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  1. Article: Abdominal Wall Reconstruction After Extirpation of a 140-Pound Primary Ovarian Mucinous Adenocarcinoma.

    Raj, Mamtha S / Pittala, Karthik / Wallace, Sean J / Wojcik, Randolph

    Cureus

    2023  Volume 15, Issue 2, Page(s) e35542

    Abstract: Ovarian cancer is a feared diagnosis for women and clinicians alike. Ovarian mucinous adenocarcinoma is a unique subset of ovarian cancer. As a primary tumor, massive ovarian masses, and more specifically mucinous adenocarcinomas, have been infrequently ... ...

    Abstract Ovarian cancer is a feared diagnosis for women and clinicians alike. Ovarian mucinous adenocarcinoma is a unique subset of ovarian cancer. As a primary tumor, massive ovarian masses, and more specifically mucinous adenocarcinomas, have been infrequently reported in the medical literature. Team approaches to massive tumor extirpations are essential, as patients often require the expertise of various subspecialists including, but not limited to, gynecologic-oncologists, general surgeons, and plastic and reconstructive surgeons. Here we present a case of a 71-year-old woman with a massive, incapacitating pelvic mass, later found to be a primary ovarian mucinous adenocarcinoma. Once medically optimized, a multi-service team approach was utilized for tumor extirpation and abdominal wall reconstruction. Involved surgical services included Gynecologic-Oncology, General Surgery, and Plastic and Reconstructive Surgery. Exploratory laparotomy for tumor extirpation, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal stripping, bilateral inguinal lymphadenectomy, and appendectomy was performed. Extensively thin, devascularized, and attenuated abdominal wall fascia that was adherent to the tumor was removed. The abdominal wall defect was reconstructed and reinforced with inlay and overlays of biologic monofilament mesh. Inverted-T of the vertical and horizontal skin components was performed in a tailor-tacking fashion, assuring the maintenance and protection of the abdominal skin flap vascularity through utilizing the Huger Zones of perfusion. Pathology revealed a stage IA grade 2 mucinous adenocarcinoma of the ovary without evidence of metastasis. No adjuvant therapies were required. The tumor's weight was 140 pounds, and its dimensions were 63 x 41 x 40 cm. It is our hope that presenting this experience will raise awareness of this spectrum of diseases and allow for earlier diagnoses and treatments, as well as exemplify the virtues of a team-based approach in the successful extirpation and subsequent reconstruction of the abdominal wall and skin.
    Language English
    Publishing date 2023-02-27
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.35542
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Transorbital Approach for Clipping of Anterior Communicating Artery Aneurysm: 2-Dimensional Operative Video.

    Jean, Walter C / Piper, Keaton / Wojcik, Randolph / Saez-Alegre, Miguel

    Operative neurosurgery (Hagerstown, Md.)

    2023  Volume 25, Issue 4, Page(s) e237

    MeSH term(s) Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/surgery ; Neurosurgical Procedures/methods ; Microsurgery/methods
    Language English
    Publishing date 2023-07-25
    Publishing country United States
    Document type Video-Audio Media ; Journal Article
    ZDB-ID 2767575-0
    ISSN 2332-4260 ; 2332-4252
    ISSN (online) 2332-4260
    ISSN 2332-4252
    DOI 10.1227/ons.0000000000000816
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Sternectomy Reconstruction Using a Customized Three-Dimensional-Printed Polyetheretherketone Implant.

    Terrasse, Weston A / Mansour, Ahmed / Miles, Marshall G / Misselbeck, Timothy / Wojcik, Randolph

    Cureus

    2023  Volume 15, Issue 10, Page(s) e47216

    Abstract: Complex sternal and chest wall reconstruction can be a challenging clinical situation, with the main objectives being restoration of chest wall rigidity, protection of intrathoracic organs, preservation of respiratory function, and reduction of pain and ... ...

    Abstract Complex sternal and chest wall reconstruction can be a challenging clinical situation, with the main objectives being restoration of chest wall rigidity, protection of intrathoracic organs, preservation of respiratory function, and reduction of pain and clicking. The treatment of choice is varied, with several different materials available to aid in adequate reconstruction. We present the case of a 60-year-old male with a post-sternectomy defect and debilitating symptoms who underwent reconstruction with a customized, three-dimensional (3D)-printed polyetheretherketone (PEEK) implant and pectoralis muscle flaps. There were no complications in the perioperative period, and the patient reported significant improvement in pain and subjective improvement in chest stability and respiration. The use of PEEK as a reconstructive material for cardiothoracic defects is a viable and safe method that has several important benefits over other utilized materials in the literature. The early success of this case in relieving patient symptoms opens the door for further exploration of PEEK as an alternative for cardiothoracic reconstruction.
    Language English
    Publishing date 2023-10-17
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.47216
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Incidence of Complications Associated With Lipectomy Techniques and Patient Body Mass Index: An Institutional and National Analysis Using the Tracking Operations and Outcomes for Plastic Surgeons.

    Mansour, Ahmed / Steele, Andrew / Terrasse, Weston / Butte, Zara / Kincaid, Hope / Wallace, Sean / Miller, Nathan / Miles, Marshall / Wojcik, Randolph / Murphy, Robert X

    Annals of plastic surgery

    2023  Volume 90, Issue 6S Suppl 5, Page(s) S526–S532

    Abstract: Introduction: An evaluation of complication rates in different abdominal lipectomy techniques with relationship to body mass index (BMI) and other risk factors.: Methods: We identified patients who underwent an abdominal lipectomy at our institution ... ...

    Abstract Introduction: An evaluation of complication rates in different abdominal lipectomy techniques with relationship to body mass index (BMI) and other risk factors.
    Methods: We identified patients who underwent an abdominal lipectomy at our institution from January 2015 to July 2020. Those with concurrent hernia repair were excluded. Patients were classified into 2 groups: (1) horizontal lipectomy with or without umbilical translocation and (2) inverted-T lipectomy with translocation. Demographics, operative details, and postoperative complications were collected for 1 year postoperatively. Bivariate analyses were conducted to determine factors associated with type of procedure and complications. Crude and stratum-specific (based on BMI) odds ratios for complications were calculated for the inverted T as compared with the horizontal group. A replicate analysis using the national Tracking Operations and Outcomes for Plastic Surgeons (TOPS) as a single cohort was performed.
    Results: At our institution, 362 patients (group 1 = 196, group 2 = 166) were included. A total of 40.9% of patients experienced at least one complication at 1 year postoperatively with the complication rate decreasing to 28.0% when analyzed at the 30-day postoperative period. Specifically, wound disruption rates were highest in group 2 (39.8%) compared with group 1 (15.6%; P < 0.0001). The odds of experiencing a complication were greater in the inverted-T group overall and within each stratum of BMI. When dividing the cohort based on BMI class (normal weight, overweight, class I, class II, and class III obesity), the incidence of wound disruption increased as did BMI (2.6%, 22.2%, 27.2%, 48.2%, and 56.3%, respectively; P < 0.0001). The TOPS data set included 23,067 patients and showed an overall complication rate of 13.1% at 30-day postop. Overall, wound disruption rate was 4.6%. Compared with normal weight patients, the odds of experiencing a complication trended higher with each stratum of BMI. Other factors associated with complications included BMI, tobacco use, diabetes, American Society of Anesthesiology, prior massive weight loss, and LOS.
    Conclusions: The increasing complication rate within each BMI stratum of the large sample size of the TOPS patient cohort, in addition to our similar institutional trends, suggests that a staged procedure may be more appropriate for higher BMI patients. Surgical technique modification with limited flap undermining in patients undergoing inverted-T lipectomy to preserve flap perfusion may also decrease overall complication rates.
    MeSH term(s) Humans ; United States/epidemiology ; Lipectomy/adverse effects ; Lipectomy/methods ; Body Mass Index ; Incidence ; Obesity/complications ; Obesity/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Surgeons ; Retrospective Studies
    Language English
    Publishing date 2023-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 423835-7
    ISSN 1536-3708 ; 0148-7043
    ISSN (online) 1536-3708
    ISSN 0148-7043
    DOI 10.1097/SAP.0000000000003532
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Cutaneous Carcinosarcoma: A Small Case Series and Review of the Literature of a Rare Skin Tumor.

    Song, Ethan Y / Wallace, Sean J / Sheikh, Hina / Wojcik, Randolph / Nayak, Chetan

    Cureus

    2020  Volume 12, Issue 8, Page(s) e9569

    Abstract: Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this ... ...

    Abstract Carcinosarcomas are composed of epithelial and mesenchymal elements and primarily present within visceral organs. Despite being potentially aggressive, they are a rare diagnosis in the skin, and few manifestations have been reported to date. In this report, we describe two separate cases of carcinosarcoma presenting as nonhealing scalp wounds. Patient A: a 57-year-old male with a nonhealing skin lesion of ten years successfully treated with wide-local excision and local ortichochea flap reconstruction. Patient B: a 75-year-old female that presented with a painless, slow-growing hemorrhagic mass of 7 years invading the skull and dura ultimately requiring craniectomy and free-tissue transfer with anterolateral thigh flap. Cutaneous carcinosarcomas have more favorable outcomes due to low metastatic rates likely due to earlier detection, but delayed presentation can be fatal. Histopathological analysis is critical for determining diagnosis and prognosis. Adequate reconstruction after wide base excision varies and follows the reconstructive ladder/elevator ranging from primary closure up through free-tissue transfer. With cutaneous manifestations of carcinosarcoma seldom reported in the literature, it is our hope that reporting unusual instances such as this will raise awareness and allow for earlier diagnoses, treatments, and reconstructions.
    Language English
    Publishing date 2020-08-05
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.9569
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  6. Article: Non-surgical Management of Complex Refractory Pyoderma Gangrenosum With Negative Pressure Wound Therapy With Instillation.

    Lee, Frank G / Song, Ethan / Wallace, Sean J / Shaughnessy, Thomas J / Raj, Mamtha / Teixeira, Robert / Miles, Marshall G / Wojcik, Randolph

    Cureus

    2021  Volume 13, Issue 10, Page(s) e18951

    Abstract: Pyoderma gangrenosum (PG) is a rare skin disorder primarily treated with immunosuppression medication. We report a case of a large, chronic PG wound treated with adjunct negative pressure wound therapy with instillation and dwell time (NPWTi-d) using ... ...

    Abstract Pyoderma gangrenosum (PG) is a rare skin disorder primarily treated with immunosuppression medication. We report a case of a large, chronic PG wound treated with adjunct negative pressure wound therapy with instillation and dwell time (NPWTi-d) using nonadherent dressing (Mepitel) and reticular open-cell foam with through holes (ROCF-CC) with positive outcomes. The patient was a 62-year-old female with rheumatoid arthritis, Hashimoto's thyroiditis, lymphedema, and morbid obesity who presented with a 19.5 cm x 13.2 cm x 2.1 cm wound of three years duration on the right posterolateral lower extremity that successfully responded to a multimodality approach of immunosuppression and wound vac therapy. We conclude in our case that NPWTi-d with Mepitel and ROCF-CC enhanced the wound healing process, and we discuss NPWTi-d's potential role and benefit as an adjunctive therapy option for chronic and poorly controlled PG on patients taking concurrent immunosuppression.
    Language English
    Publishing date 2021-10-21
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.18951
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  7. Article: Pyoderma Gangrenosum after Fat Grafting in Alloplastic Breast Reconstruction: An Unusual Outcome.

    Song, Ethan Y / Wallace, Sean J / Teixeira, Robert M / Mansour, Ahmed / Naktin, Jaan P / Miles, Marshall / Low, Yee Cheng / Wojcik, Randolph

    Plastic and reconstructive surgery. Global open

    2020  Volume 8, Issue 11, Page(s) e3223

    Abstract: Pyoderma gangrenosum (PG) is a rare and painful inflammatory skin disorder that has been recently associated with breast surgery. It is commonly mistaken for postoperative ischemia or wound infection and does not show response to antibiotics or ... ...

    Abstract Pyoderma gangrenosum (PG) is a rare and painful inflammatory skin disorder that has been recently associated with breast surgery. It is commonly mistaken for postoperative ischemia or wound infection and does not show response to antibiotics or debridement. We describe the first case of post-surgical PG (PSPG) after alloplastic breast reconstruction involving fat grafting. A 47-year-old woman underwent bilateral mastectomy and 2-stage alloplastic breast reconstruction, with fat grafting from the abdomen. Two days post-surgery, she developed bilateral erythema with tender grouped pustules that progressed rapidly into necrotic ulcerations. She did not respond to antibiotics and serial debridement. Subsequent biopsy confirmed a diagnosis of PG. She was started on steroid therapy and responded well. She was discharged on a steroid regimen, local wound care, and eventually a T-cell inhibitor. Over the next 12 months, her wounds healed without surgical intervention. PSPG has been observed in a variety of reconstructive breast surgeries, but never reported in the setting of fat grafting. As PG involves subcutaneous fat, fat grafting may accelerate and exacerbate the course of disease. Treatment for PSPG includes systemic steroid therapy or other immunomodulatory agents (or both). Surgical management remains controversial, as serial debridement and reconstruction have shown to exacerbate and stimulate disease progression. A long-term follow-up is recommended to monitor for wound healing. Delayed diagnosis of PG in breast reconstruction patients can lead to severe morbidity and disfigurement. This is first case of PSPG following fat grafting in the literature.
    Language English
    Publishing date 2020-11-20
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2851682-5
    ISSN 2169-7574 ; 2169-7574
    ISSN (online) 2169-7574
    ISSN 2169-7574
    DOI 10.1097/GOX.0000000000003223
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Picayune? Peripherally inserted central catheter problems with pectoralis flaps.

    Wojcik, Randolph / Hallock, Geoffrey G

    Plastic and reconstructive surgery

    2008  Volume 122, Issue 5, Page(s) 157e–159e

    MeSH term(s) Catheterization, Central Venous ; Catheterization, Peripheral/adverse effects ; Coronary Artery Bypass ; Female ; Foreign-Body Migration/etiology ; Foreign-Body Migration/surgery ; Humans ; Intraoperative Complications/etiology ; Mammary Arteries/surgery ; Middle Aged ; Pectoralis Muscles/surgery ; Surgical Flaps/blood supply
    Language English
    Publishing date 2008-07-15
    Publishing country United States
    Document type Case Reports ; 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.0b013e318186cd56
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  9. Article: The role of surveillance duplex scanning in preventing venous thromboembolism in trauma patients.

    Cipolle, Mark D / Wojcik, Randolph / Seislove, Elizabeth / Wasser, Thomas E / Pasquale, Michael D

    The Journal of trauma

    2002  Volume 52, Issue 3, Page(s) 453–462

    Abstract: Background: This study was performed to determine the role of duplex scanning in preventing pulmonary embolism (PE), the correlation of venous thromboembolism (VTE) risk score with the incidence of deep venous thrombosis (DVT), and patients who may ... ...

    Abstract Background: This study was performed to determine the role of duplex scanning in preventing pulmonary embolism (PE), the correlation of venous thromboembolism (VTE) risk score with the incidence of deep venous thrombosis (DVT), and patients who may benefit from surveillance duplex scanning.
    Methods: Age, sex, Injury Severity Score (ISS), VTE score, length of stay, diagnoses, and bleeding risk were recorded from the trauma registry in patients who had a duplex scan from 1995 to 2000.
    Results: There were 1,513 duplex scans obtained (10,141 trauma admissions), 253 (2.5%) cases of DVT (52% above-knee, 8% upper extremity), and 30 cases of PE (0.3%). Only 5 of 21 duplex scans were positive in PE patients. DVT patients were older (52.9 vs. 46.7 years), with higher ISS (24.0 vs. 20.8) than patients without DVT. Regression analysis showed poor correlation between VTE score and DVT incidence (r2 = 0.27). Univariate analysis identified age, ISS, and VTE score as risk predictors for DVT.
    Conclusion: Adherence to an evidence-based VTE prophylaxis protocol is more important than surveillance duplex scanning in preventing VTE in trauma patients.
    MeSH term(s) Chi-Square Distribution ; Female ; Humans ; Injury Severity Score ; Male ; Multiple Trauma/complications ; Pulmonary Embolism/diagnosis ; Pulmonary Embolism/etiology ; Pulmonary Embolism/prevention & control ; Registries ; Regression Analysis ; Risk Assessment ; Ultrasonography, Doppler, Duplex ; Vena Cava Filters ; Venous Thrombosis/complications ; Venous Thrombosis/diagnostic imaging ; Venous Thrombosis/prevention & control
    Language English
    Publishing date 2002-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/00005373-200203000-00007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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