Rotations

Dr. Green Rotation.  You will work with Dr. Green in clinic at The Hand Center on Tuesdays and Wednesdays.  Dr. Green currently works 1 1/2 days in the clinic.  The fellow from Dr. Bagg's, Dr. Person's and Dr. Srinivasan's rotation will each spend one 1/2 day of clinic with Dr. Green.  In total, each fellow will interact with Dr. Green for a total of 9 months out of 12 months.  This presents a unique opportunity to not only learn from the patients seen directly in Dr. Green's clinic, but to also discuss patients/cases from the other rotations with him.

Dr. Saucedo's Rotation:  On Monday afternoons, you will see patients in the VA clinic with Dr. Saucedo and orthopaedic surgery residents.  On Tuesday, the fellow and resident, under the direct supervision of Dr. Saucedo, will work together in the surgical management of VA patients. Generally acting as the supervising surgeon, the fellow teaches and assists the resident through surgical cases, thereby gaining mastery of these procedures through instruction and performance.  In the remainder of the work week, the hand surgery fellow works with Dr. Saucedo, who sees and treats a wide variety of conditions in pediatric and adult patients, including acute and cold trauma from fingertip to elbow, post-traumatic sequelae, congenital hand differences and "typical" elective conditions, such as cubital and carpal tunnel syndrome, thumb CMC arthritis and trigger digit, to name a few.

Sample cases include:
VA- wrist fusion, open carpal tunnel release, ray amputation, cubital tunnel release with submuscular ulnar nerve transposition, distal radius malunion osteotomy, proximal row carpectomy, MPJ arthroplasty and fusion for rheumatoid arthritis
Saucedo - distal radius fractures (including closed reduction percutaneous pinning, fragment-specific and bridge plate fixation as indicated, in addition to volar locked plating), malunions of the wrist and forearm, hand fractures (closed treatment as well as open and percutaneous techniques), scaphoid fractures, DRUJ reconstruction, radioscapholunate fusion, ulnar shortening osteotomy, flexor tendon repair and reconstruction, syndactyly (primary and revision), thumb duplication (Wassell IV and Wassell III), thumb CMC mini-tightrope suspensionplasty, percutaneous ECRB debridement (TENEX procedure).

Dr. Bagg's Rotation.  You will spend an average of 2.5 days in the OR and 2 days in clinic. You will encounter a wide breadth of orthopaedic cases, including shoulder and elbow arthroplasty.  The fellow will encounter “cold trauma cases” throughout the entire year, but the majority of fractures proximal to the elbow are treated while on service with Dr. Bagg.  Dr. Bagg will also perform microsurgical reconstruction of lower limb and upper limb soft tissue defects.  The fellow will gain confidence with the anatomy of the upper extremity given the wide variety of procedures performed on the upper extremity (from fingertip to shoulder) on this rotation.  In addition, a half day will be committed to research and academic activities.

Sample cases include:
Mini open carpal tunnel releases, thumb CMC trapeziectomy with LRTI, total elbow arthroplasty, total and reverse shoulder arthroplasty, rotator cuff repair, DRUJ reconstruction, thumb UCL repair and reconstruction, ORIF distal radius, CRPP and ORIF metacarpal fractures, lateral epicondyle release, ORIF olecranon fracture, ORIF humerus fracture (distal, shaft, and proximal), vascularized bone grafting of scaphoid nonunions with medial femoral condyle, opponensplasty.

Dr. Person, Dr. Desai's Rotation.  You will spend an average of 1 full day in the OR and 1.5 days in clinic with each surgeon.  You will be exposed to a wide variety of cases, ranging from the common to the exquisitely complex.  You can expect to add considerably to your skill set in the evaluation and surgical treatment of complex problems.

Dr. Person sees both pediatric and adult patients and performs a variety of surgical procedures, ranging from “typical” elective hand surgery cases to complex microvascular head and neck reconstruction. Fellows will benefit from exposure to a wide array of hand pathology as well as microvascular reconstruction of complex head and neck defects after radical tumor resection.

Dr. Desai, similarly, sees a typical variety of congenital and adult elective hand surgery cases.  Fellows will be exposed to complex upper and lower extremity microvascular reconstruction for scaphoid nonunions, trauma, and following tumor extirpation surgery.  Fellows will also be exposed to complex peripheral nerve reconstruction and challenging hand ischemia cases.  In addition, he, along with Dr. Srinivasan, staffs the Brachial Plexus clinic at Methodist Hospital and is responsible for the assessment and subsequent surgical management of these patients.

By the end of this rotation, fellows should be comfortable with the management of skin and soft tissue, nerves and blood vessels, WALANT and the operating microscope.

Sample cases include:
Endoscopic carpal tunnel release, trapeziectomy with APL suspensionplasty, radial forearm free flap, free Latissimus myocutaneous flaps, Anterolateral thigh flaps, free Fibula flaps, free Medial Femoral Condyle vascularized bone grafts, free Functional muscle transfers, Distal Radius fracture ORIF, Scaphoid ORIF, Metacarpal and other hand fracture ORIF, trigger releases, syndactyly release, Thumb Duplication reconstruction, pollicization.

Dr. Srinivasan, Dr. Dutta, Dr. Morrey, Dr. Wirth and Dr. Cromack’s Rotation.  A true “flex rotation”, the hand and upper extremity surgery fellow will spend time with both Dr. Srinivasan and Dr. Dutta during this rotation in scheduled fashion, sharing time between the Hand Center and the University (UTHSCSA).  On average, 3 days per week are spent in the operating room and 2 days in clinic.  In addition to that, the fellows have the opportunity to work with Drs.  Morrey, Wirth and Cromack depending on interest and time available on the fellows’ part.  The hand surgery fellow will be exposed to a wide variety of techniques in the care of upper extremity conditions.  The fellow can expect to see a wide range of conditions, from the simple to the complex.  In addition, Dr. Srinivasan shares the brachial plexus clinic with Dr. Desai, giving hand surgery fellows exposure to brachial plexus injuries.

Sample cases include:  

Elbow and wrist arthroscopy, ORIF wrist fracture, shoulder arthroscopy (including sad, dce, rcr, capsular release), ulnar shortening osteotomy, open and endoscopic carpal tunnel release, thumb CMC trapeziectomy with LRTI, elbow arthrotomy and contracture release, total elbow arthroplasty, total and reverse shoulder arthroplasty, rotator cuff repair, DRUJ reconstruction, thumb UCL repair and reconstruction, CRPP and ORIF metacarpal and phalangeal fractures, lateral epicondyle release, ORIF olecranon fracture, ORIF humerus fracture (distal, shaft, and proximal), vascularized free fibula reconstruction of nonunion, brachial plexus injuries.