Division of Plastic and Reconstructive Surgery celebrates 50 years

An iconoclastic approach to training residents, championed by the division’s founder, made a lasting impact on the field.

- By Sara Wykes

From left, Robert Chase, James Chang and Vincent Hentz at the Division of Plastic and Reconstructive Surgery’s 50th anniversary celebration.
Libby Roberts

Robert Chase, MD, founder of the Stanford's Division of Plastic and Reconstructive Surgery, kicked off a recent celebration of the division’s 50th anniversary by recounting the history of an innovation with far-reaching consequences.

The celebration brought together past and present residents, fellows and faculty of the division. Chase, the Emile Homan Professor of Surgery, Emeritus, said that shortly after he arrived at Stanford in 1963, he proposed upending how plastic surgeons learned their craft. The traditional sequence — seven years of training in general surgery, followed by two years focused on plastic surgery — just didn’t make sense to him.

“General surgery was mostly about repairing intra-abdominal organs, and plastic surgery involves many tissues types: bones, nerves and tendons,” said James Chang, MD, current division chief and professor of plastic surgery, who co-chaired the celebration, which included a conference. “You would train for seven years to sew tissues you would never touch again in practice.”

Chase recalled that, in the 1960s, the tools and techniques for craniofacial surgery, microsurgery and hand surgery were advancing at breakneck speed. “Learning all that in two years was not good for the doctor and not good for the patient,” Chang said.

Chase’s plan was to train surgeons in plastic surgery techniques from the very start, for five years of direct training in the specialty. It also included another innovation: a sixth year for residents to conduct research or concentrate on a particular kind of surgery — even outside the Stanford medical school.

For example, Chase encouraged one resident, Vincent Hentz, MD, to spend a year working at a hospital in New York City with hand surgeon William Littler, MD. Littler was Chase’s teacher and one of plastic surgery’s legendary innovators. Hentz also spent six months learning about surgical techniques for head and neck cancer. “It was a very nonstandard residency,” Hentz said. In 1975, he joined the Stanford division as faculty member No. 6 and, later, became its chief. Hentz, who co-chaired the celebration, is now a professor emeritus of surgery.

An idea that caught on

Fifty years on, Chase’s approach to plastic surgery residencies dominates the field nationwide. Stanford Medicine’s plastic and reconstructive surgery residency program, recently lengthened to seven years, is now directed by Gordon Lee, MD, associate professor of surgery. The program attracts more than 300 applicants each year for three spots. 

Andrew Zhang, MD, a recent alumnus of the program, was first drawn to the field by an anatomy lecture Chase gave to Stanford medical students and further in by Chang, who invited Zhang to join him in a tendon-tissue-engineering project. After earning a medical degree, Zhang stayed on at Stanford as a resident and then as a fellow in hand surgery. Now, he is an assistant professor of surgery at the University of Texas Medical Branch at Galveston.

The celebration also provided a good opportunity for the division to gauge the accomplishments of its alumni: Twenty-six of them, including former residents and fellows, direct programs in plastic and reconstructive surgery. Thirty-nine have been hospital chiefs. Seventy-eight hold academic titles. More than 5,000 journal articles have come from the research and clinical work of the division’s former trainees, who have also authored or co-authored 396 books and book chapters. Nearly 170 serve on the boards of professional journals.

We have some huge names here who could all be chiefs and chairs in their own right, but we keep them here by fostering an environment they can thrive in.

Two of its alumni have served as president of the American Society for Surgery of the Hand, and Chang, another alumnus of the residency program, will become president in 2018. In addition, alumnus Robert Pearl, MD, is executive director and CEO of the Permanente Medical Group, which operates 21 medical centers in California. And alumnus Ronald Iverson, MD, is a past president of the American Society of Plastic Surgeons, the profession’s top national organization. Alumna Debra Johnson, MD, is the society’s next president. “We have a presence,” Hentz said.

Donald Laub, MD, one of the program’s first graduates and, eventually, one of the division’s first six chiefs, founded Interplast, now Resurge International, the first organization to send American surgeons, many of them trained at Stanford, to developing countries to repair cleft palates, disabling wounds, burns and other injuries. 

The division has also grown in numbers, too. When Chang became chief in 2006, there were just six full-time faculty. Now, there are 16, and there are plans to add four more by 2020. “We have some huge names here,” Chang said, “who could all be chiefs and chairs in their own right, but we keep them here by fostering an environment they can thrive in. We give them support and acknowledgement and room to do their own thing.”

The division’s current faculty have been awarded more than $38 million in research grants. Two of them, Michael Longaker, MD, and Geoff Gurtner, MD, have large laboratory enterprises. The division’s clinical volumes have quadrupled in the last decade. Its clinical expertise draws patients from all over the world for complex hand, craniofacial, reconstructive and microsurgical treatments.

The most recent change to the residency program has been the addition of a seventh year — a new year of professional development for its residents. The year can be used for research, additional clinical training or work in biodesign, public health or government.

The division’s strong network of alumni maintains close ties to each other, said Ronald Iverson, MD, who founded the alumni group. The anniversary celebration was “a great way for all of us to see what we’ve been doing, to share our memories” — and to find out about the next generation of Stanford-trained plastic and reconstructive surgeons, he said.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu.

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