Browsing by Author "Patel, Ashit"
Now showing 1 - 13 of 13
- Results Per Page
- Sort Options
Item Open Access A simple technique for augmentation of axonal ingrowth into chondroitinase-treated acellular nerve grafts using nerve growth factor.(Annals of plastic surgery, 2012-05) Ovalle, Fernando; Patel, Ashit; Pollins, Alonda; de la Torre, Jorge; Vasconez, Luis; Hunt, Thomas R; Bucy, R Pat; Shack, R Bruce; Thayer, Wesley PBackground and purpose
Improvement in axonal regeneration may lead to the development of longer nerve grafts and improved outcomes for patients with peripheral nerve injury. Although the use of acellular nerve grafts has been well documented (Groves et al, Exp Neurol. 2005;195:278-292; Krekoski et al, J Neurosci. 2001;21:6206-6213; Massey et al, Exp Neurol. 2008;209:426-445; Neubauer et al, Exp Neurol. 2007;207:163-170; Zuo et al, Exp Neurol. 2002;176:221-228), less is known about the ability of neurotrophic factors to enhance axonal regeneration. This study evaluates axonal ingrowth augmentation using acellular, chondroitinase-treated nerve grafts doped with nerve growth factor (NGF).Methods
Acellular chondroitinase-treated murine nerve grafts were placed in experimental (NGF-treated grafts) and control (carrier-only grafts) rats. Five days after implantation, axonal regeneration was assessed by immunocytochemistry along with digital image analysis.Results
Higher axon count was observed throughout the length of the nerve in the NGF group (P < 0.0001), peaking at 3 mm from proximal repair (P = 0.02). Although the NGF group displayed a higher axon count per slice, the mean diameter of individual NGF axons was smaller (P < 0.0001), potentially consistent with induction of sensory axons (Rich et al, J Neurocytol. 1987;16:261-268; Sofroniew et al, Annu Rev Neurosci. 2001;24:1217-1128; Yip et al, J Neurosci. 1984;4:2986-2992).Conclusion
The simple technique of doping acellular, chondroitinase-treated nerve grafts with NGF can augment axonal ingrowth and possibly preferentially induce sensory axons.Item Open Access Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review.(Hand (New York, N.Y.), 2023-07) Kohan, Joshua; Mangan, Jack; Patel, AshitBackground
Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation.Methods
The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence.Results
Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature.Conclusions
This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.Item Open Access An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature.(Plastic and reconstructive surgery. Global open, 2022-08) Chawla, Sahil; Shihadeh, Hanaa; Patel, AshitBackground
Racial disparities in the visual representation of patients in the plastic surgery literature can contribute to health inequities. This study evaluates racial diversity in photographs published in the aesthetic and breast reconstruction literature.Methods
A photogrammetric analysis of plastic surgery journals from the USA, Canada, and Europe was performed. Color photographs depicting human skin, pertaining to breast reconstruction and aesthetic surgery in 2000, 2010, and 2020, were categorized as White (1-3) or non-White (4-6) based on the Fitzpatrick scale.Results
All journals demonstrated significantly more White skin images than non-White for all procedures (P < 0.05) except blepharoplasty and rhinoplasty. Blepharoplasty was the only procedure with more non-White images (P = 0.02). When examining USA journals, significant differences were not found in blepharoplasty, rhinoplasty, and male chest surgery. European journals published a greater proportion of non-White images than USA journals (P < 0.0001). There was a decreasing rate of change in diversity with 15.5% of images being non-White in 2000, 32.7% in 2010, and 40.7% in 2020 (P < 0.01). Percentage of non-White images varied by geographical region and ranged from 3.6% in Oceania to 93.5% in Asia (P < 0.01).Conclusions
Diversity of patient populations depicted in plastic surgery literature has increased over the past two decades. Despite this improvement, the racial diversity seen in photographs published in the literature does not adequately reflect this demographic for aesthetic and breast procedures. Equitable visual representation may promote cultural competency and improve care for the populations we serve.Item Open Access Assessment of the Wisconsin Criteria at a Level I Trauma Center.(The Journal of craniofacial surgery, 2022-09) Gray, Megan C; Kollu, Tejas; Uppal, Priya A; Hanos, Christina; Heiman, Adee; Ricci, Joseph A; Patel, AshitAbstract
The Wisconsin Criteria was developed for physicians evaluating facial trauma to determine the likelihood of facial fractures. Subsequent studies have not consistently validated these criteria. This study seeks to validate the Wisconsin Criteria and determine its utility in predicting operative facial fractures.Retrospective chart review of the trauma database registry at a Level I Trauma Center was conducted from September 2011 to May 2019. Adult patients who had a complete facial examination by otolaryngology or plastic surgery as well as a head computed tomography scan completed, were included. Fisher exact test was utilized for statistical analysis ( P < 0.05) and positive predictive value, and negative predictive value (NPV) were calculated with a 95% confidence interval.After screening, 546 patients met eligibility, 448 had at least 1 finding of the Wisconsin Criteria, and 472 patients had facial fractures. The sensitivity of the Wisconsin Criteria for determining the presence of a facial fracture was 86.23%, the specificity was 44.59%, and the NPV was 33.67% ( P < .0001). Malocclusion was the criterion most specific in determining if a facial fracture was present (98.65%), and Glasgow Coma Score < 14 was the least specific (67.57%).The Wisconsin Criteria did aid in the identification of facial fractures in trauma patients with a comparable sensitivity, higher specificity, and much lower NPV than originally described. Further investigation should be done to validate the criteria in other large trauma centers.Item Open Access Can You Trust What You Watch? An Assessment of the Quality of Information in Aesthetic Surgery Videos on YouTube.(Plastic and reconstructive surgery, 2020-02) Gray, Megan C; Gemmiti, Amanda; Ata, Ashar; Jun, Brandon; Johnson, Philip K; Ricci, Joseph A; Patel, AshitBackground
Videos on YouTube can be posted without regulation or content oversight. Unfortunately, many patients use YouTube as a resource on aesthetic surgery, leading to misinformation. Currently, there are no objective assessments of the quality of information on YouTube about aesthetic surgery.Methods
YouTube was queried for videos about the 12 most common aesthetic surgical procedures, identified from the 2015 American Society of Plastic Surgeons procedural statistics between May and June of 2016. The top 25 results for each search term were scored using the modified Ensuring Quality Information for Patients criteria based on video structure, content, and author identification. Average Ensuring Quality Information for Patients score, view count, and video duration were compared between authorship groups.Results
A total of 523 videos were graded after excluding duplicates. The mean modified Ensuring Quality Information for Patients score for all videos was 13.1 (SE, 0.18) of a possible 27. The videos under the search "nose reshaping" had the lowest mean score of 10.24 (SE, 0.74), whereas "breast augmentation" had the highest score of 15.96 (SE, 0.65). Physician authorship accounted for 59 percent of included videos and had a higher mean Ensuring Quality Information for Patients score than those by patients. Only three of the 21 search terms had a mean modified Ensuring Quality Information for Patients score meeting criteria for high-quality videos.Conclusions
The information contained in aesthetic surgery videos on YouTube is low quality. Patients should be aware that the information has the potential to be inaccurate. Plastic surgeons should be encouraged to develop high-quality videos to educate patients.Item Open Access Isolated urethral injury after coitus-related penile trauma.(The Journal of trauma, 2010-04) Patel, Ashit; Kotkin, LeonidItem Open Access Outcomes of the Keystone Island Perforator Flap: A Systematic Review.(Journal of reconstructive microsurgery, 2022-11) Weinberg, Maxene; Heiman, Adee J; DeSanti, Rebecca; Lanni, Michael A; Kouwenberg, Emily Van; Patel, AshitBackground
The Keystone Design Perforator Island Flap (KDPIF), first described by Behan in 2003, has been demonstrated as a versatile, safe, and straightforward reconstructive option for various soft tissue defects. The purpose of this systematic review is to evaluate the indications, variations, and overall complication profile of the keystone flap in reconstructive surgery.Methods
A literature review was conducted in accordance with PRISMA guidelines using MeSH term "surgical flaps" with the keyword "keystone flap." Empirical studies with at least 15 patients who underwent keystone flap reconstruction were assessed for quantitative analysis. Outcomes of interest included patient demographics, indications, anatomic location, flap design, and complications.Results
Database search produced 135 articles, of which 25 were selected for full-text review. Out of 23 studies selected qualitative analysis and 22 met criteria for quantitative analysis. Overall success rate of this flap was 98%. Wound complications were highest in extremity flaps. Several modifications of this flap were described.Conclusion
Keystone reconstruction demonstrates excellent success rates and versatility. However, further studies with more standard reporting are needed to determine guidelines for patient specific surgical planning.Item Open Access Reducing Opioid Exposure Following Common Ambulatory Hand Surgery: A Systematic Review.(Hand (New York, N.Y.), 2023-05) Horne, Mason J; Kotamarti, Vasanth S; Patel, AshitBackground
The opioid epidemic is a health crisis in the United States. Physicians contribute to this problem by overprescribing opioids. Ambulatory hand surgery (AHS) is common in the United States and associated with overprescribing of opioids. Education and guidance regarding the effectiveness of nonopioid compared with opioid interventions for pain management following ambulatory hand procedures are lacking. We assessed the current literature to suggest evidence-based protocols for postoperative analgesia.Methods
A systematic review was performed using PubMed, Web of Science, and Cochrane Library. Studies comparing nonopioid with opioid treatments for pain management following AHS were identified. Studies investigating opioid-sparing strategies after AHS were also identified. Evidence was examined to determine efficacy of nonopioid interventions and to provide recommendations for optimal nonopioid protocols and opioid-sparing strategies.Results
A total of 510 studies were identified in the search with 18 meeting inclusion criteria. High-level evidence demonstrated efficacy of nonopioid interventions for pain management following AHS (levels I and II evidence). Results provided evidence-based guidelines for recommendations of nonopioid treatment protocols and opioid-sparing strategies (levels I and II evidence).Conclusions
Our review demonstrated nonopioid interventions are adequate in multiple aspects of pain management compared with opioid treatments. Recommendations were established for two nonopioid treatment protocols, and for an opioid-sparing intervention (levels I and II evidence). The evidence provided in this review should be strongly considered for pain management guidance following AHS and provides a means to decrease opioid overprescribing in the United States.Item Open Access Systematic Review and Guidelines for Perioperative Management of Pediatric Patients Undergoing Major Plastic Surgery Procedures, with a Focus on Free Tissue Transfer.(Plastic and reconstructive surgery, 2022-08) Mountziaris, Paschalia M; Rudolph, Christina M; Fournier, Craig T; Haykal, Siba; Ricci, Joseph A; Rezak, Kristen M; Patel, AshitBackground
Microsurgical free tissue transfer has been successfully implemented for various reconstructive applications in children. The goal of this study was to identify the best available evidence on perioperative management of pediatric patients undergoing free tissue transfer and to use it to develop evidence-based care guidelines.Methods
A systematic review was conducted in the PubMed, Embase, Scopus, and Cochrane Library databases. Because a preliminary search of the pediatric microsurgical literature yielded scant data with a low level of evidence, pediatric anesthesia guidelines for healthy children undergoing major operations were also included. Exclusion criteria included vague descriptions of perioperative care, case reports, and studies of syndromic or chronically ill children.Results
Two hundred four articles were identified, and 53 met inclusion criteria. Management approaches specific to the pediatric population were used to formulate recommendations. High-quality data were found for anesthesia, analgesia, fluid administration/blood transfusion, and anticoagulation (Level I Evidence). Lower quality evidence was identified for patient temperature (Level III Evidence) and vasodilator use (Level IV Evidence). Key recommendations include administering sevoflurane for general anesthesia, implementing a multimodal analgesia strategy, limiting preoperative fasting, restricting blood transfusions until hemoglobin level is less than 7 g/dl unless the patient is symptomatic, and reserving chemical venous thromboembolism prophylaxis for high-risk patients.Conclusions
Pediatric-specific guidelines are important, as they acknowledge physiologic differences in children, which may be overlooked when extrapolating from adult studies. These evidence-based recommendations are a key first step toward standardization of perioperative care of pediatric patients undergoing plastic surgical procedures, including free tissue transfer, to improve outcomes and minimize complications.Item Open Access Telemedicine and Plastic Surgery: Principles from the American Society of Plastic Surgeons Health Policy Committee.(Plastic and reconstructive surgery, 2022-07) Gfrerer, Lisa; Eberlin, Kyle R; Figura, Laura; Freedman, Michael; Hadeed, Josef; Ver Halen, Jon; Perdikis, Galen; Zielinski, Marta; Patel, AshitSummary
In the wake of the recent coronavirus disease of 2019 public health emergency, care delivery by means of telemedicine using audiovisual virtual platforms has become an important tool for patient communication. There are many logistic, medicolegal, and practical aspects of telemedicine that should be considered by the practicing plastic surgeon. Successful virtual patient interactions require an understanding of medical licensure requirements to perform telemedicine visits in a certain region. In addition, it is imperative to be familiar with specific liability and malpractice concerns, in addition to Health Insurance Portability and Accountability Act regulations before conducting electronic visits. During consultations, providers should be aware of proper physician conduct and the potential role of chaperones. Furthermore, appropriate visit documentation, in addition to telemedicine billing and coding, has to be ensured. Lastly, plastic surgeons should adhere to the rules of controlled substance prescription by means of telemedicine platforms. This article describes these salient topics surrounding telemedicine visits that are faced by plastic surgeons and discusses strategies to optimize and ensure safe use of virtual platforms.Item Open Access Use of Innovative Technologies in Pediatric Lower Extremity Reconstruction.(Plastic and reconstructive surgery. Global open, 2016-08) Mountziaris, Paschalia M; Soteropulos, Carol E; Rezak, Kristen M; Patel, AshitThe anterolateral thigh (ALT) free flap has proven to be a reliable option for the coverage of soft tissue defects in adults and more recently in the pediatric population. When considering the use of the ALT flap in the pediatric patient, there are few studies that detail techniques specific to pediatric free flap management. We present a unique case of a 14- × 8-cm ALT flap used for traumatic wound coverage in a distal tibial injury in a 6-year-old girl. This case highlights innovative techniques in pediatric perioperative free flap monitoring and the use of continuous external tissue expansion to achieve delayed primary closure of the donor site.Item Open Access Websites or Videos: Which Offer Better Information for Patients? A Comparative Analysis of the Quality of YouTube Videos and Websites for Cosmetic Injectables.(Plastic and reconstructive surgery, 2022-03) Patel, Anooj A; Mulvihill, Lianne; Jin, Alison; Patel, Ashit; Galiano, Robert DBackground
YouTube is used by more than 70 percent of adults and 81 percent of 15- to 25-year-olds. The information quality of videos related to the two most performed aesthetic procedures-botulinum toxin type A (Botox) and soft-tissue filler injections-has not been assessed or compared to that of websites.Methods
A YouTube search for "Botox" and "fillers" was performed in July of 2020, identifying the most popular health information videos. Quality was assessed using the validated Journal of American Medical Association, Health on the Net principles, and the DISCERN criteria in addition to a procedure-specific content score. Quality scores were compared between different groups of video contributors and against websites.Results
A total of 720 measurements of quality were performed across 95 YouTube videos and 85 websites. The mean quality scores were as follows: Journal of the American Medical Association, 1.74/4 ± 0.718; Health on the Net, 6.66/16 ± 2.07; DISCERN, 40.0/80 ± 9.25; and content, 39.1/100 ± 11.9. Physician, nonphysician health professionals, and other (news, magazine channels, and influencers) were all of higher quality than patient-based videos (p < 0.001). The mean DISCERN percentage score for videos was 50.04 ± 11.57 and significantly less than that of websites, 55.46 ± 15.74 (p = 0.010). The mean content scores showed a similar result, 39.06 ± 11.92 versus 60.76 ± 17.65 (p < 0.001), respectively.Conclusions
Improvement is needed in the quality of YouTube videos related to aesthetic injectables. Plastic surgeons, who are the most frequent video contributors, are most qualified to provide this change. Plastic surgeons should include videos as part of their online presence, as they may help facilitate a greater viewership.Item Open Access What's in a Name? Implicit Bias Affects Patient Perception of Surgeon Skill.(Plastic and reconstructive surgery, 2021-06) Bhat, Deepa; Kollu, Tejas; Ricci, Joseph A; Patel, AshitBackground
Implicit bias is the unconscious associations and beliefs held toward specific demographic groups. Instagram is commonly used by plastic surgeons to market their practice. This study investigates whether a surgeon's name on a social media platform influences perception of their competence and their likelihood of gaining a new patient.Methods
A mock Instagram post was created using before-and-after photographs of a breast augmentation patient. Eight different ethnicities were selected, and common female and male names were selected based on U.S. Census data for each ethnicity. Surveys using the Instagram post were distributed asking responders to evaluate the competency of the surgeon and how likely they are to become a patient of that plastic surgeon. The surgeon's name was the only variable in the survey.Results
A total of 2965 survey responses were analyzed. The majority of responders were Caucasian (57 percent); 55 percent were men and 45 percent were women. Overall, competence and recruitment likelihood scores between surgeons of different ethnicities were not significantly different. Caucasian and Latinx responders both assigned higher competence and recruitment likelihood scores to their own respective ethnicities.Conclusions
Implicit bias plays a role in whether or not a patient is likely to seek care from a surgeon with an ethnically identifiable name. The two most common cosmetic surgery demographic groups, Caucasians and Latinxs, were also the only two ethnic groups to display in-group favoritism. Public education should be directed toward surgeon qualifications and experience in an effort to reduce implicit bias on patient decision-making.