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Emerick, Kevin

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Emerick

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Kevin

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Emerick, Kevin
Author's Publications: search.filters.isAuthorOfPublication.2f455e8a-7412-41f4-a6ea-cd5bd2f5adb1

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    Chicken thigh microvascular training model improves resident surgical skills
    (John Wiley and Sons Inc., 2017) Creighton, Francis X.; Feng, Allen; Goyal, Neerav; Emerick, Kevin; Deschler, Daniel
    Objectives: Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design Validation study Methods: Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator. Results: There was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance. Conclusions: The chicken thigh model demonstrates objective improvements in resident microvascular surgical skills. Level of Evidence NA
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    Nasal mucosal melanosis may act as a harbinger of melanoma: A case report
    (OceanSide Publications, Inc., 2016) Yao, William C.; Emerick, Kevin; Kraft, Stefan; Holbrook, Eric
    Background: The progression from a benign pigmented lesion on the skin to cutaneous melanoma is better understood, and it could be presumed that a similar progression occurs with mucosal lesions. However, to our knowledge, there has never been documentation of melanosis transforming into melanoma over time. Objective: To describe a transformation of a mucosal melanosis into melanoma. Methods: A 53-year-old man with diffuse melanosis of the nasal cavity underwent surgical resection. Results: Pathology revealed melanocytic hyperplasia without evidence of melanoma. The patient was serially examined, with excisions for new areas of melanosis. The pathology progressed to severely atypical melanocytic proliferation and melanoma in situ over a 4-year period. Conclusion: Nasal melanosis may be a precancerous lesion and may transform into melanoma. All melanosis should be biopsied with close endoscopic observation. Lesions with dysplasia or atypia should be excised due to potential transformation to melanoma.
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    Postoperative Care in an Intermediate-Level Medical Unit After Head and Neck Microvascular Free Flap Reconstruction
    (Wiley, 2018-11-28) Yu, Phoebe K.; Sethi, Rosh; Rathi, Vinay; Puram, Sidharth; Lin, Derrick; Emerick, Kevin; Durand, Marlene; Deschler, Daniel
    Objective: The need for intensive care unit (ICU) admission and mechanical ventilation after head and neck microvascular free flap reconstructive surgery remains controversial. Our institution has maintained a longstanding practice of immediately taking patients off mechanical ventilation with subsequent transfer to intermediate, non-ICU level of care with specialized otolaryngologic nursing. Our objective was to describe postoperative outcomes for a large cohort of patients undergoing this protocol and to examine the need for routine ICU transfer. Materials and Methods: We performed a retrospective review of 512 consecutive free flaps treated with a standard protocol of immediate postoperative transfer to an intermediate-level care unit with specialized otolaryngology nursing. Outcome measures included ICU transfer, ventilator requirement, flap failure, postoperative complications, and length of stay. Predictors of ICU transfer were identified by multivariable logistic regression. Results: The vast majority of patients did not require intensive care. Only a small fraction (n = 18 patients, 3.5%) subsequently transferred to the ICU, most commonly for respiratory distress, cardiac events, and infection. The most common complications were delirium/agitation (n = 55; 10.7%) and pneumonia (n = 51; 10.0%). Sixty-five cases (12.7%) returned to the OR, most commonly for hematoma/bleeding (n = 41; 8.0%) and anastomosis revision (n = 20; 3.9%). Heavy alcohol consumption and greater number of medical comorbidities were significant predictors of subsequent ICU transfer. Conclusions: Among head and neck free flap patients, routine cessation of mechanical ventilation and transfer to intermediate-level care with specialized ENT nursing was found to be safe with infrequent subsequent ICU transfer and low complication rates. Routine transfer to intermediate-level care in this population may prevent unnecessary ICU utilization and facilitate the delivery of high-value, disease-centered care. Level Of Evidence: 3b