Department of Surgery

Division of Plastic and Reconstructive Surgery
Fellowships — Hand Surgery Fellowship Program

Hand Surgery

We are pleased to announce that the Orthopaedic and Plastic Surgery Services at the University of Pittsburgh and the Hand & UpperEx Center (formerly the Western Pennsylvania Hand Center) have further enhanced the collaboration and cross-fertilization of their respective Hand and Upper Extremity Fellowship Programs. The new format offers an unparalleled experience in both skeletal and soft tissue aspects of hand surgery, including microsurgery, conducted in both an academic setting and a private surgery center environment.

Trainees in both fellowship programs will attend joint conferences, didactic lectures, and Journal Clubs together. Exchange rotations would result in equally diverse experience in all aspects of hand and upper extremity conditions. Between the two fellowships, there are a total of seven positions for candidates completing their residency training in Plastic Surgery, Orthopaedic Surgery, and/or General Surgery. Matched candidates will have the opportunity to be trained by 10 full time faculty members, perform surgical procedures in a newly established state-of-the-art freestanding surgery center, as well as complex upper extremity reconstruction and microsurgical procedures at the University Health Center of Pittsburgh. The faculty members include Joseph Imbriglia, MD, W.P. Andrew Lee, MD, Glenn Buterbaugh, MD, Robert Goitz, MD, William Hagberg, MD, Marshall Balk, MD, Robert Kaufmann, MD, Kodi Azari, MD, Aaron Grand, MD, and Ronit Wollstein, MD. All physicians have Certificates of Added Qualification in hand surgery or are eligible for the CAQ.

Over the 12-month fellowship-training period, experience and responsibility are gradually increased and by the end of the program each fellow is comfortable and competent in all areas of shoulder, elbow and hand surgery, and microsurgical techniques.

Duration and Scope

  • The University of Pittsburgh Plastic Surgery Hand Program is a one-year, ACGME accredited hand surgery fellowship program.
  • Prerequisite resident education must be completed in a general surgery, orthopaedic surgery, or plastic surgery program accredited by the Accreditation Council for Graduate Medical Educatioin (ACGME) or the Royal College of Physicians and Surgeons of Canada.

Clinical Goals and Objectives

Purpose: The Plastic Surgery, Hand Fellowship Curriculum: Goals and Objectives is provided to hand residents and attendings for the purpose of education and assessment. The curriculum is not only an educational tool, but also a guide for assessment. Hand residents should utilize the curriculum to direct independent study and self-assessment. Attendings should utilize the curriculum to direct resident teaching and assessment. The curriculum is the tie between education and assessment.

Note: The Hand Fellowship Curriculum has been written to address the goals and objectives of the hand fellowship so that it specifically addresses the six core competencies:

  1. Medical Knowledge
  2. Patient Care
  3. Practice-Based Learning and Improvement
  4. Interpersonal and Communication Skills
  5. Systems Based Practice
  6. Professionalism

Plastic Surgery of the Hand and Upper Extremity

A. Medical Knowledge

I: Anatomy/Physiology/Embryology

Goal: The resident will achieve a detailed knowledge of the anatomy, physiology, and embryology of the upper extremity and will utilize this knowledge in the complete management of the hand, arm, and brachial plexus.

Objectives:

  1. Describe in detail the anatomy and physiology of the muscles, tendons, ligaments, and bones of the hand and upper extremity.
  2. Identify in detail the anatomy of the vascular tree of the upper extremity, including relationships to the surrounding structures.
  3. Identify in detail the anatomy of the major nerves and their branchings in the upper extremity, including relationships to surrounding structures.
  4. Draw the anatomy of the brachial plexus.
  5. Demonstrate the detailed radiographic anatomy of the bony structures of the upper extremity.
  6. Utilize the radiologic techniques, including plain films, CT scan, angiography and MRI of the upper extremities.
  7. Discriminate the principles of electrical evaluation and recite knowledge of the techniques of electrical examination of the upper extremities, including conduction studies and EMG evaluation.
  8. Recite the principles of upper extremity biomechanics.

II: Congenital Disorders

Goal: The resident will achieve familiarity with the spectrum of congenital abnormalities of the upper extremity and perform comprehensive diagnostic evaluation and surgical management of such problems.

Objectives:

  1. Recite the classification system for congenital hand anomalies including:

    a. Failure of part formation
    b. Failure of differentiation
    c. Duplication
    d. Overgrowth
    e. Undergrowth
    f.  Congenital bands

  2. Generalized musculoskeletal anomalies
  3. Describe the embryologic development and the physiologic theories which explain the etiology of hand anomalies.
  4. Recite the operations, including timing and techniques used in the surgical management of hand anomalies.

III. Benign and Malignant Tumors

Goal: The resident will understand the principles of diagnosis and treatment of extremity tumors and undertake comprehensive management of a wide variety of such lesions.

Objectives:

  1. Describes the principles and techniques of management of upper extremity tumors.
  2. Describe the etiologic factors, epidemiology, and modalities of treatment for tumors of the upper extremities.
  3. Describe the clinical manifestations of both soft and hard tissue tumors of the upper extremities.
  4. Describe the reconstructive principles and techniques for restoration of form and function after surgical resections.
  5. Recite the indications and use of adjunctive therapy (i.e. radiation therapy and chemotherapy) in the management of and the prognosis for upper extremity tumors.
  6. Describe the principles and techniques of management for upper extremity tumors, including reconstruction after surgical extirpation, for:

    a. Vascular tumors
    b. Nerve tumors
    c. Benign deep soft tissue tumors
    d. Malignant deep soft tissue tumors
    e. Primary bone tumors

  7. Rationalize the utilization of radiotherapy, medical oncology, hand therapy, occupational therapy, and prosthetics where appropriate for patients with upper extremity tumors.

IV: Trauma

Goal: The resident will understand the principles of diagnosis and treatment of extremity trauma and perform comprehensive management of acute injuries and other trauma-related problems of the hand and arm.

Objectives:

  1. Recite the principles and applications of diagnostic techniques for the evaluation of hand and upper extremity trauma.
  2. Describe the techniques for operative management of traumatic injuries of the upper extremity, their indications and contraindications, and their possible complications and the treatment thereof.
  3. Explain the indications for, contraindications to, and techniques in nonoperative management of traumatic injuries of the hand and upper extremity.
  4. Describe the options for soft tissue coverage of upper extremities including:

    a. Skin grafts
    b. Local flaps
    c. Free tissue transfer

V. Functional Problems of the Upper Extremities

Goal: The resident will achieve familiarity with aesthetic and functional problems of the hand and arm, understand the principles of rehabilitation of the upper extremity and the management, including comprehensive rehabilitation of the upper extremity.

Objectives:

  1. List the surgical and nonsurgical treatment of nerve compression and entrapment syndromes of the upper extremity.
  2. Draw the pathologic anatomy and physiology of upper extremity contractures and Dupuytren's disease.
  3. Recite the basic pathophysiology of rheumatoid and nonspecific arthritis of the upper extremity.
  4. Describe the pharmacological therapy of rheumatoid arthritis.
  5. Demonstrate the surgical treatment of rheumatoid arthritis, timing of therapeutic treatment and interactions with medical therapy.
  6. Describe the common circulatory disorders of the upper extremity including, but not limited to:

    a. Arterial thromboses
    b. Aneurysms
    c. Embolic disorders
    d. Arteriovenous fistulae
    e. Vasospastic disease
    f.  Scleroderma

  7. Describe the diagnosis and treatment of common pain syndromes including sympathetic dystrophy.
  8. Recite the management of upper extremity lymphedema.

VI. Reconstruction

Goal: The resident will understand the principles and techniques of upper extremity reconstruction and apply these to a variety of developmental, traumatic, and acquired problems.

Objectives:

  1. Recite the diagnostic techniques for evaluation of function, including EMG and conduction studies, arteriography, CT scan, and MRI evaluation.
  2. Recite the use of tendon transfers.

B. Patient Care

Goal: The resident will provide patient care that is compassionate, appropriate, and effective for the treatment of hand problems.

Objectives:

  1. Perform the clinical techniques for physical examination of the hand and upper extremity.
  2. Perform the surgical techniques used to treat congenital and developmental hand anomalies.
  3. Perform postoperative care of patients with congenital and developmental anomalies of the upper extremity.
  4. Apply casts and splints for the preoperative and postoperative care of hand patients.
  5. Utilize the diagnostic techniques for upper extremity tumors.
  6. Demonstrate the techniques of management of extremity tumors.
  7. Perform the procedures for the acute management and participate in the post-operative rehabilitation of traumatic injuries of the upper extremity including:

    a. Fractures and dislocations
    b. Nerve injury including brachial plexus
    c. Major amputation and avulsions
    d. Joint injury
    e. Tendon extensor and flexor injury of the hand
    f.  Muscle and tendon injury of the arm
    g. Nail bed injuries
    h. Infections
    i.  Fingertip and other minor injuries

  8. Perform the surgical treatment options for contractures.
  9. Perform treatment for tenosynovitis and tendon rupture.
  10. Describe the indications for and perform the techniques of tendon reconstruction including, tendon grafting sources, methods, and indications.
  11. Perform the management of nerve injuries, including primary, delayed primary, and secondary repair.
  12. Perform the techniques for reconstruction of the amputated thumb, including lengthening, pollicization, free toe to thumb, and free wrap-around techniques.
  13. Perform the technical methods of soft tissue coverage, including skin grafts, local flaps, distant flaps, and transfers.

C. Practice-Based Learning and Improvement

Goal: The resident will investigate and evaluate his or her own patient care practices, appraise and assimilate scientific evidence, and improve patient care practices.

Objectives:

  1. Uses information technology to prepare for surgical cases, bringing to the OR the knowledge of current modalities of care and the scientific evidence for that care.
  2. Routinely analyzes the effectiveness of own practices in caring for hand patients.
  3. Improves own practices in the care of hand patients by integrating appropriately gathered data and feedback.
  4. Educates medical students and other healthcare professionals in the practices of hand surgery.
  5. Functions independently with graduated advancement and appropriate faculty supervision.

D. Interpersonal and Communication Skills

Goal: The resident will demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and professional associates.

Objectives:

  1. Educates patients and families in postoperative strategies for hand therapy.
  2. Demonstrates compassion for patients and families with traumatic and congenital hand deformities.
  3. Provides adequate counseling and informed consent to patients.
  4. Listens to patients and their families.
  5. Assimilates data and information provided by hand therapists and other members of the health care team.
  6. Charts and records accurate information.

E. System Based Practice

Goal: The resident will demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Objectives:

  1. Coordinates all aspects of hand and upper extremity rehabilitation, including splinting, prosthesis use, physical therapy, and sensory re-education.
  2. Direct the rehabilitation of upper extremities following trauma by partnering with the following:

    a. Physical Therapy
    b. Occupational Therapy
    c. Prosthetic and orthotic specialists
    d. Demonstrates knowledge of cost-effective hand care.
    e. Advocates for hand patients within the health care system.

  3. Understands the basics of Worker's Compensation.
  4. Refers hand patients to the appropriate practitioners and agencies.
  5. Facilitates the timely discharge of hand patients.

F. Professionalism

Goal: The resident will demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Objectives:

  1. Develops a sensitivity of the unique stresses placed on families under care for congenital anomalies of the hand.
  2. Exhibits an unselfish regard for the welfare of hand patients.
  3. Demonstrates firm adherence to a code of moral and ethical values.
  4. Is respectful to hand patients and their families especially in times of trauma and stress to the family unit.
  5. Respects and appropriately integrates other members of the hand care team.
  6. Provides appropriately prompt hand consultations when requested.
  7. Demonstrates sensitivity to the individual patient's profession, life goals, and cultural background as they apply to hand surgery.
  8. Is reliable, punctual, and accountable for own actions in the OR and hand clinic.

Research Opportunities

While at least one clinical research project leading to presentation and publication is expected during the fellowship year, significant basic and applied basic science research opportunities are available. For those interested, research experience can be obtained in a nationally known research laboratory.

Application Process for the Hand Surgery Fellowship

Applications for the Hand Surgery Fellowship beginning July 1, 2009 will be accepted from September 1, 2007 until January 1, 2008.

You will need to register with the National Resident Match Program (NRMP) (http://www.nrmp.org/fellow/registration.html) for the Combined Musculoskeletal Matching Program (CMMP).

Please submit the following information with your application packet:

  • Completed Hand Fellowship Application
  • Curriculum Vitae
  • Transcript
  • Copy of USMLE Step I, II and III Scores
  • Personal Statement
  • Three letters of recommendation, including one from your program director.

You may mail your completed Hand Fellowship Application materials to:

Nina D. Beedle
Hand Surgery Fellowship Coordinator
3550 Terrace Street
Scaife Hall, Suite 683
Pittsburgh, PA 15261
Office: 412-383-8082
Fax: 412-383-8986
E-mail: beedlend@upmc.edu

If you have any questions or require additional information regarding the Fellowship or Match, please do not hesitate to contact me.