J Reconstr Microsurg
DOI: 10.1055/s-0040-1716404
Original Article

Intraoperative Microvascular Complications in Autologous Breast Reconstruction: The Effects of Resident Training on Microsurgical Outcomes

Sumeet S. Teotia*
1  Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
1  Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Yulun Liu
2  Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
,
Avinash P. Jayaraman
1  Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Nicholas T. Haddock
1  Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations

Abstract

Background Academic medical centers with large volumes of autologous breast reconstruction afford residents hand-on educational experience in microsurgical techniques. We present our experience with autologous reconstruction (deep inferior epigastric perforators, profunda artery perforator, lumbar artery perforator, bipedicled, and stacked) where a supervised trainee completed the microvascular anastomosis.

Methods Retrospective chart review was performed on 413 flaps (190 patients) with microvascular anastomoses performed by postgraduate year (PGY)-4, PGY-5, PGY-6, PGY-7 (microsurgery fellow), or attending physician (AP). Comorbidities, intra-operative complications, revisions, operative time, ischemia time, return to operating room (OR), and flap losses were compared between training levels.

Results Age and all comorbidities were equivalent between groups. Total operative time was highest for the AP group. Flap ischemia time, return to OR, and intraoperative complication were equivalent between groups. Percentage of flaps requiring at least one revision of the original anastomosis was significantly higher in PGY-4 and AP than in microsurgical fellows: PGY-4 (16%), PGY-5 (12%), PGY-6 (7%), PGY-7 (2.1%), and AP (16%), p = 0.041. Rates of flap loss were equivalent between groups, with overall flap loss between all groups 2/413 (<1%).

Conclusion With regard to flap loss and microsurgical vessel compromise, lower PGYs did not significantly worsen surgical outcomes for patients. AP had the longest total operative time, likely due to flap selection bias. PGY-4 and AP groups had higher rates of revision of original anastomosis compared with PGY-7, though ultimately these differences did not impact overall operative time, complication rate, or flap losses. Hands-on supervised microsurgical education appears to be both safe for patients, and also an effective way of building technical proficiency in plastic surgery residents.

* These authors should be considered as first authors.




Publication History

Received: 20 April 2020

Accepted: 26 July 2020

Publication Date:
06 September 2020 (online)

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