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Background and Objectives: Sarcopenia is an objective measure of patient frailty and is a predictor of adverse surgical outcomes. We hypothesized that sarcopenia is associated with increased surgical site occurrence (SSO) and hernia occurrences in patients undergoing oncologic abdominal wall reconstruction. Methods: Consecutive patients who underwent abdominal wall reconstruction (AWR) for an abdominal wall ablative defect at a single center from 2005 to 2015 were evaluated. The total psoas index (TPI) was used to define sarcopenia. The primary endpoint of the study was hernia occurrence; (SSO) was a secondary outcome measure. Results: Eighty-six patients met the inclusion criteria. Multivariate analysis demonstrated that sarcopenia increased the risk of hernia more than threefold, trending toward significance (OR = 3.3; 95% CI: 0.69-15.4; P = .13). Multivariate logistic regression demonstrated that preoperative radiotherapy (OR = 4.8, 95% CI: 1.4-16; P = .01) and obesity (OR = 4.9, 95% CI: 1.5-16.3; P =.009) were independent predictors of developing an SSO. Conclusions: Sarcopenia, as defined by TPI, is correlated with hernia occurrence, but not SSO. These findings emphasize the importance of preoperative fitness and nutritional optimization and provide useful information for preoperative counseling and risk stratification.

Background. Obese patients can develop a large lower abdominal panniculus (worsened by significant weight loss). Patients with advanced chronic kidney disease (CKD) affected by this obesity-related sequela are not infrequently declined for kidney transplantation because of the high risk for serious woundhealing complications. We hypothesized that pretransplant panniculectomy in these patients would (1) render them transplant candidates, and (2) result in low posttransplant wound-complication rates. Methods. In a pilot study, adult patients with CKD who had a high-risk panniculus as the only absolute contraindication to kidney transplantation subsequently were referred to a plastic surgeon to undergo a panniculectomy in order to become transplant candidates. We analyzed the effect of panniculectomy on (1) transplant candidacy and (2) wait list and transplant outcomes (04/2008-06/2014). Results. Overall, 36 patients had panniculectomy (median prior weight loss, 38 kg); all were wait-listed with these outcomes: (1) 22 (62%) patients were transplanted; (2) 7 (19%) remain listed; and (3) 7 (19%) were removed from the wait list. Survival after panniculectomy was greater for those transplanted versus not transplanted (at 5 years, 95% vs 35%, respectively; P = .002). For the 22 kidney recipients, posttransplant wound-complication rate was 5% (1 minor subcutaneous hematoma). Conclusion. For obese CKD patients with a high-risk abdominal panniculus, panniculectomy was highly effective in obtaining access to the transplant wait list and successful kidney transplantation. This approach is particularly pertinent for CKD patients because they are disproportionally affected by the obesity epidemic and because obese CKD patients already face multiple other barriers to transplantation. (Surgery 2015;

Background Component separation (CS) is an effective technique for reconstructing complex abdominal wall defects. Violation of the rectus abdominis complex is considered a contraindication for CS, but we hypothesized that patients have similar outcomes with or without rectus complex violation. Study Design We retrospectively studied all consecutive patients who underwent CS for abdominal wall reconstruction over 8 years and compared outcomes of patients with and without rectus violation. Primary outcome measures included complications and hernia recurrence. Logistic regression analysis identified potential associations between patient, defect, and reconstructive characteristics and surgical outcomes. Results One hundred and sixty-nine patients were included: 115 (68%) with and 54 (32%) without rectus violation. Mean follow-up was 21.3 ± 14.5 months. Patient and defect characteristics were similar except for the rectus violation group having a higher body mass index (BMI). The overall complication rates were similar in the violation (24.3%) and the non-violation (24.0%) groups, as were the respective rates of recurrent hernia (7.8% vs. 9.2%, p=0.79), abdominal bulge (3.5% vs. 5.6%, p=0.71), skin dehiscence (20.0% vs. 22.2%, p=0.74), skin necrosis (6.1% vs. 3.7%, p=0.72), cellulitis (7.8% vs. 9.2%, p=0.75), and abscess (12.3% vs. 9.2%, p=0.58). Regression analysis demonstrated BMI to be the only factor predictive of complications. Conclusions CS surgical outcomes were similar whether or not the rectus complex was violated. To our knowledge, this study is the first to evaluate the effects of rectus violation on surgical outcomes in CS patients. Surgeons should not routinely avoid CS when the rectus complex is violated.

Breast cancer management has witnessed major advances over the past several years that have translated into significant gains in life expectancy and improved survival. 1 Moreover, reconstruction following primary tumor extirpation has been associated with improved patient satisfaction and body image and better quality of life. 2-4 However, these technological enhancements in cancer care have attendant high costs to patients, their families, and society. In 2010, the cost of care of breast cancer was among

ore than 300,000 women are diagnosed with breast cancer in the United States each year, making it the malignancy with the highest incidence. 1 According to estimates, breast cancer was to be associated with both the highest annualized cost of care ($20 billion) and rate of increase in annual costs by 2020. 2 This number is expected to rise further, coinciding with an escalation in spending on breast cancer treatment driven by innovations in imaging, testing, pharmacotherapy, and surgical treatment. 2,3 Although the implementation of these advances has contributed to gains in life expectancy and quality of life, 4-7 the escalating costs of care have been increasingly passed on to patients during this time. 8,9

Background: Surgical specialists in plastic, head and neck, hand, trauma surgery, and emergency medicine physicians bear the burden of treating the most serious injuries caused by animals. Most of these incidents result from an attack by a known dog, and breed has been proposed, but not proven, to be a controllable factor. The authors summarize the peer-reviewed literature on dog bites in the United States, specifically as related to the breeds implicated. Methods: A systematic review of all peer-reviewed publications reporting on dog bites in the United States was performed. MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Library searches were conducted through May 8, 2018, for studies from the United States implicating a specific dog breed as responsible. Results: Forty-one articles met inclusion criteria, the majority of which were single-institution retrospective reviews. Main outcomes were any dog bite reported in the peer-reviewed literature where a specific breed was implicated. Secondary measures included dog bites reported in areas where breed-specific legislation was enacted. The most common pure breed identified was German Shepherd, followed by Pit Bull–type breeds (i.e., American Staffordshire Terrier, American Pit Bull Terrier, Staffordshire Bull Terrier, American Bully), Labrador, Collie, and Rottweiler, respectively. Pit bull–type and German Shepherd breeds are consistently implicated for causing the most serious injuries to patients in the United States across heterogeneous populations, and this remained consistent across multiple decades. Conclusions: The authors’ results indicate that German Shepherd and Pit Bull–type breeds account for the largest subset of pure breeds implicated in severe dog bites inflicted on humans in the medical literature. The role and complexity of mentioning breed in relation to human injuries are also discussed.

Panniculectomies in preparation for renal transplant may be performed in patients with end-stage renal disease with an acceptable complication rate, converting previously ineligible patients into eligible candidates for kidney transplant. It also seems those who undergo panniculectomy before kidney transplant may expect to have lower rates of wound complications after their transplant had they not had a panniculectomy.