Download PDF
J Reconstr Microsurg 2021; 37(02): 167-173
DOI: 10.1055/s-0040-1715879
Original Article

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

Meera Reghunathan
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Diego, San Diego, California
,
Michelle Zaldana-Flynn
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Diego, San Diego, California
,
John Rose
2   Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland
,
Christopher A. Crisera
3   Division of Plastic and Reconstructive Surgery, University of California Los Angeles, Westwood, California
,
Chris M. Reid
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Diego, San Diego, California
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background Although microsurgery fellowships have existed since the 1980s, there is no established curriculum. Microsurgery fellowships vary greatly in clinical caseload, case diversity, and training resources, and there is no consensus on the appropriate composition of a microsurgery fellowship. This study surveys fellowship directors (FD) and recent microsurgery fellows (MFs), graduates, to describe the ideal microsurgery fellowship program.

Methods A 15-item questionnaire was sent to 38 FDs and 90 recent microsurgery fellowship graduates. This questionnaire addressed program attributes, case volumes and compositions, ideal experiences, and time allocation to different fellowship experiences. Data were analyzed using descriptive statistics, t-tests, and Chi-squared tests.

Results The FD and MF surveys had a response rate of 47 and 49%, respectively. Both MF and FD agreed that exposure to microsurgical breast reconstruction is the most important characteristic of a microsurgery fellowship (p = 0.94). MF ranked replantation and supermicro/lymphatic surgery as the next most important microsurgical cases, while FD ranked the anterolateral thigh (ALT) flap and free fibula flap (p < 0.001). Both agreed that revisional surgery after microsurgical reconstruction is a very valuable fellowship experience (p = 0.679). Both agreed that 1 day of clinic a week is sufficient.

Conclusion Microsurgical training programs vary in quality and resources. The ideal microsurgery fellowship prioritized breast reconstruction, head and neck reconstruction, and lower extremity reconstruction. Although microsurgical technical expertise is important, a fellowship should also train in revisional surgeries and clinical decision making.

Keywords

microsurgery - fellowship - training

Note

This study was presented at the American Society of Reconstructive Microsurgery (ASRM) Annual Meeting 2020 in Fort Lauderdale, FL. It was accepted as Tier-1 Abstract for Plastic Surgery the Meeting (PSTM) 2020.


Supplementary Material



Publication History

Received: 23 April 2020

Accepted: 26 July 2020

Article published online:
01 September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Stitzenberg KB, Sheldon GF. Progressive specialization within general surgery: adding to the complexity of workforce planning. J Am Coll Surg 2005; 201 (06) 925-932
    CrossrefPubMedGoogle Scholar
  • 2 Coleman JJ, Esposito TJ, Rozycki GS, Feliciano DV. Early subspecialization and perceived competence in surgical training: are residents ready?. J Am Coll Surg 2013; 216 (04) 764-771 , discussion 771–773
    CrossrefPubMedGoogle Scholar
  • 3 Silvestre J, Serletti JM, Chang B. Trends in accreditation council for graduate medical education accreditation for subspecialty fellows hip training in plastic surgery. Plast Reconstr Surg 2018; 141 (05) 768e-774e
    CrossrefPubMedGoogle Scholar
  • 4 Dasari CR, Gunther S, Wisner DH, Cooke DT, Gold CK, Wong MS. Rise in microsurgical free-flap breast reconstruction in academic medical practices. Ann Plast Surg 2015; 74 (Suppl. 01) S62-S65
    CrossrefPubMedGoogle Scholar
  • 5 Miller MW, Dean NR, Cannady SB, Rosenthal EL, Wax MK. Free tissue transfer for head and neck reconstruction in solid organ transplant patients. Head Neck 2012; 34 (08) 1143-1146
    CrossrefPubMedGoogle Scholar
  • 6 Momeni A, Lanni M, Levin LS, Kovach SJ. Microsurgical reconstruction of traumatic lower extremity defects in the pediatric population. Plast Reconstr Surg 2017; 139 (04) 998-1004
    CrossrefPubMedGoogle Scholar
  • 7 Cooper MN, Daneshgaran G, Yu R. et al. Analysis of the microsurgery match from 2014 to 2018 reveals increased competition for microsurgery fellowship positions. J Reconstr Microsurg 2019; 35 (09) 662-668
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Livingston CK, Ruiz-Razura A, Cohen BE. Guidelines for a successful microsurgery training center and research fellowship. Plast Reconstr Surg 1999; 104 (05) 1555-1558
    CrossrefPubMedGoogle Scholar
  • 9 Chao AH. Starting a microsurgery fellowship: a program's perspective. Microsurgery 2017; 37 (04) 274-275
    CrossrefPubMedGoogle Scholar
  • 10 Rostom M, Lam WL. Microsurgery fellowships-development of a clinical curriculum. J Reconstr Microsurg 2018; 34 (02) 145-150
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Sullivan BJ, Maliha S, Henderson PW. Microsurgery fellows' impression of clinical and educational offerings during fellowship year. J Reconstr Microsurg 2020; 36 (03) 191-196
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Statistics-Microsurgery Fellowship Match. Microsurgery fellowship. Accessed March 17, 2020 at: https://www.sfmatch.org/SpecialtyInsideAll.aspx?id=26&typ=1&name=Microsurgery#
    Google Scholar
  • 13 Hashmi A, Khan FA, Herman F. et al. A survey of current state of training of plastic surgery residents. BMC Res Notes 2017; 10 (01) 234
    CrossrefPubMedGoogle Scholar
  • 14 Blackwell KE, Brown MT, Gonzalez D. Overcoming the learning curve in microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 1997; 123 (12) 1332-1335
    CrossrefPubMedGoogle Scholar
  • 15 Kulkarni AR, Sears ED, Atisha DM, Alderman AK. Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons. Plast Reconstr Surg 2013; 132 (03) 534-541
    CrossrefPubMedGoogle Scholar
  • 16 Maldonado AA, Song DH. European and American microsurgery training programs: the fellowship concept difference. Plast Reconstr Surg 2015; 136 (02) 292e-293e
    CrossrefPubMedGoogle Scholar
  • 17 Kordahi AM, Hoppe IC, Lee ES. A comparison of free tissue transfers to the head and neck performed by surgeons and otolaryngologists. J Craniofac Surg 2016; 27 (01) e82-e85
    CrossrefPubMedGoogle Scholar
  • 18 Drinane JJ, Drinane J, Nair L, Patel A. Head and neck reconstruction: does surgical specialty affect complication rates?. J Reconstr Microsurg 2019; 35 (07) 516-521
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Ruan QZ, Ricci JA, Silvestre J, Ho OA, Lee BT. Academic productivity of faculty associated with microsurgery fellowships. Microsurgery 2017; 37 (06) 641-646
    CrossrefPubMedGoogle Scholar
  • 20 Odom EB, Schmidt AC, Myckatyn TM, Buck II DW. A Cross-sectional study of variations in reimbursement for breast reconstruction: Is a healthcare disparity on the horizon?. Ann Plast Surg 2018; 80 (03) 282-286
    CrossrefPubMedGoogle Scholar
  • 21 Alderman AK, Storey AF, Nair NS, Chung KC. Financial impact of breast reconstruction on an academic surgical practice. Plast Reconstr Surg 2009; 123 (05) 1408-1413
    CrossrefPubMedGoogle Scholar
  • 22 Eom JS, Kobayashi MR, Paydar K, Wirth GA, Evans GR. The number of operations required for completing breast reconstruction. Plast Reconstr Surg Glob Open 2014; 2 (10) e242
    CrossrefPubMedGoogle Scholar
  • 23 Albornoz CR, Bach PB, Mehrara BJ. et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. Plast Reconstr Surg 2013; 131 (01) 15-23
    CrossrefPubMedGoogle Scholar
  • 24 Yueh JH, Slavin SA, Adesiyun T. et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg 2010; 125 (06) 1585-1595
    CrossrefPubMedGoogle Scholar
  • 25 Egro FM, Blecher NA, Gimbel ML, Nguyen VT. Microsurgery fellowship selection criteria: a national program director survey. J Reconstr Microsurg 2017; 33 (03) 206-210
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schaverien MV, Butler CE, Suami H, Garvey PB, Liu J, Selber JC. Interview scores correlate with fellow microsurgical skill and performance. J Reconstr Microsurg 2018; 34 (03) 211-217
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Mueller MA, Pourtaheri N, Evans GRD. Microsurgery training resource variation among US integrated plastic surgery residency programs. J Reconstr Microsurg 2019; 35 (03) 176-181
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Accreditation Council for Graduate Medical Education. What we do. Accessed March 16, 2020 at: http://www.acgme.org/What-We-Do/Accredidation/Common-Program-Requirements
  • 29 Masia J, Sanchez-Porro L, Vega C. et al. New paradigms in reconstructive microsurgery education. Ann Plast Surg 2019; 83 (03) 243-246
    CrossrefPubMedGoogle Scholar
  • 30 Payatakes AH, Zagoreos NP, Fedorcik GG, Ruch DS, Levin LS. Current practice of microsurgery by members of the American Society for Surgery of the Hand. J Hand Surg Am 2007; 32 (04) 541-547
    Google Scholar
  • 31 Bennion DM, Dziegielewski PT, Boyce BJ, Ducic Y, Sawhney R. Fellowship training in microvascular surgery and post-fellowship practice patterns: a cross sectional survey of microvascular surgeons from facial plastic and reconstructive surgery programs. J Otolaryngol Head Neck Surg 2019; 48 (01) 19
    CrossrefPubMedGoogle Scholar