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The PSF President's Page: July 2018

ASPS and The PSF accomplished several important milestones recently, including the second annual Advocacy Summit in Washington, D.C., last month. More than 70 physicians from 25 states attended the event – including 24 first time attendees. Attendees partook in 83 meetings with senate and house staff from ASPS members' home states, where we highlighted five top priority issues of relevance to our daily practices as plastic surgeons. Of the 75 physicians in attendance, 35 were plastic surgeons early in their careers or in training, including five recent graduates of the Essentials of Leadership program, 11 members of the Young Plastic Surgeons committee, 13 residents and one medical student. This kind of engagement in advocacy early in one's career will help to shape our future leaders, and ensure the continued integrity of our profession. All of us at the Society and Foundation thank those of you who attended the summit for actively advocating for the future of our specialty. You can learn more about the full program of the summit here.

Breast reconstruction awareness efforts also are worth noting, including a recent award of $180,000 for awareness outreach, charitable care and research. In addition, a community-based network to support breast reconstruction has been developed in Chicago, where the community helped to raise funds specific to their needs. There will be a Close the Loop 5K run/walk during Plastic Surgery The Meeting 2018, with all proceeds going towards the Chicago breast reconstruction fund (register here). The Breast Reconstruction Awareness Committee is also forming a Chicago-based subcommittee to help promote and distribute proceeds from this local fund throughout Chicagoland. We invite all of you to participate in this event, and to consider developing local fundraising efforts in your respective communities to further develop the Breast Reconstruction Awareness Committee's efforts toward community-based outreach.

Speaking of community outreach, July is Cleft-Craniofacial Awareness Month, so this is a perfect time to highlight the importance of cleft-craniofacial teams throughout your respective communities. The PSF is focused on improving access and delivery of pediatric care, and we have initiated a new task force to develop strategies as to how best to impact pediatric care in the United States.

We would also like to recognize progress in three PSF Committees: GRAFT, chaired by Babak Mehrara, MD, and J. Peter Rubin, MD; the Clinical Trials Network, chaired by Clara Lee, MD; and FRANCHISE Study, which has Kevin Chung, MD, as principal investigator.


Arun Gosain, MD

GRAFT Steering Committee Update

The General Registry of Autologous Fat Transfer (GRAFT) is a quality-improvement initiative of The PSF and was established to collect data on fat-grafting performed for aesthetic and reconstructive indications. GRAFT collects procedure and outcomes data on fat grafting performed to all areas of the body. In addition, GRAFT has a more detailed Breast Module, that captures more extensive procedure information and patient outcomes in fat grafting to breast only. The GRAFT Steering Committee has identified three major initiatives for this year:

  • Open GRAFT All Procedures Module for international data collection
  • Make enhancements to GRAFT database
  • Increase member engagement in GRAFT

The GRAFT All Procedures module opened for international data collection this month, starting with Brazil and Canada. This launch will help us expand GRAFT to more than 600 potential new users, as well as increase the utilization of the registry and determine fat-grafting trends around the globe. Several enhancements have also been made this year to the GRAFT All Procedures module, including the addition of benchmarking reports for physicians and the addition of new fields to capture complications for fat grafting to face and buttocks. Changes to add new fields to capture technique information on fat grafting to the buttocks are also underway. A total of 477 sites have registered to participate in GRAFT. The more detailed GRAFT Breast Module is also continuing to grow with nine core sites participating, 467 Baseline and 572 Follow-Up visits entered (78 percent reconstructive, 18 percent aesthetic, 4 percent other). You can learn more about GRAFT and register here.

-Babak Mehrara, MD, Chair

Clinical Trials Network Subcommittee Update

The Clinical Trials Network Subcommittee enables ASPS members to engage in large, multi-site clinical research studies on the highest-priority issues facing plastic surgeons. It does this by connecting individual plastic surgeon investigators to each other, identifying the highest-priority research topics and partnering with The PSF staff to conduct research. This year, the committee is developing a multi-site, randomized controlled trial to evaluate the effectiveness of antibiotics for prophylaxis of surgical site infection after prosthetic breast reconstruction. Christine Rohde, MD, and Brian Gastman, MD, are leading this effort. The committee is also exploring ways to improve the value of breast reconstruction, with The PSF serving as a key stakeholder on an AHRQ grant proposal by Clara Lee, MD, and Terry Myckatyn, MD.

In addition, the committee is examining the development of a breast reconstruction quality collaborative, under the leadership of Evan Matros, MD, and Anaeze Offodile, MD. There are also three ongoing research initiatives in which the committee is involved: The GRAFT Registry Breast Module has nine core sites collecting new and follow-up data on breast fat grafting cases; the FACE-Q Study completed its pilot phase last year and is conducting data analyses; and the 19 sites participating in FRANCHISE continue to collect data on patients undergoing finger amputation or replantation.

-Clara Lee, MD, Chair

FRANCHISE Study Update

Finger Replantation And amputation Challenges in assessing Impairment, Satisfaction and Effectiveness (FRANCHISE) is a retrospective, multicenter study that was developed as a collaboration of 19 participating sites (10 in the United States and nine internationally). This study aims to compare outcomes in digit-amputation patients treated with finger amputation vs. finger replantation to determine factors influencing the decision to amputate or reconstruct following finger trauma.

Traumatic digit amputations have a substantial effect on individuals, with 45,000 injuries occurring each year in the Unites States and many more worldwide. Replantation and revision amputation treatments differ in their outcomes. There is a paucity of evidence for appropriate management of these injuries owing to few comparative studies and low replantation rates in the United States, as compared to Asian countries. To date, FRANCHISE has recruited 331 participants (156 in revision amputation cohort and 175 in replantation cohort). Participants were enrolled 1-5 years after treatment and were assessed with patient-reported outcomes (MHQ, DASH, SF-36, and PROMIS upper extremity module), as well as for functional outcomes. Data extraction and data analysis are nearly complete. Manuscript is under preparation and we intend to submit our first paper to JAMA very soon. This study data was also included in The Finger Replantation and Amputation Multicenter Study grant that is being submitted to NIH this July.

-Kevin Chung, MD, Principal Investigator