Plastic and Reconstructive Surgery — Featured News
Basic science fuels nerve graft success
New methods to restore function to nerve-damaged arms, legs, hands and feet have revolutionized the treatment of peripheral nerve injuries over the past 30 years. Much of the science contributing to these advancements has emerged — and continues to originate — from the Washington University Peripheral Nerve Research Lab.
“Every question that comes up in the clinic, we have looked at in the laboratory,” says Susan Mackinnon, MD, the Shoenberg Professor and chief of the Division of Plastic and Reconstructive Surgery. “We bring the answers we discover in the lab back to the clinic and the operating rooms at Barnes-Jewish Hospital.”
The lab recently tested the use of an anti-adhesive barrier to treat pain from neuroma, which occurs when scarring forms on the branch of an injured sensory nerve. But the lab’s major current focus takes aim at an old problem: the barrier to successful outcomes in nerve graft surgery.
Nerve grafts involve replacing or bridging the injured portion of a nerve with a segment of unrelated nerve — reinnervating muscles or providing sensation where it has been lost. The grafts should be done in a timely fashion; but even when they are, axon growth through longer grafts to restore functional connections is often inadequate. As a possible cause, the lab is looking at Schwann cells — nerve-sheathing cells that help axons cross the graft but undergo premature senescence, or irreversible decay.
The lab is collaborating with cell biologist Sheila Stewart, PhD, an expert in cell senescence, and is in the T1 stage of translational research to understand the senescence process in nerve grafting.
“Ultimately, we’d like to design methods to prevent the Schwann cells from becoming senescent in the first place,” says Matthew Wood, PhD, a biomedical engineer in Mackinnon’s lab. In tissue culture, the Mackinnon lab is investigating drugs to potentially block inhibitory proteins from the Schwann cells to allow better axon growth.
Wood says he and Mackinnon each bring different perspectives to the research. “It’s wonderful to work with a physician on this type of research to more quickly understand the medical problems that otherwise could take a number of years to fully appreciate.”
Smile is surgeon’s best reward
After being born with incomplete facial paralysis on the right side of her face, six-year-old Courtney Shepard is learning what a full smile can do.
Tom and Tracy Shepard, Courtney’s parents, brought their daughter to pediatric plastic surgeon Alison Snyder-Warwick, MD, when Courtney was 4. One year later, the surgeon performed surgery to improve the symmetry of her smile — a procedure offered at a limited number of centers nationally. In the procedure, Snyder-Warwick moved muscle from the thigh to the face, connecting the masseteric nerve and facial arteries and veins to the muscle.
It takes about three months for the nerve to grow into the muscle. “Courtney noticed movement about 10 weeks after surgery, and by May 2015, she could smile broadly,” says Snyder-Warwick.
Courtney was initially uncertain about surgery, but now she appreciates her smile and frequently tells her parents, “Check my symmetry.”
“She is doing wonderful,” Tracy says.
- At the Department of Surgery’s first annual Patient Safety and Clinical Effectiveness Meeting, Donald Buck II, MD, and plastic surgery resident Minh-Bao Le, MD, presented a study on preparedness of plastic surgery residents for operations. The study found that 100 percent of residents prepare for cases the night before, but only 70 percent adequately review the patient’s medical history. The study concludes that training residents in case preparation will become more important as hospitals place greater emphasis on patient safety and quality improvement.
- Plastic surgeons have added a white board with surgical and patient information in the plastic surgery operating rooms in the North Campus of Barnes-Jewish Hospital. The right-hand side displays the steps of the operation for the benefit of plastic surgery residents. The left side lists the patient’s initials, age, medical history, physical examination results and other information. By making that information easily accessible, the goal is to fully engage the entire surgical team in care of the patient.
- Albert Woo, MD, received a grant from The Foundation for Barnes-Jewish Hospital to fund a 3-D printer that will be used to create craniofacial models that guide him in the operating room. See article on page 18.