by Stav Brown, BS1
1 Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel
Through interviews with leaders in the field, we present here the second piece in the series “Plastic Surgery Perspectives” dedicated to providing residents and medical students a perspective on future career options and possible fellowships within the field.
This piece includes contributions from Dr. Daniel J. Ceradini.
Why did you choose this specific field of research?
Plastic surgery is all about solving problems with ideas, innovation, and execution. It is this enlightening process which led me to the field. With the incredible experience of training, designing and performing experiments in the laboratory, and operating in practice at NYU, it has confirmed that this is what my team and I should be doing.
How has this field changed since you started?
Significantly. Without change, the field would cease to progress and not remain innovative. The broad concept of how we have remained relevant as a specialty is that a clinician identifies a challenging problem in the clinic, abstracts that concept to the lab, performs exhaustive experiments to identify practical solutions, and brings it back to the clinic for advancing patient care. From bedside to bench to bedside. It has happened in microsurgery, craniofacial surgery, extremity surgery to name a few. These are monumental achievements that depict our landscape that we should all follow and build on.
What are your main interests in your field?
The scope of training and interests, I think, are very important. My path was microsurgery and trying to figure out tissue regeneration in specific disease states where we had no solution. But the concept applies in any place in plastic surgery, you just have to identify it in your own mind and there is no wrong answer. It’s about problem solving. My interests are invested in clinical and translational research mostly centered around vascular biology, tissue regeneration (specifically in diabetes), transplantation biology, and how each concept could be applied to patient care.
Tell us about a clinical case/aspect that has shaped the vision of the field for you.
Every patient shapes the vision of both their future and your own as a surgeon scientist. Mine, among many, is a young woman struck by a bus who had a significant Gustilo grade IIIB lower extremity injury. She was a runway model visiting from out of town and required an extensive revascularization, fixation, latissimus free flap coverage, and numerous subsequent operations. Because we were there, thinking about how to solve the problem, and had the expertise to do it and manage it, she is now actually on the runway again. Further, this case makes you think about fundamental problems in tissue regeneration. How does tissue revascularize? Is there something you could do to expedite it? Is there a substitute you could construct to fix it? This is the horizon in plastic surgery.
What role does technology play in your field?
The development of technology is really vital to progress. This has been evident throughout our surgical history, but you have to keep your eyes open for ways develop it. Many commonly used technical advances or products we use clinically came from other subspecialties or even from outside of medicine completely, and the relationship with industry is important, but should be without bias. In cutaneous tissue regeneration, we are investigating very specific molecular pathways that can be modulated with novel compounds to accelerate healing in diabetes and other disease states. In facial transplantation and reconstruction, we are studying ways to utilize 3D printed personalized surgical devices to facilitate a precise bony and soft tissue alignment. Additionally, we are investigating the use of stem cells to facilitate immunomodulation in both transplant biology and tissue regeneration.
What most excites you when you anticipate the future of the field?
The evolution of science and clinical practice and how this impacts patient care. We are really all scientists, but if you ask the right questions and have an approach to the problem that you can execute, this is how change happens. And it happens whether you are at the bench or in the operating room.
For a resident interested in incorporating basic science into their clinical career, what advice do you have?
In my experience, the earlier you start, the better. And likely begins even before you become a resident. The most important components in my mind are at least two years of dedicated time, and mentorship not only from your Principal Investigator, but from other fields in the scientific scope. During that time you should invest yourself into the science – need to design, troubleshoot, redesign, and analyze experiments. Additionally, the consolidation of data and rigorous analysis without bias is critical, and will carry into your clinical practice.