Face Transplant Surgery

[bluepink21]

All, but one, of the lead surgeons in facial transplant cases, Siemionow etc, are plastic surgeons. Residency trained in 5 year general surgeons + 2/3 year plastic surgery residency. (Devauchelle from France is an OMF surgeon, but he's the only non plastic program lead.) Wouldn't an ENT residency followed by a 2/3 year plastic surgery residency be better training for the vastly complex facial reconstruction required for face transplants; compared to thoracotomies and bowel resections completed in general surgery, ENT surgeons have spent 4/5 years studying facial anatomy and physiology and are already experts in head and neck surgery.

TL;DR Why are face transplant surgeons General + Plastic. Shouldn't ENT + Plastic serve as better preparation for complex face reconstruction.

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[neusu]

The surgeons who designed and implemented the procedure are attendings who have years of specialization after training. While your question seems reasonable, who would be better trained to do this, the answer is not simple in any way. Cosmetic surgery of the face is performed by both plastic surgeons and ENT surgeons with a plastics fellowship.

When it comes to the more complex portions of the case, such as neurovascular anastamosis, plastic surgery is more commonly performing procedures in this realm.

To put it this way, neither ENT nor general surgery is adequate training. The fellowship lays the ground work. Practice patterns and specific interests played a significant role.

 

[LilKangaroo]

For one, most plastic surgeons in the US are now trained in an integrated residency of 6 years, fewer and fewer are going Gen+Plastics.

Further more, if they have any hopes of doing facial transplants, they would have to do a Facial Plastics fellowship. So it's essentially the same as ENT+Plastics.

I don't think most people realize that plastic surgeons are the experts at microvascular and peripheral nerve surgery, which would be essential for a facial transplant. I would trust a plastic surgeon over an ENT to do my facial transplant, should I ever need it.

 

[bluepink21]

The surgeons who designed and implemented the procedure are attendings who have years of specialization after training. While your question seems reasonable, who would be better trained to do this, the answer is not simple in any way. Cosmetic surgery of the face is performed by both plastic surgeons and ENT surgeons with a plastics fellowship.

When it comes to the more complex portions of the case, such as neurovascular anastamosis, plastic surgery is more commonly performing procedures in this realm.

To put it this way, neither ENT nor general surgery is adequate training. The fellowship lays the ground work. Practice patterns and specific interests played a significant role.

For one, most plastic surgeons in the US are now trained in an integrated residency of 6 years, fewer and fewer are going Gen+Plastics.

Further more, if they have any hopes of doing facial transplants, they would have to do a Facial Plastics fellowship. So it's essentially the same as ENT+Plastics.

I don't think most people realize that plastic surgeons are the experts at microvascular and peripheral nerve surgery, which would be essential for a facial transplant. I would trust a plastic surgeon over an ENT to do my facial transplant, should I ever need it.

I agree with both of these comments that people underestimate plastic surgeons. The fantastic vascular and perinerve surgeries they perform on the hand transplants for example are amazing and clearly applicable to face transplants (which is why hand transplant surgeons work in the programs extensively.). But my point was that the similar length of training for Gen+plastic vs ENT+plastic would be better spent on the head and neck not thorax and abdomen. I wasn't saying ENT surgeons should do it, but ENT residency instead of general surgery followed by plastic surgery.

LilKangaroo : "Further more, if they have any hopes of doing facial transplants, they would have to do a Facial Plastics fellowship". Is this referring to Plastic Surgeons having to do Facial Plastics Fellowships or ENT residents?

 

[LilKangaroo]

I agree with both of these comments that people underestimate plastic surgeons. The fantastic vascular and perinerve surgeries they perform on the hand transplants for example are amazing and clearly applicable to face transplants (which is why hand transplant surgeons work in the programs extensively.). But my point was that the similar length of training for Gen+plastic vs ENT+plastic would be better spent on the head and neck not thorax and abdomen. I wasn't saying ENT surgeons should do it, but ENT residency instead of general surgery followed by plastic surgery.

LilKangaroo : "Further more, if they have any hopes of doing facial transplants, they would have to do a Facial Plastics fellowship". Is this referring to Plastic Surgeons having to do Facial Plastics Fellowships or ENT residents?

That comment was specifically about plastic surgeons.

Again, I'll reiterate the point that most plastic surgeons DO NOT do a general surgery residency anymore.

 

[bluepink21]

That comment was specifically about plastic surgeons.

Again, I'll reiterate the point that most plastic surgeons DO NOT do a general surgery residency anymore.

Yeah I know about the uptake in integrated residencies, but they wouldn't have been available for Bernard, Siemionow, Pomahac, rodriguez etc are 40/50 years old so wouldn't have the option. But they would have had the option of ENT + Plastics. The question was trying to gauge the skills of ENT vs General surgery specially for complex reconstructive procedures that these surgeons perform.

 

[LilKangaroo]

Yeah I know about the uptake in integrated residencies, but they wouldn't have been available for Bernard, Siemionow, Pomahac, rodriguez etc are 40/50 years old so wouldn't have the option. But they would have had the option of ENT + Plastics. The question was trying to gauge the skills of ENT vs General surgery specially for complex reconstructive procedures that these surgeons perform.

Well, the simple and very true answer to your question is that they could not foresee the future and know that they were going to be doing facial transplant surgery. They probably wanted to be generalized plastic surgeons and developed their interests further. Also, there is not nearly as much microvascular and peripheral nerve experience in ENT or the ENT Plastics fellowship as compared to a Plastic Surgery fellowship.

And for what it's worth, Sieminow didn't do a general surgery residency. She did an orthopedics residency before her microvascular fellowship.

 

[bluepink21]

Well, the simple and very true answer to your question is that they could not foresee the future and know that they were going to be doing facial transplant surgery. They probably wanted to be generalized plastic surgeons and developed their interests further. Also, there is not nearly as much microvascular and peripheral nerve experience in ENT or the ENT Plastics fellowship as compared to a Plastic Surgery fellowship.

And for what it's worth, Sieminow didn't do a general surgery residency. She did an orthopedics residency before her microvascular fellowship.

I guess thats true. Facial transplant has only really even hoguht of possible since the dawn of the century. I think its amazing how well and successful and complex the procedures are now after only a decade and a half and only about 30/40 procedures.

 

[cactusman]

Why is this in pre-med?

 

[21Rush12]

Why don't they just have CT/Neurosurg/plastics as one integrated residency?


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[Ismet]

Why is this in pre-med?

Because the OP is a pre-med.

 

[Raryn]

Why don't they just have CT/Neurosurg/plastics as one integrated residency?


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Because it would be 20 years long.

Edit: Just saw this is a reference to another pre-allo thread. It's been forever since I browsed this subforum, so you can chalk it up to me being out of touch.

 

[21Rush12]

@Raryn No offense taken, sarcasm is rarely captured well in text. I hope you had the chance to read that whole thread, it's positively riveting.


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