PURPOSE: With the advances in microsurgery, the published success rate of microsurgical reconstruction by experienced microsurgeon is >95%. However, it is unknown whether the training residents can produce similar results. At our county hospital, although under direct supervision, residents perform and lead all aspects of microsurgical reconstruction, from raising the flap to performing microanastomoses, with only as needed faculty assistance. In this study, we retrospectively reviewed the outcomes of 163 consecutive microsurgical cases to determine the efficacy and safety of resident-led reconstructions at the county hospital.
METHODS: We performed a retrospective review of patients who underwent microsurgical reconstruction at the county hospital from 2016 to 2018. Demographic, surgical procedure, flap data, resident levels, and complication data were collected.
RESULTS: Of the 163 flaps performed, the most commonly performed reconstruction was breast (63.8%), followed by lower extremity (11.7%), upper extremity (6.7%), head and neck (6.1%), and genital (1.2%). The median procedure time was 540 minutes (240–990), and anastomoses time for each flap was 57 minutes (27–180). The venous anastomoses were performed by PGY3 (1.6%), PGY4 (37.1%), PGY5 (3.2%), and PGY6 (58%), whereas the arterial anastomoses were performed by PGY4 (18%), PGY5 (3.3%), and PGY6 (78.7%). The average number of anastomosis attempts was 1.3 with a range of 1–3. The total flap success rate was 96.3% with a take back rate of 4.3%.
CONCLUSION: In conclusion, our analysis shows that resident-led reconstruction can achieve similar microsurgical success as the published rates. We believe that resident-led microsurgical reconstruction can be safely performed with as needed faculty assistance in high-risk and complicated cases while allowing resident education and maturation of technical and decision-making skills.