Overcoming the learning curve in microvascular head and neck reconstruction

Abstract

Background: It is widely accepted that most microvascular reconstructive surgeons experience a learning curve. A compilation of 6 series of microvascular surgery reported in the literature revealed that the average rate of successful free flap transfer rose from 79% to 96% as the surgeons gained clinical experience.

Objective: To review the collective experience of 3 otolaryngologist-head and neck surgeons performing free flaps during their first year of clinical practice after completion of postgraduate training.

Design: A multi-institutional retrospective case series.

Setting: Three academic tertiary care otolaryngology-head and neck surgery programs.

Patients: Eighty-one microvascular free flaps were performed in patients undergoing surgical reconstruction of head and neck defects during a 1-year period.

Interventions: Free flap selection was based on specific defect characteristics. Radial forearm, fibula, and rectus abdominis flaps together accounted for 90% of the donor sites selected.

Main outcome measure: Reported incidence of partial or complete free flap necrosis.

Results: There were 2 perioperative deaths. Among the surviving patients, there were 2 cases of complete flap failure, for an overall success rate of 97.5%. There were 2 additional cases of partial flap necrosis (2.5%) that were related to errors in flap insetting.

Conclusion: The availability of high-quality postgraduate training combined with the judicious selection of free flaps that offer long vascular pedicles and large diameter vessels can allow junior microvascular head and neck surgeons to achieve free flap survival rates that are comparable with those reported by experienced microvascular surgeons.