Publications

Scholarly Journals--Published

• Wong W, Motakef S, & Gupta S. (2017). Reply: Redefining the Ideal Buttocks: A Population Analysis. Plast Reconstr Surg, 139(4), 1023e-1024e. (04/2017) (link)
• Johnson C, Campwala I, & Gupta S. (2017). Examining the validity of the ACS-NSQIP Risk Calculator in plastic surgery: lack of input specificity, outcome variability and imprecise risk calculations. J Investig Med, 65(3), 722-725. American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) created the Surgical Risk Calculator, to allow physicians to offer patients a risk-adjusted 30-day surgical outcome prediction. This tool has not yet been validated in plastic surgery. A retrospective analysis of all plastic surgery-specific complications from a quality assurance database from September 2013 through July 2015 was performed. Patient preoperative risk factors were entered into the ACS Surgical Risk Calculator, and predicted outcomes were compared with actual morbidities. The difference in average predicted complication rate versus the actual rate of complication within this population was examined. Within the study population of patients with complications (n=104), the calculator accurately predicted an above average risk for 20.90% of serious complications. For surgical site infections, the average predicted risk for the study population was 3.30%; this prediction was proven only 24.39% accurate. The actual incidence of any complication within the 4924 patients treated in our plastic surgery practice from September 2013 through June 2015 was 1.89%. The most common plastic surgery complications include seroma, hematoma, dehiscence and flap-related complications. The ACS Risk Calculator does not present rates for these risks. While most frequent outcomes fall into general risk calculator categories, the difference in predicted versus actual complication rates indicates that this tool does not accurately predict outcomes in plastic surgery. The ACS Surgical Risk Calculator is not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools. (03/2017) (link)
• Mattison G L, Lewis P G, Gupta S C, & Kim H Y. (2016). SPY Imaging Use in Postmastectomy Breast Reconstruction Patients: Preventative or Overly Conservative?. Plast Reconstr Surg, 138(1), 15e-21e. BACKGROUND: SPY Elite imaging uses an injectable fluorescing agent to intraoperatively assess the perfusion and viability of tissue, including skin flaps, during postmastectomy reconstruction for breast cancer patients. In this study, the authors sought to compare the surgeon's assessment of flap viability with that of SPY imaging perfusion, analyzing the clinical outcomes postoperatively. METHODS: In this study, the intraoperative difference between the plastic surgeon's assessment of skin viability and the SPY imaging assessment was analyzed by the skin flap area preserved in patients undergoing skin-sparing mastectomy. After the mastectomy, the operating surgeon marked the area of the skin flap to excise; then, the SPY imaging was performed and photographs and videos of the perfusion were collected. The skin flap was resected before implant or tissue expander placement according to the plastic surgeon's assessment. The patients were routinely followed up in the clinic postoperatively. RESULTS: A total of 55 breasts were analyzed. The surface area of diminished perfusion was significantly greater in the SPY imaging compared with the surgeon's assessment. CONCLUSIONS: In this study, intraoperative indocyanine green angiography was found to be conservative in its estimation of viability and, if followed, would result in a more aggressive resection than the area deemed viable by the operating surgeon. Based on the results, intraoperative indocyanine green angiography should be used in settings where perfusion is clinically assessed as marginal. It likely does not play a useful role in lower risk cases where the operating surgeon identifies no areas of concern. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV. (07/2016) (link)
• Wong W W, Motakef S, Lin Y, & Gupta S C. (2016). Redefining the Ideal Buttocks: A Population Analysis. Plast Reconstr Surg, 137(6), 1739-47. BACKGROUND: The buttocks are a key element of female beauty, with aesthetic gluteoplasty becoming one of the fastest growing plastic surgery procedures. However, there remains no clear standard for the ideal buttocks. The authors performed a population analysis of the characteristics of the ideal buttocks to guide surgical planning. METHODS: Images of buttocks were digitally altered to create buttocks of varying proportions on posterior and lateral views. Waist-to-hip ratios and varying vertical proportions were studied. Data were stratified and analyzed according to age range, gender, ethnicity, and nationality of the respondents. RESULTS: A total of 1146 responses were collected. Of 989 respondents who submitted their gluteal preferences, 482 respondents (48.7 percent) were women and 507 (51.3 percent) were men. Overall, the most attractive buttocks waist-to-hip ratio is 0.65 from the posterior view (44.2 percent of respondents). The next most attractive ratio was 0.60 (25 percent of respondents). Positioning of the lateral prominence at the inferior gluteal fold was rated by 26.3 percent of respondents as the most attractive. From the lateral view, the most attractive buttocks have a waist-to-hip ratio of 0.70 (29.8 percent of respondents), with the most prominent portion positioned at the midpoint of the buttocks (45.1 percent of respondents), which is a 50:50 vertical ratio. There were no significant differences in preferences between respondent ages, genders, or ethnicities. CONCLUSIONS: New ideal waist-to-hip ratios of 0.6 and 0.65 update the previous standards and indicate a more dramatic and "curvier" new ideal, signaling an important preference paradigm shift. The information derived from this study has the potential to guide gluteoplasty practices and techniques. (06/2016) (link)
• Lewis P, Kobayashi E, & Gupta S. (2015). An online review of plastic surgeons in southern California. Ann Plast Surg, 74 Suppl 1, S66-70. BACKGROUND: It has become commonplace for patients to access online reviews of physicians when making choices about health care, just as any consumer would in today's computer-dependent world. Previous studies have shown that online reviews of physicians are generally positive. However, 1 negative review has the potential to adversely affect business and reputations. OBJECTIVES: To characterize the online presence of plastic surgeons in Southern California as portrayed by physician rating websites (PRWs). METHODS: An extensive online database of board-certified plastic surgeons was used to generate a list of surgeons within a 50-mile radius of Pomona, CA. Ratings from the PRWs HealthGrades.com, Vitals.com, and UCompareHealthcare.com were cataloged by number of reviews and ratings. RESULTS: Two hundred sixty-three surgeons were evaluated with the most-represented cities being Beverly Hills (N=47), Los Angeles (N=31), and Newport Beach (N=27). Ninety-seven percent of the surgeons were rated on at least 1 of the 3 PRWs chosen. In general, surgeons were rated highly, with a mean rating of 85%, SD, 14% (P<0.01), with a mean of 11.0 ratings per PRW, SD 10.9 (P<0.01). Total online ratings ranged from 0 to 222 per surgeon. The median number of total reviews was 25 and the mean rating for those surgeons above and below the median were equivocal, at 86% and 85%, respectively (P=0.284). CONCLUSIONS: In this study, we found that plastic surgeons in Southern California have an online presence that can be influenced by their patients; they should be aware of this and conscious of their online reputations. Overall, the ratings were high, regardless of the number of reviews. (05/2015) (link)
• Lewis P, Jewell J, Mattison G, Gupta S, & Kim H. (2015). Reducing postoperative infections and red breast syndrome in patients with acellular dermal matrix-based breast reconstruction: the relative roles of product sterility and lower body mass index. Ann Plast Surg, 74 Suppl 1, S30-2. PURPOSE: The use of human acellular dermal matrices (ADM) has become routinely used in implant-based breast surgery. Notwithstanding the many benefits for tissue support, the morbidity associated with its use includes seroma and infection, among other potential complications. Some patients experience a specific complication called red breast syndrome (RBS), which has been linked to ADM use, but its exact etiology remains elusive. In our institution, AlloDerm aseptic regenerative tissue matrix was recently replaced with a ready-to-use sterile version that undergoes terminal sterilization, eliminating the need for rehydration. We want to determine if this change in processing affected complications, including RBS. METHODS: We conducted a retrospective chart review analyzing patients from January 1, 2011, to June 1, 2013, who underwent breast surgery with human ADM. Patients with aseptic AlloDerm were compared to patients with sterile AlloDerm. Data were analyzed using the Fisher exact test. RESULTS: A total of 167 reconstructed breasts from 105 patients met inclusion criteria: 56% (n=93) with aseptic ADM, 44% (n=74) with sterile ADM. When comparing the two, patients had a decrease in overall necrosis, infection, seroma, and RBS with sterile ADM. However, the rates did not reach statistical significance. For example, the incidence of RBS decreased from 7.5% to 2.7% (P=0.301) and seroma decreased from 8.6% to 2.7% (P=0.188). The infection rate proved to be equivocal at 11.8% with aseptic ADM to 10.8% with sterile ADM (P=1.000). The only statistically significant change was a decrease in the total complication rate from 41.9% to 27.0% (P=0.046). The absolute risk reduction for total complications was 14.9% with a number-needed-to-treat of 7. CONCLUSION: According to our study, sterile AlloDerm has a clinically decreased incidence of complications compared to aseptic AlloDerm. Whereas RBS decreased, it was interesting to see that it was not eliminated altogether. This suggests that the etiology may be unrelated to ADM processing and warrants further investigation. Overall, the most notable difference was the statistically significant decrease in the total complication rate. Therefore, the change to sterile AlloDerm seems to be beneficial. Further benefit arises from ease of preparation in the operating room. (05/2015) (link)
• Gupta S, Gabriel A, Lantis J, & Teot L. (2015). Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J, , . Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advanced therapy that has been successful in adjunctive management of acute and chronic wounds. In recent years, the introduction of topical wound solution delivery in combination with NPWT has provided further benefits to wound healing. A commercially available system now offers automated, volumetric control of instilled topical wound solutions with a dwell time in combination with NPWT (NPWTi-d; V.A.C. VeraFlo Therapy, KCI, an Acelity company, San Antonio, TX). This NPWTi-d system differs from other instillation systems in that a timed, predetermined volume of topical wound solution is intermittently delivered (versus continuously fed) and allowed to dwell in the wound bed (without NPWT), for a user-selected period of time before NPWT is resumed. This added accuracy and process simplification of solution delivery in tandem with NPWT have prompted use of NPWTi-d as first-line therapy in a wider subset of complex wounds. However, considerably more research is required to validate efficacy of NPWTi-d in various wound types. The purpose of this review is to provide a relevant overview of wound healing, describe current literature supporting the adjunctive use of NPWTi-d, propose a clinical approach for appropriate application of NPWTi-d and conclude with case studies demonstrating successful use of NPWTi-d. Based on this review, we conclude that either a large case series examining effects of NPWTi-d on different wound types or possibly a large prospective registry evaluating NPWTi-d with real-world topical wound solutions versus immediate debridement and closure would be valuable to the medical community in evaluating the efficacy of this promising therapy. (05/2015) (link)
• Biskup N, Workman A D, Kutzner E, Adetayo O A, & Gupta S C. (2015). Perioperative Safety in Plastic Surgery: Is the World Health Organization Checklist Useful in a Broad Practice?. Ann Plast Surg, , . INTRODUCTION: In October 2007, the World Health Organization (WHO) introduced the Safe Surgery Saves Lives Program, the cornerstone of which was a 19-item safe-surgery checklist (SSC), in 8 selected hospitals around the world. After implementation, death rates decreased significantly from 1.5% to 0.8% (P = 0.003), inpatient complications reduced from 11% to 7% (P < 0.001), as did rates of surgical site infection (P < 0.001) and wrong-sided surgery (P < 0.47), across all sites. On the basis of these impressive reductions in complications and mortality, our institution adopted the WHO SSC in April 2009, with a few additional measures included, such as assuring presence of appropriate implants and administration of preoperative antibiotics and thromboembolic prophylaxis. Our purpose was to evaluate the efficacy and applicability of the surgical safety checklist in a multisurgeon plastic surgery hospital-based practice, by analyzing its effect on morbidity and outcomes. METHODS: A retrospective review of the morbidity and mortality data from the Department of Plastic Surgery at Loma Linda University Medical Center was conducted from January 2006 to July 2012. Data on morbidity and mortality before and after implementation of the surgical safety checklist were analyzed. RESULTS: The most common complications were wound related, including infection, seroma and/or hematoma, dehiscence, and flap-related complications. No significant decrease in the measured complications, neither total nor each specific complication, occurred after the implementation of the SSC. Although verifying appropriate administration of antibiotic, presence of appropriate equipment and materials, performing a preoperative formal pause, and verifying the execution of the other measures included in the SSC is critical, untoward outcomes after implementation of the checklist did not measurably decrease. In its current form as this time, the checklist does not seem to be efficacious in Plastic Surgery. CONCLUSIONS: Although certain elements of the WHO SSC checklist are universal and should be adopted, certain specific aspects require modification to improve applicability in a plastic surgery-specific practice. This necessitates the creation of a surgical safety checklist specifically for plastic surgery as other surgical specialties have proposed. (02/2015) (link)
• Gupta Subhas, Biskup Nataliya, Mattison Gennaya, & Leis Amber. (2015). Development and Validation of a Clinical Assessment Tool for Platysmal Banding in Cervicomental Aesthetics of the Female Neck. Aesthetic Surgery Journal, 35(6), NP141-6. (2015) (link)
• Champaneria Manish C, Workman Adrienne D, & Gupta Subhas C. (2014). Sushruta Father of Plastic Surgery. Ann Plast Surg, 73(1), 2-7. Sushruta is considered the "Father of Plastic Surgery." He lived in India sometime between 1000 and 800 BC, and is responsible for the advancement of medicine in ancient India. His teaching of anatomy, pathophysiology, and therapeutic strategies were of unparalleled luminosity, especially considering his time in the historical record. He is notably famous for nasal reconstruction, which can be traced throughout the literature from his depiction within the Vedic period of Hindu medicine to the era of Tagliacozzi during Renaissance Italy to modern-day surgical practices. The primary focus of this historical review is centered on Sushruta's anatomical and surgical knowledge and his creation of the cheek flap for nasal reconstruction and its transition to the "Indian method." The influential nature of the Sushruta Samhita, the compendium documenting Sushruta's theories about medicine, is supported not only by anatomical knowledge and surgical procedural descriptions contained within its pages, but by the creative approaches that still hold true today. (07/2014) (link)
• Mattison Gennaya, Leis Amber R, & Gupta Subhas C. (2014). Single-Specialty Management and Reconstruction of Necrotizing Fasciitis of the Upper Extremities Clinical and Economic Benefits From a Case Series. Ann Plast Surg, 72, S18-S21. Purpose Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. Methods Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. Results Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. Conclusions Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams. (05/2014) (link)
• Lewis P, Mattison G, Kim H, & Gupta S. (2014). SPY IMAGING USE IN POST-MASTECTOMY BREAST RECONSTRUCTION PATIENTS: PREVENTATIVE OR CONSERVATIVE?. Journal of Investigative Medicine, 62(1), 190-190. (01/2014)
• Lewis P, Mattison G, Kim H, & Gupta S. (2014). EVALUATION OF 3D PHOTOGRAPHIC IMAGING TO MEASURE DIFFERENTIAL VOLUMES IN RECONSTRUCTED BREAST TISSUE. Journal of Investigative Medicine, 62(1), 238-238. (01/2014)
• Bowman S, Lewis P, Mattison G, Chidester J, & Gupta S. (2014). IS ISOTRETINOIN USE A RISK FACTOR FOR KELOID FORMATION? AN ILLUSTRATIVE CASE SERIES. Journal of Investigative Medicine, 62(1), 168-168. (01/2014)
• Bowman S, Lewis P, Vogel, & Gupta J S. (2014). A RETROSPECTIVE ANALYSIS OF THE ROLE OF PERIOPERATIVE PATIENT TEMPERATURE IN LOWER EXTREMITY FREE FLAP RECONSTRUCTION. Journal of Investigative Medicine, 62(1), 191-191. (01/2014)
• Champaneria M C, Workman A D, Pham A T, Adetayo O A, & Gupta S C. (2013). Retrospective Analysis of Never Events in Panniculectomy and Abdominoplasty Patients and Their Financial Implications. Ann Plast Surg, , . In 2008, the Centers for Medicare and Medicaid Service adapted a list from the National Quality Forum consisting of 10 hospital-acquired conditions, also known as never events. Deeming such events as preventable in a safe-hospital setting, reimbursement is no longer provided for treatments arising secondary to these events. A retrospective chart review identified 90 panniculectomy and abdominoplasty patients. The hospital-acquired conditions examined include surgical-site infections (SSI), vascular-catheter associated infections, deep venous thrombosis/pulmonary embolism, retained foreign body, catheter-related urinary tract infection, manifestations of poor glycemic control, falls and trauma, air embolism, pressure ulcers (stages III and IV), and blood incompatibility. Information regarding age, American Society of Anesthesiologists (ASA) classification, body mass index, smoking, and chemotherapy were collected. Patients were divided into 2 groups, namely, those who developed never events and those with no events. Of the 90 patients, 14 (15.5%) developed never events because of SSI. No events occurred in the remaining 9 categories. Statistically significant risk factors included American Society of Anesthesiologists classification, age, and diabetes mellitus. The most common never event was SSI. In light of the obvious prevalence of the risk factors in patients who develop these events, the question of whether never events are truly unavoidable arises. Despite this, awareness of the impact on patient care, health care and hospital reimbursement is vital to understanding the new paradigm of the "one size fits all." (05/2013) (link)
• Workman A D, & Gupta S C. (2013). A Plastic Surgeon's Guide to Applying Smartphone Technology in Patient Care. Aesthetic Surgery Journal, 33(2), 275-280. Background: The vast array of information technology available to plastic surgeons continues to expand. With the recent introduction of smartphone application ("app") technology to the market, the potential for incorporating both social media and app technology into daily practice exists. Objectives: The authors describe and evaluate the smartphone applications most pertinent to plastic surgery. Methods: Smartphone apps from all available markets were analyzed for various factors, including popularity among general consumers, ease of use, and functionality. Using various advertising guidelines from plastic surgery societies as well as the US Food and Drug Administration, each app's content was further analyzed within the context of ethical obligations. Results: The apps with the highest number of ratings were those offering the option to upload photos and morph each photo according to the user's own preference. The title of apps also appears to play a role in popularity. A majority of apps demonstrated the same features available on websites. Conclusions: The applicability of social media marketing via smartphone apps has the potential to change future patient-surgeon interactions by offering more personalized and user-friendly encounters. The role of smartphone apps is important to the future of plastic surgery as long as plastic surgeons maintain an active role in the development of these apps to ensure their value. (02/2013) (link)
• Shores J T, Hiersche M, Gabriel A, & Gupta S. (2012). Tendon coverage using an artificial skin substitute. Journal of Plastic Reconstructive and Aesthetic Surgery, 65(11), 1544-1550. Background: Soft tissue deficits associated with exposed tendon and absent paratenon pose difficult reconstructive problems due to tendon adhesions, poor range of motion, poor cosmesis, and donor site morbidity. Integra Bilayer Matrix Wound Dressing (Integra Lifesciences Corp Plainsboro, NJ) is a skin substitute widely used in reconstructive surgery, including the incidental coverage of tendons. However, Integra's post-operative functionality of the tendons has not been well documented. We report the results of using Integra for soft tissue reconstruction overlying tendons with loss of paratenon in upper and lower extremity soft tissue defects. Methods: Forty-two patients (35 men and 7 women) with exposed tendons due to trauma (37), cancer excision( 2) or chronic wounds (3) were reconstructed using Integra. Results were compiled in a prospective manner, including age, gender, wound location, wound size, time to final closure, operative time, follow-up length, split-thickness skin graft percentage take and active post-operative range of motion. Likewise using Medline, a literature search of current surgical techniques for the treatment of exposed tendons and the results from the literature were compared with these study results. Results: All patients healed with an average split-thickness skin graft take rate of 92.5% +/- 6.1 (range, 80-100%). The thirty-two patients not lost to follow-up achieved an average range of motion of 91.2% +/- 6.5 (range, 80-100%). Conclusion: Integra offers a convenient, efficient operative procedure with minimal morbidity, demonstrating good cosmesis and tendon function. Thus, Integra may offer an alternative option for immediate tendon coverage in both the upper and lower extremities. (c) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. (11/2012) (link)
• Gupta S, & Ichioka S. (2012). Optimal use of negative pressure wound therapy in treating pressure ulcers. International Wound Journal, 9, 8-16. Pressure ulcers (PrUs) are a challenging health concern for both the clinician and the patient. The exact incidence and prevalence of PrUs varies widely among specific clinical populations, from 0.4% to 38% in acute care, from 2.2% to 24% in long-term care and from 0% to 17% in home care. The economic impact of these wounds is impressive with an estimated cost of $11 to $17.2 billion annually in the USA. Guidelines from the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel have provided recommendations for the prevention and treatment of PrUs. Negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF; V.A.C.(R) Therapy, KCI USA, Inc. San Antonio, TX) has been successfully used for managing PrUs. This review combines expert opinion with scientific evidence to describe the use of NPWT/ROCF in patients with PrUs. (08/2012) (link)
• Gupta S. (2012). Optimal use of negative pressure wound therapy for skin grafts. International Wound Journal, 9, 40-47. Skin grafting is a technique used for transplanting human skin (i.e. epidermal and some dermal layers) from a harvest site to a recipient site. However, advancements in bioengineered matrices have also introduced alternatives to skin grafts. The method used to secure the graft, whether skin or biomatrix, is critical in reducing graft failure. During the past several years, negative pressure wound therapy using reticulated open-cell foam (NPWT/ROCF; V.A.C.(R) Therapy, KCI USA, Inc., San Antonio, TX) has become a well-established method for bolstering grafts to recipient beds and is being used more frequently over biomatrices to help improve graft outcomes. This review will combine expert opinion with scientific evidence for the use of NPWT/ROCF over grafts. (08/2012) (link)
• Gupta S. (2012). Special Issue: The Impact of Evolving VAC (R) Therapy Technology on Outcomes in Wound Care Prologue. International Wound Journal, 9, III-VII. In May 2011, an international panel of wound care experts from multiple disciplines convened to develop this document to summarise the evolution of negative pressure wound therapy (NPWT) technology devices over the past 15 years, specifically concentrating on the V.A.C.(R) Therapy (KCI USA, Inc., San Antonio, TX) family of products. The aim of this document, which will be comprised of six articles, is to describe appropriate use of current technology options across a variety of wound types. The articles will include literature reviews, initiation criteria, treatment outcomes, technical pearls and clinical cases that will show the enhanced outcomes and potential economic value of the various NPWT technologies in use today. (08/2012) (link)
• Adetayo O A, Salcedo S E, Biskup N I, & Gupta S C. (2012). The Battle of Words and the Reality of Never Events in Breast Reconstruction: Incidence, Risk Factors Predictive of Occurrence, and Economic Cost Analysis. Plastic and Reconstructive Surgery, 130(1), 23-29. Background: The Centers for Medicare and Medicaid Services has a list of 10 hospital-acquired conditions for which hospitals and physicians will not be reimbursed because it deems such conditions are preventable and should be considered "never events." To evaluate the validity of this premise, the authors conducted a real-life analysis of the incidence and categories of never events occurring in a breast reconstruction cohort of a multisurgeon plastic surgery practice. Cost analysis of estimated revenue loss and risk factors associated with the development of never events are enumerated. Methods: A retrospective chart review of postmastectomy patients undergoing breast reconstruction from 2008 to August of 2010 was conducted. A total of 297 patients were identified and International Classification of Diseases, Ninth Revision codes corresponding to the never events of interest were applied to the study population. Results: Of the 297 patients, 24 (8.08 percent) developed never events in two categories: surgical-site infections (7.74 percent) and catheter-related urinary tract infections (0.34 percent). There were no complications in the remaining eight categories. Overweight body mass index and diabetes were strong independent risk factors for the development of never events (p < 0.0001). Cost estimates of associated revenue loss and economic analysis reveal substantial financial burdens to physicians and hospitals as a result of nonreimbursement. Conclusions: The "one-size-fits-all" approach of the Centers for Medicare and Medicaid Services may be misplaced and misleading. Certain risk factors are independent predictors of developing a never event, making it impossible to classify certain outcomes as "never" occurrences. The never events pendulum may have swung immensely to the left, and it is time to attain a much-needed equilibrium. (Plast. Reconstr. Surg. 130: 23, 2012.) (07/2012) (link)
• Gabriel A, Wong W D, & Gupta S. (2012). Single-stage Reconstruction for Soft Tissue Defects: A Case Series. Ostomy Wound Management, 58(6), 30-+. Various techniques for obtaining expedient aesthetic coverage of soft tissue defects with limited donor site morbidity have been developed, including the use of a dermal regeneration template (DRT) as the first step in a two-stage surgical approach. Use of DRT in reconstruction has increased as a result of reports suggesting improved cosmetic results and reduced scarring compared to split-thickness skin grafts (STSG), but this approach requires a return to the operating room. To evaluate outcomes of a single-stage procedure, a prospective evaluation of patients with complicated soft tissue defects measuring < 200 cm(2) was conducted. Following trauma or resection of a tumor, 20 patients underwent single-stage reconstruction with surgical debridement and application of a single-layered DRT and a meshed STSG. Negative pressure wound therapy (NPWT) was applied as a bolster with continuous -125 mm Hg pressure for 5 days. After 5 days, traditional dressings were applied and patients were followed until healed with a minimum follow-up of 5 months to a maximum follow-up of 19 months. Participants included 20 patients (14 men, six women; average age 60 years old [range: 27-92 years]; average wound size 104.5 cm(2) [range: 40.0-180.0 cm(2)]). Wounds were located on the lower extremities (10 patients), upper extremities (seven patients), and trunk (three patients). Average graft take was 98.3% with an average take time of 5.6 days (SD 0.50). No significant differences in graft take rates between male and female patients, smokers and nonsmokers, and patients with and without diabetes mellitus were observed. Wound location also did not affect graft take rates. No wound breakdown, adverse events, or re-operation occurred during follow-up. In this case series, single-stage reconstruction using DRT, STSG, and NPWT was used with good outcomes and second-stage reconstruction surgery was avoided. Prospective, randomized, controlled clinical studies to compare the various surgical and wound care approaches to closing these tissue defects are warranted. (06/2012)
• Champaneria M C, Wong W W, Hill M E, & Gupta S C. (2012). The Evolution of Breast Reconstruction: A Historical Perspective. World Journal of Surgery, 36(4), 730-742. Plastic surgeons have been performing operations to improve the aesthetic aspect of the breast for centuries. Throughout ancient times, great controversy produced many theories of how breast cancer occurred and the best treatment. Because of beliefs that closure of mastectomy sites could conceal tumor recurrence, breast reconstruction did not gain wide acceptance until the mid-1900s. Today, plastic surgeons have a variety of techniques to reconstruct the breast. The first autologous muscle flap for breast reconstruction was the latissimus dorsi myocutaneous flap, described in 1896 by Iginio Tansini. The introduction of Carl Hartrampf's transverse rectus abdominis myocutaneous flap and Robert J. Allen's deep inferior epigastric perforator flap have also provided excellent reconstructive options. With regard to augmentation, Vincenz Czerny attempted to enhance a woman's breast in 1895 with implantation of a lumbar lipoma. Soon after, surgeons used paraffin injections and polyvinylic alcohol sponge implantation, which yielded disastrous results. In 1961, Thomas Cronin and Frank Gerow promoted the first silicone implant, paving the way for today's silicone and saline prototypes. Although reduction mammaplasty techniques had originated centuries earlier than mastopexy methods, the advancements of both have largely paralleled one another. In 1949, the Wise pattern was introduced to preoperatively plan safer and predictable outcomes in breast reductions. Efforts to minimize scars were achieved with Claude Lassus' introduction and Madeleine Lejour's subsequent modification of the vertical scar mammaplasty. In hopes of fostering an understanding of current post-mastectomy procedures and instilling passion for innovating future techniques, we provide a near-complete, surgically focused historical account of the primary contributors to breast reconstruction. (04/2012) (link)
• Wong W W, Gabriel A, Maxwell G P, & Gupta S C. (2012). Bleeding Risks of Herbal, Homeopathic, and Dietary Supplements: A Hidden Nightmare for Plastic Surgeons?. Aesthetic Surgery Journal, 32(3), 332-346. The utilization of complementary and alternative medicine has increased tremendously in the last two decades. Herbal products, homeopathic medicines, and dietary supplements are extremely popular and are available without a prescription (which likely contributes to their popularity). Despite their "natural" characteristics, these remedies have the potential to cause bleeding in patients who undergo surgery. The high use of these supplements among cosmetic surgery patients, coupled with increasing reports of hematomas associated with herbal and homeopathic medicines, prompted the authors to conduct a comprehensive review focused on bleeding risks of such products in an effort to raise awareness among plastic surgeons. This review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can cause bleeding perioperatively and postoperatively. In addition to being aware of such adverse effects, plastic surgeons must adequately screen all patients and educate them on the possible dangers associated with these treatments. (03/2012) (link)
• Adetayo O A, Salcedo S E, Bahjri K, & Gupta S C. (2011). A Meta-Analysis of Outcomes Using Acellular Dermal Matrix in Breast and Abdominal Wall Reconstructions: Event Rates and Risk Factors Predictive of Complications. , , . BACKGROUND: The use of acellular dermal matrix (ADM) has gained acceptance in breast and abdominal wall reconstructions. Despite its extensive use, there is currently a wide variation of reported outcomes in the literature. This study definitively elucidates the outcome rates associated with ADM use in breast and abdominal wall surgeries and identifies risk factors predisposing to the development of complications. METHODS: A literature search was conducted using the Medline database (PubMed, US National Library of Medicine) and the Cochrane Library. A total of 464 articles were identified, of which 53 were eligible for meta-analysis. The endpoints of interest were the incidences of seroma, cellulitis, infection, wound dehiscence, implant failure, and hernia. The effects of various risk factors such as smoking, radiation, chemotherapy, and diabetes on the development of complications were also evaluated. RESULTS: A majority of the studies were retrospective (68.6%) with a mean follow-up of 16.8 months (SD +/- 10.1 months) in the breast group and 14.2 months (SD +/- 7.8 months) in the abdominal wall reconstructive group. The overall risks and complications were as follows: cellulitis, 5.1%; implant failure, 5.9%; seroma formation, 8%; wound dehiscence, 8.1%; wound infection, 16.1%; hernia, 27.6%; and abdominal bulging, 28.1%. Complication rates were further stratified separately for the breast and abdominal cohorts, and the data were reported. This provides additional information on the associated abdominal wall morbidity in patients undergoing autologous breast reconstruction in which mesh reinforcement was considered as closure of the abdominal wall donor site. Radiation resulted in a significant increase in the rates of cellulitis (P = 0.021), and chemotherapy was associated with a higher incidence of seroma (P = 0.014). CONCLUSION: This study evaluates the overall complication rates associated with ADM use by conducting a meta-analysis of published data. This will offer physicians a single comprehensive source of information during informed consent discussions as well as an awareness of the risk factors predictive of complications. (12/2011) (link)
• Wong W W, & Gupta S C. (2011). Plastic Surgery Marketing in a Generation of "Tweeting". Aesthetic Surgery Journal, 31(8), 972-976. Background: "Social media" describes interactive communication through Web-based technologies. It has become an everyday part of modern life, yet there is a lack of research regarding its impact on plastic surgery practice. Objectives: The authors evaluate and compare the prevalence of classic marketing methods and social media in plastic surgery. Methods: The Web sites of aesthetic surgeons from seven US cities were compared and evaluated for the existence of Facebook, Twitter, or MySpace links and promotions. To find the sites, the authors conducted a Google search for the phrase "plastic surgery" with the name of each city to be studied: Beverly Hills, California; Dallas, Texas; Houston, Texas; Las Vegas, Nevada; Miami, Florida; New York City, New York; and San Francisco, California. The trends of social networking memberships were also studied in each of these cities. Results: In comparison to aesthetic surgeons practicing in other cities, those in Miami, Florida, favored social media the most, with 50% promoting a Facebook page and 46% promoting Twitter. Fifty-six percent of New York City aesthetic surgeons promoted their featured articles in magazines and newspapers, whereas 54% of Beverly Hills aesthetic surgeons promoted their television appearances. An increase in the number of new Facebook memberships among cosmetic providers in the seven cities began in October 2008 and reached a peak in October, November, and December 2009, with subsequent stabilization. The increase in the number of new Twitter memberships began in July 2008 and remained at a steady rate of approximately 15 new memberships every three months. Conclusions: Social media may seem like a new and unique communication tool, but it is important to preserve professionalism and apply traditional Web site-building ethics and principles to these sites. We can expect continued growth in plastic surgeons' utilization of these networks to enhance their practices and possibly to launch direct marketing campaigns. (11/2011) (link)
• Gabriel A, Gialich S, Kirk J, Edwards S, Beck B, . . . Gupta S. (2011). The Haiti Earthquake: The Provision of Wound Care for Mass Casualties Utilizing Negative-Pressure Wound Therapy. Advances in Skin & Wound Care, 24(10), 456-462. Many months after the devastating earthquake in January 2010, wounds remain a major disease burden in Haiti. Since January 2010, through the efforts of corporations, nonprofit charitable organizations, and medical professionals, advanced wound care techniques, including negative-pressure wound therapy (NPWT), have been introduced into the wound care regimens of various hospitals in Haiti. In June 2010, the authors completed their second volunteer trip at a Haitian hospital specializing in orthopedic wounds. The medical team was composed of a plastic surgeon, orthopedic surgeon, anesthesiologist, medical assistant, scrub technician, and registered nurse (specializing in plastic surgery and orthopedics). The authors' team supplied NPWT devices, reticulated open-cell foam dressings, and canisters donated by Kinetic Concepts, Inc, San Antonio, Texas, for use at the hospital. This report describes the medical challenges in postearthquake Haiti (including limb salvage and infection), benefits of adjunctive use of NPWT/reticulated open-cell foam, and current wound care status in a Haitian orthopedic hospital. The future role of NPWT in Haiti and during mass catastrophe in a least-developed country is also discussed. (10/2011) (link)
• Adetayo O A, Gabriel A, & Gupta S C. (2011). Haiti and the Road to Recovery: Surviving the Human Aftershocks, Battles with the Cholera Epidemic, and the Anticipation of a New Political Era. Plastic and Reconstructive Surgery, 128(2), 577-578. (08/2011) (link)
• Camp M C, Wong W W, Filip Z, Carter C S, & Gupta S C. (2011). A quantitative analysis of periorbital aging with three-dimensional surface imaging. Journal of Plastic Reconstructive and Aesthetic Surgery, 64(2), 148-154. Background: Studies of facial aging up to the present have largely been observational and subjective. This study applies state-of-the-art facial imaging and three-dimensional computer modelling to measure changes in the aging female face. The markers of facial aging discussed here go beyond descriptive accounts by individual practitioners and are presented as quantitative measurements of the volume change in the aging periorbital region. Methods: Three-dimensional image data sets were acquired of 42 mother-daughter matched pairs (83 individuals). Overall similarity of the faces of the mother-daughter pair were confirmed using best fit analyses prior to further processing of the data. The changes in facial structure secondary to aging were measured using volumetric comparisons of periorbital tissues in the daughter and mother. The age range of the individuals imaged range from 15 to 91 years. Results: A consistent pattern of volume difference and regression of soft tissues associated with the medial canthus nasojugal groove was demonstrated in the aged individual of each pair. The volume difference associated with the tear trough ranged from 0.02 cc to 1.27 cc with median values of 0.38 cc and 0.42 cc. Volume differences in the adjacent periorbital tissues are also measured. Conclusions: Imaging clearly shows a consistent pattern of atrophy and regression of soft tissues associated with the medial canthus and nasojugal groove. Histogram depth analysis of the soft tissue shows greatest atrophy in the medial canthal region and soft tissues caudal to the lower lid. Volumetric analysis of the atrophy of these tissues is a useful adjunct in the accurate rejuvenation of the periorbital region. (C) 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. (02/2011) (link)
• Wong W W, Davis D G, Camp M C, & Gupta S C. (2010). Contribution of lip proportions to facial aesthetics in different ethnicities: A three-dimensional analysis. Journal of Plastic Reconstructive and Aesthetic Surgery, 63(12), 2032-2039. Background: Lip augmentations are commonly performed procedures in the United States, with annual numbers surpassing 100 000. While lips contribute to facial beauty, the relative influence of this feature to whole facial appeal has not yet been established. What is also of increasing interest is the consideration of ethnic differences in the evaluation of beauty. However, most current anthropometric measurements refer to Caucasians, and their use in the treatment of Asian American patients would be inappropriate. Methods: Three-dimensional models of 197 male and female Caucasian, Chinese and Korean subjects were created using surface-imaging technology. The lips and corresponding faces from these models were ranked according to subjective aesthetic appeal by 20 male and female raters of various ages, occupations and ethnicities. The raters' results were subsequently compared with individually measured lip parameters. Results: Rankings between lips and their corresponding whole faces differed greatly. Lips that were rated as the most attractive were smaller than average in midline upper lip surface heights, bilateral paramedian lip surface heights, upper lip angles and volume in the lower lip. Both Asian groups exhibited significantly different lip parameters and lip-projection volumes from that of Caucasians. Conclusions: The results from this study suggest that there are indeed measurable differences in the baseline Asian lip morphology as compared with Caucasians. Tailoring lip enhancement treatment to each individual's anatomy, ethnic background and personal goals can optimise outcomes. What is also of interest is that lips did not contribute as much to facial attractiveness as previously thought. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. (12/2010) (link)
• Wong W W, Camp M C, Camp J S, & Gupta S C. (2010). The Quality of Internet Advertising in Aesthetic Surgery: An In-Depth Analysis. Aesthetic Surgery Journal, 30(5), 735-743. Background: The aesthetic market is a growing business, as evidenced by the American Society for Aesthetic Plastic Surgery (ASAPS) reporting an increase of 147% in the number of cosmetic procedures performed by members since 1997. This market is consumer-oriented, relying heavily on advertising for survival amid the increasing provider competition. Objectives: The authors evaluate trends, ethics, and efficacy of Internet advertising in aesthetic surgery. Methods: Medical cosmetic providers in Southern California and their Web sites were catalogued through sales lists from manufacturers (Medicis and Allergan) and combined with advertised providers of surgical treatments. Using the ASAPS/American Society of Aesthetic Plastic Surgeons (ASPS) and American Medical Association Codes of Ethics as guidelines, scores were assigned to each Web site and evaluated with the provider's board certification. A geographical analysis determined whether the presence of high numbers of competitors had an impact on the adherence to ethical guidelines for advertising. To examine patient preferences in physician advertising, a survey was conducted online. Results: Board-certified plastic surgeons showed the highest total ethical scores, followed by otolaryngologists, oromaxillofacial surgeons, and ophthalmologists. No decrement in the quality of the advertising was found in densely competitive environments. A consistent correlation was found between superior compliance with ethical guidelines and board certification in plastic surgery. The patient preference survey of 208 individuals demonstrated their desire for a well-trained, board-certified plastic surgeon to perform their cosmetic procedures. Conclusions: Although plastic surgeons demonstrate greater overall compliance with the ASAPS/ASPS Advertising Code of Ethics, they can continue to improve. With the large variety of cosmetic physicians offering the same procedures, maintaining open, honest, and forthright communication with the public is essential. (09/2010) (link)
• Camp M C, Camp J S, Ray A O, & Gupta S. (2010). Demographic and Geographic Analysis of Providers of Cosmetic Services in the Greater Los Angeles Area: 2008 to 2009. Plastic and Reconstructive Surgery, 126(2), 115E-116E. (08/2010) (link)
• Wong W W, Davis D G, Son A K, Camp M C, & Gupta S C. (2010). Canary in a Coal Mine: Does the Plastic Surgery Market Predict the American Economy?. Plastic and Reconstructive Surgery, 126(2), 657-666. Background: Economic tools have been used in the past to predict the trends in plastic surgery procedures. Since 1992, U.S. cosmetic surgery Volumes have increased overall, but the exact relationship between economic downturns and procedural volumes remains elusive. If an economic predicting role can be established from plastic surgery indicators, this could prove to be a very powerful tool. Methods: A rolling 3-month revenue average of an eight plastic surgeon practice and various economic indicators were plotted and compared. An investigation of the U.S. procedural volumes was performed from the American Society of Plastic Surgeons statistics between 1996 and 2008. The correlations of different economic variables with plastic surgery volumes were evaluated. Lastly, search term frequencies were examined from 2004 to July of 2009 to study potential patient interest in major plastic surgery procedures. Results: The self-payment revenue of the plastic surgery group consistently proved indicative of the market trends approximately 1 month in advance. The Standard and Poor's 500, Dow Jones Industrial Average, National Association of Securities Dealers Automated Quotations, and Standard and Poor's Retail Index demonstrated a very close relationship with the income cif our plastic surgery group. The frequency of Internet search terms showed a constant level of interest in the patient population despite economic downturns. Conclusions: The data demonstrate that examining plastic surgery revenue can be a useful tool to analyze and possibly predict trends, as it is driven by a market and shows a close correlation to many leading economic indicators. The persisting and increasing interest in plastic surgery suggests hope for a recovering and successful market in the near future. (Mast. Reconstr. Slug. 126: 657, 2010.) (08/2010) (link)
• Camp M C, Wong W W, Mussman J L, & Gupta S C. (2010). The Battle for Hearts and Minds: Who Is Communicating Most Effectively With the Cosmetic Marketplace?. Aesthetic Surgery Journal, 30(4), 614-617. Background: Cosmetic surgery, historically the purview of plastic surgeons, has in recent years seen an influx of practitioners from other fields of training. Many of these new providers are savvy in marketing and public relations and are beginning to control a surprisingly large amount of cosmetic patient care. Objectives: The purpose of this study is to measure the amount of traffic being attracted to the Web sites of individual practitioners and organizations vying for cosmetic patients. This study investigates the trends of the past 12 months and identifies changes of special concern to plastic surgeons. Methods: The Web sites of 1307 cosmetic providers were monitored over a year's time. The Web activity of two million individuals whose computers were loaded with a self-reporting software package was recorded and analyzed. The Web sites were analyzed according to the specialty training of the site owner and total unique visits per month were tallied for the most prominent specialties. The dominant Web sites were closely scrutinized and the Web optimization strategies of each were also examined. Results: There is a tremendous amount of Web activity surrounding cosmetic procedures and the amount of traffic on the most popular sites is continuing to grow. Also, a large sum of money is being expended to channel Web traffic, with sums in the thousands of dollars being spent daily by top Web sites. Overall in the past year, the private Web sites of plastic surgeons have increased their reach by 10%, growing from 200,000 to approximately 220,000 unique visitors monthly. Plastic surgery remains the specialty with the largest number of Web visitors per month. However, when combined, the private Web sites of all other providers of aesthetic services have significantly outpaced plastic surgery's growth. The traffic going to non-plastic surgeons has grown by 50% (200,000 visitors per month in September 2008 to 300,000 visitors monthly in September 2009). Conclusions: For providers of aesthetic services, communication with the public is of utmost importance. The Web has become the single most important information resource for consumers because of easy access. Plastic surgeons are facing significant competition for the attention of potential patients, with increasingly sophisticated Web sites and listing services being set up by independent parties. It is important for plastic surgeons to become familiar with the available Internet tools for communication with potential patients and to aggressively utilize these tools for effective practice building. (07/2010) (link)
• Bollero D, Driver V, Glat P, Gupta S, Lazaro-Martinez J L, . . . Woo K. (2010). The Role of Negative Pressure Wound Therapy in the Spectrum of Wound Healing. Ostomy Wound Management, , 4-+. Wound care clinicians have a wide array of available treatment options to manage and help heal acute and chronic complex wounds that require a systematized and comprehensive approach to address the complexity of wound care and to optimize patient outcomes. The treatment of wounds represents a major cost to society. Public policies increasingly focus on quality of care, patient outcomes, and lowering costs. Wound care clinicians are not immune to these pressures. Wound care clinicians must ensure that their assessments, treatment pathways, and product selections are both clinically and economically sound. Negative pressure wound therapy (NPWT) has been demonstrated to be an efficacious option to promote healing in a variety of acute and chronic complex wounds. Previous guidelines on the use of NPWT have focused on application but have not provided recommendations on when it is most appropriate to use NPWT; there are few criteria for 1) when to initiate NPWT based on various wound types, 2) pre-application management to optimize treatment outcomes, 3) identification of appropriate candidates for NPWT, 4) benchmark indicators for treatment response, and 5) recommendations on when to transition between NPWT and moist wound healing (MWH) or another treatment mooality. In September 2009, an international panel of wound care experts from multiple disciplines convened to develop a document to guide clinicians in making decisions about the appropriate use of NPWT within the spectrum of wound healing. Where empirical research was lacking, clinical experiences and patient factors were considered to ensure the clinical utility of the document. The goal of these guidelines is to encourage responsible wound management across the healthcare continuum and spectrum of wound pathologies to achieve positive, cost-effective patient outcomes. (05/2010)
• Camp M C, Wong W W, Wong R Y, Camp J S, Son A K, & Gupta S C. (2010). Who Is Providing Aesthetic Surgery? A Detailed Examination of the Geographic Distribution and Training Backgrounds of Cosmetic Practitioners in Southern California. Plastic and Reconstructive Surgery, 125(4), 1257-1262. Background: In recent years, there has been a significant increase in the number of non-plastic surgeons performing cosmetic procedures. This has the potential to have an impact on the plastic surgery practitioner by increasing competition and bringing into question the assurance of patient safety. In this study, a demographic analysis was performed of providers of invasive and minimally invasive cosmetic treatments in the Southern California region. Methods: Providers of minimally invasive aesthetic procedures were catalogued using the sales lists from the manufacturers of the hyaluronic acid fillers Juvederm and Restylane. The data set was further analyzed to enumerate the providers of surgical treatments, with a focus on the provision of liposuction. Data were analyzed using Environmental Systems Research Institute ArcGIS to focus on the Southern California area. Physician board certification and training background were detailed exhaustively. Results: In the 45,238-square mile area encompassing the San Diego/Los Angeles megalopolis, there are 1867 cosmetic practitioners offering hyaluronic acid injections. Of this number, 495 are trained in plastic surgery. In the same geographic region, there are 834 individuals offering liposuction. Practitioners are concentrated in downtown Los Angeles and San Diego, where the potential patient-to-provider ratios are 1088: 1 and 1185: 1, respectively. Interestingly, primary care physicians comprise the third largest group providing hyaluronic acid fillers and the fourth largest group of liposuction providers. Conclusions: The authors' data demonstrate that there are numerous non-plastic surgeons performing cosmetic procedures, especially in the field of minimally invasive therapies. In addition, there is a growing contingent of non-surgery-trained individuals providing surgical cosmetic treatments, especially liposuction. (Plast. Reconstr. Surg. 125: 1257, 2010.) (04/2010) (link)
• Gabriel A, Heinrich C, Shores J, Cho D, Baqai W, . . . Gupta S. (2009). Outcomes of vacuum-assisted closure for the treatment of wounds in a paediatric population: case series of 58 patients. Journal of Plastic Reconstructive and Aesthetic Surgery, 62(11), 1428-1436. Objective: This retrospective case series describes our experiences and outcomes using the vacuum-assisted closure (VAC) Therapy System for the management of difficult acute and chronic wounds in paediatric patients. Summary background data: Difficult wounds that cannot be closed primarily can create major challenges in paediatric patient care. Decreasing the time to wound closure is especially critical when managing paediatric patients. Methods: A retrospective review of medical records for 58 consecutive paediatric patients treated with VAC therapy was performed. Demographics, diagnosis, length of therapy, time to closure, time to discharge, type of VAC dressing used, dressing change schedule, therapy settings, and complications were recorded for each patient. Results: The median age of all 58 patients was 10 years (range, 10 days to 16 years). Fifty-four of the 58 wounds reached full closure. Patients were divided into five different groups according to diagnosis. The median time to closure for each group follows: Group 1 (abdominal wounds) 10 days (range, 3-99 days); Group 2 (surgical soft tissue deficit) 12 days (range, 3-30 days); Group 3 (trauma wounds) 7 days (range, 3-10 days); Group 4 (stage III/IV pressure ulcers) 15 days (range, 14-15 days); Group 5 (fasciotomy wounds) 5 days (range, 5-10 days). No complications were recorded for any of the patients. Conclusions: The results demonstrate that VAC therapy may be a viable, safe and effective method of managing this difficult-to-treat population. (C) 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. (11/2009) (link)
• Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, . . . Gupta S. (2009). A clinical review of infected wound treatment with Vacuum Assisted Closure (VAC) therapy: experience and case series. , 6 Suppl 2, 1-25. Over the last decade Vacuum Assisted Closure((R)) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.((R)) Therapy and V.A.C. Instill((R)) with either GranuFoam() or GranuFoam Silver() Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.((R)) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.((R)) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.((R)) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. (10/2009) (link)
• Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, . . . Gupta S. (2009). A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure (R) (VAC (R)) Therapy: Experience and Case Series. International Wound Journal, 6, 1-25. Over the last decade Vacuum Assisted Closure (R) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.(R) Therapy and V.A.C. Instill (R) with either GranuFoam (TM) or GranuFoam Silver (TM) Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.(R) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.(R) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.(R) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. (10/2009)
• Baharestani M, Amjad I, Bookout K, Fleck T, Gabriel A, . . . Gupta S. (2009). VAC (R) Therapy in the management of paediatric wounds: clinical review and experience. International Wound Journal, 6, 1-26. Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure (R) (V.A.C.(R) Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.(R) Therapy System. (08/2009) (link)

Abstract

• Yang S, Lewis P, & Gupta S. (2015). BREAST RECONSTRUCTION REFERRALS, RATES, AND MANAGEMENT FOLLOWING MASTECTOMY. Journal of Investigative Medicine, 63(1), 128-128. (01/2015)
• Pinette W, Dhillon J, Lewis P, Hill M E, & Gupta S. (2015). RISK FACTORS CONTRIBUTING TO REVISION RATE IN BREAST RECONSTRUCTION PATIENTS. Journal of Investigative Medicine, 63(1), 162-162. (01/2015)
• Kutzner E, Lewis P, & Gupta S. (2015). THE IMPACT OF THE AFFORDABLE CARE ACT ON PAYOR MIX IN AN ACADEMIC PLASTIC SURGERY CENTER. Journal of Investigative Medicine, 63(1), 135-135. (01/2015)
• Kutzner E, Lewis P, Dhillon J, Biskup N, & Gupta S. (2015). APPLYING A STANDARDIZED, VALIDATED INSTRUMENT TO QUANTIFY PAIN BEFORE AND AFTER REDUCTION MAMMOPLASTY. Journal of Investigative Medicine, 63(1), 159-160. (01/2015)
• Korsich D, Biskup N, Dhillon J, & Gupta S. (2015). THE "JULY EFFECT": FACT OR FICTION IN A TEACHING HOSPITAL-BASED PLASTIC SURGERY PRACTICE?. Journal of Investigative Medicine, 63(1), 128-128. (01/2015)
• Danci I, Biskup N, Dhillon J, Wong W, & Gupta S. (2015). COMPLETE KELOID EXCISION AND DERMAL REGENERATION TEMPLATE APPLICATION IN RECALCITRANT FACIAL KELOIDS: A NOVEL APPROACH TO TREATING. Journal of Investigative Medicine, 63(1), 157-157. (01/2015)
• Danci I, Dhillon J, Lewis P, Biskup N, Kim H, & Gupta S. (2015). ANTIBIOTICOGRAM FOR PERI-PROSTHETIC INFECTIONS: A TOOL FOR BETTER INFORMED SELECTION OF EMPIRIC ANTIBIOTICS. Journal of Investigative Medicine, 63(1), 171-171. (01/2015)
• Danci I, Ford R, Dhillon J, & Gupta S. (2015). PERIORBITAL USES OF A SILK DERIVED BIOLOGICAL SCAFFOLD: A CASE SERIES OF A NEW TECHNIQUE FOR SOFT TISSUE SUSPENSION. Journal of Investigative Medicine, 63(1), 128-128. (01/2015)
• Richardson C, Workman A, Mattison G, & Gupta S. (2013). THE OPTIMAL DURATION OF ANTIBIOTIC PROPHYLAXIS IN PLASTIC SURGERY: A META-ANALYSIS OF 32 PUBLICATIONS. Journal of Investigative Medicine, 61(1), 179-179. (01/2013)
• Richardson C, Workman A, & Gupta. (2013). COST ANALYSIS OF COMMON PLASTIC SURGERY PROCEDURES: GEOGRAPHY VERSUS ECONOMICSf. Journal of Investigative Medicine, 61(1), 194-195. (01/2013)
• Mitchell E, Workman A, & Gupta S. (2013). ORAL VITAMIN SUPPLEMENTATION AND WOUND HEALING: AN EVIDENCE BASED REVIEW OF THE PLASTIC SURGERY LITERATURE. Journal of Investigative Medicine, 61(1), 177-178. (01/2013)
• Mitchell E, Workman A, & Gupta S. (2013). INTERNATIONAL PUBLICATION TRENDS IN PLASTIC AND RECONSTRUCTIVE SURGERY. Journal of Investigative Medicine, 61(1), 177-177. (01/2013)
• Huberty S A, Gabriel A, & Gupta S. (2011). USE OF NEGATIVE PRESSURE THERAPY ON CLOSED SURGICAL INCISIONS. Journal of Investigative Medicine, 59(1), 179-179. (01/2011)
• Richards S M, Adetayo O A, Salcedo S E, Ray A O, & Gupta S C. (2011). SURGICAL MANAGEMENT IN THE TREATMENT OF FIBROUS DYSPLASIA. Journal of Investigative Medicine, 59(1), 180-180. (01/2011)
• Son A K, Wong W, Ray A, & Gupta S. (2010). RECONSTRUCTION OF MALIGNANT MELANOMA RESECTION WITH ARTIFICIAL DERMAL SUBSTITUTE. Journal of Investigative Medicine, 58(1), 193-193. (01/2010)
• Carter C S, Camp M C, Wong W W, & Gupta S C. (2010). CHANGES IN FACIAL SHAPE WITH ACE: AN ANALYSIS WITH THREE-DIMENSIONAL IMAGING. Journal of Investigative Medicine, 58(1), 151-152. (01/2010)