The Chang Gung Memorial Hospital Microsurgery Fellowship: A Review of 1 Year of Experience.

Abstract

Sir: The microsurgery fellowship at the Chang Gung Memorial Hospital in Taiwan was founded in 1984 by Professor Fu Chan Wei.1 The Department of Plastic and Reconstructive Surgery offers a 1-year fellowship in microsurgery. The fellowship setup, diversity and number of cases, and high success rate make it a sought target for training. In this article, I share my personal experience from a 1-year fellowship as a guide tool for those considering microsurgery training at this prestigious institution. FELLOWSHIP SETUP This fellowship is provided by the Division of Microsurgery at the Department of Plastic and Reconstructive Surgery. In total, 6 to 8 fellows are selected annually for duration of 1 year. Different areas of reconstruction are covered during the fellowship, and rotations can be customized based on the need and interest of the fellows, and these areas include head and neck reconstruction, breast reconstruction and lymphedema surgery, upper limb reconstruction, lower limb and trauma reconstruction, peripheral nerve, and facial reanimation. The fellowship is based on the principle of mentorship, and the year is composed of six 2-month rotations, where in each rotation, the team is composed of the professor, the fellow, and 1 resident. The fellow is engaged actively in the clinical and operative activity including the preoperative planning and postoperative care. There is no assigned on-call schedule for the fellow; however, he/she is expected to be in any flap takeback for the team as part of the learning experience. Table 1 summarizes the structure of the fellowship.Table 1.: Fellowship StructureEDUCATION Activities that emphasize educational value to enrich the theoretical knowledge and surgical judgment skills are as follows: Biweekly plastic surgery grand rounds: Valuable review of topics in plastic surgery, updates, and new researches are discussed. Weekly microsurgery teaching rounds: During this meeting, a review of scientific microsurgery articles, book chapters, and all cases mandates exploration during that week. Thirty-four scientific articles and 8 book chapters were reviewed this year. Operative education: Formal teaching about surgical cases is done at the day of surgery where there will be a full presentation of the cases followed by relevant literature review. SURGICAL CASES AND WORKLOAD There was an average of 3 operative days, with 2 rooms running simultaneously, and 1½ clinic days each week. The cases included microsurgical cases (free flaps, peripheral nerve surgery, and lymphatic surgery), pedicle flap, and secondary revision for all procedures. I was involved in a total of 164 cases: 101 microsurgical cases, 4 pedicled flaps, and 59 nonmicrosurgical cases. Table 2 summarizes the areas and flaps for reconstruction.Table 2.: Area of Reconstruction and Types of Free FlapRESEARCH OPPORTUNITY AND FUNDING There are ample opportunities for research in different aspects of reconstructive microsurgery. Funding is not promised for the fellow during this year. CONCLUSIONS The microsurgery fellowship at the Chang Gung Memorial Hospital provides an unparalleled opportunity to learn, understand, and practice microsurgery. I personally liked the fellowship setup, diversity and surgical loads, and the advanced techniques used here, which I think are reproducible and essential to achieve competency in microsurgery. ACKNOWLEDGMENTS The author would like to acknowledge all the professors at the Department of Plastic Surgery and the Ministry of Foreign Affairs of Taiwan (MOFA).