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Table of Contents
Dr. Cohen Introduction
- Princeton University, A.B. Department of Molecular Biology (2005)
- Howard Hughes Medical Institute Research Training Fellowship (2008-2009)
- Yale University School of Medicine, MD/Masters of Health Sciences (2010)
- Washington University in St. Louis/Barnes-Jewish Hospital, Combined Plastic Surgery and General Surgery Residency (2010-2016)
- Harvard Medical School/Beth Israel Deaconess Medical Center, Breast Reconstructive & Microsurgery Fellowship (July 2016-June 2017)
Hobbies and Interests:
Competitive and recreational soccer leagues
Former concert choir singer and classical pianist
Enjoys cultural activities such as art museums, theater, ballet, and classical music
Breast Reduction Procedure
Dr. Cohen Gloves: 7-blue latex free indicator / 7 - latex free
Procedure: Breast Reduction
Position: Supine, arms out and secured with 2 kerlix on each side, lower body bair hugger, SCD boots
Prep: Chloraprep if allergy will use betadine, careful not to rub off surgical site markings
Draping: Universal drape Will use: Skin stapler 4 blue towels Ioban strip cut into fourths
Medications: 30cc 0.5% marcaine with epinephrine Saline irrigation
Equipment: 2- ESU machines with smoke evacuators at foot of bed – Settings: 30/30 1-Bair hugger 1- Scale to weigh specimen
Supplies: 2 -Smoke evac bovie pencils 2- Teflon protected bovie tips 2- bovie grounding pads 4- 10 blades 4-marking pens 2- rulers 2-25g needles 2-10cc syringes 2-aspeto 1-Basin for irrigation 38, 42 and 45 cookie cutter Lap pads only no raytec sponges on field
*if specimen >900g will use 15F round drain with 2-0 nylon on PS-2 Sutures: 2-0 vicryl SH X 1 3-0 monocryl PS-2 x6 4-0 monocryl PS-2 X 6 3 skin staplers
Dressing: 4- Dermabond
*Have prineo available 6 ABD pads and bra Special Instructions:
* IF oncoplastic reduction WEIGH LUMPECTOMY SPECIMEN PRIOR TO SENDING
**At end of case please provide patient label and specimen weights on card for Dr. Cohen
Tissue Expander
Subpectoral tissue expander using alloderm. He says that the press should be one thumb width apart that's cosmetically advantageous position of breast implants. This allows for cleavage, obviously. He uses 2-O vicryl in order to sew in the tissue expander as well as sew the alloderm to the muscle. He then uses 3-0 and 4-0 monocryl in order to close the skin.
Panniculectomy
Date of surgery: 11/5/2019
Preop Dx: Panniculitis, excess abdominal skin
Postop Dx: same
Procedure: Panniculectomy with umbilical transposition
Surgeon: Justin Cohen, MD
Assistant: Dayana Olivares, PA; Andrew Paredo MD; Jonathan Freedman MD
Anesthesia: GETA
EBL: 100 cc
Complications: None
Findings: As expected
Drains: 2 X 19F round blake drains
The risks included bleeding, pain, infections, damage to surrounding tissue, seroma, wound healing problems, need fur further surgery, loss of umbilicus, and unattractive scarring. Informed consent was obtained.
Operative Report
I marked the patient in the preoperative suite while standing. A high lateral tension approach was utilized to reduce dog ears. The lower incision was made above the mons pubis and in a dumbbell shape laterally with the maximum amount of resection marked.
The patient was brought into the operating room and placed in the supine position. All bony prominences were padded and the SCDs were on and functioning prior to the induction of anesthesia. All lines were obtained and secured and the patient was intubated and sedated as per protocol. The patient received preoperative antibiotics prior to surgical incision. A timeout was performed with the entire team and the patient was then prepped and draped in the standard fashion.
The umbilicus was dissected free from the abdominal skin using a 15 blade scalpel. Dissection was carried down to the abdominal wall being sure to leave adequate tissue to maintain perfusion. A larking stitch was placed into the umbilicus for future placement onto the abdominal wall. Next the lower abdominal incision was made with a 10 blade and then carried to just above rectus fascia with bovie electrocautery. Many large superficial veins were encountered and controlled with a combination of surgical clips and electrocautery. Dissection was carried cephalad to the superior incision which was above the umbilicus. I then confirmed that we could close the wound with a reasonable tension with a small amount of retroflex of the bed. The superior extent of the incision was then marked and incised. The pannus was then removed after all the bleeding vessels were controlled. Weight of specimen ~1500g. The wound was irrigated copiously with saline and meticulous hemostasis was confirmed. 30cc of 0.5% marcaine was added into the abdominal wall for post operative pain control. The upper abdominal skin was then tailor tacked closed. 2X19F drains were placed into the wound and secured with 2-0 nylon sutures laterally. The Scarpa's fascial layer was then closed with with 2-0 vicryl. The dermis was closed with interrupted 3-0 monocryl. The epidermis was then closed with an intracuticular 4-0 monocryl.
The umbilicus was then delivered through a new opening on the abdominal skin making sure not to twist it. This was secured in position with 3-0 monocryl and 4-0 fast gut. The wounds were subsequently dress with Prineo and Biopatches to the drain sites. The patient was then placed in an abdominal binder with ABDs for padding.
The patient tolerated the procedure well and without complication. She was brought to PACU in stable condition.
Drains: 2 X 19F round blake drains brought at lateral edge of incision
Sutures: Drains 2-0 nylon, SFS 2-0 vicryl, Skin:3-0, 4-0 monocryl. Umbilicus: 3-0 monocryl, 4-0 fast gut.
Dressing: Abdomen: prineo, Umbilicius dermabond, drains: biopatch and tegaderm, ABDs, Binder.
Markings: High lateral tension approach. Markings are dumbbell shaped.
Resident Notes:
The high lateral tension approach changes the area of greatest tension to about the 1/3rd mark of the incision and off midline. The dumbbell shape helps decrease dog ears. Dr. Cohen will mark the maximum that you can cut with his pre-op markings. In the OR, you will have to remeasure and will not get that far. Remember that the area of greatest tension is not in the middle and you are lateralizing the upper part of your skin flap.
Questions you will be asked:
If you can't close your incision what are your options? More reflex, more undermining superiorly and inferiorly, progressive tension suturing, incisional wound vac. Wedge out flap subcutaneous tissue.
Abdominoplasty/Liposuction
place holder for op report
