Making a Flap
What cancer or accidents destroy, a skilled physician helps replace.
Mention plastic surgery and many of us think of facelifts, nose jobs, or breast enhancements. But if you spend a little time with the doctors in UT Medical Group's plastic surgery department, you'll find their work goes far beyond that. Like rebuilding the face of a boy who couldn't open his mouth; he'd received radiation and his jaw locked. Or the young woman who'd been treated for tumors and never grew breasts; with the doctors' skills in reconstructive microsurgery, she now looks like her peers.
Among these surgeons is Dr. Robert Wallace, who has chaired UTMG's plastic surgery department since 1996. Scattered around his bookshelves are a few small pink skulls; these represent the heads of children who, after cancer surgery and treatment, had their skulls rebuilt. But because of his small staff of six, Wallace knew that many patients — both children and adults — were having to go elsewhere for rehabilitative help. So he recently hired 35-year-old Dr. Jon Ver Halen, whose specialties include plastic and microvascular surgery.
"Jon has hit the ground running," says Wallace, "meeting with the surgeons at St. Jude [Children's Research Hospital] who have sarcoma patients." Because sarcomas involve bone and soft tissue, reconstruction is often vital to their lifelong function. "That's where Jon comes in," adds Wallace, "doing some of these procedures my other staff and I haven't had the time or skill sets to do."
While a fellow at the renowned M.D. Anderson Cancer Center in Houston, which has 16 full-time microsurgeons doing reconstruction, Ver Halen would see a couple of patients each month from Memphis. "So there's potential here for a large volume of this," he says. "The tradition has been, especially with sarcomas on the extremities, to get them through the surgery and get the wounds closed. The result would be patients trying to resume normal activities when they couldn't move their arms. So I think there's an untold and growing population here who can benefit from the advanced techniques."
One of the newer techniques he's learned involves harvesting flaps of tissue while minimizing damage to the donor site. "These are perforator flaps," says Wallace, "that allow for various types of reconstruction without some of the deformities that occur when you take tissue from muscle, for instance. That's one reason I wanted Jon here, his expertise in that."
Describing the steps involved in surgical reconstruction, Ver Halen says the whole job can take up to 14 hours. "It's really four or five different surgeries, combined into one. In breast reconstruction, there's the mastectomy, lymph node dissection, and biopsy. Then the reconstruction starts. We prepare the recipient vessels in the chest – or head or neck, depending on the area I'm working on. Then harvesting the flap, from the patient's tummy, buttock, back, thigh, or other donor site. That's a whole other surgery that takes about two hours. Then picking up that tissue, moving it to the reconstructive site, doing the microsurgery and sewing the vessels together, and then manipulating the tissue, so that it looks like a breast, a jaw bone, or a face."
Ver Halen pauses a minute — as if resting after such painstaking procedures — then adds with a hearty laugh, "It's meticulous. It takes a certain personality. But that to me is plastic surgery. And I think cancer surgeons will tell you, they're not able necessarily to take the cancer out unless we can correct the defects. We work hand in hand."
In addition to cancer cases, UTMG's plastic surgeons often get The Med's trauma patients. "Say a leg bone is exposed after an ATV [all terrain vehicle] injury," says Wallace. "The only way to keep it from being amputated is to cover that bone with a flap from another part of the body. People don't realize how important plastic surgery is till they get hurt."
Though selling Memphis to new surgeons can be tough, Wallace says he had some help luring Ver Halen, whose fiancee — now a physician's assistant at St. Jude — had a brother attending Rhodes College and showed them around the city. "Memphis is a good community for young people," says Ver Halen, who lives downtown. "We've made friends easily, we both enjoy outdoor activities, and we've found the arts, music, and sports scene." But he's most excited about those complex procedures awaiting him and how they can improve patients' lives. "St. Jude is unique," says Ver Halen. "I see tremendous opportunity here."