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2. Z-Plasty technique using a large C-flap to maximize symmetry of Cupid´s bow and minimize scar in unilateral cleft lip repair

Author

Sanjay Naran, Renata Maricevich, and Lorelei Grunwaldt

Subjects
cleft lip, cupid's bow, z-plasty, Dentistry, RK1-715, Surgery, RD1-811
Abstract

Purpose: Gaining symmetry of Cupid's bow can be challenging in cleft lip repair. We describe a technique that utilizes a modified rotation-advancement type repair to gain maximum length and to minimize scar. Methods: A retrospective chart review of unilateral cleft lip repairs performed by a single surgeon between 2010 and 2014, with at least 6 months of postoperative follow-up, Pre-, intra-, and post-operative photographs were reviewed. Patients included were those who had undergone unilateral cleft lip repair using a Z-plasty type rotation of the C-flap. Postoperative photographs were analyzed for overall symmetry of Cupid's bow and scar appearance using a 5-point visual analog scale (VAS) performed by five independent evaluators. Results: Twenty-three patients were analyzed. On VAS assessment by five independent observers, 22 out of 23 patients (96%) had good, very good, or excellent symmetry of Cupid's bow. All patients (100%) had good, very good, or excellent scar appearance. Twenty-two out of 23 patients (96%) had good, very good, or excellent overall appearance of the repaired lip. Conclusion: Z-Plasty with a very large C-flap as the method for the rotation flap in unilateral cleft lip repair is a useful technique for leveling Cupid's bow and for attaining scars that are nearly imperceptible. Further work will include longer-term follow-up, will look at the severity of the preoperative cleft, and will compare this to postoperative appearance of the lip (symmetry of Cupid's bow and scar).

Published
2018
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4. Transgender Mastectomy

Author

Madeleine K, Bruce, Walter J, Joseph, Lorelei, Grunwaldt, Vu T, Nguyen, and Carolyn, De La Cruz

Subjects
Adult, Male, Incidence, Humans, Breast Neoplasms, Female, Surgery, Middle Aged, Transgender Persons, Mastectomy, Transsexualism
Abstract

Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and postsurgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery.Medical records were reviewed from all FtM patients undergoing gender-affirming chest reconstructive surgery from January 2010 to February 2021 by 3 plastic surgeons at the University of Pittsburgh Medical Center. Relative risk of malignant progression was used to stratify pathologic data. Subsequent management of atypical, in situ, and invasive pathology were recorded.A total of 318 patients were included in this study; the average age at surgery was 24.6 ± 8.1 years. Eighty-six patients (27%) had a family history of breast and/or ovarian cancer. Overall, 21 patients (6.6%) had some increased risk of breast cancer: 17 (5.3%) had proliferative lesions, mean age 38.2 ± 12.4 years; 2 had atypical ductal hyperplasia, ages 33.4 and 38.3 years; and 2 had invasive ductal carcinoma, ages 35.4 and 40.6 years.In this study, we found that 6.6% of FtM transgender patients undergoing top surgery had an elevated risk of breast cancer, with 1.2% of patients having a greater than 2 times risk of breast cancer. These results highlight the importance of appropriate preoperative screening as well as pathological analysis of surgical specimens to help guide clinical care. The authors advocate for a thorough breast cancer risk assessment before surgery for all patients, as well as using pathologic findings to guide postoperative cancer screening and follow-up.

Published
2022

5. Contributors

Author

Ann G. Bailey, Jeffrey R. Balzer, Victor C. Baum, David S. Beebe, Sue R. Beers, Kumar G. Belani, Bruno Bissonette, Brian Blasiole, Adrian T. Bosenberg, Barbara W. Brandom, Claire M. Brett, James G. Cain, Thomas M. Chalifoux, Franklyn P. Cladis, David E. Cohen, Ira T. Cohen, Joseph P. Cravero, Nicholas M. Dalesio, Andrew Davidson, Jessica Davis, Peter J. Davis, Duncan G. de Souza, Nina Deutsch, Laura K. Diaz, James A. DiNardo, Peter F. Ehrlich, Demetrius Ellis, James J. Fehr, Jeffrey M. Feldman, Kathryn Felmet, Jonathan D. Finder, Sean Flack, Randall P. Flick, Michelle A. Fortier, Geoff Frawley, Samir K. Gadepalli, Jeffrey L. Galinkin, Nancy Glass, Salvatore R. Goodwin, George A. Gregory, Lorelei Grunwaldt, Padma Gulur, Nina A. Guzzetta, Dawit T. Haile, Denise M. Hall-Burton, Gregory B. Hammer, Jennifer L. Hamrick, Justin T. Hamrick, Daniel M. Hayward, Eugenie S. Heitmiller, Andrew Herlich, Robert S. Holzman, Vincent C. Hsieh, Elizabeth A. Hunt, James W. Ibinson, Lori T. Justice, Zeev N. Kain, Evan Kharasch, Rahul Koka, Sabine Kost-Byerly, Elliot J. Krane, Barry D. Kussman, Robert Scott Lang, Helen Victoria Lauro, Jennifer K. Lee, Joseph Losee, Igor Luginbuehl, Mohamed Mahmoud, Brian Martin, Keira P. Mason, William J. Mauermann, Lynne G. Maxwell, Francis X. McGowan, Bruce E. Miller, Constance L. Monitto, Philip G. Morgan, Michael L. Moritz, Etsuro K. Motoyama, Michael E. Nemergut, Julie Niezgoda, Shelley Ohliger, Phillip M.T. Pian, David M. Polaner, George D. Politis, Andrew J. Powell, Paul Reynolds, Karene Ricketts, Richard S. Ro, Mark A. Rockoff, Thomas Romanelli, Nancy Bard Samol, Paul J. Samuels, Joseph A. Scattoloni, Jamie McElrath Schwartz, Deborah A. Schwengel, Victor L. Scott, Donald H. Shaffner, Avinash C. Shukla, Allan F. Simpao, Erica L. Sivak, Matthew D. Sjoblom, Kyle Soltys, Sulpicio G. Soriano, Eric T. Stickles, Jennifer M. Thomas, Stevan P. Tofovic, Kha M. Tran, Premal M. Trivedi, Robert D. Valley, Monica S. Vavilala, Lisa Vecchione, Keith M. Vogt, Jeffrey R. Wahl, Kerri M. Wahl, Ari Y. Weintraub, Timothy P. Welch, Robert K. Williams, Eric P. Wittkugel, Susan Woelfel, Myron Yaster, Koichi Yuki, Steven Zgleszewski, Basil J. Zitelli, and Aaron L. Zuckerberg

Published
2017

8. Postoperative hyponatremia following calvarial vault remodeling in craniosynostosis

Author

Franklyn P, Cladis, Michael, Bykowski, Erica, Schmitt, Sanjay, Naran, Michael L, Moritz, James, Cray, Lorelei, Grunwaldt, and Joseph, Losee

Subjects
Male, Blood Volume, Intracranial Pressure, Skull, Sodium, Blood Loss, Surgical, Infant, Comorbidity, Plastic Surgery Procedures, Craniosynostoses, Logistic Models, Postoperative Complications, Blood Substitutes, Risk Factors, Child, Preschool, Monitoring, Intraoperative, Fluid Therapy, Humans, Anesthesia, Deamino Arginine Vasopressin, Female, Child, Hyponatremia, Retrospective Studies
Abstract

The incidence, severity, and risk factors for the development of hyponatremia in patients undergoing craniosynostosis surgery are not well known. To determine the incidence and severity of hyponatremia as a complication in surgical correction of craniosynostosis and to identify risk factors for postoperative hyponatremia. A retrospective medical record review for 2003-2008 of the Cleft and Craniofacial Database was made. Specific data collected included sodium values, age, weight, type of surgery, duration of surgery, administration of DDAVP, composition and volume of pre-operative, intra-operative, postoperative parenteral fluids, volume of blood, colloid, and crystalloid transfused, estimated blood loss (EBL), medications, comorbidities, pre-operative signs of elevated intracranial pressure (ICP), syndromic vs nonsyndromic craniosynostosis, and the complications associated with hyponatremia. A total of 72 records were reviewed. The incidence of postoperative hyponatremia was 30.6%. There was no intra-operative hyponatremia. While hospital stay was not prolonged, ICU stay was significantly longer (1.9 vs 2.9 days, P = 0.001). Elevated ICP was significantly associated with hyponatremia (P0.002). A greater volume of blood loss (EBL) was associated with postoperative hyponatremia (P = 0.019). Patients with normal pre-operative ICP were more likely to become hyponatremic if they were female (relative risk = 2.43; P0.05). The average decrease in sodium was greater in patients receiving hyponatremic (hypotonic) vs normonatremic (isotonic) postoperative IVF's (5.5 vs 3.2 mEq·l(-1), P = 0.039). There were no postoperative complications related to hyponatremia. The incidence of postoperative hyponatremia after calvarial vault remodeling was determined to be 30.6%. Hyponatremia was significantly associated with increased pre-operative ICP, blood loss, and female gender (normal pre-operative ICP). The average decrease in sodium was greater in patients receiving hyponatremic postoperative IVF's.

Published
2011

9. Contributors

Author

Ann G. Bailey, Vipin Bansal, David Barinholtz, Victor C. Baum, David S. Beebe, Kumar G. Belani, Richard Berkowitz, Bruno Bissonnette, Adrian Bosenberg, Barbara W. Brandom, Claire Brett, Robert B. Bryskin, Patrick Callahan, Franklyn P. Cladis, David E. Cohen, Ira Todd Cohen, Andrew Davidson, Jessica Davis, Peter J. Davis, Duncan de Souza, Nina Deutsch, James A. DiNardo, Peter Ehrlich, Demetrius Ellis, Jeffrey M. Feldman, Kathryn Felmet, John E. Fiadjoe, Jonathan D. Finder, Randall P. Flick, Michelle Fortier, Salvatore R. Goodwin, George A. Gregory, Lorelei Grunwaldt, Dawit T. Haile, Steven Hall, Gregory Hammer, Michael W. Hauser, Eugenie S. Heitmiller, Andrew Herlich, Robert S. Holzman, Elizabeth A. Hunt, Nathalia Jimenez, Lori T. Justice, Zeev N. Kain, Evan Kharasch, Sabine Kost-Byerly, Elliot J. Krane, Barry D. Kussman, Ira S. Landsman, Ronald S. Litman, Joseph Losee, Igor Luginbuehl, Anne M. Lynn, Thomas J. Mancuso, Brian P. Martin, Keira Mason, William J. Mauermann, Lynne G. Maxwell, George M. McDaniel, Francis X. McGowan, Constance L. Monitto, Philip G. Morgan, Etsuro K. Motoyama, Julie Niezgoda, David M. Polaner, Paul Reynolds, Mark A. Rockoff, Thomas Romanelli, Allison Kinder Ross, Joseph A. Scattoloni, Jamie McElrath Schwartz, Robert J. Sclabassi, Victor L. Scott, Donald H. Shaffner, Avinash C. Shukla, Robert M. Smith, Kyle Soltys, Sulpicio G. Soriano, Brian P. Struyk, Kevin J. Sullivan, Jennifer Thomas, Stevan P. Tofovic, Kha Tran, Donald C. Tyler, Robert D. Valley, Monica S. Vavilala, Lisa Vecchione, Kerri M. Wahl, Jay A. Werkhaven, Susan Woelfel, Myron Yaster, Aaron L. Zuckerberg, Cuneyt M. Alper, Lawrence M. Borland, James G. Cain, William A. Devine, Joseph E. Dohar, Christopher M. Grande, Timothy D. Kane, Lizabeth M. Lanford, George V. Mazariegos, Douglas A. Potoka, Kenneth P. Rothfield, and Robert F. Yellon

Published
2011

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