Taiwan Today

Wei Fu-chan has helped make Taiwan a world leader in reconstructive microsurgery.

Until July this year, the convocation of Academia Sinica, Taiwan’s foremost research institute, counted among its members more than 270 scientists from the humanities, life sciences, mathematics, physics and social sciences—but not a single surgeon. That situation changed when the institution’s academicians voted to admit microsurgery pioneer Wei Fu-chan (魏福全) to their ranks on July 5. The somewhat tardy admission of a surgeon to the academy was perhaps a reflection of the common perception—one that is sometimes even shared by members of the academic community—that surgery is more of a technique than a scientific field. As their vote showed, however, Academia Sinica’s scholars found that Wei’s decades-long career as an innovative surgeon, hospital administrator, professor and researcher rendered such stereotypical distinctions meaningless.

Remarking on Wei’s selection, Wu Cheng-wen (吳成文), a biomedical scientist and a member of the Council of Academia Sinica, the organization’s steering body, said that as deep knowledge of scientific disciplines including anatomy, body mechanics, cytology and histology is required to perform innovative surgical procedures, Wei was clearly qualified to become an academician. Academy members and medical experts Lai Ming-chiao (賴明詔) and Chen Pei-jer (陳培哲) noted that Wei’s election also countered the misperception that surgeons do not conduct research.

Wei’s admission to the ranks of the institution’s academicians was merely the latest addition to a long list of honors he has received at home and abroad. In 2008, for example, the Republic of China (ROC) Executive Yuan honored him with the Award for Outstanding Contributions in Science and Technology, while in 2006 the American Society of Plastic Surgeons selected him as one of the 20 most important innovators in the history of plastic surgery. That same year, the American Society for Reconstructive Microsurgery named Wei as its Harry J. Buncke Lecturer, one of the highest honors in that field.

Wei received his medical degree in 1972 from the School of Medicine at Kaohsiung Medical College, which is located in Kaohsiung City, southern Taiwan and was renamed Kaohsiung Medical University in 1999. His superior performance as a medical student allowed him to specialize in surgery, although he admits he also chose the field because its professors were such charismatic leaders.

During his subsequent surgical residency at Mackay Memorial Hospital and training in plastic surgery at Chang Gung Memorial Hospital, both of which are located in Taipei, Wei was greatly inspired by the medical and philanthropic devotion of American plastic surgeon Samuel Noordhoff, who was Wei’s “teacher, mentor and boss,” as the erstwhile resident puts it, at both hospitals. Noordhoff came to Taiwan in 1959 as a medical missionary, became Mackay’s superintendent in 1960 and served in that position for 16 years. In 1976, Noordhoff transferred to newly opened Chang Gung to become the hospital’s first superintendent and went on to found the institution’s plastic surgery department later that same year. The American surgeon is also known for establishing the Noordhoff Craniofacial Foundation-Taiwan in 1989 to help children born with a cleft lip or cleft palate.

Very Small Structures

In the late 1970s, Wei ventured abroad to receive postgraduate training at the University of Toronto in Canada as a plastic microsurgery fellow and then at the University of Louisville in the United States as a hand microsurgery fellow. As its name suggests, microsurgery involves the use of a microscope and specialized instruments to perform surgery on very small structures such as blood vessels and nerves. The need for the surgical technique became increasingly apparent in Taiwan in the 1970s as the country underwent rapid industrial development, with the government encouraging people to perform light manufacturing at home through slogans such as “living room as factory.” Although the economy boomed, home operation of production machinery in the absence of regulations, safety measures and experienced supervision resulted in frequent hand injuries, including the loss of fingers. Other factors that increase the need for advanced surgical techniques in Taiwan include the frequency of motorcycle and scooter accidents and the common habit of chewing betel nuts, which can cause oral cancer. “More often than not, great human pain is the reason for medical progress,” Wei says.

In 1981, Wei returned to Taiwan and joined the faculty at Chang Gung Memorial Hospital, where he was instrumental in founding the Division of Reconstructive Microsurgery. Procedures involved in reconstructive microsurgery center on transplanting healthy tissue from one part of a patient’s body to another that has been damaged. Peering through a microscope, surgeons attach blood vessels and sometimes nerves from the transplanted tissue to counterparts bordering the damaged area. “We’re able to reconnect severed fingers to the hand,” Wei says. “If the fingers are crushed, they can be replaced with [the patients’ own] toes.”

In 1990, Wei became a professor at Chang Gung Medical College, which was founded in 1987 in Taoyuan County, northern Taiwan and was renamed Chang Gung University in 1997. At the hospital, he held the position of chairman of the Department of Plastic and Reconstructive Surgery from 1994 to 2000 and served as vice superintendent from 1997 to 2003.

In the operating room, Wei gained a reputation for performing complicated surgical procedures such as toe-to-hand transplantation and for coming up with innovations such as the use of vascularized fibula tissue to reconstruct the mandible and extremity bones. In 2001, his widely recognized surgical prowess was a major factor in the World Society for Reconstructive Microsurgery’s (WSRM) decision to hold its first congress in Taipei. The WSRM was formed in 1999 through the merger of the International Society of Reconstructive Microsurgery and the International Microsurgical Society. Wei went on to be elected as WSRM president for 2002 and 2003.

Wei took over as dean of Chang Gung’s College of Medicine in 2003 and stepped down from that position in 2011, although he still performs surgery and teaches. “The biggest, core group of learners here consists of ‘fellows,’ or medical school graduates who have received years of training in plastic surgery and then seek to specialize in microsurgery,” he explains. Chang Gung Memorial Hospital’s reputation for having one of the world’s most active microsurgical centers helps to attract such fellows from around the world. Some 1,000 microsurgical cases are performed by Wei’s unit each year with a success rate of more than 96 percent, according to the hospital. In 2009, the inaugural issue of the WSRM Newsletter took notice of Chang Gung’s leadership in the field by calling it “one of the busiest microsurgical centers in the world.”

The high volume of cases is one of the factors luring surgeons from Taiwan and overseas. Since the mid-1980s, the hospital’s plastic surgery department has trained more than 1,200 doctors and scholars from 68 countries including Germany, Japan, mainland China, South Korea, the United Kingdom and the United States.

Local and foreign fellows accompany Wei and his team throughout the day. One recent member of Wei’s entourage was a Syrian doctor who had been trained in the United States before coming to Taiwan. “He touched me,” says Wei, “because he wanted to go back to serve his injured countrymen and help his country recover from the war.”

Still, most applicants accepted as fellows at Chang Gung come from developed countries, as the expense of building and operating microsurgery facilities and the cost of the surgery itself make the procedure rare in the developing world. In a recent interview for a local TV program, a German doctor said she knew she had made the right decision to do her fellowship at Chang Gung when she learned Wei sometimes did complicated “free flap” cases five times a day. In free flap procedures, doctors move tissue with intact blood vessels from one part of the body to another, where microsurgery is used to reconnect the blood vessels. Wei is proud of the success his foreign microsurgery fellows find when they return home. “Many of them have gone on to become professors or heads of their departments in their countries,” he says.

Wei says that the microsurgery experience and know-how Chang Gung has accumulated over the years now make the hospital a leader in the sector. “Our early efforts in developing this area of expertise were crucial to our present competitiveness in the world,” Wei says. “In this field, we’re far ahead in the world in terms of the aspects covered, number of cases performed and innovation.” Currently, Wei’s team is advancing into the transfer of composite tissue between individuals—a branch of surgery known as allotransplantation, which also includes organ donation.

Wei and other medical professionals have also put their competence and experience to work to boost Taiwan’s medical diplomacy efforts. The International Cooperation and Development Fund (ICDF), for example, was established by the government in 1996 to coordinate the country’s resources for aid programs abroad. In 2006, the ICDF began working together with more than 20 domestic private medical organizations to form an international alliance that offers medical aid to ROC diplomatic allies. Wei was dean of Chang Gung University’s College of Medicine when it became a founding member of the alliance.

The surgeon says that the ROC has participated in international medical aid efforts in the past in order to strengthen ties with diplomatic allies and solicit support from partner nations to establish a greater presence on the world stage. To pursue medical diplomacy more actively, Wei suggests that the government build partnerships with international nongovernmental organizations (NGO) like Operation Smile, which is dedicated to providing surgery for children who suffer from cleft lip, cleft palate or other facial deformities. Through regularly contributing funding and personnel to help NGOs accomplish specific medical missions, Taiwan would be able to carve out a more distinct role for itself on the world stage than it would by just donating money to international NGOs, as is sometimes now the case, Wei says.

Taiwan could also do more to help patients living in foreign countries who require craniofacial surgery or heart or liver transplantation, Wei says. One way to do that would be by having the government’s overseas offices identify people who need such treatment and then introduce them to medical centers in Taiwan. Providing medical services for foreign patients could help spread awareness of Taiwan’s strength in health care and its willingness to offer help by treating serious cases sent from abroad, he says.

Less Humble Profile

Given the high level of expertise Taiwan has achieved, Wei believes it is time for the country to adopt a less humble profile in international medicine. Taiwan’s breakthroughs in hepatitis research and microsurgical reconstruction, for example, make the country a world leader in those fields. Rather than just acting as a provider of medical aid, Taiwan could serve as a role model for other advanced countries as they develop their own related programs, he says.

One way for Taiwan to consolidate its international health care leadership would be to make better use of the research and teaching strengths of the country’s major medical centers, Wei says. The government could help in that effort by sponsoring fellowships for foreign doctors in select fields such as microsurgery and hepatitis B treatment. To distribute the knowledge Taiwan has gained in those fields more evenly, it would be best to invite foreign doctors from all over the world, he says, not just those from countries with which the ROC has official diplomatic ties.

Wei is a strong proponent of government funding for such scholarships. “It wouldn’t be hard to find private sponsors,” he says, “but the government’s funding has a different meaning. It’s given in the name of the people. After going back to their countries, those doctors would be appreciative toward us and that emotional attachment would last a long time.”

Having completed his own fellowships in Canada and the United States, Wei believes it is time for Taiwan to return the favor. “In the past we’ve taken pride in the competence we’ve gained in practicing medicine introduced from the West,” he says. “But now we can export our own medical techniques to Western countries. One day, our techniques could become the international standard.”

Write to Pat Gao at cjkao@mofa.gov.tw