Goals and Objectives

 July 2008-2009

UNC- 1st Year

A. Wound Repair

1. Compare the physiology of normal and abnormal wound healing, including hypertrophic scars and keloids.
2. Describe the management of complex wounds, including dressings and splints, to achieve complete healing with optimal aesthetic result.
3. Describe how to manage healing of bone, tendon, cartilage, skin, and muscle.
4. Demonstrate the various lines of the skin (e.g. relaxed skin tension lines) for optimal design of incisions.
5. Discuss treatment of hypertrophic scars and keloids, including techniques for scar alteration (e.g. z-plasty, w-plasty).

B. Flaps and Grafts

1. Describe flap classification by vascular supply (random, axial, island, free, etc.) movement (advancement, rotation, transposition, etc.) and anatomy (cutaneous, fasciocutaneous, musculocutaneous, etc.).
2. Discuss the “delay” phenomenon and staged transfer of flaps.
3. Explain the physiology and compare specific techniques for grafting of split and full thickness skin, dermal, cartilage, bone, tendon, nerve, fascial, and composite grafts.

C. Medicolegal/Psychiatric Aspects of Plastic Surgery

1. Discuss the medical and legal perspective of the contractual agreement between physician and patient.
2. Discuss the concepts of informed consent and implied guarantee.
3. Explain the role of the medical record as a legal document.
4. Discuss the impact of physical deformity on patients and their families.
5. Explain the concept of medical negligence.

D. Anesthesia and Critical Care

1. List the common agents for local, regional, and general anesthesia.
2. Explain the principles and techniques for administration of local anesthesia.
3. Discuss emergency care and treatment of burn and trauma patients.
4. Describe the postoperative management of plastic surgical patients.
5. Identify safe techniques for conscious sedation and monitoring.
6. Explain local and systemic anesthesia management in infants and children.

E. Transplantation/Immunology

1. Describe the physiology of skin graft take.
2. Explain the immunology of allograft rejection.

F.   Pharmacology/Therapeutics

1. List the common pathogens in skin, head and neck, breast, and hand infections.
2. List the pathogens specific to human and animal bites and farm injuries.
3. Discuss indications for and selection of antibiotics for prophylactic and therapeutic use.
4. Describe the pharmacology and use of steroids in scar treatment, hand problems, and steroid-dependent patients.

G. Benign and Malignant Skin Lesions

1. Describe the clinical presentation and natural course of benign and malignant skin lesions and generalized skin disorders.
2. Describe the histologic grading and clinical staging systems for malignant and premalignant skin tumors.
3. Be able to evaluate simple and complex skin lesions, secure a definitive diagnosis, and formulate a definitive treatment plan, selecting a surgical or nonsurgical modality which is appropriate for the lesion based on size, location, and the patient’s physical condition.
4. Explain other treatment modalities, such as Moh’s micrographic surgery, radiation therapy, cryotherapy, laser therapy, and topical chemotherapy.
5. Review management of regional and distant spread of malignant cutaneous tumors.
6. Describe the presentation and treatment of common inflammatory skin disorders such as impetigo, cellulitis, lymphangitis, hidradenitis suppurativa, and necrotizing fasciitis.

H. Head and Neck Anatomy, Physiology, and Embryology

1. Discuss the anatomy of the skull, suture lines, foramina, structure exiting foramina, and cranial nerves.
2. Demonstrate the anatomy of the facial bones, their ostia, and their bony relationships.
3. Demonstrate the vascular structures of the head and neck.
4. Discuss the anatomy of the eye, orbit, eyelids, and lacrimal apparatus.
5. Discuss the anatomy of the external, middle, and inner ear.
6. Describe the anatomy and physiology of the nose and septum.
7. Describe the anatomy and physiology of the oropharynx including palatal function, speech, and swallowing.
8. Describe the anatomy and function of the facial muscles and salivary glands.
9. Discuss the embryology of the head and neck with particular reference to development of the upper lip, palate, and ear.

I. Congenital Defects of the Head and Neck

1. Describe the common congenital disorders of the head and neck, including cleft lip, cleft palate, craniofacial syndromes, vascular malformations, and ear anomalies.
2. Discuss surgical and nonsurgical management of cleft lip and palate, including primary and secondary surgery, as well as surgical correction of the cleft lip nose.
3. Explain the evaluation and management (surgical and nonsurgical) of head shape abnormalities, including positional molding and true craniosynostosis.
4. Discuss the surgical management of external ear abnormalities including microtia.

J.    Trunk Reconstruction

1. Discuss the etiology, nonsurgical management, and prevention of pressure sores.
2. Describe in detail the surgical aspects of pressure sore reconstruction, including indications for surgery, choice of operation, and pre and postoperative management.

K. Head and Neck Trauma

1. Review the priorities involved in treating patients with multiple trauma, including evaluation and management of the cervical spine, indications for endotracheal intubation and tracheostomy, and timing of treatment of head neck injuries.
2. Describe an orderly, thorough approach to the physical examination of patients with facial trauma.
3. Discuss the indications for diagnostic studies such as conventional radiography, Panorex films, tomograms, CT scans (with or without three-dimensional reconstruction), and magnetic resonance imaging.
4. Explain the biomechanical properties of the facial skeleton and patterns of injury including cervical and cranial trauma.
5. Discuss management of open facial wounds including anesthesia, timing, debridement, and closure.
6. Review the pathophysiology of primary bone healing, malunion, nonunion, and osteomyelitis.
7. Describe the indications and timing of operative treatment for facial fractures.
8. Discuss the indications, contraindications, advantages, and disadvantages of different treatment techniques for facial fractures, including nonoperative management, closed reduction, mandibular-maxillary fixation, open reduction with and without fixation, wire fixation, compressive and non-compressive plate fixation, intra-oral splints, and external fixation.
9. Discuss the specific management of maxillary, mandibular, orbital, nasoethmoid, frontal, and zygomatic (including arch) fractures; potential complications; and management of complications.
10. Review with operative incisions for management of facial fractures.
11. Explain the anatomy and evaluation of the facial nerve and techniques for treatment of facial nerve injuries.
12. Discuss the evaluation and treatment of parotid injuries.
13. Discuss the etiology and treatment of enophthalmos.

Charlotte - 1st year

A. Head and Neck Trauma

1. Review the priorities involved in treating patients with multiple trauma, including evaluation and management of the cervical spine, indications for endotracheal intubation and tracheostomy, and timing of treatment of head and neck injuries.
2. Describe an orderly, thorough approach to the physical examination of patients with facial trauma.
3. Discuss the indications for diagnostic studies such as conventional radiography, Panorex films, tomograms, CT scans (with or without three-dimensional reconstruction), and magnetic resonance imaging.
4. Explain the biomechanical properties of the facial skeleton and patterns of injury including cervical and cranial trauma.
5. Discuss management of open facial wounds including anesthesia, timing, debridement, and closure.
6. Review the pathophysiology of primary bone healing, malunion, nonunion, and osteomyelitis.
7. Describe the indications and timing of operative treatment for facial fractures.
8. Discuss the indications, contraindications, advantages, and disadvantages of different treatment techniques for facial fractures, including nonoperative, closed reduction, mandibular-maxillary fixation, and open reduction with and without fixation, wire fixation, compressive and non-compressive plate fixation, intra-oral splints, and external fixation.
9. Discuss the specific management of maxillary, mandibular, orbital, nasoethmoid, frontal, and zygomatic (including arch) fractures; potential complications; and management of complications.
10. Review with operative incisions for management of facial fractures.
11. Explain the anatomy and evaluation of the facial nerve and techniques for treatment of facial nerve injuries.
12. Discuss the evaluation and treatment of parotid injuries.
13. Discuss the etiology and treatment of enophthalmos.

B. Benign and Malignant Breast Tumors

1. Describe the biology, histology, and clinical manifestations of breast malignancies.
2. Discuss surgical options for management of the opposite breast after mastectomy for breast cancer, and principles of long-term management of patients with breast carcinoma.
3. List diagnostic techniques and treatment methods for management of premalignant and other disease processes of the breasts.
4. Discuss the etiology of gynecomastia and surgical options for treatment.

C. Trunk and Breast Reconstruction

1. Review the medical and surgical management of trunk and breast injuries.
2. Discuss the surgical aspects of breast reconstruction, including selection of method, recognition of complications, and prevention and treatment of complications.
3. Discuss prosthetic breast reconstruction, including implants and tissue expanders.
4. Review the psychosocial aspects of post-mastectomy breast reconstruction.

 D. Aesthetic and Functional Problems of the Trunk and Breast

1. Describe surgical techniques for breast reduction, indications, contraindications, and prevention and management of complications.
2. Describe surgical techniques for breast augmentation, indications, contraindications, and prevention and management of complications.
3. Discuss the different types of breast implants and selection of a particular type for a particular problem.
4. Describe surgical techniques for mastopexy, indications, contraindications, and prevention and management of complications.
5. Review selection of specific procedures for specific deformities, e.g. mastopexy vs. augmentation mammoplasty, abdominoplasty vs. abdominal liposuction.
6. Discuss principles and techniques for treating inverted nipples, tubular breasts, and localized lipodystrophy.
7. Review the long-term consequences of augmentation mammoplasty and follow up, including special techniques for mammography.
8. Describe techniques for treatment of aesthetic deformities of the abdomen (including panniculectomy and abdominoplasty), indication and contraindications, and prevention and management of complication.
9. Describe techniques of suction lipectomy as applied to aesthetic deformities of the trunk.

UNC Burn Center

A. Burns

1. Review the pathophysiology of thermal injury, including the relationship between duration of exposure and temperature, as well as the specific changes which occur in the zone of coagulation, stasis, and hyperemia.
2. Describe rapid and more detailed estimation of involved body surface area and the differences in relative surface area of body parts in children and adults.
3. Define major, moderate, and minor burns.
4. Discuss other factors, in addition to body surface area, which affect prognosis of thermal injuries.
5. Review the pathophysiology and treatment of inhalation injuries and carbon monoxide poisoning.
6. Discuss the principles and techniques of fluid resuscitation, including monitoring.
7. Review the pathophysiology of chemical burns and chemotherapy and calcium extravasations.
8. Discuss the evaluation and management of electrical injuries.
9. Describe the anatomy and physiology pertinent to excision and skin grafting of burns.
10. Discuss burn rehabilitation and reconstruction including hand splinting and early and later management of hand burns.
11. Review the pharmacology and use of topical antibacterials, analgesics, and systemic antibiotics in burn management.

UNC – 2nd Year  

A. Microsurgery

1. Discuss the use of the operating microscope and technical aspects of microvascular and microneural repair. 
2. Review indications, contraindications, and techniques for replanting amputated parts.
3. Discuss monitoring of free flaps and replanted parts, and pharmacologic and surgical intervention for failing flaps.
4. Discuss choice of donor site for free flaps.
5. Describe the physiology of nerve injury (axonotmesis, neurotmesis, neurapraxia, Wallerian degeneration) and nerve healing, plus primary and late nerve repair and indications for nerve grafting.
6. Review with diagnostic methods and treatment options for facial paralysis.

B. Implants and Biomaterials

1. Discuss the general characteristics of various implant materials, including silicone, methyl methacrylate, hydroxyapatite, tricalcium phosphate, and Proplast.
2. Discuss the various types of breast implants and factors involved in implant choice.
3. Review injectable materials for subcutaneous filling, including autologous fat.
4. Discuss the characteristics and joint type replacements.

C. Special Techniques

1. Review the physiologic principles, indications, techniques, devices, and management of tissue expansion, including its potential complications.

D. Benign and Malignant Tumors of the Head and Neck

1. Discuss diagnosis and treatment of squamous cell carcinoma of the head and neck, particularly the oropharynx.
2. Discuss the diagnosis and treatment of benign and malignant salivary gland tumors.
3. Describe the lymphatic drainage patterns of the head and neck, and its relationship to the management of malignant tumors.
4. Discuss management of rhinophyma.

E. Head and Neck Reconstruction

1. Discuss the treatment of contour defects, including alloplastic material, autograft, and tissue transfers.
2. Describe the correction of structural defects, including bone graft and vascularized bone graft.
3. Discuss the correction of functional defects, including muscle transfers, nerve transfers and transections, slings, gold weights, etc.
4. Review techniques of bony fixation and relative indications and contradictions of each.
5. Describe a wide variety of grafts and flaps for head and neck reconstruction including the rationale for specific choices.
6. Review the specific reconstructive needs of special tissues such as oral mucosa and nasal lining.

F. Upper Extremity Anatomy, Physiology, Embryology, and Congenital Anomalies

1. Describe the anatomy of muscles, tendons, ligaments, bones, blood vessels, and nerves of the hand and upper extremity.
2. Demonstrate the clinical techniques for physical examination of the hand and upper extremity.
3. Review the classification, incidence, and inheritance patterns of the more frequent congenital anomalies of the hand and upper extremity.
4. Describe the operative and non-operative treatment of the more frequent congenital anomalies of the hand and upper extremity.

G. Upper Extremity Tumors

1. Discuss the principles and techniques for management of benign and malignant upper extremity tumors.

H. Upper Extremity Trauma

1. Describe the anatomy and pathophysiology of hand and upper extremity injuries.
2. Demonstrate diagnostic techniques for the evaluation of the hand and upper extremity injuries.
3. Review techniques for operative management of hand and upper extremity injuries, including timing, indications and contradictions, and potential complications and their treatment.
4. Discuss nonoperative management of hand and upper extremity injuries, including splinting and rehabilitation.

I.  Aesthetic and Functional Problems of the Upper Extremity

1. Describe the common nerve compression and entrapment syndromes of the upper extremity, diagnostic evaluation, and medical and surgical treatment.
2. Discuss the pathophysiology and treatment of upper extremity contractures, including Dupuytren’s disease.

J. Upper Extremity Reconstruction

1. Review the principles, indications, and techniques of the tendon reconstruction, including tendon grafting.
2. Discuss diagnostic evaluation of functional loss, including EMG and conduction studies, arteriography, conventional radiographs, CT scan, and MRI evaluation.
3. Review management of nerve injuries of the hand and upper extremity, including primary, delayed primary and secondary repair.
4. Describe techniques of grouped fascicular nerve grafting, including harvesting of grafts, as well as vascularized nerve graft techniques.
5. Discuss techniques and indications for thumb reconstruction, including lengthening, pollicization, and free tissue transfer techniques.
6. Review indications and methods of skin and soft tissue coverage, including skin grafts, flaps, and free tissue transfer.
7. Discuss specific indications and techniques for sensate resurfacing of critical areas of the hand.

K.  Trunk and Breast Anatomy, Physiology, and Embryology

1. Describe the musculature, blood supply, lymphatic drainage, and innervation of the trunk, abdominal wall, and breast.
2. Discuss the glandular function and structure of the breasts, and hormonal influence on breast development and function.
3. Review differences in breast structure and function in adolescence, the reproductive years, pregnancy, lactation, and menopause.
4. Discuss the relationships between breast diseases and breast physiology.

L.   Congenital Disorders of the Trunk and Breast

1. Describe normal and abnormal male and female breast growth and development.
2. Review basic principles and techniques of surgical treatment of common developmental breast anomalies, including amastia, Poland’s syndrome, ectopic mammary tissue, virginal hypertrophy, and gynecomastia.
3. Describe chest wall anatomy and developmental chest wall deformities.
4. Discuss the physiologic consequences of developmental chest wall deformities.

M. Benign and Malignant Breast Tumors

1. Describe the biology, histology, and clinical manifestations of breast malignancies.
2. Discuss surgical options for management of the opposite breast after mastectomy for breast cancer, and principles of long-term management of patients with breast carcinoma.
3. List diagnostic techniques and treatment methods for management of premalignant and other disease processes of the breasts.
4. Discuss the etiology of gynecomastia and surgical options for treatment.

N. Trunk and Breast Reconstruction

1. Review the medical and surgical management of trunk and breast injuries.
2. Discuss the surgical aspects of breast reconstruction, including selection of method, recognition of complications, and prevention and treatment of complications.
3. Discuss prosthetic breast reconstruction, including implants and tissue expanders.
4. Review the psychosocial aspects of post-mastectomy breast reconstruction.

O.  Aesthetic and Functional Problems of the Trunk and Breast

1. Describe surgical techniques for breast reduction, indications, contraindications, and prevention and management of complications.
2. Describe surgical techniques for breast augmentation, indications, contraindications, and prevention and management of complications.
3. Discuss the different types of breast implants and selection of a particular type of a particular problem.
4. Describe surgical techniques for mastopexy, indications, contraindications, and prevention and management of complications.
5. Review selection of specific procedures for specific deformities, e.g. mastopexy vs. augmentation mammoplasty, abdominoplasty vs. abdominal liposuction.
6. Discuss principles and techniques for treating inverted nipples, tubular breasts, and localized lipodystrophy.
7. Review the long-term consequences of augmentation mammoplasty and follow-up, including special techniques for mammography.

Charlotte – 2nd Year

A. Special Techniques

1. Discuss indications, contraindications, instrumentation, techniques, and limitations of suction lipectomy.
2. Discuss preoperative, intraoperative, and postoperative management of patient undergoing suction lipectomy, and be able to manage potential complications.
3. Review the pathophysiology of dermabrasion and chemical peel, indications, contraindications, choice of technique, instrumentation, and recognition of management of potential complications.

 B.Medicolegal/Psychiatric Aspects of Plastic Surgery

1. Describe how to explore the motivations and expectations of patients seeking aesthetic surgery, and know how to recognize unacceptable and pathological motivations.
2. Discuss how to interview and evaluate patients, especially aesthetic surgery candidates.

C.Head and Neck Aesthetic and Functional Problems

1. Discuss the effects of aging and sun exposure on the facial skin and structures.
2. Review concepts of beauty and aesthetic principles of the facial structures.
3. Discuss primary and secondary aesthetic rhinoplasty.
4. Describe diagnostic and therapeutic techniques in the management of nasal airway obstruction.
5. Review complications of rhinoplasty and septoplasty, including prevention and treatment.
6. Discuss rhytidectomy, suction lipectomy, browlift, blepharoplasty and other techniques for treatment of the aging face.
7. Discuss complications of facial aesthetic surgery, including prevention and treatment.
8. Review with aesthetic and functional problems of the eyelid, including blepharochalasis and ptosis, their treatment, as well as prevention and treatment of complications.

D.   Anatomy, Physiology, Embryology of the Lower Extremity

1. Review vascular, neural, osseous, and muscular anatomy of the lower extremity.
2. Describe the muscular and vascular anatomy of specific flaps, including tensor fascia lata, vastus lateralis, rectus femoris, sartorius, gracilis, biceps femoris, medial and lateral gastrocnemius, soleus, and tibialis flaps.
3. Describe the boundaries and vascular anatomy of specific cutaneous flaps, including lateral thigh, medial thigh, posterior thigh, and groin.
4. Review the venous anatomy of the leg.
5. Discuss the design of fasciocutaneous flaps on the distal lower extremity.
6. Describe the cutaneous margins and vascular anatomy of foot flaps, including medial plantar, lateral plantar, V-Y plantar, and dorsalis pedis.
7. Describe the anatomy and boundaries of sensate flaps in the lower extremity.
8. Discuss the physiology of arterial insufficiency, venous hypertension, and diabetes mellitus as they pertain to the lower extremity.

E.   Lower Extremity Trauma Reconstruction

1. Review indications and timing of closure of soft tissue traumatic defects of the lower extremity.
2. Describe coverage techniques (including skin grafts, local skin flaps, distant flaps, muscle flaps, and free flaps) for soft tissue and bony closure of the lower extremity.
3. Discuss management of infectious processes, including osteomyelitis, related to traumatic injuries of the lower extremity.
4. Review operative and nonoperative management of traumatic, ischemic, venous, hypertensive, diabetic and infectious foot ulcers.
5. Discuss the etiology and treatment (operative and nonoperative) of lymphedema.