Winter 2006

Orthopaedic, Plastic Surgeons Team-up in Hand Care

Patients who sustain complex extremity trauma from motor vehicle accidents, workplace injuries, etc. often require the services of both orthopaedic and plastic surgeons. But orthopaedic surgeon Milan Sen, M.D., says there is often inadequate communication between physicians in those specialties, even when they are working on the same patient.

Sen recently joined the UCSF faculty as a trauma surgeon at San Francisco General Hospital (SFGH) following a trauma fellowship with David Helfet, M.D., at the Hospital for Special Surgery in New York City. He also completed a fellowship in hand and microsurgery at the Kleinert Institute in Louisville, Ky., an unusual combination for an orthopaedic surgeon.

After training with both orthopaedic and plastic surgeons, he decided that there are a lot of good reasons for creating a closer working relationship. "We can do things that make it easier for the plastic surgeons to do their job, and vice versa," Sen says. "It's better for the physicians and better for the patient if we cooperate."

An 'Orthoplastic' Approach

Accordingly, Sen and UCSF plastic surgeon Scott Hansen, M.D., are working together to provide an "orthoplastic" approach to managing these injuries. The two believe that working more closely will not only improve patient care, but also result in more collaborative laboratory and clinical research between the two departments.

Sen observes that in many cases, specialists in orthopaedics and plastic surgery are isolated by their interests. "Most orthopaedic surgeons want nothing to do with soft tissue and microsurgery techniques," Sen says.

Sen, however, with experience in microsurgery as part of his training in treating traumatic hand injuries, wanted to play a part in all aspects of hand surgery. While some surgeons can be very protective of their specialty areas, Sen found like interests in Hansen.

"We've been working as a team together on cases, and eventually we will be able to provide more efficient and effective treatment," Sen says. The two are currently doing both hand and flap cases together, he adds. "Scott learns from me during the hand cases, and I am learning from him during the free-flap cases."

With the old system, the two services worked more slowly, resulting in delayed treatment, longer hospital stays and a slower start to rehabilitation. "Working together, we combine our resources and are able to treat these patients earlier," Sen says. "We are also able to do some bone and soft tissue procedures in the same sitting, which results in fewer operations."

Sen says that surgeons in both orthopaedic surgery and plastic surgery will benefit from the cooperation, because the improved service should lead to better patient care, which in turn should translate into better outcomes and fewer complications. It also will benefit both training programs because it leads to more referrals and to a higher volume of cases for the residents.

"To have this collaboration between plastics and orthopaedics is really a positive thing," Sen says. "We still have some kinks to be worked out, but we are getting along really well, and things look good."

Hansen will be starting a one-year hand fellowship at UCLA this summer. When Hansen returns to UCSF upon the completion of his fellowship, he and Sen plan to build a combined orthopaedic and plastics hand and microsurgery service at SFGH.

Milan Sen can be contacted at (415) 206-8812.

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