Unveiling the Learning Curve of Fibular Flap Lateral Approach Elevation: A Solo Surgeon's Journey

Abstract

Objectives: Free flap transplantation is a fundamental technique in reconstructive surgery, and the free fibular flap presents a unique challenge owing to its composite tissue nature. Despite the difficulty of this procedure, there is a lack of research on the learning curve associated with free fibular flap harvesting.

Methods: This study, conducted between April 2011 and March 2023, aimed to calculate the learning curve for fibular flap elevation on the basis of the experience of a single surgeon. The power-law approximation formula was used to model the learning curve, with the flap elevation time as the key parameter.

Results: The average tourniquet time for 36 cases in which the first author performed as the primary surgeon was 72.8 minutes, with a range of 32 minutes to 178 minutes. The power-law approximation formula, derived using Python, was y = 187.76x^-0.376, indicating a strong correlation (maximal information coefficient = 0.870) between the formula and actual elevation times. The target elevation time was set at a single tourniquet time of 90 minutes, requiring experience with seven to eight cases.

Conclusions: This study suggests that mastering the elevation of the fibular flap requires experience with seven to eight cases, within the duration of a single tourniquet application. The findings contribute to understanding the learning curve associated with fibular flap transplantation and provide valuable insights for surgical training.