71 results on '"Borsuk DE"'
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2. The use of population modeling to optimize dosing of drugs used in anaesthesiology and intensive care
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Agnieszka Borsuk-De Moor and Paweł Wiczling
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0301 basic medicine ,education.field_of_study ,medicine.medical_specialty ,business.industry ,030106 microbiology ,Population ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Medicine ,Dosing ,business ,education ,Intensive care medicine - Abstract
Effective pharmacotherapy requires an adequate drug dose that maximizes the effectiveness of therapy while minimizing adverse effects. Difficulties in dose selection arise from interindividual differences in drug pharmacokinetics and pharmacodynamics. Population modeling describes pharmacokinetic and pharmacodynamic processes in a population, taking into account the relationships in each patient, differences between patients, and the influence of covariates on drug pharmacokinetics and pharmacodynamics. The aim of this study was to develop population models for drugs used in anesthesiology and intensive care in special patient populations. The pharmacokinetics of sufentanil was described in infants and children after epidural and intravenous administration. The estimated absorption rate constant from the epidural space suggests slow systemic absorption of sufentanil and the possibility of flip-flop kinetics, which results in a slower decline in plasma concentrations at the end of drug administration compared with intravenous administration. The dependence of metabolic clearance on body weight and age was also demonstrated. A population model for the pharmacokinetics of tigecycline was developed for patients with sepsis or septic shock. No relationship between pharmacokinetic parameters and patient characteristics was detected, and the estimated interindividual and inter-occasion variability for clearance was small. This suggests that a universal dose is sufficient to achieve homogeneous drug exposure in critically ill patients. The pharmacokinetics of caspofungin was described in critically ill patients. The clearance and volume of central compartment showed systematic increase over time that was not explained by the covariates. The estimated increase in clearance values for three consecutive doses results in a clinically relevant reduction in drug exposure. The developed population models extend the knowledge of the pharmacokinetics of sufentanyl, tigecycline, and caspofungin. Simulations based on these models can aid the dosing decision-making process.
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- 2021
3. Population analysis to assess the influence of age and body weight on pharmacokinetics and pharmacodynamics of dexmedetomidine in New Zealand White rabbits
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Agnieszka Borsuk-De Moor, Paweł Wiczling, Hanna Billert, Edmund Grześkowiak, Karolina Kulińska, Agnieszka Bienert, Włodzimierz Płotek, Justyna Warzybok, Katarzyna Czerniak, Jan Matysiak, and Agnieszka Klupczynska
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Sedation ,Population ,Pharmaceutical Science ,Withdrawal reflex ,Pharmacology ,Models, Biological ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,New Zealand white rabbit ,Pharmacokinetics ,polycyclic compounds ,medicine ,Animals ,Hypnotics and Sedatives ,Pharmacology (medical) ,Prospective Studies ,Dexmedetomidine ,education ,education.field_of_study ,Cross-Over Studies ,Dose-Response Relationship, Drug ,biology ,business.industry ,Body Weight ,Age Factors ,General Medicine ,biology.organism_classification ,Crossover study ,Nonlinear Dynamics ,030220 oncology & carcinogenesis ,Pharmacodynamics ,Injections, Intravenous ,Rabbits ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug - Abstract
The purpose of this work was i) to develop a population pharmacokinetic (PK) and pharmacodynamic (PD) model of dexmedetomidine (DEX) in New Zealand White rabbits, ii) to investigate the influence of the age and weight of the animals on the model parameters, and iii) to assess the linearity of DEX PKs in the examined dose range. This was a prospective, crossover study, using a total of 18 New Zealand White rabbits. DEX was administered as a single intravenous bolus injection in the doses from 25 to 300 μg kg-1 . Each New Zealand White rabbit was given the same dose of drug in its three developmental stages. To determine the DEX PK, seven blood samples were taken from each animal. The pedal withdrawal reflex was the PD response used to assess the degree of sedation. Nonlinear mixed effects modelling was used for the population PK/PD analysis. The typical value of elimination clearance was 0.061 L min-1 and was 35% higher in younger New Zealand White rabbits compared with older animals. The PK of DEX was linear in the examined concentration range. Age-related changes in sensitivity to DEX were not detected. The results suggest that due to the pharmacokinetics, younger animals will have lower DEX concentrations and a shorter duration of sedation than older animals given the same doses of DEX per kg of body weight.
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- 2020
4. The use of population modeling to optimize dosing of drugs used in anaesthesiology and intensive care
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Borsuk-De Moor, Agnieszka, primary and Wiczling, Paweł, additional
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- 2021
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5. Nonstationary Pharmacokinetics of Caspofungin in ICU Patients
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Elżbieta Rypulak, Michał Borys, Agnieszka Borsuk-De Moor, Grzegorz Raszewski, Dariusz Onichimowski, Paweł Wiczling, Justyna Sysiak-Sławecka, Paweł Piwowarczyk, and Mirosław Czuczwar
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Antifungal Agents ,Critical Illness ,medicine.medical_treatment ,Population ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pharmacokinetics ,population pharmacokinetics ,Caspofungin ,law ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Pharmacology (medical) ,Renal replacement therapy ,education ,Pharmacology ,Volume of distribution ,0303 health sciences ,education.field_of_study ,030306 microbiology ,business.industry ,Area under the curve ,030208 emergency & critical care medicine ,Intensive care unit ,Intensive Care Units ,Infectious Diseases ,chemistry ,Anesthesia ,business ,Invasive Fungal Infections - Abstract
Standard dosing of caspofungin in critically ill patients has been reported to result in lower drug exposure, which can lead to subtherapeutic 24-h area under the curve to MIC (AUC0–24/MIC) ratios. The aim of the study was to investigate the population pharmacokinetics of caspofungin in a cohort of 30 intensive care unit patients with a suspected invasive fungal infection, with a large proportion of patients requiring extracorporeal therapies, including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT)., Standard dosing of caspofungin in critically ill patients has been reported to result in lower drug exposure, which can lead to subtherapeutic 24-h area under the curve to MIC (AUC0–24/MIC) ratios. The aim of the study was to investigate the population pharmacokinetics of caspofungin in a cohort of 30 intensive care unit patients with a suspected invasive fungal infection, with a large proportion of patients requiring extracorporeal therapies, including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Caspofungin was administered as empirical 70 mg antifungal therapy administered intravenously (i.v.) on the first day and at 50 mg i.v. on the consecutive days once daily, and the concentrations were measured after three subsequent doses. Population pharmacokinetic data were analyzed by nonlinear mixed-effects modeling. The pharmacokinetics of caspofungin was described by two-compartment model. A particular drift of the individual clearance (CL) and the volume of distribution of the central compartment (V1) with time was discovered and described by including three separate typical values of CL and V1 in the final model. The typical CL values at days 1, 2, and 3 were 0.563 liters/h (6.7% relative standard error [6.7%RSE]), 0.737 liters/h (6.1%RSE), and 1.01 liters/h (9.1%RSE), respectively. The change in parameters with time was not explained by any of the recorded covariates. Increasing clearance with subsequent doses was associated with a clinically relevant decrease in caspofungin exposure (>20%). The use of ECMO, CRRT, albumin concentration, and other covariates did not significantly affect caspofungin pharmacokinetics. Additional pharmacokinetic studies are urgently required to assess the possible lack of acquiring steady-state and suboptimal concentrations of the drug in critically ill patients. (This study has been registered at ClinicalTrials.gov under identifier NCT03399032.)
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- 2020
6. HPLC-APCI-MS/MS method development and validation for determination of tocotrienols in human breast adipose tissue
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Zbigniew Jankowski, Ewa Bartosińska, Agnieszka Borsuk-De Moor, Wiesław Janusz Kruszewski, Michał Kaliszan, Julia Jacyna, and Danuta Siluk
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0301 basic medicine ,medicine.medical_treatment ,Atmospheric-pressure chemical ionization ,01 natural sciences ,High-performance liquid chromatography ,Analytical Chemistry ,03 medical and health sciences ,Tandem Mass Spectrometry ,Liquid chromatography–mass spectrometry ,medicine ,Humans ,Sample preparation ,Breast ,Solid phase extraction ,Chromatography, High Pressure Liquid ,030109 nutrition & dietetics ,Chromatography ,Chemistry ,Tocotrienols ,Vitamin E ,Solid Phase Extraction ,010401 analytical chemistry ,Reproducibility of Results ,0104 chemical sciences ,Triple quadrupole mass spectrometer ,Adipose Tissue ,Female ,Quantitative analysis (chemistry) - Abstract
For the last decade, significant attention has been paid to the potential role of tocotrienols in prevention and therapy of breast cancer. Therefore, the aim of this study was to develop and validate analytical method for quantitative determination of tocotrienols (α-, β-, γ- and δ-tocotrienol) in human breast adipose tissue with the use of high performance liquid chromatography coupled with APCI-MS/MS detection. Separation of target compounds was achieved within 10min with the use of naphthylethyl Cosmosil 2.5π-NAP column with methanol/water mixture (90:10, v/v) under isocratic elution. Adipose tissue samples were obtained from breast cancer patients and women deceased as a result of accidents. Sample preparation procedure was optimized with the application of the Plackett-Burman design and included tissue homogenization with the use of isopropanol/ethanol/aqueous 0.1% FA mixture (13:3:8, v/v), centrifugation and solid phase extraction (SPE). The method was validated in terms of linearity, precision, accuracy, stability (bench top, autosampler, postpreparative, freeze and thaw stability), matrix effect (ME), recovery (RE) and process efficiency (PE). As for all four tocotrienols ME was negligible (< 15%), precision and accuracy tests were performed with the use of tocotrienols' standard solutions within the ranges of 10.0-400.0ng/g for all four tocotrienols. As the validation requirements were met, the validated method was applied for quantitative analysis of tocotrienols in breast cancer patients.
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- 2018
7. Nonstationary Pharmacokinetics of Caspofungin in ICU Patients
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Borsuk-De Moor, Agnieszka, primary, Sysiak-Sławecka, Justyna, additional, Rypulak, Elżbieta, additional, Borys, Michał, additional, Piwowarczyk, Paweł, additional, Raszewski, Grzegorz, additional, Onichimowski, Dariusz, additional, Czuczwar, Mirosław, additional, and Wiczling, Paweł, additional
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- 2020
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8. Population analysis to assess the influence of age and body weight on pharmacokinetics and pharmacodynamics of dexmedetomidine in New Zealand White rabbits
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Warzybok, Justyna, primary, Bienert, Agnieszka, additional, Borsuk‐De Moor, Agnieszka, additional, Płotek, Włodzimierz, additional, Kulińska, Karolina, additional, Czerniak, Katarzyna, additional, Billert, Hanna, additional, Klupczyńska, Agnieszka, additional, Matysiak, Jan, additional, Grześkowiak, Edmund, additional, and Wiczling, Paweł, additional
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- 2020
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9. Determination of tocopherols and tocotrienols in human breast adipose tissue with the use of high performance liquid chromatography-fluorescence detection
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Michał Kaliszan, Agnieszka Borsuk-De Moor, Alicja Renkielska, Julia Jacyna, Michał J. Markuszewski, Ewa Bartosińska, Danuta Siluk, Karolina Kondej, Wiesław Janusz Kruszewski, and Jerzy Jankau
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0301 basic medicine ,Central composite design ,Formic acid ,medicine.medical_treatment ,Clinical Biochemistry ,Adipose tissue ,Tocopherols ,Breast Neoplasms ,01 natural sciences ,Biochemistry ,High-performance liquid chromatography ,Analytical Chemistry ,03 medical and health sciences ,chemistry.chemical_compound ,Breast cancer ,Limit of Detection ,Drug Discovery ,medicine ,Humans ,Sample preparation ,Breast ,Molecular Biology ,Chromatography, High Pressure Liquid ,Pharmacology ,030109 nutrition & dietetics ,Chromatography ,Chemistry ,Vitamin E ,Tocotrienols ,010401 analytical chemistry ,Reproducibility of Results ,General Medicine ,medicine.disease ,0104 chemical sciences ,Spectrometry, Fluorescence ,Adipose Tissue ,Case-Control Studies ,Linear Models ,Homogenization (biology) - Abstract
Tocopherols and tocotrienols have been extensively studied owing to their anticancer potential, especially against breast cancer. Therefore, the aim of this study was to quantitatively determine tocochromanols in human breast adipose tissue with the use of HPLC-FLD. The sample preparation procedure included homogenization and solvent extraction with isopropanol-ethanol-0.1% formic acid mixture prior to solid-phase extraction. After implementation of central composite design, satisfactory separation of all eight target compounds was achieved within 10.5 min. Chromatographic runs were carried out with the use of a naphthylethyl chromatographic column with methanol-water mixture (89:11, v/v) as the mobile phase. Fluorescence detection of tocochromanols was performed with excitation and emission wavelengths 298 and 330 nm, respectively. The method was validated in terms of linearity, carryover, recovery, precision, accuracy and stability. Extraction yield was also determined for accurate evaluation of vitamin E content in human breast adipose tissue samples. Finally, concentrations of particular tocochromanols compounds were assessed in human breast adipose tissue samples obtained from 99 patients, including women with breast cancer, healthy volunteers and deceased women who had died as a result of accidents. The raw data was transformed according to the newly developed equation for accurate estimation of the concentrations of tocochromanols in breast adipose tissue samples. Results obtained in the study indicated that the proposed analytical assay could be useful in breast cancer research.
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- 2018
10. Population Pharmacokinetics of High-Dose Tigecycline in Patients with Sepsis or Septic Shock
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Dariusz Onichimowski, Paweł Wiczling, Elżbieta Rypulak, Grzegorz Raszewski, Agnieszka Borsuk-De Moor, Beata Potręć, Justyna Sysiak, Michał Borys, Mirosław Czuczwar, and Paweł Piwowarczyk
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0301 basic medicine ,Adult ,Male ,030106 microbiology ,Population ,Tigecycline ,Microbial Sensitivity Tests ,Glycylcycline ,Loading dose ,Sepsis ,03 medical and health sciences ,Pharmacokinetics ,population pharmacokinetics ,Medicine ,Humans ,Pharmacology (medical) ,Dosing ,Prospective Studies ,education ,Aged ,Pharmacology ,education.field_of_study ,business.industry ,Septic shock ,Middle Aged ,medicine.disease ,Shock, Septic ,Anti-Bacterial Agents ,Infectious Diseases ,Anesthesia ,Female ,business ,pharmacokinetics ,medicine.drug - Abstract
Tigecycline is a glycylcycline often used in critically ill patients as the antibiotic of last resort. The pharmacokinetics (PK) of tigecycline in intensive care unit (ICU) patients can be affected by severe pathophysiological changes so that standard dosing might not be adequate. The aim of this study was to describe population PK of high-dose tigecycline in patients with sepsis or septic shock and evaluate the relationship between individual PK parameters and patient covariates. The study population consisted of 37 adult ICU patients receiving a 200-mg loading dose of tigecycline followed by multiple doses of 100 mg every 12 h. Blood samples were collected at 0.5, 2, 4, 8, and 12 h after dose administration. A two-compartment model with interindividual (IIV) and interoccasion (IOV) variability in PK parameters was used to describe the concentration-time course of tigecycline. The estimated values of mean population PK parameters were 22.1 liters/h and 69.4 liters/h for elimination and intercompartmental clearance, respectively, and 162 liters and 87.9 liters for volume of the central and peripheral compartment, respectively. The IIV and IOV in clearance were less than 20%. The estimated values of distribution volumes were different from previously published values, which might be due to pathophysiological changes in ICU patients. No systematic relationship between individual PK parameters and patient covariates was found. The developed model does not show evidence that individual tigecycline dosing adjustment based on patient covariates is necessary to obtain the same target concentration in patients with sepsis or septic shock. Dosing adjustments should be based on the pathogens, their susceptibility, and PK targets.
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- 2018
11. Ionization of tocopherols and tocotrienols in atmospheric pressure chemical ionization
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Danuta Siluk, Michał J. Markuszewski, Ewa Bartosińska, Agnieszka Borsuk-De Moor, and Paweł Wiczling
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Chromatography ,Atmospheric pressure ,010405 organic chemistry ,Chemistry ,010401 analytical chemistry ,Organic Chemistry ,Atmospheric-pressure chemical ionization ,Standard solution ,Tandem mass spectrometry ,01 natural sciences ,High-performance liquid chromatography ,Ion source ,0104 chemical sciences ,Analytical Chemistry ,chemistry.chemical_compound ,Ionization ,Trolox ,Spectroscopy - Abstract
Rationale Tocopherols and tocotrienols are chemical compounds insusceptible to the ionization process under atmospheric pressure conditions. Therefore, the selection of the optimal ion source settings for their quantification requires special attention. The aim of this study was to analyse the influence of the APCI source parameters on the response of tocochromanols and two related compounds. Methods Standard solutions of target compounds were injected on the high-performance liquid chromatography/atmospheric pressure chemical ionization tandem mass spectrometry (HPLC/APCI-MS/MS) system separately and analysed with 30 randomly selected ion source settings. The obtained responses were modelled by multivariate linear regression with least absolute shrinkage and selection operator. The developed models were used to choose the best APCI conditions. Results Multivariate linear models were built for eight tocochromanols, trolox and BHT. The APCI settings derived from the models did not increase the peak areas obtained for T and T3 during the ionization process. Ionization conditions based on models for trolox and BHT improved analytical responses by 12-36% and 4-32%, respectively. The application of the ion source settings optimal for trolox and BHT to tocochromanols did not result in better analytical responses. Conclusions The ionization pattern of tocochromanols in the APCI source is problematic and should be further investigated. Modelling methodology for response improvement presented in this study can be applied in similar studies.
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- 2017
12. Determination of tocopherols and tocotrienols in human breast adipose tissue with the use of high performance liquid chromatography-fluorescence detection
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Bartosińska, Ewa, primary, Jacyna, Julia, additional, Borsuk-De Moor, Agnieszka, additional, Kaliszan, Michał, additional, Kondej, Karolina, additional, Jankau, Jerzy, additional, Renkielska, Alicja, additional, Kruszewski, Wiesław Janusz, additional, Markuszewski, Michał Jan, additional, and Siluk, Danuta, additional
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- 2018
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13. Ionization of tocopherols and tocotrienols in atmospheric pressure chemical ionization
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Bartosińska, Ewa, primary, Borsuk-De Moor, Agnieszka, additional, Siluk, Danuta, additional, Markuszewski, Michał J., additional, and Wiczling, Paweł, additional
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- 2018
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14. Population Pharmacokinetics of High-Dose Tigecycline in Patients with Sepsis or Septic Shock
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Borsuk-De Moor, Agnieszka, primary, Rypulak, Elżbieta, additional, Potręć, Beata, additional, Piwowarczyk, Paweł, additional, Borys, Michał, additional, Sysiak, Justyna, additional, Onichimowski, Dariusz, additional, Raszewski, Grzegorz, additional, Czuczwar, Mirosław, additional, and Wiczling, Paweł, additional
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- 2018
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15. Abstract 109
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Brown, EN, primary, Dorafshar, AH, additional, Bojovic, B, additional, Christy, MR, additional, Borsuk, DE, additional, Brazio, PS, additional, Shaffer, C, additional, and Rodriguez, ED, additional
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- 2012
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16. An Update on the Survival of the First 50 Face Transplants Worldwide.
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Homsy P, Huelsboemer L, Barret JP, Blondeel P, Borsuk DE, Bula D, Gelb B, Infante-Cossio P, Lantieri L, Mardini S, Morelon E, Nasir S, Papay F, Petruzzo P, Rodriguez E, Özkan Ö, Özmen S, Pomahac B, and Lassus P
- Abstract
Importance: Since 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established., Objective: To assess the survival of the face transplant grafts and evaluate factors potentially influencing it., Design, Setting, and Participants: Data on all the transplants included in this multicenter cohort study were collected at participating transplant centers for updated nonpublished data, supplemented with literature review for nonparticipating centers. Data from 2005 until September 2023, were included. Data were analyzed from November 11, 2005, through September 18, 2023. Patients included the first 50 patients in the world to have received a face transplant., Exposure: Face transplant graft., Main Outcomes and Measures: The primary outcome was the overall survival of the face transplant graft, defined as either transplant loss or patient death. The secondary outcome was the number of acute rejection episodes per year., Results: The 50 transplants were performed on 39 men (81%) and 9 women (19%) with a median age of 35 (range, 19-68) years at the time of the transplant. The median follow-up time was 8.9 (range, 0.2-16.7) years. During the follow-up, 6 transplants were lost with 2 patients retransplanted. There were 10 patients who died, 2 of whom had lost a transplant. The 5- and 10-year survival of the transplants was 85% (SD, 5%) and 74% (SD, 7%), respectively. The sequential number of the transplant in the world was a significant predictor of survival (hazard ratio, 95; 95% CI, 90-100; P < 05). The median number of acute rejection episodes per year was 1.2 (range, 0-5.3) for the transplants that were lost and 0.7 (range, 0-4.6) for the transplants that survived. No correlation with patient and transplant variables was detected for either the transplant survival or the number of rejection episodes., Conclusions and Relevance: In this study, the overall survival of the face transplants is encouraging. These data suggest that the acceptable long-term survival of face transplants makes them a reconstructive option for extensive facial defects.
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- 2024
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17. Determination of Novel, Cranium-Based Relationships for Construct Placement in Microtia Reconstruction for Hemifacial Microsomia Patients.
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Bouhadana G, Gornitsky J, Saleh E, El Jalbout R, Borsuk DE, and Cugno S
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- Humans, Facial Asymmetry, Skull Base, Face, Goldenhar Syndrome diagnostic imaging, Goldenhar Syndrome surgery, Congenital Microtia surgery
- Abstract
Objective: Determine if the ideal location of the construct in microtia reconstruction for hemifacial microsomia (HFM) can be more accurately derived from measurements on the cranium., Design: High-resolution computerized tomography (CT) images were analyzed through craniometric linear relationships., Setting: Our tertiary care institution from 2000 to 2021., Patients/participants: Patients diagnosed with HFM and microtia, who had high-resolution craniofacial CT scans, yielding 36 patients accounting for 44 CT scans., Main Outcome Measure(s): First, the integrity of the posterior cranial vault among HFM patients was determined. If proven to be unaffected, it could be used as a reference in the placement of the construct. Second, the position of the ear in relation to the cranium was assessed in healthy age-matched controls. Third, if proven to be useful, the concordance of these cranium-based relationships could be validated among our HFM cohort., Results: The posterior cranial vault is unaffected in HFM ( P > .001). Further, craniometric relationships between the tragus and the Foramen Magnum, as well as between the tragus and the posterior cranium, have been shown to be highly similar and equally precise in predicting tragus position in healthy controls ( P > .001). These relationships held true across all age groups ( P > .001), and importantly among HFM patients, where the mean absolute difference in predicted tragus position never surpassed 1.5 mm., Conclusions: Relationships between the tragus and the cranium may be used as an alternative to distorted facial anatomy or surgeon's experience to assist in pre-operative planning of construct placement in microtia reconstruction for HFM patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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18. Burn Patients and Mental Health: A Matched Cohort Study.
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Kang-Auger G, Borsuk DE, Low N, Ayoub A, Auger N, and Buteau S
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Objective: To determine the association between burns and hospitalization for mental health disorders up to three decades later., Summary Background Data: Burns are associated with pain, disability, and scarring, but the long-term impact on mental health is unclear., Methods: We analyzed a cohort of 23,726 burn patients aged ≥10 years who were matched to 223,626 controls from Quebec, Canada, between 1989 and 2022. The main exposure was admission for a burn. We followed patients during 3,642,206 person-years of follow-up to identify future hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts. We estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between burns and subsequent mental health hospitalization using Cox proportional hazards regression., Results: Burn patients had 1.76 times greater risk of mental health hospitalization over time (95% CI 1.72-1.81), compared with controls. Associations were present regardless of burn site, but were greatest for burns covering ≥50% of the body (HR 3.29, 95% CI 2.61-4.15), third degree burns (HR 2.04, 95% CI 1.94-2.14), and burns requiring skin grafts (HR 2.00, 95% CI 1.90-2.10). Compared with controls, burn patients had more than two times the risk of hospitalization for eating disorders (HR 3.14, 95% CI 2.50-3.95), psychoactive substance use disorders (HR 2.27, 95% CI 2.17-2.39), and suicide attempts (HR 2.42, 95% CI 2.23-2.62). Risks were particularly elevated within 5 years of the burn, but persisted throughout follow-up., Conclusions: Burns are associated with an increased risk of hospitalization for mental health disorders up to 30 years later., Competing Interests: Conflicts of Interest and Source of Funding : GK-A has received a grant from the Quebec Network on Suicide, Mood Disorders and Related Disorders. NA has received a grant (#PJT-191702) from the Canadian Institutes of Health Research, and a grant (#296785) from the Fonds de recherche du Québec-Santé. For the remaining authors none were declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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19. Rates of hepatic artery thrombosis in liver transplantation with the use of a microscope: A systematic review.
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Trabelsi NO, Melhem HB, Matouk MA, Borsuk DE, and Efanov JI
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- Adult, Humans, Child, Adolescent, Hepatic Artery surgery, Anastomosis, Surgical methods, Microsurgery methods, Living Donors, Retrospective Studies, Liver Transplantation adverse effects, Liver Transplantation methods, Thrombosis epidemiology, Thrombosis etiology, Thrombosis surgery
- Abstract
Objective: Hepatic artery anastomosis in liver transplantations requires a meticulous technique to minimize the risk of hepatic artery thrombosis (HAT). The microscope helped improve anastomosis techniques in pediatric patients with small caliber vessels. The aim of this review was to compare microsurgical and non-microsurgical techniques on the incidence of HAT in liver transplantations. The secondary objective was to compare HAT incidence between pediatric and adult cohorts and between plastic and transplant surgeons., Methods: A systematic review of the literature using Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was conducted on studies involving HAT in liver transplantations with microsurgery. Three reviewers performed a full article review and data extraction for studies meeting the eligibility criteria of the study., Results: Forty-five studies were incorporated in the final analysis. A total of 7346 patients and 7506 liver transplants were included. The mean age was 17 years old with an equivalent distribution between pediatric (51%, n = 3218) and adult patients (49%, n = 3145). A total of 6351 of these transplantations underwent microsurgical repair, against 1157 with non-microsurgical techniques. The overall HAT rate was 4.9%, including 4.2% in the microsurgical group (n = 268) and 8.5% in the non-microsurgical group (n = 98), a statistically significant increase of 4.3%. The occurrence of HAT was 2.6% with a plastic surgeon versus 4.6% with other types of surgeons. When using microsurgical techniques, the HAT rate was 4.2% with living donors versus 7.7% with deceased donors., Conclusions: HAT and subsequent liver transplant failure are lower when microsurgical techniques, living donors, and plastic surgeons with a microsurgical training are involved in the operation., Competing Interests: Declaration of Competing Interest None to declare., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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20. How Big Is Too Big? Exploring the Relationship between Breast Implant Volume and Postoperative Complication Rates in Primary Breast Augmentations.
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Medor MC, Bouhadana G, Churchill IF, Hemmerling T, Bonapace-Potvin M, Papanastasiou C, Mussie A, Borsuk DE, and Papanastasiou VW
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There is no consensus regarding implant size as an independent risk factor for complications in primary breast augmentation. Choosing appropriate implant volume is an integral part of the preoperative planning process. The current study aims to assess the relationship between implant size and the development of complications following augmentation mammaplasty., Methods: A retrospective chart review of patients undergoing primary breast augmentation at the Westmount Institute of Plastic Surgery between January 2000 and December 2021 was conducted. Demographics, implant characteristics, surgical technique, postoperative complications, and follow-up times were recorded. Univariate logistic regression was used to identify independent predictors, which were then included in multivariate logistic regressions of implant volume and implant volume/body mass index (BMI) ratio regarding complications., Results: A total of 1017 patients (2034 breasts) were included in this study. The average implant volume used was 321.4 ± 57.5 cm
3 (range: 110-605). Increased volume and volume/BMI ratio were associated with a significant increase in risk of implant rupture (odds ratio = 1.012, P < 0.001 and 1.282, P < 0.001 respectively). Rates of asymmetry were significantly associated with increases in implant volume and volume/BMI ratio (odds ratio = 1.005, P = 0.004 and 1.151, P < 0.001, respectively). No single implant volume or volume/BMI ratio above which risks of complications significantly increase was identified., Conclusions: Implant rupture and postoperative asymmetries are positively correlated with bigger implant volumes. Implant size could likely be a useful independent predictor of certain complications, especially in patients with high implant to BMI ratios., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)- Published
- 2023
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21. Validating a Novel Device to Improve Skin Color Matching for Face Transplants.
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Gornitsky J, Saleh E, Bouhadana G, and Borsuk DE
- Abstract
Facial vascularized composite allotransplantation (VCA) offers an added layer of complexity when compared to solid organ transplantation. VCAs must account for aesthetic variables such as skin tone and color. The goal of this study is to validate the Nix Color Sensor as a novel tool to be added to the plastic surgeon's armamentarium for evaluating skin color match of the donor and recipient., Methods: A prospective study of 100 individuals was conducted. All participants were photographed and scanned with the Nix Color Sensor. Sixty pairwise comparisons were randomly generated. Skin color analysis was performed using photographs and the Nix Color Sensor. Delta E2000 values were compared to mean evaluator ratings using a Spearman correlation analysis., Results: One hundred patients were included. A Spearman's correlation demonstrated a strong inverse correlation between Delta E2000 values and the mean evaluator ratings. The higher the mean evaluator rating for likeness, the lower the delta. A correlation coefficient of -0.850 demonstrates a statistically significant relationship ( P < 0.01)., Conclusions: When the Delta E2000 rises above 5 there is a significant drop in the mean evaluator ratings. As mean evaluator ratings of 5 and above would be considered adequate for face transplant amongst most plastic surgeons, an E2000 value of 5 or lower should be targeted when matching donors with recipients for face transplant. The Nix Color Sensor positively correlates to the plastic surgeon's perception of skin color and can serve as an adjunct in donor selection for facial VCAs., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2022
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22. Surgical Microtia Reconstruction in Hemifacial Microsomia Patients: Current State and Future Directions.
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Bouhadana G, Gornitsky J, Saleh E, Borsuk DE, and Cugno S
- Abstract
Background: Hemifacial microsomia (HFM) is one of the most common congenital craniofacial disorders. Among many other features, microtia is present in the large majority of these patients. However, mainly due to the unilateral hypoplastic anatomy, microtia reconstruction among this patient population remains a reconstructive challenge for plastic surgeons. Given that no clear standards exist, an evidence-based synthesis of the literature was devised., Methods: A systematic search of Pubmed, Medline, and Embase was carried out, in accordance with the PRISMA guidelines. Studies discussing surgical microtia reconstruction for HFM patients were retained. Qualitative data regarding study design, challenges addressed, specific recommendations, and their respective strengths/limitations were extracted from each. Retrieved recommendations were consolidated and assigned a level of evidence grade., Results: Although only 11 studies were included in this review, these provided 22 main recommendations regarding the eight HFM-specific challenges identified, which were of either grade C (n = 5) or D (n = 17). Included studies addressed construct location (n = 7), the low hairline (n = 6), soft tissue construct coverage (n = 6), earlobe reconstruction (n = 6), construct projection (n = 5), anomalies of the relevant neurovascular systems (n = 2), retroauricular construct coverage (n = 2), and sizing of the construct (n = 2)., Conclusions: Given the many persisting reconstructive challenges regarding surgical microtia reconstruction for HFM patients, the authors present a comprehensive and evidence-based consolidation of recommendations specific to these challenges. The authors hope this systematic review can appropriately guide plastic surgeons and will ultimately improve care for this patient population., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2022
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23. Expanding the Classic Facial Canons: Quantifying Intercanthal Distance in a Diverse Patient Population.
- Author
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Bouhadana G, Gornitsky J, Saleh E, Oliveira Trabelsi N, and Borsuk DE
- Abstract
Background: The intercanthal distance (ICD) is central to our perception of facial proportions, and it varies according to gender and ethnicity. Current standardized reference values do not reflect the diversity among patients. Therefore, the authors sought to provide an evidence-based and gender/ethnicity-specific reference when evaluating patients' ICD., Methods: As per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of PubMed, Medline, and Embase was carried out for studies reporting on the ICD. Demographics, study characteristics, and ICDs were extracted from included studies. ICD values were then pooled for each ethnicity and stratified by gender. The difference between men and women, and that across ethnicities and measurement types were compared by means of independent sample t -test and one-way ANOVA (SPSS v.24)., Results: A total of 67 studies accounting for 22,638 patients and 118 ethnic cohorts were included in this pooled analysis. The most reported ethnicities were Middle Eastern (n = 6629) and Asian (n = 5473). ICD values (mm) in decreasing order were: African 38.5 ± 3.2, Asian 36.4 ± 1.6, Southeast Asian 32.8 ± 2.0, Hispanic 32.3 ± 2.0, White 31.4 ± 2.5, and Middle Eastern 31.2 ± 1.5. A statistically significant difference ( P < 0.05) existed between all ethnic cohorts, between genders among most cohorts, and between most values stratified by measurement type., Conclusions: Our standards of craniofacial anthropometry must evolve from the neoclassical canons using White values as references. The values provided in this review can aid surgeons in appreciating the gender- and ethnic-specific differences in the ICD of their patients., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2022
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24. Face Transplant: Current Update and First Canadian Experience: Correction.
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Govshievich A, Saleh E, Boghossian E, Collette S, Desy D, Dufresne S, St-Jacques H, Chollet A, Tremblay D, Guertin C, Tardif M, Poirier J, Ayad T, Rahal A, Lin JC, and Borsuk DE
- Published
- 2021
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25. Fine Details That Improve Nasal Reconstruction.
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Borsuk DE, Papanastasiou C, and Chollet A
- Subjects
- Esthetics, Female, Humans, Male, Nose anatomy & histology, Nose injuries, Nose surgery, Nose Deformities, Acquired etiology, Postoperative Complications etiology, Rhinoplasty adverse effects, Surgical Flaps adverse effects, Surgical Flaps transplantation, Treatment Outcome, Nose Deformities, Acquired surgery, Nose Neoplasms surgery, Postoperative Complications prevention & control, Rhinoplasty methods
- Abstract
Learning Objectives: After studying this article, the participant should be able to: 1. Identify common negative outcomes that arise with conventional nasal reconstruction. 2. Understand the technical refinements that help avoid and reduce negative outcomes in nasal reconstruction. 3. Learn about the utility of regional axial island flaps for nasal reconstruction, in particular, the lateral nasal artery flap., Summary: Nasal reconstruction has been a preoccupation of surgeons dating to before 600 bc. The nose is the central focal point of the face and a key identifying facial feature, and surgery to the nose can prove to be challenging to even the most experienced surgeon. The objective of this CME article is to outline the most commonly used surgical options for each nasal aesthetic subunit, and the specific complications observed for each. The best surgical options and technical refinements are highlighted, and principles that may help restore the nose are outlined., Competing Interests: Disclosure:The authors have no conflicts of interest to declare., (Copyright © 2021 by the American Society of Plastic Surgeons.)
- Published
- 2021
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26. Microsurgical and Endovascular Management of Congenital Iliac Aneurysms in the Neonatal Period: Two Cases and a Literature Review.
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Iyer H, Joharifard S, Le-Nguyen A, Dubois J, Ghali R, Borsuk DE, and Lallier M
- Abstract
Introduction: Congenital aneurysms of major arteries are very rare diagnoses and prognosis can be poor if treatment is not initiated rapidly. This is the presentation of two cases of infants with congenital iliac aneurysms who underwent treatment in the neonatal period. The report then proceeds with a literature review of paediatric iliac aneurysms., Report: Case 1: A female neonate was diagnosed antenatally with right common iliac (CIA) and internal iliac (IIA) artery aneurysms. Embolisation on day of life (DOL) eight was impossible because of partial thrombosis. The infant was subsequently observed for several months and the aneurysm was injected percutaneously with thrombin on DOL 78. A small residual aneurysm was coil embolised at five months of age. Satisfactory results were observed at one year follow up. Case 2: A female neonate was diagnosed antenatally on routine third trimester ultrasound with voluminous, bilateral CIA aneurysms. The patient underwent surgery on DOL 9 for aneurysm resection and microsurgical vascular reconstruction. The intervention was successful with triphasic flow through the anastomoses on colour Doppler ultrasound at six week follow up., Discussion: Ten cases of congenital iliac aneurysms have been reported previously, with just two diagnosed in the neonatal period and eight undergoing surgical intervention. Definitive management to avoid aneurysm rupture or thrombosis should be timed carefully, and sometimes delayed with watchful waiting, to maximise success and minimise complications. Surgery is the key treatment modality, but endovascular intervention can be considered in selected cases. Congenital iliac aneurysms should be addressed at the safest time for the patient. Following resection, primary microvascular anastomosis is the ideal reconstructive technique, but other options for neonates have been described. Endovascular treatment should be considered for anatomically amenable saccular aneurysms., (© 2021 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery.)
- Published
- 2021
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27. Face transplantation: anesthesia and other organizational considerations.
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Bélanger ME, Borsuk DE, Clairoux A, Fortier LP, Nguyen A, Georgescu M, Richebé P, Tanoubi I, Verdonck O, and Gobert Q
- Subjects
- Canada, France, Humans, Anesthesia, Facial Transplantation
- Abstract
In 2005, the first facial vascularized composite allotransplant was performed in France. In May 2018, our team at Maisonneuve-Rosemont Hospital, Montreal, Quebec, had the privilege to participate in the first facial transplant in Canada. Interdisciplinary collaboration, coordination, and communication formed the cornerstone of this medical undertaking and, ultimately, its success. This report details the anesthetic and organizational considerations of our experience.
- Published
- 2021
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28. The Pediatric Arterialized Venous Flow-through Flap.
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Efanov JI, ElHawary H, Chollet A, Mottard S, and Borsuk DE
- Abstract
Arterialized venous flow-through flaps are solely vascularized through the venous plexus. The flaps were first described 40 years ago; however, reports of venous congestion and ischemia discouraged surgeons from adopting them into their armamentarium. Nevertheless, recent studies have demonstrated a resurgence of venous flow-through flaps for reconstruction of small to medium defects of the hand and digits. Although current data report variable levels of success in adults, no case reports have been published in the pediatric population for this type of flap. In this study, an arterialized venous flow-through flap from the medial forearm was used to reconstruct a volar hand defect in a young child. Flap markings, surgical technique, and aftercare are described. The surgery was uncomplicated, and the postoperative outcomes were aesthetically and functionally excellent. Venous flow-through flaps restore full-thickness defects, are relatively easy to perform, allow an early return to daily activities, and have almost no morbidity. These flaps offer excellent options for pediatric hand and finger defects., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2021
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29. Facial Transplantation in a Nationalized Health System: The Canadian Experience.
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Lorquet E, Govshievich A, Chollet A, Tremblay DM, and Borsuk DE
- Abstract
Facial transplantation (FT) is recognized as the ultimate reconstruction for severely disfigured patients. The substantial cost of these procedures in a nationalized health system has not been extensively published. The first Canadian FT performed in May 2018 was a great opportunity to address this subject and evaluate the viability of such a program., Methods: A detailed patient chart review was performed and a cost per unit approach was used to estimate the procedure cost. The preoperative, operative, and the postoperative periods up to 1-year after the surgery were analyzed. Financial support from private sponsors and Hospital Fund donations were considered. The literature on international FT and national solid organ transplantation was reviewed., Results: The overall 1-year cost was estimated at $440,224 (2018 CAD). The costs are explained by a long hospital length of stay, costly immunosuppressive therapy, and high immunosuppression-related complications. Those findings are consistent with international FT literature. The societal impact of the surgery was minimized with a $36,921 (2018 CAD) grant obtained from an external contributor. Interestingly, the hospital foundation sustained a 794% increase in donations ($1,787,148; 2019 CAD) the year following the surgery., Conclusion: Our experience confirmed that the combination of private funding, with positive goodwill and hospital donations, is a workable model for innovative surgery in the setting of a nationalized health system with financial restrictions., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2021
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30. Utility Outcome Measures for the Treatment of Ameloblastomas during Childhood.
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David C, Efanov JI, and Borsuk DE
- Abstract
Our objective was to determine the potential impact of the surgical treatment of ameloblastoma in children through validated health state utility outcome measures., Methods: A survey-based preference health utility assessment using the visual analog scale, time trade-off, and standard gamble methods was undertaken among a general population sample. Quality-adjusted life years were derived from these measures. A one-way ANOVA was used for statistical analysis, with a mean ( P ) value of 0.05 considered significant. Demographic parameters were individually assessed as possible predictors of each utility score., Results: In total, 86 participants took part in this study, with a mean age of 29.9 years. Greater utility scores were observed among participants reporting no religious beliefs ( P = 0.025, t = 2.28). No other demographic parameters showed statistically significant prediction of utility score. From the mean utility scores (± SD) (visual analog scale = 0.60 ± 0.17; time trade-off = 0.65 ± 0.22; standard gamble = 0.64 ± 0.20), a gain of 30.0, 32.3, and 32.1 quality-adjusted life years may be derived, respectively. All utility outcome measures suggested that an ameloblastoma during childhood is perceived as more burdensome than several debilitating conditions, such as cleft lip and palate., Conclusions: To attain perfect health, participants would theoretically undergo surgical treatment of an ameloblastoma during childhood, with willingness to trade off 28.2 years of life and accepting a 35.7% risk of death. The objective assessment of the perceived burden of an ameloblastoma affliction during childhood may inspire cost-utility or cost-effectiveness analyses at broader societal levels., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2021
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31. Velopharyngeal Space Assessment in Patients Undergoing Le Fort 1 Maxillary Advancement.
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Saleh E, Saleh J, Beauchemin G, El-Jalbout R, and Borsuk DE
- Abstract
The effects of maxillary advancement on velopharyngeal anatomy have primarily been studied using lateral cephalometric radiographs. However, with recent advances in orthognathic surgery, there is an increased need for more detailed and precise imaging such as computerized tomographic (CT) scan reconstructions, to help in surgical planning and to measure outcomes. The purpose of this study was to compare the pre- and post-operative velopharyngeal anatomic configuration modifications as measured on CT scans., Methods: This is a retrospective cohort study of 44 patients with and without cleft palate who were treated with maxillary advancement. The pre- and post-operative CT scans were compared with respect to pre-established landmarks. Linear distances, cross-sectional areas, and volumes were measured using 3-dimensional CT scan reconstructions., Results: For the linear distances measured, a statistically significant difference was found when comparing the pre- and post-operative measures of the narrowest part of the nasopharynx and the narrowest part of the retropalatal airway space ( P = 0.001 and 0.026, respectively). Retropalatal cross-sectional areas, nasopharyngeal cross-sectional areas, and the volumetric assessment of the nasopharyngeal space showed no statistically significant differences when comparing pre- and post-operative scans ( P < 0.05). Mean changes in the measures did not differ over time (pre- and post-operative) depending on whether there was a prior history of cleft palate repair., Conclusions: Although structural modifications of the pharyngeal space are inherent to maxillary advancement, its surface area and volume do not significantly change. The use of 3-dimensional reconstruction using CT scans should be the first choice for evaluation of the upper airway., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)
- Published
- 2020
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32. Lymphocytic Vasculitis Associated With Mild Rejection in a Vascularized Composite Allograft Recipient: A Clinicopathological Study.
- Author
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Roy SF, Krishnan V, Trinh VQ, Collette S, Dufresne SF, Borsuk DE, and Désy D
- Subjects
- Aged, Biopsy, Canada, Composite Tissue Allografts blood supply, Composite Tissue Allografts pathology, Dose-Response Relationship, Drug, Graft Rejection immunology, Graft Rejection pathology, Graft Rejection prevention & control, Graft Survival drug effects, Graft Survival immunology, Humans, Immunosuppressive Agents pharmacokinetics, Male, Retrospective Studies, Severity of Illness Index, Skin blood supply, Skin pathology, Tacrolimus pharmacokinetics, Transplantation, Homologous adverse effects, Treatment Outcome, Vasculitis diagnosis, Vasculitis drug therapy, Vasculitis immunology, Facial Transplantation adverse effects, Graft Rejection diagnosis, Immunosuppressive Agents administration & dosage, Tacrolimus administration & dosage, Vasculitis complications
- Abstract
Background: Histologic criteria for diagnosing acute rejection in vascularized composite tissue allograft (VCA) have been established by the Banff 2007 Working Classification of Skin-Containing Composite Tissue Allograft, but the role of early vascular lesions in graft rejection warrants additional analysis., Methods: We performed a retrospective study of 34 skin biopsies performed over 430 d for rejection surveillance, in Canada's first face allotransplant recipient. Three observers reviewed all biopsies to assess the nature and intensity of the inflammatory skin infiltrate. A complete histological and immunohistochemical review of the vascular components was performed with a focus on lymphocytic vasculitis, intravascular fibrin, vessel caliber, extent of injury, C4d positivity, and inflammatory cell phenotyping. We then correlated these data points to clinical and immunosuppression parameters., Results: Acute vascular damage in biopsies that would be classified as mild acute rejection correlates with troughs in immunosuppression and subsides when immunosuppressive tacrolimus doses are increased. Grade 0 Banff rejection and Grade I without lymphocytic vasculitis were almost indistinguishable, whereas Grade I with lymphocytic vasculitis was an easy and reproducible histologic finding., Conclusions: Our results highlight the possible relevance of vascular injury in the context of VCA, as its presence might underlie a more aggressive form of immune rejection. If these findings are validated in other VCA patients, vascular injury in mild rejection might warrant a different clinical approach.
- Published
- 2020
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33. The Use of Virtual Surgical Planning for Reduction Cranioplasty.
- Author
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Saleh E, Govshievich A, Justino J, Weil AG, and Borsuk DE
- Abstract
Hydrocephalic macrocephaly may occur as a result of untreated hydrocephalus. Reduction cranioplasty is the treatment of choice for these patients when the weight of their head interferes with normal development and negatively impacts quality of life. However, this procedure has several associated risks, including prolonged anesthesia, significant blood loss, and death. Virtual surgical planning (VSP) has been shown to be a useful adjunct for orthognathic and craniofacial surgery. The following report details the application and advantages of this technology in the setting of a reduction cranioplasty. We report the case of a 2-year-old girl with severe hydrocephalic macrocephaly who underwent a reduction cranioplasty guided by VSP with computer-aided design and manufacturing (CAD/CAM). Prefabricated cutting guides and a concave assembly bowl were used for precise fixation of bony segments. Our patient underwent a successful reduction cranioplasty using VSP and CAD/CAM. This technology allowed precise remodeling of the cranial vault with minimal bony gaps in the final construct. Head circumference and intracranial volume were reduced from 70 cm and 4,575 cm
3 to 62 cm and 2,645 cm3 , respectively. VSP with CAD/CAM can serve as a useful adjunct in complex cases of cranioplasty allowing for an increase in the precision, the efficacy, and the esthetic result., (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)- Published
- 2020
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34. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Immediate or Delayed Implant Replacement?
- Author
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Shine JJ, Boghossian E, Beauchemin G, Papanastasiou VW, and Borsuk DE
- Subjects
- Biopsy, Needle, Device Removal, Female, Follow-Up Studies, Humans, Immunohistochemistry, Lymphoma, Large-Cell, Anaplastic pathology, Mammaplasty methods, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Risk Assessment, Time Factors, Treatment Outcome, Breast Implants adverse effects, Lymphoma, Large-Cell, Anaplastic etiology, Lymphoma, Large-Cell, Anaplastic surgery, Mammaplasty adverse effects, Reoperation methods
- Abstract
Introduction: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare and recently described type of peripheral T-cell lymphoma. Fewer than 550 cases have been reported worldwide. Although BIA-ALCL is usually indolent, early diagnosis and treatment have been shown to improve outcome., Case Description: This case report describes the management of a 50-year-old healthy Caucasian woman presenting with rapid painful enlargement of the left breast. Imaging revealed findings consistent with BIA-ALCL. This diagnosis was confirmed by fine needle aspiration cytology and subsequent pathological analysis. Bilateral removal of implants, complete left capsulectomy and immediate bilateral implant exchange were performed., Conclusion: No consensus currently exists regarding optimal time of implant exchange and management of the contralateral capsule. The immediate replacement with smooth implants was thoroughly discussed with the patient and endorsed by expert opinion, given complete removal of the disease. There was no sign of recurrence at 6 months. Close clinical and radiological visits are planned for the next years., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
- Published
- 2018
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35. Publication Rates and Author Characteristics From 3 Plastic Surgery Journals in 2006 and 2016.
- Author
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Efanov JI, Shine J, Ghazawi N, Ricard MA, and Borsuk DE
- Subjects
- Cross-Sectional Studies, Humans, Plastic Surgery Procedures, Research Design statistics & numerical data, Specialization statistics & numerical data, Authorship, Bibliometrics, Periodicals as Topic statistics & numerical data, Publishing statistics & numerical data, Surgery, Plastic statistics & numerical data
- Abstract
Background: Areas of surgical care in which, traditionally, plastic surgeons were exclusively involved are now routinely offered by other surgical specialists. Whether this shift in clinical responsibilities influenced publication rates of plastic surgeons remains unknown. The current article investigates the proportion of contributions in plastic surgery journals originating from authors with a plastic surgery background as well as publication rates and author demographics., Methods: A cross-sectional sample study of every publication originating from Annals of Plastic Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Plastic and Reconstructive Surgery was performed for 2006 and 2016. Data about the articles' methodological design and branch of plastic surgery as well as authors' country of origin, educational degree and specialty training were analyzed., Results: From 1721 publications included, head and neck reconstruction was the branch of plastic surgery with the highest number of publications at 18% and most articles (30%) were retrospective cohort studies. From 3381 authors analyzed, a significant proportion originated from United States (34%). More than 85% of authors were physicians as opposed to other health care professionals. The specialty with the highest representation was plastic surgery at 72%, but the proportion decreased in all 3 journals by a mean rate of 3.8% in 2016., Conclusions: A slight decrease in publication rates from plastic surgeons occurred in Annals of Plastic Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery, and Plastic and Reconstructive Surgery from 2006 to 2016. Publications rates and author characteristics in plastic surgery journals provide valuable insight on plastic surgeons' contribution to contemporary scientific literature.
- Published
- 2018
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36. Virtual Surgical Planning: The Pearls and Pitfalls.
- Author
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Efanov JI, Roy AA, Huang KN, and Borsuk DE
- Abstract
Objective: Over the past few years, virtual surgical planning (VSP) has evolved into a useful tool for the craniofacial surgeon. Virtual planning and computer-aided design and manufacturing (CAD/CAM) may assist in orthognathic, cranio-orbital, traumatic, and microsurgery of the craniofacial skeleton. Despite its increasing popularity, little emphasis has been placed on the learning curve., Methods: A retrospective analysis of consecutive virtual surgeries was done from July 2012 to October 2016 at the University of Montreal Teaching Hospitals. Orthognathic surgeries and free vascularized bone flap surgeries were included in the analysis., Results: Fifty-four virtual surgeries were done in the time period analyzed. Forty-six orthognathic surgeries and 8 free bone transfers were done. An analysis of errors was done. Eighty-five percentage of the orthognathic virtual plans were adhered to completely, 4% of the plans were abandoned, and 11% were partially adhered to. Seventy-five percentage of the virtual surgeries for free tissue transfers were adhered to, whereas 25% were partially adhered to. The reasons for abandoning the plans were (1) poor communication between surgeon and engineer, (2) poor appreciation for condyle placement on preoperative scans, (3) soft-tissue impedance to bony movement, (4) rapid tumor progression, (5) poor preoperative assessment of anatomy., Conclusion: Virtual surgical planning is a useful tool for craniofacial surgery but has inherent issues that the surgeon must be aware of. With time and experience, these surgical plans can be used as powerful adjuvants to good clinical judgement.
- Published
- 2018
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37. Avoiding Facial Incisions with Midface Free Tissue Transfer.
- Author
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Stalder MW, Sosin M, Urbinelli LJ, Mayo JL, Dorafshar AH, Hilaire HS, Borsuk DE, and Rodriguez ED
- Abstract
Background: We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions., Methods: Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions., Results: The pathology included palatal defects due to mucoepidermoid carcinoma and ischemic necrosis from cocaine abuse, maxillary defects secondary to fibrous dysplasia and avascular necrosis from traumatic blast injury, and a residual posttraumatic bony deformity of the zygoma. Reconstructions were performed with a free ulnar forearm flap, a free vastus lateralis muscle flap, a deep circumflex iliac artery myoosseous flap, a free fibula flap, and a deep circumflex iliac artery osseous flap, respectively. The facial artery and vein were used as recipient vessels for microvascular anastomosis for all cases. Mean follow-up was 12.2 months. All free tissue transfers were successful, and each patient had a satisfactory aesthetic outcome with no associated facial scars., Conclusion: This technique can be employed during reconstruction of an array of bony or soft-tissue midface deficits with minimal morbidity. This small series effectively demonstrates the varied pathologies and tissue deficiencies that can be successfully reconstructed with free tissue transfer using an entirely intraoral approach to the recipient facial vessels, resulting in no visible scars on the face and an improvement in the overall aesthetic outcome.
- Published
- 2017
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38. Zygomatico-maxillary Reconstruction with Computer-aided Manufacturing of a Free DCIA Osseous Flap and Intraoral Anastomoses.
- Author
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Roy AA, Efanov JI, Mercier-Couture G, Chollet A, and Borsuk DE
- Abstract
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient's unaffected side to allow for perfect fit to the zygomatico-maxillary defect. An intraoral dissection of the facial artery and vein was performed within the right cheek mucosa and allowed for end-to-end microvascular anastomoses. 3D preoperative planning and customized free DCIA osseous flap combined with an intraoral microsurgical technique provided restoration of facial esthetics and function without visible scars. In cases where zygomatico-malar reconstruction by alloplastic material fails, a customized free DCIA osseous flap can be designed by virtual surgical planning to restore facial appearance and function.
- Published
- 2017
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39. Reply: "Composite orbital reconstruction using the vascularized segmentalized Osteo-Fascio-Cutaneous Fibula flap".
- Author
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Borsuk DE
- Subjects
- Humans, Bone Transplantation methods, Fibula transplantation, Maxilla surgery, Orbit surgery, Plastic Surgery Procedures methods, Skin Transplantation methods, Surgical Flaps blood supply
- Published
- 2016
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40. Antibiotics and facial fractures: evidence-based recommendations compared with experience-based practice.
- Author
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Mundinger GS, Borsuk DE, Okhah Z, Christy MR, Bojovic B, Dorafshar AH, and Rodriguez ED
- Abstract
Efficacy of prophylactic antibiotics in craniofacial fracture management is controversial. The purpose of this study was to compare evidence-based literature recommendations regarding antibiotic prophylaxis in facial fracture management with expert-based practice. A systematic review of the literature was performed to identify published studies evaluating pre-, peri-, and postoperative efficacy of antibiotics in facial fracture management by facial third. Study level of evidence was assessed according to the American Society of Plastic Surgery criteria, and graded practice recommendations were made based on these assessments. Expert opinions were garnered during the Advanced Orbital Surgery Symposium in the form of surveys evaluating senior surgeon clinical antibiotic prescribing practices by time point and facial third. A total of 44 studies addressing antibiotic prophylaxis and facial fracture management were identified. Overall, studies were of poor quality, precluding formal quantitative analysis. Studies supported the use of perioperative antibiotics in all facial thirds, and preoperative antibiotics in comminuted mandible fractures. Postoperative antibiotics were not supported in any facial third. Survey respondents (n = 17) cumulatively reported their antibiotic prescribing practices over 286 practice years and 24,012 facial fracture cases. Percentages of prescribers administering pre-, intra-, and postoperative antibiotics, respectively, by facial third were as follows: upper face 47.1, 94.1, 70.6; midface 47.1, 100, 70.6%; and mandible 68.8, 94.1, 64.7%. Preoperative but not postoperative antibiotic use is recommended for comminuted mandible fractures. Frequent use of pre- and postoperative antibiotics in upper and midface fractures is not supported by literature recommendations, but with low-level evidence. Higher level studies may better guide clinical antibiotic prescribing practices.
- Published
- 2015
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41. Revisiting the anatomic relationship of the marginal mandibular nerve and the posterior facial vein: a cadaveric study.
- Author
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Mohan R, Brown EN, Borsuk DE, Christy MR, Bojovic B, Rodriguez ED, and Dorafshar AH
- Subjects
- Face innervation, Facial Nerve surgery, Facial Transplantation, Humans, Mandibular Nerve surgery, Veins anatomy & histology, Face blood supply, Facial Nerve anatomy & histology, Mandibular Nerve anatomy & histology
- Abstract
In preparation for the donor and recipient facial vascularized composite allotransplant (VCA), the marginal mandibular nerve branch should be identified and co-apted to the recipient's nerve to allow for re-innervation. We describe a method to identify the marginal mandibular branch of the facial nerve in facial VCA donors and recipients. Through cadaver dissections, the posterior facial vein was traced posteriorly to identify the marginal mandibular branch of the facial nerve. In cases where we were unable to use this relationship, we found the posterior facial venous system to be diminutive. This technique is useful for finding the marginal mandibular branch when dissecting anterograde to the parotid gland.
- Published
- 2014
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42. Aesthetic and functional facial transplantation: a classification system and treatment algorithm.
- Author
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Mohan R, Borsuk DE, Dorafshar AH, Wang HD, Bojovic B, Christy MR, and Rodriguez ED
- Subjects
- Adult, Esthetics, Female, Humans, Male, Middle Aged, Young Adult, Algorithms, Facial Transplantation classification
- Abstract
Background: As of July of 2013, 27 facial vascularized composite allotransplantations have been performed. The authors developed a classification system and treatment algorithm that is practical and surgically applicable., Methods: The majority of the transplants have been described in the surgical literature and the media, and a review of the data was performed. A classification system and a treatment algorithm were designed. Skeletal defects were defined by craniofacial osteotomies and soft-tissue defects by aesthetic facial subunits. The soft-tissue defect was subdivided into the following subunits: oral-nasal (type 1), oronasal-orbital (type 2), and full facial (type 3). The bony defects were subdivided into mandibular involvement (M), Le Fort 1 (A), Le Fort 3 (B), and monobloc (C)., Results: The mechanisms of injury included trauma (n = 13), burns (n = 8), congenital deformity (n = 3), oncologic resection (n = 1), and unreported (n = 2). According to the proposed classification system: one was type 1; one was type 1-M; one was type 1-MB; two were type 2; two were type 2-B; two were type 2-MB; six were type 3; one was type 3-B; and three were type 3-MB; eight could not be classified due to a lack of data. The treatment algorithm designed a vascularized composite allotransplantation that addressed the bony and soft-tissue components., Conclusions: Patient selection for these complicated procedures, currently dependent on lifelong immunosuppression, is crucial to their success. The authors describe a classification system and treatment algorithm for facial defects that may be ideally suited for facial transplantation. The proposed classification and algorithm may help centers define indications and ideally improve patient outcomes., Clinical Question/level of Evidence: Therapeutic, V.
- Published
- 2014
- Full Text
- View/download PDF
43. Computer-aided design and manufacturing in craniosynostosis surgery.
- Author
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Seruya M, Borsuk DE, Khalifian S, Carson BS, Dalesio NM, and Dorafshar AH
- Subjects
- Child, Child, Preschool, Craniosynostoses diagnostic imaging, Female, Humans, Image Processing, Computer-Assisted methods, Infant, Male, Osteotomy methods, Patient Care Planning, Tomography, X-Ray Computed methods, Computer-Aided Design, Craniosynostoses surgery, Plastic Surgery Procedures methods
- Abstract
Background: Considerable operative time is expended during the planning, shaping, and reconfiguring of the cranial vault in the pursuit of symmetry during open craniosynostosis surgery. Computer-aided design and manufacturing has recently been implemented in orthognathic surgery and complex craniomaxillofacial reconstruction as a means of optimizing operative accuracy and efficiency. In this report, we highlight our growing experience with this promising modality for the preoperative planning and intraoperative execution of cranial vault remodeling in patients with both simple and complex forms of craniosynostosis., Methods: Computer-assisted surgical planning begins with acquisition of high-resolution computed tomography scans of the craniofacial skeleton. An Internet-based teleconference is then held between the craniofacial and biomedical engineering teams and provides a forum for virtual manipulation of the patient's preoperative three-dimensional computed tomography with real-time changes and feedback. Through virtual surgical planning, osteotomies are designed and calvarial bones reconfigured to achieve the desired cranial vault appearance. Cutting and positioning guides are manufactured to transform the virtual plan into a reality., Results: From February to March 2012, 4 children (aged 9 months to 6 years) with craniosynostosis underwent computer-assisted simulation and surgery. Diagnoses included metopic, unicoronal (n = 2), and multisutural synostoses (sagittal and left unicoronal). Open craniofacial repairs were performed as virtually planned, including front o-orbital remodeling, fronto-orbital advancement, and anterior two-thirds calvarial remodeling, respectively. Cutting and final positioning guides demonstrated excellent fidelity and ease of use., Conclusions: Computer-aided design and manufacturing may offer a platform for optimizing operative efficiency, precision, and accuracy in craniosynostosis surgery, while accelerating the learning curve for future trainees.
- Published
- 2013
- Full Text
- View/download PDF
44. Total face, double jaw, and tongue transplantation: an evolutionary concept.
- Author
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Dorafshar AH, Bojovic B, Christy MR, Borsuk DE, Iliff NT, Brown EN, Shaffer CK, Kelley TN, Kukuruga DL, Barth RN, Bartlett ST, and Rodriguez ED
- Subjects
- Adult, Humans, Male, Facial Injuries surgery, Facial Transplantation, Jaw transplantation, Multiple Trauma surgery, Plastic Surgery Procedures methods, Tongue transplantation, Wounds, Gunshot surgery
- Abstract
Background: The central face high-energy avulsive injury has been frequently encountered and predictably managed at the R Adams Cowley Shock Trauma Center. However, despite significant surgical advances and multiple surgical procedures, the ultimate outcome continues to reveal an inanimate, insensate, and suboptimal aesthetic result., Methods: To effectively address this challenging deformity, a comprehensive multidisciplinary approach was devised. The strategy involved the foundation of a basic science laboratory, the cultivation of a supportive institutional clinical environment, the innovative application of technologies, cadaveric simulations, a real-time clinical rehearsal, and an informed and willing recipient who had the characteristic deformity., Results: After institutional review board and organ procurement organization approval, a total face, double jaw, and tongue transplantation was performed on a 37-year-old man with a central face high-energy avulsive ballistic injury., Conclusions: This facial transplant represents the most comprehensive transplant performed to date. Through a systematic approach and clinical adherence to fundamental principles of aesthetic surgery, craniofacial surgery, and microsurgery and the innovative application of technologies, restoration of human appearance and function for individuals with a devastating composite disfigurement is now a reality., Clinical Question/level of Evidence: Therapeutic, V.
- Published
- 2013
- Full Text
- View/download PDF
45. Surface anatomy of the middle division of the facial nerve: Zuker's point.
- Author
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Dorafshar AH, Borsuk DE, Bojovic B, Brown EN, Manktelow RT, Zuker RM, Rodriguez ED, and Redett RJ
- Subjects
- Cadaver, Humans, Facial Nerve anatomy & histology
- Abstract
Background: The anatomy of the facial nerve and its branches has been well documented. The course of the extratemporal facial nerve, its anatomical planes, and the surface landmarks of the temporal division and marginal mandibular division are well known. However, the surface landmark of the middle division of the facial nerve has not been studied to date., Methods: Eighteen hemifacial dissections in 10 fresh human cadavers were performed through a preauricular face-lift incision. An 18-gauge needle with brilliant green dye was used to mark the nerve through the skin before dissection. The exact location of the middle division branches of the facial nerve was documented in relation to the transcutaneous marking., Results: The middle division branches of the facial nerve were found to lie at a mean of 2.3 mm from the tattooed point, with a range of 0 to 6 mm. A nerve branch was found directly tattooed by the needle seven of 18 times, inferior to the tattoo five of 18 times, and superior to the tattoo six of 18 times., Conclusions: The zygomatic/buccal motor branch that innervates the zygomaticus major muscle can be reliably found at the midway point on a line drawn from the root of the helix and the lateral commissure of the mouth. This study will help guide surgeons to the middle division of the facial nerve as it applies to facial surgery.
- Published
- 2013
- Full Text
- View/download PDF
46. Aesthetic microvascular periorbital subunit reconstruction: beyond primary repair.
- Author
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Borsuk DE, Christensen J, Dorafshar AH, Bojovic B, Sauerborn PJ, Christy MR, and Rodriguez ED
- Subjects
- Adult, Aged, Aged, 80 and over, Algorithms, Esthetics, Female, Humans, Male, Microvessels surgery, Middle Aged, Retrospective Studies, Young Adult, Face surgery, Orbit surgery, Plastic Surgery Procedures methods, Surgical Flaps
- Abstract
Background: Reconstructing periorbital defects is challenging because of the simultaneous need for ocular support, corneal protection, and restoration of aesthetic subtleties. In patients with extensive periorbital tissue loss, microvascular free tissue transfer is a reliable reconstructive option for composite defects., Methods: The authors conducted a retrospective review of patients with periorbital craniofacial defects and identified those treated with microvascular reconstruction at the R Adams Cowley Shock Trauma Center and The Johns Hopkins Hospital from 2001 to 2010., Results: Twenty-four patients underwent free flap reconstruction for periorbital defects secondary to trauma (n = 12), oncologic resection (n = 11), and congenital deformity (n = 1). The majority were men (n = 13), and the average age of the patients was 47 years (range, 19 to 80 years). Microvascular reconstructions included fibula (n = 9), anterolateral thigh (n = 6), ulnar forearm (n = 7), and groin flaps (n = 2). Flap survival rate was 100 percent, with an average follow-up of 26.5 months., Conclusions: Microvascular reconstruction of the periorbit can be accomplished successfully through careful analysis of tissue loss, eye or ocular prosthetic support, donor-site morbidity, and patient preference. Despite the multiple flap options that fulfill periorbital reconstructive needs, the authors find that the fibula, anterolateral thigh, ulnar forearm, and groin flaps can be used reliably to successfully reconstruct these defects., Clinical Question/level of Evidence: Therapeutic, IV.
- Published
- 2013
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47. The role of computer-assisted design and modeling in an edentulous mandibular malunion reconstruction.
- Author
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Broyles JM, Wallner C, Borsuk DE, and Dorafshar AH
- Subjects
- Accidental Falls, Aged, Fractures, Malunited diagnostic imaging, Humans, Imaging, Three-Dimensional, Male, Mandibular Fractures diagnostic imaging, Tomography, X-Ray Computed, Computer-Aided Design, Fractures, Malunited surgery, Jaw, Edentulous diagnostic imaging, Jaw, Edentulous surgery, Mandibular Fractures surgery, Mandibular Reconstruction methods
- Abstract
Mandibular trauma is a common problem encountered by the craniofacial surgeon. Fractures in the edentulous mandible represent only 3% of these injuries, and optimal management is controversial. This problem is further compounded by malunion and malocclusion when fracture lines heal in incorrect positions. Even with recent advances in imaging and hardware systems, they remain difficult problems that often require multiple operations to obtain satisfactory results. We present a 69-year-old man with an edentulous mandibular fracture and concomitant malocclusion after a series of unsuccessful operations. By using computer-assisted design and manufacturing technology, we were able to plan osteotomies for correct anatomic positioning, which restored dental occlusion and facial aesthetics. A follow-up at 6 months postoperatively revealed a stable and anatomic reconstruction.
- Published
- 2013
- Full Text
- View/download PDF
48. Total face, double jaw, and tongue transplant simulation: a cadaveric study using computer-assisted techniques.
- Author
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Brown EN, Dorafshar AH, Bojovic B, Christy MR, Borsuk DE, Kelley TN, Shaffer CK, and Rodriguez ED
- Subjects
- Cadaver, Cephalometry methods, Fasciotomy, Humans, Imaging, Three-Dimensional, Osteotomy methods, Plastic Surgery Procedures methods, Sensitivity and Specificity, Skin Transplantation methods, Transplantation, Homologous, Facial Transplantation methods, Orthognathic Surgical Procedures, Surgery, Computer-Assisted methods, Tongue surgery, User-Computer Interface
- Abstract
Background: With the transplantation of more extensive facial vascularized composite allografts, fundamental craniofacial and aesthetic principles become increasingly important. In addition, computer-assisted planning and intraoperative navigation may improve precision and efficiency in these complex procedures., Methods: Ten mock face transplants were performed in 20 cadavers. The vascularized composite allograft consisted of all facial skin, mimetic muscles, the tongue, the midface by means of a Le Fort III osteotomy, and the mandible by means of sagittal split osteotomies. Craniofacial computed tomographic scans were obtained before and after the mock transplants. Surgical planning software was used to virtually plan the osteotomies, and a surgical navigation system guided the osteotomies intraoperatively. Cephalometric analyses were compared between the virtually planned transplants and the actual postoperative results., Results: The combination of preoperative computerized planning and intraoperative guidance consistently produced a vascularized composite allograft that could be easily fixated to the prepared recipient, with only minimal burring of osteotomy sites necessary. Satisfactory occlusion was maintained, and postoperative computed tomography confirmed accurate skeletal fixation. Insignificant differences with regard to cephalometric analyses were noted when predicted and actual postoperative data were compared., Conclusions: The authors' experience treating severe craniofacial injury allowed consistent transfer of facial vascularized composite allografts, maintaining proper occlusion. Preoperative computer planning and intraoperative navigation ensured precise osteotomies and a good donor-recipient skeletal match, which greatly reduced the need for intraoperative adjustments and manipulation. This total facial vascularized composite allograft represents one of the most extensive described and is intended to represent a typical central facial demolition pattern.
- Published
- 2012
- Full Text
- View/download PDF
49. Total face, double jaw, and tongue transplant research procurement: an educational model.
- Author
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Bojovic B, Dorafshar AH, Brown EN, Christy MR, Borsuk DE, Hui-Chou HG, Shaffer CK, Kelley TN, Sauerborn PJ, Kennedy K, Hyder M, Brazio PS, Philosophe B, Barth RN, Scalea TM, Bartlett ST, and Rodriguez ED
- Subjects
- Aged, Anatomic Landmarks, Brain Death, Face blood supply, Facial Expression, Fluorescein Angiography methods, Humans, Models, Educational, Preoperative Care methods, Time Factors, Tissue Donors, Transplantation, Homologous, Face surgery, Facial Transplantation methods, Orthognathic Surgical Procedures, Tissue and Organ Procurement, Tongue surgery
- Abstract
Background: Transplantation of a facial vascularized composite allograft is a highly complex procedure that requires meticulous planning and affords little room for error. Although cadaveric dissections are an essential preparatory exercise, they cannot simulate the true clinical experience of facial vascularized composite allograft recovery., Methods: After obtaining institutional review board approval to perform a facial vascularized composite allograft research procurement, a 66-year-old, brain-dead donor was identified. The family graciously consented to donation of a total face, double jaw, and tongue allograft and multiple solid organs., Results: A craniofacial computed tomographic angiogram was obtained preoperatively to define the vascular anatomy and facilitate virtual computerized surgical planning. The allograft was procured in 10 hours, with an additional 2 hours required for an open tracheostomy and silicone facial impression. The donor was coagulopathic throughout the recovery, resulting in an estimated blood loss of 1500 ml. Fluorescence angiography confirmed adequate perfusion of the entire allograft based on lingual and facial arterial and external jugular and thyrolinguofacial venous pedicles. The solid organ transplant team initiated abdominal organ isolation while the facial allograft procurement was in progress. After completion of allograft recovery, the kidneys and liver were recovered without complication., Conclusions: Before conducting a clinical face transplant, adequate preparation is critical to maximize vascularized composite allotransplantation outcomes and preserve solid organ allograft function. As more centers begin to perform facial transplantation, research procurement of a facial vascularized composite allograft offers a unique educational opportunity for the surgical and anesthesia teams, the organ procurement organization, and the institution.
- Published
- 2012
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50. Subperiosteal release of the floor of the mouth to correct airway obstruction in pierre robin sequence: review of 31 cases.
- Author
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Caouette-Laberge L, Borsuk DE, and Bortoluzzi PA
- Subjects
- Airway Obstruction etiology, Deglutition Disorders etiology, Deglutition Disorders surgery, Female, Humans, Infant, Infant, Newborn, Length of Stay statistics & numerical data, Male, Monitoring, Physiologic, Pierre Robin Syndrome complications, Pierre Robin Syndrome physiopathology, Retrospective Studies, Sleep Apnea Syndromes etiology, Sleep Apnea Syndromes surgery, Tongue physiopathology, Tongue surgery, Treatment Outcome, Airway Obstruction surgery, Mouth Floor surgery, Neck Muscles surgery, Pierre Robin Syndrome surgery
- Abstract
Objective: The purpose of this study was to evaluate subperiosteal release of the floor of the mouth (SRFM) musculature to correct neonatal airway obstruction in children with Pierre Robin sequence and to compare this procedure with other surgical options available., Methods: A retrospective chart review of patients who underwent a SRFM for neonatal severe airway obstruction unresponsive to conservative management was performed. Preoperative and postoperative oxygenation parameters, sleep studies, feeding difficulties, and long-term evolution were documented., Results: Thirty-one consecutive patients between 1995 and 2009, 19 boys and 12 girls, had an SRFM procedure to alleviate severe neonatal airway obstruction. Eight children were syndromic, 15 had associated malformations, and eight had an isolated Pierre Robin sequence. The airway obstruction was corrected with SRFM alone in 26 children (84%), three patients remained dependent on nasopharyngeal airway, and two required subsequent mandibular osteogenic distraction procedures following the SRFM to manage persistent obstruction. No patient required a tracheostomy. The average age at SRFM was 33 days, and the patients were kept intubated for an average of 6 days postoperatively. Average hospital stay after the surgery was 45 days, and 10 patients went home with gavage feeding., Conclusions: The SRFM is effective for the treatment of severe airway obstruction in patients with Pierre Robin sequence. The procedure is simple and has fewer complications and secondary procedures than other surgical options for correction of the airway obstruction.
- Published
- 2012
- Full Text
- View/download PDF
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