Gregory Dumanian - Academia.edu (original) (raw)
Papers by Gregory Dumanian
BACKGROUND Upper extremity (UE) vascularized composite allotransplantation (VCA) (hand transplant... more BACKGROUND Upper extremity (UE) vascularized composite allotransplantation (VCA) (hand transplantation) is a reconstructive treatment option for patients with upper extremity loss. Approximately 37 UE VCAs have been performed in the U.S. to date, thus little is known about long-term psychosocial outcomes and whether benefits outweigh risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available that provide unbiased, comprehensive information about UE VCA. OBJECTIVE This paper describes the development of a neutral, accessible and ADA-compliant educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. METHODS Website content development was informed by 9 focus groups conducted with civilians and military service members with UE amputations at three study sites (Northwestern University, Johns ...
With the increasing availability of more advanced prostheses individuals with a transradial amput... more With the increasing availability of more advanced prostheses individuals with a transradial amputation can now be fit with single to multi-degree of freedom hands. Reliable and accurate control of these multi-grip hands still remains challenging. This is the first multi-user study to investigate at-home control and use of a multi-grip hand prosthesis under pattern recognition and direct control. Individuals with a transradial amputation were fitted with and trained to use an OSSUR i-Limb Ultra Revolution with Coapt COMPLETE CONTROL system. They participated in two 8-week home trials using the hand under myoelectric direct and pattern recognition control in a randomized order. While at home, participants demonstrated broader usage of grips in pattern recognition compared to direct control. After the home trial, they showed significant improvements in the Assessment of Capacity for Myoelectric Control (ACMC) outcome measure while using pattern recognition control compared to direct co...
Plastic and Reconstructive Surgery - Global Open, 2021
Background: Concerns regarding infection, extrusion, and pain have traditionally precluded the us... more Background: Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication. Methods: Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last ...
Plastic & Reconstructive Surgery, 2020
Learning Objectives: After reading this article, the participants should be able to: 1. List curr... more Learning Objectives: After reading this article, the participants should be able to: 1. List current nonsurgical and surgical strategies for addressing postamputation neuroma pain and discuss their limitations. 2. Summarize the indications and rationale for targeted muscle reinnervation. 3. Develop an operative plan for targeted muscle reinnervation in an acute or delayed fashion for upper and lower extremity amputations. 4. Propose a management algorithm for treatment of symptomatic neuromas in an intact limb. 5. Discuss the risk of neuroma development after primary revision digital amputation or secondary surgery for a digital neuroma. 6. Compare and contrast targeted muscle reinnervation to the historical gold standard neuroma treatment of excision and burying the involved nerve in muscle, bone, or vein graft. 7. Interpret and discuss the evidence that targeted muscle reinnervation improves postamputation neuroma and phantom pain when performed either acutely or in a delayed fash...
Plastic & Reconstructive Surgery, 2018
Prosthetics & Orthotics International, 2004
A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient w... more A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. Th...
Plastic & Reconstructive Surgery, 2019
Journal of Surgical Oncology, 2018
Plastic & Reconstructive Surgery, 2018
Background: Targeted muscle reinnervation reroutes the ends of cut nerves to reinnervate small mo... more Background: Targeted muscle reinnervation reroutes the ends of cut nerves to reinnervate small motor nerves of nearby muscles, with the goal of reducing neuroma pain and/or improving prosthesis function. Anatomical roadmaps for targeted muscle reinnervation have been established in the upper extremity and thigh, but not for the lower leg. Methods: The major branch points of motor nerves and the motor entry points to muscles of the leg were dissected in five cadaver specimens. Leg length was defined as distance from the lateral femoral condyle to the lateral malleolus. The distances from the lateral femoral condyle to major branch points and motor entry points were recorded as percentages of leg length to identify targets for targeted muscle reinnervation. Results: The tibialis anterior and extensor digitorum longus were both acceptable targets in the anterior compartment, with an average 4.4 motor entry points within 10 to 80 percent and 3.0 motor entry points within 20 to 80 percen...
Plastic & Reconstructive Surgery, 2017
Summary: The biocompatibility of prosthetic mesh is dependent on a number of physicochemical prop... more Summary: The biocompatibility of prosthetic mesh is dependent on a number of physicochemical properties that ultimately incite an optimal foreign body response. The magnitude and character of the foreign body response directly affect the clinical success of the hernia repair, with too little scar resulting in bulge or hernia recurrence and too much scar causing mesh wrinkling and pain. Moreover, it is important to consider the effect of a sustained foreign body response and scar remodeling on the combined strength of the mesh-tissue construct over time. Understanding key elements that determine the foreign body response, such as implant porosity, surface area, and filament size, is critical to the performance of surgery. New absorbable materials introduce the additional variable of durability and persistence of the foreign body response after the foreign body itself has dissolved. In this review, we discuss the experimental and clinical literature relating the quality of the foreign...
Plastic and Reconstructive Surgery, 2016
Although we are unsure whether the attachments between the anterior rectus sheath and the muscle ... more Although we are unsure whether the attachments between the anterior rectus sheath and the muscle are restricting medialization of the rectus complex, we do agree that a wide diastasis would necessitate greater tension on the midline plication sutures that could lead to pull-through or cheese-wiring of the suture through the fascia. We also agree that retrorectus prosthetic mesh placement is the best plane for a reinforcing mesh, as it preserves blood supply to the overlying tissues and does not disrupt the innervation to the rectus complex, it does not become exposed with skin disruptions, it permits optimal “loading” of tension on the abdominal wall, and the well-vascularized rectus muscles enhance tissue incorporation of macroporous mesh. However, we find suture plication of the posterior rectus sheath unnecessary to achieve repair of the rectus diastasis, and we prefer to avoid the potential risks of injury to underlying bowel and the bladder as demonstrated by the intraoperative complication noted in the article by Dr. Batchvarova et al.2 We believe that a high-tension aesthetic closure that resists suture pull-through is best achieved with multiple transrectus sutures (as opposed to posterior fascia plication) that achieve proper force distribution across the repair. Drs. Quilichini and Leyder cite the work of Dr. de Pina3 in their rationale for why plication of the posterior sheath leads to greater medialization of the lateral musculature than plication of the anterior sheath. Although this is an interesting concept, the posterior rectus sheath is thinner and does not extend below the arcuate line, thus limiting the utility of posterior sheath plication. In addition, plication of the anterior sheath does lead to medialization of the lateral abdominal muscles, as demonstrated by the standard midline plication of abdominoplasty. We agree that plication of the anterior rectus sheath can lead to redundant or bunched rectus muscle in the midline, particularly in the epigastrium, and we too have performed marginal resection of the rectus muscle on occasion. In our experience, macroporous soft polypropylene mesh is safe and provides a durable repair.1 The combination of macroporosity with a well-fixed implant has sufficed to avoid any polypropylene mesh infections in the senior author’s (G.A.D.) experience to date. The question of whether or not absorbable mesh will create a lasting scar is a relatively unstudied question. It makes logical sense that the foreign body reaction that creates fibrosis dissipates when the foreign body itself disappears, and this concept is tangentially supported in the literature.4–7 In terms of the ability of Vicryl (Ethicon, Inc., Somerville, N.J.) mesh to create a lasting scar, one can consider the model of an open abdomen closed with Vicryl mesh. After skin graft closure of the granulated Vicryl bed, the scar does loosen and expand over time. This goes against the concept that Vicryl mesh creates a lasting scar. Therefore, we feel that use of a permanent mesh in the retrorectus plane Robert Ballanger Hospital Aulnay-sous-bois, France Avicenne Hospital Bobigny, France Paris XIII Medical School Paris, France
Series in Medical Physics and Biomedical Engineering, 2013
Plastic and Reconstructive Surgery, 2012
This technique represents a surgical adjunct for the management of chronic, localized pain in pat... more This technique represents a surgical adjunct for the management of chronic, localized pain in patients who continue to have pain despite exhaustive prior evaluation and treatment. The patient-guided approach was used in 10 patients referred with "intractable pain" and yielded good to excellent results in all but one patient. When applied selectively to cases with significantly distorted anatomy or previous failed interventions, this simple technique can minimize dissection and unnecessary resection, while offering relief to a patient population otherwise resigned to a life with chronic pain. Therapeutic, V.
Plastic and Reconstructive Surgery, 2012
Plastic and reconstructive surgery, 2014
Journal of Reconstructive Microsurgery, 2007
BACKGROUND Upper extremity (UE) vascularized composite allotransplantation (VCA) (hand transplant... more BACKGROUND Upper extremity (UE) vascularized composite allotransplantation (VCA) (hand transplantation) is a reconstructive treatment option for patients with upper extremity loss. Approximately 37 UE VCAs have been performed in the U.S. to date, thus little is known about long-term psychosocial outcomes and whether benefits outweigh risks. To make an informed treatment decision, patients must understand the procedure, risks, and potential benefits of UE VCA. However, few educational resources are publicly available that provide unbiased, comprehensive information about UE VCA. OBJECTIVE This paper describes the development of a neutral, accessible and ADA-compliant educational website supporting informed decision-making about UE VCA as a treatment option for individuals with UE amputations. METHODS Website content development was informed by 9 focus groups conducted with civilians and military service members with UE amputations at three study sites (Northwestern University, Johns ...
With the increasing availability of more advanced prostheses individuals with a transradial amput... more With the increasing availability of more advanced prostheses individuals with a transradial amputation can now be fit with single to multi-degree of freedom hands. Reliable and accurate control of these multi-grip hands still remains challenging. This is the first multi-user study to investigate at-home control and use of a multi-grip hand prosthesis under pattern recognition and direct control. Individuals with a transradial amputation were fitted with and trained to use an OSSUR i-Limb Ultra Revolution with Coapt COMPLETE CONTROL system. They participated in two 8-week home trials using the hand under myoelectric direct and pattern recognition control in a randomized order. While at home, participants demonstrated broader usage of grips in pattern recognition compared to direct control. After the home trial, they showed significant improvements in the Assessment of Capacity for Myoelectric Control (ACMC) outcome measure while using pattern recognition control compared to direct co...
Plastic and Reconstructive Surgery - Global Open, 2021
Background: Concerns regarding infection, extrusion, and pain have traditionally precluded the us... more Background: Concerns regarding infection, extrusion, and pain have traditionally precluded the use of mesh to treat severe rectus diastasis during abdominoplasty in the United States. We describe a mesh abdominoplasty technique, and we hypothesize that the complication rate using mesh is greater than the complication rate of suture plication. Methods: Inclusion criteria for mesh abdominoplasty were patients who (1) had retrorectus planar mesh for repair of rectus diastasis, (2) did not have concurrent ventral hernia, and (3) underwent skin tailoring. Patients who underwent rectus plication with suture, and met criteria 2 and 3 above were included in a sample of consecutive standard abdominoplasty patients. The primary endpoint was surgical site occurrence at any time after surgery, as determined with review of their office and hospital medical records. Secondary endpoints included surgical site infection, revision rates, postoperative course, and aesthetics assessed with their last ...
Plastic & Reconstructive Surgery, 2020
Learning Objectives: After reading this article, the participants should be able to: 1. List curr... more Learning Objectives: After reading this article, the participants should be able to: 1. List current nonsurgical and surgical strategies for addressing postamputation neuroma pain and discuss their limitations. 2. Summarize the indications and rationale for targeted muscle reinnervation. 3. Develop an operative plan for targeted muscle reinnervation in an acute or delayed fashion for upper and lower extremity amputations. 4. Propose a management algorithm for treatment of symptomatic neuromas in an intact limb. 5. Discuss the risk of neuroma development after primary revision digital amputation or secondary surgery for a digital neuroma. 6. Compare and contrast targeted muscle reinnervation to the historical gold standard neuroma treatment of excision and burying the involved nerve in muscle, bone, or vein graft. 7. Interpret and discuss the evidence that targeted muscle reinnervation improves postamputation neuroma and phantom pain when performed either acutely or in a delayed fash...
Plastic & Reconstructive Surgery, 2018
Prosthetics & Orthotics International, 2004
A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient w... more A novel method for the control of a myoelectric upper limb prosthesis was achieved in a patient with bilateral amputations at the shoulder disarticulation level. Four independently controlled nerve-muscle units were created by surgically anastomosing residual brachial plexus nerves to dissected and divided aspects of the pectoralis major and minor muscles. The musculocutaneous nerve was anastomosed to the upper pectoralis major; the median nerve was transferred to the middle pectoralis major region; the radial nerve was anastomosed to the lower pectoralis major region; and the ulnar nerve was transferred to the pectoralis minor muscle which was moved out to the lateral chest wall. After five months, three nerve-muscle units were successful (the musculocutaneous, median and radial nerves) in that a contraction could be seen, felt and a surface electromyogram (EMG) could be recorded. Sensory reinnervation also occurred on the chest in an area where the subcutaneous fat was removed. Th...
Plastic & Reconstructive Surgery, 2019
Journal of Surgical Oncology, 2018
Plastic & Reconstructive Surgery, 2018
Background: Targeted muscle reinnervation reroutes the ends of cut nerves to reinnervate small mo... more Background: Targeted muscle reinnervation reroutes the ends of cut nerves to reinnervate small motor nerves of nearby muscles, with the goal of reducing neuroma pain and/or improving prosthesis function. Anatomical roadmaps for targeted muscle reinnervation have been established in the upper extremity and thigh, but not for the lower leg. Methods: The major branch points of motor nerves and the motor entry points to muscles of the leg were dissected in five cadaver specimens. Leg length was defined as distance from the lateral femoral condyle to the lateral malleolus. The distances from the lateral femoral condyle to major branch points and motor entry points were recorded as percentages of leg length to identify targets for targeted muscle reinnervation. Results: The tibialis anterior and extensor digitorum longus were both acceptable targets in the anterior compartment, with an average 4.4 motor entry points within 10 to 80 percent and 3.0 motor entry points within 20 to 80 percen...
Plastic & Reconstructive Surgery, 2017
Summary: The biocompatibility of prosthetic mesh is dependent on a number of physicochemical prop... more Summary: The biocompatibility of prosthetic mesh is dependent on a number of physicochemical properties that ultimately incite an optimal foreign body response. The magnitude and character of the foreign body response directly affect the clinical success of the hernia repair, with too little scar resulting in bulge or hernia recurrence and too much scar causing mesh wrinkling and pain. Moreover, it is important to consider the effect of a sustained foreign body response and scar remodeling on the combined strength of the mesh-tissue construct over time. Understanding key elements that determine the foreign body response, such as implant porosity, surface area, and filament size, is critical to the performance of surgery. New absorbable materials introduce the additional variable of durability and persistence of the foreign body response after the foreign body itself has dissolved. In this review, we discuss the experimental and clinical literature relating the quality of the foreign...
Plastic and Reconstructive Surgery, 2016
Although we are unsure whether the attachments between the anterior rectus sheath and the muscle ... more Although we are unsure whether the attachments between the anterior rectus sheath and the muscle are restricting medialization of the rectus complex, we do agree that a wide diastasis would necessitate greater tension on the midline plication sutures that could lead to pull-through or cheese-wiring of the suture through the fascia. We also agree that retrorectus prosthetic mesh placement is the best plane for a reinforcing mesh, as it preserves blood supply to the overlying tissues and does not disrupt the innervation to the rectus complex, it does not become exposed with skin disruptions, it permits optimal “loading” of tension on the abdominal wall, and the well-vascularized rectus muscles enhance tissue incorporation of macroporous mesh. However, we find suture plication of the posterior rectus sheath unnecessary to achieve repair of the rectus diastasis, and we prefer to avoid the potential risks of injury to underlying bowel and the bladder as demonstrated by the intraoperative complication noted in the article by Dr. Batchvarova et al.2 We believe that a high-tension aesthetic closure that resists suture pull-through is best achieved with multiple transrectus sutures (as opposed to posterior fascia plication) that achieve proper force distribution across the repair. Drs. Quilichini and Leyder cite the work of Dr. de Pina3 in their rationale for why plication of the posterior sheath leads to greater medialization of the lateral musculature than plication of the anterior sheath. Although this is an interesting concept, the posterior rectus sheath is thinner and does not extend below the arcuate line, thus limiting the utility of posterior sheath plication. In addition, plication of the anterior sheath does lead to medialization of the lateral abdominal muscles, as demonstrated by the standard midline plication of abdominoplasty. We agree that plication of the anterior rectus sheath can lead to redundant or bunched rectus muscle in the midline, particularly in the epigastrium, and we too have performed marginal resection of the rectus muscle on occasion. In our experience, macroporous soft polypropylene mesh is safe and provides a durable repair.1 The combination of macroporosity with a well-fixed implant has sufficed to avoid any polypropylene mesh infections in the senior author’s (G.A.D.) experience to date. The question of whether or not absorbable mesh will create a lasting scar is a relatively unstudied question. It makes logical sense that the foreign body reaction that creates fibrosis dissipates when the foreign body itself disappears, and this concept is tangentially supported in the literature.4–7 In terms of the ability of Vicryl (Ethicon, Inc., Somerville, N.J.) mesh to create a lasting scar, one can consider the model of an open abdomen closed with Vicryl mesh. After skin graft closure of the granulated Vicryl bed, the scar does loosen and expand over time. This goes against the concept that Vicryl mesh creates a lasting scar. Therefore, we feel that use of a permanent mesh in the retrorectus plane Robert Ballanger Hospital Aulnay-sous-bois, France Avicenne Hospital Bobigny, France Paris XIII Medical School Paris, France
Series in Medical Physics and Biomedical Engineering, 2013
Plastic and Reconstructive Surgery, 2012
This technique represents a surgical adjunct for the management of chronic, localized pain in pat... more This technique represents a surgical adjunct for the management of chronic, localized pain in patients who continue to have pain despite exhaustive prior evaluation and treatment. The patient-guided approach was used in 10 patients referred with "intractable pain" and yielded good to excellent results in all but one patient. When applied selectively to cases with significantly distorted anatomy or previous failed interventions, this simple technique can minimize dissection and unnecessary resection, while offering relief to a patient population otherwise resigned to a life with chronic pain. Therapeutic, V.
Plastic and Reconstructive Surgery, 2012
Plastic and reconstructive surgery, 2014
Journal of Reconstructive Microsurgery, 2007