Scott Spiro - Academia.edu (original) (raw)
Papers by Scott Spiro
Plastic and reconstructive surgery. Global open, 2020
Off Label Disclosure: Da Vinci systems (Xi and SP) are not cleared for breast surgery or reconstr... more Off Label Disclosure: Da Vinci systems (Xi and SP) are not cleared for breast surgery or reconstruction in the United States or EU. Performing robot-assisted breast or reconstructive surgery is an off-label practice and should be conducted under specific clinical trials approved by the board of the concerned hospital and in some countries by the clinical authority.
Head & neck, Sep 1, 1991
True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case report... more True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case reports have appeared regarding this entity. We present a case of a congenital internal jugular venous aneurysm which manifested itself after abdominal surgery and prolonged positive pressure ventilation. A theory regarding its manifestation is presented. We believe this case to be unique in its presentation.
Otolaryngology-Head and Neck Surgery, Jun 1, 1994
Annals of Plastic Surgery, Feb 1, 1993
Aesthetic Plastic Surgery, 1996
The surgical management of patients desiring removal of silicone mammary prostheses can be contro... more The surgical management of patients desiring removal of silicone mammary prostheses can be controversial. Patients fearful of implants may choose not to undergo implant exchange with saline implants. This fear is well documented and has been influenced by the media. Anecdotal reports attempting to link silicone mammary prostheses to human adjuvant diseases have exacerbated this fear. Large outcome studies refute these claims. Significant breast deformity can result after implantectomy/capsulectomy. Various autogenous tissues have been used in the post mastectomy group of patients. Recently, latissimus dorsi muscle has been used in breast augmentation. This case report delineates the thought process involved in patient selection, describes the techniques employed, and suggests that bilateral deepithelialized TRAM flaps can be utilized in the aesthetic reconstruction of a growing population of patients: those who decline implant exchange but desire to maintain or improve the aesthetic appearance of their breasts.
PubMed, Jun 1, 1991
Thirty-seven patients underwent the high posterior approach to the internal jugular vein with a 9... more Thirty-seven patients underwent the high posterior approach to the internal jugular vein with a 97.3 percent success rate. The authors present a simple technique for central venous cannulation. A comparison is made to three standard methods of jugular vein catheterization.
Plastic and Reconstructive Surgery, Apr 1, 1997
A review was done of the records of 50 patients who had osseous genioplasty performed at the same... more A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.
Otolaryngology–Head and Neck Surgery, 1994
Annals of Plastic Surgery, 1993
Urology, 1992
Herein we report on 7 children with hypospadias and dorsal chordee. A theory is proposed to expla... more Herein we report on 7 children with hypospadias and dorsal chordee. A theory is proposed to explain this rare combination of anomalies. A method for surgical correction is presented.
Plastic and Reconstructive Surgery, 1999
Plastic & Reconstructive Surgery, 1997
A review was done of the records of 50 patients who had osseous genioplasty performed at the same... more A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.
Head & Neck, 1991
True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case report... more True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case reports have appeared regarding this entity. We present a case of a congenital internal jugular venous aneurysm which manifested itself after abdominal surgery and prolonged positive pressure ventilation. A theory regarding its manifestation is presented. We believe this case to be unique in its presentation.
Cancer, 1993
Background. There have been few reported series of liposarcomas in patients younger than or equal... more Background. There have been few reported series of liposarcomas in patients younger than or equal to 22 years of age. Methods. A retrospective analysis of all patients presenting with liposarcoma between 1949-1990 at Memorial Sloan-Kettering Cancer Center with age at diagnosis younger than or equal to 22 years was performed. Variables evaluated for their predictive effect on survival included anatomic location of the primary, size, and completeness of surgical resection. Results. Eighteen patients were identified. Only 1 patient (6%) presented with a high-grade lesion, and in 13 patients (72%), the myxoid subtype was observed. All but one patient undergoing complete resection remain disease-free 1.3-29.1 years after treatment, while all patients with gross residual tumor have died from disease. Two of three patients with microscopic residual at resection are disease-free 2 and 11.8 years after diagnosis with the addition of external beam radiation therapy. Conclusions. The authors conclude that complete surgical resection is crucial for survival in young patients with liposarcoma and that external beam radiation therapy may be effective against microscopic residual.
Annals of Plastic Surgery, 1993
Aesthetic Plastic Surgery, 1996
The surgical management of patients desiring removal of silicone mammary prostheses can be contro... more The surgical management of patients desiring removal of silicone mammary prostheses can be controversial. Patients fearful of implants may choose not to undergo implant exchange with saline implants. This fear is well documented and has been influenced by the media. Anecdotal reports attempting to link silicone mammary prostheses to human adjuvant diseases have exacerbated this fear. Large outcome studies refute these claims. Significant breast deformity can result after implantectomy/capsulectomy. Various autogenous tissues have been used in the post mastectomy group of patients. Recently, latissimus dorsi muscle has been used in breast augmentation. This case report delineates the thought process involved in patient selection, describes the techniques employed, and suggests that bilateral deepithelialized TRAM flaps can be utilized in the aesthetic reconstruction of a growing population of patients: those who decline implant exchange but desire to maintain or improve the aesthetic appearance of their breasts.
Plastic and Reconstructive Surgery - Global Open, 2020
Breast reconstruction has undergone significant innovation over the past 50 years. Both the devel... more Breast reconstruction has undergone significant innovation over the past 50 years. Both the development of nipple sparing mastectomy and the use of acellular dermal matrices have facilitated the concept of direct to implant (DTI) reconstruction. The next step in this evolution is further limiting the length of incisions as well as placing access in a more remote location. A robot-assisted surgical approach for DTI reconstruction (R-DTI) with an acellular dermal matrix scaffold is feasible and addresses limitations with open approaches and ergonomics. The authors performed a cadaveric exploration to demonstrate proof of concept and feasibility for an R-DTI following a robot-assisted nipple sparing mastectomy. Tremor stabilization, direct visualization, endo-wristed robotic instrumentation, and exposure were noted as key benefits over existing open DTI reconstruction techniques. Additionally, the ability to have a more remote access to entry at the perimeter of the breast eliminated i...
Annals of Plastic Surgery, 1996
Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplas... more Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplasty for resection of a portion of columella in cases of overly projecting nasal tip. The mid columellar incision has come to be known as the "Rethi" incision. Numerous variations of this approach have been popularized through the years. Recently, a great debate has raged over the criteria to be used in selecting patients for rhinoplasty. In this paper, we review 100 consecutive rhinoplasties and discuss our technique of labiocolumellar crease incision for open approach, and relate the criteria that we utilize to select patients for open rhinoplasty. There were 37 male and 63 female patients. Of these, 32 primary, 45 secondary, 18 cleft, and 5 reconstructive rhinoplasties were performed. Twenty-eight percent of primary, 62% of secondary, 78% of cleft, and 80% of reconstructive rhinoplasties were performed using the open approach via the labiocolumellar crease incision. There were no cases of circulatory compromise of the columella. The presence of a scar along the columella base (as with the C-flap in cleft patients) should be an indication for open rhinoplasty. Several myths about the labiocolumellar crease incision are dispelled. Adhering to principles of aesthetic subunits should guide the surgeon to place scars in a less noticeable position.
Plastic and reconstructive surgery. Global open, 2020
Off Label Disclosure: Da Vinci systems (Xi and SP) are not cleared for breast surgery or reconstr... more Off Label Disclosure: Da Vinci systems (Xi and SP) are not cleared for breast surgery or reconstruction in the United States or EU. Performing robot-assisted breast or reconstructive surgery is an off-label practice and should be conducted under specific clinical trials approved by the board of the concerned hospital and in some countries by the clinical authority.
Head & neck, Sep 1, 1991
True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case report... more True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case reports have appeared regarding this entity. We present a case of a congenital internal jugular venous aneurysm which manifested itself after abdominal surgery and prolonged positive pressure ventilation. A theory regarding its manifestation is presented. We believe this case to be unique in its presentation.
Otolaryngology-Head and Neck Surgery, Jun 1, 1994
Annals of Plastic Surgery, Feb 1, 1993
Aesthetic Plastic Surgery, 1996
The surgical management of patients desiring removal of silicone mammary prostheses can be contro... more The surgical management of patients desiring removal of silicone mammary prostheses can be controversial. Patients fearful of implants may choose not to undergo implant exchange with saline implants. This fear is well documented and has been influenced by the media. Anecdotal reports attempting to link silicone mammary prostheses to human adjuvant diseases have exacerbated this fear. Large outcome studies refute these claims. Significant breast deformity can result after implantectomy/capsulectomy. Various autogenous tissues have been used in the post mastectomy group of patients. Recently, latissimus dorsi muscle has been used in breast augmentation. This case report delineates the thought process involved in patient selection, describes the techniques employed, and suggests that bilateral deepithelialized TRAM flaps can be utilized in the aesthetic reconstruction of a growing population of patients: those who decline implant exchange but desire to maintain or improve the aesthetic appearance of their breasts.
PubMed, Jun 1, 1991
Thirty-seven patients underwent the high posterior approach to the internal jugular vein with a 9... more Thirty-seven patients underwent the high posterior approach to the internal jugular vein with a 97.3 percent success rate. The authors present a simple technique for central venous cannulation. A comparison is made to three standard methods of jugular vein catheterization.
Plastic and Reconstructive Surgery, Apr 1, 1997
A review was done of the records of 50 patients who had osseous genioplasty performed at the same... more A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.
Otolaryngology–Head and Neck Surgery, 1994
Annals of Plastic Surgery, 1993
Urology, 1992
Herein we report on 7 children with hypospadias and dorsal chordee. A theory is proposed to expla... more Herein we report on 7 children with hypospadias and dorsal chordee. A theory is proposed to explain this rare combination of anomalies. A method for surgical correction is presented.
Plastic and Reconstructive Surgery, 1999
Plastic & Reconstructive Surgery, 1997
A review was done of the records of 50 patients who had osseous genioplasty performed at the same... more A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.
Head & Neck, 1991
True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case report... more True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case reports have appeared regarding this entity. We present a case of a congenital internal jugular venous aneurysm which manifested itself after abdominal surgery and prolonged positive pressure ventilation. A theory regarding its manifestation is presented. We believe this case to be unique in its presentation.
Cancer, 1993
Background. There have been few reported series of liposarcomas in patients younger than or equal... more Background. There have been few reported series of liposarcomas in patients younger than or equal to 22 years of age. Methods. A retrospective analysis of all patients presenting with liposarcoma between 1949-1990 at Memorial Sloan-Kettering Cancer Center with age at diagnosis younger than or equal to 22 years was performed. Variables evaluated for their predictive effect on survival included anatomic location of the primary, size, and completeness of surgical resection. Results. Eighteen patients were identified. Only 1 patient (6%) presented with a high-grade lesion, and in 13 patients (72%), the myxoid subtype was observed. All but one patient undergoing complete resection remain disease-free 1.3-29.1 years after treatment, while all patients with gross residual tumor have died from disease. Two of three patients with microscopic residual at resection are disease-free 2 and 11.8 years after diagnosis with the addition of external beam radiation therapy. Conclusions. The authors conclude that complete surgical resection is crucial for survival in young patients with liposarcoma and that external beam radiation therapy may be effective against microscopic residual.
Annals of Plastic Surgery, 1993
Aesthetic Plastic Surgery, 1996
The surgical management of patients desiring removal of silicone mammary prostheses can be contro... more The surgical management of patients desiring removal of silicone mammary prostheses can be controversial. Patients fearful of implants may choose not to undergo implant exchange with saline implants. This fear is well documented and has been influenced by the media. Anecdotal reports attempting to link silicone mammary prostheses to human adjuvant diseases have exacerbated this fear. Large outcome studies refute these claims. Significant breast deformity can result after implantectomy/capsulectomy. Various autogenous tissues have been used in the post mastectomy group of patients. Recently, latissimus dorsi muscle has been used in breast augmentation. This case report delineates the thought process involved in patient selection, describes the techniques employed, and suggests that bilateral deepithelialized TRAM flaps can be utilized in the aesthetic reconstruction of a growing population of patients: those who decline implant exchange but desire to maintain or improve the aesthetic appearance of their breasts.
Plastic and Reconstructive Surgery - Global Open, 2020
Breast reconstruction has undergone significant innovation over the past 50 years. Both the devel... more Breast reconstruction has undergone significant innovation over the past 50 years. Both the development of nipple sparing mastectomy and the use of acellular dermal matrices have facilitated the concept of direct to implant (DTI) reconstruction. The next step in this evolution is further limiting the length of incisions as well as placing access in a more remote location. A robot-assisted surgical approach for DTI reconstruction (R-DTI) with an acellular dermal matrix scaffold is feasible and addresses limitations with open approaches and ergonomics. The authors performed a cadaveric exploration to demonstrate proof of concept and feasibility for an R-DTI following a robot-assisted nipple sparing mastectomy. Tremor stabilization, direct visualization, endo-wristed robotic instrumentation, and exposure were noted as key benefits over existing open DTI reconstruction techniques. Additionally, the ability to have a more remote access to entry at the perimeter of the breast eliminated i...
Annals of Plastic Surgery, 1996
Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplas... more Aurel Rethi, in 1934, first described the transverse upper columellar incision for open rhinoplasty for resection of a portion of columella in cases of overly projecting nasal tip. The mid columellar incision has come to be known as the "Rethi" incision. Numerous variations of this approach have been popularized through the years. Recently, a great debate has raged over the criteria to be used in selecting patients for rhinoplasty. In this paper, we review 100 consecutive rhinoplasties and discuss our technique of labiocolumellar crease incision for open approach, and relate the criteria that we utilize to select patients for open rhinoplasty. There were 37 male and 63 female patients. Of these, 32 primary, 45 secondary, 18 cleft, and 5 reconstructive rhinoplasties were performed. Twenty-eight percent of primary, 62% of secondary, 78% of cleft, and 80% of reconstructive rhinoplasties were performed using the open approach via the labiocolumellar crease incision. There were no cases of circulatory compromise of the columella. The presence of a scar along the columella base (as with the C-flap in cleft patients) should be an indication for open rhinoplasty. Several myths about the labiocolumellar crease incision are dispelled. Adhering to principles of aesthetic subunits should guide the surgeon to place scars in a less noticeable position.