Lessons from a Low-Volume and Non-academic hospital: Optimizing Outcomes in Free Tissue Transfer—A Case Series by a novice plastic surgeon
Keywords:
Free tissue transfer (FTT), Novice Plastic Surgeon, Postoperative Complications, Non-Academic Hospital, Flap survivalAbstract
Background: Free tissue transfer (FTT) has become the preferred method in modern reconstructive surgery, offering excellent functional and aesthetic outcomes, particularly for complex oncologic, traumatic, and post-infectious defects. This study describes the early experience and key lessons learned from a series of FTT procedures performed by a novice plastic surgeon at Nakhon Phanom Hospital, a standard-level (S-level) hospitals in Thailand.
Methods: Medical records of all patients who underwent FTT performed by a single surgeon were reviewed. Data collected included demographics, operative details, pathology results, and postoperative complications.
Results: Nineteen FTT procedures were identified, performed for reconstruction of the head and neck (n = 15) and lower extremities (n = 4). Five cases experienced postoperative complications resulting in flap compromise. Three of eight threatened flaps were successfully salvaged. The primary causes of flap loss were vascular complications, including venous congestion (26.3%) and arterial thrombosis (15.7%). The overall flap success rate was 73.7%.
Conclusions: Performing free tissue transfer as a novice plastic surgeon in a non-academic hospital with no prior experience in this procedure posed significant challenges. Limited early postoperative monitoring capacity, insufficiently trained nursing staff, and the surgeon’s learning curve contributed to delays in critical decision-making. Ultimately, improving outcomes in such settings requires recognizing systemic limitations, implementing continuous team training, and maintaining perseverance throughout the demanding early learning phase.
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