Dr Dellon and Fabio Santanelli de Pompeo, MD, who is the Secretary General of the European Association of Plastic Surgery, with the number 1 indicating the Table 1 at which we were sitting for the formal dinner.
"Here’s an interview I need to sprinkle around like salt and pepper on plain green beans. Dr. Lee Dellon – man, he tells it like he sees it and in regards to treatment for pelvic pain, I’m thankful for that. A few things in here were practice-changing ideas for me. I hope this interview challenges some of your thoughts or your approach to healing from pelvic pain. If you are not familiar with Dr. Dellon’s approach, please check out Chapters 4 and 12 of his free, online book Pain Solutions. This interview is like a Werther’s Original, so sit on the couch and suck on this one for a while – in a good stupor – like I did.”
Read more at http://www.blogaboutpelvicpain.com
Dr Dellon was invited to present his conception of the role of peripheral nerves in the mechanism of pelvic pain at a Consensus Conference on Vulvovaginal Pain held in Annapolis, Maryland on April 8 and 9, 2015. His position is that pudendal neuralgia should be replace by naming the branch of the pudendal nerve that is involved and whether there is a nerve compression or a nerve injury (neuroma). This distinction has not previously been made, with essentially all pudendal nerve patients being treated as if they had a compression of the main pudendal nerve deep within the buttock at the sacrotuberous ligament. Many patients have their problem more anteriorly where the surgical approach Dr Dellon developed can help them.
Dr Dellon speaking at Plastic Surgery Grand Rounds in the Tilghman Auditorium at Johns Hopkins on April 2 on the subject of Peripheral Nerve Surgery related to Nerve Decompression in Diabetics with Neuropathy.
At the American Society for Peripheral Nerve Surgery President’s reception, the President, Nam Nash’s son, Ramez Nam, and Ramez fiancé are with Luiann Greer Dellon and A Lee Dellon. Ramez gave the Presidential Invited Speaker Lecture. He is a futurist who has written the Trilogy beginning with Nexus, then Crux, and ending with the soon to be released Apex.
At the American Society for Peripheral Nerve Surgery meeting in the Bahamas in January,
A Lee Dellon (on the left), a Past-President of ASPN is next to his wife Luiann. Center is Demetrio Aguila, “Kato” as he as called in the Air Force where he finished up as a Lieutenant Colonel. Kato completed Plastic Surgery at Johns Hopkins and has brought Peripheral Nerve Surgery to his new home in Norfolk, Nebraska. Tessa Gordon, PhD, is President-Elect of ASPN, and her basic science research, first in Edmonton, and now in Toronto, Canada, has help advance the understanding of how we think of peripheral nerve injury and regeneration. On the right is Eric Wan, BS, a young Johns Hopkins researcher currently working with surgical rehabilitation of leprous neuropathy in Guayaquil, Ecuador.
Past Presidents of the American Society for Peripheral Nerve (ASPN), and both Professors of Neurosurgery at Johns Hopkins University, Drs A. Lee Dellon, left, and Allan Belzberg right at the ASPN meeting in the Bahamas, January 2015.
By STEVEN MOORE
Pardon Dr. Tim Tollestrup’s tunnel vision.
The Henderson peripheral nerve surgeon has two fingers inserted into a 53-year-old woman’s left ankle during surgery to correct tarsal tunnel syndrome, the lower extremity equivalent of the more common condition affecting the wrists and hands.
“I spend a lot of time in tunnels,” Tollestrup says as he slices through tissue compressing nerves in the patient’s left ankle.
Most of the time, however, Tollestrup has a broader view, working as he does on the periphery where millions of Americans are plagued with pain, numbness, tingling and motor weakness. He is among a select group of surgeons who can eliminate chronic pain through peripheral nerve decompression, creating space for the nerves to function properly, or segmental denervation, which involves cutting a nerve to interrupt the pain response.
Tollestrup addresses the underlying causes of patients with chronic conditions, freeing them from a reliance on medications, returning them to a life that’s pain free. Use of opioid painkillers has increased dramatically in the past decade, resulting in more overdoses and deaths, and a legion of patients who rely on various medications for relief. A health care provider’s first, best intervention for pain management should be treating the underlying cause, but often such a diagnosis is elusive for even the most skilled and dedicated doctors.
Neuropathy, functional disturbances and pathological changes in the peripheral nervous system, causes nerves that are grossly swollen, infiltrated and encased in fatty tissue, sometimes two or three times the size of a normal nerve.
“The current understanding of peripheral neuropathy calls it a progressive, incurable disease,” Tollestrup said.
The approach of most doctors is to manage such conditions with medications, but the surgery Tollestrup specializes in has been shown to be effective in up to 80 percent of patients.
The central nervous system, the brain and spinal cord, serves as the body’s command center. Nerves that exit the skull or bony spine become part of the peripheral nervous system. More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis, according to the National Institutes of Health.
Gross anatomy in medical school focuses mainly on the central nervous system, and a doctor in training receives few specifics on peripheral nerves. When medical students receive their first cadaver in medical school, all of the skin and fat is stripped off, eliminating the majority of peripheral nerves.
“You have to know the nerve anatomy very well and know where those compression points are,” he said. “It wasn’t until I did my fellowship that I learned anything at all about peripheral nerves.”
That expertise allows Tollestrup to correct situations where nerves are being compressed or pinched by surrounding tissue. Carpal tunnel release, one of the most common U.S. surgical procedures, involves severing the band of tissue around the wrist to reduce pressure on the median nerve.
“The concept is essentially the same no matter where you do a nerve decompression,” he said. “It’s just a different nerve, a different location, a different set of anatomy where you’re usually altering or removing a different piece of fascia, ligament or other tissue and opening the space around the nerve so it’s not so tightly compressed anymore.”
FIXING A FIREFIGHTER
Ryan Green, a North Las Vegas firefighter injured on the job in November 2011, was cured by Tollestrup after two surgeries failed to resolve pain in his right arm. Green was among the responders to an arson at a house near the intersection of Gowan Road and Valley Drive, an incident during which Capt. David Layton also fell. The smoke was so thick, Green went off a balcony and clutched a fire hose in his right had to break his fall.
Green didn’t feel symptoms from that strain until the next day. His arm had tightened up, but nothing was broken.
“I just felt funny,” he said. “In the beginning, it was like nothing else I had ever felt. It was annoying. It would come and go, sometimes shooting pain, sometimes dull.
“It wasn’t super bad.”
After the pain, numbness and tingling worsened in his entire right upper extremity, and Green opted for surgery. His first operation was on his shoulder in September 2012, 10 months after the injury. A second traditional surgery was performed to relieve numbness and tingling in his right hand.
Not only did the surgeries fail to relieve or even slow the progression of his symptoms, Green eventually began to lose strength in his right arm. In August 2013, nearly two years after his on-the-job fall, Tollestrup operated on Green’s brachial plexus, a complex web of nerves in the side of the neck that travels into the arm. A second surgery on his ulnar nerve near the right elbow in January 2014 was performed, and since he recovered from that procedure, he’s been pain-free.
The entire process has given Green a new appreciation for so-called drug seekers, the term emergency responders and other health care providers use to describe addicts who seek care when they need additional medications. Today, Green can identify with their plight, especially people with chronic pain issues who have lived for years without have the underlying cause addressed.
The only time Green missed from work were the four recovery periods after his surgeries. He was prescribed opioid pain relief to recuperate from surgery, but pushed himself to return to work. That experience gave him insight into why some people with chronic pain might give up and resolve themselves to a life of misery.
“When you get going on these narcotics, you have to detox to come off of them,” he said. “I never wanted to put myself in that position.
“I don’t do drugs at all, but I went through my own addictive phase.”
SUPPLY AND DEMAND
Tollestrup trained at the prestigious Dellon Institutes For Peripheral Nerve Surgery in Baltimore under Dr. A. Lee Dellon, a pioneer who took a more detailed understanding of nerve anatomy to employ surgical techniques to address chronic pain problems in parts of the body never before attempted.
Dr. Thomas Tung, immediate past president of the American Society for Peripheral Nerve, said fewer than 10 programs exist, but the need for such specialists is growing, and existing programs will be expanded and new ones created to meet the demand.
“We have an aging population,” said Tung, a professor at Washington University School of Medicine in St. Louis. “And we have more awareness. Patients are becoming more aware of solutions and treatment options. In the past, patients were told there was nothing that could be done for them, but that new awareness has been very helpful.”
In health care as with other industries, demand will create supply as more people understand how symptoms can be relieved through surgery, Tung said. As patients require more treatment options, doctors eventually will go into those fields to meet the need.
The techniques Tollestrup learned from Dellon are even more specialized than conventional peripheral nerve surgery.
Tollestrup’s patients range in age from as young as 10 to people in their 80s. Neuropathies increase in severity with age, but a person at any age can be affected by injury or repetitive stress.
“With some of these nerve problems, if they’re significant enough, the patients can feel like their lives are basically over,” Tollestrup said. “It’s not something you can give pain medication for.”
For example, patients can undergo multiple knee surgeries, but their pain issues fail to resolve because each operation leaves scarring that eventually results in the nerves becoming squeezed again.
“The reason is the soft tissue envelope surrounding those knees still has all those nerves in it,” Tollestrup said. “Those nerves can become damaged or entrapped in scar tissue, and the person has an ongoing pain generator.
“Each surgery can make that condition worse. If you disconnect those nerves, patients get better.”
WINE & NERVE meeting in Napa over Valentine¹s Day was sponsored by the Association of Extremity Nerve Surgeons. In attendance, facing the camera, at the Ehler¹s Winery, were Rick Jacoby, DPM , author of the newly published book Sugar Crush, A Lee Dellon, MD, PhD, and Luiann Greer enjoying the Chenin Blanc.
At the dinner the first night of the meeting , at Tra Vinga, are seated Rick Jacoby, DPM, Luiann Greer, Robert Parker, DPM, and Mary McDowell , wife of Brian McDowell, DPM. Luiann’s husband, Lee Dellon is the photographer. Both Rick and Robert are Past Presidents of the Association of Extremity Nerve Surgeons.
At the AENS dinner on Valentine’s Eve, entering the restaurant are Eduardo Sangaris Smith MD and his wife Melanie Smith, MD. Ed is a Trauma Surgeon and Melanie is a Pediatrician working at the University of Illinois in Chicago. Ed did his training at Johns Hopkins Hospital and became interested in nerves working with Dr. Dellon. Luiann and Lee Dellon complete the group.
Dr. Jacoby describes Dellon decompression.
The Dellon Decompression–probably the most controversial surgical procedure in medicine today. Lee Dellon, professor of neurosurgery and plastic surgery at Johns Hopkins University Medical School, probably the finest medical school in the world, and he is probably the brightest person in this field.
He developed this procedure. It’s called the triple nerve release, and basically what he came upon in the early 80s and actually in the 70s, it came from a process called the double crush syndrome, and that was a process that two plastic surgeons from Harvard in 1973, two fellows by the name of Upton and McComas, came up with and they were talking about the upper extremity brachial plexus and carpal tunnel.
Carpal tunnel being the most common compressive neuropathy, and they noticed that patients who had carpal tunnel also had brachial plexus, but they also more importantly had diabetes, 16 percent, and they wondered what was the association. They came up with the term double crush.
Lee Dellon out of Johns Hopkins investigated that. He did primates. He did rat studies. He did an interesting study. He made rats diabetic artificially and put them on a piece of paper with ink on their paws and to see if their gate pattern was changed, and it was.
And then he instituted some other studies to see if there was compression causing this, and he took out the tarsal tunnel, which is the same as the carpal tunnel in the wrist. He took out the tunnel to see if they would develop the compression and they didn’t, and he came up with this procedure that is called the Dellon Triple Release.
But he only applied it to the upper extremity, and one of his patients came in one day and said, “Dr. Dellon, you fixed my arm, why don’t you fix my foot?”
He said, “Well, that’s not done.”
Then he thought about it. He said, “Wait a minute, it’s not done; why isn’t it done?” And he came up with this procedure. I trained with him in the year 2001. I drank the Kool-aid the first, and I became enamored by his teachings, by his dedication to this procedure, and I have done over 1500 procedures, not one amputation.
The real dilemma that I have with this procedure is why don’t other doctors understand this disease? Why do they give them medications? Why do they let them go on to amputations? It just doesn’t make sense.
The triple nerve release is really the carpal tunnel of the leg. We have a diagram that will show you where the three tunnels are, and we decompress them. What is a decompression? It basically makes the tunnel where the nerve goes through bigger. We don’t really do anything to the nerve itself, we just make it a larger space so it’s not compressed.
A story that just struck me and made me passionate about this procedure–I worked for a long time and I was one of the co-founders of the Scottsdale Wound Care Center. I worked there for years, and just, not to be crude, but we scraped off a lot of puss. We did a lot of amputations, but we saved a lot of legs too.
But it wasn’t as fulfilling as what I am doing today, and I had a patient early on, and I came back from Dr. Dellon’s course down in Johns Hopkins, and I remember this gal like it was yesterday. And I won’t use her real name, but her first name was Janet; I won’t use her real name, and I said, “Janet.”
She had a twin sister who had just had an amputation. I must have seen her in the hospital every year for ten years. We had this piece of toe taken off, and she had infections. It is the typical sad story. She was in a wheelchair. She was in braces. She didn’t go anywhere. I said, “Janet, you are facing an amputation. Why don’t we try this procedure? I don’t know if it will work, but what do we have to lose?” And she said, “Let’s do it.”
I did the procedure, my very first one, probably the worst patient I could even select to do it on, and it worked. But then I didn’t see her for four months, maybe five months, and I thought, ”I killed her.” I didn’t know what happened to her.
She comes in one day - walking, by the way, without a wheelchair, without braces - and I said, “This is amazing.” I said, “What happened?” She said, “I couldn’t walk, and my husband took me to Hawaii. And I was walking in Hawaii on the lava rocks, and I fell and I broke my arm. I just wanted to come in and thank you.”
About Dr. Jacoby, D.P.M.:
Dr. Richard Jacoby, D.P.M., graduated from the Pennsylvania College of Podiatric Medicine. He completed his residency at Parkview Hospital, Philadelphia, specializing in foot and ankle surgery. Board certified by the American Board of Podiatric Foot and Ankle Surgeons, he is currently president of Valley Foot Surgeons in Scottsdale, Arizona. In addition, Dr. Jacoby is chairman of the board of Healthcare Networks of America.
Dr. Jacoby has been named the 2010 President of The Association of Extremity Nerve Surgeons.
The 26 annual meeting of the American Society for Peripheral Nerve, of which Dr Dellon is a Founding Member, met in Paradise Island, in the Bahamas.
Dr Dellon along with Amy Moore, MD, from Washington University and Gedge Rosson, MD, from Johns Hopkins University gave an Instructional Course on Upper and Lower Extremity Joint Denervation.
One of the many international guests, Alexander Georganescu, MD, from Rumania, is with Dr Dellon in front of the schedule of events at the meeting.
Listening to the Invited Guest Speaker, Ramez Nam, a futurist, are, from the left, Tim Tollestrup MD and his son Max, Luiann Greer, and Eric Williams. Tim is partners with Dr Dellon in the Henderson, Nevada office, and Eric Williams is partners with Dr Dellon in the Baltimore, Maryland office.
I am up high-altitude training in the mountains in South Africa near Johannesburg at the moment prepping for my 2015 defence of my title and hopefully be racing at the European Athletics champs in Prague in March.
Dr. Dellon, I would not have been able to do this without your doing the tarsal tunnel on each of my feet. Thanks again.
4th printing of the classic book Evaluation of Sensibility and Re-Education of Sensation in the Hand is now available at Dellon.com. This book was written 35 years ago by Dr Dellon, and the principles and examination techniques outlined in this book have become the foundation for doctors and therapists measuring sensibility in the hand. This book began the field of Sensory Rehabilitation, now used throughout the world. Sections of the book can be downloaded free. (Hard copies can be ordered from Amazon.com, just in time for the Holidays!!)
Teaching Anatomy at the Mid-Western University in Phoenix, Arizona, as part of the Association of Extremity Nerve Surgeons, are Plastic Surgeons, from left to right, JB Moore from University of Kansas, A Lee Dellon, from Johns Hopkins University, and David Brown, from the University of Michigan.
Dr Steve Barrett, President of the Association of Extremity Nerve Surgeons, reviews skeletal anatomy of the foot with Dr Dellon at that society¹s Fundamental Lower Extremity Nerve Workshop, held in the Anatomy Department of Mid-Western University where Dr. Barrett is an Assistant Professor. Dr Barrett and Dr Dellon have been teaching workshops like this together since 2002.
The long term outcomes of Dr Dellon¹s site-specific pudendal nerve surgery were presented at the International Pelvic Pain Society meeting October 25 in Chicago. Viewing the poster with Dr. Dellon is Stacy Sheib, MD, from the Johns Hopkins Gynecology Department in Baltimore, Maryland. The results from the most recent group of patients, including both men and women have 100% good to excellent results, representing the current understanding from learning to solve these difficult pain problems over the last 4 years.
Dr Dellon (left) with Drs Frank Tu and Sarah Fox, both Gynecologists, who were part of the Program Committee for the International Pelvic Pain Society for the 2014 meeting held in Chicago.
Drs Richard Howard, an Interventional Radiologist from the University of Marland (on the left), Richard Marvel, MD, a Gyneclogist from Johns Hopkins University, and A. Lee Dellon, MD, PhD, from Johns Hopkins University (on the right), faculty at the inaugural Pudendal Neuralgia Association meeting held in Boston on September 27, 2014.
Ann Modest, of the National Vulvodynia Association, & A Lee Dellon MD, PhD at Pudendal Neuralgia Association meeting, Boston 9/27/14.
Dr Dellon spoke on the successful outcomes of his pudendal nerve surgery at the Pudendal Neuropathy Association meeting in Boston on Sept 27, 2014.
Visiting Professor, A Lee Dellon, MD, PhD, is seen holding plaque presented to him by Department of Orthopedic Surgery at University of Alabama, Birmingham (UAB), September 9, 2014. To the left are Gina Oates, MD, Chief of Hand Surgery in the Department of Orthopedic Surgery, Richard Meyer, MD, a member of the American Society for Peripheral Nerve and the surgeon doing Peripheral Nerve Surgery at UAB, and Luis Vasconez, MD, Chief of Plastic Surgery at UAB.
Dr. Richard Morris, Orthopedic Surgeon at University of Alabama in Birmingham, picked up Dr A Lee Dellon in this vintage Fire Truck, to bring Dr. Dellon safely to the University Medical Center for his lecture on Joint Denervation today. Dr. Meyer belongs to a group dedicated to preserving the history of Fire Fighting. The ride in that vehicle was "spectacular and inspiring" said Dr. Dellon
After his lecture at the University of Alabama, Birmingham, Dr Dellon received a plaque in thanks. Standing, from the left are Dr Steve Theis, Chief of Orthopedic Surgery, Dr John Gould, Professor of Orthopedic Surgery and former Chief of Hand Surgery, and Dr Luis Vasconez, Chief of Plastic Surgery
"Complex Regional Pain Syndrome" will be the title of the Instructional Course given on September 20 in Boston at the American Society for Surgery of the Hand. A. Lee Dellon, MD, PhD, will be the Course Chairman and speak on "Central Sensitization" and "Surgical Treatment of RSD of the Lower Extremity, Long-Term Results". Other course Surgical Faculty will include David Ring, MD, PhD, an Orthopedic Hand Surgeon from Harvard, speaking on "Disproportionate Pain & Disability", a non-surgical psychological approach, Catherine Curtin, MD, a Plastic Surgeon and Hand Surgeon from Stanford, speaking on "Surgical Approaches to RSD in the Upper Extremity", and Leta Jones, BS, PT, a Hand Therapist from Stanford speaking on non-surgical approaches to RSD.
On September 9, A. Lee Dellon, MD, PhD, will be Visiting Professor for the Department of Orthopedic Surgery at the University of Alabama School of Medicine in Birmingham. He will speak on "JOINT PAIN OF NEURAL ORIGIN; A PERIPHERAL NERVE SOLUTION
On September 8, Dr Dellon will speak on "Nerve Injuries Related to Sports" to the group developed and directed by James R. Andrews, MD, one of the leading Sports Medicine Orthopedic Surgeons in the World.
Dr Dellon (3rd from the left) responding to a question on the Complex Peripheral Nerve Problems during the Past President's Panel at the American Society for Peripheral Nerve meeting in January in Hawaii. Check out the shirt!!! With him on the Panel are, from the left, Raj Mihta, Maria Siemionow, David Chiu, Greg Evans and Keith Brandt.
Dr Dellon one of two surgeons invited to speak on surgical approach for PELVIC PAIN at the Pudendal Neuropathy Association meeting in Boston in October. Dr Dellon will present the results and surgical technique for his research-defined anterior approach for this problem, in contrast to the commonly used transgluteal (buttock) approach. Dr Dellon's approach is helpful particularly for people with pain in the penis/clitoris, perineum, scrotum/vagina, and women who have been told they have "vulvodynia". Dr Dellon does use the transgluteal approach for patients whose symptoms also include rectal pain.
Dr Dellon arrives at the University of Vienna as visiting professor. He is greeted by his former student, Oskar Aszmann, MD, now Professor of Plastic Surgery at this University. They will discus their research on Pudendal Nerve Surgery during this visit.
"Nervous in Vienna" shirts are worn by A Lee Dellon, MD, PhD (to the left of the three black shirts), Luiann O. Greer, his wife, and Oskar C. Aszmann, MD, who hosted the Dellon's at a "Garden Party" at his home in Vienna at the occasion of Dr Dellon's visiting professorship at the University of Vienna. Also in the photo, Dr. Aszmann's laboratory team.Dr Aszmann's daughter Leontyne is to the left with blowing bubbles, while Celine, his wife, stands next to Sarith Lee, his eldest daughter in the front of the group.
Dr. Dellon, left, observing Dr. Oskar Aszmann, his former Peripheral Nerve Fellow, and now Professor of Plastic Surgery, doing a transgluteal pudendal nerve decompression. Dr Dellon and Aszmann first described, in 2005, the anterior approach for this nerve for those patients who do not have rectal symptoms.Dr Dellon's approach can be downloaded from at Dellon.com, from his book PAIN SOLUTIONS, chapter 12.
At the European Association of Plastic Surgery meeting on the Island of Ischia, in the Bay of Naples, Dr Lee Dellon (left) is seen with Dr Ricardo Mazola, from MIlan, Italy, one of the EURAPS founding members. They are with the night time view of the "Fungo" the mushroom shaped volcanic rock in the harbor of the Laco Ameno, the town where the meeting was held. Dr Dellon presented a paper entitled "Sitting is a Pain in the Ischia".
Dr Dellon with Esther Vogelin, MD, Professor of Plastic Surgery in Berne, Switzerland, moderating the session on Nerve and Hand Problems at the European Association of Plastic Surgery meeting, held May 28 through 30, 2014 at the Hotel Regina Isabella, on the Island of Ischia in the Bay of Naples in Italy.
Cong Rui, MD, Chief of Hand Surgery in the Orthopedic Surgery Department at the 4th People's Hospital in X'ian, China visits with A. Lee Dellon, MD, PhD at the Dellon Institute in Baltimore. Dr Cong was part of the team that translated Dr. Dellon's book, PAIN SOLUTIONS into Chinese.
Dr. John Cameron, Past-President of the American College of Surgeons, and the William Stewart Halsted Professor of Surgery at Johns Hopkins Hospital is with Dr A Lee Dellon, in Hurd Hall of the Johns Hopkins Hospital just after Dr Cameron gave a lecture on Harvey Cushing, MD. Cushing is the Father of Neurosurgery, and did his surgery residency (1896 to 1900) under Halsted and first faculty position (1901-1912) at Johns Hopkins Hospital. It was in this very Hurd Hall that Cushing gave his historic lecture on the Pituitary Gland, establishing the field of Endocrinology. Dr. Dellon is a Professor of Neurosurgery in addition to Professor Plastic Surgery at Johns Hopkins University.
The Hotel Zaza in Houston , Texas, has its car identified with this long-horn Texas bull skull. On the left, Dr Rick Jacoby, from Scottsdale, author of the new book Sugar Crush, is standing next to Luiann Greer, Dr Dellon's wife, and CEO of Sensory Management Services, LLC. Dr Dellon is standing next to Dr. Maria Siemionow, who did the first full human face transplant, and who is now at the University of Illinois in Chicago, and her husband Vladimir, an expert in cortical electrophysiology. All were attending the annual meeting of the Association of Extremity Nerve Surgeons held at Hotel Zaza.
Dr Marcus Castro Ferreira, Chief of Plastic Surgery at University of Sao Paolo, Brazil, and his wife Nora, on the left , dine with Dr Dellon and his wife Luiann at the American Association of Plastic Surgery meeting in Miami, where Dr Dellon was invited to present his work on treating painful neuromas. Dr Ferreira has introduced Dr Dellon's work on nerve decompression for diabetics with neuropathy and with nerve compression into practice in Brazil, and will host a meeting there in December as part of his Wound Healing initiative in Brazil.
Dr. Dellon was the Visiting Professor for Sports Medicine at the University of Washington in Seattle on March 26. Here he is in the U of Washington basketball indoor practice area with Dr Kim Harmon, Chief of Sports Medicine at U of Washington. Next photo shows Dr Harmon introducing Dr Dellon for his lecture. Prior to that, Dr Dellon is seen in the Husky Football team workout facility.
Dr. Dellon spoke on Neurosensory Testing and on Peripheral Nerve Surgery to the Rocky Mountain University of Health Professions 25th Electroneuromyography Meeting in Provo, Utah, on March 22. Director of the University, Mike Skrurja, PT, PhD is shown standing next to Dr. Dellon in front of the photo of the new university building. 45 physical therapists attended the meeting.
The Plastic Surgery Research meeting was held in New York City this year and Doctor Dellon attended. The symbol of this society is a sheep with skin grafts on its back, representing research done by Baronio in Italy in 1842. Following the meeting in New York, Alex Nestor, MD, a faculty Plastic Surgeon from Timisoara, Romania, came to surgery to observe Dr Dellon in Baltimore. They are shown here after a full day of surgery. Dr Nestor is on the left.
Dr Dellon initiated peripheral nerve surgery for Leprosy patients in Guayaquil, Ecuador in 2004.
This work continues. The current team conducting outcome studies on the results of this surgery are seen with Dr Dellon in the operating room in Baltimore. From the left is Eric Wan, and Pablo Baltodano, MD, both doing research in Plastic Surgery Department at Johns Hopkins, and Andreas Rivadeneira, MD, a Plastic Surgery resident from Guayaquil.
Following surgery, the team dined at DaMimo's in Little Italy, here shown with Mary Ann Criccheo, the owner.
Dr Dellon (Lee, on the left) congratulates his son, Dr Dellon (Evan on the right) after his son's lecture on Eosinophilic Esophagitis at the North Carolina Society of Gastroenterology meeting in Pinehurst, NC, on March 1, 2014. Evan began his research efforts while still in high school in Baltimore, studying neuropathy in a diabetic rat model in 1990. He is now Associate Professor of GI medicine at University of North Carolina, in Chapel Hill.
At the recommendation of Wenchuan Zhang, MD, PhD, Professor and Chief of Neurosurgery, A Lee Dellon, MD, PhD has been honored as a Professor in Neurosurgery at the Jiao Tong University in Shangai, China.
Dr Dellon spoke about Peripheral Nerve Problems Head to Toe at the Wine & Nerve meeting sponsored by the Association of Extremity Nerve Surgeons on Valentine's Day in Napa Valley.
Past Presidents of the Association of Extremity Nerve Surgeons, with A Lee Dellon, MD, PhD, the Founder of the AENS, are, from the left, Robert Parker, DPM of Houston, Texas, Dr Dellon, Rick Jacoby, DPM from Scottsdale, Arizona, and James Anderson, DPM from Fort Collins, Colorado.
Big Toe Pain after Bunion Surgery is a Joplin's Neuroma; Successful Treatment Reported at the American Society for Peripheral Nerve Surgery meeting January 2014 in Hawaii
A. Lee Dellon, Plastic Surgery, Johns Hopkins University, Towson, MD
Orchiectomy is done for tumor, infection, torsion, and trauma. When testicular pain persists after orchiectomy, or after other peritesticular procedures such as vasectomy or epididymectomy, the differential diagnosis must include neuroma of the genitofemoral nerve. Nine patients are presented with persistent pain after orchiectomy who were successfully treated by resecting the genitofemoral nerve, placing the proximal end below the pelvic brim. Eight of these patients would have had conservation of their testis if a neural origin had been considered prior to orchiectomy.
From July of 2009 through June of 2013, using our office computer database, nine patients were identified who had an orchiectomy but had persistent testicular pain. One man had a seminoma, but the other 8 had orchiectomy as the primary approach to treating testicular pain after vasectomy (3 men) or herniorraphy (5 men). Patient mean age was 44.3 years (range 25 to 78 years). Mean duration of pain from the index surgical procedure was 25.5 months (range 16 to 48 months). Diagnosis was demonstrated by physical examination with the trigger point being at the external inguinal ring duplicating the pain. Surgical approach exposed the external ring, retracted the spermatic cord or its remnant medially, and identified the 1 to 1.5 mm genitofemoral nerve posterior and lateral to where the spermatic cord was or would have been. The proximal end of the genitofemoral nerve was resected so that it dropped into the pelvis. Surgery was on the left side in 6 and right side in 3 men. The surgical technique will be demonstrated with intra-operative photographs. There were no post-operative complications.
Outcome data is available on 6 patients with a mean follow-up of 20.1 months (range 12 to 36 months). Three patients are less than 6 months, but are included for demographic purposes. Five of the six men had excellent relief and one good relief of their pain in the long-term group. To date, all 3 of the short-term group have excellent pain relief.
Testicular pain is transmitted via the genitofemoral nerve. Once intrinsic, organic testicular disease has been treated, persistent testicular pain should be considered as due to the genitofemoral nerve, which can be resected with high expectation of long-term pain relief. Eight of the nine patients reported here would have been sparred orchiectomy if a neural origin had been considered in the differential diagnosis.
March 26, 2014; Dr Dellon to be Visiting Professor for Sports Medicine Department, University of Washington, Seattle, Wa. Dr Kim Harmon's invitation.
March 22, 2014: Dr Dellon to present to the Rocky Mountain Rehabilitation Society on Hope for Painful Peripheral Nerve Problems: Head to Toe; Provo, Utah.
February 25, 2014; Dr Dellon to present to the Johns Hopkins Oncology group on Neurosensory Testing for patients with Chemotherapy Neuropathy ; Baltimore, Maryland
Lower Extremity Review journal article by Gary Croner appears on Dr Dellon's approach to nerve decompression in diabetics with neuropathy and chronic compression of lower extremity nerves.
At the 2014 American Society for Peripheral Nerve meeting in Hawaii, on January 11, Drs Wyndell Merritt (on the left), from the Medical College of Virginia, in Richmond, Virginia, A. Lee Dellon (center), Johns Hopins University in Baltimore and Gedge D. Rosson (on the right), also from Johns Hopkins In Baltimore participated in an Instructional Course on the treatment of Complex Regional Pain Syndrome (CRPS). This used to be called "Reflex Sympathetic Dystrophy". Dr Dellon introduced the members and presented the current concept of Central Sensitization, the underlying problem in the Central Nervous System that predisposes some people to get CRPS. Dr Merritt discussed the non-operative approaches to treating CRPS. Finally, Dr Rosson presented the outcome study on the patients that he and Dr Dellon operated on with this problem.
List of 13 scientific papers published by Dr Dellon in 2013
Publications 2013 by A Lee Dellon MD PhD
Peer Reviewed Journals:
- Barac, S, Jiga, L, Barac, B, Hoinoiu, T, Dellon, AL, Ionac, M, Hindpaw withdrawal from a painful thermal stimulus after sciatic nerve compression and decompression in the diabetic rat, J Reconstr Microsurg, 29:63-66, 2013
- Valdivia Valdivia, JM, Weinand, M, Maloney, CTJr, Blount, A, Dellon, AL, Surgical treatment of superimposed, lower extremity, peripheral nerve entrapment in patients with diabetic and idiopathic neuropathy, Ann Plastic Surg, 70:675-679, 2013.
- Rose, N, Forman, S, Dellon, AL, Denervation of the lateral humeral epicondyle for treatment of chronic lateral humeral epicondylitis, J Hand Surg, Amer, 38:344-349, 2013.
- Reichl, H, Ensat, F, Dellon, AL, Wechselberger, G, Successful delayed reconstruction of common peroneal neuroma-in-continuity using sural nerve graft, Microsurg, 33:160-163, 2013.
- Gohritz, A, Dellon, AL, Guggeneheim, M, Spies, M, Vogt, PM, Otfrid Foerster (1873-1941): A Widely Unrecognized Pioneer of Reconstructive Peripheral Nerve Surgery, J Reconstr Microsurg, 29:33-44, 2013.
- Gohritz, A, Vogt, PM, Kaiser, E, Dellon, AL, Nikolaus Rüdinger (1832-1896), his Description of Joint Innervation in 1857 and the History of Surgical Joint Denervation, J Reconst Microsurg, accepted January , 2013
- Dellon, AL, Discussion of “Anatomy of the supra-trochelar nerve: implications for the treatment of migraine headaches by Jeff Janis, et al, Plast Reconstr Surgery, 131:844e-7e, 2013.s
- Gohritz, A, Dellon, AL, Kalbermattern, D, Fulco, I, Tremp, M, Shaeffer, D, Jointpreserving surgery for osteoarthris, Foot & Ankle Clin N. Amer, 18:571-589, 2013.
- Hashemi, SS , Cheikh, I, Dellon, A.L., Prevalence of the Tinel sign in extremities of patients with diabetes in a community-based practice, J Diabet & Metab, 4:3, 2013.
- Magarakis, M, Venkat, R, Dellon, AL, Shridharani, SM, , Bellamy, J, Vaca, EE, Jeter, SC Zoras,O, Manahan, MA, Rosson,GD , Pilot Study of Breast Sensation after Breast Reconstruction: Evaluating the Effects of Radiation Therapy and Perforator Flap Neurotization on Sensory Recovery, Microsurg, 33:421-433, 2013.
- Melendez, M, Glickman, L, Dellon, AL, Peroneal Nerve Injuries in Ice Skaters, Clin Research Foot & Ankle, 1:100-102, 2013. Doi:10.4172/crfa1000102
- Chhabra, A, Wadhawa, V, Thakkar, RS, Carino, JA, Dellon, AL. Correlation of recurrent ulnar nerve entrapment at the elbow and 3Tessla MR Neurography, Canadian J Plastic Surg, 21:186-189, 2013.
- Spiegel, AJ, Salazar-Reyes, H, Izaddoost, S, Menn, Z, Eldor, L, Dellon, AL, Breast reinnervation: DIEP neurotization using the third anterior intercostal nerve, Plast Reconstr Surg Global, November 2013, 1:8 p372 doi:10.1097/GOX.0000000000000008 video at http://journals.lww.com/prsgo/Pages/videogallery.aspx.
Translational Research: connection of 3rd intercostal nerve to the microsurgically-transferred transverse abdominal flap improves sensation in the reconstructed breast after breast cancer surgery. Article appears in Plastic and Recosntructive Surgery Global, November 2013. view the surgery HERE
The title and authors of the paper are : Spiegel, AJ, Salazar-Reyes, H, Izaddoost, S, Menn, Z, Eldor, L, Dellon, AL, Recovery of breast sensibility: Neurotization of the DIEP flap with the anterior branch of the 3rd intercostal nerve.
The surgery was done by Dr Aldona Spiegel at Methodist Hospital in Houston, Texas.
"Applied Peripheral Nerve Anatomy: Head-to-Toe" was the lecture title on December 4, 2013. A. Lee Dellon, MD, PhD, in the lobby of Touro Medical Center, in Henderson, Nevada, where the lecture was given is standing next to Director of Anatomy, Doctor Yehia Marreez. The lecture was attended by Faculty and students of the Osteopathic Medical School. Dr. Dellon emphasized the critical nature of the knowledge of anatomy and the physical examination in identifying peripheral nerve sources of pain.
Dr Dellon presents lecture on Peripheral Nerve Surgery, December 4, 2013 to the medical students at Tuoro University in Henderson, Nevada. The lecture will be Applied Peripheral Nerve Anatomy; Head to Toe.
Dr Dellon presents lecture, November 21, 2013, on Sensory Evaluation of the Hand to the staff and fellows of the Raymond M. Curtis National Hand Center, in Baltimore, Maryland.
A Lee Dellon, MD, PhD awarded Life Time Achievement Award from the Association of Extremity Nerve Surgeons, in Houston, November 1, 2013.
At the Association of Extremity Nerve Surgeons annual meeting in Houston Texas, November 1, 2013, Dr. Dellon (right), honored as the Founder of this Society, is here with the Past-President, Rick Jacoby DPM of Scottsdale (left) and current President, Robert Parker, DPM (center).
In the following photo, Dr Dellon (left) is with his former Peripheral Nerve Fellows Ivica Ducic, MD, PhD, Professor of Plastic Surgery at Georgetown University (right) and Maria Siemionow, MD, PhD, DSc, Professor of Plastic Surgery at the Cleveland Clinic, each of whom were invited lecturers at this AENS meeting. For more information about this Society, go to AENS.us.
He is seen here at a dinner that night with Ben Cohen (head of table), Chief of Plastic Surgery at Methodist Hospital, and seated clockwise from Dr Cohen, Drs Anthony Echo, Pierre Chevray, Aldona Spiegel, Dr Dellon's wife Luiann, and Dr Dellon.
At the International Pelvic Pain Society Meeting for 2013, Drs Deborah Coady (Gynecology), A Lee Dellon (Plastic Surgery) and Dena Harris (Gynecology), from left to right, presented, at the Poster Session, their outcome research results for surgery on the pudendal nerve.
October 2013. From left to right, Drs Johannes Ebmer, Georg Furtmueller, A Lee Dellon and Johannes Mayor.
October 5, Dr Dellon participate in an Instructional Course at the American Society for Surgery of the Hand. Participating also were Dr Keizo Fukumoto from Japan and Richard A. Berger, MD, from the Mayo Clinic.
Dear Keizo and Lee,
Thank you both for all of your hard work and fantastic presentations at the Denervation Instructional Course in San Francisco. I was really happy with the results, and I believe our learners felt the same way. It was great seeing both of you and I look forward to doing the same thing next year. Thank you again.
Dellon Team of Drs Dawn LaPorte and Shar Hashemi win Kaplan Award for best anatomy research presented at the American Society for Surgery of the Hand meeting, in 2012. Dr Dellon is shown here, October 5, 2013, accepting the award from Dr. Louis Catalano, President of the New York State Hand Surgery Society, that gives the award. The research for which the prize was awarded is entitled “Innervation of the Triangular Fibrocartilage of the Wrist”.
“Denervation of the Wrist” Course
Dr Dellon participated in an Instructional Course at the American Society for Surgery of the Hand meeting held in San Francisco, October 5, 2013. The course was entitled “Denervation of the Wrist”. Course participants included Richard A Berger, MD, from the Mayo Clinic, and Keizo Fukumoto, MD, from Japan.
Peripheral Nerve Surgery Lecture
Dr Dellon to give lecture at Methodist Hospital, Baylor University Plastic Surgery, Houston, Texas on October 30, 2013. The lecture will be on Peripheral Nerve Surgery.
Neurorsurgeons (from left to right ) Meng Feng (Beijing), Bo Zhang (Dalian), Yong Yao (Beijing) visit the Dellon Institute for Peripheral Nerve Surgery in Baltimore. A Lee Dellon, MD is accompanied by Mark Melendez, a Plastic Surgeon from Johns Hopkins University who is currently doing Peripheral Nerve training at the Institute. Yong Yao, MD, Associate Professor at Peking Medical Union College was the first to introduce into Chia Dellon's nerve decompression surgery to restore sensation and prevent ulceration in the feet of diabetics. Yong Yao trained with Dellon almost ten years previously. Bo Zhang, MD, Professor of Neurosurgery at the First Affiliated Hospital of DaLian Medical University, will introduce Peripheral Nerve Surgery into his province of China this coming year.
The meeting is in the city of Antalya, in Turkey.
Abstract of this research:
J Brachial Plex Peripher Nerve Inj. 2009 Feb 20;4:1. doi: 10.1186/1749-7221-4-1.
CRPS of the upper or lower extremity: surgical treatment outcomes.
Division of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland 21218, USA. email@example.com
The hypothesis is explored that CRPS I (the "new" RSD) persists due to undiagnosed injured joint afferents, and/or cutaneous neuromas, and/or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II (the "new" causalgia). An IRB-approved, retrospective chart review on a series of 100 consecutive patients with "RSD" identified 40 upper and 30 lower extremity patients for surgery based upon their history, physical examination, neurosensory testing, and nerve blocks. Based upon decreased pain medication usage and recovery of function, outcome in the upper extremity, at a mean of 27.9 months follow-up (range of 9 to 81 months), gave results that were excellent in 40% (16 of 40 patients), good in 40% (16 of 40 patients) and failure 20% (8 of 40 patients). In the lower extremity, at a mean of 23.0 months follow-up (range of 9 to 69 months) the results were excellent in 47% (14 of 30 patients), good in 33% (10 of 30 patients) and failure 20% (6 of 30 patients). It is concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and/or nerve compressions, and, therefore, similar to a patient with CRPS II, they can be treated successfully with an appropriate peripheral nerve surgical strategy.
A. Lee Dellon, MD, PhD gave a lecture on Peripheral Nerve Surgery at Fujairah Hospital in the United Arab Emirates on April 29, 2013. Dr Dellon is shown with Subash C. Gautam, MD, Chief of Surgery at Fuairah Hospital at the conclusion of the lecture. Also in the photo is Dr. Gautam's wife, The Chief of Obstretrics and Gynecology at Fujairah Hospitla, and their two sons, who are Internal Medicine Specialist in the United Kingdom. Attending were the Surgical staff as well as Neurologists, and Rehabilitation Specialists.
Dr Dellon is seen here after his lecture with Dr Subash C. Guatam, Chief of Surgery and his wife, Gursrup, Chief of Obstetrics and Gynecology,both at Fujairah Hospital, with their sons Siddarth and Vikrant, both Internal Medicine Specialist in the United Kingdom.
The Plastic Surgery Educational Network filmed Doctor Dellon doing his classic "Dellon Triple" nerve decompression for restoration of sensation and relief of pain in a patient with neuropathy and superimposed nerve compressions. After editing, this movie will be available on the national PSEN website for other surgeons' educational viewing, to further the spread of this technical knowledge to help more people suffering with this problem.
Dr Dellon lectures at the 2nd International Conference on Musculoskeletal Pain in Sapporo, Japan.
Wearing traditional Japanese robes at the opening ceremony, Dr Dellon and other invited guests drink a rice wine from a wooden box.
Dr Dellon presents a lecture on Neurosensory Evaluation to the Hand Fellows at the Raymond Curtis Hand Center at Union Memorial Hospital in Baltimore; 7AM on August 1, 2012. This lecture will help these 6 new Hand Surgeons understand the value of testing sensibility, the techniques for doing these evaluations, and the interpretation of this testing in the diagnosis and management of nerve compression and nerve recovery.
From the program book at the lecture that Dr Dellon gave in Sapporo.
In the operating room, Dr Dellon draws upon the glove on his hand the surgery he proposes to do on this patient. In this way, he passes down the teaching from his teacher, Dr Raymond Curtis, who used similar teaching techniques.
Dr Dellon is seen examining new patients with peripheral nerve problems in the Hand Surgery Clinic. The young girl suffered a brachial plexus injury at birth, was not previously operated on, and now has her scapula in the wrong position with a dislocated humeral head, as demonstrated by Dr Dellon, which can be corrected by shoulder surgery. The second patient is seen after a motor cycle accident with a new brachial plexus paralysis and a broken wrist.
PAIN SOLUTIONS, the book of hope for people in pain, written by Dr Dellon in 2007, was translated into Chinese and appears for the first time in July, 2012. Dr Dellon is shown at the "book signing", here giving a copy to Professor, Major, Rui Cong, Chief of Hand Surgery.
Dr. Pei, the Chief of the Department of Orthopedic Surgery, who translated Dr Dellon's book into Chinese, is given gifts that celebrate Dr Pei's farovite American sports team, the Miami Heat, winning the National Basketball Association championship the month before Dr. Dellon's visit to Xi'an, the city most famous for its "Terra Cotta Soldiers"
The Hand Surgery staff of the 4th People's Military University and Zixiang Hospital In Xi'an welcome Doctor Dellon upon his arrival at the hospital, July 16, 2012
On Friday, July 13, after traveling from Shanghai to Beijing, Dr Dellon spoke at Peking Union Medical College. Dr Dellon presented his work on his basic science and clinical experience with restoring sensation and relieving pain in diabetics with neuropathy and nerve compression. Here he is with the Department of Endocrinology, the leading group in all of China, after his presentation. To Dr Dellon's right is Yong Yao, MD, Associate Professor of Neurosurgery who was the first to do the Dellon Procedure in China. To Dr. Dellon's left is the Chief of Endocrinology, Xiaoping Xing.
Dr Dellon stands between Dr Feng Zhang (to Dr Dellon's right), the new Chief of Department of Orthopedic Surgery at Fudan University in Shanghai, China, and Doctor Gao Xin (to Dr Dellon's left), the Chief of the Department of Endocrinology at Fudan University following Dr Dellon's lecture on Preventing Ulceration & Amputation in Diabetics by Decompression of Lower Extremity Nerves. This will mark the initiation of these two Departments to introduce Dr Dellon's translational research into clinical practice at Fudan University in the future.
PAIN SOLUTIONS will have its Chinese translated edition preview in Xi'an, China on July 12, 2012. Dr Dellon will be there for a "book signing" ceremony, and then give a lecture on Partial Joint Denervation in the Upper and Lower Extremities. Following which he will be teaching surgery in the Department of Orthopedic Surgery, whose Chairman, Dr Pei, was the primary translator of Dr Dellon's book. Dr Dellon will be given an Honorary Professorship in Orthopedic Surgery at the 4th Military Hospital in Xi'an.
Before going to Xi'an, Dr Dellon will be in Shanghai and then in Beijing (Peking). In Shanghai, he will be Visiting Professor in the Department of Orthopedic Surgery at Fudan University in Shanghai, where he will speak on his work with neurolysis for diabetics with neuropathy and nerve compression. He has trained surgeons from this University and they will begin peripheral nerve surgery at their hospital. Dr Dellon will receive an Honorary Professorship in Orthopedic Surgery at Fudan University, where Dr Professor Feng Zhang is Chairman of Orthopedic Surgery. Dr Zhang is also the Editor of the journal, Microsurgery.
In Beijing, Dr Dellon will lecture at Peking Medical Union College, where he will be hosted by Dr Wang, the Chairman of Neurosurgery, and Yong Yao, Associate Professor of Neurosurgery. Dr Yao has trained previously with Dr Dellon and has published in the Chinese Medical Journal his results with Dr Dellon's technique for lower extremity nerve decompressions in people with diabetes.
Interview by Elisabeth Oas, 2PM Thursday, June 6, 2012
This is the Master's Degree Project of Courtney McKenna from the Department of Art as Applied to Medicine at Johns Hopkins University
A. Lee Dellon, MD, PhD thesis advisor
ABC Channel 2
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