The goal of this fellowship is to provide in-depth comprehensive training in hand, upper extremity, and microsurgery experience.  This is possible through the combined resources of the Departments of Plastic Surgery and Orthopaedic Surgery at the University of Texas Southwestern Medical Center.

The program combines weekly didactic sessions with conferences, clinics, and daily hand operative experience.  The weekly Monday morning conferences consist of representative cases of all involved services (plastic and orthopaedic) assigned to Parkland Memorial Hospital.  In addition, the fellow presents any additional interesting reconstructive cases as well as congenital cases.  Residents are expected to be familiar with all aspects of patient management including differential diagnosis, anatomy, and treatment options.  Case presentations are followed by an hour-long didactic session given either by the faculty or hand fellow.  The didactic presentations are chosen to cover the scope of hand surgery over one year's time.

Hand surgery topics also constitute a major component of the weekly plastic surgery conferences.  These conferences generally last three to four hours.  The resident as well as the fellow is questioned on selected cases from the weekly case logs.  Case presentations frequently involve aspects of hand surgery.

The education of the fellow is broad based; Mondays are devoted to the Parkland Health and Hospital System Hand Clinic where approximately 80 patients are evaluated.  The caseload generally involves the rehabilitation and secondary reconstruction of traumatic injuries.  The fellow takes a lead role and is responsible for the presentations of selected cases to attending staff.  Tuesdays are generally devoted to private cases.  These cases generally involve secondary reconstruction of traumatic injuries, rheumatoid arthritis, Dupuytren's disease, as well as arthroplasties.  Wednesdays are devoted to congenital cases at Texas Scottish Rite Hospital.  Thursdays are devoted to clinic at Texas Scottish Rite Hospital where 40 to 60 patients are evaluated.  The fellow alternates every other Friday between cases at Texas Scottish Rite Hospital and cases at Parkland Health and Hospital System.  There is flexibility in this schedule to allow the fellow to participate in interesting or unusual cases at other institutions.

The progress of the fellow is monitored both by direct faculty observation in the operating room and clinics as well as by performance in the bi-weekly conferences.  The hand fellow is formally evaluated by Drs. Oishi and Ezaki on a quarterly basis.  Further evaluation comes directly from the orthopaedic and plastic surgery residents who come under the supervision of the hand fellow.

In addition to the clinical responsibilities, the fellow is required to be actively engaged in research.  Scientific presentations are encouraged but not required.  At least one scientific paper ready for publication must be submitted at the conclusion of the fellowship in order to fulfill all requirements for graduation.

The fellow is directly responsible for selected hand cases done on the elective hand operating schedule at Parkland Health & Hospital System as well as cases done primarily by him at Texas Scottish Rite Hospital.  The care of private cases is under the purview of the various attending physicians, although the fellow may participate in their cases, particularly if hospitalization is required.

The fellow must be available for consultation and assistance at all times to the emergency room at Parkland Health and Hospital System.  This includes all replantation and wrist injuries, as well as other difficult fractures or soft tissue problems.

The fellow is responsible for the Monday hand clinic at Parkland Health and Hospital System.  The fellow's responsibilities at the clinic include the teaching of residents as well as the evaluation of the patients.  The fellow selects cases from this clinic for discussion in conference as well as for surgery after consultation with attending staff.  The Texas Scottish Rite Hospital offers experience in the management of the most complex congenital reconstructive problems. One or more attending physicians are always in attendance at the Texas Scottish Rite Hand Clinic and are directly involved in patient management.