The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship DirectorsFunding None.
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.
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.
Received: 23 April 2020
Accepted: 26 July 2020
01 September 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 9 Chao AH. Starting a microsurgery fellowship: a program's perspective. Microsurgery 2017; 37 (04) 274-275
- 10 Rostom M, Lam WL. Microsurgery fellowships-development of a clinical curriculum. J Reconstr Microsurg 2018; 34 (02) 145-150
- 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
- 12 Statistics-Microsurgery Fellowship Match. Microsurgery fellowship. Available at: https://www.sfmatch.org/SpecialtyInsideAll.aspx?id=26&typ=1&name=Microsurgery# . Accessed March 17, 2020
- 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
- 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
- 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
- 16 Maldonado AA, Song DH. European and American microsurgery training programs: the fellowship concept difference. Plast Reconstr Surg 2015; 136 (02) 292e-293e
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 28 Accreditation Council for Graduate Medical Education. What we do. Available at: http://www.acgme.org/What-We-Do/Accredidation/Common-Program-Requirements . Accessed March 16, 2020
- 29 Masia J, Sanchez-Porro L, Vega C. , et al. New paradigms in reconstructive microsurgery education. Ann Plast Surg 2019; 83 (03) 243-246
- 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
- 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