The Co-Surgeon model for Microsurgical Free Flaps: A Survey of Perspectives and Utility.

Abstract

Background: Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.

Methods: An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeons perspectives on the utility of the co-surgeon model.

Results: A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (±9.7) years. Most of the microsurgeons were male (71%) practicing in the US (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with Immediate Lymphatic Reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4% and 36.4% respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves "very much" or "quite a bit" operative efficiency and duration, as well as surgeon wellbeing and career longevity.

Conclusion: This study provides new insight on the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon wellbeing, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting wellbeing among microsurgeons.