It’s every parent’s worst nightmare. While playing outside on a perfect summer day in 2009, two-year old Braxton Farmer ran up behind his father’s riding mower just as he was starting to back up. Not only was his foot nearly amputated by the mower, but the fastest ambulance ride to their home was 20 minutes away…a potential death sentence.

Luckily, the family was able to secure a life flight to Norton Hospital, where Dr. Chariker, who also serves as Norton’s Chief of Pediatric Plastic Surgery, was on the team that helped him. He was rushed into a nine-hour surgery where a team of orthopedic and plastic surgeons including Dr. Chariker accomplished the daunting task of reattaching every artery, nerve and tendon from his foot to his ankle.

“The procedures to salvage his injury required skills in microsurgery, free tissue transfer and advanced wound healing techniques. The rest was really up to Braxton, who is a fighter and an extremely resilient child,” Dr. Chariker said.

Braxton remained at Kosair Children’s Hospital for five weeks, three of which were spent in the “Just for Kids” Critical Care Center. Between then and his third birthday in July, Braxton endured 19 surgeries. Because of the severity of the wound, it wasn’t possible to completely close it, which meant daily cleaning of the wound to prevent infection—a surgical procedure requiring sedation.

After months of hard work and rehabilitation, Braxton can walk, run and play just like any child. A scar is the only evidence of the ordeal he suffered. It’s a victory Dr. Chariker and the staff here will not soon forget.

“The last time I saw Braxton for a follow-up visit in my office, he ran down the hall. You cannot put a price on that feeling,” Dr. Chariker said. “It’s a little reminder why we do what we do.”

To see the whole article on Braxton, visit Kosair’s website.

When Do You Treat a Flattened Skull in a Baby?
Dr. Chariker Sets Pediatricians Straight on the Issue in a New Journal Article

When do you treat a head deformity in an infant, and how much treatment is too much?  These are the issues Dr. Chariker wrote about in an article to other physicians in the Fall 2011 issue of Kentucky Pediatrics, which goes out to all the pediatricians who are a member of the Kentucky Chapter of the American Academy of Pediatrics.

“Plagiocephaly,” which is defined as a flattening of one side of an infant’s head, is a whole lot more than just the flattening that sometimes occurs during the birth process and goes away.  In these cases, the baby’s head most often appears normal at birth but gets more flat after the baby is 6 to 8 weeks of age, as the baby’s brain grows.  This has lots of potential causes…flattening from a baby sleeping on his back, to preterm delivery, pleural births (twins), intrauterine constraint (oligohydramnios or nulliparity), congenital muscular torticollis (tight muscles in the neck), small maternal pelvis, large birth weight, and large head size.

This guide helps physicians categorize the symptoms into levels, so they know when to implement a repositioning program with the infant, and when to use more advanced corrective techniques such as prescribing a helmet (known as a “cranial remolding orthosis”) to help the baby’s head pull into a more normal growth pattern. Read the full article here.

Spreading the Word on Skin Cancer Prevention at UPS

How do you protect yourself from getting skin cancer? How do you tell a harmless mole or freckle from something more serious? What’s the best way to go about caring for your skin, regardless of your age?

These are just a few of the questions the staff of Dr. Chariker’s office fielded at UPS’s Health Fair, held on September 8, from 7 p.m. to 11 p.m. for the company’s night shift workers. “It’s not exactly our normal operating hours, but we were happy to do it. It’s really important to bring health information to people where they are, and make it entertaining and convenient,” said Karen Mosgrove, Practice Administrator. As part of their preferred provider network, UPS employees enjoy a 15 percent discount on all products and procedures through Dr. Chariker’s practice. If you’re interested in getting the same deal for your company, contact us.

Dr. Chariker Talked Breast Reconstruction Options at Gilda’s Club meeting, November 14

Having breast cancer is hard. Choosing treatment options is even harder. To help take the mystery out of the process, Dr. Chariker spoke at Gilda’s Club in Louisville, November 14.

“A lot of my patients find the process of choosing really stressful. Do you take the whole breast and do a reconstruction? Or do you skip reconstruction? Do you have a lumpectomy and radiation? If you have a reconstruction, how many surgeries will be required? It can be the most stressful part of the experience. But the good news is, options are improving all the time, and so are survival rates,” Dr. Chariker said.
The event featured a free dinner and attracted a great crowd!

Dr. Chariker’s Office Makes A Splash at Susan G. Komen Race for the Cure

At our office, we’re on the front lines of dealing with Breast Cancer. So it’s only natural we would continue to be involved in the Susan G. Komen Race for the Cure, held in Louisville, October 8. The office sponsored a water station, and we were mobbed with participants, as thousands of participants crowded into downtown for the event. We gave away more than 11,000 bottles of water to race goers. We left the day tired, but happy, that we could lend a hand to such an important event. See you next year!

Dr. Chariker Headed to Europe to Speak, Again

(photo credit—iguide.travel)
Did you know that Dr. Chariker was the co-creator of Negative Wound Pressure Therapy? It’s a technique that uses a special bandage with suction, which brings blood, antibodies and nutrients to the surface of a persistent open wound, speeding its healing. Because of his participation in the invention of this technique, he’s part of Negative Wound Pressure Council. He gives speeches around the globe as part of the effort to educate physicians on the process, and spread its adoption. This time, he’s jetting off to Copenhagen in April.

By Karen Mosgrove, Practice Manager
NFocus, Louisville’s premier magazine on philanthropy and society news, just did a really lovely story on Dr. Chariker and his dedication to providing free plastic surgery to poor children in the Philippines. Check it out at http://nfocuslouisville.com/story/charity-spotlight-0

While we’re really thrilled Dr. Chariker is getting recognition for his good deeds, it’s really not news to us. Every day, we watch as Dr. Chariker makes one more appointment, does one more trip, takes one more call, tries one more difficult surgical technique, all the in the name of compassion. He doesn’t do any of this because he thinks he might get noticed. He truly has a commitment to making kids’ lives better. He’s truly tireless. I think I can speak for everyone here when I say we’re proud we work for him. Way to go, Dr. Chariker!

What do you do when you have a wound that just won’t heal through conventional treatment? Dr. Chariker helped develop a type of treatment—negative wound pressure therapy—that helps patients heal faster, and helps prevent infection, too. Since he worked on the development of the therapy, he travels the world with the NWPA helping educate other physicians about the technique.

Negative wound pressure therapy is a type of treatment that uses long lasting, consistent suction on wounds, helping those hard-to-heal wounds heal up to 1/3 faster. Negative wound pressure therapy works because the suction helps blood, nutrients and antibodies get to the wound’s surface more quickly and evenly. It creates a seal that keeps out bacteria and contaminants, too.

Patients using this method are required to wear a portable suction device that is taped down to their wound, providing low to moderate pressure. Most people learn to live with the device quite easily, and soon forget that it’s there. But it is, working around the clock to help the body heal itself. It is especially helpful for patients who are diabetic, have circulation problems or numbness in the affected area, or who have large, hard-to-close wounds.
Photo Credit:HolidyPictures.com

Surgeries for cleft palates are often done so early in life, and so routinely these days, people often forget how serious the condition can be. Cleft palate and the malformations that come with it can affect not just a child’s ability to eat, but also their hearing and their overall development. Parents with babies who have cleft palates worry constantly about their child choking and grapple with all kinds of day-to-day struggles.

Such was the case with the parents of Clayton Freiberger, one of our surgery patients who was featured recently as a Kosair Kid on the cover of Kosair Charities Kite Tales magazine. While most children are diagnosed with cleft palate in utero, Clayton’s face was concealed in his scans. His parents were completely shocked when he was born, and were not prepared for the medical needs that came with his feeding and hearing issues. His cleft emptied into his sinuses, which made feeding dangerous and left his parents reluctant to leave him in anyone else’s care. They juggled work schedules, weekly visits to specialists and long commutes to work from Indiana. The medical bills were mounting, and his parents didn’t know how they were going to keep up.

Fortunately, Kosair Charities was able to step in to help the Freibergers, getting him cleft palate corrective surgery through Dr. Chariker while Clayton was just a small infant.

“He’s a great little guy, and he’s really turned the corner,” Dr. Chariker said. “He’s walking and talking now. He still has some treatment ahead of him to help correct his hearing issues, but I think everyone on the team who’s working with him feels good about his prognosis for the future,” he said. “It is my passion and my life’s work restoring the faces of children who, through birth defects or accidents, face medical challenges. I can’t tell you how rewarding it is to give these kids a shot at a living a more normal life. We’re very proud to have a practice that works with Kosair Charities kids. They are a huge resource to our patients, and to the community,” he added.
Photo Credit:HolidayPictures.com

Did you know that Dr. Chariker is also an author? Many of his cases have been written up in professional journals, like his most recent entry, in the March 2011 edition of the Journal of Craniofacial Surgery.

Dr. Chariker has done hundreds of cleft palate surgeries over the years, but every now and then, you get one that is one for the history books. Recently a mother brought her three-day-old infant daughter to us for a consult for a cleft palate surgery. The baby had a large cleft in the roof of her mouth and was having trouble feeding.

Upon further examination, we could see she had not just a cleft, but a mass protruding through her cleft that was actually covered with fine, soft hair. An x-ray revealed that the mass was connected through her palate to the base of her skull. Surgery was recommended, and the infant pulled through well. Pathology on the removed tumor showed that it was not cancer, or even a benign tumor. It was a duplicate pituitary gland—one of only 40 such cases ever recorded worldwide.

“We’re very happy we could treat this child so early. No one knows why this tumor grew as a malformation in the mouth. However, the pituitary gland is responsible for the distribution of growth hormone in the body. Having two working glands could have created real growth imbalances for this child. Now, she’ll have a nearly normal appearance, no eating problems, and no problems with the continued growth of that unnecessary gland. Her prognosis is great,” Dr. Chariker said.

We’re glad we could help this little girl, and at the same time, contribute to the body of knowledge about treating these rare disorders!

I can’t tell you how many calls I get a week from patients asking questions about Dr. Chariker. “What’s he like?” “What’s his philosophy?” “How does he approach his surgeries?” “What can I expect?”

NFocus magazine’s latest article about Dr. Chariker’s charity work answers all these questions. Charity work is in his heart. The children in the Philippines would never get these life-altering surgeries any other way than through Dr. Chariker.

And I see the same spirit in his eyes every day when he deals with the patients in his practice. The majority of the patients he sees are not getting minor procedures. Dr. Chariker reconstructs faces after accidents. He corrects birth defects. He reconstructs the body from ravaging of diseases like cancer or conditions like hemangiomas. He’s not giving people makeovers. He’s giving them new lives.

Dr. Chariker, we’re not surprised that your work has gotten NFocus’ attention. You deserve it. I’m proud to be part of the team making these little miracles happen every day.

–Karen Mosgrove, Practice Manager

By Dr. Mark Chariker

Most people take their faces for granted. But when you have a condition that disfigures you, you realize your face is your life. In many cases, it is your ticket to the world. Having a face that is complete, free from disease, and functional is an everyday joy many people in this world don’t get to experience.

In the U.S., most people with facial deformities have access to medical care, including surgical reconstruction. But in some other parts of the world, patients may not be so fortunate. In the Philippines, an organization called P.A.G.E.S (Philippine American Group of Educators and Surgeons) started Operation HOPE to provide medical treatment for underprivileged children with birth defects and other deformities. Every year the group brings together physicians from the U.S. and the Philippines who donate their services to perform reconstructive surgery that can change the lives of these children.

I’m looking forward to participating in this year’s trip. While there, our group will set what is, for all intents and purposes, a plastic surgery MASH unit. It’s quite an undertaking for everyone involved. People come from miles around, many of them walking dozens of miles carrying their children. So many are in dire need; some of the children have cleft palates so severe they can barely eat, but the family has no means to pay for surgical treatment.

Our nurses consult with the potential patients to pre-qualify them, and they have a short consult with a doctor before surgery begins. Our doctors may perform as many as eight to ten surgeries every day. Not exactly ideal, but for most of these children, it is their only chance to get the vital, life-changing health care they need.

When I get back, I’ll post some stories and photos, so you can see some of the wonderful work sponsored by P.A.G.E.S. Operation HOPE.

Here by popular demand, we’ve now added the dermal fillers Restylane and Perlane to our line-up of treatments for unwanted wrinkles and folds in the face.

Unlike other dermal fillers, Restylane and Perlane are made with hyaluronic acid, a natural chemical already present in the body — and present in abundance in young, smooth skin. As we age, we begin to lose hyaluronic acid, revealing more wrinkles, creases and folds such as the lines from the nose to the corners of the mouth. Restylane and Perlane are clear gel formations of hyaluronic acid that are injected into the areas patients want to be plumper and fuller — filling in those unwanted lines. Seventy percent of patients receiving the treatment report that the results last up to six months after just one treatment.

What’s the difference between the two products? “The products are made with the same materials. But Perlane has, on average, larger particles in it than Restylane. This makes it the better choice for deeper or more severe folds, where the injection needs to go deeper into the skin,” Dr. Chariker said. “Both these products are generally regarded as among the best dermal fillers out there. We’re pleased to be able to offer them here,” he added.

Dr. Chariker not only makes rounds with his patients, but also makes rounds of another sort, as a frequent speaker at surgical conferences and a contributor to medical journals.

In just the last few months, he has:

• Presented at the Tri-State Craniofacial Conference, held at the Indiana University School of Medicine in Indianapolis. His presentation was on the “Outcome of an Algorithmic Approach to the Treatment of Meningocele.” In plain English, that means he was presenting a new set of rules and procedures for the proper diagnosis of a Meningocele — a herniated malformation of the lower spine common in children with spina bifida. The presentation discussed how well the new procedures work, and how physicians should be incorporating them into their practices.
• Authored an article in the Journal of Craniofacial Surgery. The article, titled “Pituitary Duplication with Nasopharyngeal Teratoma and Cleft Palate” discusses a relatively rare but very severe series of birth defects in children. Kids with this rare combination of medical issues are born with extra pituitary glands and a type of invasive tumor of the nose called a teratoma, in addition to a full or partial cleft palate.

As a surgeon with extensive experience working with children, I’m often approached by non-profit organizations to provide pro bono surgery for children in need. I do dozens of these surgeries a year, especially through my involvement with Operation Hope, where I travel around the world with other physicians, providing surgeries to children in desperate circumstances. Surgeries like cleft palate repair have the power to change these children’s lives. I’m honored to be a part of that.

But every now and then, I have a case that’s so special, it really stands out… a case like Johanna. Johanna is a patient who came to me through an organization called Healing the Children, which opened its chapter in Louisville this year with Johanna’s case.

Johanna is from Quito, Ecuador, and has Goldenhar Syndrome. This rather rare syndrome causes a number of problems with the head and face for these children, and little Johanna, only six years old and a petite 35 pounds, has the full syndrome. When she arrived at my office this fall, she had:

• Only a flap of skin where her ears were supposed to be, and no discernible ear canal
• A lateral cleft palate
• Deformities of her jawbone that made her chin uneven
• Limited hearing, an undetermined amount of structure in her inner ear, and one corner of the mouth higher than the other

Johanna is the youngest of five children in a loving home in Ecuador. But with her father working in construction, and her mother working as a housekeeper, they just did not have the funds for the multiple surgeries required. So, through Steve Diamond at Healing the Children, they came to us and another team of specialists in Louisville. Rob and Marta McKinnon of Goshen, Ky. agreed to serve as her foster family in Louisville, to shepherd her through her surgery.

Johanna is a little marvel. Even though she is so small and in a completely foreign place, she handles the whole process with maturity far beyond her years. Her foster family seems genuinely thrilled to have her around. They report she has no trouble blending in, getting used to new things, or making her feelings known through an advanced kind of charades. We’re not sure how much she can hear us, but she responds well to signals, and seems to follow the conversation as I discuss the surgical procedure with her foster family.

My job in this process was to recreate her ears, so that Dr. Gadre, a neurotologist at the Heuser Hearing Institute, can then work on options such as hearing aids or cochlear implants to restore her full hearing. Unfortunately, we won’t be able to address all Johanna’s problems on this trip, as her visa only runs through Christmas. But we can create the framework for her ears and, we hope, her new life.

Step one of the surgery was to remove the existing flap of skin for her ear. Then we created a zigzag incision on her scalp, so we could gain access to the parietal fascial flap of skin in her scalp. To be specific, this is a thin layer of skin underneath the scalp. We placed a plastic, artificial framework for her ear, which will serve as the cartilage in the finished ear. Then we pulled the artery as well as the skin from her scalp over her ear, and attached it to the framework. We then grafted skin from her neck and groin to create the skin covering the ear, and attached the adjoining nerves and blood vessels. When we were finished, the ear looked rather undefined. But as it heals, the skin shrinks down over the framework and creates an attractive ear.

Because Johanna is so little, we had to choose certain surgical alternatives. For instance, we had to use the artificial ear, as opposed to creating a framework from her ribs, because of her size. But with the assistance of Dr. Gordon Tobin and the plastic surgery residents from the University of Louisville, both surgeries for her ears went well, with no complications.

I also credit this surgery’s success to Johanna herself, and the loving support of her foster family, as well as her family in Ecuador. As scary as this procedure can be for a small child, she never cried or refused any of our instruction. Her foster family reported that she even handled the difficulties that come with recovery with grace and determination. I am happy to report that she now has full hearing in one ear and a beautiful reconstruction. I think we all can take a lesson from Johanna, and many of the children we see in our practice. Life is full of challenges. It’s how you face them that determines the outcome. Johanna has taken only the first step of her journey. She will still need surgery to repair her jaw, her cleft palate, and possibly her hearing in the other ear. We wish her well.