Learning Curve and Technical Strategies in 100 Consecutive Head and Neck Free-Flap Reconstructions by an Early-Career Plastic Surgeon.

Objectives: Mastering microvascular techniques for head and neck reconstruction presents considerable challenges, particularly for early-career plastic surgeons in low-volume settings. This study evaluates the learning curve and technical strategies of a junior surgeon who performed 100 consecutive head and neck free-flap reconstructions at a tertiary referral center. Methods: We retrospectively analyzed 100 consecutive reconstructions by a single early-career surgeon at a university hospital in Okinawa, Japan. Cases were grouped into four sequential phases (25 each) to assess performance trends. Key parameters included operative duration, flap type, recipient vessel selection, complication rates, and flap survival. Results: Mean operative time declined from approximately 780 minutes in Phase 1 to 600 minutes in Phase 4 (23% reduction; p < 0.001). Flap survival rose from 92% to 100% across phases (overall 98%). Re-anastomosis rates decreased from 50% in the first 25 cases to 5% in the final 25 cases. Ischemic time shortened by 40% (p < 0.001). These improvements coincided with deliberate technical refinements and workflow optimizations, including expanded use of the transverse cervical artery. Conclusions: With a structured, evidence-based approach, early-career plastic surgeons can achieve excellent outcomes even in low-volume environments. The observed improvements underscore the importance of targeted technical refinements and strategic vessel selection in overcoming the microsurgical learning curve.