Microsurgery Fellowship | Department of Plastic Surgery

Location: Pittsburgh, PA
Duration: 12 months

Interviews for the 2024-25 academic year will occur virtually on May 24, 2024.

The University of Pittsburgh Medical Center (UPMC) Department of Plastic Surgery Microvascular Reconstructive Surgery fellowship provides comprehensive microsurgical training to one trainee per year. Training focuses on functional and aesthetic reconstruction of defects and deficits throughout the entire body, including after head and neck cancer extirpation or trauma, mastectomy, truncal cancer resection, upper and lower extremity cancer or trauma, for dynamic facial reanimation, and for other congenital or acquired defects. Microsurgical techniques are heavily emphasized, although conventional macroscopic techniques are also represented. The estimated number of microsurgical free flaps per year is 100-150. In addition, the fellow participates in other microsurgical cases such as lymphedema procedures and nerve repairs, as well as many non-microsurgical reconstructive procedures. The fellow participates in a busy operative schedule, as well as weekly conferences and clinics, and is involved in academic and clinical house officer teaching. The fellow may conduct clinical outcomes research projects during the year with the expected goal of regional and national meeting presentation and manuscript submission.

Clinical Training

The fellowship program is divided into five main experiences:

Head & Neck

Preceptor: Mario Solari, MD

The H&N Reconstructive Surgery Service is based at the Oakland Campus with the majority of surgeries performed at Montefiore and Presbyterian hospitals and the remainder performed at the Oakland VA hospital. Flaps include ALT, fibula, radial/ulnar forearm, and flaps based on the subscapular system with chimeric flaps commonly performed. Rarer flaps include jejunum, sural artery, gracilis, and others. Virtual surgical planning is performed for the majority of bony reconstructions. Nerve reconstruction is also commonly performed either as grafts (facial nerve, inferior alveolar nerve) or flap neurotization. Fellows will develop their core microsurgical skill sets throughout the year and will be able to independently perform complex microsurgical reconstructions upon completion of the fellowship.

The PRS microfellow shares cases with the ENT H&N fellows and can expect to perform 20-30 H&N free flap cases in the year. Fellow responsibilities include assessing the patient morning of surgery, guiding residents through the cases, and participating in operative revisions. Routine rounding and patient care is managed by the residents.

Breast

Preceptor: Michael Gimbel, MD
Other faculty: Elizabeth Bailey, MD; Carolyn De La Cruz, MD; Francesco Egro, MD; Vu Nguyen, MD; Brodie Parent, MD

The microsurgical Breast experience takes place predominantly at UPMC/ Magee Womens Hospital, where approximately 50 free flaps take place per year. These cases include DIEP, SIEA, msFTRAM, TUG, and LTP flaps. The Magee house staff team, comprised of a senior and junior resident, with varying numbers of medical students, perform perioperative care, rounding, and participate in the surgical procedures. The microsurgery fellow participates in free flap cases and is available for any urgent returns to the OR. As the fellow gains experience through the year, he/she will transition to a teaching role, taking trainees through segments of cases.

There is a weekly Breast Indications conference during which future cases and boards-style cases are presented, both microsurgical as well as conventional. The fellow is invited to this conference and attends as time allows. The fellow is also invited to any of the several breast reconstruction clinics that take place per week in order to get experience with pre-operative evaluation and decision-making as well as post-operative care. Typically, the fellow decides on which clinics to attend based on cases for the week.

Lymphedema

Preceptor: Carolyn De La Cruz, MD
Other faculty: Oguz Acarturk, MD; Elizabeth Bailey, MD; Michael Gimbel, MD

The Lymphedema experience will cover complete care of the lymphedema patient. There will be opportunities to participate in the diagnosis and work up for lymphedema patients using the latest in ICcG imaging techniques. Fellows will learn how to successfully navigate patients through conservative measures to surgical options. Patients will be seen at Hillman Cancer Center, Shadyside Hospital, and Magee-Womens Hospital. Our multidisciplinary team will prepare patients for surgery and assist in post-operative care.

Fellows will have the opportunity to participate in lymphatic surgery including LYMPHA procedures, lymphovenous bypasses, lymph node transfers and debulking procedures. In addition, procedures combining both breast reconstruction and lymph node transfers such as lateral thoracic lymph nodes or groin lymph nodes concurrent with latissimus dorsi and DIEP flaps. Fellows will be welcomed in the clinic to learn key volumetric assessment techniques and bioimpedance technology.

Extremity

Preceptor: Teun Teunis, MD
Other faculty: Dana Bregman, MD; Jason Yoo, MD

The fellow will acquire experience in complex microsurgical reconstruction of upper and lower extremities, approximately 15-30 per year. This includes flaps for coverage, as well as functional flaps such as free innervated gracilis for elbow flexion after brachial plexus injury, and toe-to thumb transplantations. The fellow will be specifically involved in flap selection and pre-operative planning. The fellow will also have the option of participating in traumatic replants. Extremity free flaps and replants provide a great opportunity to acquire specific microsurgery skills such as:

End-to-side anastomoses
Large size mismatch
Artery to vein graft anastomoses
Hand sewn venous anastomoses
Handling <1.5 mm vessel diameter.

These types of cases take place at multiple hospitals in our system. Trauma-related defects are generally cared for at PUH/MUH and Mercy Hospital, while oncology-related defects are cared for at Shadyside Hospital, Children’s Hospital, Magee-Womens Hospital, and our VA.

Burns

Preceptor: Francesco Egro, MD

The UPMC Burn Center is a comprehensive ABA (American Burn Association)-verified Burn Center located at Mercy Hospital. We are increasing performing free flaps for acute burn indications all over the body. The fellow will participate in planning and execution of these cases and learn how burn pathophysiology impacts care.

There is an in-depth and comprehensive mentorship experience with the preoperative evaluation, treatment planning, operative treatment, and postoperative management of patients with congenital and acquired defects treatable by conventional and microsurgical techniques. This includes weekly outpatient clinic experience in the preoperative evaluation and postoperative management of microsurgical patients.

Clinical Goals and Objectives

To experience a broad education in the art and science of microsurgical reconstructive plastic surgery.
To experience progressive senior surgical responsibility in the essential phases of patient care: preoperative evaluation, therapeutic decision making, operative experience, and postoperative management.
To participate in a multidisciplinary approach to breast cancer and head and neck cancer treatment and reconstruction.
To participate in the diagnosis, planning, operative treatment, and postoperative care of microsurgical reconstructive plastic surgery patients.

Research Goals and Objectives

To participate in at least one clinical research project during the fellowship year.
To submit an abstract for presentation at the U. of Pittsburgh Dept, of Plastic Surgery Research Day.
To participate in resident and medical student education, both clinically and academically.
To acquire and demonstrate depth of knowledge of the microsurgical literature.

Didactic Goals and Objectives

To demonstrate ability to interpret radiological studies including angiography, CT, and MRI imaging modalities.
To demonstrate an understanding of bone and soft tissue healing, both clinically and physiologically.

Education/Didactics

Microsurgery Training Lab:

Our trainees participate in a biannual microsurgery training lab using the chicken thigh model. These labs will provide hands-on technical training in a low-pressure environment, instructed by our group of expert microsurgeons. The micro fellow will participate as a trainee in the first of these sessions, and as a facilitator in the second. The fellow may use the training lab facilities independently or with other trainees outside the formal sessions anytime throughout the year.

H&N Flap Course:

There is a weekend-long annual H&N flap course. This includes invited lecturers, cadaver dissections, instructional sessions on the use of virtual planning/models/guides/custom plates, and didactics.

Call and Independent Cases:

As a clinical instructor, the microsurgery fellow is assigned to be on-call in the faculty call pool and takes attending level call. This amounts to approximately 3 to 5 calls days per month. Responsibilities include home call with immediate availability to cover emergencies at Oakland hospitals (PUH, MWH, VA). Plastic surgery residents take 1st call, evaluate patients, and then call the attending for support and for operative cases. The fellow will act as attending surgeon for emergency operative cases, taking trainees through procedures. A back-up hand surgeon will be available for remote support if needed. Non-urgent cases and follow-up for emergency cases will be diverted to the clinics of appropriate faculty, although the fellow can participate in or lead continued care of these patients as long as it does not conflict with their microsurgery fellowship responsibilities. The fellow will be asked to take one-half day of primary call per year while house staff participate in Resident Camaraderie Day.

Fellows Clinic:

On-call clinical responsibilities may occasionally result in clinic follow-up patients. The fellow will arrange for these patients to be seen by the fellow in clinic. Generally, the fellow can coordinate this fellow clinic to take place alongside a faculty member’s clinic, allowing for convenient continuity of care with expert support availability.

Grand Rounds:

The microsurgery fellow is expected to attend and participate weekly Department of Plastic Surgery Grand Rounds on Wednesday mornings.

ASRM Meeting:

The microsurgery fellow is expected to attend the American Society of Reconstructive Microsurgeons (ASRM) annual meeting in January.

Clinical and Basic Science Research

The fellow has the opportunity to work with any of the faculty on research projects. Most of our service lines have established retrospective and/or prospective REDCap databases. We have research coordinators who can assist with IRB, regulatory, and administrative issues. Fellows may propose their own projects or select from a list of existing projects all under faculty guidance. Fellows are encouraged to work with residents and research fellows to ensure successful completion of projects.

Benefits:

Vacation – The microsurgery fellow receives three weeks of vacation per year. Full-time benefits package, including malpractice insurance, disability insurance, and savings plan. Educational stipend – included in salary, to be applied to ASRM membership, and ASRM meeting registration, travel and accommodations.

Core Faculty

Interviews for the 2024-25 academic year will occur virtually on May 24, 2024.

Applicants are responsible for ensuring they meet all prerequisites for eligibility prior to registering for the match. All match participants must agree and abide by the SF Match rules and policies as well as any additional rules stated by the ASRM.

Please submit the following information with your application packet to the San Francisco Match: Application form, letter of interest, Curriculum Vitae, a copy of USMLE Step I, II and III scores, and three letters of recommendation, including one from your plastic surgery program director.

If you have any questions or require additional information regarding the Microsurgery Fellowship please do not hesitate to contact us:

Michelle A. Gigliotti
GME Academic Manager
Department of Plastic Surgery
University of Pittsburgh School of Medicine
3550 Terrace St.
664 Scaife Hall
Pittsburgh, PA 15261
T: 412-383-8082
F: 412-383-8986
gigliottim@upmc.edu