Background: University teaching hospitals and surgeons in Ireland have a responsibility to teach the next generation of plastic surgeons, while maintaining patient safety standards. The aim of this study is to compare consultant versus trainee flap raising and consultant versus trainee microvascular anastomosis in head and neck reconstruction.
Method: A prospectively maintained database of all head and neck free flaps in Ireland was used between 2020 and 2023 across five university hospital training sites.
Results: In total, 311 free flaps were included with trainee involvement. When there was trainee involvement in raising a flap, there was no statistically significant difference in ischemic (p=0.956), total operative time (p=0.326), or grade I to V complication rates. Free flap partial loss, total loss, and complete survival was similar across both trainee and consultant raised flaps (p=0.731). When a trainee completed the arterial or venous microanastomosis, there was no statistical increase in flap ischemia time (p=0.282), total operative time, or overall complication rate.
Conclusion: This is the largest study to compare trainee and consultant outcomes in complex head and neck free flap reconstruction. We have demonstrated trainee involvement as safe, with similar flap and patient outcomes, with no decrease in theatre time efficiency.
K O’Reilly 1, 2 , C M Hurley 1, 2 , J J Dorairaj 2,3 , S T O’Sullivan 2,3 , S Potter 2,4 , E Beausang 2,5 , C Theopold 2,5 , F Martin 1, 2 , R T Dolan 1, 2 , J B O’Sullivan 1, 2
1 Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
2 Royal College of Surgeons in Ireland, St Stephen's Green, Dublin, Ireland
3 Department of Plastic & Reconstructive Surgery, Cork University Hospital
4 Department of Plastic & Reconstructive Surgery, Mater Misericordiae University Hospital, Dublin
5 Department of Plastic & Reconstructive Surgery, St James's Hospital, Dublin, Ireland