Comparison of surgical outcomes of free flap reconstructions performed by expert microsurgeons and trainees who completed a structured microsurgical training program in a teaching hospital

초록

Background: Few studies have evaluated clinical outcomes of novice surgeons trained in a microsurgical training program. Herein, we describe successful free flap reconstructions performed by trainees who completed a structured microsurgical training program. Methods: The Microsurgical Skills Training Course, a laboratory-based structured microsurgical training program, was developed and used for microsurgical training. Three trainees (post-graduate years 6 and 7) who completed the training course during residency were assigned to perform free flap reconstructions between March 2015 and February 2019. Clinical outcomes of free flap reconstruction were assessed. A retrospective propensity-score-matched analysis was performed between the trainee and expert microsurgeon groups. Results: A total of 161 patients were included. Of them, 67 (25 of the trainee group and 42 of the expert group) were propensity score-matched. No flap failure developed in either matched group (p>0.999). Rates of overall complications, partial flap loss, and emergent reoperation due to vascular compromise were not significantly different between the two groups (p=0.384, p=0.525, and p=0.322, respectively), whereas those of donor complications and overall operation time were significantly higher in the trainee group than the expert group (p=0.002 and p<0.001, respectively). Conclusion: The use of a structured microvascular training program in qualified teaching hospitals may help trainees achieve independence as microsurgeons and favorable clinical outcomes. (C) 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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