This procedure depicts the microvascular anastomosis between the free anterolateral thigh (ALT) flap and the superficial temporal artery (STA) and superficial temporal vein (STV).
This procedure demonstrates the inset of the anterolateral thigh (ALT) flap into a large composite wound after oncologic resection.
Title: Full-thickness skin grafting for coverage of dorsal hand defect Authors: Vincent Riccelli, Brian Drolet MD, Elizabeth Lee MD Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli (firstname.lastname@example.org)
Excision of Nailbed Remnant following Finger Amputation Authors: Vincent Riccelli M.D. Candidate, Brian Drolet M.D., F. Bennett Pearce M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Vincent Riccelli
Deep Inferior Epigastric Perforator Flap: Microvascular Anastomosis and Neurotization This video depicts the microvascular anastomosis of the deep inferior epigastric artery and vein to the internal mammary artery and vein in an anterograde fashion for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old female patient status post bilateral mastectomy for breast cancer. Authors: Vincent Riccelli M.D., Eva Niklinska B.S., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
This procedure depicts the harvest of the anterolateral thigh flap to be utilized in the reconstruction of a post-extirpative scalp defect.
Deep Inferior Epigastric Perforator Flap: Abdominal Flap Dissection This video depicts the abdominal flap dissection for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old female patient status post bilateral mastectomy for breast cancer. Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
Deep Inferior Epigastric Perforator Flap: Abdominal Closure and Flap Inset This video depicts the abdominal closure and DIEP flap inset for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old patient status post bilateral mastectomy for breast cancer. Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D. Affiliations: Vanderbilt University Medical Center Corresponding Author: Eva Niklinska
In this video, we showcase the bilateral subcranial Le Fort III osteotomies with midface distraction using Kawamoto distractors. The surgery was performed in a 4-year-old boy with Crouzon Syndrome to correct his severe proptosis, increase the nasopharyngeal airway space and improve his severe negative overjet. Internal distractors were chosen to achieve maximum correction at this age. The patient undergoing surgery had no intraoperative or postoperative complications. A full separation of his facial bones was achieved. The patient had an uneventful recovery period, and there was a significant improvement in his proptosis and malocclusion. Santiago Gonzalez, BS, BA (1); Michael Golinko, MD, MS (2) 1. University of Arkansas for Medical Sciences – College of Medicine 4301 W. Markham, #550 Little Rock, AR 72205 2. Vanderbilt University Medical Center, Department of Plastic Surgery 2900 Children’s Way, 9th Floor Doctor’s Office Tower Nashville TN 37232
Join us in the journey of the legend as he gives us insights into his life and his achievements. Join us to be inspired by one of the best physicians in his field.
Most known for being the first Maness Professor and chair of Otolaryngology and for his role in founding the Vanderbilt Voice Center in 1991, Dr. Ossoff has held an array of positions since he joined Vanderbilt’s faculty in July 1986, including the first director for the Vanderbilt Bill Wilkerson Center for Otolaryngology and Communication Sciences, associate vice chancellor for Health Affairs, chief of staff for Vanderbilt University Adult Hospital, assistant vice chancellor of Compliance and Corporate Integrity and executive medical director for the Vanderbilt Voice Center. He was also highly involved with the creation of the Free Electron Laser Center at Vanderbilt University, bringing with him knowledge he gained during his residency and faculty appointment at Northwestern University in Chicago.
Dr. Ossoff will be joined by Dr. Michael Johns, Director, USC Voice Center, Dr, Albert Merati, Chief of Laryngology, UW Medicine’s Head and Neck Surgery Center, and Dr. Gaelyn Garrett, Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center.
Dr. Vyvy Young
Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery
University of California – San Francisco
VyVy Young, MD, is an Associate Professor and the Associate Residency Program Director in the Department of Otolaryngology-Head and Neck Surgery at the University of California – San Francisco. Dr. Young received her undergraduate and medical degrees from the University of Louisville, in Louisville, Kentucky, where she also pursued her Otolaryngology training. She then completed a fellowship in Laryngology and Care of the Professional Voice at the University of Pittsburgh Voice Center. She currently serves the American Academy of Otolaryngology – Head and Neck Surgery as member of the Annual Meeting Program Committee and Executive Committee for ENThealth.org. She is immediate past-chair of the Voice Committee and the Women in Otolaryngology Communications Committee and was recently selected as chair of the Finance and Audit Committee of the American Broncho-Esophagological Association.
Justin Roe, PhD, FRCSLT
Clinical Service Lead - Speech and Language Therapy – National Centre for Airway Reconstruction
Imperial College Healthcare NHS Trust
Dr. Roe is a clinical-academic and service lead, specialising in dysphagia in benign and malignant head and neck disease. He leads the speech and language therapy service for the National Centre for Airway Reconstruction at Imperial College Healthcare NHS Trust and is a consultant and service lead at the Royal Marsden NHS Foundation Trust. He is an Honorary Clinical Senior Lecturer at Imperial College London and an investigator on a number of NIHR portfolio studies. He is currently on an NIHR Imperial Biomedical Research Centre/ Imperial Health Charity funded post-doctoral research fellowship. He is an elected council member for the British Laryngological Association and British Association of Head and Neck Oncologists.
Professor Anil Patel MBBS PhD FRCA
Clinical Anaesthetist / Chairman of Department of Anaesthesia
Royal National ENT & Eastman Dental Hospital
Professor Anil Patel graduated from University College London in 1991. He is a clinical anaesthetist and continues to develop and refine the largest experience of anaesthetising adult airway patients under general anaesthesia (> 6,000 procedures) in the UK, probably Europe and possibly the world. His research interests include all aspects of shared airway and difficult airway management. Professor Patel has been an invited speaker to over 300 national and international meetings in 38 countries. He has over 130+ peer reviewed publications, 25 book chapters, over 4,500 citations and an h-index of 25.
Robbi A. Kupfer, MD
Associate Professor, Department of Otolaryngology-Head & Neck Surgery
University of Michigan
Dr. Kupfer is an Associate Professor of Otolaryngology-Head & Neck Surgery at the University of Michigan who specializes in Laryngology and Bronchoesophagology. She is the Program Director for the Laryngology Fellowship as well as the Otolaryngology Residency at the University of Michigan.
Alexander T. Hillel, MD, FACS
Johns Hopkins University School of Medicine
Dr. Alexander Hillel is a Laryngologist, Residency Program Director, and Vice Director of Education in the Johns Hopkins Department of Otolaryngology – Head & Neck Surgery. His clinical practice and research centers on the treatment, prevention, and causes of laryngotracheal stenosis (LTS).
Dale Ekbom, MD
Associate Professor of Otolaryngology / Director of Voice Disorders/Laryngology
Residency in Otolaryngology/Head and Neck Surgery at the University of Michigan with a fellowship in Laryngology/Care of the Professional Voice at Vanderbilt University Medical Center. Clinically specializing in voice, especially management of vocal fold paralysis, Zenker’s diverticulum and Cricopharyngeal muscle dysfunction, early laryngeal cancer, and airway compromise due to laryngeal, subglottic, and tracheal stenosis. Research interests include idiopathic subglottic stenosis and GPA with surgical and medical management of the airway, vocal fold paralysis, new injectables using Jellyfish collagen.
Dr. Ricky Thakrar
Consultant Chest Physician
University College London Hospital
Dr. Ricky Thakrar qualified in Medicine from Imperial College London. He trained in Respiratory Medicine at the Royal Brompton Hospital and completed his training in Northwest London. He was appointed to a three-year academic fellowship at UCL where his PhD examined state of the art bronchoscopy techniques for managing cancers arising in central airways and lung. He is a Consultant in Thoracic Medicine and his main interests are in interventional bronchoscopy procedures (laser resection, airway stenting, cryotherapy, photodynamic therapy and brachytherapy) for pre-malignant and malignant disease of the tracheobronchial tree.
Dr. Michael Rutter
Director of the Aerodigestive Center
Cincinnati Children's Hospital
Dr. Rutter is an ENT surgeon specializing in pediatric otolaryngology with an emphasis on airway problems in children, adolescents and young adults. His interests include tracheal reconstruction and complex airway surgery. Always a problem-solver, he strives to involve the patient in their own care by having them help evaluate the issue and then craft a solution together. He was drawn to his career by the challenge and highly individualized nature of pediatric airway problems and management. Dr. Rutter enjoys working in a multidisciplinary team setting and focusing on coordinated care for complex childhood airway conditions. He was honored to receive the 2016 Gabriel Frederick Tucker Award from the American Laryngological Association, and the 2018 Sylvan Stool Teaching Award from the Society for Ear Nose and Throat Advancement in Children (SENTAC). These awards are for his contributions to the field of pediatric laryngology. In addition to caring for patients, he is also dedicated to his research trying to find improvements in airway management.
Christopher T. Wootten, MD, MMHC
Director, Pediatric Otolaryngology—Head and Neck Surgery
Vanderbilt University Medical Center
Dr. Wootten has a longstanding interest in surgical management of congenital and acquired airway disorders. To better equip himself to lead the Pediatric ENT service through expansion, evolution of practice models, and differentiation into multidisciplinary care, Dr. Wootten obtained a Masters of Management in Health Care at Vanderbilt’s Owen School of Business in 2017. Areas of his professional research emphasis include airway obstruction in children and adults and aerodigestive care. He innovates minimally invasive surgical techniques in the head and neck. Dr. Wootten is actively investigating the role of eosinophil and mast cell-based inflammation in the pediatric larynx.
Karla O'Dell, M.D.
Assistant Professor / Co-director
USC Voice Center, Caruso Department of Otolaryngology Head and Neck Surgery @ University of Southern California / USC Center for Airway Intervention and Reconstruction
Karla O’Dell, MD, specializes in head and neck surgery and disorders of the voice, airway and swallowing. She is cofounder and codirector of the USC Airway Intervention & Reconstruction Center (USC Air Center).
Jeanne L. Hatcher, MD, FACS
Co-Director of the Emory Voice Center and Associate Professor of Otolaryngology
Emory University School of Medicine
Dr. Hatcher has been at Emory since 2014 after completing her laryngology fellowship with Dr. Blake Simpson; she specializes in open and endoscopic airway surgery as well as voice disorders. Dr. Hatcher is a member of the ABEA and post-graduate member of the ALA and also serves on the Ethics and Voice Committees for the American Academy of Otolaryngology Head and Neck Surgery.
Mr. Lee Aspland
Patient / Freelance Artist
Lee Aspland Photography
Lee Aspland is a photographer, author and mindful practitioner who creates photography that reflects his feelings about living in such a glorious world. He specializes in Mindful Photography, capturing a fleeting feeling or thought, a hope or fear, a frozen single moment in time.
Gemma Clunie, MSc, BA (Hon), MRCSLT
Clinical Specialist Speech-Language Pathologist (Airways/ENT) and HEE/NIHR Clinical Doctoral Research Fellow
Imperial College Healthcare NHS Trust/ Imperial College London, Department of Surgery & Cancer
Gemma is a Clinical Specialist Speech and Language Therapist with an interest in voice and swallowing disorders that is particularly focused on the benign ENT, head and neck, respiratory and critical care populations. Gemma is a current NIHR/HEE Clinical Doctoral Research Fellow at Imperial College London. Her PhD studies focus on the voice and swallowing difficulties of airway stenosis patients. She is based at Charing Cross Hospital in London where she has worked for the last six years as part of the National Centre for Airway Reconstruction, Europe’s largest centre for the management of airway disorders.
Niall C. Anderson, CPsychol, MSc, BSc
Lead Psychologist (formerly Respiratory Highly Specialist Health Psychologist)
Bart's Health NHS Trust (formerly Central & North West London NHS Foundation Trust)
Niall is a HCPC Registered & BPS Chartered Practitioner Health Psychologist, and BPS RAPPS Registered Supervisor. Niall has specialist experience of working within healthcare systems with people with long-term health conditions at all system levels to support physical, psychological and social wellbeing. Niall worked in the Airway Service at Charing Cross Hospital (London, UK) between January-December 2021 in order to develop and implement the Airway Psychology Service.
RaDonda Vaught’s conviction set a dangerous precedent for patient safety, but is also driving a push for better protections for nurses.
RaDonda Vaught, whose criminal prosecution for a fatal medical error made her case a flashpoint in national conversations about nursing shortages and patient safety, was sentenced on Friday to three years of probation in a Nashville criminal court. After the probationary period, she could ultimately have her conviction dismissed.
Vaught had been convicted of criminally negligent homicide and gross neglect of an impaired adult, which together carried a potential prison sentence of up to eight years.
In late 2017, Vaught, a nurse, mistakenly administered the wrong medication to patient Charlene Murphey while Murphey awaited a radiologic study at Vanderbilt University Medical Center. Murphey died as a consequence of the error, and an investigation later found that multiple patient safeguards that should have existed in the hospital had been absent or failing at the time of the event and were partially responsible for her death.
Vaught’s errors included removing the wrong medication from one of the hospital’s electronic prescribing cabinets, overlooking several warnings on the medication vial, and not monitoring Murphey’s vital signs after administering the medication.
What made Vaught’s case notable was that she was prosecuted in criminal court, a decision made by the Nashville district attorney. Most nursing malpractice cases are disciplined through state nursing boards, which can revoke professional licenses. If legal action is taken in nursing errors, it is generally through civil courts, where patients and families can obtain financial compensation.
Vaught’s case was also notable because while she was charged with a crime, her employer — Vanderbilt University Medical Center — faced fewer consequences.
While the hospital settled a civil case out of court with Murphey’s family, it has not been held criminally liable. And while the Tennessee health department revoked Vaught’s license, it did not punish the hospital, although the Tennessee Bureau of Investigation found multiple instances of wrongdoing and cover-ups on the hospital’s part.
Although the sentencing was lenient, patient safety advocates and nursing groups are upset about the case, and say it sets a bad precedent: because Vaught individually took the fall for a systematic failure.
Punishing individuals for systemic safety failures is concerning to patient safety advocates because it is ultimately detrimental to patient safety.
Why punishing nurses for medication errors can make patients less safe
For decades, scholars have understood that keeping patients safe requires continually improving the systems that prevent and catch medical errors before they happen. Critically, those systems cannot improve if the people within them don’t feel safe reporting problems.
One of the biggest concerns among patient safety experts is that severe punishment for medical errors — as in Vaught’s case — will lead to reduced error reporting by other nurses due to fear of being fired, or fear of prosecution. That could lead systemic problems to persist unfixed, which would be worse for patient safety.
In an April interview, Robert Gatter, a health law expert at Saint Louis University, said Vaught’s prosecution was a smokescreen that distracted from her employer’s inadequate safety systems. “They can forever now point to this person and say, ‘Wow, she is so bad,’” he said, rather than being held accountable for having a broken patient safety infrastructure.
Vaught’s case is one of several recent cases in which criminal charges were levied against nurses in settings ranging from jails to nursing homes. Many nurses say this trend, combined with the stresses of the pandemic and preexisting nursing shortages, has exacerbated already low morale among nurses.
Kedar Mate, a physician who is president of the Institute for Healthcare Improvement, recalls a recent anecdotal example of the case’s potential chilling effect among medical professionals. He was in an audience for a talk on patient safety in a room full of doctors and nurses. When the speaker asked how many of the attendees had reported a medical error, most of the hands in the room went up — and when he asked how many would do it now, in light of the Vaught case, most of the hands went down. “It’s had a very significant effect,” he said, although there isn’t hard data to cite here.https://e578181f53bd8b03e1e33f82a408238f.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html
Mate said several hospital CEOs — for example, the leadership of Northern Virginia’s Inova Health — are trying to head off that concern by communicating directly with employees. “Health system leaders are issuing statements, supporting their staff to come forward transparently to report — in essence, saying that ‘We hear and see what’s going on in Tennessee. In our system, we value transparent, candid, open, honest reporting of near misses and adverse events.’”
It’s hard to know what the outcome of that outreach will be. Rates of medical errors — and measures of staff willingness to report them — are only revealed over time.
“We’re not going to know for a little while whether this is going to have an effect,” said Mate of Vaught’s case.
The case is inspiring calls for policies that support nurses, and patients
American nurses are under enormous strain, and Vaught’s sentencing is unlikely to help. However, the case has directed attention to policies and legislations that would help prevent medical errors in the first place.
For one, the case has energized efforts to establish a National Patient Safety Board (NPSB), which would function much the way the National Transportation Safety Board does by reviewing data on medical errors and close calls with the highest likelihood of causing patient harm. The NPSB would then make recommendations for solutions and corrective actions that would prevent further bad outcomes for patients.
Karen Feinstein, leader of the advocacy coalition supporting the board’s creation, said she now uses Vaught’s case as an example of why the agency is necessary. “If you had an NPSB,” she said, “I don’t believe an accident like this would happen.”
An estimated 7,000 to 9,000 people die in the US each year as a result of a medication error. With a national board in place, many factors that contributed to the error that killed Charlene Murphey could have been identified in advance, including persistent software problems that weakened automated safety checks during medication dispensing, and Vaught’s distraction by an orientee (Vaught had been multitasking when the error occurred, helping with nursing needs across her unit and orienting a new employee).
Nurse-to-patient ratios are an important determinant of patient safety, and bills aimed at ensuring safer staffing ratios are making their way through the House and Senate. At the National Nurses March in Washington, DC, yesterday, many of those marching expressed support for the bills. The powerful hospital lobby is likely to oppose the legislation, lowering its chances of success, said a senior congressional staffer who requested anonymity to speak candidly about the bill. But nurses and nurses unions in several states are advocating for its passage.
On the day of the sentencing, hundreds of nurses gathered across the street from the Nashville municipal courthouse to support Vaught, a purple banner reading “We are nurses not criminals” on display. They held hands as they listened to a live broadcast of Judge Jennifer Smith’s decision, and erupted in cheers as the sentence was read.
Julie Griffin, a Florida nurse who was fired in 2018 after making complaints about unsafe staffing and monitoring procedures at the medical center where she worked, attended the rally. After the sentence was handed down, she said she felt ambivalent. “I mean, it’s a great verdict,” she said, “on a charge that should never have been imposed.”
The sentence notwithstanding, the case had already done damage to the nursing profession, said Griffin. Nurses were walking away from the profession before Vaught’s April verdict, but the case has intensified the sense of alienation for many, she said.
“The health care system needs to look in towards itself and start promoting a culture where nurses are allowed to speak up — to effect change before these things happen,” she said.
Read the source material for this article on vox.com.
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