Le chirurgien de la main est un chirurgien qui prend en charge les lésions de la main, de son squelette, de ses moteurs (muscles et tendons), de ses nerfs et de ses vaisseaux, dont il doit être capable d'assurer la réparation et la couverture. À l'heure actuelle 233 chirurgiens ont obtenu le droit au titre de chirurgien de la main depuis son officialisation en 2000 par le Conseil de l'Ordre des médecins. Sur les 1 400 000 blessés de la main par an en France dont les médias se font partout l'écho, ceux pris en charge par un chirurgien qualifié sont à notre sens dangereusement faibles. La formation à l'urgence nécessite une structure d'au moins trois ou quatre chirurgiens seniors, pratiquant et accueillant les urgences 24 h/24, 365 jours par an avec un plateau technique disponible pour cette chirurgie. Les trois piliers sur lesquels cette formation s'appuie sont la FESUM (Fédération européenne des services d'urgences de la main), le Collège français des enseignants en chirurgie de la main et la structure des diplômes interuniversitaires (DIU). C'est l'action conjuguée et concertée de ces trois structures qui permet d'assurer la formation complète du chirurgien de la main que le droit au titre ne vient que confirmer et valider. Le prérequis pour l'appartenance d'un centre de chirurgie de la main, public ou privé, à la FESUM doit continuer à garantir le niveau tant qualitatif que quantitatif. Nous avions proposé en 1998, comme masse critique annuelle de formation à l'urgence la gestion de 10 à 15 réimplantations, 25 à 30 mains complexes et au moins 1000 à 1500 mains opérées par centre formateur.

Training of the hand surgeon

Hand surgeon: a concept. - The hand surgeon is supposed to be in charge of all the hand lesions regarding, skeleton, muscles, tendons, nerves and vessels. He has to be able to insure reparation and coverage of all of them. So he is involved in all the structures, which insure integrity and function of the hand.

Purpose and ways of training. - To obtain the asked ability, the hand surgeon training has to be global and sustained by two underlying surgical specialities: orthopedic surgery and plastic and reconstructive surgery. From 2000 after many years of dealings, a Right to the Title in Hand Surgery was born. This Right to the Title wants to be the formal recognition of the specific training of the hand surgeon. For the well-recognized ancient hand surgeons they need to be confirmed by one's peers. Now a day the hand surgeon has to satisfy to this specific training:

Those requirements are heavy to assume and need a heavy personal involvement. That seems to be necessary to have an ability level as high as possible. Emergency surgery practice is absolutely necessary in this training. All the 17 university formative hand surgery units listed by the French College of Hand Surgeons are members of the FESUM (European Federation of the Emergency Hand Units). Unfortunately it is non-sufficient to train the necessary number of hand surgeons needed in France today. So we try to obtain from the authority the formal recognition of a training period in private practice. Eleven out of the 28 hand units listed as formative by the French College of Hand Surgeons are in private practice and may be recognized as formative in the hand surgeon training. That needs to create an official agreement between university and private Units. This part of the training is yet accepted by the Right to the Title commission for a 6-month training period. But this needs a legal modification or adaptation of the private units legal status so they will be able to offer a quite equivalent conditions of training. Now a days 233 surgeons in France passed the Right to the Title. Among them, the oldest do not have emergency practice any more. So unfortunately, out of 1 400 000 hand injuries a year in France, only few are actually cared by hand surgeons. The emergency training needs at least a three to four senior surgeons team, operating and caring emergencies, 24 h a day, 365 days a year. They need to be surrounded by high-level technical facilities for this type of surgery. Only this type of unit may have a frequent severe hand traumatology practice, especially regarding microsurgery. But on the other hand a less complex hand unit operating only planed surgery and less complicated emergencies, may also be definitively formative. This only depends on the hand surgeon's qualification. It is only with a very demanding and high-level training program that our credibility as hand surgeon may be definitively established. The mainstay of this training is the combined action of the FESUM, the French College of Hand Surgeons and the DIU diploma. The Right to the Title formally confirms that training. For university or private unit, to be a member of the FESUM, must continue to guarantee a high level training regarding emergencies as in number as in complexity. We proposed as minimum level of practice (a year) to be a formative hand surgery unit: