December 2012 Emory Surgery newsletter Department of Surgery of the Emory University School of Medicine


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DoD funds pilot wound closure study at Grady

Dr. Dente teaching surgeon-performed ultrasound to medical students
Dr. Dente leading surgeon-performed ultrasound training.

The Department of Defense (DoD) is funding a pilot wound closure study based at Grady Memorial Hospital entitled "The effect of inflammatory biomarker expression on decisions to close traumatic wounds." Dr. Christopher Dente, an associate professor of surgery of the Emory University School of Medicine, is the principal investigator, and Dr. Allan Kirk, vice chair of research of the Department of Surgery, Emory, is the co-investigator. The study is the first of its kind in the country at a civilian medical center. Dr. Dente is a surgeon-researcher-educator in the trauma/surgical critical service service at Grady.

While outcomes in wound care have improved due to such methods as serial debridement and vacuum-assisted closure devices, decisions regarding the optimum timing of wound closure have remained subjective. The need for standardization of this sensitive treatment stage has been underscored by recent military conflicts, where U.S. military surgeons have had to grapple with large numbers of traumatic and extreme combat injuries. Complications that can follow inappropriate closure include wound breakdown and secondary infections.

To address this issue, the DoD's Naval Medical Research Center (NMRC) has developed an algorithm based on objective criteria for guiding the decision to close a wound. The criteria itself was derived from the collection and analysis of tissue and blood from military patients over time and the subsequent identification of chemical and molecular biomarkers that appear to predict successful closure.

The Grady-based study hopes to lead to the development of a similar system in the civilian medical setting. Samples from Grady patients will primarily be acquired during routine surgical debridements, after which they will be examined for the presence of the same biomarkers used as indicators for closure in military patients. "Ideally, we'll acquire an understanding of the similarities and differences between civilian and military wounds and then be able to use either the NMRC's mathematical model or create one of our own," says Dr. Dente. "The best result is that we could then enact a predictive system that would greatly improve patient care in the future."

The viability of the Grady-based study is enhanced by the fact that the patient volume of the Atlanta hospital makes it an ideal center for tissue collection. "We treat more than 100 patients a year in our level I trauma center with the types of severe wounds that are comparable to critical battle injuries," says Dr. Dente. "The study is approved for three years, so I’m confident that we will acquire enough informed consent-derived tissue and fluid samples to work with."

The study will involve processing and storage of samples at the tissue bank of the Emory Transplant Center and the collaborative interpretation of data with NMRC researchers.

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Zenith fenestrated graft

Emory vascular surgery offers 1st FDA-approved fenestrated stent graft

Continuing its prominent regional and national role as a top-tier center for the treatment of arterial and venous disease, the division of vascular surgery and endovascular therapy of the Emory University School of Medicine now provides implantation of the FDA-approved Zenith® Fenestrated Endovascular Graft. Emory vascular surgeons Dr. Yazan Duwayri and Dr. Ravi Veeraswamy recently performed Georgia's first implantation of the stent graft, which has been approved as a minimally invasive treatment option for patients with abdominal aortic aneurysms (AAA) that possess an aneurysm anatomy that is incompatible with currently available devices.

In recent years, endovascular techniques have greatly improved the safety of surgical treatment of AAA, though certain high risk patients do not qualify for these methods because their aneurysms are too close to the arteries that feed the kidneys. If placed, the endovascular graft itself would block blood flow. In addition, traditional, open techniques of repair have significantly high morbidity and mortality rates for such patients.

Designed as an endovascular alternative for those at high risk, the fenestrated system is associated with faster recovery and decreased risk of complications. The most unique factor of the graft—essentially a tube of fabric and metal that functions as a sleeve inside the aorta that excludes the aneurysm from blood flow—is that it can be customized to accommodate the anatomical specifications of each individual patient. "We use specialized software to design the fenestrations or scallops of the Zenith device so that they line up with the patient's renal and mesenteric arteries," says Dr. Duwayri. "Through these holes, we can place additional stents into the branch arteries to repair the aneurysm."

The graft is inserted through small punctures in the groin and femoral arteries and guided into place using x-ray images. Wires, catheters, and stents can be placed inside the artery without the external aorta ever being touched.

By offering this new, FDA-approved technology and other devices in the clinical trial phase, Emory vascular surgeons Dr. Luke Brewster, Dr. Tom Dodson, Dr. Duwayri, Dr. Ravi Rajani, Dr. James Reeves, and Dr. Veeraswamy are advancing the delivery of care to patients with various complex conditions.

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Dr. Rachel Kelz
Dr. Rachel Kelz
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Dr. Rachel Owen
Dr. Rachel Owen

Quality in Training Initiative will prepare residents to be quality-conscious

At the July 2012 Annual Meeting of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), Dr. Rachel Kelz presented her concept of creating a formalized curriculum for training surgical residents how to apply quality data to their own clinical performances. Meeting attendees Dr. John Sweeney, director of clinical quality and patient safety of the department of surgery at Emory, and Dr. Keith Delman, program director of the general surgery residency program at Emory, were intrigued. In the weeks that followed, they consulted with Dr. Kelz—an assistant professor of surgery specializing in endocrine and oncologic surgery and clerkship director for the core surgery rotation of the University of Pennsylvania—and determined that the Emory general surgery residency would be one of the first programs in the nation to enroll in this innovative effort.

NSQIP employs a prospective, peer reviewed database to quantify 30-day risk-adjusted surgical outcomes from its participating hospitals, one of which is Emory University Hospital. The database generates comprehensive, semiannual reports to the hospitals as well as real-time, continuously updated, online benchmarking reports. Enrolled programs can monitor their quality improvement efforts and compare their surgical outcomes—on a blinded basis—with peer hospitals and national averages. Until now, however, NSQIP has not had a mechanism in place to generate resident-specific reports regarding outcomes. Dr. Kelz is currently developing the official guidelines for such a system with ACS. When launched, the program will be the only one of its kind in the country.

Dr. Rachel Owen, an Emory PGY4 resident on research sabbatical who is involved with a variety of quality projects, is the primary resident liaison for the implementation of the Quality in Training Initiative (QITI) at Emory. "Our goal is to start recording Emory resident-specific data to NSQIP cases in January 2013 so that we can begin distributing reports to residents in the summer. As they become involved with the process, residents will learn how to use their outcomes data as it corresponds to specific measures, relay it to NSQIP, interpret the resulting reports, and apply their interpretations to their clinical work, both now and in their future practices."

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Lisa Carlson
Lisa Carlson

Lisa Carlson appointed to 2013 Woodruff Leadership Academy

Various current and former Department of Surgery faculty and staff have been fellows of the Woodruff Leadership Academy (WLA), including Christian Larsen, Craig Coopersmith, Keith Delman, Seth Force, Sheryl Gabram, Heather Hamby, Jeffrey Nicholas, Thomas Pearson, John Puskas, and Vinod Thourani. As a fellow of the 2013 WLA class, Lisa Carlson, MPH, MCHES, director of academic affairs of the Department, has joined this illustrious group.

Initiated in 2003 as a measure to foster proficient, effective leaders with skills relevant to an academic health center and, specifically, Woodruff Health Sciences Center, the WLA develops managerial and technical expertise, as well as the interpersonal, communications, and presentation abilities necessary to meet the challenges of a rapidly changing health care landscape. The selection process for this intensive, five-month program is rigorous, and those selected have already proven themselves to be leaders with great promise. Upon selection, WLA fellows will engage in classroom sessions, off-site team projects, and weekend retreats.

All fellows are paired with faculty/staff mentors that provide guidance and support, particularly in connecting with key job assignments and pursuing the goal of advancing all WHSC programs into the top rank of academic health centers. Ms. Carlson's mentor is John Fox, president and CEO of Emory Healthcare.

Ms. Carlson has almost 20 years of experience in academic, federal contracting, voluntary, and other non-profit environments at the university, state, and national level. Before joining the Emory Transplant Center (ETC) in 2004 as academic program director, she worked at the Rollins School of Public Health, where she remains an active adjunct professor. Her ETC role expanded to include the Department of Surgery in 2009, when she became the director of academic programs and administration. In 2011, Ms. Carlson was elected to a four-year term on the Executive Board of the American Public Health Association, the oldest and most diverse organization of public health professionals in the world, and was recently elected to serve as vice-chair of the board. In 2012 she was promoted to director of academic affairs of the Department of Surgery, a position that expanded her role in research administration to include faculty development and promotions.

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Upcoming events

Colon Surgery in a Value-Driven Era

Presented by Virginia Shaffer, MD
– Assistant Professor of Surgery, Division of General and GI Surgery, Colorectal Surgery, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Jan. 3, 2013 EUH Auditorium
Maximizing Patient Value in Colorectal Surgery
Presented by Patrick Sullivan, MD
– Assistant Professor of Surgery, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Jan. 10, 2013 EUH Auditorium
Future Makers Lecture Series:
Educational Implications of a Changing Clinical Future

Presented by James Woolliscroft, MD
– Dean, University of Michigan School of Medicine
5:00 p.m., Jan. 15, 2013 WHSCAB auditorium
More info.
Joseph M. Craver Visiting Teacher Lectureship
The "Quality Movement" in Cardiac Surgery: The Michigan Experience

Presented by Richard L. Prager, MD
University of Michigan Health System:
– Professor of Cardiac Surgery
– Head, Section of Adult Cardiac Surgery
– Director, Cardiovascular Center
7:00 - 8:00 a.m., Jan. 17, 2013 EUH Auditorium
Surgery Faculty Meeting 5:30 - 7:00 p.m., Jan. 29, 2013 TEC, B6300
Living Donor and Split Liver Transplantation
Presented by Raul Badell, MD
– Chief Resident, Department of Surgery, Emory University School of Medicine
7:00 - 8:00 a.m., Jan. 31, 2013 EUH Auditorium
Evolving Paradigms in Clinical and Translational Research
Presented by Dennis Liotta, PhD
– Samuel Candler Dobbs Professor of Chemistry, Emory University School of Medicine
Feb. 7, 2013 Academic & Industry Intersection Conference, Emory Conference Center
More info.
Melanoma Conference
Sponsored by Winship Cancer Institute
Feb. 9, 2013 Intercontinental Buckhead
More info
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