Microvascular surgery training in a low volume setting: a single healthcare center experience

BackgroundToday, the surgical approach in the treatment of complex injuries is changing in that complex and intricate procedures, such as microvascular surgery, are no longer kept as a last resort. In Plastic and Reconstructive surgery, microvascular surgery has been described in the treatment of extensive tissue defects using free tissue transfer. This study discusses the incorporation of microvascular training in residency programs, as well as identifying the factors that influence residents' confidence in performing microsurgery without supervision.MethodsThis is a cross-sectional study conducted on thirteen current and former Plastic and Reconstructive surgery residents who practiced microsurgery during the past 8 years at the American University of Beirut Medical Center in Lebanon.ResultsNine residents (69.2%) started scrubbing in and became actively involved in microsurgery procedures at the PGY IV level with the majority being exposed to cases every 2-3 weeks (69.2%). Residents were mostly exposed to breast (100%) and orthopedic reconstruction (92.3%), and facial trauma reconstruction was the least practiced (46.2%). Eleven residents (84.6%) reported that music and choice of OR staff assisting in the operation significantly affected their speed and performance. Eleven residents (84.6%) were satisfied with the training program, and ten found the training program beneficial for their career (76.9%).ConclusionOur findings suggest that residents who had a higher workload and were actively involved in microsurgery early during residency felt more confident in performing the procedure by themselves. The choice of operating staff, playing music, and the presence of different attendings in the operating room were found to affect the speed and performance of residents.Level of evidenceLevel V, Risk/Prognostic.