Rotation Descriptions

Reconstructive Surgery Rotation:  R1 – R6 Resident Rotation

The Reconstructive Surgery Service rotation at Presbyterian Hospital and Montefiore University Hospital provides 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 Drs. T. Oguz Acarturk, Ernest K. Manders, Mario G. Solari and James M. Russavage at PUH-MUH.  All of the other staff of the Division will have patients on the service from elective admissions or via consultations and on call coverage.

The PUH-MUH center is a Level I Trauma Center and regional quaternary referral center.  A wide variety of problems will appear, often cared for in concert with the other surgical services, including General Surgery, Neurosurgery, Cardiothoracic Surgery, Orthopedic Surgery, Transplantation, Urology, and Otolaryngology-Head and Neck Surgery.  Our collaboration with the last service is particularly valuable for we do all the head and neck reconstructions in the Medical Center.

While on the Reconstructive Surgery rotation the resident will evaluate patients in the ER and on the wards.  A large share of the resident's time will be spent in the preparation of patients for surgery, in operating on them, and in caring for them afterwards.  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 is extensive.

The rotation will acquaint residents with the problems of related surgical disciplines, including as examples coverage of the brain and spinal cord, treatment of sternal infections and 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 through 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 our clinical experience.

The rotation will provide the resident with experience in assessing wounds and the patients who bear them.  The resident will have a primary role in solving the reconstructive problem 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 the resident is greater on this service than on any other in the system.  Here the resident will have a prime opportunity to become a competent and confident independent operator.  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.

Breast Surgery Rotation:  R3 and 5 Resident Rotation

The Magee breast surgery rotation is a four-month rotation for the plastic surgery resident during the R3 year and a three-month rotation during the R5 year. During this time the resident participates in the preoperative and postoperative management of a broad spectrum of breast and aesthetic problems. It includes a 6-hour weekly clinic which allows the resident to evaluate new patients and to learn about postoperative care in patients that he/she has operated on with the attending surgeon.

The resident is expected to partake in the preoperative 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, on postoperative rounds and a discussion of suggested literature articles. At the completion of these rotations the resident is 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 encompasses the spectrum of reconstructive breast cases, in addition to aesthetic breast surgeries, and includes an extensive exposure to microsurgical reconstruction of the breast.

The surgeons who partake in the breast reconstructive services are Dr. Shestak, Dr. De La Cruz, Dr. Gimbel, and Dr. Nguyen. The vast majority of procedures occur at Magee-Womens Hospital, but some procedures are done at Montefiore University Hospital. The rotation affords the resident the opportunity to focus on breast problems and breast surgical procedures and to work in a “one on one relationship” with the rotation’s preceptor (Dr. Shesta

VA Hospital of Pittsburgh Rotation:  R3 Resident Rotation

The plastic surgery rotation at the Veteran’s Administration Hospital of Pittsburgh 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 R3 year.

Residents clinically interact with Vu T. Nguyen, M.D., who is on the full-time academic faculty and is Section Chief of Plastic Surgery at the VA.

The VA Hospital of Pittsburgh 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 Hospital rotation, residents will participate in the plastic surgery clinic which meets for one full day a week. This outpatient clinic will provide the resident with an excellent continuity of care experience through preoperative evaluation and preparation for the surgical procedure, as well as post-operative management.

The VA Hospital rotation will provide the 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 of the their entire family.  Residents will learn how to assist families with preoperative teaching and counseling as well as post-operative care. 

The formal didactic component of 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 the resident with experience in general plastic and reconstructive surgery.  The multidisciplinary approach, working closely with other services (primary care, otolaryngology, urology, general surgery, vascular surgery, neurosurgery, orthopedic 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 orthopedic 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.

Body Contouring Rotation:  R4 Resident Rotation

Residents with rotate through the Body Contouring Rotation during their fourth Integrated year of residency.  A focused experience is offered in treating the unique aspects of  the massive weight loss patient following bariatric surgery; including preoperative evaluation, intraoperative technique, and postoperative care.

While on the rotation, residents will work with Drs. Rubin and Hurwitz, both of whom are internationally recognized leaders in the field.  Dr. Gusenoff just recently joined the faculty and will be working with Dr. Rubin in the comprehensive Life After Weight Loss Center  While on service, the resident will participate in the full spectrum of body contouring procedures; including brachioplasty, male and female breast contouring, panniculectomy, thighplasty, upper and lower body lifts, and total body lifts.  Procedures will take place at Presbyterian-Montifiore Hospitals, as well as at Magee-Womens Hospital.

Outpatient clinical experience is provided at the Isaly clinic, where the resident will work as a member of the multidisciplinary team involved in treating this specific patient population.  Preoperative evaluation will focus on the comprehensive evaluation of the post-bariatric patient, including for example nutritional and psychosocial issues.  Postoperatively, residents will familiarize themselves with the issues particularly pertinent to the body contouring patient, including for example DVT prophylaxis and wound care.

As with other rotations, 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 through the lectures of visiting scholars.

Hand Surgery Rotation:  R4 Resident Rotation

Education in hand surgery is provided throughout the plastic surgery training program, but accentuated in a dedicated three-month rotation during the plastic surgery R4 year.  The rotation combines outpatient clinic, emergency room, and operating room experience at the Presbyterian/Montefiore Hospital, Children’s Hospital, Veterans Administration Hospital, and the Western Pennsylvania Hand and Upper Extremity Center.

Presbyterian/Montefiore are the main teaching hospitals in the University of Pittsburgh Medical Center and represent the largest level I trauma center and tertiary referral center in western Pennsylvania.  Children’s Hospital of Pittsburgh, in turn, is the leading regional pediatric hospital.  The Western Pennsylvania Hand and Upper Extremity 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 orthopedic hand services, including Drs. Joseph Imbriglia, Glenn Buterbaugh, Robert Goitz, Robert Kaufmann, Aaron Grand, Marshall Balk, William Hagberg, and Alexander Spiess.  All faculty members are hand and upper extremity fellowship trained specialists.  Drs. Imbriglia, Buterbaugh, and Goitz are orthopedic hand surgeons with decades of experience.  They also serve as joint faculty for the Combined Plastic/Orthopedic Hand Surgery Fellowship at UPMC.

In addition to teaching conducted at bedside, clinic, and OR, there are two hourly conferences each week.  In the Monday afternoon conference conducted by Drs. Alex Spiess, all plastic surgery residents discuss the subjects covered within assigned chapters from the Trumble, Principles of Hand Surgery and Therapy textbook.  Contributions from the Children’s faculty include lectures covering pediatric hand and brachial plexus care.  The conference employs various teaching modalities including, in-service review hand questions, case presentations, and pertinent journal articles.  In the joint Friday morning conference, attended by both the Plastic and Orthopedic Hand services, two to three cases are presented and discussed, as well as presentations by the faculty on select hand and upper extremity topics.

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.

Shadyside Hospital Rotation: R4 Resident Rotation

The Shadyside Hospital rotation is a 3 month rotation experienced by clinical year four plastic surgery residents.  During this rotation, residents work with two primary attending surgeons, Dr William Swartz and Dr Michael Gimbel.  Both are ABPS certified plastic surgeons who maintain broad practices.  Additionally, the resident is exposed one to two times per week to community-based plastic surgeons, including Drs. Raymond Capone, Leo McCafferty, Mark Liang, and James O’Toole, all ABPS certified plastic surgeons.  This community-surgeon interaction provides the majority of the rotation’s aesthetic surgery exposure.  Clinical material during this rotation includes reconstruction of the head and neck, breast, chest wall, torso, abdominal wall, groin and perineum, and lower extremities, as well as aesthetic surgery.  As Shadyside has historically had a busy geriatrics service, the rotation maintains emphasis on wound care, both medical and surgical.  Also, because the U. Pittsburgh Orthopedic Oncology service is centered at Shadyside, residents frequently participate in major reconstructions following limb-salvaging extirpative procedures.

The resident rounds daily with the plastic surgery team consisting of both primary attendings and a physician assistant.  During these rounds, new patient consults are evaluated, preoperative planning is discussed, and postoperative care is administered and critiqued.  Emphasis is placed on effective communication with multiple medical and surgical services, nursing, paramedical services, and administrative figures within this broad tertiary care hospital system.  In addition to operative training, the resident also attends one to two days of outpatient clinic per week.

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 through 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 our clinical experience.

Children’s Hospital of Pittsburgh Rotation:  R3 and R5 Resident Rotation

The plastic surgery rotation at Children’s Hospital of Pittsburgh is designed as an intense and comprehensive exposure to and experience with Pediatric Plastic surgery and Craniomaxillofacial surgery.  The rotation lasts 12 weeks during the R3 year and again for 10 weeks during the plastic surgery R5 year.

Residents will clinically interact with four primary, full-time, academic faculty members. Joseph E. Losee, M.D., 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. Lorelei Grunwaldt, M.D. is also fellowship trained in Pediatric Plastic surgery and Craniofacial surgery.  Anand R. Kumar, M.D. completed both his plastic surgery residency and Craniofacial Surgery Fellowship at University of California, Los Angeles (UCLA).

The Children’s Hospital of Pittsburgh of UPMC 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 the resident 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 the residents with the opportunity to learn the unique psychosocial skill set needed to adequately care for pediatric patients and attend to the needs of the their entire family.  Residents will learn how to assist families with preoperative teaching and counseling as well as postoperative care. 

The formal didactic component of this Children’s Rotation will be obtained through the Cleft-Craniofacial Teaching Conference which is held on the 1st, 3rd, and 5th 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 the resident 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 as well as gynecomastia.

UPMC Mercy Hospital Rotation:  R5 Resident Rotation

Each resident rotates for ten weeks at Mercy Hospital, a level one trauma center.

The principal preceptors on this rotation are Guy Stofman, M.D., and Dawn J. Wang. Dr. Stofman completed an Otorhinolaryngology residency as well as a Plastic Surgery Residency.  He is board certified by the American Board of Otolaryngology, as well as the American Board of Plastic Surgery.

A broad spectrum of cosmetic and reconstructive cases is available to the resident, including complex lower extremity reconstruction, hand surgery, breast reconstruction, rhinoplasty, and late burn reconstruction.

The resident is given the opportunity to run the service and operate as independently as he/she is capable in order to allow his/her development as an autonomous surgeon. Participation in the attendings’ 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 program.  Informal operating room and bedside teaching on this rotation is a continuous process.

Allegheny General Hospital Rotation:  R5 Resident Rotation

The rotation at Allegheny General Hospital occurs during the R5 year of the Plastic Surgery Residency.

The residents interact with two clinical faculty members at Allegheny General Hospital.  Frederick R. Heckler, M.D., FACS, (Chief of the Division of Plastic Surgery at AGH) and Michael J. White, M.D., FACS.  Both of these surgeons are board certified in general surgery, 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, ob-gyn, and additionally sponsors post-graduate fellowships in many of the above disciplines of medicine and surgery.

While on the Allegheny General Hospital rotation, the 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 care for by the specialty.  Residents interact with all patients of the attendings and are included in the preoperative planning, intraoperative surgical management, and postoperative care.  The residents also have independent clinic which meets weekly.  Direct supervision for the 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 the resident’s interest and time permits.

Formal didactic rounds are conducted weekly for four hours and, in addition, clinical teaching rounds are conducted daily.  The AGH Division participates and attends the majority of teaching conferences sponsored by the University of Pittsburgh parent program.  A full and active reference library with full computer search capabilities is available 24 hours a day.

Administrative Chief Resident Rotation – R6 Chief Resident Rotation

The administrative chief resident rotation is a ten week rotation during the R6 Chief resident year.  During this rotation, the Chief resident works closely with the Program Director and Residency Coordinator on administrative matters, in addition to being the Chief resident on the adult reconstructive service at PUH/MUH.  The responsibilities of this rotation include:  coordinating resident assignments to the daily operating room schedule and assuring timely response to consultations.   In addition, the administrative chief resident organizes the Grand Rounds schedule as well as the teaching conferences

Aesthetic Surgery Rotation:  R6 Chief Resident Rotation

The Magee Aesthetic rotation is a ten week Plastic Surgery Chief resident rotation during which the resident evaluates, operates on and manages their own aesthetic surgery patients and also participates in aesthetic surgery with full-time faculty members (most frequently Dr. Shestak, Dr. Rubin, Dr. De La Cruz, and Dr. Manders) and with volunteer faculty (most frequently Dr. Hurwitz and Dr. Bragdon).  The operative experience averages over 80 cases per rotation.

Most importantly, the resident manages his/her own clinic where they see patients one morning a week. These patients are evaluated and presented to an attending regarding their feasibility for surgery. If they are felt to be surgical candidates, procedures are planned and carried out under the supervision of an assigned attending surgeon.

Presently, all aesthetic surgery is done at Magee-Womens Hospital. The rotation affords the resident exposure 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 lifting. 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 seeking facial, breast, truncal and extremity cosmetic surgery, including indications, contra-indications, surgical techniques and management of complications.

Elective Rotation – R6 Chief Resident Rotation

At the R6 level, an Elective rotation block will be provided, conferring 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, preparing for their career in academic surgery.

Community and Office Based Surgery Rotation:  R6 Resident Rotation

The National Naval Medical Center (NNMC) Rotation:  Elective Resident Rotation

Each resident will have the opportunity to rotate from 1-3 months at the prestigious Walter Reed National Military Medical Center, the Center of Excellence and Flagship Hospital for Military personnel, governmental leaders, wounded warriors, and their family members.

The principal preceptors on this rotation are LCDR Ian L. Valerio, M.D., M.S., M.B.A., the Residency Site Director and Director of Plastic Surgery Research Programs at WRNMMC, LCDR Patrick Basile, M.D., CDR Robert Howard, M.D., COL Barry Martin, M.D., the Plastic Surgery liaison to the Surgeon General, LCDR Thomas Chung, D.O., and Maj Kerry Latham, M.D., a fellowship trained craniofacial surgeon.  Their practice consists of complex traumatic war surgery, craniofacial reconstruction, limb salvage, microsurgery, head and neck reconstruction, facial reanimation, breast reconstruction, general plastic reconstruction, late burn reconstruction, cleft lip and palate surgery, pediatric plastic surgery, peripheral nerve surgery, and aesthetic surgery.  In addition, other plastic surgeons from the community such as Dr. Craig Vander Kolk, M.D. and Christian Paletta, M.D. also operate at NNMC and the resident may be interested in opportunities to learn from them.  The Orthopedic Hand, Dermatology, Oculoplastic Surgery, OMFS, and ENT facial plastic surgery teams of the hospital are also supportive in clinical partnerships with our team and are committed to our resident educational pursuits.

A broad spectrum of complex reconstructive cases and aesthetic surgery cases are available to the resident who rotates at WRNMMC.  Additionally, a number of clinical research endeavors are currently of interest and ongoing, which offer the resident opportunities to assist in or potentially to complete their own research projects with input from our faculty.

The resident is given the opportunity to run the service and operate as independently as he or she is capable, with active support and guidance from the WRNMMC faculty, in order to allow his or her development as an autonomous decision-maker, clinician, and surgeon. Participation in the attendings' clinics is required to provide follow-up as well as exposure to preoperative planning process.  The resident will be in charge of directing rounds, overseeing and teaching the junior residents and interns who are also a part of the plastic surgery team.

The formal didactic program includes Grand Rounds, M&M conference, Journal clubs, and visiting professorships arranged by the faculty to be carried out as a adjunct part of the University program.  Informal operating room and bedside teaching on this rotation is a continuous process.