Reconstructive Plastic Surgery - San Francisco

Preventing Total Knee Arthroplasty Infection with Microsurgery -- The Prophylactic Free Flap

2011-06-22T07:10:00.000-07:00

Total knee arthroplasty (TKA, knee replacement surgery) is a common procedure to treat knee pain and arthritis. Over 120,000 knee replacement surgeries are performed per year in the United States.

The surgery involves making a midline incision over the knee joint and allowing the orthopedic surgeon access to the joint area to place an implant that acts like a joint. Once the joint is in, the skin is closed over and allowed to heal. Often, the knee is started on a range of motion protocol to prevent stiffness.

On rare occasions, the knee skin may not be viable, sturdy, or durable to allow the surgeon to perform the knee replacement surgery because the closure of the soft tissue may be difficult (history of trauma with scar, thin skin, skin grafts, psorasis, etc) . If the skin can be properly closed over the implant, this is a serious situation for the viability of the implant and the leg. An exposed implant is an infection and can lead to serious complications.

At our center, we have worked with several of our orthopedic surgeons who have had the foresight to seek plastic surgery consultation to avoid a "skin" or soft tissue problem prior to the TKA. This allows for us to create a coordinated effort to first place durable, strong skin tissue/flap over the knee area prior to the TKA. Typically, a skin flap from the thigh or back can be transplanted over the knee area as a microsurgical free tissue transfer. After 3-6 months when the flap is well healed and ready for elevation, the orthopedic surgeon can then place the TKA under the flap tissue and can easily close over the implant with the additional durable skin cover.

This sequence of events is a shift away from current treatment strategies that may lead to a higher rate of failure and infection. Often times, the skin/soft tissue issue is not addressed early, and the plastic surgeon is called in on an "emergency" basis to help close over the implant. This is not an ideal situation as this prolongs the operation, may not allow for proper setup or anatomic exposure of the tissues, etc.

To learn more about the the "prophylactic free flap over the total knee", please feel free to contact us. Lplasticsurgery@gmail.com

Most Efficient Procedure Available to Treat Varicose Veins?

2011-06-06T10:18:00.001-07:00

A: Efficient treatments include endovenous ablation with laser and radiofrequency, and correct diagnosis

Varicose veins are almost never formed in isolation; there is most often, a deeper, larger, vein that is "incompetent" that connects to the superficial, visible varicose vein. This incompetent vein is usually the greater or lesser saphenous vein with valves that are not functioning normally. These root cause veins typically give rise to the varicose veins seen on the surface, and thus, to treat the varicose most effectively, the incompetent saphenous vein needs to be diagnosed first with a duplex ultrasound. Once identified, the vein can be treated with laser or radiofrequency (EVLT or VNUS), and the microphlebectomies performed at the same time to remove the varicose veins. This can most often be performed under local anesthesia under 1 hr with the patient able to walk right away.
These treatments are highly efficient and effective and far less problematic than the old "vein stripping" techniques of the past.

Negative Pressure Wound Therapy (NPWT) -- Leadership for a Global Consensus

2010-03-28T20:33:00.000-07:00

St. Mary’s Surgeon Represents United States on Expert Panel for Wound Care

News Release:   SAN FRANCISCO, Calif. Feb. 5, 2009 – Dr. Charles K. Lee, Director of the San Francisco Wound Care and Reconstructive Surgery Center, located at St. Mary’s Medical Center, will represent the United States at an international conference on Negative Pressure Wound Therapy (NWPT). NPWT has revolutionized the world of wound management and reconstructive surgery for the past ten years and has been applied on millions of patients worldwide to successfully treat wounds of all types. “Serving on this panel is a great honor and responsibility. Our challenge is to bring a together a global consensus on the benefits and limitations of NPWT and to further set guidelines on its use in every type of clinical scenario, ranging from medianstinitis to pressure ulcers.” said Dr. Charles K. Lee, Medical Director of Microsurgery and of the San Francisco Wound Care and Reconstructive Surgery Center. The NWPT expert panel consists of 22 leading, independent physicians from many clinical specialties that use NWPT for patient treatment. The panel will convene in Hamburg, Germany and panelists will attend workshops on wounds. At the end of the workshop, the panel will vote on treatments to identify best practices for wound care. The panel recommendations will be posted on the panel website, http://www.npwtexperts.com/ on February 8, 2010.

     Dr. Lee is an expert plastic and reconstructive surgeon, treating patients who suffer from chronic and acute wounds. He and his staff use a collaborative, multi-specialty approach to their wound care treatment and the center uses the latest most advanced wound dressing and surgical techniques to fully heal any type of wound. Dr. Lee has been using NWPT for the past 12 years to treat more than a thousand patients successfully.   “NPWT can be the primary treatment in some cases of wounds, but it is mainly an adjunct in my practice.   The most important thing to know about NPWT is when to recognize when NPWT is not working and needs an expert evaluation to make a new determination about further options in treatment. A wound should be seriously assessed every two weeks to determine if NPWT is working, has stopped, or needs a higher level of reconstructive treatment,” says Dr. Lee.
     NPWT is a wound healing technique used to treat both acute and chronic wounds. A vacuum source is used to create sub-atmospheric pressure in conjunction with wound filler (foam or gauze) in the local wound environment to remove fluid and enhance wound healing. It is a simple, but ingenious way to advance wound healing while also improving patient comfort and outcomes.

ABOUT THE SAN FRANCISCO WOUND CARE AND RECONSTRUCTIVE SURGERY CENTER

The San Francisco Wound Care and Reconstructive Surgery Center is dedicated to one goal – providing patients top-notch treatment of all wounds, including: diabetic and venous ulcers, chronic wounds, lymphedema, acute trauma and osteomyelitis. The well-trained multidisciplinary staff includes three reconstructive plastic surgeons who are experts in wound care and reconstructive surgery as well as general and vascular surgeons, endocrinologists, infectious disease specialists, a podiatrist and a wound care nurse practitioner. The comprehensive set-up of the clinic offers patients continuity of care all in one location.

What is the difference between a graft or a flap?

2010-02-15T02:01:00.000-08:00

There appears to be a lot of confusion between these two terms as I have often heard my medical and nursing colleagues use these words interchangeably. In many respects, they are related, however, they are completely different in their intrinsic properties and surgical technique.

A graft or a flap can be made up of the exact same tissue type-- that is, it can be skin, fat, tendon, bone, nerve, etc. The key difference is that a flap has its own blood supply, and that a graft does not, and therefore requires a good vascular bed for it to survive. We have often heard of the terms skin graft, or bone graft. These tissues are harvested from their specific locations which can afford to give up a part of their architecture. The place that the area has "donated" its tissue is called the donor site. Once the donor site has been harvested, the skin or the bone can be placed in the new area for the body to accept this tissue and eventually grow into it with new blood vessels and adjacent cells. This is why the bed, the accepting area for the graft, is so important to be prepared well. The graft can only survive well when it can be nourished by a good blood supply.

A flap has the additional advantage that it has its own intrinsic blood supply, allowing it to be transferred or transplanted to another area of the body with much less reliance upon the surrounding tissue bed. This does not mean that the surrounding bed should not be well prepared, ie debrided. It simply means that the accepting area will unlikely lead to graft survival and that designing tissue with its own blood supply is the only way for that tissue type to actually survive in the area. Because a flap has its own blood supply, the surgical technique to harvest and to move this tissue is much more complex. The surgeon has to dissect not only the block of tissue to be moved, but also the blood vessels (artery,vein) that feed the tissue block. This makes the flap an extremely powerful tool in reconstructive surgery. It is also a tool that requires significantly more surgical technique, planning, and time to make it successful.

It is understandable why there might be confusion between these two concepts because of their relationship to each other. However, the complexity and time factor between these two concepts is so significantly different that we should not pass over this as simple semantics.

Dr. Lee in the News (Saving a Firefighter's Leg--SFWeekly)

2009-12-11T08:21:00.000-08:00

For the full story, please see link:

http://www.sfweekly.com/2009-11-04/news/under-fire/

Exerpt from SFWeekly, "Under Fire," AnnaMcCarthy.

....Charles Lee, whom Estrada was visiting that day, was not one of those doctors. Lee, the director of microsurgery at St. Mary's, is a body reconstruction expert. He and his team received media attention in January 2008 when they successfully harvested a man's big toe to replace a thumb he had lost in a woodworking accident.

All expertise aside, Lee admits there were times he thought they would have to amputate Estrada's leg: "It was a pretty big wound," he said. "This is about as big as it gets." Because Estrada had lost so much muscle, the injury required a similar kind of tissue transplant as the toe-to-thumb surgery. When he first arrived at San Francisco General, his bones were sticking out of his uniform pants. Lee says he transplanted muscle from Estrada's abdomen to replace what he had lost on his leg; Estrada sports a long, dark centipede scar running down his belly to prove it.

Thanks to Lee and his crew, Estrada may have the opportunity to get back to work as a firefighter, which he says he wants to do — no matter how hard it is for him to watch the YouTube video of the fire, captured on a cellphone by a passerby. The video shows the entire incident from the moment Estrada approaches the warehouse with the hose to the moment he's loaded into the ambulance.....

Frostbite after Postoperative Cryotherapy-- Wound Management & Limb Salvage

2009-05-31T16:39:00.000-07:00

Picture #1: Skin Necrosis after Frostbite from Cryotherapy
Picture #2: After Debridement of Soft Tissues, use of Negative Pressure Dressing
Picture #3: Bilateral Free Flap (Rectus Muscles + Skin Graft) on both Knee Wounds
Picture #4: Bilateral Limb Salvage, Patient is Weight Bearing and Walking

Severe Frostbite of the Knees after Cryotherapy (Excerpts from original article by Lee CK, Pardun J, et al, Orthopedics 30(1):63-4, 2007 Jan)

"Abstract:

We present a case report of a patient who sustained full thickness soft tissue injuries over the bilateral knees after patellar tendon repairs and postoperative cryotherapy. The injury was severe enough to require bilateral microvascular free tissue transplants to cover both knee surfaces. Complications from cryotherapy have been reported in the literature, but are not common; this represents an extreme example. We review the literature and discuss treatment and prevention protocols.

Cryotherapy has been used to treat pain and inflammation since the
time of Hippocrates.1 Ice, snow,cold water, and cold compresses have been used to treat a multitude of soft-tissue traumas.2 More recently, cryotherapy
has been used increasingly in sports injuries and in the postoperative orthopedic setting.3 However, there have been a number of reports of complications from cryotherapy– most commonly frostbite and peripheral nerve injury–that point out itsbenefi ts but also its dangers.1-5 These previously reported complications has been diverse in location and severity. This article reports a significant complication of cryotherapy as a result of a relatively common regimen of application of ice packs to knees in a postoperative setting...

This case represents a severe frostbite injury after cryotherapy. With proper instruction and use of the cooling device, these complications are mainly avoidable. The patient had minimal padding between the cooling wrap and skin. In addition the patient used the device continuously for two weeks. It was likely that thermal injury occurred the moment the dressing was applied until the patient first took off the dressing two weeks later.

Frostbite occurs by the formation of ice crystals in the intracellular and extracellular space. During the cooling process, the extracellular ice crystals form and osmotic pressure increases, drawing water out of the cells. This leads to intracellular dehydration with an increase in intracellular electrolytes, proteins and enzymes which lead to cell death. Additionally, there is vascular endothelial damage leading to intravascular thrombosis and reduced blood flow. AV shunting occurs at the capillary level and end organ tissue damage is compounded. During the warming process, there is an influx of fluid back into the cells causing intracellular swelling. The warming process also allows reflow, vasodilation and reactive hyperemia to occur leading to increased inflammatory mediators, causing further cell death.

Cryotherapy works by three main processes. First is the reduction in the inflammatory process by inducing a hypometabolic state. Decreasing inflammation decreases the amount of cellular damage by inflammatory mediators, ultimately reducing the amount of capillary permeability and thereby decreasing edema. Second is the decrease in hematoma formation which is produced from vaso-capillary constriction and decreased blood flow. Finally is the induction of analgesia by cold. This is thought to be due to decreased nerve conduction velocity and decreased muscle spasm. In combination, cryotherapy is an ideal postoperative therapy which decreases pain, inflammation, hematoma, and the amount of postoperative narcotic usage...

Current recommendations for cryotherapy include 20-30 minutes of cryotherapy with a maximum time of 40 minutes, always with a protective covering (usually a towel) between the cryotherapy wrap and the skin. The cycle can be repeated every 2 hours while the patient is awake....

Although the incidence of complications from cryotherapy appear rare, estimated at 0.00225%,5 it is likely that this number is an underestimation as there are many unreported cases in conjunction with the increased use of continuous cryotherapy in the postoperative setting. We see this as an opportunity to emphasize the importance of education between the patient and doctor about this device and point out its potentially devastating risks.

Outpatient Wound Care Center in San Francisco 2009

2009-05-29T09:54:00.000-07:00

San Francisco Wound Care & Reconstructive Surgery Center

We are proud to annouce the opening of an outpatient wound care center in San Francisco on June 1, 2009. It will consist of a multidisciplinary team of reconstructive plastic surgeons, orthopedic surgeons, general and vascular surgeons, podiatrists, endocrinologists and internal medicine, and dedicated wound nurse practitioners. Our team is composed of surgeons and physicians from the University of California, San Francisco (UCSF) as well as the community at St. Mary's Medical Center.

We will focus on all wound types, both acute and chronic, and of any complexity. These wounds can be from traumatic, vascular, infectious, metabolic, and cancer and radiation. We will have every tool and cutting edge option available to heal the simple to most difficult wounds.

Our office is at 450 Stanyan (Main Building of St.Mary's), 2nd Floor at the PROS Center. Telephone number is 415 750 5588. Email: sfwounds@gmail.com Please ask to speak to Josie Gomez, our wound nurse practioner.

Achilles Tendon Rupture, Wound, and Microvascular Tendon Reconstruction

2009-04-01T06:32:00.000-07:00

Picture #1: Achilles Tendon Infection & Wound, 1 month after Rupture and Repair
Picture #2: Gracillis Muscle Free Flap as Vascularized Musculotendinous Reconstruction of Achilles Tendon Loss after Infection
Picture #3: Full Range of Motion of Ankle with Functional and Intact Achilles Tendon
Picture #4: Full Range of Motion of Ankle with Functional and Intact Achilles Tendon

The Achilles tendon is the largest tendon in the human body and a critical component in the function of the ankle joint to allow "push off" movement in walking and running. It is commonly ruptured during sports activities that require treatment by the orthopedic surgeon to repair the tendon. Usually the patient goes on to do well from this.

In some rare circumstances, the repaired tendon can become infected which can threaten the viability of the tendon. By the time we see the patient, the wound is quite large and severely infected. The patient is concerned about playing sports again.

Depending on the severity of the infection, multiple options are available to save this situation. Most importantly the wound needs to be explored and cleaned. Afterward the anatomy of the wound is further delineated. If the tendon loss is small, the wound up may be closed with local tissues and future tendon graft. If the tendon loss is moderate to large, a more complex reconstruction can be performed with both tendon and skin. This usually requires microsurgical expertise where tissue is transplanted to reconstruct the lost tissue.

We have used both the Gracillis muscle+tendon and the ALT (Antero Lateral Thigh) flap to reconstruct this complex defect with a high degree of success using microsurgical techniques. This requires an orthopedic and plastic surgery approach to combine their expertise to maximize functional recovery of the leg. Patients with Achilles' tendon ruptures are usually young and healthy men. Everything should be done, and all the options discussed to bring the injured leg back to as near normal function as possible.

Cutting Edge Treatment for Varicose Veins & Spider Veins

2009-04-01T06:19:00.000-07:00

Painful, swollen legs with bulging "varicose" veins can be treated by several methods. In the past, vein ligation and vein stripping have been the standard. However, Vein Ligation has a high recurrence rate and Vein Stripping is an extremely painful procedure, often requiring an inpatient hospital stay, bed confinement for days, and long recovery.

Varicose veins can cause a variety of symptoms: Leg swelling, aching and pain, tiredness, skin changes, and even skin ulceration (venous stasis ulcers). These issues can lead to severe problems in the quality of life and activities of daily living, and in worst cases, severe infections which may threaten the viability or function of the leg.

Nonsurgical, EndoVenous Laser Treatment (EVLT) of Symptomatic Varicose Veins has become the treatment of choice with high success rates (> 95%), can be performed as an in-office procedure under local anesthesia, and patients walk out of the office immediately afterward. It is an extremely gratifying procedure.

As a Plastic Surgeon with expertise in Microvascular Surgery, Dr. Lee offers the highest level of technical precision to this safe, effective, treatment of Varicose Veins. Most often, these treatments are covered by Insurance.

www.sfveinlaser.com

What is an ALT flap?

2009-02-24T13:24:00.000-08:00

The ALT flap is a very common, workhorse, flap used for various soft tissue reconstructionl. ALT stands for AnteroLateral Thigh flap. It is a skin flap that is harvested from the lateral thigh with the main blood vessels coming from the Deep Femoral Artery with a branch called the Lateral Circumflex Vessels.

Treatment of Chronic Wounds & Wound Care

2009-02-24T10:29:00.000-08:00

There are many thousands of patients in the community with chronic wounds. The definition of a chronic wound is one that has not healed by six weeks time. As most of us know, wounds of all types eventually do close within a span of six weeks. This can range from small cuts and abrasions to larger open wounds of the legs or the abdomen from trauma or surgery. There are many patients in the community who have been undergoing local wound care for many months to years with minimal to no results. These wounds can degenerate into deeper infection such as osteomyelitis-- deep bone infection, and future loss of the limb.

Local wound care is very important to healing a wound. There have been many technological advances in newer dressings that have made wound care safer and more effective for the patient and health care provider. When a wound and has stopped healing in the six-week timespan, it is important to stop and reassess the wound. More than likely there are other causative factors that are preventing the wound from healing. This is when it is time to seek consultation from wound care experts.

As reconstructive plastic surgeons, we are the premier wound care experts. We have the ability to not only asses the wound, but have every option available to us to treat the wound. We are surgeons who deal with three dimensional anatomy. What this means is that we can assess the wound from a top-down and bottom-up approach that accounts for every part of the wound anatomy. Not all health professionals in wound care can have this approach as they cannot take the patient to the operating room to fully explore the wound and it cleanse the wound via débridement. The the ability to explore and debride a wound is the most critical factor in healing a chronic wound.

The options available to plastic surgeons include local wound care, negative-pressure (VAC, EZCare Negative Pressure, etc), to high-tech dressings such as Actcoat, Apligraf, Dermagraft, Integra, etc. After this we have the ability to place skin grafts that are split-thickness or full-thickness. We also have the ability to perform a local flaps which allow us to move tissue into the local area to close the wound. Finally, a plastic surgeon has the ultimate tool in reconstructive surgery--Microsurgery. We are able to transplant live tissue from another part of the body to the wound that requires this new tissue. We are able to reconnect the blood vessels to the transplanted tissues to close wounds that were never thought possible. Specifically, wounds that have been radiated or are chronically infected for many years have very few options for treatment. With microsurgical free tissue transfer, we have all of the options available in the reconstructive ladder to heal any wound, of any type, and size.

I encourage those who have been living with difficult wounds in their life to seek consultation with us to see if there are better options than the status quo of a nonhealing chronic wound.

Treatment of Osteomyelitis in the Extremity

2009-02-24T01:21:00.000-08:00

Osteomyelitis is a severe and devastating bone infection. This can occur from simple wounds (venous stasis ulcers) to severe trauma of the extremity from open fractures.

In our practice, we find that many patients have not been adequately treated for osteomyelitis. In our view, osteomyelitis is a surgical disease. This means that IV antibiotics and other lesser therapies (such as hyperbaric oxygen) have only a minor role in the true treatment of this disease. The only sure way to eradicate osteomyelitis is to debride all necrotic and infected tissue, including the bone. The reason why this is not always done is because of the concern for removing bone , and soft tissue, which is not always replaceable.

At the PROS Center, we worked hand in hand with our orthopedic colleagues to have an OrthoPlastic approach to osteomyelitis. This means that we have our orthopedic surgeons, as the bone specialists, to remove all of infected bone. As plastic surgeons, we then have the expertise to provide all of the options for stable soft tissue coverage. Once the soft tissue envelope is stabilized, the orthopedic surgeons may return to perform other ancillary procedures to replace or stabilize the bone.

There are a few centers in the country, where there can be one-stop shopping to treat these extremely complex disorders such as osteomyelitis.

Face Transplantation

2008-12-17T18:54:00.000-08:00

My friends and colleagues, Drs. Risal Djohan and Robert Lohman, were lead surgeons who helped perform this monumental operation today at the Cleveland Clinic. They are to be congratulated for putting together a great team of surgeons and taking this huge step in "Composite Tissue Allotransplantation." How is this different from "solid organ" transplantation? Not very different at all.

Most people do not know the history of Transplantation and that Plastic Surgeons have been at the forefront of this area since the beginning. These concepts have grown from skin grafts, to organs, and now to "composite tissue"--face, hands, limbs, etc. This is the new era of reconstructive plastic surgery: with Microsurgery--reconnecting small blood vessels and nerves--all of this is possible.

The question for a long time has been "Can we peform a facial or hand transplantation?" The answer for the past 20 years has been, "yes." We can and have been able to technically "replant" an amputed hand and facial part, the question now has become, "Should we do this?" The simple answer of course is "yes." There are many patients who would benefit from these types of procedures. However, the issues with long-term immunosuppression that can potentially cause many disease processes is still the critical issue in performing these kinds of operations. The holy Grail is still at large. When the immunosuppression issue falls to the background, this is when composite tissue allotransplantation will no longer make headlines, but become a routine surgery, just as plastic surgeons performing reconstructive microsurgery to reconstruct limbs and cancer defects, is done on a daily basis.

Reconstructive Surgery Team

2008-12-14T11:05:00.000-08:00

Members of our Team in Reconstructive Plastic Surgery

We offer over 20years of combined experience in Microsurgical Free Tissue Transfer, Complex Wound and Extremity Reconstruction, Breast Reconstruction, Head & Neck Reconstruction, and Limb Salvage:

The Team approach offers patients the highest standard of care for patient safety, high success, shortened operating times, and superb results.

Dr. David Chang
http://plastic.surgery.ucsf.edu/faculty/david-chang-md.aspx

Dr. Scott L. Hansen
http://plastic.surgery.ucsf.edu/faculty/scott-hansen-md.aspx

Dr. Charles K. Lee
http://www.lplasticsurgery.com/about.html

Dr. David M. Young
http://plastic.surgery.ucsf.edu/faculty/david-m-young-md.aspx

Management of Acute Wounds, Chapter in Clinics in Plastic Surgery, C.Lee, S. Hansen

2008-12-06T20:55:00.000-08:00

This is an article written about the state of art mangement of Wounds. In the US, there are a whole spectrum of wounds from the feet (diabetic foot wounds), age and body impairment (pressure sores/ulcers), burns, cancer (radiation, surgery, breast cancer, skin cancer), infection, and trauma (large bone injuries, hand and facial injuries, etc). As plastic surgeons, we see these types of wounds on a daily basis. Many of these wounds have become complex, chronic wounds where patients have undergone local wound care/dressing changes for many months to years without progress. Most often, patients are frustrated and have been told they will lose their limb or that there are few options available. Plastic surgeons can offer the entire spectrum of wound healing techniques to close the most difficult, complex wounds and to give patients another chance at an improved quality of life.

Management of Acute Wounds .

Clinics in Plastic Surgery , Volume 34 , Issue 4 , Pages 685 - 696
C . Lee , S . Hansen

Article via ScienceDirect

Abstract

The acute wound presents a spectrum of issues that prevent its ultimate closure. These issues include host factors, etiology, anatomic location, timing, and surgical techniques to achieve successful wound closure. Basic surgical principles need to be followed to obtain stable, long-term coverage, ultimately restoring form and function. Recent advances in dressings, debridement techniques, and surgical repertoire allow the modern plastic surgeon to address any wound of any complexity. This article discusses these principles that can be applied to any wound.

Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder

Great Toe To Thumb Microvascular Transplantation-Abstract, Charles K. Lee

2008-12-06T20:54:00.000-08:00

Elsevier Article Locator

Great Toe-to-Thumb Microvascular Transplantation .
Clinics in Plastic Surgery , Volume 34 , Issue 2 , Pages 223 - 231
C . Lee , G . Buncke

Article via ScienceDirect

Article via Elsevier Health Sciences - Elsevier imprints, theclinics.com, and ophsource.org
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Abstract
Great toe to thumb transplantation offers the ideal reconstruction because it replaces the absent thumb with nearly identical anatomy. Functional donor site morbidity is minimal as compared with the aesthetic one; however, in comparison to the hand, the functional and aesthetic gain is tremendous. Anatomic and operative details are discussed along with preoperative and postoperative management. Postoperative functional evaluation of the thumb and donor site is assessed. Forty years of experience with this composite tissue transplantation has proven its status as the gold standard for thumb reconstruction.

Copyright © 2003 Elsevier Inc. All rights reserved. Feedback About Article Finder Help

Use of New Technology to Determine Blood Flow to Tissues

2008-12-06T20:38:00.000-08:00

Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures...
Wed Jun 11, 2008 12:23pm EDT

Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures with Novadaq SPY(R) System

First Intra-Operative Fluorescent Imaging System to Be Used in
Cardiothoracic and Plastic Surgeries

SAN FRANCISCO--(Business Wire)--

St. Mary's Medical Center (SMMC) is one of the first hospitals on the West Coast to routinely use the SPY(R) Intra-operative Imaging System (SPY or SPY System) in cardiothoracic procedures and plastic reconstructive surgeries. The SPY System is the only FDA-approved, intra-operative imaging system that provides real-time fluorescent images while the patient is in the operating room. SPY images enable surgeons to optimize surgeries, eliminate guesswork and potentially avoid post-operative complications including repeat surgical operations.

The SPY System enables cardiac surgeons at St. Mary's to simply and efficiently confirm proper placement of bypass grafts and visually assess their effectiveness during coronary artery bypass graft procedures. Similarly, physicians at SMMC's Plastic Reconstructive Orthopedic Surgery Center performing reconstructive procedures use the SPY System to see the blood flow in co-joined vessels, micro-vasculature and related tissue perfusion in real-time. "We're committed to adopting technology that allows us to provide the highest quality of cardiac care possible to our patients at St. Mary's," said Dr. Eddie Tang, cardiac surgeon at SMMC. "The SPY System enables us to immediately visually assess the blood flow in our bypass grafts, confirm that we have performed the best possible bypass procedure, and potentially improve immediate and long-term outcomes for the patient."

The SPY System combines the use of an infrared laser, high-speed imaging and a fluorescent imaging agent. The imaging agent, which is administered to patients intravenously during the procedure, emits light when stimulated by the infrared laser. During surgery, the
imaging agent lights up in blood flowing through the circulatory system while the camera captures the live images. If the images indicate that a graft might not be functioning optimally, the surgeon can immediately make revisions in the operating room. Traditionally, surgeons have been forced to make an educated guess about whether bypass grafts, co-joined arteries or veins are functioning properly. Cardiac surgeons have only been able to get images of the heart and vessels after the patient's chest is closed and the patient has been removed from the operating room. Likewise, surgeons performing plastic reconstructive procedures have not been able to easily perform real-time imaging in the operating room. Use of the SPY System may reduce the number of patients that must return to the operating room for the revision of improperly functioning or potentially misplaced grafts.

According to Dr. Charles Lee, director of microsurgery at St.
Mary's Medical Center, "The SPY technology allows plastic surgeons to
determine the blood supply to tissues we transplant to reconstruct the
human body. Specifically, in breast reconstruction and lymphedema
surgery, we use specific tissue types from the abdomen, buttocks or
thighs, and with the SPY we can determine which parts of these tissues
are best to use."

SMMC now joins other prestigious institutions utilizing the SPY System, including the Cleveland Clinic Foundation, Stanford University Medical Center and the Arizona Heart Institute.

About St. Mary's Medical Center
Founded 150 years ago, St. Mary's Medical Center is one of the
first hospitals in San Francisco. It's the home of several medical
firsts including the nation's first digital cardiac catheterization
laboratory, the first balloon angioplasty for coronary artery disease
and the first total hip replacement surgery. St. Mary's continues to
adopt the latest advances in medical technology and practices with
specialized centers for plastic reconstructive orthopedic surgery, and
innovative cardiovascular, bariatric, oncologic and acute
rehabilitation services.
With more than 575 physicians and 1,100 employees, St. Mary's
full-service acute care facility is committed to its mission to
deliver compassionate, high quality, affordable health services to the
communities it serves. St. Mary's pioneering spirit endures and it is
well poised to continue its tradition of providing health and healing
for the San Francisco community.
For more information, please call (415) 668-1000 or visit
http://www.stmarysmedicalcenter.org.
Mortar

Jamie Fishler, 415-772-9907 ext. 117 (Media)
jamie@mortarpr.com
Copyright Business Wire 2008