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Nerve_microsurgeon, 20 College Road, Singapore (2026)

18/11/2023

Taiwan Society of Reconstructive Microsurgery (TSRM) Fu Chan Wei Young Microsurgeon Lecture

Following in the footsteps of my senior colleagues and idols Drs. Tommy , JJ Huang and Chief Luke Lin , I am honored to be the fourth recipient of the FC Wei Young Microsurgeon Lecture Award, given at the annual conference meeting of the TSRM.

This awards is given to the “younger” generation of microsurgeons in Taiwan who seek to engage in continuing research and improvements of microsurgerical practice and knowledge. I am very humbled to be given an award that has my teacher Prof Wei on it, which also draws inspiration and pushes us to want to do better and never give up on this long road of reconstructive microsurgery.

Many thanks to my teachers Dr David Chuang, Susan Mackinnon , Alison Snyder-Warwick and Tommy for teaching me unselfishly and giving me the opportunity to be whom I am now. I also understand that life can be delicate and short, and time flies right under your nose if you don’t pay attention. I love what I do, especially engaging in nerve surgery as a , and am proud to be a nerve surgeon. More importantly, in the spirit of Professor Wei, to NEVER STOP learning and getting better, and to NEVER give up in the face of challenges.

Thank you TSRM for your hard work and kind blessing.

Congratulations to Jennifer and Angela for excellent presentations representing the chang gung nerve team.

10/11/2023

Delayed Nerve Reconstruction for Brachial Plexus Injuries: Is the Risk Worth the Reward

Written by Alvin Wong , Yin-Hsuan Lee , Tommy Chang , David Chuang and Johnny Lu

Published in Journal of Neurosurgery , J Neurosurg. 2023 Oct 20:1-8. doi: 10.3171/2023.8.JNS23803.

There is consensus that nerve reconstruction (transfers, grafting) provides more consistent, better outcomes if performed earlier, like within 6 months after injury. In brachial plexus injuries, time is everything, time is muscle.

However, there remains a group of patients who present late to your clinic, sometimes due to previous comorbidities from prolonged hospital stays, or inadequate referrals. They present at about 6-12 months, where nerve reconstruction is still indicated, but to what extent will it provide good enough outcomes? In BPI where every donor nerve counts, is it pragmatic to use up your major donor nerves for nerve reconstruction when you worry that suboptimal outcomes might be likely and you will be left with no secondary options such as FFMT? Does the pattern of injury matter? Should all nerves be exhausted in the primary nerve reconstruction in the delayed setting, especially in pan-brachial plexus injuries? Do you use your best donors, such as XI, for shoulder; or do you u save it for FFMT in case your elbow flexion nerve transfers don’t work?

These are questions that are often raised during the preop decision making process, but yet we always struggle to make the right one due to lack of info. The aim was to look at outcomes of delayed nerve recon in both non-panplexus and panplexus BPI. The results was very helpful in guiding my decision making process, which providing evidence for the need to always have a backup.

Many thanks to Alvin and Yin-Hsuan for putting in many extra hours of work and research to get it done. It was a collaborative process that resulted in an important paper in my view

22/10/2023

Facial Nerve and Facelift

2023 Master Series Course in Facelift, Chang Gung Memorial Hospital Surgical Training Academy and Research Center

Had the privilege to be invited as faculty for the Facelift course last weekend. Although I am not a full-on facelift surgeon as my mentor and colleagues, it is always interesting and engaging to learn about facial nerve anatomy in the realm of the different planes of the face. Understanding the danger zones, knowing how to prevent iatrogenic injuries are common practices for facelift surgeons, but predicting the consequences of nerve traction injuries, such as potential of postparetic facial synkinesis, and understanding the anatomy of the innervation for lip depressors (DAO Vs DLI Vs Mentalis) are new nuances that are important for both cosmetic and facial reanimation surgeons.

Many thanks to Professors CT Chen, Pang Yun Chou and Dr Welson Chin to be part of the faculty and learn from you all. I wasn’t in the best condition (a really bad cold) but fortunately was still able to do a presentation and learn at the same time. Opportunities come and go and this was one I couldn’t say no to.

Deepest thanks to my friend and super expert .andreas.kehrer for your consultation and sharing of presentation slides. Biggest help.

04/10/2023

2023 Facial Palsy Instructional Course, Live surgery plus Lecture

One of a kind

21/09/2023

Functioning Free Muscle Transplantation to Restore Finger Movement for Sequalae of Volkmann Ischemic Contracture

Written by Kota Hayashi , Tommy , David Chuang and Johnny Lu (corresponding author).

Published in Hand Clinic, available online ahead of print

1) VIC affects all tissues involved, from deep to superficial, including not just muscles but ALSO nerves

2) Joint contractures must be corrected, and fibrotic nonviable muscles must be removed before the implementation of FFMT.

3)Three-staged strategy is necessary to achieve optimal outcomes. REMOVE > REHAB > REPLACE

4) Application of the functioning free muscle transplantation (FFMT) for treatment of Volkmann ischemic contracture (VIC) is markedly different from trauma and brachial plexus injury.

5) Gracilis FFMT for VIC needs to include a reliable skin flap paddle in order to facilitat closure in the forearm.

This paper was a no brainer to write with Kota. Enjoyed the discussions over the aims, content and the technical concerns. Kota did most of the work and I just provided the pics and revisions. Many thanks to Dr Harvey Chim and Dr Kevin Chung for the invitation, and most importantly to David Chuang for the experiences and teachings over the years.

Link:
https://authors.elsevier.com/a/1hlbK2gKQyA8x0

21/09/2023

Quantifying Patient-Initiated Upper Extremity Movement After Surgical Reconstruction for Adult Pan-Brachial Plexus Injury

Published in the journal “Neurosurgery”, available online ahead of Print

This is the first of collaborations between Chang Gung peripheral nerve team (David Chuang, Tommy Chang, me) and the Michigan nerve team (Lynda Yang, Susan Brown, Kevin Chung, Whitney Muhlestein and Kate Chang). Through a lot of hard work and efforts, both teams were able to demonstrate the feasibility of using wearable motion sensor technology to quantify spontaneous arm movement in adult patients with pan-brachial plexus injuries after surgical reconstruction and report the time and intensity with which the affected arm was used. Despite the severity of the injuries, these patients were able to use their affected arm 50% of the time and with 30% of the intensity of their unaffected arm, which is positively correlated with return to work after injury.

Highly valuable study in the realm of brachial plexus injury outcome evaluation, providing more objective and quantifiable data that is relevant and not abstract. MRC despite its convenience does not fully provide the scope and perspectives that newer technologies can provide. Thank you Dr Brown and Dr Yang and Dr Chung for initiating this important study and fostering collaborations between the two centers. Congratulations to Whitney and for a well written study.

18/09/2023

Daddy, you’re a hand surgeon.

Let me give you a hand.

P.S. actually I’m more of a nerve surgeon. Nothing compared to the hand surgeons I know. I only know how to make a hand move.

14/09/2023

2024 American Society of Peripheral Nerve Surgery Traveling Fellowship

Early today, after waking up at 5AM to p*e, found out about this news in the email that literally woke me up instantly (as instant as a resident calling you that your flap ain’t working no more). This was a prestigious award that I had wanted to apply for for many years…and it means a great deal to finally see it come true.

I am honored to be chosen as the recipient for a fellowship award coming from the main society that I consider as my top priority in annual meetings. I follow in the footsteps of my mentors and friends , and I am eager to use this opportunity to visit my heroes and idols around the world. Also will be looking forward to presenting my experiences in ASPN 2025 in Hawaii, where it will be a very busy event for me to help out and participate in.

Can’t thank my main mentors / sponsors enough, who have inspired me to learn and love nerve (David Chuang, Susan Mackinnon), and who have pushed my career further ahead with nothing but full support (Tommy , Alison, colleagues and teachers in Chang Gung and WashU). And most importantly to ASPN, for giving this opportunity to me, and many more, such as initiating collaboration between the International Microsurgery Club (IMC) to help promote education worldwide. This is the best society to push the boundaries of nerve and muscle through research, and I will continue to support it in the years to come.

Lastly, I just wanted to share a very special gift that I got at the same day I found out about the traveling fellowship, and that is a handmade art with my name and picture in it, all hand drawn by my total brachial plexus palsy patient who used her healthy but non-dominant hand to draw. This sure made my day, and I couldn’t be more proud of her. You inspire me to want to be better for our future brachial plexus patients. Thank you

06/09/2023

Instructional Course for Facial Paralysis Reconstruction
October 2nd to 5th, 2023

12 LIVE SURGERIES ⭐️
11 International Faculty🤩
3 full days of lectures🤓
Live interactions with faculty and facial nerve nerds around the world ❤️❤️
Souvenirs and Fun Activities
Chance to visit Chang Gung and Taiwan 🇹🇼

Please register!!
www.2023fpr.com

29/08/2023

Some more great photos from WSRM official website!

Thank you at Singapore. Wonderful memories❤️

27/08/2023

Pioneers in Hand Surgery
Dr David CC Chuang
Published in APFSSH “Crafting a Legacy”
Edited by , Drs Sandeep Sebastian and Raja Sabapathy

It was a honor to be invited by APFSSH to write this article about my mentor David Chuang along with Tommy .

This is a very special book that details the hand surgery pioneers who fought and established hand surgery specialties in their own country and societies despite limitations. I didn’t realize the scope and magnitude of this book until I held it in my hand and read through the history. Biggest thanks and gratitude to our editors for putting in the effort to assure the content quality and substance would justify the legacy of these pioneers.

I didn’t want this article to just be a review of the achievements David achieved over the years.
That would be not justify the amount of effort he made to teaching us his work. Rather, it needs to be relatable and personal to anyone who has either learnt or worked with or even chatted briefly with him. David is not just a world renowned expert in nerve and hand surgery, but an enthusiastic passionate that doesn’t shy away from wanting to do better even at age of 75. I encourage you to read this book and this article if interested, and to think about your own career and your goals…cuz time sure flies by past. Before you know it, you will be looking back and wondering what you could have done better.

In my eyes, David definitely lived his life to the fullest in the field of recon micro and nerve ❤️

19/08/2023

WSRM 2023

1 Pre-congress demonstration (gracilis and PAP)
3 invited lectures (NMJ and reinnervation, Donor nerves for facial reanimation, Salvage FFMT for BPI)
2 supervised free papers (delayed BPI recon by 李映萱, recycled median nerve for FFMT by Jennifer Ann Lin)

Definitely my most productive conference so far. Many many thanks to WSRM committee and the hours of work they put in…I didn’t realize how smoothly everything went until the end, Wow.

Thanks to all those that supported me and gave me the chance to present (David Chuang, Fu Chan Wei, Tommy, JJ, Manzhi Wong, Alison and Susan, ASPN, Professor BK and Ong, Luke Lin, Allen Wong…etc). I truly cherish these opportunities and will remember all those who have carried my career.

Lastly to my Autumn and Josephine. 抱歉沒有好好陪你們，尤其是啾喜生日。but nonetheless, still many many memories for me of us together. Love you ❤️

Get well soon Professor
🥹

Nerve_microsurgeon

18/11/2023

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22/10/2023

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