Microsurgery Fellowship Research Articles

Analysis of the microsurgery fellowship match: 2019-2022 update.

A recent analysis of microsurgery fellowship match data published in 2019 demonstrated increased competition for available positions. With growing opportunities in the field, the authors hypothesize that the landscape for both applicants and programs has become more competitive. The aim of this study is to compare two periods of match data to inform residents and programs in microsurgery. Microsurgery fellowship match data was obtained from the San Francisco Match with approval by the American Society for Reconstructive Microsurgery for the years 2014-2022. Data were stratified into the categories of 2016-2018 and 2019-2022. Parameters assessed included: program and position fill rates, match rates, and in-service examination percentiles. Data were analyzed using Pearson's Chi-square tests and unpaired t-tests. The median number of participating programs and positions increased to 29 and 47 in 2019-2022, compared with 23 and 40 in 2016-2018. This coincided with a decrease in the number of applicants per position (1.3 [52-40] vs. 1.1 [50-47], p = .45). There was a significant increase in the match rate between groups (67.8% vs. 80.2%, p = .007). Recently, 2022 saw the lowest position fill rate on record, at 75.4% (40 of 53 positions filled), down from 85.3% (35 of 41) in 2018 (p = .35) and 95.6% (43 of 45) in 2019 (p = .006). Mean in-service examination percentiles for successfully matched applicants did not differ between (2016-2018) and (2019-2022) applicants. Recent years have seen a rise in the number of microsurgery fellowship training programs with a decline in the number of applicants. Accordingly, there has been an increased match rate for prospective applicants. Despite this, a pool of unmatched applicants and unfilled positions with training opportunities still remain. The reasons for which are likely multifactorial.

Characteristics and academic career outcomes of Godina Fellowship recipients

The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ​± ​4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ​± ​11 resulting from 160 ​± ​90 peer-reviewed manuscripts cited 3998 ​± ​2516 times. At the time of selection, Godina fellows had an average of 65 ​± ​42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.

Assessment of Microsurgery Simulation Course Access in Plastic Surgery Training Programs.

Microsurgery requires complex skill development with a steep learning curve for plastic surgery trainees. Flap dissection courses and simulation exercises are useful to acquire these skills. This study aims to assess plastic surgery training programs' access to and interest in microsurgical courses. A survey was distributed to plastic surgery residency and microsurgery fellowship program directors (PDs). The survey collected program demographics and attendance of trainees at structured microsurgical skills or flap dissection courses. We assessed if PDs thought trainees would benefit from instructional courses. There were 44 residency PD responses (44/105, 41.9%, 36 integrated, 8 independent), and 16 fellowship PD responses (16/42, 38.1%). For residency PDs, 54.5% (24/44) sent residents to flap courses, and 95% (19/20) of remaining PDs felt residents would benefit from attending. In addition, 59.1% of programs (26/44) sent residents to microsurgical skills courses, and 83.3% (15/18) of remaining PDs felt residents would benefit from attending. When examining fellowship PDs, 31.2% of programs (5/16) sent fellows to flap dissection courses and 10/11 of remaining PDs felt fellows would benefit from attending a course (90.1%). Half of programs (8/16) sent fellows to microsurgical skills courses, and 7/8 remaining PDs felt fellows would benefit from attending (87.5%). Only half of the plastic surgery trainees have access to microsurgical skills and flap dissection courses. The majority of residency and fellowship PDs feel that training courses are valuable. Expanding access to these courses could provide a significant benefit to microsurgical education in plastic surgery training.

Women in Microsurgery Fellowships: Trends and Impact on Future Practice Patterns.

While the number of female plastic surgeons has continued to increase over time, plastic surgery has historically been a male-dominated profession with only 15% of practicing plastic surgeons being female. Microsurgery, as a subspecialty, has been long perceived as an even more male-centric career path. The objective of this study was to determine the representation of females in the subspecialty field of microsurgery and the impact of microsurgical fellowship training. A review of all microsurgery fellowship programs participating in the microsurgery fellowship match from 2010 to 2019 were analyzed. Fellows were identified through fellowship Web site pages or direct contact with fellowship program coordinators and directors. The current type of practice and performance of microsurgery were also identified through a Web search and direct contact with fellowship program coordinators and directors. A total of 21 programs and 317 fellows over a 10-year period were analyzed. Over this 10-year period, there was a total of 100 (31.5%) female microsurgery fellows and 217 (68.5%) male microsurgery fellows. There was a small, statistically insignificant increase in the yearly percentage of female microsurgery fellows over this 10-year period with an average yearly increase of 2.7% (p = 0.60; 95% confidence interval: -6.9 to 13.2%). There were significantly fewer females who continued to practice microsurgery compared to males (75 [75.0%] vs. 186 [85.7%], p = 0.02). There was no significant difference in the current practice types (academic, private, and nonacademic hospital) between females and males (p = 0.29). Women are underrepresented in the field of microsurgery to a similar extent as they are underrepresented in overall plastic surgery. While there is a small insignificant increase in the number of female microsurgery fellows every year, a significantly smaller proportion of females continue to practice microsurgery compared to males.

Identifying Factors of Operative Efficiency in Head and Neck Free Flap Reconstruction

Head and neck oncological resection and reconstruction is a complex process that requires multidisciplinary collaboration and prolonged operative time. Numerous factors are associated with operative time, including a surgeon's experience, team familiarity, and the use of new technologies. It is paramount to evaluate the contribution of these factors and modalities on operative time to facilitate broad adoption of the most effective modalities and reduce complications associated with prolonged operative time. To examine the association of head and neck cancer resection and reconstruction interventions with operative time. This large cohort study included all patients who underwent head and neck oncologic resection and free flap-based reconstruction in Calgary (Alberta, Canada) between January 1, 2007, and March 31, 2020. Data were analyzed between November 2021 and May2022. The interventions that were implemented in the program were classified into team-based strategies and the introduction of new technology. Team-based strategies included introducing a standardized operative team, treatment centralization in a single institution, and introducing a microsurgery fellowship program. New technologies included use of venous coupler anastomosis and virtual surgical planning. The primary outcome was mean operative time difference before and after the implementation of each modality. Secondary outcomes included returns to the operating room within 30 days, reasons for reoperation, returns to the emergency department or readmissions to hospital within 30 days, and 2-year and 5-year disease-specific survival. Multivariate regression analyses were performed to examine the association of each modality with operative time. A total of 578 patients (179 women [30.9%]; mean [SD] age, 60.8 [12.9] years) undergoing 590 procedures met inclusion criteria. During the study period, operative time progressively decreased and reached a 32% reduction during the final years of the study. A significant reduction was observed in mean operative time following the introduction of each intervention. However, a multivariate analysis revealed that team-based strategies, including the use of a standardized nursing team, treatment centralization, and a fellowship program, were significantly associated with a reduction in operative time. The results of this cohort study suggest that among patients with head and neck cancer, use of team-based strategies was associated with significant decreases in operative time without an increase in complications.

Improving the Early Outcome of Digital Replantation: Technical Tricks Learned in a US Fellowship

Abstract Background Despite stable numbers of upper limb amputations there is a decline in replantation in Europe. This results in lacking experience, decreasing success rates, and fewer attempts. Training in high-volume centers is crucial for hand surgeons performing upper extremity replantation. Aims This abstract highlights the experience in a US microsurgery fellowship. Methods Upper extremity revascularization and replantation cases during a 10 month - period were retrospectively reviewed. Overall, the fellow was exposed to 29 cases: 2 hand, 5 thumb and 9 digitial replantations as well as 13 thumb and digital revascularizations. Primary outcome was the survival of the injured body part. Secondary outcomes were total case time, number of repaired arteries/veins, the use of vein grafts, and early free flap coverage. Whenever possible, all microsurgical steps including vessel debridement and anastomosis were performed under tourniquet. Results Success rate was 21/29 (72%). Failure was limited to avulsion or crush injuries. Mean surgery time for revascularization was 92 min (range, 45-134 min) per digit. Mean surgery time for thumb and single digit replantation was 133 min (range, 62-270 min) and for the two hand replantations 180 min and 300 min, respectively. Routinely, only 1 dominant artery was repaired. Forearm or saphenous vein grafts were used in 14/29 cases. Only in 3/23 cases > 1 vein was repaired and in 3 cases interpositional vein grafts were used for dorsal vein reconstruction. One venous flow-through flap was used and a dorsal hand soft tissue defect was covered with a fascio-cutaneous free flap 5 days after replantation. Conclusions Replantation remains a challenge for hand surgeons. The thoughtful use of a tourniquet with vessel debridement in a bloodless field is key to maximize the efficiency of replantation. Furthermore, the liberate use of vein grafts and venous flow-through flaps helps moving outside the trauma zone, thus increasing the likelihood of upper limb salvage.

Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship-Trained Women.

The "leaky pipeline" phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression. An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program. Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors. Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.

38. Social Media Usage by Plastic Surgery Fellowship Programs: Are There Gaps in Opportunities for Engagement?

Background: Social media utilization in plastic surgery training has been growing exponentially since 2010. The importance of social media for integrated plastic surgery residency programs has already been well-demonstrated in the literature, with previous studies identifying correlation between number of social media followers and program reputation on Doximity. While these findings could possibly generalize to fellowship programs, there has not been a comprehensive analysis in this space to date. Therefore, the aim of this study was to characterize major plastic surgery fellowship programs’ social media usage, in order to identify potential opportunities within the space to generate engagement. Methods: United States plastic surgery fellowship programs in four major sub-specialties (Hand, Microsurgery, Craniomaxillofacial, and Aesthetic) were identified via the public database plasticsurgeryfellowship.org. Fellowship program names and their respective conjugates were independently queried in August 2022 on three separate platforms (Instagram, Facebook, and Twitter) to evaluate for social media presence. Platform-specific parameters were collected on an account-by-account basis and statistically analyzed in aggregate. Results: 20.7% of US Hand fellowship programs had Instagram accounts, versus 6.7%, 4.2%, and 0% for Aesthetic, CMF, and Microsurgery programs respectively. Hand was the only fellowship to have a social media presence on Twitter, whereas Microsurgery and Aesthetic were the only fellowships to have social media presences on Facebook. The first fellowship Instagram account was created in May 2017, with the majority of accounts (14/23) being created between 2020 and 2021. Geographically, 30.4% of United States fellowship Instagram accounts were from programs located in the South, 30.4% from programs in the West coast, 26.1% in the Midwest, and 13.0% in the Northeast. Conclusion: Social media is underutilized by plastic surgery fellowship programs and therefore is a space with significant potential for growth. In particular, Instagram represents the platform with the most activity and promise, with median followers for fellowship programs in the hundreds or thousands. The absence of microsurgery fellowship Instagram accounts despite the large number of microsurgery fellowship programs in the US is a notable discrepancy. Such discrepancies represent significant opportunities for fellowship programs to increase visibility and engagement.

33. Microsurgical Simulation Training Enhances Medical Student Acting Internship Experience

Background: Microsurgical education typically does not begin until surgical residency, and requires significant investment of time and practice.1,2 Various models and simulations have been reported to support microsurgical training, and have mostly focused on post-graduate surgical trainees.3 It has been demonstrated that medical students are capable of learning microsurgical techniques and exposure to microsurgery may improve their interest in plastic surgery.4 There is limited literature on how exposure to microsurgery training influences senior medical students applying to plastic surgery residency. Methods: Fourth year medical students completed a four hour, individual training session with expert microsurgeon (WZ) during their acting internship. Pre-training and post-training survey responses were compared using Wilcoxon signed rank test. Results: Twelve medical students completed the training session. Eighty-three percent of students (10/12) came from institutions without a microsurgery fellowship program. Two-thirds of students had no prior hands-on microsurgery experience. Ninety-one percent of students (11/12) were either extremely or somewhat uncomfortable performing end-to-end anastomoses of synthetic vessels. After the session, 58% of students (7/12) felt extremely or somewhat comfortable, with only 17% feeling somewhat uncomfortable (p=0.003). All students rated the session as very or extremely useful, with 91% finding the level of instruction and skills practiced reasonable. When asked to rank their interest in plastic surgery subspecialties, one-third of students ranked microsurgery higher than they did prior to the training session (p=0.450). Ninety-one percent of students reported that it was important for them to be at a residency program that would prepare them to perform microsurgery independently after graduation. Conclusion: Medical students can successfully learn microsurgical skills, including vessel anastomoses, in just a single training session. Hands-on microsurgical practice opportunities enrich the acting internship experience, and may inspire greater medical student interest in the subspecialty as well as the hosting residency program. A microsurgical curriculum for medical students is in development, with plans to further optimize learning and professional growth.

Racial/Ethnic and Gender Disparities Over the Last Decade Within Microsurgery and Craniofacial Fellowship Training.

Racial/ethnic and gender disparities persist in plastic surgery at nearly all levels of training, becoming more pronounced at each stage. Recent studies have demonstrated that the proportion of female plastic surgery residents has increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. Other studies have identified severe declines in underrepresented minority plastic surgery representation between plastic surgery residents and academicians with only 1.6% of Black/African American and 4.9% of Hispanic/Latinx full professors of plastic surgery. Often, residents seek fellowship for advanced training before seeking an academic professorship. This study aims to describe the racial/ethnic and gender representation of microsurgery and craniofacial fellows. Names and photos of graduated fellows for the past 10 years (2012-2021) were extracted from microsurgery and craniofacial fellowship Web sites. Using a 2-person evaluation method, race/ethnicity and gender were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Distributions were analyzed with descriptive statistics and compared with the US population. Among 30 microsurgery fellowships, 180 graduated fellows (52.7%) were identified, resulting in 66 female fellows (36.7%) and the following racial/ethnic distribution: 113 (62.8%) White, 49 (27.2%) Asian, 12 (6.7%) Hispanic/Latinx, and 6 (3.3%) Black/African American. Among 31 craniofacial fellowships, 136 graduated fellows (45.0%) were identified, resulting in 38 female fellows (27.9%) and the following racial/ethnic distribution: 75 (55.1%) White, 45 (33.1%) Asian, 8 (5.9%) Hispanic/Latinx, and 8 (5.9%) Black/African American. The intersection between race/ethnicity and gender revealed the most disproportionately low representation among Black women. Relative to the US population, Hispanic/Latinx (0.31-fold) and Black/African American (0.48-fold) fellows were underrepresented, White (0.90-fold) fellows were nearly equally represented, and Asian (5.42-fold) fellows are overrepresented relative to the US population. Furthermore, despite pursuing fellowships at a greater rate, Asian and Black fellows are not reaching adequate representation among academic plastic surgeons. This study demonstrates that female racial/ethnic minorities are disproportionately underrepresented among microsurgery and craniofacial fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

Correlation of Scholarly Activity and Departmental Clinical Productivity in a Surgical Subspecialty

IntroductionPromotion within academic surgery involves demonstrated excellence in administrative, clinical, and scholarly activities. The present study analyzes the relationship between scholarly and clinical productivity in the field of reconstructive microsurgery. MethodsThis is a retrospective cohort study of microsurgery fellowship directors (MFDs). Data on clinical productivity were obtained from the American Society for Reconstructive Microsurgery and scholarly productivity from Scopus. Outcomes were department annual free flap volume, number of publications, and h-index. Descriptive statistics were calculated, and nonparametric tests were used to compare continuous variables. ResultsThirty-nine MFDs were included in this study. All were plastic surgery residency trained and 38% trained under the independent training pathway. Most underwent formal fellowship training in reconstructive microsurgery (89%). The top three microsurgery fellowships trained 37% of all MFDs. Twenty-five percent of MFDs trained at the institution where they ultimately became program director. Twenty percent of MFDs had an additional degree (4 MS, 2 PhD, and 1 MBA). The median number of annual free flaps performed per institution was 175 (interquartile range [IQR] 122). The median h-index was 17 (IQR 13) resulting from 48 (IQR 99) publications. There was a correlation between department annual free flap volume and h-index (r = 0.333, P = 0.038). ConclusionsThere is a correlation between academic productivity of MFDs and the clinical productivity of their department. This study provides a benchmark for aspiring reconstructive microsurgeons.

P24. Diversity in Microsurgery and Craniofacial Fellowship Training: Racial and Gender Disparities in the Last Decade

Background: Racial/ethnic and gender disparities becoming more pronounced at each stage in the pipeline to academia. Female plastic surgery residents have increased to nearly 40%, yet only 11% of full professors of plastic surgery are female. The representation of underrepresented minorities severely declines between plastic surgery residents and academicians with only 1.6% of Black/African-American and 4.9% of Hispanic/Latinx full professors of plastic surgery.1 This study aims to describe the gender and racial representation of microsurgery and craniofacial fellows and how it may be affecting the pipeline from residency to academia Methods: Names and photos of graduated fellows for the past ten years (2012-2021) were extracted from institutional websites for microsurgery and craniofacial fellowship. Using a two-person evaluation method as described in Smith et al1, race and ethnicity were primarily determined by photographic and surname and verified, when possible, through online confirmation methods (articles, social media). Racial/ethnic and gender distributions will be analyzed with ARIMA time series modeling Results: Among 30 US microsurgery fellowships, 174 (51.0%) graduated fellows were identified, resulting in 64 (36.8%) females and the following racial/ethnic distribution: 105 (60.3%) White, 51 (29.3%) Asian, 12 (6.9%) Hispanic or Latinx, and 6 (3.5%) Black or African-American. Among 31 US craniofacial fellowships, 134 (44.1%) graduated fellows were identified resulting in 39 (29.1%) females and the following racial/ethnic distribution: 74 (55.2%) White, 44 (32.8%) Asian, 7 (5.2%) Hispanic/Latinx, 8 (5.9%) Black/African-American, and 1 (0.8%) mixed race. Relative to the US population, Hispanic/Latinx (0.35-fold) and Black/African-American (0.31-fold) were underrepresented whereas Asian fellows (4.41-fold) were overrepresented Conclusion: This study demonstrates that racial/ethnic minorities are disproportionately underrepresented among fellowships. Efforts should be made to improve the recruitment of fellows of underrepresented backgrounds and thus improve the pipeline into academic careers.

Call to Action: Accreditation of Microsurgery Fellowship.

Call to Action: Accreditation of Microsurgery Fellowship.

The Newcastle Microsurgery Fellowship: A Truly Multidisciplinary Training Experience.

The Newcastle upon Tyne Hospitals NHS Foundation Trust Plastic Surgery Department offers a 12-month, intense and comprehensive fellowship covering almost every aspect of reconstructive microsurgery. Across its 2 sites at The Royal Victoria Infirmary and Freeman Hospital, over 175 free flaps are performed every year, spanning the breadth of head and neck oncology, sarcoma, facial palsy, and breast and limb reconstruction. The appointed fellow is expected to be involved in at least 90 microsurgical cases, plus a reasonable number of complex nonfree flap reconstructions. An overview of this hands-on microsurgery fellowship is hereby presented based on the experience of 2 recent fellows.

Pedicled Myocutaneous Flap Breast Reconstruction in the Community Hospital Setting: An Analysis of Cost and Complications

BackgroundFree tissue transfer breast reconstruction is an option for breast cancer patients that is precluded by a number of factors. The authors’ objective was to assess the use of pedicled myocutaneous breast reconstruction in the community hospital setting, with more limited resources, as a viable option with comparable rates of complications, cost, and outcomes.MethodsThe authors performed a retrospective cohort review of pedicled myocutaneous breast reconstructions of a single surgeon at a community-based institution from 2015 to 2019. Rates of complications, including partial and total flap failure, infection, seroma/hematoma, and reoperation were evaluated, as well as initial hospital cost, readmission cost, and subjective patient satisfaction. Statistical analysis was performed on the data and compared to published data on free flap breast reconstruction with regards to similar data points.ResultsThere were ten patients included in the analysis. This data demonstrated an immediate reoperation rate of 0%, with no incidence of partial or total flap loss, infection, seroma, hematoma, or medical complication. Delayed complications included delayed wound healing of the donor site (10%), abdominal wall bulge (10%), and umbilical partial necrosis (10%). The average length of initial stay was 5.7 days and the average initial hospital costs were $94,717.ConclusionsAs demonstrated at St. Barnabas Hospital, this type of breast reconstruction does not require the presence of a microsurgery fellowship program, high volumes, significant ancillary staff training, or other costly resources to monitor the patient, yet yields comparable or favorable rates of complications when compared to free tissue reconstruction. This allows more reconstructive options to be available to patients who may not have access to large tertiary centers for free flap reconstruction.

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

Microsurgery Fellowship Website and Social Media Presence: Are Programs Optimizing Recruitment Strategy?

Microsurgery fellowship applicants make decisions for future training based on information obtained from colleagues, mentors, and microsurgery fellowship program Websites (MFWs). In this study, we sought to evaluate the accessibility and quality of available information by microsurgery programs by analyzing the most commonly used web resources and social media outlets for applicants. The San Francisco (SF) Match and American Society of Reconstructive Microsurgery Websites were queried in April 2020 for microsurgery fellowship programs (MFPs) participating in the SF Match. Twenty-two independent variables of information were assessed on MFWs based on previously published data. Social media presence was also assessed by querying Facebook, Instagram, and Twitter for official hospital, plastic surgery residency, and microsurgery fellowship accounts. All 24 MFWs participating in the SF Match had a webpage. Program description, faculty listing, operative volume, and eligibility requirements were listed for all programs (100%). The majority of MFWs listed affiliated hospitals (75%), provided a link to the fellowship application (66.7%), listed interview dates (66.7%), and highlighted research interests (50%). A minority of MFWs provided information on conference schedule (37.5%), current fellow listing (25%), previous fellow listing (16.67%), and positions held by previous fellows (8.33%). No MFWs (0%) presented information on selection process, or rotation schedule.All hospitals with an MFP had a Facebook page and nearly all had Instagram (83.3%) and Twitter accounts (95.8%). Plastic surgery residency programs at the same institution of an MFP had social media presence on Facebook (38.9%), Twitter (38.9%), and Instagram (66.7%). Only three MFPs had Facebook accounts (12.5%) and none had Instagram or Twitter accounts. As the field of microsurgery continues to grow, the need for effective recruitment and training of microsurgeons continues to be essential. Overall, we conclude that both the accessibility and quality of information available to applicants are limited, which is a missed opportunity for recruitment.

The Ideal Microsurgery Fellowship: A Survey of Fellows and Fellowship Directors

Although microsurgery fellowships have existed since the 1980s, there is no established curriculum. Microsurgery fellowships vary greatly in clinical caseload, case diversity, and training resources, and there is no consensus on the appropriate composition of a microsurgery fellowship. This study surveys fellowship directors (FD) and recent microsurgery fellows (MFs), graduates, to describe the ideal microsurgery fellowship program. A 15-item questionnaire was sent to 38 FDs and 90 recent microsurgery fellowship graduates. This questionnaire addressed program attributes, case volumes and compositions, ideal experiences, and time allocation to different fellowship experiences. Data were analyzed using descriptive statistics, t-tests, and Chi-squared tests. The FD and MF surveys had a response rate of 47 and 49%, respectively. Both MF and FD agreed that exposure to microsurgical breast reconstruction is the most important characteristic of a microsurgery fellowship (p = 0.94). MF ranked replantation and supermicro/lymphatic surgery as the next most important microsurgical cases, while FD ranked the anterolateral thigh (ALT) flap and free fibula flap (p < 0.001). Both agreed that revisional surgery after microsurgical reconstruction is a very valuable fellowship experience (p = 0.679). Both agreed that 1 day of clinic a week is sufficient. Microsurgical training programs vary in quality and resources. The ideal microsurgery fellowship prioritized breast reconstruction, head and neck reconstruction, and lower extremity reconstruction. Although microsurgical technical expertise is important, a fellowship should also train in revisional surgeries and clinical decision making.

Microsurgery Training in Plastic Surgery.

Summary:Advances in surgical instruments, magnification technology, perforator dissection techniques, and vascular imaging over the past decades have facilitated exponential growth in the field of microsurgery. With wide application potential including but not limited to limb salvage, breast reconstruction, lymphedema treatment, and sex affirmation surgery, microsurgery represents a critical skill set that powerfully augments the reconstructive armamentarium of plastic surgeons. Accordingly, microsurgical training is now a critical component of the plastic surgery residency education curriculum. Trainees must meet minimum microsurgery case requirements in addition to the core competencies outlined by the Accreditation Council for Graduate Medical Education. Through the use of simulation models, residency programs increasingly incorporate early skills development and assessment in microsurgery in the laboratory. Beyond residency, microsurgery fellowships offer additional exposure and refinement by offering volume, complexity, autonomy, and possible focused specialization. With continued refinement in technology and advances in knowledge, new types of simulation training models will continue to be developed and incorporated into microsurgery training curricula.

Abstract 13: Microsurgery Fellowship Entrustable Professional Activity Curriculum

Abstract 13: Microsurgery Fellowship Entrustable Professional Activity Curriculum