Physicians & Staff

• Ronald K. Downs, M.D., F.A.C.S.
• Patrick J. Viscardi, M.D.
• Reconstructive and Rehabilitation Staff
• Locations

The History of Hand Surgery
War has played a huge role in the history of hand surgery, as well as plastic surgery. World War I presented surgeons with many severe wounds and burns, specifically to the face and hands as these two areas were the most exposed. Modern weapons at that time caused types and severity of injuries that were unprecedented in previous wars. Some of the greatest medical talents of that era devoted themselves to fully creating new techniques to treat men maimed by war.

The specialty of hand surgery developed out of necessity during the Second World War. Hand injuries required special expertise from several surgical disciplines to repair injured nerves, bones, joints, and arteries. Gathering together many different specialists to treat a single injured soldier was not practical or even possible during wartime and it quickly became obvious that a select group of surgeons needed to be trained to care for all components of the arm. A training program that taught interested surgeons the multiple skills needed to care for all of the parts of the arm and the surgical specialty of hand surgery was born. Current training requires that Hand Surgeons first complete training in orthopedic surgery, general surgery or plastic surgery and they qualify to pass the certifying boards of their specialty.

What does it mean when a physician is board certified?
The American Board of Medical Specialties (ABMS) has approved 24 subspecialty boards out of the hundreds that apply. Plastic surgery is one that has met the ABMS’s strict qualification and examination criteria. Plastic surgery is one of the most difficult and intensive certification processes within all the subspecialties. A word of caution to consumers looking for a board-certified plastic surgeon: Certification by other boards does not offer the same strict criteria for certification; in some cases, physicians can receive certification by simply paying a fee. A few of the boards which have NOT been approved by the ABMS are:  Cosmetic Plastic Surgery, Aesthetic Plastic Surgery, Facial Cosmetic Surgery, Dermatologic Surgery, Plastic Esthetic Surgery and Opthalmic Plastic Surgery.

To be properly certified by the American Board of Plastic Surgery, a plastic surgeon must spend at least two years in an approved plastic surgical residency. When in practice for at least one year, the surgeon must pass both oral and written examinations to be considered for the prestigious distinction of being called a board certified plastic surgeon.

What is a hand fellowship?
Physicians who have completed their training in orthopedic surgery, general surgery or plastic surgery may elect to gain greater expertise in surgery of the hand and upper extremity. To do so, they commit one year of their time at an institute devoted to this worthy endeavor.

Throughout the year, they may attend workshops, lectures, courses and meetings, and gain experience at various hospitals and clinics. Whether in the emergency room, office setting or the operating room, fellows assist with surgical procedures, or perform them under direct supervision. This experience gives them a wide exposure to a variety of interdisciplinary approaches to upper limb problems.

In addition to refining their understanding of hand surgery, many of these physicians have contributed immeasurably to the fellowship, bringing new ideas and techniques from around the world.

Click here to schedule a consultation with one of our reconstructive surgeons. The Centre for Working Hands offers the latest reconstructive hand surgery procedures to patients in Elkhart and South Bend, Indiana, Michiana and the Southern Michigan area.

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