MD, FRCS(C), FACS
I was fortunate to be a resident in Plastic Surgery (1972-76) when new anatomical studies and new techniques of sewing small blood vessels using a microscope meant that there was excitement in creating solutions for reconstructive challenges. More fingers were revascularized and innovative flaps no longer were limited by their pedicle but could be used as a vascularized patch to a needy part of the body. Trauma surgery and surgery for many neoplasms had increasingly innovative choices of being successfully patched. I participated in a cross leg flap as a resident. With microvascular anastomoses and an increasing armamentarium of flaps solutions, one step solutions were being sought. Dr. Manktelow initiated the enthusiasm in Toronto. He introduced replantations and was the first to do free functioning muscle flaps in Canada. Anatomical details of muscle fiber lengths, nerves and vessels (location, number and size) were always checked first in the anatomy lab.
As a young surgeon on staff at MSH (first woman and first non-Jewish surgeon) I performed Canada's first free vascularized fibula in August 1978. MSH (Dr. Gross) attracted patients with skeletal defect challenges from many corners of the world. This provided challenges that were met by a double free fibula, and free flaps to preserve integrity and leg length and function. There are fewer knee fusions these days. However with total joint replacements becoming mainstream treatment some people with a knee fusion opted for a staged approach to acquire knee mobility. By placing and expanding a tissue expander between the quads and the distal femur, two goals were achieved. The skin and subcutaneous tissue was expanded and adhesions between femur and quads were eliminated. Some stretching of the quads over the distal femur with an expander made it possible to convert a knee fusion into a mobile knee replacement with safe skin cover.
Dr. Ralph Manktelow supported me in setting up a research laboratory in the Medical Sciences Building where we could answer questions about anastomoses and blood flow. Over the years I was fortunate to have many exceptional graduate students (Dr. Howard Clarke, Dr. Joel Fish, Dr. Bill Kuzon and others) who made significant contributions to the understanding of reperfusion of flaps and the time and temperature limits of ischemia of muscle that could be survived with return of function. The last PhD student whom I supervised (Anne Agur, Anatomy) has gone on to create a busy group of graduate students who have mapped the 3D coordinates of many human muscles and their innervation patterns. We now have details of muscle that exceed our current ability to provide realistic contraction images of the different parts of a complex muscle. I still dream of creating an educational computer program that can create/demonstrate how functioning muscles that can create finger and hand movement realistically.
Areas of Specialty
• Hand Surgery
Skeletal Muscle Laboratory
Research interests continue to evolve with the interface of technology and the ability to:
i) establish useful 3D data bases of the internal muscle fiber and nerve branching anatomy of the muscles that contribute to hand function;
ii) explore computer simulation of complex wrist bone articulations in movement and muscle contraction and resulting tendon dynamics;
iIi) continue to attempt to create a realistic, functioning hand for educational purposes.