Better isn’t good enough for Roman Skoracki, MD, and the reconstructive oncological plastic surgery team he leads at The James. “The wheels are always turning and I’m always thinking: Is there another way, can we do this better and improve the quality of life of our patients even more?” says Skoracki, whose creativity and skill have helped reduce incidence of lymphedema — painful swelling in the arms, legs, head and neck that can affect cancer patients. A skilled surgeon Skoracki, who was born in Germany and emigrated to Canada when he was 17, was fascinated by surgery at a young age. “What drew me to surgery was that there was a tangible problem that needed a hands-on fix,” he says. “It’s like a detective story you have to solve, and with all the advances in imaging, pathology and laboratory support we now have so much more information available to help us solve problems.” He specialized in plastic surgery, eventually becoming a pioneer in the field of oncologic microsurgery, working with his team at The James to devise and implement innovative surgical transplant procedures. Reducing lymphedema Lymph vessels are the body’s drainage system, delivering fluid to the regional lymph nodes that act, in a way, like a filtration and absorption station. Cancer can start in the lymph nodes (lymphomas) or spread to them from other sites in the body. When lymph nodes are removed, this can create a fluid build-up called lymphedema. “We can either try and prevent lymphedema during the initial surgery, or if the patient has already developed lymphedema, we have surgical options to reverse it,” Skoracki says. Among those procedures are: Preventive Lymphovenous Bypass Surgery: Skoracki calls this procedure — used most often during surgery for breast and gynecologic cancers — a “supermicro surgery” that connects blood vessels as small as .2 millimeters in diameter, the size of a thread. “We inject the arm with a dye and can follow the flow of the lymphatic system from the hand to the armpit,” he explains. “We can see the lymphatic channels that have been divided when the lymph nodes were removed, where the dye is spilling out, and using the same incision the breast cancer surgeon has made, we can see and connect the cut end of the lymphatic channels to a small blood vessel in the area, providing a new outflow for the lymph fluid. “We’re one of the few cancer hospitals that offer this preventative surgery (the technique can also be used when lymphedema is already present) so we see patients from all over Ohio and beyond.” Abdominal Lymph Node Transfer Surgery: While searching for methods to address possible complications of lymph node transfer surgery, which can include lymphedema, Skoracki noticed that there were rarely complications during bowel resections, and that the mesentery of the bowel — the tissue that connects to blood vessels — contains “a large number of redundant lymph nodes that we could use for lymph node transfer surgery.” He pioneered this type of surgery, which is now being practiced at other leading cancer hospitals. “We’ve had several oncologic plastic surgeons come here to observe the procedure,” says Skoracki, who estimates that he’s performed this type of microsurgery more than 60 times. “It wasn’t just me, it was a total team effort, and I can’t overstate the importance of collaboration. I think that’s what sets The James apart. Working in this environment of innovators and world experts is humbling and inspiring on a daily basis.” Patients first The interactions with and connection to his patients inspire Skoracki to ask questions and seek creative answers and new surgical techniques to improve their quality of life. “We really owe everything we can do to the patients who come to us and trust us with their lives or the quality of their lives,” he says. “I can’t think of a better motivator than that, and that’s why I always try to push the envelope and think about better ways.”