Starting an autologous breast reconstruction program after plastic surgical training. Is it as good as it gets?
| Autor: | Pieter S. Verduijn, Thijs de Wit, Inge Smits, Marc A.M. Mureau, Thomas Rijntalder, Hinne A. Rakhorst, Renske Spierings, Nikki Beudeker |
|---|---|
| Přispěvatelé: | Plastic and Reconstructive Surgery and Hand Surgery |
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Microsurgery Center of excellence medicine.medical_treatment Mammaplasty Free flap 030230 surgery 03 medical and health sciences 0302 clinical medicine DIEP flap Statistical significance medicine Humans Surgery Plastic Autografts business.industry Gold standard Middle Aged Epigastric Arteries Surgery Plastic surgery Treatment Outcome 030220 oncology & carcinogenesis Female Clinical Competence Breast reconstruction business Perforator Flap Learning Curve |
| Zdroj: | Journal of Plastic, Reconstructive & Aesthetic Surgery, 73(2), 286-294. Churchill Livingstone |
| ISSN: | 1878-0539 1748-6815 |
| Popis: | Summary Background Today, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard in microvascular breast reconstruction. Although this procedure is known as technically demanding, novice plastic surgeons must be able to perform these procedures to meet the rising demand. The purpose of this study was to evaluate if the young junior professional is trained adequate enough to set up and safely perform microsurgical breast reconstructions. Methods We compared outcomes of three identically trained novice plastic surgeons who all introduced the DIEP flap in their working environment. Their hospitals differed in size and experience with microsurgery. Outcomes were compared between all start-ups and to a center of excellence (EMC). Results A total of 152 DIEP flaps were performed in 123 patients among all start-ups together. Baseline characteristics and major complications were comparable between all groups. The total flap loss rate was 2% in the start-ups versus 3.9% in the control group (p=0.5). Although there seems to be a trend in a longer operating time in both training and non-training academic centers, no statistical significance was found between the start-ups (p=0.13) and compared to the control group (p=0.17). However, a learningcurve seems to be present when it comes to duration of surgery and is greatest in the community centers with zero experience in microsurgery (ZGT p=0.002, Amphia p=0.065). The same accounts for hospital stay. Conclusion Although there seems to be a learningcurve in terms of duration of surgery in hospitals with no experience in microsurgery, it is safe to perform microvascular breast reconstructions as a novice plastic surgeon. |
| Databáze: | OpenAIRE |
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