Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers

Adam Gałązka; Karolina Bieńkowska-Pluta; Monika Paszkowska; Magdalena Misiak-Gałązka; Katarzyna Stawarz

doi:10.5114/wo.2025.155692

eISSN: 1897-4309
ISSN: 1428-2526

Contemporary Oncology/Współczesna Onkologia

Current issue Archive Manuscripts accepted About the journal Supplements Addendum Special Issues Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures

Editorial System

Submit your Manuscript

Editorial Policies

Sarajevo Declaration on Integrity and Visibility of Scholarly Publications

4/2025
vol. 29

Send email

Copy url:

abstract:

Original paper

Surgical learning curve and flap survival in head and neck microvascular reconstruction using arterial and venous couplers

Adam Gałązka

^{1, 2}

,

Karolina Bieńkowska-Pluta

¹

,

Monika Paszkowska

¹

,

Magdalena Misiak-Gałązka

^{3, 4}

,

Katarzyna Stawarz

¹

Head and Neck Cancer Department, Maria Skłodowska-Curie National Research Institute of Oncology, Warszawa, Poland
Department of Otolaryngology of the Ministry of the Interior and Administration Hospital, Warszawa, Poland
Maria Skłodowska-Curie Medical Academy, Evimed Medical Center Ltd., Warszawa, Poland
Department of Pathology, Maria Skłodowska-Curie National Research Institute of Oncology, Warszawa, Poland

Contemp Oncol (Pozn) 2025; 29 (4): 333–340

DOI: https://doi.org/10.5114/wo.2025.155692

Online publish date: 2025/10/30

View full text Get citation

EndNote

Papers, Reference Manager, RefWorks, Zotero

AMA

Gałązka A, Bieńkowska-Pluta K, Paszkowska M, Misiak-Gałązka M, Stawarz K. Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers. Contemporary Oncology/Współczesna Onkologia. 2025;29(4):333-340. doi:10.5114/wo.2025.155692.

APA

Gałązka, A., Bieńkowska-Pluta, K., Paszkowska, M., Misiak-Gałązka, M.,  & Stawarz, K. (2025). Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers. Contemporary Oncology/Współczesna Onkologia, 29(4), 333-340. https://doi.org/10.5114/wo.2025.155692

Chicago

Gałązka, Adam, Karolina Bieńkowska-Pluta, Monika Paszkowska, Magdalena Misiak-Gałązka,  and Katarzyna Stawarz. 2025. "Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers". Contemporary Oncology/Współczesna Onkologia 29 (4): 333-340. doi:10.5114/wo.2025.155692.

Harvard

Gałązka, A., Bieńkowska-Pluta, K., Paszkowska, M., Misiak-Gałązka, M.,  and Stawarz, K. (2025). Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers. Contemporary Oncology/Współczesna Onkologia, 29(4), pp.333-340. https://doi.org/10.5114/wo.2025.155692

MLA

Gałązka, Adam et al. "Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers." Contemporary Oncology/Współczesna Onkologia, vol. 29, no. 4, 2025, pp. 333-340. doi:10.5114/wo.2025.155692.

Vancouver

Gałązka A, Bieńkowska-Pluta K, Paszkowska M, Misiak-Gałązka M, Stawarz K. Surgical learning curve and flap survival in head and neck
microvascular reconstruction using arterial and venous couplers. Contemporary Oncology/Współczesna Onkologia. 2025;29(4):333-340. doi:10.5114/wo.2025.155692.

PlumX metrics:

Introduction
This study evaluated the surgical learning curve associated with the simultaneous use of arterial and venous couplers, alongside flap survival outcomes, in head and neck cancer reconstruction.

Material and methods
A total of 127 pa- tients (51 women, 76 men; aged 30–84 years) underwent microvascular free tissue transfer using the Synovis coupler device. Three flap types were used: radial forearm free flap, anterolateral thigh flap, and free fibula flap. Flap viability was assessed clinically during the first 7 postoperative days and at monthly follow-ups for up to one year. Operative time was recorded to monitor procedural efficiency.

Results
Four flap failures were observed. The cumulative sum analysis of surgical time revealed three distinct learning phases: Initial Learning (cases 1–30), Performance Improvement (31–58), and Plateau (59 onward). Piecewise linear regression confirmed minimal trend predictability in the first two phases (R² = 0.08), while Phase 3 demonstrated a strong linear decline in operative time (R² = 0.82), indicating attainment of surgical proficiency.

Conclusions
While hand-sewn anastomosis remains the standard in microsurgical reconstruction, this study supports arterial couplers as a safe, efficient alternative with a manageable learning curve –encouraging broader adoption in clinical practice.

keywords:

Surgical learning curve and flap survival in head and neck microvascular reconstruction using arterial and venous couplers

Adam Gałązka 1, 2 , Karolina Bieńkowska-Pluta 1 , Monika Paszkowska 1 , Magdalena Misiak-Gałązka 3, 4 , Katarzyna Stawarz 1

surgical learning curve, head and neck cancer, microsurgery, coupler anastomosis

Adam Gałązka

^{1, 2}

,

Karolina Bieńkowska-Pluta

¹

,

Monika Paszkowska

¹

,

Magdalena Misiak-Gałązka

^{3, 4}

,

Katarzyna Stawarz

¹