July 15, 2010 - Another successful
Visiting Professor session.
From left to right: Dr. Neil Jones, Dr. Ying Chi, Dr.
Andy Koman, and Dr. Gustavo Machado at UC Irvine Surgical Skills
Hand & Upper Extremity Surgery
University of California, Irvine
1. UC Irvine Medical Center
Fellows will spend alternating three month rotations at the
UC Irvine Medical Center where the fellows will be exposed to
traumatic and elective hand surgery as well as attending the
private offices of Drs. Jones, Gupta and Rafijah. UC Irvine
Medical Center is a brand new hospital opening in February 2008
and is the only University Hospital and Level 1 Trauma Center
in Orange County covering a population of over 3 million. UCI
Medical Center also contains the Regional Burn Center.
2. Kaiser Permanente
Fellows will spend alternating three month rotations at Kaiser
Permanente Orange County Medical Center where they will obtain
a broad experience in hand, wrist, elbow and shoulder surgery
while working with three hand surgeons and one shoulder/elbow
surgeon. Kaiser Permanente opened a new hospital in Irvine
in May 2008 where outpatient and inpatient cases are performed. The
Kaiser Anaheim and Irvine medical centers are Level II Trauma
Centers covering approximately 400,000 Kaiser Permanente members.
3. Children’s Hospital of Orange County
Children’s Hospital of Orange County (CHOC) is the only
Children’s hospital covering Orange County and is a Level
II Trauma Center for pediatric trauma. The hand fellow
based at the UCI Medical Center will accompany Dr. Jones to a
pediatric and congenital hand clinic twice a month as well as
operating at CHOC once a week on congenital hand anomalies and
post-traumatic reconstruction of pediatric hands.
4. Shriners Hospital – Los Angeles
The hand fellow based at the UCI Medical Center will accompany
Dr. Jones to a congenital hand clinic at Shriners Hospital Los
Angeles, held on the first or second Thursday of the month. Both
hand fellows will gain extensive experience in microsurgical
reconstruction of congenital hand anomalies, approximately 6-12 toe-to-hand
transfers per year. Shriners Hospital Los Angeles has the
largest series of pediatric toe-to-hand transfers in the United
- Neil F. Jones, M.D., Fellowship Director,
Professor Department of Orthopaedic Surgery and Division of
Plastic and Reconstructive Surgery
- Ranjan Gupta, M.D., Professor and Chairman
Department of Orthopaedic Surgery
- Gregory Rafijah, M.D., Clinical Assistant
Professor Department of Orthopaedic Surgery
- Emil Dionysian, M.D., Attending Hand Surgeon
- Neil Harness, M.D., Attending Hand Surgeon
- Brett Pederson, M.D., Attending Hand Surgeon
- Michi Kono, M.D. Attending Hand Surgeon
- Edward Yian, M.D. Attending Shoulder Surgeon
Dr. Jones trained in General Surgery and Orthopaedic
Surgery in England and completed a residency in Plastic and Reconstructive
Surgery at the University of Michigan. He completed a Hand
Surgery Fellowship in the Department of Orthopaedic Surgery at
the Massachusetts General Hospital with the late Richard Smith,
M.D. and Jesse Jupiter, M.D.
Dr. Jones is currently the President of the American Society for Reconstructive
Microsurgery. He has served on the Council of the American Society for
Surgery of the Hand. He has been an Associate Editor of the Journal of
Hand Surgery and is currently an Associate Editor of Techniques in Hand and
Upper Extremity Surgery, Journal of Reconstructive Microsurgery and Annals
of Plastic Surgery.
Dr. Gupta completed his residency in Orthopaedic
Surgery at the University of Pennsylvania and his Hand Fellowship
at UCLA Medical Center.
Dr. Gupta has recently been the 2007-2008 Bunnell Fellow of the American Society
for Surgery of the Hand.
Dr. Rafijah completed his Orthopaedic Surgery
residency at Harbor-UCLA Medical Center and his Hand Surgery
Fellowship at the University of Washington, Seattle.
Dr. Dionysian completed his Orthopaedic Surgery
residency at UCLA Medical Center and his Hand Fellowship at Roosevelt
Hospital in New York. He completed a second fellowship
in Shoulder surgery with Louis Bigliani, M.D. at Colombia Presbyterian
Hospital in New York.
Dr. Harness completed his Orthopaedic Surgery
residency in the Harvard Combined Program and his Hand Fellowship
at UCLA Medical Center.
Dr. Pederson completed his Orthopaedic Surgery
residency at UCLA Medical Center and his Hand Fellowship at UC
Dr. Kono completed his Orthopaedic Surgery
residency at UCLA Medical Center and his Hand Fellowship at the
University of Cincinnati.
Dr. Yian completed his Orthopaedic Surgery
residency at the University of Michigan and completed the Transcontinental
Shoulder Fellowship at the Massachusetts General hospital with
Jon J.P. Warner, M.D. and at the Balgrist Klinik in Zurich, Switzerland
with Christian Gerber, M.D.
The hand fellows will also work with dedicated hand therapists
at the UCI Medical Center, Children’s Hospital of Orange
County and Kaiser Permanente.
UCI HAND SERVICE
This is a collaborative combined service between the Department
of Orthopaedic Surgery and the Division of Plastic and Reconstructive
Surgery at the University of California, Irvine. All bone
and soft tissue injuries distal to the wrist are referred to
the Hand Surgery Service and all distal radius fractures and
wrist fractures are treated by the Hand Surgery Service. Complex
combined injuries of the upper extremity and nerve injuries of
the upper extremity are also managed by the Hand Surgery Service.
The Hand Surgery Service also performs all bone and soft tissue
reconstructions for limb salvage of malignant bone and soft tissue
tumors of the upper and lower extremities, and is also frequently
consulted for reconstruction of grade III open fractures of the
The Hand Surgery Service consists of:
- 3 attending hand surgeons
- 2 hand surgery fellows
- 1 Orthopaedic Surgery Resident – 4 residents alternating
every 3 months
- 1 Plastic Surgery Resident – 3 residents alternating
every 4 months
- 1 Junior Orthopaedic Resident on Trauma call - takes care
of all the minor hand trauma in the Emergency Room including
finger tip injuries and initial reduction of wrist and hand
Patients with more severe hand injuries are initially seen by
one of the 2 hand surgery residents and the hand fellow is then
involved in the operative treatment or in a consultant role. The
two hand surgery fellows alternate night call at UCI Medical
Center (taken from home).
The UC Irvine hand fellowship provides an extensive in-depth
exposure to not only traditional hand surgery, but also upper
extremity surgery including the elbow and shoulder as well as
traumatic and elective microsurgery. This provides the
hand surgery fellows an extraordinary opportunity to structure
their fellowship, either to concentrate only on hand surgery;
or hand and upper extremity surgery; or hand surgery and microsurgery. The
fellowship is also completely integrated between Orthopaedic
Surgery and Plastic Surgery and there are very few totally integrated
fellowships in the United States.
Secondly, it is very much a mentorship type fellowship with
a “one-on-one” relationship between the fellow and
faculty. This is in contradistinction to fellowships where
a fellow only spends one or two months with six attendings and
does not get to understand the thinking and judgment of an attending. The
fellows spend three months with Dr. Jones, Gupta and Rafijah
and then three months at Kaiser and this cycle is then repeated. All
of the attendings have trained in the best hand surgery fellowship
programs (Boston, New York, Cincinnati, Seattle, UCLA) and are
very good teachers and will take the fellow through surgical
procedures rather than having the fellow “hold hooks” or
at the other extreme “relearn the wheel”.
The entire spectrum of hand surgery is seen at UCI Medical Center
and Kaiser, nothing is too over emphasized and there is nothing
missing. Fellows will be involved in straight forward hand
trauma as well as complex tertiary hand trauma, post-traumatic
reconstruction, distal radius fractures, wrist arthroscopy, rheumatoid
arthritis and congenital anomalies. There is also excellent
exposure to elbow and shoulder surgery with two attending surgeons,
Dr. Gupta at UCI Medical Center and Dr. Yian at Kaiser Permanente. There
is a high volume of peripheral nerve surgery and brachial plexus
surgery and the fellowship is particularly strong in microsurgical
reconstruction of the upper extremity including free flaps and
toe transfers. There is excellent exposure to both upper
and lower extremity salvage reconstruction after malignant tumor
resections and toe transfers for congenital hand reconstruction. There
is a high volume of pediatric hand surgery both at Children’s
Hospital of Orange County and Shriners Hospital of Los Angeles. Finally,
the hand fellows can also become involved in free flap coverage
of the lower extremity for grade III tibial fractures and osteomyelitis
and also in free vascularized bone transfers for bony reconstruction
after tumor resection.
One of the great advantages of the UCI fellowship is that there are excellent
opportunities for the fellow to act as an attending hand surgeon and teach
hand surgery techniques to orthopaedic surgery residents and plastic surgery
residents during both emergency and elective hand surgery. However, this
is coupled with a “safety-net” in that the fellows can still feel
comfortable by obtaining telephone advice from one of the attending surgeons
or if necessary asking the attending surgeon to come in and help.
Hand surgery fellows are given an academic appointment as a
Clinical Instructor at the University of California, Irvine and
therefore once a month can act as the attending of record for
admission and surgical treatment of hand trauma patients. The
hand surgery fellow at Kaiser Permanente also runs a weekly hand
clinic and can operate independently on patients from this clinic.
- Weekly Hand Conference on Monday afternoons. Either
a resident or fellow will give a 45 minute didactic talk on
a specific topic, and this is followed by a lively discussion
generated by the attendings. At the second Monday of
the month hand conference, the two hand fellows show all the
interesting cases from the previous month and this also acts
as an audit of cases performed by the fellows in their attending
role. This is probably the most informative conference
and the fellows are obligated to take digital photographs of
all cases and relevant x-rays. This photographic documentation
allows teaching at all levels from the medical student level
through the orthopaedic surgery and plastic surgery residents
up to the fellows and attending level.
- Monthly Journal Club organized by the hand
fellows and held at a local restaurant.
- Orthopaedic Surgery Grand Rounds. Thursday
mornings from 7:00 to 10:00 AM. Several lectures are given
on basic hand surgery topics to the orthopaedic surgery residents
and usually each hand surgery fellow will give one or two of
- Hand dissections – a state of the
art, fresh cadaver lab will open in January 2010, and this
will allow the hand surgery fellows and residents on the hand
surgery service to dissect and prosect hand and upper extremity
anatomy specimens as well as providing a source for research
- Microsurgical laboratory – we usually
arrange for an orthopaedic- trained hand fellow to spend one
week in the microsurgery lab during the first month of their
fellowship in August to hone their microsurgical skills. However,
we would also prefer any incoming orthopaedic-trained fellow
to have completed a one week basic microsurgery course at their
home institution prior to starting the fellowship. Similarly,
for any plastic surgery-trained fellow, we would expect them
to have completed a basic AO internal fixation course prior
to beginning the fellowship.
- Local courses and lectures – the UCI
hand fellows are encouraged to attend lectures by visiting
hand surgeons at other institutions in southern California
such as USC, UCLA and Orthopaedic Hospital. In addition,
several nationally and internationally recognized hand surgeons
are invited to UC Irvine during the year as visiting professors.
- Fresh cadaver Anatomy Laboratory
- Microsurgery Laboratory
- Biomechanics Laboratory based at Long Beach
VA Hospital and headed by Thay Lee, PhD is an internationally
recognized biomechanics lab focusing on the shoulder and elbow
and wrist. At any one time there are approximately 10
international fellows or visiting residents from USC and Kerlan-Jobe
involved in research projects and the hand fellow will have
an ideal opportunity to become involved.
- Peripheral Nerve and Molecular Biology of Nerve Regeneration
laboratories. These two laboratories housed
in the Gillespie Neuroscience Research Facility at UC Irvine
are directed by Dr. Gupta who has two NIH RO1 grants. The
hand fellows can become involved in basic science projects
in these labs during the year.
Each hand surgery fellow is expected to complete two research
projects, one of which is usually presented at the annual UCI
Orthopaedic Residents Day in June, but ultimately should be
presented at a national meeting and published. Fellows
have usually become involved in clinical projects, but there
are superb opportunities for basic science projects, either
in the biomechanics laboratory or in peripheral nerve research.
SALARY, VACATION and MEETINGS
The hand fellows are paid at their relevant PGY 6, 7, 8 or 9
level. The salary is approximately $54,900 per year. The
fellows can take one month of vacation. Travel and accommodation
expenses are paid for one meeting per year, which is usually
the American Society for Surgery of the Hand meeting in the fall.
- The three attending hand surgeons at UCI Medical Center have
all been Chief of Hand Surgery at Level 1 Trauma Centers in
California – Dr. Jones was Chief at UCLA Medical Center
for 15 years, Dr. Gupta was Chief at UCI Medical Center for
10 years and Dr. Rafijah was Chief at Harbor – UCLA Medical
Center for 10 years. The attending hand surgeons at Kaiser
Permanente all trained in Orthopaedic Surgery at either UCLA
Medical Center or the Harvard combined program and completed
fellowships in leading hand surgery programs.
The UCI hand and upper extremity fellowship is now the largest
hand surgery fellowship in California, in terms of having 6
fellowship-trained hand surgeons and one fellowship-trained
shoulder surgeon. It has an extraordinary wealth of clinical
material from microsurgical reconstruction to brachial plexus
to congenital hand anomalies to shoulder and elbow surgery. Dr.
Jones and Dr. Gupta bring their international and national
reputations to the UCI Hand Surgery Fellowship, which should
only continue to increase with our major commitment to basic
research in peripheral nerve, tissue engineering and transplantation,
which will be the future of hand surgery.
- The fellowship is a combined program between the University
of California, Irvine and Kaiser Permanente and allows the
hand fellows to experience both a University academic medical
center and a private practice group. The fellowship is
also a truly integrated combined program between the Department
of Orthopaedic Surgery and the Division of Plastic and Reconstructive
Surgery. It allows an orthopaedic-trained fellow to develop
a very high level of expertise in nerve and tendon reconstruction
and flap coverage, and conversely a plastic surgery-trained
fellow to achieve a very high level of expertise in the treatment
of distal radius fractures and wrist arthroscopy. In
addition, the fellowship covers the entire spectrum of traditional
hand surgery, as well as upper extremity surgery of the shoulder
and elbow and traumatic and reconstructive microsurgery, which
very few hand fellowships can emulate.
- The UCI fellowship is a very intense mentorship type program
with “one-on-one” teaching in the operating room
and private offices and clinics, but at the same time allows
progressive responsibility for operating independently.
- Hand fellows graduating from the UCI fellowship will rank
extremely favorably with graduates of the other top hand fellowship
programs and we would expect several of our fellowship graduates
to eventually become future leaders in academic hand surgery
over the next few years.
We accept the Universal
Hand Surgery Fellowship application.
Complete and return the application and waiver form, along
with the list of documents listed below Please arrange
to have three letters of recommendation forwarded, one
from the chief of your residency training program and one
from the hand surgeon who knows you best.
Below is a list of additional documents that need to be sent in along with
- USMLE Scores Steps I, II & III
- Medical School Transcripts
- Personal Statement
- Current CPR, ACLS or BLS certificate (Proof required if you
are granted an interview)
- Three current letters of recommendation A fourth letter is
- Dean's Letter
- Copy of any published articles
UCI participates in the NRMP Hand Fellowship Specialty Match
and you should contact the NRMP for an applicant agreement for
the Hand Surgery Specialty Match. Applicants should have completed
a residency in orthopaedic surgery, plastic and reconstructive
surgery or general surgery. A California license is a requisite
for the incoming fellow.
Please submit your application and letters of recommendation
to the Department of Orthopaedic Surgery Office at the location
listed below. After review of the applications, applicants will
be invited to UC Irvine Medical Center, usually in late February-March,
for a mutual visit and interview.
The deadline for submitting application materials to UC Irvine is January 31.
Thank you again for your interest in the UC Irvine Hand and Microsurgery Fellowship.
We encourage you to remain in touch with the Fellowship Coordinator regarding
the status of your application.
Interviews will be held in March 2011
Attn: Maria Lampino Guerrero
Department of Orthopaedic Surgery
101 The City Drive, Pavilion 3, 2nd Floor
Orange, CA 92868
Tel: (714) 456-5547
Fax: (714) 456-7547
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