Washington University Division of Plastic and Reconstructive Surgery - Annual Report 2022

Division of Plastic & Reconstructive Surgery 2022 Annual Report Living Our Legacy

My vision for the Division of Plastic and Reconstructive Surgery is a vision of becoming the number one plastic surgery program in the United States. It’s an audacious vision, but with the infrastructure, support and colleagues here, it is a vision we are headed for. JUSTIN M. SACKS, MD, MBA, FACS 2 Washington University School of Medicine in St. Louis | Department of Surgery

LETTER FROM THE CHIEF Justin M. Sacks, MD, MBA, FACS Chief, Division of Plastic and Reconstructive Surgery Sidney M. Jr. and Robert H. Shoenberg Chair in Plastic and Reconstructive Surgery When you look at the history of plastic surgery, many Washington University plastic surgeons cover head to toe cancer and trauma reconstruction and aesthetic/cosmetic significant things started here in St. Louis. Vilray P. Blair, the surgery. One of my first priorities as chief was to clearly first chief of plastic and reconstructive surgery at Washington establish the 10 clinical programs that define the scope of our University (WashU) School of Medicine, laid the foundation for practice as plastic surgeons. These clinical programs are: nerve the American Board of Plastic Surgery in 1937. Blair and his surgery, pediatric plastic surgery, aesthetic surgery, breast successor as division chief, James Barrett Brown, reported the reconstruction, craniofacial surgery, gender affirming surgery, first repeatable cleft lip repair in 1929. The pair also developed general reconstruction, hand surgery, limb preservation, a split thickness skin grafting technique still used nearly a and lymphedema surgery. Our division has excelled in many century later. Both served as chair of plastic surgery for the of these areas for decades, but as plastic surgeons we are U.S. Army—Blair during World War I and Brown in World War innovators—forward-thinking problem solvers. If there is II. The surgeons who trained under Blair and Brown went on room to improve, we improve. If there is an opportunity for to shape our specialty for years to come. growth, we will grow. We have forged new partnerships across Chiefs at WashU that followed Blair and Brown were Jack specialties to develop stronger, more comprehensive care Hoopes, Paul Weeks, and Susan Mackinnon. All pioneers pathways for our patients in each of these vital clinical areas. themselves within their own unique sub-specialties of plastic When we challenge ourselves to innovate, we are leading and reconstructive surgery. We truly stand on the shoulders by example. Just as Blair and Brown inspired their trainees, of giants. Today we honor the legacy of these surgeons by we have the opportunity to motivate the next generation of defining the future of plastic and reconstructive surgery. plastic surgeons by thinking big, asking difficult questions and Our division has seen tremendous growth across the board. achieving groundbreaking results. I see this reflected every Since 2020, we have doubled the size of our clinical faculty, day in our residents. Their genius is on display when they tripled our dedicated research faculty, and significantly grown acquire new skills in our simulation programs or present their our residency and fellowship programs. We have expanded research at national and international conferences. When a our service lines to care for more patients across the region. resident participates in a case or publishes their findings in a In collaboration with our partners in orthopedic surgery, we high-impact journal, it serves as a reminder that our legacy is established a microsurgery fellowship that attracts the most alive and well. capable candidates from around the world. Our investigators I could not be more proud of what we have done in the past few lead multiple laboratories funded by R01 grants from the years, and I am truly excited to see what the future holds for National Institutes of Health. We are building the processes plastic and reconstructive surgery at Washington University. to investigate fundamental questions in basic science, in translational medicine and in clinical care. Division of Plastic and Reconstructive Surgery | Annual Report 2022 3

Division of Plastic and Reconstructive Surgery From left: Mitchell Pet, MD, Justin Sacks, MD, MBA, FACS, Kelly Currie, MD, and Joani Christensen, MD. Plastic and reconstructive surgeons are experts in craniofacial, aesthetic, breast and general reconstructive, gender affirming, hand, limb preservation, lymphedema, nerve and pediatric plastic surgeries. The division is an international center for nerve injury and pioneer of peripheral nerve transfers. Faculty are leaders in basic, translational and clinical research, including clinical outcomes research and bench-to- bedside discoveries in nerve research and tissue engineering. Building on a legacy of training leaders and innovators, the division’s residency and fellowship programs offer comprehensive training, outstanding mentorship and exposure to advanced surgical technology. 3,894 5,575 Operating room cases Office procedures 35,166 $459,796 Visits $$$ Research funding 21 153 Faculty Clinical research studies 4 Washington University School of Medicine in St. Louis | Department of Surgery

The Innovation Effect Kelly Currie, MD. Plastic and reconstructive surgery, a specialty that Surgery Simulation Center of Excellence with national and international recognition.” encompasses complex head-to-toe procedures, grows Other advanced training techniques include the use and thrives on innovation. Since his arrival in 2020, of VR headsets in training and preoperative planning Division Chief of Plastic and Reconstructive Surgery for microvascular breast surgeons, an initiative led by Justin Sacks, MD, MBA, FACS, has made innovation a Rachel Anolik, MD, Joani Christensen, MD, and Sacks. focus within the division, bringing with this initiative The division is pilot testing a new technology that uses a multitude of new programs, expertise and surgical virtual reality to create 3D versions of CT scans before techniques. procedures like DIEP flap surgery. Kelly Currie, MD, has introduced a new program “We are able to color code different types of tissue of simulation training for residents in the division. in this 3D visualization,” says Anolik, who uses the The training, which takes place at the Washington technology to train residents and fellows in the University Institute for Surgical Education (WISE) is preoperative setting. “This technology allows us to used to teach and practice what is otherwise difficult, shade those things in different colors and make them unsafe or expensive to do by other means. It provides a semitransparent, so we can see the path of blood low stress environment where trainees can acquire and vessels through the muscle.” practice surgical skills without the risk of patient harm. Monthly simulation sessions focus on microsurgical Alongside training and planning initiatives, new techniques, approaches to the craniofacial skeleton, echnology plays a key role in patient care. Clinical flap dissection and fixation of hand fractures. In trials of new devices, such as a pressure sore monitor addition to technical skills and medical knowledge, invented by Sacks with clinical trials lead by Amanda simulated scenarios help residents learn and cultivate Westman, PhD, and a tissue perfusion device non-technical skills, such as obtaining informed developed by Mitchell Pet, MD, are technological consent. innovations being implemented in the division. The Currie has witnessed the positive outcomes of this division has hired a clinical trials manager, Kelly training model firsthand. “Overall, there has been Koogler, to support these programs, providing critical overwhelming positive feedback from the residents, infrastructure for continued innovation. fellows, and medical students,” she reports. “This is “Innovation is about more than doing a surgery faster,” our inaugural year of the Washington University Plastic explains Sacks. “Innovation means a complete shift in Surgery Simulation Lab. The goal is to develop a Plastic thinking, a shift in how you approach a surgery.” Division of Plastic and Reconstructive Surgery | Annual Report 2022 5

Plastic and Reconstructive Surgery Highlights CLINICAL The Washington University Transgender Center offers multidisciplinary care programs and teams for transgender, non- binary and genderqueer individuals in a comfortable, respectful environment. All transitioning and care is comprehensive and personalized, addressing the unique needs of each individual with a range of available services. Plastic and Reconstructive Surgery faculty Alison Snyder-Warwick, MD, FACS, Joani Christensen, MD, Justin Sacks, MD, MBA, FACS, and Marissa Tenenbaum, MD, provide top surgery, while Snyder-Warwick provides the full spectrum of gender affirming bottom surgery. RESEARCH Alison Snyder-Warwick, MD, FACS, left, and Marissa Tenenbaum, MD. The Plastic and Reconstructive Surgery Research Laboratories – a From left: Xiaowei Li, PhD, Amanda Westman, consortium of research faculty from the division – has initiated a PhD, and Matt Wood, PhD. multitude of pioneering investigative programs. These programs From left: Andrew Linkugel, MD, Ema include expert research in peripheral nerve surgery, tissue Zubovic, MD, amd Amelia Van Handel, MD. engineering, vascular reconstruction, lymphatic reconstruction, breast implant associated fibrosis and novel devices for use in plastic surgery procedures. Acquiring funding for preclinical research projects in the past academic year was highly successful for initiating and augmenting these new research programs. Funding was awarded to Mitchell Pet, MD, Xiaowei Li, PhD, Justin Sacks, MD, MBA, FACS, Alison Snyder-Warwick, MD, FACS, Amanda Westman, PhD, and Matt Wood, PhD, from multiple accredited organizations that support promising research in plastic and reconstructive surgery. EDUCATION Trainees in the division benefit from exposure to innovative research programs across the specialty. At the 26th annual James Barrett Brown Visiting Professor and Research Day, trainees exhibited presentations from their research in the Plastic Surgery Research Laboratories. The event represented the breadth of basic science, translational, clinical, educational and innovations research in the division. Presentations from over 20 researchers highlighted the diverse interests of trainees and faculty at the medical school. Plastic surgery resident Ema Zubovic, MD, was awarded for her work developing a simulation tool for teaching alveolar bone grafting, while residents Andrew Linkugel, MD, and Amelia Van Handel, MD, received awards for their projects on magnetic resonance cranial imaging and geo-demographics of ballistic injuries. 6 Washington University School of Medicine in St. Louis | Department of Surgery

A New Direction in Hand Surgery Hand surgery has long been an area of excellence within the Division of Plastic and Reconstructive Surgery. From pioneering nerve transfer techniques to restore function after peripheral nerve injuries, to offering innovative treatments for carpal tunnel syndrome and other hand conditions, the division continues to advance the field of hand surgery through dedicated clinical, research and education programs. Mitchell Pet, MD, was named director of the Mitchell Pet, MD, left, and patient. hand and upper extremity surgery program in 2022. Pet earned his medical degree at Washington University, then completed plastic and reconstructive surgery residency training at University of Washington School of Medicine, and then a hand and microsurgery fellowship at The Curtis National Hand Center in Baltimore before joining the faculty at Washington University in 2018. His clinical practice focuses on adult and pediatric hand and upper extremity surgery and microvascular reconstruction, and he offers care for all manner of hand and wrist complaints, including degenerative, traumatic, congenital and oncologic concerns. In particular, he enjoys the opportunity to perform complex and interdisciplinary reconstructive procedures and frequently collaborates with surgeons in other fields to solve challenging problems that cross boundaries between specialties. “It is very rewarding when we can find a solution for a patient in a difficult situation,” says Pet, who also serves as associate director of the hand surgery fellowship in the division. “I hope to continue to build the hand program at Washington University so we can meet the needs of more patients, innovate for the advancement of the field, and train future leaders in our specialty.” In addition to his clinical and education roles, Pet is a successful investigator with a focus on developing novel wireless biosensors for tissue perfusion assessment. This collaborative effort has generated external grant funding, industrial support, an active human clinical device trial and a pending U.S. patent. The division performs hand surgery at Barnes-Jewish Hospital as well as multiple sites across the BJC HealthCare system. Notably, Kelly Currie, MD, an assistant professor of surgery, has built a successful practice offering “wide awake local anesthesia no tourniquet,” or WALANT, hand surgery at Christian Hospital in north St. Louis County. Surgeons also work alongside colleagues in the Department of Orthopedics by taking call for emergency and traumatic hand injuries, which has led to a significant increase in clinical activity. “With our growing hand practice, structured leadership for clinical, education, research and innovation is required,” says Chief of Plastic and Reconstructive Surgery Justin Sacks, MD, MBA, FACS. “It is one of the joys of academic medicine to see colleagues take on leadership roles in areas they truly enjoy and thrive in. Dr. Pet will work with our faculty, clinical operations team and partners in orthopedics to optimize the delivery of hand surgery at Washington University.” Division of Plastic and Reconstructive Surgery | Annual Report 2022 7

Spinal Cord Injury and Recovery For people living with cervical spinal cord injury, the decision to have surgery to restore function can be complex. Research and education initiatives in the Division of Plastic and Reconstructive Surgery aim to address this critical, time-sensitive decision. Professor of Surgery Ida Fox, MD, FACS, and her dedicated, multidisciplinary research team at the Nerve, Extremity and Wound Reconstruction Lab are on a mission to expand treatment options and understanding of SCI. Fox, who also serves as director of the hand surgery fellowship program, is nationally and internationally known for her work to restore hand and upper extremity function in the setting of mid-cervical level SCI. In 2022, Fox and an International team of researchers published a study on spontaneous motor recovery after cervical SCI in the journal Spinal Cord. “This study provides important information for people living with cervical spinal cord injury. People with cervical SCI can chose surgery to improve upper extremity function, but spontaneous or natural recovery also occurs after injury,” says Fox, who is senior author on the publication. “Information in our work helps define the extent and timing of recovery so clinicians and people living with SCI have the facts they need to consider early surgery to restore function.” Another study, led by Fox and a team of trainees from the division, was published in the Journal of Hand Surgery and selected as the editors’ choice article for its findings on nerve transfer surgery. The prospective study included people undergoing upper extremity nerve transfer to improve function in cervical SCI. Fox and her team found that use of expendable donor nerves with redundant function to perform nerve transfer surgery has relatively little impact on strength or capacity to perform activities of daily living, even in the unique and highly vulnerable SCI population. These findings may help surgeons better counsel people considering upper extremity reconstruction. In addition to nerve transfer and SCI research led by Fox, investigators in the division represent the truly head-to-toe nature of the specialty. Surgeons, physician-scientists, dedicated research faculty and staff, and trainees collaborate to expand knowledge of conditions, treatments and technologies with the ultimate goal of advancing patient care. Areas of research excellence include biomaterials and bioengineering, tissue and nerve regeneration, extremity reconstruction, and congenital facial conditions, among others. From basic science to retrospective chart reviews, database development, surveys, shared decision-making studies, device creation and randomized controlled trials, the division has built a comprehensive program of research initiatives. Justin Sacks, MD, MBA, FACS, left, and Ida Fox, MD, FACS. 8 Washington University School of Medicine in St. Louis | Department of Surgery

World-class Microsurgical TrainingRachelAnolik, MD. The Division of Plastic and Reconstructive Surgery associate program director. “Fellows see the full offers innovative fellowships in hand, peripheral spectrum of microvascular reconstruction, and they nerve and microvascular surgery. The division is have opportunities to develop skills in the areas that currently training three hand fellows and one fellow interest them.” in microsurgery. The microsurgery fellowship, now in The fellowship includes a variety of clinical and its second year, offers an interdisciplinary approach operative experiences. Fellows are assigned on a encompassing head-to-toe reconstructive surgery rotating basis to work with attending microvascular with strong emphasis on limb salvage and cancer surgeons in orthopedic and plastic surgery. The goal reconstruction. of the fellowship is to offer fellows approximately Program Director and Chief of Plastic and equal exposure to orthopedic and plastic surgical Reconstructive Surgery Justin Sacks, MD, MBA, FACS, perspectives and to leverage the advantages of envisions the fellowship as an opportunity to gain interdisciplinary collaboration. valuable operative experience while working alongside Plastic and reconstructive faculty are closely involved clinical leaders in microsurgery. in fellow training while still providing them the “Our dedicated microvascular faculty understand the opportunity to gain clinical independence. Fellows value of advanced fellowship training, and we as a participate not only as trainees but also as teachers. division are dedicated to training future leaders in our They have instructor-level appointments and work specialty,” says Sacks, who is the Sydney M. Shoenberg, closely with residents in plastic surgery and with Jr. and Robert H. Shoenberg Endowed Chair in Plastic medical students. and Reconstructive Surgery. During fellowship, trainees have the opportunity For fellows, microsurgical education encompasses the to conduct research within the division’s multiple full breadth of orthoplastic reconstruction including laboratories. At the end of this year-long program, head, neck, trunk, upper and lower extremity surgeries; fellows submit abstracts to the American Society of free tissue transfer; lymphedema surgery; transgender Reconstructive Microsurgery Annual Meeting, building surgery; pediatric surgery; and traumatic and cancer their academic surgical portfolio in the process. reconstruction. Current fellow Saif Badran, MD, earned his medical “One unique aspect of our fellowship program is the degree at the University of Jordan College of Medicine strong partnership between plastic and orthopedic and conducted his residency at Hamad Medical surgeons,” says Rachel Anolik, MD, who serves as Corporation, Qatar. Division of Plastic and Reconstructive Surgery | Annual Report 2022 9

FACULTY Division of Plastic and Reconstructive Surgery Justin M. Sacks, MD, MBA, FACS Chief, Division of Plastic and Reconstructive Surgery Sidney M. Jr. and Robert H. Shoenberg Chair in Plastic and Reconstructive Surgery ENDOWED PROFESSORS ASSISTANT PROFESSORS NURSE PRACTITIONERS Keith E. Brandt, MD, FACS Rachel A. Anolik, MD Lauren Bayens, FNP-C Susan E. Mackinnon, MD Joani M. Christensen, MD Carrie Roth Bettlach, FNP-C PROFESSORS Kelly B. Currie, MD Barb Champions, CPNP, CWOCN Terence M. Myckatyn, MD Trina G. Ebersole, MD Meg Costa, ACNP-BC Thomas H. Tung, MD John M. Felder, MD Sybill Naidoo, PhD, RN, CPNP-PC ASSOCIATE PROFESSORS Amy F. Kells, MD, PhD Lorraine Seiffert, ACNP-BC Ida K. Fox, MD, FACS Xiaowei Li, PhD Ashley Titchenal, ACPCNP-BC Kamlesh B. Patel, MD, MSc Dennis C. Nguyen, MD, MS PHYSICIAN ASSISTANTS Marissa M. Tenenbaum, MD Mitchell A. Pet, MD Allison French, PA-C Alison K. Snyder-Warwick, MD, FACS McKenna Roberts, PA-C Shoichiro Tanaka, MD, MPH Emily Weinhaus, PA-C Amanda Westman, PhD Matthew D. Wood, MS, PhD 2022 Plastic and Reconstructive Surgery Team. 10 Washington University School of Medicine in St. Louis | Department of Surgery

RESIDENT CORNER From left: Ema Zubovic, MD, Kaamya Varagur, Justin Sacks, MD, MBA, FACS, Rachel Skladman, MD, Jackson Burton, William Moritz, MD, Sarah Chiang, Annahita Fotouhi, Alison Snyder-Warwick, MD, Matt Wood, PhD and Alexandra Keane, MD at the Plastic Surgery Research Council Meeting in Toronto, Ontario. RESIDENT CORNER 2022 Plastic and Reconstructive Surgery residents class. WHAT ARE YOUR GOALS FOR THIS YEAR? “To continue developing my clinical skill set and be able to effectively manage patients in perioperative, inpatient and postoperative settings. To adjust to living in St. Louis and achieve a healthy work-life balance!” -Anna Rose Johnson, MD, MPH William Zhu, MD, left, From left: Justin Sacks, MD, MBA, FACS, Alison Snyder- Anna Rose Johnson, MD, MPH. and Justin Sacks, MD, MBA, FACS. Warwick, MD, FACS, Shoichiro Tanaka, MD, MPH, David Chi, Mitchell Pet, MD, left, and Ema Zubovic, MD. MD, PhD, Austin Y. Ha, MD and Andrew Linkugel, MD. WMEHMATO’RSYYFORUORMFARVEOSRIDITEENCY? “We have a lot of fun operating together, but my favorite memories have been our Graduation/Resident Research Days at the end of each academic year. It’s sad to see our graduates leave, but it is always a great day to get our whole program together and present our research.” -Andrew Linkugel, MD WWAHSYHDIINDGYTOOUNCUHNOIVOESRESITY? “I chose WashU for the strong, supportive community and the opportunity to train at a busy, world- class academic medical center. The surgical training here is second to none, and I feel simultaneously challenged and valued by my patients, co-residents and faculty every day.” Front row from left: Alexandra Keane, MD, Alison Snyder-Warwick, -Ema Zubovic, MD MD, FACS, Ida Fox, MD, FACS, Amelia Van Handel, MD and Justin Sacks, MD, MBA, FACS. Back row from left: Kash Tadisina, MD, Anna Rose Johnson, MD, MPH, Austin Y. Ha, MD and Keith Brandt, MD, FACS at the American Association of Plastic Surgeons (AAPS) meeting in San Diego Division of Plastic and Reconstructive Surgery | Annual Report 2022 11

DIVISION OF PLASTIC & RECONSTRUCTIVE SURGERY OFFICE OF THE CHIEF Justin M. Sacks, MD, MBA, FACS Division Chief of Plastic and Reconstructive Surgery Sidney M. Jr. and Robert H. Shoenberg Chair in Plastic and Reconstructive Surgery ADMINISTRATIVE OFFICES Suite 1150, Northwest Tower 660 South Euclid Avenue Campus Box 8238 St. Louis, MO 63110 APPOINTMENTS (314) 362-7388 plasticsurgery.wustl.edu PARTNER INSTITUTIONS The 1,500 specialty and primary care clinicians who make up Washington University Physicians comprise the medical staffs at Barnes-Jewish Hospital and St. Louis Children’s Hospital. SCAN ME SHARE ON SOCIAL For more, please scan the QR code below or visit @WashUPlastics plasticsurgery.wustl.edu @washuplasticsurgery @washuprs CONTACT: [email protected]