CHOC Experts Provide High Level of Care for Brachial Plexus Surgery

CHOC Children’s offers the highest level of care for children requiring brachial plexus surgery.

Brachial plexus surgery is a complex procedure that repairs damage to the bundle of connected nerves in the neck region. Damage to these nerves is often caused by birth complications, contact sport collisions and automobile accidents. A severe brachial plexus injury can cause a patient to lose function and sensation in their arm, impairing their ability to perform everyday tasks.

Surgical procedures such as nerve grafts and transfers can restore this function and sensation and help the patient regain their lost quality of life.

“While many patients will regain movement with therapy alone, a small percentage will require nerve surgery,” says Dr. Joffre Olaya, pediatric neurosurgeon at CHOC. “Patients may even need a series of surgeries,” he adds. “The first surgery may be focused on the nerves, where the second would be focused on the transfer of muscle or movement of bones.”

The experienced multidisciplinary team at CHOC is fully equipped to handle all aspects of the repair and guide the patient and their family through every stage of treatment and healing. The surgery is performed in the Tidwell Procedure Center at CHOC, which features seven operating rooms and advanced technology and information systems.

“We like to evaluate patients as early as possible,” says Dr. Amber Leis, a CHOC and UC Irvine plastic surgeon. “We want to be part of the child’s journey and provide long-term care to ensure the best possible outcome.”

Whether or not these patients end up requiring surgery, they all benefit from therapy, explains Dr. Leis. CHOC is proud to offer the latest, research-based physical therapy in one of the most comprehensive rehabilitation centers in the area. Further, depending on their age, diagnosis and treatment plan, some brachial plexus patients may benefit from aquatic physical therapy, which takes place in the center’s pool.

Dr. Olaya and Dr. Leis are committed to building a robust, one-of-a-kind brachial plexus program for children in the region and beyond.

They offer community physicians the following guidelines on when to refer:

  • As early as possible, after a brachial plexus birth palsy with impaired arm movement.
  • After a sports or motor vehicle accident with impaired arm movement or sensation.

Learn more about surgical services at CHOC.

In the Spotlight: Peter Yu, M.D.

Peter Yu, M.D. A new pediatric surgeon with unique expertise in fetal surgery has joined CHOC Children’s Specialists Pediatric Surgery. Dr. Peter Yu specializes in the full spectrum of pediatric surgery, including neonatal, thoracic, and hernia surgery, and has quickly become an integral part of the surgery team.

“I’m extremely happy to be at CHOC,” Dr. Yu says. “There is so much talent and potential here, as well as a pioneering spirit and willingness to undertake big things.”

He is working closely with Dr. David Gibbs, division chief, pediatric surgery, CHOC Children’s Specialists, and Dr. Mustafa Kabeer, pediatric surgeon, CHOC Children’s Specialists, to launch a multi-disciplinary fetal surgery program at CHOC in the near future.

This highly complex surgery was uncharted territory about 30 years ago, Dr. Yu says. Many advances have been made in the field since, including new techniques that have allowed for the in utero surgical intervention of previously unsurvivable conditions. With special training from The Children’s Hospital of Philadelphia, one of the pioneering institutions in fetal surgery, Dr. Yu is determined to bring that level of expert care to CHOC and add to his team’s scope of services.

Among his goals, he hopes to help his team enhance the trauma program, advance CHOC’s minimally invasive surgery program, and increase CHOC’s national reputation through quality patient care and innovative research.

A passion for pediatric surgery

Dr. Yu followed in his older brother’s footsteps to become a doctor and attended Stanford University for his undergraduate studies. He graduated from the medical school at University of Missouri School of Medicine, where he fell in love with the culture and technical aspects of surgery, as well as the potential to make sick patients better quickly.

“I realized that the best surgeons were kind, dedicated, hard-working and team players – traits that I really value. When I discovered pediatric surgery, I felt it was a perfect fit for me, as it allows me to take care of children with an incredibly broad spectrum of pathology through surgical excellence,” he says.

Dr. Yu completed his general surgery residency at University of California, San Diego, followed by a surgical critical care fellowship at Boston Children’s Hospital and a pediatric surgery fellowship at The Children’s Hospital of Philadelphia. Additionally, he is board certified in general surgery, pediatric surgery and surgical critical care, and is currently working on a master of public health degree from Johns Hopkins Bloomberg School of Public Health.

This dedicated physician is interested in outcomes research to better understand the end results of specific health care practices and interventions.

“We presently live in an era where massive amounts of data are available at the click of a few buttons. The roadblock for many physicians is that we often don’t know how to access this data or organize it,” Dr. Yu explains. “My goal, along with my partner, Dr. Yigit Guner, as well as the division of pediatric general and thoracic surgery at CHOC, is to build an outcomes research center. This center will help all CHOC physicians access healthcare data and turn it into something meaningful so that we can provide the highest quality of clinical care to our patients, and do so in a financially sustainable manner.”

Dr. Yu has given numerous national presentations at meetings such as the American College of Surgeons Clinical Congress and the Association for Academic Surgery and Society of University Surgeons Academic Surgical Congress. He is a member of several organizations, including the American Pediatric Surgical Association and Society of Critical Care Medicine.

In his spare time, he enjoys spending time with his wife and three children. He also enjoys surfing, basketball and competitive swimming on a local U.S. Masters swim team.

To get in contact with Dr. Yu or to refer a patient, please call 714-364-4050.

CHOC Surgical NICU Reduces Post-Op Hypothermia in Infants

Consistent, standardized efforts across several disciplines helped CHOC Children’s reduce rates of post-operative hypothermia in neonates by nearly 88 percent, results of a quality improvement project show.

Staff decreased the number of babies who returned to the Surgical Neonatal Intensive Care Unit with body temperatures below 36 degrees Celsius from 10.7 percent to 1.3 percent following surgeries between September 2014 and August 2015.

Due to high body surface area, infants undergoing surgery are at risk for hypothermia, especially premature infants with decreased subcutaneous and brown fat. Hypothermia-induced vasoconstriction can lead to impaired wound healing, surgical site infections, impaired coagulation and decreased drug metabolisms, which can collectively increase perioperative morbidity, said Dr. Irfan Ahmad, co-director of the unit.

Though CHOC’s baseline figure was well below the national average rate of 15.6 percent, reducing post-operative hypothermia rates wasmock-surgery-1 identified as an area for quality improvement for the Surgical NICU and staff set out to reduce rates by half, Dr. Ahmad said.

Involving a cross-disciplinary team including nurses, neonatologists, surgeons and anesthesiologists, the project tracked 76 patients. Because infants can be at risk for hypothermia before surgery, intra-operatively and post-operatively, their temperatures were tracked during each operative stage. Staff were then able to identify problem areas and make improvements over each quarter.

Dr. Ahmad attributed the success to consistently implementing measures such as ensuring patients wore hats and blankets while headed to the operating room; pre-warming transport isolettes before placing babies inside; and using intra-operative heating devices during procedures.

Dr. Ahmad presented this data earlier this month to a quality congress held by the Vermont Oxford Network, a nonprofit, voluntary collaboration of health care professionals dedicated to the quality and safety of medical care for newborns and their families.

CHOC established its Surgical NICU in October 2013, and remains one of a handful of hospitals nationwide to cohort infants needing and recovering from surgery in a dedicated space.

Surgical NICU patients receive care from a multidisciplimock-surgery-4nary team that includes neonatologists, surgeons and many other clinicians. The surgical NICU team cares for patients jointly, discussing the cases as a group and forming a treatment plan that often calls for the expertise of other specialties.

Patients and families are a key component of the surgical NICU care team, collaborating and partnering with clinicians on every stage of the patient’s care.

The Surgical NICU rounds out CHOC’s expansive suite of services for neonates, including a main NICU; the Small Baby Unit, where infants with extremely low birth weights receive coordinated care; the Neurocritical NICU, where babies with neurological problems are cohorted; and the Cardiac NICU, which provides comprehensive care for neonates with congenital heart defects.

Learn more about CHOC’s neonatal services.

Dr. Troy Reyna Discusses Lumps, Bumps in Children

Though commonly found in children, lumps and bumps are don’t always require surgery, Dr. Troy Reyna, a pediatric surgeon at CHOC Children’s, tells “American Health Journal.”

These conditions can occur anywhere under the skin, and are commonly found in the head and neck region, says Dr. Reyna.

Learn more about lumps and bumps in “American Health Journal,” a television program that airs on PBS and other national network affiliates that reach more than 30 million households.

Each 30-minute episode features six segments with a diverse range of medical specialists discussing a full spectrum of health topics. For more information, visit www.discoverhealth.tv.

Troy Reyna, M.D. is board certified in pediatric surgery and general surgery by the American Board of Surgery. Dr. Reyna is a graduate of the United States Military Academy at West Point, where he majored in chemistry. He received his medical degree from Georgetown University Medical School. He completed his surgical internship at Walter Reed Army Medical Center and his surgical residency at Tripler Army Medical Center in Honolulu. Dr. Reyna served his pediatric surgery fellowship at Columbus Children’s Hospital.

Get more information about referring patients to CHOC, including referral information directory, services directory and referral guidelines.