Ryan Garcia | Texas A&M University (original) (raw)

Papers by Ryan Garcia

Asian-Pacific Law & Policy, Journal, 2010

Revista de Neurología

Introduccion. El espasmo hemifacial (EHF) se caracteriza por el espasmo o fasciculaciones cronica... more Introduccion. El espasmo hemifacial (EHF) se caracteriza por el espasmo o fasciculaciones cronicas de un lado de la cara. Afecta a los musculos activados por el nervio facial. Se cree que el EHF se deriva de la irritacion del nervio facial en su salida del tronco encefalico y, en la mayoria de casos, esta vinculado a una pequena compresion por un asa vascular. En raras ocasiones, esta asociado a una dolicoectasia de la arteria vertebral. Casos clinicos. Presentamos tres casos de EHF en los cuales los resultados de una resonancia magnetica y de una angiorresonancia pusieron de manifiesto dolicoectasia de las arterias vertebrales que comprimian el nervio facial y provocaban EHF. Estos casos se seleccionaron del grupo de pacientes tratados en las consultas externas para los trastornos distonicos, en el Servicio de Neurologia, entre el 1 de abril de 1998 y el 30 de diciembre de 2007. Conclusiones. La resonancia magnetica y la angiorresonancia son fundamentales para el diagnostico de una dolicoectasia de la arteria vertebral, y deben considerarse como los procedimientos iniciales de deteccion sistematica en la evaluacion de los pacientes con EHF. El papel de estos estudios neurorradiologicos en el diagnostico del EHF no es solo detectar las estructuras vasculares con una trayectoria proxima a la zona de salida de la raiz, que podrian deformar el nervio facial y comprimir el tronco encefalico alrededor de la zona de salida de la raiz, sino tambien excluir otras causas en una unica exploracion no invasiva.

HAND, 2016

Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoi... more Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoid fractures, although less information has been reported about outcomes for unstable, displaced fractures. The aim of this study was to evaluate the union and complication rates following manual closed reduction and percutaneous screw placement for a consecutive series of unstable, displaced scaphoid fractures. Methods: A total of 28 patients (average age, 27 years; 22 male/6 female) were treated for isolated unstable displaced scaphoid waist fractures. Closed reduction and percutaneous headless, compression screw fixation was successfully performed in 14 patients (average age, 32 years; 10 male/4 female), and the remaining 14 patients required open reduction. Patients who underwent percutaneous treatment were followed for radiographic fracture union and clinical outcomes. Results: Thirteen of 14 fractures (93%) had clinical and radiographic evidence of bone union at an average of 2.8 mo...

The Faseb Journal, Mar 1, 2008

Nearly all studies that seek to uncover the effects of military service on the individual are pla... more Nearly all studies that seek to uncover the effects of military service on the individual are plagued with the self-selection bias that comes with studying the all-volunteer-force. In order to solve this problem, this paper takes advantage of the natural experiment afforded by the suspension of the French National Service program to produce unbiased causal analyses of the effect of national service on a range of civic engagement measures. The results of the natural experiment indicate that participation in national service does affect individual levels of civic engagement in a statistically significant way. However, the degree to which mandatory national service can be considered a desirable form of civic education depends upon the relative importance one assigns to participation in activities that reflect responsibility to the collective, foster attitudinal development, or are official forms of political participation.

Mycoses, 2009

Three cases of paracoccidioidomycosis observed in 1990-199 1 in Quillabamba, Peru, and its surrou... more Three cases of paracoccidioidomycosis observed in 1990-199 1 in Quillabamba, Peru, and its surroundings are described. The climate and the living conditions of the inhabitants favour paracoccidioidomycosis. It can be assumed that a majority of cases could not be identified, because the symptoms are disguised as other tropical diseases. The application of ketoconazole to the patients showed different results, from optimal to scarce, while temporary remission of the disease was obtained with itraconazole. The best therapy for paracoccidioidomycosis appears to be the application of amphotericin B plus sulphamidics. Zusammenfassung. Es werden drei Falle von Paracoccidioidomykose beschrieben, die 1990 und 1991 in Quillabamba, Peru, und Umgebung beobachtet wurden. Klima und Lebensbedingungen der Bewohner begiinstigen die Paracoccidioidomykose. Viele Krankheitsfalle konnten nicht erfaBt werden, da die Symptome als andersartige Tropenkrankheiten fehlgedeutet werden konnen. Die Therapie mit Ketoconazol zeigte unterschiedliche Resultate, von optimal bis geringgradig, wahrend mit I traconazol vorubergehende Erfolge erzielt wurden. Die beste Therapiestrategie f i r

Risk analysis : an official publication of the Society for Risk Analysis, Dec 1, 2016

We propose a methodology, called defender-attacker decision tree analysis, to evaluate defensive ... more We propose a methodology, called defender-attacker decision tree analysis, to evaluate defensive actions against terrorist attacks in a dynamic and hostile environment. Like most game-theoretic formulations of this problem, we assume that the defenders act rationally by maximizing their expected utility or minimizing their expected costs. However, we do not assume that attackers maximize their expected utilities. Instead, we encode the defender's limited knowledge about the attacker's motivations and capabilities as a conditional probability distribution over the attacker's decisions. We apply this methodology to the problem of defending against possible terrorist attacks on commercial airplanes, using one of three weapons: infrared-guided MANPADS (man-portable air defense systems), laser-guided MANPADS, or visually targeted RPGs (rocket propelled grenades). We also evaluate three countermeasures against these weapons: DIRCMs (directional infrared countermeasures), perim...

Journal of Reconstructive Microsurgery, 2015

Background The decision to perform an end-to-end (ETE) or end-to-side (ETS) arterial anastomosis ... more Background The decision to perform an end-to-end (ETE) or end-to-side (ETS) arterial anastomosis in lower extremity free tissue transfer has not been thoroughly evaluated in a large multisurgeon setting. The authors compared the reconstructive outcomes of lower extremity free flaps with ETE and ETS arterial anastomoses. Methods The authors retrospectively reviewed their 17-year institutional experience with lower extremity free flaps to determine whether ETE or ETS arterial anastomoses were associated with foot ischemic complications and flap failure. Results From 1996 to 2013, 398 patients underwent 413 lower extremity free flaps with ETE (66%) or ETS (34%) arterial anastomoses. The incidence of postoperative foot ischemia was 2% (n = 8). The flap failure rate was 11% (n = 45). The ETS technique was preferred in patients with fewer intact vessels to the foot (32% ETS for three-vessel runoff, 36% ETS for two-vessel runoff, and 50% ETS for single-vessel runoff) and when an intact recipient vessel was selected for anastomosis (60% ETS for intact vessel vs. 25% ETS for distally occluded vessel). No differences were observed in the foot ischemia (p = 0.45) and flap failure rates (p = 0.59) for ETE versus ETS arterial anastomoses. In subset analyses, the incidence of foot ischemia did not differ for either technique in the context of impaired vascular runoff or recipient vessel selection. Conclusion No advantage was noted for ETE or ETS arterial anastomoses based on reconstructive outcomes. The choice of anastomotic technique in lower extremity free tissue transfer should be based on patient factors and the clinical circumstances encountered.

Journal of Reconstructive Microsurgery, 2015

Background Multiple studies have detailed promising smile restoration following gracilis free mus... more Background Multiple studies have detailed promising smile restoration following gracilis free muscle transfer for facial reanimation but information detailing the potential complications is lacking. The aim of this study is to systematically review the literature to evaluate the reported complication rate associated with this procedure. We also aim to determine the most common occurring complications. Methods The PubMed, Embase, and Web of Science databases were queried with multiple search strategies for published articles between January 1950 and February 2013 that detailed gracilis free muscle transfer for facial reanimation. Title, abstract, and full text review was performed. Complications were defined as any reported, identifiable adverse outcome that required an alteration in treatment for correction. Results The literature search yielded 62 studies of gracilis free muscle transfer for facial reanimation. Overall, 36 articles (58%) reported whether or not a complication had occurred. The overall complication rate based on pooled proportions was 9.6% and the most commonly occurring complications were postoperative hematoma (3.6%) and infection (3.5%). Conclusions Our data suggests that complications after gracilis free muscle transfer for facial reanimation may be underreported and this complex procedure may in fact be associated with significant adverse outcomes as high as 9.6%.

Plastic and Reconstructive Surgery, 2015

After reviewing this article, the participant should be able to: 1. Understand the most modern in... more After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis. Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

Clinical orthopaedics and related research, 2014

Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue co... more Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue coverage. The foot and ankle region is challenging to reconstruct for orthopaedic and plastic surgeons owing to its complex bony anatomy and unique functional demands. Therefore, identifying strategies for plastic surgery of these wounds may help guide surgeons in defining the best treatment plan. We evaluated our current algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle with respect to whether (1) prophylactic or simultaneous soft tissue coverage affected wound-healing complications (secondary plastic surgery, orthopaedic hardware removal, malunion, further orthopaedic surgery, ultimate failure) and (2) postoperative referral for soft tissue management was associated with wound location, size, and orthopaedic procedure. We retrospectively reviewed 112 patients who underwent elective orthopaedic foot or ankle surgery and required concomitant plastic surger...

Current Orthopaedic Practice, 2011

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Cu... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Current Orthopaedic Practice. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...

Abstract will be provided by author.

Political Behavior, 2014

Nearly all studies that seek to uncover the effects of military service on the individual are pla... more Nearly all studies that seek to uncover the effects of military service on the individual are plagued with the self-selection bias that comes with studying the all-volunteer force. To solve this problem, this paper takes advantage of the natural experiment afforded by the suspension of the French National Service program to produce unbiased causal analyses of the effect of national service on a range of civic engagement measures. Results generated using Instrumental Variables estimation indicate that there is little difference in individual-level civic engagement between service participants and their non-serving peers. However, when potential mediators are taken into account, the ensuing results imply that the substantial increase in the likelihood of having children associated with national service participation has a suppressive effect on service participants’ overall level of civic engagement.

Current Orthopaedic Practice, 2014

S ince the first reported hand replantation in 1964, the success of distal extremity replantation... more S ince the first reported hand replantation in 1964, the success of distal extremity replantation has improved secondary to refined surgical techniques and dedicated replantation centers. Hand amputation results in severe functional loss and psychological distress. Every effort should be made to replant the upper extremity because outcomes from replantation exceed outcomes from prostheses. We present a patient in whom extreme measures were taken to locate the dominant, amputated hand, resulting in a successful distal-forearm replantation with a functional thumb. Ischemic time of the hand was 2 hr at the bottom of the river and seven hours hypothermic ischemic time packed in ice. This patient was informed about the collection of data and consented to having his case submitted for publication.

The Spine Journal, 2004

BACKGROUND CONTEXT: Andriacchi performed a computer-simulated mathematical analysis showing that ... more BACKGROUND CONTEXT: Andriacchi performed a computer-simulated mathematical analysis showing that the rib cage enhances stability of the normal thoracic spine in flexion, rotation, lateral bending, and especially extension. He showed an increase of 27 per cent in flexion and of 132 percent in extension with the addition of the rib cage. Panjabi and White established criteria assessing stability in the thoracic spine by performing studies supporting the stabilizing role of the costovertebral joints. However, these experiments underestimated the role of the rib cage because the ribs were removed 3 cm lateral to the costovertebral joints. Recently, Oda et al. showed significant increases in the neutral zone in lateral bending and axial rotation after resection of the costovertebral joints and destruction of the rib cage. The limitation to this study was the use of canine specimens rather than human. There is no published study of biomechanical testing of human cadaveric specimens with the rib cage intact. PURPOSE: To determine the amount of stability the rib cage imparts to the thoracic spine and to show the amount of stability lost by a sternal fracture. STUDY DESIGN/SETTING: Specimens were tested using a biaxial material testing machine (MTS) synchronized with an opto-electronic three-dimensional motion measuring device (Opto-trak 3020). PATIENT SAMPLE: Ten fresh-frozen human cadaveric thoracic spines with the rib cage and sternum intact. OUTCOME MEASURES: Multidirectional flexibility of the whole thoracic spine was measured using the Optotrak 3020, an opto-electronic threedimensional motion measuring device. This machine uses three cameras to detect movement of multiplexed arrays of light emiting diodes (LEDs). An array attached to the MTS machine established the fixed coordinate axes. One array was attached to T1 by way of a rigid pin placed in the pedicle. With T12 rigidly fixed to the base of the MTS system, motion of the T1 array represented motion of the entire thoracic spine specimen. METHODS: The specimens were tested in axial compression, axial rotation, lateral bending, and flexion/extension. First, the specimens were tested through all four loading types with the sternum and rib cage intact. Next, the sternum was fractured at the sternomanubrial junction displacing the proximal fragment posteriorly. Lastly, the entire rib cage was removed by cutting the ribs 3 cm lateral to the costovertebral joints. RESULTS: The rib cage increased the stability of the thoracic spine by 40% in flexion/extension (pϭ.012), 35% in lateral bending (pϭ.038), and 31% in axial rotation (pϭ.008). An indirect flexion-compression type of sternal fracture decreased the stability of the thoracic spine by 42% in flexion/extension (pϭ.036), 22% in lateral bending (pϭ.008), and 15% in axial rotation (pϭ.011). CONCLUSIONS: The rib cage significantly increases the stability of the thoracic spine in flexion/extension, lateral bending, and axial rotation. A sternal fracture significantly decreases the stability of the thorax. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: Author (RWI) Other: Synthes, Sofamor-Danek, Depuy, and Blackstone all contributed monetary funds to pay for the materials of this project.

Asian-Pacific Law & Policy, Journal, 2010

Revista de Neurología

Introduccion. El espasmo hemifacial (EHF) se caracteriza por el espasmo o fasciculaciones cronica... more Introduccion. El espasmo hemifacial (EHF) se caracteriza por el espasmo o fasciculaciones cronicas de un lado de la cara. Afecta a los musculos activados por el nervio facial. Se cree que el EHF se deriva de la irritacion del nervio facial en su salida del tronco encefalico y, en la mayoria de casos, esta vinculado a una pequena compresion por un asa vascular. En raras ocasiones, esta asociado a una dolicoectasia de la arteria vertebral. Casos clinicos. Presentamos tres casos de EHF en los cuales los resultados de una resonancia magnetica y de una angiorresonancia pusieron de manifiesto dolicoectasia de las arterias vertebrales que comprimian el nervio facial y provocaban EHF. Estos casos se seleccionaron del grupo de pacientes tratados en las consultas externas para los trastornos distonicos, en el Servicio de Neurologia, entre el 1 de abril de 1998 y el 30 de diciembre de 2007. Conclusiones. La resonancia magnetica y la angiorresonancia son fundamentales para el diagnostico de una dolicoectasia de la arteria vertebral, y deben considerarse como los procedimientos iniciales de deteccion sistematica en la evaluacion de los pacientes con EHF. El papel de estos estudios neurorradiologicos en el diagnostico del EHF no es solo detectar las estructuras vasculares con una trayectoria proxima a la zona de salida de la raiz, que podrian deformar el nervio facial y comprimir el tronco encefalico alrededor de la zona de salida de la raiz, sino tambien excluir otras causas en una unica exploracion no invasiva.

HAND, 2016

Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoi... more Background: Percutaneous techniques have been described for the treatment of nondisplaced scaphoid fractures, although less information has been reported about outcomes for unstable, displaced fractures. The aim of this study was to evaluate the union and complication rates following manual closed reduction and percutaneous screw placement for a consecutive series of unstable, displaced scaphoid fractures. Methods: A total of 28 patients (average age, 27 years; 22 male/6 female) were treated for isolated unstable displaced scaphoid waist fractures. Closed reduction and percutaneous headless, compression screw fixation was successfully performed in 14 patients (average age, 32 years; 10 male/4 female), and the remaining 14 patients required open reduction. Patients who underwent percutaneous treatment were followed for radiographic fracture union and clinical outcomes. Results: Thirteen of 14 fractures (93%) had clinical and radiographic evidence of bone union at an average of 2.8 mo...

The Faseb Journal, Mar 1, 2008

Nearly all studies that seek to uncover the effects of military service on the individual are pla... more Nearly all studies that seek to uncover the effects of military service on the individual are plagued with the self-selection bias that comes with studying the all-volunteer-force. In order to solve this problem, this paper takes advantage of the natural experiment afforded by the suspension of the French National Service program to produce unbiased causal analyses of the effect of national service on a range of civic engagement measures. The results of the natural experiment indicate that participation in national service does affect individual levels of civic engagement in a statistically significant way. However, the degree to which mandatory national service can be considered a desirable form of civic education depends upon the relative importance one assigns to participation in activities that reflect responsibility to the collective, foster attitudinal development, or are official forms of political participation.

Mycoses, 2009

Three cases of paracoccidioidomycosis observed in 1990-199 1 in Quillabamba, Peru, and its surrou... more Three cases of paracoccidioidomycosis observed in 1990-199 1 in Quillabamba, Peru, and its surroundings are described. The climate and the living conditions of the inhabitants favour paracoccidioidomycosis. It can be assumed that a majority of cases could not be identified, because the symptoms are disguised as other tropical diseases. The application of ketoconazole to the patients showed different results, from optimal to scarce, while temporary remission of the disease was obtained with itraconazole. The best therapy for paracoccidioidomycosis appears to be the application of amphotericin B plus sulphamidics. Zusammenfassung. Es werden drei Falle von Paracoccidioidomykose beschrieben, die 1990 und 1991 in Quillabamba, Peru, und Umgebung beobachtet wurden. Klima und Lebensbedingungen der Bewohner begiinstigen die Paracoccidioidomykose. Viele Krankheitsfalle konnten nicht erfaBt werden, da die Symptome als andersartige Tropenkrankheiten fehlgedeutet werden konnen. Die Therapie mit Ketoconazol zeigte unterschiedliche Resultate, von optimal bis geringgradig, wahrend mit I traconazol vorubergehende Erfolge erzielt wurden. Die beste Therapiestrategie f i r

Risk analysis : an official publication of the Society for Risk Analysis, Dec 1, 2016

We propose a methodology, called defender-attacker decision tree analysis, to evaluate defensive ... more We propose a methodology, called defender-attacker decision tree analysis, to evaluate defensive actions against terrorist attacks in a dynamic and hostile environment. Like most game-theoretic formulations of this problem, we assume that the defenders act rationally by maximizing their expected utility or minimizing their expected costs. However, we do not assume that attackers maximize their expected utilities. Instead, we encode the defender's limited knowledge about the attacker's motivations and capabilities as a conditional probability distribution over the attacker's decisions. We apply this methodology to the problem of defending against possible terrorist attacks on commercial airplanes, using one of three weapons: infrared-guided MANPADS (man-portable air defense systems), laser-guided MANPADS, or visually targeted RPGs (rocket propelled grenades). We also evaluate three countermeasures against these weapons: DIRCMs (directional infrared countermeasures), perim...

Journal of Reconstructive Microsurgery, 2015

Background The decision to perform an end-to-end (ETE) or end-to-side (ETS) arterial anastomosis ... more Background The decision to perform an end-to-end (ETE) or end-to-side (ETS) arterial anastomosis in lower extremity free tissue transfer has not been thoroughly evaluated in a large multisurgeon setting. The authors compared the reconstructive outcomes of lower extremity free flaps with ETE and ETS arterial anastomoses. Methods The authors retrospectively reviewed their 17-year institutional experience with lower extremity free flaps to determine whether ETE or ETS arterial anastomoses were associated with foot ischemic complications and flap failure. Results From 1996 to 2013, 398 patients underwent 413 lower extremity free flaps with ETE (66%) or ETS (34%) arterial anastomoses. The incidence of postoperative foot ischemia was 2% (n = 8). The flap failure rate was 11% (n = 45). The ETS technique was preferred in patients with fewer intact vessels to the foot (32% ETS for three-vessel runoff, 36% ETS for two-vessel runoff, and 50% ETS for single-vessel runoff) and when an intact recipient vessel was selected for anastomosis (60% ETS for intact vessel vs. 25% ETS for distally occluded vessel). No differences were observed in the foot ischemia (p = 0.45) and flap failure rates (p = 0.59) for ETE versus ETS arterial anastomoses. In subset analyses, the incidence of foot ischemia did not differ for either technique in the context of impaired vascular runoff or recipient vessel selection. Conclusion No advantage was noted for ETE or ETS arterial anastomoses based on reconstructive outcomes. The choice of anastomotic technique in lower extremity free tissue transfer should be based on patient factors and the clinical circumstances encountered.

Journal of Reconstructive Microsurgery, 2015

Background Multiple studies have detailed promising smile restoration following gracilis free mus... more Background Multiple studies have detailed promising smile restoration following gracilis free muscle transfer for facial reanimation but information detailing the potential complications is lacking. The aim of this study is to systematically review the literature to evaluate the reported complication rate associated with this procedure. We also aim to determine the most common occurring complications. Methods The PubMed, Embase, and Web of Science databases were queried with multiple search strategies for published articles between January 1950 and February 2013 that detailed gracilis free muscle transfer for facial reanimation. Title, abstract, and full text review was performed. Complications were defined as any reported, identifiable adverse outcome that required an alteration in treatment for correction. Results The literature search yielded 62 studies of gracilis free muscle transfer for facial reanimation. Overall, 36 articles (58%) reported whether or not a complication had occurred. The overall complication rate based on pooled proportions was 9.6% and the most commonly occurring complications were postoperative hematoma (3.6%) and infection (3.5%). Conclusions Our data suggests that complications after gracilis free muscle transfer for facial reanimation may be underreported and this complex procedure may in fact be associated with significant adverse outcomes as high as 9.6%.

Plastic and Reconstructive Surgery, 2015

After reviewing this article, the participant should be able to: 1. Understand the most modern in... more After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis. Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

Clinical orthopaedics and related research, 2014

Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue co... more Wound breakdown after orthopaedic foot and ankle surgery may necessitate secondary soft tissue coverage. The foot and ankle region is challenging to reconstruct for orthopaedic and plastic surgeons owing to its complex bony anatomy and unique functional demands. Therefore, identifying strategies for plastic surgery of these wounds may help guide surgeons in defining the best treatment plan. We evaluated our current algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle with respect to whether (1) prophylactic or simultaneous soft tissue coverage affected wound-healing complications (secondary plastic surgery, orthopaedic hardware removal, malunion, further orthopaedic surgery, ultimate failure) and (2) postoperative referral for soft tissue management was associated with wound location, size, and orthopaedic procedure. We retrospectively reviewed 112 patients who underwent elective orthopaedic foot or ankle surgery and required concomitant plastic surger...

Current Orthopaedic Practice, 2011

Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Cu... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Current Orthopaedic Practice. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...

Abstract will be provided by author.

Political Behavior, 2014

Nearly all studies that seek to uncover the effects of military service on the individual are pla... more Nearly all studies that seek to uncover the effects of military service on the individual are plagued with the self-selection bias that comes with studying the all-volunteer force. To solve this problem, this paper takes advantage of the natural experiment afforded by the suspension of the French National Service program to produce unbiased causal analyses of the effect of national service on a range of civic engagement measures. Results generated using Instrumental Variables estimation indicate that there is little difference in individual-level civic engagement between service participants and their non-serving peers. However, when potential mediators are taken into account, the ensuing results imply that the substantial increase in the likelihood of having children associated with national service participation has a suppressive effect on service participants’ overall level of civic engagement.

Current Orthopaedic Practice, 2014

S ince the first reported hand replantation in 1964, the success of distal extremity replantation... more S ince the first reported hand replantation in 1964, the success of distal extremity replantation has improved secondary to refined surgical techniques and dedicated replantation centers. Hand amputation results in severe functional loss and psychological distress. Every effort should be made to replant the upper extremity because outcomes from replantation exceed outcomes from prostheses. We present a patient in whom extreme measures were taken to locate the dominant, amputated hand, resulting in a successful distal-forearm replantation with a functional thumb. Ischemic time of the hand was 2 hr at the bottom of the river and seven hours hypothermic ischemic time packed in ice. This patient was informed about the collection of data and consented to having his case submitted for publication.

The Spine Journal, 2004

BACKGROUND CONTEXT: Andriacchi performed a computer-simulated mathematical analysis showing that ... more BACKGROUND CONTEXT: Andriacchi performed a computer-simulated mathematical analysis showing that the rib cage enhances stability of the normal thoracic spine in flexion, rotation, lateral bending, and especially extension. He showed an increase of 27 per cent in flexion and of 132 percent in extension with the addition of the rib cage. Panjabi and White established criteria assessing stability in the thoracic spine by performing studies supporting the stabilizing role of the costovertebral joints. However, these experiments underestimated the role of the rib cage because the ribs were removed 3 cm lateral to the costovertebral joints. Recently, Oda et al. showed significant increases in the neutral zone in lateral bending and axial rotation after resection of the costovertebral joints and destruction of the rib cage. The limitation to this study was the use of canine specimens rather than human. There is no published study of biomechanical testing of human cadaveric specimens with the rib cage intact. PURPOSE: To determine the amount of stability the rib cage imparts to the thoracic spine and to show the amount of stability lost by a sternal fracture. STUDY DESIGN/SETTING: Specimens were tested using a biaxial material testing machine (MTS) synchronized with an opto-electronic three-dimensional motion measuring device (Opto-trak 3020). PATIENT SAMPLE: Ten fresh-frozen human cadaveric thoracic spines with the rib cage and sternum intact. OUTCOME MEASURES: Multidirectional flexibility of the whole thoracic spine was measured using the Optotrak 3020, an opto-electronic threedimensional motion measuring device. This machine uses three cameras to detect movement of multiplexed arrays of light emiting diodes (LEDs). An array attached to the MTS machine established the fixed coordinate axes. One array was attached to T1 by way of a rigid pin placed in the pedicle. With T12 rigidly fixed to the base of the MTS system, motion of the T1 array represented motion of the entire thoracic spine specimen. METHODS: The specimens were tested in axial compression, axial rotation, lateral bending, and flexion/extension. First, the specimens were tested through all four loading types with the sternum and rib cage intact. Next, the sternum was fractured at the sternomanubrial junction displacing the proximal fragment posteriorly. Lastly, the entire rib cage was removed by cutting the ribs 3 cm lateral to the costovertebral joints. RESULTS: The rib cage increased the stability of the thoracic spine by 40% in flexion/extension (pϭ.012), 35% in lateral bending (pϭ.038), and 31% in axial rotation (pϭ.008). An indirect flexion-compression type of sternal fracture decreased the stability of the thoracic spine by 42% in flexion/extension (pϭ.036), 22% in lateral bending (pϭ.008), and 15% in axial rotation (pϭ.011). CONCLUSIONS: The rib cage significantly increases the stability of the thoracic spine in flexion/extension, lateral bending, and axial rotation. A sternal fracture significantly decreases the stability of the thorax. DISCLOSURES: No disclosures. CONFLICT OF INTEREST: Author (RWI) Other: Synthes, Sofamor-Danek, Depuy, and Blackstone all contributed monetary funds to pay for the materials of this project.