Microvascular reconstruction is a complex surgical procedure with the major end points being a healthy, viable flap with minimal peri‑operative flap and/or patient-related morbidity. A number of peri‑operative factors or ‘barriers’ influence these end points. The aim of the study was to evaluate these barriers and assess their relationship to outcomes.

Retrospective analysis of onco-microvascular reconstruction performed at a rural-based tertiary medical college was undertaken. Two surgical cohorts (historical/ first and present/ second) were defined and compared for flap and patient-related outcomes. Barriers across the surgical time line (pre-, intra- and post-operative period) were also evaluated for these outcomes.

Fifty-six patients from the first and 64 from the second cohort were compared. A significant reduction in the overall surgical (629 vs. 576 min; p = 0.017) and reconstructive time (438 vs 351 min.; p < 0.001), less multiple re-explorations (p = 0.012) and lower flap-related complications (41.1 vs 15.6%; p = 0.002) were observed in the second cohort when compared to the first. Barriers across all the surgical time lines were also significantly reduced (84.4 vs 55.4%; p < 0.001), resulting in better flap outcomes (87–97% vs. 37–55%). However, non-flap related morbidity was comparable (p > 0.05).

Surgical efficiency and flap success rates significantly improved in the second cohort with a notable reduction in the barriers across the surgical time line. Barrier-based approach can help audit outcomes and facilitate enhanced care pathways.