Complex Plastic Surgery Cases

Plastic Surgery Division Tackles Toughest Reconstructive Plastic Surgery Cases

Say the words "plastic surgery" and most people immediately think of cosmetic procedures such as facelifts, breast augmentation or liposuction. But at University of Maryland Medical Center, a long list of far more complex — and perhaps unexpected — procedures also apply, from burn restoration to limb reconstruction to massive hernia repair and more.

In the 25 years since Sheri Slezak, M.D., chief of the Division of Plastic Surgery, arrived at UMMC, the division staff has grown from three to 10 physicians, many working at several affiliate locations and involved in innovative clinical trials that set the program apart from others in the region and the rest of the nation.

"There's been a tremendous growth in plastic surgery … and plastic surgery in a teaching hospital like ours is almost all reconstructive," says Dr. Slezak, who is also a professor of surgery at University of Maryland School of Medicine. "We do a lot of tertiary procedures such as wounds, cancer resections, facial and limb fractures, head and neck reconstruction after cancer and burns. Plastic surgeons treat the skin and its contents, head to toe, male and female, from babies to the elderly."

10 Reconstructive Plastic Surgeons, Multiple Locations

Cosmetic surgery is, of course, part of the extensive offerings of the Division of Plastic Surgery — as well as taught to medical residents here — and Dr. Slezak points to the many locations served by staff members as evidence of the division's wide reach. In addition to the main campus, satellite locations include UMMC Midtown Campus; UM Rehabilitation & Orthopaedic Institute (former Kernan Hospital – cleft palate specialty); UM St. Joseph Medical Center; St. Agnes Hospital; UM Baltimore Washington Medical Center; UM Shore Medical Center at Chestertown, Greater Baltimore Medical Center, and a practice in Timonium.

Dr. Slezak is joined in the Division of Plastic Surgery by Devinder Singh, M.D.; Luther (Tripp) Holton III, M.D.; Rachel Bluebond-Langner, M.D.; Yvonne Rasko, M.D.; Ronald Silverman, M.D.; Nelson Goldberg, M.D.; Michael R. Christy, M.D.; and Branko Bojovic, M.D.

"Nelson Goldberg has been here 30-plus years, I've been here for 25, and we have new, young physicians who have been here just a year, so it's nice to have the interaction between the different levels of experience," explains Dr. Slezak. "We help each other so that we have the perfect blend of experience and new technology.

"Each of us go to separate hospitals … but we discuss difficult cases, show pictures to each other and ask each other's advice," she adds. "That's one of the great advantages of academic practice — you have fellow surgeons to consult with."

New Techniques Improve Outcome

As a tertiary referral center, UMMC handles more complex plastic surgery cases requiring the interaction of many specialties, including oncology, general surgery, trauma and others. Compared to community plastic surgery practices, "there's more interdisciplinary assessment of cases, with physicians working together to come to the best solution," Dr. Slezak notes.

"Plastic surgery is very innovative," she says. "It's not like if you've done one, you've done them all. Every patient is different... it's a very individual process."

Distinctive research on a broad spectrum of plastic surgery topics is helping to single out UMMC in subjects such as wound care, biologic meshes and negative pressure dressings, according to Dr. Singh, the division's director of research and an associate professor of surgery. More than 20 research projects are currently in progress, he says, spread across animal studies, clinical outcomes and clinical trials.

A newer technique helping to improve outcomes is the use of indocyanine green (ICG) angiography to confirm adequate blood flow to skin areas during and after surgery. After the dye is injected, an infrared laser aimed at the skin will show if it's properly perfused, Dr. Singh explains.

"It's really valuable for plastic surgeons because in some way we're like tissue transfer surgeons, often robbing Peter to pay Paul and moving tissue around," he says. "We have to be certain that blood supply to the area is adequate. It's really a big deal because it helps increase patient safety, decrease OR time and lower infections."

Research Explores ICG Angiography and Massive Hernia Repair

Dr. Singh is doing a study which employs ICG angiography to support his theory that the use of negative pressure dressings, or suction, on closed skin incisions serves to increase blood flow under the wounds and improves healing. Typically, negative pressure dressings are used on open, packed wounds, he says, but novel techniques may offer better outcomes for patients.

Another leading-edge research project Dr. Singh hopes to launch is the use of abdominal wall transplants for patients requiring massive hernia repair. These patients, whose abdomens are horrendously distorted from recurrent, huge hernias, may benefit from a transplant of their abdominal wall in much the same way that a few patients worldwide — including at UMMC — are benefiting from face or hand transplants, he says.

Dr. Singh is also experimenting with stronger biologic mesh material for hernia patients that is made from pig skin instead of synthetic grafts. "When the size of a hernia becomes so large, it's better that a reconstructive plastic surgeon uses reconstructive techniques to repair it," says Dr. Singh, who in 2011 was the only plastic surgeon appointed to the Maryland state medical board. "Admittedly, (abdominal wall transplants) would be for the worst of the worst cases, for those whom we've exhausted all alternatives, but for whom this would offer significant improvement in quality of life."

To reach the Division of Plastic Surgery directly, please call 410-328-2360.

Key Points:

  • Division of Plastic Surgery has grown from three to 10 physicians in last quarter-century
  • Plastic surgeons tackle tough cases involving issues such as burns, limb reconstruction and complex hernia repair in addition to cosmetic surgery
  • Plastic surgery patients served in many affiliate locations throughout UMMC system
  • More than 20 ongoing research problems address issues such as wound care, biologic meshes, negative pressure dressings and potential abdominal wall transplants

This page was last updated: June 23, 2014

         
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