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Psychological Sequelae and Support for Microsurgeons After Free Flap Failure
Skyler Palmer1, Malka Korenblit1, Zain Aryanpour1
1University of Colorado Anschutz Medical Campus, Department of Surgery, Colorado, United States, Aurora.
Background:
Free tissue transfer is the standard for complex reconstruction, yet flap failure remains an inevitable reality of microsurgical practice. Beyond patient impact, these events can profoundly affect surgeons through psychological, physical, and professional sequelae. Comprehensive data on prevalence, risk factors, and support systems specific to microsurgeons remain limited.
Methods:
Following IRB approval, a 15-item REDCap survey was distributed to American Society for Reconstructive Microsurgery members. The survey assessed demographics, flap experience, psychological and physical symptoms following flap loss, symptom duration and impact, coping strategies, available institutional support, and desired support. Statistical analyses included descriptive statistics, Fisher's exact test, Spearman correlation, and logistic regression. Free-text responses underwent thematic content analysis.
Results:
Eighty-two microsurgeons completed the survey (63.4 male and 36.6% female; mean: 12.2 years in practice). Sixty-seven point one percent experienced guilt, 61.0% fear of future poor outcomes, 58.5% difficulty sleeping, and 56.1% anxiety and questioning of surgical ability. While most experienced short-term symptoms, 17.1% reported prolonged duration (several months or longer). Female-identifying surgeons experienced prolonged symptoms significantly more often than male-identifying surgeons (30.0% vs. 9.6%, p = 0.031). Having ≤ 5 microsurgical colleagues was associated with prolonged symptoms (27.3% vs. 5.3%, p = 0.009). Years in practice were modestly associated with shorter symptom duration and lower perceived impact. The most common coping strategy was discussing events with colleagues (72.8%). A substantial gap existed between available and desired support: only 25.9% had access to counseling services, while 51.9% desired peer support programs.
Conclusion:
Psychological sequelae after flap loss are nearly universal among microsurgeons, with female-identifying surgeons and those in smaller practices particularly vulnerable. Institutions and microsurgical societies should develop structured, psychologically safe support systems to improve surgeon well-being, promote professional sustainability, and strengthen a culture of reflection and learning.
Insights
Free flap failure causes significant psychological distress for microsurgeons, especially women and those in smaller practices. Enhanced support systems are crucial for surgeon well-being and professional sustainability.
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.
