Unveiling the Learning Curve of Fibular Flap Lateral Approach Elevation: A Solo Surgeon's Journey

Free flap transplantation is a fundamental technique in reconstructive surgery, and the free fibular flap presents a unique challenge owing to its composite tissue nature. Despite the difficulty of this procedure, there is a lack of research on the learning curve associated with free fibular flap harvesting.

This study, conducted between April 2011 and March 2023, aimed to calculate the learning curve for fibular flap elevation on the basis of the experience of a single surgeon. The power-law approximation formula was used to model the learning curve, with the flap elevation time as the key parameter.

The average tourniquet time for 36 cases in which the first author performed as the primary surgeon was 72.8 minutes, with a range of 32 minutes to 178 minutes. The power-law approximation formula, derived using Python, was y = 187.76x^-0.376, indicating a strong correlation (maximal information coefficient = 0.870) between the formula and actual elevation times. The target elevation time was set at a single tourniquet time of 90 minutes, requiring experience with seven to eight cases.

This study suggests that mastering the elevation of the fibular flap requires experience with seven to eight cases, within the duration of a single tourniquet application. The findings contribute to understanding the learning curve associated with fibular flap transplantation and provide valuable insights for surgical training.