May 19, 2012

It's About Improving Research

John Persing, MD, PSF President

We are fortunate enough to be in a specialty that is characterized by innovation and excellence in patient care. With success comes increasing responsibilities for continued improvement, as that is what our patients expect and deserve. In order for us to maintain our leadership role in reconstructive and aesthetic care, a considerable amount of effort and funds needs to be invested in research.

While the Foundation supports other activities, which include Volunteers in Plastic Surgery (the volunteer international program), international scholars program, and academic affairs, the PSEF exists to support basic, translational and clinical research that will enhance treatment opportunities for our patients and ensure the future of our specialty.

Recent studies sponsored or facilitated by our Foundation include thromboembolism risk outcomes in reconstructive surgery patients, fat/stem cell graft research, and composite tissue transfer, to name a few. These investigations are opening the door to new opportunities to enhance patient safety, develop innovative procedures and enhance quality of life.

We are committed to exploring even more clinical questions and ideas that will impact our practice of medicine today and provide opportunities to open new fields of treatment for the future. To achieve these goals we are:

  • Partnering with other sister societies to co-sponsor research projects
  • Enhancing the quality of our process for analyzing, grading and awarding research grants
  • Confirming, through evidence-based medicine, the efficacy of our current practices
  • Anticipating opportunities for development of our specialty
  • Enhancing researcher educational programs to support those who have good ideas, but lack the infrastructure to develop a successful grant proposal.

The contributions of every plastic surgeon play an important part in enabling the PSEF to ensure the future of our specialty. This includes not only those of us who have been practicing plastic surgery for quite some time, but also those in the very beginning of their plastic surgery careers as they will also be the individuals most likely to benefit from these investments in the future of the specialty. No contribution is too small, or for that matter, too large. Please join us in this effort -- we need your support.

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Appreciation for the Specialty and a Desire to Honor His Father Leads to First Father and Son Maliniac Fellows

A Father and Son Team

Dr. Luis Rios, Jr. says there were two reasons he chose to support the future of plastic surgery with not one but two gifts to the Maliniac Circle. "I wanted to honor my father, Dr. Luis Rios, Sr., who had dedicated his whole career to plastic surgery on the Border of South Texas. I also wanted to express my appreciation of what the field of Plastic Surgery has done for my family, my many patients and me."

Dr. Rios, Sr. was the first plastic surgeon in the Rio Grande Valley. "A poor only child raised by his mother in Mexico City. His journey to the United States and the success he achieved could be the basis of an epic novel." His son will never forget his dedication to all his patients and his joie de vivre. "My father was an incredible man. He was the consummate physician. There is not a week that goes by when I do not hear about some wonderful thing he did for a patient of his. He loved his work and had an extra step in his shoes as he made rounds every morning", says Dr. Rios. "I was proud to make a contribution that would allow both him and me to become the first father son Maliniac members."

Dr. Rios credits his father and mother as great role models who kept him grounded and passed along good values. "Hard work, honesty, integrity, loyalty, cheerfulness, and intelligence were qualities drilled into me while I was growing up. However, the most important lesson I learned, and it serves me well in my practice, is to treat everyone with dignity regardless of socioeconomic status. My father provided top-notch care to his patients regardless of their economic status."

Because of the example, his father set and the values he taught, Dr. Rios, chose to make a gift of life insurance to the PSEF. In recognition of his generosity, Dr. Rios and his father were both inducted in to the Maliniac Circle in 2005. The Maliniac Circle recognizes the generosity of ASPS members and other individuals who have demonstrated their commitment to the future of plastic surgery. Maliniac Circle Fellows have all committed $50,000 or more in cash or securities or through a $100,000 deferred gift to the PSEF or National Endowment for Plastic Surgery.

"Sometimes we need to momentarily put aside our day-to-day problems, and look at what simple things we can do to insure the longevity of our specialty. For young surgeons, the cost of a life insurance policy is negligible. In other words, the financial impact on your practice will be minimal. However, the financial impact on our field will be immeasurable," says Dr. Rios. "For us older surgeons, how much would it hurt to donate 2-5% of your estate, in the form of a will, to the specialty that sustained you during your professional career?"

Achievements and Challenges

While Maliniac contributions cannot be targeted, when asked what challenges the specialty is facing that he hopes his contribution to the Foundation will address, Dr. Rios keeps it plain and simple. "The biggest challenge will be distinguishing us from other specialties that are encroaching on our specialty." How can we expect our specialty to continue to succeed and survive in the current economic and competitive environment without supporting our educational base and foundation? Without advances in plastic surgery that help distinguish our specialty, we will be absorbed by the other specialties.

Dr. Rios would like to see more minority leadership in all aspects of Plastic Surgery. "Women have made advances in leadership positions, but I do not see the same strides being made by my minority colleagues. Living on the Border of South Texas, I encounter different issues than my colleagues in the urban settings. There are good lessons to be learned from our colleagues of varying backgrounds. As an alumni and interviewer for Harvard, I see the positive impact that diversity has on this illustrious institution. Diversity will strengthen our foundation," he says.

Dr. Rios also believes that, "the emphasis on patient safety will eventually help distinguish us from other specialties. It is a win-win proposition. Promoting patient safety makes a safer environment for the patient and surgeon. It demonstrates our dedication to the issue. Although it might incur short-term costs, the long-term benefits are undeniable. We will maintain our independence from government regulation if we continue to maintain high safety standards."

Giving Back to Help His Neighbors and His Specialty

Giving back through active involvement in South Texas where he lives and practices has been an important part of Dr. Rios life. He fills his free time by coordinating interviews in the Rio Grande Valley for Harvard University where he was an undergraduate. Dr. Rios also speaks at "college nights" for high schools. He enjoys talking to the students and giving them advice. Dr. Rios says, "You would be amazed how smart this next generation of students is."

Dr. Rios is very proud of his service on the Board of the Boy's and Girl's Club of McAllen, Texas. The organization provides comprehensive sport's programs for the youth of the city. It also develops after school programs that have been statistically proven to help kids stay out of gangs and increase graduation rates from high school and college.

Dr. Rios is also intensely involved in scouting, serving as a Cub Master for pack 68 and an Assistant Scoutmaster for Boy Scout Troop 68 in McAllen, Texas. He believes that, "it develops character, leadership and outdoor skills that positively affect a young man's entire life."

In addition, Dr. Rios is an Assistant Clinical Professor for the Department of Surgery for The University of Texas San Antonio. Medical students rotate with him for 3-week periods. He teaches them how to write orders, suture, conduct themselves in the OR, etc... "I enjoy my one on one time with them. I try to be the teacher I would want to have," he says.

With all of the organizations vying for his attention and support, why did he choose to become a Maliniac Fellow? Dr. Rios put it this way, "My Plastic Surgery and Hand Fellowship lasted three years. However, my education continues with the courses and meetings directed by ASPS and PSEF. These courses have helped me enhance my practice and provide a safer environment for my patients. I could not imagine a more worthy cause."

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PSEF Visiting Professor Opens Doors

PSEF fosters the career development of plastic surgeons by sponsoring Visiting Professors who impact the education of plastic surgeons by sharing their clinical, technical and educational expertise on a variety of topics. The PSEF Visiting Professors Program enables ASPS members to travel to teaching institutions where they lecture and hold other informal educational sessions.

A 2009-2010 Visiting Professor, Dr. Robert Havlik took a few minutes out of his schedule to talk about his experiences and share what he learned.

Why did you decide to volunteer as a visiting professor?

Dr. Havlik: The role as Visiting Professor allows an important conduit for clinical education. I was able to share some of my insights into craniofacial surgery and plastic surgery for children, but I was also able to take away something from each visit. In my role as Professor of Plastic Surgery, Indiana University School of Medicine, and as a member of the ACGME Residency Review Committee, I am interested in surgical resident educational paradigms. My year as a Visiting Professor provided a unique opportunity to meet educators and residents in plastic surgery across North America. It offered a chance to directly view other education paradigms and view how other training programs are tackling complex problems inherent in modern surgical education.

What did you hope to accomplish?

Dr. Havlik: As a Visiting Professor, I was able to share some of the things that I have learned in clinical practice, as well as some of the current thoughts regarding patient management, with residents in the programs that I visited. I was also able to share some of my perspective about careers in plastic surgery and some of the opportunities for growth. From a personal viewpoint, I was able to view plastic surgery education across a spectrum of programs and to urge residents and faculty to become engaged in keeping plastic surgery vital as a specialty.

What were the topics of your lectures and other educational sessions?

Dr. Havlik: Throughout my year as a Visiting Professor, I visited the plastic surgery programs of the University of Pennsylvania, Loma Linda University, University of Manitoba and the Medical College of Wisconsin. I presented talks on management of vascular malformations, congenital hand surgery, pediatric tumors, and distraction osteogenesis of the midface and mandible to both residents and faculty. I also spoke about the history of medical education and how we got to where we are today.

What surprised you most during your year as a visiting professor?

Dr. Havlik: I was very impressed with the strength of the training programs that I visited. All programs were strong programs that blended a broad base of clinical experience with active research efforts. It was evident that all programs formed critical components of their medical centers, and that they were well respected within their surgical communities. Some programs were real eye-openers - the plastic surgery program at the University of Manitoba has a very active microvascular surgery core and they are conducting over 500 free tissue transfers each year. The programs at Penn, Medical College of Wisconsin, and Loma Linda were all exceptionally solid programs where the residents were enthusiastic and fully engaged in their education. This is strong evidence of plastic surgery as a vital specialty.

What did you take away from the experience?

Dr. Havlik: I was able to learn how other plastic surgery programs are structured, how they manage their surgical practice mission and their research mission, and how they draw upon their strengths to optimize their educational opportunities. While each program shares some common structures, each has also developed areas unique within its' medical community and, in many ways, is leading development within that community of its' unique areas of interest.

Perhaps above all, I also learned that despite the gloom and doom of the economy, plastic surgery academic sites are very vibrant, and plastic surgery as a specialty is thriving.

Other than sharing your expertise, what impact does a visiting professor have on young plastic surgeons?

Dr. Havlik: As a plastic surgery educator, I was able to talk with residents about the variety of career choices they have. I was able to help residents to identify issues that they should consider when deciding on an academic career or one in private practice.

What did you learn as a Visiting Professor that you wish every ASPS member knew?

Dr. Havlik: Each of the training programs I visited is vibrant and outstanding. I believe that these programs are indicative of the quality and excellence of other plastic surgery programs throughout North America.

Every plastic surgery institution values the Visiting Professor program. The Chief Resident of one of the programs I visited told me that the Visiting Professor program is one of the most fantastic things the Plastic Surgery Educational Foundation does to help plastic surgery. With the support of every ASPS member, the PSEF can continue to provide this opportunity to learn from each other and to strengthen the future of our specialty.

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How Research Impacts My Practice with Dr. Paul Cederna

How does research and data influence the way you practice?

Dr. Cederna: There is no doubt that we all practice surgery based upon our personal experiences and the experiences of surgeons we trust. It is very easy for a single bad experience or bad outcome to change the way we practice. It is not entirely an evidence-based approach to surgery, but it does provide us some comfort knowing that we are adjusting our practice to reduce our complication rates and improve our outcomes. In a large academic practice like the University of Michigan, we try to follow the literature very closely and employ evidence-based practice to guide our procedures and protocols. Overall, I think we are reasonably good at integrating the results of sound research into our practice improvements to enhance the quality of care we provide. The process of continuous quality improvement is essential to high quality patient care and resident education. However, do we occasionally allow anecdotal experiences to adjust the way we practice medicine? Unfortunately, the answer to that question is "Absolutely"....but we do our best to reduce that practice as much as possible.

What areas of research are you currently following?

Dr. Cederna: There are a number of areas where academic plastic surgeon scientists are making substantial advances. The areas which are most exciting include the areas of stem cell based therapies and composite tissue allotransplantation (CTA). There has been an immense amount of basic science research that has translated into clinically viable options for reconstruction of many difficult medical conditions. Without the basic science research, which has been performed, neither stem cell based therapies nor CTA would be available to the reconstructive and cosmetic surgeons. There are a number of world-renowned clinical outcomes experts in plastic surgery who have also made substantial progress in the areas of breast reconstruction outcomes and venous thromboembolism (VTE) prevention. These advances will significantly improve the quality of care we provide for our patients.

How have you used this new information in your practice?

Dr. Cederna: There is no doubt that stem cell based therapies (ie. autogenous fat grafting), findings from breast reconstruction outcome studies and studies evaluating VTE prophylaxis have all substantially impacted the way almost every plastic surgeon practices. I suspect that well over 50% of our ASPS members will routinely perform autogenous fat grafting for reconstructive and cosmetic indications. Those ASPS members actively performing breast reconstruction are impacted routinely by the health services research performed in this area. It goes without saying that the work being performed in VTE will impact all of our practices in the future. Of course, CTA has not become commonplace in plastic surgery yet, but has provided a reasonable option for reconstruction of some of the most difficult medical problems in surgery. There is no doubt that the role of CTA in face and hand reconstruction will become more common over the next 5-10 years. As we make advances in immunosuppressive regimens, to permit more selective immunomoodulation with a reduction in the adverse sequelae of global, nonspecific immunsuppression, CTA will become even more common.

Where do you look to find your research information?

Dr. Cederna: There are a number of resources available to us where we have the opportunity to learn about the advances in basic science and clinical research including; ASPS/PSEF Annual Scientific Meeting, subspecialty scientific meetings, Plastic and Reconstructive Surgery, symposiums, workshops, and instructional courses. There are also a number of high quality on-line resources available to learn more about the advances in our field. With that said, I must admit that a majority of the new information I receive regarding our advances in basic science and clinical research are at our scientific meetings, which provides me with the most current and high quality information from around the world.

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

Dr. Cederna: In the past few years, the PSEF has provided substantial research funding to its members who are performing clinically relevant basic science and clinical research. With nearly $1,000,000 per year in research support, many researchers have had the opportunity to perform high quality research that directly impacts the practicing plastic surgeon. In addition, the PSEF has created a broad research portfolio including Directed Research Projects and Investigator Initiated Projects to provide the most "bang for the buck" in regards to research funding. The PSEF has helped to direct the research being performed to provide the greatest impact on the practices of our ASPS members. The PSEF has achieved its goal at all levels. I would hope that the PSEF will continue on its current path maintaining the level of current funding, directing research towards the areas of greatest concern for our members, and still allowing the opportunity for "cutting edge" research that may not be quite ready for clinically application.

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

Dr. Cederna: With all of the advances that our ASPS members have seen in clinical practice as a consequence of basic science and clinical research, particularly as it relates to some of the higher profile advances like fat grafting, perforator flaps, and CTA, I do not think our members would be surprised. It is possible that our ASPS members are not as familiar with some of the incredible advances in research, which have not yet translated in wide clinical applicability. However, it will not be long until they start becoming more familiar with this work as well. Our future is very bright.

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