Limitations
This study is limited by its retrospective design, inability to account for confounding variables not available in the patient’s medical record, such as intra-operative decision-making, that may have affected both operative time and complication rate. Whilst the sample size of this study is relatively small, we have analyzed a contemporary cohort over a relatively short period where outcomes can reliably be recorded and verified. The heterogeneity of ablative and reconstructive surgeons from multiple specialties, contribution and experience of trainee surgeons, and flap selection introduces bias into this study but also accurately reflects the unique characteristics of our institution. Increased operative time within this cohort is likely to be a surrogate for multiple factors, including but not limited to patient complexity and concurrent procedures performed which increase both time and complications, such as tracheostomy and osseo-integrated implant placement. Our study did not investigate how specific components (e.g. anesthesia time, resection time, flap harvest time, in-setting time, and ischemia time) affected overall time. This may be important as flap ischemia time is likely to be a better predictor of flap outcome.27-29 Given that surgical interventions may impact each component of operative time differently, future studies should investigate associations with each time element separately in a multi institutional design to aid the generalizability of findings.