Hand Surgery, Upper Extremity, and Microvascular Surgery Fellowship

Program training directorMarc J. Richard, MD

Associated FacultyDavid S. Ruch, MDSuhail K. Mithani, MDTyler Pidgeon, MDChristopher Klifto, MD; Warren C. Hammert, MD, Neill Y. Li, MD

ACGME accredited program#: 2633621022

Available positions: Three (one year)

Training dates: August 1 through July 31

Program description

The purpose of the Duke Orthopaedic Hand, Upper Extremity, and Microvascular Surgery Fellowship is to offer fellows special knowledge and training in the management of:

  • Acute hand and upper extremity trauma
  • Hand and upper extremity microvascular emergencies
  • Reconstructive hand and upper extremity conditions
  • Congenital upper limb deformities
  • Brachial plexus and peripheral nerve injuries

Two residents, three fellows, and one plastics resident are each assigned to one or more faculty member(s) who has some or all of their practice dedicated to hand and upper extremity surgery. The hand trauma call schedule includes a dedicated attending and hand fellow daily. Hand call includes replantation / microvascular emergency services, for which our institution is a major referral center for the entire southeast United States. Our faculty appreciates a mentorship-type relationship with the fellows who are expected to participate in teaching residents and students and to gradually assume greater responsibilities in patient care in clinic and in the operating room over the course of the fellowship year, under the direct supervision of the faculty. Highlights of clinical exposure include:

Adult reconstruction includes experience in treatment of osteoarthritis (including post-traumatic) and rheumatoid arthritis for the upper extremity, Dupuytren’s contracture, nerve compression syndromes, scleroderma and vascular insufficiency, and tendon reconstructions. In association with the orthopaedic oncology service, treatment of benign and malignant tumors of the upper extremity is included in the education of the residents and fellows.

Trauma includes treatment of fractures and dislocations of the upper extremity, flexor and extensor tendon injuries, nerve injuries, compartment syndromes, and replantation / microvascular emergency services. Experience is obtained for both acute, sub-acute and chronic injury presentation.

Brachial Plexus and Peripheral Nerve Injuries include the evaluation and management of both adult and pediatric patients with traumatic and birth-related brachial plexus injuries as well as the treatment of acute and chronic peripheral nerve injuries.

Congenital hand includes treatment of all birth-related injuries, such as congenital absence of the thumb, radial and ulnar club-hand, syndactyly, and cerebral palsy.

Free-tissue transfer includes our significant experience with free, vascularized fibular grafting, soft tissue reconstruction with local, regional, and distant tissue transfer.

Clinic and operating room experience

Fellows actively participate in both the clinic and the operative room. In the clinic and in the operating room, a structured mentorship education program encourages the development of examination skills, diagnostic test interpretation, treatment decision making, pre- and post-operative management of patients with upper extremity disorders, and surgical techniques and principles.

Education / conferences

The following conference schedule occurs on a weekly basis:

  • Tuesday: Core Lecture
  • Wednesday:  Core Anatomy / Surgical Skills Laboratory
  • Thursday:  Hand – Radiology Conference (1x/month)
  • Friday: Indications Conference

Also, there is a monthly Hand Journal Club.


An extensive orthopaedic research laboratory, including a hand and microvascular lab, is available to residents and fellows. A modern fresh cadaver laboratory fully equipped with hand surgery instruments and a microscope is available for the practice of surgical procedures and anastomosis dissections of the upper extremity. It allows for extensive research opportunities as well as the development of microsurgical skills.

Each fellow is expected to design, to lead and to complete a research project during the fellowship year. Many opportunities exist throughout the year to participate in various research projects, book chapters, review articles, based on an individual fellow’s interest.


Each rotation is two months in duration. Fellows rotate with the senior faculty twice during the year.




















Pidgeon; Mithani (plastics)







Alumni society

Graduating fellows of the Duke Hand program will become part of the prestigious Piedmont Orthopedic Society. Induction into this group of life-long learners includes access to an annual meeting and alumni reunions at events such as the AAOS annual meeting, and the annual meeting of the Piedmont Society.

Also, the Duke Hand Club is an active society that meets each year at the ASSH Annual Meeting and holds a formal Duke Hand Club meeting every three years. The next meeting is in the fall 2022 in Marbella, Spain.

How to apply

Accepting applications: 2025-2026 (Fall 2023)

Match participation: NRMP (#1529263F0)

Application deadline: December 15

To be considered for this fellowship, you must have completed a general surgery, orthopaedic surgery or plastic surgery program accredited by one of the following:

  • Accreditation Council for Graduate Medical Education (ACGME)
  • American Osteopathic Association (AOA)
  • Royal College of Physicians and Surgeons of Canada (RCPSC)

What you’ll need

Applicants should apply through the American Society for Surgery of the Hand (ASSH) by completing an online application and providing other requested documents. The online application is expected to be available on October 15, 2017.

  • ASSH Universal Hand Application
  • Brief personal statement
  • Picture
  • Curriculum vitae
  • List of Publications and presentations
  • List of hobbies
  • Copy of USMLE/COMLEX transcript (all three steps; passed within three attempts)
  • Three letters of recommendation:
    • One of which should be from the chairman or program training director of your training program
    • Letters must be on official letterhead and may not be older than six months
  • Copy of medical school transcript
  • ECFMG Certificate (applicable to international graduates)

ACGME application requirements

In order to be eligible for ACGME-accredited fellowship training, you must adhere to the following application requirements:

  • You must have completed an ACGME-accredited residency program or RCPSC-accredited or CFPC-accredited residency program located in Canada. Exceptions may apply for exceptionally qualified applicants (and institutional GME approval is required). For details, please refer to the Fellowship Appointments section of the ACGME Program Requirements for Hand Orthopaedic Surgery (approved but not in effect until 2016).
  • You must provide proof that you have taken and passed all three steps (within three attempts) of appropriate medical licensure examinations (USMLE/COMLEX). This is required by the North Carolina Medical Board and is a Duke institutional policy for all graduate medical trainees, whether U.S. or international medical school graduates at the PGY-3 level or higher, as well as qualify for a resident training license in the state of North Carolina in order to be eligible for employment at Duke University Hospital.

Foreign medical graduates: additional requirements

Foreign medical graduates must hold a valid and current ECFMG certificate in addition to meeting the above requirements. Your ECFMG Certificate must be valid as of the start date of the program. For foreign nationals who are medical graduates of LCME-accredited schools in the U.S., Canada, and Puerto Rico, copies of the diploma will suffice in lieu of an ECFMG certificate.

The Department of Orthopaedic Surgery will provide visa sponsorship, J-1 Clinical House Staff Visa (ECFMG sponsored) sufficient for clinical fellowship training, for individuals participating in an ACGME accredited fellowship. Non-ACGME positions are not eligible for visa sponsorship. For more visa information, please visit the Duke Visa Services web at https://visaservices.duke.edu/. The department does not sponsor an H-1B visa nor has the appropriate funds to support associated fees (petition, fraud detection, premium processing).

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Contact us

Cheryl DePaolis
Fellowship Program Coordinator
Department of Orthopaedic Surgery
Duke University School of Medicine

Wendy Thompson/ Tyranicia Green
Residency and Fellowship Program Coordinators