A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstructio... more A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstruction was performed to determine the effect of reconstruction on the treatment of these patients. The overall complication rate was 50% (25 of 50). Smoking statistically correlated with an increased rate of wound complications (0 = 0.0001). Obese patients had nearly twice as many wound complications; however, this finding was not statistically significant (P = 0.261). Eleven of the 50 patients underwent reconstruction with a prosthesis, with an overall complication rate of 64% (seven of 11) and a 55% (six of 11) rate of prosthesis loss. Thirty-nine of the 50 patients underwent reconstruction with autologous tissue. Forty-six per cent (18 of 39) of the patients in the autologous group developed complications, and eight required emergent reoperation to prevent flap loss. The wound complication rate was significantly lower for bipedicled transverse rectus abdominis muscle (TRAM) flap reconstruc...
Background Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumpt... more Background Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumption in patients undergoing mastectomies, but the effectiveness of these blocks in breast reductions has not been established. This trial aims to evaluate the efficacy of Pecs blocks (I and II) on perioperative pain management in patients undergoing breast reductions. Methods Thirty-six patients were enrolled in the randomized controlled trial divided into 2 groups. The treatment group (n = 16) received general anesthesia plus postinduction ultrasound-guided Pecs blocks. The control group (n = 20) received general anesthesia alone. The primary outcomes measured were perioperative narcotic requirements, need for postoperative antiemetics, pain scores, and length of time in the operating room (OR). We measured patient and procedural risk factors including pedicle/skin excision patterns, concurrent liposuction, weight of resection, and additional local anesthesia. Risk factors as well as out...
Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and h... more Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme—linking pathogenesis to a chronic inflammatory state—continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase–signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival ...
Cancer Epidemiology, Biomarkers & Prevention, 2020
Background: Healthcare disparities in rural women are well-defined, however little is known about... more Background: Healthcare disparities in rural women are well-defined, however little is known about breast reconstruction (BR) utilization in this population, especially rural Kentucky. The goal of this study was to determine if disparities in BR exist among post-mastectomy rural female patients in Kentucky. Methods: The Kentucky Cancer Registry was used to identify patients diagnosed with breast cancer and treated with mastectomy from 2006-2015. Patients were subdivided into mastectomy-only and mastectomy plus BR groups. 2013 Beale codes were used to stratify patients according to urban, near-metro or rural status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease and treatment factors was used to predict BR. The likelihood of undergoing BR was reported in odds ratios (OR) using a 95% confidence interval (CI). Results: Overall, 12,036 patients underwent mastectomy. Of ...
Background Nasal aesthetics can be significantly affected by the interdependence of the surroundi... more Background Nasal aesthetics can be significantly affected by the interdependence of the surrounding bone and soft tissues of the face. These include the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose. Therefore, it is pertinent to analyze and address these critical relationships of the nose in order to achieve a successful rhinoplasty. This work seeks to describe the battery of adjunct procedures available to supplement a rhinoplasty. Furthermore, each preoperative finding or indication for the adjunct is described in an algorithmic fashion.
Background Health care disparities in Appalachia are well documented. However, no previous studie... more Background Health care disparities in Appalachia are well documented. However, no previous studies have examined possible differences in the utilization of breast reconstruction (BR) in Appalachia. This study aims to determine if a disparity in BR utilization exists in women from Appalachia Kentucky. Methods A retrospective, population-based cohort study was conducted from January 1, 2006, to December 31, 2015. The Kentucky Cancer Registry was queried to identify population-level data for female patients diagnosed with breast cancer and treated with mastectomy. A multivariate logistic regression model controlling for patient, disease, and treatment characteristics was constructed to predict the likelihood of BR. Results Bivariate testing showed differences (P < 0.0001) in BR utilization between Appalachian and non-Appalachian women in Kentucky (15.0% and 26.3%, respectively). Multivariate analysis showed that women from Appalachia (odds ratio, 0.54; confidence interval (95), 0.48...
Background With the demand for stem cells in regenerative medicine, new methods of isolating stem... more Background With the demand for stem cells in regenerative medicine, new methods of isolating stem cells are highly sought. Adipose tissue is a readily available and non-controversial source of multipotent stem cells that carries a low risk for potential donors. However, elevated donor body mass index has been associated with an altered cellular microenvironment and thus has implications for stem cell efficacy in recipients. This review explored the literature on adipose-derived stem cells (ASCs) and the effect of donor obesity on cellular function. Methods A review of published articles on obesity and ASCs was conducted with the PubMed database and the following search terms: obesity, overweight, adiposederived stem cells and ASCs. Two investigators screened and reviewed the relevant abstracts. Results There is agreement on reduced ASC function in response to obesity in terms of angiogenic differentiation, proliferation, migration, viability, and an altered and inflammatory transcriptome. Osteogenic differentiation and cell yield do not show reasonable agreement. Weight loss partially rescues some of the aforementioned features. Conclusions Generally, obesity reduces ASC qualities and may have an effect on the therapeutic value of ASCs. Because weight loss and some biomolecules have been shown to rescue these qualities, further research should be conducted on methods to return obese-derived ASCs to baseline.
Plastic and Reconstructive Surgery - Global Open, 2017
The ideal monitoring tool to evaluate free flap success should be minimally invasive, continuous,... more The ideal monitoring tool to evaluate free flap success should be minimally invasive, continuous, costeffective and reliable. Our group has previously introduced implantable oxygen sensors as a mean to monitor flaps in the immediate post-operative period and detect acute vascular compromise. The purpose of the current study was to compare and contrast intradermal vs. subcutaneous implantation of the sensors in their ability to detect flap compromise.
Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of curr... more Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system. The effectiveness of liposomal bupivacaine has not been systematically analyzed relative to conventional treatments in plastic surgery. A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through October of 2015 with search terms related to liposomal bupivacaine and filtered for relevance to postoperative pain control in plastic surgery. Data on techniques, outcomes, complications, and patient satisfaction ...
This represents the close relationship with which the Annals and the Southeastern Society have ha... more This represents the close relationship with which the Annals and the Southeastern Society have had for many years. Both groups recognize the high commitment of the other to quality and education and to provide the readers examples of excellence in clinical and basic science in the field of Plastic and Reconstructive Surgery. The program Chairman, Dr. Kevin Hagan, and his Scientific Committee, provided a good spectrum of contemporary reconstructive and aesthetic surgery. They, along with the Resident Scientific Committee, chaired by Bruce Mast, selected the best member and resident papers from a large pool of submitted abstracts. With this supplement, we present the best of those member and resident articles, including the best of the poster presentations which were also a significant element of the meeting. Because of the rising costs in publication, this supplement was at risk in not seeing the light of day. It was through the efforts of the Annals, primarily its editor in chief, Bill Lineaweaver, MD, the deputy editor, Bruce Mast, MD, and the Southeastern Board of Directors, that this supplement has been maintained. In fact, it is a keen desire that this supplement will continue for many years to come. This, in part, is because of the collaboration of forward-minded industry representatives through nonrestrictive grants. The quality of the papers presented at the Southeastern meeting is consistently of outstanding caliber each year. They go through a rigorous peer review process on the part of the Southeastern, and then before publication, by the Annals of Plastic Surgery as well. It is a definite value-added perk to members of the Southeastern Society to have the opportunity to present original work at the meeting, and then in turn be able to submit the manuscript for possible publication. Scientific Societies are always looking to add value to its members. The Southeastern Society also offers grant funding, funding for postgraduate fellowship training, the ability to provide volunteer service on committees, and the ability to meet old and new colleagues and friends in an enjoyable environment. I want to once again express our gratitude to the Annals of Plastic Surgery for their support and collaboration with the Southeastern Society of Plastic and Reconstructive Surgeons. It is our hope and desire that you will find the articles in this supplement to be enjoyable and instructive. We also hope that you will attend the winter and summer meeting of the society, and if you are not already, that you will consider becoming a member.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2014
Numerous techniques have been described for repair of myelomeningoceles, but outcome data is scar... more Numerous techniques have been described for repair of myelomeningoceles, but outcome data is scarce. A retrospective review was performed in 32 consecutive patients who underwent neonatal myelomeningocele repair and extra-dural closure to determine the influence of repair type on outcome. All procedures for myelomeningocele closure were classified into one of three groups, which included primary closure, myocutaneous flaps, and fasciocutaneous flaps. Defect size ranged from 1 to 48 cm(2). Primary skin closure was performed in 3 patients, fasciocutaneous flaps in 13 patients, and myocutaneous flaps in 16 patients. The overall complication rate was 18%. No difference in the complication rates among the primary closure, myocutaneous, and fasciocutaneous flap groups was observed in our analysis. While not statistically significant, our data documents an association of fasciocutaneous flaps with postoperative complications that were not evident with primary skin closure or myocutaneous f...
BACKGROUND: Plastic Surgery is among the most competitive specialties, and although some of the a... more BACKGROUND: Plastic Surgery is among the most competitive specialties, and although some of the attributes of successful applicants have been described, little is known about the characteristics of programs that are most attractive to successful applicants. 1-5 This study aimed to understand program characteristics that are most infl uential to students when ranking plastic surgery programs and to identify changes that programs may make to improve and to attract the best students. METHODS: An anonymous, 21-question, multiple choice and open response online survey of newly matched plastic surgery residents for the integrated and combined match in the 2011-2012 and 2012-2013 academic years was conducted. Subjects were queried regarding their personal qualifi cations, application experiences, and motivations for residency program selection.
A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstructio... more A retrospective review of 50 patients who underwent immediate postmastectomy breast reconstruction was performed to determine the effect of reconstruction on the treatment of these patients. The overall complication rate was 50% (25 of 50). Smoking statistically correlated with an increased rate of wound complications (0 = 0.0001). Obese patients had nearly twice as many wound complications; however, this finding was not statistically significant (P = 0.261). Eleven of the 50 patients underwent reconstruction with a prosthesis, with an overall complication rate of 64% (seven of 11) and a 55% (six of 11) rate of prosthesis loss. Thirty-nine of the 50 patients underwent reconstruction with autologous tissue. Forty-six per cent (18 of 39) of the patients in the autologous group developed complications, and eight required emergent reoperation to prevent flap loss. The wound complication rate was significantly lower for bipedicled transverse rectus abdominis muscle (TRAM) flap reconstruc...
Background Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumpt... more Background Pectoralis nerve (Pecs) blocks have been shown to reduce perioperative opioid consumption in patients undergoing mastectomies, but the effectiveness of these blocks in breast reductions has not been established. This trial aims to evaluate the efficacy of Pecs blocks (I and II) on perioperative pain management in patients undergoing breast reductions. Methods Thirty-six patients were enrolled in the randomized controlled trial divided into 2 groups. The treatment group (n = 16) received general anesthesia plus postinduction ultrasound-guided Pecs blocks. The control group (n = 20) received general anesthesia alone. The primary outcomes measured were perioperative narcotic requirements, need for postoperative antiemetics, pain scores, and length of time in the operating room (OR). We measured patient and procedural risk factors including pedicle/skin excision patterns, concurrent liposuction, weight of resection, and additional local anesthesia. Risk factors as well as out...
Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and h... more Summary: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an emerging and highly treatable cancer of the immune system that can form around textured-surface breast implants. Although the underlying cause has yet to be elucidated, an emerging theme—linking pathogenesis to a chronic inflammatory state—continues to dominate the current literature. Specifically, the combination of increasing mutation burden and chronic inflammation leads to aberrant T-cell clonal expansion. However, the impetus remains largely unknown. Proposed mechanisms include a lipopolysaccharide endotoxin response, oncogenic transformation related to viral infection, associated trauma to the breast pocket, particulate matter digestion by capsular macrophages, chronic allergic inflammation, and genetic susceptibility. The Janus kinase–signal transducer and activator of transcription 3 (JAK-STAT3) pathway is a major signaling pathway that regulates a variety of intracellular growth and survival ...
Cancer Epidemiology, Biomarkers & Prevention, 2020
Background: Healthcare disparities in rural women are well-defined, however little is known about... more Background: Healthcare disparities in rural women are well-defined, however little is known about breast reconstruction (BR) utilization in this population, especially rural Kentucky. The goal of this study was to determine if disparities in BR exist among post-mastectomy rural female patients in Kentucky. Methods: The Kentucky Cancer Registry was used to identify patients diagnosed with breast cancer and treated with mastectomy from 2006-2015. Patients were subdivided into mastectomy-only and mastectomy plus BR groups. 2013 Beale codes were used to stratify patients according to urban, near-metro or rural status. Chi-square tests were used to examine the association of BR along the rural-urban continuum. A multivariate logistic regression model controlling for patient, disease and treatment factors was used to predict BR. The likelihood of undergoing BR was reported in odds ratios (OR) using a 95% confidence interval (CI). Results: Overall, 12,036 patients underwent mastectomy. Of ...
Background Nasal aesthetics can be significantly affected by the interdependence of the surroundi... more Background Nasal aesthetics can be significantly affected by the interdependence of the surrounding bone and soft tissues of the face. These include the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose. Therefore, it is pertinent to analyze and address these critical relationships of the nose in order to achieve a successful rhinoplasty. This work seeks to describe the battery of adjunct procedures available to supplement a rhinoplasty. Furthermore, each preoperative finding or indication for the adjunct is described in an algorithmic fashion.
Background Health care disparities in Appalachia are well documented. However, no previous studie... more Background Health care disparities in Appalachia are well documented. However, no previous studies have examined possible differences in the utilization of breast reconstruction (BR) in Appalachia. This study aims to determine if a disparity in BR utilization exists in women from Appalachia Kentucky. Methods A retrospective, population-based cohort study was conducted from January 1, 2006, to December 31, 2015. The Kentucky Cancer Registry was queried to identify population-level data for female patients diagnosed with breast cancer and treated with mastectomy. A multivariate logistic regression model controlling for patient, disease, and treatment characteristics was constructed to predict the likelihood of BR. Results Bivariate testing showed differences (P < 0.0001) in BR utilization between Appalachian and non-Appalachian women in Kentucky (15.0% and 26.3%, respectively). Multivariate analysis showed that women from Appalachia (odds ratio, 0.54; confidence interval (95), 0.48...
Background With the demand for stem cells in regenerative medicine, new methods of isolating stem... more Background With the demand for stem cells in regenerative medicine, new methods of isolating stem cells are highly sought. Adipose tissue is a readily available and non-controversial source of multipotent stem cells that carries a low risk for potential donors. However, elevated donor body mass index has been associated with an altered cellular microenvironment and thus has implications for stem cell efficacy in recipients. This review explored the literature on adipose-derived stem cells (ASCs) and the effect of donor obesity on cellular function. Methods A review of published articles on obesity and ASCs was conducted with the PubMed database and the following search terms: obesity, overweight, adiposederived stem cells and ASCs. Two investigators screened and reviewed the relevant abstracts. Results There is agreement on reduced ASC function in response to obesity in terms of angiogenic differentiation, proliferation, migration, viability, and an altered and inflammatory transcriptome. Osteogenic differentiation and cell yield do not show reasonable agreement. Weight loss partially rescues some of the aforementioned features. Conclusions Generally, obesity reduces ASC qualities and may have an effect on the therapeutic value of ASCs. Because weight loss and some biomolecules have been shown to rescue these qualities, further research should be conducted on methods to return obese-derived ASCs to baseline.
Plastic and Reconstructive Surgery - Global Open, 2017
The ideal monitoring tool to evaluate free flap success should be minimally invasive, continuous,... more The ideal monitoring tool to evaluate free flap success should be minimally invasive, continuous, costeffective and reliable. Our group has previously introduced implantable oxygen sensors as a mean to monitor flaps in the immediate post-operative period and detect acute vascular compromise. The purpose of the current study was to compare and contrast intradermal vs. subcutaneous implantation of the sensors in their ability to detect flap compromise.
Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of curr... more Management of postoperative pain often requires multimodal approaches. Suboptimal dosages of current therapies can leave patients experiencing periods of insufficient analgesia, often requiring rescue therapy. With absence of a validated and standardized approach to pain management, further refinement of treatment protocols and targeted therapeutics is needed. Liposomal bupivacaine (Exparel) is a longer acting form of traditional bupivacaine that delivers the drug by means of a multivesicular liposomal system. The effectiveness of liposomal bupivacaine has not been systematically analyzed relative to conventional treatments in plastic surgery. A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through October of 2015 with search terms related to liposomal bupivacaine and filtered for relevance to postoperative pain control in plastic surgery. Data on techniques, outcomes, complications, and patient satisfaction ...
This represents the close relationship with which the Annals and the Southeastern Society have ha... more This represents the close relationship with which the Annals and the Southeastern Society have had for many years. Both groups recognize the high commitment of the other to quality and education and to provide the readers examples of excellence in clinical and basic science in the field of Plastic and Reconstructive Surgery. The program Chairman, Dr. Kevin Hagan, and his Scientific Committee, provided a good spectrum of contemporary reconstructive and aesthetic surgery. They, along with the Resident Scientific Committee, chaired by Bruce Mast, selected the best member and resident papers from a large pool of submitted abstracts. With this supplement, we present the best of those member and resident articles, including the best of the poster presentations which were also a significant element of the meeting. Because of the rising costs in publication, this supplement was at risk in not seeing the light of day. It was through the efforts of the Annals, primarily its editor in chief, Bill Lineaweaver, MD, the deputy editor, Bruce Mast, MD, and the Southeastern Board of Directors, that this supplement has been maintained. In fact, it is a keen desire that this supplement will continue for many years to come. This, in part, is because of the collaboration of forward-minded industry representatives through nonrestrictive grants. The quality of the papers presented at the Southeastern meeting is consistently of outstanding caliber each year. They go through a rigorous peer review process on the part of the Southeastern, and then before publication, by the Annals of Plastic Surgery as well. It is a definite value-added perk to members of the Southeastern Society to have the opportunity to present original work at the meeting, and then in turn be able to submit the manuscript for possible publication. Scientific Societies are always looking to add value to its members. The Southeastern Society also offers grant funding, funding for postgraduate fellowship training, the ability to provide volunteer service on committees, and the ability to meet old and new colleagues and friends in an enjoyable environment. I want to once again express our gratitude to the Annals of Plastic Surgery for their support and collaboration with the Southeastern Society of Plastic and Reconstructive Surgeons. It is our hope and desire that you will find the articles in this supplement to be enjoyable and instructive. We also hope that you will attend the winter and summer meeting of the society, and if you are not already, that you will consider becoming a member.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2014
Numerous techniques have been described for repair of myelomeningoceles, but outcome data is scar... more Numerous techniques have been described for repair of myelomeningoceles, but outcome data is scarce. A retrospective review was performed in 32 consecutive patients who underwent neonatal myelomeningocele repair and extra-dural closure to determine the influence of repair type on outcome. All procedures for myelomeningocele closure were classified into one of three groups, which included primary closure, myocutaneous flaps, and fasciocutaneous flaps. Defect size ranged from 1 to 48 cm(2). Primary skin closure was performed in 3 patients, fasciocutaneous flaps in 13 patients, and myocutaneous flaps in 16 patients. The overall complication rate was 18%. No difference in the complication rates among the primary closure, myocutaneous, and fasciocutaneous flap groups was observed in our analysis. While not statistically significant, our data documents an association of fasciocutaneous flaps with postoperative complications that were not evident with primary skin closure or myocutaneous f...
BACKGROUND: Plastic Surgery is among the most competitive specialties, and although some of the a... more BACKGROUND: Plastic Surgery is among the most competitive specialties, and although some of the attributes of successful applicants have been described, little is known about the characteristics of programs that are most attractive to successful applicants. 1-5 This study aimed to understand program characteristics that are most infl uential to students when ranking plastic surgery programs and to identify changes that programs may make to improve and to attract the best students. METHODS: An anonymous, 21-question, multiple choice and open response online survey of newly matched plastic surgery residents for the integrated and combined match in the 2011-2012 and 2012-2013 academic years was conducted. Subjects were queried regarding their personal qualifi cations, application experiences, and motivations for residency program selection.
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Papers by Henry Vasconez