|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
|While it is true that complex microsurgical procedures can be performed by a single surgeon with an experienced operating room crew,1 our microsurgical unit has evolved into a large team. We feel that our organization allows us to deliver optimum care to our large volume of emergency and elective patients while we also perform clinical teaching and laboratory research.
Each year we manage approximately 180 patients referred for emergency microsurgery; 120 patients receiving elective microsurgical procedures (including flap transfer, toe transfer, and neural reconstructions); and 700 patients undergoing emergency, reconstructive, and cosmetic procedures. In addition, we supervise as many as 6 clinical fellows and 4 laboratory fellows, and produce approximately 60 publications and presentations a year. Our arrangement of clinical and adjunctive personnel reflects our commitment to demanding and diverse clinical, educational, and research interests.
Each 24-hour period is covered by an emergency surgical team consisting of a staff surgeon and two clinical fellows. This team is responsible for accepting and managing all emergency referrals. Three surgeons can readily perform a replantation case, including tagging of parts, recipient site dissection, and vein and skin graft harvesting, while rotating operating time in such a way that no one surgeon must work more than 4 hours consecutively. Three-man coverage also permits some overlapping of cases, so that a second replantation case can be started while a first case is in progress. When more than three surgeons are needed for multiple cases, volunteers must be recruited from staff surgeons and fellows not on call.
The staff surgeons, numbering four to five, are committed to making emergency referrals their first priority on their call days and providing necessary relief if multiple emergencies arrive.
The clinical fellows, who number between four and six individuals, function as either junior or senior fellows. Junior fellows, who are usually in the midst of their plastic, orthopedic, or general surgery residencies, operate under staff supervision, which decreases with the progress of the resident. Senior fellows, who have completed their residencies, begin to operate under staff supervision and are allowed to progress toward independent operating and staff responsibilities as they demonstrate competence. Senior staff members are always available for consultation. The emergency cases provide ample clinical opportunities for instruction in decision making and microsurgical technique.
Operating Room Teams
Our center maintains three fully equipped microsurgical operating rooms and provides sufficient experienced personnel to allow three microsurgical cases to proceed simultaneously. These resources allow us to accept frequent emergency cases while other emergency and elective microsurgical cases are in progress.
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