Advancing Clinical Practice and Postgraduate Education

From the 2014 Department of Surgery Annual Report

Myckatyn-fellowTerence Myckatyn, MD, above, center, with fellow Utku Dolen, MD, left, is among 12 plastic and reconstructive surgeons building strength across all three missions of patient care, education and research.DATING FROM the early 20th century, Washington University plastic and reconstructive surgeons have played a leading role in the development and advancement of their specialty.

Vilray Blair, MD — division chief from 1925-1955 — is recognized as one of the most prominent pioneers of the field. His excellence as a surgeon enabled him to build one of the largest plastic surgery centers in the country and to train top young American surgeons who went on to become leaders in the field. Along with many clinical contributions, he led the section of head and neck trauma in World War I and proposed the development of a national plastic surgery board that would oversee postgraduate training.

One of Blair’s brightest pupils was James Barrett Brown, MD, who became division chief in 1955. Together, they reported the first reproducible cleft lip repair in 1929. Blair went on to lead the treatment of wounded veterans returning from World War II, giving rise to new techniques, and trained a number of plastic surgeons who went on to notable accomplishments. Paul Weeks, from 1970 to 1996, carried on the tradition of innovation, pioneering critical procedures for complicated hand and wrist problems.

Today, the division’s surgeons remain leaders in clinical innovation and excellence at Barnes-Jewish Hospital and St. Louis Children’s Hospital. Division Chief Susan Mackinnon, MD, the Shoenberg Professor of Plastic and Reconstructive Surgery, continues to develop new nerve transfer techniques, which have restored hand, arm and leg function in many patients with injured limbs and even spinal cord injuries. Other areas of strength in the division include hand and wrist surgery, craniofacial surgery for children and adults, and treatment of facial paralysis.

In addition to a flourishing cosmeticsurgery practice, Terence Myckatyn, MD, is building a comprehensive breast plastic surgery program, encompassing both cosmetic and reconstructive surgery. “We’re trying to leverage our large patient volume to become known as a leading center in education, research and clinical care,” says Myckatyn.

A breast fellowship under his leadership, now in its second year, gives trainees exposure to both complex cosmetic surgery and microvascular breast reconstruction. Myckatyn is also heavily engaged in research. He is principal investigator of a multicenter trial analyzing the safety of fat grafting in breast reconstruction. Another trial is looking at how three-dimensional simulation of breast augmentation affects how patients view their outcomes.

In the future, advances in microvascular techniques will improve surgeons’ ability to transfer critical structures and tissues in reconstructive procedures, says Mackinnon.