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Award funds help them establish and support their own research laboratories. In 2014, the VCA Journal was launched with Gerald Brandacher, scientific director of the reconstructive transplantation program, serving as editorin-chief. The publication is the official journal of The American Society for Reconstructive Transplantation and chronicles advances in the field of vascularized composite allotransplantation. The past five years have seen the launch of several new department programs. These include Hand/Arm Transplant, Face Transplant, Nonbreast Oncologic Reconstruction, Lymphedema and Penile Transplant. The penile transplant program was established after years of research and development of novel surgical techniques to better perfuse the graft and enhance nerve regeneration. It aims to restore genitourinary function in servicemen and civilians who have suffered devastating injuries to the pelvic region. The reconstructive transplant team performed the nation’s most extensive and complicated bilateral arm transplant in 2012 in a quadruple amputee soldier. That success laid the foundation for another above-elbow transplant, in 2015. The department’s hand transplant surgeons have performed three of the four above-elbow transplants in the U.S. to date. Plastic and Reconstructive Surgery | 3 4 When patients experience lymphedema, the most common treatment approach is the conservative route, reducing the swelling and discomfort with compression and massage therapy and/or diet modification. But some patients find greater relief with surgical management, which may include tissue removal, liposuction, lymph node transfer or the lesser-known lymphovenous bypass. Five years ago, few were performing lymphovenous bypasses. Although the concept had existed for decades, the technology had not yet caught up to the procedure, which involves super-microscopic techniques and equipment. The procedure is now an outpatient one that reroutes the lymphatic system directly to the venous system, bypassing the damaged nodes and connecting the lymphatic channels directly into tiny, almost microscopic veins. It can significantly reduce the swelling and, in some cases, return the limb to normal function. “We’re excited about this technique because it can have the potential to help a lot of people with not a lot of downside for the patient,” says Damon Cooney, assistant professor of plastic and reconstructive surgery. Another microvascular option for patients with lymphedema is lymph node transfer, where surgeons transplant a group of lymph nodes, along with their blood supply, from a healthy part of the body to the affected area. “For years, patients had no good option other than therapy,” says Justin Sacks, director of oncological reconstruction. “Now we have new techniques that address the physiology of the patient, literally rewiring the lymphatic system.” While the department is currently performing several lymphovenous bypasses per month, faculty members are also conducting research to find out how to maximize its success rate, eventually hoping to expand the pool of candidates who could benefit. Improving Surgical Management of Lymphedema LYMPHOVENOUS BYPASS “We’re excited about this technique because it can have the potential to help a lot of people with not a lot of downside for the patient.” In the outpatient operation performed at Johns Hopkins, the lymphatic system is rerouted to the venous system. 4 | Plastic and Reconstructive Surgery 5 On the Forefront of Breast Reconstruction The department’s breast reconstruction program has taken on multiple initiatives. There’s patient safety, where groups of nurses, physicians, allied health professionals, epidemiology and infection specialists, patient safety specialists, and administrators make up a CUSP team (Comprehensive Unit-based Safety Program) to generate ideas to improve patient care and bring down patient infection rates and lengths of stay. There’s clinical research into the effects of radiation treatment on various breast reconstruction procedures and its impact on patient quality of life at various points along the process. There are advanced and technically demanding procedures like DIEP (deep inferior epigastric perforators) flap and fat grafting, also known as lipo-filling and fat-transfer, which help to rebuild the breast and surrounding areas following mastectomy and which are available widely only in select institutions. “It’s important for us to be leaders in making the patient experience and patient care world-class,” says Gedge Rosson, director of breast reconstruction and the microsurgery fellowship program. Amid all this innovation, what remains perhaps most unique is the department’s ongoing commitment to personalizing the experience for patients. It’s not just about the ability to provide the most advanced techniques, but about getting to know every patient and matching each with the reconstruction that best fits his or her own life circumstances and recovery expectations, says Michele Manahan, the department’s director of patient safety. “Our role is to rebuild to what a patient wants to be,” Manahan says. “It’s like fashion: what one person thinks is pretty, another doesn’t. We find out a patient’s wants and goals and apply our technology and skills to that.” literally rewiring the lymphatic system.” While the department is currently performing several lymphovenous bypasses per month, faculty members are also conducting research to find out how to maximize its success rate, eventually hoping to expand the pool of candidates who could benefit. Improving Surgical Management of Lymphedema LYMPHOVENOUS BYPASS “We’re excited about this technique because it can have the potential to help a lot of people with not a lot of downside for the patient.” In the outpatient operation performed at Johns Hopkins, the lymphatic system is rerouted to the venous system. 4 | Plastic and Reconstructive Surgery On the Forefront of Breast Reconstruction The department’s breast reconstruction program has taken on multiple initiatives. There’s patient safety, where groups of nurses, physicians, allied health professionals, epidemiology and infection specialists, patient safety specialists, and administrators make up a CUSP team (Comprehensive Unit-based Safety Program) to generate ideas to improve patient care and bring down patient infection rates and lengths of stay. There’s clinical research into the effects of radiation treatment on various breast reconstruction procedures and its impact on patient quality of life at various points along the process. There are advanced and technically demanding procedures like DIEP (deep inferior epigastric perforators) flap and fat grafting, also known as lipo-filling and fat-transfer, which help to rebuild the breast and surrounding areas following mastectomy and which are available widely only in select institutions. “It’s important for us to be leaders in making the patient experience and patient care world-class,” says Gedge Rosson, director of breast reconstruction and the microsurgery fellowship program. Amid all this innovation, what remains perhaps most unique is the department’s ongoing commitment to personalizing the experience for patients. It’s not just about the ability to provide the most advanced techniques, but about getting to know every patient and matching each with the reconstruction that best fits his or her own life circumstances and recovery expectations, says Michele Manahan, the department’s director of patient safety. “Our role is to rebuild to what a patient wants to be,” Manahan says. “It’s like fashion: what one person thinks is pretty, another doesn’t. We find out a patient’s wants and goals and apply our technology and skills to that.” Restoring Form and Function: Oncologic Reconstruction Oncologic reconstruction is the epitome of a team effort. Plastic surgeons collaborate with a multitude of other specialists, supporting the most appropriate oncologic treatment with cutting-edge reconstructive techniques. The goal is patient outcomes that maximize both form and function. As any surgeon knows, when resecting a tumor, it’s often impossible to avoid nerves, bone and muscle. In some cases, the tumor could not be removed unless surgical oncologists can count on reconstructive surgeons to rebuild what they must destroy. So with plastic surgeons at the table from the start, each procedure is planned and executed to ensure that patients with cancer leave not just free of the disease, but also at their highest possible level of physical functioning. Plastic surgery team members at Johns Hopkins attend regular tumor board and multidisciplinary clinic meetings to discuss cases with their interdepartmental colleagues. For example, when a patient presents with a sarcoma that’s invading the spinal cord, the physicians plan the resection that will best address removal of the tumor and simultaneously devise the reconstruction of the affected bone, muscle, tissue and blood vessels. The reconstructive team regularly collaborates with colleagues in urology, vascular surgery, surgical oncology, orthopaedic oncology, neurology, radiation oncology, gynecology, and physical medicine and rehabilitation, combining the highest level of cancer treatment with the most advanced surgical and microsurgical techniques. This approach treats the disease while preserving, or even enhancing, the patient’s wholeness, says oncological reconstruction director Justin Sacks. The department has made interdepartmental collaboration a centerpiece of its oncologic reconstruction efforts, and some faculty members consider it the essence of their work. “You’re getting the most sophisticated cancer surgery known to man,” Sacks says. Restoring Wholeness Through Reconstructive Surgery ONCOLOGIC RECONSTRUCTION “You’re getting the most sophisticated cancer surgery known to man.” Plastic and Reconstructive Surgery | 5 I n a span of just five years, the department has protocols approved and in place for hand, face and penile transplants—an indication of just how quickly its transplant portfolio has grown, and how the entire field has evolved. “Transplant is now accepted as a bona fide tool to restore both form and function in patients with devastating damage and tissue loss,” says Gerald Brandacher, scientific director of the reconstructive transplantation program. Hand Transplant Two patients in particular illustrate the dramatic effect reconstructive transplantation can have. Brendan Marrocco, severely injured in a 2009 roadside bomb attack in Iraq, was the first American soldier to survive losing all
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