by Anup Patel, MD, MBA
While plastic surgery certainly proves to be among one of the smallest medical communities, this can be advantageous for those seeking to experience an away rotation. Most of the plastic surgery community proves accessible with a few phone calls or emails. For me, I contacted my close friends, Antonio J. Forte and Matthew Mcrae, the two fellows at the Buncke Clinic, and Brian White, the fellow at the University of Southern California (USC) Hand and Microsurgery Program, about spending some time with them at their respective institutions. They facilitated my approval to rotate with them and their attendings.
Add to this Justin and Amy Watzka, my friends from high-school and whose apartment was two blocks from the Buncke Clinic, called me in August to tell me about the incredible surgery going on at the institution in their neighborhood. Specifically, Amy did her clinicals at the Buncke Clinic and had the responsibility on certain rotations of monitoring fresh free flaps that she said were coming from all parts of the body. I figured what better opportunity could exist than to experience some complex orthopedic and plastic surgery upper extremity cases from master surgeons, while getting the chance to see some of my closest friends and possibly make it to Sonoma for some wine tasting.
Below, I share with you my experience at the programs and highly recommend for those you interested in honing your hand and micro surgical skills to “go back to Cali.”
Figure 1: USC Hand Clinic with Dr. Stevanovic and Brian
USC Hand and Microsurgery Program:
Dr. Milan Stevanovic, who heads the program, attracts many complex hand and microsurgery cases due to his broad training in orthopedic surgery followed by microsurgical fellowship under Dr. James Urbaniak. He operates from head to toe with a particular interest in nerve reconstruction and brachial plexus palsies. Many of the patients referred to him present at late stages precluding the utilization of nerve or pedicled muscle transfer leading him to perform free functional muscle transfer (1). His orthopedic background generates referrals for tumors involving the bones that often require vascularized bone grafts and rare congenital deformities including Madelung’s. Spending a week with him, he made me feel welcomed, taking me to lunch and going over the intricate details of cases with Brian and me. Dr. Stevanovic makes this a great place to train and the sunny weather year around is “icing on the cake.”
Figure 2: Radial Forearm Flap for Phalloplasty
The Buncke Clinic:
Synonymous for microsurgery, the Buncke Clinic, led by Dr. Greg Buncke and Dr. Rudy Buntic, attracts some of the most difficult reconstructive cases in the country. From replantations of digits to “spaghetti wrists,” Matt and Antonio work with their attendings to save these extremely difficult upper extremity cases. (2) In addition, I witnessed a phalloplasty for transgender reassignment surgery with Dr. Curtis Crane and Dr. Bauback Safa, who together used a free radial forearm for the operation. Both took the time to explain the intricate steps to raising the flaps and setting up the microsurgical parts. Dr. Brian Parrett provided the same training experience during the finger replants. The attendings made me feel like part of their team with Dr. Buncke taking all of us out for drinks and providing us the history of the development of microsurgery. I highly recommend anyone considering microsurgery as a specialty to come visit what is one of the mecca’s of microsurgery and reconstructive surgery in the world.
Figure 3: Buncke Clinic in front “The Opinion” with Dr. Greg Buncke, Dr. Bauback Safa, Antonio J. Forte. The picture portrays some of the giants in plastic surgery and given to Dr. Burt Brent for his book entitled “The Artistry of Reconstructive Surgery.”
Plastic surgery continues to push the frontiers of surgery with its interdisciplinary approach. At these institutions, attendings and fellows have no anatomical boundaries reconstructing some of the most complex injuries and diseases in medicine. I am indebted to my close friends, Brian, Antonio, and Matt, as well as the attendings in this piece for making me part of their team and teaching me so much. And, of course to Justin and Amy for housing me and showing me in Sonoma that just as there are many nuances to making a fine wine, there are equally, if not more, to developing an outstanding plastic and reconstructive surgeon.
1. Functional Free Muscle Transfer for Upper Extremity Reconstruction Plastic & Reconstructive Surgery. Stevanovic, Milan M.D.; Sharpe, Frances M.D. Plastic & Reconstructive Surgery: August 2014 – Volume 134 – Issue 2 – p 257e–274e
2. Refining outcomes in dorsal hand coverage: consideration of aesthetics and donor-site morbidity.
Parrett, Brian M. M.D.; Bou-Merhi, Joseph S. M.D.; Buntic, Rudolf F. M.D.; Safa, Bauback M.D.; Buncke, Gregory M. M.D.; Brooks, Darrell M.D.
Plastic & Reconstructive Surgery: November 2010 – Volume 126 – Issue 5 – pp 1630-1638