Juliana Hansen, M.D., is professor of surgery and division head of plastic and reconstructive surgery, OHSU School of Medicine.

October 26, 2015

What’s been the most interesting development in your area in the last two years?

The most interesting recent development in my practice has been the incorporation of perforator flaps. This type of surgical procedure is a truly elegant way to move tissue from one place to another, taking only the parts that are needed and not sacrificing tissue that is not needed.

When large composite flaps were first described for distant coverage of defects, we recognized that the essential blood supply ran through the underlying muscle before sending perforating vessels up through the fascia to supply the overlying skin and fat. In order to ensure that the superficial tissue remained well perfused, entire muscles were sacrificed and brought along with the flap.

We now recognize that large blocks of skin and fat can remain well perfused based on a single perforating vessel. Harvesting these perforator flaps requires extreme delicacy. The process involves identifying the small (one mm diameter) vessels as they perforate the fascia, splitting the fascia and the underlying muscle and dissecting the perforators back to their source. The resulting pedicle then allows for local or distant transfer.

The added technical challenge of these cases is justified by the quicker recovery and decreased morbidity associated with muscle sparing procedures. Dr. Shiliang Chang, assistant professor of surgery and the newest member of our division is masterful with these sophisticated procedures and has brought this expertise to OHSU.

What projects are you currently working on and are there opportunities for fellow faculty to participate? 

Over the last few years I have been participating in the establishment of an OHSU multidisciplinary transgender health program. This endeavor was borne out of a true need in our community. Whether directly related to gender reassignment surgery or to basic health care needs, the OHSU Transgender Health Program will address the needs of these individuals and provide a center of excellence.

This is a true multidisciplinary program involving family medicine, particularly the Richmond clinic, plastic surgery, gynecologic surgery, urology, endocrinology, pediatrics, psychologists and social workers among others. There are many new areas of research opportunities that have and will arise from this new program.

I am indebted to all the individuals from these groups and in particular to Wendy Schlicting, plastic surgery clinic manager, for taking a lead role on the establishment of this program. OHSU has provided essential support by establishing a new position, a transgender health program coordinator. This role is filled by Amy Penkin, LCSW, who is brilliantly bringing this program to its full potential.

A hypothetical: If you could have one tool that would solve a seemingly impenetrable problem in your work, what would it do? You have unlimited resources to design this tool, so think big.

A tool which quickly and consistently enlarges and lengthens blood vessels (both arteries and veins) would open up innumerable additional options for tissue transfer and create less morbid options.

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