Karan Desai - Academia.edu (original) (raw)

Papers by Karan Desai

Research paper thumbnail of The Effect of BMI on Outcomes Following Complex Abdominal Wall Reconstructions

Annals of Plastic Surgery, 2016

The management of complex abdominal wall defects continues to be a challenging process secondary ... more The management of complex abdominal wall defects continues to be a challenging process secondary to the high potential for wound healing issues and ventral hernia recurrences. Body mass index (BMI) is a well-known risk factor when it comes to complications. We hypothesize that higher BMIs result in higher rates of postoperative complications in complex abdominal wall reconstructions (CAWRs). We retrospectively reviewed all patients who underwent CAWR at Emory University Hospital over a 12-year period. Patients were divided into 4 cohorts based on BMI (15-24.9, 25-29.9, 30-34.9, and ≥35 kg/m). Complication rates among the 4 groups were evaluated as the primary outcome using Pearson χ analysis. Further analysis was done on specific complications including mesh exposure, skin necrosis, delayed healing, rate of fistula formation, seroma, hematoma, infection, rate of recurrence, and rate of reoperation. We included 313 patients with a mean follow-up of 15.6 months. The rate of overall complications demonstrated a nonsignificant increase with BMI of 15 to 24.9, 25 to 29.9, 30 to 34.9, and 35 kg/m or greater (31.7%, 35.0%, 47.6%, and 48.3%; P = 0.079, respectively). The rate of skin necrosis was significantly increased in the higher BMI groups (1.7%, 1.3%, 9.5%, and 13.5%; P = 0.004). The rate of ventral hernia recurrence was significantly increased in the higher BMI groups (8.3%, 12.5%, 29.8%, and 27.0%; P = 0.002). Rates of reoperation were also statistically increased in the higher BMI groups (25.0%, 22.5%, 41.7%, and 34.8%; P = 0.035). Rates of mesh exposure, delayed healing, fistula formation, seroma, hematoma, and infection were not statistically significant among the 4 BMI groups. Patients undergoing CAWR with BMIs greater than 30 kg/m have significantly higher rates of skin necrosis, hernia recurrence, and reoperation compared with subgroups of lower BMI. Rates of overall complications among all BMI groups are similar, although trended up with BMI. Surgeons should weight the risks and benefits of CAWR in patients with higher BMIs to reduce specific postoperative complications.

Research paper thumbnail of The impact of mesh reinforcement with components separation for abdominal wall reconstruction

Journal of the American College of Surgeons, 2015

Research paper thumbnail of Roux-en-Y gastric bypass alters tumor necrosis factor-α but not adiponectin signaling in immediate postoperative period in obese rats

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Adiponectin has anti-inflammatory properties and is increased with weight loss. Tumor necrosis fa... more Adiponectin has anti-inflammatory properties and is increased with weight loss. Tumor necrosis factor (TNF)-α is a pro-inflammatory cytokine that negatively regulates adiponectin. Previously, we have demonstrated that Roux-en-Y gastric bypass (RYGB) induces weight loss and improves steatosis in obese rats. We hypothesized that RYGB would alter the interplay of TNF-α and adiponectin signaling in the postoperative period. Obese Sprague-Dawley male rats that had undergone RYGB (n = 5) or sham (n = 4) were euthanatized at 9 weeks postoperatively. The adiponectin levels from serial serum samples were measured by enzyme-linked immunosorbent assay. Adiponectin, adiponectin receptor 2, and TNF-α mRNA from adipose and liver samples were quantified by reverse transcriptase-polymerase chain reaction. Data are presented as mean ± standard deviation; using a t test, P <.05 was significant. RYGB did not change the serum adiponectin, adipose tissue adiponectin mRNA, or hepatic adiponectin recep...

Research paper thumbnail of Upper extremity deep vein thrombosis with tourniquet use

International Journal of Surgery Case Reports, 2015

Upper extremity deep vein thrombosis is an increasingly important clinical finding with significa... more Upper extremity deep vein thrombosis is an increasingly important clinical finding with significant morbidity and mortality. The condition may be under-diagnosed in trauma and surgery settings. We present a case of upper extremity thrombosis with venous congestive symptoms secondary to the use of an operative tourniquet. A literature review and discussion of the causes of upper extremity deep vein thrombosis and the pathophysiological disturbances seen with tourniquet use are presented. Upper extremity deep venous thrombosis is uncommon. In this case the likely cause was operative tourniquet use. Operative tourniquet may be a risk factor in upper extremity deep vein thrombosis.

Research paper thumbnail of Roux-en-Y gastric bypass improves steatosis by downregulating key transcription factors of hepatic stearoyl-CoA desaturase 1 (SCD1) in obese rats

Journal of the American College of Surgeons, 2009

CONCLUSIONS: Prior work has demonstrated that NGF promotes activation of the p42 survival pathway... more CONCLUSIONS: Prior work has demonstrated that NGF promotes activation of the p42 survival pathway in neuroblastoma via TrkA. We now show the p38 apoptotic pathway can be activated via p75. NGF stimulation of p75 in combination with inhibition of TrkA may provide a useful therapeutic adjuvant in neuroblastoma treatment.

Research paper thumbnail of Time to Completion of Nipple Reconstruction

Annals of Plastic Surgery, 2013

Nipple reconstruction is often used as a marker for completion of the breast reconstructive proce... more Nipple reconstruction is often used as a marker for completion of the breast reconstructive process. The purpose of this study was to determine the average time to nipple reconstruction and the factors that influence this process. All patients who underwent postmastectomy breast reconstruction at Emory University between 2005 and 2011 were reviewed. Only those who had completed nipple reconstruction were included. Variables recorded were body mass index, age, smoking history, surgeon, presence of preoperative or postoperative chemotherapy or radiation therapy, type of reconstruction, timing of reconstruction, unilateral or bilateral reconstruction, and complication history. Time to completion of nipple reconstruction was calculated and comparisons were made. A total of 451 patients completed nipple reconstruction (128 implant reconstructions, 120 latissimus plus implant reconstructions, 23 latissimus only reconstructions, and 180 transverse rectus abdominus myocutaneous flap [TRAM] or deep inferior epigastric perforator flap [DIEP] reconstructions). Average time to nipple reconstruction was 12.25 months. Patients who underwent TRAM or DIEP flaps completed reconstruction on average earlier than implant-based reconstruction and latissimus-only reconstruction (8.67 vs 11.2 and 11.3 months, respectively, P = 0.0016). Patients who underwent postoperative chemotherapy or radiation therapy were delayed compared to those that did not (11.3 vs 9.33 and 13.87 vs 9.87 months, P = 0.0315 and P = 0.0052). Timing of completion was also dependent on attending surgeon (9.8 and 11.43 months for the 2 senior surgeons, P = 0.0135) and presence of complications (10.3 compared to 9.77 months for patients without complications, P = 0.0334). Body mass index, smoking history, preoperative chemotherapy or radiation therapy, timing of reconstruction, and unilateral versus bilateral reconstruction did not affect time to nipple reconstruction. Type of reconstruction, surgeon, presence of complications, and need for postoperative chemotherapy or radiation therapy all affect timing to completion of breast reconstruction. Patients should be counseled as to these factors at the initial consultation to set appropriate expectations.

Research paper thumbnail of Case Report: Surgical Management of a Giant Juvenile Fibroadenoma

Breast Case, Mar 25, 2014

Giant fibroadenomas are rare breast masses that occur largely in a juvenile population. These tum... more Giant fibroadenomas are rare breast masses that occur largely in a juvenile population. These tumors are benign and clinically are very similar to phyllodes tumors of the breast. Given their extremely large size, giant fibroadenomas can cause significant breast disfigurement and be difficult to surgically treat. We present a case of a 12 year old who presented with a rapidly enlarging breast mass diagnosed as a juvenile fibroadenoma. She successfully underwent surgical excision through a periareolar incision and had satisfactory cosmetic results with no recurrences.

Research paper thumbnail of The Effect of BMI on Outcomes Following Complex Abdominal Wall Reconstructions

Annals of Plastic Surgery, 2016

The management of complex abdominal wall defects continues to be a challenging process secondary ... more The management of complex abdominal wall defects continues to be a challenging process secondary to the high potential for wound healing issues and ventral hernia recurrences. Body mass index (BMI) is a well-known risk factor when it comes to complications. We hypothesize that higher BMIs result in higher rates of postoperative complications in complex abdominal wall reconstructions (CAWRs). We retrospectively reviewed all patients who underwent CAWR at Emory University Hospital over a 12-year period. Patients were divided into 4 cohorts based on BMI (15-24.9, 25-29.9, 30-34.9, and ≥35 kg/m). Complication rates among the 4 groups were evaluated as the primary outcome using Pearson χ analysis. Further analysis was done on specific complications including mesh exposure, skin necrosis, delayed healing, rate of fistula formation, seroma, hematoma, infection, rate of recurrence, and rate of reoperation. We included 313 patients with a mean follow-up of 15.6 months. The rate of overall complications demonstrated a nonsignificant increase with BMI of 15 to 24.9, 25 to 29.9, 30 to 34.9, and 35 kg/m or greater (31.7%, 35.0%, 47.6%, and 48.3%; P = 0.079, respectively). The rate of skin necrosis was significantly increased in the higher BMI groups (1.7%, 1.3%, 9.5%, and 13.5%; P = 0.004). The rate of ventral hernia recurrence was significantly increased in the higher BMI groups (8.3%, 12.5%, 29.8%, and 27.0%; P = 0.002). Rates of reoperation were also statistically increased in the higher BMI groups (25.0%, 22.5%, 41.7%, and 34.8%; P = 0.035). Rates of mesh exposure, delayed healing, fistula formation, seroma, hematoma, and infection were not statistically significant among the 4 BMI groups. Patients undergoing CAWR with BMIs greater than 30 kg/m have significantly higher rates of skin necrosis, hernia recurrence, and reoperation compared with subgroups of lower BMI. Rates of overall complications among all BMI groups are similar, although trended up with BMI. Surgeons should weight the risks and benefits of CAWR in patients with higher BMIs to reduce specific postoperative complications.

Research paper thumbnail of The impact of mesh reinforcement with components separation for abdominal wall reconstruction

Journal of the American College of Surgeons, 2015

Research paper thumbnail of Roux-en-Y gastric bypass alters tumor necrosis factor-α but not adiponectin signaling in immediate postoperative period in obese rats

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Adiponectin has anti-inflammatory properties and is increased with weight loss. Tumor necrosis fa... more Adiponectin has anti-inflammatory properties and is increased with weight loss. Tumor necrosis factor (TNF)-α is a pro-inflammatory cytokine that negatively regulates adiponectin. Previously, we have demonstrated that Roux-en-Y gastric bypass (RYGB) induces weight loss and improves steatosis in obese rats. We hypothesized that RYGB would alter the interplay of TNF-α and adiponectin signaling in the postoperative period. Obese Sprague-Dawley male rats that had undergone RYGB (n = 5) or sham (n = 4) were euthanatized at 9 weeks postoperatively. The adiponectin levels from serial serum samples were measured by enzyme-linked immunosorbent assay. Adiponectin, adiponectin receptor 2, and TNF-α mRNA from adipose and liver samples were quantified by reverse transcriptase-polymerase chain reaction. Data are presented as mean ± standard deviation; using a t test, P <.05 was significant. RYGB did not change the serum adiponectin, adipose tissue adiponectin mRNA, or hepatic adiponectin recep...

Research paper thumbnail of Upper extremity deep vein thrombosis with tourniquet use

International Journal of Surgery Case Reports, 2015

Upper extremity deep vein thrombosis is an increasingly important clinical finding with significa... more Upper extremity deep vein thrombosis is an increasingly important clinical finding with significant morbidity and mortality. The condition may be under-diagnosed in trauma and surgery settings. We present a case of upper extremity thrombosis with venous congestive symptoms secondary to the use of an operative tourniquet. A literature review and discussion of the causes of upper extremity deep vein thrombosis and the pathophysiological disturbances seen with tourniquet use are presented. Upper extremity deep venous thrombosis is uncommon. In this case the likely cause was operative tourniquet use. Operative tourniquet may be a risk factor in upper extremity deep vein thrombosis.

Research paper thumbnail of Roux-en-Y gastric bypass improves steatosis by downregulating key transcription factors of hepatic stearoyl-CoA desaturase 1 (SCD1) in obese rats

Journal of the American College of Surgeons, 2009

CONCLUSIONS: Prior work has demonstrated that NGF promotes activation of the p42 survival pathway... more CONCLUSIONS: Prior work has demonstrated that NGF promotes activation of the p42 survival pathway in neuroblastoma via TrkA. We now show the p38 apoptotic pathway can be activated via p75. NGF stimulation of p75 in combination with inhibition of TrkA may provide a useful therapeutic adjuvant in neuroblastoma treatment.

Research paper thumbnail of Time to Completion of Nipple Reconstruction

Annals of Plastic Surgery, 2013

Nipple reconstruction is often used as a marker for completion of the breast reconstructive proce... more Nipple reconstruction is often used as a marker for completion of the breast reconstructive process. The purpose of this study was to determine the average time to nipple reconstruction and the factors that influence this process. All patients who underwent postmastectomy breast reconstruction at Emory University between 2005 and 2011 were reviewed. Only those who had completed nipple reconstruction were included. Variables recorded were body mass index, age, smoking history, surgeon, presence of preoperative or postoperative chemotherapy or radiation therapy, type of reconstruction, timing of reconstruction, unilateral or bilateral reconstruction, and complication history. Time to completion of nipple reconstruction was calculated and comparisons were made. A total of 451 patients completed nipple reconstruction (128 implant reconstructions, 120 latissimus plus implant reconstructions, 23 latissimus only reconstructions, and 180 transverse rectus abdominus myocutaneous flap [TRAM] or deep inferior epigastric perforator flap [DIEP] reconstructions). Average time to nipple reconstruction was 12.25 months. Patients who underwent TRAM or DIEP flaps completed reconstruction on average earlier than implant-based reconstruction and latissimus-only reconstruction (8.67 vs 11.2 and 11.3 months, respectively, P = 0.0016). Patients who underwent postoperative chemotherapy or radiation therapy were delayed compared to those that did not (11.3 vs 9.33 and 13.87 vs 9.87 months, P = 0.0315 and P = 0.0052). Timing of completion was also dependent on attending surgeon (9.8 and 11.43 months for the 2 senior surgeons, P = 0.0135) and presence of complications (10.3 compared to 9.77 months for patients without complications, P = 0.0334). Body mass index, smoking history, preoperative chemotherapy or radiation therapy, timing of reconstruction, and unilateral versus bilateral reconstruction did not affect time to nipple reconstruction. Type of reconstruction, surgeon, presence of complications, and need for postoperative chemotherapy or radiation therapy all affect timing to completion of breast reconstruction. Patients should be counseled as to these factors at the initial consultation to set appropriate expectations.

Research paper thumbnail of Case Report: Surgical Management of a Giant Juvenile Fibroadenoma

Breast Case, Mar 25, 2014

Giant fibroadenomas are rare breast masses that occur largely in a juvenile population. These tum... more Giant fibroadenomas are rare breast masses that occur largely in a juvenile population. These tumors are benign and clinically are very similar to phyllodes tumors of the breast. Given their extremely large size, giant fibroadenomas can cause significant breast disfigurement and be difficult to surgically treat. We present a case of a 12 year old who presented with a rapidly enlarging breast mass diagnosed as a juvenile fibroadenoma. She successfully underwent surgical excision through a periareolar incision and had satisfactory cosmetic results with no recurrences.