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Background: As microsurgery gains in popularity, surgical training becomes more critical. There have been numerous studies assessing resident involvement in an array of surgical subspecialties; however, there is a dearth of data as it relates to patient outcomes in the field of Reconstructive Microsurgery. Methods: A retrospective review was conducted by searching for all free tissue transfer cases from 2011 to 2012 in the NSQIP database. Study groups were divided based on presence of a resident. The flaps were then subdivided into type of free flap. The primary outcome was the development of major complications, defined as return to OR or flap loss. Secondary outcomes were total hospital length of stay, total operative time, and minor complications defined as surgical site infection, wound dehiscence, and bleeding not requiring return to OR or readmission. Results: A total of 462 free tissue transfers were identified, 92 of which were performed without resident participation, and 369 included resident participation. The majority of flaps of cases were done for breast reconstruction. After adjusting for comorbidities, cases in which residents participated had a statistically significant increase in bleeding, SSI, and total operative time. Interestingly, cases involving a PGY-6 and above conferred a protective effect from developing major complications. Conclusions: Resident involvement in Reconstructive Microsurgery cases is safe, with only a slightly higher probability of minor complications. There was no difference in major complications, and in fact, having a chief resident and above participate in the case conferred a protective effect. Attending surgeons can be confident that their patients will be safe, and that involving residents will not negatively affect their outcomes. Level of evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Background:  Microvascular thrombosis has been associated with cytokine release and inflammatory syndromes which can occur as a result of blood transfusions. This phenomenon could potentially lead to complications in breast free flap reconstruction. The aim of this study was to evaluate the impact of perioperative blood transfusion in free flap breast reconstruction using large population analysis., Methods:  The American College of Surgeons National Quality Improvement Program database was queried for delayed free flap breast reconstructions performed in 2016. The study population was divided based on perioperative blood transfusion within 24 hours of the start of the operation. Propensity score matching analysis was used to ensure homogeneity between the two study groups. Primary outcome was unplanned return to the operating room (OR) within 30 days. Secondary outcomes were readmission and complications., Results:  A total of 1,256 patients were identified. Out of those, 91 patients received a perioperative blood transfusion. All the patients received only one unit of PRBC within the first 24 hours. Those patients were matched with similar patients who did not receive a transfusion on a ratio of 1:3 (273 patients). Patients who received a transfusion had a significantly higher incidence of reoperation (42 vs. 10%, p  < 0.001). Patients who received a transfusion were more likely to return to the OR after 48 hours from the initial operation (13 vs. 5%, p  = 0.001). All returns to the OR were due to flap-related complications. Perioperative blood transfusion increased the incidence of wound dehiscence (9 vs. 2%, p  = 0.041) but had no protective effect on the development of other postoperative complications., Conclusion:  Perioperative blood transfusion in free flap breast reconstruction is associated with an increased probability of flap-related complications and subsequent return to the OR without decreasing the probability of developing other systemic postoperative complications., Competing Interests: None declared., (Thieme. All rights reserved.)