Fellowship Details & Requirements
The University of Texas MD Anderson Reconstructive Microsurgery Fellowship was founded in 1988 and began with one fellow annually. Over time, as microsurgical procedures advanced and case numbers increased, the fellowship grew accordingly. Currently, the fellow class includes eight fellows trained in Plastic Surgery and one fellow trained in Head and Neck Surgery. The fellowship is built upon multidisciplinary collaboration with world class surgical, medical, and radiation oncologists and many other specialists. Our goal is to teach the next generation of reconstructive surgeons to be prepared for any defect with which they are faced.
Program highlights:
- Advanced microsurgical cases across a broad range of disease sites
- Cadaver Flap Course
- Microsurgical Skills Course Reconstructive Core Curriculum, including didactic lectures in the basics of surgical oncology, microsurgical techniques, flap selection, and patient management
- Research Opportunities, including one required faculty-sponsored project
- Professional Development Lecture Series
- Clinical Specialist Program
- Journal Club
- Quality Improvement Project
- Robotic Training Program
- Attendance at the American Society of Reconstructive Microsurgery Annual Meeting
Eligibility, Prerequisites & Application Process
Our GME Office has preliminary eligibility requirements that all prospective trainees must meet before applying for a training program at our institution. In addition to these criteria, our program also the following requirements:
- Candidates must have completed a formal plastic surgery residency or the foreign equivalent to begin fellowship training. International candidates are eligible for application pending qualification for institution-specific visa requirements.
- Candidates must be board-eligible in plastic surgery or the foreign equivalent.
- All applicants must register through the SF Match Website. Additional details regarding the Microsurgery Fellowship match can be found on the American Society for Reconstructive Surgery website. Interviews are required and conducted annually, by invitation.
Program Goals & Objectives
The University of Texas MD Anderson Cancer Center Reconstructive Microsurgery Fellowship is a one-year program designed to prepare the next leaders in our specialty. MD Anderson offers a unique opportunity for the training of board-eligible plastic surgeons interested in microvascular and complex reconstructive surgery required for the definitive care of the oncologic patient.
This education program involves 12 months of training in advanced microvascular techniques and a required clinical or basic science research project. The objectives of this program include:
- Technical Mastery: Aim to master the intricate techniques involved in microsurgery, including suturing, anastomosis, and tissue manipulation under high magnification. Consistently refine skills to achieve precision and efficiency.
- Broad Clinical Experience: Achieve competency through breadth of exposure to subspecialties within microsurgery, including breast reconstruction, head and neck reconstruction, trunk reconstruction, extremity and peripheral nerve reconstruction, and lymphedema.
- Case Volume: Challenge and accelerate learning curve by participating in high microsurgery case volumes.
- Clinical Judgment and Decision-Making: Develop sound clinical judgment and decision-making skills, particularly in evaluating patient suitability for microsurgical procedures, assessing risks and managing complications.
- Patient-Centered Care: Prioritize patient-centered care throughout the fellowship journey. Strive to communicate effectively with patients, address their concerns, and ensure their well-being before, during, and after microsurgical procedures.
- Research: Undertake meaningful research projects in collaboration with experienced mentors with aim for knowledge dissemination through publication in high-impact journals and presentations at conferences.
- Interdisciplinary Collaboration: Foster collaborative multidisciplinary approaches to patient care with colleagues in related fields including but not limited to surgical oncology, head and neck surgery, breast surgery, orthopedics, neurosurgery, radiation, and medical oncology through case preparation, perioperative management and multidisciplinary conferences.
- Teaching: Provide education, guidance, and support to rotating medical students and residents, including in the settings of ambulatory clinic, call coverage, operative assistance, and inpatient management.
- Networking: Build a strong professional network within the microsurgery community.
- Professionalism: Expand professional acumen in the organization, execution, and management of a high volume microsurgery practice, including curriculum in finances, emotional intelligence and work-life balance.
Program Structure & Curriculum
The MD Anderson Reconstructive Microsurgery Fellowship has multiple components including clinical, research, and didactic responsibilities.
Clinical:
The fellow is expected to be actively involved in patient care in the clinic, operating room, and hospital floors at the working level of a fully-trained plastic surgeon. Under the supervision of the faculty, the fellow is directly responsible for primary post-operative management of microvascular flap reconstructions. The fellow will also work closely with referring physicians in the overall definitive care of the cancer patient. The trainee will also see patients preoperatively in a clinic with the consulting faculty. This provides robust knowledge for micro-surgical planning and presentations at the Surgical Indications Conference.
For those trainees with a valid Texas Medical License, the Clinical Specialist program is an additional stipend based program that allows fellows to act as attending physicians with independent hospital and admitting privileges at MD Anderson Cancer Center. The Clinical Specialist participates in oncologic cases as the attending physician, provided that it does not require micro-surgical privileges.
Research:
Each fellow is required to complete a research project during the fellowship. The Department’s Director of Clinical Research (Dr. Alexander F. Mericli) oversees the coordination of the fellowship research projects. There is a faculty mentor for each research project and at least one additional faculty collaborator. Available projects will be presented to the fellows by the faculty early in the academic year. Fellows also may formulate their own research project ideas with appropriate faculty oversight and approval.
Didactic Curriculum:
The MD Anderson Reconstructive Fellowship Program has a robust didactic curriculum that is broken into several components:
12-Month Core Curriculum Series: This includes didactic lectures regarding microvascular techniques and flaps for each area of the body, including head and neck, breast, trunk, pelvis and extremity. Additional lectures are given for lymphedema and nerve reconstruction. As part of the Core Curriculum, fellows will also receive didactic lectures from our referring oncologic specialists in the basics of surgical oncology to prepare for defect planning. Additionally, our Professionalism lectures provide unique perspectives on the establishment, maintenance, and successful growth of micro-surgical career.
Microsurgical Skills Course: Every fellow enters the program with variable micro-surgical skill and volume. At the beginning of the year, the faculty mentors will guide fellows through a training course designed to teach the basics of instrumentation, suture manipulation, knot tying and microscope management.
Flap Cadaver Course: Early each academic year, the faculty teach the flap cadaver course to allow trainees to practice micro-surgical dissection and demonstrate unique techniques. The cadaver course is designed to allow robust practice of both bony and soft tissue flaps and enhance anatomic acumen.
Journal Club, Morbidity and Mortality, and Surgical Indications Conferences: As part of surgical growth, the fellowship program encourages educational discussions in a group setting with the faculty. Fellows are required to attend these instructional conferences to learn about new advances, review important complications and plan the entire continuum of care for the micro-surgical patient.
Trainee Success & Program Outcomes
The MD Anderson Reconstructive Microsurgery Fellowship generates leaders within the field of microsurgery. Our fellows routinely receive multiple competitive job offers and are able to select positions of their choice at high levels of academia. This reflects our reputation to train fellows with a complexity and case volume that prepares our graduates to enter practice without reserve. Within the last 10 years, more than 85% have taken positions at academic institutions nationally and internationally. Many graduates have successfully gone on to become national leaders and chairs of departments.
Case Breadth and Volume
Head and Neck
• Scalp Reconstruction
• Orbital Exenteration
• Skull Base Resection
• Maxillectomy
• Mandibulectomy
• Glossectomy
• Pharyngectomy
• Tracheal Resection
Breast
• Primary and delayed autologous reconstruction
• Alternative flaps (Example: Lumbar Artery Perforator)
• Stacked and conjoined flaps including lymph nodes
Trunk
• Chest Wall Reconstruction
• Abdominal Wall Reconstruction, including functional transfers
• Spinal reconstruction
Pelvis
• Internal and External Hemipelvectomy
• Sacrectomy
• Perineal reconstruction
Extremity
• Limb Salvage
• Fillet flaps for amputations
Lymphedema
• Diagnostic staging and on-table imaging
• Lymphovenous bypass
• Lymph node transfer (Submental/Omental/Lateral Thoracic)
Nerve
• Facial Nerve Reconstruction (grafting, nerve transfers, and free functional muscle)
• Extremity Nerve Reconstruction (grafting, Targeted Muscle Reinnervation, Regenerative Peripheral Nerve Interfaces, free functional muscle transfers)
Clinical Specialist Program
The Clinical Specialist program allows fellows with a valid Texas Medical License to act as attending physicians with independent hospital and admitting privileges to MD Anderson Cancer Center. Clinical Specialists participate in the surgical care of oncologic patients needing reconstruction that does not require microsurgical privileges. Potential Clinical Specialists must go through the appropriate credentialing process and must be cleared by the institution prior to functioning as attending physicians.
This program is one of the most valuable learning experiences offered by our department and is a tremendous opportunity to gain proficiency at patient work-up, reconstructive surgery, and postoperative management as well as learn to coordinate other members of the patient care team, such as referring physicians, nurses, and physician assistants. Clinical Specialists are under the direction of Dr. Margaret Roubaud, although they are highly encouraged to consult and seek advice from all members of the faculty.
Clinical Specialists in the Department of Plastic Surgery will be referred reconstructive surgery cases, many of which can be quite complex. Clinical Specialists are encouraged to consult both with the faculty and their co-fellows in order to formulate an appropriate treatment plan. If a patient requires a free flap, which is a procedure for which Clinical Specialists are not credentialed to perform independently, the Clinical Specialist must seek out a faculty member of their choice (or the on-call faculty member by default) to assist with the case and serve as the primary surgeon.
The Clinical Specialist program is complemented by a dedicated clinic space with a physician assistant. The Clinical Specialist is also provided a physician assistant to help cover operative cases and a provider to help with rounding. This program is subsidized with a stipend and is an incredible opportunity to begin a surgical career. Clinical specialists will be assigned a combined clinic and operative day based on a set schedule, determined by the number of clinical specialists that year, in advance. The clinical specialists will rotate their days, if needed, every three months.
Clinical specialists must maintain a valid Texas Medical License. For licenses expiring during the academic year, it is the Clinical Specialist’s responsibility to renew the license and pay the appropriate fees. Clinical Specialists are expected to see patients and perform indicated surgeries until the completion of their fellowship year on June 30. Long-term follow-up of patients will be arranged based on the specific needs of the patient.
Fellow & Faculty Publications
The following list is not meant to be exhaustive, but exemplifies some of the research projects completed in recent years by prior fellows and their mentoring faculty:
- Akdeniz-Dogan Z, Roubaud MS, Kapur SK, Liu J, Yu
P, Selber JC, Mericli AF. Free Flap Reconstruction of Posterior Trunk
Soft-Tissue Defects: Single-Institution Experience and Systematic Literature
Review. Plast Reconstr Surg. 2021 Mar 1;147(3):728-740. doi:
10.1097/PRS.0000000000007675. PMID: 33587562.
- Bishop SN, Asaad M, Liu J, Chu CK, Clemens MW,
Kapur SS, Largo RD, Selber JC. Robotic Harvest of the Deep Inferior Epigastric
Perforator Flap for Breast Reconstruction: A Case Series. Plast Reconstr Surg.
2022 May 1;149(5):1073-1077. doi: 10.1097/PRS.0000000000008988. Epub 2022 Mar
7. PMID: 35255056.
- Boukovalas S, Goepfert RP, Smith JM, Mecham E,
Liu J, Zafereo ME, Chang EI, Hessel AC, Hanasono MM, Gross ND, Yu P, Lewin JS,
Lewis CM, Diaz EM Jr, Weber RS, Myers JN, Offodile AC 2nd. Association between
postoperative complications and long-term oncologic outcomes following total
laryngectomy: 10-year experience at MD Anderson Cancer Center. Cancer. 2020 Nov
15;126(22):4905-4916. doi: 10.1002/cncr.33185. Epub 2020 Sep 15. PMID:
32931057.
- Cho MJ, Hanasono MM. Virtual Surgical Planning
in Free Tissue Transfer for Orbito-Maxillary Reconstruction. Semin Plast Surg.
2022 Aug 31;36(3):183-191. doi: 10.1055/s-0042-1754386. PMID: 36506272; PMCID:
PMC9729062.
- Contrera KJ, Hassan AM, Shuck JW, Bobian M, Ha
AY, Chang EI, Garvey PB, Roubaud MS, Lee ZH, Hanasono MM, Gross ND, Myers JN,
Yu P, Largo RD. Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head
and Neck Reconstruction. Otolaryngol Head Neck Surg. 2024 Mar;170(3):747-757.
doi: 10.1002/ohn.596. Epub 2023 Nov 30. PMID: 38037485
- Coroneos CJ, Lin YL, Sidey-Gibbons C, Asaad M,
Chin B, Boukovalas S, Roubaud MS, Miggins M, Baumann DP, Offodile AC 2nd.
Correlation Between Financial Toxicity, Quality of Life, and Patient
Satisfaction in an Insured Population of Breast Cancer Surgical Patients: A
Single-Institution Retrospective Study. J Am Coll Surg. 2021
Mar;232(3):253-263. doi: 10.1016/j.jamcollsurg.2020.10.023. Epub 2020 Dec 11.
PMID: 33316424.
- Egan KG, Selber JC. Modern Innovations in Breast
Surgery: Robotic Breast Surgery and Robotic Breast Reconstruction. Clin Plast
Surg. 2023 Apr;50(2):357-366. doi: 10.1016/j.cps.2022.11.004. Epub 2023 Jan 25.
PMID: 36813413.
- Kurlander DE, Garvey PB, Largo RD, Yu P, Chang
EI, Hanasono MM, Mericli AF. The Cost Utility of Virtual Surgical Planning and
Computer-Assisted Design/Computer-Assisted Manufacturing in Mandible
Reconstruction Using the Free Fibula Osteocutaneous Flap. J Reconstr Microsurg.
2023 Mar;39(3):221-230. doi: 10.1055/s-0042-1755260. Epub 2022 Aug 21. PMID:
35988577.
- Ismail T, Padilla P, Kurlander DE, Corkum JP,
Hanasono MM, Garvey PB, Chang EI, Yu P, Largo RD. Profunda Artery Perforator
Flap Tongue Reconstruction: An Effective and Safe Alternative to the
Anterolateral Thigh Flap. Plast Reconstr Surg. 2024 Jun 1;153(6):1191e-1200e.
doi: 10.1097/PRS.0000000000010890. Epub 2023 Jun 27. PMID: 37384852.
- Mueller MA, Mericli AF, Roubaud MS, Liu J,
Adelman D, Lewis VO, Lin PP, Hanasono MM. Comparing Fibula Flap Insetting
Techniques for Pediatric Oncologic Extremity Reconstruction. Plast Reconstr
Surg. 2024 Mar 1;153(3):636e-643e. doi: 10.1097/PRS.0000000000010613. Epub 2023
May 2. PMID: 37166051.
- Nemir S, Mericli AF, Adelman DM, Liu J, Feig BW,
Lin PP, Roubaud MS. A reconstructive algorithm of oncologic defects of the
upper trunk and shoulder girdle: Factors predicting complexity and outcomes. J
Surg Oncol. 2020 Aug;122(2):283-292. doi: 10.1002/jso.25957. Epub 2020 May 3.
PMID: 32363601.
- Sharabi SE, Baumann DP, Selber JC, Killon E,
Mericli AF, Liu J, Caudle AS, Smith BD, Chavez-MacGregor M, Schaverien MV.
Complications of Contralateral Prophylactic Mastectomy: Do They Delay Adjuvant
Therapy? Plast Reconstr Surg. 2020 Nov;146(5):945-953. doi:
10.1097/PRS.0000000000007237. PMID: 33136936.
- Coroneos CJ, Selber JC, Offodile AC, Butler CE,
Clemens MW. US FDA Breast Implant Postapproval Studies: Long-term Outcomes in
99,993 Patients. Ann Surg 2019;269(1):30-36.
- Maricevich M, Lin LO, Liu J, Chang EI, Hanasono
MM. Interposition Vein Grafting in the Head and Neck Free Flap Reconstruction.
Plast Reconstr Surg 2018;142(4):1025-1034.
- Poh M, Selber J, Skoracki R, Walsh GL, Yu
P. Technical Challenges of Total Esophageal Reconstruction Using a Supercharged
Jejunal Flap. Ann Surg 2011 Jun;253(6):1122-9.
Program Faculty & Leadership
Our trainees have the opportunity to work alongside leading cancer experts at MD Anderson and institutions across the Texas Medical Center. Additionally, our trainees receive exceptional support from the fellowship leadership team:
Margaret (Meg) Roubaud, M.D., F.A.C.S.
Associate Professor, Department of Plastic Surgery, Division of Surgery
Director, Microvascular Reconstructive Surgery Fellowship Program
Phone: 713-794-1247
Email: MSRoubaud@mdanderson.org
Jessie Z. Yu, M.D., F.A.C.S.
Assistant Professor, Department of Plastic Surgery, Division of Surgery
Assistant Director, Microvascular Reconstructive Surgery Fellowship Program
Phone: 713-794-1247
Email: JZYu@mdanderson.org
Andrea Warren
Education Coordinator, Plastic Surgery
Phone: 713-794-1247
Email: amwarren@mdanderson.org
Why This Program
The MD Anderson Reconstructive Microsurgery Fellowship gives the trainee unparalleled experience in microsurgery due to the volume, breadth and complexity of cases. In addition to the unique patient volume, the fellowship is designed to prepare the fellow for comprehensive microsurgical care from consult, preoperative planning, intraoperative execution, and postoperative management. A trainee is exposed to nearly 30 faculty that can teach the basics of establishing a practice, performing cases, handling difficult outcomes with expertise, and starting innovative new programs. With a well-developed clinical, research, and didactic curriculum, the trainee emerges well-rounded and well-prepared.
Particular resources in the department include:
- In-office fellow training microscope
- Access to training robotic console
- Microskills and Flap Cadaver Course
- Research resources and Statistician
- 10 Leica and 4 Mitaka MM51 Operative Microscopes
In addition to gaining unparalleled education and training experience, MD Anderson trainees have access to exceptional resources and benefits to help them build meaningful careers and lead fulfilling lives.
Institutional benefits and support
GME trainees’ salary stipends are updated every year based on the ACGME’s recommendations, and because our trainees are considered workforce members, they also enjoy MD Anderson’s employee benefits, including health insurance, retirement planning, disability insurance and six weeks of parental leave.
Our GME House Staff Senate offers trainees the opportunity to experience a leadership role in a medical field career, and the institution’s Academic Mentoring Council provides avenues to secure tailored academic mentoring from faculty. Our GME trainees benefit from the extensive support offered to our research trainees, too; they are invited to participate in grant application workshops, apply for pilot grants to support their research ideas and receive monetary awards for securing extramural grant funding.
Trainee wellness is also of utmost importance at MD Anderson.
Our trainees have access to MD Anderson’s employee networks, fitness center and other wellness resources provided by the institution. Additionally, our Graduate Medical Education Committee (GMEC), which provides oversight of our accredited programs, regularly assess our trainees’ needs and implements various initiatives, such as providing free call meals and discounted parking to GME House Staff, to address those gaps. The committee even has a subcommittee entirely dedicated to supporting the wellness of our trainees.
Our efforts to ensure a welcoming and supportive education and training experience have been commended nationally. In 2023, the Office of Graduate Medical Education received the DeWitt C. Baldwin, Jr. Award, a prestigious national award that recognizes our institution for its respectful and supportive environment for delivering medical education and patient care.
Beyond MD Anderson
MD Anderson’s location has many benefits, too. Our main campus is nestled inside the Texas Medical Center, the world’s largest medical center which boasts about 10 million patient encounters each year. Many of our faculty are involved in interorganizational research collaborations, both within the TMC and across the nation, exposing trainees to groundbreaking advancements in medical care in real time.
Most importantly, the city of Houston is a great place to call home and raise a family. We are one of the most culturally diverse cities in the nation. More than 145 different languages are spoken across the city, placing us behind only New York and Los Angeles. In fact, about 30% of the city’s population speaks a language other than English at home. And, paychecks here stretch farther than most U.S. metro areas, thanks to our low cost of living.