J reconstr Microsurg 2018; 34(01): 059-064
DOI: 10.1055/s-0037-1606541
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Two Attendings on the Outcomes of Microvascular Limb Reconstruction

Denis Ehrl1, Paul I. Heidekrueger1, Milomir Ninkovic1, P. Niclas Broer1
  • 1Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany
Further Information

Publication History

04 April 2017

31 July 2017

Publication Date:
03 October 2017 (eFirst)


Background Free tissue transfers are routinely performed for extremity reconstruction. In an era of increasing economic pressure in many healthcare systems, efficiency needs to be optimized for any kind of operative procedure. This study is examining the possible benefit of a two-attending approach to microsurgical reconstruction of the limbs using antero-lateral thigh- (ALT) or gracilis-muscle flaps at a major academic microsurgical center.

Methods 309 patients underwent 392 free ALT- (206) or gracilis-muscle (186) flaps for limb defect reconstruction at our institution (2009–2015). All available data was retrospectively screened for patients' demographics, perioperative details, surgical complications, and overall flap survival. The cases were divided into two groups according to the number of operating microsurgeons: one versus two attendings.

Results No significant differences existed between the two groups (341 “one attending” versus 51 “two attendings”) regarding preoperative comorbidities. Overall, there was no significant difference between both groups regarding operative times, revision surgery rates, total as well as partial flap loss, and hospital length of stay (p > 0.05) during the 3-month follow-up period. Further, evaluating ALT and gracilis flaps separately also showed no significant differences between both groups (one versus two attendings).

Conclusion The addition of a second operating attending does not significantly shorten surgery times, hospital length of stay, need for revision surgery, or complications rates. A two-operation surgeon approach may therefore only provide a marginal benefit in microsurgical limb reconstruction.

Funding Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.