What's New | Decker

Novel treatment modalities include Negative Pressure Wound Therapy, bioengineered skin substitutes and placental derived constructs
Advances in microsurgical techniques including perforator flaps and understanding angiosomes
Improvements in management of vascular disease including advances in diagnostic methods and new non-invasive stenting techniques

Lance Griffin, MD, Cathline Layba, MD

Sarah Culbreth, PharmD, BCPS, Jessica Rimsans, PharmD, BCPS, Dirk Varelmann, MD

As the direct acting oral anticoagulants (DOACs) have short half-lives, they are able to be continued throughout low bleeding risk procedures, or for high bleeding risk procedures, they may be held 1 to 4 days depending on renal function.
Idarucizumab (Praxbind) is a new FDA-approved targeted reversal agent to reverse the effects of dabigatran (Pradaxa) in those with life-threatening bleeding or requiring urgent or emergent surgery.
Andexanet alfa is a modified decoy protein newly FDA approved for reversal of apixaban and rivaroxaban, based on results of the ANNEXA-4 trial.

Minimally invasive management strategies exist for treatment of gynecomastia
Various management strategies exist for treatment of Poland syndrome
Minimally invasive technologies exist for treatment of congenital breast anomaly reconstruction

Steven N Hochwald, MD, FACS, Rupen Shah, MD

Nomograms and consensus management of complications of esophageal surgery
Multimodality treatment approaches using neoadjuvant carboplatin, paclitaxel, and radiation therapy followed by surgery
Results from minimally invasive treatment approaches
Trastuzumab for anti-growth factor treatment in cases of metastatic adenocarcinoma of the esophagus

Approaching hypospadias with an algorithm for correction helps eliminate variation in surgical techniques.
Understanding the anatomy of the phallus helps the surgeons troubleshoot when they come across challenges in hypospadias repair.
Key surgical techniques should be applied to hypospadias surgery to decrease complications and improve outcomes.

Maulik Rajyaguru, DO, Jill Yaung, MD

For outpatients, recent trials have demonstrated non-vitamin K oral anticoagulants to be just as efficacious in VTE management while significantly decreasing the risk of hemorrhagic events.
The CLOTS 1 and 3 trials provide evidence that SCDs but not compression stockings have an additive, preventative effect on the prevention of VTE in immobile patients who suffered a stroke.
For the general critical care patient, transfusion for a hemoglobin level greater than 7 g/dL is rarely recommended, except for patients with ischemic heart disease.
The minimum platelet count for a bronchoscopy is 30 × 103 platelets/µL.

MRI safe devices and leads: older implanted devices were considered an absolute contraindication for MRI, depriving patients of the benefits of this important diagnostic imaging modality. Although many of the fears of device malfunction during MRI have been shown to be unfounded, newer devices and leads have been manufactured to ensure safety within the MRI scanner.
Leadless pacemakers: a recent innovation is the implantation of miniaturised pacemakers directly into the myocardium, avoiding the need for pacemaker leads.
Recent studies suggest improved outcomes by novel cardiac resynchronization therapy pacing modes (LV only modes).
Device innovation for MAZE procedures: technologic advances allow reduction of invasiveness of MAZE procedures, such as robotic-assisted procedures, or translate advances in energy delivery developed in transcatheter ablations to the surgical world (cryoMAZE).

Surgery of the Lower Extremity