Hands: Ortho v. Plastics

[pagemmapants]

I'm really fascinated by hand surgeries, particularly the developing approach to hand transplantations that's been going on for the past 9 years or so. My question is, is it better to approach hand surgery via ortho or via plastics? I think most hand surgeons are originally orthopedists, but do both fields lead into the same hand fellowships or are there separate hand fellowships for plastics-trained and ortho-trained?
In the interest of full disclosure I'm a 5'2" female. But I'm strong!

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[maxheadroom]

First, most hand surgeons would tell you that hand transplantation has been a failure. I think Andy Lee wrote a pretty nice editorial on this a year or two ago. At least one US hand transplant patient has had his transplanted hand amputated. Transplanted hands lack intrinsic motor function and do not gain very good sensation. The continued improvements in prosthetics make hand transplants overall an untenable option. The larger field of composite tissue allotransplantation (face transplants most notably) depends upon systemic immunosuppression -- something that most physicians do not take lightly.

Hand surgery is a great field! Cases are fun. You get to sit down! Most cases are fairly short (less than an hour), but there are some really long cases, especially associated with upper extremity trauma. You have a great opportunity to impact a patient's ability to take care of themselves, earn a living, and function in the world.

Both ortho and plastics are good pathways to hand surgery. You really need to figure out which field you like more. Do you like doing hand surgery plus breast and facial surgery? Do you like fixing lower extremity fractures and doing total joints? That was the question that I asked myself. Plastics training was an easy answer for me.

Scott Levin is a big time upper extremity specialist and microsurgeon at Duke. He completed both ortho training and plastics training.

Hand fellowships will take people from either field. While there are "ortho" hand fellowships and "plastics" hand fellowships, most fellowships include some cross-training.

 

[pagemmapants]

Yeah, I'm in discussion with Dr. Levin about doing my 3rd year research in his CTA lab. As I'm just finishing up my first year it's still very preliminary, but it sounds like an absolutely incredible option.

I guess I'll see what I can do about getting both ortho and plastics electives next year and see how they go. Thanks for the info. Are you heading into hands? Ever since I first saw those perforated tendons I've been enthralled.

 

[babern]

I believe I have also heard that general surgeons can also get into hand fellowships. Is this true? I would think it would be a less optimal approach, but I'm prett sure one GS from my program went into a hand fellowship a few years ago.

 

[pagemmapants]

I have also heard that general surgeons can also get into hand fellowships

Huh, I haven't heard that before but it's definitely something to consider. However, that does mean having to put up with loops of bowel for a while. Yuck.

 

[berkeleyboy]

Huh, I haven't heard that before but it's definitely something to consider. However, that does mean having to put up with loops of bowel for a while. Yuck.

YES its absolutely true. Gen surg can def. go into hand fellowships. Many go into plastics after hand.

 

[plasticdraper]

Hello, congratulations on your interest in hand! The field is dominated by orthopedics but in my opinion, plastic surgeons remain a vital component to this field.

If you are purely interested in hand surgery, my opinion is that orthopedics provides a better background for fellowship and advanced training. AO principles are not generally taught in most plastic surgery programs and this is particularly important in forearm and elbow injuries.

That being said, many pioneer hand surgeons were plastics trained and there is a relative advantage in microsurgery that I've seen in plastics-trained hand surgeons vs. orthopedics, though certainly, I've seen great microsurgeons of both disciplines.

If I could do things over again and wanted to be the penultimate hand surgeon, I would have done an ortho residency, plastics fellowship and then ortho-based hand fellowship. That being said, if you have other interests in either ortho or plastics, that should guide your decision rather than being purely invested in hand surgery.