The Orthopaedic and Plastic Surgery Services at the University of Pittsburgh and the Hand & UpperEx Center have further enhanced the collaboration and cross-fertilization of their respective Hand and Upper Extremity Fellowship Programs. This format offers an unparalleled experience in both skeletal and soft tissue aspects of adult and pediatric hand surgery, including microsurgery, conducted in both an academic setting and a private surgery center environment.
Trainees in both fellowship programs will attend joint conferences, didactic lectures, and Journal Clubs together. Rotation through both Orthopaedics and Plastic Surgery would result in a diverse experience in all aspects of hand and upper extremity conditions. Between the two fellowships, there are a total of seven positions for candidates completing their residency training in Plastic Surgery, Orthopaedic Surgery, and/or General Surgery. Matched candidates will have the opportunity to be trained by 10 full time faculty members, perform surgical procedures in a state-of-the-art freestanding surgery center, as well as complex upper extremity reconstruction and microsurgical procedures at the University Health Center of Pittsburgh. The faculty members include Joseph Imbriglia, MD, Glenn Buterbaugh, MD, Robert Goitz, MD, William Hagberg, MD, Marshall Balk, MD, Robert Kaufmann, MD, Aaron Grand, MD, Alex Spiess, MD, Alex Davit, MD, and Kia Washington, MD. The majority of physicians have Certificates of Added Qualification in hand surgery or are eligible for the CAQ.
Over the 12-month fellowship-training period, experience and responsibility are gradually increased and by the end of the program each fellow is comfortable and competent in all areas of shoulder, elbow and hand surgery, and microsurgical techniques.
Prerequisite resident education must be completed in a general surgery, orthopaedic surgery, or plastic surgery program accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada.
Duration and Scope
The University of Pittsburgh Plastic Surgery Hand Program is a one-year, ACGME accredited hand surgery fellowship program.
While at least one clinical research project leading to presentation and publication is expected during the fellowship year, significant basic and applied basic science research opportunities are available. For those interested, research experience can be obtained in nationally known basic science research laboratories at the University of Pittsburgh.
The Tissue Engineering Laboratory
The Tissue Engineering Laboratory is directed by Kacey G. Marra, PhD, Assistant Professor of Surgery and Bioengineering. This laboratory conducts scientific investigation in multiple interdisciplinary areas. The scope of projects revolve around the fields of nerve regeneration and tissue engineering. Novel biomaterials are being designed for skin, bone, and nerve regeneration, with a strong focus on polymeric materials, both native and synthetic. This laboratory isolates preadipocytes from human adipose tissue, and is exploring applications of these adult stem cells in soft tissue reconstruction. Of recent interest is the differentiation of preadipocytes into adipocytes, neural progenitor cells, and osteoblasts for tissue engineering applications. The two areas of concentration for hand surgery are: novel nerve regeneration techniques and immunobiology of rat dendritic cells.
Vascularized Composite Tissue Allograft Laboratory
Under the guidance of Mario Solari, MD, PhD residents and fellows are given an opportunity to participate in the UPMC VCA lab during their year long fellowship. Major soft tissue and skeletal defects, including limb amputation, represent a deficit of form and function, as well as diminution of quality of life for the affected individuals. However, any reconstructive measures to improve these non-life threatening conditions must address a delicate balance of risks and benefits. As experiments in vascularized composite allotransplantation are being conducted, a number of human hand transplants have been performed worldwide, including 8 limbs at the University of Pittsburgh. These allografts require an intense maintenance regimen of medications, subjecting the recipients to the significant morbidities of chronic, systemic immunosuppression. To address the risk-benefit ratio, therefore, our laboratory investigates novel techniques in inducing tolerance to vascularized composite allografts without long-term immunosuppression. We are utilizing a minimally toxic, non-myeloablative regimen for the creation of mixed chimeric miniature swine, in order to achieve tolerance to allogenic vascularized composite allografts. This large animal protocol entails use of an anti-CD3 immunotoxin, in conjuction with high dose hematopoietic donor cell infusion and short-term cyclosporin administration. Tolerance to the musculoskeletal portions of grafts has been achieved.
Future research will focus on the tolerance of the epidermal elements and the mechanisms behind skin allograft rejection.Dendritic cells have been a highly active area of research in the fields of cancer immunology and transplantation. Several groups have investigated the tolerogenic function of these unique antigen-presenting cells, and postulated mechanisms for their manipulation. Our laboratory is focusing on the use of host dendritic cells as carriers of foreign peptide and inducers of donor specific tolerance. We propose to utilize donor antigen-pulsed host dendritic cells, in conjuction with antilymphocyte serum, to induce tolerance to vascularized composite allografts in an orthotopic, rat hindlimb model.
Other future avenues of research include the xenotransplantation of composite tissues, and the use of thymoglobulin as a tolerance induction agent.
Immunobiology of Rat Dendritic Cells
Dendritic cells (DC) are known to be the most efficient antigen presenting cells (APCs) and have the capacity to stimulate naïve T-cells and initiate immune response. DC originate from bone marrow hematopoietic stem cells and are less than 1% of circulating blood mononuclear cells. DC induce peripheral tolerance via several mechanisms including the deletion of autoreactive T-cells and induction of regulatory mechanisms. The aim of this project is to generate subsets of DC from rat bone marrow and spleen with abilities to regulate T cell responses in vitro. These functions are mediated through the differential ability of DC subsets to secret cytokines as well as the level of costimulatory molecule expression. The purified dendritic cells will be characterized based on phenotype by flow cytometry, cytokine production, and capacity to stimulate allogeneic T-cells in a primary MLR. The nature of T cell responses induced by DC subsets will be determined in DC-T cell co-culture experiments for the generation of regulatory T cell population(s).
Application Process for the Hand Surgery Fellowship
Applications for the Hand Surgery Fellowship beginning July 1, 2014 will be accepted until January 30, 2013.
You will need to register with the NRMP (http://www.nrmp.org/fellow/registration.html) for the Combined Musculoskeletal Matching Program (CMMP).
Please submit the following information with your application packet:
- Completed Universal Hand Application
- Curriculum Vitae
- Copy of USMLE Step I, II and III Scores
- Personal Statement
- Three letters of recommendation, including one from your program director.
You may send your completed Hand Fellowship Application materials to:
Hand Surgery Fellowship Coordinator
Department of Plastic Surgery
3550 Terrace Street
Scaife Hall, Suite 664
Pittsburgh, PA 15261