AB131. SOH24AB_091. Training surgeons in real-time complex microvascular reconstructive techniques: do patient outcome differ in the hand of the novice versus the master?

Background: Reconstruction of the head and neck defect endeavours to overcome the variety of functional and aesthetic challenges that present to plastic surgeons1 Research lacks consensus on whether involvement of trainee surgeons results in greater complications and inadequate patient outcomes. Acquisition of technically demanding skills and accurate self-assessment of limitations is paramount to progression and continuous development of trainees. The aim of this study is to compare consultant versus trainee flap raising and consultant versus trainee microvascular anastomosis in head and neck reconstruction. Methods: Through multi-site Irish Association of Plastic Surgery data base, all head and neck free flap reconstruction between the years 2020 to present. Data available on 311 flaps were analysed. Results: Overall, when there was any trainee involvement in raising a flap, there was no statistically significant difference in ischaemic (P=0.956) or total operative time (P=0.326). Free flap partial loss, total loss, and complete survival was similar across all groups (P=0.731). When a consultant raised the flap, the consultant was more likely to complete the arterial anastomosis (P<0.001) and vein anastomosis (P<0.001) themselves compared to when there was any trainee involvement in raising the flap. Conclusions: The lack of statistical difference in post-operative complications supports studies that support the safety of trainee involvement. Interestingly, the results demonstrate that when the consultant alone raised the flap, trainee involvement in microvascular reconstruction decreased. Thus, these results reinforce evidence that surgical training in microvascular reconstructive techniques provides satisfactory outcomes, however their participation in real-time complex reconstruction requires continuous encouragement.