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THE BUNCKE CLINIC HAND AND MICROSURGICAL FELLOWSHIPS
CPMC DAVIES CAMPUS, SAN FRANCISCO

Senior Clinical Fellows:
Individuals who have completed their training in Plastic Surgery or Orthopaedic Surgery are eligible to apply for our two ACGME accredited positions. The clinical volume of the fellowship will address upper and lower extremity trauma as well as the full breadth of reconstructive microsurgery using the most advanced techniques (see Procedures Performed at the Buncke Clinic). The senior fellows will have graded responsibility for 3-6 months and will be under the proctorship and mentorship of full-time attendings of the Buncke Clinic at all times.

The twelve month fellowship begins July 1st of each year. To apply, please send letter of intent, CV, passport sized photo and three letters of recommendation (one from current chief of service) to the attention of Dr. Gregory Buncke.

Junior Clinical Fellows:
Individuals who are in the midst of training in Plastic, Orthopaedic Surgery or General Surgery may apply for this fellowship. This fellowship is not an accredited position, but junior fellows may participate it all clinic and research activities, including clinical call. Patient management and operative skills will be stressed; however, junior fellows do not operate independently nor admit patients to the hospital. The junior fellowship can be for 6 months or 12 months. This fellowship is an excellent opportunity to prepare or to be accepted into a plastic surgery training program as the volume and breadth of cases will address most of the components of a plastic and reconstructive surgery residency.

To apply, please send letter of intent, CV, passport sized photo and three letters of recommendation (one from current chief of service) to the attention of Dr. Gregory Buncke.

Research Fellows:
Research Fellows work in the Research Laboratory, make clinical rounds and attend meetings. They usually do not scrub on operations or take clinical call. However, if they have a California license to practice medicine, they may function clinically as well.

To apply, please send letter of intent and CV to the attention of Dr. Gregory Buncke.

A Unique Service:
The Microsurgery Service at CPMC Davies in San Francisco is unique in that it is one of the major services of the hospital. Most referrals come directly to the service from outlying hospital emergency rooms or private physicians. The service is staffed by plastic surgeons of considerable experience in upper extremity trauma and all forms of acute and chronic injury. The attending on call has the primary responsibility of evaluating all potential referrals and must filter these calls carefully before accepting cases. When associated injuries are suspected, general surgeons, neurosurgeons and orthopaedic surgeons are immediately notified. The team approach is used at all times. Orthopaedists scrub on all major limb replants and general surgeons are brought in in any case of multiple trauma. Neurosurgeons scrub when appropriate. We also work closely with our medical colleagues and any patient with metabolic or cardiopulmonary problems is carefully evaluated preoperatively, intra-operatively and postoperatively. As per hospital regulation, all children have a pediatrician following them.

On elective cases, free use of consultations with our colleagues in related specialties is the rule. In return, we are often called in by other services to consult concerning the management of complex problems in all regions of the body which require reconstruction (see Procedures Performed at the Buncke Clinic).

Research Component:
Research is an important part of our Fellowship and has been since its inception in 1972. Over 400 publications have been generated by this service, most of them in the fields of clinical and laboratory research in microsurgery and hand surgery. All fellows are encouraged to become involved in on-going research projects and to develop their own protocols to solve problems encountered in the operating room and in the management of complex cases. We all subscribe to the scientific method and the motto of the laboratory is: "Ideas are cheap, results are priceless."

Preliminary protocols are presented at the weekly division meeting. Suggestions and criticisms are incorporated and attendings and additional investigators if needed are assigned to each project. Final protocols are then submitted to the laboratory director and the program director, including budgets and a time-schedule.

Periodic progress reports are again presented at division meetings and discussion is encouraged. Preliminary and final results are submitted in abstract form to local and national meetings and worthwhile projects are almost always brought to some sort of publication in peer review journals.

The fellows are free to use the laboratory during the day and in the evening and can arrange for free time with their colleagues for concentrated exposure.

All funding is through the Microsurgical Transplantation Research Foundation and the Franklin Benevolent Corporation. Occasional seed grants are received from various organizations, private foundations, private sources and federal grants. A list of previous grants is available and is included in the supplemental material for the on-site visitor.

Resources available in the Microsurgery Laboratory.
The Harry J. Buncke Microsurgery Laboratory is one of the oldest microsurgical teaching and research laboratories in the United States.; It has been associated with CPMC Davies since 1971 (the facility was known the Davies Medical Center until 1998), and has served as a model for several other microsurgery laboratories around the country.

The laboratory, under the direction of Harry J. Buncke, M.D., has a reputation of excellence in teaching and clinically-oriented research. Over the years, the laboratory has attracted research personnel from over forty-seven countries.

1. The Laboratory has 1300 square feet of floor space. This includes a main laboratory (440 sq. ft.); research fellows room (165 sq. ft.); workroom/storage room (187 sq. ft.); display room (100 sq. ft.); video editing/graphics room (200 sq. ft.); office/repair shop (220 sq. ft.). There is also a temperature-controlled animal room and prep. room (400 sq. ft.). The main laboratory has six work-stations. Three of these stations can be used for teaching and dissection (a stock of frozen arms and legs is maintained for dissection purposes). One station is equipped for photomicrography and another for videomicography. All stations are equipped with Zeiss operative microscopes, surgical and microsurgical instruments, and bipolar coagulators. The room has been wired for surgical lasers and has facilities for bottled gasses. The fellows room has office/study space for three researchers. There is also a computer with fax and voice-mail capabilities and a laser printer for their use. The normal complement of M.D. researchers is three. Clinical researchers and observers have office space in the Microsurgery office). The workroom/storage room is equipped with a sink, refrigerator, bandsaw (for preparation of frozen specimens) and soon will have a small hyperbaric chamber. The video\graphics room is equipped with a 3/4" Sony video editor, audio mixer, tape deck, CD player, film/video processor, two computers with graphics capabilities, computer slide-maker, four video monitors, Videosho slide show device, VHS and SVHS cassette decks, three video cameras, set-up for transferring 8mm film to videotape and a color scanner with word-recognition capabilities. It also contains master patient tapes (operative, preoperative and postoperative) and presentation and instructional tapes of the Microsurgery Department. The office\repair shop is used for tape, drug and surgical supply storage. It also has a small shop for repairing and modifying electronic, video and microsurgical instruments. 
    
2. Equipment available. The laboratory has eight functional microscopes; seven floor-mount Zeiss operative microscopes, five of which are dual-headed, one dual-headed portable microscope and one bench-mount Mentor fixed-focus microscope, a storage oscilloscope, bench-mount nerve and muscle stimulators, magnetic and thermal blood-flow meters, electromyograph, two freezers and two refrigerators, bipolar coagulators, hand tools, surgical instruments and supplies, video cassette decks, monitors, slide projector, slide maker, three computers, laser printer, two twenty-four-pin printers and three chart recorders. 
    
3. Capabilities. The laboratory is equipped for small animal surgery (both training and research), anatomical preparation and dissection, videotaping and production, tape duplication and format changing and presentation slide and overhead creation and production. 
    
4. Other resources. E. M. , SEM, histology, blood chemistry, etc., are done either in other departments of the Davies Medical Center or can be done in specialized laboratories at Stanford University or at the University of California at San Francisco. 
    
5. Attached are a list of videos available in the Microsurgery Laboratory (this does not include videos available in other departments) and a partial listing of the research published, presentations and videos produced in the laboratory.