Abstract
BACKGROUND: Our institution has conducted an annual perforator flap-based microsurgical training course for clinicians from different institutions. This study aims to characterize the post-training practice patterns and outcomes of the course. METHODS: From 2016 to 2022, a two-week course was conducted annually, including three modules: theoretical lectures, cadaver-based surgical simulation, and live surgical demonstrations. A cross-sectional study was carried out among course participants in November 2024. Participant demographics, training backgrounds, course evaluations, and their clinical practice over the two years following the training were collected and analysed. RESULTS: A total of 279 two-year follow-up questionnaires were distributed, with a 74.6% response rate, yielding 208 completed questionnaires. On the basis of microsurgical experience, the trainees were divided into three groups: the inexperienced group (n = 34), intermediate group (n = 139), and experienced group (n = 35). The participants highly rated the course, with an overall score of 4.92 out of 5. Surgical simulation emerged as the most beneficial module. After training, 191 trainees (91.8%) performed perforator flap surgeries, with an average of 54 surgeries performed over 2 years and a success rate of 95.5%. The participation rate was 100% in the experienced group and 94.2% in the intermediate group, which was significantly higher than the 73.5% in the inexperienced group (p < 0.05). The mean procedure volume was significantly higher in both the experienced (56 cases) and intermediate (57 cases) groups than in the inexperienced group (37 cases) (p < 0.05). CONCLUSIONS: The perforator flap-based microsurgical training course provides systematic training, covering theoretical lectures, cadaver-based surgical simulation, and live case surgical demonstrations. Participation in this course was associated with the successful clinical application of perforator flap techniques across all experience levels. The curriculum equipped surgeons with a structured foundation, enabling them to implement these procedures with a high degree of proficiency. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-026-08708-8.