My friends and colleagues, Drs. Risal Djohan and Robert Lohman, were lead surgeons who helped perform this monumental operation today at the Cleveland Clinic. They are to be congratulated for putting together a great team of surgeons and taking this huge step in "Composite Tissue Allotransplantation." How is this different from "solid organ" transplantation? Not very different at all.
Most people do not know the history of Transplantation and that Plastic Surgeons have been at the forefront of this area since the beginning. These concepts have grown from skin grafts, to organs, and now to "composite tissue"--face, hands, limbs, etc. This is the new era of reconstructive plastic surgery: with Microsurgery--reconnecting small blood vessels and nerves--all of this is possible.
The question for a long time has been "Can we peform a facial or hand transplantation?" The answer for the past 20 years has been, "yes." We can and have been able to technically "replant" an amputed hand and facial part, the question now has become, "Should we do this?" The simple answer of course is "yes." There are many patients who would benefit from these types of procedures. However, the issues with long-term immunosuppression that can potentially cause many disease processes is still the critical issue in performing these kinds of operations. The holy Grail is still at large. When the immunosuppression issue falls to the background, this is when composite tissue allotransplantation will no longer make headlines, but become a routine surgery, just as plastic surgeons performing reconstructive microsurgery to reconstruct limbs and cancer defects, is done on a daily basis.
Wednesday, December 17, 2008
Sunday, December 14, 2008
Reconstructive Surgery Team
Members of our Team in Reconstructive Plastic Surgery
We offer over 20years of combined experience in Microsurgical Free Tissue Transfer, Complex Wound and Extremity Reconstruction, Breast Reconstruction, Head & Neck Reconstruction, and Limb Salvage:
The Team approach offers patients the highest standard of care for patient safety, high success, shortened operating times, and superb results.
Dr. David Chang
http://plastic.surgery.ucsf.edu/faculty/david-chang-md.aspx
Dr. Scott L. Hansen
http://plastic.surgery.ucsf.edu/faculty/scott-hansen-md.aspx
Dr. Charles K. Lee
http://www.lplasticsurgery.com/about.html
Dr. David M. Young
http://plastic.surgery.ucsf.edu/faculty/david-m-young-md.aspx
We offer over 20years of combined experience in Microsurgical Free Tissue Transfer, Complex Wound and Extremity Reconstruction, Breast Reconstruction, Head & Neck Reconstruction, and Limb Salvage:
The Team approach offers patients the highest standard of care for patient safety, high success, shortened operating times, and superb results.
Dr. David Chang
http://plastic.surgery.ucsf.edu/faculty/david-chang-md.aspx
Dr. Scott L. Hansen
http://plastic.surgery.ucsf.edu/faculty/scott-hansen-md.aspx
Dr. Charles K. Lee
http://www.lplasticsurgery.com/about.html
Dr. David M. Young
http://plastic.surgery.ucsf.edu/faculty/david-m-young-md.aspx
Saturday, December 6, 2008
Management of Acute Wounds, Chapter in Clinics in Plastic Surgery, C.Lee, S. Hansen
This is an article written about the state of art mangement of Wounds. In the US, there are a whole spectrum of wounds from the feet (diabetic foot wounds), age and body impairment (pressure sores/ulcers), burns, cancer (radiation, surgery, breast cancer, skin cancer), infection, and trauma (large bone injuries, hand and facial injuries, etc). As plastic surgeons, we see these types of wounds on a daily basis. Many of these wounds have become complex, chronic wounds where patients have undergone local wound care/dressing changes for many months to years without progress. Most often, patients are frustrated and have been told they will lose their limb or that there are few options available. Plastic surgeons can offer the entire spectrum of wound healing techniques to close the most difficult, complex wounds and to give patients another chance at an improved quality of life.
Management of Acute Wounds .
Clinics in Plastic Surgery , Volume 34 , Issue 4 , Pages 685 - 696
C . Lee , S . Hansen
Article via ScienceDirect
Abstract
The acute wound presents a spectrum of issues that prevent its ultimate closure. These issues include host factors, etiology, anatomic location, timing, and surgical techniques to achieve successful wound closure. Basic surgical principles need to be followed to obtain stable, long-term coverage, ultimately restoring form and function. Recent advances in dressings, debridement techniques, and surgical repertoire allow the modern plastic surgeon to address any wound of any complexity. This article discusses these principles that can be applied to any wound.
Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder
Management of Acute Wounds .
Clinics in Plastic Surgery , Volume 34 , Issue 4 , Pages 685 - 696
C . Lee , S . Hansen
Article via ScienceDirect
Abstract
The acute wound presents a spectrum of issues that prevent its ultimate closure. These issues include host factors, etiology, anatomic location, timing, and surgical techniques to achieve successful wound closure. Basic surgical principles need to be followed to obtain stable, long-term coverage, ultimately restoring form and function. Recent advances in dressings, debridement techniques, and surgical repertoire allow the modern plastic surgeon to address any wound of any complexity. This article discusses these principles that can be applied to any wound.
Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder
Great Toe To Thumb Microvascular Transplantation-Abstract, Charles K. Lee
Elsevier Article Locator
Great Toe-to-Thumb Microvascular Transplantation .
Clinics in Plastic Surgery , Volume 34 , Issue 2 , Pages 223 - 231
C . Lee , G . Buncke
Article via ScienceDirect
Article via Elsevier Health Sciences - Elsevier imprints, theclinics.com, and ophsource.org
To skip this screen in the future, update your preferred Elsevier websites . To learn more, read help
Update My Preferred Elsevier Websites
Abstract
Great toe to thumb transplantation offers the ideal reconstruction because it replaces the absent thumb with nearly identical anatomy. Functional donor site morbidity is minimal as compared with the aesthetic one; however, in comparison to the hand, the functional and aesthetic gain is tremendous. Anatomic and operative details are discussed along with preoperative and postoperative management. Postoperative functional evaluation of the thumb and donor site is assessed. Forty years of experience with this composite tissue transplantation has proven its status as the gold standard for thumb reconstruction.
Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder Help
Great Toe-to-Thumb Microvascular Transplantation .
Clinics in Plastic Surgery , Volume 34 , Issue 2 , Pages 223 - 231
C . Lee , G . Buncke
Article via ScienceDirect
Article via Elsevier Health Sciences - Elsevier imprints, theclinics.com, and ophsource.org
To skip this screen in the future, update your preferred Elsevier websites . To learn more, read help
Update My Preferred Elsevier Websites
Abstract
Great toe to thumb transplantation offers the ideal reconstruction because it replaces the absent thumb with nearly identical anatomy. Functional donor site morbidity is minimal as compared with the aesthetic one; however, in comparison to the hand, the functional and aesthetic gain is tremendous. Anatomic and operative details are discussed along with preoperative and postoperative management. Postoperative functional evaluation of the thumb and donor site is assessed. Forty years of experience with this composite tissue transplantation has proven its status as the gold standard for thumb reconstruction.
Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder Help
Use of New Technology to Determine Blood Flow to Tissues
Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures...
Wed Jun 11, 2008 12:23pm EDT
Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures with Novadaq SPY(R) System
First Intra-Operative Fluorescent Imaging System to Be Used in
Cardiothoracic and Plastic Surgeries
SAN FRANCISCO--(Business Wire)--
St. Mary's Medical Center (SMMC) is one of the first hospitals on the West Coast to routinely use the SPY(R) Intra-operative Imaging System (SPY or SPY System) in cardiothoracic procedures and plastic reconstructive surgeries. The SPY System is the only FDA-approved, intra-operative imaging system that provides real-time fluorescent images while the patient is in the operating room. SPY images enable surgeons to optimize surgeries, eliminate guesswork and potentially avoid post-operative complications including repeat surgical operations.
The SPY System enables cardiac surgeons at St. Mary's to simply and efficiently confirm proper placement of bypass grafts and visually assess their effectiveness during coronary artery bypass graft procedures. Similarly, physicians at SMMC's Plastic Reconstructive Orthopedic Surgery Center performing reconstructive procedures use the SPY System to see the blood flow in co-joined vessels, micro-vasculature and related tissue perfusion in real-time. "We're committed to adopting technology that allows us to provide the highest quality of cardiac care possible to our patients at St. Mary's," said Dr. Eddie Tang, cardiac surgeon at SMMC. "The SPY System enables us to immediately visually assess the blood flow in our bypass grafts, confirm that we have performed the best possible bypass procedure, and potentially improve immediate and long-term outcomes for the patient."
The SPY System combines the use of an infrared laser, high-speed imaging and a fluorescent imaging agent. The imaging agent, which is administered to patients intravenously during the procedure, emits light when stimulated by the infrared laser. During surgery, the
imaging agent lights up in blood flowing through the circulatory system while the camera captures the live images. If the images indicate that a graft might not be functioning optimally, the surgeon can immediately make revisions in the operating room. Traditionally, surgeons have been forced to make an educated guess about whether bypass grafts, co-joined arteries or veins are functioning properly. Cardiac surgeons have only been able to get images of the heart and vessels after the patient's chest is closed and the patient has been removed from the operating room. Likewise, surgeons performing plastic reconstructive procedures have not been able to easily perform real-time imaging in the operating room. Use of the SPY System may reduce the number of patients that must return to the operating room for the revision of improperly functioning or potentially misplaced grafts.
According to Dr. Charles Lee, director of microsurgery at St.
Mary's Medical Center, "The SPY technology allows plastic surgeons to
determine the blood supply to tissues we transplant to reconstruct the
human body. Specifically, in breast reconstruction and lymphedema
surgery, we use specific tissue types from the abdomen, buttocks or
thighs, and with the SPY we can determine which parts of these tissues
are best to use."
SMMC now joins other prestigious institutions utilizing the SPY System, including the Cleveland Clinic Foundation, Stanford University Medical Center and the Arizona Heart Institute.
About St. Mary's Medical Center
Founded 150 years ago, St. Mary's Medical Center is one of the
first hospitals in San Francisco. It's the home of several medical
firsts including the nation's first digital cardiac catheterization
laboratory, the first balloon angioplasty for coronary artery disease
and the first total hip replacement surgery. St. Mary's continues to
adopt the latest advances in medical technology and practices with
specialized centers for plastic reconstructive orthopedic surgery, and
innovative cardiovascular, bariatric, oncologic and acute
rehabilitation services.
With more than 575 physicians and 1,100 employees, St. Mary's
full-service acute care facility is committed to its mission to
deliver compassionate, high quality, affordable health services to the
communities it serves. St. Mary's pioneering spirit endures and it is
well poised to continue its tradition of providing health and healing
for the San Francisco community.
For more information, please call (415) 668-1000 or visit
http://www.stmarysmedicalcenter.org.
Mortar
Jamie Fishler, 415-772-9907 ext. 117 (Media)
jamie@mortarpr.com
Copyright Business Wire 2008
Wed Jun 11, 2008 12:23pm EDT
Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures with Novadaq SPY(R) System
First Intra-Operative Fluorescent Imaging System to Be Used in
Cardiothoracic and Plastic Surgeries
SAN FRANCISCO--(Business Wire)--
St. Mary's Medical Center (SMMC) is one of the first hospitals on the West Coast to routinely use the SPY(R) Intra-operative Imaging System (SPY or SPY System) in cardiothoracic procedures and plastic reconstructive surgeries. The SPY System is the only FDA-approved, intra-operative imaging system that provides real-time fluorescent images while the patient is in the operating room. SPY images enable surgeons to optimize surgeries, eliminate guesswork and potentially avoid post-operative complications including repeat surgical operations.
The SPY System enables cardiac surgeons at St. Mary's to simply and efficiently confirm proper placement of bypass grafts and visually assess their effectiveness during coronary artery bypass graft procedures. Similarly, physicians at SMMC's Plastic Reconstructive Orthopedic Surgery Center performing reconstructive procedures use the SPY System to see the blood flow in co-joined vessels, micro-vasculature and related tissue perfusion in real-time. "We're committed to adopting technology that allows us to provide the highest quality of cardiac care possible to our patients at St. Mary's," said Dr. Eddie Tang, cardiac surgeon at SMMC. "The SPY System enables us to immediately visually assess the blood flow in our bypass grafts, confirm that we have performed the best possible bypass procedure, and potentially improve immediate and long-term outcomes for the patient."
The SPY System combines the use of an infrared laser, high-speed imaging and a fluorescent imaging agent. The imaging agent, which is administered to patients intravenously during the procedure, emits light when stimulated by the infrared laser. During surgery, the
imaging agent lights up in blood flowing through the circulatory system while the camera captures the live images. If the images indicate that a graft might not be functioning optimally, the surgeon can immediately make revisions in the operating room. Traditionally, surgeons have been forced to make an educated guess about whether bypass grafts, co-joined arteries or veins are functioning properly. Cardiac surgeons have only been able to get images of the heart and vessels after the patient's chest is closed and the patient has been removed from the operating room. Likewise, surgeons performing plastic reconstructive procedures have not been able to easily perform real-time imaging in the operating room. Use of the SPY System may reduce the number of patients that must return to the operating room for the revision of improperly functioning or potentially misplaced grafts.
According to Dr. Charles Lee, director of microsurgery at St.
Mary's Medical Center, "The SPY technology allows plastic surgeons to
determine the blood supply to tissues we transplant to reconstruct the
human body. Specifically, in breast reconstruction and lymphedema
surgery, we use specific tissue types from the abdomen, buttocks or
thighs, and with the SPY we can determine which parts of these tissues
are best to use."
SMMC now joins other prestigious institutions utilizing the SPY System, including the Cleveland Clinic Foundation, Stanford University Medical Center and the Arizona Heart Institute.
About St. Mary's Medical Center
Founded 150 years ago, St. Mary's Medical Center is one of the
first hospitals in San Francisco. It's the home of several medical
firsts including the nation's first digital cardiac catheterization
laboratory, the first balloon angioplasty for coronary artery disease
and the first total hip replacement surgery. St. Mary's continues to
adopt the latest advances in medical technology and practices with
specialized centers for plastic reconstructive orthopedic surgery, and
innovative cardiovascular, bariatric, oncologic and acute
rehabilitation services.
With more than 575 physicians and 1,100 employees, St. Mary's
full-service acute care facility is committed to its mission to
deliver compassionate, high quality, affordable health services to the
communities it serves. St. Mary's pioneering spirit endures and it is
well poised to continue its tradition of providing health and healing
for the San Francisco community.
For more information, please call (415) 668-1000 or visit
http://www.stmarysmedicalcenter.org.
Mortar
Jamie Fishler, 415-772-9907 ext. 117 (Media)
jamie@mortarpr.com
Copyright Business Wire 2008
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