Christoph Hirche1, Ulrich Kneser2, Lingyun Xiong3, Paul Wurzer4, Felicitas Ringwald2, Franziska Obitz2, Sebastian Fischer2, Leila Harhaus2, Emre Gazyakan2, Thomas Kremer2. 1. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany; Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: christoph.hirche@bgu-ludwigshafen.de. 2. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany; Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany. 3. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany; Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany; Department of Plastic and Reconstructive Surgery, Union Hospital, Huazhong Science and Technique University, Hubei, China. 4. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany; Department of Plastic and Hand Surgery, University of Heidelberg, Heidelberg, Germany; Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: Microvascular free flaps have become a reliable standard procedure. Due to increasing microsurgical experience in teaching hospitals, residents are getting acquainted with performing free flap surgeries earlier in their training. However, economic considerations and safety regulations contradict adequate teaching. A validation of procedures for residency training is necessary to reduce the existing concerns. METHODS: This retrospective, comparative cohort study was designed to investigate whether free flaps are a safe residency training procedure. In addition, the aim was to establish standards for microsurgical training. Between 2008 and 2011, 391 patients were included who underwent reconstructive surgery with free flaps, under the supervision of either an experienced microsurgeon (cohort 1) or a resident in training (cohort 2). Patient demographics, interventional characteristics, as well as outcome parameters were attributed for comparative analysis. RESULTS: The comparison of both cohorts revealed a significant difference for defect cause (p < 0.01) and defect localization (p < 0.001). Free flaps for breast reconstruction were more frequently used in cohort 1, and ALT flaps were more used in cohort 2 (p < 0.001). The length of hospital stay was significantly reduced in cohort 1 (p < 0.001). No significant differences for major postoperative complications were identified. CONCLUSION: With respect to standardized environmental conditions and risk stratification, microvascular free flaps can be applied as a safe training procedure during residency. Adequate teaching conditions require a sufficient case load and a high level of expertise of the teacher. The resident's experience and skills as well as the institutional infrastructure and expertise require consideration. LEVEL OF EVIDENCE: III.
BACKGROUND:Microvascular free flaps have become a reliable standard procedure. Due to increasing microsurgical experience in teaching hospitals, residents are getting acquainted with performing free flap surgeries earlier in their training. However, economic considerations and safety regulations contradict adequate teaching. A validation of procedures for residency training is necessary to reduce the existing concerns. METHODS: This retrospective, comparative cohort study was designed to investigate whether free flaps are a safe residency training procedure. In addition, the aim was to establish standards for microsurgical training. Between 2008 and 2011, 391 patients were included who underwent reconstructive surgery with free flaps, under the supervision of either an experienced microsurgeon (cohort 1) or a resident in training (cohort 2). Patient demographics, interventional characteristics, as well as outcome parameters were attributed for comparative analysis. RESULTS: The comparison of both cohorts revealed a significant difference for defect cause (p < 0.01) and defect localization (p < 0.001). Free flaps for breast reconstruction were more frequently used in cohort 1, and ALT flaps were more used in cohort 2 (p < 0.001). The length of hospital stay was significantly reduced in cohort 1 (p < 0.001). No significant differences for major postoperative complications were identified. CONCLUSION: With respect to standardized environmental conditions and risk stratification, microvascular free flaps can be applied as a safe training procedure during residency. Adequate teaching conditions require a sufficient case load and a high level of expertise of the teacher. The resident's experience and skills as well as the institutional infrastructure and expertise require consideration. LEVEL OF EVIDENCE: III.
Authors: Raquel Bernardelli Iamaguchi; Lucas Sousa Macedo; Alvaro Baik Cho; Marcelo Rosa de Rezende; Rames Mattar; Teng Hsiang Wei Journal: Rev Bras Ortop (Sao Paulo) Date: 2022-03-11
Authors: Sebastian Fischer; Yannick F Diehm; Dimitra Kotsougiani-Fischer; Emre Gazyakan; Christian A Radu; Thomas Kremer; Christoph Hirche; Ulrich Kneser Journal: J Clin Med Date: 2021-12-14 Impact factor: 4.241