American Society for Peripheral Nerve (ASPN)
Issue 15, Winter 2023

See you in Miami!
The entire ASPN Executive Council and Program Chairs look forward to welcoming an incredible group of ASPN members and prospective members to Miami for our 2023 Annual Meeting. Drs. Henk Coert (Netherlands) and Sami Tuffaha (United States) have assembled an outstanding educational program. Be sure to refer to the ASPN website and/or the meeting mobile app for details.

The Society also has a number of fun networking events this week, and our #nervenerds Instagram team has all sorts of social education planned. Be sure to follow along with them and participate in their activities!
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A Markov Analysis of Surgical versus Medical Management of Chronic Migraines
Plast Reconstr Surg. 2022 May 1;149(5):1187-1196.
Pooja S Yesantharao, Erica Lee, Kevin M Klifto, Salih Colakoglu, A Lee Dellon, Sashank K Reddy

This is a cost-effectiveness analysis investigating medical versus surgical management of refractory chronic migraine. We used a Markov cohort analysis to compare surgical decompression versus erenumab for the treatment of refractory migraines in adults. We found that over a 5-year period, migraine surgery was more cost effective than medical therapy, even when considering revision surgery needs. We used sensitivity analyses to determine that surgery was more cost-effective than medical therapy when patients were expected to require medical therapy for at least 1 year. We hope that our study can help to inform conversations on high-value care for chronic migraine patients, as this is a condition affecting 8 million Americans that results in billions of dollars in lost productivity. Furthermore, as healthcare policy evolves, we hope that such analyses can also help to secure more robust insurance coverage pathways for relatively novel procedures such as migraine surgery. We plan to continue expanding upon this study to characterize the ever-evolving clinical/economic landscape of chronic migraine treatment in years to come."
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Welcome new recruits!!!!

Matthew Curan, MSc, FRCSC
My name is Matthew Curran and I am Assistant Professor in the Division of Plastic Surgery at the University of Alberta. I completed my training at the University of Alberta where I a completed a MSc focusing on clinical strategies to improve peripheral nerve regeneration. After residency I completed a fellowship in upper extremity surgery at the Brisbane Hand and Upper Limb Research Institute. My interests include translational medicine to bring new therapies to peripheral nerve injuries and peripheral nerve outcomes research.
 
Dattesh R. Davé, MD, MSc
I am a 4th year Integrated Resident in Plastic Surgery at UC Davis Medical Center. I am very excited to be part of the ASPN. My current research involves the use of label-free imaging techniques to distinguish healthy from traumatized nerve segments in a large animal Sunderland grade III crush injury model. I plan to pursue a fellowship in Hand & Upper Extremity Surgery. When I'm not operating or working on research, I enjoy spending time with my family in the great outdoors – backpacking, skiing, and kayaking.
 
Gordana Georgieva, MD
Gordana Georgieva, MD is a plastic and reconstructive surgeon at the University Clinic for Plastic and reconstructive surgery in Skopje, North Macedonia. She is also leading and organizing the Residence program at the clinic. This year she received the award for Successful young scientist from the President of the country. Currently she is working on her PhD thesis in the field of peripheral nerves and RPNIs. Together with ASPN member, Prof. Sofija Pejkova are working basic research focusing on nerve repair and treatment. Influenced by Prof. Oscar Aszmann and Prof. Lee Dellon, her clinical work concentrates in implementing novelties in nerve surgery.
 
Balduino Neto
Balduino Neto holds a degree in medicine from the Federal University of São Carlos in Brazil, with a medical residency in general surgery and plastic surgery in Botucatu Medical School. He has a master's degree in cicatrization from the Botucatu Medical School and is a doctoral student at the same institution with the subject of neurorrhaphy and muscle neurotization. He works in a private clinic and is a volunteer assistant at Botucatu Medical School, under the guidance of Professor Fausto Viterbo.
 
Alexander Y. Shin, MD
Dr. Alexander Y. Shin is a Professor of Orthopedic Surgery, Neurosurgery and Regenerative Medicine at the Mayo Clinic, Rochester, Minnesota. He has been an integral member of a multidisciplinary Brachial Plexus practice for over 20 years. He has been an educator his entire career and has trained and mentored numerous orthopedic and plastic hand surgeons and Ph.D. candidates. He has a rich academic history that involves clinical, biomechanical, and nerve and muscle regeneration studies. It took him a while to join ASPN, but he looks forward to the comradery, friendships and collaboration the future holds.
 
James Wilton, DPM
Dr. Jim Wilton is a board-certified podiatric foot and ankle surgeon working at Cottage Hospital in Woodsville New Hampshire. He holds an undergraduate degree in marine biology and chemistry from the Catholic University of America and graduated from the Pennsylvania College of Podiatric Medicine in Philadelphia Pennsylvania. He completed a residency in foot and ankle surgery at Montgomery Hospital in Norristown Pennsylvania training under Dr. James V. Ganley. In addition to foot and ankle surgery, Jim has a clinical interest in peripheral nerve surgery and is a founding member of the Association of a SPN-Dr. Wilton Senior critters on your walk developed an directs the basic peripheral nerve surgery course since 2010 and has directed the advanced peripheral nerve surgery course from 2010 to 2016. In 2011 he was awarded the Jules Tinel MD award by the association for the scientific advancement of knowledge regarding human peripheral nerve disorders. In addition to foot and ankle surgery, Jim also directs a peripheral nerve surgery team for upper and lower extremity surgery working with Hansen's patient's in Ecuador and has directed 17 surgical missions. He is also an attending surgeon with Project Perfect World performing pediatric reconstructive foot surgery in Ecuador.
 
 


Did you know?

What’s the cost of migraines?

  • Total annual estimated costs for migraine headaches in the U.S. is $13-17 billion.
  • Mean annual direct all-cause healthcare costs are more for patients with migraines compared to matched patients without migraines.
  • Patients with migraines are twice as likely to use opioids than patients without migraines.
Source: Machaon Bonafede PhD, MPH, Sandhya Sapra PhD, Neel Shah PhD, Stewart Tepper MD, Katherine Cappell PhD, Pooja Desai PhD. 2018. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States. Headache, 58(5): 700-714.


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

“Sick-Headache”
--The Migraine Issue

Often a picture is indeed worth a thousand words (sometimes you’ll be up against an editor who wants you to keep it 500-600). Intrepid Dr Alison Snyder Warwick informed me that this issue of Synapse would be focused on migraine and wanted to know if that could also be the topic of Forgotten Fascicles; I have many old books on neuralgia, cephalgia, but none that I could think of that were solely devoted to the “sick headache” throat assistant looking title an old synonym for migraine and symptoms beyond mere head pain. When I seemed to demur, she graciously said, “OK, write whatever you wish.” Fearing a disgruntled Alison, despite her usual kind, understanding tone (we actually happen to have a daughter named Allison, and believe me, a fully gruntled Allison is easier to deal with, whether spelled with one “l” or two)- I pressed ahead with the assignment.
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Upcoming meetings around the globe

AAHS/ASPN/ASRM January 17-24, 2023, Miami, FL
PSRC April 12-16, 2023, Cleveland, OH
Mexican Society of Plastic Surgery (AMCPER) March 22-25 2023, Guadalajara City, Mexico.
Chang Gung Facial Nerve Instructional Course October 2-5 2023, Taoyuan City, Taiwan. | letter of invitation


Penny for your thoughts?

Thank you to everyone who responded to the “Penny for your thoughts” in issue 14. Results are depicted in the graph below.


And for the next figurative Penny...

Create your own user feedback survey


Check out these cool videos about migraine surgery!!!

Published in Plast Reconstr Surg Glob Open. 2019 Jul; 7(7): e2291.
Published online 2019 Jul 31. doi: 10.1097/GOX.0000000000002291
PMCID: PMC6952133
PMID: 31942333

Migraine Surgery
Lisa Gfrerer, MD, PhD, William G. Austen, Jr, MD, and Jeffrey E. Janis, MD
Greater occipital nerve decompression:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952133/bin/gox-7-e2291-s001-pmcvs_normal.mp4

Frontal trigger (Supraorbital and supratrochlear) decompressions:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952133/bin/gox-7-e2291-s002-pmcvs_normal.mp4

Zygomaticotemporal nerve avulsion:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952133/bin/gox-7-e2291-s003-pmcvs_normal.mp4


Please send us your non-clinical artistic endeavors—visual, text, audio… anything! Nerve not necessary here—we want to highlight our very talented members!

Anthony Baker
Medical Illustrator
Medical Visuals, Ohio State University
anthony.baker@osumc.edu
(submitted by Kevin Zuo)

This illustration was created for the 2021 Ohio State University College of Medicine annual report to highlight the work of Benjamin Segal, MD, professor and chair of the Department of Neurology at the Ohio State College of Medicine and co-director of the Ohio State Wexner Medical Center’s Neurological Institute. Dr. Segal, along with other researchers at The Ohio State University College of Medicine, are exploring the potential of a “holy grail” immune cell’s ability to repair or regrow damaged nerves in humans. This illustration depicts these cells (neutrophils, in purple) sending growth factors (in orange) to help restore damaged neurons. Neurologists hope this discovery could lead to new, life-changing treatments for people with degenerative diseases or brain or spinal cord trauma.


Postaxial Polydactyly in Marc Chagall`s “Self-Portrait with Seven Fingers“
Andreas Gohritz 1, Kerstin Bitar 2, Shai Lurija 3, A. Lee Dellon 4

Affiliation of authors:
Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Basel, Switzerland 1
Kunsthaus, Zürich, Switzerland 2
Hand and Microsurgery, Hadassah Hospital, Jerusalem Israel 3
Dellon Institutes for Peripheral Nerve Surgery, John Hopkins University, Baltimore, USA 4

The painter Marc Chagall (1887-1985), depicted himself in a very early self-portrait (1912/13) with seven finger (unilateral postaxial septadactyly) on his left dominant hand (fig. 1). As Chagall possessed only 5 fingers, interpretations include his birth date (07.07.1887) or the spiritual power of the number seven (shevan) in Judaism which also means “oath” in Hebrew and represents 7 days of creation, spiritual submission, good fortune and blessing. Another explanation is the Yiddish idiom doing something “mit ale zibn finger“ (with all seven fingers) meaning to the best, with particular dedication and creative energy 1,2. Hand surgeons mostly see polydactyly as congenital impairment. However, recent studies on a six-fingered family revealed that human brains can control more than five fingers and supernumerary digits may in reality enable superior manipulation skills 3. This opens future perspectives, e.g. regarding artificial extra limbs, yet also confirms the symbolic wisdom of this old colorful folk expression.

Figures and Legends


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!


Synaptic Connections!

Fellowship Position
A one year Peripheral Nerve Fellowship is being offered at the Johns Hopkins Medical Institutions commencing July 1 2023. Candidates should be completing or have recently completed a residency in Neurosurgery, Orthopedic Surgery or Plastic Surgery. The multi-disciplinary program consists of exposure to clinical and research activities with an emphasis on a well-rounded education in the management of peripheral nerve issues. Research opportunities are endless including both clinical and basic science.
The fellow will participate in clinical work spanning the full gamut of nerve surgery.
https://www.hopkinsmedicine.org/peripheral_nerve_surgery/
The fellowship is Cast Accredited
https://sns-cast.org/cast-approved-fellowship-programs-in-peripheral-nerve/

For further information please contact
Allan Belzberg MD FRCSC
Belzberg@jhu.edu


Nerve and Hand Surgery Fellowship
Location: Sunnybrook Health Sciences Centre, University of Toronto, Toronto Canada

Description: One-year fellowship in peripheral nerve surgery and hand surgery fellowship at Canada's largest and busiest tertiary care trauma center: Sunnybrook Health Sciences Centre. Fellows will spend 12 months enhancing their clinical expertise in the evaluation and management of patients presenting with complex upper and lower extremity nerve problems, including peripheral nerve, brachial plexus and spinal cord injuries, as well as patients presenting with acute traumatic and acquired hand problems.

Start date: July 1 or August 1, 2023

For more information, please contact: jana.dengler@mail.utoronto.ca


Nerve and Hand Surgery Fellowship

Location: Sunnybrook Health Sciences Centre, University of Toronto, Toronto Canada

Description: One-year fellowship in peripheral nerve surgery and hand surgery fellowship at Canada's largest and busiest tertiary care trauma center: Sunnybrook Health Sciences Centre. Fellows will spend 12 months enhancing their clinical expertise in the evaluation and management of patients presenting with complex upper and lower extremity nerve problems, including peripheral nerve, brachial plexus and spinal cord injuries, as well as patients presenting with acute traumatic and acquired hand problems.

Start date: July 1 or August 1, 2024

For more information, please contact: jana.dengler@mail.utoronto.ca


Board Eligible/ Board Certified Plastic Surgeons
Expanding multi-location private plastic and reconstructive practice is seeking BE/BC plastic surgeons as well as CAQ eligible hand surgeons (orthopedic and plastic surgeons) for several locations throughout NJ and NY with a focus on reconstructive surgery while offering a variety of surgical and non-surgical aesthetic procedures.

Competitive compensation package with full partnership track after 3 years. No restrictive covenant will apply for the first 18 months of practice. Full benefits offered include health insurance, malpractice insurance, and retirement.

Email your CV to: Heather O'Neill at recruitment@arsahealth.com and schedule an interview today for more information visit us at https://www.advancedreconstruction.com/physician-careers/


MGH/Harvard Advanced Peripheral Nerve and Microsurgery Fellowship
Reconstructive Fellowship offered at Massachusetts General Hospital (Boston, MA), a Harvard teaching hospital, beginning August 1, 2023 (12 months).

High volume experience in all areas of peripheral nerve surgery and microsurgery applied to complex and challenging reconstructive care spanning “head to toe” traumatic and oncologic defect restoration. Emphasis on advanced microsurgical techniques and innovations within this rapidly evolving field including clinical and translational research projects and international visiting scholar travel program for select individuals. Opportunities to participate in other areas of clinical interest, research, and teaching is heavily emphasized and supported. Must have completed a plastic surgery, orthopaedic, and/or neurosurgery residency.

Forward CV to: Dr. Ian Valerio, 55 Fruit Street, WACC435, Boston, MA 02114. Fax: 617-726-1812. Email jldaddario@mgh.harvard.edu


I know you!

Here they are... your fearless 2023 ASPN Executive Council