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

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 (postgraduate 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.