Contemporary Issues in Surgical Oncology (Virtual Session)

Contemporary Management of Well-Differentiated Thyroid Cancer

Jessica Shank, MD, Assistant Professor, Division of Surgical Oncology, Department of General Surgery, University of Nebraska Medical Center, Omaha, NE

Contemporary Management of Well-differentiated Thyroid Cancer

Updated guidelines regarding cure with lobectomy of low risk well-differentiated thyroid cancer

Learner will be able to appropriately counsel patients on surgical options for cancer treatment

Cancer treatment algorithms change rapidly; the audience will benefit from review of thyroid cancer management

Surgical Management of Melanoma in the Era of Effective Systemic Therapies

Joshua Mammen, MD PHD, Professor of Surgery, University of Nebraska, Omaha, NE

The surgical treatment of melanoma has evolved over the last decade since the advent of effective systemic therapies. Areas that have changed include indications for lymph node staging, extent of lymphadenectomies, extent of margins for primary resections, adjuvant treatment, and consideration of neoadjuvant approaches. After the presentation, attendees will be able to describe the contemporary management of melanoma which will enhance the care of their patients.

Breast Cancer Update

Colleen Murphy, MD, Assistant Professor of Surgery, University of Colorado School of Medicine, Aurora, Colorado, Denver, CO Colorado

This presentation will review the latest techniques in Breast Surgery, including wire-free localization techniques, the latest options for axillary mapping and advances in early detection of lymphedema.

Vascular Surgery 2022 (Virtual Session)

Endovascular Management of Axillo-subclavian Arterial Injuries at the Puerto Rico Trauma Hospital

Fernando Joglar, MD, Associate Professor of Surgery, University of Puerto Rico School of Medicine, San Juan, PR

Injuries to the axillo-subclavian vessels have a high degree of morbidity and mortality, despite representing only about 9% of all vascular injuries. Management of axillo-subclavian injuries can be performed with either an open or an endovascular approach, with recent data suggesting that in appropriately selected patients, endovascular treatment is associated with improved outcomes. Our goal is to describe the characteristics and outcomes of all axillo-subclavian injuries repaired by an endovascular approach at our institution. Methods: An IRB-approved case-series analysis was conducted with data from the PRTH Registry, operation reports, and verified with surgeon specific registry (SSR). The domains measured were sociodemographic profile, injury characteristics, hospital course, and outcomes (i.e., hospital length of stay (LOS) and mortality). The statistical analysis is expressed as mean ± standard deviation or frequencies and proportions, as appropriate.

An IRB-approved case-series analysis was conducted with data from the PRTH Registry, operation reports, and verified with surgeon specific registry (SSR). The domains measured were sociodemographic profile, injury characteristics, hospital course, and outcomes (i.e., hospital length of stay (LOS) and mortality). The statistical analysis is expressed as mean ± standard deviation or frequencies and proportions, as appropriate.

From January 2011 to January 2021 there were a total of 13,974 admissions to the PRTH. A total of 15 (0.11%) patients were identified that underwent endovascular procedure due to an axillo-subclavian injury. Thirteen (86.7%) patients were male, and the median age was 32 (17-69) years. Of the cohort, 13 (86.7%) patients had public health insurance and 1(6.7%) was uninsured. The most common type of injury was penetrating (9; 60.0%) followed by blunt (5; 33.3%) and iatrogenic (1; 6.7%). Gunshot wound was the most common mechanism of injury (8; 53.3%). The median injury severity score of this cohort was 20 (9-75). The most common diagnosis was pseudoaneurysm (9;60.0%), followed by transection (6;40.0%) and thrombosis (4;26.7%). Moreover, the median hospital LOS amounted to 26 (3-84) days, and 2 (13.3%) patients died while hospitalized. The median follow-up for this trauma population was 9.4 (0.4-70.4) months.

Axillo-subclavian vessel injuries are an infrequent but lethal condition affecting a healthy young population in Puerto Rico. Endovascular repair of axillo-subclavian vessels is a safe and successful method of treatment. It has been performed with good results at the PRTH for the last 10 years. Longer follow up is seen in blunt injury patients.

Reconstructive Plastic Surgery Symposium (Virtual Session)

Improving Surgical Outcomes Utilizing Negative Pressure Wound Therapy

Anthony N. Dardano, DO, Chief of Plastic Surgery, Trauma Associate Professor of Surgery, Florida Atlantic University, Boca Raton, FL

Presentation will give review of abdominal wall hernias and defects as well as mesh product updates, and tips for optimizing outcomes utilizing Botox, SPY imaging for tissue perfusion and ciNPWT for dressings

Orthoplastic Approach to The Management of Complex Extremity Wounds

Ricardo Castrellon, MD, Program Director, Integrated Plastic Surgery Residency Program, Larkin Community Hospital Palm Spring Campus, Miami, FL

The management of complex acquired, or traumatic open wounds of extremities pose a significant challenge, often times requiring a multidisciplinary approach requiring the close collaboration of orthopedic surgeons, plastic surgeons, trauma surgeons and multiple specialties. With close collaboration, limb salvage and successful functional outcomes has improved, so it is important that surgeons are aware of reconstructive options that will allow for limb salvage on patients that traditionally might have not been offered those options.