Psychological Sequelae and Support for Microsurgeons After Free Flap Failure

Area of Science:

• Microsurgery
• Surgical Outcomes
• Psychological Impact

Background:

• Free tissue transfer is standard for complex reconstruction.
• Flap failure is an unavoidable aspect of microsurgical practice.
• Surgeon well-being and support systems after flap loss require further investigation.

Purpose of the Study:

• To investigate the prevalence and nature of psychological and physical sequelae experienced by microsurgeons after flap loss.
• To identify risk factors associated with prolonged symptoms.
• To assess current coping strategies and institutional support systems.

Main Methods:

• A 15-item REDCap survey was distributed to members of the American Society for Reconstructive Microsurgery.
• The survey assessed demographics, flap experience, psychological/physical symptoms, coping strategies, and support systems.
• Statistical analyses included descriptive statistics, Fisher's exact test, Spearman correlation, logistic regression, and thematic content analysis of free-text responses.

Main Results:

• 67.1% of microsurgeons reported guilt, 61.0% fear of poor outcomes, and 56.1% anxiety.
• 17.1% experienced prolonged symptoms (months+).
• Female surgeons (30.0% vs 9.6%) and those with fewer colleagues (27.3% vs 5.3%) reported prolonged symptoms more frequently. Peer discussion was the primary coping strategy (72.8%).

Conclusions:

• Psychological distress following flap loss is nearly universal among microsurgeons.
• Female surgeons and those in smaller practices are particularly vulnerable to prolonged symptoms.
• Institutions and societies must create structured support systems to enhance surgeon well-being and professional sustainability.