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Plastic and Reconstructive Surgery: Research

RESEARCH TEAM

Bernard Lee, MD, Faculty Member
Samuel Lin, MD, Faculty Member
Amir Taghinia, MD, Faculty Member
Joseph Upton, MD, Faculty Member
Sumner Slavin, MD, Faculty Member
Adam Tobias, MD, Faculty Member
Amr Rabie, MD, International Research Fellow
Salíh Çolakoğlu, MD, International Research Fellow
Catherine DeBlacam, MD, International Research Fellow
Ahmed Ibrahim, MD, International Research Fellow
Kenneth Hughes, MD, Aesthetic Plastic Surgery Fellow
Adeyiza Momoh, MD, Reconstructive and Aesthetic Breast Surgery Fellow
Simon Talbot, MD, Hand/Microsurgery Fellow
Sharon Fox, MD, MIT/HMS PHD Candidate
HMS residents and medical students
Graduate and undergraduate interns

BASIC RESEARCH

Perforator Breast Reconstruction Project

Perforator Identification Using Near-Infrared Imaging (NIR)

A New 3-Dimensional Imaging Device in Facial Aesthetic & Reconstructive Surgery
Harvard Catalyst Grant: Neural Prosthetics with Chemical Harvesting and Stimulation for Facial Nerve Reanimation

Perforator Breast Reconstruction Project

The project assesses the impact of breast reconstruction, following mastectomy, on improving the psychology and quality of life of patients. Functional MRI is utilized changes in areas of self-recognition following breast reconstruction. In 2008, a study was established for nine patients with breast cancer. After analyzing the results, it was concluded that patients who choose breast reconstruction with autologous tissue demonstrate self-recognition of the reconstructed breast. In addition, self-perception of the reconstruction may be a mechanism by which these procedures improve patient quality of life. Continuing on this pathway in 2008, we prepared a Pre-Application for the 2009 NIH Director's New Innovator Award (X02) which was submitted in January, 2009. The project is entitled,, "Subjective and Objective Assessment of Reconstruction after Breast Cancer with a Longitudinal Survey and Functional Imaging." Dr. Bernard Lee is the Director of this project proposal. The fMRI component is performed and coordinated by Sharon Fox, M.D., a former Doris Duke Fellow from HMS, and now a PHD candidate of MIT / HMS.

Perforator Flap Perfusion Assessment Using Near-Infrared Imaging (NIR)

We are using real time, light emitting diode (LED)-based imaging system to exploit invisible near-infrared (NIR) light for assessment of flap physiology. The perforator flaps are assessed with NIR fluorescence angiography using indocyanine green (ICG), a FDA-approved NIR fluorophore. This permits patient-specific planning, image-guided creation, and intraoperative assessment without the need for lasers or ionizing radiation. We are currently looking at ways to quantify perforator flap perfusion and identifying vascular compromise. We have created two indices for arterial occlusion and venous congestion in which we are able to perform a cutaneous assessment that will provide information about vascular status. In addition, we are completing projects looking at the importance of perforator number, dominance, and location to flap perfusion. This collaborative large animal project is conducted between Bernard T. Lee MD and John V. Frangioni MD, PhD.

A New 3-Dimensional Imaging Device in Facial Aesthetic & Reconstructive Surgery

Using conventional methods, the assessment of facial aesthetic outcomes is largely based upon subjective observation in contrast to objectively measured data. It is not possible to quantify 3-dimensional change on a 2-dimensional surface, such as a photograph. Attempting to make measurements based on photographs, for many years the state of the art, is inherently inaccurate as the facial structure is 3-dimensional. One of the most challenging issues of imaging is producing a reliable and consistent method of obtaining 3 dimensional images of a patient, both preoperatively and postoperatively over time.

Our project uses a 3 dimensional imaging device, the Minolta Vivid 300, that has a high degree of precision for depicting the surface topography in facial reconstructive and aesthetic patients. Through the use of this 3-dimensional device, we attempt to accurately capture the finest details of a human face over different time points. Collating each time point, we then study the imagery to quantify topographical changes of the patient’s face over time. This type of 3-dimensional imagery can serve as an improved objective guide to assess changes in facial surface topography, both in the immediate and long-term post-operative period. It is our view that this 3 dimensional approach will provide better a more reliable, objective, and consistent method than conventional photography. Dr. Samuel Lin is the project leader for the study. Dr. Amr Rabie, an international research fellow, works closely with Dr. Lin on this project.

Harvard Catalyst Grant: Neural Prosthetics with Chemical Harvesting and Stimulation for Facial Nerve Reanimation.

Project investigates the stimulation of facial nerve reanimation through a new and creative process. Principal Investigator: Samuel J. Lin, MD, Co-Investigator(s): Amr N. Rabie, MD, Jongyoon Han, PhD; Rahul Sarpeshkar, PhD; Yong-Ak Song, PhD, Massachusetts Institute of Technology (MIT)

CLINICAL RESEARCH

Peter Jay Sharp Program for Aesthetic & Reconstructive Breast Surgery

The BIDMC has become a regional center for women seeking the DIEP (Deep Inferior Epigastric Perforator Flap), SIEA (Superficial Inferior Epigastric Artery Flap) and SGAP (Superior Gluteal Artery Perforator Flap) options for reconstructive breast surgery. Since starting the program, Drs. Adam Tobias, Bernard Lee, and Samuel Lin have performed more than 550 perforator flap breast reconstructive procedures. This surgical experience led to the development of an Intraoperative Pathway to further standardize care, increase efficiency, reduce morbidity, as well as optimally utilize staff in the operating room. Most recently, this Pathway was taken to Israel by the graduating 2007 – 2008 Fellow, Dr. Eran Bar-Meir, who will institute the pathway in the Department of Plastic & Reconstructive Surgery at the Rambam Medical Center in Haifa, Israel. The pathway has also been utilized at the Brigham & Women's Hospital by former fellow, Dr. Stephanie Caterson (2006-2007), and at the University of Cincinnati Medical Center by our most recent graduating fellow, Dr. Minh-Doan Nguyen (2008-2009). Recent clinical research for breast reconstructive surgery includes:

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.

Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.

Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.

Analysis of the use of Pressors during microsurgical breast reconstruction.

Assessment of infectious complications of AlloDerm in breast reconstruction.

Clinical analysis of Vioptix monitoring in perforator flap surgery.

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.
Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.
Analysis of the use of Pressors during microsurgical breast reconstruction.
Assessment of infectious complications of AlloDerm in breast reconstruction.
Clinical analysis of Vioptix monitoring in perforator flap surgery.

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.
Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.
Analysis of the use of Pressors during microsurgical breast reconstruction.
Assessment of infectious complications of AlloDerm in breast reconstruction.
Clinical analysis of Vioptix monitoring in perforator flap surgery.

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.
Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.
Analysis of the use of Pressors during microsurgical breast reconstruction.
Assessment of infectious complications of AlloDerm in breast reconstruction.
Clinical analysis of Vioptix monitoring in perforator flap surgery.

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.
Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.
Analysis of the use of Pressors during microsurgical breast reconstruction.
Assessment of infectious complications of AlloDerm in breast reconstruction.
Clinical analysis of Vioptix monitoring in perforator flap surgery.

Analysis of breast reconstruction rate and referral patterns before and after the development of a DIEP flap program.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Comparison of clinical outcomes of the different types of breast reconstruction, including a comparison of complication rates among the DIEP, TRAM, latissimus, and implant procedures.
Assessment of patient satisfaction among the DIEP, TRAM, latissimus, and implant procedures.
Investigation of inpatient hospital cost of a DIEP flap, comparing it to the average reimbursement offered by Medicare and other insurance providers. A proposal was created for the ICD-9-CM Coordination and Maintenance Meeting to advocate new ICD-9 Procedure Codes to distinguish the various types of breast reconstruction available after mastectomy. The study helped lead to the changing of Medicare reimbursement rates throughout the United States.
Analysis of the use of Pressors during microsurgical breast reconstruction.
Assessment of infectious complications of AlloDerm in breast reconstruction.
Clinical analysis of Vioptix monitoring in perforator flap surgery.

Centralized Otolaryngology Research Efforts (CORE) grant:

"Real-time Intraoperative Computed Tomography Monitoring of Facial Fractures." Principal Investigator: Samuel J. Lin, MD. with Co-Investigator(s): Amr N Rabie, MD; Bernard T Lee, MD; Adam M Tobias, MD; Amir H Taghinia, MD; Joseph Upton, MD; Charles S Day, MD

RECENT ORIGINAL ARTICLES

Bar-Meir ED, Reish RG, Yueh JH, McArdle C, Tobias AM, Lee BT. The Maylard incision: a low transverse incision variant seen in DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg. 2008 Oct 5. Epub ahead of print.

Bar-Meir ED, Merali HS, Yueh JH, Tobias AM, Lee BT. Paradoxical venous Doppler signal: a sentinel sign of early venous congestion. J Reconstr Microsurg. 2008;24(4):255-7.

Burga LN, Tung NM, Troyan SL, Bostina M, Konstantinopoulos PA, Fountzilas H, Spentzos D, Miron A, Yassin YA, Lee BT, Wulf GM. Altered proliferation and differentiation properties of primary epithelial cells from BRCA1 mutation carriers. Cancer Res 2009;69(4):1273-1278.

Caterson SA, Tobias AM, Lee BT. Ultrasound-assisted liposuction as a treatment of fat necrosis after deep inferior epigastric perforator flap breast reconstruction: a case report. Ann Plast Surg . 2008;60(6):614-7.

Fox SE, Ridgway EB, Slavin SA, Upton J, Lee BT. Equestrian-related injuries: implications for treatment in plastic surgery. Plast Reconstr Surg. 2008;122(3):826-32.

Getnick G, Lin SJ, Raviv J, Walsh W, Altman KW. Lingual hematoma and heparin induced thrombocytopenia: a case report. Ear Nose Throat J 2008;87:163-165.

Guo L, Ferraro NF, Padwa B, Kaban L, Upton J, Vascularized fibular graft for pediatric mandibular reconstruction, Plast Reconstr Surg, 2008;121(6):2095-2105.

Karnes JC, Lee BT, Phung T, Alomari AI, Mulliken JB, Greene AK. Adult-onset kaposiform hemangioendothelioma in a post-traumatic wound. Ann Plast Surg 2009;62(4):456-458.

Labow BI, Green AK, Upton J. Hypercoagulability Due to Homocystinuria in a Case of Head and Neck Reconstruction Resolved with Combined Systemic Therapy: Reply. Plast Reconstr Surg. 2008; 121(4):1509-1510.

Lee, BT, Yueh, JH, Chen, C, Lin SJ, Tobias AM, Slavin SA. A Blueprint of the New England Perforator Flap Program at 400 Flaps; If You Build It Will They Come? Plastic and Reconstructive Surgery. Accepted for publication April 2009.

Lee, B.T. et al. A New Classification System for Muscle and Nerve Preservation in DIEP Flap Breast Reconstruction. Accepted to Plast Recon Surg

Lee BT, Lin SJ, Bar-Meir ED, Borud LJ, Upton J. Pedicled perforator flaps: a new principle in reconstructive surgery. Plast Reconstr Surg 2009 (in press).

Lee BT. Computer and data disposal in plastic surgery: guidelines for HIPAA compliance. Plast Reconstr Surg 2008 (in press).

Lee BT, Yueh JH, Chen C, Lin SJ, Tobias AM, Slavin SA. Establishment of perforator flap programs for breast reconstruction: the New England program experience. Plast Reconstr Surg 2009 (in press).

Lee BT*, Matsui A, Winer JH, Kianzad V, Frangioni JV. Image-guided perforator flap design using invisible near-infrared light and validation with x-ray angiography. Ann Plast Surg 2009 (in press).

Lee BT, Lin SJ, Bar-Meir ED, Borud LJ, Upton J. Pedicled perforator flaps: a new principle in reconstructive surgery. Plast Reconstr Surg 2009 (in press).

Lee BT*, Matsui A, Winer JH, Laurence RG, Frangioni JV. Quantitative assessment of perfusion and vascular compromise in perforator flaps using a near-infrared fluorescence guided imaging system. Plast Reconstr Surg 2009 (in press).

Lee BT*, Matsui A, Winer JH, Laurence RG, Frangioni JV. Submental perforator flap design using near-infrared fluorescence imaging: the relationship among number of perforators, flap perfusion, and venous drainage. Plast Reconstr Surg 2009 (in press).

Lin SJ, Lee BT. The intrinsic tying platform in microsurgery. Plast Reconstr Surg 2009 (in press).

Lin SJ, Hanasono M. Microvascular free tissue transfer of previously irradiated flaps. Otolaryngol Head Neck Surg 2008 Aug; 139(2):320-322.

Lin SJ, Patel N, O’Shaughnessy K, Fine NA. 3-dimensional imaging in measuring facial aesthetic outcomes. Laryngoscope 2008;118(10):1733-1738.

Lin SJ, Patel N, O’Shaughnessy K, Fine NA. A new 3-dimensional imaging device in facial aesthetic and reconstructive surgery. Otolaryngol Head Neck Surg 2008;139(2):313-315.

Lin SJ, Jacobs DS, Frankenthaler R, Rubin PAD. An ocular surface prosthesis as an innovative adjunct in treating head and neck cancer patients. J Otolaryngol Head Neck Surg 2008;139(4):589-591.

Lin SJ, Rabie A, Yu P. Designing the anterolateral thigh flap without preoperative Doppler or imaging. J Reconstr Microsurg. Publication Status: 2009 Aug 11. [Epub ahead of print] Cited in PubMed; PMID: 19672820.

Lin SJ, Rabie AN, Yu P. Unusual anterolateral thigh donor site complications: Intraneural hemangioma and traumatic neuroma. Plast Reconstr Surg. Publication Status: Accepted.

Lin SJ, Rabie AN. Head and Neck Cancer: Reconstruction. eMedicine from WebMD (March 2009). http://www.emedicine.com/plastic/topic375.htm. Accessed September 20, 2009.

Lin SJ, Villa M, Gottlieb L, Butler C. Subtotal thigh flap and bioprosthetic mesh reconstruction for large, composite abdominal wall defects. Plast Reconstr Surg 2008;121(6S):66.

Parrett BM, Talbot SG, Pribaz JJ, Lee BT. A review of local and regional flaps for distal leg reconstruction. J Reconstr Microsurg 2009 (in press).

Parrett BM, Lee BT. More on the rib-sparing approach to the internal mammary vessels. Plast Reconstr Surg 2009 (in press).

Rabie AN, Tobias AM, Lee BT, Lin SJ, Broud L. Common patterns of reconstruction for Mohs defects. Otolaryngol Head Neck Surg. 2009 Sep; 141(3): P36.

Rabie AN, Helal MZ, El-Tarabishi MN, Sabry SM, Lin SJ. The effect of rhinoplasty on the internal nasal valve: A comparison between internal continuous osteotomy and external perforating osteotomy. Plast Reconstr Surg. 2009 Jun; 123(Supplement 6): 21.

Upton J, Hypercoagulability due to homocystinuria in case of head and neck reconstruction resolved with combined systemic therapy: reply, Plast Reconstr Surg, 2008;121(4):1510.

Upton J, Guo L, Pediatric Free Tissue Transfer: A 29-year experience with 433 transfers, Plast Reconstr Surg, 2008:121(5):1725-37.

Yueh, JH, Houlihan MJ, Slavin SA, Lee BT, Pories SE, Morris DJ. Nipple-Sparing Mastectomy: Evaluation of Patient Satisfaction, Aesthetic Results and Sensation. Ann Plast Surg, In Press.

Yueh, JH, Slavin, SA, Bar-Meir, ED, Merali, HS, Gautam S., Morris DJ, Tobias, AM, LeeBT. The Role of Regional Referral Centers in Breast Reconstruction: The New England Perforator Flap Experience. J Am Coll Surg. 2009; 208:246-254.