Clinical Component
The four hand surgery fellows rotate through various institutions in four equally divided rotations. At each institution, the fellow works with assigned clinical attendings. The fellow assumes progressive responsibility and accountability, applicable to all clinical settings, including inpatient, outpatient, operating rooms, emergency room, and private office.
During the year, each fellow achieves clinical competence in the full breadth of hand and microsurgery under the guidance of faculty from both Plastic Surgery and Orthopedic Surgery who are fully trained in hand surgery. This training includes skeletal and soft tissue trauma, peripheral nerve, brachial plexus and microvascular surgery, congenital, pediatric, and adolescent surgeries, Dupuytren contracture, posttraumatic contractures, elbow and wrist instabilities, minimally invasive and arthroscopic procedures, as well as degenerative and rheumatoid arthritis.
Microsurgery Training
Irrespective of the background training of the fellow, all fellows attend the week-long microvascular skills course early in the training year- this includes live animal surgery for end-to-end artery and vein anastomosis, interposition vein graft, and free flap transfer.
Anatomy Skills
Opportunities arise throughout the year for fresh cadaver dissection for understanding general basic upper extremity anatomy and soft tissue flap design. In addition to the annual flap course, there are other opportunities in bioskills sponsored by industry and orthopedic device companies. These allow fellows to become familiar with specific orthopedic devices and endoscopic equipment and provide anatomy skills, extensile exposure, and carpal kinematics.
Rotations
There are four rotations (currently for each of the two orthopedic and two plastic surgery hand fellows which have been combined into one full year fellowship). Each rotation is designed to be a continuum; for example, one of the rotations focuses on congenital and pediatric hand problems. Another rotation deals mainly with the spectrum of adult hand and upper extremity problems in the private setting (both clinic and operating room), and the remaining rotations have the fellow primarily at the two public institutions, namely VA Medical Center and Ben Taub Hospital.
Didactic Curriculum
Hand Surgery Fellowship Research
This program strongly encourages research activity. Research may involve direct participation in clinical or anatomic projects, helping with writing book chapters, or technical articles, and case reviews.
A research project is required of all hand fellows before completion of the fellowship. The research manuscript must be completed and acceptable for submission to a journal for publication. Fellows are required to prepare and make a formal presentation to the orthopedic faculty at the Scientific Program each year.
