Microvascular Surgeons: The Second Victim With Free Flap Failure

Second victim syndrome (SVS) is when a health care provider involved in a patient complication is traumatized by the event, manifesting as symptoms of anxiety, depression, and shame. We investigated microvascular surgeons' emotional responses to free flap failure and their emotional support systems.

Twenty-question survey of microvascular surgeons. Questions focused on participant demographics and practice dynamics, emotional responses to free flap failure, and emotional support systems.

Ninety-three surgeons completed the survey and reported emotional responses to free flap failure. Survey response rate was 47.6%. Most (83.9%) practiced in an academic setting. Over half of surgeons reported anxiety (74%), guilt (70%), sadness (68%), shame or embarrassment (63%) and doubt (51%) following flap failure. Females were statistically more likely to report sadness (82% vs. 58.1%, p = 0.018) and doubt their surgical acumen (61.8% vs. 34%, p = 0.011) compared to men. Women rated therapists (3.88 vs. 2.07, p = 0.004) and online forums (6.18 vs. 1.64, p < 0.011) to be better support systems than those reported by men. Surgeons who had a recent free flap failure in the last 6 months expressed a desire to decrease free flap volume compared to those who had a free flap failure > 6 months (34% vs. 14%, p = 0.047).

Flap failure results in SVS for microvascular surgeons of all ages, gender, and geographic distributions. Interventions during the first 6 months after a free flap failure may be most beneficial to microsurgeons going through an emotionally challenging time.

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