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Browsing by Author "Tran, Phu C."
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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 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 MedicineBackground: 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.Item Virtual Interviews for the Independent Plastic Surgery Match: A Modern Convenience or a Modern Misrepresentation?(Elsevier, 2020-09-18) Bamba, Ravinder; Bhagat, Neel; Tran, Phu C.; Westrick, Evan; Hassanein, Aladdin H.; Wooden, William A.; Surgery, School of MedicineObjective: The virtual interview for residency and fellowship applicants has previously been utilized preliminarily in their respective processes. The COVID-19 pandemic forced many programs to switch to a virtual interview process on short notice. In the independent plastic surgery process, which was underway when the pandemic started, applicants had a heterogeneous experience of in-person and virtual interviews. The purpose of this study was to assess if applicants prefer a virtual interview experience to an in-person interview as well as determine if virtual interview applicants had a different opinion of a program compared to the in-person interview applicants. Design/Setting/Participants: The 2019 to 2020 applicants who interviewed at the Indiana University Independent Plastic Surgery program were administered an anonymous online survey about their interview experience at our program. Results: Our survey response was 60% (18/30). The in-person interview group (n = 10) rated their overall interview experience higher than the virtual interview group (n = 8) 8.8 vs 7.5 (p = 0.0314). The in-person interview group felt they became more acquainted with the program, the faculty, and the residents more than the virtual group (4.7 vs 3.25, p < 0.0001) (4.3 vs 3.25, p = 0.0194) (4.3 vs 2.75, p < 0.0001). The majority of applicants favored in-person interviews (16/18, 88.9%). The in-person interview group spent significantly more money on their interview at our program compared to the virtual interview group ($587 vs $0, p < 0.0001). Conclusion: Our study demonstrated that the virtual interview process was an efficient process for applicants from both a financial and time perspective. However, the virtual interview process left applicants less satisfied with their interview experience. The applicants felt they did not become as acquainted with the program as their in-person counterparts. The virtual interview process may play a large role in residency and fellowship applications in the future, and programs should spend time on how to improve the process.Item The Virtual Visiting Professor: Temporary Form of COVID-19 Social Distancing or Potential Paradigm Shift?(American Society of Plastic Surgeons, 2021-10) Bamba, Ravinder; Tran, Phu C.; Lester, Mary E.; Wooden, William A.; Gordillo, Gayle M.; Hadad, Ivan; Hassanein, Aladdin H.; Medicine, School of Medicine