User:Richardedlich

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RICHARD F. EDLICH From Wikipedia, the Free Encyclopedia

Richard F. Edlich, MD, PhD (b. January 19, 1939, New York City, New York) is a Professor Emeritus of Plastic Surgery, Biomedical Engineering and Emergency Medicine at the University of Virginia Health System. His basic clinical and research interests are focused on improving the safety and outcome of wound care in emergency medicine as well as surgery. His research program has involved gifted basic scientists like Dr. George T. Rodeheaver, who holds the Edlich Endowed Chair in Basic Science in the Department of Plastic Surgery, as well as Dr. John Thacker, a professor and vice chairman of the Department of Mechanical and Aerospace Engineering at the University of Virginia. Together, they have worked with gifted undergraduate and graduate students, as well as residents, to make revolutionary advances in healthcare in our nation.

CONTENTS

  • 1. Introduction
  • 2. General Surgery Training in Camelot
  • 2.A. Revolutionary Advances in Wound Repair
  • 2.B. Improved techniques to control gastrointestinal hemorrhage
  • 2.C. New techniques to revascularize the ischemic myocardium
  • 3. Academic Career at the University of Virginia Health Sciences Center
  • 3.A. Development of a emergency medical system in our nation
  • 3.B. Development of a regional burn and wound healing center
  • 3.C. Search for safe examination and surgical gloves
  • 4. Awards

1. INTRODUCTION

It is the purpose of this report to describe the career of Dr. Richard Edlich in which he and his colleagues made revolutionary advances in healthcare. In this report, the contributions of Dr. Richard Edlich are described working with his beloved colleagues, which have been integrated into healthcare systems throughout the world, resulting in improved survival of critically injured and ill patients.

2. GENERAL SURGERY TRAINING IN CAMELOT

Richard F. Edlich, Distinguished Professor Emeritus of Plastic Surgery, Biomedical Engineering and Emergency Medicine (University of Virginia Health Sciences Center, Charlottesville, Virginia), was a Ford Foundation Scholar who gained admission to Lafayette College at age 15, after finishing his sophomore year at Stuyvesant High School in New York City. Three years later, he was accepted as an early admission student at New York University School of Medicine, after completing his junior year in college.

After graduating from New York University Medical School in 1970, he began his 8-year surgical residency at the University of Minnesota Health Sciences Center under the guidance of his beloved mentor, Dr. Owen H. Wangensteen. Dr. Owen Wangensteen is known as the greatest teacher in the history of surgery in the last century. His training program was considered by his surgical residents as the Camelot of their surgical education. During the academic career of Dr. Wangensteen, 136 of his surgical residents received a Doctor of Philosophy in Surgery. 1

Dr. Edlich also received his Doctor of Philosophy in surgery degree at the University of Minnesota after an 8-year surgical residency. During his residency, he spent 4 years in Dr. Wangensteen’s multidisciplinary research laboratory, initiating a wide variety of important clinical investigations involving the biology of wound repair and infection, the control of gastrointestinal hemorrhage, as well as revascularization of the ischemic myocardium. During Dr. Edlich’s research training, Dr. Wangensteen stressed the importance of partnerships with basic scientists at the University of Minnesota as well as medical manufacturers and companies.

2.A. Revolutionary Advances in Wound Repair

In their studies of the biology of wound repair and infection, Dr. Wangensteen and Dr. Edlich designed the first adhesive skin closure tape that could approximate the wound edges without the use of sutures.2-4 These research studies were a collaborative undertaking with three people in the Healthcare Division of 3M, Inc. (St. Paul, Minnesota), which was headed at that time by Mr. Lou Lehr. Dr. Edlich’s studies led to the development of the Reinforced Steri-Strip™, which has been used in more than an estimated 20 billion patients. After the development of this product, Mr. Lehr took a leadership position in the company, becoming Chief Executive Officer of 3M, Inc.

Another focus of Dr. Edlich’s attention was the development of a skin wound cleanser that was safe enough to be poured into the patient’s eye without any toxic effects.5-7 His research identified a solution of poloxamer 188 that was approved for use by the Food and Drug Administration (FDA) and is now marketed as Shur-Clens™ by ConvaTec (Skillman, New Jersey). This skin wound cleanser has been used to cleanse wounds in an estimated five billion patients without any reported adverse effect.

Realizing the limitations of the large Bovie electrical generator for electrosurgery, Dr. Edlich teamed up with Bob Anderson, one of the electrical engineers at Medtronics Inc., to develop the first compact electrosurgical unit, which was the first product manufactured by Valleylab (Boulder, Colorado).8 The first electrosurgical unit, the BOVIE, had a ubiquitous presence in operating room and clinics, and it was used daily by most surgeons. This first electrical generator that was widely accepted by surgeons was produced by the collaboration of a physicist and a surgeon. At Harvard in 1926, a physicist name William T. Bovie developed an electrical surgical device to aid in the removal of brain tumors by Dr. Harvey Cushing.9

The BOVIE became synonymous with electrosurgical units. This ground reference unit stood almost four feet tall, weighed about 300 lbs, and was set in a beautifully crafted wooden cabinet. After Bob Anderson established his company in Boulder, Colorado, he introduced the first portable, solid state electrosurgical generator, SSEI. This unit was the first portable, solid state electrosurgical generator. His technology substituted transistors and solid state circuitry for the old BOVIE vacuum tubes and spark gaps. This innovation was comparable to the miniaturization of radios, which eliminated vacuum tubes and created the modern pocket receiver. His first electrosurgical unit revolutionized surgery. His type of generator isolated the therapeutic current from ground by referencing it within the generator circuitry. By removing ground as a reference to current, the isolated generator eliminated many of the hazards inherent in grounded systems, most importantly current division and alternate site burns.

His company also produced the first reusable hand switching pencil. The pencil allowed surgeons to hand activate the electrosurgical generator, reducing the fatigue associated with foot switching devices. Valleylab is now a division of Tyco Healthcare (Norwalk, Connecticut).

2.B. Improved Techniques to Control Gastrointestinal Hemorrhage

Dr. Edlich’s efforts to control gastrointestinal hemorrhage were guided by Dr. Wangensteen. After considerable discussion with Dr. Edlich, Dr. Wangensteen purchased for Dr. Edlich an endoscope for gastroscopic visualization of the patient’s stomach.10,11 As a surgical resident, Dr. Edlich was the first physician to do gastroscopy at the University of Minnesota Hospitals. Dr. Edlich’s picture was featured on the cover of Postgraduate Medicine, the Journal of Applied Medicine, in November, 1968. His experiences with gastroscopy led to the first minimally invasive surgical procedure at the University of Minnesota Hospital, an endoscopic gastrostomy.12

As Dr. Edlich expanded his endoscopic experience, he realized the deficiencies of the thick, narrow-diameter latex Ewald tubes that were being used to evacuate blood clots from the patient’s stomach before endoscopic examination.13 Dr. Edlich teamed up with Kendall, a Division of Tyco Healthcare, to devise a thin-walled, transparent, plastic tube for evacuation of blood clots from a patient’s stomach. The Edlich gastric lavage kit has been used in an estimated half million patients, replacing the inefficient latex opaque narrow diameter Ewald tube.

2.C. New Techniques to Revascularize the Ischemic Myocardium

Dr. Frank Quattlebaum, a cardiothoracic surgical resident, working in Dr. C. Walton Lillehei’s Laboratory adjacent to that of Dr. Wangensteen’s research Laboratory, enlisted Dr. Edlich’s help to quantitate the perfusion of a saphenous vein graft implanted in canine ischemic myocardium using tissue blood flow measurements.14 When their studies failed to show revascularization of the heart using the Vineberg procedure, Drs. Lillehei and Quattlebaum suggested that the revascularization of the heart could be improved by a coronary artery bypass graft.

When Dr. Lillehei asked Dr. Edlich to continue his residency at Cornell Medical Center (New York, New York) with him, Dr. Wangensteen interceded, advising Dr. Edlich to continue his career in his studies on the biology of wound repair by pursuing his academic career in a 2-year plastic surgery residency. After Dr. Edlich completed his 8-year residency training at the University of Minnesota Hospital, Dr. Wangensteen selected a 2-year plastic surgical residency at the University of Virginia Health Sciences Center for Dr. Edlich that would allow him to complete his plastic surgical training and then pursue an academic career in surgery.

3. ACADEMIC CAREER AT THE UNIVERSITY OF VIRGINIA HEALTH SCIENCES CENTER

Following the advice of his mentor, Dr. Edlich accepted this residency position in plastic surgery at the University of Virginia Health Sciences Center. During his plastic surgical training and subsequent academic career at the University of Virginia, Dr. Edlich modeled his clinical and research training after that envisioned by Dr. Owen Wangensteen. Dr. Edlich first enlisted the help of an organic chemist, Dr. George Rodeheaver, who joined his research team, becoming the Edlich Research Professor of Plastic Surgery. Dr. John G. Thacker, a mechanical engineer, is now the Vice-Chairman of the Department of Mechanical and Aerospace Engineering at the University of Virginia. Together these gifted scientists made revolutionary advances in emergency medical care as well as burn care.

3.A. Development of a Emergency Medical System in our Nation

Because of Dr. Edlich’s extensive experience in the care of traumatic wounds, he accepted a position as Director of an outdated emergency room at the University of Virginia without any faculty skilled in Emergency Medicine. Realizing the limitations in the emergency medical system in the Commonwealth of Virginia, as well as in our nation, he made the following revolutionary advances in emergency medical care: an emergency medical communication system for ambulances,15 emergency training for ambulance attendants,16 a rape crisis center,17 a crisis center for the deaf,18 a poison control center,19 an advanced life support emergency medical system,20 and the first medical air transport system in the Commonwealth of Virginia.21

Dr. Edlich was selected as one of the eight physician technical advisors for the Department of Emergency Medical Services in the Department of Health Education and Welfare to develop emergency medical systems throughout our nation. He personally supervised the development of emergency medical systems in the Commonwealth of Virginia, Pennsylvania, West Virginia, Maryland, Washington DC, and Puerto Rico. In 1979, Dr. Edlich received the Distinguished Public Service Award for Contributions to Emergency Medicine by the US Public Health Service. Working with Dr. David Boyd of the Department of Emergency Medical Services, Dr. Edlich devised the Emergency Medical Plan that saved President Reagan’s life in 1981.22 Dr. Edlich was the recipient of the President’s Award from the University Association of Emergency Medical Services for his exemplary contributions in Emergency Medical Systems. His successes in developing Emergency Medical Systems in the Commonwealth of Virginia were greatly facilitated by Governor John Dalton, his wife Eddy Dalton, and the State Senator Emily Couric.

3.B. Development of a Regional Burn and Wound Healing Center

Dr. Edlich’s extensive interest in emergency medical care was complemented by his clinical experience in burn care. After accepting the position as Director of University of Virginia Burn Center, which initially consisted of only two beds, he enlisted the help of benefactors as well as the University of Virginia to build the 16-bed DeCamp Burn and Wound Healing Center, which included a hyperbaric oxygen treatment system for patients with necrotizing fasciitis and purpura fulminans. His team of scientists devised and patented a new silver sulfadiazine cream containing poloxamer 188 that exhibits less tissue toxicity than that of the commercially available silver sulfadiazine cream.23 Dr. Edlich devised a new Gram stain technique for quantitative bacteriology using stable iodophors rather than unstable aqueous iodine. This reliable Gram stain technique is now being used throughout the world. 24

When Dr. Edlich treated burn patients in which the patient’s ignited clothing was adherent to the burned skin, he was concerned that the adult textiles were highly flammable and became the ignition source for the burn injury. To test this hypothesis, he enlisted the help of the Institute of Textile Technology in Charlottesville Virginia to assess the flammability of textiles in all burn patients in the Commonwealth of Virginia. Financial support for this landmark study was provided by a grant from Federal Government as well as financial support from Milliken, Incorporated (Spartanburg, South Carolina). His clinical measurements of fabric flammability of the textiles as well as a careful review of the ignition source documented that flammable liquids, such as gasoline, were the ignition sources of the burn injury. Dr. Edlich brought the results of this statewide investigation to the American Petroleum Institute (Washington, DC), who with Dr. Edlich initiated a nationwide educational program that has dramatically reduced the frequency of burn injuries stemming from flammable liquids.25,26

3.C. Search for Safe Examination and Surgical Gloves

During his surgical career, Dr. Edlich and his team of scientists made important scientific contributions that have protected health care workers as well as operating room personnel. His studies on the toxicity of cornstarch became a catalyst for the development of powder-free gloves. His scientific investigation proved conclusively that cornstarch was a dangerous foreign body that potentiated wound infection and was a vector for the latex allergy epidemic.27,28

His comprehensive scientific studies convinced 120 hospitals in the nation to abandon the use of powdered surgical and examination gloves. The hospitals of the Commonwealth of Virginia have played a leadership role in banning the use of powder in gloves, with 27 hospitals now using only powderfree gloves. In contrast, eight hospitals in Minnesota presently use powder-free examination and surgical gloves (www.deadlydust.com).

On January 7, 1998, Public Citizen’s Health Research Group and its Director, Sidney M. Wolfe, MD, and Staff Researcher, Christine Dehlendorf, along with Timothy Sullivan, MD, Professor of Medicine at Emory University School of Medicine and Head of the Subsection of Allergy and Immunology at the Emory Clinic, petitioned the FDA to immediately ban the use of cornstarch powder in the manufacture of latex surgical and examination gloves because of the serious and widespread dangers these powdered gloves cause to medical personnel and to patients. (www.citizen.org/publications/release.cfm?ID=6629) The FDA denied this petition to ban the use of cornstarch powder in medical examination and surgical gloves because it did not believe that there was an adequate supply of powder-free examination and surgical gloves to protect the health care workers. Because most of the glove manufacturers now manufacture either powder-free or powdered examination and surgical gloves, Dr. Edlich believes that the FDA must ban the use of the “deadly cornstarch” product.

Dr. Edlich’s recent studies on a new double glove hole indication system has provided further scientific support for the use of a new powder-free double glove hole detection system in every surgical procedure in an effort to prevent the spread of deadly blood-borne viral infection. This double glove hole indication system (Molnlycke Healthcare, LLC, Norcross, Georgia) is especially important because 1.5% of single sterile surgical gloves have undetected holes when first used by members of the surgical team, an invitation for a deadly blood-borne viral infection. 29

Dr. Edlich has repeatedly celebrated the visionary efforts of Milt Hinsch, Technical Services Director of Molnlycke Healthcare, who has courageously sponsored landmark research programs to demonstrate the irrefutable benefits of this remarkable double-glove hole indication system.

On September 24, 2008, Dr. Edlich and 11 colleagues submitted a Citizen’s Petition to the FDA to ban cornstarch on medical gloves (FDA-2008-P-0531). On February 3, 2011, the FDA prepared a Federal Register on the safety and performance of medical gloves with cornstarch, in which healthcare professionals have 60 days to make comments that will ultimately lead to the FDA’s final decision regarding banning cornstarch on medical gloves.

4. AWARDS

Dr. Edlich’s contributions to teaching and healthcare have been recognized by the following awards: the University of Virginia Alumni Association’s Distinguished Professor Award (April 26, 1995), the Commonwealth of Virginia Council of Higher Education’s Outstanding Faculty Award (May 1989), and the 1990 Thomas Jefferson Award. Because Dr. Edlich founded the Northfork Research Park in Charlottesville, Virginia, in 1998 the University of Virginia named one of the streets in the park Edlich Drive.

In 1992 Dr. Edlich received the George Washington Kidd Class of 1836 Award for achieving distinction in his career in medicine and teaching from Lafayette College (Easton, Pennsylvania). In 1995 Dr. Edlich and his respected colleague and friend Christopher Henderson established the Edlich–Henderson Inventor of the Year Award for The Patent Foundation of the University of Virginia. In March 2000, Dr. Edlich received the Harvey Stuart Allen Distinguished Service Award from the American Burn Association.

On January 8, 2000, Dr. Edlich met with President Clinton in the Oval Office and convinced him to increase funding of the National Institutes of Health to cure chronic illnesses by the largest amount in the history of our nation.30 He left the University of Virginia Health Sciences Center in 2001.

Most recently, in recognition of Dr. Edlich’s scientific contributions, he was the recipient of the Distinguished Alumni Award from the University of Minnesota Medical Alumni Association as well as the James D. Mills Award from the American College of Emergency Physicians.

REFERENCES

1. Peltier LF, Aust J. An account of Owen Harding Wangensteen (1898–1981). The American College of Surgeons, Chicago, IL, 1994.

2. Rodeheaver GT, Halverson JM, Edlich RF. Mechanical performance of wound closure tapes. Ann Emerg Med 1983; 12:203–207.

3. Rodeheaver GT, McLane M, West L, Edlich RF. Evaluation of surgical tapes for wound closure. J Surg Res 1985; 39:251–257.

4. Rodeheaver GT, Spengler MD, Edlich RF. Performance of new wound closure tapes. J Emerg Med 1987; 5:451–462.

5. Edlich RF, Schmolka IR, Prusak MP, Edgerton MT. The molecular basis for toxicity of surfactants in surgical wounds. I. EO:PO block polymers. J Surg Res 1973; 14:277–284.

6. Rodeheaver GT, Smith SL, Thacker JG, Edgerton MT, Edlich RF. Mechanical cleansing of contaminated wounds with a surfactant. Am J Surg 1975; 129:241–245.

7. Bryant CA, Rodeheaver GT, Reem EM, Nichter LS, Kenney JG, Edlich RF. Search for a nontoxic surgical scrub solution for periorbital lacerations. Ann Emerg Med 1984; 13:317–321.

8. Madden JE, Edlich RF, Custer JR, Panek PH, Thul J, Wangensteen OH. Studies in the management of the contaminated wound. IV. Resistance to infection of surgical wounds made by knife, electrosurgery and laser. Am J Surg 1970; 119:222–224.

9. Bovie WT, Cushing H. Electrosurgery as an aid to the removal of intracranial tumors with a preliminary note on a new surgical-current generator. Surg Gynecol Obstet 1928; 47:751–784.

10. Goodale RL, Okada A, Gonzales R, Borner J, Edlich RF, Wangensteen OH. Rapid endoscopic control of bleeding gastric erosions by laser radiation. Arch Surg 1970; 101:211–214.

11. Edlich RF. Endoscopic visualization of the stomach. Post Grad Med 1968;44(5):cover.

12. Edlich RF, Prevost MV, Tsung MS, Ritchie WP Jr, Wangensteen OH. Transilluminated distention gastrostomy: a preliminary report of a simplified method employing an illuminated gastric catheter. Surgery 1967; 62:448–451.

13. Edlich RF. A gastric lavage assembly for rapid evacuation of the stomach. Am J Dig Dis 1971; 16: 160–162.

14. Carlson RG, Edlich RF, Lande AJ, Bonnabeau RC, Gans H, Lillehei CW. A new concept for the rationale of the Vineberg operation for myocardial revascularization. Surgery 1969; 65:141–147.

15. Wenzel V, Attinger E, Rockwell D, Stearns C, Rosenthal K, Buck R, Edlich RF. Evaluating the pre-hospital phase of the emergency medical system. Va Med 1979; 106:858–859.

16. Buck R, Attinger E, Stone D, Geolot D, Edlich RF. The training of the emergency medical technician. Va Med 1976; 103:271–276.

17. Talbert S, White SD, Bowen JD, Stephens LM, Mapstone SJ, Spisson KR, Edlich RF. Improving emergency care of the sexual assault victim. Ann Emerg Med 1980; 9:293–297.

18. Compton MV, Lattin-Souder M, Walsh WM III, Sanders E, Stier D, Spyker DA, Edlich RF. Computer- aided emergency telecommunications for the deaf. Ann Emerg Med 1982; 11:324–326.

19. Anne A, Spyker D, Edlich RF, Attinger EO. A comprehensive information system for emergency medical services. Proceedings of Fifth Annual Symposium on Computer Applications in Medical Care, November 1981; 979–983.

20. The Advanced Life Support Handbook. Charlottesville, VA: Cambridge Publications, 1979.

21. Edlich RF. Riding Pegasus on a heavenly journey. J Emerg Med 1995; 13:811–814.

22. Edlich RF, Krome R, Crampton R, Boyd D, Jelenko C III, Poliafico F. Emergency medical support plan for the President of the United States and VIPS. J Am Coll Emerg Phys 1977; 6:462–464.

23. Gear AJL, Hellewell TB, Wright HR, Mazzarese PM, Arnold PB, Rodeheaver GT, Edlich RF. A new silver sulfadiazine water soluble gel. Burns 1997; 23:387–391.

24. Spengler M, Rodeheaver GT, Richter L, Edgerton MT, Edlich RF. The Gram stain—the most important diagnostic test of infection. J Am Coll Emerg Phys 1978; 7:434–438.

25. Edlich RF, Glasheen W, Attinger E, Anne A, Haynes B, Hiebert JT. Epidemiology of serious burn injuries. Surg Gynecol Obstet 1982; 154:505–509.

26. Glasheen WP, Attinger EO, Anne A, Boyd DR, Ruffin W, Haynes B, Hiebert JT, Edlich RF. Epidemiology of minor burn injuries. Burns 1982; 8: 423–432.

27. Ruhl CM, Urbancic JH, Foresman PA, Kupke MJ, Rodeheaver GT, Zura RD, Edlich RF. A new hazard of cornstarch, an absorbable dusting powder. J Emerg Med 1994; 12:11–14.

28. Edlich RF. A plea for powder-free surgical gloves. J Emerg Med 1994; 12:69–71.

29. Edlich RF, Wind TC, Heather CL, Thacker JG. Reliability and performance of innovative surgical double-glove hole puncture indications systems. J Long Term Eff Med Implants 2003; 13(2):69–83.

30. Edlich RF, Pine SA. The quest for the cure of all chronic illnesses: a wake-up call from the President of the United States. J Emerg Med 2000; 19: 281–285.

EXTERNAL LINKS

Begell House Journal of Long-Term Effects of Medical Implants http://www.begellhouse.com/editors/edlich/

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