Dr Amber Leis

Thank you for an amazing three days in Albuquerque! It was such a pleasure to be your PSF visiting professor. We spent two days in the cadaver lab, which was amazing, and I got to teach your residents as much as I could about brachial plexus injury, congenital hand surgery, compartment syndrome, and nerve and tendon transfers. They are an awesome group! Best wishes to all of them, and thank you for being such wonderful hosts .e.schwartz and Sammy! Thank you for a wonderful place to stay and a fun day in the OR, and to .oneill and the team for the awesome lab support. Lastly, I got the pleasure of meeting .d.onofrio and who were visiting from Rome! It was an international experience 💕

Wrapping up a very long stretch of work away from work at the and meetings. There was lots of great learning and thinking about ways to be a better educator, the opportunity to speak about ethical challenges in our specialty, and how to build our careers with an eye for our legacy. There was great food, great friends, and a great black tie affair to conclude the whole thing. Thank you Boston, we will be back!

What a blast I had at this past week as their PSF visiting professor. We had two wonderful days of lectures and cadaver labs and conversations and meals. It is an amazing hospital with beautiful facilities and amazing faculty and residents.

What an amazing meeting! I won an award, got to watch one of parters win a grant, watch another of my partners Dr. Gordon Lee take over as president of the , see my partner get elected to the nominating committee and watch yet another partner present an amazing case for the best case competition. Our residents showed up in full force, and several of our alumni were invited speakers (🙌 and 🙌). Of course seeing so many friends and mentees and mentors was wonderful as well. Can’t wait til we meet again in Napa next year!

I had an incredible experience as the visiting professor to the this week. The Kleinert Kutz Hand Center is the largest and the oldest hand surgery practice in the United States. The history of this center could not be more impressive: it is the birthplace of hand surgery and the home of the first successful hand transplant, zone II flexor tendon repair, digital artery repair, cross hand transplant, toe to hand transfer, and free epiphyseal transfer to name a few. It was truly an honor to see Dr. Kleinert’s drawings and the microscope used for many of these groundbreaking procedures. I got to spend time in the lab with the many (15!!!!) hand fellows and plastic surgery residents from , got to spend time in the operating room with the fellowship director and all around inspirational as well as host journal club and two days of lectures. This fellowship prides itself on educating many international hand surgeons and truly raises the bar for hand surgery around the world. I was delighted to teach them what I know about congenital hand differences, brachial plexus birth injury, and peripheral nerve injury. I can’t wait to come back! Thank you for a wonderful visit .ahmetserhat 🙏🏻

This young boy is a little older than most of the patients that I make thumbs for, but that doesn’t mean he can’t have the surgery! His parents had noticed that he was having a hard time with some everyday activities like doing buttons and holding waterbottles, and that’s why he came to see me. Our thumbs are so important for so many activities! I performed a pollicization for him, which means I moved his pointer finger over and shortened and rotated it so that it will work more like a thumb. His muscles and nerves still work for this finger, and with time and hand therapy will learn how to do their new job. a Manske pattern skin incision, and am a believer in not shortening the flexors or extensors, and further not shortening the intrinsic muscles either. Al-Qattan has a great publication about this.

Madelung’s deformity is a rare type of congenital (meaning people are born with it) difference of the long bones in the wrist. Part of one of the bones, called the radius, doesn’t grow normally, while the other bone, called the ulna, does. This difference in growth means the bones start to separate, and the wrist starts to look curved. Some people describe this shape as ‘windswept’. Not everyone who has this condition will have pain, but for those that do, surgery can help! This young girl was having a hard time doing simple things like writing because of the pain she was experiencing. To help her, I broke and shortened her ulna, and broke and repositioned her radius. This is called a dome osteotomy and an ulnar shortening osteotomy. You can swipe to see some X-rays. After a few months of healing she will start hand therapy and should be feeling well in no time. For those in the know: the Vickers ligament was also release (last picture) and an abnormal slip of the pronator quadratus was released and repositioned (second to last picture.)

What a fun surprise to find Dr. Miguel Pirela-Cruz among the attendees at our Nerve Masters course this weekend. He is the incoming VP of the , the illustrator of one of the original textbooks of nerve surgery, and a colonel in the Air Force reserve command 944th medical squadron, not to mention an incredible surgeon and amazing all around human (ask him about his SEVEN recent swimming medals!). It was a true pleasure to teach this group about nerve transfers and to learn from my co-faculty about advanced nerve imaging and complex nerve trauma.

What does it take to make advances in the field of medicine? Creativity and innovation are essential elements of plastic surgery. We got to put those skills to use today working through a dry run of an experiment we are doing to help improve outcomes for patients who are getting muscle transfer surgeries like the one I posted about yesterday. I am beyond proud of our resident for his AFSH grant that has funded this research, and so impressed by and our amazing students who are putting in some serious work to bring this project to fruition. Thank you for spending time with us in the materials research lab today to troubleshoot setup before we go live with the study.

Can you spot the difference in these photos? This patient just had a very long operation where I took a muscle from his leg and moved it to his arm to give him the ability to bend his elbow! You can see on the picture on the right side the skin from his leg muscle is now in the middle of his tattoos. He had a severe injury to the nerves in his neck that control his arm, and his arm has been paralyzed for several years. Another surgeon had tried to fix these nerves, but they didn’t recover (this can happen and is not because the other surgeon didn’t do a good job.) You can see the scar along his chest from his old surgery. Once so much time has passed, I can’t do anything to help his nerves, but I can move muscles to help. I’ve posted about these types of operations before, called free functional muscle flaps, and the many ways I use them (some examples include helping recreate smiles for patients with paralysis in their face, restoring finger motion for children with severe nerve injuries, and restoring elbow flexion for patients like this who have a brachial plexus injury.) These are complex operations where patients essentially receive a transplant from themselves. The muscle I usually use is the gracilis muscle (an extra leg muscle) and I have to completely detach the muscle from the nerve that controls it and the blood vessels that feed it. I then reattach the muscle to new blood vessels and nerves in the arm using a microscope and stitches thinner than human hair. This type of operation typically takes an entire day and the patient has to stay in the ICU for several days afterwards while we monitor the healing of the blood vessels. The healing process takes time, and it is several months before we will know how well the nerve is healing. With severe brachial plexus injury I can sadly never restore the patient’s arm to normal, but I can help by giving them the best of what science and surgical techniques have available.

This is one of my favorite operations, it’s called a pollicization (literally making a thumb.) When children are born with very small thumbs that are not connected to the rest of the hand, we make a new thumb out of their index, or pointer, finger. In order to achieve this, I need to shorten one of the long bones of the index finger and reposition it so it will work more like a thumb. Children recover quickly from this surgery and only need a cast for a few weeks, followed by some physical therapy with a hand specialist. For those in the know, this is a Blauth IV hypoplasia. I use a Manske pattern skin incision, and am a believer in not shortening the flexors or extensors, and further not shortening the intrinsic muscles either. Al-Qattan has a great publication about this.

It was so fun to catch up with one of my very first hand fellows while at the AAOS meeting this week in San Francisco. Dr. Jesse Dashe was such a wonderful fellow. During his training year the ortho program lost all of their hand faculty, meaning his fellowship would have lost accreditation. I was given the opportunity to take the program over on a very short notice. It was a tough way to meet his new fellowship director, but Jesse was such a good sport about it. We had a lot of fun together figuring out how to take care of all the patients and rebuild the fellowship. I am forever grateful for how things turned out, and the opportunity to be part of his path. Thanks to the and and for the invitation to speak!

Macrodactyly means big fingers, or in this case, big toes. This is a rare condition that causes extreme enlargement of body parts. When possible, we try to make the parts smaller (debulking) or stop the growth of the bones before they become larger than normal (epiphysiodesis.) Children whose fingers or toes have gotten too big sometimes even need amputation of the large parts in order to have the best use of their hands or feet. Every case is different! This young child had extensive debulking to be able to fit in her shoes. I broke and repositioned the bones at the end of her toes to make them straighter. When her toes grow to the same size as her Mom’s, we will do another surgery to stop the growth of the toe bones. Hopefully someday we will understand why macrodactyly happens, and maybe even have medication to stop it. Until then, we do our best to help these children with surgery.

Back to what I love: complex surgery! This patient had a severe crushing injury of his arm more than one year ago. To save his hand, we had to repair the arteries, fix the broken bones (swipe left for some X-rays), and cover his missing skin with a muscle from his back. Even then, all of the muscles that bend his fingers were damaged too badly to repair. Problems like this take several surgeries to fix, and something we have to wait for a long time in between steps to make sure we are doing our best for the patient. After a year of healing, he was ready for the next stage of surgery. To fix his damaged arm muscles I removed a working muscle from his leg and attached it into his arm and connected it to blood vessels and a working nerve that wasn’t damaged. This type of transplant requires a day long operation and an ICU stay afterwards. The patient has a long road to healing as well, but I am so excited to see how things turn out for him. You can also swipe left to see the awesome team who helped with this surgery, celebrating together at the end of a great case. For those in the know, this was a dysvascular crush avulsion injury revascularized with vein graft and covered with a free latissumus. He was missing the entirety of the deep and superficial flexor compartments. Over the year his ulnar nerve recovered but not his median. He got a free gracilis here with obturator to the residual AIN.

Interviews done! Yesterday we wrapped up our second and final day of interviews for next years class of residents. From more than 300 applications we selected the top 10% to interview. These are quite literally the most inspirational group of medical students, and it is always wonderful to learn more about them. From here, three of them will be selected to join us at , and I can’t wait to see who we match! These days, although fun, are also long. Thank you so much to my incredible faculty team and senior residents who spent long hours reviewing applications and preparing for the interviews, and for all of the residents who joined the meet & greet and break room; you all were amazing. The biggest of thanks to my APD and my Program Coordinator who did so much work to make the day smooth and on schedule. I am truly grateful/blessed/honored and all the other hashtags for what you do for our program. YOU are the best.