Restorative Endeavor for Service members Through Optimization of Reconstruction (RESTOR)

MISSION

Holistic restoration of complex devastating battlefield injuries with rapidly advancing and proven technologies and therapies that renew, regenerate, repair, reconstruct, and recreate human form and function.

HISTORY

The Restorative Endeavor for Service members Through Optimization of Reconstruction (RESTOR™) Research Program at the 59th MDW ST was initially conceived in 2011 and formally established in 2013. RESTOR™is a pioneering attempt at changing this traditional role of DOD research to serve DOD investigators and beneficiaries. RESTOR™ identifies critical capability gaps and addresses mission-critical research needs by facilitating robust, convergent research and partnership between military subject matter experts/investigators and civilian clinician-scientists and academia.

Such convergence of military and civilian programs is leveraged by RESTOR’s commitment to the development and delivery of novel therapies and strategies for far-forward medical care to minimize morbidity, improve survival, enhance performance and maximize recovery after disabling or life-threatening combat trauma. options have been exhausted.

Since its inception, RESTOR™ has expanded into a paradigm – shifting program that enables seamless transition of innovation to clinical implementation of conventional and cutting-edge reconstructive, regenerative, restorative, rehabilitative techniques, therapies, technologies and tools to serve our wounded warriors.

KEY GOALS OF RESTOR™

Establish a formal mechanism through which the breadth of combat casualty care and wound healing possibilities can be exploited at the most advanced research level and optimize clinical outcomes after injury or disability for soldiers and civilians.

Identify and facilitate a network of successful partnerships and collaborations between clinician scientists, academia, institutions, industry and DOD entities to improve and exploit the most viable technologies, therapies and techniques while adhering to standardized operating principles, regulatory, reporting and policy guidelines.

Implement a rigorous process to expedite transition of innovative therapies from extramural academia and industry to the veteran and military medical community.

Generate a viable pipeline of military scientists, clinicians and young intellect in the fields of regenerative, restorative, reconstructive, human performance, integrative clinical medicine, and allied specialties by providing an ideal, multidisciplinary training environment that encourages and sustains a coordinated research training experience.

KEY RESEARCH AREAS

• Vascularized Composite Allo- and auto- transplant (VCA) research developing translational models for reconstructive transplantation
  Donor Tissue Specific Immunomodulation research to obviate the need for chronic toxic immunosuppression in service members who are candidates for VCA
• Tissue preservation therapeutics and technologies for ischemia reperfusion injury prevention, treatment, neuroregeneration support and anti-inflammatory action
• Clinical Vascularized Composite Allo- and Auto- transplantation reconstructing and re-functionalizing service members through Auto- and Allo- transplantation
• Regenerative Medicine combining biologic scaffolds, adult stem cells and growth factors to produce high quality composite replacement tissues in bone, nerve and composite tissue
• Body-integrated/implantable, skin-based or garment-embedded low profile, smart biosensors for real-time telecapable diagnostics and sophisticated sensing/autonomous analysis of DE/RF input/exposure, and physiologic and pathologic response surrogates to direct targeted interventions
• Nanomedicine platforms as carriers for therapeutics
• Limb optimization
• Human performance
• Chronic Pain Management

SURGICAL RESIDENTS MENTORED

• Carole Villamaria, MD, Major, USAF, MC
• Robert Houston, MD, CPT, USA, MC
• Devin Watson, MD, Capt, USAF, MC
• Kyle Sokol, MD, CPT, USA, MC
• Sahar Leazar, MD
• Megan Burgess, MD, Major, USAF, MC
• Surg. Lt. Cdr. Charles Anton Fries, MRCS, British Royal Navy
• Sharon Lawson, MD. UTHSCSA General Surgery
• Lin Wang, MD, CPT, USA, MC
• Renford Cindass, MD, CPT, USA, MC
• Kevin Wu, MD
• Samuel Tahk, MD, CPT, USA, MC
• Nicholas Robbins, DO, UTHSCSA General Surgery
• Matthew Wordsworth, MRCS, Major, Royal Army Medical Corps
• Michael Sippel, MD, UTHSCSA General Surgery
• Jaclyn Yracheta, MD, UTHSCSA General Surgery
• Mallory Wampler, MD, UTHSCSA General Surgery

MENTORED AWARDS

• J Bradley Aust Society 2019
  2nd Place Basic Science- Michael Sippel, MD
• J Bradley Aust Society 2019
  3rd Place Basic Science- Jaclyn Yracheta, MD
• J Bradley Aust Society 2018
  3rd Place Basic Science- Nicholas Robbins, DO
• San Antonio Military Health System & Universities Research Forum (SURF) 2017
  2nd Place Poster Competition- CPT Samuel Tahk, MD
• J Bradley Aust Society 2017
  2nd Place Basic Science- Nicholas Robbins, DO
• San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Research Day 2017
  3rd Place Podium-CPT Samuel Tahk, MD
• Society of Military Surgeons 2017
  Paul Myers Award in Basic Science (1st Place)-Nicholas Robbins, DO
• American Association of Plastic Surgeons 96th Annual Meeting
  2nd Place AAPS Resident Poster Competition-Kevin Wu, MD
• American Burn Association 49th Annual Meeting
  Best in Category Poster-Wounds Clinical Category-CPT Samuel Tahk
• J Bradley Aust Society 2016
  1st Place Basic Science-Sharon D. Lawson, MD
• Society of Military Surgeons 2016
  COL Jeff Kavolius Award in Basic Science-CPT Renford Cindass, MD
• J Bradley Aust Society 2015
  1st Place Basic Science-Sharon D. Lawson, MD
• Society of Military Surgeons 2015
  COL Jeff Kavolius Award in Basic Science-Sharon D. Lawson, MD
• ORISE Incentive Award
  Sharon D. Lawson, MD
• Colt Foundation Research Prize Award 2014, The Royal Society of Medicine, London
  Finalist – Surg Lt Cdr C A Fries MA MRCS British Royal Navy
• Texas Society of Plastic Surgeons 2014
  Cronin Award – Megan Burgess, MD, Major, USAF, MC
• Association of Surgeons of Great Britain and Ireland/Association of Trauma and Military Surgery 2014
  The Wiseman Medal- Surg Lt Cdr Charles Anton Fries, British Royal Navy
• J Bradley Aust Society 2013
  1st Place Basic Science- Carole Villamaria, Major, USAF, MC
• Military Health Systems Research Symposium 2013
  Honorable Mention Poster- Carole Villamaria, Major, USAF, MC
• J Bradley Aust Society 2012
  2nd Place Basic Science- Carole Villamaria, Major, USAF, MC
• Society of Air Force Clinical Surgeons 2012
  Paul W. Myers Award for Excellence in Resident Research- Carole Villamaria, Major, USAF, MC
• Peripheral Vascular Surgery Society- Society of Military Vascular Surgeons 2012
  Norman Rich Award- Carole Villamaria, Major, USAF, MC

RESTOR TM PUBLICATIONS

• Rask DMG, Adams MH, Liverneaux P, Plucknette BF, Wilson DJ, Alderete JF, Sabbag CM. Targeted muscle reinnervation in upper extremity amputation in military hand surgery: A systematic review. Hand Surg Rehabil. 2023 Oct;42(5):392-399. doi: 10.1016/j.hansur.2023.07.006. Epub 2023 Jul 26. PMID: 37499798.
• Convertino VA, Schauer SG, Weitzel EK, Cardin S, Stackle ME, Talley MJ, Sawka MN, Inan OT. Wearable Sensors Incorporating Compensatory Reserve Measurement for Advancing Physiological Monitoring in Critically Injured Trauma Patients. Sensors (Basel). 2020 Nov 10;20(22):6413. doi: 10.3390/s20226413. PMID: 33182638; PMCID: PMC7697670.
• Carius BM, Naylor JF, April MD, Fisher AD, Hudson IL, Stednick PJ, Maddry JK, Weitzel EK, Convertino VA, Schauer SG. Battlefield Vital Sign Monitoring in Role 1 Military Treatment Facilities: A Thematic Analysis of After-Action Reviews from the Prehospital Trauma Registry. Mil Med. 2022 Jan 4;187(1-2):e28-e33. doi: 10.1093/milmed/usaa515. PMID: 33242098.
• Maddry JK, Mallory A, Araña AA, Morris MJ, Clemons MAR, Burdette AJ, True MW, Niemeyer D, Weitzel EK. Establishment of the Clinician-Scientist Investigator Opportunity Network to Develop Military Medical Research Leaders. Mil Med. 2023 Sep 6:usad332. doi: 10.1093/milmed/usad332. Epub ahead of print. PMID: 37702367.
• Ríos JD, Hughes CK, Lally J, Wienandt N, Esquivel C, Serhan CN, Weitzel EK. Neuroprotectin D1 Attenuates Blast Overpressure Induced Reactive Microglial Cells in the Cochlea. Laryngoscope. 2021 Jun;131(6):E2018-E2025. doi: 10.1002/lary.29337. Epub 2021 Jan 11. PMID: 33427310.
• Ghergherehchi CL, Shores JT, Alderete J, Weitzel EK, Bittner GD. Methylene blue enhances polyethylene glycol-fusion repair of completely severed rat sciatic nerves. Neural Regen Res. 2021 Oct;16(10):2056-2063. doi: 10.4103/1673-5374.308099. PMID: 33642394; PMCID: PMC8343334.
• Fisher JD, Zhang W, Balmert SC, Aral AM, Acharya AP, Kulachi Y, Li J, Turnquist HR, Thomson AW, Solari MG, Gorantla VS, Little SR. In Situ Recruitment of Regulatory T Cells Promotes Donor-Specific Tolerance in Vascularized Composite Allotransplantation. Sci Adv 6, eaax8429 (2020).
• Schweizer R, Waldner M, Oksuz S, Zhang W, Komatsu C, Plock JA, Gorantla V, Gorantla S, Kokai L, Marra KG, Rubin JP. Evaluation of Porcine versus Human Mesenchymal Stromal Cells from Three Distinct Donor Locations for Cytotherapy. Frontiers in Immunology 11, 1-14 (2020).
• Fisher JD, Balmert SC, Zhang W, Schweizer R, Schnider J, Komatsu C, Dong L, Erbas, V, Unadkat JV, Aral AM, Acharya AP, Kulachci Y, Turnquist HR, Thomson AW, Solari Mario, Gorantla VS, Little SR. Treg-inducing microparticles promote donor-specific tolerance in experimental vascularized composite allotransplantation. Proc Natl Acad Sci U S A 116, 25784-25789 (2019).
• Chorath K, Krysinski M, Bunegin L, Majors J, Weitzel EK, McMains KC, Chen PG. Failure Pressures of Dural Repairs in a Porcine Ex Vivo Model: Novel Use of Titanium Clips Versus Tissue Glue. Allergy Rhinol (Providence) 10, 2152-6567 (2019).
• Nagy A, Robbins NL. The hurdles of nanotoxicity in transplant nanomedicine. Nanomedicine (Lond). 2019 Oct;14(20):2749-2762. doi: 10.2217/nnm-2019-0192. Epub 2019 Oct 23. PMID: 31642385.
• Benedict JL, Robbins NL, Kaplan B, Breidenbach WC. A Call to Accountability: Reporting Outcomes in Vascularized Composite Allotransplantation. Plast Reconstr Surg Glob Open. 2019 Jun 14;7(6):e2266. doi: 10.1097/GOX.0000000000002266. PMID: 31624677; PMCID: PMC6635189.
• Robbins NL, Wordsworth MJ, Parida BK, Kaplan B, Gorantla VS, Weitzel EK, Breidenbach WC. A Flow Dynamic Rationale for Accelerated Vascularized Composite Allotransplant Rejection. Plast Reconstr Surg 143, 637e-643e (2019).
• Robbins NL, Wordsworth MJ, Parida BK, Kaplan B, Weitzel EK, Gorantla VS, Breidenbach WC. Is Skin the Most Allogenic Tissue in Vascularized Composite Allotransplantation and a Valid Monitor of the Deeper Tissues? Plast Reconstr Surg 143, 880e-886e (2019).
• Fries CA, Lawson SD, Wang LC, Spencer JR, Roth M, Rickard RF, Gorantla VS, Davis MR. Composite Graft Pretreatment With Hydrogen Sulfide Delays the Onset of Acute Rejection. Ann Plast Surg 82, 452-458 (2019).
• Fries CA, Villamaria CY, Spencer JR, Lawson S, Wang L, Raj T, Wolf EG, Parida BK, Gorantla VS, Rickard RF, Davis MR. A Hyperbaric Warm Perfusion System Preserves Tissue Composites Ex vivo and Delays the Onset of Acute Rejection. J Reconstr Microsurg 35, 97-107 (2019).
• Gorantla VS, Davis MR. Vascularized Composite Allograft Preservation: Ubi Sumus? Journal Transplantation. 2017 Mar;101(3):469-470
• Kostereva NV, Wang Y, Fletcher DR, Unadkat JV, Schnider JT, Komatsu C, Yang Y, Stolz DB, Davis MR, Plock JA, Gorantla VS. (2016) IGF-1 and Chondroitinase ABC Augment Nerve Regeneration after Vascularized Composite Limb Allotransplantation. PLoS ONE 11(6): e0156149. doi:10.1371/journal.pone.0156149
• S Lawson, L Wang, CA Fries, MR Davis, VS Gorantla. Lower Extremity Allotransplantation in: Lower Extremity Gait Systems (LEGS) Program / Full Strides. Springer Publishing. 2016. In press.
• S Lawson, L Wang, CA Fries, MR Davis, VS Gorantla. Development of a Clinical Vascularized Composite Allotransplantation (VCA) Program: Requirements and Recommendations. Karger Publishing. 2016.
• Fries, CA, Villamaria, CY, Spencer, JR, Rickard, RF, Gorantla, VS, Davis, MR. A Porcine Orthotopic Forelimb Vascularized Composite Allotransplantation Model: Technical Considerations and Translational Implications. Plastic and Reconstructive Surgery. Volume 138(2), September 2016, p 461e-417e.
• Fries, CA, Villamaria, CY, Spencer, JR, Rasmussen, TE and Davis, MR (2016), C1 esterase inhibitor ameliorates ischemia reperfusion injury in a swine musculocutaneous flap model. Microsurgery. doi:10.1002/micr.30053. Early View.
• Cannon J, Davis M, Elster, E, et al Dismounted complex blast injuries: a comprehensive review of the modern combat experience. Journal of the American College of Surgeons. 2016. Pending Publication.
• Kevin Wu, M. R. Davis, V. S. Gorantla, S. D. Lawson, R. Cindass, J. Karp, P. Vemula, A. Dhayani, K. Slaughter & N. Joshi (2016) 2602: GRAFT-implanted tacrolimus-eluting hydrogels prolong survival after vascularized composite allotransplantation, Vascularized Composite Allotransplantation, 3:1-2, 60, DOI: 10.1080/23723505.2016.1234226
• Fries, C.A., Tuder, D.W. & Davis, M.R. Preclinical Models in Vascularized Composite Allotransplantation. Curr Transpl Rep (2015) 2: 284. doi:10.1007/s40472-015-0071-8.
• Fries CA, Villamaria CY, Spencer JR, Rasmussen TE, Davis MR. Hyperbaric warm ex vivo perfusion preserves tissue composites beyond normal limits of cold ischemia. 2015. JTransplatation. Submitted.
• Villamaria CY, Spencer JR, Fries AC, Davis MR, Roth M. Hydrogen Sulfide Mitigates Reperfusion Injury in Porcine Model of Vascularized Composite Autotransplantation. Ann Plast Surg 2014;72.
• Villamaria CY, Rasmussen TE, Spencer JR, Patel S, Davis MR. Microvascular porcine model for the optimization of vascularized composite tissue transplantation. J Surg Res. 2012; 178(1):452-9
• Villamaria C,Rasmussen T, Spencer J, Davis M. (PVSS2). Microvascular Porcine Model for the Optimization of Composite Tissue AutoTransplantation, J. Vasc. Surg. 2012; 55(6):Suppl 4S-5S.
• Xing G. Cheng,, Robert G. Hale, Michael R. Davis, Hyun-Wook Kang, Sang J. Lee. 3D Printed Biomaterials for Maxillofacial Tissue Engineering and Reconstruction – A Review Open Journal of Biomedical Materials Research (2014) 33-39