The Impact of Residency and Fellowship Training on the Practice of Microsurgery by Members of the American Society for Surgery of the Hand

Purpose: The purpose of this study was to assess the microsurgical training background of current members of the American Society for Surgery of the Hand (ASSH) and then determine the impact that prior training had on current microsurgical practice. Methods: A 174-item anonymous Web-based survey was sent to all active ASSH members. Items addressed prior residency and fellowship training, practice setting, and training, comfort, and practice of specific microsurgical procedures. Data were analyzed using frequency tables, cross-tabulations, chi(2) tests, and other established statistical methods. Results: Surveys were received from 377 of 2019 ASSH members (18.7% response rate). Residency training was in orthopedics (n = 249, 66.9%), plastic surgery (n = 56, 15.1%), or general surgery (n = 55, 14.8%). Fellowship training was in orthopedic (n = 242, 65.1%), combined (n = 65, 17.5%), and plastic surgery (n = 15, 4%) programs. Microsurgical procedures involving nerves were performed by 96.6% of surgeons (n = 337), with no significant differences between surgeons trained in plastic surgery versus orthopedic surgery residencies, and no differences between those who had completed orthopedic versus combined fellowships. Of the surgeons completing the survey, 56.1% (n = 208) performed general microvascular procedures, 50% (n = 179) performed replantations, and 30.6% (n = 113) performed free flaps. Hand surgeons who completed plastic surgery residencies were more likely to perform general microvascular procedures, replantations, and free flaps than surgeons trained in orthopedic residencies. When comparing training in orthopedic and combined fellowships, there was no difference in performance of replantations, free flaps, general microvascular surgery, or microsurgical procedures involving nerves. Conclusions: Training backgrounds have a substantial impact on current microsurgical practice, with residency having the most significant effect. Specifically, hand surgeons trained in plastic surgery residency programs are more likely to perform replantations, free tissue transfer, and general microvascular surgery than those who completed orthopedic residencies. Fellowship training background does not significantly affect microsurgical practice.