Microsurgery

Microsurgery is a technique that requires the utmost precision, accuracy, and finesse. It requires artistry and determination, balanced with attention to the minutest of details. Microsurgeons are a rare breed of surgeon, taking on the most difficult challenges in the pursuit for greater quality of life and function.

Dr. Lee has dedicated his career to microsurgery and has cared for thousands of patients to regain lost form and function. He brings nearly two decades of training and experience to his patients, some of whom have traveled from around the globe, seeking his expertise, and is often called upon by his colleagues to take on the most challenging cases.  Dr. Lee was fortunate to train with the pioneer microsurgeons of the world, including Drs. Susan Mackinnon, Robert Walton, Lawrence Gottlieb, and Harry Buncke.   Dr. Lee is deeply honored by this opportunity to give patients another chance to improve their quality of life through reconstructive microsurgery.

Microsurgical breast reconstruction

Microsurgical reconstruction of the breast after mastectomy offers the patient the use of their own tissues, usually in the form of abdominal or inner thigh tissue.  “Self tissue” has many advantages over implants or devices: it is your own, living tissue that will not be rejected. Often times, patients are happy to give up additional tissue around their belly or thigh to recreate a breast—hence getting a tummy tuck or thigh lift for a breast. Additionally, the active patient is now looking to get the procedure without losing the abdominal six pack muscles. This is where the DIEP, SIEA, and TUG flaps using microsurgical techniques to transplant robust self tissues comes in. These vascularized tissue flaps have revolutionized breast reconstruction, with only a small percentage of plastic surgeons in the United States performing this technically challenging operation at major centers.

Dr. Lee has successfully performed hundreds of microsurgical free tissue transfers for breast reconstruction and brings over a decade of experience and dedication to helping patients who need the power of vascularized “self tissue” for breast implant infections, capsular contracture, radiation wounds, and immediate or delayed reconstruction after mastectomy. Dr. Lee has been a pioneer at St. Mary’s Medical Center, performing the first the unilateral and bilateral DIEP and SIEA flaps, the first TUG flap, and the first Lymphatico-Venous Anastomosis (LVA) and Lymph Node Transplant for Lymphedema. He works with an expert team of plastic surgeons from UCSF Medical Center, including UCSF microsurgery fellows, residents, and specialized nurses. Dr. Lee is fortunate to offer this world-class service to patients who are looking for expertise in Microsurgical Breast Reconstruction.

Postoperative Recovery:  Microsurgical flap procedures  typically take 3-5 hours per flap under general anesthesia, and require an inpatient stay of 3-7 days. Patients will have drains to take care and are asked to keep activity level low, specially keeping their upper arms quiet, elbows at the side so as not to disturb the blood vessels reconnected in the chest area. It will take about 4 weeks to to recover from both the breast and abdomen/thigh areas.

Key concepts:  DIEP  (Deep Inferior Epigastric Perforator ) Flap, SIEA (Superficial Inferior Epigastric Artery) Flap, TUG (Transerse Upper Gracilis) Flap,  Reconstructive Microsurgery, Perforator flaps, Implant infections, Radiation, Wounds, Capsular Contracture, Abdominal Wall Preservation, Rectus Muscle, TRAM (Transverse Rectus Abdominus Muscle) Flap.

Designer Flaps & Phalloplasty

Flaps are sections of tissue (skin, fat, nerve, muscle, etc) that have their own blood supply and can be designed into various shapes and sizes.    Designer flaps can be folded and shaped to fit a specific 3-dimensional area of the human body; in the case of phalloplasty (reconstruction of the penis), skin, nerves, and blood vessels are designed to create a tube-within-a-tube, making a urethra, outer shaft, and glans.   Phalloplasty may be needed to reconstruct the penis after trauma, cancer, and female to male (FTM) transgender surgery.

Dr. Lee is skilled in using the Radial Forearm Free (RFF) Flap and the Anterolateral Thigh (ALT) Flap for phalloplasty.  He was fortunate to train with Dr. Lawrence Gottlieb at the University of Chicago, where he was first introduced to advanced microsurgical techniques in 2001.    More recently, Dr. Lee was asked to join the world renowned team of Drs. Curtis Crane and Mang Chen at Brownstein & Crane, San Francisco, where he works with fellow expert microsurgeons (Drs. David Chang, Gabriel Kind, and Brian Parrett) to provide exceptional surgical technique and compassionate care.

Hand & microsurgery

The hand is a complex external organ giving human beings the ability to perform the simple to most complex tasks with finesse and power. Hand function is comprised by a symphony of movements enabled by the most delicate interaction of nerves, blood vessels, muscles, tendons, bone, and skin. Acute and chronic injuries to the hand are common, ranging from fractures and crushing injuries to carpal tunnel syndrome and thumb arthritis.  Any issue in the hand can be debilitating and requires the highest level of expertise to treat them.

Dr. Lee is an expert hand and microsurgeon who has treated countless patients to restore function to the hand. He has treated prominent Bay Area athletes, musicians, artists, mechanics, and professionals. He has been featured on the Discovery Chanel, local and national news, and is internationally recognized for his expertise in reconstructive hand surgery. Dr. Lee and Dr. Scott Hansen (UCSF) performed the first great toe-to-thumb, and second toe-to-hand transplantation at St.Mary’s Medical Center.

Key concepts: Hand injury, Hand reconstruction, Local Flaps, Free Flaps, Bone Grafts, Tendon Grafts and Transfers, Functional Muscle Transfers, Replantation, Toe-to-Thumb Transplantation, Thumb Replacement and Reconstruction, Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Dupuytren’s Contracture, Osteomyelitis, Infection, Fracture, Arthritis, Digital Nerves, Neuroma, Ganglion, Hand Tumor, Vascularized Bone.

Peripheral nerve

Peripheral nerves function to give us movement and sensation in our hands, legs, and face.  These critical nerves flow through the body in defined planes that can be injured or compressed. Unlike the central nerves (brain and spinal cord), the beauty of peripheral nerves is that they can regrow and regenerate. When peripheral nerves are injured, patients can lose movement, sensation, and can have intractable pain. Common peripheral nerve injuries occur in the hand, such as the median, ulnar, or radial nerves; in the leg, injuries can occur around the sciatic, peroneal or tibial nerve; in the face, such as the facial nerve, infraorbital nerve, or cranial nerves. Chronic nerve compression and scarring in these corresponding areas can lead to Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Tarsal Tunnel Syndrome, or Neuromas. Expertise in Microsurgery allows repair, reconstruction, and decompression of these nerves.

Dr. Lee’s experience and expertise in microsurgery make him uniquely qualified to treat peripheral nerves. He has helped hundreds of injured patients regain function or improve their pain syndrome in the immediate or late setting, for revision surgery, and second opinion.

Key concepts: Carpal tunnel syndrome, Cubital tunnel syndrome, Median nerve, Ulnar nerve, Peroneal nerve, Nerve Grafts, Nerve Wrapping, Brachial Plexus Injury, Nerve Transfer, Neuroma treatment, Nerve pain, Nerve Reconstruction, Nerve Repair, Functional Muscle Transfer.

Lymphatic Reconstruction

Lymphedema is a debilitating disorder of the lymphatic system that most commonly affects the arms and legs leading to swelling, pain, infection, and disability. Patients may have had a previous history of surgery, cancer, infection, or radiation. The mainstay of treatment has been compression garments and lymphatic massage which provide only temporary relief. Surgical treatment of lymphedema has been controversial, but with newer and advanced microsurgical techniques, the outcomes are improving significantly. Reduction of limb circumference, decreased pain and swelling, fewer infections, and reduced need for garments are some of the benefits of microsurgical LymphaticoVenous Anastomosis (LVA) and vascularized Lymph Node Transplantation (LNT).

Dr. Lee has pioneered the LVA technique and LNT procedures at St.Mary’s Medical Center. He performed the first multi-LVA procedure with LNT in the leg and arm and has transplanted groin and neck lymph nodes with significant results, ranging from 60%-80% improvement in symptoms and circumference. Most recently, Dr. Lee traveled to Japan to sharpen his Super-Microsurgery techniques from Dr. Isao Koshima (U. of Tokyo) and Dr. David Chang (University of Chicago) to further refine and improve results.

Postoperative Recovery: The extremity will be lightly wrapped and should remain elevated and still; sutures may be removed in 3 weeks and lymphedema therapy may resume after 4 weeks.

Key concepts: Lymphedema, Lymph Node Transplantation (LNT), Lymphatico Venous Anastomosis (LVA), Surgical Treatment of Lymphedema

Limb Salvage and Amputation Prevention

Limb salvage and amputation prevention is a multidisciplinary process to save a patients’ hand or leg when conventional methods have failed. This requires thinking “outside the box” to address the appropriate anatomy which ultimately needs improved blood flow to heal. This can be done by a combination of microsurgically transplanting new tissue, creating new blood flow, and cleaning/debriding the non-healing area. Through a disciplined team approach, Dr. Lee works closely with an expert team of Orthopedic, Vascular, and Podiatric Surgeons to give patients a second chance at saving their hand or leg.

Dr. Lee has successfully treated thousands of patients who have been told they would need an amputation. He has developed a systematic team approach to treating the most difficult limb injuries, infections, and wounds. As the Co-Director of the PROS (Plastic, Reconstructive, Orthopedic Surgery) and Advanced Wound Healing Center, Dr. Lee specializes in healing acute, chronic, and complex wounds using the most advanced surgical techniques, technologies, and dressings.   His recent innovations include: saving hip and knee implants after infection, developing a procedure to allow patients to be candidates for total knee replacement, total Achilles tendon reconstruction, treatment for recurrent seromas, and many others.

Key concepts: Limb Salvage, Amputation Prevention, Limb Reconstruction, Wound Debridement, Soft Tissue, Flaps, Skin graft, Free flap, Free tissue Transfer, Hardware Removal, Negative pressure wound therapy (NPWT), Achilles Tendon Reconstruction, Versajet, Venous Ulcers, Varicose Veins, Vein Ablation, Reconstructive Ladder, Seroma

Dr. Lee is very intelligent. He makes patient feel comfortable during and after the procedure. For me, before the procedure, I was very nervous and tense but he made sure everything will be fine. That made me felt good and thankful. Now I’m very happy with the results. Dr. Lee and his staff are overall excellent, friendly and knowledgeable of their work.

I have enjoyed a very positive experience. The staff and Dr. Lee are very personal, courteous and helpful. Making sure I was well informed. No questions went unanswered. Great experience. I felt very comfortable through my entire surgical procedure. I never felt rushed through my pre and post appointments.

It’s been outstanding! Awesome! From start to finish meeting Dr. Lee for the first time. Showing the images from of patients before and after surgery impressed me. Great skills. Translated fine surgeon. Staff was also great, thoughtful, and caring. They answered all my personal questions. Pre-op and Post-op instructions were helpful. Procedure copies were helpful. Keep up the good work!