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New medical practice restores function for trauma, cancer patients

Army Lt. Col. Owen Johnson III (left), chief, Plastic and Reconstructive Surgery Service, and Dr. Khang Thai, plastic surgeon, WBAMC, utilize a microscope during a microvascular transplant or "free flap" surgery as part of WBAMC's Reconstructive Microsurgery Program. Reconstructive microsurgery is a new practice to WBAMC and includes the autologous transfer of tissue, nerves and bone to trauma, cancer, or birth-related defected areas of patients, restoring function to the affected area. (U.S. Army photo by Marcy Sanchez) Army Lt. Col. Owen Johnson III (left), chief, Plastic and Reconstructive Surgery Service, and Dr. Khang Thai, plastic surgeon, WBAMC, utilize a microscope during a microvascular transplant or "free flap" surgery as part of WBAMC's Reconstructive Microsurgery Program. Reconstructive microsurgery is a new practice to WBAMC and includes the autologous transfer of tissue, nerves and bone to trauma, cancer, or birth-related defected areas of patients, restoring function to the affected area. (U.S. Army photo by Marcy Sanchez)

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EL PASO, Texas — A new procedure at William Beaumont Army Medical Center is opening doors for patients with severe reconstructive needs which are repercussions from cancer, trauma or other deforming events. 

The launch of the Reconstructive Microsurgery Program at WBAMC has brought the latest in reconstructive surgery to beneficiaries with several successful cases already accomplished. 

"It's different from other types of reconstruction (surgery)," said Army Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery Service, who, along with a team of medical professionals, performed the state-of-the-art surgeries. "You're removing a piece of the body completely on its own blood supply, completely separating tiny little arteries and veins from the body, and connecting all the arteries and veins back under a microscope." 

The procedure, specifically free flap and microvascular transplant in Johnson's cases, has been applauded as groundbreaking medicine, with cases as common as breast reconstruction to the extremely complex full-face transplant. 

The use of microsurgery in free-flap procedures isn't new though with origins dating back to the mid-20th century starting with toe to hand transplants. As technology and microsurgery techniques advanced, surgeries have expanded focus from trauma to treatment of cancer with function and aesthetic restoration. 

Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery Service, utilizes a microscope during a microvascular transplant or "free flap" surgery as part of WBAMC's Reconstructive Microsurgery Program. Reconstructive microsurgery is a new practice to WBAMC and includes the autologous transfer of tissue, nerves and bone to trauma, cancer, or birth-related defected areas of patients, restoring function to the affected area. (U.S. Army photo by Marcy Sanchez)Lt. Col. Owen Johnson III, chief, Plastic and Reconstructive Surgery Service, utilizes a microscope during a microvascular transplant or "free flap" surgery as part of WBAMC's Reconstructive Microsurgery Program. Reconstructive microsurgery is a new practice to WBAMC and includes the autologous transfer of tissue, nerves and bone to trauma, cancer, or birth-related defected areas of patients, restoring function to the affected area. (U.S. Army photo by Marcy Sanchez)

"In the past reconstruction was mostly moving tissues around in the area or transferring tissue from somewhere with it still connected to the body," said Johnson, a native of Woodbridge, Virginia. "With the free flap technique, you can take things other than skin (such as bones and muscle to transplant to the affected area). Because the donor tissue can be distant from the target area, it doesn't matter as much where the transplant comes from or where it goes, so reconstruction options are more numerous."

To improve chances for success, Johnson's cases have utilized a multi-disciplinary approach to treating patients. Recent cases included reconstruction of lower lip defects due to cancer with the otolaryngology/head and neck service, and upper jaw reconstruction with dental rehabilitation in partnership with the hospital's oral and maxillofacial surgery service. 

"These cases are more complex than what we have been doing before," explained Johnson. "Every step of the way from anesthesia, logistics and nursing care post-surgery is new to WBAMC." 

Extensive experience with microvascular transplants via four years of trauma and cancer reconstruction has prepped Johnson with the practice necessary to introduce the program at WBAMC. 

Advancements for the cases include patient examinations every 30 to 60 minutes for 24 hours post-surgery to ensure the transplants are successful. 

Also new to WBAMC is the use of CT scan and 3D imaging to allow simulation of the process beforehand with physical models, and as templates throughout the procedure for a perfect "fit." Utilizing an innovative cutting guide derived from the imaging, Johnson is able to use precision cuts to remove the tissue, muscle, nerves and bone necessary to transplant to the affected site. The process is similar to 3D printing techniques via computer-aided design except the surgeon "prints" the design. 

Depending on the complexity of the case, treatment can require several surgeries, with each lasting 8 to 14 hours for completion. 

"When you're sewing together these tiny little vessels (some smaller than a millimeter) the risk of one of those vessels having a problem is pretty high. If the artery shuts down or vein clots off or even bleeding or swelling in other tissues around the transplant can threaten the flap's viability," said Johnson. "The nice thing is that in experienced hands, the success rate is pretty high. It takes a lot of time and investment upfront, but brings a good healthy tissue into an area that may otherwise be radiated or have a huge hole." 

While the surgery is extensive, the multidisciplinary approach saves the patient time and trips to the OR by fabricating and preparing other necessary implants, such as dental implants, prior to the actual surgery and then applying them to the patient at the time of the microvascular transplant. 

"It saves a lot of time because it's done ahead of time," said Johnson. "If you're able to design the tissue, muscle, nerve and/or bone transplant, there's really no limit. That's what is so revolutionary: You can do what you need to do based on these concepts." 

To date, WBAMC's reconstructive microsurgery program has involved four successful transplants, with more scheduled in the near future. Because of WBAMC's unique partnership with the El Paso Veterans Affairs Healthcare System, Veterans requiring reconstruction may now be assessed to see if they are candidates for this treatment at WBAMC.

"If (other departments and the VA) know they have reconstructive choices here at WBAMC, they're able to tackle bigger cases they would otherwise not feel comfortable doing," said Johnson. "The multidisciplinary or transdisciplinary care we are providing is the way of the future. It's increasing collaboration and ultimately will be better for the patients. There's more of a culture of cooperation that's fostered." 

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.

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This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (m), establishes the Defense Health Agency’s (DHA) procedures for acceptable use of DHA IT by authorized and privileged users.

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  • Type: DHA Procedural Instruction
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