May 19, 2012

Addressing the Issues of Today - Assuring the Innovations of Tomorrow

The National Endowment for Plastic Surgery (NEPS) represents one of the most significant and potentially far-reaching initiatives of the specialty. Created in 1994, NEPS enables plastic surgery to be proactive in identifying opportunities and to quickly respond to the changing demands on the specialty.

As a restricted investment fund within the Plastic Surgery Foundation (PSF), contributions to the Endowment:

Support research directed toward immediate issues facing the clinical practice of plastic surgery;
Assure the place of plastic surgery as an innovative surgical specialty of the future through early investigation of new technology;
Facilitate programs directed toward defining the efficacy and safety of established plastic surgery procedures;
Greatly enhance both the quality and quantity of clinically relevant research that promotes evidence-based medicine in plastic surgery
Promote strong and vigorous collaboration among trained clinical researchers and clinical practice.

All contributions to the Endowment are added to the principal of the fund, and remain there in perpetuity. Only the income generated by prudent investing of this principal is available to fund projects. Roughly 5% of the Endowment Fund's market value is awarded each year to grant recipients.

Over the past year, through the Endowment, the PSF was able to award $300,000 to six outstanding researchers who are studying topics from across the specialty.

Ernest Chiu, MD, Tulane Health Science Center, New Orleans
Project: The Use of Adipose Stem Cells in Breast Surgery: Friend or Foe?
Dr. Chiu's research is studying the safety interaction between adipose-derived stem cells and breast cancer cells.

Kevin Chung, MD, University of Michigan Medical School
Project: Economic analysis of hand transplantation
The goal of Dr. Chung's project is to develop an economic model to understand the cost and outcomes associated with hand transplantation.

Toni Zhong, MD, University Health Network Toronto
Project: Acellular Dermal Matrix in One-Stage Breast Reconstruction: A RCT
Dr. Zhong is studying patient satisfaction and quality of life associated with the use of acellular dermis in one-stage, implant reconstruction compared to the traditional two-stage TE/I reconstruction.

Babak Mehara, MD, Memorial Sloan-Kettering Cancer Center
Project: Tissue Derived Stem Cells and Radiation Injury
Dr. Mehara is evaluating the potential of inhibiting p21, a cell cycle regulator, on preventing radiation induced stem cell injury. The research also seeks to optimize methods of stem cell delivery which has implications for fat and tissue regeneration as well as tissue engineering and wound healing.

Howie Levinson, MD, Duke University Medical Center
Project: Cell Contractility in Dupuytren's Disease
Dr. Levinson is identifying the contractile proteins that are active in Dupuytren's disease to allow for development of novel small molecule inhibitors to prevent disease progression.

Andrea Pusic, MD, Memorial Sloan-Kettering Cancer Center, New York
Project: The BODY-Q: A New Patient-Reported Outcome Measure for Body Contouring
The BODY-Q is designed to be a tool for researchers and clinicians to measure patient-reported outcomes for cosmetic body contouring and post- bariatric massive weight-loss procedures.

Through their contributions to the National Endowment for Plastic Surgery generous ASPS members are supporting these studies and others like them. Donations to the Endowment create a predictable source of funding for plastic surgery research that is providing important clinical information that directly impacts - and improves - the daily care of patients today and into the future.

Maliniac Fellows

Many individuals have demonstrated their commitment to the future of plastic surgery by joining the Maliniac Circle Fellows and designating their gift to the NEPS. Maliniac Fellows have all committed $50,000 or more in cash or securities or have provided a minimum $100,000 deferred gift through such instruments as life insurance, a bequest or trust.

For more information about how making a contribution to NEPS or how becoming a Maliniac Fellow can enable you to: support clinically relevant research, provide invaluable support for generations of gifted investigators and make an inestimable contribution to medicine contact:

Carol V. Wargo, CFRE, CAE, Chief Development Officer, phone 847-228-3358, or email cwargo@plasticsurgery.

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PSF launches new web-based searchable grant abstract database

The PSF is pleased to announce the launch of its searchable grant abstract database. The Research Abstract Search provides you with easy access to full text grant abstracts from past PSF-funded research projects 2003 to present. The abstracts are the work of the principal investigator and were retrieved from their PSF grant application. Several different filters may be applied to locate abstracts specific to a particular focus area, or PSEF funding mechanism.

Discover who's doing what - find current research activity, search by principal investigator, institution and more. View the new Research Abstract Search tool.

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Passion for the work is motivation to give back to the specialty

Dr. Debra Reilly, a national wound-healing expert, is the Nebraska Medical Center wound-care centerdirector and runs the center's burn rotation and general reconstruction program. Dr. Reilly devotes at least 60 percent of her practice to burn care, an endeavor that has tremendous rewards, she says. In turn, she has donated $100,000 to the National Endowment for Plastic Surgery through a life insurance policy as a way to give back to the specialty.

For her contribution, Dr. Reilly was inducted into the Maliniac Circle - a distinction reserved for plastic surgeons who have contributed or will contribute to the National Endowment or the PSF at least $100,000 through estate bequests or life insurance policies, or $50,000 in cash or securities.

Although Dr. Reilly financially supports other organizations, the decision behind her contribution to the National Endowment was motivated by her passion for the work. "I spent the first half of my life working to get to where I am now and to have enough disposable income that I can do this," she says.

A passion for work

"I've been unbelievably happy in my training and practice. I love what I do," she says. "The Maliniac Circle is a chance to showcase my passion for my job. I am a burn doctor and there are not many of us who treat burns primarily. It's important to show that all types of plastic surgery practices can be financially successful and rewarding."

Dr. Reilly would like to see more young plastic surgeons be made more aware of the breadth of the field.

"It's important to not be just a plastic surgeon, but one who tries to promote the specialty," she says. "To me, that means working with national organizations on committees or boards. I work with other organizations to promote aspects of surgery that are unique to plastic surgery. And within my burn field, I can promote early reconstruction."

A passion for giving

Outside of her contribution to plastic surgery through the National Endowment, one such initiative which Dr. Reilly donates her time and skill is IPRAS Women for Women. Women for Women aims to supply help by female surgeons to patients suffering from disfiguring and socially excluding sequelae of trauma that often occurs out of ethnic or social traditions or typical environmental conditions that women in other countries may be subject to.

"It's important not to be isolated as plastic surgeons," she adds. "We need to get out and educate other physicians about the uniqueness of the skill that we can offer."

On a recent trip to India, Dr. Reilly admits, "I immediately fell in love with the idea that women plastic surgeons would be operating on women patients from different parts of the world."

Dr. Reilly enjoys the ability to interact with other medical professionals throughout the world; to teach what she has learned to others hoping to improve medical care in the host country keeps her excited about each new mission trip. "It is gratifying to see parents from all countries care very deeply about an injured child, to see a head nurse manage her personnel to maintain the highest standards of medical care for their patients, to see other medical professionals giving of their time and knowledge to ease suffering wherever they are needed," she adds.

"Plastic surgery is a broad, global specialty, and I hope burns always remain a part of the requirement for plastic surgery training. But you do need to be trained to do everything."

Though Dr. Reilly has found a new appreciation for her mission work, and looks forward to future Women for Women mission trips, her first love will always be plastic surgery.

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PSF web-based application, review process offers feedback, greater efficiency

A paperless grant application and review process designed to streamline the PSF grant application method, peer review function and grant management system has exceeded expectations of Foundation leaders. The proposalCENTRAL system, which PSF deployed two years ago, allows grant applications to be completed and reviewed online. Once reviews are complete and funding decisions made, the system also allows applicants to receive solid, constructive feedback to help foster their research efforts and fine-tune their grant-writing skills.

"This process has the obvious goal of furthering the quantity and quality of research in plastic surgery, while concurrently unifying our diverse specialty behind our research agenda," says PSF President William Kuzon, MD. "Looking forward, and in order to elevate the quality of our research effort and bond us behind a common purpose - and ultimately provide the best possible care for our patients - I would fully support the participation of all our component organizations in the study section process."

All business

PSF convened more than 50 members of its Clinical Evidence-Based Research, Basic and Translational Research and Researcher Education committees, as well as members of subspecialty societies, to review 136 grant applications March 28 in Chicago. The 136 grant applications represent a 20% increase in investigator initiated research grant proposals since just last year. ASPS/PSF Board VP of Research Michael Neumeister, MD, served as PSF Study Section chair.

Opportunities for collaboration

This year, PSF reached out to all subspecialty societies to collaborate on a new grant program - the Combined Pilot Research Grant. The purpose of this program is to foster the development of surgeon scientists and innovative research in all areas of plastic surgery. Thus far, the AACPS, ASPN, ASRM and AAHS have teamed up with PSEF to each offer a Combined Pilot Research Grant that funds seed grants up to $10,000 - and focus on the relevant charge of each subspecialty.

"All of us who are actively participating in basic science and clinical research have seen a steady decline in research funding during the late 1990s and early 2000s - but a rapid increase in funding over the past three years," says ASPN President Paul Cederna, MD.

"During the recent past, the PSF's research portfolio has grown dramatically with a full complement of investigator initiated funding mechanisms. As a clinician/scientist, I am amazed at the generosity of our society to continue to support research and in fact grow the research program, in a time of economic recession, when our surgeons have felt up to a 40% decline in their clinical productivity," he adds.

"With nearly 1 million in funding, PSF is truly helping to support a wide range of basic science and clinical investigations. As part of this diverse research portfolio, the Foundation provides matching funds to specialty societies to increase the amount available for each grant. ASPN has been one of the beneficiaries of this generosity through our combined grant with PSF," says Dr. Cederna.
For more information on how to partner with PSF on a combined grant program, please contact the PSF Research Office at (847) 228-9900 or email research@plasticsurgery.org.

Unyielding Commitment to Support Research

Surgeons not actively involved in research may ask, "Why should the PSF continue to support research when there are so many other sources of research funding available to our membership?" The answer to that question is quite simple, says Dr. Cederna. "Extramural funding has become extremely competitive making it very difficult to obtain. In addition, for new academic surgeons in plastic surgery, it is virtually impossible to receive extramural funding without a substantial amount of preliminary data and support for the hypotheses proposed," he says. "There are far more great ideas that our members have than money to fund their research and there are far more outstanding clinical and basic scientists in our membership than there is funding available through the NIH, VA, or DoD. Fortunately, these ideas and grants do not have to die and wither away, but in fact can be cultivated and nurtured through seed grants by the PSEF to become fully funded ideas in the future."

Study Section future directions

We will continue streamlining our grant review and management process. We also intend to further develop our reviewers to serve on study sections for the NIH and other agencies, and cultivate a reviewer pool to include plastic surgeons as well as other experts in fields such as postdoctoral researchers and statistics.

PSF sees this as an opportunity to include all of plastic surgery; the Combined Pilot Research Grant program is the first step in realizing this goal. We hope that all of plastic surgery will embrace this enhanced means of peer review and grant administration by allowing the entire specialty to fall under one streamlined process.

For information on the PSF Study Section or proposalCENTRAL, please contact the PSF Research Office at (847) 228-9900 or email research@plasticsurgery.org.

The PSF thanks the members of the 2010 PSF Study Section for their hard work and dedication. They are:

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Where are they now: PSF and Maria Siemionow, MD

Investigator: Maria Siemionow, MD
Award: 2005 National Endowment for Plastic Surgery Grant
Project: "Stem Cell Therapy for Tolerance Induction in Composite Tissue Allografts"
Institution: Cleveland Clinic Foundation/Plastic Surgery Microsurgery Lab

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

Dr. Siemionow: I received my first PSF award in 2005 and the title/focus was "Stem Cell Therapy for Tolerance Induction in Composite Tissue Allografts". The aim of this research was to introduce new tolerance inducing therapy with application of bone marrow transplantation and selective depleting therapy using alpha-beta TCR receptor antibody. This novel approach was tested in composite tissue allograft model pertinent to reconstructive transplantation in plastic surgery.

What are you working on now?

Dr. Siemionow: I'm now working on a PSF-funded study titled "Cellular Therapy with Tolerogenic Cells in Face Transplant Model". The current study is further development of the therapy of bone marrow transplantation and includes fusion of the bone marrow derived cells between the donor and the recipient of the composite tissue allograft transplant. In this particular project, the new protocol is tested in the most difficult, from an immunologic standpoint, model of face transplantation in the rat. The ability to extend face allograft survival with use of chimeric cells representing both the donor and the recipient is encouraging, and further studies will follow with refinement of this protocol.

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

Dr. Siemionow: Since receiving my PSF award, I have moved application of alpha-beta T-cell receptor monoclonal antibody as an induction therapy in transplantation, from experimental research to development in clinical trials. Currently, we have produced clinical quality alpha beta TCR receptor antibody which will be applied soon in clinical trials of kidney transplants. The next step will be to combine this new antibody with bone marrow transplantation, which we envision will have a direct application in composite tissue allograft transplantation such as hand and face transplant.

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

Dr. Siemionow: My research has direct clinical applicability in transplantation in humans. My research on new protocols in transplantation should facilitate more routine application of composite tissue allografts into the armamentarium of plastic and reconstructive surgery. Specifically, introduction of the new selective and safer antibody may, in the near future, revolutionize the field of composite tissue transplantation.

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

Dr. Siemionow: I would like to see researchers further refine cellular therapeutics as supportive protocols during composite tissue allograft transplantation. Once supportive cellular therapeutic protocols are developed, the next step will be to define them to the specific procedures and develop a bank of cells which will be applicable to specific donor-recipient combinations. At the same time, I would envision the development of new tissue engineering procedures and models which, in combination with cellular therapies, may replace the current standard in transplantation.

What advice would you give someone just embarking on their research career?

Dr. Siemionow: Someone just starting a research career should understand that it takes many years of trials and errors before a clinically relevant idea can be applied to clinical practice; however, if the idea is right, there will always be a way of adjusting it to the current standards in plastic and reconstructive surgery, with the understanding that clinical research and experimental research takes years before the final results can be achieved. There is an exciting field in which many young plastic surgeons can contribute. My final advice for all young scientists is to be patient.

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Did you enjoy this issue of foundation? We would like to hear about it! Please direct your comments and inquiries to us at research@plasticsurgery.org. 

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