(502) Building Sustainable Local and Free Flap Capacity Through Structured Surgical Training in Vietnam

Introduction: Access to training in advanced head and neck reconstruction remains limited in many low- and middle-income countries. A multimodal surgical training program was implemented in Hanoi, Vietnam, in March 2025 to address this gap and prospectively evaluate changes in reconstructive knowledge and self-reported technical confidence among otolaryngology surgeons and trainees.

Methods: Seventeen participants completed a three-day course incorporating didactic lectures, cadaveric dissection, and supervised operating room participation. Participants completed needs assessments and pre- and post-course evaluations, including flap-specific confidence and competence ratings using a five-point Likert scale and a knowledge-based assessment. Paired statistical analyses compared pre- and post-training outcomes.

Results: Baseline exposure to reconstructive techniques was limited, with ≥65% of participants reporting no prior exposure across most flap categories, despite near-universal interest in learning each procedure. Barriers to free flap implementation included limited resources and lack of formal training. Paired data were available for six to eight participants depending on assessment type. Overall test performance improved significantly from pre- to post-course (50% vs 68% correct, p=0.035). Significant knowledge gains were observed for forehead flap (p=0.008) and radial forearm free flap (p=0.038). Confidence and competence scores increased significantly for radial forearm free flap, submental island flap, supraclavicular flap, temporoparietal fascial flap, and anterolateral thigh flap (all p< 0.05).

Conclusions: The surgical training program was associated with significant improvements in reconstructive knowledge and self-reported confidence and competence across multiple free and local flap procedures. While outcomes reflect a single training cycle, these results support longitudinal, skills-based surgical education models with ongoing outcome tracking as part of a planned multi-year training initiative to build a sustainable microvascular program in Vietnam.