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Teaching Microsurgical Breast Reconstruction-A Retrospective Cohort Study.
Sebastian Fischer1, Yannick F Diehm1, Dimitra Kotsougiani-Fischer1
1Department of Hand, Plastic and Reconstructive Surgery, Burn Center, Hand and Plastic Surgery of Heidelberg University, BG Clinic Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
This study introduces a step-wise training method for microsurgical breast reconstruction using deep inferior epigastric artery perforator (DIEP) and transverse upper gracilis (TUG) flaps. The approach ensures safe implementation and satisfying outcomes from the start, minimizing the typical learning curve complications.
Area of Science:
- Plastic Surgery
- Microsurgery
- Surgical Education
Background:
- Microsurgical breast reconstruction requires advanced surgical expertise.
- Complex procedures often involve a learning curve with increased initial complications.
- Standardized training can mitigate risks and improve early outcomes.
Purpose of the Study:
- To present a structured, step-wise approach for teaching deep inferior epigastric artery perforator (DIEP) and transverse upper gracilis (TUG) flap breast reconstruction.
- To evaluate the safety and efficacy of this training method by comparing outcomes across different training stages.
- To demonstrate that this approach can reduce complications and yield satisfactory results from the outset.
Main Methods:
- A comparative analysis of DIEP and TUG flap breast reconstructions was conducted.
- Procedures were categorized into 'no-training' (senior surgeon), 'passive training' (senior assisted), 'active training' (senior supervised), and 'after training' (independent trainee).
- Surgical outcomes including operating room (OR) time, complication rates, and refinement procedures were analyzed across groups.
Main Results:
- No statistically significant differences were observed in OR-time, complication rates, or refinement procedures between the training groups and the experienced surgeon group.
- Trainees underwent a mean of 6.8 DIEP and 7.3 TUG training surgeries before independent procedures.
- The deep inferior epigastric artery perforator (DIEP) flap required no more training than the transverse upper gracilis (TUG) flap, emphasizing flap inset technique.
Conclusions:
- The step-wise training approach enables safe and secure implementation of microsurgical breast reconstruction.
- This method effectively minimizes the learning curve and associated complications for trainees.
- Satisfying aesthetic and reconstructive outcomes are achievable from the beginning of the training process.
