Bio

Bio


Dr. Arash Momeni is an Assistant Professor of Surgery in the Division of Plastic and Reconstructive Surgery at Stanford University. He graduated with magna cum laude honors from the Johannes Gutenberg University (Mainz, Germany). After completing his Plastic Surgery and Hand Surgery training at the University of Freiburg (Germany), Dr. Momeni completed a second residency in Plastic and Reconstructive Surgery at Stanford University. This was followed by a fellowship in Advanced Reconstructive Microsurgery at the University of Pennsylvania.

Dr. Momeni’s clinical interests include reconstruction after cancer and trauma with the goal of helping patients get back to normal both from a functional and aesthetic standpoint. His clinical practice focuses on complex reconstructive surgery of the breast, head and neck, trunk, and extremities. He uses state-of-the-art surgical techniques, including perforator flaps and vascularized lymph node transfer. Additionally, Dr. Momeni has a clinical interest in vascularized composite allotransplantation. He was part of the surgical team that performed the world’s first case of bilateral hand transplantation in a pediatric patient.

Dr. Momeni is recognized nationally and internationally for his research in clinical outcomes after microsurgical reconstruction and Evidence-based medicine (EBM). In addition to having authored over 100 peer-reviewed publications he is the author of numerous chapters in major plastic surgery textbooks. He speaks regularly at national and international meetings and is an ad hoc reviewer for numerous scientific journals, including Surgery, Journal of Plastic, Reconstructive and Aesthetic Surgery (JPRAS), Journal of Reconstructive Microsurgery, Aesthetic Plastic Surgery, and European Journal of Plastic Surgery. Additionally, he serves on the Editorial Board of leading plastic surgery journals, including Annals of Plastic Surgery and Microsurgery.

Clinical Focus


  • Plastic Surgery
  • Reconstructive Microsurgery
  • Breast Reconstruction
  • Extremity Reconstruction
  • Head and Neck Reconstruction
  • Lymphedema
  • Abdominal Wall Reconstruction
  • Perforator Flaps
  • Facial Paralysis
  • Hand Surgery
  • Free Flaps

Academic Appointments


Administrative Appointments


  • Co-Director, Hand Transplant Program (2016 - Present)

Professional Education


  • Fellowship:University of Pennsylvania Health System (2016) PA
  • Residency:Stanford University Plastic Surgery Program (2015) CA
  • Internship:Stanford Hospital and Clinics - Dept of Surgery (2009) CA
  • Residency:University of Freiburg Medical Center (2008) Germany
  • Medical Education:Johannes Gutenberg University Mainz (2004) Germany

Research & Scholarship

Current Research and Scholarly Interests


Dr. Momeni's research focuses on clinical outcomes after microsurgical reconstruction, with a particular emphasis on modifiable risk factors that contribute to the development of VTE.

Projects


  • Assessing incidence and timing of venous thromboembolism (VTE) in patients undergoing breast reconstruction

    Location

    Stanford, CA

  • Determining changes in venous flow pattern in patients undergoing microsurgical breast reconstruction

    Location

    Stanford, CA

Publications

All Publications


  • Technology and vascularized composite allotransplantation (VCA)-lessons learned from the first bilateral pediatric hand transplant. Journal of materials science. Materials in medicine Momeni, A., Chang, B., Levin, L. S. 2016; 27 (11): 161-?

    Abstract

    The reconstructive principle of replacing "like with like" is best met with vascularized composite allotransplantation in which the components of an existing defect are "matched" to the greatest extent possible in a single stage restoration. Hand transplantation is a labor-intensive and time-intensive process and can be conceptualized into distinct phases that include (1) patient selection and preoperative preparation, (2) technical execution of the procedure, and (3) postoperative rehabilitation and follow-up. The advent of technological innovations, such as 3D printing technology, novel implant technology, as well as innovative imaging technology, such as functional magnetic resonance imaging have the potential of favorably affecting all phases of this process, thus contributing to improved outcomes. The use of these technologies in the world's first case of bilateral hand transplantation in a pediatric patient is discussed.

    View details for DOI 10.1007/s10856-016-5771-9

    View details for PubMedID 27638100

  • Improved pocket control in immediate microsurgical breast reconstruction with simultaneous implant placement through the use of mesh. Microsurgery Momeni, A., Kanchwala, S. K. 2016

    Abstract

    Autologous breast reconstruction is associated with long-term patient satisfaction that is superior to implant-based approaches. Occasionally, however, patients who desire autologous reconstruction present with inadequate donor-site volume. A hybrid approach, combining free flap reconstruction with simultaneous implant placement, is a solution. We present our experience with the use of mesh for improved pocket control using this reconstructive modality.A retrospective analysis of a prospectively maintained database of patients undergoing autologous breast reconstruction was performed. Patients who underwent bilateral immediate breast reconstruction with free microsurgical abdominal tissue transfer with simultaneous implant placement were included for analysis.A total of 19 patients (38 breasts) with a mean age of 42.7 years (range, 31-57 years) and mean BMI of 26.3 (range, 23.6-30.8) were included in the study. No flap loss or implant-related complications were encountered during a mean follow-up of 14.2 months. The most common implant volume was 150 cc (N = 15; [78.9%]). No patient requested an implant change due to malposition or insufficient volume. Secondary fat grafting was performed in 5 patients (26.3%), 4 of which had undergone adjuvant radiotherapy. Three cases of red breast syndrome were observed following acellular dermal matrix placement. This prompted a transition to using polyglactin mesh thereafter without any untoward sequelae.Abdominal flap transfer with simultaneous implant placement is a safe reconstructive option in select patients. Improved implant pocket control is achieved through the use of mesh, thus, minimizing problems related to implant malposition. Adjuvant radiotherapy does not appear to put the reconstruction at risk with the occasional flap volume loss being easily remedied by secondary fat grafting.

    View details for DOI 10.1002/micr.30123

    View details for PubMedID 27770576

  • Clinical Significance of Internal Mammary Lymph Node Biopsy during Microsurgical Breast Reconstruction: Review of 264 Cases PLASTIC AND RECONSTRUCTIVE SURGERY Wright, E. J., Momeni, A., Kraneburg, U. M., Otake, L. R., Echo, A., Lee, T., Buchanan, E. P., Lee, G. K. 2016; 137 (6): 917E-922E

    Abstract

    Despite the knowledge of alternate lymphatic draining patterns of the breast, routine evaluation of the internal mammary lymph node basin is still not considered standard of care. The advent of microsurgical breast reconstruction using the internal mammary vessels as recipients, however, has allowed sampling of internal mammary lymph nodes with technical ease, thus revisiting their role in breast cancer management. In the present study, the authors reviewed their experience with this practice.A retrospective analysis of patients who underwent internal mammary lymph node biopsy at the time of autologous breast reconstruction using the internal mammary vessels between 2004 and 2012 was performed. Parameters of interest included patient age, timing of reconstruction (immediate versus delayed), disease stage, and pathologic findings of internal mammary lymph nodes.A total of 264 autologous breast reconstructions using the internal mammary vessels were performed in 204 patients with a median age of 44.5 years. The majority of reconstructions were immediate [n = 211 (79.9 percent)]. Seventy-two percent of patients had either stage I [72 patients (35.3 percent)] or stage II disease [75 patients (36.8 percent)]. Six patients were found to have internal mammary lymph node metastasis. Stage migration and alteration in adjuvant therapy occurred in all patients.Internal mammary lymph node sampling at the time of autologous breast reconstruction using the internal mammary system should become routine practice, as the morbidity associated with internal mammary lymph node harvest is low and the impact in cases of nodal involvement is quite substantial.Therapeutic, IV.

    View details for DOI 10.1097/PRS.0000000000002174

    View details for Web of Science ID 000377098100001

    View details for PubMedID 27219258

  • Important considerations in chest wall reconstruction. Journal of surgical oncology Momeni, A., Kovach, S. J. 2016; 113 (8): 913-22

    Abstract

    Chest wall reconstruction represents one of the most challenging tasks in plastic surgery. Over the past several decades, a more profound understanding of surgical anatomy and physiology along with tremendous advances in surgical technique have resulted in substantial improvements in postoperative outcomes. Conceptually, the reconstructive goals include dead space obliteration, restoration of skeletal stability with protection of intrathoracic structures, and stable soft tissue coverage. Ideally, these goals are achieved with minimal aesthetic deformity. J. Surg. Oncol. 2016;113:913-922. © 2016 Wiley Periodicals, Inc.

    View details for DOI 10.1002/jso.24216

    View details for PubMedID 26969557

  • Microsurgical Reconstruction of Traumatic Lower Extremity Defects in the Pediatric Population. Plastic and reconstructive surgery Momeni, A., Lanni, M., Levin, L. S., Kovach, S. J. 2016

    Abstract

    Very few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. As such, we felt it prudent to contribute to this area of clinical research. We hypothesized that reconstructive success would be comparable to success rates reported in adults and that young age or concerns regarding vessel size or behavior do not negatively impact surgical outcome.A retrospective review of microsurgical lower extremity reconstruction cases at two academic medical centers (University of Pennsylvania and Duke University) was performed. All pediatric patients who underwent microsurgical reconstruction of traumatic lower extremity defects between 1997 and 2012 were included for analysis.Forty flaps were transferred in 40 patients with a mean age of 11.4 years (range, 1 to 17 years) were included for final analysis. Muscle flaps were predominantly used (N=23; 57.5%); however, with a recent increase in fasciocutaneous flaps (N=16; 40%). Postoperative complications were seen in 25% of patients with total flap loss rate of 5%. No donor-site complications were observed. The mean postoperative length of hospital stay was 12.9 days (range, 4 to 41 days) with patients returning to full weight bearing after a mean of 2.6 months (range, 1 to 8 months).Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population is safe as evidenced by a flap survival rate of 95%. Concerns related to patient age, vessel size, or vessel behavior (i.e. vasospasm) should not detract from offering free flap reconstruction, as they do not negatively impact outcomes.

    View details for DOI 10.1097/PRS.0000000000003156

    View details for PubMedID 28002282

  • Increased Lower Extremity Venous Stasis May Contribute to Deep Venous Thrombosis Formation after Microsurgical Breast Reconstruction-An Ultrasonographic Study. Journal of reconstructive microsurgery Momeni, A., Tecce, M. G., Lanni, M. A., Aggarwal, S., Pannucci, C., Kovach, S. J., Kanchwala, S. K., Wu, L. C., Serletti, J. M. 2016

    Abstract

    Background Despite guideline-compliant prophylaxis, an increased rate of deep venous thrombosis (DVT) formation has been reported following autologous versus implant-based breast reconstruction. We hypothesized that tight abdominal fascia closure might decrease lower extremity venous return and promote venous stasis. Methods An observational crossover study of patients who underwent autologous breast reconstruction using transverse rectus abdominis musculocutaneous/deep inferior epigastric artery perforator flaps was conducted. Ultrasonographic measurements of the left common femoral vein (CFV) and right internal jugular vein (IJV) were performed preoperatively, in the postanesthesia care unit, and on postoperative day (POD) 1. Parameters of interest included vessel diameter, circumference, area, and maximum flow velocity. Results Eighteen patients with a mean age and body mass index of 52.7 years (range, 29-76 years) and 31.3 kg/m(2) (range, 21.9-43.4 kg/m(2)) were included, respectively. A 29.8% increase in CFV diameter was observed on POD 1 (p < 0.0001). Similarly, a 24.3 and 69.9% increase in CFV circumference (p = 0.0007) and area (p < 0.0001) were noted, respectively. These correlated with a 28.4% decrease in maximum flow velocity in the CFV (p = 0.0001). Of note, none of these parameters displayed significant changes for the IJV, thus indicating that observed changes in the CFV were not the result of changes in perioperative fluid status. Conclusion Postoperative changes observed in the CFV reflect increased lower extremity venous stasis after microsurgical breast reconstruction and may contribute to postoperative DVT formation.

    View details for DOI 10.1055/s-0036-1594297

    View details for PubMedID 27894155

  • Inadequate enoxaparin dosing predicts 90-day venous thromboembolism risk among plastic surgery inpatients: an examination of enoxaparin pharmcodynamics. Plastic and reconstructive surgery Pannucci, C. J., Rockwell, W. B., Ghanem, M., Fleming, K. I., Momeni, A., Agarwal, J. 2016

    Abstract

    Evidence-based plastic surgery guidelines support the effectiveness of once daily enoxaparin prophylaxis. Despite prophylaxis, one in 25 highest risk patients has a VTE event. We examined the pharmacodynamics of standard enoxaparin doses in plastic surgery patients to examine whether patient-level factors predict enoxaparin metabolism, whether inadequate enoxaparin dose predicts downstream VTE events, and whether a pharmacist-driven dose adjustment protocol was effective.We recruited adult plastic surgery patients who received post-operative enoxaparin at 40mg daily. Steady state peak anti-Factor Xa (aFXa) levels, a marker of enoxaparin effectiveness and safety, were drawn. Patients with out of range aFXa levels had real-time dose adjustment based on a written protocol. Patients were followed for 90-day VTE events.94 patients were recruited, and 44% had in range peak aFXa levels in response to standard enoxaparin dosing. Patient-level factors including extent of surgical injury and gross weight were independent predictors of enoxaparin metabolism. Patients with low aFXa levels were significantly more likely to have 90-day VTE (10.2% vs. 0%, p=0.041). Real time dose adjustment allowed a significantly increased proportion of patients to have in range levels (67.1% vs. 44.3%, p=0.002).Based on pharmacodynamic data, the majority of plastic surgery patients receive inadequate enoxaparin prophylaxis using fixed dosing. Patient-level factors can predict how patients will metabolize enoxaparin, and patients who receive inadequate enoxaparin prophylaxis are significantly more likely to have downstream VTE events. Individualization of enoxaparin prophylaxis may minimize peri-operative VTE risk and further improve patient safety after plastic and reconstructive surgery procedures.

    View details for DOI 10.1097/PRS.0000000000003159

    View details for PubMedID 28002279

  • Predictors of internal mammary vessel diameter: A computed tomographic angiography-assisted anatomic analysis. Journal of plastic, reconstructive & aesthetic surgery : JPRAS Cook, J. A., Tholpady, S. S., Momeni, A., Chu, M. W. 2016; 69 (10): 1340-1348

    Abstract

    The internal mammary vessels are the most common recipient vessels in free flap breast reconstruction. The literature on internal mammary vascular anatomy is limited by small sample sizes, cadaveric studies, or intraoperative changes. The purpose of this study is to analyze internal mammary anatomy using computed tomographic angiography. A retrospective review of 110 consecutive computed tomographic angiography studies of female patients was performed. Measurements of vessel caliber, distance of internal mammary vessels to sternum, location of internal mammary vein bifurcation, intercostal space height, and chest width were analyzed. Patient demographics and comorbidities were reviewed. The right internal mammary artery and vein were larger than the left in all intercostal spaces (p = 0.02 and p < 0.001, respectively). A significant correlation was found between both skeletal chest width and body mass index with internal mammary vessel caliber at the third intercostal space (p ≤ 0.02). The internal mammary vein bifurcated at the third intercostal space bilaterally, 4.3 and 1.2 mm caudal to the third rib on the right and left sides, respectively. The third intercostal space was <1.5 cm in 25% of patients. Understanding the anatomy, bifurcation, and caliber of internal mammary vessels can aid preoperative planning of autologous, free flap breast reconstruction. On average, the internal mammary vein bifurcates at the third intercostal space; patients with larger chest widths and body mass index had larger caliber internal mammary vessels, and 25% of patients had third intercostal space <1.5 cm and, thus, may not be suitable candidates for rib-sparing techniques.

    View details for DOI 10.1016/j.bjps.2016.07.005

    View details for PubMedID 27475336

  • Primary Open Rhinoplasty. Aesthetic surgery journal Momeni, A., Gruber, R. P. 2016; 36 (9): 983-992

    Abstract

    Rhinoplasty is perhaps the most complex cosmetic surgery procedure performed today. It is characterized by an intricate interplay between form and function, with patient satisfaction being dependent not only on improvement of nasal appearance but also resolution of preexisting airway symptoms. The prerequisite for successful execution of this challenging procedure is a thorough understanding of nasal anatomy and physiology. Hence, a thorough preoperative evaluation is at least as important and the surgical skill in performing the operation. Establishing an accurate diagnosis through a comprehensive nasal analysis is obligatory. As to the surgical approach, much has been written about the advantages and disadvantages of closed vs open rhinoplasty. The more commonly chosen open approach has numerous advantages, including improved visualization without distortion, thus, enabling precise diagnosis and correction of deformities. While the surgical treatment of existing nasal deformities is tailored to the needs of the individual patient, the authors have noted a total of 10 essential components to form the foundation for successful technical execution of rhinoplasty. These include: (1) septoturbinotomy; (2) opening the nose; (3) humpectomy/spreader flaps; (4) tip-plasty; (5) supratip-plasty; (6) columellar strut; (7) dorsal augmentation; (8) nasal base reduction; (9) osteotomies; and (10) rim grafts. Postoperative, a variety of problems, such as edema, may be successfully addressed without surgical intervention. Diligent postoperative management is critical in ensuring a positive patient experience. Finally, a comprehensive understanding of possible postoperative complications, such as bleeding, ecchymosis, edema, and persistent or new iatrogenic deformity is mandatory prior to offering rhinoplasty to patients.

    View details for DOI 10.1093/asj/sjw093

    View details for PubMedID 27651480

  • Systematic Reviews in Craniofacial Trauma-Strengths and Weaknesses. Annals of plastic surgery Hunter, C., Januszyk, M., Wan, D. C., Momeni, A. 2016; 77 (3): 363-368

    Abstract

    Despite substantial advances in the management of craniofacial trauma, numerous clinical questions remain. These are increasingly being answered using systematic reviews (SRs). However, caution is warranted as their validity and role in influencing clinical practice has been called into question.A PubMed search was performed in October 2014 to identify SRs published up to and including September 2014 in 35 scientific journals. Two authors independently reviewed the literature and extracted data from included studies. Discrepancies were resolved by consensus. Assessment of multiple systematic reviews (AMSTAR) was used to determine the quality of SRs.The initial search retrieved 3080 articles of which 3051 articles were excluded after screening title and abstract. After full-text review of the remaining 29 articles, 3 additional articles were excluded, thus, leaving 26 SRs for final analysis. Regression analysis demonstrated that the overall number of published SRs increased significantly throughout the period analyzed (P = 0.022). The median AMSTAR score of all SRs was 4.5, consistent with a "poor-to-fair" quality. The interobserver agreement was high, as evidenced by a mean κ of 0.91. Although there appeared to be a trend toward an increase in AMSTAR score by year over the period analyzed, this failed to reach statistical significance in terms of median (P = 0.36) or absolute (P = 0.26) counts.A tremendous opportunity exists for improvements in the quality of SRs focusing on craniofacial trauma. In addition to familiarizing authors with quality criteria for SRs, adoption of strict reporting criteria by scientific journals may result in long-term improvements in the quality of reporting.

    View details for DOI 10.1097/SAP.0000000000000633

    View details for PubMedID 26418794

  • Clinical Use of Deferoxamine in Distraction Osteogenesis of Irradiated Bone JOURNAL OF CRANIOFACIAL SURGERY Momeni, A., Rapp, S., Donneys, A., Buchman, S. R., Wan, D. C. 2016; 27 (4): 880-882

    Abstract

    The deleterious effects of radiotherapy, including hypovascularity and hypocellularity, have made distraction of irradiated bones challenging. Animal studies, however, have demonstrated adjunctive measures such as the administration of deferoxamine to significantly improve bone regeneration across irradiated distraction gaps. In this report, the authors demonstrate, for the first time, enhanced bone formation following deferoxamine application in a patient following distraction of a previously irradiated maxilla. Computed tomography imaging of the pterygomaxillary buttress on the side of administration revealed significantly increased bone area and density relative to the contralateral buttress. This is the first presentation of clinical deferoxamine use to promote bone formation following irradiated bone distraction and highlights the promise for this adjunctive measure to make outcomes after distraction of irradiated bone more reliable.

    View details for DOI 10.1097/SCS.0000000000002633

    View details for Web of Science ID 000378088800052

    View details for PubMedID 27171947

  • Microsurgical ear replantation is venous repair necessary? A systematic review MICROSURGERY Momeni, A., Liu, X., Januszyk, M., Wan, D. C., Buncke, G. M., Buntic, R. F., Parrett, B. M. 2016; 36 (4): 345-350

    Abstract

    A common postoperative observation after microsurgical ear replantation has been venous congestion necessitating alternate modes of decongestion, frequently in conjunction with blood transfusion. A comprehensive literature search was performed to assess the relationship between mode of vascular reconstruction and postoperative outcome as well as postoperative transfusion requirement after microsurgical ear replantation.The search was limited to cases of microsurgical ear replantation following complete amputation. Only articles published in English and indexed in PubMed were included.The initial search retrieved 285 articles, which was narrowed down to 40 articles reporting on 60 cases that matched the aforementioned criteria. Reconstruction of the arterial and venous limb (Group 1) was performed in 63.3% of patients and artery-only anastomosis (Group 2) was performed in 31.7%. Among measurable outcomes, only the duration of surgery was significantly different between groups (2.6 hours longer in Group 1 than Group 2; P = 0.0042).In light of contemporary data demonstrating successful artery-only ear replantation, replantation should not be abandoned when unable to establish venous outflow microsurgically. © 2015 Wiley Periodicals, Inc. Microsurgery 36:345-350, 2016.

    View details for DOI 10.1002/micr.22411

    View details for Web of Science ID 000377114900013

    View details for PubMedID 25847853

  • Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats. Microsurgery Nguyen, D. H., Chou, P., Hsieh, Y., Momeni, A., Fang, Y. D., Patel, K. M., Yang, C., Cheng, M. 2016; 36 (3): 239-245

    Abstract

    This study was conducted to investigate the correlation between the number of vascularized lymph nodes (LN) transferred and resolution of hind limb lymphedema in a rat model.Unilateral hind limb lymphedema was created in 18 male Sprague-Dawley rats following inguinal and popliteal LN resection and radiation. A para-aortic LN flap based on the celiac artery was subsequently transferred to the affected groin. The three study groups consisted of Group A (no LN transfer), Group B (transfer of a single vascularized LN), and Group C (transfer of three vascularized LNs). Volumetric analysis of bilateral hind limbs was performed using micro-CT imaging at 1, 2, and 3 months postoperatively. Lymphatic drainage was assessed with Tc(99) lymphoscintigraphy preoperatively and at 3 months postoperatively.A statistically significant volume reduction was seen in Groups B and C compared to Group A at all time points. Volume reduction of Group A vs.Group B at 1 month (8.6% ± 2.0% vs. 2.7% ± 2.6%, P < 0.05), 2 months (9.3% ± 2.2% vs. -4.3% ± 2.7%, P < 0.05), and 3 months (7.6% ± 3.3% vs. -8.9% ± 5.2%, P < 0.05). Volume reduction of Group A vs. Group C at 1 month (8.6% ± 2.0% vs. -6.6% ± 3.1%, P < 0.05), 2 months (9.3% ± 2.2% vs. -10.2% ± 4.6%, P < 0.05), and 3 months (7.6% ± 3.3% vs. -9.1% ± 3.1%, P < 0.05). Of note, comparison of Groups B and C demonstrated greater volume reduction in Group C at 1 (P < 0.02) and 2 (P = 0.07) months postoperatively.LN flap transfer is an effective procedure for the treatment of lymphedema. The number of vascularized LNs transferred correlates positively with the degree of volume reduction. © 2015 Wiley Periodicals, Inc. Microsurgery 36:239-245, 2016.

    View details for DOI 10.1002/micr.22388

    View details for PubMedID 25715830

  • Enrichment of Adipose-Derived Stromal Cells for BMPR1A Facilitates Enhanced Adipogenesis TISSUE ENGINEERING PART A Zielins, E. R., Paik, K., Ransom, R. C., Brett, E. A., Blackshear, C. P., Luan, A., Walmsley, G. G., Atashroo, D. A., Senarath-Yapa, K., Momeni, A., Rennert, R., Sorkin, M., Seo, E. Y., Chan, C. K., Gurtner, G. C., Longaker, M. T., Wan, D. C. 2016; 22 (3-4): 214-221

    Abstract

    Reconstruction of soft tissue defects has traditionally relied on the use of grafts and flaps, which may be associated with variable resorption and/or significant donor site morbidity. Cell-based strategies employing adipose-derived stromal cells (ASCs), found within the stromal vascular fraction (SVF) of adipose tissue, may offer an alternative strategy for soft tissue reconstruction. In this study, we investigated the potential of a bone morphogenetic protein receptor type 1A (BMPR1A)(+) subpopulation of ASCs to enhance de novo adipogenesis.Human lipoaspirate was enzymatically digested to isolate SVF and magnetic-activated cell separation was utilized to obtain BMPR1A(+) and BMPR1A(-) cells. These cells, along with unenriched cells, were expanded in culture and evaluated for adipogenic gene expression and in vitro adipocyte formation. Cells from each group were also labeled with a green fluorescent protein (GFP) lentivirus and transplanted into the inguinal fat pads, an adipogenic niche, of immunocompromised mice to determine their potential for de novo adipogenesis. Confocal microscopy along with staining of lipid droplets and vasculature was performed to evaluate the formation of mature adipocytes by transplanted cells.In comparison to BMPR1A(-) and unenriched ASCs, BMPR1A(+) cells demonstrated significantly enhanced adipogenesis when cultured in an adipogenic differentiation medium, as evidenced by increased staining with Oil Red O and increased expression of peroxisome proliferator-activating receptor gamma (PPAR-γ) and fatty acid-binding protein 4 (FABP4). BMPR1A(+) cells also formed significantly more adipocytes in vivo, as demonstrated by quantification of GFP+ adipocytes. Minimal formation of mature adipocytes was appreciated by BMPR1A(-) cells.BMPR1A(+) ASCs show an enhanced ability for adipogenesis in vitro, as shown by gene expression and histological staining. Furthermore, within an adipogenic niche, BMPR1A(+) cells possessed an increased capacity to generate de novo fat compared to BMPR1A(-) and unenriched cells. This suggests utility for the BMPR1A(+) subpopulation in cell-based strategies for soft tissue reconstruction.

    View details for DOI 10.1089/ten.tea.2015.0278

    View details for Web of Science ID 000369987900004

    View details for PubMedID 26585335

  • The Role of Current Techniques and Concepts in Peripheral Nerve Repair. Plastic surgery international Houschyar, K. S., Momeni, A., Pyles, M. N., Cha, J. Y., Maan, Z. N., Duscher, D., Jew, O. S., Siemers, F., van Schoonhoven, J. 2016; 2016: 4175293-?

    Abstract

    Patients with peripheral nerve injuries, especially severe injury, often face poor nerve regeneration and incomplete functional recovery, even after surgical nerve repair. This review summarizes treatment options of peripheral nerve injuries with current techniques and concepts and reviews developments in research and clinical application of these therapies.

    View details for DOI 10.1155/2016/4175293

    View details for PubMedID 26904282

  • Optimizing functional upper extremity reconstruction-Simultaneous free anterolateral thigh flap and tendon transfers-A case report. Microsurgery Sorice, S. C., Press, B., Momeni, A. 2016

    Abstract

    Composite upper extremity defects involving muscle-tendon units are amongst the most formidable reconstructive challenges and mandate functional restoration in addition to stable soft-tissue coverage. Here, the authors present a case of a composite defect involving the extensor muscle-tendon units of the forearm resulting from surgical resection of a recurrent Merkel cell cancer. Functional restoration was achieved via multiple tendon transfers followed by soft tissue coverage with a free anterolateral thigh (ALT) flap. No donor- or recipient-site complications were encountered and complete flap survival was noted. Following a 6-week period of immobilization, physical therapy and range of motion exercises were initiated. Excellent functional outcome and high patient satisfaction were noted at 8 weeks postoperatively. In summary, simultaneous tendon transfers and microsurgical tissue transfer may provide a potentially superior approach for upper extremity reconstruction in complex composite defects.

    View details for DOI 10.1002/micr.30096

    View details for PubMedID 27580418

  • Clinical outcomes in breast cancer expander-implant reconstructive patients with radiation therapy JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Chen, T. A., Momeni, A., Lee, G. K. 2016; 69 (1): 14-22
  • RNA Sequencing for Identification of Differentially Expressed Noncoding Transcripts during Adipogenic Differentiation of Adipose-Derived Stromal Cells PLASTIC AND RECONSTRUCTIVE SURGERY Luan, A., Paik, K. J., Li, J., Zielins, E. R., Atashroo, D. A., Spencley, A., Momeni, A., Longaker, M. T., Wang, K. C., Wan, D. C. 2015; 136 (4): 752-763

    Abstract

    Adipose-derived stromal cells represent a relatively abundant source of multipotent cells, with many potential applications in regenerative medicine. The present study sought to demonstrate the use of RNA sequencing in identifying differentially expressed transcripts, particularly long noncoding RNAs, associated with adipogenic differentiation to gain a clearer picture of the mechanisms responsible for directing adipose-derived stromal cell fate toward the adipogenic lineage.Human adipose-derived stromal cells were cultured in adipogenic differentiation media, and RNA was harvested at days 0, 1, 3, 5, and 7. Directional RNA sequencing libraries were prepared and sequenced. Paired-end reads were mapped to the human genome reference sequence hg19. Transcriptome assembly was performed and significantly differentially expressed transcripts were identified. Gene ontology term analysis was then performed to identify coding and noncoding transcripts of interest. Differential expression was verified by quantitative real-time polymerase chain reaction.Of 2868 significantly differentially expressed transcripts identified, 207 were noncoding. Enriched gene ontology terms among up-regulated coding transcripts notably reflected differentiation toward the adipogenic lineage. Enriched gene ontology terms among down-regulated coding transcripts reflected growth arrest. Guilt-by-association analysis revealed noncoding RNA candidates with potential roles in the process of adipogenic differentiation.The precise mechanisms that guide lineage-specific differentiation in multipotent cells are not yet fully understood. Defining long noncoding RNAs associated with adipogenic differentiation allows for potential manipulation of regulatory pathways in novel ways. The authors present RNA sequencing as a powerful tool for expanding the understanding of adipose-derived stromal cells and developing novel applications within regenerative medicine.

    View details for DOI 10.1097/PRS.0000000000001582

    View details for Web of Science ID 000361735400001

  • Medical leech therapy in plastic reconstructive surgery. Wiener medizinische Wochenschrift Houschyar, K. S., Momeni, A., Maan, Z. N., Pyles, M. N., Jew, O. S., Strathe, M., Michalsen, A. 2015; 165 (19-20): 419-425

    Abstract

    The use of Hirudo medicinalis in clinical practice has increased in recent years. The primary indication in plastic surgery has traditionally been venous congestion. However, other reported clinical applications were in varicose veins, thrombophlebitis, and osteoarthritis. In this review, we summarize recent data elucidating the role that medicinal leeches play in the field of plastic surgery.

    View details for DOI 10.1007/s10354-015-0382-5

    View details for PubMedID 26297126

  • How "Low-Level" Evidence Has Changed Plastic Surgery: Time to Appreciate the Value of Case Reports and Case Series. Annals of plastic surgery Momeni, A., Wan, D. C. 2015; 75 (4): 361-363

    View details for DOI 10.1097/SAP.0000000000000596

    View details for PubMedID 26207557

  • SURGICAL TREATMENT OF SYSTEMIC SCLEROSIS-IS IT JUSTIFIED TO OFFER PERIPHERAL SYMPATHECTOMY EARLIER IN THE DISEASE PROCESS? MICROSURGERY Momeni, A., Sorice, S. C., Valenzuela, A., Fiorentino, D. F., Chung, L., Chang, J. 2015; 35 (6): 441-446

    Abstract

    Systemic sclerosis (SSc) is a rare connective tissue disease associated with significant digital vasculopathy. Peripheral sympathectomy is frequently offered late in the disease process after severe digital ischemia has already occurred with patients being symptomatic for numerous years. The purpose of the present study was to analyze the results of peripheral sympathectomy in patients with a confirmed diagnosis of SSc.A retrospective analysis of 17 patients (26 hands) who underwent peripheral sympathectomy between January 2003 and September 2013 was performed. Data regarding patient demographics, clinical features, and postoperative outcomes were retrieved. Of note, preoperative pain was present in all patients with a mean duration of 9.6 years prior to peripheral sympathectomy.Pain improvement/resolution was seen in 24 hands (92.3%). Digital ulcers healed in all patients with only two patients (two hands; 7.7%) requiring surgical intervention for ulcer recurrence 6 months and 4.5 years later. Minor complications were seen in seven hands (26.9%); including infection, wound opening, and stitch abscess, but none required surgical intervention. Seven of eight patients queried would have preferred surgical treatment at an earlier point in the disease process.Peripheral sympathectomy is a well-tolerated procedure in patients with SSc and is associated with predictable pain relief and ulcer healing in the majority of patients. In light of these findings it seems prudent to offer surgical treatment not as a last resort but rather earlier in the disease process to decrease the duration that patients suffer pain. © 2015 Wiley Periodicals, Inc. Microsurgery, 2015.

    View details for DOI 10.1002/micr.22379

    View details for Web of Science ID 000363416300004

  • Wnt signaling induces epithelial differentiation during cutaneous wound healing ORGANOGENESIS Houschyar, K. S., Momeni, A., Pyles, M. N., Maan, Z. N., Whittam, A. J., Siemers, F. 2015; 11 (3): 95-104
  • Studies in Fat Grafting: Part V. Cell-Assisted Lipotransfer to Enhance Fat Graft Retention Is Dose Dependent PLASTIC AND RECONSTRUCTIVE SURGERY Paik, K. J., Zielins, E. R., Atashroo, D. A., Maan, Z. N., Duscher, D., Luan, A., Walmsley, G. G., Momeni, A., Vistnes, S., Gurtner, G. C., Longaker, M. T., Wan, D. C. 2015; 136 (1): 67-75

    Abstract

    Cell-assisted lipotransfer has shown much promise as a technique for improving fat graft take. However, the concentration of stromal vascular fraction cells required to optimally enhance fat graft retention remains unknown.Human lipoaspirate was processed for both fat transfer and harvest of stromal vascular fraction cells. Cells were then mixed back with fat at varying concentrations ranging from 10,000 to 10 million cells per 200 μl of fat. Fat graft volume retention was assessed by means of computed tomographic scanning over 8 weeks, and then fat grafts were explanted and compared histologically for overall architecture and vascularity.Maximum fat graft retention was seen at a concentration of 10,000 cells per 200 μl of fat. The addition of higher number of cells negatively impacted fat graft retention, with supplementation of 10 million cells producing the lowest final volumes, lower than fat alone. Interestingly, fat grafts supplemented with 10,000 cells showed significantly increased vascularity and decreased inflammation, whereas fat grafts supplemented with 10 million cells showed significant lipodegeneration compared with fat alone: The authors' study demonstrates dose dependence in the number of stromal vascular fraction cells that can be added to a fat graft to enhance retention. Although cell-assisted lipotransfer may help promote graft survival, this effect may need to be balanced with the increased metabolic load of added cells that may compete with adipocytes for nutrients during the postgraft period.

    View details for DOI 10.1097/PRS.0000000000001367

    View details for Web of Science ID 000357096300002

  • Nanotechnology in bone tissue engineering NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE Walmsley, G. G., McArdle, A., Tevlin, R., Momeni, A., Atashroo, D., Hu, M. S., Feroze, A. H., Wong, V. W., Lorenz, P. H., Longaker, M. T., Wan, D. C. 2015; 11 (5): 1253-1263

    Abstract

    Nanotechnology represents a major frontier with potential to significantly advance the field of bone tissue engineering. Current limitations in regenerative strategies include impaired cellular proliferation and differentiation, insufficient mechanical strength of scaffolds, and inadequate production of extrinsic factors necessary for efficient osteogenesis. Here we review several major areas of research in nanotechnology with potential implications in bone regeneration: 1) nanoparticle-based methods for delivery of bioactive molecules, growth factors, and genetic material, 2) nanoparticle-mediated cell labeling and targeting, and 3) nano-based scaffold construction and modification to enhance physicochemical interactions, biocompatibility, mechanical stability, and cellular attachment/survival. As these technologies continue to evolve, ultimate translation to the clinical environment may allow for improved therapeutic outcomes in patients with large bone deficits and osteodegenerative diseases.Traditionally, the reconstruction of bony defects has relied on the use of bone grafts. With advances in nanotechnology, there has been significant development of synthetic biomaterials. In this article, the authors provided a comprehensive review on current research in nanoparticle-based therapies for bone tissue engineering, which should be useful reading for clinicians as well as researchers in this field.

    View details for DOI 10.1016/j.nano.2015.02.013

    View details for Web of Science ID 000363967100022

  • Postsurgical Pyoderma Gangrenosum After Autologous Breast Reconstruction Case Report and Review of the Literature ANNALS OF PLASTIC SURGERY Momeni, A., Satterwhite, T., Eggleston, J. M. 2015; 74 (3): 284-288

    Abstract

    Pyoderma gangrenosum (PG) is a rare skin disorder of unknown etiology that is believed to be part of the spectrum of neutrophilic dermatoses. Although 25% to 50% of cases are idiopathic, PG is associated with systemic disease in up to 70% of patients, most notably inflammatory bowel disease, rheumatoid arthritis, and paraproteinemia. Although a multitude of PG cases after breast reduction have been reported, only recently has an association of PG with breast reconstruction been acknowledged. In the present article, the case of postsurgical PG (PSPG) after autologous breast reconstruction is presented along with a review of the literature. The importance of early diagnosis and initiation of appropriate treatment is discussed. The authors discuss the possibility that the increased number of breast reconstructions being performed may increase the incidence of PSPG cases seen by plastic surgeons. As such, it is critical to remove PSPG from the list of "exotic" diseases and place it higher on the list of differential diagnoses as delays in treatment can result in debilitating complications with substantial patient morbidity.

    View details for DOI 10.1097/SAP.0b013e318296b7ae

    View details for Web of Science ID 000349678900005

    View details for PubMedID 24557050

  • Systematic reviews addressing microsurgical head and neck reconstruction. journal of craniofacial surgery Momeni, A., Jacobson, J. Y., Lee, G. K. 2015; 26 (1): 210-213

    Abstract

    Systematic reviews frequently form the basis for clinical decision making and guideline development. Yet, the quality of systematic reviews has been variable, thus raising concerns about the validity of their conclusions. In the current study, a quality analysis of systematic reviews was performed, addressing microsurgical head and neck reconstruction.A PubMed search was performed to identify all systematic reviews published up to and including December 2012 in 12 surgical journals. Two authors independently reviewed the literature and extracted data from the included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR.The initial search retrieved 1020 articles. After screening titles and abstracts, 987 articles were excluded. Full-text review of the remaining 33 articles resulted in further exclusion of 18 articles, leaving 15 systematic reviews for final analysis. A marked increase in the number of published systematic reviews over time was noted (P = 0.07). The median AMSTAR score was 5, thus reflecting a "fair" quality. No evidence for improvement in methodological quality over time was noted.The trend to publish more systematic reviews in microsurgical head and neck reconstruction is encouraging. However, efforts are indicated to improve the methodological quality of systematic reviews. Familiarity with criteria of methodological quality is critical to ensure future improvements in the quality of systematic reviews conducted in microsurgery.

    View details for DOI 10.1097/SCS.0000000000001248

    View details for PubMedID 25478976

  • Systematic Reviews Addressing Microsurgical Head and Neck Reconstruction JOURNAL OF CRANIOFACIAL SURGERY Momeni, A., Jacobson, J. Y., Lee, G. K. 2015; 26 (1): 214-217
  • Utilization of a genetically modified muscle flap for local BMP-2 production and its effects on bone healing: a histomorphometric and radiological study in a rat model. Journal of orthopaedic surgery and research Lampert, F. M., Momeni, A., Filev, F., Torio-Padron, N., Finkenzeller, G., Stark, G. B., Steiner, D., Koulaxouzidis, G. 2015; 10: 55-?

    Abstract

    We developed an experimental rat model to explore the possibility of enhancing the healing of critical-size bone defects. The aim of this study was to demonstrate the feasibility of this concept by achieving high local BMP-2 expression via a transduced muscle flap that would facilitate bony union while minimizing systemic sequelae.The transduction potential of the adenoviral vector encoding for BMP-2 was tested in different cell lines in vitro. In vivo experiments consisted of harvesting a pedicled quadriceps femoris muscle flap with subsequent creation of a critical-size defect in the left femur in Sprague-Dawley rats. Next, the pedicled muscle flap was perfused with high titers of Ad.BMP-2 and Ad.GFP virus, respectively. Twelve animals were divided into three groups comparing the effects of Ad.BMP-2 transduction to Ad.GFP and placebo. Bone healing was monitored radiologically with subsequent histological analysis post-mortem.The feasibility of this concept was demonstrated by successful transduction in vitro and in vivo as evidenced by a marked increase of BMP-2 expression. The three examined groups only showed minor difference regarding bone regeneration; however, one complete bridging of the defect was observed in the Ad.BMP-2 group. No evidence of systemic viral contamination was noted.A marked increase of local BMP-2 expression (without untoward systemic sequelae) was detected. However, bone healing was not found to be significantly enhanced, possibly due to the small sample size of the study.

    View details for DOI 10.1186/s13018-015-0196-6

    View details for PubMedID 25924919

  • Cloud-Based Applications for Organizing and Reviewing Plastic Surgery Content. Eplasty Luan, A., Momeni, A., Lee, G. K., Galvez, M. G. 2015; 15

    Abstract

    Cloud-based applications including Box, Dropbox, Google Drive, Evernote, Notability, and Zotero are available for smartphones, tablets, and laptops and have revolutionized the manner in which medical students and surgeons read and utilize plastic surgery literature. Here we provide an overview of the use of Cloud computing in practice and propose an algorithm for organizing the vast amount of plastic surgery literature. Given the incredible amount of data being produced in plastic surgery and other surgical subspecialties, it is prudent for plastic surgeons to lead the process of providing solutions for the efficient organization and effective integration of the ever-increasing data into clinical practice.

    View details for PubMedID 26576208

  • Retrospective Clinical Studies in Microsurgery: Has the Quality of Reporting Changed in the Last 2 Decades? Annals of plastic surgery Momeni, A., Houschyar, K. S., Wan, D. C., Kim, R. Y., Lee, G. K., Stark, G. B. 2015

    Abstract

    Although the level of evidence is an important parameter during critical appraisal, the quality of reporting is similarly relevant. It is surprising that no objective analysis of the quality of reporting of the most common group of studies (ie, evidence level 4) has been performed to date.A hand search was conducted including all issues of Plastic and Reconstructive Surgery, British Journal of Plastic Surgery, Journal of Plastic Reconstructive and Aesthetic Surgery, Annals of Plastic Surgery, and Microsurgery for the years 1992, 2002, and 2012. All evidence level 4 studies with a focus on microsurgical reconstruction were included in the study. To assess the quality of reporting, a modification of an established quality assessment scale for retrospective clinical studies was used. This instrument generates a total possible score of 32, with a score of lower than 11, 12 to 21, and 22 to 32 representing poor, fair, and good quality of reporting, respectively.A total of 223 studies were included in the final analysis. An increase in the number of published case series was noted (46, 73, and 104 in 1992, 2002, and 2012, respectively). Similarly, an increase in the median number of patients was seen over time (8 [range, 2-165], 11 [range, 2-660], and 16 [range, 2-819] patients in 1992, 2002, and 2012, respectively) (P = 0.03). Most of the studies were conducted in Asia (38.1%) and North America (30.5%) and predominantly focused on head and neck (30.5%) as well as lower extremity reconstruction (21.5%). Although the quality of reporting was poor in 1992 and 2002 (median score, 10 [range, 3-19] in both years), an improvement to a fair quality of reporting was noted in 2012 (median score, 13 [range, 4-24]) (P = 0.0001).The trend to publish an increasing number of case series with a focus on microsurgical reconstruction is paralleled by an improvement in the quality of reporting. Although a favorable trend is seen, increased efforts are indicated to further improve the quality of case series in microsurgery.

    View details for DOI 10.1097/SAP.0000000000000488

    View details for PubMedID 25710552

  • Aesthetic Surgery Performed by Plastic Surgery Residents An Analysis of Safety and Patient Satisfaction ANNALS OF PLASTIC SURGERY Koulaxouzidis, G., Momeni, A., Simunovic, F., Lampert, F., Bannasch, H., Stark, G. B. 2014; 73 (6): 696-700

    Abstract

    Aesthetic surgery is an integral component of plastic surgery. Despite its importance, adequate training in aesthetic surgery is met with challenges. Although the educational benefit of resident clinics has been demonstrated, such clinics are rarely found outside the United States. The objective of the present study was to assess safety and patient satisfaction associated with aesthetic surgery procedures performed by plastic surgery residents at a German academic medical center.The study had 2 components, namely, a retrospective chart review and an administration of a patient satisfaction survey. Only patients who underwent a surgical intervention by a plastic surgery resident between 2003 and 2011 were included in the study. Parameters of interest included age, sex, procedure performed, number of procedures, revenue (in &OV0556;), length of follow-up, revision rate, and postoperative complication rate. Patient satisfaction was assessed by the client satisfaction questionnaire-8.A total of 273 aesthetic procedures were performed in 206 patients with an increase in recent years. The median follow-up period was 49.5 months. The most frequently performed procedures were liposuction (n = 59), breast augmentation (n = 53), and upper eyelid blepharoplasty (n = 31). One hundred ninety-two (90.3%) patients had an uneventful postoperative course. The client satisfaction questionnaire-8 questionnaire was completed by 110 patients (response rate, 50.2%). The median value of 28 indicates a high degree of patient satisfaction. An association between occurrence of major complications and patient satisfaction was seen.Aesthetic surgery performed by plastic surgery residents under supervision by attending physicians is safe and provides for high levels of patient satisfaction postoperatively. Offering these services may be able to bridge the gap between providing high-quality aesthetic surgery training while yet recruiting an increasing number of patients who may appreciate the lower fees associated with these services.

    View details for DOI 10.1097/SAP.0b013e31828d7090

    View details for Web of Science ID 000345160000016

    View details for PubMedID 23759970

  • USING AN UNCONVENTIONAL PERFUSION PATTERN IN EAR REPLANTATION-ARTERIALIZATION OF THE VENOUS SYSTEM MICROSURGERY Momeni, A., Parrett, B. M., Kuri, M. 2014; 34 (8): 657-661

    Abstract

    Ear amputation is a devastating injury characterized by a conspicuous deformity that is not easily concealed and can result in tremendous psychological trauma in addition to the physical insult. While numerous different approaches have been proposed, microvascular replantation is widely considered to deliver the best esthetic outcome. In this article, the authors report a case in which an unconventional perfusion pattern (i.e., arterialization of the venous system) was chosen, as intraoperative anatomic conditions precluded conventional vascular reconstruction. A 25-year-old male patient sustained a human bite resulting in subtotal amputation of his left ear. In the setting of an adequate arterial donor vessel, that is, branch of the posterior auricular artery, and a single suitable recipient vein (0.4 mm), the decision was made to perform an end-to-end arterio-venous anastomosis without the use of vein grafts. Medicinal leeches were applied postoperatively to provide for venous drainage. The ear survived and the patient was discharged after 14 days. To the best of our knowledge, this is first case of a subtotal ear amputation that was successfully replanted by arterialization of the venous system without the use of vein grafts and with preservation of the superficial temporal vessels.

    View details for DOI 10.1002/micr.22308

    View details for Web of Science ID 000343761700012

    View details for PubMedID 25116223

  • Reply: The Quality of Systematic Reviews in Hand Surgery: An Analysis Using AMSTAR PLASTIC AND RECONSTRUCTIVE SURGERY Momeni, A., Talley, J. R., Lee, G. K. 2014; 134 (3): 483E-484E

    View details for DOI 10.1097/PRS.0000000000000470

    View details for Web of Science ID 000349460300018

    View details for PubMedID 25158729

  • Studies in Fat Grafting: Part II. Effects of Injection Mechanics on Material Properties of Fat PLASTIC AND RECONSTRUCTIVE SURGERY Atashroo, D., Raphel, J., Chung, M. T., Paik, K. J., Parisi-Amon, A., McArdle, A., Senarath-Yapa, K., Zielins, E. R., Tevlin, R., Duldulao, C., Walmsley, G. G., Hu, M. S., Momeni, A., Domecus, B., Rimsa, J. R., Greenberg, L., Gurtner, G. C., Longaker, M. T., Wan, D. C. 2014; 134 (1): 39-46
  • Studies in fat grafting: Part I. Effects of injection technique on in vitro fat viability and in vivo volume retention. Plastic and reconstructive surgery Chung, M. T., Paik, K. J., Atashroo, D. A., Hyun, J. S., McArdle, A., Senarath-Yapa, K., Zielins, E. R., Tevlin, R., Duldulao, C., Hu, M. S., Walmsley, G. G., Parisi-Amon, A., Momeni, A., Rimsa, J. R., Commons, G. W., Gurtner, G. C., Wan, D. C., Longaker, M. T. 2014; 134 (1): 29-38

    Abstract

    Fat grafting has become increasingly popular for the correction of soft tissue deficits at many sites throughout the body. Long-term outcomes, however, depend on delivery of fat in the least traumatic fashion to optimize viability of the transplanted tissue. In this study, we compare the biologic properties of fat following injection using two methods.Lipoaspiration samples were obtained from five female donors and cellular viability, proliferation, and lipolysis were evaluated following injection using either a modified Coleman technique or an automated, low shear device. Comparisons were made to minimally processed, uninjected fat. Volume retention was also measured over twelve weeks following injection of fat under the scalp of immunodeficient mice using either the modified Coleman technique or the Adipose Tissue Injector. Finally, fat grafts were analyzed histologically.Fat viability and cellular proliferation were both significantly greater with the Adipose Tissue Injector relative to injection with the modified Coleman technique. In contrast, significantly less lipolysis was noted using the automated device. In vivo fat volume retention was significantly greater than with the modified Coleman technique at 4, 6, 8, and 12 week time points. This corresponded with significantly greater histological scores for healthy fat and lower scores for injury following injection with the device.Biological properties of injected tissues reflect how disruptive and harmful techniques for placement of fat may be, and our in vitro and in vivo data both support the use of the automated, low shear devices compared to the modified Coleman technique.

    View details for DOI 10.1097/PRS.0000000000000290

    View details for PubMedID 24622574

  • Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: a critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q BREAST CANCER RESEARCH AND TREATMENT Liu, C., Zhuang, Y., Momeni, A., Luan, J., Chung, M. T., Wright, E., Lee, G. K. 2014; 146 (1): 117-126
  • Studies in fat grafting: Part II. Effects of injection mechanics on material properties of fat. Plastic and reconstructive surgery Atashroo, D., Raphel, J., Chung, M. T., Paik, K. J., Parisi-Amon, A., McArdle, A., Senarath-Yapa, K., Zielins, E. R., Tevlin, R., Duldulao, C., Walmsley, G. G., Hu, M. S., Momeni, A., Domecus, B., Rimsa, J. R., Greenberg, L., Gurtner, G. C., Longaker, M. T., Wan, D. C. 2014; 134 (1): 39-46

    Abstract

    Although fat grafting can address many soft-tissue deficits, results remain inconsistent. In this study, the authors compared physical properties of fat following injection using an automated, low-shear device or the modified Coleman technique.Lipoaspirate was obtained from nine patients and processed for injection using either a modified Coleman technique or an automated, low-shear device. Fat was passed through a 2-mm cannula and compared with minimally processed fat. A rheometer was used to measure the storage modulus and shear rate at which tissues began to lose their solid-like properties. Viscosity was also measured, and gross properties of treatment groups were evaluated qualitatively with a glass slide test.Fat injected through an automated, low-shear device closely matched physical properties of minimally processed fat. The storage modulus (G') of fat for the device group was greater than for the modified Coleman group, and the onset of breakdown was delayed. Similarly, viscosity measurement of fat from the automated device closely matched minimally processed fat and was greater than that of othe modified Coleman group.The physical properties of lipoaspirate processed using an automated, low-shear device with a 2-mm cannula preserved the intactness of fat more than the modified Coleman technique. The authors' rheologic data demonstrate less damage using an automated device compared with the modified Coleman technique and potentially support its use for improved fat graft integrity.

    View details for DOI 10.1097/PRS.0000000000000289

    View details for PubMedID 25028817

  • The Quality of Aesthetic Surgery Training in Plastic Surgery Residency: A Survey Among Residents in Germany: Reply ANNALS OF PLASTIC SURGERY Momeni, A., Stark, G. B. 2014; 73 (1): 115-116

    View details for DOI 10.1097/SAP.0b013e31828f6303

    View details for Web of Science ID 000338342000026

    View details for PubMedID 24918741

  • Studies in Fat Grafting: Part I. Effects of Injection Technique on In Vitro Fat Viability and In Vivo Volume Retention PLASTIC AND RECONSTRUCTIVE SURGERY Chung, M. T., Paik, K. J., Atashroo, D. A., Hyun, J. S., McArdle, A., Senarath-Yapa, K., Zielins, E. R., Tevlin, R., Duldulao, C., Hu, M. S., Walmsley, G. G., Parisi-Amon, A., Momeni, A., Rimsa, J. R., Commons, G. W., Gurtner, G. C., Wan, D. C., Longaker, M. T. 2014; 134 (1): 29-38
  • Outcome Analysis of Expander/Implant Versus Microsurgical Abdominal Flap Breast Reconstruction: A Critical Study of 254 Cases ANNALS OF SURGICAL ONCOLOGY Liu, C., Momeni, A., Zhuang, Y., Luan, J., Chung, M. T., Wright, E., Lee, G. K. 2014; 21 (6): 2074-2082

    Abstract

    Expander-implant breast reconstruction (EIBR) and microsurgical abdominal flap breast reconstruction (MAFBR) are currently the two most frequent breast reconstruction techniques performed in the United States. The aim of this study was to compare outcomes between EIBR and MAFBR in order to help future breast cancer patients to be more knowledgeable and better informed in choosing their optimal reconstruction option.Medical records of 795 patients who underwent breast reconstruction at Stanford Hospital from 2007 to 2011 were reviewed. We found 254 patients to be candidates for both MAFBR and EIBR preoperatively and included them in the study. Patients demographics, postoperative clinic visits, length of hospital stay, postoperative complications, and follow-up time were compared. Logistic regression analysis was used to determine risk factors for major complications.MAFBR patients had 8.7 clinic visits postoperatively, while 14.6 visits were needed for EIBR patients. Length of hospital stay was 4.8 ± 1.32 days for MAFBR and 2.1 ± 0.9 days for EIBR. Complication occurred in 21.3 % of MAFBR versus 37.4 % for EIBR patients. Follow-up duration was 24.7 ± 17.2 months for EIBR and 30.1 ± 18.5 months for MAFBR. On multivariate analysis, EIBR and a body mass index of ≥30 kg/m(2) were the only significant predictors of major complication.For patients eligible for both options, MAFBR has a lower incidence of major complications and fewer postoperative visits, but it has a longer initial hospital stay compared to EIBR. Patients should be informed of not only short-term but also long-term possible risks and benefits in order to make an informed decision.

    View details for DOI 10.1245/s10434-014-3521-0

    View details for Web of Science ID 000335726900047

    View details for PubMedID 24558063

  • Outcomes of breast reconstruction in breast cancer patients with a history of mantle radiation for Hodgkin lymphoma. Annals of plastic surgery Wong, R. K., Morrison, S. D., Momeni, A., Nykiel, M., Lee, G. K. 2014; 72: S46-50

    Abstract

    Although mantle radiation (ie, extended field radiation) represented the standard of care in the past for Hodgkin disease, contemporary treatment of lymphoma consists of a multimodal approach with chemotherapy. Patients who were exposed to mantle radiation have a higher risk of breast cancer and are more susceptible to postoperative complications after breast reconstruction due to radiation. In this study, we present postoperative outcomes in patients with a history of mantle radiation who underwent mastectomy and breast reconstruction.All patients at Stanford University Medical Center between January 2006 and December 2012 with a history of Hodgkin lymphoma treated with mantle radiation who received breast reconstruction were identified. A retrospective chart review was conducted analyzing patient demographics, history of Hodgkin treatment, type of reconstruction, follow-up, and complications. Complications were further classified into medical complications, donor-site complications, and recipient-site complications.Sixteen patients with a history of Hodgkin disease and mantle radiation received breast reconstruction. The average age of the patients at their mastectomy was 46 (33-60) years, with the average age at the time of their mantle radiation of 20.5 (10-33) years with an average interval of radiation to breast cancer treatment of 24.8 (16-38) years. There were five unilateral and 11 bilateral reconstructions. All patients had immediate reconstruction with tissue expanders (14 patients) or autologous tissue (one muscle-sparing transverse rectus abdominis myocutaneous and one transverse upper gracilis flap). Eleven (69%) patients had postoperative complications. In the patients who had tissue expander reconstruction, there was an overall complication rate of 64%, which included capsular contracture (n = 5, 56%), mastectomy flap necrosis (n = 5, 56%), cellulitis (n = 4, 44%), seroma (n = 3, 33%), hematoma (n = 1, 11%), and chronic pain (n = 1, 11%). Three (two unilateral and one bilateral) tissue expander infections required removal of the expander and delayed reconstruction with a latissimus dorsi flap, whereas one patient with chronic pain and capsular contracture required a muscle-sparing transverse rectus abdominis myocutaneous for a unilateral implant failure.Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.

    View details for DOI 10.1097/SAP.0000000000000167

    View details for PubMedID 24740024

  • Outcomes of Breast Reconstruction in Breast Cancer Patients With a History of Mantle Radiation for Hodgkin Lymphoma ANNALS OF PLASTIC SURGERY Wong, R. K., Morrison, S. D., Momeni, A., Nykiel, M., Lee, G. K. 2014; 72: S46-S50
  • Abstract 46: surgical treatment of systemic sclerosis: re-thinking the role and timing of peripheral sympathectomy. Plastic and reconstructive surgery Momeni, A., Sorice, S. C., Valenzuela, A., Fiorentino, D. F., Chung, L., Chang, J. 2014; 133 (4): 1010-?

    View details for DOI 10.1097/01.prs.0000445829.40020.04

    View details for PubMedID 24675339

  • Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Berger, A. J., Momeni, A., Ladd, A. L. 2014; 472 (4): 1155-1159

    Abstract

    Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed.We therefore performed a systematic review to determine the intra- and interobserver reliability of the Eaton staging system.We systematically reviewed English-language studies published between 1973 and 2013 to assess the degree of intra- and interobserver reliability of the Eaton classification for determining the stage of trapeziometacarpal joint arthritis and pantrapezial arthritis based on plain radiographic imaging. Search engines included: PubMed, Scopus(®), and CINAHL. Four studies, which included a total of 163 patients, met our inclusion criteria and were evaluated. The level of evidence of the studies included in this analysis was determined using the Oxford Centre for Evidence Based Medicine Levels of Evidence Classification by two independent observers.A limited number of studies have been performed to assess intra- and interobserver reliability of the Eaton classification system. The four studies included were determined to be Level 3b. These studies collectively indicate that the Eaton classification demonstrates poor to fair interobserver reliability (kappa values: 0.11-0.56) and fair to moderate intraobserver reliability (kappa values: 0.54-0.657).Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. Currently, diagnosis and treatment of thumb CMC arthritis are based on the surgeon's qualitative assessment combining history, physical examination, and radiographic evaluation. Inconsistent agreement using the current common radiographic classification system suggests a need for better radiographic tools to quantify disease severity.

    View details for DOI 10.1007/s11999-013-3208-z

    View details for Web of Science ID 000332576400017

    View details for PubMedID 23917991

  • Abstract 151: short hairpin RNA interference therapy for diabetic murine wound closure and hindlimb ischemia. Plastic and reconstructive surgery Paik, K. J., Rennert, R., Chung, M. T., Sorkin, M., Duscher, D., Atashroo, D., Chen, H., Morrison, S. D., Zimmermann, A., Nauta, A., Ko, S., Tevlin, R., Zielins, E., Hu, M. S., McArdle, A., Walmsley, G., Senarath-Yapa, K., Hong, W. X., Garza, R. M., Duldulao, C., Wearda, T., Momeni, A., Wu, J. C., Gurtner, G. C., Longaker, M. T., Wan, D. C. 2014; 133 (3): 167-168

    View details for DOI 10.1097/01.prs.0000444979.14443.08

    View details for PubMedID 25942261

  • Abstract 165: Enhanced Adipose-Derived Stromal Cell Osteogenesis through Surface Marker Enrichment and BMP Modulation using Magnet-assisted Transfection. Plastic and reconstructive surgery Chung, M. T., Morrison, S. D., Paik, K. J., McArdle, A., Walmsley, G., Senarath-Yapa, K., Hu, M. S., Tevlin, R., Zielins, E., Atashroo, D., Hong, W. X., Duldulao, C., Wearda, T., Garza, R. M., Momeni, A., Longaker, M. T., Wan, D. C. 2014; 133 (3): 181-182

    View details for DOI 10.1097/01.prs.0000444994.28797.34

    View details for PubMedID 25942275

  • EVIDENCE-BASED PLASTIC SURGERY-"STATUS QUO" MICROSURGERY Momeni, A., Stark, G. B. 2014; 34 (2): 85-90

    View details for DOI 10.1002/micr.22194

    View details for Web of Science ID 000331394700001

    View details for PubMedID 24123172

  • Current Concepts for Eyelid Reanimation in Facial Palsy ANNALS OF PLASTIC SURGERY Momeni, A., Khosla, R. K. 2014; 72 (2): 242-245
  • Endoscopic Release of the Cubital Tunnel HAND CLINICS Zajonc, H., Momeni, A. 2014; 30 (1): 55-?

    Abstract

    It is safe to say that in situ decompression of the ulnar nerve in cubital tunnel syndrome has been demonstrated to achieve equivalent functional results when compared with more elaborate techniques, such as decompression with nerve transposition. The evolution toward procedures associated with less patient morbidity is reflected by the introduction of endoscopic techniques for the treatment of cubital tunnel syndrome. The authors have incorporated the endoscopic approach as proposed by Hoffmann and Siemionow into their practice and have obtained favorable results. Although the skin incision can frequently be kept to a minimum (<2 cm), superior visualization associated with this approach allows for in situ decompression of the ulnar nerve along a distance of up to 30 cm. Despite the extent of decompression performed, operative morbidity is minimal, with return to full duty being the rule even in manual laborers within 10 to 14 days postoperatively.

    View details for DOI 10.1016/j.hc1.2013.08.021

    View details for Web of Science ID 000329087000009

    View details for PubMedID 24286743

  • Cross-Leg Flaps: Preferred Alternative To Free Flaps? JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Momeni, A., Buntic, R. F., Buncke, G. M. 2014; 218 (2): 308-309

    View details for Web of Science ID 000329763900029

    View details for PubMedID 24440075

  • Assigning a team-based pager for on-call physicians reduces paging errors in a large academic hospital. Joint Commission journal on quality and patient safety / Joint Commission Resources Shieh, L., Chi, J., Kulik, C., Momeni, A., Shelton, A., DePorte, C., Hopkins, J. 2014; 40 (2): 77-82

    Abstract

    As complexity of care of hospitalized patients has increased, the need for communication and collaboration among members of the team caring for the patient has become increasingly important. This often takes the form of a nurse's need to contact a patient's physician to discuss some aspect of care and modify treatment plans. Errors in communication delay care and can pose risk to patients. This report describes the successful implementation of a standardized team-based paging system at an academic center. Results showed a substantial improvement in nurses' perceptions of knowing how to contact the correct physician when discussion of the patient's care is needed. This improvement was found across multiple medical and surgical specialties and was particularly effective for services with the greatest communication problems.

    View details for PubMedID 24716330

  • Aesthetic Surgery Training during Residency in the United States: A Comparison of the Integrated, Combined, and Independent Training Models. Plastic surgery international Momeni, A., Kim, R. Y., Wan, D. C., Izadpanah, A., Lee, G. K. 2014; 2014: 281923-?

    Abstract

    Background. Three educational models for plastic surgery training exist in the United States, the integrated, combined, and independent model. The present study is a comparative analysis of aesthetic surgery training, to assess whether one model is particularly suitable to provide for high-quality training in aesthetic surgery. Methods. An 18-item online survey was developed to assess residents' perceptions regarding the quality of training in aesthetic surgery in the US. The survey had three distinct sections: demographic information, current state of aesthetic surgery training, and residents' perception regarding the quality of aesthetic surgery training. Results. A total of 86 senior plastic surgery residents completed the survey. Twenty-three, 24, and 39 residents were in integrated, combined, and independent residency programs, respectively. No statistically significant differences were seen with respect to number of aesthetic surgery procedures performed, additional training received in minimal-invasive cosmetic procedures, median level of confidence with index cosmetic surgery procedures, or perceived quality of aesthetic surgery training. Facial aesthetic procedures were felt to be the most challenging procedures. Exposure to minimally invasive aesthetic procedures was limited. Conclusion. While the educational experience in aesthetic surgery appears to be similar, weaknesses still exist with respect to training in minimally invasive/nonsurgical aesthetic procedures.

    View details for DOI 10.1155/2014/281923

    View details for PubMedID 25225615

  • Nipple Reconstruction: Risk Factors and Complications after 189 Procedures. European journal of plastic surgery Momeni, A., Ghaly, M., Gupta, D., Karanas, Y. L., Kahn, D. M., Gurtner, G. C., Lee, G. K. 2013; 36 (10): 633-638

    Abstract

    A multitude of different approaches have been proposed for achieving optimal aesthetic results after nipple reconstruction. In contrast, however, only a few studies focus on the morbidity associated with this procedure, particularly after implant-based breast reconstruction.Using a cross-sectional study design all patients who underwent implant-based breast reconstruction with subsequent nipple reconstruction between 2000 and 2010 at Stanford University Medical Center were identified. The aim of the study was to analyze the impact of the following parameters on the occurrence of postoperative complications: age, final implant volume, time interval from placement of final implant to nipple reconstruction, and history of radiotherapy.A total of 139 patients with a mean age of 47.5 years (range, 29 to 75 years) underwent 189 nipple reconstructions. The overall complication rate was 13.2 percent (N = 25 nipple reconstructions). No association was observed between age (p = 0.43) or implant volume (p = 0.47) and the occurrence of complications. A trend towards higher complication rates in patients in whom the time interval between final implant placement and nipple reconstruction was greater than 8.5 months was seen (p = 0.07). Radiotherapy was the only parameter that was associated with a statistically significant increase in postoperative complication rate (51.7 percent vs. 6.25 percent; p < 0.00001).While nipple reconstruction is a safe procedure after implant-based breast reconstruction in patients without a history of radiotherapy, the presence of an irradiated field converts it to a high-risk one with a significant increase in postoperative complication rate. Patients with a history of radiotherapy should be informed about their risk profile and as a result may choose autologous reconstruction instead.IV.

    View details for PubMedID 24072956

  • Evidence-Based Plastic and Reconstructive Surgery: Developments over Two Decades PLASTIC AND RECONSTRUCTIVE SURGERY Becker, A., Bluemle, A., Momeni, A. 2013; 132 (4): 657E-663E
  • Evidence-based Plastic and Reconstructive Surgery: developments over two decades. Plastic and reconstructive surgery Becker, A., Blümle, A., Momeni, A. 2013; 132 (4): 657e-663e

    Abstract

    Increasing awareness of the importance of evidence-based medicine is demonstrated not only by an increasing number of articles addressing it but also by a specialty-wide evidence-based medicine initiative. The authors critically analyzed the quality of reporting of randomized controlled trials published in this Journal over a 21-year period (1990 to 2010).A hand search was conducted, including all issues of Plastic and Reconstructive Surgery from January of 1990 to December of 2010. All randomized controlled trials published during this time period were identified with the Cochrane decision tree for identification of randomized controlled trials. To assess the quality of reporting, a modification of the checklist of the Consolidated Standard of Reporting Trials Statement was used.Of 7121 original articles published from 1990 to 2010 in the Journal, 159 (2.23 percent) met the Cochrane criteria. A significant increase in the absolute number of randomized controlled trials was seen over the study period (p < 0.0001). The median quality of these trials from 1990 to 2010 was "fair," with a trend toward improved quality of reporting over time (p = 0.127).A favorable trend is seen with respect to an increased number of published randomized controlled trials in Plastic and Reconstructive Surgery. Adherence to standard reporting guidelines is recommended, however, to further improve the quality of reporting. Consideration may be given to providing information regarding the quality of reporting in addition to the "level of evidence pyramid," thus facilitating critical appraisal.

    View details for DOI 10.1097/PRS.0b013e31829fe0f7

    View details for PubMedID 24076714

  • Nipple reconstruction after implant-based breast reconstruction: A "matched-pair" outcome analysis focusing on the effects of radiotherapy JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Ghaly, M., Gupta, D., Gurtner, G., Kahn, D. M., Karanas, Y. L., Lee, G. K. 2013; 66 (9): 1202-1205

    Abstract

    BACKGROUND: The major focus of research when addressing nipple reconstruction has been on developing new techniques to provide for long-lasting nipple projection. Rarely, has the outcome of nipple reconstruction as it relates to postoperative morbidity, particularly after implant-based breast reconstruction, been analyzed. METHODS: A "matched-pair" study was designed to specifically answer the question whether a history of radiotherapy predisposes to a higher complication rate after nipple reconstruction in patients after implant-based breast reconstruction. Only patients with a history of unilateral radiotherapy who underwent bilateral mastectomy and implant-based breast reconstruction followed by bilateral nipple reconstruction were included in the study. RESULTS: A total of 17 patients (i.e. 34 nipple reconstructions) were identified who met inclusion criteria. The mean age of the study population was 43.5 years (range, 23-69). Complications were seen after a total of 8 nipple reconstructions (23.5 percent). Of these, 7 complications were seen on the irradiated side (41.2 percent) (p = 0.03). CONCLUSION: While nipple reconstruction is a safe procedure after implant-based breast reconstruction in patients without a history of radiotherapy the presence of an irradiated field converts it to a procedure with a significant increase in postoperative complication rate.

    View details for DOI 10.1016/j.bjps.2013.04.052

    View details for Web of Science ID 000324166800014

    View details for PubMedID 23664573

  • The Quality of Aesthetic Surgery Training in Plastic Surgery Residency A Survey Among Residents in Germany ANNALS OF PLASTIC SURGERY Momeni, A., Goerke, S. M., Bannasch, H., Arkudas, A., Stark, G. B. 2013; 70 (6): 704-708

    Abstract

    The importance of providing high-quality exposure and training in aesthetic and reconstructive surgery during residency has come to the forefront of plastic surgery education. Adequate training in aesthetic surgery, however, has traditionally been challenging. The authors were interested in how these challenges were met abroad.A 17-item online survey was developed to assess the quality of training in aesthetic surgery in Germany. The survey had 3 distinct sections: demographic information, current state of aesthetic surgery training, and residents' opinions about the perceived quality of aesthetic surgery training. Only responses of senior residents were included in the final analysis.A total of 112 residents responded (30% response rate), of which 88 were senior plastic surgery residents. Ninety percent (n = 79) reported that a resident aesthetic surgery clinic was not part of their training experience. Eighty-eight percent (n = 77) reported that they did not have a dedicated aesthetic surgery rotation during their residency training. According to 69.3% (n = 61), no didactic training in aesthetic surgery was provided. Fifty-six percent (n = 49) of senior plastic surgery residents had performed only a maximum of 10 aesthetic surgery procedures at the time of the survey. Although only 43.2% of senior residents claimed to be interested in a predominantly aesthetic surgery practice, 90.9% (n = 80) felt that they require further training in aesthetic surgery (ie, fellowship).Deficiencies exist with respect to aesthetic surgery training among senior plastic surgery residents in Germany. Structural improvements in residency training with formal exposure and teaching in aesthetic surgery are warranted. The German Society of Plastic, Reconstructive and Aesthetic Surgeons is actively addressing deficiencies identified with the goal of improving the quality of training.

    View details for DOI 10.1097/SAP.0b013e3182468346

    View details for Web of Science ID 000319068200023

    View details for PubMedID 22868325

  • Microsurgical Head and Neck Reconstruction After Oncologic Ablation A Study Analyzing Health-Related Quality of Life ANNALS OF PLASTIC SURGERY Momeni, A., Kim, R. Y., Kattan, A., Lee, G. K. 2013; 70 (4): 462-469
  • The foreskin advancement flap: An alternative technique for reconstruction of penile burns JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Abidari, J. M., Karanas, Y. L. 2013; 66 (4): 570-573

    Abstract

    Penile burns are devastating injuries and are frequently associated with significant functional and psychological sequelae. The goals of penile reconstruction after burn injury include: 1) skin coverage, 2) preservation of penile length, sensation and erectile function, 3) esthetic integrity, and 4) permissive for penile growth in the pediatric patient. A multitude of different techniques have been proposed, including skin grafts, local, regional, and free flaps, each of which fail to address all goals of reconstruction. We introduce the foreskin advancement flap that, when available, successfully addresses these key challenges and as such provides for an ideal reconstruction.

    View details for DOI 10.1016/j.bjps.2012.08.026

    View details for Web of Science ID 000316738100033

    View details for PubMedID 22981384

  • The Quality of Systematic Reviews in Hand Surgery: An Analysis Using AMSTAR PLASTIC AND RECONSTRUCTIVE SURGERY Momeni, A., Lee, G. K., Talley, J. R. 2013; 131 (4): 831-837

    Abstract

    Systematic reviews constitute the top of the "level-of-evidence pyramid." Despite their strengths, they have been found to be of varying quality, thus raising concerns about their validity and role in influencing clinical practice. In the present study, a quality analysis of systematic reviews with a focus on hand surgery was performed.A PubMed search was performed to identify all systematic reviews published up to and including December of 2011 in eight surgical journals. Two authors independently reviewed the literature and extracted data from included reviews. Discrepancies were resolved by consensus. Quality assessment was performed using AMSTAR.The initial search retrieved 687 articles. After screening titles and abstracts, 635 articles were excluded. Full-text review of the remaining 52 articles resulted in further exclusion of 10 articles, leaving 42 systematic reviews for final analysis. A significant increase in the number of published systematic reviews over time was noted (p = 0.04), with the majority of systematic reviews being published in The Journal of Hand Surgery (n = 19) and Plastic and Reconstructive Surgery (n = 12). Although a significant improvement in the quality of systematic reviews was noted over time (p = 0.01), a median AMSTAR score of 7 indicated the bulk of reviews to be of fair to good quality.The trend to publish more systematic reviews in hand surgery is paralleled by an increase in the quality of systematic reviews. Nonetheless, increased efforts are indicated to further improve the quality of systematic reviews in hand surgery.

    View details for DOI 10.1097/PRS.0b013e3182818d24

    View details for Web of Science ID 000317282800062

    View details for PubMedID 23542254

  • Is routine histological examination of mastectomy scars justified? An analysis of 619 scars JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Tran, P., Dunlap, J., Lee, G. K. 2013; 66 (2): 182-186

    Abstract

    The increasing incidence of breast cancer is paralleled by an increasing demand for post-mastectomy breast reconstruction. At the time of breast reconstruction routine submission of mastectomy scars has been considered appropriate clinical practice to ensure that no residual cancer exists. However, this practice has been challenged by some and has become the topic of controversy. In a retrospective analysis we wished to assess whether routine submission of mastectomy scars altered treatment.Utilizing the Stanford Translational Research Integrated Database Environment (STRIDE) all patients who underwent implant-based breast reconstruction with routine histological analysis of mastectomy scars were identified. The following parameters were retrieved and analyzed: age, cancer histology, cancer stage (according to the American Joint Committee on Cancer staging system), receptor status (estrogen receptor [ER], progesterone receptor [PR], Her2neu), time interval between mastectomy and reconstruction, and scar histology.A total of 442 patients with a mean age of 45.9 years (range, 22-73 years) were included in the study. Mastectomy with subsequent reconstruction was performed for in-situ disease and invasive cancer in 83 and 359 patients, respectively. A total of 619 clinically unremarkable mastectomy scars were sent for histological analysis, with the most common finding being unremarkable scar tissue (i.e. collagen fibers). Of note, no specimen revealed the presence of carcinoma.According to published reports routine histological examination of mastectomy scars may detect early local recurrence. However, we were not able to detect this benefit in our patient population. As such, particularly in the current health-care climate the cost-effectiveness of this practice deserves further attention. A more selective use of histological analysis of mastectomy scars in patients with tumors that display poor prognostic indicators may be a more reasonable utilization of resources.

    View details for DOI 10.1016/j.bjps.2012.09.013

    View details for Web of Science ID 000313620600012

    View details for PubMedID 23044349

  • Microsurgical Head and Neck Reconstruction After Oncologic Ablation: A Study Analyzing Health-Related Quality of Life. Annals of plastic surgery Momeni, A., Kim, R. Y., Kattan, A., Lee, G. K. 2013

    Abstract

    BACKGROUND: Evaluation of quality of life (QOL) measures is increasingly being valued as an essential parameter to determine treatment results after head and neck reconstruction. The present study was designed to evaluate the effect of microsurgical reconstruction on patient-reported QOL. METHODS: Patients undergoing microsurgical reconstruction after radical oncosurgical ablation of head and neck malignancies from March 2007 to March 2010 were included in the study. To assess health-related QOL, the following questionnaires were sent to patients who met inclusion criteria: European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30 [Version 3.0]) and Head and Neck Cancer Quality of Life Questionnaire (QLQ-H and N35). RESULTS: A total of 60 patients underwent microsurgical reconstruction of postablative head and neck defects during the study period. Twenty-one patients were successfully contacted, all of which completed the surveys. Satisfactory global QOL scores were achieved. Advanced age correlated with greater impairment for the ability to taste and smell (P = 0.05). Radiotherapy seemed to be associated with "sticky saliva"; although this was not statistically significant (P = 0.06). Recurrent disease at the time of surgical ablation and microsurgical reconstruction did not seem to have any appreciable impact on QOL. Finally, patients who developed postoperative complications had lower levels of "cognitive functioning" (P = 0.04), problems with "insomnia" (P = 0.04) and "social contact" (P = 0.03), and more commonly "felt ill" (P = 0.03). CONCLUSIONS: Improved global QOL scores were observed after microsurgical reconstruction of various head and neck defects when compared to reported pretreatment scores. Of the parameters analyzed, it seems that postoperative complications have the most profound effect on items assessed with the EORTC QLQ-C30 and H and N35 surveys. Our findings provide further scientific evidence that patients with head and neck malignancy benefit from surgical intervention with respect to postoperative QOL.

    View details for PubMedID 23486123

  • Microsurgical reconstruction of the smilecontemporary trends MICROSURGERY Momeni, A., Chang, J., Khosla, R. K. 2013; 33 (1): 69-76

    Abstract

    The treatment of facial palsy is a complex and challenging area of plastic surgery. Microsurgical innovation has introduced the modern age of dynamic reconstruction for facial palsy. This review will focus on microsurgical reconstruction for smile restoration in patients with long-standing facial palsy. The most common donor muscles and nerves will be presented. The advantages and disadvantages of single-stage versus multi-stage reconstruction will be discussed. Contemporary trends will be highlighted and the authors' preferred practice outlined.

    View details for DOI 10.1002/micr.22042

    View details for Web of Science ID 000313812600013

  • Commentary to "A Transatlantic Difference in Aesthetic Surgery Training" Annals of plastic surgery Momeni, A., Sstark, G. B. 2013

    View details for DOI 10.1097/SAP.0b013e31828f6303

    View details for PubMedID 23676523

  • Is Microsurgical Head and Neck Reconstruction Profitable? Analysis at an Academic Medical Center ANNALS OF PLASTIC SURGERY Momeni, A., Kattan, A., Lee, G. K. 2012; 68 (4): 401-403

    Abstract

    The complexity of modern head and neck reconstruction is paralleled by consumption of large amounts of resources provided by both treating physicians as well as the institution, that is, hospital. In times of increasing economic constraints, analysis of the financial value of providing these services seems prudent. A retrospective analysis of medical and billing records of patients who underwent immediate microsurgical reconstruction of postablative head and neck defects from 2007 to 2010 at Stanford University Medical Center was performed. Financial data related to the treatment of 60 patients were analyzed. Total reimbursement for plastic surgery services was $319,609, representing a collection rate of 18.4%. Total hospital charges were $31,038,846.10. Actual reimbursement was $9,109,776.55, which represents a collection rate of 29.3%. Analysis of hospital revenue revealed a net profit of $1,512,136.46, which represents a mean net revenue of $25,202.27 per case. Microsurgical reconstruction secures substantial revenue for the institution. Innovative reimbursement models need to be implemented to attract skilled microsurgeons, who represent the backbone of these services.

    View details for DOI 10.1097/SAP.0b013e31823d2dec

    View details for Web of Science ID 000301800600017

    View details for PubMedID 22421488

  • Should we continue to consider obesity a relative contraindication for autologous microsurgical breast reconstruction? JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Ahdoot, M. A., Kim, R. Y., Leroux, E., Galaiya, D. J., Lee, G. K. 2012; 65 (4): 420-425

    Abstract

    Obesity is not only a causative factor for premature mortality, it has also been demonstrated to be associated with an increased postoperative complication rate. As such, it has traditionally been considered a relative contraindication to autologous breast reconstruction. The purpose of this study was to assess whether this recommendation is justified.A retrospective study was conducted analyzing the effect of obesity on complication rate after microsurgical autologous breast reconstruction using abdominal tissue. Patients undergoing breast reconstruction between November 2006 and February 2011 were included. In contrast to prior studies, only patients meeting criteria to undergo bariatric surgery were included in the study, thus, representing a particularly high-risk subset of patients (Group 1: BMI greater 40 kg/m(2); Group 2: BMI greater 35 kg/m(2) with co-morbidities).A total of 42 breast reconstructions were performed in 28 patients who met inclusion criteria. Surgical complications were seen in a total of 9 patients (p = 1.00). All complications were successfully managed conservatively and did not prolong hospitalization. No differences were seen among study groups with respect to donor-site (p = 0.57) and recipient-site complications (p = 1.00). Of note, no partial or total flap loss was seen in this study.Obesity is associated with a relatively high risk of minor complications postoperatively. However, complications can typically be managed non-operatively and on an outpatient basis with fairly minimal patient morbidity. We believe that obesity should not be considered a relative contraindication to autologous microsurgical breast reconstruction. Patients should, however, be informed preoperatively about their higher risk of postoperative complications.

    View details for DOI 10.1016/j.bjps.2011.10.005

    View details for Web of Science ID 000301982000012

    View details for PubMedID 22024538

  • Soft tissue reconstruction with a temporoparietal fascial flap (TPFF) OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE Koulaxouzidis, G., Torio-Padron, N., Momeni, A., Lampert, F., ZAJONC, H., Bannasch, H., Stark, G. B. 2012; 24 (1): 32-42

    Abstract

    Soft tissue reconstruction with a temporoparietal fascial flap (TPFF).Defect coverage with thin, pliable, and well-vascularized tissue. A bilayered TPFF provides a gliding surface in tendon reconstruction. Further options include TPFF harvest with overlying skin or subjacent bone for composite tissue reconstruction or the application as a sensate local fascial flap. Maximum defect dimensions: 17 × 14 cm.Absolute: prior injury to the flap or flap pedicle, temporal arteritis, Moyamoya syndrome, defects with volume deficit. Relative: alopecia along the planned incision.Pedicle location is outlined using Doppler ultrasound. Injection of the incision line with diluted epinephrine solution. Skin incision with subsequent visualization of the temporoparietal fascia and supplying vessels. Skin flaps are raised carefully paying special attention to the hair follicles (CAVE: postoperative alopecia). Primary closure of the donor site. Defect coverage with pedicled or free TPFF with subsequent full or split-thickness skin grafting. Dressing: Bolster or V.A.C.Immobilization/elevation in the setting of extremity reconstruction. Removal of bolster dressing or V.A.C. on postoperative day 5. Dangling protocol instituted on postoperative day 7. Removal of sutures/staples at the donor site on postoperative day 5-7 and at the recipient site on postoperative day 12-14.The TPFF was utilized for soft tissue reconstruction in 8 patients. A pedicled TPFF was used in 2 patients. Mean time to healing was 16.3 days. Mean follow-up was 13.4 months. Successful reconstructive results with satisfactory functional and aesthetic appearance were obtained in all patients. Complications were encountered in 3 patients and included alopecia at the donor site and iatrogenic injury to the frontal branch of the facial nerve. Vascular compromise was observed in the early postoperative period in a third patient. However, operative revision resulted in successful flap salvage.

    View details for DOI 10.1007/s00064-011-0097-8

    View details for Web of Science ID 000300780700004

    View details for PubMedID 22190272

  • Current Concepts for Eyelid Reanimation in Facial Palsy. Annals of plastic surgery Momeni, A., Khosla, R. K. 2012

    Abstract

    ABSTRACT: The treatment of facial palsy is a complex and challenging area of plastic surgery. Two distinct anatomical regions and functions are the focus of interest when managing facial palsy: (1) reanimation of the eyelids and (2) reconstruction of the smile. This review will focus on the treatment of ocular manifestations of facial palsy. The principles of eyelid rehabilitation will be presented along with a discussion of surgical and nonsurgical treatment options.

    View details for PubMedID 23241787

  • The effect of preoperative radiotherapy on complication rate after microsurgical head and neck reconstruction JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Kim, R. Y., Kattan, A., Tennefoss, J., Lee, T. H., Lee, G. K. 2011; 64 (11): 1454-1459

    Abstract

    The introduction of radiotherapy (XRT) has resulted in increased survival of patients diagnosed with head and neck malignancies. However, the potentially deleterious impact of radiotherapy on reconstructive efforts continues to be the subject of intense debate. The present study was designed to evaluate the effects of preoperative XRT on complication rates in patients undergoing microsurgical reconstruction of head and neck defects after oncosurgical resection.A retrospective cohort study was conducted of all patients who underwent immediate microsurgical reconstruction of post-ablative defects over a 3-year period. Study subjects were divided into two groups: (1) those who did not receive XRT and (2) those who received preoperative XRT. Clinical variables examined and analysed included age, gender, co-morbid conditions, tobacco history, the presence of recurrent disease and ischaemia time. Outcomes of interest included length of intensive care unit (ICU) and hospital stay and postoperative complications. Complications were further classified as flap-related as well as 'medical'.A total of 60 patients were included in this study (group 1: 26 patients; group 2: 34 patients). Results were similar between the study groups with the exception of a higher rate of flap-related complications in patients undergoing XRT. Overall, 19 patients (31.7%) experienced flap-related complications, with 12% of the patients being in group 1 (N=3) versus 47% of patients being in group 2 (N=16) (p=0.003).Our data suggest that preoperative radiotherapy is associated with a significant increase in postoperative flap-related complications. However, these did not result in a prolonged hospital stay, reflecting the fact that the majority of flap-related complications can be managed on an outpatient basis. Although microsurgical reconstruction is frequently successful, patients with a history of XRT should be informed preoperatively about their increased risk of complications.

    View details for DOI 10.1016/j.bjps.2011.06.043

    View details for Web of Science ID 000296579400015

    View details for PubMedID 21783448

  • FREE TISSUE TRANSFER IN RECONSTRUCTION FOLLOWING SOFT TISSUE SARCOMA RESECTION MICROSURGERY Penna, V., Iblher, N., Momeni, A., Stark, G. B., Bannasch, H. 2011; 31 (6): 434-440

    Abstract

    Radical surgical resection remains the single-most important treatment in the curative multimodal therapy of soft tissue sarcomas. Refinements in surgical techniques have resulted in the development of function preserving approaches increasingly avoiding limb amputation.The records of all patients (n = 34) who underwent microsurgical soft tissue coverage subsequent to primary resection of soft tissue sarcoma of the upper or lower limb from 1999 to 2009 are reviewed regarding postoperative complications, time until start of adjuvant radiation and functional outcome (Toronto Extremity Salvage Score, TESS).Thirty-four patients (range: 21-86 years) received a total of 35 free flaps. Complete tumor resection was obtained in 33 patients, one patient required re-excision ultimately resulting in tumor-free margin status (R0 resection). Major complications were encountered in four cases including one patient with complete flap loss requiring an additional free flap and three patients with partial flap loss requiring split-thickness skin graft procedures. Minor complications were observed in three patients (9%). Extremity salvage could be achieved in 33 patients with adequate postoperative ambulation (TESS 84 ± 18) and adequate use of the upper extremity (TESS 80 ± 22). One patient underwent amputation. Mean time until start of adjuvant radiotherapy was 37 days (range 24-56 days).A synergetic center-based interdisciplinary approach is crucial in therapeutical management of soft tissue sarcomas with the aim of R0 resection status and limb preservation. Plastic surgery contributes by offering microsurgical reconstruction using free tissue transfer, thus broadening surgical possibilities. This increases the chance of both adequate oncosurgical resection and limb preservation.

    View details for DOI 10.1002/micr.20895

    View details for Web of Science ID 000295214400003

    View details for PubMedID 21630335

  • The use of the anterolateral thigh flap for microsurgical reconstruction of distal extremities after oncosurgical resection of soft-tissue sarcomas JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Kalash, Z., Stark, G. B., Bannasch, H. 2011; 64 (5): 643-648

    Abstract

    Prior to the advent of a multidisciplinary approach to the treatment of soft-tissue sarcomas, surgical treatment consisted of extremity amputation. Advances in treatment modalities such as radiotherapy allowed more limited resections with similar survival rates. As local control is the primary objective in the management of these neoplasms, distally located tumours pose a particular reconstructive challenge. Limb preservation is now possible due to the availability of microsurgical techniques. A retrospective analysis was conducted assessing the suitability of the free anterolateral thigh (ALT) flap for distal-extremity reconstruction after wide local excision of sarcomas. Nine patients were included in the study with a median follow-up period of 36 months. In all patients, tumours were located at or distal to the elbow and knee, respectively. All flaps survived. In one patient, the ALT donor site was addressed with a split-thickness skin graft after wound dehiscence was observed postoperatively after initial primary closure. The free ALT perforator flap is an ideal flap for the reconstruction of distal-extremity defects after sarcoma resection as it allows coverage of large skin defects with minimal donor-site morbidity. Its thinness addresses the shallow defects typically encountered in the distal extremity and thus avoids the bulkiness encountered after reconstruction with musculocutaneous flaps.

    View details for DOI 10.1016/j.bjps.2010.08.005

    View details for Web of Science ID 000289284800021

    View details for PubMedID 20829135

  • The Diagnosis and Treatment of Soft Tissue Sarcomas of the Limbs DEUTSCHES ARZTEBLATT INTERNATIONAL Bannasch, H., Eisenhardt, S. U., Grosu, A., Heinz, J., Momeni, A., Stark, G. B. 2011; 108 (3): 32-U24

    Abstract

    The diagnosis of soft-tissue sarcomas of the limbs is often delayed, sometimes markedly so, even though prompt and appropriate treatment improves survival and lowers the amputation rate.On the basis of a selective literature review and consideration of the relevant guidelines, we developed an algorithm that can serve as a guide to the diagnosis of soft-tissue tumors in general and to the treatment of soft-tissue sarcomas of the limbs.Surgical resection accompanied by multimodal therapy is the only treatment strategy for soft-tissue sarcoma that provides a chance of cure. Particularly when the tumor is located in the distal part of a limb, plastic-reconstructive surgical techniques often enable adequate local control, along with limb salvage and preservation of function. The role of adjuvant or neo-adjuvant radiotherapy and/or chemotherapy is currently debated. The overall survival rate at 5 years is 87% for low-grade sarcomas and 62% for high-grade sarcomas.Any solid mass of the limbs that has been present for more than four weeks requires diagnostic evaluation. Excisional biopsy is suitable only for epifascial lesions measuring less than 5 cm in diameter. All other lesions should be imaged with MRI and then diagnosed with an incisional biopsy. Patients with soft tissue sarcomas must be treated in an interdisciplinary collaboration so that they can undergo multimodal treatment. The proposed algorithm should help avoid delays in diagnosis and optimize treatment strategies.

    View details for DOI 10.3238/arztebl.2011.0032

    View details for Web of Science ID 000288600900002

    View details for PubMedID 21286000

  • Evidence-Based Medicine - Principles and Impact on Plastic Surgery HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE Momeni, A., Stark, G. B. 2010; 42 (6): 374-378

    Abstract

    The increasing importance of evidence-based medicine (EBM) is the result of an increasing demand for a rational decision-making process in healthcare. It has been demonstrated that 15-40% of decisions made in healthcare do not have a solid scientific basis. This is particularly problematic in times of limited financial resources, when reimbursement increasingly depends on how "evidence-based" a particular treatment is. Application of EBM principles in plastic surgery is therefore no longer an option. This, however, requires a basic understanding of the existing levels of evidence. In the present article, principles of EBM will be presented. The importance of randomized controlled trials and systematic reviews for plastic surgery will be highlighted along with a discussion of the quality of the plastic surgical literature based on results of recent systematic analyses. The plastic surgical community has appreciated the need for higher quality clinical studies. Improvement of the quality of reporting is, however, critical.

    View details for DOI 10.1055/s-0030-1263129

    View details for Web of Science ID 000286686100008

    View details for PubMedID 20814855

  • Abdominal Wall Strength: A Matched-Pair Analysis Comparing Muscle-Sparing TRAM Flap Donor-Site Morbidity with the Effects of Abdominoplasty PLASTIC AND RECONSTRUCTIVE SURGERY Momeni, A., Kim, R. Y., Heier, M., Bannasch, H., Stark, G. B. 2010; 126 (5): 1454-1459

    Abstract

    Microsurgical autologous breast reconstruction has evolved significantly over the last three decades. The muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), deep inferior epigastric artery perforator, and superficial inferior epigastric artery flaps have been developed to minimize abdominal donor-site morbidity. Assuming that harvest of the superficial inferior epigastric artery flap has the same impact on abdominal wall morbidity as performing an abdominoplasty, the authors designed a matched-pair analysis comparing patients' abdominal wall strength after muscle-sparing TRAM flap reconstruction with that after abdominoplasty.A total of 104 patients were included in the study. Fifty-two TRAM flap patients were matched with 52 abdominoplasty patients for age and body mass index. Outcome measures included postoperative complications, particularly hernia and abdominal bulge formation. Two surveys were used to assess patient satisfaction as well as the impact of the procedure on everyday life.Both study groups were similar with regard to age, body mass index, past medical history, and postoperative complication rate, including hernia and abdominal bulge formation. Results were similar between the study groups, with the exception of a higher rate of satisfaction with the appearance of the abdominal scar among TRAM flap patients (p=0.03) as well a lower likelihood of TRAM flap patients to engaging in sporting activities postoperatively (p=0.01).In the present study, the muscle-sparing TRAM flap did not result in a higher rate of postoperative complications related to abdominal wall morbidity. Differences observed regarding the postoperative level of activity are unlikely to be related to the surgical insult to the abdominal wall.

    View details for DOI 10.1097/PRS.0b013e3181ef904b

    View details for Web of Science ID 000283844700005

    View details for PubMedID 21042101

  • The Use of the Vacuum-Assisted Closure in Microsurgical Reconstruction Revisited: Application in the Reconstruction of the Posttraumatic Lower Extremity JOURNAL OF RECONSTRUCTIVE MICROSURGERY Eisenhardt, S. U., Momeni, A., Iblher, N., Penna, V., Schmidt, Y., Torio, N., Stark, G. B., Bannasch, H. 2010; 26 (9): 615-621

    Abstract

    Introduction of vacuum-assisted closure (VAC) system into clinical practice has revolutionized wound care. Despite its multiple advantages, however, the VAC is only rarely used in the setting of microsurgical reconstruction. Concerns have been the inability to clinically monitor the flap as well the possibility of flap compression by the device. The authors put their postoperative treatment concept of applying the VAC to free flaps to the test by reviewing their experience with this concept in patients undergoing microsurgical reconstruction of posttraumatic lower-extremity soft tissue defects. Twenty-six patients (22 male, 4 female) were included in this study. Use of the implantable Doppler probe allowed for postoperative flap monitoring. Two flap failures were observed, both in patients with peripheral vascular disease. In conclusion, using the VAC device in the setting of microsurgical reconstruction is safe and allows for increased patient comfort.

    View details for DOI 10.1055/s-0030-1267378

    View details for Web of Science ID 000283452100007

    View details for PubMedID 20922656

  • Effectiveness of the Asteame Nipple Guard (TM) in maintaining projection following nipple reconstruction: A prospective randomised controlled trial Rosing, J. H., Momeni, A., Kamperman, K., Kahn, D., Gurtner, G., Lee, G. K. ELSEVIER SCI LTD. 2010: 1592-1596

    Abstract

    As the final step in breast reconstruction, nipple reconstruction is considered a minor surgical procedure. However, despite the multitude of techniques and postoperative dressings proposed, none have proven to resist the tendency of the reconstructed nipple to gradually flatten over time. A prospective randomized controlled trial was conducted assessing the value of using the Asteame Nipple Guard™ compared to standard gauze dressing in maintaining nipple projection postoperatively. A total of 30 nipple reconstructions in 22 patients were included in the study with randomisation of 15 nipples to each study arm. Nipple projection was measured at various time points postoperatively with calculation of the percent changes in nipple projection. The mean decrease in long-term nipple projection at 6 months in the experimental group was 46.6% vs. 71.8% in the control group (p<0.05). In conclusion, the Nipple Guard™ helps in maintaining nipple projection postoperatively.

    View details for DOI 10.1016/j.bjps.2009.10.006

    View details for Web of Science ID 000281655500003

    View details for PubMedID 19897430

  • A CASE OF INTRAOPERATIVE VENOUS CONGESTION OF THE ENTIRE DIEP-FLAP-A NOVEL SALVAGE TECHNIQUE AND REVIEW OF THE LITERATURE MICROSURGERY Momeni, A., Lee, G. K. 2010; 30 (6): 443-446

    Abstract

    The deep inferior epigastric perforator (DIEP) flap is gaining popularity for autologous breast reconstruction as it reportedly reduces abdominal donor site morbidity when compared with the transverse rectus abdominis musculocutaneous (TRAM) flap. Disadvantages include greater technical difficulties during flap harvest and a greater incidence of vascular compromise. A well-known and feared complication is venous congestion which requires immediate intervention. We present a novel salvage technique in a case of total flap venous congestion in the setting of absent drainage via the deep inferior epigastric vein (DIEV). Utilizing the superficial venous system via the superficial inferior epigastric vein (SIEV) and using the DIEV as a venous interposition graft resulted in successful salvage of the DIEP flap.

    View details for DOI 10.1002/micr.20774

    View details for Web of Science ID 000282253300004

    View details for PubMedID 20878727

  • Complications After Flexor Tendon Injuries HAND CLINICS Momeni, A., Grauel, E., Chang, J. 2010; 26 (2): 179-?

    Abstract

    Management of flexor tendon injuries is one of the most demanding tasks in hand surgery. Despite substantial improvements in surgical technique and postoperative rehabilitation protocols, functional outcomes may still be somewhat unreliable. In the present article, the authors present complications encountered after flexor tendon repair and provide their preferred methods of prevention and treatment.

    View details for DOI 10.1016/j.hcl.2009.11.004

    View details for Web of Science ID 000278887200004

    View details for PubMedID 20494744

  • Single-Stage Microsurgical Reconstruction for Facial Palsy Utilising the Motor Nerve to the Masseter HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE Momeni, A., Eisenhardt, S., Stark, G. B., Bannasch, H. 2010; 42 (2): 95-101

    Abstract

    One of the most demanding areas in plastic surgery is reconstruction of the smile in the setting of facial palsy. A multitude of surgical techniques and approaches have been proposed with variable success rates. The most frequently applied treatment algorithm is a two-stage approach with placement of a cross-facial nerve graft (CFNG) initially and subsequent free functional muscle transfer. As this approach has several limitations, the authors have performed single-stage reconstructions utilising the motor nerve to the masseter as the donor nerve. Four patients underwent this single-stage reconstruction for facial palsy between July 2007 and May 2008. In all patients free functional transfer of the gracilis muscle was performed using the motor nerve to the masseter as the donor nerve. Outcome measures were functional result as well as patient satisfaction. The intraoperative as well as postoperative course was uneventful in all patients. In only one patient we encountered a small area of delayed wound healing which was amenable to conservative treatment. In all patients voluntary contraction of the gracilis muscle was visible after a mean period of 2.5 months. All patients displayed a high level of satisfaction with the functional result. Utilising the motor nerve to the masseter muscle as a donor nerve allows single-stage microsurgical reconstruction of the smile in the setting of facial palsy with reproducible results.

    View details for DOI 10.1055/s-0030-1249030

    View details for Web of Science ID 000276307900004

    View details for PubMedID 20217642

  • Ten Years Stable Internal Fixation of Metacarpal and Phalangeal Hand Fractures-Risk Factor and Outcome Analysis Show No Increase of Complications in the Treatment of Open Compared With Closed Fractures JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE Bannasch, H., Heermann, A. K., Iblher, N., Momeni, A., Schulte-Moenting, J., Stark, G. B. 2010; 68 (3): 624-628

    Abstract

    : Stable internal screw/plating systems for hand fractures have evolved during the last 20 years. The improved versatility leads to the increased use of these materials in open fractures, with the benefit of early mobilization. The aim of this retrospective study is to discern whether the broadening of the indications for these implants is accompanied by increased complication rates.: Data from 365 patients treated during the last 10 years at our department for metacarpal or phalangeal fractures with stable internal fixation by screw or plate were gathered and analyzed.: Uneventful bony consolidation was observed in 91.2% (n = 333). The functional results were excellent to acceptable in 85.2%, whereas in 14.8% (n = 54), the result was unsatisfactory, the latter group presenting with concominant soft tissue injury. There was no statistically significant difference in infection and nonunion rates when comparing open and closed fractures.: These results confirm that most patients with open metacarpal and phalangeal fractures can be treated by stable internal fixation.

    View details for DOI 10.1097/TA.0b013e3181bb8ea0

    View details for Web of Science ID 000275491200027

    View details for PubMedID 20220420

  • Distal phalangeal bone cysts: differentiation of enchondromata and epidermal cysts. journal of hand surgery, European volume Momeni, A., Iblher, N., Herget, G., Bley, T., Stark, G. B., Bannasch, H. 2010; 35 (2): 144-145

    Abstract

    Enchondromas are common in the hand but less frequent in the distal phalanges. Epidermal cysts are rare in the hand but when they occur can be difficult to differentiate from enchondromas both clinically and radiologically. Our review of seven distal phalangeal bone lesions treated over 7 years included four enchondromas and three epidermal cysts. The patients with epidermal cysts all had a history of previous penetrating trauma 5-8 years earlier. One patient with an enchondroma had a history of a penetrating injury. Patients presenting with distal phalangeal lesions and a history of previous penetrating injury appear more likely to have an epidermal cyst than an enchondroma. This is important as there may be a higher recurrence rate following curettage and bone grafting.

    View details for DOI 10.1177/1753193409349957

    View details for PubMedID 19828567

  • DISTAL PHALANGEAL BONE CYSTS: DIFFERENTIATION OF ENCHONDROMATA AND EPIDERMAL CYSTS JOURNAL OF HAND SURGERY-EUROPEAN VOLUME Momeni, A., Iblher, N., Herget, G., Bley, T., Stark, G. B., Bannasch, H. 2010; 35E (2): 144-145
  • Open Fracture and Soft tissue injury. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE Strohm, P. C., Bannasch, H., Helwig, P., Momeni, A., Stark, G. B., Suedkamp, N. P. 2010; 148 (1): 95-111

    View details for Web of Science ID 000274430700015

    View details for PubMedID 20151354

  • Association Between Research Sponsorship and Study Outcome in Plastic Surgery Literature ANNALS OF PLASTIC SURGERY Momeni, A., Becker, A., Bannasch, H., Antes, G., Bluemle, A., Stark, G. B. 2009; 63 (6): 661-664

    Abstract

    Financial and other competing interests have recently received increasing attention. In particular clinical research in plastic surgery attracts for-profit organizations, thus, explaining the increasing number of financial sponsorships. However, research articles often lack sufficient description of study design as well as disclosure of the source of funding. Furthermore, debate exists whether industry funding influences research findings and is leading to pro-industry results. A hand search was conducted identifying all randomized controlled (RCT) and controlled clinical trials (CCT) in 4 plastic surgery journals (Plastic and Reconstructive Surgery, British Journal of Plastic Surgery, Annals of Plastic Surgery, and Aesthetic Plastic Surgery) between 1990 and 2005. Subsequently, the influence of financial support on study outcome was analyzed. A total of 10,476 original articles were analyzed, resulting in the identification of 346 clinical trials which meet the Cochrane criteria for RCTs and CCTs. One hundred eighty-three trials and 163 studies were found to be RCTs and CCTs, respectively. Hereof, only 70 trials (20.2%) reported on grant support. Of these, 42 trials (60%) were supported by the industry. Depending on the topic addressed marked differences were detected regarding grant support. Studies with a focus on reconstructive plastic surgery were supported by the industry and by public institutions in almost equal shares (18 trials vs. 15 trials), whereas aesthetic surgical topics were predominantly funded by the industry (13 trials vs. 6 trials). Industry-funded trials reported more often statistically significant differences between treatment arms (28 trials vs. 16 trials). Authors' conclusions were found to be positively associated with financial competing interests. However, trial funding is rarely declared in the plastic surgery literature. Thus, the quality of reporting needs to be improved to be able to investigate these relationships in greater detail and draw more representative conclusions.

    View details for DOI 10.1097/SAP.0b013e3181951917

    View details for Web of Science ID 000272316400019

    View details for PubMedID 19887933

  • Complications in abdominoplasty: A risk factor analysis JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Heier, M., Bannasch, H., Stark, G. B. 2009; 62 (10): 1250-1254

    Abstract

    Abdominoplasty is one of the most popular body-contouring procedures. However, it is associated with a significant number of complications, the most common being seroma and wound-healing problems. In this study, we analysed postoperative complications following abdominoplasty and evaluated the presence of statistically significant correlations between pre-existing risk factors and postoperative complications.We carried out a retrospective chart review of all patients who underwent abdominoplasty from June 1994 to April 2004 at our institution. Patient demographics, risk factors (smoking, previous abdominal surgery, obesity, and male gender) and complications (minor and major) were noted from the patient's medical record.In all, 139 patients were included in the study (126 female and 13 male), with a mean age of 42.8 years at the time of surgery. Minor and major complications were seen in 40 (28.8%) and 16 patients (11.5%), respectively. Smoking and previous abdominal surgery were not associated with a significantly increased complication rate. However, patients without previous surgery displayed a significantly increased complication rate (43.2% vs. 22.1% for minor and 25% vs. 5.3% for major complications; p<0.05). Obesity (BMI >30 kg/m(2)) was associated with a significant increase in major complications (20.8% vs. 9.7%; p<0.05). Male gender was predisposed to increased minor and major complications; however, this was not statistically significant.Despite its popularity, abdominoplasty is still associated with a significant rate of complications. In particular, obese patients and those with no previous history of abdominal surgery seem to be at risk for complications. The role of male gender needs to be evaluated further.

    View details for DOI 10.1016/j.bjps.2008.03.043

    View details for Web of Science ID 000272523800004

    View details for PubMedID 18692451

  • The Free Gracilis Perforator Flap: Is a Perforator Flap Really Indicated in the Case of the Gracilis Flap? PLASTIC AND RECONSTRUCTIVE SURGERY Momeni, A., Bannasch, H., Lee, G. K. 2009; 124 (3): 1008-1009

    View details for DOI 10.1097/PRS.0b013e3181b03a79

    View details for Web of Science ID 000269485200055

    View details for PubMedID 19730342

  • Evidence-Based Plastic Surgery Controlled Trials in Three Plastic Surgical Journals (1990 to 2005) ANNALS OF PLASTIC SURGERY Momeni, A., Becker, A., Antes, G., Diener, M., Bluemle, A., Stark, B. G. 2009; 62 (3): 293-296

    Abstract

    Although a myriad of original articles is published annually in plastic surgical journals assessment of the level of evidence-based medicine has rarely been conducted. A hand search was conducted identifying randomized controlled (RCTs) and controlled clinical trials in 3 plastic surgical journals from 1990 to 2005. The quality of reporting was assessed and additional parameters investigated including report of statistical significance, type of institution, and country affiliation of the first author. Nine thousand four hundred twenty-eight original articles were analyzed of which 172 and 139 articles met the inclusion criteria for RCTs and controlled clinical trials, respectively. Fifty-nine RCTs reported on successful double-blinding with only 20 RCTs reporting the allocation concealment appropriately. Description of participant drop-outs was detected in 64 RCTs and a statistically significant result was reported in 118 RCTs. The annual publication of controlled trials has increased over the last 16 years, with the majority of controlled trials being from North-America and Europe. Execution and publication of controlled trials has increased in the plastic surgical literature. However, the quality of reporting deserves improvement.

    View details for DOI 10.1097/SAP.0b013e31818015ff

    View details for Web of Science ID 000263640800018

    View details for PubMedID 19240528

  • Correlation Between Complication Rate and Patient Satisfaction in Abdominoplasty ANNALS OF PLASTIC SURGERY Monieni, A., Heier, M., Torio-Padron, N., Penna, V., Bannasch, H., Stark, B. G. 2009; 62 (1): 5-6

    Abstract

    Abdominoplasty has become one of the most frequently performed procedures for improving body contour. Numerous reports exist focusing on postoperative complications with even more studies suggesting technical modifications to decrease their occurrence. However, the impact of complications on patient satisfaction has not been sufficiently addressed to date. A retrospective analysis was performed investigating the occurrence of complications following abdominoplasty and their effect on patient satisfaction. Patient satisfaction was assessed by means of the client satisfaction questionnaire-8. From June 1994 to April 2004 a total of 139 patients underwent an abdominoplasty. Minor and major complications were encountered in 40 (28.8%) and 16 (11.5%) patients, respectively. The median client satisfaction questionnaire-8 score among those patients with and without complications was 29. Thus, it seems that postoperative complications after abdominoplasty do not negatively affect patient satisfaction.

    View details for DOI 10.1097/SAP.0b013e318174f973

    View details for Web of Science ID 000262026000003

    View details for PubMedID 19131709

  • The Semi-Open Approach to the Gracilis Muscle Flap: Aesthetic Refinements in Gracilis Muscle Harvest JOURNAL OF RECONSTRUCTIVE MICROSURGERY Momeni, A., Bannasch, H. 2009; 25 (1): 63-67

    Abstract

    The gracilis muscle flap is certainly among the most versatile sources of vascularized tissue available for microsurgical reconstruction. However, the aesthetic appearance of the resultant scar has frequently been a source of dissatisfaction. Various minimal invasive techniques have been proposed, all of which aim to reduce scar formation. Drawbacks of endoscopic techniques, however, include a steep learning curve as well the need for special technical equipment. A semi-open approach without endoscopic assistance is presented, characterized by a short transverse incision in the groin area without a counterincision distally. This technique was performed in six patients (mean age, 48.8 years). Mean incision length was 8.8 cm, and average muscle harvesting time was 49 minutes. We suggest the semi-open approach to the gracilis muscle flap because it does not require special instruments and training and is characterized by easy performance and a short incision in the inconspicuous groin area with resultant better cosmesis.

    View details for DOI 10.1055/s-0028-1104560

    View details for Web of Science ID 000262164000010

    View details for PubMedID 19048464

  • Oncosurgical and reconstructive concepts in the treatment of soft tissue sarcomas: a retrospective analysis ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY Bannasch, H., Haivas, I., Momeni, A., Stark, G. B. 2009; 129 (1): 43-49

    Abstract

    Patients with soft tissue sarcomas are initially treated in community hospitals and in the private practice setting in the majority of cases. Thus, this disease entity is initially treated by surgeons with limited experience and expertise regarding the complex and demanding therapeutic regimen necessary to address this distinct group of malignancies.A retrospective analysis was conducted with a particular focus on factors affecting patient outcome, oncosurgical intervention, and plastic surgical reconstruction.A total of 75 patients were included in the study. Only 66% of all patients presented with a primary tumor. The remaining 34% presented with either local recurrence or distant metastasis. The oncosurgical procedure most commonly performed was wide excision (69%). However, amputation was unavoidable in 7% of cases. Single-step reconstruction included primary closure (19%), skin grafting (19%), local fascio- or myocutaneous flap transfer (31%), as well as free flap transfer (31%). 17 patients (20%) have deceased due to their underlying disease. Yet another 10% are alive with evidence of residual tumor. Kaplan-Meier analysis displayed significant differences in overall survival rate depending on disease stage upon initial presentation.Based on our data favorable oncological outcomes with satisfactory functional results and limb preservation are achievable if oncological principles for resection are respected and reconstruction is performed according to plastic surgical principles.

    View details for DOI 10.1007/s00402-008-0576-z

    View details for Web of Science ID 000260765800008

    View details for PubMedID 18210141

  • Reconstruction of distal phalangeal injuries with the reverse homodigital island flap INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Momeni, A., Zajonc, H., Kalash, Z., Stark, G. B., Bannasch, H. 2008; 39 (12): 1460-1463

    Abstract

    Reconstruction of extensive distal phalangeal defects with exposure of tendon, bone, or joint can be particularly a difficult problem. For assessment of the value of the reverse homodigital island flap patients with distal phalangeal avulsion and crush injuries who were treated from January 2005 to April 2006 were analysed retrospectively. Main outcome measurements included flap survival rate, sensory restoration, occurrence of cold intolerance, length of occupational disability, and joint mobility. Eleven patients were included in the study. Only one patient suffered from venous congestion with partial flap necrosis, requiring debridement with subsequent skin grafting. The minimum follow-up was 6 months. The static 2-point discrimination had a mean value of 9 mm. None of our patients complained of cold intolerance or residual joint contracture. All patients returned to full occupational activity within an average time period of 4.5 weeks. In conclusion, the reverse homodigital island flap is an excellent option for 1-stage reconstruction of distal phalangeal defects.

    View details for DOI 10.1016/j.injury.2008.02.015

    View details for Web of Science ID 000262072900020

    View details for PubMedID 18573493

  • The extended pectoralis major flap for reconstruction of the upper posterior chest wall and axilla JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Iblher, N., Penna, V., Momeni, A., Padron, N. T., Stark, G. B. 2008; 136 (3): 790-U141

    View details for DOI 10.1016/j.jtcvs.2007.11.066

    View details for Web of Science ID 000259327500037

    View details for PubMedID 18805291

  • Evidence-based plastic surgery - Controlled trials in three plastic surgical journals (1990-2005) ANNALS OF PLASTIC SURGERY Momeni, A., Becker, A., Antes, G., Diener, M., Bluemle, A., Bjoern, G. S. 2008; 61 (2): 221-225

    Abstract

    Although a myriad of original articles is published annually in plastic surgical journals, assessment of the level of evidence-based medicine has rarely been conducted. A hand search was conducted identifying randomized controlled trials (RCTs) and controlled clinical trials in 3 plastic surgical journals from 1990-2005. The quality of reporting was assessed and additional parameters investigated including report of statistical significance, type of institution, and country affiliation of the first author. Of the 9428 original articles that were analyzed, 172 and 139 articles met the inclusion criteria for RCTs and controlled clinical trials, respectively. Fifty-nine RCTs reported on successful double-blinding with only 20 RCTs reporting the allocation concealment appropriately. Description of participant drop-outs was detected in 64 RCTs and a statistically significant result was reported in 118 RCTs. The annual publication of controlled trials has increased over the last 16 years, with the majority of controlled trials being from North-America and Europe. Execution and publication of controlled trials has increased in the plastic surgical literature. However, the quality of reporting deserves improvement.

    View details for DOI 10.1097/SAP.0b013e31815f39dc

    View details for Web of Science ID 000257942200020

    View details for PubMedID 18650619

  • Technical refinements of composite thoracodorsal system free flaps for 1-stage lower extremity reconstruction resulting in reduced donor-site morbidity ANNALS OF PLASTIC SURGERY Bannasch, H., Strohm, P. C., Al Awadi, K., Stark, B., Momeni, A. 2008; 60 (4): 386-390

    Abstract

    A multitude of local flaps has been suggested for lower extremity reconstruction. However, the gold standard for defect coverage remains free tissue transfer. In this regard, the scapular vascular axis is a well-established source of expendable skin, fascia, muscle, and bone for use in free flap reconstruction of defects requiring bone and soft tissue in complex 3-dimensional relationships. Composite bone and soft-tissue flaps derived from the subscapular vascular axis include the osteocutaneous scapular flap, the "latissimus/bone flap," and the thoracodorsal artery perforator-scapular osteocutaneous flap.Patient outcome following reconstruction of lower extremity defects with composite free flaps from the thoracodorsal system were analyzed. Here, we demonstrate the execution of technical refinements on free composite flap transfers based on the thoracodorsal vascular axis, thus resulting in a stepwise reduction of donor-site morbidity.

    View details for DOI 10.1097/SAP.0b013e3180dc9a77

    View details for Web of Science ID 000254501600011

    View details for PubMedID 18362565

  • The "Rising-Sun-Technique" in abdominoplasty ANNALS OF PLASTIC SURGERY Momeni, A., Heier, M., Bannasch, H., Torio-Padron, N., Stark, G. B. 2008; 60 (4): 343-348

    Abstract

    A multitude of studies has been published focusing on different technical aspects of abdominoplasty. However, rarely has attention been drawn to skin closure techniques and its implications on postoperative scar length and complication rate. A retrospective analysis was conducted comparing a new comprehensive approach to skin closure with conventional techniques. Patients in each study group were matched for race, body mass index, gender, medical history, and smoking habits. We focused on postoperative scar length and rate of wound healing problems. Forty-six patients were included in each study group. Patients in whom wound closure was achieved via the technique presented here displayed a mean scar length of 33.68 cm (vs. 49.92 cm) and wound healing problems in 8.7% (vs. 23.9%). A marked reduction of scar length and postoperative wound healing problems is achievable with application of the technique presented in this article.

    View details for DOI 10.1097/SAP.0b013e31812f6df0

    View details for Web of Science ID 000254501600002

    View details for PubMedID 18362556

  • A New Method for Reducing Postoperative Complications and Scar Length in Abdominoplasty PLASTIC AND RECONSTRUCTIVE SURGERY Momeni, A., Torio-Padron, N., Bannasch, H., Borges, J., Stark, G. B. 2008; 121 (4): 227E-228E
  • Controlled trials in aesthetic plastic surgery: A 16-year analysis AESTHETIC PLASTIC SURGERY Becker, A., Bluemle, A., Antes, G., Bannasch, H., Torio-Padron, N., Stark, G. B., Momeni, A. 2008; 32 (2): 359-362

    Abstract

    Aesthetic surgery is one pillar of plastic surgery. Thus, not surprisingly, journals exist that focus predominantly on advances within this subspecialty. However, rarely has the process of systematic reviewing that identified randomized controlled trials (RCTs) and controlled clinical trials (CCTs) been conducted within this subspecialty. All original articles published in Aesthetic Plastic Surgery were analyzed to identify all RCTs and CCTs. The proportion of RCTs and CCTs in all original articles was determined, and the quality of reporting was assessed on the basis of established quality items. Additional parameters were investigated including reporting of statistically significant differences, type of institution, and country affiliation of the first author. Of the 1,048 original articles analyzed, 11 (1%) and 24 (2.3%) articles met the inclusion criteria for RCTs and CCTs, respectively. Only two studies were single blinded, whereas only one study reported on successful double blinding and appropriate allocation concealment. Notably, these trials were RCTs. Participant dropout was reported in one study. Statistically significant differences were reported in 18 trials, 6 of which were RCTs. The annual publication of RCTs has increased over the past 5 years. North America and Europe contributed a total of 28 controlled trials (80%). Controlled trials are being conducted in aesthetic surgery at a strikingly low rate. However, a recent increase in published RCTs reflects the recognition that performing outcome studies is pivotal in moving practice toward a foundation based on assessment by outcome. The quality of reporting, however, needs improvement.

    View details for DOI 10.1007/s00266-007-9075-9

    View details for Web of Science ID 000253680200027

    View details for PubMedID 18058165

  • Nipple reconstruction: Evidence-based trials in the plastic surgical literature AESTHETIC PLASTIC SURGERY Momeni, A., Becker, A., Torio-Padron, N., Iblher, N., Stark, G. B., Bannasch, H. 2008; 32 (1): 18-20

    Abstract

    Although many technical descriptions of nipple reconstruction exist in the medical literature, insufficient evidence-based data are present about the outcome. This study aimed to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) in the plastic surgical literature addressing nipple reconstruction, and to elucidate whether a hand search was superior to an extensive database search in retrieving all pertinent studies. The hand search included analysis of all "original articles" published in four of the leading plastic surgery journals from January 1990 to December 2005, with subsequent identification of RCTs and CCTs. Additionally, a computerized search was conducted including the following databases: PubMed, Web of Science, and Evidence-Based Medicine Reviews. From a total of 10,476 published original articles in four plastic surgery journals over a 16-year period, only one RCT was identified that addressed nipple reconstruction. The database search, however, retrieved two trials: the RCT identified by hand search and one CCT. The impact of nipple reconstruction is well described in the literature. However, it is astonishing that the plastic surgical literature lacks evidence-based trials addressing this issue. Clearly, more evidence-based trials are necessary to ensure that recommendations for a particular technique are based on solid scientific data.

    View details for DOI 10.1007/s00266-007-9039-0

    View details for Web of Science ID 000252159800004

    View details for PubMedID 17943342

  • A critical evaluation of the concomitant use of the implantable Doppler probe and the vacuum assisted closure system in free tissue transfer MICROSURGERY Bannasch, H., Iblher, N., Penna, V., Torio, N., Felmerer, G., Stark, G. B., Momeni, A. 2008; 28 (6): 412-416

    Abstract

    Introduction of the Vacuum-Assisted Closure (V.A.C.) system has revolutionized the approach to a multitude of clinical settings. Yet, its use precludes adequate clinical monitoring of skin-grafted free flaps, thus, making a reliable monitoring system essential if broad clinical application is aspired. In a clinical study, the usefulness of the combination of the V.A.C. and implantable Doppler probe was critically evaluated in patients with microsurgical lower extremity reconstruction. We retrospectively analyzed the usefulness of the implantable Doppler probe in five consecutive patients treated in our department from January to July 2007. Inclusion criteria were lower extremity reconstruction by means of skin-grafted free tissue transfers with subsequent application of the V.A.C. device. Five consecutive patients (four males, one female) with a mean age of 37.8 years (range, 8-58 years) matched the criteria mentioned above. Of note, the two pediatric patients (8-year-old male and 12-year-old female) suffered from significant posttraumatic stress disorder necessitating concomitant psychological care by the Department of Psychiatry. All flaps healed uneventfully displaying no signs of vascular compromise. Interpretation of the Doppler signal was simple and well received by the nursing staff. The combination of V.A.C. and the implantable Doppler probe enhances patient comfort due to a reduction of the number of dressing changes while still allowing continuous free flap monitoring. Interpretation of the signal transmitted by the probe is simple and potentially reduces misinterpretations due to different levels of experience.

    View details for DOI 10.1002/micr.20512

    View details for Web of Science ID 000259624400005

    View details for PubMedID 18623161

  • In vitro angiogenesis properties of endothelial progenitor cells: A promising tool for vascularization of ex vivo engineered tissues TISSUE ENGINEERING Finkenzeller, G., Torio-Padron, N., Momeni, A., Mehlhorn, A. T., Stark, G. B. 2007; 13 (7): 1413-1420

    Abstract

    Survival of ex vivo constructed tissues after transplantation is limited by insufficient oxygen and nutrient supply. Therefore, strategies aiming at the improvement of neovascularization of engineered tissues are a key issue. A method to enhance graft vascularization is to establish a primitive vascular plexus within the graft before transplantation by the use of cellular-based concepts. To explore the utility of endothelial progenitor cells (EPCs) for the ex vivo vascularization of tissue engineered grafts, we analyzed the in vitro angiogenic properties of this cell type in two different angiogenesis models: the 3-dimensional spheroid sprouting assay and the 2-dimensional matrigel assay. In both assays, EPCs were able to form tubelike structures, resembling early capillaries. This process was significantly enhanced by the addition of angiogenic growth factors. Direct comparison between EPCs and mature endothelial cells, represented by human umbilical vein endothelial cells (HUVECs), revealed that both cell types displayed an almost identical angiogenic potential. Other functional in vitro parameters such as angiogenic growth factor induced cell proliferation and cell survival were investigated as well, revealing a significantly decreased level of apoptosis of EPCs in relation to HUVECs under serum-deprived conditions. The observed survival advantage of EPCs along with the observation that EPCs perform very well in the above mentioned in vitro angiogenesis assays, make them an ideal autologous cell source for vascularization of ex vivo generated tissues. The attractiveness of this cell type for tissue engineering applications is strengthened further by the fact that these cells can be easily isolated from the peripheral blood of patients, thereby eliminating donor site morbidity.

    View details for DOI 10.1089/ten.2006.0369

    View details for Web of Science ID 000248035500003

    View details for PubMedID 17550338

  • Serotonin and 5-hydroxy indole acetic acid in infantile hydrocephalus PEDIATRIC SURGERY INTERNATIONAL Gopal, S. C., Sharma, V., Chansuria, J. P., Gangopadhyaya, A. N., Singh, T. B. 2007; 23 (6): 571-574

    Abstract

    The concentration of metabolites of neurohormones in cerebrospinal fluid (CSF) is an index of turnover of substances in brain parenchyma. The raised intracranial pressure in hydrocephalic children may cause alteration in the metabolism of neurohormones. Serotonin and its metabolite 5-HIAA have been studied extensively in CSF of patients with neuropsychiatric diseases. Hence we studied the neurohormones serotonin and its end product 5-hydroxy indole acetic acid (5-HIAA) in CSF of hydrocephalus infants before and after ventriculoperitoneal (VP) shunt. Ventricular CSF samples form 50 hydrocephalic infants were obtained serially at the time of shunt insertion, and then on day 8 and day 30 postoperatively by direct puncture from shunt chamber using 26G needles. Control CSF samples were taken from otherwise healthy children operated under spinal anesthesia. The samples were analyzed for serotonin and 5-HIAA by spectrofluorophotometric method. At the time of shunt insertion, serotonin was significantly decreased (P<0.05) while 5-HIAA was significantly increased (P<0.001) in hydrocephalic infants. On day 8 and day 30 values of serotonin and 5-HIAA approached the baseline values. In patients who developed VP shunt blockade there was again a rise in levels of 5-HIAA. However, no correlation could be established between the levels of serotonin, 5-HIAA and the duration of hydrocephalus and the type of hydrocephalus. Our study shows increased 5-HIAA concentration in CSF indicating increased turnover of serotonin to its metabolite due to pressure changes in hydrocephalus. Long-term follow-up is required to assess if they could be of prognostic significance as regards to long term attainment of brain functions in hydrocephalic children.

    View details for DOI 10.1007/s00383-006-1689-5

    View details for Web of Science ID 000246757500011

    View details for PubMedID 17380338

  • Engineering of adipose tissue by injection of human preadipocytes in fibrin AESTHETIC PLASTIC SURGERY Torio-Padron, N., Baerlecken, N., Momeni, A., Stark, G. B., Borges, J. 2007; 31 (3): 285-293

    Abstract

    Despite efforts of plastic surgeons in recent years to discover new alternatives, the techniques currently used for restoration of soft tissue defects still have disadvantages. The gold standard for soft tissue reconstruction remains autologous pedicled/free tissue transfer. This technique often results in high rates of operative morbidity and donor site deformity. Results obtained by autologous fat tissue transfer usually are disappointing because of a high graft resorption rate with unpredictable outcomes. Different tissue engineering approaches have been used in the past to generate adipose tissue. However, long-term results in terms of volume persistence have been disappointing.In this study, different concentrations of undifferentiated human preadipocytes in fibrin were injected into athymic nude mice (n = 8). Mice that had fibrin injection without cells served as control subjects (n = 8). The specimens were explanted after 1, 2, 6, and 9 months, with subsequent qualitative and quantitative analysis of adipose tissue formation by histologic and image analysis.Within the first 4 weeks after initial volume reduction of the implants, the volume and shape of the implants with preadipocytes remained stable. The implants without cells were completely resorbed within 3 weeks. Histologic analysis demonstrated generation of stable adipose tissue with no signs of an inflammatory response or evidence of tissue necrosis in the implants containing preadipocytes. The best results were obtained after implantation of 30 million preadipocytes. Adipose tissue formation was not observed in the control group.The findings demonstrate that long-term stable adipose tissue can be engineered in vivo by simple injection of human preadipocytes using fibrin as a carrier material. After further investigation, this approach may represent an alternative to the techniques currently used for soft tissue restoration.

    View details for DOI 10.1007/s00266-006-0221-6

    View details for Web of Science ID 000246220300013

    View details for PubMedID 17380359

  • Implantation of VEGF transfected preadipocytes improves vascularization of fibrin implants on the cylinder chorioallantoic membrane (CAM) model MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES Torio-Padron, N., Borges, J., Momeni, A., Mueller, M. C., Tegtmeier, F. T., Stark, G. B. 2007; 16 (3): 155-162

    Abstract

    The successful substitution or augmentation of soft tissues by implantation of three dimensional cell constructs, consisting of human preadipocytes and fibrin glue as a carrier matrix, requires a rapid and homogeneous vascularization of the whole implant in order to provide a sufficient blood supply of centrally situated cells. Previous investigations have shown that under in vivo conditions primary human preadipocytes induce vascularization of fibrin matrices by secretion of several growth factors, such as VEGF and bFGF. The current study investigates whether vascularization of implants can be improved by transplantation of preadipocytes following transfection with a VEGF-vector. Transfection was performed by electroporation with an pCMX-GFP and pCMX-VEGF165 vector. Transfection efficiency (GFP expression) and VEGF expression were determined in vitro by FACS analysis and VEGF immunoassay, respectively. In vivo investigations to determine the vascularization of the implants were performed on the cylinder chorioallantoic membrane (CAM). Four million VEGF transfected cells were transferred within a fibrin matrix onto the CAM on the 7(th) day of incubation and after 8 days the vascularization of the implant was histologically examined and evaluated by means of a computer-assisted image analysis program. Transfection of preadipocytes with the GFP vector by electroporation yielded transfection efficiencies between 12% and 41% of surviving cells. Results of the VEGF immunoassay demonstrated that VEGF expression was significantly higher following transfection. Investigations on the CAM outlined a significantly higher rate of vascularization in the transfected vs. control population. Our investigations demonstrate that primary human preadipocytes can be successfully transfected by electroporation with a VEGF vector. The enhanced VEGF expression on transfected cells results in an increase of vascularization of the cell constructs on the CAM.

    View details for DOI 10.1080/13645700701384116

    View details for Web of Science ID 000247724200004

    View details for PubMedID 17573620

  • In vitro analysis of the interactions between preadipocytes and endothelial cells in a 3D fibrin matrix MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES Borges, J., Mueller, M. C., Momeni, A., Stark, G. B., Torio-Padron, N. 2007; 16 (3): 141-148

    Abstract

    The volume-persistent survival of transplanted adipose tissue in vivo relies on early vascularization, due to an otherwise early induction of apoptosis of the centrally located cells. Thus, one way to enable the early formation of a capillary network resulting in a sufficient perfusion of the transplanted construct might be the co-transplantation of autologous preadipocytes with endothelial cells. To investigate preadipocyte-endothelial cell interaction, three-dimensional proliferation- and angiogenesis assays were performed in vitro. Proliferation rates of co-cultured endothelial cells and preadipocytes suspended in a fibrin matrix were elucidated by Alamarblue assays. The spheroid angiogenesis model was applied for analyzing the effects of vascular endothelial cell growth factor (VEGF) and basic fibroblast growth factor (bFGF) (produced by preadipocytes) as well as the impact of cell-cell interaction between preadipocytes and endothelial cells and fibrin matrix on endothelial cell migration. Preadipocytes proliferated in fibrin glue, whereas endothelial cells underwent apoptosis. By co-culturing, both cell types demonstrated an increased proliferation rate. Preadipocytes provoked migration of endothelial cells. Blocking bFGF and/or VEGF led to a significant decrease of migration. Changes in fibrin structure were followed by migration of single cells instead of sprouting. An appropriate fibrin matrix as well as already differentiated endothelial cells are necessary for preadipocytes to develop their angiogenic activity via bFGF and VEGF.

    View details for DOI 10.1080/13645700600935398

    View details for Web of Science ID 000247724200002

    View details for PubMedID 17573618

  • Early Marjolin's ulcer in Bureau-Barriere syndrome. international journal of lower extremity wounds Momeni, A., Stark, G. B. 2006; 5 (3): 204-206

    Abstract

    Bureau-Barrière syndrome (BBS) describes a rare destructive process affecting skin and bone resulting from an acquired unilateral or bilateral polyneuropathy. Clinically, it is characterized by a triad of symptoms, namely, acral ulcerations, polyneuropathy, and bone lesions. To date, the development of Marjolin's ulcer in the course of BBS has not been described to the authors' knowledge.

    View details for PubMedID 16928676

  • Adipose precursor cells (preadipocytes) induce formation of new vessels in fibrin glue on the newly developed cylinder chorioallantoic membrane model (CAM) MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES Borges, J., Torio-Padron, N., Momeni, A., Mueller, M. C., Tegtmeier, F. T., Stark, B. G. 2006; 15 (4): 246-252

    Abstract

    Successful augmentation of soft tissues by transplantation of preadipocytes within a matrix requires the formation of a new capillary network with connection to the host vessel system. Particularly, cells located centrally within the transplanted cell-matrix-construct represent a population with a blood supply questionable for survival. We demonstrated that under in vivo conditions preadipocytes possess the ability to induce and support the vascularization of the implant presumably by expression of several growth factors, such as VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor). Fertilized White-Leghorn eggs were incubated under standardized conditions. Opening was performed at day three of incubation and preadipocytes with and without recombinant growth factors were transferred into a fibrin matrix and subsequently placed on the Chorioallantoic Membrane (CAM), respectively. Eight days later, the implanted constructs were explanted, histologically processed and vascularization evaluated by means of a computer-assisted image analysis program. Matrices containing preadipocytes displayed a significantly higher density of vascularization, whereas in the control group (fibrin without preadipocytes) no vessel ingrowth was observed. Daily application of recombinant growth factors added to the medium did not positively influence vascularization of the implant. Our investigations demonstrate that preadipocytes possess a strong angiogenic potential to induce and support neovascularization of 3D-fibrin matrices under in vivo conditions. Addition of recombinant growth factors did not result in any stimulatory effect. Neither did the application of fibrin alone demonstrate an angiogenic potential with regard to induction of vascularization.

    View details for DOI 10.1080/14017450600761620

    View details for Web of Science ID 000240435100009

    View details for PubMedID 16966139

  • The application of endoscopy in aesthetic breast surgery HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE Momeni, A., Bannasch, H., Torio-Padron, N., Borges, J., Stark, G. B. 2006; 38 (3): 144-148

    Abstract

    During the last decades, numerous surgical techniques have been described for breast augmentation. In addition to the very popular inframammary and the periareolar approaches, the transaxillary technique provides an elegant means of conducting a safe and accurate implant placement without producing visible scars on the breast mound. Due to a questionable lack of intraoperative visualisation with resultant higher complication rates,we conducted a retrospective analysis comparing the endoscopy-assisted transaxillary approach with the inframammary technique. A retrospective analysis was conducted comparing the endoscopy-assisted transaxillary approach with the more commonly chosen inframammary aditus. Patients undergoing breast augmentation from 1997 to 2005 were analysed retrospectively. The analysis was conducted in patients undergoing this procedure for aesthetic reasons only. Underlying breast pathology as well as previously performed breast surgery were among the exclusion criteria. The Client Satisfaction Questionnaire (CSQ-8) was applied for assessment of patient satisfaction. From 1997 to 2005, 96 patients underwent breast augmentation at our institution. Implant volumes ranged from 150 to 400 ml.62.5% preferred the transaxillary technique vs. 37.5% who chose the inframammary route. Complication rates were low in both patient subsets, the statistics revealing no differences. Assessment of patient satisfaction displayed high levels of satisfaction in both groups without any significant differences. The endoscopy-assisted transaxillary breast augmentation is a safe technique which generates high levels of patient satisfaction. Predictable results can be achieved by this approach which is preferred by the majority of patients when offered.

    View details for DOI 10.1055/s-2006-924252

    View details for Web of Science ID 000242047800003

    View details for PubMedID 16883498

  • The free fibular flap: A useful flap for reconstruction following composite hand injuries JOURNAL OF HAND SURGERY-BRITISH AND EUROPEAN VOLUME Momeni, A., Stark, G. B. 2006; 31B (3): 304-305
  • The free fibular flap: a useful flap for reconstruction following composite hand injuries. Journal of hand surgery (Edinburgh, Scotland) Momeni, A., Stark, G. B. 2006; 31 (3): 304-305

    Abstract

    The free fibular flap has been used extensively in facial and extremity long bone reconstruction but has not been presented as a tool for reconstruction following composite hand injuries, in particular for reconstruction of the ulnar border of the hand. We present a case of the use of this flap for reconstruction of such a complex composite hand injury.

    View details for PubMedID 16621209

  • Endoscopic transaxillary subpectoral augmentation mammaplasty: A safe and predictable procedure JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY Momeni, A., Padron, N. T., Bannasch, H., Borges, J., Stark, G. B. 2006; 59 (10): 1076-1081

    Abstract

    During the last decades breast augmentation has gained worldwide acceptance. In addition to the inframammary and periareolar approach for augmentation mammaplasty, the transaxillary route provides an elegant means of retaining the integrity of the breast mound by avoiding visible scars. Due to concerns as to the safety of this technique we analysed 47 patients who underwent endoscopy-assisted transaxillary submuscular augmentation mammaplasty in our department from 1999 to 2004. The inclusion criteria were aesthetic breast augmentation due to breast hypoplasia. Patients with a history of breast cancer, other malignancies, or previously performed mastectomy were excluded. Procedures for tuberous breast deformity as well as concomitantly performed mastopexy were also excluded. No complications were observed impairing final outcome or requiring early operative intervention, such as infection or haematoma. This technique is suitable for patients who prefer a hidden incision at a distant site, and provides predictability of aesthetic outcome and is safe.

    View details for DOI 10.1016/j.bjps.2006.01.031

    View details for Web of Science ID 000241412700011

    View details for PubMedID 16996432

  • The thoracodorsal artery perforator flap with a vascularized scapular segment for reconstruction of a composite lower extremity defect MICROSURGERY Momeni, A., Krischak, S., Bannasch, H. 2006; 26 (7): 515-518

    Abstract

    High-energy trauma resulting in a composite defect of the lower extremity confronts the microvascular surgeon with more difficulties than do free flap reconstruction elsewhere in the body, since the choice of distant recipient vessels is particularly difficult. Combining principles of perforator flap surgery with those of composite tissue transfer, we designed a thoracodorsal artery perforator flap with a vascularized bone segment from the scapula for reconstruction of a composite lower extremity defect in a patient following a paragliding accident. This is the first report on the application of a composite thoracodorsal artery perforator flap with vascularized scapula in lower extremity reconstruction. Among its multiple advantages, such as preservation of latissimus dorsi function, it is a good tool for one-stage reconstruction of traumatic composite lower extremity defects because its low donor site morbidity and long vascular pedicle enables anastomosis placement outside the zone of injury.

    View details for DOI 10.1002/micr.20279

    View details for Web of Science ID 000241801500005

    View details for PubMedID 17001635

  • Safety, complications, and satisfaction of patients undergoing submuscular breast augmentation via the inframammary and endoscopic transaxillary approach AESTHETIC PLASTIC SURGERY Momeni, A., Padron, N. T., Fohn, M., Bannasch, H., Borges, J., Ryu, S. M., Stark, G. B. 2005; 29 (6): 558-564

    Abstract

    Since its introduction, augmentation mammaplasty has gained widespread popularity, as demonstrated by the fact that an estimated 2 million women in the United States have received implants. During recent decades, several surgical approaches have evolved in terms of implant placement or site of access to the surgical plane. Debate has existed concerning the questionable superiority of a particular technique for achievement of optimal results. Thus, the inframammary approach, an established and widely accepted technique for breast augmentation, and endoscopically assisted transaxillary breast augmentation were retrospectively compared in terms of safety and aesthetic outcome, as measured, respectively, by the rate of postoperative complications and patient satisfaction.This study analyzed 78 patients undergoing augmentation mammaplasty between 1997 and 2004. Only patients seeking primary augmentation mammaplasty solely for aesthetic reasons were included in the study. Previously performed breast surgery and simultaneously conducted ipsilateral mastopexy were among the exclusion criteria. Patient satisfaction was assessed using the client satisfaction questionnaire (CSQ-8) because of its easy applicability.The complication rate was low in both patient subsets, thus confirming the safety of the transaxillary approach, as compared with the more common submammary technique. However, a higher level of satisfaction was detected in the former patient group, indicating a more favorable aesthetic outcome with the transaxillary augmentation mammaplasty.Endoscopically assisted transaxillary augmentation mammaplasty is a safe method with predictable results associated with a high level of patient satisfaction. If applied in the setting of appropriate indications, it is an excellent tool for use with patients who prefer to have an incision at a distant site.

    View details for DOI 10.1007/s00266-005-0095-z

    View details for Web of Science ID 000234298300022

    View details for PubMedID 16237580

  • Tissue engineering of skin substitutes PANMINERVA MEDICA Bannasch, H., Momeni, A., Knam, E., Stark, G. B., Fohn, M. 2005; 47 (1): 53-60

    Abstract

    Cultivated epithelial autografts as multilayered thin sheets represent common standard in clinically applied tissue engineering substitutes, outnumbering all experimental alternatives. However, the unsatisfying short and long term results concerning mechanical stability and scarring demand for alternatives. Our group investigated cultivation and transplantation of cultured autologous keratinocytes as a single cell suspension in a fibrin sealant matrix in athymic mice in combination with allogenic skin grafting. We observed reliable wound reepithialization after a cultivation period of only 2 weeks. Additionally, we could allocate successful combination of a keratinocyte fibrin sealant suspension and acellular dermis in an attempt to regenerate full thickness skin defects in a pig animal model. The potential clinical implication of subconfluently cultured keratinocytes is enhanced by the possibility of co-transplantation with decellularized dermis.

    View details for Web of Science ID 000230564700006

    View details for PubMedID 15985977

  • Enzymatically modified LDL induces cathepsin H in human monocytes - Potential relevance in early atherogenesis ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY Han, S. R., Momeni, A., Strach, K., Suriyaphol, P., Fenske, D., Paprotka, K., Hashimoto, S., Torzewski, M., Bhakdi, S., Husmann, M. 2003; 23 (4): 661-667

    Abstract

    Modification with proteases and cholesterylesterase transforms LDL to a moiety that resembles lipoproteins isolated from atherosclerotic lesions and possesses atherogenic properties. To identify changes in monocyte-derived foam cells laden with enzymatically modified LDL (E-LDL), we compared patterns of the most abundant transcripts in these cells after incubation with LDL or E-LDL.Serial analyses of gene expression (SAGE) libraries were constructed from human monocytes after treatment with LDL or E-LDL. Several tags were differentially expressed in LDL-treated versus E-LDL-treated cells, whereby marked selective induction by E-LDL of cathepsin H was conspicuous. We show that cathepsin H is expressed in atherosclerotic lesions in colocalization with E-LDL. Furthermore, we demonstrate that LDL modified with cathepsin H and cholesterylesterase can confer onto LDL the capacity to induce macrophage foam cell formation and to induce cathepsin H.Cathepsin H could contribute to the transformation of LDL to an atherogenic moiety; the process might involve a self-sustaining amplifying circle.

    View details for DOI 10.1161/01.ATV.0000063615.21233.BF

    View details for Web of Science ID 000182165100021

    View details for PubMedID 12615673