Papers by Lawrence Gottlieb
JAMA: The Journal of the American Medical Association, 1990
... Hans-Olav Adami, MD Lars Klareskog, MD Lars Holmberg, MD Jan Pont\l=e'\n,MD IngemarPerss... more ... Hans-Olav Adami, MD Lars Klareskog, MD Lars Holmberg, MD Jan Pont\l=e'\n,MD IngemarPersson, MD University Hospital Uppsala, Sweden Hyperbaric Oxygen Therapy Hyperbaric Oxygen Therapy To the Editor. ... 5. Raphael JC, Elkharrat D, Jars-Guincestre MC, et al. ...
Journal of Reconstructive Microsurgery
Background End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is cr... more Background End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. Methods The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a “spatula” fitting this defect. This technique removes sutures from the point of most turbulent blood flow while holding the recipient vessel open with a patch vesselplasty effect. We perform a retrospective review of a single surgeon's experience using this technique. Results The geometric 3D ETS technique was used in 87 free flaps with a total of 102 ETS anastomoses in ...
Journal of Burn Care & Research
Introduction As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increas... more Introduction As extracorporeal membrane oxygenation (ECMO) becomes more popular, there is increasing evidence supporting the safety and feasibility of early physical and occupational therapy (PT, OT) and mobility with patients on ECMO. However, there is limited evidence to support mobilizing burn ECMO patients. This case discusses safety and feasibility and explains how to successfully mobilize a burn patient on ECMO. Methods The patient is a 56-year old male admitted after sustaining 16% total body surface area partial and full thickness burns to his face, neck, forearms, and hands following an explosion at work. He sustained an inhalational injury and was intubated upon admission. Progression of his inhalation injury led to respiratory failure despite maximal ventilatory support. To maintain appropriate oxygenation, he underwent placement of left femoral-left internal jugular veno-venous ECMO (VV-ECMO). The patient received PT and OT throughout his stay in the Burn ICU. After star...
Journal of Burn Care & Research
Introduction Scald burn injuries are the leading cause of burn-related emergency room visits and ... more Introduction Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. An increasing portion of these injuries occur when children are removing items from microwave ovens. Many of these occur on the face/chest and can have lifelong physical, functional, aesthetic and psychological consequences. Over the past 15 years we have published a series of studies supporting our advocacy for a change in microwave oven design to protect children from severe scalds. Requiring microwave oven doors to be more difficult for a child to open would help to protect young children from these types of burn injuries. Our analysis of the National Electronic Injury Surveillance System found an estimated 7000 young children were treated in US emergency departments over the last decade for burns suffered when the child opened a microwave oven door and spilled the heated contents. This report describes our continued research and advocacy to finall...
Journal of Burn Care & Research
Under ideal circumstances, severely frostbitten extremities are rapidly rewarmed and treated with... more Under ideal circumstances, severely frostbitten extremities are rapidly rewarmed and treated with thrombolytic therapy within 6 to 24 hours. In an “inner city,” urban environment, most patients who suffer frostbite injuries present in a delayed fashion, sustain repeated injuries further complicated by psychological issues or intoxication, and are rarely ideal candidates for thrombolytic therapy within the prescribed timeframe. We describe our experience with the treatment of urban frostbite injuries. A retrospective review of patients with cold injuries sustained between November 2013 and March 2014 treated at a verified burn center in an urban setting was performed. Fifty-three patients were treated (42 males, 11 females). Average patient age was 41.8 years (range 2–84 years). No patients met criteria for thrombolytic therapy due to multiple freeze-thaw cycles or presentation greater than 24 hours after rewarming. Deep frostbite was seen in 10 patients. Of these patients, nine unde...
Journal of Reconstructive Microsurgery
Background In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side ... more Background In 1949, a French vascular surgeon, Jean Kunlin, first described a venous end-to-side anastomotic technique to address large vessel size mismatches. It was later modified by Dr. Robert Linton for end-to-end (ETE) anastomoses on the “macrovascular” scale. While multiple procedures exist for addressing moderate caliber discrepancies, few safely and reliably compensate for marked diameter differences at the microvascular level. In this study, we present the first large series adapting a modified geometric Kunlin's technique for arterial and venous ETE anastomoses in reconstructive microsurgery. Methods We reviewed 100 consecutive cases of free flap reconstructions from 2006 to 2015 utilizing a modified geometric Kunlin's technique for arterial and venous ETE anastomoses. Patient demographics and flap outcomes were analyzed. Overall flap survival rates and postoperative complications were analyzed and compared with standard values in the microsurgical literature. Resu...
The Journal of Sexual Medicine
Journal of Reconstructive Microsurgery
Journal of Reconstructive Microsurgery
Glabrous skin on the palmar aspect of the hands and the plantar aspect of the feet has special at... more Glabrous skin on the palmar aspect of the hands and the plantar aspect of the feet has special attributes. These attributes define the skin on the palm, fingers, and sole as functionally and aesthetically different from skin on other parts of the body. When there is a glabrous skin defect, it should be replaced with similar skin to restore function and aesthetics. The authors report their 12-year experience with the technique of glabrous dermal grafting for the reconstruction of palmar and plantar skin defects. From 1992 to 2004, 13 patients with 14 defects underwent glabrous dermal grafting of either palmar or plantar defects. Defects included nine hand and five foot defects. Causes included nine acute burns, one secondary burn reconstruction, two delayed reconstructions of traumatic injuries, one congenital nevus, and one malignant melanoma. Donor sites included 12 glabrous dermal grafts from the foot and two from the hand. Follow-up ranged from 1 month to 65 months. All glabrous dermal grafts demonstrated complete epithelialization and no incidence of complete loss. There was return of sensation without hyperkeratosis or breakdown. The grafts demonstrated good color match with the surrounding skin. The donor site healed without complications, and there were no incidences of significant hypopigmentation, hyperpigmentation, or hypertrophic scarring. Glabrous dermal grafting of palmar and plantar defects is the ideal way of reconstructing glabrous skin to restore both function and aesthetics and minimize donor-site morbidity.
Journal of Reconstructive Microsurgery
Journal of Reconstructive Microsurgery
Journal of Reconstructive Microsurgery
Journal of Reconstructive Microsurgery
Journal of Clinical Oncology
160 Background: There is debate over the value of comparative effectiveness research to address n... more 160 Background: There is debate over the value of comparative effectiveness research to address national health problems, but less attention has focused on its value to solve smaller questions. We present an example of local, clinician initiated, and unfunded comparative effectiveness research to address problems related to negative pressure wound therapy (NPWT) at our hospital. NPWT was popularized as the VAC (Vacuum Assisted Closure, Kinetic Concepts, Inc., San Antonio, TX) system and became standard treatment for many inpatient wounds. Between 2000 and 2006, VAC was the only form of NPWT at our hospital. When it became apparent that VAC therapy was costly, and painful, clinicians tried an alternative method using wall suction and gauze (GSUC). In 2007 and 2008 a randomized prospective trial showed the techniques were equally effective while GSUC was less painful and less costly. After the trial, we tracked the frequency of VAC and GSUC use, as well as the cost of NPWT. Methods: F...
Plastic and reconstructive surgery. Global open, 2017
Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. I... more Current predominantly used equipments for negative-pressure wound therapy (NPWT) are expensive. In current healthcare climate continually emphasizing cost containment, importance in developing more cost-effective alternatives cannot be understated. Previously, therapeutically equivalent methods of providing NPWT was demonstrated using just low-cost, universally available supplies, coined Gauze-SUCtion (GSUC). Here, we examine long-term potential financial savings of utilizing GSUC over commercialized products. A retrospective cost analysis was performed at the University of Chicago Medical Center between 1999 and 2014. All NPWT was provided via either GSUC or commercialized vacuum-assisted closure (VAC, KCI) device. Sum of all material component costs were reviewed to determine theoretical average daily cost. For the VAC group, recorded institutional spend to KCI was also reviewed to determine actual daily cost. In the GSUC group, this figure was extrapolated using similar ratios. L...
Urology, Jan 2, 2017
Penile prosthesis insertion allows individuals with a neophallus to achieve erectile function. La... more Penile prosthesis insertion allows individuals with a neophallus to achieve erectile function. Lack of corporal bodies to accommodate cylinders makes anchoring of any prosthesis challenging. Anchoring the device to pubic bone is one strategy to achieve proximal stabilization of the prosthesis. To describe outcomes of bone anchoring of penile implant in a neophallus with an accompanying video focusing on operative technique and salient tips for surgeons performing these procedures. A single institution retrospective chart review of 10 neophallus patients undergoing penile prosthesis placement from 2006 to 2015. The pubic symphysis is exposed and corticotomy created for placement of the rear tip extender of the implant using a Stryker TPS bone drill. Anchoring sutures through the corticotomy defect, rear tip, and proximal cylinder seat the implant. The remainder of the implantation procedure mirrors that used in native tissue. The overall peri-operative complication rate was 20% with ...
Journal of Reconstructive Microsurgery, 2017
Background Ablation of locally advanced or recurrent head and neck cancer often results in large ... more Background Ablation of locally advanced or recurrent head and neck cancer often results in large composite orofacial defects with limited recipient vessels. These complex defects lend well to intrinsic chimeric flap reconstruction, which allows greater ability to inset various flap component tissue types than composite flaps and requires only one set of microvascular anastomoses. Methods A retrospective chart review was performed on all patients who underwent orofacial reconstruction with an intrinsic chimeric free flap from 2002 to 2015. Flaps with only one tissue type, such as two separate skin paddles with no additional component, were not considered chimeric flaps and therefore not included in this report. Patient demographic data, defect, and flap characteristics, as well as complications and outcomes were analyzed to create a guide for flap selection. Univariate and multivariate analysis was performed to determine risk factors for flap take-back and failure. Results Seventy-five patients underwent orofacial intrinsic chimeric free flap reconstruction. Results were organized based on defect characteristics to create a guide for flap selection. The number of chimeric flap components and operation duration were independently statistically associated with flap take-backs (p < 0.05). There were two (3%) total and five (7%) partial flap losses. Average follow-up time was 32.7 months. Conclusions Intrinsic chimeric flaps provide a versatile and elegant reconstructive option for a variety of complex orofacial defects. We provide a guide to facilitate decision making in flap selection for these challenging reconstructions and report factors associated with flap take-backs and losses.
Pediatrics, Oct 1, 2008
... El responsable del registro de quemaduras combina la información de diversas fuentes, incluid... more ... El responsable del registro de quemaduras combina la información de diversas fuentes, incluido el departamento de sistemas de información y el departamento financiero hospitalarios, historias ... Gina Lowell, MDa, Kyran Quinlan, MD, MPHb, y Lawrence J. Gottlieb, MD, FACSc ...
Annals of Plastic Surgery, Apr 1, 2007
Utilizing both rectus abdominis muscles for unilateral breast reconstruction poses significant ri... more Utilizing both rectus abdominis muscles for unilateral breast reconstruction poses significant risks for hernia or bulge formation and decreased abdominal wall strength. We have used the fascial sparing double pedicle deep inferior epigastric artery perforator (DIEP)/DIEP or DIEP/muscle sparing TRAM (MS-TRAM) flap to overcome the disadvantages of the conventional bilateral TRAM or bilateral free TRAM flaps. Between January 1996 and March 2005, 14 double pedicle free DIEP/DIEP or DIEP/MS-TRAM flaps were performed in 14 patients for unilateral breast reconstruction. The abdominal wall was closed without mesh in all cases. Evaluation of results was conducted through a retrospective chart review and questionnaire. The average hospital stay was 5.4 days. The follow-up period ranged from 9 months to 10 years. There was no flap loss. There were no hernias, although 1 obese patient had lower abdominal wall bulging. Questionnaire was returned by 11 out of 14 patients, with an average rating of 4.5 (1-5), with all but 1 who would recommend it to others. None of the 11 patients had postoperative abdominal pain or back pain, and 9/11 patients returned to daily activities and/or sports. All patients that worked preoperatively returned to work postoperatively. Double pedicle free flaps for unilateral breast reconstruction are a safe option when autologous breast reconstruction is desired, but the volume of tissue required to build a breast exceeds the amount that could be transferred on a single pedicle flap. The double pedicle DIEP (DIEP/DIEP) and/or MS-TRAM (DIEP-MS-TRAM) flap offers good symmetric results for unilateral breast reconstruction and can minimize abdominal wall morbidity.
Uploads
Papers by Lawrence Gottlieb