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J Reconstr Microsurg 2025; 41(05): 443-449
DOI: 10.1055/a-2404-7899
Original Article

Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications

Brooke E. Porter
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Thalia C. Anderson
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Angela S. Ash
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Sarah E. Langsdon
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Leanna M. Zelle
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
,
Thomas D. Willson
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri
› Author Affiliations Funding None.
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Abstract

Background Microsurgical free tissue transfer has become an essential method for reconstruction of complex surgical defects, making the level of training an important factor to consider. There is little published regarding the impact of training level on microsurgical outcomes. This study investigates microsurgical free tissue transfer ischemia time and postoperative complications based on resident and attending surgeon experience level.

Methods A retrospective review of all free flaps at a single institution from January 1, 2013, to December 31, 2021 was performed. Linear regression was performed analyzing ischemia time of 497 free flaps and attending surgeon experience defined by years in practice and resident level defined as postgraduate year (PGY). Logistic regression model was used to analyze complications based on attending experience and resident level.

Results The average resident PGY was 3.5 ± 0.8; the average attending has been practicing for 6.4 ± 5.1 years. There was no statistically significant difference in ischemia time or complication rates based on resident PGY or attending surgeon experience level.

Conclusion Lower PGY residents were not found to increase ischemia time or increase complication rates. Lower attending surgeon year was not found to increase ischemia time or increase complication rates compared with surgeons who had been practicing for longer. Microsurgical free tissue transfer is considered a safe procedure in residency training and trainee involvement should be encouraged to improve resident education and enhance technical skills.

Keywords

microsurgery - training - experience

Poster Presentation At

American Society for Reconstructive Microsurgery 2024 Annual Meeting.




Publication History

Received: 06 June 2024

Accepted: 12 August 2024

Accepted Manuscript online:
27 August 2024

Article published online:
28 September 2024

© 2024. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Steel BJ, Cope MR. A brief history of vascularized free flaps in the oral and maxillofacial region. J Oral Maxillofac Surg 2015; 73 (04) 786.e1-786.e11
    Search in Google Scholar
  • 2 Khouri RK. Avoiding free flap failure. Clin Plast Surg 1992; 19 (04) 773-781
    Search in Google Scholar
  • 3 Kroll SS, Schusterman MA, Reece GP. et al. Choice of flap and incidence of free flap success. Plast Reconstr Surg 1996; 98 (03) 459-463
    Search in Google Scholar
  • 4 Kreymerman P, Silverman AL, Rebecca AM, Casey WJ. Contradicting an established mantra: microsurgeon experience determines free flap outcome. Plast Reconstr Surg 2012; 130 (04) 507e-512e
    Search in Google Scholar
  • 5 Cho MJ, Halani SH, Davis J, Zhang AY. Achieving balance between resident autonomy and patient safety: analysis of resident-led microvascular reconstruction outcomes at a microsurgical training center with an established microsurgical training pathway. J Plast Reconstr Aesthet Surg 2020; 73 (01) 118-125
    Search in Google Scholar
  • 6 Hirche C, Kneser U, Xiong L. et al. Microvascular free flaps are a safe and suitable training procedure during structured plastic surgery residency: a comparative cohort study with 391 patients. J Plast Reconstr Aesthet Surg 2016; 69 (05) 715-721
    Search in Google Scholar
  • 7 Patel UA, Lin AC. Flap outcomes when training residents in microvascular anastomosis in the head and neck. Am J Otolaryngol 2013; 34 (05) 407-410
    Search in Google Scholar
  • 8 Teotia SS, Dickey RM, Liu Y, Jayaraman AP, Haddock NT. Intraoperative microvascular complications in autologous breast reconstruction: the effects of resident training on microsurgical outcomes. J Reconstr Microsurg 2021; 37 (04) 309-314
    Search in Google Scholar
  • 9 Jubbal KT, Chang D, Izaddoost SA, Pederson W, Zavlin D, Echo A. Resident involvement in microsurgery: an American College of Surgeons National Surgical Quality Improvement Program analysis. J Surg Educ 2017; 74 (06) 1124-1132
    Search in Google Scholar
  • 10 Simunovic M, To T, Baxter N. et al. Hospital procedure volume and teaching status do not influence treatment and outcome measures of rectal cancer surgery in a large general population. J Gastrointest Surg 2000; 4 (03) 324-330
    Search in Google Scholar
  • 11 Hannan EL. The relation between volume and outcome in health care. N Engl J Med 1999; 340 (21) 1677-1679
    Search in Google Scholar
  • 12 Hamilton BH, Ho V. Does practice make perfect? Examining the relationship between hospital surgical volume and outcomes for hip fracture patients in Quebec. Med Care 1998; 36 (06) 892-903
    Search in Google Scholar
  • 13 Sowden AJ, Deeks JJ, Sheldon TA. Volume and outcome in coronary artery bypass graft surgery: true association or artefact?. BMJ 1995; 311 (6998): 151-155
    Search in Google Scholar
  • 14 Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes-perfect or selective-referral patterns?. Health Serv Res 1987; 22 (02) 157-182
    Search in Google Scholar
  • 15 Buckley CE, Wrafter PF, Sheil F, McInerney NM, Hussey AJ. Impact of microsurgery skill acquisition on free flap ischaemia time and free flap outcomes. Eur J Plast Surg 2021; 44 (02) 1-4
    Search in Google Scholar
  • 16 Saad NH, Wang H, Cromack D, Karamanos E. Evaluation of the impact of residents' participation on free flap reconstruction. Eur J Plast Surg 2022; 45 (02) 321-326 . Available at: https://doi.org/10.1007/s00238-021-01832-2
    Search in Google Scholar
  • 17 Politano SF, Balchander D, Cabrera CI. et al. Impact of intraoperative ischemia time on acute complications of head and neck microvascular free tissue transfer: a systematic review and meta-analysis. Am J Otolaryngol 2022; 43 (03) 103467
    Search in Google Scholar
  • 18 Lee KT, Mun GH. The efficacy of postoperative antithrombotics in free flap surgery: a systematic review and meta-analysis. Plast Reconstr Surg 2015; 135 (04) 1124-1139
    Search in Google Scholar
  • 19 Stepanovs J, Ozoliņa A, Rovīte V, Mamaja B, Vanags I. Factors affecting the risk of free flap failure in microvascular surgery. Proc Latv Acad Sci B Nat Exact Appl Sci 2016; 70 (06) 356-364
    Search in Google Scholar
  • 20 Kwok AC, Agarwal JP. An analysis of free flap failure using the ACS NSQIP database. Does flap site and flap type matter?. Microsurgery 2017; 37 (06) 531-538
    Search in Google Scholar
  • 21 Suh JD, Sercarz JA, Abemayor E. et al. Analysis of outcome and complications in 400 cases of microvascular head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2004; 130 (08) 962-966
    Search in Google Scholar
  • 22 Xiong L, Gazyakan E, Kremer T. et al. Free flaps for reconstruction of soft tissue defects in lower extremity: a meta-analysis on microsurgical outcome and safety. Microsurgery 2016; 36 (06) 511-524
    Search in Google Scholar
  • 23 Chen J, Varagur K, Xun H. et al. Predictors and consequences of intraoperative anastomotic failure in DIEP flaps. J Reconstr Microsurg 2023; 39 (07) 549-558
    Search in Google Scholar
  • 24 Jordan SW, Mioton LM, Smetona J. et al. Resident involvement and plastic surgery outcomes: an analysis of 10,356 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Plast Reconstr Surg 2013; 131 (04) 763-773
    Search in Google Scholar
  • 25 Jensen JA, Goodson WH, Hopf HW, Hunt TK. Cigarette smoking decreases tissue oxygen. Arch Surg 1991; 126 (09) 1131-1134
    Search in Google Scholar
  • 26 Brunton LL, Hilal-Dandan R, Knollmann B. Goodman & Gilman's Pharmacological Basis of Therapeutics. 13th ed.. McGraw-Hill Education; 2018
    Search in Google Scholar
  • 27 Dormand EL, Banwell PE, Goodacre TE. Radiotherapy and wound healing. Int Wound J 2005; 2 (02) 112-127
    Search in Google Scholar
  • 28 Kean J. The effects of smoking on the wound healing process. J Wound Care 2010; 19 (01) 5-8
    Search in Google Scholar
  • 29 Elver AA, Egan KG, Phillips BT. Assessment of microsurgery simulation course access in plastic surgery training programs. J Reconstr Microsurg 2024; 40 (06) 482-488
    Search in Google Scholar
  • 30 Joy MT, Applebaum MA, Anderson WM, Serletti JM, Capito AE. Impact of high-fidelity microvascular surgery simulation on resident training. J Reconstr Microsurg 2024; 40 (03) 211-216
    Search in Google Scholar
  • 31 Cuteanu A, Hellich A, Cardinal AL. et al; Microsurgery Training Group at The Griffin Institute. Evaluation of a microsurgery training curriculum. J Reconstr Microsurg 2023; 39 (08) 589-600
    Search in Google Scholar
  • 32 Javid P, Aydın A, Mohanna PN, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: a systematic review. Microsurgery 2019; 39 (07) 655-668
    Search in Google Scholar