The First Free Flaps and the Problems They Addressed

A Propeller Perforator Flap in the Distal Lower Extremity: An Alternative to Free Flap Coverage Near the Ankle

As perfusion assessment technologies and microsurgical techniques have evolved, plastic surgeons have become increasingly aggressive and creative in offering reconstructive solutions to limb salvage problems. In the distal lower extremity, pedicled perforator flap transfer has grown in popularity as compared to the historically reliable option of free tissue transfer. Pedicled perforator flaps typically avoid muscle harvest and restore the thin, supple soft tissue in the distal extremity, where there is a relative lack of redundancy of soft tissues. They also allow for a shorter operative time and recovery in otherwise complex wounds of the foot and ankle. This case report highlights the indications, nuance, and post-operative course of a patient who underwent peroneal perforator flap for coverage of a complex ankle wound in the setting of a calcaneal fracture.

Comparison of surgical outcomes of free flap reconstructions performed by expert microsurgeons and trainees who completed a structured microsurgical training program in a teaching hospital

BACKGROUND

Few studies have evaluated clinical outcomes of novice surgeons trained in a microsurgical training program. Herein, we describe successful free flap reconstructions performed by trainees who completed a structured microsurgical training program.

METHODS

The Microsurgical Skills Training Course, a laboratory-based structured microsurgical training program, was developed and used for microsurgical training. Three trainees (postgraduate years 6 and 7) who completed the training course during residency were assigned to perform free flap reconstructions between March 2015 and February 2019. Clinical outcomes of free flap reconstruction were assessed. A retrospective propensity-score-matched analysis was performed between the trainee and expert microsurgeon groups.

RESULTS

A total of 161 patients were included. Of them, 67 (25 of the trainee group and 42 of the expert group) were propensity score-matched. No flap failure developed in either matched group (p>0.999). Rates of overall complications, partial flap loss, and emergent reoperation due to vascular compromise were not significantly different between the two groups (p=0.384, p=0.525, and p=0.322, respectively), whereas those of donor complications and overall operation time were significantly higher in the trainee group than the expert group (p=0.002 and p<0.001, respectively).

CONCLUSION

The use of a structured microvascular training program in qualified teaching hospitals may help trainees achieve independence as microsurgeons and favorable clinical outcomes.