The hand fellowship program at Stony Brook University Hospital is structured to provide exposure to surgical reconstruction of the entire upper extremity. The program allows the fellows to split time in rotations with both the Orthopaedic and Plastic Surgery trained hand surgeons. While on the Orthopaedic rotations, procedures include arthroscopy and arthroplasty of the shoulder, elbow and wrist. Highlights of the plastic surgery rotation include microvascular exposure to free functioning muscle transfer, free flap coverage of soft tissue injuries, as well as complex tendon transfer and nerve repair. Overlap among the services occurs in exposure to various approaches to manage common hand and wrist pathologies; including traumatic, arthritic, tendinopathy and compressive neuropathies. The sum total of this structure provides a comprehensive and complete training background to the graduating hand fellow.