What is a Free Flap?

Oct 15, 2019 | Health Tips, Your Health

Patients who are diagnosed with cancer of the head and neck are often treated with surgery. Removal of tumors in the mouth and the throat can significantly inhibit speech and swallowing. Similarly, removal of the bone involved with cancers of the jaw affects appearance and function of patients. In some cases, the wounds, left as a result of cancer surgery, can be allowed to heal or be covered with the surrounding tissues. Often, however, the wounds are too big, and the tissue removed with the tumor must be replaced. In such circumstances, a “free flap” may be a sound option for repairing the defect.

Local Flaps Versus Free Flaps

A flap is any piece of tissue that is moved to cover a wound. A free flap is a piece of tissue that is disconnected from its’ original blood supply, and is moved a significant distance to be reconnected to a new blood supply. Let us use a lamp as an example. When a lamp has to be moved from one part of the table to another it may not need to be unplugged. This is similar to a “local” flap that is “rotated” into the wound. The electric cord is analogous to the blood vessels delivering blood to the flap. When the lamp must be moved from one side of the room to another, the cord cannot stretch the required distance. In these cases the lamp is unplugged (“free”), brought to its’ new location and plugged into another outlet.

Similarly, a free flap is taken from the body of the patient; the blood vessels that bring the blood in and out of the tissue are cut, and then reconnected to another source of blood (usually in the neck). The artery that comes with the flap is sewn to the artery in the neck to bring the blood in, and the vein is sutured to a vein in the neck, re-establishing the blood flow. The blood vessels feeding the flap are usually very small and the “re-plugging” of the flap is done through microvascular surgery. Microvascular surgery is a technique of sewing two small blood vessels together under a microscope.

The surgeon has to select tissue in the body that will do the best job of restoring the function and the appearance of head and neck tissues destroyed by the tumor. The commonly used free flaps include: forearm or thigh skin (thin skin that can be used to rebuild the inside of the mouth and throat), muscles from the abdomen or the back, and fibula bone (bone on the outer side of the leg).

The success of using a free flap in reconstruction after head and neck cancer surgery is 95-98 percent. The goal of the reconstructive surgeon is to return the patient to a state where they can enjoy eating, swallowing and speaking. With the advancements in the field of microvascular and reconstructive surgery, this goal is often achieved.

Mohemmed Nazir Khan, MD

Assistant Professor, Department of Otolaryngology at Mount Sinai-Union Square

Dr. Khan’s clinical interests and expertise include the medical and surgical management of benign head and neck tumors; thyroid and parathyroid disorders; salivary gland disorders; head and neck cancers; and reconstructive surgery involving the head and neck. In addition to his professorship, he is the Associate Director of the Head and Neck Cancer Research Program at the Icahn School of Medicine at Mount Sinai. Dr. Khan is available for rapid referrals and same day appointments.

Make an appointment with Dr. Khan

More information on ENT services at Mount Sinai

What Does a Brain Tumor Feel Like?

Oct 1, 2019 | Featured, Neurosurgery, Your Health

After ignoring seemingly harmless symptoms for at least a year, Emmy-nominated producer Jeannie Gaffigan was diagnosed by a medical team at The Mount Sinai Hospital with a pear-shaped brain tumor. The large mass was severely compressing her brain stem, causing headaches, dizzy spells, and a loss of hearing in one ear. She had attributed the symptoms to being a busy working mom. Her doctors wondered how she was even able to walk or talk normally.

The Neurosurgery team at Mount Sinai, headed by Joshua B. Bederson, MD, Professor and Chair of Neurosurgery for the Mount Sinai Health System, quickly scheduled surgery to remove the life-threatening mass, which turned out to be benign (non-cancerous).

Read more about Jeannie Gaffigan’s story

Ms. Gaffigan’s case sheds light on the importance of paying attention to persistent symptoms. But not every dizzy spell is cause for concern.

Leslie Schlachter, PA-C, Clinical Director of Neurosurgery at The Mount Sinai Hospital, works closely with Dr. Bederson and was there to greet Ms. Gaffigan and her husband, comedian Jim Gaffigan, when they arrived looking for answers. Drawing on the numerous cases she has seen over the years, she explains which symptoms you should never ignore and why you are—probably—fine.

What specific symptoms may point to a brain tumor?

The brain is complex. It controls everything we do, allowing us to see, smell, and move. Because of this, symptoms of a brain tumor depend on where the tumor is located and what section of the brain it is pressing on. Generally, changes in your sensory, motor, or visual function that linger for more than a few days need to get checked. For example, if you have played tennis every weekend for the past twenty years and one day you cannot hold your racquet; that is a problem. Or, if you suddenly cannot see well out of your right eye, that is concerning.

I experienced dizziness for a few days last month. Should I check in with my doctor?

Nausea, vomiting, or a change in balance that lingers and does not respond to medicine warrants a visit to your doctor, especially if these symptoms are limiting your ability to function. Keep in mind: if you have a neurological condition, things are not going to get better. So, if your symptoms subside after a few days, there is likely no cause for concern.

Should I go to the emergency room if I am concerned? Will I seem like a hypochondriac?

If you are concerned, make an appointment with your medical provider first, whether that be a doctor, nurse practitioner, or physician assistant. I always tell people, you are going to get a cold, the flu, and food poisoning, and you may feel terrible. That is normal. However, if you are experiencing symptoms that progressively worsen and do not go away, call your medical provider. Not seeking medical help is the problem.

The only time you should panic is if you are having what I call “The Worst Headache of Your Life.” If your headache is so severely debilitating that all you want to do is sleep because you feel as though your head is going to explode, seek medical assistance immediately as you may have a brain bleed.

What happens if my doctor is concerned about my symptoms? Will I see a neurosurgeon right away?

No. If your medical provider is concerned about your symptoms, he or she may recommend a CT scan or, depending on your symptoms, refer you to an ear, nose, and throat specialist or neurologist. You will only see a neurosurgeon if you have been diagnosed with a neurosurgical condition that requires intervention.

What should I do if my doctor is not taking my symptoms seriously?

Unfortunately, there are times when a patient’s concerns are not heard. And sometimes, your doctor may chalk up your symptoms to stress. The most important message I can give to patients is: Advocate for yourself. You know your body. If something does not feel right, get a second opinion.

Learn more about Neurosurgery at Mount Sinai

I Am An Adult. Do I Still Need Vaccinations?

Updated on Jun 30, 2022 | Your Health

Recent measles outbreaks, which have disproportionately impacted New Yorkers, feel like an unforced error. Although the measles/mumps/rubella (MMR) vaccine has been available for more than 50 years, the highly contagious illness has landed dozens in the emergency room. Time and science has proven that vaccines are safe and effective, but there are still many misconceptions.

While most of the measles cases in the current outbreak in New York City are among children who were never vaccinated, 10 percent of confirmed measles patients are among those who had previously received a dose of the MMR vaccine, according to the New York City Department of Health and Mental Hygiene. Because the immunity conferred by the vaccine can wear off over time, this has prompted adults to seek another round of vaccinations that were previously completed in childhood. Erick A. Eiting, MD, MPH, MMM, Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai, explains why some adults need “booster” vaccinations and which shots you may want to discuss with your primary care physician.

What is a “booster” and why might I need one for a childhood vaccination?

Booster shots are additional doses of a vaccine that was previously administered. Adults may need to “boost” their immune system so that they are adequately protected from an illness. The need for a booster shot depends on the person and the vaccine. Certain vaccines may be needed before international travel or after reaching a particular age. People who work in health care may need booster shots because they are exposed to certain diseases more frequently and need the extra protection.

Do I need a booster shot for measles?

If you have proof of immunity to measles, you don’t need a booster. Proof of immunity includes one of the following:

Written documentation of two doses of the vaccine during childhood
Lab tests that show enough measles antibodies in your blood
Lab tests confirming an actual measles infection
Being born before 1957

If none of the above applies, talk to your doctor about getting an additional dose of the vaccine. People with higher risk of getting measles (health care workers, for example) should get two doses.

What other booster shots may be needed as an adult?

In addition to MMR, you may need an additional vaccination for hepatitis A, typically a food-borne illness, and hepatitis B, transmitted through infected body fluids. Both illnesses can cause severe liver damage. Health care workers are usually required to get the hepatitis B vaccine, and the hepatitis A vaccine is often encouraged before international travel.

Booster shots are also required for the tetanus/diphtheria/pertussis (Tdap) vaccine. This combination vaccine protects against tetanus, diphtheria, and pertussis (whooping cough). It needs to be updated every 10 years, although health care workers may be required to do so more frequently, and you will receive a booster if you get a cut that lands you in the emergency room.

Which other illnesses should I be vaccinated against?

In addition to your annual influenza vaccine—which should be received by healthy people starting at six months—speak to your primary care physician about the following:

Shingles. Adults over the age of 50 who have previously had the chickenpox should be vaccinated against this painful rash. Shingles comes from the same virus as the chickenpox and can flare up when the immune system is weakened, including during times of increased stress, following physical trauma, and while fighting a disease like cancer or HIV.
Pneumococcal diseases. Smokers over the age of 19 and adults over 65 should be vaccinated against this set of conditions. The vaccination protects against pneumonia (infection of the lungs), meningitis (infection of the tissue covering the brain and spinal cord), and bacteremia (infection of the bloodstream).
Human papilloma virus (HPV). First introduced in 2006, this vaccine protects against HPV 16 and 18—the strains most associated with cervical cancer. Previously, the vaccine was only approved for those up to 26; however, the U.S. Food and Drug Administration recently approved the vaccination for people up to age 45.

Erick A. Eiting, MD, MPH, MMM

Associate Professor, Emergency Medicine, Icahn School of Medicine at Mount Sinai

Dr. Eiting is a tireless advocate for vulnerable patient populations. He has focused efforts on improving access to care for incarcerated patients using innovative care models and medical technology. In previous roles, he has used telemedicine to expand access to specialty care as well as to help triage patients with same day needs.

Visit a Mount Sinai Urgent Care location

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I Am A Woman. Why Should I See A Urologist?

Updated on Jun 30, 2022 | Your Health

There is a common belief that the purview of urologists is limited to the male anatomy. In dealing with the penis, prostate, and other portions of the male reproductive tract, urologists are essentially “gynecologists for men,” right?

Wrong. Urologists treat both men and women and there are many situations when a woman should check in with a urologist instead of a gynecologist. Barbara M. Chubak, MD, Assistant Professor, Urology, Icahn School of Medicine at Mount Sinai, explains what a urologist really does and why women should book an appointment.

What is a urologist?

Urologists specialize in the urinary tract and surrounding organs—including the kidneys, ureters, bladder, and urethra—as well as external genitalia encompassing the clitoris, vulva, vaginal vestibule, and introitus (the opening that leads to the vaginal canal). Gynecologists, by contrast, treat the female reproductive organs.

Additionally, urologists are both physicians and surgeons. Treatment with medicine or surgery is used as most appropriate for the disease and the patient.

So what kind of doctor should I see if I have a urinary tract infection?

A routine urinary tract infection can be managed by your primary care physician. However, if you get more than three UTIs per year or the UTI does not go away after antibiotics, it’s best to consult a urologist. In addition, the following serious symptoms definitely warrant a visit to a urologist:

Blood in the urine
Gravel or stones in the urine
Increased or decreased urinary frequency or urgency
Waking at night to urinate
Difficulty getting the urine out or difficulty holding it in (i.e. urinary incontinence)

What female-specific concerns may bring me to a urologist?

A urologist can help with several common bladder issues that affect women following pregnancy, such as:

Incontinence, or urine leakage
Pelvic floor dysfunction, the inability to control the muscles supporting the bladder, vagina, and rectum
Pelvic organ prolapse, the drooping of any of the pelvic floor organs, including the bladder, uterus, vagina, small bowel, and rectum

Additionally, if you are experiencing sexual dysfunction such as pain with sexual activity, lack of genital arousal, or lack of pleasure with sexual activity, a urologist may be able to help.

Barbara M Chubak, MD

Assistant Professor, Urology, Icahn School of Medicine at Mount Sinai

Dr. Chubak provides general urological care. She specializes in the diagnosis and treatment of sexual dysfunction for all patients, regardless of sex, gender, orientation, or congenital condition. Dr. Chubak is particularly committed to addressing the sexual health needs of women and other populations who have been historically marginalized and underserved.

Make an appointment with Dr. Chubak

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Medical Experts Separate Fact From Fiction at Dubin Breast Center’s Annual Luncheon and Symposium

Updated on Jun 30, 2022 | Featured, Your Health

From left: Elisa Port, MD, FACS; Isabel S. Blumberg, MD; Stafford R. Broumand, MD; Hanna Y. Irie, MD, PhD; Laurie Margolies, MD, Director of Breast Imaging, Dubin Breast Center; Jeffrey Mechanick, MD, Professor of Medicine (Cardiology, Endocrinology, Diabetes and Bone Disease); and Hank Schmidt, MD, PhD.

Are breast implants safe? Do oral contraceptives increase your risk for breast cancer? These were among the questions answered by a panel of physicians in May, at the seventh annual Dubin Breast Center Fact vs. Fiction Luncheon and Symposium that was held in Manhattan.

The sold-out event featured the latest information on breast cancer from six doctors at the Icahn School of Medicine at Mount Sinai and was moderated by Elisa Port, MD, FACS, Director of the Dubin Breast Center and Chief of Breast Surgery, Mount Sinai Health System. The goal of the annual luncheon is to clarify information about one of the most common cancers in women worldwide, so patients can keep up with advances and make informed decisions about their health.

“There is no one who gets a diagnosis of breast cancer who doesn’t think it’s the worst day of their life, the worst thing that’s happened to them, and the question of mortality always comes up,” Dr. Port said at the luncheon. “But let me be crystal clear that with a diagnosis of breast cancer there is so much room for optimism in 2019. For most cases, we are saying you have a 90 percent chance of survival. In some cases, a 98 percent or 99 percent chance of survival. This is success.”

Dr. Port said the development of “a few key drugs” over the past decade has led to increased survival rates. “What we need to work on are the outliers that don’t respond well. That continues to be the reason we get up every morning and sit in the lab and look for better treatments,” she added. “You will hear more from us, because we are on it.”

The following questions and answers were among those included at the luncheon.

Do birth control pills increase my risk for breast cancer?

Isabel S. Blumberg, MD, Clinical Instructor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine: Yes. Even newer ones slightly increase the risk for breast cancer. The risk is very small. Someone who has had breast cancer is not a candidate for oral contraceptives. But there is a nonhormonal IUD that is really safe, lasts for 10 years, and works extremely well, so that may be the answer. A new diaphragm that is universally sized is coming to market, and condoms are always an option.

Are breast implants safe?

Stafford R. Broumand, MD, Associate Clinical Professor of Plastic Surgery, Icahn School of Medicine: Silicone implants are safe. But there are issues that need to be clarified. Different types of implants have different types of issues. Lately, anaplastic large cell lymphoma (ALCL) has been diagnosed in women with textured implants. We don’t really know why that is. We now use smooth implants because there is no incidence of ALCL. Women who have textured implants and those who are not sure whether they have them should discuss this with their physician.

Can a liquid biopsy detect cancer cells in the blood of someone who is not known to have breast cancer or determine if a patient’s cancer is returning? Can it also be used to track a patient’s response to treatment?

Hanna Y. Irie, MD, PhD, Associate Professor of Medicine (Hematology and Medical Oncology), and Oncological Sciences: A liquid biopsy is a blood test aimed at detecting small amounts of cancer cells circulating in the blood stream, as well as the footprint, or DNA, of these cancer cells. Most studies use the biopsy in the context of advanced cancers. However, because of the power of liquid biopsy in detecting small amounts of cancer, researchers at the Dubin Breast Center are trying to understand its utility in patients diagnosed with triple negative aggressive breast cancer. We are studying whether it can detect recurrences at an earlier stage than either CT scans or MRIs.

What is the right screening for me based on my family history?

Hank Schmidt, MD, PhD, Associate Professor of Surgery, Director, High-Risk Program at the Dubin Breast Center: The big question is ‘what is your risk?’ There are a lot of ways to risk stratify patients to find out where they lie on the spectrum of risk. Some patients have a strong family history of cancer but their genetic testing is negative. We look at a variety of risk factors. Then we define a plan for risk management. A big component of our surveillance is imaging. For women over age 40 mammography is the standard. We always begin with that. Then, based on personal risk, we decide whether to add ultrasound on a yearly basis, or for higher-risk patients or someone who wants to be more aggressive, we’ll consider adding annual breast MRI.

Urology Department Renovates Union Square Location

May 13, 2019 | Community, MSBI, Your Health

Faculty and staff of the Mount Sinai Health System’s Department of Urology recently celebrated the completion of a more than $3 million renovation project at Mount Sinai-Union Square. Upgrades to the 6,500-square-foot practice are being done in several phases, allowing the Sol & Margaret Berger Urology Department at Union Square to continually serve patients.

The project has doubled the Department’s capacity to perform in-office procedures and features new medical equipment. Wall outlets in the waiting room allow patients to charge their phones, and soon, patients will be able to check in for their appointments while seated on a couch rather than waiting at the front desk. Modern art, furniture with warm natural tones and finishes, special lighting, and a tank with 12 species of saltwater fish are designed to provide patients with a welcoming environment.

“All aspects of the renovation maximize the patient’s experience by reducing stress and making check-in and services more convenient and efficient,” says Ash Tewari, MBBC, MCh, Chair of the Department of Urology, Mount Sinai Health System. Plans also call for the Urology Department to launch a prostate cancer and men’s health program downtown and install a real-time location system that will enhance patient safety and improve clinical quality.

“We are excited to have this large, modern space in which to treat our patients and accommodate the more than 24,000 patient visits we receive each year,” says Michael A. Palese, MD, Chair of Mount Sinai-Union Square Urology. “World-class medicine with access to academic professionals and clinical trials in the setting of a brand new office space enhance the overall patient experience.”

Faculty and staff at the Department of Urology joined Michael Palese, MD, left, center, and Ash Tewari, MBBC, MCh, right, center, to celebrate the newly renovated facility at Mount Sinai-Union Square.