52 results on '"Michael S Golinko"'
Search Results
2. 70. Environmental Sustainability of Internal Fixation Hardware
- Author
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Christopher L. Kalmar, MD, MBA, Michael S. Golinko, MD, Salam Kassis, MD, Wesley P. Thayer, MD, PhD, Brian C. Drolet, MD, and Galen Perdikis, MD
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Surgery ,RD1-811 - Published
- 2023
- Full Text
- View/download PDF
3. Self-development Tools Utilized by Plastic Surgeons: A Survey of ASPS Members
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Santiago R. Gonzalez, MD, MPH, Brian J. Blumenauer, MD, James C. Yuen, MD, and Michael S. Golinko, MD, MS
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Surgery ,RD1-811 - Abstract
Background:. The plastic surgery literature is devoid of research on the topic of professional development tools that may be used to enhance performance as a plastic surgeon. After an extensive review of the medical literature, we selected the most frequently referenced professional development tools utilized by plastic surgeons, which included the following: goal setting, positive visualization, scheduled practice, critically analyzing mistakes, professional development conferences, involvement in sports, motivational videos, podcasts & audiobooks, daily morning routines, self-development books, and advice from mentors. Methods:. A 10-question survey was sent to 2542 members of the American Society of Plastic Surgeons (ASPS). The algorithm used to select ASPS members to survey was based on member demographics that would best reflect the views of the entire active society membership. Responses were compared based on demographic factors such as type of practice, gender, and age. Results:. A total of 286/2542 (11.25%) ASPS members participated in the survey. Analyzing mistakes (96.3%), goal setting (88.51%), and advice from mentors (85.2%) were most commonly attributed to self-development. Respondents in an academic practice favored conferences and advice from mentors. Participants in a solo practice favored self-help books and morning routines. No statistical differences were observed based on training background. Conclusions:. ASPS members attribute their professional development to setting measurable goals, carefully analyzing surgical mistakes, and guidance from mentors. This information opens the door for continued analysis of professional development within plastic surgery as well as supplement training practices at the resident and post-graduate level.
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- 2021
- Full Text
- View/download PDF
4. Resorbable Versus Titanium Rigid Fixation for Pediatric Mandibular Fractures: A Systematic Review, Institutional Experience and Comparative Analysis
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Stephane A. Braun, Nolan Jaeger, Eva B. Niklinska, Kevin J. Kelly, Michael S. Golinko, and Matthew E. Pontell
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Orthodontics ,Unerupted Teeth ,business.industry ,Mandible ,Maxillomandibular fixation ,030206 dentistry ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Otorhinolaryngology ,Medicine ,Surgery ,Oral Surgery ,030223 otorhinolaryngology ,business ,Mixed dentition - Abstract
Study Design: Pediatric mandible fractures mandate special consideration because of unerupted teeth, mixed dentition, facial growth and the inability to tolerate maxillomandibular fixation. No consensus exists as to whether resorbable or titanium plating systems are superior with regards to clinical outcomes. Objective: This study aims to systematically review and compare the outcomes of both material types in the treatment of pediatric mandible fractures. Methods: After PROSPERO registration, studies from 1990-2020 publishing on outcomes of ORIF of pediatric mandible fractures were systematically reviewed according to PRISMA guidelines. An additional retrospective review was conducted at a pediatric level 1 trauma center. Results: 1,144 patients met inclusion criteria (30.5% resorbable vs. 69.5% titanium). Total complication rate was 13%, and 10% required a second, unplanned operation. Complication rates in the titanium and resorbable groups were not significantly different (14% vs. 10%; P = 0.07), and titanium hardware was more frequently removed on an elective basis (P < 0.001). Condylar/sub-condylar fractures were more often treated with resorbable hardware (P = 0.01); whereas angle fractures were more often treated with titanium hardware (P < 0.001). Within both cohorts, fracture type did not increase the risk of complications, and comparison between groups by anatomic level did not demonstrate any significant difference in complications. Conclusions: Pediatric mandible fractures requiring ORIF are rare, and hardware-specific outcomes data is scarce. This study suggests that titanium and resorbable plating systems are equally safe, but titanium hardware often requires surgical removal. Surgical approach should be tailored by fracture anatomy, age-related concerns and surgeon preference.
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- 2023
5. Nationwide Analysis of Complex Midface Advancement in Pediatric Patients
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Christopher L. Kalmar, Nicholas R. O’Sick, Matthew E. Pontell, and Michael S. Golinko
- Abstract
Background: The purpose of this study was to utilize a multicenter database to better understand preexisting comorbidities, postoperative complications, and hospital financial charges for pediatric patients undergoing complex midface advancement procedures. Methods: Retrospective cohort study was conducted of patients undergoing midface advancement, including Le Fort II (LF2), Le Fort III (LF3), and Monobloc procedures in the United States between 2010 and 2020 using the Pediatric Health Information System. Preexisting comorbidities, postoperative complications, and hospital admission charges among these cohorts were analyzed. Results: During the study interval, 91 patients underwent complex midface reconstruction. Median age was 12.7 years. Postoperative complication rate was 44.0%, and LF2 procedures had fewer surgical complications than LF3 ( P Conclusions: While midface advancement procedures are conceptually grouped together, LF2 has significantly lower surgical complications, blood transfusions, hospital lengths of stay, hospital admission charges, ICU lengths of stay, and ICU charges than LF3 or Monobloc procedures.
- Published
- 2022
6. Interfacility Transfers for Isolated Craniomaxillofacial Trauma: Perspectives of the Facial Trauma Surgeon
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Matthew E. Pontell, MD, Jordan P. Steinberg, MD, PhD, FACS, FAAP, Donald R. Mackay, MD, Michael S. Golinko, MD, FACS, FAAP, and Brian C. Drolet, MD, FACS
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Surgery ,RD1-811 - Published
- 2020
- Full Text
- View/download PDF
7. Frontal sinus hypoplasia in unoperated older patients with craniosynostosis: a pilot study
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Sonia K. Pandey, Christopher L. Kalmar, Christopher M. Bonfield, and Michael S. Golinko
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Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,General Medicine - Published
- 2023
8. National Trends in Orthognathic Surgery: A Multi-Institutional Analysis of 6640 Patients
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Christopher L. Kalmar, Sara Chaker, Matthew E. Pontell, Nicholas R. O’Sick, and Michael S. Golinko
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Otorhinolaryngology ,Surgery ,General Medicine - Published
- 2023
9. Resorbable Versus Titanium Hardware for Rigid Fixation of Pediatric Upper and Midfacial Fractures: Which Carries a Lower Risk Profile?
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Kevin J. Kelly, Eva B. Niklinska, Matthew E. Pontell, Michael S. Golinko, Nolan Jaeger, and Stephane A. Braun
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medicine.medical_treatment ,Lower risk ,Fracture Fixation, Internal ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Humans ,Medicine ,Internal fixation ,Child ,Reduction (orthopedic surgery) ,Retrospective Studies ,Fixation (histology) ,Titanium ,Skull Fractures ,business.industry ,030206 dentistry ,Open Fracture Reduction ,Exact test ,Treatment Outcome ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Maxillary Fractures ,Surgery ,Oral Surgery ,business ,Complication ,Computer hardware - Abstract
Titanium associated risks have led to interest in resorbable hardware for open reduction and internal fixation (ORIF) of pediatric facial fractures. This study aims to systematically review and compare the outcomes of titanium/resorbable hardware used for ORIF of upper/midfacial fractures to determine which hardware carries a higher complication rate in the pediatric patient.Studies published between 1990 and 2020 on the ORIF of pediatric upper/midfacial fractures were systematically reviewed. A retrospective institutional review was also conducted, and both arms were compiled for final analysis. The primary predictor value was the type of hardware used and the primary outcome was the presence of a complication. Fisher's exact test and 2-proportion 2-tailed z-test calculations were used to determine statistical significance, which was defined as a P value.05. The low quality of published evidence precluded meta-analysis.Systematic review of 23 studies identified 659 patients, and 77 patients were identified in the institutional review. A total of 736 patients (299 resorbable, 437 titanium) were included in the final analysis. Total complication rate was 22.8%. The titanium group had a higher complication rate (27 vs 16.7%; P.01), and more often underwent elective hardware removal (87.3 vs 0%, P.01). In each hardware subgroup, the incidence of complications was analyzed by fracture site. In the titanium group, complication incidence was higher when treating maxillary fractures (32.8 vs 22.9%, P = .03). When comparing the 2 hardware groups by fracture site, maxillary fractures had a higher rate of complications when treated by titanium hardware compared with resorbable hardware (32.8 vs 18%, P.01).Upper/midfacial pediatric fractures requiring ORIF, especially maxillary fractures, may be best treated with resorbable hardware. Additional hardware-specific outcomes data is encouraged.
- Published
- 2021
10. Pediatric Craniomaxillofacial Trauma
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Matthew E. Pontell, Nicholas R. O’Sick, Christopher L. Kalmar, and Michael S. Golinko
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Pediatrics, Perinatology and Child Health ,Humans ,Craniocerebral Trauma ,Child - Published
- 2022
11. Radiographic Optic Nerve Findings and Their Clinical Implications in the Setting of Craniomaxillofacial Trauma
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Matthew E. Pontell, Alexandra L. Alving-Trinh, Nolan Jaeger, Michael S. Golinko, Kevin J. Kelly, and Stephane A. Braun
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Facial trauma ,medicine.medical_specialty ,genetic structures ,medicine.diagnostic_test ,business.industry ,Radiography ,Traumatic optic neuropathy ,Computed tomography ,medicine.disease ,eye diseases ,medicine.anatomical_structure ,medicine ,Optic nerve ,Radiology ,business ,Orbit (anatomy) - Abstract
Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.
- Published
- 2021
12. Interfacility Transfer Guidelines for Isolated Facial Trauma: A Multidisciplinary Expert Consensus
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Matthew E. Pontell, Jordan P. Steinberg, Donald R. Mackay, Eduardo D. Rodriguez, E. Bradley Strong, Alexis B. Olsson, J. David Kriet, Kevin J. Kelly, Mark W. Ochs, Peter J. Taub, Shaun C. Desai, Stephen MacLeod, Srinivas Susarla, Travis T. Tollefson, Warren Schubert, Brian C. Drolet, and Michael S. Golinko
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Emergency Medical Services ,Consensus ,Delphi Technique ,Trauma Centers ,Humans ,Surgery ,Facial Injuries - Abstract
The objective of this study was to develop guidelines for the transfer of patients with isolated craniomaxillofacial trauma.A national, multidisciplinary expert panel was assembled from leadership in national organizations and contributors to published literature on facial reconstruction. The final panel consisted of five plastic surgeons, four otolaryngologist-head and neck surgeons, and four oral and maxillofacial surgeons. The expert panelists' opinions on transfer guidelines were collected using the modified Delphi process. Consensus was predefined as 90 percent or greater agreement per statement.After four Delphi consensus building rounds, 13 transfer guidelines were established, including statements on fractures of the frontal sinus, orbit, midface, and mandible, as well as soft-tissue injuries. Twelve guidelines reached consensus.The decision to transfer a patient with craniomaxillofacial trauma to another facility is complex and multifactorial. While a percentage of overtriage is acceptable to promote safe disposition of trauma patients, unnecessarily high rates of secondary overtriage divert emergency medical services, increase costs, delay care, overload tertiary trauma centers, and result in tertiary hospital staff providing primary emergency coverage for referring hospitals. These craniomaxillofacial transfer guidelines were designed to serve as a tool to improve and streamline the care of facial trauma patients. Such efforts may decrease the additional health care expenditures associated with secondary overtriage while decompressing emergency medical systems and tertiary emergency departments.
- Published
- 2022
13. Pediatric Orbital Floor Reconstruction with Split Corticocancellous Rib Graft
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Eva B. Niklinska, Kevin J. Kelly, Michael S. Golinko, Matthew E. Pontell, and Nolan Jaeger
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03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,genetic structures ,Orbital reconstruction ,business.industry ,030220 oncology & carcinogenesis ,Medicine ,030223 otorhinolaryngology ,business ,eye diseases ,Surgery - Abstract
Background: Orbital floor fractures constitute roughly 20% of all pediatric facial fractures. Reconstructive techniques are broadly subdivided into alloplastic and autologous. While pediatric literature exists for alloplastic orbital reconstruction, autologous orbital reconstruction studies are limited. Here we present several cases of posttraumatic pediatric orbital reconstruction utilizing autologous split rib graft. Methods: After IRB approval, a retrospective chart review was conducted at Monroe Carell Jr. Children’s Hospital at Vanderbilt from 2003 to 2019. A review of relevant published literature was also performed. Results: From 2003 to 2019, 5 pediatric patients underwent orbital reconstruction with split rib graft. Of the 5 patients, 3 were female and 2 were male with an age range of 4 to 8 years old (mean 4.8). Two patients had isolated orbital blow-out fractures while 3 presented with concurrent midfacial fractures. In each patient, the orbit was reconstructed by contoured split rib corticocancellous graft. Average length of stay was 5.2 days. There were no postoperative pneumothoraces. Mean follow-up length was 18.7 months, with no rib donor site complications. Each patient had adequate orbital volume restoration with no postoperative globe malposition or persistent diplopia. Conclusion: Pediatric orbital fractures are complex and challenging injuries. While alloplastic reconstruction is common and reliable, the risks of foreign body implantation and fixation must be carefully considered in patients who have not yet reached skeletal maturity. This is especially pertinent in younger patients as orbital growth continues until approximately 9 years of age. Rib graft use for adult orbital reconstruction has been explored. Data in the pediatric literature has not been identified. Corticocancellous rib graft harvest mandates a second surgical site; however, it is relatively inconspicuous with low postoperative morbidity. Corticocancellous rib grafting is a safe and durable option for orbital reconstruction and should be considered for use in the pediatric patient with a growing facial skeleton.
- Published
- 2021
14. Management of an open nasofrontal encephalocele during the first day of life
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Michael S. Golinko, Eva B. Niklinska, Christopher M. Bonfield, and Matthew E. Pontell
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Surgical repair ,medicine.medical_specialty ,business.industry ,Day of life ,Treatment options ,030206 dentistry ,General Medicine ,medicine.disease ,Surgery ,Encephalocele ,03 medical and health sciences ,0302 clinical medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Nasofrontal encephalocele ,Neurology (clinical) ,Neurosurgery ,Craniofacial ,business ,Meningitis - Abstract
Nasofrontal encephaloceles are extremely rare craniofacial defects that present with herniation of cerebral tissue through the junction of the frontal and nasal bones. They often have a cutaneous covering which allows management to be delayed until early infancy, decreasing the risks of anesthesia and acute blood loss. Further bone development also facilitates cranial remodeling. Encephaloceles with a compromised cutaneous envelope pose an imminent threat to life due to the risk of meningitis, necessitating surgical repair in the first days of life. This report presents a patient born with an open nasofrontal encephalocele that underwent encephalocele excision, dural repair, and cranial remodeling on the first day of life. Anterior encephaloceles represent a spectrum of uncommon craniofacial dysraphias. Given the rarity of these diseases, it is important to understand their many presentations and the treatment options that exist for each. When the cutaneous covering of the encephalocele is compromised, surgical correction must be undertaken urgently to mitigate the mortality associated with neonatal meningitis. This represents the first report of an open nasofrontal encephalocele managed in the first day of life. A multidisciplinary surgical approach involving the neurosurgical and craniofacial surgical teams is paramount to the treatment and survival of such complicated patients.
- Published
- 2021
15. Management of an open nasofrontal encephalocele during the first day of life
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Matthew E, Pontell, Eva, Niklinska, Christopher M, Bonfield, and Michael S, Golinko
- Subjects
Skull ,Infant, Newborn ,Humans ,Anesthesia ,Encephalocele - Abstract
Nasofrontal encephaloceles are extremely rare craniofacial defects that present with herniation of cerebral tissue through the junction of the frontal and nasal bones. They often have a cutaneous covering which allows management to be delayed until early infancy, decreasing the risks of anesthesia and acute blood loss. Further bone development also facilitates cranial remodeling. Encephaloceles with a compromised cutaneous envelope pose an imminent threat to life due to the risk of meningitis, necessitating surgical repair in the first days of life. This report presents a patient born with an open nasofrontal encephalocele that underwent encephalocele excision, dural repair, and cranial remodeling on the first day of life. Anterior encephaloceles represent a spectrum of uncommon craniofacial dysraphias. Given the rarity of these diseases, it is important to understand their many presentations and the treatment options that exist for each. When the cutaneous covering of the encephalocele is compromised, surgical correction must be undertaken urgently to mitigate the mortality associated with neonatal meningitis. This represents the first report of an open nasofrontal encephalocele managed in the first day of life. A multidisciplinary surgical approach involving the neurosurgical and craniofacial surgical teams is paramount to the treatment and survival of such complicated patients.
- Published
- 2021
16. NAM Therapy-Evidence-Based Results
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Fawzi AlQatami, Lucia Pannuto, Yuki Sato, Belma Işık Aslan, Michael S Golinko, Serena N. Kassam, Athina Chatzigianni, M. Okan Akcam, Ayşe Gülşen, Beatrice Campo, Pedro E. Santiago, Mariana Sabás, Judah S. Garfinkle, Travis L. Gibson, Anastasios A Zafeiriadis, Kamile Keskin, Michael Alperovich, Nancy Edith Rojas, Daisy Masis, Kristen M. Lowe, Emine Kaygisiz, Atılım Akkurt, Fatma Deniz Uzuner, Sagit Nissan, Lizbeth Holguin, Catherine Lee, Seher Gündüz Arslan, Maria Ana Muñoz-Mendoza, Ignacio Nacho Yarza, Christopher M. Runyan, Aracely Granados, Paolo Morselli, Elçin Esenlik, Ana Tejero Martinez, Esra Yüksel Coşkun, Neslihan Üçüncü, Alvaro A. Figueroa, Banafsheh Hosseinian, Esenlik, Elçin, Gibson, Travi, Kassam, Serena, Sato, Yuki, Garfinkle, Judah, Figueroa, Alvaro A, AlQatami, Fawzi, Runyan, Christopher, Alperovich, Michael, Golinko, Michael S, Lee, Catherine, Chatzigianni, Athina, Zafeiriadis, Anastasios A, Santiago, Pedro, Hosseinian, Banafsheh, Kaygısız, Emine Uluğ, Üçüncü, Neslihan, Arslan, Belma Işık, Uzuner, Fatma Deniz, Gülşen, Ayşe, Akkurt, Atılım, Arslan, Seher Gündüz, Sabás, Mariana, Muñoz-Mendoza, Maria Ana, Masis, Daisy, Holguin, Lizbeth, Granados, Aracely, Rojas, Nancy Edith, Campo, Beatrice, Keskin, Kamile, Akçam, M Okan, Lowe, Kristen M, Morselli, Paolo G, Pannuto, Lucia, Yarza, Ignacio Nacho, Martinez, Ana Tejero, Coşkun, Esra Yüksel, and Nissan, Sagit
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medicine.medical_specialty ,Evidence-based practice ,infant orthopedic ,medicine.medical_treatment ,Cleft Lip ,midfacial growth ,Nose ,Burden of care ,03 medical and health sciences ,Primary repair ,0302 clinical medicine ,Intervention (counseling) ,medicine ,Deformity ,Maxilla ,Humans ,Orthopedic Procedures ,030223 otorhinolaryngology ,Intensive care medicine ,Maxillary growth ,Reduction (orthopedic surgery) ,business.industry ,Infant orthopedics ,Infant ,030206 dentistry ,Plastic Surgery Procedures ,Cleft Palate ,Otorhinolaryngology ,facial growth ,Oral Surgery ,medicine.symptom ,business ,nonsyndromic clefting - Abstract
Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.
- Published
- 2020
17. The Arkansas Tessier Number 3 Cleft Experience: Soft Tissue and Skeletal Findings With Primary Surgical Management: Four-Step Approach
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Adam B. Johnson, James Phillips, John D. Pemberton, Larry D. Hartzell, and Michael S. Golinko
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medicine.medical_specialty ,Lagophthalmos ,Cleft Lip ,030230 surgery ,Facial Bones ,Surgical Flaps ,Encephalocele ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Abnormalities, Multiple ,Oculoplastics ,Craniofacial ,business.industry ,Facial cleft ,Infant, Newborn ,Infant ,General Medicine ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,Cleft Palate ,Plastic surgery ,Otorhinolaryngology ,Bilateral cleft lip ,Face ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Tessier No 3 facial cleft (oro-nasal-ocular clefts) is the rarest and most challenging of all the Tessier clefts. Reports on Tessier No 3 clinical findings, surgical techniques, and outcomes are varied due to the scarcity of patients and the wide range of phenotypic findings. The authors present our experience of 2 children born with Tessier No 3 clefts who were both managed at the Arkansas Children's Hospital. Our purpose is to add knowledge on this rare craniofacial cleft by providing detailed soft tissue findings, skeletal findings, operative techniques, early postoperative outcome, and suggestions of a treatment protocol.Both were born at 38 weeks gestation and had multiple associated anomalies including: syndactyly, limb anomalies, cardiac defects, and encephalocele in Patient 1 and hydrocephalus and dysphagia in Patient 2. While both patients had a bilateral cleft lip and palate, Patient 1 had a severe left-sided cleft and Patient 2 had a right-sided incomplete cleft. A multidisciplinary team of specialists in Plastic Surgery, Otolaryngology, and Oculoplastics were assembled to devise a top-down approach for repair. In brief, our surgical sequence for both infants was a dorsal nasal Reiger flap to level the ala, cheek advancement flap along with medial canthal repositioning, and more traditional bilateral cleft lip repair using a modified Millard technique. Postoperatively, Patient 1 experienced some early scarring, medial canthal rounding, lagophthalmos, and cicatricial retraction of the lower lid and patient 2 demonstrated under-correction of the displaced ala but had satisfactory medial canthal position.Future evaluations will include serial photography and annual 3-dimensional computed tomography scans to evaluate the soft tissue and bony growth. After these initial procedures, both infants will be followed for routine cleft clinical and surgical care.
- Published
- 2018
18. Characteristics of Dog Bites in Arkansas
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Michael S. Golinko, Jacob Carlson, Aaron Smith, Ashley B Bartels, and Cody B McLeod
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Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,Odds Ratio ,medicine ,Animals ,Humans ,Bites and Stings ,030212 general & internal medicine ,Child ,Retrospective Studies ,Retrospective review ,Arkansas ,business.industry ,Infant ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Odds ratio ,Emergency department ,Hospitals, Pediatric ,medicine.disease ,Dog bite ,Breed ,Confidence interval ,Increased risk ,Child, Preschool ,Female ,Emergency Service, Hospital ,business - Abstract
OBJECTIVE Dog bite injuries are encountered frequently in emergency departments and can cause significant morbidity. The objective of this study was to explore the associations between the multiple variables at play during these occurrences (eg, the patient's age, the bite location, the bite severity, the dog's relationship with the patient, the breed of dog). METHODS This two-institution study collected and analyzed dog bite data from Arkansas' only Level I trauma centers. The charts of 740 patients were included in our retrospective chart review. The chart review extracted data, including each individual patient's age, sex, dog bite location, and dog bite severity, as well as the patient's relationship to the dog and the dog's breed. To determine the relation between and among variables, contingency tables were created and analyzed to determine odds ratios (ORs) and confidence intervals (CIs). In addition, standard t tests were used in statistical comparisons of means and proportions. RESULTS Of the 740 patient charts reviewed, 574 were for patients who presented to Arkansas Children's Hospital and 166 were for patients who presented to the University of Arkansas for Medical Sciences. Of the patients across both institutions, 267 (37.1%) required some form of repair, with 225 (30.4%) receiving closure within the emergency department and 42 (6.7%) requiring an operative intervention. Among children, those younger than age 5 years were >8 times as likely to require an operative repair (OR 8.1, 95% CI 2.77-23.58, P 4 times as likely to be bitten on the head and neck (OR 4.30, 95% CI 3.00-6.16, P 3 times as likely to be bitten on an extremity (OR 3.43, 95% CI 2.08-5.65, P < 0.0001). CONCLUSIONS The results of this retrospective review are aligned mostly with the general trends found in previous national and global studies, supporting the notion that family dogs represent a more significant threat than often is realized and that, among the breeds identified, pit bulls are proportionally linked with more severe bite injuries. Our data further validate previous studies that note an increased risk of bites and bite severity in children younger than 5 years. In addition, our data show that bites to the head and neck occurred more frequently among children younger than 5 years than among older children, and that boys younger than 5 years were bitten more frequently than girls.
- Published
- 2018
19. Less common underlying genetic diagnoses found in a cohort of 139 individuals surgically corrected for craniosynostosis
- Author
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Eylem Ocal, Katherine A. Bosanko, Benjamin R. Ittleman, Jasmine Mckissick, Michael S. Golinko, and Yuri A. Zarate
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Male ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,030105 genetics & heredity ,Craniosynostoses ,Craniosynostosis ,03 medical and health sciences ,Text mining ,Genetics ,medicine ,Humans ,Receptor, Fibroblast Growth Factor, Type 3 ,Receptor, Fibroblast Growth Factor, Type 1 ,Receptor, Fibroblast Growth Factor, Type 2 ,Medical diagnosis ,Genetics (clinical) ,Craniotomy ,medicine.diagnostic_test ,business.industry ,Twist-Related Protein 1 ,Infant ,Nuclear Proteins ,Endoscopy ,medicine.disease ,Child, Preschool ,Cohort ,Female ,business - Published
- 2017
20. Surgical management of craniosynostosis in the setting of a ventricular shunt: a case series and treatment algorithm
- Author
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Eylem Ocal, Michael S. Golinko, and Danielle N. Atwood
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Male ,medicine.medical_specialty ,Dolichocephaly ,Adolescent ,Ventriculoperitoneal Shunt ,Craniosynostosis ,Craniosynostoses ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid diversion ,medicine ,Humans ,Child ,Papilledema ,Retrospective Studies ,Intracranial pressure ,business.industry ,Infant, Newborn ,Disease Management ,Infant ,General Medicine ,medicine.disease ,Surgery ,Hydrocephalus ,Shunt (medical) ,Treatment Outcome ,Intraventricular hemorrhage ,Child, Preschool ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Algorithm ,Algorithms ,030217 neurology & neurosurgery - Abstract
Cerebrospinal fluid diversion via ventricular shunt is a common treatment for hydrocephalus. Change in cranial morphology associated with a sutural fusion has been termed shunt-related or induced craniosynostosis (SRC) or craniocerebral disproportion (CCD). We present a series of patients with SRC who underwent cranial vault remodeling (CVR) and our treatment algorithm. Thirteen patients were retrospectively reviewed who had SRC and CVR; 92% of patients had a ventriculoperitoneal (VP) shunt placed for largely intraventricular hemorrhage of prematurity (69% of patients) at a mean age of 2.2 months. The shunt revision rate was 38.4%, and 54% of patients had a programmable shunt placed initially. The mean age at time of CVR was 3.6 years old. The most commonly affected sutures (CT confirmed) were the sagittal and coronal sutures, with three patients exhibiting pancraniosynostosis. The mean time from placement of the shunt to CT evidence of sutural fusion was 2.0 years. Abnormal head shape was noted in all 13 patients; 11 of these also had either chronic headaches, papilledema, seizures, or behavioral changes in the setting of functional shunt. Mean follow-up after the initial CVR was 3.3 years. No shunt infections were attributed to the CVR. The families of all patients were contacted and reported improvement in head shape with 60% of families reporting improvement in behavior, 75% reported improvement in headaches, and 40% reported decrease in seizure frequency or intensity. Shunt setting or type was not routinely changed after CVR. Our threshold for CVR in SRC is met when shunt malfunction has been ruled out and there are (1) radiographic evidence of craniosynostosis, (2) signs of increased ICP clinically or radiographically, and (3) cranial dysmorphism, i.e., dolichocephaly. The majority of cases of SRC result in improved cranial morphology in addition to some abatement of the symptoms of increased intracranial pressure. Early involvement of an experienced craniofacial/neurosurgical team could allow for early diagnosis and intervention which may prevent progression to more severe deformities. SRC is a complex entity, with multiple etiologies, and a future study is needed.
- Published
- 2017
21. Surgical Approach in a Patient With Agnathia-Otocephaly Complex: Three-Stage Mandibular Distraction Protocol
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Santiago R, Gonzalez, John K, Jones, and Michael S, Golinko
- Subjects
Craniofacial Abnormalities ,Adolescent ,Jaw Abnormalities ,Osteogenesis, Distraction ,Quality of Life ,Humans ,Female ,Mandible - Abstract
Agnathia-otocephaly complex (AOC) is a rare malformation complex of the first pharyngeal arch that is characterized by agnathia/dysgnathia, microstomia, aglossia/hypoglossia and variable displacement of the ears. Only 11 post-infancy patients with severe AOC have been described in the literature, and the incidence of this malformation complex is estimated to be 1 per 70,000 births. In this brief clinical study, the authors describe the case of an 18-year-old female diagnosed with AOC who underwent a 3-step mandibular distraction protocol with an external distraction device. The surgical protocol the authors used was unique in that we first placed a tissue expander in the submental area to enlarge the skin envelope in an effort to mitigate skeletal relapse from soft tissue forces. Furthermore, the way in which the authors slowed the activation of the distraction device to allow for soft tissue healing behind the pins was a novel component of the patient's treatment. The 3-step mandibular distraction protocol the authors present in this study increased the length of the mandible by 20 mm, and nearly doubled the size of the patient's mandible from an initial volume of 3.62 cm to a post-operative volume of 6.89 cm. Future surgeries will aim to improve the function of our patient's expanded mandible. Most important of all, the surgical treatment authors are presenting led to a significant improvement in our patient's physical appearance and 3d quality of life.
- Published
- 2019
22. Characteristics of 1616 Consecutive Dog Bite Injuries at a Single Institution
- Author
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Brian Arslanian, Michael S. Golinko, and Joseph K. Williams
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Georgia ,Adolescent ,Poison control ,Suicide prevention ,Occupational safety and health ,Young Adult ,03 medical and health sciences ,Dogs ,0302 clinical medicine ,Trauma Centers ,030225 pediatrics ,Injury prevention ,medicine ,Animals ,Humans ,Bites and Stings ,030212 general & internal medicine ,Single institution ,Child ,Retrospective Studies ,business.industry ,Infant, Newborn ,Infant ,Emergency department ,medicine.disease ,Dog bite ,Surgery ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Pediatric trauma - Abstract
Dog bite injuries remain a common form of pediatric trauma. This single-institution study of 1616 consecutive dog bite injuries over 4 years revealed a much higher prevalence of dog bites as compared with other similar centers. Though inpatient admission was rare (9.8%), 58% of all patients required laceration repair, primarily in the emergency department. Infants were more than 4 times as likely to be bitten by the family dog and more than 6 times as likely to be bitten in the head/neck region. Children ≤5 years old were 62% more likely to require repair; and 5.5% of all patients required an operation. Pit bull bites were implicated in half of all surgeries performed and over 2.5 times as likely to bite in multiple anatomic locations as compared to other breeds. The relatively high regional prevalence and younger age of injured patients as compared with other centers is a topic of further study but should draw attention to interventions that can minimize child risk.
- Published
- 2016
23. The deepithelialized skin flap for closure of large myelomeningoceles: a common plastic surgery technique for a novel neurosurgery application
- Author
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Rong Cai, Eylem Ocal, Kumar Patel, Aaron Smith, and Michael S. Golinko
- Subjects
Adult ,Male ,medicine.medical_specialty ,Meningomyelocele ,Skin flap ,Muscle flap ,Neurosurgical Procedures ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,Excess skin ,Chart review ,medicine ,Humans ,030212 general & internal medicine ,Surgery, Plastic ,Retrospective Studies ,business.industry ,Infant ,General Medicine ,Surgery ,Plastic surgery ,Pediatrics, Perinatology and Child Health ,Female ,Dural closure ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
The study aims to demonstrate proof of principle of a common plastic surgery technique of deepithelialization for repair of large myelomeningoceles (MMCs). Whereas repair typically consists of a watertight dural closure followed by a muscle or fasciocutaeneous layer, excess skin, however, need not be discarded and can be deepithelialized to augment or, in selective cases, replace the muscle repair. The study was performed through a retrospective chart review of two patients. Step-by-step figures illustrate the technique. Two patients each born with large MMCs measuring 10 × 11 cm and 6 × 9 cm, respectively, were reviewed. Excess skin was deepithelialized to create an additional layer of vascularized tissue over the muscle repair. There were no post-operative complications at 3-month follow-up. In large MMCs with excess skin, the use of a deepithelialized skin flap can potentially be an alternative or adjunct to a muscle flap to buttress the dural repair.
- Published
- 2016
24. Parental Perceptions of Neurodevelopment in Toddlers Following Craniosynostosis Repair
- Author
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Michael S. Golinko, Z-Hye Lee, David A. Staffenberg, Michael Alperovich, and Christopher M. Runyan
- Subjects
Male ,Parents ,Pediatrics ,medicine.medical_specialty ,Developmental Disabilities ,Standardized test ,Head shape ,Craniosynostosis ,Craniosynostoses ,03 medical and health sciences ,Child Development ,0302 clinical medicine ,Surveys and Questionnaires ,Cranial vault ,Humans ,Medicine ,Parental perception ,School age child ,business.industry ,Infant ,Mean age ,General Medicine ,medicine.disease ,Child development ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Female ,Surgery ,business ,030217 neurology & neurosurgery - Abstract
Introduction The relationship between nonsyndromic craniosynostosis and neurodevelopment remains controversial. Beyond standardized testing, little data exist about parental perceptions of their child's development. Methods Parents of children who underwent cranial vault remodeling for nonsyndromic craniosynostosis from 2011 to 2015 were asked to complete an anonymous survey. Results Twenty-two parents (31%) completed the survey. Patients included 52.4% males and 47.6% females with a mean age at surgery of 9.2 months and mean follow-up time of 19.8 months. Craniosynostosis types were primarily metopic (45%) and coronal (35%).The mean score for overall satisfaction with head shape with a maximum score of 10 was 9.2 (range 5-10). When answering whether their child is different for the better other than appearance with a 5 rating as "strongly agree," the mean score was 3.8 (range 1-5). When asked whether their child's motor, speech and behavior, or attention were different following surgery, the majority responded "No" (74%, 83%, and 67%, respectively).All parents would have their child undergo surgery again or recommend surgery to another family. There were no statistically significant differences when stratifying by age at surgery or length of follow-up. When stratifying by sex, parents of males gave higher ratings for whether their children were better other than appearance compared with females, 4.8 versus 3.1 (P = 0.031). Discussion Parents rated their child's neurodevelopment as largely age-appropriate following cranial vault remodeling. These findings are concordant with the majority of formal, standardized testing for this age group. Assessing parental perceptions once children enter school age may reveal increased developmental delays.
- Published
- 2016
25. Cerebrospinal Fluid Fistula for the Craniofacial Surgeon: A Review and Management Paradigm
- Author
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David A. Staffenberg, David H. Harter, Scott M. Rickert, and Michael S. Golinko
- Subjects
Leak ,medicine.medical_specialty ,Monobloc ,business.industry ,Fistula ,General Medicine ,medicine.disease ,Surgery ,Catheter ,Lumbar ,Cerebrospinal fluid ,Otorhinolaryngology ,Cranial vault ,medicine ,Craniofacial ,business - Abstract
Craniofacial surgeons perform operations that involve exposure of the dura. Typical procedures include cranial vault remodeling (CVR), fronto-orbital advancement (FOA), Le Fort III, monobloc, bipartition advancement, or distraction. Cerebrospinal fluid (CSF) fistulas remain one of the most common complications encountered, occurring in up to 30% of patients. Cerebrospinal fluid fistulas can be encountered intraoperatively, acutely, or in the late postoperative period. Traditional management has been well described in the neurosurgical literature. While several studies of complications exist, there is a relative lack of adequate information for craniofacial surgeons. The authors review current literature and provide 3 patients to illustrate our management paradigm.The authors review 30 years of experience at our institution and the pertinent literature. The mean rate of CSF fistula was 11.2%; rates were lowest for FOA/CVR, 5.5%. Patients with fistulas persisting after 2 days of conservative therapy or whom were symptomatic prompted placement of a lumbar subarachnoid catheter. Failure of the leak to resolve with CSF diversion prompted exploration and therapy which could include a patch, pericranial flap, and/or endonasal repair with septal flaps. Three patients are used to illustrate the paradigm, all of which have had no recurrence thus far.Cerebrospinal fluid fistula remains one of most common complications craniofacial surgeons encounter. Although neurosurgeons are often part of the clinical team, the craniofacial surgeon should be familiar with all aspects of treatment. Prompt diagnosis and appropriate knowledgeable management may avoid morbidity and mortality.
- Published
- 2017
26. Fronto-Orbital Advancement and Cranial Vault Remodeling for Metopic Craniosynostosis
- Author
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Kumar Patel, Akshay Krishnan, Eylem Ocal, and Michael S. Golinko
- Subjects
business.industry ,Cranial vault ,Medicine ,General Medicine ,Anatomy ,business ,Metopic craniosynostosis - Published
- 2016
27. Lessons learned measuring peripheral venous pressure waveforms in an anesthetized pediatric population
- Author
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Morten O. Jensen, Melvin S. Dassinger, Steven C Mehl, Abul Hayat, Jeffrey M. Burford, Samuel D. Smith, Michael S. Golinko, Patrick C. Bonasso, Jingxian Wu, and Kevin W. Sexton
- Subjects
medicine.medical_specialty ,business.industry ,Venous pressure ,Internal medicine ,Cardiology ,Medicine ,business ,General Nursing ,Pediatric population ,Peripheral - Published
- 2019
28. A Histopathologic Basis for Surgical Debridement to Promote Healing of Venous Ulcers
- Author
-
Sheila Blumberg, Weiliam Chen, Jonathan Melamed, Frank L. Ross, Michael S. Golinko, and Jason Maggi
- Subjects
Male ,Ulcer healing ,medicine.medical_specialty ,medicine.medical_treatment ,Varicose Ulcer ,Vascularity ,Refractory ,Fibrosis ,medicine ,Humans ,Retrospective Studies ,Ultrasonography, Doppler, Duplex ,Wound Healing ,Debridement ,business.industry ,Surgical debridement ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Wound area ,Female ,medicine.symptom ,Wound healing ,business ,Follow-Up Studies - Abstract
Background Pathologic analysis of deep tissue obtained during debridement of venous ulcers is often unnoticed in its importance. We previously reported pathologic findings on 139 patients with venous ulcers. The objective of this study was to correlate the pathologic findings in venous ulcers with wound healing to establish a negative margin for debridement. Study Design Consecutive patients with a lower extremity venous ulcer present for at least 4 weeks, presenting to a single wound healing center, were included. Wounds underwent aggressive surgical debridement beyond the subcutaneous level until judged to have a viable base. Specimens were scored based on cellularity, vascularity, collagen composition, inflammation, and dense fibrosis, with a highest possible score of 13. Healing was the primary outcome for analysis. Results Of the 26 patients who met inclusion criteria, only 50% of them (13 patients) with a total of 18 venous ulcers underwent surgical debridement available for pathologic analysis. Mean ulcer area was 34.7 cm 2 at initial presentation, and 89% of patients had a continuous positive healing curve as measured by decreasing wound area (from 34.7 cm 2 to 14.3 cm 2 ). However, specimens with dense fibrosis, decreased cellularity, mature collagen, and pathology score less than 10 were predominantly nonhealing ulcers. Conclusions Presence of dense fibrosis and high levels of mature collagen in deep tissue specimens are significant correlative factors in nonhealing of venous ulcers. We recommend deep debridement on all venous ulcers that are refractory to healing until the level of absence of dense fibrosis and mature collagen is reached to promote venous ulcer healing.
- Published
- 2012
29. Efficacy of Standard Costochondral Grafting in Patients With Bilateral Craniofacial Microsomia
- Author
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Christopher M. Runyan, David A. Staffenberg, Michael S. Golinko, Arman T. Serebrakian, and Michael Alperovich
- Subjects
musculoskeletal diseases ,Male ,medicine.medical_specialty ,Symphysis ,Nonunion ,Goldenhar syndrome ,Ribs ,Condyle ,03 medical and health sciences ,0302 clinical medicine ,Goldenhar Syndrome ,Cartilage transplantation ,medicine ,Deformity ,Ankylosis ,Humans ,Craniofacial ,030223 otorhinolaryngology ,Bone Transplantation ,business.industry ,030206 dentistry ,General Medicine ,musculoskeletal system ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Cartilage ,Otorhinolaryngology ,Child, Preschool ,medicine.symptom ,business - Abstract
Craniofacial microsomia remains the second most common craniofacial deformity after cleft lip and palate. Mandibular pathology has been classically scored from type I to type III by the modified Pruzansky-Kaban classification. The authors report a case of a 5-year-old patient with Goldenhar syndrome and bilateral type III craniofacial macrosomia. The patient had absence of bilateral glenoid fossas, condyles, coronoids, and rami as well as hypoplasia of the symphysis, parasymphysis, and mandibular body. Reconstruction was performed using 2 costochondral rib autografts to reconstruct a ramus and assist in the development of a neo-glenoid fossa at the cranial base. An additional portion of costal rib graft was used to augment the deficient symphysis. The patient was placed in class III occlusion postoperatively using maxillo-mandibular fixation screws and heavy elastics. The bone grafts healed without complications with no evidence of ankylosis, nonunion, or resorption to date. For the most severe forms of craniofacial microsomia, costochondral grafting remains an effective initial technique for lengthening the hypoplastic mandible and providing a foundation for future distraction.
- Published
- 2016
30. Long-Term Surgical and Speech Outcomes Following Palatoplasty in Patients With Treacher-Collins Syndrome
- Author
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Roberto L. Flores, Michael Alperovich, Andrew M. Hallett, Étoile LeBlanc, and Michael S. Golinko
- Subjects
0301 basic medicine ,Adult ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Oral Surgical Procedures ,030105 genetics & heredity ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Speech ,Craniofacial ,Young adult ,Child ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Infant ,Retrospective cohort study ,030206 dentistry ,General Medicine ,medicine.disease ,Surgery ,Cleft Palate ,Palatoplasty ,Treatment Outcome ,Otorhinolaryngology ,Child, Preschool ,Airway ,Speech-Language Pathology ,business ,Treacher Collins syndrome ,Mandibulofacial Dysostosis - Abstract
Background Cleft palate is present in one-third of patients with Treacher-Collins syndrome. The authors present long-term speech and surgical outcomes of palatoplasty in this challenging patient population. Methods A retrospective review of all patients with Treacher-Collins syndrome and cleft palate was conducted over a 35-year period at a single institution. Demographics, palatal, mandibular, airway, and surgical outcomes were recorded. Speech outcomes were assessed by the same craniofacial speech pathologist. Results Fifty-eight patients with Treacher-Collins syndrome were identified: 43% (25) had a cleft palate and 16% (9) underwent palatoplasty at our institution. Cleft palate types included 1 Veau I, 5 Veau II, 1 Veau III, and 2 Veau IV. Mean age at the time of palatoplasty was 2.0 years (range, 1.0-6.7 years). Three patients had fistulas (33%) and underwent repairs. Pruzansky classifications included 1 type IIA, 6 type IIB, and 2 type III. Seven patients completed long-term speech evaluations. Mean age at follow-up was 13.9 years (range 2.2-24.3 years). Six patients had articulatory velopharyngeal dysfunction related to Treacher-Collins syndrome. Two patients had structural velopharyngeal dysfunction and required further palatal/pharyngeal surgery. Conclusions Cleft palate repair in patients with Treacher-Collins syndrome has a high incidence of velopharyngeal dysfunction. However, the majority of patients are articulatory-based in whom further surgery would not provide benefit. Patients with Treacher-Collins syndrome and cleft palate require close evaluation by a speech pathologist as the incidence of articulatory dysfunction is high.
- Published
- 2016
31. Posterior Cranial Vault Remodeling for Shunt-Induced Crainiocerebral Disporpotion (CCD)
- Author
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Kumar Patel, Gregory W. Albert, and Michael S. Golinko
- Subjects
business.industry ,Cranial vault ,Medicine ,General Medicine ,Anatomy ,business ,Shunt (medical) - Published
- 2016
32. Preliminary development of a diabetic foot ulcer database from a wound electronic medical record: A tool to decrease limb amputations
- Author
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Adit Tal, David J. Margolis, Andrew J. M. Boulton, Ole Hoffstad, Michael S. Golinko, and Harold Brem
- Subjects
Adult ,Male ,Databases, Factual ,Medical Records Systems, Computerized ,medicine.medical_treatment ,Dermatology ,computer.software_genre ,Article ,Amputation, Surgical ,Patient safety ,Diabetes mellitus ,Humans ,Medicine ,Medical history ,Aged ,Database ,business.industry ,Proportional hazards model ,Osteomyelitis ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Diabetic foot ulcer ,Amputation ,Female ,Surgery ,Forms and Records Control ,business ,computer - Abstract
Our objective was to create a practical standardized database of clinically relevant variables in the care of patients with diabetes and foot ulcers. Numerical clinical variables such as age, baseline laboratory values, and wound area were extracted from the wound electronic medical record (WEMR). A coding system was developed to translate narrative data, culture, and pathology reports into discrete, quantifiable variables. Using data extracted from the WEMR, a diabetic foot ulcer-specific database incorporated the following tables: (1) demographics, medical history, and baseline laboratory values; (2) vascular testing data; (3) radiology data; (4) wound characteristics; and (5) wound debridement data including pathology, culture results, and amputation data. The database contains variables that can be easily exported for analysis. Amputation was studied in 146 patients who had at least two visits (e.g., two entries in the database). Analysis revealed that 19 (13%) patients underwent 32 amputations (nine major and 23 minor) in 23 limbs. There was a decreased risk of amputation, 0.87 (0.78, 1.00), using a proportional hazards model, associated with an increased number of visits and entries in the WEMR. Further analysis revealed no significant difference in age, gender, HbA1c%, cholesterol, white blood cell count, or prealbumin at baseline, whereas hemoglobin and albumin were significantly lower in the amputee group (p < 0.05) than the nonamputee group. Fifty-nine percent of amputees had histological osteomyelitis based on operating room biopsy vs. 45% of non-amputees. In conclusion, tracking patients with a WEMR is a tool that could potentially increase patient safety and quality of care, allowing clinicians to more easily identify a nonhealing wound and intervene. This report describes a method of capturing data relevant to clinical care of a patient with a diabetic foot ulcer, and may enable clinicians to adapt such a system to their own patient population.
- Published
- 2009
33. Standardization of Wound Photography Using the Wound Electronic Medical Record
- Author
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Dave Kaplan, Harold Brem, Michael S. Golinko, Robert C. Rennert, and Anna Flattau
- Subjects
medicine.medical_specialty ,Medical Records Systems, Computerized ,Standardization ,Documentation ,Dermatology ,Varicose Ulcer ,Clinical Protocols ,Cost of Illness ,Image Processing, Computer-Assisted ,Photography ,Prevalence ,medicine ,Cost of illness ,Humans ,Medical physics ,Pressure Ulcer ,Advanced and Specialized Nursing ,Skin care ,Anthropometry ,Extramural ,business.industry ,Electronic medical record ,Cellulitis ,Skin Care ,Diabetic Foot ,United States ,Surgery ,Chronic disease ,Acute Disease ,Chronic Disease ,Wounds and Injuries ,business - Abstract
INTRODUCTIONClinical decisions regarding the treatment of chronic wounds often rely on the synthesis of information from multiple sources (radiology, pathology, vascular and culture reports, current treatments, etc). The utilization of technology, specifically digital photography combined with a Wou
- Published
- 2009
34. Operative Debridement of Diabetic Foot Ulcers
- Author
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Jason Maggi, Dalton Cox, Eashwar B. Chandrasekaran, Michael S. Golinko, R. Marjana Tomic-Canic, Harold Brem, and Renta Joffe
- Subjects
medicine.medical_specialty ,Debridement ,business.industry ,medicine.medical_treatment ,medicine.disease ,Bandages ,Diabetic foot ,Diabetic Foot ,Surgery ,Humans ,Medicine ,business - Published
- 2008
35. Severe Agnathia-Otocephaly Complex: Surgical Management and Longitudinal Follow-up From Birth Through Adulthood
- Author
-
David A. Staffenberg, Pradip R. Shetye, Michael S. Golinko, and Roberto L. Flores
- Subjects
Otocephaly ,Adult ,Male ,Reoperation ,Pediatrics ,medicine.medical_specialty ,Agnathia ,Adolescent ,medicine.medical_treatment ,Mandible ,Bone grafting ,Ultrasonography, Prenatal ,Tongue Diseases ,Young Adult ,Imaging, Three-Dimensional ,Jaw Abnormalities ,Pregnancy ,Microstomia ,medicine ,Humans ,Longitudinal Studies ,Ear, External ,Child ,business.industry ,Age Factors ,Infant, Newborn ,Infant ,General Medicine ,Aplasia ,medicine.disease ,Transplantation ,Otorhinolaryngology ,Tongue disease ,Child, Preschool ,Quality of Life ,Surgery ,Female ,Mandibular Reconstruction ,business ,Tomography, X-Ray Computed ,Tissue expansion - Abstract
Agnathia-otocephaly complex (AOC) is characterized by mandibular hypo- or aplasia, ear abnormalities, microstomia, and microglossia. Though rare and often fatal, this is the first report detailing various reconstructive strategies beyond infancy as well as longitudinal follow-up into adulthood. All patients with AOC treated at our institution over a 30 year period were reviewed. Four patients were identified, one with agnathia, one with micrognathia. Two males with nanognathia (defined as a symphyseal remnant without body nor ramus) were also included. The mean follow-up was 17 years. All four underwent perinatal tracheostomy and gastrostomy-tube placement. Commissuroplasties were typically performed before 3 years of age and repeated as necessary to allow for oral hygiene. Mandibular reconstruction was most successful with rib between ages 3 and 8, after which time, free fibula transfer was utilized. Due to some resoprtion or extrusion, all patients underwent repeated bone grafting procedures. Tissue expansion of the neck was used to restore the lower third of the face, but was most successful in the teenage years. At last follow-up of the eldest patients, one was in college while another was pursuing graduate education. AOC need not be a fatal nor untreatable condition; a reasonable quality of life can be achieved. Although the lower-facial contour may be improved, and a stoma created, the lack of musculature make deglutition virtually impossible with current therapies. Just as transplantation has emerged as a modality for facial restoration following severe trauma, so too may it be a future option for congenital deformities.
- Published
- 2015
36. Erratum
- Author
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Sasa Vukelic, Marjana Tomic-Canic, Olivera Stojadinovic, Mỹ G. Mahoney, Donna Brennan, Agata Krzyzanowska, Irena Pastar, Harold Brem, and Michael S. Golinko
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Molecular Medicine ,Medicine ,Cell Biology ,Keratinocyte differentiation ,Erratum ,business ,Molecular medicine - Published
- 2009
37. Facial nerve paralysis and frey syndrome in an infant following removal of an internal mandibular distraction device
- Author
-
Joseph K. Williams, Michael S. Golinko, and Sameer M. Kapadia
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,education ,Facial Paralysis ,Osteogenesis, Distraction ,Sweating, Gustatory ,Retrognathia ,stomatognathic system ,Paralysis ,Medicine ,Humans ,Device Removal ,Trigeminal nerve ,Facial Nerve Injuries ,business.industry ,Infant ,General Medicine ,Facial nerve injury ,Facial nerve ,humanities ,Surgery ,stomatognathic diseases ,Otorhinolaryngology ,Mandibular distraction ,Distraction osteogenesis ,Female ,medicine.symptom ,Complication ,business ,Mandibular Advancement ,psychological phenomena and processes - Abstract
Mandibular distraction using an implantable device has become a widely accepted and utilized procedure for the treatment of retrognathia. Although excellent results have been reported and observed with distraction osteogenesis, complications such as facial nerve injury have been previously reported. Often, this injury is usually temporary and corrects over the course of time. Frey syndrome has been classically described as an injury or severance of the auricotemporal branch of the trigeminal nerve. It is commonly seen as a complication of parotid surgery and has never been reported in association with mandibular distraction. The authors report a unique case of both facial nerve paralysis and Frey syndrome in a patient following the removal of an internal mandibular distraction device. A review of the literature along with diagnosis and management are discussed.
- Published
- 2013
38. High cost of stage IV pressure ulcers
- Author
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Linda Rolnitzky, David Bell, Courtney Lyder, Jason Maggi, Alan Yan, Michael S. Golinko, Bruce C. Vladeck, Robert C. Rennert, Harold Brem, and David M. Nierman
- Subjects
medicine.medical_specialty ,Treatment outcome ,Severity of Illness Index ,Hospital records ,Article ,Hospitals, University ,Cost of Illness ,Severity of illness ,medicine ,Humans ,Stage (cooking) ,Hospital Costs ,Pressure Ulcer ,business.industry ,General Medicine ,Health economy ,Length of Stay ,digestive system diseases ,United States ,Surgery ,Hospital treatment ,Emergency medicine ,Cost of treatment ,Stage iv ,business - Abstract
BACKGROUND: The aim of this study was to calculate and analyze the cost of treatment for stage IV pressure ulcers. METHODS: A retrospective chart analysis of patients with stage IV pressure ulcers was conducted. Hospital records and treatment outcomes of these patients were followed up for a maximum of 29 months and analyzed. Costs directly related to the treatment of pressure ulcers and their associated complications were calculated. RESULTS: Nineteen patients with stage IV pressure ulcers (11 hospital-acquired and 8 communityacquired) were identified and their charts were reviewed. The average hospital treatment cost associated with stage IV pressure ulcers and related complications was $129,248 for hospital-acquired ulcers during 1 admission, and $124,327 for community-acquired ulcers over an average of 4 admissions. CONCLUSIONS: The costs incurred from stage IV pressure ulcers are much greater than previously estimated. Halting the progression of early stage pressure ulcers has the potential to eradicate enormous pain and suffering, save thousands of lives, and reduce health care expenditures by millions of dollars.
- Published
- 2009
39. Wound emergencies: the importance of assessment, documentation, and early treatment using a wound electronic medical record
- Author
-
Michael S, Golinko, Sunday, Clark, Robert, Rennert, Anna, Flattau, Andrew J M, Boulton, and Harold, Brem
- Subjects
Aged, 80 and over ,Male ,Inpatients ,Wound Healing ,Time Factors ,Documentation ,Middle Aged ,Skin Care ,Early Diagnosis ,Chronic Disease ,Electronic Health Records ,Humans ,Wounds and Injuries ,Female ,Emergencies ,Hospital Units ,Nursing Assessment ,Aged ,Retrospective Studies - Abstract
Chronic wounds such as diabetic foot ulcers, venous ulcers, and pressure ulcers are a major source of morbidity and mortality. To describe wound characteristics associated with a wound emergency, the Wound Electronic Medical Records (WEMR) of 200 consecutive admissions (139 patients, average number of admissions 1.4) to a dedicated inpatient wound healing unit over a period of 5 months were retrospectively reviewed. Patient mean age was 62 +/- 16 years, 59% were men, 27% had a foot ulcer and diabetes mellitus, and 29% had venous ulcers. Presenting signs and symptoms included wound pain, cellulitis, nonpurulent drainage, and undermining, but few presented with classic local clinical signs of infection. Treatment consisted of sharp debridement with deep tissue culture and pathology from the wound base and/or systemic antibiotics. Twenty-percent (20%) of patients had pathology-confirmed and 38% had pathology- or radiology-confirmed osteomyelitis on admission, supporting that new or increasing wound pain, cellulitis, and/or nonpurulent drainage or presence of significant undermining may be indicative of an invasive infection and that patients presenting with these signs and symptoms require an immediate treatment plan and consideration of hospital admission. Use of an objective documentation system such as the WEMR may help alert clinicians to subtle wound changes that require aggressive treatment; thereby, avoiding emergency room visits and hospital admissions. Future research is needed utilizing the WEMR across multiple medical centers to further define criteria for a chronic wound emergency.
- Published
- 2009
40. Mechanism of sustained release of vascular endothelial growth factor in accelerating experimental diabetic healing
- Author
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Alan D. Weinberg, Claudia M. Sheahan, Marjana Tomic-Canic, Savio L. C. Woo, Hyacinth Entero, Vincent M. Wang, Harold Brem, Arber Kodra, Michael S. Golinko, Olivera Stojadinovic, and H. Paul Ehrlich
- Subjects
Vascular Endothelial Growth Factor A ,medicine.medical_specialty ,Angiogenesis ,Dermatology ,Pharmacology ,Biochemistry ,Epithelium ,Adenoviridae ,03 medical and health sciences ,chemistry.chemical_compound ,Mice ,0302 clinical medicine ,Mice, Inbred NOD ,Tensile Strength ,Diabetes Mellitus ,Medicine ,Animals ,Humans ,Regeneration ,Molecular Biology ,030304 developmental biology ,0303 health sciences ,Wound Healing ,integumentary system ,business.industry ,Regeneration (biology) ,Cell migration ,Cell Biology ,Genetic Therapy ,medicine.disease ,Diabetic foot ,Controlled release ,3. Good health ,Surgery ,Vascular endothelial growth factor ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Granulation Tissue ,Female ,Collagen ,business ,Wound healing ,Blood vessel - Abstract
In this study, we hypothesize that local sustained release of vascular endothelial growth factor (VEGF), using adenovirus vector (ADV)-mediated gene transfer, accelerates experimental wound healing. This hypothesis was tested by determining the specific effects of VEGF165 application on multiple aspects of the wound healing process, that is, time to complete wound closure and skin biomechanical properties. After showing accelerated wound healing in vivo, we studied the mechanism to explain the findings on multiple aspects of the wound healing cascade, including epithelialization, collagen deposition, and cell migration. Intradermal treatment of wounds in non-obese diabetic and db/db mice with ADV/VEGF165 improves healing by enhancing tensile stiffness and/or increasing epithelialization and collagen deposition, as well as by decreasing time to wound closure. VEGF165, in vitro, stimulates the migration of cultured human keratinocytes and fibroblasts, thus revealing a non-angiogenic effect of VEGF on wound closure. In conclusion, ADV/VEGF is effective in accelerating wound closure by stimulating angiogenesis, epithelialization, and collagen deposition. In the future, local administration and sustained, controlled release of VEGF165 may decrease amputations in patients with diabetic foot ulcers and possibly accelerate closure of venous ulcers and pressure ulcers.JID JOURNAL CLUB ARTICLE: For questions, answers, and open discussion about this article, please go to http://network.nature.com/group/jidclub
- Published
- 2009
41. Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record
- Author
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Stephan Barrientos, Michael S. Golinko, Sasa Vukelic, David de Vinck, Harold Brem, Marjana Tomic-Canic, Eashwar B. Chandrasekaran, Renata A Joffe, and Olivera Stojadinovic
- Subjects
Gangrene ,medicine.medical_specialty ,Debridement ,integumentary system ,Medical Records Systems, Computerized ,Quality Assurance, Health Care ,business.industry ,medicine.medical_treatment ,Osteomyelitis ,Anatomical pathology ,medicine.disease ,Diabetic foot ,Surgery ,Surgical pathology ,Diabetic foot ulcer ,Outcome and Process Assessment, Health Care ,Amputation ,Chronic Disease ,medicine ,Humans ,Wounds and Injuries ,business - Abstract
Background Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Study Design Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Results Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. Conclusions This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.
- Published
- 2009
42. Growth factors and cytokines in wound healing
- Author
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Stephan, Barrientos, Olivera, Stojadinovic, Michael S, Golinko, Harold, Brem, and Marjana, Tomic-Canic
- Subjects
Wound Healing ,Animals ,Cytokines ,Humans ,Intercellular Signaling Peptides and Proteins - Abstract
Wound healing is an evolutionarily conserved, complex, multicellular process that, in skin, aims at barrier restoration. This process involves the coordinated efforts of several cell types including keratinocytes, fibroblasts, endothelial cells, macrophages, and platelets. The migration, infiltration, proliferation, and differentiation of these cells will culminate in an inflammatory response, the formation of new tissue and ultimately wound closure. This complex process is executed and regulated by an equally complex signaling network involving numerous growth factors, cytokines and chemokines. Of particular importance is the epidermal growth factor (EGF) family, transforming growth factor beta (TGF-beta) family, fibroblast growth factor (FGF) family, vascular endothelial growth factor (VEGF), granulocyte macrophage colony stimulating factor (GM-CSF), platelet-derived growth factor (PDGF), connective tissue growth factor (CTGF), interleukin (IL) family, and tumor necrosis factor-alpha family. Currently, patients are treated by three growth factors: PDGF-BB, bFGF, and GM-CSF. Only PDGF-BB has successfully completed randomized clinical trials in the Unites States. With gene therapy now in clinical trial and the discovery of biodegradable polymers, fibrin mesh, and human collagen serving as potential delivery systems other growth factors may soon be available to patients. This review will focus on the specific roles of these growth factors and cytokines during the wound healing process.
- Published
- 2009
43. Primary cultured fibroblasts derived from patients with chronic wounds: a methodology to produce human cell lines and test putative growth factor therapy such as GMCSF
- Author
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Hyacinth Entero, Marjana Tomic-Canic, Donald L. Coppock, Arber Kodra, Michael S. Golinko, Robert F. Diegelmann, Sasa Vukelic, Olivera Stojadinovic, and Harold Brem
- Subjects
medicine.medical_treatment ,Cell Culture Techniques ,lcsh:Medicine ,Disease ,General Biochemistry, Genetics and Molecular Biology ,Cell Line ,Varicose Ulcer ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Cell Movement ,medicine ,Humans ,Fibroblast ,030304 developmental biology ,Medicine(all) ,Wound Healing ,0303 health sciences ,Biochemistry, Genetics and Molecular Biology(all) ,business.industry ,Growth factor ,lcsh:R ,Methodology ,Granulocyte-Macrophage Colony-Stimulating Factor ,General Medicine ,Fibroblasts ,Colony-stimulating factor ,Phenotype ,Recombinant Proteins ,3. Good health ,Granulocyte macrophage colony-stimulating factor ,medicine.anatomical_structure ,Cell culture ,Immunology ,business ,Wound healing ,medicine.drug - Abstract
Background Multiple physiologic impairments are responsible for chronic wounds. A cell line grown which retains its phenotype from patient wounds would provide means of testing new therapies. Clinical information on patients from whom cells were grown can provide insights into mechanisms of specific disease such as diabetes or biological processes such as aging. The objective of this study was 1) To culture human cells derived from patients with chronic wounds and to test the effects of putative therapies, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) on these cells. 2) To describe a methodology to create fibroblast cell lines from patients with chronic wounds. Methods Patient biopsies were obtained from 3 distinct locations on venous ulcers. Fibroblasts derived from different wound locations were tested for their migration capacities without stimulators and in response to GM-CSF. Another portion of the patient biopsy was used to develop primary fibroblast cultures after rigorous passage and antimicrobial testing. Results Fibroblasts from the non-healing edge had almost no migration capacity, wound base fibroblasts were intermediate, and fibroblasts derived from the healing edge had a capacity to migrate similar to healthy, normal, primary dermal fibroblasts. Non-healing edge fibroblasts did not respond to GM-CSF. Six fibroblast cell lines are currently available at the National Institute on Aging (NIA) Cell Repository. Conclusion We conclude that primary cells from chronic ulcers can be established in culture and that they maintain their in vivo phenotype. These cells can be utilized for evaluating the effects of wound healing stimulators in vitro.
- Published
- 2008
44. Wound healing where there is no CT scanner
- Author
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Michael S. Golinko
- Subjects
Advanced and Specialized Nursing ,Patient Care Team ,Scanner ,Wound Healing ,business.industry ,Dermatology ,Health Services Accessibility ,Nepal ,Medicine ,Humans ,Surgery, Plastic ,Triage ,business ,Nuclear medicine ,Wound healing ,Delivery of Health Care - Published
- 2008
45. The role of vascular endothelial growth factor in wound healing
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H. Paul Ehrlich, Philip Bao, Harold Brem, Michael S. Golinko, Marjana Tomic-Canic, and Arber Kodra
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Chronic wound ,Vascular Endothelial Growth Factor A ,Pathology ,medicine.medical_specialty ,Angiogenesis ,medicine.medical_treatment ,Neovascularization, Physiologic ,Article ,chemistry.chemical_compound ,medicine ,Animals ,Humans ,Therapeutic angiogenesis ,Wound Healing ,business.industry ,Growth factor ,Granulation tissue ,Vascular endothelial growth factor ,Vascular endothelial growth factor A ,medicine.anatomical_structure ,Receptors, Vascular Endothelial Growth Factor ,chemistry ,Cancer research ,Surgery ,medicine.symptom ,business ,Wound healing - Abstract
Background A chronic wound is tissue with an impaired ability to heal. This is often a consequence of one of the following etiologies: diabetes, venous reflux, arterial insufficiency sickle cell disease, steroids, and/or pressure. Healing requires granulation tissue depending on epithelialization and angiogenesis. Currently no growth factor is available to treat patients with impaired healing that stimulates both epithelialization and angiogenesis. The objective is to review is the multiple mechanisms of vascular endothelial growth factor (VEGF) in wound healing. Materials and methods The authors reviewed the literature on the structure and function of VEGF, including its use for therapeutic angiogenesis. Particular attention is given to the specific role of VEGF in the angiogenesis cascade, its relationship to other growth factors and cells in a healing wound. Results VEGF is released by a variety of cells and stimulates multiple components of the angiogenic cascade. It is up-regulated during the early days of healing, when capillary growth is maximal. Studies have shown the efficacy of VEGF in peripheral and cardiac ischemic vascular disease with minimal adverse effects. Experimental data supports the hypothesis that VEGF stimulates epithelialization and collagen deposition in a wound. Conclusion VEGF stimulates wound healing through angiogenesis, but likely promotes collagen deposition and epithelialization as well. Further study of the molecule by utilizing the protein itself, or novel forms of delivery such as gene therapy, will increase its therapeutic possibilities to accelerate closure of a chronic wound.
- Published
- 2008
46. Severe Agnathia–Otocephaly Complex
- Author
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Pradip R. Shetye, Michael Alperovich, Michael S. Golinko, David A. Staffenberg, and Roberto L. Flores
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Otocephaly ,Pediatrics ,medicine.medical_specialty ,Agnathia ,business.industry ,Medicine ,Surgery ,business ,medicine.disease - Published
- 2015
47. A piece of my mind. A bump in the neck
- Author
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Michael S, Golinko
- Subjects
Physicians ,Adaptation, Psychological ,Humans ,Convalescence ,Thyroid Neoplasms - Published
- 2006
48. Molecular markers in patients with chronic wounds to guide surgical debridement
- Author
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Hyacinth Entero, Marjana Tomic-Canic, Harvey J. Rosenberg, Brian Lee, Michael S. Golinko, Harold Brem, Irena Pastar, Olivera Stojadinovic, and Robert F. Diegelmann
- Subjects
medicine.medical_specialty ,Pathology ,medicine.medical_treatment ,Biopsy ,Varicose Ulcer ,Pathogenesis ,Cell Movement ,Gene expression ,Genetics ,medicine ,Humans ,Vimentin ,Molecular Biology ,Genetics (clinical) ,Cells, Cultured ,Oligonucleotide Array Sequence Analysis ,Wound Healing ,Debridement ,Epidermis (botany) ,business.industry ,Gene Expression Profiling ,Histology ,Articles ,Fibroblasts ,Molecular medicine ,Surgery ,Gene expression profiling ,Procollagen peptidase ,Chronic Disease ,Molecular Medicine ,Wounds and Injuries ,business ,Transcription Factors - Abstract
Chronic wounds, such as venous ulcers, are characterized by physiological impairments manifested by delays in healing, resulting in severe morbidity. Surgical debridement is routinely performed on chronic wounds because it stimulates healing. However, procedures are repeated many times on the same patient because, in contrast to tumor excision, there are no objective biological/molecular markers to guide the extent of debridement. To develop bioassays that can potentially guide surgical debridement, we assessed the pathogenesis of the patients’ wound tissue before and after wound debridement. We obtained biopsies from three patients at two locations, the nonhealing edge (prior to debridement) and the adjacent, nonulcerated skin of the venous ulcers (post debridement), and evaluated their histology, biological response to wounding (migration) and gene expression profile. We found that biopsies from the nonhealing edges exhibit distinct pathogenic morphology (hyperproliferative/hyperkeratotic epidermis; dermal fibrosis; increased procollagen synthesis). Fibroblasts deriving from this location exhibit impaired migration in comparison to the cells from adjacent nonulcerated biopsies, which exhibit normalization of morphology and normal migration capacity. The nonhealing edges have a specific, identifiable, and reproducible gene expression profile. The adjacent nonulcerated biopsies have their own distinctive reproducible gene expression profile, signifying that particular wound areas can be identified by gene expression profiling. We conclude that chronic ulcers contain distinct subpopulations of cells with different capacity to heal and that gene expression profiling can be utilized to identify them. In the future, molecular markers will be developed to identify the nonimpaired tissue, thereby making surgical debridement more accurate and more efficacious.
- Published
- 2006
49. A Bump in the Neck
- Author
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Michael S. Golinko
- Subjects
medicine.medical_specialty ,business.industry ,Convalescence ,media_common.quotation_subject ,medicine ,General Medicine ,business ,Surgery ,media_common - Published
- 2006
50. Operative Debridement of Pressure Ulcers
- Author
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Jessica Schiffman, Marjana Tomic-Canic, Alan Yan, Harold Brem, Michael S. Golinko, and Anna Flattau
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,macromolecular substances ,Risk Assessment ,Severity of Illness Index ,Surgical Flaps ,Article ,Cohort Studies ,Sepsis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Negative-pressure wound therapy ,Severity of illness ,Humans ,Surgical Wound Infection ,Medicine ,Registries ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Pressure Ulcer ,Wound Healing ,Debridement ,business.industry ,Biopsy, Needle ,fungi ,food and beverages ,Middle Aged ,Vascular surgery ,medicine.disease ,Immunohistochemistry ,3. Good health ,Surgery ,Cardiac surgery ,Treatment Outcome ,Cardiothoracic surgery ,Female ,business ,Negative-Pressure Wound Therapy ,Follow-Up Studies ,Abdominal surgery - Abstract
Background Infection in severe pressure ulcers can lead to sepsis with a 6-month mortality as high as 68%. Methods Operative records of 142 consecutive operative debridements on 60 patients in a dedicated wound healing inpatient unit were reviewed, from the Wound Electronic Medical Record, for identification of key steps in debridement technique, mortality, unexpected returns, and time to discharge following debridement. Results The mean age of the patients was 73.1 years, and 45% were men. Most wounds (53%) were located on the hip (ischial or trochanteric); others were on the sacrum (32%) and the heels (14%). The mean initial wound area prior to debridement was 14.0 cm2, and 83% of debridements were performed on stage IV pressure ulcers. The postoperative hospital stay averaged 4.1 days. Key steps in the technique included (1) exposure of areas of undermining by excising overlying tissue; (2) removal of callus from wound edges; (3) removal of all grossly infected tissue; and (4) obtaining a biopsy of the deep tissue after debridement of all nonviable or infected tissue for culture and pathology to determine the presence of infection, fibrosis, and granulation tissue. There was one death 9 days post-debridement of a sacral ulcer and one unplanned return to the operating room for bleeding 8 days post-debridement. Conclusions Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Proper debridement technique may prevent sepsis and death in patients with multiple co-morbid conditions.
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