Hand, Nerve and Microsurgery Fellowship Overview

The Division of Plastic and Reconstructive Surgery offers a one-year fellowship in hand, peripheral nerve, and microsurgery. The Hand, Nerve and Microsurgery Fellowship is sponsored by the Washington University/Barnes-Jewish Hospital/Saint Louis Children’s Hospital Graduate Medical Education Consortium and is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Hand, Nerve and Microsurgery fellows are exposed to a variety of hand, nerve and upper extremity pathology. Our goal is to provide a comprehensive learning environment to gain confidence, competence and technical proficiency to begin a long-lasting career in hand surgery. We strive to provide a multidisciplinary approach to hand surgery to include electrodiagnoticians, therapist, nurse practitioners and others to develop a well-rounded educational experience.

Hand Trauma/Elective Surgery Rotation

The fellowship includes training in all aspects of hand surgery from the distal forearm to the fingertip, and from the infant to aged adult. The trauma volume is high at this large tertiary hospital, providing exposure and competence in the treatment of distal radius fractures, carpal pathology and microsurgery for soft tissue coverage.

The program provides an incredible experience in limb salvage, including TMR, RPNI, and other techniques. We also perform oncologic reconstruction, treat unusual infections and complex arthritis, contractures, and spasticity due to traumatic brain injury and stroke.

Nerve Surgery Rotation

The fellowship also has a strong brachial plexus and peripheral nerve component that provides a unique experience for our fellows. Historically, Washington University Hand faculty have been world leaders in nerve transplantation, peripheral nerve surgery, hand/upper extremity and lower extremity, carpal tunnel syndrome, tarsal tunnel syndrome, thoracic outlet syndrome, brachial plexus, cumulative trauma disorder, nerve transplant, nerve compression, facial palsy, and hand and upper extremity disorders and injuries.

Congenital Hand Surgery Rotation

Routine pediatric hand trauma, congenital pediatric hand disorders such as polydactylies and syndactylies are seen at St. Louis Children’s Hospital. The volume and variety of cases is high with 5 hand faculty participating and contributing educational value. The site support is high with its location adjacent to the adult hospital.

In order to broaden the congenital hand experience, we have joined forces with Shriners Hospital in Philadelphia. Our fellows have a required one-month congenital hand rotation with Scott Kozin, MD and Dan Zlotolow, MD. We are excited about this collaboration and know that it will continue to positively impact the experience of our fellows.

Research Opportunities

The faculty in the division of plastic surgery have a wide range of research interest and publications. Please visit the linked PubMed pages on each faculty member’s page for details. Fellows have the opportunity to collaborate with faculty on projects which have resulted in an impressive number of publications and presentations at national conferences. Despite the relatively short training program length, Fellow Achievements show what can be accomplished with the faculty at Washington University in just 1 year.

Some current areas of interest most pertinent to the hand fellows include:

  • Improving upper extremity function in spinal cord injury
  • Nerve transfers, peripheral neuropathy and nerve imaging
  • Pediatric replantation outcomes

Didactics

Hand Fellowship Conferences: Every Monday from 5-6 PM.

*If you are planning to apply for the December 15, 2021 deadline and would like the opportunity to attend Hand didactics to gain exposure to the WashU Faculty, Staff and Fellows, please contact Pam Wolf, pamela.wolf@wustl.edu, for more information.

Rotating schedule amongst the following:

  • Indications conferences: fellows alternate and present interesting cases for faculty and fellow discussion
  • Attending presentations: the yearly schedule of attending, nurse practitioner, and hand therapists talks is included below.
  • Journal Club: case based discussion of relevant literature on complex issues in hand surgery. 
  • M&M: The fellows are encouraged to prospectively track cases similar to the fashion in which people do for the American Board of Plastic Surgery/Hand subspecialty certification. Outcomes such as fracture outcomes (delayed healing/nonunion/malunion/unanticipated loss of congruence), stiffness, greater than expected pain (need for additional pains meds), as well as readmission, re-operation, and systemic adverse outcomes and death, etc., will be discussed amongst the group in a de-identified, non-pejorative, improvement-focused fashion.

Fellows are also expected to attend the following Plastic & Reconstructive Surgery Divisional Conferences and Education Sessions:

  • Plastic Surgery Grand Rounds (Wednesdays 6:30-8am)
    • During this time, the fellows will present two 30-minute Grand Rounds; one in the winter and one in the spring.
  • Upper Extremity Cadaver Dissection Lab (Wednesdays 9-10am) while on the Hand Trauma/Elective Rotation