Tormod Westvik - Academia.edu (original) (raw)

Papers by Tormod Westvik

defects of the torso and extremities

Plastic and reconstructive surgery, Jan 14, 2018

1. Khansa I, Khansa L, Westvik TS, et al. Work-related musculoskeletal injuries in plastic surgeo... more 1. Khansa I, Khansa L, Westvik TS, et al. Work-related musculoskeletal injuries in plastic surgeons in the United States, Canada, and Norway. Plast Reconstr Surg. 2018;141:165e–175e. 2. Sommerlad BC. The use of the operating microscope for cleft palate repair and pharyngoplasty. Plast Reconstr Surg. 2003;112:1540–1541. 3. Mendez BM, Chiodo MV, Vandevender D, Patel PA. Headsup 3D microscopy: An ergonomic and educational approach to microsurgery. Plast Reconstr Surg Glob Open 2016;4:e717. 4. Capone AC, Parikh PM, Gatti ME, Davidson BJ, Davison SP. Occupational injury in plastic surgeons. Plast Reconstr Surg. 2010;125:1555–1561. Fig. 1. Surgeons are shown sharing the same surgical view and discussing the operation, using a heads-up three-dimensional microscope in a comfortable posture.

Plastic and reconstructive surgery, 2018

Musculoskeletal injuries are more common among surgeons than among the general population. Howeve... more Musculoskeletal injuries are more common among surgeons than among the general population. However, little is known about these types of injuries among plastic surgeons specifically. The authors' goals were to evaluate the prevalence, nature, causes, and potential solutions of these musculoskeletal injuries among plastic surgeons in three different countries: the United States, Canada, and Norway. A survey was e-mailed to plastic surgeons in the United States, Canada, and Norway, soliciting their demographics, practice description, history of musculoskeletal issues, potential causes of these symptoms, and proposed suggestions to address these injuries. The prevalence of various musculoskeletal symptoms was calculated, and predictors of these symptoms were evaluated using multivariate logistic regression. The survey was sent to 3314 plastic surgeons, with 865 responses (response rate, 26.1 percent); 78.3 percent of plastic surgeons had musculoskeletal symptoms, most commonly in t...

Plastic and Reconstructive Surgery - Global Open, 2017

Since the Plastic Surgery Education Network's (PSEN) acceptance in 2014 as a nationwide education... more Since the Plastic Surgery Education Network's (PSEN) acceptance in 2014 as a nationwide educational tool by the Norwegian Association of Plastic Surgery, 84 users have now been registered throughout 6 of the 7 teaching hospitals in Norway. This study reports the frequency of use, perception, and usefulness of PSEN in a national teaching environment outside the United States. METHODS A 10-question SurveyMonkey questionnaire was sent to registered PSEN users in Norway; duplicates due to transfers between teaching institutions were removed. Answers were collected during a 2-week period in October 2016. Simple analysis of the answers produced data to be interpreted and visualized graphically utilizing Microsoft Excel 2010 (Microsoft Corp, Seattle, Wash.).

Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti

Journal of Vascular Surgery

Vascular smooth muscle cells exhibit varied responses after vessel injury and surgical interventi... more Vascular smooth muscle cells exhibit varied responses after vessel injury and surgical interventions, including phenotypic switching, migration, proliferation, protein synthesis, and apoptosis. Although the source of the smooth muscle cells that accumulate in the vascular wall is controversial, possibly reflecting migration from the adventitia, from the circulating blood, or in situ differentiation, the intracellular signal transduction pathways that control these processes are being defined. Some of these pathways include the Ras-mitogen–activated protein kinase, phosphatidylinositol 3-kinase-Akt, Rho, death receptor-caspase, and nitric oxide pathways. Signal transduction pathways provide amplification, redundancy, and control points within the cell and culminate in biologic responses. We review some of the signaling pathways activated within smooth muscle cells that contribute to smooth muscle cell heterogeneity and development of pathology such as restenosis and neointimal hyperp...

A single institution reports on the experience of three full face transplantation cases. After th... more A single institution reports on the experience of three full face transplantation cases. After the established protocol for the operation received approval from our institution, we began a thorough pre-operative evaluation of these three patients. Each patient presented with unique challenges; however, we describe a standardized approach to their perioperative care outlining the details of our technique with regards to both procurement and inset. The first patient presented with a history of electrical injury to the face leaving him blind and without discernible facial features. The second patient also suffered from facial injuries sustained during an electrical injury. His sight remained intact, though scar contracture from repeated reconstructive procedures left him with poor facial function. The third patient in our series was involved in an animal attack leaving her with severe facial disfigurement and without either hand. We report the following complications: hematoma, facial ...

Annals of plastic surgery, 2015

Since 2009, the face transplant team at Brigham and Women's Hospital in Boston has performed ... more Since 2009, the face transplant team at Brigham and Women's Hospital in Boston has performed 6 successful partial and full facial transplantations on carefully selected patients. The development of these techniques has led to a new era in facial reconstruction which now more correctly can be described as facial restoration. Besides the obvious facts of giving someone with a missing or severely disfigured face a new appearance, facial restoration has led to many other interesting observations in terms of immunologic models, airway functionality, sensory recovery and cerebral cortical functioning. In this article, we present an overview of our experience, and where we are today-also presenting some of the interesting avenues that have opened and will lead us further in the daunting experience of facial allotransplantation.

Danish medical journal, 2013

We present Scandinavia's first series of immediate alloplastic breast reconstructions with an... more We present Scandinavia's first series of immediate alloplastic breast reconstructions with an acellular dermal matrix. Data were collected retrospectively in 76 cases of immediate breast reconstruction using an acellular dermal matrix (ADM) and an implant. A total of 59 women were reconstructed between June 2011 and January 2013. Cases included 42 unilateral and 17 bilateral reconstructions. A large number of patients had adjuvant therapy, hormone therapy (34), radiation therapy (27) or chemotherapy (38). The median age was 51 years (30-70 years) and the median follow-up period was 326 days (68-624 days). The co-morbidity factors included hypertension (n = 11), diabetes (n = 2) and 19 patients were smokers. Unsuccessful reconstructions counted ten cases (13%), eight of these due to necrosis and/or wound dehiscence (10%) and two due to infection (3%). The failure rate in non-smokers was 2/52 (4%) compared with 8/24 (33%) in smokers, p = 0.001. In hypertensive patients, the failur...

Current problems in surgery, 2011

Vascular

Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid ... more Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid stenosis, the role of and indications and evidence for many pharmacologic agents that are used adjunctively in the perioperative setting have not been conclusively established. Aspirin (acetylsalicylic acid) is the pharmaceutical agent that has been studied most extensively in conjunction with CEA; other than aspirin and dextran, the use of many agents before, during, and after CEA has not been standardized. Prospective randomized trials are still needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in their adjunctive use during CEA to improve patient care and obtain optimal surgical outcomes.

Annales de Chirurgie Vasculaire, 2008

ABSTRACT Des publications récentes d'établissements isolés ont confirmé l'efficac... more ABSTRACT Des publications récentes d'établissements isolés ont confirmé l'efficacité de l'endartériectomie carotidienne (EC) en urgence ou semi-urgence, bien qu'avec une mortalité et une morbidité périopératoires plus élevées. Nous avons déterminé les résultats de l'EC en urgence dans des hôpitaux universitaires et généraux et si des facteurs liés au patient ou à l'hôpital influençaient les résultats. Les dossiers des patients ayant une EC dans tous les hôpitaux non fédéraux dans l'état du Connecticut entre 1992 et 2002 ont été revus, et les patients symptomatiques qui se sont présentés en urgence ou en semi-urgence ont été comparés aux patients traités de manière élective. La régression logistique multivariée a été employée pour déterminer l'effet des facteurs de risque des patients sur la mortalité périopératoire, les AVC, et les complications cardiaques. Les patients ayant une EC en urgence (n = 764, 6,3%) ont eu des taux périopératoires plus élevés de mortalité (2% contre 0,3%, p < 0,0001) et d'AVC (2,9% contre 1,1%, p < 0,0001) mais pas de complications cardiaques (3% contre 2,2%, p = 0,14) comparés aux patients ayant une EC élective (n = 11,312). Les patients ayant une EC en urgence et avec des taux élevés de comorbidités associées avaient un risque périopératoire plus élevé de mortalité (7,8% contre 0,4, p = 0,001), d'AVC (10,9% contre 0,8%, p = 0,0002), et de complications cardiaques (14,1% contre 0,8%, p < 0,0001) comparés aux patients se présentant en urgence mais avec peu de comorbidités. La mortalité périopératoire était associée à la réalisation de l'intervention dans les hôpitaux à faible capacité en lits (rapport de risque [OR] = 4,6, p = 0,01). Les AVC périopératoires étaient associés à l'insuffisance rénale (OR = 5,3, p = 0,04). Les complications cardiaques périopératoires étaient associées au diabète (OR = 2,6, p = 0,03) et aux hôpitaux à faible capacité en lits (OR = 5, p < 0,01). L'admission en urgence était associée à l'âge > 80 (OR = 1,2, p = 0,04), à l'insuffisance rénale (OR = 1,8, p = 0,05), et à l'atteinte cardiaque (OR = 1,3, p < 0,01). L'EC en urgence a une mortalité et un taux d'AVC périopératoires plus élevés par comparaison aux cas traités de manière élective. Cependant, le sous-ensemble de patients présentant peu de comorbidités médicales associées et nécessitant une EC en urgence est associé à un faible taux de complications périopératoires. Les patients présentant des comorbidités médicales associées graves qui ont besoin d'une EC en urgence peuvent former un groupe de patients à haut risque pouvant faire envisager un transfert dans des grands centres ou un traitement alternatif.

Annals of vascular surgery

Recent reports from single institutions have confirmed the efficacy of carotid endarterectomy (CE... more Recent reports from single institutions have confirmed the efficacy of carotid endarterectomy (CEA) performed in the urgent or emergent setting, although with higher perioperative mortality and morbidity. We determined the results of urgently performed CEA in academic and community hospitals and whether patient or hospital factors affected outcome. The records of patients undergoing CEA in all nonfederal hospitals in the state of Connecticut between 1992 and 2002 were reviewed, and symptomatic patients who presented in an urgent or emergent fashion were compared to patients treated electively. Multivariable logistic regression was used to determine the effect of patient risk factors on perioperative mortality, stroke, and cardiac complications. Patients undergoing urgent CEA (n = 764, 6.3%) had higher perioperative mortality (2.0% vs. 0.3%, p < 0.0001) and stroke (2.9% vs. 1.1%, p < 0.0001) but not cardiac complications (3.0% vs. 2.2%, p = 0.14) compared to patients undergoing...

European Journal of Plastic Surgery, 2014

Background Perforating vessels are a consistent anatomical finding and well described in the curr... more Background Perforating vessels are a consistent anatomical finding and well described in the current literature. Any skin flap can be raised on a subcutaneous pedicle as long as it contains at least one supplying perforator. Perforator flaps have been interlinked with microsurgery and generally not widely performed by the general plastic surgeons. The aim of this paper is to present the simplicity of pedicled perforator flap reconstruction of moderate-sized defects of the extremities and torso. Methods We retrospectively reviewed the charts of 34 patients reconstructed using 34 freestyle pedicled perforator flaps for moderate-sized defects of the truncus and extremities. We registered indications, flap size and localization, success rate, and complications. Most importantly, we describe a simple approach to the design of freestyle pedicled perforator flaps and elaborate on technical aspects in the context of current literature. Results The reconstructive goals were achieved in all cases without any total flap loss or major complications. Minor complications occurred in 7/34 (21 %) cases consisting of venous congestion leading to distal tip necrosis or epidermolysis; partial flap loss was significant in 4 cases, however never more than 10 % of the total flap size. Reconstruction was performed on the lower limb in 13 cases, upper limb in 12, and 9 cases were on the truncus. The angle of rotation was 90°in 21 cases and 180°in 13 cases. The most common indication was reconstruction of oncological skin defects; melanoma 19, BCC 6, SCC 2, other 7. The flap size varied from 1.5×3 cm to 12×22 cm. The perforator identification was done by intraoperative exploration in 17 cases and by color Doppler ultrasonography in 17 cases. Conclusions Moderate-sized defects of the torso and extremities can be successfully reconstructed by pedicled perforator flaps. The flap dissection is simple, and the complication rates comparable to other reconstructive options. Level of evidence IV, therapeutic study

Vascular Pharmacology, 2007

Both neointimal hyperplasia and inward remodeling contribute to restenosis and lumen loss. Nogo-B... more Both neointimal hyperplasia and inward remodeling contribute to restenosis and lumen loss. Nogo-B has been recently described as an inhibitor of vascular injury and neointimal hyperplasia. To determine whether Nogo-B expression may be a mediator of inward remodeling, we examine the localization of expression of Nogo-B in an in vivo model that examines both neointimal hyperplasia and inward remodeling. The rabbit carotid artery was subjected to balloon injury, outflow branch ligation to reduce flow, or both balloon injury and reduction in flow. In balloon injury-induced neointimal hyperplasia Nogo-B expression was reduced in the intima and media but stimulated in the adventitia. In low flow-induced inward remodeling medial Nogo-B expression was not reduced and adventitial Nogo-B expression was not stimulated. Low flow significantly augmented balloon injury-induced neointimal hyperplasia and was accompanied by reduced intimal and medial Nogo-B expression, and increased adventitial Nogo-B expression in both smooth muscle cells and macrophages. Low flow-induced inward remodeling is not associated with changes in medial Nogo-B expression and is distinct from injury-induced neointimal hyperplasia. Pharmacological strategies to inhibit neointimal hyperplasia and restenosis using normal flow models may only partially account for lumen loss and therefore may not accurately predict responses in patients with extensive outflow disease.

The American Journal of Surgery, 2006

The deleterious effects of perioperative malnutrition on recovery after general surgery are estab... more The deleterious effects of perioperative malnutrition on recovery after general surgery are established. Since the effects of perioperative malnutrition on recovery after vascular surgery are not known, we examined the effects of nutritional status, and risk factors predictive of malnutrition, on outcome after vascular surgery. The records of all open index vascular cases (abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], lower extremity bypass) performed at the Veterans Affairs (VA) Connecticut between July 2004 and June 2005 were reviewed. The primary outcome was mortality; secondary outcomes included infection and nutritional risk index (NRI) scores. Sixty-eight open vascular cases were performed during the study period. Nutritional depletion developed in 55% of patients and was more likely in patients undergoing AAA (85%) or bypass (77%) than CEA (30%; P = .0005). Patients who developed malnutrition had similar mortality as patients who did not develop postoperative malnutrition (6.1% vs. 3.7%; P = .68); however, malnourished patients had higher rates of postoperative infection (24.2% vs. 3.7%; P = .03). Chronic renal failure was the only patient-associated risk factor predictive of postoperative nutritional depletion (odds ratio 5.9, confidence interval 1.0 to 33.6; P = .04). Patients undergoing major open vascular surgery have high rates of postoperative malnutrition, with patients undergoing AAA repair having the highest rates of postoperative malnutrition and infection. Patients with chronic renal failure undergoing vascular surgery are associated with increased risk for postoperative malnutrition and may be a group to target for perioperative risk factor modification and nutritional supplementation.

Plastic & Reconstructive Surgery, 2012

Background: Full face transplantation raises a new set of ethical concerns and technical difficul... more Background: Full face transplantation raises a new set of ethical concerns and technical difficulties when compared with partial face transplantation. Previously, it was thought that full face allografts must include bilateral superficial temporal and facial arteries, dictating the need for inclusion of donor parotid glands. This would lead to poor aesthetic outcomes and limit facial nerve coaptation to the level of the main trunk, which often results in synkinesias. The authors present a new approach to full facial allograft recovery based on blood supply from facial arteries alone. This approach eliminates the need to include parotid glands, enabling more distal coaptation of facial nerve branches and targeted innervation of effector muscles. The recovery can be reproducibly performed within 4 hours. Methods: Three mock cadaver dissections and three full face transplantations were performed. Results: Donor facial allografts were dissected in cranio-caudal and lateral-tomedial fashion. Individual facial nerve branches were cut medial to parotid glands and coapted to corresponding recipient nerve branches. With the exception of one parotid gland used to add bulk, parotids were generally not included in the allografts. Relevant sensory nerves were coapted. External carotid arteries were dissected, leaving only bilateral facial arteries as the primary arterial supply. All full facial allografts were well perfused immediately following transplantation and are surviving. Conclusions: The authors describe a new, simple, and reproducible technique of full facial allograft recovery that allows perfusion using only bilateral facial arteries. Their technique follows critical principles of targeted sensory and motor nerve coaptation.

Journal of Vascular Surgery, 2007

Vascular smooth muscle cells (SMC) exhibit varied responses after vessel injury and surgical inte... more Vascular smooth muscle cells (SMC) exhibit varied responses after vessel injury and surgical interventions, including phenotypic switching, migration, proliferation, protein synthesis, and apoptosis. Although the source of the SMC that accumulate in the vascular wall is controversial, possibly reflecting migration from the adventitia, from the circulating blood, or in situ differentiation, the intracellular signal transduction pathways that control these processes are being defined. Some of these pathways include the Ras-MAPK, PI3K-Akt, Rho, death receptor-caspase, and nitric oxide pathways. Signal transduction pathways provide amplification, redundancy, and control points within the cell and culminate in biological responses. We review some of the signaling pathways activated within SMC that contribute to SMC heterogeneity and development of pathology such as restenosis and neointimal hyperplasia.

Journal of Vascular Surgery, 2009

Objective: Older patients are thought to tolerate acute ischemia more poorly than younger patient... more Objective: Older patients are thought to tolerate acute ischemia more poorly than younger patients. Since aging may depress both angiogenesis and arteriogenesis, we determined the effects of age on both angiogenesis and arteriogenesis in a model of severe acute limb ischemia. Methods: Young adult (3-months-old) and aged (18-months-old) C57BL/6 mice underwent right common iliac artery and vein ligation and transection. Data were collected on days 0, 7, and 14. Perfusion was measured with a laser Doppler scan and compared to the contralateral limb. Functional deficits were evaluated with the Tarlov scale. Capillary density and endothelial progenitor cell (EPC) number were determined by direct counting lectin-positive/alpha-actin-negative cells and VEGFR2/CXCR4 dually-positive cells, respectively; angiography was performed to directly assess arteriogenesis. Results: Young adult and aged mice had a similar degree of decreased perfusion after iliac ligation (young, n ‫؍‬ 15: 20.4 ؎ 1.9%, vs aged, n ‫؍‬ 20: 19.6 ؎ 1.3%; P ‫؍‬ .72, analysis of variance [ANOVA]); however, young mice recovered faster and to a greater degree than aged mice (day 7, 35 ؎ 6% vs 17 ؎ 4%, P ‫؍‬ .046; day 14, 60 ؎ 5% vs 27 ؎ 7%, P ‫؍‬ .0014). Aged mice had worse functional recovery by day 14 compared to young mice (2.3 ؎ 0.3 vs 4.3 ؎ 0.4; P ‫؍‬ .0021). Aged mice had increased capillary density (day 7, 12.9 ؎ 4.4 vs 2.8 ؎ 0.3 capillaries/hpf; P ‫؍‬ .02) and increased number of EPC incorporated into the ischemic muscle (day 7, 8.1 ؎ 0.9 vs 2.5 ؎ 1.9 cells; P ‫؍‬ .007) compared to young mice, but diminished numbers of collateral vessels to the ischemic limb (1 vs 9; P ‫؍‬ .01), as seen on angiography. Conclusion: After severe hind limb ischemia, aged animals become ischemic to a similar degree as young animals, but aged animals have significantly impaired arteriogenesis and functional recovery compared to younger animals. These results suggest that strategies to stimulate arteriogenesis may complement those that increase angiogenesis, and may result in improved relief of ischemia. (J Vasc Surg 2009;49:464-73.) Clinical Relevance. The incidence of chronic limb ischemia increases with age as do the consequences of acute ischemia. We show, using a new model of severe acute limb ischemia that does not wound the ischemic limb, that aged mice increase angiogenesis in response to acute ischemia, but do not show arteriogenesis, ie, large collateral formation. These results suggest why elderly patients develop large vessel disease such as claudication but can still heal small wounds. They also suggest that strategies to treat ischemia in elderly patients should focus on stimulating large vessel arteriogenesis, rather than solely small vessel angiogenesis.

Journal of Vascular Research, 2008

Background/Aims: Age-associated changes in endothelial nitric oxide synthase (eNOS) expression ha... more Background/Aims: Age-associated changes in endothelial nitric oxide synthase (eNOS) expression have not been definitively linked to the pathophysiology of aortic aneurysms. We examined the role of eNOS in human patients and an age-appropriate mouse model. Methods: eNOS transcripts and immunodetectable protein were assessed by quantitative PCR and immunohistochemistry in human ascending thoracic aneurysms (n = 29) and referent aortae (n = 31). Carotid aneurysms were induced with CaCl2 in young adult (3 months) and aged (18 months) C57BL/6 and eNOS-knockout (eNOS-KO) mice. Results: eNOS transcripts and protein were reduced in human aneurysms compared with controls, although aortic eNOS expression also decreased with patient age. Aged wild-type mice had significantly larger aneurysm diameter than young adult mice. Aged wild-type mice had reduced eNOS transcripts and protein compared with young adult mice. Aged eNOS-KO mice had smaller aneurysms compared with aged wild-type mice but sim...