May 19, 2012

PSF: A New Name, a New Look - a Streamlined Focus

By John Persing, MD
President, Plastic Surgery Foundation

As you have been hearing about for months, the Plastic Surgery Educational Foundation has changed its name to The Plastic Surgery Foundation. This change was done to signify a marked change in the direction of the Foundation's structure and activities. Previously, the Foundation was known as the Educational Foundation, because it was involved in development of the educational symposia, as well as research activities for the body of plastic surgery. We know this role is an important role for plastic surgery overall, but we also came to the realization that we needed to dramatically increase our investment in innovation and creativity to secure the future of our specialty. The bylaws, structure, mission, and everything else about the Foundation were reviewed, to optimize this one, and so very important, responsibility.

The new Foundation has emerged as a streamlined, focused effort, which provides opportunities for clinically relevant investigations, that will have immediate and long-term benefits to the breadth and quality of the specialty. This is a significant change. Virtually all income donated to the Foundation is sent directly to clinician investigators in practice, who wish to test well thought-out novel ideas. As such, we also believe that a new logo was important to visibly signify this change. We were fortunate to have Chris Mallon and the creative staff at ASPS/PSF to help offer designs, which represent our understanding of what the new Foundation is. We also wished the design to have a connection to the Educational Foundation's rich past, yet make a statement about the potential for the Foundation's future in solving problems, bridging clinical and basic sciences, and being comprehensive and forward thinking. Following multiple iterations, a new symbol of the Foundation emerged. As you can see before you, this symbol represents the newly energized, invigorated, streamlined, and focused research effort that is designed to be the basis for quality improvements in plastic surgery for many years to come.

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National Endowment Grant Award - Understanding the economics of hand transplants

Editor's note: The following is part of an ongoing series highlighting National Endowment Grant Award winners, and the research they are conducting to improve patient safety and develop new technologies for plastic surgeons. This interview was published in the December 2009 issue of Plastic Surgery News.

The Researcher: Kevin Chung, MD, Professor of Surgery and Assistant Dean for Faculty Affairs at the University of Michigan Medical School, Ann Arbor, MI
Project: Economic Analysis of Hand Transplantation

PSN: What is the goal of your project?

Dr. Chung: Plastic surgery is an innovative specialty that constantly strives to develop new procedures to help our patients. Hand transplantation is a novel technique that one day may help a greater number of patients who suffer from hand amputations. The goal of this project is to develop an economic model to understand the cost and outcomes associated with hand transplantation.

PSN: How far along are you in your work?

Dr. Chung: Takashi Oda, MD, and I have found that for unilateral hand amputations, prosthetic use was favored over hand transplantation because, in this scenario, hand transplantation costs more and has fewer quality-adjusted life years (QALYs). Double hand transplantation also costs more than prosthetic adaptation, but it's also associated with more QALYs. In economic terms, the incremental cost-effectiveness ratio for double transplantation is more than $300,000 per QALY, which far exceeds the accepted threshold of $50,000 per QALY. This means that double-hand transplantation may not be considered a "good buy." Of course, with improvement of immunosuppressive strategies and better functional outcomes in the future, the results of this economic model may change to potentially favor double-hand transplantation. In the current era of comparative effectiveness, a new intervention must be compared to the traditional treatment to assess both cost and outcomes. Embarking on an economic analysis is such a way to critically examine such innovations.

PSN: What led you to embark on this research?

Dr. Chung: Outcomes studies and economic modeling were my research focuses during my training in the University of Michigan Robert Wood Johnson (RWJ) Clinical Scholar's program more than 15 years ago. I was the first plastic surgeon to train in the RWJ program; since then, it has trained five additional plastic surgeons. These scholars are Amy Alderman, MD, rheumatoid hand surgery and breast reconstruction; Catherine Curtin, MD, upper limb rehabilitation in spinal cord patients; Christi Cavaliere, MD, wrist arthroplasty research; Jennifer Waljee, MD, health disparity in breast cancer; and Erika Davis-Sears, MD (our fourth-year plastic surgery resident), economic modeling and health policy. These physicians have and will continue to make seminal contributions to plastic surgery. PSF support is instrumental in developing the academic careers of young plastic surgeons who will lead our specialty in research, education and health policy.

PSN: What is next for your research?

Dr.Chung: We will continue to apply sophisticated economic modeling techniques to assess various plastic surgery innovations. Clinical research and evidence-based medicine are receiving a great deal of attention from the Society's leadership, and we have various projects underway relating to comparative effectiveness research, multicenter clinical trials and health policy. We strive to be creative in expanding the specialty's research portfolio by including a variety of research designs. I'm particularly excited that the PRS journal has published a series of tutorial articles on clinical research that will enrich our specialty - and encourage practitioners to make bold moves into the full spectrum of clinical research.

PSN: How has the PSF grant influenced your ability to obtain other funding?

Dr. Chung: PSF funding is particularly important in generating data that can be leveraged for national funding support. Past and current support from PSF has enabled me to obtain four NIH grants, and several other promising grants are being considered. The PSF's concerted effort to support research is the best investment of our resources - it will yield excellent return-on investment from federal agencies. Despite the decrease in national funding for research, the Society still maintains its allocation for research, which enables many young investigators to be competitive in the national scene. Our specialty is under threat from many others, and our innovations become quickly adopted by those who want to acquire our skills. We should continue to support research to find the next "big thing" in plastic surgery that will energize our specialty. Contributions supporting PSF will fulfill the dreams and aspirations of our specialty - that we are a respected voice in American medicine.

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Improving Care for Children through the International Scholar Program

The International Scholar Program enables plastic surgeons from abroad to come to the United States for three to six months to study at host plastic surgery institutions. Since 1990, the International Scholar Program has funded 72 scholars from 35 countries.

Through the generosity of PSF donors, Dr. Daniela Y. S. Tanikawa from the University of São Paulo School of Medicine, São Paulo, had the opportunity to visit five institutions in the United States from August through December 2010 to learn from ASPS members. She was pleased to share how this experience will enable her to better care for her patients in Brazil.

Why did you choose to become a plastic surgeon and where did you receive your training?

Dr. Tanikawa: I chose to become a plastic surgeon because of the idea of melding the science of medicine with my need to be manually creative, and I received my training in the Plastic Surgery Division at the University of São Paulo School of Medicine.

How many patients do you see in a year?

Dr. Tanikawa: Since 2007, I have worked in the Craniofacial Group of the Plastic Surgery Division at the University of São Paulo School of Medicine, and I see about 1,200 patients in a year.

How many are children?

Dr. Tanikawa: Approximately 70 percent are children

Why did you decide to participate as an International Scholar?

Dr. Tanikawa: In pursuit of excellence, the International Scholar Program offered by the ASPS/PSF and the ASMS represents the unique opportunity to learn from leaders in the field.

How has the experience changed your perspective of plastic surgery or international outreach?

Dr. Tanikawa: Through this experience, I have been able to see advanced technologies being used and advanced research projects being developed in the United States, and this has definitely changed my perspective of the future of plastic surgery that we have to reach.

What did you learn and what were you able to implement when you returned home?

Dr. Tanikawa: By observing, Dr. Stal, and Dr. Hollier and their team at the Baylor College of Medicine, I learned the orthodontic principles of pre-surgical orthopedics for cleft lip/palate. I learned a lot about the cutaneous lesions in children, and the pediatric tissue expansion from Dr. Bauer at the University of Chicago. Meeting Dr. Forrest at the Hospital for Sick Children led me to a concentrated interest in learning more about craniofacial surgery. Drs. McCarthy, Cutting and Warren at the Institute of Reconstructive Plastic Surgery, shared different craniofacial procedures and the nasoalveolar molding device. Dr. Mulliken's sensitive and caring manner with children at the Children's Hospital of Boston will serve as my model in clinical practice forever.

Currently, I am working to implement pre-surgical orthopedics for cleft lip/palate and new surgical concepts in cleft lip, microtia and congenital nevi repair.

What were you able to share with residence and plastic surgeons in the US that surprised them the most?

Dr. Tanikawa: In developing countries we do not have the same facilities and conditions to work that are available in the United States: Surgeons usually have to help nurses to prepare the operating room. Most surgeons have to bring their own surgical instruments. There is little technology available. Surgical sutures are limited, and the reconstructive plastic surgery is only done in a few academic hospitals, where salary is not good.

What did you learn as an International Scholar that you wish every ASPS member knew?

Dr. Tanikawa: As an International Scholar I have been able to learn much more than medicine from great leaders of the American Society of Plastic Surgeons. These leaders shared a meticulous attention to detail, the joy of surgery, a constant questioning of the status quo and a pursuit of perfection.

This scholarship has definitely stimulated me to pursue new concepts in search of better solutions in my country. I am very confident that a better care for the pediatric population in our Institution will be possible.

How could the International Scholars program have an even greater impact on plastic surgery?

Dr. Tanikawa: In my opinion, the International Scholar Program would have an even greater impact on plastic surgery if besides observing we could be able to do a sort of fellowship in one of the host institutions for a one-year period.

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Where are they now: PSF and Lisa Gould, MD

Research Focus: Chronic Wound Healing
Institution: James A Haley Veterans' Hospital

When did you receive your first PSF award and what was the focus of your project?

I received my first PSF award during my residency, while taking 2 years out for research in the wound healing laboratory at the Medical College of Virginia. The first year I received the small grant ($5000) and the following year I received one of the Fellowship awards. Both of these were to study fetal wound healing with an emphasis on the collagenases that fetal fibroblasts produce.

Since you received your PSF award, what significant scientific findings have you made in your continued efforts?

When I first received my PSF award, I was in a laboratory that was very interested in fetal wound healing. However, during my two years in that laboratory I shifted my focus to chronic wounds as I felt that would be the best way to combine my clinical and research interests. I have developed a model of ischemic wound healing that has been well received by the research community. Using that model, we have shown that hyperbaric oxygen reduces inflammation through multiple mechanisms in ischemic wounds.

What are you working on now?

My current research focuses on the mechanisms of impaired wound healing in the elderly. I use the model of wound ischemia to tease out signaling that results in oxidative stress. We have shown that oxidative stress is increased by age alone, but markedly increased when ischemia is added. This results in wounds that stay open for more than 21 days in the rat model. We will soon be testing modulators of oxidative stress that are specifically targeted at the age- associated deficiencies in redox reduction.

What applicability in today's world does your research have?

The number of elderly people in the world is increasing at an unprecedented rate. They are staying healthier, in general, and therefore are subject to more operations than was previously thought safe. However, they have multiple co-morbidities, including obesity, diabetes and cardiovascular disease, putting them at high risk for development of ischemic, non-healing wounds. We anticipate discovery of agents that can be used to treat and possibly even prevent the development of these devastating complications.

What would you like to see the researchers of today/tomorrow do with your work?

As this work is still in progress, it is hard for me to advise researchers to use my research at this time. However, in the near future, I hope that I can depend on my colleagues to validate the work in other animal models and help with enrolling patients as we move to clinical trials. To advance the field of wound healing we absolutely require sound clinically relevant research. Ironically, one of my PSF grants was to study Light Emitting Diode photo stimulation of wound healing. Although my laboratory was not able to demonstrate statistically significant differences in wound healing, this therapy is now being promoted to the lay public to treat pain (for LOTS of MONEY) with the suggestion that it also improves wound healing. Guess I should have stayed after it.

What advice would you give someone just embarking on his or her research career?

I think there are two things that are very important to someone just starting out. 1) The subject of your research should be something you are truly passionate about. I chose to focus on chronic wounds because it is a problem that I am faced with every day in my clinical practice and it frustrates me that we do not have scientifically valid strategies to heal these wounds. Because my research dovetails with my clinical practice, I stay on top of the field and get new ideas every day that benefit my patients. 2) It is absolutely critical that the researcher of today find excellent collaborators. It is impossible for a busy clinician to do everything. Good relationships with collaborators will rocket the junior researcher's career forward, but it must be a two-way street, i.e., the collaborator must also benefit from the relationship.

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