Fah-Q: exposure to reconstructive and aesthetic techniques in the head & neck will vary GREATLY among ENT programs from almost zero (where I train) to signifigant (say Univ. of Iowa => a KILLER ENT program). Talking with my friends in ENT, aesthetics training is almost universally weak around the country & reconstructive training varies with the interest of the staff. Here in Louisville, Plastic Surgery does all the big head & neck reconstructions for our excellent MD Anderson oncology trained ENT's (this is the most common scenario in private practice as well). At other places, it may be split or done by ENT themselves (although the length of some of the head & neck resections makes most people less than enthusiastic about starting another marathon reconstruction to follow). As far as whether a graduating ENT will have done more plastic surgery-type procedures than a fellowship trained PRS...... They may have been in the room watching their upper level ENT's do them while holding retractors, but heavy operative experience doing those things is not the norm @ most programs during most of their training.
That being said, an ENT background does bring a lot to the table for Plastic Surgery should they do a fellowship in it. We had a awesome fellow when I was an intern who had done ENT, then facial plastics, then private practice for 2 years prior to Plastc Surgery (this scenario apparently is not to uncommon as I met a number of people interviewing for fellowships who had already done ENT + facial plastics b/c they felt limited in what they could do) He was really gifted on head and neck anatomy, but struggled with some of the other areas as compared to his peers. General surgeons who do plastic surgery tend to have less experience with facial fractures & some of the anatomy of the mid-face, but bring a much more signifigant experience in vascular, breast, tissue-handling, burns, wounds/wound healing, patient care, and usually overall operative experience. Orthopedic background usually brings a lot of hand and extremity anatomy experience & fracture fixation techniques but with horrible tissue handling habits and little head/neck and no breast work. OMFS is similar to ENT without the oncology background, but with the best craniofacial experience & the best @ mandibular fx. repairs. Each pathway has its advantage/disadvantage, but I humbly submit that general surgery has probably the fewest "holes" in their training. The integreated positions are an attempt @ a compromise b/w an acceptable training & financial constraits. It seems to work @ some places, but the experience from all these other backgrounds is hard to "compress" into 3 years of bits & pieces of each of them to me. It would seem to me that a 4 + 3 model like Univ. of Chicago would be the best compromise, with most of that first 4 being a general surgeon.
Arthur v- I have probably done @ least 150 excisions of skin cancers including basal cell, squamous cell, melanoma, etc. You can probably half as many liopmas, nevi, warts, debridements,etc.. on top of that. We have extensive experience in skin-grafting during our training (from burns, trauma, & some cancer excisions) & routinely use any number of local flaps and a few specific type of pedicled flaps from head to toe. We do not do major facial advancement-type flaps & I have not done any signifigant MOHS excision-type surgeries, the best technique for SCC excision on the head/neck.
