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Lisa R David

Publications and source records attributed to Lisa R David.

14 recordsLinked to original sources
PubMed2006

Vacuum-assisted closure: state of clinic art.

Treatment of wounds has been the cornerstone of plastic surgery since its inception. Vacuum-assisted closure provides a new paradigm that can be used in concert with a wide variety of standard existing plastic surgery techniques. It was originally developed as an alternative treatment for debilitated patients with chronic wounds. It has rapidly evolved into a widely accepted treatment of chronic and acute wounds, contaminated wounds, burns, envenomations, infiltrations, and wound complications from failed operations. The ease of technique and a high rate of success have encouraged its adaptation by thoracic, general, trauma, burn, orthopedic, urologic, as well as plastic surgeons. This article discusses multidisciplinary advances in the use of the vacuum-assisted closure technique over the past 10 years and its status as of 2006. Creative surgeons continue to regularly adapt the system to difficult problems. This technique in trained surgical hands greatly enhances the scope and safety of wound treatment.

Abdominal Wall↗
PubMed2006

Impact of significant weight loss on outcome of body-contouring surgery.

Morbid obesity in the United States has reached startling proportions, with serious physical and psychosocial ramifications. As the number of patients undergoing bariatric surgery increases to treat this problem, it is expected there will be an increase in the number of patients presenting to plastic surgery offices for body contouring after weight loss. It is imperative that plastic surgeons prepare patients with extreme weight loss as to the risks and complications as compared with the general population undergoing body contouring. In this retrospective chart review, 26 patients undergoing body contouring from May 2001 to November 2004 were reviewed. Only patients who had extreme weight loss, defined as losing greater than 50 pounds, were included in this study. The age, gender, amount of weight lost, comorbidities, tobacco use, and weight-loss method were recorded. Additionally, the type of body-contouring procedure and presence of complications were collected from the records. The percentage of complications in our patient population is significantly higher than reported in the literature for the general population undergoing an abdominoplasty. We believe the increased wound complications seen in our patients can be attributed to the inherent complications seen with obese patients.

Abdomen↗
PubMed2004

Cost-effective management of isolated facial fractures.

The purpose of this study was to evaluate the subset of costs incurred for surgical treatment of isolated midface and mandible fractures of patients admitted directly from the emergency department compared with those admitted as outpatients after evaluation and discharge from the emergency department. After institutional review board approval, the records of patients admitted to Wake Forest University Baptist Medical Center were studied retrospectively for patients who underwent surgical repair of an isolated facial fracture between July 1, 1999 and June 30, 2000. Patients were placed into one of two groups: admission from the emergency department versus admission as an out-patient. Total hospital charges were compared, and complications were evaluated. Mechanism of injury, age, and gender were recorded within each group. Forty-two patients met the study criteria. Twenty-eight patients were admitted directly from the emergency department (Group A), and 14 were admitted as outpatients after elective scheduling for operative repair (Group B). Operative charges based on utilization of time and materials showed no statistical significance between Group A (P = 0.275) and Group B (P = 0.393). Patients admitted directly from the emergency department had a mean hospital charge of 3,556.66 dollars higher (P< or = 0.001) and stayed 2 days longer in the hospital as compared with the outpatient group. No differences were noted in complications between the study groups. The results of this study reveal a significant decrease in cost for patients with isolated facial fractures admitted as outpatients on scheduling surgery as compared with immediate admission from the emergency department.

Adult↗
PubMed2004

Objective outcome analysis of soft shell helmet therapy in the treatment of deformational plagiocephaly.

Deformational plagiocephaly, cranial asymmetry secondary to positioning, continues to be a leading cause of head shape abnormalities in infants. Treatment recommendations include nonintervention, positioning therapies, and helmet therapy. Although most agree that surgical intervention is rarely indicated, the ideal therapy is not agreed on. Some even debate the necessity of treatment, especially third-party payers. The purpose of this prospective study is to use an objective outcome analysis tool, computerized tomography, to assess the efficacy of a soft shell helmet therapy. Sixty-nine children with a diagnosis of deformational plagiocephaly were enrolled in this study to assess the success of a soft shell helmet for the correction of cranial asymmetry. Computed tomography scanning was done before therapy and 6 months after the initiation of therapy. Three-dimensional reconstructions of these scans were reformatted into a standardized orientation by utilizing the nasion (radix), frontozygomatic suture lines, and posterior aspect of the foramen magnum. Intracranial volumes were calculated on a quadrant basis, and asymmetry was evaluated with regard to the hemispheres (left versus right) and the posterior quadrants. Thirty-four children (27 boys and 7 girls) completed the study protocol. The side involved was the right in 62% of cases and the left in 38%. Mean age at the initial scan was 6.3 months, and mean age at the follow-up scan was 14 months. Mean duration of helmet therapy was 7 months. Compliance with therapy was average to above average in 88% of the children and poor in 12%. There was a 36% to 54% improvement in asymmetry in the compliant patients over the 6-month study period. Soft shell helmet therapy is an effective technique to decrease cranial asymmetry based on objective outcome measurements. Additionally, it is cost-effective, with the total cost of therapy for the helmet and office visits ranging from 600 dollars to 700 dollars. This therapy compares favorably with other more expensive and time-consuming therapies that have been reported in the literature.

Cephalometry↗
PubMed2004

Spring-mediated cranial reshaping for craniosynostosis.

The evolution of modern craniofacial surgery has come full circle from the early strip craniectomies to the complete calvarial remodeling and now back to attempts at minimally invasive surgical interventions. The goal of the craniofacial surgeon has always been the correction of form and function with minimization of associated morbidity and mortality. Particularly problematic has been the ability to maintain the anatomical correction beyond the result seen on the operating room table secondary to changes with growth. The ability to improve the clinical result in a growing and developing child has been the impetus for dynamic treatment modalities. Dr Claes Lauritzen's pioneering work in this area has been particularly successful using internal springs to correct craniofacial deformities. The purpose of this study is to assess this treatment modality clinically in terms of safety and efficacy and to develop a methodology for the spring formation that would be easily reproducible. This is an institutional review board-approved prospective study of 15 children (11 male, 4 female) with non-syndromic sagittal suture synostosis. All patients were treated with a sagittal strip craniectomy and placement of 2 omega-shaped stainless steel springs at a mean age of 3.9 months. Patients were followed clinically and with cephalograms; after reossification of the intervening bone, the springs were removed at a mean age of 8.2 months. The mean force applied at initial placement of the springs was 6.9 N, and the mean spring deflection at formation was 6.87 cm. All patients completed the study protocol without any significant morbidity or any mortality. Perioperative variables, including blood loss, transfusion rate, operative time, intensive care unit stay, hospital stay, and hospital charges, were all significantly less (P < 0.05) in this study group compared with children with the same diagnosis treated with cranial vault reshaping during the same period. Furthermore, the preoperative mean cephalic index of 64.3 corrected to 77.6 after surgery and was maintained over time. Spring-mediated cranial reshaping is efficacious and safe for the treatment of sagittal synostosis. Long-term study of cranial development and clinical morphology are ongoing to validate further the effectiveness of this treatment modality.

Cephalometry↗
PubMed2004

Personal experience with the Whipple operation: outcomes and lessons learned.

Pancreaticoduodenectomy (PD) has evolved into a safe procedure in major high-volume medical centers. This retrospective outcome review is from a database of 134 consecutive PDs from 1985 through 2002; all of whom underwent resection in a community hospital with a general surgery residency. All resections were performed by senior residents under the supervision of the same attending surgeon (V.L.H.). Follow-up was 100 per cent. There were 117 (88%) pyloric-sparing pancreaticoduodenectomies (PSPD) and 17 (12%) standard Whipple (SW) operations. Mean age for patients was 60 years with a range 29 to 84 years. There were 62 female and 72 male patients. Resections performed were periampullary malignancies, 83.6 per cent; benign neoplasm, 3.7 per cent; and non-neoplastic disease, 12.7 per cent. For the pancreatic anastomoses, 84 (63%) were pancreaticogastrostomies (PGs) and 50 (37%) were pancreaticojejunostomies (PJs). Mortality was 3.7 per cent, and 60 major complications occurred in 38 patients (28%) which included pancreatic fistula, 5.2 per cent; bile leak, 0.7 per cent; other anastomotic leaks, 1.5 per cent; intra-abdominal abscesses, 8.2 per cent; intra-abdominal bleeding, 3.0 per cent; upper gastrointestinal bleeding, 3.7 per cent; bowel ischemia, 1.5 per cent; and delayed gastric emptying (DGE), 17.9 per cent. Reoperation was required in only five patients (3.7%). There were no complications in 96 patients (72%) with an average hospital stay of 9.0 days. Long-term complications were peptic ulcer disease, liver abscess, hepatic stones, pancreatic insufficiency, and radiation jejunal strictures. Long-term survival was achieved in periampullary malignancies including pancreatic with excellent functional status.

Adenocarcinoma↗
PubMed2003

Double myelomeningocele: case report and review.

The presence of a myelomeningocele at multiple levels along the spinal column is a rare event. There are only a few cases of double myelomeningocele reported in the world's literature. Large myelomeningoceles present surgical closure challenges due to the size and location of these defects. We report the case of a newborn female who had two myelomeningoceles with one at the thoracic level and the other at the lumbar level. Surgical closure must provide durable and stable coverage for the spinal cord. Stable coverage was provided for this patient using bilateral paraspinous myofascial turnover flaps. This unusual case report as well as a review of the literature is presented.

Female↗
PubMed2003

Efficacy of pulse dye laser therapy for the treatment of ulcerated haemangiomas: a review of 78 patients.

BACKGROUND: Haemangiomas are common vascular lesions occurring in up to 10-12% of infants by 1 year of age. Typically, these lesions are treated expectantly unless complicated by haemorrhage, ulceration, infection, or compromise of adjacent vital structures. Ulceration is a particularly difficult problem because of associated pain, infection, haemorrhage, and subsequent scarring. MATERIALS AND METHODS: Seventy-eight children (54 girls, 24 boys) with ulcerated haemangiomas, from our vascular malformation clinic were enrolled in a prospective pulse dye laser treatment protocol from April of 1995 to November of 2001. The mean size of the ulcerated haemangiomas requiring treatment was 21 cm2. Lesions were treated with minimal debridement and the Cynosure pulse dye laser with a mean energy of 6.6 J, and a mean number of 173 pulses per treatment. Lesions were treated in a sequential pattern at 3-4 week intervals until cutaneous healing or involution of the haemangioma occurred. RESULTS: Seventy-one of the 78 patients (91%) responded to laser therapy alone with a mean number of 2.0 treatments. Six patients with very large haemangiomas required oral steroids (2-3 mg/kg/day) in combination with the pulse dye laser. After failing to improve on steroid therapy, two patients required the addition of interferon to their treatment protocol. The mean follow up time is 15 months with no sign of recurrent ulceration or regrowth of the haemangiomas in our study population. SUMMARY: Pulse dye laser therapy is a reasonably effective means of resolving the untoward complication of ulceration of haemangiomas. We report the largest series to date of ulcerated haemangiomas treated with this modality.

Facial Neoplasms↗
PubMed2003

Cost-based analysis of the treatment of mandibular fractures in a tertiary care center.

BACKGROUND: The objective of this study was to assess the cost effectiveness of alternative treatment algorithms for the management of isolated mandibular fractures. METHODS: This is an institutional review board-approved retrospective study consisting of a chart review of 25 patients who underwent operative repair of an isolated mandible fracture between July 1, 1999, and June 30, 2000. Patients were stratified into two groups: patients who were immediately admitted to the hospital from the emergency department (ED) versus patients who were discharged from the ED and who returned for elective scheduled operative repair. Patients' total hospital charges were compared on the basis of operating room (OR) time, operative materials, and hospital charges. RESULTS: Seventeen of the study patients were directly admitted from the ED, and eight underwent elective scheduled operative repair. Of the patients directly admitted from the ED, the mean age was 34.9 years (range, 19-57 years), and the study population consisted of 16 men and 1 woman. This group had a mean OR time of 161 minutes, a mean OR time charge of $1,978.66, a mean OR supply charge of 1,049.43 US dollars, a mean hospital floor charge of 5,041.02 US dollars, and an average hospital stay of 2.82 days. The treatment group of patients undergoing scheduled operative repair (n = 8) had a mean age of 30.3 years (range, 19-49 years), and all were men. This second treatment group had a mean OR time of 167.1 minutes, a mean OR time charge of 2,162.03 US dollars, a mean OR supply charge of 871.00 US dollars, a mean hospital floor charge of 2,759.38 US dollars, and a mean hospital stay of 0.88 days. Comparison of the two study groups demonstrated operative charges were made on the basis of time and materials and were shown to have no statistically significant difference (p = 0.753 and p = 0.289, respectively). Comparison of hospital charges revealed that patients admitted directly from the ED had a mean charge 2,276.70 US dollars higher (p = 0.019) and stayed 1.95 days longer in the hospital than patients discharged from the emergency department who returned for elective scheduled repair. There were two complications in the study patients; both occurred in the group admitted directly from the emergency room. CONCLUSION: The results of this study indicate that the most cost-effective management of an isolated mandibular fracture is initial evaluation in the ED with elective interval operative repair. This management protocol is, of course, only applicable if the patient is clinically stable and has no other injuries or comorbidities necessitating in-hospital observation.

Adult↗
PubMed2003

Surgical advancement influences perioperative care: a comparison of two surgical techniques for sagittal craniosynostosis repair.

Methods for surgical correction of sagittal craniosynostosis have progressed. The hypothesis is that advances in surgical interventions for craniosynostosis affect perioperative anesthetic care. We reviewed the records of eight children who underwent cranial vault reconstruction (CVR) and nine who underwent spring-mediated cranial expansion (SME) for sagittal craniosynostosis. We compared the data from the CVR procedure to data from the combined procedures for SME (insertion and removal of springs). Anesthesia times were similar between the CVR (4 h 24 min) and the combined SME (4 h 27 min) groups, whereas surgical times were different between the CVR (3 h 25 min) and combined SME groups (2 h 21 min) (P = 0.002). Length of stay was 4.1 days for the CVR group (confidence interval [CI], 3.8-4.4 days) versus 3.1 days (CI, 2.9-3.4 days) in the combined SME group (P = 0.0001). Blood loss was significantly less in the combined SME group at 48 mL (CI, 29-83 mL) compared with the CVR group at 291 mL (CI, 230-352 mL). All eight patients in the CVR group received blood with a mean of 1.4 U (range, 1-2 U). No SME patient received any blood products. The reduction in blood loss with this new surgical treatment is significant for the patient in reducing blood transfusion and for the anesthesiologist in reducing concerns of volume resuscitation.

Adolescent↗
PubMed2002

Clinical findings precede objective diagnostic testing in the identification of increased ICP in syndromic craniosynostosis.

Crouzon syndrome is an autosomal dominant disorder resulting in facial dysmorphism and craniosynostosis involving multiple cranial sutures. A common but often unrecognized early complication associated with craniosynostosis is a finding of increased intracranial pressure (ICP). This increase in ICP can lead to optic atrophy, neuronal damage, and mental deficits. The case of a 21-month-old girl with Crouzon syndrome is described. Although the child was clinically asymptomatic, a routine ophthalmic exam revealed papilledema and subsequently increased intracranial pressure and craniosynostosis were found. Cranial expansion and bicanthal advancement were performed to relieve the increased pressure. In cases such as these, long-term follow-up is essential because of the progressive nature of the disorder as well as the possibility of a recurrence of elevated intracranial pressure and a need for secondary decompressive surgery.

Craniofacial Dysostosis↗
PubMed2002

Dynamic spring-mediated cranioplasty in a rabbit model.

Since the beginning of craniofacial surgery, there has been an ongoing search for surgical techniques to enhance outcome while, at the same time, decreasing the invasiveness of the surgical treatment of craniofacial deformities. The purpose of this study was to test a recently reported minimally invasive treatment modality, the dynamic spring, in a rabbit calvarial model for efficacy and safety. Specifically, the results of spring cranioplasty on skull growth, the underlying brain, and adjacent bone were to be assessed. The study population consisted of 36 7-week-old New Zealand white rabbits. The rabbits were divided into four treatment groups (9 rabbits each): control, sham surgery, stainless steel springs, and memory metal springs. Postoperative analysis included weekly radiographs to evaluate movement of amalgam markers placed at standardized locations. Additionally, 16 rabbits (4 from each group) were killed at 14 days after surgery, and postmortem histological analysis was done. The remaining rabbits were followed until they were adults and were then killed and similarly analyzed. No morbidity or mortality occurred in the immediate perioperative period secondary to the surgery. Postmortem histological analysis of all study animals revealed no intracranial, subcutaneous, or skin infections and no technical complications related to the surgery. Statistical analysis using ANOVA and pair-wise comparisons between treatment groups revealed a statistically significant difference (P < 0.05) between the marker movement in the spring groups versus the sham and control groups. There were no significant differences between the sham and control groups or between the two spring groups. In conclusion, this study confirms the efficacy and safety of the dynamic spring in a rabbit model.

Analysis of Variance↗
PubMedDate not supplied

Breast asymmetry: presentation of a giant fibroadenoma.

Patients often present to plastic surgeons with breast asymmetry of unknown etiology. Many patients are females in late adolescence and present complaining of a hypoplastic breast on the smaller side. However, full evaluation may reveal that the larger breast contains the abnormality. Fibroadenomas typically present as firm, mobile, painless, easily palpable breast nodules. However, giant fibroadenomas can present as unilateral macromastia without definable borders or texture differences. Diagnosis is essential since fibroadenomas tend to persist and grow. However, physical examination and standard radiographic evaluations (mammograms and ultrasounds) fail to clarify the diagnosis in many cases. Magnetic resonance imaging (MRI) has improved preoperative diagnosis, but tissue diagnosis is frequently necessary and resection of giant fibroadenomas is essential as they enlarge to the point of causing psychological detriment or mass effects, including venous congestion, glandular distortion, pressure necrosis, and occasionally ulceration. In this article we review nine patients presenting with unilateral macromastia to a tertiary breast care center with a review of the pertinent literature. The differential diagnosis, evaluation modalities, and treatment options of breast asymmetry and unilateral breast masses are presented. Postexcision breast reconstruction is discussed.

Adolescent↗