PS News: Issue 10, December 2011

Chair’s Column

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Dr. Christopher R. Forrest
Division of Plastic and Reconstructive Surgery
Interim Chair

“Vision is the art of seeing things invisible”. – Jonathan Swift

I am honored to have been asked by our Department Chair, Dr. Jim Rutka to act as Interim Chair for the Division of Plastic and Reconstructive Surgery following Dr. Dimitri Anastakis’s move into the Dean’s office as Vice-Dean, Continuing Education and Professional Development, Faculty of Medicine, University of Toronto. While I was disappointed that the office furniture was to remain unchanged (I had been looking forward to having something better to sit on), it is somewhat humbling when I think of the former occupants of this position and recognize how the division has gone from strength to strength over the 25 years that I have been associated with the University of Toronto Division of Plastic and Reconstructive Surgery.

In his recent annual address, Professor Rutka talked about his BHAGs for the Department of Surgery (Big Hairy Audacious Goals) and how he wants to improve our standing on the world stage. The term “interim” [in-ter-uh’m] is defined as a temporary or provisional arrangement, a stopgap or makeshift for an intervening period of time. However, it doesn’t mean that things have to be put on hold and as such, I plan to pick up Jim’s challenge and strive to make our division the best in its class.

The first order of business as Interim Chair is to recognize the tremendous work and energy that Dimitri invested in our division and to thank him for his efforts. As he said in his last column as Chair, 5 years goes by quickly and it is important to appreciate the growth and development his leadership brought to the division culminating with a celebration of 90 Years of Plastic Surgery in Toronto at the last Gala Graduation Dinner in June. Many thanks to Dimitri and best wishes for continued success in his new position in the Dean’s Office. It is good to have friends in high places!

I would also like to recognize the tireless contributions of our Program Director, Dr. Mitch Brown who truly represents the backbone of the division. His level of commitment and fairness in ensuring that our trainees have the best possible training experience is something that should never be overlooked.

My next task is to announce that the Plastic Surgery Executive Committee will be expanding with the addition of Dr. Kyle Wanzel as Associate Program Director and Dr. Greg Borschel as Associate Research Director for the division. This additional manpower will allow an expansion of scope and provide energy for important new initiatives that I will highlight in the coming year.

The Division is looking forward to hosting the 66th annual meeting of the Canadian Society of Plastic Surgeons in Toronto from June 5th to 9th 2012. We would like to show our colleagues that Toronto’s reputation as a cold and impersonal space applies only to Bay Street and not to University Avenue and hope that former graduates and alumni take advantage of the opportunity to visit.

The Adjacent Possible

As I was heading for the ASPS meeting in Denver last fall, I did my usual tour of duty around the airport concessions and loaded up for the trip. Vanity Fair, Rolling Stone, Guitar Aficionado, People and US magazines – brain candy for the 4-hour flight just in case I had seen all the good movies.  I happened to glance across to the book section and my attention was held by Steven Johnson’s latest “Where good ideas come from: The natural history of innovation”. Steven Berlin Johnson is a brainy 43 year old English lit grad from Columbia who established his reputation as a popular American science author with “Everything bad is good for you: How popular culture is actually making us smarter”.  In this easily read book, he demonstrates how the increasing complexities of pop culture have helped enable higher-order thinking skills. His latest book explores the concepts of how great ideas develop and he convincingly makes the argument that innovation is a slow and methodical process based upon the concept of the “slow hunch” as opposed to the “eureka moment”. As Plastic and Reconstructive Surgeons, we think of ourselves as innovators, not just in techniques but also in hardware – there are a ton of examples that come to mind: the small microsurgical needle, bioresorbable plates and screws, CAD-CAM technology, endoscopic instrumentation to mention a few. There is much to be learned in his book but the first chapter talks about the concept of the “adjacent possible” a term first coined by Stuart Kauffman. In his original work, Kauffman used the term “adjacent possible” to describe the untapped potential of what could be but Johnson expands on the term and feels it  “captures both the limits and the creative potential of change and innovation.” He talks about how we are often better served by connecting ideas than we are by protecting them. Environments that build walls around good ideas are less innovative than those in which a free transmission of information is available. Good ideas are not conjured out of thin air but are built from a collection of existing parts. The adjacent possible emphasizes the importance of seeing the ever-present set of opportunities at the boundaries of our reach and stresses the importance of capitalizing on the resources close at hand. A great example he uses in the book relates to the harrowing rescue of the astronauts on Apollo 13 and how the mission control engineers successfully created an improvised carbon dioxide filter with a limited armamentarium of resources.

So what does all this have to do with the Division of Plastic and Reconstructive Surgery at the University of Toronto? One of the strengths of our division is also one of its criticisms and that relates to the diversity and size. We are large. Huge in fact. We have a staff of 44 surgeons and as many house-staff at 10 geographic sites with a distance of 58 km separating Toronto East General Hospital on the east and Trillium Health Centre on the west. We see each other at meetings more than we do in the city. However, we have a fantastic resource available at our fingertips and that relates the opportunities we can generate through communication and interaction through the levels of expertise that exists within the division.

How can we capitalize on the concept of the adjacent possible? I think it is from an enhanced opportunity for interaction and information exchange. While my own specialty of pediatric craniofacial surgery is quite distinct and separate from aesthetic surgery, an impromptu chat at a recent national meeting with a colleague from SoCal led me to think about the importance of fat as a supporting structure for the facial soft tissues. My traditional thought processes had always placed emphasis on the intrinsic strength of good old bone but his application of fat injections for facial rejuvenation made me think about its application in patients with zygomatic hypoplasia and eyelid malposition which I put to the test when I returned home. An example of the adjacent possible! As the quote highlights, vision relates to seeing potential opportunities and taking advantage of them. We have tremendous talent and energy within our faculty and trainees and I am looking forward to capitalizing on this to explore our divisions “adjacent possible” in the coming months.

For those of you who are looking for interesting reading over the holiday season, check out this link from the New Yorker magazine that was sent to me a couple of weeks ago by Dr. Ralph Manktelow, former Chair of the Division http://www.newyorker.com/reporting/2011/10/03/111003fa_fact_gawande. It was written by Atul Gawande and talks about the importance of performance and the effect that a coach can have. He makes the point that physicians, especially surgeons, do not have a coach and that given the high level of expectation around what we do, perhaps something should be done about that. Perhaps the only time we get critiqued by our peers is during M&M rounds. Anyhow, I include this out of interest for those of us who are striving to become the best at what we do and would like to thank Ralph for his continued interest in performance enhancement.

And finally, given that we are coming up to the end of the year, I have decided that this newsletter should not be left out from the likes of the New York Times, Globe and Mail and the Economist and as such, I have made a list of some of the highlights of the past 12 months (apologies to anyone who thinks I should have included Lady Gaga’s TO concert).

Top Ten List of 2011 (in no particular order)

1. IPRAS 2011

2. Successful program graduates: Drs Karen Wong, Mary-Helen Mahoney, Amer Al-Kudmani

3. The Gala Graduation Dinner in June 2011 and celebration of 90 years of Plastic Surgery in Toronto.

4. Recruitment of Drs Laura Snell and Joan Lipa to Sunnbrook Health Sciences Centre with creation of a Breast Centre and  enhancement of the Sunnybrook Division.   Recruitment of Dr. Christine Novak to the Dept. of Surgery, University of Toronto, University Health Network Hand Program and the Toronto Rehabilitation Institute.  Recruitment of Dr. Manuel Dibildox to the Ross Tilley Burn Centre at Sunnybrook Health Sciences Centre.

5. The Fellows in the Division of Plastic and Reconstructive Surgery

6. A continued commitment to research and education from our industry partners IAMGOLD, MENTOR Canada (Johnson & Johnson Medical Companies)Synthes Canada, Stryker, Allergan and Medicis Aesthetics Canada.

7. Hoyle Campbell Visiting Professor Dr. Joseph Losee and the Division of Plastic and Reconstructive Surgery Research Day organized by Dr. Joel Fish

8. A successful 5-year review for Dr. Dimitri Anastakis

9. IAMGOLD and their commitment to Global Health with Dr. Leila Kasrai

10. Kathy Pavlovic – our fantastic Division Administrator

At this time, I would like to wish all of you and your families all the best for the holiday season and a safe and healthy 2012. I look forward to the coming year and all its challenges and to working towards making our division with its fine faculty and exceptional trainees, the best in the world.

In Memoriam

The Division lost two of its former valued members in the past year.

Dr. E. Peter McDougall passed away on September 1, 2011. Peter was born in Toronto on November 22, 1932 and attended De La Salle College where he demonstrated his superior skills as an athlete on the rink and football field. He graduated from the University of Toronto Medical School and performed his training in Plastic Surgery in the Gallie Program before joining the staff at St. Michael’s Hospital. Peter was the former Chief of the Division of Plastic Surgery at St. Michael’s Hospital and a past president of the Canadian Society of Plastic Surgeons. He retired from clinical practice in 1998 to his farm property in Duntroon near Collingwood. Peter was a superb clinical teacher and had a great eye. He is survived by his wife, Dorothy, brother Hugh, sons Ian and Kevin, daughter Terri and five grandchildren.

Dr. Leith Douglas was a fixture in our division for many years and passed away on September 15, 2011 at the age of 80.  Leith was born in Charlottetown, Prince Edward Island and was the son of the late Ira and Ella Douglas.  He is survived by his loving wife Lorna, his daughter Ellen, son-in-law Peter Woodward and his three beloved grandchildren Julian, Caroline and Liam of Cobourg, Ontario.

Eulogy given by Dr. Arnis Freiberg:

About a year ago, during one of our semi-regular dinners with Leith, Lorna and I, after the reminiscences and funny stories about our residencies, which Leith was very good at, he became serious and asked me to promise that I would say a few words at his funeral. To-day I am fulfilling this promise, and would like to share some of my thoughts and memories with you.

Leith and I have been friends for the past 40 years. In 1963 we became co-residents in our plastic surgery training program. That year there were three of us, Al Taylor was the third trainee that year. One year, my wife Ruth and I were invited by the Douglases  to celebrate with them  New Years Eve. This was in a small apartment in Don Mills, the venue  was later moved to the current home and the party included many of their neighbours. It became an annual event, I do not think that I missed more than two over the next thirty some odd years. True to his Scottish heritage, Leith often greeted us in his Douglas tartan kilt, which he also wore to the gala dinner when he was the president of the Canadian Society of Plastic Surgeons.

Let me tell you about Leith and some highlights during our friendship.

Leith was an amazing and  entertaining story teller and imitator. He could imitate not only our fellow Galley slave Al Taylor but also our numerous teachers, who shall remain nameless to protect their identity.

Both Leith and I did a year of research in WK Lindsay’s research lab. And therefore, became  members of the so called “Chicken Club”. Every Wednesday late afternoon we had a meeting with WK to report our progress, or the lack of it, over the microscope. Invariably our reports were less than stimulating, and because of the late hour, WK often dozed off and nearly hit the microscope with his glasses. Leith was a master imitator!!

Leith had a brilliant mind. He finished medical school at Dalhousie with a silver medal. During our last few months of our residency we were obviously studying for the big exam and spoke to each other weekly, until one day Leith informed me that he was now going through the standard plastic surgery text books for the second time, and I was only half way through my final study notes. That was the last time that I called him to talk about studies for the exams!!

This brought us to the final Royal College exams in 1967 which were held in Montreal. After some anxious moments after the oral exams,[anxious  for me]  we fortunately both passed, we were joined by Lorna for a good meal and more than a few drinks. This was followed by a pub crawl in an ankle deep first snow in Montreal’s steep hills, for which we were certainly not prepared for, but did not mind. We parted for the night and promised to meet during the train ride back to Toronto. This however did not materialize,mainly because of a case of bad hangover!!

On a more serious note, let me tell you about Leith for those of you who are not familiar with some of his academic life.

After the final exams Leith did a one year fellowship in Sweden with a well known plastic surgeon Dr Tord Skoog. During this time, and as part of the fellowship, he spent many hours assisting Dr Skoog writing his classic textbook. They became good friends and as the result Leith later went back to Sweden on several occasions to put the final touches to the book.

In 1983, while he was the Historian of the Canadian Society of Plastic Surgery, he wrote and published the only book of the history of the Canadian Society of Plastic Surgeons. It is my understanding that volume number two is in the works.

Upon his return to Toronto he was appointed to the staff at the Wellesley Hospital where he  practised until the closure of the hospital, which was one of the low points of his surgical career. While at the Wellesley he developed an  interest in burns and an admiration for Dr Tilley which resulted in the formation of Dr Tilley’s burn fellowship which is still active. Dr Tilley was well known during the second world war as a military plastic surgeon and  treated many English soldiers with mainly facial and hand burns. Patients from the East Grinsted Hospital in England formed ” The Guinea Pig Club” during the war years and it continued to flourish after the war. Dr Tilley was named the Canadian wing of the club which met yearly. Following Dr Tilley’s death Leith sort of took over and for a while enjoyed contact with some of the members.

Outside medicine Leith was a dedicated and proud member of the Canadian Navy which was based in Halifax. Leith loved to tell stories about his naval experiences and adventures.

Shortly after he started to work at the Wellesley he called me one day and told me that he was offered a position as one of the team doctors of the Toronto Maple Leafs. He asked me for advice and I told him: of course to take it. He also wondered if I would be able to fill in for him from time to time. And of course I agreed, however I am still waiting because I do not think that he ever missed a game! He told me that he thoroughly enjoyed this experience and the players came to him with various problems, some unrelated to medicine. The man who often opened and closed the doors to the players bench became a fixture to the many thousands of TV watchers on Saturday nights. His first disappointment came when the player’s benches became too short and Leith had to watch the games from the stands. The second low point in his hockey career came when the club decided to get a new team of doctors. It affected him so much so that he told me that he had not watched another Leafs game since. Despite this, the Harold Ballard and related stories continued long after. Leith was a very talented and entertaining story teller. It was also interesting to me how a man who had never played hockey became so interested and involved in the game.

Leith, although you are no longer with us, you will always remain in my memory as one of my best friends. For that I thank you!

Program Director’s Report

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Program Director
Dr. Mitch Brown

It seems as if the academic year just started, but as I write this report we are already half way through the calendar. The Division of Plastic and Reconstructive Surgery welcomed four new residents to our program; Joseph Catapano (University of Ottawa), Kathryn Isaac (University of Toronto), Ryan Austin (University of Toronto) and Katie Armstrong (University of Toronto).  This brings our total complement of residents to 27.  Dr. Siba Haykal has embarked on her PhD after two successful years doing her Masters work in the Surgical Scientist Program (SSP). Dr Jennica Platt entered the SSP this summer and will be working with Drs Nancy Baxter and Toni Zhong .

The CARMS selection  process is now underway for next year’s residents and the Residency Program Committee (RPC) has begun their review of all of the applications. There are 57 candidates for the four Canadian Medical Graduate positions and 81 candidates for the one potential International Medical Graduate position. The RPC is working to improve the process of our selection of new residents. As such, this year we will be implementing a standardized psychometric test to all candidates invited for interviews, which we hope will provide us with a more in depth understanding of the strengths and weaknesses of each applicant. We will also structure our interview process with standardized questions so that there is less variability between the mini interviews that each candidate undergoes.

A new addition to our already busy academic curriculum has been the Resident Presentation Series. Our first evening was held at the home of Dr. Michael Weinberg and we expect to have at least two such sessions per year. Residents who have given presentations at local hospital rounds are invited to present to their resident peers and faculty, so that all residents can learn from their colleagues excellent work.

The first six months of 2012 will include a number of exciting educational programs and activities. The popular PGY2 boot camp, under the direction of Dr. Paul Binhammer will begin in January. This unique skills program assists junior residents to prepare for the role of a senior plastic surgery resident. Our annual visiting professor is scheduled for February 9th and 10th, 2012. This year, we are pleased to welcome Dr. Michael Bentz from the University of Wisconsin School of Medicine and Public Health.  Other events include the 41st Annual Toronto Aesthetic Surgery Symposium, the 11th Annual Toronto Breast Surgery Symposium, as well as an AO North American Hand and Wrist Fracture Management Workshop organized by Dr. Paul Binhammer.  Our second Resident Graduation Dinner is scheduled for  June 21st, 2012.  We look forward to celebrating a momentous occasion with our graduating residents and their families.

Finally, the 66th Canadian Society of Plastic Surgeons annual meeting will be held in Toronto June 5-9, 2012 at the Toronto Hilton Hotel.  It has been many years since Toronto hosted the CSPS meeting. Our entire faculty and residents are excited about having  the meeting in our own backyard and the residents will be preparing to show  the plastic surgery trainees from across the country a fantastic time.

Wishing everyone a happy and healthy holiday season!

Fellowship Update

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Fellowship Director
Dr. Toni Zhong

This year has seen another extremely successful year for our Division’s Fellowship Program. We currently have 22 clinical and research fellows in the Division of Plastic and Reconstructive Surgery from across 4 continents including North America, Europe, Asia, Australia/New Zealand. This year we will have the second Annual Graduation Gala Dinner in the spring to honour our graduating residents and fellows. We hope to see as many of you there as possible.

www.UofTPlasticSurgery.ca

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www.uoftplasticsurgery.ca
Kathy Pavlovic

Coming soon:

NEW Microsite entitled “Burn Prevention – Africa”.  Look for this new launch in the new year 2012.  This new microsite will connect the ongoing collaboration between the Division of Plastic and Reconstructive Surgery and the African Medical and Research Foundation (AMREF) for a needs assessment in reconstructive surgery in East Africa.

Growing interest in our website:

With the use of Google Analytics, the program which monitors our website traffic, utilization and time spent on any given page of the site, we have captured the continued growth of this website from its initial launch in March 2008.  Almost four years later, during the period of November 14th – December 14th, 2011, we had a total of 4,299 visits in that one month alone.  There were 14,166 pageviews and 3.30 pages viewed/visit.  Visitors spent on average 2.07 minutes on our website and 66.20% of all visits were new visits. Traffic sources included 72.83% from Search Engines, 15.963% from Referring Sites and 11.21% Direct Traffic. Interestingly, there were 3,270 unique visits and all visitors came from 85 countries in that one month alone.

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Site Speed Reports
Google Analytics allow us to learn which pages on our site load slowly. Slow loading pages often cause visitors to leave in frustration. By reviewing the site speed reports, we can see the average load time by page.

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Webmaster Tools in Google Analytics help us to understand more about our site’s performance, allowing us to understand how our site drives user engagement from Search (impressions, clicks, click through rate, and average position).

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Google Analytics has expanded support for 40 Languages
and is now available in 9 additional languages: Arabic, Hebrew, Croatian, Hindi, Latvian, Romanian, Slovenian, Serbian and Ukrainian.

Link to detailed map showing locations of unique visits to our website.

Alumni News

Greetings from Dr. Mary-Helen Mahoney!

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Luke James, Mary-Helen & Steve

Mary-Helen had a beautiful healthy baby boy, Luke James, at the end of her residency on June 29th. She has since been enjoying motherhood immensely! Since graduating she has started a locum at North York General Hospital. Life is excellent!!

Other Stories

Breast Reconstruction Awareness Day – October 19, 2011

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October 19, 2011 saw the inaugural Breast Reconstruction Awareness Day (BRA Day).  This initiative was started by Dr. Mitchell Brown after he recognized an ongoing problem with education and access for reconstructive breast surgery.  Dr. Brown struck an organizing committee with representation across the country of plastic surgeons, nurses, industry and patient advocates.

To mark this historic day events were held all across Canada to promote both awareness and patient access to reconstructive breast surgery.  Events were organized on both the local and regional grass roots level in order to take advantage of the unique environments, populations and diverse resources that exist across Canada.  A variety of efforts were created to help raise awareness of BRA Day.  Sleep Country Canada, a major mattress retailer, displayed BRA Day posters in their stores, Okanagan Health Group and their supporters had a wrap-around bus banner travelling for five days, fund-raising t-shirts were created and sold and Dr. Nick Guay launched the Canadian collaboration on breast reconstruction information website.  A flash mob was held in Kelowna, BC with almost 100 people dancing in support of National Breast Reconstruction Awareness Day.  Over 20 events were held across the country.

The BRA Day committee have received commitments from the United States, Israel, Australia and New Zealand to initiate BRA Day in their countries in 2012, making this a truly international event.  Please find further information about BRA Day on the web at www.BRA-day.com, twitter at http://twitter.com/mybraday, on facebook at www.facebook.com/breastreconawareness and by e-mail at info@bra-day.com

Fun Events

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Birthday Celebration!!

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Hospital Updates

St. Joseph Health Centre

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This November 4th, St. Joseph’s Health Centre hosted its 56th Annual Clinical Day.  Ontario’s Chief Coroner, Dr. Andrew McCallum, FRCPC, was the keynote speaker.  He discussed how analyzing “coroner’s cases” can elucidate systemic safety issues in health care facilities.  Another enlightening lecture was given by our new opthomologist on:  “How to Blind Your Patient with a Prescription – An Update on Common Drugs and their Ocular Side Effects.” The highlight of the event was when Dr. Kyle Wanzel was given the St. Joseph Health Centre’s Department of Surgery Teaching Award for 2011.  Congratulations to Kyle!  Earlier in the year, Dr. Levine was awarded the St. Joseph’s Health Centre’s Division of Plastic Surgery Best Teacher Award.

Over the past 6 months, much progress has been made in the East African (Kenya) project funded by the IAMGOLD corporation.  We have identified burns as our area of focus.  Care of burn patients is one of the most expensive and resource intensive areas in plastic surgery.  Governments of East Africa allocate very little health care funding to burn patients.  As a result, burn patients have extremely high rates of mortality and morbidity.  Hence, we have identified burn prevention as the area of greatest need.  The ultimate goal of the project will be, in collaboration with AMREF, to implement burn prevention programs across East Africa.  In order to tailor the eventual burn prevention program to the leading causes of burns, we have designed both a cross-sectional and a qualitative research protocol to analyze the factors leading to burns in children in Kenya.  The project with be conducted in urban, rural and slum settings.  To date, very little descriptive research on burns in Kenya has been documented in the literature. We are currently waiting for the final approval from the AMREF Ethics Committee and hope to start the project in February of 2012.

University Health Network (UHN)

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Dr. Stefan Hofer

Staff

Dr. Toni Zhong obtained a Masters of Health Science Degree in Clinical Epidemiology at the Harvard School of Public Health in March 2011. Her Master’s thesis paper was published in the Annals of Surgical Oncology entitled: Comparison of Surgical Complications between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy-An Analysis of 391 Procedures. 2011 Jul 27 [Epub ahead of print] with co-authors Hofer Stefan OP, McCready DR, Jacks LM, Cook FE, Baxter N.

Dr. Zhong was appointed as the Breast Cancer Reconstruction Fellowship Coordinator as well as the Clinical Fellowship Coordinator for the Division at the University of Toronto.

Research Grant Funding Update

Utilization of Breast Reconstruction in the Treatment of Breast Cancer in Ontario and Identification of Barriers to Access: A Population-Based Study.  Toni Zhong, Nancy Baxter, David Urbach, Rinku Sutradhar, Stefan OP Hofer, Melinda Musgrave, Kristen Davidge, Jennica Platt: Canadian Breast Cancer Foundation – Ontario Region.  ($257,474 from 2011 – 2014.)

The use of transversus abdominis plane (TAP) block in autologous breast reconstruction donor site: A randomized, double-blind, placebo-controlled trial.  Toni Zhong, Srinivas, Coimbatore; McCluskey, Stuart; Hofer, Stefan OP: Educational Foundation – Canadian Society of Plastic Surgeons – Outcome/Clinical Study Research Grant 2010 – 2011.  ($10,000 from 2011 – 2012.)

The use of transversus abdominis plane (TAP) block in autologous breast reconstruction donor site: A randomized, double-blind, placebo-controlled trial.  Toni Zhong, Srinivas, Coimbatore; McCluskey, Stuart; Hofer, Stefan OP: Plastic Surgery Educational Foundation – American Society for Reconstructive Microsurgery – Combined Pilot Research Grant.  ($10,000 from 2011 – 2012.)

Awards

In June 2011, Dr. Toni Zhong was awarded with William K. Lindsay Faculty Research Mentor Award, Division of Plastic Surgery, University of Toronto 2011.

Global Plastics Outreach

The division has established several National and Global Plastics clinical outreach programs and volunteer humanitarian activities including several missions per year at the Dryden Regional Health Centre (DRHC) in Northwestern Ontario led by Dr. Stefan Hofer and the Women for Women Program sponsored by the IPRAS in collaboration with Friendship and the Emirates Floating Hospital in the Northern Chilmari region of Bangladesh led by Dr. Toni Zhong.

Who was also recently appointed the Director of Bangladesh-Canada Chapter of the Women for Women Foundation and the Co-Director of Research for WFW.

The Emirates Floating Hospital on the bank of the Ganges-Brahmaputra River that provides medical and surgical services to 4 million people of the Char region in Bangladesh.

Clinical and Research Fellows

Dr. Anne O’Neill from Ireland began her microsurgery fellowship from July 2011 to June 2012.  Dr.’s Michelle Locke and Natalie Ngan from Australia and New Zealand have successfully completed the Breast Reconstruction Fellowship Program at UHN and WCH.

Research Staff

We are pleased to announce that Dr. Christine Novak has recently been recruited and appointed as an Associate Professor in the Division of Plastic & Reconstructive Surgery, Department of Surgery, as a Scientist at the Toronto Rehabilitation Institute and a Research Associate at the University Health Network in the Hand Program (Toronto Western Hospital). Dr. Novak has expertise in peripheral nerve research and will focus on clinical outcomes and assessment of patients with musculoskeletal disorders, particularly nerve injury and nerve compression.

The UHN Division would also like to welcome Shaghayegh Bagher as a Research Analyst and database manager for the UHN research program.

Hospital for Sick Children

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Dr. Christopher R. Forrest

Introduction

It has been a banner year for the Division of Plastic and Reconstructive Surgery at the Hospital for Sick Children. Geographic localization of the offices on the Fifth Floor, renovations to the nursing unit on 8C, multiple visits from observers and students from around the world and meetings, meetings, meetings! The major event of 2011 was of course the IPRAS Meeting in Vancouver.  Dr. Ronald M. Zuker was proud to serve as President of IPRAS, Vancouver 2011 and did a spectacular job.  The meeting was a huge success in every way, with outstanding attendance and scientific program, and a significant profit even though we did not charge anything extra for special lectures, courses or seminars. During the meeting, a special dinner was hosted by the Division to honor the teaching contributions of Dr. Zuker with 35 former and current fellows participating. While this was an energetic and spontaneous affair, it must be noted that the streets of Vancouver were perfectly safe as the participants spilled out of the restaurant and in no way was a harbinger of things to come.

The hot topic in Plastic and Reconstructive Surgery in the past few years has been composite tissue transplantation and I am pleased to announce that SickKids is leading an initiative in this area with Dr. Ron Zuker acting as Deputy Chairman for a combined UHN-SickKids CTA initiative which falls under the Transplant Program managed by Dr. Gary Levy at UHN. A submission for program status has been made to the Ministry of Health and Long Term Care. While there are a number of logistic and biologic hurdles that need to be conquered before CTA become a reality in the pediatric population, it is critical that a protocol to handle composite allograft transplants in children be formulated and ready for implementation.

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Business as usual. From left to right: Drs. Matthew McRae, Regan Guilfoyle (PGY4 – Edmonton), Karen Cross, Tom Sitzman, Adel Fattah, Ehud Arad, Alison Snyder-Warwick and David Khechoyan. Another routine day at work for the house-staff at the Hospital for Sick Children!

Special Events

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Mark your calendars! June 12, 2012 is the date for the annual Lindsay-Thomson Pediatric Plastic Surgery Symposium and this year’s Vale Lecturer is Professor Yu-Ray Chen from Taipei, Taiwan. Dr. Chen is one of the founding members of the International Society of Craniofacial Surgery and a former fellow at the Hospital for Sick Children where he trained with Dr. Ian Munro. The symposium is multi-disciplinary and will cover hot topics in Pediatric Plastic Surgery and provide an overview of state of the art in the management of infants, children and young adults with congenital and acquired problems. For registration details, please contact Ms. Dyanne Bechard at dyanne.bechard@sickkids.ca.

Departures

The Division would like to acknowledge the outgoing fellows from the previous year for all their hard work and dedication. Dr. Mike Bezuhly is currently completing a fellowship in Craniofacial Surgery with Drs. Eric Arnaud and Daniel Marchac in Paris and is scheduled to assume a staff position at the IWK Hospital in Halifax, NS. Dr. Jonathan Burge has just finished a 5-month fellowship in head and neck reconstructive surgery in Cochin, India and has just arrived back home in Auckland, NZ where he will be starting his practice in Pediatric Craniomaxillofacial surgery. His co-fellow and partner-in-crime, Dr. Brooke French has successfully established her practice in Pediatric Craniomaxillofacial Surgery at Denver Children’s Hospital and is expecting her second child with her husband, Jason who is a staff pediatrician at the same hospital. Dr. Isaac Harvey has returned to Australia with his family and is somewhere near Adelaide. And finally, Dr. Adel Fattah is on track to become the best trained Plastic Surgeon in the history of the specialty and is currently half-way through his fellowship in Pediatric Craniofacial Surgery at the Hospital for Sick Children before embarking on a microsurgery fellowship back home in the UK. This team of fellows was truly exceptional and we would like to take this opportunity to wish them well.

Staff News and Travels

Division members racked up the air miles in the fall attending meetings all over the world! In October, Dr. Christopher R. Forrest attended the Cleft 2011 Meeting in Melbourne, Australia as the Invited Guest Speaker and delivered 5 lectures to an audience of 150 trainees and surgeons. This meeting is held every 2 years and was organized by Dr. David Chong who is a former SickKids fellow. The SickKids division has strong ties with our Antipodean colleagues and have trained surgeons in all the major units across the continent. It was a great opportunity to meet former and potential new fellows and enjoy a seriously excellent flat white.

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From left to right: CRF with former fellows Dr. Jonathan Wheeler, Dr. Jonathan Burge and Dr. David Chong.

Dr. Christopher R. Forrest accepted the position of Interim Chair for the Division of Plastic and Reconstructive Surgery in November following the departure of Dr. Dimitri Anastakis. Dr. Anastakis has moved to the Vice-Dean’s Office in the Faculty of Medicine.

The Chang Gung Mayo Clinic Symposium in Reconstructive Surgery was held in Taipei, Taiwan in October 2011 and our division was well represented by the presence of Drs. Borschel, Zuker and fellow Dr. Alison Snyder-Warwick. Dr. Zuker was as the Honorary Chairman for the Instructional Course in Facial Palsy.  This took place at the Chang Gung Linkou Medical Center in Taiwan, from October 25th to October 27th.

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From left to right: Dr. Stuart Bade (former SickKids fellow currently in Brisbane, Australia), RMZ, Dr. Alison Snyder-Warwick, Dr. Greg Borschel.

SickKids Researchers Take Shape to the Next Level

While there is no such thing as the “perfect” head, Craniofacial Surgeon Dr. John Phillips hypothesized that data collected from the CT scans of babies born with normal head shapes could be averaged and used to create virtual 3D models.  Once fabricated, these models could then be used as templates for reshaping the heads of patients up to 12 months old who require cranial vault reshaping surgery to achieve an aesthetically normal skull contour.

Dr. Phillips engaged the Centre for Image Guided Innovation and Therapeutic Intervention (CIGITI) at SickKids, and worked with Dr. Peter Kim, Dr. Nikoo Saber and Mr. Thomas Looi to further develop this vision.  The team successfully created a methodology for the technology. After working with the Industry Partnerships & Commercialization office to establish clear goals and commercialization options, a company called Medical Modeling Inc. in Golden, Colorado, expressed an interest in licensing the technology. The fit was perfect, and Medical Modeling Inc. sealed the deal by signing an exclusive license with SickKids to manufacture and sell normative skull model templates world-wide. As teaching and pre-operative planning aids, these templates will have a long-lasting, positive impact on patient outcomes around the globe.  In addition, surgeons using the templates could see a reduction in operation times which, in turn, would mean an increase in the number of patients that can be treated.

For additional information regarding this story contact Heidi Falckh, Senior Project Manager (heidi.falckh@sickkids.ca).

Publication:  “Application of CAD/CAM Prefabricated Age-Matched Templates in Cranio-Orbital Remodeling in Craniosynostosis”. Jonathan Burge, BHB, MBChB, FRACS(Plas),* Nikoo R. Saber, PhD, Thomas Looi, PhD, Brooke French, MD,* Zoha Usmani, Niloofar Anooshiravani,* Peter Kim, FRCSC, PhD,* Christopher R. Forrest, FRCSC, PhD,* and John Phillips, FRCSC*. The Journal of Craniofacial Surgery & Volume 22, Number 5, September 2011, Pg 1810-1813.

“Generation of normative pediatric skull models for use in cranial vault remodeling procedures.”Nikoo R. Saber & John Phillips & Thomas Looi & Zoha Usmani & Jonathan Burge & James Drake & Peter C. W. Kim. Received: 13 October 2011 / Accepted: 31 October 2011. Childs Nerv Syst.

Awards

Dr. Mike Bezuhly was the recipient of the 2011 Lindsay Research Award in Pediatric Plastic Surgery. Dr. Bezuhly’s award winning paper was entitled “Impact of 22q deletion syndrome on speech outcomes following primary surgery for submucous cleft palate.” and was performed under the supervision of Dr. David Fisher. This yearly award was established in 2008 in honor of Dr. William K Lindsay, former Professor and Chair of the Division of Plastic Surgery in recognition and support of research in the field of Pediatric Plastic Surgery through a generous donation from his wife, Mrs. Peggy Lindsay.

Dr. Greg Borschel was the recipient of a 3-year CIHR grant to assess opportunities for improving functional recovery after peripheral nerve injury with his co-investigator, Dr. Tessa Gordon. In the current funding climate for research, this is an exceptional achievement and Greg and his team are to be congratulated.

Dr. Greg Borschel was recently inducted as a member of the Sunderland Society. This is quite an important achievement and is by invitation-only for a select group of recognized leaders in the fields of nerve repair and plastic surgery. Greg joins Dr. Howard Clarke in this prestigious society.

Dr. Ronald Zuker was the recipient of the “Fu Chan Wei Award” at the Chang Gung Mayo Clinic Symposium in Reconstructive Surgery in 2011. This was to honor his contributions in facial reanimation surgery and was named after Dr. Fu Chan Wei who actually trained as a fellow in Toronto with Drs. Zuker and Manktelow.

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Dr. Fu Chan Wei (recipient of bilateral “smile” procedure with a great result!) and Dr. Ron Zuker.

At the 2011 Chang Gung Mayo Clinic Symposium in Reconstructive Surgery, Pediatric Plastic Surgery Fellow Dr. Alison Snyder-Warrick was awarded the best paper for her presentation on “Axonal Counts for Free Muscle Transfer for Facial Paralysis”.

Dr. Howard Clarke was fortunate to have been invited as a guest speaker at two meetings in India in February 2011.  The first was the 17th Annual Conference of Paediatric Orthopaedic Society of India held in Chandigarh in northern India where he spoke on primary and secondary surgery for obstetrical brachial plexus palsy.  This was followed by the 4th Biennial Meeting of Brachial Plexus Group of India (Brachialcon) meeting in Bangalore. While in India he had the pleasure of making many new friends (below).

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House-staff News

The division was fortunate over the summer months to have the expertise of Drs. Richard Backstein and Matthew Plant rotate through our service. Dr. Karen Cross and Dr. Matt McRae are currently working their way through the service. During their spare time, they aspire to emulate their role-model, Dr. David Fisher.

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With 3 of our current fellows from the US, the Division is greatly relieved that the written component of the American Board Examinations was completed in the late fall and that the blood pressures and stress levels of Drs. David Khechoyan, Tom Sitzman and Alison Snyder-Warwick have returned to baseline. We are most fortunate to have a stellar group of fellows that include Dr. Ehud Arad from Tel Aviv and Adel Fattah from the UK.

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Research Fellow Dr. Eva Placheta (Vienna, Austria) is enrolled in doctoral studies program (Clinical Neurosciences) at the Medical University of Vienna and is halfway through her research year abroad working under the supervision of Dr. Greg Borschel in his peripheral nerve laboratory. The title of her thesis is “Enhancing cross facial nerve grafts with regional sensory nerves”. She plans to return to clinical training in April 2012 and is doing a phenomenal job at mastering the art of  time compression by completing 2 years worth of work in 1.

Our very own Dr. Karen Wong also has expertise in the same discipline and is currently working on her Masters of Science in Health Research Methodology at McMaster (Supervisors: Dr. Anne Klassen and Christopher R. Forrest) in the Department of Clinical Epidemiology & Biostatistics, Health Research Methodology Program. The title of her thesis is “CLEFT-Q: Developing a Patient-Reported Outcome Measure for Cleft Lip and/or Palate” and represents novel and innovative work with an emphasis on incorporating patient input to document outcomes following treatment of children and young adults with orofacial clefts. Karen is scheduled to follow her thesis work with a 6-month fellowship at the Chang Gung Memorial Hospital in Tapei under the supervision of Drs. Phillip Chen and Yu Ray Chen.

Former fellows Dr. Bart Stubenitsky (Utrecht, Netherlands) and Dr. David Chong (Melbourne, Australia) met up with each other on an Op Smile mission to Addis Ababa in Ethiopia. Both Bart and David completed fellowships in Pediatric Craniofacial Surgery and have the opportunity to use their skills in developing countries.

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Future Plans

Following an exhaustive application review, the Division is looking forward to the arrival of the new crop of fellows in July 2012. This past year was highly competitive and saw a record 99 applications for the available positions. Drs. Guy Watt (Adelaide, Australia) and Mahsa Bidgoli-Moghaddam  (Rochester, MN) will be the new Craniofacial fellows. Drs. Erika Henkelman (Springfield, IL), Sally Hines (Vancouver, BC), Gail Lim (Singapore) and Mark Swan (Oxford, UK) will be the new Pediatric Plastic Surgery Fellows for 2012-2013.

At this time, the Division members would like to wish you all the best for the holiday season and a happy, productive and safe 2012!

Sunnybrook Health Sciences Centre

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Dr. Paul Binhammer, Plastic Surgery

This past fall has been a very exciting time at Sunnybrook within the Division of Plastic and Reconstructive Surgery. The Ross Tilley Burn Centre has welcomed a fourth surgeon, Dr. Manuel Dibildox. Dr. Dibildox obtained his medical degree from Monterrey, Mexico and completed his residency in general surgery in Chicago. He did his Burn Fellowship in Galveston Texas. Besides his busy work in the Burn Centre, Dr. Dibildox is completing his Masters in Science. We enthusiastically welcome Dr. Dibildox to Toronto and Sunnybrook.

The Burn Centre has a new clinical fellow Dr. David Boudana from France. Dr. Boudana has a local connection, his wife is from Toronto. Dr Anna Arno is transitioning her fellowship from clinical to research. She is working on cellular mechanisms of hypertrophic and keloid scarring. Dr. Jeshke will be moving into his new research lab in May. We are looking forward to a tour as well as an upcoming paper in Lancet.

Craniofacial surgery at Sunnybrook has been very busy. The fellow, Dr. Ian Sunderland has come from Seattle to work with Drs Antonyshyn and Fialkov. He has initiated several research projects. We appreciate his hard work. Finally I want to tell you about the explosive start to our Breast Program. We have a new Immediate Breast Reconstruction Clinic. This is a multidisciplinary clinic. Within the first year of this program we have had more than 40 immediate breast reconstruction and more than 40 free flaps. Drs Lipa and Snell are doing a fantastic job providing innovative patient care. They have also provided invited talks at the Canadian Breast Cancer Annual Meeting and the Toronto Breast Surgery Symposium. Their BRA Day event was attended by more than 180 at Sunnybrook Estates.

Women’s College Hospital

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Dr. John Semple

Women’s College Hospital has had an exciting last half of 2011!  We have developed several innovative new ambulatory programs as well as celebrating Women’s College Hospital’s centennial anniversary.  Construction of the new Women’s College Hospital is well under way (just east of the current site) and is already up to the 4th of 9 floors. Phase I, which will house 8 operating rooms and clinical space will be completed in 2013 and Phase II, which houses education, research and administrative offices will be completed in 2015. This new space will house the core surgical activities and programs of the Department of Ambulatory Surgery.  See photo of our new hospital.

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Divisional Activities

Dr. Mitch Brown chaired the 11th Annual Toronto Breast Surgery Symposium held this past April. Women’s College Hospital continues to host international candidates under the Allergan Breast Reconstruction clinical fellowship. Dr Semple stepped down as Director of the Breast Reconstruction Fellowship. Dr Toni Zhong has taken on this position as well as being appointed as the overall Director of the Fellowship program at the University of Toronto Division.

WCH team lead by Dr John Semple was awarded the Leading Practice Award: Ambulatory Model of Care for Breast Reconstruction by Accreditation Canada 2010.  This is a very high honour and testament to all the hard work that the team put into this initiative.

Dr. Semple was nominated as a member of the Judicial Council for the Canadian Society of Plastic Surgeons (2011).

Education

Women’s College provides a unique surgical education setting because of its ambulatory mandate. Developing an ambulatory curriculum with learning objectives specific to ambulatory surgery is being developed. The experience rated by undergraduate, resident, fellows and CME is excellent. Teaching volumes have steadily increased over the transition period. A Simulation Education Centre has been established in a multidisciplinary content with a primary contribution by our Sports Orthopaedic Surgical group.

Research

The Division of Plastic Surgeons at Women’s College Hospital has several active areas of research and grants through 2010-2011. We are engaged in a variety of clinical and basic research and continue to supervise residents and fellows in projects and graduate degree programs.

Grants

Acellular Dermal Matrix in One-Stage Breast Reconstruction: A RCT.  Zhong T, Brown B (Co-Principal Investigator), Beber B, Hofer S, Semple JL: Plastic Surgery Educational Foundation Program: National Endowment for Plastic Surgery.  ($55,000 2009 – 2010.)

Implementation of 23 hr length of stay for breast reconstruction surgery:  Quality of recovery evaluation following discharge.  Semple J, Brown M, Morgan P, Davidge K: WCH AFP Innovation Grant.  ($29,841 2011 – 2012.

Quality of Recovery in Women Undergoing Autogenous Breast Reconstruction in an Ambulatory Setting.  Davidge K, PSI Residents Award  ($13,500 2011.) Supervisor: Semple JL: Women’s College Hospital.

Impact of Radiation Therapy on the Lymphatic Circulatory System: Relevance to Breast Cancer Related Lymphedema.  Johnston M, Semple JL: Canadian Breast Cancer Foundation  Ontario Region Chapter.  ($430,631 2011 – 2014.)

Residents and Fellows

Our residents and fellows have been an integral part of this year and we’ve had the pleasure of having Taiba Alrasheed and Ryan Neinstein as residents at Women’s College as well as two more New Zealanders, Natalie Ngan and Michelle Locke come through as Breast Reconstruction Fellows.

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The picture from the recent CSPS/IPRAS meeting in Vancouver: (left to right) Michelle Locke, Mitch Brown, Meredith Simcock, Natalie Ngan and John Semple.

Breast Reconstruction Awareness Day – October 19, 2011

October 19, 2011 saw the inaugural Breast Reconstruction Awareness Day (BRA Day).  This initiative was started by Dr. Mitchell Brown after he recognized an ongoing problem with education and access for reconstructive breast surgery.  Dr. Brown struck an organizing committee with representation across the country of plastic surgeons, nurses, industry and patient advocates.

To mark this historic day events were held all across Canada to promote both awareness and patient access to reconstructive breast surgery.  Events were organized on both the local and regional grass roots level in order to take advantage of the unique environments, populations and diverse resources that exist across Canada.  A variety of efforts were created to help raise awareness of BRA Day.  Sleep Country Canada, a major mattress retailer, displayed BRA Day posters in their stores, Okanagan Health Group and their supporters had a wrap-around bus banner travelling for five days, fund-raising t-shirts were created and sold and Dr. Nick Guay launched the Canadian collaboration on breast reconstruction information website.  A flash mob was held in Kelowna, BC with almost 100 people dancing in support of National Breast Reconstruction Awareness Day.  Over 20 events were held across the country.

The BRA Day committee have received commitments from the United States, Israel, Australia and New Zealand to initiate BRA Day in their countries in 2012, making this a truly international event.  Please find further information about BRA Day on the web at www.BRA-day.com, twitter at http://twitter.com/mybraday, on facebook at www.facebook.com/breastreconawareness and by e-mail at info@bra-day.com

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Future

The WCH Department of Surgery looks forward to further exciting developments in recruitment and development in ambulatory surgical programs and continue to work towards innovative and quality initiatives.

Advancement Update

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Department of Surgery
Darina Landa

Allergan Increases Annual Support

Allergan Inc. has been a long-time supporter of the Division of Plastic & Reconstructive Surgery at the University of Toronto, funding two Breast Cancer Reconstruction Fellowships each year since 2008.

The Division is pleased to announce that Allergan has increased its annual support by providing an additional $50,000 in support of aesthetic medicine education for plastic surgery residents.

The funds will be managed and administered under the direction of the Program Director, Dr. Mitch Brown, in consultation with the Residency Program Committee and with ultimate approval from the Division Chair. Faculty members interested in funding for resident educational initiatives within aesthetic medicine are encouraged to contact Dr. Brown directly.

We are grateful to Allergan for this additional funding and the company’s continued support of education within plastic and reconstructive surgery.