Elliott River M, Baldwin Keith D, Foroohar Abtin, Levin Lawrence Scott
Department of Orthopaedic Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
Ann Plast Surg. 2012 Oct;69(4):451-8. doi: 10.1097/SAP.0b013e318248036d.
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.
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, χ tests, and other established statistical methods.
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.
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.
本研究旨在评估美国手外科协会（ASSH）现任成员的显微外科培训背景，然后确定先前培训对当前显微外科实践的影响。
向所有活跃的ASSH成员发送了一份包含174个条目的匿名网络调查问卷。问题涉及先前的住院医师培训和 fellowship 培训、执业环境以及特定显微外科手术的培训、熟练程度和实践情况。使用频率表、交叉表、χ检验和其他既定的统计方法对数据进行分析。
在2019名ASSH成员中，有377人回复了调查问卷（回复率为18.7%）。住院医师培训方向为骨科（n = 249，66.9%）、整形外科（n = 56，15.1%）或普通外科（n = 55，14.8%）。fellowship培训方向为骨科（n = 242，65.1%）、联合培训（n = 65，17.5%）和整形外科（n = 15，4%）项目。96.6%的外科医生（n = 337）进行涉及神经的显微外科手术，接受整形外科住院医师培训的外科医生与接受骨科住院医师培训的外科医生之间无显著差异，完成骨科fellowship培训的医生与完成联合fellowship培训的医生之间也无差异。在完成调查的外科医生中，56.1%（n = 208）进行一般微血管手术，50%（n = 179）进行再植手术，30.6%（n = 113）进行游离皮瓣手术。完成整形外科住院医师培训的手外科医生比接受骨科住院医师培训的医生更有可能进行一般微血管手术、再植手术和游离皮瓣手术。在比较骨科和联合fellowship培训时，再植手术、游离皮瓣手术、一般微血管手术或涉及神经的显微外科手术的操作情况没有差异。
培训背景对当前的显微外科实践有重大影响，其中住院医师培训的影响最为显著。具体而言，接受整形外科住院医师培训项目的手外科医生比完成骨科住院医师培训的医生更有可能进行再植手术、游离组织移植和一般微血管手术。fellowship培训背景对显微外科实践没有显著影响。
