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  • Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

    Abstract Full Text
    JAMA Surg. 2017; 152(10):944-950. doi: 10.1001/jamasurg.2017.1716

    This cohort study examines satisfaction and quality-of life in women who undergo fat grafting for breast reconstruction after mastectomy.

  • Comparison of Wound Complications After Immediate, Delayed, and Secondary Breast Reconstruction Procedures

    Abstract Full Text
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    JAMA Surg. 2017; 152(9):e172338. doi: 10.1001/jamasurg.2017.2338

    This cohort study compares the incidence of surgical site infection and noninfectious wound complications after immediate, delayed, and secondary implant and autologous breast reconstruction in patients undergoing mastectomy.

  • JAMA Surgery September 20, 2017

    Figure 2: Incidence of Surgical Site Infection (SSI) and Noninfectious Wound Complications (NIWCs) After Secondary Reconstruction (SR) Stratified by SSI and NIWC After Immediate Implant Reconstruction

    aSSIs attributable to the immediate implant reconstruction (implant IR) were identified within 90 days of the index procedure. Follow-up to identify SR was performed through 365 days after mastectomy.bIndicates attributable to implant IR.cOf these, 273 (39.9%) did not have a secondary reconstructive procedure within 365 days of the index surgery.dExcludes 9 women with an SSI or cellulitis within 30 days before SR, not attributable to implant IR.eIf we included the 105 women with SSI more than 90 days after implant IR who had SR in the uninfected category, an additional 8 women had an SSI and 6 women had an NIWC after SR, bringing the total number of SSIs attributable to SR to 139 (2.9%) and the total number of NIWCs attributable to SR to 126 (2.6%). Compared with the incidence of SSI and NIWCs for women who had SSI within 90 days after implant IR, the differences remain statistically significant (P < .001).fNIWCs attributable to the immediate implant reconstruction were identified within 90 days of the index procedure. Follow-up to identify SR was performed through 365 days after mastectomy.gIndicates attributable to implant IR.hIf we included the 79 women with NIWCs more than 90 days after implant IR who had SR into the uncomplicated category, an additional 2 women had an SSI and 3 women had an NIWC after SR, bringing the total number of SSIs attributable to SR to 144 (3.0%) and the total number of NIWCs attributable to SR to 116 (2.4%). Compared with the incidence of SSI and NIWCs for women who had NIWCs within 90 days after implant IR, the differences remain statistically significant (P < .001).
  • JAMA Surgery September 20, 2017

    Figure 1: Diagram of Study Population, Including Index Mastectomy and Immediate and Subsequent Reconstruction After Mastectomy

    aWe required all women included in the study population to have at least 90 days of insurance coverage after mastectomy. The women with subsequent breast reconstruction procedure(s) were more likely to have at least 1 year of health insurance coverage after mastectomy than those without a subsequent reconstruction procedure (5763 [89.7%] vs 8194 [75.4%]; P < .001). Among women with less than 1 year of coverage after mastectomy, those with a subsequent procedure had a greater median number of days of health insurance coverage (295 vs 227 days; P < .001).bImmediate reconstruction (IR) occurred within 7 days of mastectomy.cIncludes tissue expander or permanent implant.dIncludes use of an autologous tissue flap (abdominal, buttock, and back tissue transferred on its vascular pedicle or by free tissue transfer microsurgical anastomosis techniques).eIncludes use of an implant and autologous tissue flap, as defined above.fIncludes a woman’s first subsequent reconstruction 8 to 365 days after the index mastectomy. The first subsequent implant reconstruction (secondary reconstruction [SR] or delayed reconstruction [DR]) was performed a median of 156 days after mastectomy (interquartile range [IQR], 112-210 days); the first subsequent autologous reconstruction (with or without implant), a median of 232 days (IQR, 157-294 days) after mastectomy (P < .001). Implant DR was performed at a later date after mastectomy than was implant SR (181 days [IQR, 113-252 days] vs 155 days [IQR, 112-207 days]; P < .001), and autologous DR was performed at a later date than was autologous SR (250 days [IQR, 189-299 days] vs 209 days [IQR, 133-279 days]; P = .007).gPerformed in patients without IR.hIndicates no implant or flap reconstruction within 365 days of mastectomy. Implant procedures consistent with contralateral procedures were included in this group (eg, implant insertion in a woman with unilateral mastectomy without immediate reconstruction but with other code[s] consistent with secondary implant procedures [eg, capsulectomy]). Because we only required 90 days of health insurance enrollment after mastectomy, some women may have had DR at 91 to 365 days that we could not identify owing to cessation of insurance coverage.
  • Quality of Patient Decisions About Breast Reconstruction After Mastectomy

    Abstract Full Text
    JAMA Surg. 2017; 152(8):741-748. doi: 10.1001/jamasurg.2017.0977

    This cross-sectional survey study assesses the quality of patient decisions about breast reconstruction.

  • JAMA Surgery July 1, 2017

    Figure 3: State Variation in Proportions of Reconstructive Surgical Procedures Among Women Undergoing a Contralateral Prophylactic Mastectomy (CPM) During the Period From 2010 to 2012

    A, Percentage of women 20 to 44 years of age who underwent a CPM for invasive unilateral early-stage breast cancer during the period from 2010 to 2012 who also underwent reconstructive surgery. B, Percentage of women 45 years of age or older who underwent a CPM for invasive unilateral early-stage breast cancer during the period from 2010 to 2012 who also underwent reconstructive surgery.
  • State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012

    Abstract Full Text
    JAMA Surg. 2017; 152(7):648-657. doi: 10.1001/jamasurg.2017.0115

    This cohort study examines state variation in the temporal trend and the proportion of women among a cohort of US women with early-stage breast cancer treated with surgery.

  • JAMA Surgery June 1, 2017

    Figure 1: Acute Large-Bowel Obstruction in an Institutionalized Man

    A, A plain abdominal x-ray shows a huge colonic distension and a clear coffee-bean-like or “bent inner tube” sign is visible. B, A computed tomography scan with multiplanar reconstruction.
  • JAMA Surgery April 1, 2017

    Figure 1: Incidentaloma in the Right Iliac Fossa

    Contrast-enhanced computed tomographic scan of the abdomen showing a cystic lesion (arrowheads) in the right iliac fossa (axial view [A] and planar reconstruction image [B]).
  • Trends in Surgical Treatment of Breast Cancer in the Veterans Affairs System

    Abstract Full Text
    JAMA Surg. 2017; 152(3):305-306. doi: 10.1001/jamasurg.2016.3191

    This study investigates the increasing need for breast surgery in the Veterans Affairs health care system and the current trends in surgical approaches.

  • Implications of Intraoperative Vascular Surgery Assistance for Hospitals and Vascular Surgery Trainees

    Abstract Full Text
    free access
    JAMA Surg. 2016; 151(11):1032-1038. doi: 10.1001/jamasurg.2016.2247

    This study describes the broad spectrum of nonvascular surgery cases that require intraoperative vascular surgery assistance.

  • Defining the Need for Transitional Care From Pediatric to Adult Surgery for Young Adult Patients With Surgically Corrected Congenital Anomalies

    Abstract Full Text
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    JAMA Surg. 2016; 151(4):393-394. doi: 10.1001/jamasurg.2015.4417

    This study seeks to quantify the need for transitional surgical care for pediatric patients with surgically corrected congenital anomalies in the coming decades.

  • Transversus Abdominis Release as an Alternative Component Separation Technique for Ventral Hernia Repair

    Abstract Full Text
    JAMA Surg. 2016; 151(4):383-384. doi: 10.1001/jamasurg.2015.3611

    This review describes the innovative use of transversus abdominis release as an alternative component separation technique for ventral hernia repair and addresses limitations of traditional reconstructive options.

  • Pedicled Flap Reconstruction for Patients With Pressure Ulcers: Complications and Resource Utilization by Ulcer Site

    Abstract Full Text
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    JAMA Surg. 2016; 151(1):93-94. doi: 10.1001/jamasurg.2015.3228

    This study identifies the factors associated with flap-related complications and increased resource utilization in patients with pressure ulcers.

  • JAMA Surgery January 1, 2015

    Figure 3: Temporal Trends in Type of Mastectomy for Early Breast Cancer

    Proportion of mastectomies for early breast cancer that were unilateral without reconstruction (dark blue line with diamonds), unilateral with reconstruction (light blue line with squares), bilateral without reconstruction (bright blue line with triangles), and bilateral with reconstruction (orange line with circles) by year of diagnosis in the National Cancer Data Base. Operative categories determined based on definitive operation for each breast cancer case (includes staged approaches). Reconstruction categories include tissue, implant, and combined reconstructive approaches. All trends are significant (P < .001).
  • Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making

    Abstract Full Text
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    JAMA Surg. 2014; 149(10):1015-1021. doi: 10.1001/jamasurg.2014.548

    Morrow et al examine correlates of reconstruction and determine if a significant unmet need for reconstruction exists among women with breast cancer who undergo mastectomy.

  • JAMA Surgery September 1, 2014

    Figure 2: Abrupt Vomiting and Pain With Abdominal Mass

    A, Typical corkscrew vessels and both tapering and obstruction of the superior mesenteric artery are shown by use of a 3-dimensional reconstruction of a computed tomographic angiographic scan. B, Encircled loops of the small-bowel volvulus around the superior mesenteric artery.
  • JAMA Surgery August 1, 2014

    Figure 2: Unpredictable Location of Central Catheter

    Three-dimensional reconstruction of computed tomography with intravenous contrast demonstrating partial anomalous pulmonary venous return (arrowhead) of the vein from the left upper lung to the left subclavian vein.
  • JAMA Surgery August 1, 2014

    Figure 1: Radiological Examination

    A, Radiological workup with bone window 3-dimensional computed tomography reconstruction shows polyostotic fibrous dysplasia, including axial and peripheral involvement. B, Preoperative enhanced portal-phase abdominal computed tomography image obtained through the mid-part of the pancreas shows a heterogeneous 11-cm duodenal infiltrating pancreatic mass, with biliary and pancreatic duct dilatation.
  • JAMA Surgery April 1, 2014

    Figure: Man With Hypoechoic Lesion Abutting the Pancreas

    A, Computed tomography of an enhancing mass (dotted circle) surrounding the common hepatic artery with emanating gastroduodenal artery, right hepatic artery, and left hepatic artery (arrowheads). B, 3-Dimensional reconstruction of the location of the lesion (dotted circle) with relation to the involved vessels and surrounding structures. C, Intraoperative view of a 3-cm mass surrounding the common hepatic artery just prior to the trifurcation of the gastroduodenal artery, right hepatic artery, and left hepatic artery. D, The tumor cells showed strong cytoplasmic expression of the smooth-muscle marker desmin. Original magnification ×20.