Dr. Jacques Michael Casparian This is Me

Education

 Web References

1. 1. www.totalskinandbeauty.com

   www.totalskinandbeauty.com/The - [Cached]

   Published on: 11/19/2007   Last Visited: 1/16/2008

   Jacques Michael Casparian, M.D. Assistant Professor of Medicine (Dermatology), Pathology, and Otorhinolaryngology Kansas University Medical Center 4023 Wescoe, Division of Dermatology 3901 Rainbow Boulevard Kansas City, Kansas 66160
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   Recently, Casparian and Monheit described a simple, easily available means of intraorperative tissue expansion utilizing a continuous running suture called the "winch stitch."

2. 2. DermatologyTimes - Refined 'winch stitch' wields better tissue expansion

   www.dermatologytimes.com/derma - [Cached]

   Published on: 6/23/2002   Last Visited: 6/23/2002

   Dallas - A recent technique modification has made the "winch stitch" an even easier and more controllable method for achieving intraoperative tissue expansion to facilitate closure of large, high-tension wounds, Jacques Michael Casparian, M.D., said at the annual meeting of the American College of Mohs Micrographic Surgery and Cutaneous Oncology.
   
   The winch stitch is a multiple pulley suture used to temporarily hold and stretch the skin. It is based on the principle of mechanical creep and relies on the mechanical advantage provided by the presence of the multiple pulleys, ie., loops of a running suture, that allow tension to be exerted over an increased distance using less force.
   
   In the winch stitch, the surgeon closes the wound loosely with a simple continuous running suture, beginning at the edge of the wound that is under the least tension and leaving that initial end free. In the original description of the winch stitch, after the desired number of throws are placed - usually three to five - the end of the suture attached to the needle is brought back toward the free end, and the two ends are tied together. Then, using a needle holder or hook, the surgeon pulls upward on the length of the suture connecting the two ends.
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   Meanwhile, the second and third hemostats are used alternately in a pulling and holding fashion analogous to how tug-of-war competitors change the position of their hands, explained Dr. Casparian.
   
   In the modified winch stitch, the first hemostat is placed to hold the free end of the suture close to the skin right after the needle is introduced through the skin. Then the surgeon proceeds to run the suture. After making the desired number of throws, the terminal end of the suture is grasped with a second hemostat. That device is then pulled away from the skin, bringing the wound edges together. With care to avoid placing excessive tension on the suture, a third hemostat is clamped close to the skin onto the suture material freed by pulling with the second hemostat. The second hemostat can then be removed while the third is allowed to remain in place, exerting tension to cause tissue expansion.
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   In addition, by freeing the surgeon from the task of pulling on the suture, it gives him or her the flexibility to leave the room during the period of the tissue expansion," said Dr. Casparian, chief of dermatology, Eastern Kansas VA Medical Centers, Leavenworth and Topeka.
   
   Dr. Casparian learned the winch stitch from Gary D. Monheit, M.D., in 1993, when he was a fellow in Dr. Monheit's practice in Birmingham, Ala. Recognizing its utility and realizing that it had never been described in the literature or in the forum of a professional meeting, Dr. Casparian presented a talk about the winch stitch at the 2000 ASDS/ACMMSCO meeting. Earlier this year, Dr. Casparian and Dr. Monheit coauthored a paper about it that was published in the "Surgical Pearl" section of the Journal of the American Academy of Dermatology.
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   After reporting on the winch stitch, Dr. Casparian developed the idea of modifying the technique by using the hemostats.
   
   He added that surgeons interested in using the winch stitch should appreciate that it is ideally designed for use on the scalp. While it has potential application at other anatomic sites, such as at some areas on the trunk and proximal extremities, in general it should not be used on the face.
   
   As another caveat, Dr. Casparian emphasized that when using the winch stitch, surgeons must be careful to avoid pulling with excessive force on the suture so as not to cause strangulation of the tissue.
   
   "Keep in mind that with the winch stitch's multiple pulleys, less tension is needed to pull the tissue together because the force is being applied over a greater distance. With too much pulling force, there can be significant damage to the tissue," he explained.
   
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