IU Indianapolis ScholarWorks :: Browsing by Author "Bamba, Ravinder"

Browsing by Author "Bamba, Ravinder"

Now showing 1 - 10 of 14

65. Prophylactic Absorbable Antibiotic Beads: Effect on Tissue Expander Reconstruction Outcomes Following Mastectomy Skin Necrosis
(Wolters Kluwer, 2025-04-24) Ahmed, Shahnur; Zaidi, Shozaf S.; Fisher, Carla S.; Ludwig, Kandice K.; Imeokparia, Folasade O.; VonDerHaar, R. Jason; Bamba, Ravinder; Danforth, Rachel M.; Hassanein, Aladdin H.; Lester, Mary E.; Surgery, School of Medicine
PURPOSE: Mastectomy skin necrosis is problematic in tissue expander reconstruction with rates between 7 to 30%. Partial or full-thickness skin necrosis may harbor bacterial colonization promoting infection and risk of implant loss. Absorbable antibiotic-impregnated calcium-sulfate antibiotic beads have been described to reduce tissue expander (TE)/implant infection when used prophylactically for prepectoral breast reconstruction. The purpose of this study is to evaluate the effect of absorbable antibiotic beads on outcomes in patients who develop mastectomy skin necrosis after immediate postmastectomy tissue expander breast reconstruction. METHODS: A single-center retrospective review was performed for patients who underwent mastectomy, immediate prepectoral TE reconstruction on the same day (2018-2024). Patients who developed mastectomy skin necrosis were included. Patients were divided into two groups: Group 1 (absorbable antibiotic beads with TE placement) and Group 2 (no antibiotic beads with TE). Demographical information was recorded. Surgical-site infection (90-days) and implant removal were the outcome variables. RESULTS: The study included 61 patients (75 total breasts with necrosis) who underwent prepectoral TE breast reconstruction following mastectomy and developed mastectomy skin necrosis. The patients included in the study with mastectomy skin necrosis were 12 patients in Group 1 (16 breasts) and 49 patients in Group 2 (59 breasts). Baseline characteristics were not significantly difference between groups (p=1). There was no difference between nipple-sparing mastectomy or skin-sparing mastectomy between groups (p=0.1094). Acellular dermal matrix was used in 66.7% (8/12) of Group 1 compared to 83.7% (41/49) of Group 2 (p=0.2285). Operative management of mastectomy skin necrosis including debridement and reclosure was required in 50% (6/12) of Group 1 compared to 69.4% (34/49) of Group 2 patients (p=0.3093). There was one occurrence (6.3%, 1/16 TEs) of surgical-site infection in Group 1 and 35.6% (21/59 TEs) in Group 2 (p=0.0288). TE removal resulted in 6.3% (1/16 TEs) in Group 1 and 33.9% (20/59 TEs) in Group 2 (p=0.0310). The mean follow-up time was 189 days (range 146-236 days). CONCLUSIONS: Patients who develop mastectomy skin necrosis after prepectoral tissue expander reconstruction may experience lower rates of TE removal and infection when prophylactic absorbable antibiotic-impregnated beads are used. Patients who develop mastectomy skin necrosis are at high risk for infection and TE loss. Prophylactic antibiotic beads used at the time of mastectomy with prepectoral TE reconstruction decrease the risk of infection and TE loss in patients who experience mastectomy skin necrosis.
A Comparative Analysis of Negative Pressure Wound Therapy Methods for Sternal Wound Infections
(Wolters Kluwer, 2025-03-07) Bamba, Ravinder; Harvey, Brianna I.; Malik, Noor U.; Higgins, Jasmine; Sung, Cynthia; Corvera, Joel S.; Hartman, Brett C.; Hassanein, Aladdin H.; Lester, Mary E.; Surgery, School of Medicine
Sternal wound infection can be a severe complication of cardiac surgery. Multiple debridements are often necessary before definitive coverage, and negative pressure wound therapy (NPWT) is often used as a temporary dressing between debridements. NPWT with instillation and dwell (NPWT-i) has been used in many wound types including sternal wounds with success. The purpose of this study was to compare outcomes between sternal wounds managed with conventional NPWT and NPWT-i. A total of 47 patients who had sternal wound infections were managed with debridement, negative pressure therapy, and flap. Patients were divided into 2 groups based on the type of negative pressure therapy: NPWT (n = 24) and NPWT-i (n = 23). The NPWT group required 3.3 debridements per patient before flap coverage, whereas the NPWT-i group required 3.4 debridements per patient (P = 0.86). Other postoperative outcomes including seroma, hematoma, delayed wound healing, and surgical site infection were similar between the 2 groups. We found NPWT similar to NPWT-i for the number of debridements needed and outcomes in the management of sternal wound infections. NPWT-i does not replace or decrease the need for operative debridement in sternal wounds.
Comparison of Breast Reconstruction Outcomes Using Oxychlorosene versus Triple Antibiotic Solution for Pocket Irrigation
(Wolters Kluwer, 2022-08-18) Bamba, Ravinder; Tran, Phu C.; Mailey, Brian A.; Lin, Jenny; DeBrock, William; Dawson, Steven; Sinha, Mithun; Hartman, Brett C.; Hadad, Ivan; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
Background: Breast pocket irrigation with antiseptic solutions is performed to reduce contamination with breast implants. The optimal antiseptic irrigation solution and the efficacy of individual practices are unclear. Oxychlorosene sodium is frequently used at our institution. Oxychlorosene is bactericidal with a mechanism of action of oxidation and hypochlorination. The purpose of our study was to compare the outcomes of oxychlorosene sodium irrigation with triple antibiotic solution (TAS) in implant-based breast reconstruction. Methods: All patients who underwent implant-based reconstruction after mastectomy were reviewed. The primary predictive variable was type of solution used for pocket irrigation (TAS or oxychlorosene). Outcome variables included surgical site infection, device removal, and wound complications. Results: Between 2013 and 2018, 331 implant-based breast reconstructions were performed. Of these, 62% (n = 206) received oxychlorosene for surgical pocket irrigation (group I), and 38% (n = 125) received TAS (group II). Group I had an 11.7% (n = 24) 90-day surgical site infection rate, with 4.9% (n = 10) requiring oral antibiotics, 2.4% (n = 5) requiring intravenous antibiotics without device removal, and 4.4% (n = 9) requiring prosthetic removal. Group II had an 11.2% (n = 14) 90-day infection rate, with 5.6% (n = 7) requiring oral antibiotics, 2.4% (n = 3) requiring intravenous antibiotics without device removal, and 3.2% (n = 4) requiring removal (P = 0.90). When comparing the cost of oxychlorosene irrigation with TAS irrigation, oxychlorosene was less expensive. Conclusions: Oxychlorosene and TAS have similar surgical site infection rates in prosthetic breast reconstruction. Ease of preparation and cost make oxychlorosene a more favorable option for antibiotic irrigation in reconstructive breast surgery with prosthetic devices.
Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma
(Thieme, 2024-10-24) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott N.; Knox, Kevin R.; Adkinson, Joshua M.; Hassanein, Aladdin H.; Bamba, Ravinder; Surgery, School of Medicine
Background: There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods: The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n = 33) or amputation ( n = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results: Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p = 0.021 and p = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p = 0.01), SF-36 physical functioning ( p = 0.031), physical role functioning ( p = 0.031), and emotional role functioning ( p = 0.047) scores than amputation patients. Conclusion: Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.
Conversion to Prepectoral Breast Implant Reconstruction after Chest Wall Resection for Desmoid Tumor
(Wolters Kluwer, 2020-08-17) Bamba, Ravinder; Kerwin, K. Blaire; Mailey, Brian; Ceppa, DuyKhanh P.; Hassanein, Aladdin H.; Surgery, School of Medicine
Direct-to-Implant in the Era of Prepectoral Breast Reconstruction: Evaluation of the National Trend in 59,313 Patients
(Wolters Kluwer, 2025-03-18) Ahmed, Shahnur; Baril, Jackson A.; Fisher, Carla S.; Danforth, Rachel M.; Bamba, Ravinder; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery
(Sage, 2022) Loewenstein, Scott N.; Bamba, Ravinder; Adkinson, Joshua M.; Surgery, School of Medicine
Background: The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods: We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results: Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) (P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) (P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions: Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.
Evaluation of Prepectoral Breast Tissue Expander Reconstruction Intraoperative Fill: Air or Saline?
(American Society of Plastic Surgeons, 2023-04) Bamba, Ravinder; Christopher, Laura; Mailey, Brian A.; Mercho, Raphael; Dawson, Steven E.; Hadad, Ivan; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
Staged implant-based breast reconstruction with immediate tissue expanders (TEs) is the most common method of breast reconstruction after mastectomy. TEs traditionally are filled with saline for expansion. Some surgeons have advocated initial intraoperative fill of the TE with air to avoid excess pressure on ischemic mastectomy skin flaps. The purpose of the study was to compare intraoperative air versus saline tissue fills. All patients who underwent prepectoral TE reconstruction after mastectomy from 2017 to 2019 were reviewed. The primary predictive variable was whether saline or air was used for initial tissue expansion. Outcome variables included mastectomy skin necrosis, nipple necrosis, infection, number of expansions, hematoma, and explantation. A total of 53 patients (88 TEs) were included in the study: 28 patients (44 TEs) who underwent initial intraoperative fill with air and 25 patients (44 TEs) who underwent an initial saline fill were assessed. There were no significant differences in complication rates between initial TE fill with saline versus air, including nipple necrosis, wound dehiscence, cellulitis, abscess, or TE removal (P = 1.0). The number of postoperative TE fills in the initial air fill group was 3.2 compared to 2.7 in the initial saline fill group (P = 0.27). Prepectoral TE initial fill with air has similar postoperative outcomes compared to initial saline fill. The authors found no benefit to initially filling prepectoral TEs with air intraoperatively. Given the additional effort of exchanging air for saline during the first postoperative fill, there was no clinical advantage of filling prepectoral TEs with air.
Implant-based Breast Reconstruction Salvage with Negative Pressure Wound Therapy with Instillation: An Evaluation of Outcomes
(Wolters Kluwer, 2024-09-03) Ahmed, Shahnur; Hulsman, Luci; Imeokparia, Folasade; Ludwig, Kandice; Fisher, Carla; Bamba, Ravinder; Danforth, Rachel; VonDerHaar, R. Jason; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of Medicine
Background: Implant infection is problematic in breast reconstruction. Traditionally, infected tissue expanders (TE)/implants are removed for several months before replacement, resulting in breast reconstruction delay. Salvage involving device removal, negative pressure wound therapy with instillation and dwell (NPWTi-d) placement, and early staged TE/implant replacement within a few days has been described. The purpose of this study was to compare outcomes of the NPWTi-d salvage pathway with traditional implant removal. Methods: A retrospective review was performed on patients who underwent implant-based reconstruction and developed TE/implant infection/exposure requiring removal. Patients were divided into two groups. Group 1 had TE/implant removal, NPWTi-d placement, and TE/implant replacement 1-4 days later. Group 2 (control) underwent standard TE/implant removal and no NPWTi-d. Reinfection after TE/implant salvage, TE/implant-free days, and time to final reconstruction were assessed. Results: The study included 47 patients (76 TE/implants) in group 1 (13 patients, 16 TE/implants) and group 2 (34 patients, 60 TE/implants). The success rate (no surgical-site infection within 90 days) of implant salvage was 81.3% in group 1. No group 1 patients abandoned completing reconstruction after TE/implant loss versus 38.2% (13 of 34) in group 2 (P = 0.0094). Mean implant-free days was 2.5 ± 1.2 in group 1 versus 134.6 ± 78.5 in group 2 (P = 0.0001). The interval to final implant-based reconstruction was 69.0 ± 69.7 days in group 1 versus 225.6 ± 93.6 days in group 2 (P = 0.0001). Conclusions: A breast implant salvage pathway with infected device removal, NPWTi-d placement, and early TE/implant replacement was successful in 81.3%. Patients experienced 132 less implant-free days and faster time to final reconstruction.
Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program
(Wiley, 2022-05) Bamba, Ravinder; Chu, Amanda; Gallegos, Jose; Herrera, Fernando A.; Hassanein, Aladdin H.; Medicine, School of Medicine
INTRODUCTION: Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30-day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database. METHODS: NSQIP was queried (2012-2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30-day morbidities, and hospital length of stay. RESULTS: The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co-morbidities between the groups (p = 0.26). 30-day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21). CONCLUSIONS: Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon's preference and experience as the operations have similar complication rates.

Browsing by Author "Bamba, Ravinder"

Results Per Page

Sort Options