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Contradicting an Established Mantra: Microsurgeon Experience Determines Free Flap Outcome

Kreymerman, Peter M.D.; Silverman, Anna L.; Rebecca, Alanna M. M.D.; Casey, William J. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 507e–512e
doi: 10.1097/PRS.0b013e318262efdf
Breast: Original Articles

Background: Since the inception and popularization of microsurgery in the 1960s and 1970s, it has been commonly accepted that the outcome of free tissue transfer directly correlates with surgeon experience.

Methods: The clinical outcomes of three young microsurgeons at a single institution were retrospectively reviewed. Free flaps performed by these individuals were categorized according to the surgeon’s years of practice and analyzed using statistical methods.

Results: A total of 410 free flaps were identified. No correlation was found between the surgeon’s years of experience and the outcomes measured.

Conclusions: There has been increased exposure to microsurgery during plastic surgery training at many programs, and consequently, residents have often already surpassed the learning curve. The imperfect correlation between experience and superior outcomes in medicine serves to suggest that further research in the specific underlying principles of surgical learning is needed to understand the relationship between experience and superior surgical outcomes.


Phoenix, Ariz.

From the Mayo Clinic, Division of Plastic and Reconstructive Surgery, Department of Surgery.

Received for publication January 14, 2012; accepted April 23, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Peter Kreymerman, M.D., Mayo Clinic, Division of Plastic and Reconstructive Surgery, Department of Surgery, 5777 East Mayo Boulevard, Phoenix, Ariz. 85054,

©2012American Society of Plastic Surgeons