During her residency at the University of Iowa, Mohana Amirtharajah, M.D., got a powerful introduction to reconstructive wrist surgery. At a huge tertiary care hospital that serves vast stretches of the Midwest, Amirtharajah found herself performing a steady stream of traumatic wrist reconstructions and follow-up care for patients who had suffered severe farm injuries and motor vehicle accidents.
"We did a lot of bony reconstruction, soft tissue coverage and functional tendon transfer," says Amirtharajah, the latest addition to the UCSF Medical Center team for hands and upper extremities. "Often in these cases, the key is the diagnosis: understanding what's working — that we can spare — and what is gone."
After her residency, Amirtharajah returned to New York City — she'd attended medical school at New York University — to do a fellowship at the Hospital for Special Surgery. It was more than a change of locale; the type of surgery changed dramatically as well. "There was less trauma and the bulk of cases were osteoarthritis, chronic degenerative conditions, tumors and sports injuries of high-level athletes," says Amirtharajah.
She brings all of that experience to her practice at UCSF Medical Center — including the latest techniques learned while working with renowned surgeons Brian Adams, M.D., in Iowa and Robert Hotchkiss, M.D., Andrew Weiland, M.D., and Scott Wolfe, M.D., in New York City.
For example, when surgery becomes necessary to treat osteoarthritis in the wrist, Amirtharajah relies on her training and experience to match symptoms with X-rays, so she can tailor a proper treatment. Most surgeons know that diffuse arthritis might require a fusion or proximal row carpectomy, or that a scapholunate advanced collapse with mild symptoms on the radial side might require a radial styloidectomy. But, says Amirtharajah, the devil is in the details.
"Whether you do a small procedure or a large reconstruction or fusion depends on multiple factors, including age, lifestyle and other health factors," she says.
For severe injuries like the mangled and crushed hands she saw frequently in Iowa, Amirtharajah notes that working on a team that includes an experienced plastic surgeon makes a tremendous difference. "Without a plastic surgeon available, we often wouldn't use a free flap," she says. "But going without a flap doesn't allow for the coverage that helps prevent infection and aids healing. At UCSF, I can fix an unstable fracture and [plastic surgeon] Scott Hansen, M.D. can do the soft tissue part."
"Bringing in someone with Dr. Amirtharajah's extensive and up-to-date training significantly expands our ability to address complex surgical cases," says Lisa Lattanza, M.D., chief of the Hand and Upper Extremity Service.
Mohana Amirtharajah, M.D. can be contacted at (415) 353–7200.
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