Dr. OSAM AHMED AL-NAJJAR,
PLASTIC SURGEON,
AL-WASITY HOSPITAL for reconstructive surgery.
BAGHDAD, IRAQ
FIRST CONSTABLE FELLOW, BRACHIAL PLEXUS SURGERY
My journey started on April 2008 when Dr. BRYANT TOTH called me and told me that I was accepted
as the first John Constable fellow for training in Brachial plexus surgery.
I had to travel to Ankara/Turkey to apply for my visa, and after 9 months of administrative and
security clearance work my visa was issued and started planning for my visit with Dr. Bud Alpert to
visit multiple centers in the united states that do brachial plexus surgery and arrange for attendance
of 2 major international conferences during my visit, and after few weeks of E-mails and planning
(mostly done by Dr. Alpert) the schedule was done as follow: New york, Seattle, San Francisco, Los
Angeles, St. Louis, Alabama (to visit my sister-in-low during chrisms ), Florida, Boston, New York.
I left Baghdad on the 14th of Nov. 2009, to ISTANBUL, stayed for 2 days, and took the Delta Airlines
to New York on the 16th of Nov. arrived at 6:00pm, and spent 5 beautiful days of fun and tourism
and visited Rockefeller building, Empire state building, Broadway street, the Central Park, the
Museum of history and art, Bodies museum, the Statue of liberty, statin Island.
On the 20th of Oct. I received an invitation from Dr. David Chiu to attend a conference at the
University of New York and that was the beginning of my learning journey.
Tuesday 20 Oct.: New York university hospital conference – tendon transfer in tetraplegia. Dr. David
Chiu.
Wednesday 21 Oct.: going to Seattle.
Seattle:
Thursday 22 Oct.: Updates in crainiomaxillofacial reconstruction symposium.
Friday 23 Oct.: Updates in surgical and nonsurgical facial rejuvenation
symposium.
Saturday 24th - Tuesday 27th: Plastic
Surgery 2009 conference.
Wednesday 28th Oct. HARBORVIEW hospital
7:00AM Dr. MANIK’s lecture on Nasal reconstruction by forehead flap – 3 stage surgery.
8:00AM: Bilateral DIEP flap for breast reconstruction (first time) -Dr. MATHES.
Thursday 29th Oct.: Multiple facial fracture fixations by miniplates and screws - Dr. GRASS.
Friday 30th Oct.: Reduction mammoplasty by central mound technique – Dr. LOUI.
Saturday 31st Oct.: Space needle /monorail/down town/farmer market/coast line tour.
Sunday 1st Nov.: Bainbridge Island/the IMAX Theater experience.
Monday 2nd Nov.: University of Washington hospital: bilateral double pedicle DIEP flap for
Unilateral breast reconstruction. Dr. PETER NELIGAN.
Tuesday 3rd Nov. Harbor view hospital: Dr. NICK VEDDER Hand cases:




Ulnar nerve transposition.
Wound excision and VAC.
Tenolysis for extensor policis longus.
Debulking of flap.
Wednesday 4th Nov.: Traveling to San Francisco.
San Francisco
Thursday 5th Nov.: Visiting UCSF – Dr. Bill Hoffman operating on cleft palate and palatal fistula.
Friday 6th Nov.: CPMC Davis campus, bilateral DIEP flap for breast reconstruction -Dr. Gabriel Kind.
Saturday 7th – Sunday 8th: site seeing- marina, fisherman’s harbor, downtown , Chinatown , golden
gate park, the pacific ocean.
Monday 9th Nov.: CPMC, right subcutaneous mastectomy and reconstruction with DIEP flap- Dr.
GABRIEL KIND, Dr. NIMA GRISSOM.
Tuesday 10th Nov.: Oakland children hospital: Crainiosynostosis reconstruction (first time). Dr.
BRYANT TOTH.
CMPC: lower limb reconstruction with rectus abdominus free flap.
Wednesday 11th Nov.: St. Mary Hospital: Bilateral Breast reconstruction with DIEP flap. Dr. Scott
Hansen.
Thursday 12th Nov.: CMPC median nerve exploration and sural nerve graft. Dr. GREG BUNCKE.
Friday 13th Nov.: Excision of hand tumor and skin graft.
Saturday 14th and Sunday 15th : site seeing.
Monday 16th Nov.: CMPC, My presentation on microsurgery unit in Al-WASITY Hospital in Iraq.
Reduction mammoplasty by central mound technique- Dr. BUD ALPERT.
Neurolysis of Ulnar nerve. Dr. GREG BUNCKE.
Tuesday 17th Nov.: CMPC, De-neurotisation of the Dorsum of the foot for causalgia. (first time) Dr.
BUNCKE.
Tendon transfere for radial nerve injury. Dr. BUNCKE.
Change of breast Implant, Dr. BUD ALPERT.
Bilateral DIEP flap for breast reconstruction. Dr. Rudolf Buntic, Dr. Karen Horton.
Wednesday 18th Nov.
CMPC: ulnar to median end–to-side nerve transfer for sensory recovery .(first time) Dr. BUNCKE.
Free fibula flap for thumb reconstruction. Dr. BUNTIC.
Take the train to Palo Alto to meet Dr. ROD HENTZ, Stanford University.
Palo Alto, Stanford
Thursday 19th Nov.: Visit Ambulatory medical center, at Stanford.
Nerve transfer, anterior interosseous to motor branch of ulnar nerve. Dr. HENTZ.
Friday 20th Nov.: Visit Veteran hospital-Palo Alto, Fasciectomy and skin graft for Deupoetren
contracture, Dr. CATHRIN CURTIN, Dr. HENTZ.
Nerve transfere for upper trunk brachil plexus injury, spinal accessory to Supra scapular, and radial
branch to medial head of triceps to Axillary nerve. (first time) Dr. CATHRIN CURTIN.
At 5:00pm went to WESTIN COYOTE Inn Hotel,
Saturday 21st Nov.: Go to Los Angeles; arrive at 2:00pm, going to Santa Monica beach.
Los Angeles
Sunday 22nd Nov.: Go to UNIVERSAL
STUDIOS.
Monday 23rd Nov. : Visit Kaiser Permanente west los Angeles hospital, free gracilis muscle flap for
reconstruction of elbow flexion for brachial plexus injury, innervated by intercostal nerves 3,4,and
5.(first time) Dr. Brad Edgerton.
Tuesday 24th Nov.: Kaiser Permanente hospital: breast reconstruction with free rectus abdominus
myocutaneous flap. Dr. D. J. Lee.
Wednesday 25th Nov.: Kaiser: arthrodesis of MP joint of the thumb with plate and screws. Dr. Brad
Edgerton.
Reduction mammoplasty by inferior pedicle technique. Dr. Brad Edgeron.
Remodeling of reconstructed breast by liposuction, fat injection, with nipple/areola reconstruction.
Dr. D. J. Lee.
Endoscopic brow lift, with upper and lower blepharoplasty. Dr. D. J. Lee.
Thursday 26th Nov. Thanksgiving day: invited to Dr. D. J. Lee‘s house.
Friday 27th-Sunday 29th Nov. went to Las
Vegas stayed at LUXOR.
Monday 30th Nov. Kaiser, excision of recurrent dorsal wrist ganglion.
Ulnar nerve transfer with intra neural neurolysis.
Tuesday 1st Dec. went to Disney
land.
Wednesday 2nd Dec. went to the Turkish embassy to get transit visa.
Thursday 3rd Dec. Kaiser, open septorhinoplasty with spreader and colamellar cartilage graft. Dr. D.
J. Lee.
Correction of Mallet finger by Hook plate and screw (new technique). Dr. Brad Edgerton.
Friday 4th Dec. went to the airport, the flight to St. Louis cancelled because of the weather.
Went to Hollywood boulevard.
Saturday 5th Dec. took the flight to St. Louis. Arrive 7:30PM, miss the party at Suzan Mackinnon
house, stayed at Homewood suites.
St. Louis
Sunday 6th Dec. went for site seeing in St. Louis, visit the Arch of St. Louise at the Mississippi river.
Monday 7th Dec. visit Barns-Jewish hospital.
7:30AM lab meeting with Susan Mackinnon.
8:30AM Susan Mackinnon consultation clinic .
Tuesday 8th Dec. Advance medical center.
ulnar nerve transposition-revision.
Median nerve decompression at proximal forearm.
Common flexor origin transfer for flexion of elbow.
Wednesday 9th Dec.
Excision of tumor (recurrent Schwannoma) in the left brachial plexus.
Carpal tunnel release.
Thursday 10th Dec. Susan Mackinnon consultation clinic.
Friday 11th Dec.
Posterior interosseous nerve decompression. Dr. Mackinnon. ( first time ).
Peroneal nerve decompression.
median nerve exploration and grafting-Dr. Tommy Tung.
Saturday 12th Dec. site seeing Down town.
Sunday 13 Dec. site seeing Downtown.
Monday 14th Dec. Susan Mackinnon consultation clinic.
Tuesday 15th Dec.
ulnar nerve decompression at the wrist ( Guion’s canal)
Ulner nerve transposition at elbow and wrist with carpal tunnel release.
Saphenous nerve neuroma excision.
Radial to Axillary nerve transfer.
Wednesday 16th Dec.
Ulnar nerve decompression at the wrist with carpal tunnel release.
Posterior interosseous nerve decompression with Superficial radial sensory nerve decompression.
Dorsal sensory ulnar nerve excision.
Exchange of nerve stimulator for pain relief.
Thursday 17th Dec.
Susan Mackinnon consultaion clinic.
Friday 18th Dec.
Susan Mackinnon consultation clinic.
Saturday 19th Dec. take the flight to Montgomery, Alabama, to visit my nieces and nephew.
Prattville/Alabama
Thursday 24th of December: Drive to Orlando with my brother’s family.
Friday 25th of December: visit Disney’s Magical World.
Saturday 26th of December: visit Universal Studios.
Sunday 27th of December: visit Sea World.
Monday 28th of December: Drive back to Prattville Alabama.
Sunday 3rd of January: fly to Miami/Florida. Stay at Best Miami Beach Hotel.
Boca Raton/ Florida
Wednesday 6th of January: take the train to Boca Raton to attend the AAHS/ASPN/ASRM meeting.
6th to 12th of January: AAHS/ASPN/ASRM annual meeting.
Thursday 14th of January: fly to Boston. Visit the Massachusetts General Hospital.
Boston
Friday 15th of January: morning conference at 7:00AM.
8:00AM: unilateral breast reconstruction with DIEP flap.
Saturday 16th of January: visit Dr. John Constable at his house with Dr. ALYA ANTON.
Sunday 17th of January: site seeing in Boston.
Monday 18th of January: Martin luther king day , site seeing in boston.
Tuesday 19th of January: MGH hospital, Crainioplasty with titanium mesh and methylacrelate. Dr.
Yarimchuck.
Division of Forehead flap for nasal reconstruction.
Wednesday 20th of January: Nasal augmentation with Medpore.
Thursday 21st of January: morning conference, chief resident’s complication cases.
Friday 22nd of January: morning conference,
What I gained during my trip to the United States, visiting many centers is the tremendous
experience I had from this attachment with many different centers and Doctors, mostly in perforator
flaps and Brachial plexus surgery, which was my main interest. This experience will certainly change
my life and carrier as I am one of the faculties in the Iraqi Council for plastic surgery training program
and will add to my ability to teach my residents as well as to treat my patients up the best standards
in the world.
There are surgeries that I have seen for the first time like:
1. Perforator flaps
2. Crainioplasty.
3. Double nerve transfer for shoulder abduction, spinal accessory to suprascapular and radial
to axillary.
4. Median to Ulnar nerve transfer.
5. Reduction Mammoplasty by central mound technique.
As well as a new techniques and concepts like:
1.
2.
3.
4.
5.
6.
7.
8.
Intercostal nerve exposure and transfer.
Internal mammary artery exploration.
Posterior interosseous nerve exploration and decompression.
End-to-side nerve repair for motor or sensory recovery.
Proximal forearm median nerve exploration and decompression.
Double crush syndrome and reverse double crush.
Exposure of the spinal accessory nerve.
Exposure of the suprascapular nerve.
And many more things that is difficult to enumerate, but the most important thing that I have
learned from getting in touch with some of the world leaders in their fields is the dedication for
teaching and scientific unselfishness.
the thing that touched my heart is the warmth and care that I have seen from the Surgeons I have
met who made me feel at home in a strange country like Dr. Bud Alpert, Dr. Bryant Toth, Dr. Rob
Hentz, Dr. Nick Vedder, Dr. Susan Mackinnon, Dr. J. Austin, to whom I will be indebted forever, may
god bless them.
Osam Al-Najjar.