Browsing by Author "Cohen, Adam C."

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    Age at Diagnosis as a Relative Contraindication for Intervention in Facial Nonmelanoma Skin Cancer
    (American Medical Association, 2018-04-01) Chauhan, Ruvi; Munger, Brook N.; Chu, Michael W.; Munshi, Imtiaz; Cohen, Adam C.; Wooden, William A.; Tholpady, Sunil S.; Surgery, School of Medicine
    Facial nonmelanoma skin cancers (fNMSCs), consisting of basal cell carcinoma and squamous cell carcinoma, are the most common cancers diagnosed worldwide and increase with age. Standard treatment for fNMSCs requires biopsy for pathological confirmation, followed by excision. Excision can lead to a pathological diagnosis of no residual carcinoma (NRC) due to no identifiable carcinoma within the excisional specimen. This situation can occur owing to wound healing in the specimen clearing the carcinoma or to the original biopsy shaving off the entire lesion. This study assesses the utility of excising fNMSCs according to age, with the hypothesis that the indolent nature of fNMSCs and the high NRC rate, coupled with increasing age-related all-cause mortality, should cause the surgeon to counsel patients differently. Such counseling may prevent surgery among elderly patients (>90 years) who may never see a benefit from fNMSC excision.
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    Patient-Reported Outcomes and Factors Associated With Patient Satisfaction After Surgical Treatment of Facial Nonmelanoma Skin Cancer
    (American Medical Association, 2019-02-01) Sasor, Sarah E.; Cook, Julia A.; Loewenstein, Scott N.; Wooden, William A.; Cohen, Adam C.; Chu, Michael W.; Tholpady, Sunil S.; Surgery, School of Medicine
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    Tourniquet Use in Wide-Awake Carpal Tunnel Release
    (Sage, 2020-01) Sasor, Sarah E.; Cook, Julia A.; Duquette, Stephen P.; Lucich, Elizabeth A.; Cohen, Adam C.; Wooden, William A.; Tholpady, Sunil S.; Chu, Michael W.; Surgery, School of Medicine
    Background: Carpal tunnel syndrome is a common cause of upper extremity discomfort. Surgical release of the median nerve can be performed under general or local anesthetic, with or without a tourniquet. Wide-awake carpal tunnel release (CTR) (local anesthesia, no sedation) is gaining popularity. Tourniquet discomfort is a reported downside. This study reviews outcomes in wide-awake CTR and compares tourniquet versus no tourniquet use. Methods: Wide-awake, open CTRs performed from February 2013 to April 2016 were retrospectively reviewed. Patients were divided into 2 cohorts: with and without tourniquet. Demographics, comorbidities, tobacco use, operative time, estimated blood loss, complications and outcomes were compared. Results: A total of 304 CTRs were performed on 246 patients. The majority of patients were male (88.5%), and the mean age was 59.9 years. One hundred patients (32.9%) were diabetic, and 92 patients (30.2%) were taking antithrombotics. Seventy-five patients (24.7%) were smokers. A forearm tourniquet was used for 90 CTRs (29.6%). Mean operative time was 24.97 minutes with a tourniquet and 21.69 minutes without. Estimated blood loss was 3.16 mL with a tourniquet and 4.25 mL without. All other analyzed outcomes were not statistically significant. Conclusion: Operative time was statistically longer and estimated blood loss was statistically less with tourniquet use, but these findings are not clinically significant. This suggests that local anesthetic with epinephrine is a safe and effective alternative to tourniquet use in CTR. The overall rate of complications was low, and there were no major differences in postoperative outcomes between groups.
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    The Veterans Affairs Medical Center's Contribution to Plastic Surgery Education
    (American Medical Association, 2018-03-01) Sasor, Sarah E.; Chu, Michael W.; Evans, Tyler A.; Cook, Julia A.; Wooden, William A.; Cohen, Adam C.; Tholpady, Sunil S.; Surgery, School of Medicine
    Veterans Affairs (VA) medical centers have played a major role in graduate medical education since the 1940s. Currently, the VA health system operates 168 medical centers across the United States and supports the clinical training of more than 41 200 medical residents annually. Teaching hospitals within the VA provide subspecialty medical and surgical care and perform the majority of complex and high-risk surgical procedures. The diversity of pathologic conditions requiring a plastic surgery skill set are prominent within the VA population: cancer reconstruction, hand surgery, facial fractures, and burn care. Educational opportunities are ample. Plastic surgery residents in university-based training programs typically rotate at the VA hospital for several months each year. This study examines the relationship between the plastic surgery service and resident education within the VA hospitals.