Papers by Danielle Minteer
Aesthetic Surgery Journal
Background The shock-absorbing soft tissues of the heel are composed of dermis and specialized fa... more Background The shock-absorbing soft tissues of the heel are composed of dermis and specialized fat pads. Heel fat pad atrophy is common and can be painful and debilitating. In our previous work, autologous fat grafting was effective for treating pain from forefoot fat pad atrophy. Objectives The authors hypothesized that autologous fat grafting to the heel would relieve pain and improve function in patients with heel fat pad atrophy. Methods Patients with heel fat pad atrophy and associated pain were recruited and randomized into 2 groups. Group 1 received autologous fat grafting on enrollment and was followed for 2 years. Group 2 received offloading and activity modification for 1 year, then crossed over, underwent autologous fat grafting, and was followed for 1 year afterward. Outcome measures included ultrasound-measured fat pad and dermal thickness; pedobarograph-measured foot pressures and forces; and patient-reported outcomes as measured by the Manchester Foot Pain and Disabil...
Plastic and reconstructive surgery. Global open, Apr 1, 2017
Friday, May 5, 2017 scores were lower than the norm post-op for all breast cancer patients. CONCL... more Friday, May 5, 2017 scores were lower than the norm post-op for all breast cancer patients. CONCLUSIONS: Normative values provide an important reference point for interpreting BREAST-Q data. Normative values will improve the quantification of the health burden of surgical breast conditions. Normative values will additionally provide clinical context for interpreting the changes in satisfaction and well-being associated with breast reduction, augmentation, and breast cancer resection and reconstruction.
Plastic and Reconstructive Surgery, 2022
Summary: Plantar fasciitis affects 2 million patients per year. Ten percent of cases are chronic,... more Summary: Plantar fasciitis affects 2 million patients per year. Ten percent of cases are chronic, with thickened plantar fascia. Treatment may lead to prolonged recovery, foot instability, and scar. The authors hypothesized that perforating fat injections would decrease plantar fascia thickness, reduce pain, and improve quality of life. Adults with plantar fascia greater than 4 mm for whom standard treatment had failed were included in a prospective, randomized, crossover pilot study. Group 1 (intervention) was followed for 12 months. Group 2 was observed for 6 months, injected, and then followed for 6 months. Validated patient reported outcome measures, ultrasound, and complications were assessed. Group 1 had nine female patients and group 2 had five patients. A total of 2.6 ± 1.6 ml of fat was injected per foot at one to two sites. In group 1, plantar fascia thickness decreased from screening at 6 and 12 months (p < 0.05). Group 2 had decreased plantar fascia thickness from scr...
Plastic and Reconstructive Surgery Global Open, 2017
INTRODUCTION: Patients with end-stage renal disease (ESRD) may require a panniculectomy in prepar... more INTRODUCTION: Patients with end-stage renal disease (ESRD) may require a panniculectomy in preparation for renal transplantation. ESRD is associated with increased cardiovascular risk factors, electrolyte imbalances, and chronic anemia. These factors may increase the risk of adverse outcomes in patients undergoing panniculectomy. Purpose of this study was to evaluate safety and perioperative complication rates in ESRD patients following panniculectomy.
Plastic and Reconstructive Surgery Global Open, 2017
INTRODUCTION: Diabetic foot ulceration is known to be the result of multiple factors, including n... more INTRODUCTION: Diabetic foot ulceration is known to be the result of multiple factors, including neuropathy, plantar pressure, shoe fit, and pedal soft tissue thickness. Excessive pressure is recognized to play a role by inducing ischemic change. There is no standardized normal value for pedal soft tissue thickness. In this study, we aimed to investigate the degree of pedal soft tissue atrophy due to diabetes and aging.
Aesthetic Surgery Journal Open Forum, 2020
Background Pedal fat grafting has been shown to improve pain and functional impairment from foref... more Background Pedal fat grafting has been shown to improve pain and functional impairment from forefoot fat pad atrophy. Objectives We aimed to determine if patient demographics and foot characteristics play a role in the level of impact that is achieved following surgery. Methods We performed a retrospective review of patients who received forefoot autologous fat injections for the treatment of pedal fat pad atrophy. Patient improvement of pain and functional impairment were evaluated for correlation with patient characteristics including gender, age, BMI, unilateral versus bilateral injections, flexible versus rigid arch, previous foot deformity or surgery, and presence of callus. Results Forty-four patients received fat injections into the ball of their foot. 73% of them were women; their mean age was 61 years and mean BMI was 26.6 kg/m2. 75% had injections performed bilaterally; 41% had a flexible arch, 73% had a past history of pedal deformity or surgery, and 43% had callus. Only ...
Plastic and Reconstructive Surgery - Global Open, 2018
Human adipose derived stem cells (ASCs) are considered to be an ideal adult stem cell for regener... more Human adipose derived stem cells (ASCs) are considered to be an ideal adult stem cell for regenerative medicine applications due to their wide availability, ease of harvest, multilineage differentiation potential, trophic factor secretion, and low immunogenicity and oncogenic capacity. Unfortunately, aging negatively affects the therapeutic efficacy of ASCs. Currently, the precise molecular mechanisms governing adult stem cell aging remains poorly understood. Therefore, elucidating the mechanisms of ASC aging is critical for improving treatment outcomes for human stem-cell based therapies and aging prevention.
Plastic and Reconstructive Surgery - Global Open, 2020
Background: Biomaterials derived from human adipose extracellular matrix have shown promise in vi... more Background: Biomaterials derived from human adipose extracellular matrix have shown promise in vitro and in animal studies as an off-the-shelf adipogenic matrix for sustained volume replacement. Herein, we report the results of a randomized prospective study conducted with allograft adipose matrix (AAM) grafted into the pannus of presurgical abdominoplasty patients 3 or 6 months before scheduled surgery. This is the first report of a longitudinal histologic analysis of AAM in clinical use. Methods: Ten healthy patients undergoing elective abdominoplasty were recruited to receive AAM before surgery. Enrolled subjects were randomized into either a 3-month follow-up cohort or a 6-month follow-up cohort. Subjects were monitored for adverse events associated with AAM grafting in addition to undergoing serial biopsy. Following surgical excision of the pannus, representative samples from the AAM surgical sites were stained and evaluated with hematoxylin and eosin for tissue morphology, Mas...
Science Translational Medicine, 2020
A polycaprolactone conduit containing growth factor–encapsulated microspheres repairs 5-cm median... more A polycaprolactone conduit containing growth factor–encapsulated microspheres repairs 5-cm median nerve defects in rhesus macaques.
Advances in Wound Care, 2020
The objective of this prospective clinical study was to validate two prototype pressure ulcer mon... more The objective of this prospective clinical study was to validate two prototype pressure ulcer monitoring platform (PUMP) devices, (PUMP1 and PUMP2), to promote optimal bed repositioning of hospitalized patients to prevent pressure ulcers (PUs). Approach: PUMP1 was a wearable electronic device attached to the patient gown with no skin contact. PUMP2 was a set of four identical electronic devices placed under the patient's bed wheels. A video camera recorded events in the patient room while measurements from the PUMP devices were correlated with true patient repositioning activity. The performance of these PUMP devices developed by our research team were evaluated and compared by both clinicians and engineers. Results: Ten mobility-restricted patients were enrolled into the study. Repositioning movement was recorded by both PUMP devices for 10-2 h and corroborated with video capture. One hundred thirty-seven movements in total were detected by both PUMP1 and PUMP2 over 105 h of capture. Two false positives were detected by the sensors and 11 movements were missed by the sensors. PUMP1 and PUMP2 never conflicted in data collection. Innovation: The presented study evaluated two different sensors' abilities to capture accurate patient repositioning to eventually prevent PU formation. Importantly, detection of patient motion was completed without contact to patient skin. Conclusion: The clinical study demonstrated successful capture of patient repositioning movement by both PUMP1 and PUMP2 devices with 85% reliability, 2 false positives, and 11 missed movements. In future studies, the PUMP devices will be combined with a SMS-based mobile phone alert system to improve caregiver repositioning behavior.
Plastic and Reconstructive Surgery - Global Open, 2019
BACKGROUND: Nearly 2 million people in the United States experience limb loss each year. Challeng... more BACKGROUND: Nearly 2 million people in the United States experience limb loss each year. Challenges precluding successful long-term prosthesis use include skin break down, pain, and poor fit. These challenges are often exaggerated for military service members with combatrelated wounds. The aim of this Department of Defensesupported study was to assess the efficacy of standard autologous fat transfer compared to fat graft enriched with adipose-derived stem cells (ASCs) to reduce pain and improve lower extremity amputation site soft tissue volume and quality.
Plastic and Reconstructive Surgery - Global Open, 2019
Skin damage by either trauma or surgical intervention inevitably results in scar formation. Facia... more Skin damage by either trauma or surgical intervention inevitably results in scar formation. Facial scars can be cosmetically disfiguring and may cause functional impairment and psychosocial withdrawal. Botulinum toxin type A (BoNTA) is known to prevent fibroblast proliferation and expression of transforming growth factor-β1. It also induces temporary muscle paralysis and decreases tension vectors. Fibroblasts induce scar contracture and hypertrophy by producing collagen fibers in wound healing processes. In theory, botulinum toxin can play a vital role in scar prevention by reducing contracture and relaxing the adjacent muscles. Several studies have suggested the possibility of injecting botulinum toxin into nearby musculature around the traumatic or incisional wounds. However, sound clinical evidence has been missing. The aim of this study is to investigate the subjective and objective evidence of the effect that botulinum toxin has on scar formation in human. This is a prospective, split-scar, double-blinded, randomized controlled study. From February 2012 to December 2015, patients who presented forehead lacerations were recruited from the emergency room. Forty-five patients with forehead laceration were enrolled in this study and randomized into 2 groups with or without injection of BoNTA. When the patients presented to the clinic to remove the stitches, BoNTA was injected to the BoNTA group with 24 patients and saline was injected to the control group with 21 patients. The BoNTA was injected on dermal layer with 5 units/cm within a 0.5 cm distance on BoNTA group. Placebo drug was prepared as a vial containing 0.9% saline which is similar to BoNTA. After that, follow-up was done in 1, 3, and 6 months. The scars were analyzed with the Patient and Observer Scar Assessment Scale, Stony Brook Scar Evaluation Scales, and Visual Analog Scale and analyzed with independent t test, along with clinical photographs, cutometer, and biopsies. There were 21 patients in the control group and 24 patients in the BoNTA group. There were no significant adverse events in all patients. In all scar scales, the scores changed into favorable direction in both groups and the changes were larger in BoNTA group compared with the control group. However, when the amount of changes of the scar scales was investigated, there were more favorable changes in BoNTA group, which was proved statistically in Stony Brook Scar Evaluation Scales (P = 0.047) and Visual Analogue Scale (P = 0.046). Even without statistical significance, there were more favorable changes in BoNTA group in Patient Scar Assessment Scale (P = 0.110) and Observer Scar Assessment Scale (P = 0.169). Skin biopsy showed less collagen deposition on dermal layer in BoNTA group. In hematoxylin and eosin stain and Masson-trichrome stain, there was a denser deposition of collagen fibers of the specimen belonging to the control group compared to the BoNTA group. Based on the findings above, BoNTA can improve scar properties in various aspects, especially in decreasing collagen synthesis. The gross findings also showed favorable changes. This study provides useful indication of application of BoNTA in scar prevention with promising results.
Plastic and Reconstructive Surgery, 2019
at pad atrophy of the forefoot is common, affecting approximately 30 percent of patients older th... more at pad atrophy of the forefoot is common, affecting approximately 30 percent of patients older than 60 years. 1 Although often age-related, it may be caused by abnormal foot mechanics, obesity, steroid use, or collagen vascular disease. 2-4 Displacement or atrophy of the fat pad can lead to osseous prominences in the foot that may be seen with painful skin lesions. Fat pad atrophy may result in significant pain or compensatory gait, leading to callus formation or ulceration. In sensate patients, the pain can lead to emotional and physical pain, leading to productivity and financial losses. 5-9 Various procedures have been described to augment atrophied fat pads; however, many of these techniques have failed to demonstrate sustained tissue thickness over time. 10-12 Our group previously published our results from the first clinical trial to apply standardized fat grafting techniques for pedal fat pad atrophy. 13,14 This study served as a proof-of-concept and highlighted the effectiveness of fat grafting in significantly improving pain and disability and also decreasing foot pressures and forces at 2 years. Our prior randomized, crossover clinical trial demonstrated that patients treated with standard-ofcare padding got worse, with decreased tissue thickness over time. In our fat grafting group, the tissue thickness under the metatarsal heads was measured by ultrasound and discovered to return to baseline
Aesthetic Surgery Journal, 2018
Background: Pedal fat grafting is a cosmetic procedure to treat the functional and aesthetic sequ... more Background: Pedal fat grafting is a cosmetic procedure to treat the functional and aesthetic sequelae of pedal fat pad atrophy. Fat grafting has been found to mitigate these symptoms, but the exact mechanism is unknown. Objectives: The authors hypothesized that pedal fat grafting may improve skin quality, accounting for prolonged symptomatic improvement despite loss of grafted fat. Methods: Patients with pedal atrophy were enrolled in a randomized crossover clinical trial. Group 1 underwent fat grafting upon enrollment with 2-year follow-up. Group 2 was managed conservatively for 1 year then placed into the fat grafting group with 1-year follow-up. Patients underwent pedal ultrasounds to determine thicknesses of the fat pad and dermis, and photographs were taken to assess skin quality. Results: Three men and 20 women with an average age of 63 ± 6 years and an average BMI of 26.0 ± 4.6 kg/m 2 were enrolled in the study. Twenty-six feet were injected in Group 1 and 17 were injected in Group 2. Group 1 dermal thickness increased at 6 months post-injection (P < 0.05). This increase persisted through 24 months. Group 2 dermal thickness decreased prior to injection (P < 0.05) but returned to baseline after injection and through 12-month follow-up (P < 0.05). Fat pad thickness returned to baseline by study completion in both groups (P < 0.05). Conclusions: Pedal fat grafting yielded a significant, sustained increase in dermal thickness, though grafted fat was not retained. Fat grafting may improve skin quality, which could contribute to improved clinical outcomes despite loss of grafted fat.
Plastic & Reconstructive Surgery, 2018
Background: By age 60, 30 percent of Americans suffer from fat pad atrophy of the foot. Forefoot ... more Background: By age 60, 30 percent of Americans suffer from fat pad atrophy of the foot. Forefoot fat pad atrophy results from long-term aggressive activity, genetically dictated foot type, multiple forefoot steroid injections, surgery, and foot trauma. Methods: The authors present data from a 2-year, prospective, randomized crossover study performed to assess pain and disability indexes, fat pad thickness, forces, and pressures of stance and gait. Group 1 underwent fat grafting with 2 years of follow-up, and group 2 underwent conservative management for 1 year, then underwent fat grafting with 1 year of follow-up. Results: Eighteen subjects (14 women and four men) constituted group 1. Thirteen subjects (nine women and four men) constituted group 2. Group 1 reported the worst pain at baseline and group 2 experienced the worst pain at 6- and 12-month standard-of-care visits; pain for both groups improved immediately following fat grafting and lasted through study follow-up (p < 0.0...
Plastic and Reconstructive Surgery - Global Open, 2017
Friday, May 5, 2017 scores were lower than the norm post-op for all breast cancer patients. CONCL... more Friday, May 5, 2017 scores were lower than the norm post-op for all breast cancer patients. CONCLUSIONS: Normative values provide an important reference point for interpreting BREAST-Q data. Normative values will improve the quantification of the health burden of surgical breast conditions. Normative values will additionally provide clinical context for interpreting the changes in satisfaction and well-being associated with breast reduction, augmentation, and breast cancer resection and reconstruction.
Journal of Biomedical Materials Research Part A, 2017
Journal of neuroscience methods, Jan 20, 2015
Biomedical implants used in tissue engineering repairs, such as scaffolds to repair peripheral ne... more Biomedical implants used in tissue engineering repairs, such as scaffolds to repair peripheral nerves, can be too large to examine completely with histological analyses. Micro-computed tomography (micro-CT) with contrast agents allows ex vivo visualization of entire biomaterial implants and their interactions with tissues, but contrast agents can interfere with histological analyses of the tissues or cause shrinkage or loss of antigenicity. Soft tissue, ex vivo micro-CT imaging using Lugol's iodine was compatible with histology after using a rapid (48h) method of removing iodine. Adult normal and repaired rat sciatic nerves were infiltrated ex vivo with iodine, imaged with micro-CT and then the iodine was removed by incubating tissues in sodium thiosulfate. Subsequent paraffin sections of normal nerve tissues showed no differences in staining with hematoxylin and eosin or immunostaining with multiple antibodies. Iodine treatment and removal did not alter axonal diameter, nuclear...
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Papers by Danielle Minteer