Plastic Surgery Rotation Descriptions
The Western Pennsylvania Hospital Plastic Surgery Rotation: R5 Resident Rotation
Each resident rotates for three months at the Western Pennsylvania Hospital, a tertiary regional referral center.
The principal preceptors on this rotation are E. Douglas Newton, MD, Robert W. Bragdon, MD, and Robert Kang, MD; all three are diplomats of the American Board of Plastic Surgery. Dr. Newton completed a fellowship in microvascular surgery; Dr. Kang is fellowship-trained in hand surgery with added qualification in surgery of the hand; and Dr. Bragdon is a member of The American Society for Aesthetic Plastic Surgery. In addition, other plastic surgeons from the community operate at The Western Pennsylvania Hospital and residents may avail themselves of opportunities to operate with them. The Burn-Trauma Unit of the hospital also provides clinical material.
A broad spectrum of cosmetic and reconstructive cases is available to residents, including cleft lip and palate, congenital deformities, breast reconstruction, body sculpturing after bariatric surgery, hand surgery, and late burn reconstruction. The presence at West Penn of a major training program in foot and ankle surgery provides exposure to clinical material unique to this rotation. An active microvascular program of 20 years’ duration allows residents to take part in and evaluate the results of this particular modality.
Residents are given the opportunity to run the service and operate as independently as he or she is capable in order to allow for development as an autonomous surgeon. A residents’ clinic is held once a week under the auspices of Dr. Newton. Participation in the attending physicians’ clinics is encouraged to provide follow-up as well as exposure to preoperative planning.
The formal didactic program is carried out as a part of the overall University of Pittsburgh program. Informal operating room and bedside teaching on this rotation is a continuous process.
Breast Surgery Rotation: R5 Resident Rotation
The Magee-Womens Hospital of UPMC breast surgery rotation is a three-month rotation for plastic surgery residents. During this time, residents participate in the preoperative and postoperative management of a broad spectrum of breast and aesthetic problems. It includes a six-hour weekly clinic which allows residents to evaluate new patients and to learn about postoperative care in patients that he or she has operated on with the attending surgeon.
Residents are expected to participate in planning of the operations. The plan for each case is didactically outlined by discussing the “markings” prior to surgery. The didactic educational experience also includes a dialogue about each patient in the operating room, postoperative rounds, and a discussion of suggested literature articles. At the completion of this rotation, residents are expected to be familiar with the management of patients with a broad spectrum of both cosmetic and reconstructive breast procedures including management of complications. The operative experience averages more than 100 cases per rotation.
The surgeons who partake in the breast reconstructive services are Dr. Kenneth Shestak, Dr. Carolyn De La Cruz, Dr. J. Peter Rubin, Dr. Vu Nguyen and Dr. Michael Gimbel. The vast majority of procedures occur at Magee-Womens Hospital, but some procedures are done at UPMC Montefiore. The rotation gives residents the opportunity to focus on breast problems and breast surgical procedures.
Hand Surgery Rotation: R5 Resident Rotation
Hand surgery education is provided throughout the three years of concentrated plastic surgery training, but accentuated in a dedicated three-month rotation during the plastic surgery R5 year. The rotation combines outpatient clinic, emergency department, and operating room experience at UPMC Presbyterian and UPMC Montefiore, Children’s Hospital of Pittsburgh of UPMC, the VA Pittsburgh Healthcare System, and the Western Pennsylvania Hand and Trauma Center.
UPMC Presbyterian and UPMC Montefiore are the main teaching hospitals within the University of Pittsburgh Medical Center, and represent the largest Level I trauma center and tertiary referral center in western Pennsylvania. Children’s Hospital is the leading regional pediatric hospital. The Hand & UpperEx Center is a specialized, privately owned center located in the suburb of Wexford, PA. Through these varied settings, rich clinical volume is provided across the entire spectrum of hand and upper extremity conditions, including congenital, acquired, and traumatic conditions.
Skills in diagnosis, treatment options, technical execution, and postoperative care are developed under close mentorship by the faculty in the plastic surgery and orthopaedic hand services, including Drs. W. P. Andrew Lee, Joseph Imbriglia, Glenn Buterbaugh, Robert Goitz, Robert Kaufmann, Aaron Grand, Marshall Balk, William Hagberg, Ronit Wollstein, and Kodi Azari. All faculty members are hand and upper extremity fellowship-trained specialists.
Dr. Lee is the chief of Division of Plastic Surgery at the University of Pittsburgh. In addition to a practice focused in hand surgery, he pursues basic science research in transplantation of composite tissue/limb allografts. Dr. Azari is the plastic surgery hand fellowship director. Drs. Imbriglia, Buterbaugh, and Goitz are orthopaedic hand surgeons with decades of experience. They also serve as joint faculty for the integrated plastic/orthopaedic hand surgery fellowship at UPMC.
There are ample didactic opportunities in hand surgery throughout the two concentrated years of plastic surgery training. In addition to teaching conducted at bedside, clinic, and OR, there are two hourly conferences each week. During the Monday afternoon conference conducted by Dr. Lee, all plastic surgery residents in the program discuss the subjects covered in assigned chapters from the Trumble, Principles of Hand Surgery and Therapy. During the joint Friday morning conference attended by the plastic and orthopaedic hand services, two to three cases are presented and discussed.
Guided by dedicated hand surgeons and teachers, the rotation in hand surgery offers a concentrated experience in state-of-the-art management of a rich and varied volume of hand and upper extremity conditions.
Reconstruction Rotation: R5, R6, and R7 Resident Rotation
The reconstructive surgery service rotation at UPMC Presbyterian and UPMC Montefiore will provide a comprehensive experience in various aspects of reconstructive surgery. Working with sister surgical services is an essential part of this rotation and will acquaint residents with a much larger body of surgical knowledge and experience.
Residents will interact principally with Dr. James Russavage and Dr. Ernest Manders at UPMC Presbyterian and UPMC Montefiore. All of the other staff of the division will have patients on the service from elective admissions or via consultations and on-call coverage.
UPMC Presbyterian and UPMC Montefiore are Level I Trauma Centers and regional quaternary referral centers. A wide variety of problems will appear, often cared for in concert with the other surgical services, including general surgery, neurosurgery, cardiothoracic surgery, orthopaedic surgery, transplantation, urology, and otolaryngology-head and neck surgery. Our collaboration with the last service is particularly valuable because we do all the head and neck reconstructions within UPMC.
While on the reconstructive surgery rotation, residents will evaluate patients in the emergency department and on the units. A large share of residents’ time will be spent preparing patients for surgery, performing surgery and in postoperative care. The facial nerve center offers interested residents a unique opportunity to examine and treat patients with a variety of facial nerve disorders. The microsurgery experience will be heavy.
The rotation will acquaint residents with the problems of related surgical disciplines, such as coverage of the brain and spinal cord; treatment of sternal infections, mediastinitis and chest wall defects; complex soft tissue coverage for fracture care, including free flaps to the lower extremity, complex wounds in immunosuppressed patients; genitourinary reconstruction, and head and neck reconstructions involving local, distant, and free flaps.
The formal didactic component of the rotation will be obtained through the weekly grand rounds on Wednesdays, morbidity and mortality conferences, Monday teaching conferences requiring reading in preparation, and the lectures of visiting scholars. During the three years of primary plastic surgery residency training all the major topics of reconstructive surgery will be covered in the didactic conferences and in the weekly grand rounds. There is an abundance of clinical material and residents are encouraged to prepare presentations and manuscripts describing their clinical experience.
The rotation will provide residents with experience in assessing wounds and patients. Residents will have a primary role in solving the reconstructive problems with the guidance of fellow residents and the supervising staff. Independence in decision making and skillful execution of the operative plan is expected. A graded increase in responsibility is permitted as competence is demonstrated. The independence and responsibility afforded residents are greater on this service than on any other in the UPMC system.
Here residents will have a prime opportunity to become competent and confident independent operators. The patients are sicker, frequently requiring care in the ICU setting, and the challenge of caring for them will increase the medical fund of knowledge of every resident.
VA Pittsburgh Healthcare System Rotation: R6 Resident Rotation
The plastic surgery rotation at the VA Pittsburgh Healthcare System is designed as an intense and comprehensive exposure to and experience with reconstructive plastic surgery. The rotation lasts 12 weeks and occurs during the plastic surgery R6 year.
Residents clinically interact with Vu T. Nguyen, MD, who is on the full-time academic faculty and is chief of plastic surgery at the VA.
The VA Pittsburgh Healthcare System is a regional referral center. Patients seen in this rotation will include the full range of congenital and acquired anomalies seen in the adult population.
While on the VA rotation, residents will participate in the plastic surgery clinic which meets for one full day a week. This outpatient clinic will provide residents with an excellent continuity of care experience through preoperative evaluation and preparation for the surgical procedure, as well as postoperative management.
The VA rotation will provide residents with the opportunity to learn the unique psychosocial skill set needed to adequately care for adult and geriatric patients and additionally attend to the needs their entire families. Residents will learn how to assist families with preoperative teaching and counseling as well as postoperative care.
The formal didactic component of the VA rotation will be obtained through the core curriculum conference. This conference consists of interactive sessions and assigned reading from Grabb and Smith’s Plastic surgery, Sixth Edition.
The rotation will provide residents with experience in general plastic and reconstructive surgery. The multidisciplinary approach, working closely with other services (primary care, otolaryngology, urology, general surgery, neurosurgery, orthopaedic surgery, dermatology, and podiatry) in the hospital will provide competence in interpersonal and communication skills as well as systems-based practice.
A detailed experience in the evaluation and management of malignant and pre-malignant skin lesions and reconstructive options for the closure of Mohs defects will be obtained. Experience with the reconstruction of head and neck defects after ENT ablative procedures, post-sternotomy defects, wounds of the trunk and lower extremity, and exposed hardware from orthopaedic and neurosurgical interventions will be obtained. Additionally, exposure to the full range of diagnoses pertinent to general plastic surgery (for example: post-bariatric surgery, macromastia, gynecomastia, post-traumatic facial and body deformities) will be gained.
Allegheny General Hospital Rotation: R6 Resident Rotation
The rotation at Allegheny General Hospital occurs during the R6 year of the plastic surgery residency.
The residents interact with two clinical faculty members at Allegheny General Hospital. Frederick R. Heckler, M.D., FACS, is chief of the Division of Plastic Surgery, and Michael J. White, M.D., FACS is the other faculty member. Both of these surgeons are board certified in general surgery and plastic surgery, and both hold the certificate of added qualifications in hand surgery. Dr. Heckler has been at Allegheny General Hospital since 1982 and Dr. White joined him in practice in 1988.
Allegheny General Hospital is a 750-bed institution. It is a Level I Trauma Center and major regional referral center. It houses its own independent residencies in medicine, surgery, cardiothoracic surgery, neurosurgery, orthopaedics, anesthesia, radiology, emergency medicine, and ob-gyn. It also sponsors post-graduate fellowships in many of the above disciplines of medicine and surgery.
While on the Allegheny General Hospital rotation, plastic surgery residents are assisted by rotating residents from general surgery, emergency medicine, and occasional elective rotations from our specialties. Additionally, third-year medical students from Drexel University rotate on the service as do fourth-year students who may elect a one-month time frame to gain additional experience in this specialty. Allegheny General Hospital is one of the major teaching hospitals for Drexel University School of Medicine.
During this rotation, the focus is on clinical care of the broad spectrum pathophysiologic entities usually cared for by the specialty. Residents interact with all patients of the attending physicians and are included in the preoperative planning, intra-operative surgical management, and postoperative care. The residents also have independent clinic which meets weekly.
Direct supervision for residents in this clinic is always immediately available but young surgeons are also given an opportunity to practice in this setting independently as their own experience and abilities permit. The majority of the clinical load at AGH is drawn from populations requiring reconstruction including trauma, cancer reconstruction in head and neck and breast, post infection defects requiring reconstruction, cosmetic surgery and hand surgery. Congenital and pediatric problems are seen on a more limited but nevertheless active basis. Opportunities for clinic research in conjunction with the faculty members are offered as residents’ interest and time permits.
Formal didactic rounds are conducted weekly for four hours and clinical teaching rounds are conducted daily. The Allegheny General division participates and attends the majority of major teaching conferences sponsored by the University of Pittsburgh parent program. A full and active reference library with full service computer search capabilities is available 24 hours a day.
Children’s Hospital of Pittsburgh of UPMC Rotation: R6 Resident Rotation
The plastic surgery rotation at Children’s Hospital of Pittsburgh of UPMC is designed as an intense and comprehensive exposure to and experience with pediatric plastic surgery and craniomaxillofacial surgery. The rotation lasts six to eight weeks and occurs during the plastic surgery R6 year.
Residents will clinically interact with three primary full-time academic faculty members. Joseph E. Losee, MD, FACS, FAAP, is the chief of pediatric plastic surgery and the director of the Cleft and Craniofacial Center. Dr. Losee is a board-certified plastic surgeon, fellowship-trained in pediatric plastic and craniofacial surgery. Frederic W.B. Deleyiannis, MD, is board-certified in plastic surgery and otorhinolaryngology and fellowship-trained in head and neck surgery. Dr. Jiang is a board certified plastic surgeon, fellowship trained in pediatric plastic surgery and cleft-craniofacial surgery.
Children’s Hospital is a Level I pediatric trauma center and regional quaternary referral center. Patients seen in this rotation will include the full range of congenital and acquired anomalies seen in the pediatric population.
While on the Children’s Hospital rotation, residents will participate in the cleft-craniofacial clinic which meets for one full day a week, as well as the pediatric hand clinic. These outpatient clinics will provide residents with an excellent continuity of care experience through preoperative evaluation and preparation for the surgical procedure, as well as postoperative management.
The Children’s Hospital rotation will provide residents with the opportunity to learn the unique psychosocial skill set needed to adequately care for pediatric patients and attend to the needs of their families. Residents will learn how to assist families with preoperative teaching and counseling as well as postoperative care.
The formal didactic component of the Children’s Hospital rotation will be obtained through the cleft-craniofacial teaching conference which is held on the first, third and fifth Monday of each month. This conference consists of didactic lectures, preparatory reading of journal articles and book chapters, as well as case reports. During a 12-month period, the entire scope of cleft and craniofacial surgery will be covered.
The rotation will provide residents with experience in primary and secondary cleft lip and palate, as well as congenital and traumatic craniofacial surgery. The unique experience of functioning within a multidisciplinary, cleft-craniofacial team caring for syndromic patients will be the expectation and will provide competence in interpersonal and communication skills as well as systems-based practice. A detailed experience with congenital and traumatic pediatric hand will be obtained. Additionally, exposure to the full range of diagnoses pertinent to pediatric plastic surgery will be obtained, including, vascular anomalies, congenital nevi, congenital ear anomalies, congenital breast anomalies and gynecomastia.
The UPMC Mercy Plastic Surgery Rotation: R6 Resident Rotation
Each resident rotates for three months at UPMC-Mercy, a Level I trauma center.
The principal preceptors on this rotation are Guy Stofman, MD, and Kodi Azari, MD. Dr. Stofman completed an Otorhinolaryngology residency as well as a plastic surgery residency. He is board-certified by the American Board of Otolaryngology and the American Board of Plastic Surgery. Dr. Azari completed his plastic surgery residency at the University of Pittsburgh and has been fellowship trained in hand and microsurgery from UCLA. He is board certified by the American Board of Plastic Surgery and also has an added qualification in hand surgery.
A broad spectrum of cosmetic and reconstructive cases is available to residents, including complex lower extremity reconstruction, hand surgery, breast reconstruction, rhinoplasty, and late burn reconstruction.
Residents are given the opportunity to run the service and operate as independently as he or she is capable in order to allow his or her development as an autonomous surgeon. Participation in the attending physicians’ clinics is encouraged to provide follow-up as well as exposure to preoperative planning.
The formal didactic program is carried out as a part of the overall University of Pittsburgh program. Informal operating room and bedside teaching on this rotation is a continuous process.
Aesthetic Surgery Rotation: R7 Resident Rotation
The Magee-Womens Hospital of UPMC aesthetic rotation is a three-month plastic surgery chief resident rotation during which the resident evaluates, operates on and manages his or her own aesthetic surgery patients, and also participates in aesthetic surgery with full-time faculty members (most frequently Dr. Kenneth Shestak, Dr. J. Peter Rubin, Dr. Kodi Azari, Dr. Carolyn De La Cruz, and Dr. Ernest Manders) and with volunteer faculty (most frequently Dr. Dennis Hurwitz). The operative experience averages over 80 cases per rotation.
Most importantly, the resident manages his or her own clinic where they see patients one morning a week. These patients are evaluated and are presented to an attending physician regarding their feasibility for surgery. If they are felt to be surgical candidates, surgeries are planned and carried out under the supervision of an assigned attending.
Presently, all aesthetic surgery is done at Magee-Womens Hospital. The rotation exposes the resident to the full spectrum of aesthetic surgery procedures including face, breast, trunk, extremity and body aesthetics. There is a broad exposure to the newest concepts of body contouring from the standpoint of both liposuction and body lifts. Approximately three days per week are spent in the operating room. At the completion of their rotation, the student should have an understanding of the approaches to aesthetic surgery patients seeing facial, breast, truncal and extremity cosmetic surgery including indications, contraindications, surgical techniques and complications’ management.
The didactic experience includes the aesthetic conference that is conducted the second and fourth Monday of the month. The second Monday aesthetic conference is moderated on an aesthetic surgery topic by one of our aesthetic surgeons. The fourth Monday aesthetic conference is led by the aesthetic resident in which selected teaching cases are discussed.
Administrative Chief Resident: R7 Chief Resident Rotation
The administrative chief resident rotation is a three-month rotation during the R7 chief resident year that combines administrative responsibilities with clinical responsibilities on the busy reconstructive surgery service. During this rotation, the chief resident works closely with the program director and residency coordinator on administrative matters. The responsibilities of this rotation include: coordinating resident assignments to the daily operating room schedule, assuring timely response to consultations, monitoring resident duty hour compliance, and running the reconstructive surgery service. In addition, the administrative chief resident organizes the grand rounds schedule as well as the teaching conferences.
Elective Rotation: R7 Chief Resident Rotation
At the R7 level, an elective rotation block will be provided, conferring on the senior resident the flexibility to pursue experience tailored to individual interests. If desired, away rotations will be individually arranged for “mini-fellowships” and concentrated experience in specialized areas of interest will be sought. Coordinated and advanced preparation with significant oversight, under the direct supervision of the program director, will be provided to ensure a valuable educational experience for each resident. This time may be utilized to confirm interest in pursuing further education with fellowships in a specialized area of plastic surgery. Alternatively, this elective block may also be used to obtain further experience in areas that individual residents may feel the need for additional education and exposure. Finally, for the residents committed to pursuing an academic career, this time may be spent in scholarly pursuit, such as outcome research, clinical projects, or basic research that will prepare them for their career in academic surgery.
Community and Office Based Plastic Surgery Rotation: R7 Chief Resident
The community- and office-based plastic surgery rotation is a three-month rotation that provides an alternative look at plastic surgery. Pittsburgh has a unique environment in which many of the community-based plastic surgeons actively participate in the residency program. The chief resident will gain experience in billing, coding, and practice management. This rotation will highlight life in the private practice setting, including: outpatient management, outpatient surgery, and office based procedures.