Guest Editorial: Today's Residency Insight is presented by returning guest editor, Wenjay Sung, DPM. Dr. Sung is a graduate of the Dr. William M. Scholl College, North Chicago, IL., and completed his residency training at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania. He went on to complete advanced fellowship training at the Weil Foot-Ankle and Orthopedic Institute, Des Plaines, IL and is now practicing with the Sinai Medical Group, Chicago, IL.

Wenjay Sung, DPM RI Guest Editor

From Russia, with Love

“What a motley crew,” exclaimed our guide. Small Bone Innovations (SBi) assembled a team of 17 podiatrists from all over the United States to attend the SBi Ilizarov International External Fixation course in Kurgan, Russia, and we had just arrived in Moscow for a briefing. Our diverse group included post-graduate trainees (Jason Mallette, DPM, Victor Herrera, DPM, etc), successful surgeons (Robert Brarens, DPM, Steven Laxson, DPM, etc), and leaders in our profession (John Grady, DPM, Michael Marcus, DPM, etc). Our broad histories and experiences were colliding with an unfamiliar country and language, but Rich from SBi was reassuring the team before our venture into Siberia. It may not be apparent as to why Siberia was our exotic destination, but auspiciously, in 1963, a little known doctor presented his findings on a previously unknown phenomenon of osteogenesis activation.¹

Russian Professor Gavril Abramovic Ilizarov, the namesake of our international fellowship, presented his findings and technique at the 1st Russian Meeting of Orthopaedic and Trauma Surgeons,¹ eventually becoming a national hero of medicine. The Orthopaedic Center in Kurgan, Siberia, where he performed his craft and trained other Russian surgeons, was renamed after his death in 1992.² For over 30 years, international surgeons have been invited to train at the institute and witness the principles and teachings at the Russian Ilizarov Scientific Centre.³ Our group was privileged to be part of the exceptional few.

To be fair, our group comprised many outstanding and unabashed experts on external ring fixators who had been performing modified Ilizarov techniques and methods for many years. Some have reported on their results in publications and lectured throughout the United States, and others have been involved with education of post-graduates trainees regarding this method. However, like all believers on their way toward enlightenment, we journeyed together to the Mecca of Transosseous Osteosynthesis, hoping our dedication had significance.

In Kurgan, the sign for welcome was not vodka, but a warm smile. We were pleasantly surprised at the warmth and ease of the people of Russia. Whether we were lost in an elaborate underground subway station or in the sprawling woods of Siberia, local residents were gracious hosts in light of our ignorance. The doctors at the Ilizarov Institute were even more magnanimous. We were provided generous access to their surgeries, charts, and inpatient wards, while a post-operative patient cavalcade was available for us to examine and question. We were even allowed to participate in operative deformity correction.

Although their surgical techniques and methods were not foreign to us, their delivery of healthcare was. Patients stayed at the hospital for as long as their surgeon thought necessary, and some had been living there for nearly five years. Their operating suite decor with open windows left a lot to be desired toward sterility. However, during the operation, they continuously poured anti-septic solution (a 50/50 blend of 70% alcohol and chlorohexadine) on every wire, every bolt, every tightening, and every open wound. It was as if no part of the skin was allowed to be dry during the attachment of the external ring fixator. And although patients shared a room with up to five other patients, all dressing changes were done in a separate clean room and under sterile technique. The doctors boasted of an overall 2% infection rate. This was counter to our paradigm of creating a wide environment of sterility, and instead, their focus was on the field and surgical site.

Regardless, their amazing work with deformity correction and limb salvage was evident with the satisfaction of their patients. Several books ^1-3 have already been authored by international alum of the fellowship, with a multitude of graphics and photos, but to witness firsthand the work of these humble surgeons was truly awesome. Near the end of our training, one of the surgeons from the Institute toasted to us as his fellow comrades in the field of under-appreciated, underpaid humanitarians. Through a translator, he espoused that doctors worldwide were bonded by our love for our patients.

As we returned to our homes from abroad, we regained the fire to serve and an appreciation for our counterparts overseas. However, the success of the course was not measured by our satisfaction, but our renewed resolve to do what is best for our patients, as they do in Russia.

If you would like to hear more about my experience during the SBi Ilizarov International External Fixation Course, please find me at the below email (or follow me on Twitter).

Wenjay Sung, DPM
Fellowship-Trained Foot & Ankle Surgeon

Residency Education Coordinator
Mount Sinai Hospital Podiatric Residency Program
Sinai Medical Group
1108 South Kedzie Avenue
Chicago, IL 60612
Office:  (773) 722-2712
Email: [email protected]
Twitter: @jaysung

References:

1. Defects of the Lower Limb Bones: Treatment Based on Ilizarov Techniques. V. I Shevtsov, V.D. Makushin, L.M. Kuftyrev, Editors. Zauralye: Kurgan, Russia. 2000.
2. Treatment of Fractures, Nonunions, and Bone Loss of the Tibia with the Ilizarov Method: Including War Injuries and Tumor Resection, 3rd Ed. M.A. Catagni, A.B. Maiocchi. Editors. Medi Surgical Video: Milan, Italy. 2005.
3. Ilizarov Technique for Complex Foot and Ankle Deformities. A. Kirienko, A. Villa, J.H. Calhoun, Editors. Marcel Dekker: New York. 2004.

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