Ben Taub Hospital
At Ben Taub, a county hospital, fellows are exposed to acute multitrauma, high impact trauma, as well as post-injury secondary reconstructions, and complex rehabilitation of the injured upper extremity. Considerable experience is required with microvascular replantation and revascularization, microsurgical and pedicle soft tissue flap reconstruction, fixation of bony orthopedic injuries (particularly with complex injuries of wrist, distal radius and elbow), and also experience dealing with infections and traumatic soft tissue wounds, including tendon and nerve injuries. Clinical management skills are tested in the hand clinic.
Dr. Lee Reichel is the principal supervising faculty of Ben Taub. He supervises in the operating room as well as in the clinic.
Michael E. DeBakey Veterans Affairs Medical Center
At the VAMC the hand fellow is totally responsible for the organizational aspects of the service. This enables the fellow to run the service as a “mini private practice” – that is time management, scheduling, and interaction with consulting specialties are key elements. This enables the fellow to mature as an independent professional practitioner. Emergencies are infrequent. Most surgeries are elective and range from simple to the most complex.
A physician assistant and rotating surgical resident, as well as a dedicated service secretary, are available for the fellow’s assistance. Attending supervision is clear and is always present at every clinic as well as in the operating room (for both elective and emergency surgeries). The fellow manages the service, arranges the operating schedule and gains operative independence with complex elective surgery procedures – such as tendon transfers, contractures, arthritis surgery, peripheral nerve surgery, complex wrist disorders, and secondary reconstructions.
Dr. David Netscher is the principal supervising faculty at VAMC in the operating room as well as in the clinic.
Baylor St. Luke's Medical Center, Kelsey-Seybold Clinic and Baylor Clinic
Baylor St. Luke’s Medical Center is the preferred provider for Kelsey-Seybold although patients are also seen at the Kelsey-Seybold main campus clinic as well as operated on in the ambulatory care center. Patients are seen in the Baylor Clinic with Dr. Stafford. Responsibilities thus are in the Kelsey-Seybold clinics, Baylor Clinic, and Baylor St. Luke’s.
The clinical spectrum of patients includes peripheral nerve entrapment (including endoscopic carpal tunnel and cubital tunnel release), wrist arthroscopy, treatment of contractures and soft tissue problems, arthritis surgery (rheumatoid and osteoarthritis), skeletal trauma of the hand, wrist and elbow (mostly elective delayed reconstructions), treatment of distal radius fractures and some acute trauma to soft tissues and skeletal structures (to include peripheral nerve and tendon repairs).
Reconstructions involving complex tendon transfers, soft tissue flap transfers, and complex wrist disorders are all included. This rotation has sufficient volume to expose fellows in the yearly interval to most elective procedures currently performed in hand surgery. Together with the experience afforded at the Texas Orthopedic Hospital, there is also opportunity to gain exposure to treatment of shoulder disorders, as well as arthroscopy of the shoulder and elbow.
The supervising responsible faculty is Dr. David Netscher. Other attending faculty members are Dr. James Stafford, and Dr. Jose Nolla.
Shriners Hospital for Children
This experience affords the fellow an opportunity to treat a variety of pediatric hand and upper extremity problems that include congenital anomalies, spastic conditions, brachial plexus problems, and arthrogryposis.
Attendings are Dr. Idris Gharbaoui and Dr. James Bennett. Under these two physicians direct supervision, the fellow has the opportunity to attend reconstructive cases performed at that hospital as well as exposure to clinics. Shriner's Hospital for Children is also the main hospital for treatment of pediatric brachial plexus conditions as well as for chronic musculoskeletal problems such as arthrogryposis.
Texas Children’s Hospital
Clinical cases include pediatric trauma and congenital anomalies, as well as treatment of pediatric spastic and paralytic conditions. Pediatric patients are treated in the operating room at Texas Children’s Hospital but are seen in the private office with the attending. A wide variety of complex congenital anomalies are treated that include microvascular reconstruction, cleft hand deformities, radial dysplasia, absent thumb and pollicization, syndactyly and polydactyly. Additionally, patients are treated both in the clinic and in the operating room that have cerebral palsy and spastic disorders.
The supervising faculty is Dr. David Netscher.
Texas Orthopedic Hospital
At the Texas Orthopedic Hospital most of the general hand and upper extremity reconstructive problems are encountered. Endoscopic and arthroscopic surgery is emphasized. No emergency coverage is provided by the hand Fellow. Reconstructive problems of the elbow and sports injuries and joint instability are encountered. Some opportunities arise for shoulder reconstructive and arthroscopic surgery. A variety of pediatric trauma and congenital deformities are treated.
As such, this rotation interfaces well with the Shriners Hospital pediatric experience as a number of the faculty at TOH have dual privileges at the Shriners Hospital as well. Between the experience of TOH and the Shriners Hospital, this forms a focal point for an understanding in the diagnosis, treatment strategies, and surgical skills necessary to treat brachial plexus injuries in both the pediatric and adult patient populations.
Dr. James Bennett is the principal supervising faculty at TOH. He is supported by active participating faculty that includes Dr. Thomas Melhoff, Dr. Idris Gharbaoui, and Dr. Craig Crouch. Periodically, combined reconstructive sports medicine and arthroscopic cases arise, particularly with regard to elbow instability in the throwing athlete. These are performed in association with Dr. James Bennett, Jr. who is fellowship trained in orthopedic sports medicine.
Additionally, complex posttraumatic problems may be treated by Ilizarov distraction osteogenesis lengthening techniques under the auspices of either Dr. Mark Brinker or Dr. John Gugenheim. Thus, Texas Orthopedic Hospital, being a well renowned multispecialty orthopedic facility, offers a wealth of clinical experience to the rotating hand Fellow.