatment of the 15% to 24% of patients with syndromic diagnoses. In this study, the authors examine postoperative outcomes ... ...

Abstract	Background: Endoscopic craniosynostosis repair has emerged as an effective alternative to open repair, but data are limited on treatment of the 15% to 24% of patients with syndromic diagnoses. In this study, the authors examine postoperative outcomes after endoscopic repair in syndromic craniosynostosis. Methods: Retrospective review was performed of all consecutive patients undergoing endoscopic repair and all syndromic patients undergoing open repair from 2006 to 2021. Demographics, complications, and reoperations were compared between groups. Patient-reported measures of stigma and cognitive function were recorded at age 5 years and older. Results: A total of 335 patients underwent endoscopic repair, of which 38 (11%) had syndromic craniosynostosis. Syndromic craniosynostosis was associated with bicoronal involvement ( P < 0.001) and female sex ( P = 0.003). Secondary procedures were significantly more common in the syndromic group (24% versus 2.4%; P < 0.001), as were transfusions (18% versus 6.4%; P = 0.018). Secondary procedures were performed at a mean 2.8 years of age (range, 10 months to 8 years), and most commonly consisted of fronto-orbital advancement (seven in the syndromic group, and three in the nonsyndromic group). The degree of patient-reported stigma was higher in patients with syndromes ( P = 0.002), but cognitive function did not differ significantly ( P = 0.065). The incidence of reoperations after open repair was 13%, but baseline differences precluded direct comparison with the endoscopic group. Conclusions: Minimally invasive approaches in early infancy can alleviate the need for additional cranial procedures in the growing child. Syndromic craniosynostoses are a complex and heterogeneous group, and in more severe cases, endoscopic repair can be considered an adjunct technique to reduce the number of major craniofacial procedures. Clinical question/level of evidence: Risk, II.
Mesh-Begriff(e)	Child ; Humans ; Female ; Infant ; Child, Preschool ; Craniosynostoses/surgery ; Craniotomy/methods ; Skull/surgery ; Retrospective Studies ; Endoscopes ; Treatment Outcome
Sprache	Englisch
Erscheinungsdatum	2022-12-09
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010006
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: The impact of the COVID-19 pandemic on alloplastic breast reconstruction: An analysis of national outcomes.

Chiang, Sarah N / Finnan, Michael J / Skolnick, Gary B / Sacks, Justin M / Christensen, Joani M

Journal of surgical oncology

2022 Band 126, Heft 2, Seite(n) 195–204

Abstract: Background: Immediate alloplastic breast reconstruction shifted to the outpatient setting during the COVID-19 pandemic to conserve inpatient hospital beds while providing timely oncologic care. We examine the National Surgical Quality Improvement ... ...

Abstract	Background: Immediate alloplastic breast reconstruction shifted to the outpatient setting during the COVID-19 pandemic to conserve inpatient hospital beds while providing timely oncologic care. We examine the National Surgical Quality Improvement Program (NSQIP) database for trends in and safety of outpatient breast reconstruction during the pandemic. Methods: NSQIP data were filtered for immediate alloplastic breast reconstructions between April and December of 2019 (before-COVID) and 2020 (during-COVID); the proportion of outpatient procedures was compared. Thirty-day complications were compared for noninferiority between propensity-matched outpatients and inpatients utilizing a 1% risk difference margin. Results: During COVID, immediate alloplastic breast reconstruction cases decreased (4083 vs. 4677) and were more frequently outpatient (31% vs. 10%, p < 0.001). Outpatients had lower rates of smoking (6.8% vs. 8.4%, p = 0.03) and obesity (26% vs. 33%, p < 0.001). Surgical complication rates of outpatient procedures were noninferior to propensity-matched inpatients (5.0% vs. 5.5%, p = 0.03 noninferiority). Reoperation rates were lower in propensity-matched outpatients (5.2% vs. 8.0%, p = 0.003). Conclusion: Immediate alloplastic breast reconstruction shifted towards outpatient procedures during the COVID-19 pandemic with noninferior complication rates. Therefore, a paradigm shift towards outpatient reconstruction for certain patients may be safe. However, decreased reoperations in outpatients may represent undiagnosed complications and warrant further investigation.
Mesh-Begriff(e)	COVID-19/epidemiology ; Humans ; Mammaplasty/methods ; Pandemics ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Reoperation ; Retrospective Studies
Sprache	Englisch
Erscheinungsdatum	2022-04-07
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.26883
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: National Outcomes of Prophylactic Lymphovenous Bypass during Axillary Lymph Node Dissection.

Chiang, Sarah N / Skolnick, Gary B / Westman, Amanda M / Sacks, Justin M / Christensen, Joani M

Journal of reconstructive microsurgery

2022 Band 38, Heft 8, Seite(n) 613–620

Abstract: Background: Breast cancer treatment, including axillary lymph node excision, radiation, and chemotherapy, can cause upper extremity lymphedema, increasing morbidity and health care costs. Institutions increasingly perform prophylactic lymphovenous ... ...

Abstract	Background: Breast cancer treatment, including axillary lymph node excision, radiation, and chemotherapy, can cause upper extremity lymphedema, increasing morbidity and health care costs. Institutions increasingly perform prophylactic lymphovenous bypass (LVB) at the time of axillary lymph node dissection (ALND) to reduce the risk of lymphedema but reports of complications are lacking. We examine records from the American College of Surgeons (ACS) National Surgery Quality Improvement Program (NSQIP) database to examine the safety of these procedures. Methods: Procedures involving ALND from 2013 to 2019 were extracted from the NSQIP database. Patients who simultaneously underwent procedures with the Current Procedural Terminology (CPT) codes 38999 (other procedures of the lymphatic system), 35201 (repair of blood vessel), or 38308 (lymphangiotomy) formed the prophylactic LVB group. Patients in the LVB and non-LVB groups were compared for differences in demographics and 30-day postoperative complications including unplanned reoperation, deep vein thrombosis (DVT), wound dehiscence, and surgical site infection. Subgroup analysis was performed, controlling for extent of breast surgery and reconstruction. Multivariate logistic regression was performed to identify predictors of reoperation. Results: The ALND without LVB group contained 45,057 patients, and the ALND with LVB group contained 255 (0.6%). Overall, the LVB group was associated with increased operative time (288 vs. 147 minutes, Conclusion: Prophylactic LVB at time of ALND is a generally safe and well-tolerated procedure and is not associated with increased reoperations or wound complications. Although only four patients in the LVB group had DVTs, this was a significantly higher rate than in the non-LVB group and warrants further investigation.
Mesh-Begriff(e)	Axilla/surgery ; Breast Neoplasms/complications ; Female ; Humans ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Lymphatic System ; Lymphedema/surgery ; Mastectomy/adverse effects ; Sentinel Lymph Node Biopsy/adverse effects ; Venous Thrombosis/surgery
Sprache	Englisch
Erscheinungsdatum	2022-02-14
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	605983-1
ISSN	1098-8947 ; 0743-684X ; 0743-684X
ISSN (online)	1098-8947 ; 0743-684X
ISSN	0743-684X
DOI	10.1055/s-0042-1742730
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Buccal Myomucosal Flap Repair for Velopharyngeal Dysfunction.

Chiang, Sarah N / Fotouhi, Annahita R / Grames, Lynn M / Skolnick, Gary B / Snyder-Warwick, Alison K / Patel, Kamlesh B

Plastic and reconstructive surgery

2023 Band 152, Heft 4, Seite(n) 842–850

Abstract: Background: Velopharyngeal dysfunction (VPD) is the incomplete separation of the nasal and oral cavities during speech sound production that can persist following primary palatoplasty. Surgical technique used in management of VPD (palatal re-repair ... ...

Abstract	Background: Velopharyngeal dysfunction (VPD) is the incomplete separation of the nasal and oral cavities during speech sound production that can persist following primary palatoplasty. Surgical technique used in management of VPD (palatal re-repair versus pharyngeal flap or sphincter pharyngoplasty) is often dictated by the preoperative velar closing ratio and closure pattern. Recently, buccal flaps have increased in popularity in management of VPD. Here, the authors investigate the effectiveness of buccal myomucosal flaps in the treatment of VPD. Methods: A retrospective review was performed of all patients undergoing secondary palatoplasty with buccal flaps at a single center between 2016 and 2021. Preoperative and postoperative speech outcomes were compared. Speech assessments included perceptual examinations, graded on a four-point scale of hypernasality, and speech videofluoroscopy, from which the velar closing ratio was obtained. Results: A total of 25 patients underwent buccal myomucosal flap procedures for VPD at a median of 7.1 years after primary palatoplasty. Patients had significantly increased velar closing postoperatively (95% versus 50%; P < 0.001) and improved speech scores ( P < 0.001). Three patients (12%) had continued hypernasality postoperatively. There were no occurrences of obstructive sleep apnea. Conclusions: Treatment of VPD with buccal myomucosal flaps leads to improved speech outcomes without the risk of obstructive sleep apnea. Traditionally, palatal re-repair techniques have been used for smaller preoperative velopharyngeal gaps; however, the addition of buccal flaps allows for anatomical velar muscle correction for patients with a larger preoperative velopharyngeal gap. Clinical question/level of evidence: Therapeutic, IV.
Sprache	Englisch
Erscheinungsdatum	2023-03-21
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010443
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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