Reconstructive Surgery

Reconstructive surgery is the foundation upon which all plastic surgery is based.   The ability to perform plastic surgical procedures is based upon the principles of moving tissues based upon its blood supply.   Understanding the different tissue characteristics (skin, fat, muscle, tendon, bone) and its related blood flow allows the reconstructive plastic surgeon to repair and reconstruct nearly any structure in the human body.   Reconstructive Plastic Surgeons use the “Reconstructive Ladder” to help heal the most simple to complex wounds.    It is truly in this respect, that plastic surgeons are the surgeon’s surgeon; they are called to help in difficult and demanding situations where creativity and science come together.

Advanced Wound Healing

Millions of patients a year suffer from wounds of all types and it is difficult to estimate the emotional and financial toll that a “non-healing” would can cause. A wound can occur on any part of the human body in any size or shape depending on the cause. Wounds can be caused by trauma, surgery, infection, blood flow issues, cancer, pressure, burns, radiation, and more. The time course of the wound is important to know whether it is recent – acute—or long standing – chronic.   At the consultation, it is important to determine the wound depth and complexity, and order special studies to identify the cause and anatomy of the wound. Once all of these factors are known, a treatment process plan can be started. Plastic Surgeons use the Reconstructive Ladder to formulate the correct process to definitively heal a wound. Options available to a plastic surgeon include appropriate wound exploration and debridement, advanced wound dressings, skin grafts, flaps, and free tissue transfer (microsurgery). Having every tool available to heal a wound leads to faster, stable healing.

As the Co-Director of the Advanced Wound Healing Center at St.Mary’s Medical Center, Dr. Lee works with a team of physicians (General, Vascular, Orthopedic, and Podiatric Surgeons), nurses, medical assistants, and therapists to bring a multi-disciplinary approach to the patient in need of advanced wound healing. Dr. Lee has treated patients from San Francisco firefighters, to professional athletes, to bed-ridden patients, who have been told there are no more options.  In many cases, in 1 to 2 operations and a 4-6 week healing course, these complicated wounds can be healed.  Dr. Lee and his team are dedicated to healing your specific wound.

Key concepts: Reconstructive Ladder, Reconstructive Surgery, Skin Graft, Local Flaps, Free Tissue Transfer, Wound debridement, Advanced wound healing, Advanced Dressings, Silver, Collagen, Negative Pressure Wound Therapy, Biologic dressings, Hyperbaric oxygen (HBO)

Hand Surgery & Reconstructive 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 Surgery

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

Skin Cancer

Dr. Lee treats patients for all types of skin cancers, including the common Basal Cell, Squamous Cell, and Melanomas. He works in conjunction with the Cancer and Melanoma Center to ensure comprehensive cancer treatment. After the cancer is excised, Dr. Lee can perform local tissue flaps or grafts to close the excised area.   Cancers around the face benefit from early consultation with  the plastic surgeon to coordinate appropriate cancer resection and reconstruction options together.

Scar Revision

Scars occur because the wound healing process is not optimized and the body responds by creating tissue that does not appear normal.   Scars can occur for many reasons including:  location of trauma, too much skin tension at closure, surgical technique, healing ability, and genetics. Depending on the severity, there are scars that may be improved and other that may not. A complete and careful evaluation of the scar must be done prior to making a decision to perform a scar revision; notably, the scar should be matured beyond 1 year as scars can change significantly over that time period.

Dr. Lee performs scar revisions of all types. He uses a combination of surgical excision and complex re-closure, and may add laser and steroid to the treatment process. It is important to remember that scar revision is a procedure to minimize the existing scar, not to simply make it disappear. Most scar revisions can be performed in the office under local anesthesia.

Varicose Veins, Spider Veins, & Venous Ulcers

Varicose veins and spider veins of the legs can be unsightly, but also a source of pain and swelling. If left untouched, these can develop into venous ulcers or be a source of significant bleeding. In the past, this was treated with painful “vein stripping” procedures which required general anesthesia, an in-hospital stay, and significant down time. With cutting edge EndoVenous Ablation, these veins can be treated with a laser or radiofrequency energy under local anesthesia, in the office or outpatient center, with minimal down time. Larger varicose veins are treated with micro-phlebectomy; spider veins and smaller branch veins can be treated with a combination of Sclerotherapy (chemical irritant to vein) and Laser.

Dr. Lee has devoted significant expertise in treating leg veins; as a microvascular surgeon, he has the technical expertise to perform all of the required, delicate maneuvers to treat veins effectively. Not all vein doctors are surgeons and few are plastic surgeons, and even fewer, have microvascular surgical expertise. Most often, treatment of symptomatic varicose veins can be covered by insurance.

Key concepts: EndoVenous Ablation, Laser, MicroPhlebectomy, Perforator Vein Ligation, Foam Sclerotherapy, Leg Pain, Leg Cramps, Varicose Veins, Spider Veins, Venous Ulcer, EVLA, VNUS Procedure, Insurance covered

Abdominal Wall Reconstruction, Complex Hernias, Infected Mesh

Complex abdominal wall hernias have become a greater problem over the years requiring the expertise of reconstructive surgeons to create a strong, dynamic abdominal wall.   A hernia should no longer be viewed as a “hole” in the abdomen to be filled with a prosthetic mesh, but a living, muscular organ that should be restored to its original state, to house and protect the abdominal organs and intestines. The current state of the art of hernia repair is about re-creation of the musculo-fascial system that combines using the body’s own muscle and tissues, and when necessary, biologic mesh that can augment the repair and has a low chance for infection.

Dr. Lee has extensive experience in the treatment of complex abdominal wall hernias and infections. He has used components separationtechniques, local flaps, and free tissue transfer to reconstruct complex defects. He has been an early adopter of Biologic mesh products and recognized the advantage that these products have, particularly in patients who have infected or failed prosthetic mesh. He works with his team of general surgeons, residents, nurses, nutritionists, and therapists to help rehabilitate patients back to an improved quality of life. Dr. Lee lectures and works with various biologic mesh companies for his expertise in reconstructive surgery.

Key Concepts: Hernia, Ventral Hernia, Recurrent Hernia, Prosthetic Mesh, Infected Mesh, Rectus Diastasis, Abdominal wall reconstruction, Biologic Mesh

Dr. Lee and his staff are very professional and knowledgeable and upbeat!

I first met Dr. Lee & his staff when I was having a very bad day (an accident & possible scarring). From the first minute I arrived, I felt better. Dr. Lee really cares and his staff is warm & efficient.

The staff is very friendly, always greeting me with a warm smile. Dr. Lee is very nice and makes me feel I’m not just another patient or a random face.