Abstract
Surgical learning curve and flap survival in head and neck microvascular reconstruction using arterial and venous couplers
- 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
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, head and neck cancer, microsurgery, coupler anastomosis
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