Abstract
BackgroundThere is a lack of published literature on the training in microvascular reconstructive techniques in facial plastic and reconstructive surgery (FPRS) fellowships or of the extent these techniques are continued in practice. This cross-sectional web-based survey study was conducted to describe the volume, variety, and intended extent of practice of free tissue transfers during fellowship and the post-fellowship pattern of microsurgical practice among FPRS surgeons in various private and academic practice settings across the United States.MethodsThis survey was sent to recent graduates (n = 94) of a subset of U.S. Facial Plastic and Reconstructive Surgery fellowship programs that provide significant training in microvascular surgery.ResultsAmong survey respondents (n = 21, 22% response rate), two-thirds completed 20–100 microvascular cases during fellowship using mainly radial forearm, fibula, anterior lateral thigh, latissimus and rectus free tissue transfers. In post-fellowship practice, those who continue practicing microvascular reconstruction (86%) complete an average of 33 cases annually. The choice of donor tissues for reconstruction mirrored their training. They are assisted primarily by residents (73%) and/or fellows (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures. Interestingly, among those who began in private practice (29%), only half remained with that practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%).ConclusionsThese results provide the first formal description of the training and practice patterns of FPRS-trained microvascular surgeons. They describe a diverse fellowship training experience that often results in robust microvascular practice. The maintenance of substantial microsurgical caseloads after fellowship runs counter to the perception of high levels of burnout from free tissue transfers among microvascular surgeons.Trial RegistrationThis study was approved as exempt by the University of Florida Institutional Review Board (#201601526).
Highlights
Within the field of Otolaryngology – Head and Neck Surgery, several training pathways have developed through which surgeons are trained in microvascular head and neck reconstructive surgery, including free tissue transfer (FTT)
Included as part of Head & Neck Oncology fellowships, training in microvascular surgery techniques in certain Facial Plastic and Reconstructive Surgery (FPRS) fellowships has become well-established over the last several decades [1, 2]
After facial plastic and reconstructive surgery (FPRS) fellowship, practicing microvascular and reconstructive surgeons pursue a wide variety of surgical techniques, caseloads, and practice models, and no previously published literature exists to describe their patterns of practice, including the continuance of microvascular and reconstructive surgery, which is suggested to carry higher risk of physician burnout [4]
Summary
FPRS fellowship training in microvascular surgical techniques We received 21 voluntary responses from FPRS-trained microvascular surgeons who completed fellowships between 1996 and 2014 (median year, 2011). In performing FTT procedures, every respondent was trained to perform radial forearm free flaps (100%), and the large majority were trained in fibula (95%), anterior lateral thigh (67%), latissimus (67%), and rectus FTTs (57%, Fig. 1b) When asked about their intentions for post-fellowship performance of microvascular surgical cases, 14% did not plan to do so, citing lifestyle concerns, lack of interest, and plans to join partners who already performed FTTs, while 2 of 3 planned to pursue microvascular surgery for 10+ years (Fig. 1c). When choosing donor tissue for transfer, surgeons reported choosing at nearly equal frequencies from fibula (29.5%), anterior lateral thigh In performing these procedures, respondents were most often assisted by a resident (73%) and/or fellow (43%), while some worked with a micro-trained partner, surgical assistant, or performed solo procedures (Fig. 4a). Among those who began in private practice (29%) out of fellowship, half had experienced a subsequent move to a different practice, while those who joined academic practices (71%) largely remained at their initial post-fellowship location (87%, Fig. 4c&d)
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