An Excerpt from Plastic
Surgery Products Magazine


Dennis M. Nigro, MD. FACS, FICS is a Board Certified Plastic Surgeon, who is Chief of Section at Scripps Encinitas Hospital. He is Founder and Chief Surgeon of Fresh Start Surgical Gifts. He graduated from the University of Notre Dame, Creighton Medical School, University of California of San Francisco in Surgery and the University of California San Diego in Plastic Surgery.

Fresh Start Surgical Gifts
Dennis M. Nigro, M.D. FACS, FICS

"There, that just about does it, doesn't it?" With that, Dr. Fred McCoy placed a last stitch in a long zigzag suture line, which years later became familiar to me as a Z-plasty, as he released a large scar contracture on a missionary priest's arm from Africa.

My father, a cardiologist, had suggested watching Dr. McCoy, who was a friend of his, in hopes it might satiate, as a 13-year old, my emerging interest in surgery. I had been going to the hospital to make "rounds" with my dad on weekends since I was five years old.

Later, I had the good fortune of seeing Dr. McCoy examine and interact with his patient. The reaction that patient had and the look the two of them exchanged in the twinkling of an eye clearly changed my perception of medicine and profoundly and inextricably textured my psyche. Galvanized.

Dr. McCoy went on to point out that this missionary had no money and no ability to pay him; however, Dr. McCoy said the time he had invested in this man's life was a reward in itself.

Years later, I began to realize how profound those words were. Just a forgotten moment in Dr. McCoy's long and distinguished career, but unforgettable in my young life.

When I went to college at the University of Notre Dame, I had already decided I wanted to pursue a career in Plastic Surgery. In a subtle but convincing way, Notre Dame President, Father Theodore Hesburgh's emphasis on public service and its importance to the development of the whole person began to solidify my future plans. Hearing and reading about Notre Dame graduate and Nobel Laureate Dr. Thomas Dooley's work in Southeast Asia set a benchmark of Olympian parameters. A hero.

While I was in medical school, I told my insurance agent, by the patrician moniker of Armisted Browning that I was going to start a clinic or establish a residence and bring children in to work on them pro bono. Armisted looked at me somewhat askance, but nonetheless, I talked to him about plans for a clinic, world service and a residence. Why tell Armisted? Probably he was the only one who wouldn't laugh at me since he wanted to sell me insurance! While it was sophomoric, it felt right.

During my residency in Plastic Surgery I went on numerous missionary trips and this brought the practical aspect of missionary work and community service into focus. I came to the conclusion that it would be best to bring the patients to us and establish a local community sponsored effort for the children locally, regionally, nationally and internationally.

So, in the late 1980's Fresh Start Surgical Gifts was born. It had very limited and humble beginnings. The first couple of years I funded it pretty much on my own but this began to be quite expensive, as it climbed into six figures.

I proposed a cooperative service idea to the San Diego and National Notre Dame Alumni Association and over the next year or so a corporation was formed, volunteers were engaged, and the infectious spirit of community service caught on - rapidly.

Lou Holtz, Notre Dame's Head Football Coach and Dick Rosenthal, Notre Dame's Athletic Director stopped their busy schedules to come out to help with fund raising. To this day Jon Carney, a Notre Dame alumnus and field goal kicker for the San Diego Chargers works constantly to help raise money and public awareness. He attends surgery weekends and interacts with the patients. Jon has been recognized as NFL and San Diego Chargers "Man of the Year" numerous times, honors that are well deserved - I assure you.

The development of Fresh Start has been a great thing to be a part of for the last ten years. The volunteer surgical organization now operates every six weeks. There are over 500 volunteers, a lay Board of Directors and six full-time salaried employees with a 3,500 square foot office.

The surgery weekends start on the Wednesday before when the children are brought up and laboratory tests are done. Surgical procedures are performed on Saturday and Sunday involving everything from cranial bone grafts to laser surgery.

We provide a wide variety of reconstructive services from treatment of very complicated problems like a very large midline lymphangioma of the neck and jaw, a complicated facial reconstruction secondary to resection of massive facial neurofibromatosis to simple traumatic scar revision. One of these cases is depicted in this reading.

Our volunteer professional panel includes plastic surgeons, cranial facial surgeons, oral surgeons, ENT surgeons, eye surgeons, speech pathologists, sociologists and psychologists. Our annual giving is about one million dollars in materials and services.

We work diligently in trying to provide a full compliment of care for our patients. Many of the patients are housed for significant periods of time in the San Diego area while their work-ups are being completed and their post-op care has come to the point that I feel comfortable they can return to their native countries or local communities without fear of any problems.

Just this past year we established a new office in Johnson City, Tennessee. This embryonic endeavor, headed by Jim Brantner, M.D., is carrying on Fresh Start's mission in that area. Dr. Brantner and his team are committed to the project and are wonderful examples of its spirit.

Furthermore, we are in the process of beginning to work out an affiliation in Puerto Rico. Dr. Pedro Rossello, the Governor of Puerto Rico and I played tennis for Notre Dame. Pedro is a pediatric surgeon and a great humanitarian. I am as confident in Pedro now as I was thirty years ago. We are also developing a relationship with Dr. Gupta in Bombay, India who visited us just last month.

Fresh Start Surgical Gifts is proud to have recently hosted a worldwide symposium on "Pediatric Vascular Anomalies and Pigmented Lesions" at the Salk Institute in La Jolla, California. This meeting had a stellar faculty representing virtually every highly regarded teaching institution. We will continue to work with the Plastic Surgery Educational Foundation to co-sponsor more seminars and meetings. Our next seminar will be again at the Salk Institute and will consist of a wide spectrum of reconstructive efforts and is currently being worked on by Fred Menick, M.D. of Tucson, Arizona.

Early work on symposium efforts was spearheaded by Harvey Zarem, M.D. of Santa Monica, California and UCLA who has been a tremendous asset to Fresh Start with the educational advice he has given to both our program organizers and me. He has been a beacon in his wisdom and advice. Harvey, despite his years at the helm of UCLA's Department of Plastic Surgery, reveled in this non-bureaucratic and non-political milieu. A pillar.

One exciting probability is the establishment of a fellowship, which will be given either yearly or biyearly to a deserving young surgeon. We are currently entertaining ideas about this being in pediatric surgery or craniofacial surgery.

We currently have two "summer service students" who stay with us all summer - they are Notre Dame students on a stipend. We have had this program for about 7 years and many have gone onto careers in medicine. So the circle is complete.

In addition, we now are in the process of establishing good working relationships with UCSD's new Chief of Section of Plastic Surgery, Merek Dobke, M.D, the Children's Hospital in San Diego, California and their craniofacial program, with Dr. Stephen Cohen, as well as Dr. Jim Watson at UCLA Harbor Hospital. Our mission of a multi-level approach to our gifts is moving along with exciting deliberateness and gratifying results.

Fresh Start has been honored as a "Point of Light" by President Bush and was given the "Volunteer Action Award" by President Clinton, which at the time was the only community service activity recognized in the State of California. The litany of awards given to both the organization and some of its individuals is lengthy and is appreciated, but it is also a telling and revealing commentary on the importance and the regard that community service at the professional level is valued.

The application of Plastic Surgery as well as the things that I was taught and learned from my mentors and from my patients through community service is an experience that I will always treasure and I feel has helped me stay balanced in my own life. (Well, about as balanced as one can hope for anyway.)

As Jackson Brown says in the song "The Pretender," a poignant story about people living their lives with altered purposes, he laments the "struggle for the legal tender" and how desperate and unfulfilling unilateral career goals are when your dreams are sold out. Existence without soul - always looking but now forlorn - as the mission became misdirected (my words). Jackson rhetorically asks "…say a prayer for the Pretender, who started out so young and strong…only to surrender."

Fresh Start has become a part of my life, my family's life and a number of the people that I know and respect. I recommend it. Highly.

Dreams die only when you let go.

760.753.1050 | 351 Santa Fe Drive Suite 1 | Encinitas, CA 92024 | www.drnigro.com