Program Goals
- Train fellows for independent evaluation and management of peripheral nerve disorders
- Develop technical proficiency in microvascular surgery and microsurgical nerve procedures
- Foster multidisciplinary collaboration across surgical and non-surgical specialties
- Promote academic productivity and evidence-based practice
- Prepare fellows for leadership roles in academic or high-level clinical practice
Educational Objectives
Upon completion of the fellowship:
- Perform comprehensive peripheral nerve physical examinations and diagnostic evaluations
- Independently develop a comprehensive treatment plan for Brachial plexus and other complex peripheral nerve reconstructions
- Independently perform nerve decompressions, repairs, grafting, and transfers
- Treat peripheral nerve tumors and neuromas
- Understand and appreciate non-surgical approaches to neuropathic pain (spinal cord stimulators, ketamine infusion, targeted nerve blocks, hydrodissection)
- Utilize neuromodulation techniques for pain and functional restoration
- Independently perform free flaps, pedicle flaps, and skin grafts for complex wound closure
- Lead multidisciplinary care discussions and conferences
Clinical Experience
- Nerve repair and nerve grafting (autografting, allografting, conduit assisted)
- Upper and lower extremity nerve transfers
- Brachial Plexus surgery
- Peripheral nerve tumors
- Compression neuropathies (Thoracic Outlet syndrome, carpal tunnel, cubital tunnel, radial tunnel)
- Neuroma and neuropathic pain treatment (TMR, RPNI, nerve caps, migraine surgery)
- Peripheral nerve stimulation
- Tendon transfers, tenodesis, tendon lengthening
- Functional muscle transfers (pedicle, free)
- Microvascular soft tissue coverage (free flaps)
- Non-microvascular soft tissue coverage (pedicle flaps, skin grafts, local flaps)
- Functional optimization and prosthetics in amputees
Didactic Curriculum
- Weekly protected educational conference (2 hours)
- Monthly multidisciplinary case conference
- Quarterly Multidisciplinary Peripheral Nerve Conference (fellow-run)
- Quarterly Morbidity and Mortality Conference
- Monthly Journal Club
- Annual Kaiser-Stanford Brachial Plexus Cadaver Hands-On Lab
- Robotic Microsurgery orientation and cadaver lab
Clinical Rotations
The fellowship will consist of 7 rotation blocks:
- Peripheral nerve surgery (Neurosurgery/Plastic Surgery): 6 months
- Brachial Plexus and Complex Reconstruction (Neurosurgery/Plastic Surgery): 2 months
- Hand, Microvascular, and Functional Reconstruction (Plastic Surgery/Ortho Surgery): 1 month
- Pain and Neuromodulation (Anesthesia/Neurosurgery/Plastic Surgery): 1 month
- Electrodiagnostics and Neurology: 2 weeks (Neurology)
- Advanced Nerve Imaging: 2 weeks (PM&R)
- Research/Elective: 1 month
Clinical Experience
Microsurgical and Soft-Tissue Expertise
- Advanced microsurgical and non-microsurgical (local flaps, pedicle flaps, skin grafts) soft tissue coverage procedures, with an emphasis on scalp reconstruction:
- cranioplasty, scalp reconstruction
- head and neck reconstruction
- lower extremity reconstruction
- upper extremity reconstruction
Peripheral Nerve Surgery
- Brachial plexus and lumbosacral plexus injuries and complex reconstruction (hybrid reconstruction, grafting, nerve transfers)
- Peripheral nerve tumors
- Compression Neuropathies (Thoracic Outlet Syndrome, Tarsal Tunnel)
- Neuroma and neuropathic pain (migraine surgery, TMR, RPNI, nerve caps)
- Peripheral nerve stimulation and neuromodulation
- Stroke and Spasticity reconstruction
Upper and Lower and Extremity Functional Surgery
- Tendon Transfers, Tenodesis, tenotomy, tenolysis
- pedicle and free functional muscle transfers
Non-Surgical Approaches
- hydrodissection, U/S guided injections, spinal cord stimulators, radiofrequency ablation, targeted nerve blocks