ISSUE 147: Special Section

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LOUISVILLE At the Robley Rex VA Medical Center (VAMC) in Louisville, the Plastic Surgery Section has a different focus from what you might first think of when you consider a plastic surgery practice. There are no rhinoplasties or breast augmentations here. In fact, there are no cosmetic procedures at all. According to Morton L. Kasdan, MD, FACS, chief of Plastic Surgery for the VA, “All of our surgery is for functional reasons,” and more specifically, focused heavily on the hand.

Kasdan estimates more than half his practice is devoted to hand surgery. He was inspired to subspecialize in hand surgery by Dr. Harold Kleinert, a pioneer in the field whom Kasdan trained under at the University of Louisville (UofL). Kasdan completed medical school and took his general surgery residency at UofL, then completed a fellowship in plastic and reconstructive surgery at Duke University Medical Center. A Veteran himself, Kasdan was a Lieutenant Colonel in the United States Air Force and served as chief of the Division of Plastic Surgery at Wright-Patterson Air Force Base in Ohio from 1971–1973 before starting in private practice.

Ten years ago, Kasdan left private practice to join the VA because he wanted to get back to teaching. His position at the VAMC allows him to practice clinically and surgically, publish, and teach. Kasdan has over 150 published articles, including editing 12 books. Currently a clinical professor at UofL, he teaches medical students and plastic surgery residents who rotate at the VAMC. In addition, Kasdan teaches physician assistant students for the US Army and hosts a suturing class on Sundays for medical students.

Contrary to what you might think, Kasdan saw more hand injuries in private practice than he does at the VAMC today. While you may associate Veterans with injury, or trauma, Kasdan says, “I’ve only seen four combat injuries in the 10 years I’ve been here.” They had received excellent care down range. He attributes the greater number of hand trauma cases he saw in private practice to the industry Louisville once had. At the VA, Kasdan sees “mostly diseases of the upper extremity,” rather than injuries.

Common diseases Kasdan sees include skin cancers, Dupuytren’s contracture, nerve entrapments, and inflammatory tendon conditions. The most common surgical procedures he performs are carpal tunnel release and excision of skin cancers. Many of the treatments are non-surgical. For example, injections are used for some conditions.

One area where Kasdan’s Veteran patients do differ from the general population lies in his research interest – factitious disorders. Defined as a condition where someone deliberately creates or exaggerates symptoms to feign a physical illness, factitious disorders are not as prevalent among Veterans as compared to private practice.

When it comes to plastic surgery, there is one misconception Kasdan would like to dispel. “All incisions leave scars,” he says. While equipment and techniques have advanced over the years and there are things that you can do to hide or minimize scarring, there is no such thing as a scar-free incision.

Ever the teacher, Kasdan is grateful to be practicing among a physician group at the VA he considers top-notch and to be doing what they love.