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Papers by Demetrios Rizis

Dermatologic Surgery, Mar 1, 2014

structions with composite full-thickness skin and fat grafts and found them to have a take rate s... more structions with composite full-thickness skin and fat grafts and found them to have a take rate similar to that of skin-only grafts, with much better contour match. Our experience mirrors that of Holt and Hubbard in that this method of reconstruction can result in fair to good results when an expedient, low-morbidity procedure is called for. Although other reconstructive methods may provide better cosmetic outcomes, composite skin and fat grafts are worth considering in appropriate patients. Our experience suggests that composite grafts result in better restoration of nasal contour than skin-only grafts, without the morbidity of more-complex reconstructive techniques.

Journal of Plastic Reconstructive and Aesthetic Surgery, Jul 1, 2011

ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method,... more ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

Journal of Plastic Reconstructive and Aesthetic Surgery, May 1, 2016

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation.... more Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. Methods: A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Results: Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p Z 0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p Z 0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p Z 0.502). Conclusion: Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2016

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation.... more Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. Methods: A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Results: Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p Z 0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p Z 0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p Z 0.502). Conclusion: Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.

Plastic and Reconstructive Surgery, 2011

Background: The use of leeches has fluctuated greatly gaining and losing favor over time. In rece... more Background: The use of leeches has fluctuated greatly gaining and losing favor over time. In recent years, reconstructive surgeons have used leeches in the management of venous congestion in microvascular free-tissue transfer and reimplantation. (1-5) The aim of this study is to describe the Québec Provincial Replantation Program's experience with leeches in salvage of upper extremity replantation/revascularization surgery. Methods: A retrospective review of all revascularized or reimplanted digits treated over a 5 year period in a centralized provincial reimplantation center was conducted. Particular attention was focused on patients in whom leech therapy was used. Indications for leech therapy, complications associated with treatment, as well as success rates were evaluated. Results: Four hundred and eleven patients with upper extremity trauma were treated with revascularization (271) or replantation (259) for a total of 760 digits referred to the program and an overall success rate at discharge of 92.9% for operated digits. Acute complications were noted in 23.3% of digits with venous congestion being the most frequently observed (54.8% of complications). Seventy (72.2%) of the congestive digits were treated with leech therapy. All patients undergoing leech therapy were placed on prophylactic antibiotics. No infections were reported. Fifty two point two percent (52.2%) of patients that received leech therapy required one or multiple transfusions. A salvage rate of 67.1% was obtained using leeches in managing venous congestion. Conclusions: Leech therapy is an effective modality for the treatment of non-surgically manageable venous congestion in digital replantation/revascularization. Leeches remain a useful tool in the plastic surgeon's armamentarium for the management of venous congestion.

Plastic and Reconstructive Surgery, 2011

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2011

ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method,... more ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

Dermatologic Surgery, 2014

structions with composite full-thickness skin and fat grafts and found them to have a take rate s... more structions with composite full-thickness skin and fat grafts and found them to have a take rate similar to that of skin-only grafts, with much better contour match. Our experience mirrors that of Holt and Hubbard in that this method of reconstruction can result in fair to good results when an expedient, low-morbidity procedure is called for. Although other reconstructive methods may provide better cosmetic outcomes, composite skin and fat grafts are worth considering in appropriate patients. Our experience suggests that composite grafts result in better restoration of nasal contour than skin-only grafts, without the morbidity of more-complex reconstructive techniques.

Aesthetic Plastic Surgery, 2009

Numerous complications have been reported following abdominoplasty. In this report, the case of a... more Numerous complications have been reported following abdominoplasty. In this report, the case of a 48year-old woman who developed an esophageal stricture, and subsequently Barrett's esophagus, secondary to increased intra-abdominal pressure following abdominoplasty is presented.

Plastic and Reconstructive Surgery, 2011

ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.

Dermatologic Surgery, Mar 1, 2014

structions with composite full-thickness skin and fat grafts and found them to have a take rate s... more structions with composite full-thickness skin and fat grafts and found them to have a take rate similar to that of skin-only grafts, with much better contour match. Our experience mirrors that of Holt and Hubbard in that this method of reconstruction can result in fair to good results when an expedient, low-morbidity procedure is called for. Although other reconstructive methods may provide better cosmetic outcomes, composite skin and fat grafts are worth considering in appropriate patients. Our experience suggests that composite grafts result in better restoration of nasal contour than skin-only grafts, without the morbidity of more-complex reconstructive techniques.

Journal of Plastic Reconstructive and Aesthetic Surgery, Jul 1, 2011

ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method,... more ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

Journal of Plastic Reconstructive and Aesthetic Surgery, May 1, 2016

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation.... more Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. Methods: A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Results: Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p Z 0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p Z 0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p Z 0.502). Conclusion: Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2016

Background: Venous congestion/insufficiency plays a major role in failure of finger replantation.... more Background: Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. Methods: A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Results: Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p Z 0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p Z 0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p Z 0.502). Conclusion: Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.

Plastic and Reconstructive Surgery, 2011

Background: The use of leeches has fluctuated greatly gaining and losing favor over time. In rece... more Background: The use of leeches has fluctuated greatly gaining and losing favor over time. In recent years, reconstructive surgeons have used leeches in the management of venous congestion in microvascular free-tissue transfer and reimplantation. (1-5) The aim of this study is to describe the Québec Provincial Replantation Program's experience with leeches in salvage of upper extremity replantation/revascularization surgery. Methods: A retrospective review of all revascularized or reimplanted digits treated over a 5 year period in a centralized provincial reimplantation center was conducted. Particular attention was focused on patients in whom leech therapy was used. Indications for leech therapy, complications associated with treatment, as well as success rates were evaluated. Results: Four hundred and eleven patients with upper extremity trauma were treated with revascularization (271) or replantation (259) for a total of 760 digits referred to the program and an overall success rate at discharge of 92.9% for operated digits. Acute complications were noted in 23.3% of digits with venous congestion being the most frequently observed (54.8% of complications). Seventy (72.2%) of the congestive digits were treated with leech therapy. All patients undergoing leech therapy were placed on prophylactic antibiotics. No infections were reported. Fifty two point two percent (52.2%) of patients that received leech therapy required one or multiple transfusions. A salvage rate of 67.1% was obtained using leeches in managing venous congestion. Conclusions: Leech therapy is an effective modality for the treatment of non-surgically manageable venous congestion in digital replantation/revascularization. Leeches remain a useful tool in the plastic surgeon's armamentarium for the management of venous congestion.

Plastic and Reconstructive Surgery, 2011

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2011

ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method,... more ABSTRACT Although microvascular free-tissue transfer has become a reliable reconstructive method, vascular compromise of the flap necessitating surgical exploration and attempts at flap salvage commonly occurs. Thrombectomy using Fogarty vascular catheters can be used in the setting of vascular pedicle thrombosis. However, this is not without potential complications. The following report describes a case in which the use of a Fogarty vascular catheter during a thrombectomy for microsurgical flap salvage resulted in complete separation of the balloon from the catheter.

Dermatologic Surgery, 2014

structions with composite full-thickness skin and fat grafts and found them to have a take rate s... more structions with composite full-thickness skin and fat grafts and found them to have a take rate similar to that of skin-only grafts, with much better contour match. Our experience mirrors that of Holt and Hubbard in that this method of reconstruction can result in fair to good results when an expedient, low-morbidity procedure is called for. Although other reconstructive methods may provide better cosmetic outcomes, composite skin and fat grafts are worth considering in appropriate patients. Our experience suggests that composite grafts result in better restoration of nasal contour than skin-only grafts, without the morbidity of more-complex reconstructive techniques.

Aesthetic Plastic Surgery, 2009

Numerous complications have been reported following abdominoplasty. In this report, the case of a... more Numerous complications have been reported following abdominoplasty. In this report, the case of a 48year-old woman who developed an esophageal stricture, and subsequently Barrett's esophagus, secondary to increased intra-abdominal pressure following abdominoplasty is presented.

Plastic and Reconstructive Surgery, 2011

ABSTRACT An abstract is unavailable. This article is available as HTML full text and PDF.