About

Detlev Erdmann is a Professor of Surgery at Duke University and a member of the Duke Cancer Institute. His clinical and research focus includes plastic, maxillofacial, and oral surgery, with specific expertise in craniomaxillofacial trauma and reconstructive surgery. He is involved in the Division of Hand Surgery and participates in the General Surgery Residency Program, as well as the Integrated Plastic and Reconstructive Surgery Residency Program. His work encompasses both human anatomic research and advanced surgical techniques, contributing to the fields of reconstructive surgery and trauma management.

Research topics

• Medicine
• Biology
• Surgery
• Radiology
• Cardiology
• Immunology
• Cell biology
• Pathology
• Genetics

Selected publications

• Modified V-Y Flap Reconstruction Following Abdominoperineal Resection in Irradiated Patients: Analysis of 10 Years of Experience

  Plastic & Reconstructive Surgery Global Open · 2026-04-01

  articleOpen access

  Background: Wound complications following primary closure after abdominoperineal resection reach rates of up to 66%. The de-epithelialized V-Y flap has emerged as a common closure technique, particularly in irradiated patients. This study evaluates the 10-year experience of the modified V-Y flap at our institution. Methods: A retrospective review of patients who underwent de-epithelialized V-Y flap reconstruction for abdominoperineal resection defects between 2013 and 2024 was performed. An analysis of wound complications (eg, infections, dehiscence) and surgical outcomes (eg, reoperations, readmissions) was performed. Multivariate logistic regression assessed the effects of comorbidities and operative factors on wound complications, 30-day reoperations, 30-day readmissions, interventional radiology drainage, and length of stay. Results: Eighty-three patients were included, with a wound complication rate of 30.1%. The most common complication was pelvic fluid collections (22.9%), followed by dehiscence (21.7%). Within 30 days, 6 (7.2%) patients required reoperation, and 13 (15.7%) patients were readmitted. Patients with chronic obstructive pulmonary disease ( P = 0.046) or atrial fibrillation ( P = 0.048) were more likely to have wound complications. Mesh use (n = 6) was associated with higher wound complications ( P = 0.02), reoperations ( P = 0.03), readmissions ( P < 0.001), and interventional radiology drainage ( P = 0.01). Conclusions: The modified V-Y flap demonstrated improved wound complication with more robust data compared with our prior study. Patients with chronic obstructive pulmonary disease or atrial fibrillation may face higher risks of wound complications. Mesh use was associated with an increased rate of complications and interventions.

  PublisherDOI

• Apolipoprotein E Mimetic Peptide CN-105 and Postoperative Delirium in Older Patients

  JAMA Network Open · 2026-04-03

  articleOpen access

  Importance: The apolipoprotein E (APOE) gene ε4 allele leads to increased Alzheimer disease risk and neuroinflammation and is also believed to play a role in postoperative delirium. However, the safety and feasibility of modulating apoE protein signaling to reduce postoperative neuroinflammation and delirium in older adults are unclear. Objective: To assess the safety and feasibility of the apoE mimetic peptide CN-105 for reducing delirium incidence and severity and neuroinflammation after noncardiac or nonintracranial surgery in older adults. Design, Setting, and Participants: This triple-blind, escalating dose, phase 2 randomized clinical trial enrolled patients from April 17, 2019, to December 28, 2022, at a tertiary academic medical center. Included patients were 60 years or older and scheduled for a noncardiac or nonintracranial surgery. Exclusion criteria were incarceration, planned chemotherapy within 6 weeks after surgery, or inability to undergo lumbar punctures. Data analyses were based on a modified intention-to-treat approach and were performed from August 14, 2023, to August 22, 2025. Interventions: Patients were randomly assigned 3:1 to the CN-105 group or placebo group. The CN-105 group received intravenous CN-105 doses of 0.1, 0.5, or 1 mg/kg starting within 1 hour before surgery and administered every 6 hours afterward until hospital discharge or 13 doses were received. Patients in the placebo group followed the same administration schedule. Main Outcomes and Measures: The primary outcome was safety-the incidence and number of postoperative adverse events (AEs). Secondary outcomes included feasibility (rate of drug doses administered within 90 minutes of schedule), postoperative delirium incidence and severity, and postoperative changes in cerebrospinal fluid (CSF) cytokine levels (interleukin [IL] 6, granulocyte-colony stimulating factor [G-CSF], monocyte chemoattractant protein-1 [MCP-1], and IL-8). Results: Among 203 enrolled patients, 186 (mean [SD] age, 68.7 [5.2] years; 119 males [64.0%]) were randomized (137 to the CN-105 group, 49 to the placebo group) and underwent surgery. The rates of grade 2 or higher AEs among patients in the CN-105 and placebo groups were 76.6% and 87.8% (relative risk [RR], 0.87; 95% CI, 0.76-1.00; P = .10). The CN-105 vs placebo group had fewer grade 2 or higher AEs per patient (median [IQR], 1 [1-3] vs 2 [1-5]; P = .03). The percentage of CN-105 doses administered within the time window was 94.6% (860 of 909; 95% CI, 92.9%-96.0%) in the CN-105 group and 93.8% (346 of 369; 95% CI, 90.8%-96.0%) in the placebo group. Among patients in the CN-105 vs placebo group, the postoperative delirium incidence was 19.3% vs 26.5% (odds ratio [OR], 0.66; 95% CI, 0.31-1.42; P = .29); the median (IQR) postoperative delirium severity scores were 1 (1-2) vs 2 (1-2) (P = .19); and the median difference in preoperative to 24-hour postoperative CSF cytokine-level changes were as follows: -0.39 pg/mL (95% CI, -0.93 to 0.14 pg/mL, P = .12) for IL-6, -0.84 pg/mL (95% CI, -3.06 to 1.40 pg/mL; P = .18) for G-CSF,-23.32 pg/mL (95% CI, -94.36 to 44.93 pg/mL; P = .57) for IL-8, and -2.36 pg/mL (95% CI, -58.57 to 58.62 pg/mL; P = .50) for MCP-1. Conclusions and Relevance: In this phase 2 randomized clinical trial of older surgical patients, CN-105 (vs placebo) administration was feasible and did not increase AEs. A phase 3 trial is warranted to further evaluate the efficacy of CN-105 for reducing postoperative AEs and to more precisely determine its effects on postoperative delirium incidence and severity. Trial Registration: ClinicalTrials.gov Identifier: NCT03802396.

  PublisherOA PDFDOI

• Massive Weight Loss with Bariatric Surgery and GLP-1RA Therapy Predicts Postoperative Complications Following Abdominal Body Contouring

  Plastic & Reconstructive Surgery · 2026-03-11

  article

  BACKGROUND: . Body contouring patients increasingly utilize potent weight loss modalities, including bariatric surgery and glucagon-like peptide-1 receptor agonists (GLP-1RAs). This study assessed the effect of massive or rapid weight loss from high-potency weight loss modalities on abdominal body contouring outcomes. METHODS: . A retrospective cohort study was performed on patients who underwent abdominal body contouring surgery at a large academic institution between 2013 and 2025. Patients were stratified by preoperative weight loss from bariatric surgery, GLP-1RAs, or combined bariatric surgery/GLP-1RAs. Preoperative weights were extracted, and postoperative complications were compared between cohorts. RESULTS: . 552 patients were included. Patients using combined bariatric surgery/GLP-1RAs (28.6%) and bariatric surgery alone (24.1%) had the highest total body weight loss percentages (TBWL%). Patients with combined bariatric surgery/GLP-1RA use had the highest rate of weight loss at 0.95% TBWL per month. Irrespective of weight loss modality, a higher magnitude of weight loss was predictive of seroma (OR 1.05 [1.02-1.08], p=0.004) and composite complications (OR 1.03 [1.01-1.05], p=0.017) on multivariable regression. Higher weight loss rate was also predictive of postoperative seroma (OR 2.64 [1.26-5.60], p=0.010). Combined bariatric surgery/GLP-1RA use was predictive of seroma (OR 3.05 [1.02-8.08], p=0.032), hematoma (OR 3.74 [1.02-13.76], p=0.047), and unplanned return to the operating room (OR 6.78 [2.42-17.99], p<0.001). CONCLUSIONS: . Massive or rapid weight loss prior to abdominal body contouring surgery is predictive of postoperative complications. Patients with combined bariatric surgery and GLP-1RA use have the highest degree and rate of weight loss and subsequently experience higher complication rates.

  PublisherDOI

• Giant Condyloma Acuminatum

  Annals of Plastic Surgery · 2025-03-28 · 4 citations

  reviewSenior author

  ABSTRACT: The management of giant condyloma acuminatum in the male population remains challenging given the anatomic complexity of this region. Preservation of micturition and sexual function are key considerations. After primary resection, reconstructive plastic surgery is often necessary for coverage of soft-tissue defects, necessitating a multidisciplinary approach by urologic, plastic, and colorectal surgery. Because of the rarity of this disease, a defined treatment protocol has not been established. This review aims to outline key considerations and reconstructive options for this challenging disease, which are highlighted by two cases of successful reconstruction.

  PublisherDOI

• Invited Commentary From the Authors of

  Annals of Plastic Surgery · 2025-10-24

  article
  PublisherDOI

• Complications and Hardware Failure Following Synthetic Cranioplasty Implants and Free Flap Coverage

  Journal of Reconstructive Microsurgery · 2025-07-18 · 1 citations

  article

  Background: Composite defects of the scalp and calvarium are complex reconstructive problems. Bony reconstruction is often achieved with synthetic implants, demanding robust soft tissue coverage. In cases where the native scalp has been compromised, free tissue transfer may be indicated. The existing literature on this topic lacks a robust analysis of long-term outcomes and hardware retention rates. The current study is a multi-institutional review of composite calvarial reconstruction with free flap coverage of synthetic cranioplasty implants, focusing specifically on flap selection, long-term outcomes, hardware extrusion, and explantation rates. Methods: A retrospective review was conducted at two high-volume institutions for patients who had undergone cranioplasty and free tissue transfer between 2001 and 2022. Patient demographics and comorbidities, reconstructive indications, cranioplasty material, flap type, and complications within a 90-day period were collected. Implant exposure and explantation data were collected through follow-up. Results: A total of 42 patients were identified with an average age of 59 years (SD 14.9). Prior scalp radiation was present in 54.7% of cases. Cranioplasty was most commonly indicated after tumor extirpation (88.0%), with titanium mesh as the most common material utilized (64.3%). The most commonly used free flaps were latissimus (45.2%), anterolateral thigh (ALT) (16.7%), and radial forearm (16.7%). The most common recipient vessels were the superficial temporal (64.2%), facial (21.4%), and superior thyroid (9.5%). Flap compromise requiring return to the operating room occurred in two patients (4.8%) and partial flap loss occurred in three patients (7.14%). Surgical complications occurred in 60% of cases with wound complications (33.3%) and surgical site infection (28.6%) being the most common. Implant extrusion occurred in 31% of cases at an average of 7.9 months (SD 30.1) after definitive reconstruction, and explantation was required in 42.9% of cases at an average of 12.8 months (SD 33.6). The average total length of follow-up was 27.1 months. Conclusion: This multi-institutional analysis found that patients who undergo composite cranial vault reconstruction and free flap coverage experience high rates of surgical complications, and over one-third of these patients experience implant extrusion or explantation. Although no individual patient-related risk factor was independently associated with increased complication rates, our findings suggest that flap composition and timing of reconstruction may influence hardware retention and should be carefully considered during preoperative planning.

  PublisherDOI

• The Uroplastic Approach to Complex Rectourethral Fistula Repair: Indications, Technique, Results

  Plastic & Reconstructive Surgery Global Open · 2025-04-01 · 2 citations

  articleOpen accessSenior author

  Background: Rectourethral fistulae are complex pathologies with significant morbidity that warrant multidisciplinary care. Although gracilis muscle interposition for fistula repair has been reported, specific indications and techniques for this mode of reconstruction remain unclear. Methods: A retrospective quasi-experimental study was previously conducted to assess outcomes of rectourethral fistula management before and after the implementation of a multidisciplinary treatment algorithm. Patients with complex rectourethral fistulae and repair with gracilis muscle flap interposition were further investigated. Plastic surgery involvement for gracilis muscle interposition was indicated for (1) radiated rectourethral fistulae less than 3 cm and (2) nonradiated rectourethral fistulae more than 2 cm. Our preferred technique for gracilis muscle flap harvest, transposition, and inset is described in detail. Primary outcomes included healing of rectourethral fistulae and secondary reversal of urinary or fecal diversions. Results: Twenty-three patients with complex rectourethral fistulae underwent gracilis muscle flap interposition between 2001 and 2022 before (n = 12) and after (n = 11) algorithmic implementation. The frequency of definitive rectourethral fistula healing improved in the postalgorithm group by 33%. There was no significant difference in fistula healing time or the rate of urinary or fecal diversions after algorithm implementation. The technique of gracilis muscle flap interposition is also described. Conclusions: The gracilis muscle interposition flap is a valuable reconstructive option for complex rectourethral fistula repair. Implementation of a multidisciplinary treatment algorithm including plastic surgery involvement and refinement of the operative approach was associated with improved frequency of definitive healing of rectourethral fistulae.

  PublisherDOI

• Assessing the Benefits and Downsides of Physician Review Websites to Plastic Surgeons

  Annals of Plastic Surgery · 2024-01-06

  articleSenior author

  BACKGROUND: Patients often evaluate the reputations of plastic surgeons based on their performances on physician review websites. This article aims to compare rating methodologies and conduct a cost-benefit analysis of physician review websites to further understand how plastic surgeons and their patients can utilize review websites to inform their practice and care. METHODS: A review of online literature, blogs, and 17 of the most common physician review websites was conducted to identify information on review website methodology, cost, and benefits most pertinent to plastic surgeons and their patients. RESULTS: Physician review websites utilize various combinations of physician-related and unrelated criteria to evaluate plastic surgeons. Across 17 reviewed platforms, most (71%) utilize star ratings to rate physicians, 18% require an appointment to conduct a review, and 35% feature search engine optimization. Many websites (53%) allow physicians to pay for benefits or extension packages, with benefits offered including advertising, search engine optimization, competitor blocking, social media marketing, consultant services, and data analytics. Competitor blocking was provided by the most number of websites who offered additional services for pay (78%). CONCLUSIONS: Appointments are not required to post physician reviews on many review websites, and many websites allow physicians to purchase packages to enhance their search engine optimization or consumer reach. Accordingly, plastic surgeons' reputations on review websites may be influenced by factors extraneous to actual patient care. Patients and physicians should be cognizant that physician review websites may not be reflective of factors related to quality of patient care.

  PublisherDOI

• Combined posterior approach brachioplasty and cubital tunnel release in massive weight loss patients

  European Journal of Plastic Surgery · 2024-05-03

  articleSenior author
  PublisherDOI

• 53. The Influence Of Patient And Surgeon Characteristics On Provider Ratings In Plastic Surgery: An Analysis Of 6000 Press Ganey Surveys

  Plastic & Reconstructive Surgery Global Open · 2024-05-01 · 1 citations

  articleOpen accessSenior author

  PURPOSE: While patient satisfaction ratings are increasingly used as hospital and provider performance metrics, these ratings may be affected by extraneous factors. This study aimed to assess whether outpatient Press Ganey ratings for plastic surgery providers were tied more to provider or patient characteristics. METHODS: All CG-CAHPS responses for plastic surgery providers from 2017-2023 at a single institution were analyzed. Ordered logistic regression was used to identify characteristics associated with provider ratings. RESULTS: 6,442 surveys from 4,594 patients across 29 plastic surgery providers were analyzed. Across the cohort, 23.2% (N=1,492) rated providers lower than a 10/10. After adjustment, provider characteristics including provider gender, patient-provider gender concordance, and years in practice were not associated with overall provider ratings (all p>0.05). Hand surgery or craniomaxillofacial trauma providers tended to receive lower ratings compared to other plastic surgery subspecialties (both p<0.001). Older patient age [Odds Ratio (OR) 1.02; p<0.001)] was associated with higher ratings. Finally, poorer patient-reported overall health and mental health were associated with lower provider ratings (both p<0.05), CONCLUSION: Press Ganey ratings for plastic surgeons are influenced by patient factors including age and mental health, as well as subspecialty indication, a finding likely attributable to the proportion of patients presenting for trauma compared to elective indications. As satisfaction ratings are increasingly used as performance metrics, adjusted models may be needed to more accurately reflect surgeon performance.

  PublisherDOI

Frequent coauthors

• L. Scott Levin

  173 shared

• L. Scott Levin

  University of Pennsylvania

  140 shared

• Keith E. Follmar

  Johns Hopkins University

  133 shared

• Bruce Klitzman

  Duke University

  108 shared

• Jeffrey R. Marcus

  Duke University

  90 shared

• Kevin C. Olbrich

  Duke University Hospital

  69 shared

• G. Germann

  Heidelberg University

  66 shared

• Scott L. Levin

  University of Pennsylvania

  65 shared

Labs

• Division of Hand SurgeryPI