May 19, 2012

2010 PSF Research Initiative Grows

In 2010, the PSF awarded 34 investigator-initiated research projects and allocated nearly $800,000 to support the newest clinically-relevant research in plastic surgery. This represents a significant increase in PSF research funding over previous years, as the ASPS/PSF leadership is committed to continuing to provide high levels of research support to ensure that plastic surgeons have the needed research resources to be pioneers and innovators in advancing the practice of medicine.

2010 PSF Grant Recipients

The PSF is proud to announce the recipients of the 2010 PSF Grant Programs. We would like to offer you the opportunity to meet the investigators and learn about their projects, and where the work will be conducted by viewing the 2010 PSF Grant Recipients online.

PSF Programs and Funding Results: The Proof is in the Pudding

Through its three main funding programs, the PSF is supporting investigators from the beginning of their career in their residencies on up to well-established plastic surgeons. This year, PSF received 20% more applications requesting over $3M in funding.

What's more, 15% of all successful applicants attended the 2009 PSF Research Fundamentals Workshop in Pittsburgh. This day-and-a-half workshop focused on the fundamentals of grant writing and career development for the surgeon scientist.

"The PSF Research Fundamentals Workshop was extremely beneficial in helping me understand the grant review process and study section. Not only was I better able to articulate my ideas while writing a grant proposal, but it also helped me understand the types of grants available to researchers starting out like myself," says Harvey Chim, MBBS, Case Western Reserve University.

Important Information for 2010 Grant Applications

The PSF has implemented an online process for submitting your grant application. Only applications submitted online will be eligible for scientific review and potential funding. The grant submission portal will open late summer 2010. The application deadline for ALL programs is December 1, 2010.

For more information on the PSF grant programs, or to apply, please visit the grant and applications page on the ASPS/PSF website, or contact the Research Office at research@plasticsurgery.org, or phone (847) 228-9900.

Back to Top

Reaching Out through Volunteers in Plastic Surgery

Dr. William Schneider, Chair: Volunteers in Plastic Surgery (VIPS) Steering Committee

In how many surgical missions have you participated? Why did you choose to participate in the particular mission(s) that you did?

Dr. Schneider: I have been on lots of trips. I have worked in multiple countries in Asia, Africa, South and Central America. The poverty in many of these places is really beyond what most North Americans can imagine. There are so many well-qualified plastic surgeons in the United States that all patients are taken care of and the surgery will be well done. In developing countries, there is much more of a feel that if volunteer mission teams are not there to do it, it may not be done.

What was the most challenging aspect of your experience?

Dr. Schneider: One of the greatest challenges in this type of work is the need to provide both quality and safe plastic surgery, something we take for granted in our developed world. So making the correct decisions about what is reasonable to do, as well as anticipating what will be needed to work safely are ongoing challenges.

What was your most memorable moment?

Dr. Schneider: There have been many. Once in Ecuador a three-year-old girl with a severe burn deformity of the arm was discovered by our local host begging on a street in their city. They managed to find the mother and asked if she would bring her child to our clinic the following week. Her mother brought her. We did a major operation and released her severe burn contractures (elbow fixed at 90˚, arm attached to her side). She stayed in the hospital for 10 days after her surgery. She had a magnetic, vivacious personality. A six-month follow-up revealed full motion of her arm and shoulder. That sort of impact is personally unbelievably rewarding.

How can what you learned from your mission experience help to improve and advance plastic surgery around the world?

Dr. Schneider: I think, as we all better understand that there are parts of the world where the access to plastic surgery is very limited, more people will be either willing to participate in helping the poor and underserved by providing the needed surgeries, or be willing to provide the funding for others to do so. Likewise, we as a specialty can undertake helping local plastic surgeons to provide care by giving both educational and financial support. Ideally, this will ensure better care in developing countries in the long run more than any individual mission trip.

How has the experience changed the way you practice plastic surgery in the United States?

Dr. Schneider: After doing this work I became far more appreciative of the way my life is here. We are privileged to live the way we do. One also appreciates the superb state of medicine in general, and plastic surgery in particular as it is practiced here.

What real impact does this kind of service have on improving health care?

Dr. Schneider: One aspect of the long-term answer to providing and improving healthcare in developing countries is to help train and support local plastic surgeons, of which there are many capable ones around the world, to be able to provide quality care for the people of their countries year-round. VIPS is implementing a program that will make teaching materials available for these surgeons.

You mentioned that VIPS is implementing a program that will make teaching materials available for surgeons in developing countries. Can you tell me a little more about this?

Dr. Schneider: Our long-term plan is to create two DVDs containing teaching materials that would be of use to surgeons in developing countries who are faced with caring for patients with clefts, burn deformities, hand injuries or congenital problems and problem wounds. These DVDs would be provided free to ASPS members who are working in poorer countries to be given to their physician counterparts.

As Chair of the VIPS Steering Committee, what advice would you give to ASPS members who are considering joining a mission team?

Dr. Schneider: In the VIPS section of the ASPS website, there is information for surgeons who are interested in participating in international work in developing countries. The website has a list of organizations they can contact about getting involved. I believe one of the highest forms of medical citizenship is to provide the very special skills we have to the poor and underserved of the world, and ask nothing in return.

Is there anything else that you would like to share with your ASPS colleagues about VIPS?

Dr. Schneider: I would encourage others to become involved. VIPS works in several ways. We award grants through the PSF/Smile Train Grant program. We have developed both technical and ethical guidelines for plastic surgeons working in underserved countries. We also deliver a course at the annual meeting every year for those interested in pursuing this type of work.

Many of the members of the ASPS are very generous with their time. Hundreds of members have participated in international work providing reconstructive plastic surgery for the poor and underserved. Some do this regularly, even once a year or more. Others try it and it may not suit their style or methods. However, everyone can help by providing funding for these projects even if they are not able to do one themselves.

Back to Top

PSF National Endowment Grant Award Winner - Researcher strives for optimal functionality in CTA

The Researcher: Kia McLean Washington, MD
Title: Plastic Surgery Resident, University of Pittsburgh (Pa.) Medical Center
Project: Improving Somatosensory Cortical Response Properties after Composite Tissue Transplantation

What is the goal of your project?

Dr. McLean Washington: Composite tissue allografts (CTA) from cadaveric sources provide the opportunity for a functional graft, while eliminating donor-site morbidity and utilizing a similar tissue type. In order for CTA to be widely accepted as a reconstructive option, consistent optimal motor and sensory recovery must be obtained. Our long-term goal is to mitigate central changes in the somatosensory cortex after composite tissue allotransplantation in order to optimize the specificity and magnitude of sensory recovery.

How are you working toward your goal?

Dr. McLean Washington: Studies of functional MRI in CTA have shown increased activity in previously quiescent areas of the sensorimotor cortex after hand and face transplants. Although functional MRI can give a broad picture of remodeling taking place in the cortex, it cannot give specific electrophysiological information on the behavior of neurons. Functional alterations of excitatory and inhibitory connections, sprouting of new connections, and reorganization of somatosensory maps are important electrophysiological properties of cortical remodeling after transplantation. In order to establish the electrophysiological changes that occur in the somatosensory cortex after CTA, we developed a functional rodent hemi-face transplant model ideal for studying cortical reintegration after transplantation.

Through invasive electrophysiological testing we first aim to define the changes that occur in the primary somatosensory cortex after CTA, including mapping, response magnitude, latency and spontaneous activity. After we have defined these changes, we aim to correlate central changes with actual functional recovery of sensation through behavioral testing in our transplanted animals. Last, we aim to test both pharmacological and electrophysiological therapeutic interventions to enhance cortical functional restitution after CTA.

At what stage are you in your research?

Dr. McLean Washington: With our rodent hemifacial transplant model, we have identified patterns of cortical mapping in the somatosensory cortex after transplantation. It appears that the pathways to the brain from the periphery significantly reorganize. In addition, we have characterized electrophysiological properties of neurons in the central nervous system (CNS) after transplantation. For example, there is more spontaneous firing of neurons. The response latency increases after transplantation. Thus, there is a longer time period for a signal to get from the periphery to the cortex and activate neurons in the CNS. This is an indication that new pathways are created from the periphery to the cortex rather than old pathways reactivated after transplantation. The magnitude of a response also decreases after transplantation. This is likely due to a decrease in synchronous firing of neurons in the thalamus, the "control center" to the brain.

We have started to use pharmacologic agents to mitigate the changes that occur in the brain after transplantation. We have begun to examine which pharmacologic agents best optimize cortical plasticity. We have found that both cyclosporine and tacrolimus increase the number of cortical neurons that respond to a stimulus after transplantation. We are currently looking at electrophysiological techniques to stimulate the brain and optimize plasticity after transplantation.

What will be the project's applicability?

Dr. McLean Washington: We believe that our research will lead to the development of innovative techniques to target the central nervous system after CTA for improvement of functional outcome.

What led you to embark upon this project?

Dr. McLean Washington: We believe that CTA is the next frontier of reconstructive surgery. In order to optimize its advancement, basic science research in the field must parallel clinical endeavors. Along with methods to achieve donor specific tolerance, optimal functional outcome in CTA will ensure its widespread usage.

What's next for your research?

Dr. McLean Washington: We hope to investigate pharmacological and electrophysiological therapeutic interventions in large animal models.

Has your research affected or attracted other investigators in this field?

Dr. McLean Washington: We have presented our findings around the world in both plastic surgery and non-plastic surgery arenas. We believe that our research has both informed other investigators and sparked interest in CTA.

How has the PSEF grant helped your research gain additional funding?

Dr. McLean Washington: The PSF funding has enabled us to embark on this novel research, and will help us to obtain funding under the NIH's new initiative for innovations in monitoring and manipulating nervous system plasticity.

Back to Top

How Research Impacts my Practice

PSF with Matthew Concannon, MD

How does research and data influence the way you practice?

Dr. Concannon: When I step back and think about it, research and data heavily influence the way I practice. On a day-to-day basis, it is easy to overlook the impact; though when I think about even a few different developments in the past 5 years, research has completely changed the way that I practice - as a matter of fact, it has a huge impact on the way I practice. I finished training in 1994 - so much has changed since then. Following research is the only way to stay abreast of those types of changes and innovations. Following research, specifically following clinical research, is what really directly impacts my practice.

What areas of research are you currently following?

Dr. Concannon: My interest now is mostly clinical; though I follow many areas of research. If there is a specific topic that is going to affect my practice, I'm very interested in it. Ten years ago, I was a lot more interested in basic science type research since I was actively involved myself.

How have you used this new information in your practice?

Dr. Concannon: One such example, which may have had the greatest impact on my practice, is with regard to hand surgery. When I was in training, it was dogma that you could not use epinephrine in the hand. Epinephrine is a profound vasoconstrictor and it was supposedly malpractice. I was also trained you had to use a tourniquet for hand surgery - that was to keep blood from obscuring the view. There were a series of clinical research papers in PRS that refuted this as clinical researchers began to ask the question "is this really the case?" Through a series of research projects performed by different investigators, research showed that it actually is not the case. You CAN use epinephrine in the hand. How that translates to my practice is that I now do all of my hand surgery under a local anesthetic in my office OR. Five years ago, I had to do all of my hand surgery under general anesthetic or major block in an outpatient or hospital facility. This has had a huge impact on my patients and my practice. It is much easier on my patients and convenient for me to be able to perform this procedure in my office under local. This revolutionized the way I practice and came to me from directly following clinical research.

Where do you look to find your research information?

Dr. Concannon: I routinely go to the white journal. Our journal is the premiere place for information for plastic surgeons. It may be that once I see something in there that sparks my interest, I continue my search through Medline to find other resources, but the starting point for me is always the white journal. It is completely online - you can search through it easily. Since it is such a prestigious publication - everyone wants to be published in the journal - it can afford to be selective. That way you know you are getting the best, most relevant information on plastic surgery out there.

What would you like to see done in research to further your practice?

Dr. Concannon: I may not have the foresight to imagine the next innovation in plastic surgery, but I do know there are going to be more. Plastic surgery exists because of research and innovation, and I look forward to our future as a specialty because of this.
Furthermore, it seems that in the past few years there has been a huge emphasis on outcomes. The drive to show true outcomes is admirable and we are really gaining traction and ground, as a specialty, by pursuing it.

What would other plastic surgeons be surprised to know about research and how data driven research can improve their practice?

Dr. Concannon: I feel that plastic surgeons, by nature, are conservative. Once we find a method that works in our hands, we are reluctant to change our technique or approach. The thing that would surprise most plastic surgeons is that the potential for positive change in their practice is at their fingertips. We, however, must be receptive to change.

Back to Top

Why I Give to the PSF with Robert Whitfield, MD

Which PSF programs (Research, VIPS, International Scholars, and Visiting Professors) most interest you?

Dr. Whitfield: The program I am focused on is research. Research is key to the future of plastic surgery. Innovation has always been at the forefront of plastic surgery. With aggressive funding of research initiatives, PSF will continue to foster innovation in craniofacial surgery, extremity surgery, breast reconstruction, and aesthetic surgery. It is vital that plastic surgery lead the way in innovation.

When did you make your first gift?

Dr. Whitfield: March 18th, 2010 was my first gift to the PSF - it was long overdue. I had no idea how difficult it was to find funding until I started to look for money to fund a stem cell project. I now feel more so than ever that contributing to the PSEF is imperative to helping establish funding for plastic surgery research. Without private donations there will not be enough funding to support research projects that can benefit patients now and in the future.

What motivates you to give to the PSF?

Dr. Whitfield: I believe that ASPS member surgeons have to not only set the bar clinically with our knowledge and expertise, but we also need to be substantiated through science using both basic and translational research projects as the vehicles. Plastic surgeons have always been at the forefront but we have sadly lacked data to support our practices. We often practice on the anecdotal rather than the best evidence. Through PSF funding of plastic surgery research projects we can ultimately benefit our patients.

What impact do you hope your gift to the PSF will have on Plastic Surgery?

Dr. Whitfield: I would like to think that each donation will lead to funding of investigators in plastic surgery to support their research in areas such as stem cell therapy and regenerative medicine. One of the most interesting issues in plastic surgery is the use of adipose derived stem cells for autologous tissue reconstruction. Although it has been done for many patients after mastectomy it has now been done for premenopausal women. This obviously is a sensitive issue which demands data to support the practice. It is incumbent upon plastic surgeons to provide this data. By supporting the PSEF, my donation may help to fund a clinical trial which would provide the data needed to safely inform patients about the potential risks and benefits of fat grafting in native breast tissue.

What would you tell someone who is thinking about donating to the PSF?

Dr. Whitfield: Giving back to plastic surgery is easy for me when I reflect on what I have seen accomplished even early in my career. It is routinely humbling to care for patients with complicated problems from cancer, trauma or congenital problems. Personally I want the specialty of plastic surgery to continue growing. As a plastic surgeon, it is hard to grasp how significant of an impact you can have on a patient's life. We all want to continue to share the special skill sets we have developed as plastic surgeons with our patients. Maybe more so than anything we want to expand our ability to provide care for our patients. This growth process can be accelerated if we want. Contributing to the PSEF shows our dedication and desire to strive for the best and safest treatments for our patients.

You can contribute to the PSEF online or contact Susan Hacker, CFRE, Individual Giving Associate, via e-mail at shacker@plasticsurgery.org.

Back to Top

Back