28 results on '"KACHARE, SWAPNIL D."'
Search Results
2. The 5 D's to Dunk the Dog: A Retrospective Clinical Review to Prevent Dog-Ear Contour Abnormalities in Vertical Breast Reductions and Breast Lifts
- Author
-
Kachare, Swapnil D, Kachare, Milind D, Vivace, Bradley J, Barrow, Brooke E, Ablavsky, Michael, Abell, Sara, Choo, Joshua H, and Wilhelmi, Bradon J
- Subjects
Original Research - Abstract
BACKGROUND: In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties. METHODS: A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially. RESULTS: A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m(2) (21.3-42.7 kg/m(2)). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%. CONCLUSIONS: Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties.
- Published
- 2023
3. Basic suture technique: Instructional videos explaining suturing for medical students in a qualitative study
- Author
-
Kachare, Swapnil D., Abell, Sara R., Kachare, Milind D., Jhang, Joyce, Wilhelmi, Bradon J., and Kasdan, Morton L.
- Published
- 2019
- Full Text
- View/download PDF
4. Prevention of Implant Malposition in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction Using an Acellular Dermal Matrix With Pectoralis Muscle Following Mastectomy for Breast Cancer: A Clinical Review
- Author
-
Kachare, Milind D, Barrow, Brooke E, Corey, Samuel, Elfanagely, Omar, Rossi, Alexander J, Simpson, Alyssa M, Kachare, Swapnil D, Choo, Joshua, and Wilhelmi, Bradon J
- Subjects
Original Research - Abstract
BACKGROUND: Latissimus dorsi myocutaneous (LDM) pedicled flaps are a well-established method for breast reconstruction in women with inadequate soft tissue coverage following mastectomy for breast cancer. The robust nature of the latissimus blood supply can accommodate immediate implant placement to increase breast volume; however, a known risk factor with this technique is implant malposition. By utilizing an acellular dermal matrix (ADM) in subpectoral implant-based LDM reconstruction, it is hypothesized that patients will experience a lower incidence of implant malposition. This 13-year retrospective review aims to evaluate the effectiveness of breast reconstruction using this technique. METHODS: A retrospective review was conducted to identify all patients who underwent breast reconstruction following mastectomy with a LDM flap, subpectoral implant, and an ADM from 2007 to 2020 by a single surgeon at a single institution. Demographic and clinical data were collected and analyzed. RESULTS: A total of 40 patients (LDM flaps, N = 51) were identified. Mean participant age was 50.25 ± 9.67 years and mean body mass index (BMI) was 30.85 ± 6.15 kg/m(2). Comorbidities included hypertension (40.0%), diabetes mellitus (17.5%), and current smoking (25.0%). Mean follow-up was 31.52 ± 29.51 months. The most common complication was seroma formation (9.8%). No patients experienced implant malposition or flap necrosis. CONCLUSIONS: The use of a LDM flap and an ADM in implant-based breast reconstruction are each well described in the literature. This 13-year series supports the efficacy of these techniques utilized in combination to provide an aesthetic result while mitigating implant malposition during breast reconstruction of oncologic patients.
- Published
- 2022
5. Complete Penile Amputation: An Anatomical Reference and Surgical Pearls to Ensure a Successful Replantation
- Author
-
Kachare, Milind D, Elfanagely, Omar, Safeek, Rachel H, Barrow, Brooke, Simpson, Alyssa M, O’Toole, Adam, Hsiao, Eugene C, Kachare, Swapnil D, Engineer, Nitin, Quintero, Juan, and Wilhelmi, Bradon J
- Subjects
Interesting Cases - Abstract
1. How common are penile amputations, and how are they treated? 2. What key anatomic structures are involved? 3. What are some technical pearls for a successful replantation? 4. What are common complications, and how can they be prevented/treated?
- Published
- 2022
6. Total Intravenous Anesthesia With Dexmedetomidine for Hemodynamic Stability and Enhanced Recovery in Facial Aesthetic Surgery
- Author
-
Moore, Alec C M, primary, Kachare, Swapnil D, additional, Barber, Debra A, additional, Barrow, Lara, additional, and O’Daniel, T Gerald, additional
- Published
- 2022
- Full Text
- View/download PDF
7. Centralizing the Umbilicus in Abdominoplasty: Eccentric versus Concentric Fascial Plication in Addition to Medializing at the Skin.
- Author
-
Vavra, Jessica M., Kachare, Swapnil D., Vivace, Bradley J., Choo, Joshua H., and Wilhelmi, Bradon J.
- Published
- 2023
- Full Text
- View/download PDF
8. Assessment of health care cost for complex surgical patients: review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre
- Author
-
Kachare, Swapnil D., Liner, Kendall R., Vohra, Nasreen A., Zervos, Emmanuel E., Hickey, Todd, and Fitzgerald, Timothy L.
- Published
- 2015
- Full Text
- View/download PDF
9. Effect of Oblique Tendon Laceration on Core Suture Strength: A Biomechanical Evaluation.
- Author
-
Muresan, Claude, Muresan, Colin W., Harris, Alexandria L., Shaterian, Ashkaun, Van Royen, Kjel, Kachare, Swapnil D., Bhandari, Laxminarayan, and Palazzo, Michelle D.
- Abstract
Background: The effect of obliquity of tendon laceration on repair strength is not well studied. The overwhelming majority of biomechanical studies assess repair strength following a laceration that is perpendicular to the long axis of the tendon. The aim of this study was to investigate whether the angle of tendon laceration affects the core suture strength. Methods: In all, 110 fresh human cadaveric flexor tendons were cut at varying angles of 15°, 30°, 45°, and 60° and the control group at 90°. All tendons were repaired with 6-strand modified Tang technique. The repair strength was tested using a custom-made tensioning machine, and the initial static gap force and the ultimate breaking force were measured. Results: The mean gap force and 95% confidence interval (CI) for the 15°, 30°, 45°, 60°, and 90° groups were 15.2 N (11.4-19.0 N), 15.8 N (13.6-18.1 N), 15.6 N (13.1-18.4 N), 16.6 N (13.7-19.5 N), and 22.3 N (16.6-27.9 N), respectively. In the same respective order, the break force and 95% CI were 25.9 N (21.9-29.8 N), 26.5 N (23.2-29.7 N), 31.1 N (26.1-36.1 N), 35.6 N (28.2-43.1 N), and 51.8 N (62.5-41.0), respectively. The Fisher least significant difference demonstrated significant differences between the control group and all experimental groups for both gap force and break force. Conclusions: Obliquity of tendon laceration affects the core suture strength when compared with a transverse cut. Flexor tendons cut at 90° demonstrated a higher overall gap force and breaking strength that were statistically significant when compared with all obliquely cut groups. These findings should be considered when repairing and starting postoperative therapy for obliquely cut tendons. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. Posterior Interosseous Nerve Graft: Utilizing External Landmarks and Anthropometric Ratios to Predict Available Length for Digital Nerve Reconstruction in a Cadaveric Study
- Author
-
Vivace, Bradley J., primary, Kachare, Swapnil D., additional, Meredith, Luke T., additional, Kachare, Milind D., additional, Kapsalis, Christina N., additional, Muresan, Claude, additional, Choo, Joshua H., additional, Kasdan, Morton L., additional, and Wilhelmi, Bradon J., additional
- Published
- 2021
- Full Text
- View/download PDF
11. Effect of Oblique Tendon Laceration on Core Suture Strength: A Biomechanical Evaluation
- Author
-
Muresan, Claude, primary, Muresan, Colin W., additional, Harris, Alexandria L., additional, Shaterian, Ashkaun, additional, Van Royen, Kjel, additional, Kachare, Swapnil D., additional, Bhandari, Laxminarayan, additional, and Palazzo, Michelle D., additional
- Published
- 2020
- Full Text
- View/download PDF
12. Anatomic surface landmarks to guide injection for posterior interosseous nerve block
- Author
-
Kachare, Swapnil D., primary, Vivace, Bradley J., additional, Meredith, Luke T., additional, Kachare, Milind D., additional, Kapsalis, Christina N., additional, Ablavsky, Michael, additional, Safeek, Rachel H., additional, Muresan, Claude, additional, Choo, Joshua H., additional, Kasdan, Morton L., additional, and Wilhelmi, Bradon J., additional
- Published
- 2020
- Full Text
- View/download PDF
13. Puffy Hand Syndrome: What Plastic Surgeons Need to Know.
- Author
-
Bethea, Joseph P., Cai, Sunny R., Peine, Brandon, Mendes, Jesse O., Zeri, Richard S., and Kachare, Swapnil D.
- Subjects
PLASTIC surgeons ,CELLULITIS ,SYNDROMES ,INTRAVENOUS drug abuse ,HAND injuries ,SOFT tissue infections - Abstract
Puffy Hand Syndrome is a complication of intravenous (IV) drug abuse that causes swelling and edema in the hands. It was first described in prisoners in New York in 1965 and can affect up to 16% of IV drug users. The syndrome is characterized by non-pitting or minimally pitting edema, affecting the dorsal surface of the fingers and hands, and can progress to permanent swelling. The exact cause is not fully understood, but it is believed to be due to the sclerosing of the superficial venous system and lymphatics from IV injections of irritants commonly found in street drugs. There are currently no known medical or surgical treatments to reverse the swelling, and management focuses on symptomatic relief through elevation and compression. [Extracted from the article]
- Published
- 2024
14. Posterior Interosseous Nerve Graft: Utilizing External Landmarks and Anthropometric Ratios to Predict Available Length for Digital Nerve Reconstruction in a Cadaveric Study
- Author
-
Vivace, Bradley J., Kachare, Swapnil D., Meredith, Luke T., Kachare, Milind D., Kapsalis, Christina N., Muresan, Claude, Choo, Joshua H., Kasdan, Morton L., and Wilhelmi, Bradon J.
- Abstract
Objective: In digital nerve defects that require grafting, autografts remain the efficacious option. The sensory posterior interosseous nerve (PIN) is an ideal choice as it is of similar caliber to digital nerves and leaves no donor morbidity upon resection. However, a finite length of harvestable PIN exists, and considerable variations of this length have been reported in the literature. There exists no predictive model to estimate this length. We sought to determine a method to accurately predict the available length of PIN based on individual patient anthropometry.Methods: A cadaveric dissection study was performed in a fresh tissue laboratory. The length of the sensory branch of the PIN and various anthropometric measurements were made in respect to surface anatomy of the ulna to develop a predictable ratio for available PIN donor graft.Results: A total of 16 specimens were obtained. On average the length of the PIN was 5.7 cm (range: 3.3-9. cm) and the length of the ulna was 25.7 cm (range: 23.5-30.6 cm). The ratio of PIN to ulnar length was 0.222 (r= 0.4651). Using one-fifth the length of the ulna, the mean predicted length of the PIN was 5.14 cm (range: 4.7-6.1 cm). On univariate analysis, there was no significant difference between the measured and predicted PIN length (P= .249).Conclusion: An anthropometric ratio predicated on reproducible surface anatomy of the ulna is a useful tool in predicting the sensory PIN length. Such a prediction may be a useful in guiding patient discussions concerning surgical options for digital nerve reconstruction.
- Published
- 2022
- Full Text
- View/download PDF
15. The Safe Gluteoplasty: Anatomic Landmarks to Predict the Superior and Inferior Gluteal Veins
- Author
-
Muresan, Claude, Davis, Jared M., Hiller, Andrea R., Patterson, Brittany E., Kapsalis, Christina N., Ford, Meghan F., Anderson, Eric W., Kachare, Swapnil D., Hazani, Ron, and Wilhelmi, Bradon J.
- Subjects
body regions ,lipoinjection ,gluteal veins ,pulmonary fat embolism ,Journal Article ,gluteoplasty ,anatomic landmarks - Abstract
Objective: The increase in demand for gluteal fat grafting seen in recent years in the United States has not been met with an equal gain in knowledge of the perils of this anatomic territory. The purpose of this study was to identify anatomic landmarks that can be readily used by surgeons to identify the takeoff of the superior and inferior gluteal veins. Method: Six fresh cadaveric gluteal specimens were dissected at the University of Louisville anatomy laboratory. A question mark incision was made for exposure, followed by identification of the sciatic nerve in the proximal thigh. This was traced retrograde to the sciatic forearm. The piriformis muscle was identified dividing the foreman into superior and inferior portions, which corresponded to the takeoff of the superior and inferior gluteal vessels, respectively. The distance of the gluteal vessels from the one-third point of a line from the mid-sacrum to the greater trochanter was measured. Result: Our cadaveric dissection series demonstrated that the superior and inferior gluteal veins were on average 3.28 cm (2-5.9 cm) and 1.25 cm (0-3.5 cm) away from the point one third the distance from the mid-sacral border to the greater trochanter. Conclusion: The mid-sacrum and the trochanter of the femur are the anatomic landmarks used to identify the large gluteal vein trunks. Understanding the location and trajectory of these deep gluteal structures with use of readily identifiable landmarks may assist surgeons in avoiding inadvertent injection of fat to these veins during fat grafting.
- Published
- 2019
16. Anatomic surface landmarks to guide injection for posterior interosseous nerve block.
- Author
-
Kachare, Swapnil D., Vivace, Bradley J., Meredith, Luke T., Kachare, Milind D., Kapsalis, Christina N., Ablavsky, Michael, Safeek, Rachel H., Muresan, Claude, Choo, Joshua H., Kasdan, Morton L., and Wilhelmi, Bradon J.
- Subjects
- *
NERVE block , *INJECTIONS , *ANATOMICAL specimens , *PERSONAL identification numbers , *PAIN management - Abstract
Proper injection of the posterior interosseous nerve (PIN) is important for both the therapeutic and diagnostic management of wrist pain. However, no anatomical study exists describing the site of injection based on individual wrist width. We sought to develop a reproducible anthropometric ratio utilizing external wrist surface anatomy to predict a safe and accurate injection site for the PIN. Fresh frozen cadaver forearms were dissected at the University of Louisville tissue lab. Several anthropometric measurements were obtained in order to develop a reproducible ratio to calculate location of injection. A total of 16 cadaver forearms of equal male to female ratio were obtained. On average, the male forearm had a greater mean wrist circumference obtained at the level of Lister's tubercle compared to female forearms, 17.1 cm vs. 13.5 cm. An injection given ulnar to proximal edge of Lister's tubercle at a length of one-fourth the distance between Lister's tubercle and radial aspect of ulnar styloid resulted in 100% accurate perineural injection without intraneural injection. An anthropometric ratio of one-fourth the distance from Lister's tubercle to the ulnar styloid was able to predict accurate injection sites for the distal PIN in cadaveric specimens of varying anatomical proportions. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
17. Breast ReconstructionWith Local Flaps: Don’t Forget Grandma.
- Author
-
Vivace, Bradley J., Kachare, Swapnil D., Ablavsky, Michael, Abell, Sara R., Meredith, Luke T., Kapsalis, Christina N., Choo, Joshua H., and Wilhelmi, Bradon J.
- Subjects
- *
MAMMAPLASTY , *PATIENT satisfaction , *BREAST surgery , *BREAST , *MUSCULOCUTANEOUS flaps , *GRANDMOTHERS - Abstract
Objective: Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects.We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Methods: From 2016 to 2017, 3 different varieties of random flaps were used in 5 women requiring lateral breast defect reconstruction secondary to resection of localized cancer or cutaneous lesion. The local flaps included a rhomboid flap, the bilobed flap, and a rotational flap. Patients were then evaluated in the clinic 10 to 12 months postoperatively for complications, symmetry, and satisfaction of reconstruction. Results: In 4 of 5 patients, the local flap remained fully viable and therewas no incidence of seroma, infection, or further complications. One patient developed a post-operative hematoma requiring evacuation and a second patient experienced distal flap necrosis and delayed wound healing. Patients reported satisfaction with the reconstruction. Conclusions: Several random patterned local flaps exist for a variety of breast defects. They can yield excellent cosmetic results, high patient satisfaction, and bolster a low rate of complications. Our case series emphasizes the utility of random patterned flaps for lateral breast oncoplastic reconstruction. [ABSTRACT FROM AUTHOR]
- Published
- 2019
18. Kickstand External Fixator for Immobilization Following Free Flap Plantar Calcaneal Reconstruction.
- Author
-
Kachare, Swapnil D., Vivace, Bradley J., Henderson, Joshua T., Kachare, Milind, Kapsalis, Christina, Fulfer, Jamie L., Choo, Joshua, and Wilhelmi, Bradon J.
- Subjects
- *
FREE flaps , *PATIENT satisfaction , *LEG , *MANAGEMENT by objectives ,EXTERNAL fixators - Abstract
Objective: Management of calcaneal wounds is challenging due to a paucity of tissue, complex local anatomy, and limited vascularity. These wounds are commonly associated with lower extremity fractures, which are often treated with external fixation. Free tissue transfers are frequently employed as a means for closure of plantar heel wounds; however, postoperative management can be challenging due to their dependent location. We sought to describe how simple modification of the external fixator can help relieve direct pressure, provide joint immobilization, and optimize accessibility necessary for flap survival. Methods: Three patients requiring autologous free tissue reconstruction of hindfoot defects were immobilized using an external fixator with a “kickstand” modification. Viability of the transferred tissue and the postoperative outcomes were assessed. Results: All free flaps survived with no associated complications. The “kickstand” modification was well tolerated with minimal discomfort. All 3 patients expressed satisfaction with early return to ambulation. Conclusion: An external fixator with a “kickstand” modification provides an essential function in maintaining the viability of the transferred tissue to plantar calcaneal wounds. [ABSTRACT FROM AUTHOR]
- Published
- 2019
19. Optimal Inframammary Fold Incision Length Based on Implant Volume for Breast Enlargement: A Cadaveric Study.
- Author
-
Muresan, Claude, Ford, Meghan M., Anderson, Eric W., Lee, Thomas J., Hiller, Andrea R., Kachare, Swapnil D., and Wilhelmi, Bradon J.
- Subjects
BREAST implants ,AUGMENTATION mammaplasty ,BREAST ,ANATOMY ,AESTHETICS ,DEAD - Abstract
Purpose: Breast augmentation is the most commonly performed aesthetic operation in the Unites States annually. With the increasing popularity of gel implants, optimal incisional length for specific implant volumes becomes a factor to consider. Our study is the first, to date, to measure optimal incisional length for increasing Mentor smooth, round, moderate plus silicone implant volumes. Method: Three cadaver breasts were dissected in our anatomy laboratory. After dissection of a subpectoral pocket via an inframammary fold incision, time of implant insertion was measured for increasing volumes with the use of increasing incisional site lengths. Results: Values for increased incisions are as follows: 2.5-cm incision facilitated 100-cm3 implant (average time [AvgT] 76 seconds); 3-cm incision 100-cm3 implant (AvgT 32 seconds), 200 cm3 (AvgT 84.33 seconds); 3.5-cm incision 100-cm3 implant (AvgT 13.00 seconds), 200 cm3 (AvgT 22.00 seconds), 300 cm3 (AvgT 33.67 seconds); 4-cm incision 100-cm3 implant (AvgT 5.67 seconds), 200 cm3 (AvgT 11.33 seconds), 300 cm3 (AvgT 21.33 seconds), 400 cm3 (AvgT 26 seconds); 4.5-cm incision 100-cm3 implant (AvgT 5 seconds), 200 cm3 (AvgT 15.17 seconds), 300 cm3 (AvgT 19.67 seconds), 400 cm3 (AvgT 26 seconds), 500 cm3 (AvgT 39.67 seconds), 600 cm3 (AvgT 59.33 seconds), 700 cm3 (AvgT 78.67 seconds); 5-cm incision 100-cm3 implant (AvgT 1 second), 200 cm3 (AvgT 3.67 seconds), 300 cm3 (AvgT 8 seconds), 400 cm3 (AvgT 13 seconds), 500 cm3 (AvgT 19.33 seconds), 600 cm3 (AvgT 23.33 seconds), 700 cm3 (AvgT 28 seconds), 800 cm3 (AvgT 33 seconds). Conclusion: Based on our results, the optimal incision size for increasing Mentor smooth, round, moderate plus volumes is as follows: 2.5 cm for 100-cm3 implant, 3 cm for 200-cm3 implant, 3.5 cm for 300-cm3 implant, 4 cm for 400-cm3 implant, 4.5 cmfor 500- to 700-cm3 implant, and 5 cm for 800-cm3 implant. This guideline can be used to provide the most aesthetic results without tissue compromise. [ABSTRACT FROM AUTHOR]
- Published
- 2019
20. Call the Bomb Squad: An Interesting Case of a Retained Explosive in the Mouth.
- Author
-
Barrow, Brooke E., Kachare, Milind D., Kachare, Swapnil D., Alur, Abhishek A., and Little, Jarrod
- Subjects
FACIAL injuries ,BOMB squads ,BLAST injuries ,BONE grafting ,MEDICAL personnel ,MANDIBLE surgery ,SOFT tissue injuries - Abstract
This article discusses a case of a 23-year-old man who presented with a firework-related injury to his face. The firework became lodged in his left jaw, and the bomb squad was called to safely remove the explosive. The patient underwent surgery to repair the facial fractures and restore function and aesthetics. The article also provides information on the epidemiology of firework-related injuries, the important considerations for managing facial injuries, and the potential causes of early and long-term morbidity following facial reconstruction. The case highlights the complex management required for facial injuries caused by fireworks and emphasizes the need for multidisciplinary care. [Extracted from the article]
- Published
- 2023
21. The 5 D's to Dunk the Dog: A Retrospective Clinical Review to Prevent Dog-Ear Contour Abnormalities in Vertical Breast Reductions and Breast Lifts.
- Author
-
Kachare, Swapnil D., Kachare, Milind D., Vivace, Bradley J., Barrow, Brooke E., Ablavsky, Michael, Abell, Sara, Choo, Joshua H., and Wilhelmi, Bradon J.
- Subjects
- *
DOGS , *RETROSPECTIVE studies , *HUMAN abnormalities - Abstract
Background. In 2020, reduction mammoplasties and mastopexies comprised 34.2% of all breast surgeries performed by plastic surgeons. Various approaches for the skin incision of these procedures have been described. The vertical pattern has become an increasingly popular option due to its lower scar burden. However, it is prone to dog-ear formation along the caudal aspect of the incision. Herein, we describe 5 technical steps to eliminate the dog-ear in patients undergoing vertical mammoplasties. Methods. A retrospective chart review was performed on all patients who underwent vertical breast reduction and mastopexy between the years 2008 and 2020 performed by the senior author. The 5 steps employed in eliminating the dog-ear are delineated and depicted pictorially. Results. A total of 58 patients and 89 breasts were operated upon. A majority of 66.6% were Caucasian, 33.3% were African American, and 1 patient was of Hispanic descent. The mean age was 53.2 years (19-73 years), and average BMI was 31.5 kg/m² (21.3-42.7 kg/m²). The average resection weights for reduction and mastopexy patients were 479 grams (100-1500 grams) and 58.1 grams (18-100 grams), respectively. Mean follow-up was 10.5 months (1-35 months). Only one patient developed a dog-ear (1.7%) in bilateral breasts (2.2%); however, the patient did not request a revision. Our revision rate over 13 years remained at 0%. Conclusions. Utilizing these 5 technical steps reduces the risk of dog-ear deformity and thereby diminishes the overall need for revisional surgery in patients undergoing short scar vertical mammoplasties. [ABSTRACT FROM AUTHOR]
- Published
- 2023
22. Surface Landmarks to Provide a Safe Ulnar Nerve Block in the Wrist.
- Author
-
Kachare, Swapnil D., Meredith, Luke T., Kachare, Milind D., Vivace, BS, Bradley J., Kapsalis, Christina N., Muresan, Claude, Choo, Joshua H., Kasdan, Morton L., and Wilhelmi, Bradon J.
- Subjects
- *
ULNAR nerve , *LOCAL anesthesia , *NERVE block , *ULNAR nerve injuries , *WRIST , *RADIAL nerve , *RADIAL artery - Abstract
Objective: Use of local anesthesia in awake patients undergoing hand surgery has become increasingly popular. A thorough understanding of local anatomy, such as the distal wrist for ulnar nerve block, is required to provide safe blockade. We sought to conduct an anatomic study of the distal wrist and review cadaveric studies describing various techniques for ulnar nerve block. Methods: Dissection of fresh-frozen cadaver forearms at the University of Louisville Robert Acland Fresh Tissue Lab assessing relationships between the flexor carpi ulnaris tendon and the ulnar nerve and the ulnar artery was performed. Three cadaveric studies on ulnar nerve blockade using the ulnar, volar, and/or transtendinous technique were identified and reviewed. Results: A total of 16 cadaver forearms of equal male to female ratio were obtained. The ulnar nerve was noted to be directly posterior to the flexor carpi ulnaris tendon in 15 (93.8%) forearms, with 1 (6.3%) specimen having the nerve extend along the ulnar border of the flexor carpi ulnaris. The ulnar artery was radial to the ulnar nerve 1 cm proximal to the pisiform in all specimens. In all 3 cadaveric studies, only the ulnar technique was associated with no ulnar artery and/or ulnar nerve injury. Conclusion: Knowledge of distal wrist anatomy can help minimize risk of iatrogenic injury during local blockade. On review, the ulnar approach provides the safest method for ulnar nerve block. [ABSTRACT FROM AUTHOR]
- Published
- 2020
23. Prevention of Implant Malposition in Latissimus Dorsi Myocutaneous Flap Breast Reconstruction Using an Acellular Dermal Matrix With Pectoralis Muscle Following Mastectomy for Breast Cancer: A Clinical Review.
- Author
-
Kachare MD, Barrow BE, Corey S, Elfanagely O, Rossi AJ, Simpson AM, Kachare SD, Choo J, and Wilhelmi BJ
- Abstract
Background: Latissimus dorsi myocutaneous (LDM) pedicled flaps are a well-established method for breast reconstruction in women with inadequate soft tissue coverage following mastectomy for breast cancer. The robust nature of the latissimus blood supply can accommodate immediate implant placement to increase breast volume; however, a known risk factor with this technique is implant malposition. By utilizing an acellular dermal matrix (ADM) in subpectoral implant-based LDM reconstruction, it is hypothesized that patients will experience a lower incidence of implant malposition. This 13-year retrospective review aims to evaluate the effectiveness of breast reconstruction using this technique., Methods: A retrospective review was conducted to identify all patients who underwent breast reconstruction following mastectomy with a LDM flap, subpectoral implant, and an ADM from 2007 to 2020 by a single surgeon at a single institution. Demographic and clinical data were collected and analyzed., Results: A total of 40 patients (LDM flaps, N = 51) were identified. Mean participant age was 50.25 ± 9.67 years and mean body mass index (BMI) was 30.85 ± 6.15 kg/m
2 . Comorbidities included hypertension (40.0%), diabetes mellitus (17.5%), and current smoking (25.0%). Mean follow-up was 31.52 ± 29.51 months. The most common complication was seroma formation (9.8%). No patients experienced implant malposition or flap necrosis., Conclusions: The use of a LDM flap and an ADM in implant-based breast reconstruction are each well described in the literature. This 13-year series supports the efficacy of these techniques utilized in combination to provide an aesthetic result while mitigating implant malposition during breast reconstruction of oncologic patients., Competing Interests: Disclosures: This study received no means of outside funding. The authors report no known or perceived conflicts of interest regarding the material presented in this manuscript., (© 2022, HMP Global. All rights reserved. Reproduction in whole or in part prohibited. Content may not be reproduced in any form without written permission. Rights, Permission, Reprint, and Translation information is available at www.hmpglobal.com.)- Published
- 2022
24. Complete Penile Amputation: An Anatomical Reference and Surgical Pearls to Ensure a Successful Replantation.
- Author
-
Kachare MD, Elfanagely O, Safeek RH, Barrow B, Simpson AM, O'Toole A, Hsiao EC, Kachare SD, Engineer N, Quintero J, and Wilhelmi BJ
- Abstract
How common are penile amputations, and how are they treated?What key anatomic structures are involved?What are some technical pearls for a successful replantation?What are common complications, and how can they be prevented/treated?, (© 2022, HMP Global. All rights reserved. Reproduction in whole or in part prohibited. Content may not be reproduced in any form without written permission. Rights, Permission, Reprint, and Translation information is available at www.hmpglobal.com.)
- Published
- 2022
25. Restoring Breast Volume in High BMI Patients: A Single-Center Review of Breast Reconstruction Using Hyperinflated Saline Implants.
- Author
-
Kachare MD, Kachare SD, Vivace BJ, Elfanagely O, Barrow B, O'Toole A, Simpson AM, Safeek R, Choo JH, McCurry TM, and Wilhelmi BJ
- Abstract
Background: Breast reconstruction in the obese patient is often fraught with poor patient satisfaction due to inadequate volume restoration. The off-label hyperinflation of saline implants is a direct yet controversial solution to this problem, with limited studies in the literature. This study sought to determine the safety and efficacy of this technique for breast reconstruction., Methods: A retrospective chart review was performed to identify all patients with a body mass index (BMI) greater than or equal to 30 kg/m2 who underwent breast reconstruction between the years 2013 to 2020 with saline implants filled beyond the manufacturer's maximum recommended volume., Results: The 21 patients identified had an average age of 49 years. The mean BMI was 39.5 kg/m2. A total of 42 implants were placed; 34 were 800 mL, 4 were 750 mL, and 4 were 700 mL. The average overfill volume was 302 mL (138%). Mean follow-up was 65.0 months. Of these, 1 (4.8%) patient with a history of chest wall radiotherapy underwent reoperation for unilateral implant exposure 27 days after the index procedure, no patient sustained spontaneous leak or rupture, and 1 patient had unilateral deflation following emergent central line and pacemaker placement 2 years after the implant was placed for an unrelated cardiovascular event., Conclusions: Hyperinflation of saline implants beyond the maximum recommended volume may be considered for volume replacement in obese patients undergoing implant-based breast reconstruction. This practice is well tolerated, has a complication rate comparable to using implants filled to the recommended volume, and has the potential to restore lost breast volume in the obese patient post mastectomy., Competing Interests: Disclosures: This study received no means of outside funding. The authors report no known or perceived conflicts of interest regarding the material presented in this manuscript., (© 2022, HMP Global. All rights reserved. Reproduction in whole or in part prohibited. Content may not be reproduced in any form without written permission. Rights, Permission, Reprint, and Translation information is available at www.hmpglobal.com.)
- Published
- 2022
26. Breast Reconstruction With Local Flaps: Don't Forget Grandma.
- Author
-
Vivace BJ, Kachare SD, Ablavsky M, Abell SR, Meredith LT, Kapsalis CN, Choo JH, and Wilhelmi BJ
- Abstract
Objective: Lateral breast defects of various causes can be reconstructed with random patterned local flaps utilizing oncoplastic techniques. These local flaps are used frequently in other areas but are infrequent in breast reconstruction despite affording excellent utility in small lateral defects. We sought to demonstrate this with a case series involving 5 patients who underwent oncoplastic breast surgery with random patterned flap reconstruction. Methods: From 2016 to 2017, 3 different varieties of random flaps were used in 5 women requiring lateral breast defect reconstruction secondary to resection of localized cancer or cutaneous lesion. The local flaps included a rhomboid flap, the bilobed flap, and a rotational flap. Patients were then evaluated in the clinic 10 to 12 months postoperatively for complications, symmetry, and satisfaction of reconstruction. Results: In 4 of 5 patients, the local flap remained fully viable and there was no incidence of seroma, infection, or further complications. One patient developed a post-operative hematoma requiring evacuation and a second patient experienced distal flap necrosis and delayed wound healing. Patients reported satisfaction with the reconstruction. Conclusions: Several random patterned local flaps exist for a variety of breast defects. They can yield excellent cosmetic results, high patient satisfaction, and bolster a low rate of complications. Our case series emphasizes the utility of random patterned flaps for lateral breast oncoplastic reconstruction., (Copyright © 2019 The Author(s).)
- Published
- 2019
27. Assessment of health care cost for complex surgical patients: review of cost, re-imbursement and revenue involved in pancreatic surgery at a high-volume academic medical centre.
- Author
-
Kachare SD, Liner KR, Vohra NA, Zervos EE, Hickey T, and Fitzgerald TL
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Medicare economics, Middle Aged, Models, Economic, Multivariate Analysis, Odds Ratio, Pancreatectomy adverse effects, Pancreaticoduodenectomy adverse effects, Postoperative Complications economics, Retrospective Studies, Risk Factors, Treatment Outcome, United States, Young Adult, Academic Medical Centers economics, Hospital Costs, Hospitals, High-Volume, Insurance, Health, Reimbursement economics, Pancreatectomy economics, Pancreaticoduodenectomy economics, Process Assessment, Health Care economics
- Abstract
Background: Pancreatic surgery is complex with the potential for costly hospitalization., Methods: A retrospective review of patients undergoing a pancreatic resection was performed., Results: The median age of the study population was 64 years. Half of the cohort was female (51%), and the majority were white (62%). Most patients underwent a pancreaticoduodenectomy (PD) (69%). The pre-operative age-adjusted Charlson comorbidity index was zero for 36% (n = 50), 1 for 31% (n = 43) and ≥2 for 33% (n = 45). The Clavien-Dindo grading system for post-operative complication was grade I in 17% (n = 24), whereas 45% (n = 62) were higher grades. The medians direct fixed, direct variable, fixed indirect and total costs were $2476, $15,397, $13,207 and $31,631, respectively. There was a positive contribution margin of $7108, whereas the net margin was a loss of $6790. On univariate analyses, age, type of operation and complication grade were associated with total cost (P ≤ 0.05), whereas operation type and complication grade were associated with a net margin (P = 0.01). These findings remained significant on multivariate analysis (P < 0.05)., Conclusions: Increased cost, reimbursement and revenue were associated with type of operation and post-operative complications., (© 2014 International Hepato-Pancreato-Biliary Association.)
- Published
- 2015
- Full Text
- View/download PDF
28. Reconstruction using a pedicled upper arm fillet flap after excision of a malignant peripheral nerve sheath tumor: A case report.
- Author
-
Singla P, Kachare SD, Fitzgerald TL, Zeri RS, and Haque E
- Abstract
Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the "spare parts" concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the "spare parts" concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. Limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting.
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.