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PATIENT CARE / EDUCATION / RESEARCH / COMMUNITY SERVICE NEWS UPDATE FROM THE DEPARTMENT OF UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER AT STONY BROOK APRIL 2005

Stony Brook Surgical Associates, PC Beating the clock was a major BREAST CARE OTOLARYNGOLOGY-HEAD PLASTIC AND TRANSPLANTATION Performing a Medical Miracle factor in the happy outcome of John S. Brebbia, MD AND NECK SURGERY (ENT) RECONSTRUCTIVE SURGERY John J. Ricotta, MD this dramatic multidisciplinary Martyn W. Burk, MD, PhD Balvant P. Arora, MD JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY Prajoy P. Kadkade, MD Wayne C. Waltzer, MD With Multidisciplinary Surgery operation that took about 11 hours Louis T. Merriam, MD Arnold E. Katz, MD Duc T. Bui, MD Making Surgical History to complete. A detached hand, if Brian J. O’Hea, MD Denise C. Monte, MD Alexander B. Dagum, MD TRAUMA/SURGICAL MAKING NEWS WITH Ghassan J. Samara, MD Steven M. Katz, MD CRITICAL CARE And National News placed in an ice-slurry, has just 12 A MEDICAL MIRACLE CARE Maisie L. Shindo, MD John S. Brebbia, MD hours before it can no longer be John S. Brebbia, MD SURGICAL Marc J. Shapiro, MD successfully reattached, according t the news conference held at Stony Brook University Marc J. Shapiro, MD John S. Brebbia, MD James A. Vosswinkel, MD to Dr. Dagum. Harry S. Soroff, MD Thomas K. Lee, MD Martyn W. Burk, MD, PhD Hospital four days after the successful operation, Cedric J. Priebe, Jr., MD Marvin L. Corman, MD where reporters and camera crews of local and Our surgeons performed Richard J. Scriven, MD Martin S. Karpeh, Jr., MD Enrique Criado, MD what is believed to be Anational news media had gathered to cover this miraculous Thomas V. Bilfinger, MD, ScD Louis T. Merriam, MD Antonios P. Gasparis, MD Irvin B. Krukenkamp, MD Brian J. O’Hea, MD the first simultaneous story, Dr. Dagum said about the operation, “To take Cheng H. Lo, MD reattachment of hands something that literally is dead, and all of a sudden, to see life Allison J. McLarty, MD David E. Rivadeneira, MD John J. Ricotta, MD Frank C. Seifert, MD done in New York State. in it again is very gratifying.” William B. Smithy, MD GENERAL/GASTROINTESTINAL For consultations/appointments with our , please call Stony Brook University Hospital is Mr. Matias himself, his arms wrapped in surgical dressing SURGERY (631) 444-4550 for our specialists in breast care one of just two replantation centers as thick as pillows, was at the news conference, and in John S. Brebbia, MD (631) 444-2565 for our specialists in burn care Martyn W. Burk, MD, PhD (631) 444-1820 for our specialists in cardiothoracic surgery in the downstate region of New response to the question about how he was feeling, he just York and the only one on Long smiled and said, “Perfect, perfect—I never have pain. This is Marvin L. Corman, MD (631) 444-4545 for our specialists in general/gastrointestinal surgery Martin S. Karpeh, Jr., MD (631) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT) Island, where surgeons have the unbelievable.” And then, about the surgeons who took care Louis T. Merriam, MD (631) 444-4545 for our specialists in pediatric surgery ability—the necessary expertise in of him, he said, “These doctors are the best in the world.” David E. Rivadeneira, MD (631) 444-9287 for our specialists in plastic and reconstructive surgery reconstructive microsurgery—to re- Marc J. Shapiro, MD (631) 444-2565 for our specialists in attach severed limbs. Our seemingly In late March, almost four weeks to the day of his accident, James A. Vosswinkel, MD (631) 444-2209 for our specialists in transplantation Kevin T. Watkins, MD (631) 444-2565 for our specialists in trauma/surgical critical care miraculous ability in this area of Mr. Matias was able to leave the hospital and go home. Soon emergency care is among the many after he started his physical . He faces about a year of (631) 444-2565 for our specialists in vascular surgery (631) 723-5000 for our specialists at Stony Brook Outpatient Services in Hampton Bays: pediatric surgery reasons why Stony Brook is the rehabilitation, including exercises to regain strength in his designated Level I Trauma Center hands and increase his range of motion. According to Dr. Please visit the Department of Surgery website at www.uhmc.sunysb.edu/surgery serving our region. Dagum, he should regain 50% of the motion of his hands and 50% of the feeling. Although that prognosis may sound The State University of New York at Stony Brook is an equal opportunity/affirmative action educator and employer. This publication can be made available in an alternative format upon request. he clock started ticking at around 9 o’clock in the Finger amputations are a common limiting, the outcome is still great, considering how much morning on the last day of February, as soon as injury but complete hand amputa- damage had been done in the accident. Arsenio Matias had a terrible accident at his factory tions are rare. Stony Brook surgeons Tjob in Bay Shore, NY. At the moment he looked down to OFFICE LOCATIONS POST-OP is published by the Advisory Board All correspondence perform a multitude of finger All of us at University Hospital are proud of the Department of Surgery Enrique Criado, MD should be sent to: see blood gushing from his wrists and both of his hands reattachments every year in contrast historic success of our surgeons. This success reflects University Hospital University Hospital and Alexander B. Dagum, MD lying on the floor beside the machine he had been operating, to one single-hand reattachment Martin S. Karpeh, Jr., MD Dr. Jonathan Cohen the amazing ability of their surgical expertise and Level 5, Suite 6 Health Sciences Center the 49-year-old man thought he was going to die. Stony Brook University Arnold E. Katz, MD Writer/Editor, POST-OP operation about every one to two Nicolls Road Department of Surgery their multidisciplinary teamwork. Stony Brook, New York Irvin B. Krukenkamp, MD years. Stony Brook, NY 11794 Margaret A. McNurlan, PhD Health Sciences Center T19 But thanks to the first-aid of his coworkers and, ultimately, 631-444-2565 tel Cedric J. Priebe, Jr., MD Stony Brook, NY 11794-8191 But more than that, it also represents the success of nearly Editor-in-Chief 631-444-8973 fax Marc J. Shapiro, MD USA to the state-of-the art care of the physicians at Stony Brook The simultaneous reattachment 100 other hospital staff members who provided them with John J. Ricotta, MD University Hospital, he didn’t die. Not only that—as if of both hands is so rare that, Cover Photo Credit the support they needed in- and out-side the operating room, Surgical Care Center Writer/Editor a miracle—his hands were successfully reattached in a previous to the present case, Daniel Goodrich. as well as the success of the county’s rescue team and the 37 Research Way history-making operation led by Alexander B. Dagum, Jonathan Cohen, PhD © 2005, Newsday. Dr. Dagum had known of only one quick-thinking coworkers who, together, helped us beat the East Setauket, NY 11733 Distributed by MD, associate professor of surgery and chief of plastic and other such operation, which took clock to save one man—one very grateful man today. 631-444-4545 tel Contributing Editor Tribune Media Services. reconstructive surgery. place in China. 631-444-4539 fax Andrew E. Toga, FACHE Reprinted with permission. 2 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY 3 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY

Saving This Man’s Life Performing Plastic surgeons learned that Cancers resulting in the they could sever the blood loss of the cervical portion Through Teamwork Reconstructive vessels supplying a chosen of the esophagus can now donor tissue, and transfer be reconstructed with Microsurgery it to a “distant” site where transplantation of a portion t started out as an ordinary Monday. Mr. Matias was operating room. Another professor and associate chairman it was needed to solve a of the patient’s own small doing his job at a display-making factory, operating a anesthesiologist, John of orthopaedic surgery. ur clinical program in reconstructive microsurgery reconstructive problem. intestine. Even reconstruction vacuum form machine that has parts to help form plastic A. Petrie, MD, assistant offers truly state-of-the-art care for some of the most This new modality rendered of the breast can be enhanced Iand then cut it to size. But suddenly his hands got caught in professor of , Dr. Dagum worked closely clinically vexing problems that, until recently, were many previous multi-stage via microsurgical techniques. the machine and severed at the wrists—all in a split second. came to help with the together with Dr. Arora. Ovirtually unsolvable. procedures obsolete, and in preparations needed to They focused their attention on many instances provided Lost digits can be Soon after the accident took place, one coworker put him in ready the patient for surgery. the patient’s left hand, while Microsurgery involves magnifying the visual field of surgeons reconstructive options where reconstructed with toe- a chair and told him to raise his arms over his head to slow Together, they placed Drs. Hurst and Sampson worked to enable them to see better, dissect better, and perform micro- none before existed. to-hand transfers, even (left to right) Dr. Lawrence Hurst, surgeon; Dr. Neera Tewari, the bleeding. Two other coworkers tied their belts around his intravenous and monitoring together on the right hand. Neera manipulation. This magnification helps them to perform very years after their loss. And anesthesiologist; Dr. Alexander Dagum, lead surgeon; Dr. arms to further stem the bleeding. Other workers there ran lines and further stabilized Tewari, MD, assistant professor Kenneth Rosenfeld, anesthesiologist; Dr. Steven Sampson, precise surgery that was not possible in the past. Although a relatively burn reconstruction can be to a nearby store to get ice to store his hands in. The phone him. of anesthesiology, arrived to surgeon; and Dr. Balvant Arora, surgeon—at news conference new form of surgery, made more functional and held at Stony Brook on March 4. call to 911 brought to the scene the Suffolk County Police take over for Dr. Petrie in the The greatest impact of microsurgery has been in our ability to reconstructive microsurgery aesthetically appealing. helicopter that quickly airlifted him to University Hospital, Dr. Dagum soon arrived management of the anesthesia. suture small blood vessels and nerves, thus making it possible is now widely accepted. Over about 18 miles away. to start the operation. He Three orthopaedic surgery Our program in reconstructive microsurgery to replant—reattach—limbs severed from the body, as well as the last three decades more The increasing application offers patients the most sophisticated care immediately went to work to residents provided assistance to transplant tissues from one part of the body to another. than 100 donor “flaps”— of microsurgical techniques available for control the bleeding and then during the case. pieces of tissue completely is currently being seen more commenced preparing the The grateful Microsurgical techniques greatly enhance the reconstructive severed from their place of and more in limb preservation and happy parts of the patient’s hands Late in the operation, another p Reattachment of acutely severed body parts surgeon’s armamentarium for dealing with a multitude of origin that are transplanted surgery for trauma, tumor patient, Arsenio and arms. specialist, Edward p Soft-tissue trauma of the arms/hands and legs/feet Matias (seated) complex reconstructive problems. By reestablishing blood flow to a new site to reconstruct resection, congenital D. Wang, MD, assistant profes- with surgeon into and out of muscle tissue, skin, bone, or even a portion a tumor defect—have been abnormality, and organ p Reconstruction after limb-sparing tumor removal Dr. Alexander “This was one of the sor of orthopaedic surgery, came of small intestine, the plastic surgeon so trained is able to described, and a nationwide transplant. p Cancers involving the head and neck, Dagum. Standing greatest challenges to help briefly by relieving Dr. behind them are perform seemingly miraculous operations—like the operation success rate of over 90% has including the cervical esophagus, mandible of my career,” says Hurst, who had been working and floor of the mouth anesthesiologists Dr. Dagum, who in which the severed hands of Arsenio Matias were successfully been realized. All told, the advent of Dr. Kenneth steadily for many hours. microsurgery has been p Severe burn contracture of the Rosenfeld (left) has been doing reattached. NEW POSSIBILITIES one of the most important neck and shoulders and Dr. Neera replantations for FOR THERAPY Tewari. 12 years. By the ninth hour of the replan- All four of our plastic surgeons—as well as developments in modern p Traumatic or congenital absence of digits, tation procedure involving com- JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY otolaryngologist-head and neck surgeons on Reconstructive microsurgery surgery, and it has made especially the thumb plex reconstructive microsurgery, Dr. Dagum, the lead surgeon our faculty—have expertise in reconstructive offers a wide range of possible rapid, major advances p Breast reconstruction the patient’s reattached hands microsurgery, for which they completed Mr. Matias entered our emergency room just over an hour of the operation, was then therapeutic possibilities. in the field of plastic and p Limb salvage in patients with peripheral began to take on their normal advanced training, and their skills enable after the accident took place. At that point, he had lost joined by three other hand Injuries to limbs that reconstructive surgery. vascular disease almost 40% of his blood, nine pints in all. Our trauma color, and the outcome of the them to perform all kinds of new operations surgery specialists: Balvant previously could only be p Management of difficult wounds team—led by Marc J. Shapiro, MD, professor of surgery and surgery became clear to the team that seem miraculous. P. Arora, MD, assistant treated by amputation can p Vascular and vasospastic disorders of the hand, anesthesiology, and chief of , trauma, surgical in the operating room. now be successfully treated professor of surgery (plastic Microsurgery first drew clinical attention in the late 1960s and such as Raynaud’s syndrome critical care, and —successfully stabilized the patient and reconstructive surgery); and the limbs reconstructed Life had been restored to the two early 1970s when it was used mainly as a tool to assist with Nerve injuries in the arms/hands and legs/feet whose injuries were nothing less than devastating. Lawrence C. Hurst, MD, with functional results. p hands that earlier in the day were the reattachment of severed fingers and limbs. The dissecting professor and chairman of dead. The operation was at last a microscope provided a means of visualizing and repairing At around 10:30 a.m. Kenneth I. Rosenfeld, MD, associate orthopaedic surgery and chief success—and the patient a lucky injured small blood vessels and nerves. Its use in general professor of anesthesiology and vice chairman for clinical of hand surgery; and Steven Our colleagues in the Department of man. reconstructive surgery soon followed. affairs, brought the patient who was still awake to the P. Sampson, MD, associate Orthopaedics—Stony Brook Orthopaedics Associates, PC—also perform reconstructive microsurgery for replantation of severed fingers and limbs, as well The Operation Itself [Hours 0-2] [Hours 2-3] [Hours 3-9] [Hours 9-11] as for other kinds of operations. PREPARING FOR SURGERY MATCHING UP THE PARTS MAKING DELICATE REPAIRS & RESTORING BLOOD FLOW CLOSING UP The 11-hour operation During the course of the that was performed to The patient was hemorrhaging from both arms, and so the Hand and arm bones were then Two major arteries, four veins with two vein grafts, and two major The right forearm skin and reattach Arsenio Matias’ long operation, nearly bleeding vessels were isolated and microsurgical clamps applied rejoined with pins—and set to grow nerves in each hand were repaired. Circulation was reestablished, connective tissue had to be cut 100 other hospital staff hands involved a team to stop the bleeding. The severed hands, which had been put in together. Clamps were removed, and with the cold, pale hands turning warm and pink—indicating the to release pressure from the of four surgeons working an ice-slurry to preserve them, were then cleaned of any dead sutures tied to reconnect a total of success of the operation. Some sutures were so fine, as the thickness traumatized forearm. Skin grafts members provided the overleaf: simultaneously, with tissue, as were the arms at the point of the injury. Clamps and 24 tendons in each hand. of a hair, that the surgeons used microscopes and magnifying were then applied to the right surgeons with the support Dr. Alexander Dagum (left) describing the operation, two on each hand: sutures were used to identify all bones, tendons, blood vessels, glasses, performing what is called reconstructive microsurgery. hand, and finally the skin was they needed in- and out- with anesthesiologist Dr. Kenneth Rosenfeld and surgeon Dr. Steven Sampson. and nerves to be reconnected. sutured in the hands. side the operating room. 2 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY 3 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY

Saving This Man’s Life Performing Plastic surgeons learned that Cancers resulting in the they could sever the blood loss of the cervical portion Through Teamwork Reconstructive vessels supplying a chosen of the esophagus can now donor tissue, and transfer be reconstructed with Microsurgery it to a “distant” site where transplantation of a portion t started out as an ordinary Monday. Mr. Matias was operating room. Another professor and associate chairman it was needed to solve a of the patient’s own small doing his job at a display-making factory, operating a anesthesiologist, John of orthopaedic surgery. ur clinical program in reconstructive microsurgery reconstructive problem. intestine. Even reconstruction vacuum form machine that has parts to help form plastic A. Petrie, MD, assistant offers truly state-of-the-art care for some of the most This new modality rendered of the breast can be enhanced Iand then cut it to size. But suddenly his hands got caught in professor of anesthesiology, Dr. Dagum worked closely clinically vexing problems that, until recently, were many previous multi-stage via microsurgical techniques. the machine and severed at the wrists—all in a split second. came to help with the together with Dr. Arora. Ovirtually unsolvable. procedures obsolete, and in preparations needed to They focused their attention on many instances provided Lost digits can be Soon after the accident took place, one coworker put him in ready the patient for surgery. the patient’s left hand, while Microsurgery involves magnifying the visual field of surgeons reconstructive options where reconstructed with toe- a chair and told him to raise his arms over his head to slow Together, they placed Drs. Hurst and Sampson worked to enable them to see better, dissect better, and perform micro- none before existed. to-hand transfers, even (left to right) Dr. Lawrence Hurst, surgeon; Dr. Neera Tewari, the bleeding. Two other coworkers tied their belts around his intravenous and monitoring together on the right hand. Neera manipulation. This magnification helps them to perform very years after their loss. And anesthesiologist; Dr. Alexander Dagum, lead surgeon; Dr. arms to further stem the bleeding. Other workers there ran lines and further stabilized Tewari, MD, assistant professor Kenneth Rosenfeld, anesthesiologist; Dr. Steven Sampson, precise surgery that was not possible in the past. Although a relatively burn reconstruction can be to a nearby store to get ice to store his hands in. The phone him. of anesthesiology, arrived to surgeon; and Dr. Balvant Arora, surgeon—at news conference new form of surgery, made more functional and held at Stony Brook on March 4. call to 911 brought to the scene the Suffolk County Police take over for Dr. Petrie in the The greatest impact of microsurgery has been in our ability to reconstructive microsurgery aesthetically appealing. helicopter that quickly airlifted him to University Hospital, Dr. Dagum soon arrived management of the anesthesia. suture small blood vessels and nerves, thus making it possible is now widely accepted. Over about 18 miles away. to start the operation. He Three orthopaedic surgery Our program in reconstructive microsurgery to replant—reattach—limbs severed from the body, as well as the last three decades more The increasing application offers patients the most sophisticated care immediately went to work to residents provided assistance to transplant tissues from one part of the body to another. than 100 donor “flaps”— of microsurgical techniques available for control the bleeding and then during the case. pieces of tissue completely is currently being seen more commenced preparing the The grateful Microsurgical techniques greatly enhance the reconstructive severed from their place of and more in limb preservation and happy parts of the patient’s hands Late in the operation, another p Reattachment of acutely severed body parts surgeon’s armamentarium for dealing with a multitude of origin that are transplanted surgery for trauma, tumor patient, Arsenio and arms. hand surgery specialist, Edward p Soft-tissue trauma of the arms/hands and legs/feet Matias (seated) complex reconstructive problems. By reestablishing blood flow to a new site to reconstruct resection, congenital D. Wang, MD, assistant profes- with surgeon into and out of muscle tissue, skin, bone, or even a portion a tumor defect—have been abnormality, and organ p Reconstruction after limb-sparing tumor removal Dr. Alexander “This was one of the sor of orthopaedic surgery, came of small intestine, the plastic surgeon so trained is able to described, and a nationwide transplant. p Cancers involving the head and neck, Dagum. Standing greatest challenges to help briefly by relieving Dr. behind them are perform seemingly miraculous operations—like the operation success rate of over 90% has including the cervical esophagus, mandible of my career,” says Hurst, who had been working and floor of the mouth anesthesiologists Dr. Dagum, who in which the severed hands of Arsenio Matias were successfully been realized. All told, the advent of Dr. Kenneth steadily for many hours. microsurgery has been p Severe burn scar contracture of the Rosenfeld (left) has been doing reattached. NEW POSSIBILITIES one of the most important neck and shoulders and Dr. Neera replantations for FOR THERAPY Tewari. 12 years. By the ninth hour of the replan- All four of our plastic surgeons—as well as developments in modern p Traumatic or congenital absence of digits, tation procedure involving com- JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY otolaryngologist-head and neck surgeons on Reconstructive microsurgery surgery, and it has made especially the thumb plex reconstructive microsurgery, Dr. Dagum, the lead surgeon our faculty—have expertise in reconstructive offers a wide range of possible rapid, major advances p Breast reconstruction the patient’s reattached hands microsurgery, for which they completed Mr. Matias entered our emergency room just over an hour of the operation, was then therapeutic possibilities. in the field of plastic and p Limb salvage in patients with peripheral began to take on their normal advanced training, and their skills enable after the accident took place. At that point, he had lost joined by three other hand Injuries to limbs that reconstructive surgery. vascular disease almost 40% of his blood, nine pints in all. Our trauma color, and the outcome of the them to perform all kinds of new operations surgery specialists: Balvant previously could only be p Management of difficult wounds team—led by Marc J. Shapiro, MD, professor of surgery and surgery became clear to the team that seem miraculous. P. Arora, MD, assistant treated by amputation can p Vascular and vasospastic disorders of the hand, anesthesiology, and chief of general surgery, trauma, surgical in the operating room. now be successfully treated professor of surgery (plastic Microsurgery first drew clinical attention in the late 1960s and such as Raynaud’s syndrome critical care, and burns—successfully stabilized the patient and reconstructive surgery); and the limbs reconstructed Life had been restored to the two early 1970s when it was used mainly as a tool to assist with Nerve injuries in the arms/hands and legs/feet whose injuries were nothing less than devastating. Lawrence C. Hurst, MD, with functional results. p hands that earlier in the day were the reattachment of severed fingers and limbs. The dissecting professor and chairman of dead. The operation was at last a microscope provided a means of visualizing and repairing At around 10:30 a.m. Kenneth I. Rosenfeld, MD, associate orthopaedic surgery and chief success—and the patient a lucky injured small blood vessels and nerves. Its use in general professor of anesthesiology and vice chairman for clinical of hand surgery; and Steven Our colleagues in the Department of man. reconstructive surgery soon followed. affairs, brought the patient who was still awake to the P. Sampson, MD, associate Orthopaedics—Stony Brook Orthopaedics Associates, PC—also perform reconstructive microsurgery for replantation of severed fingers and limbs, as well The Operation Itself [Hours 0-2] [Hours 2-3] [Hours 3-9] [Hours 9-11] as for other kinds of operations. PREPARING FOR SURGERY MATCHING UP THE PARTS MAKING DELICATE REPAIRS & RESTORING BLOOD FLOW CLOSING UP The 11-hour operation During the course of the that was performed to The patient was hemorrhaging from both arms, and so the Hand and arm bones were then Two major arteries, four veins with two vein grafts, and two major The right forearm skin and reattach Arsenio Matias’ long operation, nearly bleeding vessels were isolated and microsurgical clamps applied rejoined with pins—and set to grow nerves in each hand were repaired. Circulation was reestablished, connective tissue had to be cut 100 other hospital staff hands involved a team to stop the bleeding. The severed hands, which had been put in together. Clamps were removed, and with the cold, pale hands turning warm and pink—indicating the to release pressure from the of four surgeons working an ice-slurry to preserve them, were then cleaned of any dead sutures tied to reconnect a total of success of the operation. Some sutures were so fine, as the thickness traumatized forearm. Skin grafts members provided the overleaf: simultaneously, with tissue, as were the arms at the point of the injury. Clamps and 24 tendons in each hand. of a hair, that the surgeons used microscopes and magnifying were then applied to the right surgeons with the support Dr. Alexander Dagum (left) describing the operation, two on each hand: sutures were used to identify all bones, tendons, blood vessels, glasses, performing what is called reconstructive microsurgery. hand, and finally the skin was they needed in- and out- with anesthesiologist Dr. Kenneth Rosenfeld and surgeon Dr. Steven Sampson. and nerves to be reconnected. sutured in the hands. side the operating room. 2 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY 3 DEPARTMENT OF SURGERY I UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER I STONY BROOK UNIVERSITY

Saving This Man’s Life Performing Plastic surgeons learned that Cancers resulting in the they could sever the blood loss of the cervical portion Through Teamwork Reconstructive vessels supplying a chosen of the esophagus can now donor tissue, and transfer be reconstructed with Microsurgery it to a “distant” site where transplantation of a portion t started out as an ordinary Monday. Mr. Matias was operating room. Another professor and associate chairman it was needed to solve a of the patient’s own small doing his job at a display-making factory, operating a anesthesiologist, John of orthopaedic surgery. ur clinical program in reconstructive microsurgery reconstructive problem. intestine. Even reconstruction vacuum form machine that has parts to help form plastic A. Petrie, MD, assistant offers truly state-of-the-art care for some of the most This new modality rendered of the breast can be enhanced Iand then cut it to size. But suddenly his hands got caught in professor of anesthesiology, Dr. Dagum worked closely clinically vexing problems that, until recently, were many previous multi-stage via microsurgical techniques. the machine and severed at the wrists—all in a split second. came to help with the together with Dr. Arora. Ovirtually unsolvable. procedures obsolete, and in preparations needed to They focused their attention on many instances provided Lost digits can be Soon after the accident took place, one coworker put him in ready the patient for surgery. the patient’s left hand, while Microsurgery involves magnifying the visual field of surgeons reconstructive options where reconstructed with toe- a chair and told him to raise his arms over his head to slow Together, they placed Drs. Hurst and Sampson worked to enable them to see better, dissect better, and perform micro- none before existed. to-hand transfers, even (left to right) Dr. Lawrence Hurst, surgeon; Dr. Neera Tewari, the bleeding. Two other coworkers tied their belts around his intravenous and monitoring together on the right hand. Neera manipulation. This magnification helps them to perform very years after their loss. And anesthesiologist; Dr. Alexander Dagum, lead surgeon; Dr. arms to further stem the bleeding. Other workers there ran lines and further stabilized Tewari, MD, assistant professor Kenneth Rosenfeld, anesthesiologist; Dr. Steven Sampson, precise surgery that was not possible in the past. Although a relatively burn reconstruction can be to a nearby store to get ice to store his hands in. The phone him. of anesthesiology, arrived to surgeon; and Dr. Balvant Arora, surgeon—at news conference new form of surgery, made more functional and held at Stony Brook on March 4. call to 911 brought to the scene the Suffolk County Police take over for Dr. Petrie in the The greatest impact of microsurgery has been in our ability to reconstructive microsurgery aesthetically appealing. helicopter that quickly airlifted him to University Hospital, Dr. Dagum soon arrived management of the anesthesia. suture small blood vessels and nerves, thus making it possible is now widely accepted. Over about 18 miles away. to start the operation. He Three orthopaedic surgery Our program in reconstructive microsurgery to replant—reattach—limbs severed from the body, as well as the last three decades more The increasing application offers patients the most sophisticated care immediately went to work to residents provided assistance to transplant tissues from one part of the body to another. than 100 donor “flaps”— of microsurgical techniques available for control the bleeding and then during the case. pieces of tissue completely is currently being seen more commenced preparing the The grateful Microsurgical techniques greatly enhance the reconstructive severed from their place of and more in limb preservation and happy parts of the patient’s hands Late in the operation, another p Reattachment of acutely severed body parts surgeon’s armamentarium for dealing with a multitude of origin that are transplanted surgery for trauma, tumor patient, Arsenio and arms. hand surgery specialist, Edward p Soft-tissue trauma of the arms/hands and legs/feet Matias (seated) complex reconstructive problems. By reestablishing blood flow to a new site to reconstruct resection, congenital D. Wang, MD, assistant profes- with surgeon into and out of muscle tissue, skin, bone, or even a portion a tumor defect—have been abnormality, and organ p Reconstruction after limb-sparing tumor removal Dr. Alexander “This was one of the sor of orthopaedic surgery, came of small intestine, the plastic surgeon so trained is able to described, and a nationwide transplant. p Cancers involving the head and neck, Dagum. Standing greatest challenges to help briefly by relieving Dr. behind them are perform seemingly miraculous operations—like the operation success rate of over 90% has including the cervical esophagus, mandible of my career,” says Hurst, who had been working and floor of the mouth anesthesiologists Dr. Dagum, who in which the severed hands of Arsenio Matias were successfully been realized. All told, the advent of Dr. Kenneth steadily for many hours. microsurgery has been p Severe burn scar contracture of the Rosenfeld (left) has been doing reattached. NEW POSSIBILITIES one of the most important neck and shoulders and Dr. Neera replantations for FOR THERAPY Tewari. 12 years. By the ninth hour of the replan- All four of our plastic surgeons—as well as developments in modern p Traumatic or congenital absence of digits, tation procedure involving com- JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY otolaryngologist-head and neck surgeons on Reconstructive microsurgery surgery, and it has made especially the thumb plex reconstructive microsurgery, Dr. Dagum, the lead surgeon our faculty—have expertise in reconstructive offers a wide range of possible rapid, major advances p Breast reconstruction the patient’s reattached hands microsurgery, for which they completed Mr. Matias entered our emergency room just over an hour of the operation, was then therapeutic possibilities. in the field of plastic and p Limb salvage in patients with peripheral began to take on their normal advanced training, and their skills enable after the accident took place. At that point, he had lost joined by three other hand Injuries to limbs that reconstructive surgery. vascular disease almost 40% of his blood, nine pints in all. Our trauma color, and the outcome of the them to perform all kinds of new operations surgery specialists: Balvant previously could only be p Management of difficult wounds team—led by Marc J. Shapiro, MD, professor of surgery and surgery became clear to the team that seem miraculous. P. Arora, MD, assistant treated by amputation can p Vascular and vasospastic disorders of the hand, anesthesiology, and chief of general surgery, trauma, surgical in the operating room. now be successfully treated professor of surgery (plastic Microsurgery first drew clinical attention in the late 1960s and such as Raynaud’s syndrome critical care, and burns—successfully stabilized the patient and reconstructive surgery); and the limbs reconstructed Life had been restored to the two early 1970s when it was used mainly as a tool to assist with Nerve injuries in the arms/hands and legs/feet whose injuries were nothing less than devastating. Lawrence C. Hurst, MD, with functional results. p hands that earlier in the day were the reattachment of severed fingers and limbs. The dissecting professor and chairman of dead. The operation was at last a microscope provided a means of visualizing and repairing At around 10:30 a.m. Kenneth I. Rosenfeld, MD, associate orthopaedic surgery and chief success—and the patient a lucky injured small blood vessels and nerves. Its use in general professor of anesthesiology and vice chairman for clinical of hand surgery; and Steven Our colleagues in the Department of man. reconstructive surgery soon followed. affairs, brought the patient who was still awake to the P. Sampson, MD, associate Orthopaedics—Stony Brook Orthopaedics Associates, PC—also perform reconstructive microsurgery for replantation of severed fingers and limbs, as well The Operation Itself [Hours 0-2] [Hours 2-3] [Hours 3-9] [Hours 9-11] as for other kinds of operations. PREPARING FOR SURGERY MATCHING UP THE PARTS MAKING DELICATE REPAIRS & RESTORING BLOOD FLOW CLOSING UP The 11-hour operation During the course of the that was performed to The patient was hemorrhaging from both arms, and so the Hand and arm bones were then Two major arteries, four veins with two vein grafts, and two major The right forearm skin and reattach Arsenio Matias’ long operation, nearly bleeding vessels were isolated and microsurgical clamps applied rejoined with pins—and set to grow nerves in each hand were repaired. Circulation was reestablished, connective tissue had to be cut 100 other hospital staff hands involved a team to stop the bleeding. The severed hands, which had been put in together. Clamps were removed, and with the cold, pale hands turning warm and pink—indicating the to release pressure from the of four surgeons working an ice-slurry to preserve them, were then cleaned of any dead sutures tied to reconnect a total of success of the operation. Some sutures were so fine, as the thickness traumatized forearm. Skin grafts members provided the overleaf: simultaneously, with tissue, as were the arms at the point of the injury. Clamps and 24 tendons in each hand. of a hair, that the surgeons used microscopes and magnifying were then applied to the right surgeons with the support Dr. Alexander Dagum (left) describing the operation, two on each hand: sutures were used to identify all bones, tendons, blood vessels, glasses, performing what is called reconstructive microsurgery. hand, and finally the skin was they needed in- and out- with anesthesiologist Dr. Kenneth Rosenfeld and surgeon Dr. Steven Sampson. and nerves to be reconnected. sutured in the hands. side the operating room. SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION

NEWS UPDATE FROM THE PATIENT CARE / EDUCATION / RESEARCH / COMMUNITY SERVICE DEPARTMENT OF SURGERY UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER AT STONY BROOK NEWS UPDATE APRIL 2005

Stony Brook Surgical Associates, PC Beating the clock was a major BREAST CARE OTOLARYNGOLOGY-HEAD PLASTIC AND TRANSPLANTATION Performing a Medical Miracle factor in the happy outcome of John S. Brebbia, MD AND NECK SURGERY (ENT) RECONSTRUCTIVE SURGERY John J. Ricotta, MD this dramatic multidisciplinary Martyn W. Burk, MD, PhD Balvant P. Arora, MD JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY Prajoy P. Kadkade, MD Wayne C. Waltzer, MD With Multidisciplinary Surgery operation that took about 11 hours Louis T. Merriam, MD Arnold E. Katz, MD Duc T. Bui, MD Making Surgical History to complete. A detached hand, if Brian J. O’Hea, MD Denise C. Monte, MD Alexander B. Dagum, MD TRAUMA/SURGICAL MAKING NEWS WITH Ghassan J. Samara, MD Steven M. Katz, MD CRITICAL CARE And National News placed in an ice-slurry, has just 12 A MEDICAL MIRACLE BURN CARE Maisie L. Shindo, MD John S. Brebbia, MD hours before it can no longer be John S. Brebbia, MD SURGICAL ONCOLOGY Marc J. Shapiro, MD successfully reattached, according t the news conference held at Stony Brook University Marc J. Shapiro, MD PEDIATRIC SURGERY John S. Brebbia, MD James A. Vosswinkel, MD to Dr. Dagum. Harry S. Soroff, MD Thomas K. Lee, MD Martyn W. Burk, MD, PhD Hospital four days after the successful operation, Cedric J. Priebe, Jr., MD Marvin L. Corman, MD VASCULAR SURGERY where reporters and camera crews of local and Our surgeons performed CARDIOTHORACIC SURGERY Richard J. Scriven, MD Martin S. Karpeh, Jr., MD Enrique Criado, MD what is believed to be Anational news media had gathered to cover this miraculous Thomas V. Bilfinger, MD, ScD Louis T. Merriam, MD Antonios P. Gasparis, MD Irvin B. Krukenkamp, MD Brian J. O’Hea, MD the first simultaneous story, Dr. Dagum said about the operation, “To take Cheng H. Lo, MD reattachment of hands something that literally is dead, and all of a sudden, to see life Allison J. McLarty, MD David E. Rivadeneira, MD John J. Ricotta, MD Frank C. Seifert, MD done in New York State. in it again is very gratifying.” William B. Smithy, MD GENERAL/GASTROINTESTINAL For consultations/appointments with our physicians, please call Stony Brook University Hospital is Mr. Matias himself, his arms wrapped in surgical dressing SURGERY (631) 444-4550 for our specialists in breast care one of just two replantation centers as thick as pillows, was at the news conference, and in John S. Brebbia, MD (631) 444-2565 for our specialists in burn care Martyn W. Burk, MD, PhD (631) 444-1820 for our specialists in cardiothoracic surgery in the downstate region of New response to the question about how he was feeling, he just York and the only one on Long smiled and said, “Perfect, perfect—I never have pain. This is Marvin L. Corman, MD (631) 444-4545 for our specialists in general/gastrointestinal surgery Martin S. Karpeh, Jr., MD (631) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT) Island, where surgeons have the unbelievable.” And then, about the surgeons who took care Louis T. Merriam, MD (631) 444-4545 for our specialists in pediatric surgery ability—the necessary expertise in of him, he said, “These doctors are the best in the world.” David E. Rivadeneira, MD (631) 444-9287 for our specialists in plastic and reconstructive surgery reconstructive microsurgery—to re- Marc J. Shapiro, MD (631) 444-2565 for our specialists in surgical oncology attach severed limbs. Our seemingly In late March, almost four weeks to the day of his accident, James A. Vosswinkel, MD (631) 444-2209 for our specialists in transplantation Kevin T. Watkins, MD (631) 444-2565 for our specialists in trauma/surgical critical care miraculous ability in this area of Mr. Matias was able to leave the hospital and go home. Soon emergency care is among the many after he started his . He faces about a year of (631) 444-2565 for our specialists in vascular surgery (631) 723-5000 for our specialists at Stony Brook Outpatient Services in Hampton Bays: pediatric surgery reasons why Stony Brook is the rehabilitation, including exercises to regain strength in his designated Level I Trauma Center hands and increase his range of motion. According to Dr. Please visit the Department of Surgery website at www.uhmc.sunysb.edu/surgery serving our region. Dagum, he should regain 50% of the motion of his hands and 50% of the feeling. Although that prognosis may sound The State University of New York at Stony Brook is an equal opportunity/affirmative action educator and employer. This publication can be made available in an alternative format upon request. he clock started ticking at around 9 o’clock in the Finger amputations are a common limiting, the outcome is still great, considering how much morning on the last day of February, as soon as injury but complete hand amputa- damage had been done in the accident. Arsenio Matias had a terrible accident at his factory tions are rare. Stony Brook surgeons Tjob in Bay Shore, NY. At the moment he looked down to OFFICE LOCATIONS POST-OP is published by the Advisory Board All correspondence perform a multitude of finger All of us at University Hospital are proud of the Department of Surgery Enrique Criado, MD should be sent to: see blood gushing from his wrists and both of his hands reattachments every year in contrast historic success of our surgeons. This success reflects University Hospital University Hospital and Alexander B. Dagum, MD lying on the floor beside the machine he had been operating, to one single-hand reattachment Martin S. Karpeh, Jr., MD Dr. Jonathan Cohen the amazing ability of their surgical expertise and Level 5, Suite 6 Health Sciences Center the 49-year-old man thought he was going to die. Stony Brook University Arnold E. Katz, MD Writer/Editor, POST-OP operation about every one to two Nicolls Road Department of Surgery their multidisciplinary teamwork. Stony Brook, New York Irvin B. Krukenkamp, MD years. Stony Brook, NY 11794 Margaret A. McNurlan, PhD Health Sciences Center T19 But thanks to the first-aid of his coworkers and, ultimately, 631-444-2565 tel Cedric J. Priebe, Jr., MD Stony Brook, NY 11794-8191 But more than that, it also represents the success of nearly Editor-in-Chief 631-444-8973 fax Marc J. Shapiro, MD USA to the state-of-the art care of the physicians at Stony Brook The simultaneous reattachment 100 other hospital staff members who provided them with John J. Ricotta, MD University Hospital, he didn’t die. Not only that—as if of both hands is so rare that, Cover Photo Credit the support they needed in- and out-side the operating room, Surgical Care Center Writer/Editor a miracle—his hands were successfully reattached in a previous to the present case, Daniel Goodrich. as well as the success of the county’s rescue team and the 37 Research Way history-making operation led by Alexander B. Dagum, Jonathan Cohen, PhD © 2005, Newsday. Dr. Dagum had known of only one quick-thinking coworkers who, together, helped us beat the East Setauket, NY 11733 Distributed by MD, associate professor of surgery and chief of plastic and other such operation, which took clock to save one man—one very grateful man today. 631-444-4545 tel Contributing Editor Tribune Media Services. reconstructive surgery. place in China. 631-444-4539 fax Andrew E. Toga, FACHE Reprinted with permission. SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION SPECIAL EDITION

NEWS UPDATE FROM THE PATIENT CARE / EDUCATION / RESEARCH / COMMUNITY SERVICE DEPARTMENT OF SURGERY UNIVERSITY HOSPITAL AND HEALTH SCIENCES CENTER AT STONY BROOK NEWS UPDATE APRIL 2005

Stony Brook Surgical Associates, PC Beating the clock was a major BREAST CARE OTOLARYNGOLOGY-HEAD PLASTIC AND TRANSPLANTATION Performing a Medical Miracle factor in the happy outcome of John S. Brebbia, MD AND NECK SURGERY (ENT) RECONSTRUCTIVE SURGERY John J. Ricotta, MD this dramatic multidisciplinary Martyn W. Burk, MD, PhD Balvant P. Arora, MD JOHN GRIFFIN | MEDIA SERVICES | STONY BROOK UNIVERSITY Prajoy P. Kadkade, MD Wayne C. Waltzer, MD With Multidisciplinary Surgery operation that took about 11 hours Louis T. Merriam, MD Arnold E. Katz, MD Duc T. Bui, MD Making Surgical History to complete. A detached hand, if Brian J. O’Hea, MD Denise C. Monte, MD Alexander B. Dagum, MD TRAUMA/SURGICAL MAKING NEWS WITH Ghassan J. Samara, MD Steven M. Katz, MD CRITICAL CARE And National News placed in an ice-slurry, has just 12 A MEDICAL MIRACLE BURN CARE Maisie L. Shindo, MD John S. Brebbia, MD hours before it can no longer be John S. Brebbia, MD SURGICAL ONCOLOGY Marc J. Shapiro, MD successfully reattached, according t the news conference held at Stony Brook University Marc J. Shapiro, MD PEDIATRIC SURGERY John S. Brebbia, MD James A. Vosswinkel, MD to Dr. Dagum. Harry S. Soroff, MD Thomas K. Lee, MD Martyn W. Burk, MD, PhD Hospital four days after the successful operation, Cedric J. Priebe, Jr., MD Marvin L. Corman, MD VASCULAR SURGERY where reporters and camera crews of local and Our surgeons performed CARDIOTHORACIC SURGERY Richard J. Scriven, MD Martin S. Karpeh, Jr., MD Enrique Criado, MD what is believed to be Anational news media had gathered to cover this miraculous Thomas V. Bilfinger, MD, ScD Louis T. Merriam, MD Antonios P. Gasparis, MD Irvin B. Krukenkamp, MD Brian J. O’Hea, MD the first simultaneous story, Dr. Dagum said about the operation, “To take Cheng H. Lo, MD reattachment of hands something that literally is dead, and all of a sudden, to see life Allison J. McLarty, MD David E. Rivadeneira, MD John J. Ricotta, MD Frank C. Seifert, MD done in New York State. in it again is very gratifying.” William B. Smithy, MD GENERAL/GASTROINTESTINAL For consultations/appointments with our physicians, please call Stony Brook University Hospital is Mr. Matias himself, his arms wrapped in surgical dressing SURGERY (631) 444-4550 for our specialists in breast care one of just two replantation centers as thick as pillows, was at the news conference, and in John S. Brebbia, MD (631) 444-2565 for our specialists in burn care Martyn W. Burk, MD, PhD (631) 444-1820 for our specialists in cardiothoracic surgery in the downstate region of New response to the question about how he was feeling, he just York and the only one on Long smiled and said, “Perfect, perfect—I never have pain. This is Marvin L. Corman, MD (631) 444-4545 for our specialists in general/gastrointestinal surgery Martin S. Karpeh, Jr., MD (631) 444-4121 for our specialists in otolaryngology-head and neck surgery (ENT) Island, where surgeons have the unbelievable.” And then, about the surgeons who took care Louis T. Merriam, MD (631) 444-4545 for our specialists in pediatric surgery ability—the necessary expertise in of him, he said, “These doctors are the best in the world.” David E. Rivadeneira, MD (631) 444-9287 for our specialists in plastic and reconstructive surgery reconstructive microsurgery—to re- Marc J. Shapiro, MD (631) 444-2565 for our specialists in surgical oncology attach severed limbs. Our seemingly In late March, almost four weeks to the day of his accident, James A. Vosswinkel, MD (631) 444-2209 for our specialists in transplantation Kevin T. Watkins, MD (631) 444-2565 for our specialists in trauma/surgical critical care miraculous ability in this area of Mr. Matias was able to leave the hospital and go home. Soon emergency care is among the many after he started his physical therapy. He faces about a year of (631) 444-2565 for our specialists in vascular surgery (631) 723-5000 for our specialists at Stony Brook Outpatient Services in Hampton Bays: pediatric surgery reasons why Stony Brook is the rehabilitation, including exercises to regain strength in his designated Level I Trauma Center hands and increase his range of motion. According to Dr. Please visit the Department of Surgery website at www.uhmc.sunysb.edu/surgery serving our region. Dagum, he should regain 50% of the motion of his hands and 50% of the feeling. Although that prognosis may sound The State University of New York at Stony Brook is an equal opportunity/affirmative action educator and employer. This publication can be made available in an alternative format upon request. he clock started ticking at around 9 o’clock in the Finger amputations are a common limiting, the outcome is still great, considering how much morning on the last day of February, as soon as injury but complete hand amputa- damage had been done in the accident. Arsenio Matias had a terrible accident at his factory tions are rare. Stony Brook surgeons Tjob in Bay Shore, NY. At the moment he looked down to OFFICE LOCATIONS POST-OP is published by the Advisory Board All correspondence perform a multitude of finger All of us at University Hospital are proud of the Department of Surgery Enrique Criado, MD should be sent to: see blood gushing from his wrists and both of his hands reattachments every year in contrast historic success of our surgeons. This success reflects University Hospital University Hospital and Alexander B. Dagum, MD lying on the floor beside the machine he had been operating, to one single-hand reattachment Martin S. Karpeh, Jr., MD Dr. Jonathan Cohen the amazing ability of their surgical expertise and Level 5, Suite 6 Health Sciences Center the 49-year-old man thought he was going to die. Stony Brook University Arnold E. Katz, MD Writer/Editor, POST-OP operation about every one to two Nicolls Road Department of Surgery their multidisciplinary teamwork. Stony Brook, New York Irvin B. Krukenkamp, MD years. Stony Brook, NY 11794 Margaret A. McNurlan, PhD Health Sciences Center T19 But thanks to the first-aid of his coworkers and, ultimately, 631-444-2565 tel Cedric J. Priebe, Jr., MD Stony Brook, NY 11794-8191 But more than that, it also represents the success of nearly Editor-in-Chief 631-444-8973 fax Marc J. Shapiro, MD USA to the state-of-the art care of the physicians at Stony Brook The simultaneous reattachment 100 other hospital staff members who provided them with John J. Ricotta, MD University Hospital, he didn’t die. Not only that—as if of both hands is so rare that, Cover Photo Credit the support they needed in- and out-side the operating room, Surgical Care Center Writer/Editor a miracle—his hands were successfully reattached in a previous to the present case, Daniel Goodrich. as well as the success of the county’s rescue team and the 37 Research Way history-making operation led by Alexander B. Dagum, Jonathan Cohen, PhD © 2005, Newsday. Dr. Dagum had known of only one quick-thinking coworkers who, together, helped us beat the East Setauket, NY 11733 Distributed by MD, associate professor of surgery and chief of plastic and other such operation, which took clock to save one man—one very grateful man today. 631-444-4545 tel Contributing Editor Tribune Media Services. reconstructive surgery. place in China. 631-444-4539 fax Andrew E. Toga, FACHE Reprinted with permission.