1.Complex sternal and rib reconstruction with allogeneic material.
Charles Miles MALISKA III ; Robert Lloyd ARCHER ; Sharon Kaye TARPLEY ; Archibald Sanford MILLER III
Archives of Plastic Surgery 2018;45(6):593-597
Sternal malunion, or loss, developed after a median sternotomy cannot only be difficult to manage and treat, but also may diminish one’s quality-of-life drastically. The technique presented here represents a multispecialty approach in one stage for the reconstruction of an unstable thoracic cage. The procedure utilized a donated sternum and ribs. The sternum with ribs harvested from a single donor included adipose derived stromal vascular fraction (ADSVF) cells with marrow also from the same donor. Autologous muscle flaps, stabilized with acellular dermal matrix were utilized to provide a robust blood supply to the ADSVF cells and bone grafts. Acellular dermal matrix was used to construct the ribs and stabilize the plugs of stem cells and bone. These procedures, in the hands of multispecialty physicians, have led to several successful reconstructions involving complex chest wall deformities. This surgical intervention was performed in a one stage operation. This represents the first successful complete sternal transplant in a patient with return to normal activities and increased quality-of-life.
Acellular Dermis
;
Bone Marrow
;
Congenital Abnormalities
;
Fractures, Malunited
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Hand
;
Humans
;
Reconstructive Surgical Procedures
;
Ribs*
;
Stem Cells
;
Sternotomy
;
Sternum
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Thoracic Surgical Procedures
;
Thoracic Wall
;
Tissue Donors
;
Transplants
2.Treatment of In-Stent Stenosis Following Flow Diversion of Intracranial Aneurysms with Cilostazol and Clopidogrel
Ehsan DOWLATI ; Kory B. Dylan PASKO ; Jiaqi LIU ; Charles A. MILLER ; Daniel R. FELBAUM ; Samir SUR ; Jason J. CHANG ; Ai-Hsi LIU ; Rocco A. ARMONDA ; Jeffrey C. MAI
Neurointervention 2021;16(3):285-292
In-stent stenosis is a feared complication of flow diversion treatment for cerebral aneurysms. We present 2 cases of patients treated with pipeline flow diversion for unruptured cerebral aneurysms. Initial perioperative dual antiplatelet therapy (DAPT) consisted of standard aspirin plus clopidogrel. At 6-month follow-up cerebral angiography, the patients were noted to have developed significant in-stent stenosis (63% and 53%). The patients were treated with cilostazol and clopidogrel for at least 6 months. Subsequent angiography at 1-year post-treatment showed significant improvement of the in-stent stenosis from 63% to 34% and 53% to 21%. The role of cilostazol as treatment of intracranial in-stent stenosis has not been previously described. Cilostazol’s vasodilatory effect and suppression of vascular smooth muscle proliferation provides ideal benefits in this setting. Cilostazol plus clopidogrel may be a safe and effective alternative to standard DAPT for treatment of in-stent stenosis following flow diversion and warrants further consideration and investigation.
3.Planning for and responding to pandemic influenza emergencies: it’s time to listen to, prioritize and privilege Aboriginal perspectives
Kristy Cooks ; Peter Massey ; Kylie Taylor ; Adrian Miller ; Sandra Campbell ; Ross Andrews
Western Pacific Surveillance and Response 2018;9(5):5-7
Australia’s Indigenous peoples account for 3% of the country’s population yet continue to experience disproportionately higher rates of mortality and hospitalization for many infectious diseases.1 The 2009 influenza pandemic had an inequitable impact on Indigenous peoples in Australia,2 New Zealand,3 the Americas and the Pacific.4 Genuine and tangible actions that include Indigenous peoples in the planning and response for pandemic influenza is overdue. This paper will identify some of the strategies to incorporate the perspectives of Australia’s Indigenous peoples (hereafter Aboriginal) in planning and responding to infectious disease emergencies.