Pushing the Envelope for Upper-Extremity Injuries

John Ingari, left, operates with surgical technician Lauren Powell, middle, and orthopaedic surgery resident Lara Atwater, right.
John Ingari, left, operates with surgical technician Lauren Powell, middle, and orthopaedic surgery resident Lara Atwater, right.
John Ingari, left, operates with surgical technician Lauren Powell, middle, and orthopaedic surgery resident Lara Atwater, right.

Orthopaedic Surgery
Spring 2017

When orthopaedic surgeon John Ingari came to The Johns Hopkins Hospital two years ago, he brought 25 years of experience as a surgeon in the U.S. Air Force. What he found at Johns Hopkins was the opportunity to combine this expertise with that of clinicians across disciplines to treat patients with the most complex upper-extremity injuries.

Such conditions include scaphoid nonunions, in which there is no blood supply to the scaphoid. Ingari is preparing to publish his own technique for vascularized bone grafting in such patients. He also recently worked as part of the Johns Hopkins hand/arm transplant team, collaborating with 18 experts, including neurosurgeons and plastic surgeons, to perform a successful upper-extremity transplant.

Ingari finds Johns Hopkins is on the forefront of both limb transplant and prosthetic design. “We’re now developing prostheses that are on the verge of getting sensation back to patients. For some patients, that’s the best option. For others, it’s a transplant. We’re pushing both envelopes at once.”

He is particularly enthusiastic about the advances in understanding the basic science of chimerism, which have led to less need for anti-rejection medications in transplant patients. “There’s a lot more science that needs to be done to figure out how to avoid the need for immunosuppressants altogether. We’re not there yet, but we’re pushing,” he says.

The commitment to research in the hand division is strong, with orthopaedic surgery faculty members currently involved in three multicenter trials exploring the areas of fracture care, nerve regeneration and nerve repair.“At Johns Hopkins,” Ingari says, “we’re always asking, how do we push ourselves forward?"

Ingari is also proud of the care Johns Hopkins offers to the youngest upper-extremity patients. “Pediatric patients have their own ORs, their own anesthesia team, their own nursing care facilities,” he says. “We even have separate floors for teenagers so we can really customize care by age group. The size of the institution allows that kind of specialization.”

Ingari collaborates closely with plastic surgeons like Jaimie Shores, working together in a neuromuscular clinic to treat brachial plexus injuries. “We have geneticists on staff to help us understand whether patients have a syndromic condition versus a birth palsy,” he says. “Some need surgery and some don’t, and we work together to figure out the best approach for each patient.”

As motivating as Ingari finds difficult cases of wrist reconstruction, elbow replacement and vascularized bone grafting, he is equally dedicated to treating more common conditions. “No surgery is mundane,” he says. “I tell patients that small surgery is the kind somebody else has. For you, this is one of the bigger days of your life. I think that’s a philosophy shared by all of our surgeons here. We treat even the straightforward surgeries with the greatest care.”

 

Pushing the Envelope for Upper-Extremity Injuries

“At Johns Hopkins, we’re always asking, how do we push ourselves forward?...No surgery is mundane.”
 - John Ingari

 

ADVANCES AT JOHNS HOPKINS MEDICINE

  • Science of chimerism
  • Vascularized bone grafting
  • Limb Transplant
  • Prosthetic design
  • Fracture care, nerve regeneration, nerve repair

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