Browsing by Author "Socas, Juan"
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Item Abstract 68: The False Positive Rate Of Transcutaneous Tissue Oximetry Alarms In Microvascular Breast Reconstruction Rises After 24 Hours(Wolters Kluwer, 2020-05-13) Tran, Phu C.; DeBrock, Will; Lester, Mary E.; Hartman, Brett C.; Socas, Juan; Hassanein, Aladdin H.; Medicine, School of MedicinePurpose: Transcutaneous tissue oximetry is widely used as an adjunct for postoperative monitoring after microvascular breast reconstruction and has been shown to improve flap salvage rates. Despite a high sensitivity at detection of postoperative vascular issues, alarms from probe malfunctions/ and or positioning can generate unnecessary nursing calls, concerns, and evaluations. The purpose of this study is to analyze the false positive rate of transcutaneous tissue oximetry monitoring over the postoperative period and assess changes in its utility over time. Methods: Consecutive patients undergoing microvascular breast reconstruction out our institution were assessed between 2017-2019. Inclusion criteria included use of transcutaneous tissue oximetry for monitoring. Variables of interest were transcutaneous tissue oximetry alarms that triggered nursing calls, flap loss, re-exploration, and salvage rates. Results: The study included 175 patients (286 flaps). The flap loss rate was 1.0% (3/175). A total of twelve patients (6.8%) required re-exploration, with a 67.0% flap salvage rate. Nine of these patients required exploration within 24 hours. The 3 takebacks after 24 hours were not for vascular compromise but were for abdominal wall hematoma, increasingly sanguineous drain output, and exam concerning for hematoma. Within the 24-hour postoperative period, 43 tissue oximetry alarms triggered nursing calls; 7 alarms (16.2%) were confirmed to be for flap issues secondary to vascular compromise. After 24 hours, 44 alarms were triggered, none of which were associated with flap compromise. The false positive rate of the alarm within 24 hours was 83.7% (36/43) compared to 100% (44/44) after 24 hours (p= 0.01). Conclusions: Transcutaneous tissue oximetry is a helpful adjunct to the clinical exam in the postoperative monitoring of flaps in microsurgical breast reconstruction. The false positive rate significantly rises after 24 hours. The benefit may not outweigh the concerns, labor, and effort that results from alarms after postoperative day 1. We recommend considering discontinuing transcutaneous tissue oximetry monitoring after 24 hours.Item Evaluation of an Extended-duration Chemoprophylaxis Regimen for Venous Thromboembolism after Microsurgical Breast Reconstruction(Wolters Kluwer, 2021-08) Pittelkow, Eric M.; DeBrock, Will C.; Mailey, Brian; Ballinger, Tarah J.; Socas, Juan; Lester, Mary E.; Hassanein, Aladdin H.; Medicine, School of MedicinePatients undergoing free flap breast reconstruction are at a high risk for venous thromboembolism based upon Caprini scores. Guidelines for venous thromboembolism prophylaxis recommend high-risk groups receive extended chemoprophylaxis for several weeks after gynecological, orthopedic, and surgical oncology cases. Extended prophylaxis has not been studied in free flap breast reconstruction. The purpose of this study was to compare outcomes of free flap breast reconstruction patients who received extended venous thromboembolism (VTE) prophylaxis with those who received standard inpatient-only prophylaxis. Methods: Patients undergoing microsurgical breast reconstruction were divided into two groups: standard VTE prophylaxis (Group I) and extended prophylaxis (Group II). Both groups received prophylactic subcutaneous heparin or enoxaparin preoperatively and enoxaparin 40 mg daily postoperatively while inpatient. Group II was discharged with a home regimen of enoxaparin 40 mg daily for an additional 14 days. Results: In total, 103 patients met inclusion criteria (36 patients in Group I, 67 patients in Group II). The incidence of VTE was 1.5% in Group II compared with 2.8% in Group I (P = 0.6). There was no difference in reoperative hematoma between Group I (n = 0) and Group II (n = 1) (P = 0.7). Total flap loss was 2.2%. Conclusions: Although this retrospective pilot study did not show statistical significance in VTE between those receiving extended home chemoprophylaxis (1.5% incidence) compared with inpatient-only chemoprophylaxis (2.8%), the risk of bleeding complications was similar. These results indicate that a larger, higher powered study is justified to assess if an extended home chemoprophylaxis protocol should be standard of care post free flap breast reconstruction.Item Immediate Bilateral Breast Reconstruction with Unilateral Deep Superior Epigastric Artery and Superficial Circumflex Iliac Artery Flaps(KoreaMed Synapse, 2016-09) Hansen, Keith S.; Gutwein, Luke G.; Hartman, Brett C.; Sood, Rajiv; Socas, Juan; Department of Surgery, IU School of MedicineAutologous breast reconstruction utilizing a perforator flap is an increasingly popular method for reducing donor site morbidity and implant-related complications. However, aberrant anatomy not readily visible on computed tomography angiography is a rare albeit real risk when undergoing perforator flap reconstruction. We present an operative case of a patient who successfully underwent a bilateral breast reconstruction sourced from a unilateral abdominal flap divided into deep superior epigastric artery and superficial circumflex iliac artery flap segments.Item A novel biosynthetic scaffold mesh reinforcement affords the lowest hernia recurrence in the highest-risk patients(Springer, 2021) Parker, Mitchell J.; Kim, Rachel C.; Barrio, Martin; Socas, Juan; Reed, Lawrence R.; Nakeeb, Attila; House, Michael G.; Ceppa, Eugene P.; Surgery, School of MedicineIntroduction Patients with higher postoperative infection risk undergoing ventral hernia repair (VHR) have limited options for mesh use. Biosynthetic mesh is intended to utilize the durability of synthetic mesh combined with the biocompatibility of biologic mesh. We sought to assess the outcomes of a novel biosynthetic scaffold mesh for VHR in higher risk patients over a 12-month postoperative period. Methods Two cohorts of 50 consecutive patients who underwent VHR with TELA Bio OviTex biosynthetic or synthetic mesh were retrospectively compared. Endpoints included surgical site occurrence (SSO), readmission rate, and hernia recurrence following VHR at 12 months postoperatively. Results OviTex mesh placement was associated with higher risk Ventral Hernia Working Group (VHWG) distribution and more contaminated CDC wound class distribution compared to synthetic mesh placement (VHWG grade 3: 68% vs. 6%, p < 0.001; CDC class > I: 70% vs. 6%, p < 0.001). Additionally, concomitant procedures were performed more often with OviTex mesh placement than synthetic mesh placement (70% vs 10%, p < 0.001). The OviTex mesh performed comparably to synthetic mesh in terms of incidences of SSO (36% vs 22%, p = 0.19), readmission rates (24% vs 14%, p = 0.31), and hernia recurrence (6% vs 12%, p = 0.74). On further evaluation, patients who developed SSO with OviTex mesh (n = 18) had a 17% hernia recurrence whereas those with synthetic mesh (n = 11) had an associated 55% hernia recurrence (p = 0.048). Conclusions The OviTex biosynthetic mesh was used in higher risk patients and performed similarly to synthetic mesh in regards to rate of SSO, readmissions, and hernia recurrence. Furthermore, patients who developed SSO with Ovitex mesh were significantly less likely to have hernia recurrence than those with synthetic mesh. Overall, the data suggest that biosynthetic mesh is a more desirable option for definitive hernia repair in higher risk patients.Item Postoperative Day 1 Dangling Protocol with Tissue Oximetry Guidance Decreases Hospital Stay in Lower Extremity Fasciocutaneous Free Flaps: Early Experience(Wolters Kluwer, 2024-08-27) Danforth, Rachel; Wiebe, Jordan E.; Socas, Juan; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of MedicineItem Technical Considerations to Avoid Microvascular Complications during Groin Lymph Node Free Flap Transfer(KoreaMed Synapse, 2015-09-15) Ciudad, Pedro; Orfaniotis, Georgios; Socas, Juan; Dower, Rory; Kiranantawat, Kidakorn; Nicoli, Fabio; Sapountzis, Stamatis; Maruccia, Michele; Chen, Hung-Chi; Department of Medicine, IU School of Medicine