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Areas of Active Research

Figure Diagram

Clinical research in the Division of Plastic Surgery at the University of Pennsylvania investigates a broad range of topics in plastic and general surgery. Our residents, fellows, and students are continually developing new research endeavors and arranging intra- and inter-institution collaborations. The majority of this research can be divided into the broad categories depicted here. Please click on an area of interest to find out more about the latest investigations in this area and recent publications. Contact information is also listed for each area of interest. Please do not hesitate to get in touch to find out more or get involved with the Penn Plastic Surgery Research Group.

 

 

 

 

 

 

 

 

 

BreastAutologous Breast Reconstruction

The plastic surgery faculty at Penn performs autologous breast reconstructions for well over 200 patients a year, forming one of the most clinically active programs in the country. This flurry of clinical activity forms a wealth of data for research inquiries. Every patient who receives breast reconstruction is logged into a prospectively maintained database, allowing for numerous intra-institution studies. In tandem, our researchers have based several lines of investigation on national datasets, employing advanced statistics to track longitudinal outcomes, cost and subsequently validate their models.

 

 

Selected Publications

  1. Fischer, J. P., Nelson, J. A., Cleveland, E., Sieber, B., Rohrbach, J. I., Serletti, J. M., Kanchwala, S. Breast reconstruction modality outcome study: a comparison of expander/implants and free flaps in select patients. Plast Reconstr Surg 2013;131:928-934.
  2. Fischer, J. P., Nelson, J. A., Sieber, B., Cleveland, E., Kovach, S. J., Wu, L. C., Serletti, J. M., Kanchwala, S. Free tissue transfer in the obese patient: an outcome and cost analysis in 1258 consecutive abdominally based reconstructions. Plast Reconstr Surg 2013;131:681e-692e.
  3. Fischer, J. P., Sieber, B., Nelson, J. A., Cleveland, E., Kovach, S. J., Wu, L. C., Kanchwala, S., Serletti, J. M. Comprehensive outcome and cost analysis of free tissue transfer for breast reconstruction: an experience with 1303 flaps. Plast Reconstr Surg 2013;131:195-203.
  4. Fischer, J. P., Wes, A. M., Nelson, J. A., Basta, M., Rohrbach, J. I., Wu, L. C., Serletti, J. M., Kovach, S. J. Propensity-matched, longitudinal outcomes analysis of complications and cost: comparing abdominal free flaps and implant-based breast reconstruction. J Am Coll Surg 2014;219:303-312.
  5. Wink, J. D., Fischer, J. P., Nelson, J. A., Serletti, J. M., Wu, L. C. Direct-to-implant breast reconstruction: An analysis of 1612 cases from the ACS-NSQIP surgical outcomes database. J Plast Surg Hand Surg 2014;48:375-381.
  6. Wes, A. M., Cleveland, E., Nelson, J. A., Fischer, J. P., Kovach, S. J., Kanchwala, S., Serletti, J. M., Wu, L. C. Do Prior Abdominal Surgeries Increase Complications in Abdominally Based Breast Reconstructions? Ann Plast Surg 2014.
  7. Nelson, J. A., Stransky, C. A., Fischer, J. P., Fosnot, J., Serletti, J. M., Wu, L. C. Reexamining free flap breast reconstruction in the community and university setting: is there a difference? Ann Plast Surg 2014;73 Suppl 2:S171-174.
  8. Nelson, J. A., Fischer, J. P., Yan, C., Fosnot, J., Selber, J. C., Wu, L. C., Serletti, J. M., Kanchwala, S. The impact of obesity on abdominal wall function after free autologous breast reconstruction. Microsurgery 2014;34:352-360.
  9. Nelson, J. A., Fischer, J. P., Radecki, M. A., Pasick, C., McGrath, J., Serletti, J. M., Wu, L. C. Delayed autologous breast reconstruction: factors which influence patient decision making. J Plast Reconstr Aesthet Surg 2013;66:1513-1520.
  10. Nelson, J. A., Fischer, J. P., Pasick, C., Nelson, P., Chen, A. J., Fosnot, J., Selber, J. C., Wu, L. C., Serletti, J. M. Chronic pain following abdominal free flap breast reconstruction: a prospective pilot analysis. Ann Plast Surg 2013;71:278-282.
  11. Nelson, J. A., Fischer, J. P., Grover, R., Mirzabeigi, M. N., Nelson, P., Wes, A. M., Au, A., Serletti, J. M., Wu, L. C. Intraoperative perfusion management impacts postoperative outcomes: An analysis of 682 autologous breast reconstruction patients. J Plast Reconstr Aesthet Surg 2014.
  12. Nelson, J. A., Fischer, J. P., Grover, R., Cleveland, E., Erdmann-Sager, J., Serletti, J. M., Wu, L. C. The impact of anemia on microsurgical breast reconstruction complications and outcomes. Microsurgery 2014;34:261-270.
  13. Nelson, J. A., Fischer, J. P., Chung, C. U., Fosnot, J., Selber, J. C., Serletti, J. M., Wu, L. C. Preoperative anemia impacts early postoperative recovery following autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2014;67:797-803.
  14. Grover, R., Nelson, J. A., Fischer, J. P., Kovach, S. J., Serletti, J. M., Wu, L. C. The impact of perforator number on deep inferior epigastric perforator flap breast reconstruction. Archives of plastic surgery 2014;41:63-70.
  15. Fosnot, J., Fischer, J. P., Smartt, J. M., Jr., Low, D. W., Kovach, S. J., 3rd, Wu, L. C., Serletti, J. M. Does previous chest wall irradiation increase vascular complications in free autologous breast reconstruction? Plast Reconstr Surg 2011;127:496-504.
  16. Fischer, J. P., Wes, A. M., Tuggle, C. T., Wu, L. C. Venous thromboembolism risk in mastectomy and immediate breast reconstruction: analysis of the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program data sets. Plast Reconstr Surg 2014;133:263e-273e.
  17. Fischer, J. P., Wes, A. M., Tuggle, C. T., Nelson, J. A., Tchou, J. C., Serletti, J. M., Kovach, S. J., Wu, L. C. Mastectomy with or without immediate implant reconstruction has similar 30-day perioperative outcomes. J Plast Reconstr Aesthet Surg 2014;67:1515-1522.
  18. Fischer, J. P., Wes, A. M., Tuggle, C. T., Serletti, J. M., Wu, L. C. Risk analysis and stratification of surgical morbidity after immediate breast reconstruction. J Am Coll Surg 2013;217:780-787.
  19. Fischer, J. P., Wes, A. M., Tuggle, C. T., 3rd, Serletti, J. M., Wu, L. C. Risk analysis of early implant loss after immediate breast reconstruction: a review of 14,585 patients. J Am Coll Surg 2013;217:983-990.
  20. Fischer, J. P., Wes, A. M., Kanchwala, S., Kovach, S. J. Effect of BMI on modality-specific outcomes in immediate breast reconstruction (IBR)--a propensity-matched analysis using the 2005-2011 ACS-NSQIP datasets. J Plast Surg Hand Surg 2014;48:297-304.
  21. Fischer, J. P., Nelson, J. A., Au, A., Tuggle, C. T., 3rd, Serletti, J. M., Wu, L. C. Complications and morbidity following breast reconstruction--a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg 2014;48:104-114.
  22. Fischer, J. P., Nelson, J. A., Kovach, S. J., Serletti, J. M., Wu, L. C., Kanchwala, S. Impact of obesity on outcomes in breast reconstruction: analysis of 15,937 patients from the ACS-NSQIP datasets. J Am Coll Surg 2013;217:656-664.
  23. Fischer, J. P., Nelson, J. A., Mirzabeigi, M. N., Serletti, J. M., Kanchwala, S. Perioperative hemodynamics in free flap breast reconstruction: incidence, predictors, and management of tachycardia. Ann Plast Surg 2012;69:356-360.
  24. Fischer, J. P., Nelson, J. A., Serletti, J. M., Kanchwala, S. Breast reconstruction in the morbidly obese patient: assessment of 30-day complications using the 2005 to 2010 national surgical quality improvement program data sets. Plast Reconstr Surg 2014;133:882e-883e.
  25. Fischer, J. P., Nelson, J. A., Serletti, J. M., Wu, L. C. Peri-operative risk factors associated with early tissue expander (TE) loss following immediate breast reconstruction (IBR): a review of 9305 patients from the 2005-2010 ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg 2013;66:1504-1512.
  26. Fischer, J. P., Nelson, J. A., Sieber, B., Stransky, C., Kovach, S. J., Serletti, J. M., Wu, L. C. Transfusions in autologous breast reconstructions: an analysis of risk factors, complications, and cost. Ann Plast Surg 2014;72:566-571.
  27. Fischer, J. P., Tuggle, C. T., Au, A., Kovach, S. J. A 30-day risk assessment of mastectomy alone compared to immediate breast reconstruction (IBR). J Plast Surg Hand Surg 2014;48:209-215.
  28. Lu, S. M., Nelson, J. A., Fischer, J. P., Fosnot, J., Goldstein, J., Selber, J. C., Serletti, J. M., Wu, L. C. The impact of complications on function, health, and satisfaction following abdominally based autologous breast reconstruction: a prospective evaluation. J Plast Reconstr Aesthet Surg 2014;67:682-692.
  29. Nelson, J. A., Guo, Y., Sonnad, S. S., Low, D. W., Kovach, S. J., 3rd, Wu, L. C., Serletti, J. M. A Comparison between DIEP and muscle-sparing free TRAM flaps in breast reconstruction: a single surgeon's recent experience. Plast Reconstr Surg 2010;126:1428-1435.
  30. Del Corral, G. A., Wes, A. M., Fischer, J. P., Serletti, J. M., Wu, L. C. Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures. Ann Plast Surg 2014.
  31. Selber, J. C., Bergey, M., Sonnad, S. S., Kovach, S., Wu, L., Serletti, J. M. Free flap breast reconstruction in advanced age: is it safe? Plast Reconstr Surg 2009;124:1015-1022.
  32. Selber, J. C., Nelson, J. A., Ashana, A. O., Bergey, M. R., Bristol, M. N., Sonnad, S. S., Serletti, J. M., Wu, L. C. Breast cancer screening prior to cosmetic breast surgery: ASPS members' Adherence to American Cancer Society Guidelines. Plast Reconstr Surg 2009;124:1375-1385.
  33. Jandali, S., Wu, L. C., Vega, S. J., Kovach, S. J., Serletti, J. M. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010;125:792-798.
  34. Selber, J. C., Fosnot, J., Nelson, J., Goldstein, J., Bergey, M., Sonnad, S., Serletti, J. M. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: Part II. Bilateral reconstruction. Plast Reconstr Surg 2010;126:1438-1453.
  35. Selber, J. C., Nelson, J., Fosnot, J., Goldstein, J., Bergey, M., Sonnad, S. S., Serletti, J. M. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: part I. unilateral reconstruction. Plast Reconstr Surg 2010;126:1142-1153.
  36. Mirzabeigi, M. N., Au, A., Jandali, S., Natoli, N., Sbitany, H., Serletti, J. M. Trials and tribulations with the inferior gluteal artery perforator flap in autologous breast reconstruction. Plast Reconstr Surg 2011;128:614e-624e.
  37. Mirzabeigi, M. N., Sbitany, H., Jandali, S., Serletti, J. M. The role of postoperative antibiotics in reducing biofilm-related capsular contracture in augmentation mammaplasty. Plast Reconstr Surg 2011;128:34e-35e.
  38. Sbitany, H., Serletti, J. M. Acellular dermis-assisted prosthetic breast reconstruction: a systematic and critical review of efficacy and associated morbidity. Plast Reconstr Surg 2011;128:1162-1169.
  39. Serletti, J. M., Fosnot, J., Nelson, J. A., Disa, J. J., Bucky, L. P. Breast reconstruction after breast cancer. Plast Reconstr Surg 2011;127:124e-135e.
  40. Mirzabeigi, M. N., Lee, M., Smartt, J. M., Jr., Jandali, S., Sonnad, S. S., Serletti, J. M. Extended trimethoprim/sulfamethoxazole prophylaxis for implant reconstruction in the previously irradiated chest wall. Plast Reconstr Surg 2012;129:37e-45e.
  41. Mirzabeigi, M. N., Wang, T., Kovach, S. J., Taylor, J. A., Serletti, J. M., Wu, L. C. Free flap take-back following postoperative microvascular compromise: predicting salvage versus failure. Plast Reconstr Surg 2012;130:579-589.
  42. Nelson, J. A., Kim, E. M., Eftekhari, K., Low, D. W., Kovach, S. J., Wu, L. C., Serletti, J. M. Late venous thrombosis in free flap breast reconstruction: strategies for salvage after this real entity. Plast Reconstr Surg 2012;129:8e-15e.
  43. Nelson, J. A., Nelson, P., Tchou, J., Serletti, J. M., Wu, L. C. The ethnic divide in breast reconstruction: a review of the current literature and directions for future research. Cancer treatment reviews 2012;38:362-367.
  44. Nelson, J. A., Tchou, J., Domchek, S., Sonnad, S. S., Serletti, J. M., Wu, L. C. Breast reconstruction in bilateral prophylactic mastectomy patients: factors that influence decision making. J Plast Reconstr Aesthet Surg 2012;65:1481-1489.
  45. Sbitany, H., Mirzabeigi, M. N., Kovach, S. J., Wu, L. C., Serletti, J. M. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconstr Surg 2012;129:809-815.
  46. Wang, T. Y., Serletti, J. M., Cuker, A., McGrath, J., Low, D. W., Kovach, S. J., Wu, L. C. Free tissue transfer in the hypercoagulable patient: a review of 58 flaps. Plast Reconstr Surg 2012;129:443-453.
  47. Wang, T. Y., Serletti, J. M., Kolasinski, S., Low, D. W., Kovach, S. J., Wu, L. C. A review of 32 free flaps in patients with collagen vascular disorders. Plast Reconstr Surg 2012;129:421e-427e.

Abdominal Wall Reconstruction

Abdominal WallVentral hernia is a widely prevalent and heavily burdensome problem from the patient, provider, and healthcare system perspectives. As one of our most active clinical and research areas at Penn, our endeavors in complex abdominal wall reconstruction are numerous and varied. A few of our primary areas of interest include outcomes, cost-utility, and health related quality of life. Recent publications have focused on risk-assessment and stratification for patient selection and preoperative counseling with regards to morbidity and the placement of prophylactic mesh. We have also attempted to better characterize the impact of this disease state through targeted market research and survey administration. Other studies have ranged from cost containment to intraoperative strategies to optimize postoperative outcomes. Finally, several studies in this area pair with our active research in autologous breast reconstruction by describing the changes in the abdominal wall after autologous breast reconstruction.

Selected Publications

  1. Mirzabeigi MN, Wilson AJ, Fischer JP, Basta M, Kanchwala S, Kovach SJ, Serletti JM, Wu LC. Predicting and managing donor-site wound complications in abdominally based free flap breast reconstruction: improved outcomes with early reoperative closure. Plast Reconstr Surg. 2015 Jan;135(1):14-23. doi: 10.1097/PRS.0000000000000805. PubMed PMID: 25539292.
  2. Basta MN, Fischer JP, Kovach SJ. Assessing complications and cost-utilization in ventral hernia repair utilizing biologic mesh in a bridged underlay technique. Am J Surg. 2015 Apr;209(4):695-702. doi: 10.1016/j.amjsurg.2014.04.017. Epub 2014 Jul 11. PubMed PMID: 25305799.
  3. Fischer JP, Basta MN, Wink JD, Wes AM, Kovach SJ. Optimizing patient selection in ventral hernia repair with concurrent panniculectomy: an analysis of 1974 patients from the ACS-NSQIP datasets. J Plast Reconstr Aesthet Surg. 2014 Nov;67(11):1532-40. doi: 10.1016/j.bjps.2014.07.001. Epub 2014 Jul 12. PubMed PMID: 25085825.
  4. Fischer JP, Wes AM, Wink JD, Nelson JA, Rohrbach JI, Braslow BM, Kovach SJ. Analysis of perioperative factors associated with increased cost following abdominal wall reconstruction (AWR). Hernia. 2014 Oct;18(5):617-24. doi: 10.1007/s10029-014-1276-y. Epub 2014 Jul 20. PubMed PMID: 25038893.
  5. Wink JD, Wes AM, Fischer JP, Nelson JA, Stranksy C, Kovach SJ 3rd. Risk factors associated with early failure in complex abdominal wall reconstruction: A 5 year single surgeon experience. J Plast Surg Hand Surg. 2015 Apr;49(2):77-82. doi: 10.3109/2000656X.2014.903195. Epub 2014 Apr 3. PubMed PMID: 24693869.
  6. Nelson JA, Fischer JP, Chung CU, Fosnot J, Selber JC, Serletti JM, Wu LC. Preoperative anemia impacts early postoperative recovery following autologous breast reconstruction. J Plast Reconstr Aesthet Surg. 2014 Jun;67(6):797-803. doi: 10.1016/j.bjps.2014.02.017. Epub 2014 Feb 21. PubMed PMID: 24613772.
  7. Lu SM, Nelson JA, Fischer JP, Fosnot J, Goldstein J, Selber JC, Serletti JM, Wu LC. The impact of complications on function, health, and satisfaction following abdominally based autologous breast reconstruction: a prospective evaluation. J Plast Reconstr Aesthet Surg. 2014 May;67(5):682-92. doi: 10.1016/j.bjps.2014.01.017. Epub 2014 Feb 5. PubMed PMID: 24553313.
  8. Nelson JA, Fischer JP, Cleveland EC, Wink JD, Serletti JM, Kovach SJ 3rd. Abdominal wall reconstruction in the obese: an assessment of complications from the National Surgical Quality Improvement Program datasets. Am J Surg. 2014
  9. Apr;207(4):467-75. doi: 10.1016/j.amjsurg.2013.08.047. Epub 2014 Jan 4. PubMed PMID: 24507860.
    Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. A population-level analysis of abdominal wall reconstruction by component separation in the morbidly obese patient: can it be performed safely? J Plast Surg Hand Surg. 2014 Oct;48(5):305-11. doi: 10.3109/2000656X.2014.880350. Epub 2014 Feb 4. PubMed PMID: 24495185.
  10. Fischer JP, Wink JD, Nelson JA, Kovach SJ 3rd. Among 1,706 cases of abdominal wall reconstruction, what factors influence the occurrence of major operative complications? Surgery. 2014 Feb;155(2):311-9. doi: 10.1016/j.surg.2013.08.014. PubMed PMID: 24433774.
  11. Nelson JA, Fischer JP, Yan C, Fosnot J, Selber JC, Wu LC, Serletti JM, Kanchwala S. The impact of obesity on abdominal wall function after free autologous breast reconstruction. Microsurgery. 2014 Jul;34(5):352-60. doi: 10.1002/micr.22218. Epub 2013 Dec 26. PubMed PMID: 24375437.
  12. Fischer JP, Wes AM, Wink JD, Nelson JA, Braslow BM, Kovach SJ. Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. Plast Reconstr Surg. 2014 Jan;133(1):147-56. doi: 10.1097/01.prs.0000436836.96194.a2. PubMed PMID: 24374674.
  13. Fischer JP, Nelson JA, Wes AM, Wink JD, Yan C, Braslow BM, Chen L, Kovach SJ. The use of epidurals in abdominal wall reconstruction: an analysis of outcomes and cost. Plast Reconstr Surg. 2014 Mar;133(3):687-99. doi: 10.1097/01.prs.0000438048.91139.31. PubMed PMID: 24263390.
  14. Fischer JP, Shang EK, Butler CE, Nelson JA, Braslow BM, Serletti JM, Kovach SJ. Validated model for predicting postoperative respiratory failure: analysis of 1706 abdominal wall reconstructions. Plast Reconstr Surg. 2013 Nov;132(5):826e-835e. doi: 10.1097/PRS.0b013e3182a4c442. PubMed PMID: 24165634.
  15. Cleveland EC, Fischer JP, Nelson JA, Sieber B, Low DW, Kovach SJ 3rd, Wu LC, Serletti JM. Optimizing the fascial closure: an analysis of 1261 abdominally based free flap reconstructions. Ann Plast Surg. 2013 Sep;71(3):255-60. doi: 10.1097/SAP.0b013e318286380e. PubMed PMID: 23945529.
  16. Fosnot J, Serletti JM. Discussion: Abdominal wall stability and flap complications after deep inferior epigastric perforator flap breast reconstruction: does body mass index make a difference? Analysis of 418 patients and 639 flaps. Plast Reconstr Surg. 2012 Jul;130(1):34e-35e. doi: 10.1097/PRS.0b013e3182547d77. PubMed PMID: 22743952.
  17. Nelson JA, Fosnot J, Selber JC, Wu LC, Serletti JM. Age and abdominal wall strength: assessing the aging abdominal wall after autologous breast reconstruction. Microsurgery. 2013 Jan;33(1):14-23. doi: 10.1002/micr.21984. Epub 2012 Apr 18. PubMed PMID: 22511251.
  18. Nelson, J. A., Fischer, J. P., Yan, C., Fosnot, J., Selber, J. C., Wu, L. C., Serletti, J. M., Kanchwala, S. The impact of obesity on abdominal wall function after free autologous breast reconstruction. Microsurgery 2014;34:352-360.

Minimally Invasive Facial Rejuvenation

InjectablesOur research in the area of minimally invasive facial rejuvenation techniques is new, but growing. Using state of the art imaging, we have performed a number of clinical trials examining the stress and strain of FDA-approved neuromodulators. We are slated to use this same imaging apparatus to examine improvement in skin contour and wrinkle reduction with hyaluronic-based facial fillers. Using objective data, as well as the recently published FACE-Q to evaluate patient response to treatments, we are encouraged that our findings will help significantly affect translational research. In an era where for some the “liquid facelift” is more palatable than surgery, our results could significantly impact the world of facial aesthetics.

Selected Publications

  1. Bucky LP, Percec I. The science of autologous fat grafting: views on current and future approaches to neoadipogenesis. Aesthet Surg J. 2008 May-Jun;28(3):313-21; quiz 322-4. doi: 10.1016/j.asj.2008.02.004. Review. PubMed  PMID: 19083543.
  2. Hsu VM, Stransky CA, Bucky LP, Percec I. Fat grafting's past, present, and future: why adipose tissue is emerging as a critical link to the advancement of regenerative medicine. Aesthet Surg J. 2012 Sep;32(7):892-9. doi: 10.1177/1090820X12455658. Review. PubMed PMID: 22942117.
  3. Stransky CA, Hsu VM, Dierov R, Hoover WJ, Donahue G, Bucky LP, Percec I. Beyond fat grafting: what adipose tissue can teach us about the molecular mechanisms of human aging. Ann Plast Surg. 2012 Oct;69(4):489-92. doi: 10.1097/SAP.0b013e31824c0e43. PubMed PMID: 22964682.
  4. Imadojemu S, Sarwer DB, Percec I, Sonnad SS, Goldsack JE, Berman M, Sobanko JF. Influence of surgical and minimally invasive facial cosmetic procedures on psychosocial outcomes: a systematic review. JAMA Dermatol. 2013 Nov;149(11):1325-33. doi: 10.1001/jamadermatol.2013.6812. Review. PubMed PMID: 24068036.
  5. Hsu VM, Wes AM, Tahiri Y, Cornman-Homonoff J, Percec I. Quantified Facial Soft-tissue Strain in Animation Measured by Real-time Dynamic 3-Dimensional Imaging. Plast Reconstr Surg Glob Open. 2014 Oct 7;2(9):e211. doi: 10.1097/GOX.0000000000000185. eCollection 2014 Sep. PubMed PMID: 25426394; PubMed Central PMCID: PMC4229270.
     

Lymphedema Surgery

Lymph NodesPost-mastectomy lymphedema continues to be a major source of morbidity after breast cancer surgery despite the increasing use of more conservative operative interventions such as sentinel node mapping and breast conservation therapy. Our research at Penn focuses on the microsurgical treatment of lymphedema, the influence of breast reconstruction on primary lymphedema development, and the cost/resource burden of lymphedema on health systems recently. Recent publications have focused on risk stratification for the development lymphedema to inform cost-effective resource allocation and tailor perioperative clinical decision-making and counseling based upon individual risk. Future efforts may focus on developing a risk-assessment tool prior to any surgical intervention that can help guide the implementation of proactive instead of reactive management strategies. We also continue to advance the surgical treatment of lymphedema with one of the largest cohorts of women treated with supraclavicular lymph node transfer in the country.

Selected Publications

  1. Basta MN, Gao L, Wu L.  Operative Treatment of Lymphedema: A systematic meta-analysis of the safety and efficacy of lymphovenous shunt vs. lymphatic tissue transplant. Plast Reconstr Surg. 2014 Apr;133(4):905-13.
  2. Basta MN, Gao L, Wu L.  Reply: Operative Treatment of Lymphedema: A systematic meta-analysis of the safety and efficacy of lymphovenous shunt vs. lymphatic tissue transplant. Plastic & Reconstructive Surgery. 2014; (134) 3: 492e-493e.
  3. Basta MN, Fischer JP, Kanchwala SK, Silvestre J, Wu LC, Serletti JM, Tchou JC, Fosnot J. A Propensity-Matched Analysis of the Influence of Breast Reconstruction on Subsequent Development of Lymphedema. Plast Reconstr Surg. Accepted, in production.
  4. Basta MN, Fox JP, Fosnot J, Serletti JM, Kanchwala SK, Fischer JP. “Women Who Develop Complicated Lymphedema Following Surgical Treatment For Breast Cancer Experience High Rates Of Hospitalization”  Submitted for publication.
  5. Pannucci C, Gerety P, Basta M, Wang AR, Mies C, Zhang P, Kanchwala SK. Vascularized Lymph Node Transfer for Lymphedema: Anatomic Comparison of the Supraclavicular and Thoracodorsal Lymph Node Flaps. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2015; (3) 1: 124.
  6. Fosnot J, Fischer JP, Wu LC, Serletti JM. The Patient's Perspective on the Effect of Autologous Breast Reconstruction on Lymphedema. Ann Plast Surg. 2014 Mar 29. [Epub ahead of print] PubMed PMID: 24691304.

Lower Extremity Reconstruction

Lower ExtremityPenn Plastics manages some of the most complicated patients in lower extremity reconstruction. Our research endeavors reflect the complicated nature of these clinical efforts. Recent projects have focused on predictors of limb and joint salvage, as well novel, protocol-driven management of complicated lower extremity trauma. We pair closely with our orthopedic colleagues in the management and investigation of these wounds. We have also newly established a multi-institutional database to facilitate cross-institution collaboration and augment the power and applicability of our conclusions.

 

 

Selected Publications

  1. The Versatility of the Anterolateral Thigh Free Flap in Lower Extremity Limb Salvage for Trauma.  Christopher Bibbo, John P. Fischer, Jonas A. Nelson, Liza C.Wu, David Low, Samir Mehta, and Stephen J. Kovach. Accepted-in production,  J Ortho Trauma, 2015, accepted-in production, manuscript# JOT5752
  2. Maintaining levels of lower extremity amputation. JSOA-2014-309 Christopher Bibbo DO, David Ehrlich MD, L. Scott Levin MD, Stephen J. Kovach MD. J Orthopaedic Surgical Advances, accepted, January 2015
  3. A Lower Extremity Musculoskeletal and Vascular Trauma Protocol in a Children's Hospital May Improve Treatment Response Times and Appropriate Microvascular Coverage. John Flynn, Itai Gans, Keith Baldwin, Michael Nance, Benjamin Chang, Stephen J. Kovach, L Scott Levin. Accepted-in production, J Ortho Trauma, July 2014, JOT6127R
  4. Low wound complication rates for the lateral extensile approach for calcaneal ORIF when the lateral calcaneal artery is patent.  Stephen J. Kovach MD, Christopher Bibbo, MD. Foot and Ankle International, manuscript FAI-14-0025-R1. Accepted, 2014
  5. Approaching lower extremity reconstruction in the obese population: Does weight matter?  Emily Cleveland BA , John P Fischer, MD, Jonas A Nelson, M.D.,  Jason D Wink, B.A, L. Scott Levin, MD,  Stephen J Kovach, M.D. J Recon Microsurgery, 30(1) p. 263-270 May 2014.
  6. Microsurgery without the anastomosis: a review of propeller flaps for distal lower extremity soft tissue reconstruction. Nelson, JA Fischer, JP, Kovach, SJ, Rosson, GD, and Rad, AN. Accepted to Microsurgery, 2013.
  7. Cho EH, Garcia RM, Pien I, Kuchibhatla M, Levinson H, Erdmann D, Levin LS, Hollenbeck ST:  Vascular Considerations in Foot and Ankle Free Tissue Transfer: Analysis of 231 Free Flaps. Microsurgery, 2015.
  8. Zheng HP, Zhuang YH, Lin J, Zhang YX, Levin LS, Grassetti L, Lazzeri D, Persichetti P. Revisit of the anatomy of the distal perforator of the descending genicular artery and clinical application of its perforator "propeller" flap in the reconstruction of soft tissue defects around the knee. Microsurgery, October 2014.
  9. Clement, R. C., Kheir, M. M., Derman, P. B., Flynn, D. N., Speck, R. M., Levin, S., Fleisher, L.:  What are the economic consequences of unplanned readmissions following total knee arthroplasty? Clinical Orthopaedics and Related Research. 472(10):3134-3141. October 2014.
  10. Courtney PM, Melnic CM, Gutsche J, Hume EL, Scott LS, Lee GC:  Prospective Evaluation of the Need for Critical Care Intervention after Total Joint Arthroplasty.  Journal of the American College of Surgeons, Vol 219, Number 3, September 2014.
  11. Bibbo C, Ehrlich DA, Nguyen HML, Levin LS, Kovach SJ:  Low Wound Complication Rates for the Lateral Extensile Approach for Calcaneal ORIF When the Lateral Calcaneal Artery is Patent.  Foot and Ankle International, 35(7):650-656. July 2014.
  12. Cho EH, Garcia R, Pien I, Thomas S, Levin LS, Hollenbeck ST:  An Algorithmic Approach for Managing Orthopaedic Surgical Wounds of the Foot and Ankle. Clinical Orthopaedics and Related Research, Vol. 473, No. 6, pgs. 1991-1929. June 2014.
  13. Haddock NT, Wapner K, Levin LS:  Vascular Bone Transfer Options in the Foot and Ankle: A Retrospective Review and Update on Strategies.  Journal of Plastic and Reconstructive Surgery, Vol. 132, No. 3, pgs. 685-693. September 2013.
  14. Fischer J, Nelson J, Kovach S, Levin LS, Wu L, Cleveland E, Serletti J:  A Retrospective Review of Outcomes and flap Selection in Free Tissue Transfers for Complex Lower Extremity Reconstruction.  Journal of Reconstructive Microsurgery, Vol. 29(6):407-416.  July 2013.
  15. Tintle SM, Kovach SJ, Levin LS:  Free Tissue Transfer to the Foot and Ankle:  Perforator Flaps.  Techniques in Foot and Ankle Surgery, Vol. 12, No. 2, pgs. 79-86, June, 2013.

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