Microsurgical training is challenging in our current healthcare environment. There has been a paradigm shift in surgical training due to the reduced hands-on training opportunities. This is particularly true for highly specialised advanced skills such as microsurgery. Understandably, there is a reluctance to encourage trainees to perform micro-anastomosis due to the high stakes nature of free flap surgery. We aimed to compare flap ischaemia times and return to theatre between attending plastic surgeons and plastic surgery residents. Our secondary aim was to correlate flap outcomes to the grade of a surgeon performing the microsurgical anastomosis.
Data was collected on all free flap surgeries in a single institution over a 12-month period. Patient demographics, flap ischaemic times, return to theatre, flap outcomes and overall complications were recorded. Statistical analysis was performed using Stata 12.0. T test two group means comparison was used to compare ischemia times. Non-parametric statistics were used to evaluate flap outcome measures. A p value < 0.05 was considered statistically significant.
Fifty-four free flaps were performed in a single institution over a 12-month period. Attending group (n = 34) average flap ischaemia time was 70 min compared to 65 min for the resident group (n = 20), p = 0.4. There were no differences in return to theatre (p = 0.2), flap loss (p = 0.6), or overall complications (0.4).
This study demonstrates that resident performance of microsurgery does not adversely affect clinical outcomes in free flap surgery. The hands-on operative teaching of microsurgery should be encouraged amongst residents in plastic surgery.
Level of evidence: Level IV, risk/prognosic study
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Aggarwal R, Grantcharov T, Moorthy K et al (2006) A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. Am J Surg 191:128–133
Babineau TJ, Becker J, Gibbons G et al (2004) The “cost” of operative training for surgical residents. Arch Surg 139:366–369
Crofts TJ, Griffiths JM, Sharma S et al (1997) Surgical training: an objective assessment of recent changes for a single health board. BMJ 314:891–895
Kohn LT, CJ, Donaldson M (1999) To err is human: building a safer health system. Institute Of Medicine, Washington DC
Hallam MJ, Lo S, Mabvuure N et al (2013) Implications of rationing and the european working time directive on aesthetic breast surgery: a study of trainee exposure in 2005 and 2011. J Plast Reconstr Aesthet Surg 66(2):E37–E42
Aggarwal R, Grantcharov TP, Eriksen JR et al (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244:310–314
Nugent E, Joyce C, Perez-Abadia G et al (2012) Factors influencing microsurgical skill acquisition during a dedicated training course. Microsurgery 32(8):649–656
Javid P, Aydin A, Mohanna PN et al (2019) Current status of simulation and training models in microsurgery: a systematic review. Microsurgery 39(7):655–668
Evgeniou E, Walker H, Gujral S (2018) The role of simulation in microsurgical training. J Surg Educ 75(1):171–181
Khouri RK (1992) Avoiding free flap failure. Clin Plast Surg. 19(4):773–781
Hernández-Irizarry R, Zendejas B, Ali SM et al (2012) Impact of resident participation on laparoscopic inguinal hernia repairs: are residents slowing us down? J Surg Educ 69:746–752
Iannuzzi Jc CA, Rickles A et al (2013) Resident involvement is associated with worse outcomes after major lower extremity amputation. J Vasc Surg 58:827–831
Kern SQ, Lustik MB, Mcmann LP et al (2014) Comparison of outcomes after minimally invasive versus open partial nephrectomy with respect to trainee involvement utilizing the American College of Surgeons National Surgical Quality Improvement Program. J Endourol. 28(1):40–47
Papandria D, Rhee D, Ortega G et al (2012) Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ. 69(2):149–155
Schoenfeld AJ, Serrano JA, Waterman BR et al (2013) The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases. Arch Orthop Trauma Surg. 133(11):1483–1491
Fischer JP, Wes AM, Kovach SJ (2014) The impact of surgical resident participation in breast reduction surgery – outcome analysis from the 2005–2011 ACS-NSQIP datasets. J Plast Surg Hand Surg. 48(5):315–321
Kiran RP, Ahmed Ali U, Coffey JC et al (2012) Impact of resident participation in surgical operations on postoperative outcomes. Ann Surg. 256(3):469–475
Jordan SW, Mioton LM, Smetona J (2013) Resident involvement and plastic surgery outcomes. Plast Reconstr Surg. 131(4):763–773
Jubbal KT, Chang D, Izaddoost SA et al (2017) Resident involvement in microsurgery: an American College of Surgeons National Surgical Quality Improvement Program Analysis. J Surg Educ 74(6):1124–1132
Patel U, Lin A (2013) Flap outcomes when training residents in microvascular anastomosis in the head and neck. Am J Otolaryngol. 34(5):407–410
Hirche C, Kneser U, Xiong L et al (2016) 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. 69(5):715–721
Mokhtari P, Meybodi A, Benet A et al (2019) Microvascular anastomosis: proposition of a learning curve. Oper Neurosurg (Hagerstown) 16(2):211–216
Conflict of interest
Christina E. Buckley, Paula F. Wrafter, Fiachra Sheil, Niall M. McInerney and Alan J. Hussey declare that they have conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Galway Clinical Research Ethics Committee approved this study (approval # C.A. 2163).
Informed consent was obtained from all participants included in this study.
Patients signed informed consent regarding publishing their data
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Buckley, C.E., Wrafter, P.F., Sheil, F. et al. Impact of microsurgery skill acquisition on free flap ischaemia time and free flap outcomes. Eur J Plast Surg 44, 493–496 (2021). https://doi.org/10.1007/s00238-021-01782-9
- Surgical training
- Ischaemia time
- Flap outcomes