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Plastic Surgeon, Surgeon
13 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score
George Washington University (1997)
  • Currently 2 of 4 apples

Awards & Distinctions ?

Awards  
Patients' Choice Award (2010 - 2014)
Compassionate Doctor Recognition (2010, 2012 - 2013)
Top 10 Doctor - City (2014)
Philadelphia, PA
Plastic Surgeon
Appointments
University of Pennsylvania
Assistant Professor of Surgery at the Hospital of the University of Pennsylvania and the Penn Presbyterian Medical Center of Philadelphia and the Pennsylvania Hospital and the Veteran`s Administration Medical Center
Associations
American Board of Plastic Surgery
American Board of Surgery
American Society of Maxillofacial Surgeons

Affiliations ?

Dr. Kovach is affiliated with 13 hospitals.

Hospital Affilations

Score

Rankings

  • Pennsylvania Hospital University PA Health System
    800 Spruce St, Philadelphia, PA 19107
    • Currently 4 of 4 crosses
    Top 25%
  • Main Line Hospital - Bryn Mawr
    130 S Bryn Mawr Ave, Bryn Mawr, PA 19010
    • Currently 4 of 4 crosses
    Top 25%
  • Main Line Hospital Lankenau
    100 E Lancaster Ave, Wynnewood, PA 19096
    • Currently 4 of 4 crosses
    Top 25%
  • Bryn Mawr Rehabilitation Hospital
    414 Paoli Pike, Malvern, PA 19355
    • Currently 4 of 4 crosses
    Top 25%
  • Hospital of the University of PA
    3400 Spruce St, Philadelphia, PA 19104
    • Currently 4 of 4 crosses
    Top 25%
  • Riddle Memorial Hospital
    1068 W Baltimore Pike, Media, PA 19063
    • Currently 3 of 4 crosses
    Top 50%
  • University of PA Medical Center/Presbyterian
    51 N 39th St, Philadelphia, PA 19104
    • Currently 3 of 4 crosses
    Top 50%
  • Graduate Hospital
    1800 Lombard St, Philadelphia, PA 19146
    • Currently 1 of 4 crosses
  • Lankenau Medical Center - On staff since
  • Lankenau Medical Center
  • Clinical Practices of the University of Pennsylvania
  • Bryn Mawr Hospital - On staff since
  • University of Penn Med Center-Presb Med Group
  • Publications & Research

    Dr. Kovach has contributed to 20 publications.
    Title Breast Reconstruction with Free Tissue Transfer from the Abdomen in the Morbidly Obese.
    Date August 2011
    Journal Plastic and Reconstructive Surgery
    Excerpt

    There are national trends of increasing incidence of morbid obesity and autologous breast reconstruction with free tissue transfer from the abdomen. The purpose of this study was to assess the safety and efficacy of free flap breast reconstruction in the morbidly obese population.

    Title A Comparison Between Diep and Muscle-sparing Free Tram Flaps in Breast Reconstruction: a Single Surgeon's Recent Experience.
    Date November 2010
    Journal Plastic and Reconstructive Surgery
    Excerpt

    Discussions of abdominal donor-site morbidity and risk of flap loss continue to surround free flap breast reconstruction. The authors performed a head-to-head comparison of deep inferior epigastric perforator (DIEP) and muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flaps performed by a single senior surgeon at a single institution.

    Title Role for Trauma in Inducing Pencil "lead" Granuloma in the Skin.
    Date May 2010
    Journal Journal of the American Academy of Dermatology
    Title 1000 Consecutive Venous Anastomoses Using the Microvascular Anastomotic Coupler in Breast Reconstruction.
    Date April 2010
    Journal Plastic and Reconstructive Surgery
    Excerpt

    Microvascular anastomosis is one of the more critical aspects of free flap surgery. A safe, effective, and expedient method for venous anastomosis minimizes flap ischemia time, is easier on the surgical team, and saves costly operating room time. The authors report on their experience using the Synovis microvascular anastomotic coupling device in 1000 consecutive venous anastomoses in free flap breast reconstruction.

    Title Open Tibial Shaft Fractures: Ii. Definitive Management and Limb Salvage.
    Date March 2010
    Journal The Journal of the American Academy of Orthopaedic Surgeons
    Excerpt

    Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function. Advances in orthobiologics, modern plastic surgical techniques, and fracture stabilization methods, most notably locked intramedullary nailing, have led to improved prognosis for functional recovery and limb salvage. Despite improved union and limb salvage rates, the prognosis for severe type III open fracture of the tibial shaft remains guarded, and outcomes are often determined by patient psychosocial variables.

    Title Open Tibial Shaft Fractures: I. Evaluation and Initial Wound Management.
    Date March 2010
    Journal The Journal of the American Academy of Orthopaedic Surgeons
    Excerpt

    Open fractures of the tibial diaphysis are often associated with severe bone and soft-tissue injury. Contamination of the fracture site and devitalization of the soft-tissue envelope greatly increase the risk of infection, nonunion, and wound complications. Management of open tibial shaft fractures begins with a thorough patient evaluation, including assessment of the bone and soft tissue surrounding the tibial injury. Classification of these injuries according to the system of Gustilo and Anderson at the time of surgical débridement is useful in guiding treatment and predicting outcomes. Administration of antibiotic prophylaxis as soon as possible after injury as well as urgent and thorough débridement, irrigation, and bony stabilization are done to minimize the risk of infection and improve outcomes. The use of antibiotic bead pouches and negative-pressure wound therapy has proved to be efficacious for the acute, temporary management of severe bone and soft-tissue defects.

    Title Skin Banking in Autologous Breast Reconstruction.
    Date July 2008
    Journal Plastic and Reconstructive Surgery
    Title Advantages of Minimally Invasive, Balloon-dissector-assisted Tissue Expander Placement: a Clinical and Experimental Study.
    Date March 2008
    Journal Annals of Plastic Surgery
    Excerpt

    BACKGROUND: Tissue expansion has been dependent upon healing the access incision after placement. Delay can be reduced with minimally placed expanders. Smaller, remote incisions allow for earlier expansion. METHODS: Balloon-assisted tissue expander placement was evaluated in a pig model and compared with open placement. Open placement with delayed expansion versus minimally invasive placement with immediate expansion, and open placement with immediate expansion versus balloon dissection with delayed expansion were compared. Our clinical series with balloon dissector tissue-expander placement was reviewed. Fifty-two tissue expanders were placed minimally invasively and successfully expanded. RESULTS: Use of balloon dissector in the pig model yielded a shorter reconstructive period, faster expansion, and greater flap advancement. Clinical results revealed no infections, dehiscence, extrusion, or hematomas. All cases had expansion begun intraoperatively and were successfully expanded. CONCLUSIONS: Minimally invasively placed expanders resulted in shorter expansion times, the ability to institute immediate expansion, and improved expansion compared with open placement.

    Title The "banked" Tram: a Method to Insure Mastectomy Skin-flap Survival.
    Date January 2007
    Journal Annals of Plastic Surgery
    Excerpt

    BACKGROUND: Necrosis of the skin flaps after mastectomy can be a devastating complication following immediate breast reconstruction with a TRAM flap. Skin-flap loss compromises the aesthetic result and may necessitate revisional surgery. The authors wish to present a simple and effective method to insure mastectomy skin-flap survival. METHODS: Seven patients over the last 5 years were treated with immediate breast reconstruction with a TRAM flap after skin-sparing mastectomy and had evidence of skin-flap compromise intraoperatively. These patients had their TRAM flaps "banked" under the flaps and returned to the operating room within 72 hours for definitive debridement of the skin flaps, deepithelialization, and insetting of the TRAM. RESULTS: In all cases, there was 100% survival of the skin flaps after delayed insetting. There was no skin-flap loss. No patients required additional surgery for revision. CONCLUSIONS: The banked TRAM is a simple and effective method to insure mastectomy skin flap survival if there is a question of flap viability.

    Title Anatomical Basis and Clinical Application of the Infragluteal Perforator Flap.
    Date October 2006
    Journal Plastic and Reconstructive Surgery
    Excerpt

    BACKGROUND: When selecting flaps for coverage of pressure ulcers of the sacrum and perineal region in paraplegic patients, long-term high recurrence rates should be considered. Therefore, the authors developed an infragluteal perforator flap to avoid "burning bridges" for future reconstruction. METHODS: Infragluteal perforator flaps were dissected in five fresh human cadavers to define the anatomy of the cutaneous branches of the descending branch of the inferior gluteal artery and cluneal nerves and define anatomical landmarks for clinical application. In a series of 13 paraplegic patients, the authors used perforator-based flaps (additional skin bridge) to cover four perineal ulcers and one sacral ulcer and perforator flaps to cover six perineal and two sacral ulcers. Donor sites were closed by direct approximation. RESULTS: Twelve of 13 flaps healed uneventfully. In all cadaver and clinical dissections, one or two cutaneous branches of the descending branch of the inferior gluteal artery and one or two cluneal nerves were found at the lower border of the gluteus maximus muscle supplying the infragluteal perforator flap. These direct cutaneous branches allowed dissection of inferior gluteal perforator flaps with improved flap mobility compared with the perforator-based flaps. The descending branch of the inferior gluteal artery could always be spared for future flaps. CONCLUSIONS: The infragluteal perforator flap is a versatile and reliable flap for coverage of ischial and sacral pressure sores. It can be designed as a perforator-based or perforator flap and could provide a sensate flap in ambulatory patients. Donor-site morbidity is minimal, and options for future flaps of the gluteal and posterior thigh region are preserved.

    Title Inflammatory Myofibroblastic Tumors.
    Date October 2006
    Journal Journal of Surgical Oncology
    Excerpt

    INTRODUCTION: Inflammatory myofibroblastic tumors (IMT) while uncommon may arise within numerous organs. Historically, the literature regarding IMT has been confined to small one organ case series, with few reviews encompassing multiple anatomic sites, and little data regarding adjuvant treatment. METHODS: A review of patients with IMT treated at two large academic medical centers over a 15-year period was undertaken. Patient demographics, pathologic diagnoses, and pertinent clinical data were obtained. RESULTS: Forty-four cases of pathologically confirmed IMT were identified. Tumor locations included multiple anatomic sites. Therapies included complete resection, incomplete resection, observation, or chemotherapy, and/or radiation. Five patients underwent adjuvant chemotherapy and/or radiation therapy following surgery (14%) for local aggressiveness of the tumor, invasion, positive margins, or location of tumor that was not amenable to surgical resection. A second, concomitant, histologically distinct, neoplasm was identified in five cases. Of the patients who underwent treatment three local recurrences were noted (8%) and occurred in patients with partial resection without adjuvant chemo- or radiotherapy. CONCLUSIONS: Inflammatory myofibroblastic tumors may be a locally aggressive and destructive neoplasm. Tumor recurrence is unusual following complete surgical resection or organ-preserving combined modality therapy.

    Title Ipsilateral Reversed Free Fibula Transfer for Femoral Shaft Reconstruction: a Modification of a Previously Reported Technique.
    Date July 2006
    Journal Annals of Plastic Surgery
    Title Role of Cyclic-amp Responsive Element Binding (creb) Proteins in Cell Proliferation in a Rat Model of Hepatocellular Carcinoma.
    Date March 2006
    Journal Journal of Cellular Physiology
    Excerpt

    The role of cyclic adenosine monophosphate (cAMP) is poorly understood in the regulation of normal and abnormal hepatic cell growth. In this study, we examined the regulation of intracellular cAMP levels and its effect on nuclear cAMP responsive elements (CREs) in a rat model of hepatocellular carcinoma (HCC). Tumorigenic liver cells were cultured from an in vivo model of HCC and the role of cAMP in cell mitogenesis determined. These data demonstrated agents that elevate intracellular cAMP ([cAMP]i) levels caused significant dose-dependent inhibition of serum-stimulated mitogenesis in HCC cells. Cells were next analyzed for transcription factor expression and activity following increased [cAMP]i. These data demonstrated time- and dose-dependent increases in CRE binding protein (pCREB) activity, a maximal response occurring after 10-20 min before returning to basal levels within 60 min. In contrast, increased [cAMP]i levels led to sustained inducible cAMP early repressor (ICER) II/IIgamma mRNA and protein induction. To understand these data in relation to the in vivo setting, HCC tumors were analyzed and compared to pair-matched normal liver (NL) samples. These studies demonstrated significantly elevated Gsalpha-protein expression in HCC versus NL in the absence of significant changes in basal cAMP levels. Analysis of total and active CREB demonstrated significantly increased total CREB/pCREB in HCC versus NL. Further analysis of CRE expression demonstrated significantly increased expression of ICER mRNA and protein in HCC versus sham operated (Sh). These data demonstrate cAMP, while capable of stimulating promitogenic CREB activation inhibits cell mitogenesis in HCC possibly via ICER induction.

    Title Hypophosphatemia After 95 Right-lobe Living-donor Hepatectomies for Liver Transplantation is Not a Significant Source of Morbidity.
    Date December 2003
    Journal Transplantation
    Excerpt

    BACKGROUND: Hypophosphatemia appears to be a universal event after right hepatic lobectomy for live-donor adult liver transplantation according to one report. Because hypophosphatemia appears to contribute to increased postoperative complications, routine hyperalimentation with supratherapeutic levels of phosphorus was advocated. METHODS: From July 2000 to May 2002, we performed 95 right-lobe living-donor hepatectomies for 95 adult liver-transplant recipients, the largest single institutional experience. We reviewed our data that were collected prospectively. RESULTS: We did not find profound hypophosphatemia (<1.0 mg/dL) to be prevalent in our donors. At least six (6.3%) donors did not have postoperative hypophosphatemia. In addition, there appears to be no increased morbidity related to hypophosphatemia when aggressively corrected with intravenous or oral phosphates in our group of donors that underwent right-lobe hepatectomies. CONCLUSIONS: We, therefore, cannot endorse the routine administration of hyperalimentation with supratherapeutic phosphorus because of its potential morbidity.

    Title Insulin-like Growth Factor I is a Comitogen for Hepatocyte Growth Factor in a Rat Model of Hepatocellular Carcinoma.
    Date December 2002
    Journal Hepatology (baltimore, Md.)
    Excerpt

    Hepatocyte growth factor-scatter factor (HGF-SF) is a potent hepatic mitogen yet inhibits hepatocellular carcinoma (HCC) cell growth in vitro. Insulin-like growth factor I (IGF-I) is a pleiotropic growth factor shown to be important in cell growth and differentiation in other tumors. We hypothesized that IGF-I may play a role in regulating HGF-SF activity and HCC progression. Using an in vivo model of HCC, we showed elevated IGF-I messenger RNA (mRNA) expression in normal liver from tumor-burdened animals in the absence of changes in circulating IGF-I levels. Analysis of IGF-I receptor (IGF-IR) and HGF-SF (c-met) receptor expression showed significantly higher expression of both receptors in normal liver compared with an HCC specimen. Using cultured HCC cells from this model, we next showed that treatment with IGF-I led to significant increases in mitogen-activated protein kinase (MAPK) activity. Furthermore, we observed significant time-dependent increases in the expression of the c-fos and c-jun proto-oncogenes after addition of IGF-I (n = 5 per group, P <.05). Despite activation of a MAPK pathway and increased proto-oncogene expression, IGF-I failed to significantly affect cell mitogenesis. In contrast, HGF significantly inhibited cell mitogenesis in HCC lines (68.4% +/- 9.4% vs. control, n = 4, P <.05). Pretreatment of HCC cells with IGF-I (60 minutes) led to significant HGF-SF stimulation of total cell mitogenesis dependent on both IGF-I and HGF-SF dose (194% +/- 8% increase vs. control, n = 4, P <.05). In conclusion, tumor burden is important in altering intrahepatic growth factor synthesis. Signal cooperation between multiple cytokine pathways is an important factor in the progression of HCC.

    Title Gamma Probe-confirmed Laparoscopic Accessory Splenectomy.
    Date November 2002
    Journal Surgical Endoscopy
    Excerpt

    The simultaneous occurrence of idiopathic thrombocytopenic purpura (ITP) and Hodgkin's disease in the same patient is uncommon. There have been only a limited number of reported cases of newly diagnosed ITP following Hodgkin's disease. Even more uncommon is the development of ITP after splenectomy for Hodgkin's disease. Of the reported cases of ITP following splenectomy for Hodgkin's disease, all have been successfully treated with medical therapy. We report an unusual case of an accessory spleen causing ITP in a patient who had undergone a splenectomy for Hodgkin's disease 10 years earlier. The patient underwent hand-held gamma-probe-assisted laparoscopic accessory splenectomy.

    Title Torsion of a Wandering Spleen.
    Date October 2002
    Journal Surgery
    Title Cryoablation of Unresectable Pancreatic Cancer.
    Date April 2002
    Journal Surgery
    Excerpt

    BACKGROUND: Most patients with pancreatic cancer are not candidates for curative resection. The goal of this study was to evaluate the safety of an intraoperative ultrasound-guided cryosurgical procedure in a phase I study of unresectable pancreatic cancer. METHODS: From March 1995 to March 1999, 10 cryosurgeries using intraoperative ultrasound were performed on 9 patients with unresectable cancers at laparotomy. Four patients had a concurrent gastrojejunostomy, 2 had a chemical splanchnicectomy, and 1 underwent a concurrent hepatic cryosurgical procedure. RESULTS: There was no intraoperative morbidity or mortality. No patients developed postoperative pancreatitis or fistula. All patients had good pain control postoperatively and were tolerating a regular diet at the time of discharge. Pain control at discharge was achieved with an oral formulation (4/9), transdermal patch (3/9), no pain medication (1/9), and intravenous patient controlled analgesia (1/9). CONCLUSIONS: Ultrasound-guided cryoablation for unresectable pancreatic cancer appears safe and may contribute to improved postoperative pain control. Future studies to determine its therapeutic role in the management of unresectable pancreatic cancer are indicated.

    Title Inhibition of Alcohol Dehydrogenase Blocks Enhanced Gi-protein Expression Following Ethanol Treatment in Experimental Hepatocellular Carcinoma in Vitro.
    Date December 2001
    Journal European Journal of Gastroenterology & Hepatology
    Excerpt

    OBJECTIVE: Chronic alcohol abuse is one of the major contributors to the onset and progression of hepatocellular carcinoma (HCC). We have previously identified increased expression and function of inhibitory guanine nucleotide regulatory proteins (Gi-proteins) in primary human and animal models of HCC. Stimulation of Gi-proteins in HCC stimulates cell mitogenesis, an effect not observed in hepatocytes. The aim of this study was to determine the effect of ethanol and ethanol metabolism on Gi-protein expression in an experimental model of HCC. DESIGN: Pharmacological agents that inhibit alcohol metabolism were used in conjunction with ethanol or ethanol metabolites. We were also able to assess the relative contribution of alcohol and acetaldehyde, the major metabolite of alcohol, on Gi-protein expression in HCC and hepatocytes. METHODS: These studies used the rat hepatic tumorigenic H4IIE cell line in conjunction with isolated rat hepatocytes. Cells were cultured in vitro and exposed to ethanol, ethanol in the presence of an alcohol dehydrogenase (ADH) inhibitor, or acetaldehyde for varying lengths of time. Ethanol metabolism and changes in Gi-protein expression were subsequently determined by assay. RESULTS: Exposure to ethanol alone led to significant dose and time dependent increases in Gialpha1/2 and Gialpha3 protein and mRNA expression in HCC cells. In contrast, ethanol failed to alter Gialpha1/2, and only moderately affected Gialpha3 protein expression in isolated cultured hepatocytes. Pretreatment of HCC cells and hepatocytes with 4-methyl pyrazole (4-MP, 10 microm) significantly inhibited alcohol metabolism. Treatment of HCC cells with 4-MP inhibited changes in Gi-protein expression following exposure to ethanol (25 mm, 24 h). In addition, the increased expression of Gi-proteins observed after exposure to ethanol in HCC were mimicked by direct exposure of HCC cells to acetaldehyde in a dose and time dependent manner. CONCLUSIONS: These data suggest that alcohol metabolites, not alcohol, lead to increased Gi-protein expression in HCC in vitro. Ethanol and ethanol metabolites, in contrast, fail to significantly alter Gialpha1/2 protein expression in hepatocytes. These data may have significant implications in HCC progression in vivo.

    Title Does Previous Chest Wall Irradiation Increase Vascular Complications in Free Autologous Breast Reconstruction?
    Date
    Journal Plastic and Reconstructive Surgery
    Excerpt

    BACKGROUND:: Prior radiation therapy to the chest, in theory, has a detrimental impact on the recipient vessels in breast reconstruction and may impact microvascular success. The purpose of this study was to determine if pre-reconstruction radiation therapy affects the rate of vascular complications in free flap breast reconstruction. METHODS:: This was a retrospective review of free flap breast reconstruction between 2005 and 2009 by the senior authors. In addition to medical and surgical history, vascular complications were recorded including intra and post operative thromboses and technical difficulties resulting in a variation of the standard approach. RESULTS:: In total, 226 flaps were placed into an irradiated field, whereas 799 were transposed to a radiation naïve defect. Vascular complications as a whole were more prevalent in the radiated group (9.6% vs. 17.3%, p = 0.001). In regression modeling, radiation therapy was identified as an independent risk factor (OR 1.68, CI 1.04 - 2.70). In sub-analysis, there is a significantly higher rate of intraoperative vascular complications (7.6% vs. 14.2%, p = 0.003), although individual outcomes did not reach formal significance. Previous radiation had no effect on delayed vascular complications, flap loss, fat necrosis, infection, skin flap necrosis, hematoma, seroma, or delayed wound healing. CONCLUSIONS:: Pre-reconstruction radiation therapy increases the rate of vascular complications in free flap breast reconstruction, the majority of which appear intraoperatively. Although radiation does not hinder overall success of reconstruction nor contribute to post operative complications, surgeons should be aware that working in a previously irradiated field carries additional technical risk.

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