Background Microvascular free flaps have become a reliable standard procedure. Due to
increasing microsurgical experience in teaching hospitals, residents are getting acquainted
with performing free flap surgeries earlier in their training. However, economic
considerations and safety regulations contradict adequate teaching. A validation of
procedures for residency training is necessary to reduce the existing concerns. Methods
This retrospective, comparative cohort study was designed to investigate whether free flaps …

We read with interest this paper by Hirche et al., 1 which discussed microvascular training of
Plastic Surgery residents. We agree that a residency program should offer work based
training opportunities with annual progression towards achieving microsurgical competency.
It is excellent that residents are exposed to such valuable free flap surgical experiences, as
the microsurgery learning curve is steep. Since Halsted first described the benefits of
supervised hands-on training [the apprenticeship model], his model has expanded into all …