Objective: We propose an algorithm on how to create a prospectively maintained database, which ca... more Objective: We propose an algorithm on how to create a prospectively maintained database, which can then be used to analyze prospective data in a retrospective fashion. Our algorithm provides future researchers a road map on how to set up, maintain, and use an electronic database to improve evidence-based care and future clinical outcomes. Methods: The database was created using Microsoft Access and included demographic information, socioeconomic information, and intraoperative and postoperative details via standardized drop-down menus. A printed out form from the Microsoft Access template was given to each surgeon to be completed after each case and a member of the health care team then entered the case information into the database. Results: By utilizing straightforward, HIPAA-compliant data input fields, we permitted data collection and transcription to be easy and efficient. Collecting a wide variety of data allowed us the freedom to evolve our clinical interests, while the platform also permitted new categories to be added at will. Conclusion: We have proposed a reproducible method for institutions to create a database, which will then allow senior and junior surgeons to analyze their outcomes and compare them with others in an effort to improve patient care and outcomes. This is a cost-efficient way to create and maintain a database without additional software.
Of our 55 patients treated for lower extremity osteomyelitis, 91% underwent debridement and micro... more Of our 55 patients treated for lower extremity osteomyelitis, 91% underwent debridement and microvascular muscle flap coverage with eradication of their infections and restoration of ambulation. This series of patients helps to solidly establish the efficacy of this approach to the treatment of osteomyelitis.
Replantation of the traumatically amputated lower extremity is a technically feasible surgical un... more Replantation of the traumatically amputated lower extremity is a technically feasible surgical undertaking. Successful outcome must be judged by functional achievements of the patient toward returning to the preinjury level. Appropriate patient selection significantly increases the potential for obtaining a satisfactory outcome. Patients in whom peripheral nerve injury precludes return of sensation in the extremity or in whom severe joint destruction will yield an immobile extremity will have marginal results. The risks of replantation, including blood transfusions, sepsis, and prolonged hospitalization, must be weighted heavily against prosthetic substitution as an alternative. If the lower extremity can be successfully replanted, however, this provides a superior functional and aesthetic result for the patient. Salvage replantation to preserve maximal functional length and durability of an extremity must always be considered when assessing a patient with a traumatic amputation. Free-tissue transfer to salvage a threatened replanted limb must be similarly a part of the armamentarium of the replantation surgeon. Although lower limb replantation may continue to be controversial, improved surgical techniques and increasing experience make it an excellent alternative to prosthetic substitution. In the well-motivated patient, an excellent result may be achieved.
Several studies have evaluated patient satisfaction following breast reconstruction with the tran... more Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.
... Talmor, Mia MD; Hydo, Lynn J. BS, RN, CCRN; Shaikh, Nina MD; Gayle, Lloyd B. MD; Hoffman, Llo... more ... Talmor, Mia MD; Hydo, Lynn J. BS, RN, CCRN; Shaikh, Nina MD; Gayle, Lloyd B. MD; Hoffman, Lloyd A. MD, FACS; Barie, Philip S. MD, FCCM, FACS. Collapse Box Abstract. ... Forty-two patients (1.5%) who had undergone major plastic/reconstructive procedures were identified. ...
Objective: We propose an algorithm on how to create a prospectively maintained database, which ca... more Objective: We propose an algorithm on how to create a prospectively maintained database, which can then be used to analyze prospective data in a retrospective fashion. Our algorithm provides future researchers a road map on how to set up, maintain, and use an electronic database to improve evidence-based care and future clinical outcomes. Methods: The database was created using Microsoft Access and included demographic information, socioeconomic information, and intraoperative and postoperative details via standardized drop-down menus. A printed out form from the Microsoft Access template was given to each surgeon to be completed after each case and a member of the health care team then entered the case information into the database. Results: By utilizing straightforward, HIPAA-compliant data input fields, we permitted data collection and transcription to be easy and efficient. Collecting a wide variety of data allowed us the freedom to evolve our clinical interests, while the platform also permitted new categories to be added at will. Conclusion: We have proposed a reproducible method for institutions to create a database, which will then allow senior and junior surgeons to analyze their outcomes and compare them with others in an effort to improve patient care and outcomes. This is a cost-efficient way to create and maintain a database without additional software.
Of our 55 patients treated for lower extremity osteomyelitis, 91% underwent debridement and micro... more Of our 55 patients treated for lower extremity osteomyelitis, 91% underwent debridement and microvascular muscle flap coverage with eradication of their infections and restoration of ambulation. This series of patients helps to solidly establish the efficacy of this approach to the treatment of osteomyelitis.
Replantation of the traumatically amputated lower extremity is a technically feasible surgical un... more Replantation of the traumatically amputated lower extremity is a technically feasible surgical undertaking. Successful outcome must be judged by functional achievements of the patient toward returning to the preinjury level. Appropriate patient selection significantly increases the potential for obtaining a satisfactory outcome. Patients in whom peripheral nerve injury precludes return of sensation in the extremity or in whom severe joint destruction will yield an immobile extremity will have marginal results. The risks of replantation, including blood transfusions, sepsis, and prolonged hospitalization, must be weighted heavily against prosthetic substitution as an alternative. If the lower extremity can be successfully replanted, however, this provides a superior functional and aesthetic result for the patient. Salvage replantation to preserve maximal functional length and durability of an extremity must always be considered when assessing a patient with a traumatic amputation. Free-tissue transfer to salvage a threatened replanted limb must be similarly a part of the armamentarium of the replantation surgeon. Although lower limb replantation may continue to be controversial, improved surgical techniques and increasing experience make it an excellent alternative to prosthetic substitution. In the well-motivated patient, an excellent result may be achieved.
Several studies have evaluated patient satisfaction following breast reconstruction with the tran... more Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.
... Talmor, Mia MD; Hydo, Lynn J. BS, RN, CCRN; Shaikh, Nina MD; Gayle, Lloyd B. MD; Hoffman, Llo... more ... Talmor, Mia MD; Hydo, Lynn J. BS, RN, CCRN; Shaikh, Nina MD; Gayle, Lloyd B. MD; Hoffman, Lloyd A. MD, FACS; Barie, Philip S. MD, FCCM, FACS. Collapse Box Abstract. ... Forty-two patients (1.5%) who had undergone major plastic/reconstructive procedures were identified. ...
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