Plastic and Reconstructive Surgery:

While outpatient visits declined by 10% from 2001 to 2002, operating room cases experienced a 53% increase. Although unfilled recruitments in 2001 produced atypically low numbers of cases for that year, increased participation in the Burn and the Cleft Lip and Palate Programs and the initiation of the Craniofacial Clinic contributed to the substantial increase in surgical cases in 2002. The recent recruitments of Joyesh Raj, MD, and David Schnur, MD, are expected to expand the services offered by the department and contribute to ongoing growth in the number of young patients treated.

Lawrence L. Ketch, MD
Chairman
with five-year-old Angelo

Departmental Activities
The department provides surgical management of pediatric plastic surgery conditions, such as extensive vascular malformations; external ear anomalies; scar revisions; acquired and congenital facial deformities; supernumerary and polydactylous digits, including wound and laceration repair and care; cystic hygroma and tumor excisions; and macro and gynecomastia reconstructions.

The Cleft Lip and Palate Program
With its breadth of facilities, technology and consulting expertise, the Cleft Lip and Palate Clinic is the only major regional resource center bringing together the benefits of comprehensive care, teaching and research. The program is staffed by a multidisciplinary team specializing in children with cleft lip and/or cleft palate, and treats other conditions such as submucous cleft palate, palatal paralysis and oral-motor problems. The program has been providing services to children in the Rocky Mountain region with cleft lips and palates since the early 1970s. It has grown to serve more than 200 children annually. The program offers expertise in the use of distraction osteogenesis and orthodontic appliances for reconstructive needs and nasal-alveolar molding to assist with cleft lip and palate patient’s nasal deformities.

The program also sponsors a cleft palate camp in the summer. The cleft palate summer camp experience is designed to promote the development of self-confidence and independence for children aged nine to 13 years with facial differences. The camp is staffed by members of The Children’s Hospital cleft team and has been in
existence since 2000.

The Craniofacial Clinic
The Craniofacial Clinic provides a combined surgical effort with Neurosurgery in the correction of craniofacial anomalies, such as craniosynostosis, craniofacial dysmorphism, hypertelorism, fibrous dipplasia, correction of traumatic facial injuries and maxillary and mandibular abnormalities.

The Burn Program
The Burn Program offers the only pediatric burn program for acute and rehabilitative care for neonates through adolescents in the
Rocky Mountain region. Surgery is performed on children with scars, contractures or functional limitations. This service also restores the appearance of the face, hands, trunk and other visible areas in young burn patients. The program sponsors numerous burn camps for young patients and family members.

All ancillary support services at The Children’s Hospital are available to patients, including respiratory therapy, radiology, patient representatives, home health care, and any of the other clinical services, as needed. Additionally counseling services and financial aid services provide support for young patients, their parents and families.

Teaching Programs
The department of Plastic Surgery maintains a very active residency-training program. Plastic surgery and general surgery residents are exposed to reconstructive surgical principles used in the treatment of children with deformities that are acquired, congenital or traumatic. Periodic lectures are given to physicians, paramedical and ancillary personnel as well and nursing and non-surgical pediatric staff. Outreach burn education to community medical practices is available.

Research
Research is an ongoing commitment for the Plastics and Reconstructive Program. The affiliation with the University of Colorado School of Medicine provides opportunities to conduct and participate in ongoing studies. Treatment modalities including the use of vacuum suction of chronic and acute traumatic wounds, specialty wound products and synthetic skin products for reconstructive wounds is ongoing.

Plans for the Future
Plastics Surgery aggressively recruited two additional plastic surgeons to meet the growing program needs at The Children’s Hospital. Joyesh Raj, MD, who has an interest in vascular malformations, and David Schnur, MD, who has additional training as a hand surgeon, will help the department meet the increasing demand for pediatric plastic and reconstructive services.

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Plastic Surgery Treats Rare Congenital Skin Defect

Baby J was born with aplasia cutis congenita, a rare congenital absence of skin. About 40 percent of his scalp and skull was missing and about 30 percent of the skin and musculature on his anterior abdominal wall. The scalp lesion exposed the brain. Because of the extent of missing skin and the unavailability of tissue for local coverage, another solution was needed and needed quickly for the four-pound Baby J.

Partnering with a biotechnology company on the East Coast, the Plastic Surgery team at Children’s sent a skin biopsy to the biotech firm. Sheets of epidermal graft were grown from the patient’s own skin cells. The culturing of skin from the baby’s own cells eliminated the threat of graft rejection.

Shortly after birth, the Plastic Surgery team successfully placed biobrane and integra, two biosynthetic skin substitutes on the baby’s scalp and abdomen. Several weeks later, a healthy skin transplantation, grown from the baby’s own tissue, took place. Lawrence Ketch, MD, reports the child is doing well, “Our ability to couple the latest biotechnology techniques with our expertise in recognizing and treating these rare conditions gives these kids a chance to grow and thrive.”