Division of Plastic and Reconstructive Surgery

Our major interests include hand surgery, cosmetic surgery, breast reduction, free tissue transfer (microsurgery), and the repair of cleft lip and craniofacial abnormalities. Our residents and faculty seek excellence in the operating room, caring for patients and researching new techniques.

Plastic surgery is a calling to restore the beauty, function and symmetry that have been taken away by disease, trauma or inborn defects. The breadth of our practice is defined by the American Board of Plastic Surgery but the true scope is infinite, spanning all ages, body systems and technologies.

Faculty

Residency Training

Saint Louis University’s plastic and reconstructive surgery residency program provides a complete plastic surgical experience, encompassing:

  • General reconstructive surgery and wound care
  • Head and neck surgery
  • Pediatric plastic surgery including craniofacial and cleft patient care
  • Hand surgery
  • Aesthetic surgery
  • Breast surgery including microsurgical reconstruction

There are no formal fellowship programs so our residents get to have a greater direct operative experience with the attending surgeons.

A recent review by the Residency Review Committee for Plastic Surgery has resulted in the Accreditation Council for Graduate Medical Education granting SLU's plastic surgery residency program continued full accreditation for five years with no citations.

Plastic and Reconstructive Surgery Training

Our goal is to provide our residents with all of the necessary skills to be competently practicing plastic surgeons. The program focuses on teaching residents to be teachers, thereby ensuring mastery of the material and maximal learning and retention. Approximately half of our graduating chief residents go on to further fellowship training at top programs while the other half immediately enter clinical practice.

Clinical Practice Settings

The five hospital practice sites in the Saint Louis University plastic and reconstructive surgery training program allow residents to experience first-hand the various clinical practice settings they will ultimately face when they decide to go into practice: the academic model, the totally private practice model, the government hospital model, the hospital supported model and the hospital owned practice model.

Residents can appreciate the pros and cons of each system and better select the venue that they feel best suits their clinical practice life goals. Our graduates have found this invaluable when making the final decisions regarding career path selection.

SSM Health Saint Louis University Hospital

SSM Health Saint Louis University Hospital is the home base of the program. Experience is primarily in the areas of facial and general trauma, reconstructive surgery of all types, and hand surgery. There are two major general plastic surgery/hand clinics every week at the hospital and three at other locations in the city.

 

SSM Health Cardinal Glennon Children's Hospital

 

At SSM Health Cardinal Glennon Children's Hospital, residents gain experience in congenital disorders, clefts, burns, pediatric reconstructive surgery and hand surgery. There are two general plastic surgery clinics every week and a cleft palate/craniofacial clinic twice a month. Both SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children’s Hospital have Level 1 Trauma Centers with a wide variety of trauma and hand surgery patients.
VA Saint Louis Health Care System - John Cochran Division

The VA Saint Louis Health Care System - John Cochran Division provides experience in head and neck, hand, and reconstructive surgery as well as wound care. There is a general plastic surgery clinic once a week and a hand clinic every two weeks. 

SSM Health St. Mary's Hospital

At SSM Health St. Mary's Hospital, residents will mostly interact with private patients who have problems in general reconstructive plastic surgery and aesthetic surgery. This setting provides the residents experience in treating and processing patients in a private practice atmosphere.

Mercy Hospital St. Louis

Residents also have a rotation at Mercy Hospital St. Louis where they gain further experience in the private setting as well as in resuscitation of acute burns and operative burn treatment, in addition to hand surgery and breast surgery, including microsurgical breast reconstruction.

All of these hospitals are within in a 14-mile radius and can be reached in less than 20 minutes driving time.

The supervision and degree of independent operative experience during this program is carefully graduated to meet the abilities, initiative and educational needs of each resident. Our overriding concern in all operative activities is the quality of our service and the safety of the patient. These are never compromised for the sake of independent operative experience by residents.

Excellence in patient care is a prerequisite to excellence in teaching and surgical education. As a Jesuit institution, we provide a great deal of compassionate charity care and the residents experience the gratification of having new abilities to help the less fortunate.

Residency Program Education

Our plastic surgery residency program is structured along three major educational activities.

Patient Care and Service

Patient care including patient selection, preoperative planning, operative experience and postoperative follow-up is emphasized. Residents are provided with a rich, well-rounded experience in all aspects and categories of plastic surgery. The majority of the hospitals in the program utilize the EPIC electronic medical records system.

Surgical Education

Formal didactic teaching includes the full spectrum of teaching conferences including case presentations, seminars, review of selected readings, journal review, mortality and morbidity conferences, anatomy dissections and lectures on basic science topics related to plastic surgery. There are two 1.5 hour sessions held on Tuesday and Wednesday mornings of each week. In addition, the In-Service Examination is required of all our residents, a mock oral board examination is organized each year, and a microsurgical workshop is held each year.

Research

Basic and clinical research is encouraged and each resident is expected to complete a project and hopefully, submit it for publication/presentation each year. Funds are available to send residents to meetings when they present their research papers. A microsurgery laboratory is available for practice of microsurgical techniques and research and a large animal research facility located in the medical school is also available for basic research support.

Program Objectives

Residents will be able to have unique experiences by participating in rotations at these area hospitals. Click below for objectives for the different programs. 

SSM Health Cardinal Glennon Children's Hospital (PS1 and PS2)

Cardinal Glennon Children’s Medical Center was the first children’s Level 1 Trauma Center in the St. Louis metropolitan region. As a result,  our plastic surgery residents gain exposure to acute traumatic injuries in the pediatric populations. In addition, Cardinal Glennon established the first Cleft Palate Clinic in the Midwest in 1956. This team currently meets three times a month.

The plastic surgery resident should obtain experience in the following areas:

  • Congenital defects of the head and neck, including cleft lip and palate, craniosynostosis, and craniofacial deformities secondary to various syndromes (i.e., Aperts, Crouzons, etc.).
  • Craniomaxillofacial trauma in children.
  • Pediatric tumors of the head and neck (neurofibromatosis clinic).
  • Pediatric breast deformities such as Poland’s syndrome and gynecomastia
  • Congenital upper extremity deformities.
  • Pediatric upper extremity trauma and reconstruction fractures, tendon and nerve injuries, soft tissue injuries.
  • Congenital trunk deformities (omphalocele and myelomeningocele).
  • Acute pediatric burn care, debridement and grafting, and correction of burn contracture deformities in children.
  • Microsurgical techniques in children.
  • Tissue transfer in children (for example, trunk and lower extremity), including the use of tissue expanders in scalp and trunk reconstruction.
  • Management of benign skin and soft tissue lesions in children (congenital nevi, facial lesions).
  • Snake bites and compartment syndrome in children.
  • The complex interrelationship between congenital pediatric anomalies, indigent care and how they interface with limitations in health care resources.

Progression of core knowledge, clinical skills, surgical technique, clinical judgment and maturity is expected as plastic surgery residents advance from their first year (PS1) to the second year (PS2) of residency during this rotation. First-year plastic surgery residents should become familiar with and proficient in the diagnosis and surgical techniques in the management of the pediatric wounds in an emergency room setting, skin grafts in children, local and regional flaps in children, cleft lip, cleft palate, velopharyngeal incompetence, benign and malignant cutaneous lesions and tumors.

The plastic surgery resident should also learn the special considerations in the anesthetic and critical care management of the pediatric patient. This is especially important as it related to airway management, administration of medications and fluid resuscitation. Using experience gained during his/her first year of plastic surgery residency, the second year resident (PS2) should become experienced in managing the more complex pediatric plastic surgical conditions such as complex facial fractures, complex hand injuries, complex secondary congenital facial anomaly reconstructive procedures, craniosynostosis, etc.

SSM Health Saint Louis University Hospital Rotation (PS1 and PS2)

SSM Health Saint Louis University Hospital  is one of three adult Level 1 Trauma Centers in the St. Louis metropolitan region. As a result, our residents get most of their trauma experience, as it relates to plastic surgery, here.

The plastic surgery resident should obtain experience in the following areas:

Hand Surgery: The plastic surgery resident will learn how to diagnose and manage traumatic hand injuries, including tendon and nerve injuries, and hand fractures.The resident will also learn to manage patients with conditions such as nerve compression syndromes, Dupuytren’s contracture, ganglions, etc.

Craniomaxillofacial Surgery: The emergency diagnosis, management and surgical treatment of craniomaxillofacial trauma, including mandibular fractures, nasal fractures, simple and complex maxillary fractures, frontal bone and sinus fractures, and soft tissue injuries of the face.

Lower Extremity Reconstruction: Soft tissue and bony injuries to the thigh, leg, foot and ankle. This includes evaluation and management of radiation wounds, burns, grade III open tibial fractures, and soft tissue tumors as well as lymphedema, both congenital and acquired. Coordination of care and communication with services such as Trauma, General Surgery and Orthopedics is critical in the management of our patients with lower extremity soft tissue wounds.

Breast Surgery: During this rotation, the plastic surgery residents will gain exposure to breast reconstruction, both immediate and delayed, as well as breast reduction.

Surgery of the Week:  In conjunction with general surgery and thoracic surgery, the plastic surgery residents gain experience in both chest wall and abdominal wall reconstruction. Chest wall reconstruction includes both the diagnosis and management of complex sternal wounds following median sternotomy as well as acute and chronic thoracic wounds following trauma, lobectomy and pneumonectomy. The resident will also learn how to manage and treat patient with complex pressure sores. This is not limited to only the surgical closure of such wounds, but includes the importance of patient selection, nutrition, and postoperative social support systems.

Practice Management: The plastic surgery resident will assist in the coordination of care for patients with complex conditions, whether from trauma, transplants (liver and kidney), tumors or multisystem organ failure. The resident will learn the importance of communicating and interfacing with nursing staff, case managers, social service, pastoral care, patient family caregivers, and plastic surgery office staff in the care and discharge planning for patients.

Many of the patients cared for during this rotation are critically ill and/or have very complex comorbid illnesses requiring a more complex and diligent patient care plan
Progression of core knowledge, clinical skills, surgical technique, clinical judgment and maturity is expected as plastic surgery residents advance from their first year (PS1) to the second year (PS2) of residency.

First-year plastic surgery residents should become familiar with, and proficient in, surgical techniques such as skin grafting, local flaps, tissue expanders, simple and common hand surgical procedures such as carpal tunnel release, cubital tunnel release, fingertip repairs and finger amputations, hand splinting, and more simple facial fractures.

Second-year residents should become familiar with the management of more complex reconstructive procedures such as free tissue transfer, complex hand trauma, complex lower extremity traumatic wounds, complex facial fractures such as nasoethmoidal fractures, Lefort fractures, complex mandibular fractures, and, most importantly, learn how to anticipate and manage plastic surgical complications. Finally, during the Chief Resident year (PS3), residents are expected to perform as independent surgeons in the evaluation, surgical planning and postoperative care of the variety of patients on this rotation.

 

SSM Health St Mary's Health Center/VA Medical Center Rotation (PS1 and PS2)

SSM Health St. Mary’s Medical Center is an acute care facility located approximately four miles west of Saint Louis University. Patients from SSM Health Saint Louis University Hospital requiring rehabilitation are often transferred to the St. Mary’s Rehab Unit, thereby allowing the plastic surgery resident follow-up care for patients cared for during the acute phase of their illness at SLUH.

The plastic surgery resident should obtain experience in the following areas:

  • An office setting that is less “clinic” oriented and more representative of a private practice environment. The resident will learn how to run an office, efficiently schedule and see patients, understand the overhead issues involved in the practice of medicine, and learn the costs involved in office and patient care.
  • Plastic surgery of the breast: This rotation complements experience in the management of breast disease including congenital and acquired breast deformities and breast reconstruction.
  • Plastic surgery of the lower extremities:  The plastic surgery resident will see patients in the Wound Care Center every Friday afternoon. The resident will learn how to evaluate and treat patient with complex nonhealing wounds. The resident will gain familiarity with the multitude of wound care products as well as their costs and effectiveness for various conditions. Part and parcel of this experience is the care of our increasing geriatric population.
  • Surgery of benign and malignant lesions of the skin and soft tissue. This office practice provides the plastic surgery resident exposure and experience in the diagnosis and management of benign and malignant skin disease, most notably basal cell and squamous cell carcinoma and melanoma.
  • Perineal and gynecologic reconstruction. The plastic surgery resident will learn how to work with both general surgeons and gynecologic surgeons in the treatment of complex pelvic, perineal and vaginal wounds. This includes complex abdominal wall reconstruction, panniculectomy, vaginal reconstruction, and perineal reconstruction and repair following tumor resection oftentimes with radiation injury.

Progression of core knowledge, clinical skills, surgical technique, clinical judgment and maturity is expected as plastic surgery residents advance from their second year (PS2) to the Chief year (PS3) of residency. Second-year plastic surgery residents (PS2) should become familiar with, and proficient in, surgical techniques such as breast reduction, expander and implant breast reconstruction, excision and repair of facial, trunk and extremity skin cancers, management of nonhealing lower extremity wounds, aesthetic surgery procedures such as liposuction, abdominoplasty, postbariatric procedures, etc.

Working in the private office setting, the resident should also develop proficiency in interviewing and communicating with the elective plastic surgery patients. The Chief Resident (PS3) should build upon his/her experience and function as a Chief Resident taking a leadership role in patient selection, management and operative decision making.

Mercy Hospital St. Louis Rotation (STJI)

Mercy Hospital St. Louis's Medical Center Burn Unit is the only burn unit in the St. Louis metropolitan region and serves a population of over three million. Each resident in the coordinated track spends two months during the third year of general surgical residency in the Burn Unit. The purpose of this rotation is for the residents to gain experience in the acute resuscitation of the burn patient as well as in the acute surgical management of burn wounds. 

The plastic surgery resident should obtain experience in the following areas:

  • Acute resuscitation of the pediatric and adult burn patient.
  • Airway management of the burn patient.
  • Management of chemical and electrical burns.
  • Surgical debridement and grafting in the acute burn setting.
  • Familiarity with skin substitutes such as porcine grafts, biobrane, Apligraft, tissue cultured skin autografts.
  • Psychological impact of burn trauma of a patient and his/her family.
  • Postoperative hospital and office care of the burn patient.
  • Free tissue transfer of the upper and lower extremity. (Mercy Hospital St.Louis  has a fully staffed microsurgical lab. Each resident should take advantage of this opportunity during this rotation to become proficient in microsurgical technique.)
  • The relationship between burn care, recovery and systems-based practice.
  • Evaluation and selection of the aesthetic surgery patient.
  • Breast reconstruction
  • Aesthetic surgery, including facelift, blepharoplasty, rhinoplasty, breast augmentation and mastopexy, abdominoplasty and liposuction.
Aesthetic Surgery Rotation (PS2,PS3)

The aesthetic surgery rotation is a focused experience in the evaluation, operative treatment, and postoperative management of the patient seeking aesthetic surgery. The goals and objectives are centered around the six core competencies set forth by the Residency Review Committee for Plastic Surgery : 

Medical Knowledge

  • Understand the anatomy of the breast, eyelid and periorbital region, nose, and facial skeletal and soft tissues as they relate to aesthetic surgical procedures.
  • Describe the conventional ideal aesthetics of the male and female face, the breast, and the trunk, and be able to contrast these with common primary and secondary deformities of these areas for which corrective procedures may be sought (breast hypoplasia, tuberous breast deformity, Poland syndrome, lipodystrophy, nasal deformities, facial disharmony, facial aging, eyelid ptosis, brow ptosis, prominent ear, etc).
  • Understand the procedures and alternatives available for the correction of facial, breast and trunk aesthetic and functional complaints:
      • Rhinoplasty
      • Blepharoplasty
      • Brow lift
      • Rhytidectomy
      • Facial soft tissue augmentation
      • Otoplasty
      • Orthognathic surgery
      • Genioplasty
      • Reduction mammaplasty
      • Augmentation mammaplasty
      • Mastopexy
      • Liposuction
      • Lipectomy (abdominoplasty, brachioplasty, thigh lift, total body lift)
  • Be able to identify the differences and historical relevance of the different types of breast implants available, and the advantages and disadvantages of each.
  • Understand the unique physical, medical, nutritional, and emotional issues associated with the massive-weight-loss patient.
  • Understand the oncologic issues relevant to elective breast surgery.
  • Know the options available for nonoperative facial rejuvenation.
  • Describe the use of lasers for hair removal, tattoo removal, facial resurfacing, and other dermatological applications.
  • Discuss the complications that may arise after aesthetic surgical procedures, both short-term and long-term, and the management of these complications.

Patient Care

  • Perform the preoperative assessment of the patient presenting for elective aesthetic surgery, including obtaining a history and an appropriate physical examination, as well as obtaining any further testing needed (i.e., mammogram, bloodwork, etc).
  • Gain experience in performing the following: mammoplasty, mastopexy, liposuction, brachioplasty, abdominoplasty, thigh lift, rhinoplasty, septoplasty, rhytidectomy, brow lift, blepharoplasty, genioplasty, nonoperative facial rejuvenation, laser use and soft tissue filler placement).
  • Participate in the postoperative care and follow-up of the aesthetic surgery patient.
  • Consider the different approaches to female patients, male patients and patients of varied ethnic backgrounds.
  • Identify psychosocial stressors affecting patients presenting for aesthetic surgery, considering issues of interpersonal relationships, career and body image, including body dysmorphic disorder.

Practice-Based Learning and Improvement

  • Prepare for surgical cases by reviewing the current literature and evaluating the appropriateness of clinical decision making based on quality of published evidence.
  • Analyze the resident’s own effectiveness in caring for aesthetic surgical patients.
  • Continue to progress towards independence in the care of the aesthetic surgery patient.
  • Present patients as appropriate in the monthly plastic surgery morbidity and mortality conference.

Systems-Based Practice

  • Discuss the issues related to patient financing of elective aesthetic surgery.
  • Study the unique structure and challenges of the plastic surgery practice specializing in aesthetic surgery from the viewpoint of the surgeon as well as the global health care system.
  • Facilitate efficiency in the operating room and timely discharge of aesthetic surgery patients
  • Understand the state, local and specialty requirements for outpatient surgical centers utilized in the care of aesthetic surgery patients.

Interpersonal Communication

  • Educate patients and families in operative strategies for aesthetic surgery.
  • Provide preoperative counseling and informed consent to aesthetic surgical patients.
  • Understand patient expectations and be able to address any limitations in being able to meet those expectations.
  • Demonstrate accurate and efficient documentation.
  • Demonstrate effectiveness in communicating with other members of the care team.

Professionalism

  • Exhibit unselfish care and regard for the welfare of patients presenting for aesthetic surgery.
  • Demonstrate adherence to a code of moral and ethical values.
  • Demonstrate reliability, punctuality and accountability.
  • Exhibit courtesy and respect for all members of the care team.
  • Demonstrate sensitivity to the differences in backgrounds, lifestyles and priorities of patients presenting for aesthetic surgery.
  • Appreciate the unique challenges of treating patients seeking elective surgical procedures, with respect to placing the patients' best interest over the profit of the aesthetic surgical practice.