Browsing by Author "Dawson, Steven"

Now showing 1 - 5 of 5
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    A Novel Framework for Optimizing Efficiency and Education in Microsurgical Breast Reconstruction
    (Wolters Kluwer, 2023-11-27) Lester, Mary E.; Berns, Jessica; Dawson, Steven; Newsom, Keeley; Hartman, Brett; Hassanein, Aladdin H.; Surgery, School of Medicine
    Deep inferior epigastric perforator (DIEP) flaps are becoming the most frequent choice for autologous breast reconstruction. There are many benefits to DIEP flaps, but the procedures can be lengthy and have a steep learning curve. The balance of efficiency and education can be difficult to achieve. A framework was implemented to focus on both efficiency and education at each stage of the DIEP flap procedure. The author's methods to improve efficiency include a two-team approach with assigned roles for faculty and residents. The roles are consistent across the institution. Methods to enhance education include practice in a laboratory-based microsurgical training course and assigning goals for the rotation. Trainees include independent and integrated plastic surgery residents without microsurgical fellows. Bilateral DIEPs are performed with two attendings, and unilateral DIEPs, with one attending. A retrospective review identified patients undergoing DIEP flap reconstruction from 2017 to 2020. Outcome measures include operative time and complications, which are comparable to previously published data. Focusing on education allows residents to learn each stage of the case. The authors present a framework for training residents in DIEP flap reconstruction to optimize efficiency and education.
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    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.
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    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.
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    Patient-reported Outcomes after Local Flap Coverage Versus Amputation for Complex Lower Extremity Trauma
    (Wolters Kluwer, 2022) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott; Knox, Kevin; Adkinson, Joshua M.; Bamba, Ravi; Surgery, School of Medicine
    PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. RESULTS: Surveys were completed by 65 patients (response rate 60.7%). The mean time of survey after flap reconstruction was 3.2 years. Recent trauma (within 90 days) was the most common indication for local flap coverage (n=26). Flap complications included wound dehiscence (n=8) and infection (n=4). Other flap complications included partial flap necrosis (n=12), total flap necrosis (n=2), and secondary amputation (n=4). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared to fasciocutaneous flaps (p=0.021 and p=0.022 respectively). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS (p=0.017), SF-36 physical functioning (p=0.033), and health change (p=0.050) scores than amputation patients. CONCLUSION: PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. Patients who underwent 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. This data suggests 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.
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