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.
Keywords
resident outcomes - microsurgery - breast reconstruction
