This issue of Inside Surgery describes some of the latest advances in fetal surgery and pediatric plastic and reconstructive surgery. Nancy Ascher, M.D., Ph.D., chair of the UCSF Department of Surgery, discusses some of these recent developments.
Every fetal surgery has at least two patients — the mother and the fetus — and sometimes more, in the case of twins. When presenting different options to families, the most important consideration is the safety of the mother and her reproductive potential. Minimally invasive approaches can reduce the potential harm to the mother, and may also result in less preterm labor, the major complication of fetal intervention.
After a two-year journey to become pregnant, Marci and Paul conceived a child, only to hear the words every expectant parent dreads: "There's a big problem here." An ultrasound at 20 weeks showed that their fetus had CHAOS (Congenital High Airway Obstruction Syndrome), a rare condition in which a tracheal obstruction blocks the flow of lung fluid, distends the lungs and can adversely affect the heart.
Pediatric plastic and reconstructive surgeons at UCSF treat patients with a wide range of conditions, including craniofacial, birthmark and vascular anomalies, and hand problems. They offer a multidisciplinary, coordinated approach to complex cases, depth and breadth of expertise, and excellent outcomes.
Samantha Ruso was diagnosed at 2 months old with bilateral coronal synostosis, a congenital disorder in which the bones of the skull fuse prematurely. By the time she was 1 year old, she had undergone several craniofacial operations at a university hospital near their home. When craniosynostosis recurred at age 4, her parents brought her to UCSF Benioff Children's Hospital.
UCSF hand surgeons treat a wide range of anomalies related to genetic mutations, amniotic band syndrome, burns, trauma and other causes.” Every child is different,” said Scott Hansen, MD, chief of hand and microvascular surgery. “As a pediatric hand surgeon, my goal is to reconstruct a useful hand.”
The UCSF Birthmark and Vascular Anomalies Center published a recent study that found only 22 percent of its patients had been assigned correct, specific diagnoses before coming to the center. To help determine a correct diagnosis, a multidisciplinary team of specialists tailors a plan for each patient from a full range of treatment options.
A philanthropic visionary, Connie Frank recognized a need for patients and caregivers in the Transplant Service at UCSF. "When the patients come to the clinic, we know they are receiving world-class treatment, but they need a place that gives them a better sense of comfort and care," Frank said.
With generous support from the K.H. Hofmann Foundation, the UCSF Center for Bioengineering and Tissue Regeneration opened last year on the Parnassus campus. Valerie Weaver, Ph.D., a biochemist and the center's director, said, "This is a center for transdisciplinary research, integrating basic cell biology and clinical perspectives with skills and concepts from the physical sciences. We hope to serve as a bridge."
The laboratory of Jason Pomerantz, M.D., a plastic and reconstructive surgeon, has joined the UCSF Craniofacial and Mesenchymal Biology Program in its new facilities on the Parnassus campus. Pomerantz seeks to understand how different regenerative capacities arose among species such as salamanders, and ultimately hopes to develop novel approaches to repair and regenerate human tissues.
See information on upcoming continuing medical education courses.
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