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Article ; Online: Virtual planning and navigational technology in reconstructive surgery.

Shenaq, Deana S / Matros, Evan

2018 Volume 118, Issue 5, Page(s) 845–852

Abstract: Reconstructive technologies have expanded to include the use of virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD-CAM), and 3-Dimensional printing. The advantages of VSP over traditional techniques are highlighted in many ... ...

Abstract	Reconstructive technologies have expanded to include the use of virtual surgical planning (VSP) and computer-aided design and manufacturing (CAD-CAM), and 3-Dimensional printing. The advantages of VSP over traditional techniques are highlighted in many scenarios: (a) delayed reconstruction, (b) maxillary reconstruction, (c) placement of dental implants, and (d) precision guided oncology. Microsurgery is undergoing a paradigm shift with virtual planning at its foreground. Herein, we describe the versatile uses for CAD-CAM and key operative steps.
MeSH term(s)	Computer-Aided Design ; Dental Implantation, Endosseous ; Humans ; Mandibular Reconstruction/methods ; Maxilla/surgery ; Microsurgery ; Printing, Three-Dimensional ; Reconstructive Surgical Procedures/methods ; Surgery, Computer-Assisted
Language	English
Publishing date	2018-10-07
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.25255
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Article: Safety and Efficacy of Extended Postdischarge Venous Thromboembolism Prophylaxis in Microsurgical Breast Reconstruction.

Hansdorfer, Marek A / Sadowsky, Rachel L / Horen, Sydney R / Becerra, Adan Z / Shenaq, Deana S / Kokosis, George

Plastic and reconstructive surgery. Global open

2023 Volume 11, Issue 2, Page(s) e4839

Abstract: Discharging patients on extended postoperative venous thromboembolism (VTE) prophylaxis is trending in microsurgical breast reconstruction (MBR). This study investigated contemporary bleeding and thromboembolic complications after MBR and reported ... ...

Abstract	Discharging patients on extended postoperative venous thromboembolism (VTE) prophylaxis is trending in microsurgical breast reconstruction (MBR). This study investigated contemporary bleeding and thromboembolic complications after MBR and reported postdischarge enoxaparin outcomes. Methods: The PearlDiver database was queried for MBR patients who did not receive postdischarge VTE prophylaxis (cohort 1) and MBR patients discharged with enoxaparin for at least 14 days (cohort 2), then queried for hematoma, deep venous thrombosis (DVT), and/or pulmonary embolism. Concurrently, a systematic review was undertaken to identify studies investigating VTE with postoperative chemoprophylaxis. Results: In total, 13,541 patients in cohort 1 and 786 patients in cohort 2 were identified. The incidence of hematoma, DVT, and pulmonary embolism were 3.51%, 1.01%, 0.55% in cohort 1, and 3.31%, 2.93%, and 1.78% in cohort 2, respectively. There was no significant difference in hematoma between these two cohorts ( Conclusions: This is the first study utilizing a national database and a systematic review to investigate extended postoperative enoxaparin in MBR. Overall, rates of DVT/PE seem to be declining compared with previous literature. The results of this study suggest that there remains a lack of evidence supporting extended postoperative chemoprophylaxis, although the therapy appears safe in that it does not increase bleeding risk.
Language	English
Publishing date	2023-02-27
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.0000000000004839
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Article ; Online: Cold Injuries.

Shenaq, Deana S / Gottlieb, Lawrence J

Hand clinics

2017 Volume 33, Issue 2, Page(s) 257–267

Abstract: New treatments of frostbite have led to unprecedented salvage of extremities including fingers and toes. Success is predicated on prompt institution of time-sensitive protocols initiated soon after rewarming, particularly the use of thombolytics. ... ...

Abstract	New treatments of frostbite have led to unprecedented salvage of extremities including fingers and toes. Success is predicated on prompt institution of time-sensitive protocols initiated soon after rewarming, particularly the use of thombolytics. Unfortunately, in the urban setting, most patients are not candidates for these treatment modalities. Triple-phase bone scans have allowed for early determination of devitalized parts that need amputation. Reconstructive surgical techniques are typically used to salvage limb length in these devastating injuries.
Language	English
Publishing date	2017-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1315374-2
ISSN	1558-1969 ; 0749-0712
ISSN (online)	1558-1969
ISSN	0749-0712
DOI	10.1016/j.hcl.2016.12.003
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Article: Trends in Skin Melanoma Burden: Findings From the Global Burden of Disease Study.

Siotos, Charalampos / Grunvald, Miles W / Damoulakis, George / Becerra, Adan Z / O'Donoghue, Cristina M / Dorafshar, Amir H / Shenaq, Deana S

Eplasty

2022 Volume 22, Page(s) e9

Abstract: Background: Melanoma is the third most common skin cancer and the leading cause of skin cancer mortality. This study sought to investigate trends in melanoma incidence, mortality, and burden of disease.: Methods: The authors assessed the records of ... ...

Abstract	Background: Melanoma is the third most common skin cancer and the leading cause of skin cancer mortality. This study sought to investigate trends in melanoma incidence, mortality, and burden of disease. Methods: The authors assessed the records of the Global Burden of Disease Study 2017 to extract information about the incidence, mortality, and disability adjusted life years (DALY) related to melanoma during 1990-2017 in the US and other countries based on their socio-demographic index (SDI). Results: Melanoma incidence in the US increased 1.6 times, although the difference was not statistically significant. For patients over the age of 60, the incidence was significantly increased by 1.72 to 164.6 times. Mortality was relatively stable during the study period; however, it was increased for patients over 65 years of age (range: 1.03 to 70 times), although not statistically significant. Mortality-to-incidence ratio was decreased, but the difference was not statistically significant. For patients over 75 years of age, DALYs were statistically significantly increased by 1.34 to 1.71 times. Conclusions: This study highlights differences in melanoma incidence and mortality from 1990-2017. Physicians involved in melanoma care should be aware of these changes in order to anticipate care needs.
Language	English
Publishing date	2022-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2412803-X
ISSN	1937-5719
ISSN	1937-5719
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Article: Burden of Pressure Injuries: Findings From the Global Burden of Disease Study.

Siotos, Charalampos / Bonett, Andrew M / Damoulakis, George / Becerra, Adan Z / Kokosis, George / Hood, Keith / Dorafshar, Amir H / Shenaq, Deana S

Eplasty

2022 Volume 22, Page(s) e19

Abstract: Background: Pressure injuries remain among the most common problems faced by plastic surgeons and comprise a large portion of wound clinic practice. However, little is known about the overall morbidity related to the disease. This research sought to ... ...

Abstract	Background: Pressure injuries remain among the most common problems faced by plastic surgeons and comprise a large portion of wound clinic practice. However, little is known about the overall morbidity related to the disease. This research sought to identify the burden related to the diagnosis of pressure injuries. Methods: We used the Global Burden of Disease Study 2017 to extract information about incidence and disability-adjusted life years (DALYs) related to pressure injuries from 1990 to 2017. Descriptive statistics were used to identify changes in the outcomes of interest. Results: A relative though not statistically significantly decrease in the incidence and burden of pressure injuries was observed between 1990 and 2017. Rates of incidence in the US appear higher than other higher socio-demographic index countries. No clinically and statistically significant changes were observed based on age or sex. Conclusions: Pressure injury incidence and burden have remained relatively stable between 1990 and 2017 with no significant improvement noted. There is room for improvement on a national performance level, and further research is needed regarding inconsistencies in regional outcomes.
Language	English
Publishing date	2022-06-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2412803-X
ISSN	1937-5719
ISSN	1937-5719
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Article ; Online: Clinical Outcomes Following Resection of Distal Lower Extremity Soft Tissue Sarcomas.

Gusho, Charles A / Lee, Linus / McCormick, Johnathon R / Derman, Gordon H / Shenaq, Deana S / Dorafshar, Amir H / Kokosis, George / Colman, Matthew W / Gitelis, Steven / Blank, Alan T

Bulletin of the Hospital for Joint Disease (2013)

2023 Volume 81, Issue 4, Page(s) 265–272

Abstract: Objective: Resection of soft tissue sarcoma (STS) in the distal lower extremity can result in large soft tissue defects that create difficult wounds to manage and significant risks for complications. Often, the anticipated or resultant tissue defect or ... ...

Abstract	Objective: Resection of soft tissue sarcoma (STS) in the distal lower extremity can result in large soft tissue defects that create difficult wounds to manage and significant risks for complications. Often, the anticipated or resultant tissue defect or loss of functional anatomy is an indication for amputation over limb salvage. Soft tissue reconstruction managed by plastic and reconstructive surgery (PRS) may help offer limb salvage as a therapeutic option with acceptable oncologic outcomes and wound complication rates. Methods: This was a review of 52 patients who underwent resection of STS at the level of the knee or distal between 2010 and 2020. Plastic and reconstructive surgery soft tissue management was utilized in 40.4% (n = 21) of cases, most of whom would have otherwise been considered candidates for amputation. Results: The overall rate of limb salvage was 76.9%. The overall rate of wound complications was 19.2%. The overall rate of negative margins of resection was 92.3%. The 1-, 5-, and 10-year overall survival probabilities were 92%, 85%, and 85%, respectively. Of the 40 limb salvage procedures, two required subsequent amputation, one for multiply recurrent disease and one for necrosis. The wound complication rate was 14.3% in the PRS management group and 22.6% in cases of wound closure managed by the primary surgeon. There were zero instances of total wound or flap loss in PRS- managed closures. When comparing patients with wound complications to those without, there was no difference in age (59.5 ± 21 vs. 51 ± 18 years, p = 0.42), body mass index (31.1 ± 4.8 vs. 26.1 ± 7.1 kg/m2 , p = 0.19), or tumor size (6.8 ± 5.0 vs. 6.4 ± 4.7 cm, p = 0.82). At final follow-up, 67% (n = 35) of patients were alive and disease-free. Conclusions: Wound complications are not uncommon after resection of distal lower extremity STS. Our experience has been successful in achieving limb salvage in these challenging cases. Without PRS soft tissue management, however, many patients may alternatively be candidates for amputation.
MeSH term(s)	Humans ; Surgical Flaps/surgery ; Plastic Surgery Procedures/adverse effects ; Limb Salvage ; Lower Extremity/surgery ; Sarcoma/surgery
Language	English
Publishing date	2023-11-18
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	390411-8
ISSN	2328-5273 ; 1936-9727 ; 1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
ISSN (online)	2328-5273 ; 1936-9727
ISSN	1936-9719 ; 0018-5647 ; 0883-9344 ; 2328-4633
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Article ; Online: Trends of Medicare Reimbursement Rates for Lower Extremity Procedures.

Siotos, Charalampos / Aminzada, Amir / Whitney, Natalia / Najafali, Daniel / Toms Iii, John A / Mpontozis, Anastasios / Kokosis, George / Shenaq, Deana S / Derman, Gordon H / Dorafshar, Amir H / Kurlander, David E

Journal of reconstructive microsurgery

2023 Volume 40, Issue 4, Page(s) 294–301

Abstract: Background: Data collected across many surgical specialties suggest that Medicare reimbursement for physicians consistently lags inflation. Studies are needed that describe reimbursement rates for lower extremity procedures. Our goal is to analyze the ... ...

Abstract	Background: Data collected across many surgical specialties suggest that Medicare reimbursement for physicians consistently lags inflation. Studies are needed that describe reimbursement rates for lower extremity procedures. Our goal is to analyze the trends in Medicare reimbursement rates from 2010 to 2021 for both lower extremity amputation and salvage surgeries. Methods: The Physician Fee Schedule Look-Up Tool of the Centers for Medicare and Medicaid Services was assessed and Current Procedural Terminology codes for common lower extremity procedures were collected. Average reimbursement rates from 2010 to 2021 were analyzed and adjusted for inflation. The rates of work-, facility-, and malpractice-related relative value units (RVUs) were also collected. Results: We found an overall increase in Medicare reimbursement of 4.73% over the study period for lower extremity surgery. However, after adjusting for inflation, the average reimbursement decreased by 13.19%. The adjusted relative difference was calculated to be (-)18.31 and (-)11.34% for lower extremity amputation and salvage procedures, respectively. We also found that physician work-related RVUs decreased by 0.27%, while facility-related and malpractice-related RVUs increased. Conclusion: Reimbursement for lower extremity amputation and salvage procedures has steadily declined from 2010 to 2021 after adjusting for inflation, with amputation procedures being devaluated at a greater rate than lower extremity salvage procedures. With the recent marked inflation, knowledge of these trends is crucial for surgeons, hospitals, and health care policymakers to ensure appropriate physician reimbursement. Level of evidence: IV (cross-sectional study).
MeSH term(s)	Aged ; United States ; Humans ; Medicare ; Insurance, Health, Reimbursement ; Cross-Sectional Studies ; Surgeons ; Lower Extremity/surgery
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	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/a-2161-7947
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Article ; Online: Pressure injuries in COVID-19 patients: A tertiary center experience.

Siotos, Charalampos / Arnold, Sydney H / Aminzada, Amir / Sadowsky, Rachel L / Siotou, Kalliopi / Kurlander, David E / Kokosis, George / Shenaq, Deana S / Dorafshar, Amir H

Journal of plastic, reconstructive & aesthetic surgery : JPRAS

2023 Volume 83, Page(s) 89–93

Abstract: Pressure ulcers continue to severely impact patient outcomes and increase health care costs. We aimed to examine the incidence and risk factors related to pressure ulcers among COVID-19 patients. A retrospective was conducted between March 2020-April ... ...

Abstract	Pressure ulcers continue to severely impact patient outcomes and increase health care costs. We aimed to examine the incidence and risk factors related to pressure ulcers among COVID-19 patients. A retrospective was conducted between March 2020-April 2021. Baseline differences were examined using chi-square and Fischer's exact test. Logistic regression was employed to examine the association of the collected variables to development of new pressure ulcers. 4608 patients were included, of which eighty-three acquired new pressure ulcers. Risk factors were increased age, peripheral artery disease, abnormal albumin levels, but not prone position.
MeSH term(s)	Humans ; Pressure Ulcer/epidemiology ; Pressure Ulcer/etiology ; Retrospective Studies ; COVID-19/epidemiology ; COVID-19/complications ; Risk Factors ; Crush Injuries ; Incidence
Language	English
Publishing date	2023-05-18
Publishing country	Netherlands
Document type	Journal Article
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.2023.05.028
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Article ; Online: United States insurance coverage of immediate lymphatic reconstruction.

La-Anyane, Okensama / Alba, Brandon E / Harmon, Kelly A / To, Jocelyn / Siotos, Charalampos / Adepoju, Jubril / Madrigrano, Andrea / Alvarado, Rosalinda / O'Donoghue, Cristina / Perez, Claudia B / Kurlander, David E / Shenaq, Deana S / Kokosis, George

Journal of surgical oncology

2023 Volume 129, Issue 3, Page(s) 584–591

Abstract: Introduction: Immediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance ... ...

Abstract	Introduction: Immediate Lymphatic Reconstruction (ILR) is a prophylactic microsurgical lymphovenous bypass technique developed to prevent breast cancer related lymphedema (BCRL). We investigated current coverage policies for ILR among the top insurance providers in the United States and compared it to our institutional experience with obtaining coverage for ILR. Methods: The study analyzed the publicly available ILR coverage statements for American insurers with the largest market share and enrollment per state to assess coverage status. Institutional ILR coverage was retrospectively analyzed using deidentified claims data and categorizing denials based on payer reason codes. Results: Of the 63 insurance companies queried, 42.9% did not have any publicly available policies regarding ILR coverage. Of the companies with a public policy, 75.0% deny coverage for ILR. In our institutional experience, $170,071.80 was charged for ILR and $166 118.99 (97.7%) was denied by insurance. Conclusions: Over half of America's major insurance providers currently deny coverage for ILR, which is consistent with our institutional experience. Randomized trials to evaluate the efficacy of ILR are underway and focus should be shifted towards sharing high level evidence to increase insurance coverage for BCRL prevention.
MeSH term(s)	Humans ; United States ; Retrospective Studies ; Plastic Surgery Procedures ; Breast Cancer Lymphedema ; Insurance Coverage ; Lymphatic System
Language	English
Publishing date	2023-11-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.27512
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Article ; Online: The Affordable Care Act and Its Impact on Plastic and Gender-Affirmation Surgery.

Wiegmann, Aaron L / Young, Ezra I / Baker, Kellan E / Khalid, Syed I / Seu, Michelle / Shenaq, Deana S / Dorafshar, Amir H / Schechter, Loren S

Plastic and reconstructive surgery

2021 Volume 147, Issue 1, Page(s) 135e–153e

Abstract: Summary: The Affordable Care Act's provisions have affected and will continue to affect plastic surgeons and their patients, and an understanding of its influence on the current American health care system is essential. The law's impact on pediatric ... ...

Abstract	Summary: The Affordable Care Act's provisions have affected and will continue to affect plastic surgeons and their patients, and an understanding of its influence on the current American health care system is essential. The law's impact on pediatric plastic surgery, craniofacial surgery, and breast reconstruction is well documented. In addition, gender-affirmation surgery has seen exponential growth, largely because of expanded insurance coverage through the protections afforded to transgender individuals by the Affordable Care Act. As gender-affirming surgery continues to grow, plastic surgeons have the opportunity to adapt and diversify their practices.
MeSH term(s)	Female ; Health Services Accessibility/economics ; Health Services Accessibility/legislation & jurisprudence ; Health Services Accessibility/statistics & numerical data ; Health Services Accessibility/trends ; Healthcare Disparities/economics ; Healthcare Disparities/statistics & numerical data ; Healthcare Disparities/trends ; Humans ; Insurance Coverage/economics ; Insurance Coverage/statistics & numerical data ; Insurance Coverage/trends ; Male ; Medicaid/economics ; Medicaid/statistics & numerical data ; Patient Protection and Affordable Care Act/economics ; Patient Protection and Affordable Care Act/legislation & jurisprudence ; Plastic Surgery Procedures/economics ; Plastic Surgery Procedures/statistics & numerical data ; Plastic Surgery Procedures/trends ; Sex Reassignment Surgery/economics ; Sex Reassignment Surgery/statistics & numerical data ; Sex Reassignment Surgery/trends ; Socioeconomic Factors ; United States ; Value-Based Health Insurance/economics ; Value-Based Health Insurance/statistics & numerical data
Language	English
Publishing date	2021-08-02
Publishing country	United States
Document type	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.0000000000007499
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