title: The learning curve in microtia surgery.
abstract: Reconstruction of the auricle is known to be complex. Our objective was to evaluate the improvement of the outcome of the lobulus-type microtia reconstruction. Patient satisfaction was also evaluated. There are no previous reports of the learning process in this field. Postoperative photographs of 51 microtia reconstructions were assessed and rated by a panel made up of six surgeons. The ratings were gathered to generate learning curves. Twenty-two patients assessed the outlook of their reconstructed ears, and the results were analyzed as a self-assessment group. The reliability of the rating by a panel was tested by intraclass correlations. There is a highly significant increasing trend in learning ( P = 0.000001). This trend is not constantly upward, and the steady state was not reached during the study. In the self-assessment group, females were significantly more critical than males ( P = 0.014). Intraclass correlation for six panel members was 0.90, and the rating was considered reliable. Thus, a long and gentle learning curve does exist in microtia reconstruction. To secure good quality and continuity, centralization of the operations and trainee arrangements are highly advisable. Outcomes of plastic surgery can reliably be rated by an evaluation panel.
authors.affiliation: Kymenlaakso Central Hospital, Kotka, Finland. samuli.suutarla@kymshp.fi
authors.forename: Samuli
authors.initials: S
authors.lastname: Suutarla
authors.forename: Jorma
authors.initials: J
authors.lastname: Rautio
authors.forename: Tuomas
authors.initials: T
authors.lastname: Klockars
mesh_terms: D000293:Adolescent; D002648:Child; D002983:Clinical Competence / Q000592:standards; D000013:Congenital Abnormalities / Q000601:surgery*; D054644:Ear Auricle / Q000002:abnormalities / Q000601:surgery; D004424:Ear Canal / Q000002:abnormalities / Q000601:surgery; D004425:Ear Cartilage / Q000002:abnormalities / Q000601:surgery; D004427:Ear Diseases / Q000145:classification / Q000151:congenital / Q000601:surgery*; D004431:Ear, External / Q000002:abnormalities / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010380:Peer Review; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000592:standards; D013518:Surgery, Plastic / Q000379:methods* / Q000592:standards; D055815:Young Adult