Volume 10, Issue 1, 2011-2012 - Department of Surgery - University ...

hand, or finger – cansignificantly impactquality of life. A lossof function in oneof these areas is adevastating blow torecovery and to anyhope of returning toa normal life.As members ofthe Division of Reconstructive andPlastic Surgery, Warren BreidenbachIII, MD, Tolga Turker, MD, and JiyaoZou, MD, specialize in microsurgicaltransfer of bone, tissue, and nerve, aswell as free or pedicled skin flaps torepair wounds, injuries, or defects tothe upper extremities and to restoresensation and movement. They also aretrained to perform composite tissue allotransplants(the transplantation of tissueor limbs from deceased donors).Whether their patients come inelectively or with trauma, these surgeonshave the combined skills of reconstructive,plastic, and vascular surgeons, eliminatingthe need for multiple providersand resulting in less duplicated care andshorter recovery time. They have particularexpertise in the treatment of all typesof hand surgeries, including transplantinghands and replanting severed digits.“Restoring function is our numberone priority,” said Dr. Zou. “After anaccident, we are able to save a patient’sthumb or finger by performing a replantation,which includes bone fixation andtendon, artery, and nerve repair.“We use a vein graft from the forearmin order to keep the length of thedigit. If the digit is not replantable, aswith a fingertip injury, we can salvagethe finger’s length usingdifferent kindsof flaps,” Dr. Zouexplained.Other types ofmiscrosurgical reconstructionon extremitiesperformed byDrs. Zou and Turkerinclude woundcoverage.“We can use both pedicled and freeflaps to cover the tissue defects. Flapcoverage can be successfully done andwill provide a better outcome with severeupper extremity injuries,” saidDr. Turker.Drs. Zou and Turker were broughton board by Dr. Breidenbach, the newchief of the Division of Reconstructiveand Plastic Surgery.Dr. Breidenbach came to the UA fromthe Christine M. Kleinert Institute forHand and Microsurgery in Louisville,Ky., where he performed the world’s firstsuccessful complete hand transplant. Heis interested in expanding the types oftransplants performed at the UA to otherareas of the body, including face transplants.“There’s always been a need forthis kind of specialized microsurgicalrestoration,” Dr. Breidenbach said. “Wenow have highly qualified hand surgeonsavailable 24/7.”Breast SurgeryUnlike some of the other areas of thebody where microsurgery techniques areused, form outweighs function in breastreconstruction.Ethan Larson, MD, in the Divisionof Reconstructive and Plastic Surgery,offers state-of-the-art microsurgery breastreconstruction techniquesafter mastectomy to helpwomen recovering frombreast cancer begin to feelwhole again.DIEP (deep inferiorepigastric perforator) andTUG (transverse uppergracilis) flap proceduresuse skin, tissue, and tinyblood vessels taken fromeither the patient’s abdomenor inner thigh areato form a new breast. The breast reconstructionflaps are much larger than mostother flaps used in other microsurgicalprocedures, but the technical aspects arenot so different from other areas of thebody, Dr. Larson said. These particularflaps are often made up of the patient’sown skin and fat, without the need tosacrifice a functional muscle.“The surgery itself is quite lengthy,so completing the dissection of the flapin a timely fashion is often the mostdifficult portion of the procedure, alongwith the added challenge of shaping anattractive breast from abdominal tissue– one that matches a remaining breast,”he said.Dr. Larson is one of the few surgeonsin Southern Arizona to offer microsurgicalfree-flap breast reconstruction. “I doall types of microsurgery, but breast reconstructionseems to answer the biggestneed,” he said.DIEP andTUG flapproceduresuse skin,tissue, andtiny bloodvesselstaken fromeither theabdomen orinner thighto form anew breast.3