Browsing by Author "Dawson, Steven E."

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    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.
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    Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer
    (Thieme, 2023-01-11) Gross, Jeffrey N.; Dawson, Steven E.; Wu, Gerald J.; Loewenstein, Scott; Borschel, Gregory H.; Adkinson, Joshua M.; Surgery, School of Medicine
    Background: Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. Methods: We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. Results: At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end ( n  = 4) or end-to-side ( n  = 5) AIN to DBUN transfer. Conclusion: We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.
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    Supraclavicular Approach to the Brachial Plexus
    (Wolters Kluwer, 2023-01-23) Dawson, Steven E.; Gross, Jeffrey N.; Berns, Jessica M.; Weinzerl, Thomas; Adkinson, Joshua M.; Borschel, Gregory H.; Surgery, School of Medicine
    Background: The brachial plexus consists of an intricate array of nerves originating from the C5–T1 ventral rami of the spinal cord. Their course is complex and can be substantially distorted after injury. Thus, dissection of the brachial plexus can be difficult. Here, we present a practical approach to the supraclavicular dissection of the brachial plexus, with emphasis on relevant anatomy and surgical landmarks. Methods: This anatomical review was prepared using intraoperative surgical imaging. In addition, illustrations are used to display the images in schematic form. We present a stepwise surgical approach to the supraclavicular dissection of the brachial plexus. We highlight the differences between pre- and postganglionic nerve root injuries, and also relevant anatomical variants of the brachial plexus. Results: Eleven steps are recommended to facilitate the supraclavicular approach to the brachial plexus. Conclusion: The supraclavicular dissection of the brachial plexus is reliable with consistent landmarks and can be carried out in a stepwise fashion.