9 results on '"Jonas A. Nelson"'
Search Results
2. Effects of COVID‐19 on mastectomy and breast reconstruction rates: A national surgical sample
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Robyn N. Rubenstein, Carrie S. Stern, Ethan L. Plotsker, Kathryn Haglich, Audree B. Tadros, Babak J. Mehrara, Evan Matros, and Jonas A. Nelson
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Oncology ,Breast Implants ,Mammaplasty ,COVID-19 ,Humans ,Breast Neoplasms ,Female ,Surgery ,General Medicine ,Pandemics ,Mastectomy ,Retrospective Studies - Abstract
The COVID-19 pandemic profoundly impacted breast cancer treatment in 2020. Guidelines initially halted elective procedures, subsequently encouraging less invasive surgeries and restricting breast reconstruction options. We examined the effects of COVID-19 on oncologic breast surgery and reconstruction rates during the first year of the pandemic.Using the National Surgical Quality Improvement Program, we performed an observational examination of female surgical breast cancer patients from 2017 to 2020. We analyzed annual rates of lumpectomy, mastectomy (unilateral/contralateral prophylactic/bilateral prophylactic), and breast reconstruction (alloplastic/autologous) and compared 2019 and 2020 reconstruction cohorts to evaluate the effect of COVID-19.From 2017 to 2020, 175 949 patients underwent lumpectomy or mastectomy with or without reconstruction. From 2019 to 2020, patient volume declined by 10.7%, unilateral mastectomy rates increased (70.5% to 71.9%, p = 0.003), and contralateral prophylactic mastectomy rates decreased. While overall reconstruction rates were unchanged, tissue expander reconstruction increased (64.0% to 68.4%, p 0.001) and direct-to-implant and autologous reconstruction decreased. Outpatient alloplastic reconstruction increased (65.7% to 73.8%, p 0.0001), and length of hospital stay decreased for all reconstruction patients (p 0.0001).In 2020, there was a nearly 11% decline in breast cancer surgeries, comparable mastectomy and reconstruction rates, increased use of outpatient alloplastic reconstruction, and significantly reduced in-hospital time across all reconstruction types.
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- 2022
3. Management of postoperative microvascular compromise and ischemia reperfusion injury in breast reconstruction using autologous tissue transfer: Retrospective review of 2103 flaps
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Joseph Dayan, Evan Matros, Michelle Coriddi, Joseph J. Disa, Paige Myers, Robert J. Allen, Peter G. Cordeiro, Colleen M. McCarthy, Jonas A. Nelson, and Babak J. Mehrara
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Mammaplasty ,Ischemia ,Physical examination ,Blood flow ,Anastomosis ,medicine.disease ,Free Tissue Flaps ,Article ,Surgery ,Postoperative Complications ,Fibrosis ,Reperfusion Injury ,Tissue Plasminogen Activator ,Humans ,Medicine ,Fat necrosis ,business ,Breast reconstruction ,Reperfusion injury ,Retrospective Studies - Abstract
BACKGROUND Although rates of microvascular thrombosis following free-flap breast reconstruction are low, debate persists about the optimal methods to restore blood flow and prevent ensuing flap shrinkage or fibrosis. Here we evaluate our management of microvascular compromise, including both a review of our approach for restoring blood flow and addressing the ensuing inflammatory changes following ischemia reperfusion. METHODS We conducted a retrospective review of autologous free tissue transfer breast reconstructions from 1/2010 to 1/2020. Patients who had flaps requiring take-back for salvage were identified. Management of microvascular compromise and ischemia reperfusion injury were recorded. RESULTS Of 2103 flaps were used in the breast reconstructions, 47 flaps required take-back for microvascular compromise (2.2%). Most flaps were either completely salvaged (n = 29, 61.7%) or partially salvaged (n = 5, 10.6%). Thirteen (27.7%) were a total flap loss, for an overall rate of 0.8% (including 3 flaps with no salvage attempt). Management of microvascular compromise most often included revision of the anastomosis (n = 33, 70.2%), thrombectomy (n = 27, 57.4%), tissue plasminogen activator administration (n = 26, 55.3%), and vein grafts (n = 18, 38.3%). Management of ischemia reperfusion included intraoperative steroids (n = 33, 70.2%), postoperative steroids (n = 17, 38.6%), and postoperative therapeutic anticoagulation (n = 27, 61.3%). Of 34 salvaged flaps, 5 (14.7%) had partial flap loss and/or fat necrosis on clinical examination at an average follow-up of 2.7 ± 2.8 years. CONCLUSIONS Salvage of microvascular compromise in autologous breast reconstruction should include restoration of blood flow and management of ischemia reperfusion injury. Attention to both is paramount for successful outcomes.
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- 2021
4. Double vascularized omentum lymphatic transplant (VOLT) for the treatment of lymphedema
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Jonas A. Nelson, Elizabeth Kenworthy, JeanJacques Mbabuike, Babak J. Mehrara, Richa Verma, and Joseph H. Dayan
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medicine.medical_specialty ,Subgroup analysis ,030230 surgery ,Free Tissue Flaps ,Article ,No donors ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Humans ,Minimally Invasive Surgical Procedures ,Medicine ,Lymphedema ,Lymph node ,Retrospective Studies ,business.industry ,Volt ,Retrospective cohort study ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Lymphatic system ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Lymph Nodes ,business ,Omentum ,Indocyanine green ,Follow-Up Studies - Abstract
Background and objectives Orthotopic vascularized lymph node transplant has been successfully used to treat lymphedema. A second, heterotopic lymph node transplant in the distal extremity may provide further improvement. The vascularized omentum lymphatic transplant (VOLT) provides adequate tissue for two simultaneous flap transfers to one limb. The purpose of this study was to review our experience with this technique. Methods We conducted a retrospective study of patients who underwent VOLT, with a subgroup analysis of patients who underwent double VOLT. Technical aspects of the procedure, complications, and early outcomes were reviewed. Results From May 2015 to August 2017, 54 VOLTs were performed in 38 patients, of whom 16 received double VOLT. Among patients in the double VOLT group with postoperative imaging at 1 year, uptake into the transplanted omentum was seen in three of six (50%) patients on lymphoscintigraphy and in one of five (20%) patients on indocyanine green lymphangiography. One patient (3.1%) in the double VOLT group required a return to the operating room. There were no donor site complications in the double VOLT group. The overall complication rate was 15.8%. Conclusions Double VOLT to the mid-level and proximal extremity is a safe and viable option.
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- 2018
5. Medicinal leeches for surgically uncorrectable venous congestion after free flap breast reconstruction
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Cyndi U. Chung, John P. Fischer, Jonas A. Nelson, Stephen J. Kovach, Christopher J. Pannucci, Suhail K. Kanchwala, Joseph M. Serletti, and Liza C. Wu
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medicine.medical_specialty ,animal structures ,business.industry ,medicine.medical_treatment ,Free flap breast reconstruction ,Salvage therapy ,Leech ,Retrospective cohort study ,Microsurgery ,Surgery ,Anesthesia ,Mammaplasty ,Leech Therapy ,Medicine ,business ,Breast reconstruction - Abstract
Background: Free tissue transfer is an accepted method for breast reconstruction. Surgically uncorrectable venous congestion is a rare but real occurrence after these procedures. Here, we report our experience with the management of surgically uncorrectable venous congestion after free flap breast reconstruction using medicinal leech therapy. Methods: We queried our prospectively maintained institutional database for all patients with venous congestion after free flap breast reconstruction since 2005. Chart review was performed for all patients having post-operative venous congestion. We compared patients with surgically correctable venous congestion and surgically uncorrectable venous congestion requiring medicinal leech therapy. Results: Twenty-three patients had post-operative venous congestion, and four of these patients were surgically uncorrectable requiring medicinal leech therapy. Patients who required leech therapy had lower hemoglobin nadirs, received more blood transfusions, and received a higher number of total units of red blood cells than patients who did not require leech therapy. Among four patients who required leech therapy, one flap was partially salvaged and three flaps were completely lost. Leech therapy was associated with higher total flap loss rates (75.0% vs. 42.1%) and longer length of stay (8.0 6 3.6 days vs. 6.5 6 2.1 days) when compared to non-leeched flaps. These differences were not statistically significant (P 5 0.32 and P 5 0.43, respectively). Conclusions: In patients with surgically uncorrectable venous congestion after free flap breast reconstruction, total flap loss is common despite leech therapy. When venous congestion cannot be corrected, total flap removal may be a better option than attempted salvage with leech therapy. V C 2014 Wiley Periodicals, Inc. Microsurgery 00:000‐000, 2014.
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- 2014
6. The impact of obesity on abdominal wall function after free autologous breast reconstruction
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Liza C. Wu, Joshua Fosnot, Jesse C. Selber, B A Chen Yan, Jonas A. Nelson, Joseph M. Serletti, John P. Fischer, and Suhail Kanchwala
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Functional testing ,Microsurgery ,Functional Independence Measure ,Surgery ,Abdominal wall ,medicine.anatomical_structure ,Mammaplasty ,medicine ,Breast reconstruction ,Prospective cohort study ,business ,Perfusion - Abstract
Background The functional impact of obesity on abdominal wall strength after abdominally based autologous reconstruction is unknown. The purpose of this study was to determine if obesity alters the postoperative abdominal wall strength profile after autologous reconstruction. Methods We prospectively examined abdominal wall strength and function following autologous breast reconstruction between 2005 and 2010. Enrolled patients completed functional testing [upper abdominal strength (UA), lower abdominal strength (LA), and functional independence measure (FIM)] and psychometric testing utilizing the short form 36 (SF36). Data were obtained at preoperative, early (
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- 2013
7. The impact of anemia on microsurgical breast reconstruction complications and outcomes
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Liza C. Wu, Jonas A. Nelson, Emily Cleveland, Ritwik Grover, Joseph M. Serletti, John P. Fischer, and Jessica Erdmann-Sager
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medicine.medical_specialty ,Blood transfusion ,business.industry ,Anemia ,Incidence (epidemiology) ,medicine.medical_treatment ,Free flap breast reconstruction ,Perioperative ,Free flap ,medicine.disease ,Surgery ,hemic and lymphatic diseases ,medicine ,Hemoglobin ,Breast reconstruction ,business - Abstract
Introduction: Appropriate and adequate blood flow and oxygen delivery to a free flap is paramount to viability and success. We present a comprehensive examination of perioperative anemia, determining its prevalence and effect on complications and outcomes in autologous breast reconstruction. Methods: We analyzed all autologous free flap breast reconstruction at the Hospital of the University of Pennsylvania from 2005 to 2011 with regards to anemia (hemoglobin (Hgb) 12 g dL−1 at preoperative and postoperative timepoints. Complications were analyzed relative to HgB levels and the incidence of anemia. Subgroups were analyzed based on worsening degrees of anemia. Results: Overall, 839 patients were included in the analysis with an 18.3% incidence of preoperative anemia. No significant differences were noted in outcomes of these patients relative to their anemic state, although a higher percent did receive a blood transfusion (18% of anemic patients vs. 6% of nonanemic patients, P
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- 2013
8. A review of propeller flaps for distal lower extremity soft tissue reconstruction: Is flap loss too high?
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Stephen J. Kovach, John P. Fischer, Gedge D. Rosson, Philip S. Brazio, Jonas A. Nelson, and Ariel N. Rad
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medicine.medical_specialty ,business.industry ,Propeller ,Soft tissue ,Context (language use) ,Healthy tissue ,Microsurgical anastomosis ,eye diseases ,Surgery ,Form and function ,Soft tissue reconstruction ,Medicine ,Flap necrosis ,business - Abstract
Soft tissue coverage in the distal lower extremity remains a significant challenge. While free flaps are often utilized for larger defects, local perforator-based propeller flaps may be ideal for smaller wounds requiring coverage. Propeller flaps can provide excellent form and function for both traumatic and atraumatic defects with minimal donor site morbidity but can have concerning rates of flap loss. We reviewed the literature, identifying 21 studies presenting 310 propeller flaps for distal lower extremity reconstruction. Total flap necrosis was noted in 5.5% of flaps, with partial necrosis in 11.6%. While these flaps do enable transfer of local, healthy tissue to the defect site without the need for a microsurgical anastomosis, this rate of flap loss is concerning and appropriate patient selection is crucial. This review provides a brief history and overview of the clinical application and research into distal lower extremity perforator propeller flaps to place this technique into a clinical context.
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- 2013
9. Age and abdominal wall strength: Assessing the aging abdominal wall after autologous breast reconstruction
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Joseph M. Serletti, M.P.H. Jesse C. Selber M.D., Liza C. Wu, Joshua Fosnot, and Jonas A. Nelson
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Free flap breast reconstruction ,Microsurgery ,Surgery ,Abdominal wall ,medicine.anatomical_structure ,Older patients ,Cohort ,Medicine ,Abdomen ,business ,Breast reconstruction ,Prospective cohort study - Abstract
Autologous breast reconstruction is safe in advanced age, yet no study has examined its effects on the aging abdomen. We, therefore, studied 145 women who participated in a prospective study of abdominal strength following abdominal free flap breast reconstruction, comparing preoperative and late follow-up scores in patients ≥60 years old (11 unilateral, 13 bilateral) compared with patients
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- 2012
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