Microvascular
The University of Pittsburgh Medical Center (UPMC) has added a robust microvascular experience to the advanced oncologic head and neck surgery fellowship. The fellow is expected to participate in and gain proficiency in microvascular reconstruction for traumatic and oncologic head and neck defects.
At our institution, approximately 200 cases of microvascular head and neck reconstruction are performed on an annual basis by our Head and Neck fellows. The faculty leading microvascular reconstructive surgery include Drs. Spector, Sridharan, Contrera, and Solari who are all jointly appointed in both Otolaryngology and Plastic Surgery departments. By the end of the year, fellows are expected to demonstrate competence and independence with these cases.
In addition to offering a high clinical volume, our program offers a diverse exposure to a variety of free flap donor sites and oncologic defects. Particularly common in our practice include radial forearm, anterolateral thigh, fibula, medial sural, and subscapular system flaps. Given the high volume endoscopic/open skull base program at UPMC, fellows will also have a strong experience with flaps for skull base reconstruction. Fellows will participate in several cases of virtual surgical planning and primary osteointegrated implants for osseous reconstructions in collaboration with the involved faculty.
A variety of clinical research opportunities are available in our reconstructive division. With the addition of a REDCap prospective database and a dedicated research coordinator, our research efforts have become more streamlined. This will provide fellows with ample opportunity for clinical investigation depending on their level of interest.
A particular area of reconstructive innovation has been in reconstruction of complex bone defects of the maxillofacial skeleton. Advances in computer assisted design allows the surgeons to essentially create a virtual simulation of the anticipated cancer surgery. This facilitates the generation of computer generated surgical guides, patient specific implants, and models that have been shown to both increase the anatomic accuracy of reconstructions as well as reduced surgical time. Additionally, these planning abilities have made primary dental implant placement during jaw reconstruction feasible for some patients. This shortens the time to oral rehabilitation and improves quality of life. An increasing interest in nerve reconstruction concurrent with these procedures has occurred, which optimizes the functionality and sensate nature of the reconstructed tissue.
