Plastic Surgery losing an important discipline?

by Amanda Silva, MD

I recently reviewed an article from the July 2015 issue of Plastic and Reconstructive Surgery with some of my fellow residents that investigated what plastic surgery applicants desire in a program.[i] A lesser focus of the article that we did not touch on, but stood out to me was that applicants ranked burn surgery of least importance in their ranking process behind, in order of importance, reconstructive surgery, pediatric/craniofacial surgery, microsurgery, hand surgery, breast surgery, and cosmetic surgery. Understandably when asked to rank these disciplines, which actually have a lot of overlap, I can see how burn may have been neglected, but I would encourage applicants to consider a burn surgery rotation to be a great strength in their training.

At University of Chicago we rotate in our burn unit for 2 months as a PGY-3 under the direction of one of our plastic surgery faculty, Dr. Lawrence Gottlieb. It was an invaluable experience for me, and was the perfect time during my training to develop autonomy before being the chief on our plastic surgery services the following year. As the surgical resident in the burn unit those patients are your patients and your responsibility. You run the unit under the guidance of Dr. Gottlieb, our amazing nurse practitioner Anne O’Connor, and the critical care anesthesia team. We were encouraged to determine the surgical plan for every patient and know every detail about their care, which definitely improved my surgical judgment and patient management skills.

When faced with a Jehovah’s witness patient with a large burn that needed debridement. I researched and discussed with our pharmacist, critical care attending, and Dr. Gottlieb the best plan to safely provide him the necessary surgical intervention while still respecting his wishes. This was a difficult case that I was also able to present for discussion in the monthly hospital-wide medical ethics conference.

An additional benefit of rotating in the burn unit was that it expanded my knowledge on wound care and healing, which are at the core of plastic surgery. Knowing just how much to debride, and when a burn can heal well with simply biobrane or needs a skin graft is a important skill to hone, so much so that groups are trying to create machines to aid that difficult judgment.[ii] Additionally, having the opportunity to reconstruct patients with scar contractures from poorly healed burns with multiple z-plasties or perforator flaps expanded my knowledge on basic flap principles.

In addition to providing strong core knowledge and the opportunity to mature as a surgical resident, the burn unit has offered many scholastic opportunities. The nurses, pharmacists, nutritionists, and occupational and physical therapists are all involved in burn research and present at national meetings. Additionally, multiple residents have published work from their experience in the burn unit. Including most recently, my co-resident Deana Shenaq on her experience with urban frostbite when we had a slew of patients during Chicago’s polar vortex.

I believe my experience is not just unique to University of Chicago. As a medical student I rotated at Stanford where Dr. Yvonne Karanas ran the burn unit and residents had similar glowing experiences. I’m certain this is true in many other programs that I haven’t had the opportunity to see closely. In this upcoming interview season I would encourage applicants to look a little closer at the burn experience offered by programs, as I truly believe it is at the core of becoming an excellent plastic surgeon.

REFRENCES
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[i] Atashroo DA, Luan A, Vyas KS, et al. What Makes a Plastic Surgery Residency Program Attractive? An Applicant’s Perspective. Plastic and reconstructive surgery. Jul 2015;136(1):189-196.

[ii] Eng-Kean Y, Tzu-Chien H, Huihua KC, Chii-Wann L. Prediction of burn healing time using artificial neural networks and reflectance spectrometer. Burns. 2005;31:415–420.

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