Objectives of the Saint Louis University Hospital Rotation (PS1,PS2,PS3)
Saint Louis University Hospital is the sponsoring institution of the Saint Louis University Medical Center. It is the major teaching facility for the Saint Louis University School of Medicine, which is directly across the street. SLUH is one of three adult Level 1 Trauma Centers in the St. Louis metropolitan region, the two others being Barnes/Jewish/Christian Hospital and St. John's Mercy Medical Center. As a result, our residents get most of their trauma experience, as it relates to plastic surgery, at SLUH.
Saint Louis University Hospital is also the sponsoring institution for all of the major ACGME- accredited residencies, including Medicine (Cardiology, Internal Medicine, Hematology/ Oncology, Gastroenterology, Neurology, Pulmonary Medicine, Endocrinology), Surgery (General Surgery, Trauma Surgery/ Critical Care Medicine, Vascular Surgery, Transplant Surgery, Neurosurgery, Urology, Cardiothoracic Surgery, Plastic Surgery), Anesthesiology, Orthopedics, Otolaryngology, and Psychiatry. The Department of Pediatrics, Pediatric Surgery, and Ophthalmology have their central offices at adjacent institutions (Pediatrics at Cardinal Glennon Children’s Medical Center, across the street from SLUH, and Ophthalmology at the Eye Institute six blocks south of SLUH).
The plastic surgery resident should obtain experience in the following areas:
- HAND SURGERY
The plastic surgery resident will learn how to diagnose and manage traumatic hand injuries, including tendon and nerve injuries, and hand fractures.
The resident will also learn to manage patients with conditions such as nerve compression syndromes, Dupuytren’s contracture, ganglions, etc.
- CRANIOMAXILLOFACIAL SURGERY
The emergency diagnosis, management and surgical treatment of craniomaxillofacial trauma, including mandibular fractures, nasal fractures, simple and complex maxillary fractures, frontal bone and sinus fractures, and soft tissue injuries of the face.
- LOWER EXTREMITY RECONSTRUCTION
Soft tissue and bony injuries to the thigh, leg, foot and ankle. This includes evaluation and management of radiation wounds, burns, grade III open tibial fractures, and soft tissue tumors as well as lymphedema, both congenital and acquired. Coordination of care and communication with services such as Trauma, General Surgery and Orthopedics is critical in the management of our patients with lower extremity soft tissue wounds.
- BREAST SURGERY
During this rotation, the plastic surgery residents will gain exposure to breast reconstruction, both immediate and delayed, as well as breast reduction.
- SURGERY OF THE TRUNK
In conjunction with General Surgery and Thoracic Surgery, the plastic surgery residents gain experience in both chest wall and abdominal wall reconstruction.
- Chest wall reconstruction includes both the diagnosis and management of complex sternal wounds following median sternotomy as well as acute and chronic thoracic wounds following trauma, lobectomy and pneumonectomy. The resident will also learn how to manage and treat patient with complex pressure sores. This is not limited to only the surgical closure of such wounds, but includes the importance of patient selection, nutrition, and postoperative social support systems.
- PRACTICE MANAGEMENT
The plastic surgery resident will assist in the coordination of care for patients with complex conditions, whether from trauma, transplants (liver and kidney), tumors or multisystem organ failure. The resident will learn the importance of communicating and interfacing with nursing staff, case managers, social service, pastoral care, patient family caregivers, and plastic surgery office staff in the care and discharge planning for patients. Many of the patients cared for during this rotation are critically ill and/or have very complex comorbid illnesses requiring a more complex and diligent patient care plan
Progression of core knowledge, clinical skills, surgical technique, clinical judgment and maturity is expected as plastic surgery residents advance from their first year (PS1) to the second year (PS2) of residency. First-year plastic surgery residents should become familiar with, and proficient in, surgical techniques such as skin grafting, local flaps, tissue expanders, simple and common hand surgical procedures such as carpal tunnel release, cubital tunnel release, fingertip repairs and finger amputations, hand splinting, and more simple facial fractures. Second-year residents should become familiar with the management of more complex reconstructive procedures such as free tissue transfer, complex hand trauma, complex lower extremity traumatic wounds, complex facial fractures such as nasoethmoidal fractures, Lefort fractures, complex mandibular fractures, and, most importantly, learn how to anticipate and manage plastic surgical complications. Finally, during the Chief Resident year (PS3), residents are expected to perform as independent surgeons in the evaluation, surgical planning and postoperative care of the variety of patients on this rotation.
Saint Louis University Faculty: Drs. Kraemer, Bernstein, Carstens and Paletta