Dr. Patel in Honduras

facial fracture
Dr. Patel repairing a mandible fracture
Dr. Sapna Patel Our UW Facial Plastic Surgery Fellow for 2015-2016
Dr. Sapna Patel Our UW Facial Plastic Surgery Fellow for 2015-2016

Sapna A. Patel MD, our University of Washington facial plastic surgery fellow for this year, just completed a mission trip to Balfate, Honduras on March 12-20, 2016 at the Hospital Loma de Luz in Balfate, Honduras. Here are some of her insights from that trip as well as some personal impressions about her mission. The model of combining education with surgery and commitment to follow-up is one we have embraced over the years.

Dr. Johnson grabbed my attention, “Hey, can you come see this patient with me? The other attending recommended a lip switch flap for reconstruction.” Imagining an elderly man with squamous cell carcinoma of the lip, my breath was taken away as there sat a petite, young blind girl whose face was consumed by a disease that I had only read about in textbooks, xeroderma pigmentosum.

The Honduran sun had transformed her beautiful face into one consumed by malignancy – a fate predestined despite all the medical and surgical care we could provide. “She wants to touch your hands,” said her caretaker. I slowly approached, as her hands reached out to my fingers, tears rolled down my face. During my ten years of medical training, I had never felt so moved by a patient. The intraoral bleeding from her dehisced excision site was treated with a simple bolster and figure of eight stitch, realizing that less is more for Deleny. Deleny’s story was echoed in every patient we saw, and it outlined the reality of healthcare in Honduras. The town of Balfate is served by missionary doctors and families providing for the local population. Together, they put this city on the map and made the Hospital Loma de Luz a tertiary care center for patients in the region. More impressive than the organization and high standards for patient care was the selfless dedication displayed by the physicians and surgeons on the front lines. For most Hondurans, aside from the hospital in the capital city of Tegucigalpa, no real options exist.

During our week-long mission trip, we performed a variety of cases from maxillomandibular fixation, gold weight placement for eyelid paralysis, scar revision from a machete wound, cleft palate repair, total parotidectomy, complex thyroidectomies, and even a rhinophyma excision. Each case we saw and the surgeries that we performed affirmed my confidence and knowledge in facial plastic and head and neck surgery. The challenges we faced humbled me each time; I had never done a parotidectomy without a facial nerve monitor. We may not have had the sharpest instruments or the best dissector, but each case was done without reservation to provide the best care possible. We planned accordingly and brought down our needed instruments, including arch bars, an eyelid gold weight, and a lacrimal set, providing sub-specialized care to a population that didn’t have access to it elsewhere. At the end of the week, we reviewed each patient’s case, and could rest assured knowing that our sister team from the Eastern Virginia Medical School would be able to provide follow-up in the fall, creating a continuity of care unlike most mission trips.

These missions, combining surgery with education and organized for excellent ongoing care, provide a good model for humanitarian assistance from the developed to less developed world. On our last day in Balfate, we visited the Children’s Center, which like many organizations in the community is run by a missionary family. As we walked through, there she was sitting on her chair, so innocent and welcoming. She touched my hands and hair, and tears filled my eyes yet again. Deleny had not had any further bleeding. She led us to her shoes and motioned for us to come outside with her. We sat in the shaded area on the porch, as she crawled in our arms wanting to listen to music; her sense of touch, smell, and hearing remained, while the rest were consumed by the disease. We may not have cured her cancer, but at age six, her smiling face as she listened to music reminded me that sometimes the smallest things have the greatest impact. While we are proud of what we accomplished, we also recognize that our team members benefited so much from the experience and will be bringing those new insights back to our home practices.

Elibrary

Click on the links below to read scholarly articles written by Dr. Larrabee.

The Art of the Smile

Humans have the most complex array of facial musculature in all the animal kingdom, and correspondingly the most elaborate and subtle mechanisms for controlling those muscles. Facial expression has evolved as one of our most important social skills, and our ability to both recognize and communicate our feelings through often tiny facial movements is unparalleled, and is of enormous, irreplaceable value in strengthening our social bonds. 


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Osteotomy Techniques to Correct Posttraumatic Deviation of the Nasal Pyramid

The use of osteotomy techniques is an effective way to ensure a successful outcome when surgically correcting posttraumatic nasal deviations. The right technique will depend on your unique situation. In general, perforating osteotomies will preserve more soft tissue support than linear osteotomies. Sequential osteotomies, occasionally combined with intermediate osteotomies, are useful in straightening an extremely deviated nasal pyramid.


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Clefts In China

A clinical study was conducted to evaluate the methodology, surgical reconstruction techniques and cost of cleft lip-palate deformity procedures in Western China. The study included 46 procedures performed on 42 patients in Lanzhou, China. Patients ranged in age from 6 months to 18 years.


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Ptosis Repair and Cosmetic Blepharoplasty

Sagging of the upper eyelid is a common condition impacting elderly people. This condition is often accompanied by excess skin, which may mask its presence. This sagging can be repaired as part of a blepharoplasty procedure. This approach typically produces the best functional and cosmetic result.


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The First Composite Face and Maxilla Transplant

This study evaluates the world’s first successful combined face and maxilla transplant, performed at the Cleveland Clinic in December 2008. Based on the results of this procedure, near-total face and maxilla allograft transplant presents a novel method for reconstructing massive facial injuries with significant involvement of the facial skeleton.


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Computerized Three Dimensional Facial Analysis

Three-dimensional facial analysis has many possible applications for the facial plastic and reconstructive surgeon. The system can be used to evaluate the facial contour of any population of patients, and it may be used to compare pre- and postoperative results as well as other aesthetic variables associated with facial plastic surgery.


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Facial Analysis for Rhinoplasty

Excellent rhinoplasty results require careful patient evaluation, an understanding of facial aesthetics and the ability to set appropriate surgical goals for the patient. This article discusses some basics of facial analysis, including methods that use photography, computers and cephalometrics to study patients pre- and postoperatively.


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Otoplasty

Otoplasty is a challenging procedure. This article discusses the ways in which the surgical techniques used in otoplasty can be creatively combined to address the specific problems experienced by each individual patient. Combining these techniques based on the unique needs of the patient is the most effective way to achieve a natural and symmetrical appearance.


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Preoperative Facial Analysis

Facial plastic surgery requires an intimate knowledge of normal facial structure as well as the ability to diagnose structural differences in patients desiring a change to their facial form. In order to adequately evaluate the face, there must be an agreed-upon concept of what is attractive in a particular society. This article discusses the ways in which an evaluation of anatomic deficiencies is crucial to preoperative planning before facial plastic surgery. Age, gender, race and culture are all crucial factors which must be addressed during this preoperative phase of the procedure.


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Rhinoplasty in the Aging Patient

This article discusses the anatomy of an aging nose, the special psychological and medical needs of an aging rhinoplasty patient, and some of the surgical approaches to rhinoplasty that will achieve the best possible outcomes in older patients. In addition, the aesthetic goals for rhinoplasty in older patients are often subtly different from the goals for younger patients. These differences in aesthetic goals should be discussed during the preoperative planning phase in order to establish clear expectations for the outcome of the procedure.


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Finite Element Analysis of Skin Deformation

This study reviews the theoretical and experimental mechanics of skin and soft tissues, and proposes a mathematical model of skin deformation based on the finite element method. This model can be used to simulate would closures and the deformation of a strip of skin.


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Global Burden of Surgical Disease (Co-Authored by Dr. Larrabee)

This article describes the progress of global surgery initiatives, outlines research priorities, reviews metrics that asses the cost-effectiveness of surgical services, and discusses approaches to building surgical capacity to reduce the global surgical burden of disease.


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Cleft Craft (Foreword by Dr. Larrabee)
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Claus Walter- Regensburg Address

Read a transcript of renowned facial plastic surgeon Dr. Claus Walter’s address at the Regensburg Conference in Germany. It discusses the development of the European Academy in relation to his professional life.


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Dr. Larrabee founded the International Federation of Facial Plastic Surgery Societies (Federation) when he was president of the AAFPRS. In this article, he describes the history of the Federation and how it has developed over the years to become a strong force in the international education of facial plastic surgeons.

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Joseph Ka Hoi Wong was born in Guangzhou, China, to two loving parents, Hsi Huang and Ching Lam. He came to Canada at the age of 17. He completed his medical degree at the University of Toronto, his residency in otolaryngology at the University of West Ontario, and spent a year in Tokyo, Japan, on a fellowship with the renowned cleft lip and palate surgeon Takuya Onizuka, MD. Joe later established a busy and respected private practice in facial plastic surgery and continued throughout his career to be active in academic teaching.

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