July 15, 2010 - Another successful Visiting Professor session.
From left to right: Dr. Neil Jones, Dr. Ying Chi, Dr. Andy Koman, and Dr. Gustavo Machado at UC Irvine Surgical Skills Lab.

Hand & Upper Extremity Surgery
Microsurgery Fellowship
University of California, Irvine

HOSPITAL ROTATIONS

1. UC Irvine Medical Center

Fellows will spend alternating three month rotations at the UC Irvine Medical Center where the fellows will be exposed to traumatic and elective hand surgery as well as attending the private offices of Drs. Jones, Gupta and Rafijah.  UC Irvine Medical Center is a brand new hospital opening in February 2008 and is the only University Hospital and Level 1 Trauma Center in Orange County covering a population of over 3 million.  UCI Medical Center also contains the Regional Burn Center.

2.  Kaiser Permanente

Fellows will spend alternating three month rotations at Kaiser Permanente Orange County Medical Center where they will obtain a broad experience in hand, wrist, elbow and shoulder surgery while working with three hand surgeons and one shoulder/elbow surgeon.  Kaiser Permanente opened a new hospital in Irvine in May 2008 where outpatient and inpatient cases are performed.  The Kaiser Anaheim and Irvine medical centers are Level II Trauma Centers covering approximately 400,000 Kaiser Permanente members.

3.  Children’s Hospital of Orange County

Children’s Hospital of Orange County (CHOC) is the only Children’s hospital covering Orange County and is a Level II Trauma Center for pediatric trauma.  The hand fellow based at the UCI Medical Center will accompany Dr. Jones to a pediatric and congenital hand clinic twice a month as well as operating at CHOC once a week on congenital hand anomalies and post-traumatic reconstruction of pediatric hands.

4.  Shriners Hospital – Los Angeles

The hand fellow based at the UCI Medical Center will accompany Dr. Jones to a congenital hand clinic at Shriners Hospital Los Angeles, held on the first or second Thursday of the month.  Both hand fellows will gain extensive experience in microsurgical reconstruction of congenital hand anomalies, approximately 6-12  toe-to-hand transfers per year.  Shriners Hospital Los Angeles has the largest series of pediatric toe-to-hand transfers in the United States.

FACULTY

1. Neil F. Jones, M.D., Fellowship Director, Professor Department of Orthopaedic Surgery and Division of Plastic and Reconstructive Surgery
2. Ranjan Gupta, M.D., Professor and Chairman Department of Orthopaedic Surgery
3. Gregory Rafijah, M.D., Clinical Assistant Professor Department of Orthopaedic Surgery
4. Emil Dionysian, M.D., Attending Hand Surgeon Kaiser Permanente
5. Neil Harness, M.D., Attending Hand Surgeon Kaiser Permanente
6. Brett Pederson, M.D., Attending Hand Surgeon Kaiser Permanente
7. Michi Kono, M.D. Attending Hand Surgeon Kaiser Permanente
8. Edward Yian, M.D. Attending Shoulder Surgeon Kaiser Permanente

Dr. Jones trained in General Surgery and Orthopaedic Surgery in England and completed a residency in Plastic and Reconstructive Surgery at the University of Michigan.  He completed a Hand Surgery Fellowship in the Department of Orthopaedic Surgery at the Massachusetts General Hospital with the late Richard Smith, M.D. and Jesse Jupiter, M.D.
Dr. Jones is currently the President of the American Society for Reconstructive Microsurgery.  He has served on the Council of the American Society for Surgery of the Hand.  He has been an Associate Editor of the Journal of Hand Surgery and is currently an Associate Editor of Techniques in Hand and Upper Extremity Surgery, Journal of Reconstructive Microsurgery and Annals of Plastic Surgery.

Dr. Gupta completed his residency in Orthopaedic Surgery at the University of Pennsylvania and his Hand Fellowship at UCLA Medical Center.
Dr. Gupta has recently been the 2007-2008 Bunnell Fellow of the American Society for Surgery of the Hand.

Dr. Rafijah completed his Orthopaedic Surgery residency at Harbor-UCLA Medical Center and his Hand Surgery Fellowship at the University of Washington, Seattle.

Dr. Dionysian completed his Orthopaedic Surgery residency at UCLA Medical Center and his Hand Fellowship at Roosevelt Hospital in New York.  He completed a second fellowship in Shoulder surgery with Louis Bigliani, M.D. at Colombia Presbyterian Hospital in New York.

Dr. Harness completed his Orthopaedic Surgery residency in the Harvard Combined Program and his Hand Fellowship at UCLA Medical Center.

Dr. Pederson completed his Orthopaedic Surgery residency at UCLA Medical Center and his Hand Fellowship at UC Sacramento

Dr. Kono completed his Orthopaedic Surgery residency at UCLA Medical Center and his Hand Fellowship at the University of Cincinnati.

Dr. Yian completed his Orthopaedic Surgery residency at the University of Michigan and completed the Transcontinental Shoulder Fellowship at the Massachusetts General hospital with Jon J.P. Warner, M.D. and at the Balgrist Klinik in Zurich, Switzerland with Christian Gerber, M.D.

The hand fellows will also work with dedicated hand therapists at the UCI Medical Center, Children’s Hospital of Orange County and Kaiser Permanente.

UCI HAND SERVICE

This is a collaborative combined service between the Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery at the University of California, Irvine.  All bone and soft tissue injuries distal to the wrist are referred to the Hand Surgery Service and all distal radius fractures and wrist fractures are treated by the Hand Surgery Service.  Complex combined injuries of the upper extremity and nerve injuries of the upper extremity are also managed by the Hand Surgery Service.

The Hand Surgery Service also performs all bone and soft tissue reconstructions for limb salvage of malignant bone and soft tissue tumors of the upper and lower extremities, and is also frequently consulted for reconstruction of grade III open fractures of the lower extremity.

The Hand Surgery Service consists of:

1. 3 attending hand surgeons
2. 2 hand surgery fellows
3. 1 Orthopaedic Surgery Resident – 4 residents alternating every 3 months
4. 1 Plastic Surgery Resident – 3 residents alternating every 4 months
5. 1 Junior Orthopaedic Resident on Trauma call - takes care of all the minor hand trauma in the Emergency Room including finger tip injuries and initial reduction of wrist and hand fractures. 

Patients with more severe hand injuries are initially seen by one of the 2 hand surgery residents and the hand fellow is then involved in the operative treatment or in a consultant role.  The two hand surgery fellows alternate night call at UCI Medical Center (taken from home).

FELLOWSHIP GOALS

The UC Irvine hand fellowship provides an extensive in-depth exposure to not only traditional hand surgery, but also upper extremity surgery including the elbow and shoulder as well as traumatic and elective microsurgery.  This provides the hand surgery fellows an extraordinary opportunity to structure their fellowship, either to concentrate only on hand surgery; or hand and upper extremity surgery; or hand surgery and microsurgery.  The fellowship is also completely integrated between Orthopaedic Surgery and Plastic Surgery and there are very few totally integrated fellowships in the United States.

Secondly, it is very much a mentorship type fellowship with a “one-on-one” relationship between the fellow and faculty.  This is in contradistinction to fellowships where a fellow only spends one or two months with six attendings and does not get to understand the thinking and judgment of an attending.  The fellows spend three months with Dr. Jones, Gupta and Rafijah and then three months at Kaiser and this cycle is then repeated.  All of the attendings have trained in the best hand surgery fellowship programs (Boston, New York, Cincinnati, Seattle, UCLA) and are very good teachers and will take the fellow through surgical procedures rather than having the fellow “hold hooks” or at the other extreme “relearn the wheel”. 

The entire spectrum of hand surgery is seen at UCI Medical Center and Kaiser, nothing is too over emphasized and there is nothing missing.  Fellows will be involved in straight forward hand trauma as well as complex tertiary hand trauma, post-traumatic reconstruction, distal radius fractures, wrist arthroscopy, rheumatoid arthritis and congenital anomalies.  There is also excellent exposure to elbow and shoulder surgery with two attending surgeons, Dr. Gupta at UCI Medical Center and Dr. Yian at Kaiser Permanente.  There is a high volume of peripheral nerve surgery and brachial plexus surgery and the fellowship is particularly strong in microsurgical reconstruction of the upper extremity including free flaps and toe transfers.  There is excellent exposure to both upper and lower extremity salvage reconstruction after malignant tumor resections and toe transfers for congenital hand reconstruction.  There is a high volume of pediatric hand surgery both at Children’s Hospital of Orange County and Shriners Hospital of Los Angeles.  Finally, the hand fellows can also become involved in free flap coverage of the lower extremity for grade III tibial fractures and osteomyelitis and also in free vascularized bone transfers for bony reconstruction after tumor resection.

INDEPENDENT RESPONSIBILITY
 
One of the great advantages of the UCI fellowship is that there are excellent opportunities for the fellow to act as an attending hand surgeon and teach hand surgery techniques to orthopaedic surgery residents and plastic surgery residents during both emergency and elective hand surgery.  However, this is coupled with a “safety-net” in that the fellows can still feel comfortable by obtaining telephone advice from one of the attending surgeons or if necessary asking the attending surgeon to come in and help. 

Hand surgery fellows are given an academic appointment as a Clinical Instructor at the University of California, Irvine and therefore once a month can act as the attending of record for admission and surgical treatment of hand trauma patients.  The hand surgery fellow at Kaiser Permanente also runs a weekly hand clinic and can operate independently on patients from this clinic.

EDUCATIONAL PROGRAM

1. Weekly Hand Conference on Monday afternoons.  Either a resident or fellow will give a 45 minute didactic talk on a specific topic, and this is followed by a lively discussion generated by the attendings.  At the second Monday of the month hand conference, the two hand fellows show all the interesting cases from the previous month and this also acts as an audit of cases performed by the fellows in their attending role.  This is probably the most informative conference and the fellows are obligated to take digital photographs of all cases and relevant x-rays.  This photographic documentation allows teaching at all levels from the medical student level through the orthopaedic surgery and plastic surgery residents up to the fellows and attending level.

2. Monthly Journal Club organized by the hand fellows and held at a local restaurant.

3. Orthopaedic Surgery Grand Rounds. Thursday mornings from 7:00 to 10:00 AM. Several lectures are given on basic hand surgery topics to the orthopaedic surgery residents and usually each hand surgery fellow will give one or two of these lectures.

4. Hand dissections – a state of the art, fresh cadaver lab will open in January 2010, and this will allow the hand surgery fellows and residents on the hand surgery service to dissect and prosect hand and upper extremity anatomy specimens as well as providing a source for research projects.

5. Microsurgical laboratory – we usually arrange for an orthopaedic- trained hand fellow to spend one week in the microsurgery lab during the first month of their fellowship in August to hone their microsurgical skills.  However, we would also prefer any incoming orthopaedic-trained fellow to have completed a one week basic microsurgery course at their home institution prior to starting the fellowship.  Similarly, for any plastic surgery-trained fellow, we would expect them to have completed a basic AO internal fixation course prior to beginning the fellowship.

6. Local courses and lectures – the UCI hand fellows are encouraged to attend lectures by visiting hand surgeons at other institutions in southern California such as USC, UCLA and Orthopaedic Hospital.  In addition, several nationally and internationally recognized hand surgeons are invited to UC Irvine during the year as visiting professors.

RESEARCH OPPORTUNITIES

1. Fresh cadaver Anatomy Laboratory

2. Microsurgery Laboratory

3. Biomechanics Laboratory based at Long Beach VA Hospital and headed by Thay Lee, PhD is an internationally recognized biomechanics lab focusing on the shoulder and elbow and wrist.  At any one time there are approximately 10 international fellows or visiting residents from USC and Kerlan-Jobe involved in research projects and the hand fellow will have an ideal opportunity to become involved.

4. Peripheral Nerve and Molecular Biology of Nerve Regeneration laboratories.  These two laboratories housed in the Gillespie Neuroscience Research Facility at UC Irvine are directed by Dr. Gupta who has two NIH RO1 grants. The hand fellows can become involved in basic science projects in these labs during the year.

Each hand surgery fellow is expected to complete two research projects, one of which is usually presented at the annual UCI Orthopaedic Residents Day in June, but ultimately should be presented at a national meeting and published.  Fellows have usually become involved in clinical projects, but there are superb opportunities for basic science projects, either in the biomechanics laboratory or in peripheral nerve research.

SALARY, VACATION and MEETINGS

The hand fellows are paid at their relevant PGY 6, 7, 8 or 9 level.  The salary is approximately $54,900 per year.  The fellows can take one month of vacation.  Travel and accommodation expenses are paid for one meeting per year, which is usually the American Society for Surgery of the Hand meeting in the fall. 

SUMMARY

1. The three attending hand surgeons at UCI Medical Center have all been Chief of Hand Surgery at Level 1 Trauma Centers in California – Dr. Jones was Chief at UCLA Medical Center for 15 years, Dr. Gupta was Chief at UCI Medical Center for 10 years and Dr. Rafijah was Chief at Harbor – UCLA Medical Center for 10 years.  The attending hand surgeons at Kaiser Permanente all trained in Orthopaedic Surgery at either UCLA Medical Center or the Harvard combined program and completed fellowships in leading hand surgery programs. 

The UCI hand and upper extremity fellowship is now the largest hand surgery fellowship in California, in terms of having 6 fellowship-trained hand surgeons and one fellowship-trained shoulder surgeon.  It has an extraordinary wealth of clinical material from microsurgical reconstruction to brachial plexus to congenital hand anomalies to shoulder and elbow surgery.  Dr. Jones and Dr. Gupta bring their international and national reputations to the UCI Hand Surgery Fellowship, which should only continue to increase with our major commitment to basic research in peripheral nerve, tissue engineering and transplantation, which will be the future of hand surgery.

2. The fellowship is a combined program between the University of California, Irvine and Kaiser Permanente and allows the hand fellows to experience both a University academic medical center and a private practice group.  The fellowship is also a truly integrated combined program between the Department of Orthopaedic Surgery and the Division of Plastic and Reconstructive Surgery.  It allows an orthopaedic-trained fellow to develop a very high level of expertise in nerve and tendon reconstruction and flap coverage, and conversely a plastic surgery-trained fellow to achieve a very high level of expertise in the treatment of distal radius fractures and wrist arthroscopy.  In addition, the fellowship covers the entire spectrum of traditional hand surgery, as well as upper extremity surgery of the shoulder and elbow and traumatic and reconstructive microsurgery, which very few hand fellowships can emulate.

3. The UCI fellowship is a very intense mentorship type program with “one-on-one” teaching in the operating room and private offices and clinics, but at the same time allows progressive responsibility for operating independently.

4. Hand fellows graduating from the UCI fellowship will rank extremely favorably with graduates of the other top hand fellowship programs and we would expect several of our fellowship graduates to eventually become future leaders in academic hand surgery over the next few years.

APPLICATION PROCESS

We accept the Universal Hand Surgery Fellowship application. Complete and return the application and waiver form, along with the list of documents listed below Please arrange to have three letters of recommendation forwarded, one from the chief of your residency training program and one from the hand surgeon who knows you best.
Below is a list of additional documents that need to be sent in along with your application:

• USMLE Scores Steps I, II & III
• Medical School Transcripts
• Photograph
• CV/Resume
• Personal Statement
• Current CPR, ACLS or BLS certificate (Proof required if you are granted an interview)
• Three current letters of recommendation A fourth letter is acceptable.
• Dean's Letter
• Copy of any published articles

UCI participates in the NRMP Hand Fellowship Specialty Match and you should contact the NRMP for an applicant agreement for the Hand Surgery Specialty Match. Applicants should have completed a residency in orthopaedic surgery, plastic and reconstructive surgery or general surgery. A California license is a requisite for the incoming fellow.

Please submit your application and letters of recommendation to the Department of Orthopaedic Surgery Office at the location listed below. After review of the applications, applicants will be invited to UC Irvine Medical Center, usually in late February-March, for a mutual visit and interview.

Application Deadline
The deadline for submitting application materials to UC Irvine is January 31.
Thank you again for your interest in the UC Irvine Hand and Microsurgery Fellowship. We encourage you to remain in touch with the Fellowship Coordinator regarding the status of your application.

Interview Dates
Interviews will be held in March 2011

Contact Information
Attn: Maria Lampino Guerrero
Department of Orthopaedic Surgery
101 The City Drive, Pavilion 3, 2nd Floor
Orange, CA 92868

Tel: (714) 456-5547
Fax: (714) 456-7547
email: mlampino@uci.edu

NON-DISCRIMINATION STATEMENT
The University of California, in accordance with applicable Federal and State law and University policy, does not discriminate on the basis of race, color, national origin, religion, sex, gender identity, pregnancy*, disability, age, medical condition (cancer-related), ancestry, marital status, citizenship, sexual orientation, or status as a Vietnam-era veteran or special disabled veteran. The University also prohibits sexual harassment. This nondiscrimination policy covers admission, access, and treatment in University programs and activities.

Inquiries regarding the University's student-related nondiscrimination policies may be directed to: Kirsten K. Quanbeck, Assistant Executive Vice Chancellor, Director, Office of Equal Opportunity and Diversity, 4500 Berkeley Place, Irvine, CA 92697-1130, Phone (949) 824-5594, email: eod@uci.edu

*Pregnancy includes pregnancy, childbirth, and medical conditions related to pregnancy or childbirth.

Please visit our new Orthopaedic & Sports Medicine Center in Costa Mesa at:

1640 Newport Blvd., Suite 230
Costa Mesa, CA 92627
949-515-5210

www.sportsmedicine.uci.edu

Dr. Nitin Bhatia and Dr. Thay Lee were presented with the prestigious "Harold and Nancy Willingham Award for Outstanding Research Paper" at the meeting of the Western Orthopaedic Association this year. Drs. Bhatia and Lee presented their paper, entitled "Biomechanical Evaluation of Short-Segment Posterior Instrumentation with Crosslinks In An Unstable Human Burst Fracture Model".

The WOA, with more than 1,700 members, held it's 73rd annual meeting in Seattle, Washington.

Dr. Bhatia, an orthopaedic surgeon and Dr. Lee, a Ph.D Research Career Scientist/Biomedical Engineer, are on staff at University of California at Irvine.