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Research Publications

Research Publications

Naidu N.  Striae distensae after breast augmentation [letter]. Aesthetic Plastic Surgery 2013 Feb 37(1): 189. Comments on an article authored by Basile FV, Basile AV, Basile AR. Striae distensae after breast augmentation Aesthetic Plast Surg 2012 36: 894-900.

Naidu N, Patrick P: The Influence of Career Stage, Practice Type and Location, and Physician’s Sex on Surgical Practices Among Board-Certified Plastic Surgeons Performing Breast Augmentation.  Aesthetic Surgery Journal 2011 Nov 31(8): 941- 952. Breast augmentation is the most commonly performed cosmetic surgical procedure in the United States, but surgeon preferences in terms of technique and postoperative care regimen vary widely. The authors investigated the influence of career stage, practice type and location, and physician’s sex on surgical technique preferences among board-certified plastic surgeons performing breast augmentation. In October 2009, an online survey was e-mailed to all active members of the American Society of Plastic Surgeons practicing within the United States. Response frequencies were calculated and correlated with surgeon demographics. From the pool of 4737 respondents, 898 responses were received (18.9%). Surgeons performing breast augmentation were more frequently male, between 46 and 65 years old, and had practiced for at least 20 years in solo private practice in a suburban setting. Surgical volume most frequently consisted of 10% to 25% cosmetic surgery, with 10 to 50 breast augmentations performed per year. Surgeons in practice for five years or less were more likely to use smooth, round silicone gel-filled implants, to select implants smaller than 300 cc, to use the dual-plane pocket, and to recommend yearly follow-up. Surgeons in practice for more than 20 years were more likely to select saline implants, utilize the subglandular plane, perform closed capsulotomy, and place drains. Surgeons at academic centers performed fewer breast augmentation surgeries and placed smaller implants than those in private practice, while surgeons in suburban locations performed more breast augmentations than those in urban or rural locations. Surgeons in the West performed the greatest number of augmentations, although the largest-sized implants were placed in the Southwest. Compared with men, women surgeons appeared significantly less likely to use saline implants, were less likely to perform more than 100 breast augmentations per year, and were significantly more likely to place implants less than 300 cc. Surgical preferences were associated with years in practice and included differences in technique and postoperative care. Practice location was associated with differences in procedural volume, implant size, incision location, and recommended follow-up time, while practice type was related to surgical volume, implant size, implant location, and percentage of cosmetic surgery performed.

Shaikh-Naidu N, Beredjiklian PK: Complications after pi-plate osteosynthesis [letter]. Plastic and Reconstructive Surgery 2006 Jul 118(1): 273-274. Comments on an article authored by Sánchez, T, Jakubietz, M, Jakubietz, R, Mayer, J, Beutel, FK, and Grünert, J. Complications after Pi plate osteosynthesis. Plast Reconstr Surg 2005 116: 153.

Shaikh-Naidu N, Bozentka DJ, Katzman B, Beredjiklian PK: Synovectomy of the wrist and tenosynovectomy of the extensor tendons. Atlas of the Hand Clinics 2005 Sept 10(2): 199-207.  Rheumatoid arthritis is fundamentally a disease of the synovium. Synovial proliferation with the tendon sheath is extremely common and may occur before other symptoms of the disease are noted. The incidence of tenosynovitis in patients with chronic rheumatoid arthritis has been reported to be as high as 64%. Initially, the synovial sheath, retinaculum, and skin may become distended from fluid. Subsequently, the synovium thickens and forms adhesions to the extensor tendons. The synovium may continue to proliferate and infiltrate the tendon, weakening it and potentially leading to rupture. Further changes will lead to firm tissue unlikely to respond to medication. Persistent tenosynovitis for more than 6 months has been associated with a significantly higher rate of tendon rupture.

Shaikh-Naidu N, Preminger BA, Rogers K, Messina P, Gayle LB: Determinants of aesthetic satisfaction following breast reconstruction after mastectomy. Annals of Plastic Surgery 2004 May 52(5): 465-469. Several studies have evaluated patient satisfaction following breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap and tissue expander/implant. However, the specific aesthetic determinants of patient satisfaction have not been determined. Patients who had undergone tissue expander/implant or TRAM flap reconstruction were retrospectively polled on their age, type and timing of reconstruction, mastectomy type, laterality of reconstruction, adjuvant therapy, and symmetrizing and nipple-areolar procedures. Aesthetic satisfaction based on breast shape, symmetry of breast shape, breast size, symmetry of breast size, breast scarring, and breast sensation was assessed using a 5-point scale. Two hundred eleven patients with 105 TRAM flaps and 160 expander/implants responded. Unilateral TRAM recipients rated their breast shape, symmetry of breast shape, and symmetry of breast volume significantly higher than did implant patients. When bilateral reconstruction patients were evaluated, no significant differences were seen. The presence of nipple-areolar reconstruction positively influenced every parameter except breast sensation. Immediate reconstruction, skin-sparing mastectomy, and age >60 years at the time of reconstruction were also associated with higher scores, while postoperative radiation therapy resulted in lower satisfaction. Free flap reconstruction produced higher satisfaction in breast shape and breast scarring when compared with pedicle flap reconstruction. Aesthetic satisfaction after breast reconstruction is highly influenced by the presence of nipple-areolar reconstruction and less so by age, timing of reconstruction, adjuvant therapy, or free flap procedures. The type of reconstructive procedure is a significant variable only in unilateral reconstruction.

Shaikh-Naidu N, Hoffman LA, Jacobs M, Becker D: Correction of full-thickness defects of the auricular scapha following Mohs surgery. Plastic and Reconstructive Surgery 2004 Mar 113(3): 1073-1075. Reconstruction of nonmarginal defects of the ear has been sparsely addressed in the literature. This topic is of importance because the structural integrity of the ear may be affected not only by the defect but also by its reconstruction. We present a patient with a large full-thickness defect of the scapha of the ear and describe a one-stage, simple, and reliable method of repair.

Shaikh-Naidu N, Breitbart A: Eccrine spiradenoma of the upper extremity: Case report and an algorithm for management.
European Journal of Plastic Surgery 2003 Jun 26(3): 160-163. Eccrine spiradenoma is a tumor that may arise from sweat glands throughout the body. Although most cases are benign, occasional malignant transformation has been reported. A case in which a young woman presented with a long-standing lesion of the forearm sustained after trauma is reported. On histological examination a diagnosis of benign eccrine spiradenoma was made. The presentation of this disorder in the upper extremity is discussed, and an algorithm for treatment is proposed.

Shaikh N, LaTrenta G, Osborne M, Swistel A: Detection of recurrent breast cancer after TRAM flap reconstruction.
Annals of Plastic Surgery 2001 Dec 47(6): 602-607. Breast cancer remains a significant cause of morbidity and mortality among women today. The transverse rectus abdominis myocutaneous (TRAM) flap has played a substantial role in the reconstruction of defects secondary to mastectomy. Although such reconstruction has not been shown to adversely affect survival or local recurrence, specific screening modalities for recurrence in this population of patients have not been delineated. Three patients were examined retrospectively at the authors’ institution. They presented with local recurrences of breast cancer after mastectomy and TRAM flap reconstruction. All patients’ recurrences were detected on physical examination, and all had the diagnosis of recurrent carcinoma made on biopsy of the mass. A review of the literature demonstrates that mammography, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), scintimammography, and biopsy have all been used as adjuncts to clinical examination in detecting recurrence. Subsequent treatment of recurrent breast cancer is determined by the results of a metastatic workup and the receptor status of the tumor. The most reliable form of diagnosis of recurrent breast cancer after TRAM flap reconstruction remains fine-needle, core, or open biopsy if indicated.

Talmor M, Hydo L, Shaikh N, Gayle L, Hoffman L, Barie P: Clinical features and outcome of patients admitted to the intensive care unit after plastic surgical procedures: implications for cost reduction and quality of care. Annals of Plastic Surgery 1997 Jul 39(1): 74-9. Recent interest in cutting cost and improving utilization and delivery of perioperative services has prompted surgeons to identify patient populations that would benefit from care in an intensive care unit as opposed to intermediate or standard care. The purpose of this study was to evaluate patients admitted to the surgical intensive care unit (SICU) after major plastic/reconstructive surgical procedures in order to determine appropriate perioperative management strategies for these patients. We reviewed retrospectively the data from 2,805 consecutive admissions to the SICU between 1990 and 1996. Forty-two patients (1.5%) who had undergone major plastic/reconstructive procedures were identified. Outcomes (mortality, length of stay in the SICU and hospital, and the degree of organ dysfunction) were compared between this population, an illness severity-matched (Acute Physiology and Chronic Health Evaluation [APACHE]-II and APACHE III) population of patients recovering from vascular surgical procedures, and a similarly matched population of SICU patients who were randomly assigned to serve as a second control group. The hospital mortality of the plastic surgical patient population (9.5%) was significantly higher than the zero mortality of the random cohort (p < 0.05). A second analysis compared the SICU plastics group to a case-controlled group of patients who were admitted to the postanesthesia care unit (PACU) for at least 24 hours of perioperative monitoring. SICU patients had significantly higher APACHE II scores (10.9) when compared to PACU patients (7.2; p < 0.01). Based on severity of illness scoring and eventual mortality, patients admitted to our SICU after major reconstructive surgery were selected appropriately for that setting. In contrast, the patients who stayed in the PACU for perioperative monitoring did not require life-supporting therapy and, therefore, were overmonitored. Care could be provided in a specialized unit with dedicated nursing specifically trained for that purpose.

Brown M, Shaikh N, Brenowitz M, Brand L: The allosteric interaction between D-galactose and the Escherichia coli Galactose Repressor Protein. The Journal of Biological Chemistry 1994 269(17): 12600-12605. The Escherichia coli galactose repressor protein (GalR) inhibits transcription of the gal operon upon binding to two operator sites (1-7). This DNA binding activity is inhibited when D-galactose or D-fucose binds to GalR (8-14). Fluorescence spectroscopy was used to characterize the single tryptophan of GalR and to investigate the interaction between galactose and GalR. Fluorescence quenching experiments place both tryptophan residues of the GalR dimer in similar, solvent-exposed locations. Galactose is shown to enhance the intrinsic tryptophan fluorescence of GalR, the source of which is not explained by a change in decay times, but is due to an increase in the pre-exponential factor of the longest of the three fluorescence decay times. It is shown that the beta-anomer of D-galactose is the likely form that binds to GalR. An increase in pH from 6.3 to 9.5 causes the equilibrium association constant (K alpha) describing the galactose-GalR interaction to decrease 10-fold. The interaction is cooperative below pH 9.5. Over the pH range of 6.3 to 9.5, the tryptophan solvent exposure of GalR increases. Galactose binding also induces an increase in exposure. These results, and others presented in this paper, show that both pH and galactose cause global alterations in the structure of GalR.