Andrew Koman, MD
L. Andrew Koman, M.D., Professor and Chair
Dr. L. Andrew Koman was born and raised in Winchester, Virginia. He received his medical degree, completed his residency in Orthopaedic Surgery and a hand/microsurgery fellowship at Duke University. He accepted a position in the Department of Orthopaedic Surgery at Duke University from 1980 through 1981. He joined the Wake Forest School of Medicine in the Department of Orthopaedic Surgery in 1981. He is currently Professor and Vice Chair of the Department of Orthopaedic Surgery and has cross-appointments in the Department of Pediatrics and the Wake Forest Institute for Regenerative Medicine. Dr. Koman is the author of numerous papers in two major areas: hand and microsurgery and management of pediatric cerebral palsy patients. In September 2006, Dr. Koman was recognized as the Established Investigator in Clinical Sciences by Wake Forest University Health Sciences.
SYNOPSIS OF AREA OF INTEREST: Control of the microcirculation of the digits; nerve repair and development of novel methods of nerve repair; digital thermoregulation and its relation to extremity pathology; use of bioprotection with intramuscular botulinum toxin injections for orthopaedic injuries; management of spasticity associated with cerebral palsy with intramuscular botulinum toxin injections.
DETAILED AREA OF INTEREST: Since 1987, Dr. Koman has been studying the use of intramuscular injections of botulinum toxin for the management of spasticity associated with pediatric cerebral palsy. As a result of several multicenter clinical trials, the injections have been found to be safe and effective in improving upper and lower extremity function and joint range of motion. He has also developed a large database that is used to study the natural history of cerebral palsy. Based on his experience with intramuscular injections of botulinum toxin, the use of toxin injections has been expanded to weaken muscles in order to protect the surgical sites in a variety of orthopaedic procedures. For example, chemo-denervation of muscle protects tendon repairs, rotator cuff repairs, and tendon transfers. In addition, the injections reduce post-operative pain associated with hyperactive muscles.
The other major area of research involves the neurovascular control of the thermoregulatory microcirculation in the digits. Clinical studies utilize a microangiology laboratory built for examining the microvascular control of patient extremities. This facility is used to assess the impact of surgical interventions for alleviating cold sensitivity. In addition, the testing techniques assist in the diagnosis of patients presenting with clinical signs and symptoms of peripheral vascular pathology. Basic research in the area has focused on animal models of thermoregulatory end organs and studies of peripheral nerve repair. Rabbit ears have been studied as thermoregulatory models of the human digit and can be used to predict the impact and time-course of recovery following removal of vascular periadventitial tissue. Studies of peripheral nerve repair have utilized mouse and rat models to assess the impact of delays in nerve repair on recovery of nerve and muscle function. These studies have improved our understanding of how nerves and muscles interact to affect muscle functional recovery following nerve injury. Improved methods for repair of large nerve deficits using nerve conduits currently are being pursued.