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Exploring the Vanguard of Transplantation: Hand, Face and Urogenital RECONSTRUCTIVE TRANSPLANT 8 | Plastic and Reconstructive Surgery 9 W. P. Andrew Lee, M.D. The Milton T. Edgerton, M.D., Professor and Director Department of Plastic and Reconstructive Surgery MD: Johns Hopkins University School of Medicine General surgery residency: The Johns Hopkins Hospital Plastic surgery residency: Massachusetts General Hospital Hand surgery fellowship: Indiana Hand Center Expertise: hand transplant; immune modulation; hand and upper extremity surgery Accomplishments: Distinguished Alumnus Award by Johns Hopkins University (2015); Research Achievement Award for Basic Research from the American Association of Plastic Surgeons (2014); the Andrew J. Weiland Medal for Outstanding Research from the American Society for Surgery of the Hand (2014); led the surgical team that performed the nation’s first double-hand transplant in 2009 and the first trans-humeral transplant in 2010; chair of Plastic Surgery Research Council (2001-2); president of the American Society for Surgery of the Hand (2011–12); chair of the American Board of Plastic Surgery (2012–13); president of American Society of Reconstructive Transplantation (2014-16) Gerald Brandacher, M.D. Scientific Director, Vascularized Composite Allotransplantation Program Associate Professor of Plastic and Reconstructive Surgery MD: School of Medicine, Leopold Franzens University, Innsbruck, Austria General and transplant surgery residency: Innsbruck Medical University, Austria Expertise: vascularized composite allotransplantation (VCA); solid organ transplantation; transplant immunology Accomplishments: helped design a novel, cell-based immunomodulatory treatment protocol for VCA; member of the team performing the first bilateral hand transplant and first forearm transplant in the U.S.; research on donor-specific immune tolerance and immunomonitoring strategies for hand and face transplant; chair of the American Society of Transplantation VCA Advisory Council, chair of VCA Committee of the European Society of Organ Transplantation, treasurer of American Society of Reconstructive Transplantation; co-founder and Editor-in-Chief Vascularized Composite Allotransplantation (VCA) journal; selected as a “Fellow of the American Society of Transplantation (FAST)” (2015) Kristen Parker Broderick, M.D. Assistant Professor of Plastic and Reconstructive Surgery MD: Texas A&M University General surgery residency: University of North Carolina Hospital Plastic surgery residency: New York Presbyterian Hospital Weill Cornell/Columbia Breast reconstruction fellowship: Washington University St. Louis Expertise: breast reconstruction, cosmetic breast surgery, microvascular reconstruction, body contouring Accomplishments: numerous clinical and leadership awards and recognitions Julie Caffrey, D.O., M.S. Assistant Professor of Plastic and Reconstructive Surgery DO: Philadelphia College of Osteopathic Medicine MS: Philadelphia College of Osteopathic Medicine General surgery residency: Flushing Hospital Medical Center Burn Fellowships: Westchester Medical Center and The Johns Hopkins University Expertise: adult and pediatric acute burn injury, burn reconstruction, laser therapy forpost-burn scar contractures and hypertrophic scarring, surgical management of hidradentitis suppurativa Accomplishments: researching laser therapy for hypertrophic scarring after burn injury, establishing educational curriculum in burn Carisa Cooney, M.P.H., C.C.R.P. Assistant Professor of Plastic and Reconstructive Surgery and Clinical Research Manager BA: Kenyon College; Gambier, OH MPH: University of Illinois; Springfield, IL Expertise: clinical research on abdominal surgery wound therapy, vascularized composite allo-transplantation (VCA), and breast reconstruction outcomes; enhancement of resident physician education Accomplishments: original publications and ongoing research grants on improving patient outcomes after plastic and reconstructive surgery and on enhancing residency training Damon S. Cooney, M.D., Ph.D. Assistant Professor of Plastic and Reconstructive Surgery MD: University of Oklahoma Health Sciences Center PhD: Ohio State University Plastic surgery residency: Southern Illinois University School of Medicine Microsurgery fellowship: University of Pittsburgh Medical Center Expertise: general plastic surgery; microvascular reconstruction after breast cancer, head and neck cancer and trauma; hand surgery; reconstructive transplantation Accomplishments: research on vascularized composite allo-transplantaion (VCA); engineering human tissues for reconstructive purposes and nerve regeneration; microsurgical education; hand, face, and penile transplantation clinical trials Amir H. Dorafshar, M.B.Ch.B. Associate Professor of Plastic and Reconstructive Surgery Clinical Co-Director, Face Transplant Program MBChB: University of Manchester, United Kingdom General surgery residency: University of Chicago Medical Center Plastic surgery residency: University of Chicago Medical Center Vascular surgery research fellowship: University of California Los Angeles Craniofacial surgery and microsurgery fellowship: Otolaryngology-Head and Neck Surgery issues. The majority of this work has been done in the field of head and neck cancer therapy, as clinicians have realized that it is not only survival or length of life, but in addition, the quality of that remaining life that is most important to patients and their loved ones [5,6]. In facial plastic and reconstructive surgery, a field in which mortality is not a prime concern, these issues of satisfaction or quality of life are of the utmost importance. The WHO defines health as the state of “complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” [2]. In this way, the well-being of the individual defines the ultimate goal of any treating physician. This well-being is intimately related not only to the physical health of the patient but the individual’s mental or emotional satisfaction and social functioning as well. The facial form, and the mental, emotional, and social consequences of this form, thus contribute greatly to the overall well-being or health of the facial plastic surgery patient. For this reason, measuring the outcomes of facial plastic surgery in a more comprehensive manner naturally follows from the clinical focus on this overall well-being, and the specific attention that is paid to the satisfaction of the individual. Outcomes research is performed in order to provide a quantitative assessment of otherwise subjective results. The steps in performing this form of evaluation include: 1. Identify the specific procedure or illness to be studied (e.g., rhinoplasty results). 2. Determine the key factors that contribute to the satisfaction following the treatment modality. Physical (e.g., nasal appearance, nasal airway function) Mental/Emotional (e.g., confidence, desire for change) Social (e.g., family/friend, social/professional acceptance) 3. Develop a quality of life instrument (questionnaire) to measure the outcome of interest (Figs. 1–4). 4. Test the instrument in the appropriate clinical setting. Reliability (consistency, reproducibility) Validity (responsiveness to change, accuracy) 5. Revise or amend the instrument for better quality of life assessment. 6. Use the final instrument for outcomes studies. Evaluation of individual patient satisfaction. Comparisons between different procedures. There are many instruments that have been developed for the measurement of other nonfacial plastic outcomes in the head and neck. Illnesses such as otitis media, sinusitis, obstructive sleep apnea, and head and neck cancer have all been evaluated with outcomes questionnaires that have been shown to be reliable and valid measures of patient-related satisfaction or quality of life [4–8]. Unfortunately, there are no current instruments that have been tested for use in the realm of facial plastic and reconstructive surgery, despite the dependence of outcomes in this field on these primarily subjective factors. In fact, the endpoints of many studies in the facial plastic surgery literature are presented as the proportion of patients who are “satisfied” with their results, without any standardized method of comparison between various treatment outcomes. One issue that may contribute to the lack of formal outcomes research in facial plastic surgery, particularly the realm of aesthetic rather than reconstructive surgery, is the difficulty in attempting to organize and collect data in a prospective fashion in the community outpatient setting. This difficulty has been addressed in other fields of Otolaryngology outcomes research, as the community setting may lack the dedicated resources, time, and support for research that are found in the academic setting [9]. If the goal of a standardized, reliable, and valid means of assessing patient outcomes is to be achieved, however, the facial plastic surgeon must overcome these obstacles. In order to address this issue, Isenberg and Rosenfeld [9] have outlined five major problems faced in community-based outcomes research, as surveyed from the private practice Otolaryngologists in their own study: 1. An overly long and complex survey. 2. Lack of time during office hours. 3. Cumbersome data collection requirements. 4. Inadequate ongoing communication between the principal investigator and participating physicians. 5. Lack of enthusiasm for the project. Recommendations for conducting outcomes research in the community setting include simple to use, streamlined questionnaires that require little time to complete. The instruments provided in this paper attempt to meet these criteria, and provide the facial plastic surgery with a quick and easy method of data collection in the community practice setting. Outcomes in Facial Plastic Surgery In order to measure outcomes such as patient satisfaction and quality of life in the facial plastic surgery patient, R. Alsarraf 193 one must first identify the key aspects that constitute such satisfaction for each treatment modality of interest. Four common facial plastic surgery procedures include rhinoplasty, rhytidectomy (facelift), blepharoplasty, and the various skin resurfacing procedures [laser, chemical peels (Figs. 1–4)]. Certainly there are factors that influence quality of life that are common to each of these specific interventions. For instance, acceptance by friends and family is an important component of the patient’s quality of life. Similarly, the manner in which the individual’s appearance affects his or her
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