Learning Microsurgery from the Master: A Few Days With JP Hong

by Chad Purnell, MD (@ChadPurnellMD)

Northwestern’s plastic surgery program was lucky enough to have JP Hong, MD, PhD, MMM, Professor and Chief of Plastic Surgery at Asan Medical Center in Seoul, South Korea as our visiting professor in November.  In case you haven’t been exposed to Dr. Hong personally, he isn’t just a master of supermicrosurgery, he is a fantastic all-around educator, scientist, and spokesperson for the specialty of plastic surgery.  For just a few of Dr. Hong’s articles pushing the limits of reconstructive microsurgery, see the references below.

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Our time with Professor Hong began with a few lectures to start the afternoon.  His first lecture highlighted the superficial circumflex iliac perforator (SCIP) flap, which has become his workhorse for reconstruction.  He described detailed anatomic studies of the flap, as well as his technical modification of harvesting the flap as an ultra-thin perforator flap at the level of the superficial fascia.  He demonstrated some impressive cases where this flap could be harvested quickly and cover extremity defects with perfect contour.  Combined with perforator-to-perforator anastomoses, he was able to tackle complex reconstructive problems quickly and effectively.

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His second lecture was more philosophical:  it regarded the thought process of how to assess and critically question everything we do in order to drive innovation.  He stressed that we should all view problems like a junior resident, not set in our ways, but ready to learn and think outside the box to discover new solutions to problems in plastic surgery.

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By this point, we were all anxious to add the SCIP flap to our arsenal, and no better place to test that than the cadaver lab.  At Northwestern’s Center for Advanced Surgical Education (NCASE), Dr. Hong guided our residents through multiple flaps with his technical modifications, including SCIP, ultrathin ALT raised at the level of superficial fascia, medial sural artery perforator flap, and osteoseptocutaneous fibula flap.  He also showed us his method for raising freestyle superior gluteal artery perforator flaps for pressure sore reconstruction.  By the end of the lab, we all felt a little more comfortable with monopolar-only perforator dissection and how to harvest an ultra-thin flap.

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No visiting professor trip is complete without a great dinner and better drinks, and this was no exception.  Dr. Hong treated us to some incredible stories of plastic surgery in Korea over tapas and drinks.  Between early morning running, the intense Asan medical center indications conference, and his supermicrosurgery mentors, we covered a lot of ground. There was barely time for sleep before his final lecture the next morning.  For a combined grand rounds between plastic surgery and orthopedic surgery, Professor Hong discussed the data guiding lower extremity reconstruction and his techniques for supermicrosurgical reconstruction of lower extremity trauma and for diabetic foot wounds.  By the end of our time with him, it was very clear why Dr. Hong is one of the driving forces in reconstructive microsurgery; espousing efficient and anatomic reconstructions of extremity defects, and backing this up with research to guide surgical principles.  He continues to push the envelope of microsurgery, and we were honored to learn from him.  I’m looking forward to finding an excuse to attend the World Society of Reconstructive Microsurgery meeting that he is hosting in Seoul in 2017.

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REFERENCES:

  1. Suh HS, Oh TS, Lee HS, Lee SH, Cho YP, Park JR, Hong JP. A New Approach for Reconstruction of Diabetic Foot Wounds Using the Angiosome and Supermicrosurgery Concept.   Plast Reconstr Surg. 2016 Oct;138(4):702e-9e.
  2. Goh TL, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap–a review of 210 cases. Plast Reconstr Surg. 2015 Feb;135(2):592-601.
  3. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg. 2009 Jan;123(1):230-5.
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