Browsing by Author "Sood, Rajiv"
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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 Integrated sensing and delivery of oxygen for next-generation smart wound dressings(Springer Nature, 2020-05-18) Ochoa, Manuel; Rahimi, Rahim; Zhou, Jiawei; Jiang, Hongjie; Yoon, Chang Keun; Maddipatla, Dinesh; Narakathu, Binu Baby; Jain, Vaibhav; Oscai, Mark Michael; Morken, Thaddeus Joseph; Oliveira, Rebeca Hannah; Campana, Gonzalo L.; Cummings, Oscar W.; Zieger, Michael A.; Sood, Rajiv; Atashbar, Massood Z.; Ziaie, Babak; Pathology and Laboratory Medicine, School of MedicineChronic wounds affect over 6.5 million Americans and are notoriously difficult to treat. Suboptimal oxygenation of the wound bed is one of the most critical and treatable wound management factors, but existing oxygenation systems do not enable concurrent measurement and delivery of oxygen in a convenient wearable platform. Thus, we developed a low-cost alternative for continuous O2 delivery and sensing comprising of an inexpensive, paper-based, biocompatible, flexible platform for locally generating and measuring oxygen in a wound region. The platform takes advantage of recent developments in the fabrication of flexible microsystems including the incorporation of paper as a substrate and the use of a scalable manufacturing technology, inkjet printing. Here, we demonstrate the functionality of the oxygenation patch, capable of increasing oxygen concentration in a gel substrate by 13% (5 ppm) in 1 h. The platform is able to sense oxygen in a range of 5–26 ppm. In vivo studies demonstrate the biocompatibility of the patch and its ability to double or triple the oxygen level in the wound bed to clinically relevant levels.Item A manufacturable smart dressing with oxygen delivery and sensing capability for chronic wound management(SPIE, 2018-05) Ochoa, M.; Rahimi, R.; Jiang, H.; Yoon, C. K.; Oscai, M.; Morken, T.; Jain, V.; Oliveira, R. H.; Maddipatla, D.; Narakathu, B. B.; Campana, Gonzalo L.; Zieger, M. A.; Sood, Rajiv; Atashbar, M. Z.; Ziaie, B.; Surgery, School of MedicineChronic non-healing wounds, impact over 6.5 million Americans, costs in excess of $25 billion to treat on an annual basis and its incidence is predicted to rise due to the prevalence of obesity and type-2 diabetes. One of the primary complications often associated with chronic wounds is the improper functionality of the peripheral vasculature to deliver O2-rich blood to the tissue which leads to wound hypoxia. Although hyperbaric oxygen therapy are widely used and accepted as an effective approach to bolster tissue O2 levels in hypoxic chronic wounds, most of such treatments require bulky equipment and often expose large areas of the body to unnecessarily elevated oxygen concentrations that can damage healthy tissue. In this paper, we present a smart low-cost wound dressing with integrated oxygen sensor and delivery for locally generating and delivering oxygen to selected hypoxic regions on the wound. The dressing is fabricated on a biocompatible water resistant/hydrophobic paper-based substrate with printed optical oxygen sensors and patterned catalytic oxygen generating regions that are connected to a flexible microfluidic systems. Oxygen generation occurs by flowing H2O2 through the channels and chemical decomposition at the catalyst printed regions on the paper substrate. The hydrophobic paper provides structural stability and flexibility while simultaneously offering printability, selective gaseous filtering, and physical/chemical protection. The fabrication process take advantage of scalable manufacturing technologies including laser processing, inkjet printing, and lamination.Item Plastic and Reconstructive Surgery Advance Online Article(Lippincott Williams & Wilkins, 2015) Tahiri, Youssef; Greathouse, S. Travis; Tholpady, Sunil S.; Havlik, Robert; Sood, Rajiv; Flores, Roberto L.; Department of Surgery, IU School of MedicineBackground: The aim of this study was to evaluate the efficacy, safety profile, and complications associated with mandibular distraction osteogenesis performed in infants weighing less than 4 kg with Robin sequence. Methods: An 11-year retrospective review of all infants (younger than 6 months) with mandibular distraction osteogenesis–treated Robin sequence was performed. Patients weighing less than 4 kg (experimental) and 4 kg or more (control) who underwent mandibular distraction osteogenesis were compared. Demographics, medical comorbidities, improvement in apnea/hypopnea index, need for tracheostomy, repeated distraction, and complications were evaluated. Results: One hundred twenty-one patients underwent mandibular distraction osteogenesis. Eighty-one patients weighed less than 4 kg and 40 weighed 4 kg or more. The mean follow-up was 2.8 years in patients weighing less than 4 kg and 3.0 years in the control group. Mean age and weight at the time of distraction were 23 days and 3.1 kg, respectively, in the study group; and 2.7 years and 11 kg, respectively, in the control group. There was no significant difference in success of mandibular distraction osteogenesis to treat airway obstruction in the group weighing less than 4 kg compared with the control group (92.6 percent versus 88.9 percent; p = 0.49). The most common complication in each group was surgical-site infection (9.9 percent and 20.0 percent; p = 0.15). Overall complication rates were similar between the two groups (17.3 percent versus 25.0 percent; p = 0.34). The rates of repeated distraction were similar between the two groups (6.3 percent and 13.5 percent; p = 0.28). Conclusions: Mandibular distraction osteogenesis is a safe and effective treatment modality for infants weighing less than 4 kg with severe airway obstruction. The efficacy, safety, and complication profiles are not significantly different from those of larger patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.Item A prospective analysis describing the innovative use of liposomal bupivacaine in burn patients(Elsevier, 2020-03) Boyd, Allison N.; Blair, Mary E.; Degenkolb, Kerri E.; Foster, David R.; Hartman, Brett C.; Sood, Rajiv; Walroth, Todd A.; Medicine, School of MedicineBurn patients frequently require autograft harvesting to facilitate wound healing, often resulting in significant pain. Liposomal bupivacaine is indicated for administration into a surgical site to produce postsurgical analgesia. The objective of this study was to evaluate efficacy, safety, and duration of postoperative analgesia with liposomal bupivacaine for donor site pain in burn patients. This was an observational, case–control study including adult patients with <20% total body surface area (TBSA) burned who received liposomal bupivacaine for postoperative pain management after autograft harvesting from lower extremity donor site(s). Patients from the case group were matched to historical control patients treated with traditional pain management. The primary outcome was the cumulative pain scores on postoperative day one measured by the area under the curve (AUC0–24). Secondary outcomes included AUC0–72, total milligram morphine equivalents (MME), length of stay, and adverse events. Data were collected in 36 patients who received liposomal bupivacaine, with 21 patients eligible for matching to historical controls. Patients included in the intervention and control groups were well-matched at baseline. Patients in the intervention group had a significantly lower median (IQR) AUC0–24 [578 (408,740) vs. 680 (544,803); p = 0.05] and shorter length of stay [4 days (1,9.5) vs. 6 days (318); p = 0.01]. No differences in adverse events related to the administration of liposomal bupivacaine or opioid-related adverse events were observed. Results indicate liposomal bupivacaine is safe and effective in burn patients. The results of this study add to the limited body of literature examining efficacy in this population.Item Skin Regeneration Using Dermal Substrates that Contain Autologous Cells and Silver Nanoparticles to Promote Antibacterial Activity: In Vitro Studies(AMSUS, 2017-03) Zieger, Michael A. J.; Ochoa, Manuel; Rahimi, Rahim; Campana, Gonzalo; Tholpady, Sunil; Ziaie, Babak; Sood, Rajiv; Surgery, School of MedicineWe hypothesized that the addition of silver nanoparticles (AgNP) to a dermal substrate would impart antibacterial properties without inhibiting the proliferation of contained cells. Our in vitro model was based on the commercial substrate, Integra. The substrate was prepared by simple immersion into 0 to 1% suspension of AgNP (75 or 200 nm diameter) followed by rinsing for 20 minutes and sterilization under an ultraviolet C lamp. A total of 107 human adipose stem cells per cubic centimeter were injected and after 1 hour, 6 × 105 keratinocytes/cm2 were seeded and cultured for up to 14 days. Constructs were evaluated using a metabolic assay (WST-1), and hematoxylin and eosin and immunoperoxidase staining. Bactericidal activity was measured using a log reduction assay against bacteria that are prevalent in burns. The presence of AgNP did not significantly change the metabolic activity of constructs after 14 days of culture, and the distribution of cells within the substrate was unchanged from the controls that did not have AgNP. Antibacterial activity of Integra containing AgNP (75 nm diameter) was concentration dependent. In conclusion, the addition of AgNP to the dermal substrate suppressed bacterial growth but did not significantly affect cell proliferation, and may represent an important property to incorporate into a future clinical skin regeneration system.Item Smoking Related Home Oxygen Burn Injuries: Continued Cause for Alarm(Karger, 2016-02) Carlos, William G.; Baker, Mary S.; McPherson, Katie A.; Bosslet, Gabriel T.; Sood, Rajiv; Torke, Alexia M.; Department of Medicine, IU School of MedicineBackground: Home oxygen therapy is a mainstay of treatment for patients with various cardiopulmonary diseases. In spite of warnings against smoking while using home oxygen, many patients sustain burn injuries. Objectives: We aimed to quantify the morbidity and mortality of such patients admitted to our regional burn unit over a 6-year period. Methods: A retrospective chart review of all patients admitted to a regional burn center from 2008 through 2013 was completed. Admitted patients sustaining burns secondary to smoking while using home oxygen therapy were selected as the study population to determine morbidity. Results: Fifty-five subjects were admitted to the burn unit for smoking-related home oxygen injuries. The age range was 40-84 years. Almost all subjects were on home oxygen for chronic obstructive pulmonary disease (96%). Seventy-two percent of burns involved <5% of the total body surface area, 51% of patients were intubated, and of those 33% had evidence of inhalation injury. The hospital mortality rate was 14.5%. The mean length of hospital stay was 8.6 days, and 54.5% were discharged to a nursing home or another advanced facility. Finally, concomitant substance abuse was found in 27%, and a previous history of injury from smoking while on home oxygen was discovered in 14.5%. Conclusions: This single-center analysis is one of the largest describing burn injuries stemming from smoking while using home oxygen therapy. We identified the morbidity and mortality associated with these injuries. Ongoing education and careful consideration of prescribing home oxygen therapy for known smokers is highly encouraged.Item A wireless strain sensor for wound monitoring with direct laser-defined patterning on a commercial dressing(IEEE, 2016-01) Rahimi, Rahim; Ochoa, Manuel; Zieger, Michael; Sood, Rajiv; Ziaie, Babak; Department of Surgery, IU School of MedicineControlled mechanical strain or stress on a wound site can promote accelerated neovascularization and cellular proliferation for improved wound healing; however, these mechanical forces have not been properly quantified due to a lack of standardized technique. As a solution, we developed a wireless strain sensor on a commercial wound dressing. The sensor consists of a flexible antenna coil whose resonant frequency changes in response to applied strain. The frequency change of the sensor is observed to be a linear function of applied strain in the range of 0-35%, with an average sensitivity of 150 kHz/%strain and negligible hysteresis. The sensor is fabricated through a simple process that consist of defining a screen-printing mask directly over the wound dressing using laser machining. The fabrication technique can be scaled up for mass production using roll-to-roll methods.