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.