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which residency for burn grafting?

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stolen_biscuit

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I was wondering if anyone knew how to go about training to do burn grafting at a burn center?
I recently assisted in grafting in the OR and really loved the artistic aspect of it and the fact that it will not be going minimally invasive, as many surgical specialties are doing.

I initially assumed general surgery (so I could manage pts in Burn ICU also) followed by a burn fellowship, but then someone clued me in that burn fellowships were not necessarily...effective.
Plastics was suggested, but I don't particularly care for most of what they do, and I didn't see anything about plastics residencies that specialize in burns. Plus, on the plastics threads, it seems most people say they don't really get ICU-type training, just the reconstruction. Also, while my numbers are competitive and I do have some published research, it is not in plastics as I previously had no interested, and my school does not have a PRS dept; I'm not convinced of the likelihood of getting a residency. Is that really the only way to go?

I am not at all interested in trauma lifestyle.

(I apologize if this info is on here somewhere. I searched with many different combinations of words and couldn't find anything.)
 

Winged Scapula

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What do you mean by [burn fellowship] "is not effective"?

If you want to do burns without the rest of PRS, then it's the way to go.
 

stolen_biscuit

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Thank you for the replies.

Winged Scapula - I don't even know what I mean, but I was asking a resident about it and was told not to do a burn fellowship unless you can't get a plastics residency/fellowship? As I mentioned, this is all brand new to me. Since MS1, I have been intending to do another surgical specialty.

SouthernSurgeon - Yes, the burn surgeon I worked with also suggested plastics based on my interest and experience in crafting. I do agree that the burn surgery wasn't the prettiest, but I found it to be like quilting...fitting to an area, tiny little stitches over fingers. Very cool. Outcome is definitely not the most aesthetic thing. Considering that I had only seen surgeries within body spaces previously, however, it was just an entirely different concept. I do not know if I'd like other parts of PRS (as mentioned, I have no exposure at my school), but I previously associated it only with the cosmetic spas in my area, which have never drawn interest from me. Maybe I should find time to visit some of the private PRS surgeons around here. I have been working with a breast surgeon who does her own reconstruction, and I will admit, after going to the ASBS conference in the spring and being shown videos on developing techniques, I did find myself impressed.
 

bc65

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I agree with the posters above.. Burn fellowships focus primarily on the acute care. As mentioned above, the skin grafting you saw is the crudest and least artistic aspect of plastic surgery. I think the tiny suturing around the fingers that you liked is not something that will hold your interest for long, but if you like that at all, you might like plastic surgery. Most plastic surgeons do mostly reconstructive surgery. However, investigate a lot more. Burn surgery itself is God's work, but can be a very frustrating, Sisyphus -like task. in that:

1. You graft
2. the graft contracts over time,
3. you release the graft,
4. Go to step 1.

If you like plastic surgery, you might also like ortho, although the similarities might not be obvious until you get deeper into both.
 
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bc65

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my school does not have a PRS dept; I'm not convinced of the likelihood of getting a residency. Is that really the only way to go?

If you want to do burns, but can't match into an integrated plastics program, you certainly can go the general surgery to burns route, but if you want to do any reconstruction beyond the simple skin grafts, you would probably need to do plastic surgery. If you go the general surgery route, and burns, you would have a leg up on getting into plastics afterwards, but that would be gen surg + burn + plastic surgery, so at least 9 years, plus whatever research you end up doing, either because you want to or your program requires it. Lots of people go that route, but there would still be no guarantee that you would get in.

You would also need to find out if there are jobs for you in burn units. You might have to move for a job, or you might end up having to do general surgery. You would probably have a better lifestyle and higher income in ortho, but there you reconstruct primarily bone rather than primarily soft tissue, and while you wouldn't get to admire your work from the outside, you would get to admire the xrays. It's a slightly different skill set, but a similar mind set, at least in my opinion.
 
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stolen_biscuit

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I most definitely need to do a lot of investigation into all of this, and so I appreciate your replies. Without a PRS contact at my school, I was trying to look things up myself, and now at least I know what to look into and what direction I would take if I end up captivated.

I think the tiny suturing around the fingers that you liked is not something that will hold your interest for long, but if you like that at all, you might like plastic surgery. Burn surgery itself is God's work, but can be a very frustrating, Sisyphus -like task. in that:
1. You graft
2. the graft contracts over time,
3. you release the graft,
4. Go to step 1.

I may be unusual in this sense, but I do think tiny sutures would make me happy for a long time. I sew gifts in my spare time and have made quilts during my school holidays last year. :)
That does sound very frustrating though! I do plan on spending more time in our Burn ICU to really get a feel for that.
ETA: When we were at Trauma & Burn M&M recently, I remember thinking, "I wonder what could be done to minimize those problems." Made me realize there is a lot of opportunity for research in burn grafting.

Additional cons to burns:
1. Sh******e patients who set themselves on fire while cooking meth/smoking on oxygen/setting various things on fire with gasoline. Or who burn their kids through either negligence, stupidity, or abuse
2. Tremendous rates of withdrawal on your inpatient service
3. Patients who smoke and their grafts fall off

Ugh. Yes, one of the ones I saw recently was burned due to falling asleep while smoking.

You might have to move for a job, or you might end up having to do general surgery. You would probably have a better lifestyle and higher income in ortho, but there you reconstruct primarily bone rather than primarily soft tissue, and while you wouldn't get to admire your work from the outside, you would get to admire the xrays. It's a slightly different skill set, but a similar mind set, at least in my opinion.

Moving and income don't bother me a ton. But 10y of residency might! I think 6-7 might be my limit there.

I wouldn't have guessed that people in PRS and Ortho are of similar mindset. I thought the carpentry part of Ortho was fun, but I don't really have much interest beyond that.

My intent since beginning shadowing as an MS1 has been to do Urology, and I know I would be happy with that. I have always fit in with the personalities of both docs and pts, and I like the type of interventions they have available. I only dislike the robotic surgeries, which I know I will have to train in regardless (although I don't think what research has shown in outcomes justifies this); I suppose I would have to have grown up as a gamer to enjoy that.
I was just so excited to see I could possible combine my hobbies with surgery! That's why I want to look into what that would look like in terms of training and career.

Thank you again for the information.
 
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MediCane2006

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Burn surgery is literally the LEAST artistic surgery we do as plastic surgeons. OP, check out plastics as a specialty. There is plenty of "tiny sutures"-type stuff that doesn't involve the misery of burn surgery.

(In fairness though, burn surgery does reimburse tremendously well)
 
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ACSurgeon

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I was wondering if anyone knew how to go about training to do burn grafting at a burn center?
I recently assisted in grafting in the OR and really loved the artistic aspect of it and the fact that it will not be going minimally invasive, as many surgical specialties are doing.

I initially assumed general surgery (so I could manage pts in Burn ICU also) followed by a burn fellowship, but then someone clued me in that burn fellowships were not necessarily...effective.
Plastics was suggested, but I don't particularly care for most of what they do, and I didn't see anything about plastics residencies that specialize in burns. Plus, on the plastics threads, it seems most people say they don't really get ICU-type training, just the reconstruction. Also, while my numbers are competitive and I do have some published research, it is not in plastics as I previously had no interested, and my school does not have a PRS dept; I'm not convinced of the likelihood of getting a residency. Is that really the only way to go?

I am not at all interested in trauma lifestyle.

(I apologize if this info is on here somewhere. I searched with many different combinations of words and couldn't find anything.)

I'm not sure burn surgeons have a better lifestyle.

General surgeons with burn fellowships manage the acute burn, they do split thickness skin grafts, and some simple flaps. Plastic surgeons do more complex grafting/flapping but I doubt you'll find a plastic surgeon who only works on burn patients. You can do other complex flaps and reconstruction, so if microvascular surgery is interesting to you, then plastics might be your thing. Lifestyle would also be better than that of a trauma or burn surgeon.
 
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