A Global Surgical Reach
Two Miller School plastic surgeons performed complex reconstructive procedures abroad to help patients in underserved areas.
Two facial plastic surgeons from the University of Miami Miller School of Medicine recently traveled abroad on separate humanitarian missions, performing complex reconstructive plastic surgery procedures to help patients in underserved areas.
Working in teams that included former mentors and local surgeons, Shekhar Gadkaree, M.D., and Liliana Ein, M.D., both assistant professors of clinical otolaryngology in the Miller School’s Department of Ototolaryngology-Head and Neck Surgery, spent a week in Rwanda and Ecuador, respectively. The trips proved mutually educational for the local surgical teams and the Miller School doctors alike.
A Humanitarian Lineage
Each year, Dr. Ein’s fellowship director at Harvard, Tessa Hadlock, M.D., accompanied a fellow on a week-long trip to Ecuador. Organized by Dr. Vito Quatela’s nonprofit Help Us Give Smiles (HUGS), the trip coordinates facial plastic surgeons from around the world to perform free reconstructive surgeries on children born with cleft lip or without an outer ear (microtia).
But since Dr. Ein’s fellowship happened to fall during the beginning of the COVID-19 pandemic, the trip that year was cancelled.
“I was always sad about that,” she said.
Earlier this year, one of the surgeons scheduled to go on the annual HUGS trip had to cancel at the last minute. Dr. Ein’s mentor asked if she’d be able to go instead.
“I said, ‘Yes, yes. I will drop everything. And that’s what I essentially did. I dropped everything and booked the trip,” Dr. Ein said.
The trip leaders brought 16 duffel bags of instruments and supplies for the nearly 50 surgeries performed over the course of the week.
Microtia has a higher prevalence in South America, perhaps because of genetic disposition or environmental factors like reduced oxygen during pregnancy at higher altitudes. While it’s possible to live and even hear and develop normal speech without an outer ear, the effects of this genetic condition on patients are still significant.
“It has a profound impact on their quality of life because there’s a huge stigma with not having an ear,” Dr. Ein said. “They can get socially isolated. So it’s not just an aesthetic thing. And the surgery really does change their life.”
Dr. Ein worked on patients undergoing various steps of the multi-stage surgery, which involves reconstructing the framework of the outer ear using cartilage from the rib area. The new “ear” then gets tunneled under the skin. Surgeons insert drains for fluid and air.
“A lot of unpredictable things can happen, and it’s a very steep learning curve. That’s why even the people who have been doing it for 20 to 30 years are still refining their technique to improve outcomes. There’s a lifelong learning component,” said Dr. Ein.
Owing to Miami’s proximity to South America, Dr. Ein anticipates being able to practice her new skills on microtia patients in the area.
“Because it’s such a complicated surgery, you can’t get good at it unless you do it a lot. So these trips are amazing because I’m learning a skill and getting a lot of reps in a short period of time,” she said. “I hope that, because I’m getting more experience with this type of surgery, I can take better care of patients in Miami with this condition.”
A Mutual Learning Experience
Dr. Gadkaree attributes his desire to be a facial plastic surgeon to his Harvard residency mentor, David Shaye, M.D., M.P.H.
A specialist in global surgery, Dr. Shaye spends almost half of every year abroad. Much of that time is in Rwanda, which is rebuilding its health care system. This year he invited Dr. Gadkaree to help operate on patients and train local surgeons at the University Teaching Hospital of Kigali during the hospital’s “in reach” week.
More than simply treating patients, the trip focused on training local surgeons and residents.
“You don’t want to do a mission trip and just operate on people,” said Dr. Gadkaree. “The whole point of the trip should be to enhance the health, literacy, education and surgical knowledge of people there. If you can help train or do cases with local surgeons so that they’re learning, you’ll give back a lot more to that community.”
The team stayed at Dr. Shaye’s house, arriving at the university each day at around 6:30 a.m. Dr. Gadkaree worked all day, teaching residents or taking them through complex cases, including operating on post-trauma chronic infections, removing complex head and neck tumors and performing nasal reconstructions.
At the end of the day, they’d debrief and do a final round before arriving back home at 7:30 or 8 p.m. to gear up for the next day.
“It was a pretty intense experience. But we got to work a lot with the local surgeons, and the residents were all really awesome. We developed connections with them, and they treated us really well,” Dr. Gadkaree said.
Though he was there in a training capacity, Dr. Gadkaree also learned a great deal.
“The system’s totally different. The operating rooms are different and they waste a lot less. They’re not as needy, and everything doesn’t have to be perfect. You learn to be flexible and use what you have available. There’s a lot of creativity involved, and I’ve used different approaches I learned there, even the very next week. So it’s definitely a bi-directional learning experience,” he said.
Tags: Division of Plastic Surgery, Dr. Liliana J. Ein, Dr. Shekhar Gadkaree, head and neck surgery, plastic surgery