American Society for Peripheral Nerve (ASPN)
Issue 12, Spring 2022
Message from the President Dr. Gedge Rosson

Gedge Rosson, MD

I am honored to assume the Presidency of the ASPN and humbled to be following Greg Borschel, an incredible leader and great friend. I have big shoes to fill, and with the support of our amazing Executive Council I know ASPN will have a productive year. We are already off to a great start!

I am thrilled to be working with co- Program Chairs Drs. Henk Coert and Sami Tuffaha, who are planning the scientific program for our 2023 Annual Meeting in Miami. Henk and Sami are planning some fun, interactive sessions and will provide the best balance of topics and a domestic versus international perspective. The call for abstracts should be available soon, so please start preparing your best work!

Dr. Catherine Curtin is leading a new program for our Society, Nerve Without Borders Outreach Program, designed to extend ASPN educational resources to under resourced communities around the world. Dr. Shilu Shrestha from Nepal is the inaugural recipient of this program award and will have complimentary access to 2022 Annual Meeting recordings. We hope that Shilu and her team will be able to apply tips and tricks gleaned from these recordings to enhance their practice and improve patient care. Catherine and her team will be announcing more details about this program and how future recipients will be identified shortly. Thank you for pushing this important initiative forward, Catherine! We are excited to see this program expand and help nerve surgeons around the world.

The application for the 2023 Traveling Fellowship is now available. This program allows for our young members (no more than ten years in practice) to travel to centers of excellence focusing on peripheral nerve surgery in order to experience the distinctive clinical, research, and organizational opportunities offered. Learn more about this incredible program and be sure to apply by Friday, July 1, 2022. Our 2020 and 2021 Fellows should be traveling soon and we look forward to hearing about their experiences!

During our leadership meetings in January the Executive Council amended the ASPN policy document to reflect greater transparency related to the nominating committee process, and agreed to extend the window for nominations from several weeks to several months. In addition, the EC moved to expand the number of opportunities to be involved at the leadership level by adding an additional Member at Large position to the roster. This amendment to the by-laws will soon be forwarded to voting members for ratification. We anticipate releasing the call for leadership nominations later this spring; please keep an eye on your inboxes for that communication, which will outline the process and materials required to submit a nomination.

Be sure to follow ASPN on Instagram @nervenerds to see the fun and interesting programs put out by our social media committee. For those who registered for the ASPN 2022 Annual Meeting, remember that you can now access the on-demand recordings including any instructional courses that you may have missed, the outstanding guest speakers, and Greg Borschel’s Presidential Address. Login instructions should have been sent to you from the Central Office.

Thank you for entrusting me with leading our growing Society. Wishing everyone a happy and healthy Spring!

Sincerely,
Gedge


Joseph Catapano, MD Hollie Power, MD
Back to the future never sounded so fitting! In addition to big hair, shoulder pads, and Pac Man, centralization of pain and walking tracks were leading innovations! Let’s travel back to the 1980’s to see what was the future of nerve… and the top 5 most cited nerve injury-related articles from that decade (according to Scopus).
  1. Woolf, C.J. Evidence for a central component of post-injury pain hypersensitivity.
    Nature. 1983; 306(5944), 686-688

    Citations: 1573


  2. Bain, J.R., Mackinnon, S.E., Hunter, D.A. Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat.
    Plastic and Reconstructive Surgery, 1989; 83(1): 129-136

    Citations: 1036

Read Full Article


Welcome new recruits!!!!

Néha Datta, MD
Néha Datta is an Independent Plastic Surgery resident at Johns Hopkins/University of Maryland. Originally from Calgary, Alberta, she completed her undergraduate training in Bioengineering/Electrical engineering at Rice University, followed by medical school in the Harvard-MIT Health Sciences and Technology (HST) program. She then completed General Surgery residency at UCLA Medical Center, during which she completed an in-folded post-doctoral research fellowship in Vascularized Composite Allotransplantation at Johns Hopkins and the Dumont-UCLA Transplant Center. Her interests include peripheral nerve surgery, facial paralysis and complex microsurgical reconstruction.
 
Jana Dengler, MD MASc FRCS(C)
After completing undergraduate and graduate degrees in biomedical engineering, Dr. Dengler completed medical school and plastic surgery residency training at the University of Toronto followed by fellowship training in hand, peripheral nerve, and microsurgery at the Washington University of St. Louis, under the direction of Drs. Susan Mackinnon, Amy Moore and Ida Fox. Dr. Dengler joined Sunnybrook Health Sciences Centre and the University of Toronto in 2019, where her clinical focus is in adult hand, peripheral nerve, and microsurgery. She has a special interest in improving upper extremity function in people living with cervical spinal cord injury. Her research program currently focuses on improving access to care, processes of care, and outcomes in peripheral nerve injuries and cervical-level spinal cord injury.
 
Rawan O. ElAbd, MD
Dr. Rawan O. ElAbd is an incoming PGY-1 in Plastic & Reconstructive Surgery at McGill University Health Centre in Quebec, Canada. Dr. ElAbd is interested in peripheral nerve and hand surgery. Her research focus is on the clinical outcomes of electrical stimulation for peripheral nerve regeneration and pain and functional outcomes of targeted muscle reinnervation.
 
Kate Elzinga, MD, FRCSC
Dr. Kate Elzinga completed medical school at the University of Calgary, a plastic surgery residency at the University of Alberta, a hand and wrist fellowship at the University of Michigan, and a microsurgery fellowship at the University of Manitoba. She is a Clinical Lecturer at the University of Calgary. Her clinical interests are adult and pediatric peripheral nerve surgery, hand and wrist surgery, and microsurgery. She is the chair of the University of Calgary Department of Surgery Quality Improvement Committee.
 
Konstantinos Gasteratos, MD, MSc
Konstantinos Gasteratos, MD, MSc graduated from the Aristotle University of Thessaloniki School of Medicine, Greece in 2011. He completed an integrated Plastic & Reconstructive Surgery Residency program in 2021, while earning his Master's degree (Distinction) in Reconstructive Microsurgery from the Queen Mary University of London, UK. In October 2021, Dr. Gasteratos joined the Elmezzi Graduate School of Molecular Medicine at Northwell Health. His research interests include both basic science laboratory work as well as clinical research. Since joining Dr. Daniel Grande's lab, his research has focused on regenerative medicine investigating the role of stem cells in peripheral nerve repair.
 
Matthew Q. Miller, MD
Dr. Matthew Q. Miller graduated from the University Of Pennsylvania School Of Medicine and completed his Otolaryngology-Head and Neck Surgery residency at the University of Virginia. He went on to complete his two-year facial reanimation fellowship at Mass Eye and Ear/Harvard in June 2021. During this fellowship he received NIH funding to study gene therapy delivery to transected peripheral nerves. Dr. Miller is now an assistant professor at the University of North Carolina and inaugural director of the UNC Facial Nerve Center. He is widely published and lectures nationally and internationally on cutting-edge treatments for facial paralysis.


Ever wonder about the results related to the surveys that you take? Well, do we have some data for you! We will be highlighting summaries of different ASPN member-initiated surveys for your viewing pleasure. First up is the Paradigm shift in nerve surgery team from WashU led by Drs. Mackinnon and Domeshek...

Paradigm shift in nerve surgery—Mackinnon, Domeshek

Nerve surgery evolved tremendously over recent decades with increased utilization of nerve transfers. In 2017, we surveyed practicing nerve surgeons regarding their use of nerve transfers for motor and sensory reconstructions. 72% of respondents included nerve transfers in their practice. Transfers for proximal plexus and ulnar nerve injuries were most common with fewer performed for median and radial lesions (Table/Figure 1)1. For AIN to ulnar motor transfers, end-to-end coaptations were more popular for proximal lesions while end-to-side was more common for distal injuries. Transfers for sensation were much less common than for motor.
Read Full Article


Did you know?

Since 1983, the year of the first American Society of Reconstructive Microsurgery meeting (see Blast from the Past section photo), the annual number of publications related to nerve injuries has quadrupled! Publications have essentially steadily increased over that 38 year span, reflecting a lot of blood, sweat, and tears by our ASPN membership over time. Congrats—you all deserve a break... and then keep going!!! Source: Scopus, search terms: peripheral AND nerve AND injury, March 7, 2022.


Coding Corner

Noah Raizman, MD
by Noah Raizman

Q: How do you code a nerve transfer procedure with more than one donor nerve (ex: 3 intercostals to musculocutaneous; 2 supinator branches to PIN)? What about neurotized flaps?

A: As for those two scenarios, neurovascular pedicle flaps have their own code: 15750. Neurotized free flaps do not. Therefore I would code Suture of Nerve (64856 or similar depending on identity of nerve) in addition to 15756 for the free flap. Because both 64856 and 64905 are Harvard codes that have never been further defined or surveyed, there is lack of definition as to which is more appropriate in this setting, but their RVU's are essentially identical (15.06 vs 15.11) so I would just use the simpler and more obvious code here.

As for the 3-to-2 transfer, there's no specific guidance. Given the CMS listed maximums for individual iterations of 64905 is three, do not attempt to bill for more than three 64905s in any case and expect payment. You could, however, bill for three instances of 64905 in this situation, with a 59-modifier and VERY clear documentation of EACH transfer so that no coder will get confused.


Aron Wahrman, MD, MBA
(Occasional notes from an unapologetic bibliophile and indulged husband)

An Unusual Glimpse Of A Legend;
Sterling Bunnell, MD (1882-1957)

Every so often, the “joy of the hunt”, as we say in the collecting world, will come full circle, and you are happily connected with a “one off” item that was completely unexpected. Serendipity is always more satisfying (and often less expensive) then buying an object from a dealer or high end catalogue. Don’t get me wrong- everyone deserves to make a good living, and dealers and their catalogues are not only beautiful (and collectible) in and of themselves- and also very educational.
Read Full Article



And now for a quiz...

This photo was taken at the first ASRM meeting in NYC in 1983.
Can you identify the person(s) in this photograph who made this historic contribution to peripheral nerve surgery?
Enlarge this image and take the quiz!

Thank you to Dr. A. Lee Dellon for submitting this photo and the associated questions. He has graciously offered to provide a copy of his text, Joint Denervation, to the ASPN member who gets the most questions correct! Please email snydera@wustl.edu with your responses (if you’d like to go for the win!)… no cheating! Answers will be published in the next issue of Synapse.


Upcoming meetings around the globe

ASPN 2023 Annual MeetingJanuary 20-22, 2023Miami, Florida
AAPSApril 9-12, 2022San Diego, California
International Facial Nerve Symposiumpril 28-30, 2022(virtual only)
PSRCJune 9-12, 2022Toronto, Ontario
World Society of Reconstructive Microsurgery1-4, 2022Cancun, Mexico


Penny for your thoughts?

Thank you to everyone who responded to the “Penny for your thoughts” in issue 11. Results are depicted in the graph below


And now for the next figurative Penny...

Create your own user feedback survey


This is our column to highlight the creative expressions of our membership...
Please send us your non-clinical artistic endeavors—visual, text, audio… anything! Nerve not necessary here—we want to highlight our very talented members!


Show me the money... research money!

Do you have great ideas? Do you love science? Well, then get your projects funded!!! Translate your ideas to projects! Create data to help us all! The ASPN Grants Committee has compiled valuable information to help fund your nerve-related science... follow the link to learn more! #scienceiscool

See the ASPN list of peripheral nerve funding sources!


We are excited to launch our newest column in Synapse—nerve-related job and fellowship opportunities… your next nerve career adventure awaits! Please send us postings at your institution to showcase.

What's in a name?
Well, maybe a little, maybe a lot. Let’s at least find a name for this newest column… and we need your help! Please vote and send us your ideas using this survey. We’ll be excited to unveil the long-anticipated column title in the Summer issue! The anticipation is incredible...

Submit your vote to name this newest column!


I know you!

Here they are... your fearless 2022 ASPN Executive Council