Reconstructive Microsurgery: From a Set of Skills to a Stand-Alone Specialty of Elite Surgeons
29 April 2018 (eFirst)
Can Reconstructive Microsurgery be Separable from Plastic Surgery?
Traditionally, most plastic surgeons train in reconstructive microsurgery and utilize these techniques when needed.
Other specialties, such as head and neck, orthopedic, and maxillofacial surgeries, do their own reconstruction in many centers worldwide, as they have bred their own reconstructive microsurgeons.
Reconstructive microsurgery is, therefore, considered a set of techniques learned, just well-enough, to get the task done. And, it has never been an independent specialty.
Interestingly, reconstructive microsurgery is not confined by anatomy; microsurgical procedures are needed from head to toe. The result of this is that reconstructive microsurgery can serve as a big umbrella under which surgeons can train and operate on the whole body then focus on one or more anatomic regions they are passionate about. This path could save trainees time, energy, and money, and allow earlier development of expertise and a more profound dedication to advancing reconstructive techniques. As government policies are more resources restricted, and demand delivering the best treatment possible by the experts, would not be beneficial to build those experts early on?
I would like to argue that success is no longer defined by our ability to do a free flap that lives and “get the job done,” but by our ability to do the right reconstruction for the given case in a time- and cost-effective way that improves patient's quality of life and function. A sustainable success of that quality is only attainable to a dedicated, full-time reconstructive microsurgeon who has seen enough, done enough, and experienced enough. And, while it is still essential to allow each specialty to train in reconstruction and microsurgery, why not to build a reconstructive microsurgeon who with his clan act as the “elite force” within surgery, called upon to do what many cannot?
Some experts may share a different view from the one presented in this letter. There is a serious concern that such career may not be financially sound, as reconstruction does not pay well in certain countries. Others feel that plastic and reconstructive surgery could be more “fun,” given that you can do a lot from simple reconstruction to a wide array of aesthetic surgeries. And, others will argue that specialization within the specialty itself is the trend; the “hedgehog vs. fox” work model, not the other way around.
These are legitimate concerns, yet, it could be feasible to find a reconstructive microsurgery division in carefully selected centers where adequate volume of cases, enough number of experts, and strong collaboration among surgical departments exist to assure a flourishing career and elite-level training. And, while reconstructive microsurgery could appear initially too broad to a hedgehog philosophy, the truth is it trains a fox who eventually, and certainly sooner than before, ends up being a foxy hedgehog.
Reconstructive microsurgery lacks no teaching materials, communication platforms, organizations, or heroes who come from different surgical backgrounds. The foundations for a new stand-alone specialty are there already. It is colorful, diverse specialty-to-be that has all what it takes to be one.
- 1 Al Deek NF, Wei FC. It is the time to say good bye to the reconstructive ladder/lift and its variants. J Plast Reconstr Aesthet Surg 2017; 70 (04) 539-540
- 2 Collins J. From Good to Great. New York, NY: HarperCollins; 2001