Grants Funded

Abstract
The current global war on terrorism has revived the topic of gunshot wounds, blast-induced injuries, and motor vehicle accidents in military personnel. Mutilating trauma to the hand and upper extremity is a common consequence. A field survey in Iraq found that over a 23-day period, upper extremity injuries consisted of 57% of injuries suffered by local civilians and 32% of injuries suffered by U.S. soldiers. Injuries to the upper extremity often include all tissue components: skin, subcutaneous tissue, tendons, ligaments, and bone. Specifically, injury to tendons often results in grave disability-transmission of muscle forces across the joints of the wrist and fingers is damaged, obliterating both fine and gross motor function. With increasing prevalence, tendon injures are seen in the military population. These injuries involve tears at the tendon/ligament-bone interface (TBI). Often, reconstruction by tendon-tendon opposition is not feasible secondary to poor tissue quality. For this reason, tendon/ligament-bone approximation is quintessential. Unfortunately, tendon/ligament-bone healing persists as an area of academic challenge. An ideal modular and off-the-shelf solution for these complex tissue injuries has yet to be discovered. As such, we propose the development of biocompatible tendon/ligament-bone constructs to reconstruct composite musculoskeletal defects. In this manner, military surgeons would be able to synchronically debride injured tissue and harvest cell-rich biopsies. At time of debridement, the patient's own cells could be obtained biopsies from the tendon, bone, skin, and fat. Decellularized tissue engineered allografts could then be seeded with the patient's own cells. Large amounts of biocompatible, composite graft material, including the TBI, would then be available for second stage reconstruction, thereby transforming treatment strategies in extremity reconstruction.

Biography
Dr. Grace Chiou obtained her undergraduate degree in Biomedical Engineering from the Johns Hopkins University, where she also investigated the pathophysiologic causes of heart failure. After graduating from her undergraduate studies, she spent some time in Mozambique, mentoring street children residing in an orphanage, as well as establishing the first medical clinic in a rural part of the country. Upon returning from Mozambique, she focused her work on clinical outcome studies in the field of trauma surgery. She then went on to attend Harvard Medical School, in addition to continuing her work in surgical outcomes research. Dr. Chiou then decided to pursue residency training in General Surgery at Stanford Hospital and Clinics, where she is currently located. Her research interests lie in the areas of composite tissue engineering, in addition to clinical outcomes studies. Her ultimate goal is to have an academic career in Pediatric Plastic Surgery.