INTRODUCTION Plastic Surgery is often described as the surgical specialty that is concerned with “the skin and its contents.” Thus, the anatomic reach of plastic surgery is broader than any other surgical specialty. The term “plastic” is derived from the Greek word πλαστικός [plastikos] meaning to “change the shape or form of.” It otherwise has nothing to do with implantation of biomaterials such as silicone, although many families may ask because of the intense lay press coverage of cosmetic plastic surgery. Fundamentally, Plastic Surgery alters anatomy anywhere in the body in order to improve function, form, and often both simultaneously. Before starting your rotation with us it would be helpful to review your notes regarding anatomy and physiology, particularly regarding the face, craniofacial skeleton, and upper extremity, including musculoskeletal, vascular and neurologic anatomy. In addition, it would be useful to review class notes dealing with obtaining a history and performing a physical examination in children. A brief review of certain surgical conditions (cleft lip and palate, craniosynostosis, burns, hand trauma, syndactyly and other common congenital hand anomalies, nerve injuries, and vascular anomalies) before your visit to the clinic or operating room will give you a tremendous advantage and help make your experience more productive. Plastic surgery (alternatively called “Plastic and Reconstructive Surgery”) is particularly challenging and rewarding because of the breadth of anatomic problems we treat. Don’t be surprised if you see something extremely rare, such as a previously undescribed condition or syndrome while on our service. You may also be involved in extremely complex procedures. WHAT SHOULD YOU DO ON YOUR FIRST DAY? Go to our office, which is located on the 5th floor of the hospital above the Shopper’s Drug Mart and Tim Hortons on the University Avenue side of SickKids. Our
room with the residents that come from the Division of Plastic and Reconstructive Surgery at the University of Toronto. In addition, we have nurse practitioners that help us with the clinical management of many of our patients, as well as nurses in the clinic, ward (8C) and the operating room (E and F ORs). The operating room team includes nurses that scrub with us, help with the surgical intervention, and provide care for the child while they are under anesthesia as well as the time they are awake and away from their parents. CLINIC SCHEDULE Day Surgeon / NP Clinic Nurse Monday Dr. Joel Fish Dr. Ronald Zuker Mary Harris, RN Lisa Browne, RN Charis Kelly, RN, NP Tuesday Dr. Howard Clarke Ms. Charis Kelly (NP burn clinic) Mary Harris, RN Lisa Browne, RN Wednesday Dr. Chris Forrest Dr. Howard Clarke (Brachial plexus clinic) Mary Harris, RN Alison Miller, RN Thursday Dr. Greg Borschel Dr. David Fisher Mary Harris, RN Lisa Browne, RN Friday Dr. Dr. John Phillips Dr. Philip John (Vascular Anomalies Clinic) Mary Harris, RN Alan George, RN We hold a Facial Paralysis Clinic usually once a month in order to perform preoperative assessments on patients with facial palsy of varying etiologies. This clinic is usually held on Wednesdays near the plastic surgery offices, and is staffed by Drs. Zuker and Borschel.
The operating room starts between 7:30 and 8 am. The Operating Room is located on the second floor of the Atrium, and entry requires use of hospital-issues scrubs (provided during your first day meeting). At 7:30 the staff urologist and/or a designated fellow will perform what is called a “huddle”, where there is a discussion of the cases of the day with all the members of the operating room working together that day, establishing a plan for care with the anesthetist and nurses. Patients are expected to arrive in the operating room by 8 am. During the day, you will witness and participate in all the safety checks introduced to minimize errors, such as following our standardized checklists, conducting “time-outs” and debriefing after each case. If it is your day to spend in the OR, it is the expectation that you will be there at 8 am. The weekly schedule also has to take into account morning and afternoon rounds period. These are performed before any clinical activities in the morning and in the afternoon after completing the clinic or operating room duties. When possible, the attending surgeons round with the team. Throughout the day, there may be times when further care may need to be rendered on the ward and this may also include consultations requested from many of the services within the hospital as well as the emergency department. You are invited to participate in this process by working closely with our fellows and residents on service. Our weekly schedule also includes teaching sessions as well as presentation rounds. On Wednesday mornings at 7 am in Rm 8704 we hold rounds during which we discuss ongoing research endeavors and a variety of clinical subjects. There is a wonderful opportunity to learn more about pediatric Plastic and Reconstructive Surgery and also to become part of ongoing research projects, if you should desire to do so. We also have case rounds and teaching presentations that are scheduled on Friday morning, understanding the limitations imposed by some university lecture requirements. During these rounds you will witness the review process of indications for surgery, as well as controversies in treatment options. Lastly, Morbidity and Mortality rounds are held once