Adam Hamawy - Academia.edu (original) (raw)

Papers by Adam Hamawy

Research paper thumbnail of Aesthetic breast reconstruction: Navigating the choices for optimum results

Research paper thumbnail of Transmyocardial laser revascularization dose response: enhanced perfusion in a porcine ischemia model as a function of channel density

The Annals of Thoracic Surgery, 2001

Transmyocardial laser revascularization (TMR) appears to provide symptomatic relief to patients w... more Transmyocardial laser revascularization (TMR) appears to provide symptomatic relief to patients with ischemic heart disease, but evidence that TMR enhances perfusion to ischemic myocardium remains limited. Furthermore, it is uncertain whether there exists a TMR dose-response relationship that is a function of channel number. We therefore compared restoration of blood flow as analyzed by rest and stress 99mTc-sestamibi scans and histologic grading of neovascularization after 50-channel, 25-channel, or 10-channel TMR using the excimer laser in an established model of porcine myocardial ischemia. Yorkshire swine underwent a thoracotomy and placement of an ameroid constrictor around the proximal circumflex coronary artery. Three weeks later, the animals underwent resting and adenosine stress 99mTc-sestamibi scans for evaluation of ischemia immediately before repeat thoracotomy and TMR with either 50 channels (n = 4), 25 channels (n = 4), or 10 channels (n = 4) in the circumflex territory. The animals underwent repeat perfusion analyses 4 weeks later, after which the animals were sacrificed and the hearts were perfusion fixed for histologic evaluation of neovascularization. All animals survived to sacrifice. Semiquantitative analyses of the sestamibi perfusion scans 4 weeks after lasing demonstrated significant improvement (p < 0.04) in stress-induced ischemia in the 50-channel TMR animals, but not in the 25- or 10-channel TMR groups, as compared with scans obtained immediately before lasing. A computerized image analysis of perfusion scans similarly demonstrated an improvement in the area of ischemia of 42% +/- 22% in the scans obtained 4 weeks after lasing compared with scans obtained immediately before lasing in the 50-channel group (p < 0.004), but only a 12% +/- 9% improvement in the 25-channel group and an 8% +/- 4% improvement in the 10-channel group (p > 0.05). Histologic assessment of neovascularization demonstrated significantly greater number of microvessels per low-power field in the 50- versus the 25- and 10-channel groups (p < 0.001). In an animal model of myocardial ischemia, TMR appears to enhance myocardial perfusion. A dose-response relationship related to channel number may be of significance when evaluating the efficacy of various treatment strategies.

Research paper thumbnail of Essentials of Aesthetic Surgery

Aesthetic Surgery Journal, 2018

Continuing in the model of the earlier sister book, Essentials of Plastic Surgery, which he coaut... more Continuing in the model of the earlier sister book, Essentials of Plastic Surgery, which he coauthored, Jeffrey E. Janis, MD, has packed this small (5½ by 8½ inches) but thick book with a lot of information covering the breadth of aesthetic surgery and aesthetic medicine. Divided into 9 parts and 65 chapters, the book begins with a discussion of "The Aesthetic Patient" and finishes with "Aesthetics of Gender Affirmation Surgery." Between these opening and closing chapters, Janis and his long list of contributors divide aesthetic surgery and medicine into Basic Considerations, Anesthesia, Safety, Skin Care, Noninvasive and Minimally Invasive Therapy, Adjuncts to Aesthetic Surgery, Facial Surgery, Breast Surgery, and Body Contouring. Each of these segments is subdivided into chapters covering a specific subject in aesthetics. Each chapter is designed to be read independent of the other chapters in the book. Each chapter ends with a "Top Takeaway" list of key points and a focused reference list. The format design makes Essentials of Aesthetic Surgery an excellent reference source for students, residents, and fellows in plastic surgery. In his preface, Dr Janis refers to this text as a "… fit-in-your-coat-pocket format" suggesting its target reader. However, even the experienced plastic surgeon wanting a quick review or a reference on a specific area would find its uncomplicated, straight-to-the-point design beneficial. Dr Lund is a plastic surgeon in private practice in Chesterfield, MO.

Research paper thumbnail of Chest Wall Reconstruction

Research paper thumbnail of Graft repair of a pulmonary artery aneurysm

Heart Surgery Forum, 2002

Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We... more Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We report the successful surgical resection and repair of a pulmonary artery aneurysm using aneurysmectomy and replacement of the pulmonary artery with Dacron, a procedure with excellent longterm outcome that eliminates the risk of recurrence. The 65-year-old male patient presented with a marked decrease in exercise tolerance and worsening dyspnea. He had a history of pulmonary stenosis diagnosed during childhood, episodic shortness of breath beginning during his teenage years, hypertension, and smoking. On physical examination, the patient appeared generally well. Computed tomographic scan of the chest revealed an 8-cm aneurysm involving the main pulmonary artery and pulmonary artery bifurcation. Coronary angiography showed a massive aneurysm of the main and left pulmonary arteries, with mild dilation of the proximal right pulmonary artery. Surgery was performed through a median sternotom...

Research paper thumbnail of Direct Lateral Canthal (DLC) Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve (Hamawy-Amirlak Technique)

Atlas of Surgical Therapy for Migraine and Tension-Type Headache, 2019

The direct lateral canthal (DLC) approach to the zygomaticotemporal branch of the trigeminal nerv... more The direct lateral canthal (DLC) approach to the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) is a short procedure that can be done under local anesthesia to treat migraine headache pain originating from this nerve. Direct visualization of the zygomaticotemporal branch of the trigeminal nerve can be obtained with this approach, and this technique is especially useful in cases where the surgeon is less familiar with the endoscopic approach, extensive scarring of the dissection planes, and when an endoscopic procedure needs to be converted to open.

Research paper thumbnail of Direct Lateral Canthal Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve for Surgical Treatment of Migraines

Plastic and Reconstructive Surgery

Research paper thumbnail of ACR Appropriateness Criteria(®) Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Journal of the American College of Radiology : JACR, 2017

Breast cancer is the most common malignancy in women in the United States. Breast reconstruction ... more Breast cancer is the most common malignancy in women in the United States. Breast reconstruction surgery is a commonly used therapy for patients with breast cancer. The technique for the deep inferior epigastric perforator flap uses a preserved rectus muscle, which decreases donor site morbidity. Accurate identification and measurement of the perforator branches of the deep inferior epigastric artery is pivotal during pre-operative planning so that the surgeon can prioritize the best vessel to use and ultimately improve clinical outcome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Developme...

Research paper thumbnail of People & Appointments

Filtration Industry Analyst

Research paper thumbnail of Surgical Treatment of Migraine Headaches

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Chest Wall Reconstruction

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Graft repair of a pulmonary artery aneurysm

The heart surgery forum, 2002

Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We... more Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We report the successful surgical resection and repair of a pulmonary artery aneurysm using aneurysmectomy and replacement of the pulmonary artery with Dacron, a procedure with excellent longterm outcome that eliminates the risk of recurrence. The 65-year-old male patient presented with a marked decrease in exercise tolerance and worsening dyspnea. He had a history of pulmonary stenosis diagnosed during childhood, episodic shortness of breath beginning during his teenage years, hypertension, and smoking. On physical examination, the patient appeared generally well. Computed tomographic scan of the chest revealed an 8-cm aneurysm involving the main pulmonary artery and pulmonary artery bifurcation. Coronary angiography showed a massive aneurysm of the main and left pulmonary arteries, with mild dilation of the proximal right pulmonary artery. Surgery was performed through a median sternotom...

Research paper thumbnail of Facial Skeletal Trauma

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Eyelid Reconstruction

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of The Anatomy of the Greater Occipital Nerve: Part II. Compression Point Topography

Plastic and Reconstructive Surgery, 2011

Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral... more Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral nerves in the head and neck as a cause of this debilitating condition. An anatomical study was undertaken to develop a greater understanding of the potential entrapment sites along the course of this nerve. The posterior neck and scalp of 25 fresh cadaveric heads were dissected. The greater occipital nerve was identified within the subcutaneous tissue above the trapezius and traced both proximal and distal. Its fascial, muscular, and vascular investments were located and accurately measured relative to established bony landmarks. Dissection of the greater occipital nerve revealed six major compression points along its course. The deepest (most proximal) point was between the semispinalis and the obliquus capitis inferior, near the spinous process. The second point was at its entrance into the semispinalis. The previously described "intermediate" point was at the nerve's exit from the semispinalis. A fourth point was located at the entrance of the nerve into the trapezius muscle. The fifth point of compression is where the nerve exits the trapezius fascia insertion into the nuchal line. The occipital artery often crosses the nerve, and this frequently occurs in this distal region of the trapezius fascia, which is the final point. There are six compression points along the greater occipital nerve. These can be located using the data from this study, serving as a guide for surgeons interested in treating patients with migraine headaches originating in these areas. Long-term relief from migraine headaches has been demonstrated clinically by using both noninvasive and surgical decompression of these points.

Research paper thumbnail of Preventing and Managing Dry Eyes after Periorbital Surgery: A Retrospective Review

Plastic and Reconstructive Surgery, 2009

Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek p... more Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek periorbital rejuvenation, understanding the pathophysiology, diagnosis, and treatment of this condition perioperatively is essential for managing patient expectations and maximizing outcomes. A retrospective review of charts for 202 consecutive patients (180 women and 22 men) who underwent upper and/or lower blepharoplasty was performed. Additional facial cosmetic procedures were performed in 91 percent of patients. Data were collected identifying associated risk factors and the incidence of persistent dry eye symptoms. Key elements of perioperative care are described and algorithms for detection of those at risk, prevention, and management are outlined. Dry eyes persisting longer than 2 weeks after surgery were noted in 22 patients (10.9 percent) and longer than 2 months in only four patients (2 percent). In most cases, dry eyes resolved with conservative management, including artificial tears, lubrication, topical and systemic steroids, and night taping. One patient (0.5 percent of all studied patients) eventually needed surgical correction of lower eyelid retraction after failure of the punctate plug. Persistent chemosis occurred in 15 patients (68.2 percent) who had symptomatic dry eyes (p < 0.01). Recognizing and addressing risk factors before surgery and an algorithmic approach to prevention and management of patients undergoing periorbital surgery are essential for minimizing the occurrence of dry eye syndrome.

Research paper thumbnail of Carotid artery anastomosis with albumin solder and near infrared lasers: A comparative study

Lasers in Surgery and Medicine, 2001

Background and Objective: Laser tissue-welding has been used for anastomosis of carotid arteries.... more Background and Objective: Laser tissue-welding has been used for anastomosis of carotid arteries. During welding, thermal injury sustained by the vessel walls should be minimized to prevent thrombosis. Two different types of lasers were used and effects on tissue damage were studied in vitro and in vivo. Study Design/Materials and Methods: End-to-end anastomosis of dog carotid arteries (n ‫ס‬ 10) was performed by using a human albumin solder (HAS) in conjunction with Nd:YAG or diode lasers (‫ס‬ 1.32 m and 1.9 m, respectively). The arteries were evaluated for patency and evidence of histologic injury after 21 days. Another group of arteries was laser soldered in vitro to measure the intimal and adventitial temperatures by using thermocouples. Results: The arteries repaired with the diode laser sustained significantly less thermal damage than those repaired with Nd:YAG laser, both in vitro and in vivo. In particular, the intimal temperature was significantly lower (P < 0.05) for the diode than for the Nd:YAG repairs (∼35°C and ∼50°C, respectively). In the latter group, the patency rate was 75%, but thrombosis occurred in 75% of the specimens at 21 days. All diode anastomoses were patent and thrombosis developed in only 17% of the arteries. Conclusion: Use of the diode laser and albumin solders may provide a means to successfully repair carotid arteries with minimal thermal damage.

Research paper thumbnail of Effect of laser welding with human serum albumin on the expression of P-selectin on platelets

Lasers in Surgery and Medicine, 1999

Artery repair by means of laser energy induces activation of platelets with a risk of thrombosis ... more Artery repair by means of laser energy induces activation of platelets with a risk of thrombosis and local inflammatory reactions. The aim of this study was to investigate the effect of human serum albumin, the most common solder in laser surgery, on platelet activation. Platelet activation was evaluated in canine blood by using two-color flow cytometry with a phycoerythrin-labeled antibody to a common platelet marker, glycoprotein IIb/IIIa and fluorescein isothiocyanate-labeled antibody to a platelet activation molecule, P-selectin. Human serum albumin was applied in vitro and in vivo, as a solder during laser reconstruction of canine arteries. In vitro, albumin significantly (P &lt; 0.01) reduces the expression of P-selectin on platelets. This is most likely related to the blockage of P-selectin by albumin, which binds to the platelet surface, as confirmed by flow cytometry with fluorescein isothiocyanate-labeled albumin. In vivo, application of albumin solder tended to result in a lower percentage of P-selectin-expressing platelets in laser-repaired arteries compared to suture-repaired arteries. Albumin decreases the percentage of P-selectin-expressing platelets in vitro. Further research may allow the platelet activation inhibiting properties of albumin to be further optimized in vivo.

Research paper thumbnail of VS3. Video Presentation Superficialization of Arteriovenous Fistulas Employing Minimally Invasive Liposuction

Journal of Vascular Surgery, 2011

Objectives: Haemodialysis through LTVA is preferable in ESRD patients because of the shorter dura... more Objectives: Haemodialysis through LTVA is preferable in ESRD patients because of the shorter duration of dialysis. We aim to compare the outcome of PAVF to DAVF. Primary endpoint is patency. Secondary endpoints are complication rates, secondary intervention and mortality. Methods: 179 patients with ESRD had 200 AVF formations from January 2003 to June 2009. 69% were males. Mean age 53.6 years. All were upper limbs. All patients had duplex ultrasound mapping of superficial veins prior to surgery. No synthetic grafts were used. 37 procedures were distal AVF (radiocephalic) while 163 were proximal; either brachio-cephalic or brachio-basilic. Results: 1 year patency rate was 89% in proximal AVF vs 22% distal (PϽ0.0001). Occlusive thrombosis occurred in 6% of PAVF (nϭ10/163), compared to 54% in DAVF (nϭ20/37) (PϽ0.0001), with a significantly less need for re-intervention (4% vs 32%) (PϽ0.0001). PAVF had lower incidence of non-occlusive thrombus (6%, nϭ9/163) vs 24% (nϭ9/ 37) in DAVF PϽ0.001. PAVF had reduced incidence of aneurysm formation (12%, nϭ19/163) vs 27% (nϭ10/37) in DAVF PϽ0.033. 30 days mortality was 0.6% (nϭ1/ 163) in the PAVF group and 0% in the DAVF group. 5year mortality was 7% (nϭ12/163) in PAVF vs 30% (nϭ11/37) in DAVF patients (Pϭ0.0004). Conclusions: PAVF is less tedious with greater blood flow and easer manipulation for the nephrologists' team. Venous mapping prior to surgery with meticulous surgical techniques increases patency. PAVF is established as a reliable proficient procedure to bestow long-term access for haemodialysis with low rates of infection. It has considerably less incidence of complications and re-interventions compared to DAVF. We believe that PAVF must be offered as the first step in Long term venous access.

Research paper thumbnail of Superficialization of arteriovenous fistulae employing minimally invasive liposuction

Journal of Vascular Surgery, 2010

Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for pro... more Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for prolonged utilization and more efficient dialysis treatment. Multiple methods are described for superficializing arteriovenous fistulae, and minimizing the surgical intervention is advantageous for patient recovery and potentially improved outcomes. We describe a novel technique of superficialization of an upper extremity arteriovenous fistula employing ultrasound-guided liposuction. This article describes the suction lipectomy technique and the tools necessary for superficialization of an upper extremity arteriovenous fistula.

Research paper thumbnail of Aesthetic breast reconstruction: Navigating the choices for optimum results

Research paper thumbnail of Transmyocardial laser revascularization dose response: enhanced perfusion in a porcine ischemia model as a function of channel density

The Annals of Thoracic Surgery, 2001

Transmyocardial laser revascularization (TMR) appears to provide symptomatic relief to patients w... more Transmyocardial laser revascularization (TMR) appears to provide symptomatic relief to patients with ischemic heart disease, but evidence that TMR enhances perfusion to ischemic myocardium remains limited. Furthermore, it is uncertain whether there exists a TMR dose-response relationship that is a function of channel number. We therefore compared restoration of blood flow as analyzed by rest and stress 99mTc-sestamibi scans and histologic grading of neovascularization after 50-channel, 25-channel, or 10-channel TMR using the excimer laser in an established model of porcine myocardial ischemia. Yorkshire swine underwent a thoracotomy and placement of an ameroid constrictor around the proximal circumflex coronary artery. Three weeks later, the animals underwent resting and adenosine stress 99mTc-sestamibi scans for evaluation of ischemia immediately before repeat thoracotomy and TMR with either 50 channels (n = 4), 25 channels (n = 4), or 10 channels (n = 4) in the circumflex territory. The animals underwent repeat perfusion analyses 4 weeks later, after which the animals were sacrificed and the hearts were perfusion fixed for histologic evaluation of neovascularization. All animals survived to sacrifice. Semiquantitative analyses of the sestamibi perfusion scans 4 weeks after lasing demonstrated significant improvement (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.04) in stress-induced ischemia in the 50-channel TMR animals, but not in the 25- or 10-channel TMR groups, as compared with scans obtained immediately before lasing. A computerized image analysis of perfusion scans similarly demonstrated an improvement in the area of ischemia of 42% +/- 22% in the scans obtained 4 weeks after lasing compared with scans obtained immediately before lasing in the 50-channel group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.004), but only a 12% +/- 9% improvement in the 25-channel group and an 8% +/- 4% improvement in the 10-channel group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). Histologic assessment of neovascularization demonstrated significantly greater number of microvessels per low-power field in the 50- versus the 25- and 10-channel groups (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In an animal model of myocardial ischemia, TMR appears to enhance myocardial perfusion. A dose-response relationship related to channel number may be of significance when evaluating the efficacy of various treatment strategies.

Research paper thumbnail of Essentials of Aesthetic Surgery

Aesthetic Surgery Journal, 2018

Continuing in the model of the earlier sister book, Essentials of Plastic Surgery, which he coaut... more Continuing in the model of the earlier sister book, Essentials of Plastic Surgery, which he coauthored, Jeffrey E. Janis, MD, has packed this small (5½ by 8½ inches) but thick book with a lot of information covering the breadth of aesthetic surgery and aesthetic medicine. Divided into 9 parts and 65 chapters, the book begins with a discussion of "The Aesthetic Patient" and finishes with "Aesthetics of Gender Affirmation Surgery." Between these opening and closing chapters, Janis and his long list of contributors divide aesthetic surgery and medicine into Basic Considerations, Anesthesia, Safety, Skin Care, Noninvasive and Minimally Invasive Therapy, Adjuncts to Aesthetic Surgery, Facial Surgery, Breast Surgery, and Body Contouring. Each of these segments is subdivided into chapters covering a specific subject in aesthetics. Each chapter is designed to be read independent of the other chapters in the book. Each chapter ends with a "Top Takeaway" list of key points and a focused reference list. The format design makes Essentials of Aesthetic Surgery an excellent reference source for students, residents, and fellows in plastic surgery. In his preface, Dr Janis refers to this text as a "… fit-in-your-coat-pocket format" suggesting its target reader. However, even the experienced plastic surgeon wanting a quick review or a reference on a specific area would find its uncomplicated, straight-to-the-point design beneficial. Dr Lund is a plastic surgeon in private practice in Chesterfield, MO.

Research paper thumbnail of Chest Wall Reconstruction

Research paper thumbnail of Graft repair of a pulmonary artery aneurysm

Heart Surgery Forum, 2002

Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We... more Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We report the successful surgical resection and repair of a pulmonary artery aneurysm using aneurysmectomy and replacement of the pulmonary artery with Dacron, a procedure with excellent longterm outcome that eliminates the risk of recurrence. The 65-year-old male patient presented with a marked decrease in exercise tolerance and worsening dyspnea. He had a history of pulmonary stenosis diagnosed during childhood, episodic shortness of breath beginning during his teenage years, hypertension, and smoking. On physical examination, the patient appeared generally well. Computed tomographic scan of the chest revealed an 8-cm aneurysm involving the main pulmonary artery and pulmonary artery bifurcation. Coronary angiography showed a massive aneurysm of the main and left pulmonary arteries, with mild dilation of the proximal right pulmonary artery. Surgery was performed through a median sternotom...

Research paper thumbnail of Direct Lateral Canthal (DLC) Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve (Hamawy-Amirlak Technique)

Atlas of Surgical Therapy for Migraine and Tension-Type Headache, 2019

The direct lateral canthal (DLC) approach to the zygomaticotemporal branch of the trigeminal nerv... more The direct lateral canthal (DLC) approach to the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) is a short procedure that can be done under local anesthesia to treat migraine headache pain originating from this nerve. Direct visualization of the zygomaticotemporal branch of the trigeminal nerve can be obtained with this approach, and this technique is especially useful in cases where the surgeon is less familiar with the endoscopic approach, extensive scarring of the dissection planes, and when an endoscopic procedure needs to be converted to open.

Research paper thumbnail of Direct Lateral Canthal Approach to the Zygomaticotemporal Branch of the Trigeminal Nerve for Surgical Treatment of Migraines

Plastic and Reconstructive Surgery

Research paper thumbnail of ACR Appropriateness Criteria(®) Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Journal of the American College of Radiology : JACR, 2017

Breast cancer is the most common malignancy in women in the United States. Breast reconstruction ... more Breast cancer is the most common malignancy in women in the United States. Breast reconstruction surgery is a commonly used therapy for patients with breast cancer. The technique for the deep inferior epigastric perforator flap uses a preserved rectus muscle, which decreases donor site morbidity. Accurate identification and measurement of the perforator branches of the deep inferior epigastric artery is pivotal during pre-operative planning so that the surgeon can prioritize the best vessel to use and ultimately improve clinical outcome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Developme...

Research paper thumbnail of People & Appointments

Filtration Industry Analyst

Research paper thumbnail of Surgical Treatment of Migraine Headaches

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Chest Wall Reconstruction

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Graft repair of a pulmonary artery aneurysm

The heart surgery forum, 2002

Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We... more Aneurysm of the main pulmonary artery is a rare anomaly with a poorly understood pathogenesis. We report the successful surgical resection and repair of a pulmonary artery aneurysm using aneurysmectomy and replacement of the pulmonary artery with Dacron, a procedure with excellent longterm outcome that eliminates the risk of recurrence. The 65-year-old male patient presented with a marked decrease in exercise tolerance and worsening dyspnea. He had a history of pulmonary stenosis diagnosed during childhood, episodic shortness of breath beginning during his teenage years, hypertension, and smoking. On physical examination, the patient appeared generally well. Computed tomographic scan of the chest revealed an 8-cm aneurysm involving the main pulmonary artery and pulmonary artery bifurcation. Coronary angiography showed a massive aneurysm of the main and left pulmonary arteries, with mild dilation of the proximal right pulmonary artery. Surgery was performed through a median sternotom...

Research paper thumbnail of Facial Skeletal Trauma

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of Eyelid Reconstruction

Essentials of Plastic Surgery, Second Edition, 2014

Research paper thumbnail of The Anatomy of the Greater Occipital Nerve: Part II. Compression Point Topography

Plastic and Reconstructive Surgery, 2011

Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral... more Advances in the understanding of migraine trigger points have pointed to entrapment of peripheral nerves in the head and neck as a cause of this debilitating condition. An anatomical study was undertaken to develop a greater understanding of the potential entrapment sites along the course of this nerve. The posterior neck and scalp of 25 fresh cadaveric heads were dissected. The greater occipital nerve was identified within the subcutaneous tissue above the trapezius and traced both proximal and distal. Its fascial, muscular, and vascular investments were located and accurately measured relative to established bony landmarks. Dissection of the greater occipital nerve revealed six major compression points along its course. The deepest (most proximal) point was between the semispinalis and the obliquus capitis inferior, near the spinous process. The second point was at its entrance into the semispinalis. The previously described &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;intermediate&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; point was at the nerve&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exit from the semispinalis. A fourth point was located at the entrance of the nerve into the trapezius muscle. The fifth point of compression is where the nerve exits the trapezius fascia insertion into the nuchal line. The occipital artery often crosses the nerve, and this frequently occurs in this distal region of the trapezius fascia, which is the final point. There are six compression points along the greater occipital nerve. These can be located using the data from this study, serving as a guide for surgeons interested in treating patients with migraine headaches originating in these areas. Long-term relief from migraine headaches has been demonstrated clinically by using both noninvasive and surgical decompression of these points.

Research paper thumbnail of Preventing and Managing Dry Eyes after Periorbital Surgery: A Retrospective Review

Plastic and Reconstructive Surgery, 2009

Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek p... more Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek periorbital rejuvenation, understanding the pathophysiology, diagnosis, and treatment of this condition perioperatively is essential for managing patient expectations and maximizing outcomes. A retrospective review of charts for 202 consecutive patients (180 women and 22 men) who underwent upper and/or lower blepharoplasty was performed. Additional facial cosmetic procedures were performed in 91 percent of patients. Data were collected identifying associated risk factors and the incidence of persistent dry eye symptoms. Key elements of perioperative care are described and algorithms for detection of those at risk, prevention, and management are outlined. Dry eyes persisting longer than 2 weeks after surgery were noted in 22 patients (10.9 percent) and longer than 2 months in only four patients (2 percent). In most cases, dry eyes resolved with conservative management, including artificial tears, lubrication, topical and systemic steroids, and night taping. One patient (0.5 percent of all studied patients) eventually needed surgical correction of lower eyelid retraction after failure of the punctate plug. Persistent chemosis occurred in 15 patients (68.2 percent) who had symptomatic dry eyes (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Recognizing and addressing risk factors before surgery and an algorithmic approach to prevention and management of patients undergoing periorbital surgery are essential for minimizing the occurrence of dry eye syndrome.

Research paper thumbnail of Carotid artery anastomosis with albumin solder and near infrared lasers: A comparative study

Lasers in Surgery and Medicine, 2001

Background and Objective: Laser tissue-welding has been used for anastomosis of carotid arteries.... more Background and Objective: Laser tissue-welding has been used for anastomosis of carotid arteries. During welding, thermal injury sustained by the vessel walls should be minimized to prevent thrombosis. Two different types of lasers were used and effects on tissue damage were studied in vitro and in vivo. Study Design/Materials and Methods: End-to-end anastomosis of dog carotid arteries (n ‫ס‬ 10) was performed by using a human albumin solder (HAS) in conjunction with Nd:YAG or diode lasers (‫ס‬ 1.32 m and 1.9 m, respectively). The arteries were evaluated for patency and evidence of histologic injury after 21 days. Another group of arteries was laser soldered in vitro to measure the intimal and adventitial temperatures by using thermocouples. Results: The arteries repaired with the diode laser sustained significantly less thermal damage than those repaired with Nd:YAG laser, both in vitro and in vivo. In particular, the intimal temperature was significantly lower (P < 0.05) for the diode than for the Nd:YAG repairs (∼35°C and ∼50°C, respectively). In the latter group, the patency rate was 75%, but thrombosis occurred in 75% of the specimens at 21 days. All diode anastomoses were patent and thrombosis developed in only 17% of the arteries. Conclusion: Use of the diode laser and albumin solders may provide a means to successfully repair carotid arteries with minimal thermal damage.

Research paper thumbnail of Effect of laser welding with human serum albumin on the expression of P-selectin on platelets

Lasers in Surgery and Medicine, 1999

Artery repair by means of laser energy induces activation of platelets with a risk of thrombosis ... more Artery repair by means of laser energy induces activation of platelets with a risk of thrombosis and local inflammatory reactions. The aim of this study was to investigate the effect of human serum albumin, the most common solder in laser surgery, on platelet activation. Platelet activation was evaluated in canine blood by using two-color flow cytometry with a phycoerythrin-labeled antibody to a common platelet marker, glycoprotein IIb/IIIa and fluorescein isothiocyanate-labeled antibody to a platelet activation molecule, P-selectin. Human serum albumin was applied in vitro and in vivo, as a solder during laser reconstruction of canine arteries. In vitro, albumin significantly (P &lt; 0.01) reduces the expression of P-selectin on platelets. This is most likely related to the blockage of P-selectin by albumin, which binds to the platelet surface, as confirmed by flow cytometry with fluorescein isothiocyanate-labeled albumin. In vivo, application of albumin solder tended to result in a lower percentage of P-selectin-expressing platelets in laser-repaired arteries compared to suture-repaired arteries. Albumin decreases the percentage of P-selectin-expressing platelets in vitro. Further research may allow the platelet activation inhibiting properties of albumin to be further optimized in vivo.

Research paper thumbnail of VS3. Video Presentation Superficialization of Arteriovenous Fistulas Employing Minimally Invasive Liposuction

Journal of Vascular Surgery, 2011

Objectives: Haemodialysis through LTVA is preferable in ESRD patients because of the shorter dura... more Objectives: Haemodialysis through LTVA is preferable in ESRD patients because of the shorter duration of dialysis. We aim to compare the outcome of PAVF to DAVF. Primary endpoint is patency. Secondary endpoints are complication rates, secondary intervention and mortality. Methods: 179 patients with ESRD had 200 AVF formations from January 2003 to June 2009. 69% were males. Mean age 53.6 years. All were upper limbs. All patients had duplex ultrasound mapping of superficial veins prior to surgery. No synthetic grafts were used. 37 procedures were distal AVF (radiocephalic) while 163 were proximal; either brachio-cephalic or brachio-basilic. Results: 1 year patency rate was 89% in proximal AVF vs 22% distal (PϽ0.0001). Occlusive thrombosis occurred in 6% of PAVF (nϭ10/163), compared to 54% in DAVF (nϭ20/37) (PϽ0.0001), with a significantly less need for re-intervention (4% vs 32%) (PϽ0.0001). PAVF had lower incidence of non-occlusive thrombus (6%, nϭ9/163) vs 24% (nϭ9/ 37) in DAVF PϽ0.001. PAVF had reduced incidence of aneurysm formation (12%, nϭ19/163) vs 27% (nϭ10/37) in DAVF PϽ0.033. 30 days mortality was 0.6% (nϭ1/ 163) in the PAVF group and 0% in the DAVF group. 5year mortality was 7% (nϭ12/163) in PAVF vs 30% (nϭ11/37) in DAVF patients (Pϭ0.0004). Conclusions: PAVF is less tedious with greater blood flow and easer manipulation for the nephrologists' team. Venous mapping prior to surgery with meticulous surgical techniques increases patency. PAVF is established as a reliable proficient procedure to bestow long-term access for haemodialysis with low rates of infection. It has considerably less incidence of complications and re-interventions compared to DAVF. We believe that PAVF must be offered as the first step in Long term venous access.

Research paper thumbnail of Superficialization of arteriovenous fistulae employing minimally invasive liposuction

Journal of Vascular Surgery, 2010

Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for pro... more Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for prolonged utilization and more efficient dialysis treatment. Multiple methods are described for superficializing arteriovenous fistulae, and minimizing the surgical intervention is advantageous for patient recovery and potentially improved outcomes. We describe a novel technique of superficialization of an upper extremity arteriovenous fistula employing ultrasound-guided liposuction. This article describes the suction lipectomy technique and the tools necessary for superficialization of an upper extremity arteriovenous fistula.