Surgical learning curve and flap survival in head and neck microvascular reconstruction using arterial and venous couplers.

[INTRODUCTION] This study evaluated the surgical learning curve associated with the simultaneous use of arterial and venous couplers, alongside flap survival outcomes, in head and neck cancer reconstruction.

[MATERIAL AND METHODS] A total of 127 pa-- tients (51 women, 76 men; aged 30-84 years) underwent microvascular free tissue transfer using the Synovis coupler device. Three flap types were used: radial forearm free flap, anterolateral thigh flap, and free fibula flap. Flap viability was assessed clinically during the first 7 postoperative days and at monthly follow-ups for up to one year. Operative time was recorded to monitor procedural efficiency.

[RESULTS] Four flap failures were observed. The cumulative sum analysis of surgical time revealed three distinct learning phases: Initial Learning (cases 1-30), Performance Improvement (31-58), and Plateau (59 onward). Piecewise linear regression confirmed minimal trend predictability in the first two phases (R = 0.08), while Phase 3 demonstrated a strong linear decline in operative time (R = 0.82), indicating attainment of surgical proficiency.

[CONCLUSIONS] While hand-sewn anastomosis remains the standard in microsurgical reconstruction, this study supports arterial couplers as a safe, efficient alternative with a manageable learning curve -encouraging broader adoption in clinical practice.