Browse
Recent Submissions
Item Spiritual Distress in Caregivers of Patients with Cleft and Craniofacial Anomalies — a Single-Center Cross-Sectional Study(2024-04-12) Mercho, Patrick; Tran, Khoa; Muraru, Rodica; Cordes, Emma; Tholpady, Sunil; Makar, KatelynBackground and purpose: Spiritual distress describes an “impaired ability to experience and integrate meaning and purpose,” and frequently occurs when an illness or diagnosis results in significant disruptions in patients’ lives. The initial diagnosis of a cleft or craniofacial anomaly, as well as the recurrent need for surgical intervention, can cause significant upheaval and stress for family members. In an effort to provide more comprehensive care, we sought to measure spiritual distress in caregivers of children presenting for care at our multidisciplinary cleft and craniofacial clinic. Methods: Caregivers of patients presenting to the multidisciplinary cleft and craniofacial clinic were surveyed during either new or return visits between October 2022 and April 2023. Those able to read English were eligible for inclusion. Our primary outcome was caregiver spiritual distress, measured by the 12-item Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale (FACIT-Sp 12). Caregivers also completed the PHQ-8 and GAD-7 to measure depression and anxiety, respectively. Covariates included dimensions of religiosity as measured by the Duke Religion Index (DUREL), caregiver health, and financial strain. Clinical and demographic data were also collected. Logistic regression with cluster adjustment was used to control for demographic and clinical variables. Results: A total of 159/191 caregivers completed the survey, for a response rate of 83.2%. Median age was 33 (IQR 25-39), with the majority being female (76.7%). Most were white (86.7%) and non-Latino (91.1%). The majority identified as Christian (76.7%), with nearly 20% not endorsing any religion. Intrinsic religiosity as measured by the DUREL was high (cohort median score=12, maximum score=15). Only 50.3% reported education beyond high school. Most patients were being seen as return visits (79.3%) with a cleft diagnosis (90.8%). Only 50.1% of caregivers reported very good or excellent health, with 10.7% reporting fair to poor health. Over a quarter (26.4%) reported weekly or daily financial worry. Thirty percent of caregivers demonstrated spiritual distress on the FACIT-Sp 12. Depression was present in 15.5% and moderate to severe anxiety in 17.9%. Christianity was associated with lower odds of spiritual distress (OR 0.33, p=0.047). Both depression (OR 14.2, p=0.001) and anxiety (OR 4.1, p=0.004) were associated with higher odds of spiritual distress. Conclusions: Nearly a third of caregivers presenting with their children to our cleft and craniofacial clinic demonstrated spiritual distress, which was associated with other mental health diagnoses. Addressing family stress and equipping caregivers with necessary resources is critical for effective team-based care. Main objectives of presentation: Learners will understand the meaning and significance of spiritual distress in the setting of life-altering diagnoses such as cleft and craniofacial conditions. Learners will also be able to apply simple screening tools to assess caregiver health and provide resources that will equip those caregivers to better care for patients with cleft and craniofacial anomalies.Item Comparing long-term patient-reported outcomes after cranial vault remodeling and strip craniectomy with the FACE-Q Craniofacial Module—a single-center retrospective study(2024-01-31) Bello, Margaret; Mercho, Patrick; Gupta, Salil; Shirrell, Mariah; Cordes, Emma; Thoplady, Sunil; Ackerman, Laurie; Makar, KatelynBackground: The debate continues among craniofacial surgeons regarding the effectiveness of strip craniectomy (SC) compared with cranial vault remodeling (CVR) in achieving optimal functional and aesthetic outcomes in patients with single-suture craniosynostosis. This study aimed to compare long-term patient-reported outcomes (PROs) between SC and CVR procedures at a single institution using the validated FACE-Q Craniofacial module. Methods: Patients older than or equal to 8 years of age and parents of patients younger than 8 years of age who underwent SC or CVR for single-suture craniosynostosis were eligible. Patients with <2 years of follow-up, lambdoid synostosis, and syndromes were excluded. Primary endpoints were PROs as measured by the FACE-Q, with higher scores indicating increased health-related quality of life. Linear regression was used to control for covariates. Results: Sixty-two participants completed the module (response rate 33.3%). SC was performed in 29 patients (46.8%), and CVR in 33 patients (53.2%). On unadjusted bivariate analysis, SC patients had higher eye (P=0.03) and forehead (P=0.05) scores. On regression analysis, controlling for sex, race, craniosynostosis type, and follow-up, there were no significant differences between operation types in any domain. Metopic and sagittal synostosis were associated with higher Eye (metopic: 17.61, P=0.049; sagittal: 41.44, P<0.001) and Head scores (metopic: 48.12, P=0.001; sagittal: 49.35, P<0.001), and sagittal synostosis was associated with higher Face (38.16, P<0.001), Forehead (55.93, P<0.001), and Nose scores (19.28, P=0.003). Conclusions: From patients' and parents' perspectives at a single institution, SC and CVR were equivalent regarding aesthetics and health-related quality of life.Item Complication Rates of Casts Versus Bulky Dressings After Syndactyly Release(2025-02-19) Mercho, Patrick; Peipert, Leah; Martinez, Carlos; Tran, Khoa; Borschel, Gregory; Adkinson, JoshuaIntroduction: Pediatric patients undergoing surgical correction of congenital syndactyly are commonly immobilized in rigid casts postoperatively . Casts have previously been associated with complications including skin irritation/breakdown, pressure sores, and unplanned cast changes in populations of pediatric fractures. This study directly compares complication rates between patients treated with postoperative casting and soft dressing after undergoing congenital syndactyly release. Methods: A retrospective chart review was performed of patients treated by one of two surgeons at a single institution between 2016 and 2024. Patients were included if they underwent primary surgical release of congenital syndactyly and excluded if their syndactyly was not congenital (i.e., a result of trauma). Data regarding surgical procedures and postoperative complications (infection, web creep, scar contracture, hypertrophic scarring, etc.) were recorded in addition to unplanned caregiver phone calls, clinic appointments, and emergency department (ED ) visits. Hands were categorized according to the type of dressing placed after surgery. Results: 92 patients met inclusion criteria, representing 151 hands in the casted group and 20 hands in soft dressings postoperatively. No significant differences were observed in complication rates between the two groups. The most common complications across all hands were web creep (9.9% vs.10.0%, casts vs. soft dressings, p=1 ), hypertrophic scarring (10.6% vs. 5.0%, p=0.697), and scar contracture (5.3% vs. 10.0%, p=0.330). Three casts required unplanned ED visits and 11 required unplanned clinic visits related to casts whereas no patients in the soft dressing group required ED or unplanned clinic visits (p=1 and p=0.366, respectively). Five casts (3.3%) required replacement. The number of parent phone calls and dressing changes were not significantly different between the two groups (p=0.976 and p=0.803, respectively). Conclusion: Utilizing rigid casts after syndactyly release is not associated with greater rates of postoperative complications compared to soft dressings alone.Item Measuring spiritual distress in adolescent patients with cleft lip and palate—a prospective study(2025-02-17) Mercho, Patrick; Mohamedsidi, Khadija; Tran, Khoa; Makar, KatelynIntroduction: Adolescents with cleft lip (CL) and palate (CP) can experience stigmatizing facial and speech differences. These may cause spiritual distress, an “impaired ability to experience and integrate meaning and purpose,” which occurs commonly in patients facing chronic disease and repeated interventions, like surgery. This study utilized a validated instrument to measure spiritual distress in these patients and compare spiritual distress between those with CL and those with CP only. Methods: Patients aged 14-21 presenting to a multidisciplinary cleft clinic were surveyed. The primary outcome was spiritual distress, measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being scale (FACIT-Sp 12) with scores <36 indicating spiritual distress. Patients also completed the PHQ-8 and GAD-7. Covariates included diagnosis, sociodemographic variables, religion, organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiosity (IR), as measured by the Duke University Religion Index (DUREL). Bivariate tests evaluated associations between spiritual distress and other variables. Results: 41 patients participated (response rate=87.2%). Mean age was 17.0 years (SD 1.9); 61% were female. Most were white (75.6%), non-Latino (87.8), and Christian (66.7%). Most patients presented with a cleft lip (85.3%), and most of the remaining presented with isolated cleft palate (12.2%). Fourteen patients (34.1%) exhibited spiritual distress. The mean FACIT-Sp 12 score was 37.5 (SD 6.8). Approximately half had symptoms of depression (48.8%) or anxiety (53.7%). Patients with spiritual distress tended to be older (p=0.02) and were more likely to have symptoms of anxiety (p=0.01) and depression (p=0.04). NORA (p=0.01) and IR scores (p=0.05) were lower for patients with distress. Conclusions: More than one third of patients demonstrated spiritual distress, which was associated with anxiety and lesser degrees of religious connectedness. A critical need exists to understand the impact of spiritual distress so that appropriate interventions can be incorporated in team-based care.Item Carpometacarpal Arthrodesis for Spasticity-Related Thumb-in-Palm Deformity(2025-04-12) Mercho, Patrick; Martinez, Carlos; Adkinson, JoshuaIntroduction: Patients who suffer from upper motor neuron (UMN) disease frequently develop a thumb-in-palm (TIP) deformity, wherein the thumb metacarpal is adducted, severely limiting function and potentially causing compromised hand hygiene. The role of surgical treatment in this population ranges from tendon transfers, soft tissue releases, and in severe cases, arthrodesis. In this study, we review our experience with carpometacarpal (CMC) arthrodesis with staples for the treatment of UMN related recurrent TIP deformity. Methods: This single surgeon case series included 5 patients with UMN-related TIP deformity who underwent CMC arthrodesis with nitinol staples. Data regarding union, infection, hardware failure, and recurrence of TIP deformity were recorded from the electronic medical record. Results: All patients achieved radiographic union. The average follow-up was 2.7 months. No patients had evidence of recurrence of TIP deformity, hardware loosening, infection, dehiscence or delayed healing. Conclusion: This is the first described use of thumb CMC arthrodesis using nitinol staples in patients with UMN-related recurrent TIP deformity. The use of staples for CMC arthrodesis in the UMN population is an effective method without evidence of failure or recurrence.Item Spiritual Distress in Caregivers of Patients with Cleft and Craniofacial Anomalies—a Single-Center Cross-Sectional Study(2024-01-31) Mercho, Patrick; Tran, Khoa; Muraru, Rodica; Cordes, Emma; Tholpady, Sunil; Makar, KatelynPurpose: Spiritual distress describes an “impaired ability to experience and integrate meaning and purpose,” frequently occurring when diagnoses cause significant life disruption. The diagnosis of a craniofacial anomaly and repeated surgical intervention generate significant disruption and stress for families. This study measured spiritual distress in caregivers of children presenting at a multidisciplinary craniofacial clinic. Methods: Caregivers of patients presenting to a multidisciplinary cleft and craniofacial clinic were surveyed. The primary outcome was caregiver spiritual distress, measured by the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being scale (FACIT-Sp 12). Caregivers also completed the PHQ-8 and GAD-7 to measure depression and anxiety. Covariates included caregiver health, financial strain, and religiosity measured by the Duke Religion Index. Logistic regression with cluster adjustment was used to control for demographic and clinical variables. Results: 149/191 caregivers completed the survey (response rate=78.0%). Median age was 33 (IQR 25-39), with the majority being female (76.7%). Most were white (86.7%), non-Latino (91.1%), and Christian (76.7%). Most patients were being seen for a cleft diagnosis (90.8%). Thirty percent of caregivers demonstrated spiritual distress on the FACIT-Sp 12. Depression was present in 16.1% and moderate to severe anxiety in 18.1%. Christianity was associated with lower odds of spiritual distress (OR 0.32, p=0.039). Both depression (OR 14.36, p=0.001) and anxiety (OR 3.81, p=0.006) were associated with higher odds of spiritual distress. Conclusions: Nearly one third of caregivers demonstrated spiritual distress, which was associated with mood disorders. Addressing caregiver stress and providing necessary resources is critical for effective team-based care.Item Effect of Immediate Lymphatic Reconstruction on Postmastectomy Implant Reconstruction(2024-01-31) Ahmed, Shahnur; Mercho, Patrick; Brown, Whitney; Aguilar, Paola; Fisher, Carla; Ludwig, Kandice; Lester, Mary; Hassanein, AladdinItem Complication Rates of Casts Versus Bulky Dressings After Syndactyly Release(2025-04-11) Mercho, Patrick; Peipert, Leah; Martinez, Carlos; Tran, Khoa; Borschel, Gregory; Adkinson, JoshuaIntroduction: Pediatric patients undergoing surgical correction of congenital syndactyly are commonly immobilized in rigid casts postoperatively. Postoperative casting is associated with complications including skin irritation/breakdown, pressure sores, and unplanned dressing changes. This study directly compares complication rates between patients undergoing congenital syndactyly release treated with postoperative casting and soft dressing. Methods: A retrospective chart review was performed of patients who underwent primary surgical release of congenital syndactyly at a single quaternary referral center between 2016 and 2024. Demographic data and postoperative complications (infection, web creep, scar contracture, hypertrophic scarring, etc.) were recorded and compared between patients who had postoperative casting and soft dressing. Results: Ninety-two patients met inclusion criteria, representing 151 hands in the cast group and 20 hands in soft dressing group. No significant differences were observed in complication rates between the two groups. The most common complications across all hands were web creep (9.9% vs.10.0%, casts vs. soft dressings, p=1), hypertrophic scarring (10.6% vs. 5.0%, p=0.697), and scar contracture (5.3% vs. 10.0%, p=0.330). Three casts required unplanned ED visits and 11 required unplanned clinic visits related to casts whereas no patients in the soft dressing group required ED or unplanned clinic visits (p=1 and p=0.366, respectively). Five casts (3.3%) required replacement. The number of parent phone calls and dressing changes were not significantly different between the two groups (p=0.976 and p=0.803, respectively). Conclusion: Utilizing rigid casts after syndactyly release is not associated with greater rates of postoperative complications compared to soft dressings. Casting has an increased risk of unplanned visits relating to cast management. Significance: This is the first study showing that postoperative casting and soft dressings for congenital syndactyly release have very similar complication profiles. The use of soft dressings may avoid the unplanned healthcare visits and costs associated with casting.Item Mild Anastomotic Stenosis in Patient-Specific CABG Model May Enhance Graft Patency: A New Hypothesis(Public Library of Science, 2013-09-13) Huo, Yunlong; Luo, Tong; Guccione, Julius M.; Teague, Shawn D.; Tan, Wenchang; Navia, José A.; Kassab, Ghassan S.; Surgery, School of MedicineIt is well known that flow patterns at the anastomosis of coronary artery bypass graft (CABG) are complex and may affect the long-term patency. Various attempts at optimal designs of anastomosis have not improved long-term patency. Here, we hypothesize that mild anastomotic stenosis (area stenosis of about 40-60%) may be adaptive to enhance the hemodynamic conditions, which may contribute to slower progression of atherosclerosis. We further hypothesize that proximal/distal sites to the stenosis have converse changes that may be a risk factor for the diffuse expansion of atherosclerosis from the site of stenosis. Twelve (12) patient-specific models with various stenotic degrees were extracted from computed tomography images using a validated segmentation software package. A 3-D finite element model was used to compute flow patterns including wall shear stress (WSS) and its spatial and temporal gradients (WSS gradient, WSSG, and oscillatory shear index, OSI). The flow simulations showed that mild anastomotic stenosis significantly increased WSS (>15 dynes · cm(-2)) and decreased OSI (<0.02) to result in a more uniform distribution of hemodynamic parameters inside anastomosis albeit proximal/distal sites to the stenosis have a decrease of WSS (<4 dynes · cm(-2)). These findings have significant implications for graft adaptation and long-term patency.Item Treatment with placenta-derived mesenchymal stem cells mitigates development of bronchiolitis obliterans in a murine model(Elsevier, 2014) Zhao, Yunge; Gillen, Jacob R.; Harris, David A.; Kron, Irving L.; Murphy, Michael P.; Lau, Christine L.; Surgery, School of MedicineObjective: Bone marrow-derived mesenchymal stem cells (MSCs) have shown therapeutic potential in acute lung injury. Recently, placenta-derived human mesenchymal stem cells (PMSCs) have shown similarities with bone marrow-derived MSCs in terms of regenerative capabilities and immunogenicity. This study investigates the hypothesis that treatment with PMSCs reduces the development of bronchiolitis obliterans in a murine heterotopic tracheal transplant model. Methods: A murine heterotopic tracheal transplant model was used to study the continuum from acute to chronic rejection. In the treatment groups, PMSCs or PMSC-conditioned medium (PMSCCM) were injected either locally or intratracheally into the allograft. Phosphate-buffered saline (PBS) or blank medium was injected in the control groups. Tracheal luminal obliteration was assessed on sections stained with hematoxylin and eosin. Infiltration of inflammatory and immune cells and epithelial progenitor cells was assessed using immunohistochemistry and densitometric analysis. Results: Compared with injection of PBS, local injection of PMSCs significantly reduced luminal obliteration at 28 days after transplantation (P = .015). Intratracheal injection of PMSCs showed similar results to local injection of PMSCs compared with injection of PBS and blank medium (P = .022). Tracheas treated with PMSC/PMSCCM showed protection against the loss of epithelium on day 14, with an increase in P63+CK14+ epithelial progenitor cells and Foxp3+ regulatory T cells. In addition, injection of PMSCs and PMSCCM significantly reduced the number of neutrophils and CD3+ T cells on day 14. Conclusions: This study demonstrates that treatment with PMSCs is protective against the development of bronchiolitis obliterans in an heterotopic tracheal transplant model. These results indicate that PMSCs could provide a novel therapeutic option to reduce chronic rejection after lung transplant.