Plastic Surgery in the department of Surgery

Clinician-Scientists

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James Chang, MD

 

My basic science research interests include modulation of Transforming Growth Factor-Beta in scarless flexor tendon wound healing and tissue engineered flexor tendon grafts for hand reconstruction. We have expertise in molecular biology and tissue engineering techniques and their applications to plastic and hand surgery research. For example, we recently demonstrated that physicochemical decellularization of tendon-bone interface grafts using targeted ultrasonication and chemical treatment resulted in near-complete reduction in cellularity and maintenance of tensile strength. In the future, we anticipate that these decellularized composite scaffolds can be used for reconstruction of tendon-bone injuries.

 

 

 

 

 

 

 

Catherine Curtin, MD

Chronic pain affects quality of life and adversely affects functional outcomes. Chronic postoperative pain is a frustrating problem for the surgeon because it ruins a technically perfect procedure, and the surgeon may be unsure of treatment strategies. There is much information on chronic pain and its treatment, but it is often published outside of surgery and diffusion of this information across disciplines is slow. This article synthesizes some of this literature and provides a systematic presentation of the evidence on pain associated with peripheral nerve injury. It highlights the use of perioperative and early intervention to decrease this debilitating problem.

 

 

 

 

 

 

 

 

Sabine Girod, DDSThe final stages of reconstruction following craniofacial trauma or tumor resection often involve the fitting of prostheses. Development of osseointegrated implants for retention of prostheses has improved function and aesthetic outcome. Placement of osseointegrated implants requires coordinated care from multiple specialists and a lifetime commitment of the patient. The workup and surgical treatment algorithms for placement of intraoral compared with extraoral implants are discussed. The quality and quantity of bone available are the most important factors influencing design and placement. The long-term retention of implants is influenced by implant site, local tissue bed preparation, and hygiene. Osseointegrated implants are a part of the complete rehabilitation of patients with craniomaxillofacial defects. Although final fitting and maintenance of prostheses is completed by prosthodontists and patients, successful placement and preservation of implants is affected largely by the plan set forth by the reconstructive surgeon.

 

 

 

 

 

 

 

Geoffrey Gurtner, MD

Human skin is a remarkably plastic organ that sustains insult and injury throughout life. Its ability to expeditiously repair wounds is paramount to survival and is thought to be regulated by wound components such as differentiated cells, stem cells, cytokine networks, extracellular matrix, and mechanical forces. These intrinsic regenerative pathways are integrated across different skin compartments and are being elucidated on the cellular and molecular levels. Recent advances in bioengineering and nanotechnology have allowed researchers to manipulate these microenvironments in increasingly precise spatial and temporal scales, recapitulating key homeostatic cues that may drive regeneration. The ultimate goal is to translate these bench achievements into viable bedside therapies that address the growing global burden of acute and chronic wounds.

 

 

 

 

 

 

 

Jill Helms, DDS, PH.D.

Every adult tissue harbors stem cells, which potentially could be used to regenerate damaged or diseased tissues. In my laboratory, one of our goals is to understand the regulatory pathways that control stem cell self-renewal, proliferation, and differentiation. We have focused on two signaling pathways whose activities seem to be an essential feature of tissue healing. Wnts and Hedgehog proteins are both lipid-modified growth factors that have well documented- and essential- roles in embryonic development. We have found that both pathways are active during the repair of bones, muscle, skin, heart, brain, and retina, and that repair of most or all of these tissues is impeded when these two pathways are blocked.
We have developed a novel packaging method whereby the biological activity of lipidated Wnt and Hedgehog proteins can be preserved in the in vivo wound environment. Using these and other tools developed by our collaborator Roel Nusse, we have embarked on experiments to first understand the mechanisms of action of these growth factors in the healing wound, and second, to use this information in biomimetic strategies to accelerate tissue repair.

 

 

 

 

 

 

Rohit Khosla, MD

My group is interested in understanding the basis for a class of birth defects known as craniosynostoses, which cause premature closure of some or all of the head sutures. Children who are affected by this condition display characteristic phenotypes according to the suture or sutures involved. Restricted normal growth of the skull can lead to increased intracranial pressure and changes in brain morphology, which in turn may contribute to neurocognitive deficiency. Management has primarily focused on surgical correction of fused sutures prior to 12 months of age to optimize correction of the deformity and to ameliorate the effects of increased intracranial pressure. However, emphasis has recently shifted to better understanding the pathogenesis of neurocognitive impairment observed in these children, along with genetic mutations that contribute to premature suture fusion. We believe that this understanding will provide opportunities for earlier and more specific neurocognitive interventions and for the development of targeted genetic therapy to prevent pathologic suture fusion. 

 

 

 

 

 

 

 

Michael Longaker, MD

In my laboratory we investigate reparative and regenerative medicine using mouse models of normal wound healing, diabetic wound healing, skeletal regeneration, and craniofacial development. We are interested in adipose-derived mesenchymal cells for tissue repair, in particular skeletal repair. My lab studies normal and cancer stem cells in the breast and lung in order to develop a deeper understanding of the similarities and differences between these two cell types. We are particularly interested in identifying pathways and genes critical for cancer stem cell function that could be exploited therapeutically.

 

 

 

 

 

 

 

 

Peter Lorenz, MD

Scar formation, a physiologic process in adult wound healing, can have devastating effects for patients; a multitude of pathologic outcomes, affecting all organ systems, stems from an amplification of this process. In contrast to adult wound repair, the early-gestation fetal skin wound heals without scar formation, a phenomenon that appears to be intrinsic to fetal skin. An intensive research effort has focused on unraveling the mechanisms that underlie scarless fetal wound healing in an attempt to improve the quality of healing in both children and adults. Unique properties of fetal cells, extracellular matrix, cytokine profile, and gene expression contribute to this scarless repair. Despite the great increase in knowledge gained over the past decades, the precise mechanisms regulating scarless fetal healing remain unknown. Herein, we describe the current proposed mechanisms underlying fetal scarless wound healing in an effort to recapitulate the fetal phenotype in the postnatal environment.

 

 

 

 

 

 

 

Subhro Sen, MD

An in-house method was evaluated for its efficiency to detect the HIV-1 drug resistance mutations. This method was compared with the ViroSeq™ Genotyping System 2.0 (Celera Diagnostics, US) a gold standard. Sixty-five stored plasma samples, previously tested for HIV-1 drug resistance using the ViroSeq™ method were used to evaluate the in-house method. Out of the sixty five plasma samples, sixty were HIV-1 positive clinical samples; four samples from the Virology Quality Assessment (VQA) program and one positive control from the ViroSeq™ kit were used in this study. The sequences generated by the ViroSeq™ and an in-house method showed 99.5±0.5% and 99.7±0.4% (mean±SD) nucleotide and amino acid identity, respectively. Out of 214 Stanford HIVdb listed HIV-1 drug resistance mutations in the protease and reverse transcriptase regions, concordance was observed in 203 (94.9%), partial discordance in 11 (5.1%) and complete discordance was absent. The in-house primers are broadly sensitive in genotyping multiple HIV-1 group M subtypes. The amplification sensitivity of the in-house method was 1000 copies/ml. The evaluation of the in-house method provides results comparable with that of ViroSeq™ method thus, making the in-house method suitable for HIV-1 drug resistance testing in the developing countries.

 

 

 

 

 

 

Derrick Wan, MD

Understanding the basis for a birth defect is an important consideration when planning for surgical reconstruction. For example, Pierre Robin sequence and Treacher Collins syndrome are rare birth defects that are associated with mandibular hypoplasia. It has been hypothesized, however, that the mandible may be differentially affected. Some of our recent research focuses on comparing mandibular morphology in children with Pierre Robin sequence with children with Treacher Collins syndrome using three-dimensional analysis of computed tomographic scans. Three-dimensional mandibular morphometric analysis in patients with Pierre Robin sequence and Treacher Collins syndrome thus revealed distinctly different patterns of mandibular hypoplasia relative to normal controls.

 

 

 

 

 

 

 

 

Clinical Trials

Stanford clinician scientists are engaged in a wide variety of clinical trials, in which they investigate new approaches to preventing and treating medical conditions through the new of new drugs or devices, or through new applications for those already in widespread use. These trials are done in close collaboration with scientists and physicians from many areas of expertise across Stanford University. To insure the highest ethical standards are maintained the Institutional Review Board (IRB) is responsible for oversight of all studies.

Directory of current clinical trials in Plastic Surgery.

 

Recent Publications/Press

Located in the Hagey Laboratory for Pediatric Regenerative Medicine, Children's Surgical Research is a collaborative endeavor that incorporates researchers from across the Department of Surgery. The Hagey Laboratory facility is fully equipped for cellular, molecular, and animal research. Under the direction of Dr. Michael T. Longaker, this comprehensive team of principal investigators, senior scientists, post-doctoral fellows, and graduate students investigates the fundamentals of bone and soft-tissue biology with application towards tissue engineering and regeneration.

 

Recent Grant Awards

 

Recent Research

 

7th. Year Residency Program

 


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