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two methods to help increase accuracy in reconstruction: • Virtual surgical planning: using computers to generate virtual models for more accurate reconstruction surgeries (see images) • Rapid protoype modeling: using 3-D printers to create models 3D printed cutting and drill guides are based on computerized models of the patient’s leg bones and arteries created from CT scans. These cutting and drill guides enable our surgeons to create precisely-designed, vascularized, bony reconstructions for a patient’s jaw, midface or spine. Our plastic surgeons are using virtual surgical planning to visualize and outline the steps for complex reconstructions before the patient enters the operating room. In this picture, a vascularized fibula bone from the patient’s leg will be used to replace most of this patient’s jaw. Division of Surgery | Surgical Outcomes FY18 37 At MD Anderson, we use 3-D printed models to create exact replicas of body parts damaged by cancer. These replicas, or models, serve as templates to guide doctors as they carve and shape customized, implantable body parts out of patients’ own bone or tissue. The results are more natural and more realistic. It even allows us to reconstruct areas we never could before this type of technology existed. “Our own Plastic Surgery department has the highest volume of users of this strategy and technology in the world,” says Patrick Garvey, M.D., associate professor of plastic surgery. “As a result, our surgeons are the most experienced when it comes to using this technique.” Bringing new insights to abdominal wall surgery and fat grafting The second highest volume of surgeries our plastic surgeons perform are hernia and abdominal wall repair. Patients with all types of cancer who have surgery can be at risk for developing a hernia. Not only are our surgeons highly skilled because of the high volume of surgeries they perform, but they’re constantly looking at ways to improve the surgery. MD Anderson is home to a lab where researchers are studying how stems cells taken from fat can be used to help abdominal walls heal in rats. A recent study showed that the stem cells could help reduce severe inflammation and activate muscle restoration. In short, those rats injected with stem cells saw improved wound healing. Our researchers are also are investigating whether different types of fat and different ways of grafting fat can improve patients appearance, while lowering risk of cancer recurrence. In one particular study, a review was performed of 119 consecutive patients undergoing autologous fat grafting for oncologic head and neck reconstruction from 2005 to 2014. Aesthetic outcomes were rated by a group of 10 plastic surgeons and 10 laypersons using a five-point Likert scale. Volumes Free Flap Cases 2016-2018 2018 0 100 200 300 400 500 600 700 800 375 561 654 2016 2017 Lymphedema Surgeries 2016-2018 0 30 60 90 120 150 2018 50 99 123 2016 2017 This study found that autologous fat grafting plays a valuable role in enhancing aesthetic outcomes, either by complementing or replacing reconstructive flaps for oncologic head and neck reconstruction. The technique was found to have low complication rates and no evidence of being associated with cancer recurrence. 38 MD Anderson Cancer Center SURGICAL ONCOLOGY Jeffrey E. Lee, M.D. Department Chair Adolfo Chavez Division of Surgery | Surgical Outcomes FY18 39 Sarcoma survivor finds a way by Kellie Bramlet Blackburn As a high school soccer player, Alex Frankenfeld often heard his coach say, “Busca la forma,” Spanish for “Find a way.” Three years later, Alex was diagnosed with soft tissue sarcoma, and the phrase became a mantra that helped him get through the experience. “I’m going to do whatever I can to beat this thing,” Alex told his mother on their first trip to MD Anderson in fall 2015. “Mom, I’m going to find a way.” Alex had just started his junior year at the University of Oklahoma when he began noticing sarcoma symptoms: frequent urination, constipation and back pain so intense he found himself in the emergency room. A CT scan revealed an 11-inch mass in his pelvis. He was diagnosed with stage II leiomyosarcoma, a very rare type of soft tissue sarcoma. At the time, Alex was only 21. After Alex received his diagnosis from a doctor in Dallas, he made two important decisions: he was coming to MD Anderson for soft tissue sarcoma treatment – his parents heard it was the best - and he was putting college on hold. “In some ways, it was a hard decision,” he says. “But in other ways, it was easy. My life was so much important than anything else.” Alex had his first appointment at December 2015, when he met with Christina Roland, M.D., a surgeon and associate medical director of the Sarcoma Center, and Ravin Ratan, M.D., an oncologist. They outlined his sarcoma treatment plan: 18 weeks of chemotherapy and 25 rounds of radiation, followed by surgery to remove the tumor. Alex received chemotherapy and radiation in Dallas so he could continue to live at home. After finishing chemo and radiation, Alex began to prepare for the next step: surgery. That procedure took place on June 20, 2016. During the surgery, Roland removed the tumor and a part of a nearby vein. Then, Tam Huynh, M.D., a cardiovascular surgeon, helped replace it with one grafted from Alex’s leg. William Graber, M.D., a urology
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