HCA International foundation Travel fellowship

Report by Mr J Kim following generous support by HCA International foundation

Title: Free style perforator based free tissue transfer for reconstruction post skin and Head & Neck skin cancer reconstruction

Venue: Hanyang University Medical Center, Seoul, South Korea

Supervisor: Professor Jeong Tae Kim

Duration: 4 months (2012)

This fellowship was intended to provide wide exposure and intensive clinical training in all aspects of microsurgical free tissue transfer/microsurgery for a range of oncoplastic reconstructions following major Head & Neck cancer resection, Craniofacial, Lower limb trauma and Breast reconstruction. More specifically, wide ranging exposure and supervised training in major craniofacial, maxillofacial and head & neck reconstruction, which I could not easily obtain here in the UK. In addition, the fellowship unit is one of the pioneers of the “free style perforator flaps” whereby a composite piece of tissue from virtually any part of the body can be used, as long it has a blood supply, to reconstruct a given defect.

The second reason for selecting Hanyang University Hospital was that it had pioneered and routinely used endoscopic and robotic assisted techniques for head & neck/thyroid cancer surgery (ENT), urological and general surgery. My objective was to observe and learn about the technique of endoscopic & robotic assisted surgery in head & neck/thyroid cancer, urological/pelvic surgery and abdominal surgery so that I can translate the technique into axillary, pelvic and head & neck lymphadenectomies, following skin based regional metastasis, in my future surgical oncology practice. Ilio/inguinal lymph node dissections more than the others have a high morbidity rate due to wound breakdown and this could potentially be a solution to reducing the problem (Nice Guidelines on melanoma – Endoscopic Radical Inguinal Lymphadenectomy, 2011).

Finally, Seoul, South Korea is now ranked 1st in the world for the number of cosmetic procedures performed per population density. Wide ranging exposure to cosmetic and aesthetic procedures, some not performed in Europe, was available based at allied private aesthetics clinics recommended by Professor Kim. 

I had met Professor Kim previously on a prior visit to Seoul when exploring fellowship opportunities. I was delighted to learn that he was willing allow me to come act as a visiting fellow. Indeed, I learnt another UK Plastic surgery trainee had visited the unit to set up a fellowship.  I am extremely grateful to HCA for their generous support of this fellowship. 

The fellowship certainly lived up to its promise. I was welcomed warmly by the whole unit, which comprised of four professors and two senior fellows and eight junior staff. My time was devoted to clinics and theatre. Clinics and theatre ran on a daily basis with a wide variety of reconstructive problems.

I started immediately, learning to a raise perforator flap from the chest for reconstruction of a lower limb trauma defect. As expected of a regional microsurgical centre the case ran extremely smoothly and efficiently with the whole procedure being completely soon after lunch. Due to a large caseload and years of experience the failure rate was virtually non-existent. The microsurgical technical ability was first rate and well superior to my ability and that seen in the UK. Before long I was invited to start raising my own flaps with the assistance of the very experienced junior staff. I learnt some invaluable tips on selecting and raising flaps for given reconstructive problems.

My other purpose was to learn and get involved with Robotic assisted surgery with a view to translating this into my practice in the UK. I was involved in several cases learning the benefits and challenges with Robotics.

Now, as a newly appointed consultant I am in discussions to learn robotic surgery for pelvic dissections for metastases following penile cancer. My exposure and experience from the fellowship will be extremely helpful. Following the intensive training in free tissue transfer I received under Professor Kim’s supervision I feel confident to tackle most reconstructive problems that require free tissue transfer. I feel the training I received on this fellowship will be extremely useful in my forthcoming consultant career.

Mr Jong B Kim

Consultant Plastic Surgeon

County Durham and Darlington NHS Foundation Trust