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Proceedings of the 57th Annual Scientific Meeting

Southeastern Society of Plastic and Reconstruction Surgeons

June 8-12, 2014Atlantis Resort, Paradise Island, Nassau – Bahamas

On behalf of the Board of the Southeastern Society of Plastic and Reconstructive Surgeons I would like to welcome you to the Atlantis Resort on Paradise Island in the Bahamas. The resort is a fabulous venue for combining learning with relaxation and fun with family and fellow Southeasterners. Dr. Kevin Hagan has put together a great program which should provide you with the latest information in many areas of our specialty as well as providing details on the new affordable care act. Dr. Joe

MacInnis a world-renowned deep-sea underwater explorer will not only be our keynote speaker, but he is also organizing a scuba diving expedition for those who are qualified and interested. There are a great number of water activities at the resort, including a dolphin and sea lion encounter at Dolphin Cay. We have organized a luncheon with paired wine tasting at Graycliff restaurant that boasts the 2nd largest wine cellar in the world. It also has a cigar making and chocolate factory that are well worth visiting.

It is our sincere hope that you will enjoy and take full advantage of both the great educational program along with all of the fun in the sun.

Harold I. Friedman, MD, PhD President, 2013-2014

PRESIDENTIAL WELCOME

3Atlantis Resort | Paradise Island, Nassau | June 8-12, 2014

5 SESPRS Officers & Trustees

6-7 Week At A-Glance

8-11 Social-Recreational-Spouse Events

12 Program Objectives

13 Disclosure Policies & Accreditation

14-23 Scientific Program

24-83 Abstracts

84-91 Posters for Presentation

92-93 Past Presidents

94-95 Past Upchurch Lecturers

96 Past Jurkiewicz Lecturers

97 Future SESPRS Meetings

98-101 Society Awards

102-129 Member Roster

130-139 Geographical Roster

140-143 Notes

TABLE OF CONTENTS

4 SESPRS 57th Annual Scientific Meeting

Atlantis Resort1 Casino Drive

Paradise Island, Nassau - Bahamas

242-363-3000

www.atlantis.com


PRESIDENTHarold I. FriedmanColumbia, South Carolina

PRESIDENT-ELECTHenry C. VasconezLexington, Kentucky

VICE-PRESIDENTKevin F. HaganNashville, Tennessee

SECRETARYBraun H. GrahamSarasota, Florida

ASSISTANT SECRETARYStephan Finical Charlotte, North Carolina

TREASURERWalter L. Erhardt, Jr.Albany, Georgia

HISTORIANJorge de la TorreBirmingham, Alabama

PARLIAMENTARIANMark A. CodnerAtlanta, Georgia

PAST PRESIDENT AND TRUSTEEAnn Ford-Reilley Baton Rouge, Louisiana

TRUSTEESPeter C. HainesColumbia, South Carolina

C. Scott HultmanChapel Hill, North Carolina

John LindseyMetairie, Louisiana

Albert LoskenAtlanta, Georgia

Bruce A. MastGainesville, Florida

John SparrowJackson, Tennessee

The Society By-laws and Policy Manual may be found online though our website: www.sesprs.org

OFFICERS AND TRUSTEES


WEEK AT A GLANCE

SUNDAYJUNE 8

8:00amBoard Meeting

3:00pmRegistration open

3:00-5:00pmPoster Session - Evaluation and Grading

6:00-8:00pmWelcome Reception

7:30-10:00pmPast President’s Dinner

MONDAYJUNE 9

SCIENTIFIC SESSION

6:30am Registration open, Breakfast

7:30am Welcome & Society Reports

8:00am Face Panel: “It’s More Than the Lift”

9:00am Resident Competition Papers

9:40am Lightning Rounds Papers

10:00am Break, Exhibits, Posters

10:30am Keynote Speaker: Dr. Joe McGinnis “Deep Leadership: Lessons from the James Cameron-National Geographic 7-Mile Dive into the Mariana Trench”

11:30am Member Papers

12:00pm Resident Jeopardy Bowl

SOCIAL EVENTS

8:00-10:00am

Spouse Hospitality Suite

12:00-5:00pm

Dive Trip

1:30pm Golf Tournament

7:00pm Theme Dinner

TUESDAYJUNE 10

SCIENTIFIC SESSION


7:30am Resident Competition Papers

8:15am Member papers

9:00am Health Care Reform and the Affordable Care Act - Dr. John Mcdonough


10:30am Panel: Where is Healthcare Headed?

12:00pm Upchurch Lecture - Foad Nahai, “Half Century not Cricket”

1:30pm Teaching course: IV Sedation

SOCIAL EVENTS

6:00am Fun Run

8:00-10:00am


1:30-5:30pm

Tennis Tournament

4:00pm Toast to Trudy Reception

Dinner on your own


WEEK AT A GLANCE

WEDNESDAYJUNE 11

SCIENTIFIC SESSION


6:30am Faculty Development Panel

7:00am Problems and Pearls

8:30am Research grant award and reports from research grant and Aesthetic fellowship recipient



10:30am Lightning Rounds Papers

11:00am Lecture: Barrera, “Hair Transplant”

12:00pm Business Meeting

12:00pm Resident’s Luncheon with Barrera “Tips to Build a Successful Practice”

12:30pm Board Meeting

SOCIAL EVENTS

8:00-10:00am


7:00-11:00pm

Black Tie Reception and Dinner

THURSDAYJUNE 12

SCIENTIFIC SESSION


8:00am Panel: Safety and Communication in Plastic Surgery

9:00am Panel: Pain Control in the Outpatient Setting



11:30am Panel: Ready-for-Prime-Time Technologies in Hand Surgery

12:30pm Closing Remarks

SOCIAL EVENTS

8:00-10:00am



SOCIAL / RECREATIONAL / SPOUSE EVENTS


All paid meeting registrants, spouse, children and guests are eligible to attend the events below but must be registered. Several events require additional registration fees. Our Black Tie event has an age restriction of 16 or older. See the SESPRS Registration Desk for details related to any events.

SUNDAY, JUNE 8

3:00 – 5:00 pm Early Registration and Poster Session Grand Ballroom C Beverages will be served 6:00 – 8:00 pm Welcome Reception Dig Deck- Royal Tower

7:00 – 10:00 pm Past Presidents Reception and Dinner Olives – Royal Tower By Invitation Only. See Registration Desk for details. Dinner on your own. Reservations highly recommended.

MONDAY, JUNE 9

8:00 – 10:00 am Spouse Hospitality Suite Imperial Club – 19th Floor Registered Spouse & family welcome Royal Tower

12:30 pm Special Dive Tour Guided by Dr. Joe MacinnisRegistration prior to meeting required. Tour limited to 20. Transportation to and from the tour will be provided. The shuttle will depart the Royal Tower outside motor lobby promptly at 12:30 pm. Registered tour guests are responsible to make their way to the transportation area. Additional fee applies.




MONDAY, JUNE 9 (CONTINUED)

12:45 pm Annual Golf Tournament Ocean Club CourseSeparate Registration Required – boxed lunch provided.Transportation to and from the course will be provided. The shuttle will depart the Royal Tower outside motor lobby promptly at 12:45 pm. Registered golfers are responsible to make their way to the transportation area. Modified Shotgun start promptly at 1:30 pm. Additional fee applies.

7:00 – 10:00 pm Theme Dinner – “Under The Sea” Royal Deck-Royal Tower Open to all paid registrants. Festive attire. Children of all ages welcome! See the Registration Desk for Details.

TUESDAY, JUNE 10


6:30 am Annual Fun Run Royal Tower LobbyRegistration preferred but not required. No Charge. Participants should meet in the lobby of the Royal Tower at 6:15 am.

12:00 – 3:00 pm Graycliff Wine Pairings LuncheonRegistration required, tour is limited to 25. Transportation to and from the tour will be provided. The shuttle will depart the Royal Tower outside motor lobby promptly at 12:00 pm. Registered tour guests are responsible to make their way to the transportation area. See the Registration desk for details. Additional fee applies.

2:00 – 5:00 pm Annual Tennis Tournament Atlantis Tennis CourtsRegistration is required. On property shuttle transportation should be taken from the Royal or Coral Towers to the tennis courts. Shuttles run approximately every 8-10 minutes. Please be at the tennis courts by 1:45 pm. Additional fee applies.


TUESDAY, JUNE 10 (CONTINUED)

4:00 – 6:00 pm Toast to Trudie Imperial Club Reception for Women in Plastic Surgery Royal Tower – 19th Floor Registration preferred. Host: Ann Ford Reilley, MD

Dinner on your own. Reservations highly recommended.

WEDNESDAY, JUNE 11


12:00 pm Resident Luncheon with Dr. Barrera Imperial Club “Tips to Build a Successful Practice Royal Tower –19th Floor A 28-Year Experience” Registration Required.

7:00 – 11:00 pm Black Tie Reception and Dinner Grand Ballroom E-GOpen to paid registrants 16 and older. Separate registration required for exhibitors. Registrants are asked to RSVP in advance of the meeting.Resident’s of the Glancy Award Competition are complimentary all other Resident’s and Spouse’s separate registration is required. See the registration desk for details.

Atlantis has many children’s activities that may be arranged through the hotel directly. Babysitting services are available through Atlantis. Reservations are required in advance.



Upon completion of this meeting, participants should be able to:

• Describe ancillary techniques to enhance the overall effects of facial rejuvenation surgery.

• Access the underlying theory behind, and ramifications of, the Affordable Care Act and health care reform in general.

• Evaluate ways in which the changes in healthcare delivery in the coming years may affect the practice of plastic surgery.

• Synthesize the latest techniques of hair transplantation into current knowledge, and apply these techniques as ancillary procedures in a plastic surgery practice.

• Discuss the latest advances in hand surgery.

• Distinguish critical elements in setting up a successful practice of Plastic Surgery.

• Apply the most up-to-date techniques for safely controlling post-operative pain in the outpatient setting.

• Connect communication and adherence to recognized safety standards to the prevention of surgical complications.

• Describe the history of aesthetic plastic surgery, including the disruptive products and procedures that influenced the evolution of aesthetic surgery, and consider how to apply these lessons to the practice of medicine today and in the future.

• Discuss advances and new approaches incorporated by our members in a variety of areas including craniofacial, aesthetic, reconstructive breast surgery, and general reconstructive techniques.

• Apply new knowledge or strategies to his/her practice of medicine.

PROGRAM OBJECTIVES


SESPRS DISCLOSURE POLICY As a provider accredited by the ACCME, SESPRS must ensure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored educational activities. All planners, presenters and faculty members are required to disclose all relevant financial relationships with commercial interests in advance of the activity. All individuals responsible for the content of any SESPRS educational activity must disclose. Anyone who refuses to disclose will be removed. All disclosures are reviewed by the SESPRS ACCME Committee, and conflicts of interest are identified and managed in advance of the activity. Management takes place either through recusal, limiting participation, peer review, or divestment of the relationship. All planners, presenters and faculty members’ disclosures will be provided to the audience in advance of the activity via slides. Additionally, all presenter disclosures will be announced verbally. Additionally, if any unapproved or off-label use of a product is to be referenced in a CME program presentation, the faculty member/participant is required to disclose that the product is either investigational or it is not labeled for the usage being discussed. SESPRS shall convey any information disclosed by the faculty member/participant to the CME program audience prior to the activity.

COMMERCIAL SUPPORT DISCLOSUREContributions have been received from more than one company. Commercial contributors acknowledge that the Accredited Provider (SESPRS) will make all decisions regarding the disposition and disbursement of contributions and/or commercial support and that the funding received from each company will in no way affect; the identification of

CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content of the CME, selection of educational methods, or evaluation of the activity. Per the ACCME Standards for Commercial Support, the SESPRS will ensure that no contribution or commercial support will be used to pay for travel, honoraria, or personal expenses for non-teacher or non-author participants associated with the CME activity. The SESPRS will, as requested, provide documentation detailing the receipt and expenditure of the commercial support. Commercial contributors also agree that it will provide no other support of any type, whether financial, travel, speaker’s bureau funding for a particular faculty member, or in kind support for any speaker at the meeting to which this agreement pertains. We plan to acknowledge fully the contribution from all commercial contributors in conference materials in conjunction with the meeting, and in other ways as applicable according to the guidelines of our program.

ACCREDITATION The Southeastern Society of Plastic and Reconstructive Surgeons is accredited by the Accreditation Council for Continuing Medical Education in order to provide continuing medical education for physicians. The Southeastern Society of Plastic and Reconstructive Surgeons designates this live activity for a MAXIMUM of 17 CME CATEGORY 1 CREDITS toward the AMA Physician’s Recognition Award. Physicians should claim only the credit commensurate with the extent of their participation in the live activity. Of the 17 credits, 2 have been identified as applicable to patient safety.

DISCLOSURE POLICIES & ACCREDITATION


SCIENTIFIC PROGRAM SCHEDULE

SUNDAY, JUNE 8

3:00 – 5:00 pm Poster Session, Evaluation Grand Ballroom C 4:00 – 6:00 pm Early Registration Grand Foyer


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MONDAY, JUNE 9

6:30 am Registration Open Grand Foyer 6:30 – 7:30 am Continental Breakfast Grand Ballroom A-C Visit Exhibits and Poster Viewing 7:30 - 8:00 am Welcome and Society Reports Grand Ballroom D ASPS - Robert X. Murphy, Jr., MD ASAPS - Michael C. Edwards, MD 8:00 – 9:00 am Face Panel Grand Ballroom D “It’s More Than the Lift” Braun Graham, Alfonso Barrera, Mark Codner, Bruce Mast, James Grotting 9:00 – 9:40 am Resident Competition Papers (7 minutes each) Grand Ballroom D Moderator: Bruce Mast Secretary: Peter Arnold

#1 “The Benefits on Margin Control of the Oncoplastic Reduction Approach to Breast Conservation Therapy” (p. 25)Ximena Pinell-White – Emory University

#2 “Effectiveness and Safety of Autologous Fat Grafting to the Soft Palate Alone” (p. 26)Cristiano Boneti – University of Alabama

#3 “The Utility of Composite Flexor Tendon Allografts for Hand and Upper Extremity Reconstruction” (p. 27)Brent DeGeorge – The University of Virginia Health System

#4 “VAC Therapy to the Brain: A Safe Method for Wound Temporization in Complex Scalp and Calvarial Defects” (p. 28-29)Noah Prince – University of Florida

9:40 – 10:00 am Lightning Rounds (3 minutes each) Grand Ballroom D

#1 “Impact of Diabetes Mellitus on complications in Breast Reconstruction” (p. 30)Carrie Chu

SCIENTIFIC PROGRAM


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#2 “Pedicled TRAM in the Era of Microsurgical Breast Reconstruction – Is There Still a Role?” (p. 31)Samuel Shih

#3 “The Effects of Breast Reconstruction on Adjuvant Therapy in Breast Carcinoma Patients” (p. 32-32)Galen Perdikis

10:00 – 10:30 am Break – Visit Exhibits and Poster Viewing Grand Ballroom A-C 10:30 – 11:30 am Keynote Speaker: Grand Ballroom D “Deep Leadership: Lessons From the James Cameron- National Geographic 7-Mile Dive Into the Mariana Trench” Joe MacInnis 11:30 – 12:00 pm Member Papers (7 minutes each) Grand Ballroom D Moderator: Monique Abner Secretary: Andrea Pozez #1 “Craniofacial Fracture Patterns in All-Terrain Vehicle Injuries” (p. 34-35) Angel Rivera-Barrios

#2 “Four Cranial-Plate Total Vault Remodeling in Correction of Sagittal Craniosynostosis: Description of a Refined Technique Over 30 Years and Review of the Last Fifty Cases” (p. 36-37)Larry Sargent

#3 “A Plea for the Abandonment of One Stage Bilateral Cleft Lip Repairs” (p. 38) Anthony Wolfe

12:00 - 1:00 pm Resident Jeopardy Bowl Grand Ballroom D

SCIENTIFIC PROGRAM


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TUESDAY, JUNE 10

6:30 am Registration Open Grand Foyer 6:30 – 7:30 am Continental Breakfast Grand Ballroom A-C Visit Exhibits and Poster Viewing 7:30 - 8:15 am Resident Competition Papers (7 minutes each) Grand Ballroom D Moderator: Daniel Haynes Secretary: Holly Wall

#5 “Mastectomy Skin Flap Stabilization: Preventing Seromas and Decreasing Duration of Drain Time in Tissue Expander Based Breast Reconstruction” (p. 39-40)Devan Griner – University of Tennessee

#6 “The Role of Hedgehog Inhibitor Therapy in the Surgical Treatment of Extensive Basal Cell Carcinoma” (p. 41-43)Jessica Ching – University of South Florida

#7 “The Role of Obesity and Breast Adipose Tissue in Breast Cancer Formation” (p. 44-45)Naveen Kumar – Duke University

#8 “Replantation Outcomes at a Specialized Regional Replant Center: Should We Give Them the Finger?” (p. 46)Christopher Sanders – Louisiana State University

8:15 – 9:00 am Member Papers (7 minutes each) Grand Ballroom D Moderator: Galen Perdikis Secretary: Adam Katz

#4 “Comparison of Allergan, Mentor and Sientra Anatomic Cohesive Gel Breast Implants: A Single Surgeon’s 10-Year Experience” (p. 47-49)Erin Doren

#5 “A Reconstructive Algorithm and Outcome Analysis for the Correction of Breast Conservation Therapy (BCT) Deformities” (p. 50)Albert Losken

SCIENTIFIC PROGRAM


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#6 “Acellular Dermal Matrix Performance Comparing to Latissimus Dorsi Myocutaneous Flap in Expander-Based Breast Reconstruction: Postoperative Outcomes and Patient Satisfaction” (p. 51-53)Badr Al Majed

#7 “A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expansion Breast Reconstruction: Long Term Aesthetic Outcomes and Capsular Contracture” (p. 54)Michael Lynch

9:00 – 10:00 am Special Guest Lecture Grand Ballroom D “Health Care Reform and the Affordable Care Act” John McDonough 10:00 – 10:30 am Break – Visit Exhibits and Poster Viewing Grand Ballroom A-C 10:30 – 12:00 pm Healthcare Panel Grand Ballroom D “Where is Healthcare Headed?” John McDonough, Jim Moore, Cole Goodman, Scott Corlew 12:00 – 1:00 pm Upchurch Lecture Grand Ballroom D “Half Century Not Cricket” Foad Nahai 1:30 – 3:30 pm Special Teaching Course Location TBD “The Use of IV Sedation and TIVA in Aesthetic Plastic Surgery A 29 Year Experience” Alfonso Barrera Separate Registration Required – Lunch provided

SCIENTIFIC PROGRAM


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SCIENTIFIC PROGRAM

WEDNESDAY, JUNE 11

6:30 am Registration Open Grand Foyer 6:30 am Faculty Development Panel Grand Ballroom D Registration preferred but not required. Jorge de la Torre 6:30 – 7:30 am Continental Breakfast Grand Ballroom A-C Visit Exhibits and Poster Viewing 7:30 – 8:30 am Problems and Pearls Grand Ballroom D Scott Hultman 8:30 – 9:00 am Research Grant Award & Aesthetic Fellowship Reports Moderator: Bruce Mast 2013 Research Grant Report – Sherry Collawn, “Role of Adipose- Derived Stromal Cell Conditioned Media in Wound Healing” 2013 Aesthetic Fellowship Report – Michael Leyngold 9:00 – 10:00 am Member Papers (7 minutes each) Grand Ballroom D Moderator: Peter Haines Secretary: Elliott Chen

#8 “A Novel Approach for the Treatment of Spider Veins” (p. 55-56)Mirsad Mujadzic

#9 “Lower Extremity Reconstruction After Limb-sparing Sarcoma Resection in the Pediatric Population: Case Series, With Algorithm” (p. 57)Jon Ver Halen

#10 “Anatomical Consideration and Clinical Results of Extended Component Separation” (p. 58)Mirsad Mujadzic

#11 “Autologous Fat Grafting With Laser-Assisted Facelifts” (p. 59)Sherry Collawn


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#12 “Stuck in a Moment: An Ex Ante Analysis of Unsolicited Patient Complaints in Plastic Surgery, Dermatology, and Surgery, to Predict Malpractice Risk Profile, in a National Cohort of Physicians from the Patient Advocacy Reporting System (PARS)” (p. 60-61)C. Scott Hultman

#13 “Reconstruction of Scalp Defects with Dermal Regenerative Template: A Comparative Review of Metanalysis” (p. 62)Nneamaka Agochukwu

10:00 – 10:30 am Break – Visit Exhibits and Poster Viewing Grand Ballroom A-C 10:30 – 11:00 am Lightning Rounds (3 minutes each) Grand Ballroom D Moderator: Brian Rinker Secretary: Ashley Lentz

#4 “Twenty-Five Year Experience Using Metal Mesh Reconstruction of 524 Internal Orbital Fractures by a Single Surgeon” (p. 63)Devan Griner

#5 “Efficacy of Intense Pulsed Light in the Treatment of Burn Scar Dischromia” (p. 64)Renee Edkins

#6 “Targeting SGK-1 in Head and Neck Cancer: A Novel Midality of Local Control” (p. 65-66)Henrik Berdel

#7 “High Volume Hydrodissection: Assessment of DIEP Flap Perfusion Utilizing Laser Doppler” (p. 67-68)Ashley Lentz

#8 “The Effect of Progressive-Tension Closure on Donor Site Seroma Formation in Delayed Latissimus Dorsi Flaps for Breast Reconstruction” (p. 69-70)Lesley Landis

SCIENTIFIC PROGRAM


WED

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SCIENTIFIC PROGRAM

11:00 – 12:00 pm Special Guest Lecture Grand Ballroom D “Incorporating Hair Transplantation Into Your Aesthetic Surgery Practice” Alfonso Barrera 12:00 pm SESPRS Annual Business Meeting Grand Ballroom D 12:00 pm Resident Luncheon with Dr. Barrera Imperial Club “Tips to Build a Successful Practice Royal Tower –19th Floor a 28-Year Experience”


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THURSDAY, JUNE 12

7:00 am Registration Open Grand Foyer 7:00 – 8:00 am Continental Breakfast Grand Ballroom A-C Visit Exhibits and Poster Viewing 8:00 – 9:00 am Safety Panel Grand Ballroom D “Safety and Communication in Plastic Surgery” Galen Perdikis and Monte Eaves 9:00 – 9:45 am Pain Control Panel – “Pain Control in the Grand Ballroom D Outpatient Setting”

“A Multi-modal Analgesia Regimen for Plastic Surgery” (p. 71) James A. Ramsey, MD “Two Years Experience with Liposome Bupivacaine” Stephan Finical

9:45 – 10:00 am Lightning Rounds (3 minutes each) Grand Ballroom D Moderator: Kevin Hagan

#10 “The Incorporation of Liposome Bupivacaine Into an Opiod-Sparing Strategy for Patients Undergoing Rhytidectomy” (p. 72)Daniel Man

#11 “Efficacy of Liposomal Bupivacaine in Plastic and Breast Surgery” (p. 73)Nathan Eberle

#12 “Improving Comfort and Throughput for Patients Undergoing Fractionated Laser Ablation of Symptomatic Burn Scars” (p. 74)Renee Edkins

10:00 – 10:30 am Break – Visit Exhibits and Poster Viewing Grand Ballroom A-C

SCIENTIFIC PROGRAM


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SCIENTIFIC PROGRAM

10:30 – 11:30 am Member Papers (7 minutes each) Grand Ballroom D Moderator: David Drake Secretary: Kent Higdon

#14 “The Retrograde Internal Mammary System: Default Recipient Vessels for Stacked Perforator Flap Breast Reconstruction” (p. 75-76)Mark Stadler

#15 “Feraheme Enhanced Magnetic Resonance Angiography Evaluation of Deep Inferior Epigastric Perforator Flap Vasculature: Early Experience” (p. 77-78)Stephanie Koonce

#16 “The Impact of Laser-Assisted Indocyanine Green Dye Fluorescent Angiographic on Fat Necrosis in DIEP Free Flap Breast Reconstruction” (p. 79)James Mayo

#17 “The Use of Reduction Mammaplasty with Breast Conservation Therapy: An Analysis of Timing and Outcomes” (p. 80)Albert Losken

** #18 “Bovine Fetal Dermal Collagen Matrix Modulates Alpha Smooth Muscle Actin Accumulation in Full Thickness Skin Wounds” (p.81-82)William Lineaweaver

11:30 – 12:30 pm Hand Panel Grand Ballroom D “Ready-for-Prime-Time Technologies in Hand Surgery” Brian Rinker, Wyndell Merritt, David Friedman, Wesley Thayer 12:30 pm Closing Remarks Henry Vasconez

Meeting Adjourns

** Member paper #18 is not available for CME Credit


ABSTRACTS


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RESIDENT COMPETITION .................. 9:00-9:40am

#1 “The Benefits on Margin Control of the Oncoplastic Reduction Approach to Breast Conservation Therapy” Ximena Pinell-White MD, Alexandra M. Hart MD, Alessandrina M. Freitas MD, Grant W. Carlson MD, Toncred M. Styblo MD, Albert Losken MD

BACKGROUND: Breast conservation therapy (BCT) achieves locoregional control by excision of margins of uninvolved breast tissue and adjuvant radiotherapy. Oncoplastic surgery has emerged to improve aesthetic results following BCT, but the oncologic impact of wider resections has not been described.

METHODS: This is a retrospective review of all patients who underwent BCT by a single oncologic surgeon between 2009 and 2013. Patients who underwent oncoplastic reduction at the time of BCT were compared to those who underwent pure lumpectomy in terms of incidence of positive margins, need for reexcision, and conversion to mastectomy.

RESULTS: 207 patients underwent BCT to 222 breasts during the period studied, 83 of which (37.4%) had an adjunctive oncoplastic procedure. Oncoplastic patients had a lower incidence of positive margins (24.1% vs. 41.0%, p=0.01), less often required reexcision (12.0% vs. 25.9%, p=0.01), and less frequently went on to completion mastectomy (2.4% vs. 9.4%, p=0.05). Resection specimens revealed wider margins when oncoplastic surgery was performed (4.3 vs. 2.8 mm, p=0.01). Patients who underwent oncoplastic surgery were noted to be younger and to have more advanced stage cancer, but controlling for these variables on multivariate analysis, the oncoplastic technique was independently associated with fewer positive margins and reexcisions.

CONCLUSIONS: Oncoplastic surgery achieves wider resections around a cancer and thus less often necessitates reexcision or subsequent mastectomy. The long-term oncologic impact of this practice deserves further study.


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#2 “Effectiveness and Safety of Autologous Fat Grafting to the Soft Palate Alone”Boneti, C; Ray, PD; Macklem, EB; Kohanzadeh, S; de la Torre, J; Grant, JH

BACKGROUND: Posterior pharyngeal augmentation is an accepted method of treating velopharyngeal insufficiency (VPI). Techniques using autologous fat harvest, preparation and grafting are well-described. Based on complications from retropharyngeal injection, we perform augmentation of the nasal surface of the palate to reduce hypernasality with decreased risks.

METHODS: After IRB approval, a chart review from 2010 to 2013 identified 46 patients with cleft palate, subjective and nasoendoscopic evidence of VPI treated with autologous fat grafting to the soft palate. Speech evaluation of velopharyngeal function was compared before and after autologous fat grafting.

RESULTS: A total of 61 autologous fat grafting procedures were performed in 46 patients. The average age of the study population is 5.59±2.05 years. The majority underwent a single procedure (32/46 or 69.6%), 13/46(28.2%) had two fat grafting procedures and only 1 patient (2.2%) had three. The fat was injected primarily in the soft palate. The recorded volume of fat grafted averaged 2.4±1.1 ml. Average operative time was 39±12.55 min. There were no local or donor site complications. Seven patients were lost to follow-up. Of 34 patients with adequate speech follow-up, including Pittsburgh Weighted Speech Scale (PWSS) assessment, the average preoperative score of 8.17±3.59 was reduced to 5.17±3.14 post-op. While 26/34 (76.5%) had an improvement in their PWSS score, only 13/34 (38.23%) saw an improvement in their PWSS category.

CONCLUSION: Autologous fat grafting to the soft palate is a safe operation with minimal risks. Speech outcomes are subjectively enhanced in the majority of patients, with a full PWSS category improvement seen in 40% of the cases. Patient selection criteria to optimize results are provided.


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#3 “The Utility of Composite Flexor Tendon Allografts for Hand and Upper Extremity Reconstruction”Brent R. DeGeorge Jr., MD, PhD; David B. Drake, MD

INTRODUCTION: We have developed a human composite flexor tendon allograft (CFTA) consisting of the intrasynovial digital flexor tendons and associated intact pulley structures, volar plates, and periosteum as a single functional unit with a distal bone attachment as a sterile, ready-to-use, tissue processed construct to directly address fundamental problems in hand surgery.

METHODS: We have established an IRB approved protocol for using these CFTA constructs for upper extremity reconstruction. At present, we have utilized this CFTA construct to reconstruct devastating injuries to the volar hand, extensor tendonopathies, thumb basal joint arthritis, and pulley reconstruction.

RESULTS: We have studied 11 CFTA constructs in 6 patients with a follow-up period between 8 to 16 months. There have been no reported cases of surgical site infection, infectious disease transmission, tissue antigenicity, or removal of the CFTA implant. Patient reported functional outcomes as assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score have improved from a baseline of 39.3 +/- 10.3 to 3.8 +/- 2.7 at six months postoperatively.

CONCLUSIONS: Herein, we describe a novel combination of tissue processing and operative techniques to directly address two fundamental problems in reconstructive surgery of the hand, scar formation and lack of suitable donor material. The CFTA construct can be applied in a safe and effective manner to reconstruct common problems outside of the digital flexor mechanism. These composite allografts provide a limitless source of intrasynovial tendon, pulley and volar plate structures, and bone with minimal tissue reactivity and negligible potential for disease transmission.


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#4 “VAC Therapy to the Brain: A Safe Method for Wound Temporization in Complex Scalp and Calvarial Defects” Noah Prince, M.D., Spiros Blackburn, M.D., Gregory Murad, M.D., Bruce Mast, M.D., Christiana Shaw, M.D., John Werning, M.D., Dhruv Singhal, M.D.

BACKGROUND: Active infection or indeterminate oncologic margins complicate the timing of scalp reconstruction. The purpose of this study is to evaluate the safety of VAC therapy as a temporizing measure in these defects with dural or cortical brain exposure.

METHODS: From December 2012 to December 2013, all composite scalp and calvarial defects reconstructed by the senior author were reviewed and 10 cases were identified. 5 of these cases were temporized with VAC therapy. The medical records of these patients were reviewed.

RESULTS: Five patients (mean age 66.2 years) with composite scalp and calvarial defects were temporized with VAC therapy. The indications for delay included gross wound infection in 4 patients and an indeterminate intra-operative oncologic margin. The average size of the scalp and calvarial defects measured 123 cm2 and 49 cm2 respectively. One patient underwent VAC therapy over exposed cortical brain with a dural defect measuring 25 cm2. The average time between the initial operation and definitive reconstruction was 4.8 days. The average daily VAC output was 74cc. Reconstructive methods included one free flap, two scalp rotational advancement flaps, and re-advancement of two prior free flaps. At an average follow-up of 32 weeks, two patients developed a sub-centimeter wound breakdown, which was treated with local wound care.

CONCLUSIONS: We found the use of VAC therapy applied directly to the dura or cortical brain as a safe and effective technique for short term wound temporization in the setting of indeterminate oncologic margins or active infection.


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Table 1. Demographics and clinical data for 5 patients with composite scalp and calvarial defects that underwent VAC therapy for wound temporization

Figure 1. Case #2. 56yM with a malignant peripheral nerve sheath tumor of the scalp and calvarium. (A) Anticipated resection of the left fronto-parietal scalp. (B) Composite scalp (112 cm2) and calvarial (50 cm2) resection with exposed dura. (C) White sponge placement into calvarial defect. (D) Black sponge applied over top with Duoderm applied to the wound edges.

Figure 2. Case #2. Two month follow-up after staged titanium mesh placement and scalp rotation advancement flaps.


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LIGHTNING ROUNDS ........................ 9:40-10:00am

#1 “Impact of Diabetes Mellitus on Complications in Breast Reconstruction” Carrie K. Chu MD, Ximena Pinell-White MD, Christopher Funderburk MD, Alexandra Hart BA, Grant Carlson MD, Albert Losken MD

BACKGROUND: While diabetes mellitus (DM) is a known risk factor for overall surgical morbidity, its impact on breast reconstruction outcome is not well defined.

METHODS: Cases of post-mastectomy breast reconstruction from 2002-2012 were identified from a prospectively maintained institutional database. A retrospective cohort analysis was performed to compare patients with and without DM. Morbidity was examined with stratification by reconstructive method and analyzed with logistic regression.

RESULTS: Of 1035 patients (1371 cases), 65 (6.3%) carried diagnoses of DM. On average, patients with DM were older (58.6 vs. 49.5 years, p<0.001), had higher BMI (33.3 vs. 27.3, p<0.001), and more commonly had comorbid hypertension (68% vs. 23%, p<0.001). Reconstructive methods were statistically similar (implant-based DM 57%, non-DM 63%, p=0.37), with no differences in overall complication rates (major DM 27.7%, non-DM 26.6%, p=0.85) (minor DM 32.3%, non-DM 29.0%, p=0.57). While prevalence of skin flap necrosis, hematoma, seroma, and infection were all equivalent, patients with DM who underwent implant-based reconstruction experienced significantly higher frequency of delayed wound healing (21.6% vs. 9.7%, p=0.04). Implant malfunction, loss, and contracture rates, however, were similar. In autologous reconstruction, delayed wound healing rates were similar (DM 7.1%, non-DM 6.6%, p=0.71). DM patients reconstructed with autologous tissue did not experience higher flap loss or fat necrosis rates. Adjusted for age, BMI, smoking, chemotherapy, and radiation, DM was independently associated delayed wound healing following implant-based reconstruction (OR 2.52, 95%CI 1.2-6.2) but not after autologous reconstruction (OR 0.97, 95%CI 0.2-4.6).

CONCLUSIONS: DM heightens risk of wound healing complications among patients undergoing implant-based breast reconstruction. Complications were not higher in patients with DM who underwent autologous reconstructions.


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#2 “Pedicled TRAM in the Era of Microsurgical Breast Reconstruction – Is There Still a Role?”Samuel Shih MD1, L .Franklyn Elliot MD 1,2

1 Emory University, Atlanta, GA2 Atlanta Plastic Surgery, Atlanta, GA

BACKGROUND: The abdomen is still the leading donor site for autologous breast reconstruction since the introduction of the pedicled TRAM by Hartampf in 1981. Microsurgical reconstruction with msTRAM and DIEP flaps have become increasingly popular due to the potential of improved blood supply and decreased donor site morbidity. However, free flap reconstruction is time consuming, requires a significant amount of resources intraoperatively and postoperatively as well as a different set of skills and additional training.

METHOD: Data were collected retrospectively of all pedicled TRAM flaps performed by one senior surgeon between 2011-2013. The technique used for the TRAM procedure is that first described by Hartrampf where a muscle-sparing method was used. Patient demographics, length of operative time, perioperative morbidities and long-term outcomes were reviewed.

RESULTS: Sixty-eight consecutive patients underwent bilateral pedicled muscle-sparing TRAM for a total of 136 flaps. Average BMI was 26.2. Average operative time was 188 minutes (3 hours 8 minutes). There was one flap loss (1%). Eleven flaps had fat necrosis. Mesh was used in 46 percent of patients. Abdominal weakness was detected in one (1.5%) patient that required mesh repair.

CONCLUSIONS: The pedicled TRAM, when performed using a muscle-sparing technique as that originally described in 1981 still has an important role in autologous breast reconstruction. The surgery can be performed expeditiously while the rate of abdominal wall morbidity is similar to that of current microsurgical flaps. The authors advocate the use of the pedicled muscle sparing TRAM as a tool for breast reconstruction.


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#3 “The Effects of Breast Reconstruction on Adjuvant Therapy in Breast Carcinoma Patients”Dustin L. Eck MD, Sarah A. McLaughlin MD, Bhupendra Rawal, Galen Perdikis MD

BACKGROUND: We sought to quantify the additional risk associated with immediate breast reconstruction following mastectomy and determine how these risks influence adjuvant cancer therapy.

METHODS: Retrospective review of women undergoing mastectomy for breast cancer and immediate breast reconstruction between 1/2007 and 12/2012 was conducted. We abstracted clinicopathological variables and stratified women according to the type of reconstruction and presence or not of surgical complications. Additionally, time to adjuvant therapy (radiation, chemotherapy, or hormonal therapy) was assessed.

RESULTS: Overall, 56/199 (28%) women suffered 70 complications, of which hematoma, skin necrosis, cellulitis, or seroma accounted for 53/70 (76%). Start date of adjuvant therapy was known in 116/199 (58%) women with invasive carcinoma. Patients that underwent immediate breast reconstruction did not have delay in adjuvant treatment when compared to patients without reconstruction (41days vs. 42days, p=0.61). Women with any complication had a significantly longer interval to adjuvant treatment when compared to those with no complications (45days vs. 40days, p=0.003). When further stratified according to type of reconstruction, only patients with a complication that had tissue expanders had a significant delay (45days vs. 40days, p=0.004). There was no significant delay in patients with flap reconstruction (44days vs. 42days, p=0.44).

CONCLUSION: In general, immediate reconstruction following mastectomy does not delay additional cancer treatment. When complications do occur, adjuvant therapy is delayed solely in patients with tissues expander reconstruction and the median delay was only 5 days. Overall, reconstruction following mastectomy for breast carcinoma is safe and even in the face of complications does not meaningfully postpone adjuvant treatment.


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Table 1: Time to adjuvant therapy (days) according to complication status and reconstruction type

Reconstruction type Time to adjuvant therapy:

without complications

Time to adjuvant therapy:

with complications

P-value

Any reconstruction 40 (7, 120), n = 84 45 (16, 175), n = 32 0.003

Tissue expander 40 (7, 120), n = 70 45 (30, 175), n = 25 0.004

Pedicled flap 42 (34, 97), n = 12 44 (16, 158), n = 7 0.44

Free flap 42 (27, 57), n = 2 n/a, n = 0 N/A

The sample median (range) and sample size is given for numeric variables. The p-values were obtained using Wilcoxon two sample test.


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MEMBER PAPERS ............................ 11:30-12:00pm

#1 “Craniofacial Fracture Patterns in All-Terrain Vehicle Injuries”Authors: Angel E. Rivera-Barrios, MD; Fernando Herrera, MD; Satara Brown

INTRODUCTION: Every year, hundreds of adults and children suffer severe injuries or even death from all-terrain vehicle (ATV) accidents. These popular off-road, motorized vehicles with low-pressure tires, a straddle seat for the operator and handlebars for steering control can travel up to 50 mph. In 2011, there were over 107,000 emergency department visits associated with ATVs in the United States, 27% of which included children younger than 16 years of age. Reportedly, 327 of these injuries resulted in death. 1 The three mechanisms of injury include falls (32%), loss of stability/rollover (33%) and collision (27%), which result in various head, musculoskeletal, orthopedic, and thoraco-abdominal injuries. Head injuries are often the most severe and can include life-altering craniofacial fractures2. A multicenter, retrospective study was conducted to determine the frequency and distribution of craniofacial fractures sustained from ATV accidents.

METHODS: Medical records of all patients presenting to two trauma centers, Medical University of South Carolina (MUSC) and University of Southern California – Los Angeles (UCLA), with ATV related craniofacial trauma from 2001-2013 were reviewed. Patient notes and radiographic images were analyzed for detailed craniofacial injury data. The identified fractures were classified as: frontal/skullbase, naso-orbital, maxilla/zygoma, and mandible. In addition, patient demographic information, length of stay (LOS), airway status, intensive care unit (ICU) stay, Glasgow coma scale (GCS), use of safety equipment, associated traumatic brain injury, and surgical intervention were compiled.

RESULTS: A total of 156 patients with craniofacial fractures secondary to ATV accidents presented from 2001-2013; 55 patients from MUSC and 101 patients from UCLA. The mean age of the injured patients was 28.4 years (range 4-78 years), with an 85.3% male predominance and average Glasgow coma scale score of 12.2. The average LOS was 7 days. Due to the severity of their injuries, 21.8% were intubated prior to presentation to the trauma center and 39.7% of patients were admitted


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to the ICU. Of those admitted to the ICU, the mean ICU LOS was 6 days. Sixty-one (39.1%) patients suffered frontal/skullbase fractures, 98 (62.8%) experienced naso-orbital fractures, 62 (39.7%) had maxillary/zygoma fractures, and 35 (22.4%) mandibular fractures were identified. Forty-one patients (26.3%) required surgical intervention to correct their craniofacial injuries. Lack of helmet use correlates with associated traumatic brain injuries, which averaged 63.5% and 61.5%, respectively.

DISCUSSION: The most common craniofacial fractures experienced in ATV injuries identified in our population were naso-orbital fractures. The correlation of nonuse of safety equipment and associated traumatic brain injuries clearly displays the importance of utilizing helmets when operating ATVs. Safety mandates instead of recommendations should be enacted in order to decrease injuries and fatalities associated with ATVs. Future studies can be conducted to determine the incidence of other injuries in ATV-related accidents, their economical and health implications.

REFERENCES:1. Garland, S, 2011 Annual Report of ATV Related Deaths and Injuries,

United States Consumer Product Safety Commission, Feb 2013.

2. Concannon E, Hogan A, Lowery A, Ryan RS, Khan W, Barry K., Spectrum of all-terrain vehicle injuries in adults: A case series and review of the literature. Int J Surg Case Rep, 2012;3(6):222-6. Epub 2012 Feb 19.


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MEMBER PAPERS ............................ 11:30-12:00pm

#2 “Four Cranial-Plate Total Vault Remodeling in Correction of Sagittal Craniosynostosis: Description of a Refined Technique Over 30 Years and Review of the Last Fifty Cases”Larry A. Sargent, MD and Devan Griner, MD, Timothy Strait, MD University of Tennessee College of Medicine Chattanooga

BACKGROUND: Recent studies document a variety of methods of treating sagittal craniosynostosis with various aesthetic outcomes and complications including skull defects. Our senior author has modified his remodeling technique over 30 years achieving consistent aesthetic outcomes without re-operation for contour irregularities or skull defects. The purpose of this study is to describe our refined cranial remodeling technique and show the outcomes of our last 50 cases.

METHODS: A retrospective study of the last 50 cases with at least 6 months follow-up. Demographic information, perioperative /operative data, follow-up information and pre/postoperative cranial indices were reviewed.

RESULTS: Our method comprises a 4-cranial plate removal, remodeling and repositioning with lateral flaring and a posterior cranial base setback (Figure 1 and 2). Of our last fifty patients 41 were male and 9 female. The average age at surgery was 10.3 months and 35 months at final follow-up. Total hospital and ICU days averaged 5.4 and 2.2 respectively. Average operative time was 151min with an average blood loss of 326 ml. Average transfusion volumes were 304 ml of PRBCs, 135 ml of FFP, and 50 ml of platelets. Complications included cellulitis (1), subdural hematoma (2), frontal seroma (1), sagittal sinus bleed (1), and scalp hematoma (1). Average pre and post-operative cranial index was 70.1 and 77.8 respectively. Re-operation rate for contour irregularities and bony defects was 0%.

CONCLUSIONS: Vault remodeling by our technique can be done quickly and safely while providing an excellent outcome without the need for reoperation for contour irregularities or bony defects.


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Figure 1 – A. Preoperative CT scan of patient with sagittal craniosynotosis. B. Postoperative CT scan showing remodeling and immediate change in configuration of skull

Figure 2 – Total Vault Four Cranial Plate Removal and Remodeling shown in Drawings and Intraoperative Photos.


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MEMBER PAPERS ............................ 11:30-12:00pm

#3 “A Plea for the Abandonment of One Stage Bilateral Cleft Lip Repairs”S. Anthony Wolfe, MD, FACS, FAAP

The rotation advancement procedure is used by the majority of cleft surgeons around the world for repair of unilateral cleft lips. With the use of naso-alveolar moulding, and primary nasal correction, results should be uniformly good.

However, most recognized authorities advise a one-stage procedure for bilateral clefts (even for incomplete ones): narrowing and elevating the prolabial skin, bringing muscle flaps from lateral lip elements beneath, and either turning down prolabial vermillion and bringing in lateral lip vermillion (Millard), or maintaining the prolabial vermillion (Manchester). Mulliken advises that the prolabium be no wider than 6 mm.

This approach often results in a lip that is short, tight, positioned posterior to the lower lip, with a rectangular philtrum, an artificial Cupid’s bow, and a nose that lacks lobular projection.

What is a bilateral cleft, other than two separate unilateral clefts, with the exception that in bilateral cases there is no muscle in the prolabium? If excellent results can be obtained with rotation advancements for unilateral clefts, why not use the procedure in bilateral clefts (staged, of course, since doing both sides at one would devascularize the prolabium.

The author has been using staged rotation advancements for 15 years for both complete and incomplete clefts. The results are better than the results of one-stage procedures, performed by the same surgeon. Lips are fuller, the prolabia admittedly wider, and the noses are normal, with not only adequate columellae, but adequate lobules.


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RESIDENT COMPETITION ...................7:30-8:15am

#5 “Mastectomy Skin Flap Stabilization: Preventing Seromas and Decreasing Duration of Drain Time in Tissue Expander Based Breast Reconstruction”Devan Griner M.D., Mark A. Brzezienski M.D. University of Tennessee School of Medicine, Chattanooga

BACKGROUND: Implant-based breast reconstruction, the most common method of reconstruction, is troubled with complications relating to seroma formation and infection. Soft tissue stabilization using progressive tension closure has shown decrease seroma formation in such procedures as abdominoplasty and latisimus dorsi donor sites. The purpose of this study is to assess the effect on seroma formation of a new method of soft tissue stabilization of mastectomy flaps using barbed polyglycolic-acid bioabsorbable fixation strips. (Figure 1-2)

METHODS: This is a retrospective review of patients with mastectomy skin flap stabilization using our bioabsorbable fixation strip method compared to a similar historical population with no skin flap stabilization. Demographic data, comorbidities, complications, presence of seroma, and total number of drain days were recorded.

RESULTS: There were 31 breasts in the stabilization group and 36 breasts in the non-stabilized/control group. The groups were statistically similar in age, tobacco use, body mass index, operative side, and oncologic surgeon. There were 12 seromas in the control group and 0 in the study group with the study group having 33% fewer seromas than the control (p<0.003). The total number of indwelling drain days was also decreased by an average of 5 days in the study group (p<0.01).

CONCLUSIONS: Soft tissue stabilization of mastectomy skin flaps to the underlying acellular dermal matrix significantly reduces seroma formation as well as decreases the number of days that suction drains are required.


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Soft tissue stabilization of mastectomy skin flaps to the underlying acellular dermal matrix significantly reduces seroma formation as well as decreases the number of days that suction drains are required.

Figure 1. PLGA fixation strip secured to the acellular dermal matrix demonstrating the stabilization of the mastectomy skin flap.

Figure 2. Before and after photos of a patient who underwent circumverticalmastectomy and implant reconstruction using our mastectomy skin flap stabilization technique.


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#6 “The Role of Hedgehog Inhibitor Therapy in the Surgical Treatment of Extensive Basal Cell Carcinoma”Jessica A. Ching, MD1; Heather L. Curtis, MD1; Jonathan Braue, BS2; Ragini Kudchadkar, MD3, Tania Mendoza, MD4; Jane Messina, MD3,5; C. Wayne Cruse, MD1,3; and Michael A. Harrington, MD, MPH1,3. 1Division of Plastic Surgery, University of South Florida Morsani College of Medicine2University of South Florida Morsani College of Medicine3Cutaneous Oncology Department, Moffitt Cancer Center4Department of Pathology, University of South Florida Morsani College of Medicine5Department of Anatomic Pathology, Moffitt Cancer Center

BACKGROUND: While surgical excision is the mainstay of treatment for basal cell carcinoma (BCC), some patients with extensive BCC are poor candidates for excision because of significant anticipated deformity and reconstruction. With the recent FDA approval of hedgehog inhibitor therapy (HHIT) for extensive BCC, we sought to analyze the effect of neoadjuvant HHIT on the subsequent surgical treatment of patients with extensive BCC.

METHODS: An IRB-approved, retrospective chart review was performed of patients who received HHIT as primary treatment for extensive BCC prior to October 2013. Patients who stopped HHIT and underwent surgical resection were included. Data included: BCC lesion response to HHIT, operative and pathology reports, radiation requirement, and recurrence of BCC.

RESULTS: Five patients were identified (Figures 1-5). Lesion location was face/scalp (n=4) and upper extremity (n=1). All patients received HHIT until unable to tolerate its side effects (n=2, mean=32.5 weeks) or lesion response subsided (n=3, mean=71 weeks). After HHIT, all tumor burdens decreased in surface area and/or tissue depth, and ultimately, less sizeable operations were performed than were proposed prior to the HHIT. In two cases, segmental mandibulectomy was avoided. BCC was present in all resected specimens, with 3 specimens exhibiting clear margins and no postoperative recurrence. Cases with positive margins (n=2) were treated with postoperative radiation; one patient experienced considerable local recurrence. Length of follow up was 7.6 to 11.8 months (mean=8.7 months).

CONCLUSIONS: HHIT is a viable option for neoadjuvant treatment of extensive BCC, potentially improving the morbidity of surgical treatment.


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(Center) Lesion after HHIT at the time of resection, exhibiting size decrease of lesion with residual scar. (Right) Patient 7 months post surgical resection of BCC and reconstruction with local flaps. Segmental mandibulectomy was avoided.

Figure 2. (Top left) Patient with right forehead and temple BCC after several months of HHIT. (Top center) Lesion after one year of HHIT at the time of resection, exhibiting size decrease with surrounding residual scar. Depth of involvement also decreased on radiologic studies (Top right) Patient 3 months after surgical resection of BCC and reconstruction with skin graft. (Bottom left) Close-up of the exophytic lesion prior to HHIT. (Bottom right) Close-up of lesion after 1 month of HHIT.


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Figure 3. (Top left) Patient with right face and ear BCC prior to HHIT, with significant muscle, parotid, and mandibular involvement. (Top right) Patient 7 months following resection of BCC and reconstruction with free latissimus dorsi flap and skin graft. (Bottom left) The lesion at the time of resection with planned excision outlined. Lesion was decreased in size and

depth of tissue involvement. (Bottom right) Patient after the defect was reconstructed with free latissimus dorsi flap and skin graft. Segmental mandibulectomy was avoided.

Figure 4. (Top left) Patient with near-total scalp BCC prior to HHIT. Necrotic soft tissue and bone are visualized throughout the wound bed. (Top center) BCC lesion after debridement of necrotic tissue prior to initiation of HHIT. Dura with minima overlying granulation tissue is exposed centrally in

the wound bed. Rim of calvarial bone can be seen at the circumferential wound margin as well. (Top right) Patient 7 months after excision of BCC and reconstruction with free latissimus flap and skin graft. Pink nodules along the posterior incision are recurrent BCC. (Bottom left) Lesion after HHIT at the time of resection with improved wound bed and decreased size. (Bottom right) Residual defect reconstructed with free latissimus flap and skin graft.

Figure 5. (Top left) Patient with left shoulder and left arm BCC prior to HHIT. Lesion with extensive muscle involvement. (Top center) Patient after excision of lesions and reconstruction with skin grafts. (Top right) Patient 8 weeks after excision and reconstruction with no disability of the left upper extremity. (Bottom left) Lesions

after HHIT at the time of resection. Lesions showed decreased size and minimal muscle involvement. (Bottom right) The lesions after excision. Left specimen is from the left shoulder, and the right specimen is from the left arm. Decreased lesion size and residual surrounding scar can be seen.


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#7 “The Role of Obesity and Breast Adipose Tissue in Breast Cancer Formation”Naveen Kumar, Irene Pien, Michele Bowie, Catherine Ibarra-Drendall, Matthew Sweede, Victoria Seewaldt, Scott T. Hollenbeck

PURPOSE: We hypothesize that adipose tissue may release cytokines that are associated with breast cancer progression. To test this hypothesis, we evaluated the obesity related cytokines: Leptin (Lp), Monocyte Chemoattractant Protein 1 (MCP-1), and CD31 (indicator of vascularization) at the serum and tissue level.

METHODS: Peripheral blood was taken from 74 women followed in our high-risk breast clinic and analyzed (Lp, MCP-1) using ELISA. In 14 patients undergoing mastectomy for breast cancer, Lp and CD31 were detected using IHC staining. In 4 patients with a unilateral breast cancer, Lp and MCP1 levels were measured from left and right breast adipose tissue effluent.

RESULTS: (1) Serum: Lp levels were 11899 +/- 9668 pg/ml in normal weight individuals (N=25), 22117 +/- 15235 pg/ml in overweight individuals (N=28) and 27800 +/- 10628 pg/ml in obese individuals (N=21) (p<0.05). MCP-1 levels were 142 +/- 107 pg/ml in normal weight individuals, 159 +/- 108 pg/ml in overweight individuals and 172 +/- 166 pg/ml in obese individuals (p=0.7). (2) Tissue: In breast adipose tissue from bilateral mastectomies, mean MCP-1 levels were higher in the invasive cancer side (6364 +/- 217 pg/ml versus 5606 +/- 442 pg/ml; p=0.03) (Figure 1). IHC staining revealed a subjectively greater presence of leptin and lower presence of CD31 in patients with higher BMIs (Figure 2).

CONCLUSION: Serum adipokines (Lp, MCP-1) are related to BMI in patients at high risk for breast cancer. In adipose tissue of matched bilateral mastectomy specimens, MCP-1 levels are elevated in the breast that contains cancer.


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Figure 1.

Figure 2. Breast Adipose Tissue with Leptin IHC stain. Increased IHC staining for Lp is seen in a representative breast cancer patient with a higher BMI.

BMI – 22.5 BMI – 37


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#8 “Replantation Outcomes at a Specialized Regional Replant Center: Should We Give Them the Finger?”Christopher Sanders, MD, Alex Lin, MD, Oren Tessler, MD, Joshua Vorstenbosch, MD, Hugo St. Hilaire, MD, Charles Dupin, MD

INTRODUCTION: Digital replantation has long been considered a landmark achievement of microsurgery. Few reports of the health related quality of life (HRQOL) associated with replantation surgery have been described. In the current changing health care economic environment, the assessment of outcomes of resource-demanding services is increasingly scrutinized and utilized in the allocation of limited health care assets. The goal of the current study is to take a broad look at replant outcomes and indications.

METHODS: All patients operated on by the Quebec Replantation Program from April 2004 to April 2007 were contacted by phone to complete the study. 264 patients fulfilled inclusion criteria and 84 patients completed the interviews. 51 patients completed both utility scores and the DASH questionnaire.

RESULTS: 141 digits were replanted on 84 patients. Specific utility measures were positively correlated with thumb replantation and negatively correlated with both index finger and number of digits replanted (p <0.05). No statistically significant difference was found between replant and revision amputation groups on all outcome constructs. Replant patients had superior functional outcomes when the injury occurred on the dominant hand. Amputation patients displayed higher levels of anxiety and pain when the injury transpired on the dominant hand.

CONCLUSION: Our study revealed modest support for current relative replant indications. On most measures, digital replant patients did not fare functionally or psychologically better than their amputation counterparts. Given the high cost and time demands associated with replants, our data suggests a more rigorous criteria set for replant indications requires formulation.


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MEMBER PAPERS ...............................8:15-9:00am

#4 “Comparison of Allergan, Mentor and Sientra Anatomic Cohesive Gel Breast Implants: A Single Surgeon’s 10-Year Experience”Erin L. Doren MD, Yvonne Pierpont MD, Lewis H. Berger MD, FACS, Steven C. Shivers PhD, David J. Smith Jr. MD

BACKGROUND: Breast implant technology has developed significantly with the introduction of modern anatomic implants. These implants have been available for pre-market approval studies for selected surgeons; only two having access to all three manufacturers. The purpose of this study is to compare the outcomes and efficacy of anatomic/shaped implants (Allergan, Mentor, Sientra) over a 10-year period.

METHODS: Retrospective review of a single surgeon’s experience with pre-market approval anatomic cohesive silicone gel breast implants. Patients enrolled for primary breast augmentation, secondary augmentation, and breast reconstruction. All patients participated in FDA-clinical trials. Demographic and outcomes data were recorded and statistical analysis performed.

RESULTS: 733 women enrolled, 695 patients had complete data. Mean age at implantation was 42.7 years (range 18-82), mean time enrolled 5.3 years (range <1-10). 164 (24%) patients received Allergan implants, 245 (35%) Mentor, 286 (41%) Sientra. Most procedures were performed with inframammary incisions 95.5%. Surgical plane included 39.2% submuscular/biplanar, 60.9% subglandular. 385 (55.4%) patients had primary augmentation, 242 (34.8%) secondary augmentation, 113 (16.2%) breast reconstruction. Complications requiring explantation/removal occurred for Allergan (28) 17.5%, Mentor (16) 6.5%, Sientra (36) 12.8%. Complications categorized by manufacturer were assessed (Table1) inclusive of capsular contracture rates (Table2). Implant rotation rates were low (0-7.4%) without significant difference between groups. Patient and surgeon satisfaction were high (Table3).

CONCLUSIONS: Anatomic implants overall have low complication rates and high satisfaction. In this comparative study primary augmentation with Mentor implants had less complications, implant ruptures, lower explantation


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rates and the lowest capsular contracture. No differences in implant rotation, fracturing, rippling or palpability was found. Implants were comparable when used for secondary augmentation and reconstructive surgery.

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MEMBER PAPERS ...............................8:15-9:00am

#5 “A Reconstructive Algorithm and Outcome Analysis for the Correction of Breast Conservation Therapy (BCT) Deformities”Albert Losken MD, Ximena A Pinell-White MD, Maggie Hodges MD

BCT remains a popular option for patients with breast cancer. However, BCT deformities still exist and can be challenging to repair. The goal of this review is to evaluate outcomes based on the extent of the deformity and reconstructive technique.

Sixty-three patients treated for a BCT deformity were included. Data queried included demographics, extent of the deformity, type of reconstruction, and outcomes. A panel judged aesthetic outcomes, and patient satisfaction was determined using the validated Breast Q reconstruction questionnaire.

There were 22 Grade I/II deformities, and 29 Grade III/IV deformities. Local revisions (n=3) were more common for Grade I, and myocutaneous flaps (n=7) more common for Grade IV. Bilateral reduction techniques (n=20) and contralateral reduction only (n=6) were most common for Grade II/III defects. Augmentation was used in 9 Grade III patients. Complications occurred in 35%, with no significant variation across the different modes of reconstruction. There was a trend toward higher complications with defect severity (grade 1:0%, grade 2:32%, grade 3:39%, and grade 4:50%). Average follow up was 2.5 years. Eighty percent of patients had one reconstructive operation, 14 percent required a second operation, and 6 percent a third. Patient satisfaction was generally high (3.2/4). The mean aesthetic rating was 5/7, and trended down with the extent of the deformity. Contralateral reduction only patients were most satisfied and had the highest aesthetic scores (5.8/7). Local revisions had the lowest aesthetic scores (4.6).

Correcting the BCT deformity requires critical evaluation of the extent of the deformity. Reconstructive options are numerous and need to be appropriately tailored for each patient. Though it can require multiple revisions, good patient satisfaction and aesthetic outcomes can be achieved.


TUESD

AY

MEMBER PAPERS ...............................8:15-9:00am

#6 “Acellular Dermal Matrix Performance Comparing to Latissimus Dorsi Myocutaneous Flap in Expander-Based Breast Reconstruction: Postoperative Outcomes and Patient Satisfaction”Badr M Al Majed, M.D.*; Stephanie L Koonce, M.D.*; James R Patrinely Jr, B.S.**; Jeffrey A Ximenes, MHA*; Domenech Asbun, M.D.***; Sarvam P TerKonda, M.D.*; Galen Perdikis, M.D.*

* Mayo Clinic Florida, Jacksonville, FL 32224, ** University of Florida, Gainesville, FL 32611, *** Kern Medical Center, Bakersfield, CA 93306

BACKGROUND: Latissimus Dorsi Myocutaneous Flap (LDMF) with tissue expander provides excellent results in breast reconstruction. Recently, acellular dermal matrix (ADM) has been used in expander-based reconstruction (EBR) with variable results. This study assesses how ADM compares to LDMF in EBR.

METHODS: The cohorts comprised 124 patients (218 breasts) that had EBR using ADM between 2006 and 2012; and 242 patients (266 breasts) that had EBR using LDMF between 1994 and 2012. Postoperative complications and reoperations, BreastQ scores, and objectively assessed aesthetic outcomes were compared.

RESULTS: Median age was 55 years for both ADM (range 23-84) and LDMF (range 26-88) groups. Median follow-up period was 18 (range 1-76) and 28 (range 1-191) months for ADM and LDMF groups, respectively. No statistically significant differences were noted between the groups in the rates of major postoperative complications (p>0.3) [Table1]. 22.5% (49/218) of the ADM group, and 25.2% (67/266) of the LDMF group had a total of 63 and 84 reoperations, respectively (p=0.52), with no significant differences in the reoperations rate for any major reason (p>0.3) [Table2]. No significant differences were observed in the BreastQ scores [Table3]. Some categorical differences were noted in the aesthetic outcomes; however, the difference between the overall outcomes was not significant (p>0.5) [Table4].

CONCLUSIONS: Our study revealed no statistically significant differences in the complication or reoperation rates, patient satisfaction, or overall aesthetic outcomes when comparing the use of ADM to LDMF in EBR. In conclusion, this study supports the hypothesis that ADM performs as well as LDMF in EBR.


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#7 “A Comparison of Dermal Autograft and Acellular Dermal Matrix in Tissue Expander Breast Reconstruction: Long Term Aesthetic Outcomes and Capsular Contracture”Michael P. Lynch, M.D.1, Michael T. Chung, B.S.2, Brian D. Rinker, M.D1.1University of Kentucky Department of Surgery, Division of Plastic and Reconstructive Surgery, 2University of Kentucky College of Medicine, Lexington, KY

BACKGROUND: The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has been touted to reduce capsular contracture rates and improve aesthetic outcomes. Autogenous grafts may offer a safer and more cost-effective alternative while maintaining equivocal capsular contracture rates and aesthetic results. The purpose of this study was to compare the capsular contracture rates and long term aesthetic outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction.

METHODS: Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. Capsular contracture rate was assessed by the senior author via physical examination using the Baker scale. The photographs were also scored for aesthetic appearance on a seven-point Leikert scale by blinded female observers. The ADM and autograft groups were compared using the Student’s t-test. Significance was defined as p<0.05.

RESULTS: Forty-eight patients were enrolled (76 breasts). Twenty-seven patients received ADM, and twenty-one patients received dermal autograft. The average long term aesthetic outcome score for dermal autograft assisted breast reconstruction was 3.85, compared to 3.79 for ADM-assisted reconstruction. However this difference was not statistically significant (p=0.87). Capsular contracture scores were identical between the two groups (1.15 avg. Baker Grade, p=0.55).

CONCLUSIONS: In addition to an improved safety profile and lower cost, dermal autograft-assisted tissue expander breast reconstruction affords equivalent aesthetic results and capsular contracture rates, when compared to ADM.


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MEMBER PAPERS .............................9:00-10:00am

#8 “A Novel Approach for the Treatment of Spider Veins”Mujadzic, MM MD Georgia Regent University, Ritter, F E MD Georgia Regent University, Given, KS MD Georgia Regent University

BACKGROUND: Spider veins or telangiectasia of the lower extremities, are very common and have been reported to be present in 41% of women over the age of 50. Sclerotherapy and lasers have been the standard of treatment in their management. Both modalities have significant complications.

We present a new alternative in management of spider veins and its results which involve low power delivered via an insulated micro needle with beveled tip.

METHODS: The technique utilizes a micro needle with an insulated shaft and beveled tip, which is inserted into a handle connected to a mono-polar electrical generator. The needle is introduced through the skin into or on the spider vein. The current is then applied with obliteration of the vein. Thirty patients were treated with the “Given needle”. All patients were female with an average age of 43 years.

Only one pass was performed and patient follow up was an average of 6 months.

RESULTS: Twenty patients (66%) had more than a 70% resolution.

The most common complication was skin erythema, which developed in 8 patients, followed by bruising in 5 patients. Both of these complications resolved in 2-3 weeks. There were no complications as seen with sclerotherapy or laser, such as vessel thrombosis, serious allergic reactions, hypopigmentation, ulceration, or scar formation.

CONCLUSIONS: The insulated micro needle with a beveled tip, utilizing low power, has minimized adjacent tissue damage and improved efficacy. The low cost, low level of complications and comparable results offer a reasonable alternative to sclerotherapy and laser treatment.


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Table 1. Showing number of patients with percentage of clearance after one pass

1= 0-25% 4

2= 25-50% 5

3= 50-75% 7

4= 75-100% 14

total 30

Figure 1. The Given needle

Figure 2. Schematic drawing of needle very tip magnified 100x

Figure 3. Proper placement of the Given needle


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MEMBER PAPERS .............................9:00-10:00am

#9 “Lower Extremity Reconstruction After Limb-sparing Sarcoma Resection in the Pediatric Population: Case Series, With Algorithm”Miguel Soto, MD; Mike Neel, MD; John Sandoval, MD; Jon Ver Halen, MD

BACKGROUND: Limb salvage surgery (LSS) is the current treatment of choice for bone sarcomas in children. These procedures require composite resection and reconstruction, and are subject to high functional demands. To date, authors have not described algorithms for reconstruction of these defects.

METHODS: We performed a retrospective review of all patients undergoing resection of proximal tibia bone sarcomas at a single center over a 12 year period.

RESULTS: 82 patients (45 male, 37 female) with an average age of 13.4 years (range 2.9, 23.7 years) underwent resection of a proximal tibial sarcoma. Pathology included osteosarcoma (OS) in 64, and Ewing’s sarcoma family of tumors (ESFT) in 18. 42 patients had bone tumor reconstruction with modular endoprsothesis; 7 patient with allograft; 3 patients with a bone transport rod; 18 patients had no bone reconstruction (either had no surgery, fibular reconstruction, or amputation); and 12 patients with an expandable endoprosthesis. 47 patient had primary closure; 22 patients had combined gastrocnemius and soleus flap reconstruction; 3 patients required subsequent bipedicled flap reconstruction; 2 patients required subsequent sural artery flap reconstruction; 1 patient required pedicled ALT flap; 3 patients required pedicled posterior thigh flap for AKA; 9 patients did not have primary surgical treatment of their primary tumor, and thus did not require soft tissue reconstruction. No patients required free flap reconstruction. The average length of tibial osteotomy was 23.7 cm (range, 8.5, 71 cm). Median soft tissue mass volume resected was 914 cm3 (range 197, 3697 cm3). Median followup was 3.1 years (range 0.5, 6.8 years). Nine patients died from metastatic disease. Ten patients ultimately required amputation. 76 patients were ambulatory at last follow-up.

CONCLUSIONS: We present an algorithm for soft-tissue reconstruction after resection of bone sarcomas of the lower extremity. These techniques minimize complications, and maximize function in the pediatric population.


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MEMBER PAPERS .............................9:00-10:00am

#10 “Anatomical Consideration and Clinical Results of Extended Component Separation”Mujadzic M Mirza, Georgia Regent University, Jack Yu, Georgia Regent University, Mujadzic M Mirsad, Georgia Regent University, Nina You, Georgia Regent University, Henrik Berdel, Georgia Regent University, Kenna S Given, Georgia Regent University, Ritter F Edmond Georgia Regent University

BACKGROUND: The Component separation (CS) technique, described by Ramirez, quoted 0% recurrence rate in a series of 11 patients. Consequent literature quoted high complication rate due to excessive tension at the midline. We are presenting the Extended Component Separation technique (ECS) as a modification to CS in an attempt to decrease tension at the midline and thus decrease complications.

METHODS: ECS consists of CS and two modifications including detachment of the rectus and pectoralis muscles from their costal attachments and lateral abdominal wall muscle mobilization from the iliac crest.

We performed ECS on 10 fresh cadavers with measurements of advancement of fascial edges towards midline at the preset tension of 0, 5 and 10 mmHg.

In clinical part of study we did a chart review of 31 patients who underwent hernia repair with the ECS.

RESULTS: Anatomical study, showed additional gain achieved with ECS, was 30mm in upper, 46mm in the middle and 50 mm in the lower abdomen at 0mmHg. At tensions of 5 and 10 mmHg significantly greater amounts of mobilization were achieved.

Using the ECS technique direct fascial approximation was achieved in all 31 patients. There were no hernia recurrences. Marginal skin necrosis occurred in 2 and wound infections in 3 patients.

CONCLUSION: Cadaveric measurements helped us to develop clinical guidelines by defining amount of mobilization at the preset tensions. The ECS technique was helpful in the management of large abdominal hernia by demonstrating no hernia recurrence and a low complication rate in our study group.


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MEMBER PAPERS .............................9:00-10:00am

#11 “Autologous Fat Grafting With Laser-Assisted Facelifts”Authors: Sherry S. Collawn, Omar S. Ahmed

BACKGROUND: Skin tightening and improved facial contouring can be achieved through a variety of modalities including traditional facelifts, fat injections, fillers, botox, as well as noninvasive ultrasound and radiofrequency. In recent years, the use of laser-assisted liposuction for skin tightening and facial contouring has increased as laser technology allows for enhanced lipolysis and skin heating with minimal complications. In addition, facial fat grafting has been helpful in treating the volume deficient aging face and can easily be injected following subcutaneous laser therapy. We will demonstrate in this clinical study that lasers and fat grafting can be used safely in combination with facelifts to improve skin contouring and tightness compared to single therapy.

METHODS: Facial contouring was achieved using a subcutaneous laser fiber with the wavelengths 1064nm and 1320nm. Following the laser treatment, fat injections were performed with 1ml syringes and small injection cannulas. Surgical facelifts were then performed.

RESULTS: From 2010 to 2013 thirty-one patients received laser fiber contouring, facial fat injections and facelift. The patient shown in figures 1a,c,e underwent laser assisted facelift and fat injections. At 21 months she has maintained improvement in the cheeks (figures 1b,d) and temple hollows (figure 1f).

CONCLUSIONS: Overall, laser fiber contouring and autologous facial fat injections represents an excellent therapy for facial contouring and can be used safely and effectively in combination with facelifts.


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MEMBER PAPERS .............................9:00-10:00am

#12 “Stuck in a Moment: An Ex Ante Analysis of Unsolicited Patient Complaints in Plastic Surgery, Dermatology, and Surgery, to Predict Malpractice Risk Profile, in a National Cohort of Physicians from the Patient Advocacy Reporting System (PARS)”

INTRODUCTION: Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased malpractice risk, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry.

METHODS: We examined the patient complaint profiles and risk scores of 31,077 physicians (3,935 surgeons, 338 plastic & reconstructive surgeons, and 519 dermatologists), who participated in the Patient Advocacy Reporting System (PARS), a national registry of UPCs. Patient complaint data were collected from 70 community and academic hospitals across 29 states, from 2009-2012. In addition to determining the specific complaint mix for plastic surgery compared to all physicians, each physician was assigned a patient complaint risk score, based on a weighted sum algorithm. Patient complaint profiles and risk scores were compared between all groups, using Wilcoxon rank and chi-square analysis. P values <0.05 were assigned statistical significance.

RESULTS: Over this 4-year period, the majority of plastic surgeons (50.8%) did not generate any patient complaints, but those who did received an average of 9.8 complaints from 4.8 patients.

All physicians All surgeons Plastic & recon surgeons (PRS)

Dermatologists Plastic surgeons (PS)

Recon surgeons (RS)

N=31,077 N=3,935 N=338 N=519 N=245 N=93

Index score > 50 (moderate risk)

5.5% 9.2% 6.9% 3.2% 5.3% 15.0%

Index score > 70 (high risk)

2.0% 4.1% 2.4% 1.4% 1.4% 7.5%


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CONCLUSIONS: Plastic surgeons are at increased risk for UPCs, compared to most physicians, especially dermatologists. Because UPCs are a robust proxy for malpractice risk, targeted interventions to decrease patient complaints may improve patient satisfaction and reduce malpractice claims. Monitoring UPCs may permit early identification of high risk surgeons, before malpractice claims accumulate.


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MEMBER PAPERS .............................9:00-10:00am

#13 “Reconstruction of Scalp Defects with Dermal Regenerative Template: A Comparative Review of Metanalysis”Nneamaka B Agochukwu1, James Y Liau1, Henry C Vasconez1 1University of Kentucky Medical Center, Division of Plastic Surgery

BACKGROUND: Scalp reconstruction is challenging depending on medical comorbidities or fragility, as well as the condition of surrounding tissues. Autologous reconstruction can be associated with substantial donor-site morbidity, prolonged operative time and prolonged hospital stay. We present our institutions experience with complex scalp wound reconstruction with dermal regeneration template (DRT) in patients who are relatively poor candidates for autologous reconstruction.

METHODS: Along with a retrospective review of scalp reconstruction with DRT at our institution from 2008 to present, we performed a retrospective review of autologous scalp reconstruction and a metanalysis of the literature for comparison.

RESULTS: We had a total of 10 patients with 12 scalp wounds underwent scalp reconstruction with DRT. During the same time period, a total of 12 patients underwent scalp reconstruction with autologous reconstruction. We compared multiple variables including age, size of wound, time in OR, length of hospital stay, wound complications, and time to closure.

Statistically significant variables included age, with the DRT group having an older average age compared to the autologous group. Additional statistically significant variables included complication rate (autologous > DRT), inpatient stay (autologous > DRT) and operating room time (autologous > DRT). There was no statistically significant difference in the time to closure between the two groups.

Our metanalysis of the literature found 19 papers, 9 level V and 10 level IV. We present their findings and compare it to our experience.

Conclusion: DRT reconstruction provides another excellent option of immediate scalp reconstruction with minimal morbidity and complications.


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LIGHTNING ROUNDS ....................... 10:30-11:00am

#4 “Twenty-Five Year Experience Using Metal Mesh Reconstruction of 524 Internal Orbital Fractures by a Single Surgeon”Larry A. Sargent, MD and Devan Griner, MD University of Tennessee College of Medicine Chattanooga

BACKGROUND: Evaluate the long-term experience and outcome of metal mesh reconstruction of internal orbital fractures at a Level I trauma center by a single surgeon.

METHODS: A retrospective chart review of the senior author’s patients with operative internal orbital fractures from 1987 to 2012. Patients with inadequate follow-up (< 3 months) were excluded. Charts were analyzed for demographics, associated fractures, and outcomes.

RESULTS: 524 internal orbital fractures were repaired in 423 patients. The mean age was 34 years (5-91). There were 135 females versus 288 males. The mean follow-up time was 10 months (3months – 18 years). Mechanisms included: motor vehicle collision 67%, altercations 22%, falls 5%, gunshot wounds 3%, sports injuries 2%, and others 1%. Only 10% of patients demonstrated isolated fractures. Many were associated with complex injuries including: nasoethmoid-orbital fractures 33% and panfacial fractures 24%. Bilateral orbital fractures were present in 24%. Ocular injuries occurred in 1%. Complications included: diplopia 3.5%, infraorbital sensory disturbances 3%, ectropion or excessive scleral show 1%. No mesh was removed secondary to infection, erosion, or displacement. Six patients developed enophthalmos and 4 required mesh repositioning.

CONCLUSIONS: This study describes the successful use of titanium mesh for reconstruction of a range of internal orbital fractures and to our knowledge is the largest single surgeon series in the literature. Infection, displacement, extrusion and effects on ocular mobility have not been a problem. On re-exploration it can be repositioned without difficulty. This series confirms that titanium mesh is well tolerated in long-term follow-up.

Figure 1. Sargent Radial Titanium Orbital Mesh. A Large Floor Defect is Reconstructed with Titanium Mesh.


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#5 “Efficacy of Intense Pulsed Light in the Treatment of Burn Scar Dischromia: A Pilot Study Assessing Patient Satisfaction and Patient Safety”

INTRODUCTION: No treatment algorithms exist to reliably treat burn scar dyschromias. Intense pulsed light (IPL) has been used successfully to treat hyperpigmentation disorders, but has not been studied extensively in the treatment of burn scar. The purpose of this investigation was to assess clinical efficacy and patient satisfaction with IPL in the treatment of burn scar dyschromia.

METHODS: Patients with burn scar dyschromias were treated utilizing the Lume 1 platform (Lumenis) targeting pigmented lesions in the mid-dermis utilizing fluences between 10-22 joules/cm2 & filters ranging from 560-640 nm. At conclusion providers assessed changes in dyschromias while patients were queried to assess satisfaction and perception of efficacy. Subjects were not charged for service, but were queried regarding willingness to pay.

RESULTS: Twenty patients, an average of 3.2 years after burn injury were treated. Mean fluence was 15.4 J/cm2, and the most common filter used was 590 nm. Complications included pain (4) & blistering (2). A majority (16) evidenced mild to moderate improvement. Utilizing a 1-5 Likert scale, patient perception of efficacy was positive (4.5) as was satisfaction (4.0). Patients reported a willingness to pay up to $5571.

CONCLUSIONS: Intense pulsed light is perceived by providers and patients as efficacious in the treatment of burn scar dyschromia, with a high level of patient satisfaction, despite the potential for morbidity.


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#6 “Targeting SGK-1 in Head and Neck Cancer: A Novel Midality of Local Control”Henrik O. Berdel, MD; G. Mabel Gamboa, MD, FACS; Mahmoud Mozaffari, DMD, PhD; Jack C. Yu, MD, DMD, FACS; Babak Baban, PhD

BACKGROUND: The Serum glucocorticoid-regulated kinase-1 (SGK-1) has recently been found to decrease growth of colon and prostate cancer when competitively inhibited. Until now, no therapeutic effect of SGK-1 inhibition in head and neck SCC has been described.

METHODS: Human head and neck tumors (HTB41/43) were established subcutaneously in athymic mice. Growth rates between mice treated with local vehicle injection (control- group 1, n=5), local SGK-1 Inhibitor injection (group 2, n=6), systemic cisplatin (group 3, n=6), and a combination of local SGK-1 Inhibitor injection and systemic Cisplatin (group 4, n=6) were compared using repeated measures one-way ANOVA with Newman- Keuls Multiple Comparison Test (p<0.05). Tumor cells were subsequently submitted to fluorescence-activated cell sorting (FACS).

RESULTS: Growth rates were 5.00 +/- 5.27, 2.99 +/- 1.60, 3.57 +/- 3.26, 0.58 +/- 0.72 mm2/day (mean +/- sd) for groups 1 to 4. Groups 2,3, and 4 showed significantly decreased tumor growth compared to controls (figures 1,2). Furthermore, group 4 fared significantly better than group 3. While local SGK-1 inhibition was superior to systemic cisplatin, this advantage did not reach significance. CD44 expression was significantly reduced by SGK-1 inhibition, and a tendency towards significant reduction of HER-2 expression was noted with combination therapy (figure 3).

CONCLUSIONS: SGK-1 inhibition significantly suppresses tumor growth. Decreased expression of CD44 and HER-2 implies depletion of cancer stem cells, less tumorigenicity, and perhaps better survival. SGK-1 inhibition represents a potential modality of local control for palliation in advanced cases.


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Figure 1: Tumor growth in mm2 over time in days (Grp=Group)

Figure 2: Repeated measures ANOVA for growth rates, and Newman-Keuls Multiple Comparison Test; Sig.=Significance; df=degrees of freedom, Diff.=Difference, **=p<0.001; ***=p<0.0001, ns=not significant

Figure 3: FACS of CD44 and HER-2 expression (CSC=Cancer Stem Cells)


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#7 “High Volume Hydrodissection: Assessment of DIEP Flap Perfusion Utilizing Laser Doppler”Ashley Lentz, M.D., Paolo Maria Fanzio, M.D., Ming Huei Cheng, M.D., Vijay Gorantla,M.D., Bernard T. Lee, M.D., Dhruv Singhal, M.D.

ABSTRACT: High volume hydrodissection of intramuscular perforators of deep inferior epigastric perforator (DIEP) flaps in Sprague Dawley rats has previously demonstrated a significant reduction in dissection time while simultaneously increasing the safety of dissection. However, increasing volumes of fluid injected into the closed rectus compartment may have adverse consequences on perfusion to the overlying flap. A prospective experimental animal study was performed to define a safe upper limit of volume injection for high volume hydrodissection. Eight Sprague-Dawley rats underwent bilateral “DIEP” flap dissections with varying volumes of fluid (1 cc, 3 cc, 6 cc and 9 cc) injected into the study side. The primary outcome measurement was overlying tissue perfusion, measured using laser Doppler imaging, at 6 separate time points during the flap harvest. While no significant difference in perfusion was noted between study and control sides despite increasing volumes of injection, a trend towards significant altered perfusion was noted immediately following injection in the 9cc study group. 6cc is defined as the safe upper limit volume of injection into the closed rectus compartment without significantly altering overlying flap perfusion in our Sprague Dawley rats. Using volumetric analysis, this data translates to 425cc as the safe upper limit for high volume hydrodissection for a single average sized human rectus sheath during DIEP flap harvesting. The mechanical and potentially pharmacologic implications of this data in humans remains to be seen.

KEY WORDS: hydrodissection; intramuscular perforator; perforator flap; laser doppler imaging


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FIGURES & LEGENDS

FIG. 1: (A) The laser doppler head was kept at a constant distance from the cutaneous surface of the flaps (30 cm) in accordance with the calibration settings provided by the manufacturer. (B) A view of the bilateral DIEP flaps from the Doppler head. The designation “C” signified the control flap and “S” the study

flap. The visible red beam from the Doppler head was always centered in the midline prior to data acquisition.

FIG. 2: (A) A color map of flow was generated and saved with the software for image review. Note, in this color map, each flap has been isolated on the most cranial perforator with maximal flow

centered around the pedicle. (B) A real time image of the flaps taken at the exact same moment the data was acquired.

FIG. 3: For each of the four subgroups (two rats per group) which underwent a different volume of injection on the study side, an average of flap perfusion at each of the six time points for the control and study sides was calculated and plotted. Note essentially parallel trends for perfusion between control and study sides throughout except at Tinjection for the 9 cc gr


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#8 “The Effect of Progressive-Tension Closure on Donor Site Seroma Formation in Delayed Latissimus Dorsi Flaps for Breast Reconstruction”

BACKGROUND: The latissimus dorsi myocutaneous flap is an effective and aesthetic method of breast reconstruction with a high incidence of donor-site seroma formation. The management of these seromas requires a significant amount of time and resources. No studies have examined a progressive-tension closure (PTC) technique to limit seroma formation.

METHODS: This is a retrospective cohort study of 100 breasts reconstructed using a traditional closure or PTC of the donor site. The PTC closes the operative field with 15-20 interrupted sutures in a progressive-tension form. The information collected includes patient age, date of surgery, side of surgery, BMI, smoking status, diabetes diagnosis, number of days the drain was present, seroma occurrence, seroma aspirations, seroma catheters placed, and operative interventions.

RESULTS: The PTC technique significantly decreased seroma formation, with 40% of the traditional closure sites developing seromas and only 14% in the PTC group. There was no significant difference in mean patient age (54.1, 52.4) or BMI (28.1, 27.3). The mean number of days the post-operative drain remained was significantly reduced with the PTC technique, just 16.6 days compared to 27.8 days. Of the seromas which did develop, the PTC group had significantly less aspirations (38.9 vs. 14%), drains placed (15.8 vs. 4.6%), and operative interventions (7 vs. 0%).

CONCLUSIONS: The PTC technique of closing latissimus dorsi donor sites decreases seroma formation, number of days a drain is present, and post-operative interventions.


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PAIN CONTROL PANEL ...................... 9:00-9:45am

A Multi-modal Analgesia Regimen for Plastic SurgeryJames A. Ramsey, MD

Preoperatively:1) Celebrex 400 mg p.o. @ H.S. (Ibuprofen 800 mg if sulfa allergic)2) Benadryl (diphenhydramine) 50 mg p.o. @ H.S. (Loratidine 20 mg

may be substituted)3) Delsym Cough Syrup 10 cc’s, (dextromethorphan 60 mg) @ H.S.4) +/- Lyrica 150 mg p.o. @ H.S.5) Celebrex 400 mg po a.m. of surgery6) Famotidine 20 mg/metoclopramide 10 mg po 1-1 ½ hr prior to OR7) +/- Lyrica 150 mg 1 ½ hr prior to OR

Intraoperatively:1) Lidocaine 100 mg IV on induction2) Ketamine 25- 50 mg IV on induction (range is .3-.5 mcg/kg)3) Ketorolac 90 mg IV before incision4) Dexamethasone 10-12 mg IV before incision 5) Hydromorphone .3-.5 mg IV before emergence6) Lidocaine 25-50 mg IV beginning of emergence7) Zofran 4.5 mg IV on emergence

Post Operatively: Immediately in Recovery1) Delsym 10 cc’s (Dextromethorphan 60 mg) p.o.2) Acetomenophen 1000 mg p.o.3) +/- Diazepam 5 mg p.o.

After Discharge:1) Delsym 10 cc’s(Dextromethorphan 60 mg) p.o. q 12 h X 3 days 2) Acetomenophen 1000 mg q 4-6 h prn3) Diazepam 5 mg p.o. q 4-6 h prn4) Celebrex 200 mg b.i.d. X 3 days5) Oxycodone/hydrocodone 5-10 mg p.o. q 4 h prn(Narc. Of choice)6) Decrease Acetaminophen if comb. given.7) +/- Lyrica 150 mg p.o. qd X 3 days


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#10 “The Incorporation of Liposome Bupivacaine Into an Opiod-Sparing Strategy for Patients Undergoing Rhytidectomy”Daniel Man, MD1 1 Boca Raton, FL

PURPOSE: Although effective, opioids are known to cause adverse events that can hinder patient recovery. To determine if we could reduce opioids following cosmetic rhytidectomy, we incorporated liposome bupivacaine (LB), which provides up to 72 hours of localized pain control, into our postsurgical analgesic regimen.

METHODS: A retrospective chart review was conducted on a total of 15 patients undergoing cosmetic facial surgery. Ten consecutive patients received 20 mL of LB infiltrated at end of the procedure; five subjects who received IV opioids as the standard of care were used as controls. For comparator analysis, categorical data was compared using Fischer’s exact test, a t test was used to compare the means of the two groups.

RESULTS: More LB patients were opioid-free in the PACU compared to control subjects (70% vs. 0%; P=0.02), resulting in a reduction in mean IV opioid use, expressed as morphine-equivalent doses (0.7 mg vs 3.0 mg; P=0.03). On the day of surgery, LB patients required numerically less opioids than control subjects (4.3 mg vs 10.7 mg), and opioid requirements continued to decline on POD1 (1.5 mg vs 11 mg; P=0.03). Overall, LB patients demonstrated a significant reduction in mean total opioids through POD3 compared to control subjects (6.3 mg vs 21.6 mg; P=0.007 ).

CONCLUSION: Infiltration of LB resulted in a reduction in opioid requirements in the PACU following rhytidectomy, as well as a 60% reduction in IV opioids the day of surgery, and a 71% reduction in mean total opioids through POD3 compared to control patients.


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#11 “Efficacy of Liposomal Bupivacaine in Plastic and Breast Surgery”Nathan Eberle DDS, MD, Martin Newman MD, FAAPS, FACS

BACKGROUND: Since obtaining FDA approval for postsurgical pain management in 2011, a number of well-designed studies have reported favorably on the safety and efficacy of liposomal bupivacaine (LB). However, the literature lacks adequate reports of patient perception of postoperative pain and subjective satisfaction.

METHODS: A telephone survey of patients who received LB injection at time of operation at a single institution was contacted. Included were patients who underwent cosmetic, reconstructive and/or breast procedures. Patients were asked to report their perception of pain on POD# 1 and 3 using the verbal scale (1-10). Additionally, patients reported on: understanding of medications received; overall satisfaction; perception of economic value; and, perception of preference to elastomeric pump.

RESULTS: A total of 50 patients met inclusion criteria and could be reached by telephone; 23(46%) cosmetic and 27(54%) reconstructive and/or breast procedures. Mean pain score reported 2.6[0-9] POD#1 and 3.6[0-8] POD#3.

24(48%) patients were aware they had received the medication. 49 (98%) reported they would want LB again if they needed surgery in the future and would pay $230 [$100- $1,000] for the medication. All (100%) patients favored LB over a perceived elastomeric pump device.

CONCLUSIONS: Patient perception of efficacy following the injection of LB correlates with previous clinical findings. Our experience with LB injections for cosmetic and reconstructive/breast procedures indicates that patients experienced low postoperative pain scores with high overall patient satisfaction. Additional studies comparing the use of LB to standard narcotic regimens and its use in multi-modality pain management are warranted.


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#12 “Improving Comfort and Throughput for Patients Undergoing Fractionated Laser Ablation of Symptomatic Burn Scars”Renee Edkins, DNP, ANP; C. Scott Hultman, MD, MBA; Paul Collins, DO; Bruce Cairns, MD; Margaret Carman, DNP, ACNP

INTRODUCTION: Utilization of fractionated ablation with a carbon dioxide (CO2) laser has shown to be efficacious in the management of symptomatic burn scars. As this procedure is painful and burn patients traditionally evidence low pain tolerance, intravenous anesthesia (IVA) is used. Large amounts of operative anesthetics and postoperative intravenous opioids are associated with patient discomfort postoperatively and prolonged recovery times. Prolonged time to discharge prevents additional patient introduction into a fixed system resulting in decreased efficiency.

METHODS: The literature was searched for best practices guidelines for the management of the ambulatory surgical patient. The American Society of Anesthesia guidelines regarding utilization of an amide anesthetic prior to induction of IVA were adopted and tailored for use with a CO2 laser by utilizing a topical as opposed to an injectable agent.

RESULTS: Two cohorts of 40 patients were compared utilizing a t-test for continuous variables (anesthetic used [propofol], intravenous narcotics [fentanyl], average pain scores in PACU [0-10 verbal scale] and recovery to discharge time [minutes]) while Chi square was utilized to analysis dichotomous variables (IV narcotics postoperatively). IV narcotic utilization and mean pain scores were significantly improved as a result of our adoption of best practice guidelines. Recovery times evidenced no significant change. While overall throughput times increased by 34 minutes, this was felt to be related more to case order.

CONCLUSIONS: Analyzing present practice and incorporating best practice guidelines in an outpatient surgical facility can improve patient pain scores and comfort while providing insight into facility utilization.


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MEMBER PAPERS .............................10:30-11:30am

#14 “The Retrograde Internal Mammary System: Default Recipient Vessels for Stacked Perforator Flap Breast Reconstruction”Mark W. Stalder MD, Robert J. Allen MD FACS, Alireza Sadeghi MD FACS

INTRODUCTION: The DIEP flap is the preferred tissue source for autologous breast reconstruction. However, in select patients with inadequate abdominal tissue, additional volume must be recruited to achieve optimal outcomes. The use of stacked flaps is an excellent approach in these cases, but can be limited by the need for adequate recipient vessels. There are reports of the retrograde internal mammary system being used in these cases, but standardization of these vessels has not been demonstrated.

METHODS: 34 patients underwent stacked autologous tissue breast reconstruction with a total of 92 free flaps. 19 patients underwent unilateral stacked DIEP reconstruction, 2 had unilateral stacked PAP reconstruction, 1 had bilateral stacked DIEP/SGAP reconstruction, and 12 underwent bilateral stacked DIEP/PAP reconstruction. In all cases the antegrade and retrograde internal mammary vessels were used for anastomoses.

RESULTS: Of the 34 patients, one patient experienced total loss of a stacked DIEP construct (98% flap survival rate), and 2 patients experienced minor fat necrosis. All other patients achieved satisfactory tissue volume, with the stacked flaps averaging 615 grams.

CONCLUSION: This is the first study reporting the standard use of the retrograde internal mammary system as recipient vessels for stacked flaps. Our technical success and clinical results suggests this is a viable and reproducible technique. We believe the antegrade/retrograde internal mammary system is not only a safe and effective option, but that it also decreases surgical time, facilitates ease of inset, and improves overall efficiency of the case with excellent post-surgical results.


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Figure 1. 46 year-old female with DCIS under the left nipple. The patient underwent left skin-sparing mastectomy with immediate stacked DIEP breast reconstruction using both the antegrade and retrograde internal mammary systems for microvascular anastomosis. The top images show the patient pre-opertively (left), after initial reconstruction (middle), and following second stage reconstruction (right). The

bottom image shows the stacked bi-pedicled DIEP construct after anastomosis.

Figure 2. 62 year-old female with a history of right breast cancer, having undergone bilateral nipple-sparing mastectomies with post-operative radiation, and multiple failed attempts at implant-based reconstruction. The patient had symptomatic capsular contracture, and desired autologous tissue reconstruction. The top image shows the patient pre-operatively (left), and after bilateral stacked DIEP/PAP reconstruction (right), having used the antegrade and

retrograde internal mammary systems for microvascular anastomosis. The bottom image shows the DIEP and PAP flaps just prior to in-set.


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MEMBER PAPERS .............................10:30-11:30am

#15 “Feraheme Enhanced Magnetic Resonance Angiography Evaluation of Deep Inferior Epigastric Perforator Flap Vasculature: Early Experience”Stephanie L. Koonce, MD, Mellena Bridges, MD, Galen Perdikis, MD

BACKGROUND: The optimal pre-operative imaging for deep inferior epigastric perforator(DIEP) flaps would demonstrate the anatomy of both the arterial and venous systems. Ferumoxytol is a carbohydrate-coated-iron-nanoparticle that has been established as a contrast agent for magnetic resonance angiography (MRA) at our institution. This study evaluates our initial experience with ferumoxytol-enhanced MRA(f-MRA) in pre-operative imaging of both arterial and venous systems in DIEP flaps.

METHODS: Patients undergoing breast reconstruction using DIEP flaps underwent pre-operative f-MRA . Perforator identification, measurement of vessel caliber, intramuscular course, and evaluation of connections between deep and superficial veins were performed. Results of f-MRA imaging were correlated with intraoperative findings.

RESULTS: Nine consecutive patients (13 total DIEP flaps) underwent pre-operative f-MRA. MRA acquisitions were all of diagnostic quality with excellent depiction of vascular anatomy particularly fine venous detail. There was 100% concordance between pre-operative imaging and intraoperative findings in identifying main perforators, intramuscular course, and relationship between deep and superficial venous systems(Figure1,2). Median of 3 (range 1-7) perforators were identified on each side. In n=2 patients where f-MRA demonstrated a dominant superficial venous system a second venous anastomosis was created. There were no incidences of venous congestion or flap failure in any patients.

CONCLUSIONS: Pre-operative f-MRA results in excellent imaging of arterial and venous systems. Imaging of venous anatomy is particularly impressive and accurately depicts the quality of connections between the deep and superficial venous systems. This novel technique has potential to decrease operative time and aid in decision-making particularly regarding modification of the venous anastomosis.


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Figure 1: f-MRA, equilibrium phase. Coronal image depicts the deep inferior epigastric vessels, with individual demonstration of deep inferior epigastric arteries and venae comitantes (thick arrows). (arrowheads = perforators, long arrows = intramuscular course)

Figure 2: Axial reformat of the abdominal wall just below the umbilicus demonstrates many perforators, both medial and lateral. (arrow – left rectus muscle; B – peristalsing bowel).


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MEMBER PAPERS .............................10:30-11:30am

#16 “The Impact of Laser-Assisted Indocyanine Green Dye Fluorescent Angiographic on Fat Necrosis in DIEP Free Flap Breast Reconstruction”Authors: James L Mayo, MD, Mark W Stalder, MD, Austin Pharo, Matthew Bartow, Matthew W Wise, MD

BACKGROUND: Fat necrosis in perforator free flap breast reconstruction remains relatively common. Additional surgery is often required to exclude cancer, improve cosmesis, and treat symptoms. The authors investigated the impact of indocyanine green dye fluorescent angiography on the rate of operable fat necrosis in DIEP free flap breast reconstruction.

METHODS: The authors conducted a retrospective review of all DIEP breast reconstructions from January 2009 to October 2013. Data points reported were timing of reconstruction, number of perforators, co-morbidities, BMI, tobacco usage, radiation therapy, and use of fluorescent angiography. The rate of operable fat necrosis among those cases utilizing fluorescent angiography was compared to that of those in which it was not used.

RESULTS: Three hundred and twelve flaps were divided into those cases in which fluorescent angiography was utilized (n=162) or was not utilized (n=150). The two groups did not demonstrate a significant difference in fat necrosis, 10.5% versus 10% respectively. A significant increase in fat necrosis was seen in those patients with a BMI over 31. Within this subgroup, utilization of fluorescent angiography also did not protect against fat necrosis.

CONCLUSIONS: Our retrospective review did not show a reduction in operable fat necrosis when utilizing fluorescent angiography. Reasons for these findings may be a lack of depth in visualization or an etiology of fat necrosis not recognized by fluorescent angiography. The utilization of this technology to reduce fat necrosis is brought into question by the results of this study.


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MEMBER PAPERS .............................10:30-11:30am

#17 “The Use of Reduction Mammaplasty with Breast Conservation Therapy: An Analysis of Timing and Outcomes”Egro FM, Pinell XA, Hart AM, Losken A

Emory Division of Plastic and Reconstructive Surgery, Atlanta, GA 30308, USA

BACKGROUND: Oncoplastic reduction mammoplasty (RM) is often used to prevent or correct breast conservation therapy (BCT) deformities. The purpose of this review was to evaluate surgical outcomes, patient satisfaction and aesthetic outcomes of this procedure when performed before or after radiation therapy.

METHODS: Breast cancer patients treated with BCT and RM between 2005 and 2012 were divided into immediate reconstruction (IR), delayed immediate (DI) and delayed reconstruction (DR). Greater than 6 month follow-up was required for inclusion. Patient demographics and clinical outcomes, including complications, patient satisfaction, and aesthetic result, were queried. Patient satisfaction was determined using the Breast-QTM survey. Post-operative photographs were used to rate aesthetic outcomes blinded to the timing of the procedure.

RESULTS: Patients in the IR group had fewer complications (IR=20.5%, DI=33.3%, DR=60.0%, p<0.001) and asymmetry (IR=8.5%, DI=44.4%, DR=24.0%, p<0.001), and required fewer procedures to complete the reconstruction (IR=1.2, DI=2.4, DR=2.2, p<0.001). Delayed reconstruction resulted in higher complication and fat necrosis rate (IR=0.9%, DI=0.0%, DR=8.0%, p=0.047 ). Although patient satisfaction and aesthetic outcomes were better in the IR group, this difference was not statistically significant.

CONCLUSION: Oncoplastic reduction techniques performed prior to radiation therapy result in fewer complications. Good patient satisfaction and aesthetic outcomes can be achieved when reduction is performed before or after radiation therapy, but patient selection and education are important.


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MEMBER PAPERS .............................10:30-11:30am

#18 “Bovine Fetal Dermal Collagen Matrix Modulates Alpha Smooth Muscle Actin Accumulation in Full Thickness Skin Wounds”Katie Bush, PhD1, Kenneth James, PhD1, and William Lineaweaver, MD, FACS2

1TEI Biosciences Inc., Waltham, MA, 2Joseph M Still Burn and Reconstructive Center, Brandon, MS

INTRODUCTION: Reconstructive strategies to reduce wound contraction and scar contracture remains a topic of clinical interest. We have evaluated a series of wound biopsies for the presence of alpha smooth muscle actin (њSMA), a protein invlolved in wound contraction. These biopsies were obtained during full thickness skin wound reconstructions where bovine fetal dermal collagen (BFC) was used to generate new tissue during two stage split thickness skin graft (STSG) procedures.

MATERIALS & METHODS: Wounds in five patients undergoing BFC-STSG reconstruction were biopsied at time of STSG coverage. Slides from each biopsy were stained with H&E as well as immunohistochemically (IHC) to identify њSMA and BFC (PriMatrix, TEI Biosciences). The percent њSMA coverage in a high powered field (HPF) (0.21 mm2) was calculated with image analysis software. For comparison, three biopsis of normal human skin were also examined.

RESULTS: Granulation tissue was observed blending with regions of decelluarized BFC that had been repopulated and revascularized in situ (Figure 1). There was a 2-5x fold greater accumulation of the њSMA protein in the contractile granulation tissue compared to the regions of BFC dermal tissue (Figures 2 and 3). њSMA acumulation in the BFC dermal tissue was similar to what is found in normal human dermis (Figures 2 and 3).

CONCLUSION: Implanting bovine fetal dermis into full thickness skin wounds may be an important new strategy to diminish the generation of contractile granulation tissue during healing. Clinical reports suggest that decreasing post-operative skin graft contraction with this strategy may be possible.1

REFERENCE:1. Neill J, James K, Lineaweaver W. Utilizing biologic assimilation of

bovine fetal collagen in staged skin grafting. Annals of Plastic Surgery. 2012;68:451–456


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Figure 1. Biopsy stained for H&E (A) and њSMA (B). њSMA (brown stain) was found to accumulate in the granulation tissue and not in the regions of BFC dermal tissue. Scale bars = 4 mm.

Figure 2. Accumulation of њSMA (brown stain). Representative images of contractile granulation tissue, BFC dermal tissue, and normal human dermis are shown. Scale bars = 200 µm.

Figure 3. Quantification of њSMA accumulation. њSMA stained biopsy slides were analyzed to determine the percent area of the high powered field that stained positive for њSMA. Presented is the comparative percent њSMA accumulation measured in representative fields (n=3/condition) of contractile granulation tissue, BFC dermal tissue, and normal human dermis.


NOTES


POSTERS FOR PRESENTATION


Poster viewing is located in Grand Ballroom C. The numbered poster titles below correspond to the location in the poster hall.

#1 Downregulation of Scar Fibroblasts by Antineoplastic Drugs: A Potential Treatment for Fibroproliferative Disorders

M. Georgina Uberti, MD1,Yvonne N. Pierpont, MD1,2, Rajat Bhalla, BS1,2, Karan Desai, MD1,2, Martin C. Robson, MD2, Wyatt G. Payne, MD1,2

#2 Status of Microsurgical Simulation in Plastic Surgery Training: a Survey of US Program Directors

Saif S. Al-Bustani, MD, DMD, and Eric Halvorson, MD

#3 Aesthetic Abdominal Donor Site Revision After DIEP Breast Reconstruction Mark W. Stalder MD, Katherine Accardo MD, Robert J. Allen MD FACS,

Alireza Sadeghi MD FACS

#4 Wound Healing With Stem Cells and Biologically Engineered Acellular Dermal Matrix as A Carrier

Phuong Pham; Mirsad Mujadzic; Mirza Mujadzic, Edmond Ritter

#5 Title: Effects of Bovine Fetal Collagen Onlay on Component Absominal Wall Reconstructions in a Rat Model

Authors: Kevin G. Cornwell, Ph.D,† William C. Lineaweaver, MD‡

#6 Breast Reconstruction Following Solid Organ Transplant Stephanie L. Koonce, M.D.1, Brian Giles, M.D.1, Sarah A. McLaughlin,

M.D.1, Galen Perdikis, M.D2, Sarvam Terkonda, M.D.2

#7 Effect of Ceruloplasmin on Ischemia-reperfusion Injury in a Rat Epigastric Flap Model

Mircafer Seyidov M.D., *Yigit Ozer M.D., **Turker Cavusoglu M.D.,** *Ovunc Akdemir M.D, ****William C. Lineaweaver M.D.




#8 Mastectomy Skin Flap Stabilization: Preventing Seromas and Decreasing Duration of Drain Time in Tissue Expander Based Breast Reconstruction

Devan Griner M.D., Mark A. Brzezienski M.D. University of Tennessee School of Medicine, Chattanooga

#9 All That You Can’t Leave Behind: Use of a Lean Six Sigma Program in Microsurgery to Improve Outcomes in Perforator Flap Breast Reconstruction

C. Scott Hultman, MD

#10 Multiple Simultaneous Free Flaps for Reconstruction of Major Defects in Patients with a History of Head and Neck Cancer

Mark W. Stalder MD, Austin Pharo BS, Matthew Bartow BS, Rizwan Aslam DO MS, Hugo St. Hilaire DDS MD

#11 Sickle Cell Trait and Wound Healing; Beware the Use of Epinephrine. A Report of Three Cases.

Chelsea A. Cernosek, BS, Jorge I. de la Torre, MD, Som Kohanzadeh, MD, Cristen M. Catignani,MD, Luis O. Vasconez, MD

#12 Georgia Dogs: Characteristics and Morbidity of Dogbites in 1230 Consecutive Children

Michael S. Golinko, MD, Brian Arslanian, MD, Jessica Liu, MD, Brittany Leader, MD, Natalie Justicz, MD, Varun Katadre, MD, Joe Williams, MD

#13 Shark Attack: Analysis of 208 cases using Shark Induced Trauma Scale

Jaclyn Smith, Justine Pierson, Ashley K. Lentz, M.D.

#14 Surgical Treatment of Cutaneous and Subcutaneous Mycobacterium Abscessus Infections

Elliott Chen, MD

#15 Concomitant Volumization of the Breast with Perforator Free Flaps Maria LoTempio, MD


#16 The Inferio-medial Vector Fleur-de-Lis Abdominoplasty R.C. Dinsmore; P.M. Pham; J.M. Lopez; J.H. Palubicki

#17 Osteosynthesis for Free Fibula Flap Reconstruction of the Mandible in the Head and Neck Cancer Patient: Choose Your Plate

Saif S. Al-Bustani, MD, DMD, Grace Kim Austin, MD, Emily Cohn Ambrose, Justin Miller, Trevor G. Hackman, MD, Eric Halvorson, MD

#18 Results of Using a Gracilis Interposition Flap for the Repair of a Recto-urinary Fistula

Angel E. Rivera-Barrios; M. Lance Tavana; Rebecca Knackstedt

#19 Prominent Antihelix: a Normal and Frequent Anatomical Variation of Relevant to AestheticOtoplasty.

Shokrollahi K1, Sadri A1, Manning S2 , Lineaweaver WC3

#20 Lower Extremity Fillet Flap for Multiple Stage IV Pressure Ulcers in Paraplegics

Nora E. Burkart, MD, Mabel Gamboa, MD, FACS

#21 The Discreet Scar in Prominent Ear Correction – a 3D Analysis Using Digital Imaging to Determine the Best Scar Location

Shokrollahi K1, Sadri A1, Yeung K2, Javed M2

#22 Asymmetry of Inframammary Folds in Patients Undergoing Reduction Mammaplasty

Maksym Yezhelyev, MD, Rooks Hunter, MD, Marcia Spear, MD, Stephane Braun, MD

#23 Nipple Preservation in Skin Sparing Mastectomy: Reconstructive Implications and Outcomes

Carrie Chu, MD, Ximena Pinell-White, MD, Albert Losken, MD, Grant Carlson, MD



#24 Prevention and Treatment of Biofilm Formation on Breast Implants Using an In-vitro Assay of Antibiotic Efficacy

Brian Showalter, MD

#25 Danger Zones in Labiaplasty – The Importance of Sensory Nerve Mapping in Preventing Sexual Dysfunction

Cindy Wu MD, Jasmine Lewis BS, Denniz Zolnoun MD, Lynn Damitz MD

#26 Using A Long-Term Absorbable Synthetic Matrix for Nipple Reconstruction: A Novel Alternative

Jeffrey G. Lind II, MD, Hilton Becker, MD

#27 Effect of Obesity on Satisfaction with Breast Cancer Operations: An Outcomes Study.

Erin L. Doren MD, Michael Zenn MD, Gregory Georgiade MD,David J. Smith Jr. MD, Dunya Atisha MD

#28 Fluorescent Angiography and Breast Reconstruction: Does it Make a Difference?

J. Clayton Crantford, Michael F. Reynolds, & Ivo A. Pestana

#29 Use of Integra in the Management of Complex Hand Wounds from Cancer Resection and Non-Burn Trauma

David A. Kelly, MD and Anthony J. Defranzo, MD

#30 Does the Type or Duration of Microsurgical Experience Affect Outcomes in Head and Neck Reconstruction?

Cindy Wu, Grace Kim, Emily Cohn, Justin Miller, Kamil Erfanian, Trevor Hackman, Eric Halvorson

#31 The Sternal Talon® Device Offers an Effective Solution for Secondary Sternum Osteosynthesis in Patients with Persistent Non-union

Running Title: Secondary Sternal Talon Closure Michael R. DeLong, M.D.1, Duncan B. Hughes, M.D.1, Jeffrey G. Gaca,

M.D., F.A.C.S.2, John Fischer, M.D.3, Jennifer E. Bond, Ph.D.1, W. Clark Hargrove, M.D.4, Pavan Alturi, M.D.4, L. Scott Levin, M.D., F.A.C.S.3,5, Detlev Erdmann, M.D., Ph.D., M.H.Sc., F.A.C.S.1



#32 Modifications of the Anterolateral Thigh Flap for Reconstruction of Large Traumatic Lower Extremity Defect

Alexander F. Mericli, M.D.; Brent R. DeGeorge, M.D., Ph.D., Christopher A. Campbell, M.D.

#33 Nipple-sparing Mastectomy and Immediate Reconstruction Through an Inframammary Fold Incision is an Effective and Safe Approach.

Umbareen Mahmood, M.D.; Jessica S. Suber, M.D.; Ronit Zadikany, BS; Brian Kellogg, M.D.; Christine Laronga, M.D.; Deniz Dayicioglu. M.D.; Paul D. Smith, M.D.

#34 An Anastomosis Method for Resident Education in Microsurgical Breast Reconstruction

Jessica A. Ching, Erin L. Doren, Jeffery D. Cone, Paul D. Smith, David J. Smith, and Deniz Dayicioglu

#35 Optimizing Aesthetic Outcomes in Reduction Mammaplasty: Analysis of Two Techniques.

Fernandez Sarah, Cohen-Shohet Rachel, Molas-Pierson Justine, Mast Bruce A.

#36 Outcomes Analysis of a Resident Aesthetic Clinic: A 12-Year Review J. Clayton Crantford, Benjamin C. Wood, James T. Thompson, Lisa R.

David, & Malcolm W. Marks

#37 Breast Reconstruction Following Nipple Sparing Mastectomy in Patients with Ptotic Breasts

Yin Kan Hwee, Yoav Barnavon

#38 DIEP Mastopexy: A Novel Technique Jared Troy, MD1; Sergio Alvarez, MD1; Erin Doren, MD1: Deniz

Dayicioglu, MD1

#39 Evaluation of Preoperative Risk Factors!and Complication Rates in Rhytidectomy

Gupta,’V;’Winocour,’J;’Shack,’RB;’Grotting,’JC;’Higdon,’K’




#40 Success and Failure of Immediate Expander Placement for Staged Implant Breast Reconstruction in Radiated Patients: Quantification for Improved Patient Counseling.

Richard B. Nesmith M.D., Justine M. Pierson B.S., Kyle Robinson B.S., Bruce A. Mast M.D.

#41 Accelerated Wound Closure of Upper Extremity Fasciotomy with the use of External tissue expander ”

Ramirez JR; Thayer, WP; Parikh, R.

#42 Non-osteotomy Treatment of Class III Skeletal Malocclusion Using Bone Anchored Maxillary Protraction

Pedro Vieira, MD, Eric Stelnicki, MD

#43 Laparoscopic Visualization of Cleft Lip and Palate Repair Wilson, Ryan M: Liau, James Y.

#44 Augmentation of Calvarial Soft Tissue Using Acellular Dermal Matrix Martinovic, Maryann; Feldman, Lisa; Pozez, Andrea; Rhodes, Jennifer

#45 Reduction Mammaplasty with a Supermedial Pedicle Technique: A Retrospective Review of 179 Consecutive Patients with Symptomatic

Breast Hypertrophy Gill, Kiranjeet MD; Bauermeister, Adam MD; Earle, Steven A. MD,

Newman, Martin MD

#46 Retrospective Review of Peri-operative Antibiotics, Post-operative Infections and Fistulas in Cleft Palate Surgery in a University Based Craniofacial Center

Carlos Rivera-Serrano, MD; Jillian McLaughlin, MD; Justin Pierson, MD; Ashley Lentz, MD


PAST PRESIDENTS & LECTURERS


1958 Founding 1986 John R. Reynolds1959 Neal Owens 1987 John R. Royer1960 Greer Ricketson* 1988 James H. Carraway1961 Robert F. Hagerty* 1989 John H. Hartley, Jr.1962 Lorenzo H. Adams* 1990 W. Michael Bryant1963 Clifford C. Snyder* 1991 Allen H. Hughes1964 Samuel E. Upchurch* 1992 Norman M. Cole1965 McCarthy DeMere* 1993 Edward A. Luce1966 Charles Horton* 1994 Benjamin H. Wofford1967 Francis Marzoni* 1995 William F. Mullis1968 Andrew M. Moore* 1996 Thomas W. Orcutt1969 Carter P. Maguire* 1997 J. Barry Bishop1970 James H. Hendrix* 1998 Kenna S. Given1971 John R. Lewis* 1999 W. Howard Kisner1972 James G. Stuckey* 2000 R. Cole Goodman1973 James B. Cox 2001 L. Franklyn Elliott1974 William M. Berkeley* 2002 Andrew M. Moore, II1975 Henry T. Brobst* 2003 Ronald J. Johnson1976 John M. Hamilton 2004 William H. Wallace1977 Jerome E. Adamson 2005 Michael E. Beasley1978 Byron E. Gree 2006 Anthony J. Pizzo1979 George W. Hoffman* 2007 R. Bruce Shack1980 William E. Huger* 2008 Suman K. Das1981 Eugene F. Worthen 2009 James W. Wade1982 Joel W.L. Mattison* 2010 James Moore1983 James H. Fleming* 2011 James C. Grotting1984 Robert C. Reeder* 2012 W. Byron Barber1985 Andrew W. Walker* 2013 Ann Ford Reilley

*deceased

PAST PRESIDENTS


Samuel Upchurch (1909–1968) was born in Clanton, Alabama on April 13, 1909. He died in 1968 at the age of 59 at University Hospital in Birmingham, Alabama. He started his undergraduate education at the Citadel in Charleston, SC in 1925 and later finished his A.B. degree at Vanderbilt University in 1929. He stayed at Vanderbilt to complete his M.D. degree in 1933 and then began his surgical training at Duke University. He became Chief Resident in Surgery and stayed on the Duke faculty as Instructor in Surgery. He then trained in plastic surgery in St. Louis under Drs. Barrett Brown, Frank McDowell, and Louis Byars.

During World War II, he was ordered to active duty and installed as a Major in the Surgical Division of the 65th General Hospital, which was sent to England for the duration of the war. He ultimately became Regional Consultant in Plastic Surgery for the Eighth Air Force. After the war, he returned to St. Louis for an additional year of training with the plastic surgical group, and in 1947 he moved to Birmingham, Alabama and became the pioneer plastic surgeon in Alabama. He was soon made Chief of the Division of Plastic Surgery. He published numerous scientific articles and was an investigator in the use of silicones as a soft tissue substitute. He was President of the Southeastern Society of Plastic and Reconstructive Surgeons in 1964. Upon his death, his wife, Ann (Samford) Upchurch, bequeathed to the Society the funds for the establishment of the Upchurch Educational Fund and the annual Upchurch Lectureship.

PAST UPCHURCH LECTURERS


The inaugural Samuel E. Upchurch Memorial lecture was given on May 27, 1975 by Ian Jackson entitled, “Reconstruction of the Upper Limb in Rheumatoid Arthritis”.

Ian Jackson .............................1975 Maurice J. Jurkiewicz...............1995Thomas Cronin .........................1977 Milton T. Edgerton .....................1996Sal Castanares .........................1978 Carl R. Hartrampf ...................... 1997Kenneth Pickrell ......................1979 John B. McCraw ........................1998Robert Goldwyn .......................1980 D. Ralph Millard .........................1999Richard Stark ...........................1981 Burton D. Brent .........................2000William Hamm ..........................1982 Jacques Baudet ........................2001Red Dingman ...........................1983 Leonard Furlow .........................2002Clifford Snyder .........................1984 Norman M. Cole .........................2003John Mustarde .........................1985 Michael E. Jabaley ....................2004Fernando Ortiz-Monasterio .....1986 P.G Arnold ..................................2005Jack Sheen ..............................1987 Luis O. Vasconez .......................2006Jacques van der Meulen .........1988 Edward A. Luce .........................2007Thomas Rees ...........................1989 Wayne Morrison ........................2008Paul Weeks ..............................1990 Gustavo Colon ...........................2009Frederick McCoy ......................1991 T. Roderick Hester ..................... 2010Simon Fredericks ....................1992 William P. Magee, Jr. ................. 2011John Hoopes ............................1993 Thomas Biggs ............................ 2012J.B. Lynch .................................1994 R. Bruce Shack .......................... 2013

PAST UPCHURCH LECTURERS


Maurice (Josh) Jurkiewicz, M.D. (1923–2011) was born on September 24, 1923 in Claremont, New Hampshire. He died on May 29, 2011. He was the second of five children born to his Polish immigrant parents who passed through Ellis Island before World War I. The family moved to Bellow’s Falls, VT where they operated a family grocery store. After high school, Josh graduated magna cum laude with a D.D.S. from the University of Maryland in 1946. During a brief enlistment in the Navy, he became interested in surgery. After his discharge, he enrolled at Harvard Medical School completing his M.D. studies and stayed for residency training in general surgery.

He received his plastic surgery training at Barnes Hospital in St. Louis under Drs. Brown and Byars. After completing his surgical training in 1959, he was appointed chief of plastic surgery at the University of Florida. He did not take his plastic surgery board exam until 1963. Thus, formal plastic surgery resident training did not occur until 1965 at the University of Florida. In 1971, Dr. Jurkiewicz moved to Atlanta and

became the chief of plastic surgery at Emory University. His surgical skills coupled with excellent faculty recruitment and training resulted in Emory’s residency training program becoming renowned throughout the country. After years of national and international contributions to surgery, Dr. Jurkiewicz was selected as president of the American College of Surgeons in 1989. In 2001, the Jurkiewicz Society of Emory University honored him by providing funding for a biannual Jurkiewicz lecture to be presented on odd years during the annual SESPRS meeting. The first Jurkiewicz lecture was presented by Dr. Carl Hartrampf, Jr on June 11, 2001 entitled “Plastic Surgery at Emory Before Jurkiewicz and Plastic Surgery at Emory, 1971–2001.”

Carl R. Hartrampf ................ 2001Leonard T. Furlow ............... 2003Luis O. Vasconez ................. 2005T. Roderick Hester .............. 2007John McCraw ...................... 2009John J. Coleman, III .............2011Jack Fisher ..........................2013

PAST JURKIEWICZ LECTURERS


FUTURE ANNUAL SCIENTIFIC MEETINGS

June 7-11, 2015 Omni, Amelia Island Plantation, Florida

June 11-15, 2016 Disney’s Grand Floridain Resort, Orlando, Florida

June 11-15, 2017 The Cloister, Sea Island, Georgia

FUTURE OCULOPLASTIC SYMPOSIA

January 22, 2015 Intercontinental Hotel, Atlanta, Georgia

January 21, 2016 Intercontinental Hotel, Atlanta, Georgia

January 19, 2017 Intercontientnal Hotel, Atlanta, Georgia

FUTRE ATLANTA BREAST SURGERY SYMPOSIA

January 23-25, 2015 Intercontinental Hotel, Atlanta, Georgia

January 22-24, 2016 Intercontinental Hotel, Atlanta, Georgia

January 20-22, 2017 Intercontientnal Hotel, Atlanta, Georgia

UPCOMING EVENTS


AWARD WINNERS


SPECIAL ACHIEVEMENT AWARD

William J. Pitts ..........................1977Robert C. Reeder .......................1979John R. Lewis ............................1981Bernard L. Kaye .........................1982Joel Mattison .............................1985McCarthy DeMere ......................1987Greer Ricketson .........................1994Allen Hughes ..............................1995Richard Hagerty ........................1997Erle Peacock ............................. 2001Andrew Moore II ........................2010

FOUNDERS AWARD

The Founders Award initiated in 2011 honors the best presentation by a SESPRS Member from the preceding Annual Meeting with votes cast by those members attending.

Albert Losken ...........................2012Wyndell Merritt ..........................2013

PICKRELL AWARDKenneth L. Pickrell, M.D. (1910–1984) was born on June 6, 1910 in Reading, PA. He died on August 20, 1984 in Durham, NC. He completed his undergraduate studies at Franklin and Marshall College in 1931. He received his MD from Johns Hopkins University in 1935. He completed his general surgery and plastic surgery training under Dr. John Stage Davis (1872–1946) at Johns Hopkins from 1935–1943. He subsequently became Chief of the Division of Plastic Surgery at Duke University where he trained scores of talented plastic surgery residents. The SESPRS honored him posthumously by creating the Pickrell Award given meritoriously to a Southeastern member exemplifying outstanding teaching attributes in plastic surgery. The first recipient of the award was Dr. Andrew Moore from Lexington, KY in 1985.

Andrew M. Moore ...........................1985Charles E. Horton ............................1986James W. Davis ...............................1987James H. Hendrix ............................1988Maurice J. Jurkiewicz ....................1989Carl R. Hartrampf ............................1990Leonard T. Furlow ...........................1992Hal. G. Bingham ..............................1993Norman Cole ...................................1994John McCraw ..................................1996

Robert F. Hagerty ............................1997John B. Lynch ..................................1998Joel Mattison ..................................1999John Bostwick, III ...........................2001Milton T. Edgerton ...........................2002Luis Vasconez .................................2005Michael E. Jabaley ..........................2006Wyndell Merritt ...............................2012

AWARD WINNERS


GLANCY AWARDGeneral Alfred Robinson Glancy, a former vice president of General Motors Corporation, was appointed by Franklin Roosevelt in 1942 to become Brigadier General in charge of running the automotive combat division of Army Ordnance in Detroit. In 1944, Gen and Mrs. Glancy donated funds at the request of their daughter, Nora, to help build a hospital in Duluth, GA. The hospital was named the Joan Glancy Memorial Hospital in memory of their other daughter, Joan, who died as a child of pneumonia. While visiting Georgia long after his retirement, General Glancy had a successful surgical encounter with Southeastern member Dr. Billy Huger of Atlanta. When the General asked what he could do for Dr. Huger in gratitude for medical services rendered, he was politely asked to fund a residency competition award for the SESPRS. Hence, the Glancy Competition and the Glancy Award were founded. This award is given every year to the resident judged to have the best paper presented in the resident’s competition. The winning resident’s program director is allowed to retain the coveted Glancy Bowl and display it at their institution for the following year until a new resident winner is named. The first award was presented to Dr. Foad Nahai in 1977 for the paper “Facial Reconstruction with Microvascular Free Omental Transfer and Split Rib Grafts”.

Foad Nahai ......................................1977Emory University

H. Louis Hill .....................................1978Emory University

E.D . Newton ...................................1979University of Tennessee

Dan H. Shell ....................................1981University of Tennessee

Donato Viggiano .............................1982University of Tennessee

Larry Nichter ...................................1983University of Virginia

Leonard Miller ................................1984Emory University

Richard Sadove ..............................1985Eastern Virginia Medical School

Mason Williams ..............................1986Eastern Virginia Medical School

David Hurley....................................1987University of Virginia

J.D. Stuart .......................................1988University of Virginia

James H. Schmidt ..........................1989University of Florida

AWARD WINNERS


Paul A. Watterson ...........................1990Emory University

Michael G. Kanosky ........................1991University of Mississippi

Joseph M. Woods, IV ......................1992Vanderbilt University

David Brothers ................................1993University of N.C. at Chapel Hill

Scott N. Oishi ..................................1994University of Kentucky

Gregory Mackay .............................1995Emory University

R.C. High .........................................1996Bowman Gray School of Medicine

Henry F. Garazo ..............................1997Medical College of Georgia

Kim Edward Koger ..........................1998Duke University

J. Timothy Katzen ...........................1999Vanderbilt University

Richard Rosenblum ....................... 2000Vanderbilt University

Colin Riordan ................................. 2001Vanderbilt University

Julia MacRae ................................. 2002University of Virginia

M.I. Okwueze ................................. 2004Vanderbilt University

Robert EH Ferguson ...................... 2005Kentucky Clinic

Dean DeRoberts ............................. 2006Wake Forest

Howard Levinson ........................... 2007Duke University

S. S. Tholpady ................................ 2008University of Virginia

Scott Hollenbeck ........................... 2009Duke University

Yvonne Pierpont .............................2010University of South Florida

Anthony Capito ...............................2011University of Virginia

Matthew Blanton ............................2012Duke University

Michael Lynch.................................2013University of Kentucky

AWARD WINNERS

proceedings of the 57th annual scienti c meeting · 2018-04-02 · • synthesize the latest...

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