Impact of Resident and Attending Surgeon Training Level on Free Tissue Transfer Ischemia Time and Complications.

Background: Microsurgical free tissue transfer has become an essential method for reconstruction of complex surgical defects, making the level of training an important factor to consider. There is little published regarding the impact of training level on microsurgical outcomes. This study investigates microsurgical free tissue transfer ischemia time and post-operative complications based on resident and attending surgeon experience level.

Methods: A retrospective review of all free flaps at a single institution from 1/1/2013 to 12/31/2021 was performed. Linear regression was performed analyzing ischemia time of 497 free flaps and attending surgeon experience defined by years in practice and resident level defined as post graduate year (PGY). Logistic regression model was used to analyze complications based on attending experience and resident level.

Results: The average resident PGY was 3.5 +/- 0.8; the average attending has been practicing 6.4 +/- 5.1 years. There was no statistically significant difference in ischemia time or complication rates based on resident PGY or attending surgeon experience level.

Conclusion: Lower PGY residents were not found to increase ischemia time or increase complication rates. Lower attending surgeon year was not found to increase ischemia time or increase complication rates compared to surgeons who had been practicing for longer. Microsurgical free tissue transfer is considered a safe procedure in residency training and trainee involvement should be encouraged to improve resident education and enhance technical skills.