5000 Free Flaps and Counting: 10 Years of a Single Academic Institution’s Microsurgical Experience and A Practical Guide to Developing a Successful Surgical Culture
Martin J. Carney, III, B.S., Jason M. Weissler, M.D., Michael G. Tecce, D.O., Liza C. Wu, M.D., Joseph M. Serletti, M.D..
University of Pennsylvania, PHILADELPHIA, PA, USA.
PURPOSE: Academic plastic surgery training depends upon open access to learning reconstructive techniques provided by free vascularized soft tissue coverage. Key components of this approach include recruitment of an accomplished and diverse faculty, broad-based collaboration, patient geographic outreach, and fundamental support from all levels of staff. This study reviews a 10-year experience of microsurgical procedures and illustrates a successful framework for building a harmonized microsurgery team.
METHODS: A 10-year retrospective institutional review was performed for FY 2006-2016. Microsurgical flap type, operative volume, and outcomes were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons, accounting for 97% of all free flap cases.
RESULTS: The 5000th flap was performed in December, 2015 within this institutional study period. Of the 6 highest volume surgeons, 4,847 free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53% across 4 participating hospitals. Overall, 74.4% flaps performed were breast flaps, and the remainder were upper/lower extremity and head/neck flaps.
CONCLUSION: With focused faculty and trainee recruitment, this institution has built the largest clinically productive academic microsurgical program in the country. Collaboration among faculty, staff and residents, all contribute to continual learning, innovation, and quality patient care. This established framework offers a workable and reproducible model in any metropolitan area within the US.
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