Taking microvascular training through the elevator: institutional experience in structured microsurgical training in India

BACKGROUND: Microsurgery is an essential skill in plastic surgery, particularly for oncological reconstructions. The traditional training pathway in India spans approximately 12 years, encompassing medical school, general surgery residency and plastic surgery specialization. Given the projected 12.8% rise in cancer incidence by 2025 in India, there's an urgent need to expedite microsurgical training without compromising patient care quality. METHODS: At a tertiary cancer institute, a structured four-phase microsurgical training program was implemented from April 2022 to December 2023 for second-year plastic surgery residents. The program incorporated Peyton's four-step teaching approach-demonstration, deconstruction, comprehension, and performance-and utilized simulation-based training with latex gloves, silicon tubes, and live rat models. Progression to subsequent phases required achieving a minimum score of 8/10 on the Microsurgical Anastomosis Rating Scale (MARS10). Residents advanced from assisting in flap harvests to independently performing complete microsurgical procedures. RESULTS: Over the study period, 1,520 free flap surgeries were performed in our institute. Residents individually conducted between 73 and 79 flap harvests and 18 to 22 microvascular anastomosis. The flap survival rate among resident-performed surgeries was 94.73%, close to the institute's overall rate of 95.53%. According to statistical analysis, there was no significant difference (p = 0.812), indicating the training model's effectiveness. CONCLUSION: The structured training model effectively reduced the microsurgical learning curve, maintaining high standards of patient care. By integrating simulation-based practice and objective assessment, the program offers a replicable framework for accelerating microsurgical competency among plastic surgery residents.