Hand, Nerve and Microsurgery

The Division of Plastic and Reconstructive Surgery offers a one-year fellowship in hand, peripheral nerve, and microsurgery. The Hand, Nerve and Microsurgery Fellowship is sponsored by the Washington University/Barnes-Jewish Hospital/Saint Louis Children’s Hospital Graduate Medical Education Consortium and is fully accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Hand, Nerve and Microsurgery fellows are exposed to a variety of hand, nerve and upper extremity pathology. Our goal is to provide a comprehensive learning environment to gain confidence, competence and technical proficiency to begin a long-lasting career in hand surgery. We strive to provide a multidisciplinary approach to hand surgery to include electrodiagnoticians, therapist, nurse practitioners and others to develop a well-rounded educational experience.

Hand Trauma/Elective Surgery

The fellowship includes training in all aspects of hand surgery from the distal forearm to the fingertip, and from the infant to aged adult. The trauma volume is high at this large tertiary hospital, providing exposure and competence in the treatment of distal radius fractures, carpal pathology and microsurgery for soft tissue coverage.

The program provides an incredible experience in limb salvage, including TMR, RPNI, and other techniques. We also perform oncologic reconstruction, treat unusual infections and complex arthritis, contractures, and spasticity due to traumatic brain injury and stroke.

Nerve Surgery

The fellowship also has a strong brachial plexus and peripheral nerve component that provides a unique experience for our fellows. Historically, Washington University Hand faculty have been world leaders in nerve transplantation, peripheral nerve surgery, hand/upper extremity and lower extremity, carpal tunnel syndrome, tarsal tunnel syndrome, thoracic outlet syndrome, brachial plexus, cumulative trauma disorder, nerve transplant, nerve compression, facial palsy, and hand and upper extremity disorders and injuries.

Congenital Hand Surgery

Routine pediatric hand trauma, congenital pediatric hand disorders such as polydactylies and syndactylies are seen at St. Louis Children’s Hospital. The volume and variety of cases is high with 5 hand faculty participating and contributing educational value. The site support is high with its location adjacent to the adult hospital.

In order to broaden the congenital hand experience, we have joined forces with Shriners Hospital in Philadelphia. Our fellows have a required one-month congenital hand rotation with Scott Kozin, MD and Dan Zlotolow, MD. We are excited about this collaboration and know that it will continue to positively impact the experience of our fellows.

Research Opportunities

The faculty in the division of plastic surgery have a wide range of research interest and publications. Please visit the linked PubMed pages on each faculty member’s page for details. Fellows have the opportunity to collaborate with faculty on projects which have resulted in an impressive number of publications and presentations at national conferences. Despite the relatively short training program length, Fellow Achievements show what can be accomplished with the faculty at Washington University in just 1 year.

Some current areas of interest most pertinent to the hand fellows include:

  • Improving upper extremity function in spinal cord injury
  • Nerve transfers, peripheral neuropathy and nerve imaging
  • Pediatric replantation outcomes

Didactic Conferences

Hand Fellowship Conferences: Every Monday from 5-6 PM.

*If you are planning to apply for the December 15, 2020 deadline and would like the opportunity to attend didactic conferences, please contact Stephanie Martino, paule@wustl.edu, for more information.

Rotating schedule amongst the following:

  • Indications Conferences-fellows alternate and present interesting cases for faculty and fellow discussion
  • Attending subject matter presentations-the yearly schedule of attending, nurse practitioner, and hand therapists talks is included below.
  • Journal Club-case based discussion of relevant literature on complex issues in hand surgery. 
  • M and M- The fellows are encouraged to prospectively track cases similar to the fashion in which people do for the American Board of Plastic Surgery/Hand subspecialty certification. Outcomes such as fracture outcomes (delayed healing/nonunion/malunion/unanticipated loss of congruence), stiffness, greater than expected pain (need for additional pains meds), as well as readmission, re-operation, and systemic adverse outcomes and death, etc. will be discussed amongst the group in a de-identified, non-pejorative, improvement focused fashion
8/17/2020Hand Trauma–Don’t forget the nerves! – Fox
9/28/2020Nerve Injury Evaluation and Treatment – Mackinnon
11/2/2020Carpal instability – Pet
12/14/2020TMR/RPNI and Upper Extremity Amputations – Felder
2/1/2021Bone and joint trauma and infections – Kells Oncologic Processes in the Upper Extremity and Complex Reconstruction after Extirpation – Sacks
3/8/2021Pediatric Brachial Plexus – Snyder-Warwick
4/12/2021Advanced Hand Therapy Talks: Communication to improve outcomes – Cia Carpenter and Lorna Kahn
5/17/2021Practical Points in Hand Surgery Practice: wound care, use of advanced practitioners, and billing tips – Bettlach Wide Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery – Currie
6/28/2021Management of near complete and complete brachial plexus injury: Free functional muscle transfer, Steindler flexorplasty and other advanced approaches – Tung
10/19/2020M and M
10/26/2020Fellow: Pripotnev – Cases
11/2/2020Carpal instability – Pet
11/9/2020Fellow: Medina – Cases
11/16/2020Journal Club
11/23/2020Thanksgiving
11/30/2020M and M
12/7/2020Fellow: Medina – Cases
12/14/2020TMR/RPNI and Upper Extremity Amputations – Felder
12/21/2020Fellow: Pripotnev – Cases
12/28/2020Christmas/New Years
1/4/2021Journal Club
1/11/2021M and M
1/18/2021MLK Day
1/25/2021Fellow: Medina – Cases
2/1/2021Bone and joint trauma and infections – Kells/Oncologic Processes in the Upper Extremity and Complex Reconstruction after Extirpation – Sacks
2/8/2021Fellow: Pripotnev – Cases
2/15/2021Journal Club
2/22/2021Fellow: Medina – Cases
3/1/2021M and M
3/8/2021Pediatric Brachial Plexus – Snyder-Warwick
3/15/2021Fellow: Pripotnev – Cases
3/22/2021Journal Club
3/29/2021Fellow: Medina – Cases
4/5/2021M and M
4/12/2021Advanced Hand Therapy Talks: Communication to improve outcomes – Cia Carpenter and Lorna Kahn
4/19/2021Fellow: Pripotnev – Cases
4/26/2021Wide Awake Local Anesthesia No Tourniquet (WALANT) Hand Surgery – Currie/Journal Club
5/3/2021M and M
5/10/2021Fellow: Medina – Cases
5/17/2021Practical Points in Hand Surgery Practice: wound care, use of advanced practitioners, and billing tips – Bettlach
5/24/2021Fellow: Pripotnev – Cases
5/31/2021Memorial Day
6/7/2021Journal Club
6/14/2021M and M
6/21/2021Fellow: Medina – Cases
6/28/2021Management of near complete and complete brachial plexus injury: Free functional muscle transfer, Steindler flexorplasty and other advanced approaches – Tung
7/5/2021Independence Day Observed
7/12/2021Fellow: Pripotnev – Cases
7/19/2021Journal Club
7/26/2021M and M

Fellows are also expected to attend the following Divisional Conferences and Education Sessions:

Wednesday Plastic Surgery Grand Rounds and Teaching Conferences (6:30-8am).

  • During this time, the fellows will present two 30-minute Grand Rounds; one in the winter and one in the spring.

PRS Upper Extremity Cadaver Dissection Lab (7-8am).—Please note as of 8-1-2020 this is on hold due to COVID-19.